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Master Study Guide

study guide for the RA Exam

Question
1. What is the prep for a Barium Swallow/UGI?	BS-No prep; UGI-NPO for 8 hrs prior to exam
2. Which part of the stomach is most posterior?	Fundus
3. Where is the air located in an UGI when the pt is erect?	Fundus
4. Where is the air located in an UGI when the pt is supine?	Antrum
5. Where is the air located in an UGI when the pt is prone?	Fundus
6. On a sthenic person, where is the duodenal bulb located?	Slightly right of midline at L1-2
7. On a hypersthenic person, where is the duodenal bulb located?	Slightly right of midline at T11-12
8. On an asthenic person, where is the duodenal bulb located?	L3-4 at the midline
9. The pt is oblique and has air in the funds. What position are they in?	RPO/RAO
10. The pt is oblique and has barium in the body and pylorus. What position are they in?	RPO/RAO
11. The pt is oblique and has air in the body and pylorus. What position are they in?	LPO/LAO
12. The pt is in a lat position and air is in the funds? What position is the pt in?	RT LAT-lt side up
13. The pt is in a lat position and barium is in the fundus. What position is the pt in?	LT LAT-rt side up
14. The pt is in a lat position and barium is in the pylorus. What position is the pt in?	RT LAT-lt side up
15. The pt is in a lat position and air is in the pylorus. What position is the pt in?	LT LAT-rt side up
16. The pt is in the AP supine position. The fundus is filled with what?	Barium
17. The pt is in the PA position. The fundus is filled with what?	Air
18. The pt is in the RAO position. The fundus is filled with what?	Air
19. The pt is in the LPO position. The fundus is filled with what?	Barium
20. The pt is in the RT LAT position. The fudus is filled with what?	Air
21. The pt is in the LT LAT position. The fundus is filled with what?	Barium
22. What is a MBS and what does it show?	MBS is a speech study that's done in the AP and LAT positions. It shows oral prep of food and swallowing. It diagnoses disorders in the structures, aspiration or residue
23. What type of procedure examines oral and pharyngeal dysphagia?	MBS
24. Is it ok to combine a MBS and an Barium Swallow?	NO because the MBS look at the oral and pharyngeal structures only and the Barium Swallow looks at the esophageal structure.
25. What types of consistences are used in a Speech Swallow?	Liquid, paste, mastication
26. What are 2 things you can tell from a Speech Swallow?	Transient time and aspiration
27. What is aspiration?	When it enters the airway and goes below the vocal cords
28. What is penetration?	When it enters the airway and does not go below the vocal cords.
29. Why is a KUB done before an UGI?	To look for abdominal calcifications, tumors, masses
30. What is a biphasic study?	A double (air and barium) and single (barium only) contrast study. The only 2 studies that uses these techniques are BE and UGI
31. What can be detected on a single contrast UGI?	The size, shape and position of the stomach. Any contour and emptying and filling of the doeudenal bulb, any abnormalities of the stomach, duodenum and esophagus.
32. What is deglutition?	Process of swallowing
33. What are the most common diseases diagnosed with an UGI?	GERD and Barrett's esophagus, inflammation and ulcers, cancer and tumors, esophageal varicose and strictures
34. What is a Roux-en-y procedure?	Procedure used to create a new stomach pouch roughly the size of an egg. The smaller stomach is then directly connected to the middle portion of the jejunum. It bypasses the rest of the stomach and upper portion of the duodenum
35. What is GERD?	It's a digestive disorder that affects the lower esophageal sphincter (LES). Causes occur when the LES is weak or relaxes inappropriately, allowing the stomach contents to go back up into the esophagus.	The severity depends on the LES dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.
36. What are esophageal ulcers?	Ulcers in the lining of the esophagus that are created by corrosive, acidic digestive juices from the stomach cells. Their formation is related to the presence of H. pylori bacteria in the stomach,	use of anti-inflammatory medications and cigarette smoking. Complications include perforation and bleeding. Treatment includes using antibiotics to eradicate the H. pylori bacteria an well as eliminating risk factors and preventing complications
37. What are esophageal varices?	Extremely dilated sub-mucosal veins in the lower third esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. Pt's have a tendency to develop bleeding.
38. What are esophageal strictures?	A narrowing or tightening of the esophagus that cause swallowing difficulties. Caused by or associated with GERD, esophagitis, a dysfunctional LES, disordered motility and H.H.	Symptoms include heartburn, bitter or acid taste in the mouth, choking, coughing, SOB, frequent burping or hiccups, pain or tousle swallowing, throng up blood or weight loss
39. Name the type of hernia that has a normal esophagogastric junction with the hernia displaced anteriorly	Paraesophageal
40. Name the type of hiatal hernia where the stomach and the gastroesophageal junction slide up into the chest through the hiatus?	Sliding H.H.-Also the most common type of hernia
41. Name all 9 mediastinal structures	Heart, Great vessel, esophagus, trachea, phrenic nerve, cardiac nerve, thymus, thoracic duct, lymph nodes
42. Swelling below epiglottis in a 2 yr old indicates what?	Croup
43. Increasing you FOV size during fluoroscopy will increase or decrease you radiation exposure? Why?	Decrease because of the electronic magnification or "zoom." The largest FOV with the least electronic magnification will cover the largest area of theft during live fluoro and spot images. The largest FOV also exposes the pt to the least radiation dose.
44. Why is a SBFT done?	For Crohn's Disease, Ulcerative Colitis, abdominal pain, bleeding tumor/masses, obstruction and cancer
45. What are the 3 parts of the small bowel? What role does each one do	Duodenum-where food mixes with bile from the gallbladder and digestive juices form the pancreas Jejunem-very active in digestion & where many different enzymes mix from the stomach, pancreas, gallbladder and liver Ileum-absorbs mainly Vit B12,	other water-soluble vitamins, bile salts and nutrients that were not absorbed in the jejunum.
46. What is the most common site for gastrointestinal cancer or pathology?	Large Intestine
47. What is Crohn's Disease?	It's an inflammatory bowel disease which causes inflammation of the lining of the digestive tract. It can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. The inflammation caused by Crohn's often spreads deep into	the layers of the affected bowel tissue. No known cure. Therapies can greatly reduce its signs and symptoms and even bring about long-term remission
48. What is Ulcerative Colitis?	An inflammatory bowel disease that causes long-lasting inflammtion and ulcers in the digestive tract. It affects the innermost lining of your colon and rectum. Symptoms usually develop over time, rather than suddenly. No known cure. Treatment can greatly	reduce signs and symptoms of the disease and even bring about long-term remission
49. What are the fluoroscopic features of Crohn's?	Apthoid lesions, Skip lesions, Cobblstoning, Strictured, Rigidity, Fistula Formation
50. What are the fluoroscopic features of Ulcerative Colitis?	Granular, Sand and Velvet like appearance
51. What are the causes of small bowel obstruction?	Mechanical and Non-mechanical
52. What is mechanical obstruction?	Something that is physically lodged in the intestine that can cause a blockage. Causes can be a volvulus, tumor, hernia, adhesions and intussusception. Potential causes are cancer, diverticulitis and impacted feces
53. What is Non-mechanical?	Occurs when the muscles or nerves within the small or large intestine no longer function. Also called paralytic ileum or dynamic obstruction. The intestines work in a coordinated system of movement and when this movement is interrupted, it can cause a	functional intestinal obstruction or sensation of parastalsis. Causes are surgery, drugs, Herschsprung's, Parkinson's and other nerve and muscle disorders, decreased potassium levels and other mineral/elcectrolyte imbalances
54. What is enterocolitis?	The inflammation of both small intestine and colon
55. What is valvular conniventes/plicae circulares fold in the small bowel?	Large valvular flaps projecting into the lumen of the small intestine
56. What is haustra?	Small pouches caused by sacculations, which give the colon its segmented appearance
57. The TI is a common site of focus for the RAD because....	Tumor, lesions and polyps appear here
58. What's the valve between the TI and the cecum?	The Ileocecal valve/jucnction
59. What is the prep for a SBFT?	NPO for 12 hours/fasting for 12 hours
60. Where is the appendix located?	Inferior to the cecum, attaches to the posteromedial surface of the cecum
61. What is volvulus?	A twisting of a portion f the intestine around itself resulting in an obstruction or blockage of the bowel. This can be a life threatening condition due to the loss of blood supply and accumulation of toxic gases and fluids in the portion of	the obstructed bowel segment. Volvulus mostly involves the sigmoid section of the large bowel, small intestine, stomach and sometimes the cecum
62. A pediatric UGI is often done to look for what 2 conditions?	Reflux and Intestinal malrotation
63. What is intestinal malrotation?	It's a condition that is congenital and results from a problem in the normal formation of the fetal intestines. There is a disruption in the usual steps that the intestines follow to arrive at the correct position within the abdomen.	Malrotation causes the parts of the intestine to settle in the wrong part of the abdomen, which can cause them to become blocked or to twist.
64. What are the suggested fasting regimens for pediatric small patients?	Neonates-3 months: 2 hrs 3-12 mo: 3 hrs 1 yr +: 4 hrs
65. What is the key finding during an UGI fluoro that indicates intestinal malrotation?	An abnormal duodeno-jejunal junction aka ligament of treitz
66. What is pneumoperitoneum?	Presence of air or gas in the abdominal cavity. Causes can include perforated duodenal ulcer, bowel obstruction, ruptured diverticulum, bowel cancer, steroid, colonic or peritoneal infection
67. Where is the ligament of treitz?	Where the duodenum and the jejunum meet up the duodenojejunal flexures. This flexure is fixed in place by the ligament of treitz ( a suspensory ligament created from the connective tissue around the celiac axis and left crus of the diaphragm)
68. What is an "air block" situation in the colon?	There is no such thing as "air block" a situation in which a colon distended by air prevents further passage of barium, because barium is much heavier than air and will fill any dependent space. If there's difficulty moving the barium pool	into the right side of the colon, it usually means there's not a large enough volume of barium
69. The colon is viewed in various degrees of luminal distention. The lumen should be distended sufficiently so that the interhaustral folds are....	Straight and oriented perpendicular to the longitudinal axis of the bowel. The rows of taeniae coli are at the edges of the haustral sacculations and should be separated by about 2-3 cm. The interhaustral folds are straight;	a representative fold is identified with an arrow The haustral saculations are distended but not overdistended and flattened.
70. What is thumb printing?	A radiographic sign of large bowel wall thickening, usually caused by oedema (fluid/swelling retention in bowel wall) and related to an infective or inflammatory process.	oedema (fluid/swelling retention in bowel wall), and related to an infective or inflammatory process (colitis). The normal hausfrau become thickened at regular intervals appearing like thumbprints projecting into the aerated lumen	Thumb-shaped, nodular, indentations at regular intervals in the bowel wall
72. Not filling the colon with enough barium during a BE causes what issue?	Too little barium results in poor mucosal coating or incomplete filling of the right side of the colon
73. Over filling the colon with too much barium during a BE causes what issue?	Too much barium results in large barium pools that may obscure lesion en face
74. What is best for seeing pathology in colon during barium enema? Spot or overhead radiographs?	Spot images
75. During a BE, what images should be obtained first in order to avoid the area being obscured by barium refluxing into the TI?	2 images of the sigmoid colon
76. If a pt is elderly or very feeble and unable to move/turn, what BE should be performed?	A single contrast BE
77. What is a polyp?	An abnormal growth of tissue projecting from a mucous membrane.
78. What are the 2 types of polyps?	Pedunculated-Attached to the surface by a narrow elongated stalk Sessile-No stalk
79. What is diverticulosis?	When a diveritcula that does not become inflamed or bleed
80. What is deverticulitis?	A complication of having colonic diverticulosis if one of the diverticulum become inflamed
81. What is a diverticulum?	A small pouch, or sac that has formed and pushed outward through weak spots in the colon wall
82. What is colorectal cancer?	It occurs when tumors form in the lining of the large intestine. It's common in both men and women. Risk of developing is after age 50.
83. What are the symptoms of colorectal cancer?	Diarrhea, fatigue, nausea or vomiting, weight loss with no known reason, blood in stool, frequent gas pain or cramps, feeling full or bloated
84. Describe 3 underlying predisposing pathologies associated with VCUG	Vesico-Ureteric Reflux-Reflux or urine from the bladder into the ureter Posterior Urethral Valve-The existence of membranous valve in the male urethra; this is an abnormality that develops in utero; it can lead to a bladder obstruction and distention	of the bladder and pressure that can lead to reflux Congential Urinary Tract Anomaly-Duplex Kidneys-Duplex kidneys can mean an ectopic ureter that can insert into the bladder more perpenducular than normal, which can lead to reflux
85. What are the 5 grades of vesico-ureteric reflux?	1. Grade 1-Result in urine reflux into the ureter only 2. Grade 2-Results in urine reflux into ureter and renal pelvis 3. Grade 3-Results in urine reflux into the ureter and renal pelvis, causing mild hydronephrosis	4. Grade 4-Results in moderate hyronephrosis 5. Grade 5-Results in severe hydronephrosis and twisting of the ureter
86. What is duplicated ureter?	A congential condition where the ureter splits resulting in 2 ureters draining a single kidney. It's the most common renal abnormality. The additional ureter may result in a ureterocele or an ectopic ureter.	In older children, ureteral duplication may present as urinary tract infection most commonly due to vesicoureteral reflux as well as urinary incontinence.
87. What are the indications for a Cystourethrography?	Stricture, uretheral tears, congenital abnormalities, abscess on the prostate or around the urethra, fistula or false passages
88. What components make up the urinary system?	Kidneys, ureters, bladder and urethra
89. What is the function of the urinary system?	Remove waste from the blood, maintain fluid and electrolyte balance and regulate pH
90. What is the average daily urine output?	1-2L or 1,000-2,000 ml
91. What makes up the pelvacalyceal system?	Renal pelvis and the calyces
92. What is retrograde?	Directed or moving backward; going against the flow
93. What is antegrade?	Moving or extending forward, going with the flow
94. What is Cystography?	A retrograde examination of the bladder
95. What is Cystourethrogram?	A retrograde examination of the bladder and urethra
96. What are some indications for an exam of the urinary tract?	UTI, vesicoureteral reflux, stricture, fistula, trauma, impaired urination
97. What kind of contrast is used in a urianry exam?	Non-Ionic Iodinated
98. What is the type of catheter used for an adult?	Foley
99. What type of catheters are used for infants and children?	5-8 French feeding tubes
100. What is a ureterocele?	A congenital prolapse of the dilated distal ureter and orifice into the bladder lumen at the normal insertion site of the ureter into the trigon. It's usually found accidentally but if it becomes enlarged, it may cause ureter obstruction, infection or	stone formation. On am x-ray, it will appear like a cobra head or spring onion
101. What is an ectopic ureterocele?	Usually associated with uteral duplication. Females with ectopic ureters are proned to urinary incontinence because the ureter may insert distal to the external sphincter into the vestibule, uterus or vagina. Males no incontinence
102. Where do the ureters insert on the bladder?	They are depicted as running posteroinferiorly on the lateralwalls of the pelvis and then curve anteriomedially to enter the bladder
103. What is hydronephrosis?	A condition that typically occurs when one kidney becomes swollen due to the failure of normal drainage of urine from the kidney to the bladder
104. What is pyonephrosis?	It's an infection of the kidneys
105. What is nephrolithiasis?	Kidney stones
106. What is renal calculi?	Kidney stones
107. What is papillary necrosis?	A disorder of the kidneys in which all or part of the renal papillae die. Occurs with analgesic nephropathy but also can cause kidney infection and transplant, sickle cell anemia and urinary tract blockage.
108. What are the 4 most significant causes of papillary necrosis?	Sicle cell disease, analgesic use, diabetes mellitus and severe pyelonephritis (inflammation of the kidney tissue, calyces and pelvis)
109. What is transitional cell carcinoma?	TCC or aka Urothelial Cell Carcinoma (UCC) is a type of cancer that typically occurs in the urinary system; the kidneys, urinary bladder and accessory organs. It's the most common type of bladder cancer and cancer of the ureter, urethra and urachus.
110. What is the important cause of TCC?	Cigarette smoking, which contributes to approximately half of the disease burden.
111. What is polyuria hypertrophy?	A condition usually defined as excessive or abnormally large production or passage of urine (greater than 2.5-3.0L oever 24 hrs in adults)
112. What is benign prostatic hyperplasia?	A benign increase in size of the prostate.
113. What does BPH involve?	Hyperplasia of prostatic stromal and epithelial cells,resulting in the formation of large, fairly discrete nodules in the transition zone of the prostate
114. What is vesicourachal diverticulum?	It's the proximal equivalent of a urachal umbilical sinus, representing a result of failure of the urachus to close at the urinary baldder, forming an out-pouching fo vaiable length from the anterosuperior aspect of the urinary bladder,	which does not communicate with the umbilicus.
115. What are the 3 layers of the bladder?	Mucosa-The innermost layer which comes in contact with urine stored inside the bladder. Consists of several layers of specialized cells called tansitional cells, which are almost exclusively found in the urinary system of the body.	Lamina Propria-The middle layer and is a thin lining. Forms the boundary between the inner mucosa and the outer muscular layer. This layer has a network of blood vessels and nerves and is an important landmark in terms of the staging of bladder cancer	Muscularis-Comprises of the detrusor muscle. This is the thickest layer. Its main function is to relax slowly as the bladder fills up to provide low-pressure urine storage and then to contract to compress the bladder and expel the urine out
116. What are some types of bladder fistula's?	Vesicoganigal-AKA bladder fistula. This type of fistula occurs between the vagina and urinary bladder, allowing urine to flow into the vagina. Vesicouterine-This rare type of fistula occurs between the bladder & uterus. Caused by trauma	Urethrovaginal-Fistula between the urethra and the vagina Ureterovaginal-Fistula between the ureter and the vagina	Colovesical-Fistula between the colon and the bladder Rectovaginal-Fistula between the rectum and the vagina
117. What is Cowper's Gland?	AKA bulbourethral gland and are paired glands that are roughly the size of a pea. Located in the deep perineal pouch. At the base of the penis and are lateral and posterior to the urethra.
118. What is the purpose of performing a shoulder arthrogram?	Rotator cuff tear, persistent pain and weakness and limited ROM
119. How much contrast is used for a single contrast shoulder arthrogram?	10-12ml
120. What are the common radiographs taken with a shoulder arthrogram?	AP internal and external rotation, 30 degrees AP, oblique, axillary and tangential
121. What is the purpose of a wrist arthrogram?	Trauma, persistent pain and limited ROM
122. How much contrast is used for a wrist arthrogram?	1.5-4ml
123. What is the injection site for a wrist arthrogram?	Radiocarpal joint or dorsal wrist at the junction of radius scaphoid and lunate
124. What are the common radiographs taken with a wrist arthrogram?	PA, Lat, both obliques
125. What is the purpose of a hip arthrogram in children?	Congenital hip dislocation
126. What is the purpose of a hip arthrogram in an adult?	To detect a loose hip prosthetic, confirm an infection in the hip joint, pain limited ROM, injury and trauma
127. What is the puncture site for a hip arthrogram?	3/4 inch inferior to the inguinal crease and 3/4 inch lateral to the palpable femoral pulse
128. What type of needle is used for a hip arthrogram?	20 gauge spinal needle
129. What type of needle is used for a wrist arthrogram?	25 gauge butterfly
130. What is the purpose of a knee arthrogram?	To demonstrate and asses the joint and the soft tissue structures around it, a tear of the joint capsule, menisci or ligaments
131. What is a Baker's Cyst?	A synovial cyst that arises from the synovial lining of the knee and occurs in the popliteal fossa
132. What is arthrography?	Imaging of the joint after administering contrast into the capsular space
133. What are the structural groups of joints?	Fibrous, cartilaginous, synovial
134. What is a fibrous joint?	A joint that has little or no movement
135. What is a cartilaginous joint?	A joint that has little or no movement
136. What is a synovial joint?	A joint that is freely moveable
137. What are the types of joints?	Gliding, hinge, ball and socket, pivot, ellipsoidal
138. How do you prepare the contrast for a MR arthrogram?	Withdraw 0.1ml of gad-based contest in a 1ml syringe. Inject the 0.1ml of gad-based contrast into a 10ml vial of 1% lido. Withdraw all 10ml of gad-lido mixture into a 20ml syringe for total volume of 20ml	Insure that the mixture within the syringe is thoroughly mixed. Connect the 20ml string to your tubing. Flush the contrast through the tubing to eliminate any visible gas bubbles.
139. What are the 3 compartments of the wrist that do not intercommunicate?	Radiocarpal, midcarpal, distal radio-unlnar joint
140. Is an arthrogram a sterile procedure and does it require consent?	Yes! The injection of contrast into a joint should be undertaken as a sterile fluoroscopic procedure and require consent
141. What are the risks of an arthrogram?	Bleeding, infection, joint rupture
142. What is the puncture site for shoulder arthrogram?	Aim for the glenohumeral joint at the middle to lower 2/3 of the humeral head
143. Long term vesicoureteral reflux causes what problem in the kidney?	Chronic vesicoureteral reflux causes renal scarring and hydronephrosis. Long term VUR leads to chronic renal failure.
23. How do you prepare MRI arthrography contrast?	1.Draw up 10 mL of 1% lidocaine solution into a 10 mL syringe using an 18 gauge 2. Draw up 10 mL of x-ray dye (Omnipaque 300) into a 10 mL syringe	3.Draw 0.5 ml of gadolinium-based contrast into a 20mL syringe 4.Aspirate about 15 mL of saline into the same 20 ml syringe for a total volume of 15 ml.	6. Connect the 20 ml syringe to your tubing. Flush the contrast through the tubing to eliminate any visible gas bubbles. Injected bubbles can mimic intra-articular bodies.
144. Do you use air for an MRI arthrogram?	NO
145. Do you use air for a CT Arthrogram?	Yea, if it's ordered with air.
146. Which arthrogram study do you use air with?	CT arthrogram
147. What is systole?	Contraction of heart muscle
148. What is diastole?	Relaxation of heart muscle
149. What are drugs you use for Vtach and Vfib?	Epinephrine, Vasopressin, Amiodarone, Lidocaine and Magnesium
150. What are drugs for asystole and Pulseless electrical activity (PEA)?	Epinephrine Vasopressin
151. What are drugs for Bradycardia?	Atropine Epinephrine Dopamine
152. What are the drugs used for tachycardia?	Adenosine Diltiazem Beta-blockers amiodarone Digoxin Verapamil Magnesium
153. What drugs are used for an acute coronary syndrome?	Oxygen Aspirin Nitroglycerin Morphine Fibrinolytic therapy Heparin Beta-Blockers
154. What drugs are used for an acute stroke?	tPA-tissue plasminogen activator Glucose (D50) Labetalol Nitroprusside Nicardipine Aspirin
155. What is Epinephrine?	It's the primary drug used in the pulseless arrest algorithm. It is used for its potent vasoconstrictive effects and also for its ability to increase cardiac output. Epinephrine is considered a vasopressor.
156. Epinephrine does 2 things. What are they?	Vasoconstriction-epinephrine binds directly to alpha-1 adrenergic receptors of the blood vessels (arteries and veins) causing direct vasoconstriction, thus, improving perfusion pressure to the brain and heart.	Cardiac Output-epinephrine also binds to beta-1-adrenergic receptors of the heart. This indirectly improves cardiac output by: Increasing heart rate Increasing heart muscle contractility Increasing conductivity through the AV node
157. Epinephrine is used in the _____ algorithm as a direct IV push and also in the ______ algorithm as an infusion	Pulseless arrest algorithm and Bradycardia algorithm
158. Epinephrine can be given three ways. What are they?	intravenous; intraosseous, and endotracheal tube
159. What is the first drug given in someone who is in bradycardia?	Atropine
160. What type of needle is used for a knee arthrogram?	22 gauge spinal needle
161. What type of needle is used for a shoulder arthrogram?	20 gauge spinal needle
162. What are the drugs used for the endotracheal tube route?	A: NAVEL N arcan (must be diluted) A tropine E pinephrine V asopressin L idocaine
164. Mobitz 1 or Wenckebach	is a disease of the electrical conduction system of the heart in which the PR interval» Powered by Hackadelic Sliding Notes 1.6.5 has progressive prolongation until finally the atrial impulse is	completely blocked and does not produce a QRS electrical impulse.	One of the main identifying characteristics of second degree heart block type 1 is that the atrial rhythm will be regular.
165. Second-Degree Heart Block (Type 1)	Mobitz 1 or Wenckebach
164. Gland controls the amount of calcium in our blood and bones	Parathyroid
166. Hyperparathyroidism affects calcium and bone density in what ways	It decreases bone density and calcium in the bone
167. Trace the path of bile from the Liver. The way it would flow from the Liver to the duodenum	Liver > Right & Left Hepatic > Common Hepatic> Common Bile> Ampulla of Vater
168. The muscular sphincter around the point where the common bile duct and pancreatic duct join together to enter into the duodenum. It opens and closes the Ampulla of Vater.	Sphincter of Oddi
169.Where is the nipple of the breast located?	NIPPLE OF BREAST IS CENTRALLY LOCATED & NIPPLE ALWAYS IN THE CENTER OF BREAST NO MATTER WHAT.
170.Calculate the total amount needed of a drug to deliver .3mg\kg for a 155 lb. person. Also calculate the amount you would give per dose to administer the medicine twice a day.	First convert to pounds to kilograms. To convert pounds to kilograms, an important equivalency to remember is 2.2 lb. = 1 kg. Divide pounds by 2.2 to get the weight in kg. 155lb\2.2kg = 70kg	To calculate a patient's dose using his weight, consider this example. Example: Order reads: Give "Drug X" 3 mg/kg per day in two divided doses. Patient weighs 155lbs or 70 kg Step 1. Calculate the daily dose (.3 mg X 70 kg = 21 mg per day)	Step 2. Divide the daily dose (21 mg) by number of doses per day (2) to = mg per dose >> 21 / 2 = 10.5 per dose. Answer: 10.5 mg per dose
171. Medical malpractice typically falls under	tort of negligence not intentional torts
172. Most courts consider lack of informed consent________ then ________even though it can be considered harmful or offensive touching without consent.	Negligence \ Battery
173. What 2 ways does hyperparathyroidism affect calcium and bone density?	It decreases bone density and calcium in the bone
174. What is personal liability?	The legal responsibility for one's acts or omissions
175. What is negligence?	The omission to do something that a reasonable person would do or the doing of something which a reasonable and prudent person wouldn't do
176. What is Element of Tort?	A person who suffers injury caused by someone else.
177. What are the 4 types of Element of Tort?	The Presence of Duty The Breach of the Duty The Presence of an Injury The Breach of Duty Caused the Injury
178. What is Res Ispa Loquitur?	"the thing itself speaks"; states that the element of duty of care and breach can be sometimes inferred from the very nature of an accident or other outcome, even w/out direct evidence of how any defendant behaved
179. What it is called when an employer takes responsibility for an employee's actions?	Respondeat Superior-An employer is responsible for the actions of the employee performed w/in the course of their employment
180. What is the generic name for Versed?	Midazolam
181. What drug is used to reverse a narcotic overdose?	Naloxone
182. What drug and dosage is given for a barbiturate and benzodiazepines overdose?	2mg of Naloxone
183. What is skeletal sclerosis?	Typically referred to as bone sclerosis; an abnormal increase in density and hardening of bone	When patients with osteoarthritis or osteoma are injured, the bone compresses and thickens, resulting in increased bone density.
184. What is Osteoathritis?	Degeneration of joint capsule and the underlying bone. Causes pain and stiffness, especially in the hip, knee and thumb joint
185. What is Gaucher's Disease?	The bones fail to remodel (grow properly) and there is a decrease in bone substance (diffuse osteopenia) so the patients have lower bone density. Lytic lesions (holes) appear in the bone and the cortex (hard rim of the bone) thins. The bone	becomes weak and patients experience fractures in the hips, shoulders and spine, Osteonecrosis (death of the bone) leads to sclerotic lesions (hardening of the bone).	A genetic disease in which fatty substances accumulate in cells and certain organs. Characterized by bruising, fatigue, anemia, low blood platelets and enlargement of the liver and spleen. Caused by a hereditary deficiency of the enzyme glucocerebrosidase
186. What is Paget's (woven weak bone)?	A disease where osteoclastic (bone destruction) and osteoblastic (bone formation) activities repeat until bone formation dominates and the bone that is formed has a disorganized pattern (woven bone)	Has three phases lytic-phase, in which normal bone is resorbed by osteoclasts. mixed lytic & blastic-rapid increases in abnormal bone formation from numerous osteoblasts , sclerotic-bone formation dominates and the bone that is	formed has a disorganized pattern (woven bone) and is weak Paget disease can affect every bone in the skeleton, but it has an affinity for the axial skeleton, long bones, and the skull.
187. What is MS?	A disease in which your immune system attacks the myelin that covers your nerves. Myelin damage disrupts communication between your brain and the rest of your body.
188. What part of the brain does MS affect?	The myelinated axons in the CNS
189. What part of the heart is the most muscular?	Left ventricle
190. What is breast dimpling?	aka orange peel appearance; may relate to a tumor near the upper layer of skin and tumor may be blocking the lymphatic system and causing a build up of fluids
191. 1rad equals how many gray?	0.01gray
192. 1 rad equals how many rem?	1rem
193. 1 rad equals how many millisieverts?	10mSv
194. 1 gray equals how many rads?	100rads
195. 1 rad equals how many milligray?	10mGy
196. 1 sievert equals how many millisieverts?	1,000mSv or 1,000,000microsieverts
197. 1 sievert equals how many rem?	100rem
198. 3 rads equals how many mSv?	30mSv
199. What is the annual effective yearly dose equivalent for the body?	5rem/yr or 50mSv/yr
200. What is the annual organ dose limit?	50rem/yr or 500mSv/yr
201. What is the annual lens dose limit?	15rem/yr or 150mSv/yr
202. What is the annual skin and extremity dose limit?	50rem/yr or 500mSv/yr
203. What is the dose limit for a fetus of an occupational worker?	.5rem/pregnancy
204. What is beneficence?	The action that is done for the benefit of other. The actions can be taken to help prevent or remove harms or simply improve the situation of others
205.What is Non-Maleficence?	"do no harm"; Physicians must refrain from providing ineffective treatments or acting with malice toward patients
206. What is arteriovenous malformation (AVM)?	A tangle of abnormal and poorly formed blood vessels (arteries and veins). Can occur anywhere in the body but most often in the brain or spine
207. What is arteriovenous fistula and what is it used for?	An abnormal connection or passageway between an artery and vein. Hemodialysis
208. What is osteomyelitis?	An infection in bone. In children, the long bones are usually affected. In adults, the vertebrae and the pelvis are most commonly affected.
209. What is rheumatoid arthritis?	A chronic inflammatory disorder that typically affects the small joints in your hands and feet. Affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and deformity
210. What is ankolosing spondylitis?	An inflammatory disease that can cause some of the vertebrae in your spine to fuse together. Symptoms include pain and stiffness in lower back and hips.The condition can cause hunching and lead to difficulty breathing. It can also affect the eye.	causing a red eye and light sensitivity.
211. How do you assess the liver?	1. Pt supine, place right hand on pt's abdomen, just lat to rectus abdominis, well below lower border of liver dullness 2. Ask pt to take a deep breath and try to feel the liver edge as it descends	3. Be sure to allow liver to pass under the fingers, note texture
212. What is contractility of the heart?	A measure of cardiac pump performance, the degree to which muscle fibers can shorten when activated by stimulus independent of preload and afterload
213. What is automaticity of the heart?	The cardiac cell's ability spontaneously generate an electrical impulse (depolarize) without an external stimulus
214. What is conductivity of the heart?	The normal electrical conduction in the heart allows the impulse that is generated by the SA node of the heart to be propagated to (and stimulate) the cardiac muscle (myocardium)
215. What are renal papillae?	The areas where the openings of the collecting ducts enter the kidney and where the urine flows into the ureters
216. What are some symptoms of papillary necrosis?	Back and flank pain, bloody or cloudy urine and dark, rust-colored or brown urine.
217. What is carpal tunnel syndrome?	An irritation of the median nerve in the wrist that leads to numbness, tingling, pain and weakness in the hand.
218. What is de Quervain's Disease?	A painful inflammation of tendons in the thumb that extend to the wrist. The swollen tendon and their coverings rub against the narrow tunnel through which they pass
219. What is a ganglion cyst?	The most common soft tissue mass of the hand. It's a fluid filled sac and is attached to a tendon sheath in the hand or wrist or connected with an underlying joint
220. What is a Colle's fracture?	A fracture of the distal radius in the forearm with dorsal and radial displacement of the wrist and hand
221. What is a Smith's fracture?	A reverse Colle's fx; a fracture of the distal radius
222. What is congenital hip dislocation (dysplasia)?	A congenital development deformation or misalignment of the hip joint.
223. What is Legg-Calve-Perthes Disease?	A childhood hip disorder initiated by a disruption of blood flow to the femoral head. It's due to a lack of blood flow,therefore, the bone dies and stops growing
224. What is slipped capital femoral epiphysis?	A fracture through the growth plate, which results in slippage of the overlying end of the femur of the femoral neck
225. What is cox valga of the hip?	A deformity of the hip where the angle formed between the head and neck of the femur is usually above 135 degrees
226. What is coxa vara of the hip?	A deformity of the hip whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees
227. What is a torn rotator cuff?	A tear of one or more of the tendons of the 4 rotator cuff muscles of the shoulder.
228. What muscles make up the rotator cuff?	Supraspinatus, Infraspinatus, Teres Minor and Subscapularis muscles
227. What is impingement syndrome?	A clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space
228. What is adhesive capsulitis?	AKA frozen shoulder; a painful and disabling disorder of unclear cause in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder becomes inflamed and stiff, greatly restricting motion and causing chronic pain
229. What is acromioclavicular separation?	AKA separated shoulder; a common injury to the AC joint and occurs as a result of a downward force being applied to the superior part of the acromion
230. What is a clavicle fracture?	A bone fracture of the clavicle, often caused by a fall onto an outstretched upper extremity, a fall onto a shoulder or a direct blow to the clavicle
231. What is a dislocated shoulder?	Occurs when the head of the humerus is dislocated from its socket in the shoulder blade. 90% or more shoulder dislocations are anterior dislocations (humeral head moved in front of joint)
232. What is genu valgum?	AKA knock knees; a condition in which the knees angle in and touch one another when the legs are straightened
233. What is genu varum?	AKA bowlegs; a physical deformity marked by outward bowing of the lower leg in relation to the thigh
234. What is patellar tendonitis?	AKA jumpers knee; a relatively common cause of pain in the inferior patellar region
235. What is patellofemoral pain syndrome (PFPS)?	AKA runner's knee; a syndrome characterized by pain ranging from severe to mild discomfort seemingly originating from the contact of the posterior surface of the patella with the femur
236. What is iliotibial band syndrome?	A common injury to the knee, generally associated with running, cycling, hiking or weight-lifting.
237. What is the iliotibial band?	A thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis over the hip and knee and inserting just below the knee
238. What are the types of fractures?	Potts, Comminuted, Transverse, Spiral, Displaced, Non-Displaced, Colle's, Greenstick, Epiphyseal, Compression and Avulsion
239. What is a potts fracture?	A fracture of the lower part of the fibula often accompanied with injury to the tibial articulation so that the foot is dislocated outward
240. What is a comminuted fracture?	Shatter of the affected area into a multitude of bony fragments
241. What is a transverse fracture?	Broken straight across the bone
242. What is a spiral fracture?	Produced by twisting stresses that spread along the length of the bone
243. What is a displaced fracture?	Abnormal position of the distal fracture fragment in relation to the proximal bone. Types include angulation, rotation, change of bone length and loss of alignment
244. What is a non-displaced fracture?	The bone cracks either part or all of the way through but does move and maintains its proper alignment
245. What is a greenstick fracture?	When only one side of the bone is broken and the other only bent
246. What is an epiphyseal fracture?	AKA Salter fracture; a fracture involving the epiphyseal plate of a long bone which causes separation or fragmentation of the plate
247. What is a compression fracture?	A collapse of the vertebra
248.What are you imaging with the pt in an erect LPO position for an UGI?	Upper, middle and lower esophagus
249. What images of the stomach are obtained for a double contrast UGI?	LPO-gastric antrum, AP-inferior portion gastric body, Rt Lat-fundus, LPO-superior portion of gastric body
250. What images and position are obtained in a single contrast UGI?	RAO-Duodenal bulb and C-loop
251. What images and position are obtained in a double contrast UGI?	LPO-Duodenal bulb and air-filled duodenal C-loop
252. What images and position are obtained with a single contrast esophagram?	RAO-proximal, mid and distal esophagus
253. What initial position is obtained in a SBFT?	PA
254. What image and position is obtained once the barium reaches the TI/Cecum in a SBFT?	Supine and if can't visualize the TI/Cecum then place pt in RAO
255. What image and position is obtained first with a single BE?	AP and LT Lat for a barium filled rectum
256. What image and position is obtained for the sigmoid in a single BE?	LPO
257. What positions are obtained for a reverse sigmoid for a single BE?	RPO and Rt Lat
258. What position is obtained for the hepatic flexure in a single BE?	LPO
259. What position is obtained for the splenic flexure in a single BE?	RPO
260. What position is obtained of the cecum for a single BE?	AP
261. What image is obtained to view the entire colon in a single BE?	AP
262. What position is obtained to view both flexures and transverse colon in a single BE?	RPO/LPO
263. What is depolarization?	Once an electrical cell generates an electrical impulse, this impulse causes the ions to cross the cell membrane and causes the action potential
264. When first administering barium in a double contrast BE, what is the first image that is taken?	Lat view of rectum and sigmoid
265. Once barium reaches the transverse colon in a double contrast BE, what's the next thing that's administered and in what positions?	4-5 puffs of air in the LPO, Lt Lat, LAO, PA, RAO and Rt lat postitions
266. Once barium is well into the right colon during a double contrast BE, what position do you place the pt in?	PA
267. What position do you place the pt in to drain the rectum in a double contrast BE?	PA and elevate table 80 degrees or semi-erect
268. What position is obtained after barium is emptied in a double contrast BE?	PA and Lat of rectum
269. What positions are obtained of the sigmoid in a double contrast BE once the barium is emptied?	AP and Lat
269. What position is the pt placed to obtain the splenic flexure in a double contrast BE once the barium is emptied?	Erect coned downed RPO
270. What position is the pt placed to obtain the hepatic flexure in a double contrast BE once the barium is emptied?	Erect cone downed LPO
271. What position is the pt placed in to obtain the cecum in a double contrast BE once the barium is emptied?	AP and LPO with table in the horizontal position
272. What position is the pt placed to image the entire colon and rectum in a double contrast BE once the barium is emptied?	AP
273. What position is obtained to view both flexures and transverse colon in a double contrast BE once the barium is emptied?	RPO and LPO
274. What positions are obtained for a post evac in a double contrast BE?	AP, RPO, LPO, Rt Lat
275. What position is obtained to view the rectum post evac in a double contrast BE?	AP and Rt Lat
276. What position is obtained to view the descending colon post evac in a double contrast BE?	AP
277. What position is obtained to view the splenic flexure post evac in a double contrast BE?	RPO
278. What position is obtained to view the transverse colon post evac in a double contrast BE?	AP
279. What position is obtained to view the hepatic flexure post evac in a double contrast BE?	LPO
280. What position is obtained to view the entire ascending colon and cecum post evac in a double contrast BE?	AP
281. What positions are obtained once the bladder is full in a cystogram?	Both obliques and Rt Lat
282. What is renin and its affects on the heart and blood pressure?	Renin-Angiotensin-Aldosterone-System (RAAS) is a hormone that regulates blood and water balance. When blood volume is low->juxtaglomerular cells in the kidney secrete renin->renin stimulates the production of angiotensin 1->Angio 1 converts to angio 2	by the enzyme angiotensin converting enzyme->Angio 2 causes blood vessels to contract resulting in an increase in BP
283. What drug is used to treat premature ventricular contractions (PVCs)?	Beta blockers
284. What are premature ventricular contractions (PVCs)?	Extra, abnormal heartbeats that begin in one your heart's two lower ventricles.These extra beats disrupts your regular heart rhythm, sometime causing you to feel a flip-flop or skipped beat
285. What test would be used for a pt who has an allergy to contrast to rule out pulmonary embolism?	Since PE is difficult to diagnose, especially with pt who have underlying heart or lung disease, a series of test may be ordered. Such as a blood test, chest x-ray, US, CT, pulmonary angiogram or MRI
286. What is pneumothorax?	AKA a collapsed lung; a buildup of air in the space between the lung and chest wall
287. What part of the heart is more muscular?	The left ventricle
288. 3 rads equals how many gray?	0.03gray
289. What is the SA node?	It's the pacemaker of the heart and is responsible for the initiation of the heart beat.
290. Where is the posterior tibial pulse located?	Just distal of the medial malleous
291. Where is the dorsal pedal pulse?	Just lateral of the 1st metatarsal bone
292. How long does it take for blood to clot?	25-30 seconds
293. What test is done to measure how well and how long for blood to clot?	Prothrombin Time (PT)
294. What is creatine?	A compound formed in protein metabolism and present in much living tissue. It's involved in the supply of energy for muscular contraction.
295. Does creatine effect kidney damage?	You have to take a lot of creatine to get any extra muscle and most of what you take ends up in your urine. That's why there's some concern that creatine supplementation could damage kidneys
296. What are some contraindications for a hystersalpingogram (HSG)?	Pregnancy, active pelvic infection with tenderness or palpable mass, uterine or tubal surgery, contrast allergy, active uterine bleeding
297. What are some indications for a hysterosalpingogram (HSG)?	Infertility to assess uterine morphology and tubal latency, polyps, adhesions, repeat abortions, PID w/ tubal involvement, post surgical eval, lost IUD, abnormal uterine bleeding
298. What are the requirements set by The Joint Commission for RA's?	Performs procedural timeout, implements an action plan, uses an integrated team approach, modifies the action plan according to changes in the clinical situation, administers first aid or provides life support, assesses and monitors the pt's physical,	emotional and mental status, allies principles of sterile technique and monitors pt for reactions to medications
299. What agency make recommendations about radiation safety but doesn't regulate it?	National Commission on Radiologic Protection (NCRP)
300. The NRC enforces recommendations for what organizations?	NCRP, ICRP and EPA
301. What happens to the heart when the coronary arteries become blocked?	Causes ischemia, angina and a heart attack
302. What is the most likely condition of hypoalbuminemia?	A medical condition where blood levels of albumin are abnormally low. Albumin is a major protein in the body, making up about 55-60% of total human plasma protein by mass. Many hormones, drugs and other molecules are mostly bound to albumin in the	bloodstream and must be released before becoming biologically active
303. How does oxygen from the outside enter into the bloodstream?	In the lungs, oxygen and carbon dioxide are exchanged in the tiny sacs (alveoli) at the end of the bronchial tubes. The alveoli are surrounded by capillaries. When a person inhales, oxygen moves from the alveoli to the surrounding capillaries and into	the bloodstream. At the same time, carbon dioxide moves from the bloodstream to the capillaries and into the alveoli.
304. How do you measure oxygen in the blood?	Pulse oximetry
305. What is a central venous catheter?	A catheter that is placed into a large vein in the jugular vein, subclavian or axillary vein or the groin. It's used to administer medications or fluids, obtain blood tests and measure central venous pressure, long term IV antibiotics and pain meds,	chemo, dialysis and frequent blood draws
306. What are some types of central venous catheters?	Non-tunneled, tunneled, port and PICC line
307. What is a non-tunneled catheter?	They are fixed in place at the site of insertion with the catheter and attachments protruding directly
308. What is a tunneled catheter?	They are passed under the skin from the insertion site to a separate exit site,where the catheter and its attachments emerge from underneath the skin
309. What is a port?	Similar to a tunneled catheter but is left entirely under the skin
310. What is a PICC line?	A peripherally inserted central catheter is a catheter inserted into a vein in the arm rather than a vein in the neck or chest with the tip positioned in the superior vena cava
311. What is a bruit?	The abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery. Occur only in systole
312. What is a thrill?	A vibration caused by the movement of fluid felt by the examiner on palpation. Created by turbulence in a fluid column passing through an incompetent valve or from a vessel of smaller caliber to a larger. The larger the orifice, the bigger the thrill
313. What is a heart murmur?	Sound during your heartbeat cycle, such as whooshing or swishing made by turbulent blood in or near your heart.
314. What is skin turgor?	The skin's ability to change shape and return to normal elasticity. It's a sign used by health care workers to assess fluid loss or dehydration.
315. What is crepitus?	A grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone.
316. What are the types of crepitus?	Bone, joint and crepitus of bursitis
317. Where in the body does breast cancer usually spread?	The lymph nodes but can also spread to the muscle, fatty tissue and skin, bones, bone marrow, liver, lungs and the brain
318. What is Standard Precautions (Mechanism of Disease Transmission)?	They are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes) and mucous membranes. These practices include hand hygiene,	personal protective equipment (PPE), needlestick and sharps prevention, cleaning and disinfection, respiratory hygiene (cough etiquette), waste disposal and safe injection practices
319. What mode of transportation (standard precautions) prevents medical asepsis?	Hand washing and "no touch" dressing technique
320. What is pulmonary artery catheter?	Frequently referred to as a Swanz-Ganz Catheter; It's the insertion of a catheter into a pulmonary artery. Its purpose is diagnostic; it's used to detect heart failure or sepsis, monitor therapy and eval the effects of drugs.	PAC allows direct, simultaneous measurement of pressures in the right atrium, ventricle, pulmonary artery and the filling pressure of the left atrium.
321. What's it called when blood pressure starts to drop and heart rate is 60bpm?	Vasovagal syncope; occurs when the body overreacts to certain triggers, such as sight of blood or extreme emotional distress
322. What is an aneurysm?	A localized widening (dilation) of an artery, a vein or the heart. At the point of an aneurysm, there's typically a bulge. The wall of the blood vessel or organ is weakened and may rupture
323. What is hypovolemia?	An abnormal decrease in the volume of blood plasma. Occurs with dehydration or bleeding
324. What are beta blockers?	A class of drugs that block the effect of beta-adrenergic substances such as adrenalin (epi), that plays a key role in the sympathetic portion of the involuntary nervous system.	They slow the heartbeat and relive stress on the heart
325. How is a percutaneous catheter put in?	1. Image-guided 2. Position pt on table 3. Connect monitor's to pt to track heart rate and bp 4. Insert IV line 5. Radiologist numbs the area 6. Shave area of interest where catheter is to be inserted 7. Make an incision	8. Using fluoro, insert catheter through the skin and into the abscess for drainage
326. What is a pigtail (lock) catheter?	A drainage catheter with side holes, used for draining clear non viscid or coagulable collections of bile, urine or pancreatic fluids and even air in case of spontaneous pneumo
327. What is a myelogram (myelography)?	It's an imaging examination that involves the introduction of a spinal needle into the spinal canal and the injection of contrast media in the space around the spinal cord and nerve roots using real-time fluoroscopy
328. What is an avulsion fracture?	A bone fracture which occurs when a fragment of bone tears away from the main mass of bone as result of physical trauma
329. What is an absent bow tie sign?	Represents the loss of the normal appearance of the menisci; a menisci injury
330. What is CSF?	A clear, colorless body fluid found in the brain and spine.
331. Where is CSF produced?	Produced by ependymal cells of the choroid plexuses of the ventricles of the brain
332. What does LD 50/60 mean?	Refers to a dose without treatment will be lethal to 50% of the population within 60 days
333. What are the 4 basic densities in CT?	1. Air = -1000; 2. Fat = -60 to -120; 3. Water = 0; 4. Compact bone = +100
334. How much more radiation does a CT chest have verses a regular chest x-ray?	2-10 times more
335. What is a Loopography or Loopogram?	Ureters are connected to a loop of small bowel, which drains out of an ostomy. Involves placing a foley catheter into the conduit and injecting contrast retrograde to evaluate the bowel loop, ureters and kidneys
336. Why is a Loopography or Loopogram done for?	Done due to the large amount of bladder removed due to cancer
337. What is Defecography procedure?	Imaging in which the mechanics of a pt's defecation are visualized in real time using fluoro.
338. What are some indications for doing a Defecography procedure?	Evaluation of rectal outlet obstruction symptoms and all types of rectal incontinence, suspected conditions such as internal rectal intussesception, enterocele, rectocele or sigmoidocele, compare pre-and post- surgical repair of rectal outlet obstruction
339. What are the 4 quadrants of a mammogram?	Upper-outer, Lower-outer, Upper-inner and Lower-inner
340. What is ethics?	Moral principles that govern a person's or group's behavior; the rightness or wrongness of certain actions
341. What is autonomy?	The ability of a person to make his or her own decisions
342. What are the different kinds of shock?	Respiratory, Neurogenic, Cardiogenic, Hemorrhagic, Anaphylactic, Metabolic, Psychogenic and Septic
343. What is Respiratory shock?	Trauma to the respiratory that causes a reduction of oxygen and carbon dioxide
344. What is Neurogenic shock?	Injury or trauma to the nervous system (spinal cord, brain)
345. What is Cardiogenic shock?	Myocardial infarction with damage to heart muscle
346. What is Hemorrhagic shock?	Severe bleeding or loss of body fluid from trauma, burns, surgery or dehydration from severe nausea and vomiting
347. What is Anaphylactic shock?	Results from reaction to substance to which a pt is hypersensitive or allergic
348. What is Metabolic shock?	Body's homeostasis is impaired; acid-base balance is disturbed (diabetic coma or insulin shock)
349. What is Psychogenic shock?	Shock caused by overwhelming emotional factors. Sudden dilation of blood vessels results in fainting because of lack of good supply to the brain
350. What is Septic shock?	An acute infection, usually systemic, that overwhelms the body (toxic shock syndrome)
351. Where is oxygen found in the body?	Hemoglobin
352. What are the function of the cerebellum?	Responsible for controlling motor movement functions and muscle coordination. Controls how we move, talk, walk and other physical activities. Also controls the aspects of balance, equilibrium and muscle tone
353. What nerve is affected by carpal tunnel?	Median nerve
354. What is Compton Effect?	It's a radiation scattering event where the incoming x-ray gets scattered by an outer atomic electron
355. What is Coherent Effect?	An incoming x-ray photon causes an electron to vibrate. The electron subsequently emits an x-ray photon of an equivalent energy in a forward direction but atom is otherwise left unchanged
356. What is the most injured muscle in the shoulder?	The supraspinatus muscle
357. What part of the hip is most affected by AVN?	The femoral head
358. What is another name for AVN?	Osteonecrosis
359. What are myocyte cells?	Types of cells found in muscle tissue; long, tubular cells that develop from myoblasts to form muscles in a process known as myogenesis
360. What is the process called when myocyted cells don't need to be stimulated?	Automaticity
361. What is the pt closest to during a fluoro procedure?	Image intensifier
362. What 4 drugs do you administer for an acute MI?	Aspirin, oxygen, nitrates and morphine
363. At what level does the bronchi separate at?	At the level of the sternal angle and T5
364. Where are sebaceous glands found?	Skin
365. What causes peripheral edema?	Most common is aging but can also be caused by other conditions such as CHF, trauma, alcoholism, pregnancy or merely sitting or standing for long periods of time
366. Who is ultimately responsible for consent for a pt?	Radiologist
367. How much protection provided from a 75 kVp x-ray beam when using a 0.50 mm lead equivalent apron?	88%
368. In regards to pumping blood, what does the right side do?	1. Blood enters the heart through 2 large veins, the inferior and superior vena cava, emptying oxygen-poor blood from the body into the right atrium 2. As the atrium contracts, blood flows from the right atrium into the right ventricle through the open	tricuspid valve 3. When the ventricle is full, the tricuspid valve shuts. This prevents blood from flowing backward into the atria while the ventricle contracts 4. As the ventricle contacts, blood leaves the heart through the pulmonic valve, into the	pulmonary artery and to the lungs where it's oxygenated
367. In regards to pumping blood, what does the left side do?	1. The pulmonary vein empties oxygen-rich blood from lungs into the left atrium of the heart 2. As the atrium contacts, blood flows from the left atrium into the left ventricle through the open mitral valve	3. When the ventricle is full, the mitral valve shuts. This prevents blood from flowing backward into the atrium while the ventricle contracts. 4. As the ventricle contracts, blood leaves the heart through the aortic valve, into the aorta and to the body
368. What are some indications for a LP?	Suspected CNS infection, suspected subarachnoid hemorrhage, therapeutic reduction of CSF and sampling of CSF for any other reason (i.e. demyelinating disease, Guillain-Barre Syndrome (GBS)
369. What are some contraindications for a LP?	Local skin infection, Increased intracranial pressure (ICP), coagulopathy, suspected spinal cord mass or intracranial mass lesion and lack of pt cooperation
370. What are some risks with a LP?	Spinal headaches, spinal hematoma, infection and nerve root irritation
371. What are the pt positions for a LP?	Left lateral recumbent or prone
372. What can't the pt be placed in an upright position for a LP?	Because opening pressure can't be measured in this position
373. What is the puncture site for a LP?	L4-5 interspace
What other puncture site can be used if L4-5 is unavailable?	L3-4
375. Where does the spinal cord end in adults?	L1-2
How many tubes are collected with a LP?	4
377. What does each tube in a LP tested for?	Tube1-Glucose, protein electrophoresis Tube2-Gram's stain, bacterial and viral cultures Tube 3-Cell count and differential Tube4-Reserve tube for any special tests
378. True or False: Does inserting the needle bevel up minimize the dural trauma	True
379. What are iatrogenic spinal epidermoid tumors?	These are caused if you forget to put your stylet in the needle before puncturing the skin. The hollow needle will core out tissue, hair and skin which will get deposited in the thecal sac once the needle enters.
380. What is Guillen Barre Syndrome?	A rapid onset of weakness of the limbs as a result of an acute polyneuropathy, a disorder affecting the peripheral nervous system. The disease is usually triggered by an infection, which provokes immune-mediated nerve dysfunction.	Many experience changes in sensation or develop pain, followed by muscle weakness beginning in the feet and hands that develop rapidly.
382. What does Guillen Barre Syndrome affect/damage?	The myelin sheaths covering the nerves in the peripheral nervous system, which disrupts the nerve impulses, similar to MS and other demyelinating diseases.
383. What is meningitis?	A relatively rare infection that affects the delicate membranes, called meninges, that cover the brain and spinal cord
384. What are the different types of meningitis?	Bacterial-Can be deadly and contagious among people in close contact Viral-Tends to be less severe and most people recover completely without specific therapy Fungal-Rare form of meningitis and generally occurs only in people with weakened immune system
385. What is encephalitis?	An inflammation of the brain that's usually caused by a virus
386. What is Reye syndrome?	A potentially fatal disease that causes severe problems with the brain and other organs; although no known cause, it's been associated with giving aspirin to children and the development of this syndrome
387. What is myelitis?	An inflammation of the spinal cord or bone marrow
388. What is pseudo tumor cerebri?	AKA idiopathic intracranial hypertension (IIH); a condition in which pressure within the subarachnoid space is elevated for reasons that are still not clear
389. What is normal pressure hydrocephalus?	A rare condition affecting mainly older individuals in which there is a triad of loss of urinary control, memory problems and an unsteady gait
390. What is hydrocephalus?	A medical condition in which there's an abnormal accumulation of CSF in the brain. The cause can be congenital or acquired factors. Congenital causes include spinal bifida, Arnold-Chiari malformation, Vein of Galen malformation.	Acquired include hemorrhage, meningitis, head trauma, tumors and cysts
391. What is demyelinating disease?	Disease that attacks the protective coating that surround certain nerve fibers
392. What is the subarachnoid space?	Located between the arachnoid membrane and the pia mater, is maintained by delicate, web-like strands that connect the arachnoid membrane and the pia mater. CSF is found abundantly here and is where it buoys the CNS and protects it from injury
393. What is the pia mater?	The delicate innermost layer of the meninges, the membranes surrounding the brain and spinal cord
394. What is the dura mater?	Forms a tough, tubular dural sheath that extends into the vertebral canal and surrounds the spinal cord
395. What is arachnoid mater?	The middle of three layers that make up the meninges, or membranes, that surround the brain and spinal cord.
396. What is the 3rd ventricle in the brain?	It's one of the four connected fluid-filled cavities comprising the ventricular system within the human brain. It's a median cleft in the diencephalon between the two thalami and is filled with CSF.	It's in the midline, between the left and right lateral ventricles.
397. What does the 3rd ventricle do?	It communicates with the lateral ventricles anteriorly by the inter ventricular foramina (of Monro). It also communicates with the 4th ventricle posteriorly by the cerebral aqueduct (of Sylvius)
398. What is the 4th ventricle in the brain?	Located in the brain stem, just in front of the cerebellum; it's connected to the 3rd ventricle by a narrow canal, the cerebral aqueduct, which passes lengthwise through the brain stem
399. What does the 4th ventricle do?	Its main function is to protect the human brain from trauma and to help form the central canal, which runs the length of the spinal cord
400. What is the choroid plexus?	A plexus in the ventricles of the brain where CSF is produced. It must produce about 500 milliliters a day
401. What is an epidural hematoma (EDH)?	A traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane. Usually caused be a blow to the head
402. What is a subdural hematoma?	A collection of blood outside the brain. Usually caused by severe head injuries and can be life-threatening
403. Trace the pathway of CSF	Formed in the lat ventricles, circulates through the inter ventricular foramens into the 3rd ventricle and then via cerebral aqueduct into the 4th ventricle. Here the fluid scapes via the lat apertures of the 4th ventricle and the medial foramen of the	4th ventricle into the subaracnoid spaces, where it diffuses over the brain and spinal cord
404. What are the types of brain aneurysms?	There are 2 main types: saccular (berry) aneurysms and fusiform aneurysms.
405 What is a saccular aneurysm?	AKA Berry aneurysm; the most common type and accounts for 80%-90% of all intracranial aneurysms. They are the most common cause of non traumatic sub archnoid hemorrhage. Named berry because of its shape. The aneurysm look like a sac or berry forming at	the bifurcation or "Y" segment of the arteries. It has a neck and stem. These are small, berry-like projections that occur at the arterial bifurcation and large branches of the large arteries at the base of the brain, known as the Circle of Willis
406. What is a fusiform aneurysm?	Less common type of aneurysm and it looks like an out pouching of an arterial wall on both sides of the artery or like a blood vessel that is expanded in all directions. This does not have a stem and seldom ruptures
407. What are some indications for a diagnostic paracentesis?	New-onset of ascites, to determine the presence of infection in pts with no known or suspected ascites and useful in the management of AIDS pts
408. What is an indication for a therapeutic paracentesis?	Performed in an emergency setting to relieve the cardiorespiratory and gastrointestinal manifestations of tense ascites
409. What are contraindications for a paracentesis?	Acute abdomen, severe thrombocytopenia and coagulopathy, pts with an INR greater than 2.0, pregnancy, distended urinary bladder, abdominal wall cellulitis, distended bowel, intra-abdominal adhesions
410. What is the distance from the skin to the fluid in a paracentesis?	1cm
411. What is the distance to the midpoint of the collection in a paracentesis?	3cm
412. Typically, where is the needle insertion in a paracentesis?	Through the abdominal wall in the left lower quadrant
413. What areas should be avoided when inserting a needle for a paracentesis?	In the midline cephalad or caudad to the umbilicus, surgical scars and visible veins
414. What is the preferred entry site for a paracentesis?	Approximately 2cm below the umbilicus in the midline
415. What are some complications from a paracentesis?	Persistent leak from the puncture site, abdominal wall hematoma, perforation of bowel, introduction to infection, hypotension after large volume para, delusional hyponatremia, hepatorenal syndrome, major blood vessel laceration
416. What are the labs ordered for a paracentesis?	Ammonia, CBC, CMP, albumin, amylase, lipase, INR/PTT, protein, glucose, bilirubin, triglyceride, LDH, pH
417. What is ascites?	Refers to abnormal accumulation of fluid within the peritoneal cavity. It's a symptom with important diagnostic, therapeutic and prognostic implications.
418. What is portal hypertension?	An increase in the blood pressure within system of veins called portal venous system.
419. What is the hepatic portal system?	The system of veins comprising the hepatic portal vein and its tributaries. Responsible for directing blood from parts of the GI tract to the liver
420. What is peritonitis?	An inflammation of the peritoneum that is usually due to a bacterial or fungal infection
421. What are the complications with paracentesis?	Systemic, local, intraperitoneal, hemodynamic compromise, abdominal wall hematoma, infection
422. What is hemodynamic compromise?	Most common systemic complication and is due to overzealous removal of ascitic fluid. It's recommended that a maximum of 4-5L be removed at a time
423. Where do you puncture for a thora? Over or under a rib?	Over because vessels are located under the rib
424. T/F A coagulopathy, such as an elevated PTT or INR, is an absolute contraindication for a para?	True
425. What is Starling's hypothesis?	States that the fluid movement due to filtration across the wall of a capillary is dependent on the balance between the hydrostatic pressure gradient and the oncotic pressure gradient across the capillary
426. What are the 4 Starling forces?	1. Hydrostatic pressure in the capillary (Pc) 2. Hydrostatic pressure in the interstitium (Pi) 3. Oncotic pressure in the capillary (pc) 4. Oncotic pressure in the interstitial (pi)
427. What is the formula for net driving pressure?	NDP=[ (Pc - Pi) - (pc-pi) ]
428. What are the indications for a NG intubation?	Eval of upper GI bleeding (i.e. presence, volume), aspiration of gastric fluid content, identification of the esophagus and stomach on a chest xray and administration of contrast to the GI tract
429. What are the indications for a therapeutic NG intubation?	Gastric decompression, relief of symptoms and bowel rest in the setting of a small bowel obstruction, aspiration of gastric content from recent ingestion of toxic material, administration of medication, feeding and bowel irrigation
430. What are some absolute contraindications for a NG intubation?	Severe midface trauma and recent nasal surgery
431. What are some relative contraindications for a NG intubation?	Coagulation abnormality, esophageal varices or stricture, recent banding or cautery of esophageal varicose and alkaline ingestion
432. How do you measure the length of the NG tube?	The distance from the tip of the nose, around the ear and down to just below the left costal margin (or roughly 5cm below the xiphoid process)
433. What are some complications with a NG intubation?	Patient discomfort, throat irritation, epitstaxis, respiratory tree intubation and esophageal perforation
434. What are some indications for a thora?	Pleural effusion which needs diagnostic work-up and symptomatic treatment of a large pleural effusion
435. What are some contraindications for a thora?	Uncooperative pt, uncorrected bleeding diathesis and chest wall cellulitis at the site of puncture
436. What are some relative contraindications for a thora?	Bullous disease (i.e. emphysema), positive end-expiratory pressure (PEEP) mechanical ventilation, only one functioning lung and small volume of fluid (less than 1cm thickness on a lat decub film)
437. What are some benefits of doing a thora?	Less SOB and obtaining a diagnosis
438. What are some risks of doing a thora?	Pneumothorax, bleeding and death
439. What is transudate?	Extravascular fluid with low protein content and a low specific gravity
440. What is exudate?	A fluid with a high content of protein and cellular debris which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation
441. What are complications from a thora?	Pneumothorax, hemopneumothorax, hemorrhage, hypotension due to a vasovagal response, pulmonary edema due to a lung re-expansion, spleen or liver puncture, air embolism and introduction to infection
442. What should a procedure note include?	Patient consent, indications for the procedure, relevant labs (i.e. INR/PTT, platelet count), procedure technique, sterile prep, anesthetic, amount of fluid obtained, character of fluid, estimated blood loss, any complications and tests ordered
443. What is the purpose of a PICC line?	To provide IV therapy through a intravenous catheter
444. What is the benefit of a PICC line?	The catheter can remain for a long period of time, typically 2-6 weeks, over which a course of medication such as antibiotics can be delivered
445. T/F Can a PICC line be used for short intervals in a pt with difficult vein access?	True
446. What are the typical IV therapies administered through a PICC line?	Antibiotics, total parenteral nutrition (tpn), blood products, immunoglobulins and chemo
447. What are contraindications for a PICC line?	INR greater than 2.0, major shoulder and vascular surgery, radiation therapy, venous thrombosis, axillary lymph node dissection,	local dermatitis, cellulitis, burn injury or infection near insertion site
448. What are risks/possible complications of a PICC line?	Infection, bleeding, clotting of blood in vein around the catheter or at the wall of the vein, increased venous thrombosis, pulmonary embolus and allergic reactions to anesthetic, latex, sterol prep solutions, etc...
449. What are the alternatives to a PICC line?	Oral antibiotic therapy and peripheral IV catheter (needs to be replaced at least every 3 days)
450. What is lymphedema?	Swelling that generally occurs in one of your arms or legs. Sometimes both legs and arms
451. What is lymphedema caused by?	Common cause is by the removal of or damage to the lymph nodes as a part of cancer treatment
452. What does lymphedema result from?	Results from a blockage in your lymphatic system, which is a part of your immune system. The blockage prevents lymph fluid from draining well, causing swelling
453. What arm should a PICC line be inserted?	Non dominant arm
454. What is pleural effusion?	An accumulation of excess fluid between two layers of tissue (the visceral and parietal pleurae) surrounding the lungs
455. What are some complications that cause pleural effusion?	Heart failure and pneumonia
456. What organ becomes the most calcified as we age?	Arterial vessels
457. When an IV infiltrates, what will be the first sign you see?	Swelling/edema
458. What is the name of the disease where more oxygen a pt receives, the more they are unable to breathe?	Emphysema
459. What is it called when you have a reaction to something in the blood?	Anaphylactic
460. What is the best calculation for total IR procedure?	Cumulative timer
461. Who credentials a RA?	ARRT
462. What IR procedure that is done where the pt is asked to hum?	Thora
463. What test would be done to rule out PE if a pt is allergic to contrast?	MRI
466. What organ produces cholecystokinin?	Gallbladder
464. Trace the path of bile through the liver	Starts in Liver- bile canaliculi >> canals of Hering >> bile ductules (in portal tracts) >> intrahepatic bile ducts >> left and right hepatic ducts >>merge to form >> common hepatic duct >>exits liver and joins >> cystic duct ( from gall bladder)
465. There are two fundamentally important functions of bile. What are they?	1. critical for digestion and absorption of fats and fat-soluble vitamins in the small intestine.	2. waste products, including bilirubin, are eliminated from the body by secretion into bile and elimination in feces
467. What is oncotic pressure?	A form of osmotic pressure exerted by proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that usually tends to pull water into the circulatory system. It's the opposing force to capillary filtration pressure and interstitial colloidal	osmotic pressure. It has major effect on the glomerular filter pressure.
468. What is hydrostatic pressure?	As blood moves along the capillary, fluid moves out through its pores and into the interstitial space. This movement means that the pressure exerted by the blood will become lower, as the blood moves along the capillary, from the arterial to the	venous end
469. What is osmotic pressure?	The minimum pressure which needs to be applied to a solution to prevent the inward flow of water across a semipermeable membrane. Also defined as the measure of the tendency of a solution to take in water by osmosis
470. Epinephrine intravenous push/IO; how much and how often?	1mg given every 3-5 minutes
471. Epinephrine should be used with caution in pts suffering from what?	Myocardial infarction. Since epi increases the heart rate and raises blood pressure, this increase can increase myocardial oxygen demand and worsen ischemia
472. What is the IV infusion rate of epi for bradycardia?	1mg mixed with 500ml NS or D5W; the infusion should run at 2-10 micrograms/min (titrated to effect)
473. Under Respondeat Superior a hospital is responsible for employee actions. Even if the physician is not actually an employee or agent of the organization the court may hold the organization vicariously liable under the doctrine of	ostensible agency, also referred to as apparent authority
474. Hospital can be held vicariously liable for an employee	on the basis of an actual employment of agency relationship or on the basis of ostensible agency (apparent authority).
475. Is a type of bone cell that reabsorbs (breaks down) bone tissue	Osteoclast
476. Cells that synthesize (form) bone	Osteoblast
477. Nuclear Med bone scan is helpful in diagnosing what disease	Pagets (this is on test) You are shown a Nuc Med scan where there is increased uptake (black) through the entire femur and wing of hip. Then ask to say which disease it is. Pretty sure it's Paget's
478. MS affects which matter on early MRI scans	White matter
479. What is suppuration	pus formation
480. Periosteum	a membrane that covers the outer surface of all bones, except at the joints of long bones.
481. Endosteum	lines the inner surface of all bones.
482. Risk factors for developing osteomyelitis	When adults are affected, it may be because of compromised host resistance due to debilitation, intravenous drug abuse, infectious root-canaled teeth, or other disease or drugs (e.g., immunosuppressive therapy).	Osteomyelitis is a secondary complication in 1–3% of patients with pulmonary tuberculosis. The most common form of the disease in adults is caused by injury exposing the bone to local infection	Acute osteomyelitis almost invariably occurs in children
483. What is spina bifida	birth defect where there is incomplete closing of the backbone and membranes around the spinal cord. There are three main types: spina bifida occulta, meningocele, and myelomeningocele	Occulta has no or only mild signs. Signs may include a hairy patch, dimple, dark spot, or swelling on the back at the site of the gap in the spine. Meningocele typically causes mild problems with a sack of fluid present at the gap in the spine.	Myelomeningocele also known as open spina bifida is the most severe form. Associated problems include poor ability to walk, problems with bladder or bowel control, hydrocephalus, a tethered spinal cord, and latex allergy. Learning problems are uncommon.
484. What is repolarization?	The return of the ions to their previous resting state, which corresponds with relaxation of the myocardial muscle
485. What is the generic name for Demerol?	Meperidine
486. What is the generic name for Valium?	Diazepam
487. What is the generic name for Ativan?	Lorazepam
488. What is the generic name for Nembutal?	Pentobarbital
163. What is intestinal volvulus?	A condition in which the bowel becomes twisted, which may be the result of malrotation. Twisted intestines may become blocked or may become injured when the twisting cuts off the intestine's blood supply.	If the blood supply is cut off for a prolonged period of time, some or all of the intestine may die, which can be fatal. It's therefore an emergency surgery. Malrotation of the bowel during fetal development may predispose infants to volvulus,	although volvulus can occur in the absence of malrotation. Volvulus associated with malrotationoften occurs early in life, frequently in the firs year.

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