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Radiology > Ortho/Vascular/Peds > Flashcards

Ortho/Vascular/Peds Flashcards

1
Q

Indications for ortho studies

A 
Injury
Pt is unsure whether injury occurred
Abscesses
Osteomyelitis
Bony tumors
MSK pathologies, think sprains, tears, etc
Pt assurance
Parental assurance
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2
Q

How to choose imaging modality for ortho?

A

Usually start with plain films for injuries and FBs
CT/MRI/NM after plain films usually if re: injury
Abnormal labs?
Length of sx
Mechanism of injury
-Always report this when you order the test
Pt limitations with regard to radiographic principle of 2 views/obliques, etc

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3
Q

How to order ortho imaging

A

If injury: MOI, PE findings (deformity, TTP, test results if any)
If chronic or no injury: labs if applicable, PE findings (same as above)
Order what hurts. However, radiology principles dictate if long bones are ordered they must include both proximal and distal joints. Keep in mind so you don’t overorder

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4
Q

General bony pathology

A 
Will have the same general appearance among the pathology regardless of which bone is involved
Osteomyelitis
Bony tumors
RA
OA
Osteopenia/osteoporosis
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5
Q

What is the test of choice for sprains/strains/tears?

A

MRI, without contrast

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6
Q

Types of Salter-Harris fractures

A 
Type I: straight
Type II: Above
Type III: Below
Type IV: Through
Type V: Crush
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7
Q

Colles fx

A

Distal radius

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8
Q

Greenstick fx

A

Rare, long bones with angulated longitudinal force, incomplete fx

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9
Q

Buckle/torus fx

A

Primary wrist fx

Incomplete fx

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10
Q

Stress fx

A

10 day rule for feet

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11
Q

Shoulder

A

Includes the clavicle, scapula, and proximal humerus
Complete shoulder is neutral/external/internal rotation and Y view of scapula
Also can do an axillary view (must be at a 90 degree angle) but the Y view is easier on the pt usually and standard in the shoulder series

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12
Q

Elbow

A 
Complete is 4 views:
AP
Lateral
Internal rotation
External rotation
If obvious deformity, 2 views (AP/lateral) will suffice
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13
Q

Occult fractures

A

Commonly a concern with the elbow
Nothing seen overtly on radiographic imaging including CT sometimes. MRI/NM will usually show them
Pos fat pad signs (anterior/posterior), sail sign (anterior)
Adults: radial head fx
Children: supracondylar fx
Children don’t lie or fake guarding their extremities, err on side of caution and splint with ortho f/u

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14
Q

Pelvic girdle

A

If ordering a unilateral hip, also order an AP pelvis
Hip fxs and dislocations are pretty straightforward
Pelvis fxs need CT of the pelvis for best detail, regardless of age

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15
Q

Pathologies possible in the pelvic girdle

How can they be imaged?

A

AVN
Slipped capital femoral epiphysis
Legg-Calve-Perthes dz
All can be diagnosed usually with plain films but MRI will give definitive dx
Hip clicks/dysplasia in infants, u/s is test of choice for dx IF sonographers are capable

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16
Q

Knees

A

Fxs are rare
Dislocations are more rare
Knee complete is 4 views: AP, lateral, int/ext obliques
Older people (60 and older) with injury, neg plain films, still with pain days later, do CT will find tibial plateau fxs
Most knee plain films will be negative, high incidence of strain/sprain/tear, good PE, if no improvement after 7-10 days of RICE, MRI warranted

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17
Q

Ankles

A

When examining pts with ankle injuries, always check the fibular head for point tenderness
Many twisting injuries can result in fibular head fractures
If TTP on fibular head order a knee series as well
Ankle complete is 3 views:
AP
Lateral
Internal oblique
Ankle joint should be flexed to see if ankle mortise is intact

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18
Q

Feet

A

Standard exam is 3 views:
AP
Lateral
Oblique
Neg X-ray at time of injury with continued sx 7-10 later pt should be re-imaged with plain film
Foot fxs can show on later films, always caution your pts to return to clinic for re-eval or see PCP if no improvement in sx
Jones fxs must be NWB

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19
Q

Specialty ortho

A

C arm for surgery and reductions (in ER if the doctor wants)
-Reactive when it’s on
Nuclear medicine: bone scans for fx age, bony mets, tumors
MRI: gold standard for eval of sprains/tears
-Not routinely ordered in ER, either in office or by ortho specifically

20
Q

Words of wisdom in ortho

A

Dislocations must be reduced ASAP, regardless of fracture type
If you have access to ortho, call
When in doubt, splint and refer, treat it like a fracture
Always have help when reducing fractures/dislocations

21
Q

What is considered part of the peripheral vascular system?

A

Carotid arteries
Jugular veins
Upper extremities
Lower extremities

22
Q

Imaging that is possible on the carotid arteries

A

U/S (fast, cheap and easy)- good screening tool
Images the common carotid, internal carotid, external carotid, vertebral arteries
Internal carotid/external carotid named for what they feed not where they lie
CTA of neck
MRA of neck
Angiogram

23
Q

Carotid duplex/doppler

A

CCA/ICA/ECA/vertebrals in black and white, with color, with doppler waveforms and measurements

24
Q

Indications for carotid duplex/doppler

A

Any neuro complaint, e.g. dizziness, visual changes, weakness
Usually done post CVA/TIA
Bruit on exam
Screening exam now for pts >65 yo with RFs

25
Q

Jugular/subclavian veins

A

included with an upper extremity venous doppler (ultrasound)
Can order separately if needed
Can use bedside u/s to localize EJ for IV access in difficult pts

26
Q

Upper/lower extremity imaging options

A

Arterial doppler
ABIs
Venous doppler
CTA/MRA/Angiography

27
Q

Upper/lower extremity arterial indications

A

Decreased or absent pulses
Skin changes: color, temp
Pain in the setting worrisome for vascular dz (think DM, smoking)

28
Q

How to order upper/lower extremity arterial

A 
RUE
LUE
BUE
RLE
LLE
BLE 
arterial doppler (duplex)
29
Q

What you get with upper/lower extremity arterial imaging

A

Subclavian to as much radial/ulnar arteries as is able to be visualized, includes axillary and brachial
Common femoral vein/great saphenous vein/popliteal vein/post tibs
Black and white images, color images, doppler with waveforms and measurements

30
Q

Types of extremity arterial waveforms

A

Triphasic flow is nl
Biphasic flow is indicative of early changes/disease
Monophasic flow is diseased/pre-occlusive
No flow = occlusive
Can have collaterals

31
Q

ABI

A

Screening test, easy, can do in your office if you have a doppler
The ankle-brachial pressure index (ABPI) or ABI is the ratio of the BP of the ankle to the BP in the upper arm. Compared to the arm, lower BP in the leg is an indication of diseased arteries d/t PVD

32
Q

Upper/lower extremity venous

A

Very overused test
Fast, cheap, and easy, most bang for your buck
Rules out something potential deadly
Pt reassurance
Images deep venous system from hip to knee and then as far as is possible to image, usually mid-calf region
Common femoral vein/great saphenous vein/superficial femoral vein, pop, post tibials
Never order venous and arterial together just because you are unsure

33
Q

What you get with upper extremity venous

A 
Internal jugular
Subclavian
Axillary
Brachial (s)
Cephalic
Basilic
Radial/ulnar as far as you can see usually mid forearm
34
Q

Lower extremity venous- what you get

A 
Central femoral vein
Great saphenous vein
Superficial femoral vein
Popliteal vein
Posterior tibial
35
Q

Pediatric pearls

A

Good hx from parent/guardian
Good PE
Learn how to build rapport with the pt AND the parents
Both can tell when you’re not confident
Defer to radiologist whenever possible
When in doubt err on side of caution and proceed as needed

36
Q

Pediatric considerations

A 
Head injury/LOC
Neurologic sx
Spine injuries/scoliosis
CXR
Abd X-ray: common and uncommon pathology
Appendicitis
Pyloric stenosis
Hip dysplasia
Ortho
Osteogenesis imperfecta
Radiation exposure
37
Q

Head injury with or without LOC

A

Assess pt, neuro exam
Good hx from parents
PE concerns
Benign exam findings with no LOC: monitor for concussive sx
Benign exam findings with LOC: monitor vs skull X-ray vs CT scan
Pos exam findings with or without LOC: scan the pt

38
Q

Neuro sx in the pediatric pt

A 
Chronic headaches
Syncope
New onset seizure
Abnl neuro exam
CT scan without contrast
39
Q

Spine injuries/scoliosis

A

Start with plain films and proceed based on those results
If <18 but adult sized teenager may do CT scans instead
Scoliosis series: radiologist will give you the degree of lateral curvature

40
Q

CXR in peds: when to get it

A 
Cough, fever, ill-appearing
Low O2 sat
Unable to correct wheezing/coarse breath sounds with meds
Hx of pneumonia
Abnl labs: elevated WBC
Ingestion of FB
41
Q

Abdominal X-ray in peds: when to get it

A 
Vague abdominal complaint no worry for appy
Constipation
Exam findings with no worry for appy
Ingestion of FB
Worrisome for:
Volvulus
Intussusception
SBO
Free air
NEC
Duodenal atresia
These conditions usually require a barium study either under fluoro or CT scan
42
Q

Appendicitis

A

Good hx from parents
PE findings worrisome for appy
May order u/s first- know the LIMITATIONS
Best imaging choice when u/s is not a viable option: CT abd/pelvis with IV/PO contrast
If an obese teenager may do without any contrast same as adult

43
Q

Pyloric stenosis

A

Start with u/s, usually an excellent way to diagnose

If u/s is neg, pt still with sx, proceed to upper GI

44
Q

Hip dysplasia

A

U/s if PE is concerning
Must be done by a confident sonographer
Read by a confident radiologist

45
Q

Orthopedics

A

For small children and infants, it’s really difficult to interpret images
Treat as a fracture, splint and ortho this DOES NOT AID IN DX
Radiograph the unaffected side for comparison when a dx is needed
Your decision will be based on parents mostly, some want to know for sure if there is a fx
Elbow fxs (supracondylar
fx) are emergent and must be found

46
Q

Radiation exposure

A

Osteogenesis imperfecta pts get imaged a lot d/t multiple fxs, try to order the least amount of exams to limit their lifetime exposure
CT head to children is a lot of radiation, be prudent when ordering this, esp if PE if benign and the pt is well-appearing, parent reassurance is important, you must learn to reassure without ordering
Sick infants will be imaged a lot, always limit your orders as best you can to decrease their lifetime exposure
Use u/s when possible

Radiology (4 decks)

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