State four (4) abnormal findings shown in this CT scan. (4 marks) R Blow out # R trapped inf rectus R maxilliary sinus blood L maxilliary sinusitis Air in R orbit List (6) associated examination findings that you would expect to be associated with this injury. (6 mark) Periocular bruising Infraorbital numbness Inability to look up/ upward gaze palsy Pain on eye movement Tenderness to orbital rim Facial subcutaneous emphysema Question 6 (12 marks) An 82 year old woman presents to your emergency department with 10 hours of abdominal pain. Your clinical assessment leads to a clinical diagnosis of mesenteric ischaemia. List three (3) options for definitive imaging in this patient. State one (1) relevant pro and one (1) con for each of these options. (9 marks) NB: you only have 1 choice for each so make it a it clinically relevant. “goody”. Make Imaging option Pro Con Most sensitive for mesenteric risk of contrast nephropathy CT abdo + contrast venous thrombosis Sensitivity and specificity can be as low Can define embolic vs as 64% and 92% thrombotic- arterial and venous contrast allergies occlusion Dx other Dx Specific and gold standard Limited availability Angiography Diagnostic and therapeutic Radiocontrast Good resolution of bowel wall Invasive oedema Identify the type of occlusion, site of occlusion and state of collateral circulation Detailed information of the Limited resolution of bowel gas MRI/MRA vasculature Availability Can define embolic vs Out of department thrombotic Time for procedure and interpretation
State four (4) abnormal findings shown in this CT scan. (4 marks) R Blow out # R trapped inf rectus R maxilliary sinus blood L maxilliary sinusitis Air in R orbit List (6) associated examination findings that you would expect to be associated with this injury. (6 mark) Periocular bruising Infraorbital numbness Inability to look up/ upward gaze palsy Pain on eye movement Tenderness to orbital rim Facial subcutaneous emphysema Question 6 (12 marks) An 82 year old woman presents to your emergency department with 10 hours of abdominal pain. Your clinical assessment leads to a clinical diagnosis of mesenteric ischaemia. List three (3) options for definitive imaging in this patient. State one (1) relevant pro and one (1) con for each of these options. (9 marks) NB: you only have 1 choice for each so make it a “goody”. Make it clinically relevant. Imaging option Pro Con CT abdo + contrast Most sensitive for mesenteric venous thrombosis Can define embolic vs thrombotic- arterial and venous occlusion Dx other Dx risk of contrast nephropathy Sensitivity and specificity can be as low as 64% and 92% contrast allergies Angiography Specific and gold standard Diagnostic and therapeutic Good resolution of bowel wall oedema Identify the type of occlusion, site of occlusion and state of collateral circulation Limited availability Radiocontrast Invasive MRI/MRA Detailed information of the vasculature Can define embolic vs thrombotic Limited resolution of bowel gas Availability Out of department Time for procedure and interpretation
Wk-21A.docx