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PAM Semester 2 > Diagnostics Radiology Exam 2 > Flashcards

Diagnostics Radiology Exam 2 Flashcards

1
Q

GI Contrast Agents

A

Barium (no bowel perf)

Gastrografin (water soluble) (for perf)

air used as a negative contrast agent

Barium and air = Double

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2
Q

GI contrast studies

A

Barium swallow

Upper GI (single/double)

Barium enema (single/double)

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3
Q

Contraindications to Barium Studies

A

large bowel obstruction (not by mount)

Elctrolyte imbalance

Perforation

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4
Q

Pharynx/Esophageal Imaging

A

modified barium swallow

Performed as videofluoroscopy

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5
Q

gold standard

at evaluating dysphagia

A

Barium swallow

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6
Q

Schatzki Ring

A

Esophageal ring stenosis typically
causing dysphagia

Very capable at blocking solid
food that is poorly chewed

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7
Q

Best view for esophogeal imaging

A 
oblique view of a normal
barium swallow shows the
normal impressions made by the
aortic arch, left mainstem
bronchus, and (LA) left atrium on
the esophagus.
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8
Q

Esophageal stricture

A

Stem from repeated bouts of
esophagitis with ulceration and
then subsequent fibrosis

(restriction)

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9
Q

Common sign of divertiucla and varices

A

Bad Breath

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10
Q

Esophageal Perforation

A

See following ETOH binges and
frequent vomiting

(Boerhaave’s syndrome)

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11
Q

Achalasia

A

Lower esophageal sphincter disfunction

“Bird’s Beak appearance”

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12
Q

Scleroderma

A

Collagen-vascular disease
characterized by diffuse fibrosis

Esophageal involvement occurs
in 75 to 87% of patients

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13
Q

Scleroderma difference from achalasia

A

no Birds beak LES constriction,

just widely patent dysfunctional LES

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14
Q

Types of esphogeal neospasms

A 
Infiltrative
Polypoid
Annular stenotic
Ulcerative
Varicoid
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15
Q

Reasons for Abdominal XRay

A
  • Abdominal Distention
  • Suspected Bowel Perforation
  • Suspected Bowel Obstruction
  • Swallowed FB
  • Diffuse Abdominal Pain
  • Localize enteric tube or other device
  • Screen for large kindey stones
  • Post-op Fever
  • Ruptured AAA
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16
Q

How often is SBO missed

A

SBO may be missed 30-70% of all
radiographs

• CT is preferred if available

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17
Q

Abdominal X ray reading approach

A

– Bones

– Stones or FBs

– Gas
• Extraluminal – free air/pneumatosis
• Intraluminal – dilation and air fluid levels

– Mass
• Look at all organs

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18
Q

Normal Abdominal series (xray)

A

Upright abdomen (pt must be upright for at least 5 min.).

Flat abdomen/KUB (aka supine abdomen)

PA CXR
more sensitive for pneumoperitoneum than upright ABD

(Might be just “Upright Ab” and “PA CXR”…unsure)

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19
Q

Abdominal X ray if unable to stand

A

AP Supine,
left lateral decubitus and
AP chest

(to be done if patient is unable to stand for upright abdomen or chest)

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20
Q

Free Peritoneal Air

aka

Pneumoperitoneum

A

• Free intraperitoneal air will accumulate under the right hemidiaphragm on an upright film.

(under the left is less common due to phrenicolic ligament)

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21
Q

Free Peritoneal Air

aka

Pneumoperitoneum

A

• Free intraperitoneal air will accumulate under the right hemidiaphragm on an upright film.

(under the left is less common due to phrenicolic ligament)

Usually seen with large amount
of air (>1000ml)
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22
Q

Most vommon cause of Free Peritoneal Air

Pneumoperitoneum

A

A perforated viscus (intestinal perforation) is probably the most common cause of free air

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23
Q

Pneumoperitoneum differential diagnosis:

A

Perforated viscus (90%)

  1. Peptic ulcer
  2. Diverticulitis
  3. Appendicitis
  4. Toxic megacolon
  5. Intestinal infarct
  6. Neoplasm
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24
Q

What is Rigler sign

A

(double wall sign)

where gas outlines both sides of the bowel wall (intraluminal and extraluminal)

Seen on supine view (Pneumoperitoneum)

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25
Q

What does KUB mean

A

Kidneys, ureters, bladder

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26
Q

When to order KUB

A

Order this exam when you need a flat film of the abdomen only (e.g. large kidney stones, constipation, FBs)

(CT’s are more sensetive)

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27
Q

What combination of studies complete the abdominal series in a patient that cannot stand?

  1. PA Abd, KUB and PA Chest
  2. PA, Lateral and LLDP
  3. AP chest and abdomen, LLD
  4. PA, LLDP and AP Chest
A
  1. AP chest and abdomen, LLD
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28
Q

Bowel wall evaluation of malignancy

A

Tumor
Edema
Post inflammatory changes

Note an apple-core lesion, which is generally a sign of malignancy

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29
Q

CT Imaging of Abdomen

A

Preferred modality in majority of
Bowel abnormalities

Transverse is the primary plane
for CT evaluation

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30
Q

Transverse Plane

A

Viewed from below as looking

towards head

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31
Q

Sagittal Plane

A

• Looking at patient from the left

side

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32
Q

Frontal or Coronal Plane

A

• Looking at patient from the front

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33
Q

CT Windows

A

Important to distinguish
evaluation of specific tissue by
adjusting density

adjusting density
– Increasing the window level

decreases the brightness
– Decreasing the window level will
INCREASE the brightness of the
image

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34
Q

Appendicitis X ray

A

Most patients with acute
appendicitis have normal
abdominal plain films

• Do NOT use XRay to diagnose
appendicitis

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35
Q

Appendicitis in Peds

A

In a pediatric population
• RLQ Ultrasound is first-line

  • CT with oral and IV contrast is the next step
  • MRI if high suspicion but severe contrast allergy or pregnancy
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36
Q

Appendicitis in Adults

A

In an adult, CT with at least IV contrast is indicated

• Consider alternative studies if suspect other pathology or have low
BMI

• **Normal appendix is rarely visualized on an ultrasound

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37
Q

Abdominal/Pelvic Abscess imaging choice

A

CT

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38
Q

You are seeing a 13yo female with complaints of abdominal pain and
vomiting at a large academic pediatric hospital. Patient denies
diarrhea or UTI symptoms. She denies vaginal bleeding. Abdomen is
soft, patient has mild positive McBurney’s and negative Rovsing signs.
What imaging choice would be best to screen patient for suspected
diagnosis?

  1. Xray
  2. CT without contrast
  3. RLQ Ultrasound with Duplex
  4. MRI with contrast
A
  1. RLQ Ultrasound with Duplex
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39
Q

Bowel Obstruction, Free Fluid and Free Air
in Adults
DDX

A
  1. Adhesions
  2. Hernias
  3. Neoplasms
40
Q

Bowel Obstruction, Free Fluid and Free Air
in Peds
DDX

A
  1. Intussusception
  2. Hernia
  3. Appendicitis
41
Q

What are the normal calibers of small
bowel, large bowel/transverse colon,
and the cecum?

A

3=Small

6=Large

9=Cecum

42
Q

You are seeing a 65yo WM wit Hx of multiple abdominal surgeries with 1 day worth of abdominal pain. Abdomen is tight, tympanic. Patient has had vomiting but no BM. KUB notes multiple small bowel dilated loops with air-fluid levels.

What is the most likely diagnosis?

  1. SBO
  2. Constipation
  3. Enteritis
  4. Appendicitis
A
  1. SBO
43
Q

What does an ileus look like on imaging

A

enlargement of the GI tract

44
Q

You are seeing a 9yo male with complaints of Abdominal pain. KUB shows distended large bowel at the distal transverse colon. What is upper limit of normal diameter size of colon in this region?

  1. 3cm
  2. 6cm
  3. 9cm
  4. 12cm
A
  1. 6cm
45
Q

Crohn’s Disease

A

Ulcerations, erosions, and full-thickness bowel wall inflammation

• As with Ulcerative Colitis,

Crohn’s diagnosis can only be made via colonoscopy with biopsy.

46
Q

Ulcerative Colitis

A

Superficial ulcerations, edema, and hyperemia of the colonic mucosa and submucosa

• Thumbprinting – indentation

Only in Large intestine

• As with Crohn’s

Ulcerative Colitis, diagnosis can only be made via colonoscopy with biopsy.

47
Q

Sigmoid Volvulus

A

A closed loop obstruction of the bowel - twisting; can lead to ischemia and necrosis

  • Most common in the sigmoid colon and cecum
  • Usually seen in elderly debilitated patients with chronic obstruction.

Diagnosis is made by Barium enema or endoscopy

CT is preferred

Coffee Bean sign

48
Q

Cecal Volvulus

A
  • Displaced cecum (normal location is within the right iliac fossa)
  • Small and large bowel obstruction up to the point of torsion

Barium enema does not extend to Cecal valve

• Less common than sigmoid volvulus

49
Q

A coffee-bean sign can be observed in which
radiologic conditions?

  1. SBO
  2. Ulcerative Colitis
  3. Volvulus
  4. Intussusception
A
  1. Volvulus
50
Q

Intussusception

A

Most patients are children less than 2 years old with a “telescoping” of the bowel

Usually idiopathic

Seen on plain film radiographs as a small bowel obstruction

• Diagnosis and treatment of pediatric intussusception is made by single contrast barium enema

51
Q

Hirschsprung’s Disease

A

Congenital aganglionic megacolon

52
Q

Meckel Diverticulum

A

Due to incomplete obliteration of omphalomesenteric duct causing fistula between ileum and umbilicus.

Clinically see painless rectal bleeding “currant jelly stools” in a patient <2yo.

Tc-99M nuclear scintigraphy is the study of choice

53
Q

Toxic Megacolon

A

Extreme dilation of the colon in which the affected area of bowel loses all tone and contractility

  • Ulcerative Colitis is the most common cause
  • Rectum is usually spared
  • Enemas are contraindicated due to high risk of perforation
54
Q

Free Peritoneal Fluid

A

Large amounts of free air in the abdomen will appear more radiolucent (darker) than normal

Large amounts of free fluid in the abdomen will appear more radiopaque (whiter) than normal

Fluid = White
Air = Dark
55
Q

Flank stripe

A

Should be able to see the flank stripe on normal x ray with no fluid (ascites)

56
Q

What kind of contrast do most abdominal CT’s require

A

at least IV contrast

Under BMI of 21 needs Oral contrast

57
Q

Causes of bowel thickening

A

Crohns

Abnormalities like strictures, fistulas, shigella, abcess

58
Q

Hernia

A

• Inguinal are most common (75%)

Diagnosis is usually clinical, but CT with IV contrast is the study of choice

59
Q

Lower abdominal pain should always receive

A

genitalia exam to r/o hernia or ovarian/scrotal problems

60
Q

Diverticulosis

A

herniation of portions of the mucosal and submucosal layers of the colonic wall

Usually painless but can lead to bleeding

Can become diverticulitits

61
Q

Bladder fistula

A

Air inside of bladder

62
Q

Bowel Neoplasms

Colorectal Adenocarcinoma

A

Applecore Lesions appearance

63
Q

Appendicitis Imaging

A

Start with ultrasound

CT shows best

64
Q

Vascular imaging of the bowel

A

for rectal bleeding

65
Q

Bowel ischemia

A

Pain disproportionate to exam finding

• Mesenteric CT Angiogram is imaging of choice

66
Q

AAA occur where

A

Most occur infra-renal
L2

3 types

67
Q

Pseudomyxoma Peritonei

A

“Jelly Belly”

The morbidity and mortality from
this process is very high.

68
Q

Presence of pneumatosis and pneumobilia on CT in a patient with rectal bleeding and abdominal pain usually represents what condition?

  1. SBO
  2. Bowel Ischemia
  3. Diverticulitis
  4. Ulcerative Colitis
A
  1. Bowel Ischemia
69
Q

When do you get benign liver tumors

A

Benign tumors such as hepatic adenoma and focal nodular hyperplasia are more common in young and middleaged women who have been taking birth control pills or hormonal replacement therapy

70
Q

When do you get liver carcinoma

A

Hepatocellular carcinoma, or hepatoma is more common in cirrhotic patients

71
Q

What is the most common benign liver tumor

A

The most common benign liver tumor is the cavernous

hemangioma

72
Q

Hepatic cyst imaging

A

With ultrasound, a hepatic cyst appears as a sharply defined round mass with a thin wall that is echolucent

73
Q

Diagnosis of a liver abscess is confirmed how

A

by percutaneous aspiration, performed by a radiologist, using CT or ultrasound guidance

74
Q

Best imaging for liver trauma

A

CT with oral and IV contrast is the imaging method of choice for liver trauma,

75
Q

Unstable patient abdomen (liver trauma)

A

Fast exam first

76
Q

Penetrating trauma vs blunt trauma

A 
Spleen = Blunt
Liver = penetrating
77
Q

Biliary Tree imaging

A

Ultrasound first

Then

Ultrasound
Cholescintigraphy
CT
Percutaneous transhepatic cholangiography (PTC)
Endoscopic retrograde cholangiopancreatography (ERCP)
MRCP

78
Q

Gall stone choleithiasis imaging

A

Ultrasound
95% detection rate

They appear echogenic
(shadow)

79
Q

Cholescintigraphy

A

Nuclear medicine imaging of the
liver and gallbladder

HIDA Scan

20-30 minutes for uptake
24 hours to clear nuclear agent

80
Q

Percutaneous Transhepatic Cholangiography

A

Carried out by injection of a water-soluble contrast material directly into the liver through the skin

81
Q

MRCP
vs
ERCP

A

ERCP is invasive with a scope

MRCP is noninvasive

82
Q

Common side effect fo ERCP

A

Pancreatitis

83
Q

You are seeing a 35yo WF with chronic Hx of obesity for evaluation of RUQ abdominal pain following Church’s Chicken meal. She has a positive Murphy sign. What imaging modality would you order?

  1. MRCP
  2. Ultrasound
  3. Cholescintigraphy
  4. CT without contrast
A
  1. Ultrasound
84
Q

Pancreas imaging

A

CT is the imaging method of choice for patients suspected of having pancreatic cancer, pancreatitis, pancreatic abscesses, and pancreatic trauma

85
Q

Painless jaundice think?

A

Pancreatic mass

obstruction of biliary tree

86
Q

Courvoisier’s law

A

the gallbladder is smaller than usual if a gallstone
blocks the common bile duct but is dilated,

if the common bile duct is blocked by something
other than a gallstone, such as pancreatic cancer.

87
Q

Cirrhosis

A

Cirrhosis resulting from chronic alcoholismwill alter the size, shape, contours, or density of the liver

CT is the imaging method of choice for cirrhosis,

88
Q

Causes of spleenomegaly

A 
malignancy (lymphoma), 
hemochromatosis,
thallassemia 
and many other
conditions
89
Q

Trauma and contrast?

A

All trauma below neck gets Contrast

90
Q

Spleen trauma imaging

A

CT is the imaging method of
choice for splenic trauma,

with contrast

91
Q

You are seeing a 55 yo WM who was involved in a MVC. He has
strong odor of ETOH. There is no external trauma besides a few
abrasions. Upon arrival his BP is 88/46 and HR is 122. What organ
is the most likely injured in this case?

  1. Pancreas
  2. Liver
  3. Spleen
  4. Small Bowel
A
  1. Spleen
92
Q

• Pt is a middle-aged man who noted increased prominence in his abdomen after recovering
from a laparotomy a year earlier

Condition?

A

Incisional hernia

93
Q

Middle aged male with chronic
alcoholism now complaining of
progressive right abdominal pain.

Condition

A

Large spleen and liver

94
Q

Young male suffered multiple
trauma in a motor vehicle
accident. He is hypotensive.

Condition

A

Liver laceration

Spleenic rupture

95
Q

40yo male in ED with Hx of right flank pain radiating to scrotum for 1 day and hematuria. Pain came on gradually and is 10/10. Naturally, you suspect kidney stone. Patient reports Hx of exploratory laparotomy following splenic rupture from MVC. Patient reports subjective fever and has RLQ abdominal tenderness on exam. Abdomen is soft. Patient refuses genitalia exam.

• Blood work and UA does not show anything exciting. His BMI is 20. What 2 imaging studies will cover all bases and exclude all most likely pathology in this patient?

A

Ultrasound of scrotum and testes with duplex

CT abdomen and pelvic CT with IV and PO contrast

PAM Semester 2 (22 decks)

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