Lmcc

Question 1

When is MRI best?

Answer 1

Note this is almost never the first choice on a test
Neuro:
- Cauda equina
– Demyelinating disease
– Posterior fossa and skull base 
– pituitary lesions
- all tumors in the spine and brain

MSK
– Bone and soft tissue infection
– bone and soft tissue tumor

Question 2

Best imaging test for biliary tract including gallstone and duct? Exception?

Answer 2

Ultrasound

Though it is not good for biliary tract malignancies

Question 3

Best imaging test for pelvis of males and females uterus/adnexa/ovaries

Answer 3

Ultrasound

Question 4

Best imaging for DVT

Answer 4

U.S.

Question 5

Best imaging for thyroid

Answer 5

U.S.

Question 6

Best imaging for breast in young female ?

Answer 6

U.S.

Question 7

Work up for PE in preg woman?

Answer 7

If pos leg sx… Then calf US
if no leg sx… First is CXR.
If CXR n then VQ bc less rad. If nondxic VQ or abn CXR, do CT PA

Question 8

Abdo pain CT indications

Answer 8

Infx or inflamm (acute diverticulitis, pancreatitis, appendicitis)
Suspect neoplasm (painless jaundice, progressive sx)
Suspect AAA

Question 9

When to go straight to OR

Answer 9

Perforation, ischemia, unstable trauma

Question 10

Ultrasound first line for?

Answer 10

Biliary colic, cholecystitis, choledocholithiasis, cholangitis

Question 11

How to distinguish gas pattern for bowel obstruction

Answer 11

Mucosal folds:
- for small bowel uninterrupted valvulae conniventes

• for large bowel interrupted haustra extended only partway across Lumen.

Location central for small, peripheral for large (ie picture frame)

Diameter at max is 3 cm for sbo
6 for transverse and 9 for cecum for lbo

Question 12

Ultrasound findings for cholecystitis:

Answer 12

Dilated gb
Thickened wall
Hyperemic wall
Pericholecystic fluid
Impacted gallstone 
Positive sonographic Murphy sign

Question 13

What is definitive tx for epidural?

Answer 13

Craniotomy due to middle meningeal artery bleed

Question 14

Initial test for central neurological issues 
Ie head trauma
Hemorrhage or mass lesion stroke
Headache w red flag
Seizure or worsening seiUre d/o 
LOC

Answer 14

Ct non contrast

MRI is 2nd and best for seizures.

Question 15

If clinical picture of PID, first best test?

Answer 15

B HCG for ectopic

Question 16

Utility of endovag US

Answer 16

Look at adnexa
Endometrium for vag bleed
Early preg and fetal demise
T1 bleed

Question 17

When not to do endovag US for bleed?

Answer 17

T3!

Question 18

How good are ultrasounds and detecting vascularity of masses in the ovary?

Answer 18

Worse with larger size… Laparoscopy

Question 19

Painful mass plus preg = ?

Answer 19

Ectopic

Question 20

Painful mass plus not preg = ?

Answer 20

Torsion

Question 21

9 yo girl + mass

Answer 21

Germ cell tumor

Question 22

Elderly woman and mass = ?

Answer 22

Epithelial Tumor

Question 23

Mass plus history of gastric ulcers = ?

Answer 23

kruckenberg tumor
- GI met to ovary.
Signet ring

Question 24

In a solid mass of breast when is only time fine needle biopsy ok?

Answer 24

Breast lymph nodes

Question 25

First test in diagnostic workup of breast mass?

Answer 25

Mammogram

Question 26

Indications for diagnostic mammography?

Answer 26

Any symptoms except isolated pain including skin change, lump, nipple discharge
– Screening mammography which revealed a suspicious abnormality

Question 27

First Assessment of acute onset of scrotal pain and bruising in young person?

Answer 27

Ultrasound to differentiate between testicular fracture and torsion

Question 28

When is CT best?

Answer 28

Not CATs!

Neurological emergencies
Chest CT for parenchymal lung disease
Abdo/pelvic CT for retroperitoneal structures and malignancy.
Trauma

Question 29

What is seen on us of orchitis?

Answer 29

Inc blood flow

Question 30

Premature infant with respiratory distress within hours of birth with ground glass granular CXR and effusions. Potential pneumothorax complication. Dec lung vol.

Answer 30

Hyaline membrane disease

Question 31

Term infant w respiratory distress 24-48 hr following c /s with evidence of interstitial edema and effusions. Inc lung vol.

Answer 31

Transient tachypnea of the newborn

Question 32

Post term infant w resp distress 12-24 he following delivery w coarse, nodular, asymmetric radiograph and inc lung vol.

Answer 32

Meconium aspiration

Question 33

Fine granular CXR appearance in newborn

Answer 33

Surfactant deficiency

Question 34

Steeple sign on radiograph

Answer 34

Croup (think C for Church)

Question 35

Thumbprinting

Answer 35

Epiglottitis

Question 36

Differential diagnosis for bilious vomit in the infant

Answer 36

Ilias vomit indicates below the ampulla. (Duodenal papilla) . Differential includes
V: necrotizing enterocolitis
C: Hirschsprung, atresia
A: volvulus/ malrotation
T: meconium ileus

Question 37

Best imaging for intussusception?

Answer 37

Ultrasound

Question 38

When can x-ray be used for the best study?

Answer 38

To exclude a surgical abdomen evidenced by free air, and necrotizing enterocolitis, bowel obstruction.

Question 39

Best imaging study for malrotation?

Answer 39

Upper G.I. study

Question 40

What is intussusception associated with?

Answer 40

Henoch schonlein purpura

Question 41

Hyposplenism or functional asplenia predisposes patients to serious infection with encapsulated organisms such as
Meningitis - S. pneumoniae

Answer 41

S pneumonia

Question 42

Bacteremia -

Answer 42

S. pneumoniae

Question 43

Mycoplasma, Chlamydia, and Legionella (i.e. atypicals)

Answer 43

Pneumonia - ; S. pneumo relatively uncommon)

Question 44

Osteomyelitis -

Answer 44

Salmonella