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1
Q

Most common cystic neoplasm of the pancreas?

A

mucinous cystic pancreatic tumor

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2
Q

Findings associated with Gardener syndrome?

A

multiple GI tract neoplasms

osteomas of the facial bones

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3
Q

cystic pancreatic mass with honeycomb appearance

A

serous cystadenoma

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4
Q

Zenker diverticulum is located where?

A

hypopharynx. superior to cricopharyngeus muscles (c5-6)

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5
Q

Location of killian-jamieson diverticulum?

A

cervical esophagus- below cricopharyngeus

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6
Q

Reticular mucosal pattern in esophagram?

A

Barretts

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7
Q

Esophagram with concentric rings

young patient

atopia

ringed esophagus

A

Eosinophilic esophagitis

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8
Q

Esophageal carcinoma assoc with alc, tobacco, alkaloid ingestion, mid esoph

A

squamous

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9
Q

esophageal cancer related to chronic reflux

A

adeno

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10
Q

What is the difference between stage 3 and stage 4 esophageal malignancy?

A

adventitia vs. invasion into adjacent structures. (CT)

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11
Q

UGI demonstrates plaque-like lesions or granularity in esophagus

A

candidiasis.

patient will be immunocompromised

severe form looks shaggy with irregular luminal surface

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12
Q

esophageal ulcer with halo of edema

A

Herpes

Ð herpes has a halo

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13
Q

asymptomatic version of esophageal candidiasis (mult elevated nodules, elderly)

A

glycogen acanthosis

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14
Q

large flat ulcer of esophagus

A

CMV or HIV

they are not distinguishable

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15
Q

Water density mass in posterior mediastinum

A

esophageal (enteric) duplication cysts

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16
Q

How do you distinguish between an epiphrenic diverticula and para-esophageal hernia?

A

Epiphrenic will be on right and hernia on left

epiphren considered a pulson type diverticulum

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17
Q

multiple small outpouchings of the esophagus

A

esophageal pseudodiverticulosis

2/2 chronic gerd

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18
Q

Liver lesion

young woman

large

well-circ

solitary

peripherally draped vascular supply

A

Hepatic adenoma

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19
Q

MC cause of linitis plastica?

A

Scirrhous cardcinoma

2nd most common: lymphoma

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20
Q

ribbon-like bowel (barium)

A

graft vs. host

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21
Q

Irregular, nodular fold thickening, adenopathy, and diarrhea

A

Mycobacterium avium-intracellulare (MAl) infection

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22
Q

soft-tissue thickening centered at the superior mesenteric root, with central calcifications extending outward to produce mass effect on the small bowel.

A

retractile mesenteritis

ddx: Carcinoid: spoked wheel or star burst pattern of mesenteric thickening and retraction with central calcifications. Hypervascular metastases to liver would suggest this. less dense than retractile mesenteritis.

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23
Q

nutcracker esophagus

A

esophageal spasm

manometric findings >180 mmHg

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24
Q

iron deficiency anemia, dysphagia, thyroid issues, spoon shaped nails

A

Plummer-Vinson Syndrome

esophageal web

risk factor for esophogeal and hypopharyngeal carcinoma

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25
dysphagia 2/2 compression by aberrant R SCA
dysphagia lusoria
26
what lung problem occurs with scleroderma?
NSIP
27
H pylori gastritis occurs *where* in the stomach?
antrum
28
"jejunal ulcer" also ulcerations in the stomach and duodenal bulb
Zollinger Ellison ZE is from gastrinoma- could test MEN syndromes this way
29
where in the stomach does Menetriers disease occur?
fundus massive gastric folds
30
which gastric wall problem "crosses the pylorus"?
lymphoma adenocarcinoma does it too
31
FAP+ Desmoid tumors, osteomas, papillary thyroid cancers
Gardener Syndrom
32
FAP + gliomas and medulloblastomas
Turcots
33
cancer everywhere in everything (early colon) and DNA mismatch repair
Lynch Syndrome aka Hereditary nonpolyposis syndrome
34
hamartomas, mucocutaneous pigmentation, small and large bowel CA, panc CA, and GYN CA
Peutz-Jeghers
35
hamartomas, **breast CA**, thyroid CA, lhermitte-duclose (posterior fossa noncanerous brain tumor)
Cowden's \*\*\*likely to be asked
36
hamartomas with stomach, small bowel, colon, and ectodermal stuff (skin, hair, nails)
Conkite-Canada
37
Hamartomas + nada
Juvenile polyps
38
MC mesenchymal tumor of the GI tract
GIST 70% in the stomach. rare before age 40 \*\* no LN involvement, malignant can be huge, NF-1 association
39
Carney's Triad
chordoma extra adrenal pheo GIST carney's eat garbage
40
features of malignant stomach ulcers
wider than tall located within lumen nodular/irreg edges folds adjacent to ulcer can be anywhere
41
features of benign stomach ulcers
deeper than wide project beyond lumen sharp contour folds radiate to ulcer lesser curvature
42
risk factor associated with gastric carcinoma
H pylori median age 70
43
metastatic spread of gastric carcinoma to the ovary
Krukenberg tumor
44
MC location for sarcoid in the GI tract
stomach
45
sand like nodules and thickened irregular mucosal folds of duodenum and prox jejunum
Whipples "like a stripper" look for near-fat LNs
46
findings of whipples (sand like nodules in jejunum with mucosal fold thickening) + big spleen and RP LNs
Pseudo Whipples/ MAI infection
47
Clinical stuff related to celiac's
malabsorption of iron idiopathic pulmonary hemosidrosis (Lane Hamilton Syndrome) increased risk of bowel wall lymphoma Gold standard is bx dermatitis herpetiformis
48
fold reversal (feathery jejunum looks like ileum and vice versa) cavitary LNs splenic atrophy
Celiac sprue
49
intestinal lymphangiectasia
obstruction of the flow of lymph from the small intestine into the mesentery
50
SMA syndrome
obstruction of 3rd portion of the duodeum by the SMA recent weight loss
51
Meckel's Diverticulum 1. Rule of 2's 2. NM scan
1. 2 feet from IC valve, 2 inches long, 2cm in diameter, symptoms before age 2 2. Tc-Pertechnetate
52
MC primary location of carcinoid
distal appendix and terminal ileum
53
Epidemiology of SPEN? solid psuedopapillar epithelial neoplasm.
They are extremely rare and thought to account for 1-2% of exocrine pancreatic tumours. They tend to present in young non-Caucasian females around the 2nd and 3rddecades of life.
54
venous drainage of the adrenal glands
R: IVC L: L renal vein
55
Where is aldosterone made?
Zona glomerulosa regulator of Na, K and HTN
56
Where is cortisol made?
zona fasiculata
57
where are androgrens made (in regards to adrenal gland)?
zona reticularis
58
Where are catecholamines made?
Medulla of adrenal gland
59
You are shown an thickened adrenal gland with loss of the central hperechoic stripe.
21-Hydroxylase Deficiency/ Congenital adrenal hypertrophy in girls, genital ambiguity in boys, salt loosing pathology which can be lethal
60
Bilateral adrenal gland hyperplasia in a patient with small cell lung cancer
Cushing syndrome= too much cortisol. ectopic production from small cell. cushings can also be from pituitary adenoma (75%) and adrenal adenoma (20%)
61
What are some of the causes of adrenal hemorrhage?
**Stress:** breech, fetal distress, calcs as end result, should be avascular. (neuroblastoma will not get smaller) **Trauma:** more common on R **Waterhouse-Friderichesen Syndrome:** in the setting of fulminantn meningitis from Neisseria Meningitidis
62
Heterogenous adrenal mass that is T2 bright.
pheochromocytoma usually larger than 3cm on presentation MIBG\>octreotide also organ of Zuckerkandl
63
Rule of 10s with pheo?
_10% are:_ extra adrenal bilateral in children hereditary NOT active (no HTN)
64
Syndromes associated with pheochromocytoma?
Von Hippel Lindau MEN IIa, IIb less likely: NF-1, Sturge Weber, TS
65
Carney Triad? (not carney complex)
Extra-adrenal pheo, GIST, pulmonary chondroma (hamartoma)
66
Adrenal tumor that contains bulk fat?
Myelolipoma B9 if bigger than 4cm, can bleed
67
If a pt has a known primary and an adrenal lesion that looks like lipid poor adenoma?
Adrenal met. (esp lung, breast, melanoma)
68
LARGE adrenal mass, 20% have calcs and met everywhere with direct extension first
Adrenal cortical carcinoma
69
Absolute equation for adrenal washout? what value = adenoma?
(enahnced CT-Delayed CT)/(enhanced CT- unenhanced CT) x 100 Greater than 60%=Adenoma ÐAbsolute Vodka is clear (unenhanced) and 60 proof
70
What is the equation for relative washout for adrenal adenoma? What value = adenoma?
(Enhanced CT- Delayed CT)/Enahnced CT x 100 Greater than 40% = Adenoma Your relatives drink brandy, which is not clear (unenhanced) and it is 40 proof
71
Which syndrome = too much aldosterone?
Conn. most commonly caused by benign adenoma.
72
what are some of the causes of adrenal calcs?
prior trauma prior infxn (TB) cortical carcinoma, neuroblastoma, melanoma
73
bialteral enlarged calcified adrenals (peds)
Wolman disease fat metabolism error that kills in 6 mos
74
Can you think of a way to remember the MEN syndromes?
MEN 1: *parathyroid hyperplasia*, pituitary adeno, pancreatic tumor (gastrinoma) MEN 2a: **medullary thyroid**, *parathyoid hyperplasia,* _pheo_ MEN 2b: **medullary thyroid**, _pheo_, mucosal neuroma, marfanoid body habitus. (Lincoln had this? he is a Man2Be)
75
microcalcifications in a thyroid nodule
papillary thyroid cancer
76
what do you do with a cold nodule on thyroid scan?
usually B9, but cancer 15% of the time- deserve futher workup
77
why care about thyroglossal duct cyst?
can get infected, can rarely have papillary thyroid cancer
78
most common location for ectopic thyroid?
base of the tongue- will look hyperdense because of iodine (just like thyroid)
79
most common cause of goiter?
North America: multi-nodular goiter/graves Africa: low iodine
80
What is Grave's dz?
autoimmune dz -\> HYPERthyroid ism, antibody directed at TSH receptor
81
I-123 scan value indicateing Graves?
usually 50-80% uptake
82
What is Hashimotos?
autoimmune dz -\> hyper and hypo thyroid **MC cause of goitrous hypo** Abs against TPO and anti-thyroglobulin
83
U/S appearance of Hashimotos?
Giraffe skin heterogenous appearance white knights (hyperechoic regenerative nodules)
84
Solid, asymptomatic pancreatic tumor.
Pancreatic neuroendocrine tumors are usually solid and hypoechoic or isoechoic in appearance.
85
jejunal ulcer
buzzword for ZE. ZE is from gastrinoma, could test MEN syndromes this way duodenal bulb is actually MC location for ulcers in ZE
86
menetriers dz
enalrgement gastric folds of fundus
87
diff bw Gardner and Turcots?
both have FAP, but Gardener has desmoids, osteomas, and papillary thyroid CA while Turcots has gliomas and medulloblastomas
88
Cowden's syndrome
hamartomas Breast CA Thyroid CA Lhermitte-Dulcose (posterior fossa non-CA brain tumor)
89
What defines stage T3 rectal cancer?
breaking out of the rectum and into the perirectal fat- changes managment to neoadjuvant
90
Nuc Med studies: which liver lesions are hot (with what tracer) and just plain cold? 1. Hepatic adenoma 2. FNH 3. Cavernous Hemangioma 4. HCC 5. Cholangiocarcinoma 6. Mets 7. Abscess 8. Focal Fat
1. cold 2. Sulfur colloid hot- 40% 3. RBC hot 4. Gallium hot 5. cold 6. cold 7. gallium hot 8. xenon hot
91
High liver signal on ***_in phase_*** imaging
hemachromatosis
92
Pancreatic lesions with subtle mutliple cysts, septa, and central scar
microcystic adenoma

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