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rest for final Flashcards

1
Q

how can fluid collections be classified?

A
  • body location
  • infected
  • potentially infected
  • intravisceral/extravisceral
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2
Q

body locations

A
  • neck
  • thoracic
  • abdominal
  • pelvic
  • extremity
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3
Q

infected

A

asbcess

empyema

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4
Q

potentially infected

A
  • hematoma
  • seroma
  • lymphocele
  • bile (biloma)
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5
Q

what fluid collection drainage is the primary focus today?

A

extravisceral abdominal fluid collection

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6
Q

what are fluid collection drainage indications?

A
  • urgent drainage fo fluid colletions

- elective drainage of fluid collection

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7
Q

what is involved in the pre scan of drainage?

A

look for adjacent organs that can be mistaken for the collection by ultrasaound during the drainage procedure

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8
Q

what organs must we look for in the pre scan for drainage?

A
  • focally dilated small bowel loop
  • gallblader
  • urinary bladder
  • distended stomach
  • ovaries, fallopian tubes, uterus
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9
Q

what does the lab value evaluation mostly revolve around for pre drainage procedure?

A

ruling out coagulopathy

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10
Q

what is a normal INR range?

A

0.8-1.2

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11
Q

what is a normal platelet range?

A

150 000-450 000

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12
Q

what is the normal PTT range?

A

25-35 sec

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13
Q

what must be mentioned when obtaining informed consent?

A
  • explain procedure
  • indications
  • alnertatives
  • procedureal risks
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14
Q

what is given to control the pain caused by fluid collection drains?

A

nonarcotic medication. Pain is usually not a problem

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15
Q

is pleural/thoracic complications common or not?

A

not common

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16
Q

if a person with chest pain or reduced oxygen after a pleural or thoracic fluid drainage, what should be obtained?

A

CXR to rule out pneumothorax or hemothorax

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17
Q

is puncture to adjacent structures common in drainages?

A

not common

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18
Q

operators should not _________ the fluid collection?

A

over distend

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19
Q

what rigors can respond to medication?

A

rigors only without fever

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20
Q

what should be done in cases of postoperative fever in drainages?

A

operators should continue with antobiotics and should check for culture and sensitivity of fluid sample obtained

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21
Q

what does sepsis require?

A

requires fluid resuscitation and even vasopressors with ICU admission

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22
Q

what are the 2 types of drainages?

A

diagnostic

therapeutic

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23
Q

Cytopathology/cytology

A

diagnosis malignant vs premalignant/other types of cells in fluid collection on the microscopic level

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24
Q

Medical biochemistry/ chemical pathology/ clinical biochemistry

A

concerned with analysis of bodily fluid. Usually check for cell count and different electrolytes, total protein, minerals within the fluid

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25
Q

Microbiology - culture

A

to check if there is infection within the fluid. Fluid samples are tested for presence of pathogens, which is determined by growth in a medium

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26
Q

what idoes PUBS stand for?

A

percutaneous umbilical cord sampling

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27
Q

what is another word for PUBS?

A

cordocentesis

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28
Q

what is PUBS?

A

sampling of blood via the vein in the umilical cord

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29
Q

why is PUBS preformed?

A

a diagnostic test that examines blood from the fetus to detect fetal abnormalities

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30
Q

how does a PUBS work?

A

ultrasound sees where the cord inserts to placenta and a needle goes through abdomen and uterine walls to umbilical cord. A small sample of blood is taken

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31
Q

when do results come in from a PUBS?

A

72 hours

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32
Q

how is PUBS different from an amniocentesis?

A

similar but this but PUBS retrieves blood from the fetus vs amniotic fluid

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33
Q

why would a PUBS be preformed?

A

when diagnostic information can not be obtained through amniocentesis, CVS, ultrasound or the results were inconclusive

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34
Q

when is a cordocentesis (PUBS) preformed?

A

after 17 weeks into pregnancy

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35
Q

what is a primary risk for cordocentesis?

A

miscarriage (between 1-2 times out of every 100 procedures)

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36
Q

what are other potential side effects to PUBS?

A
  • blood loss from the puncture site
  • cord hematoma
  • infection
  • drop in fetal heart rate
  • premature rupture of membranes
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37
Q

what does PUBS detect?

A

chromosome abnormalities (down syndrome) and blood disorders (fetal hemolytic disease)

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38
Q

PUBS may be preformed to diagnose what?

A
  • malformation of the fetus
  • fetal infection
  • fetal platelet count in the mother
  • fetal anemia
  • isoimmuninization
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39
Q

what does PUBS not diagnose?

A

neural tube defects (amniocentesis does this)

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40
Q

what are reasons for prenatal testing?

A
  • Pursue potential medical interventions that may exist
  • Begin planning for a child with special needs
  • Start addressing anticipated lifestyle changes
  • Identify support groups and resources
  • Make a decision about carrying the child to term
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41
Q

why maybe reasons not to test for prenatal testing?

A

parents may decline testing

  • personal or religous reasons
  • outcome has no impact on comfort level
  • avoid risk of miscarriage or injury to fetus
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42
Q

what is coelocentesis?

A

sampling of fluid from the exoxoelomic cavity

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43
Q

what is the approach for coelocentesis?

A

endovaginal approach

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44
Q

when is prenatal diagnosis for coelocentesis?

A

7 weeks

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45
Q

what are the disadvantages for coelocentesis?

A
  • Coelomic cells difficult to culture
  • Nuchal lucency + lab as accurate
  • Procedure safety
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46
Q

what is culdocentesis?

A

fluid aspirated from the posterior cul-de-sac

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47
Q

what are the findings for culdocentesis?

A
  • blood-intraperitoneal bleeding
  • pus-infectious process
  • serous-ascitic fluid
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48
Q

what are the indications for culdocentesis?

A

large collection of fluid in the posterior cul-de-sac

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49
Q

what are the contraindications for culdocentesis?

A
  • masses
  • cysts
  • fixed retroverted uterus
  • bleeding diathesis
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50
Q

what must the patient do before a culdocentesis?

A

sit or stand upright 10 to 15 minutes prior to procedure

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51
Q

is anesthetic given in a culdocentesis?

A

topical anesthetic applied to the posterior vagina and cervix

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52
Q

what is the postion for a culdocentesis?

A

lithotomy position, head elevated 60 degrees

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53
Q

what is the vagina cleansed with in culdocentesis?

A

iodine

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54
Q

how is the culdocentesis preformed?

A

18G needle attached to 20 mL syringe inserted through the posterior vaginal wall into the posterior cul de sac

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55
Q

what are complcations for a culdocentesis?

A

puncture pelvic nerves

puncture vessels

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56
Q

what is a Hysterosonography &Hysterosonosalpingography?

A

Procedure used to improve or further evaluate the visualization of the uterus, endometrial canal and tubal patency.

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57
Q

when is Hysterosonography &Hysterosonosalpingography preformed?

A

4 - 10 days into the patients menstrual cycle

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58
Q

what are indications dor a Hysterosonography &Hysterosonosalpingography?

A
  • infertility
  • recurrent miscarriage
  • endometrial polyps, hyperplasia, carcinoma
  • AUB / Pre and post menopausal
  • submucosal fibroids
  • uterine anomalies
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59
Q

what are contraindications for a Hysterosonography &Hysterosonosalpingography?

A
  • pregnancy
  • pelvic infections
  • excessive vaginal bleeding
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60
Q

what is done prior to a Hysterosonography &Hysterosonosalpingography?

A
  • NSAID one hour prior (motrin, advil)
  • consent obtained
  • empty bladder
  • pre procedural endovaginal U/S images taken
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61
Q

what pre procedure images are taken in a Hysterosonography &Hysterosonosalpingography?

A
  • uterus and cervical postion
  • size of uterus
  • endometral thickness
  • Rt and Lt adnexa
  • R/O hydrosalphinx / PID
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62
Q

what is injected into the uterine cavity in a Hysterosonography &Hysterosonosalpingography?

A

saline

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63
Q

what is taken simultaneously during a Hysterosonography &Hysterosonosalpingography?

A

Sag and Trv images as well as cine loops

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64
Q

what can a Hysterosonography &Hysterosonosalpingography diagnose?

A
  • endometrial polyps
  • submucosal fibroids
  • ashermans syndrome
  • tubal patency
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65
Q

what are the complications for a Hysterosonography &Hysterosonosalpingography?

A
  • pain
  • cramping
  • spotting/light bleeding
  • watery discharge
  • nausea
  • vasovaginal
  • infection
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66
Q

what are failed attempts for Hysterosonography &Hysterosonosalpingography?

A
  • severe cervical stenosis
  • pelvic pain
  • vagal symtoms
  • fear of the procedure
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67
Q

where does the fetus grow?

A

within the uterus in a sac called the amniotic sac or cavity

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68
Q

what does amniotic fluid contan?

A

amniocytes and fetal epithelial cells

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69
Q

what is amniocentesis?

A

a prenatal test in which amniotic fluid is removed from the amniotic sac by means of FNA

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70
Q

how much fluid is drawn in amniocentesis?

A

less than one ounce of amniotic fluid is drawn

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71
Q

is their harm by extraxting alot of amniotic fluid?

A

no becuase the body will produce more

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72
Q

where is the needle inserted in amniocentesis?

A

through the abdomen under ultrasound guidance

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73
Q

what has amniocentesis been used for?

A

infusion of dye such as indigo carmine to evaluate for rupture of membranes

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74
Q

what has amniocentesis been used for?

A

in cases of oligohydramnois for therapeutic reasons or to improve visualization

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75
Q

what can amniotic fluid help in determining?

A
  • amniocytes for fetal karyotype
  • prenatal genetic diagnosis of specific disorder
  • evaluation for neural tube defects
  • evaluation for infection
  • determination of fetal lung indices
  • determination of degree of fetal anemai
  • therpapeutic amniocentesis for polyhydramnois
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76
Q

when is an amniocentesis typically preformed?

A

15-20 weeks GA

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77
Q

genetic testing for amniocentesis?

A
  • postive results from prenatal screening
  • chromosomal or neural tube defect in prev, pregnanacy
  • you are over 35 age
  • family history of specific genetic condition
78
Q

maturity testing for amniocentesis?

A

determine if lungs matured enough for birth

  • only done if delivery or Csection is early
  • between 32 and 39 weeks
79
Q

what are other reasons for amniocentesis?

A
  • infection or illness
  • decrease amniotic fluifd amount
  • evaluate severity of anemia in babies with Rh sensitization
80
Q

why may you might not have an amniocentesis?

A
  • you may have placental problems (low lying)
  • history of pre term labour
  • incompetent cervix
81
Q

what are the risks/complications for amniocentesis?

A
  • miscarriage
  • leaking amniotic fluid
  • bleeding
  • rupture of membranes
  • preterm labour
  • Rh sensitization
  • needle injury
  • infection and infectious transmissions
82
Q

what are the factors that affect the risk of miscarriage in amniocentesis?

A

bloody or discolored fluid withdrawl and vaginal bleeding

83
Q

where is an amniocentesis preformed?

A

done in an out-patient facility or healthcare providers clinic

84
Q

when do you need a full bladder for an amniocentesis?

A

under 20 weeks, after 20 weeks you do not need a full bladder

85
Q

how long does an amniocentesis take?

A

20-30 minutes

86
Q

what antiseptic is the abdomen prepared with for an amniocentesis?

A

povidone-iodine (betadine) or chlorhexidine

87
Q

what type of needle is used for a amniocentesis?

A

22 guage

3.5 inch long spinal needle is used

88
Q

what other types of needles may be used for an amniocentesis?

A

20 guage for therapeutic

2 or 7 inch for obese

89
Q

what is documented before the patient leaves from an amniocentesis?

A

fetal cardac activity

90
Q

what should be given to Rh-negative mother after amniocentesis is complete?

A

Rh (D) immune globulin (RhoGAM)

91
Q

what may be felt after an amniocentesis?

A

a stinging sensation and a cramping feeling

92
Q

what may happen following an amniocentesis?

A

vagial bleeding

93
Q

what should the patient not do after an amniocentesis?

A

no strenuous physical activity 2-3 days afterwards

94
Q

if you experience what symtoms, you should contact your doctor from an amniocentesis?

A
  • Persistent fluid leaking from vagina
  • Heavy vaginal bleeding
  • Abdominal pain uterine cramping that lasts more than a few hours
  • Fever
  • Redness and inflammation where the needle was inserted
  • Unusual fetal activity or a lack of fetal movement
95
Q

how are the cells from amniotic fluid examined?

A

can be tested directly or grown in cultures

96
Q

when are the results ready after an amniocentesis?

A

10-14 days following the procedure

97
Q

when can information be gathered sooner after an anmiocentesis?

A

trisomy 21, 18, or 13-information can be gathered sooner using florescence in situ hybridization (FISH)

98
Q

what is chorionic vilus sampling?

A

prenatal test that involves taking a sample of fetal cells from the tissue of the placenta under the guidance of an ultrasound scan

99
Q

where is the sample taken in chorionic vilus sampling?

A

tiny-finger like projections on the placental called chorionic villi

100
Q

what is the purpose of chorionic vilus sampling?

A
  • assess the fetal karyotype
  • biochemical test of fetal cells for evaluation of disease status
  • detects more than 200 genetic disorders
101
Q

what genetic disorders can chorionic vilus sampling detect?

A

trisomt 13, 18, 21

tay-sachs disease

102
Q

when is chorionic vilus sampling preformed?

A

between 10-13 weeks

103
Q

successful genetic diagnosis is obtained in _____ of cases

A

99.7%

104
Q

what are the indications of a CVS?

A
  • US showed baby had structural defects with a chromosomal anomaly
  • your a carrrier of a recessive genetic disorder (cystic fibrosis or sickle cell)
  • previously been pregnant with a child with genetic abnormality
  • family history
  • over 35
105
Q

what are the 2 techniques for a CVS?

A
  • transcervical

- transabdominal

106
Q

when is a transcervical approach CVS preformed?

A

posterior and low placentas

107
Q

when is a transabdominal CVS preformed?

A

fundal and anterior placentas

108
Q

what is done in the pre scan for CVS?

A
  • measure size of baby
  • document location of placenta
  • obatin heart rate
109
Q

what cleans the cervix in an CVS?

A

betadine or chlorohexidine

110
Q

what is used in a CVS?

A

a 5.7 Fr flexible CVS cannula with a rigid metal introducer

111
Q

what size of syringe is used for a CVS?

A

20 cc

112
Q

how much of a CVS sample is required?

A

atleast 15 mg

113
Q

what is prepared on the abdomen with a CVS?

A

betadine or chlorhexidine

114
Q

what anesthetic will you recieve for a CVS?

A

anesthetic of 1% lidocaine

115
Q

what type of needle is used for an CVS?

A

18 or 20 guage needle

116
Q

what type of syringe is used for CVS?

A

20 cc with 2mL transport

117
Q

why is RhoGam given if mothers blood is Rh-negative?

A

becuase your baby’s blood may have mixed with your during procedure

118
Q

how long should recovery with CVS take?

A

about a day

119
Q

what may you experience after your CVS procedure?

A

light bleeding or cramps after the procedure

120
Q

when should you contatc your doctor after a CVS?

A
  • a high temperature of 38 C (100.4F) or over
  • excess bleeding
  • excess vaginal discharge
121
Q

what is the role of the sonographer during an CVS?

A

assist the radiologist and making sure the patient is at ease

122
Q

what are the duties of the sonographer during an CVS?

A
  • preform prescan and confirm placenta location
  • prepare the trays and equipment
  • ensure and maintain a sterile field
  • directly visualise the needle of the cathedar entering the placenta for a precise diagnosis and limit the risks
  • watch the patient for signs of discomfort or vasovagal reaction
123
Q

what is the possibly of miscarriage for a CVS?

A

1%

124
Q

does CVS or amniocentesis have a higher miscarriage rate?

A

CVS

125
Q

when is risk of miscarriage considered to be higher for CVS?

A

when its thorugh the cervix

126
Q

what are complications of CVS?

A
  • bleeding
  • infection
  • Rh incompatibility in the mother
  • rupture of the membranes
127
Q

when should you have your results after a CVS?

A

2 weeks

128
Q

what is done in the lab for a CVS?

A

lab techs isolate the tissue cells and allow them to reproduce, they then analyze the cells for chromosomal abnormalities

129
Q

what is FISH?

A

will give you CVS findings in a few days

130
Q

can else can FISH tell you?

A

tell you the baby’s gender

131
Q

what is the negative result for CVS?

A

this means you are negative for signs of any genetic defects in the developing baby

132
Q

what is the postive result for CVS?

A

the baby has the disorder that was tested

133
Q

when is a CVS preformed?

A

10-13 weeks

134
Q

what is your only option for testin after 15 weeks?

A

amniocentesis

135
Q

what locks into place when we stand?

A

valves

136
Q

when is pressure created in the legs?

A

valves become faulty and remain open, causing blood to flow backwards and pool in legs

137
Q

what is backwards flow known as?

A

venous disease, venous insufficiency or venous reflux

138
Q

what are signs and symtoms of venous reflux?

A
  • heaviness
  • aching
  • pain
  • swelling
  • varcose veins
  • spider veins
  • skin color changes
  • ulcers
139
Q

whata are the risk factors for venous reflux?

A
  • family history
  • obesity
  • pregnancy
  • standing or sitting for long periods of time
  • previous DVT
  • Injury
  • surgery
140
Q

what are the 3 components of US used for diagnosis of venous reflux?

A
  • greyscale
  • color flow doppler
  • spectral doppler
141
Q

what can greyscale detect?

A
  • thickened walls
  • webbing
  • diameter
  • presence of tributaries
142
Q

what can color doppler detect?

A
  • presence or absence of flow
  • direction of flow
  • color fill
143
Q

what can spectral doppler detect?

A
  • measurment of the duration of reflux

- velocity

144
Q

what are the forms of treatment for deep veins?

A
  • compression stockings

- leg elevation

145
Q

what are the forms of treatment for superficial veins?

A
  • endovenous laser treatment / radiofrequency ablation
  • VenaSeal
  • sclerotherapy
  • ambulatory phlebectomy
146
Q

what is US guided endovenous laser / radiofrequency ablation?

A

uses heat to close the vein under US

147
Q

what are the steps for US guided endovenous laser / radiofrequency ablation?

A
  • identifies the refluxing vein
  • confirms access into the vessel
  • navigates the ablation fiber through the correct vessel
  • aides in the placement of tumescent anesthetic around the vein
  • determines a safe distance from the deep veins
148
Q

what is VenaSeal?

A

uses a medical adhesive to close the vein under US guidance

149
Q

what are the steps for a venaseal?

A
  • identifies the vessel
  • confirms access into the vessel
  • determines a safe distance from deep veins
  • provides guidance and compression as the adhesive is administered
150
Q

what is sclerotherapy?

A

under US guidance a medical grade solution is injected into the vein causing the vein to spasm and close over time

151
Q

what is the post procedure US for therapy for reflux?

A
  • determine the success of the closure
  • thrombus extension into the deep veins
  • locate the presence of open tributaries
  • neovascularity
  • monitors mild cases of reflux in other vessels
152
Q

what are US contrast agents?

A

gas liquid suspensions of biocompatible gas-filled microspheres

153
Q

what does the contrast agents do once injected into the arms?

A

the flow unimpeded through the patients circulatory system, miminking the flow patterns of red blood cells while producing enhanced ultrasond reflectivity

154
Q

do US contrast agents contain dye?

A

no and does not expose to radiation

155
Q

what is the structure of contrast agents?

A

gas filled microbubbles surrounded by an outershell composed of phospholipids or synthetic polymers

156
Q

are RBC’s or microbubbles smaller?

A

microbubbles are smaller

157
Q

how do contrast agents leave the body?

A

remiain in vessles, not excreted. Must last several minutes in blood streaming before dissolving

158
Q

how do the microbubbles oscillate within the circulation system?

A

in responce to changes with the US beam, compressing and expanding

159
Q

what do the bubbles do as they oscillate?

A

produce a non-linear frequencies (harmonic) and a strong signal

160
Q

what is the MI in contrast agents?

A

0.1-0.3

161
Q

descrive the mechanism with MI?

A

the oscillations are no longer synchronized with the applied U/S beam and scattering with harmonic frequencies ensues (non-linear response)

162
Q

how long do the agent doses last?

A

4-6 minutes

163
Q

what is the contrast agent dose for all adults?

A

0.1-0.3 ml

164
Q

what is the dose of contrast agents for pediatrics?

A

varies depending in the weight of the patient

165
Q

when may lower doses of contrast agents be used?

A

with newer equipment

166
Q

what did the very first generation of contrast agents do?

A

air based, proved unstable during lung passage

167
Q

what are the contrast agents that are no longer in use?

A
  • echovist

- levovist

168
Q

what are the brand names for second generation contrast agents?

A
  • sonovue
  • definity
  • optison
  • lumason
169
Q

what do all machines have for contrasts?

A

contrast specific software used to display the harmonic bubble signal well

170
Q

what does the contrast preset do?

A

set to enhance the image with the use of contrast agents NOT the organ itself

171
Q

what is the image opitimization for CEUS?

A
  • low MI
  • Dual screen is utilized
  • focus zone places atnthe posterior part of image NOT AOI
  • use of timer
  • shallow breathing may be needed
  • store cine clips during procedure
172
Q

what are the images in the dual screen?

A
  • one image 2-D (keeps AOI in sight)

- one image black (pre and post injection)

173
Q

why do we plaace the focus zone at the posterior part of the image?

A

bubbles tend to burst at the area of the focal zone

174
Q

what do we do before the contrast is injected to the cine clips?

A
  • increase length of clips prior to procedure

- store images from cine clips post procedure

175
Q

what organs and vessels are used to enhance imaging organs and vessels?

A
  • abdominal
  • small parts
  • vascular
  • cardiac
176
Q

contrast enhancement is _______

A

echogenic

177
Q

what does anechoic mean in CEUS?

A

anechoic indicates an area of no blood flow

178
Q

what is wash in phase?

A

early phase of injection, entry of agent into the plane of imaging

179
Q

what is wash out phase?

A

late phase of injection, exit of agent from the plane of imaging

180
Q

why does the liver have 3 phases?

A

dual blood supply

181
Q

what are the 3 phases with the liver and in what order?

A
  • arterial phase
  • portal venous phase
  • sinusoidal phase (parenchyma)
182
Q

what is the CEUS characterization for benign lesions?

A

lesions will remain enhanced in the late phase, stays echogenic from early phase to late phase

183
Q

what is the CEUS characterization for malignant lesions?

A
  • fast wash in and fast wash out
  • lesions will wash out in late phase going from echogenic to hypoechoic in the late phase
  • irregular vessel pattern
184
Q

what can CEUS vessels show?

A
  • ulcerative plaque
  • hypoechoic plaque
  • dissections
185
Q

what arm is preferred for a CEUS?

A

left arm

186
Q

what are the steps for a CEUS?

A
  • obtain consent
  • start IV (cannula 20G)
  • pre procedural images
  • mark skin
  • switch to contrast pre set
187
Q

what must be done when switching to contrast preset?

A
  • dual screen
  • increase cine clip length
  • annotate prior to injection
188
Q

what must be done to the drug before injecting it in CEUS?

A

shake and must be at room temperature

189
Q

what is injected with contrast?

A

saline

190
Q

what are the possibles side effects for a CEUS?

A

minimal but some may experience

  • transient altered taste sensation
  • headache
  • backache
  • dizziness
  • palpations
  • urticaris (hives)
191
Q

what are the CEUS advanatges?

A
  • accurate and reliable diagnosis
  • strong safety profile
  • no radiation
  • no iodinated dye
  • no risk of nephrotoxicity
  • no anesthesia or sedation
  • help characterize type of lesion
  • can be used during and post interventional procedures
  • cheaper equip
  • easy to use
  • portable
192
Q

what are CEUS disadvanatges?

A
  • very small risk of allergic reaction
  • microbubbles dont last very long in blood
  • usually on one area of the body can be evaluated per injection

Interventional (2 decks)

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