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Med > Radio > Flashcards

Radio Flashcards

1
Q

Xray attenuating order of structures

A

Air < fat < water < bone < metal

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2
Q

Pulse vs continues fluoroscopy with regards to time/ radiation exposure

A

Both time and radiation exposure reduced in pulsed fluoroscopy

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3
Q

The effect of higher U/S frequencies on resolution and attenuation

A

Both increase

Better resolution, but deeper structures more difficult to visualize

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4
Q

Duplex vs colur doppler

A

Duplex:
Gray-scale
Utilizes the doppler effect to visualize the velocity of blood flow past the transducer

Color doppler: assigns a color based on direction.
Red: toward, blue: away

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5
Q

U/S attenuation order of structures

A

Bone (bright) > gray matter > white matter > CSF > air (dark)

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6
Q

Use of different MRI techniques

A

Diffusion-weighted:
Neuroimaging
Detection of acute ischemic stroke

T1:
Anatomic scan

T2:
Pathologic scan

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7
Q

How to reduce risk of contrast mediated nephropathy (GFR<60)

A

NS 1 ml/kg/h since 12 h before to 12 h after contrast administration

If same-day procedure:
0.9% NS or NaHCO3, 3 ml/kg/hr, 1-3 hr pre-procedure and 6 hr post-contrast administration

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8
Q

Contraindications to IV iodine contrast

A 
Multiple myeloma
Adverse reaction previously
DM
Dehydration
Renal failure
Severe heart failure
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9
Q

Contraindication to contrast mediated MRI

A

Adverse reaction

ESRD

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10
Q

U/S with microbubble contrast enhancement contraindication

A

Rt to Lt cardiac shunt

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11
Q

Barium contrast contraindications

A

Toxic megacolon

Acute colitis

Suspected perforation

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12
Q

PA vs lateral CXR in picking up pleural effusion

A

Lateral more sensitive

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13
Q

Xray view for lung apices

A

Lordotic view

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14
Q

Ribs on Xray

A

Inspiration:
6th anterior
10th posterior

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15
Q

Cardiomegaly on CXR

A

Cardiothoracic ratio > 0.5

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16
Q

Spine sign on CXR

A

On lateral film, Vertebral bodies should appear progressively Radiolucent as one moves down that thoracic vertebral column. If they appeared more radio-opaque, it is an indication of Pathology. for example consolidation in overlying left lower lobe

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17
Q

Using silhouette sign, what is the location of pathology if SVC/Rt superior mediastinum interface lost?

A

RUL

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18
Q

Using silhouette sign, what is the location of pathology if Rt heard border interface lost?

A

RML

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19
Q

Using silhouette sign, what is the location of pathology if Rt hemidiaphragm interface lost?

A

RLL

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20
Q

Using silhouette sign, what is the location of pathology if aortic knob/Lt superior mediastinum interface lost?

A

LUL

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21
Q

Using silhouette sign, what is the location of pathology if left heart border interface lost?

A

Lingula

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22
Q

Using silhouette sign, what is the location of pathology if left hemidiaphragm interface lost?

A

LLL

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23
Q

Indications of HRCT

A

Hemoptysis

Diffuse lung disease

Pulmonary fibrosis

Normal CXR but abn PFT

Solitary pulmonary nodule

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24
Q

Low dose CT

A

1/5th radiation

Screening

F/U of infections, lung transplant, metastases

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25
Q

CTA indications

A

PE

Aortic aneurysm

Aortic dissection

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26
Q

Persisting athelectasia in the absence of a known etiology

A

CT thorax

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27
Q

Linear interstitial patterns

A

Kerley A:
Long thin lines in upper lobes

Kerley B:
Short horizontal lines extending from lateral lung margine

Kerley C:
Diffuse linear pattern throughout lung

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28
Q

DDx of linear interstitial patterns

A

Pulmonary edema

Lymphangitic carcinomatosis

Atypical interstitial pneumonias

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29
Q

Nodular pattern of interstitial lung disease

A

1-5 mm, well-defined, evenly distributed throughout lung

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30
Q

DDx of nodular interstitial pattern

A

Malignancy

Pneumoconiosis

Granulomatous disease: sarcoidosis, miliary TB

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31
Q

Reticular (honeycomb) interstitial lung pattern

A

Parenchyma replaced by thin-walled cysts.

Suggests extensive destruction of pumonary tissue anf fibrosis

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32
Q

DDx of reticular interstitial pattern

A

IPF
Asbestosis
Collagen vascular disease

Complication: pneumothorax

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33
Q

Drugs causing ILD

A 
Cephalo
Notrofurantoin
NSAIDs
Phenytoin
Carbamazepine
Fluoxetine
Amiodarone
Chemo : MTX
Heroin
Cocaine
Methadone
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34
Q

Mx of ILD

A

HRCT

Bx

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35
Q

Infections presenting as pulmonary nodule

A

Histoplasmosis

Coccidioidomycosis

Tuberculosis

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36
Q

Mx of lung nodule

A

If high probability of malignancy:
Invasive testing

If low probability:
Repeat CXR/CT in 1-3 mo, then q 6 mo for 2 yr

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37
Q

Upper ILDs

A 
Farmer’s lung
Ankylosing spondylitis
Sarcoidosis
Silicosis
TB
Eosinophilic granuloma
NF
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38
Q

Lower ILDs

A 
BOOP
Asbestosis
Drugs
Rheumatological disease
Aspiration
Scleroderma
Idiopathic pulmonary fibrosis
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39
Q

Margin of benign vs malignant pulmonary nodule

A

M: ill-defined/spiculated

B: well-defined

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40
Q

Contour of benign vs malignant pulmonary nodule

A

M: lobulated

B: smooth

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41
Q

Calcification of benign vs malignant pulmonary nodule

A

M: eccentric or stipled

B: diffuse, central, popcorn, concentric

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42
Q

Doubling time of benign vs malignant pulmonary nodule

A

M: 20-460 d

B: <20 d, > 460 d

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43
Q

Size of benign vs malignant pulmonary nodule

A

M: > 3cm

B <3 cm

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44
Q

Cavitation in benign vs malignant pulmonary nodule

A

M: yes, esp with wall thickness > 1.5 cm, eccentric cavity and shaggy internal margins

B: no

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45
Q

Satellite lesion in benign vs malignant pulmonary nodule

A

M: no

B: yes

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46
Q

Other features in favor of malignant nodule

A 
Colapse
LAP
Pleural eff
Lytic bone lesions
Smoking Hx
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47
Q

Patterns of interstitial fluid accumulation in pulmonary edema

A

Loss of definition of pulmonary vasculature

Peribronchial cuffing

Kerley B lines

Reticulonodular pattern

Thickening of interlobar fissures

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48
Q

Vascular changes on CXR in pulmonary edema

A

Vascular redistribution

Vascular enlargement

Cephalization

Pleural effusion

Cardiomegaly

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49
Q

Bat wing or butterfly pattern is the result of

A

Alveolar fluid collection

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50
Q

Emboli can be seen in up to which order of arterial branching in PE?

A

4th

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51
Q

CTA and V/Q scan in PE

A

V/Q scan is not a diagnostic study

CTA: definitive

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52
Q

The CXR view with most sensitivity for pleural effusion detection

A

Lateral decubitus: 25 ml

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53
Q

Pleural effusion volumes needed to be detected on CXR

A

Lateral decubitus: 25 cc

Upright lateral: 50cc

PA: 200 cc

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54
Q

A horizontal fluid level is seen in:

A

Only hydropneumothorax

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55
Q

Standard of care for detection of pleural effusion in acute situations

A

Point of care U/S

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56
Q

Indication to perform thoracentesis

A

Fluid level > 1 cm on lateral decubitus

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57
Q

CXR view woth better visualization of pneumothorax

A

Expiratory

Lateral decubitus

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58
Q

How to detect pneumothorax on supine film

A

Deep costophrenic sulcus sign

Double diaphragm sign

Hyperlucent hemithorax

Sharpening of adjacent mediastinal structures

Mediastinal shift if tension pneumothorax

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59
Q

Most common finding in CXR of asbestos

A

Benign pleural plaques (may calcify)

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60
Q

CXR of asbestos

A

Pleural plaques

Diffuse pleural fibrosis

Effusion

Malignant mesothelioma

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61
Q

DDx of anterior mediastinum

A

Thyroid
Thymus
Teratoma
Terrible lymphoma

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62
Q

DDx of middle mediastinum lesions

A 
Esophageal lesions
LAP
hiatus hernia
Bronchogenic cyst
Metastatic disease
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63
Q

Posterior mediastinum lesions

A

Neurogenic tumors (NF, schwanoma)

MM

Pheo

Neurenteric cyst

Thoracic duct cyst

Lateral meningocele

Bochdalek hernia

Extramedulary hematopoiesis

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64
Q

Cardiophrenic angle mass DDx

A

Epicardial fat pad

Morgani hernia

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65
Q

Which cardiac chamber does not contribute to cardiac borders on PA CXR?

A

Rt ventricle

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66
Q

Chamber making the anterior and posterior borders of heart on lateral CXR

A

Ant: Rt ventricle

Post: left atrium and left ventricle

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67
Q

Which pathologies can arise in all 3 parts of mediastinum? (Ant., post., middle)

A

Lymphoma

Lung cancer

Aortic aneurysm

Vascular anomalies

Abscess

Hematoma

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68
Q

Posterior border of middle mediastinum on lateral Xray

A

A line 1 cm posterior to the anterior border of the thoracic vertebral bodies

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69
Q

Cardiothoracic ratio definition

A

Greatest transverse dimension of the central shadow relative to the greatest transverse dimension of the thoracic cavity

Abn if > 0.5

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70
Q

Cardiothoracic ratio in pectus excavatum

A

> 0.5

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71
Q

Pericardial effusion on chest x-ray

A

Globular heart

Loss of indentation on the left mediastinal border

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72
Q

RA enlargement on CXR

A

Increase in curvature of Rt heart border

Enlargement of SVC

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73
Q

Left atrium enlargement on CXR

A

Straightening of left heart border

Increased opacity of lower right side of cardiovascular shadow (double heart border)

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74
Q

RV enlargement on CXR

A

Elevation of cardiac apex from diaphragm

Loss of retrosternal airspace

Increased contact of right ventricle against sternum

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75
Q

LV enlargement on CXR

A

Rounding of cardiac apex

Displacement of left cardiac border leftward, inferiorly and posteriorly

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76
Q

Central venous catheter place

A

Tip: proximal to Rt atrium (in a zone demarcated superiorly by anterior first rib end and clavicle amd inferiorly by top of RA

If monitoring CVP: catheter tip must be proximal to venous valves

Course parallel to SVC

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77
Q

ETT on CXR

A

Progressive gaseous distention of stomach: esophageal intubation

Tip: 4 cm above carina

Maximum inflation diameter < 3 cm

Diameter of balloon < tracheal diameter above and bellow

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78
Q

Nasogastric tube

A

Tip and sideport: distal to LES, proximal to gastric pylorus

Must radiographically confirm tube

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79
Q

Swan-Ganz catheter

A

Tip: right or left main pulmonary arteries or in one of their large lobar branches

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80
Q

Chest tube on CXR

A

In dorsal and caudal portion of pleural space to evacuate fluid

In ventral and cephalad portions of pleural space to evacuate pneumothoraces

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81
Q

Abdominal xray not useful in evaluating:

A

GIB

Chronic anemia

Vague GI Sx

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82
Q

Mucosal folds in small vs large bowel xray

A

S: uninterrupted valvulae connivents (plicae circularis)

L: interrupted haustra. Extend only partly across lumen

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83
Q

Maximum diameter of small vs large bowel on xray

A

3 cm

L: 6 cm (9 in cecum)

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84
Q

Maximum fold thickness in small vs large bowel xray

A

S: 3 mm

L: 5 mm

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85
Q

How long after surgery is there intraperitoneal air on x-ray

A

10 d

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86
Q

Small amounts of fluid on abdominal x-ray

A

Increased distance between lateral fat stripes and adjacent colon

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87
Q

Large amounts of fluid on abdominal x-ray

A

Diffuse increased opacification on supine film

Bowel floats to standard of interior abdominal wall

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88
Q

Coffee bean projecting to right or mid-upper abdomen

A

Sigmoid volvolus

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89
Q

Dilated loop projecting to left or mid-upper abdomen

A

Cecal dilation

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90
Q

Corkscrew sign on plain film

A

Small bowel volvolus

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91
Q

Toxic megacolon on x-ray

A

Dilatation of colon > 6.5 cm

Mucosal changes:
Foci of edema
Ulceration
Pseudopolyps
Loss of normal haustral pattern
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92
Q

Bowel wall thickening on xray

A

Increased soft tissue density in bowel wall

Thumb printing

Stacked coin appearance

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93
Q

Extraluminal air on abdominal xray, intraperitoneal

A

Air under diaphragm in upright film

Air between liver and abdominal wall on left lateral decubitus film

Supine: gas outlines of structures not normally seen:
Rigler’s sign: inner and outer bowel wall
Falciform ligament
Football sign: peritoneal cavity

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94
Q

Extraluminal air on abdominal xray, retroperitoneal

A

Increased visualization of psoas shadow and renal shadow

Gas outlining retroperitoneal structures

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95
Q

Pneumatosus intestinalis on abdominal xray

A

Linear/rounded Air streaks in bowel wall

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96
Q

Mottled, localized, loculated air in abnormal position without normal bowel features

A

Abscess

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97
Q

Air-fluid level onbabdominal xray

A

Intraluminal wall

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98
Q

Air centrally over liver

A

Biliary

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99
Q

Air peripherally over liver in branching patern

A

Portal vein

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100
Q

DDx of intramural air

A

Linear:
Ischemia
Necrotizing enterocolitis

Rounded/cystoid:
Primary
Secondary to COPD

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101
Q

DDx of portal vein air

A

Bowel ischemia/infarction

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102
Q

Caliber of bowel loops in adynamic vs mechanical obstruction

A

Adynamic:
Normal or dilated

Mechanical:
Usually dilated

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103
Q

Air-fluid level in adynamic vs mechanical obstruction

A

Adynamic: same level in the same loop

Mechanical:
Multiple air-fluid levels (step ladder)
Dynamic
Steing of pearls

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104
Q

Distribution of bowel gases in adynamic vs mechanical obstruction

A

Adynamic:
Air throughout GI tract is generalized or localized

If localized, dilated sentinel loop remains in the same location on serial films

Mechanical:
Dilated bowel up to the point of obstruction.

No air distal to the obstructed segment

Hairpin turns in bowel (180°)

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105
Q

The best imaging choice for finding the cause of bowel obstruction

A

CT

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106
Q

Indications for CT colonoscopy

A

Surveillance in low-risk pt

Incomplete colonoscopy

Staging of obstructing colonic lesions

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107
Q

Imaging helpful in differentiating common benign hepatic hemangiomas from primary liver tumors and metastases

A

MR

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108
Q

Methods for liver elastography

A

U/S (fibroscan)

MRI (MR elastography)

(Quantify liver fibrosis)

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109
Q

Findings on portal HTN imaging

A

Increased portal vein diameter

Collateral veins

Splenomegaly > 12 cm

Portal vein thrombosis

Recanalization of the umbilical vein

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110
Q

U/S findings in liver cirrhosis

A

Nodular, hyperechoic liver

Irregular areas of atrophy of Rt lobe

Hypertrophy of the caudate or left lobes

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111
Q

Fatty liver infiltration on CT

A

Hypodense

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112
Q

If a lesion in liver is identified via U/S, what’s the next step?

A

CT (non-contrast, arterial, venous, delayed)
or
MRI

113
Q

4 phase liver CT helps to R/O:

A

Hemangioma

114
Q

Hepatic adenoma on U/S

A

Well-defined

Hyperechoic areas (hemorrhage)

115
Q

Hepatic adenoma on CT

A

Well-defined

Hypervascular

Enlarged central vessel (isoattenuating in venous phase)

116
Q

Hemangioma on U/S

A

Homogenous hyperechoic mass

117
Q

Hemangioma CT

A

Peripheral globular enhancement in arterial phase

Central filling and persistent enhancement on delayed scans

118
Q

Focal nodular hyperplasia on U/S

A

Well-defined

Central scar (in 50% of cases)

119
Q

Liver FNH on CT

A

Hypervascular in arterial phase

Isoattenuation to liver in portal venous phase

120
Q

Liver abscess on U/S

A

Ill-defined

Irregular margin

Hypoechoic contents

121
Q

Liver abscess CT

A

Low attenuation

Irregular enhancing wall

122
Q

Hydatid cyst on U/S

A

Simple/multiloculated cyst

123
Q

Hydatid cyst on CT

A

Low attenuation

Simple/muliloculated

Calcification

124
Q

HCC on U/S

A

Single/multiple mass

Or

Diffuse infiltration

125
Q

HCC on CT

A

Hypervascular

Enhances in arterial phase

Washes out in venous phase

Portal venous tumor thrombus

126
Q

Liver mets on U/S

A

Multiple

Variable echotextures

127
Q

Liver mets on CT

A

Low attenuation

128
Q

The purpose of nuclear medicine scan for spleen

A

To distinguish ectopic splenic tissue from enhancing tumors

129
Q

Pancreas tumor on ultrasound

A

More ecogenic than normal pancreatic tissue

130
Q

Liver versus spleen density on CT

A

Liver in denser

If not: suspect fatty infiltration

131
Q

Test of choice for diagnosis of cholelithiasis

A

U/S

132
Q

Most sensitive sonographic findings in acute cholecystitis

A

Presence of gallstones

Sonographic Morphy’s sign

Other findings:

Thickened gall bladder (>3mm)

Pericholecystic fluid

Dilated gallbladder

133
Q

Best imaging modality for Dx of acute cholecystitis

A

U/S

HIDA can diagnose cases of acalculis or chronic cholecystitis

134
Q

Best imaging modality for appendicites

A

U/S
Or
CT

135
Q

Appendicitis on U/S

A

Thick-walled

Appendicolith

dilated/fluid filled

Non compressible

136
Q

Appendicitis on CT

A

Enlargement (>6 mm) in outer diameter

Enhancement of the wall

Adjacent inflammatory stranding

Appendicolith

Helps percutaneous abscess drainage

137
Q

Best imaging modality for diverticulitis

A

CT (with oral and rectal contrast)

138
Q

CT findings in diverticulitis

A

Thickened wall

Mesenteric infiltration

Gas-filled diverticula

Abscess

Also used to guide abscess drainage

139
Q

Imaging modality used for screening and follow up of acute pancreatitis

A

U/S

140
Q

First line imaging test for assessment of complications in acute pancreatitis

A

CT

141
Q

U/S findings of acute pancreatitis

A

Hypoechoic

Enlarged

Gas obscures pancreas if qileus present

142
Q

CT findings of acute pancreatitis

A

Enlarged

Edema

Stranding in surrounding fat

Indistinct fat planes

Mesenteric and Gerota thickening

Pseudocyst in lesser sac

Abscess

Necrosis

Hemorrhage

Also used for needle aspiration/drainage of abscess

F/U of pseudocyst

143
Q

Pancreatic necrosis on CT

A

Low attenuation

Gas-containing

Non-enhancing

144
Q

Best imaging modality for chronic pancreatitis

A

MRCP

145
Q

MRCP findings in chronic pancreatitis

A

Calcification

Duct obstruction

Duct dilatation

Enlargement of pancreas

Fluid collection adjacent to gland (pseudocyst)

146
Q

The amount of bleeding needed to be visualized by angiography

A

Optimal: 1-1.5 ml/min

147
Q

Standard imaging for renal masses

A

Renal triphasic CT

Unenhanced
Arterial and venous
Excretory

148
Q

Indications of CT urography

A

Microscopic/gross hematuria

Detailed assessment of urinary tracts

Uroepithelial malignancies of the upper urinary tract

149
Q

Indications of MRI over CT for urologic evaluation

A

Previous nephron sparing surgery

Requiring serial follow up

Reduced renal function

Solitary kidney

Clinical staging of prostate cancer

150
Q

Indications for VCUG

A

Children with recurrent UTI

Hydronephrosis

Hydroureter

Suspected lower urinary tract obstruction

Vesicoureteral reflux

151
Q

Renal scans to assess anatomy, scar, pyelonephritis

A

Tc-DMSA

Tc-glucoheptonate

152
Q

Renal scans to assess renal function and collecting system

A

Tc-pentetate (DTPA)

Mertiatide (MAG3)

153
Q

Initial investigation for pelvic pathology

A

Transabdominal U/S

154
Q

Polyps on U/S

A

Well-defined

Homogenous

Isoechoic to the endometrium

Preservation of the endometrial-myometrial interface

155
Q

Atypical polyp features on ultrasound

A

Cystic components

Multiple polyps

Broad base

Hypoechogenicity

Heterogeneity

156
Q

Typical leiomyoma on U/S

A

Well defined

Broad-based

Hypoechoic

Solid

Shadowing

The overlying layer of endometrium is echogenic and distorts the endometrial-myometrial interface

157
Q

Atypical features of leiomyoma on ultrasound

A

Pedunculation

Multilobulated surface

158
Q

Endometrial hyperplasia and cancer on ultrasound

A

Diffuse echogenic endometrial thickening without focal abnormality

Early cases can be focal and appear as a polypoid mass

159
Q

Uterine adhesions on ultrasound

A

Mobile

Thin

Echogenic bands

Cut across the endometrial cavity

160
Q

Atypical features of uterine adhesions on ultrasound

A

Thick

Broad-based

Completely obliterate the endometrial cavity

(As in Asherman)

161
Q

Adrenocortical adenoma on CT

A

<3 cm

Smooth

Round/oval

Homogenous

Not highly vascular

> 50% washout of contrast medium on CT at 10 min

Stable or very slow growth (<1 cm/yr)

Low density

MRI T2: isointense in relation to liver

162
Q

Adrenocortical carcinoma on CT

A

> 4 cm

Irregular

Unclear margins

Heterogenous with mixed densities

Usually vascular

<50% washout at 10 min

Rapid growth (>2 cm/yr)

Necrosis

Calcification

Hemorrhage

MRI T2: hyperintense in relation to Liver

163
Q

Pheo on CT

A

> 3 cm

Round/oval

Clear margins

Heterogenous with cystic areas

Usually vascular

< 50% contrast washout at 10 min

Slow growth (0.5-1 cm/ yr)
Hemorrhage

MRI T2: markedly hyperintense in relation to liver

164
Q

Adrenal mets on CT

A

< 3 cm

Oval/irregular

Heterogenous

Mixed density

Usually vascular

<50 % washout

Variable growth

Hemorrhage

MRI T2: hyperintense in relation to liver

165
Q

Area of brain that can be obscured by bony-related artifact

A

Posterior fossa

166
Q

Screening tests for assessment of SAH

A

CTA

MRA

167
Q

SPECT

A

Assesses cerebral blood flow and cellular metabolism

Using:
Tc-exametazime
Tc-bicisate

Taken up predominantly in gray matter

Diffuse rapidly across the BBB and become trapped within neurons (proportionate to cerebral blood flow)

168
Q

FDG PET

A

Assesses cerebral metabolic activity

169
Q

Indications of FDG PET

A

Differentiating residual tumor from radiation necrosis

Localizing epileptic seizure foci

Evaluation of atypical dementia

170
Q

Increased thickness of dura may suggest

A

Presence of blood

171
Q

Poor contrast between white and gray matter suggests:

A

Possible infarction, edema, tumor, infection, contusion

172
Q

Central gray matter nuclei not visible:

A

Infarction

Tumor

Infection

173
Q

Hyperdensity in parenchyma suggests

A

Enhancing lesion

Hemorrhage

Calcification

174
Q

Imaging after Sx of stroke

A

1st non-contrast CT

If negative: MRI with diffusion weighted sequence or CTA

175
Q

Best imaging modality for brain infarct

A

MRI

176
Q

Brain infarction findings on CT (0-24 h)

A

Normal within 6 h

Edema:
Loss of gray-white diff
Insular ribbon sign
Effacement of sulci
Mass effect

Hyperdense MCA sign:
Thrombosis, emboli

If hemorrhagic:
Hyperattenuating acute blood, surrounded by edema

177
Q

Brain infarction findings on CT (24h-1wk)

A

Increasing edema:
Hypoattenuation

Mass effect

178
Q

Brain infarction findings on CT (1-3wk)

A

Resolution of edema, therefore increased attenuation of infarcted area:

Near-normal density, may mask stroke (fogging phenomenon)

179
Q

Brain infarction findings on CT (>3wk)

A

Encephalomalacia (parenchyma volume loss):

Hypoattenuation with negative mass effect

180
Q

Brain infarction findings on MRI (0-24 h)

A

DWI:
Hyperintense within minutes

ADC:
Hypointense within minutes

T2/FLAIR:
Hyperintense 6 h after onset

181
Q

Brain infarction findings on MRI (24h-1wk)

A

DWI:
Hyperintensity

ADC:
Hypointensity

T2/FLAIR:
Hyperintensity

182
Q

Brain infarction findings on MRI (1-3wk)

A

DWI:
Hyperintensity

ADC:
Continues rising. Hyperintensity at 10-15 d

T2/FLAIR:
Hyperintensity

183
Q

Brain infarction findings on MRI (>3wk)

A

DWI/T2/FLAIR:
Hyperintensity progressively decreases

ADC:
Remains elevated

184
Q

Best imaging modality for carotid artery disease

A

Duplex doppler U/S

185
Q

If plan to perform carotid angioplasty or endarterectomy, next imaging?

A

MRA or CTA

If inadequate, then:
Conventional angio

186
Q

Best imaging modality and its sensitivity and specificity for MS

A

MRI
High sensitivity
Low specificity

187
Q

MRI findings in MS

A

Cerebral or spinal plaques

Areas:
Periventricular
Corpus callosum (at right angle)
Centrum semioval
Deep white matter
Basal ganglia
Dawson’s fingers
Perivascular/interstitial edems

Ovoid

Hyperintense on T2
Hypointense on T1

Spinal:
Hyperintense lesion on T2 (at least 3 mm but less than 2 vertebral segments)

Occupy only part of the cord on cross-section

Focal, clearly delineated and circumscribed on T2

Little or no cord swelling

188
Q

Best imaging modality for meningitis

A

MRI T2:

Meningeal enhancement

Hydrocephalus

Subdural effusion

Cerebral swelling

189
Q

Sites of herpes simplex encephalitis

A 
Limbic regions:
Temporal lobe
Orbitofrontal region
Insula
Cingulate gyrus
190
Q

Best imaging modality for HSV encephalitis

A

MRI T1 and T2

T2:
High intensity lesions on T2 MRI in temporal and inferior frontal lobes

191
Q

CT findings of HSV encephalitis

A

Low density in temporal lobe and insula

Rarely basal ganglia involvement

192
Q

Best imaging modality for brain abscess or cerebritis

A

MRI

Early cerebritis(1-3d):
Low intensity on T1
High intensity on T2
Late cerebritis(4-9d):
Ring enhancement

Early capsule(10-13d): ring

Late capsule(14 d or greater): ring, considerable edema around

193
Q

Indications for bone CT

A

Complex, comminuted, intra-articular, occult fx including:

Distal radius

Scaphoid

Skull

Spine

Acetabulum

Calcaneus

Sacrum

194
Q

Indications for MRI of musculoskeletal system

A

Internal derangement of joints (ligaments, capsule, menisci, labrum, cartilage)

Tendons

Muscles

Bony masses

195
Q

Indications for musculoskeletal U/S

A

Tendon injury

Detection of soft tissue masses,

Cystic or solid

Foreign body

Guide for Bx, injection

Doppler for vascularity

196
Q

Bone scintigraphy

A

Tc-Methylene

Determines the location and extent of bony lesions.

Areas with increased turnover/calcification:

Growth plates
Tumors
Infections
Paget
Fx
Reactive bone formation
Periostitis
197
Q

Osteoarthritis on Xray

A

Joint space narrowing (non-uniform)

Subchondral sclerosis

Subchondral cyst formation

Osteophytes

198
Q

RA on Xray

A

Uniform joint space narrowing

Soft tissue swelling

Erosions

Periarticular osteopenia

199
Q

Most common bone tumors by age

A

<1 y:
Metastatic neuroblastoma

1-20 yr:
Ewing

10-30:
Osteosarcoma

> 40:
Mets, MM, chondrosarcoma

200
Q

DDx of multiple bone tumors

A

Mets

Myeloma

Lymphoma

Fibrouse dysplasia

Enchondromatosis

201
Q

Epiphysis bone lesions

A

Giant cell tumor

Chondroblastoma

Geode

Eosinophilic granuloma

Infection

202
Q

Metaphysis bone lesions

A

Simple bone cyst

Aneurysmal bone cyst

Enchondroma

Chondromyxoid fibroma

Non-ossifying fibroma

Osteosarcoma

Chondrosarcoma

203
Q

Diaphysis bone lesions

A

Fibrous dysplasia

Aneurysmal bone cyst

Brown tumor

Eosinophilic granuloma

Ewing

204
Q

Expansile bone lesions

A

Aneurysmal bone cyst

Giant cell tumor

Enchondroma

Brown tumor

Mets

Plasmacytoma

205
Q

Bone matrix mineralization types

A

Chondroid (popcorn calcification)

Osseous

206
Q

Characteristics of benign bone tumors

A

Thin sclerotic margin

Sharp delineation

No or simple periosteal reaction

No soft tissue mass

207
Q

Characteristics of malignant bone lesions

A

Poor delineation

Wide zone of transition

Loss of overlying cortex

Bony destruction

Periosteal reaction

Soft tissue mass

208
Q

DDx of Codman’s triangle

A

Osteosarcoma

Ewing

Subperiosteal abscess

209
Q

Onion skin periosteal reaction

A

Ewing

210
Q

Sunburst periosteal reaction

A

Osteosarcoma

211
Q

Hair on end periosteal reaction

A

Osteosarcoma

212
Q

Imaging modality of choice for osteomyelitis

A

MRI

213
Q

When are plain film changes visible in osteomyelitis?

A

After 8-10 d:

Soft tissue swelling

Local periosteal reaction

Pockets of air (if anaerobes or necrotizing fasciitis)

Mottled and non-homogenous appearance (moth-eaten)

Cortical destruction

214
Q

Benign lesions which may have aggressive features on imaging

A

Osteomyelitis

Osteoblastoma

Aneurysmal bone cyst

LCH

Myositis ossificans

215
Q

Bone abscess imaging

A

Sharply outlined

Radiolucent

Variable thickness in zone of transition

Sequestrum

Sinus tract or cloaca to the skin surface

216
Q

Best imaging for diagnosis of bone abscess

A

MRI: bone, bone marrow, soft tissue

CT: sequestra, cortical erosion

217
Q

Gold std for measuring BMD

A

DEXA

Z-score: SD from the age-matched mean

T-score: SD from young adult mean (most clinically valuable)

218
Q

Codfish vertebra (biconcave) seen in

A

Osteoporosis

219
Q

Long bone osteoporosis on xray

A

Thinned cortex

Increased medullary cavity

220
Q

DDx of osteopenia on Xray

A

Osteoporosis

Osteomalacia

Hyperpara

Disuse

221
Q

Xray of osteomalacia/rickets

A

Initial osteopenia (coarse and poorly defined bone texture)

Fuzzy, ill-defined trabeculae

Looser’s zones (pseudofracture): fissures and clefts at right angle to the bone

222
Q

Hyperparathyroidism on Xray

A

Ca deposit in hyaline cartilage or fibrocartilage

Resorption of bones in hands (subperiosteal and at tufts)

Resorption at sacroiliac joints (subchondral)

Resorption at skull (salt and pepper)

Osteoclastoma (brown tumor)

Rugger jersey spine: band-like sclerosis at superior/inferior margins of vertebral bodies

223
Q

Paget’s disease onnXray

A

Esp: skull, spine, pelvis

1st phase: lytic
2nd phase: mixed
3rd phase: sclerotic

Coarsening of trabeculae with bone expansion

Bone softening/bowing

High activity on bone scan, esp at bone ends

Thickened cortex

224
Q

Indications of SPECT

A

Dementia

Traumatic brain injury

Vasculitis

Neuropsychiatric disorders

Stroke

Confirming brain death

Seizure (determining the epileptogenic focus)

225
Q

PET indications

A

Dementia

Grade and stage of brain tumor

Sizure imaging

Vasculitus

Alzheimer (amyloid tracing)

226
Q

Indication for intrathecal In-DTPA

A

CSF leak

Differentiation between NPH and brain atrophy

227
Q

MIBG in dementia

A

If decreased MIBG activity in heart = autonomic impairment = Lewy body dementia, Parkinson

228
Q

False negative thyroid RAIU

A

Recent radiographic contrast study

High dietary iodine (seaweed, thyroid vitamin)

229
Q

Thyroid RAIU is index of:

A

Thyroid function

I 131

Useful for differentiation of hyperthyroidism in adults, and also hypothyroidism in children

230
Q

Thyroid imaging

A

Tc-pertechnetate

Radioactive iodine (I 123)

Functional anatomic detail

231
Q

Results of scintiscan of thyroid

A

Hot nodule

Cold nodule: cancer must be considered

Isointense (warm) nodule: cancer must be considered

232
Q

Radioiodine thyroid ablation

A

I 131

Remain away from family members and care givers

No pregnancy for 6 mo

Risk of:
Exophthalmus
Thyroid storm
Secondary malignancy

233
Q

DDx of ventilation scan defect

A

Airway obstruction

Chronic lung disease

Bronchospasm

Tumor obstruction

234
Q

Perfusion scan contraindications

A

Relative:

Severe pulmonary HTN

Rt to Lt shunt

Previous Hx of pneumonectomy

Small child

235
Q

Indications of V/Q scan in PE

A

Pregnancy

CT contraindicated

236
Q

Abn V/Q test:

A

Ventilation present but perfusion absent

237
Q

When is V/Q scan not valid?

A

Consolidation

Ventilatory problems (use modified V/Q scan which is perfusion only)

Modified scan also suitable for pregnancy if CXR is nl and there are no ventilatory problems

238
Q

DDx of perfusion scan defect

A

Reduced blood flow

COPD

Asthma

Bronchogenic carcinoma

Inflammatory lung disease

Pneumonia

Sarcoidosis

Mediastinitis

Mucous plug

Vasculitis

239
Q

Indications for myocardial perfusion scanning

A

To investigate coronary artery disease

To assess treatment of CAD

Preop risk stratification

Viability testing

240
Q

Myocardial perfusion scanning in patients with left bundle

A

Given pharmacologic stress (persantine vasodilator)

241
Q

Contraindications to pharmacologic stress

A

sBP <90

Asthma

242
Q

Myocardial perfusion scan in patients with asthma who cannot exercise

A

Give dobutamin

243
Q

Interpretation of myocardial perfusion scan

A

Persistent defect at rest and stress:
Suggest infarction or myocardial scar

Reversible defect (only during stress):
Ischemia

Patience with >10% ischemic myocardium benefit most from revascularization

244
Q

Radionuclide ventriculography purpose

A

Provides information about RV function, presence of shunts

245
Q

Cardiac MUGA scan

A

Sums multiple cardiac cycles

Evaluates: LV function, regional wall motion, ejection fraction, diastolic dysfunction, ventricular volume

246
Q

Indications of radionuclide ventriculography/MUGA

A

To monitor potential cardiac toxicity with chemotherapy or Herceptin

Gold standard for ejection fraction in defibrillator work up

247
Q

HIDA scan

A

Cholescintigraphy

Prefer NPO after modnight (but could be non-fasting state)

248
Q

Interpretation of HIDA

A

Acute cholecystitis:

No visualization of gallbladder at 4 h
No visualization of gallbladder at 1 hr after administration of morphine

Chronic cholecystitis:
No visualization at 1 h, but seen at 4 h, or seen after morphine injection

249
Q

Gallbladder normal ejection fraction

A

> 38%

250
Q

Effect of fasting on HIDA

A

Fasting < 4 h or > 24 can make test abnormal (obstruction)

251
Q

RBC scan

A

Active GIB < 0.5 ml/min

Liver hemangioma:
Cold early
Fills in later

252
Q

Nuclear scan for meckel

A

M pertechnetate after ranitidine premedication

Meckel lights up as the stomach

253
Q

Nuclear scan for neuroendocrine tumors ( carcinoid, gastrinoma, insulinoma)

A

In-octreoscan (somatostatin analogue)

Gastrinoma and carcinoid are more octreotide avid than insulinoma

254
Q

Tc DTPA orTc MAG3 renal scan

A

Renal function and anatomy

UPJ obstruction

Assess renal transplant

Kidney donation

255
Q

Tc DMSA

A

Pyelonephritis in children

Reflux (injection into bladder)

256
Q

Bone scan shows

A

Increased blood supply to bone
Or
High bone turnover

Indications:

Bone pain of unknown origin
Tumor staging
Arthroplasty complications
Osteomyelitis

257
Q

DDx of positive bone scan

A 
Mets
Primary bone tumor
Arthritis
Fx
Infection
Anemia
Paget
258
Q

Lytic lesions on bone scan

A

Normal or cold (false negative)
Examples:

MM
RCC
Eosinophilic glanuloma

259
Q

Superscan

A

Increased bone uptake + poor renal uptake

DDx:
Diffuse mets
Renal osteodystrophy

260
Q

Most common indication of thrombolytic therapy

A

Treatment of ischemic limb

261
Q

Tumors amenable to RF ablation

A

HCC, hepatic mets

Renal tumors

262
Q

Indications for central vein access

A

Fluid

AB

TPN

Chemo

Blood

Blood sampling

263
Q

Indications for breast cancer screening by mamo

A

From age 50 q 2-3 yr

> 70 yr, if in good general health

<50 if high risk

264
Q

Other indications of mamo

A

F/U of women with previous breast cancer

Lump/thickening,

Nodularity

Dimpling

Contour deformity

Persistent focal pain

Spontaneous discharge from a single duct (serous, sanguinous)

Abn screening mammo

Complications of breast implants

265
Q

Mammo report:
Probably benign, likelihood of malignancy <2%

Next step?

A

Unilateral mammo at 6 mo

266
Q

Mammo report:
Suspicious abnormality

Next step?

A

Bx

267
Q

Mammo report:

Highly suspicious of malignancy, likelihood: 95%

A

Bx

268
Q

Mammo report:

Negative or normal

A

Routine screening

269
Q

Mammo report:

Incomplete

A

Additional imaging

Comparison to prior films

270
Q

Indication of breast U/S

A

Palpable abnormalities in:
<30 yr
Lactating
Pregnant

Further characterization of mammo findings

Guide for interventions

271
Q

Breast MRI indications

A

For Dx, after indeterminate mammo and U/S. “Problem solving”

For screening in high-risk pts, in conjunction with mammo.

Suspected silicone implant rupture/problems

Evaluation of previous breast cancer for: margins, recurrence, response to chemo…

272
Q

High-risk pts for breast cancer

A

Known BRCA1 and BRCA2 mutation

Known other gene predisposing to breast cancer

Untested 1st degree relative of a carrier of such mutations

FHx of hereditary breast cancer syndrome

Estimated personal life-time cancer risk >25%

High risk marker on prior Bx:
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Lobular carcinoma in situ

RT to chest before 30

273
Q

Breast mass vs breast asymmetry

A

Mass: space-occupying lesion seen in 2 different projections

Asymmetry: seen only in a single projection

274
Q

Benign breast mass on mammography

A

Oval/round/lobular

Circumscribed/well-defined margin

Radiolucent

Calcifications:
Popcorn (hyalinizing fibradenoma)
Lucent centered
Layering (milk of Ca)
Vascular
Round
Scattered
275
Q

Mammographic features of malignant breast lesion

A

Irregular shape

Indistinct, microlobulated, spiculated margin

Radiodense

Calcification:
Pleomorphic
Amorphous
Fine linear
Coarse heterogeneous
Regional
Segmental
Clustered
276
Q

Significance of tubular density/dilated ducts

A

Of little concern

277
Q

Typical Intramammary lymph nodes

A

Circumscribed

Reniform

Fatty notch and centre (particularly important)

< 1cm

Outer upper part of breast

If all seen: benign

278
Q

Focal asymmetry on mammo, next step?

A

Must be carefully evaluated with focal compression

Bx if:
The area can be palpated
Or
Focal compression shows mass-like character

Med (25 decks)

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