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Vertical Curriculum > TCM 2 Exam - Second Semester > Flashcards

TCM 2 Exam - Second Semester Flashcards

(110 cards)

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1
Q

2 causes of dilated bowel

A
  1. Paralytic ileus

2. Bowel obstruction (small or large)

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2
Q

Radiologic findings of paralytic ileus?

A

Distended bowel with multiple air-fluid levels

Gas seen in the rectum

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3
Q

Common causes of paralytic ileus

A

Inflammation of the peritoneum (post-abdominal surgery, appendicitis, pancreatitis, etc.)

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4
Q

Normal postoperative ileus lasts ___ hours.

A

48

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5
Q

Common causes of small bowel obstruction (4)

A

Post-operative adhesions
Gallstone ileus
Intussusception
Tumors

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6
Q

Common causes of large bowel obstruction (3)

A

Colon cancer
Fecal impaction
Diverticulitis

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7
Q

How should bowel obstruction be evaluated with imaging?

A

Screening - plain film

CT of the abdomen

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8
Q

Radiologic findings of small bowel obstruction?

A

Multiple air-fluid levels
Stacked
Centrally located loops of intestine
Dilated small bowel greater than 3 cms visible with valvulae conniventes; colon not dilated
String of pearls sign (small bubbles trapped)
Absence of colon gas (collapsed colon)

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9
Q

Radiologic findings of large bowel obstruction?

A

Peripherally located distended bowel with haustral markings
Dilated loops of small and large bowel
No air distal to site of obstruction
Mass might be seen

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10
Q

Compare small vs. large bowel (location)

A

Small - central abdomen

Large - peripheral abdomen

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11
Q

Compare small vs. large bowel (appearance)

A

Small - valvulae conniventes crosses the entire width

Large - haustra, bubbly appearance of feces, diverticula

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12
Q

Findings of acute pancreatitis on abdominal CXR?

A 
Calcification
Mass from a pseudo cyst
Sentinel loop (dilation of duodenum)
Colon cut off (dilated colon to the mid-transverse colon, no air beyond the splenic flexure)
Diffuse ileus (small bowel dilation)
Left pleural effusion
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13
Q

Findings of acute pancreatitis on abdominal CT (contrast-enhanced)?

A 
Enlargement due to edema
Peripancreatic inflammation (linear strands in the surrounding fat)
Phelgmon
Hemorrhagic
Necrosis (decreased or no enhancement) 
Fluid in the paracolic gutter
Fluid collections
Pseudocysts
Abscesses
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14
Q

What is the normal size of the pancreas?

A

Same width as the abdominal aorta (2.5 cm in diameter)

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15
Q

How does the pancreas appear on CT compared to the liver and spleen?

A

Similar enhancement with contrast

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16
Q

How does an edematous pancreas appear on CT compared to the liver and spleen?

A

Less dense

More dense if hemorrhagic

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17
Q

How does pancreatitis appear on ultrasound?

A 
Edematous pancreas
Gallstones
Dilated common bile duct
Pseudocyst
Poorly defined
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18
Q

The normal pancreas is in the ___peritoneum, ___cm long, and located in the ___.

A

Retro; 12-15; epigastrum

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19
Q

What surrounds the head of the pancreas?

A

Duodenum

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20
Q

What vein runs along the posterior inferior groove of the pancreas?

A

Splenic vein

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21
Q

The ___ duct traverses through the head of the pancreas and joins with the pancreatic duct at the ___ to empty bile into the descending part of the duodenum.

A

Common bile; ampulla of Vater

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22
Q

Imaging findings of chronic pancreatitis

A

Calcifications

Pseudocysts

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23
Q

Imaging of choice for pancreatitis

A

CT with IV contrast

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24
Q

Useful imaging procedures to evaluate pancreatic cancer

A 
CT scan (evaluate tumor, stage)
US/nuclear medicine (biliary obstruction)
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25
Neoplasm in the ___ of the pancreas can compress the common bile duct, causing an extra-hepatic biliary obstruction.
Head
26
Cancer in the ___ of the pancreas may obstruct the splenic vein or cause mass effect.
Tail
27
What is indicated for initial study of a patient who presents with jaundice?
Abdominal US (dilated bile ducts or presence of a mass in the head suggests tumor) CT is useful in patients who are not jaundiced and in those in whom intestinal gas interferes with US
28
What is indicated when CT and US do not reveal a mass lesion within the pancreas, and when chronic pancreatitis is suspected?
ERCP
29
What are common malignant liver masses?
Metastatic tumors, HCC, cholangiocarcinoma
30
What are common benign focal liver lesions?
Cysts (congenital, parasitic - echinococcal), cavernous hemangiomas, focal nodular hyperplasia, hepatic adenomas, abscesses
31
What is the best imaging modality to evaluate liver masses?
CT
32
When is ultrasound useful to evaluate liver masses?
Intra-operatively
33
When is MRI useful to evaluate liver masses?
Delineating vascular involvement and identifying additional intra-abdominal lesions
34
True or false - normal biliary ducts are not seen on CT.
True (only seen when dilated)
35
What are the imaging findings of hepatoma on CT?
``` Single or multiple masses or diffuse involvement Low attenuation lesions Hemorrhage, fat, necrosis Calcification Hypodense capsule or rim Enhancement seen with contrast Can invade portal and hepatic veins ```
36
How do hepatomas appear on MRI?
Mass with low intensity on T1 and high signal on T2
37
How do liver cysts appear on CT?
Oval, well-defined Imperceptible or thin wall Water density No enhancement
38
How do liver cysts appear on US?
Well-defined, anechoic (echogenic if fluid filled)
39
How does a liver cyst appear on MRI?
Mass with low intensity on T1 and high signal on T2, may be indistinguishable from hemangioma without IV contrast
40
Common primary source sof liver metastases
Colon carcinoma, breast, kidney
41
What is the imaging procedure of choice to evaluate the liver for mets?
CT scan with IV contrast
42
Liver tumors are usually hypodense on CT with IV contrast performed in ___ phase (70 seconds). However, tumors may be hyperdense on CT in ___ phase (15 seconds).
Standard portal venous phase; arterial
43
Compare the density of the normal liver and spleen on non-contrast CT.
Approximately the same
44
What is the diagnostic procedure of choice for cirrhosis?
CT with IV contrast
45
How does a cirrhotic liver appear on CT?
Small liver with nodular margins | Ascites
46
Common renal masses (4)
Simple renal cyst Renal cell carcinoma PCKD Abscess
47
What is the initial imaging procedure of choice for a renal mass?
US (distinguish between a cyst and a solid mass)
48
What are the three major criteria for a single simple cyst on US?
1. Round mass, sharply demcarted with smooth walls 2. No echoes (anechoic) within the mass 3. Strong posterior wall echo indicating good sound transmission through the cyst
49
What US findings suggest a renal malignancy?
``` Solid or complex Internal echoes Irregular walls Calcifications or septae Multiple cysts clustered (could mask underlying carcinoma) ```
50
When is CT and MRI used in evaluating a renal mass?
CT (with and without IV contrast) - next appropriate step | MRI - if patient is unable to receive IV contrast, useful to evaluate vascular invasion
51
How does renal carcinoma appear on CT?
Hypodense (unless hemorrhagic) Cystic Calcified Most enhance after contrast administration, but less than normal kidney enhnacement Thickened or irregular walls of the cystic portion Thickened or enhanced septae within the cystic mass Multilocular mass Invasion of renal vein and IVC Nodes
52
Normal size of the kidney, normal appearance of kidney on US
9-11 cm | Same extent of echoes as the liver
53
Central echoes in the kidney are from ___ surrounding the renal pelvis and are white.
Fat
54
The ___ of the kidney is hypoechoic and appears dark.
Medulla (can distinguish it from fluid filled calyces, as there will be no increased transmission of sound beyond)
55
How do kidneys appear in acute renal failure?
Normal
56
How do kidneys appear in chronic renal failure?
Smaller than normal, surface may be irregular, cortex is thinned and hyperechoic compared to the liver due to scar tissue
57
How do kidneys appear in hydronephrosis?
Dilated anechoic calyces with increased posterior transmission of sound, cortex is normal, separation of hyperechoic fat within the central renal sinus
58
How does AAA appear on ultrasound?
Widened aortic lumen >3 cm
59
How does AAA appear on CXR?
Calcification of both walls at the same level with increased diameter
60
How does AAA appear on CT?
Calcification of the wall, may show chronic erosion of adjacent vertebrae
61
How does ruptured AAA appear on CT without IV contrast?
High density blood
62
What is the role of interventional radiology in the management of AAA?
Permanent stent placement
63
What is the procedure of choice in adults to diagnose acute appendicitis?
Abdominal and pelvic CT with IV contrast
64
What are the findings of acute appendicitis on CT?
Appendicolith Dilated appendix with thick wall Periappendiceal fluid, abscess (indicated by an air pocket)
65
Where should a Dobhoff feeding tube tip go?
Junction of the second and third parts of the duodenum
66
5 types of intracranial hemorrhage
``` Subdural hematoma Epidural hematoma Subarachnoid hemorrhage Intracerebral hemorrhage Intraventricular hemororhage ```
67
Optimal imaging procedure to evaluate suspected intracranial hemorrhage?
Pre-contrast CT
68
Defined as a collection of blood between the inner table of the skull and the dura
Epidural hematoma
69
Common etiology of epidural hematoma?
Head trauma, often in children
70
Epidural hematoma often demonstrates what finding on XR?
Fracture line (parietal) across the middle meningeal artery
71
Findings of epidural hematoma on pre-contrast CT?
Biconvex/lens shape Acute blood is hyperdense Does not cross suture line Mass effect
72
Defined as a collection of blood between the dura and the arachnoid
Subdural hematoma
73
Common causes of subdural hematomas
Head trauma (child abuse), coagulopathy
74
Compare the appearance of acute, chronic, and subacute subdural hematomas on CT.
Acute - blood appears hyper dense Chronic - blood appears hypodense Subacute - isodense
75
Subdural hematoma is common in patients with brain atrophy - why?
Superficial veins are stretched over a greater distance and more prone to rupture with rapid head movement
76
Findings of an acute subdural hematoma on CT?
``` History of recent fall Hyperdense blood Crescentic shape (medial margin is less convex) Crosses suture lines Mass effect ```
77
Findings of a chronic subdural hematoma on CT?
Bilateral chronic subdural hygromas produce slight compression of the adjacent sulci Hypodense blood
78
Blood within the CSF subarachnoid space
Subarachnoid hemorrhage
79
How does a subarachnoid hemorrhage typically present?
Worst headache of my life
80
Spontaneous subarachnoid hemorrhage is most often caused by what?
Rupture of arterial aneurysms, which release blood into the CSF; most common cause overall is trauma
81
Type of hematoma with a lucid interval followed by deterioriation
Epidural hematoma
82
Common causes of intracerebral hemorrhage
HTN, trauma, rupture of aneurysm, rupture of AVM
83
Most intracranial aneurysms occur in what artery?
Anterior communicating artery
84
How does ICH appear on CT?
Round shape | High density
85
CT findings of SAH?
Subarachnoid blood in subarachnoid space Normal sulci filled with low density normal CSF and appear dark Sulci filled with blood appear hyperdense
86
Common causes of stroke
``` Ischemic (atherosclerotic disease, embolus, inadequate cerebral blood flow) Hemorrhagic Venous sinus thrombosis Vasculitis Traumatic arterial dissection ```
87
Imaging modality of choice to rule out hemorrhagic stroke
CT
88
Imaging modality to diagnose acute stroke
MRI (CT does not detect)
89
Does a normal CT rule out stroke?
No
90
Acute infarct appearance on Non-contrast CT
``` Large hypodense area Effacement of gyri and sulci Can be normal Loss of gray-white matter differentiation Blurred basal ganglia Insular ribbon sign Dense MCA sign ```
91
How does edema and infarction appear on CT?
Low density (black)
92
How does edema and infarction appear on MRI?
High signal intensity on T2 and FLAIR
93
How does edema appear on T2?
Bright, high intensity
94
What is FLAIR?
Equivalent to T2
95
An abnormality such as a tumor or infarct that is dark on T1 becomes bright after IV gadolinium contrast. What does this indicate?
Breakdown of BBB
96
Acute infarct appearance on DWI MRI?
Hyperintense
97
Wha causes the bright signal of an infarct using DWI?
Restriction of the ability of water protons to diffuse extracellularly
98
How does a glioblastoma appear on T1 MRI (post-contrast)?
Ring-enhancing lesion
99
What is the on the differential for a ring enhancing lesions?
Glioblastoma Metastatic tumor Abscess
100
Imaging test of choice for metastatic tumors to the brain?
MRI
101
What are common malignant tumors that met to the brain?
Lung Breast Melanoma Renal
102
Most common intracranial benign tumor
Meningioma
103
How does meningioma appear on MRI?
Mass involving the floor of the anterior cranial fossa Dural-based tumor, extra-axial Enhances like a light bulb on T1 MRI post-contrast
104
How does a pyogenic abscess appear on T1 MRI post contrast?
Ring enhancing lesion | Edema surrounding the abscess is hypointense on T1
105
How does MS appear on FLAIR?
Asymmetrical, abnormal high signal weight matter lesions in the periventricular and subcortical areas
106
Diagnostic imaging of choice for MS?
MRI
107
DDX white matter lesions
White matter infarctions (HTN, DM) MS HIV-related infections Radiation or chemo induced leukoencephalopathy
108
How does a spine compression fracture appear?
Vetebral body is wedge shaped, flattened, higher density
109
Compare the appearance of osteoblastic and osteolytic spinal lesions on CXR
Osteoblastic: bone production and sclerotic, hyperdense, white bone Osteolytic - lucent, hypodense
110
Best study to evaluate possible spinal cord compression?
MRI

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