Core Radiology 11-16-2007 Squire

Front 1

what does mechanical SBO look like on plainfilm?

Back 1

distended small bowel with collapsed, empty colon

Front 2

what is the dependent part of the peritoneal space in a supine patient?

Back 2

bowl of the PELVIS -- usu not seen on plain film b/c often confused with distended bladder; followed by FLANKS (paracolic gutters) -- look for gap between flank stripe and colon

Front 3

what supine plain film findings in ascites?

Back 3

overall increase in gray haziness, but also see increased air-filled bowel loops pushed to the surface; if air-filled bowel displaced to one side, look for a mass

Front 4

air in the fundus of the stomach on barium contrast suggests what position?

Back 4

prone

Front 5

most common location of duodenal ulcer

Back 5

posterior wall of the bulb

Front 6

temporal changes of radiographic visualization of duodenal ulcers

Back 6

easy to visualize in early stages with barium, but becomes more difficult with successive attacks due to scar formation

Front 7

cause of intussusception

Back 7

kids: usu no cause; adults: often 2/2 neoplasm

Front 8

location of intussusception

Back 8

kids: ileocolic (TI herniating into cecum and ascending colon); adults: anywhere (2/2 neoplasm)

Front 9

CT findings in appendicitis

Back 9

if uncomplicated, see enlarged appendix with pericolic fat inflammation; if complicated, can see abscess

Front 10

what does abscess look like on ct

Back 10

lower density pus + gas bubbles

Front 11

complications a/w diverticulitis (2)

Back 11

perf --> peritonitis; fistulas (eg bladder --> air and fecal material vis on CT)

Front 12

presentation of ischemic bowel

Back 12

abd pain +/- peritoneal signs on PE

Front 13

CT findings in bowel ischemia

Back 13

air trapped in bowel lumen (seen in dependent areas)

Front 14

what does bursitis look like on plain film?

Back 14

areas of calcification around joint

Front 15

causes of engorged pulmonary veins

Back 15

impaired venous return (eg mitral stenosis, acute MI)

Front 16

causes of engorged pulmonary arteries

Back 16

L-->R shunt (eg PDA)

Front 17

characteristics of hilar enlargement 2/2 tumor

Back 17

round, smooth, unilateral

Front 18

causes of b/l hilar enlargement

Back 18

sarcoid (benign), lymphoma (malignant), vascular

Front 19

what causes radiating perihilar pattern?

Back 19

lymphangitic spread of breast cancer; also stomach/pancreatic cancers

Front 20

causes of focally decreased lung opacity (3)

Back 20

air trapping, emphysema, cysts

Front 21

causes of solitary pulmonary nodules

Back 21

granuloma (histo/TB), neoplastic, single met

Front 22

what can cause depression/flattening of diaphragm?

Back 22

increased intrathoracic contents (eg hyperinflation from emphysema, pleural fluid, lung masses)

Front 23

two views to visualize a small ptx

Back 23

bolt upright or lateral decubitus (pt on good side); end expiration with both

Front 24

Most common findings in PE

Back 24

decreased lung volumes (atelectasis, elevation of hemidiaphragm); if infarct (10%), can see Hampton's Hump

Front 25

most common location of hampton's hump

Back 25

lateral border, esp at costophrenic angle

Front 26

what to watch out for in V/Q scan of elderly pt?

Back 26

if emphysema, lack of VQ mismatch could suggest UNDERPERFUSION, possibly 2/2 PE --> consider angiography

Front 27

plain film findings of emphysema

Back 27

HYPERINFLATION (extra ribs, low/flattened diaphragm); sometimes concomitant PULMONARY FIBROSIS (strands radiating from hilum); EMPHYSEMATOUS BULLAE (huge air cysts, possible rupture --> PTX)

Front 28

three landmarks useful for assessing mediastinal shift

Back 28

1) AORTIC KNOB; 2) TRACHEA; 3) R HEART BORDER

Front 29

what causes transient mediastinal shift?

Back 29

obstruction of bronchus --> mediastinal shift with respiration!

Front 30

what shifts observed with RUL collapse?

Back 30

upward shift of minor fissure, can also pull up hilum if sufficient volume loss

Front 31

plain film findings in LLL collapse

Back 31

loss of medial L diaphragm, L hilum pulled behind heart border, R heart border disappears behind spine

Front 32

what can cause enlarged anterior mediastinum (4)

Back 32

ectopic thyroids (Goiter), thymomas, teratomas, lymphomas

Front 33

what can cause enlarged middle mediastinum (3)

Back 33

ESOPHAGEAL PATHOLOGY (carcinoma, dilitation, achalasia, scleroderma); TRACHEOBRONCHIAL TREE; LYMPH NODES

Front 34

what can cause enlarged posterior mediastinum (2)

Back 34

NEURAL ORIGIN (gangliomas, neurofibromas); AORTIC ANEURYSMS

Front 35

lateral plain film findings in RV vs LV enlargement

Back 35

RV: heart fills anterior clear space behind sternum; LV: heart extends posteriorily, ?depresses diaphragm

Front 36

how does emphysema confound assessment of cardiomegaly?

Back 36

overinflated lungs can compress heart/mediastinum, hide cardiomegaly

Front 37

with what conditions is rib notching associated? (2)

Back 37

coarctation of the aorta, neurofibromatosis

Front 38

sudden shapeless or globular increase in cardiac size --> ?

Back 38

pericardial effusion

Front 39

defn compound fracture

Back 39

open to skin

Front 40

defn complete fracture

Back 40

extends through both cortices

Front 41

defn comminuted fracture

Back 41

several fragments and intersecting fragment lines

Front 42

characteristic clinical finding a/w avulsion fx

Back 42

overlying point tenderness

Front 43

displaced fat-pad sign seen with what type of fx? What common clinical finding also seen?

Back 43

intra-articular fractures, usu a/w hemarthrosis

Front 44

expansion of bone by lesion --> benign or malignant?

Back 44

likely benign (slow growing)

Front 45

which fractures often missed on plain film? (2)

Back 45

scaphoid, femoral neck

Front 46

MCC osteomyelitis

Back 46

staph aureus (esp in IVDU)

Front 47

radiographic findings in osteomyelitis

Back 47

bone destruction (lytic lesion) + periosteal reaction (2wks into process); often a/w swelling and loss of fat planes

Front 48

how to detect osteomyelitis

Back 48

MR / bone scan -- can't be seen on plain film!

Front 49

radiographic findings in OA (4)

Back 49

1) narrowed JOINT SPACE; 2) SCLEROSIS on both sides of joint; 3) OSTEOPHYTES; 4) small CYSTS in bone

Front 50

radiographic findings in RA (4)

Back 50

1) soft-tissue SWELLING; 2) OSTEOPOROSIS; 3) narrowed JOINT SPACE; 4) marginal EROSIONS

Front 51

radiographic findings in GOUT

Back 51

1) large EROSIONS of bone with overhanging HOOKLIKE margins, DENSE/sclerotic; 2) RANDOM joint involvement

Front 52

plain film appearance of osteonecrosis

Back 52

initally normal, then patchy radiolucencies; best seen with MR

Front 53

most common location of osteonecrosis

Back 53

epiphyseal marrow cavities of long bones (eg femoral heads, joints)

Front 54

pathognomonic sign of hyperPTH? Where best seen?

Back 54

subperiosteal erosion of bone; best seen in bones of hand (esp phalynx)

Front 55

how to distinguish old from new fracture?

Back 55

need BONE SCAN (increased uptake in new fx) or MR (new fracture shows loss of fat signal due to hemorrhage)

Front 56

what is a "fish vertebrae"

Back 56

"lozenge-shaped" disc spaces b/c of herniation of discs into vertebral bodies 2/2 bone loss + repetitive trauma (eg osteoporosis, hyperPTH, steroids)

Front 57

what is a burst fracture? What is the significance?

Back 57

comminuted fracture of a vertebral body with retropulsed fragments into neural canal --> surgical decompression (vs conservative mgmt if only compression fx)

Front 58

best initial screen for bone tumor

Back 58

radioisotope bone scan

Front 59

findings with osteomyelitis of the spine (plain film, bone scan)

Back 59

plain film: bone destruction on both sides of disc space; bone scan: increased uptake

Front 60

which mets to bone are generally lytic?

Back 60

lung, thyroid, kidney, untreated breast

Front 61

what mets to bone are blastic?

Back 61

PROSTATE, breast if treated --> slowed destruction

Front 62

pagets vs blastic prostatic mets

Back 62

prostatic mets do NOT cause bone enlargement!

Front 63

what do menisci, tendons, and lesions look like on MR?

Front 64

what does cancer look like on mammogram?

Back 64

clusters of microcalcifications +/- stellate mass with spiculated margins

Front 65

why is US useful in breast imaging?

Back 65

can differentiate cyst from solid mass

Front 66

transabdominal vs transvaginal ultrasound requirements

Back 66

transabdominal requires full bladder --> pushes bladder out of the way, urine increases through transmisison

Front 67

what US technique allows visualization of ovaries?

Back 67

transvaginal

Front 68

what is a hysterosalpingogram? What is good for?

Back 68

contrast injected via catheter into the cervix, followed by xray imaging; used to detect congenital abnormalities of uterus, scarring in uterine tubes, etc.

Front 69

what is a hysterosonograph and what is it used for

Back 69

ultrasound with saline injected into the uterus --> Good for detecting polyps / filling defects

Front 70

diffence b/w leiomyoma and adenomyosis?

Back 70

can look similar on US, MR better at distinguishing; adenomyosis less common and occurs in F > 40yo; TREATMENT diff: surg resection for leiomyomas w/o loss of uterus or fertility; adenomyosis may require hysterectomy

Front 71

what does echogenic fluid in the cul-de-sac suggest in the 1st trimester?

Back 71

ruptured ectopic pregnancy

Front 72

how to assess fetal well-being during 1st trimester? (2)

Back 72

1) Crown-rump length (CRL); 2) cardiac activity

Front 73

how to assess fetal well-being during 2nd trimester? (2)

Back 73

1) head/abdominal circumference; 2) femur length

Front 74

what is US used for during 3rd trimester? (2)

Back 74

1) Placental PREVIA (painless bleeding); 2) placental ABRUPTION (retroplacental hemorrhage, PAIN, fetal mortality in 15-20%)

Front 75

imaging modality for scrotum and normal findings

Back 75

ultrasound; testes and epidydimes have a fine, homogeneous texture, with echolucent fluid often around epidydymis

Front 76

what do testes/epidydymis look like on US when infected?

Back 76

enlarged, hypoechoic, increased vasculature on doppler

Front 77

what does testicular torsion look like on US?

Back 77

little or no blood flow (doppler)

Front 78

what to different fluid collections in the tunica vaginalis look like? (3)

Back 78

1) HYDROCELE: anechoic; 2/3) HEMATOCELE (blood) and PYOCELE (pus): heterogenous, echogenic;

Front 79

what does prostate look like on urogram

Back 79

if large (?enlarged), can be seen indenting bladder (~filling defect)

Front 80

how to visualize prostate?

Back 80

transrectal ultrasound (esp peripheral zone, staging cancers by detecting local invasion)

Front 81

what does croup look like on AP?

Back 81

"inverted v:" edema causes narrowing of subglottic trachea immediately below the larynx

Front 82

what imaging to visualize epiglottitis?

Back 82

single lateral film (see edematous epiglottis)

Front 83

CXR findings with bronchiolitis/bronchitis

Back 83

hyperinflation, thickening of bronchial walls, peribronchial cuffing, increased linear opacities

Front 84

findings in CF

Back 84

infants/young kids: none; older kids: bronchiectasis

Front 85

causes of acute abdomen in neonates (3)

Back 85

congenital defects (eg atresia), NEC, abdominal mass (hydronephrosis, usu benign)

Front 86

causes of acute abdomen in first 6 wks of life (1)

Back 86

hirschsprung's dz (as late as 5 months)

Front 87

causes of acute abdomen in first 3 months of life (2)

Back 87

1) inguinal hernia; 2) hypertrophic pyloric stenosis (visualized by upper GI or US)

Front 88

causes of acute abdomen in 6mo-2yrs

Back 88

ileocecal intussusception (seen on barium enema)

Front 89

causes of acute abdomen in kids >2yo (2)

Back 89

1) appendicitis; 2) abd mass

Front 90

what is a greenstick fracture?

Back 90

bend (torus or bowing fx) + complete fx of cortex on convex side

Front 91

which type of physeal fracture most common in kids? Description?

Back 91

type II (physeal + metaphyseal fracture)

Front 92

what is pediatric cranial US used for

Back 92

most commonly to assess for intracranial hemorrhage, also for hydrocephalus, fluid, cystic/solid lesions