Appropriateness ordering Flashcards
85 yo female presents to ER with acute RUQ pain. She has a history of cholecystectomy (25 years ago). She denies trauma but gives a history of life time of smoking and alcohol use. Her labs show elevated liver enzymes. What imaging examination(s) would be appropriate to order?
Think differential dx… can one test cover all of the items on your list?
RUQ U/S
Abdominal U/S
CT Abd/Pel with Contrast
In this case, any of the above examinations would be appropriate. The RUQ U/S would the first examination to consider if you did not suspect any other organ involvement or have a longer differential dx list. Several things to consider here, like if she has an allergy to iodinated contrast. I was giving some clues to cirrhosis of the liver.
24 year old male presents with left testicular pain and palpable mass.
U/S Scrotum
72 year old male patient has recurrent aspirate pneumonia. He lives in an assisted living facility for the past two years following a stroke.
Modified Barium Swallow
46 yo female has intermittent abdominal pain with a history of Crohn’s dx. You suspect a partial small bowel obstruction.
Small Bowel Follow Through
36 year old male comes to ER with a left flank pain complaint and hematuria.
CT Abd/Pel without Contrast (Stone protocol)
80 y/o female with severe pelvic pain and change in stool patterns. You suspect diverticulitis…
Barium Enema
40 year old female presents with severe upper abdominal pain and reflux. She states she has a history of GERD and ulcers.
Upper GI
20 year old female presents with RLQ abd pain, fever, elevated WBC. +McBurneys, Rovsings, Obturator and Psoas
CT Abd/Pel with Contrast
Remember… an U/S should be considered in children due to radiation
50 year old female has bladder mass at the junction of the ureter to the bladder (UVJ). You are concerned that her ureter may be obstructed
Intravenous Pyelogram (IVP)
Also called Intravenous Urogram (IVU)
2 day old infant presents with sacral dimple
U/S Spine (assess for tethering, meningeoceal)
28 year old female is having difficulty getting pregnant and has had a history of chronic inflammation of her Fallopian tubes.
Hysterosalpingogram
Can be done with iodinated contrast using fluoroscopy
OR
Dr. Dodge shows this as being done in U/S as well… just know the name of the exam I think for the exam.
28 year old male trauma patient with suspected perforation of the bowels
Acute Abd Series (supine abdomen, prone abdomen, erect abdomen, decubitus abd)
You may consider a CT Abd/Pel with contrast (depends on your differential list.
Note: most places do a erect chest xray (CXR) with this series… so you would have a CXR, supine and erect abdomen
65 year old smoker is having pain when swallowing. She states that everything feels like it gets caught she points directly to the bottom of her sternum. She also notes that she has been vomiting some blood.
Esophogram
Suspect esophogeal varices.
75 year old patient (smoker) with atherosclerosis presents with a sudden onset severe back pain.
CT Angiography Abd/Pel for suspected AAA
Chad complains of severe abdominal pain after being kicked in the abdomen by the bull he was trying to milk.
CT Abd/Pel with Contrast
