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clinical medicine II exam 2 > pulmonary diagnostic imaging > Flashcards

pulmonary diagnostic imaging Flashcards

(49 cards)

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1
Q

What is the benefit of using US and/or MRI imaging in pulmonary diagonistics

A

no ionizing radiation

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2
Q

which diagnostic imagining is often the initial study to evaluate respiratory symptoms

A

chest xray

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3
Q

describe the inherent contrast of chest xray

A
  • air in lungs is black
  • soft tissue (light grey)
  • bone (nearly white)
  • metal (white)
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4
Q

what are the chest xray views? which two are used most often?

A
  • PA
  • Lateral
  • AP: (anything on anterior part of chest is magnified)
  • Decubitus
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5
Q

silhoutette sign

A

when you see a nice silhouette of heart border

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6
Q

How is the lateral view chest xray taken

A
  • taken from right to left so that the heart does not appear abnormally large
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7
Q

when is is appropriate to order a decubitus CXR

A
  • suspect pleural effusion
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8
Q

benefits of CXR

A
  • non-invasive
  • low radiation exposure (0.1 mSv)
  • inexpensive
  • widely available
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9
Q

what do you look for on CXR when you suspect pneumothorax

A

look for edge of pleura as a light line that has advanced inward toward heart

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10
Q

what condition does this wedge shaped sign suggest

A

Hampton’s hump -> pulmonary infarct

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11
Q

Computed tomography (CT scan) takes what kind of pictures

A

cross sectional images (slices) through the body

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12
Q

Why would you order a CT

A
  • clarify abn CXR
  • characterize pulmonary nodules
  • detection and staging of primary and metastatic lung neoplasms
  • evaluate suspected mediastinal or hilar masses
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13
Q

What are the various types of CT scans

A
  1. conventional
  2. helical
  3. high resolution
  4. low dose CT
  5. CT angiography
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14
Q

conventional CT scan

A
  • 10 mm slice
  • “step and shoot:
  • 25-30 min
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15
Q

helical CT

A
  • continuous
  • < 5 min
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16
Q

high resolution CT (HRCT)

A
  • better detail
  • 1 mm slice
  • used to figure out what is going on with lung tissue; ex: chronic lung diseases
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17
Q

multi_detector CT

A
  • also called multislice CT
  • 4-620 slides
  • conventional or helical scans
  • very fast; higher radiation
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18
Q

what are the benefits of CT

A
  • fast
  • real-time imaging
  • can be performed even if patient has implantable device
  • less expensive and sensitive to patient movement than MRI
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19
Q

what contrast is used in CT

A
  • iodine
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20
Q

why is constrast used

Study These Flashcards
A

to enhance differences in densities of various structures

21
Q

does the following require CT with or without contrast:

Masses, CA, metastatic disease, obstructive processes, PE or dissection

Study These Flashcards
A

CT chest with contrast

22
Q

does the following require CT with or without contrast:

pulmonary fibrosis; interstitial lung disease; follow up of known pulmonary nodules

Study These Flashcards
A
  • CT chest without contrast
    • pulmonary fibrosis; interstitial lung disease: use HRCT
23
Q

risk of CT

Study These Flashcards
A
  • radiation exposure 8 mSv
  • increased CA risk
  • pregnancy exposure
  • body habitus > 450 lbs
24
Q

CT chest and CT chest with contrast can be approximated to have the radiation exposure equivalent to how many plain chest xrays

Study These Flashcards
A
  • CT chest: 80
  • CT chest with contrast: 150
25
why should CTs be avoided in pediatric patients
* more radiosensitive than adults * increased risk of leukemia and brain tumors with CT scans
26
what are the risks of getting a CT with contrast
* **allergic reaction** * w/in 5-60 min of administration * risk factors: prior reaction, asthma, atopy (NOT shellfish allergy) * can pretreat with prednisone and benadryl * **contrast induced nephropathy**
27
which imaging modality should you use cation with in patients taking metformin (Glucophage)
CT with contrast * hold medication for 48 hours after exam * recheck creat/BUN before restarting * can cause lactic acidosis
28
what is contrast induced nephropathy
* serum creatinine increase \> 25% form baseline or \> 0.5 mg/dL * usually reversible * best treatment is prevention * **caution with impaired kidney function** * **creat \> 1.5 mg/dL or GFR \< 60**
29
when should you check renal function prior to iodine contrast
* age \> 60 yo * history of renal disease * dialysis, single kidney, kidney transplant, renal CA, renal sx * h/o HTN _treated with medication_ * h/o DM * taking metformin
30
which imaging modiality assess vasculature in the body
angiography * CT-\> CTA * MRI-\> MRA * xray with catheter
31
which imaging modality should be used for suspected PE, aortic dissection, superior vena cava syndrome; or vascular malformation
CT pulmonary angiography (CTPA)
32
risks and limitations of CTPA
* can miss sub-segmental PEs * allergy to contrast * nephrotoxicity from contrast * radiation exposure: 10-15 mSv * body habitus \> 450 lbs
33
what imagining modality is the gold standard in evaluation of PE
direct pulmonary angiography
34
describe direct pulmonary angiography technique
* catheter inserted into right femoral or internal jugular vein -\> Rt heart -\> pulm arteries * dye injected; xrays taken * used if V/Q scan or CTPA are inconclusive and high clinical suspicion * invasive and expensive
35
risks of direct pulmonary angiography
* bleeding or hematoma at insertion site * heart arrhythmia * allergic reaction to contrast * impaired kidney function * radiation exposure (5 mSv)
36
benefits of using MRI over CT
* no bone artifact as with CT * no ionizing radiation
37
the following indicate evaluating with what imaging hilar or mediastinal densities, sulcus tumors, possible cysts and lesions of chest wall; allergy to iodinated contrast or renal disease (GFR \<30)
MRI
38
functio of Magnetic resonancy angiograph
* high quality images of many blood vessels * less detailed view of lung parenchyma and diminished spatial resolution compared to CT
39
what is the contrast material used for MRI and MRA
Gadolinium
40
limitations/risk of MRI/MRA
* patient must remain still * claustrophobia * body habitus * risk of nephrogenic systemic fibrosis ( GFR \<15 ml/min)
41
contraindications of MRI/MRA
* pacemaker or defibrillator * metal in eye * clips used in brain aneurysms * cochlear implant
42
when is V/Q scan used
* to evaluate for PE * for pre-op assesment prior to lung resection
43
how does V/Q scan work
emitted radiation is captured by external detectors in 2 phases 1. **IV phase**: technetium-99m labeled to human albumin is injected and follows distribution of blood flow -\> **perfusion** 2. **inhalation phase** -\> radio labeled xenon gas demonstrates distribution of **ventilation**
44
test of choice for diagnosis of PE in pregnant women
V/Q scan
45
benefits of V/Q scan
* allergic reaction is rare * low dose radiation 2-2.5 mSv
46
which imaging is the acquisition of **physiologic images** based on the detection of radiation emitted from FDG (radioactively labeled glucose) which is injected into patient
positron emission tomography (PET)
47
where does FDG (radioactively labeled glucose) accumulate
* is tissues/organs with high metabolic activity (cancer cells\*\*\*) * PET scan most often used to detect CA
48
in a PET scan, patient is scanned and measurements of the uptake are made in standardized uptake value (SUV). and SUV \> **X** raises the possibility of malignancy
SUV \> 2.5
49
limitations of PET scan
* radiation exposure 14 mSv * false results occur with metabolic imbalances * radioactive substance decays quickly * high cost

clinical medicine II exam 2 (7 decks)

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