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PAM Semester 2 > Diagnostics Radiology Exam 3 > Flashcards

Diagnostics Radiology Exam 3 Flashcards

1
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

CT abdomen and pelvis with IV and PO contrast

US scrotum and testes with duplex

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2
Q

Thin patients need what kind of contrast for CT

A

IV due to low fat content

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3
Q

Imaging for kidneys

A

Normal IVU (intravenous urogram) on KUB phase and horseshoe kidney on CT

CT with contrast is diagnostic imaging of choice in most GU imaging

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4
Q

Imaging for renal disease

  • Renal cysts
  • Nephroureterolithiasis
  • Polycystic renal disease
  • Pyelonephritis
  • Renal masses
A

CT abdomen and pelvis with and without IV contrast is study of choice

(With only in ER)

(couple of exceptions)

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5
Q

Renal Parenchymal Disease (renal disease)

A

• Involves Cortex and Medulla

Renal Disease involving glomeruli, interstitium, tubules, and small blood vessels of the kidneys.

Could always start with US but CT with and without contrast is the study of choice

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6
Q

Polycystic kidney disease may be similar to?

A

May have similar appearance to

malignancy

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7
Q

Polycystic kidney disease vs malignancy

A

Polycystic kidney disease usually bi lateral

Malignancy usually unilateral

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8
Q

Pyelonephritis can appear similar to?

A

Appears similar to Renal Cell Carcinoma or renal

lymphoma

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9
Q

Blood in peritoneal space can mean?

A

Lacerated or fractured kidney

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10
Q

Nephroureterolithiasis

A

Kidney Stones

Rule of thumb, anything under 5mm
passes

10% of ureterolithiasis cause no
hematuria

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11
Q

Nephroureterolithiasis imaging

A

CT without contrast

Consider contrast if something else is suspected

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12
Q

Nephroureterolithiasis when to use US

A

Young patient

Repeat visits with known stones

looking for obstructed stone, hydronephrosis or distended ureter.

If ureter is normal, probably not obstructed stone

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13
Q

When to consider pheochromocytoma

A

if adrenal lesions and unexplained HTN

check vanillylmandelic acid levels

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14
Q

Imaging for Adrenal Gland

A

CT or MRI are both suitable to image this pathology

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15
Q

What do vanillylmandelic acid levels represent

A

Pheochromocytoma

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16
Q

Causes of pre renal hematuria

A 
Vascular trauma, 
septicemia, 
purpura 
hemorrhagica, 
hemophilia
Renal Cell Carcinoma
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17
Q

Causes of Post Renal hematuria

A

cystitis
urolithiasis
malignancy
fistula

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18
Q

Causes of Renal hematuria

A

Acute Glomerular Nephritis,
renal infarct/embolism,
ATN
pyelonephritis

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19
Q

What do you always consider in hematuria

A

smoking history

if hematuria and smoker, cancer until proven otherwise

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20
Q

Painless hematuria

A

Cancer until proven otherwise

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21
Q

IV pyelogram

A

Can show stones
phlebolith
hydro nephrosis

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22
Q

Retrograde urethrogram

A

Inject the contrast through the meatus and travels into up urethra and into the bladder

Used to evaluate any flow problems

Usually done in pediatric or elderly populations

Can show prostatic hypertrophy

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23
Q

Retrograde cystogram

A

Used to evaluate the anterior urethra
or
Bladder abnormalities

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24
Q

What evaluates anterior urethra

A

Retrograde cystogram

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25
Q

Voiding cystourethrogram

A

Used to look at posterior urethra

Insert foley
infuse contrast straight into bladder,
remove foley
let them urinate and view the outflow

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26
Q

What evaluates posterior urethra

A

Voiding cystourethrogram

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27
Q

What can cause prolapse of the bladder

A

straining to urinate can cause prolapse when cystocele is present

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28
Q

Cystocele

A

Bladder herniation/diverticulum

Can be caused by straining to urinate

Seen with Voiding cystourethrogram

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29
Q

CT Urography

A

Can be ordered before any other tests to globally screen patient for renal and nonrenal abnormalities and explain symptoms

CT will have higher resolution and identify problems not found on Urography

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30
Q

Which study involves injection of contrast locally (not
intravenously) to evaluate for urologic abnormalities in a male patient?

  1. Pelvic Ultrasound
  2. Voiding Cystourethrogram
  3. CT abdomen and pelvis with contrast
  4. Intravenous Pyelogram
A
  1. Voiding Cystourethrogram
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31
Q

What is the primary imaging method for the female

pelvis

A

Ultrasound

Great for ovaries, pregnancy

A wide variety of benign pelvic conditions can be diagnosed with ultrasound including
ovariancysts
PID
endometriosis
benign tumors of the uterus (leiomyomas)
benign tumors of the ovaries (cystadenomas, cystic
teratomas)

MRI should be preferred if US is not definitive

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32
Q

How is Transabdominal pelvic ultrasound is performed

A

using the patient’s full bladder as an acoustic window

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33
Q

Is bladder better full or empty for transvaginal US

A

Empty

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34
Q

When is Transvaginal pelvic ultrasound specifically useful?

A

Visualization of small structures and is especially valuable in obstetrical imaging to depict first trimester development

diagnose ectopic pregnancy

Bladder is preferably empty

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35
Q

US • Hypoechoic

A

Tissues that do not reflect but absorb sound waves and therefore appear black (anechoic)

– Cysts, leiomyomas, fat

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36
Q

US • Hyperechoic

A

– Tissues that reflect sound waves and therefore appear white

– Renal stones, calcified lesions, teratomas, inflammatory change (PID), ectopic pregnancy

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37
Q

Are ovarian masses cystic, solid or complex?

A

All three

Ovarian masses may be cystic, solid, or complex.

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38
Q

What can show the flow to the ovary?

A

US with duplex

CT/MRI/ X-ray cannot show flow

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39
Q

What should you always order if you are considering torsion? (Ovary/Teste)

A

US duplex to show flow

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40
Q

Does absence of flow confirm torsion? (Ovary/Teste)

A

no

Flow may be intermittent or torsion may come and go

absence of flow does not rule out torsion

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41
Q

Leiomyomatous Disease

A

Uterine fibroid disease

large fibroids may need surgery

small fibroids may be managed with IR uterine artery embolization (cut off blood flow to fibroid)

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42
Q

What is helpful in staging pelvic malignancies

A

CT and MRI

MRI should be preferred if US is not definitive

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43
Q

Hysterosalpingogram (HSG)

A

outpatient OBGYN procedure

Contrast is injected up through the cervix
coats the uterus and is then expelled

NO barium (can cause peritonitis)

Abnormal will be unilateral or no extravasation out of uterus into peritoneal cavity.

Common in chlamydia

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44
Q

Hydorsalpinx

A

Dilation of the fallopian tubes

can be caused by ectopic pregnancy or other things

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45
Q

Obstetrical (fetal) imaging

A

US does not cause damage to fetus

(can raise temp if too long)

US can detect:
accurate date the pregnancy,
multiple pregnancies
monitor fetal growth
assess fetal wellbeing
fetal cardiac motion
fetal movements
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46
Q

Ectopic Pregnancy

A

Usually presents with abdominal pain and vaginal bleeding.

    • HCG test
  • PID is a risk factor
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47
Q

What does post menopausal bleeding DDX always include?

A

Malignancy

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48
Q

Post menopausal bleeding Study of choice

A

Ultrasound

MRI should be preferred if US is not definitive

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49
Q

Endometrium measurements

A

Endometrium is thickened if
greater than 15mm in pre menopause
greater than 5mm in post menopause

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50
Q

scrotal imaging of choice

A

Ultrasound

due to:

general availability
low cost
high accuracy
utilization of nonionizing radiation.

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51
Q

US imaging in men can identify

A 
inguinal hernias
testicular tumors
testicular torsion (Duplex)
testicular trauma
hydrocele
and many other conditions

MRI is alternative

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52
Q

Indications for US in men

A

acute testicular pain
palpable mass
scrotal swelling

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53
Q

How is the prostate evaluated

A

IVP (intravenous pyelogram)
US
CT

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54
Q

You are seeing a 16yo sexually active WM with complaints of RLQ abdominal pain radiating to right scrotum. No prior surgical history is reported. What study will be most important to order to screen for potential issues considering patients age?

  1. CT abdomen and Pelvis with IV and Oral Contrast
  2. CT abdomen and Pelvis without contrast
  3. KUB
  4. Ultrasound of scrotum and testes
A
  1. Ultrasound of scrotum and testes
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55
Q

What imaging for men when looking for scrotal, testicular, penile cancer

A

MRI

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56
Q

Leading cause of non-preventable cancer death in

women

A

Breast Cancer

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57
Q

How early can mammograms detect cancer

A

early at non palpable stage

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58
Q

Can Mammogram rule out cancer

A

Mammograms can rule in cancer
but
cannot rule it out

Cannot rule out cancer

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59
Q

Two types of Mammograms

A

Screening
used on asymptomatic women to detect unseen cancer

Diagnostic
Used to evaluate abnormal findings

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60
Q

Mammogram ages recommended annual screenings

A

over 50 should get bi annual screenings
(some say over 40)
American academy of oncologist recommend 40

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61
Q

Breast Imaging in Average Risk of Cancer

A

• Mammography is for patients older than 30 with a palpable breast mass

Ultrasound is for women younger than 30 with a palpable breast mass

30-39 could have either one

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62
Q

Negative Predictive Value

A

A value of combined mammography and sonography in patients with focal / diffuse breast pain but without highly suspicious exam findings is nearly 100%

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63
Q

Highly suspicious exam findings that warrant biopsy

A

Skin tethering
Peau d’ orange (orange peal)
nipple inversion
axilla lymphadenitis

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64
Q

Mammography imaging views

A

mediolateral oblique (MLO)

craniocaudad (CC) view

Top boob, side boob

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65
Q

What imaging is used in augmented breasts (implants)

A

MRI

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66
Q

What imaging is used to detect implant leakage

A

Ultrasound

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67
Q

kVp and mAs in mammogram?

A

Low KVP

High MAS

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68
Q

Breast Cancer Risk Factors

A

▪ Maternal relative with breast cancer

▪ Longer reproductive span

▪ Obesity

▪ Nulliparity

▪ Later age at pregnancy

▪ Atypical hyperplasia

▪ Previous breast or uterine cancer

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69
Q

What makes cancer easier or more difficult to see in the breast tissue

A

Fatty tissue is easier to see through than fibrocystic tissue or calcified tissue

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70
Q

BIRADS

A

Breast imaging reporting and Data system

5 types

Circumscribed
Obscured
Micro-lobulated
Ill-defined
Spiculated
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71
Q

BIRADS 5 types

A 
Circumscribed
Obscured
Micro-lobulated
Ill-defined
Spiculated
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72
Q

BIRADS Categories

A

Category 0 (need more imaging)

Category 1 (negative)

Category 2 (Benign)

Category 3 (Probably benign)

Category 4 (suspicious)

Category 5 (Highly suggestive of cancer)

Category 6 (Known biopsy, proven cancer)

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73
Q

When is a mass almost always cnacer

A

Spiculated

74
Q

Case:

You are seeing a middle-aged female with breast pain.

  • Mammography shows an oval, isodense mass with obscured margins measuring 1 cm.
  • Ultrasound shows a lobular, mixed echogenic mass with well-defined margins and no significant associated findings.
A

Diagnosis:

– Hematoma from seatbelt injury in MVA

– Additional history-taking raised the possibility of a seatbelt injury about 2 weeks prior to the examination. Clinical follow-up showed complete resolution after six months.

BIRADS doesn’t apply here

75
Q

Skin Calcification description

A

Skin calcifications have a typical lucent center and polygonal shape

76
Q

Vascular Calcification description

A

Vascular calcifications can be seen as parallel tracks or linear tubular calcifications that run along a blood vessel.

77
Q

Coarse or Popcorn-like Calcifications

A

Typically found in involuting fibroadenomas

Fibroadenomas usually regress with menopause

78
Q

Rod-Shaped Calcifications

A

Typical of secretory disease but not of breast cancer

Usually >1mm, are occasionally branching, and may have lucent centers

79
Q

Round Calcifications and Smooth round calcifications

A

Associated with a benign process

When <1mm they are often found in the acini of lobules

When <0.5mm the term punctate is used.

80
Q

Spherical or Lucent Centered Calcifications

A

Spherical or lucent centered calcifications can range from <1mm to >1cm.

They may be found as debris collected in a duct, in areas of fat necrosis and Fibroadenomas.

81
Q

When should MRI be done on breasts

A

• Should be done on a selective group of patients (including breast augmentation) with inconclusive evaluation of mammography identified noncalcified nonpalpable findings

82
Q

What is the diagnostic study of choice for a palpable breast mass in a 23yo female?

  1. Mammogram
  2. Ultrasound
  3. MRI
  4. CT
A
  1. Ultrasound
83
Q

Why does MRI increase your chances of?

A

Biopsy

84
Q

Standard skull View

A

AP or PA
Lateral
Oblique

Trauma views must include 2 views 90 degrees from each other so you can see all of the structures
i.e. Lateral and AP

85
Q

Is there strong correlation between skull fracture and brain injury?

A

No
there is little correlation

X-ray not helpful for brain injury, need CT

86
Q

What is the mainstay of emergent diagnostic neuro radiology?

A

CT

87
Q

Best imaging for facial bones

A

CT (without contrast)

anything but nasal bone, then x-ray

88
Q

What is waters view, and what is it used for?

A

Skull x ray that looks at the air-fluid levels of the maxillary sinuses

Patient must be upright to evaluate air/fluid levels

89
Q

Fuchs view

A

Fuchs view is used on patients who are in a a c collar and cannot open their mouths to evaluate the dens

Modified waters view is a fuchs view to look at dens

90
Q

Sinus series

A

X ray use is limited
CT is better for sinuses

Patient must be upright

91
Q

What imaging is for
Uncomplicated sinusitis
i.e. 3 days of sinus congestion and fever

A

does not require imaging for sinues

92
Q

Sinus Submentovortex

A

Looks at Ethmoid and Sphenoid
sinuses from under patients’ chin

CT is better

93
Q

Nasal Bone Series

A

• Waters and Lateral views

excellent for just nasal bone

94
Q

Mandible series

A

For mandible trauma, always look for a fracture in two places,

because ring-shaped structures, when they break, break in TWO places.

Hard to X ray due to its contours
and round shape.

PA Mandible, oblique use multiple views

CT is better

Panorex mandible (Dental)

95
Q

Zygoma Fractures

A

2 major components:
▪ Zygomatic arch
▪ Zygomatic body

Caused by blunt trauma

▪ Arch fracture (most common)
▪ Tripod fracture (most serious)

96
Q

Zygoma Tripod Fractures

A

– 1. Zygomatic arch
– 2. Zygomaticofrontal suture
– 3. Inferior orbital rim and floor

97
Q

Orbital Blowout Fractures

A

Blunt Trauma (usually small like a fist or golf ball)

Periorbital tenderness,
swelling
ecchymosis 
Enopthalmus
sunken eyes

SQ emphysema

CT

98
Q

Le Fort Fracture

A

Type 1,2 or 3

– I: Maxilla fracture (floating palate)

– II: Maxilla, orbital rim and nasal bones
(floating maxilla)

– III: II+ zygomatic arch fracture (floating
face)

patient has a dish face appearance (flat face)

99
Q

You are seeing a 75yo AAM in a c-collar following MVC where patient struck a steering wheel with his face. Airbags did not deploy. Exam shows entrapment of superior oblique muscle. You also note smell of ETOH from patient’s breath. Exam of torso/abdomen and all extremities show no abnormalities. What combination of imaging studies should you order to rule out pathology?

  1. CT Facial bones without contrast
  2. CT Facial bones with contrast, CT Brain with contrast and CT C-Spine with
    contrast
  3. CT Orbit without contrast
  4. CT Facial bones without contrast, CT Brain without contrast and CT C-Spine
    without contrast
A 
4. 
CT Facial bones without contrast,
CT Brain without contrast
and
CT C-Spine without contrast

No contrast to look at bones
No contrast when looking at brain (bleeding will look like contrast)

100
Q

Thyroid Imaging

A

Ultrasound
combine with TSH (Lab)

Benign tumors are more likely (Thyroid Adenomas or cysts)

US will identify the blood flow

Nodules that appear unstable will require aspiration

101
Q

TI-RADS

A

TR1 = 0 (benign)

TR2 = 2 (not suspicious)

TR3 = 3 (Mildly suspicious) (1.5-2.5cmm-)

TR4 = 4-6 ( moderately suspicious) (1-1.5cm)

TR5 = 7 & up( Highly suspicious) (0.5 cm & up)

102
Q

Parathyroid Imaging

A

Nuclear PTH Tc-99m Sestamibi

Study of choice if US is inconclusive

(correlates with calcium)

103
Q

Primary vs secondary headaches

A

Primary headaches have no cause

secondary headaches have an underlying issue

104
Q

Imaging for primary headache?

A

No imaging if no red flags

i.e. worst, thunderclap, trauma, etc.

CT if reason

105
Q

Sensitivity percentage to rule out bleeding in head trauma

A

A CT is 58% sensitive for infarction within the first 24 hours.

MRI is 82% sensitive.

If the patient is imaged greater than 24 hours after the event, both CT and MR are greater than 90% sensitive

106
Q

CT brain is usually combined with what?

A

CT Brain usually combined with CT C-Spine,

both without contrast,

and are imaging modalities of choice in a trauma patient.

107
Q

Basic CT interpretation

A

Check the name and the date
Scout film
Window width (bone or soft tissue)
Imaging plane
Radiologic images are simply black or white images where abnormalities can be described as:
too white, too black, too large, wrong place

108
Q

Brain CT colors

A

White matter will appear darker on CT

CSF in the ventricles and subarachnoid space appears black

Gray matter appears gray

Acute hemorrhage will appear white

IV contrast, vascular structures appear white

109
Q

On brain CT Acute hemorrhage will appear?

A

white

110
Q

On brain CT CSF in the ventricles and subarachnoid space appears?

A

black

111
Q

On brain CT IV contrast, vascular structures appear?

A

White

112
Q

Brain CT Key Concepts

A
  1. The X (base of skull)
  2. The Star
  3. The Happy Face
  4. The Sad Face
  5. The Worms
  6. The Coffee Bean
113
Q

Brain CT Key Concepts

The X

A

Base of skull

114
Q

Brain CT Key Concepts

The Happy face

A

Ventricles

115
Q

Brain CT Key Concepts

The Sad Face

A

Ventricles

Choroid plexus

116
Q

Brain CT Key Concepts

The Worms

A

The Worms

Ventricles, great for looking at midline shift

117
Q

Brain CT Key Concepts

The Coffee Bean

A

Coffee bean is top of cerebral cortex

118
Q

Subarachnoid hemorrhage

A

Blood in CSF

aneurysm or trauma

119
Q

Intraventricular hemorrhage

A

seen in trauma or hypertensive issues

Frequently have subarachnoid bleeds as well

120
Q

Epidural Hematoma

A

Football sign

middle meningeal artery(origin)

LOC, brain herniation, delerium (lucid)

121
Q

Football sign

A

Epidural Hematoma

middle meningeal artery(origin)

122
Q

Subdural Hematoma

A

crescent-shaped lesion on CT Scan

Usually a venous origin

can occur very slowly hours/days

alcoholic/elderly/under 2

123
Q

Hemorrhagic Stroke

A

Account for 16% of all strokes

Appear white on CT (blood)

Can stem from berry aneurisms, drug abuse, HTN or coagulopathy

124
Q

Ischemic Stroke

A

Reduced blood flow to area of stroke

absence of hemorrhage, not bright white

greyish, darker discoloration

Non-contrast CT

125
Q

Brain Tumors

A

Present with a focal neurological deficit, seizure, or headache.

Slow growers, not acute

Can be confused with ischemic or hemorrhagic strokes

Correlate clinically to diagnose

126
Q

Extra-axial empyema

A
  • 50% are from frontal sinusitis
  • 30% are post-craniotomy
  • Rest are infectious – meningitis

enhancing rim (crescent shape along frontal skull)

127
Q

Cerebral abscess

A

HIV patients mostly
also
lymphoma or
toxoplasmosis

128
Q

Meningitis

A

fever, headache and neck pain

petechia

MRI brain with and without contrast is the study of choice

129
Q

Alzheimer’s

A

Affects >65% of patients with known dementia

Caused by neuronal degeneration from amyloid precursor protein

See marked diffuse atrophy of brain mass, enlarged lateral ventricles and widened Sulci on CT

MRI is more sensitive

130
Q

Parkinsons

A

loss of neuromelanin containing dopaminergic neurons

Triad of bradykinesia and hypokinesia, resting tremor

CT similar to Alzheimer’s

MRI more sensitive

131
Q

Huntingtons

A

Triad of choreoathetoid movements, behavioral disturbances, and progressive dementia

Genetic

significant brain mass loss and atrophy

• MRI is more sensitive

132
Q

Picks Disease

A

Third most common cause of dementia
– After Alzheimers and Lewy body

Tau-protein degeneration causing atrophy of tissue

• MRI is more sensitive

133
Q

MS

A

Dawson fingers is diagnostic for MS

MRI brain with & without contrast is best

• Middle-aged women with monocular vision loss

134
Q

You are evaluating a 90yo male with sudden onset
of facial droop and right arm weakness. You obtain a
CT scan but the connection to remote radiologist is
lost and he cannot read the CT. Your attending is in a
code. You review the CT scan and see this–>
Would the patient be a candidate for
tPA/anticoagulation therapy assuming he meets all
the criteria?

  1. Yes
  2. No
A
  1. No

huge bleed

135
Q

Carotid Screening

A

typically 55 and up (40 if risk factors)

Can differentiate between Calcified plaque, soft plaque

Ultrasound (doppler)

136
Q

MR Angiography

A

MRA great for people with kidney problems

Gadolinium

great for neurovasculization

image blood vessels of patients in renal failure

137
Q

Conscious sedation NPO for how long

A

8 hours

138
Q

Interventional Neuroradiology

great for two conditions

A

cerebral aneurysms

cerebral arteriovenous malformations

139
Q

Transcatheter embolization

A

Great for aneurysms

occlude vessel to prevent rupture or bleed

140
Q

Macaroni sign

A

concentric thickening of aortic wall

141
Q

Bleeding

A

– Intraperitoneal will require laparotomy

– Extraperitoneal areas you can inject gel foam slurry or metallic coils into affected vessels
• In this case femoral artery

142
Q

temporary percutaneous nephrostomy tube

A

Tube through the skin into the renal pelvis to drain the urine

Done with US or Fluoroscopy

143
Q 
Virtual Endoscopy
Virtual Colonoscopy (CT colonoscopy)
Virtual Bronchoscopy (CT Bronchoscopy)
A

three-dimensional computer models

data combined from ct scans

less expensive, noninvasive examination
no reactions, perforations

Used for low risk

144
Q

Colon cancer

A

third leading cause of cancer deaths in both men and women in the United States

145
Q

3D ultrasound

A

Most commonly used today in obstetrical imaging

3D ultrasound can enhance the visualization of uterine polyps, uterine fibroids, and congenital uterine abnormalities

146
Q

PET (Positron Emission Tomography)

A

Cancer cells require a great deal of sugar (glucose)

uses flourine molecule that tags the glucose

This then accumulates in malignant cells

Shows up on PET scan

147
Q

Fusion imaging

A

PET and CT scan combined

PET can see cancer CT cannot, CT can pinpoint where it is.

148
Q

What is PET or PET-CT used for?

A
  1. Detection of primary tumors or metastases to lymph nodes or other organs.
  2. Detection of decreased blood flow to heart muscle.
149
Q

Pediatric imaging

A

least amount of radiation

1 day old to 1 year don’t move much

over 4 years are usually cooperative

1 to 3 usually need to be restrained for x-ray
sedated for MRI or CT

150
Q

Most Common Pediatric pathology

A
  • Croup and epiglottitis
  • Viral pneumonia
  • Bronchitis
  • Cystic fibrosis
  • Foreign bodies
  • Retropharyngeal abscess
151
Q

Pediatric foreign body imaging

A

Nose to anus in 1 view

152
Q

Croup

A

Causes acute airway obstruction;

caused by influenza and parainfluenza viruses

6 months -3 years

Steeple sign (inverted “V”) just below larynx

153
Q

Epiglottitis

A

Hemophilus influenza

much more dangerous(life threatening) than croup

film must be taken upright

lateral soft tissue neck film

marked enlargement of the epiglottis, and thickening of the surrounding tissues

“thumb sign”

154
Q

Airway abscess

A

Can be peritonsillar or retropharyngeal

CT neck (NOT cervical) with contrast preferred

present with fever, difficulty swallowing & lymphadenitis

155
Q

Pneumonia

A 
Chest films show 
thickening of the bronchial wall, 
hyperaeration, 
and
increased lung markings
156
Q

Bronchiolitis Age

A

occurs in infants (less than 1 year old),

157
Q

Bronchitis Age

A

in toddlers and children

158
Q

Bronchitis VS Bronchiolitis ages

A

Bronchiolitis occurs in infants
(less than 1 year old), (under 3 per Sereda)

bronchitis
in toddlers and children

159
Q

Round Pneumonia

A

Not typical after about 8 years old

can be confused with a mass

antibiotics, repeat x-ray 7-10 days

160
Q

Cystic Fibrosis

A

Chest film may be normal

present with chronic cough
repeated pneumonia, bronchitis

old children may have scarring

Pseudomonas

161
Q

Abdominal Masses in Infants and Children

A

Almost half of the abdominal masses in children are renal (kidney)

most of these are benign

Hydronephrosis is the most common cause of neonatal abdominal mass

in older infants/children
22% are wilms tumor, hydronephrosis 20%

Ultrasound is study of choice

162
Q

You are evaluating a 5yo male child with
complaints of cough and shortness of breath.
You note musical sounds from upper airway
and decide to order a neck xray. On the
image you see this—>
What is the most likely pathogen involved?

  1. Ricketsia ricketsii
  2. Parainfluenza
  3. Plasmodium vivax
  4. Hemophilus influenza
A
  1. Parainfluenza

Steeple sign

Influenza and para influenza are causes of croup

163
Q

Best imaging to evaluate normal healing progression of fractures

A

Plain x-ray evaluation is the GOLD STANDARD

  • Inflammatory phase: 1-4 days (shows a radiolucent fracture line)
  • Reparative phase: 1-3 weeks (shows callus formation, slight widening of the fracture line)
  • Remodeling phase: 3-4 weeks
164
Q

Why do pediatric fractures differ from adult fractures

A

young bones are more pliable than older ones related to calcium content.

165
Q

Child Abuse

imaging signs

A

healing fractures of various stages

fractures at the edges of the metaphysis

epiphyseal and metaphyseal fractures

posterior rib fractures

compression fractures of the vertebral bodies

166
Q

Common child abuse fx’s

A

Torus fracture (aka “buckle” fracture)

Bowing Fracture

Greenstick Fracture

167
Q 
If suspected child abuse
Skeletal survey (x-rays)
A
  1. AP and Lat skull
  2. AP views of the chest, abdomen, and pelvis
  3. AP views of all the long bones of the extremities, including the hands and feet
  4. You may need a CT head depending on other injuries
168
Q

The vast majority of Child Abuse fractures occur in patients aged?

A

under 3 years of age, and half of them are in infants.

extremity fractures are most common

169
Q

metaphyseal lesion

A

The metaphyseal lesion of child abuse is virtually pathognomonic

The fracture extends transversely across the extreme end of the metaphysis

may appear as a chip fracture

(secondary to pulling extremity)

170
Q

Diaphyseal spiral fractures

A

highly suggestive of abuse,

especially in the non-ambulatory child

171
Q

Transverse long bone fractures

A

have a high specificity for child abuse

172
Q

Rib fractures

A

Rib fractures are highly suggestive of child abuse
– Seen in excessive squeezing

Rib fractures are practically never seen after resuscitative efforts in children

Nuclear medicine bone scans are ideal for detecting rib fractures

173
Q

Calluses on ribs

A

Can be seen in Shaken Baby Syndrome

174
Q

Fractures of the sternum and spinous processes of the spine

A

A high specificity for child abuse

175
Q

The most common cause of death from child abuse

A

trauma to the head

176
Q

• A linear skull fracture

A

not highly suggestive of child abuse

the level of suspicion should increase with complex skull fractures

177
Q

A frequent site of abusive trauma,

particularly after the child becomes ambulatory?

A

• The abdomen

178
Q

The most common abdominal injury seen in child abuse

A

Intramural hematoma of the duodenum

Laceration of the liver and pancreas are also common

179
Q

You are seeing a 3yo WM in the ER with leg pain. Father reports that patient slid off the lazy boy and fell under the chair which is the only mechanism of injury. XR reveals midshaft femur fracture. What should be the next step?

  1. Try to investigate further and confront the father
  2. Call the Department of Children and Family Services
  3. Splint the patient and discharge home
  4. Call mother to confirm
A
  1. Call the Department of Children and Family Services
180
Q

hi

A

hi

PAM Semester 2 (22 decks)

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