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Principles 2 A > Exam 1 - Radiation and Laser Safety > Flashcards

Exam 1 - Radiation and Laser Safety Flashcards

1
Q

What are the 4 types of radiation?

A

electromagnetic, mechanical, nuclear (neutron), and cosmic (beta)

xray is considered electromagnetic..

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2
Q

What kind of radiation only travels through substances?
A. cosmic
B. electromagnetic
C. mechanical
D. nuclear

A

C. mechanical

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3
Q

What kind of radiation comes from unstable atom nuclei?
A. cosmic
B. electromagnetic
C. mechanical
D. nuclear

A

D. nuclear

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4
Q

What kind of radiation comes from electrons only, like from sun rays?
A. cosmic
B. electromagnetic
C. mechanical
D. nuclear

A

A. cosmic

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5
Q

Non-ionizing radiation can be described as: select 2.
A. electrons are knocked off the atoms
B. harmful only due to heat energy
C. doesn’t break molecular bonds
D. ion electrical charges cause intracellular chemical reactions

A

B. harmful only due to heat energy
C. doesn’t break molecular bonds

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6
Q

Ionizing radiation is bad because:
A. of the harmful heat energy like radiowaves or microwaves
B. it only travels through substances
C. electrons are knocked off atoms creating ions with electrical charges
D. it is almost at the speed of light

A

C. electrons are knocked off atoms creating ions with electrical charges

which cause intracellular chemical reactions… like cell death, cancer, birth defects

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7
Q

What differentiates x-rays and visible light rays?
A. presence of photons
B. wavelength
C. unstable atom nuclei
D. one is electromagnetic energy and one is not

A

B. wavelength (the energy level!)

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8
Q

Place in chronological order:

How is light emitted?

  1. electron jumps to a higher orbit
  2. moving particles excite atoms
  3. electron falls back to original orbit and releases a photon
A

first: (2) moving particles excite atoms
then, (1) electron jumps to a higher orbit
third, (3) electron falls back to original orbit and releases a photon (energy)

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9
Q

What type of tissue is less likely to absorb xray photons?
A. bone
B. skin
C. pathologic
D. soft

A

D. soft tissue b/c it has small atoms

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10
Q

What tissue is more likely to absorb xray photons?
A. soft
B. bones
C. masses
D. muscle

A

B. bones

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11
Q

What describes a cathode? select 2.
A. positively charged
B. filament in center and current heats the filament
C. attracts electrons
D. made of tungsten
E. heat causes electrons to fly off the filament

A

B. filament in center and current heats the filament
E. heat causes electrons to fly off the filament

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12
Q

An anode is: select 3.

A. negatively charged
B. positively charged
C. made of tungsten
D. attracts electrons across the tube
E. has a filament in center

A

B. positively charged
C. made of tungsten
D. attracts electrons across the tube

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13
Q

How do the photons escape the xray machine to create our picture?

A

a window in the shield that surrounds the machine allows a narrow beam of photons to escape
- then a camera on opposite side records the pattern of photons

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14
Q

T/F: Ambient light does not alter the appearance of xray imaging.

A

false - ambient light can darken or lighten the image!

and intense changes to beam can cause over/under exposure

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15
Q

Computed tomography (CT) is x-ray combined with ____ to generate a 3D image.
A. foreign objects
B. contrast
C. real time recording
D. computer processing

A

D. Computed tomography (CT) is x-ray combined with computer processing to generate a 3D image.

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16
Q

What is a therapeutic use of x-ray?
A. mammography
B. fluoroscopy
C. radiation
D. computed tomography

A

C. radiation therapy to damage cancer cell DNA with a much higher dose

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17
Q

What is the most common side effect of radiation therapy (from the chart provided in lecture)?
A. diarrhea
B. hair loss
C. fatigue
D. N/V

A

C. fatigue

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18
Q

What is the annual allowable dose for whole body?
A. 15,000 mrem
B. 50,000 mrem
C. 5000 mrem
D. 500 mrem

A

C. 5000 mrem

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19
Q

What is the annual allowable dose for extremities?
A. 15,000 mrem
B. 50,000 mrem
C. 5000 mrem
D. 500 mrem

A

B. 50,000 mrem

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20
Q

What is the annual allowable dose for the lens of eye?
A. 15,000 mrem
B. 50,000 mrem
C. 5000 mrem
D. 500 mrem

A

A. 15,000 mrem

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21
Q

What is the annual allowable dose for pregnancy?
A. 15,000 mrem
B. 50,000 mrem
C. 5000 mrem
D. 500 mrem

A

D. 500 mrem and preferably after 2nd trimester

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22
Q

What are the 2 direct sources of radiation?
A. primary xray beams
B. scattered radiation
C. leakage from other sites within the equipment
D. reflection off tables and patients

A

A. primary xray beams
C. leakage from other sites within the equipment

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23
Q

Which diagnostic imaging has the highest leakage of radiation?
A. CXR
B. CT
C. coronary angiogram
D. angioplasty

A

D. angioplasty (5700 mrem)

  • cxr (5-10 mrem)
  • coronary angio (1500 mrem)
  • ct (5000 mrem - so second most)
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24
Q

What are considered indirect sources of radiation? select 2.
A. primary xray beams
B. scattered radiation
C. reflection off tables, patients, and other surfaces
D. leakage from other sites within the equipment

A

B. scattered radiation
C. reflection off tables, patients, and other surfaces

25
Q

What are the 3 factors of scattered radiation?
A. air gap
B. leakage amount
C. shield size
D. collimation
E. object thickness
F. time

A

A. air gap
D. collimation
E. object thickness

26
Q

At what amount of radiation might transient erythema occur?
A. 150,000 mrem
B. 350,000 mrem
C. 200,000 mrem
D. 500,000 mrem

A

C. 200,000 mrem

27
Q

Less than what dose of radiation is unlikely to cause effects to a fetus after 20 wks gestation?
A. 5,000 mrem
B. 10,000 mrem
C. 15,000 mrem
D. 20,000 mrem

A

B. 10,000 mrem

28
Q

What are the important factors to consider for radiation protection?
A. time
B. distance
C. shielding
D. all of the above

A

D. all of the above!

29
Q

Doubling the distance from the beam will decrease the exposure rate by:
A. 25%
B. 33%
C. 50%
D. 75%

A

D. 75%

30
Q

To protect yourself from scattered radiation, you should attempt to be more than ___ ft from patient.
A. 5 ft
B. 6 ft
C. 10 ft
D. 12 ft

A

B. 6 ft

31
Q

What should you wear to shield yourself from radiation? select 3.
A. lead apron and glasses
B. close toed shoes
C. thyroid shield
D. portable shield
E. face mask
F. dosimeters

A

A. lead apron and glasses
C. thyroid shield
D. portable shield

32
Q

Where are the 2 places you should wear your dosimeters? select 2.
A. outside in the car
B. outside the apron on the collar
C. inside the apron on the chest
D. inside the apron on the waist

A

B. outside the apron on the collar
D. inside the apron on the waist

jk, don’t leave it in your car on dashboard or seat cause it’ll jack it up

33
Q

The magnetic field of a MRI machine is used to:
A. orient nuclei of hydrogen molecules to east-west poles
B. orient nuclei of carbon molecules to east-west poles
C. orient nuclei of hydrogen molecules to north-south poles
D. orient nuclei of carbon molecules to north-south poles

A

C. orient nuclei of hydrogen molecules to north-south poles

34
Q

How is the contrast between tissues generated?
A. by magnets pulling the tissues from their nuclei
B. by time until tissue relaxation when radiofrequency is turned off
C. from spinning of different axis
D. by individual atom nuclei moving in different directions

A

B. by time until tissue relaxation when radiofrequency is turned off

35
Q

In t1, when the magnetic vector relaxes, fat appears ____; water appears ____.

A. bright; dark
B. dark; bright
C. bright; bright
D. dark; white

A

In t1, when the magnetic vector relaxes, fat appears bright; water appears dark. = normal anatomy!!

b/c this provides good grey-white matter contrast

36
Q

When the axial spin relaxes, fat is ____ than water which can identify tissue edema easily.
A. brighter
B. darker
C. rounder
D. thinner

A

When the axial spin relaxes, fat is darker than water which can identify tissue edema easily. = pathology (cysts, tumors, etc) will appear!

37
Q

What is the key component in contrast material?
A. barium
B. tungsten
C. gandolinium
D. iodine

A

C. gandolinium

38
Q

How does gandolinium enhance the quality of MR images?
A. by altering magnetic properties of nearby air molecules
B. by altering magnetic properties of nearby water molecules
C. by altering magnetic properties of nearby carbon molecules
D. by altering magnetic properties of nearby hydrogen molecules

A

B. by altering magnetic properties of nearby water molecules

39
Q

What can we give to relieve the mild side effects (itching, rash, abnormal skin sensation) of contrast?

A

Diphenhydramine (benadryl) 25 mg IV

40
Q

What do ferromagnetic objects experience within the magnetic field? select 2.
A. centripetal force
B. attractive force
C. jolts
D. torque

A

B. attractive force
D. torque

41
Q

What are some risks in MRI regarding the magnetic field? select 3.
A. altered oxygen delivery
B. extremely loud
C. patient claustrophobia
D. tissue/device heating
E. crash cart may be unavailable
F. ECG artifact

A

B. extremely loud - need hearing protectors for CRNA and patient
D. tissue/device heating - from RF energy
F. ECG artifact - from electromagnetic interference

AND projectile risk (think of image with bed flung inside machine)

42
Q

What are anesthesia considerations for MRI? select 3.

A. minimize movement
B. do not use ventilator inside of MRI machine room
C. prepare really long IV tubing
D. must do induction in separate room
E. o2 cannula must be removed before entering
F. suction in seperate room since tubing is incompatible

A

A. minimize movement
C. prepare really long IV tubing unless you have MRI compatible infusion pumps:)
D. induction in separate room

43
Q

What should the CRNA remember about positioning for abdominal scans in MRI?
A. arms placed palms up at pt’s side
B. brachial plexus injury could occur
C. airway is inaccessible
D. sciatic nerve injury is common

A

B. Brachial plexus injuries because arms are over head

44
Q

What should the CRNA remember about positioning for head/neck scans in MRI?

A. arms placed palms up at pt’s side
B. brachial plexus injury could occur
C. airway is inaccessible
D. ventilator should be on opposite side so requires extension tubing

A

C. airway is inaccessible

45
Q

Rapid movement toward magnetic field can cause: select 3.
A. dizziness and headache
B. concussion
C. light flashes
D. disorientation
E. nausea
F. eye pain

A

A. dizziness and HA
C. light flases
E. nausea

46
Q

What 3 devices are NOT compatible with MRI?

A

pacemakers, AICDs, and implanted insulin pumps

47
Q

What is considered OK immediately for MRI?
A. heart valves
B. endovascular and biliary stents
C. IVC filters
D. coronary stents

A

D. coronary stents

48
Q

What type of orthopedic implants are safe for MRI?

A

titanium - but screws may cause image artifact b/c they’re made of lead

49
Q

Properties of laser radiation include: select 3.
A. polychromatic
B. incoherence
C. monochromatic
D. coherence
E. focus on large area
F. collimation

A

C. monochromatic
D. coherence
F. collimation

50
Q

The most powerful lasing medium which is used for tumor debulking is:
A. tungsten
B. carbon dioxide
C. argon
D. Nd:YAG

A

D. Nd:YAG (neodymium-doped yttrium aluminum garnet)

for deeper tissue penetration (2-6mm)

51
Q

The lasing medium with modest tissue penetration commonly used in derm is:
A. tungsten
B. carbon dioxide
C. argon
D. Nd:YAG

A

C. argon

modest tissue penetration (0.05 - 2mm)

52
Q

Describe carbon dioxide as a lasing medium. Select 3.
A. used in derm
B. disperses little heat so surrounding tissue damage is negligible
C. great for vocal cords, oropharynx
D. most powerful
E. scatter is minimal
F. used for tumor debulking

A

B. disperses little heat so surrounding tissue damage is negligible
C. great for vocal cords, oropharynx
E. scatter is minimal

53
Q

What are the 2 biggest hazards of using laser? (starred by mordecai in her ppt)
A. embolism
B. inappropriate energy transfer
C. atmospheric contamination
D. airway fire

A

C. atmospheric contamination
D. airway fire

54
Q

What are key considerations about the laser plume causing atmospheric contamination? select 2.
A. could cause pulmonary embolism
B. fine particulates are produced from vaporization of tissue
C. is not carcinogenic
D. HA and nausea can occur after inhalation

A

B. fine particulates are produced from vaporization of tissue
D. HA and nausea can occur after inhalation

ALSO:
* could be carcinogenic
* could cause interstitial pneumonia, bronchiolitis, emphysema

55
Q

What is NOT considered a part of generic laser safety?
A. windows covered
B. laser glasses for provider
C. tent drapes to control air flow
D. water/saline irrigation on back table
E. laser glasses for patient w/ eyes taped

A

C. tent drapes to control air flow

do NOT tent drapes/have pockets of oxygen!

56
Q

What is the fire triad?
A. laser, fire, oxidizer
B. ignition source, fuel, oxidizer
C. airflow, fuel, oxidizer
D. spark, fire, oxygen flow

A

B. ignition source, fuel, oxidizer

57
Q

Select 3 tips for airway fire safety:
A. deflate ETT cuff during lasering
B. low FiO2 (21% if possible)
C. methylene blue in the ETT cuff
D. use an LMA instead
E. ask surgeon to use scissors/scalpel instead of bovie
F. dry pledgets around the ETT

A

B. low FiO2 (21% if possible)
C. methylene blue in the ETT cuff
E. ask surgeon to use scissors/scalpel instead of bovie

also:
* Laser-resistant ETTs
* Wet pledgets around the ETT
* Remove ETT during laser procedure and reinsert ETT prn sats

58
Q

What are some anesthesia considerations to prevent airway fires? select 3.
A. volatile anesthetics only
B. FiO2 30-35%
C. intermittent apneic oxygenation
D. TIVA
E. avoid nitrous
F. do not use saline gauze protection

A

C. intermittent apneic oxygenation and/or jet ventilation
D. TIVA (prop, remi, precedex)
E. avoid nitrous

Also:
* Preop evaluation of airway
* methylene blue in cuff
* saline gauze protection of airway/face
* short, repeated pulses of laser
* o2 < 30%
* communicate and monitor video camera for signs of airway fire

59
Q

How fast is contrast cleared by someone with a normal GFR?

A

24 hrs

Principles 2 A (21 decks)

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