Radiology Flashcards
(123 cards)
1
Q
The ASIS is the site of origin of the _____. The AIIS is the site of origin of the _____.
A
Sartorius (both have 2 Ss)
Rectus Femoris
2
Q
The greater trochanter of the femur is the site of insertion of the ____ and _____ and the lesser trochanter is the site of insertion of the ______
A
Gluteus medius and minimus
Iliopsoas
3
Q
Hips tend to dislocate _____. _____ could also be injured by this dislocation.
A
Posteriorly (slide 49)
The sciatic nerve
4
Q
Sholders tend to dislocate ____
A
anteriorly
5
Q
The ligamentum teres originates from the ____ and attaches it to the _____
A
femoral head
acetebulum
6
Q
In an acetebular labral tear, the joint space appears _____
A
as areas of bright signal. Normal= dark
slide 50
7
Q
A 5-8 year old might have what disease of the hip?
A
Avascular necrosis of the femoral head. Legg-perthes disease.
Flattening and increased sclerosis of the femoral head.
Slide 52
8
Q
A 13-16 year old going through puberty might have what disease of the hip? What type of salter fracture is this? What predisposes a child to this? Is there a Hx of trauma? What does the X-ray look like? How often is this bilateral?
A
SCFE- slipped capital femoral epiphysis
Salter I (only physis/growth plate affected)
Obesity
No trauma
Ice cream falling off of an ice cream cone
20% of pts
Slide 52
9
Q
What pathology of the hip might a newborn have? How can you tell if this happened in utero?
A
Developmental dysplasia of the hip. Hip is dislocated.
The acetebulum is not curved and appears steep on X-ray-> increased ace tabular angle (slide 53, on L)
10
Q
What is the difference between dislocation and subluxation?
A
Whole bone is out of joint space in dislocation. Only part of bone is out in subluxation
11
Q
A motor vehicle accident could cause a ____ of the distal femur.
This specific case means there’s a fracture of the ____ and ____. If this occurs in a child, what might you be concerned with?
A
Salter II fracture (slide 56)
Metaphysis and physis
A fracture that enters the growth plate (physis) could cause abnormal growth later in life (30% of the time)
12
Q
What is the most common type of Salter-harris fracture? How about the next most common?
A
Type II (of the physis and metaphysis) Type IV- of the epiphysis, physis, and metaphysis
13
Q
An ACL tear looks like ____ on MRI
A
a mess and seems lax. You can’t really make out the ACL (slide 60)
14
Q
A meniscal tear looks ____ on MRI
A
bright in what should be a dark space
15
Q
MRI of a torn quadriceps tendon looks like…
A
discontinuity and increased signal (slide 61)
16
Q
If the patella is upwardly or downwardly displaced, the ____ might be torn. On MRI, you can see____
A
Patellar tendon
Increased signal in the usually dark space around it
17
Q
A jones fracture is a ____. It likely stems from ____.
What is the significance of this?
A
Proximal fracture of the base of the 5th metatarsal
A twisting inversion injury (rolling your foot)
There’s an increased incidence of non-healing due to a poor blood supply
18
Q
an MRI of an achilles tendon tear shows ____
A
Increased signal, irregularity, and discontinuity (slide 65)
“Mush”
19
Q
The tendon of the posterior tibial muscle runs behind the lateral malleolus with….
A tear of this tendon shows ___ on MRI.
A Hx of ___ would make you consider this Dx.
A
the flexor digitorum tendon, a vessel, a nerve, and the flexor hallucis longs tendon.
Hyperdensity and increased signal in a space that’s usually black
Acute flat foot.
20
Q
Osteoarthritis is due to _____. It typically occurs in ____ joints and causes _____ due to _____
A
Wear and tear Weight-bearing joints Irregular narrowing of the joint space The formation of more bone including visible osteophytes- HALLMARK of this disease (slide 69)
21
Q
Rheumatoid arthritis is associated with ____. Bones become more lucent due to ____. It can be seen in _____ joints.
A
Inflammation
erosion/demineralization
Both weight-bearing and non-weight bearing joints
22
Q
Pt comes in complaining of shoulder pain. He fell on his outstretched arm. See slide 72. What’s your Dx?
A
Anterior glenohumeral dislocation
23
Q
A QB comes in with shoulder pain after a particularly hard tackle (slide 74). Whats your Dx?
A
AC joint separation
24
Q
A full thickness tear looks like ____ on MRI
A
hyper density that goes all the way through something that is usually black (slide 77)
25
A joint effusion in the elbow will have 2 signs on X-ray:
| On CT, this looks like...
The anterior sail sign and the posterior fat pad sign
| Fat (dark) being pushed out of the joint space [by fluid]
26
A supracondylar fracture is common in which general age group?
Kids
27
Avascular necrosis can result if you miss a fracture in one of these 3 locations:
Femoral neck, scaphoid, talar neck
28
What are the carpal bones, starting from the radial head:
scaphoid, lunate, triquetrum, pisiform; trapezium, trapezoid, capitate, hamate
29
What does avascular necrosis look like on X-ray?
increased density in a bone (slide 84)
30
A fall on an outstretched hand, in which the radius and ulna move dorsally, can lead to a ____ fracture. If they move ventrally, that's called a ___ fracture.
Colles or dinner fork (slide 86)
[They move together b/c of the TFCC ligament]
Smith
31
If the carpal bones are not all the same distance apart, this could indicate a ___
torn ligament
32
A boxer's fracture is a fracture of ___
the neck of the 5th metacarpal. It's an angulated fracture (slide 89)
33
A hangman's fracture is a fracture through the ____ of ____ vertebra. It is typically a(n) _____ injury.
```
pars interarticularis/ lamina/ posterior part
C2
acute hyperextension (i.e. due to hitting the dashboard in a MVA)
```
34
A teardrop fracture is seen in ____ and _____ injuries. It occurs along the anterior part of the vertebral body (slide 114)
Hyperextension and hyperflexion injuries
35
Pt presents with a Hx of being punched in the face and complains of pain and diplopia that is worse when looking up. What's a potential Dx?
Orbital floor or blowout fracture (slide 116)
36
Why would a pt with an orbital floor fracture have trouble looking up?
The inferior rectus muscle can get trapped by the fracture
37
A patient presents with Horner's syndrome (ptosis, anhydrous, mitosis). You conclude that there is a blockage in the _____. A tumor that could cause this is a _____
```
Sympathetic chain
Pancoast tumor (slide 118 for x-ray)
```
38
Pt presents with facial pain and congestion. On PE, you find swollen turbinates and L sided tenderness to palpation on maxilla. What is a possible Dx?
```
Maxillary sinusitis (slide 123)
Air-fluid level indicates acute sinusitis
```
39
Croup is typically seen in children aged ___ to ___. Sx include ____. Etiology is often _____. An A-P x-ray will show a ____
6 months-6 yrs
Barking cough, hoarseness, stridor. Worse at night
Viral (75%)
Steeple sign (slide 119)
40
Epiglottitis is usually seen in children ___ to ____. Sx include _____. Etiology is usually due to____. On a lateral X-ray, the _____ sign can be observed.
2-7 years old
Hoarseness, stridor, drooling. Anxious pt with outstretched neck.
H. influenza or other bacteria
Thumbprint (slide 121)
41
The circle of willis is composed of...
The anterior cerebrals, anterior communicating a., posterior communicating a.s, and posterior cerebrals
42
The internal carotid can be divided into 4 portions. Name them, beginning with the most inferior
Cervical, petrous, cavernous, supraclinoid
43
The internal carotid gives off two main cerebral arteries:
| Name 2 other arteries commonly associated with the internal carotid
```
The anterior and middle cerebral
The ophthalmic (off of the internal carotid) and the pericallosal (off of the anterior cerebral)
```
44
The 2 vertebral arteries join to form the ____ which gives off ____, _____, and ____ before becoming the 2 posterior cerebral arteries
Basilar a
Pontine Br.
AICA
Superior cerebellar
45
PICA comes off of the ____ artery
Vertebral
46
An intracerebral hemorrhage is a bleed into the brain (slide 132). Name a few DDxs
What does it look like on MRI?
How can you tell if it has mass effect?
```
Neoplasm
Infarction
Vascular malformation.
Aneurysm
Trauma
Increased attenuation
Look at the ventricles
```
47
What are the most common sites of brain aneurysms?
The anterior communicating, posterior communicatings, and middle cerebrals in that order
48
An occlusion of a cerebral artery can lead to...
a stroke
49
What are the 4 lobes of the brain?
Frontal, temporal, occipital, parietal
50
The lateral ventricles empty into the 3rd ventricle via the ____. The 3rd ventricle connects to the 4th ventricle via the ____. The 4th ventricle empties via 3 foramens with 2 names:
The foramen of monroe/intraventricular foramen
The cerebral aqueduct/ aqueduct of sylvius
The foramens of magendie (1) and lushka (2)
51
On MRI, T1 means fluid is ____. T2 means fluid is ____
T1= dark
T2= bright
1 if by land, 2 if by sea
52
Describe what happens in an arnold chiari malformation.
The cerebellum occludes the ventricles so CSF builds up in them and they appear dilated (slide 140)
53
A acoustic neuroma commonly occurs in the ___
Cerebellopontine angle (slide 141)
54
What is often described as the worst headache of your life?
| What could cause this?
A subarachnoid hemorrhage. (slide 142)
| A ruptured aneurysm
55
Dilated lateral ventricles are commonly seen in...
Hydrocephalus (slide 143)
56
An epidural hematoma is a/n (arterial/venous) bleed. A common vessel involved is the ____. On CT, it appears ____. It has large mass effect and puts pressure on the brain. Tx is to ____
```
arterial
middle meningeal a.
Bi-convex
Evacuate the blood from the epidural space- Surgical emergency!
slide 144
```
57
A subdural hematoma is a/n (arterial/venous bleed). On CT, it appears _____. It has a mass effect on the brain. It occurs (faster/slower) than an epidural hematoma.
Venous
Concave
Slower
slide 145
58
An asymmetric wedge-shaped region of low attenuation is consistent with...
An infarct (i.e. stroke), especially if it occurs in the territory that one vessel perfuses
59
What are Dawson's fingers? What do they represent and what disease are they specific for?
areas of increased signal perpendicular to the lateral ventricle through the corpus callosum on a sagittal MRI image
Demyelinating plaques
Multiple sclerosis
60
A pt with a Hx of chronic alcohol abuse may have a liver that looks ____ compared to a normal liver, which has a smooth margin. Other findings in this pt may include_____. The Dx could be_____
small and scarred
Splenomegaly, varices, ascites
Cirrhosis of the liver (slide 168)
61
Multiple lesions in the liver (slide 169) with a Hx of colorectal cancer suggests...
metastases to the liver
62
an ultrasound of a pt with cholecystitis will show...
Gallbladder wall thickening, gallstones, possibly fluid around the gallbladder
63
A HIDA scan of the same pt (done by injecting radioactive dye into a vein, which will be conjugated with bile) will show...
an absence of the gallbladder silhouetted against the liver (slide 171).
Can also see an obstruction of fluid movement
64
If stranding is visible on an MRI, it indicates....
inflammation and edema
65
A pt with a Hx of alcohol abuse presents with abd pain. He/she has elevated lipase and amylase levels and an MRI shows stranding of the pancreas. What Dx are you thinking of?
Pancreatitis (slide 173)
66
Left flank pain should make you consider ___ in your DDx
A kidney stone
67
An ultrasound of a pt with hydronephrosis will show...
A dilated renal pelvis and calyces system (slide 178)
68
On CT without contrast, a kidney stone may cause _____ in the patient
A bigger kidney (renal asymmetry) with a dilated renal pelvis (hydronephrosis) and peri-renal stranding on the side of the stone. Stone may be visible too (slide 180)
69
On MRI, a lesion that has an outer margin that enhances with contrast is probably ____
It is also called a...
An abscess/from an infectious process (slide 91)
| Ring-enhancing lesion
70
Opacity in a pts chest on a chest x-ray should make you consider ___ in your DDx.
Infection, edema, pneumonia if it's localized
71
Apical lung parenchymal disease with consolidation and/or opacity on a chest x-ray should make you consider ___ in your DDx.
You should ___ as a next step.
Tuberculosis (the most common cause of infectious disease-related mortality worldwide)
It may also present as lymph node involvement or a miliary pattern on chest x-ray.
Call infection control.
72
An MRI that shows edema around a bone plus bony destruction/air in the bone should make you consider a Dx of ___. What findings on H & P might suggest this Dx?
Osteomyelitis (an infection within a bone).
PMH of diabetes, PE finding of ulceration near the site of infection
(slide 94)
73
What does TIPS stand for (it's an IR procedure)? What occurs during this?
Transjugular intrahepatic portosystemic shunt
| The radiologist connects the R hepatic v and the R portal v with a stent to reduce portal hypertension
74
The R coronary a. comes off of the aorta and travels _____. It gives off the ____ and typically also the ____ which is on the posterior aspect of the heart.
B/wn the RA and the RV (slide 102)
Acute marginal a.
Posterior descending
(slide 99)
75
The L coronary a. comes off of the aorta. It then gives off the LAD which travels ____ and gives off ____. The L coronary is then referred to as the ____ which gives off_____.
```
Along the IV septum on the anterior surface of the heart
Diagonal branches (both have Ds in them)
Circumflex a.
Marginal branches
(slide 99)
```
76
COPD is a diagnosis that encompasses a few other diseases. Pts with COPD who have emphysema are commonly referred to as ____ because ____. Pts with COPD who have chronic bronchitis can be referred to as ____ because _____.
Pink puffers- the pts can take air in, but can't blow it out (alveolar walls have been destroyed and no longer have elastic recoil)
Blue bloaters- pts are hypoxic and cyanotic and may have systemic edema due to R heart failure
77
COPD findings on x-ray include....
| What findings are specific for emphysema?
Hyperinflation/air trapping in the lungs manifested as flattened hemidiaphragms, an increased AP diameter of the chest, hyperlucency of the lungs (extra darkness), and a decreased TTD of the heart. Also may be able to see more than 10 ribs (slide 107)
Emphysema- may seen bulla (fusion of adjacent alveoli due to destruction of the lung) and avascularity in the peripheral 1/3 of the lung (slide 110)
78
What do atelectasis on a chest x-ray indicate?
Incomplete expansion or loss of volume of a portion of the lung. Can be seen in pts with emphysema (slide 111)
79
The calcaneus is on the same side as which tarsal bone? How about the talus?
Calcaneus- cuboid
| Talus- navicular
80
In a CT scan, what you see on the L is on the pt's ...
Right
81
Midshaft of the bone is the ....
Closer to the growth plate is the...
The growth plate is....
The articular surface is the ....
Diaphysis
Metaphysis
Physis
Epiphysis
82
The lateral meniscus is ...
| How do the sizes of the horns compare?
C shaped. Anterior and posterior horns are the same size.
83
Costophrenic angles should be ____. If they are blunted, what does this indicate?
Sharp
| There is fluid in the lungs (i.e. from a pleural effusion) (slide 9)
84
The heart should be ____ or less than the transthoracic diameter. A heart greater than this is considered _____.
50%
| Cardiomegaly (slide 5)
85
A silhouette sign is when...
There is an opacity in the middle lobe of the right lung or the lingual of the L lung that obscures the cardiac border on a sagittal CXR
86
Name 3 Ddx for opacity in the lung:
Pneumonia (especially if is assoc with fever), pulmonary edema (if Hx of CHF), hemorrhage (if pt presents coughing up blood)
87
The two fissures of the lung are the ___ and the ____ fissures
Major and minor
| Or major and horizontal
88
A CXR of a pt with a pleural effusion will show...
| Turning this patient onto this side will show ____ on CXR
Blunting of the CP angle with possible slight elevation of the hemidiaphragm (slide 9)
Movement of the fluid to the lowest point on the patient; "dependent layering" of fluid (slide 10)
89
On CT, a pleural effusion would show fluid _____. A pneumothorax would show air _____
Posteriorly
| Anteriorly
90
```
On CT, the houndsfield units for ___ are....
Air
Fat
Fluid
Soft tissue
Bone
```
```
Air- -1000
Fat- -100
Fluid- 0-20
Soft tissue- 30-40
Bone- +1000
```
91
A split-pleura sign, with gas in a pleural effusion is indicative of ___
empyema (pus in the pleural cavity, slide 13)
| air in something indicates an infection
92
A CXR can suggest pneumothorax if...
No lung markings are visible (slides 14 and 15)
93
A tension pneumothorax appears as .... on CXR. What are some physiologic consequences of this? How would you treat it?
A large collection of air on one side with an inversion of that hemidiaphragm and wider intercostal spaces on that side. Also, a mediastinal shift to the opposite side.
Cardiac and respiratory problems, including decreased venous return
Decompress with a chest tube @ now
94
A CXR of a pt with CHF will show...
Cardiomegaly, bilateral blunting of CP angles (due to bilateral pleural effusions), cephalization of the vessels in the upper lobes of the lungs (vessels are more prominent due to redistribution of fluid), Kerley B lines visible (perpendicular to chest wall, indicates fluid in interstitial space due to high pulm vasc pressure). Slides 18 + 19
Cephalization of upper lobe vessels at pulm v pressure 12-14 mm Hg. Kerley B lines indicate pressure > 20 mm Hg
Need 125 ccs of fluid to visualize CP angle blunting
95
If a pt presents with a Hx of trauma (i.e. motor vehicle accident) and has a widened mediastinum on CXR, consider....
Aortic injury of some type
| Slide 21
96
An aortic transsection tears through ___ layers of the aorta, commonly at the site of the ___. A dissection tears through ___ layers.
3 (all of the layers).
Ligamentum arteriosum, just distal to the sublclavian artery attachment (slide 22)
2.
97
A pt presenting with sharp pain between the shoulder blades should make you consider ...
This looks like ___ on CT
```
Aortic dissection (slides 23-25)
The patient has 2 lumens in the aorta
```
98
On CT, a pulmonary embolism can be described as...
Filling defects (something that displaces contrast) caused by pulmonary emboli in pulmonary arteries
99
```
Pneumoperitoneum is ....
It can present as....
How can this happen?
What is the best way to visualize this?
Is this a surgical emergency?
```
Air under the diaphragm
Chest or abd pain (slide 30)
Somewhere along the GI tract has been perforated
On X-ray, with the pt sitting up b/c air rises
Yes
100
On x-ray, ___% of gallstones can be visualized. ___ % of kidney stones can be visualized
What else can be seen?
10; 90
Anything metal (i.e. surgical clips)
Fibroids
(Slide 32)
101
Describe cholelithiasis on ultrasound:
You can see stones with acoustic shadowing in line with them
102
A HIDA scan can give you information on ____ because .....
Acute cholecystitis
You inject a radiopharmaceutical dye which should be conjugated into bile so it can be excreted. If you can't visualize the gallbladder, there must be a blockage of the cystic duct
103
Most cases of acute cholecystitis are due to...
Blockage of the cystic duct by a gallstone (95%)
104
Stranding ("dirty fat") on CT indicates:
inflammation, edema, swelling, infection
105
Describe appendicitis on CT:
Stranding can be seen around the appendix. It's bigger than usual (>6 mm) and has thicker walls too. May have fluid in it.
106
A pt with a pulsatile abd mass may have....
How is this defined on CT?
At what point is it repaired?
an abdominal aortic aneurysm (AAA)
Diameter of >3 cm (slide 43)
At 4-5 cm in diameter
107
Where do most AAAs occur? What do they look like on ultrasound?
Near the renal arteries
Diameter > 3 cm, hypoechoic mural thrombus within the aneurysm. If it ruptures, can see fluid or hematoma around the aorta (slide 45)
108
A 5 cm AAA has a ___% chance of rupturing within 5 years.
A <5 cm AAA has a ___% chance of rupturing within 5 years.
The average rate of increase per year is...
25%; 3%
| 2 mm/yr
109
What are some positives and negatives about ultrasound?
It's cheap and doesn't use radiation
| You need a skilled technician to get the images you want
110
The lower lobe of the lung goes up to about the ___ vertebrae
T4
111
The hamstring muscles originate from the ...
ischium
112
Bright on MRI indicates...
fluid, edema, inflammation
113
A bankhart lesion affects the shoulder. It is caused by ___ and results in____.
Repeated anterior dislocations of the shoulder
| Damage to the glenoid labrum
114
A hill-sachs deformity is..... It comes from ....
a depression in the posterior part of the humeral head
| Repeated anterior dislocations of the shoulder
115
If there's a question about rotator cuff muscles, the answer is probably...
Supraspinatus
116
Hemorrhage in the basal ganglia is probably due to...
hypertension
117
An endotracheal tube is more likely to go into the R or L lung by mistake?
R- it's shorter, wider and straighter
118
A pt complaining of reflux may have a ___
hiatal hernia (slides 156-7)
119
Small bowel has ____ which go all the way across. Folds in the large bowel are called ____
Plica circularis
| haustra
120
A soft tissue mass on plain film and a intraluminal mass on a barium enema in a child (3-9 mo old) may be ....
Hx may include...
```
bowel intususception (slide 164)
severe, intermittent colicky abd pain
```
121
A mechanical small bowel obstruction looks like ____ on X-ray. Pt Hx for this might include....
Multiple air-fluid levels on an upright film (slide 159, R)
| Abd pain, nausea, vomiting
122
Lumenal narrowing such as apple-core lesions of the colon may be due to...
Cancer, specifically carcinoma (slide 160)
123
What is your Ddx for all conditions?
```
NIVDICATE
Neoplasm
Infection
Vascular
Drugs
Idiopathic
Congenital
Alcohol
Trauma
Endocrine
```
