Clinical 2017 Flashcards

Question

25. What/why early post-op complication more common in cadaveric transplants than living donors

Answer 1

``` ATN significantly more frequent in cadaveric vs living donor transplants (25% vs 5%) Longer cold ischemic time Donor hypotension Excess lactate Increased vascular resistance ```

Answer 2

Side effects: - Thyroid storm - Sialadenitis - Exacerbation of ophthalmopathy - Hypothyroidism (long term) - Neck tenderness Safety Issues - Separate bathroom - Flush immediately - Not primary child caregiver - Drive home separate from children if possible - Teratogenic (no pregnancy) - No breastfeeding

Answer 3

Urease products: Ammonia + 14CO2 False positives: Chewing capsule Achlorhydria (overgrowth of non H-pylori bacteria) Chemiluminescence Interfering medications: Antibiotics PPI Bismuth

Answer 4

``` Stress defect size and severity ≥ 10% Rest defect size and severity ≥ 10% Reversibility size and severity ≥ 10% Transient cavity dilation >1.13 Increased lung uptake - Visual estimate Rest LVEF - <40% Stress LVEF - <40% Increased RV tracer uptake - Visual estimate ```

Answer 5

Prior stress imaging study of poor quality or inconclusive Body characteristics affecting image quality (obesity, large breasts/implants, pleural effusion) High-risk patients (Chronic kidney disease, DM, CABG, suspected LM or 3VD) Young patients with established CAD (decreased radiation) If myocardial blood flow quantification is desired

Answer 6

Lower dose Higher sensitivity Better spatial resolution Less attenuation artifacts

Answer 7

``` PTU Tapazol Iodinated contrast Perchlorate Lugol’s Synthroid Sulfonamides Corticosteroids ACTH ```

Answer 8

Full bladder Poor hydration Poor underlying renal function which causes a diminished diuretic response. A noncompliant/rigid renal pelvis An over compliant/patulous renal pelvis (reservoir effect) Large hydronephrotic volume (reservoir effect) need larger diuretic dose the larger the hydronephrosis volume.

Answer 9

``` Patient hydration status Free tech in preparation Interstitial injection Meds (aluminum, dipyridamole, etc.) CHF Record wrong times for plasma collection Take samples too early (before 3rd space activity has all redistributed back into plasma) ``` Plus camera-based errors: Background correction Attenuation System dead time

Answer 10

“Most experts recommend a low-iodine diet for 7– 14 d before administration of therapy, in order to increase radioiodine uptake and improve the ablation rate” “It must be emphasized to the patient that this is not a low-salt or low-sodium diet but a low-iodine diet (50 mg/d) and that non-iodized salt is allowed and widely available.”

Answer 11

Idiopathic non-inflammatory, non atherosclerotic progressive vasculo-occlusive disease involving circle of Willis, most commonly the supraclinoid ICAs. Bimodal - early childhood + middle age (30-40s) Presents w/ hemispheric ischemic strokes in children Hemorrhage +/- watershed infarcts in adults Puff of smoke appearance on angio Nuc med study Tc99m-ECD SPECT to show results of pathologic changes in vessels on distal tissue; Acetazolamide reserved for surgical planning

Answer 12

``` Long-standing congestive heart failure Myocardial infarction: Focal localization to calcium hydroxyapatite from local tissue necrosis Unstable angina: Patchy uptake is seen. Pericarditis Amyloidosis: Abnormal extracellular deposition of protein. Cardiac involvement indicates a worse prognosis. 99mTc phosphate binds to calcium-binding sites of amyloid. Hyperparathyroidism Postresuscitation/Cardiac contusion Post defibrillation Cardiomyopathy: Diffuse uptake. Pericardial tumor: Diffuse uptake. ```

Answer 13

``` Diffuse increased uptake throughout the skeleton with decreased soft tissue or absent kidney. Nonmalignant Causes: ● Renal osteodystrophy ● Primary hyperparathyroidism ● Osteomalacia (Vit D or Ca2+ deficiency) ● Paget disease ● Myelofibrosis ● Mastocytosis ```

Answer 14

``` Enlarged heart Enlarged hilum Elevated hemidiaphragm Costophrenic angle effusion Linear atelectasis Malignancy Pneumonia ```

Answer 15

``` Known allergy or adverse reaction to sedative Abnormal airway Increased ICP Decreased conscious level Hx of sleep apnea Respiratory failure Cardiac failure ```

Answer 16

``` Bronchogenic carcinoma Mucous plug Central PE Bronchogenic cyst Thoracic aortic aneurysm Aortic dissection Congenital absence of pulmonary artery ```

Answer 17

Seminomatous Non-seminomatous 18F-FDG Overall sensitivity (94%), specificity (75%), PPV (83%),NPV (91%) and accuracy (86%) Seminomatous GCT: sensitivity (90%), specificity (74%), PPV (72%), NPV (91%) and accuracy (81%) Non-seminomatous GCT: sensitivity (97%), specificity (77%), PPV (91%), NPV (91%) and accuracy (91%)

Answer 18

Anterior cortex of the tibia Bases of the 5th metatarsal Tarsal navicular Femoral neck

Answer 19

Thyroid malignancy (e.g. papillary or follicular carcinoma) Thyroid adenoma Thyroid abscess Thyroid hematoma Thyroid lymphoma Intrathyroidal parathyroid lesions (e.g. parathyroid adenoma, parathyroid carcinoma)

Answer 20

Alzheimer’s: Bilateral temporoparietal and posterior cingulate gyrus hypometabolism LBD: Occipital lobe hypometabolism, otherwise similar pattern to Alzheimer’s FTLD: Frontal and temporal hypometabolism CJD: Patchy reduced uptake of different patterns throughout cortex and subcortical structures

Answer 21

Assess for early Alzheimer’s disease in patients with mild cognitive impairment Differentiate Dementia with Lewy bodies from AD and/or FTLD Localize seizure focus in epilepsy Assess relative cerebral blood flow and relative glucose metabolism in stroke patients Schizophrenia (negative syndrome had decreased metabolism in all regions of the brain, positive syndrome had increased glucose metabolism in the medial temporal regions, basal ganglia and left thalamic regions as well as hypometabolism in the cerebellum Major depressive disorder (Decreased glucose metabolism in the cingulate, superior frontal, rectal and orbital gyri)

Answer 22

``` Brain tumor Brain abscess Post-surgical changes Post-radiation gliosis Tuberous sclerosis Vasculitis Vascular malformation, i.e. AVM ```

Answer 23

Disorder that results in skin ischemia and necrosis from decreased arterial blood flow in the dermo-hypodermic arterioles. Most commonly seen in end stage renal disease. Medial vessel calcification occurs first. Ongoing vascular endothelial injury causes cutaneous arteriolar narrowing and a hypercoagulable state that causes tissue infarction.

Answer 24

Initial screening test for reflux in girls with UTIs. Screening of asymptomatic siblings. Follow-up exam for patients with known reflux. Serial evaluation of children with neuropathic bladders at increased risk for reflux to develop. Assess of the results of antireflux surgery

Answer 25

Max dose: 70 mg IV over a 4-minute period (0.56 mg/kg IV over 4 min, up to 125 kg weight). Earliest time of reversal: > 1 minute. BP & ECG monitored every minute during infusion & 3-5 minutes into recovery or until stable. ECG monitoring should be carried out as with exercise stress testing. A 12-lead electrocardiogram will be recorded every minute during the infusion. Indications for reversal of dipyridamole (50- to 250-mg aminophylline intravenously at least 1 minute after the tracer injection) include the following: (1) Severe hypotension (systolic BP <80 mmHg). (2) Development of symptomatic, persistent second degree or complete heart block. (3) Other significant cardiac arrhythmia. (4) Wheezing. (5) Severe chest pain associated with ST depression of 2 mm or greater. (6) Signs of poor perfusion (pallor, cyanosis, cold skin). (7) Can be considered in the presence of less-severe side effects or ischemic ECG changes if at least 1 minute has elapsed since radiotracer injection

Answer 26

``` Classic metaphyseal lesion Multiple rib fractures Scapular fractures Spinous process fractures Sternal fractures ```

Answer 27

Leader Contribute to improvement of health care delivery in teams, organizations, & systems Engage in the stewardship of health care resources Demonstrate leadership in professional practice Manage career planning, finances, and health human resources in a practice

Answer 28

``` Neuroblastoma Pheochromocytoma Paraganglioma Carcinoid Medullary thyroid cancer ```

Answer 29

Increased FDG uptake correlates with poor prognosis for neuroendocrine tumours SUVmax correlates with higher expression of Ki-67 and a greater tumor size In NET patients, the presence of 18F-FDG-positive tumours correlates strongly with a higher risk of progression. Initially, patients with 18F-FDG-negative NET may show 18F-FDG-positive tumours during follow-up. Also patients with grade 1 and grade 2 NET may have 18F-FDG-positive tumours. Therefore, 18F-FDG PET/CT is a complementary tool to 68Ga-DOTA-TOC PET/CT with clinical relevance for molecular investigation. Loss of SSTR expression was found to coincide with a gain in glucose utilization in tumours.

Answer 30

Falsely elevated in compression #, degenerative changes, blastic mets, surgical hardware Falsely decreased in laminectomy, lytic lesions, improper technique Only accounts for 2 types of tissues: bone and soft tissue (muscle and fat)

Answer 31

Fragility fracture of the hip or spine or 2 fragility fractures elsewhere = high risk. One fragility fracture elsewhere increases fracture risk by one category. Systemic steroids =/> 7.5 mg prednisone/day for a total of 90 days in the last 12 months. The increased fracture risk continues for 12 months after discontinuing prednisone. Fracture risk increases by one category.

Answer 32

Primary hyperparathyroidism results from a hyperfunction of the parathyroid glands themselves. Over-secretion of PTH due to a parathyroid adenoma, parathyroid hyperplasia or, rarely, a parathyroid carcinoma. Characterized by the quartet stones, bones, groans, and psychic overtones referring to the presence of kidney stones, hypercalcemia, constipation and peptic ulcers, as well as depression, respectively. Secondary hyperparathyroidism is due to physiological (i.e. appropriate) secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels). Most common causes are vitamin D deficiency (caused by lack of sunlight, diet or malabsorption) and chronic kidney failure. Tertiary hyperparathyroidism is seen in patients with long-term secondary hyperparathyroidism which eventually leads to hyperplasia of the parathyroid glands and a loss of response to serum calcium levels. Most often seen in patients with chronic renal failure and is an autonomous activity.

Answer 33

1. Attenuation from hardware, barium, external objects. 2. Lytic lesion 2. Encapsulated non-pyogenic abscess. 3. Vertebral osteomyelitis. 4. Chronic low-grade infection. 5. Parasites, mycobacterial, fungal infection. 6. Infarct.

Answer 34

In-111 oxine WBC (8-hydroxyquinoline) 40-80 mL of venous blood from adults, minimum 10-15 mL from children Direct venipuncture and mixed immediately with acid citrate dextrose or heparin Large-bore butterfly needle (18-20 gauge) IV injection. If using existing IV line, should flush with normal saline, not dextrose because can cause clumping Supplied in aqueous solution pH 6.5-7.5, containing polysorbate 80 as the stabilize Tc-99m-HMPAO (exametazime) 40-60 mL of venous blood from adults, minimum 10-15 mL from children Direct venipuncture and mixed immediately with acid citrate dextrose anticoagulant Large-bore butterfly needle (18-20 gauge) via intravenous injection Separated leukocytes suspended in plasma/ACD mixture of Freshly formulated 99mTc-HMPAO added to cell Incubated for 15 min at room temperature Washed with plasma Suspended in plasma for injection Labeling yield 50-60%

Answer 35

``` Diverticular disease (diverticulosis, diverticulitis) Neoplasm Angiodysplasia Infectious colitis Inflammatory bowel disease Rectal varices Hemorrhoids ```

Answer 36

Infection (i.e. Pneumocystis carinii, Myobacterium avium-intracellulare) Drug toxicity (i.e. Bleomycin, Amiodarone) Acute radiation pneumonitis Pneumoconiosis: Silicosis Sarcoidosis Lymphangitic carcinomatosis

Answer 37

Overall: Staphylococcus aureus Neonates: Group B Streptococcus Sickle cell anemia: Salmonella, Staphylococcus aureus Most common locations: Children < 18 months: epiphyseal and joint involvement due to transphyseal vessels Older children: metaphysis of long bones due to turbulent slow flow Adult: vertebral bodies due to red marrow with abundant vascular supply

Answer 38

``` P - pancreatitis, pregnancy L - legg-calves perthes, lupus A - alcohol, atherosclerosis S - steroids T - trauma I - idiopathic (SONK, Freiberg), infection C - collagen vascular disease, caisson disease R - radiation, rheumatoid arthritis A - amyloid G - gaucher disease S - sickle cell disease ```

Answer 39

Anaplastic, Medullary, Tall cell, Hurthle, follicular

Answer 40

Emergent cases Inpatients and Urgent cases Patients who have travelled from out of town Patients who have a same-day appointment with their physician Perform studies that don’t need SPECT nor anterior + posterior views (i.e. renogram, thyroid)

Answer 41

Wait 8-12 weeks (post RT, and at least 3 weeks post chemo) ``` To minimize frequency of false positive, postpone PET/CT after the following procedures: o Biopsy: 5–7 days o Chemotherapy: at least 3 weeks o Surgery: 6 weeks o Radiation therapy: 8–12 weeks ```

Answer 42

Periarticular accumulation most commonly seen in: Shoulders Hips Most specific sites are extra-articular bursitis (in at least 2 out of 3 locations): Ischial tuberosity Greater trochanter Spinous processes

Answer 43

A discordant nodule is hot on Tc-99m images, but cold on the I-123 exam. Discordant nodules can be explained by either the preservation of Tc-pertechnetate trapping, but failure of organification or the rapid release of organified iodine from nodule (washed out by 24 hours). Solitary discordant thyroid nodules are generally considered to be rare (2 to 8%) and appear most often in multinodular goiters. Discrepancies are more likely to be benign. Although some authors feel as many as 30% of discordant nodules may be malignant, earlier concern for discordant nodules has lessened. A conservative approach to this problem would be to re-scan any patient with a hot nodule on the Tc-99m pertechnetate exam with I-123. However, risk of cancer in a nodule appearing hot with Tc-99m and cold with radioiodine is probably so low that routine reimaging is not necessary.

Answer 44

Malignancy (compression or invasion of lymphatics) Post-surgical (excised lymphatics) Trauma (transected lymphatics) Post-radiation Infection (filariasis: parasite infection in tropical and subtropical countries > 90 million people)

Answer 45

``` Gorham disease Kaposiform lymphangiomatosis Congenital lymphatic dysplasia (chylothorax, chylous ascites, pericardial effusion) Plastic bronchitis Pulmonary lymphatic perfusion syndrome ```

Answer 46

Stop methimazole for 3 days, can be resumed 2-3 days afterwards Hold IV contrast for 6-8 weeks for water soluble contrast, 1-6 months for lipophilic contrast

Answer 47

No (non-zero risk from any medical procedure, but only tiny fraction of pulmonary capillaries become occluded). Reduce number of particles to 60,000-100,000.

Clinical 2017 Flashcards

(71 cards)