HA Ch. 19

Question 1

Defect in blood-clotting mechanisms

Answer 1

Coagulopathy

Question 2

Method of performing an ultrasound-guided procedure without the use of a needle guide on the transducer

Answer 2

Free-hand technique

Question 3

Diminished blood volume

Answer 3

Hypovolemia

Question 4

Method developed to standardize prothrombin time (PT) results among laboratories be accounting for the different thromboplastin reagents used to determine PT

Answer 4

International normalized ratio

Question 5

Collecting air or gas in the pleural cavity

Answer 5

Pneumothorax

Question 6

Laboratory test that measures levels of this antigen in the body, elevated levels of which could indicate prostate cancer

Answer 6

Prostate-specific antigen

Question 7

Decreased systolic and diastolic blood pressure below normal

Answer 7

Hypotension

Question 8

Laboratory test that can be used to evaluate the effects of heparin, aspirin, and antihistamines on the blood-clotting process by detecting clotting abnormalities of the intrinsic and common pathways

Answer 8

Partial thromboplastin time (PTT)

Question 9

Surgical puncture of the chest wall for removal of fluids: usually done by using a large-bore needle

Answer 9

Thoracentesis

Question 10

Concerning the action of stimuli from the vagus nerve on blood vessels: vasovagal syncope is a brief loss of consciousness caused by sudden drop in heart rate and blood pressure, which reduces blood from the brain

Answer 10

Vasovagal

Question 11

AFP

Answer 11

Alpha-fetoprotein

Question 12

FNA

Answer 12

Fine needle aspiration

Question 13

INR

Answer 13

International Normalized Ratio

Question 14

PSA

Answer 14

Prostate Specific Antigen

Question 15

PT

Answer 15

Prothrombin Time

Question 16

PTT

Answer 16

Partial Thromboplastin Time

Question 17

Discuss the main advantages of using ultrasound for biopsy guidelines

Answer 17

The main advantage of using ultrasound for guidance is continuous real-time visualization of the biopsy needle, which allows adjustment of the needle as needed. Moreover, as the biopsy specimen is being obtained, the needle tip can be watched in real-time to ensure that it does not slip outside the mass. Ultrasound also has the advantage of allowing different patient positions and approaches to be considered for safest access to the mass. Subcostal approaches can allow the use of steep angles with the needle directed cephalad, which can help reduce the risk of a pneumothorax or bleeding from an injury to an intercostal artery. Another benefit is the ability to comfort and reassure the patient, as the sonologist, sonographer, and nurse are all near the patient during the procedure. Other advantages include the ability to perform the biopsy in a single breath hold, portability, lack of radiation, decreased costs, and shorter procedure times

Question 18

List the limitations of ultrasound guidance

Answer 18

Not all masses can be visualized with ultrasound because they may be isoechoic to normal tissue. In the abdomen, bowel gas may move in and obscure the mass before or even during the procedure; overlying bowel may not be able to be displaced. The needle tip may be difficult to see or may deviate from the projected path because of bending or deflection of the needle. Other disadvantages of using ultrasound to guide procedures include the inexperience of ultrasound personnel, the comfort level of the radiologist and/or sonologist with other imaging modalities, and the need to use fixed angles when needle guides are used on the transducer.

Question 19

The most common indication for a biopsy is to confirm ________________ in a mass

Answer 19

Malignancy

Question 20

Identify the contraindications of a biopsy

Answer 20

Contraindications may include an uncorrectable bleeding disorder, lack of a safe needle path, and an uncooperative patient

Question 21

Which laboratory test is used to evaluate the effects of heparin, aspirin, and antihistamines on the blood-clotting process?

Answer 21

PTT (Partial Thromboplastin Time)

Question 22

Biopsies are used to confirm if a mass is

Answer 22

Benign, malignant, or infectious

Question 23

A(n) ____________ uses an automated, spring loaded device, termed a biopsy gun, to provide a core of tissue for histologic analysis

Answer 23

Core biopsy

Question 24

FNA uses a(n) ____________ needle to obtain cells from a mass

Answer 24

Thin

Question 25

One method of ultrasound-guided intervention is called the ___________ technique and is performed without the use of a needle guide on the transducer

Answer 25

Free-hand

Question 26

Identify the benefits of using a needle guide

Answer 26

Faster learning curve, faster placement of the needle and assurance that the needle is going through the anesthetized area when multiple passes are required

Question 27

The patient must be informed of the potential __________ , alternate methods of obtaining the same information, and what would be the course of the disease if the biopsy were not performed and the correct treatment could not be planned

Answer 27

Risks

Question 28

The national patient safety standards (www.jcaho.org) mandate that a “timeout” be performed before beginning any procedure. Explain what a “timeout” is and what its purpose is.

Answer 28

A member of the biopsy team should ask the patient to recite his or her name. The patient’s ID or history number is confirmed, along with the type and location of the procedure. This is documented usually at the bottom of the consent form. The word “timeout” may also be typed on the screen and an image documented to be part of the ultrasound examination. This is helpful because there will be preprocedural image, the “timeout” image, which documents date and time; and then needle tip documentation images

Question 29

Complications from an ultrasound-guided biopsy are usually minor and may include _________, ____________ reactions, and ____________

Answer 29

Postprocedural pain or discomfort, vasovagal reaction, hematomas

Question 30

It is important to determine how much the mass moves with ___________ and also how well and how long the patient can hold his or her breath

Answer 30

Respiration

Question 31

Describe how to see the needle tip in ultrasound

Answer 31

Move the needle up and down in a bobbing motion. Bob or jiggle the stylet inside the needle. Angle the transducer in a superior and inferior motion. This is helpful when the needle is bent out of the plane of the sound beam. Use harmonics or compound imaging. A last resort is to remove the needle and start again, while closely watching displacement of the tissue as the needle advances.

Question 32

Whenever possible, a(n) _______________ approach should be used to prevent the possibility of a pneumothorax or damage to the intercostal arteries

Answer 32

Subcostal

Question 33

Typically the ___________ pole of the kidney is biopsied to prevent possible lacerations of the main renal vessels and ureter

Answer 33

Upper

Question 34

Patients may be marked for a thoracentesis or have the procedure under sonographic guidance. Patients should be scanned in the ___________ position that the procedure will be performed in, which is usually in an upright position, through the back.

Answer 34

Same