in service exams Flashcards
what is the appearance of retinal detachment?
SUDDEn vision loss, bright T1, spares posterior optic disc, no enhancement
which HSV virus causes Herpes encephalitis? where do u see T2 hyper intensity?
HSV 1. See T2 hyperintensity in the temporal lobes, limbic system, basal ganglia
what lobes are gyro calcifications seen in in Sturge Weber?
parietal and occipital
what is a renal pseudo tumor?
mass in kidney that has been affected by chronic peel - see a clubbed calyx, mass enhances like rest of kidney - it is due to hypertrophy of the normal kidney parenchyma left
what are bladder fungus balls most likely due to?
candida
what happens to contrast in a shattered kidney?
severe compromise of excretion of contrast material
what are the findings of a UPJ laceration? what are the findings in UPJ avulsion?
contrast into medial perinephric space, with low density surrounding the DISTAL contrast filled ureter. In UPJ avulsion, no contrast is seen in the distal ureter past the UPJ
what is the treatment for a sub capital fracture?
if patient is less than 65, pinning. if the patient is older, hip arthroplasty
what is the treatment for an intertrochanteric fracture?
compression screw fixation
what GU anomalies are assoc with cystic dilation of the mediastinum testes?
MDCK, renal agnesis
what are the GI findings of a paraduodenal hernia?
encapsulated loops of small bowel on one side of the abdomen
which lung cancer takes up octreotide?
small cell lung ca
what thyroid cancer takes up ocreotide?
medullary thyroid ca
what is the appearance of the aorta and PA in L-TGA? what is the appearance in D TGA?
in L-TGA aorta is anterior and to the left of the PA. in D-TGA the aorta is anterior and to the right of the PA
what syndrome is interruption of the aortic arch associated with?
DiGeorge
what is nutcracker syndrome?
compression of left renal vein btw aorta and SMA
where is a first branchial cleft cyst seen? 3rd? 4th?
first: close to parotid/external auditory canal, fourth: along the course of the recurrent laryngeal n
what is a radial ray?
hypoplasia of the radius and absent thumb
which duct drains the parotid gland? the submandibular gland?
Stensens -> parotid. Whartons -? submandibular.
what part of the orbit is spared in a tripod fracture
orbital roof
where does orbital access originate from?
ethmoid sinus
what is the most common GI location for sarcoid?
stomach
what are the two most common islet cell tumors?
insulinoma and gastrinoma
what are the findings in popliteal artery entrapment?
medial deviation of the popliteal artery
what are the findings in adventitial cystic disease?
extrnisic compression of the popliteal artery by a mucin filled cyst
what is the mgmt for pyonephrosis?
emergent nephrostomy tube placement
what is a contraindication to nephrostomy tube placement?
severe hyperkalemia
what blood supply does the coronary sinus receive? where does it lie? where does it drain into?
lies in the posterior AV groove and receives myocardial venous supply from the cardiac veins -> drains into RA
is annuloaortic ectasia assoc with aortic stenosis or regard?
regurgitation due to myxomatous (floppy) aortic valve leaflets
what are the HU values of a b9 adrenal adenoma on non contrast CT and contrast enhance CT?
on non contrast: less than 10 HU. on contrast enhance: less than 30-40 HU.
what reduces the success of pyeloplasty in UPJ obstruction?
presence of crossing vessels
how does congenital UPJ obstruction usually present in a child?
flank pain, abdominal mass, GI symptoms, NOT UTI
how much contrast is needed in the bladder to diagnose bladder rupture?
at least 300 ml
what are the findings on a tc 99 m MAA study that indicates right to left shunt?
radiotracer in the brain indicates right to left shunt. this is NOT see in free tech.
what part of the FT is salpingitis nods seen in? venous intravasation?
isthmus part (second part). venous intravsation is seen in the same part but u see tortuous veins filled with contrast that mimic a FT
in what subset of patients is medullary renal cell ca seen?
sickle cell TRAIT (not in patients with sickle cell disease)
what are the findings of reflux nephropathy in the kidney?
see a dilated calyx filled with contrast and urine (like a calyces diverticulum) with an overlying cortical scar
what is dysplasia epiphyseal (trevors disease)
osteochondromas at the epiphyses, usually on one side of the body and one side of the joint
what effect does fibrous dysplasia have on the concavity of the bone?
causes bowing (NOF does not)
from which side does the closure at the growth plate occur at the distal tibia? which fractures does this predispose to in a child?
occurs medial to lateral (lateral side of the growth plate fuses later). predisposes to tillaux and triplane fractures
what is parsonage turner syndrome? what are the findings?
acute brachial neuritis. causes supra scapular nerve denervation (idiopathic) and therefore supraspinatus and infraspinatus atrophy, see high T2 signal due to acute edema in these muscles
what is the most common skeletal manifestation of hyperthyroidism?
osteoporosis and accelerated bone maturity in kids
what is thyroid acropachy?
periostitis in the small bones of the hands and feet seen after Rx of hyperthyroidism
what is seen on T2 images of osteoid osteoma?
increased T2 signal reflecting edema
what does rupture of the ACL cause to the appearance of the PCL?
buckling of the PCL
is bucket handle tear due to a horizontal or longitudinal tear of the medial meniscus?
longitudinal
what is the rotator interval?
the space btw the supraspinatus and the subscapularis btw which the long head of the biceps traverses
what is the difference in patient dose when using MDCT vs SDCT?
dose is increased by 30% in MDCT due to patient overscanning
in computed radiography what is the photostimulable phosphor made out of?
BaFBr - contains “traps” with the latent image
what is an everting ureterocele?
ureterocele everts back into the extravesical ureter, outside the bladder - see a contrast filled ureterocele protruding outside the bladder
what are the findings on MAG 3 scan of ATN vs acute rejection?
normal flow and decreased excretion in ATN. in acute rejection there is decreased flow and function of the kidney.
what is the definition of a sentinel node?
the FIRST node to be seen (timing is the most important, not size or intensity of uptake)
what are the findings of mucus plugging on a VQ scan?
MATCHED ventilation and perfusion defect - mucus prevents ventilation and there is reflex vasoconstriction leading to decreased perfusion
where is aluminum seen if it exceeds the normal level on a Tc99m scan? how is excess aluminum tested for and what are the findings if it is in excess?
liver and lungs. excess Al is tested with colorimetry. will see the paper turn pink if there is excess.
what is the mechanism of uptake of Tc 99m?
related to mitochondrial content and the negative plasma membrane potential
what structures are always absent in all forms of holoprosencephaly?
fornix and septum pellucidum
is PVL due to arterial or nervous infarction?
arterial infarction. grade 4 GM bleed is due to venous infarction
what is the mechanism of a perirenal fluid collection in a newborn?
it represents forniceal rupture due to high grade obstruction - urine collects in the peritoneal space - will see it on delayed CT or MR contrast enhanced study. often associated with PUV and preservation of renal function due to decompression of the collecting system
where are thyme cysts most commonly found? what diseases are they assoc with?
found in the neck. assoc with bone marrow aplasia, HIV and treated lymphoma
what are the VQ scan findings of a foreign body
matched defect (perfusion is low bc of reflex vasoconstriction)
what are the fluoro findings in a foreign body in the lung?
on expiration the mediastinum moves away from the affects, hyper inflated side. there is also lack of deflation and diaphragmatic movement on the affected side
what percent of patients with Truncus arterioles have right sided aortic arch? what percent of patients with tetralogy of ballot have right sided aortic arch?
30% and 20-25%
what is penology of fallot? in what percent of cases does it occur?
Tetralogy of fallot with an ASD is penology. occurs in 15%
what are the metabolic findings in pyloric stenosis? is it more associated with maternal or paternal history?
paradoxical aciduria and hypochloremic alkalosis, more associated with maternal history
what congenital syndrome is tracheal bronchus associated with?
downs syndrome
what type of salter harris fracture is a tillaux fracture?
salter harris 3 - has a coronal component thru the epiphyses, and a horizontal component thru the metaphysis
what type of salter harris fracture is a lateral condylar fx of the elbow? medial epicondyle?
salter harris 4. salter harris 1
what part of the lung does LCH spare? is the disease upper or lower lobe predominant?
CP angles. upper lobe predominant
how do adenoid cystic tumors spread? how do they appear in the trachea?
perineural spread. appear as soft tissue encircling the trachea with spread into the bronchial tree - they were previously known as “cylindromas”
what is the appearance of pulmonary alveolar microlithiasis?
sandstorm appearance - multiple micro nodules in the middle and lower lung zones
what gauge needle is used for biopsy of a lung lesion? what b9 lesion is hardest to get a definitie diagnosis for?
20 or 22G core biopsy needle is used. healed granuloma which may have internal necrotic material is hardest to get a diagnosis on.
which vessels does fibrosing mediastinitis typically affect
the pulmonary artery, pulmonary veins, SVC (tends to spare the aorta and great vessels)
what paraneoplastic syndromes does small cell ca cause?
hyponatremia and cushings (SIADH causes hyponatremia)
what clinical symptom does solitary fibrous tumor of the pleura cause?
hypoglycemia
what does a rupture of a bronchus close to the trachea cause?
pneumomediastinum
what is loefflers syndrome?
blood eosinophilia with mixed interstitial and alveolar opacities that are migratory and spontaneously clear
what is seen on expiratory CT in sawyer james?
this is post infectious bronchiolitis that results in a hyper lucent lung or lobe. will see air trapping on expiratory films due to bronchiolar obliteration.
what space does a bronchogenic cyst cause obliteration of on a CXR
azygoesophageal interface (subcarinal region)
what is the mechanism of F-18 NaG uptake?
chemisorption - in areas of increased osteoblastic activity
what would the Tc MAA perfusion findings be in pulmonary AVM?
multiple perfusion defects bc the particles don’t aggregate in the AVM since there is no intervening capillary bed
what effect does ROI over the spleen during a MUGA scan have? what is the effect if the same ROI is used for systole and diastole?
including spleen: artificially elevates the EF. using the same ROI for systole and diastole: artificially reduces the EF.
why are forearm measurements of bone density insensitive for the detection of post menopausal osteoporosis? in what patients can measurements of the extremities be used?
bc the bones of the extremities are mainly cortical bone and osteoporosis typically affects the trabecular bone - so will get a “normal” bone density if u measure the extremities. in patients with metabolic bone disease (total body decrease in calcium)
where doe clear cell chondrosarcoma arise in a bone?
at the epiphyses, in an adult. mimics chondroblatoma that u would see in a kid
what malignant transformation is seen with multiple hereditary exostoses?
chondrosarcoma
what type of tibial bowing is seen with NF1?
anterolateral
what is the inheritance pattern of ollier and maffuci syndrome?
non inherited
what is a cancer that can be seen after neuroblastoma treatment?
RCC - can be from age 2 to 20. usually bilateral and not related to whether the patient got chemo or XRT. can be after any type of neuroblastoma
what type of deficiencies cause a patient to get a bexoar?
zinc and iron deficiency
what is hemolytic uremic sydrome? what would u see on abdominal X-ray?
acute renal failure, t.cytopenia and hemolytic anemia, see thumb printing of colon on X-ray
what are the two most common ligaments injured in an inversion ankle injury? what ligament tears with an eversion injury?
anterior talofibular and calcaneofibular. deltoid ligament tears with an eversion injury.
what does area under ROC curve represent?
accuracy of interpretation of a diagnostic test
what relationship btw sensitivity and specificity would cause an ROC curve to be done?
if sensitivity and specificity are negatively correlated
what is the most important outcome to consider in screening test effectiveness?
disease specific mortality reduction
what is seen in robson stage 3A RCC? stage 3b?
invasion into renal vein or IVC is 3a. invasion into lymph nodes but NOT renal v or IVC is 3b.
what is pseudodiverticulosis of ureter? what is the mgmt for pseudodiverticula of the ureter?
outouchings of ureter due to inflammation - indicates increased risk for TCC (25%) so look for TCC - if don’t find it, do semi annual follow up.
what percent of adrenal cortical ca has calcs?
30%
what is the mgmt of PTLD?
stop immunosuppressants
what malignancy is leukoplakia assoc with?
sq cell ca
what is the treatment for epidydmoorchitis?
Abx for 4-6 weeks
what is the most common cause of oligohydramnios?
PPROM
what conditions is intracardiac echogenic focus seen in? where are they most commonly located?
trisomy 13 and 21. most commonly in LV.
if a hyper echoic lesion that looks like AML is seen on renal US what is the next step in mgmt?
get a CT to confirm for the presence of fat, and can then follow the lesion with US
why does mag views on mammo lead to more blur? is noise more in regular or mag mammo?
smal focal spot size limits tube current reading to increased time -> more motion blur. noise is less in mag mammo bc more photons reach a smaller area
what is the risk of recurrence of breast ca after lumpectomy and XRT? what is the mean time to recurrence?
1-2 % in the first 5-10 years and then 1%. mean time to recurrence is 3.5 years
where is omental infarction most commonly seen?
on the right side, less well defined and larger than epiploic appendicitis
what are the top 2 most common b9 hepatic masses? which can increase in size with OCP?
hemangioma then FNH, FNH can increase in size with OCP
what is a “coned cecum”
sign of TB - shrinkage of the cecum and loss of the ileocecal angle
after partial gastrectomy for b9 peptic ulcer disease, what is the risk of malignancy?
risk of malignancy to adenocarcinoma in the gastric remnant 15-20 yrs after surgery
what is the most common pancreatic tumor to calcify?
serous or microcystic cyst adenoma
what is the most common etiology of jaundice?
b9 stricture
what is mirrizzi syndrome and what patients are more likely to get it?
it is extrinsic obstruction of the common hepatic duct by a stone lodged in the cystic duct. patients with low insertion of the cystic duct are more likely to get it
which is more common, UC or crohns?
UC
what are the three ASD types, and how common are they? where are they seen?
ostium secundum is most common (75%), seen at level of fossa ovalis. osmium premium is second most common (15%), seen at the level of the mitral and tricuspid valves. sinus venous is least common (10%), seen near the junction of the SVC and right atrium. order is “VSP” from crainial to caudal. sinus venosus is associated with TAPVR and osmium premium is associated with downs.
which is the most anteriorly located valve? which is most posteriorly located?
tricuspid is most anterior. mitral is most posterior. pulmonic is most superior valve. aortic is inferior to the pulmonic.
what are the two types of VSD, which is more common and where are they located?
membranous (most common) and muscular. membranous is near aortic valve and muscular is near the apex.
what percent of total plaque burden does coronary artery calcification contribute to?
20 percent
what is the dominance of coronary system that most people have?
right dominant in 85% of people
are accessory pulmonary veins more common on the left or the right? what is a contraindication to pulmonary vein ablation?
more common on the right. LA thrombus is a contraindication to pulmonary vein ablation.
what does the BT shunt connect? Fontan? Glenn?
BT shunt: connects the subclavian artery to the PA. Fintan: connects the RA to the PA. Glenn: connects SVC to PA
what does rhematic heart disease cause in the mitral valve and in the tricuspid valve?
mitral valve stenosis and tricuspid regurgitation
what is the appearance that is suggestive of pancreatic head carcinoma on a cholangiogram?
rat tailed stricture of distal CBD with intra an extra hepatic dilation - rat tailed appearance is due to extrinsic compression on the CBD by the pancreatic head mass
what is the treatment for SVC syndrome?
angioplasty and stent placement
what is the disadvantage of a transjugular approach to biopsy in the liver? in which patients is this approach done?
cannot reliably biopsy a discrete lesion, done in patients who are at a high risk of bleeding with diffuse parenchymal disease
what is parkes weber syndrome?
hypoplasia of the deep veins of the legs, port wine stains, limb hypertrophy, AVM
what is the chance of premature menopause after UAE? what is the rate of success after UAE for fibroids?
2-5% premature menopause. 80-90 percent success.
what is Foix Alaujanoe syndrome?
spinal dural AVF and venous hypertension
are calculi more common in the SMG or parotid?
SMG
what is binswanger disease?
WM demyelinating disease in patients older than 55 associated with HTN - doesn’t have focal stroke symptoms
what vascular structures are compressed in transtentorial herniation?
PCA and anterior choroidal artery are compressed along with CN3
is a low lying tethered cord associated with chiari 1?
No
which is more common, mets to the pericardium or mets to the myocardium? what are the most common mets to pericardium and myocardium?
mets to pericardium more common. often from lung ca. myocardial mets are from melanoma.
what is the thickness of normal pericardium?
2 mm or less
what percent of cardiac neoplasms are malignant?
25%
what are the paraneoplastic syndromes assoc with solitary fibrous tumor of the pleura?
hypoglycemia and HPOA
what do the changes of XRT pneumonitis occur in the lung?
1-3 months after XRT
how does MAI present in elderly patients with COPD?
nodules or cavitary lesions in the upper lobes
what percent of duodenal ulcers are solitary? what percent are malignant?
80%. less than 5% duodenal ulcers are malignant.
what is the treatment of internal hernias?
it is a closed loop obstruction so do surgery
what part of bowel do broad ligament hernias involve?
small bowel
is malakoplakia premalignant? what do u see on the stain?
not premalignant, associated with immunocompromised patients. see michalis gutman bodies.
what artery produces collaterals in median arcuate ligament syndrome?
GDA (from SMA) to supple the celiac which is stenosed
what part of the spine must be excised in SGT?
the coccyx otherwise 40% recurrence
what layers of germ cells does SGT contain?
all three layers (endoderm, mesoderm, ectoderm)
what are the findings of ventricular terminals?
normal findings - small cyst at a normally positioned conus
how often should QC be performed on an ultrasound transducer?
quarterly
what is the mgmt for GGO ?
less than 5 mm, no F/U. more than 5 mm, F/U in 3 mo then annually for 3 years.
what is the mgmt for ovarian cysts in pre menopausal women?
simple cyst 5-7 cm: annual follow up. simple cyst more than 7 cm: surgical or MRI.
are pleural and pericardial effusion more common in CH or LAM?
seen in LAM not LCH
what is the mgmt for GB polyps 5-10mm? more than 10mm?
monitor those 5-10 mm, excise if more than 10 mm.
what are the specifications to be eligible for liver transplant?
age less than 65, 1 tumor less than 5 cm or up to 3 tumors less than 3 cm
what imaging test should u do before removing an IVC filter?
LE doppler
what can a static magnetic field cause on ECG?
augemented T waves
what is the deinfition of power?
probability that a type 2 error is avoided (study fails to reject null when it is false)
what is the ddx for capsular retraction of the liver?
cholangioca, hemangioendothelioma, schrods breast mets (pseudo cirrhosis)
what is the size criteria for a giant hemangioma?
4 cm
what is the vascularity of GB cancer?
avascular
what are the findings of GB perforation?
sloughed mucosa and striated GB wall
what is the diff in retrospective and prospective in QA vs QI? which is zero tolerance?
QA: retrospective, QI: prospective and retrospective. QI is zero tolerance
what are examples of ionization chambers?
cutie pie, pocket dosimeter, dose calibrator, well counter
what are the segments of the fallopian tube from medial ro lateral?
isthmic, interstitial, ampullary, infundibular
what is the appearance of a duodenal hematoma on barium?
coiled spring
what is the diff on contrast enema btw meconium ileum and jejunoileal atresia?
meconium ileus: total microcolon with reflux of contrast into ileum with meconium and see dilated SB loops proximally. in Jejileal atresia: don’t see any contrast in dilated SB loops
what percent of gastroschisis is associated with bowel atresias?
30%
what are the most common locations for congenital lobar emphysema?
LUL then RML then RUL
what is another name for a mature ovarian teratoma?
dermoid
what coronary artery anomaly is seen in patients with TOF?
LAD from RCA
what type of salter harris fx is tibial tubercle avulsion?
salter harris 3
what is type 4 SGT? is the mature or immature type malignant?
all intrapelvic. immature is malignant.
what circle of willis anomaly is seen with holoprosencephaly?
single anterior cerebral artery (azygous artery)
what are the complications of UVC in RA or PA?
in RA -> arrythmias, in PA -> stenosis/thrombosis
what does the prognosis of CDH depend on?
presence of liver herniation not stomach herniation
what does the continuous diaphragm sign indicate?
pneumomediastinum
what is the diff in mgmt if u see double bubble alone vs double bubble with distal gas?
with distal gas means emergency -> to UGI to rule out volvulus
in what condition do u see a white cerebellum?
diffuse cerebral edema
which two neonatal orbital conditions have small globes?
ROP (has calcs) and PHPV (no calcs)
what is a sign of duodenal hematoma on CT in terms of relationship of mesenteric vessels and aorta?
see superior mesenteric vessels anteriorly displaced from the aorta by the hematoma
how do u tell which vein was accessed for placement of a port?
if the line is above the clavicles, IJV or EJV was accessed, if the line is at the level of the clavicles or below, subclavian vein was accessed
what is the treatment for empyema vs pulmonary abcess?
drain empyema (D, E)
what veins are used for PICC placement?
basilic > brachial> cephalic
what is the mgmt of cervical ectopic?
medial - NOT D and C bc too much bleeding risk
at what CRL and no heartbeat can u say non-viable?
7 mm
what are ancillary findings of biliary atresia on US?
no GB, echogenic cord anterior to the PV bc no CBD, biliary atresia = no extra hepatic biliary duct
does pulmonary sequestration connect with the airway?
no it has no normal connection with the bronchial tree so u should not see air in it unless it also has components of CCAM
what does heterotaxy refer to?
cardiac APEX and stomach on opposite sides
what is granuloma annulare?
high T2 lesion in subcutaneous tissues of pretibial region
what is the mgmt for thyroglossal duct cyst?
sistrunk procedure - resect the cyst, midline hyoid bone, and the tract to the foramen cecum
what are the GI finings of graft vs host disease?
submucosal edema, featureless small bowel and enhancement - “ribbon bowel”
what is the mgmt for cardiac rhabdomyoma in patients with TS?
it regresses on its own
what is hemimegencephaly
hamartomatous overgrowth of part of all of cerebral hemisphere - see straight and elongated lateral ventricle on that side
what do 1/3 of ABC transform into?
chondroblastoma (at epiphyses)
what is a matrix forming posterior element lucent lesion?
osteoblastoma
what is choanal atresia? what is piriform aperture stenosis?
narrowing of posterior nasal cavities. piriform is anterior nasal stenosis.
at what age do u see infantile hemangioma? at what age do u see lymphatic malformation?
infantile hemangioma appears after birth in the first few months, grows with child then regresses. lymphatic malformation is present at birth
if u see the pulmonary trunk anterior and draped over the aorta on axial, what procedure has been done?
Jatene procedure or arterial switch for TGA
where does juvenile nasopharyngeal carcinoma arise from? what vessel supplies it?
lateral nasopharynx at SP foramen - supplied by internal maxiallry artery
what are the findings of LCH? what is EG?
lucent lesions in skull with beveled edges, floating tooth. EG is isolated bone and or pulmonary findings.
what is body stalk anomaly?
fetal adherance to placenta - abdomen is stuck to placenta, so don’t see an umbilical cord
on which side is the main bronchus epiarterial vs hyparteria?
right is epiarterial - bronchus above the pulmonary artery. left is hyparterial - bronchus below the pulmonary artery
what is the formula for I-131 dose to treat
gland weight * 100 microci / 24 hour RAIU
what is the counaid system
above portal vein from left to right: 2.4.8 lucky 7. below portal vein plane, 3,4,5,6. caudate is segment 1.
what tendon attaches to the iliac crest? what attaches at the pubic symphysis?
iliac crest: tensor fascia lata. public symphysis: gracilis.
what is the appearance of the ACL and PCL on a coronal image?
in the IC notch, the ACL is a linear band, the PCL is a dot medial to the ACL.
when do u resect a serous cyst adenoma of the pancreas?
if symptomatic and more than 4 cm
what does the presence of calcium in a pancreatic mass imply?
excludes pancreatic adenocarcinoma
what are the imaging features of pancreatic serous cyst adenoma?
spngy, multiple cysts, with central enhancing scar in 30% and 10% have calcifications
when is a fetus at risk for organ malformations? for MR?
week 2-8 for organ malformation at a dose of more than 100 mGy. week 8-15 for MR at a dose of more than 100 mGy.
where do u set the window and level for soft tissue vs bone?
always set the level at the HU of the ROI (30-80 for soft tissue). the window is narrow for soft tissue (200-400)and wide for bone (1000-3000)
where is a popliteal cyst = baker cyst located
btw the medial head of the gastroc and the semimembranosus tendon
is the bladder full with intra or extra peritoneal rupture?
it is empty with intraperitoneal rupture and contrast is seen outline bowel loops, it is full in exztraperitoneal rupture with collections of contrast seen at the base or alongside the bladder
what type of sac to neck relationship do u want in a PA to inject thrombin?
want the sac to be wider than the neck, if the neck is too wide may need to stent it
where do the ovarian/testicular arteries arise from?
the aorta or the renal arteries
what is mid aortic syndrome?
smooth tapering of the infra-renal aorta -? severe HTN, absent femoral pulses, abdominal bruit, can be seen in young kids as a cause of HTN
where do posterior circulation aneurysms most often occur?
basilar bifurcation, then PICA
what effect does glucagon have on bowel and vessels?
it decreases peristalsis and increases vasodilation
what are the HIDA scan findings of a choledochal cyst?
persistent pooling of contrast btw the liver and duodenum
what is the appearance of streak (incomplete projection) artifact in a head CT?
the artifact converges outside the FOV so its not beam hardening (see the apex of the artifact originating outside FOV and not at the base of the bone)
what is a dromedary hump?
hypoechoic, seen in the left kidney, looks like a bulge of normal renal tissue at the supernatural kidney
what is sirenomelia?
fusion of the lower limbs, mermaid syndrome
what are the conditions assoc with mid aortic syndrome
takayasus, atherosclerosis, NF1, williams syndrome
what does PAN cause
microaneurysms
where is a weber A fracture? weber B?
weber a is below the joint line, weber B is at the level of the joint line
what are the findings of a lateral compression pelvic fracture? is it stable?
horizontal fractures of the pubic rami, and ipsilateral sacral compression fx, is partially stable
what are the findings of an AP compression pelvic fracture?
diastase of the pubic symphysis and SI joints - unstable
which is more urgent emphysematous pyelonpehritis or pyelitis?
pyelonephritis
from what point to what point does the moderator band extend in the RV?
septum to the anterior wall
what forms the border of the right heart on a frontal view?
RA and IVC
what is the most important complication of a CCF?
pressure over optic n -> blindess and/or SAH from SOV/cerebral vein rupture.
what causes contrast induced nephropathy?
ATN
what is the best angle of insinuation for accurate velocity measurement on doppler?
60 degress or less
what is the US appearance of adenomyosis?
venetian blind
what part of the brain does CADASIL spare? what clinically is it associated with?
occipital lobes, and U fibers are not involved. associated with migraines.
what is the first sign of central pontine myelinolysis
restricted diffusion in the lower pons
what is the buzzword appearance for FD. what table in the skull does it involve?
ground glass. involves outer table (Pagets involves inner and outer)
what part of the heart do cardiac rahbdomyomas in TS usually involve? at what age?
age less than 1, involves ventricular septum
what are the renal manifestations of VHL? what do they get in the pancreas?
pheo and bilateral clear cell RCC. think “cysts” everywhere -> Serous cyst adenoma
what is cowden syndrome?
bowel hamartoma, breast CANCER, lhermitte in cerebellum (tiger sripe non enhancing tumor that does not cross midline)
what is an inverting papilloma
b9 sinonasal tumor from the middle turbinate, lateral wall of the nasal cavity. has 10-15 percent conversion to sq cell ca. it looks like a “mini brain” gyriform pattern on MRI. on CT it looks like a lobulated mass containing fragments of bone. a cancer mimic is schneirdan cancer.
what is the MRI appearance of angio-invasive fungal sinusitis?
non enhancing middle turbinate (black turbinate sign)
what is the MRI appearance of allergic fungal sinusitis
IgE response to fungal antigens - dark on T1 and T2, HYPERDENSE on CT.
what is large vestibular aq syndrome associated with?
sensorineural hearing loss, absence of bony modulus
what is tulio phenomenon? what condition is it seen with?
noise induced vertigo. seen with Superior SCC dehiscence - see lack of bony covering of the S SCC (can be normal but if have symptoms, its called the superior SCC dehiscence syndrome)
what percent of pts with spinal hemangio have VHL? what does it look like?
30%. ID IM mass - has a lot of surrounding edema and adjacent flow voids.
what is the T2 appearance of spinal schwanomma vs meningioma?
S: v T2 bright.
what type of sacral dimple does not need to be screened?
low sacral simples (less than 2.5 cm from anus) don’t need to be screened. everything else does.
what is stills disease
JRA under the age of 5, males = females
in what patient population is erosive OA most common? what joints does it affect?
post menopausal female. affects DIP, PIP, first CMC.
what is the difference btw primary and secondary synovial osteochondromatosis?
primary: self limiting, all calcs are the same size. secondary: due to OA or trauma, all calcs are different sizes.
what leg bone does pagets often spare?
fibula
what line in the pelvis does pagets always affect
iliopectineal
what is a secondary ABC associated with?
comes from a giant cell tumor
what type of discoid meniscus is the most common?
wrisberg variant - no posterior coronary or capsular attachment
which meniscus tears most commonly with an acute ACL?
longitudinal tear of the posterior horn of the lateral meniscus
which meniscus tears with chronic ACL tear?
posterior horn of the medial meniscus
what is a dancers fracture in the foot?
avulsion of the base of the 5th metatarsal where the preens brevis inserts
what pre disposes to a preens brevis tear
accessory peroneus quartus
what pre disposes to a PTT tear? what are the consequences? what is a subtle finding on X-ray?
accessory navicular. tear causes: flat foot, plantar fasciitis, spring ligament tear, sinus tarsi syndrome. see periosteal reaction at the medial mall on X-ray.
what are the MRI findings of adhesive capsulitis?
loss of fat in the rotator interval, thickening of the IGHL
when can anisotropy be useful in the imaging of a tendon?
to diffrentiate btw normal hyperechoic tendon and hyper echoic fat - if u change angle of transducer, tendon will appear hypo echoic (anisotropy)
what type of aneurysms does cardiac cath cause in the coronary arteries
pseudoaneurysms
what is the ratio of non compacted to compacted myocardium on MRI that is abnormal
2.3:1 of the myocardium measured at end DIASTOLE
in a spin echo dark blood sequence, what is nulled in the double inversion recovery
flowing blood is nulled to make it black, good for anatomy
what is nulled in the phase sensitive inversion recovery sequence
normal myocardium is nulled by selecting the correct time to inversion so you can see abnormal enhancement
in amyloid, after you null normal myocardium what does the blood pool look like compared to the myocardium
blood looks darker than myocardium (instead of normally is bright)
what is the most common associated anomaly with ebstains?
ASD
what is the most common abnormality of venous drainage in the heart seen with asplenia
supracardiac TAPVC (all veins drain above the heart -> snowman)
where does UIP first manifest in the lungs?
posterior CP angle
what herpes virus is kaposi associated with? what type of pleural effusion does it cause?
HHV 8, causes bloody pleural effusion
what type of infection do people with PAP get? what is the cause of PAP
nocardia, PAP is due to abnormal surfactant accumulation
why does SVC syndrome cause a hot quadrate sign
there is flow directed to the left branch of the portal vein which causes increases flow in the arterial phase in that area
what is another name for siderotic nodules in the spleen? when are they seen?
gamma gandy bodies. seen in portal HTN and SC. caused by microhemmorrhages.
at what size should you take out a mucocele of the appendix
2 cm
in shock bowel, what organ besides the bowel do u see hyper enhancing?
adrenals
what does disseminated PCP in HIV patients cause in the kidneys?
multiple punctate cortical calcifications
what are the US appearances of HIV nephropathy?
big echogenic kidney, or kidney with loss of renal sinus fat (this is due to edema)
what three tests is sestamibi used for
parathyroid, cardiac, breast - works by binding to mitochondria
on what scans should u never see BONES?
MIBG, 1-131, octreotide
what is the critical organ for gallium?
colon
what lung disease is gallium very sensitive for?
PCP
what are the T2 findings of hunting tons? what is seen on CT?
high T2 in the putamen. On CT, see atrophy of the caudate nucleus which results in box shaped frontal horns
what percent of trisomy 18 kids have CP cysts?
about 50%
what is the most common chromosomal anomaly seen with omphalocele?
trisomy 18
how does the bowel rotate at week 11 GA?
270 degrees counterclockwise around the SMA and returns to the abdominal cavity.
when is physiologic periostitis of the newborn seen?
at 3 months or later, diaphysial not metaphysical
what artery typically originates from the false lumen in aortic type B dissection
left renal artery
what sequences is type 1 chemical shift artifact seen on? type 2? what direction are each of these seen on?
type 1 seen on SE and GRE. type 2 only seen on GRE. type 1 is F encoding direction, Type 2 is both P and F directions.
how to u correct incomplete fat sat?
use spin echo, use STIR not freq select fat sat, use higher BW, use higher FOX and higher matrix
what is signal flare artifact?
part of body is too close to the coil -> v bright signal. to correct position the patient away and put padding. its worse with 3T.
how do u fix gibbs/truncation artifact? what direction does it occur in?
increase the matrix but this leads to more time and decreased SNR. occurs in F and P directions.
is magic angle phenomenon worse or better at higher field strengh
it gets better at higher field strength bc have more shortening of T2
what is star artifact due to?
septal penetration from using a lower energy collimator
what is the relationship btw gain and lateral resolution
increasing the gain makes lateral resolution worse bc it widens the beam.
what is the definition of the focal zone in US
the point at which the beam is the most narrow and the intensity is the highest
which TORCH infection has the highest assoc with polymicrogyria?
CMV
what is the difference btw a glomus cell tumor, fibroma and giant cell tumor of the tendon sheath in the finger?
glomus cell: bright T2, enhances avidly. fibroma: dark T1 and T2, no blooming. giant cell: dark T1 and T2, blooms on GRE.
what type of pattern do u see in the lungs with hematogenous spread of cancer? lymphatic?
hematogenous: random pattern, lymphatic: perilymphatic pattern
what should the umbilical artery S/D ratio be at 34 weeks? what is the MCA fetal resistance done for?
not more than 3. MCA resistance is evaluated in cases of anemia or Twin twin transfusion syndrome
what is the side effect of ECMO?
bc they are systemic anticoagulation they get anemia and consumption of platelets putting them at high risk for intracranial bleed
where should the lines be in the lung in ECMO?
carotid should be over the aortic arch and the jugular catheter should be over the RA
in what infant bowel obstruction is a sawtooth rectum appearance seen?
hirschpriungs
how big are MAA particles for the perfusion in a VQ scan?
10-100 microns
what is the critical organ for MAG 3? for DMSA?
MAG 3: bladder. DMSA: kidney
what is the normal pattern of enhancement in the breast (central to peripheral or vice versa). what effect does tampixfen have?
peripheral to central, nipple enhances last . tamoxifen decreased normal BPE and then increases (rebound)
what arteries does FMD affect?
renal> carotid> iliacs
how many inches is 3 french?
0.038 inches is 3 french
what is the conversion from french to mm?
1 french = 0.3 mm
what is the relationship between sheath and catheter?
a 5 french sheath can accept a 5 french catheter. A 3 french wire (0.038 inches) will fit in a 5 french catheter
what is the coumadin ridge?
band of tissue in the LA that separates the LUL pulmonary vein from the LAA
where do the tricuspid papillary muscles insert? the mitral papillary muscles?
tricuspid: on the septum. mitral: posterior and lateral walls of the LV
what wraps around listers tubercle
the 3rd extensor compartment: extensor policies longs
what does not go thru the carpal tunnel
flexor carpi ulnaris and radialis
when would u label WBC with Tc 99 vs indium?
use Tc 99 for small parts (hands and feet), use indium for larger infections
when do u see liver uptake on an iodine whole body scan?
after 1 131 ablation
what is the pattern seen on esophagram with a double aortic arch? right aortic arch with left subclavian? left aortic arch with right subclavian?
double aortic arch and right aortic arch with aberrant left subclavian: posterior E and anterior T. left aortic arch with right subclavian: only posterior on E.
what conditions is thymoma associated with?
lymphoma, myasthenia, red cell aplasia, thyroid ca
what are the ASD’s most common to least common?
most common: secundum, then premium then venous
what are the contraindications to intraarterial tPA with stroke?
absoulte: acute infarct more than 1/3 vascular territory, intracranial bleed, CNS lesion with a high propensity to bleed, bacterial endocarditis.
what is the amount and rate of CCK given in HIDA? morphine?
CCK: 0.02microgram/kg over 60 mins. Morphine: 0.04mg/kg or 2 mg over 2-3 mins.
when is imaging done of the thyroid in a Tc 99 m sestamibi scan?
15-20 mins after injecting tracer
what GI bleeding rate does a Tc 99 m SC scan detect? Tc99m RBC scan?
Tc 99 m SC scan: 0.05-0.1 ml/min, RBC scan: 0.2-0.4 ml/min, CTA: 0.5-1.0 ml/min
what thyroid cancers concentrate I-131? what are the complications of this therapy?
follicular and papillary. complications: pulmonary fibrosis, dry mouth, leukemia, XRT thyroiditis
in the lumbar spine, at L4/L5 which nerve root is compressed with a paracentral disc herniation? which is compressed with a lateral disc herniation?
paracentral: L5 is affected, lateral: L4 is affected
what is flare phenomenon? when is it seen?
it represents a good response to therapy. it is seen as increased uptake and lesions on bone scan 2 weeks to 3 months after therapy, and should go away by 6 months.
what percent of patients with pulmonary emboli have DVT?
70%
what percent of patients treated with TPA for stroke have post thrombolytic iCH?
10%
what is the amount of glucagon given to decrease peristalsis? what condition is it contraindicated in?
1 mg IV. don’t give to patients with pheo.
what cancers are associated with radial scar/complex sclerosing lesion?
DCIS, ADH, IDH, tubular carcinoma
what percent of phyllodes recur?
20%
on perfusion imaging, what parameter defines penumbra?
preserved or increased cerebral blood volume (flow and MTT will be low)
what part of the clavicle is most commonly fractured?
middle 1/3
what are the peak energies of cobalt 57?
122 and 136
what is the definition of T1? T2?
T1: time it takes for long mag to reach 63% of its final. T2: time it takes for transverse mag to decrease to 37% of its original.
what is the risk of malignancy in a solitary hot nodule? cold nodule?
hot: 1 percent. cold 15-20 percent.
what is the daily, weekly, quarterly, and semi annual MQSA?
daily: darkroom cleanliness, processor QC, accuracy localization. weekly: view box and phantom. quarterly: repeat analysis. semiannual: darkroom fog
what is the Av glandular dose in mag view vs non mag?
mag: twice the AGD.
what are the findings in biliary atresia vs hepatitis?
biliary atresia: no tracer in bowel, hepatitis: see tracer in bowel with persistent hepatic activity
which artery is immobilized prior to Y 90 chemoembo of a liver tumor?
the GDA to prevent non target embolization
