Imaging (and a few other random things that were already here)

Question 1

According to the American College of Rheumatology, how many of the 7 criteria must be satisfied for a diagnosis of rheumatoid arthritis to be confirmed?

Answer 1

4

At least 4 of the 7 criteria must be satisfied for a diagnosis of rheumatoid arthritis to be confirmed. The onset of rheumatoid arthritis is typically insidious and usually affects the joints of the hands and feet initially. The individual will often report pain, stiffness, and swelling in a variety joints.

Question 2

Which of the following statements about rheumatoid arthritis is generally true?

• affects joints symmetrically, but deformities are asymmetrical
• affects joints symmetrically, but deformities are symmetrical
• affects joints asymmetrically, but deformities are asymmetrical
• affects joints asymmetrically, but deformities are symmetrical

Answer 2

affects joints symmetrically, but deformities are asymmetrical

Rheumatoid arthritis affects joints symmetrically, but deformities are typically asymmetrical. This asymmetry is attributed to increased use of a dominant extremity or protection of a painful extremity.

Question 3

Which osteoarthritic related deformity is found at the proximal interphalangeal joints?

Answer 3

Bouchard’s nodes

found at the proximal interphalangeal joints and are characteristic of osteoarthritis in the hands. The nodes are often tender in the early stages of osteoarthritis and can lead to restrictions in range of motion and fine motor skills.

Question 4

Pain from osteoarthritis of the hip is most commonly experienced in which location?

Answer 4

Groin

Pain in the groin is most common with osteoarthritis of the hip. Pain in the buttock, knee, and trochanteric region are also consistent with osteoarthritis, but are less common.

Question 5

Recurring fractures are a leading concern in individuals with what disorder?

Answer 5

osteogenesis imperfecta

Osteogenesis imperfecta is an autosomal disorder of collagen synthesis that affects bone metabolism. Children with osteogenesis imperfecta often have delayed developmental milestones secondary to ongoing fractures.

Question 6

Which clinical finding is not a characteristic of rheumatoid arthritis?

ulnar deviation of the fingers
swan neck deformity
Boutonniere deformity
Heberden’s nodes

Answer 6

Heberden’s nodes

palpable osteophytes in the distal interphalangeal joints and are usually seen in women, but not men. This finding is a characteristic of osteoarthritis which is a chronic disease that causes degeneration of articular cartilage, primarily in weight bearing joints.

Question 7

patient recently had a radionuclide bone scan. This type of diagnostic imaging would be MOST beneficial for the management of which condition?

1.Osteoporosis
2.Bone cancer

Answer 7

Bone Cancer

Bone cancer is a malignant tumor of the bone that results from primary bone cancer or, more commonly, from metastatic cancer that spreads from other areas of the body. Bone scans are used to identify the location and extent of bone cancer by identifying areas of the skeletal system that show a high level of radiopharmaceutical uptake, which indicates an increase in the metabolic activity of the bone.

Osteoporosis – DEXA scan

Question 8

Ateriography

Answer 8

Aka angiography

invasive procedure that uses x-ray imaging and an injected contrast dye to visualize blood vessels (Fig. 8-32). This technique can visualize the major systemic arteries as well as the arterial systems that perfuse the major organs (e.g., brain, heart). A catheter is inserted into an artery, either at the groin or in the arm, and is guided up to the heart. The test can be used to identify arteriosclerosis, aneurysm, vascular malformations, tumors or blockages.
Advantages:
• useful in the diagnosis of vascular abnormalities
Disadvantages:
• invasive procedure
• contrast dye may cause an allergic reaction

Question 9

Arthrography

Answer 9

invasive procedure that uses x-ray imaging and an injected contrast dye to visualize joint structures. A long needle is used to inject the dye directly into the joint (i.e., direct arthrography), Alternatively, the dye can be injected into a blood vessel and then absorbed into the joint space (i.e., indirect arthrography). X-rays are then taken with the joint in different positions. Arthrography is useful in identifying pathology of joint structures (e.g., ligament damage, capsular tears). Soft tissue disruption can be identified by leakage of fluid from the joint cavity. The test is commonly used at peripheral joints such as the hip, knee, ankle, shoulder, elbow, and wrist. Arthrography is commonly used with x-ray imaging, though it can also be used with fluoroscopy, MRI, and CT imaging.

Advantages:
• provides a more detailed image of a joint compared to a
standard x-ray
Disadvantages:
• invasive procedure
• contrast dye may cause an allergic reaction (especially with indirect arthrography)
patient may experience joint swelling after the procedure
* not recommended for patients with active arthritis or joint
infection

Question 10

Bone Scan

Answer 10

• aka skeletal scintigraphy
• Invasive procedure used specifically to provide detailed information on bony structures, such as stress fractures, infection, and bone cancer or metastasis (Fig. 8-33).
• Injection of a radionuclide into the body. The body is then scanned with a gamma camera to see which bones have taken up the radioactive material.
• Image produced during the scan shows areas that have high levels of bone remodeling since the radionuclide is taken up by the osteoblast cells within the bone. Bone scans can identify bone disease or stress fractures with as little as 4-7% bone loss.
• High levels of radiopharmaceuticals indicate areas where there is an increased level of mineral turnover, indicating pathology of the bone.

Advantages:
* provides information on bone pathology that is not identified on x-ray
* low dose of radiation used
* less expensive than PET scans

Disadvantages:
* invasive procedure
* requires a 2-3 hour waiting period between injection and imaging
* patient must lie still for long periods of time
* radionuclide may cause an allergic reaction
* not recommended for patients who are pregnant

Question 11

Computed Tomography (CT)

Answer 11

• non-invasive imaging procedure
• x-ray images are taken from multiple angles using a large circular scanner (Fig. 8-34).
• Images are combined using computer analysis to produce cross-sectional images.
• Some use a contrast medium, which can be swallowed or injected, to improve the image quality.
• CT scans are most commonly used to diagnose spinal lesions and in diagnostic studies of the brain.

Advantages:
* offers quick results and is useful in emergent situations generates images of multiple structures at the same time (typically used to determine if ischemic or hemorrhagic stroke)
* produces more detailed images than x-ray

Disadvantages:
* uses a higher dosage of radiation than other imaging techniques
* not recommended for patients who are pregnant
* contrast dye may cause an allergic reaction
* patient is in a small space and may become claustrophobic

Question 12

Electroencephalographs

Answer 12

• non-invasive procedure
• Record the electrical activity of the brain.
• Several electrodes are placed on the scalp and are used to record the electrical impulses that result from brain activity.
• Electrical activity is recorded and displayed as characteristic waveforms on a monitor. Brain disorders, such as epilepsy or narcolepsy, can be diagnosed based on abnormalities in these waveforms.
• Evoked potential studies are a form of EEG in which brain activity is measured in response to various stimuli (e.g., light, sound).

Advantages:
* useful in diagnosing brain disorders by measuring electrical activity directly as opposed to measuring blood flow or metabolic activity
* noninvasive procedure
detects changes over the course of milliseconds, as opposed to seconds or minutes with other imaging techniques (e.g., MRI)
* costs less than other imaging techniques

Disadvantages:
* less effective at providing information on exact location of the pathology compared to other imaging techniques (e.g., MRI)
* several factors can affect the accuracy of the results (e.g., medications, caffeine, hypoglycemia, hair products, small movements)
* in some patients with epilepsy, use of an evoked potential study may cause a seizure

Question 13

Fluoroscopy

Answer 13

• Designed to show motion within the body with the use of x-ray imaging and injection of a contrast dye.
• Permits objects placed between a fluorescent screen and a roentgen tube to become visible.
• Instead of a single X-ray image being taken, the X-ray beam is passed through the body continuously to allow for the visualization of movement
• Can show motion within joints or movement of the dye within the digestive tract.
• A barium swallow exam is a specific type of fluoroscopy procedure used to assess the gastrointestinal tract.
• The procedure can also be used during the insertion of medical devices (e.g., pacemakers).

Advantages:
* can visualize movement within the body

Disadvantages:
* invasive procedure
*higher dose of radiation than x-rays
* not recommended for patients who are pregnant
* contrast dye may cause an allergic reaction

Question 14

Lumbar Puncture

Answer 14

• Invasive procedure
• Used to diagnose problems with brain or SC
• Inserting needle into the subarachnoid space in the lumbar spine and drawing out CSF
• Used to diagnosis encephalitis, meningitis, and Guillain-Barre Syndrome…or also measure the pressure of the CSF.

Advantages:
* useful in diagnosing a variety of brain and spinal cord pathologies

Disadvantages:
* invasive procedure
* should not be performed in the presence of increased intracranial pressure
* leakage of CSF can cause a headache small risk of bleeding occurring in epidural and subarachnoid
* patient must remain inactive after the procedure

Question 15

Magnetic Resonance Imaging (MRI)

Answer 15

• noninvasive procedure
• Utilizes magnetic fields and radio waves to produce cross-sectional images of the body (Figs. 8-35, 8-36).
• Large cylindrical device with a hollow tunnel in the center where the patient lies.
• Used to visualize almost any structure within the body:
• soft tissue structures, such as muscles, menisci, ligaments, tumors, and internal organs.
• MRI provides excellent contrast detail, therefore contrast dyes rarely need to be used, though they may still be used in certain types of imaging to improve the image quality.

Advantages:
* useful in imaging a wide variety of structures, especially soft tissue structure
* noninvasive procedure
* does not use radiation
* safe for use on patients who are pregnant
* contrast dye used is unlikely to cause an allergic reaction

Disadvantages:
* cannot be used if there is metal in the body
* interferes with functioning of internal devices (e.g., pacemaker, cochlear implant)
* patient must lie still for long periods of time
* patient is in a small space and may become claustrophobic
* high cost compared to other tests

Question 16

Myelography

Answer 16

• Invasive procedure
• Combines x-ray/ fluoroscopy or computed tomography with use of a contrast dye
• Evaluate spinal structures, specifically the spinal cord, nerve roots, and meninges.
• Contrast dye is injected directly into the epidural space by lumbar puncture.
• Used to identify bone displacement, spinal stenosis, disk herniation, spinal cord compression, infection/inflammation of the meninges or tumors.

Advantages:
* provides better detail of spinal structures than X-ray
* provides imaging of spinal structures for those patients who cannot have MRI
* low dose of radiation

Disadvantages:
* invasive procedure
* contrast dye may cause an allergic reaction
* may cause headache if cerebrospinal fluid leaks out
* small risk of seizure since dye is injected into cerebrospinal fluid

Question 17

Nerve Conduction Velocity Test (NCV)

Answer 17

• Used to determine the extent of nerve damage by measuring the speed of an electrical impulse through the nerve.
• 2 surface electrodes are attached on the skin over the course of the nerve.
• 1st electrode - stimulates the nerve while the
• 2nd electrode - measures the speed of the electrical impulse.
• NCV is often used in conjunction with electromyography testing.
• Performing both tests allows the health care practitioner to determine if the condition is related to nerve pathology or muscle pathology.
• NCV is helpful in the diagnosis of conditions such as Guillain-Barre syndrome, carpal tunnel syndrome, and peripheral neuropathy.

Advantages:
* effective at diagnosing nerve-related pathology
* noninvasive procedure
* offers quick results

Disadvantages:
*precautions need to be taken for patients with a pacemaker

Question 18

Positron Emission Tomography (PET)

Answer 18

• Invasive procedure that uses radiography and an injected radionuclide to determine the metabolic activity of an organ or tissue.
• The radionuclide is attached to a substance that would be used by the organ of interest (e.g., attached to glucose when studying the brain).
• A scanner is used to determine the amount of radionuclide taken up by the organ, thereby determining how metabolically active the organ is. * Commonly used in oncology to identify malignant tumors, though it is also used in the neurology (e.g. identifying brain diseases) and cardiology (e.g., identifying impaired blood flow) fields.
• More recently been used in conjunction with CT scan to provide greater detail on tumors and other lesions.

Advantages:
* images the function of an organ as opposed to just its anatomy
* detects pathological changes at the cellular level
* identifies the onset of disease processes before other imaging techniques
* low dose of radiation

Disadvantages:
* invasive procedure
* radionuclide may cause an allergic reaction
* not recommended for patients who are pregnant
* results may be affected by high blood glucose levels, medications, caffeine, alcohol or tobacco
* patient must lie still for long periods of time
* patient is in a small space and may become claustrophobic

Question 19

Ultrasound (diagnostic)

Answer 19

• noninvasive procedure that uses sound waves to produce images of structures within the body, especially the internal organs (e.g., liver, kidneys).
• Transducer sends sound waves into the body, where they reflect off the internal structures and are then received and processed by the transducer. * Information is converted into an image based on the different speeds at which the sound waves travel.
• Ultrasound shows not only an image of a structure, but also the movement of that structure since it is performed in real time.
• Doppler ultrasound - evaluates blood flow in the major veins, arteries, and cerebrovascular system. Can provide auditory output in addition to the visual projection.

Advantages:
* shows movement of internal structures in real time
* noninvasive procedure
* does not use radiation
* can be used on patients who are pregnant safer and less expensive than other procedures (e.g., arteriography)

Disadvantages:
* quality of images highly dependent on the skill of the operator
* cannot image structures filled with air (e.g., stomach, intestines) or structures behind bone (e.g., brain)
*not as effective for patients who are obese due to subcutaneous fat

Question 20

Venography

Answer 20

• Invasive procedure that uses x-ray imaging and an injected contrast dye to visualize the venous system.
• Catheter is inserted into a vein in the foot so that the contrast dye can be injected.
• Visualizing the veins in the leg, though it can also be used for the upper extremities or the inferior vena cava.
• Helpful for diagnosing DVT, tumors, valve dysfunction or other pathology of the venous system.

Advantages:
* effective in visualizing the venous system
* low dose of radiation

Disadvantages:
* invasive procedure
* contrast dye may cause an allergic reaction

Question 21

X-Ray

Answer 21

• assist with the diagnosis of issues related to the bones, such as fractung dislocations, arthritis, and bone infections (Fig. 8-37).
• Chest X-rays may be performed to help diagnose lung conditions, such as pneumonia or chronic obstructive pulmonary disease.
• Uses radiation to penetrate the body and create a two-dimensional picture.
• Structures with low density (e.g., soft tissue structures) do not absorb x-rays as well and therefore do not show up on a radiograph.
• Produces only two-dimensional images and as a result often requires images to be taken in multiple planes in order to visualize a lesion’s location and size.

Advantages:
* useful in diagnosing bone and joint pathology
* noninvasive procedure
* low dose of radiation
* low cost and rapid results

Disadvantages:
* cannot image soft tissue structures not recommended for patients who are pregnant

Question 22

Which type of diagnostic imaging is designed to show motion in joints through x-ray imaging?

Answer 22

Fluoroscopy

Fluoroscopy permits objects placed between a fluorescent screen and a roentgen tube to become visible. A continuous x-ray beam is passed through the body part being examined. The beam is transmitted to a monitor so that the body part and its motion can be seen in detail.

Question 23

What is the primary disadvantage of using fluoroscopy as an imaging technique?

Answer 23

Excessive radiation exposure

Fluoroscopy is designed to show motion in joints through x-ray imaging. The technique permits objects placed between a fluorescent screen and a roentgen tube to become visible. Fluoroscopy is not used commonly due to excessive radiation exposure.

Question 24

Which of the following imaging techniques shows the greatest detail in soft tissue structures?

Answer 24

magnetic resonance imaging

Magnetic resonance imaging (MRI) uses a magnetic field to align hydrogen atoms in the body. MRI can be weighted in T1 images to show the greatest anatomical detail of soft tissues. The other options all utilize x-ray, which is preferable when imaging bony structures.

Question 25

Which imaging technique provides the best view of a disc protrusion, differentiating between the nucleus pulposus and the annulus fibrosus?

Answer 25

Magnetic resonance imaging

Magnetic resonance imaging (MRI) differentiates soft tissues and bone. MRI uses the quantity of hydrogen in tissues to determine water content, which allows it to differentiate between the nucleus pulposus and annulus fibrosus.

Question 26

Which diagnostic test refers to a radiograph that visualizes injected radiopaque dye in an artery?

Answer 26

Arteriography

Arteriography is the diagnostic test that refers to a radiograph that visualizes injected radiopaque dye in an artery. Arteriography can be used to identify arteriosclerosis, tumors or blockages.

Question 27

Which diagnostic test refers to an invasive test utilizing a contrast medium to provide visualization of joint structures through radiographs?

Answer 27

Arthrography

Arthrography is an invasive test utilizing a contrast medium to provide visualization of joint structures through radiographs. Soft tissue disruption can be identified by leakage from the joint cavity and capsule. The test is commonly used at peripheral joints such as the hip, knee, ankle, elbow, and wrist.

Question 28

Which diagnostic test is an invasive test which utilizes isotopes to identify stress fractures, infection, and tumors?

Answer 28

Bone scan

A bone scan is an invasive test which utilizes isotopes to identify stress fractures, infection, and tumors. Bone scans can identify bone disease or stress fractures with as little as 4-7% bone loss.

Question 29

Which diagnostic test produces cross-sectional images based on x-ray attenuation and is commonly used to diagnose spinal lesions and in diagnostic studies of the brain?

Answer 29

Computed tomography

Computed tomography produces cross-sectional images based on x-ray attenuation and is commonly used to diagnose spinal lesions and in diagnostic studies of the brain. A computerized analysis of the changes in absorption produces a detailed reconstructed image

Question 30

Which diagnostic test is non-invasive and relies on the transmission and reflection of high frequency sound waves to produce cross-sectional images in a variety of planes?

Answer 30

Doppler ultrasonography

Doppler ultrasonography is safer, less expensive, and requires a shorter time period than more invasive tests such as arteriography and venography. It evaluates blood flow in the major veins, arteries, and cerebrovascular system

Question 31

Which diagnostic test is an invasive test that combines fluoroscopy and radiography to evaluate the spinal subarachnoid space?

Answer 31

Myelography

Myelography combines fluoroscopy and radiography to evaluate the spinal subarachnoid space. The test utilizes a contrast medium that is injected into the epidural space by spinal puncture. Myelography is used to identify bone displacement, disk herniation, spinal cord compression or tumors.

Question 32

Which medical imaging devices produces images from radioactive emissions?

Answer 32

positron emission tomography

Positron emission tomography (PET) creates an image based on the amount of a radioactive dye that is absorbed by tissue. As a result, this type of imaging can be used to assess the function of structures and organs.

Question 33

What technique used to quantify body fat is also used to analyze bone mineral content?

Answer 33

dual energy X-ray absorptiometry

Dual energy X-ray absorptiometry (DEXA) uses specialized computers to analyze penetration of tissues by two rays of differing energies. DEXA is used to quantify regional body fat, muscle, and bone mineral content. It is most often used to investigate suspected cases of osteoporosis.

Question 34

During a cerebral angiography, radiopaque dyes are injected into which artery?

Answer 34

Vertebral artery

During a cerebral angiography, radiopaque dyes are injected into the carotid and/or vertebral arteries. The purpose of a cerebral angiography is to visualize cerebral vessels and localize lesions such as aneurysms, occlusions, angiomas, tumors or abscesses.

Question 35

Which scenario is not considered to be a contraindication for magnetic resonance imaging?

presence of a pacemaker
presence of pins
presence of artificial heart valves
presence of a tumor

Answer 35

presence of a tumor

Magnetic resonance imaging (MRI) examines the distribution of hydrogen molecules in the body in three dimensions. MRIs are used to differentiate types of tissues. They can be used to examine the brain, tumors, vascular abnormalities, as well as cardiac, respiratory, and renal conditions. MRIs provide greater contrast of soft-tissue structures than CT scans.

Question 36

What are the black areas produced on a radiograph called?

Answer 36

Radiolucent

Dense objects such as bone and metal fragments display brighter because they block more of the beam, therefore reducing the films exposure. Objects that block X-rays are said to be radiopaque, whereas those that pass X-rays are radiolucent and produce black areas.

Question 37

Which diagnostic procedure allows direct visual examination of the bladder, ureteral orifices, and urethra?

Answer 37

cystoscopy

Cystoscopy allows direct visual examination of the bladder, ureteral orifices, and urethra. It is used to view, diagnose, and treat disorders of the lower urinary tract, interior bladder, urethra, male prostatic urethra, and ureteral orifices.

Question 38

Which diagnostic test records the electrical activity of the superficial layers of the brain?

Answer 38

electroencephalography

Electroencephalography (EEG) uses electrodes attached to the patient’s head to record electrical activity of the outer layers of the cerebral cortex. The electrical activity is collected by examining the difference between the electrical potential of two electrodes placed at different locations on the scalp. Electroencephalography is used to assess seizure activity, metabolic disorders, and cerebellar lesions.