egans ch 21 pt.1

What lung problem can a ventilation/perfusion ( ) scan be used to detect?

a.Asthma

b.Pulmonary embolism

c.Pneumonia

d.Lung cancer

b. Pulmonary embolism

What structures will result in the most radiopaque shadow on the chest radiograph?

a.Aorta

b.Heart

c.Lungs

d.Ribs

d. Ribs

The right heart shadow is not visible on your patient's chest radiograph. What pathologies may explain this?

a.Right middle lobe pneumonia

b.Right lung pneumothorax

c.Bilateral emphysema

d.Bleb in the right lower lobe

a. Right middle lobe pneumonia

In what situations is obtaining a chest radiograph least useful?

a. Following intubation

b. Following placement of a central venous pressure line

c. When the static pressure drops by 2 cm H2O during CMV

d. When the patient's oxygenation status deteriorates for no known reason

c. When the static pressure drops by 2 cm H2O during CMV

In what pulmonary condition does the chest radiograph often "lag behind" the clinical status of the patient?

a.Pulmonary embolism

b.Emphysema

c.Pneumonia

d.Congestive heart failure

c. Pneumonia

Which radiographic view of the chest allows the physician to read the best quality film?

a. Anteroposterior

b. Posteroanterior

c. Lateral

d. Lordotic

b. Posteroanterior

our patient just had an anteroposterior chest film taken. When you view the film, what may be a consideration?

a. The lungs may appear smaller than they really are.

b. The heart may appear less dense then it really is.

c.The ribs may appear more horizontal than normal.

d.The heart may appear larger than it really is.

d. The heart may appear larger than it really is.

What abnormality may appear to be present on the chest x-ray but is simply due to abnormal rotation of the patient during production of the film?

a.Enlarged lungs

b.Enlarged heart

c.Widened mediastinum

d.Thickened pleura

c. Widened mediastinum

What problem exists when interpreting an overexposed chest film?

a.There is difficulty in seeing the peripheral blood vessels.

b.The ribs appear wider than normal.

c.The heart shadow is blurred.

d.The lymph nodes in the mediastinum cannot be seen.

a. There is difficulty in seeing the peripheral blood vessels.

In the standard posteroanterior chest film, the heart shadow should be less than what proportion of the chest width?

a.33%

b.40%

c.50%

d.65%

c. 50%

In what condition is it not useful to use computed tomography (CT) scanning of the chest?

a.To evaluate the large vessels of the mediastinum

b.To evaluate the pleura

c.To evaluate lung masses

d.To evaluate patients with asthma

d.To evaluate patients with asthma

What diseases are typically evaluated using high-resolution CT?

1. Emphysema

2. Asthma

3. Bronchiectasis

4. Interstitial lung disease

1, 3 and 4

CT angiography is most often used to evaluate the patient for what conditions?

a.Pulmonary emboli

b.Chronic obstructive pulmonary disease

c.Congestive heart failure

d.Bilateral pneumonia

a. Pulmonary emboli

What is a major limitation of magnetic resonance imaging (MRI) of the chest?

a.Cannot visualize large vessels.

b.Cannot be used in patients with pacemakers.

c.Cannot be used to examine hilar structures.

d.Interpretation is difficult.

b. Cannot be used in patients with pacemakers.

What structures in the chest are typically examined using MRI?

1. Lung parenchyma

2. Hilar structures

3. Large vessels in the lung

4. Structures in the mediastinum

2, 3 and 4

What are the considerations regarding the use of ultrasound to image the chest?

a.It is useful to image the heart.

b.It is useful to image pleural abnormalities.

c.It is useful to image lung tissue.

d.It uses sound waves that echo back to the sensor.

c.It is useful to image lung tissue.

Blunting of the costophrenic angles seen on the posteroanterior or lateral chest film typically indicates

a.emphysema.

b.excess pleural fluid.

c.obesity.

d.rib fractures.

b.excess pleural fluid.

Which chest x-ray view is best used to identify excess pleural fluid?

a.Posteroanterior

b.Anteroposterior

c.Lateral decubitus

d.Apical lordotic

c. Lateral decubitus

What is the earliest sign of a left-sided pleural effusion on an upright chest radiograph?

a.An increased distance between the inferior margin of the left lung and the stomach gas bubble

b.Inability to see small pulmonary blood vessels over the left lower lung

c.A widened mediastinum

d.Elevation of the right hemidiaphragm

a. An increased distance between the inferior margin of the left lung and the stomach gas bubble

What does an air-fluid level in the pleural space typically indicate?

a.tension pneumothorax.

b.hydropneumothorax.

c.pleural effusion.

d.an aerobic infection.

b.hydropneumothorax.

In what condition would loculation of pleural fluid be as likely to occur?

Empyema

2. Exudative fluid

3. Hemothorax

4. Congestive heart failure

1, 2 and 3

What is indicated by the presence of gas bubbles within the pleural fluid without prior surgery or needle insertion?

a.Hemothorax

b.Pneumothorax

c.Empyema

d.CHF

b.Pneumothorax

What are the consdierations regarding the use of the chest x-ray to detect a pneumothorax?

1.An expiratory film may be best for a small pneumothorax.

2.The standard chest film is of limited use in detecting a pneumothorax.

3.The film will show a lack of vascular markings in the affected region.

4.The lung margin is often visible with a pneumothorax.

1, 3 and 4

What are the consideratioons regarding the recognition and treatment of a tension pneumothorax as seen on the chest radiograph?

1.The hemidiaphragm on the affected side will be pushed downward.

2.The mediastinum will be pushed toward the unaffected side.

3.It requires immediate insertion of a chest tube.

4.The patient should be intubated.

1, 2 and 3

What term is used to describe the shadows seen on the chest film when the alveoli fill with pus, fluid, or blood?

a.Consolidates

b.Infiltrates

c.Alveolar lesions

d.Densities

b.Infiltrates

What are the considerations regarding the visualization of air bronchograms on the chest film?_

1.They indicate fluid in the pleura.

2.They are caused by air-filled airways surrounded by consolidation.

3.They are the hallmark of alveolar consolidation.

4.They signify airspace disease.

1, 3 and 4

What are typical causes of pulmonary edema as seen on the chest radiograph?

1. Left heart failure

2. Renal failure

3. Cor pulmonale

4. Fluid overload

1, 2 and 4

What is the most common cause of cephalization as seen on the upright chest film?

a.Renal failure

b.Left heart failure

c.Hypoxemia

d.Empyema

b.Left heart failure

What term is used to describe the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs as seen on the chest film?

a.Bat's wing

b.Hilar wings

c.Butterfly wings

d.Heart wings

a. Bat's wing

How do you best describe the typical findings on a chest radiograph for a patient with interstitial lung disease?

a.Unilateral upper lobe infiltrates

b.Diffuse bilateral infiltrates

c.Diffuse pulmonary hyperinflation

d.Diffuse pleural inflammation

b.Diffuse bilateral infiltrates

What is the most common type of interstitial lung disease?

a.Asbestosis

b.Silicosis

c.Sarcoidosis

d.Scleroderma

c.Sarcoidosis

What is the most common cause of pulmonary fibrosis?

a.A virus

b.Inhaled dusts

c.Drug reaction

d.Unknown

d. Unknown

What type of imaging is most useful for diagnosing idiopathic pulmonary fibrosis?

a.Conventional chest radiography

b.CT angiography

c.HRCT

d.MRI

c. HRCT

What are the typical cause of atelectasis?

1.Abdominal surgery

2.Rib fracture

3.Hepatomegaly

4.Pleurisy

1, 2 and 4

What is the most common cause of lobar atelectasis?

a.Bronchial obstruction

b.Loss of surfactant

c.Viral pneumonia

d.Pleurisy

a. Bronchial obstruction

What are common radiographic findings seen in patients with volume loss due to atelectasis?

1. Elevation of the hemidiaphragm

2. Narrowing of the space between the ribs

3. Increase in the retrosternal airspace

4. Shift of the mediastinum

1, 2 and 4

What findings on the chest radiograph is considered a secondary sign of emphysema?

a.Flattening of the diaphragm

b.Widening of the cardiac shadow

c.Narrowing of the space between the ribs

d.Blunting of the costophrenic angle

a. Flattening of the diaphragm

What imaging technique would be most useful to determine which patients with emphysema may benefit from lung volume reduction surgery?

a.Chest HRCT

b.CT angiography

c.MRI

d.Ultrasound

a. Chest HRCT

How many solitary pulmonary nodules (SPNs) would be encountered for every 1000 routine chest radiographs?

a.1 or 2

b.10 to 15

c.30 to 40

d.80 to 100

a. 1 or 2

Radiographically, into how many compartments is the mediastinum divided?

a.Two

b.Three

c.Four

d.Five

b.Three

What is the best imaging technique for examining mediastinal masses?

a.Conventional lateral chest radiography

b.Chest CT

c.MRI

d.Ultrasound

b.Chest CT

conditions are least likely to cause pneumomediastinum?

a.Chest trauma

b.Esophageal rupture

c.Thyroid surgery

d.Pericarditis

d.Pericarditis

What is the optimal position of the endotracheal tube following intubation as seen on the chest radiograph?

a.1 to 2 cm above the carina

b.3 to 4 cm above the carina

c.5 to 7 cm above the carina

d.In the upper third of the carina

c.5 to 7 cm above the carina

What is the optimal position of the tip of an intra-aortic balloon pump?

a.2 cm above the carina

b.4 cm above the carina

c.7 cm above the carina

d.In the upper third of the carina

a. 2 cm above the carina

What are the two most common reasons for placing a chest tube?

a.Pneumothorax and pleural effusion

b.Pneumothorax and empyema

c.Hemothorax and hydrothorax

d.To place medicine in the pleural space and to withdraw excess fluid

b.Pneumothorax and empyema

A 49-year-old COPD patient arrives to the ER complaining of shortness of breath (SOB) and difficulty breathing. The physical examination reveals bilateral coarse crackles throughout the lung fields, pedal edema, and hepatomegaly. The chest x-ray shows bilateral fluffy infiltrates with a "bat's wing" configuration. What clinical condition you may suspect on this patient?

a.Acute coronary syndrome

b.COPD exacerbation

c.Hypertensive crisis

d.Left heart failure

d. Left heart failure

high-resolution CAT scan of a 62-year-old smoker has revealed several nodules on the right lung. What procedures would you suggest to assess the "malignancy" of these nodules?

a.Ultrasound tomography

b.Positron emission tomography

c.Magnetic resonance imaging

d.CAT scan angiography

b.Positron emission tomography