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Clinical Medicine LAB - Professor Sample > US, Echocardiography, Venous Duplex US > Flashcards

US, Echocardiography, Venous Duplex US Flashcards

(63 cards)

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1
Q

Ultrasound aka?

A

AKA sonography, ultrasonography

Developed in mid-20th century

Narrow beam of high-frequency sound waves

Reflected back (echoed) to the handheld transducer

Reflected back differently by different densities

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2
Q

With US, solid organs are __________?

A

echogenic (white)

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3
Q

With US, fluid filled cysts and fluid are ____-____(echo lucent or anechoic) because they do not reflect

A

echo-free ( black)

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4
Q

US is not useful for ___ and ____?

A

air
bone

Not as clear an image as CT

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5
Q

US advantages?

A

No radiation
Good for obstetric, gynecological, pediatric and testicular conditions

Can view structures at any angle

Less expensive than CT, MRI

Can be performed portably, at bedside

Real-time view
Heart, fetus and other structures

Newer models – better resolution and less expensive

May become part of routine screens in office

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6
Q

US disadvantages?

A

Takes longer to complete
Most take 20-30 minutes

Quality is operator dependent

  • Accuracy is variable
  • Transducer angle varies – not always along strict anatomic planes
  • More difficult to interpret, need to look at surrounding structures

Some tissues are isoechoic
-Reflection is the same though different structures
look similar to surrounding tissue

Some tissues obscured by overlying structures
-Ribs obscure underlying portions of spleen or liver

Quality of image reduced by thick adipose tissue
-thin people easier to look at

Cannot look at bones – too much reflection to see detail

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7
Q

Images that are close to being in the _____ plane should be presented and viewed as if the viewer is standing at the ____ of the patient’s bed (Pt’s right is to viewer’s left)

A

axial
foot

axial view, we are look up throguht the feet

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8
Q

Images that are close to the ________ plane are shown as if the viewer is looking at those sections from the _________ of the supine patient, with the head of the patient to the viewer’s left.

A

sagital

right side

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9
Q

Aortic Aneurysm etiologies ?

A

Atherosclerosis

Infection (mycotic) - rare

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10
Q

Aortic Aneurysm blood flow becomes _________.

A

turbulent

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11
Q

Aortic Aneurysm can be ________ or ________

A

fusiform, saccular

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12
Q

Aortic Aneurysm may be found incidentally by?

A

pulsatile mass on abdominal exam

Or patient can be symptomatic
Abdominal or back pain

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13
Q

Complications with AA?

A

leakage or rupture

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14
Q

AA USPSTF?

A

once for all men 65-75 who have ever smokedp

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15
Q

AA medicare coverage?

A

all men, once, upon receiving Medicare

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16
Q

US of AA?

A

evaluate for size and determines size

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17
Q

Aortic dissection 3 layers?

A

Intima – thin, smooth inner layer
Media – thicker, muscular
Adventitia – outer layer

Dissection is a separation of the layers

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18
Q

Aortic dissection patho?

A

Dissection is a separation of the layers

False lumen forms
Blood can flow through it or thrombose

Patients present with sudden “tearing” chest pain

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19
Q

DeBakey Type 1?

A

Type I – ascending and descending aorta

Originates just above aortic valve
May extend to abdominal aorta

part of A

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20
Q

DeBakey Type 2?

A

Type II – only the ascending

Originates just above the aortic valve

part of A

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21
Q

DeBakey Type 3?

A

Type III – only the descending

Originates distal to the left subclavian artery
May extend to abdominal aorta

part of B

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22
Q

Stanford classification?

A

Type A – ascending

Type B – descending

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23
Q

AD - If carotid arteries are involved, what signs and symptoms are we going to see?

A

CVA

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24
Q

AD - If superior mesenteric artery involved, what signs and symptoms are we going to see?

A

bowel ischemia

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25
AD - If coronary arteries involved , what signs and symptoms are we going to see?
MI
26
For aortic dissection ________________ can be used, but most often diagnosed with _____________ (CTA).
echocardiography CT angiography MRI is too time-consuming US cannot demonstrate aortic branches well
27
US is not good at determining ____ _____ in retroperitoneum.
free blood
28
IF AD In symptomatic patients with uncertain diagnosis– do __, not __.
do a CT not a US is the patient is stable and their kidneys working well then - do a CTA better and more useful in the situation acutely we use US
29
Echocardiography -type- M-mode?
Narrow US beam directed at cardiac structures Observed over time - Time-motion study of structures Considered to be obsolete by many, but an efficient way to record multiple cardiac cycles Real time 2D Real time 3D
30
Echocardiography -type- - color flow doppler?
Numerous sample volumes are overlaid on a 2-D echocardiogram and the direction of flow is recorded on the screen as either red or blue, depending on whether the flow direction was towards or away from the transducer. Some indication of the velocity is given by the brightness of the color. Flow which is turbulent, having no definite direction, is displayed as a third color, e.g. green or yellow. blue is away
31
Echocardiography-types- TTE?
Transthoracic echocardiography: Close to anterior heart A type of 2D real-time
32
Echocardiography-types- TEE?
Transesophageal echocardiography better images of STABLE aneurysm Oral or nasogastric probe Close to posterior heart
33
TEE?
invasively Endoscopic ultrasound transducer Inserted orally or nasogastric, advanced into esophagus Good for evaluating posterior heart Can be done at bedside
34
Indications for Echocardiography? US of heart indications?
Ventricular function Wall thickness and motion Valvular heart disease - movement of leaflets, blood flow Atrial septal defect Ventricular septal defect Pericarditis Pericardial effusion Pericardial effusion vs. pleural effusion Cardiac tamponade Aortic dissection (but CT angiography faster)
35
Heart failure can affect?
wall thickness | wall motion
36
Echo - Ejection fraction?
Measurement of how much blood the LV pumps out with each contraction many ways to determine EF but US is the mainstay - standard
37
Normal EF?
55-70% E.g. of 60 means 60% of total amount of blood in LV is pumped out with each contraction
38
EF of 40-55% indicates?
damage - previous MI or from heart failure
39
EF of +75% indicates?
Hypertrophic Cardiomyopathy - HOCM
40
Preserved ejection fraction (HFpEF) – diastolic heart failure?
Heart contracts normally, but ventricles do not relax during systole Ventricles are thick and stiff, hold a smaller amount of blood Percentage is good, but the overall amount is deficient cannot fill
41
Reduced ejection fraction (HFREF) – systolic heart failure?
Heart does not contract effectively during systole Deficient amount of blood pumped can get the blood out cannot squeeze
42
Rheumatic and degenerative changes can affect?
Leaflet function | blood flow
43
Congenital abnormalities that affect blood flow?
ASD | VSDp
44
Pericarditis patho?
Inflammation of the sac around the heart
45
Pericardial Effusion patho?
Collection of fluid in the pericardial sac Can be difficult to determine effusion by CXR Echo helpful in diagnosing pericardial effusion Reflection off heart and off layer of fluid are different
46
Pericardial Tamponade patho?
Acute increase of fluid in the pericardial space. This can be caused by chest trauma, bacterial infection, myocardial rupture, and other occurences that affect the heart's ability to fill during diastole. Ejection fraction drops and the patient can develop a cardiac crisis. Immediate treatment is recommended which may be by pericardiocentesis or by surgery.
 By 2D echocardiography one can note the "swinging heart" inside of the pericardial sac.
47
what is the modality of choice for evaluation of DVT? what did it used to be?
US used to be venogram - contrast material injected US used no contrast material, noninvasive, no pa
48
Venous Duplex US sensitivity and specificity?
sensitivity - 95% | specificity - 98%
49
DVT in what locations puts a patient at risk for PE?
popliteal and common femoral veins
50
DVT of the ____ is not a risk factor for PE, but is a risk for extension of thrombus into deep veins of the thigh
calf lest risk of PE is clot is below the knee
51
Venous Duplex method / procedure?
Pt is supine, slight reverse Trendelenberg position Examine from inguinal ligament to popliteal fossa Popliteal area examined with patient prone, knee slightly flexed
52
When using Venous Duplex in evaluating a DVT be sure to compress and release vein every _ cm?
1
53
When compressing a artery when examine for DVT the ______ should maintain its lumen, and a ____ should compress or "wink".
artery | vein should wink
54
When looking for a DVT and a clot is present, the vein will require more _______ to compress or it will not compress at all.
pressure when technician put pressure on the veins and arteries the artery should not collapse cuSE THE HIGH PRESSURE IN THE ARTERIAL SYSTEM but if the vein does not collapse then we can suspect a DVT. - non compressibility
55
Why are duplex of the ____ veins not usually performed?
calf b/c Many anatomical variations, so time consuming Less accurate Anticoagulation not routinely prescribed anyway Clot often resolves spontaneously 20% will propagate to popliteal or femoral vein – serial evals every 3-5 days in patients who are still symptomatic Llł
56
Limitations to Venous Duplex of LE's?
Iliac and pelvic veins are difficult to evaluate Obesity and severe edema limit exam Saphenous vein (superficial) can be mistaken for the femoral vein (deep) Patient may have collaterals - we can miss a DVT then cause the collateral circulation will a lot the vein to compress even if there is a DVT there Vein may be compressed externally by node or tumor, not clot Difficult to determine acute from chronic DVT -Abnormalities may persist for 6 months
57
Venous duplex LE - CVI - leaky valves?
Common – 20% of American adults, esp women Previous DVT is an important risk factor
58
CVI diagnosis tool?
Duplex US
59
What is used to map VV?
Duplex US
60
What is used to locate the level or venous reflux?
Dulex US
61
Duplex US also guides _____________ treatments
percutaneous
62
Venous duplex US for CVI is don't with patient in what position?
standing Also used as preoperative evaluation for autologous vein graft
63
CVI patho?
chronic venous engorgement - from valvular insufficiency or venous occlusion

Clinical Medicine LAB - Professor Sample (36 decks)

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