Diagnostic Imaging Lecture

Question 1

air appears (what color)

Answer 1

black

Question 2

fat appears (what color)

Answer 2

gray/black (faint)

Question 3

water appears (what color)

Answer 3

white

Question 4

bone appears (what color)

Answer 4

bright white

Question 5

xray front to back is what view

Answer 5

AP

Question 6

which chest view is more accurate interpretation of heart size

Answer 6

PA

Question 7

WHAT cxr view is good for seeing an effusion

Answer 7

Lat decub

Question 8

pneumonic for looking at xray

Answer 8

A-airway
B - Bones
C - cardiac silhouette/size
D - diaphragm/costophrenic angle
E -everything else

Question 9

Airway documentation

Answer 9

midline trachea, no deviation

Question 10

potential problems with x ray to assess (technique)

Answer 10

penetration - if its too dark, make it lighter and vs versa
position - assess for correct labeling of position
rotation - make sure they are not rotated (look at clavicles to make sure they are symmetrical)

Question 11

in an outpatient setting, do you need a chest x ray to diagnose pneumonia

Answer 11

no, clinically diagnosed with tachypnea, fever and focality on auscultation

Question 12

what lobes are more common in aspiration pneumonia

Answer 12

RU and R Middle lobe pneumonia

Question 13

Loculated bubble with an air fluid level

complication of what?

Answer 13

pneumatocele - complication of staphylococcal pneumonia

Question 14

most common with bilat, hazy appearance

perihilar densities/peribronchial cuffing seen

Answer 14

bronchiolitis

Question 15

can range in size from trace to large, and in complexity with cavitations/loculations being hardest to resolve

Answer 15

pleural effusion

Question 16

can range from trace to large and can be life threatening if evolves

Answer 16

pneumothorax

Question 17

what can pneumo turn into if not treated

how to treat?

Answer 17

tension pneumo - medical emergency treat with needle decompression … mid clavicular line between 2nd and 3rd intercostal space

Question 18

image shows the water bottle sign

Answer 18

pericardial effusion

Question 19

Air accumulation in the pericardial cavity

Answer 19

pneumopericardium

Question 20

optimal endotracheal tube placement

Answer 20

T3-T4
above the carina

(t 1 is where the first rib comes off)

Question 21

AP image of abdomen through pelvis

Answer 21

KUB

kidney ureters bladder

Question 22

intraluminal gas within the bowel wall, giving the bowel a mottled appearance with dilated loops

what is this and what is it most consistent with

Answer 22

Pneumatosis intestinalis

most consistent with necrotizing enterocolitis (NEC)

Question 23

Can see dilated loops > 3 cm, stepladder appearance or string of pearls

Answer 23

small bowel obstruction

Question 24

see dilations >7cm, haustration

Answer 24

large bowel obstruction

Question 25

twisting of intestine and mesentery upon itself with distal obstruction - coffee bean sign

Answer 25

Volvulus - surgical emergency

Question 26

telescoping of intestine upon itself at multiple possible points target sign meniscus or crescent sign

Answer 26

intussusception

Question 27

target sign

Answer 27

intussusception

Question 28

step ladder appearance

Answer 28

small bowel obstruction

Question 29

string of pearls

Answer 29

small bowel obstruction

Question 30

coffee bean sign

Answer 30

volvulus

Question 31

meniscus sign

Answer 31

intussusception

Question 32

crescent sign

Answer 32

intussusception

Question 33

best for addressing bones, blood (bleeding)

Answer 33

CT scan

Question 34

takes multiple x rays (slices)

Answer 34

CT scan

Question 35

best for addressing fine details of soft tissue (looking for brain lesion not noted on CT) Gray/white matter differentiation

Answer 35

MRI

Question 36

looking for brain lesion not noted on CT

Answer 36

MRI

Question 37

bleed lens shaped being pushed away brain from skull inward bleed between skull and dura mater

Answer 37

epidural hematoma

Question 38

"hugging the brain" "c shaped or crescent" | bleed between dura mater and brain, usually due to stretching/tearing of blood vessels

Answer 38

subdural hematoma

Question 39

type of bleed common in shaken baby

Answer 39

subdural hematomas

Question 40

rarely found in isolated fashion if caused by trauma, almost always found in concert with another bleed

Answer 40

subarachnoid bleed

Question 41

s/s terrible headache, n/v/ ams | requires coils or clipping and vasospasm reduction

Answer 41

subarachnoid bleed

Question 42

dilation of ventricles in response to either excess csf production or due to obstruction somewhere in path of CSF flow

Answer 42

Hydrocephalus

Question 43

what chest view gives a more accurate depiction of heart size

Answer 43

PA

Question 44

1st rib comes off of what vertebrae

Answer 44

T1

Question 45

how many ribs should you see on x ray

Answer 45

8-10

Question 46

lobes and fissures for R lobe vs L lobe

Answer 46

R 3 lobes 2 fissures | L 2 lobes 1 fissure

Question 47

How can you tell if pneumonia is RUL vs RML....

Answer 47

For RML your heart border is more hazy where as RUL is a clear hear border

Question 48

diagnosis described: area of focality, focused to a specific lobe or lobes of lung

Answer 48

Bacterial Pneumonia

Question 49

ABX for bacterial pneumonia home oral vs inpatient IV if they arent getting better on the IV abx what are you going to change to If they still continue to worsen/look toxic

Answer 49

45mg/kg Amoxicillin Ampicillin Rocephin Vanc

Question 50

most common secondary infection following influenza

Answer 50

Staph ....can loculate off and form a pneumatocele

Question 51

where should your ET tube show up on the x ray (vertebrae)

Answer 51

T3

Question 52

in an intubation if you have a lung collapse. what do you do

Answer 52

You can try some retraction of tube in an infant. In an adult you will prob have to extubate, bag and re-intubate

Question 53

what x ray view allows free fluid to layer out with air which will let air rise to top

Answer 53

lateral decub

Question 54

what is diagnostic for and also therapeutic for Intussusception

Answer 54

Barium Enema

Question 55

what do you do if you have a confirmed ng tube placement into the lung

Answer 55

leave it....and get assistance. at risk to perf the lung when you remove

Question 56

Nasoduodenal tube placement x ray

Answer 56

crosses the midline - past spine, should be outside the stomach....should start to curve downward

Question 57

subdural intervention depends on

Answer 57

size...sometimes they will monitor, sometimes needs surgical intervention

Question 58

treatment for hydrocephalus

Answer 58

Neurosurgery consult -possible ICP monitoring ETV vs VP shunt Ophthalmology consult

Question 59

MRI with contrast

Answer 59

infection Hem onc patients usually depending on what looking for if not concerned for infection, then without

Question 60

CT with contrast

Answer 60

for abd, usually lights up better with contrast.... CTA - looking for vascular abnormalities