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3rd year medicine > CLASP - radiology > Flashcards

CLASP - radiology Flashcards

1
Q
A

3 - CXR (if AP will usually say)

4 - rounded mass extending from left hilum, left heart border visible

5 - left lower lobe (because PA)

6 - lung cancer

7 - biopsy

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2
Q
A

8 - CT

9 - lung mass

10 - left pulmonary artery (hilum)

11 - left pulmonary artery, left atrium, pulmonary veins

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3
Q
A

12 - emphysema (black cystic holes)

13 - liver, brain, bone, andrenal glands

* lymph nodes = hilar, bronchial

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4
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14 - liver

15 - metastases, dark and round (streaks are thehepatic veins)

16 - 7th and 8th liver segments

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5
Q
A

osteolytic lesion (costal metastases)

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6
Q
A

18 - left and right renal masses

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7
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A

19 - CT contrast (remember T1 and T2 is MRI)

20 - mass in RIGHT frontal lobe

21 - right frontal lobe

22 - metastasis

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8
Q

X-ray density of air? fat? soft tissue/muscle? bone? metal?

A

air = black

fat = grey

soft tissue/muscle = grey/white

bone = white

metal = bright white

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9
Q

how is CTR measured?

normal?

A

PA CXR

normal = <50%

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10
Q

how to tell is CXR is adequately inspired?

correctly centred?

A

will be able to see at least 6 ribs

centred = medial ends of clavicles equal distance from spinous processes of vertebrae

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11
Q

borders that should be visible on CXR?

A
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12
Q

contents of lung hila?

which hilum sits higher?

A

contents = pulmonary arteries, pulmonary veins + bronchi

left hilum sits higher than right

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13
Q

are diaphragms normally same height?

A

no - right diaphragm sits 1.5cm above left

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14
Q

review areas on X-ray

A

review areas are often missed - so special attention paid to them

* lung apices e.g. pancoast tumour, pneumothorax

* behind heart e.g. consolidation, masses, hiatus hernia

* below diaphragm e.g. free gas, lines and tubes, bowel obstruction

* bones and soft tissue e.g. fractures, masses, subcutaneous emphysema

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15
Q

lung lobes

A
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16
Q

Ax lobar collapse?

A

obstrcution of lobar bronchus - tumours, aspirated foodstuffs, mucous impaction

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17
Q

left lower lobe collapse

A

sail sign!!

also left hemi-dipahragm higher than right

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18
Q

left upper lobe collapse

A

veil-like heart border

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19
Q

right upper lobe collapse

A

increased desnity + volume loss

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20
Q

right middle lobe collapse

A

loss of right heart border

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21
Q

right lower lobe collapse

A

preservation of heart border

loss of hemi-diaphragm

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22
Q

what is the diagnosis

A

right middle + lower lobe collapse

cant see diaphragm or heart border + volume loss

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23
Q

diagnosis?

A

right middle lobe consolidation

* loss of clarity of right heart border but preservation of right hemi-diaphragm

* follows same pattern of collpase without volume loss

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24
Q
A

left lingular consolidation (part of left upper lobe)

* consolodation of lingula causes left heart border to become obscured

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25
left upper lobe consolidation \* volume preserved \* can still see heart border \* loss of clarity of left upper mediastinum
26
pleural effusion - meniscus sign
27
right pneumothorax - cant see lung markings
28
tension pneumothorax - mediastinal shift
29
diagnosis?
heart failure - pulmonary oedema ABCDE A - alveolar effusion (batwing opacities) B - kerley B lines C - cardiomegaly D - dilated upper lobe vessles E - pleural effusion
30
heart failure - pulmonary oedema \* ABCDE
31
endotracheal tube position? most common malposition?
normal = tip 5cm above carina malposition = tip extends past carina most common malposition = tip in right **main** bronchus
32
ET tube positioned correctly?
no - it is in the right main bronchus
33
ideal position for nasogastric tube? malposition examples?
ideal position = subdisphragmic, overlying gastric bubble, at least 10cm beyond gastro-oesophageal junction malposition: remains in oesophagus, bronchus
34
is NG tube correctly placed?
no it's in right lower lobe bronchus
35
central venous catheter vs peripheral venous catheter insertion
CVC = inserted via right and left internal jugular or subclavian veins PVC = via cephalic, basilic or brachial veins
36
position of central venous catheter? malposition?
tip should be in **cavoatrial junction** malposition = tip too high (proximal SVC), tip too low (RA or RV)
37
CVC placed correctly?
no it has gone into subclavian vein should be in cavoatrial junction
38
Dx?
cannon ball metastasis from renal cell cancer
39
lung cancer staging
T - tumour size N - intrathoracic lymph node M - metastases
40
imaging modalities for staging lung cancer
contrast enhanced CT PET CT
41
Dx?
pneumoperitoneum perforation of GI tract results in gas in the peritoneal cavity radiograph must be taken in the ERECT position (allows gas to rise up under diaphragm)
42
first line Ix for pneumoperitoneum?
erect CXR
43
1 - CVA, TIA (recovery is quick) 2 - non-contrast CT
44
3 - non-contrast CT 4 - thrombus in right middle cerebral artery 5 - right MCA 6 - ischaemic stroke 7 - age, hypertension, angina, irregular HR
45
8 - thrombolysis 9 - no bleed
46
10 - hypodense region (ischaemia), hypoattenuation
47
11 - haemorrhage 12 - CT without contrast
48
13 - haemorrhage, midline shift 14 - right parietal lobe 15 - haemorrhagic stroke
49
16 - NG tube in correct position
50
17 - gliosis (scarring of brain tissue) 18 - AF
51
fissures CT brain
supracellar = above sella turkica
52
suprasellar cistern contains?
circle of willis
53
familiarise anatomy MRI
54
vascular territories
55
circle of willis
56
imaging in stroke?
**non contrast CT scan**
57
findings stroke CT?
58
gliosis
59
acute on chronic subdural haematoma see fluid level
60
subarachnoid haemorrhage can see blood in sulci, suprasellar cistern, sylvian fissures
61
left MCA
62
coning?
tonsillar herniation
63
....
64
...
65
spinal cord compression? Ax?
surgical emergency!! Ax * disc prolapse * trauma * tumour * epidural abscess/haematoma * spinal meningioma * nerve sheath tumour
66
Ix spinal cord compression?
**MRI spine!!**
67
what does this CT show what should be done now?
fracture at L2 MRI must be done to Ix cord compression
68
1 - pancreatitis, bowel ischaemia, perforation, ectopic rupture, leaking AAA 2 - ABCDE 3 - erect CXR (perforation)
69
8 - acute pancreatitis 9 - USS to check for gallstones
70
12 - CT, it shows necrosis of the pancreas 13 - venous thrombosis, ARDS, renal failure, sepsis, abscess vessles = splenic artery + vein, SMA, hepatic arteries + portal vein
71
liver stomach (fasted) gallbladder CBD pancreatic duct 15 - ECRP (gallstones)
72
peri-pancreati fluid compression (can see compressing stomach anteriorly) Tx = percutaneous drainage
73
pancreatic pseudocyst compressing stomach
74
NJ tube (not NG) lies in jejunum
75
acute abdominal pain DDx?
76
Dx acute appendicitis?
CT and USS ## Footnote **no role for X-ray**
77
USS findings acute appendicitis
aperistaltic = not moving
78
CT findings acute appendicitis
79
gold standard imaging for ureteric stones?
**non-contrast CT** (CT KUB)
80
LIF pain DDx?
diverticulitis colitis colorectal cancer tubo-ovarian pathology renal colic
81
acute diverticulitis s/? as disease progresses?
LIF pain unremitting pain with associated tenderness sometimes ill-defined mass as disease progresses symptoms become more generalised
82
gold standard Ix for acute diverticulitis?
**CT with IV contrast**
83
epipolic appendagitis can mimic? what is it?
can mimic **diverticulitis** part of colon is torsioned and infarcts
84
acute cholecystitis Ax? S/s? Dx?
almost always secondary to gallstone s/s = RUQ pain, fever, raised WCC and CRP Dx = USS first line
85
where is gallbladder located?
tucked under 5th liver segment
86
2nd line Ix cholecystitis? findings?
2nd line = CT (1st line USS as CT can miss gallstones)
87
.... diagnostic?
88
Tx options acute cholecystitis
most common cause is gallstones remember
89
pancreatitis s/s? Dx?
acute onset severe epigastric pain poorly localised, tender exacerbated by supine position radiates to back in 50% of pateints Dx = serum amylase increased
90
Ix pancreatitis? Dx?
USS + CT are **not** diagnostic * USS is to look for CAUSE i.e. gallstones * CT is to look for complications e.g. necrosis, vascular comps Dx = elevated serum amylase
91
Ix of choice for perforation?
erect CXR
92
abdominal pain and distention DDx?
bowel obstruction masses ascites
93
Ax small bowel obstruction? Symptoms? signs? Ix?
Ax = adhesions, cancer, hernia, gallstone ileus symptoms = vomiting, pain, distention signs = **increased** (tinkling) bowel sounds, tenderness, palpable loops Ix = x-ray, CT (USS has no role)
94
small bowel obstruction x-ray features?
95
small bowel obstruction CT features?
96
small bowel obstruction caused by gallstone ileus
97
large bowel obstruction Ax? Ix?
colorectal cancer (most common) volvulus diverticulitis Ix = x-ray and CT
98
large bowel obstruction features x-ray?
99
large bowel obstruction CT features?
not great pic but can see pneumotosis coli (blakc dots = gas in wall of caecum)
100
sudden abdominal pain and shock DDx?
bowel ischaemia perforation pancreatitis leaking AAA ruptured ectopic pregnancy
101
Ax bowel ischaemia?
arterial occlusion (majority) - SMA, coeliac, IMA venous occlusion - hepatic portal vein, IMV, SMV, splenic vein non-occlusive hypoperfusion
102
bowel ischaemia symptoms? signs?
symptoms = severe abdominal pain, vomiting, diarrhoea signs = raised WCC, metabolic acidosis, borderline amylase
103
Dx bowel ischaemia?
CT!!!! x-ray and MRI have no role
104
CT appearance bowel ischaemia?
105
leaking AAA s/s? Ix of choice? what will you see? what can mimic?
S/s = pain, hypotension, pulsatile abdominal mass **CT is investigation of choice** on CT will see retroperitoneal haemorrhage next to aneurysm **renal colic can mimic this**
106
red = pneumothorax green = blood (consolidation)
107
plane = coronal organ = spleen injury = splenic laceration Tx = **embolisation** (splenic artery + shot gastric artery - dual supply)
108
catheter angiogram splenic artery originates from coeliac trunk other branches of coeliac trunk = splenic artery, common hepatic, left gastric
109
sagittal plane injury = T12 fracture spinal cord impingement
110
distal radius + ulna colles dinner fork deformity (like a fork)
111
Tx?
tibia + fibula (ankle) dislocation - fibula and talus normally articulated Tx = relocation, cast
112
flail segment?
more than 3 adjacent ribs are fractured in 2 or more places
113
...
114
when do you do AXR?
bowel obstruction/ileus pneumoperitoneum
115
signs of pneumoperitoneum AXR?
**rigler sign!** = pneumoperitoneum (also known as double-wall sign, gas outlines both sides of bowel wall i.e. gas within bowel's lumen and gas within peritoneal cavity)
116
most commonly injured solid organ?
spleen
117
types of fracture? which of these are seen in children?
torus and greenstick seen in children
118
anatomical vs surgical neck humerus fracture
119
signs of radial head fracture?
120
greenstick fracture
121
smiths fracture
122
blood supply to scaphoid?
at risk of AVN
123
....
124
intracapsular fracture - hip replacement
125
intertrochanteric fracture - dynamic hip screw
126
double malleolar fracture + fibula dislocation?
127
Dx? next steps?
RUL collapse next Ix = CT
128
Dx?
Hila should look like chevrons (arrow pointing in the way) Sarcoidosis!! Or TB, or lymphoma **Bilateral hilar lymphadenopathy**
129
Ng tube gone into right bronchus
130
lateral tibial plateau fracture
131
posterior dislocation - lightbulb sign
132
large bowel obstruction

3rd year medicine (13 decks)

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