Core Radiology: Pcr

Front 1

how to confirm subpulmonic effusion?

Back 1

dependent lateral decubitus

Front 2

what is a fissural pseudotumor? What does it look like on plain film?

Back 2

fluid trapped within the major or minor fissure, appears mass-like esp on frontal cxr, often ovoid on lateral

Front 3

what does a subpulmonic pleural effusion look like on CXR?

Back 3

apparent elevation of the hemidiaphragm and CPA blunting; layers on lateral decubitus

Front 4

what is the "tramtrack sign" on CXR?

Back 4

seen with pericardial effusion: black/white/black sandwich often seen on lateral view, representing (from deep to superficial) epicardial fat pad, pericardial effusion, pericardial fat pad

Front 5

DDx for cardiac sillhouette enlargement (4)

Back 5

dilated cardiomegaly, pericardial effusion, valvular heart dz, cardiac aneurysm

Front 6

findings for pericardial effusion on CXR (4)

Back 6

1) enlarged cardiac SILHOUETTE; 2) "WATER BOTTLE" shape of heart w/ sagging L apex; 3) GRAY HALO at heart's periphery; 4) TRAMTRACK sign

Front 7

what test to order for chest pain

Back 7

cxr, always first

Front 8

causes of hemorrhagic mets (4)

Back 8

melanoma, thyroid, choriocarcinoma, RCC

Front 9

what are the landing zones of testicular cancers?

Back 9

infrarenal and retroperitoneal draining lymph nodes (all testicular cancers except choriocarcinoma spread by lymphatics)

Front 10

what to do with EXTRAtesticular abnormality found on testicular US?

Back 10

nothing -- usually benign

Front 11

what to do with INTRAtesticular abnormality found on testicular US?

Back 11

presumed malignant --> staging by abdCT/CXR/brainMRI(if sx)

Front 12

use of doppler with testicular pathology?

Back 12

mainly used for torsion/infarcted traumatized testes

Front 13

what initial imaging for pt with hematuria without fever or palpable mass?

Back 13

traditionally: IVU; more recently, CTU (CT urogram); good for demonstrating stones and tumors

Front 14

causes of calcified bladder wall (4)

Back 14

TUMOR (primary, mets); INFECTION; s/p RADIATION or CHEMO

Front 15

what study needed to dx bladder cancer?

Back 15

usu C+ CT (most bladder cancers don’t show calcification --> not seen on plain film)

Front 16

causes of bladder filling defect (6)

Back 16

1) blood CLOT; 2) TUMOR; 3) FOLEY catheter balloon; 4) lucent STONE; 5) enlarged PROSTATE; 6) URETEROCELE

Front 17

what imaging for hematuria + frequency?

Back 17

suspect malignancy: IVU/CTU followed by cystoscopy+biopsy (unless upper tract abnormality found); staging by CXR/chestCT + abdominopelvic CT

Front 18

how to detect local invasion of bladder cancer?

Back 18

MRI (better than CT)

Front 19

how to detect distant mets of bladder cancer?

Back 19

CT for liver/lung, radionuclide bone scan for skeleton

Front 20

chance of bladder mass being malignant

Back 20

high; benign tumor-like masses in bladder are rare

Front 21

causes of osteosclerotic bone lesions:

Back 21

older woman: brca; older man: prostate ca; younger pt: hodgkin's

Front 22

causes of osteolytic bone mets

Back 22

RCC, transitional cell carcinoma

Front 23

test of choice for evaluating prostate

Back 23

transrectal ultrasound

Front 24

imaging test of choice for staging prostate cancer

Back 24

MRI with endorectal coil (after dx made)

Front 25

what to do with abnormal DRE/PSA when screening for prostate cancer?

Back 25

if palpable mass, get biopsy; if no palpable mass, need TRUS + biopsy, followed by staging if biopsy (+)

Front 26

how to stage prostate cancer

Back 26

MRI endorectal coil + CXR/chestCT + RN Bone Scan

Front 27

what does prostate cancer look like on ultrasound?

Back 27

hypoechoic lesion in peripheral zone with ill-defined borders

Front 28

test of choice for detection and staging of RCC

Back 28

dynamic CT scan with IV contrast

Front 29

which type of renal cancer a/w stenoses?

Back 29

TCC

Front 30

types of bugs implicated in ascending vs hematogenously spread renal infections

Back 30

ascending: G- (eg e. coli); hematogenous: G+ (eg s. aureus)

Front 31

modality of choice to confirm pyelonephritis

Back 31

renal CT with contrast

Front 32

what is RN scanning used for in renal pathology?

Back 32

evaluate for renal parenchymal loss

Front 33

what imaging if suspect UTI?

Back 33

none! (only indicated if not responsive to tx or suspect complications --> CT with contrast)

Front 34

findings in chronic pyelonephritis

Back 34

wedge-shaped defect directed toward a clubbed calyx

Front 35

usefulness of US and IVU in detecting pyelo

Back 35

minimal -- both are very insensitive

Front 36

analgesic abuse increases risk of what cancer?

Back 36

TCC

Front 37

2 broad causes of calyceal clubbing

Back 37

hydronephrosis and papillary necrosis

Front 38

3 MCC papillary necrosis

Back 38

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

Front 39

classic appearance of ADPKD

Back 39

multiple b/l renal calcifications, diverticulosis, liver/kidney cysts on CT/MRI

Front 40

what to do with solid mass in kidney with fat seen on CT?

Back 40

nothing! Fat usually suggests angiomyolipoma --> benign

Front 41

what to do with solid mass in kidney WITHOUT fat seen on CT?

Back 41

resection (usu renal adenocarcinomas)

Front 42

what to do with simple and complex cysts?

Back 42

SIMPLE: benign, no f/u; COMPLEX: need further imaging and f/u, depending on clinical suspicion for RCC

Front 43

what pathology a/w ADPKD

Back 43

diverticular dz, cerebral aneurysms

Front 44

classic imaging findings in renal obstruction (4)

Back 44

1) DELAYED NEPHROGRAM; 2) DENSE NEPHROGRAM; 3) DELAYED PYELOGRAM; 4) DILATED PELVICALYCEAL system

Front 45

most common area of mechanical renal obstruction

Back 45

ureters

Front 46

acute vs chronic urinary obstruction

Back 46

in CHRONIC obstruction, can see marked dilatation of collecting system and thinning of renal parenchyma

Front 47

nephrolithiasis vs nephrocalcinosis

Back 47

NEPHROLITHIASIS: stone in pelvocalyceal system of kidney; NEPHROCALCINOSIS: calcification of renal parenchyma

Front 48

2 MCC SBO

Back 48

hernia and post-op adhesions

Front 49

"coffee bean sign"

Back 49

sigmoid volvulus

Front 50

algorithm for abdpain + distension + vomiting

Back 50

abd plain film --> if diagnostic / ominous, treat, else get CT (SBO) or BE (LBO)

Front 51

what imaging to do if suspect SBO vs LBO after abd plain film?

Back 51

SBO: CT-abd followed by upper GI with SBFT if nondiagnostic; LBO: BE

Front 52

use of hydrostatic or pneumatic enemas for reduction of intussusception

Back 52

only in kids (usu no pathology at lead point); enemas can only be used in adults for diagnosis;

Front 53

tx of intussusception based on age

Back 53

KIDS: if no complications, water/contrast/air enema reduction; if signs of ischemia/perf, urgent surgery; ADULTS: surgery

Front 54

recommended modality for evaluation of hernias

Back 54

CT

Front 55

CT findings in infarction (7)

Back 55

1) bowel WALL THICKENING; 2) LUMINAL DILATATION; 3) PROMINENT mesenteric VESSELS + FAT STRANDING; 4) ASCITES; 5) PNEUMOTOSIS COLI + PORTAL VENOUS GAS (if infarction); 6) PNEUMOPERITONEUM (if perf); 7) SMA/SMV OCCLUSION (rare)

Front 56

complications of IBD

Back 56

colon cancer (UC), toxic megacolon, fistulas/fissures/abscesses, stenoses/obstruction, crohn's jejunoileitis, extrainsteintal (gallstones, renal stones, sacroiliitis)

Front 57

inflammatory pseudopolyps with what dz?

Back 57

UC only! (unlike "post-inflammatory pseudopolyps" which an occur in both Crohn's and UC)

Front 58

rightsided ahaustral colon

Back 58

chronic laxative use

Front 59

bowel wall thickening in ACA vs diverticulitis

Back 59

both have it, circumferential in ACA, asymmetric in diverticulitis

Front 60

what imaging to begin staging of CRC?

Back 60

CT (eval mets to liver / lymph nodes, not evaluate dept of wall invasion)

Front 61

best imaging modality for detecting CRC or polyps

Back 61

BE (double contrast better for polyps)

Front 62

best method of determining depth of wall invasion with CRC

Back 62

endoluminal ultrasound (EUS)

Front 63

focal air fluid levels

Back 63

sentinal loop

Front 64

calcification in R lower pelvis

Back 64

ureteral calcifiaction or appendicolith

Front 65

test of choice for dx appendicitis

Back 65

appendiceal CT following instillation of 3% colonic contrast (1/3 radiation of abdpelvic CT)

Front 66

arrowhead sign

Back 66

seen on CT in appendicitis: cecal wall thickens and lumen points toward base of appendix

Front 67

when not to do CT for ?appendicitis? What alt?

Back 67

kids, pregnant women: US

Front 68

first test for abdominal pain

Back 68

if acute abdomen, CT; if no acute abdomen, plain film; if pregnant, US;

Front 69

BE vs CT

Back 69

BE used to be emergent procedure, but now less sensitive than CT + complication risk + can't take to surg; CT PREFERRED

Front 70

small air bubble in colon (?wall) on BE study

Back 70

could be air in divertic, or air in abscess 2/2 inflam process

Front 71

test of choice for evaluating diverticuli / diverticulitis

Back 71

abd/pelvic CT (used to be BE)

Front 72

main CT findings for diverticulitis

Back 72

pericolic fat inflammation, thickened colonic wall (>4mm), ?sentinal loop, ?intramural sinus tract, ?pericolic or pelvic abscess

Front 73

what type of lung cancer most likely to form cavitary lesion?

Back 73

squamous cell carcinoma (10% cavitate)

Front 74

what does pancoast tumor look like on cxr?

Back 74

apical asymmetry

Front 75

what types of tumors cause pancoast's tumor? (2)

Back 75

squamous cell, adenocarcinoma

Front 76

initial test for screening the esophagus

Back 76

barium swallow --> endoscopy (for visualization +/- bx)

Front 77

how to evaluate extent of esophageal wall invasion?

Back 77

esophageal ultrasound (EUS)

Front 78

3 big categories of diseases that cause cavitary lesions

Back 78

1) NEOPLASM; 2) INFECTION; 3) VASCULITIS

Front 79

test of choice to dx early emphysema

Back 79

High-res CT (shows changes before PFTs and CXR)

Front 80

2 most reliable CXR findings in hyperinflation

Back 80

1) FLATTENED HEMIDIAPHRAGMS on lateral view; 2) increased RETROSTERNAL AIRSPACE also on lateral view

Front 81

causes of fibrothorax

Back 81

prior TB, prior empyema, prior asbestos exposure, prior trauma (look for rib fx)

Front 82

mcc bone infarcts

Back 82

longterm steroid use

Front 83

what to do if you see isolated perisoteal reaction?

Back 83

CXR! (concern about hypertrophic osteoarthropathy 2/2 lung cancer)

Front 84

how to w/u ? Aortic dissection

Back 84

CTA/MRA (CXR has low sensitivity), esp saggital

Front 85

how to eval ? AAA?

Back 85

plain films rarely useful; need US/CTA/MRA

Front 86

if suspect lung tumor on CXR, which comes first -- chest CT or biopsy?

Back 86

chest CT -- can spare pt biopsy if benign, or can be used to pinpoint location for bx

Front 87

difference in presentation of routine pleural effusion and subpulmonic pleural effusion

Back 87

routine: obscures hemidiaphragm; subpulmonic: apparent elevation of hemidiaphragm

Front 88

what characteristic finding with chronic aortic dissection on plain film?

Back 88

calcifications

Front 89

algorithm for ?Ao dissection

Back 89

CXR (to r/o other processes) followed by {CTA | MRA | TEE | Angiography}, CTA usu 1stline

Front 90

GEJ in achalasia vs scleroderma

Back 90

achalasia: "bird beak"; scleroderma: ==> gastric air bubble present in scleroderma, absent in achalasia