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71 Cards in this Set
- Front
- Back
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How should headaches be characterized? (6)
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location
duration type of pain provoking factors age sex |
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what % of headaches are a result of serious intercranial pathology?
-0.5% -1.0% -5.0% -10% |
0.5%
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which of the following warrant imaging studies?
-tension h/a -migraine h/a -simple h/a -cluster h/a -all of the above -none of the above |
none of them
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a pt presents with a headache, temp, and neck stiffness-what is the test of choice?
-serum lytes -CT -lumbar puncture -MRI |
LP
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what should you include in your physical exam of a headache patient? (8)
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neuro exam, eyes, BP, temporal arteries, ears, neck, urine, sinuses
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A sudden onset of "the worst headache of my life" is aka?
-classic migraine -storm center headache -thunderclap headache |
thunderclap headache
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Imaging of a headache is indicated when it is accompanied by?
-neuro findings -syncope -confusion -seizure -major trauma -mental status change |
all of them
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the thunder clap headache should make you worry about?
-epidural hematoma -csf leak -horner's syndrome -subarachnoid hemorrhage |
subarachnoid hemorrage
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Sudden onset of a unilateral headache with a suspected carotid or vertebral dissection or ipsilateral Horner's syndrome should prompt you to order a ??
-skull films -carotid ultrasound -MRI -CT |
MRI
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how can you tell a sinus headache from other headaches?
-worsen when pt leans forward -has purulent sinus drainage -worsens with pressure over affected sinus -A & C -all of the above |
A & C
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What is the TOC in a suspected ICH (intercranial hemorrhage)?
-CT without IV contrast -CT with IV contrast -MRI -SPECT scan |
CT without IV contrast
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Why is a CT without IV contrast ordered when there is suspicion of an ICH?
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because blood appears initially appears white on CT and so does IV contrast.
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Hemorrhage into the ventricles is usually seen in the _ horns of the lateral ventricles.
-anterior -posterior -lateral -medial |
posterior horns of the lateral ventricles
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t/f
blood is denser than CSF and therefore settles dependently. This settling process is not seen with subarachnoid or intraparenchymal blood. |
true
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t/f
the presence of hemorrhage is not a contraindication to anticoagulation |
false; obviously
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intraparenchymal bleeding can result from a ...? (STAT)
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-Stroke
-Trauma -Aneurysm (ruptured) -Tumor |
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Intraparenchymal bleeding can result from a ruptured aneurysm, stroke, trauma or a tumor which are common complications of ?
-CAD -renal artery stenosis -HTN |
HTN
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in an ICH what are grave prognostic factors? (2)
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brain stem involvement
large size |
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Most (80%) hypertensive bleeds occur in the ___.
-cerebellum -basal ganglia -temporal lobe -pons |
basal ganglia-80
cerebellum and pons each 10% |
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With a large ICH associated mass effect may be present with compression of the _ or a _ shift.
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compression of the ventricles or midline shift
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Findings of acute hemorrhage on a noncontrasted CT scan indicate increased density in the _.
-dura -parenchyma -ventricles |
parenchyma
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what is the unit of measurement in regards to CT?
-hounsfield units -standard units -regalford units |
hounsfield unit
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_ hematomas are seen as crescent shaped abnormalities between the brain and the skull.
-epidural hematomas -subdural hematomas -subarachnoid hemorrage |
subdural hematomas
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All of the following about subdural hematomas are true except for?
-can cross suture lines -cresent shaped abnormalities -is a csf leak into dura -doesn't cross tentorium or falx |
has nothing to do with csf.
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a chronic subdural hematoma on CT will appear _ in color.
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dark-close to parenchymal in color.
Acute subdural hematoma will appear as a white crescent moon |
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subarachnoid hemorrhage is usually the result of?
-trauma -stroke -ruptured aneurysm -a & c |
A & C, trauma or ruptured aneurysm
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epidural hematomas are associated with?
-middle meningeal artery tear -temporal bone fractures -lenticular shaped -do not cross suture lines -all of the above -none of the above |
all of the above
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you will see a 'texaco star' in what type of bleed?
-epidural hematoma -subdural hematoma -subarachnoid hemorrhage |
subarachnoid hemorrage
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in an infant whose fontanelles have not closed how else can you monitor an intercranial hemorrhage?
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ultrasound
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a _ may be ischemic or associated with hemorrhage.
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stroke
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in a pt with an acute stroke, what is the radiological test of choice?
-ct with contrast -ct without contrast -mri |
ct without contrast
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t/f
12 hours ago you suspect your pt had a stroke, but their CT is negative. Have you excluded your diagnosis? |
nope
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t/f
a purely ischemic acute stroke is difficult to visualize on a CT scan unless mass effect is present. |
true
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what is the key to identifying most types of stroke?
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usually confined to one vascular area
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All of the following except 1 are key to identifying ischemic stroke locations.
-compression of the lateral ventricle -possible midline shift -effacement of the sulci on the affected side -all of the above -a & c |
all of the above
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An acute ischemic stroke is very easy to see on __, because the edema can be identified as a bright area on T2 images.
ct with contrast ct without contrast mri |
mri with T2 images
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should you get an MRI on a pt you suspect as having an ischemic stroke? What are you looking for?
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not needed, the ct scan without contrast is good enough to rule out hemorrhagic stroke so that you can give anticoagulation if you want.
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24 hours after a stroke, the edema that develops will appear on CT without contrast as ?
-identical to normal brain tissue -whiter than brain tissue -lower density; darker than normal brain tissue |
lower density; darker than normal brain tissue
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what is a luxury perfusion?
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the stroked part of the brain on a contrasted CT done after 1 day that shows enhancement (inc. density or whiteness) that is seen at the edges of the area.
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what is the test of choice for suspected sinus infection?
-sinus xrays -mri -CT |
CT
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what is the primary test in the diagnosis of meningitis?
-blood cultures -mri -lp -ct |
lp
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the frontal skull films is best used to evaluate the _ and _ sinuses.
-frontal -maxillary -sphenoid -ethmoid |
frontal and sphenoid
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the frontal water's view (done with the head tipped back) is used to evaluate the _ sinuses.
-frontal -ethmoid -sphenoid -maxillary |
maxillary
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A lateral skull film can be used to evaluate the _ sinuses.
-frontal -maxillary -sphenoid -ethmoid |
sphenoid
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sinuses are not well developed enough in children until age _ or _ to bother ordering sinus xrays on them.
-2 or 3 -4 or 5 -5 or 6 -6 or 7 |
5 or 6
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In adults, hypoplasia of the _ sinuses is often seen.
-frontal -maxillary -ethmoid -sphenoid |
frontal
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sinusitis is most common in the _ sinuses.
-frontal -maxillary -sphenoid -ethmoid |
maxillary
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Acute sinusitis is diagnosed radiographically if an __ in the sinus or complete opacification is found.
-membrane edema -air/fluid levels -blood |
air/fluid levels
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__ is vastly superior for evaluation of the paranasal sinuses, mastoid sinuses, and adjacent bone.
ct with contrast ct without contrast mri |
mri
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what will you see radiographically on a pt with chronic sinusitis?
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thickening and indistinctness of the sinus walls
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_ should be suspected if recurrent episodes occur of unilateral epistaxis with no visible bleeding site, constant facial pain, anosmia, recurrent unilateral otitis media, soft tissue mass or bone destruction on a sinus or dental xray
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malignancy
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t/f
a zygomatic fracture can occur in only one spot |
false; cannot be broken in only one spot
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what view should you order if you suspect a zygoma fracture?
-boxer's view -shuttle view -jug handle view -bucket view |
jug handle view
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if only one fracture can be seen in the arch, then _ xrays should be obtained to exclude a tripod fracture.
-facial -skull -sinus -c spine |
facial
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a tripod fracture results from a direct blow to the _.
-mandible -maxillae -zygomatic process -nose |
zygoma
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a tripod fracture consists of _ fractures.
-2 -3 -4 -1 |
4
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in a tripod fracture, what bones are broken? (4)
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zygomatic arch
lateral orbital rim inferior orbital rim lateral wall of the maxillary sinus |
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nasal films are really only useful to look at depressed fractures or _ deviation.
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lateral
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t/f
in lateral nasal films there are lucent lines that are often mistaken for fractures. if the lucent lines follow along the length of the nose however, these are not fractures. |
true
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fractures are seen as _ lines that are perpendicular or sharply oblique to the length of the nose.
-white -dark |
dark
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_ fractures often occur from a direct blow to the globe of the eye.
-blow out -maxillary -zygomatic arch -sinus |
blow out
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the pressure on the eyeball fractures the weak _ or _ walls of the orbit.
-medial or lateral -lateral or inferior -medial or superior -inferior or superior -medial or inferior |
medial or inferior
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the usual blowout fracture is thru the _ walls of the orbit.
-superior -inferior -lateral -medial |
inferior
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what xray best images a blowout orbital fracture?
-plain sinus view -water's view -ct with contrast -mri |
water's view
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blowout fractures that occur medially into the _ sinus are seen on a frontal view only as opacification (whiteness) in the affected sinus.
-maxillary -frontal -ethmoid -sphenoid |
ethmoid
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__ injuries are rare that are produced by massive facial trauma.
-Le Fort -Le Port -Le Snort -Le Shart |
Le Fort
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A Le Fort _ fracture is a fracture thru the maxilla, usually caused by being hit in the upper mouth with something like a bat.
- I - II - III - IV |
I
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A Le Fort _ fracture is a facial/cranial dissociation or a separation between the face and the skull. High mortality.
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III
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A Le Fort _ fracture involves the maxilla, nose, and inferior and medial orbital walls.
- I - II - III - IV |
II
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_ fractures should be suspected especially if malocclusion after trauma is present.
-nasal -mandible -maxilla -orbital |
mandible
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what is the xray of choice of a suspected mandible fracture?
-skull -mri -panorex -mandibular ct |
panorex
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