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Clinical Medicine 2 > Exam 2: Pulmonary Diagnostic Imaging > Flashcards

Exam 2: Pulmonary Diagnostic Imaging Flashcards

1
Q

What pulmonary diagnostic tests do not have any radiation?

A

US, MRI, and bronchoscopy

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2
Q

What is the initial study to evaluate respiratory problems?

A

CXR

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3
Q

What are the indications for CXR?

A

SOB, persistent cough, hemoptysis, chest pain, and fever

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4
Q

What is an AP vs PA CXR view?

A

PA: beam coming from behind
AP: beam coming from front

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5
Q

What is the systematic approach to reading a CXR

A 
A: Airway
B: Bones
C: Cardiac silhouette
D: Diaphragms
E:Edges
F: Fields
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6
Q

What is the apical lordotic view used for?

A

Potential TB

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7
Q

What is Hampton’s hump?

A

A wedge shaped opacity seen on XR relegated to pulmonary infarct

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8
Q

What is the radiation exposure of a CXR?

A

0.1 mSv

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9
Q

What are the 5 different kinds of CT?

A

Conventional scan, helical CT, High resolution, low dose, and CT angiography

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10
Q

What are the indications for a CT?

A
  • To clarify an abnormal CXR
  • Characterize pulmonary nodules
  • assist in diagnosis of clinical signs/symptoms
  • detection and staging of primary/metastatic lung neoplasms
  • evaluate suspected mediastinal or hilar masses
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11
Q

What is the radiation exposure of a CT?

A

~8mSv

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12
Q

What two populations should you use caution when ordering a CT?

A
  • Pediatrics (increased risk of brain tumor, leukemia, and radiation risk is compounded by longer lifespan)
  • Pregnant women (in utero exposure linked to pediatric CA mortality, ALWAYS ASK LMP PRIOR TO IMAGING)
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13
Q

What kind of contrast is used with CT?

A

Iodine contrast

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14
Q

What is the purpose of contrast?

A

To enhance differences in densities of various structures

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15
Q

When should you use contrast?

A

When evaluating vessels, malignancy, and trauma

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16
Q

What are the risks associated with radiocontrast?

A
  • Allergic reaction
  • Contrast induced nephropathy
  • Lactic acidosis if taking Metformin
17
Q

What are the symptoms of a contrast allergic reaction?

A

Flushing, pruritis, urticaria, angioedema, wheezing, anaphylaxis

18
Q

What are the risk factors for a contrast allergy?

A

A prior reaction, hx of asthma or atopy

**Shellfish allergy is NOT a contraindication!

19
Q

How should you pretreat a patient with a contrast allergy that you need a contrast CT for?

A

Pretreat with prednisone and Benadryl

20
Q

What is radiocontrast induced nephropathy?

A

An increase in serum creatinine >0.5 or >25% from baseline

21
Q

What are the creatinine and GFR levels in which you should not order a contrast CT?

A

If creatinine >1.5 or GFR < 60

22
Q

When should you check renal function prior to radiocontrast?

A

older than 60, history of renal disease, diabetes, HTN treated with medication, or taking metformin

23
Q

What modalities is pulmonary angiography used in conjunction with?

A

CTPA, direct pulmonary angiography, and pulmonary MRA

24
Q

What is used in detection of PE, aortic dissection, and SVC syndrome?

A

CTPA

25
Q

What is the radiation exposure from CTPA?

A

10-15 mSv

26
Q

What is the gold standard in evaluation of PE?

A

Catheter-directed pulmonary angiography

27
Q

When is catheter directed pulmonary angiography useful?

A

If V/Q scan or CTPA is inconclusive high there is high clinical suspicion of PE

28
Q

What are the risks associated with catheter-directed pulmonary angiography?

A

Bleeding or hematoma at insertion site, heart arrhythmia, allergic reaction, potential nephrotoxicity, and radiation exposure of 5mSv

29
Q

What kind of contrast is used in MRI?

A

Gadolinium

30
Q

What are V/Q scans used for?

A

Evaluation of pulmonary embolisms and for pre-op assessment prior to lung resection

31
Q

What makes the IV (perfusion) phase of a V/Q scan present?

A

Technetium 99 labeled to albumin

32
Q

What makes the inhalation (ventilation)phase present in a V/Q scan?

A

Radio-labeled xenon gas

33
Q

What is the test of choice for diagnosis of PE in pregnant women?

A

V/Q scan

34
Q

What are PET scans used for?

A

Mostly cancer, superior to CT for mediastinal imaging because it can identify tumors in normal sized lymph nodes

35
Q

How does a PET scan work?

A

Fluorodeoxyglucose (FGD) is a radioactive glucose that is injected into patient and it accumulates in tissues/organs with high metabolic activity and cancer cells have very high metabolic activity
-Patient is scanned and measurements of the uptake are made in SUVs

36
Q

What SUV value from a PET scan raises possibility of malignancy?

A

SUV > 2.5

37
Q

When can a false negative occur in a PET scan? False positive?

A

False negative: slow growing tumors

False positive: can occur with inflammatory lesions/granulomas

38
Q

What are the indications for thoracic US?

A
  • Bedside detection of pleural fluid, hemothorax, or pnuemothorax
  • Guidance of thoracentesis
  • guidance for placement of thoracostomy tubes
39
Q

What are the therapeutic uses of bronchoscopy?

A

Removal of excess mucous or FB, and ET tube placement

Clinical Medicine 2 (22 decks)

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