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Comps - Mod 2 > PC 3 - Test 2 - Sheet1 > Flashcards

PC 3 - Test 2 - Sheet1 Flashcards

1
Q

System for reading X-rays

A

BSOO - bones, soft tissue, organs, and other

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2
Q

Before reading an x-ray, it is essential to…

A

Make absolutely certain that you have the right film for the right patient and it is turned the right way. Also, make sure the film is correctly dated.

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3
Q

What to do if the film is of poor quality

A

Have it repeated

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4
Q

Number of views mandatory of x-rays

A

Two views. Three or more for certain body parts

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5
Q

Views of out-patient chest x-rays

A

PA and lateral

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6
Q

PA versus AP chest x-ray views

A

PA is out-pt and AP is in-pt (often with pt lying in bed)

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7
Q

X-rays with fractures

A

X-ray the joint above and below the fracture

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8
Q

Information to relay to radiologist reading x-rays

A

Remember that the two of you are working for the pt together. Any info you can give the radiologist to correlate the history and the film is beneficial and helps to reduce the margin or error

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9
Q

Helpful tip for x-raying children

A

Often helpful to x-ray the same bone on the other side of the body in order to make comparisons.

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10
Q

Can you tell the patient beyond question that there is no fracture?

A

No because it may take days for some fractures to show up as calcification occurs

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11
Q

CT scan

A

A two-dimensional display of two-dimensional information, and objects appear where they really are in space. A large number of structures can be visualized simultaneously with a CT scan.

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12
Q

Radiation exposure with CT

A

About 10-100 times more radiation than with a radiograph.

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13
Q

Ultrasonography

A

Uses high-frequency sound waves to make images by sending the the high-frequency waves and assessing the echoes they return.

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14
Q

Echos of an ultrasound

A

The result of interfaces or changes or density between tissues.

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15
Q

MRI

A

Done by applying a varying magnetic field to the body.

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16
Q

Primary advantage of MRI

A

It obtains exquisite image of teh CNS and stationary sort tissue.

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17
Q

Major safety problem with MRI

A

Magnets are very strong.

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18
Q

Contraindications of MRI

A

Cardiac pacemakers, defibrillators, spinal cord stimulators, and most aneurysm clips.

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19
Q

Medications and conditions to consider before ordering CT dye

A

Metformin, kidney status, or pregnancy

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20
Q

Using x-ray to diagnose

A

It does not stand alone, and must be considered in the context of the clinical situation

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21
Q

Ordering the correct x-ray

A

It is crucial. If in question, consult the radiologist prior to placing the order

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22
Q

What radiology tests to order?

A

Choices of what to order are based on your differential diagnoses; what is available in your area; and cost, convenience, and insurance status

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23
Q

How x-rays work - basics

A

X-ray beam is the light source. The image detector is the recipient of the light. The patient lies between the x-ray beam and the image detector.

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24
Q

Darkness of x-ray films

A

More x-ray that hits the film causes a darker image

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25
Q

Radiopaque

A

Does not permit the passage of x-rays, so the film will be white

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26
Q

Radiolucent

A

Permits the passage of x-rays, so the film will be dark

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27
Q

Four basic shades on a plain x-ray

A

X-rays are absorbed in varying amounts by different tissues or materials. Air - dark. Fat, Water. Bone - light

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28
Q

Air on an x-ray

A

Does not absorb much radiation, so more radiation passes through and strikes fluorescent screen and exposes the film. This causes the film to be dark

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29
Q

Fat on an x-ray

A

Is usually gray and darker than muscle or blood

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30
Q

Bone on an x-ray

A

White, as art calcium deposits

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31
Q

Metal or contrast on an x-ray

A

Appears white

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32
Q

Process of examining an x-ray

A

Check the name. Check the date. Look at the entire film every time. Be sure the x-ray is technically well done, showing all the expected parts.

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33
Q

When to repeat an x-ray

A

If it is not technically well done. If jewelry or anything metal shows up.

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34
Q

Systemiatic exam of findings on x-ray

A

Bones; soft tissue; organs; and other things. BSOO. Using a system prevents missing the unexpected. Compare new to old x-rays whenever possible

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35
Q

Looking at bones to diagnose fractures

A

Bones should be smooth. If it is not, it is fractured

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36
Q

Determing the number of views of an x-ray to order

A

Standard x-rays are 2 dimensional. You need at least 2 views because the human body is 3 dimensional. One view is one view too few. More views increase the likehood of finding the problem.

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37
Q

Why ordering different x-ray views is essential

A

Something could be hidden in one view; it is a matter of perspective. An object could be more difficult to see or could take on a different appearance, again based on perspective.

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38
Q

Types of standard views of x-rays

A

PosteriorAnterior (PA). AnteroPosterior (AP). Lateral (Lat). Oblique

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39
Q

Positioning for x-rays

A

It can affect magnification, organ position, and blood flow. Before interpretation, it is important to know the patient’s position

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40
Q

Normal view of chest x-ray

A

PA and lateral (PA/Lat)

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41
Q

Normal view of abdomen

A

Flat and upright

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42
Q

Normal view of extremity

A

PA/AP, lateral, oblique

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43
Q

Problem with ordering unnecessary views

A

Increases the cost and radiation exposure

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44
Q

Why a chest x-ray would be ordered AP view

A

Usually because the patient is bedridden. In this view, the heart will appear larger. So, you must know what view you are looking at.

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45
Q

why does the heart appear larger in the AP view?

A

On the PA view, the heart is closer to the film, so less shadow. In the AP views, the heart is further from the film, leading to magnification.

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46
Q

Diaphragm on normal chest x-ray

A

The right hemi-diaphragm should be 1-2 cm higher than the left

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47
Q

What does a paper thin diaphragm indicate

A

Free air in the peritoneum. Diaphragm should never be that thin.

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48
Q

Costophrenic angels of normal chest x-ray

A

Should be sharp and clear

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49
Q

Blood flow in normal upright chest x-ray

A

More blood flows to the lung bases than the apices, so the vessels should be distinct from the peripheral 1/3 of the lung back to the hila, and more evident in the lower lobes than upper lobes

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50
Q

Assessing a normal chest x-ray

A

Are the clavicles symmetrical? Count ribs - anterior ribs, posterior ribs, rib spaces - 8-10 with normal expansion and 10 or more with hyperinflation

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51
Q

Assessing ribs on a normal chest x-ray

A

Use ribs to identify where lesion(s) or problem(s) may lie. Posterior ribs are straight and attach to vertebral body. Anterior ribs angle; many attach to the sternum.

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52
Q

Normal cardiac silhouette diameter of normal chest x-ray

A

Diameter is less than 1/2 the intrathoracic diameter.

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53
Q

Dextrocardia

A

Check film for demographics to reveal is film is flipped. Films usually have left and right markers, so check them.

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54
Q

Atelectasis

A

Collapse of a portion or entire lung with the re-absorption of air from the alveoli

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55
Q

Bleb or bullae

A

Portion of the lung in which there is an air space without albeoli (bled is small, bullae is greater than 1 cm)

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56
Q

Infiltrate

A

Alveolar space is filled with pus, fluid or blood

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57
Q

Assessing pneumonia on x-ray

A

Look for infiltrates. Look for loss of sharp cardiac borders (silhouette sign)

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58
Q

Essential step when patient diagnosed with pneumonia

A

Patient must always return for test of cure x-ray to prove infiltrates are clear and to be sure the infiltrate was not the result of something else, or hiding something else.

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59
Q

Landmarks of miller and upper lobes

A

Lie against the heart

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60
Q

Landmark of lower lobes

A

Lie against the diaphragm

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61
Q

Infiltrates of right lower lobe pneumonia

A

Infiltrates will appear posterior to the heart, obscuring the T-spine

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62
Q

Infiltrates of right upper lobe pneumonia

A

Heart border disappears with lateral view, as the infiltrate will be anterior of the heart

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63
Q

Landmarks of left lobes of lungs

A

Upper lobe is anterior of the heart. Lower lobe is posterior of the heart

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64
Q

Pleural effusion

A

Fluid layering in pleural cavity. If seen on upright x-ray, they are at least 100 ml in size. Most seen in dependent portions of pleural spaces. Causes blunting of costophrenic angles. Larger effusions may compress lung tissues.

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65
Q

COPD on x-ray

A

Only detects moderate or late disease. Hemi-diaphragms may be as low as 12th posterior ribs. Causes blunting of costophrenic angles. Increased AP diameter in lateral view. Marked flattening of the sternum. Flattening of the hemi-diaphragms. May also have bullae

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66
Q

Chest x-ray of advanced COPD

A

May see hyperinflation

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67
Q

Appearance of air spaces with COPD

A

Appear dark since airspace is minimal

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68
Q

Early stages of CHF on chest x-rays

A

Minimal cardiomegaly and redistribution of pulmonary vascularity (equal upper and lower)

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69
Q

Fluid accumulation on chest x-ray with worsening CHF

A

As CHF worsens, fluid may collect in intra-lobal septa at the lateral basal aspects of the lungs AKA Kerley B lines

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70
Q

Blood vessels of worsening CHF on chest x-rays

A

Vessels in the hila become more indistinct (bilateral and symmetrical indistinctness suggests CHF)

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71
Q

Fluid collection on chest x-ray with CHF

A

As fluid accumulates in the alveolar spaces, pulmonary edema becomes evident. Blunting of the costophrenic angles results from pleural effusions.

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72
Q

Appearance of heart on chest x-ray with CHF

A

Looks like a big heart with fuzzy borders

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73
Q

Additional diagnostic test in patient with CHF

A

Order an ECG

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74
Q

Kerley B lines of chest x-ray with CHF

A

Always located inside ribs. Not to be confused with blood vessels because blood vessels should not be seen in peripheral 1/4 of lung.

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75
Q

What do Kerley B lines indicate

A

Destruction of the lymphatics. They are rarely seen, really a “lucky finding”, but somehow a frequent test question

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76
Q

TB on chest x-ray

A

Normal x-ray does not exclude active TB in other sites (kidney, spine). Infiltrates and cavitations in apices. Hilar adenopathy most often present. Healed TB may present as fibrous changes or as calcifications.

77
Q

Fungal infections on chest x-ray

A

May present as focal infiltrates or discrete lesions, rarely a fungus ball (mycetoma).

78
Q

Histoplasmosis on chest x-ray

A

Findings similiar to TB

79
Q

Cryptococcal infection on chest x-ray

A

May be seen as a small cavitary lesion within the lung

80
Q

Coccidiomycosis on chest x-ray

A

Cavitary lesions

81
Q

Sarcoidosis on chest x-ray

A

Hilar and midiastinal adenopathy; pulmonary parenchymal disease; hilar masses; unknown etiology; more common in African Americans. Prefers the upper lobes

82
Q

Cystic fibrosis on chest x-ray

A

Causes low, falt diaphragm; small heart; large lungs. Prefers the upper lobes

83
Q

Silicosis on chest x-ray

A

Eggshell calcifications in hilar nodes and small nodules. Prefers the upper lobes

84
Q

TB

A

Infiltrates and cavitations in apices. Prefers the upper lobes

85
Q

Empyema

A

A collection of pus within the pleural space caused by: primary infection, postsurgical, and post-traumatic.

86
Q

Diagnosis of empyema

A

CT scan to locate and confirm diagnosis

87
Q

Treatment of empyema

A

Refer to pulmonologist

88
Q

Pneumothorax

A

Air in the pleural space caused by trauma, can occur spontaneously, other causes such as a tumor.

89
Q

Diagnosis of pneumothorax on chest x-ray

A

Look for area of lung with no vascularity and a think white line (visceral pleura separated from parietal pleura). Occurs in varying degrees.

90
Q

Life threatening element of pneumothorax

A

If a large amount of air enters the pleural space - pressure forces the mediastinal structures to shift to the opposite side. This is life threatening!

91
Q

Stolen lung on chest x-ray

A

Lung markings should be visible all the way to the periphery. No lung markings means no lung. Missing lung can be either pneumothorax, surgical removal, or cavitating lung disease.

92
Q

Hemoptysis

A

Could be from GI or nasopharyns. Most common cause is bronchitis, but must consider neoplasm and PE.

93
Q

Diagnosis of hemoptysis

A

Initial PA and lateral chest x-ray.

94
Q

Normal x-ray and low risk for cancer related to hemoptysis

A

Order CT scan

95
Q

Normal x-ray and high risk for cancer related to hemoptysis

A

Order bronchoscopy and possible CT scan. Most likely, you will be consulting or referring to a pulmonologist.

96
Q

What to do if suspect a PE

A

Order spiral CT. If not available, order VQ scan. Plain chest x-ray usually negative, but should be ordered in the differential.

97
Q

Examining the neck on x-ray

A

Evaluate stridor with plain x-ray, but may also need to do a CT. Consult with endocrinologist before ordering thyroid study

98
Q

Examining the spine on x-ray

A

Lateral spine should line up. You order either cervical, thoracic, or lumbar spine.

99
Q

X-ray for suspected scoliosis

A

Order one view of thoracolumbar spine

100
Q

Cervical spine x-rays

A

Normal lines of contour in the C-spine should have no sharp angulation. Look for normal pre-vertebral soft tissue space widths.

101
Q

Soft tissue swelling and c-spine x-rays

A

Soft tissue swelling alone may indicate fracture and can be spine cord threatening, so get a CT scan!

102
Q

Types of x-rays to order to evaluate C-spine

A

Two anterior views are done after exam of lateral view is found to be free of fracture or subluxation. If major trauma is suspected, order CT or MRI.

103
Q

Why order anterior view of lower c-spines with mouth closed and open

A

Closed - normal. Open - to view the odontoid.

104
Q

What is a Snuffbox

A

Pain on palpation over the “snuff box” area is very suspicious for a navicular fracture. Plain films may not show fracture. Risk of aspectic necrosis: do not miss this diagnosis

105
Q

Description of “an apple sitting in an cup on a saucer” with wrist x-ray

A

The applie is the capitate, the cup is the lunate, and the saucer is teh distal radius. If you see a moon, there is a twist in the lunate bone.

106
Q

Type I = Salter Harris classification of epiphyseal fracture in children

A

Straight across the epiphyseal plate

107
Q

Type II = Salter Harris classification of epiphyseal fracture in children

A

Involves a portion of the plate and a corner fracture through the metaphysis

108
Q

Type III = Salter Harris classification of epiphyseal fracture in children

A

Involves only part of the epiphysis

109
Q

Type IV = Salter Harris classification of epiphyseal fracture in children

A

Involves part of the epiphysis and metaphysis

110
Q

Type V = Salter Harris classification of epiphyseal fracture in children

A

Involves direct impaction and has most serious consequences

111
Q

Elbow: The fat pad sign

A

For trauma, order AP and oblique with elbow extended and lateral view with elbow flexed. A posterior fat pad is never normal and indicates fractures of radial head

112
Q

Positive fat pad sign

A

Displacement of the intra articular fat pads within the elbow away from the bone indicate trauma

113
Q

Knee x-rays

A

Order AP and lateral. Clinical exam (history and physical) is better than plain film for soft tissue injuries of knee.

114
Q

Lateral view of knee x-rays

A

Taken with knee flexed and used to evaluate patella and determine joint effusion

115
Q

AP views of knee x-rays

A

Used for assessing joint space narrowing and if there is calcification on the cartilage

116
Q

When to order MRI of knee

A

Indicated when exam is inconclusive or equivocal, and ligament tear is supected

117
Q

Osgood-Schlatter of knee

A

May appear like a fracture in the H&P, but there is no fracture

118
Q

Ottawa ankle rules regarding ankle pain

A

If pain near malleoli and either: inability to bear weight or bony tenderness (malleolar) order ankle films

119
Q

Ottawa ankle rules regarding foot pain

A

If mid foot pain and either: inability to bear weight or bony tenderness at navicular or base of 5th metatarsal order foot films

120
Q

What to do with ankle sprains

A

Always check for pain at base of 5th metatarsal

121
Q

What to do with ankle injuries

A

Always check calf tenderness to rule out proximal fibula fracture; if tender, obtain tib-fib film to rule out intra-osseous tear

122
Q

What and when to recheck with ankle injuries

A

Recheck calf in 48 hours; if better at 48 hrs, no worries; if still painful, obtain an MRI and refer.

123
Q

X-rays of abdomen

A

Usually order flat plate and upright

124
Q

What to look for of abdominal films

A

Gas patterns, organ shapes and sizes, calcifications, asymmetric Psoas margins, skeleton, basilar lung abnormalities

125
Q

What to look for in abdomen/KUB (kidney, ureter, bladder) films

A

Small bowel has fine lines that extend across the lumen. Normal not to exceed 3 cm. Looks like a stack of coins. Normal for 1-2 loops unless loops overlie area of tenderness; if tender, then presume abnormal.

126
Q

Indication of large bowel abdomen/KUB films

A

Usually mixed with fecal material and has a bubbly appearance

127
Q

Normal diameter of large bowel on abdomen/KUB films

A

Not to exceed 6 cm

128
Q

Normal diameter of cecum on abdomen/KUB films

A

Not to exceed 9 cm

129
Q

X-ray findings for appendicitis

A

Usually negative

130
Q

Suspected perforation, acute abdominal pain and other tests

A

In addition to H&P, ECG, and labs, order PA of the chest, and supine and upright view of the abdomen.

131
Q

Abdominal pain and pregnant or suspect gallbladder disease

A

Order ultrasound

132
Q

When to order CT for abdominal pain

A

For non-intestinal abdominal pathology

133
Q

What will ultrasound examine

A

Liver, kidneys, gallbladder, common bile duct, and maybe appendix and pancreas

134
Q

What to order when suspect kidney stone

A

CT without contrast

135
Q

What to order when suspect apendicitis

A

CT with contrast

136
Q

What to order with hematuria

A

CT with and without contrast. Most stones will show without contrast. IVP for the young. CT if older or concern of CA

137
Q

What to order with PUD

A

Upper GI or endoscopy (endoscopy is the gold standard)

138
Q

How will vegetable and plastic show on x-ray

A

Usually not visible on radiograph

139
Q

How will glass show on x-ray

A

90-95% visible

140
Q

What to order for fracture

A

Plain x-ray

141
Q

What to order for occult hip fracture

A

MRI

142
Q

What to order for occult knee fracture

A

MRI

143
Q

What to order for stress fracture

A

Nuclear medicine bone scan

144
Q

What to order for metastasis-fracture

A

Nuclear medicine bone scan

145
Q

What to order for osteomyelitis

A

Plain x-ray, then nuclear medicine bone scan

146
Q

What to order for back pain with radiculopathy

A

MRI

147
Q

What to order for non septic arthritis

A

Plain x-ray

148
Q

What to order for suspect septic arthritis

A

Plain x-ray, plus joint aspiration

149
Q

What bones are better visualized with CT

A

Fine bone structures, skull, spine, and pelvis.

150
Q

Pro of CT scans

A

A large number of structures can be visualized simultaneously with a CT scan

151
Q

Before ordering CT contrast

A

Be sure to know the renal function. There are guidelines based on creatinine levels for age and health of patients.

152
Q

If renal function is questionable

A

Consult the radiologist and possibly the nephrologist before ordering CT with contrast

153
Q

What to do with severely imapired renal function

A

An alternate test may be suggested other than CT with contrast

154
Q

Metformin and CT contrast and decreased renal function

A

Beause metformin is eliminated by the kidney, impairment can lead to persistence of metformin and development of lactic acidosis. 90% is eliminated within first 24 hrs. Holding metformin for 48 hrs allows it to clear and provides an opportunity to assess any alteration in renal function caused by CT IV contrast

155
Q

MRI

A

Uses a powerful magnetic field, radio waves and a computer to produce detailed pictures or organs, soft tissues, bone, and virtually all other internal body structures. Does ont use ionizing radiation.

156
Q

What does MRI examin

A

Useful for soft tissue (muscle, ligament, cartilage, spinal cord, and marrow spaces)

157
Q

Ultrasound

A

No exposure to radiation. Allows “real time” structure and movement of organs

158
Q

X-ray signs of child abuse

A

Multiple rib fractures, multiple fractures in multiple stages of healing, femur fracture. You are a mandated reporter of suspected abuse.

159
Q

Commonly missed fractures

A

Ribs, navicular schaphoid (law suit bone - Snuff box), and tarsal/metatarsal

160
Q

Follow up of fractures

A

Repeat x-ray in 6 weeks to 2 months to determine healing

161
Q

Referrals of children with fractures

A

Indicated for fractures that extend through the growth plate

162
Q

Treatment of open fractures

A

Warrant aggressive treatment and referral

163
Q

Education for patients regarding fractures

A

Immediately report intense pain, hypoesthesia, paresthesia, muscle weakness or paralysis (compartment syndrome); they need immediate referral

164
Q

What to educate patients about healing fractures

A

Previously fractured and healed bones are more prone to refracture. Encourage good physical conditioning and consistent exercise to strengthen muscles. Work and play safely

165
Q

Does a negative x-ray exclude a fracture?

A

No! Some fractures take days to show up

166
Q

Splinting possible fractures

A

Splint to protect injured limb, and explain to the patient that they need to report pain that increases or does not resolve

167
Q

System for evaluation of chest x-ray

A

Check for symmetry. Structures - bone: ribs, clavicle, spaculae - Soft tissues: neck, sides of chest wall, breasts. Diaphragm. Heart. Lungs

168
Q

Evaluation of the diaphragm on chest x-ray

A

Note clarity, shape, and position. Should be rounded or dome-like. Note sharpness of costophrenic angles.

169
Q

Blunting of costophrenic angles of diaphragm on chest x-ray

A

Effusion of at least 200 ml or pleural scarring

170
Q

Unilateral evaluation of diaphragm on chest x-ray

A

Pralysis of phrenic nerve

171
Q

Evaluation of heart on chest x-ray

A

Size should be 1/2 distance of chest area. If enlarged, differential diagnoses should include cardiomegalyo r pericardial effusion.

172
Q

Boot shapred heart on PA view of chest x-ray

A

Indicates left ventricular enlargement

173
Q

Loss of normal heart borders on chest x-ray

A

Indicates enlargement of R & L atria or R ventricle

174
Q

Evaluation of lungs on chest x-ray

A

Remember the apices. Usually not visible throughout except for blood vessels. Look for infiltrates (white areas), masses or unilateral white out. Know location of different lobes on x-ray

175
Q

Ordering the abdominal x-ray

A

Use only for specific purposes: intestinal obstruction, perforated viscus, ingested foreign body.

176
Q

Abdominal series includes what positions

A

Supine abdomen AP, upright abdomen AP, and one chest-ray

177
Q

System for evaluation of abdominal x-ray

A

Bones, soft tissues, LUQ, RUQ, lower mid-abdomen, pelvis, gut - small bowel and large bowel

178
Q

Air or abnormal gas collection on abnormal abdominal x-ray

A

Perforated viscus, necrotizing entercolitis, post-op, peritoneal dialysis

179
Q

Water on abnormal abdominal x-ray

A

Ascites, bowel obstruction (air/fluid levels)

180
Q

Bone on abnormal abdominal x-ray

A

Spinal abnormalities or rib fractures

181
Q

Abnormal bowel patterns of abdominal x-ray

A

Dilated loops or displacement

182
Q

Ordering the x-ray for evaluation of trauma to an extremity

A

Know the mechanism of injury. Physical exam is crucial. Views are usually 2-3 different agnles. Comparison views in children - to do or not to do. Give radiologist precise clinical information.

183
Q

Reading the x-ray of an extremity

A

Use bright light liberally. You have the advantage. Evaluate for periosteum

184
Q

Peristeum

A

White line around edge of bone

185
Q

Method of approach reading extremity x-rays

A

Identify the bones. Follow the edges of each bone; looking for interruption of periosteum. Do same for all views. Go back to area of interest and repeat.

186
Q

Fat pad sign

A

Normally, on a lateral radiograph of the elbow held in 90 degree flexion, lucency that represents fat is present along the anterior surface of the distal humerus, and no lucency is visualized along its posterior surface.

187
Q

A positive fat pad sign

A

An elevated anterior lucency and/or a visible posterior lucency on a true radiograph of an elbow flexed at 90 degrees is described as a positive sign.

188
Q

Salter-Harris fracture

A

A fracture that involves the epiphyseal plate or growth plate of a bone. Common injury among children, occurring in 15% of childhood long bone fracture.

Comps - Mod 2 (9 decks)

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