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1

When do you use contrast for a head CT?

Suspicion of tumor, infection, vascular abnormality

2

What modalities do NOT use radiation?

US
MRI

3

What is the best modality to examine skull fractures?

Non-contrast CT

4

What does MRI show in M.S.?

Periventricular plaques

6

Who is at risk for getting nephrogenic systemic fibrosis?

When does it occur?

Dialysis pts with GFR < 30mL
2 days - 18mo post-exposure

7

What imaging to use for skull fracture?

CT

8

What syndrome is associated with hoarseness and compression of the left RLN?

Ortner's --> Mitral Stenosis

9

What is a diastolic decrescendo murmur in the 3rd ICS LSB?

AR

10

What is unequal size of pupils called?

Anisocoria

11

How far away should a patent hold a chart (NOT the snellen chart) when doing an eye exam?

6 feet

12

HSV1 causes brain infections where?

Inferior and medial temporal lobes

13

Gradient across valve in AS is significant if greater than what?

Obstruction leads to what?

50

Pressure overload, LVH

15

Which visual field must be tested separately?

Nasal field

16

If you have trouble seeing far away, what kind of vision abnormality do you have?

Myopia

17

If you have a pt with M.S., a tumor, or a CVA, what imaging modality do you want to use?

MRI w/contrast

18

What are the diastolic murmurs?

AR, PR
MS, TS
Atrial myxoma

19

What tumor is benign and derived from Rathke's pouch?

Also most common supratentorial tumor?

Craniopharyngioma

20

What imaging assesses hemodynamics via soundwaves?

Doppler

21

Chronic cause of AR?

Syphilis, ankylosing spondylitis

22

T2 weighted image: describe the TR and TE

What appears bright white on image?

Long TR and TE

Compartments filled with H2O

27

What is a duplex a combination of?

Traditional and doppler US

28

What imaging to diagnose an uncal herniation?

MRI

29

Concussion mainly results in damage to what?

White matter tracts
Diffuse axonal injury

30

Pulmonic valve listening post?

Left 2nd ICS at SB

31

What are the contraindications for mydriatic drops?

Head injury and coma
Narrow-angle glaucoma

33

MRI precautions?

Cardiovascular device
Unstable pt
Claustrophobic and agitated
Fatties

34

What is the normal AoV area?

AS how big?

4cm

Less than 1 cm

35

What do you always order before getting an Xray?

bhCG

Bitch might be preggo

36

What causes a blowing systolic murmur LSB that increases with inspiration?

What is the sign called?

TR

Carvallo's

37

Where is a catheter placed for a cardiac catheter?

Is contrast used?

Femoral or radial a.

Yea

38

What bacteria causes conjuctivitis?

S. aureus (most common adults)
M. Catarrhalis (most common kids)
S. pneumo
H. Flu

38

What is a fluorescein stain used for?

Performed when?

ID epithelial defect

AFTER complete screening exam

40

Aortic valve listening post?

R 2nd ICS at SB

41

What shows a systolic murmur that is harsh, 2nd ICS RSB and radiates into suprastneral notch?

AS

42

If you have a pt with an AAA, embolism, lung nodule, hemorrhage, tumor or ischemia, what imaging modality do you want to use?

CT

43

Can contrast cross the BBB?

Nah

44

Xanthelasma are what?

Indicates what?

Cholesterol deposits

Hyperlipidemia

45

What imaging to diagnose a cingulate herniation?

CT

47

What is assoc. with PHTN, inferior MI or RV infarction?

See what?

TR

Big v wave

48

Mitral valve listening post?

L 5th ICS at Mid clavicular line

49

What are the types of valvular heart disease?

Degenerative (senile calcification)
Myxomatous degeneration (MVP)
Congenital (BAV)
RVD

50

What are the structures that you can see in a fundoscopic exam of the eye in the posterior chamber?

Optic disc - nasal and inferior
Arterioles: 2 laterally, 2 nasally
Macula is temporal

51

What can mimic MS?

Austin Flint murmur

52

What do the following indicate?

Low voltage, electrical altérants on EKG
Increased JVP
Muffled heart sounds
Decreased BP on inspiration?

Cardiac tamponade

53

Esotropia?

Medial drift of eyes

53

How do you view the palpebral conjuctiva?

Evert the eye lid

54

Where do you see an oligodendroglioma?

Frontal lobes

55

What is the normal reflection of light off the retina called?

Red reflex

57

LP is contraindicated in what kind of head trauma?

Subdural hematoma

58

What causes a blowing systolic murmur that radiates into the left axilla?

May have a systolic click

MR

59

In AS without tx, die when once you develop syncope?

Onset of HF?

3 yrs

2 yrs

60

Do males or females have a higher post-concussion symptom score 3 months post-injury?

Females

64

What requires venous access, saline, concerted effort to capture results, and a TTE?

Bubble study

65

What causes a rumbling diastolic murmur that is low pitched, best heard at the apex? May see a malar flush.

Use diaphragm or bell?

MS

Bell

66

Overgrowth of cornea due to excess sun exposure?

Pterygium

68

Why give contrast?

Increases differences in density between anatomic structures

69

When examining the optic disc how should you rotate the lens disc if the pt is myopic?

Hyperopic?

Counterclockwise to (-) diopters

Clockwise to (+) diopters

70

When do you refer a pt to a vascular specialist with an AAA?

If aneurysm is > 4cm

71

What is a chalazion?

Associated with what?

To treat, when do you give antibiotics?

Meibomian tear gland obstructed

Blepharitis and Rosales

NEVER

73

What virus most often causes conjuctivitis?

Adenovirus

74

Acute cause of MR?

Ruptured chordal tendineae, papillary muscle
Ischemic papillary m
CAD/MI
IE
Valve perforation

75

Pros of US?

Cons?

No radiation, cheap

Bowel gas and lung tissue hinder image

76

What bacteria are most common in bacterial abscessses in non-immunocompromised pts?

What imaging should you use?

Strep
Staph

MRI (DWI)

77

Without treatment in AS, what is the prognosis?

Poor

78

What is used to visualize the LA to assess for thrombus formation?

TEE

79

What is used for R->L shunts in A or V, PFO, AV shunts in pulmonary vasculature?

Bubble study

80

What occurs with nephrogenic systemic fibrosis?

What is spared?

Advanced renal failure
Thickening of hardening of skin

HEAD

81

Stroke or CVA of what artery has Motor effects only?

Lenticulo-striate artery

84

What tumor crosses both hemispheres in a butterfly pattern?

Glioblastoma

86

What imaging modalities use ionizing radiation?

XR
CT
Fluoroscopy
Angiography

87

What does a narrow pulse pressure with delayed pulses and decreased SV indicate?

AS

88

What causes a murmur in the 2nd-3rd ICS, LSB that radiates towards left shoulder and increases on inspiration?

Can cause what?

PS

Angina and syncope

89

What are the systolic murmurs?

MR (MVP), TR
AS, PS
VSD
Shunts

90

What does MRI give the greatest detail of?

Contraindication?

Soft tissue

Metal in the body

91

Most common to least common adult tumors?

Metastasis
Glioblastoma
Meningioma
Schwannoma
Oligodendroglioma
Pituitary adenoma

MGM Studios

92

What imaging to see SAH, ICH, and general acute head trauma?

CT

93

Xray pros?

Cons?

Cheap, fast, everywhere

2D, radiation, poor detail of soft tissue

95

The opening between the eyelids is called what?

Palpebral fissure

96

What causes a diastolic, blowing murmur 2nd SB (Graham Steele)?

Due to what?

PR

PHTN

97

What causes lateral drift of the eyes?

Exotropia

97

MRI pro

Con?

Safe, no radiation, precise detail soft tissue

Expensive, cant be fat, takes a long time, not widely available

98

What is assoc with MS, TR, and RHD?

See what pathophys?

TS

Big a wave in JVP ascites

99

how can damage from a concussion be visualized?

3D diffusion tensor

100

Who is at higher risk for 2nd impact syndrome?

Mortality rate?
Morbidity?

Young athletes (under 20)

50 %
100%

101

A FAST exam is a type of what?

US

103

What are the most likely carcinogenesis of ionizing radiation?

Leukemia
Thyroid
Breast
Lung
Skin

104

What is it called when a murmur radiates to the apex like MR?

Gallavardin phenomenon

105

What are the common reactions to contrast?

Hypersensitivity
Chemotoxic ie N/V (very common)
Vasovagal ie bradycardia

105

Toxo, CNS lymphoma, Cryptococcus, JC virus with CD4 count of what?

CMV with what count?

Under 200

Under 50

107

Acute cause of AR?

IE, dissection, BAV

108

S4 heard best heard with what? Describe

Due to what?

What else?

Bell, dull low pitch

Stiff low compliant ventricle

Atrial gallop

109

What is used to evaluate the structural integrity of the heart?

Describe the procedure

TEE

Invasive

110

PE of AR shows what?

Wide pulse pressure

112

T1 weighted image: describe TR and TE

What kind of tissues appear bright?

Short TR and TE

High fat content tissues

114

What are causes of provoked DVT?

Unprovoked?

Trauma, surgery

Oral BCP, cancer

115

What is the initial test of choice for cardiac tamponade due to pericarditis?

TTE

116

Tricuspid valve listening post?

L 4th ICS at SB

117

What causes brain abscesses in ketoacidotic diabetic, and neutropenic pts?

Mucor
Rhizopus

118

What kind of contrast is given in GI?

Barium and gastrograffin

118

What is one of the most frequently reported behavior sequelae of concussions?

Major depression

120

What are the 4 views of a FAST?

Pericardial
Perihepatic
Perisplenic
Peripelvic

121

Pt with reptile skin has what?

Nephrogenic systemic fibrosis

121

Where is a meningioma located?

Arises from what?

Parasagittally

Arachnoid cells

122

What causes a diastolic murmur at LSB, increases with inspiration and decreases with expiration?

TS

123

What kind of contrast is given in IV?

Iodine-based

123

What does a duplex evaluate?

Blood flow via US

123

What imaging used to see brain neoplasms?

MRI

123

What is the stepwise progression of return to play for concussions?

1. Cognitive and physical rest until asymptomatic
2. Light aerobic exercise
3. Sport aerobic exercise
4. Noncontact drills, light resistance training
5. Full contact if cleared medically
6. GAME TIME

124

What tumor arises from the posterior fossa, is GFAP +, benign with a good prognosis?

Pilocytic astrocytoma

124

Common sites of injury for concussion?

Frontal and temporal poles

125

What is involved in axonal injury at the cellular level for concussions?

JNKs

126

Most common childhood brain tumors to least?

Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Craniopharyngioma

127

What distinguishes allergic conjuctivitis from viral?

B/L redness, watery discharge and ITCHING

127

How does fluoroscopy work?

Uses continually emitted X-rays and allows for real-time visualization

127

What symptoms seen in MR?

Orthopnea, PND, RHF/LHF

128

What are the benefits of coronary angiography?

What are the risks?

Diagnostic w/immediate intervention, life saving

Anything else

129

Occlusion to what causes lateral pontine syndrome?

What nuclei are fucked?

AICA

Vestibular, facial, cochlear

129

What are the 4 major routes of an embolism?

Venous - PE
Arterial - systemic E
Portal vein - hepatic E
Paradoxical E

130

Occlusion to what causes medial medullary syndrome with ipsilateral hypoglossal, LCST, and ML dysfunction?

Anterior spinal artery

130

Where do you find a Schwannoma?

Cerebellopontine angle

130

What tumor has perivascular rosettes and causes hydrocephalus with a poor prognosis?

Ependymoma

131

What kind of contrast is given in MRI?

Gadolinium

132

What is a FAST CXR used for?

To detect hemoperitoneum and pericardial effusion

133

What is a real time assessment of intracardiac blood flow?

Bubble study

134

When does an immediate CT scan warrant use in concussion?

Loss of consciousness > 60 sec
Post-concussive seizure
Major neurologic defect (especially motor)
Sig. lethargy or rapidly progressive worsening of symptoms

134

Chronic cause of MR?

MVP - most common
MAC

135

S3 best heard with bell or diaphragm? Describe

Mnemonic?

Bell, dull and low pitch

Kent-Tuck-y

136

What organism causes a hordeolum?

What gland causes an internal hordeolum?

How to treat?

S. aureus

Meibomian gland

Warm compress

136

What kind of cells cause demyelination in M.S.?

Associated with what halpotype?

Leukocytes activated by TH17

HLA-DL2

136

What tool to evaluate concussions is the cheapest and probably most widely used?

SCAT2

136

When does MS occur most often?

Symptoms?

4th decade

DOE, cough, orthopnea, PND, PE, hemoptysis, AFib

137

Diplopia in 1 eye, with the other closed suggests a problem with what?

Cornea or lens

137

CT pros?

Cons?

Everywhere, painless

Contrast, radiation, dx limited

137

What does the following indicate?

W/in 24-48 hours there is INC serum Cr, DEC GFR with oliguria

Contrast induced nephropathy

137

What medication can cause lactic acidosis and is contraindicated when imaging with contrast?

Metformin

137

What is the persistence of concussion-induced symptomatologie for greater than 3 months post injury?

Postconcussion syndrome

137

Triad of sx in AS?

Occurs when?

SAD - syncope (HF), angina, exertional dyspnea

6th decade