Ch. 13

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Ch. 13
2011-11-23 18:07:41
test 11 28

Diagnostic Procedures
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  1. how can information about a patient's condition be obtained?
    • History and pysical examination
    • Diagnostic imaging
    • Laboratory findings
    • Electrodiagnotic studies
    • Pulmonary dignosis
    • Plethysmography and phleborheography
  2. What is the first step in determining the etiology of a patient's conditon?
    Gathering medical, social (including any ethnic and/or religious information that may impact the course of treatment), and psychological information about the patient and, if applicabel, the patient's family.
  3. how is the etiology of a patient's condiion generally achieved?
    in a personal interview with the patient or some other responsible party if the patient is unable to respond as a result of age or condition.
  4. What are seveal tools and methods available to the physicain to facilitate the physical exam?
    • Direct visualization
    • Enhanced visualization (otoscope/ophthalmoscope)
    • Indirect visualization (pharyngeal mirror)
    • Palpation external (abdominal or thyroid) and/or internal (pelvi exam or digital rectal exam)
    • Auscultation (stethoscope)
  5. A term that refers to the various techniques now available for producing images of the human body.
    Diagnstic imaging
  6. What was the historically predominant imaging technique available.
    Radiograph or X-ray
  7. Remains a viable source of diagnostic information
    Radiography, or roentgenography
  8. Penetrability of the X-ray beam is relate to the unit of energy called what measured in what, the standard unit of an absorbed dose of ionizing radiation
    • joule
    • rads (radiation absorbed dosage)
  9. Preoperative plain radiographic films of the ches are fequently ordere by whom for identification of lung abnormalitis that may interfere with the exchange of gases during aneshesia
    anesthesia provider
  10. plain radiographic films from a fixed X-ray tube or portable X-ray machines are used for what?
    • identify the location of abnormalities and foreign bodies
    • locate retained sponges, sharps, or instruents
    • Discover fluid or air witin body cavities
    • verify the correct location for an operative procedure
    • aid in bone realignment and prosthesis placement
    • verify placement of indwlling catheters, tubes, and drains
  11. radiographic views require that the film be placed underneath the pt. are what?
    _____ demand placement next to the body.
    • Anterior/posterior (AP)
    • lateral views
  12. What is the primary goalof the STSR during intraoperative radiography?
    To protect the sterile field from contamination
  13. why may the tube itself may be covered with a sterie drape or the wound may be proteced with a sterile towel.
    if the X-ray tube is to be positined over the operative field
  14. utilizes X-rays to locate tumors of the breast intheir early stages.
    Can be performed in conjunction witha needle aspiration biopsy during which a very fine, long needle my be used to biopsy a tumor after it is localized
  15. Used to evaluate the spine for patients with neck, back, or leg pain
  16. as largely replace the myelography technique, but it may still be used in some cases
    Magnetic resonance imaging (MRI)
  17. Utilizes X-rays to project images of body structures onto a monitor
  18. Fluoroscope images may be viewed durig movement and projected in __________ allowing the action of joints and organs to be viewed directly
    real time
  19. The portable image intensifier is referred to as the ______ because of its configuration
  20. frequently used in conjunction with a special radiographic table that allows X-rays to pass through the tabletop, referred to as being radiolucent
  21. Fluoroscopy has many intraoperative applications
    • Angiography (including cardiac catheterization)
    • Cholangiogaphy
    • Retrograde urography
    • Aid in bone realigment and prosthesis placement
    • verification of catheter placement (epicural/central venous pressure) and lead (pacmaker) introduction
    • to direct instrumentation (neurosurgery/orthopedics)
  22. Remains the reference standardfor assessing the caue and severity of peripheral vascular disease.
    an invasive procedure that must be accoplished under sterile conditions
  23. What is the essental equipment for angiography
    X-ray unit thatis capable of making both fluoroscopic (recorded on videotape) and still pictures, film changers for still shots, pressure injectors, contrast media, catheters, guidewires, and needle/cannula assemblies
  24. Allows tracking of the course of the injected contrast medium as it travels through the portion of the arterial or venous system being studied.
    film changer
  25. useful fr areas of nonslective angiography where large amounts of contrast solution must be injected quickly
    a pressure injector
  26. As defined in radiology, is the difference in optical density in a radiograph that results from a difference in radiocency or penetrailty of an oject.
  27. the brand name reflects what?
    the area of intended use
  28. The steps of the ercutaneous intra-arterial catheter placement described by Seldinger and called teh seldinger technique
    • 1. The skin and subcutaneous tissues in the femoral region are injected with Xylcaine 1%
    • 2. A small incision is mad witha #11 knife blade.
    • 3. Subcutaneous tissues are spread with a hemostat for fee passage of the catheter and guidewire.
    • 4. needle/cannula is than inserted into the femoral artery at an angle of 45-60 degree
    • 5. stylet is gently and slowly withdrawn until blood spurts forcefully from the proximal end o the cannula
    • 6. guidewire is then inserted through the cannula and into the artery.
    • 7. cannula is removed over the guidewire and, while pressure is aaplied t the puncture site, thecatheter is threaded over the guidewire and into the artery.
    • 8. the tip of the guidewire protruding from the distal end, the catheter is positioned at the proper level under luoroscoph, and the guidewire is removed.
    • the catheter is then flushed with heparinized sailine.
    • contrast material is injected and X-rays are taken
  29. permits teh evaluation of eart function,visualization of coronary arteries and cardiac chambers I(especially the left ventricle), andthe measurement of pressures within the cardiac chambers.
    cardiac atheterization
  30. cardiac catheterization is used to diagnose what
    coronary artey, valvular, pulmonary, and congenital heart disease.
  31. what is included in left heart studies?
    left ventriculogram, coronary artery arteriogram, and measurement of left ventricular pressures.
  32. refers to the percentage of blood that is pumped out of a filled ventricle with each heartbeat.
    ejection fraction
  33. Right heart studies are accomplished with the aid of a __________
    balloon-tipped, swan-ganz pulmonary arery catheter attached to a transducer and monitor.
  34. As a diagnostic tool properaively, and intraoperatively during cholecystectomy or common bile duct exploration, a catheter cn be inserte and contrat medium injected into the biliary system to outline calculi or other obstructions under fluoroscopy
  35. the use of a specialized X-ray machine that produces pictues of a body part in "slices" for evaluation by a radiologist
    Computed axial tomography (CT or CAT scan)
  36. The CT scan uses ________ to create an image for approximately 4,000 different tissue densities that are sorted into 16 different groups.
    electromagnetic radiation
  37. The detailed cross sections of the CT scan are useful for dtection and examination of ______ within the body
  38. CT scanning is better than MRI for emergencies related to the ____ because it is faster and better able to detect _________.
    • brain
    • fresh bleeding
  39. also useful for the dtection of ____ _____ and can be used with contrast for the dtection of tumors and infection.
    cerebral infarction
  40. Combines CT and radioisotope brain scanning
    Positron emission tomography (PET scanning)
  41. PET scanning helps to ientify how different areas of the brain function by _______ or _____
    highlightingchemical or metabolic activity
  42. Uses two different forms of energy to create an image
    Magnetic resonance imaging (MRI)
  43. MRI uses these radio waves in a strong magnetic field to form pictures of _______
    parts of teh body in slices
  44. MRI is especially good for imaging ________ so it is often used for the evaluation of
    • soft tissue
    • brain disordrs and for providing images of a herniated diskand its realtionship to the spinal cord
  45. high-frequency sound waves are directed into the body and reflected from the tissues t a recording device for diagnostic purposes.
    ultrasound examination
  46. a useful diagnostic tool for examination of the heart and abdominopelvic cavity. also useful fo identifying carotid artery stenosis.
  47. a noninvasive study that provides a twodimensional image of the heart by directing beams of ultrasonic waves from a sonar-like device throught the chest wall
  48. A slightly mor invasive procedure, involves the introduction of a transduer attached to the end of a gastroscope into the esophagus, bringing the probe into closer approximationwith the heart.
    transesophageal echcardiography (TEE)
  49. used in the OR to determine the patency of arterial anastomosis
    doppler Ultrasonography
  50. sometimes referred to as a a nuclear medicine study or radionuclide imaging, involves the intravenous injection of a radioactive isotope into the patient prior to the imaging study
    isotope scanning
  51. Collections of isotopes in a certain area are referred to as a ________ and may indicate the presence of a pathologic condition.
    hot spot
  52. A bone scan is an example of an
    isotope scan
  53. Radiation kills cells by interfering with their _____
    metabolic activity
  54. ued in predetermined doses to treat specific types of neoplasms that are susceptible to radiation by exposure of the radation source
    Radiation therapy
  55. drawn from the patient for visual or computerized examination in the laboratory setting
    venous or arterial blood
  56. vary according to the type of test to be performed
    urine collection
  57. involves cleaning the urnary meatus prior to voiding and "catching" the sample midstream into a sterile collection device.
    clean-catch sample
  58. obtained under sterile conditins and placed in a sterile specien container
    Catheterized specimens
  59. entire sample tested for electrolytes and nitrogenous wastes
    24-hour sample
  60. the excision of tissue or aspiration of flui to determine the nature of the disease or for treatment of a condition is called _______
    the tissue or fluid is referred to as ______
    • biopsy
    • a specimen
  61. Red blood cell (RBC) count
    • 4.3-5.9
    • 3.5-5
  62. hemoglobin values
    • 13.5-18 g/dL
    • 11.5-15.5 g/dL
  63. Hematocrit values:
    • 40-52%
    • 35-46%
  64. Platelets values
  65. How must the STSR pass off the specimen
    in a sterile manner to the circulator
  66. Should a counted sponge be used for passig off and transporting? Why if not what should be
    No it can be passed off on a Telfa pad or in the appropriate container
  67. the removal of fluid through a needle attached to a syringe
    aspiration biopsy
  68. entails the removal of a porton of the tissue mas or lesion for pathological study
    incisiona biopsy
  69. Formalin or normal saline will alter what type of biopsy
  70. are placed in a preservative such as formaln
    Permanent sections
  71. Tissue or fluid that is suspected of being infected may be cultured so that the pathogen can be identified and treated
    Culture and sensitivity
  72. remains a valuable tool n dentifying bacteria
    gram stain
  73. Bacteria that retain the blue dye are called ______ and those that fade to pink are ___
    • gram positive
    • gram negative
  74. withdrawn ("tapped") from the lumbar area of the spinal column for analysis
    Cerebrospinal fluid (CSF)
  75. involves the placement of a needle into a posterior porion of the pleural space for the analysis of pleural effusion
  76. a valuable tool for the detection and evaluation of all forms of heart disease, especially myocardial infarction
    electrocardiogram (ECG)
  77. performed byplacing a number of electrodes in predetermined locations on the skin of the arms, les, and torso to record the electical activity of the heart
  78. allows for 24-hour monitoring for asymptomatic and symptomatic dysrhythmias.
    holter monito
  79. a display and recording of the electrical activity of the brain by measurement of changes in electric potentials.
    Electroencephalography (EEG)