help with exam questions

[peehdee]

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1) A 48 year old male with IDDM complains of persistant nausea and abdominal pain after meals as well as occasional vomiting. His GI doc has performed an upper endoscopy which is unremarkable. Which of the following imaging studies would be expected to be most helpful in explaining the patient's symtomatology?

a) CT of the abdomen
b) barium esophagram
c) gastric emptying study
d) ultrasound study of the stomach

2) a 26 year old male is admitted after a motor vehicle accident and remains comatose for 72 hours. Which of the following studies should be ordered to assist in the confirmation of brain death

a) an MRI of the brain with gadolinium
b) a PET scan of the brain with C-11 choline
c) a SPECT of the brain with Tc-99m pertechnetate
d) a radionuclide angiogram of brain blood flow with Tc-99m pertechnetate

3) a 28 year old woman driver brought to the trauma service following an automobile accident during which she sustained a blunt steering wheel injury to her chest, complains of sharp pain radiating to her back. which of the following studies is least likely to be of value in ruling out the possibility of a post-traumatic dissection of the thoracic aorta.

a) convetional radiograph of the chest
b) MRI scans of the chest before and after the IV injection of gadolinium
c) CT scans of the chest before and after the IV injection of iodinated contrast material
d) trans-esophageal ultrasonography



i put c, b, and a, respectively.

i would appreciate any help in arguing for the answers to be those listed above (if they're wrong) 🙂


thanks guys

 

[Docxter]

1) A 48 year old male with IDDM complains of persistant nausea and abdominal pain after meals as well as occasional vomiting. His GI doc has performed an upper endoscopy which is unremarkable. Which of the following imaging studies would be expected to be most helpful in explaining the patient's symtomatology?

a) CT of the abdomen
b) barium esophagram
c) gastric emptying study
d) ultrasound study of the stomach

2) a 26 year old male is admitted after a motor vehicle accident and remains comatose for 72 hours. Which of the following studies should be ordered to assist in the confirmation of brain death

a) an MRI of the brain with gadolinium
b) a PET scan of the brain with C-11 choline
c) a SPECT of the brain with Tc-99m pertechnetate
d) a radionuclide angiogram of brain blood flow with Tc-99m pertechnetate

3) a 28 year old woman driver brought to the trauma service following an automobile accident during which she sustained a blunt steering wheel injury to her chest, complains of sharp pain radiating to her back. which of the following studies is least likely to be of value in ruling out the possibility of a post-traumatic dissection of the thoracic aorta.

a) convetional radiograph of the chest
b) MRI scans of the chest before and after the IV injection of gadolinium
c) CT scans of the chest before and after the IV injection of iodinated contrast material
d) trans-esophageal ultrasonography



i put c, b, and a, respectively.

i would appreciate any help in arguing for the answers to be those listed above (if they're wrong) 🙂


thanks guys

Answer to number 2 is d. No flow to the brain ----> confirms brain death. Question A is very poorly designed but your answer is correct.

 

[jhadow]

Answer to number 2 is d. No flow to the brain ----> confirms brain death. Question A is very poorly designed but your answer is correct.

#2 is a bad question. Don't they certify brain death with EEG's anyway?

I think PET is the best answer though. We're talking about brain activity. You could just feel for a carotid pulse if you wanted to rule out blood flow.

J.

 

[Whisker Barrel Cortex]

Actually, brain death studies are still performed, albeit rarely. It is usually performed if other results are somewhat inconclusive or to take the extra step to prove to the family that their loved one does indeed lack brain flow.

The study of choice at this point is not a PET. As Docxter pointed out, the answer is D, Tc99m flow study. If flow study shows no flow to the brain, the patient is considered brain dead. Flow will often persist to scalp. Carotid pulses will still be present (the patient is not completely dead, just brain dead).