By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP Lone Star College: Kingwood Respiratory Care Program Review chest X-ray.

By Elizabeth Kelley Buzbee By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCPAAS, RRT-NPS, RCP

Lone Star College: KingwoodLone Star College: Kingwood

Respiratory Care ProgramRespiratory Care Program

Review chest X-rayReview chest X-ray

1. 1. In the chest x-ray of a person In the chest x-ray of a person with pneumocystis carinii with pneumocystis carinii pneumonia (PCP) one would pneumonia (PCP) one would most likely see______ because most likely see______ because this diseases progresses rapidly this diseases progresses rapidly to ARDS.to ARDS.a. lobar consolidationa. lobar consolidationb. pneumomatocelesb. pneumomatocelesc. Kerley B lines in the basesc. Kerley B lines in the basesd. left-sided effusionsd. left-sided effusionse. diffuse tiny opacities & air e. diffuse tiny opacities & air bronchogramsbronchograms

answeranswer

e. diffuse tiny opacities & air e. diffuse tiny opacities & air bronchogramsbronchograms

because this is what we see in an because this is what we see in an alveolar problem. We would see this alveolar problem. We would see this in any diffuse pneumonia or in ARDS in any diffuse pneumonia or in ARDS or IRDS. or IRDS.

2.2. In the chest X-ray of a In the chest X-ray of a person with staphylococcal person with staphylococcal pneumonia one would most pneumonia one would most likely see :likely see :

a. lobar consolidationa. lobar consolidation

b. pneumomatocelesb. pneumomatoceles

c. Kerley B lines in the basesc. Kerley B lines in the bases

d. left-sided effusionsd. left-sided effusions

e. diffuse tiny opacities and air e. diffuse tiny opacities and air bronchograms bronchograms

answeranswer

b. Pneumomatocelesb. Pneumomatoceles

a pneumomatocele is a air-filled cavity a pneumomatocele is a air-filled cavity that shows up in 24 hours or less. that shows up in 24 hours or less. They will be seen in staph They will be seen in staph pneumonia and in aspiration of pneumonia and in aspiration of hydrocarbons.hydrocarbons.

3.3.In the chest X-ray of the patient with In the chest X-ray of the patient with left sided pleuritic pain and left sided pleuritic pain and diminished LLL breath sounds, one diminished LLL breath sounds, one might expect to see:might expect to see:

a. LUL consolidationa. LUL consolidation

b. pneumomatocelesb. pneumomatoceles

c. Kerley B linesc. Kerley B lines


e. diffuse tiny opacities and air e. diffuse tiny opacities and air bronchogramsbronchograms

answeranswer


Effusions will be seen as homogenous Effusions will be seen as homogenous opacities that collect in the plural opacities that collect in the plural space in the dependent part of the space in the dependent part of the thorax. One would have dullness to thorax. One would have dullness to palpation and chest pain from the palpation and chest pain from the pluresy that would accompany the pluresy that would accompany the effusioneffusion

4. 4. Kerley B lines are seen:Kerley B lines are seen:I. when alveoli are full of fluidI. when alveoli are full of fluid

ii. when interstitial spaces are ii. when interstitial spaces are edematousedematous

iii. in tuberculosisiii. in tuberculosis

iv. in pulmonary edemaiv. in pulmonary edemaa. i and iva. i and iv

b. ii and ivb. ii and iv

c. iii onlyc. iii only

d. iii and ivd. iii and iv

answeranswer

b. ii and ivb. ii and iv

Kerley B line are short, horizontal lines Kerley B line are short, horizontal lines seen on the bases of the lung. The lines seen on the bases of the lung. The lines reflex thickened alveolar septal walls. reflex thickened alveolar septal walls.

They are seen in diffuse interstitial They are seen in diffuse interstitial disorders such as interstitial pneumonia, disorders such as interstitial pneumonia, pulmonary edema [interstitial and pulmonary edema [interstitial and alveolar filling patterns] alveolar filling patterns]

5. 5. One would see an air One would see an air bronchogram at the level of the bronchogram at the level of the RML in an area of:RML in an area of:

a. consolidationa. consolidation

b. air trappingb. air trapping

c. atelectasisc. atelectasis

d. abscessd. abscess

answeranswer

a.a. ConsolidationConsolidation

Consolidation is an alveolar filling Consolidation is an alveolar filling pattern where the air is replaced by pattern where the air is replaced by fluid. Fluid is white [opaque] on the fluid. Fluid is white [opaque] on the X-ray X-ray

Because the airway is black, we now see Because the airway is black, we now see the airway against the white the airway against the white opacitiesopacities

6.6. Persons with Persons with emphysema would most likely emphysema would most likely have the following on chest film:have the following on chest film:

a. right-sided pleural effusiona. right-sided pleural effusion b. bullea/ bleb b. bullea/ bleb

c. Kerley B linesc. Kerley B lines


answeranswer

b. bullea/ blebb. bullea/ bleb Is an air pocket, seen in serious Is an air pocket, seen in serious

airtrapping. These will be seen in airtrapping. These will be seen in empysema and COPD. empysema and COPD.

7.7. Within a few hours of the Within a few hours of the incident, a baby who has incident, a baby who has aspirated a toy would most likely aspirated a toy would most likely have have distaldistal to the obstruction: to the obstruction:


b. a cavitationb. a cavitation



e. a or c are both possiblee. a or c are both possible

answeranswer

e. a or c are both possiblee. a or c are both possible

If the baby inhales a foreign object that If the baby inhales a foreign object that completely cuts off gas flow to the completely cuts off gas flow to the lower airways, then there will be lower airways, then there will be atelectasisatelectasis

If the object only causes a ball-valve If the object only causes a ball-valve obstruction, the there can be localized obstruction, the there can be localized airtrapping below the objectairtrapping below the object

8.8. If one sees homogenous If one sees homogenous opacities in the RML & narrowed opacities in the RML & narrowed intercostal spaces overlying this intercostal spaces overlying this area, one is seeing:area, one is seeing:

a. RML consolidationa. RML consolidation

b. localized RML airtrappingb. localized RML airtrapping

c. RML atelectasisc. RML atelectasis

d. a RML massd. a RML mass

answeranswer

c. RML atelectasisc. RML atelectasisOne of the signs of atelectasis is a movement of One of the signs of atelectasis is a movement of

adjacent objects into the place where the lung adjacent objects into the place where the lung has collapsed. Ribs will be closer together has collapsed. Ribs will be closer together and fissures may move toward the atelectasisand fissures may move toward the atelectasis

While atelectasis is opaque like consolidation, While atelectasis is opaque like consolidation, there will be no air-bronchograms in there will be no air-bronchograms in atelectasisatelectasis

It is possible to have both atelectasis and It is possible to have both atelectasis and consolidation in the same patient with many consolidation in the same patient with many alveolar disordersalveolar disorders

9. 9. A thick walled opacity with an A thick walled opacity with an air/fluid interface is most likely:air/fluid interface is most likely:


b. a massb. a mass


d. abscess d. abscess

e. b or c are possiblee. b or c are possible

answeranswer


An abscess is a thick-walled opacity An abscess is a thick-walled opacity that is filled with pus. It is caused by that is filled with pus. It is caused by a necrotizing bacterial pneumonia. a necrotizing bacterial pneumonia.

If the abscess ruptures into an airway, If the abscess ruptures into an airway, we might see the air/fluid interface we might see the air/fluid interface inside the abcessinside the abcess

10. 10. A tumor compressing the RUL A tumor compressing the RUL bronchus could result in:bronchus could result in:

a. RUL abscessa. RUL abscess

b. RUL consolidationb. RUL consolidation

c. RUL atelectasisc. RUL atelectasis

d. both a and bd. both a and b

e. both b and ce. both b and c

answeranswer

e. both b and ce. both b and cJust like the F.O. a tumor compressing Just like the F.O. a tumor compressing

the airway can cause atelectasis & the airway can cause atelectasis & consolidation downstreamconsolidation downstream

If the tumor is smaller, it might cause If the tumor is smaller, it might cause a ball valve obstruction and result in a ball valve obstruction and result in a localized airtrapping and you might a localized airtrapping and you might hear a wheeze over one spot—that hear a wheeze over one spot—that will not respond to bronchodialatorswill not respond to bronchodialators

11. 11. When compared to viral pneumonia, When compared to viral pneumonia, bacterial pneumonias are more bacterial pneumonias are more associated with:associated with:

i. diffuse alveolar opacities with air i. diffuse alveolar opacities with air bronchogramsbronchogramsii. localized alveolar opacities with air ii. localized alveolar opacities with air bronchogrambronchogramiii. abscessesiii. abscessesiv. cavitationsiv. cavitations

a. i, iiia. i, iiib. ii, iiib. ii, iiic. ii, iii and ivc. ii, iii and ivd. i onlyd. i only

answeranswer

c. ii, iii and ivc. ii, iii and iv

Viral pneumonias tend to be diffuse, Viral pneumonias tend to be diffuse, while bacterial pneumonias will be while bacterial pneumonias will be characterized by local problems such characterized by local problems such as abscesses, effusions or cavitationsas abscesses, effusions or cavitations

12. 12. Immediately after drainage of a small right-sided Immediately after drainage of a small right-sided empyema by needle aspiration, a AP chest film is empyema by needle aspiration, a AP chest film is ordered. You see an area of hyperlucency without ordered. You see an area of hyperlucency without lung markings in the RUL. The heart shadow is lung markings in the RUL. The heart shadow is almost completely to the left of the sternum. What almost completely to the left of the sternum. What has happened?has happened?

a. the needle has successfully aspirated the fluid a. the needle has successfully aspirated the fluid from the from the empyemaempyema

b. the needle was too small, the fluid is too thick and b. the needle was too small, the fluid is too thick and the the aspiration attempt was not successful. A chest tube aspiration attempt was not successful. A chest tube must be must be inserted.inserted.

c. the needle has punctured the lung and a tension c. the needle has punctured the lung and a tension pneumothorax has resultedpneumothorax has resulted

answeranswer

c. the needle has punctured the lung c. the needle has punctured the lung and a tension and a tension pneumothorax has pneumothorax has resultedresulted

The heart has shifted, and the The heart has shifted, and the hyperlucencyhyperlucency is air in the chest. This is air in the chest. This is a common hazard of thoracentesis. is a common hazard of thoracentesis.

All procedures involving a needle and All procedures involving a needle and the chest must be followed by a chest the chest must be followed by a chest x-ray to rule out pneumothorax x-ray to rule out pneumothorax

13. 13. Immediately after the insertion of a Immediately after the insertion of a flow directed pulmonary artery flow directed pulmonary artery catheter, a chest film is ordered. You catheter, a chest film is ordered. You see a radiopaque line enter the right see a radiopaque line enter the right subclavian vein and you see that the subclavian vein and you see that the tip of the catheter is in the right tip of the catheter is in the right atrium.atrium.

a. the catheter has migrated into the wedged a. the catheter has migrated into the wedged positionposition

b. the catheter is not inserted far enoughb. the catheter is not inserted far enough

c. the catheter is in the proper positionc. the catheter is in the proper position

d. the catheter has transected the right d. the catheter has transected the right subclavian veinsubclavian vein

answeranswer

c b. the catheter is not inserted far c b. the catheter is not inserted far enoughenough

The RA is an excellent position for a The RA is an excellent position for a central line but the pulmonary artery central line but the pulmonary artery catheter should sit in the pulmonary catheter should sit in the pulmonary arteryartery

1414. Immediately after a right-sided chest . Immediately after a right-sided chest tube has been removed from the 3rd tube has been removed from the 3rd intercostal space in the anterior, a intercostal space in the anterior, a chest film is ordered. You see that chest film is ordered. You see that there are lung markings from the hilar there are lung markings from the hilar down to the pleura in the right apical down to the pleura in the right apical area. This probably means that:area. This probably means that:

a. the effusion has returned, the chest tube may a. the effusion has returned, the chest tube may need to be reinserted.need to be reinserted.

b. the pneumothorax has returned, the chest b. the pneumothorax has returned, the chest tube may need to be reinserted.tube may need to be reinserted.

c. there in now a pulmonary infarction in this arec. there in now a pulmonary infarction in this are

d. the pneumothorax has resolvedd. the pneumothorax has resolved

answeranswer

d. the pneumothorax has resolvedd. the pneumothorax has resolved

You want to see lung markings all the way You want to see lung markings all the way to the plural. We know that the most to the plural. We know that the most common site for a chest tube to drain a common site for a chest tube to drain a pneumothorax is in the anterior upper pneumothorax is in the anterior upper chestchest

15. 15. Signs of cardiogenic pulmonary Signs of cardiogenic pulmonary edema include the following:edema include the following:

i. Kerley B linesi. Kerley B lines ii. cardiomegalyii. cardiomegalyiii. increased opacities in the hilar area, in a iii. increased opacities in the hilar area, in a butterfly patternbutterfly patterniv. segmental airtrappingiv. segmental airtrapping

a. i, ii, iii and iva. i, ii, iii and ivb. ii, iii onlyb. ii, iii onlyc. i, ii onlyc. i, ii onlyd. i, ii, iiid. i, ii, iii

AnswerAnswer

d. i, ii, iiid. i, ii, iii

In all pulmonary edema we will see In all pulmonary edema we will see alveolar filling patterns and thickened alveolar filling patterns and thickened alveolar septal walls, but if the heart alveolar septal walls, but if the heart is enlarged, it is cardiogenic is enlarged, it is cardiogenic pulmonary edemapulmonary edema

Another sign it is cardiogenic is the Another sign it is cardiogenic is the butterfly pattern [or bat wing] created butterfly pattern [or bat wing] created by engorged pulmonary arteriesby engorged pulmonary arteries

16. 16. Air bronchograms are seen in Air bronchograms are seen in cases of alveolar consolidation, cases of alveolar consolidation, because the opacity of the because the opacity of the consolidation creates a contrast consolidation creates a contrast to the radiolucency of the airway to the radiolucency of the airway as it lies over the area of as it lies over the area of consolidation.consolidation.

a. truea. true

b. falseb. false

AnswerAnswer

a. truea. true

Just like a black cat disappears in a Just like a black cat disappears in a dark room, we don’t normally see the dark room, we don’t normally see the black airways against black [air black airways against black [air filled] alveoli filled] alveoli

if the alveoli are filled with fluid we if the alveoli are filled with fluid we now see the black airways against now see the black airways against the opaque the opaque

17.17.Diffuse lesions of tiny opacities Diffuse lesions of tiny opacities of less than 4 mm in diameter of less than 4 mm in diameter are seen in varicella pneumonia. are seen in varicella pneumonia. This is also seen inThis is also seen in::

a.a. diffuse pulmonary tuberculosisdiffuse pulmonary tuberculosis

b.b. multiple fat embolimultiple fat emboli

c. ARDSc. ARDS

d. no other lung disorderd. no other lung disorder

AnswerAnswer

a.a. diffuse pulmonary tuberculosisdiffuse pulmonary tuberculosis

When one has dissiminated TB, there When one has dissiminated TB, there are tiny opacities that look like are tiny opacities that look like millet seeds. This is seen in chicken millet seeds. This is seen in chicken pox pneumonia also…very bad signpox pneumonia also…very bad sign

18. 18. It is not possible for one to It is not possible for one to have a combination of diffuse have a combination of diffuse interstitial and alveolar filling interstitial and alveolar filling patterns in the same patient patterns in the same patient who is diagnosed with non-who is diagnosed with non-cardiogenic pulmonary edema.cardiogenic pulmonary edema.

a. truea. true

b. falseb. false

AnswerAnswer

FalseFalse Because both interstitial and alveolar Because both interstitial and alveolar

filling patterns are seen in problems filling patterns are seen in problems with the alveoli, you can have both with the alveoli, you can have both show up in the X-ray. These persons show up in the X-ray. These persons will have low compliant lungs and will have low compliant lungs and refractory hypoxemia refractory hypoxemia

1919. A person who has flattened . A person who has flattened diaphragms with wide intercostal diaphragms with wide intercostal spaces and bronchial thickening spaces and bronchial thickening would most likely have:would most likely have:a. emphysemaa. emphysema

b. bilateral pneumothoraxb. bilateral pneumothorax

c. bilateral effusionsc. bilateral effusions

d. a lobectomyd. a lobectomy

e. pulmonary infarction e. pulmonary infarction

AnswerAnswer

a. emphysemaa. emphysema

the intercostal spaces are widened by the intercostal spaces are widened by airtrapping, the bronchial walls are airtrapping, the bronchial walls are thickened by secretions and the thickened by secretions and the diaphragm has been pushed down by diaphragm has been pushed down by the airtrappingthe airtrapping

20. 20. The mediastinal structures The mediastinal structures tend to shift towards a tend to shift towards a ::a. pneumothoraxa. pneumothorax

b. an area of airtrappingb. an area of airtrapping

c. an area of atelectasis c. an area of atelectasis

d. an area of consolidationd. an area of consolidation

e. c and de. c and d

AnswerAnswer

c. an area of atelectasisc. an area of atelectasis

Structures move away from Structures move away from pneumothorax or from airtrappingpneumothorax or from airtrapping

Nothing moves in consolidationNothing moves in consolidation

21. 21. Mr. Reese had a LLL lobectomy. Mr. Reese had a LLL lobectomy. Several months after this surgery, Several months after this surgery, one would not be surprised to find one would not be surprised to find what abnormal findings on a PA chest what abnormal findings on a PA chest film ?film ?

a. the LUL seems smaller or seems pulled to a. the LUL seems smaller or seems pulled to the rightthe rightb. the LUL seems to be larger and it's inferior b. the LUL seems to be larger and it's inferior borders seem to bulge into the space where borders seem to bulge into the space where the LLL used to be. The heart seems to be the LLL used to be. The heart seems to be more on the left than normalmore on the left than normalc. there is a hyper-lucency in the LLL and the c. there is a hyper-lucency in the LLL and the left hemi-diaphragm is depressedleft hemi-diaphragm is depressedd. there will be no changes d. there will be no changes

AnswerAnswer

b. the LUL seems to be larger and it's b. the LUL seems to be larger and it's inferior borders seem to bulge into the inferior borders seem to bulge into the space where the LLL used to be. The space where the LLL used to be. The heart seems to be more on the left than heart seems to be more on the left than normalnormal

Remember: objects move into a Remember: objects move into a vacuum when the lung is removed, vacuum when the lung is removed, the other lobes move into the area—the other lobes move into the area—the fissures will be alteredthe fissures will be altered

22. 22. When looking at a RUL When looking at a RUL pneumothorax, one would expect to pneumothorax, one would expect to see:see:

i. hyperlucency without lung markings in the i. hyperlucency without lung markings in the RUL RUL ii. hyperlucency without lung marking in a ii. hyperlucency without lung marking in a column on the right side of the heart.column on the right side of the heart.iii. the superior aspect of the RML may be iii. the superior aspect of the RML may be opaqueopaqueiv. the 3rd-5th right intercostal spaces will be iv. the 3rd-5th right intercostal spaces will be closer together than the same intercostal closer together than the same intercostal spaces on the left spaces on the left

a. i, iii onlya. i, iii onlyb. ii, iii only b. ii, iii only c. i, iv onlyc. i, iv onlyd. i, iii and ivd. i, iii and iv

AnswerAnswer

a. i, iii onlya. i, iii only

Pneumthorax always show up as Pneumthorax always show up as hyperlucencyhyperlucency

The air would push on the superior The air would push on the superior aspect of the RML so that it starts to aspect of the RML so that it starts to collapse. It will become opaque collapse. It will become opaque

23. 23. When the right hemi-diaphragm is When the right hemi-diaphragm is paralyzed, one would see what paralyzed, one would see what derangement on the PA chest film derangement on the PA chest film during the inspiratory phase?during the inspiratory phase?

a. the right hemi-diaphragm is 2 cm higher a. the right hemi-diaphragm is 2 cm higher than the leftthan the leftb. the right hemi-diaphragm is 2 cm lower than b. the right hemi-diaphragm is 2 cm lower than the leftthe leftc. the right hemi-diaphragm is 4 cm higher c. the right hemi-diaphragm is 4 cm higher than the leftthan the leftd. the right hemi-diaphragm is 4 cm lower than d. the right hemi-diaphragm is 4 cm lower than the leftthe left

AnswerAnswer

c. the right hemi-diaphragm is 4 cm c. the right hemi-diaphragm is 4 cm higher than the lefthigher than the left

– This is tricky. Remember: the normal This is tricky. Remember: the normal position for the right hemi-diaphragm is position for the right hemi-diaphragm is to be 2 cm higher than the left. When to be 2 cm higher than the left. When the diaphragm is paralyzed, it sits in the the diaphragm is paralyzed, it sits in the resting position which is up so the right resting position which is up so the right is higher than it should be.is higher than it should be.

24. 24. A homogenous opacity located A homogenous opacity located in the basal aspect of the LLL in the basal aspect of the LLL which causes the costophrenic which causes the costophrenic angle to be blunted would most angle to be blunted would most likely be a (an):likely be a (an):

a. LLL consolidationa. LLL consolidation

b. LLL atelectasisb. LLL atelectasis

c. left sided effusionc. left sided effusion

d. none of thesed. none of these

AnswerAnswer

c. left-sided effusionc. left-sided effusion

Blunting of the costophrenic angle is Blunting of the costophrenic angle is caused by fluid in the plural cavity. caused by fluid in the plural cavity. Fluid is opaque.Fluid is opaque.

25. 25. If you were to see an area in the If you were to see an area in the LUL, which you would describe as a LUL, which you would describe as a sharp and distinct round opacity you sharp and distinct round opacity you might be describing a/an:might be describing a/an:a. cavitationa. cavitation

b. pneumatoceleb. pneumatocele

c. bullae or bleb c. bullae or bleb

d. abscess without an air/fluid interfaced. abscess without an air/fluid interface

e. an abscess with an air/fluid interfacee. an abscess with an air/fluid interface

AnswerAnswer

d. abscess without an air/fluid interfaced. abscess without an air/fluid interface

Cavitations, bullae or blebs & Cavitations, bullae or blebs & pneumatoceles are all black because pneumatoceles are all black because they are filled with airthey are filled with air

2626. A mass is:. A mass is:i. a sharply demarcated homogenous i. a sharply demarcated homogenous opacityopacity

ii. a sharply demarcated hyperlucency ii. a sharply demarcated hyperlucency

iii. less than 4 cm in diameteriii. less than 4 cm in diameter

iv. more than 4 cm in diameteriv. more than 4 cm in diametera. i, iva. i, iv

b. ii, ivb. ii, iv

c. i, iiic. i, iii

d. ii, iiid. ii, iii

AnswerAnswer

b. ii, ivb. ii, iv

The only difference between a The only difference between a nodule and a mass is the size. Both nodule and a mass is the size. Both are opacities that replace normal are opacities that replace normal tissuetissue

27. 27. Wide-spread multiple nodules Wide-spread multiple nodules of less than 4 mm in diameter of less than 4 mm in diameter are called a milliary pattern.are called a milliary pattern.

a. truea. true

b. falseb. false

AnswerAnswer

TrueTrue Tiny opacities look like millet seedsTiny opacities look like millet seeds

28. 28. The presence of a single The presence of a single nodule in the lung fields is:nodule in the lung fields is:

a. never a sign of bronchogenic a. never a sign of bronchogenic carcinomacarcinoma

b. always seen in bronchogenic b. always seen in bronchogenic carcinomacarcinoma

c. is most likely not lung cancer if it is c. is most likely not lung cancer if it is calcifiedcalcified

AnswerAnswer

c. is most likely not lung cancer if it is c. is most likely not lung cancer if it is calcifiedcalcified

Single nodules may or may not be Single nodules may or may not be cancer, but they are less likely to be cancer, but they are less likely to be if they are calcifiedif they are calcified

29. 29. You view a PA upright chest You view a PA upright chest film. The heart is 12 cm wide and film. The heart is 12 cm wide and the internal diameter of the the internal diameter of the thorax is 20 cm wide.thorax is 20 cm wide.a. there is cardiomegalya. there is cardiomegaly

b. there is hepatomegalyb. there is hepatomegaly

c. the heart size is WNLc. the heart size is WNL

AnswerAnswer

A. cardiomegallyA. cardiomegally

The heart should be able to fit into The heart should be able to fit into the internal chest at the level of the the internal chest at the level of the diaphragms twice. If not, there is diaphragms twice. If not, there is cardiomegally. This is also called the cardiomegally. This is also called the CT ratio [cardiothoracic ratio] 1:2 is CT ratio [cardiothoracic ratio] 1:2 is normalnormal

30. 30. To find a mass that is pushing To find a mass that is pushing the trachea toward the anterior the trachea toward the anterior you would require a you would require a type of type of x-ray.x-ray.a. apical lordotica. apical lordotic

b. lateral chestb. lateral chest

c. bronchogramc. bronchogram

d. lateral decubitusd. lateral decubitus

AnswerAnswer


A side view would see the object that A side view would see the object that is shifted forward or backwards from is shifted forward or backwards from its normal positionits normal position

31. Normally the right hilum is at least:31. Normally the right hilum is at least:a. 2 cm higher than the lefta. 2 cm higher than the left

b. 2 cm lower than the leftb. 2 cm lower than the left

c. 5 cm higher than the leftc. 5 cm higher than the left

d. 5 cm lower than the left d. 5 cm lower than the left

answeranswer

b. 2 cm lower than the leftb. 2 cm lower than the left The left hilum is pushed up to make The left hilum is pushed up to make

room for the heartroom for the heart

32. 32. To visualize an apical mass To visualize an apical mass better one might want to see a better one might want to see a x-ray.x-ray.a. apical lordotica. apical lordotic


c. bronchogramc. bronchogram

d. lateral decubitusd. lateral decubitus

e. PA standard uprighte. PA standard upright

answeranswer

a. apical lordotica. apical lordotic This view looks up at the apical area This view looks up at the apical area

from an angle that spreads out the from an angle that spreads out the structures so that mass in the apical structures so that mass in the apical area could be seen better if it was area could be seen better if it was hidden behind somethinghidden behind something

33. Of the following x-ray densities, 33. Of the following x-ray densities, which is the MOST RADIO-LUCENT?which is the MOST RADIO-LUCENT?

a. watera. water

b. airb. air

c. bonec. bone

d. fatd. fat

e. tissuee. tissue

answeranswer

b. airb. air

Radiolucent is black, so air is the Radiolucent is black, so air is the darkestdarkest

Metal is most opaque, then heart, Metal is most opaque, then heart, then thicker fluid.then thicker fluid.

34. 34. When viewing a PA standard, When viewing a PA standard, if the sternal notch does NOT lie if the sternal notch does NOT lie over the vertebral column and over the vertebral column and the left clavicle is 2 cm higher the left clavicle is 2 cm higher than the left, the Xray is:than the left, the Xray is:

a. an example of good technique a. an example of good technique b. not well centeredb. not well centeredc. over penetratedc. over penetrated d. under-penetratedd. under-penetratede. done on exhalation, not end e. done on exhalation, not end inspirationinspiration

answeranswer

b. not well centeredb. not well centered

Like any photograph if the picture is Like any photograph if the picture is lined up right, the sternum should be lined up right, the sternum should be right over the vertebral columnright over the vertebral column

35. 35. When viewing a PA standard, if When viewing a PA standard, if the diaphragms extend only to the diaphragms extend only to the level of the 4th anterior the level of the 4th anterior intercostal space, this chest film intercostal space, this chest film is:is:a. an example of good technique a. an example of good technique b. not well centeredb. not well centeredc. over penetratedc. over penetrated d. under-penetratedd. under-penetratede. done on exhalation, not end inspiratione. done on exhalation, not end inspiration

answeranswer

e. done on exhalation, not end e. done on exhalation, not end inspirationinspiration

On a deep inspiration the diaphragm On a deep inspiration the diaphragm should be down to the level of the 6should be down to the level of the 6thth – 6– 6thth intercostal spaces intercostal spaces

36. 36. If you are unable to tell if the If you are unable to tell if the patient has suffered a patient has suffered a pneumothorax or has airtrapping pneumothorax or has airtrapping because of the general darkness because of the general darkness of the film, your x-ray is :of the film, your x-ray is :a. an example of good technique a. an example of good technique

b. not well centeredb. not well centeredc. poorly penetratedc. poorly penetrated d. a bronchogramd. a bronchograme. done on exhalation, not end inspiratione. done on exhalation, not end inspiration

answeranswer

c.c. poorly penetratedpoorly penetrated

Like any other photograph, an X-ray Like any other photograph, an X-ray can be over-exposed or under-can be over-exposed or under-exposed. Both are problems. You exposed. Both are problems. You want to be able to see the vertebra want to be able to see the vertebra through the heartthrough the heart

37. 37. The patient faces the film. The rays The patient faces the film. The rays enter from his back and the tube is enter from his back and the tube is placed at a 45 degree angle below the placed at a 45 degree angle below the patient and the film. This describe the patient and the film. This describe the following technique:following technique:a. obliquea. oblique


c. apical lordoticc. apical lordotic

d. apical decubitusd. apical decubitus

e. lateral necke. lateral neck

answeranswer

c. apical lordotic. This view is used to c. apical lordotic. This view is used to separate close structures to see separate close structures to see objects in the apical lobes betterobjects in the apical lobes better

patient X-ray

answeranswer

38. 38. To find retro-sternal air one To find retro-sternal air one would want to do a would want to do a film. film.a. obliquea. oblique




answeranswer


When the picture is taken from the side, When the picture is taken from the side, the air behind the sternum that collects the air behind the sternum that collects in airtrapping, will be seen as a in airtrapping, will be seen as a blackness just behind the breast bone. blackness just behind the breast bone.

This is responsible for creating the barrel This is responsible for creating the barrel chestchest

39. 39. To find a lung lesion hidden To find a lung lesion hidden behind a structure one could do behind a structure one could do the following:the following:a. obliquea. oblique




e. all but d could be used to find hidden e. all but d could be used to find hidden lesionslesions

answeranswer

e. all but d could be used to find e. all but d could be used to find hidden lesionshidden lesions

The lateral is from the side, the oblique The lateral is from the side, the oblique view is when the x-ray tube is moved view is when the x-ray tube is moved to the right or the left to see objects to the right or the left to see objects better & the apical lordotic spreads better & the apical lordotic spreads out the objects in the pictureout the objects in the picture

There is no such animal as the apical There is no such animal as the apical decubitusdecubitus

4040. This view is used to find free . This view is used to find free fluid in the pleural cavity.fluid in the pleural cavity.

a. lordotica. lordotic

b. obliqueb. oblique

c. lateral decubitusc. lateral decubitus

d. bronchogramd. bronchogram

e. c and de. c and d

answeranswer

c. lateral decubitusc. lateral decubitus

In a lateral decubitus, the patient lies In a lateral decubitus, the patient lies on his side and any free fluid in his on his side and any free fluid in his chest will layer out along the chest will layer out along the mattress. This layering of fluid is call mattress. This layering of fluid is call the ‘gutter’ the ‘gutter’

The picture is taken from the front.The picture is taken from the front.

41. 41. When looking at the chest film of a When looking at the chest film of a newborn infant, one must remember newborn infant, one must remember that one would normally see the that one would normally see the following:following:

a.a. there are only 10 ribsthere are only 10 ribs

b. the thymus gland is hugeb. the thymus gland is huge

c. the ribs are mostly cartilage and seem thinc. the ribs are mostly cartilage and seem thin

d. a and cd. a and c

e. b and ce. b and c

answeranswer

e. b and ce. b and c the babies bones are mostly the babies bones are mostly

cartilage so they seem thincartilage so they seem thin The thymus gland is so huge in an The thymus gland is so huge in an

infant that it looks like there are infant that it looks like there are bilateral apical opacities near the bilateral apical opacities near the midline—or that there is something midline—or that there is something wrong with the cardiac shadowwrong with the cardiac shadow

42. 42. One would want to see an end- One would want to see an end- expiratory film to look for the expiratory film to look for the following:following:a. small pneumothoraxa. small pneumothorax

b. localized airtrappingb. localized airtrapping

c. small effusionc. small effusion

d. a and bd. a and b

e. a, b and ce. a, b and c

answeranswer

d. a and bd. a and b

if the picture is taken on exhalation, if the picture is taken on exhalation, small areas of black will show up small areas of black will show up better against the general whiteness better against the general whiteness of the exhalation shotof the exhalation shot

43. 43. The injection of a contrast The injection of a contrast media into the pulmonary media into the pulmonary vasculature to observe the blood vasculature to observe the blood flow is done to diagnosis the flow is done to diagnosis the following:following:a. pulmonary embolisma. pulmonary embolism b. pulmonary artery stenosisb. pulmonary artery stenosisc. pleural effusionc. pleural effusion d. a and bd. a and be. a and ce. a and c

answeranswer

d. a and bd. a and b An angiogram used contrast media An angiogram used contrast media

to see arteries better, a venogram is to see arteries better, a venogram is used to see viens.used to see viens.

4545. Injection of tagged albumin into the . Injection of tagged albumin into the pulmonary vasculature which is pulmonary vasculature which is followed by an inhalation of a couple followed by an inhalation of a couple of breaths of a xenon gas to create a of breaths of a xenon gas to create a "dot matrix" type of a picture is a "dot matrix" type of a picture is a description of what type of description of what type of radiographic technique:radiographic technique:a. bronchograma. bronchogram

b. angiogramb. angiogram

c. CAT scanc. CAT scan

d. ventilation/ perfusion scan d. ventilation/ perfusion scan

answeranswer

d. ventilation/ perfusion scan d. ventilation/ perfusion scan A V/Q scan is used to screen for A V/Q scan is used to screen for

pulmonary emboli because the pulmonary emboli because the ventilation and the perfusion should ventilation and the perfusion should match. If there is ventilation without match. If there is ventilation without perfusion, then there is an obstruction to perfusion, then there is an obstruction to blood flowblood flow

Ventilation and perfusion both down may Ventilation and perfusion both down may only reflect the pulmonary only reflect the pulmonary vasoconstriction seen in alveolar hypoxiavasoconstriction seen in alveolar hypoxia

46. The46. The quickest, least invasive quickest, least invasive wayway to diagnosis pulmonary emboli to diagnosis pulmonary emboli is to perform the following:is to perform the following:a. bronchograma. bronchogram


c. CAT Scanc. CAT Scan


answeranswer


The V/Q scan is quick and can be done The V/Q scan is quick and can be done at the bedsideat the bedside

answeranswer

47. The procedure,most likely to be 47. The procedure,most likely to be the the most accurate methodmost accurate method to to diagnosis pulmonary embolism is to diagnosis pulmonary embolism is to perform the following: perform the following: a. bronchograma. bronchogram


c. CAT Scanc. CAT Scan

d. ventilation/ perfusion scand. ventilation/ perfusion scan

answeranswer

b. Angiogramb. Angiogram

The V/Q scan will miss about half of the The V/Q scan will miss about half of the pulmonary emboli, while the angiogram pulmonary emboli, while the angiogram will catch most of them.will catch most of them.

The angiogram involves insertion of a flow The angiogram involves insertion of a flow directed pulmonary artery catheter, so it directed pulmonary artery catheter, so it is dangerous and invasive—and is dangerous and invasive—and expensiveexpensive

Reference pageReference page

Pathological films & techniques:Pathological films & techniques: George Burton’s Respiratory Care 4George Burton’s Respiratory Care 4thth

ed.ed.

Techniques:Techniques: Wilkin’s Wilkin’s Respiratory AssessmentRespiratory Assessment

By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP Lone Star College: Kingwood Respiratory Care Program Review chest X-ray.

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