Pneumonia Educational Resource

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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

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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.

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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

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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

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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

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RIPE

Type of film

DOB

Date, time and indication

Patient name

ADMIN

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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

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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

Palpation