Lmcc Flashcards
When is MRI best?
Note this is almost never the first choice on a test Neuro: - Cauda equina – Demyelinating disease – Posterior fossa and skull base – pituitary lesions - all tumors in the spine and brain
MSK
– Bone and soft tissue infection
– bone and soft tissue tumor
Best imaging test for biliary tract including gallstone and duct? Exception?
Ultrasound
Though it is not good for biliary tract malignancies
Best imaging test for pelvis of males and females uterus/adnexa/ovaries
Ultrasound
Best imaging for DVT
U.S.
Best imaging for thyroid
U.S.
Best imaging for breast in young female ?
U.S.
Work up for PE in preg woman?
If pos leg sx… Then calf US
if no leg sx… First is CXR.
If CXR n then VQ bc less rad. If nondxic VQ or abn CXR, do CT PA
Abdo pain CT indications
Infx or inflamm (acute diverticulitis, pancreatitis, appendicitis)
Suspect neoplasm (painless jaundice, progressive sx)
Suspect AAA
When to go straight to OR
Perforation, ischemia, unstable trauma
Ultrasound first line for?
Biliary colic, cholecystitis, choledocholithiasis, cholangitis
How to distinguish gas pattern for bowel obstruction
Mucosal folds:
- for small bowel uninterrupted valvulae conniventes
- for large bowel interrupted haustra extended only partway across Lumen.
Location central for small, peripheral for large (ie picture frame)
Diameter at max is 3 cm for sbo
6 for transverse and 9 for cecum for lbo
Ultrasound findings for cholecystitis:
Dilated gb Thickened wall Hyperemic wall Pericholecystic fluid Impacted gallstone Positive sonographic Murphy sign
What is definitive tx for epidural?
Craniotomy due to middle meningeal artery bleed
Initial test for central neurological issues Ie head trauma Hemorrhage or mass lesion stroke Headache w red flag Seizure or worsening seiUre d/o LOC
Ct non contrast
MRI is 2nd and best for seizures.
If clinical picture of PID, first best test?
B HCG for ectopic
Utility of endovag US
Look at adnexa
Endometrium for vag bleed
Early preg and fetal demise
T1 bleed
When not to do endovag US for bleed?
T3!
How good are ultrasounds and detecting vascularity of masses in the ovary?
Worse with larger size… Laparoscopy
Painful mass plus preg = ?
Ectopic
Painful mass plus not preg = ?
Torsion
9 yo girl + mass
Germ cell tumor
Elderly woman and mass = ?
Epithelial Tumor
Mass plus history of gastric ulcers = ?
kruckenberg tumor
- GI met to ovary.
Signet ring
In a solid mass of breast when is only time fine needle biopsy ok?
Breast lymph nodes
First test in diagnostic workup of breast mass?
Mammogram
Indications for diagnostic mammography?
Any symptoms except isolated pain including skin change, lump, nipple discharge
– Screening mammography which revealed a suspicious abnormality
First Assessment of acute onset of scrotal pain and bruising in young person?
Ultrasound to differentiate between testicular fracture and torsion
When is CT best?
Not CATs!
Neurological emergencies
Chest CT for parenchymal lung disease
Abdo/pelvic CT for retroperitoneal structures and malignancy.
Trauma
What is seen on us of orchitis?
Inc blood flow
Premature infant with respiratory distress within hours of birth with ground glass granular CXR and effusions. Potential pneumothorax complication. Dec lung vol.
Hyaline membrane disease
Term infant w respiratory distress 24-48 hr following c /s with evidence of interstitial edema and effusions. Inc lung vol.
Transient tachypnea of the newborn
Post term infant w resp distress 12-24 he following delivery w coarse, nodular, asymmetric radiograph and inc lung vol.
Meconium aspiration
Fine granular CXR appearance in newborn
Surfactant deficiency
Steeple sign on radiograph
Croup (think C for Church)
Thumbprinting
Epiglottitis
Differential diagnosis for bilious vomit in the infant
Ilias vomit indicates below the ampulla. (Duodenal papilla) . Differential includes V: necrotizing enterocolitis C: Hirschsprung, atresia A: volvulus/ malrotation T: meconium ileus
Best imaging for intussusception?
Ultrasound
When can x-ray be used for the best study?
To exclude a surgical abdomen evidenced by free air, and necrotizing enterocolitis, bowel obstruction.
Best imaging study for malrotation?
Upper G.I. study
What is intussusception associated with?
Henoch schonlein purpura
Hyposplenism or functional asplenia predisposes patients to serious infection with encapsulated organisms such as
Meningitis - S. pneumoniae
S pneumonia
Bacteremia -
S. pneumoniae
Mycoplasma, Chlamydia, and Legionella (i.e. atypicals)
Pneumonia - ; S. pneumo relatively uncommon)
Osteomyelitis -
Salmonella
