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F1 anesthetics > Ward 7 > Flashcards

Ward 7 Flashcards

1
Q

What does x ray use?

A

Radiation (photons) to create a 2D image

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2
Q

Darkness and lightness of structures meaning in X-ray

A

Structures that are less dense appear dark/black (e.g. air in lungs) while more dense structures appear white (e.g. bones, tumours, metal). Structures with a medium density appear grey

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3
Q

What should you do before interpreting an x-ray?

A
  • Check patient details (name, DOB and hospital number)
  • Date and time the x-ray was performed
  • Previous imaging for comparison
  • Assess image quality
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4
Q

How to assess image quality of a chest x-ray

A

Use RIPE mnemonic- Rotation, INspiration, Projection, exposure

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5
Q

Rotation portion of ripe mnemonic

A
  • Vertebral bodies and spinous processes should be vertically aligned
  • Medial aspect of each clavicle should be equidistant from the spinous process
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6
Q

Inspiration portion of ripe mnemonic

A

Helps visual anatomical structures better
If inspiration is adequate, the following should be visible:
- 5-6 anterior libs (can distinguished from posterior ribs by their downward initial sloping)
- Both lung apices
- Both costophrenic angles
- Lateral rib edges

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7
Q

Projection portion of ripe mnemonic

A
  • Standard chest x-ray usually features posterior-anterior (PA) projection (x ray beams pass from posterior aspect of patient before reaching detector)
  • Anterior-posterior x rays are vice versa, which are often performed when patients are unwell and unable to be easily mobilised (Can be taken while they lie down)
  • If there is no label, assume the film is PA projection
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8
Q

PA vs AP chest x ray

A
  • PA more accurate assessment of cardiac size
  • PA produces higher quality image
  • Avoid drawing conclusions about heart size when assessing AP film as the heart size appears exaggerated
  • Edges of scapula are more visible on AP film (can help you distinguish between the two types)
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9
Q

Exposure portion of ripe mnemonic

A
  • Correct exposure allows visualization of pulmonary vessel, lung fields, and bony anatomy
  • Over exposed films (darker) make it easier to visualize bone and heart but lungs and pulmonary vessels are harder to visualize
  • Underexposed film (whiter) make it harder to appreciate retrocardiac region and spinal anatomy
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10
Q

How to check for correct exposure in chest x-ray

A
  • The left hemidiaphragm should be visible to the spine
  • And the vertebra should be visible behind the heart
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11
Q

What should you do after assessing image quality of an x-ray?

A

Use ABCDE approach

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12
Q

A portion of A-E chest xray

A

Airway- Trachea carina, bronchi, and hilar structures

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13
Q

B portion of A-E chest Xray

A

Breathing- Lungs and pleura

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14
Q

C portion of A-E chest x0ray

A

Cardiac- Heart size and borders

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15
Q

D portion of A-E chest x ray

A

Assessment of diaphragm and costophrenic angles

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16
Q

E portion of A-E chest X-Ray

A

Everything else- Mediastinal contours, bones, soft tissues, tubes, valves, pacemakers, and review areas

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17
Q

Trachea inspection on chest x-ray

A
  • Check for any signs of trachea deviation, which if present can be either true or apparent deviation
  • Trachea is normally located to the right of aorta, so what might appear as mild deviation to the right is actually normal
  • True deviation is due to a pathology and is serious, (should be immediately escalated) such as a large pleural effusion (away from site of pathology, tension pneumothorax (away from side pathology), or lobar collapse (towards side collapse)
  • Apparent deviation (much less concerning) and is usually due to rotation of patient (check rotation in ripe pneumonic)
18
Q

What is the carina?

A

The point in the airway where the trachea divides into the left and right main bronchus

19
Q

Right vs left main bronchus and clinical significance

A

Right is wider and more vertical than left, and because of this is more often the site of an inhaled foreign body and should be considered in pediatric patients presenting with signs of ARD

20
Q

What are the hilar structures

A

contain the pulmonary vessels, major bronchi, and lymph nodes

21
Q

What to look for when examining hilar structures

A
  • Normally similar size and symmetry and therefore asymmetry can be a sign of pathology
  • Left hilum is normally up to 2cm higher
  • When assessing size, it is important to distinguish between unilateral and bilateral
22
Q

Bilateral vs unilateral hilar enlargement clinical

A
  • Bilateral : Sarcoidosis
  • Unilateral- Malignancy
23
Q

B section of A-E of chest x ray

A
  • Breathing- Lung and pleura
  • Divide lungs into three zones and inspect each zone, nothing any asymmetry and abnormalities
  • Abnormal
24
Q

Common findings of pulmonary edema in chest x-ray

A
  • Air-space opacification (bat wing distribution)
  • Kerley B lines
  • Pleural effusions (look for costophrenic blunting)
  • Fluid in interlobular fissure
24
Q

Abnormalities that can be noticed in the lungs in chest xray

A
  • Symmetrical changes can be seen in pulmonary edema
  • Increased shadowing can be indicative of consolidation/malignancy
  • Absence of lung markings with tracheal deviation may be indicative of pneumothorax
25
Q

Common causes of pulmonary edema

A
  • Left heart failure
  • Mitral regurgitation
  • Fluid overload
26
Q

Heart valves

A
27
Q

What can pneumothorax be classified into?

A

Primary or secondary

28
Q

When is the term primary pneumothorax used?

A

When the patient has no history of respiratory disease

29
Q

When is the term secondary pneumothorax used?

A

When there is a known history of respiratory disease (e.g. COPD)

30
Q

When is a pneumothorax classified as tension pneumothorax?

A

When the trachea is deviated

31
Q

How is tension pneumothorax treated?

A

Emergency decompression, using large bore cannula inserted into 2nd intercostal space in the midclavicular line

32
Q

What is the pleura and how does it appear in chest x ray?

A
  • Membrane surrounding the lungs
  • Usually not visible in healthy individuals, but can be seen when thickened
  • Should extend to the thoracic wall and therefor visible pleural lines should raise suspicion of pneumothorax
33
Q

What are causes of thickened pleura?

A
  • One of the most common causes is a cancer known as a mesothelioma which is usually preceded by a history of asbestos exposure
  • Another very common cause is organization of an empyema, which may result from bacterial, tuberculosis, or fungal infection
  • Chronic infections, trauma to the ribs and chest, radiation are other cuases
34
Q

What is collection of fluid in the pleural space known as?

A

Hydrothorax if fluid, and haemothorax if blood, empyema for pus

35
Q

C portion of chest x ray

A

Cardiac (accurate when using PA film)- Size and borders
- cardiomegaly is present when heart is more than 50% of the thoracic window
- Size of the heart is measure by drawing a horizontal line between horizontal borders of the heart and horizontal line from widest points of the rib cage
- In healthy individuals, the borders of the heart should be clearly visible and well defined

36
Q

Causes of cardiomehaly

A

Many, such as valvular heart disease, CAD, pulmonary hypertension, congenital heart disease

37
Q

Right heart border and clinical significance chest xray

A
  • Made up most by right atrium
  • Loss of this border is usually due to right middle lobe consolidation often secondary to an infection
38
Q

Left heart border and clinical significance chest xray

A
  • Mostly made up of left ventricle
  • Loss of this border is associated with lingular ( consolidation , associated with infection
39
Q

What is the lingula?

A

a combined term (means little tongue (in Latin)) for the two lingular bronchopulmonary segments ((long shaped regions)) of the left upper lobe

F1 anesthetics (22 decks)

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