CXR

Question 1

What is the disadvantage of an AP CXR?

Answer 1

It makes the heart look larger

Question 2

Approaching a CXR

Answer 2

• Patient details and projection
  
  • AP vs PA
• Technical factors
  
  • Rotation
  • Inspiration
  • Exposure/penetration
• Lines and metalwork
• ABCDE
  
  • Airway
  • Breathing
  • Circulation
  • Diaphragm
  • Everything else
• Review areas
  
  • Lung apices
  • Costophrnic angels
  • Behind the heart
  • Behind and below the diaphragm
  • Soft tissue and bone

Question 3

How to assess rotation?

Answer 3

Spinous processes lie in the middle of the medial heads of the clavicles.

Question 4

How to assess inspiration?

Answer 4

Adequate inspiration:

5-7 anterior ribs

10 posterior ribs

Question 5

How to assess exposure?

Answer 5

Can see vertebrae and intervertebral disc space

Question 6

Four steps to assessing NG tube position

Answer 6

1. Midline
2. Crosses the carina or left main bronchus
3. Tip lies below the left hemi diaphragm
4. Tip lies 10cm distal to the GOJ

Question 7

Endotracheal tube correct position

Answer 7

5 +/- 2cm above carina

Question 8

Loss of lung volume features

Answer 8

1. Opacity
2. Tracheal shift towards side of lung volume loss
3. Hemidiaphragm shift

Question 9

Features which you would see in lung collapse and not in consolidation:

Answer 9

• Well demarcated
• Dense
• Homogenous
• No air bronchograms

Question 10

Causes of lobar collapse

Answer 10

• Luminal
  
  • Foreign body
  • Mucouus plugging
  • Malignancy
• Mural
  
  • Malignancy
• Extrinsic
  
  • Malignancy

Question 11

Causes of loss of lung volume

Answer 11

• Collapse
• Pneumonectomy/lobectomy

Question 12

How to recognise cardiomegaly

Answer 12

>0.5 thoracic width

Question 13

Answer 13

Normal

Question 14

Answer 14

Correctly placed NG tube

Question 15

Answer 15

Incorrectly placed NG tube

Question 16

Answer 16

Unilateral pleural effusion

Question 17

Answer 17

Right pneumonectomy (there are clips)

Without clips it would be right lung collapse

Question 18

Answer 18

Right lower lobe collapse

Question 19

Answer 19

Cardiomegaly

Question 20

Answer 20

Heart failure

Alveolar oedema

Cardiomegaly (although AP so can’t assess properly)

Dilated upper lobe vessels

Pleuarl effusion

Question 21

Answer 21

Left sided pneumothorax

Question 22

Answer 22

Pneumoperitoneum

Question 23

Answer 23

Heart failure

Alveolar oedema

Kerley B lines

Cardiomegaly

Dilated upper lobe vessels

Question 24

Answer 24

Right lower lobectomy

Question 25

Answer 25

Bilateral pleural effusion

Question 26

Answer 26

Right upper lobe consolidation

Question 27

Answer 27

Right lower lobe consolidation

Question 28

Answer 28

Normal

Question 29

Answer 29

ET tube correctly placed

Question 30

Answer 30

Tension pneumothorax