auckland course 2022

Question 1

A 25 year=old woman presents with amenorrhoea and hyperandrogenism, US identifies a 4cm ovarian mass. This is most likely in keeping with:
• Sertoli-Leydig tumour
• Granulosa cell tumour
• Dermoid cyst
• Serous cystadenoma
• Mucinous cystadenoma

Answer 1

• Sertoli-Leydig tumour

Question 2

A newborn presents with an enlarged scrotum. On ultrasound, multiple irregular calcifications are noted within the scrotum. Which of the following is the most likely diagnosis?
• Tuberculous peritonitis
• Meconium peritonitis
• Neuroblastoma
• Haemangiomatosis
• Teratoma

Answer 2

Meconium peritonitis

**SCS: Radiopaedia. if the processus vaginalis is patent at time of perforation, calcification may also be seen in scrotum.

Question 3

A 45 yr old man with ulceration of the nasal septum was investigated further with CT sinuses. CT shows bone destruction involving the nasal cavity, turbinates and paranasal sinuses without associated soft tissue masses. CXR done to exclude infection showed multiple nodules , masses of varying sizes. Which is the most likely diagnosis?
• Granulomatosis polyangitis
• Churg-Strauss syndrome
• Leprosy
• Ethmoid carcinoma
• Polyarteritis nodosa

Answer 3

Granulomatosis polyangitis

Question 4

A contrast enhanced CT abdomen shows an incidental renal cyst that is hyperdense with thick septations and a mural nodule. What is the Bosniak classification of the cyst?
• Type 2F
• Type 1
• Type 3
• Type 2
• Type 4

Answer 4

Type 3

SCS: Radiopaedia
B1: benign
B2: benign “minimally complex”
B2F: minimally complex
B3: indeterminate: thick septa w enhancement.
B4: clearly malignant

IV with mural nodule

Question 5

A 25 year-old woman with multiple skin lesions presents to ophthalmologist with worsening of vision. MRI brain and orbits reveal a thickened enhancing right optic nerve with further focal areas of T2 hyperintensities in the brain stem and basal ganglia. What is the most likely diagnosis?
• Tuberous sclerosis (TS) - Optic neuritis
• Neurofibromatosis type 1 (NF1) - Optic glioma
• Neurofibromatosis type 2 (NF2) - Optic tract meningioma
• Von Hippel-Lindau (VHL) - Optic haemangioblastoma
- Multiple sclerosis (MS) - Optic neuritis

Answer 5

• Neurofibromatosis type 1 (NF1) -

**SCS: skin neurofibromata, optic nerve glioma (indolent. pilocytic Astro) and FASI lesions - commonly identified in the basal ganglia (often the globus pallidus), thalamus, brainstem (pons), cerebellum, and subcortical white matter in children with neurofibromatosis type 1 (NF1)(Radiopaedia).

Question 6

Which of the following is correct in regard to Morton’s neuroma?
• Symptoms improve with activity
• Are generally poorly defined and echogenic on ultrasound
• Show little to no enhancement with gadolinium
• Are male predominant
• Are most common in the web space between the third and fourth metatarsals

Answer 6

Are most common in the web space between the third and fourth metatarsals

SCS: radiopaedia.
-chronic entrapment of the nerve by intermetatarsal ligament.
-Variable enhancement
-Well defined on USS (hypoechoic, dumbellshaped, non-compressible, sono-Mulder sign- displacement in plantar direction on MT squeeze)
3-4MT space most common location
10% bilateral.

More common in women

Question 7

White matter signal abnormalities seen on T2-weighted MR images of the brain in children with sensorineural hearing loss are most often attributed to:
• Cytomegalovirus infection
• Hypoxic ischemic encephalopathy
• Birth trauma
• Leukodystrophy
• Associated inner ear malformation

Answer 7

Cytomegalovirus infection

Question 8

A patient with a lung mass consistent with an extralobar pulmonary sequestration demonstrates:
• None of the above
• Systemic blood supply and systemic venous drainage
• Pulmonary arterial supply and systemic venous drainage
• Pulmonary arterial supply and pulmonary venous drainage
• Systemic blood supply and pulmonary venous drainage

Answer 8

Systemic blood supply and systemic venous drainage

Question 9

An 80 year-old female presented with jaundice and symptoms of biliary colic. She has a history of cholelithiasis and previously underwent ERCP with sphincterotomy. On T2 images of MRCP, there is evidence of pneumobilia and gravel-like gallstones in the gallbladder. In the moderately dilated distal CBD, there is a flow void measuring 4 mm. Which of the following would support this being a locule of gas?
• The signal void is high signal on gradient-echo T1 images
• The signal void has an angulated outline
• The signal void is outlined by high T2 signal
• The signal void is at the dependent aspect of the bile duct
• The signal void shows blooming on dual echo gradient-echo T1 images

Answer 9

The signal void shows blooming on dual echo gradient-echo T1 images

Question 10

A 20 year-old presents with a partially cystic cortically based mass in the frontal lobe with a mural nodule and calcification. Most likely diagnosis is:
• Oligodendroglioma
• Dysembryoplastic neuroepitheliel tumour (DNET)
• Gangiolioma
• Low grade astrocytoma
• Pilocytic astrocytoma

Answer 10

Oligodendroglioma

wji- ganglioglioma is a pretty reasonable alternative. More commonly temporal lobe but 50% calcify and more commonly described as cyst with a nodule than oligodendroglioma (partially cystic mass).

Question 11

What is the most common anomalous drainage of the biliary system?
• Drainage through the ducts of Luschka
• Trifurcation of the confluence
• None of the above
• Right posterior duct insertion into left hepatic duct above the confluence
• Cystic duct insertion into left hepatic duct

Answer 11

Right posterior duct insertion into left hepatic duct above the confluence

SCS: radiopaedia agrees.
RPSD draining to LHD = ~15%

Extra trivia:
option A = subvesical bile ducts = cholecysto-hepatic ducts (usually to segment 5). Cause of bile leak post cholecystectomy.

Question 12

As the senior radiology registrar, you are requested to conduct the ICU conference. Which of the following lines and tubes are considered to be abnormally positioned in chest / abdominal radiographs?
• A caval filter with its tip at the level of the 3rd lumbar vertebra
• Intra-aortic balloon pump with its tip at the level of 8th thoracic vertebra
• Nasogastric tube with its tip in the left upper quadrant
• Central venous catheter with its tip at the same level as the carina
• Endotracheal tube with its tip between the medial ends of clavicles

Answer 12

Intra-aortic balloon pump with its tip at the level of 8th thoracic vertebra

-Loo low: obstructs splanchnic circulation.

-L3 IVC filter: typically infra-renal. Renal veins at L2- correct.
ETT, NGT ans IJV are satisfactory

Question 13

A 15 year0old boy with haemophilia presents to his GP with progressive worsening of right knee pain. Plain radiographs excluded a fracture. All of the following are features of haemophilic arthropathy affecting the knee except:
• Flattened femoral condyles
• Squared patella
• Widened intercondylar notch
• Epiphyseal enlargement
• Erlenmeyer flask deformity

Answer 13

Erlenmeyer flask deformity

Question 14

What aortic segment is most often affected by Takayasu’s arteritis?
• Descending thoracic aorta
• Ascending thoracic aorta
• Abdominal aorta
• Aortic root
• Aortic arch

Answer 14

SCS: favour arch
-Stat dx location: thoracic aorta and arch branches.
-L SCA- most commonly involved (Dahnert corroborates this)
-Big robbins 9th Ed “ transmural fibrous thickening of the aorta PARTICULARLY aortic arch and great vessel
-this is wrong in the Auckland answers

Additionally (Big robbins)
- 1/3 affects remainder of aorta, pulmonary artery/ coronary and renals in half of these cases
-Histology is indistinguishable from GCA. Distinction is made based primarily on Age. >50 GCA, <50 TA.

Question 15

A 50 year-old woman with a long standing history of Crohn’s disease is referred for CT enterography for assessment of disease status. Which of the following statements regarding the CT evaluation of Crohn’s disease is TRUE?
• A thickened hyperenhancing bowel wall is a sign of active disease
• Mural stratification is characteristic of Crohn’s disease
• Perianal disease is uncommon
• Submucosal fat deposition is an early sign of Crohn’s disease
• The comb sign is a non specific sign of Crohn’s disease

Answer 15

• A thickened hyperenhancing bowel wall is a sign of active disease

comb sign:The sign may be seen on both CT and MRI. It is not pathognomonic of Crohn disease; however, in a known case of Crohn disease would suggest that the disease was extensive, advanced and active. However, the comb sign can be seen in other acute inflammatory conditions of bowel and lupus mesenteric vasculitis.

Question 16

With regard to Gadolinium brain deposition, which of the following is true?
• All Gadolinium based products can cause brain deposition
• It is not related to the total dose of contrast given
• It causes a movement disorder similar to Parkinson’s disease
• It can be prevented by giving pre-hydration
• It can cause T1 shortening in the dentate nuclei

Answer 16

It can cause T1 shortening in the dentate nuclei.

SCS:
T1 shortening confusingly means more signal.
Stat dx: gad deposition causes intrinsic T1 hyperintensity in Dentate nucleus and globus pallidus. Normal T2. No blooming/DWI.
RF= Repeated exposure
Dechelation from its ligand plays a role

WJI:
other answer that seemed reasonable was that all gad agents cause deposition but this is incorrect there’s no evidence of deposition with macrocyclics

Question 17

Which of the following pulse sequences is most appropriate to confirm chronic muscle denervation?
• STIR
• Gadolinium enhanced fat suppressed T1
• T1
• Gradient echo
• T2

Answer 17

T1

**SCS: T1- fatty atrophy
Acutely, muscle bulk preserved, high T2 signal = oedema. Think Parsonage Turner etc.

Question 18

A 42 yr old man presents with severe headache and is sent for a CT scan of the brain which was normal. MRI shows loss of normal flow voids in vessels in the basal cisterns with intense enhancement along the cisterns on post contrast scans. Which is the most likely diagnosis?
• Ruptured dermoid cyst
• Lymphoma
• Subarachnoid haemorrhage
• Creutzfeldt-Jakob disease
• Tuberculous meningitis

Answer 18

Tuberculous meningitis

Question 19

Which of the following is LEAST likely to cause a “super scan” appearance on a 99Tc MDP bone scan?
• Widespread bone metastasis from prostate cancer
• Hyperthyroidism
• Mastocytosis
• Renal osteodystrophy
• Multiple myeloma

Answer 19

Multiple myeloma

Question 20

40 year-old male in MVA has distal transection of the pancreatic tail that involves the distal duct. What grade injury is it as per AAST?
• Grade 2
• Grade 5
• Grade 1
• Grade 3
• Grade 4

Answer 20

Grade 3

**SCS AAST:
Grade 1: haematoma with minor contusion
Grade 2: major contusion or laceration without duct injury
Grade 3: distal transection or deep parenchymal injury with duct injury
Grade 4: proximal transection or deep parenchymal injury involving ampulla (and/or intra-pancreatic CBD)
Grade 5: massive disruption of pancreatic head (shattered panc).

Question 21

Which of the following is FALSE regarding normal progression of myelination in a newborn?
• Central to peripheral
• Sensory & projectional pathways before association pathways
• Motor to sensory
• Dorsal to ventral
• Caudal to rostral

Answer 21

Motor to sensory

central to peripheral “inside out”
caudal to rostral “bottom up”
dorsal to ventral “back to front”
sensory then motor

normal at birth:
dorsal brainstem
posterior limb internal capsule
perirolandic gyri

CC FORMS from genu to splenium (then rostrum last) but MYELINATES from splenium to genu

Question 22

Moyà Moyà disease is less likely to occur in which of the following disease ?
• Neurofibromatosis type 1
• Radiation injury
• Sickle cell disease
• Down syndrome
• Amyloidosis

Answer 22

Amyloidosis -FALSE.

**SCS: Nb: moyamoya disease should be reserved for an idiopathic, sometimes familial condition which leads to the characteristic vascular changes…
Other causes (listed above) = MM syndrome (or phenomenon/pattern).
Just thought I’d flex given they put cute wee the macros in…

Radiation induced vasculopathy- true
NF1- true (also TS, Ehlers-Danlos/Marfans)
Downs- true
Sickle cell- true

Additional causes:
CTD: SLE, antiphospholipid
Blood dyscrasias: sickle cell, PCV, ET, aplastic anaemia
Infection: TB
Less common causes: Downs, UC, Graves

Question 23

A 55 year-old woman with abdominal pain and bloody diarrhoea is undergoing imaging for suspected inflammatory bowel disease. Which of the following is more common in ulcerative colitis than Crohn disease?
• Fissuring ulcers
• Vitamin B12 malabsorption
• Toxic megacolon
• Colovesical fistula
• Fibrosing strictures

Answer 23

Toxic megacolon

Question 24

A 2 yr old presents with fever, erythema of oral mucosa and cheat and abdominal pain. Echocardiogram reveals the presence of coronary artery aneurysms. An underlying vasculitis is suspected. Which of the statements is LEAST accurate in this clinical setting?
• Multiple coronary artery aneurysms are more common than isolated aneurysms
• The most common site of coronary aneurysm is the left anterior descending artery
• Aneurysms are typically seen in the proximal segments of the coronary arteries
• Aneurysms less than 5 mm in diameter are considered small
• Smaller aneurysms have a higher likelihood of thrombosis

Answer 24

smaller aneurysms have higher likelihood of thrombosis.

Question 25

In a 3 month old, what is the most likely aetiology of an echogenic renal mass? • Multicystic dysplasia • Mesoblastic nephroma • Rhabdoid tumour • Neuroblastoma • Wilm's tumour

Answer 25

Mesoblastic nephroma

Question 26

A middle aged man is diagnosed on imaging with suspected laryngeal carcinoma. Which of the following factors would favour a diagnosis of adenoid cystic carcinoma over squamous cell carcinoma? • Propensity of nerve invasion • Invasion through the laryngeal cartilage • Supraglottic extension • Involvement of regional neck lymph nodes • A history of long term smoking

Answer 26

Propensity of nerve invasion

Question 27

Which is the most important anatomical land mark in the paediatric upper GI examination ? • Gastric fundus • Gastric antrum • Pyloric canal • Gastro-oesophageal junction • Duodenojejunal junction

Answer 27

Duodenojejunal junction

Question 28

A 30 year-old presents with a foot injury with Lisfranc fracture dislocation confirmed on plain films. Which two bones does the Lisfranc ligament attach to? • First metatarsal and medial cuneiform • First and second metatarsals to the medial and intermediate cuneiform • Second metatarsal and intermediate cuneiform • First metatarsal and intermediate cuneiform • Second metatarsal and medial cuneiform

Answer 28

Second metatarsal and medial cuneiform

Question 29

An ICU patient who suffered a PEA cardiac arrest had fixed pupils. She was subjected to CT head and dual phase CT angiogram (at 20 and 60 sec delays) to assess for brain death. Which of the following is the most specific and sensitive sign of brain death? • Non opacification of posterior circulation and dural venous sinuses • Diffuse loss of grey-white differentiation of the entire brain • Non opacification of cortical segments of MCA s and internal cerebral veins • White cerebellar sign • Loss of arterial flow beyond the ICA termini

Answer 29

• Loss of arterial flow beyond the ICA termini Course answer: Non opacification of cortical segments of MCA s and internal cerebral veins statdx: No flow in intracranial arteries or venous sinuses **SCS: these answers are taken from radiopaedia [Brain Death] C - is what Radiopaedia says on CTA E- seem right but is a DSA finding. Not sure why the two are different… make your own mind up

Question 30

A 30 year-old woman presents acutely with seizure, fever and headaches followed by rapid deterioration to coma. MRI shows asymmetrical swelling of the anterior temporal lobes on T1W. T2W images reveal concordant asymmetrical but bilateral areas of high signal in the anterior temporal lobes, insular cortices and hippocampi. There is no enhancement following administration of intravenous gadolinium. What is the most likely condition? • Herpes simplex encephalitis • Cytomegalovirus encephalitis • Lymphoma • HIV encephalitis • Toxoplasmosis

Answer 30

Herpes simplex encephalitis wji - enhancement often absent in first week. DWI is more sensitive than T2.

Question 31

A middle aged woman presents with headaches and papilloedema and is suspected of having idiopathic intracranial hypertension. Which of the following are true features of this entity? • MRI reliably diagnoses the condition • Ventricles are always small • Cranial nerve palsies do not occur • Subarachnoid fluid is decreased • Spontaneous remission often occurs

Answer 31

Course answer: Spontaneous remission often occurs Prior answers: SCS: All seem false, maybe MRI reliably diagnoses the condition. -Radiopaedia: “slit like ventricles (relatively uncommon cf. other findings “. StatDx says this is a poor imaging finding of IIH). -Neuro exam often normal but can get 6th nerve palsy sometimes. -MRI may be reliable incorrect demographic, but they get sent to IR for stabby in the back for manometry… -Subarachnoid fluid - doesn’t decrease, just under increased pressure. *WJI: I would chose subarachnoid fluid is decreased. Statdx describes "tight subarachnoid spaces"

Question 32

Pathological lead points are found in what percentage of paediatric intussusception? • 25% • 1% • 95% • 40% • 5%

Answer 32

5% RP: "In children, a lead point is not identified in 90% of cases, and this is most frequently thought to relate to hypertrophic lymphoid tissue following an infection". 90% infants and adults have lead point

Question 33

A 22 year-old woman who had undergone a Caesarean section presents with cyclic voiding symptoms but no haematuria. Cystoscopy revealed no abnormality. Diagnosis of bladder wall endometriosis was made following pelvic MRI. Which of the following statements is FALSE regarding deep pelvic endometriosis? • Low signal nodular thickening of uterosacral ligaments on T2W images • Ureteric endometriosis is mostly intrinsic • Endometriotic nodules can have high T2 signal • Obliteration of pouch of Douglas is seen in advanced disease • Subperitoneal invasion of endometriotic tissue must exceed 5 mm

Answer 33

Ureteric endometriosis is mostly intrinsic

Question 34

The LEAST common cause of neonatal distal bowel obstruction is: • Hirschsprung disease • Meconium ileus • Colonic atresia • Meconium plug • Ileal atresia

Answer 34

Colonic atresia

Question 35

Barium swallow of a 61 year-old man who presented with dysphagia showed a smooth filling defect in the mid oesphagus with mild hold up contrast and proximal oesophageal dilation. CT chest performed did not show any extra oesophageal organ involvement or lymphadenopathy. The most common mesenchymal tumour of the oesophagus is: • Gastrointestinal stromal tumour • Leiomyoma • Leiomyosarcoma • Lipoma • Haemangioma

Answer 35

Leiomyoma

Question 36

While performing shoulder ultrasound, how would you position the patient for optimal assessment of the subscapularis tendon? • External rotation with elbow flexed at 90 degrees • Abduction, elbow extended • Internal rotation with arm behind back • Hand touching opposite shoulder • Neural position with elbow flexed at 90 degrees

Answer 36

External rotation with elbow flexed at 90 degrees

Question 37

Regarding trans-jugular intrahepatic portosystemic shunts (TIPS), which of the following is FALSE? • Haemobilia is an early complication • Right-sided heart failure is a relative contraindication • Embolisation of varices can be performed as part of the procedure • The aim is to produce a portosystemic shunt gradient of approximately 5mm Hg • Ultrasound is accurate in the assessment of shunt patency

Answer 37

The aim is to produce a portosystemic shunt gradient of approximately 5mm Hg WJI <12mmHg. *TUS*: According to Core, right-sided heart failure is an **absolute** contraindication.

Question 38

At the weekly general medicine conference, a question was raised with regard to the association of cardiac disease with situs anomalies. Which of the following presents with more serious congenital heart disease? • Situs inversus with dextrocardia • Situs solitus • Situs ambiguous with polysplenia • Situs ambiguous with asplenia • Situs inversus with levocardia

Answer 38

Situs ambiguous with asplenia

Question 39

12 year old presenting with a seizure and MRI showing a solid, cortically based temporal lobe mass. What is the most likely diagnosis? • Ependymoma • Anaplastic astrocytoma • Pilocytic astrocytoma • Dysembryoplastic neuroepithelial tumors (DNET) • Pleomorphic xanthoastrocytoma

Answer 39

• Pleomorphic xanthoastrocytoma SCS: Additional notes: PXAs very often have cystic component. But may be solid. They haven’t given us enhancement characteristics which would help distinguish. PXA StatDx: “ cyst and enhancing mural nodule typical” “Enhancing nodule abuts Paul surface” Radiopaedia also mentions cyst w mural nodule. DNET: bubbly CYSTIC. Ependymoma: Posterior fossa. JPA: cyst w C+ mural nodule.

Question 40

A 38 year old woman presents with abdominal pain. She has previously had a gastric lap band procedure. Fluoroscopy demonstrates a 90 degree phi angle, an air fluid level, and gastric emptying at 30 minutes. Which of the following is most likely? • Erosion of band into stomach • Normal appearances • Overinflated band • Improper initial placement of band • Slipped gastric band

Answer 40

Slipped gastric band **SCS: phi angle 4-58 deg = normal Greater than 60 deg ABNORMAL. Measured on AP view, relative to a vertical line/ie the spine.

Question 41

A CT thoracic aorta study has been performed on a 20 year-old driver who was in a road traffic accident. The CT angiogram shows a fusiform dilation of the anteromedial aspect of the aortic isthmus with a steep contour superiorly , gently merging with the proximal descending aorta inferiorly. What is the most likely diagnosis? • Avulsed left subclavian artery • Ductus diverticulum • Coarctation of aorta • Aortic pseudoaneurysm • Aortic nipple

Answer 41

• Aortic pseudoaneurysm **SCS: Disagree. course answer = ductus diverticulum. Additional info on stranding, calcification of intima, intimal disruption and C+ leak would be discriminatory. The stem talks about steep angle superiorly, which classically goes against DD. See below note… Tricky. StatDx: “Gently sloping, symmetric shoulders form obtuse margins with inferior margin of aortic arch. NOTE: stat dx goes on to say atypical appearance = “acute angle at superior margin /steep asymmetric sloping superior”

Question 42

Which of the following statements best describes cardiac sarcoidosis? • It may manifest with bradycardia secondary to atrial-ventricular block • It occurs in isolation • It occurs as part of the clinical syndrome in over 20% of cases • Constrictive pericarditis is a common complication • It frequently mimics subendocardial myocardial infarction

Answer 42

It may manifest with bradycardia secondary to atrial-ventricular block SCS: note sarcoid can cause constrictive pericarditis.

Question 43

Which of the following is FALSE regarding Obstetric Doppler ultrasound? • MCA PI of <5th percentile is abnormal • CPR of <5th percentile is abnormal • Mean uterine artery PI of >95th percentile is abnormal • Bilateral notching of uterine artery waveform is a normal finding after 24 weeks of pregnancy • Umbilical artery PI is abnormal if >95th percentile

Answer 43

• Bilateral notching of uterine artery waveform is a normal finding after 24 weeks of pregnancy CCF - Shouldn't have notching after 22 weeks wji: normal uterine artery RI <0.55 **SCS: is a marker of Increased uterine vascular resistance and impaired uterine circulation. -bilateral notching is more concerning. -Ass/w: PET/PIH, abruption, IUGR, -reversal of end diastolic flow: severe state- just remember flow to placenta/ baby is alway ON. -Resistance to blood flow gradually drops during gestation as trophoblastic invasion of decidua/myometrium takes place.

Question 44

A 38 year-old man with a swollen right hemi-scrotum has an ultrasound examination. Which of the following is TRUE? • Lipomas are the commonest intratesticular benign tumours • The majority of extratesticular tumours are benign • The epididymis is hypoechoic compared to the normal testis • Epidermoid cysts are most commonly seen in the head of the epididymis • Seminomas are more commonly hyperechoic compared to the normal testis

Answer 44

The majority of extratesticular tumours are benign SCS: -Lipomas are the commonest intratesticular benign tumours- most common EXTRA-TESTICULAR benign tumour. - The epididymis is hypoechoic compared to the normal testis-Hyperechoic. -Epidermoid cysts are most commonly seen in the head of the epididymis- intratesticular, onion skin. -Seminomas are more commonly hyperechoic compared to the normal testis- hypoechoic. -Adenomatoid tumour is most common epididymal mass (tail location most common) Adenomatoid is the most comon B9 paratesticular tumor - robbins 975 and radiopedia.

Question 45

A radiologically typical fibroadenolipoma of the breast would be best classified as: • BIRADS III • BIRADS II • BIRADS I • BIRADS 0 • BIRADS IV

Answer 45

BR2 WJI: fibroadenolipoma = hamartoma A trick could be to ask re fibroadenoma. This is not BR2! see crack the core volume 2 page 468-9 when you see a typical FA in a screening mammogram it is BR0 as needs more work up after tomo/US etc. if it is still a perfect fit for fibroadenoma this is BIRADS3 (probably benign <2% chance cancer) and management options are biopsy or 6 monthly follow up for 2 years to make sure its a FA and not a well circumscribed cancer. fibroadenoma could only be BR 2 if: 1 - multiple bilateral well circumscribed masses 2- you have already biopsied it previously and know 100% its a FA then see it again

Question 46

The most likely diagnosis in a patient who has a ventilation perfusion scan showing normal ventilation and perfusion to the right lung, absent ventilation and perfusion to the left lung, and a normal (or near-normal) chest x-ray is: • None of the above • Asthma • Central embolism in the left pulmonary artery • Alpha-1 antitrypsin deficiency • Mucous plug

Answer 46

• Mucous plug

Question 47

An elderly man is found collapsed at home and undergoes a CT brain which shows an intra-parenchymal bleed. On MRI the area of haemorrhage is hyperintense on T1 and hypointense on T2 weighted images. Which of the following stages of haemorrhage best correlates? • Extracellular methaemaglobin • Haemosiderin • Deoxyhaemaglobin • Oxyhaemaglobin • Intracellular methaemaglobin

Answer 47

• Intracellular methaemaglobin

Question 48

What is the most common cause of bronchial artery hypertrophy leading to massive haemoptysis? • Pulmonary pseudoaneurysm • Chronic inflammation within bronchiectasis • Pulmonary AVM • Lung cancer • Lung abscess

Answer 48

Chronic inflammation within bronchiectasis

Question 49

A 1.5 cm adrenal nodule seen on CT colonography which has Hounsfield units of 20 is most likely to be: • Adrenal adenoma • Adrenal carcinoma • Adrenal cyst • Adrenal myelolipoma • Adrenal haemorrhage

Answer 49

• Adrenal adenoma

Question 50

Suboptimal fetal growth is NOT suspected in which of the following instances? • Abdominal circumference (AC) is above the 5th centile but is crossing centiles by >30th centile • Estimated fetal weight (EFW) on the GROW chart is at 20th centile • A change in AC of <5mm over 2 weeks • Discrepancy between head and abdominal circumference • When the abdominal circumference on the population scan chart is at or below the 5th centile

Answer 50

Estimated fetal weight (EFW) on the GROW chart is at 20th centile

Question 51

What is the name of the classification/grading system used to assess sacroiliitis on MRI? • ASAS classification system • PAIR classification system • Spetzler Martin Grading Scale • New York grading system • John’s criteria

Answer 51

ASAS classification system SCS: New York is for Sacroilitis BUT on XRAY.

Question 52

Pituitary lesion undergoes further characterization with MRI. The lesion demonstrates a well defined non-enhancing midline cyst with an intra-cystic nodule. The nodule is hyperintense to surrounding fluid on T1 and hypointense on T2. What type of lesion is most likely? • Giant cerebral aneurysm • Pituitary macroadenoma • Rathke cleft cyst • Adamantinomatous craniopharyngioma • Papillary craniopharyngioma

Answer 52

Rathke cleft cyst

Question 53

Which is a diagnostic criterion for transplant renal artery stenosis ? • Renal artery: iliac velocity < 1.8 • Resistive index > 0.8 • Peak systolic velocity of < 250 cm/s • Tardus parvus waveform in segmental artery • Resistive index < 0.8

Answer 53

Tardus parvus waveform in segmental artery Note crack the core states that the tardus parvus should not be measures in the arcuate branches ? can that also mean not the segmental artery?

Question 54

Antenatal ultrasound reveals a fetus with bowel loops outside the abdomen within the amniotic fluid. Which of the following associated features would support a diagnosis of gastroschisis rather than exomphalos? • Defect involving the whole length of the anterior abdominal wall • Defect to the right of midline • Liver herniation through the defect • Associated cardiovascular anomalies • Fetal ascites

Answer 54

• Defect to the right of midline

Question 55

What nerve is involved with Baxter neuropathy? • Recurrent branch of the median nerve • Ulnar nerve • Inferior calcaneal nerve • Mandibular division of the trigeminal nerve • Common peroneal nerve

Answer 55

Inferior calcaneal nerve

Question 56

Hirschsprung disease is MOST commonly associated with: • Prolonged rupture of membranes • Bardet-Biedl syndrome • Trisomy 21 • Prematurity • Maternal diabetes

Answer 56

Trisomy 21

Question 57

All of the following musculoskeletal manifestations of Rheumatoid arthritis can be seen on CXR, except: • Superior rib notching • Global loss of shoulder joint space • Erosion of the medial end of the clavicle • Subacromial abutment of humeral head • Erosion superolaterally in the humeral head

Answer 57

• Erosion of the medial end of the clavicle gotcha its lateral **Prometheus: Not this time mofo.

Question 58

The most common lead point in paediatric intussusception is: • Henoch-Schonlein purpura • Polyp • Lymphoid hyperplasia and mucosal edema • Meckel’s diverticulum • Duplication cyst

Answer 58

• Lymphoid hyperplasia and mucosal edema

Question 59

The following are all common imaging features of Grave’s ophthalmopathy, except: • Atrophy of the lacrimal gland • Swelling of the extraocular muscle bellies • Dilatation of the superior ophthalmic vein • Proptosis • Increased volume of orbital fat

Answer 59

Atrophy of the lacrimal gland An increase in orbital fat volume is a result of venous congestion from the compression of the superior ophthalmic vein by the enlarged muscles and/or intrinsic adipose inflammation.

Question 60

On post transplant renal graft, the ultrasound resistive index can be increased in all except: • Acute tubular necrosis • Infection • Renal artery stenosis • Extrinsic compression • Acute rejection

Answer 60

course answer: Infection previous answer: RAS **SCS: Radiopaedia lists pyelo as a cause of increased RI.

Question 61

What benign cyst is associated with high levels of human chorionic gonadotropin (hCG)? • Polycystic ovary syndrome • Physiological • Cystadenocarcinoma • Chocolate • Theca lutein

Answer 61

• Theca lutein

Question 62

Which of the following scenarios best describes the presentation of invasive lobular carcinoma? • Aggressive lesion only seen on MRI • Mass on palpation, mammography and ultrasound • Architectural distortion on mammogram and mass on ultrasound • Pain with an aggressive lesion on mammogram • Segmental pleomorphic appearing calcifications on mammography

Answer 62

Architectural distortion on mammogram and mass on ultrasound

Question 63

A 65 yr old man presents with recurrent UTI and intermittent haematuria. His urine analysis revealed atypical cells suggestive of high grade urothelial malignancy. What radiological test would you recommend for further evaluation? • Three phase CT urogram with a single bolus of IV contrast medium • Portal venous phase MDCT of the abdomen • CT cystogram • Two phase CT urogram with a split bolus of IV contrast medium • Ultrasound scan of the renal tract

Answer 63

Three phase CT urogram with a single bolus of IV contrast medium **SCS: interestingly i think we do Two phase split bolus.

Question 64

Patient with history of treated prostate cancer 2 years ago. Presenting with acute lower limb weakness but with intact sensation. MRI spine with contrast showed no abnormality. What is the mostly cause for the patient’s presentation? • Radiation myelitis • Leptomeningeal metastatic disease • Cord compression from vertebral pathological fracture • Epidural haematoma • Acute spinal cord infarction

Answer 64

Course answers: spinal cord infarct previous answer: Radiation myelitis

Question 65

In a child with a scimitar sacrum and anal stenosis, a prescaral mass is MOST likely to represent a: • Enteric duplication cyst • Anterior meningocele • Dermoid cyst • Teratoma • Lipoma

Answer 65

SCS**Anterior meningocele (most common, then teratoma, then dermoid (rare), according to radiopaedia). StatDx agrees: “Sacro-coccygeal teratoma is the second most common lesion after anterior meningocoele” (This is referring to Currarino Syndrome- Autosomal Dominant) Crack the core stresses anterior (not posterior mass) CCF - Agree with Sajith - Course answer on this one is about as useful as a screen door on a submarine. Course answer: Teratoma

Question 66

You are performing an abdominal ultrasound on a patient and have noted ascites, periportal nodal enlargement, recannalisation of the periumbilical vein and multiple echogenic foci within the spleen. The most likely cause of the splenic abnormality is: • Siderotic nodules (Gamna Gandy bodies) • Myelofibrosis • Metastases • Granulomas • Lymphoma

Answer 66

• Siderotic nodules (Gamna Gandy bodies)

Question 67

Which If the following is associated with spinal ependymoma? • Tuberous sclerosis • Von Hippel-Lindau disease • Chiari II malformation • Neurofibromatosis type 2 • Sturge-Weber syndrome

Answer 67

Neurofibromatosis type 2

Question 68

Which of the following is FALSE regarding parathyroid scintigraphy? • Parathyroid scintigraphy is more sensitive to adenomas than hyperplasia • On delayed 99 Tc sestamibi scans parathyroid adenomas typically remain 'hot' • Thallium-201 (201 Tl) is utilised in subtraction imaging, as it only localises to the parathyroid glands • 99Tc sestamibi has a half life of 6 hrs • With 201 Tl/ Tc99 subtraction imaging, may be uninterpretable in the presence of a multinodilar goitre

Answer 68

Thallium-201 (201 Tl) is utilised in subtraction imaging, as it only localises to the parathyroid glands SCS: 201 TI/Tc99 subtraction can be uninterpretable in presence of MNG (Dahnert). -Radiopaedia says Scintigraphy more sensitive to adenomas cf. hyperplasia.

Question 69

In xanthogranulomatous pyelonephritis which of the following imaging features is not typical? • Perinephric involvement • Renal pelvis contraction • Staghorn calculus • Hydroureter • Multiloculated appearance

Answer 69

• Hydroureter

Question 70

A patient with prostate cancer which was treated 2 years ago now presents with loss of power to both legs. Sensation is intact. MR (with contrast) was structurally normal. This is most likely due to: • Radiation myelitis • Leptomeningeal spread • Intrathecal disease • Transverse myelitis • Cord infarct

Answer 70

Repeat. Radiation myelitis. This is course answer for this version of the Q

Question 71

A patient is noted on examination to have multiple café au lait spots and pigmented iris hamartomas. Which of the following lesions are they least likely to also manifest? • Spinal meningiomas • Dural ectasia • Paraspinal neurofibromas • Tibial dysplasia • Kyphoscoliosis

Answer 71

Spinal meningiomas SCS: Stem= NF1. Spinal meningiomas = NF2 (MISME) Also rule of 2s - NF2, chromosome 22, bilateral schwannomas diagnostic, presents ~20s, est prevalence 1 in 25k.

Question 72

A middle aged man presents with increasing shortness of breath and ear pain. CT shows thickening of the tracheal wall. The most likely diagnosis is: • Tracheobronchopathia osteochondroplastica • Granulomatosis with polyangiitis • Amyloidosis • Relapsing polychondritis • Mounier Kuhn syndrome (Tracheobronchomegaly)

Answer 72

Relapsing polychondritis Stupid question - does not state if it involves the posterior membrane or not wji: it doesnt need to. The other conditions don't cause ear pain. (insert alpha meme here)

Question 73

Children born to diabetic mothers are at a risk of which of the following disease? • Diastometamyelia • Callosal agenesis • Sacro-coccygeal teratoma • Hydromyelia • Caudal regression syndrome

Answer 73

Caudal regression syndrome

Question 74

Which of the following is most strongly associated with choroid plexus cysts? • Trisomy 13 • Trisomy 18 • Chiari malformation • Trisomy 21 • Turner syndrome

Answer 74

Trisomy 18

Question 75

Which is the most common type of abdominal aortic stent graft endoleak? • Type III • Type V • Type I • Type II • Type IV

Answer 75

Type II

Question 76

A 50 year-old female with exertional dyspnoea was diagnosed with concentric hypertrophic cardiomyopathy on cardiac MRI. Which of the following favours the diagnosis of Concentric hypertrophic cardiomyopathy ? • Thickening of the entire LV wall measuring 17 mm at end diastole • Thickening of the interventricular septum at 7 mm. • Thickening of the LV wall measuring 14 mm with normal systolic function • Nodular high signal in the interventricular septum on T2 weighted imaging • Thickened LV with delayed hyperenhancement of mid wall

Answer 76

“Thickening of the entire LV wall measuring 17 mm at end diastole”. Radiopaedia. In concentric hypertrophic cardiomyopathy, thickness is fairly symmetrical/uniform, LV cavity decreases in volume, thickness >or equal to 15mm. They specify measured in diastole. Agree with SCS: In concentric hypertrophic cardiomyopathy, myocardial wall thickness is increased in a fairly symmetrical and circumferential fashion and the left ventricular cavity is decreased. A wall thickness of ≥15 mm in adults or a z-score of ≥2 in children is considered diagnostic Normal thickness 12mm or less.

Question 77

A CT scan post-trauma in a 20 year old female shows a well-defined hypo dense mass located between the longus colli muscles. There is no enhancement post contrast. MRI demonstrates a midline cystic structure in the posterior roof of the nasopharynx, high signal on T1 and T2 sequences. The most likely diagnosis is: • Tornwaldt’s cyst • Benign polyp • Rathke’s pouch cyst • Thyroglossal duct cyst • Ranula

Answer 77

• Tornwaldt’s cyst

Question 78

Which of the following ultrasound finding is NOT a sign of a full thickness rotator cuff tear of shoulder? • Fluid in the subacromial and subdeltoid bursa • Visualisation of the underlying hyaline cartilage • Full thickness focal hyperechogenicity of the rotator cuff • Non visualisation of rotator cuff • Focal thinning of the rotator cuff

Answer 78

Full thickness focal hyperechogenicity of the rotator cuff **SCS: Visualisation of the underlying hyaline cartilage is Referring to cartilage interface/ double cortex sign. Also remember sagging peribursal fat sign for vivas…

Question 79

Which of the following cardiac anomaly is best detected on outflow tract image of the fetal heart? • Fetal tachyarrhythmia • Hypoplastic left heart • Tetralogy of Fallot • Endocardial cushion defect • VSD

Answer 79

Tetralogy of Fallot

Question 80

Which of the following can mimic child abuse? • Canavan disease • Phenylketonuria • Homogentisic aciduria • Glutaric aciduria • Alexander disease

Answer 80

**SCS: Glutaric aciduria (type1) -This is a leukodystrophy. -Defective enzyme: glutaryl-CoA, leads to accumulation of glutaric acid (and other stuff) in brain, bodily fluids-> urine/CSF. -Presents like viral encephalitis/ADEM -Reason it can mimic NAI-> they get subdurals. - This is due to brain atrophy, increased risk of shearing cortical veins, w minor trauma. They also get a big noggin. DDX: Alexanders, Canavans.

Question 81

Which of the following MRI sequences is most sensitive to assess normal myelination in children less than 1 yr of age. • Susceptibility-weighted imaging (SWI) • T2W TSE • T1W TSE • T2W GRE • Fluid attenuated inversion recovery FLAIR

Answer 81

T1W TSE **SCS: agree. T1 most sensitive <1 year - looking for T1 hyper intensity = myelinated Extra trivia. Radiopaedia. -T2 most sensitive 1-2y/o. Showing gradual shift from hyper to hypo intense WM relative to grey matter. -Terminal zones of myelination = posterior aspect of lateral ventricles/ peritrigonal. -Can be difficult to distinguish from PVL. -Look for normal myelination between patchy areas of T2 hyper intensity and ventricle.

Question 82

A 25 year-old patient with dysphagia had a barium swallow examination which showed anterior indentation of the oesophagus and posterior Indentation of the trachea, above the level of carina. What is the most likely diagnosis? • Double aortic arch • Aberrant left pulmonary artery • Aberrant right subclavian artery • Right sided aortic arch • Aberrant left subclavian artery

Answer 82

• Aberrant left pulmonary artery

Question 83

A 1 yr old infant is admitted with acute stridor. On AP chest film, no foreign body is identified, but there is an inverted V appearance of the subglottic trachea. Which of the following is the most likely diagnosis? • A radiolucent foreign body • Acute laryngotracheobronchitis • Epiglottitis • Whooping cough • Tracheobronchomalacia

Answer 83

Acute laryngotracheobronchitis SCS: Steeple sign. Also see ballooning of hypopharynx. Caused by Parainfluenza, RSV.

Question 84

A patient undergoes SPECT imaging of the brain with 99Tcm-HMPAO. The study demonstrated symmetric relative decreased uptake in frontal, temporal and parietal lobes with sparing of motor strip and occipital lobes. Which of the following is the most likely diagnosis? • Lewy body dementia • Seizure localisation • Alzheimer disease • Pick disease • Vascular dementia

Answer 84

Alzheimer disease SCS: radiopaedia -Hypometabolism/reduced uptake: bilateral (usually) symmetric temporoparietal, precuneus, and posterior cingulate -Sparing: visual cortex, BG, thalami, occipital lobes, cerebellum. -Frontal lobes involved at a late stage.

Question 85

A 23 year-old Aussie Rules player presents with suspected diagnoses of “Turf Toe”. Which of the following is not associated with this injury at MRI? • Proximal migration of the medial sesamoid • Avulsion of the medial capsule and abductor hallucis attachement to the medial sesamoid • Muscle strain medial head of flexor hallucis brevis • Oedema and discontinuity at MRI of the medial sesamoid phalangeal ligament • Osteochondral injury to the interphalangeal joint of the great toe

Answer 85

• Osteochondral injury to the interphalangeal joint of the great toe SCS: extreme traumatic dorsiflexion, damaging PLANTAR plate. Can involve sesamoids

Question 86

Which of the following is NOT predominantly an ileocolonic disease? • Giardiasis • Tuberculosis • Campylobacter infection • Typhilitis • Crohn's disease

Answer 86

Giardiasis - small bowel

Question 87

Antenatal ultrasound scan shows fetal ascites. What is the least likely cause? • Parvovirus infection • Foetal urinary tract obstruction • Twin to Twin transfusion syndrome • Rhesus incompatibility • Multicystic dysplastic kidney

Answer 87

Multicystic dysplastic kidney

Question 88

Which of the following has a basal predominant involvement of the lungs? • Post-primary tuberculosis • Ankylosing spondylitis fibrobullous lesions • Rheumatoid arthritis associated ILD • Hypersensitivity pneumonitis • Silicosis

Answer 88

• Rheumatoid arthritis associated ILD

Question 89

Calcifications with lucent centres are newly seen near the areola. What view would be the best for localisation to the skin? • Cranio caudal view • True lateral view • Magnification view • Tangential views • Cleopatra views

Answer 89

Tangential views

Question 90

What growth rate should you see the gestational sac increase by each day in the first trimester? • 3 mm • 4 mm • 2 mm • 1 mm • 5 mm

Answer 90

SCS: 1 mm Radiopaedia: MSD increases by 1mm per day, however there is considerable variation.

Question 91

Which of the following statement is FALSE regarding MRI of the wrist? • The lunotriquetral and scapholunate ligaments are best demonstrated on sagittal plane • The normal median nerve appears hyperintense to muscle on T2W imaging • The ulnar tunnel syndrome is frequently caused by a ganglion cyst • Traumatic tears of triangular fibrocartilage usually occurs at the radial attachments • Tenosynovitis frequently affects the abductor pollicis longus and extensor pollicis brevis tendons

Answer 91

The lunotriquetral and scapholunate ligaments are best demonstrated on sagittal plane

Question 92

A 40 year-old well woman presents with a 2 year history of a painless slow growing mass in the left popliteal fossa. Fine amorphous calcification is noted in the lesion on x-ray with no osseous involvement. On MRI the mass measures 6 cm in size. It is well defined and ovoid in shape. There are some cystic areas and some haemorrhage present. The most likely diagnosis is? • Synovial sarcoma • Myositis ossificans • Ruptured Baker's cyst • Pigmented villonodular synovitis (PVNS) • Metastatic carcinoma

Answer 92

• Synovial sarcoma

Question 93

Benign invasion of the endometrium into the myometrium is known as what? • Endometriosis • Adenomyosis • Endometrial carcinoma • Endometrial hyperplasia • Endometrial atypia

Answer 93

• Adenomyosis

Question 94

What syndrome consists of apical petrositis, abducens nerve palsy and trigeminal pain? • Gradenigo syndrome • Haglund syndrome • Kallmann syndrome • Bertolotti syndrome • Parsonage Turner syndrome

Answer 94

• Gradenigo syndrome Gradenigo syndrome consists of the triad of: suppurative otitis media with persistent otorrhoea and ear pain abducens nerve palsy, secondary to involvement of the nerve as it passes through Dorello canal retro-orbital pain, or pain in the cutaneous distribution of the frontal and maxillary divisions of the trigeminal nerve, due to extension of inflammation into Meckel cave

Question 95

Hydrops is associated with fetal ascites in which of the following: 1. Cardiac abnormality 2. Echogenic foetal bowel 3. posterior urethral valves 4. Duodenal atresia 5. Renal dysplasia

Answer 95

SCS: ambiguous question. Heaps of things can directly/indirectly cause ascites in context if hydrops… -Cardiac abnormality- can lead to ascites + hydrops- my best answer. Course answer: Cardiac abn. -Echogenic foetal bowel-> CMV -/parvovirus infection can lead to ascites and hydrops… -Posterior urethral valves- rupture of urinary collecting systesm- but not hydrops so false. -Duodenal atresia- false. Polyhydramnios with good outcome if isolated. Syndromic ass/w T21

Question 96

A 25 year old man presents with left hip/groin pain after exercise that worsens on internal rotation of the hip. A plain radiograph of the pelvis shows osseous protrusion at the femoral head neck junction, and measuremen of alpha angle of greater than 55 degrees. Which of following is most likely diagnosis 1. CAM type Femoroacetabular impingement. 2. Focal acetabular overcoverage 3. Pincer type Femoroacetabular impingement 4. Protrusio acetabuli 5. Missed congenital hip dislocation

Answer 96

CAM type Femoroacetabular impingement SCS: confusingly Alpha angle is used in FAI, nothing to do with DDH in this context. >55 abnormal (radiopaedia). Measured on Dunn projection, dont worry about it lol its niche/controversial . Just know > 55deg = abnormal , or ask WJI…

Question 97

A middle aged man was diagnosed with primary haemochromatosis. What is the most characteristic MR apprearance of his abdomen on T2 weighted scans? 1. Diffuse low signal intensity of liver, spleen and pancreas 2. None of the above 3. Diffuse low signal in liver with no signal abnormality of spleen 4. Diffuse low signal intensity of liver, spleen and paravertebral mass 5. Diffuse low signal intensity of liver and spleen

Answer 97

3. Diffuse low signal in liver with no signal abnormality of spleen

Question 98

Lung cysts do not typically occur in: 1. Birt Hogg Dube (CCF get excited) 2. Laryngeal papillomatosis 3.LIP 4. HP 5. Pneumoconiosis

Answer 98

SCS: Pneumoconisosis Laryngeal papillomatosis, commonly occurs with tracheobronchial papillomatosis which forms cysts (thin walled cysts w nodules- radiopaedia). Isolated tracheobronchial involvement is extremely rare so i favour this to be true. LIP, HP, BHD- yep causes cysts. CCF - i just fucking love Birt Hogg Dube

Question 99

Which of the following is false on MRI of silicone breast implants 1. Radial folds appear thicker than lines associated with intracapsular rupture 2. Radial folds are secondary to in folding of the implant shell 3. the linguine sign is a feature of intracapsular rupture 4. Key hole sign describes the presence of a gel bleed 5. Extra-capsular rupture is more common than intra-capsular rupture

Answer 99

Extra-capsular rupture is more common than intra-capsular rupture **SCS : Extra 15% vs intra 85% radiopaedia Keyhole sign: indicates uncollapsed intracapsular breast implant rupture - with “gel bleed”

Question 100

22 year old is diagnosed with tuberculosis. Which of the following features would make a diagnosis of primary TB more likely 1. Miliary nodules 2. Apical consolidation 3. Mediastinal enlargement 4. Septal thickening 5. Upper zone cavitation

Answer 100

SCS: mediastinal enlargement. Lymphadenopathy is most commonly seen in kids, but only 10-30% of adults. -lymph adenopathy not common in secondary/ post primary - Miliary can be seen in both primary and post primary, but would assume this dude is immunocompetent and wouldn’t get this.