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Section I, Surgical Recall Sixth Edition > Surgical Radiology, C30 P183-190 > Flashcards

Surgical Radiology, C30 P183-190 Flashcards

1
Q

CHEST
What defines a technically
adequate CXR?
P183

A 
The film must be “RIPE”:
   Rotation: Clavicular heads are
      equidistant from the thoracic
      spinous processes
   Inspiration: Diaphragm is at or below
      ribs 8–10 posteriorly and ribs 5–6
      anteriorly
   Penetration: Disk spaces are visible
      but there is no bony detail of the
      spine; bronchovascular structures
      are seen through the heart
   Exposure: Make sure all of the lung
      fields are visible
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2
Q

CHEST
How should a CXR be read?
P184

A 
Check the following:
   Tubes and lines: Check placement
   Patient data: Name, date, history
      number
   Orientation: Up/down, left-right
   Technique: AP or PA, supine or
      erect, decubitus
   Trachea: Midline or deviated, caliber
   Lungs: CHF, mass
   Pulmonary vessels: Artery or vein
      enlargement
   Mediastinum: Aortic knob, nodes
   Hila: Masses, lymphadenopathy
   Heart: Transverse diameter should be
      less than half the transthoracic
      diameter
   Pleura: Effusion, thickening,
      pneumothorax
   Bones: Fractures, lesions
   Soft tissues: Periphery and below the
      diaphragm
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3
Q

CHEST
What CXR is better: P-A or A-P?
P184

A

P-A, less magnification of the heart (heart

is closer to the x-ray plate)

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4
Q 
CHEST
Classically, how much pleural
fluid can the diaphragm
hide on upright CXR?
P184
A

It is said that the diaphragm can

overshadow up to 500 cc

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5
Q 
CHEST
How can CXR confirm that
the last hole on a chest tube
is in the pleural cavity?
P184
A

Last hole is through the radiopaque line
on the chest tube; thus, look for the break
in the radiopaque line to be in the rib cage

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6
Q 
CHEST
How can a loculated pleural
effusion be distinguished from
a free-flowing pleural effusion?
P184
A

Ipsilateral decubitus CXR; if fluid is not

loculated (or contained), it will layer out

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7
Q

CHEST
How do you recognize a
pneumothorax on CXR?
P184

A

Air without lung markings is seen outside
the white pleural line—best seen in the
apices on an upright CXR

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8
Q 
CHEST
What x-ray should be obtained
before feeding via a nasogastric
or nasoduodenal tube?
P184
A

Low CXR to ensure the tube is in the GI

tract and not in the lung

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9
Q

CHEST
What C-spine views are used
to rule out bony injury?
P184

A

CT scan

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10
Q

CHEST
What is used to look for
ligamentous C-spine injury?
P185

A

Lateral flex and extension C-spine films,

MRI

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11
Q 
CHEST
What CXR findings may
provide evidence of
traumatic aortic injury?
P185
A 
Widened mediastinum 8 cm (most
   common)
Apical pleural capping
Loss of aortic knob
Inferior displacement of left main
   bronchus; NG tube displaced to the
   right, tracheal deviation, hemothorax
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12
Q

CHEST
How should a CT scan be
read?
P185 (picture)

A

Cross section with the patient in supine

position looking up from the feet

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13
Q

ABDOMEN
How should an abdominal
x-ray (AXR) be read?
P185

A 
Check the following:
   Patient data: name, date, history
      number
   Orientation: up/down, left-right
   Technique: A-P or P-A, supine or
      erect, decubitus
   Air: free air under diaphragm,
      air-fluid levels
   Gas dilatation (3, 6, 9 rule)
   Borders: psoas shadow, preperitoneal
      fat stripe
   Mass: look for organomegaly, kidney
      shadow
   Stones/calcification: urinary, biliary,
      fecalith
   Stool
   Tubes
   Bones
   Foreign bodies
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14
Q 
ABDOMEN
How can you tell the
difference between a small
bowel obstruction (SBO) and
an ileus?
P186
A 
In SBO there is a transition point
(cut-off sign) between the distended
proximal bowel and the distal bowel of
normal caliber (may be gasless), whereas
the bowel in ileus is diffusely distended
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15
Q

ABDOMEN
What is the significance of
an air-fluid level?
P186 (picture)

A

Seen in obstruction or ileus on an upright
x-ray; intraluminal bowel diameter
increases, allowing for separation of fluid
and gas

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16
Q 
ABDOMEN
What are the normal
calibers of the small bowel,
transverse colon, and
cecum?
P186
A

Use the “3, 6, 9 rule”:
Small bowel < 6 cm
Cecum < 9 cm

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17
Q

ABDOMEN
What is the “rule of 3s” for
the small bowel?
P186

A

Bowel wall should be < 3 mm thick
Bowel folds should be < 3 mm thick
Bowel diameter should be < 3 cm wide

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18
Q 
ABDOMEN
How can the small and large
bowel be distinguished on
AXR?
P186
A 
By the intraluminal folds: The small
bowel plicae circulares are complete,
whereas the plicae semilunares of the
large bowel are only partially around the
inner circumference of the lumen
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19
Q 
ABDOMEN
Where does peritoneal fluid
accumulate in the supine
position?
P186
A

Morison’s pouch (hepatorenal recess), the
space between the anterior surface of the
right kidney and the posterior surface of
the right lobe of the liver

20
Q

ABDOMEN
What percentage of kidney
stones are radiopaque?
P186

A

≈90%

21
Q

ABDOMEN
What percentage of
gallstones are radiopaque?
P187

A

≈10%

22
Q 
ABDOMEN
What percentage of patients
with acute appendicitis have
a radiopaque fecalith?
P187
A

≈5%

23
Q

ABDOMEN
What are the radiographic
signs of appendicitis?
P187

A 
Fecalith; sentinel loops; scoliosis away
from the right because of pain; mass
effect (abscess); loss of psoas shadow;
loss of preperitoneal fat stripe; and, very
rarely, a small amount of free air, if
perforated
24
Q

ABDOMEN
What does KUB stand for?
P187

A

Kidneys, Ureters, and Bladder—
commonly used term for a plain film
AXR (abdominal flat plate)

25
Q

ABDOMEN
What is the “parrot’s beak”
or “bird’s beak” sign?
P187

A

Evidence of sigmoid volvulus on barium
enema; evidence of achalasia on barium
swallow

26
Q

ABDOMEN
What is a “cut-off sign”?
P187

A

Seen in obstruction, bowel distention,
and distended bowel that is “cut-off”
from normal bowel

27
Q

ABDOMEN
What are “sentinel loops”?
P187

A

Distention or air-fluid levels (or both)
near a site of abdominal inflammation
(e.g., seen in RLQ with appendicitis)

28
Q

ABDOMEN
What is loss of the psoas shadow?
P187

A

Loss of the clearly defined borders of the
psoas muscle on AXR; loss signifies
inflammation or ascites

29
Q 
ABDOMEN
What is loss of the peritoneal
fat stripe (a.k.a. preperitoneal
fat stripe)?
P187
A

Loss of the lateral peritoneal/preperitoneal

fat interface; implies inflammation

30
Q

ABDOMEN
What is “thumbprinting”?
P187

A

Nonspecific colonic mucosal edema

resembling thumb indentations on AXR

31
Q

ABDOMEN
What is pneumatosis intestinalis?
P187

A

Gas within the intestinal wall (usually
means dead gut) that can be seen in
patients with congenital variant or
chronic steroids

32
Q

ABDOMEN
What is free air?
P188 (picture)

A

Air free within the peritoneal cavity
(air or gas should be seen only within the
bowel or stomach); results from bowel or
stomach perforation

33
Q 
ABDOMEN
What is the best position for
the detection of FREE AIR
(free intraperitoneal air)?
P188
A

Upright CXR—air below the right

diaphragm

34
Q 
ABDOMEN
If you cannot get an upright
CXR, what is the second
best plain x-ray for free air?
P188
A

Left lateral decubitus, because it prevents
confusion with gastric air bubble; with
free air both sides of the bowel wall can
be seen; can detect as little as 1 cc of air

35
Q

ABDOMEN
How long after a laparotomy
can there be free air on AXR?
P188

A

Usually 7 days or less

36
Q

ABDOMEN
What is Chilaiditi’s sign?
P188

A

Transverse colon over the liver simulating

free air on x-ray

37
Q 
ABDOMEN
When should a postoperative
abdominal/pelvic CT scan
for a peritoneal abscess be
performed?
P188
A

POD #7 or later, to give time for the

abscess to form

38
Q 
ABDOMEN
What is the best test to
evaluate the biliary system
and gallbladder?
P188
A

Ultrasound (U/S)

39
Q 
ABDOMEN
What is the normal diameter
of the common bile duct
with gallbladder present?
P189
A

< 4 mm until age 40, then add 1 mm per

decade (e.g., 7 mm at age 70)

40
Q 
ABDOMEN
What is the normal common
bile duct diameter after
removal of the gallbladder?
P189
A

8 to 10 mm

41
Q 
ABDOMEN
What U/S findings are
associated with acute
cholecystitis?
P189
A

Gallstones, thickened gallbladder wall
( >3 mm), distended gallbladder ( >4 cm
A-P), impacted stone in gallbladder neck,
pericholecystic fluid

42
Q

ABDOMEN
What type of kidney stone is
not seen on AXR?
P189

A

Uric acid (Think: Uric acid = Unseen)

43
Q 
ABDOMEN
What medication should be
given prophylactically to a
patient with a true history of
contrast allergy?
P189
A 
Methylprednisolone or dexamethasone;
the patient should also receive nonionic
contrast (associated with one fifth as
many reactions as ionic contrast, the less
expensive standard)
44
Q

ABDOMEN
What is a C-C mammogram?
P189 (picture)

A

Cranio-Caudal mammogram, in which

the breast is compressed top to bottom

45
Q

ABDOMEN
What is an MLO mammogram?
P190 (picture)

A

MedioLateral Oblique mammogram, in
which the breast is compressed in a 45˚
angle from the axilla to the lower
sternum

46
Q 
ABDOMEN
What are the best studies to
evaluate for a pulmonary
embolus?
P189
A 
Spiral thoracic CT scan, V-Q scan,
pulmonary angiogram (gold standard)

Section I, Surgical Recall Sixth Edition (33 decks)

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