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41 Cards in this Set

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signs of paget's disease on cxr
increased bone size, increased bone density, coarsened bone trabeculae
hepatomegaly on CXR
difficult to assess -- on CXR, only see posterior edge (outlined by fat), while on palpation, feel only anterior edge
what main cause of hepatomegaly? What 7 subgroups?
INFILTRATION: 1) CELLS; 2) BLOOD; 3) FLUID/edema; 4) FAT; 5) CARBS; 6) IRON; 7) AMYLOID
3 main categories of splenomegaly
1) PORTAL HTN (60%); 2) MYELOPROLIFERATIVE DISEASES; 3) ID (mono, AIDS)
what film findings in ascites (depending on severity)
MILD: loss of liver edge; MODERATE: pelvic density, bladder ears (mickey mouse); MARKED: ground glass abdomen, bulging flanks, widened paracolic gutters, centralized bowel loops
causes of loss of abdominal organ outlines (2)
1) decreased retroperitoneal fat (eg cachexia, anorexia); 2) ascites
dependent areas in supine position
morrison's pouch (subhepatic space), pericolic gutters, pelvis (esp pouch of douglas)
3 global sources of aberrent air?
1) from the OUTSIDE (trauma, surgery); 2) from the INSIDE (perf GI); 3) from gas forming organisms (emphysematous peritonitis)
best type of film for detecting aberrent abdominal air
upright cxr!
what makes kidney stone opaque on CXR?
calcium or phosphate (eg calcium phosphate, calcium oxalate, struvite -- triple phosphate, calcified uric acid)
MCC of pelvic mass in male
huge bladder 2/2 obstructing BPH or prostate CA
MCC of pelvic mass in female
mucinous tumor of ovary, noncalcified fibroid, recent delivery
approach to reading abdominal plain films (7 steps)
1) QUALITY CONTROL (std views, ROI, exposure); 2) LUNG bases + BONES; 3) SOFT TISSUE + ORGANS outlines; 4) BOWEL GAS pattern (stomach, small bowel, colon); 5) CHECKPOINTS (aberrent air, calcification, paucity of gas)
rule of 3s for small bowel
3cm lumen, 3mm bowel wall, 3 air fluid levels
what film findings suggest functional rather than mechanical obstruction?
mild to moderate dilatation, no transition point
causes of mechanical obstruction of bowel (3 main ones)
1) IN THE LUMEN (thrombus, foreign body, stone); 2) IN THE WALL (benign: polyp, adenoma, lipma; malignant: adenocarcinoma, met, lymphoma); 3) EXTRINSIC (adhesions, hernia, mass, volvulus, lymphoma)
causes of functional bowel obstruction
idiopathic, postop ileus, drugs (opiates), metabolic (HoK, HoGlyc, HCa), endocrine (DM, hypoTh, hypoPTH), infectious (peritonitis, gastroenteritis)
causes of sentinal loop
localized infection (eg appendicitis, pancreatitis, cholecysitis, pyelonephritis, abscess)
causes of ahaustral colon (5)
UC, chronic laxative abuse, chronic obstruction, s/p ischemia, s/p radiation
MCC pneumatosis coli
ischemia; (= air in the bowel wall)
approach to evaluating abdominal gas patterns (5 main steps)
1) IDENTIFY stomach, small bowel, colon; 2) LUMEN DIAMETER (?dilated); 3) AIR FLUID LEVELS (>3 = worrisome, a lot = ?diarrhea); 4) LUMEN CONTOUR (look for ahaustral or thumbprints); 5) BOWEL WALL (look for pneumatosis coli and Rigler's sign)
causes of portal venous gas (3)
OUTSIDE (umbilical vein cath); INSIDE (bowel infarction *MCC); 3) INFECTION (emphysematous cholecystitis
causes of biliary tract air
OUTSIDE (external biliary stent); INSIDE (tubular GI tract / biliary fistula *MCC); INFECTION (emphysematous cholecystitis)
causes of air in the bladder lumen (3)
foley, fistula, infectious (emphysematous cystitis)
causes of atypical calcifications
TTII: Tumor, Trauma, Infection, Infarction
what shape of calcification with prostatic calcification/
"cauliflower calcification" -- benign
what does vas deferens calcification look like? What causes it?
"v"-shaped tubular calcification, often seen with DM
what does paucity of gas suggest? (2)
1) mass; 2) proximal obstruction
classic radiographic triad of gallstone ileus
biliary tract air, low SBO, calcified RLQ stone
common radiographic findings in inflammatory bowel disease
1) calcium oxalate renal/gall stones; 2) ahaustral narrow colon; 3) sacroiliitis
how to detect pneumoperitoneum on supine film?
rigler's sign (bowel wall with air on both sides)
segments of left and right liver lobes
LEFT: lateral and medial (divided by left hepatic vein superiorily, ligamentum teres inferiorily); RIGHT: anterior and posterior (divided by right hepatic vein)
what is caroli's disease?
multiple saccular dilatations of the intrahepatic biliary ducts
what are most gallstones made of?
cholesterol (75% of stones); 25% are pigment stones, a/w chronic hemolytic conditions
what do cholesterol stones look like on CT?
isodense with bile -- difficult to detect
radioopaque-ness of gall/kidney stones
15% of gallstones, 85% of kidneystones are radioopaque -- rest can't be seen with plain film
us findings in cholecystitis (5)
1) DILATED gallbladder; 2) GALLSTONES; 3) GB wall THICKENING >2mm +/- edema; 4) PERICHOLECYSTIC FLUID; 5) sonographic MURPHY'S SIGN
HIDA SCAN: findings in normal, acute cholecystitis, and chronic cholecystitis
radiotracer given IV; NORMAL: GB and small bowel visualized in 30-60min; ACUTE CHOLECYSTITIS: no GB vis in 90 min; CHRONIC CHOLECYSTITIS: no GB for 60 mins --> morphine --> GB seen at 90min
linear echogenicities in gallbladder US
air!
AIDS cholangitis vs PSC
PSC involves both intra and extrahepatic ducts; AIDS cholangitis only involves INTRAhepatic ducts; both can cause "beading" with intermittent strictures; the differentiating feature is the CBD: dilated in AIDS cholangitis, intermittent strictures in PSC
what is adenomyomatosis?
benign hyperplasia of gallbladder muscle, can be confused radiographically with malignant cancer