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Clinical Medicine II > Pulm: Diagnostic Imaging > Flashcards

Pulm: Diagnostic Imaging Flashcards

1
Q

What is the initial test that should be ordered to evaluate respiratory sxs?

A

CXR

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2
Q

What 3 views should be obtained with CXR?

A

PA, AP, lateral decubitus

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3
Q

What is the A,B,C,D,E,F approach to reading a CXR?

A 
Airway
Bones
Cardiac Shilouette
Diaphragms
Edges
Fields
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4
Q

Biggest benefit of CXR over other imaging modalities?

A

Low radiation exposure

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5
Q

You see a CXR showing no vasculature on the left side. What is lack of vasculature concerning for?

A

PTX

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6
Q

CXR shows hampton’s hump. What is this concerning for?

A

Pulmonary infarct/PE

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7
Q

Two major limitations for CXR?

A

radiation exposure (cumulative)

Some conditions cannot be detected

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8
Q

Can CXR be done in pregnancy?

A

no

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9
Q

Which imaging modality should be ordered?

Clarify CXR
Characterize pulm. nodules
Assist in dx
detect/stage neoplasm
evaluate mediastinal mass
A

CT

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10
Q

What type of CT?

Fast
Continuous
Takes < 5 min

A

Spiral

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11
Q

What type of CT?

1mm slices
better detail
used for fibrosis/emphysema

A

High resolution

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12
Q

What type of CT?

Less detail
Used for screening

A

Low-dose

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13
Q

What type of CT

10mm slices
Step & shoot style
25-30min

A

Conventional

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14
Q

What are 4 types of mediastinal mass? (4 Ts)

A

teratoma

thymoma

thyroid CA

Terrible lymphoma

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15
Q

Can CT be performed with implanted devices?

A

yes

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16
Q

Radiation exposure from CT is ___ which is ___ x a CXR

A

8 mSv, 80x

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17
Q

Can you do CT with pregnancy?

A

no

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18
Q

CTPA is ___ x the radiation dose of a single CXR

A

150x

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19
Q

What must you ask women prior to all imaging?

A

LMP

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20
Q

Are kids more or less radiosensitive than adults?

A

more

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21
Q

What type of contrast is often used with CT?

A

Iodine

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22
Q

When is contrast CT indicated?

A

Visualize Vessels and Malignancy

Trauma

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23
Q

What are three risks of CT with radiocontrast?

A

allergic rxn

contrast induced nephropathy

lactic acidosis if taking metformin

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24
Q

How do you avoid allergic rxn to contrast?

A

pre-treat with prednisone and benadryl

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25
Q

What is the typical onset of allergic rxn to contrast?

A

5-60 min

26
Q

24-48 hours after contrast administration, a patient presents with:

Creatinine 0.5 + (25% from baseline)

What condition should be suspected, when do sxs peak

A

radiocontrast induced nephropathy

peak 3-5 days

27
Q

Caution should be taken in administering radiocontrast if creatinine or GFR values are…

A

Creat: > 1.5

GFR < 60

28
Q

What 5 populations need to have renal fxn tested prior to radiocontrast?

A

age > 60

hx renal disease

hx HTN treated wih meds

hx of DM

metformin use

29
Q

This imaging modality assesses pulmonary vasculature.

It can be performed with:

CTPA
Direct pulm. angiography
pulm MRI

A

Pulmonary angiography

30
Q

What test has largely replaced conventional, catheter-directed pulmonary angiography?

A

CTPA

31
Q

This imaging modality is useful for detecting:

PE
Aortic Dissection
SVC Syndrome

A

CTPA

32
Q

What is the radiation exposure for CTPA?

A

10-15 mSv

33
Q

What might be missed with CTPA imaging?

A

sub-segmental PE

34
Q

What is the gold standard imaging modality to evaluate PE?

A

catheter-directed pulmonary angiography

direct pulm. angiography

35
Q

A patient has an inconclusive V/Q scan and CTPA, but you still suspect PE. What should you order?

A

direct pulmonary angiography

36
Q

What are 5 risks of direct pulmonary angiography?

A
  1. bleeding/hematoma
  2. arrhythmia
  3. allergic rxn
  4. CIN
  5. radiation
37
Q

Which imaging modality:

has limited usefulness for pulmonary disease

Less detailed view of parenchyma

No ionizing radiation, bone artifacts

A

MRI

38
Q

What imaging modality is useful for visualizing the hilum, mediastinum, cancers, and lacks iodine contrast?

A

MRI

39
Q

What are three big limitations to MRI?

A

pt. must remains still

claustrophobia

body habitus limitations

40
Q

What are the contraindications for MRI (4)?

A

implanted pacemaker/defib

metal in eye

aneurysm clip

Cochlear implant

41
Q

This imaging modality:

Useful in evaluation of PE and pre-op assessment for lung resection

A

V/Q Scan

42
Q

What are the two phases of the V/Q Scan and what is used for visualization?

A

IV phase: technitium 99 bound to albumin

Inhalation phase: radio-labeled xenon gas

43
Q

A V/Q mismatch indicates…

A

imbalance of blood flow and ventilation

44
Q

What is a major limitation of V/Q scan?

A

sensitive for PE, but poor specificity (few false- neg, high false-positive)

45
Q

If you have a normal CXR but high suspicion for PE, what can be used in pregnant patients or those who can’t tolerate CTPA/direct angiography?

A

V/Q Scan

46
Q

What is the test of choice for PE dx in pregnant women?

A

V/Q Scan

47
Q

What are 2 major benefits to the V/Q Scan?

A
  1. rare allergic reaction

2. low dose radiation

48
Q

For what condition is PET scan used?

A

detection of CA

49
Q

What is superior for mediastinal imaging, CT, MRI, PET>

A

PET

50
Q

What is used for contrast in PET scan?

A

FGD–radioactively labeled glucose

51
Q

Where does FGD accumulate?

A

cells with high metabolic activity: CA cells, heart, kidneys, bladder

52
Q

This imaging modality has the following benefits:

  • detects biochem changes before appearance on CT/MRI
  • Short-lived radioactivity
  • combined with CT/MRI to give full picture of anatomy and metabolism
A

PET

53
Q

The following imaging modality has the following limitations:

  • 140 x CxR radiation
  • False results occur with metabolic imbalance
  • time sensative
  • High cost
A

PET

54
Q

This imaging modality has the following indications:

  • Bedside detection of pleural effusion, HTX, PTX
  • Guidance for thoracentesis
  • guidance for thoracostomy tube placement
A

Thoracic ultrasound

55
Q

The seashore sign on thoracic ultrasound indicates…

A

normal lung

56
Q

The barcode sign on thoracic ultrasound indicates:

A

PTX/no chest wall motion

57
Q

What imaging modality has the following diagnostic indications?

  • evaluation of pneumonia, hemoptysis, cough
  • dx of transesophageal fistula/tracheobronchomalacia
  • tissue sampling
A

Bronchoscopy

58
Q

What are the 2 therapeutic indications for bronchoscopy?

A

Removal of excess mucous or FBs

ET tube placement

59
Q

When should a rigid bronchoscope be used?

A

foreign body removal

60
Q

What are the risks of bronchoscopy? (5)

A 
Bleeding
Infx
Bronchospasm
Perf.
PTX
61
Q

What are the contraindications for bronchoscopy? (5)

A 
Severe Hypoxia
Risk of bleeding
Pulm. HTN
Severe cough
Tracheal stenosis

Clinical Medicine II (31 decks)

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