Gardens Flashcards
1
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A
Sub Arachnoid Haemorrhage
Radiodense material in the ventricles, sulci, basal cisterns and fissures is blood in the subarachnoid space
Don’t confuse with a calcified choroid (normal finding)
Image Modality = CT (note the bones are white and fluid is normally black)
2
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A
MR Venography
Contrast study taken in the venous phase to see the intracranial sinuses
used to identify VEnous sinus thromboses
(V. Unlikely to come in an exam but just in case)
3
Q
A
MRI Head
Magnetic Resonance Imaging (radiosignals cause protons to spin and as they turn back to normal position the signal is detected via radiofrequency detection)
Excellent soft tissue resolution (note how bone is dark)
T1- structural visulisation. fluid = low attenutaiton. fat= high attenutation
can use with gadolinium (high attenuation)
Can suppress fat
T2. - Good for fluid. Fluid = high attenuation. fat = high attenuation
Can suppress fat.
FLAIR = Fluid attenuating. Good for visualising fluid in tissues where it’s not meant to be (parenchymal oedema) as it attenuates CSF for example
Diffusion weighted = asses how freely fluid moves around. If moves less = infarctive pathology
4
Q
A
Subdural Haemorrhage
There is a hyperdense crescenteric area overlying the right frontal and temporal areas of this image. There is associated ventricular effacement and midline shift
This is likely to be an acute SDH as the blood is white —> turns dark overtime as the clot becomes chronic.
mx:
i) Craniostomy with burr hole irrigation
ii) craniotomy
5
Q
A
Extra Dural Haematoma
There is a hyperdense eliptical region overlying the right fronto-temporo-parietal region. It is associated with ventricular effacement and midline shift
The image modality is a CT scan
Mx
i) Craniectomy
medical:
Nueroprotective ventilation: High O2 with maintenance of normocapnea
Mannitol/ Hypertonic Saline
6
Q
A
Cerebral Abscess
(Pre and Post contrast CT is common practice/ unless MRI is planned) DW MRI is the best
Ring enhancing lesion (iso/hyper dense rim with central low attenuation area) surrounding by low attenuation area of vasogenic oedema. Can be associated with midline shift and effacement of ventricles if large enough. if more than one ring enhancing lesion ? other diagnosis i.e.e (diffuse primary cerebral malignancy)
Causes - Ear infection, throat infection, Teeth infection, Bronchiectasis, Immunosuppression, Cardiac disease
7
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A
Battle Sign ( Mastoid Ecchymycoses)
Sign of base of skull fracture
8
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A
Racoon Eyes
periorbital echhymyosis
Sign of base of skull fracture
Rarely - in older people in the absence of head injury or possibility of SOL etc. etc. —> Periorbital purpura. Sign of primary amyloidosis
9
Q
A
Tonsillar herniation
The arrow points to herniation of cerebellar tonsil through the foramen magnum due to raised ICP (or the introduction of LP when there is already raised ICP) —> leading to compression of the brainstem.
Nearly always fatal —> leads to brainstem death
10
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A
Raised hemidiaphragm
Phrenic nerve palsy
11
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A
Thenar wasting
Median nerve palsy
12
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A
Hypothenar Wasting
Ulnar nerve
13
Q
A
Charcot Marie tooth
Inverse champagne bottle legs (peroneal muscle atrophy)
Pes Cavus
Joint deformities
UL - Claw hands, hand wasting
14
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A
Charcot Joint
manifestation of long term destruction to a weight bearing joint as a result of sensory neuropathy
15
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A
Myotonic Dystrophy
long expressionless face
bilateral ptosis
facial muscle wasting
Look for - hand wasting, Difficulty inr elaxin when hand shake, percussion myotonia
16
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A
17
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A
Myasthaenia Gravis
bilateral ptosis
Myasthaenic snarl on smiling
Voice will tire counting to 50
Fatiguability in muscle groups
eyes droop on prolonged upward gaze
18
Q
A
Cafe au lait
NF
Mccune Albright
?urticaria pigmentosa, Multiple lentigenes
19
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A
Axillary freckling
NF
20
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A
Ash Leaf
Tuberous Sclerosis
21
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A
Shagreen patch
Tuberous sclerosis
22
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A
Neurofibroma
NF
can be itchy, violaceous, may bleed
overgrowth of nerve trunk, large cutaneous trunk
23
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A
iris hamartoma
NF
24
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A
Ret Hamart
TS
25
**vest schwann**
this is an MRI of a brain in the transverse plane. It is in line with the globes and the cerebellum. there is a gad-enhancing lesion situated at the CPA.
This is a vestibular schwannoma
26
**Bouchard Node**
Swelling of the PIP
OA
Bony spur
27
**Heberden Nodes**
Swelling of the DIP
OA
bony spurs
28
**Squaring of the thumb/Carpo metacarpal joint**
OA
29
Swan Neck Deformity
Hyperextension of PIP / Hyperflexion of DIP
RA
30
**Boutonniere deformity**
**Hyperflexion of PIP, hyperextension of DIP**
**RA**
31
**Z thumb deformity**
Extension of CMC Joint and Flexion of IP
RA
32
Ulnar deviation
Ulnar deviation of hand joints
RA
33
**Gouty Tophi**
Collections in pinna and tendons
34
**Gouty Podagra**
Classic inflammation of the base of first metatarsal phalangeal joint
35
**X ray of gout**
Soft tissue swelling
Joint effusion
Well defined punched out eccentric erosion
Joint space is preserved to late disease
36
**Pencil in cup**
**Psoriatic arthritis (NB this is last sign)**
**Moreso resembles RA but without the juxtarticular osteopenia**
37
**CREST syndrome**
Limited Systemic sclerosis - CREST features and skin changes on hands, feet, face
This image shows -- microstomia and multiple telangiectasia
Smiling can elicit a sclerosis grimace
38
**Sclerodactyly - CREST syndrome**
Localised thickness and tightening of the digits
39
**Calcinosis**
Yellow, white cutaneous deposits
CREST syndrome
40
**Heliotrope rash**
**Dermatomyositis**
41
**Shawl Sign**
**Maculopapular rash over hsoulders and back**
Dermatomyositis
42
**Nailford erythema**
Dermatomyositsi
43
**Gottron's Papules**
Dermatomyositis
44
**Jaccoud's arthropathy**
Non erosive arthropathy characteristically ulnar deviation of 2-5 digits.
Seen in - Post rheumatic fever, SLE, RA, Psoriatic arth etc.
45
**malar rash**
Clasically spares nasolabial folds
SLE
46
**Discoid Lupus**
NB can affect the scalp causing a scarring alopecia
47
**Bamboo spine / Dagger Sign**
Bamboo = ossification of the vertbrae
Dagger sign = ossification of the suprasinatous and interspinous ligaments
**Ank Spond**
48
**Syndesmophytes**
Bone growth occuring from inside a ligmaent
49
Nodular + Reticulonodular opacities in a patchy distribution (Nb can also be confluent)
Lung bases involved and is bilateral but asymmetrical
**Bronchopneumonia**
- Key to this one is that the distribution is patchy and bilateral but asymmetrical
50
Opacification of the right lung in the distribution of the middle lobe as represented by obscured right heart border.
**Lobar pneumonia - RML**
51
**RUL Collapse**
Horizontal fissure has been displaced upwards
Mediastinum is enlarged
Apparent volume reduction of the right lung
52
**Pleural Effusion**
53
**Empyema**
Distinguishing from PE
- Wide angle with chest wall
- Convex shape
- unilateral/ asymmetrical
54
**Pulmonary Abscess**
Radiodense rim
Radiolucent centre
with an air fluid level
55
**Fine reticular interstitial pattern**
This is actually PCP pneumonia
- Other features pleural effusions, pneumatocoels, blebs
56
**Peribronch/perivasc infiltrates (lines tracking outward from hilar region)**
**Basal airspace consolidation**
This is actually mycoplasma
57
**Consolidation in RUL**
**Bulging fissure sign - Horizontal fissure being pushed downward**
This is acutally klebsiella pneumonia
58
**Lobar consolidation of the left lower lobe (can't see the diaphragm but can kind of make out the heart)**
**Strep pneum**
59
**Tram Track opacities**
**Thickened bronchioled seen in Coronal plane**
**Increased broncho vascular marking**
**air fluid levels**
**mucus pooling**
Bronchiectasis, ABPA, CF
60
**Mycetoma**
Note there is a mass, in a pre-existing cavity, that is surrounded by a crescent of air.
There isn't an air fluid level
Aspergillosis can cause a spectrum of conditions:
Asthma
ABPA
Aspergilloma
Invasive aspergillosis
Extrinsic Allergic Alveolitis
61
Diffuse bilateral coalescent opacities. Alveolar ill-described pattern of shadowing ( looks fluffy). NB the patient is also clearly unwell considering all of the kit visibel on this radiograph
**this is actually ARDS but could equally be pulmonary haemorrhage/oedema**
62
**Right upper lobe mass - with no air bronchograms**
**Right sided effusion**
Highly suggestive of malignancy
63
RIght middle zone consolidation (obscuring of right heart border)
Outline of an irregular mass
Highly suggestive of malignancy due to the strangely shaped mass
64
Widened Mediastinum
Right hilar mass
Tracheal deviation to the right
Right pleural effusion
**Suggestive of malignancy ( mediastinal enlargement due to LN involvement)**
65
Veil like shadowin g over L side of heart
L diaphragm raised
Lung volume appears reduced
L upper lobe collapse
66
Multiple irregular opacities in both lung fields.
Metastatic lung cancer
67
Multiple well defined round opacities in both lung fields
Cannon ball mets--\> highly suggestive of RCC
68
**Bihilar Lymphadenopathy**
Stage 1 sarcoid.
Other signs can be seen are - peripheral infiltrates, fibrosis (ground glass reticulonodular shadowing), bullae
DDx for bHL:
Sarcoid
Infections - TB
Malginancy - lymphoma,
Interstitial diseases - EAA, silicosis
69
Bilateral asymmetrical opacification of lower lobes
Reticular - lines
with some nodularity - blobs
**Honeycombing**
UL causes - APENT - ABPA, Pneumoconiosis - silicosis, EAA, Sero**n**egative arthropathies- Ank Spond, TB
LL causes - STAIR. Sarcoid, Toxins- nitro, mtx, sulfasalazine, bleomycin, amiodarone, Asbestosis, IPF, Rheumatoid - RF, SLE, Sjogren
70
Lupus pernio
71
Hyperinflated chest (flattened diaphragm, "small looking heart", ribs - more than 6 anterior/ 10 posterior ribs in MCL)
Increased bronchovascular markings
COPD
**Remember** - posterior ribs emerge near perpendicular to vertebrae then slope downwards
72
**Bronchiectasis**
- Tram lining in lower left zone
73
**Pericarditis**
Note widespread saddle shaped ST elevation
PR depression
**Rx - NSAIDs**
Causes
Metabolic
infectious - viral
inflammatory
Endo
Ischaemic
Idiopathic
74
Torsaides De Pointes
Polymorphic VT
IV Mg 2g IVI
75
**P Mitrale**
Bifid p wave due to LA elargement
76
**P Pulmonale**
Peaked p wave due to RA enlargement (PHTN, PS)
77
**Left Ventricular hypertrophy + TWI**
HOCM
78
**Erythema Ab Igne**
Iron deposition in the skin due to heat related haemolysis.
Sign of chronic pain
79
**Erythema Marginatum**
Rheumatic fever
80
**Grade 4 hypertensive retinopathy**
Cotton wool spots / soft exucdates
Blurred optic disc
81
**Pretibial myxoedema**
**Grave's**
82
**Thyroid ACropachy**/ ?could also be clubbing as they're very smilar
83
**Pseudohypoparathyroidism/ pseudopseudohypoparathyroidism(normal biochem)**
Shortened fourth and fifth fingers
84
Hyperpigmentation
Think Addison's
Remember POMC --\> MSH + ACTH
NB pigmentation won't be present in secondary addisons
85
**Cuti Verticis Gyrata**
Can be sign of acromegaly
86
**Wilson's**
Kayser Fleischer Ring
Sunflower cataracts
87
**Lichen planus**
Purple, polygonal, violacious with wickem's straie
88
**Lead Pipe**
UC
89
Type of scan?
What is it
Barium Enema
Irregular mucosa
Loss of haustral markings
No skip lesions
UC
90
**Senitnal loop**
Pancreatitis (proximal jejunal loop dilatation in LUQ)
91
Dermatitis herpeteformis
IgA intraepidermal deposition
92
**Rugger jersey spine**
Sclerotic vertebral end plates
Renal osteodystrophy
93
94
Rigler's Triad
Gallstone Ileus
- Pneumobilia
- Gall stone at ileocaecal valve
- small bowel obstruction
95
**Small bowel obstruction**
Diameter \>3
Central
Valvulae coniventes: completely across
LB gas absent
Many loops
Many, short fluid levels
96
**Large Bowel Obstruction**
\>6cm (caecum \>9cm)
Peripheral loccation
Haustra- partially across
LB gas present in rectum
Few loops
Few, long fluid levels
97
**otitis externa**
Inflammation/ Infection of external ear canal and structures
- Cons -lifestyle changes
Med - Analgesics
Top acetic acid
Top Abx +/- steroid
top steroid for eczema
Cx - Cholesteatoma, Ostemyelitis of temporal bone, Cerebral abscess ---\> malignant OE
98
**Bullous Myringitis**
Painful haemorrhagic blisters on TM and surrounding meatul structures
Associated with influenza
99
**Otitis Media**
Bulgind Red TM
100
**Otitis MEdia with Effusion**
Dull, retracted TM
Fluid level behind TM
Flat tympanogram
101
**Chronic SUpparative OM**
- Drum perforation with chronic effusoon and hearing loss
Mx - aural toilet
Abx/steroid ear drops
102
**Cholsteatoma**
Locally desctructive expansion of squamous epithelium in the middle ear
103
**Mastoiditis**
Boggy swelling at mastoid process
Protrusion of ear
Can ahve CNVI/ VII nerve palsies
MX
Iv antibitoics
Mastoidectomy
104
**CN III Palsy**
protpsosis, down and out pupil.
(+blown pupil f surgical)
105
**Holmes Adie Pupil**
No response to light
Sluggish response to accomodation
Absent reflexes, reduced bp
On slit lamp - iris streaming
Postganglionic parasympathetic nerve damage
106
**Horner's Syndrome**
proptosis
Enopathalmus
Meiosis
(anhydrosis)
107
**Acute glaucoma (** closing of the angle in anterior chamber)
**Rfx -** shallow anterior chamber, hypermetropia, Drugs - anti cholinergics
Cloudy pupil, red eye, dilated pupil
Very painful
Peripheral loss of vision first
**Ix - Tonometry, Gonioscopy.** Raised IOP \>40 mmhg (normal is 5-20mmHg)
**Mx -** IV Acetozolamide, Pilocarpine, Timolol
IV mannitol
Peripheral Laser iridotomy
**Look for eclipse sign with a flash light -** broad shadow = narrow chambger = glaucoma
108
**Anterior Uveitis (Iris, Uveitis = Ciliary Body and Choroid)**
Pupil normal
Eye red
Pain on **accomodaiton** (Talbot's)
Photophobia
Pain
Normal IOP
**irregular pupil**
109
**Scleritis -** remember to exclude wegener's!
Causes - RA, SLE, idiopathic, wegener's
Epscleritis - Vessels will blanche with epinephrine, localised reddening that can be moved over the sclera
Scleritis - doesn't blanche, won't move.
110
**Corneal ulcer (Nb good differential is acnathamoeba - swimming pool contact lens wearers)**
Bacterial, viral, fungal, inflammatory (RA)
Contact lens wearers
Need ophth referral
111
**Dendritic ulcer**
herpes simplex keratitis 5
112
Herpes Opthalmicum
Herpes Zoster in the CNVI
Hutchinson's sign (nose tip involvement) ---\> indicator of imminent occular involvement
113
**optic neuritis**
pale optic disc
blurred disc margins
114
**Vitreous Haemorrhage**
115
**Central retinal artery occlusion**
pale retina, cherrry red macule
Afferent defect
Causes - GCA, THromboembolic causes
Mx - Reduce IOP
Occular massage, Antihyeprtensives, surgical removal of aqueous
116
**Central retinal vein occlusion**
**-** Unilateral visual loss, RAPD
- **Stormy sunset appearance**
Tortuous dilated vessel,s,
haemorrhages, cotton wool spots
**Causes** - Arteriosclerosis, DM, HTN, Polycythaemia
117
**Retinal Vein Branch Occlusion**
Looks like centreal retinal vein occlusion but the:
tortuosity, haemorrahges and cotton wool ischaemia are more localised
118
**Retinal Detachment**
**4 Fs -** Floaters, Flashes, Field loss, fall in acuity
Pianless
Urgent surgery - vitrectomy with gas tamponade
119
**Dry age related macular degeneration**
- Drusen around macula
Macula degeneration
**Wet** ( will have neovascularisation and haemorrahge around macula)
120
**Optic atrophy ( right image) - think open angle glaucoma**
increase cup to disc ratio (usually \<0.7)
121
**Mild NPDR**
Microaneurysms
Potentially one haemorrhage towards the left of the image
122
**Moderate NPDR**
Microaneurysms
Several haemorrhages (look just adjaceent to many of hte aneurysms in this picture)
123
**Severe NPDR**
Intraretinal microvascular malformations
Microaneurysms
Haemorrhages
Cotton wool spots
Venous beading
124
**Maculopathy**
Cotton wool/ exudates one disc space from the macula
125
**Prolfierative retinopathy**
Neovascularisation - good pace to look is over the disc for the exam
IRMAs
Venous Beading
Lots of haemorhage
Lots of ischaemia
126
**Septal haematoma**
urgent evacuation and packing required as untreated will lead to cartilaginous necrosis.
127
**HHT -** Oromucatenous telangiectasias
128
**EBV tonsillitis**
Greyish exudate covering tonsils
129
**Tonsillitis**
Most likely strep
130
**Quinsy abscess (peritonsillar abscess)**
**Uvula is deviated**
**Mx - Admit, IV abx, I&D**
131
**Optic Atrophy**
132
**Retinitis Pigmentosa**
- pale optic disc
- mid peripheral bony spicules, baring of the retinal pigmented epithelium, vessel attenuation and sparing of the central macula
Causes - mitochondiral cytopathies
- Retinitis pigmentosa AR/ AD
- Friedrich's Ataxia
- Refsum's Disease
- Usher's Syndrome
- Kearne's - Sayre's syndrome
133
**Post photocoagulation DM retinopathy**
134
**hordeolum Externum**
**(stye)**
Abscess of the pit/ follicle of an eye lash.
Mx - Fusidic acid----\> surgical removal
135
**hordeolum internum** (meibomian cyst)
Abscess of meobomian gland
136
Ptosis
Bilateral causes : Primary ptosis (LPS weakness), MG, Myotonic Dystrophy
Unilateral - Horner's, CNIII palsy
137
**KW 1 hypertensive retinopathy**
Silver wiring / Vessel tortuosity
138
**KW 2 Hypertensive retinopathy**
**AV nicking**
- to me just looks like big/medium vessels are crossing over each other
- look for silver wiring + vessel tortuosity if unsure
139
**KW 3 Hypertensive retinopathy**
Flame shaped haemmorhages
140
**KW 4 Hypertensive retinopathy**
Papilloedema
141
**Boat Shaped Haemorrhage with pale centre**
Roth spot
Infective endocarditis
142
**Kayser Fleischer Ring**
**Wilson's**
**Sunflower cataracts sometimes too**
143
**Buerger's disease**
Thromangitis obliteran
Young male smokers
144
**Wet gangrene**
Tissue death + infection
145
Tissue death
146
**Pre gangrene**
147
**Gas Gangrene**
Clostridium Perfriengens
Mx
Debridement
BenPen Metro
Hyperbaric O2
148
**Venous stars**
149
**Haemosiddherosis**
150
**venous eczema**
151
**Lipodermatosclerosis**
152
**Atrophie Blanche**
153
**Venous ulcer - medial malleolus, lateral malleolus**
Venous stockings
Improve arterial inflow , treat venous stasis issues
Pentoxyflline
154
**Arterial Ulcer -** Shin, top of feet, toes, pressure points
Punched out deep ulcer, usually dry
**mx**
- Improve arterial inflow (Endovascular, surgery, clopidogrel etc.)
- Dressings (manuka honey, alginate, silver, hydrocolloid dressings)
- Vac ( aims to create a closed wound, sub-atmospheric environment ) (reduces interstitial oedema, improves tissue oxdygenation)
- Use maggots for debridement/ surgical debridement , dressing debridement
155
**Vac dressing**
156
**Neuropathic Ulcer**
Punched out, painless ulcer with surrounding insensate skin
157
**Dupuytren's**
Fibrotic thickening of the palmar fascia
BAD FIBERS
Bent penis - peryiones patch
AIDS, DM
FH
Idiopathic
Booze - ALD
R- retroperitoneal fibrosis, reidels thyroiditis
Epileptic medications - phenytoin
Smoking
158
**hallux valgus**
Deviation of the great toe laterally at the MTP joint. May be associated bunyon due to pressure against shoe
Due to inappropriate footwear
Mx - bunion pads, metatarsal osteotomy
