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BSc Medical Imaging > Practicals > Flashcards

Practicals Flashcards

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1
Q

What are some signs of facial fracture

A 
Facial Asymmetry
Flattened cheek
Dish face
Deviation of the nose
Pupils not level
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2
Q

What must you do in orbital fracture

A

assess eye and patients vision

-if you are concerned about vision - senior clinician

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3
Q

What does dish face mean

A

posteroinferior displacement of maxilla

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4
Q

What non level pupils mean

A

orbital floor fracture

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5
Q

List some types of facial fracture and their causes

A

nasal fractures
-blunt trauma

mid face
-blunt trauma - Le Fort fractures - can be very severe

Zygomatic fractures
-blunt force to cheek

Orbital fractures
-blow out - blunt eye trauma due to transient rise in intra-orbital pressure

Frontal sinus fracture

Mandibular and TMJ fracture
-blunt trauma

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6
Q

What are the standard facial XR views and what are they good at visualising

A

OM

  • frontal and maxillary bones
  • zygomatic bone and arch
  • dens
  • frontal, ethmoid, maxillary sinuses
  • mandible

OM 30

  • allows for better visualisation of:
  • maxillary sinuses
  • inferior orbital rims
  • features of mandible

(PA mandible, PA facial)

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7
Q

What is the approach to interpreting facial xray

A

Check patient details
Techical quality
Obvious abnormalities
-symmetry

trace lines along facial bones

identify and assess sinuses
-fluid level

signs of air in the orbit
-black eyebrow sign

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8
Q

What chest pathologies are you excluding by doing a CT in an acute setting

A

CTPA - PE
Chest trauma
Thoracic aortic aneurysm rupture or dissection

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9
Q

What abdo pathologies are you excluding by doing a CT in an acute setting

A

Acute or serious intraabdominal pathology
Ruptured AAA
Caliculi

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10
Q

What spinal pathologies are you excluding by doing a CT in an acute setting

A

C spine fracture

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11
Q

What neuro pathologies are you excluding by doing a CT in an acute setting

A

intracranial bleed

Ischaemic stroke

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12
Q

How would a PE appear on CT

A

Contrast

  • filling defect
  • contrast not absorbed by clot or vessel it occludes
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13
Q

What are some considerations of CT-KUB

A

Without Contrast

  • First line KUB caliculi
  • CT demonstrates other serious pathologies that USS wont
  • CT delivers same radiation as IV pyelogram but is much faster
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14
Q

Why is a CT-C spine undertaken

A

Fracture on XR
Hx of injury, neurological symptoms
XR equivocal but ongoing clinical concern
Major trauma

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15
Q

Why perform a CT head without contrast

A

Contrast hyperdense, similar to acute intracranial bleed

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16
Q

What are the acute indications for MRI

A

Suspected spinal cord compression

Cauda Equina

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17
Q

What does T1 signal show

A

Measure of relaxation

  • fat -high signal
  • CSF - low signal
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18
Q

What does T2 signal show

A

Measures desynchronisation

- CSF - high signal

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19
Q

What is FLAIR

A

Fluid attenuated inversion recovery sequence

  • similar to T2
  • high signal from CSF suppressed
  • useful for identifying high signal lesions that lie close to CSF spaces
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20
Q

What is DWI

A

Diffusion weighted imaging

  • Glial cell dysfunction in old infarct
  • influx of sodium and water
  • restricted outflow
  • oedema
  • high signal
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21
Q

What is fat saturation sequence

A

Contrast enhanced T1

-high signal from fat suppressed

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22
Q

What is STIR

A

Short tau inversion recovery

  • More effective method to suppress high signal from fatty tissues
  • used for visualising fluid e.g. oedema
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23
Q

What is proton density sequence

A

Acquired at the same time as T2
Tissues with a high number of protons e.g. CSF appear bright
Excellent for visualising normal anatomy and pathology

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24
Q

How do cysts appear on USS

A

Anechoic/Hypoechoic - fluid filled

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25
What can you assess on echo
``` Cardiac contractility Valve function Myocardial thickness Chamber size Pericardial sac and space Cardiac masses ```
26
What are the 4 echo views
Parasternal long Parasternal short Apical 4 chambers Subcostal
27
What can the flow dynamics assessed by echo determine
Valve incompetence Vegetations of heart valve LVEF
28
Draw the cross-section of the heart given by parasternal long
-
29
Draw the cross-section of the heart given by parasternal short (A,B,C,D)
-
30
Draw the cross-section of the heart given by apical four chambers
-
31
Draw the cross-section of the heart given by subcostal
-
32
What is the systematic review process for a CXR
Airways -central traches Breathing - lung margins - lung markings - extend to outer margin Cardiac and mediastinum - mediastinum central - aorticopulmonary window - cardiomergaly Diaphragm - visible and convex? - free air? - sharp costophrenic angles
33
What is the silhouette sign
Loss of clear edges of the heart border | -indicates abnormality
34
Be careful to check these areas in CXR
``` Apices Costophrenic angles Behind the heart Under the diaphragm Soft tissues Bones ```
35
What is the systematic process for reviewing AXR
Stomach -gastric bubble or pneumoperitoneum Small intestine - central - <3cm - Plicae circulares - full width Large intestine - <6cm (9cm caecum) - Haustra - partial width Liver - only 10% gallstones are radiolucent - hepatomegaly Kidneys - T12-L3 - Renal calcifications Spleen Pancreas -not normally visible Bladder and ureters -caliculi are often radio-opaque Aorta and iliacs -calcified Bones and soft tissues
36
What is the systematic review process for MSK XR
Bone and joint alignment Joint spacing Cortical outline Medullary texture Soft tissue -fat pad?
37
What do you need to note in a fracture
Anatomical location - proximal, middle, distal third - intra-articular Fracture pattern - simple or compound - comminuted - imacted Type Displacement Medullary texture - lucent or opaque lines - areas of radio-opacity Soft tissues -fat pads
38
What are the types of fracture
``` Transverse Oblique Spiral Greenstick Vertical ```
39
What are the standard views for C spine
Lateral AP Open mouth/peg
40
How do you visualise more of the C Spine
Swimmers view | -better view of C7-T1
41
What are the three lines used to examine alignment in the C spine
Anterior line - anterior longitudinal ligament Posterior line - posterior longitudinal ligament Spinolaminar line - anterior edge of spinous processes
42
What are the three columns of the C spine
Disruption of these columns causes instability Anterior -ant long lig + ant half vert bodies Middle -post long lig + post galf vert bodies Post column -post elements of vertebra + several associated ligaments
43
Name the spinal ligaments
Anterior --> Posteriro ``` Anterior longitudinal Posterior longitudinal Ligamentum flavum Interspinal ligament Supraspinous ```
44
How do you know if the dens if fractured
Equidistant from the lateral masses of C1
45
Why is the dens likely to fracture
Less dense than surrounding bone Hyperextension or hyperflexion injuries
46
How is the dens supported
Transverse ligament -if intact, spinal cord usually unaffected by dens fractures -secures dens, spans the vertebral foramen
47
What kind of a joint is between the dens and C1
synovial Affected by RA
48
How do you check alignment of the C spine on an AP view
Spinous processes
49
What are the standard views for thoracolumbar spine
Lateral | AP
50
Label a diagram of a thoracolumbar vertebra
-
51
What does the oblique thoracolumbar view assess
Par interarticularis | -spotty dog sign
52
What are the views of the shoulder
Y | AP
53
What are the views for the elbow
AP | Lateral
54
What are the views of the wrist
PA Lateral Important to see that the capitate, lunate and radius are in a line
55
What is the standard view for the pelvis
AP
56
What are the standard views for the knee
AP Lateral (can get a skyline)
57
What is a lipohaemarthosis
Sharpy demarcated fat/fluid level within the suprapatellar pursa -indicative of intraarticular fracture
58
What is are the standard views of the ankle
AP | Lateral
59
What are the views of the foot
Dorsal plantar | Oblique
60
What might cause absence of lung margnis
Pneumothorax
61
What might cause calcific deposits
Asbestos exposure
62
What would pull the mediastinum towards and away from the pathology
Towards -collapse Away -pneumothorax
63
What are some negative symptoms that indicate a CXR
Acute onset dyspnoea Peripheral oedema Haemoptysis Cough > 3 weeks Productive cough Sudden onset pleuritic chest pain Chronic chest pain Symptoms of infection
64
What are some abnormal signs indicating a CXR
``` Reduced breath sounds Abnormal added signs Abnormal percussion RDS Tracheal tug/deviation ```
65
What are some symptoms and signs of lung malignancy
Symptoms - chronic cough - haemoptysis - Hoarseness - Increasing dyspnoea - Gradual weight loss Signs - Hilar lymphadenopathy - Consolidation - Collapse - Pleural effusion - Mets - Cavitation - Rib erosions - Pleural plaques
66
What is the first line imaging technique for the heart
Echo - non invasive - cheap - portable
67
What are some indications for further imaging in CXR
CXR suspicious of malignancy ongoing suspicion (equivocal xray)
68
What detail does a CT provide on the chest
CTPA Cardiac masses Pericardium
69
What detail does MRI provide on the heart
Cardiac function Characteristic masses Gadolinium MRI - ischaemic myocardium Angiography
70
What are some indications for AXR
Foreign bodies Renal calculus Megacolon
71
What are some advantages of USS
Cheap Portable Non invasive Non ionising Good visualisation of hollow viscera, fluid filled structure Free fluid in abdo
72
What are some disadvantages of USS
Interpretation requires skill Operator dependent Difficult in obesity May not give definitive diagnosis May not show other pathology Not adequate for detailed surgical planning
73
What are some indications for CT abdo
Definitve Dx Exclude life threatening pathologies e.g. AAA Staging Surgical planning Trauma
74
What are the indications for barium studies
Oesophageal strictures Small bowel lesions - ulceration - inflammation - erosions Large bowel lesions -diverticulitis
75
What are the disadvantages of barium studies
Radiation 300x CXR Pt must be able to swallow contrast Adequate bowel prep
76
What are some advantages of CT
Definitive diagnosis Excellent visualisation for surgical planning Other pathologies deomstrated Contrast or non contrast
77
What are some disadvantages of CT
Pt must be stable Image interpretation may take longer - radiologist report Ionising radiation Pt need to lie still in the scanner
78
What makes you suspect a fracture
Hx Trauma Sig Swelling Obvious displacement Pain Suspicious of scaphoid fracture
79
What might ongoing bone pain be
lytic lesion
80
What are some indications of limb XR
Exclude fracture Exclude dislocation Assess bone manipulation Clinical suspicion of infection Ongoing symptoms suggestive of undiagnosed pathology
81
What are some advantages of XR limb
``` Cheap Accessible Good for fracture Dislocation Joint spaces Bone thickening or thinning Foreign body detection ```
82
What is the use of CT and MRI in limb imaging
CT -detailed anatomical imaging - complex fractures MRI -Soft tissues -
83
What nerve is vulnerable in anterior dislocation
axillary - supplies deltoid - lost abduction
84
What causes posterior dislocation
Muscle spasm - electrocution - epilepsy - alcohol
85
What is the name of the sign for posterior dislocation
Light bulb sign | -loss of asymmetry of humeral head
86
How is the y view taken
from medial scapula towards glennoid fossa Arm extended
87
What nerve is at risk in humeral fracutres
radial nerves runs in a spiral groove | -test wrist extension
88
What is a colles fracture
radius fracture with dorsal displacement - FOOSH - Pain - Deformity Most common distal wrist fracture
89
What are the associated morbidities of colles fracture
median nerve injury carpal ligament injury Compartment syndrome
90
What are the associated complications of a Smith's fracture
Distal radius fracture and volar displacement falling on a bent wrist
91
How do you anaethetise a fracture site
Haematoma block - LA into haematoma - Aspirate, inject, spread around fracture site
92
Why is suspected scaphoid fracture so important
Avascular necrosis - scaphoid supplied distally first - lots of avascular articular surface
93
What is an open book fracture
Pubic symphesis translated laterally
94
What is the prognosis of a vertical shear fractures
Many venous plexi in the pelvis Major pelvic fracture has high mortality
95
Describe the arterial supply to the femoral head
Branch of profunda femoris (branch of femoral artery) - medial cirumflex - lateral circumflex Inferior gluteal branch (internal iliac) Dislocation, fracture can disrupt blood flow
96
How many views do you need of the femur
2 AP | -make sure whole femur imaged
97
What is the classification system used for femur fractures
Garden - incomplete subcapital - complete, non-dislocated - complete, partially displaced - complete, fully displaced fracture
98
What are the ottawa knee rules
XR indicated: -isolated patella tenderness -Fibular head tenderness -inability to flex knee to 90 degrees -Patient can't bear weight for at least 4 steps (immediately after injury and on examination)
99
Why do tibias break
direct blow or fall
100
What is at risk in a fibular neck fracture
common peroneal nerve
101
What must you assess in medial mallelous fracture
proximal fibular fracture | -transmitted force
102
When should the ankle be imaged
Unable to weight bear for four steps Tenderness over posterior surface of the distal 6cm lateral or medial malleolus
103
What is the sensitivity of CT post SAH
12 hours - 98% | 24 hours -93%
104
What are some indications to CT Head after head injury
GCS < 13 on initial assessment in AE GCS < 15 2 hours after assessment in AE Suspected open or depressed skull fracture Sign of basal skull fracture Post-traumatic seizure Focal neurological deficit More than 1 episode of vomiting
105
What is OM best for and what is OM30 best for?
OM -frontal and maxillary bones - zygmoatic bone and zygmomatic arch - dens - frontal, ethmoid, maxillary sinuses - mandible OM30 - superior visualisation of maxillary sinuses - inferior orbital rims - features of mandible
106
What are some uses of contrast fluoroscopy
``` Coronary angiography Micturating cystourethrogram IV pyelogram Sialogram Cholangiography ```
107
What are some negative effects of contrast
Hypersensitivity - anaphylaxis - bronchospasm - angio-oedema - urticarial reactions SE -Nausea Contrast induced nephropathy
108
What are some risk factors for negative reaction to contrast
``` CKD Elderly Diabetic patients Cardiac impairment Atopy ```
109
What do you measure in contrast imaging to predict negative outcome
``` Creatinine eGFR Sats Urine output Drug card ```

BSc Medical Imaging (5 decks)

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