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51 Cards in this Set

  • Front
  • Back
The orbital foramina contains which cranial nerves?
Where does a diverticulum have to be a Zenker's Diverticulum?
above the Cricopharyngeus muscle
What does epiglottitis look like on lateral x-ray?
thumb sign
What views are included in a complete C-spine series?
AP, lateral, odontoid, oblique, flexion/extension
Spinal cord hemorrhage or contusions are best seen with what imaging study?
What are the 4 steps of the Nexus study?
1. midline pain or bony tenderness, crepitus, or step-off
2. neurologic deficit (including complaints of paresthesia or numbness)
3. presence of distracting injuries
4. altered mental status (including intoxication)
Describe the Canadian C-Spine rules
• 1st question - any high-risk factor that mandate radiography (such as age > 65, dangerous mechanism, or paresthesias in extremities); if yes » Xray, if no » go to 2nd question

• 2nd question - any low-risk factor that allows safe assessment of range of motion (simple rear-end MVC, sitting positio in the ER, ambulatory at any time, delayed onset of neck pain, or absence of midline c-spine tenderness); if no » Xray, if yes » go to 3rd question

• 3rd question - able to rotate neck actively; if unable to rotate » Xray, if yes » no Xray
Name 3 major C-spine fractures
• Hangman's fracture
• Jefferson fracture
• Extension "teardrop" fracture
Describe a Hangman's fracture
an unstable fracture of the pedicles of the posterior arch of C2 caused by extension and distraction injury
Describe a Jefferson fracture
• an axial load compression fracture of the anterior and posterior arches of C1
• an unstable fracture
• lateral masses of C1 lying lateral to the lateral masses of C2 (results as a spread of the ring of C1)
Describe a extension "teardrop" fracture
an unstable fracture where the anterior longitudinal ligament avulses the anterior-inferior corner of the vertebral body
What are the 3 classifications of odontoid fractures?
• Type 1 - a piece of the odontoid is fractured
• Type 2 - a fracture at the base of the odontoid
• Type 3 - a fracture including part of the vertebral body
Ultrasound is used to evaluate what structures in the neck?
• thyroid
• carotid artery (for stenosis)
• jugular vein
Angiography are still used for which interventional procedures?
• for visualizing vascular stenosis (being replaced by CT/MRI)
• carotid stents
• coils in aneurysms
• stopping hemorrhage (persistent nose bleeds)
• embolizing tumors
• treating vascular malformations
What is an AVM?
arteriovenous malformation
When should you use a head CT?
• acute bleed
• trauma
• stroke
• fractures of the head and face
Which imaging study is generally the best choice for soft tissue detail of the brain?
CT scan
What are some secondary injuries caused by coup/countercoup?
• intercranial hemorrhage
• cerebral edema
• mass lesions
• increased intracranial pressure
What is a concussion?
• a diffuse head injury
• usually assoiciated with transient loss of consciousness that occurs immediately following blunt head trauma
• amnesia and confusion are clincal hallmarks
What is the Glasgow Coma Scale (GCS)?
• a numeric rating of the eye, verbal, and motor response
• used to classify traumatic brain injury
• only useful in non-intubated and non-sedated patient
Describe the rating of the GCS for eye opening
• 4 - spontaneous
• 3 - to speech
• 2 - to pain
• 1 - no response
Describe the rating for GCS for verbal response
• 5 - alert and oriented
• 4 - disoriented conversation
• 3 - speaking but nonsensical
• 2 - moans or unintelligible sounds
• 1 - no response
Describe the rating of the GCS for motor response
• 6 - follows commands
• 5 - localized pain
• 4 - movement or withdrawal to pain
• 3 - decortiate flexion
• 2 - decerebrate extension
• 1 - no response
What is the GCS for mild brain injury? moderate brain injury? severe brain injury?
• Mild: GCS 13-15
• Moderate: GCS 9-12
• Severe: GCS 3-8
What is the most common neuroimaging tool used in the emergency department?
non-contrast head CT
What are some benefits of a Non-contrast Head CT?
• gold standard in assessment for acute hemorrhage
• very good at documenting mass effect and herniation
• will visualize acute ischemia, neoplasm, localized intracranial infection
• good at visualizing skull fracture
What are drawbacks of Non-contrast Head CT?
• poor at visualizing disease in the posterior cranial fossa, especially ischemia
• poor at diagnosing intracranial mass that does not have significant mass effect
• sensitivity is not high enough to completely eliminate sub-arachnoid hemorrhage
• will miss delayed disease (delayed sub-arachnoid hemorrhage)
Epidural hematoma is assoicated with skull fracture and laceration of which artery?
dural artery (middle meningeal artery)
How do patients with epidural hematoma present?
• presents with brief loss of consciousness
• followed by lucid interval of minutes to hours
• then rapid neurological decline into coma
How does an epidural hematoma look like on CT?
• biconvex hematoma (lens shaped)
• does not cross suture lines
• frequently associated with mass effect
What vessels are injured in a patient with a subdural hematoma?
bridging veins or cortical arterioles
How does a subdural hematoma look like on CT?
• crescent shaped hematoma lying between brain and dura, conforming to brain surface
• can cross suture lines (usually spreads more extensively than epidural)
If suspicion for a subarachnoid hemorrhage is high, but the CT is negative, what additional test should be done?
lumbar puncture
What is Xanthochromia?
breakdown of RBCs in the CSF
What are some sources of subarachnoid hemorrhage?
• post-traumatic
• aneurysmal
• arteriovenous malformation (AVM)
What can diffuse or focally increased intercranial pressure (ICP) cause?
herniation of the brain at several locations
What is transtentorial (uncal) herniation?
• occurs when the uncus of the temporal lobe is forced through the tentorial hiatus
• causes compression of the ipsilateral third cranial nerve and the cerebral peduncle
How does a patient with transtentorial (uncal) herniation present?
dilated ipsilateral pupil and contralateral hemiparesis
Where can intracerebral hemorrhages occur?
anywhere in the parenchyma
What are characteristics of Diffuse Axonal Injury (DAI)?
• aka shear injury or brain stem contusion
• microscopic tearing of nerve fibers due to high acceleration/deceleration injury
• radiographically consists of small petechial hemorrhages in white matter tracts
• causes immediate deep coma
• associated with severe cerebral edema and ICP elevation
What are some causes of a ring enhancing lesion?
• Toxoplasmosis (in HIV+ patients)
• Lymphoma
Why should patients with cerebral contusions have a repeat head CT within 24 hours?
contusions frequently evolve from small petechiae to large areas of edema and hemorrhage
What type of stroke is more common?
• ischemic is more common (~75%)
• hemorrhagic occurs 25%
Name 4 subtypes of ischemic strokes
• Thrombotic - a blood clot forms within a blood vessel in the brain
• Embolic - a blood clot forms within the heart or a major blood vessel and lodges in the brain
• Lacunar - a very small blood vessel of the brain progressively narrows until completely occluded
• Cryptogenic - mechanism for the stroke is unknown
What does ischemia on CT look like?
darker area
What is the difference between a focal and diffused contusion/hemorrhage?
• focal lesions produce dysfunction specific to the inkjured area of the brain
• diffuse injuries are associated with global dysfunction (LOC, cognitive and memory problems)
When is an MRI the best test to use?
• brain tumors, strokes, certain cronic disorders of the nervous system (multiple sclerosis)
• patients with dementia and patients with disease of the pituitary gland
• to detect tiny areas of tissue abnormality in patients with disease of the eyes or inner ear
What radiology study is used to view the temporal bone?
CT because very fine bone detail is important
What imaging study is best to view the sinuses?
mostly CT, coronal plane is very helpful
What imaging study is best to view the temporomandibular joint (TMJ)?
mostly MRI
What imaging study is best to view the orbits?
• CT (for acute problems) or MRI (for chronic) used about equally
• some Opthalmologists use ultrasound