09/24/2017

Radiology mci screening test and indian medical examz high yield important topics study tips

By Live Dr - Wed Feb 11, 3:11 am

Radiology

Expiratory chest films are preferred in
Small pneumothorax

Early interstitial lung disease

Along with an inspiratory film in obstructive emphysema

*USG-

Activity of transducers of usg are based on the principle of piezoelectric effect.

Absolute barrier to usg is  air.

Ultrasound in obstetrics can induce changes in cell migration at an early stage of development.

Various modes of USG

A mode (amplitude) measures axial length of eyeball
B mode- (brightness) main mode used for ultrasound imagaing
M mode (movement) echocardiography
Structures which calcify physiologically are
Pineal gland

Habenular commissure

Falx cerebri

Choroidal  plexus

Dura

Petroclinoid ligament

Interclinoid ligament

Intracranial pathologies which calcify are
Gliomas

Haematomas

A-V malformations

Aneurysms

Tuberculomas

Cysticercosis

Hydatid disease

Sturge Weber syndrome

Tuberous sclerosis

QUOTE CORNER

All that is necessary to break the spell of inertia and frustration is this: Act as if it were impossible to fail. That is the talisman, the formula, the command of right-about-face which turns us from failure towards success.- Dorthea Bragg

ELEVENTH HOUR RADIOLOGY                                                                                                            166

Contraindications to MRI
Pacemakers

Intracranial clips

Size and weight above machine limits

First trimester of pregnancy

Claustrophobia

CONTRASTS USED IN VARIOUS STUDIES.

Oral cholecystography Iapanoic acid
Intravenous cholecystography Biligraffin (Meglumine)
Esophageal atresia Dianosil
Intravenous pyelogram Conray 420
Myelography Myodil (Iodophendylate)

Iohexol (Omnapaque)

Vertebral angiography Conray 280

RADIOLOGICAL SIGNS IN RESPIRATORY SYSTEM

Butterfly/ Batwing pattern Pulmonary edema
Moustache / Antler sign Prominence of upper lobe veins due to increased left atrial pressure in case of Mitral stenosis
Dirty chest Chronic bronchitis
Pneumatoceles Infection due Staphylococcus and Klebsiella
Egg shell cakcification Silicosis

Sarcoidosis

Histoplasmosis

Blastomycosis

Scleroderma

Amyloidosis

Bulging fissure sign Klebsiella pneumonia
Crescent sign Fungal ball within a cavity

*Bucky film / Penetrated chest X-ray

Shows better visualization of bones

*Sniff test- Used in fluoroscopy for detecting movement of diaphragm.

Kerley’s lines

Kerley’s A lines Seen near the apex
Kerley’s b lines Seen near the base perpendicular to the pleural surface
Kerley’s c lines Near the centre, interlacing , leading to spider web appearance

TRIVIAL TRUTH

It takes 17 muscles to smile, 43 to frown!

ELEVENTH HOUR RADIOLOGY                                                                                                             167

Kerley’s lines  are seen in
Pulmonary edema

Mitral valve prolapse

Pneumoconiosis

Lymphatic metastatic disease

RADIOLOGICAL SIGNS IN CARDIOVASCULAR SYSTEM

Couer en sabot / Dutch shoe / Boot shaped heart Fallot’s tetralogy
Egg on end appearance TGA
Cottage loaf heart Supracardiac total anomalous pulmonary venous return, wide mediastinum
Box shaped cardiomegaly Ebstein’s anomaly
Snowman or Figure of  8 configuration Seen in Supracardiac TAPVC
‘3′ sign Aortic coarctation, due to stenosis of aorta
Leather bottle or flask shaped heart Pericardial effusion
Double atrial shadow Left atrial enlargement

*Cardio-thoracic ratio

Maximum transverse diameter of the heart divided by maximum transverse diameter of the thorax

Normal -In adults 0.5

In children 0.6

*Best method for diagnosing aortic dissection is MRI

RADIOLOGICAL SIGNS IN GASTROINTESTINAL SYSTEM

Inverted 3 sign in barium swallow The impression of aorta on esophagus
Rat tail / Bird’s beak appearance. Achalasia cardia

Carcinoma esophagus

Apple core deformity Carcinoma esophagus
Cup and spill stomach Volvulus stomach
Leather bottle appearance / Linitis plastica Carcinoma

Corrosive gastritis

Crohn’s disease

Tuberculosis

Syphilis

Eosinophilic gastritis

Lymphoma

QUOTE CORNER

Judge your success by what you had to give up in order to get it.-Anonymous.

ELEVENTH HOUR RADIOLOGY                                                                                                             168

RADIOLOGICAL SIGNS IN GASTROINTESTINAL SYSTEM CONTINUED…

Double bubble sign Duodenal atresia
Triple bubble sign Jejunal atresia
Barber pole sign / Corkscrew sign / Spiral sign in barium studies Midgut volvulus  due to spiraling of superior mesenteric artery
Whirl sign or peacock tail sign in ct/mri Midgut volvulus  due to spiraling of superior mesenteric artery
String of beads sign Small bowel obstruction
Moulage sign / Molten wax appearance of  intestine in barium studies. Malabsorption
Concertina or stack of coins appearance Dilated jejunum
Coffee bean sign Intestinal obstruction with strangulation
Cobblestone appearance Crohn’s disease
Raspberry thorning / Rose thorn ulcers of intestine Crohn’s disease
Inverted umbrella sign

(broad base triangular appearance of ileocecal valve with base towards cecum)

Ileocecal junction tuberculosis
Sterline’s sign

( lack of retention of barium in inflammed segment of  ileum, caecum, and ascending colon.)

Ileocecal junction tuberculosis

Crohn’s disease

String sign of Kantor

(Persistent narrow stream of barium indicating stenosis and strictures)

Ileocecal junction tuberculosis

Crohn’s disease

Thumb printing appearance

(Due to ulcers and edema)

Ulcerative colitis
Lead pipe appearance

(Blunting of haustral folds)

Ulcerative colitis
Omega sign on plain X-ray abdomen Sigmoid volvulus.
Inverted U appearance of sigmoid colcon Volvulus
Twisted bird’s beak / Ace of spade deformity in barium enema Sigmoid volvulus
Bent inner tube or Omega loop sign on straight X-ray of abdomen Volvulus.

RADIOLOGICAL SIGNS IN HEPATOBILIARY SYSTEM

Floating memebrane / Water lily of Camalotte sign Ruptured hydatid cyst.
Rising sun / Serpent sign Dry hydatid cyst with crumpled membrane

TRIVIAL TRUTH

The catgut formerly used as strings in tennis rackets and musical instruments does not come from cats. Catgut actually comes from sheep, hogs, and horses.

ELEVENTH HOUR RADIOLOGY                                                                                                           169

RADIOLOGICAL SIGNS IN HEPATOBILIARY SYSTEM CONTINUED…

Bull’s eye lesion in usg of liver Metastases.
Mercedes Benz sign / Sea gull sign Radiolucent gas in triradiate or biradiate fissure in a gall bladder
Pad sign in barium meal Carcinoma pancreas
Scrambled egg appearance in ercp Carcinoma pancreas
Reversed 3 sign of Frostberg Carcinoma head of pancreas
Beading of bile duct seen in ERCP Sclerosing cholangitis
Chain of lakes appearance seen in ERCP Chronic pancreatitis
Double duct sign seen in ERCP Pancreatic carcinoma in conjunction with bile duct obstruction or stricture
Causes of pseudo pneumoperitoneum
Chiladiti syndrome- (entrapment of colon segment between liver and diaphragm)

Subdiaphragmatic fat

Curvilinear pulmonary collapse

Uneven diaphragm

Distended viscus

Omental fat

Subphrenic abscess

Subpulmonary pneumothorax

Intramural gas in pneumatosis intestinalis

Apposition of gas distended loops mimicking the double eall sign.

RADIOLOGICAL SIGNS OF PNEUMOPERITONEUM

Cupola sign Collection of gas under diaphragm
Double wall sign of Rigler Due to extra and intraluminal gas in the bowel
Umbilical ligament sign / Inverted V sign As the free gas outlines umbilical ligament
Triangle sign

(Morrison pouch sign on the anterior surface of the right kidney)

Air getting trapped between the 3 loops of intestines
Scrotal air sign When given head low, air enters the scrotum

QUOTE CORNER

Champions know that success is inevitable; that there is no such thing as failure, only feedback. They know that the best way to forecast the future is to create it.-Michael J. Gelb

ELEVENTH HOUR RADIOLOGY                                                                                                             170

Condition Minimum collection for x ray detection
Pleural effusion

250 ml

Pericardial effusion

200 ml

Pneumoperitoneum

1 ml

radiological signs of Intussusception
Coiled spring appearance

Empty Quarter sign (due to empty right iliac fossa)

Pseudo-kidney sign (Seen on USG)

Claw sign (in barium meal X-ray)

Radiological signs of hypertrophic pyloric stenosis

String sign Due to narrowed pyloric canal
Beak sign Due to an abrupt cut off of barium point in the pyloric canal
Tram track sign Double track of barium

RADIOLOGICAL SIGNS OF URINARY SYSTEM

Crescent sign / Rim sign in Nephrogram Acquired hydronephrosis
Mathe’s sign

(absence of downward displacement of kidney that normally occurs in erect position.)

Perinephric abscess
Beak sign in renal arteriogram Renal cyst
Flower vase ureters Horse shoe kidney
Spider leg calyces Polycystic kidney
Pencil line / Tram line appearance Acute cortical necrosis
Egg in cup appearance Renal papillarey necrosis.
Air pyelogram Emphysematous   diabetic pyelonephritis
Pancake kidney Failure of both kidneys to ascend from the pelvis
Spoke wheel appearance on angiography Oncocytoma
Onion layer appearance on ultrasonoigraphy Angiomyolipoma
Saw toothed , beaded or pipe stem Ureteric  tuberculosis
Cobra head deformity / Adder head sign on IVU Ureterocele
Goblet sign Filling defect in the ureter  due to tumour.
Hourglass bladder Bladder duplication.
Stipple sign on retrograde pyelography Transitional cell carcinoma
Pear shaped bladder Pelvic lipomatosis

TRIVIAL TRUTH

The liquid inside young coconuts can be used as substitute for blood plasma.

ELEVENTH HOUR RADIOLOGY                                                                                                             171

RADIOLOGICAL SIGNS OF URINARY SYSTEM CONTINUED…

Wind in the sail appearance Posterior urethral valves on micturiating cystourethrogaphy.
Fir tree appearance of bladder in X-ray Upper motor neuron disease.

(Neurogenic bladder)

Pencil like curvilinear calcification in bladder wall Bilharziasis
Fish hook appearance of ureters Prostatic  enlargement

RADIOLOGICAL SIGNS IN MUSCULOSKELETAL SYSTEM

Looser’s zone

(an area of stress fracture repaired by osteoid  in the absence of normal mineralization)

Osteomalacia
Cod fish vertebrae (biconcave) Osteomalacia
Triradiate pelvis Osteomalacia
Pepper pot skull appearance Hyperparathyroidism
Aneurysmal sign Erosion of the anterior surface of vertebral body by tuberculous abscesses, resembling erosions due to aortic aneurysm
Hot cross bun skull Congenital syphilis
Sutural diastases (In children it is the first and the most prominent sign) Raised ICT
Silver beaten appearance Raised ICT
Champagne galss pelvis Achondroplasia
Tombstone iliac blades Achiondroplasia
Saw tooth metaphysis Congenital syphilis
Lace work periosteitis Congenital syphilis
Wimburger’s sign (bilateral symmetrical perichondritis and osteitis of tibila upper growth plate medially.) Congenital syphilis
Dots and commas / Rings and broken rings  calcification Enchondroma or chondrosarcoma
Tufting of terminal phalanges of fingers and toes Acromegaly.
Celery stick appearance of long bones Congenital rubella
Doughnut apparance on radionuclide scan Avascular necroisis
Picture frane vertebra Paget’s dissease.
Dural tail sign Meningiomas.
Licked candy stick appearance (neuropathic resorption of bone) Leprosy

QUOTE CORNER

Hard work doesn’t guarantee success, but improves its chances.-B. J. Gupta

ELEVENTH HOUR RADIOLOGY                                                                                                             172

*Tumor blush-On vertebral angiography-abnormal uptake of contrast by a lesion

Radiological signs in Osteoarthritis
Osteophytes

Decreased joint space

Sclerosis of bone ends forming joints

Scotty dog appearance Normal vertebra
Scotty dog wearing collar Spondylosis
Beheaded Scottish terrier Spondylolisthesis
Commonly involveD JOINTS IN OSTEOARTHRITIS
Major joints of lower limb

Distal interphalangeal joint

Proximal interphalangeal joint

1st metacarpal joint

radiological signs in rheumatoid arthritis
Increased joint space

Peri-articular erosion and osteoporosis

Syndesmophytes

Square vertebra

Bamboo spine

Tram track sign

Radiological signs of pulmonary embolism

Westermark sign Pulmonary oligemia
Hampton’s hump Peripheral wedge-shaped density
Palla’s sign Enlarged right descending pulmonary artery
Radiological findings in Turner’s syndrome
Metacarpal sign (Gross shortening of 4th metacarpal)

Increased carrying angle of elbow

Medial tibial condyle is beak like

Kyphoscoliosis

*Sunburst appearance of  mammography is seen in scirrhous carcinoam of breast.

*Ultrasound A scan for strength of intraocular lens.

trivial truth

X-Rays were discovered in 1895 by Röntgen, accidentally. He was studying cathode rays. He wanted to know if he could see cathode rays escaping from a glass tube completely covered with black cardboard. He couldn’t, but by chance he did notice a glow appearing in his darkened laboratory several feet away. At first he thought there was a tear in the cardboard allowing light from the high-voltage coil inside the tube to escape, but he soon realized rays of light were right passing through the cardboard. He named these penetrated rays, X-rays

ELEVENTH HOUR RADIOLOGY                                                                                                             173

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  1. Remarkable! Its genuinely amazing piece of writing, I have got much clear idea about from this post.

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