UC Differential Diagnosis Test 4 with 100- correct answers

Factors to Evaluate for Optimal CXR 1-magnification 2-angulation 3-penetration of depth of inspiration 4-rotation and centering AP heart is farther from film and more magnified; portable cxr's PA heart closer to film, less magnified; standard apical lordotic view xray beam angled toward head; anterior structures projected higher on film than posterior Penetration spine disc spaces barely visible through the heart; PA; lateral view shows spine darkening caudally Under-penetrated diffusely opaque (too white); structures behind heart are obscured and LLL pathology may be missed Over-penetrated diffusely Lucent, blacker than usual, vascular markings and lung detail poorly seen # ribs seen with excellent inspiration 10; 9 is adequate in hospitalized pts posterior ribs will run horizontal and see better on xray anterior ribs slant down, harder to see rotation is nonexistent when vertebrae is equidistant from ends of both clavicles; over 3rd rib rotation spine is pushed over to side lateral chest film find stuff not seen on frontal film; confirm Right lateral decubitus view side-lying; pleural effusions (need 200-400 ml), air-fluid levels Lordotic view upper lobes; and apices; r/o CA or TB Cardiothoraic ratio should be 1:2; >.5 suggest cardiomegaly Hila loc. of central pulmonary arteries and veins; L > R Kerley B Lines perpendicular lines to pleura; indicates excessive fluid, could be CHF; thickening of interdental lines Air Bronchogram bronchi not visible since contain air; when something of fluid density fills alveoli, air in bronchus becomes visible (pulmonary edema, blood, gastric aspirate, inflammatory exudate); look like little tubes silhouette sign 2 objects of same density touch and can't see edge of either; when water density obliterates existing interface; differentiate anterior from posterior on frontal films and R and L lateral films alveolar infiltrates fluffy white clouds in alveoli; PULMONARY EDEMA interstitial infiltrates small, well-defined, reticular (net-like) nodular opacities due to fibrosis, fluid, or inflammatory by-products, honeycombing