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Radiology Exam 1

Chapter 2

What is the most common problem in viewing plain films of the skull? Differentiating between cranial sutures from vascular grooves and fractures
What are the four common cranial sutures? Coronal, Sagittal, Squamous, Lambdoidal
What do cranial sutures look like on plain films? Symmetric, "wiggly lines" that have white sclerotic edges
Why are the edges of cranial sutures white? Over ossification of the joint spaces
What do vascular grooves look like on plain films? They are linear markings that extend posteriorly and superiorly; they are irregular and do not have sclerotic edges
What view are vascular grooves usually seen on? Lateral
What does a fracture look like on a plain film radiograph? A dark, radiolucent line that has sharp edges and tends to be very straight
T or F; You can tell whether a fracture is new or old by the presence of sclerotic borders. True; sclerotic borders indicate bone healing, therefore, a new acute fx will NOT have sclerotic edges
T or F: Severe brain in injury can occur without fracture. True
What type of imaging is recommended for head trauma? CT
T or F: Skull fractures without loss of consciousness are common False; It is very rare to see skull fractures without loss of consciousness
What is the term for the appearance of increased density in the frontal region on plain film radiographs? Hyperostosis frontalis interna
Is hyperostosis frontalis interna a malignant or benign condition? It is a benign finding common in females
If pineal calcification is seen on plain film XRay, is it considered benign or malignant? Benign
What is the term for calcification of the lateral ventricles of the brain called? Choroid plexus calcifications
Are choroid plexus calcifications benign or malignant findings? Benign
Name three normal variants (benign findings) found on plain film X-Ray. Hyperostosis frontalis interna; Pineal calcifications; Choroid plexus calcifications
T or F: Large, asymmetric or unilateral calcifications found on plain film X-Ray are possible AVMs or neoplasms True; send these patients for a CT and possibly an MRI
What might an asymmetrical round or ill defined "hole" on a plain film X-Ray indicate? Possible metastatic disease
The early stage of this disease is a lytic or bone destroying phase... Paget's Disease
What happens in the second stage of Paget's disease? Bone overgrowth and increased density causing a "cotton wool" appearance
Where are the effects of Paget's disease mostly seen? The skull and the pelvis
Increased focal densities that are whiter than normal usually indicate what? Calcifications
Three types of relatively small, secondary calcifications seen on plain view X-Ray are: Tuberous sclerosis, Toxoplasmosis, and Granulomatous disease
Three types of suspicious calcifications are: AVM, gliomas, meningiomas
T or F: Large, irregular, and unilateral calcifications are called "secondary calcifications". False: Large, irregular, unilateral calcifications are "suspicious".
When dealing with a head trauma patient, the first thing that needs to be done before imaging is... Clinical examination to assess risk!
T or F: If a patient presents as asymptomatic or have only dizziness, mild HA, scalp laceration, or hematoma, they are considered at LOW RISK. True
T or F: For a low risk patient a skull X-Ray is usually adequate. True
List some clinical symptoms of someone with head trauma who is Moderate Risk. Change in level of consciousness, progressive or severe HA, post-traumatic seizures, persisting vomiting, hemotympanun, skull fracture, rhinorrhea, otorrhea, or if the pt is less than two years old
What is the term for "Raccoon eyes" caused by head trauma and what is it indicative of? Hemotympanum- indicates Basilar Skull Fx
Why are otorrhea and rhinorrea concerns in head trauma? It may be CSF leakage
What type of imaging should be ordered for a moderate-risk head trauma patient? Plain film and CT (possible MRI)
List some clinical findings of a High Risk head trauma patient. Focal neurologic findings, Glasgow Coma score of 8 or less, Definite skull penetration, Postictal state, Decreased or depressed levels of consciousness
T or F: The higher a Glasgow Coma score, the worse the neurological deficit is. False; a lower score indicates a worse neurological deficit
A high-risk head trauma patient should have what kind of imaging done? Plain Film and CT... an MRI should be ordered if the patient is stable
On a plain film radiograph of a skull, what type of fracture is classified as lucent lines (darker than surrounding bone) through the cranial vault? linear fracture
on a plain film radiograph of a skull what type of fracture has stellate or semicircular lines? Depressed skull fractures
What is the best choice to evaluate any skull fracture for proper evaluation for direct brain injury? CT with Bone Window
What would be the best choice to identify subdural or epidural hematomas? CT with Bone Window
What Glasgow Coma score correlates with mild brain injury? Moderate? Severe? Mild- 13 or higher Moderate- 9-12 Severe- 8 or less
What is the highest possible score of the Glasgow Coma Scoring system? 15- Best Eye Response (4); Best Verbal Response (5); Best Motor Response (6)
What three categories are assessed with the Glasgow Coma Score? Eye response; Verbal response, and Motor response
T or F: Due to the computed enhancement of CT, actual absorption of a specific tissue can be measured. True; this is VERY important to determine blood or fluid from solid masses in tissue
What is the name for units of CT absorption? Hounsfield units
How many hounsfield units is water? air? average bone? Water- 0 Bone- +1000 Air- -1000
T or F: Using Hounsfield measurements, we are able to differentiate between tissue masses, and cysts (fluid masses) on CT. True
T or F: X-Rays are two dimensional displays of two dimensional information. False, X-Rays are 2D images of 3D information
T or F: CT scans are two dimensional displays of two dimensional information True- therefore structures seen on CT images appear where they really are in space
T or F: Using Hounsfield measurements, we are able to differentiate between tissue masses, and cysts (fluid masses) on CT. True
T or F: X-Rays are two dimensional displays of two dimensional information. False, X-Rays are 2D images of 3D information
T or F: CT scans are two dimensional displays of two dimensional information True- therefore structures seen on CT images appear where they really are in space
What are some things that you must look for on every slice of a CT scan? Increased or decreased focal densities, asymmetric gyral patterns, ventricle size, fluid sinuses, swelling of soft tissue covering skull (trauma), fractures
What might a decreased focal density on a CT scan indicate? Stroke, edema, tumor, surgery, or radiation
What might an increased focal density on a noncontrast CT scan indicate? hemorrhage, calcium, metal
What might an increased focal density on a contrast/enhanced CT scan indicate? hemorrhage, calcium, metal, tumor, acute stroke, aneurysm, AVM
What is the purpose of IV and IA contrast agents? To identify structures of different densities so that pathology can be easily identified.
What does LOCA stand for? low osmolar contrast agent
What does HOCA stand for? high osmolar contrast agent
T or F: LOCA has less risk associated with it. True- because of low iodine content
T or F: LOCA is more expensive than HOCA. True
What patients cannot have HOCA? Patients with iodine or shellfish allergies. HOCA can send these people into anaphylactic shock.
What two factors must be evaluated when ordering contrast studies? The patients age (ppl over 50 have higher prevalence of decreased renal function) and Renal function (people with renal impairment will have difficulty clearing contrast)
Prior to performing contrast imaging, what two levels indicative of renal function should be checked in patients older than 50 or with a history of renal disease BUN and creatinine
How would you treat a person with a persistant mild allergic reaction to CT contrast? IM Benadryl (50mg)
How would you treat a person with a severe CT contrast reaction? IV atropine (.5-1.0 mg)
T or F: A reaction in which a person experiences vasovagal syncope and has difficulty or impaired breathing is considered a mild reaction. False, this is a severe reaction. A mild reaction only includes slight nausea, hives, and a metallic taste in the mouth.
When evaluating an intracranial hemorrhage on CT, what does an acute bleed look like? Increased focal density (whiter than normal)
T or F: Seeing an increased focal density on a CT scan is a contraindication to anticoagulation tx. True- these focal densities could indicate an active bleed.
T or F: Hemorrhage of the cranial ventricles is usually the result of trauma. True
Name some causes of Intraparenchmal/intracerebral hemorrhages. Ruptured aneurysm; Trauma; Stroke; Tumor; Common complication of HTN
T or F: A large hemorrhage involving the brainstem has a good prognosis for rehabilitation. False; this type of hemorrhage is very grave
Which hematoma (epidural or subdural) is seen as a crescent shaped abnormality between the skull and brain that never crosses the midline? Subdural
A white appearance of blood on a brain CT indicates an active, sub-acute, or old bleed? Acute- new
Would an old hematoma be light or dark on a CT scan? Dark
What type of hematoma shows up as a lenticular shape on a CT? Epidural
What type of hematoma is commonly associated with temporal Fxs? Epidural
Which type of intracranial hemorrhage is associated with a "Texaco Star" pattern? Subarachnoid hemorrhage
T or F: Since a subarachnoid hemorrhage is a hemorrhage into the ventricles, the only time that you can visualize it on CT is during the acute stage when the blood is denser than the CSF. True
What is it called when there is air in the cranial vault? Pneumocephalus
What does air look like on a CT? Black densities
What causes pneumocephalus? Trauma
What is Hydrocephalus? Dilation of the ventricles
What is the most commonly obstructed ventricle to cause hydrocephalus? the 4th ventricle
Even though poorly ischemic strokes do not show up until about 12 hours later, you should still order a CT without contrast immediately. Why? To rule out hemorrhage so that you can safely begin anticoagulant tx.
When you have a stroke w/o hemorrhage,how will ischemic stroke areas show up on a CT without contrast? Decreased focal densities (dark densities)
Why do you want to use contrast with a 24 hour post ischemic stroke CT? to see edema as dark areas and to enhance the edges of the effected area
Hydrocephalus is obstructive or non-obstructive? Non-obstructive
For tumors, would you order Ct with or without contrast? Both
Why would you order a CT with contrast for a tumor? contrast shows increase in densities and outlines the vascular portion
Why would you order a noncontrast CT for a tumor? looks for calcifications, focal areas of decreased densities, asymetric gyral patterns, shift
Which Sinuses are typically imaged? Frontal, Sphenoid, Maxillary, ethmoid
Which method is best for frontal and ethmoid sinuses? Frontal Skull film
Which sinus is the Walter's used commonly for? Maxillary
Which sinus is commonly imaged with the mouth open? sphenoid
Which view is best for seeing all on a sphenoid sinus. Lateral
Which sinus is sinusitis most commonly seen in? Maxillary
When imaging sinuses, what levels are we looking for? air/fluid levels
Which sinus is hypoplasia often seen? Frontal sinus
What does AVM stand for ArterioVenous Malformation
What are the two most common benign calcification findings? Pineal and bilateral choroid plexus (can be singular or matched)
Created by: Marywood