Gamesmanship

Question 1

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.

Answer 1

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Question 2

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).

Answer 2

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Question 3

Mammo:

If they show you a ML view for calcifications. Think hard about milk of calcium - is it tea cupping?

Answer 3

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Question 4

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.

Answer 4

.

Question 5

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.

Answer 5

.

Question 6

Mammo:

Gynecomastia looks like a cancer on ultrasound. This is why a male breast cancer workup (palpable finding) always begins with a mammogram.

Answer 6

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Question 7

Nukes:

Distinguishing
Tc-99 DTPA vs Xe-133.

DTPA can be done in multiple projections. DTPA tends to clump in the central airways.

Answer 7

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Question 8

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!

Answer 8

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Question 9

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

Answer 9

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Question 10

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)

Answer 10

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Question 11

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”

Answer 11

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Question 12

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.

Answer 12

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Question 13

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.

Answer 13

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Question 14

Vascular:
Renal Artery Angiogram:

Ostial narrowing—think atherosclerosis; treat with balloon + stent

Beading mid vessel—think FMD; treat with balloon only

Answer 14

.

Question 15

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?”

Answer 15

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Question 16

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)

Answer 16

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Question 17

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

Answer 17

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Question 18

Upper or Lower Lobe Predominant?

Most inhaled stuff (not asbestosis!)—coal workers, silicosis. Includes progressive massive fibrosis.

Answer 18

Upper

Question 19

Upper or Lower Lobe Predominant?

CF

Answer 19

Upper

Question 20

Upper or Lower Lobe Predominant?

RB-ILD

Answer 20

Upper

Question 21

Upper or Lower Lobe Predominant?

Centrilobular Emphysema

Answer 21

Upper

Question 22

Upper or Lower Lobe Predominant?

Ankylosing Spondylitis

Answer 22

Upper

Question 23

Upper or Lower Lobe Predominant?

Asbestosis

Answer 23

Lower

Question 24

Upper or Lower Lobe Predominant?

Primary Ciliary Dyskinesia

Answer 24

Lower

Question 25

Upper or Lower Lobe Predominant? Most Interstitial lung diseases (UIP, NSIP, DIP)

Answer 25

Lower

Question 26

Upper or Lower Lobe Predominant? Panlobular Emphysema (Alpha 1)

Answer 26

Lower

Question 27

Upper or Lower Lobe Predominant? Rheumatoid Lung

Answer 27

Lower

Question 28

Upper or Lower Lobe Predominant? Scleroderma

Answer 28

Lower

Question 29

Obtuse margin with lung. Is it mediastinal or pulmonary origin?

Answer 29

Mediastinal

Question 30

Acute margin with lung. Is it mediastinal or pulmonary origin?

Answer 30

Pulmonary

Question 31

Ground glass nodule on PET: HOT GGO = _______

Answer 31

Infection

Question 32

Ground glass nodule on PET: COLD GGO = _______

Answer 32

Cancer (BAC)

Question 33

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)

Answer 33

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Question 34

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)

Answer 34

.

Question 35

Collagen vascular tricks: RA in shoulders on frontal CXR

Answer 35

Lower lobe UIP pattern

Question 36

Collagen vascular tricks: Ankylosing Spondylitis on lateral CXR

Answer 36

Upper lobe fibrobullous disease

Question 37

Collagen vascular tricks: Dilated esophagus on CT

Answer 37

Scleroderma with NSIP lungs

Question 38

“Frozen hemithorax”—lack of contralateral mediastinal shift in association with massive pleural effusion . Diagnosis?

Answer 38

Mesothelioma. It’s due to encasement of the lung (and fissures) by cancer

Question 39

Infections in AIDS by CD4: >200

Answer 39

Bacterial infections, | TB

Question 40

Infections in AIDS by CD4: <200

Answer 40

PCP, | Atypical Mycobacterial

Question 41

Infections in AIDS by CD4: <100

Answer 41

CMV, Disseminated Fungal, Mycobacterial

Question 42

AIDS: Lung cysts = (diagnosis?)

Answer 42

LIP LIP is AIDS defining in a pediatric patient

Question 43

AIDS: Lung cysts + ground glass + pneumothorax = (diagnosis?)

Answer 43

PCP

Question 44

AIDS: hypervascular nodes = (diagnosis?)

Answer 44

Castleman’s or Kaposi

Question 45

AIDS: Most common airspace opacity

Answer 45

Strep pneumonia

Question 46

AIDS: CT with ground glass = (diagnosis?)

Answer 46

PCP

Question 47

AIDS: Flame-shaped perihilar opacity = (diagnosis?)

Answer 47

Kaposi sarcoma

Question 48

AIDS: Persistent opacities= (diagnosis?)

Answer 48

Lymphoma

Question 49

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 ____

Answer 49

Abdominal cancer

Question 50

If “hyperemesis” is in question stem (repro), think ______

Answer 50

Things that give you elevated B-hCG—like moles and multiple pregnancy (twins)

Question 51

If it’s a GYN case and has “history of abdominal surgery”, keep in mind _______

Answer 51

Peritoneal inclusion cysts (from adhesions)

Question 52

Met to vagina in anterior wall upper 1/3 is “always” (90%) from _______

Answer 52

Upper genital tract

Question 53

Met to vagina in posterior wall lower 1/3 is “always” (90%) from _______

Answer 53

GI tract

Question 54

Fluid in endometrial canal in post menopausal woman should make you think ______

Answer 54

Cervix is obstructed (cancer, or more commonly stenosis)

Question 55

Repro: combo of ovarian mass and thickened endometrium should make you think _____

Answer 55

Granulosa Cell Tumor

Question 56

IUGR: Symmetrical -baby or placenta issue?

Answer 56

Baby problem (placenta is fine)

Question 57

IUGR: Symmetrical -head spared or not?

Answer 57

head NOT spared

Question 58

IUGR: Symmetrical -when first apparent?

Answer 58

Early, including first trimester

Question 59

IUGR: Symmetrical -causes?

Answer 59

TORCHS, Fetal EtOH, Chromosomal abnormalities

Question 60

IUGR: Asymmetrical -baby or placenta issue?

Answer 60

Placenta problem

Question 61

IUGR: Asymmetrical -head spared or not?

Answer 61

Head spared

Question 62

IUGR: Asymmetrical -when first apparent?

Answer 62

Normal until third trimester

Question 63

IUGR: Asymmetrical -causes?

Answer 63

Maternal hypertension, Severe malnutrition, Ehler-Danlos

Question 64

prostate CA v BPH: ______ is usually in the *peripheral* zone. When it is in central zone, T2 is “smudgy” or charcoal.

Answer 64

Prostate CA

Question 65

prostate CA v BPH: _______ is usually in central zone. Have a sharp border. Can “draw a line around them with a pencil”

Answer 65

BPH nodules

Question 66

Gartner duct cyst v Bartholin cyst ______ is above pubic symphysis. _______ is below.

Answer 66

GARTNER DUCT CYST is above pubic symphysis. BARTHOLIN is below it.

Question 67

Bicornuate v septate uterus Distinguish the two by:

Answer 67

Apex of the fundal contour

Question 68

Bicornuate v septate uterus Apex of fundus >5mm above tubal Ostia

Answer 68

Septate

Question 69

Bicornuate v septate uterus Apex of fundus <5mm above tubal Ostia

Answer 69

Bicornuate

Question 70

Bicornuate v septate uterus Which has established increased 1st trimester loss?

Answer 70

Septate | Bicornuates have a lot less problems. Maybe no increased risk, depending who you ask

Question 71

IVPs (GU section): Haven’t been used since 1970s, but few tricks. If have *medial* deviation of the ureters, think______

Answer 71

Retroperitoneal fibrosis

Question 72

IVPs (GU section): Haven’t been used since 1970s, but few tricks. If have *lateral* deviation of the ureters, think______

Answer 72

Psoas hypertrophy, or lymph nodes

Question 73

RCC v oncocytoma: ___ is typically colder than surrounding renal parenchyma on PET

Answer 73

RCC

Question 74

RCC v oncocytoma: ___ is typically hotter than surrounding renal parenchyma on PET

Answer 74

Oncocytoma

Question 75

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

Answer 75

.

Question 76

Renal cysts syndromes: Cysts in liver, kidneys are BIG Diagnosis?

Answer 76

ADPKD

Question 77

Renal cysts syndromes: Cysts in pancreas Diagnosis?

Answer 77

VHL

Question 78

Renal cysts syndromes: kidneys are small Diagnosis?

Answer 78

Acquired (uremic)

Question 79

Renal cancer syndromes: Subtype: Clear Cell Syndrome/Association?

Answer 79

Von Hippel-Lindau

Question 80

Renal cancer syndromes: Subtype: papillary Syndrome/Association?

Answer 80

Hereditary papillary renal carcinoma

Question 81

Renal cancer syndromes: Subtype: chromophobe Syndrome/Association?

Answer 81

Birt Hogg Dube

Question 82

Renal cancer syndromes: Subtype: Medullary Syndrome/Association?

Answer 82

Sickle cell trait

Question 83

If you’re shown a unilateral renal agenesis case, remember association with _______ in men, and _______ in women

Answer 83

Men: absent vas deferens, and ipsilateral seminal vesicle Cyst Women: mullarian anomalies (unicornuate uterus)

Question 84

Showing persistent nephrograms —either by plain film or CT is the classic trick for ATN—usually contrast induced nephropathy.

Answer 84

.

Question 85

CJD restricts diffusion (MRI).

Answer 85

.

Question 86

Dilated esophagus on CT, ground glass in the lung bases (and maybe sub-pleural sparing). Diagnosis?

Answer 86

Scleroderma with NSIP

Question 87

Benign Liver Masses Hemangioma: -ultrasound appearance?

Answer 87

Hyperechoic

Question 88

Benign Liver Masses Hemangioma: -CT appearance?

Answer 88

Peripheral nodular discontinuous enhancement

Question 89

Benign Liver Masses Hemangioma: -MR appearance?

Answer 89

T2 Bright

Question 90

Benign Liver Masses Rare in cirrhotics. Which one?

Answer 90

Hemangioma

Question 91

Benign Liver Masses FNH: -ultrasound appearance?

Answer 91

Spoke wheel

Question 92

Benign Liver Masses FNH: -CT appearance?

Answer 92

Homogeneous arterial enhancement

Question 93

Benign Liver Masses FNH: -MR appearance?

Answer 93

“Stealth Lesion —Iso on T1 and T2”

Question 94

Benign Liver Masses Central scar, Bright on delayed eovist (Gd-EOB-DTPA). Which is it?

Answer 94

FNH

Question 95

Benign Liver Masses Hepatic adenoma : -ultrasound appearance?

Answer 95

Variable

Question 96

Benign Liver Masses Hepatic adenoma : -CT appearance?

Answer 96

Variable

Question 97

Benign Liver Masses Hepatic adenoma : -MR appearance?

Answer 97

Fat containing on In/Out phase

Question 98

Benign Liver Masses OCP use, Glycogen storage Disease, can explode and bleed. Which is it?

Answer 98

Hepatic adenoma

Question 99

Benign Liver Masses Hepatic angiomyolipoma : -ultrasound appearance?

Answer 99

Hyperechoic

Question 100

Benign Liver Masses Hepatic angiomyolipoma : -CT appearance?

Answer 100

Gross fat

Question 101

Benign Liver Masses Hepatic angiomyolipoma : -MR appearance?

Answer 101

T1/T2 Bright

Question 102

Benign Liver Masses 50% don’t have fat (unlike renal AML); tuberous sclerosis. Which is it?

Answer 102

Hepatic angiomyolipoma

Question 103

GI location: H. pylori gastritis

Answer 103

Antrum (usually)

Question 104

GI location: Zollinger-Ellison

Answer 104

Jejunal ulcer is buzzword. Duodenal bulb is actually the most common location for ZE ulcers

Question 105

GI location: Crohns

Answer 105

Antrum when in stomach (but uncommon in stomach)

Question 106

GI location: Menetrier’s

Answer 106

Fundus (classically spares antrum)

Question 107

GI location: Lymphoma

Answer 107

“Crosses the pylorus “ Classically describes as doing so, although in reality adenocarcinoma does it more

Question 108

GI location: Giardia

Answer 108

Duodenum

Question 109

GI location: Strongyloides

Answer 109

Duodenum

Question 110

GI location: TB

Answer 110

Terminal ileum

Question 111

GI location: Yersinia

Answer 111

Terminal ileum

Question 112

Herpes esophagitis v CMV and AIDS: Multiple small ulcers

Answer 112

Herpes esophagitis

Question 113

Herpes esophagitis v CMV and AIDS: Solitary large ulcer

Answer 113

CMV and AIDS

Question 114

Esophageal cancer: Black guy who smokes and drinks—mid esophagus. Diagnosis?

Answer 114

Squamous cell

Question 115

Esophageal cancer: White guy with reflux (history of PPIs)—Lower esophagus. Diagnosis?

Answer 115

Adenocarcinoma

Question 116

Uphill v downhill varices: Caused by portal hypertension

Answer 116

Uphill Varices

Question 117

Uphill v downhill varices: Confined to bottom half of esophagus

Answer 117

Uphill Varices

Question 118

Uphill v downhill varices: Caused by SVC obstruction (Catheter or tumor related)

Answer 118

Downhill Varices

Question 119

Uphill v downhill varices: Confined to top half of esophagus

Answer 119

Downhill Varices

Question 120

Traction v Pulsion Diverticulum: Triangular

Answer 120

Traction

Question 121

Traction v Pulsion Diverticulum: Will empty

Answer 121

Traction

Question 122

Traction v Pulsion Diverticulum: Round

Answer 122

Pulsion

Question 123

Traction v Pulsion Diverticulum: Will NOT empty (contain no muscle in their walls)

Answer 123

Pulsion

Question 124

Esophageal hernias, Sliding v Rolling: GE junction ABOVE diaphragm

Answer 124

Sliding

Question 125

Esophageal hernias, Sliding v Rolling: GE junction BELOW diaphragm

Answer 125

Rolling

Question 126

Carney’s *Triad*, parts

Answer 126

- Extra-Adrenal Pheochromocytoma - GIST - Pulmonary Chondroma (hamartoma)

Question 127

Carney’s *Complex*, parts (vaguely)

Answer 127

-*C*ardiac Myxoma (C is for Complex. Not Carney’s Triad!) - skin stuff - endocrine stuff

Question 128

Benign v malignant ulcers (on barium): Width>depth

Answer 128

Malignant

Question 129

Benign v malignant ulcers (on barium): Depth > width

Answer 129

Benign

Question 130

Benign v malignant ulcers (on barium): Located within lumen

Answer 130

Malignant

Question 131

Benign v malignant ulcers (on barium): Project behind expected lumen

Answer 131

Benign

Question 132

Benign v malignant ulcers (on barium): Nodular, irregular edges

Answer 132

Malignant

Question 133

Benign v malignant ulcers (on barium): Sharp contour

Answer 133

Benign

Question 134

Benign v malignant ulcers (on barium): Folds adjacent to ulcer

Answer 134

Malignant

Question 135

Benign v malignant ulcers (on barium): Folds radiate to ulcer

Answer 135

Benign

Question 136

Benign v malignant ulcers (on barium): Aunt Minnie: Carmen Meniscus Sign

Answer 136

Malignant

Question 137

Benign v malignant ulcers (on barium): Aunt Minnie: Hampton’s Line

Answer 137

Benign

Question 138

Inguinal Hernia: direct v indirect Less common

Answer 138

Direct

Question 139

Inguinal Hernia: direct v indirect Medial to inferior Epigastric

Answer 139

Direct

Question 140

Inguinal Hernia: direct v indirect Defect in Hesselbach Triangle

Answer 140

Direct

Question 141

Inguinal Hernia: direct v indirect NOT covered by internal spermatic fascia

Answer 141

Direct

Question 142

Inguinal Hernia: direct v indirect More common

Answer 142

Indirect

Question 143

Inguinal Hernia: direct v indirect Lateral to inferior epigastric

Answer 143

Indirect

Question 144

Inguinal Hernia: direct v indirect Failure of processus vaginalis to close

Answer 144

Indirect

Question 145

Inguinal Hernia: direct v indirect Covered by internal spermatic fascia

Answer 145

Indirect

Question 146

Crohns v UC: Slightly less common in USA

Answer 146

Crohns

Question 147

Crohns v UC: Discontinuous “Skips”

Answer 147

Crohns

Question 148

Crohns v UC: Terminal ileum—String Sign

Answer 148

Crohns

Question 149

Crohns v UC: Ileocecal valve “stenosed”

Answer 149

Crohns

Question 150

Crohns v UC: Mesenteric Fat Increased “creeping fat”

Answer 150

Crohns

Question 151

Crohns v UC: Lymph nodes are usually enlarged

Answer 151

Crohns

Question 152

Crohns v UC: Makes fistula

Answer 152

Crohns

Question 153

Crohns v UC: Slightly more common in USA

Answer 153

UC

Question 154

Crohns v UC: Continuous

Answer 154

UC

Question 155

Crohns v UC: Rectum

Answer 155

UC

Question 156

Crohns v UC: Ileocecal valve “Open”

Answer 156

UC

Question 157

Crohns v UC: Perirectal fat Increased

Answer 157

UC

Question 158

Crohns v UC: Lymph nodes NOT usually enlarged

Answer 158

UC

Question 159

Crohns v UC: Doesn’t usually make fistula

Answer 159

UC

Question 160

Volvulus, sigmoid v cecal: Old person (constipated)

Answer 160

Sigmoid

Question 161

Volvulus, sigmoid v cecal: Young person (mass, prior surgery, 3rd trimester pregnancy)

Answer 161

Cecal

Question 162

Volvulus, sigmoid v cecal: Points to the RUQ

Answer 162

Sigmoid

Question 163

Volvulus, sigmoid v cecal: Points to the LUQ

Answer 163

Cecal

Question 164

Liver Nodules, Regenerative, Dysplastic, HCC: Contains Iron

Answer 164

Regenerative

Question 165

Liver Nodules, Regenerative, Dysplastic, HCC: T1 Dark, T2 Dark

Answer 165

Regenerative

Question 166

Liver Nodules, Regenerative, Dysplastic, HCC: Does NOT enhance

Answer 166

Regenerative

Question 167

Liver Nodules, Regenerative, Dysplastic, HCC: Contains Fat, glycoprotein

Answer 167

Dysplastic

Question 168

Liver Nodules, Regenerative, Dysplastic, HCC: T1 bright, T2 dark

Answer 168

Dysplastic

Question 169

Liver Nodules, Regenerative, Dysplastic, HCC: Usually does not enhance

Answer 169

Dysplastic

Question 170

Liver Nodules, Regenerative, Dysplastic, HCC: T2 Bright

Answer 170

HCC

Question 171

Liver Nodules, Regenerative, Dysplastic, HCC: Does enhance

Answer 171

HCC

Question 172

Central Scars, FNH v FL HCC T2 Bright

Answer 172

FNH

Question 173

Central Scars, FNH v FL HCC Enhances on delay

Answer 173

FNH

Question 174

Central Scars, FNH v FL HCC Mass is sulfur colloid avid (sometimes)

Answer 174

FNH

Question 175

Central Scars, FNH v FL HCC T2 Dark (usually)

Answer 175

FL HCC

Question 176

Central Scars, FNH v FL HCC Does NOT enhance

Answer 176

FL HCC

Question 177

Central Scars, FNH v FL HCC Mass is gallium avid

Answer 177

FL HCC

Question 178

Hepatic Adenoma v FNH: Usually >8cm

Answer 178

Hepatic Adenoma

Question 179

Hepatic Adenoma v FNH: No bile ducts

Answer 179

Hepatic adenoma

Question 180

Hepatic Adenoma v FNH: No kupffer cells

Answer 180

Hepatic adenoma

Question 181

Hepatic Adenoma v FNH: Sulfur colloid cold

Answer 181

Hepatic adenoma

Question 182

Hepatic Adenoma v FNH: Usually < 8cm

Answer 182

FNH

Question 183

Hepatic Adenoma v FNH: Normal bile ducts

Answer 183

FNH

Question 184

Hepatic Adenoma v FNH: Normal kupffer cells

Answer 184

FNH

Question 185

Hepatic Adenoma v FNH: Sulfur colloid hot (sometimes)

Answer 185

FNH

Question 186

HCC v FL HCC: Cirrhosis

Answer 186

HCC

Question 187

HCC v FL HCC: Older (50-60s)

Answer 187

HCC

Question 188

HCC v FL HCC: Rarely calcifies

Answer 188

HCC

Question 189

HCC v FL HCC: Elevated AFP

Answer 189

HCC

Question 190

HCC v FL HCC: No cirrhosis

Answer 190

FL HCC

Question 191

HCC v FL HCC: Younger (30s)

Answer 191

FL HCC

Question 192

HCC v FL HCC: Calcifies sometimes

Answer 192

FL HCC

Question 193

HCC v FL HCC: Normal AFP

Answer 193

FL HCC

Question 194

Hemochromatosis—primary v secondary: Genetic—increased absorption

Answer 194

Primary

Question 195

Hemochromatosis—primary v secondary: Liver, Pancreas

Answer 195

Primary | P for Pancreas and Primary

Question 196

Hemochromatosis—primary v secondary: Heart, thyroid, pituitary

Answer 196

Primary

Question 197

Hemochromatosis—primary v secondary: Acquired—chronic illness, and multiple transfusions

Answer 197

Secondary

Question 198

Hemochromatosis—primary v secondary: Liver, Spleen

Answer 198

Secondary | S is for Spleen and Secondary

Question 199

Heterotaxia Syndromes: Right-sided or left-sided? Two fissures in left lung

Answer 199

Right

Question 200

Heterotaxia Syndromes: Right-sided or left-sided? Asplenia

Answer 200

Right

Question 201

Heterotaxia Syndromes: Right-sided or left-sided? Increased cardiac malformations

Answer 201

Right

Question 202

Heterotaxia Syndromes: Right-sided or left-sided? Reversed aorta/IVC

Answer 202

Right

Question 203

Heterotaxia Syndromes: Right-sided or left-sided? One fissure in right lung

Answer 203

Left

Question 204

Heterotaxia Syndromes: Right-sided or left-sided? Polysplenia

Answer 204

Left

Question 205

Heterotaxia Syndromes: Right-sided or left-sided? Less cardiac malformations

Answer 205

Left

Question 206

Heterotaxia Syndromes: Right-sided or left-sided? Azygous continuation of the IVC

Answer 206

Left

Question 207

Intralobular v Extralobular Sequestration: No pleural covering

Answer 207

Intralobular

Question 208

Intralobular v Extralobular Sequestration: More common

Answer 208

Intralobular

Question 209

Intralobular v Extralobular Sequestration: Presents later with recurrent infection

Answer 209

Intralobular

Question 210

Intralobular v Extralobular Sequestration: Has its own pleural covering

Answer 210

Extralobular

Question 211

Intralobular v Extralobular Sequestration: Less common

Answer 211

Extralobular

Question 212

Intralobular v Extralobular Sequestration: Presents early with other bad congenital things (heart etc)

Answer 212

Extralobular

Question 213

Location: Intralobular sequestration

Answer 213

Left lower lobe

Question 214

Location: Congenital lobar emphysema (CLE)

Answer 214

Left UPPER lobe

Question 215

Location: CCAM

Answer 215

No lobar preference

Question 216

Baby liver, Age 0-3: Diagnosis? Endothelial growth factor elevated

Answer 216

Hemangioendothelioma

Question 217

Baby liver, Age 0-3: Diagnosis? High flow heart failure, big heart on CXR

Answer 217

Hemangioendothelioma

Question 218

Baby liver, Age 0-3: Diagnosis? AFP elevated

Answer 218

Hepatoblastoma

Question 219

Baby liver, Age 0-3: Diagnosis? Associated with Wilms

Answer 219

Hepatoblastoma

Question 220

Baby liver, Age 0-3: Diagnosis? Associated with prematurity

Answer 220

Hepatoblastoma

Question 221

Baby liver, Age 0-3: Diagnosis? Can cause precocious puberty

Answer 221

Hepatoblastoma

Question 222

Baby liver, Age 0-3: Diagnosis? AFP negative

Answer 222

Mesenchymal hamartoma

Question 223

Baby liver, Age 0-3: Diagnosis? “It’s really cystic.”

Answer 223

Mesenchymal hamartoma

Question 224

How often is it bilateral? Blount’s Disease

Answer 224

“Often”—some sources say 50-60%

Question 225

How often is it bilateral? SCFE

Answer 225

33% (1/3)

Question 226

How often is it bilateral? Perthes

Answer 226

10%

Question 227

How often is it bilateral? Wilms

Answer 227

5-10%

Question 228

How often is it bilateral? DDH

Answer 228

20%

Question 229

Neuroblastoma: - age - calcifies how often - encase or invade vessels? - Well circumscribed? - mets to bone?

Answer 229

- age: usually less than 2 (can occur in utero) - calcifies 90% - ENCASES vessels (no invasion) - NO. Poorly marginated. - yes, mets to bones

Question 230

Wilms: - age - calcifies how often - encase or invade vessels? - Well circumscribed? - mets to bone?

Answer 230

- 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)

Question 231

Neuroblastoma v Adrenal Hemorrhage: Anechoic and avascular

Answer 231

Neuroblastoma

Question 232

Neuroblastoma v Adrenal Hemorrhage: Low on T2

Answer 232

Neuroblastoma

Question 233

Neuroblastoma v Adrenal Hemorrhage: Will grow on follow up

Answer 233

Neuroblastoma

Question 234

Neuroblastoma v Adrenal Hemorrhage: Echogenic and vascular

Answer 234

Adrenal hemorrhage

Question 235

Neuroblastoma v Adrenal Hemorrhage: High on T2

Answer 235

Adrenal hemorrhage

Question 236

Neuroblastoma v Adrenal Hemorrhage: Should shrink on follow up

Answer 236

Adrenal hemorrhage

Question 237

Cardiac: Cyanotic congenital heart diseases (6)

Answer 237

“Think the 6 Ts “ ``` TOF TAPVR Transposition Truncus Tricuspid atresia ``` (That’s only 5, and I don’t know why)

Question 238

Which MRI sequence is best? Cardiac Myxoma

Answer 238

Low T1, High T2 | High myxoid content

Question 239

Which MRI sequence is best? Acute vs Chronic MI

Answer 239

Look at T2–Bright on Acute, Dark on chronic (fibrous scar)

Question 240

Which MRI sequence is best? Arrhythmogenic Right Ventricular Dysplasia (ARVD)

Answer 240

T1 Bright

Question 241

Which MRI sequence is best? Microvascular Obstruction

Answer 241

First pass perfusion (25 sec post Gad)

Question 242

Which MRI sequence is best? Infarct

Answer 242

Delayed Enhancement (10-12 min post Gad)

Question 243

Constrictive v restrictive Cardiomyopathy: Pericardium is usually thickened in which?

Answer 243

Constrictive

Question 244

Constrictive v restrictive Cardiomyopathy: Diastolic septal bounce is seen in which?

Answer 244

Constrictive (sigmoidization of the septum)

Question 245

True v False Ventricular Aneurysm: Mouth is wider than body

Answer 245

True

Question 246

True v False Ventricular Aneurysm: Myocardium intact

Answer 246

True

Question 247

True v False Ventricular Aneurysm: Anterior-lateral wall

Answer 247

True

Question 248

True v False Ventricular Aneurysm: Mouth is narrower than body

Answer 248

False

Question 249

True v False Ventricular Aneurysm: Myocardium is NOT intact

Answer 249

False Pericardial adhesions contain rupture

Question 250

True v False Ventricular Aneurysm: Posterior-lateral wall

Answer 250

False

Question 251

True v False Ventricular Aneurysm: Higher risk of rupture

Answer 251

False

Question 252

Stunned v hibernating myocardium v infarct/scar: Wall motion normal or abnormal for each?

Answer 252

Abnormal wall motion for all

Question 253

Stunned v hibernating myocardium v infarct/scar: Perfusion normal or abnormal for each?

Answer 253

Stunned: normal perfusion (thallium or sestamibi) Hibernating: abnormal fixed perfusion Infarct/scar: abnormal fixed perfusion

Question 254

hibernating myocardium v infarct/scar: Will it redistribute with delayed thallium? (decide for each) Will it take up FDG? (For each)

Answer 254

Hibernating: -WILL redistribute w/delayed thallium -WILL take up FDG Infarct/Scar: - will NOT redistribute - will NOT take up FDG

Question 255

Stunned v hibernating myocardium v infarct/scar: What is each associated with?

Answer 255

Stunned: Acute MI Hibernating: chronic high grade CAD Infarct/Scar: chronic prior MI

Question 256

Left Atrial Myxoma v Clot: Which will enhance?

Answer 256

Myxoma

Question 257

Vegetations v Fibroelastoma: How do you tell difference?

Answer 257

Look for valvular damage (seen with vegetations). Contrast enhancement is NOT reliable bc how small these things are.

Question 258

Internal v External Carotid For each: -resistance

Answer 258

Internal: Low resistance External: high resistance

Question 259

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

Answer 259

.

Question 260

Internal v External Carotid For each: -systolic velocity

Answer 260

Internal: low systolic velocity External: high systolic velocity

Question 261

Internal v External Carotid For each: -diastolic velocity

Answer 261

Internal : does not return to baseline External: approaches zero baseline

Question 262

Internal v External Carotid For each: -color flow

Answer 262

Internal: continuous color flow is seen throughout the cardiac cycle External: color flow is intermittent during cardiac cycle

Question 263

HIV Encephalitis v PML: Which is symmetric, T2 bright, T1 normal?

Answer 263

HIV Encephalitis

Question 264

HIV Encephalitis v PML: Which is asymmetric, T2 bright, T1 dark?

Answer 264

PML

Question 265

# Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus Symmetric, T2 bright

Answer 265

HIV Encephalitis

Question 266

# Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus Asymmetric T2 bright, T1 dark

Answer 266

PML

Question 267

# Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus Periventricular, T2 bright, Ependymal enhancement

Answer 267

CMV

Question 268

# Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus Ring enhancement, thallium cold

Answer 268

Toxo

Question 269

# Choose HIV Encephalitis, PML, CMV, Toxo, or Cryptococcus Dilated perivascular spaces , basilar meningitis

Answer 269

Cryptococcus

Question 270

Toxo v lymphoma: For each: - ring enhancing? - hemorrhage after treatment common? - thallium cold/hot? - PET cold/hot? - MR perfusion ?

Answer 270

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

Question 271

LeFort unique components: LeFort 1? LeFort 2? LeFort 3?

Answer 271

LeFort 1—lateral nasal aperture LeFort 2—inferior orbital rim, orbital floor LeFort 3–zygomatic arch, lateral orbital rim/wall

Question 272

Temporal bone fractures: longitudinal v transverse For each: -which axis of T-bone?

Answer 272

Longitudinal: long axis of t-bone Transverse: short axis

Question 273

Temporal bone fractures: longitudinal v transverse For each: -more or less common?

Answer 273

Longitudinal: More Transverse: less

Question 274

Temporal bone fractures: longitudinal v transverse For each: -ossicular dislocation or vascular injury?

Answer 274

Longitudinal: More ossicular dislocation Transverse: more vascular injury (carotid/jugular)

Question 275

Temporal bone fractures: longitudinal v transverse For each: -less or more facial nerve damage?

Answer 275

Longitudinal: LESS facial nerves damage (20%) Transverse: MORE facial nerve damage (>30%)

Question 276

Temporal bone fractures: longitudinal v transverse For each: -type of hearing loss

Answer 276

Longitudinal: CONDUCTIVE Tranverse: SENSORINEURAL

Question 277

Open lip schizencephaly: cleft lined by grey matter (malformation) Porencephalic cyst: Hole from prior ischemia

Answer 277

.

Question 278

Vocal cord paralysis v cancer: - Affected side dilated w/Vocal cord paralysis - opposite side dilated w/Cancer

Answer 278

.

Question 279

Syndromes w/tumors (neuro)— Name associated tumors: NF-1

Answer 279

Optic nerve gliomas

Question 280

Syndromes w/tumors (neuro)— Name associated tumors: NF-2

Answer 280

MSME: Multiple Schwannomas Meningiomas Ependymomas

Question 281

Syndromes w/tumors (neuro)— Name associated tumors: VHL

Answer 281

Hemangioblastoma (brain and retina)

Question 282

Syndromes w/tumors (neuro)— Name associated tumors: TS

Answer 282

Subependymal Giant Cell Astrocytomas, Cortical tubers

Question 283

Syndromes w/tumors (neuro)— Name associated tumors: Nevoid Basal Cell Syndrome (Gorlin)

Answer 283

Medulloblastomas

Question 284

Syndromes w/tumors (neuro)— Name associated tumors: Turcot

Answer 284

GBM, Medulloblastoma (Note: nevoid basal cell Syndrome also has medulloblastoma)

Question 285

Syndromes w/tumors (neuro)— Name associated tumors: Cowdens

Answer 285

Lhemitte-Dulcos (dysplastic cerebellar gangliocytoma)

Question 286

Meningioma v Schwannoma: For each: -enhance homogenous or not?

Answer 286

Meningioma: enhance homogenously Schwannoma: LESS homogenous

Question 287

Meningioma v Schwannoma: For each: -invade IAC?

Answer 287

Meningioma: do NOT usually invade IAC Schwannoma: INVADE IAC

Question 288

Meningioma v Schwannoma: Which calcifies more often?

Answer 288

Meningioma: calcify MORE often

Question 289

Meningioma v Schwannoma: Which IAC can have “trumpeted” appearance?

Answer 289

Schwannoma

Question 290

Where is blood coming from? Match blood location to aneurysm location ACOM

Answer 290

Interhemispheric fissure

Question 291

Where is blood coming from? Match blood location to aneurysm location PCOM

Answer 291

Ipsilateral basal cistern

Question 292

Where is blood coming from? Match blood location to aneurysm location MCA Trifurcation

Answer 292

Sylvian fissure

Question 293

Where is blood coming from? Match blood location to aneurysm location Basilar tip

Answer 293

Interpeduncular cistern OR intraventricular

Question 294

Where is blood coming from? Match blood location to aneurysm location PICA

Answer 294

Posterior fossa OR intraventricular

Question 295

Skull hole contents: Foramen ovale

Answer 295

CN V3 | Accessory meningeal artery

Question 296

Skull hole contents: Foramen rotundum

Answer 296

CN V2 | “R2V2”

Question 297

Skull hole contents: Superior orbital fissure

Answer 297

CN 3 CN 4 CN V1 CN 6

Question 298

Skull hole contents: Inferior orbital fissure

Answer 298

CN V2

Question 299

Skull hole contents: Foramen spinosum

Answer 299

Middle meningeal artery

Question 300

Skull hole contents: Jugular foramen

Answer 300

Jugular vein, CN 9 CN 10 CN 11

Question 301

Skull hole contents: Hypoglossal Canal

Answer 301

CN 12

Question 302

Skull hole contents: Optic canal

Answer 302

CN 2 | Ophthalmic Artery

Question 303

Forearm Fractures: Fracture of the radial head + Anterior dislocation of the distal radial ulnar joint

Answer 303

Essex-lopresti

Question 304

Forearm fractures: Radial shaft fracture with anterior dislocation of the ulna at the DRUJ

Answer 304

Galeazzi fracture (MU*GR*)

Question 305

Forearm fracture: Fracture of proximal ulna, with anterior dislocation of the radial head

Answer 305

Monteggia Fracture (*MU* GR)

Question 306

Femoral neck stress fractures: - medial side: - stress fracture, - compressive side, - does well - lateral side: - bisphosphonate - tensile side - does terrible

Answer 306

.

Question 307

Bankart spectrum shoulders: Which has disrupted periosteum?

Answer 307

True Bankart

Question 308

Avulsions—what attaches to... Iliac crest

Answer 308

Abdominal muscles

Question 309

Avulsions—what attaches to... ASIS

Answer 309

Sartorius | A*S*IS....*S*artorius

Question 310

Avulsions—what attaches to... AIIS

Answer 310

Rectus femoris

Question 311

Avulsions—what attaches to... Greater trochanter

Answer 311

Gluteal muscles

Question 312

Avulsions—what attaches to... Lesser trochanter

Answer 312

Illiopsoas

Question 313

Avulsions—what attaches to... Ischial tuberosity

Answer 313

Hamstrings

Question 314

Avulsions—what attaches to... Symphysis

Answer 314

ADDuctor group

Question 315

Pincer v Cam Impingement : For each: -age, gender

Answer 315

Pincer: middle-age women Cam: young men

Question 316

Pincer v Cam Impingement : Which is: Over coverage of femoral head by acetabulum

Answer 316

Pincer

Question 317

Pincer v Cam Impingement : Which is: “Cross over sign”

Answer 317

Pincer

Question 318

Pincer v Cam Impingement : Which is: Bony protrusion on antero-superior femoral head-neck junction

Answer 318

Cam

Question 319

Pincer v Cam Impingement : Which is: Pistol grip deformity (appearance of the femur)

Answer 319

Cam

Question 320

Osteochondroses: Kohlers: - location - age, gender - treatment

Answer 320

- tarsal navicular - male 4-6 - treatment NOT surgical

Question 321

Osteochondroses: Freiberg Infarction: - location - age, gender - can lead to _____

Answer 321

- Second metatarsal head - adolescent girls - can lead to secondary OA

Question 322

Osteochondroses: Severs: - location - some say this is ______

Answer 322

- calcaneal apophysis | - some say it’s a normal growing pain

Question 323

Osteochondroses: Panners : - location - age - does not have ______

Answer 323

- capitellum - kid 5-10 “thrower “ - does not have loose bodies

Question 324

Osteochondroses: Perthes: - location - age, race

Answer 324

- femoral Head | - white kid, 4-8

Question 325

Osteochondroses: Kienbock: - location - age - associated with....

Answer 325

- carpal lunate - person 20-40 years - associated with negative ulnar variance

Question 326

Finger tip tumors: T1 dark, * T2 BRIGHT*, * ENHANCES AVIDLY* Diagnosis?

Answer 326

Glomus

Question 327

Finger tip tumors: T1 dark, T2 Dark, Variable enhancement, *BLOOM ON GRADIENT* Diagnosis?

Answer 327

Giant cell tumor tendon

Question 328

Finger tip tumors: T1 dark, T2 dark, *NO BLOOMING* Diagnosis?

Answer 328

Fibroma