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91 Cards in this Set
- Front
- Back
how to confirm subpulmonic effusion?
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dependent lateral decubitus
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what is a fissural pseudotumor? What does it look like on plain film?
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fluid trapped within the major or minor fissure, appears mass-like esp on frontal cxr, often ovoid on lateral
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what does a subpulmonic pleural effusion look like on CXR?
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apparent elevation of the hemidiaphragm and CPA blunting; layers on lateral decubitus
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what is the "tramtrack sign" on CXR?
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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
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DDx for cardiac sillhouette enlargement (4)
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dilated cardiomegaly, pericardial effusion, valvular heart dz, cardiac aneurysm
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findings for pericardial effusion on CXR (4)
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1) enlarged cardiac SILHOUETTE; 2) "WATER BOTTLE" shape of heart w/ sagging L apex; 3) GRAY HALO at heart's periphery; 4) TRAMTRACK sign
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what test to order for chest pain
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cxr, always first
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causes of hemorrhagic mets (4)
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melanoma, thyroid, choriocarcinoma, RCC
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what are the landing zones of testicular cancers?
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infrarenal and retroperitoneal draining lymph nodes (all testicular cancers except choriocarcinoma spread by lymphatics)
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what to do with EXTRAtesticular abnormality found on testicular US?
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nothing -- usually benign
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what to do with INTRAtesticular abnormality found on testicular US?
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presumed malignant --> staging by abdCT/CXR/brainMRI(if sx)
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use of doppler with testicular pathology?
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mainly used for torsion/infarcted traumatized testes
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what initial imaging for pt with hematuria without fever or palpable mass?
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traditionally: IVU; more recently, CTU (CT urogram); good for demonstrating stones and tumors
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causes of calcified bladder wall (4)
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TUMOR (primary, mets); INFECTION; s/p RADIATION or CHEMO
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what study needed to dx bladder cancer?
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usu C+ CT (most bladder cancers don’t show calcification --> not seen on plain film)
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causes of bladder filling defect (6)
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1) blood CLOT; 2) TUMOR; 3) FOLEY catheter balloon; 4) lucent STONE; 5) enlarged PROSTATE; 6) URETEROCELE
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what imaging for hematuria + frequency?
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suspect malignancy: IVU/CTU followed by cystoscopy+biopsy (unless upper tract abnormality found); staging by CXR/chestCT + abdominopelvic CT
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how to detect local invasion of bladder cancer?
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MRI (better than CT)
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how to detect distant mets of bladder cancer?
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CT for liver/lung, radionuclide bone scan for skeleton
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chance of bladder mass being malignant
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high; benign tumor-like masses in bladder are rare
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causes of osteosclerotic bone lesions:
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older woman: brca; older man: prostate ca; younger pt: hodgkin's
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causes of osteolytic bone mets
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RCC, transitional cell carcinoma
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test of choice for evaluating prostate
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transrectal ultrasound
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imaging test of choice for staging prostate cancer
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MRI with endorectal coil (after dx made)
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what to do with abnormal DRE/PSA when screening for prostate cancer?
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if palpable mass, get biopsy; if no palpable mass, need TRUS + biopsy, followed by staging if biopsy (+)
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how to stage prostate cancer
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MRI endorectal coil + CXR/chestCT + RN Bone Scan
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what does prostate cancer look like on ultrasound?
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hypoechoic lesion in peripheral zone with ill-defined borders
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test of choice for detection and staging of RCC
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dynamic CT scan with IV contrast
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which type of renal cancer a/w stenoses?
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TCC
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types of bugs implicated in ascending vs hematogenously spread renal infections
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ascending: G- (eg e. coli); hematogenous: G+ (eg s. aureus)
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modality of choice to confirm pyelonephritis
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renal CT with contrast
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what is RN scanning used for in renal pathology?
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evaluate for renal parenchymal loss
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what imaging if suspect UTI?
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none! (only indicated if not responsive to tx or suspect complications --> CT with contrast)
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findings in chronic pyelonephritis
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wedge-shaped defect directed toward a clubbed calyx
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usefulness of US and IVU in detecting pyelo
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minimal -- both are very insensitive
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analgesic abuse increases risk of what cancer?
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TCC
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2 broad causes of calyceal clubbing
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hydronephrosis and papillary necrosis
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3 MCC papillary necrosis
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1) ANALGESIC ABUSE; 2) DM; 3) SICKLE CELL DISEASE
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classic appearance of ADPKD
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multiple b/l renal calcifications, diverticulosis, liver/kidney cysts on CT/MRI
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what to do if suspect cyst on IVU (ie see filling defect)
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what to do with solid mass in kidney with fat seen on CT?
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nothing! Fat usually suggests angiomyolipoma --> benign
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what to do with solid mass in kidney WITHOUT fat seen on CT?
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resection (usu renal adenocarcinomas)
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what to do with simple and complex cysts?
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SIMPLE: benign, no f/u; COMPLEX: need further imaging and f/u, depending on clinical suspicion for RCC
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what pathology a/w ADPKD
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diverticular dz, cerebral aneurysms
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classic imaging findings in renal obstruction (4)
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1) DELAYED NEPHROGRAM; 2) DENSE NEPHROGRAM; 3) DELAYED PYELOGRAM; 4) DILATED PELVICALYCEAL system
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most common area of mechanical renal obstruction
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ureters
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acute vs chronic urinary obstruction
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in CHRONIC obstruction, can see marked dilatation of collecting system and thinning of renal parenchyma
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nephrolithiasis vs nephrocalcinosis
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NEPHROLITHIASIS: stone in pelvocalyceal system of kidney; NEPHROCALCINOSIS: calcification of renal parenchyma
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2 MCC SBO
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hernia and post-op adhesions
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"coffee bean sign"
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sigmoid volvulus
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algorithm for abdpain + distension + vomiting
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abd plain film --> if diagnostic / ominous, treat, else get CT (SBO) or BE (LBO)
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what imaging to do if suspect SBO vs LBO after abd plain film?
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SBO: CT-abd followed by upper GI with SBFT if nondiagnostic; LBO: BE
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use of hydrostatic or pneumatic enemas for reduction of intussusception
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only in kids (usu no pathology at lead point); enemas can only be used in adults for diagnosis;
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tx of intussusception based on age
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KIDS: if no complications, water/contrast/air enema reduction; if signs of ischemia/perf, urgent surgery; ADULTS: surgery
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recommended modality for evaluation of hernias
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CT
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CT findings in infarction (7)
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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)
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complications of IBD
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colon cancer (UC), toxic megacolon, fistulas/fissures/abscesses, stenoses/obstruction, crohn's jejunoileitis, extrainsteintal (gallstones, renal stones, sacroiliitis)
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inflammatory pseudopolyps with what dz?
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UC only! (unlike "post-inflammatory pseudopolyps" which an occur in both Crohn's and UC)
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rightsided ahaustral colon
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chronic laxative use
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bowel wall thickening in ACA vs diverticulitis
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both have it, circumferential in ACA, asymmetric in diverticulitis
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what imaging to begin staging of CRC?
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CT (eval mets to liver / lymph nodes, not evaluate dept of wall invasion)
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best imaging modality for detecting CRC or polyps
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BE (double contrast better for polyps)
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best method of determining depth of wall invasion with CRC
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endoluminal ultrasound (EUS)
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focal air fluid levels
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sentinal loop
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calcification in R lower pelvis
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ureteral calcifiaction or appendicolith
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test of choice for dx appendicitis
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appendiceal CT following instillation of 3% colonic contrast (1/3 radiation of abdpelvic CT)
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arrowhead sign
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seen on CT in appendicitis: cecal wall thickens and lumen points toward base of appendix
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when not to do CT for ?appendicitis? What alt?
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kids, pregnant women: US
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first test for abdominal pain
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if acute abdomen, CT; if no acute abdomen, plain film; if pregnant, US;
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BE vs CT
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BE used to be emergent procedure, but now less sensitive than CT + complication risk + can't take to surg; CT PREFERRED
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small air bubble in colon (?wall) on BE study
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could be air in divertic, or air in abscess 2/2 inflam process
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test of choice for evaluating diverticuli / diverticulitis
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abd/pelvic CT (used to be BE)
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main CT findings for diverticulitis
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pericolic fat inflammation, thickened colonic wall (>4mm), ?sentinal loop, ?intramural sinus tract, ?pericolic or pelvic abscess
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what type of lung cancer most likely to form cavitary lesion?
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squamous cell carcinoma (10% cavitate)
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what does pancoast tumor look like on cxr?
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apical asymmetry
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what types of tumors cause pancoast's tumor? (2)
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squamous cell, adenocarcinoma
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initial test for screening the esophagus
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barium swallow --> endoscopy (for visualization +/- bx)
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how to evaluate extent of esophageal wall invasion?
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esophageal ultrasound (EUS)
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3 big categories of diseases that cause cavitary lesions
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1) NEOPLASM; 2) INFECTION; 3) VASCULITIS
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test of choice to dx early emphysema
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High-res CT (shows changes before PFTs and CXR)
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2 most reliable CXR findings in hyperinflation
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1) FLATTENED HEMIDIAPHRAGMS on lateral view; 2) increased RETROSTERNAL AIRSPACE also on lateral view
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causes of fibrothorax
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prior TB, prior empyema, prior asbestos exposure, prior trauma (look for rib fx)
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mcc bone infarcts
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longterm steroid use
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what to do if you see isolated perisoteal reaction?
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CXR! (concern about hypertrophic osteoarthropathy 2/2 lung cancer)
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how to w/u ? Aortic dissection
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CTA/MRA (CXR has low sensitivity), esp saggital
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how to eval ? AAA?
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plain films rarely useful; need US/CTA/MRA
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if suspect lung tumor on CXR, which comes first -- chest CT or biopsy?
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chest CT -- can spare pt biopsy if benign, or can be used to pinpoint location for bx
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difference in presentation of routine pleural effusion and subpulmonic pleural effusion
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routine: obscures hemidiaphragm; subpulmonic: apparent elevation of hemidiaphragm
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what characteristic finding with chronic aortic dissection on plain film?
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calcifications
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algorithm for ?Ao dissection
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CXR (to r/o other processes) followed by {CTA | MRA | TEE | Angiography}, CTA usu 1stline
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GEJ in achalasia vs scleroderma
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achalasia: "bird beak"; scleroderma: ==> gastric air bubble present in scleroderma, absent in achalasia
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