Radiology Flashcards
Smooth narrowing of lower oesophagus seen on barium swallow?
Most common complication
Mx?
achalasia
Nocturnal aspiration -> cough / pneumonia
Ballon dilation is mainstay
Mx of primary pneumothorax if >2cm
aspiration of up to
2.5 litres with a 16–18G cannula is recommended.
If aspiration fails, a chest drain
should be inserted.
Advice following primary pneumothorax ?
Possibility recur
stop smoking
Don’t fly for 1 week after full recovery
What to do with likely TB Dx ?
Ix before treatment?
Refer to resp
Notify public health
patient education - transmission / compliance
Full blood count, liver and renal function, colour vision and acuity before mx
bilateral hilar lymphadenopathy (BHL) with symmetrical
lobulated hilar enlargement. On CXR
In Pt with cough / swellings in neck / parotids
Dx?
Seen on biopsy
Sarcoidosis
Non caseating granuloma
Name 3 conditions that could cause a non caseating granuloma
sarcoid, tuberculosis, lymphoma and fungal infections
4 sarcoid Ix
CXR CT MRI brian ECG LuFT LFT / *ALP Serum ACE (often secreted by granulomas) Serum Ca
Skin changes sarcoid
Erythema nodosum
Sarcoid Mx ? If fail ?
Oral steroids / conservative
[Defs steroids if:
a. Hypercalcaemia
b. Neurological involvement
c. Cardiac involvement
d. Ocular involvement (if topical steroids have failed).]
Immunosupressant Eg azathioprine,
methotrexate, cyclophosphamide,
Hyponatraemia in a euvolaemic patient with a suspected malignancy
What you thinking
Paraneoplastic syndrome -> SIADH
Sx of hypoNa
Often Asx
malaise, nausea, generalized weakness, confusion and anorexia
Most common Ca’s mets to brain
lung, breast, melanoma, renal and colon
Older man with sclerosis of right hip shown on XR
2 key DDx
prostate Ca
Pagets (hip is most common location)
3 phases of pagets ? What do you see in middle phase
osteolytic
mixed - cotton wool apperarnce on XR
osteoblastic
3 classic XR features of pagets
bony enlargement, coarse trabeculae and a thickened
cortex
Common mets to bone?
breast, prostate, lung
and kidney, but also thyroid, colon and melanoma
Mx of ACUTE heart failure
Sit patient upright
• High flow oxygen by mask
• Intravenous access (bloods)
• Furosemide 40–80 mg i.v. slowly
• Diamorphine 2.5–5 mg i.v. (slowly, morphine is a venodilator and off loads the
heart, watch for respiratory depression).
Name 3 XR signs of chronic heart failure
Cardiomegaly (>50%)
Upper zone vessel enlargement – a sign of pulmonary venous hypertension
Septal (Kerley B) lines – a sign of interstitial oedema – see next picture
Airspace shadowing – due to alveolar oedema – acutely in a peri-hilar (bat’s wing) distribution
Blunt costophrenic angles – due to pleural effusions
Anaemia, raised inflammatory markers and white cell count, thrombocytosis, electrolyte
abnormalities, fever, tachycardia and hypotension, with a metabolic alkalosis
DDx
Toxic colitis - see thumbprinting on xray
Secondary to - inflammatory bowel disease (most likely),
infective, drug-induced or ischaemic colitis
name 4 parts of Toxic colitis Mx
Urgent referral
to the gastroenterologists is required and review by the colorectal surgeons
stool specimens for culture + Clostridium difficile toxin
blood cultures.
IV fluids + electrolyte abnormalities,
blood transfusion if necessary,
Catheters - Fluid balance
NBM
NG tube - assist deflation of the bowel.
IV steroids 5 days - can add ciclospoin
IV ABx if indicated
Repeat AXR to monitor .
Sigmoidoscopy or proctoscopy may be required in this case if the cause of colitis is uncertain, as the rectal mucosa can be visualized and biopsies taken.
Name 3 things that might predispose someone to toxic colitis
Drugs that slow gastric motility, such as opioids, anticholinergics (e.g. buscopan),
and antidiarrhoeals (e.g. loperamide), non-steroidal anti-inflammatory drugs
(NSAIDs), chemotherapy and barium enemas.
• Infection: Salmonella, Shigella, Entamoeba histolytica,
Campylobacter, Escherischia coli and Clostridium difficile (pseudomembranous colitis),
- ESP in IBD.
[Cytomegalovirus (CMV) causes colitis in patients with
immunodeficiency.]
• Hypokalaemia/hypomagnesaemia
• Patients who abruptly discontinue treatment with 5-aminosalicylic acid (5-ASA) or
corticosteroids may also induce toxic colitis
3 signs AXR toxic colitis
Wall thickening due to mucosal oedema
• Loss of haustra
• Mucosal islands (oedematous mucosa surrounded by deep ulceration)
• Thumbprinting due to submucosal oedematous infiltration
• Dilated large bowel loops, more commonly of ascending and transverse colon
• Multiple loops of dilated small bowel, worrying sign of imminent perforation.
3 Indications for surgery in toxic coltis
free air, localized or diffuse peritonitis, distension of the colon >10 cm, major haemorrhage uncontrolled sepsis
OsteoA XR
LOSS Loss of joint space Osteophytes Subcondral cysts Sclerosis
what is caplan syndrome?
RhA + lung nodules in the upper lobes and periphery of the lung which may cavitate
[There may be associated pulmonary fibrosis and a pleural effusion (usually unilateral)]
Felty syndrome is?
RhA associated with splenomegaly, neutropenia and lymphadenopathy
Why is atherosclerosis accelerated in RhA?
increased production of cytokines
3 extra articular RhA
Lung nosules
splenomegaly, neutropenia and lymphadenopathyeye disease (e.g. keratoconjunctivitis
sicca), pericardial effusion, vasculitis, peripheral sensory neuropathy, carpal
tunnel syndrome, elbow nodules and periungal erythema
Key SEs of DMARDS
myelosupression, hepatotoxicity, pneumonitis and proteinuria
Tumor found in apical lung (superior sulcus) called?
What structures can it affect and Sx of these?
Pancoast tumour
Horner syndrome- compression of sympathetic plexus – this comprises ptosis, miosis and anhydrosis on the
affected side.
[There are other causes of Horner syndrome where the sympathetic plexus is involved in the neck or at the skull base (e.g. trauma, tumour)]
Pain/loss of function due to brachial plexus infiltration (look for small muscle
hand wasting).
Pain due to chest wall/rib invasion.
Hoarse voice due to infiltration of the recurrent laryngeal nerve.
