Pneumonia Educational Resource

Pneumonia

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Introduction

This session is organised into 3 key aims:

Questions to assess prior knowledge and guide learning

Performing a respiratory exam on a patient with suspected pneumonia and key clinical findings

Chest x ray interpretation including basic anatomy and reporting findings

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Learning outcomes

By the end of this session you should be able to:

Complete a respiratory exam on a patient and recall key findings in a patient with pneumonia

Accurately identify key anatomical landmarks on a chest x ray

Interpret a chest x ray and report typical findings in a patient with pneumonia

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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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Respiratory exam

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

4. PERCUSSION & AUSCULATION

1. WIPE

5. POSTERIOR CHEST

2. INSPECT

3. PALPATION

6. COMPLETING THE 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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Chest x ray anatomy

Please drag and drop the words around the picture to where you think they should be

R hemidiaphragm

L hemidiaphragm

L hilum

Clavicle

Pulmonary artery

Anterior ribs

Spinous processes

R atrium

L atrium

R hilum

Scapula

Aortic knob

L ventricle

Trachea

Gastric bubble

Cardiophrenic angle

Posterior ribs

Costophrenic angle

R ventricle

Liver

Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 8090

See the next slide to see how many you got correct

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Chest x ray Anatomy labelled

Source: https://rk.md/2017/reading-chest-x-rays/

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Chest x ray interpretation

Patient name

Type of film

ADMIN

Date, time and indication

DOB

A to E

RIPE

- Airway

- Rotation

- Breathing

- Inspiration

- Cardiac

- Position

- Diaphragm

- Exposure

- Everything else

TOP TIP

Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 8090

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Practice CXr interpretation

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

2. RIPE

1. ADMIN

This image is not rotation, is taken on adequate inspiration in a PA erect position and has adequate exposure.

Patient name

Date, time and indication

DOB

Type of film

3. A to E

Pneumonia Key Signs

Case taken from: https://www.radiologymasterclass.co.uk

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Summary

Thank you for interacting with this resource and I hope you found it useful.

Hopefully you now feel able to:

Perform a respiratory exam on a patient and recognise key signs of pneumonia

Interpret a chest x ray using the RIPE and A to E acronyms

Understand and recognise typical chest x ray findings in a patient with pneumonia

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Feedback

Please could you take a couple of minutes to fill in my Microsoft feedback form linked here: https://forms.office.com/r/pjYJh2uRPT Thank you.

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Quick page links

7. Chest x ray anatomy

1. Introduction

2. Learning Outcomes

8. Chest x ray anatomy labelled

3. MCQs - Question 1

9. Chest X Ray Interpretation

4. MCQs - Question 2

10. Practice Chest x ray Interpretation

5. MCQs - Question 3

11. Summary

6. Respiratory exam

12. Feedback

RIPE - Rotation

Are the medial borders of clavicles equidistant from spinous processes?

Spinous processes orientation against vertebral bodies?

RIPE - Exposure

Are the vertebral bodies visible behind the heart?

Can the L hemidiaphragm be visible from the costophrenic angle to the spine?

Can you see fine lung markings throughout?

A to E - Airway

Is the trachea visible and central?

Can you view the carina and R and L bronchi?

Can you view the hilar structures?

Useful clinical signs

A to E - Diaphragm

Right slightly higher than left?

Costophrenic and cardiophrenic angles visible?

Air below diaphragm?

Useful clinical signs

RIPE - Position

Is the image AP or PA?

Erect or supine?

A to E - Cardiac

Heart size (<50% of thorax?)

Are borders of the heart visible?

Can you see the aortic knuckle?

Useful clinical signs

A to E - Everything else

Check bones for fractures

Medical equipment?

A to E - Breathing

Do the lung markings extend all the way to the peripheries?

Check all the way along lung fields for black or white areas

Useful clinical signs

Percussion and Ausculation

Example

Airway

• The trachea is central
• Carina and R and L bronchi are visible
• Hilar structrues visible and not enlarged

Breathing

• 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

Cardiac

• 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

Diaphragm

• 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.

Everything else

• There are no visible fractures
• No medical equipment is visible

WIPE (Admin)

W - Wash your hands I - Introduce yourself P - Patient name and DOB E - Explain procedure and obtain informed consent

Example

Posterior chest

Chest expansion

Percussion

Auscultation

Example

Completing the exam

Explain to the patient the exam is finished Thank the patient Wash hands Summarise findings

Example

RIPE - Inspiration

Can you see: - 5 to 6 anterior ribs - Lung apices - Both costophrenic angles

Are the scapula out of the way of the image?

INSPECTION

1. Initial inspection End of the bed

Example

2. Specific inspection Hands Head and neck Chest

Example

Example

Example

Palpation

Trachea and mediastinum

Chest expansion

Apex beat

Example