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ACR > in service exams > Flashcards

in service exams Flashcards

1
Q

what is the appearance of retinal detachment?

A

SUDDEn vision loss, bright T1, spares posterior optic disc, no enhancement

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2
Q

which HSV virus causes Herpes encephalitis? where do u see T2 hyper intensity?

A

HSV 1. See T2 hyperintensity in the temporal lobes, limbic system, basal ganglia

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3
Q

what lobes are gyro calcifications seen in in Sturge Weber?

A

parietal and occipital

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4
Q

what is a renal pseudo tumor?

A

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

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5
Q

what are bladder fungus balls most likely due to?

A

candida

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6
Q

what happens to contrast in a shattered kidney?

A

severe compromise of excretion of contrast material

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7
Q

what are the findings of a UPJ laceration? what are the findings in UPJ avulsion?

A

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

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8
Q

what is the treatment for a sub capital fracture?

A

if patient is less than 65, pinning. if the patient is older, hip arthroplasty

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9
Q

what is the treatment for an intertrochanteric fracture?

A

compression screw fixation

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10
Q

what GU anomalies are assoc with cystic dilation of the mediastinum testes?

A

MDCK, renal agnesis

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11
Q

what are the GI findings of a paraduodenal hernia?

A

encapsulated loops of small bowel on one side of the abdomen

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12
Q

which lung cancer takes up octreotide?

A

small cell lung ca

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13
Q

what thyroid cancer takes up ocreotide?

A

medullary thyroid ca

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14
Q

what is the appearance of the aorta and PA in L-TGA? what is the appearance in D TGA?

A

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

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15
Q

what syndrome is interruption of the aortic arch associated with?

A

DiGeorge

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16
Q

what is nutcracker syndrome?

A

compression of left renal vein btw aorta and SMA

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17
Q

where is a first branchial cleft cyst seen? 3rd? 4th?

A

first: close to parotid/external auditory canal, fourth: along the course of the recurrent laryngeal n

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18
Q

what is a radial ray?

A

hypoplasia of the radius and absent thumb

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19
Q

which duct drains the parotid gland? the submandibular gland?

A

Stensens -> parotid. Whartons -? submandibular.

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20
Q

what part of the orbit is spared in a tripod fracture

A

orbital roof

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21
Q

where does orbital access originate from?

A

ethmoid sinus

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22
Q

what is the most common GI location for sarcoid?

A

stomach

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23
Q

what are the two most common islet cell tumors?

A

insulinoma and gastrinoma

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24
Q

what are the findings in popliteal artery entrapment?

A

medial deviation of the popliteal artery

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25
Q

what are the findings in adventitial cystic disease?

A

extrnisic compression of the popliteal artery by a mucin filled cyst

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26
Q

what is the mgmt for pyonephrosis?

A

emergent nephrostomy tube placement

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27
Q

what is a contraindication to nephrostomy tube placement?

A

severe hyperkalemia

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28
Q

what blood supply does the coronary sinus receive? where does it lie? where does it drain into?

A

lies in the posterior AV groove and receives myocardial venous supply from the cardiac veins -> drains into RA

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29
Q

is annuloaortic ectasia assoc with aortic stenosis or regard?

A

regurgitation due to myxomatous (floppy) aortic valve leaflets

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30
Q

what are the HU values of a b9 adrenal adenoma on non contrast CT and contrast enhance CT?

A

on non contrast: less than 10 HU. on contrast enhance: less than 30-40 HU.

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31
Q

what reduces the success of pyeloplasty in UPJ obstruction?

A

presence of crossing vessels

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32
Q

how does congenital UPJ obstruction usually present in a child?

A

flank pain, abdominal mass, GI symptoms, NOT UTI

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33
Q

how much contrast is needed in the bladder to diagnose bladder rupture?

A

at least 300 ml

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34
Q

what are the findings on a tc 99 m MAA study that indicates right to left shunt?

A

radiotracer in the brain indicates right to left shunt. this is NOT see in free tech.

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35
Q

what part of the FT is salpingitis nods seen in? venous intravasation?

A

isthmus part (second part). venous intravsation is seen in the same part but u see tortuous veins filled with contrast that mimic a FT

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36
Q

in what subset of patients is medullary renal cell ca seen?

A

sickle cell TRAIT (not in patients with sickle cell disease)

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37
Q

what are the findings of reflux nephropathy in the kidney?

A

see a dilated calyx filled with contrast and urine (like a calyces diverticulum) with an overlying cortical scar

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38
Q

what is dysplasia epiphyseal (trevors disease)

A

osteochondromas at the epiphyses, usually on one side of the body and one side of the joint

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39
Q

what effect does fibrous dysplasia have on the concavity of the bone?

A

causes bowing (NOF does not)

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40
Q

from which side does the closure at the growth plate occur at the distal tibia? which fractures does this predispose to in a child?

A

occurs medial to lateral (lateral side of the growth plate fuses later). predisposes to tillaux and triplane fractures

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41
Q

what is parsonage turner syndrome? what are the findings?

A

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

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42
Q

what is the most common skeletal manifestation of hyperthyroidism?

A

osteoporosis and accelerated bone maturity in kids

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43
Q

what is thyroid acropachy?

A

periostitis in the small bones of the hands and feet seen after Rx of hyperthyroidism

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44
Q

what is seen on T2 images of osteoid osteoma?

A

increased T2 signal reflecting edema

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45
Q

what does rupture of the ACL cause to the appearance of the PCL?

A

buckling of the PCL

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46
Q

is bucket handle tear due to a horizontal or longitudinal tear of the medial meniscus?

A

longitudinal

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47
Q

what is the rotator interval?

A

the space btw the supraspinatus and the subscapularis btw which the long head of the biceps traverses

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48
Q

what is the difference in patient dose when using MDCT vs SDCT?

A

dose is increased by 30% in MDCT due to patient overscanning

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49
Q

in computed radiography what is the photostimulable phosphor made out of?

A

BaFBr - contains “traps” with the latent image

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50
Q

what is an everting ureterocele?

A

ureterocele everts back into the extravesical ureter, outside the bladder - see a contrast filled ureterocele protruding outside the bladder

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51
Q

what are the findings on MAG 3 scan of ATN vs acute rejection?

A

normal flow and decreased excretion in ATN. in acute rejection there is decreased flow and function of the kidney.

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52
Q

what is the definition of a sentinel node?

A

the FIRST node to be seen (timing is the most important, not size or intensity of uptake)

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53
Q

what are the findings of mucus plugging on a VQ scan?

A

MATCHED ventilation and perfusion defect - mucus prevents ventilation and there is reflex vasoconstriction leading to decreased perfusion

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54
Q

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?

A

liver and lungs. excess Al is tested with colorimetry. will see the paper turn pink if there is excess.

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55
Q

what is the mechanism of uptake of Tc 99m?

A

related to mitochondrial content and the negative plasma membrane potential

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56
Q

what structures are always absent in all forms of holoprosencephaly?

A

fornix and septum pellucidum

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57
Q

is PVL due to arterial or nervous infarction?

A

arterial infarction. grade 4 GM bleed is due to venous infarction

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58
Q

what is the mechanism of a perirenal fluid collection in a newborn?

A

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

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59
Q

where are thyme cysts most commonly found? what diseases are they assoc with?

A

found in the neck. assoc with bone marrow aplasia, HIV and treated lymphoma

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60
Q

what are the VQ scan findings of a foreign body

A

matched defect (perfusion is low bc of reflex vasoconstriction)

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61
Q

what are the fluoro findings in a foreign body in the lung?

A

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

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62
Q

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?

A

30% and 20-25%

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63
Q

what is penology of fallot? in what percent of cases does it occur?

A

Tetralogy of fallot with an ASD is penology. occurs in 15%

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64
Q

what are the metabolic findings in pyloric stenosis? is it more associated with maternal or paternal history?

A

paradoxical aciduria and hypochloremic alkalosis, more associated with maternal history

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65
Q

what congenital syndrome is tracheal bronchus associated with?

A

downs syndrome

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66
Q

what type of salter harris fracture is a tillaux fracture?

A

salter harris 3 - has a coronal component thru the epiphyses, and a horizontal component thru the metaphysis

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67
Q

what type of salter harris fracture is a lateral condylar fx of the elbow? medial epicondyle?

A

salter harris 4. salter harris 1

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68
Q

what part of the lung does LCH spare? is the disease upper or lower lobe predominant?

A

CP angles. upper lobe predominant

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69
Q

how do adenoid cystic tumors spread? how do they appear in the trachea?

A

perineural spread. appear as soft tissue encircling the trachea with spread into the bronchial tree - they were previously known as “cylindromas”

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70
Q

what is the appearance of pulmonary alveolar microlithiasis?

A

sandstorm appearance - multiple micro nodules in the middle and lower lung zones

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71
Q

what gauge needle is used for biopsy of a lung lesion? what b9 lesion is hardest to get a definitie diagnosis for?

A

20 or 22G core biopsy needle is used. healed granuloma which may have internal necrotic material is hardest to get a diagnosis on.

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72
Q

which vessels does fibrosing mediastinitis typically affect

A

the pulmonary artery, pulmonary veins, SVC (tends to spare the aorta and great vessels)

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73
Q

what paraneoplastic syndromes does small cell ca cause?

A

hyponatremia and cushings (SIADH causes hyponatremia)

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74
Q

what clinical symptom does solitary fibrous tumor of the pleura cause?

A

hypoglycemia

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75
Q

what does a rupture of a bronchus close to the trachea cause?

A

pneumomediastinum

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76
Q

what is loefflers syndrome?

A

blood eosinophilia with mixed interstitial and alveolar opacities that are migratory and spontaneously clear

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77
Q

what is seen on expiratory CT in sawyer james?

A

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.

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78
Q

what space does a bronchogenic cyst cause obliteration of on a CXR

A

azygoesophageal interface (subcarinal region)

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79
Q

what is the mechanism of F-18 NaG uptake?

A

chemisorption - in areas of increased osteoblastic activity

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80
Q

what would the Tc MAA perfusion findings be in pulmonary AVM?

A

multiple perfusion defects bc the particles don’t aggregate in the AVM since there is no intervening capillary bed

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81
Q

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?

A

including spleen: artificially elevates the EF. using the same ROI for systole and diastole: artificially reduces the EF.

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82
Q

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?

A

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)

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83
Q

where doe clear cell chondrosarcoma arise in a bone?

A

at the epiphyses, in an adult. mimics chondroblatoma that u would see in a kid

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84
Q

what malignant transformation is seen with multiple hereditary exostoses?

A

chondrosarcoma

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85
Q

what type of tibial bowing is seen with NF1?

A

anterolateral

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86
Q

what is the inheritance pattern of ollier and maffuci syndrome?

A

non inherited

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87
Q

what is a cancer that can be seen after neuroblastoma treatment?

A

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

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88
Q

what type of deficiencies cause a patient to get a bexoar?

A

zinc and iron deficiency

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89
Q

what is hemolytic uremic sydrome? what would u see on abdominal X-ray?

A

acute renal failure, t.cytopenia and hemolytic anemia, see thumb printing of colon on X-ray

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90
Q

what are the two most common ligaments injured in an inversion ankle injury? what ligament tears with an eversion injury?

A

anterior talofibular and calcaneofibular. deltoid ligament tears with an eversion injury.

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91
Q

what does area under ROC curve represent?

A

accuracy of interpretation of a diagnostic test

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92
Q

what relationship btw sensitivity and specificity would cause an ROC curve to be done?

A

if sensitivity and specificity are negatively correlated

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93
Q

what is the most important outcome to consider in screening test effectiveness?

A

disease specific mortality reduction

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94
Q

what is seen in robson stage 3A RCC? stage 3b?

A

invasion into renal vein or IVC is 3a. invasion into lymph nodes but NOT renal v or IVC is 3b.

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95
Q

what is pseudodiverticulosis of ureter? what is the mgmt for pseudodiverticula of the ureter?

A

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.

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96
Q

what percent of adrenal cortical ca has calcs?

A

30%

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97
Q

what is the mgmt of PTLD?

A

stop immunosuppressants

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98
Q

what malignancy is leukoplakia assoc with?

A

sq cell ca

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99
Q

what is the treatment for epidydmoorchitis?

A

Abx for 4-6 weeks

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100
Q

what is the most common cause of oligohydramnios?

A

PPROM

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101
Q

what conditions is intracardiac echogenic focus seen in? where are they most commonly located?

A

trisomy 13 and 21. most commonly in LV.

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102
Q

if a hyper echoic lesion that looks like AML is seen on renal US what is the next step in mgmt?

A

get a CT to confirm for the presence of fat, and can then follow the lesion with US

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103
Q

why does mag views on mammo lead to more blur? is noise more in regular or mag mammo?

A

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

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104
Q

what is the risk of recurrence of breast ca after lumpectomy and XRT? what is the mean time to recurrence?

A

1-2 % in the first 5-10 years and then 1%. mean time to recurrence is 3.5 years

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105
Q

where is omental infarction most commonly seen?

A

on the right side, less well defined and larger than epiploic appendicitis

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106
Q

what are the top 2 most common b9 hepatic masses? which can increase in size with OCP?

A

hemangioma then FNH, FNH can increase in size with OCP

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107
Q

what is a “coned cecum”

A

sign of TB - shrinkage of the cecum and loss of the ileocecal angle

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108
Q

after partial gastrectomy for b9 peptic ulcer disease, what is the risk of malignancy?

A

risk of malignancy to adenocarcinoma in the gastric remnant 15-20 yrs after surgery

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109
Q

what is the most common pancreatic tumor to calcify?

A

serous or microcystic cyst adenoma

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110
Q

what is the most common etiology of jaundice?

A

b9 stricture

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111
Q

what is mirrizzi syndrome and what patients are more likely to get it?

A

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

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112
Q

which is more common, UC or crohns?

A

UC

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113
Q

what are the three ASD types, and how common are they? where are they seen?

A

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.

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114
Q

which is the most anteriorly located valve? which is most posteriorly located?

A

tricuspid is most anterior. mitral is most posterior. pulmonic is most superior valve. aortic is inferior to the pulmonic.

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115
Q

what are the two types of VSD, which is more common and where are they located?

A

membranous (most common) and muscular. membranous is near aortic valve and muscular is near the apex.

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116
Q

what percent of total plaque burden does coronary artery calcification contribute to?

A

20 percent

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117
Q

what is the dominance of coronary system that most people have?

A

right dominant in 85% of people

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118
Q

are accessory pulmonary veins more common on the left or the right? what is a contraindication to pulmonary vein ablation?

A

more common on the right. LA thrombus is a contraindication to pulmonary vein ablation.

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119
Q

what does the BT shunt connect? Fontan? Glenn?

A

BT shunt: connects the subclavian artery to the PA. Fintan: connects the RA to the PA. Glenn: connects SVC to PA

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120
Q

what does rhematic heart disease cause in the mitral valve and in the tricuspid valve?

A

mitral valve stenosis and tricuspid regurgitation

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121
Q

what is the appearance that is suggestive of pancreatic head carcinoma on a cholangiogram?

A

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

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122
Q

what is the treatment for SVC syndrome?

A

angioplasty and stent placement

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123
Q

what is the disadvantage of a transjugular approach to biopsy in the liver? in which patients is this approach done?

A

cannot reliably biopsy a discrete lesion, done in patients who are at a high risk of bleeding with diffuse parenchymal disease

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124
Q

what is parkes weber syndrome?

A

hypoplasia of the deep veins of the legs, port wine stains, limb hypertrophy, AVM

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125
Q

what is the chance of premature menopause after UAE? what is the rate of success after UAE for fibroids?

A

2-5% premature menopause. 80-90 percent success.

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126
Q

what is Foix Alaujanoe syndrome?

A

spinal dural AVF and venous hypertension

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127
Q

are calculi more common in the SMG or parotid?

A

SMG

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128
Q

what is binswanger disease?

A

WM demyelinating disease in patients older than 55 associated with HTN - doesn’t have focal stroke symptoms

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129
Q

what vascular structures are compressed in transtentorial herniation?

A

PCA and anterior choroidal artery are compressed along with CN3

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130
Q

is a low lying tethered cord associated with chiari 1?

A

No

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131
Q

which is more common, mets to the pericardium or mets to the myocardium? what are the most common mets to pericardium and myocardium?

A

mets to pericardium more common. often from lung ca. myocardial mets are from melanoma.

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132
Q

what is the thickness of normal pericardium?

A

2 mm or less

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133
Q

what percent of cardiac neoplasms are malignant?

A

25%

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134
Q

what are the paraneoplastic syndromes assoc with solitary fibrous tumor of the pleura?

A

hypoglycemia and HPOA

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135
Q

what do the changes of XRT pneumonitis occur in the lung?

A

1-3 months after XRT

136
Q

how does MAI present in elderly patients with COPD?

A

nodules or cavitary lesions in the upper lobes

137
Q

what percent of duodenal ulcers are solitary? what percent are malignant?

A

80%. less than 5% duodenal ulcers are malignant.

138
Q

what is the treatment of internal hernias?

A

it is a closed loop obstruction so do surgery

139
Q

what part of bowel do broad ligament hernias involve?

A

small bowel

140
Q

is malakoplakia premalignant? what do u see on the stain?

A

not premalignant, associated with immunocompromised patients. see michalis gutman bodies.

141
Q

what artery produces collaterals in median arcuate ligament syndrome?

A

GDA (from SMA) to supple the celiac which is stenosed

142
Q

what part of the spine must be excised in SGT?

A

the coccyx otherwise 40% recurrence

143
Q

what layers of germ cells does SGT contain?

A

all three layers (endoderm, mesoderm, ectoderm)

144
Q

what are the findings of ventricular terminals?

A

normal findings - small cyst at a normally positioned conus

145
Q

how often should QC be performed on an ultrasound transducer?

A

quarterly

146
Q

what is the mgmt for GGO ?

A

less than 5 mm, no F/U. more than 5 mm, F/U in 3 mo then annually for 3 years.

147
Q

what is the mgmt for ovarian cysts in pre menopausal women?

A

simple cyst 5-7 cm: annual follow up. simple cyst more than 7 cm: surgical or MRI.

148
Q

are pleural and pericardial effusion more common in CH or LAM?

A

seen in LAM not LCH

149
Q

what is the mgmt for GB polyps 5-10mm? more than 10mm?

A

monitor those 5-10 mm, excise if more than 10 mm.

150
Q

what are the specifications to be eligible for liver transplant?

A

age less than 65, 1 tumor less than 5 cm or up to 3 tumors less than 3 cm

151
Q

what imaging test should u do before removing an IVC filter?

A

LE doppler

152
Q

what can a static magnetic field cause on ECG?

A

augemented T waves

153
Q

what is the deinfition of power?

A

probability that a type 2 error is avoided (study fails to reject null when it is false)

154
Q

what is the ddx for capsular retraction of the liver?

A

cholangioca, hemangioendothelioma, schrods breast mets (pseudo cirrhosis)

155
Q

what is the size criteria for a giant hemangioma?

A

4 cm

156
Q

what is the vascularity of GB cancer?

A

avascular

157
Q

what are the findings of GB perforation?

A

sloughed mucosa and striated GB wall

158
Q

what is the diff in retrospective and prospective in QA vs QI? which is zero tolerance?

A

QA: retrospective, QI: prospective and retrospective. QI is zero tolerance

159
Q

what are examples of ionization chambers?

A

cutie pie, pocket dosimeter, dose calibrator, well counter

160
Q

what are the segments of the fallopian tube from medial ro lateral?

A

isthmic, interstitial, ampullary, infundibular

161
Q

what is the appearance of a duodenal hematoma on barium?

A

coiled spring

162
Q

what is the diff on contrast enema btw meconium ileum and jejunoileal atresia?

A

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

163
Q

what percent of gastroschisis is associated with bowel atresias?

A

30%

164
Q

what are the most common locations for congenital lobar emphysema?

A

LUL then RML then RUL

165
Q

what is another name for a mature ovarian teratoma?

A

dermoid

166
Q

what coronary artery anomaly is seen in patients with TOF?

A

LAD from RCA

167
Q

what type of salter harris fx is tibial tubercle avulsion?

A

salter harris 3

168
Q

what is type 4 SGT? is the mature or immature type malignant?

A

all intrapelvic. immature is malignant.

169
Q

what circle of willis anomaly is seen with holoprosencephaly?

A

single anterior cerebral artery (azygous artery)

170
Q

what are the complications of UVC in RA or PA?

A

in RA -> arrythmias, in PA -> stenosis/thrombosis

171
Q

what does the prognosis of CDH depend on?

A

presence of liver herniation not stomach herniation

172
Q

what does the continuous diaphragm sign indicate?

A

pneumomediastinum

173
Q

what is the diff in mgmt if u see double bubble alone vs double bubble with distal gas?

A

with distal gas means emergency -> to UGI to rule out volvulus

174
Q

in what condition do u see a white cerebellum?

A

diffuse cerebral edema

175
Q

which two neonatal orbital conditions have small globes?

A

ROP (has calcs) and PHPV (no calcs)

176
Q

what is a sign of duodenal hematoma on CT in terms of relationship of mesenteric vessels and aorta?

A

see superior mesenteric vessels anteriorly displaced from the aorta by the hematoma

177
Q

how do u tell which vein was accessed for placement of a port?

A

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

178
Q

what is the treatment for empyema vs pulmonary abcess?

A

drain empyema (D, E)

179
Q

what veins are used for PICC placement?

A

basilic > brachial> cephalic

180
Q

what is the mgmt of cervical ectopic?

A

medial - NOT D and C bc too much bleeding risk

181
Q

at what CRL and no heartbeat can u say non-viable?

A

7 mm

182
Q

what are ancillary findings of biliary atresia on US?

A

no GB, echogenic cord anterior to the PV bc no CBD, biliary atresia = no extra hepatic biliary duct

183
Q

does pulmonary sequestration connect with the airway?

A

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

184
Q

what does heterotaxy refer to?

A

cardiac APEX and stomach on opposite sides

185
Q

what is granuloma annulare?

A

high T2 lesion in subcutaneous tissues of pretibial region

186
Q

what is the mgmt for thyroglossal duct cyst?

A

sistrunk procedure - resect the cyst, midline hyoid bone, and the tract to the foramen cecum

187
Q

what are the GI finings of graft vs host disease?

A

submucosal edema, featureless small bowel and enhancement - “ribbon bowel”

188
Q

what is the mgmt for cardiac rhabdomyoma in patients with TS?

A

it regresses on its own

189
Q

what is hemimegencephaly

A

hamartomatous overgrowth of part of all of cerebral hemisphere - see straight and elongated lateral ventricle on that side

190
Q

what do 1/3 of ABC transform into?

A

chondroblastoma (at epiphyses)

191
Q

what is a matrix forming posterior element lucent lesion?

A

osteoblastoma

192
Q

what is choanal atresia? what is piriform aperture stenosis?

A

narrowing of posterior nasal cavities. piriform is anterior nasal stenosis.

193
Q

at what age do u see infantile hemangioma? at what age do u see lymphatic malformation?

A

infantile hemangioma appears after birth in the first few months, grows with child then regresses. lymphatic malformation is present at birth

194
Q

if u see the pulmonary trunk anterior and draped over the aorta on axial, what procedure has been done?

A

Jatene procedure or arterial switch for TGA

195
Q

where does juvenile nasopharyngeal carcinoma arise from? what vessel supplies it?

A

lateral nasopharynx at SP foramen - supplied by internal maxiallry artery

196
Q

what are the findings of LCH? what is EG?

A

lucent lesions in skull with beveled edges, floating tooth. EG is isolated bone and or pulmonary findings.

197
Q

what is body stalk anomaly?

A

fetal adherance to placenta - abdomen is stuck to placenta, so don’t see an umbilical cord

198
Q

on which side is the main bronchus epiarterial vs hyparteria?

A

right is epiarterial - bronchus above the pulmonary artery. left is hyparterial - bronchus below the pulmonary artery

199
Q

what is the formula for I-131 dose to treat

A

gland weight * 100 microci / 24 hour RAIU

200
Q

what is the counaid system

A

above portal vein from left to right: 2.4.8 lucky 7. below portal vein plane, 3,4,5,6. caudate is segment 1.

201
Q

what tendon attaches to the iliac crest? what attaches at the pubic symphysis?

A

iliac crest: tensor fascia lata. public symphysis: gracilis.

202
Q

what is the appearance of the ACL and PCL on a coronal image?

A

in the IC notch, the ACL is a linear band, the PCL is a dot medial to the ACL.

203
Q

when do u resect a serous cyst adenoma of the pancreas?

A

if symptomatic and more than 4 cm

204
Q

what does the presence of calcium in a pancreatic mass imply?

A

excludes pancreatic adenocarcinoma

205
Q

what are the imaging features of pancreatic serous cyst adenoma?

A

spngy, multiple cysts, with central enhancing scar in 30% and 10% have calcifications

206
Q

when is a fetus at risk for organ malformations? for MR?

A

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.

207
Q

where do u set the window and level for soft tissue vs bone?

A

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)

208
Q

where is a popliteal cyst = baker cyst located

A

btw the medial head of the gastroc and the semimembranosus tendon

209
Q

is the bladder full with intra or extra peritoneal rupture?

A

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

210
Q

what type of sac to neck relationship do u want in a PA to inject thrombin?

A

want the sac to be wider than the neck, if the neck is too wide may need to stent it

211
Q

where do the ovarian/testicular arteries arise from?

A

the aorta or the renal arteries

212
Q

what is mid aortic syndrome?

A

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

213
Q

where do posterior circulation aneurysms most often occur?

A

basilar bifurcation, then PICA

214
Q

what effect does glucagon have on bowel and vessels?

A

it decreases peristalsis and increases vasodilation

215
Q

what are the HIDA scan findings of a choledochal cyst?

A

persistent pooling of contrast btw the liver and duodenum

216
Q

what is the appearance of streak (incomplete projection) artifact in a head CT?

A

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)

217
Q

what is a dromedary hump?

A

hypoechoic, seen in the left kidney, looks like a bulge of normal renal tissue at the supernatural kidney

218
Q

what is sirenomelia?

A

fusion of the lower limbs, mermaid syndrome

219
Q

what are the conditions assoc with mid aortic syndrome

A

takayasus, atherosclerosis, NF1, williams syndrome

220
Q

what does PAN cause

A

microaneurysms

221
Q

where is a weber A fracture? weber B?

A

weber a is below the joint line, weber B is at the level of the joint line

222
Q

what are the findings of a lateral compression pelvic fracture? is it stable?

A

horizontal fractures of the pubic rami, and ipsilateral sacral compression fx, is partially stable

223
Q

what are the findings of an AP compression pelvic fracture?

A

diastase of the pubic symphysis and SI joints - unstable

224
Q

which is more urgent emphysematous pyelonpehritis or pyelitis?

A

pyelonephritis

225
Q

from what point to what point does the moderator band extend in the RV?

A

septum to the anterior wall

226
Q

what forms the border of the right heart on a frontal view?

A

RA and IVC

227
Q

what is the most important complication of a CCF?

A

pressure over optic n -> blindess and/or SAH from SOV/cerebral vein rupture.

228
Q

what causes contrast induced nephropathy?

A

ATN

229
Q

what is the best angle of insinuation for accurate velocity measurement on doppler?

A

60 degress or less

230
Q

what is the US appearance of adenomyosis?

A

venetian blind

231
Q

what part of the brain does CADASIL spare? what clinically is it associated with?

A

occipital lobes, and U fibers are not involved. associated with migraines.

232
Q

what is the first sign of central pontine myelinolysis

A

restricted diffusion in the lower pons

233
Q

what is the buzzword appearance for FD. what table in the skull does it involve?

A

ground glass. involves outer table (Pagets involves inner and outer)

234
Q

what part of the heart do cardiac rahbdomyomas in TS usually involve? at what age?

A

age less than 1, involves ventricular septum

235
Q

what are the renal manifestations of VHL? what do they get in the pancreas?

A

pheo and bilateral clear cell RCC. think “cysts” everywhere -> Serous cyst adenoma

236
Q

what is cowden syndrome?

A

bowel hamartoma, breast CANCER, lhermitte in cerebellum (tiger sripe non enhancing tumor that does not cross midline)

237
Q

what is an inverting papilloma

A

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.

238
Q

what is the MRI appearance of angio-invasive fungal sinusitis?

A

non enhancing middle turbinate (black turbinate sign)

239
Q

what is the MRI appearance of allergic fungal sinusitis

A

IgE response to fungal antigens - dark on T1 and T2, HYPERDENSE on CT.

240
Q

what is large vestibular aq syndrome associated with?

A

sensorineural hearing loss, absence of bony modulus

241
Q

what is tulio phenomenon? what condition is it seen with?

A

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)

242
Q

what percent of pts with spinal hemangio have VHL? what does it look like?

A

30%. ID IM mass - has a lot of surrounding edema and adjacent flow voids.

243
Q

what is the T2 appearance of spinal schwanomma vs meningioma?

A

S: v T2 bright.

244
Q

what type of sacral dimple does not need to be screened?

A

low sacral simples (less than 2.5 cm from anus) don’t need to be screened. everything else does.

245
Q

what is stills disease

A

JRA under the age of 5, males = females

246
Q

in what patient population is erosive OA most common? what joints does it affect?

A

post menopausal female. affects DIP, PIP, first CMC.

247
Q

what is the difference btw primary and secondary synovial osteochondromatosis?

A

primary: self limiting, all calcs are the same size. secondary: due to OA or trauma, all calcs are different sizes.

248
Q

what leg bone does pagets often spare?

A

fibula

249
Q

what line in the pelvis does pagets always affect

A

iliopectineal

250
Q

what is a secondary ABC associated with?

A

comes from a giant cell tumor

251
Q

what type of discoid meniscus is the most common?

A

wrisberg variant - no posterior coronary or capsular attachment

252
Q

which meniscus tears most commonly with an acute ACL?

A

longitudinal tear of the posterior horn of the lateral meniscus

253
Q

which meniscus tears with chronic ACL tear?

A

posterior horn of the medial meniscus

254
Q

what is a dancers fracture in the foot?

A

avulsion of the base of the 5th metatarsal where the preens brevis inserts

255
Q

what pre disposes to a preens brevis tear

A

accessory peroneus quartus

256
Q

what pre disposes to a PTT tear? what are the consequences? what is a subtle finding on X-ray?

A

accessory navicular. tear causes: flat foot, plantar fasciitis, spring ligament tear, sinus tarsi syndrome. see periosteal reaction at the medial mall on X-ray.

257
Q

what are the MRI findings of adhesive capsulitis?

A

loss of fat in the rotator interval, thickening of the IGHL

258
Q

when can anisotropy be useful in the imaging of a tendon?

A

to diffrentiate btw normal hyperechoic tendon and hyper echoic fat - if u change angle of transducer, tendon will appear hypo echoic (anisotropy)

259
Q

what type of aneurysms does cardiac cath cause in the coronary arteries

A

pseudoaneurysms

260
Q

what is the ratio of non compacted to compacted myocardium on MRI that is abnormal

A

2.3:1 of the myocardium measured at end DIASTOLE

261
Q

in a spin echo dark blood sequence, what is nulled in the double inversion recovery

A

flowing blood is nulled to make it black, good for anatomy

262
Q

what is nulled in the phase sensitive inversion recovery sequence

A

normal myocardium is nulled by selecting the correct time to inversion so you can see abnormal enhancement

263
Q

in amyloid, after you null normal myocardium what does the blood pool look like compared to the myocardium

A

blood looks darker than myocardium (instead of normally is bright)

264
Q

what is the most common associated anomaly with ebstains?

A

ASD

265
Q

what is the most common abnormality of venous drainage in the heart seen with asplenia

A

supracardiac TAPVC (all veins drain above the heart -> snowman)

266
Q

where does UIP first manifest in the lungs?

A

posterior CP angle

267
Q

what herpes virus is kaposi associated with? what type of pleural effusion does it cause?

A

HHV 8, causes bloody pleural effusion

268
Q

what type of infection do people with PAP get? what is the cause of PAP

A

nocardia, PAP is due to abnormal surfactant accumulation

269
Q

why does SVC syndrome cause a hot quadrate sign

A

there is flow directed to the left branch of the portal vein which causes increases flow in the arterial phase in that area

270
Q

what is another name for siderotic nodules in the spleen? when are they seen?

A

gamma gandy bodies. seen in portal HTN and SC. caused by microhemmorrhages.

271
Q

at what size should you take out a mucocele of the appendix

A

2 cm

272
Q

in shock bowel, what organ besides the bowel do u see hyper enhancing?

A

adrenals

273
Q

what does disseminated PCP in HIV patients cause in the kidneys?

A

multiple punctate cortical calcifications

274
Q

what are the US appearances of HIV nephropathy?

A

big echogenic kidney, or kidney with loss of renal sinus fat (this is due to edema)

275
Q

what three tests is sestamibi used for

A

parathyroid, cardiac, breast - works by binding to mitochondria

276
Q

on what scans should u never see BONES?

A

MIBG, 1-131, octreotide

277
Q

what is the critical organ for gallium?

A

colon

278
Q

what lung disease is gallium very sensitive for?

A

PCP

279
Q

what are the T2 findings of hunting tons? what is seen on CT?

A

high T2 in the putamen. On CT, see atrophy of the caudate nucleus which results in box shaped frontal horns

280
Q

what percent of trisomy 18 kids have CP cysts?

A

about 50%

281
Q

what is the most common chromosomal anomaly seen with omphalocele?

A

trisomy 18

282
Q

how does the bowel rotate at week 11 GA?

A

270 degrees counterclockwise around the SMA and returns to the abdominal cavity.

283
Q

when is physiologic periostitis of the newborn seen?

A

at 3 months or later, diaphysial not metaphysical

284
Q

what artery typically originates from the false lumen in aortic type B dissection

A

left renal artery

285
Q

what sequences is type 1 chemical shift artifact seen on? type 2? what direction are each of these seen on?

A

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.

286
Q

how to u correct incomplete fat sat?

A

use spin echo, use STIR not freq select fat sat, use higher BW, use higher FOX and higher matrix

287
Q

what is signal flare artifact?

A

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.

288
Q

how do u fix gibbs/truncation artifact? what direction does it occur in?

A

increase the matrix but this leads to more time and decreased SNR. occurs in F and P directions.

289
Q

is magic angle phenomenon worse or better at higher field strengh

A

it gets better at higher field strength bc have more shortening of T2

290
Q

what is star artifact due to?

A

septal penetration from using a lower energy collimator

291
Q

what is the relationship btw gain and lateral resolution

A

increasing the gain makes lateral resolution worse bc it widens the beam.

292
Q

what is the definition of the focal zone in US

A

the point at which the beam is the most narrow and the intensity is the highest

293
Q

which TORCH infection has the highest assoc with polymicrogyria?

A

CMV

294
Q

what is the difference btw a glomus cell tumor, fibroma and giant cell tumor of the tendon sheath in the finger?

A

glomus cell: bright T2, enhances avidly. fibroma: dark T1 and T2, no blooming. giant cell: dark T1 and T2, blooms on GRE.

295
Q

what type of pattern do u see in the lungs with hematogenous spread of cancer? lymphatic?

A

hematogenous: random pattern, lymphatic: perilymphatic pattern

296
Q

what should the umbilical artery S/D ratio be at 34 weeks? what is the MCA fetal resistance done for?

A

not more than 3. MCA resistance is evaluated in cases of anemia or Twin twin transfusion syndrome

297
Q

what is the side effect of ECMO?

A

bc they are systemic anticoagulation they get anemia and consumption of platelets putting them at high risk for intracranial bleed

298
Q

where should the lines be in the lung in ECMO?

A

carotid should be over the aortic arch and the jugular catheter should be over the RA

299
Q

in what infant bowel obstruction is a sawtooth rectum appearance seen?

A

hirschpriungs

300
Q

how big are MAA particles for the perfusion in a VQ scan?

A

10-100 microns

301
Q

what is the critical organ for MAG 3? for DMSA?

A

MAG 3: bladder. DMSA: kidney

302
Q

what is the normal pattern of enhancement in the breast (central to peripheral or vice versa). what effect does tampixfen have?

A

peripheral to central, nipple enhances last . tamoxifen decreased normal BPE and then increases (rebound)

303
Q

what arteries does FMD affect?

A

renal> carotid> iliacs

304
Q

how many inches is 3 french?

A

0.038 inches is 3 french

305
Q

what is the conversion from french to mm?

A

1 french = 0.3 mm

306
Q

what is the relationship between sheath and catheter?

A

a 5 french sheath can accept a 5 french catheter. A 3 french wire (0.038 inches) will fit in a 5 french catheter

307
Q

what is the coumadin ridge?

A

band of tissue in the LA that separates the LUL pulmonary vein from the LAA

308
Q

where do the tricuspid papillary muscles insert? the mitral papillary muscles?

A

tricuspid: on the septum. mitral: posterior and lateral walls of the LV

309
Q

what wraps around listers tubercle

A

the 3rd extensor compartment: extensor policies longs

310
Q

what does not go thru the carpal tunnel

A

flexor carpi ulnaris and radialis

311
Q

when would u label WBC with Tc 99 vs indium?

A

use Tc 99 for small parts (hands and feet), use indium for larger infections

312
Q

when do u see liver uptake on an iodine whole body scan?

A

after 1 131 ablation

313
Q

what is the pattern seen on esophagram with a double aortic arch? right aortic arch with left subclavian? left aortic arch with right subclavian?

A

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.

314
Q

what conditions is thymoma associated with?

A

lymphoma, myasthenia, red cell aplasia, thyroid ca

315
Q

what are the ASD’s most common to least common?

A

most common: secundum, then premium then venous

316
Q

what are the contraindications to intraarterial tPA with stroke?

A

absoulte: acute infarct more than 1/3 vascular territory, intracranial bleed, CNS lesion with a high propensity to bleed, bacterial endocarditis.

317
Q

what is the amount and rate of CCK given in HIDA? morphine?

A

CCK: 0.02microgram/kg over 60 mins. Morphine: 0.04mg/kg or 2 mg over 2-3 mins.

318
Q

when is imaging done of the thyroid in a Tc 99 m sestamibi scan?

A

15-20 mins after injecting tracer

319
Q

what GI bleeding rate does a Tc 99 m SC scan detect? Tc99m RBC scan?

A

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

320
Q

what thyroid cancers concentrate I-131? what are the complications of this therapy?

A

follicular and papillary. complications: pulmonary fibrosis, dry mouth, leukemia, XRT thyroiditis

321
Q

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?

A

paracentral: L5 is affected, lateral: L4 is affected

322
Q

what is flare phenomenon? when is it seen?

A

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.

323
Q

what percent of patients with pulmonary emboli have DVT?

A

70%

324
Q

what percent of patients treated with TPA for stroke have post thrombolytic iCH?

A

10%

325
Q

what is the amount of glucagon given to decrease peristalsis? what condition is it contraindicated in?

A

1 mg IV. don’t give to patients with pheo.

326
Q

what cancers are associated with radial scar/complex sclerosing lesion?

A

DCIS, ADH, IDH, tubular carcinoma

327
Q

what percent of phyllodes recur?

A

20%

328
Q

on perfusion imaging, what parameter defines penumbra?

A

preserved or increased cerebral blood volume (flow and MTT will be low)

329
Q

what part of the clavicle is most commonly fractured?

A

middle 1/3

330
Q

what are the peak energies of cobalt 57?

A

122 and 136

331
Q

what is the definition of T1? T2?

A

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.

332
Q

what is the risk of malignancy in a solitary hot nodule? cold nodule?

A

hot: 1 percent. cold 15-20 percent.

333
Q

what is the daily, weekly, quarterly, and semi annual MQSA?

A

daily: darkroom cleanliness, processor QC, accuracy localization. weekly: view box and phantom. quarterly: repeat analysis. semiannual: darkroom fog

334
Q

what is the Av glandular dose in mag view vs non mag?

A

mag: twice the AGD.

335
Q

what are the findings in biliary atresia vs hepatitis?

A

biliary atresia: no tracer in bowel, hepatitis: see tracer in bowel with persistent hepatic activity

336
Q

which artery is immobilized prior to Y 90 chemoembo of a liver tumor?

A

the GDA to prevent non target embolization

ACR (1 decks)

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