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Diagnostics > Radiology > Flashcards

Radiology Flashcards

1
Q

To which side of the chest is the mediastinum deviated in a tension pneumothorax?

A

Pushed to the other side - controlaterlal to the pneumothorax

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2
Q

Where may the hemidiaphragm be pushed into in a tension penumothorax?

A

The hemidiaphragm on the side of the tension penumothorax may be pushed into the abdomen (can sometimes invert!)

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3
Q

List three main categories of penumothorax

A

Spontaneous (Primary/Secondary)

Iatrogenic
Traumatic

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4
Q

List some conditions that may be associated with primary spontaneous
pneumothorax?

A

Marfan’s Syndrome
Alpha-1 Antitrypsin Deficiency
Ehler’s Danlos Syndrome

(Though usually patients with no underlying lung disease)

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5
Q

What type of pneumothorax may be associated with underlying lung conditions?

A

Secondary spontaneous pneumothorax

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6
Q

What injury is a common cause of traumatic pneumothorax?

A

Rib fracture

Any sort of chest-wall penetrating injury

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7
Q

Give some examples of interventions that may cause iatrogenic pneumothorax?

A 
Lung Biopsy
Chest wall biopsy
Supraclavicular fossa biopsy (lymph nodes)
Liver/renal biopsy
Central lines
Subclavian or IJV
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8
Q

In a chest X-ray, how can you tell if the torso is rotated?

A

Looking at the clavicles - compare to the spinous processes

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9
Q

Where should the needle be inserted in a tension pneumothorax?

A

Second intercostal space, midclavicular line

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10
Q

In what ways are penumothroax measured?

A
  • From the apex

- From the edge of the chest wall, at the level of the hilum

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11
Q

What is the rough cut-off point for large vs small pneumothorax?

A

~2cm

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12
Q

List some pitfalls to pneumothorax identification

A
  • Skin folds

- Bullous emphysema

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13
Q

What is the functional unit of the lung?

A

Secondary pulmonary lobule

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14
Q

What places in the secondary lobules can fluid in pulmonary oedema collect?

A
  • In the alveoli themselves

- In the interstitial space

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15
Q

What are the broad categories of cause of pulmonary oedema?

A
  • Cardiogenic

- Non-cardiogenic

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16
Q

Give some examples of cardiogenic causes of pulmonary oedema?

A

LHF
Valvular disease
Cardiomyopathies
Myocarditis

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17
Q

Give some examples of non-cardiogenic causes of pulmonary oedema?

A 
Fluid overload
Drug-induced causes
-ARDS
-Transfusion-relared
-High-altitude oedema
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18
Q

Give some examples of CXR findings in pulmonary oedema

A
  • Cardiomegaly (though not always present)
  • Upper zone pulmonary venous diversion
  • Interstitial fluid accumulation - Kerly B lines
  • Alveolar oedema - Batwing opacification
  • pleural effusions
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19
Q

What orientation should an Xray be for measuring cardiothoracic ratio (CTR)?

A

PA

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20
Q

What percentage should the heart normally be in CTR?

A

No more than 50%

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21
Q

How many lobes are in the right lung?

A

3

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22
Q

How many lobes are in the left lung?

A

2

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23
Q

What may happen to the rest of the hemithorax in lobar collapse?

A

-The volume loss gets taken up by something else (diaphragm) or lobar expansion

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24
Q

In a chest radiograph, if the left diaphragm isn’t visible where is the site of pathology?

A

Left lower lobe of lung

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25
Q

In a chest radiograph, if the right diaphragm isn’t visible where is the site of pathology?

A

Right lower lobe of lung

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26
Q

In a chest radiograph, if the left cardiac border isn’t visible where is the site of pathology?

A

Left upper lobe of lung

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27
Q

In a chest radiograph, if the right cardiac border isn’t visible where is the site of pathology?

A

Middle lobe of left lung

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28
Q

What may air spaces be filled with in lung consolidation?

A

Pus
Fluid
Blood
Tumour

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29
Q

What is lobar collapse usually caused by?

A

Obstruction is large airway (by tumour or dense secretions)

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30
Q

What may happen to the volume of other lobes in lobar collapse?

A

The other lobes may hyperinflate (not always!)

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31
Q

What further investigation may be needed following consolidation or collapse?

A

Further imaging

  • CXR
  • CT (identify obstructing lesion)

Bronchoscopy (identify obstructing lesion, biopsy tumour)

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32
Q

In what conditions may a supine abdominal X-Ray be helpful?

A
  • Known sigmoid volvulus
  • Possible toxic megacolon in known UC, confirming obstruction
  • Renal calculi
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33
Q

What conditions may ultrasound of abdomen and pelvis be useful for?

A
  • Acute cholecystitis
  • Ovarian pathology - torsion, haemorrhagic cyst, ectopic pregnancy
  • Acute appendicitis - to rule out gynae pathology
  • Renal calculi +/- hydronephrosis
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34
Q

In what situations would CT abdo be the investigation of choice?

A
  • Identifying sealed perforations
  • Suspected bowel ischaemia
  • Establishing site and cause of obstruction
35
Q

Give some examples of causes of generalised pain in the acute abdomen

A
  • Intra-abdominal haemorrhage
  • Vicous organ perforation
  • Mesenteric ischaemia
  • Bowel obstruction
36
Q

What does perforation cause?

A

Peritonitis (Inflammation of the peritoneum)

37
Q

What are some clinical signs of peritonitis?

A
  • Rigid abdomen
  • Involuntary guarding
  • Patient lying completely still (to avoid exacerbating pain)
  • Deranged observations, inflammatory markers and lactate
38
Q

What may cause perforation?

A
  • Gastroduodenal ulcer

- Colonic diverticulitis

39
Q

What would be the first line imaging test for perforation?

A

Erect Chest Xray

(Sensitive to free intra-peritoneal gas)

Can then be followed by CT abdomen/pelvis if confirmed

40
Q

What happens to the proximal portion of the bowel in bowel obstruction?

A

Progressive dilatation

41
Q

What are the signs and symptoms of bowel obstruction?

A
  • Colicky generalised abdominal pain
  • Nausea and vomiting
  • Absolute constipation (no gas or faeces)
  • Distended abdomen
  • Absent bowel sounds
  • Deranged observations, inflammatory markers and lactate
42
Q

What is the test of choice for bowel obstruction?

A

CT Abdo/Pelvis

43
Q

What is the normal maximal diameter of the small bowel?

A

3cm

44
Q

What is the normal maximal diameter of the large bowel?

A

6cm

45
Q

What may cause small bowel obstruction?

A

Adhesions
Hernia

Strictures
Tumour (benign or malignant)
Intussusception
Volvulus
Foreign bodies
46
Q

What may cause large bowel obstruction?

A

Tumour
Volvulus

Diverticular disease
Hernia
Foreign body
Extensive faecal impaction

47
Q

What would signs and symptoms be of intra-abdominal haemorrhage?

A
  • Generalised abdominal, back pain/loin pain (often mistaken for renal colic!)
  • Collapse
  • Hypotensive
  • Pulsatile abdominal mass
  • Lower limb ischaemia
48
Q

What is the gold standard imaging for intra-abdominal haemorrhage?

A

CT abdomen and pelvis (arterial phase)

49
Q

What are the signs and symptoms of mesenteric ischaemia?

A
  • Generalised abdominal pain out of proportion to examination
  • Abdominal examination often unremarkable
  • High lactate
50
Q

What are some risk factors for mesenteric ischaemia?

A
  • Arteriopaths ie angina, previous MI, peripheral vascular disease
  • AAA, AF, heart valve intervention, DVT, PE
51
Q

What are the causes of mesenteric ischaemia?

A
  • Mesenteric artery thromboembolism
  • Non-occlusive ishcaemia - related to hypotension
  • Mesenteric venous thrombosis - rare! Like DVTs but in the veins supplying the bowel
52
Q

What imaging should be used in suspected mesenteric ischaemia?

A

CT abdomen and pelvis (arterial and venous phases)

-Mesenteric angiogram

53
Q

List some conditions in which pain may localise to the Right Upper Quadrant of the abdomen

A 
Cholcystitits
Pyelonephritis
Ureteric colic
Hepatitis
Pneumonia
54
Q

List some conditions in which pain may localise to the Left Upper Quadrant of the abdomen

A

Gastric Ulcer
Pyelonephritis
Ureteric colic
Pneumonia

55
Q

List some conditions in which pain may localise to the Epigastric region of the abdomen

A

Peptic ulcer disease
Cholecystitis
Pancreatitis
Myocardial infarction

56
Q

List some conditions in which pain may localise to the Left Lower Quadrant of the abdomen

A 
Diverticulitis
Ureteric colic
Inguinal hernia
IBD
UTI
Gynaecological
Testicular torsion
57
Q

List some conditions in which pain may localise to the Right Lower Quadrant of the abdomen

A 
Appendicitis
Ureteric colic
Inguinal hernia
IBD
UTI
Gynaecological
Testicular torsion
58
Q

List some conditions in which pain may localise to the Peri-umbilical Region of the abdomen

A

Small bowel obstruction
Large bowel obstruction
Appendicitis
Abdominal aortic aneurysm

59
Q

What are the features of Charcot’s triad (associated with ascending cholangitis)?

A

Fever
RUQ pain
Jaundice

60
Q

What are the features of Raynaud’s Pentad (associated with obstructive picture of cholecystitis)?

A 
Fever
RUQ pain
Jaundice
Shock (Hypotension)
Altered mental status (Confusion)
61
Q

What is the preferred initial imaging method for gallstone investigation?

A

Ultrasound

62
Q

What is the most common imaging modality of choice used in renal colic?

A

CT-KUB

63
Q

What are the diagnostic criteria of pancreatitis?

A
  • Acute onset of severe epigastric pain (relieved by bending forwards)
  • Elevated amylase.lipase
  • Imaging features consistent on CT, MRI or US
64
Q

What is the imaging modality of choice in peptic ulcer

A

CT

65
Q

How is diagnosis made in appendicitis?

A

Clinically (Imaging is not essential)

66
Q

Whey may US be used in suspected appendicitis?

A

For ruling out gynaecological disease

67
Q

What test should be given in a female with reproductive age with RLQ pain?

A

Urine pregnancy test

68
Q

What would be the presentation of tubal ectopic pregnancy?

A
  • Afebrile premenopausal female
  • RLQ/LLQ pain
  • Vaginal bleeding
69
Q

What are the signs and symptoms of diverticulitis?

A

Left iliac fossa pain and tenderness
Peri rectal bleed
Fever
Raised inflammatory markers

70
Q

What bile ducts join to form the common hepatic duct?

A

Left bile duct

Right bile duct

71
Q

What bile ducts join to form the common bile duct?

A

Cystic duct

Common hepatic duct

72
Q

Where does the ampulla of vater open into?

A

Second part of duodenum

73
Q

What would be the first line investigation for suspected gallstones?

A

Ultrasound

74
Q

What would be the first line investigation for suspected cholecystitis?

A

Ultrasound (Same day!)

75
Q

What comprises Charcot’s Triad?

A

Pain
Fever
Jaundice

76
Q

What condition is associated with Charcot’s triad?

A

Ascending cholangititis

77
Q

How does water (fluid) present in a MRCP?

A

Water is bright

T2 weighted MRI

78
Q

What should be the initial investigation for pancreatitis?

A

Ultrasound (To look for gallstones)

79
Q

What imaging modality may be useful for assessing pancreatitis severity and complications?

A

CT

80
Q

What is MRCP useful for?

A

Assessment of bile ducts and potential obstructions

81
Q

What defines contrast induced kidney injury?

A
  • Serum creatinine rise >26 micromoles within 48hrs
  • Serum creatinine rise >1.5 fold from baseline within one week post scan
  • Urine output <0.5 ml/kg/hr for 6 hours
82
Q

What is measured in calculating eGFR?

A

Creatinine

83
Q

What are some examples of symptoms of contrast reactions?

A
  • Nausea/Vomiting
  • Urticaria
  • Bronchospasm
  • Laryngeal oedema
  • Hypotension
  • Generalised anaphylaxis
84
Q

List some main indications for CT

A
  • Head trauma
  • General trauma
  • Acute surgical abdomen
  • Post-operative surgical abdomen/surgical complications
  • Aortic dissection
  • Stroke
  • Intracranial haemorrhage
  • Pulmonary embolism
  • Cancer detection and staging

Diagnostics (5 decks)

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