Mixed bag
What is the best type of radiograph for evaluating pneumothorax?
A. Apical lordotic
B. Expiratory view
C. Oblique view
B. Expiratory view. (Fu)
3 year old boy present with 1 day history of nonbloody, nonbilious emesis with decreased oral intake. Patient’s mother is concerned that he may have swallowed his sister’s toy. What is the most appropriate first imaging study?
a. Front and lateral chest plain films
b. Frontal and lateral plain films of the neck, chest, and abdomen.
c. CT Abdomen
d. US Abdomen
e. MRI
Frontal and lateral plain films of the neck, chest, and abdomen. (Navarro)
A patient has a DVT ultrasound completed and is found to have a thrombus in their left greater saphenous vein 4cm from the saphenofemoral junction. What type of anticoagulation does this require?
A. Therapeutic
B. Prophylactic
C. None
Answer: Prophylactic (Fleischmann)
According to the ACR Appropriateness Criteria regarding imaging evaluation of facial trauma, radiographs of the face are:
a. The Gold Standard
b. Usually Appropriate
c. Usually Inappropriate
d. A fun thing to try while we wait for CT
C) Usually Inappropriate- due to low sensitivity/specificity. (Escudero)
24 year old female with sudden onset severe headache that reaches maximal severity within one hour. What is the most appropriate initial imaging study?
a. CT head without IV contrast
b. CTA head with IV contrast
c. MRA head with IV contrast
d. CT head with IV contrast
a. CT head without IV contrast (Navarro)
What are the indications for MSK MRI in ED after 5 pm weekdays and on weekends and holidays?
a. R/O fracture if xray is inconclusive.
b. R/O joint infection.
c. R/O osteomyelitis.
d. All of the above
d. All of the above. Starting Oct 7, 2024. The only MSK MRI can be done after hours are for these 3 indications.
Ortho can discuss with on call Radiologist if patient needs immediate surgical intervention. (Yim)
Regarding radiographs ordered as a skeletal Survey for possible Non-Accidental Trauma, Parents/Guardians or Ordering Physicians can request to omit certain views based degree of suspicion.
True
False
False. There are set guidelines for these surveys that are agreed upon by multiple departments.
Bonus: It is a huge help to the radiology techs if the parents/family are aware of the number of images before getting to the radiology department.
-children less than 2 years old get up to 23 views (Escudero)
A 5yo child is found to have a minimally displaced distal radial metaphyseal fracture with 14 degrees of angulation. They are neurovascularly intact. Does this require reduction?
Yes.
No.
No. (Fleischmann)
What is the best modality for evaluating abdominal wall hernia?
a. KUB radiograph.
b. Ultrasound.
c. CT
Ultrasound offers more detailed and dynamic evaluation of the hernia relative to CT and should be performed prior to CT when hernia is the primary diagnostic consideration, unless bowel obstruction is suspected. (Chan)
What would be the best radiology study to evaluate for suspected fishbone lodged in oropharynx/esophagus?
a. Plain film
b. Non-contrast CT
c. Contrast CT
d. MRI
b. The study of choice would be a noncontrast CT of the neck.
Diagnosis on plain films is difficult as vast majority of fish bones are radiolucent. Contrast enhancement on a CT of the neck can easily obscure thin linear hyperdensities/fish bones. (Reddy)
40 y M w N/V and diffuse abdominal pain, high concern for small bowel obstruction. Which study is the best first study:
a. XR Abdominal series (Supine & upright AXR, upright CXR)
b. CT AP with IV contrast only
c. CT AP with IV and PO contrast
d. All of these are legitimate imaging options
b. CT AP with IV contrast only.
When is it appropriate to contact the Radiologist covering pediatric radiology after hours:
a. To read a pediatric x-ray
b. To read a pediatric ultrasound
c. To read a pediatric CT
d. All of the above
e. None of the above
d – All of the above. General radiologists usually interpret all pediatric imaging studies in ED after 5 pm. Pediatric radiologists are on call to do procedures such as intussusception reduction or fluoroscopic upper GI to evaluate for malrotation. They are also available for consultation (Kraeft/ Sonik)
What is the next step to be taken if the radiology report says internal hernia ?
a. More imaging
b. Surgical consult
c. Call HBS
Surgical Consult. (Kalla)
Ovarian torsion cannot be r/o without Doppler.
True
False
False, torsed ovaries can show variable doppler, from no flow to peripheral flow to faint central flow. Size of ovary should be used to assess level of concern, size difference of 3-4x contralateral side is suspicious. (Dang)
Which of the following is not true?
A. The best modality to rule out stroke is MRI.
B. CTA Head and Neck cannot rule out a stroke.
C. Lacunar strokes are not associated with large vessels stenosis or occlusion.
D. Order CTA Head and Neck for carotid/vertebral dissection.
D. Order CTA Head and Neck for carotid/vertebral dissection. (Yim)
On same day, patient for cancer staging is scheduled for:
a. MRI brain with IV contrast (gadolinium);
b. CT Chest/Abdomen/Pelvis with IV contrast (iodine-based) Last time he received CT IV contrast, he developed a rash.
The patient needs premedication protocol beginning: a. 13 hrs prior to CT
b. 1 hr prior to CT
c. 13 hrs before the first study - whether it’s the CT or MRI
d. 1 hr before the first study - whether it’s the CT or MRI
e. Never… i.e., rash is not a true reaction
a. Premedication protocol beginning 13 hr prior to CT scan
I’ve ordered a skeletal survey on a pediatric patient for non-accidental trauma after hours and there is no pediatric radiologist to read it. What do I do?
a. Ask ER radiologist to put a preliminary read on the study.
b. Report the parents to the authorities.
c. Call the pediatric radiologist on call to read it.
d. None of the above.
Answer: A – ask the ER radiologist working to put a preliminary reading on the study. A Pediatric Radiologist will read the study during regular working hours. If there is low suspicion for non-accidental trauma, discharge the patient, and if there is high suspicion, admit the patient to await a final read on the skeletal survey. (Kraeft)
This is a regional standard workflow.
This is the next step if radiology imaging report says epiploic appendagitis ?
a. More imaging
b. Surgical consult
c. Conservative treatment
Conservative treatment. (Kalla)
What is the ACR stance on Metformin use in patients with AKI or severe CKD (GFR <30)?
A. Discontinue Metformin prior to procedure or at time of procedure, with-hold for 48 hours after procedure and re-start Metformin only after renal function.
B. New ACR guideline does not require patient to discontinue Metformin, before or after IV administration, nor is there need to re-assess renal function after procedure
For GFR <30: Discontinue Metformin prior to procedure or at time of procedure, with-hold for 48 hours after procedure and re-start Metformin only after renal function.
For GFR >30:No need to discontinue Metformin, before or after IV administration, nor is there need to re-assess renal function after procedure. (Tran)
2 month old girl present with history of cholestatic jaundice without any known medical history. What is the most appropriate first imaging study?
a. Abdominal Ultrasound
b. Plain film of the abdomen
c. MRI Abdomen
d. CT Abdomen
Abdominal Ultrasound to evaluate bile ducts.(Navarro)
If a finding on an imaging study requires follow up, it is helpful (for Radiology) to identify whether this should be done immediately (i.e. this ED visit) or if an outpatient study would be appropriate.
True
False
True. In general, workup for cancer and incidentalomas and pre-op planning can be done as outpatient.
For patients with positive ileocolic intussusception going to radiology for enema reduction, it is beneficial to give a small dose of medication to help them relax for the (stressful) procedure.
True
False
False. Anxiolytics/Sedatives can decrease the patient's ability to increase intra-abdominal pressure during the procedure and potentially lower the chance of intussusception reduction. (Unfortunately, a screaming kid will have a better chance of successful reduction).
(Escudero)
What neoplastic/incidental finding are appropriate to work up in the ED/Inpatient setting?
Only those that will change inpatient management. The vast majority of neoplastic workup and incidental findings should be followed on an outpatient basis. (Chan)
52 y s/p ORIF for ankle fracture has symptoms concerning for osteomyelitis. What is the next test if plain film is normal?
a. Ultrasound
b. CT
c. MR
d. NM scan
d. NM scan: Tagged WBC is sensitive in postsurgical patients with hardware. (Yim)
50 y s/p MVA just had CT C/A/P now concern for T spine fracture. What should you request?
a. T spine XR
b. T spine CT.
c. T spine MRI.
d. None of the above.
d. None of the above. (Yim)