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FACEM Written > Radiology > Flashcards

Radiology Flashcards

1
Q

AXR Tox Ingestions

A

Radio-dense Tablets
- Iron tablets
- Potassium Chloride (KCL Tablets)
Metals
- Mercury
Iatrogenic
- Barium

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2
Q

Aortic Dissection CXR

A
  1. Widened mediastinum > 8cm aortic arch
  2. Abnormal aortic contour - Aortic knuckle deformity/irregular or indistinct
  3. Calcium sign >5mm (separation of intiminal calcification from vessel wall)
  4. Pleural effusion L>R
  5. Tracheal shift to RHS
  6. Left apical cap
  7. NGT deviation to RHS at T4
  8. Widening of Right paratracheal-stripe >5mm
  9. Normal in 11-16%

Apical cap is formed when blood dissects above the lung on either side Left more sensitive than Right

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3
Q

CXR

A

ADV
Readily available
Bedside
Fast
Low radiation
May see other pathologies

CONS
Low sensitivity for some pathologies
May miss other diagnoses

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4
Q

AXR / XR KUB

A

ADV

Readily Available

Fast

Low radiation - monitoring renal stone

CONS

Low sensitivity

Unable to assess complications of pathology

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5
Q

USS

A

ADV

Readily available

Non-invasive

No radiation

Preferred mode for pregnant patient

Bedside procedure

CONS

Operator dependent

Formal may not be available 24/7

Difficult with large body habitus

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6
Q

Echo

A

ADV

Readily available

Non-invasive

No radiation

Bedside procedure

CONS

Operator dependent

Formal may not be available 24/7

Difficult with large body habitus

Limited by pt positioning or SC emphysema

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7
Q

Ct angio

A
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8
Q

CT A/P

A
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9
Q

MRI

A

ADV

Non-invasive

No radiation

Other causes identified

CONs

Not easily available

Time consuming

Expensive

Accuracy may be less than IVP

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10
Q

IR

A
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11
Q

USS Duplex

A

ADV

Non-invasive

Avoids contrast

Bedside

Monitor in ED for deterioration

CONS

Not always available 24/7

Operator dependent

Less sensitive below knee for DVT/embolism

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12
Q

CT KUB

A

ADV

High sensitivity for renal calculi

Measure size

Location

Detect obstruction

ID other causes of flank pain

Avoid contrast

CONS

Radiation

Higher cost

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13
Q

IVP

A

ADV

Size and location stone

Measures renal function

CONS

Contrast nephropathy

Contrast allergy

More time consuming than CT

Unable to exclue other diagnoses

Radiation

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14
Q

CXR - Foreign Body aspiration

A
  • Radio-opaque FB
  • Hyperinflation affected side
  • +/- atelectasis on affected side
  • Lobar atelectasis
  • Whole lung atelectasis
  • Shift of mediastinal shadow
  • Aeration within area of atelectasis
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15
Q

C-spine Soft Tissue Swelling

A
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16
Q

USS Causes No Lung Slide

A
  1. Loss of pleural apposition
    a. PTx / Pleural
    b. Bullae
  2. Increased adhesion between pleural layers
    a. Pleural adhesions
    b. ARDS
    c. Pulmonary fibrosis
    d. Pneumonia
    e. VATS / pleurodesis
  3. Absent local ventilation
    a. Mainstem bronchial intubation
    b. Atelectasis
17
Q

C-spine XR

A
  1. Adequate views - C1-T1
  2. Alignment
    • Ant Longitudinal Line
    • Post Longitudinal Line
    • Spinolaminal Line
    • Spinous Process Line
  3. Bones
    • Assess each vertebra for Fracture / Collapse / Avulsion
  4. Cartilage
  5. Soft tissue - Prevertebral ST swelling
    • 6mm at C2 or 22mm at C6
    • 6mm C2 or 14mm at C6 - kids
  6. Spaces
    • Predental space - betw/ C1 tubercle and anterior face of dens
      * <3mm adults
      * <5mm children
    • Basion Dental interval
      * <12mm XR
      * <8.5mm CT
    • Power’s Ratio (atlanto-occipital dislocation
      * AB/CD should be < 1
    • Line of Swischuck - line from anterior aspect C1 to C3 spinous processes
      * Anterior aspect of C2 should be < 2mm of this line
      * Deviated > 2mm ? subluxation
      * Deviated < 2mm ? pseudosubluxation
  7. Scan base skull, airway, sinuses
  8. AP and Odontoid views

[https://www.nyp.org/professionals/emergency-medicine/how-to-read-emergency-images/how-to-read-a-c-spine-film]
[https://dontforgetthebubbles.com/c-spine-x-ray-interpretation/

18
Q

Power’s Ratio

A
Marker of atlanto-occipital dissociation BC/AO <1 A = Ant arch atlas B = Basion C = Post spinolaminar line C1 O = Opisthion
19
Q

Basion Dental Interval

A
Marker of antlanto-occipital dissociation <12mm on XR < 8.5mm CT
20
Q

Line of Swischuck

A
Anterior aspect of C2 should be within 2mm of this line >2mm true subluxation <2mm ?psuedosubluxation
21
Q

Pre-Dental Space

A
Normal < 3mm >2mm ? damage transverse ligament > 5mm implies rupture to transverse ligament
22
Q

CXR Cavitating Lesions

A

Infection
Bacterial - Abscess, infected bullae, TB, Empyema
Fungal - Coccidiomycosis, Apergillis, Cryptococcus
Parasitic - Amebiasis, Entomaeba histolytica

Neoplastic
Bronchogenic - SCC or Adenocarcinoma
Metastatic
Lymphoma

Inflammatory
Sarcoidosis
Wegner’s
RA nodules

Vascular - (both bland and septic pulmonary emboli)

Trauma - pneumatoceles

Other
FB aspiration
Younger pts -
CPAM (congenital pulmonary airway malformation)
pulmonary sequestration
Bronchogenic cyst

23
Q

CXR Solitary Nodules

A

Only 30-40% malignant

Malignant - Primary Lung or lymphoma
Benign - Hamartoma, chrondroma
Infection - Tuberculoma, Aspergilloma, Abscess, round pneumonia, hydatid disease
Autoimmune - RA, Wegeners
Vasc - AV malformatio, infarct, haematoma
Congenital - brnchial atresia, sequestration

24
Q

CXR in Pneumonia

A

Segmental or lobar opacity with air bronchogram – Strep. pneumonia

Cavitation - Klebsiella, Staph aureus

Cavitation + Pleural effusion:
- Staph aureus
- Anaerobes
- Gram negatives
- TB

Lower zones: Legionella

Upper Zones: Klebsiella

*​multifocal peripheral ground glass appearance - COVID -19

*​round pneumonia (solitary pulmonary nodule)

-​C Burnetti

-​S pneumoniae

-​L pneumophilia

-​S aureus

25
Q

Urogenital injury imaging

A

USS
ADV- scrotal or penile trauma may be seen
DISADV not sensitive enough for renal/ureteric injury

CT KUB - not helpful

CT IVP

RUG

26
Q

Foetal Exposure with Imaging

A
27
Q

USS Cholecystitis

A

GB wall > 3mm
Pericholecystic fluid
Enlarged GB
Sonogrpahic Murphy’s sign
Gallstones
Dilated CBD > 10mm (usually less than 6mm)
Gas in biliary tree
Gas in gall bladder - acalculus or gangrenous cholecystitis

28
Q

USS pleural effusion

A

Hypoechoic region above diaphragm
Sinusoid sign - atelectic lung moving with respirations
Thoracic psine sign - see spine aobve vlevel of diaphragm

Effusions > 5cm depth usually indicates at least 500ml of pleural fluid

29
Q

CXR in TB

A
  • Consolidation upper and mid-zone prevelance
  • Hilar lymphadenopathy
  • Cavitating lesions
  • Ghon focus - subpleural calcifcation remains after inital infection
  • Fibrosis calcification
  • Tuberculoma - well defined mass
  • Miliar Pattern - small nodules throughout the lungs
30
Q

USS Features appendicitis

A

Appendiceal diameter >6mm
Appendiceal wall thickness >3mm
Non-compressible
Hyperaemia
Surrounding oedema or fat stranding
Appendicolith

FACEM Written (34 decks)

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