Session 12

Question 1

Features of radiographs

Answer 1

X ray beam onto plate detector
Quick, cheap, readily available, low ionising radiation dose
Low contrast, 2D

Question 2

Features of US

Answer 2

Handheld probe using sound waves
Cheap, no ionising radiation
Operator dependent, limited by bone
Useful for thyroid and superficial soft tissue only

Question 3

Features of CT

Answer 3

X ray beam from passing through a doughnut shaped scanner

Quick, readily available

High radiation dose

Question 4

Features of MRI

Answer 4

Images acquired from within a magnet- usually shaped like a long tunnel

Best contrast, no ionising radiation

Slow, expensive, limited availability

Question 5

HNN uses for radiographs

Answer 5

Minor skull trauma (no need for CT)
Cervical spine trauma
Foreign bodies within neck

Question 6

US HNN uses

Answer 6

Thyroid evaluation
Superficial head and neck masses
Superficial infection
Carotid doppler

Question 7

CT HNN uses

Answer 7

Trauma- NICE criteria
Acute focal neurological symptoms (evaluate for haemorrhagic strokes)
Malignancy
Infection
Angiographic imaging of arteries and veins

Question 8

MRI HNN uses

Answer 8

Best imaging of brain - tumour evaluation, epilepsy

Cervical spinal cord traumatic injury

HN tumours

Question 9

What abnormalities can be seen in a skull radiograph

Answer 9

Skull fracture
Pneumocranium
Fluid level
Lytic soft tissue- Mets/myeloma

Question 10

Normal lateral skull radiograph

Answer 10

Question 11

What can be seen on a facial radiograph

Answer 11

Tripod fracture
Black eyebrow
Gas in orbit
TMJ dislocation
Mandibular fracture

Question 12

Answer 12

Question 13

Answer 13

Question 14

Answer 14

Question 15

Answer 15

Question 16

Answer 16

Question 17

cervical spine radiograph can visualise

Answer 17

Fractures/subluxation
Atlanto-axial subluxation
Facet dislocation
Vertebral erosion
Soft tissue widening
Lung lesion/pneumothorax

Question 18

Answer 18

Jefferson fracture

Question 19

Answer 19

Question 20

Caution with radiographs

Answer 20

Cannot see ligamentous injury

Significant injury can be present with normal radiography- consider CT or MRI if spinal crod

Question 21

Answer 21

Question 22

Answer 22

Question 23

Answer 23

Extradural

Question 24

Features of extradural bleed

Answer 24

Defined traumatic cause
Usually arterial bleed- MMA
Biconvex Oval shape
Associated with fracture 75%
Lucid interval
Neurosurgical emergency

Question 25

Answer 25

Subdural

Question 26

Causes of sub dural bleed

Answer 26

Paeds = trauma or NAI Adult = trauma Elderly = trauma often mild

Question 27

Features of sub dural bleed

Answer 27

Usually venous bleed- bridging beins Crescentic shape Acute = history of trauma and symptoms Chronic = confusion

Question 28

Treatment for sub dural haemorrhage

Answer 28

Correct anticoagulation - warfarin Small can be managed conservatively - further CT if deteriorate Large or symptomatic = neurosurgical emergency

Question 29

Answer 29

Subarachnoid Caused by trauma or ruptured aneurysm or vessel

Question 30

Subarachnoid bleed features

Answer 30

Small vessel bleed Peripheral hyper density following sulci Can be asymptomatic Small with normal GCS can be managed conservatively- correct anticoagulation, further CT if deteriorate Consider neurosurgical option

Question 31

Features of subarachnoid due to ruptured aneurysm

Answer 31

Arterial bleed due to aneurysm Central hyper density within subarachnoid space Thunderclap headache LP if normal Neurosurgical emergency- angiographic imaging needed

Question 32

Answer 32

Subarachnoid specifically ruptured aneurysm

Question 33

Density of tissues on CT from least to most dense

Answer 33

Air < Fat < Fluid < Soft tissue and blood < bone < metal Black —> grey —> white