Labs/X-rays/ECG Lecture Flashcards
ALT vs AST
ALT elevated before AST
Alka phosphatase
increases in liver and bone disease
Wilson’s disease
Copper issues
Xrays blocked by
denser tissues like bone
Lungs fields look _____on xray
Black
Water fields look ______
Black
BLood on xray look
white, light gray
Fat on xray
Gray
You should be able to see
9-10 posteriorly
6-7 anteriorly
Motion on CXR
Blurry
Hold breath
to expands lungs for better picture
Most chest PA
posterior to Anterior
Through back to film
Heart closer to heart
PA
Magnifies heart
AP
PA best when
Standing
Spinous processes aligned with
Center of the sternum
Best xray is
PA
Overexposed xray
Looks really dark
Underexposed (underpenetrated)
Looks really white
Have to be able to differentiate
vertebral bodies
Cardiac silhouette should be
less than 50% of diameter of chest in PA
Cardiac silhouette should be (AP)
Less than 60%
RIght is usually a little higher due to
liver
Normal Carina angle =
60-100°
ETT
- S/b 5-7cm above carina
* Carina usually @ T4/T5
Non-ionizing
Ultrasound MRI
Ionizing
Xray, CT, nuclear med scans,
CT mostly for 2 parts
Chest and ABdomen
MRI mostly for
Head, Neck , spinal cord and extremities
MRI how it works
beam waves scatter water molecules.
no damage to the body
Routes of administration contrast
IV
Oral
Rectal
FOR CT iodinated contrast
High osmolarity , more side effects
CT iodinated contrast non-ionic :
low osmolality, less side effects ($
Barium: non-water soluble suspension
Used for GI Tract assessment:
Types of Barium
Swallow study
Small bowel
BE
___________can be used in place of barium if
perforated bowel, or barium allergy)
(Gastrografin
When to use IV Contrast:
solid organs
vascular structures
When to use Barium
Barium: GI tract assessment
CONTRAINDICATIONS to Constract
- Anaphylaxsis
* Nephropathy
ANaphylaxis
pt.s with atopic disease such as asthma, eczema, allergic
rhinitis (food allergies) are at higher risks – Iodine is not a proven allergen. Allergies to shellfish do
not increase risk of reaction to IV contrast any more than that of other
allergies.
Common Signs/Symptoms for ordering Exams:
Cough
SOB
Hemoptysis
Trauma
Reading check
Date Name Left and Right marker Quality – rotation, inspiration, exposure Soft tissue Bones Organs Airway
ABCDEFGHI
Assessment of quality Bones/soft tissues Cardiac Diaphragm Effusions Fields, fissures,foreign bodies Great vessels/gastric bubble Hila/mediastinum Impression
Assess lung fields for ?
• Infiltrates • Increased interstitial markings • Masses • Absence of normal margins • Air bronchograms • Phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white) • Increased vascularity
Air Bronchospasm
• Air-filled bronchi (dark) made visible by opacification of surrounding alveoli consolidation
Alveolar:
- Fluffy rounded densities (Consolidation)
- Air spaces filled with fluid, blood, pus (pneumonia)
- protein or cells (tumor)
Interstitial
- Linear or nodular densities
* Supportive tissue around/between alveoli
Chloride range
95-105
Cr
0.6-1.2
AST normal range
• 8-40 units/L
• ALT normal range
• 10-40 units/L
• Alk Phos normal range
• 35-150 units/L
• Albumin normal range
• 6-8 g/dL
Common causes of elevated Liver enzymes:
Tylenol, Statins, Antifungals
Common causes of elevated Liver enzymes:
- Etoh
- Hepatitis
- Fatty Liver/Obesity
- Hemochromatosis/Wilson’s Disease
Film turns-____ where xrays strike
black
Less dense xray
more beam, xray way blacker
Denser object xray
less beam striking, xray whiter
How many anterior ribs to qualify as a good film
6
• Spinous processes aligned with center of sternum between clavicles? What are you assessing?
• Rotation
• Preferred view for CXR
PA – energy penetrates thru pts back onto film
In PA where does energy penetrate
energy penetrates thru pts back onto film
If spine is not visible, the film is
underexposed or under penetrated (too white)
____view makes heart appear larger than it really is
AP
For MRI, contrast used
Gadolinium
Aortic knob
The first knob on the of the left side of the aortic arch
Measure knob from the
Lateral border of air in the trachea to the edge of the aortic knob
Aortic knob should measure
<35 mm
Air bronchograms is a phenomenon
• Phenomenon of air-filled bronchi (dark) being made
visible by the opacification of surrounding alveoli (grey/white)
Air-filled bronchi (dark) made visible by opacification of surrounding alveoli consolidation
Air Bronchogram
Alveolar air sacs
Radiolucent; may contain blood, mucous, tumor or edema
Interstitial disease
RADIODENSE vessels, lymphatics, bronchi, CT tissue
Tuberculosis • Almost always affects :
- posterior segments of upper lobes
* superior segments of lower lobes
• Patchy bilateral opacification of upper lobes with cavitation (Left)
Tuberculosis
- Kerley A Lines
* From____To____
Hila to periphery
• Dilated lymphatic channels
Kerley A lines
Interstitial - Reticular Patterns Fine
• 1-2mm = pulmonary edema
Interstitial - Reticular Patterns • Medium
• 3-10mm = pulmonary fibrosis
Interstitial - Reticular Patterns Coarse
• >10mm = sarcoidosis
Hyperinflated Lungs
Emphysema (COPD)
• “Flat” Diaphragm
Emphysema (COPD)
• Narrow Heart Shadow
Emphysema (COPD)
• Increased Retrosternal clear space
Barrel Chest
Emphysema (COPD)
Partial filling of air spaces with exudate or transudate
Ground Glass Opacities
Associated pulmonary edema, infections (including cytomegalovirus and Pneumocystis carinii pneumonia)
Ground Glass Opacities
Sarcoidosis -
Bilateral Hilar Enlargement
• Hilar (lung roots) mainly consist of the
major bronchi and the pulmonary veins and arteries
Nodes are seen clearly with Spiral CT
Sarcoidosis
Solitary Pulmonary Nodule
If < 3cm =
If > 3cm =
Nodule
Mass
Solitary Pulmonary Nodule CT – if calcified,
likely benign, otherwise…
Solitary Pulmonary Nodule, PET/FDG – if hot, likely _______ next step is _______
likely malignant
Order Biopsy
Atelectasis
collapse of lung tissue affecting part or all of one lung.
Results from alveoli collapse or plug.
• loss of volume
Elevation of hemidiaphragm
Atelectasis
Crowding of vessels & bronchial tree in the volume loss
Atelectasis
• Overaeration of opposite lung or other lobes
Atelectasis
• Increase in density
Atelectasis
Collapsed lung
Pneumothorax
Absent Vascular markings
Pneumothorax
Mediastinal shift
Pneumothorax
For assessment of valves and chambers of the Heart
clots, myxomas
Echocardiograms
Pneumoperitoneum
•Abnormal presence of air or gas in peritoneal cavity –
potential space within abdominal cavity
•Often during laparoscopic procedures.
Pneumoperitoneum
• Note pulmonary vascular congestion
CHF
• Enlarged Heart shadow
CHF
U wave associated with
- Hypokalemia
- Hypercalcemia
- Digitalis
