Mehlman. Diagnostic modalities 03-05 (2) Flashcards
NG tube insertion?
answer for tracheoesophageal fistula and choanal
atresia (discussed in HY Pulm PDF).
answer for tracheoesophageal fistula and choanal
atresia (discussed in HY Pulm PDF)?
NG tube insertion
Barium swallow. upper eso?
For suspected Zenker; shows outpouching.
Barium swallow. first step in what?
First step in achalasia (before monometry); shows bird’s beak.
Barium swallow. dont use in what?
Do not use for esophageal perforation. Can cause mediastinitis if it leaks out through a hole in the esophagus.
Barium swallow. can be used in what specific case?
Can be used for patients with aspiration risk, since it doesn’t cause pneumonitis.
Gastrografin swallow. solubility?
water-soluble contrast swallow.
Gastrografin swallow. used in what case and why?
Used for esophageal perforations because it doesn’t cause mediastinitis.
Gastrografin swallow. dont use in what case?
Do not use if patient has aspiration risk; causes pneumonitis. Use barium instead.
Esophageal manometry. answer in what condition?
Answer for achalasia after barium swallow shows bird’s beak.
Esophageal manometry. A pressure study of the esophagus
.
Endoscopy. immediate answer for what patient?
For any patient with new-onset dysphagia and Hx of GERD or heavy smoking/alcohol (for esophageal cancer). Then biopsy any lesion/stricture.
Endoscopy. varices treatment?
Endoscopy + banding for esophageal varices emergent management.
Endoscopy. hernia?
Diagnosis of hiatal hernia (asked on NBME).
Endoscopy. done in what specific patients (age and condition)?
Done in patients over 50 who have H. pylori positivity (on newer 2CK form).
Capsule endoscopy?
Always wrong fucking answer on USMLE
Upper GI series. in peds what cases?
Congenital midgut volvulus in pediatrics; will show a corkscrew.
Upper GI series. how performed?
This is a contrast swallow followed by X-rays to visualize the upper GI tract
abdominal UG. cholecyst condition what?
Cholelithiasis.
abdominal UG. first step to diagnose what? -> what next step?
First step to diagnose cholecystitis; if negative, do HIDA scan.
abdominal UG. what other condition also first step diagnosis? –> then what next step?
First step for choledocholithiasis, then do ERCP.
abdominal UG. what common condition esp in peds, also first step –> then what?
Intussusception Dx, then do enema (definitively diagnostic and therapeutic)
abdominal UG. kokia dvylikapirstes zarnos diagnoze?
Pyloric stenosis
HIDA scan. answer for confirmatory diagnosis ….?
Answer for confirmatory diagnosis of cholecystitis (not cholelithiasis alone) IF UG IS NEGATIVE.
HIDA scan. how is performed?
Radiocontrast is injected + secreted into bile. If gallbladder lights up, there is no obstruction of the cystic duct and it is negative; if gallbladder doesn’t light up, we know there’s an obstruction by a stone and it confirms cholecystitis
CT of abdomen. USMLE won’t force you to choose, but just assume contrast CT is always used.
.
CT of abdomen. what are two cases when non-contrast CT is answer in general? 2
The only times non-contrast CT will be an answer is for urolithiasis and intracranial bleeds.
CT of abdomen. higher yield indication in usmle?
Diagnosis of pancreatic cancer
CT of abdomen. liver cases?
Diagnosis of liver cancer and focal nodular hyperplasia.
CT of abdomen. kidney?
Renal injury (ultra-HY; discussed in HY Renal PDF).
CT of abdomen. trauma?
Blunt force trauma to abdomen in patient who is stable.
CT of abdomen. storžarnė?
Diverticulitis.
Abdominal xray. bowel gas in what case?
Used to look for bowel gas in suspected obstruction (e.g., sigmoid volvulus showing coffee bean sign).
Abdominal xray. duodenal atresia. what seen?
Duodenal atresia (double bubble sign).
Abdominal xray. diaphragma?
Congenital diaphragmatic hernia (bowel gas in left hemithorax).
Abdominal xray. what necrotizing condition?
Necrotizing enterocolitis (pneumatosis intestinalis).
Abdominal xray. what colon condition?
Toxic megacolon if patient is stable
Abdominal xray. + chest xray, what case?
“X-rays of chest and abdomen” used for duodenal ulcer perforation to look for
air under the diaphragm
ERCP. Endoscopic retrograde cholangiopancreatography; type of EGD that can also
enter the biliary tree, remove stones there, and inject contrast if necessary
.
ERCP. answer in what case as next step?
Answer on USMLE for choledocholithiasis (including gallstone pancreatitis) after
ultrasound is performed
ERCP.
Answer for diagnosis of cholangitis.
Answer for drainage of pancreatic pseudocyst.
.
MRCP. Magnetic resonance cholangiopancreatography.
.
MRCP.
Never seen this as correct answer on NBME, but I observe that students always pick it when they don’t know what’s going on, maybe because it sounds weird and specific
.
MRCP.
Can visualize biliary tree much more safely than ERCP, but unlike ERCP, it isn’t a form of treatment (ERCP is both diagnostic and therapeutic).
.
Endoscopic ultrasound.
Never seen this as correct answer, only wrong answer.
.
Endoscopic ultrasound.
Can be done to diagnose pancreatic cancer if CT is negative or to drain pancreatic fluid collections in place of ERCP. But once again, never seen this as correct.
.
Paracentesis. used in what HY case?
SBP
Paracentesis.
As mentioned earlier, choose “white cell count and differential” before “gram
stain and culture of the fluid.” Do not confuse with pericardiocentesis.
.
Meckel scan.
Radiocontrast uptake scan that localizes to the diverticulum at terminal ileum.
.
Colonoscopy. diagnose what? 3
Done for diagnosis of colorectal cancer, IBD, pseudomembranous colitis
Colonoscopy. do NOT do in what cases?
Do not do in diverticulitis (can cause perforation; do CT instead).
Colonoscopy. what case about anal cancer?
Do if patient has anal cancer prior to excision in order to first see if there’s greater extent of cancer (might change management).
Asked on 2CK form, where
they say there is cancer at anal verge, and excision is wrong; answer is colonoscopy.
Colonoscopy. screening in what population?
Commence at age 45-50 (guidelines are evolving) and then do every 10 years.
USMLE will not force you into a position where ohemgee is it 45 or 50. If they force you to choose 45 as a new guideline, it will be obvious the other answer choices are wrong
Colonoscopy. if first-degree relative have colon cancer?
If first-degree relative (parent or sibling) has colon cancer, commence at age 40 or 10 years prior to diagnosis in that family member, whichever is earlier.
In other words, NEVER LATER than 40.
For example, if dad was diagnosed at 58, commence
at age 40. If dad was diagnosed at 44, commence at age 34.
Then do every 5 years
Colonoscopy. if patient has IBD, what commence years for screening?
If patient has IBD (UC or Crohn), commence 8 years after the diagnosis was made and then do every 2-3 years.
2CK NBME is real slick about this. T
Colonoscopy. IBD case.
They give mid-30s patient with IBD diagnosed in 20s + also has dad diagnosed with colon cancer in 50s;
wrong answer = colonoscopy at age 40;
correct answer is
“colonoscopy now,” since patient has IBD and should have had one done 8 years
after his/her diagnosis.
.
Colonoscopy.
Patients who have history of dysplastic polyps need repeat colonoscopies every …
2-5 years, depending on size/morphology of polyp(s).
Colonoscopy. HNPCC (Lynch syndrome), when start?
If patient has HNPCC (Lynch syndrome), start at 20-25, then do every 1-2 years.
Colonoscopy. if has FAP? when do? what prophylaxis for this case?
For FAP, start at age 10-12 and do every 1-2 years.
Then do prophylactic proctocolectomy at age 18 (on NBME).
Colonoscopy.
For Peutz-Jeghers?
For Peutz-Jeghers, start at age 8, then every 1-2 years
Sigmoidoscopy. for what diagnosis?
“Sigmoidoscopy-guided insertion of rectal tube” is answer on NBME for treatment of sigmoid volvulus.
Sigmoidoscopy.
I’ve never seen sigmoidoscopy as a diagnostic tool. I make this point because there are alternative theoretic regimens to colon cancer screening – i.e.,
sigmoidoscopy + barium enemas, etc., but I’ve never seen these assessed.
.
Anoscopy. 2CK diagnosis for what?
Shows up on newer 2CK form as answer for diagnosis of hemorrhoids before banding is performed. This will help determine extent of hemorrhoids.
