Solutions to Test Yourself!




Solutions to Test Yourself!


The exercises and solutions have been numbered consecutively. Some of the exercises have several different correct solutions. If the exercises can be solved simply by referring to the chapters in the book, I have indicated where you will find the necessary information.


After you have completed the exercises, compare your score and results with those of your colleagues. The score on the right gives you an impression of the degree of difficulty. Enjoy the challenge!


Solution to exercise 1 (p. 32):


9 Points



You will find the sequence for interpreting CCTs on page 26. Each step gives you 1/2 point with 3 extra points for the correct sequence, which adds up to 9.


Solution to exercise 2 (p. 45):


9 Points



































 


Level


Width


Gray scale


 


Lung/pleural window


– 200 HU


2000 HU


-1200 HU to + 800 HU


3


Bone window


+300 HU


1500 HU


– 450 HU to +1050 HU


3


Soft-tissue window


+ 50 HU


350 HU


– 125 HU to + 225 HU


3


Solution to exercise 3 (p. 45):


10 Points
































a)


Barium sulfate


Routine for abdominal/pelvic CT if there are no contraindications


30 min before CT of upper abdomen 60 min before full abdominal CT


4


b)


Gastrografin


Water soluble, but expensive; if perforation ileus or fistulas are suspected; prior to surgery


20 min before CT of upper abdomen 45 min before full abdominal CT


4


 


 


 


 


1


No oral CM shortly after surgery for an ileal conduit!


1


Solution to exercise 4 (p. 45):


6 Points






















a)


Renal failure (creatinine, possibly creatinine clearance, function following kidney transplant or nephrectomy)


2


b)


Hyperthyroidism (clinical signs? if yes, hormone status, possibly thyroid ultrasound and scintigraphy)


2


c)


Allergy to CM (has CM-containing iodine already been injected? Are there any known previous allergic reactions?)


2


Solution to exercise 5 (p. 45):


2 Points



Tubular and nodular structures can be differentiated by comparing a series of images.


Solution to exercise 6 (p. 45):


3 Points



Vessels in which beam-hardening artifacts occur because of CM inflow are the superior vena cava, inferior vena cava, and the subclavian vein.


Solution to exercise 7 (p. 48):


3 Points



Fractures, inflammatory processes, and tumors or metastases can cause swelling of mucous membranes and retention of fluids in the mastoid sinuses and middle ear; these are normally filled with air.


Solution to exercise 8 (p. 57):


18 Points



This image requires careful study. You will discover several types of intracranial hemorrhage and the complications resulting from them.


































  • Bruising of the left frontoparietal soft tissues (extracranial, indicative of trauma to the head)


1




  • Subdural hematoma over the right hemisphere extending to occipital levels (hyperdense)


2




  • Edema in the right frontoparietal areas, possibly accompanied by an epidural hematoma


2




  • Signs of subarachnoid bleeding in several sulci in parietal areas on the right, adjacent to the falx


2




  • The hematoma has penetrated into the right lateral ventricle, which is practically obliterated


4




  • Choroid plexus in the left lateral ventricle appears normal


1




  • There is a midline shift toward the left, and edema surrounds the periventricular white matter on the right


2




  • Raised intracranial pressure (obstructed ventricle) and herniation of the brain (edema) can be expected


4


Solution to exercise 9 (p. 72):


9 Points



Gray and white matter appear well defined on narrow brain windows.

















Level


Width


Gray scale


+ 35 HU


80 HU


– 5 HU to + 75 HU


3




















CCT sections are normally oriented parallel to the orbitomeatal line,


 


so that initial and follow-up studies can be precisely compared.


2


2-mm sections at 4-mm increments are acquired through the petrosal bone,


2


then thickness and table movement are set at 8 mm.


2


Solution to exercise 10 (p. 72):


16 Points






























Intracerebral hemorrhage


in early phases hyperdense, often with hypodense peripheral edema


2


Subarachnoid hemorrhage


hyperdense blood instead of hypodense CSF in the sulci and cisterns


2


Subdural hemorrhage


hyperdense crescentic area close to the calvaria, concave toward the cortex, not limited by cranial sutures


4


Epidural hemorrhage


hyperdense, biconvex area close to the calvaria, smooth toward the cortex, always limited by cranial sutures


4


Complications


hemorrhage into a ventricle, CSF flow is obstructed, edema, danger of herniation


4


Solution to exercise 11 (p. 72):


2 Points



Subarachnoid hemorrhage in children may be visible only next to the falx or in the lateral (Sylvian) fissure.


Solution to exercise 12 (p. 72):


10 Points



Practice makes perfect!


Solution to exercise 13 (p. 72):


4 Points



Fracture of the right frontal bone and absent right frontal sinus (the latter is a congenital variation, not a hemorrhage, as indicated by the osseous trabeculae)


Solution to exercise 14 (p. 72):


8 Points



This was a difficult question. In the left internal jugular vein there is unusual sedimentation of the CM due to slow blood flow. The asymmetry of the jugular veins is not a sign of thrombosis. A left cervical abscess makes the neck muscles appear poorly defined.


Solution to exercise 15 (p. 73):


4 Points



In this patient the surface subarachnoid spaces are clearly too narrow and the ventricles distended. These signs indicate that CSF drainage is reduced or blocked and there is imminent danger of brain herniation. There is generalized brain edema. A neurosurgeon should be consulted about inserting an intraventricular shunt.


Solution to exercise 16 (p. 73):


3 Points



It is possible to mistake the subarachnoid hemorrhage around the left frontal lobe as an artifact. The left frontal cortex is outlined by blood. If you did not see any abnormality, return to the chapter about the head.


Solution to exercise 17 (p. 73):



You have of course taken the hint about not giving up too soon; the right medial rectus muscle (47c) is thickened. It is the second muscle to become involved in endocrine ophthalmopathy.


If you cannot remember which muscle is affected first, return to page 61.

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Jul 17, 2021 | Posted by in ULTRASONOGRAPHY | Comments Off on Solutions to Test Yourself!
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