Midterm Flashcards
When do you use contrast for a head CT?
Suspicion of tumor, infection, vascular abnormality
What modalities do NOT use radiation?
US
MRI
What is the best modality to examine skull fractures?
Non-contrast CT
What does MRI show in M.S.?
Periventricular plaques
Who is at risk for getting nephrogenic systemic fibrosis?
When does it occur?
Dialysis pts with GFR < 30mL
2 days - 18mo post-exposure
What imaging to use for skull fracture?
CT
What syndrome is associated with hoarseness and compression of the left RLN?
Ortner’s –> Mitral Stenosis
What is a diastolic decrescendo murmur in the 3rd ICS LSB?
AR
What is unequal size of pupils called?
Anisocoria
How far away should a patent hold a chart (NOT the snellen chart) when doing an eye exam?
6 feet
HSV1 causes brain infections where?
Inferior and medial temporal lobes
Gradient across valve in AS is significant if greater than what?
Obstruction leads to what?
50
Pressure overload, LVH
Which visual field must be tested separately?
Nasal field
If you have trouble seeing far away, what kind of vision abnormality do you have?
Myopia
If you have a pt with M.S., a tumor, or a CVA, what imaging modality do you want to use?
MRI w/contrast
What are the diastolic murmurs?
AR, PR
MS, TS
Atrial myxoma
What tumor is benign and derived from Rathke’s pouch?
Also most common supratentorial tumor?
Craniopharyngioma
What imaging assesses hemodynamics via soundwaves?
Doppler
Chronic cause of AR?
Syphilis, ankylosing spondylitis
T2 weighted image: describe the TR and TE
What appears bright white on image?
Long TR and TE
Compartments filled with H2O
What is a duplex a combination of?
Traditional and doppler US
What imaging to diagnose an uncal herniation?
MRI
Concussion mainly results in damage to what?
White matter tracts
Diffuse axonal injury
Pulmonic valve listening post?
Left 2nd ICS at SB
What are the contraindications for mydriatic drops?
Head injury and coma
Narrow-angle glaucoma
MRI precautions?
Cardiovascular device
Unstable pt
Claustrophobic and agitated
Fatties
What is the normal AoV area?
AS how big?
4cm
Less than 1 cm
What do you always order before getting an Xray?
bhCG
Bitch might be preggo
What causes a blowing systolic murmur LSB that increases with inspiration?
What is the sign called?
TR
Carvallo’s
Where is a catheter placed for a cardiac catheter?
Is contrast used?
Femoral or radial a.
Yea
What bacteria causes conjuctivitis?
S. aureus (most common adults)
M. Catarrhalis (most common kids)
S. pneumo
H. Flu
What is a fluorescein stain used for?
Performed when?
ID epithelial defect
AFTER complete screening exam
Aortic valve listening post?
R 2nd ICS at SB
What shows a systolic murmur that is harsh, 2nd ICS RSB and radiates into suprastneral notch?
AS
If you have a pt with an AAA, embolism, lung nodule, hemorrhage, tumor or ischemia, what imaging modality do you want to use?
CT
Can contrast cross the BBB?
Nah
Xanthelasma are what?
Indicates what?
Cholesterol deposits
Hyperlipidemia
What imaging to diagnose a cingulate herniation?
CT
What is assoc. with PHTN, inferior MI or RV infarction?
See what?
TR
Big v wave
Mitral valve listening post?
L 5th ICS at Mid clavicular line
What are the types of valvular heart disease?
Degenerative (senile calcification)
Myxomatous degeneration (MVP)
Congenital (BAV)
RVD
What are the structures that you can see in a fundoscopic exam of the eye in the posterior chamber?
Optic disc - nasal and inferior
Arterioles: 2 laterally, 2 nasally
Macula is temporal
What can mimic MS?
Austin Flint murmur
What do the following indicate?
Low voltage, electrical altérants on EKG
Increased JVP
Muffled heart sounds
Decreased BP on inspiration?
Cardiac tamponade
Esotropia?
Medial drift of eyes
How do you view the palpebral conjuctiva?
Evert the eye lid
Where do you see an oligodendroglioma?
Frontal lobes
What is the normal reflection of light off the retina called?
Red reflex
LP is contraindicated in what kind of head trauma?
Subdural hematoma
What causes a blowing systolic murmur that radiates into the left axilla?
May have a systolic click
MR
In AS without tx, die when once you develop syncope?
Onset of HF?
3 yrs
2 yrs
Do males or females have a higher post-concussion symptom score 3 months post-injury?
Females
What requires venous access, saline, concerted effort to capture results, and a TTE?
Bubble study
What causes a rumbling diastolic murmur that is low pitched, best heard at the apex? May see a malar flush.
Use diaphragm or bell?
MS
Bell
Overgrowth of cornea due to excess sun exposure?
Pterygium
Why give contrast?
Increases differences in density between anatomic structures
When examining the optic disc how should you rotate the lens disc if the pt is myopic?
Hyperopic?
Counterclockwise to (-) diopters
Clockwise to (+) diopters
When do you refer a pt to a vascular specialist with an AAA?
If aneurysm is > 4cm
What is a chalazion?
Associated with what?
To treat, when do you give antibiotics?
Meibomian tear gland obstructed
Blepharitis and Rosales
NEVER
What virus most often causes conjuctivitis?
Adenovirus
Acute cause of MR?
Ruptured chordal tendineae, papillary muscle Ischemic papillary m CAD/MI IE Valve perforation
Pros of US?
Cons?
No radiation, cheap
Bowel gas and lung tissue hinder image
What bacteria are most common in bacterial abscessses in non-immunocompromised pts?
What imaging should you use?
Strep
Staph
MRI (DWI)
Without treatment in AS, what is the prognosis?
Poor
What is used to visualize the LA to assess for thrombus formation?
TEE
What is used for R->L shunts in A or V, PFO, AV shunts in pulmonary vasculature?
Bubble study
What occurs with nephrogenic systemic fibrosis?
What is spared?
Advanced renal failure
Thickening of hardening of skin
HEAD
Stroke or CVA of what artery has Motor effects only?
Lenticulo-striate artery
What tumor crosses both hemispheres in a butterfly pattern?
Glioblastoma
What imaging modalities use ionizing radiation?
XR
CT
Fluoroscopy
Angiography
What does a narrow pulse pressure with delayed pulses and decreased SV indicate?
AS
What causes a murmur in the 2nd-3rd ICS, LSB that radiates towards left shoulder and increases on inspiration?
Can cause what?
PS
Angina and syncope
What are the systolic murmurs?
MR (MVP), TR
AS, PS
VSD
Shunts
What does MRI give the greatest detail of?
Contraindication?
Soft tissue
Metal in the body
Most common to least common adult tumors?
Metastasis Glioblastoma Meningioma Schwannoma Oligodendroglioma Pituitary adenoma
MGM Studios
What imaging to see SAH, ICH, and general acute head trauma?
CT
Xray pros?
Cons?
Cheap, fast, everywhere
2D, radiation, poor detail of soft tissue
The opening between the eyelids is called what?
Palpebral fissure
What causes a diastolic, blowing murmur 2nd SB (Graham Steele)?
Due to what?
PR
PHTN
What causes lateral drift of the eyes?
Exotropia
MRI pro
Con?
Safe, no radiation, precise detail soft tissue
Expensive, cant be fat, takes a long time, not widely available
What is assoc with MS, TR, and RHD?
See what pathophys?
TS
Big a wave in JVP ascites
how can damage from a concussion be visualized?
3D diffusion tensor
Who is at higher risk for 2nd impact syndrome?
Mortality rate?
Morbidity?
Young athletes (under 20)
50 %
100%
A FAST exam is a type of what?
US
What are the most likely carcinogenesis of ionizing radiation?
Leukemia Thyroid Breast Lung Skin
What is it called when a murmur radiates to the apex like MR?
Gallavardin phenomenon
What are the common reactions to contrast?
Hypersensitivity
Chemotoxic ie N/V (very common)
Vasovagal ie bradycardia
Toxo, CNS lymphoma, Cryptococcus, JC virus with CD4 count of what?
CMV with what count?
Under 200
Under 50
Acute cause of AR?
IE, dissection, BAV
S4 heard best heard with what? Describe
Due to what?
What else?
Bell, dull low pitch
Stiff low compliant ventricle
Atrial gallop
What is used to evaluate the structural integrity of the heart?
Describe the procedure
TEE
Invasive
PE of AR shows what?
Wide pulse pressure
T1 weighted image: describe TR and TE
What kind of tissues appear bright?
Short TR and TE
High fat content tissues
What are causes of provoked DVT?
Unprovoked?
Trauma, surgery
Oral BCP, cancer
What is the initial test of choice for cardiac tamponade due to pericarditis?
TTE
Tricuspid valve listening post?
L 4th ICS at SB
What causes brain abscesses in ketoacidotic diabetic, and neutropenic pts?
Mucor
Rhizopus
What kind of contrast is given in GI?
Barium and gastrograffin
What is one of the most frequently reported behavior sequelae of concussions?
Major depression
What are the 4 views of a FAST?
Pericardial
Perihepatic
Perisplenic
Peripelvic
Pt with reptile skin has what?
Nephrogenic systemic fibrosis
Where is a meningioma located?
Arises from what?
Parasagittally
Arachnoid cells
What causes a diastolic murmur at LSB, increases with inspiration and decreases with expiration?
TS
What kind of contrast is given in IV?
Iodine-based
What does a duplex evaluate?
Blood flow via US
What imaging used to see brain neoplasms?
MRI
What is the stepwise progression of return to play for concussions?
- Cognitive and physical rest until asymptomatic
- Light aerobic exercise
- Sport aerobic exercise
- Noncontact drills, light resistance training
- Full contact if cleared medically
- GAME TIME
What tumor arises from the posterior fossa, is GFAP +, benign with a good prognosis?
Pilocytic astrocytoma
Common sites of injury for concussion?
Frontal and temporal poles
What is involved in axonal injury at the cellular level for concussions?
JNKs
Most common childhood brain tumors to least?
Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Craniopharyngioma
What distinguishes allergic conjuctivitis from viral?
B/L redness, watery discharge and ITCHING
How does fluoroscopy work?
Uses continually emitted X-rays and allows for real-time visualization
What symptoms seen in MR?
Orthopnea, PND, RHF/LHF
What are the benefits of coronary angiography?
What are the risks?
Diagnostic w/immediate intervention, life saving
Anything else
Occlusion to what causes lateral pontine syndrome?
What nuclei are fucked?
AICA
Vestibular, facial, cochlear
What are the 4 major routes of an embolism?
Venous - PE
Arterial - systemic E
Portal vein - hepatic E
Paradoxical E
Occlusion to what causes medial medullary syndrome with ipsilateral hypoglossal, LCST, and ML dysfunction?
Anterior spinal artery
Where do you find a Schwannoma?
Cerebellopontine angle
What tumor has perivascular rosettes and causes hydrocephalus with a poor prognosis?
Ependymoma
What kind of contrast is given in MRI?
Gadolinium
What is a FAST CXR used for?
To detect hemoperitoneum and pericardial effusion
What is a real time assessment of intracardiac blood flow?
Bubble study
When does an immediate CT scan warrant use in concussion?
Loss of consciousness > 60 sec
Post-concussive seizure
Major neurologic defect (especially motor)
Sig. lethargy or rapidly progressive worsening of symptoms
Chronic cause of MR?
MVP - most common
MAC
S3 best heard with bell or diaphragm? Describe
Mnemonic?
Bell, dull and low pitch
Kent-Tuck-y
What organism causes a hordeolum?
What gland causes an internal hordeolum?
How to treat?
S. aureus
Meibomian gland
Warm compress
What kind of cells cause demyelination in M.S.?
Associated with what halpotype?
Leukocytes activated by TH17
HLA-DL2
What tool to evaluate concussions is the cheapest and probably most widely used?
SCAT2
When does MS occur most often?
Symptoms?
4th decade
DOE, cough, orthopnea, PND, PE, hemoptysis, AFib
Diplopia in 1 eye, with the other closed suggests a problem with what?
Cornea or lens
CT pros?
Cons?
Everywhere, painless
Contrast, radiation, dx limited
What does the following indicate?
W/in 24-48 hours there is INC serum Cr, DEC GFR with oliguria
Contrast induced nephropathy
What medication can cause lactic acidosis and is contraindicated when imaging with contrast?
Metformin
What is the persistence of concussion-induced symptomatologie for greater than 3 months post injury?
Postconcussion syndrome
Triad of sx in AS?
Occurs when?
SAD - syncope (HF), angina, exertional dyspnea
6th decade
