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2b + Differential Diagnosis > Differential Diagnosis > Flashcards

Differential Diagnosis Flashcards

1
Q

Nephrocalcinosis differential

A

Medullary sponge kidney
Renal tubular acidosis
HyperParathyroidism
TB - end stage (putty kidney)

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2
Q

Sacral tumours

A

Chordoma
Plasmacytoma

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3
Q

Diffusely sclerotic bone thickened trabecular markings

A

Paget’s
Fibrous dysplasia

SAPHO - hyperostosis
Thalassaemia

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4
Q

Lytic bone mets?

A

Renal
Lung
Thyroid
Melanoma
Breast

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5
Q

Differential for AVN in adults

A

Diabetes
Steroids
Sickle cell

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6
Q

Miliary nodules?

A

TB
Varicella

Sarcoidosis

Thyroid
Ovarian
Renal

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7
Q

Cavitating lung lesions

A

Infection:
Septic emboli, TB, Klebsiella,
Aspergillosis

Malignancy:
Squamous lung ca

Vascular:
Granulomatosis with polyangitis
LCH

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8
Q

Distal ureteric stricture

A

Tb
Schistosomiasis
Congenital mega ureter

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9
Q

Congenital multi cystic mass on CXR

A

CPAM - Can have connection to bronchial tree

Bronchogenic cyst - No communication with the bronchial tree

Pleuropulmonary blastoma - malignant

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10
Q

Cerebral processes involving at least two lobes of the brain

A

Gliomatosis cerebri
Lymphoma
Encephalitis

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11
Q

Interstitial lung disease and soft tissue calcification?

A

Scleroderma
Dermatomyositis

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12
Q

Multifocal splenic lesions

A

TB
Lymphoma
Sarcoidosis
Siderosis (sickle cell)

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13
Q

Differential for demyelinating lesions in the brain?

A

Multiple Sclerosis

ADEM - post infection

Progressive multifocal leukoencephalopathy - fronal and parietal lobes, AIDS related.

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14
Q

Differential for eggshell calcification mediastinal lymph nodes?

A

Sarcoidosis
Silicosis
Pneumoconiosis
Healed TB / Lymphoma

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15
Q

Differential for neonatal unilateral hyperinflated lung

A

Congenital lobar overinflation - associated with aberrant left pulmonary artery

Bronchial atresia - distal air trapping

Swyer James - post infective obliterative bronchiolitis

Pulmonary hypoplasia - contralateral lung smaller or missing

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16
Q

Signs to look for to help you find a primary lesion if you find metastases?

A

Mastectomy
Surgical clips
Post radiation changes
Nephrectomy

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17
Q

Differential for neonatal large multi cystic liver masses

A

Infantile hepatic hemangioma - benign, solid, normal AFP, often no treatment required

Mesenchymal hamartoma - benign, cystic, normal AFP, surgical resection

Hepatoblastoma - malignant, raised AFP, surgical resection +/- chemo

Hepatic abscess

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18
Q

Neuroblastoma Vs Wilms?

A

Neuroblastoma
- Poorly marginated
- Calcification
- Bone metastasis
- Encases vessels
- Spinal canal extension

Wilms
- Well circumscribed
- No calc
- Lung metastasis
- Displaces vessels

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19
Q

Differential for white out?

A

Collapse
Consolidation
Pleural effusion
Pneumonectomy

Combination of multiple

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20
Q

Differential for enlarged pulmonary arteries

A

COPD
CTEPH
Chronic left heart failure
Becet disease

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21
Q

Massive mediastinal lymph nodes compared to the size of the lung cancer. Diagnosis?

A

Small cell lung cancer

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22
Q

Most common mets to bowel?

A

Melanoma
Breast

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23
Q

Differential for necrotic lymph nodes?

A

TB
Lymphoma
Squamous cell cancer

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24
Q

What are 5 types of choledochal cysts?

A

1 - focal dilatation of the CBD
2 - bile duct diverticulum
3 - dilation of CBD within the duodenal wall (choledochocele)
4 - focal intra and extra hepatic dilatation
5 - Carolis disease (intrahepatic only)

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25
Q

Differences between metabolic and metastatic superscan

A

Metastatic - axial skeleton and proximal limbs. More heterogeneous

Metabolic - axial skeleton, distal limbs, calvarium and mandible

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26
Q

Causes of metabolic superscan?

A

Hyperparathyroidism
Renal osteodystrophy
Osteopetrosis

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27
Q

Differential for soft tissue calcification?

A

Autoimmune - scleroderma, dermatomyositis
Trauma - myositis ossificans
Vascular - arterial calcification
Metabolic - CPPD
Malignancy - osteosarcoma

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28
Q

Fat containing renal lesions

A

AML
RCC
Oncocytoma
Wilms (Paeds)

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29
Q

What is Ying Yang sign mean for arterial Doppler?

A

Aneurysm

Sharp systolic upstroke as blood enters the aneurysm. Then sharp reversal of flow as blood leaves the aneurysm.

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30
Q

Difference between inguinal, femoral, and obturator hernia?

A

Inguinal Vs femoral - femoral remains lateral to the pubic tubercle and compresses the femoral vein

Obturator hernia goes through obturator canal

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31
Q

Differential for multiple testicular lesions?

A

Lymphoma
Sarcoidosis
Multifocal seminoma
Mets - prostate, penile

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32
Q

What shows uptake on ocreotide or gallium DOTATATE scan?

A

Neuroendocrine tumours:
- Carcinoid
- Paraganglioma
- Phaeochromocytoma
- Small cell lung cancer

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33
Q

Scan to look for Meckel’s diverticulum?

A

Tc99m Pertecnitate scan

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34
Q

What are the abnormal oesophageal indentations?

A

Anterior - aberrant left pulmonary artery

Posterior - aberrant right subclavian artery

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35
Q

Diagnostic measurements for pyloric stenosis?

A

Pyloric length - >15mm
Transverse diameter - >12mm
Pyloric thickness - >3mm

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36
Q

Differential for double bubble sign on abdo film?

A

Duodenal web / atresia / stenosis,
Annular pancreas
Midgut volvulus

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37
Q

RDS Vs TTN Vs Meconium aspiration on neonatal CXR?

A

RDS - pre term, bilateral ground glass opacities, reduced lung volume

TTN - coarse interstitial marking, fluid in horizontal fissure. Resolves in 48hrs

Meconium aspiration - term, asymmetric “ropy” densities”, increased lung volume

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38
Q

Duplex kidney pattern of insertion and pathology?

A

Upper pole insert lower and obstructs + ureterocele

Lower pole inserts higher and refluxes

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39
Q

Graf method for assement of DDH?

A

Grade 1 - Alpha angle >60⁰ (normal)

Grade 2 - Alpha angle <60, centered hip

Grade 3+4 - Alpha angle <60, decentered hip

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40
Q

Differential for lung mass with separate systemic arterial supply

A

AVM
Pulmonary sequestration

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41
Q

Differential for calcification on cranial USS?

A

Infection:
- Toxoplasmosis - random distribution
- Cytomegalovirus - periventricular distribution

Teratoma

Sturge Weber - curvilinear cortical calcification

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42
Q

Things to look for if you suspect NF1

A

SNAP

Skeletal displasias - look at bones
Neurofibromas - look at spine and soft tissues
Astrocytomas + optic tract gliomas- MR brain
Pheochromocytoma - MR Adrenal

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43
Q

Differential for cerebral calcification?

A

Vascular - AVM, Amyloid, Sturge Weber.
Infection - TORCH
Trauma - healed infarct, bleed or abscess
Tumour - meningioma, oligodendroglioma

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44
Q

Causes of colonic intussusception in adults?

A

Lipoma
Colorectal carcinoma
Polyps

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45
Q

Causes of intussusception in a child?

A

Peyers patches (lymph tissue)
Duplication cyst
Meckel diverticulum

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46
Q

Upper lobe pulmonary fibrosis differential?

A

STRAP C

Sarcoid
TB/ MAC
Radiation fibrosis
ABPA
Pneumoconiosis/silicosis (progressive massive fibrosis
Chronic hypersensitivity pneumonitis

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47
Q

Cardiac uptake on bone scan?

A

Cardiac amyloid

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48
Q

Causes of hook like osteophytes

A

Haemochromotosis
CPPD

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49
Q

Appearance of appendiceal pseudomyxoma peritonei

A

Tubular appendix with curvilinear calc
Loculated low attenuation fluid
Scalloped visceral surfaces

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50
Q

Causes of pseudodiverticulosis of the oesophagus?

A

-Reflux
-Candidiasis.

Cause strictures in 90% of cases

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51
Q

Posterior mediastinal massess?

A

Oesophagus
Aorta
Infection - Paraspinal abscess

Neural tumours:
- Schwannoma
- Neurofibroma
- Paraganglioma

Osteosarcoma
Lymphoma

Extramedullay haematopoesis

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52
Q

Causes of ribbon ribs?

A

NF1
Osteogenesis imperfecta

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53
Q

Causes of acro-osteolysis

A

Scleroderma
Psoriatic arthritis
Raynauds

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54
Q

Causes of pneumocephalus?

A

Trauma
Iatrogenic
Meningitis - sinusitis/mastoiditis

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55
Q

Middle mediastinal mass differential?

A

Lymphadenopathy
Pericardial cyst
Cardiac/aortic aneurysm

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56
Q

Causes of small bowel strictures?

A

Crohns
TB
Ischaemia
Radiotherapy

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57
Q

Causes of bilateral pneumothoraces?

A

Cystic lung diseases
- LAM/LCH
- TB, Klebsiella, Staph aureus
- PCP pneumonia

Osteosarcoma mets

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58
Q

Cystic lung disease differential?

A

LAM - female, thin walled cysts, tuberous sclerosis

LIP - lower lobe predominant, sjogrens,

LCH - bizarre cysts, nodules, smoker

Birt Hogg Dube - lung cysts, rcc, skin lesions

PCP - ground glass and small cysts (pneumatoceles), AIDS, no pleural effusions

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59
Q

Diffuse muscle oedema differential?

A

Polymyositis
Dermatomyositis (if skin involvement)
Pyomyositis if infective

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60
Q

Differential for bladder diverticulosis?

A

Bladder outflow obstruction
Neurogenic bladder
Posterior urethral valves

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61
Q

Management of tuberous sclerosis?

A

MDT approach with regular follow up with

MRI brain (tubors, SEGA, chiari malformation),

MRI kidneys (AML, oncocytoma)

Echocardiogram (Rhabdomyoma)

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62
Q

Management of osteoid osteoma?

A

Can do further imaging with CT or bone scan.
Radio frequency ablation.

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63
Q

Centrilobular ground glass nodules differential?

A
  • Hypersensitivity pneumonitis
  • RB-ILD (smokers)
  • TB, Aspergillosis
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64
Q

Causes of PRES?

A

Severe hypertension
Drugs - Chemotherapy
Thrombotic thrombocytopenic purpura

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65
Q

Fleeting pulmonary opacities differential?

A

COP - Atoll sign
ABPA - asthma, finger in glove
Eosinophilic pneumonia - reverse bat wing sign.

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66
Q

Clival masses differential?

A

Chordoma - high T2
Chondrosarcoma - high T2 and calc
Plasmacytoma - low/intermediate T2

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67
Q

Features of chiari 2 malformation?

A

Tonsilar and torcular descent
Thinned corpus callosum
Tectal beaking
Myelomeningocele (spina bifida)

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68
Q

Corpus callosum lesions?

A

Tumours:
- Butterfly glioma
- Gliomatosis cerebri
- Lymphoma

Demyelination:
- MS
- NMO
- Machiafava Bignami

Congenital
- Agenesis of the corpus callosum

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69
Q

High FLAIR signal in lentiform nucleus differential?

A

Carbon monoxide poisoning - Globus pallidus (inner strip)

Methanol poisoning - Putamen (outer strip)

Wilsons disease, Huntington’s disease - Lentiform and caudate

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70
Q

Ring enhancing lesions MRI brain differential?

A

Abscess - thin wall, lots of oedema, Double rim sign: outer low signal rim (fibrous capsule), inner high signal rim (enhancing capsule)

Tumour (mets, glioblastoma, lymphoma) - thick wall

Tumourfactive demyelination (MS, ADEM) - incomplete wall, little oedema

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71
Q

Glioblastomas and intestinal polyps?

A

Turcot syndrome

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72
Q

Cortical based neuro tumours differential?

A

P-DOG

Pleomorphic xanthoastrocytoma - supratentorial cyst with enhancing nodule

DNET - bright and bubble, do not enhance

Oligodendroglioma - cortical expansion, ribbon calc

Ganglioglioma - temporal lobe, teenagers, seizures, mixed solid cystic.

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73
Q

Intraventricular tumours?

A

MESS-C

Medulloblastoma - 4th vent roof, spinal mets

Ependymoma - 4th vent floor, blood+calc

Subependymoma - subependymal, adults
SEGA - subependymal, kids, tuberous sclerosis

Central neurocytoma - swiss cheese, calc

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74
Q

CP angle massess differential?

A

Vestibular scwannoma - NF2
Meningioma - dural tail
Epidermoid - avid restriction
Dermoid - contain fat

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75
Q

Pineal lesion differential?

A

GPPP

Germinoma - fat and calc

Pineoblastoma - Heterogenous, “exploded” calc, hydrocephalus

Pineocyteoma - homogenous

Pineal cyst

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76
Q

Common brain mets?

A

Lung
Renal
Breast

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77
Q

Suprasella lesions?

A

SATCHMOE

S - sarcoid
A - aneurysm
T - teratoma, TB
C - chordoma, craniopharyngioma, cleft cyst (rathke)
H - hypothalamic hamartoma/glioma
M - meningioma, metastases, myeloma
O - optic nerve glioma
E - Eosinphilic granuloma, epidermoid/dermoid

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78
Q

Aging blood on MRI

A

T1 signal only becomes high after a couple days
T2 only high immediately and then after a week

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79
Q

What are the intradural but extramedullary tumours?

A

No more spinal masses

Neurofibroma
Meningioma
Schwannoma
Metastases

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80
Q

Amyloid vs hypertensive micro haemorrhage?

A

Hypertensive micro-haemorrhage typically affects the basal ganglia.

Amyloid micro-haemorrhage spares the basal ganglia

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81
Q

Spinal ependymoma vs astrocytoma?

A

Ependymoma - centrally within cord, haemorrhage, adults, NF2

Astrocytoma - eccentric within cord, kids, NF1

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82
Q

Lung cancer staging?

A

T1 - 1-3cm
T2 - 3-5cm, trachea or pleura
T3 - 5-7cm, chest wall, pericardium
T4 - >7cm, carina, mediastinum, oesophagus, vessels, diaphragm, vertebra.

N0
N1- ipsilateral hilar
N2 - ipsilateral mediastinal
N3 - contralateral nodes

M0
M1a - tumour in contralateral lobe
M1b - single extrathoracic met
M1c - multiple extrathoracic mets

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83
Q

Features of malignant mesothelioma?

A

Pleural thickening extending to medial pleura

Fissural extension

Pleural thickeness >1cm

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84
Q

Anterior mediastinal masses?

A

TTTT

Terrible lymphoma
Thyroid
Thymoma - myasthenia gravis
Teratoma - fat containing

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85
Q

Congenital heart diseases CXR appearances?

A

Transposition - Egg on string
Tetralogy - Boot shaped heart
TAPVR - Snowman heart
Epstein anomaly - Box heart.

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86
Q

Modified PIOPED criteria for VQ scan?

A

High probability - Two or more large (>75% of segment) segmental defects

Low probability - Upto 3 small (<25% segment) subsegmenal defects

Intermediate - anything inbetween

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87
Q

What is Caplan syndrome?

A

RA and pneumoconiosis.

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88
Q

Groundglass opacification differential?

A

Acute:
- Viral infection, (PCP, HSV, CMV, peribronchovascular)
- Hypersensitivity pneumonitis (centrilobular gg nodules)
- ARDS, dependant gradient
- Goodpastures, ground glass to crazy paving

Chronic:
- ILD, (NSIP, UIP, RB-ILD)

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89
Q

Bronchiectasis differential?

A

Upper lobe:
- CF - upper lobe
- ABPA - asthma, finger in glove
- Mycobacterium avium complex - upper lobe, cavitating lesions
- Fibrosis - radiation, pneumoconiosis, chronic hypersensitivity

Lower lobe:
- Primary ciliary dyskinesia - lower lobe

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90
Q

What is this condition?

Bronchiectasis
Situs invertus
Sinusitis

A

Kartageners syndrome

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91
Q

Eisenmenger syndrome?

A

Uncorrected left to right shunt.
Chronic pulmonary hypertension.
Pressure reveral to right to left.

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92
Q

True vs false cardiac aneurysms?

A

True - broad neck, mural thrombus

False - rupture of myocardium but containd by pericardium.

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93
Q

Reverse batwing appearance differential?

A

Peripheral opacities sparing the perihilar region.

  • Chronic eosinophilic pneumonia.
  • Eosinophilic polyangitis
  • COVID pneumonitis
  • PCP pneumonia
  • Organising pneumonia.
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94
Q

BTS solid nodule follow up guidelines?

A

> 5mm - discharge.
5-6mm - 12 month CT
6-8mm - 3 month CT

> 8mm
Brock model risk assess:
- low risk - 12 month CT
- high risk - PET CT

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95
Q

Rib notching differential?

A

Superior:
- Osteogenesis imperfecta
- Connective tissue (Marfan, scleroderma)

Inferior:
- Coarctation of aorta
- Neurofibroma
- Schwannoma

Both (Ribbon ribs)
- NF1

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96
Q

Most common metastases to oesophagus?

A

Bronchial - local
Breast - distant

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97
Q

Narrow tubular stomach differential?

A

Atrophic gastritis
Linitis plasica - nodular

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98
Q

What are the radiological features of haemochromatosis?

A

Hepatomegaly (90%)
CT - Increased liver density.
MR - Low liver signal on T2

Hook like osteophytes 2nd+3rd metacarpals. Chondrocalcinosis.

Restrictive cardiomyopathy

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99
Q

Associations with Sjogrens disease?

A

NSIP
LIP
Primary biliary cholangitis
Bilateral parotid cysts

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100
Q

Appearances of thalassaemia?

A

ThalaSSSSaemia

Skull:
- Skull hair on end appearance
- Sinus hypopneumatisation

Spine:
- Scoliosis
- Expansion of ribs, with rib within a rib appearance

Spleen:
- Splenomegaly

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101
Q

Classification of renal trauma?

A

AAST kidney score

Grade 1 - subcapsular haematoma without laceration

Grade 2 - superficial laceration <1cm, perirenal haematoma

Grade 3 - laceration >1cm, vascular injury/active bleeding

Grade 4 - laceration involving the collecting system

Grade 5 - shattered kidney

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102
Q

Classification of liver trauma?

A

AAST liver score

Grade 1 - <1cm

Grade 2 - 1-3cm

Grade 3 - >3cm, contained active bleed

Grade 4 - 25-75% of a lobe, bleed into peritoneum

Grade 5 - >75% of a lobe

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103
Q

Scimitar syndrome?

A

PAPVR
+
Pulmonary hypoplasia

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104
Q

Best imaging for carcinoid tumours?

A

Gallium DOTATATE PET

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105
Q

Large vessel vasculitides?

A

Giant cell arteritis - older than 50
Takayasu arteritis - younger than 50

Becets disease (not limited to large vessels) - aorta, SVC, pulmonary artery aneurysms

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106
Q

Medium vessel vasculitides?

A

Polyarteritis nodosa
Granulomatosis with polyangitis
Eosinophilic granulomatosis

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107
Q

What is RBC scan used to image?

A

GI bleeding
Splenosis

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108
Q

How are parathyroid adenomas imaged?

A

Tc99m Sestamibi - delayed phase
4d CT

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109
Q

What is PI-RADS score?

A

Use T2 to look at transitional zone.
Uncapsulated intermediate T2 signal is bad
Score can be upgraded with DWI

Use DWI to look at peripheral zone.
Avid restriction is bad.
Score can be upgraded with dynamic contrast enancment.

Dynamic contrast enhancment.
Enhancment earlier than normal prostate is bad.

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110
Q

Differntial for sacroiliitis?

A

Bilateral symettrical:
- Ank spond
- UC/Crohns
- Rheumatoid

Bilateral asymettrical:
- Psoriatic
- Osteoarthritis

Unilateral:
- Septic arthritis

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111
Q

Carney triad?

A

Extra adrenal phaeochromocytoma
GIST
Pulmonary chondroma

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112
Q

Common oesophageal pathology appearances on barium swallow?

A

Barretts - reticular mucosal pattern, caused by reflux

Pseudodiverticulosis - tiny outpouching and stricture, caused by reflux

Herpes oesophagitis - small ulcers with halo of oedema

Candidiasis - discrete plaques
Glycogenic acanthosis looks similar

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113
Q

Types of gastric volvulus

A

Organoaxial - gastric antrum lies below the fundus as normal. Twisted on the axis of the stomach.

Mesenteroaxial - Gastric antrum is at the level of the fundus. Stomach twists in half along the perpendicular axis.

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114
Q

Terminal ileitis differential?

A

Typhylitis - neutropaenic colitis
Inflammatory bowel disease - Crohns
Infectious - C.Diff, TB.
Ishaemic
Malingnacy - adenocarcinoma, lymphoma

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115
Q

Difference between FNH and Fibrolamellar HCC?

A

FNH scar is T2 bright and enhances.
Fibrolamellar HCC scar is T2 dark and does not enhance

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116
Q

How can you assess difference between FNH and Adenoma?

A

FNH - centrifugal enhancement (inside out)
Adenoma - centripetal fill in (outside in)

Primovist - delayed phase.
- FNH - mild enhancement compared to background liver.
- Adenoma - hypointense to background liver

Tc99m Sulfur Colloid:
- FNH - normal or increased uptake
- Adenoma - reduced uptake

HIDA:
- FNH - prompt hepatic uptake, delayed clearance

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117
Q

Imaging findings for cholangiocarcinoma?

A

Capsular retraction.
Dilated billiary ducts.
Delayed persistent enhancement.

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118
Q

What is pseudocirrhosis of liver?

A

Treated breat cancer mets to the liver

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119
Q

Primary biliary cholangitis imaging findings?

A

Lace like pattern of fibrosis
Periportal halo sign
Intrahepatic duct dilatation
Increased risk of HCC

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120
Q

Different types of pancreatic lesions?

A

Ductal adenocarcinoma - head of pancreas, blocks pancreatic duct

Serous cystadenoma - grandmother lesion, head of pancreas, bunch of grapes with central calc

Mucinous cystadenoma - mother lesion, body and tail of pancreas, uni/multi locular cyst peripheral calc

Solid pseudopapilliry tumour of pancreas - Daughter lesion, tail of pancreas, mixed solid cystic.

IPMN - main brain and side branch

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121
Q

What are the polyposis syndroms?

A

Familial adenomatous polyposis syndromes:
- Turcot - GI polyps + CNS tumours
- Gardners - GI polyps + Osteomas

Cowdens - GI polyps + Breast cancer

Peutz Jeghers - GI polyps + seminoma/adenoma malignum, skin pigmentation of fingers and toes

Juvenile polyposis - <20y.o, rectal bleeding, intusseception.

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122
Q

GI bleeding differential?

A

Vascular - AVM, angiodysplasia

Enterocolitis - infective, diverticulisis, UC, Crohns

Tumour - adenocarcinoma

Peptic ulcer disease

Meckels diverticulum

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123
Q

Benign causes of pneumatosis?

A

PSI

Pulmonary disease
Scelroderma
Inflammation

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124
Q

Pancreatic calcification differential?

A

Chronic pancreatitis

Pancreatic neoplasms - cystadenomas

Hyperparathyroidism

Hereditary pancreatitis

125
Q

Stages of renal TB?

A

Early - papillary necrosis
Progressive - strictures and hydronephrosis
Late - thinned cortex, dystrophic calc (Putty kidney)

126
Q

Diffuse oesophageal dilatation differential?

A

Upper
- stricture
- malignancy
- achalasia

Lower
- sclerodema, distal two thirds

127
Q

Difference between omphalocele and gastroschisis?

A

Omphalocele surrounded by membrane Omphalocele can contain other organs

Gastroschisis is on the right of midline, only bowel

128
Q

How do you assess haemangioma on multiphase contrast imaging?

A

Peripheral nodular discontinuous ehnancment with progressive centripetal fill in.

Matches the blood pool.

129
Q

Hypervascular liver lesions?

A

Benign
- FNH
- Adenoma
- Haemangioma

Malignant
- HCC
- Mets

130
Q

Hypo-vascular liver lesions?

A

Cyst

Cholangiocarcinoma - delayed phase enhancement due to fibrous tissue

131
Q

T2 dark renal lesions?

A
  1. Lipid poor AML
  2. Haemorrhagic cyst
  3. Papillary RCC
132
Q

Bladder calc differential?

A

Chronic cystitis
Schistosomiasis
TB

Radiation

133
Q

Difference between utricle cyst or mullerian duct cyst on urethrogram?

A

M is above P

Mullerian duct cyst can extend above the Prostate
Utricle cyst does not extend above the prostate.

134
Q

How do you differentiate AD-PKD Vs AR-PKD

A

AD - round cysts distributed throughout the kidneys, occurs in adults

AR - tubular cysts sparing the cortex, occurs in kids

135
Q

Posterior vertebral scalloping differential?

A

Intra dural spinal masses - neurofibromatosis, ependymoma, astrocytoma

Dural ectasia - Marfan’s disease, ehlers danlos

Congenital - achondroplasia, osteogenesis imperfecta

136
Q

Name some causes of anterior vertebral scalloping?

A

AAA
Lymphoma
Downs syndrome

137
Q

Causes of Chondrocalcinosis?

A

C,C,Cs

Crystals - gout, pseuodogout (CPPD)
Cation - calcium, copper, iron
Cartilage degeneration - OA

138
Q

Haemarthrosis differential?

A

Vitamin C deficiency
Trauma
Haemophylia
Tenosinvial giant cell tumour (PVNS)

139
Q

Paediatric femoral head irregularity differential?

A

Juvenile Idiopathic artheritis
Perthes disease
Infection

140
Q

Osteoid osteomas are considered osteoblastomas when over what size?

141
Q

Segond fracture vs arcuate sign?

A

Segond - Lateral tibeal plateau #, ACL rupture

Arcuate - Proximal fibular head #, PCL tear

142
Q

Subacute combined degeneration of the cord differential?

A

Vit b12 dificiency - caused by Crohn’s, PPIs, coeliac.

Demyelination - MS
Infection - Herpes myelitis
Inflammatory - sarcoid

143
Q

DISI vs VISI?

A

DISI - lunate tilts dorsally, increased scapho/capito-lunate angle

VISI - lunate tilts volar, decreased scapho/capito-lunate angle

144
Q

What is a perilunate dislocation and what is it associated with?

A

Associated with scaphoid fractures

145
Q

What are the associated injuries for positive and negative ulnar variance?

A

Positive - Lunate degeneration (Ulnar impaction syndrome)
Negative - Lunate AVN (Kienbock disease)

146
Q

What is a Barton fracture Vs reverse Barton

A

Intra articular fracture of the distal radius extending to the dorsal surface. With dorsal radial carpal dislocation.

Reverse Barton is to the volar surface.

147
Q

Different C Spine fractures?

A

Clayshoverlers - hyperextention, fracture of spinous process

Chance - hyperflexion, anterior wedge # and fracture of posterior elements. Highly unstable

Jefferson fracture - C1 blowout, axial loading

Hangmans - Bilateral pars C2 #

148
Q

What is Gamekeepers thumb?

A

Chronic avulsion fracture of the ulnar collateral ligament of the 1st MCP joint

Acute avulsion fracture is skiiers thumb.

Creates a Stener lesion if the abductor polisis muscle gets caught in the torn UCL.

149
Q

Monteggia vs Galeazzi fracture?

A

GRUesome MURder

G: Galeazzi R: radius fracture U: ulna dislocation

M: Monteggia U: ulna fracture R: radial head dislocation

150
Q

SALTER Harris fractures?

A

1 - Straight through physis
2 - Above (metaphyseal)
3 - Below (epiphyseal)
4 - Through (both metaphysis and epiphysis.
5 - Rammed

151
Q

Name the attachments:
Illiac crest
ASIS
AIIS
Greater trochanter
Lesser trochanter
Ischial tuberosity
Pubic symphysis

A

Illiac crest - abdominal muscles
ASIS - Sartorius
AIIS - Rectus femoris
Greater trochanter - Gluteal muscles
Lesser trochanter - Illiopsoas
Ischial tuberosity - Hamstrings
Pubic symphysis - ADDuctors

152
Q

What is a Masonneuve fracture?

A

Widened medial malleolus/medical malleolus fracture + proximal fibular fracture.

153
Q

What other injury is associated with bilateral calcaneal fractures?

A

Bilateral”Lover’s fractures” should prompt looking at the spine for burst fractures

154
Q

Gibbous deformity differential?

A

Congenital:
- Achondroplasia
- Mucopolysaccharides

Aquired:
- Trauma
- Infection - pyogenic discitis, TB

155
Q

Vertebra planar differential?

A

Trauma
LCH
Mets, myeloma, lymphoma
Osteomyelitis

156
Q

What are the different bone lesions that can have multiple fluid-fluid levels?

A

Telangiectatic osteosarcoma
Aneurysmal bone cyst
Giant cell tumour

157
Q

How to differentiate Osteosarcoma from Ewing’s Sarcoma?

A

Ewing’s:
- Diaphysis femur
- Rarely calcifies
- Onion skin periosteal reaction
- Mets to bones and lung

Osteosarcoma:
- Metaphysis distal femur
- Amorphous calcification
- Sun burst periosteal reaction
- Mets to bones and lung with pneumothorax

158
Q

How to differentiate enchondroma from chondrosarcoma?

A

Chondrosarcoma:
Cause pain,
Cortical destruction/scalloping,
Typically >5cm in size.

159
Q

What are the epiphyseal lesions?

A

CGI

Chondroblastoma - T2 low, <30yo
GCT - >30
Geode - degenerative disease
Infection - brodies abscess crosses physis

160
Q

What are the lucent bone lesions?

A

F - Fibrous dysplasia
E - Enchondroma, eosinophilic granuloma
G - GCT
N - NOF
O - Osteoblastoma
M - Myeloma, metastases
A - ABC
S - Simple bone cyst
H - Hyperparathyroidism
I - Infection
C - Chondroblastoma

161
Q

Polyostotic fibrous dysplasia syndromes?

A

MC Cune Albright - also gets Cafe au lait spots and precocious puberty + GI polyps and IMPN

Mazabraud - also gets soft tissue myxomas

162
Q

What is the difference between Olliers and Maffucci syndrome?

A

Both are multiple Enchondromas

Maffucci also have haemangiomas and increased risk of chondrosarcoma

163
Q

What is Undifferentiated Pleomorphic Sarcoma?

A

Malignant transformation of benign tumours

Pagets disease, fibrous dysplasia, GCT, enchondroma

164
Q

Classic imaging findings of Synovial sarcoma?

A

Young people
Periphal limb (Knee/foot)

T2 “triple sign” - necrosis, soft tissue, calc
Bowl of grapes - blood, fluid fluid levels

165
Q

What are the differences between RA and Psoriatic arthritis?

A

RA - symmetric, proximal (MCP), osteoporosis instead of bone proliferation.

PA - Asymettric, distal (IPJs), boneproliferation instead of osteoporosis (periostitis), enthesitis.

166
Q

Classic imaging features of skeletal sarcoidosis?

A

Lace like honeycomb destruction of phalanges. Preservation of joint space

Lytic lesions in the skull and spine. Preservation of disc spaces

167
Q

Classic imaging features of Rickets?

A

Fraying and cupping of the metaphyses.
Bowed legs with looser zones - pseudofracture of the compression side.

168
Q

Primary myelofibrosis imaging findings?

A

Extramedullary haematopoesis
Splenomegally
Diffuse sclerotic bone

169
Q

Diffuse sclerotic bone differential?

A

Osteopetrosis
Hyperparathyroidism/Renal osteodystrophy
Mets, myelofibrosis, mastocytosis

170
Q

Rugger jersey spine differential?

A

Pagets disease
Osteopetrosis
Hyperparathyroidsm/renal osteodistrophy

171
Q

Most common patella tumour?

A

Giant Cell Tumour >30yo
Chondroblastoma <30yo

172
Q

Typical imaging features of a chondroblastoma?

A

Epiphyseal
Lucent
Narrow zone of transition
Cloud like with rings and arcs

T2 LOW - The only epiphyseal lesion that is NOT high T2 signal

173
Q

Features of acromegally?

A

Skull and spine:
- Calvareal thickening
- Vertebral body fractures without loss of mineral density

Hand and feet:
- Spade like phalanx
- Heel pad thickness >25mm

174
Q

Secondary complications of Pagets disease?

A

Conductive hearing loss - otosclerosis
Hydrocephalus - basilar invagination
Osteosarcoma - 1% of patients

175
Q

Features of Rheumatoid Arthritis?
Hands, elbows, shoulder

A

Hands:
- marginal erosion MCP joints
- juxta-articular osteoporosis

Elbows/knees:
- Joint effusion

Shoulder:
- Erosion of distal clavicle

176
Q

How do you differentiate between Morquio and Hurler syndrome?

A

Both are mucopolysaccharidoses (lysosomal storage disorder).
Both have platyspondyly.

Morquio has anterior CENTRAL vertebral body beaking.

Hurler has anterior INFERIOR vertebral body beaking.

Remember H comes before I (Hurler Inferior).

177
Q

Types of tenosynovial giant cell tumour and most common joints affected.

A

Diffuse tenosynovial giant cell tumour (PVNS) - knee joint most affected

Localised tenosynovial giant cell tumour - fingers most affected

178
Q

Dermatomyositis appearance and associations?

A

Sheet like calcification in soft tissues

Associated with interstial lung disease and generalised increase risk of malignancy

179
Q

Different subtypes of femoro acetabular impingement syndrome?

A

Cam type - anterior superior bump on femoral neck causing impingement

Pincer type - over coverage of the femoral head by the acetabulum causing impingement. (Coxa profunda, or protrusion acetabulum are potential causes)

180
Q

How can you differentiate coxa profunda and protrusio acetabuli?

A

Protrusio acetabuli - the femoral head projects beyond the ilioischial line (i.e. into the pelvis)

181
Q

Unilateral testicular lesions differential?

A

Seminoma
Epidermoid - onion skin
Abscess
Adrenal rests
Metastases - retroperitoneal

182
Q

Bilateral testicular lesions differential?

A

Lymphoma
TB
Sarcoidosis - testicular and epididymal masses
Multifocal seminoma

183
Q

Ovarian mass, ascites, pleural effusion differential?

A

Meigs syndrome - Ovarian fibroma, Ascites, Pleural effusion.

Ovarian hyperstimulation syndrome - Theca lutein cysts, ascites, pleural effusion

184
Q

What is Salpingitis Ithmica Nodosa (SIN)

A

Nodular scarring of the fallopian tube. Basically it’s diverticulosis of the fallopian tubes secondary to inflammation/infection.

High association with infertility and ectopic pregnancy

185
Q

What is Ashermans syndrome?

A

Intrauterine adhesions.

Secondary to prior surgery, infection, or pregnancy.
Clinically can result in infertility.

186
Q

Classic imaging features of adenomyosis?

A

Thickening of the junctional zone >12mm
Can have high T2 signal in junctional zone or myometrium (cystic change)

187
Q

How does endometrial cancer typically enhance?

A

Typically enhances less than the myometrium

188
Q

Hyperechoic endometrial lesions?

A

Endometrial polyp -Single feeding vessel on Doppler

Blood clot

Retained prodeuct of pregnancy

189
Q

What are the simple ovarian cyst follow up criteria?

A

Pre menopausal:
<3cm - normal
3-5cm - report presence, no follow up
>5cm - follow up in 3-12 months based on suspicion

Postmenopausal:
<1cm - normal
1-3cm - report presence, no follow up
>3cm - follow up in 3-12 months based on suspicion

190
Q

Ovarian cystic mass differential?

A

Haemorrhagic cyst - lace like, no flow

Endometrioma - ground glass cyst

Teratoma - cyst with nodule (rokitansky)

Ovarian serous/mucinous tumours

191
Q

Seminoma vs non seminoma USS findings

A

Seminoma - Hypoechoic, homogenous, microcalc

Non seminoma - Heterogenous with cystic spaces and calc (teratoma is differential)

192
Q

Testicula tumours hormone markers?

A

bHG - Seminoma, Choriocarcinoma

AFP - Mixed germ cell, Yolk sac

193
Q

Fibroid vs leiomyosarcoma MRI?

A

Fibroid- T1 + T2 dark, homogenous enhancment

Leimyosarcoma - same, but with central necrosis

194
Q

Normal endometrial thickness in postmenopausal women vs tamoxifen thickness?

A

<4-5mm

Tamoxifen - 12mm

195
Q

Cervical cancer staging, most important part?

A

FIGO staging

2a spread beyond the cervix, NO parametrial invasion - Surgery

2b spread beyond the cervix, WITH parametrial involvement - Chemo radiotherapy

196
Q

Ring of fire ovarian lesion differential?

A

Ectopic - thick echogenic rim, ring of fire, separate from ovary

Corpus luteum - thin echogenic rim, ring of fire, moves with ovary

197
Q

What are the causes of hydrosalpinx?

A

PID
Endometriosis
Torsion

Tubal cancer
Post hysterectomy

198
Q

What is a peritoneal inclusion cyst?

A

Occurs when adhesions envelope an ovary.
Adhesions cannot absorb the normal secretions of the ovary and so they collect and form a cyst.

Risk factors include:
PID
Endometriosis
Surgery

199
Q

What day of the hormone cycle is MRI and Mammography best performed?

A

Follicular phase - day 7-14

200
Q

Benign vs malginant mammogram calcification?

A

Benign - popcorn (fibroadenoma), vascular, egg shell (oil cyst)

Malignant - pleomorphic, linear calc (DCIS)

201
Q

Linear calc mammogram differenatial?

A

DCIS
Plasmacell mastitis

202
Q

Indications for breast MRI?

A

Intralobular carcinoma - can be bilateral, difficult to see on mamogram

DCIS - see extent of disease

203
Q

Renal artery aneurysm differential?

A

Fibromuscular dysplasia
Polyarteritis nodosa
Marfans, ehlers danlos

204
Q

Classic triad of organ involvement for Granulomatosis with polyangitis?

A

Sinuses - sinusitis
Lungs - cavitating nodules
Kidneys - glomerulonephritis

205
Q

Thyroid calcification differential

A

Microcalcification - papillary thyroid carcinoma

Coarse calcification - medullary thyroid carcinoma

206
Q

BTA classification of thyroid nodules?

A

U1 - normal

U2 - benign - hyperechoic / ring down / microcystic

U3 - indeterminate - hypoechoic with equivocal echogenic foci (calc)

U4 - suspicuous - solid hypoechoic

U5 - malignant - solid hypoechoic, lobulated, with microcalc/macrocalc, taller than wide, vascularity, lymphadenopathy

207
Q

Further investigation of U3-5 thyroid lesions?

A

FNA
MDT discussion

Repeat FNA in instances of thy1 (non-diagnostic), thy3a/thy3f (neoplasm possible) or thy4 (suspicious) results.

208
Q

Midline neck mass differential?

A

Lymphadenopthy
Thyroglossal duct cyst
Thyroid/parathyroid lesion
Ranula
Cystic hygroma
Vascular malformation

209
Q

Graves vs Hashimotos thyroiditis imaging appearances?

A

Graves - hyperthyroidism, thyroid inferno doppler, increased uptake on Tc99m pertechnetate

Hashimotos - HYPOthyroidism, heterogenous, giraffe skin, low on pertechnetate, high on PET

210
Q

Medullary thyroid cancer associations?

A

MEN IIa and MENIIb

211
Q

Antrochoanal polyp vs mucocele

A

Antrochoanal polyp
- Widening of the maxillary ostium and extention into nasopharynx,
- enlargment of sinus,
- no bony destruction

Mucocele
- Contained within maxillary sinus
- can have bony destruction

212
Q

Inverted papiloma vs esthesioneuroblastoma

A

Cribiform plate lesions

Inverted papilloma - cerebreform appearance

Esthesio - dumbell shape, extends upwards towards brain.

213
Q

Ranula vs plunging ranula

A

Ranula - sublingual mucous retention cyst

Plunging ranula - crosses the mylohyoid into the submandibular space

214
Q

Parotid gland tumours?

A

Benign:
Pleomorphic adenoma
Warthin tumour

Malignant:
Mucoepidermoid
Adenoid cystic carcinoma
Lymphoma

215
Q

Warthin vs Pleomorphic adenoma

A

Warthin has increased uptake on Tc99m Pertechnetate.

216
Q

Bilateral parotid tumours?

A

Warthins
Lymphoma
(Sjogrens, HIV, sarcoidosis)

217
Q

Where do mucoepidermoid and adenoid cystic carcinoma typically affect?

A

Minor salivary glands - the small and unnamed salivary glandular tissue scattered throughout the oral cavity

218
Q

Masticator spaces malignancy/infection can spread to which other structures?

A

Cavernous sinus or orbital apex via the pterygopalatine fossa

219
Q

What 4 spaces surround the parapharyngeal space?

A

Anterior - masticator space
Lateral - parotid space
Posterior - carotid space
Medial - superficial mucosal space

220
Q

Necrotic retro pharyngeal lymph nodes suggest what pathology?

A

SCC metastatic nodal disease
Papillary thyroid carcinoma nodal disease

221
Q

What Tolosa Hunt syndrome?

A

Cavernous sinus and orbital apex inflammation

222
Q

Intraconal lesions?

A

Nerve:
Optic nerve glioma
Optic nerve meningioma

Vessels:
Cavernous haemangioma (AMV)
Orbital varix

Muscles:
Orbial pseudotumour

Globe:
Retinoblastoma

223
Q

Extraconal lesions?

A
  • Infection
  • Osteoma
  • Dermoid cyst
  • Lacrimal gland lesions
  • Capillary/cavernous haemangioma
224
Q

Lacrimal gland lesions?

A

Benign - pleomorphic adenoma, dermoid cyst

Malignant - Adenoid cystic, mucoepidermoid, lymphoma

Inflammatory - sarcoid, sjogrens

225
Q

What is the most common malignant orbital tumours in childhood?

A

Rhabdomyosarcoma
Retinoblastoma

226
Q

Children with bilateral retinoblastomas are also at risk of which other tumours?

A

Trilateral renitoblastoma - Bilateral retinoblastoma and pineoblastoma

Quadrilateral retinoblastoma - Bilateral retinoblastoma, pineoblastoma, suprasella tumour.

Osteosarcoma

227
Q

What order does thyroid eye disease affect the eye muscles?

A

IM SLO

Inferior
Medial
Superior
Lateral
Oblique

228
Q

Vascular malformations of the eye differential?

A

Venous varix - increase size on straining

Cavernous haemangiomas - slow irregular enhancment

Carotocavernous fistula - pulsatile expothalmous

229
Q

What is the most common cause of exophthalmos after a viral illness in children?

A

Orbital lymphangioma

230
Q

Cholesteatoma vs cholesterol granuloma

A

Cholesteatoma - low T1, high T2, restricts

Granuloma - high T1, high T2, no restriction

231
Q

Thing to assess when looking at cholesteatoma?

A

Oscicles
Scutum
Tegmen tympani

232
Q

Classic imaging appearance of ameloblastoma?

A

“Soap bubble” appearance
Resorption of adjacent teeth
Avidly enhancing papillary projections are common

233
Q

Age group of capillary Vs cavernous hemangiomas of the orbit?

A

Capillary hemangioma - child
Cavernous hemangioma - adults

(You take blood from children’s capillaries)

234
Q

Typical appearance of a cricopharyngeal bar?

A

Posterior oesophageal indentation at C5-C6.

235
Q

Cavernous hemangioma MRI appearance?

A

T1 - iso to muscle
T2 - hyperintense to muscle, dark capsule
Gd - slow irregular enhancement

236
Q

Papilliary necrosis differential?

A

Diabetes
TB - early phase
Sickle cell

237
Q

How can you tell the difference between pleomorphic xanthoastrocytoma, pilocytic astrocytoma, and haemangioblastoma?

A

All 3 appear as cyst with enhancing nodule.

Pleomorphic xanthoastrocytoma - Supratentorial, in temporal lobe

Pilocytic astrocytoma - Posterior fossa in kids (NF1)
Haemangioblastoma - Posterior fossa in adults (VHL)

238
Q

Posterior fossa masses?

A

4th ventricle tumours - ependymoma, medulloblastoma

Cyst with nondules - haemangioblastoma adult, pilocytic astrocytoma child

Brain stem gliomas

239
Q

Pheochromocytomas are associated with what conditions?

A

NF1
MEN IIa + MEN IIb
VHL

240
Q

Mosaic attenuation differential?

A

Air trapping - hypersensitivity, CF, MAI

Vascular occlusive disease - CTEPH

Parenchymal disease - ground glass (infection, haemorrhage)

241
Q

Soft tissue sarcoma differential?

A

SLUR

Synovial sarcoma
Liposarcoma
Undifferentiated pleomorphic sarcoma
Rhabdomyosarcoma

242
Q

Most common HIV related abscess in brain?

A

Toxoplasmosis

243
Q

How to differentiate between CNS Toxoplasmosis Vs Lymphoma in HIV patients?

A

Toxoplasmosis - multiple lesions, peripheral haemorrhage, ring enhancement, restricted diffusion

Lymphoma - single lesion, no haemorrhage, solid enhancement, facilitated diffusion.

244
Q

How does coarctation or aorta cause rib notching?

A

If the stenosis occurs distal to either subclavian artery, collateral pathways form via the internal mammary - intercostal artery - descending thoracic aorta, to supply the rest of body.

If the stenosis occurs between the subclavian arteries, then you get unilateral right sided collateral formation.

245
Q

Types of breast cancer?

A

DCIS
Intraductal carcinoma

Intra lobular carcinoma

Phyloides tumour

246
Q

Signal characteristics of endometrioma?

A

T1 high
T2 low (shading)

May have wall enhancement

247
Q

Brain stem high signal?

A

Demyelination - MS, subacute combined degeneration, osmotic degeneration (alcoholics)

Brain stem stroke.

Infection - herpes myelitis

Syrinx

248
Q

Adrenal tumours?

A

Adrenal cortical carcinoma - large heterogenous lesions

Phaechromocytoma - smaller heterogenous lesion

Adrenal myelolipoma - fat containing

Adenoma - small, <10 HU non-contast CT

249
Q

Choroid plexus tumours?

A

Choroid plexus papilloma
Choroid plexus carcinoma

250
Q

Types of osteochondromatosis?

A

Primary
Secondary - caused by degeneration

251
Q

Tamoxifen endometrium changes?

A

Thickness upto 12mm

Sub endometrial cysts

Endometrial polyps

252
Q

Calcified brain tumours differential?

A

Supratentorial - oligodendroglioma, ganglioglioma, cavernous haemangioma

Ventricular - ependymoma, subependymoma, central neurocytoma, choroid plexus papilloma

Pineal - pineoblastoma

253
Q

Bilateral thalamic infarcts differential?

A

Cerebral vein thrombosis
Artery of Percheron infarct

254
Q

H shaped vertebrae differential?

A

Sickle cell
Gaucher’s

255
Q

Calcified pulmonary metastasis differential?

A

Sarcomas - Osteosarcoma, chondrosarcoma

Mucinous - Ovarian/appendix

Medullary thyroid cancer

256
Q

Pseudoarthrosis differential?

A

NF1
Fracture non union
Ehlers danlos
Osteogenesis imperfecta

257
Q

Bowed leg differential?

A

Rickets
NF1
Osteogenesis imperfecta
Blount disease (Tibia vara)

258
Q

Globe calcification differential?

A

Retinoblastoma
Choroidal osteoma (tuberous sclerosis)
Drusen

259
Q

Klippel trenaunay syndrome triad?

A

Limb hypertrophy

Varicose veins/vascular malformations (GI bleeding)

Port wine naevi

260
Q

Calcified adrenal glands differential?

A

Previous TB
Neuroblastoma
Haemorrhage
Wolman disease

261
Q

Bilateral CPA angle masses differential?

A

Scwannoma - NF2
Sarcoidosis
Metastases

262
Q

Non accidental injury skeletal survey protocol?

A

Chest with oblique rib views
Abdomen and pelvis
Whole spine view
Limb views
CT Head all children <1yo
CT Head children >1yo if suspicion of head injury

Repeat skeletal survey in two weeks:
Any suspicious areas
Chest with oblique rib views
Limb views

263
Q

Non accidental injury highly suspicious injuries?

A

Posterior rib fractures
Metaphyseal corner fractures
Scapula
Spinous process
Sternal fracture

Subdural haematoma
Retinal haemorrhage

264
Q

Neonatal bowel obstruction differential?

A

Proximal:
- Oesophageal atresia
- Duodenal atresia, stenosis, web
- Annual pancreas
- Malrotation

Distal:
- Hernia
- Ileal atresia
- Colonic atresia, stenosis
- Meconium ileus, plug syndrome (CYSTIC FIBRROSIS)
- Hirschprung disease
- NEC

265
Q

Manifestations of cystic fibrosis?

A

ulmonary:
- Bronchiectasis

Abdominal:
- Pancreatitis
- Fatty replacement of pancreas
- Distal intestinal obstruction syndrome
- Meconium ileus/plug

266
Q

Imaging findings of autoimmune pancreatitis?

A

Sausage shaped pancreas
Minimal peripancreatic fat stranding
Peripancreatic low attenuation halo

267
Q

Management of lung cancer on CXR

A

CT Thorax and upper abdomen including liver and adrenals

Lung MDT discussion

MRI Brain

Biopsy, coaxial needle 16- 18 gauge

268
Q

Lytic bone lesion management

A

Compare previous

Chest Xray if in the department or CT TAP

269
Q

Well defined lung lesion with central calcification differential

A

Hamartoma
Lipoma
Carcinoid tumour

270
Q

Benign narrow zone of transition bone tumour differential?

A

ABC / Simple bone cyst
Brown tumour
Chondroblastoma
Enchondroma/Eosinophilic granuloma
NOF

271
Q

Wide zone of transition bone pathology differential?

A

Mets
Myeloma

Lymphoma
LCH

Osteosarcoma
Osteomyelitis

272
Q

Rib lesion differential?

A

FAMES

Fibrous dysplasia
ABC
Mets/myeloma
Enchondroma/eosinophilic granuloma
Sarcoma

273
Q

Management of suspected sarcoma Vs mets/myeloma?

A

Sarcoma:
- Refer sarcoma centre
- Don’t biopsy
- Look for skip lesions (MR entire bone)
- Look for mets - CTTAP

Mets/myeloma:
- Oncology MDT
- Look for primary - CTTAP
- Myeloma screen
- Biopsy

274
Q

Causes of perfusion defect Vs matched defect on VQ scan?

A

Perfusion - PE, Vasculitides

Matched - Asthma, pneumonia

275
Q

How do you define recurrent UTI?

A

3 or more episodes of lower UTI
1 episode lower UTI + 1 pyelonephritis
2 episodes of pyelonephritis

276
Q

Paediatric NICE guidlines UTI follow up imaging guidelines?

A

Younger than 6 month with recurrent or atypical UTI:
- USS
- DMSA
- MCUG

Between 6 months and 3 years
- DMSA
- MCUG only if hydronephrosis, NON Ecoli infection, or reduced urine flow

Over 3 years:
- DMSA with recurrent UTI

Perform the DSMA scan 4-6 months post UTI

277
Q

Germinal matrix haemorrhage grading?

A

Grade 1 - confined to Germinal matrix
Grade 2 - extension into ventricles <50%
Grade 3 - extension into ventricles >50%, or dilated ventricles
Grade 4 - extension into venous infarction

278
Q

Optic nerve glioma Vs optic nerve sheath meningioma?

A

Optic nerve glioma
- optic nerve thickening
- kinking and buckling of the optic nerve
- no calc
- variable enhancement

Optic nerve sheath meningioma
- nerve sheath thickening, sparing of nerve (tram track sign)
- calcification is common
- bright enhancement

279
Q

Differential for Charcot joint

A

Diabetes
Syringomyelia
Spinal cord injury
MS

280
Q

Batwing pulmonary opacification differential

A

Pulmonary oedema
Pneumonia
Pulmonary alveolar proteinosis
Pulmonary haemorrhage

281
Q

Bowel ischaemia - things to review?

A

Pneumatosis
Portal veinous gas
Free gas
Free fluid
Arteries
Veins - venous ischaemia

282
Q

Para-aortic mass encasing aorta differential?

A

Lymphoma
Neuroblastoma
Retroperitoneal fibrosis
Aortitis

283
Q

UK breast screening programme?

A

All women aged 50 up to 71 are invited for breast screening every 3 years.

284
Q

Non radiological tests for:
- TB
- Sarcoid
- Gout
- Rheumatoid
- Granulomatosis with poly angitis

A
  • TB - Sputum sample, acid fast bacilli
  • Sarcoid - Serum ACE
  • Gout - Uric acid levels
  • Rheumatoid - Anti CCP, rheumatoid factor
  • GPA - cANCA
285
Q

Omental cake differential?

A

Metastatic disease - ovarian, gastric, colon.

Pseudomyxoma peritonei
Lymphoma
TB

286
Q

4th ventricle tumours, Ependymoma Vs Medulloblastoma

A

Both classically 4th ventricle tumours.

Ependymoma arises from the floor of 4th ventricle, squeezing out of it (toothpaste sign). Calc + haemorrhage - enhance heterogeneously.

Medulloblastoma arises from the roof of 4th ventricle, protruding into it. Enhance more homogenously.

287
Q

What is Osler Weber Rendu syndrome?

A

Hereditary haemorrhagic telangiectasia. Autosomal dominant
Characterised by multiple AVMs.

Typically:
- Nasal 90%
- Skin 90%
- Liver 70-80%

288
Q

What is a paraganglioma and what are its classical imaging appearances on MRI?

A

They are also called glomus tumours.
Neuroendocrine tumor.
Highly vascular, containing micro haemorrhages, causing salt and pepper appearance on MRI.

289
Q

MRI signs for:
- multisystem atrophy
- Progressive supranuclear palsy
- Corticobasal degeneration

A
  • Multisystem atrophy - hot cross bun sign, cruciate high T2 signal at the pons.
  • Progressive supranuclear palsy - Mickey mouse sign, midbrain atrophy with sparing of the pedicles. Huming bird sign, flattening of the superior aspect of the midbrain.
  • Corticobasal degeneration - asymmetric cortical atrophy, basal ganglia atrophy, and atrophy of the corpus callosum.
290
Q

Acute stroke findings on MRI?

A

T2 bright
Restricted diffusion

ADC values pseudo-normalise as time progresses (~2 weeks)

291
Q

Intramedullary spinal neoplasms?

A

Ependymoma (60%) - NF2
Astrocytoma (33%) - NF1
Haemangioblastoma (2%) - VHL
Ganglioglioma (1%)

292
Q

Interstitial lung disease differential?

A
  • UIP - Honey combing
  • NSIP - ground glass with sub pleural sparing
  • RA - UIP/NSIP pattern. Pleural thickening/effusion. Pneumoconiosis (Caplan).
  • Ank spond - upper lobe fibrocystic disease
  • Scleroderma - pneumonitis and fibrosis
293
Q

How to differentiate HCC from Cholangiocarcinoma?

A

HCC invades the portal vein.
Cholangiocarcinoma encases the portal vein

294
Q

Classic imaging features of Primary Sclerosing Cholangitis, and what is its association?

A

Multifocal strictures of the intra and extra hepatic bile ducts.
Cirrhosis with regenerative nodules.

Associated with UC.

295
Q

Typical imaging features of chronic Budd Chiari syndrome?

A

Nutmeg liver - mottled contrast enhancment
Caudate lobe hypertrophy
Regenerative nodules
Ascites - Rapid onset

296
Q

MRI findings for phaeochromocytoma?

A

T1 - low
T2 - high
Gd - heterogenous enhancement
Out of phase - no signal loss

297
Q

Normal liver MRI appearance Vs spleen?

A

T1 - Liver > Spleen
T2 - Liver < Spleen
In/out - No change

298
Q

Lymphoma staging:

A

Lugano classification:

Stage I - One node/group of node.
Stage 1e - One extra-lymphatic site only (i.e. hepatic lymphoma, small bowel lymphoma WITHOUT nodal disease)

Stage II - two nodal groups on SAME side of diaphragm
Stage IIe - extralymphatic spread from a node

Stage III - nodes both sides of the diaphragm

Stage IV - nodal and separate extra nodal disease/ multiple extra nodal disease

A - absence of symptoms
B - presence of symptoms

Bulky - Single nodal mass >10cm, or 1/3 of thoracic diameter

299
Q

What is neonatal pulmonary interstitial emphysema?

A

Ventilator pressure associated.
Cystic / linear radio lucencies with hyperinflation.
Sign of impending pneumothorax.

300
Q

Correct positions for UVC and UAC?

A

UVC - atriocaval junction
UAC - initially travels inferiorly, then turns superiorly, with tip ending at T7

301
Q

How can you differentiate Pleuropulmonary blastoma from pulmonary Ewing’s sarcoma?

A

Both present as massive thoracic masses.

Ewing’s destroys ribs.

302
Q

What are the 5 types of tracheosophageal fistula?

A

A - isolated esophageal atresia
B - proximal fistula with distal atresia
C - distal fistula with proximal atresia (85%)
D - proximal and distal fistula
E - H type, isolated fistula

303
Q

What are the different diagnosis for short microcolon vs long microcolon?

A

Short microcolon - colonic atresia
Long microcolon - meconium ileus (CF patients), ileal atresia

304
Q

What are the five grades for vesico ureteric reflux?

A

1- halfway up the ureter
2 - reflex into non-dilated collecting system
3 - reflex into dilated collecting system
4 - mildly tortuous ureter
5 - very tortuous ureter

305
Q

Unilateral paediatric cystic kidney differential?

A

Muliloculated cystic nephroma
Multicystic dysplatic kidney - non functioning kidney on DSMA/MAG3

306
Q

What is associated with CPAM?

A

Renal agenesis
Pleuropulmonary blastoma
Mucinous adenocarcinoma

307
Q

What are:
Sequestrum
Involucrum

Sinus tract
Cloaca

A

Sequestrum - piece of necrotic bone surround by granulation tissue
Involucrum - thickened bone overlying chronic bone infection

Sinus tract - channel from bone to skin lined by granulation tissue
Cloaca - defect in the periosteum caused by infection

308
Q

Paraganglioma differential?

A

Schwannoma
Lymphadenopathy

2b + Differential Diagnosis (1 decks)

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