Gamesmanship Flashcards
Mammo:
The calcifications don’t change configuration on CC and MLO views. This is the so called “tattoo sign “ for DERMAL calcifications. Next step: tangential view to prove it.
.
Mammo:
Remember that secretory calcifications occur after menopause. Don’t call them secretory in a premenopausal patient (no matter how much they look like them).
.
Mammo:
If they show you a ML view for calcifications. Think hard about milk of calcium - is it tea cupping?
.
Mammo:
If a test writer wants you to say DCIS, they can prompt it 3 ways:
1) suspicious calcifications (fine linear branching or fine pleomorphic),
2) non mass like enhancement on MRI,
3) multiple intraductal masses on galactography.
.
Mammo:
Skin thickening and trabecular thickening should get progressively better with time. It should start out worst, then better, then better. If it gets worse—this recurrent disease.
.
Mammo:
Gynecomastia looks like a cancer on ultrasound. This is why a male breast cancer workup (palpable finding) always begins with a mammogram.
.
Nukes:
Distinguishing
Tc-99 DTPA vs Xe-133.
DTPA can be done in multiple projections. DTPA tends to clump in the central airways.
.
IR:
Sneaky things related to TIPS.
1) CO2 run during hepatic vein wedge—blowing liver dome off bc injection pressure too strong. Anytime see CO2 run over liver, think of this.
2) TIPS placed into hepatic artery (not portal vein). Pay attention to anatomy!
3) Could say portal systemic gradient was normal (3-6). Remember—TIPS treats portal hypertension. Don’t do TIPS on someone without portal HTN!
.
IR:
Self Expandable: anywhere you might get external compression.
Balloon Expandable: if you need more precise placement
May Thurner Syndrome—Self
SFA—Self
Focal Atherosclerosis Stenosis in distal aorta—balloon
Renal Ostium Stenosis—balloon
.
Vascular:
Thoracic Angiogram: If you see an angiogram through the great vessels and aorta, think about TOS, Takayasu, and Giant Cell. The locations are classic, and helpful.
Takayasu—young (probably Asian female),
Giant Cell-old person.
AGE TRUMPS LOCATION!
If they show you TOS, they’ll show arms up and down—dead give away.
If trauma, don’t forget to check great vessels (not just aorta)
.
Vascular:
Aortic Dissection on Angiogram:
Can show as opacification of abdominal aortic branch vessels during aortography (cath in aortic true lumen) w/branch vessels (celiac axis, sup. mesenteric a., and renal arteries) arising out of nowhere. They appear to be floating, w/little or no antegrade opacification of aortic true lumen.
“Floating Viscera Sign”
.
Vascular:
Collateral Filling:
If you inject SMA and the celiac branches fill—infers a tight stenosis at celiac origin.
If you inject celiac and the SMA branches fill—infers tight stenosis at the SMA origin.
.
Vascular:
Hand Angiograms:
Pathology: it’s going to be either Buergers or Hypothenar Hammer Syndrome (HHS).
Ask yourself: is ulnar artery involved?
If yes, go with HHS.
If the ulnar nerve (typo?) looks ok, but the fingers are out, go w/Buergers.
Careful: fingers can be out w/HHS too (distal emboli).
Pseudo-aneurysm off ulnar artery: slam dunk HHS.
.
Vascular:
Renal Artery Angiogram:
Ostial narrowing—think atherosclerosis; treat with balloon + stent
Beading mid vessel—think FMD; treat with balloon only
.
Vascular:
Kidney Angiogram
First question should always be
“Is there an RCC or AML?”
Second question should be
“Is there PAN/Speed kidney/A bunch of little aneurysms?”
.
Vascular:
Kawasaki:
Two classic ways to show this:
1) CT with a coronary artery aneurysm (obvious one),
2) calcified coronary artery aneurysm shown on CXR (old oral boards favorite)
.
Cardiac:
Signs of left atrial enlargement:
1) Double density—superimposed over contour of the right heart
2) Splaying of the carina—Angle over 90*
3) Posterior placement of the heart—seen on lateral CXR
.
Upper or Lower Lobe Predominant?
Most inhaled stuff (not asbestosis!)—coal workers, silicosis. Includes progressive massive fibrosis.
Upper
Upper or Lower Lobe Predominant?
CF
Upper
Upper or Lower Lobe Predominant?
RB-ILD
Upper
Upper or Lower Lobe Predominant?
Centrilobular Emphysema
Upper
Upper or Lower Lobe Predominant?
Ankylosing Spondylitis
Upper
Upper or Lower Lobe Predominant?
Asbestosis
Lower
Upper or Lower Lobe Predominant?
Primary Ciliary Dyskinesia
Lower
Upper or Lower Lobe Predominant?
Most Interstitial lung diseases (UIP, NSIP, DIP)
Lower
Upper or Lower Lobe Predominant?
Panlobular Emphysema (Alpha 1)
Lower
Upper or Lower Lobe Predominant?
Rheumatoid Lung
Lower
Upper or Lower Lobe Predominant?
Scleroderma
Lower
Obtuse margin with lung. Is it mediastinal or pulmonary origin?
Mediastinal
Acute margin with lung. Is it mediastinal or pulmonary origin?
Pulmonary
Ground glass nodule on PET:
HOT GGO = _______
Infection
Ground glass nodule on PET:
COLD GGO = _______
Cancer (BAC)
Collapse—
Always be on the lookout for collapse. Anytime see anything that could be, at least entertain idea.
-post intubation
-placement of central line
-ICU patient w/no other details (mucous plugging)
-outpatient w/no other history (cancer)
.
Pulmonary edema—
After chest tube placement: re-expansion edema
After crack or heroin: drug induced edema
After head injury: neurogenic edema
After lung transplant: reperfusion edema related to ischemia/reperfusion (peak day 4)
.
Collagen vascular tricks:
RA in shoulders on frontal CXR
Lower lobe UIP pattern
Collagen vascular tricks:
Ankylosing Spondylitis on lateral CXR
Upper lobe fibrobullous disease
Collagen vascular tricks:
Dilated esophagus on CT
Scleroderma with NSIP lungs
“Frozen hemithorax”—lack of contralateral mediastinal shift in association with massive pleural effusion . Diagnosis?
Mesothelioma.
It’s due to encasement of the lung (and fissures) by cancer
Infections in AIDS by CD4:
> 200
Bacterial infections,
TB
Infections in AIDS by CD4:
<200
PCP,
Atypical Mycobacterial
Infections in AIDS by CD4:
<100
CMV,
Disseminated Fungal,
Mycobacterial
AIDS:
Lung cysts = (diagnosis?)
LIP
LIP is AIDS defining in a pediatric patient
AIDS:
Lung cysts + ground glass + pneumothorax = (diagnosis?)
PCP
AIDS:
hypervascular nodes = (diagnosis?)
Castleman’s or Kaposi
AIDS:
Most common airspace opacity
Strep pneumonia
AIDS:
CT with ground glass = (diagnosis?)
PCP
AIDS:
Flame-shaped perihilar opacity = (diagnosis?)
Kaposi sarcoma
AIDS:
Persistent opacities= (diagnosis?)
Lymphoma
If they show you a varicocele, regardless of side (right being more suspicious than left), if it’s a next step question, look for the ____
Abdominal cancer
If “hyperemesis” is in question stem (repro), think ______
Things that give you elevated B-hCG—like moles and multiple pregnancy (twins)
If it’s a GYN case and has “history of abdominal surgery”, keep in mind _______
Peritoneal inclusion cysts (from adhesions)
Met to vagina in anterior wall upper 1/3 is “always” (90%) from _______
Upper genital tract
Met to vagina in posterior wall lower 1/3 is “always” (90%) from _______
GI tract
Fluid in endometrial canal in post menopausal woman should make you think ______
Cervix is obstructed (cancer, or more commonly stenosis)
Repro: combo of ovarian mass and thickened endometrium should make you think _____
Granulosa Cell Tumor
IUGR: Symmetrical
-baby or placenta issue?
Baby problem (placenta is fine)
IUGR: Symmetrical
-head spared or not?
head NOT spared
IUGR: Symmetrical
-when first apparent?
Early, including first trimester
IUGR: Symmetrical
-causes?
TORCHS,
Fetal EtOH,
Chromosomal abnormalities
IUGR: Asymmetrical
-baby or placenta issue?
Placenta problem
IUGR: Asymmetrical
-head spared or not?
Head spared
IUGR: Asymmetrical
-when first apparent?
Normal until third trimester
IUGR: Asymmetrical
-causes?
Maternal hypertension,
Severe malnutrition,
Ehler-Danlos
prostate CA v BPH:
______ is usually in the peripheral zone. When it is in central zone, T2 is “smudgy” or charcoal.
Prostate CA
prostate CA v BPH:
_______ is usually in central zone. Have a sharp border. Can “draw a line around them with a pencil”
BPH nodules
Gartner duct cyst v Bartholin cyst
______ is above pubic symphysis.
_______ is below.
GARTNER DUCT CYST is above pubic symphysis.
BARTHOLIN is below it.
Bicornuate v septate uterus
Distinguish the two by:
Apex of the fundal contour
Bicornuate v septate uterus
Apex of fundus >5mm above tubal Ostia
Septate
Bicornuate v septate uterus
Apex of fundus <5mm above tubal Ostia
Bicornuate
Bicornuate v septate uterus
Which has established increased 1st trimester loss?
Septate
Bicornuates have a lot less problems. Maybe no increased risk, depending who you ask
IVPs (GU section):
Haven’t been used since 1970s, but few tricks. If have medial deviation of the ureters, think______
Retroperitoneal fibrosis
IVPs (GU section):
Haven’t been used since 1970s, but few tricks. If have lateral deviation of the ureters, think______
Psoas hypertrophy, or lymph nodes
RCC v oncocytoma:
___ is typically colder than surrounding renal parenchyma on PET
RCC
RCC v oncocytoma:
___ is typically hotter than surrounding renal parenchyma on PET
Oncocytoma
Oncocytoma: if they wanted to ask it, can be shown 3 ways:
- CT solid mass with central scar
- ultrasound “spokewheel” vascular pattern
- PET CT it will be hotter than surrounding renal cortex
.
Renal cysts syndromes:
Cysts in liver, kidneys are BIG
Diagnosis?
ADPKD
Renal cysts syndromes:
Cysts in pancreas
Diagnosis?
VHL
Renal cysts syndromes:
kidneys are small
Diagnosis?
Acquired (uremic)
Renal cancer syndromes:
Subtype: Clear Cell
Syndrome/Association?
Von Hippel-Lindau
Renal cancer syndromes:
Subtype: papillary
Syndrome/Association?
Hereditary papillary renal carcinoma
Renal cancer syndromes:
Subtype: chromophobe
Syndrome/Association?
Birt Hogg Dube
Renal cancer syndromes:
Subtype: Medullary
Syndrome/Association?
Sickle cell trait
If you’re shown a unilateral renal agenesis case, remember association with _______ in men, and _______ in women
Men: absent vas deferens, and ipsilateral seminal vesicle Cyst
Women: mullarian anomalies (unicornuate uterus)
Showing persistent nephrograms —either by plain film or CT is the classic trick for ATN—usually contrast induced nephropathy.
.
CJD restricts diffusion (MRI).
.
Dilated esophagus on CT, ground glass in the lung bases (and maybe sub-pleural sparing). Diagnosis?
Scleroderma with NSIP
Benign Liver Masses
Hemangioma:
-ultrasound appearance?
Hyperechoic
Benign Liver Masses
Hemangioma:
-CT appearance?
Peripheral nodular discontinuous enhancement
Benign Liver Masses
Hemangioma:
-MR appearance?
T2 Bright
Benign Liver Masses
Rare in cirrhotics.
Which one?
Hemangioma
Benign Liver Masses
FNH:
-ultrasound appearance?
Spoke wheel
Benign Liver Masses
FNH:
-CT appearance?
Homogeneous arterial enhancement
Benign Liver Masses
FNH:
-MR appearance?
“Stealth Lesion —Iso on T1 and T2”
Benign Liver Masses
Central scar, Bright on delayed eovist (Gd-EOB-DTPA).
Which is it?
FNH
Benign Liver Masses
Hepatic adenoma :
-ultrasound appearance?
Variable
Benign Liver Masses
Hepatic adenoma :
-CT appearance?
Variable
Benign Liver Masses
Hepatic adenoma :
-MR appearance?
Fat containing on In/Out phase
Benign Liver Masses
OCP use, Glycogen storage Disease, can explode and bleed.
Which is it?
Hepatic adenoma
Benign Liver Masses
Hepatic angiomyolipoma :
-ultrasound appearance?
Hyperechoic
Benign Liver Masses
Hepatic angiomyolipoma :
-CT appearance?
Gross fat
Benign Liver Masses
Hepatic angiomyolipoma :
-MR appearance?
T1/T2 Bright
Benign Liver Masses
50% don’t have fat (unlike renal AML); tuberous sclerosis.
Which is it?
Hepatic angiomyolipoma
GI location:
H. pylori gastritis
Antrum (usually)
GI location:
Zollinger-Ellison
Jejunal ulcer is buzzword.
Duodenal bulb is actually the most common location for ZE ulcers
GI location:
Crohns
Antrum when in stomach (but uncommon in stomach)
GI location:
Menetrier’s
Fundus (classically spares antrum)
GI location:
Lymphoma
“Crosses the pylorus “
Classically describes as doing so, although in reality adenocarcinoma does it more
GI location:
Giardia
Duodenum
GI location:
Strongyloides
Duodenum
GI location:
TB
Terminal ileum
GI location:
Yersinia
Terminal ileum
Herpes esophagitis v CMV and AIDS:
Multiple small ulcers
Herpes esophagitis
Herpes esophagitis v CMV and AIDS:
Solitary large ulcer
CMV and AIDS
Esophageal cancer:
Black guy who smokes and drinks—mid esophagus.
Diagnosis?
Squamous cell
Esophageal cancer:
White guy with reflux (history of PPIs)—Lower esophagus.
Diagnosis?
Adenocarcinoma
Uphill v downhill varices:
Caused by portal hypertension
Uphill Varices
Uphill v downhill varices:
Confined to bottom half of esophagus
Uphill Varices
Uphill v downhill varices:
Caused by SVC obstruction (Catheter or tumor related)
Downhill Varices
Uphill v downhill varices:
Confined to top half of esophagus
Downhill Varices
Traction v Pulsion Diverticulum:
Triangular
Traction
Traction v Pulsion Diverticulum:
Will empty
Traction
Traction v Pulsion Diverticulum:
Round
Pulsion
Traction v Pulsion Diverticulum:
Will NOT empty (contain no muscle in their walls)
Pulsion
Esophageal hernias, Sliding v Rolling:
GE junction ABOVE diaphragm
Sliding
Esophageal hernias, Sliding v Rolling:
GE junction BELOW diaphragm
Rolling
Carney’s Triad, parts
- Extra-Adrenal Pheochromocytoma
- GIST
- Pulmonary Chondroma (hamartoma)
Carney’s Complex, parts (vaguely)
-Cardiac Myxoma
(C is for Complex. Not Carney’s Triad!)
- skin stuff
- endocrine stuff
Benign v malignant ulcers (on barium):
Width>depth
Malignant
Benign v malignant ulcers (on barium):
Depth > width
Benign
Benign v malignant ulcers (on barium):
Located within lumen
Malignant
Benign v malignant ulcers (on barium):
Project behind expected lumen
Benign
Benign v malignant ulcers (on barium):
Nodular, irregular edges
Malignant
Benign v malignant ulcers (on barium):
Sharp contour
Benign
Benign v malignant ulcers (on barium):
Folds adjacent to ulcer
Malignant
Benign v malignant ulcers (on barium):
Folds radiate to ulcer
Benign
Benign v malignant ulcers (on barium):
Aunt Minnie: Carmen Meniscus Sign
Malignant
Benign v malignant ulcers (on barium):
Aunt Minnie: Hampton’s Line
Benign
Inguinal Hernia: direct v indirect
Less common
Direct
Inguinal Hernia: direct v indirect
Medial to inferior Epigastric
Direct
Inguinal Hernia: direct v indirect
Defect in Hesselbach Triangle
Direct
Inguinal Hernia: direct v indirect
NOT covered by internal spermatic fascia
Direct
Inguinal Hernia: direct v indirect
More common
Indirect
Inguinal Hernia: direct v indirect
Lateral to inferior epigastric
Indirect
Inguinal Hernia: direct v indirect
Failure of processus vaginalis to close
Indirect
Inguinal Hernia: direct v indirect
Covered by internal spermatic fascia
Indirect
Crohns v UC:
Slightly less common in USA
Crohns
Crohns v UC:
Discontinuous “Skips”
Crohns
Crohns v UC:
Terminal ileum—String Sign
Crohns
Crohns v UC:
Ileocecal valve “stenosed”
Crohns
Crohns v UC:
Mesenteric Fat Increased “creeping fat”
Crohns
Crohns v UC:
Lymph nodes are usually enlarged
Crohns
Crohns v UC:
Makes fistula
Crohns
Crohns v UC:
Slightly more common in USA
UC
Crohns v UC:
Continuous
UC
Crohns v UC:
Rectum
UC
Crohns v UC:
Ileocecal valve “Open”
UC
Crohns v UC:
Perirectal fat Increased
UC
Crohns v UC:
Lymph nodes NOT usually enlarged
UC
Crohns v UC:
Doesn’t usually make fistula
UC
Volvulus, sigmoid v cecal:
Old person (constipated)
Sigmoid
Volvulus, sigmoid v cecal:
Young person (mass, prior surgery, 3rd trimester pregnancy)
Cecal
Volvulus, sigmoid v cecal:
Points to the RUQ
Sigmoid
Volvulus, sigmoid v cecal:
Points to the LUQ
Cecal
Liver Nodules, Regenerative, Dysplastic, HCC:
Contains Iron
Regenerative
Liver Nodules, Regenerative, Dysplastic, HCC:
T1 Dark, T2 Dark
Regenerative
Liver Nodules, Regenerative, Dysplastic, HCC:
Does NOT enhance
Regenerative
Liver Nodules, Regenerative, Dysplastic, HCC:
Contains Fat, glycoprotein
Dysplastic
Liver Nodules, Regenerative, Dysplastic, HCC:
T1 bright, T2 dark
Dysplastic
Liver Nodules, Regenerative, Dysplastic, HCC:
Usually does not enhance
Dysplastic
Liver Nodules, Regenerative, Dysplastic, HCC:
T2 Bright
HCC
Liver Nodules, Regenerative, Dysplastic, HCC:
Does enhance
HCC
Central Scars, FNH v FL HCC
T2 Bright
FNH
Central Scars, FNH v FL HCC
Enhances on delay
FNH
Central Scars, FNH v FL HCC
Mass is sulfur colloid avid (sometimes)
FNH
Central Scars, FNH v FL HCC
T2 Dark (usually)
FL HCC
Central Scars, FNH v FL HCC
Does NOT enhance
FL HCC
Central Scars, FNH v FL HCC
Mass is gallium avid
FL HCC
Hepatic Adenoma v FNH:
Usually >8cm
Hepatic Adenoma
Hepatic Adenoma v FNH:
No bile ducts
Hepatic adenoma
Hepatic Adenoma v FNH:
No kupffer cells
Hepatic adenoma
Hepatic Adenoma v FNH:
Sulfur colloid cold
Hepatic adenoma
Hepatic Adenoma v FNH:
Usually < 8cm
FNH
Hepatic Adenoma v FNH:
Normal bile ducts
FNH
Hepatic Adenoma v FNH:
Normal kupffer cells
FNH
Hepatic Adenoma v FNH:
Sulfur colloid hot (sometimes)
FNH
HCC v FL HCC:
Cirrhosis
HCC
HCC v FL HCC:
Older (50-60s)
HCC
HCC v FL HCC:
Rarely calcifies
HCC
HCC v FL HCC:
Elevated AFP
HCC
HCC v FL HCC:
No cirrhosis
FL HCC
HCC v FL HCC:
Younger (30s)
FL HCC
HCC v FL HCC:
Calcifies sometimes
FL HCC
HCC v FL HCC:
Normal AFP
FL HCC
Hemochromatosis—primary v secondary:
Genetic—increased absorption
Primary
Hemochromatosis—primary v secondary:
Liver, Pancreas
Primary
P for Pancreas and Primary
Hemochromatosis—primary v secondary:
Heart, thyroid, pituitary
Primary
Hemochromatosis—primary v secondary:
Acquired—chronic illness, and multiple transfusions
Secondary
Hemochromatosis—primary v secondary:
Liver, Spleen
Secondary
S is for Spleen and Secondary
Heterotaxia Syndromes:
Right-sided or left-sided?
Two fissures in left lung
Right
Heterotaxia Syndromes:
Right-sided or left-sided?
Asplenia
Right
Heterotaxia Syndromes:
Right-sided or left-sided?
Increased cardiac malformations
Right
Heterotaxia Syndromes:
Right-sided or left-sided?
Reversed aorta/IVC
Right
Heterotaxia Syndromes:
Right-sided or left-sided?
One fissure in right lung
Left
Heterotaxia Syndromes:
Right-sided or left-sided?
Polysplenia
Left
Heterotaxia Syndromes:
Right-sided or left-sided?
Less cardiac malformations
Left
Heterotaxia Syndromes:
Right-sided or left-sided?
Azygous continuation of the IVC
Left
Intralobular v Extralobular Sequestration:
No pleural covering
Intralobular
Intralobular v Extralobular Sequestration:
More common
Intralobular
Intralobular v Extralobular Sequestration:
Presents later with recurrent infection
Intralobular
Intralobular v Extralobular Sequestration:
Has its own pleural covering
Extralobular
Intralobular v Extralobular Sequestration:
Less common
Extralobular
Intralobular v Extralobular Sequestration:
Presents early with other bad congenital things (heart etc)
Extralobular
Location:
Intralobular sequestration
Left lower lobe
Location:
Congenital lobar emphysema (CLE)
Left UPPER lobe
Location:
CCAM
No lobar preference
Baby liver, Age 0-3:
Diagnosis?
Endothelial growth factor elevated
Hemangioendothelioma
Baby liver, Age 0-3:
Diagnosis?
High flow heart failure, big heart on CXR
Hemangioendothelioma
Baby liver, Age 0-3:
Diagnosis?
AFP elevated
Hepatoblastoma
Baby liver, Age 0-3:
Diagnosis?
Associated with Wilms
Hepatoblastoma
Baby liver, Age 0-3:
Diagnosis?
Associated with prematurity
Hepatoblastoma
Baby liver, Age 0-3:
Diagnosis?
Can cause precocious puberty
Hepatoblastoma
Baby liver, Age 0-3:
Diagnosis?
AFP negative
Mesenchymal hamartoma
Baby liver, Age 0-3:
Diagnosis?
“It’s really cystic.”
Mesenchymal hamartoma
How often is it bilateral?
Blount’s Disease
“Often”—some sources say 50-60%
How often is it bilateral?
SCFE
33% (1/3)
How often is it bilateral?
Perthes
10%
How often is it bilateral?
Wilms
5-10%
How often is it bilateral?
DDH
20%
Neuroblastoma:
- age
- calcifies how often
- encase or invade vessels?
- Well circumscribed?
- mets to bone?
- age: usually less than 2 (can occur in utero)
- calcifies 90%
- ENCASES vessels (no invasion)
- NO. Poorly marginated.
- yes, mets to bones
Wilms:
- age
- calcifies how often
- encase or invade vessels?
- Well circumscribed?
- mets to bone?
- age: usually around 4 (NEVER BEFORE 2 mo)
- calcifies rarely (<10%)
- INVADES vessels (no encasing)
- YES well circumscribed
- no, doesn’t usually met to bone (unless clear cell Wilms variant)
Neuroblastoma v Adrenal Hemorrhage:
Anechoic and avascular
Neuroblastoma
Neuroblastoma v Adrenal Hemorrhage:
Low on T2
Neuroblastoma
Neuroblastoma v Adrenal Hemorrhage:
Will grow on follow up
Neuroblastoma
Neuroblastoma v Adrenal Hemorrhage:
Echogenic and vascular
Adrenal hemorrhage
Neuroblastoma v Adrenal Hemorrhage:
High on T2
Adrenal hemorrhage
Neuroblastoma v Adrenal Hemorrhage:
Should shrink on follow up
Adrenal hemorrhage
Cardiac:
Cyanotic congenital heart diseases (6)
“Think the 6 Ts “
TOF TAPVR Transposition Truncus Tricuspid atresia
(That’s only 5, and I don’t know why)
Which MRI sequence is best?
Cardiac Myxoma
Low T1, High T2
High myxoid content
Which MRI sequence is best?
Acute vs Chronic MI
Look at T2–Bright on Acute, Dark on chronic (fibrous scar)
Which MRI sequence is best?
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
T1 Bright
Which MRI sequence is best?
Microvascular Obstruction
First pass perfusion (25 sec post Gad)
Which MRI sequence is best?
Infarct
Delayed Enhancement (10-12 min post Gad)
Constrictive v restrictive Cardiomyopathy:
Pericardium is usually thickened in which?
Constrictive
Constrictive v restrictive Cardiomyopathy:
Diastolic septal bounce is seen in which?
Constrictive (sigmoidization of the septum)
True v False Ventricular Aneurysm:
Mouth is wider than body
True
True v False Ventricular Aneurysm:
Myocardium intact
True
True v False Ventricular Aneurysm:
Anterior-lateral wall
True
True v False Ventricular Aneurysm:
Mouth is narrower than body
False
True v False Ventricular Aneurysm:
Myocardium is NOT intact
False
Pericardial adhesions contain rupture
True v False Ventricular Aneurysm:
Posterior-lateral wall
False
True v False Ventricular Aneurysm:
Higher risk of rupture
False
Stunned v hibernating myocardium v infarct/scar:
Wall motion normal or abnormal for each?
Abnormal wall motion for all
Stunned v hibernating myocardium v infarct/scar:
Perfusion normal or abnormal for each?
Stunned: normal perfusion (thallium or sestamibi)
Hibernating: abnormal fixed perfusion
Infarct/scar: abnormal fixed perfusion
hibernating myocardium v infarct/scar:
Will it redistribute with delayed thallium? (decide for each)
Will it take up FDG? (For each)
Hibernating:
-WILL redistribute
w/delayed thallium
-WILL take up FDG
Infarct/Scar:
- will NOT redistribute
- will NOT take up FDG
Stunned v hibernating myocardium v infarct/scar:
What is each associated with?
Stunned: Acute MI
Hibernating: chronic high grade CAD
Infarct/Scar: chronic prior MI
Left Atrial Myxoma v Clot:
Which will enhance?
Myxoma
Vegetations v Fibroelastoma:
How do you tell difference?
Look for valvular damage (seen with vegetations).
Contrast enhancement is NOT reliable bc how small these things are.
Internal v External Carotid
For each:
-resistance
Internal: Low resistance
External: high resistance
Aortic coarctation :
Infantile—pre-ductal
- can have pulmonary edema.
- Usually long segment.
- blood supply to descending aorta via PDA
Adult—ductal
- not symptomatic until later childhood
- often differential arm-leg pressure
- usually short segment
.
Internal v External Carotid
For each:
-systolic velocity
Internal: low systolic velocity
External: high systolic velocity
Internal v External Carotid
For each:
-diastolic velocity
Internal : does not return to baseline
External: approaches zero baseline
Internal v External Carotid
For each:
-color flow
Internal: continuous color flow is seen throughout the cardiac cycle
External: color flow is intermittent during cardiac cycle
HIV Encephalitis v PML:
Which is symmetric, T2 bright, T1 normal?
HIV Encephalitis
HIV Encephalitis v PML:
Which is asymmetric, T2 bright, T1 dark?
PML
Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus
Symmetric, T2 bright
HIV Encephalitis
Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus
Asymmetric T2 bright, T1 dark
PML
Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus
Periventricular, T2 bright, Ependymal enhancement
CMV
Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus
Ring enhancement, thallium cold
Toxo
Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus
Dilated perivascular spaces , basilar meningitis
Cryptococcus
Toxo v lymphoma:
For each:
- ring enhancing?
- hemorrhage after treatment common?
- thallium cold/hot?
- PET cold/hot?
- MR perfusion ?
Toxo:
- ring enhancing
- hemorrhage after treat MORE common
- Thallium COLD
- PET COLD
- MR perfusion: DECREASED CBV
Lymphoma:
- ring enhancing
- hemorrhage LESS common
- Thallium HOT
- PET HOT
- MR perfusion: Increased (or decreased) CBV
LeFort unique components:
LeFort 1?
LeFort 2?
LeFort 3?
LeFort 1—lateral nasal aperture
LeFort 2—inferior orbital rim, orbital floor
LeFort 3–zygomatic arch, lateral orbital rim/wall
Temporal bone fractures: longitudinal v transverse
For each:
-which axis of T-bone?
Longitudinal: long axis of t-bone
Transverse: short axis
Temporal bone fractures: longitudinal v transverse
For each:
-more or less common?
Longitudinal: More
Transverse: less
Temporal bone fractures: longitudinal v transverse
For each:
-ossicular dislocation or vascular injury?
Longitudinal: More ossicular dislocation
Transverse: more vascular injury (carotid/jugular)
Temporal bone fractures: longitudinal v transverse
For each:
-less or more facial nerve damage?
Longitudinal: LESS facial nerves damage (20%)
Transverse: MORE facial nerve damage (>30%)
Temporal bone fractures: longitudinal v transverse
For each:
-type of hearing loss
Longitudinal: CONDUCTIVE
Tranverse: SENSORINEURAL
Open lip schizencephaly: cleft lined by grey matter (malformation)
Porencephalic cyst: Hole from prior ischemia
.
Vocal cord paralysis v cancer:
- Affected side dilated w/Vocal cord paralysis
- opposite side dilated w/Cancer
.
Syndromes w/tumors (neuro)—
Name associated tumors:
NF-1
Optic nerve gliomas
Syndromes w/tumors (neuro)—
Name associated tumors:
NF-2
MSME:
Multiple Schwannomas
Meningiomas
Ependymomas
Syndromes w/tumors (neuro)—
Name associated tumors:
VHL
Hemangioblastoma (brain and retina)
Syndromes w/tumors (neuro)—
Name associated tumors:
TS
Subependymal Giant Cell Astrocytomas,
Cortical tubers
Syndromes w/tumors (neuro)—
Name associated tumors:
Nevoid Basal Cell Syndrome (Gorlin)
Medulloblastomas
Syndromes w/tumors (neuro)—
Name associated tumors:
Turcot
GBM,
Medulloblastoma
(Note: nevoid basal cell Syndrome also has medulloblastoma)
Syndromes w/tumors (neuro)—
Name associated tumors:
Cowdens
Lhemitte-Dulcos (dysplastic cerebellar gangliocytoma)
Meningioma v Schwannoma:
For each:
-enhance homogenous or not?
Meningioma: enhance homogenously
Schwannoma: LESS homogenous
Meningioma v Schwannoma:
For each:
-invade IAC?
Meningioma: do NOT usually invade IAC
Schwannoma: INVADE IAC
Meningioma v Schwannoma:
Which calcifies more often?
Meningioma: calcify MORE often
Meningioma v Schwannoma:
Which IAC can have “trumpeted” appearance?
Schwannoma
Where is blood coming from? Match blood location to aneurysm location
ACOM
Interhemispheric fissure
Where is blood coming from? Match blood location to aneurysm location
PCOM
Ipsilateral basal cistern
Where is blood coming from? Match blood location to aneurysm location
MCA Trifurcation
Sylvian fissure
Where is blood coming from? Match blood location to aneurysm location
Basilar tip
Interpeduncular cistern OR intraventricular
Where is blood coming from? Match blood location to aneurysm location
PICA
Posterior fossa OR intraventricular
Skull hole contents:
Foramen ovale
CN V3
Accessory meningeal artery
Skull hole contents:
Foramen rotundum
CN V2
“R2V2”
Skull hole contents:
Superior orbital fissure
CN 3
CN 4
CN V1
CN 6
Skull hole contents:
Inferior orbital fissure
CN V2
Skull hole contents:
Foramen spinosum
Middle meningeal artery
Skull hole contents:
Jugular foramen
Jugular vein,
CN 9
CN 10
CN 11
Skull hole contents:
Hypoglossal Canal
CN 12
Skull hole contents:
Optic canal
CN 2
Ophthalmic Artery
Forearm Fractures:
Fracture of the radial head + Anterior dislocation of the distal radial ulnar joint
Essex-lopresti
Forearm fractures:
Radial shaft fracture with anterior dislocation of the ulna at the DRUJ
Galeazzi fracture (MUGR)
Forearm fracture:
Fracture of proximal ulna, with anterior dislocation of the radial head
Monteggia Fracture (MU GR)
Femoral neck stress fractures:
- medial side:
- stress fracture,
- compressive side,
- does well
- lateral side:
- bisphosphonate
- tensile side
- does terrible
.
Bankart spectrum shoulders:
Which has disrupted periosteum?
True Bankart
Avulsions—what attaches to…
Iliac crest
Abdominal muscles
Avulsions—what attaches to…
ASIS
Sartorius
ASIS….Sartorius
Avulsions—what attaches to…
AIIS
Rectus femoris
Avulsions—what attaches to…
Greater trochanter
Gluteal muscles
Avulsions—what attaches to…
Lesser trochanter
Illiopsoas
Avulsions—what attaches to…
Ischial tuberosity
Hamstrings
Avulsions—what attaches to…
Symphysis
ADDuctor group
Pincer v Cam Impingement :
For each:
-age, gender
Pincer: middle-age women
Cam: young men
Pincer v Cam Impingement :
Which is:
Over coverage of femoral head by acetabulum
Pincer
Pincer v Cam Impingement :
Which is:
“Cross over sign”
Pincer
Pincer v Cam Impingement :
Which is:
Bony protrusion on antero-superior femoral head-neck junction
Cam
Pincer v Cam Impingement :
Which is:
Pistol grip deformity (appearance of the femur)
Cam
Osteochondroses:
Kohlers:
- location
- age, gender
- treatment
- tarsal navicular
- male 4-6
- treatment NOT surgical
Osteochondroses:
Freiberg Infarction:
- location
- age, gender
- can lead to _____
- Second metatarsal head
- adolescent girls
- can lead to secondary OA
Osteochondroses:
Severs:
- location
- some say this is ______
- calcaneal apophysis
- some say it’s a normal growing pain
Osteochondroses:
Panners :
- location
- age
- does not have ______
- capitellum
- kid 5-10 “thrower “
- does not have loose bodies
Osteochondroses:
Perthes:
- location
- age, race
- femoral Head
- white kid, 4-8
Osteochondroses:
Kienbock:
- location
- age
- associated with….
- carpal lunate
- person 20-40 years
- associated with negative ulnar variance
Finger tip tumors:
T1 dark,
- T2 BRIGHT*,
- ENHANCES AVIDLY*
Diagnosis?
Glomus
Finger tip tumors:
T1 dark,
T2 Dark,
Variable enhancement,
BLOOM ON GRADIENT
Diagnosis?
Giant cell tumor tendon
Finger tip tumors:
T1 dark,
T2 dark,
NO BLOOMING
Diagnosis?
Fibroma
