Emergency Body CT > The Final Quiz Answers


The Final Quiz Answers

Question 1: A patient with exravasation of IV contrast is at greatest risk for which of the following complications:
Uticaria
Hypertension with reflex bradycardia
Seizure
Compartment syndrome

Explanation: Remember that ionic contrast agents such as Hypaque and Renograffin typically have greater adverse reactions than their non-ionic (Iohexaol) counterparts. Some adverse reaction to contrast agents include: urticaria, facial and laryngeal edema, bronchospasm, hypertension, hypertension, and seizures. However, extravasation of contrast material at the site of injection (usually the forearm) place the patient at risk for compartment syndrome.


Question 2: The second most commonly injured abdominal organ following trauma is the:
Kidney
Spleen
Liver
Pancreas


Explanation: When evalauting abdominal CT for traumatic injury, it is important to know the relative incidence of specific forms of traumatic injury. A list of most common to least common organ injuries includes:
1) Spleen
2) Liver
3) Kidney
4) Pancreas
5) Bowel

The incidence of traumatic bladder rupture is greatly increased in those patients with distented bladders.


Question 3: Injury to the kidney which include damage to the capsule and disruption of the vascular pedicle would be catagerized as what class of renal injury:
I
II
III
IV
V

Explanation: Adequate assessment of tramtic renal damage include classifying the extent of injury. Classification of injury is critical for guiding either medical or surgical management. A table of clasifcation is as follows:

Class
Criteria
I
Contusions, small corticomedullary lacerations that do not communicate with the collection system
II
Laceration that communicates with the collection system
III
Shattered kidney, injury to the vascular pedicle
IV
UPJ avulsion, laceration of the renal pelvis




Question 4: Which segement of the liver is most commonly injured in blunt trauma
Caudate lobe
Posterior right lobe
Anterior right lobe
Inferior right lobe

Explanation: The liver is the second most commonly injured abdominal organ following trauma, occuring in approimately 3%-10% of all patients with blunt trauma. Injury to the right lobe is far more common than the left lobe. Injury of the posterior segment of the right lobe is more common than anterior segment. Injuries to the caudate lobe are rare and usually occur in conjunction with either right or left lobe injury.



Question 5: Given the following image, the most likely diagnosis is

Hemoperitoneum
Splenic fracture
Splenic laceration with active bleeding
Sentinal clot sign

Explanation: The extravasation of IV contrast idicates active bleeding from the spleen (arrow). A perisplenic fluid collection, most likely clotted blood, can also be seen. The sentinel clot sign is present. However, active bleeding is the more important diagnosis to make.



Question 6: The greatest percentage of deaths related to pancreatic trauma are due to:
Pancreatitis
Acute peripancreatic fluid collection
Acute formation of a pancreatic pseudocyst
Visceral hemorrhage with hypovolemic shock

Explanation: Although all of the above are possible complications of pancreatic injury due to trauma, the occurence of visceral hemorrhage with secondary hypovolemic shock is responsible for the high mortality rate assocaited with pancreatic injury. Pancreatic injuries assocaited with other injuries carry a mortality rate of approximately 25%. 50% of pancreatic trauma related deaths are due to hypovolemic shock from major visceral hemorrhage.



Question 7: Surgical management is most likley indicated for which classes of renal injury
I, II, III, and IV
II, III, and IV
III and IV
I and II

Explanation: A working classification of renal injury is as follows:

Class
Criteria
I
Contusions, small corticomedullary lacerations that do not communicate with the collection system
II
Laceration that communicates with the collection system
III
Shattered kidney, injury to the vascular pedicle
IV
UPJ avulsion, laceration of the renal pelvis

Category I lesion are usually watched and medically treated. Surgery is usually indicated for category III and IV lesions. Category II lesions may be either surically or medically managed.


Question 8: Upon examination of a CT following a motor vehicle accident, free air is found in the retroperitoneal space. Which segement of the bowel is most likely to have been injured?
First portion of the duodenum
Fourth portion of the duodenum
Second portion of the duodenum
Jejunum


Explanation: A good understanding of abdominal anatomy is critical for assessment of abdominal CT. Identifying the location of free air or extravasated contrast within the abdomen can aid in diagnosing the site of injury. In this case, the existence of free air usually indicates injury to bowel. Becuase the free air is limited to the retroperitoneal space, the most likely site of perforation is limited to a segement of bowl located within the retroperitoneal space. The second portion of the duodenum fufills these criteria.


Question 9: Given the following image, the most likely diagnosis is

Pancreatitis
Peptic ulcer disease
Colitis
Pylonephritis


Explanation: The pancreas is thickened and surrounded by fluid infiltrating the retroperitoneal fat.

Question 10: Given the following image, the most likely diagnosis is:
Colitis
Small bowel obstruction
Ileus
Leaking aortic aneurysm

Explanation: There is bowel wall thickening in segments of large bowel - the ascending, distal transverse and descending colon.


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