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Medical Diagnosis > Lecture 5 (x-ray-Pelvic)- exam 3 > Flashcards

Lecture 5 (x-ray-Pelvic)- exam 3 Flashcards

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USMLE® Step 1 flashcards
1
Q

Kidneys:
* What type of organ?
* What do you see on IVU?
* What is the modality of choice in most GU imaging?

A
  • Kidneys are retroperitoneal
  • Normal IVU (intravenous urogram) on KUB excretory phase and horseshoe kidney on CT
  • CT with contrast is the diagnostic modality of choice in most GU imaging.
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2
Q

Explain this

A

normal renal-Highlighted renal cortex

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3
Q

What are the different renal diseases?

A
  • Renal cysts
  • Nephroureterolithiasis
  • Polycystic renal disease
  • Pyelonephritis
  • Renal masses
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4
Q

What is the study of choice of renal disease?

A

CT abdomen and Pelvis with and without IV contrast (few exceptions) is the study of choice

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5
Q

Renal Parenchymal Disease:
* What does it involve?
* Could start with what imaging? BUT what is the study of study?

A
  • Involves Cortex and Medulla
  • AKA medical renal disease involving glomeruli, interstitium, tubules, and small blood vessels of the kidneys.
  • Could always startwith US but CT with and without contrast is the study of choice
  • Image depicts ARF
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6
Q

What is this?

A

Renal Parenchymal Disease
* Bolus-enhanced CT at the portal vein phase reveals almost no early renal parenchymal enhancement; normally there would be dense cortical enhancement.
* Really gray=chronic issues aka fibrosis, vascular, renal failure

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7
Q

What is this?

A

renal cyst

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8
Q

What is this?

A

Renal cyst

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9
Q

Polycycstic kidney disease is may have a similar appearance to what? What do you need to do?

A

May have similar appearance to
malignancy
* Need to do biopsy

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10
Q

What is this?

A

Polycystic kidney disease

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11
Q
  • What is this?
  • What does it appear similar to?
A
  • Pyelonephritis
  • Appears similar to renal cell carinoma or renal lymphome-> systemic issues like weight loss
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12
Q

What does this show?

A
  • Right:Arteriography in a patient with renal cell carcinoma.
  • Vasculature to kidney and tumor.-> left side, notes how vasular it is
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13
Q

What does this show?

A
  • CT scan of a fractured left kidney. This slice at the level of the kidneys shows no laceration, but reveals blood in the perirenal space, surrounding the kidney.
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14
Q

What is this?

A
  • Laceration of Kidney
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15
Q

Nephroureterolithiasis
* What is the choice of study for kidney stones?
* What is the rule of thumb for stone that will pass?
* 10% of uretherolithiasis will cause no what?
* When should you consider US?

A
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16
Q

What is this?

A

Nephroureterolithiasis

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17
Q

What does the curved and straight arrow show?

A

Enlargement of the right adrenal gland (straight arrow) due to the presence of an adrenocortical tumor, an aldosteronoma. The curved arrow points to the only left adrenal gland, which is normal in size.

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18
Q

Adrenal Gland Imaging:
* What is the sutiable imaging for this pathology?
* What do you need to consider and check if adrenal lesions are present and unexplained HTN ?

A
  • CT or MRI are both suitable to image this pathology
  • Consider pheochromocytoma if adrenal lesions and unexplained HTN – check vanillylmandelic
    acid levels
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19
Q

Hematuria:
* What does the patient ned?
* What are the pre-renal, renal and post renal cause?
* What do you need to consider and why?

A
  • Patients with gross or microscopic hematuria need thorough workup.
  • Identify typical pre-renal, renal and post-renal causes
    – Pre-renal: Vascular trauma, septicemia, purpura hemorrhagica, hemophilia
    – Renal: Acute GN, renal infarct/embolism, ATN, RCC and pyelonephritis (RARA P)
    – Post-renal: cystitis, urolithiasis, malignancy, fistula (F CUM)
  • Always consider smoking history because it will increase bladder cancer

inside () for me to remember lol

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20
Q

What are the different GU studies?

A
  • Intravenous pyelogram (IVP)
  • Retrograde urethrogram (RUG)
  • Retrograde cystogram
  • Voiding cystourethrogram (VCUG)
  • CT urography
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21
Q
  • What imaging is this?
A

Intravenous pyelogram-> over time with contrast injected in veins to see the kidneys and bladder
* Normal IVP, but possible phlebolith, appendicolith
* On right, mass or hypertrophy of prostate can elevate the floor of bladder.

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22
Q

What does this imaging show?

A

IVP

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23
Q

What imaging is this? What does these show?

A

CT

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24
Q

What is this imaging and what does it show?

A

Bladder imaging-retrograde urethrogram showing prostatic hypertrophy
* note the constriction of urethra

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25
Q

What does retrograd cystogram typical evaluate?

A

anterior urethra (R with A)

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26
Q

what is being shown?

A

Retrograde cystogram showing multiple radiolucencies within the bladder, outlined by contrast material. These represent a nodular carcinoma in a pediatric patient.

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27
Q

Voiding Cystourethrogram
* this imaging evalutes what?
* How do you do this imaging?

A
  • Typically evaluates posterior urethra (V+P)
  • Patient is catheterized to instill bladder with contrast and later told to urinate to evaluate function while under fluoroscopy.
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28
Q

What does this show?

A

Voiding Cystourethrogram

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29
Q

What does this imaging show?

A

Cystocele
* Bladder herniation/diverticulum
* Voiding CystoUrethrogram (VCUG) shows with straining, the patient voids while revealing the bladder floor relaxes allowing the bladder base (*) to extend 2 cm below the pubic symphysis (dotted line). This is a cystocele anatomically resulting in stress urinary incontenince.

Cystocele=risk factor for UTI

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30
Q

CT urography:
* Can be ordered when?
* What will the ct have?

A
  • Can be ordered before any other tests to globally screen patient for renal and nonrenal abnormalities and explain symptoms (hematuria etc.)
  • CT will have higher resolution and identify problems not found on Urography
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31
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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32
Q

Female pelvis radiology:
* What is the primary imaging method for the female pelvis?
* Transabdominal pelvic ultrasound is performed using what?
* Transvaginal pelvic ultrasound uses what?

A
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33
Q
  • What type of US is when the patients full bladder is used as an acoustic window?
  • What US helps see if a pt is having an ectopic pregnancy?
A
  • Transabdominal
  • Tranvag-> bladder should be empty
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34
Q

What type of US are these two

A
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35
Q

US:
* What is hypoechoic? What are examples?
* What is hyperecholic? what are examples?

A
36
Q

What do each of these US show?

A

Endmetrioma (bottom) vs functional cyst (top). Note no blood flow within endometrioma, therefore it is not a solid mass.

37
Q

Female Pelvis:
* What are different conditions what cna be diagnosed with US?
* Overian masses may be what?

A
  • A wide variety of benign pelvic conditions can be diagnosed with ultrasound including ovarian cysts, pelvic inflammatory disease, endometriosis, and benign tumors of the uterus (leiomyomas), and ovaries (cystadenomas, cystic teratomas)
  • Ovarian masses may be cystic, solid, or complex.
38
Q

What imaging is this? What does it show?

A

Transabdominal ultrasound showing a benign left ovarian cyst.

39
Q
  • What does this US show?
  • What imaging will show flow to the overy? What do we need to look at blood flow?
A
  • CT of large ovarian cyst
  • Only Duplex US will show flow to the ovary
  • Include it for torsion r/o (with any cyst greater than 5cm)
  • If greater than 7cm, you need a MRI becasue of malignancy
40
Q

What do these images show?

A
41
Q

What does this show? How are small ones and large ones handled?

A
42
Q
  • What is imaging is helpful in the staging of pelvic malignancies in female?
  • What should be preferred if US is not definitive?
A
  • CT and MRI can also produce excellent images of the female pelvis, and are helpful in the staging of pelvic malignancies
  • MRI should be preferred if US is not definitive
43
Q

What does this show?

A

Normal CT pelvis. Arrow indicates vaginal vault

44
Q

Hysterosalpingogram (HSG):
* How is this imaging done?
* What will normal exam show?

A

Image is normal-> after one year of trying for baby, do this because chalymia infection can cause scarring of FT

45
Q
  • What does this show?
  • What can it be seen in?
A
46
Q

What does this show?

A

Hydrosalpinx- amount of fluid in FT-> can be dt STD (clam or gon mc)

47
Q

Obstetrical Imaging:
* What is used during pregnancy and why?
* With ultrasound’s real-time motion images, you can observe?

A
  • Ultrasound during pregnancy can accurately datethe pregnancy, detect multiple pregnancies,monitor fetal growth, and assess fetal well-being
  • With ultrasound’s real-time motion images, youcan observe fetal cardiac motion and fetal movements
48
Q

patient comes in with + pregnancy test, what does this show?

A

Transabdominal ultrasound (see bladder) of the normal gestational sac at six weeks.

49
Q

What is this showing the US? What does it usually present with? What type is + and what is a risk factor?

A

mass structure inside tube

50
Q

Postmenopausal Bleeding:
* Differential almost always includes what?
* What is the initial study of choice?
* What can MRI help with?
* What does the image show?

A
  • Differential almost always includes malignancy
  • Ultrasound is the initial study of choice
  • MRI can help stage the malignancy or if US is inconclusive
  • Image depicts endometrial cancer
51
Q

What is the endometriumal thickness for pre and postmenopausal women?

A
  • > 15mm in premenopausal
  • > 5mm in postmenopausal women (thinner because you do not need lining for baby)
52
Q

Men’s Imaging:
* What is the imaging of choice for scrotal ? why?

A

Ultrasound is the imaging method of choice for scrotal imaging because of its general availability, low cost, high accuracy, and utilization of nonionizing radiation.

53
Q

Men’s Imaging:
* US can identify what?
* Indications of US are what?
* What is MRI used for?

A
  • Ultrasound can identify inguinal hernias, testicular tumors,testicular torsion (Duplex), testicular trauma, hydrocele and manyother conditions
  • Indications of US are acute testicular pain, a palpable mass or scrotal swelling
  • MRI is a diagnostic alternative in evaluation of cancer
54
Q

What does this US show?

A
  • Ultrasound of infarction of the right testis (nectroic so dark). More echolucent than left testicle.
  • Presence of blood flow does not rule out testicular torsion
55
Q

how can the prostate be evaluated?

A

using IVP (can show prostatic hypertrophy), ultrasound, or CT

56
Q

You are seeing a 16yo sexually active male 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

Ultrasound of scrotum and testes

57
Q

Mammography:
* What is the leading cause of non-preventable cancer death in women?
* Mammography can detect what?
* Mammography cannot rule out what though?

A
  • Breast cancer is the leading cause of non-preventable cancer death in women
  • Mammography can detect the presence of early breast cancer at the non-palpable stage
  • Mammography cannot rule out breast cancer in a patient with a palpable mass or other abnormality on clinical
    examination (mammography can rule in cancer, but it cannot rule it out)
58
Q

Mammography:
* Screening mammograph is performed when?
* Diagnostic mammography (problem- solving mammography) is performed when?
* When should mammogram?

A
  • Screening mammography is performed on asymptomatic women to detect unsuspecting cancer at an early age
  • Diagnostic mammography (problem-solving mammography) is performedtoevaluate abnormal clinicalfindings
  • There is general agreement that all women over the age of 50 should have bi-annual screening mammograms(some sources sayover 40).
59
Q
  • Mammography is the modality of choice in who?
  • Ultrasound is the imaging modality of choice for who?
  • Women aged 30-39 could what?
A
60
Q
  • What is negative predictive value?
  • What is the sensitivy and specificity for breast cancer detection? What is the percentage of pos and neg predictive vaule?
A
  • Negative predictive value of combined mammography and sonographyin patients with focal/ diffuse breast pain but without highly suspicious exam findings is nearly 100%.
  • sensitivity for breast cancer detection was 92.0% and the specificity 97.7%. A positive predictive value of 68.0%, a negative predictive value of 99.6%.
61
Q

Highly suspicious exam findings warrants what (breast mammography)

A

Highly suspiciousexam findings warrant biopsy regardless of what the imaging shows
* Skin tethering, Peau d’ orange, nipple inversion, axilla lymphadenitis

62
Q
  • What are the two views of mammogram?
  • What can cause problems with mammography?
  • What is the kvp and mAs levels for mammograms?
A
63
Q

What do these images show?

A
64
Q

Tomosynthesis (3D Mammography)
* What procedure is whis?
* While traditional MMG takes pictures of the breast from two angles — up and down, and left and right — tomosynthesis takes the image how?
* What is the benefit? (2)

A
65
Q

Which one is the mammogram and tomosynthesis? What does the imaging show?

A
66
Q

What are the breast cancer risk factors?

A

An overweight women with history or BC that had her peroid for 40 years without any children

67
Q

What does this imaging show? What do you need to do with the more dense breast tissue?

A

More dense breast should be evaluated with US.

68
Q

What are the structures of the boob on mammogram?

A
69
Q

BIRADS: (Breast Imaging Reporting andData System)defines five type of margins, what are they ⭐️

A
  • Circumscribed: Circumscribed margins are well defined and sharply demarcated with an abrupt transition between the lesion and the surrounding tissue.
  • Obscured: Obscured margins are hidden by superimposed or adjacent normal tissue
  • Micro-lobulated: Microlobulatedmargins have small undulating circles along the edge of the mass
  • Ill-defined: Ill-defined margins are poorly defined and scattered.
  • Spiculate: Spiculatedmargins are marked by radiating thin lines.
70
Q

What is needed for additional imaging? Which ones need biopsy and determined after biopsy?

A
71
Q

What does this show?

A

A spiculated, dense mass especially when not palpated is
almost always carcinoma.

72
Q

Value of Ultrasound when you are seeing a middle aged female with breat pain? What can be the diagnosis?

A
73
Q

What is this?

A

Skin Calcifications
* Skin calcifications have a typical lucent center and polygonal shape. Although skin calcifications are not in the breast parenchyma, they may project as such on a mammogram.

74
Q

What is this?

A

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

75
Q

What is this? What disease is it found in?

A

Coarse or Popcorn-like Calcifications
* These calcifications are typically found in involuting
fibroadenomas. Fibroadenomas usually regress with menopause and microcalcifications will develop into coarse macrocacifications.

76
Q

What does this show? What can they be from from?

A

NEEDLE shaped

77
Q

What does this show?

A
78
Q

What does this show? (+associated with?)

A
79
Q

What do these show?

A
  • Bening– breast pain Hx - well defined and circumscribed on left.
  • On right – asymptomatic breast – malignant due tospiculation
80
Q

Breast Specific Gamma Imaging:
* How does this techique work?
* Who is it used for?
* High or low rad?

A
81
Q

Breast Specific Gamma Imaging
* What will metabolic imaging who?
* better tolerated than what?
* What is the sensitivity and specificity?

A

– Metabolic imaging will show hypermetabolic uptake of t-99
– Better tolerated than MRI, less expensive
– Sensitivity is equal, specificity is increased compared to MRI

82
Q

What do these images show?

A
83
Q

What type of image is this? What is the downside?

A

MRI: increase risk fo biopsy

84
Q

MRI Breast:
* Should be done how who? What is done first?
* MRI may be miss what?

A
85
Q

What does this show?

A
86
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

US

Medical Diagnosis (16 decks)

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