patient safety

Question 1

magnetic field strength above which a patient with an implanted cardiac pacemaker should NOT be allowed

Answer 1

5 Gauss (0.5 mT)…………………… (1 Gauss = .0001 Tesla, or 1 Tesla = 10,000 Gauss)

Question 2

a physician omitted the pre-procedure time out before performing a breast biopsy. The procedure went smoothly and the pathology revealed a concordant fibroadenoma. what is the behavior and corresponding managerial strategy for this physician based on “just culture”

Answer 2

at-risk behavior - coach them most cultural problems in medicine involve at-risk behavior which responds well to coaching rather than punishment. Repeated sequential at-risk behaviors could trigger punitive measures

Question 3

52 yo presenting for a biopsy. PMH includes well controlled HTN. What is his ASA classification?

Answer 3

ASA Class II = a patient with mild systemic disease

Question 4

ASA classification: a moribund patient who is not expected to survive without operation

Answer 4

ASA Class V

Question 5

ASA Class V

Answer 5

a moribund patient who is not expected to survive without operation

Question 6

ASA Class VI

Answer 6

declared brain dead patient whose organs are being removed for donor purposes

Question 7

declared brain dead patient whose organs are being removed for donor purposes

Answer 7

ASA Class VI

Question 8

Risk factors that warrant renal function assessment prior to IV iodinated contrast

Answer 8

Age > 60, history of renal disease, HTN, diabetes, metformin use

Question 9

NSF symptoms begin where:

Answer 9

extremities

Question 10

Can a type 2 gadolinium contrast agent be used in patients with chronic renal disease?

Answer 10

yes

Question 11

Pt with ESRD, can they get a contrast MRI?

Answer 11

yes - with a type 2 gadolinium contrast agent

Question 12

reversal of midazolam

Answer 12

Flumazenil 0.2 mg IV

Question 13

maximum sterile barrier technique includes:

Answer 13

cap, mask, gown, gloves. hand washing, drapes and cutaneous anti-sepsis

Question 14

“fixation of failure” is a characteristic of:

Answer 14

high reliability organization

Question 15

High reliability organizations have the following characteristics:

Answer 15

fixation of failure, avoidance of oversimplification, sensitivity to operations, respect of expertise, dedication to resilience

Question 16

the only “never event” specific to radiology is:

Answer 16

introduction of metal objects into an MRI suite

Question 17

introduction of metal objects into an MRI suite

Answer 17

the only “never event” specific to radiology according to the criteria set by the Agency for Healthcare Research and Quality

Question 18

2 yo with shunted hydrocephalus moved from another institution for routine brain MRI with anesthesia. If no anesthesiologist is available, what is another option to image the kid?

Answer 18

Rapid sequence MRI, no anesthesia

Question 19

most common cause of MRI induced burns

Answer 19

skin to skin contact. burns can be caused when the patient’s skin comes in contact with the inner bore of the MRI scanner or skin-to-skin contact (usually inner thighs)

Question 20

highest magnetic field strength considered safe for the general public?

Answer 20

5 Gauss (0.5 mT)

Question 21

hearing protection must be provided for MRI exams in which sound pressure exceeds:

Answer 21

99 decibels

Question 22

can a patient with a fractured pace lead undergo MRI?

Answer 22

NO!!! it is an absolute contraindication

Question 23

The National Patient Safety Goals program was established by:

Answer 23

The Joint Commission

Question 24

Ideal way to wear a ring badge to monitor radiation exposure

Answer 24

dominant hand under gloves

Question 25

what radiation level can ring dosimeters detect

Answer 25

30 mrem of gamma and 40 mrem of beta

Question 26

4 main principles of the Image Gently campaign

Answer 26

Basically do as little as possible and it doesn’t need to be perfect. 1. reduce or “child size” the amount of radiation used. 2. scan only when necessary 3. scan only the indicated region 4. scan once.