Pneumonia Educational Resource
Rachael Lickorish
Created on January 13, 2024
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Transcript
GET STARTED
Pneumonia
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Chest x ray interpretation including basic anatomy and reporting findings
Performing a respiratory exam on a patient with suspected pneumonia and key clinical findings
Questions to assess prior knowledge and guide learning
This session is organised into 3 key aims:
Introduction
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Interpret a chest x ray and report typical findings in a patient with pneumonia
Accurately identify key anatomical landmarks on a chest x ray
Back
Complete a respiratory exam on a patient and recall key findings in a patient with pneumonia
By the end of this session you should be able to:
Learning outcomes
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MCQs
The following 3 slides will be a series of multiple choice questions to assess current understanding before we move on
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Question 1
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Question 2
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Question 3
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Respiratory exam
We will now look at how to perform a respiratory exam on a patient and key clinical findings in a patient with pneumonia.
Next
Follow the steps in order and before clicking on each write down/speak aloud what you would look for at each step in an OSCE exam
6. COMPLETING THE EXAM
5. POSTERIOR CHEST
4. PERCUSSION & AUSCULATION
3. PALPATION
2. INSPECT
1. WIPE
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Respiratory exam
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Chest X ray
The next few slides will cover chest x ray anatomy and interpretation, including typical findings in a patient with pnuemonia
Next
See the next slide to see how many you got correct
Spinous processes
R ventricle
L ventricle
L atrium
R atrium
Liver
Costophrenic angle
Cardiophrenic angle
Trachea
Gastric bubble
L hemidiaphragm
R hemidiaphragm
Posterior ribs
Scapula
Aortic knob
Pulmonary artery
L hilum
R hilum
Anterior ribs
Clavicle
Please drag and drop the words around the picture to where you think they should be
Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 8090
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Chest x ray anatomy
Next
Source: https://rk.md/2017/reading-chest-x-rays/
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Chest x ray Anatomy labelled
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TOP TIP
- Everything else
- Diaphragm
- Cardiac
- Breathing
- Airway
A to E
- Exposure
- Inspiration
- Position
- Rotation
Back
RIPE
Type of film
DOB
Date, time and indication
Patient name
ADMIN
Next
Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 8090
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Chest x ray interpretation
This image is not rotation, is taken on adequate inspiration in a PA erect position and has adequate exposure.
Type of film
DOB
Date, time and indication
Patient name
Please jot down your interpretation of this chest x ray using the RIPE and A to E acronym. Then click on the words around the slide to reveal the answer
3. A to E
1. ADMIN
2. RIPE
Pneumonia Key Signs
Case taken from: https://www.radiologymasterclass.co.uk
Back
Next
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Practice CXr interpretation
Understand and recognise typical chest x ray findings in a patient with pneumonia
Interpret a chest x ray using the RIPE and A to E acronyms
Perform a respiratory exam on a patient and recognise key signs of pneumonia
Hopefully you now feel able to:
Thank you for interacting with this resource and I hope you found it useful.
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Summary
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Please could you take a couple of minutes to fill in my Microsoft feedback form linked here:https://forms.office.com/r/pjYJh2uRPTThank you.
Finish
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Feedback
1. Introduction
3. MCQs - Question 1
2. Learning Outcomes
12. Feedback
11. Summary
10. Practice Chest x ray Interpretation
9. Chest X Ray Interpretation
8. Chest x ray anatomy labelled
7. Chest x ray anatomy
6. Respiratory exam
5. MCQs - Question 3
4. MCQs - Question 2
Quick page links
Spinous processes orientation against vertebral bodies?
Are the medial borders of clavicles equidistant from spinous processes?
RIPE - Rotation
Can you see fine lung markings throughout?
Can the L hemidiaphragm be visible from the costophrenic angle to the spine?
Are the vertebral bodies visible behind the heart?
RIPE - Exposure
Can you view the hilar structures?
Useful clinical signs
Can you view the carina and R and L bronchi?
Is the trachea visible and central?
A to E - Airway
Air below diaphragm?
Costophrenic and cardiophrenic angles visible?
Right slightly higher than left?
Useful clinical signs
A to E - Diaphragm
Erect or supine?
Is the image AP or PA?
RIPE - Position
Can you see the aortic knuckle?
Are borders of the heart visible?
Heart size (<50% of thorax?)
Useful clinical signs
A to E - Cardiac
Medical equipment?
Check bones for fractures
A to E - Everything else
Do the lung markings extend all the way to the peripheries?
Useful clinical signs
Check all the way along lung fields for black or white areas
A to E - Breathing
Percussion and Ausculation
Example
Airway
- The trachea is central
- Carina and R and L bronchi are visible
- Hilar structrues visible and not enlarged
- Lung markings are visible to peripheries
- R lower zone of the lung has an area of white consolidation, which could indicate an underlying infection, such as pneumonia
- The heart is <50% of the diameter of the thorax
- The borders of the heart are visible, though there is some slight blurring of the R atrium due to the consolidation in the R lower lobe
- The aortic knuckle is also visible
- The diaphragms are visible and as expected the R is slighlty higher than the L
- The L costophrenic is clear and has no evidenc of blunting. The R costophrenic angle is hard to visualise due to the consolidtion in the R lower zone but there is potentially some blunting.
- This is similar for the cardiophrenic angles with the L clearly visible and the R affected by the consolidation
- There is no evidence of air under the diaphragm.
- There are no visible fractures
- No medical equipment is visible
Example
W - Wash your handsI - Introduce yourself P - Patient name and DOB E - Explain procedure and obtain informed consent
WIPE (Admin)
Percussion
Auscultation
Chest expansion
Example
Posterior chest
Explain to the patient the exam is finishedThank the patient Wash hands Summarise findings
Example
Completing the exam
Are the scapula out of the way of the image?
Can you see: - 5 to 6 anterior ribs - Lung apices - Both costophrenic angles
RIPE - Inspiration
Example
Example
Example
Example
2. Specific inspection Hands Head and neck Chest
1. Initial inspectionEnd of the bed
INSPECTION
Apex beat
Chest expansion
Example
Trachea and mediastinum