Radiology Flashcards
Which side of hilum in a chest xray should never be higher than the other side?
The left and right hila can be equal height or left higher than right, but right hilum should never be higher than left= pathological
If there is consolidation on the right side in a chest xray, how do you know whether it is in the middle lobe or lower lobe?
If the middle lobe is affected the right heart border will be obscured, not in lower lobe consolidation.
Holly-lead shaped opacities in the lung fields are characteristic of what?
Thickened calcified pleura (plaques)
From asbestos exposure
If there is a cavity with a mass and an air crescent sign what could be the cause?
Air crescent is a crescent of air within the cavity.
Aspergilloma
Necrotising tumour (as it dies it leaves space)
Blood clot
Causes of small calcified nodules in the lung fields on xray (<5mm):
Sarcoid
past Varicella pneumonia
Calcified granulomata (secondary to TB)
Akin to an air bronchogram, what do you call it if there’s air in the alveoli (and fluffy opacity of pulmonary oedema around it)?
Air alveologram
On xray in a white out of the hemithorax why would the trachea be central?
If there was a combination of loss of density and gain, for example pleural effusion + collapse
(If severe fibrosis is thought to be the cause there should still be air bronchograms)
On xray, tram line airways suggest what?
Bronchiectasis (in upper lobes with fibrosis you are thinking sarcoid, chronic allergic alveolitis, TB)
A patient has cannonball mets on xray, what would the one differential be?
Rheumatoid nodules
Cannonball mets occur with renal and colon cancers commonly
If on abdo xray you see dilated loops of bowel what might be the cause?
Obstruction Ileus (can be due to peritonitis, post-op, tends to be small bowel)
How can you differentiate ileus from obstruction on abdo xray with dilated loops of bowel?
Paucity of gas in the rectal area/lower pelvis suggests obstruction over ileus.
Also ileus tends to affect the small intestine more than large intestine
How can you tell whether dilated bowel is small or large bowel?
Vulvuloconvenientes- more frequent and go all the way across the bowel compared to haustra (large bowel)
Central distribution
Causes of large bowel obstruction in sigmoid colon?
Tumour
Inflammation (diverticulitis- common in sigmoid colon)
Volvulus?
Causes of small bowel obstruction?
Adhesions
Internal hernias
Gallstone ileus
(Tumour not as common as large bowel)
Who is predisposed to sigmoid volvulus?
Sigmoid volvulus
Young people with learning disabilities
Old people
Chronic constipation
Who is predisposed to caecal volvulus?
Those with long mesentery, which enables it to be mobile
3 causes of upper lobe fibrosis
- TB
- Chronic sarcoidosis
- Chronic allergic alveolitis
For lower lobe consolidation, what sign would be indicative?
Loss of the hemi-diaphragm on that side
How would you determine whether heart failure was acute or chronic decompensation on an CXR?
Cardiomegaly would occur in chronic heart failure
In acute causes from an MI, there wouldn’t be enough time to accommodate
A patient has leaf-life patches of consolidation on CXR, when would you say they have developed asbestosis?
Suggests calcified pleural plaques
Only diagnosed with asbestosis if parenchymal disease present
On CXR a patient has surgical emphysema and reduced lung markings, with opacification obscuring the R heart border. What is the likely cause?
Pneumothorax with lung collapse leading to surgical emphysema
Watch out for the muscle fibres making the low density regions look less low density
Name for tearing of the oesophagus causing surgical emphysema?
Boerhaave syndrome
Cause of unilateral diffuse pleural thickening,
Might look like reduced lung volumes and apparent mediastinal widening from the thickening
- Mesothelioma
2. Metastasis
What is the difference in mechanism between NOACs and LMWH?
LMWH activates antithrombin to increase Factor Xa inhibition
NOACs like rivaroxiban directly inhibit Factor Xa
How long should a patient be on warfarin if they have a DVT post-operatively?
3 months
Unless recurrent
How long should a patient be on Warfarin if they have a first DVT and no cause is found?
6 months
What INR should be aimed for in patients who have had a second DVT?
3-4
Patient has bilateral ankle oedema and eczematous skin, what is the likely cause?
Venous insufficiency
(Valves dysfunctional due to hereditary cause or DVT destruction means blood pools and puts pressure on the walls of the veins, increasing hydrostatic pressure)
How does the information differ that CRP and ESR (or plasma viscosity) gives you?
CRP is more sensitive to acute changes in the last 24 hours
PV + ESR are less affected by recent change giving a sign of a sightly more chronic inflammation.
