1
Q
What are the foundation components of any diagnosis?
A
An individual’s medical history and physical exam
These components provide initial insights into a patient’s condition.
2
Q
What additional tests can provide more information when routine blood and urine tests are insufficient?
A
More specialized testing
Specialized tests may include imaging studies or other diagnostic procedures.
3
Q
What are the two main categories of diagnostic tests?
A
Invasive and non-invasive tests
Invasive tests involve puncturing or cutting the skin, while non-invasive tests do not.
4
Q
List the most common diagnostic imaging tests.
A
- Plain x-rays
- Computed tomography (CT)
- Ultrasound (US)
- Magnetic resonance imaging (MRI)
- Radionuclide studies
These imaging tests assist in visualizing internal structures.
5
Q
What is the primary feature of regular x-rays?
A
A beam of radiation emitted is scattered or absorbed differently by various tissues
This results in shades of black, gray, and white on the x-ray film.
6
Q
What are the four densities that produce shades on an x-ray film?
A
- Fat
- Water
- Air
- Bone
Each density interacts with x-ray radiation differently.
7
Q
What does modern computed radiography use to read and store images?
A
A laser and a computer
This method improves efficiency and image quality.
8
Q
What is digital radiography?
A
A technique using digital x-ray sensors to transmit images immediately to a computer
This method is faster and emits a lower dose of radiation.
9
Q
Why might multiple views be necessary in regular x-rays?
A
Because regular x-rays produce two-dimensional images
Multiple views allow for better visualization of structures.
10
Q
What is fluoroscopy used for?
A
To view moving parts of the body in real time
It is useful for both diagnosis and treatment, particularly with contrast agents.
11
Q
How does fluoroscopy visualize moving structures?
A
By using a continuous x-ray beam
This produces real-time images projected onto a monitor.
12
Q
What are some applications of fluoroscopy?
A
- Placement of catheters
- Arthroscopy
- Removal of foreign objects
- Image-guided therapeutic injections
- Cardiac catheterization and stent placement
Fluoroscopy aids in minimally invasive surgical procedures.
13
Q
What are contrast agents used for?
A
Contrast agents allow the radiologist to obtain a better image of tubular or hollow structures than is seen on plain x-rays.
14
Q
What are the most common types of contrast agents?
A
Barium, iodine, and gadolinium-based contrast agents are the most common contrast materials.
15
Q
How can contrast media be used?
A
Contrast media can be used with plain x-rays, CT, and MRI studies.
16
Q
How are oral or instilled contrast agents tolerated?
A
Contrast agents taken orally or instilled into hollow organs are usually tolerated well, and the risk of allergic reaction is low.
17
Q
What can intravenous (IV) contrast cause?
A
IV contrast, particularly iodine-based agents, can cause hypersensitivity reactions.
18
Q
How are most adverse reactions to contrast agents treated?
A
Most adverse reactions are easily treated with diphenhydramine (Benadryl®) and/or prednisone.
19
Q
What critical interventions may be required for anaphylactic reactions?
A
Anaphylactic reactions can require critical interventions such as epinephrine, airway protection, and ICU admission.
20
Q
In what situations should IV contrast materials be used with caution?
A
IV contrast materials should be used with caution in individuals with known allergies or impaired renal function.
21
Q
How are contrast agents eliminated from the body?
A
Contrast agents are eliminated in feces and urine.
22
Q
What does nuclear medicine involve?
A
Nuclear medicine involves the use of small amounts of a short-lived radioactive substance (radioisotope) that is formulated to be absorbed by targeted tissues.
23
Q
What is a radionuclide?
A
A radionuclide (also known as a radiopharmaceutical) can be attached to a carrier substance that is injected intravenously, taken orally, or inhaled.
24
Q
What is used to record the distribution of radioactive material in nuclear imaging?
A
A scanning device or gamma camera (scintigraphy) is used to record the distribution of the radioactive material.
25
What are the common radionuclides used in nuclear medicine?
Common radionuclides include radioactive iodine, technetium, thallium, gallium, and indium.
26
What types of imaging are nuclear studies useful for?
Nuclear studies are useful in imaging of bone and for determination of thyroid and hepatobiliary function.
27
What aspects of cardiac physiology can radionuclides assess?
Radionuclides can assess aspects of cardiac physiology, such as perfusion and ejection fraction.
28
What is ultrasonography (US)?
Ultrasonography (US) is a procedure that utilizes high-frequency sound waves to image soft tissue and produce an image known as an ultrasound.
29
How does ultrasonography work?
A transducer is placed on skin prepared with a transmitting gel, sound waves are transmitted, and echoes are received back.
30
How is the size of an organ calculated in ultrasonography?
The size of an organ is calculated by measuring the time it takes for sound waves to travel from the transducer to the reflecting surface and back.
31
What is echogenicity?
Echogenicity refers to the varying degrees to which different tissues reflect sound waves.
32
What are hyperechoic tissues?
Hyperechoic tissues reflect many sound waves and appear white on the image.
## Footnote
Examples include fascia and connective tissue strands.
33
What are hypoechoic tissues?
Hypoechoic tissues reflect only a few sound waves and appear gray on the image.
## Footnote
Examples include cartilage, muscles, and lymph nodes.
34
What does anechoic mean?
Anechoic refers to the total absence of reflected sound waves, appearing black on the image.
## Footnote
Examples include bone, blood vessels, and fat.
35
What are the advantages of ultrasonography over MRI and CT?
Advantages include the ability to differentiate solid from fluid-filled structures, lower cost, portability, accessibility, and no exposure to ionizing radiation.
36
What are the limitations of ultrasonography?
Limitations include the skill level of the ultrasonographer, lower quality of image resolution compared to other modalities, and 'noise' produced when US waves hit gas and bone.
37
What are the different ultrasound techniques?
Techniques include A-mode, B-mode, M-mode, grayscale, real-time, and Doppler.
38
What is real-time ultrasound?
Real-time ultrasound allows scanning at a rapid rate to create a moving image of the heart, including the motion of the valves and walls.
39
What is Doppler ultrasonography used for?
Doppler ultrasonography measures the velocity and direction of blood flow within the heart and blood vessels by measuring changes in pitch.
## Footnote
It is useful for evaluating venous insufficiency, blood clots, arterial occlusion, or stenosis, and for identifying valvular disorders and congenital defects.
40
What is a duplex scan?
A duplex scan combines B-mode with Doppler ultrasound.
41
What is computed tomography (CT)?
CT scans are created by passing a rotating beam of x-rays into the individual and obtaining thousands of point images at specific depths.
42
How does CT produce images?
CT produces cross-sectional, two-dimensional images from digitized data, which can also be manipulated to create three-dimensional images.
43
How can CT images be compared?
CT images can be compared to examining a loaf of sliced bread one slice at a time.
44
What is the resolution of CT images?
CT produces images at a much higher resolution compared to other imaging modalities.
45
What is Positron Emission Tomography (PET)?
PET scans are diagnostic images obtained from the decay of a positron emitting radionuclide agent.
46
What agent is used for PET scans?
Fluorine-18 ['*F]-labeled deoxyglucose (FDG) is the agent used for PET scans.
47
How do active cells utilize FDG?
FDG is like glucose and is metabolized by active cells that utilize glucose for energy.
48
What types of cancer can PET scans evaluate?
PET scans are used to evaluate lung cancer, colorectal cancer, esophageal cancer, head and neck cancer, lymphoma, and melanoma.
49
What neurological diseases can PET scans help diagnose?
PET scans are useful in the diagnosis of Alzheimer's disease, Parkinson's disease, and epilepsy.
50
What is a limitation of PET scanning?
Limitations include cost, accessibility, and the short half-life of the radionuclide agent.
51
What is traditional angiography?
Traditional angiography is an imaging study used to visualize the major blood vessels in the body.
52
What is the difference between a venogram and an arteriogram?
A venogram images veins, while an arteriogram images arteries.
53
How is access gained for traditional angiography?
Access is usually gained by inserting a needle into an artery or vein, most often in the femoral area.
54
What does the contrast material do in angiography?
The contrast material enhances the images and allows identification of obstructions, aneurysms, and other vascular issues.
55
What are the advances in angiography?
Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are less invasive alternatives.
56
What is the gold standard for vessel imaging?
Traditional angiography is the gold standard for vessel imaging and is preferred when intervention is necessary.
57
What is endoscopy?
Endoscopy allows the physician to investigate cavities or hollow organs using fiberoptic technology and a powerful lens system.
58
What are the main components of an endoscope?
An endoscope is a hollow tube with a light source, an image fiber, and a port for instillation of drugs, suction, irrigation, and biopsies.
59
What are some specific types of endoscopes?
Types of endoscopes include colonoscopy, gastroscopy, duodenoscopy, laparoscopy, bronchoscopy, cystoscopy, colposcopy, proctoscopy/sigmoidoscopy, thoracoscopy, and arthroscopy.
60
How has the role of endoscopy changed over time?
Endoscopy has evolved from a diagnostic tool to having significant surgical applications.
61
What additional technologies can be used with endoscopes?
Endoscopes can be equipped with cameras, digital equipment, laser technology, and ultrasound capabilities.
62
What types of anesthesia are used in endoscopic procedures?
General anesthesia, conscious sedation, topical anesthesia, or no anesthesia may be used depending on the procedure.
63
What are some conditions that endoscopy can visualize?
Endoscopy is useful for visualizing polyps, tumors, bleeding sites, inflammation, biliary cirrhosis, gallbladder stones, abscesses, and degenerative disease.
64
What imaging modalities are used for the skull, brain, and nervous system?
X-rays, CT, and MRI are used to define cranial and central nervous system pathology.
65
What is the role of X-rays in diagnosing skull and facial injuries?
X-rays are particularly useful for defining post-traumatic skull or facial fractures and identifying osseous changes.
66
What factors influence the choice of imaging test for brain conditions?
The choice of imaging test depends on the individual's condition, presenting symptoms, available facilities, and insurance approval.
67
What diagnostic tests are used for acute head trauma?
CT
68
What diagnostic tests are used for transient ischemic attack (TIA)?
CT/CTA, MRI/MRA, carotid Ultrasound
69
What diagnostic tests are used for acute hemorrhage or acute hemorrhagic stroke?
CT/CTA, MRI/MRA
70
What diagnostic test is used for brain abscess?
CT or MRI
71
What diagnostic test is used for sinus disease?
CT, MRI
72
What diagnostic tests are used for hydrocephalus?
CT, MRI
73
What diagnostic tests are used for aneurysm or arteriovenous malformation?
MRA, CTA
74
What diagnostic tests are used for acute non-hemorrhagic stroke?
CT/CTA, MRI/MRA, TCD ultrasound
75
What diagnostic tests are used for tumor or metastasis?
CT/MRI
76
What diagnostic test is used for multiple sclerosis?
MRI
77
What diagnostic tests are used for Alzheimer's?
MRI, PET/CT scan
78
What does carotid duplex ultrasound measure?
Focal blood flow velocities in the carotid artery and provides an estimate of carotid stenosis and residual lumen diameter.
79
What is the purpose of transcranial doppler (TCD) ultrasound?
To image the intracranial vessels and assess their patency.
80
What are MRA and CTA used for?
To view blood flow and blood vessel abnormalities.
81
What is cerebral angiography?
An invasive study where a catheter is inserted into the femoral artery to inject a contrast agent into targeted arteries of the head and neck.
82
What is a PET scan used for?
To identify the extent and spread of certain brain cancers, evaluate the efficacy of chemotherapy, and identify recurrent lesions.
83
What is the purpose of Single Photon Emission Computed Tomography (SPECT)?
SPECT is used for functional brain imaging to look at blood flow and provide three-dimensional images. It is useful in the diagnosis of dementias and neurodegenerative disorders but is less sensitive than PET scans.
84
What is a lumbar puncture?
A lumbar puncture, or 'spinal tap', is the insertion of a needle into the subarachnoid space to withdraw cerebrospinal fluid (CSF) for testing.
85
What conditions can a lumbar puncture help diagnose?
It is useful for diagnosing subarachnoid hemorrhage, infection/inflammation, multiple sclerosis, and Guillain-Barré syndrome.
86
What is cisternography?
Cisternography is the radiographic imaging of the subarachnoid spaces that contain spinal fluid, used to diagnose cerebral spinal fluid problems.
87
What is the tilt table test used for?
The tilt table test is used to evaluate syncope, particularly when cardiac testing and seizure evaluation have not provided a diagnosis.
88
What happens during a tilt table test?
The individual lies flat and is strapped to a table, which is then tilted to a 60-80 degrees angle to trigger neurocardiogenic syncope.
89
What does an electroencephalography (EEG) measure?
EEG measures and records the low voltage electrical activity produced by the brain using electrodes placed on the scalp.
90
What are the standard patterns recorded in an EEG?
EEGs record standard patterns of alpha, beta, delta, and theta waves influenced by the individual's state of alertness and level of consciousness.
91
What is electromyography (EMG)?
EMG is an invasive procedure that involves inserting a needle electrode into a muscle to record electrical activity of muscle fibers.
92
What conditions can EMG help diagnose?
EMG is used to diagnose neuropathy, myopathy, and certain neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS) and myasthenia gravis.
93
What are evoked potentials?
Evoked potentials are the measured electrical response of the brain to stimulation of specific sensory pathways.
94
How are evoked potentials recorded?
Wires are placed on the scalp overlying areas to be stimulated and electrical impulses are recorded on a graph.
95
What types of evoked potentials can be performed?
Visual, auditory, sensory, and motor evoked potentials can be performed.
96
What are visual evoked potentials (VEPs) used for?
VEPs are used in the diagnosis of multiple sclerosis and detect slowing of electrical conduction due to demyelination.
97
What is the brainstem auditory evoked response (BAER)?
BAER is an electrical response to a click or noise made in each ear, helping in the diagnosis of deafness, particularly in infants.
98
What do somatosensory evoked potentials (SSEPs) detect?
SSEPs detect sequential activation of nerves along a pathway and are used to monitor nerve function during surgery.
99
What is dermatoscopy/dermoscopy?
Dermatoscopy is an in-office procedure using a dermatoscope to visualize epidermal and deeper dermal structures of the skin.
100
What is the purpose of a skin biopsy?
Skin biopsy is used for skin lesions that are considered suspicious for malignancy and to confirm a clinical diagnosis.
101
What types of skin biopsies are there?
Shave and punch biopsies remove small pieces of tissue, while excisional biopsies are used for larger and pigmented lesions.
102
What does nailfold microscopy visualize?
Nailfold microscopy visualizes changes in size, shape, and number of capillaries in the digits.
103
What is fluorescein angiography?
Fluorescein angiography involves the intravenous injection of fluorescein dye to image the retina and choroid vasculature.
104
What does the Snellen test measure?
The Snellen test is a common test for visual acuity involving reading block letters of graduated sizes at a specified distance.
105
What does tonometry measure?
Tonometry measures intraocular pressure, with non-contact tonometry using an air puff to screen for glaucoma.
106
What is the Schirmer tear test used for?
The Schirmer tear test is used to determine if the eye is producing sufficient tears to keep it moist.
107
How is the Schirmer tear test performed?
A strip of filter paper is placed under the lower lid and the number of tears absorbed over a five-minute period is measured.
108
In which condition is the Schirmer tear test most useful?
It is most useful for determining severe dry eye conditions as seen in Sjogren's syndrome.
109
What are thyroid uptake scans used for?
Thyroid uptake scans are used to evaluate thyroid function and investigate palpable lumps, hyperactivity, and/or enlargement of the thyroid gland.
110
What does a radioactive iodine uptake (RAI) test determine?
RAI utilizes a small dose of an iodine-based radionuclide agent to determine the function of the thyroid.
111
How do hypoactive and hyperactive thyroid cells differ in RAI?
Hypoactive thyroid cells take up less radioactive iodine whereas hyperactive cells utilize more iodine.
112
What is usually done in conjunction with a thyroid uptake scan?
RAI is usually done in conjunction with a thyroid scan that provides information on the size and shape of the gland.
113
What can be used for scanning when iodine cannot be used?
Technetium can be used for scanning when thyroid function is suppressed, or iodine cannot be used.
114
How are nodules classified on a thyroid scan?
Nodules are classified as cold, functional, or hot based on their uptake of radioactive iodine.
115
What does a cold nodule indicate?
Cold nodules have an increased probability of malignancy and are usually referred for further testing.
116
What is the purpose of a thyroid ultrasound?
A thyroid ultrasound is often done to determine if a suspicious nodule is solid or cystic, provide a more accurate measurement, or guide a biopsy.
117
What are whole body iodine-131 scans used for?
They are used after surgical removal of the thyroid to look for extra-glandular metastases, evaluate treatment effectiveness, or look for recurrence.
118
What is a fine needle aspirate (FNA)?
FNA is done by inserting a needle into the thyroid nodule to obtain cells and/or fluid for pathological diagnosis.
119
What is the limitation of FNA in diagnosing certain carcinomas?
FNA cannot be used to diagnose follicular or Hürthle cell carcinomas because it cannot distinguish between adenomas and cancers.
120
What is parotid sialography used for?
Parotid sialography is used in the diagnosis and management of parotid lesions.
121
How is parotid sialography performed?
It involves injection of a contrast material into the parotid duct followed by PA and lateral x-rays.
122
What can parotid sialography differentiate?
It can differentiate intrinsic from extrinsic masses, inflammatory lesions from neoplasms, and visualize stones or ductal abnormalities.
123
What condition is sialography still used to diagnose?
It is still used for the diagnosis of xerostomia (dry mouth) in Sjogren's syndrome.
124
What is pheochromocytoma?
Pheochromocytoma is a tumor often found in the adrenal gland.
125
How are pheochromocytoma and neuroblastoma usually diagnosed?
They are usually diagnosed with CT or MRI.
126
What is a MIBG scan?
A MIBG scan involves the intravenous injection of the radionuclide MIBG, which attaches to tumor cells.
127
What does MIBG stand for?
MIBG stands for meta-iodobenzylguanidine.
128
What is the purpose of a specialized scanner in a MIBG scan?
It is used to measure the radioactivity from the injected MIBG.
129
What other scan is useful in localizing pheochromocytomas?
PET scans are useful in localizing pheochromocytomas that can develop outside the adrenals.
130
What are the major diagnostic techniques for chest pathology?
Plain x-rays, CT, and MRI are major diagnostic techniques.
131
What are the advantages of plain x-rays?
They are valuable screening tests due to their low cost and availability.
132
What can plain x-rays visualize?
They can visualize lung aeration, heart contours, mediastinal structures, calcifications, and the diaphragm.
133
What diagnostic procedure is used for pneumonia and atelectasis?
X-ray is used for diagnosing pneumonia and atelectasis.
134
What diagnostic procedures are used for chronic obstructive pulmonary disease (COPD)?
X-ray, Pulmonary Function Tests (PFTs), and CT are used.
135
What is the diagnostic procedure for pneumothorax?
X-ray and CT are used for diagnosing pneumothorax.
136
What diagnostic procedures are used for foreign body aspiration?
X-ray, CT, and Bronchoscopy are used.
137
What diagnostic tests are used for asbestosis?
X-ray and CT are used for diagnosing asbestosis.
138
What diagnostic procedure is used for hemoptysis?
X-ray and CT, and Bronchoscopy are used for diagnosing hemoptysis.
139
What is used to localize pleural effusion before thoracentesis?
CT and X-ray are used to localize pleural effusion.
140
What diagnostic tests are used for pulmonary embolus?
CTA and V/Q scan are used for diagnosing pulmonary embolus.
141
What does computed tomography provide images of?
Computed tomography provides images of bronchi, pulmonary parenchyma, and mediastinal structures.
142
How can CT imaging be enhanced?
CT imaging can be enhanced by using thinner slices (i.e., high resolution CT) and contrast agents.
143
What advancements allow for imaging of the entire chest in one breath?
Advances in helical (i.e., spiral) and multi-slice detector CT technology allow for imaging of the entire chest in one breath.
144
What is done when suspicious pulmonary nodules are seen on a chest x-ray?
Suspicious pulmonary nodules seen on chest x-ray are evaluated further or followed by CT scans.
145
What is the minimum size for lesions to provide useful information on PET scans?
Lesions must be at least 8-10 millimeters for PET scans to provide useful information.
146
What can PET scans differentiate?
PET scans can be useful for differentiating benign from malignant tumors.
147
What is usually necessary when pulmonary lesions are large, growing, or obstructing?
When pulmonary lesions are large, growing, or obstructing, biopsy is usually necessary.
148
How is diagnosis often made for pulmonary lesions?
Diagnosis is often made by a biopsy performed via bronchoscopy, mediastinoscopy, or thoracoscopy.
149
What is performed for peripheral tumors not accessible by bronchoscopy?
For peripheral tumors not readily accessible by bronchoscopy, CT- or fluoroscopy-guided percutaneous needle aspiration or an open surgical resection is performed.
150
What does endoscopy allow?
Endoscopy allows direct visualization of structures in the bronchi, larynx, thorax, or mediastinum.
151
What are the two methods of laryngoscopy?
Laryngoscopy can be done indirectly with a handheld mirror or directly using a flexible laryngoscope.
152
What is the purpose of mediastinoscopy and thoracoscopy?
Mediastinoscopy and thoracoscopy use a fiberoptic endoscope to examine and biopsy structures such as lymph nodes and masses in the chest cavity.
153
What does bronchoscopy permit visualization of?
Bronchoscopy permits visualization of the trachea, vocal cords, main bronchial tubes, and smaller branches.
154
What procedures can be performed during bronchoscopy?
Bronchoscopy allows biopsy of tissue by bronchial washing, brushing, or direct tissue removal.
155
What is thoracentesis?
Thoracentesis is an invasive procedure to remove fluid that accumulates between the visceral and parietal pleura.
156
What is done with the fluid removed during thoracentesis?
The fluid removed is sent for analysis and culture.
157
What can be done for large or persistent effusions?
For large or persistent effusions, a chest tube can be inserted, or more aggressive therapy can be instituted.
158
What is pulmonary angiography?
Pulmonary angiography utilizes fluoroscopy and intravenous contrast injected into a catheter to visualize or exclude pulmonary emboli, identify vascular anomalies, or delineate vessels before surgery.
159
What imaging technique is currently preferred for visualizing pulmonary vessels?
CT angiography is the imaging technique of choice to visualize the pulmonary vessels.
160
What does a ventilation perfusion scan study?
A ventilation perfusion scan studies airflow (ventilation) and blood flow (perfusion) in the lungs.
161
How is a ventilation perfusion scan performed?
After inhalation of a radionuclide gas or aerosol, scintigraphic studies are done, followed by the injection of a radiopharmaceutical agent to image the pulmonary vasculature.
162
What is the V/Q ratio?
The V/Q ratio is a mathematical calculation using measurements from a ventilation perfusion scan, most used for diagnosing pulmonary emboli.
163
What is oxygen saturation?
Oxygen saturation measures the percentage of red blood cells saturated with oxygen.
164
How is oxygen saturation measured?
Oxygen saturation is measured with a pulse oximeter attached to the index finger, based on how red blood cells absorb and reflect light.
165
What are pulmonary function tests (PFTs)?
PFTs record the movement of air into and out of the lungs and provide information about obstructive, restrictive, or mixed respiratory diseases.
166
What are the key measurements in pulmonary function tests?
Key measurements include forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), FEV1/FVC ratio, and diffusing capacity (DLCO).
167
What does FVC measure?
FVC measures the maximum volume of air exhaled after deep inspiration.
168
What does FEV1 measure?
FEV1 is the measurement made at 1 second after exhaling as hard and as fast as possible.
169
How is the FEV1/FVC ratio used?
The FEV1/FVC ratio is used to identify obstructive (low ratio) from restrictive (normal or high ratio) diseases.
170
What is the significance of the diffusing capacity (DLCO)?
DLCO measures the ability of inhaled carbon monoxide to move out of the lungs and into the blood, providing information about the gas exchanging capacity of the lungs.
171
What is considered a normal value for FVC and FEV1?
Values above 80% of predicted are considered normal.
172
What is polysomnography?
Polysomnography is a sleep study used to confirm a diagnosis of obstructive sleep apnea-hypopnea syndrome.
173
What data is recorded during a sleep study?
Data recorded includes EEG for sleep stages, electro-oculogram (EOG) for eye movement, respiratory effort, and airflow oxygen saturation, electrocardiogram, body position, submental and anterior tibialis movement, noises, including snoring
174
What does a technician confirm in sleep studies?
A technician confirms recorded events related to sleep data.
175
What information does the sleep data provide?
It provides information on total sleep time, sleep efficiency, percentage of time in each stage of sleep, sleep latency, arousals from sleep, and the number of obstructive apneas, hypopneas, and central apneas.
176
What is the purpose of the purified protein derivative (PPD) test?
The PPD test is done to diagnose tuberculosis (TB) by injecting a small amount of bacterial antigen under the skin.
177
How is a positive PPD test result determined?
A positive test is indicated by induration and erythema measured by the care provider after 48-72 hours.
178
What follow-up is done after a positive PPD test?
A chest x-ray is performed to look for active disease or granulomas.
179
What is an interferon-gamma assay?
It is a blood test that can also be performed for the diagnosis of TB.
180
How is sputum for analysis collected?
Sputum is collected after a deep cough or suctioned from the bronchial tubes and placed in a sterile container.
181
What is sputum analysis used for?
It is used to observe for the presence of blood and color, and to provide information about the sensitivity of antibiotic treatments.
182
What is the purpose of mammography?
Mammography is a routine screening test for breast cancer, recommended for females over age 40.
183
What is the procedure for mammography?
It involves compression of the breast between two plates while low dose x-rays are taken from different angles.
184
What advancements have been made in mammography?
Digital mammography with computer-aided detection (CAD) and digital breast tomosynthesis (3-D mammography) have replaced traditional film x-rays.
185
What can mammograms identify?
Mammograms can identify calcifications, cystic structures, solid masses, and areas of thickening.
186
What are some limitations of mammography?
Limitations include dense breast tissue, implants, and the skill of the technician.
187
What is the percentage of clinically palpable breast cancers that mammography misses?
Mammography misses up to 10-20% of clinically palpable breast cancers.
188
What type of breast cancer does mammography not detect?
Mammography does not detect inflammatory breast cancer.
189
What should be done if there is a clinically suspicious mass in the breast?
Further testing or biopsy is necessary.
190
What is the purpose of breast MRIs with gadolinium?
Breast MRIs are advocated for females at high risk of breast cancer or who have dense breasts or implants.
191
What does MRI with contrast show in relation to breast tumors?
MRI with contrast shows the characteristic increase in vascularity associated with breast tumors.
192
What is breast ultrasonography used for?
Breast ultrasonography may be performed for females with dense breast tissue.
193
What can ultrasound differentiate if a mass is detected on mammography?
Ultrasound can differentiate simple from complex cysts, and cystic structures from solid nodules.
194
What are simple cysts usually considered?
Simple cysts are usually benign.
195
What is the purpose of aspirating fluid from a cyst?
Aspirating fluid can relieve discomfort.
196
What is the typical procedure for complex cysts and solid nodules?
Complex cysts and solid nodules are usually biopsied.
197
What is a fine needle aspirate (FNA)?
FNA involves stabilizing the lesion and inserting a needle with a syringe or vacuum to withdraw fluid or cells.
198
What is a stereotactic biopsy?
Stereotactic biopsy is performed with special computerized mammography that uses intersecting coordinates to pinpoint the suspicious area.
199
What is an open surgical biopsy?
An open surgical biopsy requires a small incision after local or general anesthesia to remove the entire lesion and a portion of surrounding tissue.
200
What diagnostic test is used for most cardiac problems?
Chest x-ray, EKG, Stress test, Echocardiography.
201
What diagnostic test is used to assess left ventricular ejection fraction?
Echocardiography, Myocardial Perfusion Imaging (MPI).
202
What diagnostic tests are used for congestive heart failure?
Chest x-ray, Echocardiography.
203
What diagnostic tests are used for thoracic aneurysm?
CTA, MRA, Echocardiography.
204
What diagnostic tests are used for aortic aneurysm?
CTA, MRA, Ultrasound, Echocardiography.
205
What is coronary artery ischemia/stenosis?
A condition characterized by reduced blood flow to the heart due to narrowing of the coronary arteries.
206
What are arrhythmias?
Irregular heartbeats that can affect how well the heart works.
207
What is congenital heart disease?
A heart defect present at birth that affects the structure and function of the heart.
208
What is endocarditis/pericarditis?
Endocarditis is an infection of the heart's inner lining, while pericarditis is inflammation of the outer lining.
209
What is valvular disease?
A condition affecting one or more of the heart valves, which can disrupt blood flow.
210
What is peripheral vascular disease/claudication?
A circulatory condition characterized by narrowed blood vessels reducing blood flow to the limbs.
211
What is a carotid bruit?
An abnormal sound heard over the carotid artery, often indicating turbulent blood flow.
212
What is deep vein thrombosis?
The formation of a blood clot in a deep vein, usually in the legs.
213
What is ALU 101?
Basic Life Insurance Underwriting.
214
What tests are used for cardiac evaluation?
EKG, Stress test, Cardiac catheterization, MRA, CTA.
215
What tests are used for arrhythmia evaluation?
EKG, Holter/Event monitor, Stress test, EP testing.
216
What imaging tests are used for chest evaluation?
Chest x-ray, Echocardiography, Cardiac catheterization, CMR.
217
What tests are used for cardiac structure assessment?
Echocardiography, CMR.
218
What tests are used for peripheral vascular assessment?
Doppler ultrasonography, CTA, MRA, Ankle-brachial index.
219
What tests are used for venous assessment?
Doppler venous ultrasonography.
220
What are CT angiography (CTA) and magnetic resonance angiography (MRA)?
Techniques that use contrast material to image the coronary and peripheral arteries as well as the aorta and its branches.
221
What information can CTA and MRA provide?
Detailed information on coronary artery stenosis, atherosclerotic burden, chamber volumes, ejection fraction, and aortic dimensions.
222
When is cardiac catheterization typically reserved?
For times when intervention, such as balloon angioplasty or stenting, is necessary.
223
What is cardiac magnetic resonance (CMR) imaging used for?
To assess the functional and tissue properties of the heart, including various heart disorders.
224
What is the purpose of stress testing?
To test for coronary heart disease, including ischemia and infarction.
225
What modalities are used in stress testing?
Exercise EKG testing and pharmacologic stress testing.
226
What imaging can be combined with EKG during stress testing?
Echocardiogram, radionuclide MPI, and MRI.
227
What are the most used SPECT MPI agents?
Thallium and sestamibi.
228
What is transthoracic echocardiography (TTE)?
An echocardiogram where the transducer sends sound waves across the chest wall.
229
What does transthoracic echocardiography combined with Doppler studies assess?
Chamber sizes, sizes of great vessels, valve structures, valve function, and pressures within the heart.
230
What is a transesophageal echo (TEE)?
A TEE is a procedure where the transducer is positioned in the esophagus to visualize cardiac structures better when TTE is inadequate.
231
What is the purpose of using agitated saline in a TEE?
Agitated saline is injected into an arm vein to visualize bubbles moving from one side of the heart to the other, indicating the presence of a shunt.
232
What conditions can echocardiography with bubble study diagnose?
It is used to diagnose a patent foramen ovale or atrial septal defect.
233
What is electrophysiological (EP) mapping?
EP mapping is a study to assess significant arrhythmias by threading a catheter from the femoral vein into the right heart to induce cardiac arrhythmias.
234
What is the purpose of radiofrequency energy in EP studies?
Radiofrequency energy is used to ablate the abnormal conduction pathway or arrhythmogenic focus once the source of the arrhythmia is identified.
235
What is a Holter monitor?
A Holter monitor is an ambulatory electrocardiogram (EKG) that records continual or periodic EKGs for 24 hours or longer.
236
What is the function of an event monitor?
An event monitor is used by patients to detect the onset of symptoms and self-trigger the recording.
237
What is a patch monitor?
A patch monitor is an adhesive monitor that records only a single lead.
238
What is mobile cardiac outpatient telemetry (MCOT)?
MCOT may be worn for up to 30 days to monitor cardiac activity.
239
What are cardiac monitors like an implantable loop recorder used for?
They monitor for arrhythmias from months to years, typically used to detect infrequent events or inconclusive results from other modalities.
240
What is an endomyocardial biopsy?
It is a rare procedure done by catheterization to excise small tissue samples for pathology.
241
When is an endomyocardial biopsy performed?
It is performed when cardiac sarcoidosis or hemochromatosis is suspected, to identify myocardial dysfunction causes, or to monitor transplant rejection.
242
What does KUB stand for?
KUB stands for kidney, ureter, bladder, but it is a poor imaging method for these structures.
243
What does a barium swallow involve?
A barium swallow involves ingesting contrast material that coats the esophagus, stomach, and small intestine for better visualization.
244
What is the purpose of a barium enema?
A barium enema provides imaging of the colon.
245
What does a small bowel follow-through do?
It takes x-rays as barium passes through the small intestine into the right colon.
246
What are barium studies used to show?
Barium studies are done to show areas of stricture, ulceration, obstruction, and masses.
247
What is the most common technique for diagnosing non-intestinal pathology?
CT is the most common technique for diagnosis of non-intestinal pathology and is often used to follow-up on abnormalities seen on ultrasound.
248
What does CT imaging of the abdomen include?
CT can image the entire abdomen (i.e., solid organs, peritoneum, and retroperitoneum) and pelvis in a few minutes.
249
What is 'virtual' colonoscopy?
'Virtual' colonoscopy is a CT technique that produces 3-dimensional images of the colon.
250
What are radionuclide scans used for?
Radionuclide scans are used for functional analysis of abdominal organs and staging of tumors.
251
What is gastric emptying?
Gastric emptying is the time it takes for an ingested meal, containing a small amount of a radioactive isotope, to pass out of the stomach.
252
What is indicated for the diagnosis of gastric outlet obstruction and gastroparesis?
Gastric emptying is indicated for the diagnosis of gastric outlet obstruction and gastroparesis.
253
What is manometry?
Manometry is performed to measure the strength and coordination of muscular activity of the esophagus and stomach during swallowing and digestion.
254
How is reflux testing performed?
Reflux testing is done with a detector on the chest to monitor an ingested radioactive isotope for one hour while pressure is applied to the abdomen.
255
What is cholescintigraphy better known as?
Cholescintigraphy is better known as a HIDA scan.
256
What does a HIDA scan help define?
A HIDA scan helps define various pathologies including liver disease, gallbladder disease, bile duct obstruction, or cystic duct obstruction.
257
What is laparoscopy?
Laparoscopy is performed under general anesthesia with a small incision made near the navel to visualize abdominal structures.
258
What procedures do gastroscopy and EGD permit?
Gastroscopy and esophagogastroduodenoscopy (EGD) permit visualization of the esophagus, stomach, and duodenum.
259
What is colonoscopy?
Colonoscopy is the insertion of a flexible endoscope into the colon from the anus to the terminal ileum.
260
What is video capsule endoscopy?
Video capsule endoscopy is a wireless imaging device that is swallowed to take images as it moves through the digestive tract.
261
What is the frequency of image capture in video capsule endoscopy?
Two images per second are taken as the capsule moves through the stomach, small bowel, and colon.
262
What condition is video capsule endoscopy particularly useful for diagnosing?
Video capsule endoscopy is particularly useful in the diagnosis of Crohn's disease.
263
What is the most common technique for diagnosing non-intestinal pathology?
CT is the most common technique for diagnosis of non-intestinal pathology and is often used to follow-up on abnormalities seen on ultrasound.
264
What does CT imaging of the abdomen include?
CT can image the entire abdomen (i.e., solid organs, peritoneum, and retroperitoneum) and pelvis in a few minutes.
265
What is 'virtual' colonoscopy?
'Virtual' colonoscopy is a CT technique that produces 3-dimensional images of the colon.
266
What are radionuclide scans used for?
Radionuclide scans are used for functional analysis of abdominal organs and staging of tumors.
267
What is gastric emptying?
Gastric emptying is the time it takes for an ingested meal, containing a small amount of a radioactive isotope, to pass out of the stomach.
268
What is indicated for the diagnosis of gastric outlet obstruction and gastroparesis?
Gastric emptying is indicated for the diagnosis of gastric outlet obstruction and gastroparesis.
269
What is manometry?
Manometry is performed to measure the strength and coordination of muscular activity of the esophagus and stomach during swallowing and digestion.
270
How is reflux testing performed?
Reflux testing is done with a detector on the chest to monitor an ingested radioactive isotope for one hour while pressure is applied to the abdomen.
271
What is cholescintigraphy better known as?
Cholescintigraphy is better known as a HIDA scan.
272
What does a HIDA scan help define?
A HIDA scan helps define various pathologies including liver disease, gallbladder disease, bile duct obstruction, or cystic duct obstruction.
273
What is laparoscopy?
Laparoscopy is performed under general anesthesia with a small incision made near the navel to visualize abdominal structures.
274
What procedures do gastroscopy and EGD permit?
Gastroscopy and esophagogastroduodenoscopy (EGD) permit visualization of the esophagus, stomach, and duodenum.
275
What is colonoscopy?
Colonoscopy is the insertion of a flexible endoscope into the colon from the anus to the terminal ileum.
276
What is video capsule endoscopy?
Video capsule endoscopy is a wireless imaging device that is swallowed to take images as it moves through the digestive tract.
277
What is the frequency of image capture in video capsule endoscopy?
Two images per second are taken as the capsule moves through the stomach, small bowel, and colon.
278
What condition is video capsule endoscopy particularly useful for diagnosing?
Video capsule endoscopy is particularly useful in the diagnosis of Crohn's disease.
279
What is the purpose of diagnostic tests in relation to the small bowel?
Diagnostic tests are used to identify disease, obscure bleeding, or tumors in the small bowel. It does not permit tissue sampling.
280
What is Endoscopic retrograde cholangiopancreatography (ERCP)?
ERCP is a long endoscope that enters from the mouth into the stomach and duodenum. It allows for injection of dye into the biliary ducts and pancreas under fluoroscopic guidance.
281
What conditions is ERCP indicated for?
ERCP is indicated for bile duct abnormalities such as primary biliary cirrhosis, biliary duct dilation, obstruction, malignancies, and stones.
282
What imaging techniques are now widely used instead of ERCP?
Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are now widely used instead of ERCP for imaging of the bile duct and pancreas.
283
What is the purpose of hepatic angiography?
Hepatic angiography is done to image the liver and bile ducts for tumors, tumor-feeding arteries, or structural anomalies.
284
How is hepatic angiography performed?
Contrast material is directly injected into the hepatic artery via a catheter inserted into the femoral area.
285
What is a liver biopsy?
A liver biopsy is done to obtain a sampling of liver tissue for pathology, usually performed with local anesthesia.
286
What is percutaneous transhepatic cholangiography?
It is a method of imaging the bile duct by inserting a needle through the skin and liver into the hepatic duct and injecting dye.
287
What is the fecal occult blood (FOB) test?
The FOB test is a screening test done to detect blood in stool, usually involving three fecal samples sent for analysis.
288
What is the fecal immunochemical test (FIT)?
The FIT tests the stool for blood using antibodies.
289
What does the FIT-DNA test combine?
The FIT-DNA combines FIT with a test that detects altered DNA.
290
What is the tagged WBC scan?
The tagged WBC scan utilizes white blood cells isolated from the individual's blood that are tagged with a radioactive element and re-injected intravenously.
291
What is the purpose of a bone marrow biopsy?
A bone marrow biopsy is performed when pathology is suspected relating to over- or underproduction of blood cell lines.
292
What do lymph nodes produce?
Lymph nodes produce white blood cells known as lymphocytes.
293
What happens to lymph nodes during infection?
Lymph nodes often become enlarged during infection.
294
What is done with persistently enlarged or suspicious lymph nodes?
They are usually biopsied.
295
How are accessible lymph nodes biopsied?
Accessible lymph nodes are biopsied percutaneously or resected via a small incision after local anesthesia, which are then sent to pathology.
296
What are the diagnostic tests for calculus?
KUB, CT
297
What are the diagnostic tests for hematuria?
Cystoscopy, CT urography
298
What are the diagnostic tests for renal trauma?
CT with contrast
299
What are the diagnostic tests for hydronephrosis/obstruction?
Ultrasound, CT
300
What are the diagnostic tests for renal vein thrombosis?
CTA, MRI
301
What are the diagnostic tests for probable cyst as incidental finding on IVP or CT?
Ultrasound
302
What are the diagnostic tests for probable mass found on IVP?
CT, MRI
303
What are the diagnostic tests for polycystic kidney disease?
CT, US
304
What are the diagnostic tests for bladder tumor?
Cystoscopy, CT with contrast
305
What are the diagnostic tests for renal artery stenosis?
CTA, MRA, renal arteriography
306
What information do plain x-rays provide about the kidneys?
Plain x-rays provide the general size and shape of the kidneys and identify gross calcifications.
307
What is the purpose of an intravenous pyelogram (IVP)?
The IVP uses a contrast agent to provide detailed images of the collecting system, calyces, and renal pelvis of the kidneys, as well as the ureters.
308
What has largely replaced the IVP?
CT urography, which combines imaging capability with functional assessment of the kidneys, ureters, and bladder using contrast.
309
What can be used if contrast agents cannot be used?
Ultrasound and CT without contrast can image the renal parenchyma.
310
What is the purpose of a radionuclide renal scan?
To evaluate blood flow to the kidneys, to image the kidneys, and to observe renal function.
311
How is renal artery stenosis and renovascular hypertension most often visualized?
Via US, CTA, or MRA, although the gold standard is renal arteriography.
312
What is cystoscopy?
The insertion of a flexible cystoscope into the bladder to look for causes of bladder dysfunction or for inflammatory or malignant causes of hematuria.
313
What does a retrograde pyelogram involve?
The injection of dye into the ureters, often used with cystoscopy to image obstructing ureteral stones or lesions.
314
What is a percutaneous renal biopsy used for?
It is indicated for diagnosis of kidney disease and evaluation of reversible versus irreversible renal changes.
315
What role does history and physical examination play in musculoskeletal disorders?
It plays a particularly useful role and often imaging is done for confirmation of suspected diseases.
316
Which imaging techniques are used for skeletal abnormalities?
Plain x-ray, CT, and MRI all have their place in identification of skeletal abnormalities.
317
Which imaging technique is most useful for prolonged pain and progressive dysfunction?
MRI is the most useful for imaging bone and soft tissue abnormalities.
318
What has MRI essentially replaced in musculoskeletal imaging?
It has essentially replaced CT scanning, except for guided biopsies.
319
What is the preferred diagnostic test for a fracture or subluxation of the spine?
X-ray or CT.
320
What is the preferred diagnostic test for an occult fracture?
CT.
321
What tests are preferred for stress fractures or occult hip fractures?
CT or Bone scan.
322
What is the preferred test for bone/mineral loss?
DEXA scan.
323
What imaging techniques are preferred for detecting metastases?
X-ray, CT, Bone scan, or PET.
324
What is the preferred test for osteomyelitis?
X-ray, CT, Bone scan, or MRI.
325
What is the preferred test for back pain with radiculopathy or herniated disc?
X-ray, MRI, Myelography, or CT.
326
What is the preferred test for arthritis?
X-ray.
327
What is the preferred imaging technique for spinal tumors?
MRI.
328
What is the preferred imaging technique for soft tissue injuries?
MRI.
329
What is the preferred imaging technique for myelopathy?
MRI.
330
What tests are used for carpal tunnel syndrome?
Nerve conduction tests.
331
What is a DEXA scan used for?
It is a painless screening test done to evaluate bone mass and monitor therapeutic intervention.
332
How is the DEXA scan result reported?
It is reported as a T-score; a T-score less than minus 1 (-1.0) is considered abnormal.
333
What do bone scans produce?
Radionuclide images of the bones.
334
How is a bone scan performed?
A radioactive tracer is injected intravenously, and the body is scanned with a gamma camera.
335
What do cold areas indicate in a bone scan?
They indicate ischemia or bone infarct and certain types of cancer.
336
What do hot spots indicate in a bone scan?
They are often areas of tumor, fracture, or inflammation.
337
What are bone scans performed to detect?
Metastasis, Paget's disease, stress fractures, and persistent bone pain.
338
What is the limitation of MRI in relation to metastases?
MRI is limited as a screening test for metastases.
339
What are nerve conduction studies (NCS) or nerve conduction velocity (NCV) studies?
NCS/NCV studies involve electrode placement along the nerve to be stimulated, emitting a weak electrical stimulus to record the impulse travel time between electrodes.
340
What conditions can NCS/NCV detect?
NCS/NCV can detect sensory and motor neuropathy and differentiate demyelinating neuropathies from axonal neuropathy.
341
How can NCS/NCV and EMG be used together?
NCS/NCV and EMG can be conducted simultaneously to characterize the pathology as neurogenic or myopathic.
342
What is the preferred diagnostic test for pelvic or scrotal pain?
Pelvic or testicular ultrasound.
343
What is the preferred diagnostic test for uterine fibroids?
Pelvic ultrasound or hysterosonography.
344
What tests are preferred for cervical, uterine, and ovarian cancer?
Pelvic ultrasound, CT, or MRI.
345
What is the most common screening test for cervical cancer?
The Papanicolou (Pap) test.
346
How is the Pap test performed?
It is done during a gynecological exam after a speculum is inserted into the vagina, with scrapings or brushings of the cervix placed on slides for examination.
347
What happens if abnormal cells are found on a Pap smear?
If abnormal cells are present or HPV testing is positive, a colposcopy can be performed for further investigation.
348
What is a colposcope used for?
A colposcope allows direct visualization of the cervix, vagina, and surrounding tissues.
349
What conditions can pelvic or transvaginal ultrasound diagnose?
Dysfunctional uterine bleeding, polyps, fibroids, masses, adhesions, and atrophy.
350
What is the purpose of transvaginal ultrasound?
It allows visualization of the ovaries and measurement of endometrial thickness.
351
What is hysterosonography?
Hysterosonography is an ultrasound performed after saline is infused into the uterus to distend it and provide contrast.
352
What is the purpose of injecting contrast into the cervix, uterus, and fallopian tubes during ultrasound imaging?
To determine the patency of the fallopian tubes.
353
What imaging technique does a hysterosalpingogram utilize?
Fluoroscopy and x-rays after the infusion of contrast material.
354
What conditions can a hysterosalpingogram test for?
Causes of infertility, adhesions, masses, and uterine fibroids.
355
What is hysteroscopy?
The insertion of a small, lighted tube through the vagina into the uterus to visualize the uterine lining.
356
What can be undertaken during a hysteroscopy?
Endometrial biopsy.
357
What is the purpose of an endometrial biopsy?
To assess for malignancies, etiology of postmenopausal bleeding, or for hyperplasia.
358
What methods can be used to obtain biopsies?
Dilation and curettage (D & C), electronic suction, or jet spray to wash off uterine cells.
359
What does multiparametric MRI (mp MRI) use to visualize the prostate?
Three individual imaging MRI sequences and, if indicated, an endorectal coil.
360
When is transrectal ultrasound (TRUS) usually indicated?
When the prostate specific antigen (PSA) in the blood is elevated or rising rapidly, or an abnormality is felt on digital rectal exam (DRE).
361
What does prostate ultrasound allow for?
Measurement of prostate volume, detection of prostate masses, and to guide prostate biopsy.
362
What is uroflowmetry used to evaluate?
Voiding problems caused by enlargement of the prostate, neurological disease, or muscle dysfunction.
363
How is uroflowmetry conducted?
The individual urinates into a special toilet equipped with an uroflowmeter that measures the flow of urine per second.
364
What is cystometry?
A more involved and significantly more invasive method of determining bladder muscle function.
365
What does postvoid residual (PVR) measure?
Urinary retention.
366
What is the normal PVR measurement?
Less than 50 cubic centimeters.
367
How is PVR most often measured?
By inserting a catheter through the urethra into the bladder and draining residual urine.
368
What is another method to measure PVR?
Transabdominal ultrasound.
ALU 101 12th Ed.
flashcards
Decks in class (15)
# Cards
-
Diagnostic Tests368
-
Build & Blood Pressure153
-
Diabetes126
-
Cancer153
-
Coronary Artery Disease122
-
Basic Lab Testing218
-
Motor Vehicle Risk88
-
Intro To Financial Underwriting106
-
Life Insurance Products, Marketing, And Distribution152
-
Contract Law And Legal Factors Affecting Underwriting143
-
Aviation154
-
Avocations, Professional Sports, And Occupations152
-
International Risk78
-
Insurance Regulation, Basic Compliance, And MIB113
-
Underwriting Alcohol And Substance Use Disorders172
