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Clin Med II Exam 2 (Lauren) > Pulmonary Diagnostic Imaging > Flashcards

Pulmonary Diagnostic Imaging Flashcards

(97 cards)

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1
Q

What 3 types of pulmonary imaging do NOT emit ionizing radiation?

A

Ultrasound

MRI/MRA

Bronchoscopy

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2
Q

Almost 50% of the ionizing radiation the US population is exposed to comes from _________

A

Medical imaging

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3
Q

Which imaging type is usually the initial study to evaluate respiratory symptoms?

A

Chest x ray

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4
Q

What is inherent contrast?

A

Air in the lungs providing a contrast to surrounding soft tissue and bones

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5
Q

What are the 4 most common views for a chest x ray?

A

PA

AP

Lateral

Decubitus

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6
Q

Which one do we use more for CXR: AP or PA view

A

PA

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7
Q

Why don’t we use AP view for CXRs very much?

A

It makes the heart look bigger than it actually is.

AP usually only done if the pt cant get out of bed for whatever reason

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8
Q

We look at the structures in a chest x ray in a certain order:
ABCDEF

What do they each stand for?

A

A-airway (trachea, foreign bodies)

B- bones (clavicles, ribs)

C- cardiac (borders, size)

D- diaphragm

E- edges (edges of lungs: effusions, plaques, costophrenic angles)

F- fields (lung fields…looking for nodules etc)

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9
Q

Can you see the lower lobes from the PA view?

A

Not very well. Must do lateral to really see them

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10
Q

The R atria of the heart is next to this lung lobe______

A

RML

So if R atria border isn’t crisp, you might suspect that there’s some sort of infiltrate in the RML

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11
Q

What is the apical lordotic view used for?

A

When you’re trying to see something in the apex of the lungs.

(Its the one where the patient leans back)

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12
Q

Why would we use a decubitus view?

A

You compare the PA and the decubitus X rays to see if fluid/effusions move when the pt lays down

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13
Q

What does a “Hampton’s Hump” look like?

A

A wedge shaped opacity with its base against the pleural surface of the lung

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14
Q

What does a Hamptoms hump indicate?

A

A Pulmonary Embolism/Infarct

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15
Q

Is the radiation exposure from a chest x ray a lot?

A

It is minimal BUT cumulative

Idk she had it bolded and underlined

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16
Q

What are some of the risks and limitations of CXR/

A

Radiation (minimal but cumulative)

Pregnancy

Some conditions cant be detected (very small cancers, pulmonary emboli)

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17
Q

When reading a CT scan, whaere should you imagine you are looking in relation to the patient

A

Looking up from the patients feet

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18
Q

Why would you order a chest CT?

A

Clarify abnormal CXR (most common)

Help diagnosis

Characterize pulmonary nodules

Staging of primary and metastatic cancer

Screening for lung cancer

Evaluate mediastinal/hilar masses

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19
Q

Who needs to have a chest CT done to screen for lung cancer?

A

55-80 yr olds with a 30 pack year smoking history who currently smoke or quit in the last 15 yrs

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20
Q

What are the 2 types of CT scan “slicing patterns”?

A

Conventional- “step and shoot”

Helical/spiral- continuous

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21
Q

Which takes longer: a conventional CT or a helical/Spiral CT?

A

Conventional CT takes longer 25-30 min

Helical CT takes less than 5 min

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22
Q

What is the difference between High Resolution CT and Low Dose CT?

A

HRCT- better detail and 1mm slices

Low Dose CT- less detail, used for screening

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23
Q

What kind of CT do we use to screen for lung cancers’?

A

Low Dose CT

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24
Q

What is a multidetector/multislice CT?

A

It takes multiple slices at each step and is 64 times faster than single slices. BUT it has higher radiation

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25
What is the most common reason we order chest CTs
To clarify an abnormal CXR
26
Can you see subcutaneous emphysema on a chest CT?
Yes Looks like marbling under skin
27
Which is more sensitive to patient movement: | CT or MRI
MRI
28
Can CTs be done if pt has an implanted device?
Yes
29
Can CT be used for real time imaging when doing biopsies?
Yes
30
What are the risks of CT?
Radiation- A LOT Increased cancer risk Fetal exposure during pregnancy (avoid) Problems with contrast
31
What is the weight limit of CT?
450 lbs
32
1 chest CT = _____ CXRs
80
33
1 CT pulmonary embolism protocol = ________ CXRs
150
34
Why are we so cautious with doing CT scans on children?
They are more radiosensitive Their radiation risk is compounded by a longer lifespan Increased risk of leukemia and brain tumors
35
You have a 32 yo female patient who has a weird CXR. You decide you need to investigate further with a chest CT. What do you NEED TO DO before you proceed?
Ask LMP!!!! ************ Was Red and big and had exclamation point
36
What happens if you do a CT scan on a pregnant woman?
The kid can get cancer and die
37
What kind of contrast in used in CT
Iodine
38
Why do we use contrast?
Enhances differences in densities of various structures (Ex: would be good for a large blood vessel encased in and constricted by a tumor) CT w/o contrast: vessel and tumor will appear as one homogenous mass CT w/ contrast: narrowing of vessel will be apparent
39
What are some times you do use contrast when doing a CT?
Masses Cancer Obstructive processes PE Dissection
40
When are the only 2 times you would NOT use contrast in a CT?
High resolution CT Follow up on known pulmonary nodules *****
41
What are the risks of using contrast?
Allergic reaction Kidney damage Developing lactic acidosis if taking Metformin
42
If someone is on Metformin and they need a CT with contrast, what do you need to do to prevent them from developing lactic acidosis?
Stop taking metformin for 48 hours after the imaging
43
How long after giving the contrast would it take for an allergic reaction to happen
5-60min
44
Is shellfish allergy a contraindication to contrast?
NO*****
45
What kinds of things should make you nervous before giving contrast to a patient?
Prior reaction (itchy, SOB, flushed, etc) Asthma Atopy
46
If someon had a mild reaction to contrast before and you REALLY need to use it, what should you do?
Pre treat them with prednisone and Benadryl
47
How much of a change in serum creatinine will indicate that the patient has suffered contrast induced kidney damage?
25% or more from baseline OR 0.5mg+
48
Is contrast induced kidney damage reversible?
Usually yes
49
What is the best treatment for contrast induced nephropathy?
Prevention 🙄
50
What Creatinine levels and GFRs should make you say “I’m not OK giving this person contrast”
Creatinine: 1.5 or higher GFR less than 60
51
What are some alternate imaging methods you can use in patient whose kidneys cant handle contrast (Creat >1.5 or GFR <60)
CT w/o contrast MRI w/o gadolinium Ultrasound
52
What patients need to have their renal function checked before giving them iodine contrast?
> 60 yrs History of renal problems/dialysis HTN treated w medication Diabetes Taking metformin
53
Do you use contrast in a patient when you’re doing a 3 month follow up of a lung nodule
No
54
What does lateral decubitus position help you see
Effusions
55
When can a patient on Metformin get contrast CT and keep taking their Metformin
If their eGFR is 30 or more
56
If a patient is on Metformin and their GFR is less than 30, or their kidneys just suck, what do you need to do when you give them contrast?
Hold metformin for 48 hrs after contrast Resume only after re-checking renal function
57
What does angiography do?
Allows you to assess vasculature
58
Do you ever inject contrast and then just do nothing else
No you will always do some sort of imaging lol
59
When do you use CT Pulmonary angiography (CTPA)?
PE Aortic dissection Superior vena cava syndrome Pulmonary arterial invasion by neoplasm
60
What is the difference between CTPA and conventional pulmonary angiography?
CTPA involves a CT scan and dye is injected in a peripheral vein Conventional pulmonary angiography involves a catheter directed through the R femoral or internal jugular vein right to the pulmonary arteries, shoots dye right at the target, and then an X RAY is taken
61
What is the gold standard in evaluation of PE?
Direct Pulmonary Angiography aka Catheter/Conventional Pulmonary angiography ********* ********BOARD QUESTION****
62
When would you use Direct Pulmonary angiography to evaluate PE?
If you did a VQ scan or CTPA and they were inconclusive, but you still have a high clinical suspicion of PE. This will show a really small PE, where the other two imagings might not
63
Is direct pulmonary angiography expensive?
yes
64
Are there any risks of direct pulmonary angiography?
Yes Bleeding/hematoma at catheter insertion site Heart arrhythmia- you’re guiding the catheter THROUgh the heart Allergy to contrast Impaired kidney function Radiation exposure
65
The usefulness of MRI is limited in pulmonary disease. When would we use it?
Hilar/mediastinal densities, sulcus tumors, cysts/lesions of chest wall Allergy to contrast Extreme kidney disease (GFR<60)
66
What are the benefits of MRI over CT
No bone artifact No ionizing radiation
67
What kind of imaging would be useful to evaluate a Pancoast (sulcus) tumor?
MRI
68
What kind of contrast material is used for MRI and MRA exams?
Gadolinium
69
Compared to a chest CT, MRI gives you a (more/less) detailed view of lung parenchyma
Less
70
What is nephrogenic systemic fibrosis?
Irreversible fibrosis of the kidney
71
What can cause nephrogenic systemic fibrosis?
If the pt has a GFR<30 and you give them gadolinium!!! | So don’t freakin do an MRI with gadolinium contrast! IRREVERSIBLE FIBROSIS OF KIDNEY
72
What are the contraindications of doing MRI/MRA?
Pacemaker or defibrillator Metal in eye Aneurysm clip Cochlear implant ********************* must know
73
What is the most common use of a VQ scan?
To evaluate for pulmonary embolism
74
What does a V/Q mismatch mean?
There is an imbalance of blood flow and ventilation
75
Does VQ scan expose you to radiation?
Yes. 2 types of radiation! Technetium-99 for circulation Xenon gas for ventilation
76
What are the 2 phases of a VQ scan?
IV phase- technetium-99 is injected to see PERFUSION Inhalation phase- radio-labeled Xenon gas is inhaled to see VENTILATION
77
What is the test of choice for diagnosing PE in pregnant women?
V/Q scan**** They can do just the perfusion phase and/or cut the radiation in half
78
Is a VQ scan best used in someone with a normal or abnormal CXR?
Normal****
79
What should you do if your pt has a normal CXR, but you have a high suspicion for PE?
VQ scan**
80
VQ scans have a high number of false (positives/negatives) when evaluating PE
Many false positives | Sensitive for PE but not specific
81
What kind of images are acquired from a PET scan?
Physiologic Images******* | This was in red
82
What is injected into the patient when doing a PET scan?
fluorodeoxyglucose (FDG) This is radioactively labeled glucose
83
Where does FDG accumulate in the patient?
Tissues/organs with high metabolic activity LIKE CANCER CELLS
84
How is the uptake of FDG measured when doing a PET scan?
Measurements of the uptake are made in standardized uptake value (SUV)
85
When doing a PET scan, what SUV raises the suspicion for malignancy?
Over 2.5
86
What is PET most often used for?
Used to detect cancer/metastasis from primary site
87
What imaging might you use to examine the effects of cancer therapy?
PET scan (Chemo might have killed the tumor, but the scarring will still be there, so on CT, it might look like the chemo didn’t do anything. A PET scan will show you its dead)
88
What kind of imaging is PET scan often combined with?
CT scan. So you can see anatomic and physiologic information at the same time
89
What is one of the major benefits of a PET scan?
You can detect biochemical changes of anatomy BEFORE they can be seen with CT or MRI
90
What causes false results in PET scans?
Metabolic imbalances. False Positive- inflammatory lesions False Negative- slow growing tumors
91
When would you see a “seashore sign” and is it good or bad?
When doing a thoracic ultrasound. It is good 🏝
92
When would you see a “barcode” or “stratosphere” sign, and is it good or bad?
When doing a Thoracic ultrasound It is bad :(
93
When is Rigid Bronchoscopy most often used?
Tracheal or Bronchus Obstruction Foreign Body Removal
94
True or False: | Bronchoscopy can be diagnostic and therapeutic
True Can evaluate lung conditions and can also sample tissues, place ET tubes, and remove excess mucus or FBs
95
What are the 2 types of bronchoscope?
Flexible Rigid
96
What kind of complications does bronchoscopy have?
MINOR COMPLICATIONS | Hemmorhage, pneumothorax, hypotension, arrhythmia
97
What are the contraindications to bronchoscopy?
Severe hypoxia (can’t go without O2 for long) Bleeding risk (anticoagulants) Risk of cardio/pulm decompensation (MI, asthma or COPD exacerbation, CHF, Major arrhythmias) ***she said to know these

Clin Med II Exam 2 (Lauren) (3 decks)

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