Deck 6: Radiographic Assessment

Question 1

Which of the following radiographic views would be the best suited for evaluating fractured ribs in a pediatric patient?

A) Lateral decubitus at full inspiration
B) Posteroanterior view at full expiration
C) Anteroposterior view
D) Oblique view

Answer 1

D
Oblique views are usually rotated 45 degrees from the frontal position. They are typically used in the evaluation of rib fractures and to better evaluate the entire heart borders.

Question 2

While viewing the chest X-ray of an 18-month-old boy, a therapist notices that the trachea is truncated and that the right lung is collapsed. Which of the following situations or conditions may have caused this situation?

A) An elevated right hemidiaphragm
B) A mucous plug in the right mainstem bronchus
C) A mass compressing the trachea
D) A right-sided pneumothorax

Answer 2

B
Truncation of the right mainstem bronchus is often the sign of a mucous plug when the right lung is collapsed. Although the right hemidiaphragm is usually slightly higher than the left because of the underlying liver, the position of the diaphragm may indicate hemidiaphragm paralysis or abdominal pathology.

Question 3

Which of the following radiographic views provides the best perspective for ascertaining the position of an endotracheal tube in the patient's esophagus?

A) Anteroposterior view
B) Left lateral decubitus
C) Lateral view
D) Oblique view

Answer 3

C
If a chest radiograph is obtained for suspected esophageal intubation, the stomach, small bowel, and esophagus will be distended with air while the lungs will be underinflated. Although usually not necessary, a lateral projection would demonstrate the endotracheal tube in the more posterior esophagus. The lateral projection may be more useful for showing adequate tracheal positioning and length in long-term placement of a tracheostomy tube.

Question 4

Sonographic imaging is valuable in the evaluation of which of the following?
I) Superficial masses
II) Pleural effusions
III) Diaphragmatic motion
IV) Bony structures

A) III only
B) I and IV only
C) II and IV only
D) I, II, and III only

Question 5

Which of the following is the type of X-ray projection obtained when the radiographic plate is placed behind the patient's back with the X-ray tube placed in front of the patient's chest?

A) Anteroposterior view
B) Posteroanterior view
C) Lateral view
D) Frontal view

Question 6

While viewing an anteroposterior view of a chest radiograph of a 24-month-old intubated child, a therapist notices that the endotracheal tube has now migrated right above the inferior clavicular border. What could explain this new location of the endotracheal tube?

A) Flexion of the head
B) Extension of the head
C) Rotation of the head to the right
D) Rotation of the head to the left

Question 7

A therapist is viewing a chest X-ray of a pediatric patient who recently emerged from general anesthesia after upper abdominal surgery. The right hemidiaphragm is elevated, and atelectasis is seen as a long, thick horizontal line within the right lower lobe. Which of the following terms describes this type of atelectasis?

A) Discoid
B) Lobar atelectasis
C) Silhouette sign
D) Plate

Question 8

A therapist is viewing a frontal chest radiograph of a neonate who has just been endotracheally intubated. The tip of the endotracheal tube is located between the inferior clavicular border and the carina. What should the therapist do at this time?

A) Perform a respiratory assessment in the morning and care for an intubated patient at this time.
B) Withdraw the endotracheal tube a few millimeters.
C) Advance the endotracheal tube a few millimeters.
D) Remove the endotracheal tube and reinsert it because it is in the esophagus.

Question 9

A therapist is viewing frontal chest X-ray of a 12-year-old child and notices mediastinal shift toward the right hemithorax along with elevated hemidiaphragm and vascular crowding. Which of the following conditions does this child likely have?

A) Atelectasis
B) Pneumonia
C) Pleural effusion
D) ARDS

Question 10

A mother has just given birth to a 42-week infant who is small for his gestational age. A chest radiograph of this neonate reveals coarse, patchy opacities secondary to atelectasis from bronchial obstruction alternating with areas of hyperinflation. Which of the following clinical disorders does this infant likely have?

A) Acute respiratory distress syndrome
B) Pulmonary interstitial emphysema
C) Meconium aspiration syndrome
D) Transient tachypnea of the newborn

Question 11

Which of the following are criteria to order a chest radiograph in a pediatric patient who does not have chest symptoms?
I) Fever
II) Oxygen saturation < 95%
III) White blood cell count > 20,000/mm³
IV) Creatinine > 2 mg/dL

A) II and III only
B) I and IV only
C) I, II, and III only
D) III only

Question 12

The lateral decubitus view is a frontal radiographic projection whereby the downside can be evaluated for the presence of ____________________.

A) atelectasis
B) pleural effusion
C) consolidation
D) pneumothorax

Question 13

The respiratory therapist is evaluating a child with suspected foreign body aspiration. The radiographer gently adds pressure to the abdomen during expiration to take the chest radiograph. If an obstruction is confirmed, what changes should the RT expect to see?

A) The size of the affected lung will decrease.
B) The size of both lungs will decrease.
C) The size of the affected lung will remain normal.
D) The size of the affected lung will increase.

Question 14

While viewing a lateral view of a neck radiograph of an 18-month-old child, a therapist notices that the epiglottis is enlarged, the aryepiglottic folds are thickened, and the hypopharynx is overdistended. Which of the following conditions does this child likely have?

A) Bronchopulmonary dysplasia
B) Esophageal fistula
C) Croup
D) Epiglottitis

Question 15

A therapist is examining an AP chest radiograph of a neonate and notices a structure projecting away from the mediastinum toward the right upper lung. This structure looks like a sail with a sharp inferior margin and lateral margins with wavy contours. Which of the following structures is the therapist observing?

A) Thymus
B) Right heart border
C) Aortic notch
D) Lymph node in the hilar region on the right

Question 16

A pediatric patient with pneumonia has an infiltrate in the lower half of the right lung. The right heart border is obliterated. In which lobe(s) of the right lung is the infiltrate located?

A) Right upper lobe
B) Right middle lobe
C) Right lower lobe
D) Right middle and lower lobes

Question 17

A respiratory therapist is evaluating a chest radiograph of a patient taken 2 days after being admitted for significant respiratory distress and right middle lobe pneumonia. Although the therapist notices a dramatic clinical improvement in the patient, the chest X-ray appears to be more radiopaque than the one on admission. What could explain this situation?

A) The therapist is mistakenly looking at a different patient's film.
B) Incorrect exposure of the image receptor may have happened.
C) Although the patient looks better, the pneumonia is probably worse.
D) This is a normal phenomenon.

Question 18

A therapist is viewing frontal and lateral neck X-rays of a 12-month-old child and notices what is described as the "steeple" or "church steeple" sign: subglottic narrowing below the vocal cords and an overdistended hypopharynx. Which of the following conditions does this child likely have?

A) Laryngotracheobronchitis
B) Tracheomalacia
C) Adenoidal enlargement
D) Epiglottitis

Question 19

Which of the following structures on a chest radiograph projects to the left, causes a prominent bulge of the superior mediastinum, and creates a mild indentation on the trachea?

A) Left hemidiaphragm
B) Apex of the heart
C) Aortic arch
D) Hilum

Question 20

How will well-expanded, air-filled lungs appear on a chest radiograph?

A) Light colored
B) Gray
C) Black
D) White