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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
Budd-Chiari syndrome: findings on sulphur colloid scan
Central increased uptake due to caudate lobe enlargement | Note there's spiderweb pattern of venous collaterals
26
How often do hydatid cysts in liver have daughter cysts?
70%
27
FNH vs adenoma
FNH usually asymptomatic whilst >80% of adenomas are symptomatic
28
How many adenomas have fat and calcium?
10% have fat on CT and 10% show calcification | >35% have high signal on T1 due to fat/ haemorrhage
29
Major complication of percutaneous cholecystostomy?
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
30
Liver haemangioma: how common in females and what % multiple?
5X more common in females | 50% multiple
31
Features of RV thrombosis post Tx
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
32
Features of renal artery thrombosis post Tx
High PSV waveform >200-250 cm/sec
33
How early do lymphoceles appear post Tx?
2-4 months
34
Renal mass, high T1 and low T2 with heterogeneous enhancement
Papillary RCC
35
2 cm vascular epididymal lesion in 30M. Most likely?
Adenomatoid tumour (most common epididymal tumour)
36
Not a cause of RV thrombosis: GN, dehydration, scleroderma, amyloid
Scleroderma (SLE is a risk factor)
37
Renovascular HTN on IVP
Persistent dense nephrogram and delayed pyelogram with frusemide (renal insufficiency)
38
Duplex renal system: enuresis?
Does not affect boys because ectopic insertion is above sphincter Note PUJ obstruction affects lower moiety
39
How often is neonatal adrenal haemorrhage bilateral?
Only 10% | Usually more common on right side
40
Regarding renovascular disease, what renal artery PSV: aorta PSV ratio means >60% stenosis
Ratio of > 3.5
41
What does cortical rim nephrogram post renal trauma indicate?
Renal devascularisation
42
Intra-testicular mass vs paratesticular mass
Most intra-testicular masses are malignant whilst most para-testicular masses are benign
43
Adrenal adenoma vs phaeochromocytoma in terms of size
Adenoma 2 cm whilst phaeo 5 cm (3-12 cm)
44
Benign vs malignant teratoma
Cystic likely benign whilst solid likely malignant
45
What is malakoplakia associated with?
Soft plaque within the urinary tract (esp bladder) due to chronic inflammatory response. Associated with E.Coli in 94%
46
US and MRI findings of prostate cancer.
Hypoechoic on US | Relatively low signal compared to high signal PZ on T2WI
47
Name 2 plain film features of peri-renal abscess
1. Loss of pro-peritoneal fat strip | 2. Loss of psoas shadow
48
Lymphocele vs urinoma in terms of tracer accumulation
Urinoma accumulates tracer (has creatinine) whilst lymphocele does not
49
What is the mode of excretion of IV contrast agents?
Glomerular filtration (99% filtered)
50
Normal changes post renal Tx
Fullness of pelvicalyceal system | Note that enlargement of kidney may be 1st sign of rejection
51
Calcification and shadowing involving the WHOLE gallbladder- name 2 DDx
Massive gallstone | Porcelain GB
52
Most common location of carcinoid in large bowel?
Rectum
53
Inheritance pattern of Wilson disease?
AR
54
Cervical spine involvement in RA?
Involved in 50% Dens erosion and atlantoaxial subluxation
55
Pseudomembranes associated with which types of colitis?
PSM colitis (c.diff) Ischaemic colitis Infectious colitis (campylobacter, shigella, yersinia) Note: UC and Crohns have NO membranes
56
Lack of GB filling on HIDA scan even after morphine administration?
Acute cholecystitis
57
Reduced cortical uptake on DMSA- give 3 DDx?
Acute pyelonephritis Cortical scarring (associated volume loss) Tumour (mass like distribution)
58
Omental infarct on US
Hyperechoic
59
Thickened jejunal folds and mesenteric lymphadenopathy: name 3 DDx?
MAI infection Whipples disease Lymphoma
60
Homogeneous hyperdense lesion near GB fossa which is relatively hypoechoic on US?
Consider focal fatty sparing
61
Infectious oesophageal ulcer vs GORD ulcer?
Infection: punched out ulcer GORD: raised ulcer
62
Risk of adenocarcinoma in Barretts?
40X
63
Peptic ulcer disease: benign vs malignant
95% benign and 5% malignant Benign ulcer do NOT become malignant Malignant features: heaped up margins, nodular folds radiating out
64
2 types of gastric adenocarcinoma
Intestinal: from metaplasia- exophytic mass Signet-ring: no preceding metaplasia and infiltrative- linitis plastica
65
Most common location for gastric cancer?
Antrum 50% Lesser curvature more common
66
Lymphoma of GIT
95% B- cell with good Px 5% T-cell with poor Px Stomach most common (MALT) followed by SB
67
Carcinoid syndrome in lung vs GIT carcinoids?
GIT carcinoid can only cause syndrome if liver mets Lung carcinoid can cause syndrome without liver mets as it bypasses liver
68
Name 3 hamartomatous polyposis syndromes
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
What type of renal calculi in Crohns?
Oxalate
70
Typical age for CD and UC?
CD: 15-25 and 50-80 (male more than female) UC: 15-35 and 50-65 (female more than male)
71
Smoking and IBD
Smoking contributes to CD Smoking reduces risk of UC
72
Name 2 cancers associated with HNPCC
GI tract ca Endometrial ca
73
Hamartomatous polyps in PJ vs the others
PJ: polyps in the whole GI tract except oesophagus Cowden and Turcot only colon
74
HIDA scan in a child showing cold area in liver and no contrast in duodenum?
Choledochal cyst
75
Cyst arising from rectum in the presacral region?
Tailgut cyst Small risk of malignant transformation
76
Malabsorption and dilatation of proximal SB loops?
Coeliacs disease
77
Flip flop enhancement of liver with caudate lobe enhancing first and washing out first?
Budd-Chiari syndrome Caudate lobe drains directly into IVC whilst rest of liver has venous outflow obstruction
78
Echogenic liver mets- name 2 primaries?
Colon and breast (treated)
79
Splenomegaly and fine, hypodense nodularity- name 2 top DDx
Lymphoma/ leukaemia Infection: fungal and TB microabscesses
80
Calcifications in chronic pancreatitis
Ductal calcifications and NOT acinar Note: can cause peritoneal calcifications
81
What hepatitis is associated with cholangiocarcinoma?
Hep B
82
What pancreatic tumour causes polyarthralgia and skin fat necrosis?
Acinar cell carcinoma
83
What enzyme deficiency associated with CAH?
11-beta hydroxylase deficiency

Radiology (16 decks)

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