Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

The Patient Pathway > Cardiovascular/respiratory > Flashcards

Cardiovascular/respiratory Flashcards

1
Q

What is the initial/referal/imaging/diagnosis pathway for tumours?

A

GP
CXR - primary lung or Advanced mets
if there is further clinical concern more imaging modalities will be used:
CT/MRI/Radionuclide
Biopsy done under CT or US
Diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is bronchial adenoma?

A

(Covers a wide range of neoplasms)
- can cause obstruction
typically late diagnosis due to lack of symptoms
Rare cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What imaging modalities are used for bronchial adenoma?

A

CT is the most commonly used/useful:
Virtual bronchoscopy
Biopsy
However MRI is used if CT is unclear
- not first line due to length of time:
movement artefacts
- main use for pancoast (apical) tumour - subset of lung carcinoma invasion of the chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment for a bronchial adenoma?

A

Chemo for Mets
Radiotherapy for singular area/lesion (depends on size)
Biopsy results:
Small cell carcinoma:
chemo +/- radiotherapy
bronchial (invasion of airway):
stent - palliative
Excision - depends on complexity/vascularity:
Small (wedge) resection
lobar
whole lung
Radiofrequency ablation (can only be used in certain areas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the imaging pathway for lung carcinoma?

A

X-Ray of chest - diagnosis is not definitive
CT non-con
CT and IV contrast - chest + liver (primary and secondary mets)
MRI is superior for chest wall invasion:
assesses size/location/identifies liver mets (staging)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the advantages of using PET/CT imaging lung carcinoma?

A
  • More accurate than CT alone
  • Highly sensitive in picking up metabolic deposits
  • PET can identify the extent of the disease at initial diagnosis:
  • Essential for surgical/treatment planning
    to assess spread
    -PET is more accurate than CT in assessing spread and stage
  • And is more cost-effective in terms of determining if a tumour is operable or non-operable
  • PET is useful in determining lung tumour response to therapy and detecting recurrence in successfully treated lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the disadvantages of PET/CT in imaging lung carcinoma?

A

Not readily available
Time-consuming
Costly
High dose
Slower throughput (waiting list)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the use (Why) of CT-guided biopsy in lung cancers?

A

Accurate location means an accurate sample
Avoids major anatomical structures (nerves/peritoneal/major blood vessels)
CT fluoroscopy interventional - used with fluoro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the advantages of fine needle aspiration?

A

Less invasive than core biopsy
Less tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risks associated with lung biopsies?

A

bleeding
pnuemothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the advantages of CT fluoroscopy?

A

do not need to move in/out of room constantly
save images for reporting - reducing radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is an endobronchial ultrasound used for?

A

Bronchoscopic technique
used for submucosal tumour for example

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Future trend in imaging of lung tumours?

A

CT virtual imaging:
computer software programme
creates 3D environment from 2D CT scans
High resolution
Narrow collimation resulting in increased dose
overlapping needed for reconstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Lung radiofrequency ablation + what is it used for?

A

under imaging guidance - needles inserted into lesion - the tip of the needles/electrodes are then heated for controlled burning
used for early-stage lung cancer
or as palliative pain relief for inoperable cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is Lung radiofrequency ablation contraindicated?

A

in patients with tumours that are adjacent to the:
- Mediastinum
- Airways
- Oesophagus
- Large blood vessels (aorta)

Pace makers must be evaluated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the process for Lung radiofrequency ablation + prep + why?

A

Preliminary images are used to assess best access route:
To avoid structures such as:
Ribs
fissures
Brachial Plexus
central bronchi
large blood vessels (aorta)

CT guidance - patient is under sedation (LA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the post-op care for patients after Lung radiofrequency ablation?

A

CXR at 1hr and 3hr to check for pneumothorax (occurs in 30% of cases)

Night observation

Prescribed analgesic narcotics (for pleuritic pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What imaging modalities are most useful for imaging the vascular structures?

A

CTA
MRA
US doppler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is interventonal imaging used for?

A

Diagnostic and therapeutic interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the benefits of interventional radiography?

A

Less invasive than surgery so risks are reduced

Available, must have access to an interventional suite at all hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is needed staff wise for coronary and for peripheral vascular interventions?

A

Coronary:
Cardiologist
Radiologist
Radiographer
Nursing staff

Peripheral:
Radiologist
Radiographer
Nursing staff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the gold standard imaging done in interventional?

A

Arteriography/angio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is CTA/MRA used in vascular imaging/treatment?

A

Assessment tool used prior to intervention:
provide info about:
what intervention is needed
detail about blockage:
what it is
location
size

This means that in the suite only the intervention needs to be focussed on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the advantages of CTA in vascular imaging compared to interventional?

A

Less invasive
less prep required
Although may need to use interventional regardless if intervention is required
3D/MIP to visualise arterial structures and contrast flow in one image (pelvis to toes)
follow up on stent without contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What imaging and treatment can be used for cardiac/coronary vascular structures?
percutaneous coronary angiography PTCA - percutaneous transluminal coronary angioplasty
26
Explain the procedure of a CTA used for cardiac imaging?
Requires fast acquisition + Gated (ECG) = Image taken within 1 heartbeat to reduce movement artefacts Fast heart rate, Beta blockers can be administered to slow down heart rate Contrast can be triggered by HU using ROI to get most optimised highlighting from contrast Calcium score can be calculated (pre-contrast) which can predict a cardiac event or explain patient symptoms
27
Advantages of CTA used for cardiac imaging?
Ventricles dynamics are assessed Function and anatomy only requires 5 cardiac cycles
28
Explain the use of an MRA for cardiac imaging.
Assesses valves functionality Dynamic studies: the flow of blood through the heart
29
Avantages of MRI for cardiac imaging.
Contrast media is not always essential Depends on local protocol
30
MRA/CTA how are movement issues solved?
Gated studies ROI trigger
31
Discuss the use of NM in the imaging of CAD? when? what does it look at/see?
Diagnose and assess CAD: ischemia Cardiomyopathy Possible damage to the heart Reversible ischemia? - Visualise blood flow pattern to cardiac walls (Myocardial perfusion scan) - The extent of injury after an attack/myocardial infarction - Evaluates the results of bypass surgery or other revascularization intervention designed to restore blood flow (angioplasty/catheter) + with ECG - heart wall movement and function
32
what conditions is Myocardial perfusion scan done under and what can it identify?
Rest v Stressed = compared can identify hibernating myocardium and reversible ischemic damage
33
What is a MUGA scan and why is it used?
Multi-Gated-Acquisition Assesses left ventricular fraction rate assessed pre-chemo (as chemo affects the rate) Process: Red blood cells are labelled MIN and MAX ROI are captured and assessed to assess functionality
34
What is a future trend imaging for cardiac/coronary imaging?
Rubidium PET/CT - assesses cardiac function More sensitive and specific for myocardial viability Done at stress and rest Short half life at 75 secs Expensive
35
What is a echocardiography + what is it used for?
Cardiac ultrasound - heart and surroundingv structures imaged Diagnosis/management/follow up - used alongside other imaging modalities
36
What does an echocardiography see in images?
Chamber size wall thickness motion proximal vessels size and location of heart chamber
37
What does an echocardiography assess?
Assess: location and the extent of tissue damage The function of heart: pumping capacity Calculation of cardiac output Ejection fraction diastolic function
38
What does an echocardiography pick up abnormality wise?
Doppler: heart flow and efficiency abnormalities: eddy currents regurgitation hypertrophic dilated
39
What are the positives of echocardiography?
Non invasive no side effects
40
What is a trans oesophageal echocardiography? when is it used?
Echocardiography done through mouth Used when normal echocardiography is inconclusive or further detail is required
41
what is an exception for an echocardiography being non-invasive? what is the benefit?
Trans-oesophageal echocardiography 3D echocardiography + 4D Detailed anatomical assessment of cardiac pathology Such as: Valvular defects Cardiomyopathies
42
What is the gold standard imaging for peripheral vascular imaging?
Interventional
43
What prep will a coronary angiogram require? And what final image is required?
Vascular access Monitoring Room prep - scrub Must be available for emergency/acute situations Peripheral run-off
44
Why cant DSA be used on Interventional angiograms?
Movement - panning movement
45
What is angioplasty?
The use of balloons and stents to open vessels (ensure patency) ballons and stents can be tailored to the length and
46
What is the indication of a successful stent?
Patent vessels/blood flow less than 30% of residual plaque left behind
47
What are complications that can occur from angioplasty?
Perforation occlusion of artery/collaterals Haematoma Increased aneurysm risk Follow up imaging is essential
48
What can be done for CAD if angioplasty fails?
Surgery: Mechanical removal of plaque - peripheral CABG - coronary Drug-eluting stent: antiproliferative drug (anti-clotting) Prevents: scar tissue/narrowing
49
Future trend in treatment of blockages of vessels?
Drug-eluting stent: antiproliferative drug (anti-clotting) Prevents: scar tissue/narrowing Peripherals
50
What is C02 angiography?
C02 is used as an alternative for iodine contrast (used for contraindications)
51
What are the advantages for C02 angiography?
Used for patients with contraindications to iodine No allergic reactions
52
What are the limitations for C02 angiography?
Can only be used below diaphragm: increased risk of embolisation to spinal/coronal/cerebral arteries Less viscous + lighter than blood plasma in larger vessels not dispersed evenly Image quality slightly reduced May cause nausea/pain for aortograms/coeliac arteriography (for a few mins)
53
How is CTA used for imaging inflammation?
CTA: assess inflammation changes on fat around coronary arteries Use of colourisation Create a CT fat attenuation index - predict potential heart attack
54
What is aortitis?
Inflammtion of the aorta
55
What is used in the imaging of aortitis?
PET/CT: functionality to detect inflammation
56
Thrombus in artery treatment if interventional does not work?
Surgical alternative: peripheral vascular endarterectomy (pelvic bypass graft) CABG: Coronary artery bypass graft Requires GA Invasive more risk longer recovary time/hospital stay Graft patency and PTCA follow up
57
ANUERYSM screening/imaging?
Targeted screening program for AAA US Measure artery - compare to what should be normal VASCULAR SURGEON CONSULTS CTA: Assessing planning approaches Follow up 3D MIP MRA
58
EVAR?
tailor the size, dimensions of the stent, - which is used to support the vessel wall redirect blood flow in hopes to prevent anuersym rupturing to previous images Placed in vascular/interventional suite
59
What is CT volume rendering?
3D
60
What is the initial/referring pathway for DVT?
Emergency A/E GP -> A/E Then referred for further imaging
61
what imaging modalities are used for DVT?
First line: us dopler OR CT Interventional: Stents Inferior vena cavography MRI to see extent of ischemia
62
What treatment is used for DVT?
Anticoagulant drugs: IV heparin followed by oral warfarin IVC filter
63
What are the limitations of anticoagulant drugs in the treatment of DVT?
Patients at risk of haemorrhage: stroke recent surgery ongoing/active bleeeding
64
What is an IVC filter?
Metal pieces of equipment are inserted to catch and trap blood clots Can be permanent or temporary
65
What are essential qualities IVC filters must have?
Ease of placement and removal if temp clot trapping effectiveness ability to preserve blood flow Non-thrombogenic - maintain caval patency Durable and non-corrosive material shape and structural integrity must still work even in a suboptimal position should not migrate no perforation of IVC antiferromagnetic - so can be scanned in mri Trap most or all clots (preventing new or recurrent PE)
66
How is IVC placed?
Interventional procedure + US if needed Inferior vena cavography - before to assess iVC femoral vain Pigtail catheter for illiac vins DSA + roadmapping AP or biplane (lateral\)
67
How is the diameter of the IVC determined in different modalities?
Fluoro (DSA): Ruler with metallic markings - along left side of patient Marker catheters Guidewires Internal software calibration Typically other imaging modalities are used for a more accurate measurement: CT and MRI: visualise: size configuration anatomic variants potentially to monitor IVC after deployment
68
PE imaging pathway?
Chest x-ray: Preliminary investigation Dmonstrates: consilidation pleural effusion However, it does not exclude PE VQ (ventilation/perfusion) scan: Can only exclude clinically significant PE Is not useful for patient without COPD or Consilidation CTPA (done out of hours and most available so will be most commonly done): Reliably exclude clinically significant PE if VQ is inconclusive or alternative to VQ Transoesophageal echocardiography (not an alternative but in connection with CT)
68
Explain the VQ NM scan for PE?
2 Scans: Ventilation phase - radioactive gas Perfusion phase - injection of radioactive Difference/mismatch will demonstrate emboli
69
what does LPO/RPO stand for NM VQ:
Left posterior oblique etc.
70
Disadvantage of MRI for PE?
Long scan PE -struggling to breath so would be unable to hold their breath ALSO Emergency situation
71
How is US useful in imaging/detecting PE?
Difficult to detect emboli However is useful in terms of DVT and can detect if PE could be a complication
72
how does the outcome of the CXR impact the imaging modality used next for a PE?
CXR + go for CTPA CXR - go for a VQ scan
73
What is a dissection?
When blood enters the wall of the artery between the layers and creates a cavity/false lumen in the vessel wall Can rupture; leading to bleeding out
74
Imaging pathway dor dissection?
CTA initial alongside us However if high-risk injury Fluoro - interventional first
75
Treatment for dissection?
Stent or surgery Haematoma/bleeding out: Embolisation - deployment of material distally to cut off bleeding to reduce damage (materials such as particles/gel foams/coils)
76
What soft tissue structures are nearby CT - identify extravasation US Interventional - identify specific vessel
77
CT virtual imaging for dissection?
detection diagnosis surgical planning virtual intra-arterial angiography DSA see inside vessel and compare to dsa used to compliment
78
Endovascular ultrasound in the imaging of dissection/vessels?
Can evaluate normal and abnormal vascular anatomy from an endoluminal position (can look at the different layers/wall) Angio can only be used on lumen Miniature US probe on catheter Can determine amount of atheromatous plaque or stenosis which can be done at the same time as an angio Can be used alongside other modalities for a more accurate procedure/type + size of devices and the device deployment + position
79
What is a 3D fluoroscopic arteriography?
fast specific c-arm movements to produce 3D images from 2D used in: carotid cerebral cardiac pelvic
80
What are the limitations for 3D fluoroscopic arteriography?
Limitations: cost increased dose
81
What are the advantages for 3D fluoroscopic arteriography?
Advantage: only need to use CM once CVA - time is brain: quicker to prevent damage
82
Therapeutic hypothermia with coronary angioplasty What is it used for, how and why?
STEMI - ST-elevation myocardial infarction - normally use angioplasty Reducing body temp to try and reduce damage Interventional procedure: done by using via cooling catheter in the vena cava whilst external temp is maintained with warming blankets
83
Interventional image guided mechanical thrombectomy What is it used for, how and why?
Alternative to surgical mechanical thrombectomy Under fluoroscopy stent retriever devices is used CVA (Ischemic) intervention time-sensitive Used when: more severe CVA and when thrombolysis/drug thinning drugs will be ineffective To reduce: risk time for treatment
84
Hybrid imaging in interventional? What and why?
CT + fluoro Reduce time: CT first line to interventional Limitations: cost staff lack of use of ct
85
List of heart/ cardiac problems?
Tachycardia Bradycardia SVT - arterioventicular node AF - flutter Heart block - pathway interrupted Wolff Parkison white syndrome wpw - abnormal pathway
86
How are cardiac pathways mapped?
Triggered using internal catheters which monitor pre-treatment (under fluoroscopic guidance)
87
Treatment for cardiac arrhythmias?
Atrial fibrillation - cardioversion treatment done in the cath lab - may not need cath lab monitoring is needed after may present initial success may need further treatment such as a pacemaker - inserted under fluoroscopy For: bradycardia cardiac arrest heart block (1-3 leads)
88
ICD what is it and what does it do?
Implantable cardioverter defibrillator constant small shock simillar (cardioversion) larger shock (defibrillation) Prevents sudden death syndrome
89
future trends with pacemakers?
Pacemaker with no leads
90
What is RFA and how is it applied to cardiac pathway treatment? how is it done?
Radio frequency ablation Non surgical used on rapid heartbeat (arrhythmia) look for accessory pathways that may be disrupting the cardiac pathway radiofrequency wave is then applied to restore the normal rhythm heart muscle cells are destroyed and can be repeated Successful 90-95% of patients with recurring WPW uncommon 2-3% have complications Under fluoro - catheter - road map (colourised) - try to find or trigger abnormal rhythm - patient can communicate - RFA done (can take from 3-4 hrs but can be longer) 10% - recurrence
91
Lung infection imaging modalities:
Initially CXR CT - esp if CXR is not definitive US - differentiate between consolidation and pleural effusion
92
What is bronchiectasis?
Dilation of bronchioles leads to an increased amount of mucous Increases the risk of lung infection Damage is permanent
93
What is the treatment for bronchiectasis?
Medication to keep airways open: Nebulisers oxygen Respiratory exercises postural drainage Tram line radiographic appearance
94
What is a lung abscess?
Necrosis of lung tissue. development of a cavity which fills with necrotic debris (or fluid)
95
What is pericarditis?
An inflammation of the membrane that surrounds the heart Caused by infection metastatic disease kidney disease radiation therapy recent heart attack
96
What imaging is used for pericarditis\?
CT and MRI: demonstrate pericardium surrounding the heart CT - calcifications US - demonstrate fluid
97
What imaging modalities are used for a pleural effusion?
CXR - for detection, not characterisation CT/US - further definition/assessment of cause echo-free space MRI - if CT is not definitive/unclear Pleural effusion moves
98
Why is US so useful for imaging pleural effusions?
US - locates small or large amounts of fluid isolated loculated pockets of fluid locates fluid - can be used to guide drainage - shows exact location echo-free space between the visceral and parietal pleurae
99
What is the treatment for a pleural effusion?
percutaneous abscess drainage: done under image guidance - ct - us - fluoroscopy needle then guidewire then drainage tube (guidewire removed) then an external drainage bag is connected maybe a biopsy (for pneumonia)
100
What is cardiac tamponade?
Abnormal accumulation of blood or fluid in the pericardial sac heart is compressed great vessels enlarged
101
What imaging is used for cardiac tamponade?
US (echocardiography): demonstrates fluid level and its location
102
What is the treatment for cardiac tamponade?
MEDICAL EMERGENCY may be done blind Needle aspiration image guidance: Echocardiography +/- fluoroscopy positioned semi-recumbant precise needle position drainage via a catheter (in situ for 1-2 days) Underlying conditions need assessed
103
What imaging is used for pulmonary oedema?
CXR
104
What is pulmonary oedema?
Build up of fluid in the alveoli fluid leaks into the lungs Can result from heart failure (poor circulation and changes in pressure)
105
What is the treatment for pulmonary oedema?
Oxygen Diuretics - short term Diagnosing and treating underlying cause
105
What is a haemo/pneumothorax?
The presence of air and/or blood in the pleural space
106
What is the imaging used for a haemo/pneumothorax?
Initially CXR assessment and follow up Follow-up CT to see the extent (esp if patient cannot move from a supine position) Trauma-related: FAST CT
107
What is the treatment for a haemo/pneumothorax?
medium or large will require intervention tension pneumothorax Chest drain Thoracotomy: used to drain large amounts as well as to locate the origin of the bleed
108
what is the imaging pathway for covid?
Initial CXR - cannot exclude covid CT if more complex to assess respiratory
109

The Patient Pathway (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions