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radiology > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

why are plain films of the face not ordered anymore

A

hard to read so much overlap it is impossible might as well go right to a CT scan but they are fast and cheap

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2
Q

number of standard fews in face series

A

4

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3
Q

waters view

A

beam below the chin

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4
Q

jughandle view is helpful for looking at the

A

zygomatic arch Zygomatic arches = the “jugs”

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5
Q

highlights frontal/maxillary sinuses seen in what plain face XRAY

A

Water’s View

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6
Q

single lateral view

A

for nasal bone

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7
Q

CT indications

A

Significant trauma ○ Fracture present or suspected ○ Infections: sinusitis, periorbital cellulitis, retrobulbar pus, cavernous sinus thrombosis

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8
Q

facial infections we are worried about

A

sinusitis periorbital cellulitis retrobulbar (eye) pus cavernous sinus thrombosis need to know the extent and what is it

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9
Q

what are standard views for a CT of the face

A

Sagittal, coronal, axial recons -

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10
Q

Special CT views of the face

A

maxilofacial just the orbits (bony structures) of the eye very very thing cuts of the orbits)

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11
Q

why do you see maxillary sinus opacification

A

you can ask the houndsfield units to see if blood or infection or just look at the story

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12
Q

what is a blow out fracture

A

if the object fits into the orbit and push on the eye the eye will move back and the orbit will break BLOW OUT of the orbit fat will come out and in to the maxillary sinus (along with maybe blood or air)

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13
Q

“tear drop” sign refers to

A

blow out fracture with fat coming out into maxillary sinus

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14
Q

If the affected eye EOM’s impaired, they have ___________ and/or pain on looking up or out – suspect “__________”

A

If the affected eye EOM’s impaired, they have double vision​ and/or pain on looking up or out – suspect “entrapment”

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15
Q

direct blow to the cheek is known as a

A

tripod fracture you break the maxillary sinus and the orbit

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16
Q

NAME for Fractures in the zygomatic arch, orbit, wall of maxillary sinus ○ CT initial study

A

TRIPOD

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17
Q

Mid face fracture resulting from high force injuries

A

● LeFort fractures

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18
Q

types of LEFORT fractures

A

LEFORT 1: teeth fall off LEFORT 2: nose and teeth but orbit intact lefort 3: the bottom of your eyes fall off

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19
Q

Maxilla, or maxilla plus maxillary sinus/orbits/nose/arch in various degrees fracture involving

A

LeFort

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20
Q

plain film w/ circular view; takes horseshoe-shaped mandible and flattens it out

A

Panorex

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21
Q

what are the three things you need to describe a mandible fracture

A

Location & number of fx’s ○ Open or closed ■ Open means fx opens into mouth - worse b/c lots of bacteria in human mouth ○ Distraction (separation)

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22
Q

what is the order of operations for a mandible injury

A

PANOREX then CT for fracture or CT if it looks horrible ● Often fractures in >1 place due to horseshoe-shape

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23
Q

what is the diagnostic test of choice for suspected deep facial infx

A

CT is the diagnostic choice for suspected deep facial infections/pus collections or retrobulbar processes

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24
Q

test of choice in ED for retinal detachment (vision changes, halos, painless)

A

Ultrasound – Orbit

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25
Q

what should we normally see on the ultrasound of the orbit

A

● Normally, should see vitreous humor (black), retina should be flat in the back

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26
Q

welder comes in with eye pain they were not wearing safety glasses

A

ULS looking for metalic object

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27
Q

indications for CT imaging of TRAUMA

A

NEXUS Low Risk Criteria ○ Canadian C-Spine Rule ○ Both address who needs imaging and who does not

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28
Q

when to start of with a plain film of the neck

A

non trauma neck pain very minor trauma persistent neck pain can look for METS

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29
Q

in general obtain CT of the neck if

A

Significant mechanism (eg, freeway speed crash + neck pain) ○ Midline pain ○ Paresthesia/numbness/weakness ○ Cannot rotate or flex w/o pain ○ ALOC (alte —>Age>65 older and fall down you need this (8lb bowling ball on a stick)

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30
Q

3 views standard views for plain films of the neck

A

AP/PA views are most important in Chest; on AP view of Neck, top vertebra is usually C3 ○ 85% of diagnoses will be made with Lateral view ○ Open mouth odontoid gives better view of C1 and C2

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31
Q

85% of diagnoses will be made on what view on plain films of the neck

A

○ 85% of diagnoses will be made with Lateral view

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32
Q

three things that tell you if a lat neck film is adequate

A

Must be able to see the anterior superior corner (top of) T1​ below C7 to evaluate alignment ○ Must see base of skull ○ Must see tips of C6, C7 spinous processes

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33
Q

what will you order if you can’t get an adequate neck xray

A

SWIMMERS view

34
Q

systematic approach to reading lateral C spine films

A

1.name, date 2.COUNT 3.Check 4 lines of alignment 4.Look for consistent height/shape of vertebrae 5.Look for consistent disc spaces between bones 6.Look at soft tissue contours and spaces – measure if in doubt 7. Check all spinous processes for fx

35
Q

Check 4 lines of alignment

A
  1. Anterior longitudinal ligament line = Anterior vertebral line 2. Posterior longitudinal ligament line = Posterior vertebral line 3. Spinolaminar line 4. Spinous process line
36
Q

checking for alignment will tell you what about a lateral C spine xray

A

subluxation or ID abnormality

37
Q

how much space should their be in front of C2

A

<6mm

38
Q

how much space should their be in front of C3/4

A

<5 mm

39
Q

how much space should their be in front of C6

A

<22mm at C6 ■ Kids: < ½ width V

40
Q

how to remember the contour of the neck and the spaces

A

6mm at 2 22mm at 6

41
Q

Pre-dental space​ (atlanto-dens interval should have how much space

A

≤ 3mm adults ■ ≤ 5mm kids

42
Q

Reading the Odontoid View

A

Do the vertebral bodies of C1 and C2 line up? ● Look at symmetry of spaces between C1 and C2 ○ Is the pt rotated? Radiologist ● Look at contour of odontoid (dens) itself ○ Can you see the entire dens? ● Check lateral for clues too!

43
Q

special neck views (other than swimmers)

A

Oblique views Flexion/Extension Views

44
Q

old cspine view used for Neural foramina, facet joints ○ Less common ○ CT (fx) or MRI (spinal cord) are far superior

A

Oblique views

45
Q

Less common ○ Not used in trauma ○ Controversial - may worsen sx’s ○ CT/MRI superior have to go to confession for a month

A

● Flexion/Extension Views

46
Q

trauma C spine, contrast or nah?

A

nah, you’re looking at the bone

47
Q

look at slide 37

A

CT MRI

48
Q

when would you use MRI vs CT

A

if you suspect a deep space abscess the initial test is going to be a CT scan MRI for spinal cord injuries

49
Q

these fractures are unstable much like the pt and the exact mechanism is unknown

A

● Odontoid fractures are unstable; quite often, the patient is also unstable

50
Q

types of odontoid fracture

A

Type I, Type II, Type III

51
Q

what would you do for suspected odontoid

A

CT scan as soon as possible once stabilized

52
Q

= Fracture of the ring of C1 (like how lifesavers candy falls apart after sucking on it for a long time)

A

Jefferson Fracture

53
Q

mechanism of a Jefferson fracture

A

axial load (something falling on your head, or diving into shallow pool)

54
Q

how to dx jefferson fracture

A

*Confirm all fractures on CT scan by looking at image above and below for consistency

55
Q

Posterior element fracture of C2; usually with hyperextension

A

Hangman’s Fx

56
Q

mechanism of a hangman’s fracture

A

: hyperextension and compression (face vs. windshield) ● Soft tissue edema

57
Q

burst fracture mechanism

A

axial load compression

58
Q

Vertebral body in multiple pieces from unstable axial load compression

A

burst fracture doesn’t always violate the cord space but can be a very bad scene

59
Q

mechanism of a wedge compression Fx

A

hyperflexion with axial load compression anteriorly

60
Q

If posterior elements intrude on spinal canal on a wedge compression fracture

A

If posterior elements intrude on spinal canal, considered a burst fx

61
Q

Flexion Teardrop Fx

A

: hyperflexion and compression (this is a diver’s fx)

62
Q
A
63
Q

ubluxation​, Jumped or “Perched” Facets

mechnaism

A

hyperflexion with distraction

64
Q

name this fracture

A

Perched facets​ is essentially a ligamentous injury; fixed w/ traction

65
Q

how do you describe perched fx

A

Describe: top vertebrae is “subluxed onto” the lower one - % of vertebral body: “20% subluxation C5 onto C6”

66
Q

hyperextension is the mechanism of this fracture seen with ligamentous rupture

A

Anterior Avulsion Fx

67
Q
A

Anterior Avulsion Fx

68
Q

stable fracture seen at the spinous process fx at C6 or C7

A

Clay Shoveler’s and Spinous Process Fx’s

69
Q

name this fracture

what’s the mechanism

A

Clay shoveler’s

STABLE

Sudden hyperflexion; clay stuck to shovel when tossing overhead.

C6/7

Also caused by a direct blow to area.

● Classically, a ligamentous avulsion.

70
Q

what is typical CM of epiglottitis

A

pain out of proportion to their findings, febrile, haven’t eaten

Sx: drooling, stridor, dyspnea

as them if they are inmmunized

71
Q

what type of film would we get with a fish bone pt

A

soft tissue lateral of the neck underpenetrated (soft tissues need only)

72
Q

24 yo man w/out immunizations when young, complains of a sore troat. positive thumb sign on soft tissue

A

epiglottitis

73
Q

thumb sign

A

See enlarged epiglottis, classic “thumb” sign

74
Q

what type of dx would you get with suspected retropharyngeal abscess

A

CT???

75
Q

fever sore throat and trismus in a child

A

trismus= can’t open mouth

suspect retropharyngeal absces

76
Q

what does ULS tell us about a thyroid

A

cystic (fluid) or solid (tumor), size, composition

need this before a FNA

77
Q

thyroid scintigraphy, when is this indicated

A

Determines the functional status of a nodule (warm/hot/cold)

78
Q

when would we use a ct for a thyroid

A

● CT reserved for complex cases, eval adjacent structures

79
Q

– shows carotid/vascular flow; part of CVA work up

A

Duplex Ultrasound

80
Q

– indicated for carotid dissection, trauma

A

CT angiography (CTA) –

81
Q

● MR angiography (MRA) used for what in the neck

A

to study the vessels

82
Q

History: A 45-year-old jumped into swimming pool and hit head, now with neck pain what type of fracture would you suspect

A

Jefferson fracture

radiology (13 decks)

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