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295 Cards in this Set
- Front
- Back
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composed of live motion images viewed on a TV monitor
when may this be used? |
fluoroscopy
cardiac cath |
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digitizes an image received from a scan and back-projects the image through algorithms
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CT
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radioisotopes are used for imaging
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nuclear medicine
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uses magnetic forces for imaging
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MRI
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uses high frequency sound waves to visualize anatomy
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U/S
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how many views do you want to get for standard radiographic studies?
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at least 2, 90 degrees apart
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normal views for chest x-rays
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PA and lateral
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views for x-ray of ribs
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AP, oblique, PA
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normal views for skull x-rays
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PA, R/L lateral, Water's view
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most appropriate imaging study for sinusitis
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CT
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most appropriate imaging study to assess the TMJ
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MRI
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what view do you add to x-ray of C-spine when there is trauma?
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open-mouth view
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best way to clear all cervical vertebrae
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CT
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what should be included in an X-ray of long bones?
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the joint above and below the bone
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13 images of whole body; used for pts w/ metastatic disease and/or MM
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bone survey
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erect AP and lateral views of entire spine on a long cassette are used for dx of what?
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scoliosis
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what is KUB flat-plate used for?
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abdominal x-ray to check for bowel obstruction and/or peritoneal free air
KUB = kidneys, ureters, bladder |
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contrast agents used to increase organ density and improve visualization
give examples |
positive contrast agents
iodine and barium |
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contrast agents used to decrease organ density to produce contrast
give examples |
negative contrast agents
room air and CO2 |
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the following should be checked prior to administration of this:
allergies to shellfish, previous hx of contrast reaction, hx of asthma, and baseline renal function |
iodinated contrast media
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IVP uses this contrast material
IVP has been mostly replaced by this |
iodine
CT |
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never use this if there is the possibility of perforation b/c it may cause severe peritonitis
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barium sulfate
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when is gastrograffin used?
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when perforation is suspected, in place of barium sulfate
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evaluation of esophagus, stomach, and first portion of small bowel using orally administered barium sulfate
how long do pts have to be NPO? |
upper GI study
eight hours prior |
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progress of barium is tracked through the alimentary canal every 30 minutes with "spot" films
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small bowel study
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contrast study of the large intestine
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barium enema
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this study uses IV gadolinium
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MRI
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this study uses oral and/or IV contrast
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CT
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bat-wing appearance
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pulmonary edema
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displacement of the costophrenic angle, producing increased lucency there
what is this seen in? |
deep sulcus sign
PTX |
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PTX with mediastinal shift
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tension pneumo
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what is the best x-ray view for seeing free intraperitoneal air in acute abdominal pain?
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erect PA CXR
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valvulae conniventes vs. haustra
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valvulae conniventes - small bowel, rings go all the way around
haustra - large bowel, rings don't go all the way around |
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are compression fx stable or unstable?
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stable
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what is associated with burst fx?
are these stable or unstable? |
posterior elements of the vertebra break off and compress the cord --> retropulsion of fx fragments
unstable |
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what do the loops of bowel proximal to an obstruction look like? what about the loops distal to the obstruction?
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proximal - dilated with air or fluid
distal - eventually will become decompressed or airless |
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pneumonia
CHF (pulm edema or pleural effusion) trauma (rib fx, PTX) hospital/ICU pts (lines and tubes) |
indications for CXR
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trauma (fx or dislocation)
chronic pain (pathologic fx, degenerative disease, OA) |
indications for bone x-rays
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acute abdominal pain (free retroperitoneal air, bowel obstruction/adynamic ileus)
hospital patients (check tube position, post-op SBO or ileus) |
indications for abdominal x-rays
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RUQ pain (gall stones/cholecystitis)
cirrhosis (ascites, portal vein thrombosis, liver masses) abnl LFTs (fatty liver, biliary obstruction) |
indications for abdominal U/S
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elevated creat
decreased urinary output (hydronephrosis, bladder outlet obstruction) renal cysts seen on CT or MRI renal transplant w/ elevated creat (peritransplant fluid collection, rejection) |
indications for renal U/S
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dilatation of collecting system and caliceal blunting is consistent with...
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hydronephrosis
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acute lower extremity edema (acute DVT)
chronic lower extremity edema (chronic DVT) |
indications for lower extremity U/S
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venous mapping for dialysis graft/AVF planning
upper extremity DVT |
indications for upper extremity U/S
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2 most common uses of U/S
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gall stones
abnormal LFTs |
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Hounesfield unit (HU)
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reference for quantifying the brightness of different types of tissues on CT
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window width =
window level = |
width - contrast
level - brightness |
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pt and table move continuously through the scanner in the z direction while the gantry performs multiple 360 degree rotations in the same direction; then individual slices are reconstructed in the axial plane from a large volume of data using interpolation techniques
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helical (spiral) CT
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the advantages of this modality is that there are short scan times, complete coverage of organs in a single breath, less motion artifact, and less radiation
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helical CT
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trauma (mediastinal injury, pulm contusion, PTX)
PE hemoptysis (bronchogenic CA) |
indications for a chest CT
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RLQ pain (appendicitis)
LLQ pain and rectal bleeding (diverticulitis) N/V/abdominal distension (SBO, acute pancreatitis) trauma (liver, spleen, adrenal, pancreatic, mesenteric, kidney, or bladder injury, vertebral, rib, or pelvic fx) |
indications for abdominal/pelvic CT
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air in GB wall
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emphysematous cholecystitis
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specialized software is used to create images from post-processing of contrast-enhanced axial CT images; fast helical CT scanner is needed for 3D reconstructions
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CT angiography and CT 3D reconstructions
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advantages:
provide intra- and extraluminal info non-invasive quick |
coronary CT angiography (CTA)
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4 keys to success for CCTA
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1. pt's HR <65 bpm
2. breath-hold capacity of at least 15 s 3. ability to follow breathing instructions 4. use of test bolus or bolus tracking to enable scanning during peak enhancement of coronaries after injection of IV contrast |
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maximum intensity projection (MIP) images are seen in what modality
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CCTA
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growth characterized by 3 types of tissue: fat, soft tissue, and calcification
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teratoma
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- evaluation of liver, pancreas, kidney, or adrenal mass in a patient who cannot have CT w/ contrast
- further evaluate difficult CT cases - MRCP to evaluate biliary or pancreatic duct stenosis/stones w/o risks of ERCP - great vessels, renal, and iliac arteries as alternative to CTA |
abdominal MRI
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bended appearance of pancreatic duct is consistent with...
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chronic pancreatitis
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5 densities that can be discerned by X-ray
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metal
bone/calcium soft tissue air fat |
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is the standard chest CT protocol with or without contrast?
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with
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what modality do you need to differentate b/c pleural effusion and consolidation?
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chest CT
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which is better at density differentiation, X-ray or CT?
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CT
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what would you get to evaluate whether a finding is a complex cyst vs. a solid mass?
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pre- and post-contrast CTs
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what is used to evaluate interstitial lung disease like fibrosis, bronchiectasis, and septa thickening?
it is not used for detecting pulm nodules |
HRCT chest w/o contrast
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what is used to evaluate heart and vessel size, but no the lumen of the vessels? it is also good for identifying nodules, infiltrates, and effusions in the lungs
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standard protocol CT chest w/o contrast
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what is used for evaluation of PE or aortic dissection?
it is also the default study for the chest b/c has better evaluation of the mediastinum |
CT chest w/ contrast
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this can be used to exclude PE if patient cannot have CTA
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VQ scan
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when would an US be used in the evaluation of the lungs?
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pleural effusion b/c it picks up liquid
often used when thoracentesis is performed with imaging |
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what might an MRI be used for in the evaluation of the chest?
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lung parenchyma
heart aorta |
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on MRI of aortic dissection, how do you differentiate b/w the true and false lumen?
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true - brighter
false - darker |
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this modality measures metabolic activity and is used to evaluate solitary pulm nodules or mets
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PET scan
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interstitial or airspace disease:
1. fluffy or patchy 2. indistinct margins 3. air bronchograms |
airspace disease
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interstitial or airspace disease:
1. linear 2. nodular 3. more discrete |
interstitial lung disease
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interstitial or airspace disease:
1. pneumonia 2. CHF/pulmonary edema 3. aspiration 4. hemorrhage/contusion |
airspace disease
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interstitial or airspace disease:
1. pulm fibrosis 2. bronchiectasis 3. asbestosis 4. malignancy (primary or mets) |
interstitial lung disease
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visibility of air in the bronchus b/c of surrounding airspace disease
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air bronchogram
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5 technical factors for chest X-ray
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1. penetration
2. inspiration 3. rotation 4. magnification 5. angulation |
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this can cause the heart to appear larger and pulmonary markings to be more prominent, especially at the lung bases, which can be mistaken for an infiltrate
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underinspiratoin
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overpenetration or underpenetration:
hides nodules, infiltrates, and lung markings |
overpenetration
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overpenetration or underpenetration:
lung markings more prominent, increased density over lung fields |
underpenetration
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where are the lung markings usually greater?
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hila and at the bases
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flattened diaphragm often seen in...
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emphysema
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calcified plate-like structures in the lungs is seen in...
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asbestosis
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in most cases with chest compaints, what do you start with?
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CXR
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most common CXR finding on person with PE
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negative CXR
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when ordering a test, should you use R/O or sx?
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sx
sx and then r/o |
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most significant cause of radiation in the US
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CTs
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in fx, how do you report the angulation?
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the distal bone fragment in relation to the proximal one
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when fx lines are hazy, what does this suggest?
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there was a previous lytic lesion --> the fx is a pathologic fx
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bone marrow suppression, GI syndrome, and neurovascular syndrome
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acute radiation syndrome
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ataxia, tachycardia, tremor, hyperreflexia, and non-specific sx
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chronic radiation syndrome
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decreased mental capacity, growth retardation, and risk of leukemias
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fetal radiation effects
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when is the fetus at highest risk for effects from radiation?
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1st trimester, not counting the 1st 2 weeks
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at what dose of radiation is there significant risk to the fetus
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20-25 rad
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what should be done about breastfeeding if given iodinated contrast material?
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d/c breastfeeding for 24 hrs after admin of the iodine
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is gadolinium okay during pregnancy?
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NO
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predictive value of prior contrast reaction for IV and IA
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IV: 7% IA: 12-15%
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what is the premedication protocol for contrast reactions?
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methylprednisone 32 mg PO 12 hrs and 1 hr before study; if there was a moderate-severe reaction, can add H1-blocker, and H2 blocker if you want)
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what to give if there is a moderate-severe contrast reaction
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O2 facemask, Benadryl for hives, Albuterol for wheezing; epi is next step
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most important thing to do when there is contrast extravasation
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raise the extremity to reduce swelling
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underlying renal dysfunction (GFR <30), dehydration, DM nephropathy, compromised renal perfusion are risk factors for…
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CIN
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what is useful to preventing CIN?
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hydration (NS or sodium bicarb) with nAC (a free-radical scavenger that causes vasodilation)
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which drug should patients be taken off of after given contrast material?
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metformin
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which modality can be used in pregnancy?
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MRI w/o contrast
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use of this contrast media is linked to NSF/NSD in pts with renal failure
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gadolinium
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characterized by tight, rigid skin that renders bending of the joints difficult and fibrosis that may head to multi-organ failure and death
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NSF/NSD
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dx, tx, and prognosis of NSF/NSD
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diagnosis by deep skin bx; no known tx; prognosis usually not life-threatening, but not reversible
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what is 18-FDG and what is it used for?
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glucose analog, used for PET scans
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used to differentiate b/c recurrent brain tumor and radiation necrosis; used to diff b/w primary CNS lymphoma and toxoplasmosis; excludes brain mets
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PET scan
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only 2 times a CT colonography should be used in place of a conventional colonoscopy
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1. failed colonoscopy
2. pt is on anticoagulation and has risk of hemorrhage |
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most important structures to look for in neuroradiology
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midline structures (corpus callosum, pituitary, brainstem - midbrain, pons, and medulla)
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CT or MRI?
1. SAH 2. head trauma 3. acute stroke 4. masses 5. aneurysms |
1. SAH - CT
2. head trauma - non-contrast CT 3. stroke - CT 4. masses - MRI 5. aneurysms - either, but CT 1st |
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study of choice for brain bleeds
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non-contrast CT
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what does blood look like on CT:
acute subacute chronic |
acute (<3 days) - hyperdense (bright)
subacute (3-14 days) - isodense w/ peripheral enhancement chronic (>14 days) - hypodense (darker) |
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blood outside of the brain parenchyma (3 kinds)
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extra-axial hemorrhage:
1. SAH 2. epidural hematoma 3. SDH |
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most common cause of SAD
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aneurysm
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hyperdense CSF in Sylvian fissures or basal cisterns
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SAH
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bleeds associated with skull fx; neurosurgical emergencies
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epidural hematoma
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bleeds not associated with skull fx; cannot cross the midline
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SDH
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which artery is usually disrupted in an EDH?
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middle meningeal artery
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do EDHs cross the falx or tentorium? what about cranial suture line?
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yes to falx/tentorium
no to suture lines |
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bleeds associated with hydrocephalus
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SAH and IVH
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positive Horton sign
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patient is intubated --> probably will find something
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80% of these bleeds aer associated with abuse in infants
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SDH
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bleeds caused by tearing of bridging cortical veins
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SDH
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EDH vs. SDH vs. SAH
arterial bleed or venous bleed? |
EDH - arterial
SDH - venous SAH - arterial (aneurysms) |
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EDH vs. SDH
lens-shaped or crescent shaped? |
EDH - lens/biconcave
SDH - crescent |
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blood within the brain parenchyma and ventricles (3 types)
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intra-axial hemorrhage
1. cortical contusion 2. intraventricular hemorrhage 3. diffuse axonal injury (DAI) |
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round well-circumscribed hyperdense areas within cortical grey matter, caused by brain impacting on cranial bone; usually located in anterior or middle cranial fossae
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cortical contusion
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hyperdense material layered dependently within the ventricles, resulting from tearing of subependymal veins or from parenchymal hematoma
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intraventricular hemorrhage (IVH)
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bleeds caused by shearing forces from rapid acceleration/deceleration MVAs; LOC at time of injury; usually at grey matter/white matter junction, corpus callosum, or brainstem; best seen on T2 weighted images
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diffuse axonal injury
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stroke often caused by ruptured atherosclerotic plaques; common in carotid, vertebral, and basilar aa.; 60% of all strokes
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thrombotic infarctions
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caused by occlusion of small vessel penetrating arteries; account for 20% of all strokes and 30% of thrombotic strokes
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lacunar infarctions
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most common etiology of lacunar infarctions
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HTN
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account for 20% of strokes; can have cardiac or arterial origin
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embolic infarctions
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strokes associated with a drop in BP during surgical procedures; may cause bilateral sx
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watershed infarctions
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how much of CO does the brain require?
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15-20%
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when does irreversible ischemia occur?
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blood flow rates <18 ml/100 mg/minute
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face and arm > leg weakness
left: motor aphasia (ant) or receptive aphasia (post) right: visulospatial dysfunction |
MCA stroke
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leg weakness -- stroke in which artery?
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ACA
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hemianopsia or cortical blindness occur with stroke of which artery
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PCA
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initial imaging for a stroke
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non-contrast CT
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occurs 1-2 wks post-infarction and appears as a serpiginous line of blood with gyriform pattern
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hemorrhagic transformation --> petechial hemorrhage
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subtle blurring of gray-white layers of the insular cortex
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insular ribbon sign
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what is cytotoxic edema and what does it look like on CT?
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areas of irreversible ischemia
hypodense |
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T1 weighted MRI
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things look the way they are supposed to
gray matter looks gray, white matter is brighter |
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T2 weighted MRI
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CSF and water are bright (so ventricles are bright)
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in brain MRI, restricted diffusion corresponds to ______ within ______ of sx onset
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areas of ischemia
1 hour |
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abnormal high T2 signal on T2 weighted and FLAIR sequences corresponds to...
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areas of cytotoxic edema --> irreversible ischemia
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study of choice in identifying diffuse axonal injury
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MRI
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provides rapid quantitative info about cerebral blood flow; estimates/predicts the size of the infarcted tissue and the size of the ischemic tissue
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perfusion imaging
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what patient factor is important in the diff dx of brain lesions?
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age
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most aggressive glioma with the worst prognosis; most commonly found in the temporal and frontal lobes
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glioblastoma multiforme
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T1 or T2 or Flair
ventricles are white ventricles are black pathology is very bright |
T1 - ventricles are black
T2 - ventircles are white Flair - pathology is bright |
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JPA
medulloblastoma ependymoma pontine glioma |
posterior fossa masses in children
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Ependymoma
Astrocytoma Colloid cyst Meningioma Choroid plexus papilloma Arachnoid cyst Sub-ependymoma Central neurocytoma |
intraventricular masses
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< 15 yo: ependymoma and medulloblastoma
15-30 yo: choroid plexus papilloma >30 yo: mets, hemangioblastoma, meningioma |
4th ventricular masses
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what size does an adenoma have to be to be considered a macroadenoma?
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> 1cm
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do macroadenomas generally secrete hormones?
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not usually
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S – sellar lesions/sarcoidosis
A – aneurysm/arachnoid cyst T – teratoid lesions - dermoid/epidermoid C – craniopharyngioma H – hypothalamic glioma/hamartoma M – mets/meningioma O – other – optic nerve glioma/LCH |
suprasellar masses
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ring-enhancing lesions (MAGICDR)
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M - metastasis
A - abcess G - glioma I - infarct C - contusion D - demyelinating dz R - resolving hematoma |
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cystic components look what on T2?
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bright
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melanoma looks ______ on T2 and ______ on T1
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dark on T2
bright on T1 this is unusual |
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Hemorrhage - methemoglobin
Melanin – melanoma Fat - dermoid Very high protein– colloid cyst Gadolinium Certain states of calcium |
T1 bright lesions
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main modality for abdominal pain
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CT
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air in the wall of the bowel, rather than the lumen
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pneumatosis
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3 things that can be seen on abdominal plain film
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1. air (presence/absence/amt/location)
2. calcium, FBs, tubes, devices 3. soft tissue (not much differentiation) |
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where are air-fluid levels usually seen on abdominal plain film?
is air found in each of these places or no? |
stomach (gastric bubble)
2-3 loops of small bowel very few or none in colon Yes, air itself is found in each of the above location |
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double contrast studies use these 2 things
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air and barium
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appearance of the proximal and distal small bowel in a small bowel series
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proximal - feathery
distal (transition from jejunum to ileum) - solid column |
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what modality for acute appendicitis?
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CT with IV contrast
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how should contrast be administered when evaluating the bowel?
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oral contrast
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what should you look for if you can't find the appendix?
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the ileocecal valve
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3 primary responses of the bowel to disease processes
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1. thickening
2. dilating 3. narrowing |
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short segment vs. long segment thickening
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diverticulitis vs. colitis
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dilated small bowel only vs. dilated large and small bowel
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SBO vs. ileus
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what tests would you order for a 30 pack yr patient with dysphagia?
|
fluoroscopy, UGI, esophagram
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proximal dilated, distal flattened
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obstruction
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entire bowel is usually air-containing and dilated in...
(usually caused by surgery) |
adynamic ileus
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absence of air in the colon and rectum is found in...
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SBO
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this can be found when there is bowel ischemia/necrosis
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pneumatosis
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ability to see both sides of the bowel wall on x-ray; a sign of free intraperitoneal air
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Rigler's sign
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when suspecting free air, what test should be done?
|
erect abdominal or chest x-ray
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what does it mean if you can see the falciform ligament on abd x-ray?
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free intraperitoneal air
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if an upright chest film cannot be used to visualize free air, what should you get?
|
left lateral decubitus view
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if coffee bean sign is seen on abdominal plain film, what do you do next?
|
confirm with barium enema - worried about sigmoid volvulus
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study of choice in diagnosing bronchiectasis
|
HRCT
|
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2 modalities for evaluation of GB/cholecystitis
|
HIDA - patency of ducts
U/S - stones, GB wall thickening, sonographic Murphy's sign |
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in fluoroscopic/contrast studies of the GB, would a stone look bright or dark?
|
dark - there area that doesn't fill is dark
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modalities for evaluation of liver, spleen, and pancreas
|
U/S
MRI - w/ + w/o contrast CT - contrast or w/ and w/o contrast; avoid using only w/o contrast |
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what is the most sensitive modality for hepatocellular carcinoma in a cirrhotic pt
|
MRI
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dx:
US - echogenic (bright) MRI/CT - peripheral puddling of contrast which fills in on more delayed post-contrast images |
hemangioma
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nodular liver surface, shrunken liver, ascites, caudate lobe hypertrophy, recanalized umbilical vein, and irregular enhancement
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cirrhosis and portal HTN
|
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hematuria protocol
|
CT w/ (masses) and w/o contrast (stones)
|
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what modality would you use to check for hydronephrosis?
|
U/S
|
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enlarged kidney with wedge-shaped areas of low attenuation, perinephric strnading
|
pyelonephritis
|
|
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what does emphysematous pyelo look like on U/S? CT?
|
U/S - air is white
CT - air is black |
|
|
in kidney: area that doesn't enhance as well (darker gray) and a focal area that is dark
can be a complication of pyelo |
renal abscess
|
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do you want contrast or noncontrast for imaging a laceration?
|
contrast
|
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|
simple cysts - enhance or no?
complex cysts - enhance or no? |
simple - fluid-filled, don't enhance
complex - enhance (Type III or IV on Bosniak scale) |
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Tx for Bosniak Scale
Type I Type II Type III Type IV |
I - do nothing, simple cyst
II - f/u CT or U/S III - bx or partial nephrectomy, enhancing IV - surgical removal, malignant/solid mass |
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modality if concerned about complex cyst vs. mass
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noncontrast CT + contrast CT
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what does cancer look like on IVP?
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black - filling defect
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modality of choice for ruptured bladder
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CT cystogram
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fibrous membrane covering outer surface of bone except joint surfaces
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periosteum
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shaft-like portion of bone
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diaphysis
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between diaphysis and growth plate; portion of bone that flares out
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metaphysis
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growth plate; seals when you’re an adult, has the potential to not seal at all
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physis
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ends of bones
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epiphysis
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hollow tube-like structure within the diaphysis of a bone
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medullary (marrow)
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inner membrane lining the medullary cavity
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endosteum
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categories of disease in bone (TIC MTV)
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trauma, infx, congenital, metabolic, tumor, vascular
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gold standard modality for bone tumors
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x-rays
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gold standard modality for imaging joints
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MRI
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complete vs. incomplete fx
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complete - broken completely through
incomplete - portion of the cortex remains intact |
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incomplete fx w/ the opposite cortex still intact - found in soft bones of children
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greenstick fx
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buckle fx - one cortex is intact with buckling or compaction of the opposite cortex
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torus fx
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fx that runs at right angle to long axis of bone; usually from a direct blow or pathologic fracture
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transverse fx
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fx that runs approximately 45° axis to long bone; caused by angulation and compression forces
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oblique fx
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more that 2 fx
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comminuted
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comminuted fx in which a triangular fragment of cortical bone detached from 2 other larger fragments
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butterfly fragment
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fragment of bone is detached both proximally and distally (completely separated)
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segmental fx
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separation of bone fragments (medial or lateral)
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displacement
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compaction of bone trabeculae resulting in decreased length or width of bone; common in spine
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compression fx
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portions of fracture fragment driven inward; common in skull and tibia
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depressed fx
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abnormal stress to normal bone causing fx; common in metatarsal bones in runners
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fatigue fx (stress fx)
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normal stress to abnormal bone causing fx
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insufficiency fx
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OP, osteomyelitis, and tumors can cause these fx
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insufficiency fx
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disruption of articulation so bones are no longer in contact
partial loss of articulation |
dislocation
subluxation |
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increased distance b/w bone fragments
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distraction
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shoulder and hip dislocations: anterior or posterior more common?
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shoulder - anterior
hip - posterior |
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hint that there is anterior shoulder dislocation
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head of humerus is inferior to the glenoid fossa
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avascular necrosis is a complication of...
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scaphoid fx
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transverse fracture of distal radius with dorsal angulation often with associated fracture of ulnar styloid usually fall on outstretched hand
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Colles' fx
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transverse fx of head of fifth metacarpal with palmar angulation of distal fragment
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Boxer's fx
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posterior fat pad sign =
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radial head fx at the elbow
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how does fat pad appear on x-ray
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lucency around the joint
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Fracture involving bone and overlying cartilage (at the surface); common at distal femoral condyle, talar dome in ankle
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osteochondral injury
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osteochondral injury at lateral aspect of medial femoral condyle
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osteochondritis dessicans
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which 3 views should be used in c-spine x-ray
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frontal, lateral, and open-mouth; all 7 vertebrae and T1 should be visible
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comminuted fracture of atlas(C1); burst fracture
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Jefferson's fx
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result of acute hyperextension of the head or neck with fracture of the arch of C2 anterior to the inferior facet and is usually associated with anterior subluxation of C2 on C3
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Hangman's fx
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avulsion fracture of a spinous process in the lower cervical or upper thoracic spine
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clay-shoveler's fx
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aka Chance fracture; transverse fracture of a lumbar vertebra associated with visceral injury
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seatbelt fx
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epiphyseal plate injuries in children
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Salter-Harris fx
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Salter-Harris:
Type I Type II Type III Type IV Type V |
I - straight through epiphyseal plate
II - fx in plate and metaphysis III - fx of plate and epiphysis IV - plate, metaphysis, and epiphysis V - crush fx of plate |
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which Salter-Harris fx is the most common?
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Type II
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Corner fx are very specific for...
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child abuse fx
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periosteal reaction
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thickening of periosteum may signify healing of previous fx
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poorly formed bone, multiple fx, blue color to sclera, wormian bones, OP
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osteogenesis imperfecta
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rare hereditary bone dysplasia resulting in failure of resorptive mechanism of calcified cartilage; increased bone density causes it to become brittle
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osteopetrosis
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defect in pars interarticularis of vertebrae
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spondylolysis
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slippage of one vertebra on another
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spondylolisthesis
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Slow growing benign cartilaginous tumor arising in medullary canal; central lucent lesion w/ calcification in matrix
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enchondroma
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lytic lesion at end of bone after epiphyseal closure
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giant cell tumor
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bone-forming bone tumor
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osteoid osteoma
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ground-glass; proliferation of fibrous tissue; bowing of bones occurs
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fibrous dysplasia
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solitary, sharply defined area of dense compact bone commonly seen in pelvis and femur
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bone island
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malignant bone tumor usually at ends of long bones esp the knee; common in 2nd decade of life
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osteosarcoma
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malignant bone tumor of cartilaginous origin; 30-40 yo
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chondrosarcoma
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malignant bone tumor usually mid teens arising in bone marrow
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Ewing's sarcoma
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best screening tool for bone mets
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nuclear medicine scan
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iron kettle - most common bone mets
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Prostate (blastic*)
Brain (blastic* or lytic) Kidney (lytic) Thyroid (lytic) Lung |
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loss of articular cartilage, narrowing of joint spaces, osteophytes
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OA
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spares the DIP joints
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RA
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erosions...RA or OA?
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RA
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what do you start with if suspecting osteomyelitis? how do you confirm?
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start - X-ray
confirm - MRI |
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destruction of the cortex under the wound is the hallmark of...
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osteomyelitis
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most frequent site of avascular necrosis
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femoral head
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1st sign of avascular necrosis
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lucent line
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gold standard for evaluating avascular necrosis
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MRI
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placements:
ETT tracheostomy tube Swan-Ganz catheters NG tube |
3-5 cm above carina
level of T3 2 cm from hilum 10 cm past EG junction |
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in U/S, with increased frequency, you have ________ resolution and ________ depth
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increased res
decreased depth |
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normal diameter of abdominal aorta
normal diameter of common bile duct and appendix normal thickness of GB wall normal measurements for pancreatic head, body, and tail normal size of follicle in ovary head of epididymis |
2-3 cm
6 mm 2 mm head: 3.5 cm, body: 2.5 cm, tail: 2 cm 2 cm (anything bigger, think cyst) <1.2 cm |
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Morrison's patch is b/w what 2 structures?
what's the significance? |
liver and right kidney
2nd most vulnerable portion of the peritoneal cavity |
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most vulnerable portion of the peritoneal cavity
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cul-de-sac (rectovesicular space)
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what will abscesses look like on U/S?
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heterogeneous b/c of fluid and infectious/necrotic debris
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positive pregnancy test but no gestational sac in the uterus
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possible ectopic
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1. See echogenic clot instead of black lumen of blood
2. vein does not compress completely when tech presses on vein 3. Lack of phasic flow |
signs of DVT
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calcifications in posterior popliteal space
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Baker's cyst
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BI-RADS Codes: 1, 2, 3, 4, 5, 0
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1 - negative/normal; annual
2 - benign finding; annual 3 - probably benign; need short-term f/u 4 - suspicious abnormality; bx or US 5 - highly suggestive of malignancy 0 - incomplete/indeterminate |
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what happens to the density of the breast as a woman ages?
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density decreases, making mammography more sensitive in older age groups
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3 reasons for U/S of breast
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1. palpable mass
2. lesion detected on mammogram 3. implants |
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if something is lucent on mammography, benign or malignant?
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usually benign
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4 things that make you suspicious for breast CA
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1. mass
2. calcifications 3. skin thickening 4. retraction |
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smooth non-lobulated breast lesion that is negative on US...what code?
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code 3
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peau d'orange skin thickening
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inflammatory carcinoma of the breast
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CAD in mammography
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points out things you may not have seen
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use this modality for breast screening for:
evaluating extent of malignancy evaluating contralateral breast screening high-risk pts |
MRI
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if mammogram and US are negative but the patient has a palpable mass, what should be done?
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surgical consult
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where is thoracentesis needle placed
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above the lower rib to avoid VAN
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kind of biopsy used for liver bx, focal tumor lesion bx, abscess drainage
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CT-guided bx
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examples of short-term, mid-term, and long-term IV catheters
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short-term - standard or butterfly needle
mid-term - mid-line, PICC long-term - Hickman, Groshong |
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this must be used for TPN
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PICC
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