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5th (Final year) > Radiology > Flashcards

Radiology Flashcards

1
Q

What is the best type of CXR? Why?

A

PA

  • Scapula’s out of the way
  • Heart near detector so can interpret
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2
Q

What is the advantage to an AP CXR?

A

Can be done lying, so more unwell pt

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3
Q

How can you tell a tension pneumothorax from a N pneumothorax on CXR?

A

In a tension pneumothorax there is:

  • Increased chest expansion
  • Heart may be compressed
  • Diaphragm may be depressed
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4
Q

When assessing image quality/adequacy on a chest x-ray what 4 things do you need to assess?

A

RIPE

Rotation
- check the ends of the claviculae are equidistant from the spine.

Inspiration

  • 6 anterior ribs (the ones that are hard to see)
  • Lung apices
  • Both costophrenic angles

Projection
- Is it an AP or PA (PA better)

Exposure
- Left hemidiaphragm visible to the spine and vertebrae visible behind the heart

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5
Q

How do you say something is more white on a XR?

A

Increased density/opacity

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6
Q

How do you say something is darker on an XR?

A

Increased lucency

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7
Q

When going through the CXR how do you structure it? (Details of approach)

A

Pt details

Adequacy (RIPE)

Any striking abnormalities

ABCDE

Airway

  • Trachea deviated?
  • Is the mediastinum enlarged (lymphoma or thyroid)
  • Carina visible?
  • Hilum okay, lymph nodes?

Breathing

  • Lung markings & pleura (if reduced pneumothorax)
  • Look from apex to base (divided into 3rds on L and R)
  • Liquid? Pleura/alveoli (Pulmonary oedema)

Cardiac

  • Cardiothoracic ratio (<50% of thorax)
  • Look for cardiac borders (if fuzzy then consolidation)

Diaphragm

  • Costophrenic angle visible?
  • Any air under the R hemidiaphragm?

Everything else

  • Bone
  • Soft tissue
  • Look for any tubes or lines
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8
Q

What would cause a lung collapse on CXR?

A
  • Tumour (adult)
  • Foreign body (child)
  • Mucus plugging in infection
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9
Q

What GFR do you need to have a Contrast scan?

A

> 40 (if not on dialysis - which would be okay)

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10
Q

What are the three phases of a contrast CT scan?

A

Pre-contrast
Arterial
Portal-venous

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11
Q

What colour is the grey matter on a CT?

A

White

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12
Q

What colour is the white matter on a CT?

A

Darker grey

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13
Q

is low attenuation black or white?

A

Low attenuation = black

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14
Q

Is high attenuation black or white?

A

High attenuation = white

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15
Q

If there is high attenuation areas in the sulci what is this?

A

SAH

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16
Q

In a bleed if the blood is dark then is it old or young?

A

Dark = old

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17
Q

In a a bleed if the blood is white is it old or young?

A

White = young

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18
Q

What vessels are bleeding in a subdural haemorrhage?

A

Bridging veins crossing the subdural space

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19
Q

If there is old and acute blood both in a CT head, what is likely going on?

A

An old subdural that is rebleeding.

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20
Q

What does a central high attenuation star show?

A

Extensive SAH

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21
Q

Two main causes of SAH?

A
  1. Trauma

2. Aneurysm

22
Q

What does the pulmonary artery look like on CTPA?

A

The upside down Y one

23
Q

What are the 4 steps in reporting a fracture on radiograph?

A
  1. Which bone (and where in the bone)
  2. Joint involvement (intra/extra articular)
  3. Direction of fracture?
    - Transverse
    - Oblique
    - Spiral
    - Longitudinal
  4. Displacement? - does the cortex meet?
24
Q

What do you call a fracture that has fragmented into several pieces?

A

Comminuted

25
Q

What do you call a distal transverse radial fracture in an elderly patient? What is this due to?

A

Colles fracture - due to osteoporosis

26
Q

Where is the trapezium (carpal) in relation to other anatomical landmarks?

A

The base of the radius

27
Q

On a shoulder radiograph an anterior dislocation would move what landmark?

A

Coracoid process (part of scapula - more proximal)

28
Q

On a shoulder radiograph a posterior dislocation would move what landmark?

A

Acromion (also part of scapula) (distal)

29
Q

When bones that are rings (or form rings) break, where do they break?

A

Always break in two places

30
Q

What are examples of bones that form rings in the body?

A

Fibula and tibia

Ulnar and radius

Pelvis

Vertebrae

31
Q

On AXR can you always see the small bowel?

A

No, can’t always see, there is fluid in there

32
Q

Where is the gas in the bowel in AXR?

A

The Colon (transverse and sigmoid)

33
Q

What are the relevant sizes of the bowel in cm’s? How can you quickly compare this?

A

Small bowel = 3cm

Colon = 6cm

Cecum = 9cm

Quickly compare with the height of the vertebrae (3cm)

34
Q

Abdo XR interpretation steps?

A

Name

Date

Projection:

  • PA
  • AP

Bowel gas

  • Stomach
  • Small Bowel (may not see, but would be central with the rings that go all the way around)
  • Large bowel (Peripheral position - Sigmoid and colon are flexible and vary in position, has haustra - Arrowheads)
  • Caecum

Soft tissue

  • Liver
  • Spleen (LUQ - superior to kidney)
  • Lung bases
  • Psoas
  • Kidneys
  • Bladder

Bones

Calcification and artefact

  • Anything stuck in there
  • Calcified arteries
  • Gallstones (if calcium - 20%)
35
Q

Initial management of Small Bowel Obstruction?

A

NG tube
Fluids
Pain control

36
Q

What is the significance of a competent and incompetent ileocaecal valve on AXR?

A

In large bowel obstruction if the pt has a competent ileocaecal valve there will be no small bowel obstruction and these patients will present earlier.

If the valve is incompetent there will be small bowel obstruction and the pt will present later.

37
Q

If you see pancreatic calcification in AXR, what does this likely mean?

A

Chronic pancreatitis

38
Q

Coffee bean sign on AXR most likely means what?

A

Sigmoid volvulus

39
Q

What are the IBD signs you see on AXR?

A

Toxic megacolon
Thumbprinting
Ischaemic

40
Q

What are the three types of colitis?

A

Infective
Inflammatory
Ischaemic

41
Q

What is the NICE guidance on who needs a CT Head?

A

CT head immediately

  • GCS <13 on initial assessment
  • GCS <15 2 hours after injury
  • Suspected open/depressed skull fracture
  • Basal skull fracture (panda eyes CSF leakage from ear/nose)
  • Post traumatic seizure
  • Focal neurological deficit
  • > 1 episodes of vomiting

CT head within 8 Hrs of injury (if they have LOC/amnesia)

  • > 65
  • Bleeding/clotting disorders
  • Dangerous mechanism of injury
  • > 30mins retrograde amnesia of events before head injury

Within 8 hours anyway:
- Pt on warfarin

42
Q

Reporting structure for CT head?

A

Name/age/date

Normal/Abnormal

intra (within brain) or extra axial

Location

Grew/white matter (opposite on CT)

Attenuation

  • Black (low attenuation)
  • White (high attenuation)

Affect on adjacent structures

43
Q

How can you classify brain haemorrhages?

A

Extra-axial

  • SAH
  • Extradural
  • Sub-Dural

Intra-axial

  • Lobar
  • Contusions
44
Q

How does old blood show on CT Head?

A

Dark - low attenuation

45
Q

If the blood on a CT head is white (high attenuation) is the bleed old or young?

A

Young

46
Q

If there is bleed (normally fresh bleed) in the sulci, what type of haemorrhage is it?

A

SAH

47
Q

If there is mixed old and fresh blood on a CT Head, what is the likely pathology?

A

Subdural that is rebleeding

48
Q

What CT head changes does a SAH commonly show?

A

Hydrocephalus

Central high attentuation star

Blood in Sulci

49
Q

Two common causes of a SAH?

A

Trauma

Aneurysm

50
Q

On a CTPA what shape is the Pulmonary Artery in?

A

Upside down Y

5th (Final year) (34 decks)

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