Unit 4 (Nasolacrimal & Reproductive)

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Unit 4 (Nasolacrimal & Reproductive)
2013-03-12 01:25:16
Procedures IV

Unit 4: Nasolacrimal Drainage System and Reproductive System
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  1. examination of the nasolacrimal drainage system by filling the lumina of the canals with a radiopaque medium:
  2. indications for dacryocystography:
    • defective development
    • stenosis
    • chronic mucosal thickening
  3. who is most at risk for dacryocystography and how is it treated?
    • most common in babies
    • often goes away on its own
    • must sometimes be opened surgically
    • massage of main duct can sometimes help
  4. describe the shape, location, and function of the lacrimal gland:
    • small, almond shaped, bipartite body
    • situated anteriorly on lateral side of roof of oribit, where it is lodged in the lacrimal fossa of the frontal bone
    • secretes watery fluid
    • A. lacrimal gland
    • B. lacrimal ducts
    • C. upper eye-lid
    • D. puncta lacrimalia
    • E. lower eye-lid
    • F. lacrimal caruncle
    • G. lacrimal ducts
    • H. lacrimal sac
    • I. naso-lacrimal duct
    • J. punctum lacrimale
    • K. plica semilunaris
    • L. lacrimal caruncle
    • M. punctum lacrimale
    • N. openings of tarsal glands
  5. a membrane that lines the eyelids and covers the front of the eyeball:
  6. the space between the lids and the surface of the eyeball:
    conjunctival sac
  7. how many minute lacrimal ducts are there?
  8. convey the tear secretion from the gland to the conjuctival sac ( where the blinking movement spreads the tears):
    lacrimal ducts
  9. shallow, triangular pouch or culde-sac, formed by the conjuctiva at the inner angle or canthus of the eye:
    lacrimal lake
  10. the fleshy, reddish eminence situated in the inner angle of the eye that occupies a large portion of the lake:
    lacrimal caruncle
  11. tears collect in the ___________ and drain into the _________________ thru the _________________.
    • lacrimal lake
    • inferior nasal meatus
    • nasolacrimal system of ducts
  12. in the nasolacrimal drainage system, what is the most common area of radiographic interest?
    nasolacrimal duct
  13. two small canals leading from the free margin of the inner angle of each eyelid:
    lacrimal canaliculi
  14. upper rounded and slightly dilated part of the nasolacrimal duct:
    lacrimal sac
  15. a minute orifice where the canaliculus begins
    punctum lacrimale
  16. small elevation that the punctum lacrimale is
    situated on:
    lacrimal papilla
  17. the _________ pass within the margin of the respective eyelid to join the lacrimal sac, for a distance of about ______.
    • canaliculi
    • 10mm
  18. what is a structural occurrence that sometimes can happen with the canaliculi?
    sometimes the canaliculi unite into a single passage as they converge toward their entrance into the lacrimal sac
  19. the lacrimal sac is ________ long, rounded above and is slightly constricted at its junction with the ____________________.
    • 12 mm
    • nasolacrimal duct proper
  20. the lacrimal sac is located in a fossa on the  ____________ of the orbit that is formed by the:
    • medial wall
    • lacrimal
    • maxillary bones
    • lacrimal process of inferior nasal choncha
  21. the ____________________ passes through the lacrimal canal, and the ________________ is the beginning of this canal.
    • nasolacrimal duct
    • lacrimal fossa
  22. what two structures does the nasolacrimal duct pass between?
    • medial wall of the maxillay sinus
    • lateral wall of the nasal cavity
  23. describe the length and shape of the nasolacrimal duct:
    • varies in length, but is approximately 17mm
    • narrows as it approaches the nasal cavity where it opens under the inferior concha approximately in line with the 1st molar tooth
  24. what type of contrast is used in a dacryocystography?
    an oil-based contrast
  25. what are the preliminary films taken for a dacryocystography?
    • caldwell (15° caudal, CR @ nasion)
    • waters (MML perpendicular, OML37°, acanthion)
    • lateral (IOML parallel)
  26. what is the general layout of the dacryocystography procedure?
    • preliminary films taken first
    • contrast injected
    • films taken again
  27. how is the patient positioned for contrast injection during a dacryocystography?
    for the films?
    • seated or supine for injections
    • prone for films
  28. dacryocystography injection procedure:
    1. anesthetize __________ and ___________
    2. dilate the ________________
    3. insert _(shape)_ lacrimal needle into _____
    4. saline injection for ___________
    5. ?????
    6. needle is ___________
    7. __________ immediately and at set times
    • 1. conjunctiva and puncta
    • 2. punctum of the caniculus
    • 3. round-tipped; canaliculus
    • 4. patency
    • 5. contrast is injected
    • 6. withdrawn
    • 7. repeat films
  29. what is a technique that may be utilized when making lateral projections as part of a dacryocystography?
    if both sides are injected, rotate head 10-15 degrees away from film to separate the bilaterally opacified ducts in the lateral projection
    • A. uterus
    • B. fundus
    • C. lateral angle (cornu)
    • D. round ligament
    • E. ovarion ligament
    • F. isthmus
    • G. cervix
    • H. uterine (fallopian) tube
    • I. ovary
  30. area of the female reproductive system located outside and to the side of the uterus, where the ovaries and tubes are:
  31. name the three major internal organs of the female reproductive system:
    • ovaries
    • tubes
    • uterus
    • A. medulla
    • B. primary follicles
    • C. corpus luteum
    • D. cortex
    • E. developing follicles
    • F. graafian follicle
    • G. isthmus
    • H. ampulla
    • I. infundibulum
    • J. uterine cavity
    • K. round ligament
    • L. fimbriae
    • A. ovary
    • B. uterine (fallopian) tube
    • C. uterus
    • D. round ligament (cut)
    • E. urinary bladder
    • F. symphysis pubis
    • G. urethra
    • H. vagina
    • I. uterine (fallopian) tube (cut)
    • J. broad ligament
    • K. cervix
    • L. rectum
    • M. endometrium
    • N. uterine ostium (external os)
    • O. uterine cavity
    • P. canal of isthmus (internal os)
    • Q. canal of cervix
    • R. vaginal canal
    • A. urinary bladder
    • B. symphysis pubis
    • C. urethral orifice
    • D. vaginal orifice
    • E. placenta
    • F. cervix
    • G. vaginal fornice
    • H. rectum
  32. name two functions of the ovaries:
    • internal secretions control menstrual cycle
    • external secretions contain ovum or egg or female reproductive cells
  33. name four structures of the ovary:
    • medulla: core of vascular tissue
    • cortex: outer glandular portion
    • ovarian vesicular follicles (ovisacs): in cortex, fluid filled and contains one ovum
    • graafian follicle: a fully developed ovarian vesicular follicle
  34. where the fallopian tube attaches to the uterus:
    lateral angle of uterus
  35. the longest fimbriae:
    ovarian fimbriae
  36. give an alternate name for the uterine cavity:
    endometrial canal
  37. when should all gynecologic exams of the female be scheduled, and why?
    • approximately 10 days after onset of menstruation
    • it's before ovulation and less likely to be pregnant
    • it's when the endometrium is least congested
  38. describe prep procedures for non-pregnant females before examinations of the reproductive system:
    • constipated patients receive a non-gasforming laxative the night before
    • a cleansing enema the morning of
    • the meal preceding the exam is withheld
    • empty bladder before exam
    • no pre-medication
  39. give two alternate names for pelvic pneumography:
    • gynecography
    • pangenecography
  40. a procedure in which a gaseous contrast medium is put directly into the peritoneal cavity to evaluate the pelvic cavity:
    pelvic pneumography
  41. a procedure performed to visualize congenital abnormalities, vaginal fistulas and other conditions of the vagina:
  42. what type of contrast is used in a vaginography and how is it administered?
    • thin barium
    • put in through the usual enema equipment or water soluble contrast is put in through a syringe
    • put in vaginal canal with a rectal retention tube that is placed in the distal vagina and the balloon may be inflated using fluoro
  43. an abnormal connection between the bladder and the vagina, usually resulting form surgical trauma irradiation, or malignancy:
    vesicovaginal fistula
  44. an abnormal canal between the bowel and vagina:
    enterovaginal fistula
  45. a procedure involving the introduction of a contrast medium through a uterine cannula into the uterine cavity:
  46. for a hysterosalpingography, the bladder is ________,  vaginal canal ________ and perineal __________.
    • emptied
    • irrigated
    • cleansed
  47. name indications for a hysterosalpingography:
    • size, shape, and position of uterus and tubes
    • polyps
    • submucous tumors (fibroids)
    • fistulas
    • patency of the fallopian tubes
  48. describe first part of a hysterosalpingography (before dr):
    • have patient empty their bladder
    • patient supine on sheet 
    • scout film 10x12LW, CR 2” above symphysis
    • place patient in lithotomy position
    • have a seat and a light at the end of the table
  49. describe second part of a hysterosalpingography (with dr):
    • radiologist or OBGYN physician places speculum in vagina
    • through this speculum a uterine cannula is placed through cervical canal
    • fits an attached rubber plug (acorn) firmly against external cervical os
    • applies counterpressure with a tenaculum to prevent reflux of contrast
    • withdraws speculum
    • contrast is injected via cannula into uterine cavity
  50. describe third part of a hysterosalpingography (reactions to contrast, and after dr):
    • if tubes are patent contrast spills into the peritoneal cavity
    • the rubin test can determine patency of the tubes (this is uterine gas insufflation) 
    • only opaque contrast can demonstrate the length, position, and course of the tubes
    • peritoneal spillage is eliminated by way of the urinary system, usually within 2 hours or less
    • note. without fluoro, contrast is put in with four fractional doses so there is not excessive spillage
    • repeat overheads centering 2” above symphysis
  51. demonstration of the fetus in utero with radiography:
  52. if possible, a fetography is not performed until:
    after the 18th week of pregnancy
  53. indications for a fetography:
    • suspected abnormality of development
    • to confirm suspected fetal death
    • to determine the presentation and position of the fetus
    • to determine whether the pregnancy is single or multiple
  54. describe the projections taken for a fetogram procedure:
    • PA projection if possible (AP alternative)
    • Lat - support pt's sides to place abdomen parallel to table
    • **use higher kVp (90 or above) to reduce pt exposure
  55. a procedure performed to demonstrate the architecture of the maternal pelvis to compare the size of the fetal head with the size of the maternal bony pelvic outlet:
    pelvimetry and fetal cephalometry
  56. an instrument that consists of a metal ruler perforated at centimeter intervals and mounted on a small stand in such a way that it is always parallel to the plane of the film:
    colcher-sussmen pelvimeter
  57. a procedure in which AP and lateral images with a colcher-sussman pelvimeter are taken:
    pelvimetry "colcher-sussman" method
  58. name and describe a secondary female sex organ:
    • breast tissue:
    • fibroglandular in 20s and 30s
    • involutional changes
    • 12 major lobes
    • ducts
  59. name four main reasons for performing a mammography:
    • routine screening
    • mass
    • pain
    • nipple discharge
    • A. inguinal canal
    • B. penis
    • C. ductus deferens
    • D. genital seminal duct
    • E. rete testis
    • F. scrotum
    • G. tail of epididymus
    • H. spermatic cord
    • I. epididymus
    • J. testis
    • K. seminiferous tubules
    • A. bladder
    • B. ureter
    • C. ductus deferens 
    • D. prostate
    • E. urethra
    • F. seminal vesicles
    • G. urethra
    • H. ductus diferens
    • I. bladder
    • J. ureter
    • K. seminal vesicle
    • L. ampulla
    • M. prostate