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PAM Semester 2 > Medical Diagnostics Exam 1 > Flashcards

Medical Diagnostics Exam 1 Flashcards

1
Q

Radiation measurements

A 
R = roentgen
Rad = Radiation absorbed dose
Rem = Rad equivalent man

For diagnostic radiology purposes
R=Rad=Rem
all the same

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2
Q

colles

A

distal radial fx
foosh
elderly women
kids

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3
Q

Odontoid fx

A

C2 fx
3 types

Top of dens
bottom of dens
through mian part of bone

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4
Q

Ultrasound pearls

A 
Pregnancy
intraabdominal
pediatric
cheap
fast
harmless
results vary based on skill of tech
limited scope
worse for high BMI patients
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5
Q

Lunate dislocation

A

FOOSH

palm strike

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6
Q

Spondylosis

A

SPONDLYLOSIS is a bony defect of the pars interarticularis

It happens most often in adolescent athletes and at the L5 vertebrae.

The defect results in formation of a “collar” around the Scotty Dog Model of the lumbar vertebrae

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7
Q

Osteosarcoma

A

• Most common primary malignant bone tumor

70% show evidence of pulmonary metastasis, death usually secondary to respiratory compromise

can be familial

sunburst or codmans triangle

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8
Q

Which of the following findings will prevent you from administering IV contrast

  1. Creatinine 1.8
  2. O2 saturation of 93%
  3. Chronic use of Metformin
  4. Flushing upon prior administration of contrast
A
  1. Creatinine 1.8
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9
Q

Transverse Avulsion Patellar Fracture

A

Caused by indirect force generated by the quadriceps tendon.

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10
Q

radial head fx

A

FOOSH
most common elbow fx in adults

hard to see on xray
look for sail sign or fat pad

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11
Q

Does the “air” appear differently on CT or Xray in terms of contrast

A

No, air looks black and the same in both CT and x ray

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12
Q

Triquetral Fracture

A

2nd most common after scaphoid

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13
Q

Computed tomography CT

A

is x rays constructed by a computer

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14
Q

Bennett Fracture

A

broken / dislocated thumb

twisting hand around a tubular body

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15
Q

shoulder dislocation

A

anterior most common
head down and forward

posterior
Very uncommon and can be easily missed

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16
Q

what does the collimator do

A

Narrows the rays and focuses the x rays

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17
Q

soft tissue imaging

A

MRI

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18
Q

to image soft tissue

A

low kVp

low mAs

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19
Q

Adverse reactions

A

Idiosyncratic vs non idosyncratic

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20
Q

Lisfranc Injury

A

A fracture and or dislocation at the tarsometatarsal joint.

Seen in mountain bikers who get their feet caught in the pedal clips

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21
Q

gold standard of imaging of arterial system

A

angiography (arteriography)

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22
Q

Immobilize yes or no?

A

All suspected and confirmed
fractures need to be
immobilized.

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23
Q

Degenerative Joint Disease

A

Note Osteophyte Formation
• Decreased Joint Space
• Sclerosis
irregular joint spaces

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24
Q

Oral contrast and weight

A

Oral contrast is recommended for people with BMI less than 21 due to lack of fat

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25
MRI pearls
Expensive no radiation good for pregnant excellent for soft tissues
26
Ultrasound colors
Solid structures appear white Cystic structures appear black Doppler to detect flow Red towards transducer blue away from transducer Echogenicity
27
SCFE
Slipped capital femoral epiphysis ball head of femur slipps of the neck (broken) emergency happens in kids
28
Tear drop fx
diving into pool | tear drop piece breaks off spine
29
Segond Fracture
anterior cruciate ligament tears are commonly associated with this type of fracture
30
CT artifacts
Movement Dust particles foreign bodies
31
Which cervical injury mandates neurosurgery consultation in absence of any neurovascular compromise? 1. Clay Shovelers Fracture 2. Wedge Fracture 3. Odontoid Fracture 4. Compression Fracture
3. Odontoid Fracture due to being unstable fx
32
tomography
Same as x ray except the x ray tube and the film move at the same time
33
Scoliosis image
must have whole spine in film to see diffenret angle of rotation
34
MRI signal strength image
Strong image will appear white (high intensity) fluid Weak signal wil appear gray (low intensity) Soft Tissue No signal will appear black Air, bone (very dense)
35
how is radiation absorbed
it differs depending on the type of tissue Bone and tissue absorb differently Measured in sieverts
36
CEUS
Contrast Enhanced Ultrasound Microbubble contrast agents smaller than RBC's Enhance doppler imaging
37
Pelvic sacrum trauma
severe pelvic truama is associated with hemorrhage 60% of the time it is the main cause of death in this population
38
metformin and contrast
must stop metformin until 2 days after contrast due to the high rate of lactic acidosis
39
What is the ideal combination of kilovoltage and milliamperes per second when evaluating soft tissues on an xray? 1. High kVP, High mAs 2. Low kVp, High mAs 3. High kVp, Low mAs 4. Low kVp, Low mAs
4. Low kVp, Low mAs
40
Adverse reactions | MIld - moderate - severe
Mild - N/V , flushing moderate - uticaria, bronchospasm, vasovagal Severe (rare) - seizures, Altered mental state, Cardiac arrest
41
Unilateral Facet dislocation
Facet joint dislocation and rupture of the apophyseal joint ligaments resulting from rotatory injury of the cervical vertebrae: simultaneous flexion and rotation. Could be confused with spondylolisthesis (spondylolisthesis usually occurs in lower back, not c spine)
42
Imaging costs
CT 51 & 1565 xray and US 55 & 410 Nuc med 135 & 1138 MRI 165 & 2048
43
Malignant Bone Tumor
Primary, Metastatic Moth eaten or permeative appearance to margins
44
Malgaigne Fracture
Articular or para-articular fracture of the sacroiliac joint and ipsilateral ischiopubic rami.
45
Multiple myeloma
Males, AA, over 45 common to kidney disease punched out lesions (russel bodies)
46
Burst fx
crushed vertebral body compression fx
47
Luxatio Erecta Shoulder Dislocation
Arm dislocated straight up
48
Radiopaque vs radiolucent
Radiopaque is radio dense / structures appear white Radiolucent / structures appear black
49
Adverse reactions | Non - Idiosyncratic
``` occur rapidly can have metallic taste warth / flushing urge to urinate bradycardia, hypotension, vasovagal ``` can lead to vascular collapse / death
50
Nuclear medicine agents
Technetium 99m (bone) Gallium 67 Inflammatory disorders (tumors) Indium 111 WBC (acute infections) Labeled WBC
51
Benign Bone Tumor
* Well demarcated (round/oval) | * Narrow zone of transition
52
A 5yo female is in your office for evaluation of fall and elbow injury. Lateral elbow xray reveals posterior fat pad or Sail signs, which is an indication of what condition? 1. Dislocation 2. Hemarthrosis 3. Sprain 4. Contusion
2. Hemarthrosis
53
Gout
red hot swollen joint podagra rat bite erosions
54
Imaging
Film is fragile, flammable, wrinkles and gets moldy Most imaging today is digital
55
Osteomyelitis in Diabetics
• 94% of cases of diabetic osteomyelitis in the foot are associated with ulcers. So if an ulcer is absent, osteomyelitis is unlikely Charcot (Neuropathic Joint) MRI gold standard (acute)
56
Dexa Scan
Dual Energy Xray Absorptiometry Used for osteoporosis diagnosis Used to determine bone mineral density (BMD)
57
Arthrography
Imaging of a joint with contrast | can be injected with iodine contrast or air
58
Scottie dog sign
normal appearance on lumbar imaging
59
radiation proteciton
gold is best protector | lead is used due to cost
60
When is the swimmers view useful
heavy people
61
Calcaneal Fracture
lovers fx fall from height
62
GRUM
``` Galleazi = Radius Ulna = monteggia ```
63
C spine soft tissue measurements
Area Adult Child Predental space < 3mm < 5mm Retropharyngeal space < 7mm < 7mm (anterior to C3) Retrotracheal space < 22mm < 14mm (anterior to C6)
64
Adverse reactions | Idiosyncratic
``` Happen for no reason unpredictable usually within 20 minutes can occur with as little as 1 ml prior sensitivity testin of no value ``` can go from mild to severe
65
patella fx
sunrise view
66
MRI T1
T1 images White Matter appears white, gray matter appears gray, CSF is black Best for normal anatomy Fat and bone marrow appear bright Tendons, ligaments, cortical bone, and air always appear black because of their lack of water content
67
Femoral neck fx
in osteoporosis patients the bone breaks then they fall associated with meonpuase avascular necrosis occurs about 10-30% of the time John thomas sign
68
How long should you avoid iodine contrast before Iodine 131 is given for thyroid ablation
2 months
69
scaphoid fx
most common fx carpal FOOSH, extreme dorsalflexion avascular necrosis can occur
70
Arterial duplex
Arterial occlusive disease
71
BERT
Background equivalent radiation time This increases with altitude a single transcontinental roundtrip flight is equal to 2.5 chest xrays Measured in sieverts
72
Shaken baby
Skull and C1 seperation
73
Color doppler US
for flow and turbulence
74
Metastatic Bone Tumors
Metastatic bone tumors are much more prevalent than primary bone tumors most common originate from five organs: breast, kidney, lung, prostate, and thyroid. Generally, if there are “hot spots” in asymmetric areas in such patients, the radiologist assumes they represent metastases
75
Maisonneuve Fracture
Fracture of the proximal half of the fibula. strong eversion at the ankle joint.
76
Is flexion C-Spine xray appropriate if you suspect teardrop fracture?
NO | never flexion or extention in c spine fx
77
Tillaux Fracture
Lateral margin avulsion of the | distal tibia.
78
You are evluating a patient following MVC with suspected ligament injury. What imaging modality will best evalutate this pathology? 1. Xray 2. CT 3. Ultrasound 4. MRI
4. MRI (proton density) (flair) | CT is good, but MRI is better
79
Nuclear medicine
uses radioactive substance | expressed as high or low intensity hot or cold hot appears black cold appears white
80
Rheumatoid arthritis
MRI early, xray late in disease
81
Hangmans fx
C2 hitting windshield pars interarticularis fx
82
US Artifacts
``` Mirror image Acoustic shadow Acoustic enhancement Reverberation Refraction ```
83
lower extremity
soft tissue injuries are most then FX then dislocations
84
Greenstick 3 types
transverse (fx halfway across bone) torus (buckling, overlap) bowing (bent without crack) common in abuse
85
In suspected perforation what contrast should you give
Gastrografin It is water soluble and can be diluted Doesn't coat mucosa as well as barium
86
pretreatments for allergic reactions
prednisone 50mg | benadryl 50mg
87
Contrast ordering
Bony abnormalities, pneumonia = none Soft tissue trauma = IV contrast Cellulitis, infection, inflammation = IV contrast PE, aortic dissection, renal stones= with or without bowel abnormalities = with oral contrast
88
What is a normal predental space in an adult c-spine evaluation? 1. < 3 mm 2. < 5 mm 3. < 7 mm 4. < 14 mm
1. < 3 mm
89
Creatinine level to receive IV contrast
creatinine 1.4 to 1.7 depends where you work higher wont get IV Contrast
90
Salter-Harris IV
Second most common SH Fx • Extends through epiphysis, physis, and metaphysis • Can result in disability • Usually will require surgical repair
91
scapula fx
force to break scaupla warrants a CT
92
Thurston-Holland Sign
A triangular metaphyseal fragment seen in Salter-Harris type II fractures
93
Radiation monitoring
Thermoluminescent dosimeter = 3 months, more expensive not as common Film Badges = 1 month less expensive more common
94
MRI imaging weighting
T1 short TR, Short TE T2 Long TR, Long TE 2 is greater than 1
95
How to protect from ionizing radiation
reduce time increase distance shielding Collimate (focus the beam) Increasing the distance is the most effective way to limit radiation exposure
96
Ewing Sarcoma
Primary malignant bone tumor – Highly metastatic Most common malignant bone tumor seen in children onion skin, hair on end
97
3 images angles for C spine
Lateral, AP, odontive
98
Flouroscopy
Mobile xray generates realtime continuos results adjustable x ray beam visualization of anatomical structures in real time
99
Gadolinium
Gadolinium Deposit Disease 2017 neurovascular complications neuropathic pain Nephrogenic system fibrosis Renal impairment 2-10 weeks
100
Posterior hip dislocation
trauma 90% are posterior sciatic nerve issues in 10%
101
MRI T2
T2 images CSF is white, Fatty structures are darker Best for pathology, Water, edema, acute hemorrhage appear bright Tendons, ligaments, cortical bone, and air always appear black because of their lack of water content
102
Spondylolithesis
Anterior slipping is termed SPONDYLOLISTHESIS.
103
Osetomyelitis
Bone erosion and destruction DDX iv drugs, neck/back pain
104
Ethical principles of radiology
Autonomy Beneficience Nonmaleficence Justice
105
Pagets disease
abnormal calcium depostis on bones
106
Ottawa Ankle Rules
Presence of point tenderness at either of the 4 spots and inability to bear weight following injury warrants xray imaging. 1. medial malleolus 2. lateral malleolus 3. Navicular Bone 4. Bas eof 5th metatarsal
107
ALARA concept
As Low As Reasonable Acheivable Radiation limit set by a council Radiation worker = 5 REMS per year Average population = 0.5 Rems per year
108
CT on a pregnant woman
``` Do not image in first trimester abdomen pelvis lumbar spine hips ``` unless mother is going to die otherwise choose alternate (MRI, US)
109
Two most important US artifacts
Echo of posterior enhancement Bright band extending from posterior to the weak attenuator Distinguishes cyst from lesion y Shadowing Decreased posterior attenuation of highly reflective surfaces Helpful in stones identification
110
Acromio-Clavicular Joint Separation | 3 types
Type 1 - Partial tear Type 2 - Disruption of the acromioclavicular ligament Type 3 - Disruption of the acromioclavicular and coracoclavicular ligaments
111
Wedge Fracture
Compression fracture resulting from flexion. Very common in ED setting
112
2 tyeps of biological effects of radiation
Genetic effect DNA molecules are damaged can pass on to offspring Somatic efect cellular effects burns, hairloss, cancer etc not passed on
113
Venous Duplex
DVT venous valvular incompetence
114
Clay Shoveler's Fracture
Fracture of a spinous process C6-T1
115
MRI how it works
Radio waves excite hydrogen atoms in a patients fat and water molecules they align themselves with magnetic fields computer analyzes and reconstructs it Absorbtion does not matter (radiopaque, radiolucent dont apply)
116
supracondylar fx
median nerve most common in peds fx above epicondyle
117
Nuclear medicine scans contrasts
``` Tc99m MDP (Methyl Diphosphonate) Cancer/infection ``` • Tc99m HMPAO-WBC (Ceretec) infection • Indium 111 WBC all are used for Osteomyelitis in Diabetics and charcot
118
What are L1 fx linked to
Calcaneal fx
119
Who discovered x rays
Wilhem Rontgen | 1895
120
How much radiation is in 1 abdominal CT
1 REM = to 500 chest xrays or 4.5 years of background radiation
121
Salter-Harris V
Epiphyseal plate injury only • Have poor prognosis and significantly alter further growth refer to specialist
122
MRI safe devices
Fillings, Braces, IUD's | Surgical hemostasis clips (2-3months post implant)
123
CT benefits
Excellent contrast resolution Cross sectional images in mostly axial plane excellent for imaging cortical bone
124
Jones fx
Fracture of the base of the fifth metatarsal, at least 1.5 cm. distal to the metatarsal styloid. avascular necrosis prompt orthopedic follow-up.
125
Osteoid Osteoma
``` Distinctive benign osteoblastic tumor • Painful • Pain increased at night • Classically relieved with aspirin (NSAID) • Pinpoint tenderness directly over lesion ```
126
Tibial Plateau Fracture
Occur most often are the result of a moving vehicle striking the knee.
127
Preferred imaging for C spine
CT up to 20% of fx missed on xray (in the field) = crosstable c spine xray (in ed) = CT w/o contrast
128
Duplex ultrasound
Clear Fluid appears black (anechoic {no echo]) Not clear fluid will apear gray
129
Salter harris III
Physis and epiphysis fractures • Usually requires surgical intervention
130
Site for Bone mineral density
using dexascan hip and spine to diagnose osteoporosis forearm also for alternative uses statistical analysis
131
Radiology team
``` Radiologist Diagnostic medical physicist Radiology Assistant Radiology Nurse Radiology Tech ```
132
Bilateral facet dislocation
complete anterior dislocation of the vertebral body resulting from extreme hyperflexion injury
133
Amount of radiation required to die in short period of time
400 REM | 1 REM = 500 chest xrays
134
When should you avoid barium sulfate
when perforation or peritonitis is suspected Barium sulfate not water soluble
135
Radiation in pregnancy
embyologic effects effects on th embyro first six weeks (first trimester) most radiosensitve most severe effects occur during this time sensitiviy decreases in 2nd and 3rd trimester
136
Galeazzi Fracture
proximal radius fx with distal radial dislocation
137
Rolando fx
Comminuted (or 3 part) intraarticular fracturedislocation of the base of the thumb (proximal first metacarpal). Essentially a comminuted Bennett Fracture
138
DM with Charcots foot. Not sure about osteomyelitis based on plain xray results. What imaging study would you order?
WBC scan
139
MRI Contrast
Most are gadolinium enhanced to produce "positive" or enhanced contrast mostly on T1 weighted images. • T2 effects are negligible • Types of contrast material – Extracellular agents – Blood Pool agents – Hepatobiliary agents
140
Scottie dog sign with collar
SPONDLYLOSIS is a bony defect of the pars interarticularis looks like collar
141
kVp
Kilovoltage (for xrays) Affects the quality or penetrating power of the beam differnet kVp depending on what you are trying to image.
142
A68yo AAF presents to your ED for evaluation of fall. On exam you note right leg shortening and rotation. What is the most likely pathology expected on imaging? 1. Comminuted Nondisplaced Femoral Fracture 2. Hip Dislocation 3. Patellar Fracture 4. Hip Fracture
4. Hip Fracture
143
Monteggia Fracture
Fracture of the ulna with accompanying radial head dislocation.
144
Cells and radiosensitivity
Reproductive and WBC are most radiosensitive Muscle, nerve, bone have low sensitivity
145
psisform fx
rare | crush injury
146
best view for assessing soft tissue
Lateral view
147
Heterotopic Ossificans
extra bone growth can be caused by trauma or surgery hip joint replacemtn
148
Jefferson fx
C1 fx crush broken in places
149
Contrast
ateriograms, venograms, ingested contrast Iodine and barium IV contrast is always iodine
150
Proximal Tibial Stress Fracture
Nuclear bone scanning is more sensitive for this diagnosis. helsp diffeentiate between osgood schlatter

PAM Semester 2 (22 decks)

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