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Adult Clinical Medicine > Radiology - Exam 1 > Flashcards

Radiology - Exam 1 Flashcards

1
Q

contrast material used with CT and contraindications for use

A

iodine
allergy to iodine

contraindications for abdominal CT:

  • retroperitoneal bleed
  • diabetes (not on Metformin)
  • acute renal failure (serum creatinine >1.5 concern; GFR < 30 concern)
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2
Q

contrast material used with MRI and contraindications for use

A

gadolinium

severe renal failure (GFR<30)

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3
Q

resource: indication of when to do head CT (HCT) in trauma cases

A

PCARN

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4
Q

preferred imaging - appendicitis in adults

A

abdominal CT

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5
Q

preferred imaging - appendicits in kids / pregnant women

A

abdominal U/S - first

CT with contrast - if not seen on U/S

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6
Q

preferred imaging - bony areas of head (posterior fossa and stella turcica)

A

use plain x-ray or MRI

- CT not good due to highly dense bony areas

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7
Q

things to consider when ordering imaging

A

cost
radiation exposure (risks)
burden (time)

Must be indication driven imagining - particular reason for ordering study

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8
Q

imaging for trauma in child

A

stable: trauma series (plain film of chest, pelvis, c-spine)

unstable / suspicion of head trauma: CT

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9
Q

imaging for limp in child

A

plain film (1st): fracture, foreign body

U/S: hip effusion, infection, synovitis

MRI: myositis, marrow, abscess, osteomylitis

Bone scan: osteomyelitis, bone METS

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10
Q

standard imaging - chest radiograph

A

upright PA view with corresponding lateral view

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11
Q

standa imaging - abdomen

A

3-way: upright and supine abdomen, upright chest

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12
Q

when to do a CXR for acute respiratory illness in a healthy (immunocompetent) person

A

based on ACR appropriateness criteria

older than 40
dementia
positive PE
hemoptysis (cough up blood)

associated abnormalities (leukocytosis, hypoxemia)

other risk factors: CAD, CHF, drug-induced acute resp. failure

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13
Q

silhouette sign - what is it used for

A

helps to identify location of of pneumonias or lesions on CXR

loss of normal radiographic silhouette due to two substances of same density being in direct contact

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14
Q

air bronchogram sign

A

seen on CXR with fluid in lungs

typically, air in bronchi and lungs makes it difficult to see bronchial tree; however, they stand out (dark) when fluid is in lungs (pneumonia)

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15
Q

effusion (e.g. pleural effusion)

A

excess fluid in lungs

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16
Q

most sensitive view for pleural effusion

A

decubitus - can demonstrate effusions of 15-20 ml

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17
Q

pneumothorax - abnormalities on CXR

A 
visceral pleural line (necessary!)
convex curve of visceral pleural line
absent lung markings distal to visceral pleural line
cardiac/hemidiaphragm shift
deep sulcus sign
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18
Q

deep sulcus sign

A

excess air in costophrenic angle indicative of pneumothorax

- seen on supine view

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19
Q

pleural effusion - abnormalities on CXR

A

fluid in pleural space

  • shifts with position (unlike pneumonia)
  • fist seen below lungs (subpulmonic location)
  • decubitus: most sensitive view for pleural effusion
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20
Q

aortic aneurysm - abnormalities on CXR

A

widened mediastinum

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21
Q

pneumoperitoneum - abnormalities on CXR

A

air in peritoneum (lining of abdominal cavity)
- crescent lucency on undersurface of rt hemidiaphragm

causes: ruptured bowel, trauma, post-surgery

22
Q

COPD - abnormalities on CXR

A

elongation and narrowing of heart
flattening of diaphragm
inc. rib count (>9)

23
Q

cardiomegaly - abnormalities on CXR

A

cardiac:thoracic ratio > 50%

Note: heart should take up less than 50% thorax

24
Q

aspiration pneumonia - abnormalities on CXR

A

right and left heart borders obscured; infiltrate to bases

25
Q

Rigler’s sign

A

both walls of bowel visible (typically not) - indicates large amount of free air in supine abdominal x-ray

26
Q

hematochezia

A

passage of fresh blood through anus with or w/o stool

- indication for barium enema

27
Q

standard imaging - gallbladder disease (biliary disease, acute cholecystitis)

A

abdominal U/S

28
Q

imaging of GI (non-invasive)

A

esophagram
barium upper GI study (“barium swallow”
small bowel follow through

29
Q

imaging of GI (invasive)

A 
EGD: esophagogastroduodenoscopy 
ERCP
capsule endoscopy
sigmoidoscopy / colonoscopy
EUS: endoscopic ultrasound
30
Q

abdominal MRI - when to use (rare)

A 
adrenal pathology
biliary pathology (MRCP - similar to ERCP)
female pelvis (transplants)
31
Q

gallbladder disease: imaging and labs

A

imaging: abdominal U/S
labs:
- gallbladder (bile)
- liver: ALT/AST
- pancreas: lipase/amylase

32
Q

plain films of skull - indications

A

penetration
foreign body
presence of depressed skull fragments (likely CT)
bony areas: posterior fosse / stella turcica
waters’ view: sinuses

33
Q

Waters’ view

A

45 degree angle (plain film) into anterior skull / face

  • good image of sinuses
  • compare bilaterally
34
Q

CT of head/brain (non-contrast) - indications

A 
trauma (at all unstable)
depressed skull or facial fracture
acute intracranial hemorrhage
hydrocephalus (water in brain)
intracranial infection (meningitis, sinusitis)
acute venous/dural sinus thrombosis
35
Q

MRI of head/brain - indications

A 
neoplasma
demyelinating diseases (MS)
vascular malformations (AVM or aneurysm)
new onset seizure
examine bony areas (posterior fosse / stella turcica)
infection or inflammation
trauma (diffuse axonal injury)
36
Q

MRI of spine - indications

A 
disc disease (degenerative, infection)
spondylolydid: bony defect or fracture
congential abnormalities
neoplasm: cord, meningeal
infection: epidural absces
inflammation: MS
37
Q

CT of spine - indications

A

spinal column damage
trauma / emergencies: internal injuries or bleeding
- FAST!
if MRI contraindicated (metal in body) or unavailable

38
Q

acute stroke - approach to imaging

A 
head CT (no contrast) - 1st
 - determine if hemorrhagic v. ischemic stroke

MRI (follow-up): more sensitive

39
Q

headache - approach to imaging

A 
MRI:
Thunderclap H/A (CT if unstable)
HA that worsens with exertion, associated w/ dec. alertness, positionally related, awakens one from sleep, changes pattern over time
New HA in HIV pos. pt 
HA w/ papilledema
HA w/ focal neurological defect
HA w/ mental status change

CT:
Trauma, unstable (FAST!)
Suspected hematoma
MRI contraindicated or unavailable

40
Q

vertigo - approach to imaging

A

typically no imaging

brain CT: signs of conductive hearing loss

brain MRI: signs of sensorimotor hearing loss

41
Q

seizure - approach to imaging

A

MRI:

  • new onset - anyone (including alcoholic)
  • epilepsy w/ poor therapeutic response
  • focal nerological defect
  • abnormal EEG

CT (non contrast):
- trauma

No imagining:

  • otherwise healthy children
  • febrile seizure
  • chemical withdraw
42
Q

dementia - approach to imaging

A

MRI: useful for diagnosing treatable conditions (vascular disease, etc.)

43
Q

radiculopathy - approach to imaging

A

red flag for spinal imaging (likely MRI or CT)

44
Q

when to use CT or MRI contrast

A

head: no
chest: no (except nodules, interstitial disease, pulmonary emboli)
abdomen/pelvis: yes (except kidney stones)

45
Q

constipation - approach to imaging

A

plain x-ray (visualize masses - more dense)

  • combine with hx and PE
    note: bowel looks like mass/density with air bubbles
46
Q

FAST exam - definition and purpose

A

Focused Assessment with Sonography in Trauma
- purpose of bedside ultrasound in trauma is to rapidly identify free fluid (usually blood) in the peritoneal, pericardial, or pleural spaces

47
Q

abdominal CT - indications

A

test of choice for abdominal pain unless gallbladder is suspected (use U/S)

48
Q

pituitary gland concerns - clinical/labs

A 
thyroid (TSH)
gonads (LH, FSH)
growth hormone
adrenal glands (ACTH / cortisol)
breasts (prolactin)
49
Q

angiography

A

Inject contrast into artery to highlight vessels with x-ray is taken

Indications:

  • Definition of atherosclerotic occlusive disease.
  • Evaluation of aneurysms
  • Trauma to cervicocerebral vessels
  • Evaluation of tumor vascularity
  • Evaluation of vasculitis
50
Q

acute back pain - imaging

A

pain > 6 weeks (unless “red flags”

red flags:

  • inc. risk of cancer
  • risk of spinal infection
  • sx of cauda equina syndrome
  • trauma hx (esp. w/ osteoporosis, or >50)
  • radiculopathy (severe neuro deficits)
51
Q

spondylolosthesis

A

slippage of one vertebral body on the one below - often L5-S1 area (curvature of low back)

52
Q

spondylolysis

A

fracture of pars interacticularis

“scotty dog sign”

Adult Clinical Medicine (5 decks)

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