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(3) Surgery > 2 - General and T&O Imaging > Flashcards

2 - General and T&O Imaging Flashcards

1
Q

What are the different types of imaging that can be done for abdominal pathology and what are they used for?

A

AXR: suspected bowel obstruction, suspected perforation (erect CXR), moderate to severe undifferentiated abdominal pain, suspect foreign body, renal tract calculi follow up

CT: abdominal trauma, suspected intra-abdominal collection, malignancy

US: RUQ

Endoscopy: acute upper GI bleed

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2
Q

How should you present any x-ray in general?

A
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3
Q

How should you present an abdominal x-ray?

A

AbdoX

https://radiopaedia.org/articles/abdominal-x-ray-review-abdo-x-summary?lang=gb

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4
Q

How should you present a CXR?

A
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5
Q

How can you tell the difference between small and large bowel on an AXR?

A
  • In ascites bowel loops are clustered centrally
  • 3/6/9 rule
  • Thumbprinting when large bowel inflammation
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6
Q

What are some of the causes of pneumoperitoneum and what would you see on imaging this?

A

Erect CXR: free air under diaphragm, leaping dolphin sign, cupola sign when supine, continuous diaphragm sign

AXR: Rigler sign, Telltale triangle sign

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7
Q

What is Rigler’s sign?

A

Double wall sign where gas is on both sides of the bowel forming crisp line on bowel that you could draw around.

Sign of pneumoperitoneum

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8
Q

What are the aims of imaging in a bowel obstruction?

A
  • differentiate true mechanical obstruction from ileus or constipation
  • find site of obstruction
  • identify cause
  • assess for complications (e.g. ischaemia or perforation)
  • assess the viability of bowel segments involved
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9
Q

What would you find on imaging a bowel obstruction?

A

AXR:

  • Dilated bowel loops 3/6/9
  • Perforation
  • String of Pearl’s sign

CT:

  • Transition point
  • Collapsed or normal bowel past transition but dilated before
  • Bowel wall thickening
  • Surrounding mesenteric fat if inflammation
  • Volvulus
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10
Q

What does this AXR show and why does this occur?

A

Thumbprinting

Sign of large bowel wall thickening usually due to oedema. Haustra become thickened

Causes: UC, Crohn’s, Infection, diverticulutis, lymphoma

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11
Q

What would you use when imaging urolithiasis?

A

CT KUB non-contrast is gold standard

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12
Q

How can you tell the difference between a sigmoid and caecal volvulus and what are the different aetiologies of these two pathologies?

A

Sigmoid: chronic constipation, colonic distension, elderly, bed bounds

Caecal: congenital long mesentry, congenital malrotation, congential defect in fixation of the right colon to peritoneum

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13
Q

What does this CT show around the kidney and what does this indicate?

A

Fat stranding which shows inflammation

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14
Q

What is Rigler’s triad?

A

Sign of gallstone ileus

  • pneumobilia
  • small bowel obstruction
  • ectopic calcified gallstone, usually in the right iliac fossa
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15
Q

What are the main causes of small and large bowel obstruction?

A
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16
Q

How does a CT abdomen scan work and what are the advantages and disadvantages of this imaging?

A
  • check renal function
  • lie patient supine on CT table
  • scout image to plan study
  • IV contrast injected via pump-injector
  • 60-second delay
  • scan from dome of diaphragms to symphysis pubis
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17
Q

What should you look for on a CT with a bowel obstruction?

A
  • Find obstruction
  • Find dilated loops before obstruction
  • Find collapsed area after obstruction
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18
Q

What are some of the different phases than can be used in CT?

A

- Non contrast: CT KUB for renal stones or allergic to contrast

- Systemic arterial (35 seconds): vascular imaging can made 3D angiogram

- Portal venous (70 seconds): intravenous contrast, good for acute abdomen imaging and outpatients

- Delayed (depends): urological imaging takes 7-10 minutes

Systemic arterial and portal venous together can see bleeding

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19
Q

When is contrast for CT given enterically and through the bladder?

A

- Orally: to look for leaks and fistulas in the upper GI

- Foley catheter: after pelvic trauma to determine if bladder rupture (extra/intra peritoneal rupture)

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20
Q

How long does contrast take to get to different vessels in the body?

A
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21
Q

When should you avoid enteric contrast for CT?

A

Can be given by mouth, NG tube, PEG, stoma, rectally

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22
Q

When requesting x-rays for MSK, what do you need to consider?

A
  • Which structures?
  • Which views? (two views 90 degrees apart)
  • Compare both sides and review previous images
  • Correlation with clinical and other imaging findings
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23
Q

How do you review an MSK x-ray?

A
  1. Name, Age, Date and Time of X-rays
  2. What is being imaged and the most obvious abnormality
  3. Is the image quality and angles satisfactory?
  4. See image (Bones, Soft tissue, Joint, Anything else)
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24
Q

How do you describe a fracture on an x-ray?

A

- What type of fracture (oblique, transverse etc)

- Where is the fracture (diaphysis, metaphysis, epiphysis)

- Is it displaced (rotation, translation, angulation, length)

- Say where the distal frament is compared to proximal (e.g displaced anteriorly and medially)

- Anything else? (joint involvement, bone lesions, anothe fracture)

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25
Q

How do fractures and dislocations appear on radiographs?

A

Fractures: dark line, white line (bone on bone), irregularity in the cortex

Dislocation: irregular soft tissue, change in joint space

Always look for sclerotic, lytic, mixed bone lesions

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26
Q

How do you describe the length of a bone on a radiograph?

A
  • Normal
  • Impacted (shortened)
  • Distracted (longer)
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27
Q

How does a bone cyst, a metastatic bone deposit and multiple myeloma appear on x-ray?

A

Bone cysts: (see image) lytic lesion with sclerotic border

Metastases: irregular sclerotic or lytic (more common) lesions

Multiple myeloma: numerous, well-circumscribed, lytic bone lesions/pepperpot skull/general osteopenia

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28
Q

How do you describe fracture angulation on an x-ray?

A
  • Draw lines where bone should be and use distal fragment to describe or use apex of deformity (opposite)
  • Can use words dorsal/palmar, varus/valgus, radial/ulnar
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29
Q

What does this x-ray of the shoulder show?

A

LIGHT BULB SIGN

Internal rotation of shoulder OR Posterior Dislocation

30
Q

What views should you take of a shoulder on plain film radiograph?

A

AP with either axial or Y view

31
Q

What does this x-ray of the shoulder show?

A

Anterior dislocation (learn radiographic findings)

May see a Hill Sachs lesion if externally rotate shoulder

32
Q

What is the pathology on this shoulder radiograph?

A
33
Q

What is the pathology on this x-ray?

A

Fallen fragment sign

Sign of a pathological fracture. Bone cysts with linear areas within them

34
Q

If the inferior margin of the clavicle sits above the superior margin of the acromion on an x-ray what does this mean?

A

Grade 3 ligament injury at the acromioclavicular joint (AC joint)

35
Q

What is the pathology of this x-ray?

A

Can see fat pads (prominent anterior) so large elbow joint effusion

36
Q

What is the terrible triad?

A

Posterior elbow dislocation

Radial head fracture

Coronoid process fracture

37
Q

What is the pathology on this x-ray?

A

Radial head dislocation (radius not in line with capitulum, radiocapitullar line)

38
Q

What is the pathophysiology on this x-ray?

A

Supracondylar fracture

Raised fat pad, abnormal anterior humeral line, normal radiocapitellar line

39
Q

What is the pathology on this x-ray?

A
40
Q

What is the pathology on this x-ray?

A

MU vs GR

Man united versus Rangers

41
Q

What is the pathology on this x-ray?

A

NO INTRARTICULAR EXTENSION

42
Q

What is the pathology of this x-ray?

A

Volar displacement and no intrarticular extension

43
Q

What is the pathology on this x-ray?

A

Radial styloid fracture with scapholunate dissocation

Will result in OA if not picked up and ligament repair! Can’t just cast

44
Q

What is the pathology on this x-ray?

A
45
Q

What can you see on x-ray with early avascular necrosis of the scaphoid?

A

Early sclerosis of proximal pole of scaphoid

46
Q

What is the pathology on this x-ray?

A

Triquetral fracture (can only see on lateral)

47
Q

What is the pathology on this x-ray?

A

5th Metacarpal dislocation

48
Q

What is the pathology on this x-ray?

A

Fracture of the base of the first metacarpal due to forced abduction of the thumb. Intrarticular fracture

If comminuted into at least 3 it is called a Rolando fracture

Often needs emergency surgery

49
Q

What is the pathology on this x-ray?

A

Boxers fracture (fracture of 5th metacarpal)

50
Q

What imaging is requested on a 2 week wait for suspected colorectal cancer?

A

Flexible sigmoidoscopy

51
Q

A patient who recently had abdominal surgery develops this (see image). What is the likely causative organism and how should this patient be managed if they have no signs of systemic infection?

A

Wound dehiscence due to E.Coli

Negative pressure VAC therapy

52
Q

What is the upper limit ABPI for intermittent claudication?

A

0.7

53
Q

What bleeding complication during a carotid endartectomy causes the biggest morbidity?

A

Airway obstruction!!

54
Q

What are the 5 different ASA grades?

A

COPD with home oxygen therapy that is housebound is grade 4

55
Q

A patient following surgery has no urine output for 3 hours after the catheter was removed, what should the nurses do?

A

Encourage the patient to drink water

56
Q

How does the tetanus toxin cause damage?

A

Blocks neurotransmitter release from spinal inhibitory neurones

57
Q

What is the purpose of pre-oxygenation preceding induction of anaesthesia?

A

To replace nitrogen in the lungs with oxygen

58
Q

What prophylactic antibiotic regime is used in T+O surgery, particularly with joint replacement? (also used in vascular surgery)

A

Dose of antibiotic at induction of anaesthesia then 2 doses IV post operatively

Usually co-amoxiclav. If penicillin allergy use teicoplanin/gentamicin

59
Q

What is the empirical antibiotic choice in the following:

  • C.Diff
  • Peritonitis or Biliary Sepsis
  • Variceal bleeding in Cirrhosis
A
  • Metronidazole (can escalate to vancomycin)
  • Co-Amoxiclav or Meropenem if penicillin allergy
  • Co-Amoxiclav or Ciprofloxacin if penicillin allergy
60
Q

What is the empirical antibiotic choice in the following scenarios?

  • Infected joint replacement/metal work
  • Osteomyelitis
  • Open fractures
  • Non-prosthetic septic arthritis
A
  • Flucloxacillin or Vancomycin if penicillin allergy
  • Flucloxacillin or Vancomycin if penicillin allergy
  • Co-Amoxiclav or Meropenem or Clindamycin if anaphylactic penicillin allergy
  • Flucloxacillin or Vancomycin if penicillin allergy
61
Q

What antibiotics are used for a diabetic foot infection?

A

Mild: flucloxacillin or doxycycline if penicillin allergy

Moderate: flucloxacillin+metronidazole+ciprofloxacin (can swap F for Doxy if allergy)

Severe: piperacillin + tazobactam + vancomycin. if allergy meropenem and vancomycin

62
Q

What antibiotic is used for peripheral cannula infections, cellulitis, bursitis etc?

A

Flucloxacillin or Vancomycin if allergy

63
Q

How do you work out a man and woman’s circulating blood volume quickly?

A

Gilcher’s Rule Of Five

Weight (kg) x Average Blood ml per kg

Man: usually 70ml/kg

Woman: usually 65 ml/kg

64
Q

What antibiotics are used for acute prostatis and epididymo-orchitis?

A
65
Q

What are some risk factors for renal cell carcinoma and what is the curative treatment for this if there are no metastases?

A
  • Smoking
  • Obesity
  • FHx
  • HTN
  • Cadmium exposure
  • Genetic syndromes

RADICAL NEPHRECTOMY!!!!

66
Q

Apart from U+Es, what further blood tests should you do?

A
  • CRP and ESR
  • LFTs
  • Bone profile/Ca level

LOOKING FOR METS

67
Q

Why does this patient have a left sided varicocele?

A

Left gonadal vein drains into left renal vein.

Tumour may thrombose and this occludes the left gonadal vein causing a varicocele

68
Q

What is the medial clear space and what is the upper limit for this?

A

Space between the medial mallelous and the medial side of the talus

5mm

69
Q

How do you treat a Weber B fracture?

A

Put in a below knee back slab for 1 week then bring back and x-ray before putting full cast on

70
Q

What is the first line imaging investigation for suspected appendicitis in a woman and why?

A
  • US abdomen
  • No radiation
  • Can see pelvic and renal organs

Men tend to go straight for surgery as less differentials for pain

71
Q

What are the values for daily water, sodium and potassium requirement?

A

Sodium: 1-2 mmol/kg

Potassium: 1 mmol/kg

Water: 25-30ml/kg

72
Q

Why does appendicitis have migratory pain from the umbilicus to RIF?

A

Appendix is midgut structure so pain is periumbilical, once somatic innervation from parietal peritoneum goes to RIF

(3) Surgery (21 decks)

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