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Vertical Curriculum > TCM 2 Exam - Second Semester > Flashcards

TCM 2 Exam - Second Semester Flashcards

1
Q

2 causes of dilated bowel

A
  1. Paralytic ileus

2. Bowel obstruction (small or large)

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2
Q

Radiologic findings of paralytic ileus?

A

Distended bowel with multiple air-fluid levels

Gas seen in the rectum

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3
Q

Common causes of paralytic ileus

A

Inflammation of the peritoneum (post-abdominal surgery, appendicitis, pancreatitis, etc.)

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4
Q

Normal postoperative ileus lasts ___ hours.

A

48

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5
Q

Common causes of small bowel obstruction (4)

A

Post-operative adhesions
Gallstone ileus
Intussusception
Tumors

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6
Q

Common causes of large bowel obstruction (3)

A

Colon cancer
Fecal impaction
Diverticulitis

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7
Q

How should bowel obstruction be evaluated with imaging?

A

Screening - plain film

CT of the abdomen

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8
Q

Radiologic findings of small bowel obstruction?

A

Multiple air-fluid levels
Stacked
Centrally located loops of intestine
Dilated small bowel greater than 3 cms visible with valvulae conniventes; colon not dilated
String of pearls sign (small bubbles trapped)
Absence of colon gas (collapsed colon)

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9
Q

Radiologic findings of large bowel obstruction?

A

Peripherally located distended bowel with haustral markings
Dilated loops of small and large bowel
No air distal to site of obstruction
Mass might be seen

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10
Q

Compare small vs. large bowel (location)

A

Small - central abdomen

Large - peripheral abdomen

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11
Q

Compare small vs. large bowel (appearance)

A

Small - valvulae conniventes crosses the entire width

Large - haustra, bubbly appearance of feces, diverticula

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12
Q

Findings of acute pancreatitis on abdominal CXR?

A 
Calcification
Mass from a pseudo cyst
Sentinel loop (dilation of duodenum)
Colon cut off (dilated colon to the mid-transverse colon, no air beyond the splenic flexure)
Diffuse ileus (small bowel dilation)
Left pleural effusion
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13
Q

Findings of acute pancreatitis on abdominal CT (contrast-enhanced)?

A 
Enlargement due to edema
Peripancreatic inflammation (linear strands in the surrounding fat)
Phelgmon
Hemorrhagic
Necrosis (decreased or no enhancement) 
Fluid in the paracolic gutter
Fluid collections
Pseudocysts
Abscesses
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14
Q

What is the normal size of the pancreas?

A

Same width as the abdominal aorta (2.5 cm in diameter)

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15
Q

How does the pancreas appear on CT compared to the liver and spleen?

A

Similar enhancement with contrast

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16
Q

How does an edematous pancreas appear on CT compared to the liver and spleen?

A

Less dense

More dense if hemorrhagic

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17
Q

How does pancreatitis appear on ultrasound?

A 
Edematous pancreas
Gallstones
Dilated common bile duct
Pseudocyst
Poorly defined
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18
Q

The normal pancreas is in the ___peritoneum, ___cm long, and located in the ___.

A

Retro; 12-15; epigastrum

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19
Q

What surrounds the head of the pancreas?

A

Duodenum

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20
Q

What vein runs along the posterior inferior groove of the pancreas?

A

Splenic vein

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21
Q

The ___ duct traverses through the head of the pancreas and joins with the pancreatic duct at the ___ to empty bile into the descending part of the duodenum.

A

Common bile; ampulla of Vater

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22
Q

Imaging findings of chronic pancreatitis

A

Calcifications

Pseudocysts

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23
Q

Imaging of choice for pancreatitis

A

CT with IV contrast

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24
Q

Useful imaging procedures to evaluate pancreatic cancer

A 
CT scan (evaluate tumor, stage)
US/nuclear medicine (biliary obstruction)
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25
Q

Neoplasm in the ___ of the pancreas can compress the common bile duct, causing an extra-hepatic biliary obstruction.

A

Head

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26
Q

Cancer in the ___ of the pancreas may obstruct the splenic vein or cause mass effect.

A

Tail

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27
Q

What is indicated for initial study of a patient who presents with jaundice?

A

Abdominal US (dilated bile ducts or presence of a mass in the head suggests tumor)

CT is useful in patients who are not jaundiced and in those in whom intestinal gas interferes with US

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28
Q

What is indicated when CT and US do not reveal a mass lesion within the pancreas, and when chronic pancreatitis is suspected?

A

ERCP

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29
Q

What are common malignant liver masses?

A

Metastatic tumors, HCC, cholangiocarcinoma

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30
Q

What are common benign focal liver lesions?

A

Cysts (congenital, parasitic - echinococcal), cavernous hemangiomas, focal nodular hyperplasia, hepatic adenomas, abscesses

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31
Q

What is the best imaging modality to evaluate liver masses?

A

CT

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32
Q

When is ultrasound useful to evaluate liver masses?

A

Intra-operatively

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33
Q

When is MRI useful to evaluate liver masses?

A

Delineating vascular involvement and identifying additional intra-abdominal lesions

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34
Q

True or false - normal biliary ducts are not seen on CT.

A

True (only seen when dilated)

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35
Q

What are the imaging findings of hepatoma on CT?

A 
Single or multiple masses or diffuse involvement
Low attenuation lesions
Hemorrhage, fat, necrosis
Calcification
Hypodense capsule or rim
Enhancement seen with contrast
Can invade portal and hepatic veins
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36
Q

How do hepatomas appear on MRI?

A

Mass with low intensity on T1 and high signal on T2

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37
Q

How do liver cysts appear on CT?

A

Oval, well-defined
Imperceptible or thin wall
Water density
No enhancement

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38
Q

How do liver cysts appear on US?

A

Well-defined, anechoic (echogenic if fluid filled)

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39
Q

How does a liver cyst appear on MRI?

A

Mass with low intensity on T1 and high signal on T2, may be indistinguishable from hemangioma without IV contrast

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40
Q

Common primary source sof liver metastases

A

Colon carcinoma, breast, kidney

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41
Q

What is the imaging procedure of choice to evaluate the liver for mets?

A

CT scan with IV contrast

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42
Q

Liver tumors are usually hypodense on CT with IV contrast performed in ___ phase (70 seconds). However, tumors may be hyperdense on CT in ___ phase (15 seconds).

A

Standard portal venous phase; arterial

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43
Q

Compare the density of the normal liver and spleen on non-contrast CT.

A

Approximately the same

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44
Q

What is the diagnostic procedure of choice for cirrhosis?

A

CT with IV contrast

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45
Q

How does a cirrhotic liver appear on CT?

A

Small liver with nodular margins

Ascites

46
Q

Common renal masses (4)

A

Simple renal cyst
Renal cell carcinoma
PCKD
Abscess

47
Q

What is the initial imaging procedure of choice for a renal mass?

A

US (distinguish between a cyst and a solid mass)

48
Q

What are the three major criteria for a single simple cyst on US?

A
  1. Round mass, sharply demcarted with smooth walls
  2. No echoes (anechoic) within the mass
  3. Strong posterior wall echo indicating good sound transmission through the cyst
49
Q

What US findings suggest a renal malignancy?

A 
Solid or complex
Internal echoes
Irregular walls
Calcifications or septae
Multiple cysts clustered (could mask underlying carcinoma)
50
Q

When is CT and MRI used in evaluating a renal mass?

A

CT (with and without IV contrast) - next appropriate step

MRI - if patient is unable to receive IV contrast, useful to evaluate vascular invasion

51
Q

How does renal carcinoma appear on CT?

A

Hypodense (unless hemorrhagic)
Cystic
Calcified
Most enhance after contrast administration, but less than normal kidney enhnacement
Thickened or irregular walls of the cystic portion
Thickened or enhanced septae within the cystic mass
Multilocular mass
Invasion of renal vein and IVC
Nodes

52
Q

Normal size of the kidney, normal appearance of kidney on US

A

9-11 cm

Same extent of echoes as the liver

53
Q

Central echoes in the kidney are from ___ surrounding the renal pelvis and are white.

A

Fat

54
Q

The ___ of the kidney is hypoechoic and appears dark.

A

Medulla (can distinguish it from fluid filled calyces, as there will be no increased transmission of sound beyond)

55
Q

How do kidneys appear in acute renal failure?

A

Normal

56
Q

How do kidneys appear in chronic renal failure?

A

Smaller than normal, surface may be irregular, cortex is thinned and hyperechoic compared to the liver due to scar tissue

57
Q

How do kidneys appear in hydronephrosis?

A

Dilated anechoic calyces with increased posterior transmission of sound, cortex is normal, separation of hyperechoic fat within the central renal sinus

58
Q

How does AAA appear on ultrasound?

A

Widened aortic lumen >3 cm

59
Q

How does AAA appear on CXR?

A

Calcification of both walls at the same level with increased diameter

60
Q

How does AAA appear on CT?

A

Calcification of the wall, may show chronic erosion of adjacent vertebrae

61
Q

How does ruptured AAA appear on CT without IV contrast?

A

High density blood

62
Q

What is the role of interventional radiology in the management of AAA?

A

Permanent stent placement

63
Q

What is the procedure of choice in adults to diagnose acute appendicitis?

A

Abdominal and pelvic CT with IV contrast

64
Q

What are the findings of acute appendicitis on CT?

A

Appendicolith
Dilated appendix with thick wall
Periappendiceal fluid, abscess (indicated by an air pocket)

65
Q

Where should a Dobhoff feeding tube tip go?

A

Junction of the second and third parts of the duodenum

66
Q

5 types of intracranial hemorrhage

A 
Subdural hematoma
Epidural hematoma
Subarachnoid hemorrhage
Intracerebral hemorrhage
Intraventricular hemororhage
67
Q

Optimal imaging procedure to evaluate suspected intracranial hemorrhage?

A

Pre-contrast CT

68
Q

Defined as a collection of blood between the inner table of the skull and the dura

A

Epidural hematoma

69
Q

Common etiology of epidural hematoma?

A

Head trauma, often in children

70
Q

Epidural hematoma often demonstrates what finding on XR?

A

Fracture line (parietal) across the middle meningeal artery

71
Q

Findings of epidural hematoma on pre-contrast CT?

A

Biconvex/lens shape
Acute blood is hyperdense
Does not cross suture line
Mass effect

72
Q

Defined as a collection of blood between the dura and the arachnoid

A

Subdural hematoma

73
Q

Common causes of subdural hematomas

A

Head trauma (child abuse), coagulopathy

74
Q

Compare the appearance of acute, chronic, and subacute subdural hematomas on CT.

A

Acute - blood appears hyper dense
Chronic - blood appears hypodense
Subacute - isodense

75
Q

Subdural hematoma is common in patients with brain atrophy - why?

A

Superficial veins are stretched over a greater distance and more prone to rupture with rapid head movement

76
Q

Findings of an acute subdural hematoma on CT?

A 
History of recent fall
Hyperdense blood
Crescentic shape (medial margin is less convex)
Crosses suture lines
Mass effect
77
Q

Findings of a chronic subdural hematoma on CT?

A

Bilateral chronic subdural hygromas produce slight compression of the adjacent sulci
Hypodense blood

78
Q

Blood within the CSF subarachnoid space

A

Subarachnoid hemorrhage

79
Q

How does a subarachnoid hemorrhage typically present?

A

Worst headache of my life

80
Q

Spontaneous subarachnoid hemorrhage is most often caused by what?

A

Rupture of arterial aneurysms, which release blood into the CSF; most common cause overall is trauma

81
Q

Type of hematoma with a lucid interval followed by deterioriation

A

Epidural hematoma

82
Q

Common causes of intracerebral hemorrhage

A

HTN, trauma, rupture of aneurysm, rupture of AVM

83
Q

Most intracranial aneurysms occur in what artery?

A

Anterior communicating artery

84
Q

How does ICH appear on CT?

A

Round shape

High density

85
Q

CT findings of SAH?

A

Subarachnoid blood in subarachnoid space
Normal sulci filled with low density normal CSF and appear dark
Sulci filled with blood appear hyperdense

86
Q

Common causes of stroke

A 
Ischemic (atherosclerotic disease, embolus, inadequate cerebral blood flow)
Hemorrhagic
Venous sinus thrombosis
Vasculitis
Traumatic arterial dissection
87
Q

Imaging modality of choice to rule out hemorrhagic stroke

A

CT

88
Q

Imaging modality to diagnose acute stroke

A

MRI (CT does not detect)

89
Q

Does a normal CT rule out stroke?

A

No

90
Q

Acute infarct appearance on Non-contrast CT

A 
Large hypodense area
Effacement of gyri and sulci
Can be normal
Loss of gray-white matter differentiation
Blurred basal ganglia
Insular ribbon sign
Dense MCA sign
91
Q

How does edema and infarction appear on CT?

A

Low density (black)

92
Q

How does edema and infarction appear on MRI?

A

High signal intensity on T2 and FLAIR

93
Q

How does edema appear on T2?

A

Bright, high intensity

94
Q

What is FLAIR?

A

Equivalent to T2

95
Q

An abnormality such as a tumor or infarct that is dark on T1 becomes bright after IV gadolinium contrast. What does this indicate?

A

Breakdown of BBB

96
Q

Acute infarct appearance on DWI MRI?

A

Hyperintense

97
Q

Wha causes the bright signal of an infarct using DWI?

A

Restriction of the ability of water protons to diffuse extracellularly

98
Q

How does a glioblastoma appear on T1 MRI (post-contrast)?

A

Ring-enhancing lesion

99
Q

What is the on the differential for a ring enhancing lesions?

A

Glioblastoma
Metastatic tumor
Abscess

100
Q

Imaging test of choice for metastatic tumors to the brain?

A

MRI

101
Q

What are common malignant tumors that met to the brain?

A

Lung
Breast
Melanoma
Renal

102
Q

Most common intracranial benign tumor

A

Meningioma

103
Q

How does meningioma appear on MRI?

A

Mass involving the floor of the anterior cranial fossa
Dural-based tumor, extra-axial
Enhances like a light bulb on T1 MRI post-contrast

104
Q

How does a pyogenic abscess appear on T1 MRI post contrast?

A

Ring enhancing lesion

Edema surrounding the abscess is hypointense on T1

105
Q

How does MS appear on FLAIR?

A

Asymmetrical, abnormal high signal weight matter lesions in the periventricular and subcortical areas

106
Q

Diagnostic imaging of choice for MS?

A

MRI

107
Q

DDX white matter lesions

A

White matter infarctions (HTN, DM)
MS
HIV-related infections
Radiation or chemo induced leukoencephalopathy

108
Q

How does a spine compression fracture appear?

A

Vetebral body is wedge shaped, flattened, higher density

109
Q

Compare the appearance of osteoblastic and osteolytic spinal lesions on CXR

A

Osteoblastic: bone production and sclerotic, hyperdense, white bone

Osteolytic - lucent, hypodense

110
Q

Best study to evaluate possible spinal cord compression?

A

MRI

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