CHEST XRAYS

Question 1

what is the approach to CXrays? (6)

Answer 1

1. projection
2. patient details
3. technical quality - RIP
4. obvious abnormalities
5. Systemic review of the film - ABCDE approach
6. summary

Question 2

What is the standard projection?

Answer 2

PA

Question 3

When is an AP projection film carried out?

Answer 3

sick patients

Question 4

How do you know if a film is in PA? (2)

Answer 4

1. arms are raised up

2. scapulae are pulled out almost fully out of lung fields

Question 5

How can you tell if a film is in AP? (2)

Answer 5

1. humerus is down

2. scapulae in lung fields

Question 6

How do you check technical quality of the film? (3)

Answer 6

1. look for lung apices
2. look for lateral sides of the ribcage
3. look for both costophrenic angles on the film

Question 7

In assessing technical quality of the film what do you look for in Rotation?

Answer 7

1. the heads/medial ends of the clavicles are equidistant from the spinous processes of the vertebral bodies

Question 8

In assessing technical quality of the film what do you look for in Inspiration? (2)

Answer 8

1. PA films are held on deep inspiration

2. Count ribs - 6 anterior ribs and 10 posterior ribs

Question 9

In assessing technical quality of the film what do you look for in Penetration?

Answer 9

1. you can the vertebral bodies behind the heart

Question 10

What do you look for in obvious abnormalities and how do you describe them? (5)

Answer 10

1. which lung
2. which zone
3. size
4. shape
5. density/texture

Question 11

What do you look for in airways?

Answer 11

1. tracheal deviation

Question 12

What do you look for in breathing? (3)

Answer 12

1. start at apices down to costophrenic angles
2. inspect apices, hila, mediastinum and costophrenic angles
3. edge of lung fields - pneumothoraces

Question 13

In breathing - when you are looking at the hila which hila should be higher and when is this an exception, and what densities should they be in comparison to each other?

Answer 13

1. left hilum should NOT be lower than the right
2. exception - dextrocardia
3. both same density

Question 14

What do you loo for in circulation/cardio?

Answer 14

1. cardiomegaly
2. heart borders
3. cardiophrenic angles
4. behind the heart

Question 15

How do you know if there is cardiomegaly?

Answer 15

the heart shadow is more than half the width of the chest cavity on PA film

Question 16

What do you look for in regards to the heart borders? (3)

Answer 16

1. if the left or right heart borders are not clearly visible
2. consolidation
3. collapse

Question 17

What do you look for behind the heart?

Answer 17

1. any lung masses

Question 18

What you do you look for in diaphragm? (4)

Answer 18

1. both hemi-diaphragms are visible and NOT flattened
2. costophrenic angles
3. right hemi-diaphragms
4. air under the diaphragm
   - left = gastric bubble

Question 19

What do you look for in the costrophrenic angles? (2)

Answer 19

1. whether they are clearly demarcated

2. do they have fluid?

Question 20

Which hemi-diaphragm should be higher and why?

Answer 20

1. right - due to liver

Question 21

What do you look for in exposure? (1 (3))

Answer 21

1. bones

• fractures
• rib space narrowing = COLLAPSE
• gas in soft tissues = black areas = SURGICAL EMPHYSEMA

Question 22

What do you say in a summary?

Answer 22

1. summarise

2. provisional diagnosis and differentials

Question 23

What to look for in review? (8)

Answer 23

1. apices
2. hila
3. behind the heart
4. costophrenic angles

5, around pleura

6. edge of lung fields - pnemothoraces
7. pleural thickening
8. under diaphraghm

Question 24

What is seen in a pneumonia? (4)

Answer 24

1. dense or patchy consolidation - usually unilateral
2. air bronchograms
3. lower zones - may be difficult to distinguish from effusions
4. need to know which lobes touch which heart and diaphragmatic borders - tells you which lobe is affected

Question 25

Which lung lobes touch the diaphragm?

Answer 25

1. left and right lower lobes

Question 26

Which lung lobe touches the right heart border?

Answer 26

1. right middle lobe

Question 27

Which lung lobe touches the left heart border?

Answer 27

1. lingula

Question 28

what should you refer to the lobes as?

Answer 28

zones

Question 29

What is seen in a pleural effusion?

Answer 29

1. loss of costophrenic angles 2. homogenous opacification 3. fluid level - meniscus

Question 30

Are transudate effusions bilateral or unilateral?

Answer 30

1. more likely to be bilateral

Question 31

Are exudate effusions likely to bilateral or unilateral?

Answer 31

1. unilateral

Question 32

What criteria is used to assess pleural effusion fluid?

Answer 32

1. light's criteria

Question 33

How do you assess heart failure? (5)

Answer 33

1. A - alveolar (interstitial) shadowing 2. B - Kerley B lines 3. C - cardiomegaly - cardiothoracic ratio is greater than 50% on PA film 4. D - prominent upper lobe vasculature - due to upper lobe blood diversion 5. E - effusions and fluid in horizonatl fissures

Question 34

What are Kerley B lines?

Answer 34

1. little white horizontal lines in the lateral lower edges

Question 35

What would be seen in pneumothorax? (3)

Answer 35

1. loss of lung markings in the peripheral lung field 2. a discrete lung edge 3. tracheal deviation in tension pneumothorax

Question 36

how would you identify a lobar collapse?

Answer 36

1. loss of volume 2. narrowing of the space between ribs compared to the other side 3. look for tracheal and mediastinal drift

Question 37

What is veil sign in lobar collapse? (2)

Answer 37

- happens in the left upper lobe | - whole lung field looks like it is covered by a veil

Question 38

What is the sail sign in lobar collapse? (2)

Answer 38

- happens in the left lower lobe | - sharp line like the edge of a sail at the same angle as the left heart border

Question 39

What can be seen in the RUL of the lung is lobar collapse? (3)

Answer 39

- hazy - raised horizontal fissure - abnormality well demarcated by the fissure

Question 40

What happens to the right middle lobe in lobar collapse? (2)

Answer 40

- loss of right heart border | - can be difficult to differentiate from consolidation

Question 41

What happens to the right lower lobe in lobar collapse? (2)

Answer 41

- complete loss of diaphragmatic border | - hard to differentiate from effusion

Question 42

How do you describe demarcated lesions (single or multiple)?

Answer 42

- round opacities