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Radiology > when to order imaging > Flashcards

when to order imaging Flashcards

1
Q

True/False
In general, imaging should confirm a suspicion.

A

True

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2
Q

Good or bad consult
18 year old male with cough, please advise

A

Bad

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3
Q

Good or bad consult
18 year old male non-smoker with fever, cough, dullness to percussion at left lower lobe, course crackles. Please evaluate for pneumonia.

A

Good

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4
Q

Ottawa Rules ankle

A

Ankle series is indicated if:
(a) Has pain in the “malleolar” zone AND
(b) Has bone tenderness at the posterior edge (6cm) of the lateral or medial malleolus
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.
1) If the patient can transfer weight twice to each foot, the patient can bear weight.
2) If the patient limps, the patient can bear weight.

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5
Q

under Ottawa rules should you order an Xray for a limping patient

A

If the patient limps, the patient can bear weight.

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6
Q

Xray yes or no

Inability to bear weight both immediately after the injury and for four steps in the evaluation room.

A

YES

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7
Q

Ankle series is indicated if

A

(a) Has pain in the “malleolar” zone AND
(b) Has bone tenderness at the posterior edge (6cm) of the lateral or medial malleolus
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.

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8
Q

True/false
the patient can transfer weight twice to each foot, the patient can’t bear weight

A

False
the patient can bear weight

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9
Q

Foot series is indicated if:

A

(a) Has pain in the “midfoot” region
AND
(b) Has bone tenderness at the base of the 5th metatarsal or the navicular
OR
(c) Inability to bear weight both immediately after the injury and for four steps in the
evaluation room.

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10
Q

If plain radiographs are negative and you still suspect bony fracture what should you do?

A

Consider CT

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11
Q

Knee series is indicated if:

A

(a) Age >55 year old
(b) Isolated tenderness of the patella (with no other bony tenderness to the knee).
(c) Tenderness at the head of the fibula.
(d) Inability to flex the knee to 90 degrees.
(e) Inability to bear weight both immediately after the injury and for four steps in the evaluation room (limping is allowed).

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12
Q

If you suspect ligamentous injury, what is the preferred imaging

A

MRI

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13
Q

When is shoulder imaging warranted?

A

1) Traumatic cause
(2) Presence of pain
(3) Loss of range of motion

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14
Q

Shoulder plain films will be able to identify what?

A

Fractures
Dislocations
Arthritis
Acromioclavicular (AC) joint or
Sternoclavicular (SC) joint injuries.

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15
Q

Shoulder
What is preferred for labral, ligamentous or rotator cuff injuries?

A

MRI

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16
Q

True/ False
A radiograph of the injured part of the hand should be obtained. The type of radiograph depends on the clinical assessment and suspected injuries, based on the physical examination and mechanism of injury. Consultation with a radiologist is often helpful.

A

True

17
Q

If a fracture of the phalanx is suspected, an anteroposterior (AP) and true lateral views are obtained of what?

A

The individual digit

18
Q

When the fracture involves or is close to the joint, what view is helpful?

A

Oblique view

19
Q

Finger Xray
If the fracture cannot be delineated because of superimposed digits, such as the base of the proximal phalanx what is done?

A

radiograph of the entire hand must be obtained

20
Q

All metacarpal fractures require what views?

A

AP, lateral, and oblique views

21
Q

A suspected scaphoid fracture should be evaluated with a ______

A

scaphoid series…………………………

22
Q

True/False
Special views may be required for assessment of specific injuries.

A

True

23
Q

Intra-articular fractures refer to fractures involving what?

A

the joint

24
Q

Tuft fractures refer specifically to fractures involving what?

A

head of the distal phalanx.

25
Q

True lateral views show the pisiform projected over the scaphoid tubercle.
scapholunate angle greater than 60 degrees suggests _________________
An angle of less than 30 degrees suggests __________

A

-A scapholunate angle greater than 60 degrees suggests possible scapholunate instability.
-An angle of less than 30 degrees suggests ulnar-sided wrist instability.

26
Q

In the PA wrist view, the wrist is held in neutral, with _____ of rotation to evaluate the relative lengths of the radius and ulna.

A

0 degrees

27
Q

Scaphoid view (wrist in ulnar deviation) to check for _____

A

scaphoid fractures……………..

28
Q

Clenched fist view to check for ___________ seen with ligament disruptions.

A

scapholunate joint space widening

29
Q

_______ view is used to check for hook of the hamate fractures.

A

Hook view….

30
Q

_____________________ of the radiocarpal joint is characterized by narrowing of the joint space and sclerosis of the articular surfaces.

A

Osteoarthritis

31
Q

Imaging is not indicated in the first 4-6 weeks unless back pain is present with:

A

(a) Progressive neurological findings or cauda equina symptoms
(b) Constitutional findings (fever, weight loss)
(c) Traumatic cause
(d) Current or history of malignancy
(e) Elderly
(f) Infectious risk (IV drug use, immunosuppression)
(g) Chronic steroid use
(h) Failed conservative management with signs of nerve root irritation
(i) At risk for osteoporosis

32
Q

For back pain
______ is helpful for fractures or joint degeneration
______ is preferred for serious trauma
______ is imaging of choice for back pain with prior surgery, suspected infection, spinal cord injury, tumor, or cord compression.

A
  1. X-ray
  2. CT
  3. MRI
33
Q

headache
____ is preferred for trauma, to rule out hemorrhage, bone abnormalities, or prior to lumbar punctures.

A

CT

34
Q

For headache
____ is preferred for soft tissue causes such as tumors, or vascular.

A

MRI

35
Q

For a headache with one or more of these issues what should you consider?
(a) Associated with head/neck trauma
(b) New, worse or new features, or abrupt onset headache
(c) Focal neurologic signs or symptoms
(d) Thunderclap headache (sudden, severe)
(e) Headache radiating to the neck
(f) Persistent positional headache
(g) Temporal headache in older than 55 years of age
(h) Suspect infection
1) Associated with cough, exertion, or sexual activity

A

imaging…..

36
Q

True/False
You should Immobilize a knee while awaiting further evaluation

A

True

37
Q

For suspicion of stress fractures if X-rays are normal initially

A

Bone scan can show abnormalities before X-ray findings
Consider CT or MRI

Radiology (4 decks)

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