Chest Radiography Quiz
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Questions and Answers

Why is inspiration crucial in a chest radiograph?

  • It improves exposure factor consistency.
  • It prevents lung markings from appearing white. (correct)
  • It allows complete visualization of soft tissues.
  • It helps in assessing the vascular structures more accurately.

What effect does the Valsalva maneuver have during chest imaging?

  • It enhances the visibility of pulmonary structures.
  • It compresses the heart and blood vessels. (correct)
  • It reduces the intrapulmonary pressure.
  • It stabilizes the heart position for imaging.

What is the recommended kVp range for adult chest radiography?

  • 125-140
  • 80-90
  • 110-125 (correct)
  • 90-100

What is the consequence of decreasing kVp in chest X-rays?

<p>It obscures vascular details. (A)</p> Signup and view all the answers

What is essential to minimize during chest X-ray exposure?

<p>Short exposure time. (B)</p> Signup and view all the answers

How does AEC (Automatic Exposure Control) benefit chest imaging?

<p>It ensures consistent image density for follow-up studies. (D)</p> Signup and view all the answers

Which factor must be controlled to avoid compromising image quality in chest radiographs?

<p>Exposure time. (A)</p> Signup and view all the answers

Why is reducing mAs important in chest X-rays?

<p>To decrease the risk of heart stoppage. (B)</p> Signup and view all the answers

Which of the following is a symptom of empyema?

<p>Chest pain, worse on inspiration (B)</p> Signup and view all the answers

What transformation occurs in the alveoli due to toxic fume exposure?

<p>They become larger air-filled spaces called bullae. (B)</p> Signup and view all the answers

What causes empyema to appear as a mass on radiographic images?

<p>Loculated nature of infection (C)</p> Signup and view all the answers

What significant effect does emphysema have on the lungs?

<p>Decreased surface area for gas exchange. (C)</p> Signup and view all the answers

What is a common cause of emphysema?

<p>Heavy cigarette smoking (C)</p> Signup and view all the answers

Which treatment method is used for draining empyema?

<p>Needle aspiration under fluoroscopy (C)</p> Signup and view all the answers

What is a common symptom of emphysema?

<p>Chest tightness. (D)</p> Signup and view all the answers

What change in appearance can be seen in advanced stages of emphysema when performing a radiographic examination?

<p>Increase in vascular lung markings. (D)</p> Signup and view all the answers

How do the symptoms of emphysema relate to lung function?

<p>They suggest airway obstruction and trapped air (C)</p> Signup and view all the answers

What is the best position for diagnosing a small pleural effusion?

<p>Lateral decubitus position (A)</p> Signup and view all the answers

What happens to the heart as the lungs become less efficient in emphysema?

<p>The heart tries to compensate and may become enlarged. (C)</p> Signup and view all the answers

When suspecting pleural effusion, by how much should mAs be increased?

<p>35% (D)</p> Signup and view all the answers

Which of the following conditions can lead to emphysema in young adults?

<p>Hereditary disorders like osteogenesis imperfecta (B)</p> Signup and view all the answers

What distinguishes empyema from a simple pleural effusion on imaging?

<p>Empyema contains solid debris (B)</p> Signup and view all the answers

What is indicated by the presence of bullae in emphysema?

<p>They can compress normal lung tissue. (B)</p> Signup and view all the answers

Which symptom is NOT commonly associated with pleural effusion?

<p>Fever (A)</p> Signup and view all the answers

What treatment is available for emphysema?

<p>Treatments to relieve symptoms and prevent progression. (D)</p> Signup and view all the answers

What is a potential complication of untreated empyema?

<p>Pulmonary fibrosis (A)</p> Signup and view all the answers

What happens to a pleural effusion in cases of fibrosis?

<p>It becomes fixed and mimics a solid mass (B)</p> Signup and view all the answers

What happens to pleural effusion fluid in a supine position?

<p>It appears as a homogeneous graded increase in density (A)</p> Signup and view all the answers

What radiographic appearance is associated with subcutaneous emphysema?

<p>Streaks of lucency outlining muscle bundles. (C)</p> Signup and view all the answers

How can small pleural effusions be misdiagnosed?

<p>As pleural thickening and fibrosis (A)</p> Signup and view all the answers

Which statement about the costophrenic angles is TRUE when considering pleural effusion?

<p>They are deeper posteriorly than laterally. (D)</p> Signup and view all the answers

What is the primary treatment for pleural effusion?

<p>Thoracentesis to remove fluid (A)</p> Signup and view all the answers

What is the primary cause of chronic bronchitis in 90% of cases?

<p>Cigarette smoking (D)</p> Signup and view all the answers

Which radiographic appearance is most often associated with chronic bronchitis?

<p>Hyper inflated lungs and depressed diaphragm (D)</p> Signup and view all the answers

What is a common sign seen on a chest X-ray of a patient with chronic bronchitis?

<p>Parallel line shadows known as tram lines (B)</p> Signup and view all the answers

What factor primarily contributes to the severity of chronic bronchitis?

<p>Number of cigarettes smoked (D)</p> Signup and view all the answers

Which of the following conditions is NOT a cause of the obstructive process leading to COPD?

<p>Asthma (B)</p> Signup and view all the answers

What effect does chronic bronchitis have on the airways over time?

<p>Narrowing of the airways (C)</p> Signup and view all the answers

Which environmental factor is a known predisposition to developing COPD?

<p>Cigarette smoking (C)</p> Signup and view all the answers

What can long-term use of steroids lead to in patients with chronic bronchitis?

<p>Osteopenia of the anterior ribs (C)</p> Signup and view all the answers

What is the primary cause of atelectasis?

<p>Air obstruction in the bronchus (C)</p> Signup and view all the answers

Which of the following radiographic signs indicates atelectasis?

<p>Elevated hemidiaphragm (A)</p> Signup and view all the answers

What is the main treatment goal for atelectasis?

<p>Removing secretions and re-expanding lung tissue (D)</p> Signup and view all the answers

Which condition is also referred to as 'shock lung'?

<p>Acute Respiratory Distress Syndrome (ARDS) (B)</p> Signup and view all the answers

What can cause acute respiratory distress in patients without major underlying disease?

<p>Severe pulmonary infections (A)</p> Signup and view all the answers

What is a common radiographic appearance of acute respiratory distress syndrome?

<p>Patchy areas of alveolar consolidation (D)</p> Signup and view all the answers

Which of the following is a common method for treating intrabronchial foreign bodies?

<p>Expectoration (C)</p> Signup and view all the answers

Where do most intrabronchial foreign bodies typically lodge?

<p>In the right bronchus (C)</p> Signup and view all the answers

What can lead to hypoxemia in Acute Respiratory Distress Syndrome?

<p>Excess fluid in the lungs (D)</p> Signup and view all the answers

Which technique increases lung volume and assists with re-expansion in atelectasis treatment?

<p>Incentive spirometry (C)</p> Signup and view all the answers

What is a consequence of malpositioned endotracheal tubes?

<p>Hyperlucency of the right lung (A)</p> Signup and view all the answers

Which of the following factors does NOT contribute to the development of atelectasis?

<p>Viral infections (D)</p> Signup and view all the answers

What anatomical effect occurs due to complete obstruction of a major bronchus?

<p>Trapped air causing atelectasis (D)</p> Signup and view all the answers

What is the effect of pneumonia in ARDS?

<p>Role in fluid leakage into lung spaces (D)</p> Signup and view all the answers

Flashcards

Chest X-ray Positioning

Proper positioning and exposure factors are critical for chest X-rays, preventing rotation and ensuring consistent image quality for accurate diagnosis.

Inspiration in Chest X-rays

Two full inspirations are crucial for chest X-rays to visualize lung markings, avoiding the Valsalva effect and its impact on heart and blood vessel size.

kVp in Chest X-rays

Higher kVp (110-125) in adult chest X-rays ensures a wide range of density visualization in the thoracic cavity.

mAs in Chest X-rays

Lower mAs in chest X-rays reduces overall density, preventing overexposure while still capturing vital vascular details.

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Short Exposure Time in Chest X-rays

Short exposure times in chest X-rays are essential for reducing motion blur, especially from the heart's involuntary movement.

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AEC in Chest X-rays

Automatic Exposure Control (AEC) is recommended in chest X-rays to ensure consistent image density for repeat radiographs and follow-up.

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Follow-up studies

Following-up chest x-rays using the same technique helps to compare and contrast findings.

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Valsalva Effect

The Valsalva effect is a forced exhalation against a closed glottis, causing increased intrapulmonary pressure that compresses the heart and blood vessels, making evaluation of their size and condition difficult.

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Pleural Effusion

A buildup of fluid in the pleural space (the space between the lungs and the chest wall).

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Costophrenic Angle Blunting

A characteristic radiographic sign of pleural effusion, where the sharp angle formed by the rib and diaphragm is rounded or dull due to fluid.

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Diagnosis of small pleural effusion

Requires lateral decubitus x-ray position and a horizontal x-ray beam.

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Decubitus position

A patient lying on their side for an x-ray to help locate fluid in the chest cavity. It visualizes fluid on that side of the patient.

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Loculated Pleural Effusion

A pleural effusion with fluid collections that are not uniformly distributed.

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Thoracentesis

A procedure for removing fluid from the pleural cavity.

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Imaging for Pleural Effusion

Chest x-ray (AP/PA) and decubitus views are necessary to diagnosis. Use ultrasound to guide the procedure.

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Symptoms of Pleural Effusion

Shortness of breath (SOB), sharp chest pain, cough, rapid breathing, and sometimes asymptomatic.

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Empyema

A collection of pus in the pleural space (the area between the lungs and chest wall).

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Empyema Cause

Empyema can follow infections (like pneumonia), thoracic surgery, or trauma.

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Empyema Symptoms

Empyema symptoms include chest pain (especially worse when breathing in), dry cough, fever, and shortness of breath.

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Empyema Diagnosis

Empyema radiographically resembles a pleural effusion, but it can also appear as a mass (which locates and enlarges).

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Emphysema Cause

Emphysema is often linked to smoking, chronic bronchitis, air pollution, or respiratory irritants.

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Emphysema Mechanism

Emphysema damages the airways, trapping air and causing breathing difficulty.

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Emphysema Symptoms

Emphysema causes breathing difficulties and sometimes a popping sound.

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Emphysema Risk Factors

Genetic factors and long-term exposure can also cause emphysema in young adults.

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COPD

A group of lung diseases that cause airflow obstruction and breathing difficulties. It's often caused by long-term exposure to irritants like cigarette smoke.

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Chronic Bronchitis

A condition where the bronchi become inflamed, causing persistent coughing with mucus production. Smoking is a major contributor.

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What causes Chronic Bronchitis?

Chronic bronchitis is often caused by long-term exposure to irritants like cigarette smoke, air pollution, and respiratory infections.

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Radiographic Appearance of Chronic Bronchitis

Chest X-rays may show hyperinflated lungs, a flattened diaphragm, and increased bronchovascular markings ('dirty chest').

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Tram Lines

Parallel line shadows on chest X-ray that indicate thickening of bronchial walls, a sign of chronic bronchitis.

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What is the X-ray appearance of Chronic Bronchitis?

Chronic bronchitis can show hyper inflated lungs, a depressed diaphragm, increased bronchovascular markings, and thickened bronchial walls.

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How does cigarette smoking relate to Chronic Bronchitis?

Cigarette smoking is a major risk factor for chronic bronchitis. The severity of the disease and its progression can be directly linked to the amount of cigarettes smoked.

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Bullae

Large air-filled spaces in the lungs that result from emphysema, where the walls between alveoli have been destroyed.

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What happens to the diaphragm in emphysema?

The diaphragm flattens due to the overinflation of the lungs, affecting the normal dome shape.

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How does emphysema affect lung markings?

They become more prominent and irregular, creating a 'dirty chest' appearance on radiographs.

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Technical factor adjustment in emphysema

kVp should be decreased by 8% due to the increased air trapping and overall radiolucency in the lungs of patients with emphysema.

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Subcutaneous emphysema

A condition where air escapes into the tissues surrounding the lungs, often caused by trauma or procedures.

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Crepitation

A crackling sound or sensation felt when palpating the skin due to subcutaneous emphysema.

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Radiographic appearance of subcutaneous emphysema

Streaks of lucency outlining muscle bundles, appearing bizarre on X-rays.

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Atelectasis

A condition where there is less air in parts of the lung, leading to reduced lung volume.

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Causes of Atelectasis

Atelectasis can be caused by things like a blocked airway (bronchus), foreign objects, or complications from surgery.

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Radiographic Appearance of Atelectasis

Atelectasis shows up on X-rays as denser areas in the lungs, shifted lung structures, and an elevated diaphragm.

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Incentive Spirometry

A treatment for atelectasis that helps expand the lungs by using positive pressure.

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ARDS

A serious lung condition with sudden onset of severe respiratory distress, often happening in patients with other illnesses.

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Causes of ARDS

ARDS can be caused by various factors like trauma, infections, aspiration, or drug overdose.

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Radiographic Appearance of ARDS

ARDS shows up on X-rays as patchy, cloud-like areas of consolidation in both lungs.

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Hypoxemia

A condition where the blood has low oxygen levels.

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Intrabronchial Foreign Body

A foreign object stuck in the airway, commonly seen in children.

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Radiographic Appearance of Intrabronchial Foreign Body

A foreign body in the airway shows up as trapped air, collapsed lung tissue, and shifted lung structures.

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Endotracheal Tube

A tube inserted into the windpipe to help with breathing.

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Malpositioned Endotracheal Tube

An endotracheal tube that is not placed correctly, potentially causing lung damage.

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Diffuse Lung Disease

A broad term for diseases affecting the lungs, often causing widespread damage.

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Study Notes

Chest Pathologies

  • Proper positioning and correct exposure factors are crucial when taking chest radiographs to ensure accurate diagnosis. Consistent exposure factors are vital for follow-up studies.
  • Inspiration is essential for chest radiographs. Two full inspirations are needed to achieve maximum inspiration and avoid the Valsalva effect.
  • The Valsalva maneuver (forced expiration against a closed glottis) increases intrapulmonary pressure, compressing the heart and blood vessels, making accurate assessment difficult.
  • Chest X-rays require a wide contrast scale (kVp 110–125) to visualize the entire density spectrum within the thoracic cavity. Lowering kVp enhances bony structures but can obscure vascular details.
  • To ensure consistent image density, Automatic Exposure Control (AEC) is often recommended in chest radiography, but a manual technique may be needed for some special cases.

Disorders of the Pleura

  • Pleural effusion, pneumothorax, and empyema are pleural disorders.
  • Pleural effusion is an excess of fluid in the pleural cavity. Causes can include congestive heart failure, pulmonary embolism, infection (e.g., TB), pleurisy, neoplastic disease, connective tissue disorders, trauma, abdominal disease.
  • Radiographic appearance of small pleural effusions is best visualized on a lateral projection due to deeper posterior costophrenic angles. Larger effusions may not be immediately obvious on AP/PA views.

Pleural Effusion

  • Early findings of pleural effusion include blunting of the costophrenic angles and an upward concave border of fluid.
  • Small pleural effusions are best viewed on a lateral decubitus projection, to allow the fluid to accumulate at the base of the lung.
  • Thoracentesis is a treatment option to remove fluid from the pleural cavity.

Pneumothorax

  • Pneumothorax is the presence of air in the pleural cavity, potentially leading to lung collapse.
  • Common causes include rupture of subpleural bullae, complications of emphysema, spontaneous occurrence in otherwise healthy young adults, trauma (rib fractures, stabbing, gunshot wounds), complications of procedures like lung biopsies or thoracentesis.
  • Radiographic findings include a hyperlucent area where pulmonary markings are absent, demonstration of the visceral pleural line, potential for collapse of an entire lung, sometimes accompanied by diaphragm depression.
  • Placement of the patient in an upright position facilitates visualization on routine chest radiographs.
  • Tension pneumothorax, a more severe form, is a medical emergency requiring immediate treatment.

Tension Pneumothorax

  • Tension pneumothorax is a potentially life-threatening condition in which air enters the pleural space but can't escape, leading to increasing pressure.
  • It causes shifting of the heart and mediastinal structures, significant cardiac compromise, and venous return decrease.
  • Treatment often involves relieving the pressure buildup via a chest tube.
  • Common symptoms include difficulty breathing, sudden and severe chest pain, and shortness of breath.

Spontaneous Pneumothorax

  • This condition occurs unexpectedly.
  • Idiopathic cases, where the cause isn't apparent, are common.

Intrabronchial Foreign Bodies

  • Objects lodged in the bronchi can create an obstruction.
  • A diagnosis is often accompanied by X-ray image analysis. In the image, some objects will be seen and others wont.
  • The blockage often results in trapped air, alveolar collapse, and atelectasis of the affected lung lobe.
  • Common sites for blockage are the lower lobes, and the right side usually more than the left.
  • Treatment may include expectoration (coughing up the object), bronchoscopy, or, in some cases, surgery.

Acute Respiratory Distress Syndrome (ARDS)

  • ARDS is a severe and potentially life-threatening condition that involves fluid accumulating in the alveoli and interstitial spaces of the lungs.
  • Common causes include severe pulmonary infection, aspiration of foreign material, and other medical conditions.
  • Characteristic radiographic findings in ARDS show ground glass opacities or patchy alveolar consolidation distributed throughout both lungs.

Emphysema

  • A chronic obstructive lung disease.
  • Characterized by the enlargement of air sacs (alveoli) and destructive changes in the lung tissue.
  • Smoking and long-term exposure to irritants are common causes.
  • Radiographic findings include overinflation of the lungs, flattening of the diaphragm, increased size & lucency of retro-sternal space. Cystic spaces may be found, particularly in advanced emphysema, with distorted vascular markings giving a "dirty chest" appearance.

Subcutaneous Emphysema

  • Characterized by air in the subcutaneous tissue.
  • Often follows blunt or penetrating chest injuries and will show on a X-ray image.

Atelectasis

  • A collapse of all or part of a lung.
  • Causes of lung collapse include bronchial obstruction (e.g., a foreign body, tumor), external compression (tumors or fluid buildup), or reduced lung volume.
  • Radiographic findings include local increase in lung density which may or may not be extensive.

Bronchiectasis

  • Results in permanent abnormal dilation of one or more bronchi.
  • Due to the destruction of bronchial wall structure and the muscular component of that wall.
  • Common causes include chronic bronchitis, acute pneumonia, and conditions that weaken the body's immune system.
  • Radiographic findings may include coarseness and loss of definition in interstitial lung markings, cystic spaces up to 2 cm in diameter, and fluid levels.

Chronic Bronchitis

  • Causes chronic inflammation of the bronchi.
  • Key features include a persistent cough with sputum production.
  • Contributing factors include respiratory infections and long-term exposure to irritants such as air pollution or cigarette smoke.
  • X-ray imaging findings may include hyperinflated lungs, a flattened diaphragm, and thickening of bronchial walls creating parallel "tram lines" in an X-ray image.

Asthma

  • Asthma is marked by narrowing of the airways.
  • Causes can include, and are not limited to allergies (house dust, pollens, molds), and other irritants.
  • X-ray imaging in the early phases of disease may show no abnormalities, but in the acute phase, findings can include increased volume within the hyperlucent lungs, flattening of the hemidiaphragms, and increased retrosternal air space.

Comparing Sharp Edges

  • Highlighted comparison of normal and abnormal X-ray image features.

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Chest Pathologies 1 PDF

Description

Test your knowledge on key concepts in chest radiography. This quiz covers essential techniques, equipment settings, and the effects of various maneuvers during imaging. Perfect for students and professionals seeking to enhance their understanding of chest X-ray procedures.

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