Term
| Look at requirements for tension headache, migraine, and cluster headache. |
|
Definition
|
|
Term
| Which type of primary headache do you do initial imaging on, what type of imaging? |
|
Definition
- Cluster headache
- MRI with and without contrast and MR angiography of circle of willis |
|
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Term
| "worst headache of their life" thinking SA. What imaging? |
|
Definition
| - first CT scan, if this does not reveal SA do lumbar puncture |
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Term
| CT scan reveals SA hemorrhage and pt is perilously ill/unstable. What now? |
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Definition
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Term
| CT shows SA hemorrhage, pt is unstable> CT angiography does not show bleed, what now? |
|
Definition
| MRI with and without contrast |
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Term
| CT shows SA hemorrhage and pt is stable, what now? |
|
Definition
| Catheter Angiography (GOLD STANDARD) |
|
|
Term
| WHAT IS THE GOLD STANDARD NEXT STEP AFTER A CT REVEALS SA HEMORRHAGE? |
|
Definition
|
|
Term
| If CTA, MRI, and Catheter angiography are all negative in proven SA on CT, what do you? |
|
Definition
| repeat CT angiography in 2 weeks |
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Term
| Test of choice for HA caused by intraparenchymal hemorrhage? |
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Definition
|
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Term
| Headache suspcious of tumor, what imaging study would you order? |
|
Definition
| MRI with and without contrast |
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Term
| Isolated cranial nerve problems do not call for imaging. But if multiple cranial nerves involved or there are central symptoms, what imaging do you order? |
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Definition
|
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Term
| Sinusitis does not normally require imaging, but if it does, what do you order? |
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Definition
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Term
| Palpable thyroid lesion, what now? |
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Definition
|
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Term
| Non-thyroid neck mass. What now? |
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Definition
|
|
Term
| Amaurosis fugax, what now? |
|
Definition
- MRI of brain
- MRA or CTA of carotid arteries and the arch
(at very minimum ultrasound of neck vessels) |
|
|
Term
| acute monocular vision loss in young patient? |
|
Definition
| MRI with and without contrast to r/o Multiple Sclerosis |
|
|
Term
| Bitemporal hemianopsia. What imaging should you order? |
|
Definition
| MRI with and without IV contrast with focus on pituitary fossa |
|
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Term
| younger patient with double vision. What should you order? |
|
Definition
| MRI with and without contrast to r/o Multiple Sclerosis |
|
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Term
| In older patients with double vision you suspect a vascular cause. What should you order? |
|
Definition
| MRI with and without contrast and vascular imaging |
|
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Term
| Trigeminal neuralgia is aka __ ___ and is characterized by __ __ facial pain. Since the same pain can be caused by __ __ or a __ __ __ __ and __ of the brain should be ordered with and without contrast. |
|
Definition
- Tic douloureax
- unilateral lancinating facial pain
- Multiple Sclerosis
- Cerebellar pontine angle tumor
- MRI with and without contrast |
|
|
Term
|
Definition
patient and examiner hear ringing from ears> vascular lesion
Order MRI and MRA or CTA of skull base and neck vessels |
|
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Term
| Conductive hearing loss typically does not require imaging, but if it does order at : |
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Definition
|
|
Term
| Sensorineural hearing loss imaging: |
|
Definition
| MRI with and without contrast with thin cuts to exclude brainstem stroke, vestibular schwannoma, multiple sclerosis |
|
|
Term
| Vertigo with other central symptoms: |
|
Definition
| MRI with and without contrast with thin cuts through posterior fossa |
|
|
Term
| If you cannot tell if a neck mass is thyroid or non-thyroid, what should you order? |
|
Definition
|
|
Term
| A thyroid lesion found on ultrasound should be biopsied if it is greater than __ __. |
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Definition
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|
Term
| Thyroid lesions found on ultrasound with microcalcifications should be biopsied if they are greater than __ __. |
|
Definition
|
|
Term
| What type of imaging should you do on adult neck masses of unknown origin? |
|
Definition
| CT scan with contrast from aortic arch to skull base (head and neck), may also add chest ct if risk factors like smoking |
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Term
| If CT scan and scopes do not identify a primary lesion when there is a neck mass of unknown origin, what next? |
|
Definition
| 1. FNAB of the palpable lesion> if malignant> random biopsies of nasopharynx, tonsils, and base of tongue |
|
|
Term
| Red flags of back pain that necessitate MRI within one week: |
|
Definition
- Personal hx of cancer
- Unremitting pain (no relief with position change or medications)
- Pediatric back pain
- Constitutional symptoms |
|
|
Term
| Synovial proliferation/cyst formation of the spine presents just like a ___. |
|
Definition
|
|
Term
| Plain films are unreliable for dx of __ stress fracture. |
|
Definition
|
|
Term
| __ shows bone marrow best. |
|
Definition
|
|
Term
| study of choice for evaluation of fracture age? |
|
Definition
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|
Term
| Discography (controversial) is used to dx __ __ __ (controversial). Advocates say that injecting a symptomatic nucleus will cause pain but injecting a normal nucleus will not cause pain. Advocates say __ the painful level should alleviate the pain. |
|
Definition
- internal disc derangement
- fusing |
|
|
Term
| How can you dx facet joint pain? |
|
Definition
|
|
Term
| If pt does well with anesthesia of median nerve branches which suggest __ __ __, what are they a candidate for? |
|
Definition
- facet joint pathology
- rhizotomy |
|
|
Term
| what is rhizotomy and what is it used for? |
|
Definition
- percutaneous lesioning of the nerves supplying the facet joint
- used for facet joint pathology |
|
|
Term
| 3 options for tmt of large synovial cyst: |
|
Definition
- NSAIDs
- Percutaneous rupture by placing needle in joint and vigorously injecting it> joint rupture> relieve radiculopathy
- Resect the joint and fuse the spine |
|
|
Term
| Should chest CT be ordered with or without contrast? |
|
Definition
| - with contrast if at all possible (do not use contrast with renal failure of if just monitoring a nodule) |
|
|
Term
| - Acute cough < 3 weeks, if accompanied by febrile illness or productive cough> CXR> pneumonia> sometimes may show pulmonary mass> CT |
|
Definition
|
|
Term
| What are the red flags of cough? |
|
Definition
- fever
- sweats/chills
- unintentional weight loss
- hemoptysis
- dyspnea
if these are present> CXR and CT |
|
|
Term
|
Definition
- Post-nasal drip
- GERD
- Asthma |
|
|
Term
| chronic cough what to order? |
|
Definition
|
|
Term
| suspect GERD causing chronic cough. what do you order? |
|
Definition
| pH monitoring of esophagus or treat with H2 blockers |
|
|
Term
| suspect post-nasal drip causing chronic cough. what do you do? |
|
Definition
| - nasal glucocorticoids and/or oral antihistamines/decongestants |
|
|
Term
| Suspect asthma is cause of chronic cough. What do you do? |
|
Definition
- spirometry and metacholine challenge
- bronchodilators |
|
|
Term
| Chronic cough unreponsive to ddx treatments or suspicous findings on CXR: |
|
Definition
CT scan may show:
- bronchiectasis
- tumor
- interstitial lung disease> biopsy |
|
|
Term
| If ct shows interstitial lung disease what next? |
|
Definition
|
|
Term
| Red flags of dyspnea and SOB: |
|
Definition
- fever
- sweats/chills
- unintenional weight loss
- hemoptysis |
|
|
Term
| Severe acute dyspnea with CP ddx? |
|
Definition
- Pneumothorax
- Pulmonary embolism |
|
|
Term
| Severe acute dyspnea with chest pain. What do you order? |
|
Definition
CXR (will show pneumothorax)
Contrast enhanced CT to show PE |
|
|
Term
| If suspect PE order __ __, if elevated urgent __. |
|
Definition
- D-dimer
- CT with contrast |
|
|
Term
| Symptomatic pulmonary nodule? |
|
Definition
| CT with possible CT guided biopsy, early referral to chest surgeon |
|
|
Term
| Lesion incidentally found on CXR, what now? |
|
Definition
| - CT scan, unless old xray shows stability for at least 2 years |
|
|
Term
| Features that deomonstrate a lesion is unequivocally benign on chest CT: |
|
Definition
1. Calcifactions- esp uniformly or popcorn
2. Fat- completely fat- lipoma, fat and other tissues- hemartoma
3. Arterovenous malformation with draining and feeding vessels (embolize)
4. Stability of sequential scans (2 years) |
|
|
Term
| Ground glass nodule on CT scan: |
|
Definition
|
|
Term
| lung nodule 4 mm or less, no risk factors? |
|
Definition
|
|
Term
| lung nodule 4 mm or less with risk factors? |
|
Definition
| CT scan at 12 months, if not change> stop |
|
|
Term
| lung nodule 5-6 mm, no risk factors? |
|
Definition
| CT scan at 12 months, no change> stop |
|
|
Term
| lung nodule 5-6 mm with risk factors? |
|
Definition
| CT scan at 6 months, no change, CT scan at 24 months |
|
|
Term
| lung nodule 7-8 mm no risk factors? |
|
Definition
| CT scan at 6 months, no change, CT scan at 24 months |
|
|
Term
| lung nodule 7-8 mm with risk factors? |
|
Definition
| CT scan at 3, 9, and 24 months |
|
|
Term
| lung nodule 9 mm or more no risk factors? |
|
Definition
| CT at 3,9, and 24 months, or PET scan, or biopsy |
|
|
Term
| lung nodule 9 mm or more with risk factors? |
|
Definition
| CT scan at 3, 9, and 24 months or PET scan or biopsy |
|
|
Term
| For lesions 8 mm or more it is smart to do a __ __. |
|
Definition
|
|
Term
| normal postmenopausal endometrial stipe: |
|
Definition
- < 5mm
- uniform thickness
- uniform hyperechoic |
|
|
Term
| Endometrial polyp are more common in women on __ or __. They will cause __ or __ thickening of the stipe. |
|
Definition
- estrogen or tamoxifen
- diffuse or focal |
|
|
Term
| Thickending endometrial stripe postmenopasual always require: |
|
Definition
|
|
Term
| when should you do an u/s on a premenopausal woman for abnormal uterine bleeding? |
|
Definition
| a few days after cessation of menses to avoid secretory endometrium |
|
|
Term
| Simple endometrial cysts have no __ components. If they are greater than __ __, they should be surgically epxlored. |
|
Definition
- no solid
- 10 cm (premenopausal)
- surgically explored |
|
|
Term
| Postmenopausal ovarian cyst guidelines: |
|
Definition
| - surgically explore all greater than 5 cm or those correlated with elevated CA-125 |
|
|
Term
- Hemorrhagic ovarian cyst
- Characteristic appearance, enlarged heterogenous ovary
- Follow up study to confirm resolution |
|
Definition
|
|
Term
- Endometriosis
- MR can be used to ID endometriomas |
|
Definition
|
|
Term
- Ovarian torsion
- Ovary twists on its pedicle> compromises blood flow> pelvic pain, nausea, vomiting (looks like appendicitis)
- u/s> swollen ovary often with inflammatory free fluid
- Doppler studies may be abnormal but could be normal with intermittent torsion or b/c artery blood flow is only impeded after venous blood flow and venous flow not shown on doppler |
|
Definition
|
|
Term
| - PID- nml u/s until development of pyosalpinx |
|
Definition
|
|
Term
- Degenerating uterine fibroid (undergoing hemorrhage or infarction> pelvic pain)
- U/S: anechoic/hypoechoic areas suggesting hemorrhage
- Color Doppler: lack of blood flow |
|
Definition
|
|
Term
| Complex adnexal lesions are __ and __. Dermoid cysts have a characteristic appearance on u/s and require surgery. Hemorrhagic cysts have a characteristic apperance and require follow up studies for resolution. ALL OTHERS SHOULD BE: |
|
Definition
|
|
Term
| Most common causes of scrotal pain: |
|
Definition
1. Torsion of testicular appendage
2. Epididymitis
3. Testicular torsion |
|
|
Term
- Testicular torsion:
- U/S: swelling
- Color Doppler: anormal
- PULSED WAVE/SPECTRAL DOPPLER BETTER THAN color Doppler AND SHOULD BE USED ON ALL SCROTAL EXAMS
- PATIENTS WITH SEVERE INTERMITTENT OR SEVERE PERSISTENT PAIN SHOULD BE REFERRED TO UROLOGY REGARDLESS OF U/S RESULTS UNLESS CLEAR RESULT OF TORSION |
|
Definition
|
|
Term
- Torsion of testicular Appendage
- u/s: normal or avascular structure |
|
Definition
|
|
Term
- Epididymitis:
- PE: swollen and painful epididymis (postier superior testicle)
- U/S: enlarged epididymis with increased blood flow compared to other side on color doppler
- Causes of inflamed epididymis: trauma, straining, weight lifting, squats, bicycle, motorocycle riding, STDs |
|
Definition
|
|
Term
| Fornier's gangrene on ultrasound: |
|
Definition
| extensive skin thickening and hyperemia with normal testicles deep to abnormal superficial tissues > emergent referral and tmt |
|
|
Term
| A testicle in the inguinal canal can be seen on __. A testicle in the abdomen can be seen on __. |
|
Definition
|
|
Term
| Varicoceles are d/t venous drainage reflux on the __ side. Bag of worms. Ultrasound will show __ __ __. |
|
Definition
- left
- increased blood flow |
|
|
Term
| An epididycmal cyst is less than __ __, while a spermatocele is greater than __ __. |
|
Definition
- epididymal cyst < 2 cm
- spermatocele is > 2 cm |
|
|
Term
| An epididymal cyst is less than: |
|
Definition
|
|
Term
| A spermatocele is greater than ___. |
|
Definition
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|
