GI/GU

Question 1

28 yo previously healthy male, who presents with a 2 day h/o diffuse abdominal pain, diarrhea and temperature of 103.8°C. Mild diffuse abdominal tenderness on exam. Labs pending. Which imagining studies should be ordered?

Answer 1

#1 CT Abdomen and Pelvis with Contrast
#2 Acute Abd Series x-rays (supine, upright, left lateral decubitus)

Question 2

Which f/u imaging studies can evaluate for an acute episode of inflammatory bowel disease presenting as colonic edema?

Answer 2

CT Abdomen and Pelvis with Contrast
MRI Abdomen and Pelvis with Contrast
(contrast helps demonstrate extra-luminal complications)

Question 3

Contraindications to CT IV contrast media?

Answer 3

Renal Function impairment (BUN/Cr >20:1, or Cr > 2.0, 1.6 in diabetics. GFR

Question 4

Radiographic evaluation of suspected Crohn’s disease?

Answer 4

UGI with small bowel follow through (Aphthoid ulcers) and barium enema (terminal ileum involvement)

Question 5

Obese 44 y/o mother with RUQ, temp 101. Normal LFTs. What are your concerns? What study would you order?

Answer 5

Concern: Acute Cholecystitis, Ascending cholangitis, liver abscess
Imaging: U/S
(HIDA should be reserved for when the US is equivocal as it is more expensive)

Question 6

32 y/o female two months pregnant awakened by the sudden onset of severe, colicky, left flank pain, which radiates to the groin. Physical examination reveals left CVA and flank tenderness. Urinalysis shows microscopic hematuria. What study would you order?

Answer 6

Concern: Acute Onset Flank Pain—Suspicion of Stone Disease (Urolithiasis)
Imaging: US color Doppler kidneys and bladder
retroperitoneal or MRI
NON PREGNANT- NCT Abd/Pelvis!!!

Question 7

30 y/o female notes she has been more yellow than usual and a little itchy but now has developed a fever. What are your concerns? What imaging study(s) would you order?

Answer 7

Concern: cirrhosis, hepatitis, Gilbert’s disease, hemolytic anemia
Imaging: CT abdomen, U/S or MRI

Question 8

Acute Cholecystitis Findings on U/S?

Answer 8

• thickened wall (>3mm)
• surrounding free fluid
• dilated GB (transverse >5mm)
• presents of GB stones or sludge
• Sonographic Murphy’s sign

Question 9

CT findings in acute appendicitis?

Answer 9

• wall thickening and enhancement
• diameter > 6mm
  -Pericolonic “fat stranding”
  +/- Free intraperitoneal gas if perforated
  +/- appendicolith

Question 10

CT findings of acute pancreatitis?

Answer 10

• Thickening
• “fat stranding”
• Gallbladder wall thickening
• Splenic flexure wall thickening
• Pseudocyst

Question 11

Imaging recommendations in patients with suspected pyelonephritis?

Answer 11

• Adult uncomplicated and suspicion of pyelonephritis can be treated with antibiotics
• Imaging (CT) only if they do not respond to therapy or immunocompromised or complicated medical history

Question 12

What CT findings seen in patients with pyelonephritis would be most worrisome and may need more aggressive treatment?

Answer 12

-Renal abscess
-Emphysematous pyelonephritis
-Severe hydronephrosis
Note: enlarged kidney, delayed or striated nephrogram are normal

Question 13

Risk factors for Contrast-induced nephropathy (CIN)?

Answer 13

DM, nephrotoxic drugs, existing renal dysfunction

Question 14

How do you manage metformin regimen when CT with contrast is needed?

Answer 14

Stop for two days after contrast administration, then restart if normal serum creatinine level (or else risk of lactic acidosis)

Question 15

What imaging studies can be used to diagnose renal vascular hypertension?

Answer 15

US with doppler 
Captopril renography
CTA
MRA
Carbon Dioxide Arteriography

Question 16

What findings on 99mTc-MAG3 scintography of kidney suggest renal abnormality?

Answer 16

• delayed uptake
• delayed excretion
• prolonged retention

Question 17

What imaging modality would be most appropriate to work up persistent painless hematuria x 2 months?

Answer 17

CT urography

Question 18

If a renal mass is suspicious for malignancy by US criteria, what could be an appropriate next imaging test?

Answer 18

• Pre and Post-Contrast enhanced CT

- Gadolinium enhanced MR

Question 19

GI/GU Trauma Assessment

Answer 19

FAST U/S: perihepatic, perisplenic and pelvic fluids
CT Chest with Contrast if concerned
AP chest, AP pelvis, and lateral C-spine radiographs

Question 20

CT findings indicating bowel injury?

Answer 20

• Free abdominal air
• Retroperitoneal gas
• Free interperitoneal fluid
• Thickened bowel wall

Question 21

What imaging modalities are helpful in assessing for bladder and urethral injury?

Answer 21

CT Cystogram
Retrograde Cystogram
Retrograde urethrogram

Question 22

The dimensions of a normal, non-dilated gallbladder

Answer 22

10 cm long x 5 cm wide

Question 23

The best imaging modality for acute pancreatitis is:

Answer 23

CT WITH CONTRAST

Question 24

Double wall sign (Rigler’s sign)

Answer 24

both the inside and outside walls of bowel are visualized because they are outlined by air within the bowel and free air in the abdomen

Question 25

Falciform ligament sign

Answer 25

falciform ligament is visualized by free air in the abdomen

Question 26

Football sign

Answer 26

shape of gas outlining the peritoneal cavity

Question 27

Bochdalek hernias

Answer 27

occur “back, and to the left” at the posterior aspectof the diaphragm, most often on the left.

Question 28

Spigelian hernias

Answer 28

occur through the anterior abdominal wall, lateral to the rectus abdominus

Question 29

Which type of transducer gives the best overall image quality?

Answer 29

Linear

Question 30

Sonographic finding of a hemorrhagic cyst?

Answer 30

Homogeneous internal echoes
Fishnet appearance
Fluid-fluid levels

Question 31

Fetal heart rate can be visualized by US around when?

Answer 31

6 wks

Question 32

Plain film order to exclude pneumoperitonium

Answer 32

CXR more sensitive for pneumoperitonium than abdominal x ray.

Question 33

Plain film distinguish between small bowel obstruction and ileus

Answer 33

Small bowel obstruction- gas filled and dilated bowel loops with multiple “dynamic air fluid levels”