USMLE Forum Archives - USMLE Step 2 CK - Head trauma
Head trauma
InSitu - 01-21-08 20:58
What is the initial imaging study in the setting of acute head trauma?
a. ct scan without iv contrast
b. ct scan with iv contrast
c. MRI
d. plain skull radiograph
e. positron emission tmomgraphy scan (PET scan)
(ME658)
InSitu - 01-21-08 20:58
What is the initial imaging study in the setting of acute head trauma?
a. ct scan without iv contrast
b. ct scan with iv contrast
c. MRI
d. plain skull radiograph
e. positron emission tmomgraphy scan (PET scan)
(ME658)
Page 1
#3
Re: Head trauma laparotomy - 01-22-08 14:47 Depending on the GCS.
If the patients GCS is 15 and PERLA then do a simple skull xray. If the above is altered in any way or the patient has CSF from his nose or ear (or blood) then do a skull xray only for mere formality. What will be your diagnostic tool will be a CT without contrast. It is hard to justify a CT done in any hospital if you have not done an Xray.
#4
Re: Head trauma
InSitu - 01-22-08 15:00 
posted by laparotomy on 01-22-08 14:47
Depending on the GCS.
If the patients GCS is 15 and PERLA then do a simple skull xray. If the above is altered in any way or the patient has CSF from his nose or ear (or blood) then do a skull xray only for mere formality. What will be your diagnostic tool will be a CT without contrast. It is hard to justify a CT done in any hospital if you have not done an Xray.
Depending on the GCS.
If the patients GCS is 15 and PERLA then do a simple skull xray. If the above is altered in any way or the patient has CSF from his nose or ear (or blood) then do a skull xray only for mere formality. What will be your diagnostic tool will be a CT without contrast. It is hard to justify a CT done in any hospital if you have not done an Xray.
for USMLE purposes the answer is (a) ct without contrast. Thanks for the useful addition laparotomy.
#5
Re: Head trauma laparotomy - 01-22-08 15:08 Hi Insitu. I dont mean to be rude. But I know why I wrote what I wrote. You know in the USMLE they will never ask a question like. Question 25. What is the first test for head trauma? The question will go like this. Question 25 A 32 year old patient is brought into your ER following a MVA. His GCS is 5/15 etc. You know they will describe the case. And if he is completely okay then maybe a skull xray could come first. But now that I think of it we are talking about the USA where the equipment is endless and so is the litigation. So if a 25 year old male presents 10 years following a fall, GCS 15, PERLA and no complaints at all. On examination he has no tenderness, the answer is still CT brain. So yeah you are right. But what I wrote was the practical thing to do especially if you are not in the USA.
#6
Re: Head trauma InSitu - 01-22-08 18:02 :) I understand very well what you said and I thanked you for the additional useful info. My apologies if what i said above was offending to you. I like your explanations and its a privilege to have you with us.
#7
Re: Head trauma radhamesramos - 01-22-08 21:28 Laparotomy is right! All depends on the GCS, but the way the question was posted (difficult to see in step 2 by the way) the answer was like inSitu said
#8
Re: Head trauma InSitu - 01-22-08 21:58 This is a question that can come in such a way that the whole stem of the question is garbage in relation to the final question asked.
for example:
a blah blah blah of a case then they throw this at the end "What is the initial imaging study in the setting of acute head trauma?"
Hope you get my point. :)
#9
Re: Head trauma InSitu - 01-22-08 22:01 posted by laparotomy on 01-22-08 15:08
Hi Insitu. I dont mean to be rude. But I know why I wrote what I wrote. You know in the USMLE they will never ask a question like. Question 25. What is the first test for head trauma? The question will go like this. Question 25 A 32 year old patient is brought into your ER following a MVA. His GCS is 5/15 etc. You know they will describe the case. And if he is completely okay then maybe a skull xray could come first. But now that I think of it we are talking about the USA where the equipment is endless and so is the litigation. So if a 25 year old male presents 10 years following a fall, GCS 15, PERLA and no complaints at all. On examination he has no tenderness, the answer is still CT brain. So yeah you are right. But what I wrote was the practical thing to do especially if you are not in the USA.
Hi Insitu. I dont mean to be rude. But I know why I wrote what I wrote. You know in the USMLE they will never ask a question like. Question 25. What is the first test for head trauma? The question will go like this. Question 25 A 32 year old patient is brought into your ER following a MVA. His GCS is 5/15 etc. You know they will describe the case. And if he is completely okay then maybe a skull xray could come first. But now that I think of it we are talking about the USA where the equipment is endless and so is the litigation. So if a 25 year old male presents 10 years following a fall, GCS 15, PERLA and no complaints at all. On examination he has no tenderness, the answer is still CT brain. So yeah you are right. But what I wrote was the practical thing to do especially if you are not in the USA.
I got your point now...so the case may include GSC ans depending on the score then x-ray may be a choice in that case. Thanks
#11
Re: Head trauma laparotomy - 01-23-08 13:37 Hi Insitu. No you did not offend me and it is also a privilage to have, you in this website, you also make some valuable comments.
By the way what do you think of my pediatric case and interesting case that I posted yesterday.
Thanks
#12
Re: Head trauma InSitu - 01-23-08 21:47 Hi laparotomy...thank you I will look for that peds case and see :)
#14
Re: Head trauma funtonic - 01-24-08 22:17 CT is mostly used for head trauma, rather than MRI, and IV contrast not needed, cauze all the CT bleedings are apparent
#15
Re: Head trauma InSitu - 01-24-08 22:28 posted by funtonic on 01-24-08 22:17
CT is mostly used for head trauma, rather than MRI, and IV contrast not needed, cauze all the CT bleedings are apparent
CT is mostly used for head trauma, rather than MRI, and IV contrast not needed, cauze all the CT bleedings are apparent
I always remember this...BLOOD is the contast and CT is th choice for head trauma. So CT without contrast.
Page 1