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112 Cards in this Set

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What is the normal gastric emptying of the stomach at 1 hour?`
> 50%

So any value < 50% is considered delayed gastric emptying
What is the normal gallbladder ejection fraction?
> 35%

Any value less than 35% or >90% (hypercontractility) indicates dysfunctional contractility
Name some causes of gallbladder contractility dysfunction
-Sludge balls
-Cholesterol polyps
-Chronic Cholecystitis
-Adenomyomatosis
What imaging modality must be used in the diagnosis of epididymitis/orchitis?
Doppler US with color flow (will show hyperemia - increased blood flow to the testes)
What discoveries did these people make?
1. Bill Reinken
2. Paul Latimer
1. X-rays (1895)

2. Developed MRI
What chest structure(s) are likely to be obscured on a CXR in a pt with a lower lobe pneumonia?
Diaphragm
What chest structure(s) are likely to be obscured on a CXR in a pt with an upper lobe pneumonia?
Borders of the heart
Most common cause of pneumoperitoneum
Recent surgical intervention
What are air bronchograms?
An Air-filled bronchus against surrounding opacified alveoli. It is indicative of an airspace process, and will not be seen when a bronchus is filled with fluid or when the opacification of the alveoli is due to obstruction (as air is resorbed).
4 Causes of airspace processes
1. Pus
2. Blood
3. Water
4. Alveolar proteinosis
A LOW density on CT scan is assoc'd with the following diseases of the liver?
Fatty infiltration

Diabetes
A HIGH density on CT scan is assoc'd with the following diseases of the liver?
Hemochromatosis

Wilson's disease
What is the significance of the portal venous confluence?
Used as a landmark to identify the pancreas on CT

It is the merging of the splenic vein with the SMV, and the pancreas lies anterior to this structure
What 2 veins merge to form the portal vein?
Superior mesenteric vein and the splenic vein
What is the cavoatrial junction?
The point at which the superior vena cava meets and merges into the superior wall of the right atrium.

**It is the ideal location for placement of a central line**

The junction will lie two vertebral body units below the carina
What is the most common complication of central line placement?
Malposition (40% of cases)

Other lesser causes include pneumothorax (5%)
On head CT, what does an acute bleed look like?

What does and "old bleed" look like?
Acute blood appears bright (can mimic IV contrast)

Old blood appears dark
Should you order a head CT with IV contrast in a pt who you suspect has a brain hemorrhage?
NO! Get a head CT w/o contrast because an acute bleed can look just like IV contrast.
On MRI, what type of image (T1 or T2) is best for looking at the following:

1. Pathology
2. Normal anatomy
1. T2 are best

2. T1 images are best
What color is CSF on T2 weighted MRI?
Bright
What is the ddx of an anterior mediastinal mass?
Thymoma
Teratoma
Thyroid mass
Terrible lymphoma
What pathogens are assoc'd with epididymitis?
Gonorrhea and chlamydia in younger men

E. coli in older men
TRUE or FALSE: A porcelin gallbladder does not place a pt a increased risk for developing carcinoma of the gallbladder.
FALSE
TRUE or FALSE: A negative KUB in a pt with suspected small bowel obstruction excludes the possibility of SBO.
FALSE. Get a CT scan if the KUB is negative but you still think the pt may have SBO.
Name the most common elbow fracture in children?

What is the most common elbow fracture in adults?
Supracondylar humerous fracture

A fracture of the radial head
What radiographic findings on x-ray would you see in a pt with suspected joint effusion of the elbow?
A positive fat pad sign (usually posterior fat pad)
TRUE or FALSE: The most common fracture of the proximal humerus occurs at the anatomical neck.
FALSE! They occur at the surgical neck.
Which imaging modality is best for identification of calcium originally seen on CXR?
A CT scan
What is the best imaging modality for a palpable thyroid nodule?
Ultrasound
What is the most serious complication assoc'd with a hydatid cyst of the liver?
Rupture of the cyst can lead to immediate anaphylaxis which can be fatal in some cases.
Contrast-induced nephropathy occurs how many days after injection with contrast media?
1-3 days
What are some risk factors for the development of contrast induced nephropathy?
-Pre-existing renal disease
-NSAIDs
-ACE inhibitors
-Multiple myeloma
How can contrast-induced nephropathy be prevented?
-Pre-hydrate the patient for 24 hrs before their imaging procedure

-Give N-acetylcystiene (Mucomyst) 24 hours prior to the study

-Give bicarbonate
What is contrast-induced nephropathy?
Acute renal failure occurring within 48 hr of exposure to intravascular radiographic contrast material that is not attributable to other causes
Which type of Aortic dissection requires surgical management:

Type A or Type B?
Type A requires surgical intervention b/c it involves the ascending aorta (can damage the 3 main branching vessels that arise off the ascending aorta)
Name the imaging modality of choice for the evaluation and dx of acute appendicitis
Abdomen CT
What are the positive abdm CT scan criteria to make a diagnosis of acute appendicitis?
-Dilated appendix
-Thickened wall of the appendix
-Fecalith/Appendicolith
-Fat stranding
What are the negative abdm CT scan criteria that would exclude the dx of acute appendicitis?
-Normal appearing appendix
-Appearance of contrast media w/in the lumen of the appendix
An acute abdominal survey provides useful diagnostic information what percentage of the time?
40%
What are valvulae conniventes?
The mucosal folds of the small intestine that extend across the entire width of the small bowel lumen.

They can be used to help distinguish small bowel from large bowel (have haustra that extend only partially across the lumen) on abdominal x-rays
What plain film findings would you see in a pt with acute appendicitis?
-Appendicolith
-Psoas sign
-Focal ileus
-Positional scoliosis (convexity moves away from the side of the abdm pain - pt leans to the left due to the abdm pain on the right side)
What is the "string of pearls" sign on an abdominal x-ray?

Why is it significant?
A row or line of several small air bubbles obliquely or horizontally oriented in the abdomen, which represents air trapped between the valvulae conniventes.

Significant b/c it is virtually diagnostic of small bowel obstruction (98% confidence)
What is Ogilvie syndrome?
An acute colonic pseudo-obstruction (ACPO), with signs, symptoms, and radiographic appearance of an acute large bowel obstruction but with no evidence of distal colonic obstruction.

The colon may become massively dilated; if not decompressed, the patient risks perforation, peritonitis, and death.
What is Rigler's sign?
AKA double wall sign

Seen on an x-ray of the abdomen when air is present on both sides of the intestine.

Usually indicates a large pneumoperitoneum (free air)
What percentage of CT scans will show a normal appendix?
80%
TRUE or FALSE:

A CT scan has greater sensitivity for the detection of free air in the abdomen compared to the acute abdominal survey?
TRUE
What is the "coffee bean" sign?
A sign on an abdominal plain film of a sigmoid volvulus.
TRUE or FALSE:

If you can see air or contrast medium in the lumen of an appendix on CT, it is obstructed and you should think of appendicitis.
FALSE! An appendix is not obstructed (therefore, no appendicitis) if you can see air (black) or contrast media (brightness) on CT scan.
TRUE or FALSE:

In appendicitis, the wall thickness is > 2mm.
TRUE
TRUE or FALSE:

In appendicitis, the diameter of the appendix is > 6-7 mm.
True
TRUE or FALSE:

Cecal apical changes and periappendiceal fat infiltration are not assoc'd with acute appendicitis.
FALSE
TRUE or FALSE:

Hyperemia of the appendix wall is assoc'd with a normal appendix.
FALSE.

Wall hyperemia is associated with appendicitis.
What percentage of appendicitis is actually located at McBurney's point?
4%
TRUE or FALSE:

CT is not an absolute contraindication in pregnancy.
TRUE

CT is not thought to be mutagenic.

If mom is in the first trimester, use non-iodinated contrast!
TRUE or FALSE:

Children born to mothers who had a CT scan during pregnancy are not at risk of developing childhood neoplasms.
FALSE! These children are at double the risk for developing childhood neoplasms.
TRUE or FALSE:

MRI is not appropriate for the dx of appendicitis.
FALSE
Name the ideal location of a newly placed endotracheal tube
>5cm above the carina (the carina is usually at the level of T4)
Where is the most common location for a malpositioned endotracheal tube?
In the right mainstem bronchus --> this can lead to right tension pneumothorax and atelectasis
What complications can arise if an endotracheal tube is malpositioned into the larynx or pharynx?
Damage to the vocal cords

Aspiration
TRUE or FALSE:
The position of an endotracheal tube is not affected by flexion or extension of the neck.
FALSE.
Flexion/extension of the neck can move the the ETT approx. 2 cm
TRUE of FALSE:

The position of a tracheostomy tube is not affected by flexion and/or extension of the neck.
TRUE
Where is the ideal intravascular location for placement of a central venous catheter
The tip should be in the SVC
Where is the most common location for a malpositioned central venous catheter?
In the right atrium --> can lead to arrhythmias
Where is the ideal intravascular location for placement of a PICC line
The tip should be in the SVC
Where is the ideal intravascular location for placement of a pulmonary artery catheter?
The tip should lie within the R or L pulmonary artery
What is the most commonly malpositioned of all lines and tubes?
Nasogastric tube --> can curl in the esophagus, enter the trachea or bronchus
The tip of a nasogastric tube should be how far into the the stomach
At least 10 cm
Name the ideal location for the tip of a feeding tube in the GI tract
The tip should be located in the duodenum
What Salter-Harris bone fracture class(es) is most likely to develop early fusion of the epiphysis and shortening of the bone?
Class IV and V
What is the Salter-Harris classification of bone fractures?
Fractures of bone that involve the epiphyseal plate alone or in combination with an adjacent part of bone
Name the Salter-Harris bone fracture classification:

A crush fracture of the epiphyseal plate
Class V
Name the Salter-Harris bone fracture classification:

Fracture through the epiphyseal plate alone
Class I
Name the Salter-Harris bone fracture classification:

Fracture through the epiphyseal plate and metaphysis
Class II
Name the Salter-Harris bone fracture classification:

Fracture through the epiphyseal plate and the epiphysis
Class III
Name the Salter-Harris bone fracture classification:

Fracture through the epiphyseal plate, metaphysis and the epiphysis
Class IV
Name this bone fracture:

Fracture of the 5th metacarpal often sustained after punching a person or wall
Boxer's fracture
Name some conditions where the cardiothoracic ratio on CXR is >50% but the heart is still normal:
-Pregnancy
-Obesity
**Portable AP films**
-Ascites
TRUE or FALSE:

Pts with gallbladder perforation are never eligible for surgery during acute disease process.
TRUE
What is the imaging modality of choice for a pt with suspected cholecystitis?
Abdominal ultrasound
What is the imaging modality of choice in non-pregnant adults with suspected appendicitis?
CT of the abdomen with IV and PO contrast
What is the imaging modality of choice in pregnant females and children with suspected appendicitis?
RLQ ultrasound
What are the CT findings in a patient with small bowel obstruction?
-Proximal to the obstruction you will see dilated loops of bowel
-Distal to the obstruction you will see collapsed bowel
-A small bowel diameter >2.5 cm
-A large bowel diameter >6 cm
- Positive feces sign
What type of force is responsible for producing metaphyseal fractures (microfractures in the subepiphyseal region) in children < 2 yrs old?
Shearing across bone ends (to and fro shaking)
TRUE of FALSE:

A dislocation of the tibia does not require immediate reduction since there is no threat of losing the limb.
FALSE! Immediate reduction for most tibial dislocation is necessary.
TRUE or FALSE:

Plain radiographs are usually of little help in the diagnosis of tibial plateau fractures or ligamentous/cartilagenous acute trauma to the knee.
TRUE. Other modalities such as MRI and CT are needed for specific diagnosis of injury and surgical planning.
Why is the cross table lateral view of the knee helpful when trying to diagnose knee/tibia fracture?
When there is an intraarticular fracture of the tibial plateau or of one of the femoral condyles, bone marrow (mostly fat) migrates from the marrow space into the joint space. With fracture, blood also escapes, and a lipohemarthrosis is produced. Fat is less dense than blood, and it layers superior to it, producing the change in radiographic density referred to as a fat-blood interface.
What is the most accurate blood test to diagnose hyperthyroidism?
TSH
In patients with carotid artery disease, what thickness of carotid blood vessel is associated with increased risk for the development of coronary artery disease?
> 2 mm thickness
What calcium score is associated with a 4 fold increase in risk from dying from an adverse CAD event with in 5 years?
Score of 1,000 or greater
TRUE or FALSE:

A CT angiogram is better at determining atherosclerotic plaque deposition.
TRUE
Where in an artery is plaque deposition most likely to occur?
-Where there is a change in caliber of blood vessel
-Where there are eddy currents and turbulence (points of bifurcation)
What 2 structures are normally calcified in the human brain?
Chroid plexus and the pineal gland
What is now believed to be the most common type of lung carcinoma in the United States?
Adenomcarcinoma
TRUE or FALSE:

If a single pulmonary nodule has remained stable over 2 years, it is less likely to be benign.
FALSE.

A nodule that has remained stable for 2 years or more is likely to be benign.
What is the imaging modality of choice for the evaluation of bone mineral density and osteoporosis?
DEXA
On DEXA scan, a T-score of -1.0 to -2.5 is indicative of what bone disease?
Low bone mass (osteopenia)
On DEXA scan, a T-score of -2.5 or lower is indicative of what bone disease?
Osteoporosis
TRUE or FALSE:

In most cases of pediatric stroke, the etiology is multifactorial.
TRUE
TRUE or FALSE:

Non-contrast head CT is the imaging modality of choice to rule out acute hemorrhage.
TRUE
What are some risk factors for the development of hip osteoarthritis?
-Increasing age
-F>M
-Obesity
What is the imaging modality of choice for the evaluation of perianal complications assoc'd with Crohn's disease?
MRI (MR enterography)
Per USPSTF recommendations, when you should you begin screening women who are at increased risk for osteoporotic fractures?
Begin at age 60
Per USPSTF recommendations, at what age should persons be screened for colon cancer with colonoscopy?
Begin at age 50 yrs old until age 75 yrs.
What is the diagnostic imaging modality of choice for the diagnosis of hyperparathyroidism?
Get a nuclear medicine study
What location(s) can implants from endometriosis be found?
Almost anywhere in the body!
CT or MRI? What imaging modality is preferred for the evaluation of the female pelvis?
MRI
A hepatocellular carcinoma will be (bright or dark) on arterial phase of a CT scan?
Bright
TRUE or FALSE:

Paget's disease of bone presents with random bone lesions.
FALSE.

Bone lesions are not random
When should you get nuclear medicine scans (Iodine-123) in pts with thyroid disease?
When you are trying to differentiate Graves dz from toxic multinodular goiter.

I-123 uptake will be homogeneous and > 50% in pts with Grave's dz
TRUE of FALSE:

Patients with a solitary kidney can receive radiocontrast media.
FALSE

Pts with a single kidney or an elevated Creatinine level should not receive contrast media
TRUE or FALSE:

Dialysis is protective in pts given gadolinium for MRI who have developed Nephrogenic Systemic Fibrosis
FALSE!!!!
Name the 4 basic tissue densities identified with x-rays
Air
Fat
Water
Bone