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My CLASP Y3 > Anatomy and Radiology > Flashcards

Anatomy and Radiology Flashcards

1
Q

How is US created?

A

vibrating crystals and when this hits structures they are either transmitted on or reflected

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2
Q

What do the different colours mean on US?

A
  • White = reflected a lot of waves

- Dark = poorly reflected the sound wave energy

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3
Q

What is the orientation of the US image?

A
  • top = superficial

- bottom = deep

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4
Q

What are the four factors on taking a US?

A
  • Tilt: brightness can be altered by the probe
  • Pressure: too little is loss of contact and too much veins will be obliterated
  • Rotation: seeing nerves in different axes
  • Alignment: sliding and subtle movement aligns the probe to structures of interest
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5
Q

How do you tell direction of flow in colour doppler?

A

BART (blue away and red towards)

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6
Q

What does bone look like on US?

A

hyperechoic periosteum with acoustic shadow below

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7
Q

What do arteries look like on US?

A

anechoic, pulsatile, usually round

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8
Q

What do veins look like on US?

A

anechoic, non-pulsatile and compressible

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9
Q

What do nerves look like on US?

A

can be circular or oval with hyperechoic outline and speckled interior but more proximally they are hyperechoic interior due to less connective tissue

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10
Q

What do tendons look like on US?

A

look like nerves but blend into muscle or into thicker tendon

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11
Q

What do muscles look like on US?

A

hyperechoic mass with visible striae or hyperechoic fascia

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12
Q

What are the common artefacts on US?

A
  • acoustic shadowing: shadow behind acoustically opaque structure
  • post-cystic enhancement: bright area behind a fluid filled structure
  • reverberation: strong reflecting interface close to transducer eg vessel wall, needle or muscle fascia
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13
Q

What are the important things to check before examining an XR?

A
  • projection: PA is the best so the heart isn’t abnormally magnified as it is on AP
  • inspiration: at least 6 anterior ribs visible
  • rotation: medial ends of the clavicles should be equally distanced from the spinous processes
  • penetration: enough radiation
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14
Q

What is the normal size of the heart on an XR?

A

less than 50% of the thorax diameter

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15
Q

What is the normal comparison of hila and diaphragms?

A
  • left hilum usually sits slightly higher than the right

- right diaphragm should be slightly higher than the left

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16
Q

Where are the places in an XR that pathology is commonly missed?

A
  • lung apices eg pneumothoraces/tumours
  • behind the heart eg hiatus hernia
  • below diaphragm eg free gas/lines/tubes/bowel obstruction
  • bones/soft tissues eg subcutaneous emphysema
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17
Q

When does lobar collapse occur and what does this look like?

A
  • obstruction of a lobar bronchus

- will look white as there is no air in it

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18
Q

Where do the left lung lobes collapse to?

A
  • lower lobe collapses down to behind the heart so left hemidiaphragm will be higher than right
  • upper lobe collapses anteriorly onto the heart so the heart almost disappears ie veil like opacity
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19
Q

Where do the right lung lobes collapse to?

A
  • upper lobe collapses upwards and there is increased density in right upper zone, horizontal fissure can be seen also
  • middle lobe collapse doesn’t tend to happen without a lower lobe collapse due to bronchus intermedius obstruction, loss of clarity of the right heart border
  • lower lobe collapse will show volume loss on the right and loss of clarity of the right hemidiaphragm
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20
Q

What is seen on XR with consolidation?

A
  • air bronchograms (bronchus will contain air but surrounding lung won’t)
  • no change in volume so diaphragms okay
  • no mediastinal shift
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21
Q

What is the progression of pulmonary oedema on XR?

A
  1. Dilation of the upper lobe vessels and cardiomegaly
  2. Interstitial opacities ie peribronchovascular cuffing and septal lines aka Kerley B lines
  3. Filling of alveoli with fluid, perihilar or batwing distribution and air bronchograms
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22
Q

What are the ABCs of pulmonary oedema on XR?

A 
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural Effusion
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23
Q

Where should endotracheal tubes sit?

A
  • 5cm above carina
  • not in a bronchus
  • not in the oesophagus
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24
Q

Where should nasogastric tubes sit?

A
  • over gastric bubble
  • in subdiaphragmatic position
  • 10cm beyond gastro-oesophageal junction
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25
Q

Where do central venous catheters sit?

A
  • right/left internal jugular or subclavian veins

- tip should be at the cavoatrial junction

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26
Q

When is V/Q scan very good for PE?

A

pregnant patients as it is safer than gold standard which is CTPA

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27
Q

How can you tell the difference between PA and AP XR scans?

A 
PA = can't see scapulae as they are out of the way from standing position 
AP = heart abnormally large
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28
Q

What is easiest way to differentiate between CT and MRI?

A

bone is white on a CT but it is black on an MRI

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29
Q

What is the first and second line for brain imaging?

A
  • CT is fast

- MRI is second but first for spinal cord issues

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30
Q

What are the cisterns of the brain?

A
  • suprasellar cistern (aka stellate)
  • cisterna magna
  • quadrigeminal cistern
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31
Q

What cistern does the circle of Willis sit in?

A

supracellar

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32
Q

What is the difference between T1 and T2 weighted MRI images?

A
  • T1: fluid is black (anatomy seen better)

- T2: fluid is bright (pathology seen better)

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33
Q

What is the main investigation for a stroke?

A

non-contrast CT

34
Q

What is the earliest sign of stroke on CT?

A

hyper dense vessel due to clotted blood

35
Q

What are the later signs of stroke on CT?

A
  • loss of grey-white matter differentiation
  • hypoattenuation
  • early mass effect due to parenchymal swelling
36
Q

What are the latest and permanent signs of stroke?

A
  • gliosis (large cavity appears)

- enlarging of the ventricles

37
Q

What is the appearance of acute blood on a CT?

A

white

38
Q

What are the main types of intracranial haemorrhage?

A
  • intra axial

- extra axial: extradural, subdural and subarachnoid

39
Q

What are the most common hypertensive bleeds?

A

thalamic bleeds which are intra-axial

40
Q

What is the presentation of an extradural haemorrhage?

A

lucid interval and then sudden deterioration with herniation

41
Q

What are the most common causes of subdural haemorrhage?

A
  • NAI in children

- falls in elderly

42
Q

What is XR used for in acute abdomen?

A
  • supine for bowel obstruction

- erect for hollow viscus perforation

43
Q

What is US used for in acute abdomen?

A
  • liver
  • ascites
  • female pelvic organs
  • appendicitis in children
  • aorta
44
Q

What are the negatives of CT?

A
  • large amounts of radiation
  • allergy
  • nephropathy
45
Q

What is MRI second line for in acute abdomen?

A
  • hepato-biliary
  • pelvis
  • small bowel
46
Q

What are the differentials for RIF pain?

A
  • appendicitis
  • renal colic
  • tuba-ovarian pathology
47
Q

What is the radiology for appendicitis?

A
  • in kids: US

- in adults: US and CT to confirm

48
Q

What is seen on US in appendicitis?

A
  • aperistaltic and non-compressible dilated appendix
  • ?black fluid around
  • ?lymph nodes
49
Q

What is seen on CT in appendicitis?

A
  • appendiceal dilation
  • potential fat stranding
  • calcificated faceolith
50
Q

What is the investigation for renal colic?

A

non-constrast CT

51
Q

What are the differentials for LIF pain?

A
  • diverticulitis
  • colitis
  • colorectal cancer
  • renal colic
  • tubo-ovarian pathology
52
Q

What are the investigations for diverticulitis?

A

CT with contrast to confirm diverticula, inflammation and assess for complications eg perforation/fistulae/abscess

53
Q

What are the differentials for epigastric and RUQ pain?

A
  • biliary colic
  • cholecystitis
  • pancreatitis
  • perforation
54
Q

What is the best imaging for gallstones?

A
  • US first line to assess gallbladder and stones
  • MRI for biliary tree dilatation
  • CT not good for stones
55
Q

What is seen on US in gallstones?

A
  • gallbladder wall thickening

- pericholecystic fluid

56
Q

What are the investigations for pancreatitis?

A
  • US for causes ie gallstones

- CT done many days after too look for complications

57
Q

What is the imaging for perforation?

A
  • XR for age under diaphragm

- CT for fluid and inflammatory fat stranding

58
Q

What are the differentials for abdominal pain and distention?

A
  • small bowel obstruction
  • large bowel obstruction
  • masses
  • ascites
59
Q

What is the imaging for small bowel obstruction?

A
  • XR to differentiate between small and large obstructions

- CT is good too

60
Q

What is the imaging for large bowel obstruction?

A
  • XR to differentiate between small and large obstructions

- CT confirms diagnosis, determines location, cause and complications

61
Q

What are the differentials for sudden abdominal pain and shock?

A
  • bowel ischaemia
  • perforation
  • pancreatitis
  • leaking AAA
  • ruptured AAA
  • ruptured ectopic pregnancy
62
Q

What is the investigation for bowel ischaemia?

A

CT

63
Q

What is the investigation for leaking AAA?

A

CT

64
Q

What is a flail chest?

A

more than three ribs fractured in more than one place

65
Q

What do you look for on a chest XR in trauma?

A
  • pneumothorax
  • effusion
  • pneumonia
  • pneumoperitoneum
66
Q

What do you look for on an abdominal XR in trauma?

A
  • obstruction/ileus

- pneumoperitoneum

67
Q

What is Rigler’s sign?

A

a sign of pneumoperiotneum as you can see both sides of the wall of the bowel

68
Q

What is the anterior sail sign in the elbow?

A

enlarged fat pad due to joint effusion because of fracture

69
Q

What is a Colles fracture?

A

distal forearm fracture that has moved dorsally

70
Q

What is a Smith’s fracture?

A

distal forearm fracture that has moved volarly

71
Q

What is an important consideration with scaphoid fracture?

A

can be avascular necrosis of the proximal pole as the main blood supply is to the distal pole

72
Q

What is the diagnosis of low BP and tachycardia in trauma until proven otherwise?

A

hypovolemia due to haemorrhage

73
Q

What does fluid look liken US?

A

black

74
Q

What is likely to be injured in a supracondylar humeral fracture?

A

ulnar nerve which runs posterior to medial epicondyle of elbow

75
Q

What is different about the upper facial muscles?

A

CNVII is bilateral so there is forehead sparing in an UMN lesion

76
Q

Where does the aotic arch begin and end?

A

T4/5 level

also carina and sternal angle are here

77
Q

What are the accessory muscles of respiration used when the scapulae are fixed on the legs?

A
  • serratus anterior
  • pectorlais minor
  • pectoralis major
78
Q

What nerve injury causes foot drop?

A

peroneal nerve/common fibular

79
Q

What nerve injury causes claw hand?

A

ulnar

80
Q

What nerve injury causes wrist drop?

A

radial

81
Q

What nerve injuries do different parts of the humerus fracturing cause?

A
  • surgical neck: axillary
  • mid-shaft: radial
  • supracondylar: ulnar
82
Q

What nerve injury does a neck of fibula fracture cause?

A

common fibular/peroneal

My CLASP Y3 (2 decks)

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