Radiology Flashcards

1
Q

Smooth narrowing of lower oesophagus seen on barium swallow?
Most common complication
Mx?

A

achalasia
Nocturnal aspiration -> cough / pneumonia

Ballon dilation is mainstay

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2
Q

Mx of primary pneumothorax if >2cm

A

aspiration of up to
2.5 litres with a 16–18G cannula is recommended.

If aspiration fails, a chest drain
should be inserted.

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3
Q

Advice following primary pneumothorax ?

A

Possibility recur
stop smoking
Don’t fly for 1 week after full recovery

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4
Q

What to do with likely TB Dx ?
Ix before treatment?

A

Refer to resp
Notify public health
patient education - transmission / compliance

Full blood count, liver and renal function, colour vision and acuity before mx

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5
Q

bilateral hilar lymphadenopathy (BHL) with symmetrical
lobulated hilar enlargement. On CXR

In Pt with cough / swellings in neck / parotids

Dx?
Seen on biopsy

A

Sarcoidosis

Non caseating granuloma

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6
Q

Name 3 conditions that could cause a non caseating granuloma

A

sarcoid, tuberculosis, lymphoma and fungal infections

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7
Q

4 sarcoid Ix

A

CXR
CT
MRI brian
ECG
LuFT
LFT / *ALP
Serum ACE (often secreted by granulomas)
Serum Ca

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8
Q

Skin changes sarcoid

A

Erythema nodosum

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9
Q

Sarcoid Mx ? If fail ?

A

Oral steroids / conservative

[Defs steroids if:
a. Hypercalcaemia
b. Neurological involvement
c. Cardiac involvement
d. Ocular involvement (if topical steroids have failed).]

Immunosupressant Eg azathioprine,
methotrexate, cyclophosphamide,

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10
Q

Hyponatraemia in a euvolaemic patient with a suspected malignancy
What you thinking

A

Paraneoplastic syndrome -> SIADH

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11
Q

Sx of hypoNa

A

Often Asx
malaise, nausea, generalized weakness, confusion and anorexia

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12
Q

Most common Ca’s mets to brain

A

lung, breast, melanoma, renal and colon

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13
Q

Older man with sclerosis of right hip shown on XR
2 key DDx

A

prostate Ca
Pagets (hip is most common location)

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14
Q

3 phases of pagets ? What do you see in middle phase

A

osteolytic
mixed - cotton wool apperarnce on XR
osteoblastic

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15
Q

3 classic XR features of pagets

A

bony enlargement, coarse trabeculae and a thickened
cortex

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16
Q

Common mets to bone?

A

breast, prostate, lung
and kidney, but also thyroid, colon and melanoma

17
Q

Mx of ACUTE heart failure

A

Sit patient upright
• High flow oxygen by mask
• Intravenous access (bloods)
• Furosemide 40–80 mg i.v. slowly
• Diamorphine 2.5–5 mg i.v. (slowly, morphine is a venodilator and off loads the
heart, watch for respiratory depression).

18
Q

Name 3 XR signs of chronic heart failure

A

Cardiomegaly (>50%)

Upper zone vessel enlargement – a sign of pulmonary venous hypertension

Septal (Kerley B) lines – a sign of interstitial oedema – see next picture

Airspace shadowing – due to alveolar oedema – acutely in a peri-hilar (bat’s wing) distribution

Blunt costophrenic angles – due to pleural effusions

19
Q

Anaemia, raised inflammatory markers and white cell count, thrombocytosis, electrolyte
abnormalities, fever, tachycardia and hypotension, with a metabolic alkalosis

DDx

A

Toxic colitis - see thumbprinting on xray
Secondary to - inflammatory bowel disease (most likely),
infective, drug-induced or ischaemic colitis

20
Q

name 4 parts of Toxic colitis Mx

A

Urgent referral
to the gastroenterologists is required and review by the colorectal surgeons

stool specimens for culture + Clostridium difficile toxin

blood cultures.

IV fluids + electrolyte abnormalities,

blood transfusion if necessary,

Catheters - Fluid balance

NBM
NG tube - assist deflation of the bowel.

IV steroids 5 days - can add ciclospoin

IV ABx if indicated

Repeat AXR to monitor .

Sigmoidoscopy or proctoscopy may be required in this case if the cause of colitis is uncertain, as the rectal mucosa can be visualized and biopsies taken.

21
Q

Name 3 things that might predispose someone to toxic colitis

A

Drugs that slow gastric motility, such as opioids, anticholinergics (e.g. buscopan),
and antidiarrhoeals (e.g. loperamide), non-steroidal anti-inflammatory drugs
(NSAIDs), chemotherapy and barium enemas.

• Infection: Salmonella, Shigella, Entamoeba histolytica,
Campylobacter, Escherischia coli and Clostridium difficile (pseudomembranous colitis),
- ESP in IBD.
[Cytomegalovirus (CMV) causes colitis in patients with
immunodeficiency.]

• Hypokalaemia/hypomagnesaemia

• Patients who abruptly discontinue treatment with 5-aminosalicylic acid (5-ASA) or
corticosteroids may also induce toxic colitis

22
Q

3 signs AXR toxic colitis

A

Wall thickening due to mucosal oedema
• Loss of haustra
• Mucosal islands (oedematous mucosa surrounded by deep ulceration)
• Thumbprinting due to submucosal oedematous infiltration
• Dilated large bowel loops, more commonly of ascending and transverse colon
• Multiple loops of dilated small bowel, worrying sign of imminent perforation.

23
Q

3 Indications for surgery in toxic coltis

A

free air,
localized or diffuse peritonitis,
distension of the colon >10 cm,
major haemorrhage
uncontrolled sepsis

24
Q

OsteoA XR

A

LOSS
Loss of joint space
Osteophytes
Subcondral cysts
Sclerosis

25
Q

what is caplan syndrome?

A

RhA + lung nodules in the upper lobes and periphery of the lung which may cavitate

[There may be associated pulmonary fibrosis and a pleural effusion (usually unilateral)]

26
Q

Felty syndrome is?

A

RhA associated with splenomegaly, neutropenia and lymphadenopathy

27
Q

Why is atherosclerosis accelerated in RhA?

A

increased production of cytokines

28
Q

3 extra articular RhA

A

Lung nosules
splenomegaly, neutropenia and lymphadenopathyeye disease (e.g. keratoconjunctivitis
sicca), pericardial effusion, vasculitis, peripheral sensory neuropathy, carpal
tunnel syndrome, elbow nodules and periungal erythema

29
Q

Key SEs of DMARDS

A

myelosupression, hepatotoxicity, pneumonitis and proteinuria

30
Q

Tumor found in apical lung (superior sulcus) called?
What structures can it affect and Sx of these?

A

Pancoast tumour

Horner syndrome- compression of sympathetic plexus – this comprises ptosis, miosis and anhydrosis on the
affected side.
[There are other causes of Horner syndrome where the sympathetic plexus is involved in the neck or at the skull base (e.g. trauma, tumour)]

Pain/loss of function due to brachial plexus infiltration (look for small muscle
hand wasting).

Pain due to chest wall/rib invasion.

Hoarse voice due to infiltration of the recurrent laryngeal nerve.