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diagnostic methods > quiz 1 > Flashcards

quiz 1 Flashcards

1
Q

what does PACS stand for?

A

picture archiving communications storage

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2
Q

what types of images can be stored through PACS?

A
  • xray
  • CT
  • MRI
  • US
  • fluoroscopy
  • nuclear medicine
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3
Q

advantages to x-rays

A
  • inexpensive
  • commonly used
  • can be obtained almost anywhere via portable devices
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4
Q

disadvantages to x-rays

A
  • uses ionizing radiation

- limited to 5 basic densities

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5
Q

5 basic densities

A
  • air
  • fat
  • soft tissue/fluid
  • calcium
  • metal
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6
Q

air on an x-ray

A
  • absorbs least amount of x-rays

- appears blackest

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7
Q

fat on an x-ray

A
  • gray

- slightly darker than soft tissue

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8
Q

soft tissue/fluid on an x-ray

A
  • both have same density on films

- cannot tell the difference between the two

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9
Q

calcium

A
  • most dense of naturally occurring materials

- absorbs the most x-ray

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10
Q

metal

A

absorbs all x-rays and appears whitest

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11
Q

requirements for production of x-rays

A
  • source of electrons
  • way to accelerate them
  • way to stop them
  • vacuum
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12
Q

x-rays are the initial imaging study of choice for what type of injury?

A

skeletal trauma

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13
Q

lateral x-ray position

A
  • 90 degrees to AP or PA

- decubitus is recumbent to horizontal beam

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14
Q

lateral decubitus x-ray position

A
  • used to see air/fluid levels
  • side up shows air
  • side down shows fluild
  • good for abdominal problems
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15
Q

oblique x-ray view

A
  • halfway between AP/PA and lateral view

- most extremity projections involve 3 views

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16
Q

x-ray projections

A
  • path of central ray as it exits and goes through patient to image receptor
  • AP/PA
  • axial
  • tangential
  • lateral
  • oblique
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17
Q

extremity pain with negative x-ray

A
  • treat with splint
  • f/u with ortho in 7-10 days
  • repeat x-rays may show cortical changes
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18
Q

underpenetrated film

A

appears too white, no goo range of densities and have blurring of interfaces

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19
Q

overpenetrated film

A

appears too black, no good range of radiological densities and absence of interfaces

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20
Q

what is the most important part of musculoskeletal evals?

A

history

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21
Q

reading the x-ray

A
  • viewed in anatomical position
  • your left is pts right
  • extremity work viewed fingers/toes up
  • assess adequacy of image
  • motion, magnification, distortion
  • geometric vs photographic properties
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22
Q

geometric properties

A
  • magnification- size
  • distortion
  • elongation- shape
  • foreshortening- shape
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23
Q

shape distortion

A
  • elongation occurs when tube or image receptor are improperly aligned
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24
Q

foreshortening

A

the further away from the plate an object is the bigger it looks

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25
Q

ABCS of reading the x-ray

A
  • A- adequacy, alignment
  • B- bones
  • C- cartilage
  • S- soft tissue
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26
Q

CT scan

A
  • uses rapidly spinning arrays of x-rays and computer processing to increase sensitivity of findings visible
  • cross-sectional imaging
  • mod expensive
  • uses much higher dose of ionizing radiation than x-ray
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27
Q

CT better than x-ray in:

A
  • ident subtle fractures
  • visualizing articular fx extension
  • assessing presence of articular stop off/gap
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28
Q

ultrasound

A
  • produces images using acoustic properties of tissues
  • no ionizing radiation
  • useful in eval of soft tissue and blood flow
  • less expensive
  • portable
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29
Q

MRI

A
  • produces images based on energy derived from H atoms

- atoms placed in magnetic field and subjected to RF pulsing

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30
Q

benefits of MRI

A
  • no ionizing radiation
  • good for neuro and soft tissue
  • helpful to dx occult fx
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31
Q

fluoroscopy

A
  • utilizes ionizing radiation to produce real-time visual of body
  • eval of motion, positioning, GI studies
  • eval of fx for reduction and placement of pins/ hardware
  • c arm support system
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32
Q

nuclear medicine

A
  • utilizes radioisotopes that have been given property target
  • pt is source of radiation
  • used for metastases, occult/stress fx, insufficiency fx
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33
Q

5 radiographic opacities

A
  • air
  • fat
  • soft tissue
  • bone
  • metal
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34
Q

CXR basics

A
  • AP or PA view
  • upright/ erect or supine
  • rotation
  • inspiration
  • penetration
  • all landmarks present
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35
Q

how to tell of CXR is rotated

A

should normally have equal distance between medial end of clavicle and midline of body

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36
Q

why inspiration is important for CXR

A
  • when you inspire diaphragm goes down
  • allows for better view of cavity
  • should be able to see 10 ribs
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37
Q

CXR penetration

A
  • appropriate- should barely see discs through heart
  • over- clearly see discs
  • under- don’t see discs at all
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38
Q

pitfalls to CXR interpretation

A
  • poor inspiration -> squish effect
  • over or under penetration
  • rotation -> shadow summation effect
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39
Q

normal CXR cardiac structure

A
  • central in younger infants and kids

- more on L in older infants and teens/adults

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40
Q

normal CXR cardiac size

A
  • measure R boarder of heart to midline
  • measure L boarder of heart to midline
  • these two spaces should be less than the wides space at bottom of lungs
  • greater than 50% of chest is abnormal
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41
Q

normal CXR diaphragm

A
  • rounded with sharp pointed costophrenic and costocardiac angles
  • right diaphragm is usually slightly higher
42
Q

lung inflitrate

A
  • collection of fluid within lung parenchyma itself
43
Q

lung effusion

A
  • collection of fluid in a potential space of the lung

- outside the tissue itself

44
Q

lobes of the R lung

A
  • upper, middle and lower lobes
  • upper- more anterior
  • middle- anterior and inferior
  • lower- posterior
45
Q

lobes of left lung

A
  • upper- anterior
  • lower- posterior
  • lingula- bottom part of L lobe
46
Q

radiopacity

A
  • whiteness

- increased density

47
Q

radiolucency

A
  • blackness

- decreased density

48
Q

mass

A
  • solid
  • generally well marginated
  • doesn’t belong
49
Q

lesion

A
  • poorly marginated

- doesnt belong

50
Q

alveolar pattern

A
  • fluffy, soft, poorly demarcated opacifications
51
Q

possible causes of alveolar pattern

A
  • pulmonary edema
  • viral pneumonia
  • pneumocystis
  • alveolar cell carcinoma
52
Q

interstitial pattern

A
  • consolidation of interstitial tissue

- looks like branching lines radiating towards periphery of lungs

53
Q

possible causes of interstitial pattern

A
  • interstitial pneumonitis

- pulmonar fibrosis

54
Q

vascular pattern

A
  • increase in size of arteries that extend into lung- pulmonary HTN
  • decreased size truncation, obliteration of pulm artery- embolus
  • lack of vascular marking in the periphery- pneumothorax
55
Q

atelectasis

A
  • loss of air
  • obstructive atelectasis- no ventilation
  • compensatory hyperinflation of normal lungs
56
Q

CHF CXR

A
  • large hila with indistinct markings
  • fluid in interlobar fissues
  • pleural effusions
  • alveolar edema (bat’s wings)
  • kerley b lines (interstitial edema)
  • cardiomegaly
  • dilated prominent upper lobe vessels
57
Q

boundaries of abdomen

A
  • superior = diaphragm
  • posterior = deep back muscles
  • lateral= abdominal muscles
  • inferior = pelvic floor
58
Q

9 quadrants of abdomen

A
  • R and L hypochondriac
  • epigastric
  • R and L lumbar
  • umbilical
  • R and L iliac
  • hypograstric
59
Q

4 quadrants of abdomen

A
  • R and L upper
  • R and L lower
  • more commonly used for physical exam
60
Q

pancreas

A
  • sits across 3 upper quadrants
  • also sits in extraperitoneal space
  • pancreatic duct joins common bile duct
61
Q

intraperitoneal anatomy

A
  • pancreatic tail
  • stomach
  • jejununum, ileum, cecum
  • transverse colon
  • sigmoid colon
  • liver, GB, spleen
62
Q

retroperitoneal anatomy

A
  • head/neck/body of pancreas
  • 2, 3, 4 part of duodenum
  • ascending and descending colon
  • rectum
  • Kidney, ureters
  • abdominal aorta
  • IVC
63
Q

adequate abdominal x-ray

A
  • aka KUB xray
  • includes diaphragm to top of symphysis pubis
  • see spinal owel
  • see SI joints
64
Q

what does string of pearls sign represent

A
  • mechanical bowel obstruction

- can indicate multiple air fluid levels

65
Q

coffee bean sign

A
  • sign of volvulus
  • volvulus= twisting of loop of bowel
  • appears as big loop of colon with central dividing line
  • can be caused by colon cancer or adhesions from surgery
66
Q

wilms tumor

A

tumor of kidney

67
Q

what disease is associated with string sign

A

Chron’s

68
Q

cortical bone

A
  • hard outer surface, compact bone
  • provides skeletal support
  • site of attachments for tendons and ligaments
  • disruption= fracture
69
Q

cancellous bone

A
  • spongy/ trabecular bone
  • found in ends of long bone, pelvis, ribs, skull, vertebrae
  • disruption= bone bruise
  • has red and yellow marrow
70
Q

osteoblasts

A

build bone

71
Q

osteoclasts

A

break down bone

72
Q

metaphysis

A
  • transition of diaphysis and epiphysis

- where growth plates are found

73
Q

diaphysis

A

shaft of bone

74
Q

epiphysis

A

end of bone

75
Q

tendon

A

muscle to bone

76
Q

ligament

A

bone to bone

77
Q

xrays used to evaluate

A
  • cortical integrity
  • articular surface congruity
  • joint space
  • osseous lesions
  • bone density (to lesser extent)
78
Q

what is the most important part of musculoskel exam?

A

history

79
Q

comminuted fracture

A

greater than 2 fracture fragments

80
Q

fracture types

A
  • transverse
  • linear
  • nondisplaced
  • displaced
  • spiral
  • greenstick
  • comminuted
81
Q

spiral fracture

A
  • spirals around the bone
  • very unstable
  • needs surgery
82
Q

butterfly fracture

A
  • subtype of comminuted

- wedge shaped fracture fragment along shaft of bone

83
Q

green stick

A
  • fracture does not go all the way through the bone
  • fx in convex cortex
  • usually in kids
84
Q

lucent fracture line

A
  • most fx appear this way
  • in nondisplaced fx lucent line is thin
  • visualization depends on angle of xray
85
Q

mach bands

A
  • appear at sites of cortex overlap between two bones
  • can also be due to skin folds
  • most common site- ankle
86
Q

sclerotic fx line

A
  • compression fx may appear this way

- most common in vertebral bodies and distal radius

87
Q

cortical buckling

A
  • buckling in absence of fracture line

- often in distal radius

88
Q

aspects of displacement

A
  • translation
  • angulation
  • rotation
89
Q

translation

A
  • line drawn down center of bone with fx
  • want to describe translation of distal fx compared to proximal
  • describe amount of translation as %
90
Q

displacement

A
  • loss of normal anatomical position
  • direction of displacement described using 2 views
  • described in terms of position of distal fragment compared to proximal
91
Q

angulation

A
  • line drawn down center of bone angled at the fracture
  • describe angulation of distal fracture compared to proximal
  • amount of angulation in degrees
  • need two views
92
Q

distraction

A
  • common with transverse fx from tension force
93
Q

avulsion

A
  • caused by abnormal tensile stress on ligaments or tendons

- typical in hand, feet, and pelvis

94
Q

transverse fx

A
  • perpendicular to long axis of bone
  • commonly caused by direct force
  • can also be due to tension force
  • most common in forearm and leg
95
Q

oblique fx

A
  • commonly cause by indirect force
  • unstable
  • usually requires surgery
96
Q

buckle fx

A
  • aka torus fx
  • incomplete fx
  • typically occurs after FOOSH
  • very stable
97
Q

salter harris system

A
  • evaluates epiphyseal plate fractures
  • common in kids
  • salter harris fx can result in premature closure of growth plate
98
Q

salter harris type 1

A
  • fx plane passes all the way through growth plate
  • not involving bone
  • good prognosis
99
Q

salter harris type 2

A
  • fx passes across most of growth plate and up through metaphysis
  • good prognosis
  • most common
100
Q

salter harris type 3

A
  • fx through growth plate and epitphysis and into joint

- poorer prognosis

101
Q

salter harris type 4

A
  • contiguous through metaphysis, physis, and epiphysis

- poor prognosis

102
Q

salter harris type 5

A
  • crush injury to physis
  • crushing does not displace growth plate but damages by direct compression
  • worst prognosis

diagnostic methods (6 decks)

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