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97 Cards in this Set

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Deep Sulcus Sign
- Occurs in pneumothorax
- When lying supine, air goes to highest part in thorax --> deep sulcus.
- Occurs in pneumothorax
- When lying supine, air goes to highest part in thorax --> deep sulcus.
Aunt Minnie's Sign
Collapsed Lung - look at lateral
Obscured heart outlines
Pneumonia/involvement of right middle lobe or left upper lobe/lingula. Lower lobes do not obscure heart outlines.
Pneumomediastinum
Can be 2/2 small pleural bleb (spontaneous resolution), esophageal tear, pneumothorax, high inspiratory/expiratory pressures in asthma/COPD
Aortic Dissection
Type A - Ascending (requires surgery)
Type B - Descending
D-Dimer
- Detects fibrinogen products
- Used most often for PE ddx
- Very sensitive (negative result excludes PE)
- Best in "healthy" outpatient patients
V/Q Scan
- Used to dx PE
- Performed by injecting technetium labeled macroaggregated albumin particles intravenously - these 'stick' in the smaller pulmonary capillaries and remain there for several hours until phagocytosed. Distribution of the particles provides
- Used to dx PE
- Performed by injecting technetium labeled macroaggregated albumin particles intravenously - these 'stick' in the smaller pulmonary capillaries and remain there for several hours until phagocytosed. Distribution of the particles provides us with a perfusion map of the lungs.
Colonic Edema
- "Thumbprinting" sign
- When colon wall thickened, protrudes into bowel. 
- IBD
- "Thumbprinting" sign
- When colon wall thickened, protrudes into bowel.
- IBD
"Apple Core" Lesion
Seen in patients with colon carcinoma
Seen in patients with colon carcinoma
SBO + Ileus
Gallstones
Kidney Stones
Non-contrast CT scan is the best modality. US better for pregnant patients.
Gallbladder + Cystic Duct
Normal cystic duct is 6 mm.
Pancreas + Surrounding Vasculature
Appendicitis
"Tram Tracking"
Dilated intrahepatic bile duct adjacent/parallel to portal vein branch.
Dilated intrahepatic bile duct adjacent/parallel to portal vein branch.
MRCP
Magnetic Resonance Cholangiopancreaticogram
Magnetic Resonance Cholangiopancreaticogram
ERCP
- Endoscopic Retrograde CholangioPancreaticogram 
- More therapeutic than diagnostic
- Endoscopic Retrograde CholangioPancreaticogram
- More therapeutic than diagnostic
Ultrasound > CT Scan
- Cheaper, faster, and can better visualize gallbladder wall thickening and stones within.
- Better for f/u of renal stone.
CT Scan > Ultrasound
- Needed to visualize pancreatitis --> whenever you have painless jaundice.
- Gold standard of kidney stone eval.
Acalculus Cholecystitis
- Inflammation of gallbladder w/o presence of stones.
- Associated with anorexia nervosa.
Pancreatitis
Associated with painless jaundice.
Associated with painless jaundice.
"Colon cut-off sign"
Inflammation from the pancreatitis causes inflammation and spasm of the adjacent bowel and may result in a partial pseudoobstruction at the splenic flexure.
Inflammation from the pancreatitis causes inflammation and spasm of the adjacent bowel and may result in a partial pseudoobstruction at the splenic flexure.
Pancreatic Mass
Renal Stone
On non-contrast CT, gold standard imaging modality.
- On non-contrast CT, gold standard imaging modality.
- Located at the URETEROVESICULAR junction
Renal obstruction coronal
Right hydronephrosis, renal enlargement, and perinephric stranding.
Right hydronephrosis, renal enlargement, and perinephric stranding.
Renal obstruction transverse
Right hydronephrosis, renal enlargement, and perinephric stranding.
Right hydronephrosis, renal enlargement, and perinephric stranding.
Ureterovesicular Junction
Where ureter inserts into bladder.
Ureteropelvic Juntion
Where ureter inserts into renal pelvis
Ureteral Jets
Doppler U/S shows urine jets from ureter into bladder bilaterally. Kind of like a cysto.
Doppler U/S shows urine jets from ureter into bladder bilaterally. Kind of like a cysto.
Pyelonephritis
Image taken 8 minutes after contrast injection. Left kidney cleared it all, looks normal. Right, infected kidney retained the contrast and looks swollen. Arrows point to area of patchy/striated nephrogram. This is an UNcomplicated case.
Image taken 8 minutes after contrast injection. Left kidney cleared it all, looks normal. Right, infected kidney retained the contrast and looks swollen. Arrows point to area of patchy/striated nephrogram. This is an UNcomplicated case.
Emphysematous Pyelonephrosis
Requires drainage.
Requires drainage.
Contrast-Induced Nephropathy
- Occurs in up to 40% of patients with underlying renal failure (elevated creatinine levels)
- Prophylactic therapies include hella hydration and/or NaHCO3 and/or N-acetylcysteine
- Acetylcysteine mechanism of action: scavenges O2-derived free radicals and improves endothelium vasodilatation.
- Treat with supportive therapy
Renovascular Hypertension
- Caused by increased renin release.
- More renin released because kidneys need higher forward pressure.
- Kidneys often need higher forward pressure 2/2 renal artery stenosis. ie a vicious cycle.
Renal Artery Stenosis
Diagnosed with angiogram
Diagnosed with angiogram
Hematuria
- Glomerular: with proteinuria = problem with the neprhron.
- Extraglomerular (isolated hematuria): without proteinuria = malignancy, stones, trauma, infection, meds.
Renal Cyst U/S
Renal Cyst CT
Simple Renal Cyst on U/S
- Anechoic (black)
- Round/oval
- Increased through transmission
- Smooth walls, no septations
- No internal vascularity
Renal Cell Carcinoma
- Classic Triad: flank pain, hematuria, fnalk mass
- Surgery is main treatment
- Classic Triad: flank pain, hematuria, fnalk mass
- Surgery is main treatment
Pelvic Trauma X-Ray
Chest Trauma CT
- Right lung normal.
- Left lung anterior = "ground glass" appearing contusion
- Left lung posterior = atelectasis and effusion
- Right lung normal.
- Left lung anterior = "ground glass" appearing contusion
- Left lung posterior = atelectasis and effusion
Abdominal Trauma CT
Stars = hematomas
Stars = hematomas
Free abdominal gas
Duodenal Leak
Bladder Rupture
Yellow arrow shows rupture. Red arrows shows where urine leaked into abdomen.
Yellow arrow shows rupture. Red arrows shows where urine leaked into abdomen.
Head CT w/o Contrast
Primary and 1st modality used for head trauma.
Epidural Hemorrhage
- Do NOT cross skull bone suture lines
- Arterial in origin (middle meningeal)
- Patients lose consciousness, have lucid interval, then rapid decompensation.
- Do NOT cross skull bone suture lines
- Arterial in origin (middle meningeal)
- Patients lose consciousness, have lucid interval, then rapid decompensation.
Subdural Hemorrhage
- Occur b/w dura and arachnoid.
- Due to tearing of bridging cerebral veins
- Crescent shaped
- Do NOT cross flax
- Occur b/w dura and arachnoid.
- Due to tearing of bridging cerebral veins
- Crescent shaped
- Do NOT cross flax
Subarachnoid Hemorrhage
- Tearing of cerebral vessels
- Rupture of aneurysm or trauma or AVM
- Lumbar puncture will show elevated opening pressure, elevated RBC count, and xanthochromia (pink tint)
- Tearing of cerebral vessels
- Rupture of aneurysm or trauma or AVM
- Lumbar puncture will show elevated opening pressure, elevated RBC count, and xanthochromia (pink tint)
Clay Shoveler's Fracture
- Avulsion of spinous process 2/2 pulling from trapezius muscle. 
- Treatment = pain meds and phys. therapy
- Avulsion of spinous process 2/2 pulling from trapezius muscle.
- Treatment = pain meds and phys. therapy
Decompensation 2/2 Brain Bleed Tx
- In epidural hemorrhage, you can get cerebral herniation and rebleed
- In subarachnoid, you can get vasospasm
Brain Herniation 1
- Red arrows point to subdural collection
- Yellow star shows compressed RIGHT lateral ventricle
- Blue line is midline and shift from
- Green star shows dilated occipital horn of LEFT lateral ventricle
- Red arrows point to subdural collection
- Yellow star shows compressed RIGHT lateral ventricle
- Blue line is midline and shift from
- Green star shows dilated occipital horn of LEFT lateral ventricle
Brain Herniation 2
Suprasellar Cistern (in red) should be black/liquid... filled with brain.
Suprasellar cistern is where the cavernous sinus is?
Suprasellar Cistern (in red) should be black/liquid... filled with brain.
Suprasellar cistern is where the cavernous sinus is?
Brain Herniation Overview
Diffuse Axonal Injury
White matter damage
Acute Subdural Hemorrhage
- < 3 days, generally hyperdense. 
- Subacute (3 days-3 weeks) are isodense
- Chronic ( > 3 weeks) are hypodense
- < 3 days, generally hyperdense.
- Subacute (3 days-3 weeks) are isodense
- Chronic ( > 3 weeks) are hypodense
CT Angiography
Diagnosis and evaluation of aneurysms and subarachnoid hemorrhage.
Lumbar Puncture
Should always follow a negative non-contrast CT scan in the setting of increased ICP headache.
Aneurysm Incidence
- Anterior Communicating (30%)
- Posterior Communicating (25%)
- Middle Meningeal (20%)
- Anterior Communicating (30%)
- Posterior Communicating (25%)
- Middle Meningeal (20%)
Subarachnoid Hemorrhage 2/2 ruptured aneurysm
Progressive Multifocal Leukoencephalopathy (PML)
- Caused by JC Virus
- CD4 < 100
- Rapid demyelinating disease
Neurocysticercosis
- No edema in imaging
- Infection from eggs of Taenia solum (pork tapeworm)
- Eggs must be ingested independently of the actual tapeworm - infection by the latter only causes abdominal problems.
- No edema in imaging
- Infection from eggs of Taenia solum (pork tapeworm)
- Eggs must be ingested independently of the actual tapeworm - infection by the latter only causes abdominal problems.
Toxoplasmosis General
- Reactivation of Latent Disease
- Prophylactic treatment once CD4 < 100
Toxoplasmosis Imaging
- Multiple lesions
- Abundant edema
- Hyperintense center w/ T2 imaging
- Involvement of deep gray matter (Basal Ganglia)
- Multiple lesions
- Abundant edema
- Hyperintense center w/ T2 imaging
- Involvement of deep gray matter (Basal Ganglia)
Primary CNL Lymphoma
- Solitary lesion
- Subependymal (by ventricles) enhancement
- Encasement of ventricles
- Hypointense center w/ T2 imaging
- Solitary lesion
- Subependymal (by ventricles) enhancement
- Encasement of ventricles
- Hypointense center w/ T2 imaging
Pyogenic Absecess
- Appears bright on diffusion weighted imaging
- Appears bright on diffusion weighted imaging
Cerebral Mets
- Plenty of edema
- Plenty of edema
Intussusception
- Currant Jelly stools (stool mixed with mucous and blood).
- Paroxysms of pain
- Vertically oriented mass
- Treat and see with AIR ENEMA
- Currant Jelly stools (stool mixed with mucous and blood).
- Paroxysms of pain
- Vertically oriented mass
- Treat and see with AIR ENEMA
Upper GI Series
Fluoroscopic study that uses radio-opaque contrast to look at the entire GI tract.
Mid-Gut Volvulus
RSV
- Causes hyperinflation and perivascular markings
- Perivascular markings 2/2 bronchial wall thickening and edema.
- Hyperinflation caused by peripheral air trapping when central airways collapse 2/2 edema.
- Causes hyperinflation and perivascular markings
- Perivascular markings 2/2 bronchial wall thickening and edema.
- Hyperinflation caused by peripheral air trapping when central airways collapse 2/2 edema.
Torus (Buckle) Fracture
- 2/2 compressie force
- 2/2 compressie force
Joint Effusion in Child
- Most common cause is transient synovitis
- Also consider septic arthritis
Metaphyseal Corner Fracture (Bucket-Handle Fracture)
- Happens with shaking/grabbing
- Pathognomonic for child abuse
- Other child abuse fractures: posterior ribs, humeral head dislocation, Type V salter harris fracture (crush fracture)
- Happens with shaking/grabbing
- Pathognomonic for child abuse
- Other child abuse fractures: posterior ribs, humeral head dislocation, Type V salter harris fracture (crush fracture)
Developmental Dysplasia of the Hip
- Shallow acetabular development
- Predisposition to Subluxation and dislocation of hip
- Ultrasound is best in 2 month olds because not enough calcifications yet for radiograph.
- Shallow acetabular development
- Predisposition to Subluxation and dislocation of hip
- Ultrasound is best in 2 month olds because not enough calcifications yet for radiograph.
Necrotizing Enterocolitis
- Seen in premature infants
- Gas gets trapped under submucosal layers of intestines and causes necrosis to mucosal layers
Epiglottitis
- Caused by HIB (Haemophilus influenzae type B)
- Caused by HIB (Haemophilus influenzae type B)
Croup
- Steeple Sign
- Subglottis infection
- Steeple Sign
- Subglottis infection
Air Bronchogram
Visualizing the airways when the entire lung is consolidated 2/2 pneumo
Visualizing the airways when the entire lung is consolidated 2/2 pneumo
Rheumatoid Arthritis
- Stiff joints in the morning
- MCP and PIP joint involvement
- Swan neck and boutonniere deformities
- Stiff joints in the morning
- MCP and PIP joint involvement
- Swan neck and boutonniere deformities
Dual-energy X-ray Absorptiometry (DEXA) Scan
- Osteoporosis screening
- Can be used in osteopenia, too (precursor to osteoporosis).
- T-score > -1 = normal. 
- T-score < -2.5 = osteoporosis
- Osteoporosis screening
- Can be used in osteopenia, too (precursor to osteoporosis).
- T-score > -1 = normal.
- T-score < -2.5 = osteoporosis
Fibroadenoma
MCC of breast mass in women < 30
Hysterosalpingogram
Fill uterus with contrast, let it pour through tubes. Will show you the contours of the uterus as well as the patency of the fallopian tubes.
Fill uterus with contrast, let it pour through tubes. Will show you the contours of the uterus as well as the patency of the fallopian tubes.
Sonohysterogram
Fill uterus with saline and you can evaluate uterus for thickening... but you cannot see tube patency.
Breast Mass
- First do ultrasound. 
- If cystic, you're good. If not clear, do ultrasound guided core biopsy of mass.
- If biopsy positive, do MRI to see if any other focal lesions present.
- First do ultrasound.
- If cystic, you're good. If not clear, do ultrasound guided core biopsy of mass.
- If biopsy positive, do MRI to see if any other focal lesions present.
Tamoxifen
- Anti estrogen receptor
- Increases risk of endometrial cancer and endometrial hyperplasia
Ankle anatomy
Injured Ankle
Fracture Adjectives
Knee Injury 1
Knee Injury 2
- Lipohemarthrosis (mixture of fat and blood within joint capsule 2/2 trauma)
- Intraarticular frature --> fat and blood released from marrow space
- Lipohemarthrosis (mixture of fat and blood within joint capsule 2/2 trauma)
- Intraarticular frature --> fat and blood released from marrow space
MRI Normal Knee
Femoral Neck Insufficiency Fracture
Right Wrist Fracture
Hill-Sachs Fracture
- During dislocation, happens when humeral head hits the glenoid
- During dislocation, happens when humeral head hits the glenoid
Elbow Injury