Egan’s Chapter 20 Practice Questions:


1. Four tissue densities: Air, fat, soft tissue/water density, bone

2. Air bronchograms: Air-filled airways surrounded by infiltrates from filling of surrounding alveoli

3. Air-fluid level: Straight, level border with air above in hydropneumothorax

4. Air in anterior cardiophrenic sulcus: Does not create a visible edge between pleura & x-rya beam

5. Air is radiolucent/radiopaque: Radiolucent

6. Airspace disease: Infiltrates filling alveoli

7. Alternate name for radiograph: Roentgenogram

8. AP view is taken with: Portable x-ray

9. AP view positioning: X-ray source in front, Film behind patient’s back

10. Are x-rays used in MRI?: No

11. Atelectasis often happens…: Post-op after abdominal/thoracic surgery. After pleurisy or pleural irritation from rib fracture/pulmonary infarction

12. Bacterial pneumonia: Alveoli are filled with exudative fluid with numerous WBCs (pus)

13. Barotrauma: From positive pressure ventilation

14. Bat’s wing appearance: Predominance of edema in hilar regions with less edema in peripheral areas

15. Best film for detecting small amounts of pleural fluid: Lateral decubitus

16. Best type of imaging for mediastinum: CT scan

17. Best way to detect solitary pulmonary nodule: Chest CT scanning

18. Bleb: Gas-containing space in visceral pleural

19. Bone absorbs how much x-ray?: Large amount

20. Bone is radiolucent/radiopaque: Radiopaque

21. Can a HRCT be generated from conventional scans?: Yes

22. Cardiogenic pulmonary edema: Edema caused by vascular congestion caused by failure of the left heart

23. Causes of interstitial disease: Infectious, Occupational exposures

24. Causes of pneumothorax: Rupture of bleb, Trauma, Invasive procedure, Barotrauma

25. Causes of sarcoidosis & idiopathic pulmonary fibrosis: No known causes

26. Central line: Central venous pressure catheter placed via internal jugular veins/subclavian veins

27. Cephalization: Blood vessels to lung apices are the same size/larger than blood vessels to the base

28. Cephalization is caused by: Left-sided heart failure

29. Chest tube is placed into…: Pleural space

30. Clues favoring malignant cause of pleural effusion: Surgical absence of breast shadow, Evidence of prior axillary node dissection, Pulmonary parenchymal mass, Multiple lung masses

31. Collapsed segment in upper lobe causes: Hilum displaced upward
Minor fissure on right displaced upward

32. Color of soft tissue/water density on radiograph: Medium gray

33. Compartments of mediastinum: Anterior, Middle, Posterior

34. Components of lung parenchyma: Alveoli

35. Computed tomography angiography looks at the…: Heart

36. Conventional thickness of CT images: 3-7 mm

37. Costophrenic angle: Arch of diaphragm & chest wall meet & form a point

38. Cross table lateral radiograph: Patient lies face up while x-ray is directed across the body

39. CT scan can visualize great detail & minuscule structures how small?: 2 mm

40. Deep sulcus sign: Air accumulating anteriorly & outlining the heart border below the diaphragm dome. Upper abdomen on the same side has increased lucency.

41. Diaphragm becomes elevated on the side of a…: Atelectasis

42. Does a CT scan identify pleural fluid?: Yes, easily

43. Does an emboli show up on CT scan?: Yes

44. Does an ultrasound detect pleural effusions?: Yes, even small ones

45. Does AP view have magnification of the heart shadow?: Yes

46. Edema of ARDS: Patchy, Bilateral, Does not predominate in central hilar regions, Lacks cardiomegaly, cephalization & Kerley B lines

47. Emboli will/won’t show up on radiograph: Won’t

48. Empyema: Infection of pleural fluid, Pus in pleural space

49. Empyema appearance on CT scan: Elliptic pleural fluid collection with thickening & enhancement of surrounding pleura. Gas bubbles in fluid without surgery/needles

50. Enlarged heart may occur with: Congestive heart failure, Large pericardial effusion

51. Fat color on radiograph: Slightly darker than soft tissue

52. Features favoring benign SPN: Spherical, well-defined, central/lamellar popcorn calcification

53. Features favoring malignant SPN: Over 40 years old, smoker, larger than 3 cm, lobulated, spiculated, thick-walled, doubling time of 7-465 days, rare/usually eccentric calcification

54. Fluid build-up in alveoli causes what appearance?: Peribronchial cuffing, Kerley B lines

55. Fluid in subpulmonic location maintains a sharp costophrenic angle, hiding how much fluid?: 500 mL

56. Gantry: Examination table

57. Hallmark of infiltrates filling alveoli: Air bronchograms

58. H atoms are in…: Water, sugars, fats & amino acids

59. Heart shadow should not exceed…: 50% of thoracic diameter

60. Hemothorax: Blood in pleural space

61. Honeycombing indicates: End-stage lung disease

62. Honeycombing infiltrates: Cystic spaces with well-defined walls in lung periphery

63. Honeycombing is thought to represent: Irreversible scarring

64. How are blood vessels easily identified on ultrasound?: Compressibility of veins compared to arteries

65. How are radiograph views named?: For the path of the x-ray beam

66. How does a CT scan visualize structures?: Cross sections

67. How does MRI work?: Nuclei that have an odd number of protons & neutrons align themselves with the magnetic field & radio waves are used from realigning nuclei

68. How do you determine if the patient is properly positioned?: Spinous process midway between medial ends of clavicles & in middle of tracheal air column

69. How is a pneumothorax detected?: Thin pleural line at lung margin missing the bronchovascular markings between lung margin & inner aspect of chest wall

70. How is fluid in interlobar fissure diagnosed on chest radiograph?: Lenslike, elliptic shape on PA/lateral projection

71. How is pulmonary edema seen first?: Blurring the normally distinct walls of hilar blood vessels

72. How much fluid can be detected on lateral decubitus?: 5 mL

73. How much fluid is required to blunt costophrenic angle from pleural effusion on the frontal view?: 175-200 mL

74. How much fluid is required to blunt costophrenic angle from pleural effusion on the posterior view?: 75-100 mL

75. How much of the lung is overlaid with bone?: 80-90%

76. How much pleural fluid is normally present?: 1-8 mL

77. How to determine skin folds from pneumothorax: Look at lung margin

78. HRCT: High resolution CT scanning

79. HRCT thickness & intervals: 1 mm thick or less every 5-10 mm

80. Hydropneumothorax: Air & fluid in same space

81. Hydrothorax: Pleural effusion

82. Hyperinflation causes flattening of the…: Hemidiaphragms

83. If a pleural effusion is only on one side, it is more commonly on right/left side: Right side

84. If more than 7 anterior ribs are visible above diaphragm, what is present?: Hyperinflation

85. Increased pressure in pulmonary veins is seen as: Enlarging blood vessels to the lung apices

86. Indications for chest tube: Pneumothorax, Empyema, Hemothorax, Hydrothorax, Installing sealant, Achieve closure of pleural space

87. Infiltrates: Patchy white shadows

88. Infiltrates of interstitial disease may be: Nodular, Reticular, Honeycombing

89. Infiltrates may persist how long after symptoms have resolved?: Days-weeks

90. In MRI, blood appears: Black

91. In MRI, bone appears: Dark

92. Interstitial disease: Disease involving lower respiratory tract

93. Interstitial disease shows: Diffuse, bilateral infiltrates

94. Interstitium: Supporting structures of lung

95. Intralobular septa: Thin sheet of fibrous connective tissue

96. Is diaphragm imaged on radiograph?: Yes

97. Is the intralobular septa invisible on radiograph?: Yes

98. Kerley B lines: Edema in septa separating lobes become evidentSepta thickens. Thin lines against pleural edge running perpendicularly away from pleural edge

99. Kerley B lines often seen in what type of edema?: Cardiogenic pulmonary edema

100. Lateral decubitus: Frontal view taken as the patient lies on the side of suspected effusion

101. Loculation of pleural fluid is more common in…: Exudativ, Hemothorax, Empyema

102. Lung Interstitium: Lung that frames the airspaces & supports the vessels & bronchi

103. Mediastinum: Heart, Great vessels, Trachea, Soft tissue between lungs

104. Mediastinum shifts toward a…: Atelectasis

105. Most dense tissue density?: Bone

106. MRI: Magnetic resonance imaging

107. MRI images: Mediastinum, Large vessels in the lung, Hilar regions of the lung

108. Nodular infiltrates: Scattered, ill-defined nodules

109. Normally, airways are invisible where?: Outer 2/3 of lung

110. Nuclear medicine: Scanning radioactive material within a patient after inhalation/injection of radioisotopes

111. Nuclear medicine is used for…: V/Q scans, Positron emission tomography (PET)

112. Occasionally, fluid occupies where?: Interlobar fissure

113. Occurance of SPN: 1/2 in 1000 radiographs

114. Overpenetrated radiograph: Lung parenchyma is black (can’t visualize peripheral blood vessels/abnormalities)

115. Parietal pleura adheres to…: Inside of chest wall, Upper diaphragm, Lateral mediastinum

116. Patient is sitting/standing for PA view: Standing

117. Patient rotation makes what appearance?: Mediastinum wide, Obscures/distorts pulmonary arteries

118. Patients with long-standing heart failure have…: Enlargement of the heart or pleural effusion

119. PA view minimizes/maximizes magnification of heart: Minimizes

120. PA view positioning: Back to x-ray source, Chest against film

121. Peribronchial cuffing: Bronchial walls thicken

122. Pericardial effusion: Fluid in space around heart encased in pericardium

123. PET: Positron emission tomography

124. PET uses: Localize tumors & metastases

125. Platelike atelectasis: Localized to a subsegmental portion of lung

126. Platelike atelectasis is associated with: Ventilatory disturbance

127. Pleura can/cannot be seen on conventional chest radiograph: Cannot

128. Pleural effusion: Excessive fluid in pleural space

129. Pleural effusion is usually bilateral/unilateral: Bilateral

130. Pneumonia & a bleeding lung cause identical…: Patchy opacities that coalesce over time

131. Pneumothorax: Air in pleural space

132. Pneumothorax in supine patient may have a…: Deep sulcus sign

133. Pneumothorax pushes lung…: Away from chest wall

134. Pneumothorax usually occurs in…: Tall, thin men

135. Poor expansion of the chest causes…: Narrowing of space between ribs

136. Positioning of endotracheal tube: Midtrachea 5-7 cm above carina with head and neck in neutral position

137. Primary signs of emphysema: Loss/shifting of pulmonary vessel
Appearance of walls of bullous airspaces

138. Proper exposure should show: Intervertebral disc spaces through the shadow of the heart
Blood vessels in peripheral regions of the lungs

139. Pulmonary alveolar proteinosis: Alveoli fill with fat-rich material derived from pulmonary surfactant

140. Pulmonary edema: Alveoli are flooded with watery fluid containing few blood cells

141. Pulmonary edema is caused by: Vascular congestion, Loss of integrity of pulmonary capillaries

142. Pulmonary hemorrhage: Alveoli fill with blood

143. Pulmonary lobule: Smallest functional unit of lung

144. Pulmonary lobule contains: Alveoli & alveolar ducts built around a central pulmonary arteriole & bronchiole

145. Pulmonary lobule surrounded by: Intralobular septa

146. Radiographic signs of cardiac decompensation: Cardiac enlargement, Pleural effusion, Redistribution of blood flow to upper lobes, Poor definition to central vessels (perihilar haze), Kerley B lines, Alveolar filling

147. Radiograph may lag how long behind clinical condition?: 12-24 hours

148. Radiolucent: Black

149. Radiopaque: White

150. Reticular infiltrates: Collection of scattered lines

151. Secondary signs of pulmonary emphysema: Increased AP diameter, Enlarged retrosternal & retrocardiac airspaces, Flattening of hemidiaphragms

152. Silhouette sign: Obscuring of the margin of adjacent structures of same density

153. Situs inversus/dextrocardia: Chest/abdominal contents are reversed

154. Soft tissues: Tissues of chest wall, upper abdomen & lymph nodes

155. Soft tissue/water density absorbs how much x-ray beam?: Small amount

156. Solitary pulmonary nodule: Parenchymal opacity smaller than 3 cm in diameter surrounded by aerated lung

157. SPN: Solitary pulmonary nodule

158. SPN may be caused by: Lung cancer

159. Steps in reviewing radiograph: Identify name, Check the side, Review technique & quality, Systematically review anatomic structures

160. Structures imaged on radiograph: Bones, soft tissue, lungs, pleura, heart great vessels & mediastinum, upper abdomen, lower neck

161. Subpulmonic effusion may cause…: Slight, lateral shift of where the diaphragm dips down on frontal chest radiograph

162. Subpulmonic location: Fluid accumulates between lung & diaphragm

163. Tension pneumothorax causes…: Tracheal deviation, Hemidiaphragm pushed inferiorly, Mediastinum shifted toward opposite lung

164. Tension pneumothorax compresses…: Heart, Adjacent lung

165. Tip of central venous pressure catheter in central line should be in…: Superior vena cava

166. Tracheostomy tube size: 2/3 diameter of trachea

167. Two most common interstitial diseases: Sarcoidosis & idiopathic pulmonary fibrosis

168. Types of pleural effusion: Transudate, Exudate

169. Ultrasound is used to…: Evaluate heart & pleural fluid, Guide placement of central & arterial catheters

170. Ultrasound is useful in separating…: Pleural fluid from solid tissue

171. Underpenetrated radiograph: Branching of pulmonary arteries appear abnormal

172. Vascular congestion is caused by: Failure of left heart, Renal failure, Fluid overload

173. Visceral pleura adheres to: Surface of lung

174. Visceral pleura is thick/thin: Thin

175. Volume loss involving a whole lobe is caused by…: Cancer, Foreign body, Mucous plug

176. Volume loss involving a whole lobe is in the shape of a…: Wedge (apex at hilum, base on pleural surface)

177. Volume loss involving a whole lobe is mostly caused by: Central airway obstruction

178. Wedge of volume loss of whole lobe is visible on…: PA/lateral x-ray film

179. What absorbs the least energy?: Air

180. What absorbs less x-ray than soft tissue?: Fat

181. What allows blood vessels to be distinguished from soft tissue in CT scan?: Injection of iodinated contrast material which makes blood denser/radiopaque/white

182. What assesses correct endotracheal tube position?: Radiographs bedside after intubation

183. What atoms are mostly affected in MRI?: H atoms

184. What can help diagnose pneumothorax in supine patient?: Decutibus or cross table lateral radiograph

185. What can help diagnose pneumothorax when it is difficult due to bullous emphysema?: CT scan

186. What can mimic a pneumothorax?: Skin folds

187. What could abnormal branching of pulmonary arteries from underpenetration be misinterpreted as?: Interstitial infiltrates

188. What does a CT scan evaluate?: Lung nodules/masses, Great vessels of the chest, Mediastinum, Pleural disease

189. What do you assess first on lung evaluation?: Size & density

190. What factors do you assess in a radiograph?: Labeled?, PA/AP?, Structures cut off?, Properly positioned?, Optimal settings?

191. What film helps clarify lung abnormalities?: Lateral

192. What indicates end of endotracheal tube?: Radiopaque/opaque marker

193. What indicates good inspiratory effort for a good-quality chest film?: Visualization of 6 anterior/10 posterior ribs above diaphragm

194. What is imaged pertaining to lungs?: Trachea, bronchi, lung tissue/parenchyma

195. What is the first sign of a left-sided pleural effusion on upright chest radiograph?: Increased distance between inferior margin of left lung & stomach gas bubble

196. What radiograph should you obtain for pneumothorax?: Upright during exhalation

197. What rib should project above diaphragm?: 6th sometimes 7th

198. What suggests a skin fold?: Absence of pleural lining presence bronchovascular markings between lung margin & chest wall

199. What views show the costophrenic angle?: PA & lateral

200. When are L/R labels important?: Situs inversus, Dextrocardia

201. When can visceral pleura be seen on chest radiograph?: In pleural surface is parallel to x-ray beam, it can be seen separating lobes because it is contrasted with aerated lung

202. When fluid occupies an interlobar fissure, it is mostly seen where?: Minor fissure, between right middle lobe & right upper lobe

203. When may a radiograph appear normal in respiratory failure?: Obstructive lung disease

204. Where could subtle abnormalities hide in the lung radiograph?: Medially behind clavicles, Behind the heart, Deep in posterior sulcus (bottom of lung behind diaphragm dome)

205. Where is AP view usually taken?: ICU

206. Wher is the first place pleural effusions accumulate in upright position?: Subpulmonic location

207. Where is the PA view performed?: Radiology department

208. Which has lesser quality: AP or PA?: AP

209. Who first discovered the x-ray beam?: Roentgen

210. Why are radiographic clues subtle in supine patient for pneumothorax?: Air moves to highest point on chest, anterior cardiophrenic sulcus

211. Why are ultrasounds rarely used for lungs?: They are air-filled

212. Why can pleura not be seen on conventional chest radiograph?: They blend into the water density of chest wall, diaphragm & mediastinum

213. Why is there magnification of the heart shadow in AP view?: The heart is closer to the x-ray

214. X-ray beam path in PA view: Through posterior side, Through patient, Through anterior surface, To the film

215. X-rays through dense tissue are lighter/darker: Lighter

216. X-rays through lower-density tissue are lighter/darker: Darker

217. What are CT scans used for?: Lung nodules and masses, Greater vessels of the chest. mediastinum, and pleural disease.

218. What are infiltrates?: they are the shadows caused by the fluids building up and are often patchy

219. What are the 2 most common?: Sarcoidosis and idiopathic pulmonary fibrosis they have no known cause

220. What are the four tissue types visible on X-Rays?: Air(radiolucent or black), Fat (dark grey), Soft tissue (grey), Bone(radiopaque or white)

221. What are the technical factors for an xray?: Is it labeled properly, Is it PA or AP, Is the entire chest imaged, Was patient properly positioned, Were optimum settings used for the beam?

222. What causes interstitial disease?: Infections (viral pneumona etc), Occupational (asbestosis or silicosis).

223. What causes pulmonary edema?: Vascular congestion (which can be caused by failure of the left side of the heart, renal failure or fluid overload), loss of pulmonary capillaries integrity (which causes ARDS)

224. What does a xray fo ARDS lack from pulmonary edema?: Not predominate in the hilar regions, lacks cardiomegaly cephalization and kerley b lines.

225. What does the mediasteinum consist of?: Heart, great vessels, and trachea, and is divided up into anterior, middle, and posterior.

226. What happens if the costophrenic point is rounded on a PA Xray and on a Lateral?: This means there is Hydrothorax and at least 175-200 ml of pleural fluid must be present. On a lateral it is able to detect smaller pleural effusions with the angle becoming blunted at 75-100ml of fluid

227. What is a bleb?: A form of pulmonary air cyst in the visceral pleura

228. What is a counter indication to using an MRI?: Metal objects and pace makers

229. What is a CT Angiography?: It is a way to do CT scans of the pulmonary vessels and heart to detect for pulmonary thromboemboli and is an alternative to routine coronary angiography.

230. What is an airbronchogram?: The outer 2/3rds become visible when filled with infiltrates and is a hallmark of air-space-disease

231. What is an air-fluid level?: It is an area where a straight level border between air and fluid can be seen in a space. if it is found in the pleural space it indicates hydropneumonothorax.

232. What is a subpulmonic location?: Fluid that accumulates between the lung and diaphram and can hide as much as 500ml

233. What is barotrauma: When pressure causes the lungs to rupture or damage.

234. What is cephalization?: Enlargement of the vessels at the apex and is caused by left sided heart failure.

235. What is HRCT used for?: Interstitial Disease, Emphysema, and Bronchiectasis because only 10% is imaged it is a poor choice for other uses

236. What is intralobular septa?: is a thin sheet of connective tissue that surrounds the pulmonary lobule not visible on a normal xray left sided failure causes edema and form kerley b lines

237. What is Loculated: Fluid that does not

238. What is T1 and T2?: T1 is 100milsec T2 is 1sec

239. What is tension pneumothorax?: its where air pushes against the heart and lungs and causes them to collapse and has to be relieved by a chest tube or heimlich valve.

240. What is the average slice size? And for a HRCT?: 5-7mm, 1mm at 10 mm intervals (only 10% is imaged in HRCT)

241. What is the best view for detecting small amounts of pleural fluid?: Lateral Decubitus View as little as 5ml of fluid can be detected. Frontal view as patient is lying on side.

242. What is the costophrenic angle?: The arch diaphragm and chest wall meet to form a point

243. What is the lung parenchyma made up of?: The alveoli and the interstitium (the supporting structures)

244. What is the most common chest film finding in critically ill patients?: Pulmonary Edema

245. What is the normal amount of fluid in the pleural space?: 1-5mm

246. What is the sign of hyperinflation?: more than 7 anterior ribs are seen on the xray

247. What should a proper exposure on and xray show?: Intervertebral disc spaces through the mediastinum and the vessels in the peripheral regions to be viewed

248. What types of fluid fills up alveoli?: In Pulmonary Edema it is watery fluid that contains little blood cells., In bacterial pneumonia, they fill with exudative fluid including white blood cells., In the case of hemorrhage it is blood., In the case of pulmonary alveolar proteinosis they fill with a fat rich material derived from surfactant

249. Where are each PA and AP performed?: PA is in Radiology AP is with a portable machine

250. Where should the ET tube be?: mid trachea 5-7cm from the carina

251. Why can patient rotation make it more difficult to interpret an xray?: it can cause midline structures such as the trachea to project to the left or right

252. Why is PA view preferred over AP view in regards to the heart?: The heart is less magnified and it is of better quality