TEST 1 (GU studies,) Flashcards
1
Q
Where IV Contrast is being used
??
A
Urinary system
Vascular System
CT/ MRI
2
Q
A substance containing ions is called ___
A
ionic
3
Q
Ion is ____
A
atom with + or - charge
4
Q
cation ____ electrons
anion _____ electrons
A
loses
gains
5
Q
what is ionization
A
separating neutral atom into ions
6
Q
The # of osmoles of a solution is called ____
A
osmolality
7
Q
what is osmoles
A
particles that contribute to osmotic pressure
8
Q
what is required to stop osmosis
A
osmotic pressure
9
Q
increased osmotic pressure = ____ osmotic events
A
increased
10
Q
Osmosis is the movement of a solvent from ____ concentration to ____ concentration
A
low
high
11
Q
What is the chain of events that happens when contrast is injected
A
increased osmoles –> increased chain of reactions –> body reacting more to maintain homeostasis
12
Q
What contrast media is used for urography
A
Iodine
13
Q
What does high atomic number of iodine indicate
A
high attenuation of X-ray beam and better visualization of structures
14
Q
what is the structure of all iodinated contrast agents
A
benzene structure with 3 iodine atoms & 2 groups of amino acid
15
Q
Iodine is a ____ element
A
opacifying
16
Q
Iodine contrast agent is also referred as ____ molecule
A
tri-iodinated
17
Q
What are 4 types of iodinated contrast
A
- Ionic - High Osmolar Contrast Media (HOCM)
- Nonionic - Low osmolar Contrast media (LOCM)
- Monomer
- Dimer
18
Q
Which type of iodinated contrast does not contain charged ion
A
nonionic
19
Q
Ionic contrast usually contains which charged component
A
positive (cation)
20
Q
What is the role of cation in ionic contrast medium
A
increase solubility
21
Q
What is the role of anion in ionic contrast medium
A
stabilize & detoxify
22
Q
Injecting ionic contrast will ____ osmolality
A
increase
23
Q
An ionic tri-iodinated monomer can increase the osmolality of plasma is considered _____
A
high-osmolar contrast media (HOCM)
24
Q
Which type of iodinated contrast will decrease chance of reaction?
A
non-ionic & LOCM
25
Which type of iodinated contrast will increase chance of reaction?
ionic & HOCM
26
Which type of iodinated contrast is recommend for use as IV contrast injection
nonionic - LOCM
27
Why LOCM is preferred over HOCM
Pt less likely to have contrast medium reaction.
LOCA is nonionic so it doesn't go through ionization so the molecule is intact --> lower osmoles --> decrease osmolality --> decrease chance of reaction. BUT there is an increase in concentration in the blood stream so the body doesn't work as hard to maintain balance
28
Why monomer and dimer are used?
*need to double check again*
increase # of opacifying elements (iodine) per molecule to decrease amount of ___ to see vascular structures
29
What happened (molecular level) when the ion contrast is injected
ionization --> separate cation (salt) & anion --> increase osmolality -> increase osmotic events --> increase osmosis --> body tried to balance
30
What are the 3 things technologist must check for on patient's chart before proceeding with the injection
1. Blood urea nitrogen (BUN)
2. Creatinine
3. eGFR ( estimated glomerular filtration rate)
31
what are the 2 diagnostic indicators of kidney function
1. Blood urea nitrogen (BUN)
2. Creatinine
32
An increase in level of BUN and creatinine indicated ____
compromised kidneys --> cant be injected with contrast
33
What is normal creatinine level
0.6 - 1.5 mg/dL
34
what is normal BUN level
8-25 mg/ 100mL
35
what is normal eGFR level?
what is the ACR recommends?
> 60 mL/ min
<30 mL/ min has a risk for contrast
36
What is the most reliable diagnostic indicator on a pt's chart [Urinary System]
eGFR
37
What are possible contraindications to iodine contrast (5)
1. iodine sensitivity
2. kidney problems (except stones)
3. allergies
4. prior reactions
5. Diabetic
38
Patient whos taking ____ can be given iodine contrast only if their kidney function levels are within normal limit
metformin
39
What is Metformin
a drug for non-insulin dependent diabetes patient
40
What does metformin do ?
decrease hepatic glucose and increase body's response to insulin
41
The patient can continue to use prior to or following contrast injection if the eGFR level is ____
30mL or greater
42
If there is evidence of AKI (acute kidney injury), what is the instruction for metformin use?
withheld prior to injection and for 48hours after injection
43
What are the common side effects that may occur after an IV injection (3)
1. nausea
2. metallic taste
3. warm, flush feeling
44
Which medical equipment must be readily available whenever IV injection is performed
crash cart
45
What are two categories of contrast medium reaction
local
systemic
46
___ reactions affect specific region of the body
local
47
____ reactions do not affect site of injection but entire body or specific organ
systemic
48
Which categories of reactions can lead to significant complications
systemic
49
What are the 2 local reactions to contrast medium
extravasation & phlebitis
50
What is extravasation
contrast leak outside the vessel and fills the surrounding soft tissue surrounding the access site (BLOW VEIN)
51
extravasation aka ____
infiltration
52
What caused extravasation
venous access is lost
53
What is the common protocol for extravasation? (4)
Notify the nurse/physician
Elevate the affected arm above the heart
Cold and warm compress
Document
54
What is phlebitis
inflammation of vein
55
3 categories for systemic reactions
mild, moderate, severe
56
Which of the following is considered as a moderate reaction?
a. anxiety
b. hypotension
c. syncope
d. hives
B
57
A severe reaction is also known as __
vasovagal
58
The moderate reaction is also known as ___
anaphylactic reaction
59
Which of the 3 categories of systemic rxns is the most common
MILD
60
Uticaria is considered ____ reaction
MILD
61
Syncope (or ___) is considered ____ reaction
fainting - MILD
62
Tachycardia is _____ reaction
Bradycardia is _____ reaction
Moderate
Severe
63
Angioedema is ____ reaction
Moderate
64
what is angioedema
swelling of soft tissue
65
Convulsion, LUC are ____ reaction
Severe
66
Respiratory arrest is _____ reaction
severe
67
What is the cause of mild reaction like nausea or syncope
Anxiety
68
normal excretion of contrast is _____ within ___
100% - 24hrs
69
Reactions can be delayed up to ____
48hours
70
all life-threatening events occur within the first ____ after injection
20 min
71
Kidneys lies in the ____ space
retroperitoneal
72
Which kidney is higher than other? Why
LEFT because of the liver on the right side
73
Location of adrenal gland
superior & medial to each kidney
74
Location of kidney
between iliac crest and xiphoid process (T11-L3)
75
which structure connect kidney to urinary bladder
ureters
76
Urine is eliminated from the body through ___
urethra
77
Kidneys are in the most ___ part of the abdominal cavity
a. anterior
b. posterior
posterior
78
Normal obliquity of kidneys? due to what?
30
psoas muscles on two side
79
Ureters are anterior to which muscle group
psoas
80
Ureter starts from _____ to ____
renal pelvis
urinary bladder
81
Why stones are a problem with ureters
ureters' normal size are 1mm-1cm whereas stones are bigger than that. Thus, it causes pain for patient
82
how do you position patient for the right kidney to be parallel to IR
30 LPO
83
What are the kidneys' functions (5)
1. urine production & elimination
2. regulate water levels
3. regulate acid-base
4. regulate electrolytes
5. remove nitrogenous waste
84
what are 3 things that kidneys regulate
water level
pH
electrolytes
85
Why nitrogenous waste must be removed?
remain in blood --> renal dysfunction
86
what are considered nitrogenous waste
urea & creatinine
87
Kidneys receive arterial blood from _____ through____
abdominal aorta - L/R renal arteries
88
____ _____ must be a large vessels to return blood from kidneys back to circulatory system (heart)
renal veins
89
What is directly connected to IVC to return blood to the heart
renal veins
90
Renal veins are directly connected to _____ to return blood to the ____ side of the heart
IVC - right
91
Renal veins are _____ (anterior/posterior) to renal arteries
anterior
92
What structure is located along medial border of each kidney that all of the renal veins & renal arteries go through ?
hilum
93
what kind of blood is supplied thru the kidneys
oxygenated
94
Route for blood supply through kidney & back to heart
abdominal aorta --> renal arteries --> kidneys --> renal veins --> IVC --> RT atrium --> RT ventricle --> lungs --> LT atrium --> LT ventricle.
95
what is stenosis
narrowing
96
Which macroscopic structures provide protection for kidneys
renal capsule
97
which macroscopic structures is a blood supply for kidneys
cortex
98
Give macroscopic structures of kidney from outer to inner
capsule --> cortex --> medulla (has renal pyramids) --> renal column
99
Medulla contains ___
renal pyramids
100
Cortex dips between pyramids to form _____
renal columns
101
Minor calyx converged from ____
renal papilla
102
what is renal papilla
opening of renal pyramids
103
minor calyx merge to form ____
major calyx
104
major calyx unite to form _____
renal pelvis
105
renal pelvis continues to form ___
ureter
106
Route of urine
nephron --> minor calyx --> major calyx --> renal pelvis --> ureter --> urinary bladder
107
what is the microscopic structure of the kidney
nephron
108
what is the function of nephron
urine production
109
how many nephron per kidney
1 million
110
Blood flows to the nephron through ____
afferent arterioles
111
Blood filtration happened at the ____ inside the _____
glomeruli - nephron
112
___ go through glomeruli then thru ____
waste - glomerular capsule
113
After blood is filtered in the glomeruli, where does it go next
efferent arterioles
114
What remains in the nephron if blood is going out thru efferent arterioles
waste
115
What is the blood that coming out of efferent arterioles?
a. blood with waste
b. blood without waste
B
116
After the blood is filtered and waste remains in the nephron, where does blood go next?
thru efferent arteriole --> renal veins --> IVC --> back to heart to get reoxygenated
117
Progression of waste through nephron
glomeruli --> capsule --> proximal convoluted tubules --> ascending & descending loop of Henle -->distal convoluted tubule --> collecting tubule --> minor calyx
118
Which structures of the nephron are located in the cortex of the kidney
glomeruli/ capsuple
proximal & distal convoluted tubules
119
Which structures of the nephron are located in the medulla of the kidney
loop of henle & collecting tubules
120
Ureter is anterior to ___
psoas major muscle
121
Ureter extend from _____ to _____
renal pelvis
urinary bladder
122
Stones might have trouble passing through the 3 ureter constriction points which are ___
1. ureteropelvic junction ( UPJ)
2. Pelvic Brim
3. Ureterovesical junction ( UVJ)
123
Pelvic brim is the crossing of _____ over ___
iliac blood vessels over ureters
124
ureter join the bladder at _____
UVJ (ureterovesical junction)
125
renal pelvis funnels down into small ureter at ____
UPJ
126
kidneys stones usually stuck at which constriction point
UVJ
127
What is the muscolomembraneous sac that serves as a reservoir for urine
urinary bladder
128
what are the 3 opening of trigone
2 ureters
1 urethra
129
what is the capacity for urinary bladder
350-500mL
130
bladder location in male
posterior to symphysis pubis & extend to peritoneal cavity
131
bladder location in female
posterior to symphysis pubis & anterior to uterus
132
What is the bladder capacity to trigger the urge to void
250mL
133
IUS & EUS controls _____
retention of urine
134
what is IUS
internal urethral sphincter
135
what is EUS
external urethral sphincter
136
Which sphincter is voluntarily controlled
EUS
137
Which sphincter is involuntarily controlled
IUS
138
relaxation of which sphincter allows urine to exit
EUS
139
What is IVU?
intravenous urography
140
Prior to contrast injection, what do we need to verify
contraindications
signed consent
141
How to prep patient for IVU
NPO 8 hours
bowel prep
void prior to exam
142
Why do patient need to void prior to IVU exam
1.a full bladder can rupture, especially if there are compressions
2.urine in the bladder can dilute contrast medium
143
Routine for IVU Imaging (7)
Scout
Nephrogram
Timed films
RPO
LPO
Prone
Upright Post Void
144
What is the most important step for IVU exam
document time
145
When is nephrogram taken
1 minute post injection
146
WHat should be noted before injection of contrast medium? (3)
start time
type of contrast
amount of contrast
147
Where is CR for Nephrogram
between iliac crest & xiphoid
148
What does nephrogram show
flushing of kidneys
149
What is the purpose of RPO/LPO position for IVU exam
to see different angle of kidney and project ureter away from spine
150
Obliquity for IVU exam
30 degree posterior
151
where is CR for RPO/LPO [IVU]
iliac crest & midline
152
Which position will show the LEFT kidney in AP and RIGHT ureter unobstructed
RPO
153
LPO shows ___ kidney in AP and _____ureter unobstructed
Right
Left
154
where is CR for upright post void
1" below iliac crest
155
Upright Post Void must include____
entire bladder
156
What is Retrograde Urography
contrast is injected backward into the pelvicalyceal system via catheter by urologist in the OR
157
Retrograde Urography is an examination of ___
urinary system
158
What are the steps post uroscopy
catheter insertion
stent placement
159
what is the position patient in for Retrograde urography
Lithotomy
160
Retrograde cystography is also known as ___
cystogram
161
Retrograde Cystography is an examination of ___
urinary bladder
162
Cystogram is done with ____
a. radiologist
b. urologist
A
163
[Cystogram]The contrast flow in by _____ only
gravity
164
What does VCUG stand for
voiding cystourethrography
165
Retrograde Cystography is examination of ___
urinary bladder
165
VCUG is an examination of ____
bladder & urethra
166
VCUG evaluates the patient's ability to ____
urinate
167
Steps of VCUG
fill bladder --> remove catheter --> tilted patient while voiding
168
What does the bony thorax consists of ? (3)
1 sternum
12 thoracic vertebrae
12 rib pairs
169
What is the purpose of bony thorax
protects respiratory & mediastinum
170
What are the 3 parts of the sternum
1. manubrium
2. body
3. xiphoid tip
171
what is the superior portion of the sternum
manubrium
172
what is the most inferior portion of the sternum
xiphoid tip
173
Which structure is located at T2-3
Jugular notch
174
What is the depression on the manubrium
Jugular notch
175
What does the body of sternum articulate with
manubrium
176
What is the articulation angle of the body to the manubrium called?
sternal angle
177
Location of sternal angle
T4-5
178
What structure located at T9-10
Xiphoid tip
179
What structure provide anterior articulation of the cartilage of the rib
facet of the body of the sternum
180
There are no bony articulation of the rib ____
a. anteriorly
b. posteriorly
A
181
Ribs articulate with bony joint ____
a. anteriorly
b. posteriorly
B
182
Which structure articulate laterally to the jugular notch?
medial end of clavicle
183
SC joint is the formation of ____ & _____
medial end of clavicle and clavicular notch
184
How many ribs articulate with the sternum
7
185
Ribs articulate with the sternum through ____
costocartilage
186
Why does costocartilage show up as a gap on radiograph?
cartilage is not dense enough for Xray attenuation
187
What are other names for jugular notch
suprasternal & manubrial notch
188
Which structure of the manubrium and the body accept the costocartilage
facet
189
The 1st pair of ribs articulate with which part of the sternum
manubrium
190
the 2nd pair of ribs articulate with the ____ of the sternum
sternal angle
191
___ through ___ pair of ribs connect directly to the body of sternum through costocartilage
3rd - 7th
192
___ through ____ pair of ribs connect to costocartilage 7, which then connects to sternum
8th - 10th
193
Routine for sternum. Which routine is usually preferred?
RAO
Lateral
Lateral
194
[Sternum] SID?
RAO: ____
Lateral: __
RAO: 40"
Lateral: 72"
195
[Sternum] kVp?
70-80
196
Position patient for RAO sternum
rotate 15-20 toward right side
197
Why RAO sternum over LAO sternum
Rotate sternum away from vertebrae and superimpose the heart
198
Why is it important for the sternum to superimpose the heart when imaging
increase density of sternum --> better attenuation --> more visualization of sternum
199
CR for RAO sternum
mid-sternum
1" left to midline
between jugular notch & xiphoid process
200
What does breathing technique do?
blur ribs/ areas that not in interested
201
for a bigger patient, would you need a higher or lower obliquity for RAO Sternum
lower (15)
202
If breathing technique is not possible, suspend respiration on ____
expiration
203
Why we dont image sternum in a true AP or PA projection
thoracic spine is denser than sternum therefore, we cant see the sternum
204
Patient with a shallow or thin chest would need ____ rotation than a patient with a deep chest
MORE
205
[Sternum] If patient is unable to stand for RAO, what is the alternate position?
SUPINE LPO with CR angled 15-20 across right side of patient
206
How do you know if patient is correctly rotated for RAO sternum
sternum alongside vertebral column with no superimposition by vertebrae
207
excessive rotation of thorax could caused ____
distortion of sternum
208
For lateral sternum, which position can the patient be in
erect or recumbent
209
Lateral Sternum
For erect, arms ____
For recumbent, arms ____
What is the purpose?
Back
Up
Avoid superimposition of humerus over sternum
210
CR for Lateral Sternum
mid sternum
211
where is mid sternum
between jugular notch & xiphoid process
212
[sternum] when patient is in lateral, suspend respiration on _____
inspiration
213
Why suspend respiration on inspiration for Lateral Sternum
chest expands and pushes sternum out
214
Patient is in which projection if SC joint being imaged?
PA
215
Why patient in prone for SC joint images
place clavicle closer to IR
216
How to position patient for SC joint exam
place arms up beside head or down by the side
217
CR for SC joint
midsagittal to T2-3
or
3" distal to vertebral prominence (C7)
218
Which structure is found at T2-3
jugular notch
219
For SC joint, suspend respiration on ____
expiration
220
Which positions are possible for SC joint beside a PA?
a. RAO
b. LAO
c. RPO
d. LPO
A & B
221
Obliquity for RAO/LAO SC joint
10-15 degree
222
CR for SC joint obliques
Upside SC
223
How many ribs are considered "true" ribs
7
224
True ribs are direct ____ attachment
anterior
225
How many ribs are considered "false" ribs
5
226
_____ ribs have no anterior attachment
FALSE & floating
227
Rib 8-10th have ____ that join together at rib ____ connects to sternum
costocartilage
7
228
Which are the "floating ribs" ?
11 & 12th
229
does floating ribs have costocartilage?
NO
230
Which ribs do not connect to the sternum?
a. floating
b. true
c. false
d. all ribs are connect to sternum
A
231
If floating ribs are not connect to sternum, what does it connect to?
T12
232
Which structures of the ribs are located posteriorly
Head
Neck
Tubercle
233
Head of ribs articulate with _____
vertebral body
234
What is the rib angle
forward
235
what is the internal structure of rib
costal groove
236
what does costal groove house
artery, vein, nerve
237
What could happened if there is a rib fracture
1. HEMOTHORAX (puncture of parietal pleural surround the lungs. The veins inside the costal groove severed and leaks into the pleural )
2. PNEUMOTHORAX (puncture causing air leakage)
238
Tubercle of ribs articulate with ____
transverse process of a vertebra
239
On a radiograph, the part of ribs that most superior is ___, and most inferior is ____
posterior end (vertebral end)
Anterior end
240
What is a joint between costocartilage and ribs
costochondral
241
What is a joint between costocartilage & sternum
sternocostal
242
What is a joint between costocartilages?
interchondral
243
Interchondral joint is between the ___ of which ribs
costalcartilage / 6-10
244
Sternocostal joint is between ___ & ___ ribs
1-7
245
What is the joint between head of ribs and vertebral body
costovertebral joint
246
Costovertebral joint is between ___ & ____
head of ribs
vertebral body
247
What is the joint between tubercle to transverse process
costotransverse
248
Costotransverse joint is between __ & ___
tubercle & transverse process
249
Costotransverse joint are found on which ribs
1 - 10
250
Which joint does 11th & 12th rib don't have?
costotransverse
251
Routines for RIB
PA chest
AP Above Diaphragm
AP Below Diaphragm
RPO/LPO
252
kVp for RIB
75-85
253
unilateral rib - SID ____
bilateral rib - SID ____
40"
40-72"
254
[AP Above Diaphragm]
unilateral rib - CR ____
bilateral rib - CR ____
T7 (between midsagittal plane & lateral margins)
T7 (midsagittal)
255
suspend respiration on :
AP Above Diaphragm : _____
AP Below Diaphragm :___
inspiration
expiration
256
CR?
AP Above Diaphragm : ____
AP Below Diaphragm : ____
midsagittal plane & T7
between xiphoid tip and iliac crest
257
AP Below Diaphragm looks for which ribs
11 & 12th
258
AP Above Diaphragm can be done for ____
a. bilateral
b. unilateral
c. both
C
259
AP below diaphragm can be done for ____
a. bilateral
b. unilateral
c. both
A (unless otherwise noted)
260
RPO/LPO ribs can be done for ____
a. bilateral
b. unilateral
c. both
B
261
How much rotation is needed for RPO/LPO Rib
45
262
[RIB] if the right side is affected, which position will elongate the right side
RPO
263
If you are given an order for right rib, what is the routine?
both RPO & LPO for RIGHT SIDE
264
[RIB] if the right side is affected, which position will shorten the right side
LPO
265
[RIB] if the right side is affected, which position allow you to visualize the angle
LPO
266
[RIB] if the left side is affected, which position will elongate the left side
LPO
267
Routine for Cystogram
AP Axial
LPO/RPO
268
[Cystogram] AP Axial
CR?
Tube agle?
2" superior to symphysis pubis
10-15 caudad tube angle
269
[Cystogram] LPO/RPO
CR?
Tube angle?
Obliquity?
2" superior to symphysis pubis
no tube angle
45-60 posterior
270
which examination image the contrast in the urethra
VCUG
271
4 general goals when selecting patient for contrast medium injection
1. ensure correct administration of contrast
2. balance likelihood of adverse reaction
3. promote accurate diagnosis & treatment
4. be prepared to treat a reaction
272
What is considered the greatest risk factor for predicting future adverse reactions
prior allergic-like
273
Patient who has prior allergic-like reaction or unknown-type reaction have approximately ____ increased risk
a. 2-fold
b. 3-fold
c. 4-fold
d. 5-fold
D
274
If a patient has a reaction to gadolinium-based contrast medium, does it mean they also reacts to iodinated contrast medium?
NO
275
Between infants/children and middle-aged patients who have a higher reaction rate
middle-aged
276
If patient experiences Air Embolism as a reaction to IV contrast injection, which position should patient be placed in? treatment include?
Left lateral decub
inject 100% oxygen
277
What is the most significant adverse effect of Metformin
lactic acidosis
278
What are contraindications to use of Metformin
increase lactate production by increasing anaerobic metabolism (cardiac failure, cardiac or peripheral muscle ischemia, severe infection)
279
ACR classify patient taking metformin in Category I as _____
no AKI with eGFR > 30mL/min
patient doesnt have to discontinue use of metformin prior to or after procedure
280
ACR classify patient taking metformin in Category II as _____
AKI with eGFR <30mL/min, metformin should be temporarily discontinued prior to and after 48hours of the procedure
281
Approximately ____ in 10,000 have serious acute reaction to ____
4
IV LOCM
