Pt Interview, Physical finding, Scanning Algorithm Flashcards
______ is a variable associated with an increased risk of disease or infection.
_____ is a variable that is connected with a disease or infection. These can be clinical findings or sonographic findings.
risk factor e.g.
Risk factors for brittle bones? – Poor diet, malabsorption issue
Risk factors for heart disease? – High Cholesterol
Risk factors for skin cancer? – Too much sun tanning
Risk factors for cervical cancer? – Multiple sex partners
Risk factors for liver disease? – Excessive alcohol consumption
Risk factor for STD’s? – Unprotected intercourse
Risk factors for mouth abscess? – Poor oral health care
associated findings e.g
Associated findings with brittle bones? – Being female
Associated findings with heart disease? – Chest pain
Associated findings with liver disease? - Jaundice
Associated findings with orchitis? – Red, warm skin
Associated findings with kidney stones? – Flank pain
Associated findings with mouth abscess – Bad breath
____ is the the determination of which of two or more diseases with similar symptoms or imaging findings is the one from which the patient is suffering, by a systematic comparison and contrasting of the clinical or imaging findings
Clinical examples:
RUQ pain
Hepatomegaly
GB disease
Muscle issues
Constipation
Imaging examples:
complex lesion within the liver
various malignant tumors
Primary
Metastatic
various benign tumors
parasitic lesions
abscess
hematoma
differential diagnosis
*By combining the clinical and
imaging findings the possible
differentials will dwindle leaving the
most likely. Often times more
diagnostic tests are needed to make
a diagnosis such as a biopsy.
What is the difference b/t a sign and a symptom?
Signs = Objective finding-Can be seen or measured
Symptoms = Subjective finding-Patient needs to tell you
These can often belong in either category
Such as when a patient is doubled up in pain and crying
if the pt pt. is referred to R/O gallstones what questions do you ask?
Why? Is there pain?
When? Is it after they eat?
Where? RUQ?
What is the real problem?
–
Maybe the pt. is asymptomatic and a plain x-ray film suggested there presences.
If the pt. is asymptomatic & I don’t see gallstones then the exam stops there. However if the pt. is symptomatic and there are no gallstones I ask myself “Why is the patient having pain?” I expand the exam and look closely at the liver and hepatic flexure, use probe palpation to try and identify the area of pain and if the pain is focal or diffuse.
Did you know that constipation can cause RUQ pain?
Did you know it is also associated with eating?
With pain starting 15-20 minutes after a meal.
How?
The gastrocolic reflex – A normal reflex after eating
It involves an increase in motility of the colon in response to stretching of the stomach and byproducts of digestion moving to the small intestine. The reflex is responsible for the urge to defecate following a meal. The gastrocolic reflex helps make room for more food.
Does this make sense? The colon started to peristalsis and is unable to move material along thus causing pain in the RUQ beginning 15-20 min. or so after a meal.
________ is the determination of which of two or more diseases with similar symptoms or imaging findings is the one from which the patient is suffering, by a systematic comparison and contrasting of the clinical or imaging findings
differential diagnosis
Clinical examples
RUQ pain, Hepatomegaly, GB disease, Muscle issues, Constipation
Imaging examples
complex lesion within the liver, various malignant tumors. Primary: Metastatic, various benign tumors, parasitic lesions, abscess, hematoma
*By combining the clinical and imaging findings the possible differentials will dwindle leaving the most likely. Often times more diagnostic tests are needed to make a diagnosis such as a biopsy
Hepatomegaly is another possible etiology RUQ pain
A swollen liver will be tender over the right and left lobes not just over the RUQ.
Use your hand or probe to palpate over both lobes to see the pain can be recreate. The clip shows the proper way to palpate the liver. The first part is liver percussion and palpation follows.
Remember to check the left lobe as well if you are questioning a swollen liver as a possible cause for RUQ pain.
How does a sonographer find information?
1) The Requisition
While this is the first place to start…DO NOT…let it be the last attempt at information gathering
•
“ASS U ME” nothing
2) Electronic Chart
Notes: Physical exam, Prior medical and Surgical history, Labs, Prior imaging, Path. results
–
3) Interviewing the patient
Asking – Closed ended questions, Open ended
Listening – Objective and Subjective data
What are the five exploration questions
•
Provocative or Palliative - What causes the symptom(s), does anything make it better or worse?
•
Quality or Quantity - How does the symptom(s) feel or look
•
Region or Radiation - Ask patient to pin point the area of symptom(s)
•
Severity - How bad is it, getting better? worse? staying the same?
•
Timing - when did it start? was it gradual or suddenly onset, is it intermittent, is it worse at times….
Image optimization: Make the images the best you can, use the machine settings. which settings?
pen - deeper (heavier pt) gen - mid (normal pt) res - less deep (thin pt)
algorithm of sonography _____________
thrombocytes are ___ in the blood
platelets
the ____ cells are specilaized heatic ccells which help to place bile pigment, old blood cells and by products of phagocyosis from the blood and deposit them into the bile ducts
kupffer
___ is the term used to describe the passage of blood stools
hematorhea
what is very important in planning the approach to each sonographic exam?
pt history and pertinent clinical info
