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28 Cards in this Set

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When is an upright chest x-ray the right answer?
An upright chest X-ray is the answer when you suspect the perforation of an abdominal organ. This can be in association with ulcer disease, penetrating trauma to the abdomen, or rupture secondary to diverticulitis, appendicitis, other infections, or iatrogenically from endoscopy.
What is a skeletal survey?
Skeletal survey is a radiographic study of the entire skeleton.
When do you answer skeletal survey?
Skeletal survey is used with the suspicion of chid abuse, multiple myeloma, and metastatic bone tumors.
What is cystography?
Cystography is the radiographic visualization of bladder filling and emptying through the urethra. This is not to be confused with cystometrics, which is a pressure measurement of the bladder useful in the evaluation of incontinence. Cystography is an evaluation of the anatomy of the urogenital system.
When do you answer cystography?
Answer cystography in evaluating the following conditions:

Trauma to the bladder
Neoplasia in and surrounding the bladder
Urinary tract infections in children: All children younger than 5 yo with a UTI; children of any age with febrile UTI; boys of any age with UTI.
When do you answer DPL?
Look for the drunk or unconscious patient ho cannot have his abdomen examined reliably with multiple trauma and unexplained shock. A catheter is inserted into the abdomen and saline is infused, aspirated, and examined.
For which patients should you not answer DPL?
The following scenarios are NOT appropriate for evaluation with DPL:
1) Patient with signs of acute abdomen. Any indication of perforated viscus or intra-abdominal bleed is an indication for immediate surgical exploration.
2) Patient with gunshot wound to the abdomen. Is indication for immediate surgical exploration.
3) Hemodynamically stable patient with history of abdominal trauma but no definite signs of viscus perforation on physical exam. Abdominal CT is indicated here.
What is the abnormality you find on DPL that makes it positive?
To be considered positive a DPL should show RBC count >100,000/mm3, WBC>500/mm3, bile, or feces.
What does DPL miss?
DPL is inadequate to diagnose retroperitoneal injuries.
What is DPL?
Diagnostic Peritoneal Lavage
For which clinical condition would you answer Intravenous Pyelogram?
Intravenous pyelogram (IVP) is an old test of virtually no clinical utility and is almost always a wrong answer. In an IVP, intravenous contrast is injected and multiple X-rays are taken to look for radiographic visualization of the renal infrastructure (calices, pelvis, and ureter). This makes the test slow. It was used in the evaluation of a patient with renal colic when no stones were found on radiograph.
What is the most accurate test?
The IVP has been replaced by the renal ultrasound as the best initial test and the CT scan as the most accurate test. If an untrasound or CT scan is in the answer, then the IVP is never correct. The IVP uses contrast, which has a risk of both renal failure and allergic reaction. The CT scan is much faster, is more sensitive, and does not use contrast when looking for stones.
What is Pelvic Laparoscopy?
Pelvic laparoscopy is sed for direct visualization of pelvic structures adn is the most accurate test in the following conditions:
1) Ectopic pregnancy
2) Pelvic inflammatory disease
3) Endometriosis
4) Pelvic cyst
5) Chronic pelvic pain
When do you answer pelvic laparoscopy?
Answer pelvic laparoscopy when you see a woman who presents with pelvic pain, vaginal bleeding, and a positive BetahCG. This is particularly true if the level of BhCG is low for the estimated gestational age.

Answer pelvic laparoscopy when you are shown a case of lower abdominal pain in a woman treated for plvic inflammatory disease with an incomplete response in whom pregnancy is excluded.
What is Diagnostic Abdominal Laparoscopy (DAL)?
Diagnostic abdominal laparoscopy (DAL) is used for direct visualization of abdominal structures in the following conditions:

Ascites of unclear etiology
Liver disease with an inconclusive biopsy
Staging of abdominal cancer
When do you answer DAL?
In a trauma patient:

This modality may be used in stable patients as a less invasive alternative to laparotomy. DAL is especially useful in investigating injuries to the diaphragm.

Look for a case of a victim of a motor vehicle accident in whom the abdominal CT scan is nondiagnostic and organ damage is suspected.
What tests does prenatal screening include?
Basic prenatal screening is appropriate in ALL pregnancies. These tests include:

Cervical cytology
CBC
Urinalysis
Blood group, RH factor, and antibody
Serology for syphilis
Rubella antibody
Glucose screening
Fetal ultrasound
Cervical culture for Neisseria, GBS, and chlamydia
Which tests are specifically appropriate for high-risk pregnancies or mothers over 35?
In a woman over 35, and answer chromosomal screening for fetal abnormalities.
For which clinical conditions is renal US commonly used?
Renal US is the best initial test for:
Kidney stones
Congenital renal malformations
Pediatric tumors
Recurrent UTIs
Chronic renal failure
Renal artery stenosis
Polycystic Kidney disease
When do you answer renal US?
Answer renal US wehn you see a patient with unexplained hematuria of flank pain and tenderness.

Answer renal US when you see a patient with dysuric symptoms such as frequency and burning, the urinalysis has white blood cells, and there is flank pain.
For which clinical scenarios is RUQ US the right answer?
Right upper quadrant ultrasound is the answer when the patient presents with RUQ pain, with or without fever. The US will evaluate hepatobiliary structures for the following diseases:
Liver Pathology
Gallbladder and biliary tree
What is the most accurate test?
The most accurate test for
What if the patient experiences pronounced tenderness when performing the RUQ US?
If there is tenderness when the transducer presses against the abdomen, this is a positibe Murphy's sign. This is highly suggestive of acute cholecystitis.
What abnormalities do Skull X-rays detect?
Skull x rays can detect fractures of the skull. They can also detect lytic and blastic lesions such as form bony metastases or Paget's disease.
What do skull x rays miss?
Skull x rays are incapable of detecting intracranial bleeding. They provide no information on brain or cerebral structure.
When the patient has been hit in the head, when are skull x rays the right answer?
For a patient who has experienced head trauma, skull x rays are always the wrong answer. When there is a head trauma case, skull x-rays may be in the answer, but do NOT choose them.
When do you answer Pelvic US?
Pelvic US is indicated in the following scenarios:

Pelvic or lower abdominal pain with amenorrhea or vaginal bleeding.
Suspected pregnancy
Suspected ectopic pregnancy
When do you answer Transvaginal US?
Transvaginal US is superior to transpelvic US in:

Placenta previa (painless vaginal bleeding in teh third trimester)
Fetal monitoring in the first trimester
Obese women in examining pelvic anatomy.