5. Characterize radiation safety.

G7 p.126:165mm

a. Rem is the absorbed dose in rads multiplied by_____.

Q

b. Q “is the quality factor”; the Q of x-ray is_____.

1

c. 1 rem causes_____cases of cancer in every 1 million people.

300

d. Spine x-rays with obliques is_____rem.

5

G7 p.127:18mm

e. Cerebral angiogram is_____rem.

10 to 20

f. Cerebral embolization is rem.

34

6. Complete the following regarding occupational radiation exposure:

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a. It is advised to keep below_____rem per year,

2

b. averaged over a_____year period.

5

7. Provide the precautions advised.

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Increase the_____from the radiation source.

distance

b. Exposure is proportional to the_____ _____of the distance.

inverse square

c. Stay at least_____feet away, preferably_____feet away,

6, 10

d. Double the distance and get_____of the radiation.

1/4

e. What is better: lead “doors” or lead aprons?

doors

8. For measurement on a CT scan

G7 p.128:46mm

a. The eyeball is_____mm through its equator.

25

b. Give Hounsfield units for

     i. air

-1000

     ii. water

0

     iii. bone

+1000

     iv. blood clot

75-80

     v. calcium

100-300

     vi. disc material

55-70

     vii. thecal sac

20-30

c. Effect of anemia on an acute subdural hematoma (SDH) in a patient with less than 23% HCT will look_____.

isodense

9. True or False. The sylvian point is

G5 p.559:10mm

a. the apex of the insula

true

b. usually 5 to 10 mm from the inner table of the skull

false (30 to 43 mm from inner table)

c. at or within 1 cm below the midpoint of a vertical line from the superior inner table to the orbital apex

true

d. the point where the anterior choroidal artery enters the temporal horn of the lateral ventricle

false (That is called the plexal point.)

10. Answer the following concerning cerebral angiography:

G7 p.134:145mm

a. What is the overall risk, in %, of a complication resulting in a permanent neurological deficit with angiography?

0.1%

b. What is the risk, in %, of neuropathy from femoral angiogram?

0.2%

11. Complete the following about angiography (cerebral):

G7 p.134:145mm

a. The complication rate in

     i. uncomplicated angiography is approximately_____%.

0.1%

     ii. asymptomatic carotid stenosis is_____%.

1.2%

b. The most common of the persistent carotid basilar anastomoses is_____ _____ _____ _____.

persistent primitive trigeminal artery

c. This occurs in_____% of angiograms.

0.6%

d. The sylvian point marks the apex of the_____.

insula

12. Characterize venous structures.

G7 p.134:160mm

a. Deep lesions cause changes in_____ structures.

venous

b. Superficial lesions cause changes in_____structures.

arterial

c. Malignant lesion (i.e., GBM) show an early_____ _____.

draining vein

d. Meningiomas show draining veins_____.

late

e. Meningiomas come_____ and stay _____.

early, late

13. The recurrent artery of Heubner arises from the

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a. _____ segment of the

A1

b. _____ _____ artery (80%)

anterior cerebral

c. and supplies the:

(Controversial item: Rhoton’s Anatomy, page 119 column B 45 mm, recurrent branch most commonly arises from A²—78% A¹—14% A¹—A² junction 8%)

     i. a_____

anterior limb: internal capsule

     ii. p_____

putamen

     iii. c_____

caudate head

14. What is the name of the artery that is the continuation of the anterior cerebral artery?

pericallosal artery

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15. Complete the following statements about neuroradiology:

G7 p.101:70mm

a. The_____ _____ artery enters

anterior choroidal

b. the temporal horn via the_____fissure.

choroidal

c. This is called the p_____p_____.

plexal point

d. It is_____mm to_____mm from origin of that vessel.

18 to 26 mm

e. What is unique about this point on the angiogram?

It makes a distinct kink as seen on the lateral angiogram.

16. True or False. From proximal to distal, the branches of the anterior cerebral artery are

G7 p.101:90mm

a. medial orbitofrontal, frontopolar, callosomarginal, pericallosal

true

b. frontopolar, callosomarginal, medial orbitofrontal, pericallosal

false

c. frontopolar, medial orbitofrontal, pericallosal, callosomarginal

false

d. medial orbitofrontal, frontopolar, pericallosal, callosomarginal

false

17. True or False. The sylvian triangle on a lateral ICA angiogram is formed by

G5 p.560:135mm

a. superior insular line, angular artery, line between MCA origin, and most anterior ascending branch

true

b. superior insular line, line from bregma to torcula, line between posterior temporal branch, and lateral orbitofrontal branch

false

c. superior insular line, clinoparietal line, limbus sphenoidale

false

d. clinoparietal line, angular artery, line from bregma to torcula

false

18. True or False. The following are MCA branches:

G7 p.101:175mm

a. lateral orbitofrontal

true

b. ascending frontal

true

c. medial orbitofrontal

false (The medical orbitofrontal is a branch of the anterior cerebral artery.)

d. anterior temporal

true

e. posterior parietal

true

19. Complete the following about angiography (cerebral):

G7 p.105:86mm

a. The foramen of Monro lies at the junction of what three veins?

     i. i_____c_____

internal cerebral

     ii. t_____

thalamostriate

     iii. s_____

septal

b. This site is known as the_____ _____.

venous angle

20. True or False. The following veins will drain into the straight sinus in the normal venous anatomy:

G7 p.105:130mm

a. vein of Galen

true

b. basal cerebral vein of Rosenthal

true (via the vein of Galen)

c. inferior sagittal sinus

true

d. vein of Labbé

false

(It empties into the transverse sinus.)

21. True or False. In the setting of a brain stem mass seen on a lateral vertebrobasilar angiogram, the displacement of the choroidal and colliculocentral points should be

G5 p.562:143mm

a. both displaced anteriorly

false (They would both be displaced anteriorly by a cerebellar mass but posteriorly by a brain stem mass.)

b. choroidal anteriorly, colliculocentral posteriorly

false (They outline the fourth ventricle and would move with it.)

c. choroidal posteriorly, colliculocentral anteriorly

false (They outline the fourth ventricle and would move with it.)

d. both displaced posteriorly

true (Both would be displaced posteriorly by a brain stem mass.)

e. no displacement

false

22. Complete the following about cerebral angiography.

G5 p.562:135mm

a. True or False. On a lateral vertebrobasilar angiogram, the most sensitive indicator of the anterior border of the pons is the

     i. pontomesencephalic vein

true

     ii. basilar artery

false (Basilar artery may be off to one side.)

     iii. choroidal point

false (junction of posterior medullary loop and supratonsillar loop)

     iv. copular point

false (on the inferior vermian vein)

G5 p.562:130mm

b. Twinings line runs between

     i. t_____

tuberculum

     ii. t_____

torcula

23. Matching. Match the best completion for each of the following:

G7 p.129:49mm

short TE, short TR; short TE, long TR; long TE, short TR; long TE, long TR

a. T1-weighted MRI has:

b. T2-weighted image has:

24. Complete the following about magnetic resonance imaging (MRI):

G7 p.129:110mm

a. List the three materials that appear white on T1-weighted imaging (T1WI) MRI.

fat, melanin, and subacute blood

b. What color is pathology on T1WI?

low signal on T1 (dark)

c. What color is pathology on T2WI?

high signal on T2 (white)

25. Matching. Match the phrases with the appropriate signal.

G7 p.129:145mm

high signal (bright); low signal (dark); intermediate signal

a. Fat on T1 is_____

b. Fat on T2 is_____

c. 7-to 14-day-old blood on T2-weighted MRI is:

d. 7-to 14-day-old blood on T1-weighted MRI is:

On T1 both fat and 7-to 14-day-old blood are high signal (white).

On T2 fat drops out (i.e., is dark); blood remains white.

26. Complete the following about MRI:

G7 p.129:170mm

a. The best sequence for CVA is_____.

FLAIR

b. which stands for_____-_____ _____ _____.

fluid-attenuated inversion recovery

c. Cerebrospinal fluid (CSF) is_____.

black

d. Most lesions appear_____in this sequence.

bright

e. Most lesions are more_____.

conspicuous

27. The best MRI sequence for

a. SAH is_____

FLAIR

G7 p.130:15mm

b. blood is_____ _____

gradient echo

G7 p.130:82mm

28. Gradient echo

G7 p.130:60mm

a. aka_____ _____

T2 star

b. aka_____

grass white

c. CSF and flowing blood appear_____

white

d. In cervical spine produces a_____effect

myelographic

e. Improves delineation of_____ _____

bone spurs

f. Also shows small old_____

hemorrhage

g. It is the most sensitive MRI sequence for_____.

blood

29. Complete the following about MRI:

G7 p.130:92mm

a. True or False. An MRI sequence that summates T1 and T2 signals and causes fat to be suppressed is called the_____sequence.

     i. grass

false

     ii. stir

true

     iii. echo train

false

     iv. spin density

false

b. STIR stands for_____ _____ _____ _____.

short tau inversion recovery (summates T1 and T2 images)

c. Use it to_____.

see tissues that enhance in areas of fat

30. If a MRI contrast is given to patients with severe renal failure, a rare condition called n_____s_____f_____may occur.

nephrogenic systemic fibrosis

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31. Name two contraindications to MRI.

G7 p.131:20mm

a. patients who contain_____or_____

ferro metals or cobalt (i.e., cardiac pacemaker, implanted neurostimulators, cochlear implants, ferromagnetic aneurysm clips, foreign bodies with a large component of iron or cobalt, metallic fragments in the eye, placement of stent, coil, or filter within past 6 weeks)

b. relative contraindication to MRI is_____

claustrophobia

32. Complete the following regarding programmable valves and MRI:

G7 p.131:80mm

a. Can such patients have MRI studies?

yes

b. You may need to check the_____ _____after the MRI.

pressure setting

33. Hemorrhage on MRI. Related to time. T1

G7 p.132:15mm

Hint: George Washington Bridge

a. acute g_____

gray

b. subacute w_____

white

c. chronic b_____

black

34. Hemorrhage on MRI. Related to time. T2

G7 p.132:15mm

Hint: layers of Oreo cookie

a. acute b_____

black

b. subacute w_____

white

c. chronic b_____

black

35. Hemorrhage on MRI. Related to time.

G7 p.132:15mm

Hint: i – baby, i – di, bi – di, ba – by, da – da

a. hyper-acute

     i. T1: i_____

isodense

     ii. T2: b_____

bright

b. acute

     i. T1: i_____

isodense

     ii. T2: d_____

dark

c. subacute early

     i. T1: b_____

bright

     ii. T2: d_____

dark

d. subacute late

     i. T1: b_____

bright

     ii. T2: b_____

bright

e. chronic

     i. T1: d_____

dark

     ii. T2: d_____

dark

36. Age of hemorrhage

G7 p.132:15mm

a. hyper acute_____

<24 hours

b. acute_____

1 to 3 days

c. subacute early_____

3 to 7 days

d. subacute late_____

7 to 14 days

e. chronic_____

>14days

37. Complete the following regarding hemorrhage and the condition of hemoglobin:

G7 p.132:20mm

a. hyperacute o_____

oxy

b. acute d_____

deoxy

c. subacute early m_____

met

d. subacute late m_____

met

e. chronic h_____

hemosiderin

38. a. Complete the following regarding hemorrhage and the location of hemoglobin:

G7 p.132:20mm Also see G7 p.1125:50mm

a. hyperacute l_____

intracellular

b. acute l_____

intracellular

c. subacute early l_____

intracellular

d. subacute late E_____

extracellular

e. chronic l_____

intracellular

39. Complete the following regarding diffusion weighted images (DWI):

G7 p.132:103mm

a. Its primary use is to detect

     i. i_____

ischemia

     ii. and a_____p_____.

active plaques

b. It first generates on_____map.

ADC

c. On DWI freely diffusible water is_____.

dark

d. Restricted diffusion is_____.

bright

e. Which is abnormal?

restricted diffusion

40. Characterize DWI.

G7 p.132:135mm

a. Restricted perfusion usually indicates_____ _____.

cell death

b. DWI abnormally will be present for_____.

1 month

c. DWI abnormalities can light up within_____of ischemia.

minutes

41. The most sensitive study for ischemia of the brain is the_____.

PWI

G7 p.133:13mm

42. DWI and PWI mismatch identifies penumbra.

G7 p.133:42mm

Hint: DWI death PWI

a. Which modality shows irreversible cell injury (death)?

DWI

b. Which modality shows reversible cell injury (penumbra)?

PWI

43. The important peaks in MRS are

G7 p.133:105mm

Hint: li-la-Na-crea-chol

a. li_____

lipid

b. la_____

lactate

c. Na_____

N acetyl aspartate

d. crea_____

creatine

e. chol_____

choline

44. The significance of important peaks in MRS are

G7 p.133:105mm

a. hypoxia

lactate

b. a couplet peak

lactate

c. nerve and axons

NAA

d. a reference for choline

creatinine

e. membrane synthesis

choline

f. increased in tumor

choline

g. increased in developing brain

choline

h. reduced in CVA

choline

45. The test that may help distinguish hemangiopericytom.

G7 p.134:20mm

a. from meningioma is the_____;

MRS

b. specifically the presence of a large_____peak.

inositol

46. The test that may help a surgeon avoid critical white matter

G7 p.134:118mm

a. tracts during brain surgery is_____.

DTI

b. which stands for d_____t_____i_____.

difffusor tensor imaging

47. Complete the following about plain films.

G7 p.135:115mm

a. The basion is at the tip of the_____.

clivus

b. The opisthion is at the anterior lip of the_____ _____.

occipital bone

G7 p.135:118mm

48. A lateral C-spine x-ray has four contour lines with two marking the borders of the spinal canal.

G7 p.135:160mm

Hint: apsp

a. front of vertebral body called_____ _____ _____

anterior marginal line

b. back of vertebral body called_____ _____ _____

posterior marginal line (marks anterior border of spinal canal)

c. posterior margin of spinal canal called_____ _____

spinolaminar line

d. posterior margin of spinous processes is called_____ _____ _____

posterior spinous line

49. Complete the following about spine films:

a. Cervical spine normal diameter is_____mm.

17 ± 5 mm

G7 p.136:130mm

b. Stenosis is present when the anteroposterior diameter is less than _____mm

12 mm

G7 p.136:140mm

50. Complete the following about normal prevertebral soft tissue:

G7 p.137:15mm

a. Anterior to C1:_____mm

10

b. Anterior to C2, 3,4:_____mm

7

c. Anterior to C5-C6:_____mm

22

51. Interspinous distances

G7 p.137:50mm

a. are abnormal if it is_____times the adjacent levels on AP film

1.5

b. if present it represents: true or false

     i. fracture

true

     ii. dislocation

true

     iii. ligament disruption

true

c. this is called_____on lateral x-ray

fanning

52. C1 has how many ossification centers?

3

G7 p.137:84mm

53. C2 has how many ossification centers?

4

G7 p.137:140mm

54. Matching. Match the following skull film findings with their characteristics:

G7 p.138:115mm

enlarged sella; J-shaped sella; symmetrical ballooning; erosion of posterior clinoids

a. craniopharyngioma

erosion of posterior clinoids

b. pituitary adenoma

enlarged sella

c. optic glioma

J-shaped sella

d. empty sella

symmetrical ballooning

55. True or False. On a skull x-ray, erosion of the posterior clinoids would most often be seen in the setting of

G7 p.138:115mm

a. craniopharyngioma

true

b. empty sella syndrome

false

c. pituitary adenoma

false

d. Hurler syndrome

false

e. optic glioma

false

56. Complete the following regarding lumbosacral spine films:

G7 p.138:25mm

a. The disc space with the greatest heigh is at_____

L45

b. AP view. Look for “owl eyes.”

     i. These correspond to the_____

pedicles

     ii. Can be eroded in_____disease

metastatic

c. Oblique views. Look for the neck of the scotty dog.

     i. It corresponds to the_____ _____

pars interarticularis

     ii. Discontinuity occurs in a_____

fracture

57. True or False. The percentage of all patients over 20 years old who will have a calcified pineal gland visible on plain skull x-ray is

G5 p.570:55mm

a. 0%

false

b. 10%

false

c. 20%

false

d. 55%

true

e. 90%

false

58. True or False. The most common congenital anomaly of the craniocervical junction is

G7 p.139:140mm

a. Chiari malformation

false

b. basilar impression

true

c. os odontoideum

false

d. incomplete arch of C1

false

e. C1-C2 subluxation

false

59. True or False. Basilar invagination is seen in

G7 p.139:166mm

a. hypoparathyroidism

false

b. Paget disease

true

c. osteogenesis imperfecta

true

d. osteomalacia

true

e. hyperparathyroidism

true

60. True or False. In the evaluation of basilar invagination, in the normal patient, no part of the odontoid should be above the McRae line.

true

G7 p.139:48mm

61. True or False. A line used in the evaluation of the craniocervical junction is

G7 p.139:24mm

a. McRae line

true

b. Chamberlain line

true

c. Wackenheim line

true

d. Maginot line

false

G7 p.138:115mm

e. Fischgold line

true

62. True or False. The most common nondisc spinal lesion is:

G6 p.142:150mm

a. synovial cyst

false

b. Tarlov cyst

false

c. astrocytoma

false

d. chordoma

false

e. metastatic tumor

true

63. True or False. The risk of postlumbar puncture headache is higher with

G5 p.572:55mm

a. water-soluble contrast

false

b. non-water-soluble contrast

true

64. Matching. Match each of the following two statements with answers 1,2,3, or 4.

G5 p.571:145mm

10%; 35%; 65%; 90%

a. In lumbar disc disease, what percentage of free fragments move inferiorly?

b. In lumbar disc disease, what percentage of free fragments move superiorly?