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C. Cold medicine. This morning, as the student was getting ready for school she noticed that she was coughing up blood. Therefore, rather than driving to her high school she decided to come to the E. R. For an examination. Symptoms Face By Patient : Winces and splints her chest to the right side when she coughs.

Persistent cough Coughing up blood Blood in Sputum Physical Examination: Blood pressure is 125/75, and her pulse is 125. Cardiac sounds are normal at all auscultation points. Temperature is 104. 3 F. Respiratory rate is 23/minute. Height is 5’10”, weight is 1 17 lbs.

Preliminary Test & Their Results : examination: normal nuns: Inspection, palpation, percussion and auscultation of the lungs are normal expect for the following findings on the right lung: With the patient seated upright, auscultation reveals the following findings at the 2nd and 3rd intercessor spaces along the right medically line: diminished vesicular breath sounds; enhanced bronchial breath sounds; increased intensity and clarity of spoken voice and whispered sounds; cacophony; fine Arles near the end of deep inspiration. Percussion dullness is found at the same sites.Cardiovascular examination: normal except for the tachycardia Abdomen: normal Genitourinary examination: normal Musculoskeletal examination: normal Neurological examination: normal Sputum examination: Mucous is yellowish and very thick, with streaks of bright-red blood.

Throat swab: normal By going through the case some questions has been arises and they are being hopefully answered briefly below Q. 1 :-Explain what a normal PA chest film would demonstrate, with particular reference to the structures that would be visible and their 3-dimensional anatomical relationships.Also scribe what the lung fields of an normal individual would present. Mans : PA is a normal postmeridian (PA normal PA chest x-ray). Normal view of PA contains : A normal PA chest x-ray.

The silhouette borders are (1 ) right atrium, (2) location of gaseous vein (not present on erect film except with increased right-sided cardiac pressures), (3) superior even cave, (4) aortic knob, (5) left helium, (6) left trial appendage, (7) left ventricle LUNG FIELD Tidal volume : The volume of air in and out of the lungs with a normal breath, approve. 00 Residual Volume :Volume of air which remains in the lungs after a forced expiration (approve. 1200 ml) Inspiration reserve volume : This term is the extra volume of air which can be inhaled after the person has taken in a normal breath (“forced inspiration”) approve. 3000 ml. Expiratory reserve volume the extra amount of air that can be expired by forceful expiration after the person has expired a normal breath of air, (“forced expiration”) approve. 1100 ml of air.

Inspiration capacity :The sum of: tidal volume + inspiration reserve volume; amount of air you can breathe when you forcefully inspire, after taking a normal breath (tidal volume) (3500 ml). Functional residual capacity :l’s the sum of: expiratory reserve volume + residual volume. This volume is the amount f air left in lungs after a normal expiration. approve 2300 ml.

Vital capacity :The sum of: inspiration reserve volume + tidal volume + expiratory reserve volume. This volume is the maximum amount of air that a person can expel from the lungs after first filling lungs to maximum and then expel air to maximum extent approve. 600 ml. Total lung capacity :l’s the sum of the maximum volume to which the lungs can be expanded with the greatest possible inspiration force. approve. 5800 Q.

2 :- Why did the physician order lateral chest films in addition to PA chest films? Mans Lateral CAR is less frequently requested and more difficult to interpret. Nevertheless it contains much information on the thoracic cage, pleura, lungs, pericardium, heart, medications and upper abdomen. The lateral CAR is performed with the side of interest closer to the X-ray film, giving an effective dose of 0. 5 ms. Q. 3 :- Explain what a normal chest film would demonstrate ,with a particular reference to the structures that would be visible and their 3 dimensional anatomical relationships. Mans :-Normal landmarks of lateral chest X-RAY : The fissures are important landmarks on a lateral CAR, becoming visible when the X-ray beam passes parallel to them. The oblique fissure begins posterior at TO/5 level, passing through the helium.

The left is steeper and finishes 5 CM behind the stratospheric angle whereas the right ends just behind the angle.The horizontal fissure runs interiorly from the helium separating the right upper lobe from the middle lobe. On the left there is no horizontal fissure-Both hemispherical should be visible, silhouetted by the lung air against the fluid-density of the abdominal contents. The anterior end of the left hemorrhaging may be lost against the heart. The diaphragms can be distinguished from each other if there is clearly gastric air under one, or if one can be seen to be inserted into the magnified ribs further from the X-ray plate.