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171 chapter 20

A patient has dyspnea and tachycardia following thoracentesis to treat a pleural effusion. Evaluation of this patient should include a Chest xray
a pneumothorax would appear on a chest radiograph as a dark area without lung markings
the medical record of an intubated patient indicates that the morning chest sray shows opacification of the lower right lung field with elevated right diaphragm and a shift of the trachea to the right. these findings would suggest right-sided atelectasis
On a chest xray, the tip of the endotracheal tube for an adult patient should be 5-6cm
a patient is believed to have a pleural effusion. which of the following xray techniques would be most useful in making a confirmation? -CT -MRI -Decubitus radiograph projection -AP radiograph projection Decubitus radiograph projection
The chest (what?) is more commonly called a chest film or chest xray. radiograph
Air-filled lung tissue appears mostly dark on the film because it is easily penetrated. This quality is called radiolucent
The dense bone tissue of the ribs appears white. Dense matter that is not easily penetrated is referred to as having radiopaque qualities
Accumulation of fluid in the pleural space, or (what?), appears white and may obscure the angle where the ribs meet the diaphragm. pleural effusion
On the chest film these areas are called pulmonary infiltrates
If alveoli are filled with fluid but the airways around them are open, you will see air (what?) that may indicate pneumonia. bronchograms (and ?)
Air in the pleural space, or (what?), is another example of an abnormal density. This condition appears as a black area with non of the usual grayish markings of blood vessels in the lung tissue. Pneumothorax
Magnetic Imaging Resonance MRI
Patchy increased density shadows that coalesce over time Infiltrates
thickened septa most clearly seen as thin lines against the pleural edge. Kerley B Lines
Engorged pulmonary blood vessels visible in the apex of the lungs cephalization
Lucent tubular visible structures running through opacities air bronchograms
ventilation perfusion scan V/Q scan
object that absorbs a large amount of xray beams and appears white radiopaque
computerized tomography scan CT scan
What is the costophrenic angle? the angle provided from diaphragm and lung in cxr
Air in the pleural space is always abnormal. Name 3 common causes of this condition. 1)rupture of a bleb 2)barotrauma 3)Biopsy
Tension pneumothorax is immediately life threatening. Name at least 2 radiographic signs of tension pneumothorax. 1)depressed hemidiaphragm 2)mediastinum is shifted toward opposite lung
What lung problem is ventilation/perfusion (V/Q) scanning used to detect? pulmonary embolism
Which of the following structures will result in the most radiopaque shadow on the chest radiograph? -aorta -ribs -lungs -heart ribs
cxr is useful in? (Choose all correct.) 1.When the patient's temperature returns to normal 2) When the patient’s oxygenation status deteriorates for no known reason 3) Following an intubation 4) Following placement of a CVP (central venous pressure) line 2,3,4
In what pulmonary condition does the chest radiograph often “lag behind” the clinical status of the patient? pneumonia
Which radiographic view of the chest allows the physician to read the best quality film? posterioranterior
Your patient just had an anteroposterior chest film taken. When you view the film, what may be a consideration? The heart may appear larger then it really is.
In the standard posteroanterior chest film, what proportion of the chest width should the heart shadow not exceed? 50%
Spiral CT angiography is most often used to evaluate the patient for which of the following conditions? Pulmonary emboli
Which of the following is a major limitation of magnetic resonance imaging (MRI) of the chest? Cannot be used in patients with pacemakers
What is indicated by rounding/blunting of the costophrenic angles seen on the chest film? Excess pleural fluid
What is indicated by an air-fluid level in the pleural space? Hydropneumothorax
What term is used to describe the shadows seen on the chest film when the alveoli fill with pus, fluid, or blood? Infiltrates
Which of the following is NOT a typical cause of pulmonary edema as seen on the chest radiograph? 1. Left heart failure 2. Fluid overload 3. Renal failure 4. Right sided heart failure (Cor pulmonale) 4
What is the most common cause of cephalization (engorged pulmonary blood vessels) as seen on the upright chest film? Left sided heart failure
Which of the following findings on a chest film is most consistent with the pulmonary edema seen with acute respiratory distress syndrome (ARDS)? 1. Cardiomegaly 2. Bilateral patchy infiltrates of edema 3. Kerley B-lines 4. Cephalization Bilateral patchy infiltrates of edema
Which of the following is NOT a typical cause of atelectasis? 1. Rib fractures 2. Hepatomegaly 3. Pleurisy (inflammation of the pleura) 4. Thoracic surgery 5. Abdominal surgery 2
What is the most common cause of lobar atelectasis? Bronchial obstruction
Which of following on the chest radiograph is considered a secondary sign of emphysema (hyperinflation)? 1. Widening of the cardiac shadow 2. Narrowing of the space between the ribs 3. Blunting of the costophrenic angle 4. Flattening of the diaphragms 4
What is the optimal position of the endotracheal tube following intubation as seen on the chest radiograph in a normal adult patient? 5 - 7 cm above the carina
Why get chest x ray following placement of the central venous pressure catheter? Choose all true 1.To identify when to change the line 2.To allow better interpretation of the results 3.To rule out pneumothorax 4.To confirm proper placement of the catheter 3,4
When viewing a chest X-Ray, you should be able to view up to 8 ribs in the AP and 12 in the PA view. False
Air bronchograms are the hallmark of infiltrates that fill the alveoli (so-called air space disease). true
Created by: johndreamer