Basic Radiographic Interpretation and Mechanical Circulatory Devices

Question 1

What typically shows up as a white to light gray color on an x-ray of the human body?

Answer 1

Bone

Question 2

T/F: The left side of the diaphragm is always higher than the right side.

Answer 2

False

Question 3

Your patient has a tension pneumothorax. Would you expect for the diaphragm to be elevated or depressed on the chest x-ray?

Answer 3

Depressed

Question 4

In relation to the carina, where would you expect a properly placed endotracheal tube to be on an x-ray?

Answer 4

A properly placed endotracheal tube should be 3-7 cm above the carina

Question 5

You observe a “steeple sign” on a pediatric x-ray. What condition should you suspect?

Answer 5

Croup

Question 6

You are transporting a 14-year-old multi-trauma patient that was trampled by a horse. Your patient is intubated and mechanically ventilated. Upon reviewing the patient’s chest x-ray you notice a large black crescent over the apex of the left lung. What should you suspect?

Answer 6

Collapsed left lung

Question 7

You are participating in monthly quality assurance and you are reviewing run reports. You notice that a crew member described a chest x-ray as having “the presence of cardiomegaly, shaggy appearance around the heart boarder, and the presence of Kerley-B lines”. Based on this description, what condition does this indicate?

Answer 7

Congestive heart failure

Question 8

On a PA film, the normal heart your be no more than ____% width of the film (otherwise it would indicate cardiomegaly).

Answer 8

50

Question 9

T/F: On a head CT, black spots typically indicate an infarct or old blood.

Answer 9

True

Question 10

T/F: On a head CT, white spots typically indicate acute bleeding.

Answer 10

True

Question 11

T/F: Coronary blood flow increases during systole.

Answer 11

False, coronary blood flow increases during diastole.

Question 12

_________ is the amount of blood pumped out of the left ventricle during each cycle.

Answer 12

Ejection fraction

Question 13

What is the equation for calculating cardiac output?

Answer 13

Cardiac output = stroke volume x heart rate

Question 14

T/F: The primary benefit to the intra-aortic balloon pump (IABP) is that it corrects a supply versus demand mismatch in the heart.

Answer 14

True

Question 15

Your patient has an intra-aortic balloon pump (IABP). You know that the IABP will __________ this patient’s afterload.

Answer 15

decrease

Question 16

The proper positioning of the intra-aortic balloon pump (IABP) after insertion is _____cm _________ the subclavian artery.

Answer 16

1 - 2, below

Question 17

Which of the following patients would be a candidate for an intra-aortic balloon pump (IABP)?

a) A patient with a history of SVT
b) A patient with a congenital heart defect
c) A patient with unstable angina
d) A patient who is in hemorrhagic shock following a motor vehicle accident

Answer 17

c) A patient with unstable angina

Question 18

Which of the following represents an absolute contraindication for the intra-aortic balloon pump (IABP)?

a) Cardiogenic shock refractory to pressors
b) Cardiac tamponade
c) Patients under the age of 18
d) Severe aortic valve insufficiency

Answer 18

d) Severe aortic valve insufficiency

Question 19

You observe what appears to be rust in the intra-aortic balloon pump (IABP) tubing. What should you suspect that is?

Answer 19

Blood in the tubing

Question 20

If the machine fails for an intra-aortic balloon pump (IABP) and the balloon become immobile, it must be inflated by hand every ______ minutes.

Answer 20

5 - 10

Question 21

How much air or helium should be in the syringe that is used to manually inflate the IABP balloon in the event of failure?

Answer 21

60

Question 22

What part of the EKG is used by the IABP to determine balloon inflation?

Answer 22

R wave

Question 23

Which of the following patients would be a candidate for ECMO?

a) A patient waiting for cardiac surgery that has very low cardiac output with end-organ damage
b) A patient with advanced multi-system organ failure
c) A patient in septic shock who is unresponsive to other treatments
d) A patient who is in severe metabolic acidosis with low cardiac output

Answer 23

a) A patient waiting for cardiac surgery that has very low cardiac output with end-organ damage

Question 24

T/F: In ECMO patients, there should be hourly assessments of neurovascular status in cannulated limbs and hourly assessment of urine output.

Answer 24

True

Question 25

Which of the following statements best describes the purpose of a ventricular assist device (VAD)?

a) It is designed to replace all the functions of the heart
b) It must only be used in conjunction with a pacemaker
c) it only assists the right ventricle
d) It decreases the workload of the heart while maintaining adequate flow and blood pressure

Answer 25

d) It decreases the workload of the heart while maintaining adequate flow and blood pressure

Question 26

You are transporting a patient with a ventricular assist device (VAD). As you are auscultating heart tones, you note that the VAD is making a knocking sound. You should suspect that this indicates:

Answer 26

that the patient is hypotensive or that the VAD is in overdrive (suckdown)

Question 27

T/F: A patient with a ventricular assist device (VAD) can be in a lethal arrhythmia and still be hemodynamically stable.

Answer 27

True

Question 28

T/F: The loss of peripheral pulses in a patient with a ventricular assist device (VAD) always indicates shock or cardiac arrest.

Answer 28

False

Question 29

What is the first-line treatment of an unstable ventricular assist device (VAD) patient?

Answer 29

attempt volume resusitation