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Clinical Medicine LAB - Professor Sample > US, Echocardiography, Venous Duplex US > Flashcards

US, Echocardiography, Venous Duplex US Flashcards

1
Q

Ultrasound aka?

A

AKA sonography, ultrasonography

Developed in mid-20th century

Narrow beam of high-frequency sound waves

Reflected back (echoed) to the handheld transducer

Reflected back differently by different densities

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2
Q

With US, solid organs are __________?

A

echogenic (white)

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3
Q

With US, fluid filled cysts and fluid are ____-____(echo lucent or anechoic) because they do not reflect

A

echo-free ( black)

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4
Q

US is not useful for ___ and ____?

A

air
bone

Not as clear an image as CT

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5
Q

US advantages?

A

No radiation
Good for obstetric, gynecological, pediatric and testicular conditions

Can view structures at any angle

Less expensive than CT, MRI

Can be performed portably, at bedside

Real-time view
Heart, fetus and other structures

Newer models – better resolution and less expensive

May become part of routine screens in office

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6
Q

US disadvantages?

A

Takes longer to complete
Most take 20-30 minutes

Quality is operator dependent

  • Accuracy is variable
  • Transducer angle varies – not always along strict anatomic planes
  • More difficult to interpret, need to look at surrounding structures

Some tissues are isoechoic
-Reflection is the same though different structures
look similar to surrounding tissue

Some tissues obscured by overlying structures
-Ribs obscure underlying portions of spleen or liver

Quality of image reduced by thick adipose tissue
-thin people easier to look at

Cannot look at bones – too much reflection to see detail

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7
Q

Images that are close to being in the _____ plane should be presented and viewed as if the viewer is standing at the ____ of the patient’s bed (Pt’s right is to viewer’s left)

A

axial
foot

axial view, we are look up throguht the feet

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8
Q

Images that are close to the ________ plane are shown as if the viewer is looking at those sections from the _________ of the supine patient, with the head of the patient to the viewer’s left.

A

sagital

right side

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9
Q

Aortic Aneurysm etiologies ?

A

Atherosclerosis

Infection (mycotic) - rare

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10
Q

Aortic Aneurysm blood flow becomes _________.

A

turbulent

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11
Q

Aortic Aneurysm can be ________ or ________

A

fusiform, saccular

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12
Q

Aortic Aneurysm may be found incidentally by?

A

pulsatile mass on abdominal exam

Or patient can be symptomatic
Abdominal or back pain

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13
Q

Complications with AA?

A

leakage or rupture

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14
Q

AA USPSTF?

A

once for all men 65-75 who have ever smokedp

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15
Q

AA medicare coverage?

A

all men, once, upon receiving Medicare

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16
Q

US of AA?

A

evaluate for size and determines size

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17
Q

Aortic dissection 3 layers?

A

Intima – thin, smooth inner layer
Media – thicker, muscular
Adventitia – outer layer

Dissection is a separation of the layers

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18
Q

Aortic dissection patho?

A

Dissection is a separation of the layers

False lumen forms
Blood can flow through it or thrombose

Patients present with sudden “tearing” chest pain

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19
Q

DeBakey Type 1?

A

Type I – ascending and descending aorta

Originates just above aortic valve
May extend to abdominal aorta

part of A

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20
Q

DeBakey Type 2?

A

Type II – only the ascending

Originates just above the aortic valve

part of A

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21
Q

DeBakey Type 3?

A

Type III – only the descending

Originates distal to the left subclavian artery
May extend to abdominal aorta

part of B

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22
Q

Stanford classification?

A

Type A – ascending

Type B – descending

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23
Q

AD - If carotid arteries are involved, what signs and symptoms are we going to see?

A

CVA

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24
Q

AD - If superior mesenteric artery involved, what signs and symptoms are we going to see?

A

bowel ischemia

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25
Q

AD - If coronary arteries involved , what signs and symptoms are we going to see?

A

MI

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26
Q

For aortic dissection ________________ can be used, but most often diagnosed with _____________ (CTA).

A

echocardiography
CT angiography

MRI is too time-consuming
US cannot demonstrate aortic branches well

27
Q

US is not good at determining ____ _____ in retroperitoneum.

A

free blood

28
Q

IF AD In symptomatic patients with uncertain diagnosis– do __, not __.

A

do a CT not a US

is the patient is stable and their kidneys working well then - do a CTA better and more useful in the situation

acutely we use US

29
Q

Echocardiography -type- M-mode?

A

Narrow US beam directed at cardiac structures

Observed over time - Time-motion study of structures

Considered to be obsolete by many, but an efficient way to record multiple cardiac cycles

Real time 2D
Real time 3D

30
Q

Echocardiography -type- - color flow doppler?

A

Numerous sample volumes are overlaid on a 2-D echocardiogram and the direction of flow is recorded on the screen as either red or blue, depending on whether the flow direction was towards or away from the transducer. Some indication of the velocity is given by the brightness of the color. Flow which is turbulent, having no definite direction, is displayed as a third color, e.g. green or yellow.

blue is away

31
Q

Echocardiography-types- TTE?

A

Transthoracic echocardiography:

Close to anterior heart
A type of 2D real-time

32
Q

Echocardiography-types- TEE?

A

Transesophageal echocardiography

better images of STABLE aneurysm

Oral or nasogastric probe
Close to posterior heart

33
Q

TEE?

A

invasively

Endoscopic ultrasound transducer

Inserted orally or nasogastric, advanced into esophagus

Good for evaluating posterior heart

Can be done at bedside

34
Q

Indications for Echocardiography? US of heart indications?

A

Ventricular function
Wall thickness and motion

Valvular heart disease -
movement of leaflets, blood flow

Atrial septal defect

Ventricular septal defect

Pericarditis

Pericardial effusion

Pericardial effusion vs. pleural
effusion

Cardiac tamponade

Aortic dissection (but CT angiography faster)

35
Q

Heart failure can affect?

A

wall thickness

wall motion

36
Q

Echo - Ejection fraction?

A

Measurement of how much blood the LV pumps out with each contraction

many ways to determine EF but US is the mainstay - standard

37
Q

Normal EF?

A

55-70%

E.g. of 60 means 60% of total amount of blood in LV is pumped out with each contraction

38
Q

EF of 40-55% indicates?

A

damage - previous MI or from heart failure

39
Q

EF of +75% indicates?

A

Hypertrophic Cardiomyopathy - HOCM

40
Q

Preserved ejection fraction (HFpEF) – diastolic heart failure?

A

Heart contracts normally, but ventricles do not relax during systole

Ventricles are thick and stiff, hold a smaller amount of blood

Percentage is good, but the overall amount is deficient

cannot fill

41
Q

Reduced ejection fraction (HFREF) – systolic heart failure?

A

Heart does not contract effectively during systole

Deficient amount of blood pumped

can get the blood out

cannot squeeze

42
Q

Rheumatic and degenerative changes can affect?

A

Leaflet function

blood flow

43
Q

Congenital abnormalities that affect blood flow?

A

ASD

VSDp

44
Q

Pericarditis patho?

A

Inflammation of the sac around the heart

45
Q

Pericardial Effusion patho?

A

Collection of fluid in the pericardial sac

Can be difficult to determine effusion by CXR

Echo helpful in diagnosing pericardial effusion

Reflection off heart and off layer of fluid are different

46
Q

Pericardial Tamponade patho?

A

Acute increase of fluid in the pericardial space.

This can be caused by chest trauma, bacterial infection, myocardial rupture, and other occurences that affect the heart’s ability to fill during diastole.

Ejection fraction drops and the patient can develop a cardiac crisis.

Immediate treatment is recommended which may be by pericardiocentesis or by surgery.


By 2D echocardiography one can note the “swinging heart” inside of the pericardial sac.

47
Q

what is the modality of choice for evaluation of DVT? what did it used to be?

A

US

used to be venogram - contrast material injected

US used no contrast material, noninvasive, no pa

48
Q

Venous Duplex US sensitivity and specificity?

A

sensitivity - 95%

specificity - 98%

49
Q

DVT in what locations puts a patient at risk for PE?

A

popliteal and common femoral veins

50
Q

DVT of the ____ is not a risk factor for PE, but is a risk for extension of thrombus into deep veins of the thigh

A

calf

lest risk of PE is clot is below the knee

51
Q

Venous Duplex method / procedure?

A

Pt is supine, slight reverse Trendelenberg position

Examine from inguinal ligament to popliteal fossa

Popliteal area examined with patient prone, knee slightly flexed

52
Q

When using Venous Duplex in evaluating a DVT be sure to compress and release vein every _ cm?

A

1

53
Q

When compressing a artery when examine for DVT the ______ should maintain its lumen, and a ____ should compress or “wink”.

A

artery

vein should wink

54
Q

When looking for a DVT and a clot is present, the vein will require more _______ to compress or it will not compress at all.

A

pressure

when technician put pressure on the veins and arteries the artery should not collapse cuSE THE HIGH PRESSURE IN THE ARTERIAL SYSTEM

but if the vein does not collapse then we can suspect a DVT. - non compressibility

55
Q

Why are duplex of the ____ veins not usually performed?

A

calf

b/c Many anatomical variations, so time consuming

Less accurate

Anticoagulation not routinely prescribed anyway

Clot often resolves spontaneously

20% will propagate to popliteal or femoral vein – serial evals every 3-5 days in patients who are still symptomatic
Llł

56
Q

Limitations to Venous Duplex of LE’s?

A

Iliac and pelvic veins are difficult to evaluate

Obesity and severe edema limit exam

Saphenous vein (superficial) can be mistaken for the femoral vein (deep)

Patient may have collaterals - we can miss a DVT then cause the collateral circulation will a lot the vein to compress even if there is a DVT there

Vein may be compressed externally by node or tumor, not clot

Difficult to determine acute from chronic DVT
-Abnormalities may persist for 6 months

57
Q

Venous duplex LE - CVI - leaky valves?

A

Common – 20% of American adults, esp women

Previous DVT is an important risk factor

58
Q

CVI diagnosis tool?

A

Duplex US

59
Q

What is used to map VV?

A

Duplex US

60
Q

What is used to locate the level or venous reflux?

A

Dulex US

61
Q

Duplex US also guides _____________ treatments

A

percutaneous

62
Q

Venous duplex US for CVI is don’t with patient in what position?

A

standing

Also used as preoperative evaluation for autologous vein graft

63
Q

CVI patho?

A

chronic venous engorgement - from valvular insufficiency or venous occlusion

Clinical Medicine LAB - Professor Sample (36 decks)

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