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

Pulmonary Diagnostic Imaging Flashcards

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
Q

What is the most common reason we order chest CTs

A

To clarify an abnormal CXR

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26
Q

Can you see subcutaneous emphysema on a chest CT?

A

Yes

Looks like marbling under skin

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27
Q

Which is more sensitive to patient movement:

CT or MRI

A

MRI

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28
Q

Can CTs be done if pt has an implanted device?

A

Yes

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29
Q

Can CT be used for real time imaging when doing biopsies?

A

Yes

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30
Q

What are the risks of CT?

A

Radiation- A LOT

Increased cancer risk

Fetal exposure during pregnancy (avoid)

Problems with contrast

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31
Q

What is the weight limit of CT?

A

450 lbs

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32
Q

1 chest CT = _____ CXRs

A

80

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33
Q

1 CT pulmonary embolism protocol = ________ CXRs

A

150

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34
Q

Why are we so cautious with doing CT scans on children?

A

They are more radiosensitive

Their radiation risk is compounded by a longer lifespan

Increased risk of leukemia and brain tumors

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35
Q

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?

A

Ask LMP!!!!
****

Was Red and big and had exclamation point

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36
Q

What happens if you do a CT scan on a pregnant woman?

A

The kid can get cancer and die

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37
Q

What kind of contrast in used in CT

A

Iodine

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38
Q

Why do we use contrast?

A

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

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39
Q

What are some times you do use contrast when doing a CT?

A

Masses

Cancer

Obstructive processes

PE

Dissection

40
Q

When are the only 2 times you would NOT use contrast in a CT?

A

High resolution CT

Follow up on known pulmonary nodules
*****

41
Q

What are the risks of using contrast?

A

Allergic reaction

Kidney damage

Developing lactic acidosis if taking Metformin

42
Q

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?

A

Stop taking metformin for 48 hours after the imaging

43
Q

How long after giving the contrast would it take for an allergic reaction to happen

A

5-60min

44
Q

Is shellfish allergy a contraindication to contrast?

A

NO*****

45
Q

What kinds of things should make you nervous before giving contrast to a patient?

A

Prior reaction (itchy, SOB, flushed, etc)

Asthma

Atopy

46
Q

If someon had a mild reaction to contrast before and you REALLY need to use it, what should you do?

A

Pre treat them with prednisone and Benadryl

47
Q

How much of a change in serum creatinine will indicate that the patient has suffered contrast induced kidney damage?

A

25% or more from baseline
OR

0.5mg+

48
Q

Is contrast induced kidney damage reversible?

A

Usually yes

49
Q

What is the best treatment for contrast induced nephropathy?

A

Prevention 🙄

50
Q

What Creatinine levels and GFRs should make you say “I’m not OK giving this person contrast”

A

Creatinine: 1.5 or higher

GFR less than 60

51
Q

What are some alternate imaging methods you can use in patient whose kidneys cant handle contrast (Creat >1.5 or GFR <60)

A

CT w/o contrast

MRI w/o gadolinium

Ultrasound

52
Q

What patients need to have their renal function checked before giving them iodine contrast?

A

> 60 yrs

History of renal problems/dialysis

HTN treated w medication

Diabetes

Taking metformin

53
Q

Do you use contrast in a patient when you’re doing a 3 month follow up of a lung nodule

A

No

54
Q

What does lateral decubitus position help you see

A

Effusions

55
Q

When can a patient on Metformin get contrast CT and keep taking their Metformin

A

If their eGFR is 30 or more

56
Q

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?

A

Hold metformin for 48 hrs after contrast

Resume only after re-checking renal function

57
Q

What does angiography do?

A

Allows you to assess vasculature

58
Q

Do you ever inject contrast and then just do nothing else

A

No you will always do some sort of imaging lol

59
Q

When do you use CT Pulmonary angiography (CTPA)?

A

PE

Aortic dissection

Superior vena cava syndrome

Pulmonary arterial invasion by neoplasm

60
Q

What is the difference between CTPA and conventional pulmonary angiography?

A

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
Q

What is the gold standard in evaluation of PE?

A

Direct Pulmonary Angiography
aka Catheter/Conventional Pulmonary angiography *******

**BOARD QUESTION**

62
Q

When would you use Direct Pulmonary angiography to evaluate PE?

A

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
Q

Is direct pulmonary angiography expensive?

A

yes

64
Q

Are there any risks of direct pulmonary angiography?

A

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
Q

The usefulness of MRI is limited in pulmonary disease. When would we use it?

A

Hilar/mediastinal densities, sulcus tumors, cysts/lesions of chest wall

Allergy to contrast

Extreme kidney disease (GFR<60)

66
Q

What are the benefits of MRI over CT

A

No bone artifact

No ionizing radiation

67
Q

What kind of imaging would be useful to evaluate a Pancoast (sulcus) tumor?

A

MRI

68
Q

What kind of contrast material is used for MRI and MRA exams?

A

Gadolinium

69
Q

Compared to a chest CT, MRI gives you a (more/less) detailed view of lung parenchyma

A

Less

70
Q

What is nephrogenic systemic fibrosis?

A

Irreversible fibrosis of the kidney

71
Q

What can cause nephrogenic systemic fibrosis?

A

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
Q

What are the contraindications of doing MRI/MRA?

A

Pacemaker or defibrillator

Metal in eye

Aneurysm clip

Cochlear implant

***** must know

73
Q

What is the most common use of a VQ scan?

A

To evaluate for pulmonary embolism

74
Q

What does a V/Q mismatch mean?

A

There is an imbalance of blood flow and ventilation

75
Q

Does VQ scan expose you to radiation?

A

Yes.

2 types of radiation!
Technetium-99 for circulation

Xenon gas for ventilation

76
Q

What are the 2 phases of a VQ scan?

A

IV phase- technetium-99 is injected to see PERFUSION

Inhalation phase- radio-labeled Xenon gas is inhaled to see VENTILATION

77
Q

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

A

V/Q scan**

They can do just the perfusion phase and/or cut the radiation in half

78
Q

Is a VQ scan best used in someone with a normal or abnormal CXR?

A

Normal**

79
Q

What should you do if your pt has a normal CXR, but you have a high suspicion for PE?

A

VQ scan**

80
Q

VQ scans have a high number of false (positives/negatives) when evaluating PE

A

Many false positives

Sensitive for PE but not specific

81
Q

What kind of images are acquired from a PET scan?

A

Physiologic Images***

This was in red

82
Q

What is injected into the patient when doing a PET scan?

A

fluorodeoxyglucose (FDG)

This is radioactively labeled glucose

83
Q

Where does FDG accumulate in the patient?

A

Tissues/organs with high metabolic activity LIKE CANCER CELLS

84
Q

How is the uptake of FDG measured when doing a PET scan?

A

Measurements of the uptake are made in standardized uptake value (SUV)

85
Q

When doing a PET scan, what SUV raises the suspicion for malignancy?

A

Over 2.5

86
Q

What is PET most often used for?

A

Used to detect cancer/metastasis from primary site

87
Q

What imaging might you use to examine the effects of cancer therapy?

A

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
Q

What kind of imaging is PET scan often combined with?

A

CT scan.

So you can see anatomic and physiologic information at the same time

89
Q

What is one of the major benefits of a PET scan?

A

You can detect biochemical changes of anatomy BEFORE they can be seen with CT or MRI

90
Q

What causes false results in PET scans?

A

Metabolic imbalances.

False Positive- inflammatory lesions

False Negative- slow growing tumors

91
Q

When would you see a “seashore sign” and is it good or bad?

A

When doing a thoracic ultrasound.

It is good 🏝

92
Q

When would you see a “barcode” or “stratosphere” sign, and is it good or bad?

A

When doing a Thoracic ultrasound

It is bad :(

93
Q

When is Rigid Bronchoscopy most often used?

A

Tracheal or Bronchus Obstruction

Foreign Body Removal

94
Q

True or False:

Bronchoscopy can be diagnostic and therapeutic

A

True

Can evaluate lung conditions and can also sample tissues, place ET tubes, and remove excess mucus or FBs

95
Q

What are the 2 types of bronchoscope?

A

Flexible

Rigid

96
Q

What kind of complications does bronchoscopy have?

A

MINOR COMPLICATIONS

Hemmorhage, pneumothorax, hypotension, arrhythmia

97
Q

What are the contraindications to bronchoscopy?

A

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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