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Unit 2 Clin Med II > L9 Pulmonary diagnostics > Flashcards

L9 Pulmonary diagnostics Flashcards

1
Q

3 imaging methods that don’t use ionizing radiation

A

Ultrasound
MRI/MRA
Bronchoscopy

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2
Q

Indication for CXR

A 
SOB
Persistent cough
Hemoptysis
Chest pain or injury
Fever
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3
Q

CXR views

A

PA, AP, lateral, decubitius, apical lordotic

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4
Q

ABCDE of CXR

A 
Airway
Bones
Cardiac
Diaphragm
Edges
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5
Q

Xrays can miss

A

very small cancers

pulmonary emboli

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6
Q

CT is good for

A 
clarifying an abnormal CXR
diagnose cause of clinical s/sx
characterize pulmonary nodules
staging of primary and metastatic lung neoplasms
evaulate mediastinal or hilar masses
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7
Q

who to screen for lung cancer

A

55-80 years old with a 30 pack year history and currently smoke or quit within past 15 years

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8
Q

conventional CT is done

A

step and shoot, takes 25-30 mins

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9
Q

helical CT is done

A

continuously, <5 min

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10
Q

high resolution CT has slices that are

A

<1 mm

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11
Q

CT that is used for screening and has less detail

A

low dose CT

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12
Q

type of CT that can be done conventional or helical, is 64x faster, but has much higher radiation

A

multidectector or multislice CT

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13
Q

what to use if a patient has an implanted device

A

CT

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14
Q

real-time imaging for biopsies

A

CT

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15
Q

issues with CT

A

increased cancer risk

Body habitus >450 lbs

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16
Q

pediatric risks with CT scans

A

leukemia and brain tumors

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17
Q

pregnancy risks with CT scans

A

in utero exposure linked to pediatric cancer mortality

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18
Q

whatcha gotta ask before exposing a patient to radiation

A

LMP!!!!!!!!!

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19
Q

contrast used in CT

A

iodine

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20
Q

what’s well seen on CT with contrast

A

blood vessels encases by a tumor constricting it

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21
Q

CT with contrast is good for

A 
Masses
Cancer
Metastatic disease
Obstructive processes
PE
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22
Q

CT w/o contrast is good for

A

follow up of known pulmonary nodules

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23
Q

High resolution CT is good for

A

evaluation of diffuse lung disease

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24
Q

Risk factors for allergic reaction to CT with contrast

A

prior reaction, asthma, atopy

shellfish allergy NOT A RISK FACTOR

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25
Q

pretreat allergy to CT with contrast with

A

Prednisone and diphenhydramine

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26
Q

contrast induced nephropathy is defined as

A

serum creatinine > 25% from baseline
-or-
>.5 mg/dL

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27
Q

caution using contrast in patients with

A

impaired kidney function: Creat >1.5 mg/dL or GFR <60

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28
Q

alternatives to CT with contrast in patients with impaired kidney function

A

CT w/o contrast
MR w/o gadolinium
U/S

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29
Q

Who to check renal function in prior to iodine contrast

A 
>60
History of renal disease
history of htn (treated)
DM
taking glucophage
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30
Q

who can take glucophage and still get a CT with contrast

A

eGFR > 30 ml/min

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31
Q

who shouldn’t take their glucophage when getting a CT with contrast

A

acute kidney injury

severe CKD with eGFR <30 ml/min

32
Q

if you’ve held metformin to do a CT and it’s been 48 hours, your next step is to

A

re-evaluate renal function before resuming doses

33
Q

angiography can be performed in conjunction with

A

CT (CTA)
MRI (MRA)
Xray with catheter

34
Q

use CT pulmonary angiography if you suspect

A

pulmonary embolism
aortic dissection
superior vena cava syndrome

35
Q

CT pulmonary angiography can assess

A

vascular malformations

pulmonary arterial invasion by a neoplasm

36
Q

CT pulmonary angiography use in surgery

A

provides precise anatomical guidance

37
Q

CT pulmonary angiography can miss

A

sub-segmental PEs

38
Q

the gold standard in evaluation of PE is

A

Direct pulmonary angiography (Catheter directed)

39
Q

when is a direct pulmonary angiography used

A

if a V/Q or CTPA is inconclusive and there is still a high clinical suspicion

40
Q

risks of direct pulmonary angiography

A

Bleeding
Hematoma
Heart arrhythmia
(allergy, impaired kidney function, radiation)

41
Q

direct pulmonary goes through the ____ to reach the ______ and then the ________

A

veins (femoral, internal jugular)
right side of the heart
pulmonary arteries

42
Q

indications for MRI, which has limited usefulness in pulmonary disease

A

hilar/mediastinal densities
sulcus tumors
possible cysts/lesions of the chest wall

43
Q

Benefits to MRI

A

no bone artifact (like CT)

no ionizing radiation

44
Q

contrast material used in MRI/MRA

A

gadolinium

45
Q

MR angiography provides

A

high quality images of blood vessels

46
Q

compared to a CT chest, an MRI is

A

less detailed view of lung parenchyma

dimished spacial resolution

47
Q

what kind of kidney damage can gadolinium cause

A

Nephrogenic systemic fibrosis

IRREVERSIBLE

48
Q

In a patient with GFR<30 ml/min and MRI

A

avoid use of gadolinium

49
Q

Contraindications of MRI/MRA

A 
*********************
Pacemaker/defibrillator
metal in eye
aneurysm clip
cochlear implant
**********************
50
Q

Ventilation perfusion scans are used for

A

evaluate for PE

pre-op assessment prior to lung resection

51
Q

V/Q mismatch means

A

imbalance of blood flow and ventilation

52
Q

V/Q radiation is captured

A

by gamma cameras in 2 phases

53
Q

contrast injected in V/Q during the IV phase

demonstrates what?

A 
Technetium 99m (labeled to human albumin)
perfusion
54
Q

gas inhaled in V/Q during the inhalation phase

demonstrates what?

A

Radio labeled xenon gas

distribution of ventilation

55
Q

when to to use V/Q scan

A

normal CXR with high probability of PE

56
Q

test of choice for PE in pregnant women

A

V/Q scan

57
Q

other usefulness of V/Q scan

A

estimating post-op reserve capacity for pts undergoing lung resection

58
Q

contraindications of V/Q scan

A

NO ABSOLUTE CONTRAINDICATIONS

59
Q

V/Q will def diagnose a PE if it’s there (v sensitive) but also might

A

be falsely positive bc it do that a lot

60
Q

PET scan stands for

A

Positron Emission Tomography

61
Q

what’s the benefit to a PET scan

A

Physiologic images that can detect biochemical changes of anatomy before CT/MRI

62
Q

the radiation injected in PET scan

A

fluorodeoxyglucose (FDG)
this is radioactively labeled glucose
short-lived (benefit but time sensitive)

63
Q

FDG accumulates in

A

tissues/organs with high metabolic activity

CANCER

64
Q

measurements of radiation in PET scans

A

standardized uptake value (SUV)

65
Q

what indicates cancer on PET scan

A

SUV >2.5

66
Q

PET scan can evaluate

A

Metastasis from primary stie
effects of cancer therapy
recurrence in previously irradiated, scarred areas of the lung

67
Q

When do false results occur with PET scans

A

metabolic imbalances
false (+) inflammatory lesions, granulomas (cocci and histoplasmosis)
false (-) slow growing tumors

68
Q

indications for ultrasound (limited use) are

A

bedside detection of pleural fluid or pneumothorax

guidance for thracentesis and placing thoracostomy tubes

69
Q

bronchoscopy can evaluate

A

pneumonia
hemoptysis
cough

70
Q

bronchoscopy can diagnose

A

tracheoesophageal fistulas

tracheobronchomalacia

71
Q

other things bronchoscopy can do

these are the things it’s most commonly used for

A

remove excess mucus or FBs (debris)
ET tube placement
trachea/proximal bronchus obstruction

72
Q

side effects of bronchoscopy

A

nasal discomfort
sore throat
mild hemoptysis

73
Q

complications of bronchoscopy

A

MINOR
hemorrhage
hypotension
arrhythmia

74
Q

contraindications to bronchoscopy

A

severe refractory hypoxia
risk of bleeding
risk of respiratory and cardiovascular decompensation

75
Q

what puts you at risk of respiratory and cardiovascular decompensation with bronchoscopy

A 
asthma
COP
current/recent MI
poorly controlled CHF
life threatening arrhythmias

Unit 2 Clin Med II (7 decks)

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