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Chest and Abdomen

SJC S1U3 Zerbe

Come on...You got this!
The vertebral prominens is at the level of C7/T1
The jugular notch is level with T2/T3
The xyphoid tip is level with T9/T10
The mid thorax is at the level of T7
What separates the thoracic cavity from the abdominal cavity Diaphragm
The thoracic Cavity includes: •Lungs •Heart •Respiratory Organs •Cardiovascular System •Lymphatic system •Esophagus •Thymus Gland
What is the parietal pleura? That serous membrane attached to the wall of the cavity
What is the visceral pleura? The serous membrane that covers the organs of the thoracic cavity?
What is the Pleural Cavity? The space or potential space between these two membranes
What is a pneumothorax? When the lung collapses or when air collects between the two layers
What is the epiglottis? thin, lid-like flap of cartilage tissue covered with a mucous membrane, attached to the root of the tongue, and guards the entrance of the glottis, the opening between the vocal cords.
Where does the trachea lie in relation to the esophagus? Anteriorly
What is the name of the hook-like process on the last tracheal cartilage? Carina
After entering the hilum, each primary bronchus divides. How many primary branches are there in the right lung? 3
The lungs are composed of a light, spongy, elastic substance called the parenchyma
After entering the hilum, each primary bronchus divides. How many primary branches are there in the left lung? 2
The part of the lung that extends above the clavicle is termed the: Apex
The right lung is about how much shorter than the left? 1” Due to the liver location under the right lung
What is the name of the double-walled serous membrane sac that encloses the lung? pleura
What is the area between the Right and Left Pleural Cavities? The Mediastinum
The mediastinum includes? •Heart •Great vessels •Trachea •Esophagus (digestive system) (in posterior mediastinum between the spine and trachea) •Thymus •Lymphatics •Nerves •Fibrous tissue •Fat
Where does the esophagus lie in relation to the trachea? Posteriorly (between the trachea and spine)
List the structures of the bronchial tree in order from the carina to the terminal bronchials: •Primary Bronchi •Secondary bronchi •Teritiary Bronchi •Bronchioles •Terminal bronchioles •Alveolar ducts •Alveolar sacs •Alveoli
Where does oxygen and carbon dioxide exchange take place within the lungs? Alveoli
The right lung has how many lobes and deep fissures? 3 lobes, 2 deep fissures
The left lung has how many lobes and deep fissures? 2 lobes, 1 deep fissure
The broadened inferior portion of each lung 
that rests on diaphragm is termed the: Base
The most inferior portion of each lung that is formed by a deep recess of the parietal pleura upon inspiration is termed the: Costophrenic angles
The depression within the mediastinal surface allowing for passage of the bronchi and pulmonary vessels, lymph vessels and nerves is termed the: Hilum
The medistinum is surrounded by what structures? •Sternum anteriorly •Vertebrae posteriorly •Right and Left pleural cavities laterally
What is the most optimal position of the patient for examinations of the heart and lungs? upright
Why is the most optimal position of the patient for examinations of the heart and lungs the upright position? •To reduce Engorgement of the pulmonary vessels •Drops diaphragm to its lowest level •Air fluid level visualization •Allows for full inspiration
Why is the left lateral chest position the most commonly used for lateral radiographs of the chest? To place the heart neared to the IR and reduce magnification
For what reasons would and inspiration and an expiration chest be warranted? •Pneumothorax •Diaphragmatic excursion •Foreign body location •Atelectasis
When a foreign body is aspirated, where is more likely to lodge? Rt main bronchus: its more vertical and has a greater diameter
What is the preferred distance for chest radiography? ____72”_____ •Longer distance reduces magnification of the heart **Remember: the more SID you have, the less magnification you have. Also, less magnification gives better recorder detail**
What is the preferred kVp range for chest radiography? 100-130 kVp
Grids are recommended for chest radiography when using kVp ranges above: 100
Reasons for 72” SID for chest radiography: Decreased magnification of heart Increased recorded detail of thoracic structures
How far above the relaxed shoulders should the IR be positioned for PA and lateral chest radiographs? 1½ to 2 inches
Where are the hands placed for a PA projection of the chest? back of the hands on the hips With shoulders rolled forward to move the scapula out of the lungs
What is the CR angle for a PA chest radiograph? 0 degrees, the CR is perpendicular
What is the optimal respiration phase for a PA or lateral chest radiograph? full inspiration—second breath
How many ribs should be visible above the diaphragm on a PA chest radiograph? 10
The midcoronal plane is __________ to the plane of the IR for the PA Chest? Parallel
The midsagittal plane is _________to the IR for the PA Chest? Perpendicular and centered
Where is the CR location for a PA projection chest? T7 on the MSP
How are the arms and shoulders to be positioned fro a PA projection Chest. •Elbows flexed to place dorsal hand surface on postierior hips below costophrenic angles •Shoulder rolled forward to pull scapulae out of lung field •Shoulder depressed to place clavicles in same horizontal plane
Which plane must be accurately parallel with the IR to prevent distortion of the thoracic structures during a lateral chest radiograph? midsagittal plane
Which plane is perpendicular to the IR when doing the lateral projection of the chest? MCP
What is the CR location and direction for the Lateral Chest? Perpendicular at the Level of T7 on the MCP
How many degrees of body rotation are required for routine AP or PA oblique chest radiography? 45 degrees
Where should the top of the IR be positioned for a PA oblique projection of the lungs? 1½ -2 inches above the vertebral prominens
For AP oblique projections of the chest, the side of interest is generally: the side closest to the IR
For PA oblique projections of the chest, the side of interest is generally: the side farthest from the IR
If an oblique projection was needed to see a left sided lesion, which oblique(s) could demonstrate this best: RAO or LPO
What is the recommended SID for a supine AP chest radiograph? 72”, although 72” is recommended it is not always possible due patient condition or room set up
Each lung is divided into specific segments called: lobes
Where should the top of the IR be positioned for a supine AP chest radiograph? 1½ -2 inches above the relaxed shoulders
CR location and direction for the AP Chest? Perpendicular to the sternum and 3 inches below the jugular notch on the MSP (exits the level of T7)
How far above the top of the shoulders should the IR be positioned for any decubitus position of the chest? 1½ -2 inches above the shoulders
The Lindblom method is used to demonstrate the: pulmonary apices
What is the CR angle for the Lindblom method (lordotic position) of demonstrating the pulmonary apices? 0º If the patient can do the lordotic position the CR is perpendicular to the IR
How far should the patient stand in front of the grid device for the lordotic position? 1 foot
If the patient cannot be placed in the lordotic position for radiography of the pulmonary apices, what is the CR angle that can be used to project the clavicles above the apices? 15º-20º cephalad
How is the CR positioned for an x-ray projection done with the patient placed in a decubitus position? horizontal
How long should the patient remain in position before making the exposure when performing a projection in the lateral or dorsal decubitus position? 5 min
If the lateral decubitus position is used to demonstrate fluid in the pleural cavity, which side must the patient lie on? affected side
If the lateral decubitus position is used to demonstrate air in the pleural cavity, which side must the patient lie on? unaffected side
Decsribe CR location for an AP projection Chest? Perpendicular to the sternum at a level @3” below the jugular notch on the MSP
Describe the orientation of the CR when doing an AP projection in the RT or LT lateral decubitus position? Horizontal entering at a level 3” below the jugular notch (at T7 when doing PA)
projection (lindblom metho Perpendicular to the center of the IR at the level of the midsternum
How should the arms be positioned for the lordotic position for the lung apices? Flex elbows and place dorsal surface of hands against posterior hips to roll shoulders forward
The serous membrane that lines the abdominopelvic walls is called the: peritoneum
Which organ is included in both the respiratory and digestive systems: Pharynx
What is the Prietal peritonaeum? outer layer; on abdominal wall
Which organs are contained in the abdominal cavity? •From diaphragm to superior bony pelvis •Stomach •Small intestine •Large intestine •Liver •Gallbladder •Spleen •Pancreas •Kidneys and proximal ureters
Which organs are in the pelvic cavity? •Within margins of bony pelvis •Distal portion of large intestine •Sigmoid •rectum •Urinary bladder •Reproductive organs
What is the visceral peritoneum? The inner layer of the serous membrane that actually surrounds the organs themselves and creat folds called mesentary and omentum
What is the peritoneal cavity? is the space between the two (parietal and visceral)
What fills the peritoneal cavity? Organs and serous fluid to reduce friction between moving organs
Double fold of peritoneum that loosely connecting the small intestine to the posterior abdominal wall
 mesentary
Specific type of double fold of peritoneum extending from the stomach to another organ
 Omentum
What are the 3 major muscles in the abdominal cavity? Diaphragm and RT and LT Psoas muscles
What are the Psoas Muscles? Muscle of the lower back that orginate at the spine and end at either the femur (major) or bony pelvis (minor)
The inferior costal margin is at the level of: L2/L3
The iliac crest is at the level of: L4/L5
The greater trochanter of the hip is level with the: Symphysis Pubis
T/F: A grid should be utilized for abdominal radiography. True
List steps that should be taken to eliminate motion for abdominal radiography: Make patient comfortable as possible to prevent muscle contraction Explain breathing instructions before exposure Wait 1-2 seconds after respiration phase has stopped before exposing to give viscera time to stop moving Short exposure time (peristalsis)
What is a KUB? An AP/PA projection of the abdomen. Meaning “kidneys, ureter, and bladder”
The most commonly performed abdominal examination is referred to as a: KUB
Where is the center of the IR positioned for an AP abdominal radiograph done in the supine position? iliac crests (L4/L5)
What is the respiration phase for an AP abdominal radiograph done in the supine position? expiration
The CR for an AP Projection Supine Abdomen should be: Perpendicular at the level of the iliac crests
What plane should be perpendicular and centered to the IR for the AP projection supine Abdomen Midsagittal plane
Shielding for AP supine abdomen: Males only (shielding females will cover pelvic anatomy)
Respiration phase for abdominal radiography: Suspended on expiration Waiting 1-2 seconds after to allow viseral movement to stop
If a patient is unable to stand for an upright AP abdominal radiograph to demonstrate “free air”, which position should be used? left lateral decubitus
If a patient is unable to stand for an upright AP abdominal radiograph or turn on their side for a lateral decubitus to demonstrate free air, which position should be used? Dorsal Decubitus
Where is the center of the IR positioned for an AP abdominal radiograph to include the diaphragm done in the upright position? 2 to 3” inches above the iliac crests to include the diaphragm (top of IR at the Axilla)
What is the respiration phase for an AP or PA abdominal radiograph done in the upright position? Suspended at the end of expiration
It is often necessary to demonstrate small amounts of intraperitoneal gas in patients with an acute abdomen. How long should the patient lay in the left lateral position before the radiograph is made? Ideally, 10-20 minutes At least 5 for large Pneumoperitoneum And 20 for small
Which plane should be perpendicular and centered to the IR for upright AP/PA abdominal radiography? Midsagittal
Which abdominal projections require a horizontal beam? AP/PA projection upright AP/PA projection Left lateral decubitus Lateral projection dorsal decubitus
Which plane is placed perpendicular to the long axis of the grid for a lateral projection of the abdomen? midcoronal
Where is the center of the IR positioned for a lateral projection of the abdomen done in the dorsal decubitus position to include the diaphragm? 2 to 3 inches superior the iliac crests
CR location for a lateral projection dorsal decubitus position abdomen to include the diaphragm? Horizontal, entering midcoronal plane 2 to 3” above the iliac crest
Created by: paigeduh