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Clinical Medicine II > Pulm: Diagnostic Imaging > Flashcards

Pulm: Diagnostic Imaging Flashcards

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1
Q

What is the initial test that should be ordered to evaluate respiratory sxs?

A

CXR

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2
Q

What 3 views should be obtained with CXR?

A

PA, AP, lateral decubitus

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3
Q

What is the A,B,C,D,E,F approach to reading a CXR?

A 
Airway
Bones
Cardiac Shilouette
Diaphragms
Edges
Fields
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4
Q

Biggest benefit of CXR over other imaging modalities?

A

Low radiation exposure

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5
Q

You see a CXR showing no vasculature on the left side. What is lack of vasculature concerning for?

A

PTX

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6
Q

CXR shows hampton’s hump. What is this concerning for?

A

Pulmonary infarct/PE

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7
Q

Two major limitations for CXR?

A

radiation exposure (cumulative)

Some conditions cannot be detected

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8
Q

Can CXR be done in pregnancy?

A

no

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9
Q

Which imaging modality should be ordered?

Clarify CXR
Characterize pulm. nodules
Assist in dx
detect/stage neoplasm
evaluate mediastinal mass
A

CT

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10
Q

What type of CT?

Fast
Continuous
Takes < 5 min

A

Spiral

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11
Q

What type of CT?

1mm slices
better detail
used for fibrosis/emphysema

A

High resolution

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12
Q

What type of CT?

Less detail
Used for screening

A

Low-dose

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13
Q

What type of CT

10mm slices
Step & shoot style
25-30min

A

Conventional

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14
Q

What are 4 types of mediastinal mass? (4 Ts)

A

teratoma

thymoma

thyroid CA

Terrible lymphoma

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15
Q

Can CT be performed with implanted devices?

A

yes

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16
Q

Radiation exposure from CT is ___ which is ___ x a CXR

A

8 mSv, 80x

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17
Q

Can you do CT with pregnancy?

A

no

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18
Q

CTPA is ___ x the radiation dose of a single CXR

A

150x

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19
Q

What must you ask women prior to all imaging?

A

LMP

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20
Q

Are kids more or less radiosensitive than adults?

A

more

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21
Q

What type of contrast is often used with CT?

A

Iodine

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22
Q

When is contrast CT indicated?

A

Visualize Vessels and Malignancy

Trauma

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23
Q

What are three risks of CT with radiocontrast?

A

allergic rxn

contrast induced nephropathy

lactic acidosis if taking metformin

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24
Q

How do you avoid allergic rxn to contrast?

A

pre-treat with prednisone and benadryl

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25
What is the typical onset of allergic rxn to contrast?
5-60 min
26
24-48 hours after contrast administration, a patient presents with: Creatinine 0.5 + (25% from baseline) What condition should be suspected, when do sxs peak
radiocontrast induced nephropathy peak 3-5 days
27
Caution should be taken in administering radiocontrast if creatinine or GFR values are...
Creat: > 1.5 GFR < 60
28
What 5 populations need to have renal fxn tested prior to radiocontrast?
age > 60 hx renal disease hx HTN treated wih meds hx of DM metformin use
29
This imaging modality assesses pulmonary vasculature. It can be performed with: CTPA Direct pulm. angiography pulm MRI
Pulmonary angiography
30
What test has largely replaced conventional, catheter-directed pulmonary angiography?
CTPA
31
This imaging modality is useful for detecting: PE Aortic Dissection SVC Syndrome
CTPA
32
What is the radiation exposure for CTPA?
10-15 mSv
33
What might be missed with CTPA imaging?
sub-segmental PE
34
What is the gold standard imaging modality to evaluate PE?
catheter-directed pulmonary angiography | direct pulm. angiography
35
A patient has an inconclusive V/Q scan and CTPA, but you still suspect PE. What should you order?
direct pulmonary angiography
36
What are 5 risks of direct pulmonary angiography?
1. bleeding/hematoma 2. arrhythmia 3. allergic rxn 4. CIN 5. radiation
37
Which imaging modality: has limited usefulness for pulmonary disease Less detailed view of parenchyma No ionizing radiation, bone artifacts
MRI
38
What imaging modality is useful for visualizing the hilum, mediastinum, cancers, and lacks iodine contrast?
MRI
39
What are three big limitations to MRI?
pt. must remains still claustrophobia body habitus limitations
40
What are the contraindications for MRI (4)?
implanted pacemaker/defib metal in eye aneurysm clip Cochlear implant
41
This imaging modality: Useful in evaluation of PE and pre-op assessment for lung resection
V/Q Scan
42
What are the two phases of the V/Q Scan and what is used for visualization?
IV phase: technitium 99 bound to albumin Inhalation phase: radio-labeled xenon gas
43
A V/Q mismatch indicates...
imbalance of blood flow and ventilation
44
What is a major limitation of V/Q scan?
sensitive for PE, but poor specificity (few false- neg, high false-positive)
45
If you have a normal CXR but high suspicion for PE, what can be used in pregnant patients or those who can't tolerate CTPA/direct angiography?
V/Q Scan
46
What is the test of choice for PE dx in pregnant women?
V/Q Scan
47
What are 2 major benefits to the V/Q Scan?
1. rare allergic reaction | 2. low dose radiation
48
For what condition is PET scan used?
detection of CA
49
What is superior for mediastinal imaging, CT, MRI, PET>
PET
50
What is used for contrast in PET scan?
FGD--radioactively labeled glucose
51
Where does FGD accumulate?
cells with high metabolic activity: CA cells, heart, kidneys, bladder
52
This imaging modality has the following benefits: - detects biochem changes before appearance on CT/MRI - Short-lived radioactivity - combined with CT/MRI to give full picture of anatomy and metabolism
PET
53
The following imaging modality has the following limitations: - 140 x CxR radiation - False results occur with metabolic imbalance - time sensative - High cost
PET
54
This imaging modality has the following indications: - Bedside detection of pleural effusion, HTX, PTX - Guidance for thoracentesis - guidance for thoracostomy tube placement
Thoracic ultrasound
55
The seashore sign on thoracic ultrasound indicates...
normal lung
56
The barcode sign on thoracic ultrasound indicates:
PTX/no chest wall motion
57
What imaging modality has the following diagnostic indications? - evaluation of pneumonia, hemoptysis, cough - dx of transesophageal fistula/tracheobronchomalacia - tissue sampling
Bronchoscopy
58
What are the 2 therapeutic indications for bronchoscopy?
Removal of excess mucous or FBs ET tube placement
59
When should a rigid bronchoscope be used?
foreign body removal
60
What are the risks of bronchoscopy? (5)
``` Bleeding Infx Bronchospasm Perf. PTX ```
61
What are the contraindications for bronchoscopy? (5)
``` Severe Hypoxia Risk of bleeding Pulm. HTN Severe cough Tracheal stenosis ```

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