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Radiology > Abdominal Radiology > Flashcards

Abdominal Radiology Flashcards

1
Q

Barium swallow post oesophageal rupture. Complication.

A

Fibrosing mediastinitis

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2
Q

Grade 5 perianal fissures

A

Translevator

Grade 1: linear inter-sphincteric fistula
Grade 2: above with abscess or fistulous tract
Grade 3: trans-sphincteric
Grade 4: above with abscess or tract within ischioanal/ ischiorectal fossa
Grade 5: supra-levator or translevator

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3
Q

Pregnancy and appendicitis

A

More likely to rupture during pregnancy (esp. 3rd trimester) due to delay in Dx and intervention

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4
Q

Most common presentation of Zenker diverticulum

A

Dysphagia

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5
Q

30F with 6 cm narrowing of distal oesophagus and 1 cm dilatation at vestibule

A

Long segment Barretts

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6
Q

Colorectal cancer: eccentric mass, intact muscle layer, no perirectal LN but paraaortic LN. ? Stage

A

Stage 4

Stage 1: local disease confined to wall
Stage 2: local disease outside wall
Stage 3: nodal disease (regional)
Stage 4: distant mets and non- regional LN

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7
Q

What is an atypical feature of liver haemangiomas?

A

Capsular retraction. Note that homogeneous arterial enhancement can occur in small haemangiomas- flash filling.

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8
Q

UVC inserted. When would you notify clinical team?

A

UVC passing caudally at umbilical level- means it’s in the umbilical artery

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9
Q

Whipple’s disease on Ba follow-through

A

Rare systemic infection with tropheryma whippelii affecting bowel, CNS and joints. SB thickening and sand-like nodules on Ba study

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10
Q

What liver lesion is hot on Tc-99m sulphur colloid study?

A

FNH because it contains Kupffer cells. Helpful in distinguishing it from adenoma, HCC and mets

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11
Q

What is the main cause of hepatic adenoma?

A

Majority associated with OCP use

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12
Q

What is peliosis hepatis and what conditions is it associated with?

A

Benign disorder characterised by multiple blood filled cysts. Associated with steroids, OCP, lymphoma/ leukaemia, Tx and chronic infection (TB and HIV)

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13
Q

Name 2 renal associations of Caroli disease

A

Medullary sponge kidney (renal medullary cystic disease)

ARPKD

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14
Q

Name 3 hepatic complications of Caroli disease

A
  1. Recurrent cholangitis and abscesses
  2. Cirrhosis and portal HTN (periportal fibrosing type)
  3. Cholangiocarcinoma in 7% (NOT HCC)
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15
Q

Sensitivity of MRCP in detecting choledochothiasis

A

81-100%

Can still be done if bilirubin is high (unlike CT cholangiogram)

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16
Q

Most common cause of SBO at birth

A

Small bowel atresia.

Malrotation presents during 1st month of life

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17
Q

What is reverse-S sign (posterior indentation on lateral view) on barium swallow associated with?

A

Double aortic arch (most common symptomatic aortic arch variant)

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18
Q

Triad of prune belly syndrome

A
  1. Gross ureteric dilatation
  2. Anterior abdominal wall under-development
  3. Bilateral undescended testes
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19
Q

Which part of oesophagus does dermatomyositis affect?

A

Upper 1/3 (striated muscle)

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20
Q

Lymph nodes in Kaposi sarcoma

A

Hypervascular

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21
Q

How do you distinguish mesenteric panniculitis from malignancy?

A

Preservation of fat around mesenteric vessels (fat halo sign)

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22
Q

CMV infection in oesophagus on Ba swallow

A

Large, solitary or giant ulcers

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23
Q

Caroli disease and HIDA scan

A

Unusual pattern of retained activity throughout liver

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24
Q

Contraindications for TIPS

A
  1. Pre-hepatic portal HTN (PV thrombus or tumour)
  2. RHF, Pulmonary HTN and hepatopulmonary syndrome (immediate increased venous return to the heart)
  3. Polycystic liver disease/ caroli- if intrahepatic tract traverses cyst: severe haemorrhage
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25
Q

Budd-Chiari syndrome: findings on sulphur colloid scan

A

Central increased uptake due to caudate lobe enlargement

Note there’s spiderweb pattern of venous collaterals

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26
Q

How often do hydatid cysts in liver have daughter cysts?

A

70%

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27
Q

FNH vs adenoma

A

FNH usually asymptomatic whilst >80% of adenomas are symptomatic

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28
Q

How many adenomas have fat and calcium?

A

10% have fat on CT and 10% show calcification

>35% have high signal on T1 due to fat/ haemorrhage

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29
Q

Major complication of percutaneous cholecystostomy?

A

Bradycardia and hypotension after markedly distended GB is decompressed.
Trans-hepatic approach less bile leak whilst trans-peritoneal done if stones are to be extracted
Can also be done for acalculous cholecystitis and OK if there’s ascites

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30
Q

Liver haemangioma: how common in females and what % multiple?

A

5X more common in females

50% multiple

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31
Q

Features of RV thrombosis post Tx

A

Absent venous flow and reversal of arterial diastolic flow

Reversal of diastolic flow by itself is non-specific: also seen in severe rejection and ATN

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32
Q

Features of renal artery thrombosis post Tx

A

High PSV waveform >200-250 cm/sec

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33
Q

How early do lymphoceles appear post Tx?

A

2-4 months

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34
Q

Renal mass, high T1 and low T2 with heterogeneous enhancement

A

Papillary RCC

35
Q

2 cm vascular epididymal lesion in 30M. Most likely?

A

Adenomatoid tumour (most common epididymal tumour)

36
Q

Not a cause of RV thrombosis: GN, dehydration, scleroderma, amyloid

A

Scleroderma (SLE is a risk factor)

37
Q

Renovascular HTN on IVP

A

Persistent dense nephrogram and delayed pyelogram with frusemide (renal insufficiency)

38
Q

Duplex renal system: enuresis?

A

Does not affect boys because ectopic insertion is above sphincter
Note PUJ obstruction affects lower moiety

39
Q

How often is neonatal adrenal haemorrhage bilateral?

A

Only 10%

Usually more common on right side

40
Q

Regarding renovascular disease, what renal artery PSV: aorta PSV ratio means >60% stenosis

A

Ratio of > 3.5

41
Q

What does cortical rim nephrogram post renal trauma indicate?

A

Renal devascularisation

42
Q

Intra-testicular mass vs paratesticular mass

A

Most intra-testicular masses are malignant whilst most para-testicular masses are benign

43
Q

Adrenal adenoma vs phaeochromocytoma in terms of size

A

Adenoma 2 cm whilst phaeo 5 cm (3-12 cm)

44
Q

Benign vs malignant teratoma

A

Cystic likely benign whilst solid likely malignant

45
Q

What is malakoplakia associated with?

A

Soft plaque within the urinary tract (esp bladder) due to chronic inflammatory response.
Associated with E.Coli in 94%

46
Q

US and MRI findings of prostate cancer.

A

Hypoechoic on US

Relatively low signal compared to high signal PZ on T2WI

47
Q

Name 2 plain film features of peri-renal abscess

A
  1. Loss of pro-peritoneal fat strip

2. Loss of psoas shadow

48
Q

Lymphocele vs urinoma in terms of tracer accumulation

A

Urinoma accumulates tracer (has creatinine) whilst lymphocele does not

49
Q

What is the mode of excretion of IV contrast agents?

A

Glomerular filtration (99% filtered)

50
Q

Normal changes post renal Tx

A

Fullness of pelvicalyceal system

Note that enlargement of kidney may be 1st sign of rejection

51
Q

Calcification and shadowing involving the WHOLE gallbladder- name 2 DDx

A

Massive gallstone

Porcelain GB

52
Q

Most common location of carcinoid in large bowel?

A

Rectum

53
Q

Inheritance pattern of Wilson disease?

A

AR

54
Q

Cervical spine involvement in RA?

A

Involved in 50%

Dens erosion and atlantoaxial subluxation

55
Q

Pseudomembranes associated with which types of colitis?

A

PSM colitis (c.diff)

Ischaemic colitis

Infectious colitis (campylobacter, shigella, yersinia)

Note: UC and Crohns have NO membranes

56
Q

Lack of GB filling on HIDA scan even after morphine administration?

A

Acute cholecystitis

57
Q

Reduced cortical uptake on DMSA- give 3 DDx?

A

Acute pyelonephritis

Cortical scarring (associated volume loss)

Tumour (mass like distribution)

58
Q

Omental infarct on US

A

Hyperechoic

59
Q

Thickened jejunal folds and mesenteric lymphadenopathy: name 3 DDx?

A

MAI infection

Whipples disease

Lymphoma

60
Q

Homogeneous hyperdense lesion near GB fossa which is relatively hypoechoic on US?

A

Consider focal fatty sparing

61
Q

Infectious oesophageal ulcer vs GORD ulcer?

A

Infection: punched out ulcer

GORD: raised ulcer

62
Q

Risk of adenocarcinoma in Barretts?

A

40X

63
Q

Peptic ulcer disease: benign vs malignant

A

95% benign and 5% malignant

Benign ulcer do NOT become malignant

Malignant features: heaped up margins, nodular folds radiating out

64
Q

2 types of gastric adenocarcinoma

A

Intestinal: from metaplasia- exophytic mass

Signet-ring: no preceding metaplasia and infiltrative- linitis plastica

65
Q

Most common location for gastric cancer?

A

Antrum 50%

Lesser curvature more common

66
Q

Lymphoma of GIT

A

95% B- cell with good Px

5% T-cell with poor Px

Stomach most common (MALT) followed by SB

67
Q

Carcinoid syndrome in lung vs GIT carcinoids?

A

GIT carcinoid can only cause syndrome if liver mets

Lung carcinoid can cause syndrome without liver mets as it bypasses liver

68
Q

Name 3 hamartomatous polyposis syndromes

A

Peutz-Jegher: polyps in SB (64%), colon, stomach (AD)

Cowden: polyps + risk of FTC, breast ca and TCC (AD)

Cronkhite-Canada: not inherited and patient more than 50 years

69
Q

What type of renal calculi in Crohns?

A

Oxalate

70
Q

Typical age for CD and UC?

A

CD: 15-25 and 50-80 (male more than female)

UC: 15-35 and 50-65 (female more than male)

71
Q

Smoking and IBD

A

Smoking contributes to CD

Smoking reduces risk of UC

72
Q

Name 2 cancers associated with HNPCC

A

GI tract ca

Endometrial ca

73
Q

Hamartomatous polyps in PJ vs the others

A

PJ: polyps in the whole GI tract except oesophagus

Cowden and Turcot only colon

74
Q

HIDA scan in a child showing cold area in liver and no contrast in duodenum?

A

Choledochal cyst

75
Q

Cyst arising from rectum in the presacral region?

A

Tailgut cyst

Small risk of malignant transformation

76
Q

Malabsorption and dilatation of proximal SB loops?

A

Coeliacs disease

77
Q

Flip flop enhancement of liver with caudate lobe enhancing first and washing out first?

A

Budd-Chiari syndrome

Caudate lobe drains directly into IVC whilst rest of liver has venous outflow obstruction

78
Q

Echogenic liver mets- name 2 primaries?

A

Colon and breast (treated)

79
Q

Splenomegaly and fine, hypodense nodularity- name 2 top DDx

A

Lymphoma/ leukaemia

Infection: fungal and TB microabscesses

80
Q

Calcifications in chronic pancreatitis

A

Ductal calcifications and NOT acinar

Note: can cause peritoneal calcifications

81
Q

What hepatitis is associated with cholangiocarcinoma?

A

Hep B

82
Q

What pancreatic tumour causes polyarthralgia and skin fat necrosis?

A

Acinar cell carcinoma

83
Q

What enzyme deficiency associated with CAH?

A

11-beta hydroxylase deficiency

Radiology (16 decks)

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