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70 Cards in this Set
- Front
- Back
what does upper GI series visualize?
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esophagus, stomach, duodenum
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area gastricae vs rugal folds
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both found in stomach; area gastricae are more fine mosaic pattern, primarily in gastric antrum
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when to use gastrograffin vs barium?
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gastrograffin only if emergency (eg ?perf); gastrograffin is water soluble, secreted by kidneys, so no big deal if extravasates; also, gastrograffin doesn’t require prep (unlike NPO after midnight for barium)
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when not to use gastrograffin?
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can cause pulmonary edema --> contraindicated if aspiration risk
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esophageal anatomy on barium swallow: 3 segments, 2 lines
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SEGMENTS: tubular (majority), vestibular (bulb like area near GEJ), and submerged segments (leads to GEJ); LINES: A line (b/w tubular and vestibular portions); Z line / B ring: between vestibular and submerged segments, represents squamocolumnar junction
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types of peristalsis (3)
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1) PRIMARY: stripping wave init by swallowing; 2) SECONDARY: stripping wave follows primary, gets remaining food; 3) TERTIARY (nonstripping, disordered)
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what nerve controls esophageal motility? Where is the nucleus?
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Vagus nerve (dorsal vagal nucleus in the midbrain)
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causes of primary esophageal dysmotility
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achalasia, diffuse esophageal spasm, nutcracker esophagus, others
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causes of secondary esophageal dysmotility
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1) MIDBRAIN: MS, CVA; 2) VAGUS: esoph/lung cancer; 3) MYENTERIC/MESENTERIC PLEXI: esophagitis, esophageal CA, scleroderma, neuropathy
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classic radiographic features of achalasia (4)
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1) absent GASTRIC BUBBLE; 2) early --> disordered peristalsis, late --> absent peristalsis; 3) Dilated esophagus with AIR FLUID level; 4) BIRD BEAK lower esophagus
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what to r/o if ?achalasia?
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tumor (and other 2' causes of achalasia), incl esophageal and lung CA
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what parts of esophagus affected by scleroderma?
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distal 2/3 --> atony
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ddx of air in a dilated esophagus (3)
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1) scleroderma; 2) Achalasia; 3) lower esophageal stricture
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what 3 conditions cause absent peristalsis?
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1) LATE achalasia; 2) Scleroderma; 3) Neuropathy (DM, EtOH)
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Types of hiatal hernias (3)
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TYPE 1: Sliding (95%); TYPE 2: Paraesophageal (5%); Type 3: Combination (rare)
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how to dx a small sliding hiatal hernia?
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B-line > 1cm above hiatus between swallows (during swallows, submerged segment submerges below hiatus)
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what's seen with sliding hiatus hernia on CXR?
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retrocardiac density
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what is bochdalek hernia?
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persistent fetal posterior pleuroperitoneal canals -- > allows herniation of abdominal contents (usu L sided)
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pulsion vs traction esophageal diverticulae
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PULSION: a/w disordered peristalsis: Zencker's (posterior) and Epiphrenic (lateral); TRACTION: a/w extrinsic abnormalities (eg tuberculous mediastinal node), usu mid-esophageal
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what are feline folds?
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fine esophageal folds caused by submucosal contractions 2/2 esophagitis / irritation
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what does esophageal cancer look like on barium swallow?
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apple-core appearance
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what does post-radiation esophageal stricture look like?
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smooth tapered edges with stricture in the middle --> looks benign ("rat tail")
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what does barrett's esophagus look like on barium swallow?
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mid-esophageal stricture with reticular mucosal pattern, +/- ulcer, +/- hiatal hernia
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what to do to work up any stricture?
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biopsy! (r/o cancer)
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use of single vs double contrast study
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single better for polyps, double better for fine mucosal abnormalities
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ddx for varicoid lesion on barium swallow? (2)
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1) Varices; 2) esophageal tumor (carcinosarcoma / lymphoma)
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candidal vs Herpes esophageal ulcers
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candidal ulcers more course
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what to CMV / HIV esophageal ulcers look like?
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EITHER multiple diamond-shaped ulcers with halo OR giant ulcer toward GEJ
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major risk factors for esophageal cancer
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SMOKING (synergistic with EtOH), Barrett's esophagus, achalasia, scleroderma
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what is boerhaave's syndrome
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RUPTURE OF ESOPHAGUS: linear tear across GEJ 2/2 vomiting across closed glottis (often in drunk/passed out); similar to mallory-weiss, but goes THROUGH the wall, not just mucosal tear ==> no hematemesis, but aberrent air seen on cxr
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thickness of esophagus on CT
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<3mm
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stomach visualization in UGI with prone vs supine positions
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SUPINE: fundus and antrum are posterior --> fill with contrast; PRONE: body is anterior, so fills with contrast
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differences between benign and malignant ulcers: (7)
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1) PROJECTION (outside vs inside lumen); 2) BORDER (smooth vs irregular); 3) LOCATION relative to edema (central vs eccentric); 4) RADIATING FOLDS (start close to vs far from crater edge); 5) RADIATING FOLD THICKNESS (uniform vs clubbed); 6) hampton's line vs carmen kirklin complex; 7) HEALING (complete vs incomplete)
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what is a hamptom's line?
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thin, sharply demarcated radiolucent line along the neck of a contrast-filled BENIGN gastric ulcer, indicates mucosal edema
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what is the carmen kirklin complex?
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pathognomonic of malignant gastric ulcer: push on epigastrium --> see shadow?
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what is linitis plastica?
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infiltrating scirrhous carcinoma ==> extensive thickening of stomach wall (aka leather-bottle stomach)
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causes of linitis plastica
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infiltration: malignancy, granulomatous, radiation changes, benign ulcers
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what causes thickened mucosal folds in the stomach?
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lymphoma, menetrier's dz, gastritis, varices (proximal)
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where is the ligament of treitz?
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at the duodenal-jejunal junction
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rule of thumb for duodenal ulcers
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benign until proven otherwise
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what does cyst look like on US?
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anechoic collection + increased distal intensity
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what causes duodenal hematoma?
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often MVA (esp C3 segment)
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what can a pancreatic pseudocyst do to duodenum?
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cause c-loop widening (sweep abnormality)
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rule of thumbs for duodenal vs gastric ulcers
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duodenal benign until proven otherwise -- usu no endoscopy; gastric can be either benign or malignant, radiology helps, but most are endoscopied / biopsied (if any suspicious features)
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three spaces around kidney used on CT
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anterior pararenal space, perirenal space, posterior pararenal space
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ionic vs nonionic contrast
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ionic has fewer complications a/w it
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contraindications to IVU (intravenous uretrogram)
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same as contraindications to contrast
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3 phases of IV contrast injection (in reference to kidneys)
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1) total body opacification (kidney and liver equally opacified); 2) nephrogram phase (cortex lit up); 3) pyelogram phase (within 3-4mins --> contrast in renal calyces, pelvices, ureters)
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3 stages of reading a IVU
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1) SCOUT FILM: radio opacities/lucencies; 2) NEPHROGRAM PHASE (renal fxn, parenchymal morphology); 3) PYELOGRAM PHASE (timing, tubular evaluation -- polyps, fistulas, etc)
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contraindications to contrast (6)
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1) PREGNANCY; 2) ALLERGY to IV contrast; 3) RENAL INSUFFICIENCY; 4) MULTIPLE MYELOMA; 5) CHF; 6) GOUT
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uses of ultrasound in renal evaluation
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1) renal mass vs cyst; 2) doppler eval of blood flow; 3) guide biopsies / drainage
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what is a bosniak type I renal cyst?
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SIMPLE cyst: fluid filled, no calcification or wall thickening; BENIGN
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what is bosniak type II cyst?
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slightly more complex than type I: homogenous cyst with 1-2 septations, nonenhancing; BENIGN
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what is bosniak type IIf cyst?
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COMPLEX cyst: some suspicious features warranting followup, eg enhancing rim; PROBABLY BENIGN (but needs followup)
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what is bosniak type III renal cyst?
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COMPLEX cyst: >2 septations, ?enhancing septations, wall thickening, nodularity; POSSIBLY MALIGNANT
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what is bosniak type IV renal cyst?
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usu due to renal carcinoma with cystic component; MALIGNANT
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classic findings on different imaging modalities of renal cyst
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anechoic on US with enhanced through-transmission, no uptake on CT, hypodense on T1, hyperdense on T2
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Robson staging of renal cancers
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1: inside capsule; 2: outside capsule, inside fascia; 3: nodes/vein involvement; 4: outside fascia/distant sites
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stone vs polyp in ureter
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stone causes spasm --> stenosis; polyp causes Bergman's sign (uretral dilatation distal to obstruction
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what renal pathology can be confidently diagnosed on US/CT/MRI?
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angiomyolipma -- contains bulk fat --> hyperechoic on US, in phase and out of phase appearnace on MRI, fatty appearance? on CT
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weigert-meyer law
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in duplex kidney, upper pole obstructs, lower pole refluxes
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what is renal scan good for?
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differentiating obstructive vs nonobstructive hydronephrosis, functional studies (gfr), HTN, infection
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which stones radioopaque on CT?
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ALL! (except some anti-retroviral- associated stones, eg indinivir)
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what does pyelonephritis look like on CT?
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wedge-shaped area of low attenuation
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differentiating b/w ACUTE pyelonephritis and ACUTE infarct on CT
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both show wedge-shaped hypodensity, but in pyelonephritis, wedge is pointed TOWARD calyx, while in infarct, wedge is pointed BETWEEN calyces
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differentiating b/w CHRONIC pyelonephritis and CHRONIC infarct on CT
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both show wedged-shaped defect of PARENCHYMA, but pyelo --> apex of defect is TOWARD CLUBBED calyx, while infarct --> apex BETWEEN NORMAL calyces
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3 MCC papillary necrosis
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1) ANALGESIC ABUSE; 2) DM; 3) SICKLE CELL DISEASE
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calyceal clubbing seen with what?
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seen with both papillary necrosis and hydronephrosis; in hydronephrosis, also see pelvicalyceal dilation
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3 manifestations of renal osteodystrophy
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1) diffuse osteosclerosis; 2) osteomalacia; 3) 2' hyperPTH
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findings in 2' hyperPTH (3)
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distal resorption of b/l clavicles; widening of SI joints and pubic symphysis; horizontal linear lucency through centers of multiple vertebral bodies ("rugger jersey spine")
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