Term
| 5 factors affecting x-ray images |
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Definition
1) Thickness of body part
2) Motion
3) Scatter
4) Magnification
5) Distortion |
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Term
| Most common types of x-ray procedures |
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Definition
| Plain films are the most; examples include: chest x-ray, plain films of abdomen, and skeletal system |
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Term
| Indications of fluoroscopy |
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Definition
| watching real-time motion |
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Term
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Definition
1) Computed Tomography CT
2) Positron Emission Tomography PET |
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Term
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Definition
| Indications - evaulation of internal organs, injuries, masses, and suspected tumors |
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Term
| Indications for a nuclear medicine study |
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Definition
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Term
| Indications for ultrasound study |
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Definition
| View organs and evaluate motion |
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Term
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Definition
1) Determine age, sex and history
2) What type of film ex.AP,PA,portable or lateral
3.What position of patient Upright, supine, or decubitus
4) Is there GOOD inspiratory effort
5) Indentify structures and abnormalities ex. Heart size and shape, Mediastinal contours, Airway, lung symmetry, Hilar contours, Lung infiltrates, Hemidiaphragms, Pleural effusions, Bone abnormalities, Tubes and wires
6) Recheck "Blind spots"
7) Check old films for any changes
8) Decide what your findings are and a differnital diagnosis. |
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Term
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Definition
| Air bronchograms are seen with alveolar processes |
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Term
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Definition
Gastric contents or other objects can be aspirated into the lungs.
Shors as a alveolar infiltrate - same as any other bacterial pneumonia. |
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Term
| Community Acquired Pneumonia |
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Definition
Pneumonias that are intersitial and symmetrically diffuse in both lungs
Most likely cause is a mycoplasmal infection. |
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Term
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Definition
Enlargement of the Hilar or mediastinal lymph nodes
Primary TB presents as a focal middle or lower lobe consolidation |
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Term
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Definition
| Infiltrates are in the posterior segments of upper lobes and superior segments of the lower lobes |
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Term
| Adult Respiratory Distress Syndrome |
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Definition
| Capillaries are "leaky" and fluid shifts into the lungs from the blood supply through the capillaries - alveolar infiltrates |
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Term
| 3 steps in evaluating a solitary pulmonary nodule. |
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Definition
- Location of nodule
- Characteristics
- Age of nodule |
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Term
| What are the signs that a nodule may be malignant |
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Definition
- Malignant Nodule
- Greater than 3 cm
- Not calcified
- Irregular shape, poorly defined borders
- Cavitated
- Growth in past 2 yrs |
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Term
| How is a definitive diagnosis of lung cancer usually made. |
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Definition
| Definitive diagnosis usually made by bronchoscopy |
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Term
| Indications for a CT scan when evaluating a lung mass |
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Definition
- New or larger lesion when compared to previous films
- Size greater than 3 cm in patient less than 35 yrs old
- Any size in patient greater than 35 yrs old
- Absent or eccentric calcifications
- Hilar enlargement |
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Term
| What type of symptoms can occur with a pancoast tumor. |
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Definition
| Symptoms may include shoulder, amr and hand pain or weakness |
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Term
| What organs does lung CA metastasize to? |
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Definition
| Liver, adrenal glands, bones, and brain. |
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Term
| What is bronchiectasis, and how is it seen on CXR? |
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Definition
-Bronchiectasis - dilation of the bronchi, may be diffuse or focal
-Initially not seen well on normal CXR
-Easily seen on CT scan |
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Term
| What are the signs of COPD on CXR? |
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Definition
| -COPD is a clinical diagnosis and CXR is not idicated unless there is an exacerbation of symptoms, weight loss, or suspected pneumonia. |
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Term
| What is atelectasis, and how does it appear on CXR? |
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Definition
Atelectasis = collapse of lung or portion of lung with resorption of air from the aveoli.
It is seen on CXR as Linear (discoid or plate like) atelectasis |
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Term
| What is a consolidation? What is an air bronchogram? |
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Definition
A consolidation is a severe alveolar infiltrates while air bronchograms are often seen with alveolar processes, however, the alveoli are filled with material so air filled branches are more visible.
If you see air bronchogram = alveolar and can be throughout |
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Term
| What are interstitial markings |
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Definition
| Usually diffuse and seen as thin white lines |
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Term
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Definition
| Air in the pleural space that causes collapse of the lung. |
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Term
| What is a Pleural Effusion? |
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Definition
| Fluid in the pleural space. |
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Term
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Definition
| Pus in the pleural space. |
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Term
| What are the signs of CHF on CXR? |
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Definition
CXR changes are progressive - initially normal then redistribution of pulmonary vascular pattern and cardiomegaly.
Mild - Equal pulmonary vasculature in upper and lower lobes
Moderate - Kerley B lines in lateral basilar regions.
Severe - Pulonary edema - bilateral perihilar and basilar alveolar infiltrates |
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Term
| When is a CXR indicated in HTN? Chest pain? |
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Definition
Routine evaluation opf hypertension is not usually an indication for a CXR
CXR is indicated in chest pain or dyspnea if your exam is abnormal or if the patient is over 40 years old or is at risk for early cardiovascular disease. |
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Term
| How does a pericardial effusion appear on CXR? How many CC's of fluid must be present to be seen on CXR? |
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Definition
| Pericardial effusion causes an acute marked enlargement with the heart appearing pendulous and very wide at the base "water bag appearance" |
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Term
| How do you evaluate cardiac function? |
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Definition
To evaluate cardiac function and ejection fraction you can ordereither an echocardiogram or MUGA scan.
-Normal ejection fraction is above 50% in older patients.
-Angiogram may be indicated if the EF is less than 35% |
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Term
| What is the most common cause of left atrial enlargement and how does it appear on CXR? |
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Definition
Left atrial enlargement is most commonly caused by mitral stenosis and is seen as four bumps on the left cardiac border.
-Late findings include a prominent left atrial appendage and widening of the subcarinal angle. |
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Term
| In what condition do you see a ski mogul heart, how does it appear? |
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Definition
4 bumps on the left cardiac border
Classic for the mitral stenosis from rheumatic fever. |
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Term
| What is endocarditis and how is it evaluated? |
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Definition
Infection of the heart valves.
Echocardiogram is preferred method of evaluation. |
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Term
| What is a pulmonary embolism and how is it evaluated? |
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Definition
| Is a blockage of the pulmonary artery or one of its branches, usually occuring when a deep vein becomes dislodged from its site of formation and travels, or embolizes, to the arterial blood supply of one of the lungs. |
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Term
| What is the first line test for evaluation of the peripheral vascular system? What is the "gold standard"? |
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Definition
Gold standard for evaluation of vessels is contrast angiography.
Duplex ultrasound is the first line study for vascular disease. |
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Term
| What is the purpose of an upright abdominal film? A CXR? |
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Definition
| Evaluate gas patterns and air fluid levels. |
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Term
| Why are psoas margins significant? |
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Definition
| 25% of unilateral obscured psoas margins = pathology on that side. |
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Term
| What is the normal size of small bowel, colon, cecum? |
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Definition
Small bowel: < 3cm
Colon: < 6cm
Cecum: as large as 8cm |
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Term
| What is the best way to evaluate non-intestinal organs in the abdomen? |
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Definition
| CT scan with IV and/or GI contrast |
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Term
| What is enterclysis? What is the best way to evaluate the small bowel? |
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Definition
Enterclysis = evaluate details of the small bowel exclusively - NG tube
Plain films with contrast are the best way to evaluate the small bowel. |
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Term
| What is an ultrasound useful for? |
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Definition
Evaluating the liver, kidneys, gallbladder, and common bile duct, and ascites
U/S does not penetrate air and air in the bowel may interfere with study. |
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Term
| What is ERCP? When is it indicated? |
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Definition
Endoscopic retrograde cholangiopancreato-graphy.
It is an endoscopic procedure used to indentify the presence of stones, tumors, or narrowing in the biliary and pancreatic ducts. |
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Term
| What are some causes of acute abdominal pain? Gradual onset of pain? |
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Definition
Sudden pain - bowel perforation, ruptured ectopic pregnancy, reuptured ovarian cyst, aneurysm, ischemic bowel.
Gradually incresing and localizing pain - appendicitis, cholecystitis, bowel obstruction. |
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Term
| What is a AAS? When is a U/S indicated in the evaluation of abdominal pain? |
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Definition
| AAS = Acute abdominal series which consists of a PA CXR, supine abdominal and a upright abdominal film. |
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Term
| What is the first step in the evaluation of GERD? |
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Definition
| Trial of medication is first step, if symptoms persist or worsen next step is endoscopy. |
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Term
| What is Barrett's Esophagitis? |
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Definition
| Cells in the irritated partr of the esophagus may change and begin to resemble the cells that line the stomach. This condition may develop into adenocarcinoma of the esophagus. About 5-10% of people with Barrett's develop cancer of the esophagus. |
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Term
| What is the most common etiology of gastritis and ulcers? |
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Definition
| The most common causes of gastritis and ulcers in the stomach and duodenum and NSAID therapy and/or Helicobacter pylori infection. |
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Term
| What are the 4 signs of small bowel obstruction? |
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Definition
1) Dilated loops of bowel > 4 mm
2) "stack of coins" pattern of dilation
3) Air-Fluid levels at different heights
4) "string of pearls" air-fluid levels |
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Term
| Colonic obstruction is caused by: |
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Definition
Colon CA = 65%
Diverticulitis = 20%
Volvulus = 5% |
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Term
| Describe the size and apperance of the kidneys on a KUB? |
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Definition
Kidneys are about 13 cm long.
Left kidney slightly higher than right kidney.
Superior pole of the kidney titled medially. |
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Term
| What is IVP and what atatomy can you see on an IVP? |
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Definition
| Iodine based contrast material is injected IV and rapidly cleared by the kidneys. |
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Term
| Why does the patient have to stop taking glucophage after the IVP? |
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Definition
| The IV contrast interacts with glucophage and can cause lactic acidosis. |
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Term
| What are some advantages of a renal ultrasound and how is it done? |
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Definition
Renal ultrasound - noninvasive option for patients that may be at risk for a reaction to the IVP contrast.
-Indicated for hydronephrosis or renal cysts.
-Not a good study for ureters or bladder. |
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Term
| What percentage of visible hematuria is due cancer? infection? Calculi? |
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Definition
25% due to cancer
25% due to infection
15% due to calculi (stones) |
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Term
| What are the most common congenitial kidney disorders seen on an IVP? |
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Definition
| Most common congenital abnormalities are ureteral duplication, pelvic kidneys and horseshoe kidney. |
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Term
| How do you follow a renal cyst? What is an indication for a CT scan |
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Definition
U/S is good for following benign appearing cysts.
CT scan is indicated if the cyst has septa or internal echoes to r/o CA |
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Term
| What is clinical presentation of a patient with kidney stones? What studies are indicated? |
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Definition
Clinical presentation = intense unilateral flank pain with hematuria.
-IVP or spiral CT scan is indicated for evaluation. |
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Term
| What is a HIDA scan and what does it evaluate? |
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Definition
| HIDA scan is indicated if U/S is non diagnostic and clinical suspicion of acute cholecystits remains. |
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Term
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Definition
| Achalasia is when the gastroesophageal sphincter fails to relax and the esophagus becomes massively dilated and loses it's elasticity. |
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Term
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Definition
| Regional enteritis = can occur anywhere in the GI tract from the mouth to the rectum. |
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Term
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Definition
| Is confined to the rectum, colon, and sometimes the terminal ileum. |
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Term
| What are the indications for a testicular ultrasound? |
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Definition
1) Hydrocele
2) Testicular torsion
3) Acute Trauma
4) Any tumors |
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Term
| What are the indications for a transvaginal ultrasound? |
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Definition
1) Early or ectopic pregancy
2) Ovarian torsion or cysts
3) Measurement of the endometrial strip
4) Tubo-ovarian abscess |
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Term
| Fracture that involves the growth plate? |
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Definition
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Term
| Facture that occurs in abnormal bone? |
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Definition
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