Review Practice Exercise 3

Neurologic Diagnostic Procedures > Adult Health

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Practice Exercise 3

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Total Questions : 5

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Question 1:

A physician is concerned about a patient's potential for a skull fracture after a fall. Which of the following imaging modalities would be the most appropriate initial diagnostic study to order?

A. Positron Emission Tomography (PET) scan. B. Magnetic Resonance Imaging (MRI). C. Computed Tomography (CT) scan. D. Conventional skull X-ray. E. Sleep deprivation may be required for some EEG studies.

Answer and Explanation

Choice A:

Positron Emission Tomography (PET) scan: PET is used mainly for metabolic imaging in oncology or neurology, not for acute trauma evaluation.

Choice B:

Magnetic Resonance Imaging (MRI): MRI provides excellent soft tissue detail but is time-consuming and less sensitive than CT for detecting acute fractures.

Choice C:

Computed Tomography (CT) scan: CT is the preferred imaging modality in acute head trauma due to its speed, availability, and excellent bone detail, allowing for accurate fracture detection and evaluation of intracranial hemorrhage or edema.Rationale for incorrect answers:

Choice D:

Conventional skull X-ray: Although it can detect fractures, skull X-rays are less sensitive and less commonly used due to inferior imaging quality compared to CT.

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Question 2:

Which of the following statements are true regarding a Magnetic Resonance Imaging (MRI) scan of the brain? Select all that apply

A. It uses ionizing radiation to create images. B. It is the preferred modality for visualizing soft tissue, such as brain tumors and demyelination. C. Patients with pacemakers or certain metal implants can safely undergo an MRI. D. It provides superior contrast resolution compared to a CT scan. E. It is a fast procedure, typically taking only a few minutes.

Answer and Explanation

Choice A:

Uses ionizing radiation: MRI uses strong magnetic fields and radio waves, not ionizing radiation, which makes it safer for repeated imaging.

Choice B:

Preferred modality for soft tissue visualization: MRI provides detailed images of brain parenchyma and pathology, making it superior for detecting tumors, inflammation, and demyelination.

Choice C:

Patients with pacemakers or certain metal implants: Many pacemakers and metal implants are contraindications for MRI due to risk of malfunction or injury.

Choice D:

Superior contrast resolution: MRI’s ability to distinguish subtle differences in tissue contrast exceeds that of CT, which is more useful for bone and acute hemorrhage detection.Rationale for incorrect answers:

Choice E:

Fast procedure: MRI scans typically take 30 minutes to over an hour, which is longer than CT scans.

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Question 3:

A patient with a history of epilepsy is being evaluated for a potential surgical resection. The goal is to identify areas of decreased brain activity where seizures originate. Which functional neuroimaging scan would be most useful for this purpose?

A. A conventional skull X-ray. B. A non-contrast CT scan. C. A Single-Photon Emission Computed Tomography (SPECT) scan. D. A cerebral angiogram.

Answer and Explanation

Choice A:

Conventional skull X-ray: Provides no functional information and is inadequate for epilepsy evaluation.

Choice B:

Non-contrast CT scan: Useful for structural brain assessment but does not assess brain activity.

Choice C:

Single-Photon Emission Computed Tomography (SPECT) scan: SPECT provides functional imaging of brain perfusion during seizures or interictal periods, helping localize seizure origins for targeted surgical intervention.Rationale for incorrect answers:

Choice D:

Cerebral angiogram: Visualizes cerebral vasculature but does not provide functional data about seizure activity.

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Question 4:

Which of the following are contraindications for a patient undergoing a Magnetic Resonance Imaging (MRI) scan? Select all that apply

A. A cochlear implant. B. A history of claustrophobia. C. An intrauterine device (IUD). D. A cardiac pacemaker. E. A metallic foreign body in the eye.

Answer and Explanation

Choice A:

Cochlear implant: Most cochlear implants are not MRI-compatible due to magnetic components that can cause heating or movement.

Choice B:

History of claustrophobia: This is a relative contraindication; sedation or open MRI machines can help manage anxiety.

Choice C:

Intrauterine device (IUD): Most modern IUDs are MRI-safe and do not pose a contraindication.

Choice D:

Cardiac pacemaker: Many pacemakers are contraindicated because the MRI’s magnetic field can interfere with device function or cause device damage.

Choice E:

Metallic foreign body in the eye: Ferromagnetic objects can move during MRI, causing severe ocular injury.Rationale for incorrect answers:

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Question 5:

A PET scan is ordered to evaluate a patient with suspected Alzheimer's disease. The scan is primarily used to assess:

A. The structural integrity of the brain's gray and white matter. B. The presence of a brain bleed. C. The metabolic activity and function of different brain regions. D. The vascular flow through the cerebral arteries.

Answer and Explanation

Choice A:

Structural integrity: MRI or CT scans evaluate structural brain changes, not PET.

Choice B:

Brain bleed: CT is preferred to detect hemorrhages.

Choice C:

The metabolic activity and function of different brain regions: PET provides functional imaging by showing how active various parts of the brain are, which is crucial in neurodegenerative diseases like Alzheimer's where metabolism decreases in affected regions.Rationale for incorrect answers:

Choice D:

Vascular flow: Cerebral angiography or CT/MR angiography assess blood flow, not PET.

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