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79 Cards in this Set
- Front
- Back
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How can you tell if something is over or under penetrated?
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If you can see just the right about of cervical spine.
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What is the danger of over pentrance?
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Misdiagnosis of emphysema due to more air space.
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Which side of the CXR is marked?
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The patient's left
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Which ribs are the diaphragm at during inspiration?
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At the 6th-7th rib
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Is the anterior or posterior rib higher up?
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The posterior ribs lie above the anterior.
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What is the thin dark spot on the left diaphragm?
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The gastric bubble. This is useful for identifying the left side.
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What is the standard CXR from front to back?
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The PA. The machine is 6 feet behind the patient and he is standing.
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What is a portable CXR called?
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An AP. The machine is 3 feet in front of the patient and they are usually lying down.
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Describe the retrosternal space.
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The space right behind the sterum on the lateral view. It is usually a couple cm, but is increased in emphysema.
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What is the center column on the PA view?
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Usually the aorta. It is centered.
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How would you see an aortic dissection on a PA CXR view?
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The middle column of the aorta is widened.
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What are the verticle lines in the lateral view that are superior and slightly in front of the spine?
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The scapular lines.
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How would you diagnose emphysema.
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1. CXR showing decreased lung density and a diaphragm that is flattened out.
2. Obstructive pattern in spirometry. 3. Helium dilution, nitrogen washout, or body plethysmograph test to find out FRC and RV. It would need to be over 120% of predicted. |
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When may a child have a barrel chest?
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When they have an asthma attack, but this is reversible. They over inflate in order to keep the airways open.
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Why does the lateral cardiac silhouette look like a streak in people with emphysema?
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The diaphragm is pushed down perpetually and drags own the attached pericardial sac.
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Why are the hilar areas enlarged in chronic bronchitis? What else will you see?
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There is pulmonary hypertension. You will also see a bulging right ventricle.
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Will you see pulmonary edema in cor pulmonale?
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You won't see pulmonary edema because that is only present with left heart failure.
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When will you hear sternal tapping?
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When you have cor pulmonale because the right ventricle sits right underneath the sternum.
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What are the physical signs of cor pulmonale?
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Peripheral edema in the lower extremities and JVD. And palpation of an enlarged liver due to venous backup.
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Which signs come first?
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Usually JVD but either can come first.
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What is tenting of the diaphragm?
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It is when the diaphragm gets attached to the parietal pleura (look up) due to repeated infection and subsequent scarring.
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What is the first thing that happens in the lungs from left heart failure?
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Pulmonary edema.
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What happens later on in left heart failure? What can result from this?
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Pulmonary hypertension.
Back up pressure to right ventricle and then right ventricular failure. |
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What spinal abnormality can look like barrel chest?
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Kyphosis.
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Is kyphosis more common in men or women? Why?
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Women. They are more prone to osteoporosis.
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Can pulmonary fibrosis cause cardiac enlargement? From which side?
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Yes. the right because it increases the effort necessary to pump blood through the lungs.
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Can you ever see pulmonary edema diffusely? When?
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Yes. When the pulmonary pressure is very very high and pushes the edema throughout the lungs.
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What are air bronchograms and what do they look like?
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They are streaks of dark tubes through an opaque lung. They are the bronchi that are filled with air whereas the alveoli have consolidation.
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What do air bronchograms usually indicate?
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Infection and pneumonia. But they can also sometimes indicate pulmonary edema, especially from non cardiogenic edema from sepsis.
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What treatment action would you take based on pulmonary wedge pressure?
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Give diuretics or give fluids to make the pulmonary pressure normal to return normal circulation.
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If a person has risk factors like being hospitalized, being in a nursing home, or being a smoker, what would you do differently for their lobar pnuemonia?
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They have an increased likelihood of being infected with something other than Streptococcus pneumonia so you would treat empirically with a broad spectrum and then narrow down the abx with C&S.
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What is it if you see a white density that is pretty well contained (cavitation) with an area of lucency? What is the lucency?
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It's probably a lung abscess. The lucency is an air pocket in the abscess.
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What sx should you correlate lung abscess with?
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Found with foul smelling breath and fever.
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What does streptococcus pneumonia look like?
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gram positive diplococci
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What does usual strep look like
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gram positive small chain cocci
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What does staphylococcus pneumonia look like?
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gram positive cocci clusters
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What would you see on microscope of a lung abscess?
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Both gram positive aerobes and gram negative anaerobes. You would not see the anerobes on a C&S though because the culture is usually aerobic.
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What does viral pneumonia look like and what will it present with sometimes?
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It looks like diffuse pneumonia. (not lobar and not as patchy as bronchopneumonia, though that kind can look diffuse). Will present with vesicles on the skin if it is chicken pox although pneumonia from chickenpox is a rare complication.
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How would you treat someone with viral pneumonia?
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Treat for the symptoms.
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What is the big risk of viral pneumonia?
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It may set the stage for a super bacterial pneumonia and they will get much worse.
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Who may you treat with abx for viral pneumonia? On a physiological level, why?
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People with COPD who may already be colonized with bacteria is the lower respiratory tract.
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What does a cavitary lesion in the lung apex indicate?
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A Tuberculosis granuloma.
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What do the TB organisms look like in an acid fast stain?
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Little red rods.
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Why should you always ask for sensitivity with TB cultures?
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There is a high amount of abx resistant in TB so you need to know that you are treating it correctly.
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What kind of disease is often associated with TB?
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HIV
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What does the TB cavatation look like? How is it different than the abscess?
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It looks like a much thinner ring and it is not as opaque.
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What is the main cause of atelectasis?
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Obstruction of the airways.
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What are the two main XR signs of atelectasis?
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Volume loss and mediastinal shift due to the air in the alveoli being absorbed. You may not see the heart border if it is severe.
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If there is an atelectasis over the entire left lung, where is the obstruction?
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In the left main bronchus.
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What are some causes of obstruction causing atelectasis and which demographic are most susceptible to each?
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Foreign body - especially children
Secretions - especially people who have neurological deficits or have trouble coughing. Blood clots - especially in trauma. |
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What are two ways that you can tell pleural effusion from atelectasis?
(They are both opaque and on one side usually) |
It will not shift the mediastinum towards the opacification and there will also be volume gain rather than loss on the side.
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Why does atelectasis look opaque? How is this different from pneumothorax?
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The lung is not as inflated so there is less air in there. It is collapsed, but the visceral pleura has not separated from the parietal pleura like the pneumothorax CXR.
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What physical exam findings will come with atelectasis? Is this similar or different from pleural effusion?
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Dullness in percussion and lack of breath sounds over the area.
This is the same as pleural effusion. |
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When would you usually see bilateral pleural effusions? Why?
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Left heart failure. The increased pumonary pressure pushes the blood to both sides.
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What do the colors on a CT indicate? How is this different than an XR?
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They also indicate density except that they are better differentiated than in an XR and are assigned a Houndsfield number from -1000 to 1000.
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Why won't a pneumothorax of an entire lung collapse completely?
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There is a certain closing volume of the airways that traps air in the alveoli distal to the closed airway.
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What do you want to look for in a pneumothorax that would be very pressing for treatment?
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Any signs of tension pneumothorax.
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How would you look for tension pneumothorax on CXR?
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The right heart border or the left heart border are not where they should be. They are either closer or further away from landmarks like the ribs or the spine.
It's harder to spot a trachea shift because it is more subtle. |
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What should you think when you see a straight horizontal line on a standing CXR?
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Pleural effusion. The fluid is outside of the visceral pleura and is not made cloudy by being in the interstitium or the alveoli.
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How would you get a sample for a smear of sputum?
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have them cough it up, give them something to induce coughing, or get it from a bronchoscopy.
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What should you think when you see clubbing in a smoker?
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Lung cancer.
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Why does clubbing of the fingernail occur?
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The capillaries of the distal finger are enlarged due to substances released in the blood that are not well understood.
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What are the substances that cause clubbing (we think)?
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Either substances released from a lung tumor or some neuroendocrine substance.
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What should you think when you see a solitary pulmonary nodule in a smoker with clubbed fingers?
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Lung cancer.
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What is spiculated?
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A opacity that looks like it has many things shooting out of it.
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What abnormality does spiculation usually indicate?
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A more central lung cancer.
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What happens when the superior vena cava becomes obstructed (maybe due to a tumor)?
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You develop collateral vasculature that reroutes blood drainage from the head and upper limbs to the inferior vena cava.
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What may you see physically?
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Prominent veins all over the chest and swelling of the head and upper limbs.
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What is it called when you have this vascular rerouting?
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Superior vena cava syndrome. (rare)
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Is this long term or short term?
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Long term cause vascular changes like this take time. Usually it is in people who have ignored their tumors for a long time.
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What would you see on a CXR if there is atelecasis in one lobe?
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The fissure either being pulled up or down towards the atelectasis. the diaphragm may also be pulled up.
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What should you think when you see atelectasis in a smoker?
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Bronchogenic carcinoma. (Lung cancer)
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Would the lung appear more opaque in a PE or a pulmonary infarction.
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A pulmonary infarction because the tissue will actually die in this case. Not sure why it appears more opaque when ischemia.
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How do you see a VQ mismatch on a VQ scan.
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You would compare the extent of the ventilation images with the perfusion images and see if they match up.
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What is the gold standard for visualizing PE?
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CT Angiogram.
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What would you see in a CTA with PE?
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The vasculature would just stop in cerain lung zones.
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What would you see in a CXR for sarcoidosis?
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Hilar lymphadenopathy.
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Which ethnic group in the US is most prone to sarcoidosis?
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African Americans.
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How would you differentiate sarcoidosis from TB?
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It is non caseating granulomas whereas TB is caseating.
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