CP and SOB
In the ED 27.5% of patients with this disease, the diagnosis is initially missed. In ICU patients that die and undergo autopsy, this same diagnosis is missed in 37.9%.
What is Pulmonary Embolism? (Pagnone)
This diagnosis is missed on up to 90% of initial presentations to the Emergency Department and results a 3-fold increase in morbidity when the diagnosis is delayed > 24 hours.
a. Spinal Epidural Abscess
b. Myasthenia Gravis
c. Pseudotumor Cerebri
d. Vasculitis
It is safe for the mother and infant to continue breast feeding immediately after receiving iodinated contrast medium or gadolinium-based contrast agent.
True
False
True. But if concern, may abstain from breast-feeding for 24 hours with active expression and discarding of breast milk from both breasts during that period. (Yim)
This hospital's ER is in the states top 3 busiest emergency departments.
a. Roseville
b. Sacramento
c. Oakland
d. Walnut Creek
e. Red Wood City
Roseville (Pagnone)
What is the percentage of emergency physicians who will be named in a malpractice claim at some point in their career?
35%, 50%, 75%, 90%
75% (Pagnone)
What is the radiation dose equivalent of a single PECT study?
a. 150 chest xray
b. 50 screening mammograms
c. 4 years of natural background radiation
d. All of the above
Answer: (d) Hongkham
Can you do MRI with IV contrast on a patient with allergic reaction to CT iodinated IV contrast?
Yes.
No.
Yes (Ormsby)
In a trial looking at accuracy of trauma radiograph interpretation at a level 1 trauma center who does better?
A. Radiologists
B. Orthopedic surgeons
Orthopedic surgeons win. They have seen and examined the patients and they know what the most likely and worrisome injuries are for the patient. Knowing where to look and what to be the most worried about is critical to helping patients. Please help radiologists with your history. Thanks! (Fu)
If a patient has been in the ED for many hours (eg. Waiting for MRI), what is the best way to notify the physician currently responsible for care of the patient of urgent imaging findings?
2 (Griffin)
Patient with minor blunt trauma and suspected rib fracture - recommended initial imaging?
a. Xray chest
b. Xray ribs
c. Both.
a. CXR to r/o pneumothorax and hemothorax. (Popovski)
Rib xray is not a necessity as it does not change conservative management.
If imaging studies are ordered concurrently for a single patient and the results of one of the studies comes back with a positive finding that accounts for the patient's symptoms, then the other ordered study should be canceled immediately.
True
False
True--quite often in the ER, imaging studies are ordered concurrently for a patient. When one of the studies comes back with a positive result, the other imaging study is not canceled, wasting time and resources for the radiology department. (Reddy)
Better yet, do not concurrently order redundant studies. Wait for the result to see additional test is needed.
Can patients on hemodialysis or PD get MRI with IV contrast using our current IV contrast Clariscan or Gadavist?
Yes.
No.
Yes. (Ormsby)
Pt with R THA, unable to weight bear on R. MRI is better than CT to evaluate abnormalities that may change management.
True
False
False. Metallic artifact severely limits both studies. MRI may pick up nondisplaced sacral or rami fractures that may be missed on CT due to osteopenia. However, these fractures are treated WBAT. Any associated hematoma (which may change management) can be seen on both CT and MRI. For evaluation of subtle periprosthetic fracture or loosening, xray is the best modality. (Brown)
If patient refuses a procedure, family can give consent:
a. If team feels strongly that procedure is necessary b. If family feels strongly that procedure is necessary c. Only if patient is incompetent – a competent patient has the right to refuse a procedure
c. Only if the patient is incompetent – a competent patient has the right to refuse a procedure (Yim)
What is the cutoff for normal d-dimer in pregnancy?
a. 0.5 microgram/L
b. 0.75 microgram/L
c. 1.0 microgram/L
d. 1.5 microgram/L
c. 1.0 microgram/L. Higher than the age-adjusted d-dimer (Yim)
What is the rate of venous thromboembolism in pregnancy?
a. 5-12/ 100,000
b. 50-74/ 100,000
c. 125-200/ 100,000
a. 5-12/ 100,000 (Yim)
Which of the following should NOT be performed in patients with severe renal insufficiency (GFR<30) not on dialysis:
a. CT without contrast
b. CT with contrast
c. MRI without contrast
d. MRI with contrast
e. Ultrasound
b. CT with contrast (Yim)
Patients in the Emergency Department almost always present with a history and exam that allows the treating physician to narrow down the differential diagnosis to just a few pathologies.
True
False
False (Correct answer: Not for lack of trying. And this is particularly true in the elderly) - Griffin
This is the best test for PE in pregnancy:
a. DVT compression ultrasound
b. CTA- PA
c. VQ scan but V only
d. VQ scan but Q only.
d. VQ scan but Q only. (Yim)
Suspected atraumatic SAH with negative NCCTH, then SAH is ruled out.
a. True
b. False
c. Depends (please explain)
c. Depends (please explain):
If < 6 hrs LKWT, aSAH is ruled out.
If > 6 hrs LKWT, then LP > CTA head only (no neck)
(Yim)
Which of the following requires premedication for CT scan with IV con?
a. Prior bronchospasm with iodinated CT contrast
b. Povidone-Iodine (Betadine) allergy in chart
c. Shellfish allergy
d. Prior rash with gadolinium MRI contrast
a. Biggest risk factor for allergic-like reaction to contrast is history of prior contrast reaction to same class = 5-6x increased risk of subsequent reaction.
Shellfish or Povidone-iodine (Betadine) allergies are at no increased risk from iodinated contrast medium than are patients with other allergies.
No cross reactivity between different classes of contrast medium. (Tran)
Imaging is required for the diagnosis of acute pyelonephritis.
a. Yes
b. No
c. Depends on the patient.
Answer: B – No. Imaging is not needed for the diagnosis of acute pyelonephritis if the history, physical exam, and results of laboratory testing indicate acute pyelonephritis. Early imaging can be considered in patients at high risk for complications (gas-forming infection, abscess formation, urinary obstruction). The American College of Radiology’s Appropriateness Criteria consider patients with diabetes, immune compromise, a history of urolithiasis, or anatomic abnormality to be at highest risk for complications. (Kraft)
52 y presents to ED with LBP radiates to left leg. No neurologic deficits.
a. L spine XR series
b. CT L spine
c. MRI L spine
d. None of the above
d. None of the above.
HEDIS LBP: No imaging for 28 days if no red flags. Will not change management (Yim)