U of Washington R2 Practical, 2013 – MULTIPLE CHOICE
1. You are asked to protocol an exam for a patient with concern for SBO and severe nausea and vomiting. How would you protocol this exam?
A. CT A/P: no IV, no oral contrast
B. CT A/P: with IV contrast, no oral contrast
C. CT A/P with IV and water soluble contrast
D. CT A/P with IV and negative oral contrast.
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3. You are called to the scanner for a stroke code. You review the examination on the CT and the brain appears normal on rapid review. The next step in the typical stroke protocol is…
A. Perform a CTA of the Head and Neck
B. Perform a CTA of the Head
C. No additional imaging required
D. Review the patient on PACS monitor before deciding on next action.
4. A patient is lightheaded after contrast administration. Your physical examination demonstrates a pulse of 41 and a blood pressure of 87/32. Elevation of the legs, oxygen administration, and fluids do not cause improvement. The next step in management is:
A. Epinephrine 0.1 mg IV x 1
B. Epinephrine 1 mg IV x 1.
C. Atropine 0.6 mg IV x 1
D. Methylprednisone 60 mg x 1 IV
5. The technologist calls you because he believes a patient who just completed her exam is having a contrast reaction. He reports the patient, who is currently sitting in a chair outside the scanner, is audibly wheezing and appears distressed. Before you get off the phone you should do all of the following except:
A. Request a stat chest radiograph.
B. Get the location of the scanner.
C. Request the technologist start obtaining vitals.
D. Have the patient moved to a stretcher.
E. Request oxygen mask and fluid be made ready.
6. According to literature, what percentage of patients will have appendicitis with a nonvisualized appendix and no secondary signs?
A) Greater than 25%
B) 25-10%
C) 10-5%
D) Less than 5%.
7. Create a flow chart that describes a reasonable approach to the work-up of a pregnant patient with suspected PE.
8. 78 year old woman has had a significant contrast extravasation into a peripheral IV line in her hand. While she is being observed and treated with cold compresses she reports increasing pain and new numbness in her fingers. There is blistering at the extravasation site and her capillary refill has increased from 2 to 5 seconds. The next step in management is:
A) Discontinue cold therapy and offer warm compresses.
B) Apply a tourniquet to the upper extremity
C) Using sterile technique and after lidocaine administration, incise
the extravasation site.
D) Notify the plastic surgery resident on call.
9. A 48 year old patient with a history of end stage renal disease secondary to Diabetes I and hypertension and complete dialysis dependence presents to the ED on Saturday afternoon with symptoms suggestive of a pharyngeal abscess and the physician desires a CT neck.
He undergoes dialysis every MWF and attended his last appointment; he is reportedly his dry weight. What is your recommendation for protocolling this exam?
A) Noncontrast CT of the neck..
B) CT of the neck with IV contrast, with half dose and pre and post hydration.
C) CT of the neck with IV contrast, arrange for the patient to receive
an extra run of dialysis after the examination.
D) Routine CT of the neck with IV contrast.
10. Protocol for a patient with papillary thyroid cancer metastatic to nodes and sternal pain.
A) Noncontrast CT of chest.
B) CT of the chest, IV contrast.
C)CTA of the chest, pulmonary artery protocol
D) MRI with contrast of the chest wall.
11. A 78 year old man with multiple comorbidities including CAD and PVD, s/p CABG and AICD placement, DM II, CKD stage IV, COPD , and obesity presents after falling at home. He has 10/10 hip pain. Initial negative radiographs. Next step?
A) Immobilization and repeat hip radiographs in 5-7 days.
B) Obtain noncontrast CT of the hip.
C) MRI of the left hip
D) Obtaining MDP bone scan.
***The following questions will assess your familiarity with ACR Appropriateness Criteria***
12. A 23-year-old man with suspected cervical spine trauma after a low-speed motor vehicle collision complaining of neck pain. He is alert and sitting upright. On exam, no point tenderness over posterior midline of spine or focal neurologic deficit is elicited.
a. X-ray cervical spine lateral view only
b. X-ray cervical spine lateral, AP, and open mouth views
c. CT cervical spine with sagittal and coronal reformats
d. MRI cervical spine
e. No ideal imaging exam
13. A 54-year-old man with acute chest pain. Aortic dissection is suspected.
a. CTA chest and abdomen
b. MRA chest and abdomen
c. US echocardiography transesophageal
d. Angiogram thoracic aorta
e. No ideal imaging exam
14. A 32 year-old woman with acute pelvic pain suspected of gynecologic origin. Serum beta-hCG is positive.
a. X-ray abdomen
b. US pelvis transvaginal
c. CT pelvis with or without abdomen
d. MRI pelvis with or without abdomen
e. No ideal imaging exam
15. A 36-year-old woman with right upper quadrant pain, fever, and leukocytosis. Exam reveals a positive Murphy's sign.
a. X-ray abdomen
b. US abdomen
c. CT abdomen
d. Cholescintigraphy
e. No ideal imaging exam
Case pathologies and normals that were shown on quiz:
Case 1: RUL lobar/segmental PE with no definite CT evidence of right heart strain.
Case 2: No acute intracranial abnormalities, including hemorrhage, infarct, or mass effect. Encephalomalacia in R frontotemporal region from prior injury/infarct.
Case 3: No acute cardiopulmonary abnormalities.
Case 4: Perforated appendicitis with abscess.
Case 5:Subtle perimesencephalic SAH. Negative CTA.
Case 6: R mainstem intubation.
Case 7:Normal abdominal series.
Case 8: Large L MCA territory acute infarct. No hemorrhage. Probable hyperdense MCA sign.
Case 9:Uncomplicated acute diverticulitis.
Case 10:Soft tissue swelling over the lateral malleolus. No acute fractures or dislocations.
Case 11: Posterior shoulder dislocation with reverse Hill-Sachs deformity.
Case 12:Large R pneumothorax.
Case 13: Negative VEO for appendicitis. Nonvisualized appendix, but no secondary signs of inflammation in RLQ.
Case 14: SBO with probable closed loop.
Case 15: Obstructing L UVJ stone
Case 16: ICU CXR with diffuse lung disease and lines/tubes in expected positions.
Case 17:Normal knee.
Case 18: Lipohemarthrosis with occult tibial plateau fracture seen on subsequent CT.
Case 19: No acute fracture or subluxation of the C-spine.
Case 20: Pneumoperitoneum.
Case 21: L subclav CVC terminating at R brachiocephalic vein
Case 22: Lisfranc fracture dislocation
Case 23: Radial head fracture. Anterior fat pad sign.
.Case 24:Stanford Type A intramural hematoma