Radiology Flashcards
What is the best initial test for pulmonary complaints (cough of unknown origin, SOB/ dyspnea, pleuritic chest pain, hemoptysis)?
Chest X-ray
A pt presents with JVD and plethora most likely suffers from …
Superior vena cava syndrome
secondary to mediastinal mass compressing SVC
What is considered cardiomegaly on CXR?
heart size greater than 50% of the diameter of chest
What is the best CXR for bed-ridden patients?
AP (anterior-posterior) CXR
What is the most sensitive radiographic test for pleural effusion?
lateral CXR (can detect small amounts)
What is the finding of pleural effusion on lateral decubitus CXR?
flattening of consolidation along chest wall suggesting free fluid
What is the finding on CXR for lobar pneumonia?
localized, partially opaque consolidation
What is the finding on CXR for pulmonary nodule?
circumscribed with identifiable borders and calcifications
How many ribs should be visible on CXR if pt in full inhalation?
10
What are findings on CXR for pneumothorax?
- shift of border of lung inward
- loss of lung markings laterally
- tracheal deviation away from lesion
What does free air under the diaphragm on CXR suggest?
Bowel perforation (best seen on chest X-ray versus abdominal X-ray)
When should an abdominal X-ray be ordered?
suspect small bowel obstruction
N/V, abdominal distention, diffuse tenderness
What is a KUB film?
supine view of abdomen that visualizes kidneys, ureters and bladder
Dilation on bowel wall with presence of air-fluid levels on an upright abdominal X-ray suggests …
Small bowel obstruction
(stair stepping of air fluid levels suggests mechanical obstruction)
(no stair stepping suggest ileus)
What are the indications for Bone X-ray? (4)
- fracture
- bone tumor eval
- osteomyelitis
- skeletal survey (trauma pt; child abuse pt)
A pt presenting with bone pain, local swelling and symptoms of systemic infection (fever) with periosteal elevation (cloudy area by bone) and osteolysis (lucency of bone) on X-ray most likely suffers from
Osteomyelitis
x-ray changes delayed by 2 weeks compared to MRI
What are the drawbacks of CT imaging?
- high dose radiation (limit in kids, avoid in pregnant)
2. may require IV contrast (allergic reaction; renal failure so give fluids, NaHCO3, N-acetylcysteine)
What medication is contraindicated prior to use of IV contrast?
Metformin (b/c renally excreted)
What are the indications for non-contrast head CT?
- severe head trauma (LOC, altered mental status)
- stroke (hemorrhagiv vs. ischemic)
- intracranial bleeding
What is the appearance of blood on non-contrast CT?
white
A darkening of brain parenchyma, blurring of gray-white border, and asymmetry of brain tissue on non-contrast head CT suggests ….
Ischemic Stroke (give tPA if w/in 3 hours)
A bright, loacalized area of bleeding (white), mass effect (asyemmetry), gray-white junction intact on non-contrast head CT most likely suffers from …
Hemorrhagic stroke
A crescent shaped bright white near skull on non-contrast head CT most likely suffers from …
Sudrual hematoma
bridging veins tear
A lens (biconvex disc) shaped bright white lesion near skull on non-contrast head CT most likely suffers from ….
Epidural hemotoma
middle meningeal artery tear
What is the diagnostic test of choice for pancreatitis?
abdominal CT (blurring of visceral borders of pancreas, pancreatic enlargement)
What is the diagnostic test of choice once pheochromocytoma presence is determined via metanephrines?
abdominal CT (adrenal gland tumors)
What is the diagnostic test of choice for suspected splenic laceration (trauma w/ pain in LUQ and left shoulder)?
Abdominal CT
What are common findings of appendicitis on abdominal CT?
- appendix larger than 6 mm
- wall thickening
- fat stranding near appendix
What are common findings of diverticulitis on abdominal CT?
- localized bowel wall thickening
- fat stranding
- diverticula
What should you avoid in a patient with suspected nephrolithiasis when performing abdominal CT?
contrast (oral and IV)
What is the diagnostic test of choice for pulmonary embolism?
CT angiogram
What are the drawbacks of MRI? (3)
- long scans (take time)
- metal implants contraindicated
- small tube invoking claustrophobia
What is the diagnostic test of choice to confirm multiple sclerosis?
MRI
What is the most accurate test for osteomylelitis?
MRI
What are the drawbacks of ultrasound?
- poor at visualizing structures beyond bone
- poor at visualizing structures beyond air
- image quality loss in large body habitus
What is the diagnostic test of choice for gallstone disease?
Ultrasound
What is the diagnostic test of choice for polycystic kidney disease?
Ultrasound
What is the diagnostic test of choice for polycystic ovarian syndrome?
Ultrasound
What is the imaging diagnostic test of choice to assess for ectopic pregnancy?
Ultrasound
What are classic findings of cholecystitis on ultrasound? (4)
- echogenic within lumen of gallbladder (gallstone)
- thickened gallbladder wall (>3 mm)
- pericholestatic fluid (layer of fluid around gallbladder)
- sonographic murphy’s sign
What imaging study is used in fever of unknown origin?
gallidium scan
What is the second line test used to detect pulmonary embolism (especially used in pt with contrast allergy)?
V/Q scan (ventilation-perfusion)
