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examination of the nasolacrimal drainage system by filling the lumina of the canals with a radiopaque medium:
dacryocystography
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indications for dacryocystography:
- defective development
- stenosis
- chronic mucosal thickening
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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
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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
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- 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
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a membrane that lines the eyelids and covers the front of the eyeball:
conjunctiva
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the space between the lids and the surface of the eyeball:
conjunctival sac
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how many minute lacrimal ducts are there?
6-12
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convey the tear secretion from the gland to the conjuctival sac ( where the blinking movement spreads the tears):
lacrimal ducts
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shallow, triangular pouch or culde-sac, formed by the conjuctiva at the inner angle or canthus of the eye:
lacrimal lake
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the fleshy, reddish eminence situated in the inner angle of the eye that occupies a large portion of the lake:
lacrimal caruncle
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tears collect in the ___________ and drain into the _________________ thru the _________________.
- lacrimal lake
- inferior nasal meatus
- nasolacrimal system of ducts
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in the nasolacrimal drainage system, what is the most common area of radiographic interest?
nasolacrimal duct
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two small canals leading from the free margin of the inner angle of each eyelid:
lacrimal canaliculi
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upper rounded and slightly dilated part of the nasolacrimal duct:
lacrimal sac
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a minute orifice where the canaliculus begins
punctum lacrimale
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small elevation that the punctum lacrimale is
situated on:
lacrimal papilla
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the _________ pass within the margin of the respective eyelid to join the lacrimal sac, for a distance of about ______.
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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
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the lacrimal sac is ________ long, rounded above and is slightly constricted at its junction with the ____________________.
- 12 mm
- nasolacrimal duct proper
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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
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the ____________________ passes through the lacrimal canal, and the ________________ is the beginning of this canal.
- nasolacrimal duct
- lacrimal fossa
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what two structures does the nasolacrimal duct pass between?
- medial wall of the maxillay sinus
- lateral wall of the nasal cavity
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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
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what type of contrast is used in a dacryocystography?
an oil-based contrast
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what are the preliminary films taken for a dacryocystography?
- caldwell (15° caudal, CR @ nasion)
- waters (MML perpendicular, OML37°, acanthion)
- lateral (IOML parallel)
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what is the general layout of the dacryocystography procedure?
- preliminary films taken first
- contrast injected
- films taken again
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how is the patient positioned for contrast injection during a dacryocystography?
for the films?
- seated or supine for injections
- prone for films
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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
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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
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- A. uterus
- B. fundus
- C. lateral angle (cornu)
- D. round ligament
- E. ovarion ligament
- F. isthmus
- G. cervix
- H. uterine (fallopian) tube
- I. ovary
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area of the female reproductive system located outside and to the side of the uterus, where the ovaries and tubes are:
adenexal
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name the three major internal organs of the female reproductive system:
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- 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
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- 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
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- A. urinary bladder
- B. symphysis pubis
- C. urethral orifice
- D. vaginal orifice
- E. placenta
- F. cervix
- G. vaginal fornice
- H. rectum
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name two functions of the ovaries:
- internal secretions control menstrual cycle
- external secretions contain ovum or egg or female reproductive cells
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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
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where the fallopian tube attaches to the uterus:
lateral angle of uterus
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the longest fimbriae:
ovarian fimbriae
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give an alternate name for the uterine cavity:
endometrial canal
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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
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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
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give two alternate names for pelvic pneumography:
- gynecography
- pangenecography
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a procedure in which a gaseous contrast medium is put directly into the peritoneal cavity to evaluate the pelvic cavity:
pelvic pneumography
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a procedure performed to visualize congenital abnormalities, vaginal fistulas and other conditions of the vagina:
vaginography
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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
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an abnormal connection between the bladder and the vagina, usually resulting form surgical trauma irradiation, or malignancy:
vesicovaginal fistula
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an abnormal canal between the bowel and vagina:
enterovaginal fistula
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a procedure involving the introduction of a contrast medium through a uterine cannula into the uterine cavity:
hysterosalpingography
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for a hysterosalpingography, the bladder is ________, vaginal canal ________ and perineal __________.
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name indications for a hysterosalpingography:
- size, shape, and position of uterus and tubes
- polyps
- submucous tumors (fibroids)
- fistulas
- patency of the fallopian tubes
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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
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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
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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
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demonstration of the fetus in utero with radiography:
fetography
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if possible, a fetography is not performed until:
after the 18th week of pregnancy
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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
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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
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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
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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
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a procedure in which AP and lateral images with a colcher-sussman pelvimeter are taken:
pelvimetry "colcher-sussman" method
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name and describe a secondary female sex organ:
- breast tissue:
- fibroglandular in 20s and 30s
- involutional changes
- 12 major lobes
- ducts
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name four main reasons for performing a mammography:
- routine screening
- mass
- pain
- nipple discharge
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- 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
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- 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
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