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advan im Bedle t1
| Question | Answer |
|---|---|
| What is a gold standard? | a test that reflects the closest one can come to an absolute dx of a condition (ex: biopsy, autopsy, surgery/pathology) |
| Why aren't gold standards performed as screening tools? | increased risk to the pts health, may require that the pt is dead, and very expensive to perform |
| Utilization of a imaging procedure is based upon what four factors? | sensitivity, specificity, invasiveness, and cost. |
| What represents the probbaility that a pt who actually has a pathology will be dxed as having that pathology that the test is intended to reveal? | senisitivity |
| Represents the probability that a pat actually not having the pathology will be dxed as such? | specificity |
| Is bone scintigraphy sensitive and specific? | no, just sensitive. |
| start sensitive as a ___ test, progress to specific for a ____ testing | sensitive for screening, and specific for confirmatory. |
| what are four dif types of screening tests? | hx taking, phys exam, plain film, and bone scan. |
| how can intermediate tests be used as a gold standard? | when comparing it to a screening test (MRI or CT compared with plain film) |
| what are pros to plain film? | readily available, decent specificity***, cost effective (50-200), min pt risk. |
| what are cons of plain film? | poor sensitivity****, over-reliance, dr. financial incentive, radiation exposure. |
| what % of significant lesions are found thru hx and phys exam alone before imaging? | 90% |
| what % of chiros have an xray in the office? | 85% |
| what % range of new pts are xrayed at a chiro office? | 73-96%, avg 3.4 views |
| VINDICATES? | vascular, infection/inflam, neoplasia, degenerative, ingested/iatrogenic, congenital, autoimmune, trauma, endocrine/metabolic, syche |
| what are diagnostic radiology that can be performed on the chest? | CXR, tomography, ct, radionuclide scanning, angiograpghy, bronchography |
| what is CXR an important screening tool for> | pulm dz, mediastinal dz, disorders of the bony thorax |
| Chest abnormalities may mimic what? | musculoskel conditions of the tspine, shoulder, or neck. (many lung abnormalities are discovered on these views) |
| CXR is chiro for? | followed up to t-spine exam, pts with hx cancer, pre-employment exam, high risk lung carcionma, t-spine trauma, rib fx, or review from hospital. |
| what is the minimal diagnostic series of the chest? | PA chest, and lateral chest. |
| what are supplemental views of the chest? | apical lordotic, expiratory, lateral decubitus, ap t-spine |
| PA Chest: ___FFD, ____Cassette | 72 FFD with chest cassette - PA & 72 to min heart shadow |
| breathing instructions for chest xray? | taken on 2nd deep inspiration |
| where should the diaphragm be on xray? | at the right 10th posterior rib |
| what kvp is used for chest and why? | high (110-120) for long scale of contrast, and should see the IVD of t6, |
| What are the 4 criteria to a diagnostic CXR? | 1. Full inspiration - see 10th rt rib posteriorly, 2. exposure - just able to see the T6 IVD, 3. Top margin: lung apices, 4. bottom/lat margin: see the lat costophrenic angles |
| lateral chest: ___ FFD, ____cassette, breathing instructions? what side closest to flim and why? why high kvp? | 72 FFD, chest cassette, taken on 2nd deep inspiration, taken with left side closest to film to decrease heart magnification, and high kvp for soft tissue visualization |
| Apical Lordotic: tube tilt// or what else can be done? | tube tilt is 15-30 degrees, or pt walks ft out from bucky to increase lordosis |
| why apical lordotic? | see lung apex free of clavicular superimpositon to eval for apical lung tumoors and scarring in TB. Also to eval RML and lungula. |
| how is expiratory film set up? | same as PA chest, only with the pt in total exhalation |
| why expiratory fim? | eval trapped air in lungs (COPD, inhaled objects), used to eval pneumothorax. |
| Abdominal Plain film is 1st line diagnostic for the eval of? | abdominal pain, abdominal trauma, abdominal distension, nausea/vomiting, diarrhea, constipation. |
| Abd conditions possible to visualize | perforated viscus, interstinal obstruction, abd or gallstones ileus, organomegaly (liver and spleen), AAA, abdominal calcifications. |
| Limitations of plain film abdomen | GI BLeed, hepatobiliary dz, acute cholecystitis, hepatitis, liver masses, acute pancreatitis, ulcers, pylenephritis. |
| What is the standard abdominal plain film? | AP Recumbent (AKA KUB - kidneys/ureter/bladder) |
| AP recumbent extends from where to where? with what kvp? | extends from diaphragm to pubic symph, generally around 80kvp for good constrast |
| What is AP upright abdomen good for evaluating? | bowel gas patterns |
| What can be visualized in abd from PA chest? | subphrenic gas |
| What can be visualized abd wise in lateral decubitis | free intraperitoneal gas |
| What are three follow ups for abdomenal studies? | diagnostic ultrasound, mri, ct |
| diagnostic ultrasound abdomen is good for what? | good for organs and vascular (doppler), non-invasive, no radiation exposure, live time imaging. |
| What is CT of abdomen better for than US? | better for calcifications |
| CT of abdomen gives ___ imaging of the entire abdomen | faster imaging |
| Is acute AAA seen with MR Angiogram of abdomen? | no |
| 3 types of calcifications are? | normal physiologic, dystropic, metastatic |
| normal physiologic calcifications consist of? | thyroid cartilage, costal cartilage |
| what is dystrophic calcifications? | calcifications which occur in diseased tissues. Stone formation is an exampple |
| what is metastatic calcifications? | calcification of normal tissue, usually d/t hypercalcemi state (hyperparathyroid, lytic mets, multiple myeloma) |
| What are 4 examples of dystrophic calcifications from bone and joint? | myositis ossificans, scleroderma, SLE, dermatomyositis |
| What 3 things are dystrophic calcifications classified according to? | 1. morphologic features (what is looks like - shape, border sharpeness, marginal continuity, internal architecture) 2. location 3. mobility |
| Conduit Wall calcification shape border margin and matrix | shape - tubular profile, ring like en face. border - possibly indistinct, margin - discontinuous. matrix - none. |
| mass like calcification shape border margin and matrix | shape - variable. border - irreg, can resemble cyst. margin - interrupted. matrix - extensive internal calcification |
| cystic calcification shape, border, margin, matrix | shape - round or oval, border - curvilear or round, margin - rim calcification can be irregular, matrix - can simulate internal, but not true interna calcification |
| concretion calcification, shape, border, margin, matrix | shape - varied - round, oval, star shaped. border - sharp, clearly defined. margin - continuous, matrix - varied - dense, laminated, central lucency |
| Conduit wall calcifications are confined to only what? | the tubular walls |
| That calcifcation of conduit walls are not ____ | homogenous |
| what is the MC site of conduit wall calcifications? | walls of arteries, where you may see interrupted but basically linear calcifications which may outline the vessel's branching patterns |
| where is calcification of the abd aorta mc? | belwo the renal arteries, and may extend into both common iliac arteries |
| how is the distribution of calcification of the abd aorta> | irregular and patchy, which corresponds to plaques |
| are abd aorta calc a contraindication to manipulation? | no |
| what type of calcification is abd aortic aneurysm? | cystic calcification |
| what causes aaa? | atherosclerosis, collagen dz |
| 95% AAA occur in pts between what ages? and what sex dominance? | 60-80 yrs, Males 4:1 |
| what size AAA should you not adjust? | >3.8 cm |
| 3cm-3.5 cm Abd aorta | dilation |
| over 3.5 cm abd aorta | aneurysm |
| 4.5cm-6cm ab aorta | surgical consultation |
| over 7 cm ab aorta? | immediate consulation |
| plain films and AAA | only give estimate sizes |
| abdominal aneurysm are considered ____ lesions | unstable |
| what is the 2nd mc site for abd arterial calcification? | iliac arteries |
| can iliac arteries undergo aneurysmal changes? | yes, second only to the abdominal aorta |
| what is vas deferens calcification associated with? | diabetes, rarely secondary to infection |
| what shape does vas deferns calc take on? | v- shaped, usually bilateral and symmetic |
| what does the vas deferns calc parallel? | pubic rami |
| what is the most diverse presentation of abdominal calcification? | solid mass |
| how are the borders of solid mass calcifications? | irregular and complex internal architecture |
| where do solid mass califications occur in abd? | anywhere, central or peripheral adjactent to within organs |
| DDX for solid mass calcification? | calcified mesenteric lymph nodes, leiomyoma, dermoid cyst (teratoma), injection granuloma |
| what are the mc causes of abd calcified mesenteric lymph nodes? | TB and histoplasmosis |
| calcified mesenteric lymph nodes occur along where? | broad arch from the LUQ to the RLQ within the small bowel mesentery, and can be multiple and varied sizes |
| Where do leiomyomas occur? | anywhere, but usually uterus |
| what is a leiomyoma? | smooth mm benign tumor |
| what type of calcification do leiomyomas have? | a whorled type of a calcification or flocculation - may demonstrate a prominent bordering rim |
| What is a dermoid cyst? | teratoma, contains tissue from all 3 dermal layers, may contain teeth hair and fat. |
| are dermoid cysts premalignant? | yes although only 1% go on to degrade into squamous cell carcioma |
| what is injection granuloma? | result from subcutaneous fat necrosis secondary to intramm injection of pharmaceuticals. |
| where are injection granulomas seen? | soft tissues around the hip (glut med) |
| how are injection granulomas visulaized on xray? | as solitary or multiple small calcific spheres |
| What is a cyst wall calcification? | calcium deposition within the wall of an abnormal fluid-filled structure (AAA ex) |
| DDX cysts-wall calcification | Hydatid cyst, PORCELAIN GALLBLADD, hemorrhagic cysts, hematoma (posttraumatic), arteria aneurysms |
| arterial aneurysms begin with a _____ calcification, then becomes ___ when aneurysmal | conduit wall calcification then becomes cystic |
| What is echinococcal cyst? | splenic cyst caused by echinococcus (hydatid cyst dz) 2/3 splenic cysts |
| are echinococcal cysts common in us? | no |
| what does echinococcal cyst contain? | tape worm scolex. Humans get it by ingestion. |
| Where do hydatid cysts form? | solid organs, liver spleen, lung, brain - may have daughter cyst. |
| what age range and sex is porcelain gallbladder common in? | Females 38-70 |
| What % go on to develop gallbladder carcinoma from porcelain? | 10-20%. therefore prophylactically removed, b/c poor prognosiss and aggressive tumor |
| what are concretions aka? | stone or calculus |
| what are concretions? | calcified mass that forms in a tubular or hollow structure (lumen of vessel, hollow viscus) |
| what are radiographic apperances of concretions? | sharp, have clearly definied external margins, almost always continuous |
| what is the internal archtecture of concretions? | may have concentric laminations, may contain slighlty eccentric area of lucency, may be homogenously dense. |
| What is an appendicolith? | concreation found in the appendix (RLQ) |
| Appenidcolith plus abdominal pain? | 90% probability of acute appendicitus |
| What % of gallstones calcify? | 10-20% - must be to show up on xray |
| Most frequent pt with cholelithiasis? | fat, females, forty, flatulent |
| What may multiple gallstones look like? | bag of diamonds appearance |
| mercedes benz sign seen with? | gallstones |
| Pancreatic calculi are most commonly assoicated with what? | chronic pancreatits secondary to alcoholism |
| What are pancreatic calculi caused by? | long standing ductal obstruction and inflammation |
| what are pancreatic calculi visualized on xray? | multiple, tiny, dense, discrete opacities that cross the midline at l1-l2. DDX with radiopaque gastric contents |
| what is mc calcification of the pelvis? | phleboliths |
| What is a phleboliths? | represents a calcified thrombus within a vein. |
| what is the interior of a phlebolith like? | concentric or slightly eccentric lucency |
| What are prostatic calcuil seen as? | multiple concretions of various sizes clustered behind the pubic symphysis in males. |
| what is the cause of prostatic calculi? | prior prostatitis |
| What is the cause of urinary stones? | caused by chornic low-level dehydrations (renal stasis) or infection |
| urinary stones are MC where? | southeast and southwest US |
| urinary stones are asymptomatic until when? | until they cause obstruction |
| what are the mc urinary stones made of? | calc phosphate, calc oxalate, and magnesium ammonium phosphate (struvite) |
| about ___% of upper tract calcuili contain enough calcium to be visualized on plain films | 90% |
| what is a staghorn calculus? | a large stone that occupies the renal collecting system forming a "cast" of the major calyces and renal pelvis |
| what are staghorn calculus made of> | struvite |
| what can staghorn calculus cause? | chronic hydronephrosis which can lead to renal failure |
| where do kidney stones tend to lodge? | ureter-pelvic junc, iliac crests, and ureter-vesicle juction |
| urinary stones ddx?? | phleboliths |
| Phlebolith vs kidney stone | phleboliths are ovoid with a central lucency and located below the ischial spines, and most calculi are slightly irregular, uniformly dense and located above the ischial spines |
| what is hydronephrosis? | dilation of the renal collecting system |
| what is hydronephrosis mc due to? | obstruction by a ureteral calculus byt may also be caused by a renal mass |
| a stone in the ureter causes what? | unilateral hydronephrosis |
| a stone in the bladder or urethra may cause what? | bilateral hydronephrosis |
| what is the mc tx method or urinary calculi? | extracorpal lithotripsy. pt placed in pool of water, lithotripser is asimed at the stone, prodcues schok wave, stones turned into sand, pt strains n the urine to collect the pulverized stone. |
| What causes bladder stones? | obstruction and infection, may be a migrant renal stone. |
| what % of bladder stones are seen on xray? | 50%, most are smooth and rounded |
| what is a jackstone stone? | bladder stone that is stellate with spiculations radiating in all directions from the center |
| why are single contrast studies performed? | to visualize the morphology of the bowel which assesses for outpouchng of the bowel, and indentations of the bowel |
| what is double contrast study for? | visulazing the mucosal pattern |
| what are the 5 basic pathologic alterations seen on a contrast study? | 1.polypod lesions 2. mucosal masses, 3. ulceration 4. diverticula 5. extrinsic compression |
| Polypod lesions appear as? | small, rounded filing defects in the lumen. They may be broad based(sessile) or on a stalk (pedunculated) |
| muscosal masses, - begin as ____. there is an abrupt change of the muscosa from ___ to ____. Furhter growth will produce encasement as the tumor grows completely around the lumen --- ___ apperance | begin as small polyps, change from normal to tumor.... apple core appearance |
| how does ulceration show on barium study? | seen as a collection of barium found outside the normal lumen |
| what is Hamptons line? | a smooth collar of inflamed mucosa is present between the lumen and the crater. Not cancerous |
| Diverticula | benign out-pouching of the wall of the GI tract, may be small (colon), or large (esophagus) |
| Extrinsic compression appears as? | a smooth indentation of the bowel wall with gradually tapering margins |
| zenkers diverticula, what and cause | outpouching of the mm layer of the esophagus caused b abnormal pressure iwthin the esophageal lumen |
| location of zenkers diverticula? | posterior pharynx @ the cricopharyngeous mm. - Killiams dehiscence, may be seen on plain film radiograpghs just anterior to the c6/7 level |
| pros to MRI | excellent tissue contrast, high resolution imaging, imaging in any plane, lack of ionizing radiation, relatively noninvase, can add contrast for more info |
| cons to mri | availability in us/can, implanted metal can have an affect, claustrophobia, obese ppl, contrast rxns, expsense (500-4000) |
| mri is used for? | better visualization of patho, determining the extent of the patho, surgical planning, prognosis |
| absolute contraindications for mri? | pacemaker, metallic foreign body in eye, cochlear implants, ferromagnetic surgical clips |
| relative contraindications for mri | metallic devices in the area of interest that severely alter the resolution of the scan, prego (must get informed consent - no evidence of fetal effect), severe claustraphobia, morbid obese |
| how does ct generate an image? | by rotating a thin beam of xrays around an axial plane of the body |
| pros to ct | very available, high resolution of minute structures, useful for MRI contraindicated pts, can add contrast for more info |
| cons of ct | very high dose, has demonstrated overutilization, contrast rxns, expense (500-2000) |
| CT is the gold standard for imaging what areas? | chest, abdomen, pelvis, complex bony anatomy, acute head trauma |
| bone scan aka? | scintigraphy |
| what does bone scan utilize? | radioactive pharmaceutical (technetium 99MDP) that is injected intravenously |
| pros to bone scan | very sensitive, can be sectional (SPECT), low whole person dose study (high GU dose) |
| cons of bone scan | poor specificty, still has radiation, expense (300-1000) |
| Signs and sx of zenkers diverticulum | food gets trapped in diverticulum - regurgitation of semi-digested food, hx of bad breath, difficulty swallowing. |
| complications of zenkers div | aspiration pneumonia, bronchitis |
| what may be seen on plain film with zenkers diverticulum | may see air-fluid level in front of c-spine in the retropharyngeal space |
| most ulcers are ___ and resolve in ___ weeks | benign and resolve in 6 wks |
| 2% of ulcers aren't ulcers, but represent what? | necrosed tumor |
| where do the majority of stomach ulcers occur? | along the lesser curvature, body, or antrum |
| What is the typical shape of ulcers? | round or oval |
| how are ulcers seen on bairum? | small outpouching of the barium column |
| Hamptons line | rim of edema seen around the ulcer, indicative of a benign tumor |
| Three complications of ulcers | obstruction, perforation, bleeding |
| perforation from ulcer? | ulcer can extend thru the mucosa into free abdominal space, or into an adjacent organ |
| how does ulcer perforation appear on plain film? | intraperitoneal air collects under the diaphragms on upright views. tis a serious complication |
| Hiatal hernia plain film ap and lateral views | gastroesophageal junction goes up into the thoracic cavity. Airfluid level thru the heart shadow on the frontal view. On lateral see air/fluid level behind heart |
| Rule of 3s of normal small bowels | no more than 3 air/fluid levels, no more than 3 cm of bowel distention, the distance between the folds should not exceed 3 mm |
| what is mechanical bowel obstruction casued by | adhesions from previous surgery, hernias, neoplasms, intussusception, strictures from chrohns dz, volvulus |
| clinical findings of small bowel obstruction | nausea, vomiting, cramping, distension |
| dynamic ileus | sm bowel tries to force obstruction out by strong periastalsis, may be seen as dynamic motion on abdomen |
| adynamic ileus | bowel becomes exhausted and stops all peristalsis. Air collects in dilated loops. |
| xray findings of small bowel obstruction | dilated small bowel loops. Air fluid levels are seen on upright films proximal to the obstruction. The abdomen distal to the obstructions is usually gasless. |
| how do inguinal hernias appear on plain film? | prescence of an enlarged scrotum that contains multiple loops of air-filled bowel. |
| where is classic crohns found predominantly? | terminal ileum |
| early chrons reps? | granulomatous inflammation |
| advanced nonstenotic phase of crohns? | reps progression of inflammation wthout compromise of the bowel lumen |
| stenotic phase of crohns dz ? | reps endstage dz, stenotic lumen from strictures |
| Radiology of early crohns dz? | nodular enlargement of lymphoid follicles (cobblestone appearance - longitudinal and transverse ulcers separated by edema. Ulcerations, Skip lesions (discontinuous involvement with intervening normal areas - pseudodiverticula) |
| Radiology of stenotic phase of crohns | string sign - marked narrowing of ridged loops from strictures, stenotic bowel may cause obstruction, usually surgically removed |
| Complications of crohns dz | obstruction Fistula Formation: to hollow viscera (urethra, vagina). increased risk of carcinoma |
| what are colonic diverticulosis? | small rounded outpouchings of colonic mucosa thru the colonic wall |
| 50% pts with colonic diverticula over? | 60 |
| where are diverticula most numerous? | sigmoid colon because of increased pressure owing to normal decrease in lumenal diameter |
| xray colonic diverticula | when filled with air may be seen as asmall collection of air next to the normal gas pattern |
| contrast of colonic diverticula | filled with contrast and deomnstate small lumenal outpouching adjacent to the normal contrast column |
| what is the hallmark ulcerative collitis? | collar button appearance |
| what are pseudopolyps in ulcerative colitis? | seen in acute and severe attacks. are islands of inflamed edematous mucosa seen between ulcerated areas. |
| What is lead pipe appearace of the bowel in ulcerative colitis? | seen in chronic ulcerative colitis. it is fibrosis which leads to diffuse narrowing of the bowel lumen with a loss in any mucosal pattern. |
| what are complications of UC? | toxic megacolon, stricture formation, malignancy |
| colonic involvement of us vs crohns | crohns is right sided usually, uc is either left or universal |
| involvement of rectum in crohns and uc | HALLMARK of uc |
| continuity of lesions in crohns vs uc | crohns skips, and uc is continuous |
| fstula formation in crohns and uc | more common in crohns |
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margaretrhager
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