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BSc Medical Imaging > Practicals > Flashcards

Practicals Flashcards

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USMLE® Step 1 flashcards
1
Q

What are some signs of facial fracture

A 
Facial Asymmetry
Flattened cheek
Dish face
Deviation of the nose
Pupils not level
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2
Q

What must you do in orbital fracture

A

assess eye and patients vision

-if you are concerned about vision - senior clinician

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3
Q

What does dish face mean

A

posteroinferior displacement of maxilla

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4
Q

What non level pupils mean

A

orbital floor fracture

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5
Q

List some types of facial fracture and their causes

A

nasal fractures
-blunt trauma

mid face
-blunt trauma - Le Fort fractures - can be very severe

Zygomatic fractures
-blunt force to cheek

Orbital fractures
-blow out - blunt eye trauma due to transient rise in intra-orbital pressure

Frontal sinus fracture

Mandibular and TMJ fracture
-blunt trauma

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6
Q

What are the standard facial XR views and what are they good at visualising

A

OM

  • frontal and maxillary bones
  • zygomatic bone and arch
  • dens
  • frontal, ethmoid, maxillary sinuses
  • mandible

OM 30

  • allows for better visualisation of:
  • maxillary sinuses
  • inferior orbital rims
  • features of mandible

(PA mandible, PA facial)

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7
Q

What is the approach to interpreting facial xray

A

Check patient details
Techical quality
Obvious abnormalities
-symmetry

trace lines along facial bones

identify and assess sinuses
-fluid level

signs of air in the orbit
-black eyebrow sign

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8
Q

What chest pathologies are you excluding by doing a CT in an acute setting

A

CTPA - PE
Chest trauma
Thoracic aortic aneurysm rupture or dissection

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9
Q

What abdo pathologies are you excluding by doing a CT in an acute setting

A

Acute or serious intraabdominal pathology
Ruptured AAA
Caliculi

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10
Q

What spinal pathologies are you excluding by doing a CT in an acute setting

A

C spine fracture

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11
Q

What neuro pathologies are you excluding by doing a CT in an acute setting

A

intracranial bleed

Ischaemic stroke

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12
Q

How would a PE appear on CT

A

Contrast

  • filling defect
  • contrast not absorbed by clot or vessel it occludes
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13
Q

What are some considerations of CT-KUB

A

Without Contrast

  • First line KUB caliculi
  • CT demonstrates other serious pathologies that USS wont
  • CT delivers same radiation as IV pyelogram but is much faster
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14
Q

Why is a CT-C spine undertaken

A

Fracture on XR
Hx of injury, neurological symptoms
XR equivocal but ongoing clinical concern
Major trauma

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15
Q

Why perform a CT head without contrast

A

Contrast hyperdense, similar to acute intracranial bleed

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16
Q

What are the acute indications for MRI

A

Suspected spinal cord compression

Cauda Equina

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17
Q

What does T1 signal show

A

Measure of relaxation

  • fat -high signal
  • CSF - low signal
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18
Q

What does T2 signal show

A

Measures desynchronisation

- CSF - high signal

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19
Q

What is FLAIR

A

Fluid attenuated inversion recovery sequence

  • similar to T2
  • high signal from CSF suppressed
  • useful for identifying high signal lesions that lie close to CSF spaces
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20
Q

What is DWI

A

Diffusion weighted imaging

  • Glial cell dysfunction in old infarct
  • influx of sodium and water
  • restricted outflow
  • oedema
  • high signal
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21
Q

What is fat saturation sequence

A

Contrast enhanced T1

-high signal from fat suppressed

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22
Q

What is STIR

A

Short tau inversion recovery

  • More effective method to suppress high signal from fatty tissues
  • used for visualising fluid e.g. oedema
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23
Q

What is proton density sequence

A

Acquired at the same time as T2
Tissues with a high number of protons e.g. CSF appear bright
Excellent for visualising normal anatomy and pathology

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24
Q

How do cysts appear on USS

A

Anechoic/Hypoechoic - fluid filled

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25
Q

What can you assess on echo

A 
Cardiac contractility
Valve function
Myocardial thickness
Chamber size
Pericardial sac and space
Cardiac masses
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26
Q

What are the 4 echo views

A

Parasternal long
Parasternal short
Apical 4 chambers
Subcostal

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27
Q

What can the flow dynamics assessed by echo determine

A

Valve incompetence
Vegetations of heart valve
LVEF

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28
Q

Draw the cross-section of the heart given by parasternal long

A

-

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29
Q

Draw the cross-section of the heart given by parasternal short (A,B,C,D)

A

-

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30
Q

Draw the cross-section of the heart given by apical four chambers

A

-

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31
Q

Draw the cross-section of the heart given by subcostal

A

-

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32
Q

What is the systematic review process for a CXR

A

Airways
-central traches

Breathing

  • lung margins
  • lung markings - extend to outer margin

Cardiac and mediastinum

  • mediastinum central
  • aorticopulmonary window
  • cardiomergaly

Diaphragm

  • visible and convex?
  • free air?
  • sharp costophrenic angles
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33
Q

What is the silhouette sign

A

Loss of clear edges of the heart border

-indicates abnormality

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34
Q

Be careful to check these areas in CXR

A 
Apices
Costophrenic angles
Behind the heart
Under the diaphragm
Soft tissues
Bones
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35
Q

What is the systematic process for reviewing AXR

A

Stomach
-gastric bubble or pneumoperitoneum

Small intestine

  • central
  • <3cm
  • Plicae circulares - full width

Large intestine

  • <6cm (9cm caecum)
  • Haustra - partial width

Liver

  • only 10% gallstones are radiolucent
  • hepatomegaly

Kidneys

  • T12-L3
  • Renal calcifications

Spleen

Pancreas
-not normally visible

Bladder and ureters
-caliculi are often radio-opaque

Aorta and iliacs
-calcified

Bones and soft tissues

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36
Q

What is the systematic review process for MSK XR

A

Bone and joint alignment

Joint spacing

Cortical outline

Medullary texture

Soft tissue
-fat pad?

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37
Q

What do you need to note in a fracture

A

Anatomical location

  • proximal, middle, distal third
  • intra-articular

Fracture pattern

  • simple or compound
  • comminuted
  • imacted

Type

Displacement

Medullary texture

  • lucent or opaque lines
  • areas of radio-opacity

Soft tissues
-fat pads

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38
Q

What are the types of fracture

A 
Transverse
Oblique
Spiral 
Greenstick
Vertical
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39
Q

What are the standard views for C spine

A

Lateral
AP
Open mouth/peg

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40
Q

How do you visualise more of the C Spine

A

Swimmers view

-better view of C7-T1

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41
Q

What are the three lines used to examine alignment in the C spine

A

Anterior line - anterior longitudinal ligament

Posterior line - posterior longitudinal ligament

Spinolaminar line - anterior edge of spinous processes

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42
Q

What are the three columns of the C spine

A

Disruption of these columns causes instability

Anterior
-ant long lig + ant half vert bodies

Middle
-post long lig + post galf vert bodies

Post column
-post elements of vertebra + several associated ligaments

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43
Q

Name the spinal ligaments

A

Anterior –> Posteriro

Anterior longitudinal
Posterior longitudinal
Ligamentum flavum
Interspinal ligament
Supraspinous
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44
Q

How do you know if the dens if fractured

A

Equidistant from the lateral masses of C1

45
Q

Why is the dens likely to fracture

A

Less dense than surrounding bone

Hyperextension or hyperflexion injuries

46
Q

How is the dens supported

A

Transverse ligament
-if intact, spinal cord usually unaffected by dens fractures

-secures dens, spans the vertebral foramen

47
Q

What kind of a joint is between the dens and C1

A

synovial

Affected by RA

48
Q

How do you check alignment of the C spine on an AP view

A

Spinous processes

49
Q

What are the standard views for thoracolumbar spine

A

Lateral

AP

50
Q

Label a diagram of a thoracolumbar vertebra

A

-

51
Q

What does the oblique thoracolumbar view assess

A

Par interarticularis

-spotty dog sign

52
Q

What are the views of the shoulder

A

Y

AP

53
Q

What are the views for the elbow

A

AP

Lateral

54
Q

What are the views of the wrist

A

PA
Lateral

Important to see that the capitate, lunate and radius are in a line

55
Q

What is the standard view for the pelvis

A

AP

56
Q

What are the standard views for the knee

A

AP
Lateral

(can get a skyline)

57
Q

What is a lipohaemarthosis

A

Sharpy demarcated fat/fluid level within the suprapatellar pursa
-indicative of intraarticular fracture

58
Q

What is are the standard views of the ankle

A

AP

Lateral

59
Q

What are the views of the foot

A

Dorsal plantar

Oblique

60
Q

What might cause absence of lung margnis

A

Pneumothorax

61
Q

What might cause calcific deposits

A

Asbestos exposure

62
Q

What would pull the mediastinum towards and away from the pathology

A

Towards
-collapse

Away
-pneumothorax

63
Q

What are some negative symptoms that indicate a CXR

A

Acute onset dyspnoea

Peripheral oedema

Haemoptysis

Cough > 3 weeks

Productive cough

Sudden onset pleuritic chest pain

Chronic chest pain

Symptoms of infection

64
Q

What are some abnormal signs indicating a CXR

A 
Reduced breath sounds 
Abnormal added signs 
Abnormal percussion 
RDS
Tracheal tug/deviation
65
Q

What are some symptoms and signs of lung malignancy

A

Symptoms

  • chronic cough
  • haemoptysis
  • Hoarseness
  • Increasing dyspnoea
  • Gradual weight loss

Signs

  • Hilar lymphadenopathy
  • Consolidation
  • Collapse
  • Pleural effusion
  • Mets
  • Cavitation
  • Rib erosions
  • Pleural plaques
66
Q

What is the first line imaging technique for the heart

A

Echo

  • non invasive
  • cheap
  • portable
67
Q

What are some indications for further imaging in CXR

A

CXR suspicious of malignancy

ongoing suspicion (equivocal xray)

68
Q

What detail does a CT provide on the chest

A

CTPA
Cardiac masses
Pericardium

69
Q

What detail does MRI provide on the heart

A

Cardiac function
Characteristic masses
Gadolinium MRI - ischaemic myocardium
Angiography

70
Q

What are some indications for AXR

A

Foreign bodies
Renal calculus
Megacolon

71
Q

What are some advantages of USS

A

Cheap

Portable

Non invasive

Non ionising

Good visualisation of hollow viscera, fluid filled structure

Free fluid in abdo

72
Q

What are some disadvantages of USS

A

Interpretation requires skill

Operator dependent

Difficult in obesity

May not give definitive diagnosis

May not show other pathology

Not adequate for detailed surgical planning

73
Q

What are some indications for CT abdo

A

Definitve Dx

Exclude life threatening pathologies e.g. AAA

Staging

Surgical planning

Trauma

74
Q

What are the indications for barium studies

A

Oesophageal strictures

Small bowel lesions

  • ulceration
  • inflammation
  • erosions

Large bowel lesions
-diverticulitis

75
Q

What are the disadvantages of barium studies

A

Radiation 300x CXR

Pt must be able to swallow contrast

Adequate bowel prep

76
Q

What are some advantages of CT

A

Definitive diagnosis

Excellent visualisation for surgical planning

Other pathologies deomstrated

Contrast or non contrast

77
Q

What are some disadvantages of CT

A

Pt must be stable

Image interpretation may take longer - radiologist report

Ionising radiation

Pt need to lie still in the scanner

78
Q

What makes you suspect a fracture

A

Hx Trauma
Sig Swelling
Obvious displacement
Pain

Suspicious of scaphoid fracture

79
Q

What might ongoing bone pain be

A

lytic lesion

80
Q

What are some indications of limb XR

A

Exclude fracture

Exclude dislocation

Assess bone manipulation

Clinical suspicion of infection

Ongoing symptoms suggestive of undiagnosed pathology

81
Q

What are some advantages of XR limb

A 
Cheap
Accessible
Good for fracture 
Dislocation
Joint spaces
Bone thickening or thinning 
Foreign body detection
82
Q

What is the use of CT and MRI in limb imaging

A

CT
-detailed anatomical imaging - complex fractures

MRI
-Soft tissues
-

83
Q

What nerve is vulnerable in anterior dislocation

A

axillary

  • supplies deltoid
  • lost abduction
84
Q

What causes posterior dislocation

A

Muscle spasm

  • electrocution
  • epilepsy
  • alcohol
85
Q

What is the name of the sign for posterior dislocation

A

Light bulb sign

-loss of asymmetry of humeral head

86
Q

How is the y view taken

A

from medial scapula towards glennoid fossa

Arm extended

87
Q

What nerve is at risk in humeral fracutres

A

radial nerves runs in a spiral groove

-test wrist extension

88
Q

What is a colles fracture

A

radius fracture with dorsal displacement

  • FOOSH
  • Pain
  • Deformity

Most common distal wrist fracture

89
Q

What are the associated morbidities of colles fracture

A

median nerve injury

carpal ligament injury

Compartment syndrome

90
Q

What are the associated complications of a Smith’s fracture

A

Distal radius fracture and volar displacement

falling on a bent wrist

91
Q

How do you anaethetise a fracture site

A

Haematoma block

  • LA into haematoma
  • Aspirate, inject, spread around fracture site
92
Q

Why is suspected scaphoid fracture so important

A

Avascular necrosis

  • scaphoid supplied distally first
  • lots of avascular articular surface
93
Q

What is an open book fracture

A

Pubic symphesis translated laterally

94
Q

What is the prognosis of a vertical shear fractures

A

Many venous plexi in the pelvis

Major pelvic fracture has high mortality

95
Q

Describe the arterial supply to the femoral head

A

Branch of profunda femoris (branch of femoral artery)

  • medial cirumflex
  • lateral circumflex

Inferior gluteal branch
(internal iliac)

Dislocation, fracture can disrupt blood flow

96
Q

How many views do you need of the femur

A

2 AP

-make sure whole femur imaged

97
Q

What is the classification system used for femur fractures

A

Garden

  • incomplete subcapital
  • complete, non-dislocated
  • complete, partially displaced
  • complete, fully displaced fracture
98
Q

What are the ottawa knee rules

A

XR indicated:
-isolated patella tenderness
-Fibular head tenderness
-inability to flex knee to 90 degrees
-Patient can’t bear weight for at least 4 steps
(immediately after injury and on examination)

99
Q

Why do tibias break

A

direct blow or fall

100
Q

What is at risk in a fibular neck fracture

A

common peroneal nerve

101
Q

What must you assess in medial mallelous fracture

A

proximal fibular fracture

-transmitted force

102
Q

When should the ankle be imaged

A

Unable to weight bear for four steps

Tenderness over posterior surface of the distal 6cm lateral or medial malleolus

103
Q

What is the sensitivity of CT post SAH

A

12 hours - 98%

24 hours -93%

104
Q

What are some indications to CT Head after head injury

A

GCS < 13 on initial assessment in AE

GCS < 15 2 hours after assessment in AE

Suspected open or depressed skull fracture

Sign of basal skull fracture

Post-traumatic seizure

Focal neurological deficit

More than 1 episode of vomiting

105
Q

What is OM best for and what is OM30 best for?

A

OM
-frontal and maxillary bones

  • zygmoatic bone and zygmomatic arch
  • dens
  • frontal, ethmoid, maxillary sinuses
  • mandible

OM30
- superior visualisation of maxillary sinuses

  • inferior orbital rims
  • features of mandible
106
Q

What are some uses of contrast fluoroscopy

A 
Coronary angiography
Micturating cystourethrogram
IV pyelogram
Sialogram
Cholangiography
107
Q

What are some negative effects of contrast

A

Hypersensitivity

  • anaphylaxis
  • bronchospasm
  • angio-oedema
  • urticarial reactions

SE
-Nausea

Contrast induced nephropathy

108
Q

What are some risk factors for negative reaction to contrast

A 
CKD
Elderly
Diabetic patients 
Cardiac impairment
Atopy
109
Q

What do you measure in contrast imaging to predict negative outcome

A 
Creatinine 
eGFR
Sats
Urine output
Drug card

BSc Medical Imaging (5 decks)

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