FRCR 2A Flashcards
Solid intrarenal tumour of infancy
Mesoblastic nephroma
Which single chest x-ray view would you advise to maximise the chances of confirming foreign body inhalation in the paediatric Group?
Expiratory Scan
Regarding germinal matrix haemorrhage
Intraventricular with no dilation
Grade 2
GMH: intraventricular haemorrhage with dilation
Gade 3
GMH: intraparenchymal haemorrhage
Grade 4
Which of the following is not a cause of secondary craniodysostosis?
- Crouzon’s syndrome
- Hypothyroidism
- previous shunt procedure
- Ricketts
- thalassaemia
Hypothyroidism
18 month old boy presents with fever and watery diarrhoea. Hypertension. Palpable mass superior to left kidney containing hypoechoic area ultrasound and low density areas on CT.
- Adrenocortical carcinoma
- adrenal haemorrhage
- neuroblastoma
- TB
- Wilm’s
Neuroblastoma
Regarding enteric duplication cyst, which one is true?
- most commonly located in duodenum
- Majority communicate with lumen
- Usually calcification in the wall
- Located on the anti mesenteric side
- Capsule contains two Wall
- Capsule contains two Wall
Most commonly located in TI.
Located on the mesenteric side
No communication
No calcification
What is the commonest presenting feature of a Meckel’s diverticulum?
Obstruction Volvulus Bleeding Diverticulitis Perforation
Bleeding
Which of the following features not a typical finding of normal thymus on CXR
Wavy inferior margin Change in inspiration and expiration No mass effect convex lateral borders Homogenous density
Wavy inferior margin
Which of the following is not a risk factor for neonatal renal vein thrombosis?
Birth trauma Dehydration Diabetic mother Right adrenal haemorrhage Sepsis
Right adrenal haemorrhage
Left adrenal haemorrhage is the cause of renal vein thrombosis. The left adrenal vein drains to the left renal vein. The right adrenal drains directly into IVC
Which of the following favours a diagnosis of chronic periventricular leucomalacia over porencephaly?
- anechoic cyst
- persistence of cysts on follow-up
Separated cyst
Symmetrical distribution
Watershed territory
Symmetrical distribution
Neonate with a history of IUGR has bilateral deformity of the knees. X-ray shows dense femoral diaphysis with alternating Lucent/ dense Lines through the metaphysics. No periosteal reaction
Achondroplasia Ricketts Rubella Scurvy Syphilis
Rubella
Celery stalk
What future would make the diagnosis of SUFE more likely than Perthes?
Bilateral changes Fragmented epiphyses Reduced epiphysis height Subchondral fissure Widened growth plates
Reduced epiphysis height
Early signs of SUFE:
Widened growth plates and reduced epiphysis height.
Which of the following should be avoided prior to Pertechnetate studies for Meckel’s diagnosis.
Cimetidine Glucagon Pentagastrin Perchlorate Pertechnetate
Perchlorate
This is usually given after this study to protect the thyroid gland from accumulation of tracer. However if this is given prior to scanning it will block tracer uptake by gastric mucosa
Which is abnormal in the context of traumatic injury in a 10 year old child?
Anterior wedging of C3 vertebral body. Anterior list thesis in flexion at C2/3 Pre vertebral soft tissue thickness of 15 mm at C6 Predental space of 6 mm in flexion Predental space of 3mm in neutral
Predental space of 6 mm in flexion
The maximum space is 2.5- 3 mm in adults and 5 mm in children. Any widening suggests injury to the alar ligamentous complex in the context of trauma.
Other causes of widening: down syndrome, rheumatoid arthritis, neurofibromatosis and OI.
Anterior wedging C3 and pseudosubluxation at C2/3 and C3/4 are within normal limits in children
15 year old female whose father had progressive renal failure presents the anaemia, polyuria and haematuria. Ultrasound kidneys are small and smooth. Which associated finding is most likely?
Pancreatic cysts Posterior fossa haemangioblastoma Cystocoel Nerve deafness Hypertension
Nerve deafness
Alports syndrome. Ocular abnormalities can occur including congenital cataracts, Nystagmus, myopia. Hypertension is not feature.
Bilateral bowing of femoral and tibia. Generalised osteopenia, deficient trabeculation, multiple fractures, Cortical thinning. Diagnosis? Ricketts Blounts OI Neurofibromatosis Yaws
OI
Test used for detection of accessory spleen
Sulfor colloid
Small foci of haemorrhage in spleen , signs of P HTN. T2 dark
Diagnosis?
Gamma Gandy Bodies- sideritic nodule
Gradient is the most sensitive sequence
Triad of Felty’s syndrome
- Splenomegaly
- rheumatoid arthritis
- neutropenia
abnormal loops of bowel bwn PV and IVC. What type of hernia?
- Foramen of Winslow
- Lt paraduodenal
- Transmesenteric
- Rt Paraduodenal
- Intersigmoid
Foramen of Winslow
Lt Paraduodenal: defect in the descending colon and lie to the left of D4.
Rt paraduodenal: behind SMA and is associated with malrotation
Trans mesenteric hernia commoner following surgery
MRI shows fluid tracks extending from the perineum on the right running medial the External anal sphincter throughout its course on entering the anus at 6 o'clock position. How should you report this? Horseshoe fistula Extra sphincteric fistula Trans sphincteric fistula Supra sphincteric fistula Inter sphincteric fistula
Inter sphincteric fistula-this is the only one that doesn’t pass through the external sphincter (always medial to it).
If a fistula extends around both sides of the anal canal it’s called horseshoe extension.
Which of the following condition it Is not associated with Helicobacter pylori colonisation?
- Oesophageal carcinoma
- gastric ulcer
- gastric carcinoma
- MALT lymphoma
- Du ulcer
Oesophageal carcinoma
MRI liver: smooth contour, Dark T1/T2. What is the diagnosis?
- acute hepatitis
- focal fatty liver
- haemochromatosis
- autoimmune liver disease
- Wilson disease
haemochromatosis
A 32-year-old man undergoes an MRI scan for back pain. The MRI scan demonstrates a split cord with a bony bar in the canal.
Which of the following is NOT associated with diastematomyelia?
Spinal cord lipoma Scoliosis Tethered cord Clubfoot Narrowed interpeduncular distance
Narrowed interpeduncular distance
asso with Meningocoele Hemivertebrae and scoliosis Widened interpeduncular distance (as opposed to narrowed distance) Neurenteric cyst Talipes equinovarus Dermoid Spinal haemangioma Spinal cord lipoma
What is a typical feature of the joint affected by gout?
Joint space preserved until late in disease
No joint effusion
Periarticular de mineralisation
Erosion with thick sclerotic margin
Chondrocalcinosis in the majority of cases
Joint space preserved until late in disease
Effusion is the earliest sign with periarticular swelling and preservation of joint space until late in the disease
What findings would be typical for haemochromatosis? Osteosclerosis Geodes Chondrocalcinosis Asymmetrical joint space narrowing Narrowing of metacarpal head
Chondrocalcinosis
Skeletal features include: generalised osteoporosis small subchondral cyst like lesions in the metacarpal heads colour uniform joint space narrowing, Enlargement of metacarpal heads, Osteophyte formation and chondrocalcinosis
Differentials include psoriatic arthritis, OA, RA and gout
What future would be in keeping with a charcot joint?
- Juxta-articulate is the process
- loose bodies
- severe pain
- blunted shape of metatarsal heads
- widened joint space
Loose bodies
Middle aged man presented to ED with right hip pain that started suddenly a few weeks previously and resulted in reduced range of movement. X-ray: osteoporosis of the hip joint and loss of subchondral cortex of the femoral head with preservation of joint space. What’s diagnosis?
Avascular necrosis Transient osteoporosis Sinovial chondromatosis Disuse atrophy Villonodular synovitis
Transient osteoporosis
Loss of subchondral cortex is pathognomonic. No joint space narrowing. No collapse.
46-year-old man presented with back pain and was noted to have marked calcification and loss of height of multiple intervertebral discs predominantly in the lumbar spine. Previous radiograph of his knee also shows premature osteoarthritic changes with pronounced chondrocalcinosis. What’s your diagnosis?
Ankylosing spondylitis Ochronosis Hyperparathyroidism Wilsons disease Reiters syndrome
Ochronosis
or alkaptonuria he is an inherited enzyme deficiency resulting in the deposition of black pigment in cartilage. The features described are typical and they may also suffer from renal and cardiac failure.
What finding would be most consistent with hibernating myocardium?
75% subendocardial delayed enhancement Normal myocardial contractility at rest No myocardial delayed enhancement Epicardial hyper enhancement Patchy hyper enhancement of my recording
No myocardial delayed enhancement
43 year old female presented with fatigue and dyspnoea to her GP who requested chest x-ray. This showed an enlarged heart and pulmonary outflow tract with a small aorta and pulmonary plethora. What is the diagnosis?
VSD ASD Aortic regurgitation Pulmonary stenosis Epstein Anomaly
ASD
Enlarged heart and pulmonary plethora suggests a left-to-right shunt. At this age the only that likely cause is an ASD
Six weeks echo post MI : akinetic portion of left ventricular wall and delayed enhancement cardiac MR images shows high signal at 10 minutes in the same area of LV wall. What is the cause?
LV aneurysm Stunned myocardium Focal myocarditis Focal myocardial fibrosis Hibernating myocardium
Focal myocardial fibrosis
A 53-year-old man has AP and lateral radiographs of the right ankle after twisting it whilst playing football. There is no fracture seen, however a central, triangular radiolucent area is seen on the lateral projection in the talar dome. It is well defined with a narrow zone of transition and communicates with the joint space.
What is the most likely diagnosis? Select ONE answer only.
Pseudo-cyst of calcaneus Geode Intraosseous lipoma Chondroblastoma Unicameral bone cyst
Geode
This is a subchondral cyst associated with OA which should have communication with the joint space and be present in an older patient.
A 15-year-old boy who plays rugby for his local club injures his leg following a particularly hard tackle. He makes a good recovery initially but three months later is still experiencing symptoms at the site of bruising and he undergoes an x-ray. The x-ray points to a diagnosis of myositis ossificans which is subsequently confirmed with CT.
Which of the following patterns of calcification would be most specific for myositis ossificans?
- Poorly defined mass with marginal calcification
- Well-defined mass with central calcification
- Poorly defined mass with diffuse calcification
- Poorly defined mass with central calcification
- Well-defined mass with marginal calcification
Well-defined mass with marginal calcification
A 53-year-old man collides with one of the hurdles during his son’s sports day. Two months later he is still noticing a lump around the distal femur and undergoes an x-ray. There is a well defined partly calcified soft tissue mass underlying the tender area. There is cortical erosion of the underlying bone.
What is the most likely diagnosis?
Osteosarcoma Tumoral calcinosis Gout Myositis ossificans Malignant fibrous histiocytoma
Malignant fibrous histiocytoma
Cortical erosion of the underlying bone is an important diagnostic feature. On MRI it returns high signal on both T1 and T2 weighted sequences.
Based on age alone, what’s the most likely primary Bone tumour in 45 year old male?
Osteosarcoma Chondrosarcoma Giant cell tumour Aneurysmal bone cyst Osteoid osteoma
Chondrosarcoma
Which areas is most likely to be involved in spinal cord astrocytoma?
Brainstem Cervical spine Thoracic spine Lumbar spine Sacrum
Thoracic spine
Eccentric location
Long segments
38-year-old man presented with a lump on the dorsal aspect of his hand that moved with the tendon on flexion and extension of his fingers. X-ray and MRI performed. Expected? Dense calcified mass Low signal on T2 High signal on T1 No internal septation Periosteal bone formation
Periosteal bone formation
This is ganglion attached to tendon
Low T1, high T2, internal septation and periosteal new bone formation
What distribution of involvement is typical in haemochromatosis?
Interphalangeal joint of thumb PIP of all fingers DIP middle and ring MCP index and middle finger MCP ring and little fingers
MCP index and middle finger
Patient is in the wheelchair and is complaining of sore knee. X-ray shows Long gracile femur and tibia indicating under tabulation. What is the most likely cause? Dwarfism Gauchers disease cerebral palsy Juvenile rheumatoid arthritis
cerebral palsy
What radiographic features are consistent with hypertrophic pulmonary osteoarthropathy?
Metaphyseal lamellar periosteal reaction
Irregular epiphyseal periosteal proliferation
Asymmetrical feathery periosteal reaction
Cortical thickening and coarsening
Symmetrical solid periosteal and new bone formation
Metaphyseal lamellar periosteal reaction
Symmetrical solid periosteal and new bone formation- seen in hypervit A
Which of the following findings considered pathognomonic for nail patella syndrome?
Patellar hypoplasia Lateral elbow hypoplasia Posterior iliac horns calcanea valgus feet Madelung deformity
Posterior iliac horns
Which of these features is atypical of rheumatoid arthritis?
Symmetrical disease
Synovitis on ultrasound but no erosions radiologically
Erosions in radioulnar joint andradiocarpal joint preceding MCP erosion
Bony ankylosis of the carpal bones
Peri articular osteoporosis
Bony ankylosis of the carpal bones
25 man presented with a painful knee. An x-ray shows Lucent area with wide zone of transition in the distal femoral metaphysis. MRI shows fluid fluid levels. Diagnosis?
Aneurysmal bone cyst GCT Osteosarcoma Chondroblastoma Osteoblastoma
Osteosarcoma
35-year-old man sprained ankle and attended ED. X-ray shows no fracture. the lateral view shows well defined radiolucent lesion with a faint sclerotic margin in the mid calcaneus. Some central classification within the lesion. Diagnosis?
Simple bone cyst Normal variant Enchondroma Intraosseous lipoma Bone infarcts
Intraosseous lipoma
Central dystrophic calcification in 62% of cases is considered to to be pathognomonic.
Simple bone cyst does not contain Central classification.
30-year-old runner presented with history of pain in legs on Running. X-rays unremarkable. Isotope bone scan shows a subtle longitudinal linear uptake on the delayed bone can images with normal angiogram and blood pool images. What is the diagnosis?
Stress fracture Shinsplints Osteoid osteoma Osteomyelitis Hypertrophy osteoarthropathy
Shinsplints
In stress fracture angiogram and blood pool images are abnormal with hyperperfusion and hyperaemia. On delayed images focal fusiform uptake is seen stress fracture.
39-year-old man presents with gradually enlarging swelling in the upper lateral aspect of right calf. Ultrasound and MRI shows well-defined, thinly septated cystic lesion intimately related to proximal tibiofibular joint and extending into the adjacent soft tissue. It measures approximately 4 cm in maximum diameter. No enhancement of soft tissue component postinjection Gd. What is the diagnosis?
Para meniscal cyst Bursitis Focal Tenosynovitis Ganglion cyst Chronic seroma
Ganglion cyst
This is a ganglion cyst adjacent to tibiofibular joint causing comment peroneal nerve palsy.
Middle aged man with no significant medical history undergoes Xray of pelvis following a fall. Multiple longitudinally orientated 2 - 10 mm roundup density similar to cortical bone are seen throughout the cancellous bone in a diffuse symmetrical pattern concentrated around the acetabulum. No fractures. What is the most likely diagnosis?
Osteopathia striata Osteopetrosis Bony metastasis Melorrrhoestosis Osteopoikilosis
Osteopoikilosis
This is causing multiple bone islands which are asymptomatic and usually have no clinical significance.
They represent deposits of normal cortical bone within cancellous bone.
Osteopathic striata- this is similar but it consists of linear longitudinal or sunburst striation rather than rounded densities.
Osteopetrosis causes generalised increase in bone density
30 year old man undergoes shoulder MRI for chronic anterior pain. No history of trauma. Sag images showed absent anterior Labrum and thickend middle glenohumeral ligaments. Diagnosis?
Anterior labral tear Bankart lesion SLAP lesion GH tendinitis Normal variant
Normal variant
This is Buford complex- absent anterior Labrum with thickened cord liked middle GH ligament.
List the differential diagnosis for lytic expansile metastatic deposits (4)
Renal
Thyroid
Melanoma
Pheochromocytoma
Volar tilt of lunate seen as a triangular or pie shaped lunate on AP projection of the wrist is most commonly a feature which of the following?
scapholunate dissociation Perilunate dislocation Lunate dislocation VISI DISI
Lunate dislocation
Which MRI finding is the most specific indication of an unstable osteochondral fragment?
Joint effusion Subfragmental bone resorption 3mm cyst deep to the lesion Underlying linear high signal on T2 WI Multiple lesions
Underlying linear high signal on T2 WI
Other signs include:
Cartilaginous defect on T1 weighted images.
Hi signal in articular cartilage and a cystic lesion in the bed (>5mm)
Gastroduodenal artery has its origin from which vessel? SMA Common Hepatic Artery Left gastric artery coeliac axis Aorta
Common Hepatic Artery
CT shows multiple irregular calcified low-density lesions in the liver suggestive of metastasis. What’s the most likely primary lesion?
IDC Breast Mucinous adenocarcinoma of GI track Osteosarcoma Non small cell lung cancer Carcinoid
Mucinous adenocarcinoma of GI track
Is most commonly seen with mucinous carcinoma of gastrointestinal tract.
A 50-year-old woman has an USS thyroid which shows a mixed cystic and solid region in the left lobe with low reflectivity overall. There are associated malignant looking lymph nodes in the left cervical chain. What is the most likely diagnosis
Papillary thyroid cancer Anaplastic thyroid cancer De-Quervain thyroiditis Hashimoto thyroiditis Lymphoma
Papillary thyroid cancer
A 48-year-old man undergoes a CT scan for follow up at 12 months post resection of an adrenal malignancy. His past surgical history also includes resection of a parathyroid tumour. The CT shows a solitary pancreatic mass with significant enhancement on the arterial phase. What is the most likely diagnosis?
Adenocarcinoma Choledochal cyst Glucagonoma VIPoma Adrenal metastasis
Glucagonoma
4 Ds: Diabetes, Deep vein thrombosis, Depression and Dermatitis although this is relatively rare.
necrolytic erythema migrans which is an intensely itchy maculopapular rash.
Although less common than insulinomas and gastrinomas, glucagonomas are associated with MEN as well.
VIPomas cause a watery diarrhoea and hypokalaemia termed Verner-Morrison syndrome. They are NOT associated with MEN.
A 23-year-old man suffers an injury to the knee whilst playing basketball. Plain radiographs demonstrate a small flake of bone adjacent to the fibular head.
What is the most likely underlying ligamentous injury?
Posterior Cruciate Ligament Injury Lateral meniscus tear Anterior Cruciate Ligament Injury Posterolateral Corner injury Medial collateral ligament tear
Posterior Cruciate Ligament Injury
The ‘arcuate sign’ is an avulsion of the proximal fibula due to the insertion of the arcuate ligament. 90% of these are associated with a PCL injury.
A 55-year-old lady with a worsening headache has an MRI scan which shows enlargement of optic nerve. On the post-contrast sequences there is linear peripheral enhancement with central non-enhancement. What is the most likely diagnosis?
Orbital pseudotumour Sarcoidosis Optic neuritis Meningioma Orbital lymphoma
Meningioma
The tram-track sign refers to enhancement of the optic nerve sheath post-contrast.
Optic neuritis can sometimes be seen as high T2 signal within the optic nerve as opposed to post-contrast enhancement.
Glioma: causes kinking or buckling of the optic nerve which a meningioma does not.
A 76-year-old gentleman known to have type 2 diabetes and receiving haemodialysis for renal failure attends his GP surgery. He is a retired manual labourer and is complaining of back pain. His GP believes his back pain to be degenerative in nature but none the less requests a lumbar spine x-ray anyway. This shows end-plate sclerosis but also bilateral calcification projected over the renal outline. What is the most likely diagnosis?
Secondary Hyperparathyroidism Sclerosing encapsulating peritonitis Primary Hyperparathyroidism Renal papillary necrosis Medullary sponge kidney
Secondary Hyperparathyroidism
This patient has renal osteodystrophy as evidenced by his history of dialysis x-ray findings. Secondary hyperparathyroidism goes hand in hand with renal osteodystrophy and medullary nephrocalcinosis is a finding in hyperparathyroidism.
Contrasts in the Midcarpal compartment can be explained by which of the following structures?
Triangular fibrocartilage Lunotriquetral ligament Dorsal distal radioulnar ligament Flexor retinaculum Radio scapha lunate ligament
Lunotriquetral ligament
BM oedema in vertebra (low T1, Bright T2), is seen in all but which of the following? Degenerative disc disease Multiple myeloma Osteoporotic collapse Spondylolitis AS
Multiple myeloma
Which of the following fractures is most likely to Indicate a significant injury to the underlying intrathoracic structures? Glenoid Scapula blade Clavicle First rib Sternum
First rib
All of the following are associations of chairi II malformations except….
Dysgenesis of corpus callous Klippel Feil syndrome Syringomyelia Meningomyelocele Tectal beaking
Klippel Feil syndrome
All of the following features of contrast induced nephropathy except….
Alternative major insults to kidneys pulled out
Increase in serum Cr of 0.5 mg/dL
Rise in serum Cr level by more than 50% of baseline
Increase in Cr 48 to 72 hours after administration contrast
Raised Cr persists for 2 to 5 days
Rise in serum Cr level by more than 50% of baseline
Diagnostic criteria include exposure to contrast agent, increase in serum level of Cr 0.5 mg/dL or 25% greater than baseline, increase in level a Caring 1472 hours after administration persisting for 2 to 5 days
Central mass with a homogenous Signal intensity on MRI in the fourth ventricle in a 4yr child. Which of the following is the most likely diagnosis?
Astrocytoma Medulloblastoma Ependymoma Pontine glioma Tectal plate glioma
Medulloblastoma
Most common infratentorial brain tumour. Presents as a midline non-calcified solid mass obstructing the fourth ventricle.
It typically arises from the roof of the fourth ventricle and is midline in location in 75 to 90% of cases.
It is hyperdense relative to brain on CT shows restricted diffusion on DWI.
36-year-old woman with small cystic lesion in the liver had a CT KUB for suspected stone. CT shows speckled calcification in medulla of both kidneys. Review of an old IVU showed striated nephrogram and filling defect in the proximal right ureter. What’s the most likely diagnosis?
HyperPTH Medullary sponge kidney Medullary cystic disease Acquired renal cystic disease PCKD
Medullary sponge kidney
This involves dysplastic dilatation of medullary and papillary collecting ducts. It is associated with Ehlers Danlos syndrome, Parathyroid adenoma, Caroli’s disease.
Bunch of flower appearance and dense striated nephrogram
46-year-old woman with a constant headache has a CT which shows suprasellar solid cystic lesion with some calcification. MRI shows high signal in both T1 and T2. Marginal enhancement of the peripheral solid rim portion of the lesion is also noted. Diagnosis?
Craniopharyngioma Pituitary adenoma Pineoblastoma Meningioma Dermoid cyst
Craniopharyngioma
25 yr old man progressive pain in knee. X ray: OA with increased soft tissue swelling and density. Tomorrow: diffuse low signal on T2 with large joint effusion. Diagnosis?
Amyloid Haemophilia PVNS Primary Sinovial osteochondromatosis Rapidly destructive articular disease
Haemophilia
Haemorrthrosis- joint effusion
] synovial inflammation and hyperaemia- osteoporosis and epiphyseal overgrowth.
Subchondral erosion
Joint space narrowing
Osteophytosis
Widening of intercondylar notch, Flattening of condylar surface and squaring patella are very characteristics of chronic haemarthrosis of the knee.
Regarding malignant thyroid nodules which of the following statement is true?
Punctate calcification is feature of papillary carcinoma
Anaplastic carcinoma is associated with MEN syndrome
Echogenic foci in medullary carcinoma are due to calcitonin deposit.
Characteristic lymphadenopathy in medullary carcinoma is hypoechoic to muscle
Follicular carcinoma can be differentiated from follicular adenoma on ultrasound
Punctate calcification is feature of papillary carcinoma
Microcalcifications appears as punctate hyper echoic foci without shadowing.
Coarse Ca is seen in medullary type.
All of the following causes BG Ca except... PseudohypoPTH Lead poisoning Aging HypoTSH Wilson's disease
Wilson’s disease
