Radiology study set

signs of COPD on XRAY

-hyperinflated -generalized increased lucency (blackness) of both lungs -The central pulmonary arteries are enlarged ---Heart is narrowed and smaller appearing from the hyperinflation

How much radiation on average does a patient receive during a CT scan of the chest, abdomen and pelvis when compared to a single PA chest x-ray?

1,000 to 1,500 times as much as a PA CXR

How much do you think that Mr. Little would be charged for his non-contrast CT scan of the chest?

1200-1800

How many red blood cells per high-powered field (RBC/hpf) constitutes clinically significant hematuria for which further workup would be considered?

> 3 RBC/hpf

Does a normal ultrasound exclude Down Syndrome?

A normal ultrasound does not exclude Down syndrome.

What is a typical radiographic 'trauma series'?

AP supine CXR; AP supine abdomen; X-table lateral C-spine

What further imaging would you utilize to evaluate for intussusception?

Abdominal radiographs (KUB) Air enema Ultrasound of the abdomen and pelvis

next test you would choose for a 2-year-old girl with this presentation to evaluate for appendicitis?

Abdominal ultrasound

According to the NEXUS Criteria, cervial spine imaging is recommended for patients with trauma unless they meet ALL of the following criteria:

Absence of posterior midline cervial-spine tenderness No evidence of intoxication Normal level of alertness Absence of focal neurological deficit No clinically apparent painful injuries that might distract from pain of a cervical spine injury

Which of the following facts are true about measuring growth by ultrasound?

Accurate dating is vital for assessing intrauterine growth restriction IUGR. The abdominal circumference is the most important measurement for weight estimations. Growth should not be measured more often than every two weeks.

Although frequently requested, preoperative chest radiographs are rarely indicated. The two main indications are:

Acute cardiopulmonary findings by a history or physical. Chronic cardiopulmonary disease in the elderly (>age 70), previous chest radiograph within 6 months not available.

What renal pathology is US not sensitive in detecting?

Acute renal failure may sometimes be inferred from seeing renal atrophy or echogenic kidneys but U/S is not sensitive in detecting renal failure especially acutely.

What are some of the clinical indicators of testicular torsion?

Acute scrotal swelling Sudden onset discomfort Sudden testicular discomfort related to participation in sports or physical activities Similar previous episodes Nausea and vomiting Swollen, tender, high-riding testicle

The Ottawa ankle rules

An ankle series is indicated if the patient has pain near the malleoli and one or more of the following: Age 55 years or older Bone tenderness at the posterior edge of the tibia or tip of either malleolus Inability to bear weight immediately after injury and/or 4 steps in emergency room

What would be your choice of imaging to evaluate for a subtle pneumothorax?

An erect expiratory CXR A right lateral decubitus CXR

What are the ultrasound findings suggestive of a simple cyst that requires no further evaluation?

Anechoic (no internal echoes) Thin, well-defined wall Through transmission of sound waves with posterior enhancement

Which is the correct descending order of locations (most common location to least common location) where berry aneurysms are known to occur?

Anterior communicating artery; posterior communicating artery; middle cerebral artery

How often should an intubated infant have CXR's to check ET tube position and RSV illness progression?

As infrequently as possible

In which patient groups should you obtain a follow-up CXR?

B. On all patients over the age of 40 C. On patients with recurrent pneumonias E. On patients whose symptoms do not resolve

according to the ACR Appropriateness Criteria®, in a patient with non-localizing abdominal pain and a fever what imaging should u get?

CT abdomen and pelvis with IV contrast

which of the following imaging studies could you consider next to evaluate for an acute episode of inflammatory bowel disease presenting as colonic edema?

CT abdomen and pelvis, with oral and IV contrast MRI abdomen and pelvis with oral and IV contrast

A 39 year old man suffered femur and tibial fractures in a motor vehicle accident one day ago. He had orthopedic surgical fixation. While being transported from the post anesthesia recovery area to his hospital room, he had a drop of his O2 saturation from 98% to 75%. Which of the following is the most accurate study to evaluate for pulmonary emboli?

CT angiogram

Regarding colorectal cancer screening in average risk individuals, which of the following radiologic examinations is rated the MOST appropriate by the ACR Appropriateness Criteria for colorectal?

CT colonography

Given the injuries demonstrated in this image, which of the following studies would be helpful to evaluate for potential associated bladder injury?

CT cystogram Retrograde cystogram

A 52 year old man with a 20 pack year history of smoking has an abdominal CT performed when he presents with diverticulitis. He has no prior imaging. A 12 mm spiculated nodule is seen in the peripheral right lower lobe. Which of the following would be an appropriate form of management

CT guided needle biopsy and/or PET-FDG scan This is a highly supicious incidental finding in a high risk patient, so should not be followed. It is unlikely to be seen on bronchoscopy as it is small and peripheral. Contrast enhanced MRI is not indicated currently for this. Either a CT guided biopsy, or a PET scan with excision if positive are reasonable approaches.

According to the ACR Appropriateness Criteria® for hematuria, what imaging modality would be most appropriate to work up Ms. Greene's isolated hematuria?

CT urography

A 28-year-old male presents with acute onset of flank pain and gross hematuria. What is the most appropriate initial imaging examination?

CT without intravenous contrast

Remembering that Mr. Stoddard had a severe allergic reaction to iodine based IV contrast, what imaging studies might be performed to stage his colon cancer?

CXR CT Chest without contrast CT Chest/Abdomen/Pelvis with IV contrast, after premedication MR abdomen and pelvis with IV contrast

what is the role of CXR in diagnosing COPD?

CXRs are not a sensitive or specific way of diagnosing COPD

Your attending asks you: "What are some of the causes of cerebral herniation?"

Cerebral edema Tumor Hemorrhage

Which maging study should you order in patients with low-level trauma and clinically suspected rib fractures and new shortness of breath?

Chest XRay (erect)

In evaluation of suspected aortic trauma on a supine chest radiograph (on trauma board), what is the imaging modality of choice?

Contrast enhanced CT imaging

What are the most common breast masses in a 28 yr old patient?

Cyst Fibroadenoma

Put the following radiographic procedures in order of radiation exposure to the patient (low to high). A. Chest radiograph B. Barium enema C. CT chest, abdomen & pelvis D. Extremity radiographs E. Head CT

D, A, E, B, C Extremity radiographs-->Chest radiograph-->Head CT-->Barium enema-->CT chest, abdomen & pelvis

What are the major risk factors that might predispose a child to developmental dysplasia of the hips?

Family history Breech positioning in utero Female sex First born Certain racial backgrounds

What is the usual cause of neurocysticercosis?

Feco-oral transmission

Which of the following are indications for screening for osteoporosis?

Female over age 65 Younger individuals with chronic glucocorticoid therapy

In a normal transvaginal ultrasound, what should you be able to see in the uterus at six-and-a-half weeks of pregnancy?

Gestational sac Yolk sac Embryonic pole Embryonic heart beat

Which imaging modality should be performed first in the setting of head trauma?

Head CT without contrast

According to the ACR Appropriateness Criteria®, what is the appropriate "routine" follow-up for asymptomatic patients treated for Stage I renal cell carcinoma?

History, physical exam, CBC, LFTs and CXR every six to 12 months for three years, then annually until year five

What imaging do you order if you are concerned about epiglottitis?

Imaging can wait; transport this child to the Emergency Department now

When is imaging recommended in cases of clinically suspected pyelonephritis?

It is recommended in diabetics and immunocompromised patients with no response to medical therapy within 24 hours.

reasons why CT is the preferred imaging modality (over ultrasound) for clinically suspected pancreatitis

Less affected by bowel gas Less affected by large body habitus More sensitive for edema

What is the most accurate imaging modality for staging cervical cancer?

MRI

Alternate methods for evaluating the presence of osteomyelitis in a diabetic foot include which of the following?

MRI White blood cell scan

What is the most appropriate initial imaging method for evaluating a patient with clinical change in chronic headache?

MRI Brain

What is the most sensitive examination for detection of acute ischemia?

MRI diffusion weighted imaging (DWI)

what is MRCP? Magnetic Resonance Cholangio Pancreaticogram

MagneticResonanceCholangioPancreaticogram evaluates the biliary and pancreatic ductal systems in various angles and planes. MRCPs are done with T2 imaging with fat suppression, so the only fluid appears hyperintense (white). Stones are hypointense (black).

Which of the following can be detected in an infant transcranial (or transfontanelle) ultrasound?

Measurements of ventricular size Subependymal and intraventricular hemorrhage Evaluation of the posterior fossa Mass lesions in the anterior and middle cranial fossas Subdural hematomas

Typical CT densities (HU):

Metal: >1,000 Bone: 500 to 1,000 Soft tissues: 30 to 60 without contrast Complex fluid: 10 to 20 Water: 0 Fat: -50 to -100 Air: -1,000

What are some of the signs you would look for on a head CT to evaluate for herniation?

Midline shift of structures Compression of lateral ventricles Displacement of the uncus medially Cephalad displacement of brainstem Caudal displacement of cerebellum Effacement of cisterns

A 64-year-old man recovering from a stroke reports choking when drinking liquids. Which of the following radiologic examination is most appropriate for further evaluation?

Modified barium swallow

51-year-old man who is due to have his right knee replaced under general anesthesia due to an old high school football knee injury resulting in advanced osteoarthritis. He is an avid squash player and his painful arthritic knee has made it difficult for him to play. You decide to get a pre-operative CXR as he is a 1-pack-per-day smoker, even though he has no cardiorespiratory symptoms or other pertinent past medical history. chest xray?

No, as he has no cardiorespiratory symptoms

You suspect ureterolithiasis. Referring to the ACR Appropriateness Criteria® for acute flank pain, suspicion of stone disease, which study should you order first?

Non-contrast enhanced CT abdomen/pelvis (NCT)

In your mind, you run through the causes of non-visualization of the gallbladder on an ultrasound, what are they?

Non-distention due to inadequate fasting Surgically removed Congenitally absent Ectopic location

You have a CT scan with an indeterminate nodule. What is the best next option for the evaluation and management of Mr. Little's condition?

PET scan

what role does interventional radiology play in oncologic patient management?

Pain relief Tumor burden reduction prior to curative surgery Tumor eradication in nonsurgical candidates Pre-surgical portal vein embolization to shrink tumor-containing lobe

Which of the following is an appropriate indication(s) for image-guided paracentesis in a patient requiring a diagnostic paracentesis?

Patient with bowel ileus with dilated bowel loops Patient with large body habitus and suspected infected ascites Patient with suspected hepatosplenomegaly Patient with low volume ascites Patient with bleeding diathesis

In patients with biliary duct obstruction, which of the factor(s) would favor choice of MRCP (MR cholangiocholangiogram) over ERCP (endoscopic retrograde cholangiopancreaticogram) in a patient with work-up of biliary duct obstruction?

Patient with severe COPD Patient with suspected acute pancreatitis

Which imaging tests are involved in the initial assessment of infertility?

Pelvic ultrasound Hysterosalpingogram (HSG)

What are some of the radiographic findings that may be seen in patients with rheumatoid arthritis (RA)?

Periarticular soft tissue swelling Uniform loss of joint space Swan neck and boutonniere deformities Marginal erosions Subchondral bone erosions

In which of the following conditions can air bronchograms be seen?

Pneumonia Pulmonary edema Pulmonary hemorrhage ARDS

Which paired artery serves to connect the vertebral/basilar circulation with flow from the internal carotid arteries

Posterior communicating artery (PCom)

Which of the following imaging findings are highly suspicious for child abuse?

Posterior rib fractures Metaphyseal corner fractures Humeral head dislocation Bucket handle fractures Type V Salter Harris fractures Multiple fractures of different ages Femoral fracture < 1-year-old

If a mass is suspicious for malignancy by US criteria, what could be an appropriate next imaging test?

Pre and Post-Contrast enhanced CT Gadolinium enhanced MR

potential ways of decreasing the renal toxicity of intravenous iodinated contrast media?

Pre scan hydration Post scan hydration N-Acetylcysteine (Mucomyst®) Reducing the dose of contrast Urine alkalinization

The RECIST criteria are used to characterize which of the following tumor characteristics?

RECIST, or Response Evaluation Criteria in Solid Tumors, is the standard system used by oncologists to evaluate a patient's response to chemotherapy. It places all patients into one of 4 categories: Progressive disease [PD] stable disease [SD] partial response [PR] and complete response [CR] uses size

What is the first imaging examination for suspected osteomyelitis in the diabetic foot?

Radiographs

What CT findings seen in patients with pyelonephritis would be most worrisome and may need more aggressive treatment

Renal abscess Emphysematous pyelonephritis Severe hydronephrosis

What imaging modalities are helpful in assessing for bladder and urethral injury?

Retrograde urethrogram CT cystogram Retrograde cystogram

What imaging methods could you use to confirm the presence of a right pleural effusion?

Right lateral decubitus CXR CT Ultrasound MRI

What are the characteristics seen on ultrasound suggestive of hip dysplasia?

Shallow acetabulum Subluxation of the femoral head with stress

What is the most SPECIFIC sonographic criterion for the diagnosis of acute cholecystitis?

Sonographic Murphy's sign

what is the spine sign?

Spine sign is seen when there is a posterior lower lobe opacity on a lateral chest radiograph. As the eye scans down the spine, it should get more lucent (or at least not denser), aside from some linear vascular markings until the first hemidiaphragm is reached. It can be caused typically by pneumonia, but can also be seen in atelectasis and masses.

best Imaging to evaluate for suspected pulmonary emboli

The current recommended choice for evaluation of patients with suspected pulmonary embolism is CT angiographyexceptin patients with contraindications to intravenous contrast in whom nuclear medicine V/Q scanning remains a viable option.

what is true about vertebroplasty?

The procedure can be done under local anesthesia with sedation.

If Mr. Roger were allergic to intravenous iodinated contrast media, which of the following would be alternative means of evaluating his aorta?

Transesophageal echo MRI

Toxoplasmosis infection in the immunocompromised population is usually due to reactivation of latent disease. True or false?

True

Which of the following imaging studies can be used to diagnose renal vascular hypertension?

US renal arteries with color Doppler Captopril renography CTA abdomen MRA abdomen Carbon dioxide arteriography

Which of the following is the MOST appropriate ranking of imaging in a 32 year old pregnant patient with RLQ pain?

US, MRI, CT

What imaging modality would be most helpful to work up clicky hips in this 2-month-old?

Ultrasound

You feel pretty certain that Ms. Greene's (pregnant) pain is due to ANOTHER episode of nephrolithiasis. What would be the most appropriate imaging to order next?

Ultrasound the best choice to evaluate for urolithiasis in a patient who might be pregnant, and also is appropriate in this young patient with prior urolithiasis to assess for obstruction to reduce radiation exposure. Consider using ultrasound as first line with patients with repeated episodes of urolithiasis unless their symptoms do not resolve.

You saw that the patient's KUB showed gallstones, but you want to evaluate for signs of acute cholecystitis. In accordance with the ACR Appropriateness Criteria® for Right Upper Quadrant Pain, Which test do you recommend?

Ultrasound (US) abdomen

Which of the following would be appropriate imaging means of evaluating a toddler with a limp?

Ultrasound of hip to look for effusions Radiographs of the hip Radiographs of femur Radiographs of knee joint Radiographs of tibia and fibula AP and lateral

What is the major cause of morbidity and mortality in SAH?

Vasospasm and ischemia

In a patient with a pulsatile abdominal mass (suspected AAA), which of the following studies would be the LEAST appropriate initial imaging study?

abdominal radiograph (KUB)

A 54-year-old female with no significant past medical or family history has her annual physical exam and receives a referral for a mammogram. How often should she be getting a screening mammogram?

annually

What is the most accurate parameter for pregnancy before the embryo is seen, form 11-12 weeks, and dating at 14 weeks of gestation?

before an embryo is seen = the mean gestational sac diameter is used for dating. 11-12 weeks =The crown-rump length 14 weeks= the biparietal diameter (BPD) In later pregnancy, a combined figure using multiple biometric parameters is used calculated by computer software programs. The earlier in pregnancy the dating occurs, the more accurate the gestational age. Therefore, the gestational age should not be changed by sonographic examinations performed later in pregnancy.

Mr. Little has a well-defined 3 cm mass in the left lower lobe on his CXR, with no comparison films. He is asymptomatic and a 20-pack-year smoker. What are you going to do now?

chest CT scan

An ex-27-week gestational age premature infant has increasing head size documented at 22 days postnatal life. His head circumference has jumped from 30th percentile to 90th percentile since the last measurement. Which of the following is the best choice to image the cranium?

cranial ultrasound

A 41-year-old female presents to her gynecologist complaining of a lump in her right breast. Her physician palpates a 2 cm lobular, non-mobile mass in the right upper outer breast. What is the most appropriate next step in the work-up of this mass?

diagnostic breast ultrasound

What are DEXA scans?

dual-energy x-ray absorptiometry (DEXA) scan DEXA scans are used to screen patients for osteoporosis. They require less radiation than quantitative computed tomography; however, they are not as effective in patients with extensive degenerative disease, where values can be falsely elevated secondary to bone sclerosis. The DEXA radiation dose is very small. Normal bone: T-score better than -1 Osteopenia: T-score between -1 and 2.5 Osteoporosis: T-score less than -2.5

A 4-week-old child in your clinic has a distinct "clunk" when you abduct the child's flexed knees with your thumbs as you apply anterior pressure on the greater trochanters (Ortolani maneuver). This finding indicates imaging is needed. Which of the following imaging studies is most appropriate in this setting?

hip ultrasound

A 3-year-old boy is presented to the ED with chief complaint of abdominal pain for three days with some intermittent bloody stool on the day of the ED visit. Parents report the child intermittently doubles over with severe pain. Each episode of severe pain last about two minutes and then resolves spontaneously, returning approximately 20 minutes later. Between these episodes, the child "perks up", seems well and plays. He is afebrile.

intussuception

A PA chest radiograph in a patient with suspected pneumonia shows a confluent opacity in the right lung obscuring the right heart border. In which lobe is the pneumonia located?

r. middle lobe

What is the most common renal mass?

renal cyst

In a patient with a suspected left sided pneumothorax which is not confirmed on the routine upright PA chest radiograph, which of the following imaging studies may be helpful?

right lateral decubitus chest radiograph expiratory chest radiograph CT scan

A patient is a candidate for methotrexate treatment for ectopic pregnancy if:

the tubal mass of the ectopic pregnancy is < 4 cm embryonic heart motion is absent there is no hemoperitoneum the patient is hemodynamically stable and without severe pain.

Which alternative imaging modalities that do not use ionizing radiation could be considered for patients with suspected acute appendicitis?

ultrasound MRI

pneumothorax on upright and lateral XRay shows what?

upright = air from a pneumothorax collects at the apices, and the chest x-ray will exhibit lucency around the lung apex. supine = deep sulcus sign