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primary care > Lecture 2B > Flashcards

Lecture 2B Flashcards

1
Q

T or F: An image can be the sole reason you make a diagnosis

A

F

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2
Q

When working with patients that have imaging: request access to images themselves and ____________

A

radiologists interpretation

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3
Q

What is the advantage of radiography

A

Allows appreciation of basic bone anatomy

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4
Q

What are 2 limitations of radiography?

A

Cannot see complex boney anatomy

Limited ability to see soft tissue

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5
Q

Radiography has relatively ____________ doses of radiation

A

low

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6
Q

The light colored objects on an xray are radio__________ the dark areas on an x-ray are ____________

A

radiopaque

radiolucent

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7
Q

Metal will appear as _____ on an xray whereas fat/air/gas appears as ________

A

radiopaque

radiolucent

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8
Q

What are 3 views of an xray

A

AP view

Lateral View

Oblique View

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9
Q

What are the advantages of a CT scan

A

Excellent demostration of cortical bone anatomy and complex boney anatomy

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10
Q

What is a CT scan?

A

Computerized reconstruction of multiple slices of tissue through which xrays have been passed

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11
Q

What are limitations for CT scans

A

Ability to see soft tissue dependent on CT unit

Expensive

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12
Q

The relative dose of radiation for a CT scan is _______

A

high

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13
Q

What is contrast in a CT scan?

A

Dye is injected that makes certain areas easier to see

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14
Q

What type of imaging is especially useful for a C-Spine trauma and useful for surgical planning

A

CT scan

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15
Q

What are the 3 common views of a CT scan?

A

(1) Sagittal

(2) Coronal

(3 ) Axial

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16
Q

What kind of imaging is good for detecting metabolic activity of bone and high areas of bone turn over?

A

Bone scan (scintigraphy)

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17
Q

What are limitations of a bone scan?

A

Lack of diagnostic and anatomic specificity

increased radioscopic uptake

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18
Q

How is a Bone Scan done?

How much relative radiation does a bone scan use?

A
  • Imaging obtains through intro of radioisotopes into body that concentrate in areas with increased metabolic activity
  • moderate radiation
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19
Q

T or F: a bone scan can see soft tissues

A

F

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19
Q

What kind of imaging is best for detecting disease process, fracture, cancer, or areas of the skeleton with increased MSK stress

A

bone scan

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20
Q

What kind of imaging would be best for a shoulder dislocation?

A

MRI (because it can see the muscles and ligaments and tendons aswell)

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21
Q

What are the advantages of an mri

A

Excellent demonstration of soft tissue and bone marrow

22
Q

How does an MRI work?

A

Exposing tissue to magnetic field and radiofrequency waves to detect properties of tissue

23
Q

What are 3 limitations of an MRI?

A
  1. Lack of signal in cortical bone
  2. low sensitivity to some fractures
  3. Expensive
24
Q

How much relative radiation does an MRI expose u to

A

NONE

25
Q

T1 vs T2 MRI

Which is most common?

A

T1: Fat tends to show brighest, (best anatomical definition)

T2: Water tends to show brightest (can show swelling)

T1 is most common.

26
Q

What kind of imaging is the typical choice for evaluating deeper structures and prefered method for intra-articular tissue and bone stress injuries

A

MRI

27
Q

What is a contrast added MRI?

A

Ink is injected into the joint capsule

very painful

28
Q

What kind of imaging can PTs do?

A

Ultrasound

29
Q

What are the advantages to ultrasound imaging?

A

Allows real time diagnosic imaging (you can see the joint move)

good demonstration of soft tissues

30
Q

How does ultrasound work?

How much radiation does ultrasound cause?

A

Method of transmitting high frequency sound into tissue and looking at how much is absorbed vs reflected

NO radiation

31
Q

Bone will appear as _______ on ultrasound

Fat will appear as ________ on an ultrasound

A

Bone: Hyperechoic (this is a white color)

Fat: Hypoechoic (dark color)

note: there’s also anechoic which means it’s completely black

32
Q

Hyperechoic

Hypoechoic

Anechoic

Isoechoic

A

Appears white

appears dark

appears black

appears the same color as surrounding structures

33
Q

What are the advantages to a DEXA scan?

A

Suited for repeat testing if using same device

Good for diagnosis and monitoring

34
Q

What are disadvantages of a dexa scan

A

inconsistent preformance between different devices

not useful unless you’re looking at overall bone density

35
Q

How does a DEXA scan work?

How much radiation does a DEXA scan use?

A

Measurement of relative Xray attenuation indicative of tissue density

low amounts of radiation

36
Q

DEXA scan is most frequently used to measure what?

A

Bone density

37
Q

Osteoporisis is defined as less than ________ of standard deviations from the mean bone density

A

-2.5

38
Q

Osteopenia is defined as ____________ standard deviations from the mean

A

between -1 and -2.5 SD from the mean

39
Q

PIttsburgh guidelines for knee trauma: The mechanism of injury has to be what?

A

Has to be an acute trauma or else no imaging

40
Q

PIttsburgh guidelines for knee trauma: If the patient passes the first criterion, and If a patient’s age is ______________ they automatically get imaging

A

Less than 12 years old or more than 50

41
Q

If a 45 year old patient has blunt knee trauma, what criteria must they pass in order to get knee imaging? (according to the Pittsburgh Guidelines)

A

Be unable to walk more than 4 weight bearing steps

42
Q

The Canadian C spine rule:

What are the 3 high risk factors?

If they have any of these what happens?

A
  1. 65+
  2. Dangerous Mechanism
    * Fall from 3 feet
    * axial load to head
    * bad car crash
    * crash of any other vehicle not a car (bicycle or ATV)
  3. Numbness or Tingling in extremities

Straight to getting an image/immobilzation

43
Q

The Canadian C spine rule:

What are the LOW risk factors that require further examination?

If a patient has these risk factors what is the next test?

A
  1. Simple low-speed rear end MVC
  2. Ambulatory at scene of accident
  3. No neck pain when asked
  4. No pain during midline c spine palpation

If any of these are true, the next test is to be able to ACTIVELY TURN THEIR HEAD 45 degrees each direction. If they can’ t they need imaging.

44
Q

Using the The Canadian C spine rule, a 40 year old has a low speed accident where someone rear ends them, what do you need to do next?

A

Ask if they’re able to turn their head 45 degrees, if not IMMOBILIZE/IMAGING

45
Q

Ottawa Knee Rule:

Radiography is indicated when aged _____ or older

tenderness at head of fibula

isolated tenderness at ______________

inability to flex to 90 degrees

inability to __________________________

A

55

patella

inability to bear weight immediately and after in the emergency room (4 steps)

46
Q

Ottawa Knee Rule:

Radiography is indicated when aged 55 or older

tenderness at head of ____________

isolated tenderness at patella

inability to ________________

inability to bear weight immediately and after in the emergency room (4 steps)

A

Fibula

Inability to flex to 90 degrees

47
Q

T or F: The Mechanism of injury must be trauma for you to receive imaging using the Ottawa Knee Rule

A

F

48
Q

Ottawa ankle rules:

If there is pain in the malleolar zone and any of these findings:

____________

___________

A

inability to bear weight immediately after and in emergency room

tenderness at posterior edge of tip of lateral mal
tenderness at posterior edge/tip of medial mal

49
Q

Ottawa foot rules:

A foot xray is required if these is any pain in the midfoot zone and any of these findings:

___________

____________

A

inability to bear weight immediately after and in emergency room

Boney tenderness at navicular and base of 5th metatarsal

50
Q

New Orleans Critera for receiving a CT of your head:

Headache

_______

Age more than 60

___________

Deficits in short term memory

_____________________

Seizure

A

Vomiting

Intoxication

Physical evidence of trauma above clavicle

51
Q

New Orleans Critera for receiving a CT of your head:
_____

Vomiting

________

Intoxication

__________

Physical evidence of trauma above clavicle

_____________

A

Headache

Age more than 60

Deficits in short term memory

Seizure

52
Q

Canadian CT head rule:

_______________

suspected open skull fracture

_________________

vomiting more than once

____________________-

Amnesia before impact of greater than 30 minutes

____________________

A

Failure to reach GCS (glasgow coma score) of 15 within 2 hours of injury

sign of basal skull fracture

age more than 64

dangerous mechanism of injury
1. Pedestrian struck by motor vehicle
2. ejected from motor vehicle
3. fall from more than 3 feet

53
Q

Canadian CT head rule:

Failure to reach GCS (glasgow coma score) of 15 within 2 hours of injury

____________________

sign of basal skull fracture

_________________

age more than 64

______________________

dangerous mechanism of injury
1. Pedestrian struck by motor vehicle
2. ejected from motor vehicle
3. fall from more than 3 feet

A

suspected open skull fracture

vomiting more than once

Amnesia before impact of greater than 30 minutes

primary care (10 decks)

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