Lung pathology with CXRs you really should know..

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This 76yr old lady presented with rigors, cough, SOB and a fever. What do the CXRs show?

This example of lobar pneumonia was caused by Strep pneumonia and the lady responded to IV antibiotics.

Right sided effusion and a pacemaker.

Right middle lobe consolidation and a pacemaker.

Acute pulmonary oedema and a pacemaker.

Right middle lobe collapse and a pacemaker.

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This is a mobile CXR of a patient who presented sweaty and SOB. Which of the following best describes the CXR?

He has pulmonary oedema and the CXR shows some of these signs. Kerley B lines are named after Irish neurologist and cardiologist Peter Kerley. They are small linear opacifications caused by fluid leaking into the interstitium.

Cardiomegaly with Curley B lines.

Cardiomegaly with Kerley B lines and pulmonary venous congestion.

Cardiomegaly with bilateral infiltrates.

Upper limit heart size with bilateral infiltrates

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A 42yr old lady presented with sudden onset of SOB. She was hypotensive, hypoxic and tachycardic. What does this CT cut show (yes I know I said CXR only--I lied).

You can see the embolus right across the main pulmonary trunk. This lady fortunately responded to thrombolytic therapy and survived.

Bilateral pneumothoraces.

An aortic dissection.

Lung cancer infiltration the aorta.

A massive pulmonary embolus.

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A 26yr old lady, who was an IV drug user presented with fever, SOB and pleuritic chest pain on the left. What does the CXR show?

This lady has Staph aureus abscesses in her lungs associated with an effusion. The Staph would have entered at the site of injection and then followed the venous system to lodge in the lungs. She also, not surprisingly, had a vegetation on her tricuspid valve.

Left lower lobe consolidation.

Left lower lobe collapse.

Left sided effusion with circular lesions.

Left sided effusion and "coin" lesions.

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This is the xray of a patient who tried to commit suicide. What method did she use?

Surprisingly she survived. The patient was discharged after a week and given oral chelation therapy with dimercaprol for 9 months before the patient stopped taking it.Not sure how she went subsequently.

Injecting Mercury intravenously.

Injecting radiocontrast intravenously.

Inhaling Radioactive iodine.

Inhaling aerosolised paint.

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This CXR was taken in expiration of a man with SOB and right sided chest pain. What best describes it's findings?

You can also see flattening the right hemidiaphragm because of the positive pressure in the pleural space. This needs to be urgently decompressed.

Right tension pneumothorax with mediastinal and tracheal deviation.

Large left pneumothorax.

Left tension pneumothorax with tracheal and mediastinal deviation.

Left lower lobe collapse with mediastinal and tracheal deviation.

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This patient has a history of asthma and has presented SOB. What does the CXR reveal?

He developed a mucous plug as part of his asthma. This blocked the right upper lobe bronchus and caused it to collapse. You can see the trachea is pulled to the right and the right hemidiaphragm is pulled up. The patient required a bronchoscopy to remove the mucous plug.

Old right sided tuberculosis.

Right upper lobe collapse.

Large right sided pleural effusion.

Right sided upper zone consolidation.

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Which of the following is not recognised to cause pneumonitis.

There are many different types of pneumonitis, which is essentially just lung inflammation. Hypersensitivity, chemical, radiation and post viral are just a few causes. The CXR shown is an example of a patient who was hypersensite to the grass that you use to make brooms. Unfortunately he worked in a broom factory.

Avian antigens causing "Bird Fanciers" lung.

Measles.

Radiation therapy

Chest trauma.

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What are the recommended initial ventilator settings for respiratory rate, tidal volume and FI02 if you had intubated someone with life threatening asthma?

You want to give time for the patient to completely exhale otherwise the breaths will stack up on each other and you will get dangerously high intrathoracic pressures. The result will be that the C02 in the patient blood will rise--but to a certain extent you can accept that.

Respiratory rate 20/min. Tidal volume 5ml/kg. Fi02 1.0 (100%). 1

Respiratory rate 14/min. Tidal volume 10ml/kg. Fi02 0.5 (50%)

Resp rate 6-8/min. Tidal volume 6ml/kg. Fi02 1.0 (100%).

Respiratory rate 12/min. Tidal volume 7ml/kg. Fi02 1.0 (100%)

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Which of the following mechanisms is not used by some animals to get oxygen into their blood?

Frogs can absorb oxygen from through their skin. A number of turtles, including Australian species can extract oxygen by sucking up water through their cloaca. The following link explains an example of this.

https://www.youtube.com/watch?v=963t4MN80eM

Breathing in air through the mouth and nose into the lungs.

Flushing oxygen rich water through the ears to extract 02 in small capillaries.

Absorbing oxygen through their skin.

Sucking water up their cloaca (think anus) and extracting oxygen.

You got {number correct}/{number of questions} correct answers

The lobar pneumonia was caused by Strep pneumonia and she responded to IV antibiotics.