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Flashcards in GU Deck (28):
1

Female GU

U/s is best choice
CT not as sensitive
Plain film not of benefit

2

U/s- female

Gynecology including transabdominal and transvaginal imaging
Obstetric including transabdominal and transvaginal imaging
Most obstetric will be practice specific but for ER need to be familiar

3

Ordering criteria- female

Transvaginal vs transabdominal
Never been sexually active order transabdominal, however must have a full bladder to do the scan, if worried for sx (appy or ovarian torsion) may use IVFs or urinary catheter to fill the bladder
If sexually active, lifetime order transvaginal
First trimester, transvaginal
2nd trimester forward, order OB scan which is transabdominal

4

Indications for studies- females

Isolated pelvic pain
Worrisome for ovarian torsion/appy
Infertility
Dysmenorrhea
Dyspareunia
Abnl uterine bleeding
Dysfunctional uterine bleeding
Post-menopausal bleeding
Early pregnancy
Pregnancy complications
Know ovarian cyst for f/u
Suspect PID
IUD placement and position check

5

What can u/s diagnose in females?

Ovarian cysts
Ovarian torsion
PID/TOA/Hydrosalpinx
Ectopic pregnancies and IUPs
Reproductive CAs except cervical unless advanced
Endometrial thickness/uterine fibroids
Uterine/ovarian size
IUD placement or lack thereof
PCOS?

6

What size of ovarian cyst is at increased risk for torsion?
When is it considered surgical?

3 cm
6 cm

7

Tumors- female

Sometimes will grow in stalks around the uterus
Large fibroid- back pain during times of menstruation
Embolization of fibroids

8

What is the MC benign tumor of the uterus?

Fibroid

9

What is the only cyst in premenopausal women that you can say is 100% ok?

Unilocular

10

Bladder evaluation in males and females

U/s with full bladder is limited
-May see wall defect in full bladder
CT with IV contrast is limited
Definitive: cystoscopy

11

Male GU

U/s usually first choice
CT of pelvis may be of benefit for prostate issues
MRI useful for entire system but expensive and must be pre-approved

12

U/s- males

Scrotum/testicles
Penile tumors
Prostate transrectal and transperineal

13

Ordering criteria- males

Transrectal vs transperineal will be decided ordered by urology during that consult
Scrotal u/s
Penile u/s, clinical dx very important

14

Indications for studies- males

Scrotal/testicular pain
Scrotal/testicular injury
Dysuria
Painful intercourse
Groin pain
Palpable mass
Skin changes to either scrotum or penis
Edema of either scrotum or penis
ED
Infertility

15

What can u/s diagnose- males

Orchitis
Epididymitis
Varicocele
Hydrocele
Testicular torsion
Testicular CA
Penile CA
Epididymal cysts
Lymphedema

16

Testicular tumors are _______

Highly vascularized

17

Epididymal cysts

Posterior shadow
Benign unless they get really, really big

18

Breast and thyroid modalities

Mammography
U/s
Nuclear medicine
MRI

19

Breast imaging indications

Know age recommendations for annual screenings, if close relative under age of 50 yrs will need to start sooner
Special views recommended by radiologist
U/s for palpable masses only think young pts with fibrocystic breasts, or if radiologist recommends
MRI excellent diagnostic tool but difficult to get approved and for pts to lie still d/t positioning

20

What can be diagnosed with breast imaging

CA
Cysts
Fibroadenomas
Abscesses
Imaging guided bxs

21

What is the indication of cysts that are wider than tall?
Ones that are taller than wide?

Usually benign
Usually tumor

22

Thyroid imaging

U/s
NM
CT but not the standard

23

Indications for ordering thyroid imaging

Abnl labs
Dysphagia
Abnl PE
Usually start with u/s first then if NM needed radiologist will recommend

24

What can be diagnosed with thyroid imaging?

Goiters
CA
Nodules
Cysts
Thyroid function

25

Nuclear medicine and thyroid

Hot nodules (uptake the iodine in the radioisotope primary benign)
Cold nodules (do not uptake the iodine, 85% benign)
To bx or not to bx

26

Thyroid progression of results

Symptomatic pt
Labs may be nl or abnl
U/s- nodule/nodules seen
Nuclear medicine- cold vs hot
Refer to ENT or IR for bx, usually u/s guided

27

Soft tissue imaging

U/s
CT scans with and without contrast if possible

28

Palpable masses/abscesses

Can be anywhere in soft tissues
If no skin changes, no worry of abscess- u/s appropriate
If skin changes/fever/chills/worrisome for abscess- CT of area with and without contrast
U/s is actually appropriate any time, however, if abscess is extensive, surgeons usually prefer CT