Core Radiology

Front 1

what does upper GI series visualize?

Back 1

esophagus, stomach, duodenum

Front 2

area gastricae vs rugal folds

Back 2

both found in stomach; area gastricae are more fine mosaic pattern, primarily in gastric antrum

Front 3

when to use gastrograffin vs barium?

Back 3

gastrograffin only if emergency (eg ?perf); gastrograffin is water soluble, secreted by kidneys, so no big deal if extravasates; also, gastrograffin doesn’t require prep (unlike NPO after midnight for barium)

Front 4

when not to use gastrograffin?

Back 4

can cause pulmonary edema --> contraindicated if aspiration risk

Front 5

esophageal anatomy on barium swallow: 3 segments, 2 lines

Back 5

SEGMENTS: tubular (majority), vestibular (bulb like area near GEJ), and submerged segments (leads to GEJ); LINES: A line (b/w tubular and vestibular portions); Z line / B ring: between vestibular and submerged segments, represents squamocolumnar junction

Front 6

types of peristalsis (3)

Back 6

1) PRIMARY: stripping wave init by swallowing; 2) SECONDARY: stripping wave follows primary, gets remaining food; 3) TERTIARY (nonstripping, disordered)

Front 7

what nerve controls esophageal motility? Where is the nucleus?

Back 7

Vagus nerve (dorsal vagal nucleus in the midbrain)

Front 8

causes of primary esophageal dysmotility

Back 8

achalasia, diffuse esophageal spasm, nutcracker esophagus, others

Front 9

causes of secondary esophageal dysmotility

Back 9

1) MIDBRAIN: MS, CVA; 2) VAGUS: esoph/lung cancer; 3) MYENTERIC/MESENTERIC PLEXI: esophagitis, esophageal CA, scleroderma, neuropathy

Front 10

classic radiographic features of achalasia (4)

Back 10

1) absent GASTRIC BUBBLE; 2) early --> disordered peristalsis, late --> absent peristalsis; 3) Dilated esophagus with AIR FLUID level; 4) BIRD BEAK lower esophagus

Front 11

what to r/o if ?achalasia?

Back 11

tumor (and other 2' causes of achalasia), incl esophageal and lung CA

Front 12

what parts of esophagus affected by scleroderma?

Back 12

distal 2/3 --> atony

Front 13

ddx of air in a dilated esophagus (3)

Back 13

1) scleroderma; 2) Achalasia; 3) lower esophageal stricture

Front 14

what 3 conditions cause absent peristalsis?

Back 14

1) LATE achalasia; 2) Scleroderma; 3) Neuropathy (DM, EtOH)

Front 15

Types of hiatal hernias (3)

Back 15

TYPE 1: Sliding (95%); TYPE 2: Paraesophageal (5%); Type 3: Combination (rare)

Front 16

how to dx a small sliding hiatal hernia?

Back 16

B-line > 1cm above hiatus between swallows (during swallows, submerged segment submerges below hiatus)

Front 17

what's seen with sliding hiatus hernia on CXR?

Back 17

retrocardiac density

Front 18

what is bochdalek hernia?

Back 18

persistent fetal posterior pleuroperitoneal canals -- > allows herniation of abdominal contents (usu L sided)

Front 19

pulsion vs traction esophageal diverticulae

Back 19

PULSION: a/w disordered peristalsis: Zencker's (posterior) and Epiphrenic (lateral); TRACTION: a/w extrinsic abnormalities (eg tuberculous mediastinal node), usu mid-esophageal

Front 20

what are feline folds?

Back 20

fine esophageal folds caused by submucosal contractions 2/2 esophagitis / irritation

Front 21

what does esophageal cancer look like on barium swallow?

Back 21

apple-core appearance

Front 22

what does post-radiation esophageal stricture look like?

Back 22

smooth tapered edges with stricture in the middle --> looks benign ("rat tail")

Front 23

what does barrett's esophagus look like on barium swallow?

Back 23

mid-esophageal stricture with reticular mucosal pattern, +/- ulcer, +/- hiatal hernia

Front 24

what to do to work up any stricture?

Back 24

biopsy! (r/o cancer)

Front 25

use of single vs double contrast study

Back 25

single better for polyps, double better for fine mucosal abnormalities

Front 26

ddx for varicoid lesion on barium swallow? (2)

Back 26

1) Varices; 2) esophageal tumor (carcinosarcoma / lymphoma)

Front 27

candidal vs Herpes esophageal ulcers

Back 27

candidal ulcers more course

Front 28

what to CMV / HIV esophageal ulcers look like?

Back 28

EITHER multiple diamond-shaped ulcers with halo OR giant ulcer toward GEJ

Front 29

major risk factors for esophageal cancer

Back 29

SMOKING (synergistic with EtOH), Barrett's esophagus, achalasia, scleroderma

Front 30

what is boerhaave's syndrome

Back 30

RUPTURE OF ESOPHAGUS: linear tear across GEJ 2/2 vomiting across closed glottis (often in drunk/passed out); similar to mallory-weiss, but goes THROUGH the wall, not just mucosal tear ==> no hematemesis, but aberrent air seen on cxr

Front 31

thickness of esophagus on CT

Back 31

<3mm

Front 32

stomach visualization in UGI with prone vs supine positions

Back 32

SUPINE: fundus and antrum are posterior --> fill with contrast; PRONE: body is anterior, so fills with contrast

Front 33

differences between benign and malignant ulcers: (7)

Back 33

1) PROJECTION (outside vs inside lumen); 2) BORDER (smooth vs irregular); 3) LOCATION relative to edema (central vs eccentric); 4) RADIATING FOLDS (start close to vs far from crater edge); 5) RADIATING FOLD THICKNESS (uniform vs clubbed); 6) hampton's line vs carmen kirklin complex; 7) HEALING (complete vs incomplete)

Front 34

what is a hamptom's line?

Back 34

thin, sharply demarcated radiolucent line along the neck of a contrast-filled BENIGN gastric ulcer, indicates mucosal edema

Front 35

what is the carmen kirklin complex?

Back 35

pathognomonic of malignant gastric ulcer: push on epigastrium --> see shadow?

Front 36

what is linitis plastica?

Back 36

infiltrating scirrhous carcinoma ==> extensive thickening of stomach wall (aka leather-bottle stomach)

Front 37

causes of linitis plastica

Back 37

infiltration: malignancy, granulomatous, radiation changes, benign ulcers

Front 38

what causes thickened mucosal folds in the stomach?

Back 38

lymphoma, menetrier's dz, gastritis, varices (proximal)

Front 39

where is the ligament of treitz?

Back 39

at the duodenal-jejunal junction

Front 40

rule of thumb for duodenal ulcers

Back 40

benign until proven otherwise

Front 41

what does cyst look like on US?

Back 41

anechoic collection + increased distal intensity

Front 42

what causes duodenal hematoma?

Back 42

often MVA (esp C3 segment)

Front 43

what can a pancreatic pseudocyst do to duodenum?

Back 43

cause c-loop widening (sweep abnormality)

Front 44

rule of thumbs for duodenal vs gastric ulcers

Back 44

duodenal benign until proven otherwise -- usu no endoscopy; gastric can be either benign or malignant, radiology helps, but most are endoscopied / biopsied (if any suspicious features)

Front 45

three spaces around kidney used on CT

Back 45

anterior pararenal space, perirenal space, posterior pararenal space

Front 46

ionic vs nonionic contrast

Back 46

ionic has fewer complications a/w it

Front 47

contraindications to IVU (intravenous uretrogram)

Back 47

same as contraindications to contrast

Front 48

3 phases of IV contrast injection (in reference to kidneys)

Back 48

1) total body opacification (kidney and liver equally opacified); 2) nephrogram phase (cortex lit up); 3) pyelogram phase (within 3-4mins --> contrast in renal calyces, pelvices, ureters)

Front 49

3 stages of reading a IVU

Back 49

1) SCOUT FILM: radio opacities/lucencies; 2) NEPHROGRAM PHASE (renal fxn, parenchymal morphology); 3) PYELOGRAM PHASE (timing, tubular evaluation -- polyps, fistulas, etc)

Front 50

contraindications to contrast (6)

Back 50

1) PREGNANCY; 2) ALLERGY to IV contrast; 3) RENAL INSUFFICIENCY; 4) MULTIPLE MYELOMA; 5) CHF; 6) GOUT

Front 51

uses of ultrasound in renal evaluation

Back 51

1) renal mass vs cyst; 2) doppler eval of blood flow; 3) guide biopsies / drainage

Front 52

what is a bosniak type I renal cyst?

Back 52

SIMPLE cyst: fluid filled, no calcification or wall thickening; BENIGN

Front 53

what is bosniak type II cyst?

Back 53

slightly more complex than type I: homogenous cyst with 1-2 septations, nonenhancing; BENIGN

Front 54

what is bosniak type IIf cyst?

Back 54

COMPLEX cyst: some suspicious features warranting followup, eg enhancing rim; PROBABLY BENIGN (but needs followup)

Front 55

what is bosniak type III renal cyst?

Back 55

COMPLEX cyst: >2 septations, ?enhancing septations, wall thickening, nodularity; POSSIBLY MALIGNANT

Front 56

what is bosniak type IV renal cyst?

Back 56

usu due to renal carcinoma with cystic component; MALIGNANT

Front 57

classic findings on different imaging modalities of renal cyst

Back 57

anechoic on US with enhanced through-transmission, no uptake on CT, hypodense on T1, hyperdense on T2

Front 58

Robson staging of renal cancers

Back 58

1: inside capsule; 2: outside capsule, inside fascia; 3: nodes/vein involvement; 4: outside fascia/distant sites

Front 59

stone vs polyp in ureter

Back 59

stone causes spasm --> stenosis; polyp causes Bergman's sign (uretral dilatation distal to obstruction

Front 60

what renal pathology can be confidently diagnosed on US/CT/MRI?

Back 60

angiomyolipma -- contains bulk fat --> hyperechoic on US, in phase and out of phase appearnace on MRI, fatty appearance? on CT

Front 61

weigert-meyer law

Back 61

in duplex kidney, upper pole obstructs, lower pole refluxes

Front 62

what is renal scan good for?

Back 62

differentiating obstructive vs nonobstructive hydronephrosis, functional studies (gfr), HTN, infection

Front 63

which stones radioopaque on CT?

Back 63

ALL! (except some anti-retroviral- associated stones, eg indinivir)

Front 64

what does pyelonephritis look like on CT?

Back 64

wedge-shaped area of low attenuation

Front 65

differentiating b/w ACUTE pyelonephritis and ACUTE infarct on CT

Back 65

both show wedge-shaped hypodensity, but in pyelonephritis, wedge is pointed TOWARD calyx, while in infarct, wedge is pointed BETWEEN calyces

Front 66

differentiating b/w CHRONIC pyelonephritis and CHRONIC infarct on CT

Back 66

both show wedged-shaped defect of PARENCHYMA, but pyelo --> apex of defect is TOWARD CLUBBED calyx, while infarct --> apex BETWEEN NORMAL calyces

Front 67

3 MCC papillary necrosis

Back 67

1) ANALGESIC ABUSE; 2) DM; 3) SICKLE CELL DISEASE

Front 68

calyceal clubbing seen with what?

Back 68

seen with both papillary necrosis and hydronephrosis; in hydronephrosis, also see pelvicalyceal dilation

Front 69

3 manifestations of renal osteodystrophy

Back 69

1) diffuse osteosclerosis; 2) osteomalacia; 3) 2' hyperPTH

Front 70

findings in 2' hyperPTH (3)

Back 70

distal resorption of b/l clavicles; widening of SI joints and pubic symphysis; horizontal linear lucency through centers of multiple vertebral bodies ("rugger jersey spine")