L9 Pulmonary diagnostics Flashcards
(75 cards)
1
Q
3 imaging methods that don’t use ionizing radiation
A
Ultrasound
MRI/MRA
Bronchoscopy
2
Q
Indication for CXR
A
SOB Persistent cough Hemoptysis Chest pain or injury Fever
3
Q
CXR views
A
PA, AP, lateral, decubitius, apical lordotic
4
Q
ABCDE of CXR
A
Airway Bones Cardiac Diaphragm Edges
5
Q
Xrays can miss
A
very small cancers
pulmonary emboli
6
Q
CT is good for
A
clarifying an abnormal CXR diagnose cause of clinical s/sx characterize pulmonary nodules staging of primary and metastatic lung neoplasms evaulate mediastinal or hilar masses
7
Q
who to screen for lung cancer
A
55-80 years old with a 30 pack year history and currently smoke or quit within past 15 years
8
Q
conventional CT is done
A
step and shoot, takes 25-30 mins
9
Q
helical CT is done
A
continuously, <5 min
10
Q
high resolution CT has slices that are
A
<1 mm
11
Q
CT that is used for screening and has less detail
A
low dose CT
12
Q
type of CT that can be done conventional or helical, is 64x faster, but has much higher radiation
A
multidectector or multislice CT
13
Q
what to use if a patient has an implanted device
A
CT
14
Q
real-time imaging for biopsies
A
CT
15
Q
issues with CT
A
increased cancer risk
Body habitus >450 lbs
16
Q
pediatric risks with CT scans
A
leukemia and brain tumors
17
Q
pregnancy risks with CT scans
A
in utero exposure linked to pediatric cancer mortality
18
Q
whatcha gotta ask before exposing a patient to radiation
A
LMP!!!!!!!!!
19
Q
contrast used in CT
A
iodine
20
Q
what’s well seen on CT with contrast
A
blood vessels encases by a tumor constricting it
21
Q
CT with contrast is good for
A
Masses Cancer Metastatic disease Obstructive processes PE
22
Q
CT w/o contrast is good for
A
follow up of known pulmonary nodules
23
Q
High resolution CT is good for
A
evaluation of diffuse lung disease
24
Q
Risk factors for allergic reaction to CT with contrast
A
prior reaction, asthma, atopy
shellfish allergy NOT A RISK FACTOR
25
pretreat allergy to CT with contrast with
Prednisone and diphenhydramine
26
contrast induced nephropathy is defined as
serum creatinine > 25% from baseline
-or-
>.5 mg/dL
27
caution using contrast in patients with
impaired kidney function: Creat >1.5 mg/dL or GFR <60
28
alternatives to CT with contrast in patients with impaired kidney function
CT w/o contrast
MR w/o gadolinium
U/S
29
Who to check renal function in prior to iodine contrast
```
>60
History of renal disease
history of htn (treated)
DM
taking glucophage
```
30
who can take glucophage and still get a CT with contrast
eGFR > 30 ml/min
31
who shouldn't take their glucophage when getting a CT with contrast
acute kidney injury
| severe CKD with eGFR <30 ml/min
32
if you've held metformin to do a CT and it's been 48 hours, your next step is to
re-evaluate renal function before resuming doses
33
angiography can be performed in conjunction with
CT (CTA)
MRI (MRA)
Xray with catheter
34
use CT pulmonary angiography if you suspect
pulmonary embolism
aortic dissection
superior vena cava syndrome
35
CT pulmonary angiography can assess
vascular malformations
| pulmonary arterial invasion by a neoplasm
36
CT pulmonary angiography use in surgery
provides precise anatomical guidance
37
CT pulmonary angiography can miss
sub-segmental PEs
38
the gold standard in evaluation of PE is
Direct pulmonary angiography (Catheter directed)
39
when is a direct pulmonary angiography used
if a V/Q or CTPA is inconclusive and there is still a high clinical suspicion
40
risks of direct pulmonary angiography
Bleeding
Hematoma
Heart arrhythmia
(allergy, impaired kidney function, radiation)
41
direct pulmonary goes through the ____ to reach the ______ and then the ________
veins (femoral, internal jugular)
right side of the heart
pulmonary arteries
42
indications for MRI, which has limited usefulness in pulmonary disease
hilar/mediastinal densities
sulcus tumors
possible cysts/lesions of the chest wall
43
Benefits to MRI
no bone artifact (like CT)
| no ionizing radiation
44
contrast material used in MRI/MRA
gadolinium
45
MR angiography provides
high quality images of blood vessels
46
compared to a CT chest, an MRI is
less detailed view of lung parenchyma
| dimished spacial resolution
47
what kind of kidney damage can gadolinium cause
Nephrogenic systemic fibrosis
| IRREVERSIBLE
48
In a patient with GFR<30 ml/min and MRI
avoid use of gadolinium
49
Contraindications of MRI/MRA
```
*********************
Pacemaker/defibrillator
metal in eye
aneurysm clip
cochlear implant
**********************
```
50
Ventilation perfusion scans are used for
evaluate for PE
| pre-op assessment prior to lung resection
51
V/Q mismatch means
imbalance of blood flow and ventilation
52
V/Q radiation is captured
by gamma cameras in 2 phases
53
contrast injected in V/Q during the IV phase
| demonstrates what?
```
Technetium 99m (labeled to human albumin)
perfusion
```
54
gas inhaled in V/Q during the inhalation phase
| demonstrates what?
Radio labeled xenon gas
| distribution of ventilation
55
when to to use V/Q scan
normal CXR with high probability of PE
56
test of choice for PE in pregnant women
V/Q scan
57
other usefulness of V/Q scan
estimating post-op reserve capacity for pts undergoing lung resection
58
contraindications of V/Q scan
NO ABSOLUTE CONTRAINDICATIONS
59
V/Q will def diagnose a PE if it's there (v sensitive) but also might
be falsely positive bc it do that a lot
60
PET scan stands for
Positron Emission Tomography
61
what's the benefit to a PET scan
Physiologic images that can detect biochemical changes of anatomy before CT/MRI
62
the radiation injected in PET scan
fluorodeoxyglucose (FDG)
this is radioactively labeled glucose
short-lived (benefit but time sensitive)
63
FDG accumulates in
tissues/organs with high metabolic activity
| CANCER
64
measurements of radiation in PET scans
standardized uptake value (SUV)
65
what indicates cancer on PET scan
SUV >2.5
66
PET scan can evaluate
Metastasis from primary stie
effects of cancer therapy
recurrence in previously irradiated, scarred areas of the lung
67
When do false results occur with PET scans
metabolic imbalances
false (+) inflammatory lesions, granulomas (cocci and histoplasmosis)
false (-) slow growing tumors
68
indications for ultrasound (limited use) are
bedside detection of pleural fluid or pneumothorax
| guidance for thracentesis and placing thoracostomy tubes
69
bronchoscopy can evaluate
pneumonia
hemoptysis
cough
70
bronchoscopy can diagnose
tracheoesophageal fistulas
| tracheobronchomalacia
71
other things bronchoscopy can do
| these are the things it's most commonly used for
remove excess mucus or FBs (debris)
ET tube placement
trachea/proximal bronchus obstruction
72
side effects of bronchoscopy
nasal discomfort
sore throat
mild hemoptysis
73
complications of bronchoscopy
MINOR
hemorrhage
hypotension
arrhythmia
74
contraindications to bronchoscopy
severe refractory hypoxia
risk of bleeding
risk of respiratory and cardiovascular decompensation
75
what puts you at risk of respiratory and cardiovascular decompensation with bronchoscopy
```
asthma
COP
current/recent MI
poorly controlled CHF
life threatening arrhythmias
```
