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Essentials of Acute Care > xray > Flashcards

xray Flashcards

1
Q

what can you evaluate with xray for a pacemaker

A

Evaluation of suspected pacemaker lead fracture

Pacemaker placement

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2
Q

the thicker the structure the _____ it will appear on x-ray film

A

brighter

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3
Q

what are the 3 factors that determine shadow brightness on an x ray

A

thickness
density
duration of exposure

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4
Q

pneumonic used in assessing xrays

A 
Airways
Bones (and soft tissue)
Cardiac silhouette (and mediastinum)
diaphragm (and gastric bubble)
Effusions
Fields (ie: lung fields)
Lines tubes devices surgeries
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5
Q

what x ray views can you see the vertebral bodies on

A

Lat is best

PA you can see but not as well

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6
Q

It is normal for the right hemidiaphragm to be slightly _____ than the left

A

higher

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7
Q

what lung fissures are seen on x ray and what view can you see in it

A

Horizonal

only on the PA

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8
Q

what view is the lung apex not visible above the clavicle?

A

Lordotic view

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9
Q

consequence of z-axis rotation

A

cardiac silhouette, mediastinum and/or hilum may all be distorted

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10
Q

How many posterior ribs can be seen with adequate inspiration and why is that important

A

10

better quality film

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11
Q

consequences of insufficient inspiration for a chest x ray

A

Lung volumes appear falsely low
lung markings appear falsely prominent
false appearance of pulmonary edema
cardiac silhouette and mediastinum may appear falsely large

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12
Q

what physical factors determine low exposure vs high exposure. What can the x ray tech do to control these

A

Duration of exposure - tech controls mAs
Energy of photons - tech controls kVp
Source to image distance - SID

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13
Q

what are you looking for on an x-ray in regards to airway

A

narrowing
deviation
foreign objects

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14
Q

what radiographic finding is seen in croup and tracheal stenosis

A

subglottic airway narrowing

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15
Q

what is the hallmark sign in airway narrowing on an xray called

A

Steeple sign

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16
Q

Tracheal deviation is usually cause by

A

unequal intrathoracic pressures between R and L sides

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17
Q

abnormalities that cause tracheal deviation away from the affected side

A

Pneumothorax
Pleural effusion
large mass

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18
Q

abnormalities that cause tracheal deviation towards the affected side

A

marked atelectasis/collapsed lung
lobectomy/pneumectomy
pleural fibrosis
pulmonary fibrosis (rarely unilateral)

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19
Q

carinal angle >90 degrees

A

splaying of R and L bronchi

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20
Q

Bone problems seen on x ray

A 
fractured
deformed
sclerosed
lytic
osteopenic (difficult to identify on x ray)
Notched (applies to ribs only)
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21
Q

scoliosis is visualized in what views

A

PA and AP

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22
Q

Kyphosis is visual in what views

A

Lateral only

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23
Q

what radiographic finding is seen in advanced COPD

A

Kyphosis
increased AP diameter
“Barrel Chest”

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24
Q

increased density in bone

A

sclerosis

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25
Q

etiologies of Sclerosis

A 
osteoblastic metastasis
primary bone tumor
various benign tumor like lesions
Paget's disease
chronic osteomyelitis
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26
Q

decreased density in bone

A

lytic lesions

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27
Q

etiologies of lytic lesions

A 
osteolytic metastasis
multiple myeloma
various benign cyst like bone lesions
pagets disease
acute osteomyelitis
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28
Q

focal deformation of one or more ribs

A

rib notching

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29
Q

notching of the superior surface (less common) etiologies

A

osteogenesis imperfecta
connective tissue diseases
local pressure
hyperparathyroidism

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30
Q

notching of the inferior surface etiologies

A

coarctation of the aorta
subclavian or SVC obstruction
s/p Blalock Taussig shunt (only 2 upper ribs)

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31
Q

anatomic rib varient

A

cervical rib
unilateral or bilateral
usually incidental finding but can cause thoracic outlet syndrome

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32
Q

subcutaneous emphysema

etiologies from air introduced internally

A

Pneumothorax
Pneumomediastinum
Pulmonary interstitial emphysema

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33
Q

subcutaneous emphysema etiologies from air introduced externally

A

penetrating chest wall trauma
post surgical
complications from chest tube

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34
Q

subcutaneous emphysema etiologies from air introduced locally

A

necrotizing infection with gas producing organisms

gas gangrene

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35
Q

which chest x ray view will exaggerate the size of the heart

A

AP film

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36
Q

cardiomegaly is said to be present if

A

the cardiothoracic ratio is greater than 50% on the PA film

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37
Q

cardiothoracic ration =

A

maximum horizontal cardiac width divided by

maximum horizontal thoracic width (inner surface of the rib cage)

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38
Q

etiologies of cardiomegaly

A

any cause of L or R sided heart failure

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39
Q

_____ _______ can be mistaken for cardiomegaly

A

pericardial effusions

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40
Q

x ray findings for L atrial enlargement

A

splaying of the carinal angle >90%

Double density sign

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41
Q

etiologies for L atrial enlargement

A 
L sided heart failure (any cause)
mitral valve disease 
-mitral stenosis
-mitral regurgitation
-mitral valve prolapse
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42
Q

x ray findings that may indicate r ventricular enlargement

A

filling of the retrosternal space (seen on a lateral view)

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43
Q

etiologies for R ventricular enlargement

A 
Pulmonary hypertension (any cause)
Pulmonary valve disease (pulmonary stenosis, regurgitation)
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44
Q

Primary finding for a pericardial effusion is an

A

enlarged cardiac silhouette (not all are visible on x ray)

other findings
water bottle morphology of silhouette
Oreo cookie sign

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45
Q

oreo cookie sign is seen on what x ray view

A

lat

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46
Q

what are the layers of the oreo cookie sign

A

posterior chocolate layer = pericardial fat
middle cream layer = pericardial effusion
anterior chocolate layer = epicardial fat

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47
Q

acute pericardial effusion etiologies

A

trauma
viral pericarditis
complication of MI (free wall rupture, Dressler syndrome)
Iatrogenic (RV biopsy, EP procedures)

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48
Q

sub acute to chronic pericardial effusion etiologies

A 
Malignancy 
renal failure
collagen vascular disease
hypothyroidism
tuberculosis
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49
Q

widened mediastinum is defined as >

A

8 cm on PA

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50
Q

most cases of widened mediastinum are due to suboptimal technique such as

A

rotated pt
poor inspiratory effort
AP view

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51
Q

what anterior and superior mediastinal masses can be visualized on x ray

A 
lymphoma
thyroid
thymus
teratoma
aortic aneurysm (superior only)
52
Q

what middle mediastinal masses can be visualized on x ray

A 
lymphadenopathy
aortic aneurysm 
pericardial cysts
dilated esophagus
hiatal hernia
53
Q

what posterior mediastinal masses can be visualized on x ray

A

neurogenic tumors

extension of spinal masses (tumors, infection)

54
Q

anterior mediastinal masses are better seen on what view

A

lat

55
Q

Hilar enlargement categories

A 
malignancy
infection
other which includes - 
sarcoidosis
silicosis
pulmonary hypertension
pulmonary artery aneurysm
bronchogenic cyst
56
Q

Small pneumothorax is

A

2 cm

57
Q

large pneumothorax is >

A

2 cm

58
Q

based on the thickness of the rim of air around the lung at the level of the hilum on a PA film

A

size of a pneumothorax

59
Q

what type of film shows pneumothorax better

A

expiratory film

60
Q

Deep sulcus sign is an indication of a

A

pneumothorax

61
Q

etiologies of primary (spontaneous) pneumothorax

A

develops in the absence of lung disease or iatrogenic procedures

62
Q

etiologies of secondary pneumothorax

A

iatrogenic (thoracentesis, lung biopsy, central line placement)

COPD
Cystic fibrosis
pneumonia

63
Q

which effusions seem to defy gravity? why is this important

A

Loculated instead of free flowing

difficult to drain

64
Q

what other view other than PA to assess how free flowing the effusion is

A

Lat decub view with effusion side down.

65
Q

fluid accumulation between the lung base and the diaphragm which does not track up the pleura, and does not blunt the costophrenic angle

A

subpulmonic effusion

66
Q

fluid collection trapped within a fissure which can give the appearance of a lung mass

A

pseudotumor

67
Q

transudative pleural effusion etiologies

A

heart failure
hepatic hydrothorax (pleural effusion due to cirrhosis/ascites)
hypoalbuminemia
nephrotic syndrome

68
Q

exudative pleural effusion etiologies

A 
pneumonia/empyema
malignancy
pleural tuberculosis
pancreatitis
sarcoidosis
various rheumatologic diseases
-lupus, rheumatoid arthritis, ect
69
Q

diffuse pleural thickening is seen in

A 
prior infection
prior hemothorax
occupational exposure (asbestos)
radiation
malignancy
70
Q

elevated hemidiaphragm caused by

A

diminished lung volume
phrenic nerve paralysis
eventration of the diaphragm

71
Q

free air under diaphragm

A

pneumoperitoneum

72
Q

Perforated viscus from PUD, appendicitis, diverticulitis, malignancy, bowel obstruction, complication of endoscopy
post op complication
trauma
peritoneal dialysis

A

causes of pneumoperitoneum

73
Q 
trauma
esophageal rupture
vomiting
asthma
post neck or chest surgery
barotrauma
A

causes of pneumomediastinum

74
Q

trauma
bacterial pericarditis secondary to gas producing organism
post cardiac surgery
pericardial drain
fistula between pericardium and either lung, stomach or esophagus

A

causes of pneumopericardium

75
Q

gas seen between liver and diaphragm

A

chilaiditi’s sign

76
Q

refers to condition of ab pain or other symptoms caused by the interposed colon

A

chilaiditi’s syndrome

77
Q

Hyperinflation is seen in

A

COPD

acute exacerbations in asthma

78
Q

Kerley A lines represent

A

channels between peripheral and central lymphatics

79
Q

Kerley B lines represent

A

interlobular septa (may have heart failure)

80
Q

In cardiogenic pulmonary edema the cardiac size is typycally

A

enlarged

in non-cardiogenic it is typically normal

81
Q

Regional distribution of opacities in non cardiogenic and cardiogenic pulmonary edema

A

Cardiogenic - relatively homogenous

non-cardiogenic - opacities are relatively patchy

82
Q

Air bronchograms are common in what type of pulmonary edema

A

non-cardiogenic

83
Q

Peribronchial cuffing is more common in what kind of pulmonary edema

A

Cardiogenic

84
Q

Kerley b lines are more common in what kind of Pulmonary edema

A

Cardiogenic

85
Q

nodules <= 2mm

A 
miliary tuberculosis
fungal infection
silicosis
coal workers pneumoconiosis
sarcoidosis
86
Q

nodules > 2cm

A 
metastatic cancer
subacute hypersensitivity pneumonitis
lymphoma
sarcoidosis
granulomatosis with polyangiitis 
rheumatoid nodules
87
Q

relatively large, dense, homogenous opacification, frequently involving an entire lobe

A

consolidation

88
Q

loss of the normally visible border of an intrathoracic structure caused by an adjacent pulmonary density

A

silhouette sign

89
Q

an abnormal increase in opacification overlying the spine while moving superior to inferior on the lateral view, suggestive of lower lobe opacities/infiltrates

A

Spine sign

90
Q

causes of focal opacities

A 
Infections (pneumonia)
Malignancy
Pulmonary infarction
Pulmonary hemorrhage
vasculitis
Eosinophilic pneumonia
91
Q

Homogenous consolidation
air bronchograms common
sharp borders corresponding to fissures is consistent for what and caused by what?

A

Lobar pneumonia

streptococcus pneumoniae
Klebsiella pneumoniae
Haemophilus influenzae

92
Q

Patchy opacification
Air bronchograms uncommon
vague borders
frequently bilat

what is it
what causes it

A

segmental pneumonia (Bronchopneumonia)

Staphylococcus Aureus
Pseudomonas aeruginosa
Klebsiella pneumoniae
Haemophilus influenzae

93
Q

Reticular pattern
no air bronchograms
often develops into airspace disease

A

Interstitial Pneumonia

Mycoplasma pneumoniae
viral pneumonia
pneumocystis pneumonia

94
Q

Spherical opacification
Easily mistaken for tumor or other lung mass
Much more common in children than adults

A

Round Pneumonia

H. Influenzae
streptococcus pneumoniae

95
Q

Distinguished by cavities

may or may not have air-fluid level

A

Cavitary Pneumonia

Tuberculosis
Staphylococcus aureus

96
Q

a well circumscribed, generally round density, smaller than 3 cm in diameter

A

Solitary Pulmonary nodule

97
Q

Causes of Solitary pulmonary nodules

A

Cancer
Infectious/inflammatory
(granuloma, pneumonia)
Congenital anomalies - arteriovenous malformation or bronchogenic cyst

98
Q

what 3 categories of etiologies cause multiple pulmonary nodules

A

Cancer

  • Pulmonary metastasis
  • Lymphoma

Infectious/inflammatory

  • Fungal pneumonia
  • mycobacteria
  • nocardia
  • septic emboli
  • parasites
  • Rheumatoid Arthritis
  • Vasculitis

Misc
-Amyloidosis

99
Q

Hampton’s Hump indicates

A

pulmonary embolism

cant always be detected on x ray

dome shaped opacity due to lung infarction - takes months to resolve and can leave scarring

100
Q

Westermark sign

A

pulmonary embolism

cant always be detected on x ray

focal reduction in appearance in lung markings due to embolis

101
Q

Fleishner Sign

A

pulmonary embolism

cant always be detected on x ray

prominent central pulmonary artery caused by distension of the vessel caused by a PE

102
Q

Typically arise within preexisting lung cavities and get colonized with Aspergillus. Pt asymptomatic, may have a chronic cough

A

Aspergilloma

“fungus ball”

103
Q

loss of lung volume due to collapse of lung tissue

A

Atelectasis

104
Q

Airway obstruction followed by gas resorption within non ventilated alveoli

A

Obstructive
Resorptive atelectasis

Tumor
Mucus plug
Foreign body aspiration
External compression of airway

105
Q

Disruption of normal contact between the visceral and parietal pleura allows the elastic recoil of the lung to pull itself inward

A

Non Obstructive

Passive (relaxation) Atelectasis

Pleural effusion
Pneumothorax

106
Q

Space occupying lesion in the thorax physically compresses adjacent lung

A

Non Obstructive

Compressive Atelectasis

Tumor
Elevated diaphragm

107
Q

Diminished surfactant results in higher surface tension in fluid lining alveoli with increased tendency for collapse

A

Non Obstructive

Adhesive Atelectasis

Infant Resp distress syndrome
ARDS
Radiation pneumonitis

108
Q

Severe parenchymal scarring

A

Non obstructive
Cicatricial Atelectasis

TB
Idiopathic pulmonary fibrosis

109
Q

Elevation of the ipsilateral hemidiaphragm

Mediastinal shift

Juxtaphrenic peak sign

A

Lobar Atelectasis

Etiologies include
Lung cancer
Foreign body aspiration
Mucus plugging
External compression of an airway
110
Q

Density in upper, medial right hemithorax

Superior displacement of R hilum and horizontal fissure

A

Right upper lobe collapse

111
Q

A thin shadow overlying the heart on the lateral view

A

RML collapse

112
Q

Wedge shaped opacity behind R atrium

A

RLL collapse

113
Q

Luftsichel sign

A

50% of pt will have a portion of the LLL interposed between the collapsed LUL and the aortic arch (Luftsichel sign)

LUL collapse

114
Q

Triangular opacity behind heart
Inferior displacement of l hilum

Obscuring the outline of the descending aorta

A

LLL collapse

115
Q

optimal placement of a central line or PICC places the tip at the

A

junction of the SVC and R atrium

116
Q

Optimal placement of a PA catheter (Swan-Ganz) will place the tip at the level of the

A

hilum, no more than 3 cm r of midline or 1 cm beyond the cardiac silhouette

117
Q

Proper placement of an Endotracheal tube results in the tip being

A

approx 5 cm above the carina

118
Q

Proper placement of NG tube is confirmed by

A

descends centrally

crosses the diaphragm

once below diaphragm, initially deviates to left

optimally tip should be >10cm below the gastroesophageal junction

119
Q

Complications seen on X-ray from Cardiac Devices

A

Pneumothorax
Perforation
Lead fracture
Twiddlers syndrome - lead has been wrapped around device and displaced from person messing with it

120
Q

in profile

A

suggests aortic prosthetic heart valve

121
Q

en face

A

suggests mitral prosthetic heart valve

122
Q

What are the 2 big differences when looking at pediatric x rays vs adults

A

Thymus enlargement - in children younger than 2 this is a normal finding
Double atrium is a normal finding in kids. In adults this would indicate L atrial enlargement

123
Q

the presence of posterior and lateral rib fractures in infant is highly suspicious for

A

non accidental trauma

124
Q

Systematic approach mentioned in ped radiology video

A 
Lung parenchyma
Pulmonary vasculature
airway/mediastinum
Heart
Bony abnormalities
125
Q

meniscus sign points to

A

pleural effusion

126
Q

7- shape ribs

A

pectus excavatum

Essentials of Acute Care (9 decks)

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