Radiodx Flashcards
Weightlifter on steroids, has scleral icterus and hyperechoic liver, Dx
Fatty liver
Cirrhosis
Steatohepatitis
Steatohepatitis
Male, obese, breast lump that is lucent with a thin rim, ultrasound is intensely hyperechoic
Gynaecomastitia
Pseudogynaecomastitia
Lipoma
Breast cancer
Lipoma – typically iso but can be hyper
Beta decay is
Nucleus has too many neutrons
Nucleus has too many protons
Shell has too many electrons
Emits gamma radiation
Emits X-rays
Nucleus has too many neutrons
Regarding technetium :
Half life of 8 hours is useful
Decay product Mo99 does not confer additional radiation to the patient
Produces energies 50-5000keV
Energy produced is high enough to pass through patient tissue
Produces beta and gamma rays
Energy produced is high enough to pass through patient tissue
ARPKD associations:
Caroli
Congenital hepatitic fibrosis
Von Meyenburg complexes
Congenital hepatitic fibrosis - the best one
VQ :
1 or more filling defects is high risk on PIOPED
Low risk excludes PE
Over 90% of changes resolve over 12 months
Unilateral loss of perfusion is more likely due to bronchial obstructing tumour than massive PE
Unilateral loss of perfusion is more likely due to bronchial obstructing tumour than massive PE
Some dude has CNS symptoms, MRI shows mixed signal cystic structures in bilateral thalami, some rim enhancing, basal meningeal enhancement
TB -
Cryptococcosis
HSV
Toxoplasmosis
Answe: Cryptococcosis
TB - probably not, because T2 dark
Racemose neurocysticercosis: cystic grape like structures in the basal cisterns
25 yo male tourist visiting friends, 2 days cough, fine subtle reticular opacities, right mid zone thin walled cyst, dx most likely
Mycoplasma
TB
PCP
Streptococcus?
Mycoplasma - pneumotocele can occur, walking pneumonia
37 yo woman undergoing IVF with multiple cystic lesions left adnexa, right ovary normal
Normal response
Hyperstimulation
PCOS
Tuboovarian abscess
Cystadenoma
Cystadenoma
Which rules determine ankle imaging in acute staging
Nexus
Ottowa
Montreal
Wisconsin
Gabes Lau
Ottowa
67 yo man in MVA haemodynamically stable but with chest pain. CTA chest shows 2 mm smooth outpouching just beyond the left subclavian artery:
Aortic pseudoaneurysm
Ductus diverticulum
Traumatic dissection
Others?
Ductus diverticulum
Ductus diverticulum: a developmental outpouching of the thoracic aorta, at the anteromedial aspect of the aorta - at the site of the aortic isthmus, where the ligamentum arteriosum attaches
The differential is an aortic pseudoaneurysm, which forms sharp margins with the aorta, the ductus diverticulum usually appears as a smooth focal bulge with gentle obtuse angles with the aortic wall
Young guy twisting injury with proximal fibulae fracture and lateral talar shift
Weber A
Weber B
Weber C
Maisonneuve
Tillaux
Answer:Maisonneuve: combination of a fracture of the proximal fibula with an unstable ankle injury = ligamentous injury and/or fracture of the medial malleolus
Tillaux: Salter Harris III fracture through the anterolateral aspect of the distal tibial epiphysis with variable displacement
- The anterior tibiofibular ligament avulses the anterolateral corner
- vertical fracture through the distal tibial epiphysis, with horizontal extension through the lateral aspect of the physis
- Differential is a triplanar fracture, which will have a metaphyseal fracture in coronal
Young man MVA with fracture anterior and posterolateral maxillary sinus, zygomaticofrontal region, zygomaticotemporal, zygomatic arch
Tripod
Lefort 1
Lefort 2
Lefort 3
Nasoethmoidal fracture
Tripod - does not mention pterygoid, otherwise would be Lefort3
Most likely to cause cyanosis :
PDA
VSD
ASD
Transposition of the great arteries
Patent foramen ovale
Transposition of the great arteries
Cyanotic CHD: the 5Ts
TAPVR
Transposition of the great arteries
Truncus arteriosus
Tetralogy of Fallot
Tricuspid valve abnormalities and hypoplastic right heart syndrome
Ebstein anomaly
Acyanotic CHD:
VSD
ASD
AVSD
PDA
Coarctation
Pulmonary stenosis
Renal transplant :
High RI is specific for rejection
Reversed diastolic flow indicates venous thrombosis
Lymphoceles accumulate radiotracer
Lymphoceles develop in the first few days
Answer: Reversed diastolic flow indicates venous thrombosis – true but not specific
High RI is not specific
A lymphocele may occur from 2 weeks to 6 months after transplantation with a peak incidence at 6 weeks
FSE TSE question which limits scan speed
TE
TR
TI
SAR
Answer: TR – echo train length
SAR – this depends on the strength of the magnet
40 yo with sacral destructive lesion with rings and arcs:
Chordoma
GCT
Chondrosarcoma
Answer: Chondrosarcoma
Chordoma common but no rings and arcs
Long stem about DOPS and shoulder ultrasound, which is best position to have arm for infraspinatus tendon
Internal rotation arm touching opposite shoulder
External rotation arm behind back
Abducted arm
Internal rotation arm touching opposite shoulder
Woman from med onc outpatients with RIF pain, enterocolitis with trilaminar appearance and middle layer 35 HU, most likely
Typhlitis
Crohn disease
Ischaemic
Radiation
Typhlitis
Patient brought to department for investigation over liver lesion. Patient says he’s in hospital for hernia repair and has no liver lesion. On checking it is the correct patient who’s been brought down
Wrong sticker on form
Patient is lying
Trolley bay mix up
CA has brought wrong patient
CT techs got it wrong
Wrong sticker on form
5 yo child with bilateral perihilar streaky opacities, pneumonia, organism
Mycoplasma
Streptococcus
Staphylococcus
Mycoplasma
Down screening which is used in 1st trim
Nasal bone length
Alpha fetoprotein
Twin vs singleton
Parity
Alpha fetoprotein – second trimester, none of the other make sense
1ST TRIMESTER: Combined serum screening
Performed at 9-12 weeks
Better detection rate the earlier its performed
Measures free B-HCG and PAPP-A
2nd TRIMESTER: Maternal serum screening
Performed at 14-20wks, ideally 15-17
Measures Alpha fetoprotein (AFP), free B-HCG, unconjugated oestriol +/- inhibin A
1ST TRIMESTER
Nuchal translucency
The fluid-filled subcutaneous space at the back of the fetal neck
Different to the nuchal fold = seen in the second trimester
Thickening is thought to relate to dilated lymphatic channels, a non-specific sign of generalised abnormality
Associations:
Aneuploidy :
Trisomies
Turner
Non-aneuploidy:
Congenital heart disease
Noonan syndrome
Congenital diaphragmatic hernia
Omphalocele
Skeletal dysplasia
VACTERYL
Miscarriage/fetal demise
Intrauterine infection - Parvovirus B19
<3mm is normal
3.4mm = risk of 7%, >8,5mm has a risk >75%
Correlate with serum markers
Further workup with amniocentesis and or chorionic villus sampling, as well as fetal echo
Technique:
Mid-sagittal plane, nasal bone, tip of nose, hard palate and diencephalon must be seen
Calipers are placed inside the hyperechoic edges
2nd TRIMESTER
Chorionic villus sampling: 11-12 wks
Amniocentesis: 15-18 wks
Foetal hydrops, chest lesion, stomach bubble normal place, see a vessel from below diaphragm in lesion
Sequestration
Congenital diaphragmatic hernia
Congenital adenomatoid malformation
Sequestration
Gastroschisis which is true :
Small defect 2-4 cm
Liver herniated 40-50%
Associated with chromosomal abnormalities
Covered by membrane
Small defect 2-4 cm - tends to be about 4cm, rare to have liver – should never have liver
30 year old male with a lump in soft tissues high signal on T1 weighted imaging without fat suppression
Lipoma
Liposarcoma
Haemangioma
Lipoma - High T1, if no fat sat…if says High T1 post FS, then think liposarcoma.
Long winded question about comparing US vs MRI for assessing haemangioma of liver, if TP=a, FP=b, TN=c, FN=d, how to calculate prevalence in their study population (I’m only sure on the last opDon, not sure if the other 4 are accurate)
a/b+d
a/a+c
b/a+c
b/c+d
a+d/a+b+c+d
a+d/a+b+c+d - prevalence is the number of cases / everyone in the population
True about PCP
Affects upper lobes more than lower
Commonly associated with pleural effusion
Often coexists with CMV
Often coexists with CMV - Cytomegalovirus (CMV) pneumonia is a complication presented by these patients when they are in a state of severe immunosuppression.
Patient during angiogram feels unwell with HR 50, BP 80/50
IV atropine 0.6 mL (dose?)
IM adrenaline 0.5 mL
IV adrenaline 1 mL (dose?)
Hydrocortisone?
Antihistamine?
IV atropine 0.6 mL (dose?)
Anaphylactic reaction 3 minutes after scan
IM adrenaline
IV adrenaline
Hydrocortisone
Antihistamine
Pretend you didn’t hear the code (I made this one up)
IM adrenaline
You find 1 cm nodule on routine preoperative X-ray in patient awaiting suspicious for cancer, what do you do (something about according to college guidelines)
Call referrer
Make sure secretary faxes report to GP
Fax report to GP and cardiothoracic surgeon
Tell referrer to read your report
Close the study and let someone else sort it out (I made this one up)
Call referrer
Most often proposed mechanism for NSF :
Free gadolinium gets into tissues and incites fibrotic response
Free Gd chelate gets into soft issues
Albumin bound Gd gets into issues
Some other combinations of chelated and otherwise bound Gd
Free gadolinium gets into tissues and incites fibrotic response
Nephrogenic systemic fibrosis
Occurs almost exclusively in patients with renal impairment + gad based contrast agents
May be due to transmetallation - the replacement of the gadolinium from the chelate and forming a free gadolinium ion, free gadolinium ions may then deposit in different tissues and result in inflammation and fibrosis
50 yo non smoker with 7 mm nodule
Do nothing
Follow up in 12 months and stop if unchanged
Follow up in 3-6, 9-12 and 24 months
Follow up in 6-12 months, then 18-24 months if no change
Further work up with other imaging
Follow up in 6-12 months, then 18-24 months if no change
Post menopause woman with 7.6 cm simple ovarian cyst
Refer to gynaecologist
Follow up in 6 weeks
Ultrasound guided aspiration
Do nothing
Follow up in 1 year?
Follow up in 1 year?
Post menopausal
3 - 5cm, F/U in 3-6mo for resolution
>5cm: F/U in 3 - 6mo for resolution/recharacterise or in 6-12 mo for growth assessment
Young woman 2.4 cm cystic ovarian lesion
Do nothing this is normal
Follow up in 1 year
Follow up in 6 weeks
Aspiration
Do nothing this is normal
Tubular breast cancer
Typically has 5 y survival of 70%
Is associated with further lesion in same or other breast in <5%
Can be essentially unchanged over several years
Can be essentially unchanged over several years
Most likely spiculated lesion
Fibroadenoma
Papillary neoplasm
Mucinous
Medullary
Tubular
Tubular
Spiculated lesion :
Sclerosing adenosis
Post surgical scar
Radial scar
Fat necrosis
IDC, DCIS
ILC
Tubular carcinoma
Bilateral renal ostial stenosis
Takayasu
PAN
FMD
NF-1
NF-1 - Renal artery stenosis in NF1 is usually ostial in location,
The most common vascular abnormality in patients with NF1 is bilateral or unilateral renal artery stenosis
FMD in comparison: 95% of all stenoses are found in the distal 2/3rds of the renal artery, more than 50% of all NF1 stenoses are located in the ostia
Renal nuclear medicine scans
DTPA has 100% glomerular filtration
MAG3 good for pseudotumour
MAG3 good for calculating GFR
Renal scan has blood pool, parenchymal and excretory phases
DTPA has 100% glomerular filtration
Phaeochromocytoma imaging
MIBG can tell benign from malignant
Octreotide can tell benign from malignant
PET can tell benign from malignant
Pheo does not drop signal on out of phase
Pheo does not drop signal on out of phase – Markedly hyperintense on T2 (light bulb
PHEO MRI
T1: slightly hypo to the remaining adrenal
More heterogenous if necrotic/haemorrhagic
T2: markedly hyperintense (light-bulb sign) ~1/3 will not have this
Necrosis and haemorrhage will alter the signal
In-phase/out of phase: no signal loss. Pheos do not contain a large amount of intracellular lipid
Heterogenous enhancement - prolonged, often up to 50min
Which determines cardiac artery dominance
Posterior descending artery
SA node supply?
AV node supply?
Posterior descending artery
Suspect implant rupture, best initial investigation
Mammography
US
MRI
CT?
Clinical exam?
US
Most recurrent breast cancers after treatment detected by
Patient self-examination
Surgeon
Mammography
Ultrasound
Patient self-examination
Young girl (21 perhaps) with long history of headache, with cystic frontal lobe lesion containing a calcified mural nodule
Ganglioglioma
Pilocytic astrocytoma
Oligodendroglioma
Ganglioglioma - common in younfer patients
GANGLIOGLIOMA
A partially cystic mass with an enhancing mural nodule is seen in ~45% of cases
Frequently calcified
65 yo woman with arm symptoms (?). MRI spine shows a 6.5 mm intramedullary lesion at the C6 level, slightly to the left, and a further 5 mm lesion at T6, in the central cord. Both enhance after gadolinium:
Astrocytoma
Ependymoma
Haemangioblastoma?
Metastases
Metastases
Cystic lesion deep to parotid extending to parapharyngeal space
1st brachial cleft cyst
2nd branchial cleft cyst
3rd branchial cleft cyst
Lymphangioma
1st brachial cleft cyst
Harlequin eye. Which fusion likely?
Metopic
Coronal
Sagittal
Mendosal
Lambdoid
Coronal
65 yo man with mass centred on cribriform plate, growing/invading into anterior cranial fossa and upper nasal cavity (?). Dx?
Esthesioneuroblastoma
Lymphoma
Esthesioneuroblastoma - bimodal (10-20, 50-60)
15 yo girl with right sided abdominal pain. Mildly to moderately tender right iliac fossa. Ultrasound shows enlarged mesenteric lymph nodes. Appendix not seen. What is true of intussusception :
12 hour duration is contraindication to pneumatic reduction
X-rays usually demonstrate no abnormality
Viral gastroenteritis is a recognized risk factor
Small bowel obstruction is a contraindication to pneumatic reduction
Viral gastroenteritis is a recognized risk factor
Performed in paediatric patients with an ileocolic intussusception
A catheter is inserted into the rectum, and under fluoroscopic guidance air is instilled into the large bowel
IV access, staff and equipment for fluid resuscitation with the back up of a paediatric surgeon
Pressure 60-100mmHg are used: 3 attempts lasting 3 minutes
Success is achieved which reduction of the mass and air refluxes into the terminal ileum
Contraindications:
Signs of peritonitis
Perforation
Complications:
Less likely to be successful if:
Associated SBO
Over 24hrs of symptoms
lethargy
Best way to tell infection from Charcot joint :
Effusion with thin rim of enhancement
Sinus tract to bone
Sinus tract to bone
CHARCOT JOINT
Density change (subchondral osteopenia or sclerosis)
Destruction (osseous fragmentation and resorption)
Debris (intra-articular loose bodies)
Distension (joint effusion)
Disorganisation
Dislocation (joint mal-alignment due to ligamentous laxity
Patient with past history of metastatic breast cancer. Constant shoulder pain. Normal x-ray. Best test
Ultrasound
CT
MRI
NM bone scan
?
MRI
14 yo fat kid has a sore knee. Third presentation, previously x-rays of knee normal. For repeat knee xray. What would you do?
AP and lateral knee x-ray
AP and lateral hip x-ray
AP and lateral hip x-ray ? SCFE
Regarding non-accidental injury
Bone scan will become positive after x-ray changes are visible
Anterior rib fractures are more common than posterior
Long bone spiral fractures are typical
Metaphyseal corner fractures associated with twisting injuries
Long bone spiral fractures are typical? if non ambulatory very sus….
Patient from rheumatology clinic with infraspinatus wasting. Most likely
Ganglion cyst at suprascapular (?) notch
Ganglion cyst at spinoglenoid notch
Ganglion cyst at spinoglenoid notch
Traumatic knee dislocation:
Common peroneal nerve is more commonly injured than Tibial nerve
DSA is necessary in all patients to rule out vascular injury
Can occur without fractures
Patellar tendon is always completely torn
Answer: Common peroneal nerve is more commonly injured than Tibial nerve
Can occur without fractures
Child with previous history of meningococcal meningitis, now with unilateral sensorineural hearing loss
Otosclerosis
Some other kind of otosclerosis
Labyrinthitis ossificans
Labyrinthitis ossificans
Thyroid nuclear medicine imaging :
De Quervain shows low uptake initially
High uptake in factitious thyroiditis
Low uptake in TSH driven thyroidititis
Toxic nodule demonstrates increased uptake of surrounding thyroid tissue
Answer: De Quervain shows low uptake initially - The initial thyrotoxic phase is associated with thyroid pain, high serum thyroid hormone levels with a low radioiodine uptake.
High uptake in factitious thyroiditis – Will be low
Low uptake in TSH driven thyroidititis – No it is high
Toxic nodule demonstrates increased uptake of surrounding thyroid tissue
Nigerian man with bladder calcifications and a soft Tissue mass. Most likely?
SCC
TCC
Adenocarcinoma
SCC
Best sequence for assessing bladder cancer invasion
T1
T2
PET/CT
CECT
US
T2 - this is best, T1 rubbish in pelvis ex for l/nodes!
55 year old male with basal ganglia haemorrhage.
Hypertension
Amyloid angiopathy
Underlying lesion
Hypertension
Young female with positive beta-HCG. Has pain and ultrasound shows a 5cm heterogeneous mass in the adnexa. Trace fluid in the pelvis
Haemorrhagic corpus luteal cyst
Ruptured ectopic pregnancy
Unruptured ectopic pregnancy
Normal corpus luteum
Haemorrhagic cyst
Unruptured ectopic pregnancy
Biopsy proven radial scar, next step
a. WLE + SLNBx
b. Hook wire + Open biopsy
c. Nothing
d. Follow-up imaging
b. Hook wire + Open biopsy
Considered a high-risk breast lesion. Core and FNA underestimate the underlying associated malignancy and are controversial > the lesion is biopsied and removed
PASH benignity?
a. Always benign
Pseudoangiomatous stromal hyperplasia. Benign stromal proliferation
likely hormonal driven as only seen in premenopausal women or post-menopausal
women on HRT.
Proliferation of myofibroblasts and stromal elements.
Can mimic a mass.
Lobular ca
Only visible on one view –
Not visible on US -
Answer: Only visible on one view –
most commonly seen as a spiculated mass on mammography (50-68%) but other findings include occult mass, only-visible-on-one view focal density (3-19%) or architectural distortion (20%). ILC represents 10-15% of breast carcinomas. Sensitivity on mammography is 71%.
Not visible on US - Usually a mass lesion with irregular borders and acoustic shadowing 60%. Sensitivity is 88%. (MRI 93%).
Some breast lesion complicated by some other lesion due to radiotherapy, what do to
Total mastectomy
Cut out the lesion
Answer: Total mastectomy – If suspect angiosarcoma -> core -> mastectomy
Secondary angiosarcoma, related to prior therapy of breast cancer, has an estimated incidence of ~0.09-0.16% and occurs in older women (peak age 6th decade).
Can be occur on mammography
Surgical excision with wide margin is the standard of care, typically a mastectomy.
Patient presents to breast screen with symptoms, which is most concerning?
Bilateral nipple retraction
Cyclical pain
Focal pain
Serous nipple discharge
Milky nipple discharge
ANSWER: Serous nipple discharge - Likely a DCIS esp unilateral
Bilateral nipple retraction – can be pre-existing
Cyclical pain - Pain less concerning, especially cyclical
Focal pain - Less concerning
Milky nipple discharge Normal during pregnancy
Tubular breast cancer most true
Can be stable on imaging over years
Comprised of >90% well-formed tubules.
70% 10 yr survival
ANSWER: Can be stable on imaging over years - slow growing with low metastatic potential.
70% 10 yr survival : False higher survival rates (95-98% at 5 years)
Obese lady, cant get pregnant what will you find
10 (!) cysts, small
Bilateral mixed echoic lesions
Hydrosalpynx
ANSWER: Bilateral mixed echoic lesions (chose that for endometrioma, but might be wrong)
The most common overall cause of female infertility is the failure to ovulate, which occurs in 40% of women with infertility issues. Not ovulating can result from several causes, such as: Ovarian or gynecological conditions, such as primary ovarian insufficiency (POI) or polycystic ovary syndrome (PCOS)
Rotterdam criteria, what is not included?
Cysts individually >10mm
> 12 cysts
Hyperandrogenism
Anovulation
Peripherally distributed cysts
ANSWER: Cysts individually >10mm – they are small cysts
> 12 cysts - True then however no longer true
Hyperandrogenism - True
Anovulation - True
Peripherally distributed cysts - True
The diagnosis of PCOS generally requires any two of the following three criteria for the diagnosis, as well as the exclusion of other aetiologies (e.g. congenital adrenal hyperplasia, Cushing syndrome, and/or an androgen-secreting tumour):
- ovulatory dysfunction (oligo- or anovulation)
- clinical and/or biochemical hyperandrogenism
- polycystic ovarian morphology on ultrasound
Features include:
increased follicle number per ovary (FNPO) - usually 20 or greater
individual follicles are generally similar in size and measure 2-9 mm in diameter
peripheral distribution of follicles; this can give a “string of pearls” appearance
background ovarian enlargement (volume greater than 10 mL)
central stromal brightness +/- prominence
Antenatal scan at 7 weeks gives gestational age of 35 weeks. Scan at second trimester gives gestational age of 33 weeks. Foetus currently measuring 32 weeks. Most correct:
Use 7 week scan, foetus small for gestational age
Use 2nd trimester scan, foetus is within normal size limit
Use 2nd trimester scan, foetus is small for dates
Use 7 week scan, foetus small for gestational age
Middle aged woman with 1.5cm echogenic renal lesion on ultrasound. On MR lesion is T1 and T2 intense with no enhancement. MOST LIKELY
Haemorrhagic cyst
Proteinaceous cyst
Angiomyolipoma
Renal cell carcinoma
ANSWER: Proteinaceous cyst
Haemorrhagic cyst - Should have a fluid-fluid level.
Angiomyolipoma - Heterogenous on T1 and T2 imaging due to variable amounts of fat and muscle. Variable enhancement, usually hypoenhancing relative to renal parenchyma.
Renal cell carcinoma – unlikely to have no enhancement
HSV encephalitis
HSV 1 most common in adults
Haemorrhagic necrosis common
HSV 1 most common in kids less than 10
ANSWER: HSV 1 most common in kids less than 10 True - Neonatal HSV is HSV-2 but childhood is usually HSV-1.
HSV 1 most common in adults True
Haemorrhagic necrosis common True
NF1, false
Lisch nodules
Meningioma
Neurofibroma
Freckles
Meningioma - False
15 yo with seizure. Hypodense cortical lesion. Cystic
ANSWER: DNET Multicystic
WHO grade 1, sharply demarcated and often points towards the ventricle, temporal lobe most common.
30% demonstrates focal or ring enhancement.
Very T2 bright.
Teenager with cystic lesion under chin with multiple hypodense nodules (repeat)
ANSWER: Dermoid (ranula just fluid, won’t have fat)
- Patient with hyperthyroidism, next step
Tc99 Pertechnetate
MRI
US
CT with contrast
I131 diagnostic test
Tc99 Pertechnetate
Pancreatic lesion. Hepatic lesions: one heterogenous, one hyperdense, one hypodense, which one biopsy? (repeat)
ANSWER: Heterogenous hepatic lesion
Pancreatic lesion with multiple cysts (more than 6), measures 4 cm. Location not mentioned. Age not mentioned. Most likely?
IPMN
SPEN
MCN
SCN
ANSWER: SCN
IPMN Possible but less likely
SPEN Usually more solid/cystic with haemorrhagic component
MCN Multiloculated but usually large (up to 12cm)
Gallbladder ca least likely :
Generalised thickening
Old person with otherwise normal
ANSWER: Old person with otherwise normal
Virtually all have gallstones
20% polypoid mass
Mass replacing gallbladder invading liver 2/3
Irregular focal or diffuse GB wall thickening 20%
Calcified gallstones or porcelain gallbladder
Elderly females
Usually asymptomatic – often an incidental finding or found due to disseminated metastatic disease
Very poor survival rates, 4% 5 year survival
DDx:
Xanthogranulomatous cholecystits
Adenomyomatosis
Chronic cholecystitis
Chest lesions after trauma
Splenosis - can occur in the thorax if there is diaphragmatic injury
Associations, true
This strange worm with duodenal obstruction
Strongyloidiasis produces duodenal dilatation and wall thickening
ANSWER: This strange worm with duodenal obstruction - Ascaris Lumbricoides known for causing biliary tract and small bowel dilatation, can also cause hepatic abscesses and ascaris pneumonitis
Ascaris Lumbricoides
Large round worm – can block the bowel
Severe cases such as hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), can involve pulmonary manifestations.
Spectrum of changes that can involve the lung include
pulmonary infiltrates with eosinophilia
asthma without infiltrates
haemoptysis: from alveolar haemorrhage
hyperinfection syndrome
acute respiratory distress syndrome
lung abscess formation
interstitial infiltrates/fibrosis
cavitary lesions
Todani classification, dilation of intra-duodenal bile duct?
1
2
3
4
5
3
1: Fusiform dilatation of the extrahepatic bile duct
A - entire duct
B - focal segment
C - common bile duct
2: Bile duct diverticulum - saccular outpouching arising from the supraduodenal extrahepatic bile duct or the intrahepatic bile ducts
3: Choledochocele - protrusion of a focally dilated, intramural segment of the distal common bile duct into the duodenum
4: Intra and extra-hepatic duct cysts
4a - Fusiform dilatation of the entire extrahepatic duct with dilataion of the intrahepatic bile ducts
4b - multiple cystic dilations involving only the extrahepatic bile duct
5: Caroli disease, cystic dilation of the intrahepatic ducts
Young Asian girl, right iliac fossa pain, on US see pouch like structure arising from anterior caecal wall, with highly echogenic structure within, most likely
Appendicitis
Crohns
Caecal Diverticulitis
Mesenteric adenitis enlarged lymph nodes
Appendicitis
Old guy, CT abdomen shows fusiform AAA with thick wall, raised ESR, most likely
Inflammatory aortitis
Mycotic aneurysm
ANSWER: Inflammatory aortitis
Mycotic typically a saccular aneurysm, 75% due to salmonella . 95% are AVSD – usually fusiform
Inflammatory aneurysm – patients typically around 10 years younger (50s), risk of rupture is less, they are symptomatic before rupture with back pain, 90% have an elevated ESR, inflammatory change centred on the adventitial with infiltrate of inflammatory cells including lymphocytes, macrophages and plasma cells and fibrosis. Often relative sparing of the posterior wall of the aorta. Can be isolated and may be autoimmune, or part of IgG-4 disease with renal hydronephrosis.
Multiple hyperdense nodules in lung most likely?
Renal osteodystrophy
Sarcoid
Mets
ANSWER: Renal osteodystrophy Could be metastatic calcification
Sarcoid Less likely. Lymph nodes – 20% calcify. Lung nodules less frequent
Mets Could be
Sarcoid least likely
Lower lobes affected
Upper lobes affected
Some other stuff???
ANSWER: Lower lobes affected
TB T/F
Calcified apical
Ghon focus
Miliary lung lesions
ALL TRUE
Elderly male CTA post AAA stent. Mildly hyperdense leak thought to be due to graft porosity
Endoleak, which one?
1
2
3
4
5
ANSWER: 4
A common complication of EVAR, found in 30-40% intra-operatively, and 20-40% post operatively
Several causes:
1 - leak at graft attachment site
1A - proximal
1B - distal
1C - iliac occluder
2 - aneurysm sac filling via branch vessels
2A - single vessel
2B - two vessels or more
3 - leak through defect in the graft
3A - junctional separation of the modular components
3B - fracture or holes involving the endograft
4 - leak through graft fabric as a result of graft porosity, often intraoperative and resolves with cessation of anticoagulants
5 - continued expansion of aneurysm sac without demonstrable leak on imaging
Regarding berry aneurysms, not true?
Most are anterior
Complication due to vasospasm in first 24 hours
ANSWER: Complication due to vasospasm in first 24 hours False 4-14 days post SAH, peaking at 7 days typically
Newborn (sex not provided), brother DDH, best management (rep)
US in 6 weeks
Xray in 2 month
ANSWER: US SIX WEEKS
Newborn, no meconium, ileum meconium filled. Microcolon. Most likely
Meconium ileus
Meconium plug syndrome
Hirschprungs
Ileal atresia
ANSWER Meconium ileus
Indicative of cystic fibrosis
Newborn with lung lesion and feeding vessel
Sequestration
CPAM
CDH
ANSWER: Sequestration Depends where vessel coming from – sequestration is systemic arterial supply and variable venous drainage (systemic extralobar and pulmonary intralobar)
T21 associated with
Hirschprungs
Others include:
- 40% congenital heart disease – ASD (ostium primum), VSD, endocardial cushion defect
- Oesophageal atresia
- Duodenal atresia
- Imperforate anus
- 10-20x increased risk of childhood acute leukemia (both ALL and AML)
- Early onset Alzheimers disease
- Autoimmune disease and infections
- Umbilical hernias
- Hearing loss (conductive, middle ear infections)
- Atlanto-axial instability
- Moya moya disease
Kid with posterior fossa tumour extending through the 4th ventricle foramina
Hemangioblastoma
Medulloblastoma
Pilocytic astrocytoma
Ependymoma
ANSWER Ependymoma
6 months old with eventration of the right hemidiaphragm. Previous cxr normal. Cause?
Mixed CPAM / sequestration
CPAM
Lobar emphysema
Bronchial atresia
ANSWER: None of the above
T/F: Neuroblastoma can spontaneously resolve even if metastasised.
ANSWERTrue – neuroblastoma, ganglioneuroblastoma and ganglioneuroma can demonstrate spontaneous or therapy induced differentiation into mature neural elements, regression and a wide range of clinical behaviour and aggressiveness.
T2 signal in anterior aspect of medial tibia and femur of the medial condyle. ? mechanism
Hyperextension and varus
Hyperextension and valgus
Flexion and varus
Flexion and valgus
Pivot shift ACL
ANSWER: Hyperextension and varus
Flexion and valgus – This is ACL mechanism. Kissing contusion is posterolateral tibial plateau and lateral femoral condyle
Pivot shift ACL – a valgus load applied to a flexed knee with a variable degree of internal rotation of the femur
Unicameral bone cyst involves :
Epiphyseal location
Metaphyseal intramedullary
Are more common in the femur than the humeru
Usually contain fluid fluid level on MRI
ANSWER: Metaphyseal intramedullary – usually central, metaphyseal and medullary
Epiphyseal location - False
Are more common in the femur than the humerus False. Humerus is the most common location.
Usually contain fluid fluid level on MRI – only if there has been a fracture
Unicameral bone cyst, which is most correct: (TW) 2005, 2006
Are more common in the femur than the humerus
Involve the epiphysis in about 30% of cases
Contain fluid fluid levels on MRI in greater than 50% of cases
Arise eccentrically in the metaphysis
Migrate into the diaphysis with time
Arise in the metaphysis
Fallen fragment sign may be seen in half of cases
ANSWER: Arise in the metaphysis True
Migrate into the diaphysis with time True – grows with the child, does not cross the physeal Plate
Are more common in the femur than the humerus False – humerus most common location (although calcaneus is the most common in adults)
Involve the epiphysis in about 30% of cases False
Contain fluid fluid levels on MRI in greater than 50% of cases False – this is seen in SBC with a pathologic fracture
Arise eccentrically in the metaphysis False – central lesion
Fallen fragment sign may be seen in half of cases False
Best test for check of infected prosthesis (repeat)
MRI
White cell scan
White cell scan
Otherwise healthy man with sudden back pain during gardening. What to do next?
No imaging for 6 weeks
MRI
Xray - the other option
CT lumbar spine
No imaging for 6 weeks – if no red flags present otherwise do an x-ray
Young female runner, hip pain for several months, impacting on her professional running. Improves with rest. MR shows high signal in region of anterior femoral neck which tracks toward lesser trochanter, most likely?
Snapping gluteus maximus
Trochanteric bursitis
Tear at iliopsoas
ANSWER: Tear at iliopsoas
Snapping gluteus maximus – happens externally over greater trochanter
Trochanteric bursitis - Unlikely to cause bone marrow oedema. Does improve with rest.
Avascular necrosis, which one is not a cause?
Thalassemia Major
Sickle cell anaemia
Caisson
Gaucher
Subcapital femoral fracture
ANSWER: Thalassemia Major
Aetiology
Traumatic - usually unilateral
Chronic corticosteroid therapy
Alcoholism
Smoking
Systemic lupus erythematosus (SLE)
Hyperlipidaemia
HIV
Haemoglobinopathies
Chronic renal failure
Diabetes Mellitus
Pregnancy-related
Define Prevalence a true positive b true negative, c false positive, d false negative, n total population
a / a+b
b / a+c
a + d / n
a +c / n
ANSWER: a + d / n
number of cases (true positive+false negative)/total population)
You want to MR with contrast on a patient with egfr 29, what to do
Macrocyclic gadolinium
Linear gadolinium
Do not give contrast
ANSWER: Macrocyclic gadolinium (true) true – cyclic contrast agents reduce risk
Linear gadolinium false – linear agents are less stable and increase risk to dialysis immediate after
Can be considered hemodialysis reduces amount of gad by 75% but no proof it reduces chance of NSF
Do not give contrast False – risk of NSF is sGll low at <0.1% per dose
You do a lung biopsy, as you withdraw stylet patient coughs and has a seizure ? cause
Air embolus
Anaphylaxis
Air embolus
IV contrast anaphylaxis post CT, what to give?
IM adrenaline 1:1000, 0.5ml
IV adrenaline 1:1000, 0.5ml
Chlorprometazine
Other drugs
IM adrenaline 1:1000, 0.5ml
Access for permacath type of tunnelled CVL
Right IJV
Leo IJV
Right suclavian
Leo subclavian
Right IJV
Man with suspected pancreatic cancer is coming for an image guided biopsy. He is a type 2 diabetic on metformin and also on clopidogrel and clexane. Normal renal function. What advice do you give prior to biopsy.
Stop clopidogrel 10 days? prior, clexane 12 hours prior.
Stop clopidogrel 12 hours prior and clexane 10 days prior
Stop metformin 48hrs prior and clopidogrel 10 days prior?
Stop metformin 24hrs prior
Stop metformin 48 hrs prior and clexane 12 hrours prior?
ANSWER Stop clopidogrel 10 days? prior, clexane 12 hours prior. Answer (although usually only need to stop clopidogrel for 5 days)
Mag 3 scan for renal function, what do you explain to the patient (repeat)
Injection, immediate imaging for 30 minutes
Injection, immediate imaging for 3 hours
Injection, scan after 24 hours
Injection scan after 48 hours
Injection, immediate imaging for 30 minutes True
Young chap with cough and fever, what would the VQ scan look like
Multiple matched defects
Multiple mismatched defects
Intact perfusion, decreased ventilation
ANSWER: Multiple matched defects - seen in Pneumonia
35 yo male lesion inferior to lesser trochanter peripheral cal, centrally hypodense, faint curvilinear calcs, femoral cortex intact:
Osteosarc -
Periosteal chondroma
Osteochondroma
(? myositis ossificans)
ANSWER: (? myositis ossificans)
Osteosarc - unlikely
Periosteal chondroma – saucerisation : possible
Osteochondroma - also unlikely
Acute onset confusion in 65 yo female, inferior mesial temporal lobe with DWI restriction and T2 high signal:
MCA stroke
HSV
paraneoplastic syndrome
CADASIL
ANSWER: HSV: only if it spares the basal ganglia
Young guy with grey white matter differentiation, partying, thunderclap headache, LP had nothing, CT had grey white matter loss in frontal lobe:
Cerebral venous thrombosis
RCVS
Berry aneurysm
ANSWER: RCVS - thunderclap headache makes this possible, but CVT also possible
Stented left ICA, bilateral frontal infarcts repeat:
Azygos vessel A1
Kid with seizures, T2 high signal, bubbly:
DNET
35 yo repeated seizures, T2 high signal mesial temporal lobe, assoc:
Ipsilateral fornix atrophy
contra fornix atrophy
mamillary body hypertophy
choroidal atrophy
Ipsilateral fornix atrophy
Tectal beaking is assoc with what:
Chiari 2
Chiari 1
DWM
Agenesis of CC
Holoprosencephaly
Chiari 2
5 yo girl with midline 4th ventricle tumour extending through foramina with some calc:
Ependymoma
JPA
Medullo
Ependymoma ( calc 30-40%)
Most likely tumour arising from septum pellucidum in lateral ventricle in 40 yr old:
Central neuryoctyoma
Meningioma
metastasis
Choroid plexus lesion
Central neuryoctyoma
Most likely tumour arising from septum pellucidum in lateral ventricle in 40 yr old:
Central neuryoctyoma
Meningioma
metastasis
Choroid plexus lesion
Central neurocytoma
5 yr old with lump mixed echos
dermoid
Ranula
4th BCC
Lymphangioma
dermoid if its this repeat one
Location of a lymph node between hyoid and base of skull anterior to post SCM
2a
Young guy with SOB, CL nodules and GG change non-smoker:
Sarcoid
HP
OP
DIP
NSIP
HP
What’s the appearance on VQ in pneumonia:
recall, reverse mismatch, matched multiple perfusion, large, etc
multiple matched perfusion
V/Q: Results -
Ventilation Scan is abnormal but perfusion scan is normal indicating abnormal airway suggesting COPD or ASTHMA.
Ventilation Scan is normal but perfusion is abnormal indicating any obstruction to the blood flow (perfusion), may be because of the PULMONARY EMBOLISM obstructing the flow.
Both scans are abnormal. It may be found in PNEUMONIA or COPD.
24 yo female marathon runner VQ scan low probability and CXR normal:
No further imaging
CTPA,
VQ in 1 wk,
Do US bilateral legs
no further
Young fit guy with back pain while gardening, afebrile, otherwise well:
Do nothing
MRI
XR
CT
do onthign
Soft hard q about 1.5T vs 3T:
More susceptibility weighted artefact,
Dropout on out of phase on 3t is higher,
300 Gauss is further from the bore,
Fluid higher on T1 GRE than grey maber on 3T
300 Gauss is further from the bore,
Mid ileal dilation and 5cm strIcturing distally:
Crohns
Carcinoid,
Coeliac,
Scleroderma,
Lupus
Crohns
Lesion in ileum with desmoplastic reaction:
Carcinoid,
Adenocarcinoma,
Carcinoid,
Repeat: re barium study:
Increase jejunal folds in coeliac
Whipples has thickened nodular folds
Haematogeneous mets occur at mesenteric border
ANSWER: Whipples has thickened nodular folds
Increase jejunal folds in coeliac, F (jejunal smooth, ileum folded)
Haematogeneous mets occur at mesenteric border -F
Intraduodenal cyst continuous with CBD:
I,
II,
III
IV,
V
3
Which is more common in UC vs CD:
Pseudopolyps
Episcleritis,
Nephrophthisis,
Pseudopolyps
Least common with Ank spond:
MTP involvement
Uveitits
MTP involvement
Prevalence calculation a= TP b=FP, c= TN, d = FN, N = total number:
a+b/N,
a+d/N
b+c/N, c+d/d, etc
a+d/N
Thickening of gastric rugal folds with preservation - recall:
MALToma –
gastric adenocarcinoma intestinal type,
gastric adeno ca infiltrating (linitis plastica),
GIST
MALToma –
Rpt about pancreatic ca:
> 90% can detect unresectale on CT
Vascular and perineural invasion,
Most commonly in the head - 70%
body and tail are spared
ANSWER >90% can detect unresectale on CT
OR Most commonly in the head - 70%
Porosity leak in aortic graft. what is the most common endoleak (very sneaky quesGon)
Type I,
II
III,
IV,
V
4
Repeat about guy with MEN and diffuse dense pulmonary nodules with uptake on bone scan:
Metastatic pulmonary calcification, -
Sarcoid,
Aleveolar microlithiasis,
Other
Metastatic pulmonary calcification, -
Knee injury, contusions on anterior medial femur and medial tibia:
Valgus with extension,
Varus with ext
Valgus with lfexion,
Varus with flexion,
Pivot shio
Varus with ext
CT cystogram with contrast in perineum and extraperitoneal space, most likely injury to:
Bladder base,
Bladder dome,
prostatic urethra,
bulbous,
Membranous
Membranous
- if perineum + extra peritoneal = membranous
Rpt about diffusely thickened and irregular uterus:
Adenomyosis,
Fibroids,
some others
Fibroids,
Guy with previous rheumatic fever, presents with heart failure, fever, meningeal symptoms, what is most likely:
Ring enhancing cerebral lesions,
Leptomeningeal enhancement, ??
Ring enhancing cerebral lesions,
Lady with sudden onset headache, diplopia, ct shows nodular thickening of lateral rectus with no enhancement:
Spontaneous lateral rectus haematoma,
Inflammatory pseudotumour,
Sarcoid,
Thyroid ophthalmopathy
Spontaneous lateral rectus haematoma,
Lady with medial canthus thickening and pain, CT shows ring enhancing hypodense lesion in medial canthus:
Dacrocystocele –
Inflammatory pseudotumour,
Thyroid?
Dacrocystocele
High T3, high T4, low TSH, next test?
US .
NM- pertecnetate study
MRI,
CT
NM- pertecnetate study. Patient has Graves
Inflammatory pseudotumour involves all except? rpt:
Brain
Cavernous sinus,
Lacrimal gland,
Orbital apex,
Orbital muscles (
Brain
What is the most common tumour of the distal small bowel?
Carcinoid
Subperiosteal resorption on radial side of fingers, other HPTH things, most likely:
Osteopetrosis,
Pyknodysostosis,
Renal osteodystrophy
Renal osteodystrophy
Rpt most true about cholesteatoma:
Small most commonly in prussak space
Scutum of erosion should think of different pathology
Small most commonly in prussak space
Rpt: guy with headache, expansion of petrous apex, high T1 and T2 lesion:
Cholesterol granuloma
Metastasis,
Chondrosarcoma,
Petrous apicitits,
High jugular bulb
Cholesterol granuloma
Rpt about spine least likely:
one of the answers was about limbus vertebra being anterosuperior, - typically
chance fracture always assoc with neurology
flexion injury with ventral cord injury
chance fracture always assoc with neurology
Kid with no passed meconium, contrast enema shows microcolon with filing defects in ileum and asC colon:
meconium plug - “syndrome”
meconium ileus
hirschsprungs, ileal atresia
meconium ileus – Ans, commonly in TI, CF
Expected AXR findings in NEC:
various answers to do with bowel wall thickening,
Intramural gas
Intramural gas
Immigrant 5 yr old with lucent lung, which is true to identify abnormal lung:
Increased vasc = normal side ( in swyer james)
Enlarged PA = abnormal side,
Change on exp = abnormal side,
If lung herniates to one side that side is abnoral,
If lucent side is on side of caridac apex, that is abnormal
Increased vasc = normal side ( in swyer james)
Which is not a part of PCOS:
> 12 follicles (now 20),
Follicle > 10mm size
Peripheral distribution of follicles,
Hyperandrogenism,
Anovulation
Follicle > 10mm size
25 yo girl unable to get pregnant (rpt) what is most likely on tVUS:
varieties of anechoic cysts on one or both ovaries, and >10 follicles on both ovaries
Cant remember stem, might be part of 2qs:
OA involves medial and lateral equally
CPPD preferentially involves PFJ
Early articular cartilage degeneration in ?CPPD, involves both sides of joint
CPPD preferentially involves PFJ
35 yo guy with pain in elbow while lifting weight, has bruising and limited elbow flexion:
Biceps tendon musculotendinous junction tear,
Biceps tendon insertion tear
Brachialis tear,
CFO/CEO tear?
Biceps tendon musculotendinous junction tear,
Kid with ulnar coronoid fracture, radial head fracture, elbow dislocation, what is most likely injured:
RCL ,
CEO,
Lat ulnar collatera
Lat ulnar collateral (unhappy triad)
Atypical ductal hyperplasia, had breast MR which was normal, what to do next:
back to normal screening,
6 months and yearly screening,
mastectomy,
some type of excision biopsy after localisation - hook wire and something
some type of excision biopsy after localisation - hook wire and something
Trauma, guy has haematuria, no perinephric collection but there is reduced attenuation of kidney, next step:
Cath angiogram
Thrombolysis,
repeat CT tomorrow,
some other treatment
Cath angiogram - CT angiogram if an option
Not spiculated:
Tubular,
Medullary
ILC,
??IDC
Medullary
Someone with AML, most likely assoc?
LAM
Cutaneous angioma,
Ependymoma,
Phaeochromaocytoma (may be path)
LAM
Regarding AVN (RPT):
MRI picks up changes earlier than Tc99m,
Early xr change is subchondral lucency,
Early cartilage loss, most get degen on both sides of joint
MRI picks up changes earlier than Tc99m
RPT true re parathyroid:
T2 best at finding parathyroid adenoma,
Most common ectopic parathyorid is superior to thyroid,
T2 best at finding parathyroid adenoma,
RPT UBC is most commonly:
Intramedullary metaphyseal,
Epiphyseal,
some others
Intramedullary metaphyseal,
Most common cause of pseudomyxoma peritonei
Appendiceal mucocele
Appendiceal mucinous cystadenocarcinoma
Mucinous ovarian tumour
Appendiceal mucinous cystadenocarcinoma
Least associated with NEC
Premature
Initiation of enteral feeding
Intramural gas descending and sigmoid
Intramural gas descending and sigmoid
Ischaemic bowel, most specific finding
Bowel dilation
Intramural gas
Fixed small bowel
Intramural gas
6 months old – posterior and medial bowing of tibia and fibula
NF
Physiological (peak 6-12 mo)
Fibrocartilaginous dysplasia - varus deformity
Blounts
NF - if pseudoarthrosis basically NF1, anterolateral
Blounts
Congenital assoc with leg length discrepancy (post medial likely congenital)
Anterior is bad, posterior is good
Recurrent lateral ankle inversion and posterior and lateral swelling, most likely injury
ATFL
AInferior TFL
Spring ligament
Deltoid
PTFL
PTFL
65M with knee pain, most likely association
Asymmetrical patellofemoral suggests CPPD
OA affects medial and lateral comps evenly
Ossification of the meniscus with HADD
Asymmetrical patellofemoral suggests CPPD
Parathyroid adenoma, most useful for localising
MRI with T2 most sensitive
Don’t demonstrate gad uptake
Tech 99 pertechnetate
US
MRI with T2 most sensitive
Most likely for gout
Aspiration was clear
Gouty tophi within 1-2years
First episode polarticular
Myelogenous disease recognised cause of gout
Myelogenous disease recognised cause of gout
6yr M – bone resorption radial 2nd and 3rd phalanges, prominent trabeculae, widening of epiphysis
Renal osteodystrophy
40M – HIV – multiple small hyperdense nodules liver and spleen – most likely
Hydatid
Amoeba
Candidiasis
Karposi sarcoma
Gram positive
Candidiasis
History of preeclampsia. Relevance of uterine artery dopplers
Second trimester should be low resistance
No predictive value for pre-eclampsia
High resistance near cord insertion placenta
RI <0.9 is normal
Second trimester should be low resistance
3yr child, left sided sensorineural hearing loss, CT showed cochlear and vestibule in figure of 8 formation. Cochlear missing septation
Cystic vestibulocholear malformatioN
Large vestibular aqueduct
Cochlear hypoplasia
Cystic vestibulocholear malformatioN
Least likely associated
Limbus vertebrae most likely anterior superior endplate
Chance fracture nearly always a/w neurological injury
Cervical flexion teardrop fracture a/w ventral cord injury
Chance fracture nearly always a/w neurological injury
Ankylosing spondylitis, least likely associated
Hip, shoulder and knee involvement
MTP/MCP involvement
Inflammation of annulus fibrosis
MTP/MCP involvement
IVDU. Headache. Normal CT brain. No bleed on LP. Presents with stroke like symptoms
RCVS
SAH
RCVS
MRI brain. High T2 signal spaces, non-enhancing. Leptomeningeal enhancement/thickening around the base of skull
Cryptococcosis
Neurocysticercosis
Metastases
Lymphoma
Toxoplasmosis
Cryptococcosis
CNS cryptococcosis
Epi: AIDS or people with bird contact
There are three dominant CNS forms to the disease depending on which part of the brain is affected:
meninges: meningitis (leptomeningeal enhancement and pachymeningeal enhancement)
parenchyma: cryptococcomas
perivascular spaces: gelatinous pseudocysts
Meningitis and cryptococcomas are seen in immunocompetent hosts usually and gelatinous pseudocysts are more common in patients with HIV/AIDS.
Post partum woman with headache. Bilateral low density thalami on MRI. Most likely cause?
Cerebral venous thrombosis
MCA infarcts
Lymphocytic hypophysitis
Cerebral venous thrombosis
Cystic lesion adjacent to submandibular gland, between internal and external carotid artery, anterior to SCM
1st branchial cleft cyst
2nd branchial cleft cyst
3rd branchial cleft cyst
4th branchial cleft cyst
2nd branchial cleft cyst
Painful eye in female. Diffuse thickening of the medial rectus with surrounding fat stranding, (didn’t state enhancement characteristics)
Thyroid eye disease
Idiopathic inflammatory disease
Systemic connective tissue disease/sarcoidosis
Lymphoma
Rectus sheath haematoma
Idiopathic inflammatory disease
ZMC/Tripod fracture, which is TRUE
Medial canthus inferiorly displaced
Upgaze palsy due to entrapment inferior oblique muscle
Ipsilateral facial numbess due to facial nerve involvement
Zygomaticofrontal suture involvement
Facial numbness is as a result of facial nerve injury
Zygomaticofrontal suture involvement
Smoker, has bilateral parotid lesions, cystic with fluid levels
Sjogren’s
Warthin’s
Pleomorphic adenoma
Warthin’s
Regarding arterial dissections in the neck, which one is true?
Can be traumatic or spontaneous
Most commonly affect the vertebral arteries -
Can be traumatic or spontaneous
Which is most likely to have cervical lymphadenopathy
Papillary thyroid cancer
Follicular thyroid cancer
Medullary thyroid cancer
Anaplastic thyroid cancer
Lymphoid something
Papillary thyroid cancer – most common, most likely to go to nodes
Least likely cause of pituitary fossa enlargement
Craniopharyngioma
Meningioma
Germinoma
Macroadenoma
Lymphocytic hypophysitis
Aneurysm
Lymphocytic hypophysitis
Least likely to be an intraventricular mass?
PXA
Meningioma
Ependymoma
Central neurocytoma
Metastases
PXA
Pleomorphic xanthoastrocytoma
Pleomorphic xanthoastrocytomas (PXA) are a type of rare, low-grade astrocytoma (WHO Grade II) found in young patients who typically present with temporal lobe epilepsy.
They usually present as cortical tumours with a cystic component and vivid contrast enhancement. Features of slow growth may be present, such as no surrounding oedema and scalloping of the overlying bone. A reactive dural involvement expressed by a dural tail sign can be found. Calcifications are rare.
Typically these tumours are found in young patients (children or young adults), with a peak incidence in the second and third decade of life (10-30 years).
Old woman. Expanded cord with high T2 signal from C7 to T6, with small enhancing foci
Transverse myelitis
Haemangioblastoma
Metastases
Ependymoma
Metastases
TM - no expansion
HGB - no VHL
Epen - different enhancement
Lesions at anterior commissure, non-enhancing, patchy restriction, T2 hyperintense, basal leptoeningeal enhancement (and didn’t mention immunosuppression) (in ?adult male)
Cryptococcus
Toxoplasmosis
Lymphoma
TB
Cryptococcus
Young dude, weak left arm. Party and alcohol the night before. No blood on LP. Early loss of grey-white differentiation in the precentral gyrus. What is the most likely diagnosis?
Reversible cerebral vasoconstriction syndrome
PRES
Subarachnoid haemorrhage
CADASIL
Demyelination
PML
Reversible cerebral vasoconstriction syndrome
Small tooth like fragment surrounded by an expansile (?lucent/sclerotic) lesion
Odontoma
Dentigerous cyst
KCOT
Ameloblastoma
ABC
Metastasis
Ameloblastoma
70yo, posterior fossa mass with vasogenic oedema on CT. What is the most likely diagnosis?
Haemangioblastoma
Meningioma
Metastasis
Medulloblastoma
Pilocytic astrocytoma
Metastasis
NMO, which is ?true
Commonly presents with bilateral optic neuritis
Short segment spinal involvement
Strong predilection for males
Simultaneous brain and spinal cord lesions
A: Commonly presents with bilateral optic neuritis
Short segment spinal involvement
At least three vertebral segments = “longitudinally extensive”
Strong predilection for males
Older than MS, and female
Simultaneous brain and spinal cord lesions
Often concurrent, but may preceed each other by up to several weeks
Described a petrous apex expansile mass. Low ADC. Low T1, high T2.
Cholesterol granuloma
Abscess
Cholesteatoma
Metastasis
Schwannoma
Meningioma
Cholesteatoma
Petrous apex lesions :::
Asymmetrical marrow/asymmetrical pneumatisation
- Non expansile
- Fat intensity on all sequences
Petrous apex cephalocele
- CSF signal intensity on all sequences
Petrous apicitis
Congenital cholesteatoma
- Restricted diffusion
Cholesterol granuloma
- Most common cystic appearing lesion
- High T1 and T2, without fat saturation
Mucocele of the petrous apex
- CT opacification of the petrous apex air cells with expansion of cortical margins
- Hyperintense T2 signal and variable T1
- Possible peripheral enhancement
Benign tumours
- Meningioma
- Schwannoma
- Paraganglioma
Malignant tumours
- Chondrosarcoma
- Chordoma
- plasmacytoma
Regarding parathyroid disease
Most common ectopic location is above superior pole of thyroid
Most sensitive sequence is T2 on MRI
Most sensitive sequence is T2 on MRI
Parathyroid adenomas are seen best on which MRI sequence? (repeat)
T1
T2
DWI
Contrast enhanced study
T2
Inverted papilloma
Associated with squamous cell carcinoma
Arises from the bony nasal septum
Arises from the olfactory bulbs
Can cause isolated unilateral frontoethmoidal sinus obstruction
Associated with squamous cell carcinoma
20 year old male in an MVA, complains of chest pain immediately. CT shows pulmonary contusion and small smooth outpouching at the aortic isthmus with no mediastinal fat stranding or haematoma. Most likely cause?
Ductus diverticulum
Aortic isthmus
Pseudoaneurysm
Aortic transection
Penetrating aortic ulcer
Ductus diverticulum
Bicuspid aortic valve with systolic murmur. Most likely associated finding
LV hypertrophy and dilatation
No flow void in aorta
Decreased gradient across aortic valve
LV hypertrophy and dilatation
Which is NOT part of the Wells criteria
Pleuritic chest pain
Haemoptysis
Signs/symptoms of DVT
Malignancy
Pleuritic chest pain
Lady with left lower leg DVT, gets IVC filter, adequately anticoagulated. 2 days later, complains of SOB/chest pain and has new PE on CTPA. Most likely explanation
Duplicated IVC
Azygos continuation of IVC
Retroaortic left renal vein
Circumaortic left renal vein
Duplicated IVC
Post carotid endarterectomy, has new posterior/occipital stroke. Most likely cause
Azygos circulation
Hypoglossal artery
Trigeminal artery
Persistent foetal PCOM
Hypoglossal artery
Arises from the distal cervical ICA, usually between C1 and C3.
Passes through an enlarged hypoglossal canal, joints the basilar artery inferiorly
70 year old male 6 months post AAA repair for routine CT, which shows a blush of contrast in the aneurysm sac, in keeping with graft porosity. What type of endoleak is this?
Type I
Type II
Type III
Type IV
Type V
Type IV
A 40 year old man MEN I has multiple tiny pulmonary nodules on CXR.
Metastatic pulmonary calcification
Sarcoid
Pulmonary alveolar microlithiasis
Metastatic pulmonary calcification
Most associated with cystic fibrosis
Imperforate anus
TOF-OA
Ileal/jejunal atresia
Hypertrophic pyloric stenosis
Ileal/jejunal atresia - cystic fibrosis: ~25% of cases
Regarding aortic dissection
5-10% no intimal tear is seen
Intimal tear is usually at the junction of the aortic arch and descending aorta
Tear is between the intima and inner third of the media
5-10% no intimal tear is seen
Which is true about SVC syndrome?
It is an acute medical emergency
It can result in acute respiratory distress
Endovascular stents are of little use
Pemberton’s sign is negative
It can result in acute respiratory distress - Patients typically present with shortness of breath along with facial and upper extremity edema.
Which of the following does NOT cavitate?
Mycoplasma
Lymphomatoid granulomatosis
Lymphoma
Mycoplasma
Which is true?
Aspergillus is associated with colonization of bronchi
Aspergillus can be mistaken for mucormycosis in immunosuppressed
both
What disease is not associated with cystic airspaces?
LAM
Emphysema
Emphysema
In a patient that needs a dialysis catheter, what vein should be used? (repeat)
Right IJV
Left IJV
Right subclavian vein
Left subclavian vein
Right IJV
Regarding sequestration
Intralobar sequestration has its own pleural covering
Intralobar sequestration is supplied by the pulmonary arteries
Extralobar sequestration usually occurs in the left lower lobe
Extralobar sequestration usually occurs in the left lower lobe
65-90%
does subclavian artery dissection cause cause thoracic outlet syndrome (repeat from 2012 paper with options like pec minor tunnel)
no? this recall sucks ass
HIV patient. Multiple hypodense nodules in liver and spleen
Candida
Necrotic metastases
Pyogenic abscesses
Candida
Regarding small bowel tumours, most common
Carcinoid in ileum
Lymphoma in proximal jejunum
SB tumour presents with intussusception
SB tumours are mostly benign
Carcinoid in ileum
50 yo man 2 weeks post return from Thailand. Febrile. Liver multiseptated lesion.
Amoebic abscess
Hydatid cyst
Pyogenic abscess
Hydatid cyst
45F PHx rectal cancer. MRI liver with hepatobiliary contrast. Lesion is arterially enhancing, demonstrates signal drop out on out of phase, and hypodense to liver on delayed phase
FNH
Adenoma
Hypervascular metastasis
HCC
Adenoma
35yo with a smooth narrowing at T11 on barium swallow, with proximal oesophageal dilatation
Achalasia
Eosinophilic oesophagitis
Zenker diverticulum
Cricopharyngeus spasm
Barrett’s oesophagus
Scleroderma
SCC
Scleroderma
Otherwise achalasia, but complete closure, not narrowing
2 years post treatment for colorectal cancer. Pre sacral soft tissue thickening/mass. Next best test
MRI pelvis
PET/CT
Repeat imaging in 3-6 months
CT guided biopsy
PET/CT
Dilation of the intraduodenal portion of the common bile duct. What Todani classification is this?
Type I
Type II
Type III
Type IV
Type V
Type III
35 year old male recently immigrated from Singapore presents with fever and RLQ pain. CT shows several 1 cm areas of fat stranding posterolateral to the right side of the colon, measuring 0 to -300 HU. Most likely cause?
Epiploic appendagitis –
Diverticulitis
Appendicitis
Colitis
Epiploic appendagitis – omental infarct is >3cm
Multiple is odd
Most common cause of acute diffuse small bowel ischaemia
SMA thrombus
SMA embolus
SMV thrombus
Aortic dissection
IMA thrombus
SMA embolus
Pancreatic head mass, 3 liver lesions. Which lesion(s) should be biopsied? (repeat)
Pancreatic lesion
Heterogeneous liver lesion
Hypoechoic liver lesion
Hyperechoic liver lesion
All of the liver ones
Heterogeneous liver lesion
Thickened jejunal folds
Scleroderma
Coeliac disease
Whipple disease
Crohn’s disease
Lymphoma
Coeliac disease
Reversal of jejunal-ileal folds, and bowel wall oedema = thickening
Whipple disease
Nodular thickening
Which is most likely to present as a pancreatic head lesion in a male?
IPMN
Serous cystadenoma
Mucinous cystadenoma
Solid pseudopapillary epithelial neoplasia
IPMN
Trans-sphincteric anal fistula with abscess
Type 1
Type 2
Type 3
Type 4
Type 5
Type 4
1 - simple linear intersphincteric
2 - intersphincteric with abscess or secondary tract
3 - transsphincteric
4 - transsphincteric with abscess or secondary tract within the ischiorectal fossa
5 - supralevator and translevator extension
Calcified bladder with mass, African
TCC
SCC
Adenocarcinoma
SCC
What condition causes medialisation of the ureters?
Abdominoperineal resection
Prune belly syndrome
Herniation of the ureter through the sacrosciatic foramen
Abdominoperineal resection
Medial displacement:
Upper ureter
- Retrocaval ureter
- Retroperitoneal fibrosis
Lower ureter
- Lymphadenopathy
- Iliac artery aneurysm
- Bladder diverticulum
- Post-surgical esp. AP resection
- Pelvic lipomatosis
Lateral displacement or deviation
Upper ureter
- Lymphadenopathy
- Aortic aneurysm
- Retroperitoneal haematoma
Lower ureter
- Pelvic mass e.g. uterine fibroid
Renal stones in a leukaemia patient are most likely to be of which type?
Uric acid
Cystine
Struvite
Calcium phosphate + calcium oxalate
Pure calcium phosphate
Uric acid
Renal lesion, T1 hyperintense, T2 hyperintense, with no enhancement
Haemorrhagic cyst
Proteinaceous cyst
AML
Clear cell carcinoma
Proteinaceous cyst
Next best test for intra and extraperitoneal bladder rupture (repeat)
Retrograde cystogram
Urethrogram and cystogram
Urethrogram and cystogram
Regarding osteosarcoma, FALSE
50% around knee
Periosteal osteosarcoma has best prognosis
Older individuals get it in mandible
Involves (?metaphysis/metadiaphysis) of long bones
Telangiectatic usually demonstrates fluid-fluid levels on MRI
FALSE: Periosteal osteosarcoma has best prognosis
Parosteal DOES
What is the angle in scoliosis?
5 degrees
10 degrees
15 degrees
20 degrees
25 degrees
10 degrees
Patient with patellofemoral joint space loss, meniscal chondrocalcinosis. What is another expected finding?
Calcification of pubic symphysis
Rotator cuff calcification
MTP joint erosion
MCP joint erosion
Calcification of pubic symphysis
Regarding HADD
Periarticular calcifications
1st MTP juxta-articular erosion
MCPJ destruction
Identified within soft tissue calcifications of scleroderma
Identified within soft tissue calcifications of dermatomyositis
Periarticular calcifications
Shoulder MRI. No trauma. High T2 signal in supraspinatus, infraspinatus, teres minor. Normal T1 signal.
Brachial neuritis
Suprascapular nerve compression in spinoglenoid notch
Suprascapular nerve compression in suprascapular notch
Quadrilateral space compression
Chronic ?denervation
A: Brachial neuritis - parsonage turner syndrome
Suprascapular nerve compression in spinoglenoid notch - Just infraspinatus
Suprascapular nerve compression in suprascapular notch - Both supraspinatus and infraspinatus
Quadrilateral space compression - axillary nerve: teres minor and, or deltoid muscle
Chronic ?denervation
Woman with PHx breast cancer. Hip pain. MRI shows psoas tendon retraction + anterior soft tissue oedema.
Lesser trochanter metastasis
Iliopsoas tendon tear
Subtrochanteric fracture
Stress fracture
Iliopsoas tendon tear
Regarding shoulder ultrasound
Assess supraspinatus in flexion
Subscapular tears are often associated with long head biceps tendon tears
Assess long head of biceps tendon in extension
Subscapular tears are often associated with long head biceps tendon tears
Which is INCORRECT about MRI knee
PCL is affected by magic angle
Posterior horn medial meniscal tear more common than anterior
MCL and LCL on same coronal plane
MCL and LCL on same coronal plane
Popliteal artery entrapment – false?
Popliteal artery aneurysm does not occur
Lateral (?medial) deviation of popliteal artery on extension
Posterior tibial artery low arterial waveform (?if leg is contracted)
Popliteal artery aneurysm does not occur
Soft tissue mass on palm. T1 hyperintense, T2 hyperintense, patchy fat saturation and heterogeneous enhancement
Haemangioma
Lipoma
Schwannoma
Venous malformation
?Haematoma
Haemangioma
Where is fatty marrow most likely to be found? (repeat)
Femoral diaphysis
Ribs
Pelvis
Vertebra
Proximal humeral epiphysis
Femoral diaphysis -in kids
Proximal humeral epiphysis
Which is not an epiphyseal lesion?
ABC
GCT
Chondroblastoma
CMF
CMF
Most chondromyxoid fibromas are located in the metaphyseal region of long bones (60%)
Old lady with THR, hot on bone scan and ?loosening or infection. What should you do next? (repeat)
Aspiration + arthrogram
White cell scan
White cell scan
Hypoechoic, compressible mass in the subcutaneous tissues in the plantar aspect of the foot, overlying the 2nd, 3rd and 4th metatarsal heads
Adventitial bursitis
Intermetatarsal bursitis
Morton neuroma
Adventitial bursitis - Adventitious bursae are not permanent native bursae. They can develop in adulthood at sites where subcutaneous tissue becomes exposed to high pressure and friction.
INTERMET: BW
MORTONS: BW
12 year old girl. Lucent left hemithorax on CXR. CT shows endobronchial lesion, with some peripheral calcification and homogenous enhancement.
Pleuropulmonary blastoma
Carcinoid
Bronchial adenoma
Adenoid cystic carcinoma
Mucoepidermoid carcinoma
Carcinoid
Bronchial carcinoid is the most common primary endobronchial neoplasm; it makes up about 80% of malignant pulmonary neoplasm in children.
3 year old male with leukocoria, orbital lesion with calcifications
Retinoblastoma
Neuroblastoma metastasis
Lymphoma
Coats disease
Retinoblastoma
Leukocoria - abnormal white reflection from the retina
Top 4 causes:
Retinoblastoma 58%
Persistent hyperplastic primary vitreous 28%
Coats disease 16%
Larval ganulomatosis 16%
Normal sized eye:
Calcified - retinoblastoma
Non calcified - coats disease
Microphthalmia
Unilateral - persistent hyperplastic primary vitreous
Bilateral - retinopathy of prematurity, bilateral PHPV
Coats disease:
A disorder of weak retinal capillaries resulting in progressive retinal detachment due to exudative sUbretinal collection
CT: margins of the exudate may have a V-shaped pattern similar to retinal detachment
MRI:
T1 high - due to proteinaceous nature of the exudates
T2 high - due to proteinaceous nature of the exudates
Paediatric CXR. Normal pulmonary vascularity.
Coarctation of aorta
TOF
VSD
?AP window
ASD
Truncus arteriosus
Coarctation of aorta
3yo with macrocephaly, high signal associated with the anterior commissure, bilateral T2 thalamic high signal, forceps minor T2 hyperintensity and developmental delay. Cause
Alexander disease
Castleman disease
Adrenal leukodystrophy
Canavan
Alexander disease
Alexander disease
- Bifrontal white matter which tends to be symmetrical
- Caudate head > globus pallidus > thalamus > brainstem
- Periventricular rim
- Anterior dominance
Canavan:
- Mainly subcortical white matter, involves the subcortical U-fibres
- Globus pallidus and thalami are involved
- Spares the corpus callosum, caudate nucleus, putamen and internal capsule
Adrenoleukodystrophy
- Spares the subcortical U fibres
- Characteristic occipitoparietal periventricular distribution
Metachromatic leukodystrophy
- Spares subcortical U-fibres
- Characteristic butterfly pattern
2 day old, distal bowel obstruction, sacral abnormality
Hirschsprung’s
Ileal atresia
Meconium ileus
Imperforate anus
Meconium plug
Imperforate anus
The Currarino syndrome is a complex condition variably comprised of characteristic congenital anomalies of the sacrum, anorectum and presacral soft tissues.
Brainstem mass in 9 y/o
Pilocytic astrocytoma
Fibrillary astrocytoma - old term for diffuse astrocytoma
Medulloblastoma
Ependymoma
Pleomorphic xanthoastrocytoma
Medulloblastoma
15yo Fibrillary astrocytoma (repeat)
Pilocytic astrocytoma
Craniopharyngioma
Ependymoma
Ganglioglioma
Pilocytic astrocytoma - A pilocytic astrocytoma is most commonly found in the cerebellum. They can also occur near the brainstem, in the cerebrum, near the optic nerve, or in the hypothalamic region of the brain.
Most sensitive for diagnosis of HIE on MRI in a neonate in the first 24hrs of life (repeat)
ADC
T2
DWI
Spectroscopy
DWI
HYPOXIC ISCHAEMIC ENCEPHALOPATHY
DWI is the first to become positive
Diffuse oedema with effacement of the CSF-containing spaces
Decreased cortical grey matter attenuation with a loss of normal grey-white differentiation
Decreased bilateral basal ganglia attenuation
Wilms - spontaneous regression can be seen in infants with metastatic disease t/f
TRUE
Normal pulmonary flow in kid - ?TOF or coarctation
coarctation
Which of the following findings on a 20 week scan would you be MOST likely to perform amniocentesis for?
Choroid plexus cyst measuring 6mm
Lateral ventricles measuring 14mm
Renal pelvis measuring 5-10mm
Lateral ventricles measuring 14mm should be <7mm AHW neonate <3mm
Which placental abnormality is LEAST likely to be associated with complications
Bilobed
Succenturiate lobe
Circumvallate
Placenta praevia
Membranacea
Velamentous cord insertion
ANSWER: Succenturiate lobe
- Increased risk of type II vasa previa
- Increased incidence of PHH from RPOC
Bilobed
- Velamentous cord insertion
- Increased incidence of type II vasa previa
- May increase PPH risk due to RPOC
Circumvallate
- Higher incidence of placental abruption
- Increased risk of IUGR
20 year old G1P0 presents for 20 week scan. US shows mass at the cord/foetal abdomen junction. The cord inserts to the side of the mass. Most likely cause?
Cord AVM
Gastroschisis
Omphalocele
Pseudoomphalocele
Physiological herniation
Gastroschisis
Large multilocular cystic mass occupying most of the pelvis, most likely diagnosis?
Mucinous cystadenoma
Serous cystadenoma
Dermoid
Brenner tumour
Mucinous cystadenoma
Haemorrhagic appearing 5.6cm ovarian cyst in a young female. Appropriate follow-up?
Follow up US in 4 weeks
Follow up US in 6 weeks
No follow up required
Gynaecological referral
MRI
Follow up US in 6 weeks
DCIS common appearance
On ultrasound, hypoechoic and hypervascular
A cluster of indeterminate microcalcifications on MMG
Mass on MRI
Architectural distortion on MMG
A cluster of indeterminate microcalcifications on MMG
Regarding papillary breast cancer
Mixed cystic cut surface on gross specimen
Spiculated margins on imaging
Mixed cystic cut surface on gross specimen
Radial scar diagnosed following biopsy. Most appropriate course of action?
Return to routine screening
Repeat mammo in 6 months
Hookwire and surgical biopsy
Hookwire, WLE and sentinel node biopsy
Mastectomy
Hookwire and surgical biopsy
Phyllodes tumour diagnosed on biopsy. Most appropriate course of action?
Return to routine screening
Repeat mammo in 6 months
Hookwire and surgical biopsy/simple excision
Hookwire and WLE
Mastectomy + SLNBx
Hookwire and WLE
Hypoechoic mass on ultrasound and well circumscribed on mammogram
Invasive ductal cancer
Invasive lobular cancer
Mucinous
Phylloides
DCIS
Phylloides
Which does NOT present as a spiculated mass on mammography?
Tubular carcinoma
Invasive ductal carcinoma
Medullary carcinoma
Invasive lobular carcinoma
Fat necrosis
Medullary carcinoma
Stellate lesion with long spicules without a central mass
Radial scar
Invasive ductal carcinoma
Radial scar
Least associated with BRCA1
Colorectal carcinoma
Pancreatic carcinoma
Ovarian carcinoma
Male breast carcinoma
Prostate carcinoma
Male breast carcinoma
Why is Pagets disease of the nipple occult on mammography (repeat)
a. DCIS cells spread via the lactiferous ducts to the nipple
MEN syndrome + calcified nodules with bone scan uptake
Metastatic calcification in the lungs
Which does NOT occur in pseudohypoparathyroidism
Dentate nucleus calcification
Flask deformity of long bones
Coned epiphyses
Abnormal dentition
?short 4th metacarpal
Normal calcium
Normal calcium
Pseudohypoparathyroidism
- Short stature
- Brachydactyly
- Short metacarpals
- Short metetarsals
- Soft tissue calcification
- Exostoses: short metapyseal or more central and perpendicular to long axis of a bone
- Broad bones with coned epiphyses
CNS
- Basal ganglia calcification
- Sclerochoroidal calcification
- Deep white matter calcification
Clinical presentation:
- Hypocalcaemia and tetany
- Short stature
- Developmental delay
Lead GNOME - causes of erlyenmeyer flask deformity
- Lead: lead poisoning
- G: Gaucher disease
- N: Niemann-Pick disease
- O: osteopetrosis, osteochondromatosis
- M: metaphyseal dysplasia (Pyle disease) and craniometaphyseal dysplasia
- E: ‘ematological, e.g. thalassaemia
How many x-rays is the equivalent of a PET/CT, with a low dose CT
700
1500
2000
700
Long question about a research study, if TP=a, FP=b, TN=c, FN=d, how to calculate prevalence in their study population (repeat)
a/b+d
a/a+c
b/a+c
b/c+d
a+d/a+b+c+d
a+d/a+b+c+d
Most often proposed mechanism for NSF (repeat):
Free gadolinium gets into tissues and incites fibrotic response
Free Gd chelate gets into soft tissues and incites fibrotic reaction
Albumin bound Gd gets into tissues
Some other combinations of chelated and otherwise bound Gd
Free gadolinium gets into tissues and incites fibrotic response
Increase the signal to noise ratio on MRI
Reduce voxel size
Increase field of view
Decrease number of excitations
Increase field of view
Inversion injury of the ankle. What is the most likely ligament involved?
Anterior talofibular ligament
Posterior talofibular
Deltoid ligament
Spring ligament
Anterior talofibular ligament
A patient has erythema/eczema of the nipple and a normal mammogram and ultrasound. What is the most appropriate next management?
Referral to a breast surgeon
Referral to a dermatologist
Repeat imaging in 3-6 months
MRI with contrast
Referral to a breast surgeon
MRI with contrast
Right lower quadrant pain USS demonstrates blind ending tubular structure with echogenic focus
Appendicitis
Haemorhagic corpus luteum
Appendicitis
What is the most likely appearance of a radial scar on mammogram?
Ill defined stellate mass
Architectural distortion
Amorphous calcifications
Architectural distortion
A 40 year old female has a low density pancreatic lesion. What is the most likely diagnosis?
Mucinous cystadenoma
IPMN
Serous cystadenoma
Mucinous cystadenoma
A middle aged patient has a barium swallow. It demonstrates a posterior outpouching at C5/6. What is the most likely diagnosis?
Zenker diverticulum
Cricopharyngeus
Epiphrenic diverticulum
Zenker diverticulum
A patient has a barium follow through study. There is a narrowing at D2 secondary to external mass effect. What is the most likely diagnosis?
Annular pancreas
Pancreas divisum
Pancreatic atrophy
Annular pancreas
PET scan is commonly used to image patients with lymphoma. Which type of lymphoma is least likely to be avid on PET scan?
a. Mycosis fungoides
b. Follicular lymphoma
c. Diffuse large B cell lymphoma
a. Mycosis fungoides
What is phaeochromocytoma least likely to be associated with?
VHL
Tuberous sclerosis
NF1
MEN?
Tuberous sclerosis – extra-adrenal paragangliomas
MEN - if MEN1 then this is true
A patient has an ankle injury where there is disruption of the ankle syndesmosis and a fibula fracture 5cm proximal to the ankle joint. What is the most likely injury?
Weber A
Weber B
Weber C
Maisonneuve fracture
Weber C
Which is the least likely cause of intussusception in a 2 year old?
Crohn disease
Henoch-Schonlein purpure
Lymphoma
Intraluminal lipoma
Meckel’s diverticulum
Crohn disease
Which of the following cannot be excluded on ultrasound?
AVN of the hip
Septic arthritis
Transient synovitis
AVN of the hip
A 12 year old boy presents with a 3 month history of knee pain with a normal xray. What is the next investigation?
Hip x-ray
Knee MRI
Bone scan
Hip x-ray
Which is least likely to give endplate signal changes with are low on T1 and high on T2?
Modic type II
Spondylodiscitis
Tuberculosis
Disc herniation
Ankylosing spondylitis
Modic type II
Modic changes
1 - oedema and inflammation
T1 low, T2 high
2 - conversion into yellow fat
T1 high, T2 iso - high
3 - subchondral bony sclerosis
T1 low, T2 low
Which is the most likely right atrial lesion in a young child?
Atrial myxoma
Rhabdomyoma
Rhabdomyoma
What is the most common orbital lesion in a child?
Cavernous haemangioma
Retinoblastoma
Lymphoma
Melanoma
Coats disease
Retinoblastoma - one out of every 16,000–18,000 live births in the global population
Coats disease is a rare eye disorder involving abnormal development of blood vessels in the retina. Located in the back of the eye, the retina sends light images to the brain and is essential to eyesight. In people with Coats disease, retinal capillaries break open and leak fluid into the back of the eye.
Most pediatric orbital tumors are benign; developmental cysts comprise half of orbital cases, with capillary hemangioma being the second most common orbital tumor. The most common orbital malignancy is rhabdomyosarcoma. The most common intraocular malignant lesion is retinoblastoma.
Cavernous hemangiomas are usually encountered in the orbit as primary tumors in adults. Patients with orbital cavernous hemangiomas typically present in the fourth and fifth decade of life. Lesions are rare in childhood. On the other hand, capillary hemangioma is the most common benign orbital tumor in children.
A man has a headache a few days following an all-night party. CT demonstrates slight loss of grey-white matter differentiation in the left fronto-parietal region. LP is negative for RBCs and bilirubin. What is the most likely cause?
Ischaemia due to venous thrombosis
Encephalitis
Subarachnoid haemorrhage secondary to ruptured berry aneurysm
Ischaemia due to venous thrombosis
Which is true regarding tuberculosis?
Calcified cavitating lesion in primary tuberculosis
Lymphadenopathy is more associated with secondary tuberculosis
Pleural effusion is more associated with primary tuberculosis
Pleural effusion is more associated with primary tuberculosis
A cholangiocarcinoma involves the primary confluence and extends to the left secondary confluence. What is the stage as per the Bismuth-Corlette criteria?
1
2
3a
3b
4
3b
Which is not a hamartomatous polyp syndrome?
Gardner syndrome
Peutz-Jegher syndrome
Cowden syndrome
Cronkite-Canada syndrome
Gardner syndrome
Which liver injury is most likely to be caused by an overdose of analgesia?
Hepatocellular necrosis
Hepatitis
Cholestasis
Hepatocellular necrosis
Which is not a risk factor/cause of pre-eclampsia?
Materal diabetes mellitus
Maternal pre-existing glomerulonephritis
Anti-phospholipid syndrome
?Liver disease on previous recall
?Liver disease on previous recall
A first trimester ultrasound demonstrates a twin peak sign. Which is most correct?
There are two separate placentas - dichorionic
There is a risk of twin-twin transfusion
Diamniotic, monochorionic
Monoamniotic, monochorionic
Dizygotic, monochorionic
There are two separate placentas - dichorionic
A patient has an enhancing, vascular mass in the epididymis. What is the most likely diagnosis?
Adenomatoid tumour
Lipoma
Teratoma
Epididymal cyst
Adenomatoid tumour
Which is the most likely pure germ cell tumour to be found in an elderly patient?
Spermatocytic seminoma
Embryonal cell carcinoma
Teratoma
Spermatocytic seminoma
BPH arises in the peripheral zone T/F
F
A patient with an EVAR has a contrast filling the aneurysmal sac supplied by a lumbar artery. Which type of endoleak is this?
Type 1
Type 2
Type 3
Type 4
Type 5
Type 2
Type 1 - leak at graft attachment site
Type 2 - aneurysm sac filling via branch vessel
Type 3 - leak through a defect in the graft
Type 4 - leak through graft fabric as a result of graft porosity
Type 5 - continued expansion of the aneurysm sac without demonstrable leak on imaging
Which is the best radiological finding for the detection of bowel trauma?
Bowel wall thickening
Mucosal hyperenhancement and mural oedema
Mesenteric congestion
Free fluid
Free fluid
Which is most correct regarding sedation in an elderly patient?
250mcg of fentanyl should be the a maximum dose
5mg of midazolam is an appropriate starting dose
There is a prolonged half life of midazolam in elderly patients
The most common side effect of midazolam is hypotension
There is a prolonged half life of midazolam in elderly patients -
Plasma half-life was approximately two-fold higher in the elderly.
Which is least associated with von Hippel Lindau?
Phaeochromocytomas
Haemangioblastomas
Pancreatic cysts
Renal cell carcinoma
Phaeochromocytomas -30%
A 30 year old man has a soft tissue mass which has high T1 fat sat signal. What is the most likely diagnosis?
Melanoma
Lipoma
Haemangioma
Melanoma
A patient has high density military nodules throughout the lungs with a ‘black pleura’ sign. What is the most likely diagnosis?
Alveolar microlithiasis
Hypersensitivity pneumonitis
Metastatic pulmonary calcification
Alveolar microlithiasis
An elderly male presents with painless hematuria. What is the best sequence to show tumour invasion?
T2
T1 with fat sat
T1 without fat sat
DWI
T2
Slightly hyperintense compared to muscle, useful in determining the low signal muscle layer and its discontinuity when muscle wall invasion
A 3 year old patient presents with ataxia. Imaging shows a posterior fossa tumour with a low density enhancing mass in the vermis. What is the most likely diagnosis?
Hemangioblastoma
Metastataic neuroblastoma
Medulloblastoma
Ependymoma
Fibrillary astrocytoma
Medulloblastoma
What is the most common appearance of lobular carcinoma on mammogram?
Architectural distortion
Microlobulated mass
Well- defined mass
Architectural distortion
Lucent, well-defined lesion in S1 in young adult patient. ( No other feature mentioned)
Chordoma
ABC
Giant cell tumour
Metastasis
ABC
Best way for local staging of DCIS
Mammo
Mammo + US
Contrast enhanced MRI
? open biopsy
Contrast enhanced MRI
A patient has left superior cerebellar and left parietal infarct after stenting the extracrainal left ICA. What is the most likely explanation?
Persistent hypoglossal artery
Persistent trigeminal artery
Fetal origin of PCOMs
Persistent hypoglossal artery
A 37 yr old is undergoing IVF treatment. She has bilateral ovarian cysts and extensive ascites. What is the most likely diagnosis?
Theca lutein cysts
Normal ovarian cysts
Ovarian hyperstimulation
Ovarian hyperstimulation
Which is not associated with an ACL tear?
Medial meniscus injury
Lateral meniscus injury
Anterior medial femoral (?)
Segond fracture
MCL tear
Anterior medial femoral (?)
Which is (not) a consequence of raised intracranial pressure?
Diffuse axonal injury
PCA infarction
ACA infarction
Duret haemorrhage
Kernohan’s notch
Diffuse axonal injury
Which is most correct regarding small bowel barium studies?
Thickening of the jejunal folds is coeliac
Nodular thickening of the jejunal folds in Whipples
Nodular thickening of the jejunal folds in Whipples
Cystic ovarian lesion, 10cm (not sure), unilateral, most likely:
Serous cystadenoma
Mucinous cystadenoma
Mucinous cystadenoma
Regarding melorrheostosis - which is not a feature?
Contractures
Thickened irregular bone cortex
Muscle atrophy
Scleroderma skin changes
ALL FEATURES
60 cyst ill defined, non expansile, adjacent to root of tooth, no tooth and no expansion no nonerupted teeth
Metastases
Ameloblastoma
Dentigerous cyst
Fibrous dysplasia
Odontoma
Metastases
34 male ataxia, right cerebellar low density striated mass
Cowden
Basal cell naevus
Encephalocraniocutaneous lipomatosis
Cowden
An older male patient has a mass encasing the kidney and adrenal gland, with Housfield density between -60 and +60 units. What is the most likely diagnosis?
Myxoid liposarcoma
A woman has a 15mm well defined breast mass. What is the most likely diagnosis?
Fibroadenoma or phyllodes
t/f midline sagittal best prenatal assessment of cleft lip?
false
Which is most correct regarding meningioma?
En plaque
Expansion of sella
Destruction of bone
Intense contrast enhancement
Intense contrast enhancement
4cm well circumscribed hypodense mass in the pancreas with peripheral calcification. Most likely:
Mucinous cystadenoma
Serous cystadenoma
IPMN
SPEN
Mucinous cystadenoma
Which is the best investigation for a thyroid lesion?
Iodine 131 scan
Tc99 Pertechtenate scan
Tc99 Pertechtenate scan
A jaundiced woman has a normal liver ultrasound and normal bile ducts. What is the most likely diagnosis?
Cholestasis
Fatty liver
NASH
Hepatitis
Cholestasis
Lung biopsy of a lesion in the posterior right mid lung is complicated by perilesional haemorrhage and haemoptysis. What is the next appropriate step?
Right side down
Left side down
Supine
Prone
Head up
Right side down
On CXR, there is a structure paralleling right heart border. What is the most likely diagnosis?
PAPVR
Which liver lesion is least likely to have a central scar
Fibrolamellar HCC
HCC
FNH
Adenoma
Haemangioma
Adenoma
What is most associated with thyroid eye disease?
Pseudotumour
Graves disease
Hashimotos
Thyroiditis
Graves disease
Which is least likely to be associated with azygous continuation of the IVC?
Dextrocardia
Polysplenia
Gonadal veins draining into the ipsilateral renal veins
Hepatic veins draining into the IVC?
None of the above
Hepatic veins draining into the IVC?
A thyroid biopsy demonstrates medullary carcinoma. What is the next most appropriate investigation?
DMSA
DTPA
MAG-3
I-131
Tc99m-Pertechnetate
DMSA
A woman has intense pain in her knee after she walks her dog. There is intense oedema in the medial femoral condyle. What is the most likely diagnosis?
Radial tear medial meniscus
Medial ligament tear
Chondral defect - SONK
Loose body
Dog bite
Chondral defect - SONK
A young male patient has a renal lesion which is high T1, low T2, and intensively enhancing. What is the most likely diagnosis?
AML
Proteinaceous cyst
Haemorrhagic cyst
Lymphoma
Clear cell carcinoma
Clear cell carcinoma - actually papillary
MRI is not only excellent at imaging the kidneys and locally staging tumours, but is also able to suggest the likely histology, on the grounds of T2 differences.
T1: often heterogeneous due to necrosis, haemorrhage, and solid components
T2: appearances depend on histology 6
clear cell RCC: hyperintense
papillary RCC: hypointense
T1 C+ (Gd): often shows prompt arterial enhancement
A 3 week old neonate has jaundice, hypoplastic kidneys and an H shaped vertebra. The liver appears normal on ultrasound and the gallbladder is small.
What is the most likely diagnosis?
Caroli disease
Biliary atresia
Allagile syndrome
Bile plug syndrome
Allagile syndrome
20yo acetabular fracture, most likely injury
Bladder injury
Pelvic haematoma
Sacral injury
Pelvic haematoma
Which is true regarding fibromuscular dysplasia?
Most common cause of hypertension in children and young adults
Does not respond well to angioplasty
Only affects media
none
Which is most useful for differentiating between a ranula and lymphangioma?
Extension into paraphyrngeal space
Extension into retropharyngeal space
Extension into infrahyoid tissues
Extension into infrahyoid tissues
A hysteroscopy study for infertility shows two holes in the cervix. Which is the most likely diagnosis?
Bicornuate
Didelphys
Unicornuate
Septate
Bicornuate - more common
What is the best position to examine the subscapularis muscle on ultrasound?
External rotation with the elbow flexed
Internal rotation with the arm touching the opposite shoulder
External rotation arm behind the back
Abducted arm
External rotation with the elbow flexed
Child with previous history of bacterial meningitis, now with unilateral sensorineural hearing loss. What is the most likely diagnosis?
Otosclerosis
Labyrinthitis ossificans
Labyrinthitis ossificans
Which is incorrect regarding DVTs? (March 2016)
Most DVTs start in the soleal ‘sinusoids’
Most below knee DVTs will propagate to the surface without intervention
In ambulatory patients, only 5-10% of DVTs will result in PEs
Most patients with DVTs in the community are asymptomatic
Most below knee DVTs will propagate to the surface without intervention
Which is the most common infection associated with cystic fibrosis?
ABPA
Klebisiella
Pseudomonas
Pseudomonas
Rugby player kicked in scrotum with pain. Ultrasound shows intact tunica with heterogenous echogenic testes.
Rupture
Haematoma
Fracture
Abscess
Torsion
Haematoma
24 y.o. Obese male with retroareolar pain. Ultrasound shows hypoechoic mass under areola with lobulated posterior margins. Most likely option:
Gynaecomastia
Pseudo-gynaecomastia
Male breast cancer
Lipoma
Gynaecomastia
Which association is least likely:
Methotrexate and pneumatocoele
Phenytoin and eosinophilic lung disease
Amiodarone and interstitial infiltrate
Cyclosporine and pulmonary mass – due to fungal pneumonia
Sulfasalazine and eosinophilic lung disease
Methotrexate and pneumatocoele
Methotrexate
inflammatory: fibrotic disease
superimposed pulmonary infection: from immunosuppression
pulmonary lymphoproliferative disease: from immunosuppression
Regarding fibroadenoma which is FALSE.
Can contain invasive foci
Commonly involutes
Smooth mass on mammography
Commonly presents in <30
Common in post-menopausal women
Common in post-menopausal women
Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women.
Regarding radial scar which is true?
Requires further management.
Should be re-biopsied
Has short spicules.
Palpable as a clinical mass.
The central fat is often replaced by soft tissue
Requires further management.
45 m with neck lump which extends through thyrohyoid membrane and had an air fluid level and thin rim.
Laryngocoele
Epidermoid cyst
Abscess
Thyroglossal duct cyst
Lymphatic malformation
Laryngocoele
1.5cm well defined breast lesion in a 50yo F - what is least likely
Mucinous cancer
High grade IDC
Fibroadenoma
Simple cyst
Sebaceous cyst
High grade IDC – typically spiculated
Most likely appearance of medullary ca
Well defined mass
Spiculated mass
Mass with cystic spaces
Fine branching calcs
Thick calcs
Well defined mass
Most likely to involve epiphyses?
Osteoid osteoma
ABC
Clear cell chondrosarcoma.
Chondromyxoid fibroma.
Fibrosarcoma.
Clear cell chondrosarcoma.
Epiphyseal, unlike the conventional chondrosarcoma which is usually metaphyseal-diaphyseal
Least likely to be associated with RCC.
VHL
CRF on renal failure
NF1
Obesity
Smoking.
NF1
Least likely to affect basal ganglia.
Amyloid angiopathy.
Hypertension.
Ischaemic encephalopathy.
Amyloid angiopathy.
34yr female known twins presents for ultrasound. Twin peak sign. Which is most likely?
Monochoriotic diamniotic
Monochoriotic monoamniotic
There are two placentas
The twins are at risk of twin twin transfusion
There are two placentas
Neonate in cyanosis. Echocardiogram shows right atrial lesion. What is most likely
Haemangioma
Fibroma
Rhabdomyoma
Atrial myxoma
Lipoma
Rhabdomyoma – monitor and they go away, associated with TS
45yr female. Hypodense lesion in Pancreas with enhancing nodule. Peripheral calcification. Which is most likely?
Serous microcystic
Serous macrocystic
Mucinous cystadenoma
IPMN
SPEN
Mucinous cystadenoma
What is least like to present as a cystic lung lesion?
Mycoplasma pneumonia
Pulmonary lymphoma
Neurofibromatosis
Lymphoid granulomas
Tuberous sclerosis
Mycoplasma pneumonia
Pulmonary manifestations of NF-1, which usually include bilateral basal reticulations and apical bullae and cysts, are reported in 10-20% of adult patients.
40yr female. Right angle of jaw lesion. Painless non smoker. On ultrasound mixed solid and cystic change that involves part of the parotid gland and 2 other lesions in the adjacent soft tissue. What is most likely?
Lymph nodes
Sjogrens
Warthins tumour
Benign mixed lesion - oncogenic simian virus (SV40)
Lymphoepithelial cysts
Warthins tumour
They may be bilateral or multifocal in up to 20% of cases and are the most common neoplastic cause of multiple solid parotid masses.
Associated with smoking
Painless enlargement
50 yo male non-smoker no history of occupational exposure. CT Chest shows a 5mm non-calcified nodule in LUL. What does the Fleischner society guidelines recommend?
No follow up
Follow up in 12 months then stop if no change
Initial follow up in 6-12 months then in 18-24 months, then stop if no change
Initial follow up in 3-6 months then in 9-12 months and 18-24 months, then stop if no change
Follow up in 3, 9 and 12 months with dynamic post-contrast CT Chest and PET/CT +/- biopsy
No follow up
Low risk = no routine follow up required
47yo male (smoking history not specified) with persistent cough. Ill-defined non-calcified 8mm nodule in RUL. Which is MOST correct:
PET/CT to assess for malignancy
CT-guided FNA to assess for malignancy
Enhancement by greater than 35HU post IV contrast is associated with greater than 97% risk of malignancy
Likely benign (<2% risk of malignancy) if the lesion has remained stable in the last 30 months
Follow up in 12 months and 24 months
Follow up in 12 months and 24 months
F/U 6-12, then every 2 yrs for 5 if persistent – if subsolid, if solid, 12 mo then 24mo
10y boy with fever and cough. CXR shows bilateral lower zone opacities and linear atelectasis. Which is most likely cause (REPEAT):
Chlamydia pneumonia
Mycoplasma pneumonia
Pneumocystis jirovecii pneumonia
Staphylococcus pneumonia
Tuberculosis
Mycoplasma pneumonia
88y woman with dementia in nursing home, found collapsed. CT Brain shows a 2cm elliptical highattenuation lesion superficially in the right middle frontal gyrus. What is the MOST likely cause?
Hypertensive hemorrhage
Berry aneurysm
Hemorrhagic neoplasm
Amyloid angiopathy
Trauma
Amyloid angiopathy
What is most likely mammographic appearance of papilloma (REPEAT)
Spiculated mass
Well defined mass with microlobulated contours
Amorphous calcification
Dense linear calcs
Fine linear branching calcs
Well defined mass with microlobulated contours
With regards to osteomyelitis, which is true ?
Gadolinium helps to make the endplate changes more conspicuous on T1WI
Staph aureus is the most common cause in a 75 year old
MRI appearances can mimic modic type 1 changes
The presence of a paraspinal mass suggests malignancy.
Gadolinium helps to make the endplate changes more conspicuous on T1WI
Staph aureus is the most common cause in a 75 year old
MRI appearances can mimic modic type 1 changes
In screening mammography, granular microcalcifications of variable size and shape is suggestive of?
DCIS
LCIS
Papilloma
Milk of calcium
Oil cyst
DCIS - pleomorphic
Patient with a chance fracture of T12. Which is the most common associated injury ?
Renal laceration
Splenic laceration
Duodenal contusion
Mediastinal haematoma
Rib fracture.
Duodenal contusion
65 year old male with back pain and a T8 sclerotic lesion on xray. Most appropriate next management?
No further investigation required.
Bone scan
MRI.
CT.
Skeletal survey.
CT.
Patient with acute pulmonary oedema. Normal heart size. Which is Least likely?
Massive PE.
AMI.
Chronic pericarditis.
Mediastinal fibrosis.
Neurogenic cause.
Massive PE.
Pseudomyxoma peritoneii is most common in?
Appendiceal mucocoele
Mucinous cyst adenocarcinoma of the ovary.
Mucinous carcinoma of the appendix.
Mucinous carcinoma of the appendix.
Mr. John’s is supposed to get a PICC line. Mr Smith is supposed to get a CT Scan. Mr. John’s details are attached to Mr. Smith’s request form and he is sent for his PICC line. What is the best question to ask?
What is your name.
What is your MRN
What is your date of birth.
What is your understanding of what procedure you are getting today?
What is your understanding of what procedure you are getting today?
6 year old girl with clinodactyly of the 5th finger with features of bone and soft tissue overgrowth. What is most likely?
NF1
Macrodystrophia
Macrodystrophia lipomatosa
Clinodactyly – radial angulation at an interphalangeal joint in the radio-ulnar or palmar planes
Typically affects the 5th finger
Varied aetiology, ranging from congenital to acquired
Aneuploidic syndromic
- Down syndrome
- Klinefelter syndrome
- Trisomy 18
- Turner syndrome
Non-aneuploidic syndromic
- Cornelia de Lange syndrome
- Feingold syndrome
- Roberts syndrome
- Russell-Silver syndrome
- Fanconi anaemia
Non-syndromic
- Macrodystrophia lipomatosa
- Brachydactylyl type A3
Which of the following is NOT a component of the Wells criteria?
Haemoptysis
HR greater than 100
Oral contraceptive pill
Previous DVT/PE
No other diagnosis more likely than PE
Oral contraceptive pill
A variant of a woman presents at 32 weeks with possible intracranial calcs on the Trans abdominal study. What do you do?
If the baby is in a cephalic presentation do a TV study.
TORCH infections do not cross the placenta in the 3rd trimester and are therefore excluded
If there is also hepatic calcification this is seen in DiGeorge syndrome
If there has been prior chromosomal testing this is not necessary.
If the baby is in a cephalic presentation do a TV study.
A lady has mammographic biopsy result of LCIS with adjacent calcification. What is the cause of the calcification?
Calcification is an incidental finding.
Calcifications are related to necrotic material in ducts.
Calcification is due to periductal exudate/inflammation.
Calcification is an incidental finding.
Which is an X linked inherited disorder?
Adrenoleukodystrophy
Alexander disease
Hurler
Leigh
Tay Sachs
Adrenoleukodystrophy
Adrenoleukodystrophy
- Characterised by a lack of oxidation of very long chain fatty acids (VLCFAs) that results in severe inflammatory demyelination typically of the periventricular deep white matter with posterior-predominant pattern and early involvement of the splenium of the corpus callosum and parietal white matter changes.
- There tends to be cortical and subcortical U-fibre sparing.
Alexander disease
- There are three clinical forms: infantile/childhood-onset (most common), juvenile onset and adult onset (AOAD).
- Mutation in the coding region, mapped to chromosome 17q21, of GFAP an astrocyte-specific intermediate filament protein.
- Macrocephaly is typically present, and other clinical features include progressive quadriparesis and intellectual failure.
- Most of the cases are sporadic. However, familial disease has also been reported.
- The disease begins in the frontal region and extends posteriorly.
Hurler syndrome
- One of the mucopolysaccharidoses.
- It manifests in the first years of life with intellectual disability, corneal clouding, deafness, and cardiac disease.
- It carries an autosomal recessive inheritance.
- Hydrocephalus, J-shaped sella, cord compression at the craniovertebral junction, shortening and widening of long bones, pointing of proximal metacarpals, widening of anterior ribs, thoracolumbar kyphosis, anterior inferior vertebral body beaking.
Leigh syndrome
- Leigh syndrome, also known as subacute necrotising encephalomyelopathy (SNEM), is a mitochondrial disorder with progressive neurodegeneration that invariably leads to death, usually in childhood.
Tay Sachs
- Tay-Sachs disease is a hereditary neurodegenerative disorder resulting from excess storage of GM2 ganglioside within the lysosomes of cells.
- MRI is superior to CT in delineating deep white matter demyelination.
- Thalami may show changes consistent with calcification, best seen on T2* weighted sequences.
- No abnormal contrast enhancement is described.
Most common presentation of tracheomalacia?
Always has expiratory stridor
The trachea is extremely dilated.
There are concentric tracheal rings.
The trachea is extremely dilated. - Plain inspiratory radiographs are usually normal or may demonstrate a dilated trachea.
Regarding male breast cancer, which is most true?
40-60 y.o.
Most common type is invasive ductal cancer.
Worse prognosis than female for same subtype and age.
Painful subareolar mass.
Most common type is invasive ductal cancer.
85-90%
Regarding inverting papilloma. Most correct?
Association with SCC.
Arises from lateral pterygopalatine fossae.
When it gets large it causes posterior displacement of the posterior wall of the maxillary sinus.
Arises from bony nasal septum.
Association with SCC.
70 y.o. Man with SVC syndrome from adenopathy obstructing the SVC with lung cancer. There is an avidly enhancing structure above the right hilum. What is most likely?
Dilated azygos vein.
Dilated pulmonary artery
Dilated pulmonary vein.
Bronchogenic cancer.
Hilar LN
Dilated azygos vein.
US of the rotator cuffs for subscapularis?
External rotation with elbow flexed.
Abducted shoulder, and arm straight.
Arm across front, touching shoulder.
Arm behind back.
Neutral position.
External rotation with elbow flexed.
Patient has chondrocalcinosis of the menisci and patellofemoral OA. What would other imaging show?
Pubic symphysis calcification.
MCP involvement.
1st MTP involvement.
Pubic symphysis calcification.
Which is least likely regarding the thymus?
Thymoma is most common in adolescence.
Ectopic thymus tissue in the neck is a known variant.
The thymus decreases in size during stress.
The largest absolute size is at 10 - 15 years.
Thymoma is most common in adolescence. - The typical presentation is in the 5th to 6th decades, without gender predilection.
Q67. There is focal dilatation of the distal CBD bulging at the duodenal wall. Which type of choledochocoele is it?
1
2
3
4
5
3
Which is least likely to cause intussusception in a 2 year old?
Crohn’s disease
Meckel’s diverticulitis.
Lymphoma.
Gastroenteritis.
Crohn’s disease
A 50 y.o. Male has abdominal pain. In the terminal ileum there is a long segment of bowel with a target sign appearance and proximal dilatation of the small bowel. What is most likely?
Intussusception.
Carcinoma
Lymphoma
Crohn’s
Crohn’s
Hydatiform moles are most associated with?
Bilateral theca lutein cysts.
If there is extension into the veins then that means malignancy.
Lung mets from invasive mole are poorly responsive to chemotherapy.
Bilateral theca lutein cysts.
4 week old with jaundice. There is a 8.5mm gallbladder and a hyperechoic triangular cord at the porta hepatis. What is most likely?
Biliary atresia
Alagille syndrome.
Neonatal hepatitis.
Biliary atresia
Osteomyelitis/discitis. Which is most correct?
MRI changes mimic MODIC 1
Gadolinium helps to identify endplate changes on T1.
Staph aureus is most common in 75 y.o.
Paraspinal mass suggest malignancy.
Staph aureus is most common in 75 y.o.
Most common of all, 80-90%
In screening mammography, granular microcalcifications of variable size and shape. What is most likely?
DCIS.
LCIS.
Papilloma.
Milk of calcium.
Oil cyst.
DCIS
Young child, physiological uptake is not seen in:
Thymus
Heart
Bone marrow
Colon.
Thyroid
?Maybe thyroid
Cystic lesion deep to parotid extending to parapharyngeal space
1st branchial cleft cyst
2nd branchial cleft cyst
3rd branchial cleft cyst
Lymphangioma
1st branchial cleft cyst
Which is not involved in Le Fort 3 fracture or tripod fracture.
Orbital floor
Zygomatic arch
Maxillary wall
Orbital roof.
Orbital roof.
Le Fort
Type 1
- Horizontal maxillary fracture, separating the teeth from the upper face
- Fracture line passes through the alvoelar ridge, lateral nose and inferior wall of the maxillary sinus
Type 2
- Pyramidal fracture, with teeth at the pyramidal base, and nasofrontal suture at its apex
- Fracture arch passes through the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bone
- Uppermost fracture line can pass through the nasofrontal junction
Type 3
- Craniofacial disjunction
- Transverse fracture line passes through the nasofrontal suture, maxillo-frontal suture, orbital wall and zygomatic arch/zygomaticofrontal suture
- Risk of temporalis muscle impingement
30 yo female presents with proximal dysphagia. What is most likely?
Zenker’s diverticulum
Cancer.
Barretts
Scleroderma.
Zenker’s diverticulum
Rarely found <40yo
V/Q scan. Which is most correct?
Modified PIOPED can be reported as “normal” study.
Large perfusion defect with pleural defect is associated with high likelihood of PE.
Technegas given before perfusion
Technegas is given as 5x MAA
Pleural effusion…
Technegas given before perfusion
Used during the ventrilation phase, performed before the perfusion phase
vSacral lesion with soft tissue mass. Which is NOT definitely associated?
GCT
Chondrosarcoma
Chordoma
Lymphoma
Ewings sarcoma.
Lymphoma – but not a great answer
50yo female with chronic umbilical discharge. CT shows bladder roof wall thickening and cyst and discharge from umbilicus. Which is most likely?
Adenocarcinoma
SCC
TCC
Adenocarcinoma
6 month old with macrocephaly and retardation. MRI shows cystic collection in posterior fossa. What other features are MOST supportive of a Blake’s Pouch cyst?
Hypoplastic vermis, enlarged 4th ventricle, hydrocephalus, no occipital dysplasia.
Normal vermis, normal 4th ventricle, hydrocephalus, no occipital dysplasia
Hypoplastic vermis, normal 4th ventricle, no hydrocephalus, no occipital dysplasia.
Normal vermis, enlarged 4th ventricle, hydrocephalus, no occipital dysplasia.
Normal vemis, normal 4th ventricle, hydrocephalus, occipital dysplasia
Normal vermis, enlarged 4th ventricle, hydrocephalus, no occipital dysplasia.
Knee pain in adult. Which is LEAST likely to be injured in pivot shift injury?
ACL
PCL
MCL
Posterolateral tibial plateau
Lateral femoral condyle
PCL
Which is NOT a recognized sacral lesion with soft tissue mass?
Chrondoblastoma
Ewings sarcoma
Chordoma
Lymphoma
GCT
Chrondoblastoma
Mortons neuroma which is false?
Pain due to entrapment of a digital nerve.
As a hypoechoic, well defined lesion on ultrasound.
Bilateral in 10%
Between metatarsal shafts.
Usually occurs in middle aged women
Between metatarsal shafts.
Liver MR with hepatocyte specific contrast agent in ~40 yo. Woman. Shows arterial hyperenhancement, isointensity in both PV and delayed phase 20 minutes later. Most likely?
FNH
Adenoma
Fibrolamellar HCC
Metastasis
Hemangioma
FNH
Middle aged women with abdominal discomfort. Gastric fundus 1.5cm sessile mass at right angles to lumen. Which is most correct?
Stromal tumour
Lipoma
Lymphoma
Neurofibroma
Stromal tumour
Young boy with unilateral chest wall deformity. Small chest, absent pectoral muscles. Most likely?
Cleidocranial dysplasia.
Poland syndrome
NF 1
Poland syndrome
MAG3 + Captopril scan is used to diagnose: rep
Renal artery stenosis
PUJ obstruction
Renal function
RCC
Renal artery stenosis
Female patient in 3rd trimester has 3 days of painless PV bleeding. What is most likely?
Accreta
Abruption
Circummarginate
Praevia
Percreta.
Praevia
Low lying placenta – close to, or covering the internal cervical os
45 y.o female patient with a 9cm pancreatic lesion with a mural nodule and peripheral calcifications. What is most likely?
Mucinous cystadenoma
IPMN
Serous cystadenoma
Solid-pseudo-papillary
Mucinous cystadenoma
40 y.o. Man with a unilocular mandibular cyst with an enhancing mural nodule.
OKC
Amelloblastoma
Radicular cyst
Periapical cyst.
Amelloblastoma
Lady with painless swelling of the neck. Ultrasound shows 3 solid/cystic lesions. One in the parotid, and 2 in the adjacent soft tissues. What is most likely?
Sjogrens
Warthins tumours
Lymphoma
Metastases
Lymphoepithelial cysts.
Warthins tumours
60 year old with an intracranial calcified cyst found during work up for dementia. What is most likely?
Choroid plexus cyst
Neurenteric cyst.
Epidermoid cyst.
VIrchow robin’s spaces.
Choroid plexus cyst
A twin peak sign in pregnancy can occur in what?
Can occur in monozygotic dichorionic
Can occur in monozygotic monoaminotic
Associated with twin to twin transfusion syndrome
Can occur in dizygotic monochorionic pregnancy
. can occur in monozygotic diaminotic
Can occur in monozygotic dichorionic
78 yo. Female has painless diplopia.Imaging demonstrates nodular thickening of the medial rectus and superior rectus in right eye. What is most likely?
Metastases.
Lymphoma
Grave’s disease
Orbital pseudotumour
Inflammation.
Lymphoma
Primary lymphoma of the orbit is one of the commonest orbital tumours and accounts for as much as half of all orbital malignancies. It is a B-cell non-Hodgkin lymphoma, and in most cases arises from mucosa-associated lymphoid tissue (MALT).
Type of bladder injury that can be occult on CT:
Mucosal tear.
Intimal injury
Intraperitoneal rupture
Extraperitoneal rupture
Mucosal tear.
What is least associated with annular pancreas? (I think underlying question has to do with GI associations in Downs).
Oesophageal atresia
Anal atresia
Congenital heart disease
Hypertrophic pyloric stenosis.
Hypertrophic pyloric stenosis. – T18 or Tuners
An old man has a fall, rib fractures and pneumothorax. What is most urgent indication for drain?
Air-fluid level.
Ipsilateral mediastinal shift
Eversion of the ipsilateral hemidiaphragm.
Visualisation of lateral pleural edge.
Eversion of the ipsilateral hemidiaphragm.
CT chest in Acute chest pain patient radiation to back. Non contrast CT shows high density in the media. What is most likely?
Intramural hematoma.
Dissection
Aneurysm
Aortitis.
Intramural hematoma.
A lady has a 3mm proximal carotid ICA aneurysm. What is likely?
The aneurysm is at high risk of rupture and needs urgent neurosurgical review.
The aneurysm can compress structures and cause neurological compromise.
Monitor over next few months.
Monitor over next few months.
With Haemophilia B what is most (? Least likely)?
Most presents at birth?
Secondary avascular necrosis occurs most commonly at hip.
Secondary osteoporosis occurs most commonly at knee.
Secondary osteoporosis occurs most commonly at knee.
Neonatal renal ultrasound, which are not normal findings:
Cortical echogenicity equal to or greater than liver
Prominent hypoechoic pyramids
Prominent echogenic sinus
Junctional parenchymal defect at right upper pole
Fetal lobulations
Cortical echogenicity equal to or greater than liver
Tamm-Horsfall proteins, also known as uromodulin, may be a cause of echogenic renal pyramids in a neonate.
Voltage gated potassium channel encephalitis affects which part of the brain:
Hippocampus
Habenula
Central tegmental tracts
Dorsolateral prefrontal cortex
Olfactory gyrus/cortex/groove
Hippocampus – amygdala without hippocampus
Low T2 signal mass in the latissimus of a 33 year old male:
Desmoid
Elastofibroma
Other less correct sounding things
Desmoid - right age, right signal
Biliary atresia, which is most suggestive:
Dilated intrahepatic ducts
Reduced vascularity at periphery
Debris in gallbladder
Cyst at porta hepatic
Dilated portal vein
Cyst at porta hepatic
hepatic ducts absent
absent gb
dilated ha
Which is correct:
Vasogenic oedema has restricted diffusion
Around an abscess, the ADC is low
Intracellular methaemoglobin is low on DWI
Acute infarct is high on ADC
Arachnoid cyst is markedly hyperintense on DWI
Intracellular methaemoglobin is low on DWI
TCC:
Renal pelvis more likely papillary type
Bladder more likely sessile type
Ureter more likely papillary type
Renal pelvis more likely papillary type
Follow up for antenatal hydronephrosis, which is incorrect:
Dilated ureter implies obstruction
Renal pelvis thickening with reflux
Ectopic ureterocele implies duplex in female
Ultrasound at day two has a high false negative rate
Dilated ureter implies obstruction
Cardiac myxoma false:
Uniform low T2 signal
Heterogeneous enhancement
Attached to septum
Can be pedunculated
Carney syndrome
Uniform low T2 signal -
Can be variable due to heterogeneity in tumour components; e.g. calcific components > low signal; myxomatous components > high signal
Which is true:
Cardiac myxomas account for 50% of primary cardiac tumours
Cardiac metastasis less common than cardiac primary malignancy
Cardiac myxomas account for 50% of primary cardiac tumours
Invasive lobular CA:
Well circumscribed
Typical non-mass like enhancement on MRI
Malignant microcalcifications
Local staging best by MRI
Local staging best by MRI
Chronic recurrent multifocal osteomyelitis:
More than 5 lesions on bone scan
Typical lytic lesion at the epiphysis
Distal third of the clavicle
Tibial location is most common
Tibial location is most common
IV contrast passes into the media of an artery in:
PAU
mural thrombus
IMH
Transsection
Aneurysm leak
PAU
20 year old male with renal artery stenosis and infrarenal aortic stenosis:
Takayasu
Bechets
PAN
Kawasaki
FMD
Takayasu
Bilateral painless lacrimal gland enlargement and unilateral preseptal swelling in a female:
Lymphoproliferative
Inflammatory
Thyroid eye disease
Metastasis
Erdheim-chester disease
Lymphoproliferative
Angiodysplasia most common location:
Right colon mesenteric
Right colon antimesenteric
Left colon mesenteric
Left colon antimesenteric
Left colon mesenteric and antimesenteric
Right colon antimesenteric
Crazy paving pattern, which is false:
PAP
Invasive mucinous adenocarcinoma
PCP
RB-ILD
Alveolar sarcoidosis
RB-ILD
Renal artery stenosis:
10% FMD
15% cause of hypertension
High resistive index distal to site of stenosis
Elevated aortic ratio greater than 2.5cm/s
Acceleration time greater than 3s
Elevated aortic ratio greater than 2.5cm/s
Ectopics, which is false:
Myometrial anterior thinning and vascularity in scar ectopic.
Interstitial ectopic has thinning of myometrium but sac is continuous with endometrial cavity
20% have pseudosac appearance
Interstitial ectopics can present later
Interstitial ectopic has thinning of myometrium but sac is continuous with endometrial cavity
Hepatic Infantile hemangiomas associated with:
GLUT1 underexpressed
More than 5 skin hemangiomas
Calcification
Low T2 high T1
Calcification – occurs in 15%
Low T2 low T1 Baker’s cyst in young male:
PVNS
Erosive osteoarthritis:
DIP and PIP reasonably equally common
Synovitis
MCPJ
Synovitis
- Chronic lymphadenitis most correct
Severe infection
Most likely in the inguinal region
Complicated by fistula
Painful masses
Can be generalised in systemic viral infection
Can be generalised in systemic viral infection – true
Subacute thyroiditis (DeQuevins)
Gland grossly enlarged
Gland small and shrunk
Normal size
Slight enlargement
Gland nodular and enlarged
Slight enlargement
Sub-acute thyroiditis can either be granulomatous (De Quervain) or lymphocytic.
Granulomatous
- F>M, ages 40-50
- Probably triggered by viral infection
- ‘Unilaterally or bilaterally enlarged and firm’, ‘Is painful with variable enlargement of the gland’
- Radiopaedia ‘thyroid gland is mostly normal in size but can be enlarged or smaller in size’
- Usually have elevated T3 and T4 and low TSH
- Radioactive iodine uptake is diminished
Lymphocytic
- Usually middle aged females or in post-partum state
- Painless
- Thyroid appears normal side from possible mild symmetric enlargement
- Can present with hypertrhyoidism with most patients euthyroid by 1 year, can develop hypothyroidism
- D is favoured (mild enlargement)
Which is correct;
PML at frontal lobe gyri
HSV1 encephalitis inferior temporal lobes
HSV1 encephalitis inferior temporal lobes
HSV1 typically leads to bilateral and asymmetric involvement of the limbic system, mesial temporal lobes, insular cortices and inferolateral frontal lobes. Basal ganglia typically spared.
- Robbins ‘inferomedial temporal lobes and orbital gyri of frontal lobes’ . Perivascular infiltrate with Cowdry A intranuclear viral inclusion bodies.
PML relates to oligodendrocyte infection by the JC virus in immunosuppressed patients.
- Typically bilateral asymmetric supratentorial white matter and thalamic involvement.
- Subcortical frontal and parieto-occipital regions are common locations.
Both are correct, B maybe more specific
Asbestos related disease incorrect
Pleural effusion
Mesothelioma be difficult to histologically distinguish from metastatic adenocarcinoma
No zonal predilection of plaques
Thickening involves visceral and parietal pleura
Associated with lung adenocarcinoma and SCC
No zonal predilection of plaques
Ulcerative colitis most associated with
PSC
PBC
PSC
UC is associated with PSC, 7.5% of patients with UC have PS, 70% of those with PSC have IBD.
PSC affects both the intra and extra-hepatic ducts resulting in a beaded appearance. There is often a +ve p-ANCA. Increased risk of chronic pancreatitis, cholangiocarcinoma and HCC.
PBC is mostly middle-aged females with other autoimmune disorders (Sjogrens in 70%, scleroderma in 5%). 95% of patients are AMA positive. Radiology can be normal as only small intra-hepatic ducts are affected
AFP elevated in which testicular tumour
Seminoma
Teratoma
Embryonal
Endodermal sinus tumour
Choriocarcinoma
Endodermal sinus tumour (other name for yolk sac - yolk sac name not given)
Pelvic inflammatory disease
Endometrium is oedematous
Gonorrhoea treated with curettage
Community acquired starts in uterus
Fusion of the Fallopian tubes
Infertility common in chronic
Infertility common in chronic (40% chance of 3 episodes of PID) 8% after the first episode to as high as 40% after three
Over time the infecting organisms can disappear leaving the sequelae of chronic follicular salpingitis which is where the tubal plicae adhere to each other and fuse in a scarring process.
PID is generally an ascending infection, often beginning in the vulva or vagina. This can then lead to endometritis, salpingitis and later infect contiguous structures (TOA). Gonococcus infection usually starts in the endocervical mucosa. Non-gonococcal infections following instrumentation more likely spread from the uterus upward through the lymphatics and venous channels rather than on the mucosal surface.
Causes include:
- Neisseria gonorrhoeae
- Chlamydia trachomatis
- Polymicrobial infections in up to 35%
- Rarer aetiologies include TB and actinomyces
- Can be sexually transmitted or relate to delivery, abortion or instrumentation.
PID (?false)
Tubo ovarian abscess can be treated by antibiotics
Fallopian tubes become fused
Endometrium is oedematous
Community acquired disease originates in the uterus
Infertility common in chronic
Community acquired disease originates in the uterus FALSE
The infection generally ascends from the vagina or cervix (cervicitis) to the endometrium (endometritis), then to the fallopian tubes (salpingitis, hydrosalpinx, pyosalpinx), and then to and/or contiguous structures (oophoritis, tubo-ovarian abscess, peritonitis).
Research shows tubal scarring caused by PID can lead to tubal factor infertility (a condition in which the fallopian tubes are blocked or damaged) in between 8% (after one PID occurrence) and 40% of women (after three or more occurrences).
Ectopic pregnancy - Which does not predispose
PID
Previous miscarriage
Appendicitis
Endometriosis
IUCD
Appendicitis
Cervical cancer correct
Improved rates post HSV vaccination
Spread to pelvic wall is Stage II has a poor prognosis
Lymphadenopathy first along the gonadal vein and retroperitoneum
The combined in situ lesions have a 5yr 50% chance of turning into cervical carcinoma
Most patient die from local complications
Most patient die from local complications TRUE Most die from local tumour extension rather than distant metastases
Improved rates post HSV vaccination (yes HSV…trick, didn’t mention HPV) Improved post HPV vaccination- most closely associated with HPV 16 and 18
II - beyond the uterus, but not to the pelvic side wall
A - Involvement of the upper 2/3 of vagina
B - involvement of the parametrium
III - involvement of the lower 1/3 of vagina, pelvic side wall, hydronephrosis or pelvic/para-aortic node involvement
Incorrect, usually iliac and obturator nodes first > common iliac > para-aortic
Orbital Tumours most correct
Uveal melanoma metastases to liver
Retinoblastomas usually bilateral
? Something about capillary haemangioma of orbits in adults
Uveal melanoma metastases to liver
Most common intra-ocular malignancy in adulthood is uveal mets (typically to choroid). Most common intra-ocular primary is uveal / choroidal melanoma. Breast cancer followed by prostate, melanoma and lung are most likely to metastasise to the orbit.
Cavernous malformations / haemangiomas, although not true neoplasms, are the most common benign adult orbital tumour.
Orbital lymphoma is the most common orbital neoplasm in older adults (>60)
Retinoblastoma
- Bilateral 30-40% of cases - always have a germline mutation
- Unilateral 60-70% - are a germline mutation in 15% of cases, 85% sporadic
- So ~55% are related to a germline mutation
Fat embolus not correct
Haemorrhage and oedema in lung
Usually occurs 1-3 days post trauma
Petechial rash
Usually after long bone fracture
Contains adipose tissue
Contains adipose tissue
Represents microscopic fat globules with or without haematopoietic marrow elements
Brown pigment biliary stones
TPN
Haemolysis
Hypertriglyceridemia
none, infection
Pigment stones can be black or brown. These account for 10% of stones and have a low cholesterol content <20%.
Black pigment stones relate to chronic haemolysis, cirrhosis or intestinal malabsorption.
Brown stones relate to bacterial infection, parasitic infection (Clonorchis) and biliary stasis.
They can be formed where there is intraductal stasis and chronic colonisation of bile with bacteria i.e. postsurgical strictures, choledochal cysts.
Most (80%) stones are mixed and only 10% considered cholesterol stone (i.e. >50% cholesterol content). Risk factors for cholesterol and mixed stones include female gender, older age, diet, rapid weight loss, obesity, OCP and TPN.
Fibrous cortical defect least likely
In femur
Permeative (moth eaten) margins on xray
Permeative (moth eaten) margins on xray
A fibrous cortical defect is a fibroxanthoma, identical to a NOF although are < 3 cm.
They are very common, most typically seen between 2 – 15 yrs of age.
There is a slight male predilection.
Typically in the metaphysis or diametaphysis and most common in the distal femur or tibia.
Much less common in the upper limb.
They are lucent cortical defects with a thin rim of sclerosis.
There is no involvement of the medullary cavity and no periosteal reaction.
GIST correct
Small and large bowel commonest sites
GIST is a generic term encompassing leiomyoma and leiomyosarcoma
Exophytic mucosal lesion
Associated with NF1 Multiple in MEN1 (or maybe it said NF1?)
Associated with NF1 Multiple in MEN1 (or maybe it said NF1?) Associated with NF1, Carney triad and Carney-Stratakis syndrome
Testicular tumour associated with gynaecomastia
Leydig
Seminoma
Leydig
Leydig cell tumours account for 2% of testicular tumours.
Mostly occur between 20 – 60.
Can produce oesotrogens and/or corticosteroids. 10% are invasive and metastatic.
GCTs account for 95% of testicular tumours and are generally malignant. The sex cord stromal tumours are usually benign.
Most GCTs are mixed (60%), containing a mix of seminoatous and non-seminomatous components.
Seminomas account for 50%, peak incidence 30 – 40. Spermatocytic seminomas are rare (1-2%) and mostly in patients > 65.
They have a good prognosis and are not associated with intra tubular germ cell neoplasia (a precursor to GCTs).
Eye painless inf rectus and medial oblique involvement, adjacent stranding
Thyroid eye
IgG4
Pseudotumour
Thyroid eye
Regarding penis pathology which is incorrect;
Phimosis increased risk of SCC
???SCC and Bowen Disease (condolymata 6, 11)
Hypospadias and UTI
Epispadias and sterility
Circumcision protects against HPV
Epispadias and sterility – Sterility is not infertility
Fertility is lower with epispadias
Upper zone calcified and non calcified nodules as well as hilar calcified and non calcified lymphadenopathy
Treated TB
Sarcoidosis
Silicosis
Silicosis
Renal calculi most likely
Struvite calculus and proteus
People with hypercalemia develop stone
Both are true - Likely A
Struvite (MAP) stones are associated with chronic infection by urea splitting organisms and staghorn calculi. Proteus is one of these organisms that can convert urea to ammonia.
These calculi tend to precipitate in alkaline urine.
Most stones are calcium containing and associated with hypercalcaemia or hypercalcuria (60%). Other conditions that can contribute include hyperoxaluria and hyperuricosuria. Up to 20% have no demonstrable metabolic activity.
Haemochromatosis least correct
Erosions and subchondral cysts
Beaked (or hook?) osteophytes
Symmetric and bilateral
Chondrocalcinosis
Most commonly involves 4th and 5th MCPJs
Most commonly involves 4th and 5th MCPJs
Usually 2nd and 3rd MCPs
HADD most correct
Linear
Intra-articular
Cloudy intra-articular calcifications
Focal periarticular calcification
Focal periarticular calcification
Peri-articular > intra-articular deposition of HA crystals. More appropriately called calcific periarthritis / enthesitis / tendinitis.
Foci are typically round – ovoid and either ill or well defined. Can be intra-articular.
Parotid LEAST correct
Warthins can occur in lymph nodes
Anaplastic better prognosis
Mucoepidermoid can have perineural spread
Pleomorphic adenoma can be radiation induced
Adenoid cystic frequently recurs
Something about acinic? Most common in parotid
Anaplastic better prognosis - worst prognosis
Regarding thyroid cancer most correct
Follicular most common
Hurthle cell tumour has C cells
Anaplastic has a good prognosis
Papillary associated with something (?MEN1) or Medullary associated with MEN2
Papillary associated with something (?MEN1) or Medullary associated with MEN2
Most cases of medullary are sporadic, but also associated with MEN 2 A and B
Phaeochromocytoma most correct
MRI most sensitive ~98%
In and MIBG stuff: Differentiating between benign and malignant
Iodinated contrast contraindicated in metastatic phaeo
MRI most sensitive ~98%
Wegners most likely to affect
Trachea (maybe upper airway)
Heart
Smooth muscle / skeletal muscle
Small bowel
Trachea (maybe upper airway)
Wegner is a multisystem non caseating necrotising granulomatous cANCA positive vasculitis affecting small – medium sized arteries, capillaries and veins.
The triad is classically:
- Lung involvement
- Upper respiratory tract / sinus involvement
- Renal involvement
Can range from focal or segmental to crescenteric / proliferative glomerulonephritis
GI and cardiac involvement is uncommon.
Ductal pancreatic adenocarcinoma associated with
BRCA 2
Li Fraumeni
MEN 1
Carney triad
BRCA 2
Li Fraumeni
- AD inherited mutation in p53
- Increased risk of breast cancer, sarcoma, leukemia, multiple CNS tumours, adrenocortical carcinoma
BRCA 2
- Breast cancer (30-90%) by aged 70
- Ovarian
- Male breast
- Prostate
- Pancreas
- Stomach
- Melanoma
- GB and bile duct
- Pharyngeal
- Note BRCA1 is less associated with male breast cancer but more associated with ovarian ca.
MEN 1 ‘3 P’
- Parathyroid hyperplasia > adenoma > carcinoma
- Pituitary adenoma
- Pancreatic neuroendocrine tumours
Carney triad ‘Carney’s eat garbage’
- Chondroma (pulmonary) i.e. hamartoma
- Extra-adrenal phaeochromocytoma
- GIST
peutz jegher even higher
Trisomy 21 least likely to be associated moderately increased risk of
Secondary biliary cirrhosis
Leukaemia - AML
Alzheimers
ASD
Atlantoaxial subluxation
Secondary biliary cirrhosis
Pagets nipple least likely:
Looks like ulcerating SCC
Involves nipple before areola
Commonly associated with invasive ductal carcinoma
Approximately 100% ipsilateral DCIS
Often ipsilateral IDC
Looks like ulcerating SCC
Eczema rather than ulcerating
Regarding breast cancer treatment least likely:
Inject subdermal/inferior axilla with dye +/- isotope in the low axilla
Traditional staging included axillary node dissection
Axillary clearance associated with moderate morbidity
Negative sentinel lymph node biopsy correlates to low risk of LN involvement
Traditional staging included axillary node dissection
Least likely to be a spiculated breast mass (2 questions)
PASH
ILC
Tubular carcinoma
Adenosis
Fat necrosis
PASH
PASH is not commonly a spiculated mass, normally it is a circumscribed or partly circumscribed mass.
- Can mimic a fibroadenoma on ultrasound.
ILC is often multicentric and bilateral.
- Sensitivity of mammogram for ILC is up to 80%.
- It most commonly appears as a spiculated mass.
- Less commonly asymmetric density, architectural distortion or region of microcalcifications.
- Up to 16% are occult or benign appearing.
Tubular carcinoma is a subtype occurring in younger women with a good prognosis.
- It is usually a small <1cm spiculated mass.
- They are associated with radial scars.
Adenosis can be difficult to distinguish from an infiltrating carcinoma.
- It can appear as a mass, region of architectural distortion or demonstrate microcalcifications (up to 55%).
Ewings sarcoma (2 separate qns) ?true
Age range 15-20
Most commonly in the metaphysis
Most commonly diaphyseal, or flat bones of the pelvis
Can mimic Neuroblastoma
Preference for liver mets is a known phenomenon
Can mimic Neuroblastoma – histologically yes
t/f beta catenin adenomas have increased risk of malignant transformation
true
Beta catenin have the highest rate of malignant transformation of the adenoma subtypes.
Inflammatory type is most common and has the highest bleed rate.
HNF1 alpha Is second most common type and most often multiple
Beta-catenin mutated are the least common.
Seen in men on anabolic steroids, glycogen storage disease and with FAP
Which of the following is not associated with Tuberous Sclerosis Complex
SEGA
Hamartomas
Leptomeningeal angiomatosis
Leptomeningeal angiomatosis
Associated with Sturge-Webber, NF-1
Which of the following is LEAST associated with TS
Cortical hamartomas
SEGA
Rhabdomyoma
LAM
Subependymoma
Subependymoma
TS is associated with subependymal giant cell astrocytomas (SEGA).
- These are WHO grade 1 lesions most commonly seen in age group 8 – 18 with TS.
- They are most commonly located near the Foramen of Monro and can be differentiated from subependymomas by larger size (>1 cm), interval growth, marked enhancement.
Subependymomas are more common in middle – older aged patients and are more commonly located in the 4th ventricle and frontal horns of lateral ventricles.
Fibrolamellar HCC least likely
Are well differentiated
Worse prognosis than traditional HCC
Thick fibrous capsule (?answer) have a pseudo capsule..
Age 20-40
Worse prognosis than traditional HCC - Better prognosis than HCC
FL HCC – most common aged 20-40,
- Often well-differentiated, and
- Usually don’t produce AFP elevation.
- May contain a central scar which is usually hypointense on all phases.
Primary haemochromatosis does not cause iron deposition in
Spleen
Heart
Liver
Pancreas
Spleen
Rheumatoid arthritis most likely
Can have pulmonary nodules at presentation
Spares the small joints of the feet
Often presents with honeycombing / early presentation with honeycombing
Renal failure is most commonly caused by rheumatoid vasculitis
Can have pulmonary nodules at presentation
More common with longstanding disease
Which can cause a cardiomyopathy
Takayasu
Kawasaki
Churg straus
Wegners
Goodpastures
Takayasu Hypertrophic cardiomyopathy
eosinophilic Churg Strauss cardiomyopathy
Can cause a cardiomyopathy in up to 60%, most common cause of death
Guy with massive pulmonary haemorrhage and fibrocavitating upper lobe disease. Angiogram looks at bronchial arteries, which is most likely finding
Aneurysm
Dissection
Beads and line appearance
Neovascularity
Neovascularity
Haemoptysis usually arises from the bronchial arteries due to changes in the terminal vascular bed
aneurysm second most likely (TB)
Mycobacterial disease least associated with
Gohn focus
Asbestosis
Silicosis
Emphysema
Immunosuppression
Asbestosis
Mesothelioma least likely
Difficult to distinguish from secondary adenocarcinoma
Pleural effusion early presentation
Parietal and visceral pleura involved
Peritoneal mesothelioma is rare
Commonly associated with smoking
Commonly associated with smoking- false
“Mesothelioma of the thorax is a malignant neoplasm that involves the parietal pleura to a greater extent than the visceral pleura (,1).
There is a significantly increased risk of developing this disease in those individuals with prior exposure to asbestos.
The lifetime risk of developing mesothelioma in heavily exposed individuals is as high as 10%.
There is a long latent period of approximately 35–40 years for the development of asbestos-related mesothelioma (,1).
However, there has been no evidence to suggest smoking plays any role in the development of mesothelioma. This is in contrast to the significantly increased risk for development of adenocarcinoma in those patients who both smoke and have been exposed to asbestos”
Meigs not associated with
Fibroma
Thecoma
Dysgerminoma
Brenner
Granulosa
Dysgerminoma
MEIGS: Defined by the presence of ascites, pleural effusion (usually right sided) in associated with a benign usually solid ovarian tumour.
In the vast majority of cases (up to 90%), the primary tumour is an ovarian fibroma.
Other primary tumours include:
- Fibrothecoma
- Thecoma
- Granulosa cell tumours of the ovary
- Brenner tumour
A dysgerminoma is the most common malignant germ cell tumour (only 1%). Usually occur in the 2nd and 3rd decades. Thought to be the ovarian counterpart of the seminoma in the testis.
t/f afp up in 90% hcc
false, 75%
Gestation trophoblastic disease least likely
Partial mole is Triploid - 69 XXX or 69 XXY
10% invasive
2-3% choriocarcinoma in partial mole
Bimodal with young and older mothers
2-3% choriocarcinoma in partial mole
Never proven
Polycythemia vera, which is false?
Gallstones
Gout
Transformation to AML
Venous occlusion
Gallstones
Gout most correct:
Juxta-articular erosions
1% of the population have asymptomatic hyperuricaemia
Juxta-articular erosions
closer to 10%
Adenomyosis :
Symmetric enlargement of the uterus
Venous involvement
1% of middle age women autopsies
Clonal something
Lack of response to cyclic hormones early
Symmetric enlargement of the uterus - as opposed to nodular thickening
Enlargement can be diffuse or more focal
Gallbladder adenomyomatosis in radiodiagnosis, which is false
No association with malignancy of GB
Something about focal and diffuse (? diffuse adenomyomatous can mimic )
No association with malignancy of GB - Not premalignant, but found in associated with chronically inflammed gallbladder
Adenomyomatosis is common, 9% of autopsy specimens.
More common in females at 3:1.
Pathologically involves formation of Rokitansky – Aschoff sinuses, intramural diverticula lined by mucosal epthelium, which penetrate into the muscular wall of the GB.
Cholesterol crystals precipitate in the bile trapped in these sinuses.
Gallbladder cancer most correct
Mostly infiltrative not exophytic
Females more than males
Most diagnosed at early stage
Females more than males
3-5:1
Major risk factors are female gender, age and chronic biliary inflammation i.e. gallstones present in 95% of cases
urinary bladder malig most important prognostic factor
detrusor muscle involvment
Although lamina propria involvement worsens prognosis, involvement of the muscularis propria / detrusor is the major determinant of outcome as can be treated with BCG, where if invaded through needs cystectomy
Staging of bladder cancer
Tis – in-situ
T1 – through lamina propria
T2 – into muscularis propria
T3 – invasion into perivesical tissues
T4 – direct invasion into adjacent structures including prostate, uterus, vaginal vault
Prostate cancer most correct
Occurs in transitional zone
T3 is extraprostatic extension
PSA is very specific for prostate cancer
Some weird histo grading system starting with ?Fahman (not gleason)
T3 is extraprostatic extension
T3: localised extra-prostatic extension
Cervical cancer most correct
Stage II involves pelvic sidewall
SCC worse than neuroendocrine
both incorrect
Stage II involves pelvic sidewall
- False
- III: low 1/3 of vagina, extends to pelvic sidewall or causes hydronephrosis or has para-aortic/pelvic nodal disease
- II: tumour beyond the uterus, but not into the lower 1/3 of the vagina or pelvic side wall
SCC worse than neuroendocrine
- False, Neuroendocrine has worse prognosis
Most likely cortically based tumour
DNET
JPA
dnet
DNET is a cortically based tumour. Mnemonic is DOG Pee
- DNET
- Oligodendoglioma
- Ganglioglioma
- Pleomorphic xanthoastrocytoma
Cardiac myxomas least likely
Systemic emboli
Pulmonary emboli
Valvular damage / dysfunction
Fever
Pulmonary emboli – less likely as 75% are in the left atrium
nelson syndrome
bilateral adrenelectomy causing pit macroadenoma
Endocarditis least likely
10% have positive BCs
Abscess in sewing ring
Subacute in a damaged valve
Staph in elderly
Right sided valves >50% in IVDU
10% have positive BCs
In 10% no organism is identified
Young lady DI and hypopituitarism
Empty sella
Rathke
Lymphocytic hypophysitis
Craniopharyngioma
Lymphocytic hypophysitis
More common in women 8:1M
Most common ~35yo
Commonly presents in the peripartum period with headache and endocrine deficiencies
Can cause DI
are mature teratomas benign in an adult
yeah pretty much
A mature teratoma is a dermoid, a benign ovarian germ cell tumour.
Congenital cystic tumour composed of well differentiated derivations of at least 2 germ cell layers.
Bilateral in 20% of patients.
They represent the most common benign ovarian tumour in women < 45 years.
Risk of malignant transformation is <2% and most commonly an SCC.
Usually occurs in the 6th – 7th decades of life in larger tumours <10 cm.
Which is least likely
Idiopathic UIP has a better prognosis than NSIP
Idopathic UIP has a worse prognosis than NSIP
Idiopathic UIP has a better prognosis than NSIP
t/f Neonatal cirrhosis associated with Alpha 1 anti-tripsyin
true
Leading causes of neonatal cirrhosis include:
- Biliary atresia
- Choledochal cysts
- Viral hepatitis
- Alpha 1 antitrypsin deficiency
- Alagille syndrome - proximal biliary duct obliteration, Liver disease
- Progressive familial intrahepatic cholestasis
“Alpha-1-antitrypsin deficiency is a commonly inherited genetic disorder, affecting up to 1 in 1,600 to 1 in 2,000 live births[1,2], most common in those of Northern European heritage.
Individuals who are homozygous for the mutant Z allele (PiZZ) or are PiSZ are at risk for the development of liver disease.
Although emphysema is rarely detectable before the third decade of life, liver disease can present at any age and can be evident as early as 1-2 months after birth.
Four to ten percent of children with alpha-1-antitrypsin deficiency develop clinically significant liver disease during their first twenty years of life, making alpha-1- antitrypsin deficiency the most common genetic cause of pediatric liver disease and the most frequent inherited indication for liver transplantation in the pediatric population”
Wilsons least correct: (so many questions about wilsons & haemochromatosis)
Autosomal recessive
Deposing in lentiform nucleus causing movement disorder
Elevated serum ceruloplasmin
No increase risk of cancer
Elevated serum ceruloplasmin
reduced
atp7b gene
is haemochromatosis assoc with parkinsons
Parkinsonism is associated
Primary haemochromatosis – AR disorder with mutation in HFE gene, regulating iron absorption from the GIT. This leads to reduced hepcidin synthesis.
Iron accumulates as haemosidein in various tissues including liver, pancreas, myocardium, endocrine glands, joints and skin.
CNS involvement is relatively less common. It can present with hypopituitarism or movement disorders such as Parkinsonism due to basal ganglia.
Wilms least associated with
Denys drasher
WAGR
Hutchinsons
Pearlman syndrome
Beckwith weidman
Hutchinsons
Neuroblastoma syndrome
Wilms is a malignant tumour of primitive metanephric blastema.
It is associated with a predisposing syndrome in 10%:
- Bewkwith-Wiedemann
- WAGR
- Denys-Drash
- Sotos
- Pearlman syndrome
Other isolated abnormalities – cryptorchidism, hemihypertrophy, hypospadias, aniridia
Giant cell tumour
Joint was knee - GCT occurs at the knee
Tendon hands wrist
Red brown appearance due to haemosiderin deposition
Can invade bone and joint
Tendon hands wrist
85% around the fingers, with a volar/flexor surface
Most commonly superficial and near the IP joints of the index and long fingers
Hand > wrist > ankle/foot > knee
Regarding diabetes which is true
Type 2 has higher incidence of renal failure than type 1
Associated with mononeuropathy
Leading cause of death is by infection
Macrovascular complications don’t include coronary artery disease
Most diabetics get retinopathy
Most diabetics get retinopathy
True, 78% of type 2
they also can have mononeuropathy
Regarding late pregnancy t/f
Pre eclapsia is associated with seizures
Gestational hypertension is associated with proteinuria
Pre eclapsia is associated with seizures
False, seizures occur in eclampsia
Gestational hypertension is associated with proteinuria
False, proteinuria = pre-eclampsia
Gestational hypertension is characterised by the new onset of hypertension after 20 weeks gestation without any maternal or fetal features of preeclampsia, followed by return of blood pressure to normal within 3 months post-partum. At first presentation this diagnosis will include some women (up to 25%) who are in the process of developing preeclampsia but have not yet developed proteinuria or other manifestations. Some women initially diagnosed in this category will manifest persistent blood pressure elevation beyond 12 weeks postpartum and eventually be classified as having chronic hypertension. Gestational hypertension near term is associated with little increase in the risk of adverse pregnancy outcomes “
Pre-eclampsia usually occurs after the 34th week of pregnancy. It is associated with hypertension and microalbuminuria in 20% post delivery as well as an increase in risk for heart and CNS vascular disease.
Low lying tonsils, Obex of medulla oblongata elongated.
Chiari 0
Chiari 1
Chiari 1.5
Chiari 2
Chiari 3
Chiari 1.5 - complex chiari malformation, low opex
Heart most correct
Moderator bands can mimic masses
Pericardial cysts most likely on left
Moderator bands can mimic masses
Morphological part of the right ventricle.
Extends from the IV septum to the margin of the RV, contacting/joining the base of the anterior papillary muscle
Female, for bone age wrist study. Short stature with short 4th metacarpal
Turner’s
MPS
Achondroplasia
Turner syndrome is 45 XO
Skeletal deformities include a short 4th metacarpal,
- Madelung’s deformity,
- narrowing of the scapholunate angle,
- short stature,
- webbed neck,
- abnormal medial femoral condyle, and
- cubitus valgus.
Hemifacial spasm
AICA loop
Diffusion restriction at CP angle
Diffusion restriction in 4th ventricle
Lesions of corpus callosum
AICA loop
Hemifacial spasm can occur due to irritation of the facial nerve usually at the root exit zone.
An aberrant vascular structure is often a cause.
The vessels most commonly implicated are AICA, PICA and the vertebral artery.
Other causes include cholesteatoma, schwannoma, meningioma, intracranial lipoma and AV malformation.
STIR achieved by
Suppressing fat based on relaxation time
Suppressing fluid based on relaxation time
Suppressing fluid based on chemical shift
Suppressing fat based on relaxation time
a- STIR is ‘short Tau inversion recovery’ and is a fat suppression technique. It is a similar technique to FLAIR which is used to suppress water. Inversion recovery imaging allows homogenous and global fat suppression and can be used with low field strength magnets.
ost correct in anaphylaxis
Decreased response to adrenaline in patients on Beta blockers
IM 1:10000 adrenaline is contraindicated
Decreased response to adrenaline in patients on Beta blockers
A reduction in response to adrenaline is expected in patients on beta-blockers
Least correct about interstitial ectopics
Occurs in mural portion
Interstitial line
5mm myometrium
Interstitium is contiguous with endometrial canal
Deciduous reaction (double decidual sign) of endometrium
Deciduous reaction (double decidual sign) of endometrium
“In normal pregnancies, transvaginal US can demonstrate an intradecidual sign approximately 4.5 weeks after the last menstrual period (,12). The intradecidual sign is a small collection of fluid that is eccentrically located within the endometrium and is surrounded by a hyperechoic ring. At approximately 5 weeks, the double decidual sac sign can be visualized. The double decidual sac sign consists of two concentric hyperechoic rings that surround an anechoic gestational sac in a normal intrauterine pregnancy. The absence of the double decidual sac sign helps distinguish a pseudo–gestational sac from a true viable gestational sac”.
Note interstitials have a higher propensity to rupture due to later presentation and ability to grow to larger size. Major risk factor is previous instrumentation.
Middle aged female, 3 days of increasing knee pain. Red and pain. Effusion. Swelling. most likely
Septic arthritis
RA
septic
Worded exactly “which does not cause A single sclerotic bone lesionS”
Eosinophilic granuloma
Anklyosing Spondylitis
Haemangioma
Insufficiency fracture
Osteomyelitis
Eosinophilic granuloma
Vascular closure device most correct
Bio puts a collagen disc in the vessel wall
<5mm diameter artery contraindicated for suture devices
Suture closures cause an inflammatory reaction
Compression contraindicated in staples
Can’t re-puncture after collagen biodevice in the same site
<5mm diameter artery contraindicated for suture devices
Previous trauma, diaphragm injury. Multiple solid pleurally based masses in L hemithorax
Splenosis
Loculated pleural effusions
Splenosis
Not associated with COP
Reverse halo/Atoll sign
Ground glass
Masses
Dilated bronchi in the abnormal lung
Nodular interlobular septal thickening
Nodular interlobular septal thickening
Features include:
- Most commonly – patchy, migratory subpleural and / or peribronchovascular consolidation
- Less commonly – single pulmonary nodule or mass, multiple pulmonary nodules, parenchymal bands, basilar reticular opacities. Bronchial dilatation within consolidation or GGO is listed as a HRCT manifestation on StatDx.
- Tends to be a middle lobe, lingular and lower lobe predominance
- Most frequent finding is GGO (90%)
- Reverse halo ‘atoll’ sign seen in 19% of cases – ring of parenchymal consolidation surrounding GGO
- Classic for COP. Also seen in invasive fungal infection including aspergillosis and mucormycosis, pulmonary infarction, Wegeners, infection, sarcoid
Early pregnancy. Unsure of dates. CRL 6mm. No heart rate. No adnexal masses. Ovary has a ‘ring of fire’. What is going on
Failed early pregnancy.
Indeterminate - needs repeat
Normal go to normal antenatal care
Heterotopic pregnancy
Indeterminate - needs repeat
if CRL is < 7 mm and no heart beat this is suspicious but not diagnostic of pregnancy failure.
Follow up in 7 – 14 days would be appropriate.
If it were 7 mm, it would be diagnostic.
Findings diagnostic of pregnancy failure
- CRL >/= 7 mm and no HR
- MSD OF >/= 25 mm and no embryo
- absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac
- absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac
- pregnancy with an embryo with no heart activity on initial scan and repeat scan ≥7 days later
- sac with no embryo and an MSD <12 mm on initial scan that fails to double in size on a scan ≥14 days later
- sac with no embryo and an MSD ≥12 mm on initial scan with no embryo heart activity on a scan ≥7 days later 2
Findings suspicious but not diagnostic of pregnancy failure
- CRL < 7 mm and no HR
- MSD 16 – 24 mm and no embryo
- Absence of embryo > 6 weeks post LMP
- Large yolk sac > 7 mm
- Small GS in relation to size of embryo i.e. < 5mm difference between MSD and CRL
- Amnion seen adjacent to YS but no embryo i.e. empty amnion sign
- Absence of embryo with heartbeat 7-13 days after a scan that showed a gestational sac without a yolk sac
- Absence of embryo with heartbeat 7-10 days after a scan that showed a gestational sac with a yolk sac
- Large amniotic cavity
When is it most indicated to perform MCA dopplers
DCDA twins
Concern of Parvo virus
EFW <5% and AC <5%
EFW <5% and AC <5% (parvo also correct)
Fetal MCA doppler used for
- Assessment of fetal cardiovascular distress, anaemia and hypoxia
- IUGR
- Assessment of possible monochorionic twin related pregnancies including TTTS and TAPS
Accurate measurement
- Fetal head in transverse
- Cross section including the thalami and sphenoid bone wings magnified
- MCA found with colour or power doppler
- Obtain measurement as close to its origin in the ICA (systolic velocity decreased away from this point)
- Angle of insonation of < 15 degrees
Parameters
- PI (pulsatility index)
- PSV (peak systolic velocity)
- S/D ratio (systolic/diastolic) – a normal MCA S/D ratio should ALWAYS be higher than the UA S/D ratio
- CPR (cerebroplacental) ratio – ratio of MCA PI and UA PI
Interpretation
Normal
- High resistance flow i.e. minimal antegrade flow in fetal diastole
- CPR > 1:1
- The PI is calculated by (PSV – EDV) / TAV (time averaged velocity) It normally has a high value and slowly decreases through gestation from around 28 weeks onwards. A low PI reflects redistribution of cardiac output to the brain.
Abnormal
- Fetal anaemia
- Elevation of PSV in MCA
- Elevated is > 1.5 MoM for gestational age (multiple of the median)
- Fetal head sparing theory, MCA becomes a low resistance vessel
IUGR
- Asymmetric is the more common form and usually presents in T3. AC is reduced out of proportion to other fetal biometric parameters. AC is < 5 - 10th centile. There is often associated oligohydramnios.
- A PI is recommended in the MCA if the EFW or AC are < 10 %,
The PI is normally high and will slowly decrease through gestation from 28 weeks onwards. If it is low, this represents redistribution of cardiac output to the brain due to the fetal head sparing theory (low PI think low resistance therefore redistribution)
Brain sparing physiology will be adapted, with an increase in MCA diastolic flow and a reversal of the normal ratio between the MCA S/D and UA S/D
CPR is a ratio of the PI in the MCA vs the UA. An abnormal ratio is low and again reflects brain sparing. If the ratio is low it can indicate either an increase in placental resistance or a reduction in cerebral resistance. An abnormal CPR can thus occur even if the UA and MCA parameters are within normal limits, i.e. the MCA would be lower normal range and the UA PI at the upper normal range. Abnormal is < 5th centile or based on MoMs. Generally < 1:1 is abnormal.
Indicated to repeat US post morph scan
Velamentous cord insertion
Cervical length 27mm
Renal pelvis <4mm
Cervical length 27mm
Best measured in TV with an empty bladder
Normal >30mm
The presence of a full bladder can increase the length, esp on a TA study
Regarding vasa previa (or vasera) most correct
Important to establish is fetal or maternal
Check duplexes
Associated with marginal cord insertion
In all cases where a multilobed or succenturiate placenta or low lying placenta or velamentous cord insertion is identified, a TV scan with assessment of the lower uterus / cervix should be performed to assess for vasa previa.
There are two main types of previa:
Type 1 – 90% of cases. Vasa previa with velamentous cord insertion. Low-lying vessels from low cord insertion.
Type 2 – 10%. Low lying vessels connect bilobed or succenturiate lobes.
Pansystolic murmur, exertional syncope. Upturned cardiac apex on CXR, with dilated ascending aorta.
Pressure gradient across AV valve >50mmHg
Some other valves mentioned as the pathological cause
Pressure gradient across aortic valve is mostly used as a marker of aortic stenosis, where there would be an elevated pressure across the valve (i.e. higher in the ventricle).
Core (p 681):
If the aorta is enlarged and the cardiac silhouette is, this suggests AR.
If the aorta is enlarged and the cardiac silhouette is not, this suggests AS.
Pansystolic murmur seen in MR, TR and VSD. AS typically has an ejection systolic murmur but could result in exertional syncope and a dilated ascending aorta.
Upturned cardiac apex implies right ventricular enlargement – secondary to PAH, PV, ASD/ VSD, TR, DCM or TOF.
Not sure what the answer or question is here.
Old lady with lower limb oedema and ascites. Most likely finding on CT chest
Reflux of contrast into the IVC and dilated hepatic veins
35 year old female, mother breast Ca at 60. Has a lump in breast. Mammo 2cm well circumscribed mass, and benign sounding US description. Most likely
Cancer
Phyllodes
Fibroadenoma
Fibroadenoma
What is not associated with thoracic outlet obstruction
AC dislocation
Callous on clavicle fracture
Cervical rib
Hyperostosis 1st rib
Elongated C7 transverse process
AC dislocation
Hypoechoic lesion seen in kidney on US, thought indeterminate. MRI shows T1 low,
T2 high, no enhancement
Simple Renal Cyst
RCC
Oncocytoma
AML
Simple Renal Cyst
40 year old man, 3cm renal mass. US hypoechoic. On MRI T1 hypo, T2 hyper, mild internal enhancement
Clear cell RCC
Cyst
Proteinaceous cyst
Haemorrhagic cyst
Clear cell RCC
Which way does disease not spread from “pterygopalatine fissure” (exact wording)
Anteriorly to maxillary sinuses
Post to brain
Superiorly to orbit
Laterally to infratemporal fossa
Medially to nasal cavity
Anteriorly to maxillary sinuses
5 year old, T1 low, T2 high 2cm mass at dorsal nose with a tract to the foramen caecum of frontal bone
Nasolacrimal dacrocystocele
Nasal dermal sinus
Encephalocele
Nasal dermal sinus
- Represents defective embryogenesis of the anterior neuropore
- Any mixture of dermoid, epidermoid or sinus tract
- A fluid tract signal in the septum, from nasal dorsum to skull base
The foramen caecum represents a primitive tract between the anterior cranial fossa and the nasal space. It is located along the anterior cranial fossa, anterior to the cribriform plate of the ethmoid bone and posterior to the frontal bone, within the frontoethmoidal suture. It lies at a variable distance anterior to the crista galli.
A variety of midline nasal pathologies may occur along this transient embryologic communication:
- nasal encephalocele T2 hyperintense - extension of brain
- epidermoid or dermoid cyst - associated with skin sinus tract or dimple, extends along foramen cecum, and
- nasal glioma isointense to normal brain, no tract, extra bit of brain without continuation of cortex
Which is least likely to be a sacral mass with soft tissue component
Chondroblastoma
GCT
Ewing
Lymphoma
?Met
Chondroblastoma - soft tissue expansion rare.
Usually epiphyseal in young patients
Acute weakness in arm. Diffuse STIR high signal in supraspinatus, infraspinatus and teres minor. Normal T1 signal in muscles. Cause?
Brachial neuritis
Quadrilateral space syndrome
Acute Suprascapular nerve impingement at spinoglenoid notch
Acute Suprascapular nerve impingement at suprascapular notch
Chronic impingement
ANSWER: Brachial neuritis
- Suprascapular nerve is involved in almost all cases
- Axiallary and subscapular nerves can also be involved
Quadrilateral space syndrome
- Humerus laterally, long head of triceps medial, teres major and minor superior and inferior
- Axillary nerve and posterior humeral circumflex artery
- Results in teres minor +/- deltoid involvement
Acute Suprascapular nerve impingement at spinoglenoid notch
- Spinoglenoid notch - below the scapular spine, results in infraspinatus atrophy
Acute Suprascapular nerve impingement at suprascapular notch
- Suprascapular notch, medial to the coracoid, results in supra and infraspinatus atrophy
45M neck mass and difficulty swallowing. CT well defined thin walled mass with airfluid level crossing thyrohyoid membrane. Most likely?
Laryngocele
Abscess
Thyroglossal cyst
Lymphatic malformation
Epidermoid Cyst
Laryngocele
5 year old with a 2cm lump on chin (5HU) also has several small nodules in floor of mouth (-30HU)
Dermoid
Ranulla
Lymphatic malformation
Lymphatic malformation
This is favoured as it is a trans-spatial process. Lymphangiomas are cystic lesions, 90% are in the head and neck.
Young bloke, painful volar forearm mass, rounded, T1 hypo, T2 hyper, enhancing.
Peripheral nerve sheath tumour
Ganglion
Cyst
Nodular fasciitis
This is most likely nodular fasciitis – a non-neoplastic soft tissue lesion most commonly located on the volar aspect of the forearm. Usually patients 20 – 40 years of age.
Can be mistaken for an aggressive lesion on imaging and histology.
30 year old female with a big (?9cm) pancreatic cyst (?or did it just say hypoechoic lesion). Most likely
Solid pseudopapillary tumour
Mucinous
IPMN
SPEN
SPEN
SPEN most common in non-Caucasian females around the 2nd – 3rd decades of life.
Often large heterogenous solid cystic tumours with a median size at diagnosis of 8 cm.
Most are benign but up to 15% are malignant.
HIV cortical echogenic foci in kidneys
CMV nephritis
HIV nephritis
PJP
Calcific foci in the cortex are typical of PCP renal infection.
They were initially thought to be pathognomonic but have also been seen in MAC and CMV infection.
Gas tract between the ileum and sigmoid colon RLQ pain and fever
Diverticulitis
Crohns
Appendicitis
Crohns
Propensity to cause fistulae
Intrahepatic ductal dilatations only. Todani classification
1
2
3
4
5
5
Perianal fistula - grade 5
supralevator
Perianal fistula grading:
- 1 – Intersphincteric
- 2- Intersphincteric with abscess
- 3- Transphincteric
- 4 – Transphincteric with abscess
- 5 – Supralevator or translevator
Child lytic skull lesion T1 low/isointense and T2 high lesion on MRI
Dermoid
Cyst
EG
EG
MRI: T2 high, T1 low to iso, and often diffusely enhancing
Inner table can be eroded more than the outer - hole within a hole
Center of the lesion can contain a sequestrum
Single lesion in calvarium of child, centred on Diploic space, T1 iso, T2 hyper
Leptomeningeal cyst
LCH
Met
LCH
Which has physiological FDG uptake in a 5yr old child
Thymus
Bone marrow
Muscle
thymus
Both A and B are correct, maybe more in thymus
“A number of physiologic variants are commonly encountered, including normal physiologic uptake in the head and neck, heart, breast, thymus, liver, spleen, gastrointestinal tract, genital system, urinary collecting system, bone marrow, muscles, and brown adipose tissue
Bone marrow activity that is more intense than liver activity is considered abnormal.
Normal accumulation is generally homogeneous, with more extensive distribution in children than in adults.
The normal distribution of 18F FDG uptake in children is unique and may differ from that in adults, such as the physiologic activity of the lymphatic tissue in the Waldeyer ring, as well as uptake in the ileocecal region, thymus, hematopoietic bone marrow, and skeletal growth center”.
Child with facial enlargement, CT showing multilocular mandibular and maxillary lytic/ lucent lesions causing bony expansion
Cherubism
Venous lymphatic malformation
Burkitt lymphoma
Cherubism
Autosomal dominant, historically considered a variant of fibrous dysplasia.
Radiographic features are of lucent expanded regions within the maxilla and mandible with soap bubble appearance.
Regarding MS not correct
Optic neuritis progresses to MS in 50%
Auto antibodies against myelin sheath
Bimodal age distribution
Something about relapsing remitting
Auto antibodies against myelin sheath
- No testable antibody, thought to relate to cellular immune response directed against myelin
- Mostly mediated by CD4+ Th cells
Bimodal age distribution
- Peak onset is childhood and age 50, average age 35. Not really bimodal
34yo female with renal insufficiency and headaches. Multiple intra- and extra-cranial aneurysms.
Polycystic kidney disease
FMD
PAN
Takayasu
FMD
- Usually medial dysplasia
- Most commonly affects the mid-segment of vessels, spares the ostium
- Renal > extracranial ICA and vertebral > iliac > others
- Can be associated with aneurysms
\
Polycystic kidney disease
- False, AD PCKD is associated with renal insufficiency, but usually presents later
- 6% association with berry aneurysms
20yr old pt with headaches, HTN, renal artery ostial stenosis
FMD
PAN
NF1
NF1
Renal artery stenosis may be caused by several pathological processes:
- Atherosclerosis (~75% of cases) involves the proximal renal artery
- Fibromuscular dysplasia (~20%) involves the distal renal artery, younger population
- Vasculitides (especially polyarteritis nodosa-causing multiple microaneurysms, Takayasu arteritis, radiation)
- Neurofibromatosis type 1- most commonly involves the ostium
- Abdominal aortic coarctation
- Aortic dissection
- Segmental arterial mediolysis
Qns regarding fetal echo
With a R sided arch, trachea is on the left (of the DA presumably) on the 3 vessel view
Ductal arch and bifurcation of pulmonary trunk seen at the same level
Ductal arch is posterior to aortic arch on a sagittal view
Something about an aberrant R subclavian
With a R sided arch, trachea is on the left (of the DA presumably) on the 3 vessel view (as opposed to being to the right of the DA on a standard view with a left arch. this also presumes drainage to a right arterial duct).
Baby with T21, has distal bowel obstruction, likely
Hirschprung
Ileal atresia
Pyloric stenosis
Annular pancreas
Hirschprung
Occurs in 10% of patients with T21
Paraneoplastic syndromes which is not true
SIADH
Cushings
Cardiomyopathy
Limbic encephalitis
Cardiomyopathy
Myasthenia Gravis most correct
Thymoma in 10%
Occurs in the elderly mostly
Fatal in 50%
Antibodies block the release of acetylcholine
Extra ocular involvement
Thymoma in 10%
Occur in ~15% of patients with MG
30-50% of patients with a thymoma have MG
Sequestration intralobar, commonest lobe
LLL
RLL
RML
RUL
LUL
LLL
Extralobar sequestration. Not True:
Presents <1yr age
Drains to pulmonary veins
Males more than females
No systemic arterial supply
false: Drains to pulmonary veins
Usually to systemic veins, can be pulmonary
Baby with resp distress, CXR initially shows opacity in the L upper zone, next CXR shows a subtle lucency in the left upper zone
CPAM
Sequestration
Congenital lobar emphysema
Congenital lobar emphysema
(CPAM can also be fluid filled in early stages. Subtle lucency sounds like CPAM )
The affected lobe tends to appear opaque and homogeneous because of fetal lung fluid or it may show a diffuse reticular pattern that represents distended lymphatic channels filled with fetal lung fluid. appears as an area of hyperlucency in the lung with oligaemia (i.e. paucity of vessels) mass effect with mediastinal shift and hemidiaphragmatic depression
lateral decubitus film with the patient lying on the affected side will show little or no change in lung volume
lateral film may show posterior displacement of the heart
Regarding oesophagus
Zenker diverticulum occurs in the posterior aspect of the upper third of the thoracic oesophagus
Barrets is intestinal metaplasia
Something about scleroderma
Barrets is intestinal metaplasia
- Intestinal metaplasia of the oesophagus
- Squamous epithelium becomes columnar
Zollinger ellison syndrome is
Polyps in stomach
ZE is a syndrome secondary to a gastrinoma with subsequent gastrin hypersecretion.
Gastrinomas are usually multiple and typically located in the duodenum.
Associated with MEN1.
More than half have metastatised by presentation.
Findings include thickened gastric folds/gastritis, erosions and ulcers (particularly in atypical locations).
Alcoholic young man (20 something) has pain swallowing, barium swallow shows mucosal irregularities in lower oesophagus. Likely
Cancer
Candida oesphagitis
Reflux oesophagitis
Varices
Barretts
Reflux oesophagitis
Thickened and irregular oesophageal mucosal folds, ulcers/erosions, strictures and a reticular pattern if associated Barretts
Portal Hypertension does not cause
Splenomegaly
Ascites
Ischaemic hepatitis
Thrombocytopenia
Ischaemic hepatitis
- Possibly true - could potentially precipitate ischaemic hepatitis
Thrombocytopenia
- Possibly true, due to hypersplenism and sequestration
- Aetiology of thrombocytopenia in liver disease may just relate to reduced TPO production
Pancreatitis which is most correct
Pseudoaneurysm is a common complication
Pseudocyst has epithelial lining
Infection in acute necrosis is rare
Alcohol is more related to chronic than acute pancreatitis
Alcohol is more related to chronic than acute pancreatitis - biggest risk factor
Neonate has deranged LFTs, small GB, echogenic cord at the porta
Biliary atresia
Alagille syndrome
Hepatitis
Biliary atresia
t/f Oncocytoma has a central scar in 75%
false
Central stellate or non-enhancing scar is seen in 1/3 of cases.
Associated with Birt-Hogg- Dube syndrome and TS.
Typically a ‘spoke-wheel’ pattern on angio.
Which of the following breast lesions increases the future risk of breast cancer by the most
Radial scar
Breast apocrine metaplasia
Maybe adenosis?
Fibroadenoma
Cyst
radial scar
Which is not associated with ACL tear
Medial meniscal posterior root tear
Lateral meniscal tear
Meniscocapsular separation
Iliotibial band avulsion
Marrow oedema posteromedial tibial plateau
Marrow oedema posteromedial tibial plateau
Classic contusion pattern is posterolateral tibial plateau and mid-part of lateral femoral condyle
t/f pivot shift causes pcl tear
false. most common mech is anterior force to proximal tibia with knee in flexion
TTTS grading
Graded by the Quintero staging:
I – oligo / polyhydramnios
II – bladder not visible in donor twin
III – abnormal Dopplers in either twin
IV – hydrops
V – in-utero death
Woman with breast implants has a palpable mass, most sensitive test to exclude cancer
Mammo
US
MRI
FNA (it said FNA not core)
MRI
Radial Scar
Mammo often normal
US often normal
MRI often normal
Spiculations and central density
US often normal
Can be sonographically occult
DCIS
Mass like enhancement on MRI
Changes often extend beyond macroscopically evident extent
Well circumscribed linear 2mm calcifications
Changes often extend beyond macroscopically evident extent
Chondroid tumours in bone
Chondrosarcoma and enchondroma can be impossible to distinguish on imaging and path
Maffucci increased risk of sarcomatous change
Olliers is multiple osteochondromas
Chondrosarcoma degeneration in an osteochondroma occurs in the bony stalk
Chondrosarcoma and enchondroma can be impossible to distinguish on imaging and path
Factors favouring chondrosarcoma include large size, cortical breach, deep endosteal scalloping, presence of a soft-tissue mass and increased uptake on bone scan.
Chondrosarcoms are also more likely to have pain, be in older patietns and less likely to occur in the hands or feet.
Regarding MSK manifestations of SLE, which is false
Erosions
Subluxations
Osteonecrosis
Symmetrical
Erosions
Which is not associated with chondrocalcinosis
Haemochromatosis
Wilsons
Diabetes
Diabetes
The list is:
- Hypercalcaemia / hyperPTH
- Wilson
- Haemochromatosis
- Ochronosis
- Hypothyroidism
- Oxalosis
- Acromegaly
- ? gout ? arthritides
HOGWASH
Which does NOT cause splenomegaly
Amyloid
Sarcoid
Thrombocytopaenia
Thrombocytopaenia
CJD which is false
Variant CJD in younger patients
Inherited, acquired forms 90%
Slowly progressive disease
Slowly progressive disease false
It is rapidly progressive with dementia, cerebral atrophy,y myocolonus and death.
MRI shows high signal in basal ganglia, thalamus and cortex with diffusion restriction. The thalamic signal abnormalities ‘hockey stick and pulvinar’ signs in vCJD.
Sporadic form accounts for up to 90% of cases. vCJD is seen in younger patients and is the bovine to human transmission of bovine spongiform enecphelopathy. There is a familial form which accounts for 10% of cases.
Man with DM, septal and post septal stranding, opacification in some (but not all) sinuses, hyperattenuating component in maxillary sinus
Invasive fungal sinusitis
Favours chronic invasive fungal sinusitis.
This is usually > 12 weeks in duration and usually are immunocompetent or have a milder level of immunocompromise.
Acute fungal sinusitis should NOT show high density content in the sinuses.
Common in those with diabetes, especially ketoacidosis. It is also seen in neutropenic patients and thosewith advanced AIDS.
Zygomycetes classically seen in diabetic patients. Aspergillus more so in neutropenia.
Imaging shows low density mucosal thickening and soft tissue attenuation in the sinuses.
Nasal septal ulceration and bone destruction may be present.
Sinonasal Inverted Papilloma associated with
SCC
Inverted papillomas mostly seen in men aged 50.
They most commonly occyr on the lateral wall of the nasal cavity, most frequently related to the maxillary ostium +/- the middle turbinate.
Mucocele formation associated is uncommon.
They can undergo malignant transformation, mostly commonly to SCC (10%). Can also transform to adenocarcinoma, mucoepidermoid and verrucous carcinoma.
Pulmonary Alveolar Proteinosis is least correct
Congenital is rapidly fatal
Acquired is due to overproduction of protein rich surfactant
Acquired is like an autoimmune disease
Secondary ?something about immunocompromise
Superimposed infection common problem
Acquired is due to overproduction of protein rich surfactant
Associated with lipoprotienaceous material filling the alveoli with is PAS +ve
The material is derived from pulmonary surfactant and the disorder is one of surfactant turnover
Crazy paving least likely (recall)
RBILD
PCP
PAP
RBILD
Long wordy qn implying air embolism- pt has a CT with contrast, large atrial septal defect, seizures soon after. Mx includes all of following except
Maintain oxygenation
Lateral position right side up
Trendelenburg something
Adrenaline
Adrenaline
Prevent further air embolism
Fi02 100%
Venous air embolism – place in left lateral decubitus and Trendeleburg position
Arterial – keep flat supine as head down can worsen cerebral oedema
CPR if needed
Advanced techniques including vasopressors
Extraventricular obstructive hydrocephalus
TB common cause
NM Ventriculography doesn’t reflux into ventricles
Obstruction at the level of the cerebral aqueduct
NM Ventriculography doesn’t reflux into ventricles
Infarct in brain what type of necrosis
Liquefactive
Caseous
Coagulative
Liquefactive
six type
- Coagulative – most common, seen in infarcts (not in brain), tissue appears firm, cell outlines preserved
- Liquefactive – cerebral infarcts and abscess
- Caseous – soft, cheesy-looking material. Seen in TB and maybe syphilis or certain fungal infections
- Fat – acute pancreatitis
- Fibrinoid necrosis – immune reactions in vessels
- Gangrenous – coagulative necrosis in an ischaemic limb
Regarding aneurysmal disease in brain most correct
Anterior choroidal artery often associated with infundibulum
TOF MRA only detects 50% of aneurysms
Fusiform aneurysmal disease is most common in the posterior circulation
Murphy teat something incorrect (wasn’t the real murphy teat definition)
Fusiform aneurysmal disease is most common in the posterior circulation
Most common in vertebrobasilar circulation
Head injury
Epidural haematoma is related to injury of vein
Children more prone to subdural haemorrhage
Children more prone to subdural haemorrhage
maybe
Lymphocytic mastitis false
Soft =
Can look like cancer =
More common in type 1 than type 2 diabetes
Can look like cancer
True, can be multicentric and bilateral
Reiters arthropathy
Post gastro infection
20-30% HLAB27
Post gastro infection
True, enteric of sexually transmitted infection
Commonly yersinia, salmonella, shigella, campylobacter
Least likely to cause cirrhosis
Hep a
Hep b
Hep c
Alcohol
NASH
Hep a
Gallbladder cancer not correct
Gallstones
Men 4:1
B is false, it is more common in women with a F:M ratio of 4:1, usually > 60 years of age.
Mostly related to chronic inflammatory states including cholecystitis, gallstones (70-90%).
Other RF include IBD, FAP, PSC, porcelain gallbladder, fhx, obesity, certain ethnicities, carcinogen exposure.
50 yr old Cta contrast in media
Dissection
Mural thrombus
Dissection
Ankle fracture of medial malleolus only with talar shift, which most likely
Weber a
Weber b
Weber c
Maisonneuve fracture
Maisonneuve fracture
Maisonneuve is a fracture of the proximal fibula with an unstable ankle injury (widening of mortise). This can be either ligamentous injury and / or fracture of the medial malleolus. It is caused by pronation and external rotation mechanism.
Absent ICA associated with
PHACE Syndrome
Atlanto-occipital assimilation
Sinus pericranii
PHACE syndrome
- Posterior fossa malformations e.g. DW malformation
- Haemangiomas
- Arterial anomalies e.g. dysplasia / hypoplasia / absence of intracranial vessels
- Cardiac anomalies including coaractation
- Eye / ocular anomalies
Uterine fibroids, most correct
Hyperechoic on ultrasound
Fibroids more commonly dystrophic calcification post menopause
Fibroids more commonly dystrophic calcification post menopause
They typically involute and can calcify post menopause
Woman has US showing hypoechoic unilocular lesion in adnexa measuring 4cm
Serous ovarian tumour can be difficult to distinguish from simple cyst
Inclusion cysts are more common premenopausal
If there are shadowing regions, less likely to be benign
Inclusion cysts are more common premenopausal
Serous cystadenomas account for 60% of serous tumours, are bilateral in 15% and usually appear as a unilocular simple cyst with or without small papillary projections.
- They can be difficult to distinguish from simple cysts but are usually larger (approximately 10 cm).
Functional cysts should be smaller and would be more likely at a size of 4 cm.
Inclusion cysts - almost exclusively occur in pre-menopausal women with a history of prior surgery, PID, endometriosis or trauma. Results from entrapment of ovarian fluid contained within peritoneal adhesions. They lack a discrete limiting wall.
Many benign lesions do shadow including a dermoid and those along the fibrothecoma spectrum.
Regarding TCC of urinary tract most correct
Most in bladder are papillary
Something about synchronous and metachronous lesion stats
Lesions in ureter are mostly sessile
Renal pelvis mostly sessile
Usually diagnosed at a low stage
Most in bladder are papillary
- True, mostly superficial (70-80%), with 20-30% being invasive
- Most superficial lesions are papillary 70%
- The bladder is the most common site of TCC
more commonly papillary, which is lower grade than sessile
Guy with previous rectal cancer. Liver lesion on MRI. Signal loss on out of phase images, arterial enhancing. Not retaining contrast on delayed phase
Met
Adenoma
FNH
Adenoma
PIOPED has a normal category t/f
true, normal is no perfusion defects
Papilloma on mamm o appearance
Microlobulation
Amorphous calcs
Well defined calcs
Microlobulation
Intracranial hypotension findings in the spine, which is not true
Meningeal enhancement
High signal posterior to C1 / C2
Fluid collections
Dilated radicular arteries
Prominent venous plexus
Dilated radicular arteries
Defined as cerebrospinal fluid (CSF) pressure <6 cm H2O in patients with clinical presentation compatible with intracranial hypotension, namely, postural headache, nausea, vomiting, neck pain, visual and hearing disturbances, and vertigo
Findings include:
- Pachymeningeal enhancement
- Increased venous blood volume
- Distesion of dural venous sinuses
- Pituitary gland enlargement
- Subdural collections
- Diffuse cerebral oedema
- Sagging brainstem and acquired tonsillar ectopia
- Reduced fluid in optic nerve sheath
- Pontomesencephalic angle < 50 degrees
Work up is with:
- MRI brain with contrast
- Speculative epidural blood patch
- MRI spine with FS TS sequences looking for CSF in the epidural space or CT myelography
Paragangliomas
NF2
Carney syndrome
Charcot marie tooth type II
Not sure of the exact wording of this question. Paragangliomas are associated with four clinical syndromes:
- von Hippel-Lindau syndrome
- multiple endocrine neoplasia types 2A and 2B
- neurofibromatosis type 1
- Carney-Stratakis syndrome (also carneys triad)
von Hippel-Lindau syndrome and neurofibromatosis type 1 are more commonly associated with phaeochromocytomas
AAA repair leak at neck type
1a
1b
2
3
4
1a
Cervical lymph node above hyoid, anterior to submandibular gland
1
2
3
4
5
1
Regarding aspergillosis, which is false?
Haemoptysis is seen in non-invasive aspergillosis
Lucency in on CXR around lesion due to gelatinous exudate
Most commonly involves the lungs.
Can also involve CNS
Lucency in on CXR around lesion due to gelatinous exudate
Most sensitive to bowel injury on CT // or was this signs of shock bowel?
Free fluid
Thickened and hyperenhancing bowel
Free gas
Features of bowel injury include contrast extravasation, free gas, mural haematoma, fluid, abnormal enhancement.
Bowel injury most commonly involves the jejunum near the DJ flexure > ileum > colon
The CT hypoperfusion complex is:
- Small calibre aorta
- Collapsed IVC
- Low density fluid surrounding the IVC ‘halo-sign’
- Thickened bowel loops >3 mm with enhancing walls
- Most commonly involves jejunum
- Shock pancreas – heterogenous enhancement
- Bilateral adrenal hyperenhancement, particularly useful in paediatrics
Bladder injury not identified on CT
interstitial
An interstitial injury would not be identified. This is also called a subserosal bladder reupture.
Extraperitoneal rupture is most common (85%) followed by intraperitoneal (15%). Other injuries include a bladder contusion or combined rupture.
Suprasellar mass with high T1 signal, which is false
Ranthe cleft cyst
Craniopharyngioma
Aneurysm
Pituicytoma
Pituicytoma
Ddx for suprasellar mass with high T1 signal
- Macroadenoma with haemorrhage / nerosis
- Craniopharyngioma
- Rathke’s cleft cyst
- Thrombosed aneurysm
- Fat containing lesion including teratoma / dermoid cyst
- Ectopic posterior pituitary
A pituicytoma is a low grade glial tumour found in the neurohypophysis and infundibulum of the pituitary gland.
They are typically t1 isointense, t2 heterogenous with bright contrast enhancement.
Petrous apex lesion on MR, T1 and T2 high. No bone remodelling or destruction most likely
a. Cholesterol granuloma
b. Dipole fat
could be either
a. Cholesterol granuloma
- Typically expansile, well-marginated and thin the overlying bone
- May cause bony erosion at the petrous apex, mimic an aggressive lesion
b. Dipole fat
- Asymmetric marrow is common - fat intensity on all sequences
- May be the correct answer
Epididymal lesion, 2cm, vascular
Adamantoid tumour
Thrombosed varix
Torted appendix of Morgagni
Adamantoid tumour
these are benign, solid extratesticular lesions of the epididymis, tunica vaginalis or spermatic cord. They are the most common extratesticular neoplasm and most common tumour of the epipdidymis. They are more common at the lower pole with a ratio of 4:1. They are usually incidental, unilateral and mostly in males age 20 – 50.
Soft Tissue Lesion, low on T2, no calcification and blooming
Giant cell tumour of tendon sheath t/f
GCT of the tendon sheath fits this description. Demonstrated as low t1/t2 signal nodules with moderate enhancement. There is a slight female predilection. Can erode bone. Divided into localised or diffuse forms. Ddx include ganglion cyst, PVNS, desmoid tumours and fibromas of tendon sheath.
Regarding general pathology
Atrophy is decrease in size by programmed cell death
Hypertrophy is organ enlargement due to increased number of cells
Metaplasia is irreversible change of one differentiated cell type to another
Atrophy is decrease in size by programmed cell death
Malignant course of the coronary arteries:
Right coronary courses posterior to the aorta
Left coronary artery intra-arterial
Right coronary artery anterior to the pulmonary artery
Non suture occlusion
Left coronary artery intra-arterial - left main or LAD arises from right coronary sinus and courses between the ascending aorta and pulmonary arterial trunk
Which of the following is least correct?
Dysplasia inevitably leads to malignancy
Metaplasia is change of one cell type to another
Anaplasia is lack of differentiation from normal cell
Pleomorphism…
Dysplasia inevitably leads to malignancy
CNS infection
Brain abscess leads to coagulative necrosis
Viral meningitis worse than bacterial
HSV1 affects frontal and temporal lobes
Neisseria meningitis affects old people
Tuberculoma is most common CNS manifestation of TB
HSV1 affects frontal and temporal lobes
3.5 cm multiloculated complex ovarian cystic lesion. Which makes it most likely to be serous?
Similar lesion on other side
Ascites
Calcification
Solid nodules at the periphery
Similar lesion on other side
Cystic renal lesion. Which most likely makes it malignant
Thick enhancing septa
Calcification
Enhancing solid nodule
Enhancing solid nodule
Cystic renal lesion. Which most likely makes it malignant
Thick enhancing septa
Calcification
Enhancing solid nodule
Enhancing solid nodule
Which is T regarding RCC
Papillary lesions are classically cystic
Clear cell difficult to tell from oncocytoma
VHL is associated with chromophobe type
Renal vein invasion has 35% 5 year survival
Renal vein invasion has 35% 5 year survival
50yo female with cystic pancreatic lesion
Mucinous
Serous macrocyst
Serous microcyst
SPEN
Pseudocyst
Mucinous
Diarrhea and oesophagitis
Somatostatinoma
VIPoma
Gastrinoma
Insulinoma
Glucagonoma
Gastrinoma
Circumferential rectal tumour. CT show no nodes or metastasis. What is the staging?
1
2a
3a
3b
4
2a
Hypercalcaemia is most associated with which of these?
Long term dialysis - typically hypocalcaemia
Primary osteoporosis
Post menopausal osteoporosis
Gastric ulcer
Diarrhea
Gastric ulcer
Most likely cause of nodular or diffuse parathyroid enlargement
Chronic renal failure
MEN1
MEN2
Chronic renal failure
- Likely is true?
Somatroph secreting tumour causes Cushing
Microadenoma are mostly nonfunctional
Pituitary carcinoma causes gigantism
Macroadenoma can occur post adreneclectomy
Lactotroph more commonly diagnosed in males because of galactorrhoea
Macroadenoma can occur post adreneclectomy
Systemic hypertension least likely to be caused by
Recurrent PE
Renal artery stenosis
Combined OCP
Aortic coarctation
Hyperaldosteronism
Recurrent PE
Warthin’s
Can occur in cervical LN
Epithelial and mesenchymal cells
Can occur in cervical LN
Radiation safety in kids not true
Overcouch VS undercouch
Removing grid
Multiple attempts may be needed if kids move
Increased dose when changing cones without image hold
Pulsed VS continuous
Overcouch VS undercouch
Pregnant patient needs CTPA. Least effective in reducing the fetal dose?
Abdominal lead shield
Increased pitch
Lateral scout
Decrease MAS
Limiting scan to exclude upper abdomen
Abdominal lead shield
Regarding radiation dose in paediatric population which is least true?
Deterministic effects predominate
Organs are more radiosensitive
Organ dose is higher than adults
Multiple non-diagnostic images may be needed as kids move
Deterministic effects predominate
Cirrhosis is not seen in
Budd Chiari
A1 antitrypsin
Haemochromatosis
Wilson
Budd Chiari
Which does not cause HCC
Steatohepatitis without cirrhosis
PBC within 10 years
Steatohepatitis without cirrhosis
Cholangiocarcinoma- true?
50% in CBD
Intra-hepatic has better prognosis than Klatskin
Choledochal cyst in adolescents is a risk factor
Intra-hepatic has better prognosis than Klatskin
13 yo M with short stature, webbed neck
Turners
Noonan
Edward
Di George
Cru di chat
Noonan
Noonan syndrome (NS) is a genetically and phenotypically heterogeneous non-aneuploidic congenital RASopathy. Affected individuals can bear some clinical features similar to that of Turner syndrome.
Haemochromatosis F?
Affects 4th and 5th metacarpals (maybe should read 3rd and 4th)
Chondrocalcinosis
Bilateral and symmetrical
Subchondral sclerosis and cyst
More common in females than males
More common in females than males
Although the genetic defect is distributed equally among men and women, the iron loss as a result of menstruation is protective, resulting in a clinical male predilection (M:F ~ 2:1).
Radiographic features
- chondrocalcinosis: particularly knees and triangular fibrocartilage
- arthropathy
- symmetrical loss of joint space, subchondral cysts
- close association with CPPD which is often seen concurrently
- most commonly hands (MCP, carpal, PIP) with the characteristic hook like/ beak-like osteophytes projecting from radial ends of 2nd and 3rd metacarpals
- more extensive involvement from the second to the fifth MCP and radial hook-like/drooping osteophytes are more characteristic than in CPPD 3
- can also affect the knee, hip, and elbow
- generalised osteoporosis (~25%) or osteopaenia (~40%)
Child with horseshoe kidney and puffy kids
Turners
Prader willi
Di-george
Turners
Down syndrome is least associated with…
Alzheimer
Secondary biliary cirrhosis
Hirschsprung
Atlanto-axial instability
Acute leukaemia
Secondary biliary cirrhosis
Which is correct
Anal atresia is most common intestinal atresia
Oesophageal atresia is usually associated trachea-oesophageal fistula
Hirschsprung is associated with Down Syndrome in 50%
Oesophageal atresia is usually associated trachea-oesophageal fistula
Barium T?
Coeliac increased jejunal folds
Scleroderma thickened folds
Whipple’s get nodular folds mucosa
Whipple’s get nodular folds mucosa
Which is seen more in UC than Crohns
Creeping fat
Fistula
Fissure
Pseudopolyps
Skip lesions
Pseudopolyps
Breast lesion with greatest risk of malignancy
Adenosis
PASH
Radial scar
Duct ectasia
Breast cyst
Radial scar
Phylloides TRUE?
10% recur after resection
Same age group as fibroadenoma
Stromal component causes the metastases
Stromal component causes the metastases - It is generally thought that it is the stromal component that becomes malignant
Breast- which is most true?
Phylloides 1% are malignant
Phylloides is about 1% of all breast cancers
Phylloides is about 1% of all breast cancers
VHL least associated with
Pancreatic adenocarcinoma
Hepatic cyst
RCC
Phaeochromocytoma
Cerebellar haemangioblastoma
Pancreatic adenocarcinoma
Which is true
Dandy walker has vermian hyperplasia
Chiari 1 invariably associated with hydrocephalus
Chiari 2 asymptomatic
Both chiari associated with syringomyelia
Both chiari associated with syringomyelia
Neuromyelitis optica. Which one is least involved?
Periaqueductal grey matter
Area postrema
Subpial grey matter
Optic chiasm
Subependymal callosal
Subpial grey matter
Patient presents with facial hemiparaesis. Which is most likely the cause?
Anterior-inferior cerebellar artery looping course
Restricted diffusion at CP angle
Neurofibroma in hypoglossal canal
Restricted diffusion in 4th ventricle
Anterior-inferior cerebellar artery looping course – more classically associated
Restricted diffusion at CP angle – rare with schwannoma
True?
NF2 has schwannomas involving acoustic segment of CN8
NF1 has optic nerve schwannomas
Neurofibromas consist of Schwann cells
Neurofibromas consist of Schwann cells - Neurofibromas are benign neoplasms composed of Schwann cells and fibroblasts, containing a rich network of collagen fibres.
Child with strawberry tongue, cervical LN, non-suppurative conjunctivitis. What is next most appropriate investigation?
CT neck and chest
Echocardiogram
Neck US
Abdominal US
Echo
20 yo F with night sweats, cervical LN isointense to muscle. CT of the rest of the neck normal
Hodgkin
Metastatic thyroid cancer
Complicated branchial clei cyst
Hodgkin
Medullary thyroid cancer on biopsy. What is the next most appropriate investigation?
TC99
I131
CT neck
MRI neck
PET-CT
CT neck
Hot tub lung not seen
Bronchial dilatation
Centrilobular nodules
GGO
Interlobular septal beading
Bronchial dilatation
COP false?
Large nodules or masses
Centrilobular nodules
Atoll
Subpleural ground glass consolidation
Bronchial dilatation
Centrilobular nodules
Which is most correct?
PMF has central necrosis
Simple coal workers pneumoconiosis affects lower lobes
Asbestosis plaques has no zonal predilection
Acute silicosis can look like PAP
Macrophages is key for the diagnosis of pneumoconiosis
Acute silicosis can look like PAP
Which is not a paraneoplastic syndrome of lung cancer
SIADH
Cushing
Limbic encephalitis
Dilated cardiomyopathy
Lambert
Dilated cardiomyopathy
Regarding lung cancer which is most true?
Asbestos with smoking 5x risk of lung cancer
2pack/day for 20years has 50% risk of lung cancer
Lung cancer seen in never smokers is more likely to have an eGFR muta6on
Passive smoking has 5x risk of lung cancer
Lung cancer seen in never smokers is more likely to have an eGFR muta6on
Cystic pleural mass extending through intercostal space with adjacent consolidation
Actinomyeces
TB
Cryptococcus
Metastases
Hydatid
Actinomyeces
TB
Which is most correct?
Strep causes bronchopneumonia
H influenza in kids has indolent cause
Pseudomonas in alcoholics
Klebsiella in haemoptysis
Staph in COPD
Klebsiella in haemoptysis
Which is false?
Empyema has more than 1000ml
Asbestos bodies not present in pleural plaques
Mesothelioma involves parietal and visceral plaques
Empyema has more than 1000ml
Mesothelioma which is most true?
Can cause direct mediastional invasion
Presents with metastases commonly
Commonly occurs in asbestosis
Increased risk with smoking
Occurs 5 years after exposure
Can cause direct mediastional invasion
Wegener’s most involved
Upper airway
Small bowel
Liver
Heart
Skeletal muscle
Upper airway
Which is most correct?
Takayasu presents as pulseless disease
PAN and haemoptysis
Behcet causes aortitis
Takayasu presents as pulseless disease
Temporal arteritis T
Pulmonary arteries are rarely affected
Ophthalmic arteries are rarely affected
C-ANCA elevated
Negative biopsy excludes
Rarely causes non-specific systemic symptoms
Pulmonary arteries are rarely affected
Uncomplicated retrieval endovascular
Goose neck snare
Biopsy forceps
Stent
Microcatheter
Goose neck snare
Which one is least correct?
Femoral catheter can last several months
Tunneled have less infection
Hickmann line tip should be at junction of right brachiocephalic and SVC
IJV better than subclavian for dialysis
Fibrin sheath treated with thrombolysis
Hickmann line tip should be at junction of right brachiocephalic and SVC
20yo F with headaches and hypertension. CTA shows renal artery ostia narrowing
FMD
SLE
PAN
GCA
NF
NF - NF-1–associated stenoses often occur in patients younger than 50 years, spare the renal artery origin, are long and tapered, and extend into segmental and intrarenal branches
Paediatric lines. Which should be repositioned?
UAC at aortic arch
UVC at junction of RA and IVC
ETT 1.5cm above carina
PICC within left brachiocephalic
NGT subdiaphragmatic
UAC at aortic arch
Renal aneurysms on DSA. Which is least likely the cause?
RCC
IVDU
NF
Transplant
Diabetes
diabetes
Aetiology
- Fibromuscular dysplasia (FMD): 35%
- Degenerative aneurysm: 25%
- Vasculitides, e.g. Behcet disease
- Phakomatoses, e.g. tuberous sclerosis, neurofibromatosis
- Intrinsic collagen deficiency, e.g. Marfan syndrome, Ehlers-Danlos syndrome
- Trauma
Most correct?
Charcot bouchard at grey-white matter junction
Venous angiomas prone to cause haemorrhage
Amyloid causes basal ganglia haemorrhage
Basilar type saccular aneurysms from atherosclerosis
Venous angiomas prone to cause haemorrhage -
Developmental venous anomalies are usually incidental findings.
However, patients can present with intracranial haemorrhage (1-5%). An association has also been described with ischaemic stroke and epilepsy.
AAA which is true?
Cystic medial necrosis is a precursor
3-4cm has 1%/year rupture risk
Inflammatory aneurysm in elderly
Atherosclerosis causes ischaemia of wall causing aneurysm
Mycotic aneurysm from direct retroperitoneal spread
Cystic medial necrosis is a precursor
Which is true
ICA peak systolic is better than ICA:CCA
Renal artery velocity >300 cm/s is normal
If velocity doubles it means 50% stenosis
ICA peak systolic is better than ICA:CCA
Tetralogy of Fallot. Which is true?
LV hypertrophy
Pulmonary artery small
Right sided trachea
Pulmonary artery small
Pulmonary hypoplasia +/- atresia
TOF
- VSD
- RVOTO
- overriding aorta
- late RVH
Patient with lifted cardiac apex and systolic murmur- true?
Mitral stenosis
Valve gradient is greater than 50 mmHg
Cusps are not fused
Velocity is less than 2 m/s
Transthoracic echo is good at picking LA appendage thrombus
Valve gradient is greater than 50 mmHg
20yo young healthy man with retrocardiac density.
Bronchogenic cyst
Oesophageal cyst
Hiatus hernia
Neuroenteric cyst
LA enlargement
Bronchogenic cyst
Which one is most correct?
RHD is caused by gram negative antigen
Mitral stenosis invariably caused by RHD
Acute IE occurs on previously damaged valve
Subacute IE causes slow disease but bigger vegetation
Non-sterile marantic endocarditis caused by SLE
Mitral stenosis invariably caused by RHD
Which one is least likely to be caused by a primary cardiac tumour?
Conduction abnormality
Pericardial effusion
Outlet obstruction
Valvular dysfunction
Tumour emboli
Pericardial effusion
Small aortic arch. Which is not related?
ASD
PDA
Cor triatriatum
VSD
Cor triatriatum
20yo Asian F presenting with abdominal pain. CT shows a pouch arising from anterior caecum with high density material. Which is most likely?
Appendicitis
Diverticulitis
Crohn
Typhilis
Diverticulitis
Bone marrow transplant 1 month ago. RLQ pain. CT ceacal thickening with mucosal hyperenhancement with surrounding stranding
Lymphoma
Typhilitis
Malignancy
Diverticulitis
Pseudomembranous colitis
Typhilitis
Acute appendicitis F
Bacterial overgrowth causes inflammation
Mechanical obstruction
PV thrombosis
Arterial ischaemia
Arterial ischaemia
Pregnant woman – appendicitis. LEAST LIKELY
Red degeneration of a fibroid can mimic clinical presentation
Haemorrhagic ovarian cysts can mimic clinical presentation
More likely to perforate
Most likely to occur in 3rd trimester
Most common surgery in pregnant women
Most likely to occur in 3rd trimester
Colorectal cancer. MOST LIKELY
Left sided tumours are much more common than right
Right sided tumours present with fatigue and weakness rather than occult bleeding
70% of FAP get cancer
Perianal tumours metastasize to the liver
Left sided tumours are much more common than right
Gastric adenocarcinoma
5 year survival rate 15% if it involves coeliac lymph nodes
H. pylori is associated with gastric adenocarcinoma
Rarely arises from adenoma
Presents early because of obstructive symptoms
Most common in Caucasians
H. pylori is associated with gastric adenocarcinoma
40 yr old woman. Barium swallow shows 2 cm long segment of nodular mucosal narrowing at T6 lumen to a diameter of 1.1 cm. Sliding hiatus hernia.
Barretts oesophagus
Eosinophilic oesophagitis
Oesophageal spasm
Zenker diverticulum
Barretts oesophagus
Which is true
Retinoblastoma is most commonly bilateral
Uveal melanoma metastasizes to the liver
Neurofibroma of the optic nerve
Orbital lymphoma most commonly Hodgkins
Uveal melanoma metastasizes to the liver
Melanoma – which is most TRUE
Vertical growth occurs before radial growth
Sentinel node biopsy is most important for prognosis
100% of dysplastic naevi get melanoma before age 60
Distant metastases occur first
50% hereditary
Sentinel node biopsy is most important for prognosis
Second most common location of hydatid after liver
a. Brain
b. Lung
c. Spleen
d. Kidney
e. Heart
Lung
Hydatid disease
- Hydatid cysts result from infection by the Echinococcus tapeworm species and can result in cyst formation anywhere in the body.
There are two main species of the Echinococcus tapeworm:
- Echinococcus granulosus - more common
- pastoral: the dog is the main host; most common form
- sylvatic: the wolf is the main host
- Echinococcus alveolaris/multilocularis - less common but more invasive
- fox is the main host
Definitive hosts are carnivores (e.g. dogs, foxes, cats), and the intermediate hosts are most commonly sheep. Humans are accidental hosts, and the infection occurs by ingesting food contaminated with Echinococcus eggs.
Cyst structure
The cysts usually have three components:
- pericyst: composed of inflammatory tissue of host origin
- exocyst
- endocyst: scolices (the larval stage of the parasite) and the laminated membrane are produced here
Location
- hepatic hydatid infection: most common organ (76% of cases)
- pulmonary hydatid infection: second most common organ (15% of cases)
- splenic hydatid infection: third most common organ (5% of cases)
- cerebral hydatid infection
- spinal hydatid infection
- retroperitoneal hydatid infection
- renal hydatid infection
- musculoskeletal hydatid infection
- mediastinal hydatid infection (very rare)
Markers
- Casoni skin test
Which is the most likely to cause splenic infarcts
Alpha thalassaemia
Beta thalassaemia
G6PD
Sickle cell anaemia
Myelofibrosis
Sickle cell anaemia
Splenomegaly. TRUE.
Right heart failure causes massive splenomegaly
Chronic splenomegaly is more prone to rupture
Congestive is the most common cause of hypersplenism
Myelofibrosis is the most common cause of splenomegaly
Congestive is the most common cause of hypersplenism
With regards to cirrhosis, which is most true?
Fibrosis in cirrhosis is rarely reversible
Ruptured oesophageal varices has a 30% risk of mortality
Hepatitis D superinfection causes decompensa6on in chronic Hepatitis B
Hepatitis D superinfection causes decompensa6on in chronic Hepatitis B
Pseudogout aspirated joint – what will you see under the microscope.
Negatively birefringent crystals
Positively birefringent crystals
Gram positive cocci
Gram negative cocci
Some other bacteria
Positively birefringent crystals
Renal stones – associations. MOST TRUE?
Staghorn stones and infection
Uric acid stones are invariably associated with hyperuricaemia
Cysteine stones are associated with increased urine pH
Calcium stones in 50% of people with hypercalcaemia
Staghorn stones and infection
Renal stones MOST TRUE
Calcium oxalate stones are 30% of stones
Proteus causes struvite
Proteus causes struvite
Which of the following commonly causes partial ventral cord syndrome?
Syphillis
Acute spinal cord infarct
Vitamin B12 deficiency
Hyperextension injury
Dural mets
Acute spinal cord infarct
Ventral cord syndrome (also known as anterior cord syndrome) is one of the incomplete cord syndromes and affects the anterior parts of the cord resulting in a pattern of neurological dysfunction dominated by motor paralysis and loss of pain, temperature and autonomic function.
Anterior spinal artery ischaemia is the most common cause.
MSK Tb – LEAST LIKELY
Extraosseous extension is common
Immunocompetent patients have multifocal involvement
Septic arthritis in knees and hips
Pyogenic osteomyelitis is more likely to involve the disc than Tb osteomyelitis
Most common in the thoracolumbar spine
Immunocompetent patients have multifocal involvement
Charcot spine (least correct)
Neurosyphillis is the most common cause
Destruction of entire vertebral level
Deep sensation and proprioception loss
Differential diagnosis is infection and adjacent segment disease
Increased sclerosis and fragmentation
Neurosyphillis is the most common cause
Osteomyelitis. TRUE?
In adults the most common is direct spread from adjacent osteomyelitis
Osteomyelitis - 50% have negative blood cultures
S. aureus most common in neonates
Sequestrum is vital rim of tissue surrounding the necrotic dead, infected bone
Osteomyelitis - 50% have negative blood cultures
Hydroxyapatite deposition disease TRUE?
Linear articular calcification
Amorphous intra-articular calcification
Focal periarticular calcification
Periarticular erosions
Focal periarticular calcification
AVN hip TRUE?
MRI is more sensitive than bone scan
Changes commonly occur on both sides of the joint
Posterior more common than anterior femoral head
Subchondral lucency on X-ray is common early
Cartilage loss early on - no
MRI is more sensitive than bone scan
Classification
stage 0
- plain radiograph: normal
- MRI: normal
- clinical symptoms: nil
stage I
- plain radiograph: normal or minor osteopenia
- MRI: oedema
- bone scan: increased uptake
- clinical symptoms: pain typically in the groin
stage II
- plain radiograph: mixed osteopenia and/or sclerosis and/or subchondral cysts, without any subchondral lucency (crescent sign: see below)
- MRI: geographic defect
- bone scan: increased uptake
- clinical symptoms: pain and stiffness
stage III
- plain radiograph: crescent sign and eventual cortical collapse
- MRI: same as plain radiograph
- clinical symptoms: pain and stiffness +/- radiation to knee and limp
stage IV
- plain radiograph: end-stage with evidence of secondary degenerative change
- MRI: same as plain radiograph
- clinical symptoms: pain and limp
AIIS avulsion in young hurdler TRUE?
Hamstrings
Sartorius
Rectus femoris
Iliopsoas
Rectus femoris
Regarding enchondromas and chondrosarcomas? REPEAT
Child with chondroid tumour in phalanx with invasive component likely chondrosarcoma -
Invasive infiltration of the bone marrow spaces is not a characteristic of benign enchondromas, and this is probably the most helpful microscopic feature in distinguishing an enchondroma from a low-grade chondrosarcoma.
50 yo well defined ileum lesion enchondroma
Diaphyseal eclasia presents with multiple enchondromas
Enchondroma and chondrosarcoma can be similar radiologically and histologically
Child with chondroid tumour in phalanx with invasive component likely chondrosarcoma -
Invasive infiltration of the bone marrow spaces is not a characteristic of benign enchondromas, and this is probably the most helpful microscopic feature in distinguishing an enchondroma from a low-grade chondrosarcoma.
also Enchondroma and chondrosarcoma can be similar radiologically and histologically
Regarding achilles tendon which is most true?
Concave anteriorly
Tears at calcaneal attachment
Chronic tendinopathy results atrophy
Foci of PD increase signal within tendon can be normal
Fluid within Achilles sheath is always abnormal
Foci of PD increase signal within tendon can be normal
What is most true
Subscap tear + long head biceps tear
AP radiograph best for subacromial spur
Subscap tear + long head biceps tear
What is most true
US alone appropriate for painful arc
Even if us characterises tear need mr
US can diagnose frozen shoulder
Long head of biceps subluxes laterally
Supra tear greater tuberosity
Supra articular> bursal
Acute tears echogenic
Bursitis causes cartilage sign
US can diagnose frozen shoulder -
Rotator cuff interval capsule can be identified by ultrasound. A thickened rotator cuff interval capsule (≥2.8 mm) is suggestive of frozen shoulder.
30 year old woman. Painful lesion arising from just inferior to the lesser trochanter predominantly calcified with a lucent center, saucerisation, with an intact femoral cortex. Bone scan low level uptake of the cortex.
Periosteal chondroma
Osteochondroma
Parosteal osteosarcoma
Lymphoma
Met
Periosteal chondroma
Woman, medial femoral condyle high signal, cartilage intact. MOST LIKELY
Osteochondral defect
Insufficiency fracture
Grade V bone bruise
Osteochondritis dissecans
Subchondral insufficiency fracture
Osteochondral defect
ACL tear – LEAST likely associated
Medical meniscal tear
Lateral meniscal tear
Segond fracture
MCL tear
Anteromedial femoral condyle bone oedema
Anteromedial femoral condyle bone oedema – usually lateral
The O’Donoghue unhappy triad comprises three types of soft tissue injury that frequently tend to occur simultaneously in knee injuries. O’Donoghue described the injuries as:
- anterior cruciate ligament tear
- medial collateral ligament injury
- medial meniscal tear (lateral compartment bone bruise)
Unicameral bone cyst TRUE?
Intramedullary
Fluid-fluid levels on MRI
Femoral is more common than humeral
Intramedullary
Fibrous cortical defect
Pathological fracture most common presentation
Most commonly occurs in children
Proximal femoral metaphysis
Moth eaten appearance
Most commonly occurs in children
Rheumatoid arthritis TRUE?
Cell-mediated type 4
Rheumatoid nodules in 25%
Amyloidosis in 50%
Vasculitis affects medium sized arteries
RF positive in JRA – Yes positive in some
Rheumatoid nodules in 25%
Rheumatoid nodules are common in RA and appear in approximately 25% of patients.
Rheumatoid nodules favor subcutaneous tissues at pressure points, such as adjacent to bony protuberances.
Pulmonary embolus WHICH IS TRUE?
Large emboli cause chronic cor pulmonale
60% of PE cause infarct
Haemorrhage without infarct in pulmonary emboli affecting medium sized vessels
Most commonly come from splanchnic arteries
Haemorrhage without infarct in pulmonary emboli affecting medium sized vessels
MVA young male – extravasation of contrast on delayed phase in both extraperitoneal and perineal spaces. Where is the injury?
Bladder base
Bladder dome
Prostatic urethra
Bulbar urethra
Urogenital diaphragm
Urogenital diaphragm - membranous urethra
20 year old man binge drinking, blood stained vomitus, pain on swallowing. Barium swallow normal.
Mallory Weiss
Boerhaeves
Reflux oesophagitis
Mallory Weiss
Mucosal and submucosal tear with involvement of the venous plexus
50 year old woman, chronic umbilical discharge. CT shows mass adjacent and superior to the bladder.
SCC
Adenocarcinoma
TCC
Lymphoma
Adenocarcinoma
Bladder TCC what is TRUE?
High grade precursor lesions can be treated with BCG
Flat lesions are better than papillary lesions
Renal pelvis masses are large at presentation
Nodal spread is the strongest prognostic factor
Nodal spread is the strongest prognostic factor
Prostate cancer TRUE?
Seminal vesicle involvement is M1
Para-aortic nodes have a worse prognosis than pelvic nodes
Never becomes resistant to anti-androgen therapy
Gleason 3+4 = 7 has a better prognosis than Gleason 4+3=7
Transitional zone is 70%
Gleason 3+4 = 7 has a better prognosis than Gleason 4+3=7
BPH risk factors TRUE?
Diabetes
HTN
Ethnicity
Smoking
Cirrhosis
Diabetes
HTN
Ethnicity
Risk factors
- increasing age
- family history
- race: blacks > whites > Asians
- cardiovascular disease
- use of beta-blockers
- metabolic syndrome: diabetes, hypertension, obesity
Cervical cancer TRUE?
Caused by HPV 6 & 11
Involvement of vagina is stage IV
Average age of presentation is 70 years old
Mortality is secondary to effects of local invasion
Mortality is secondary to effects of local invasion
Endometrial cancer TRUE?
Type 1 is associated with atrophy
Type 2 is associated with hyperplasia
Type 1 occurs 10 years later than type 2
20% are type 1
Type 2 has a poorer prognosis
Type 2 has a poorer prognosis
Gynaecomastia
Associated with lung, pituitary and adrenal tumours
5% risk of malignancy
60% is symmetrical - Gynaecomastia in most cases tends to be unilateral and/or asymmetrical.
Uncommon, only 5% of males over the age of 50
Associated with lung, pituitary and adrenal tumours
Fat embolism FALSE?
Occurs 1-3 days post injury
Composed primarily of adipose tissue
Lungs oedema and haemorrhage
Commonly presents with petechial skin haemorrhage
Associated with long bone fracture
Composed primarily of adipose tissue
Highest risk for pancreatic adenocarcinoma
Li Fraumeni
MEN 1
Carney triad
FAP
BRCA2
BRCA2
Which is not associated with Meig syndrome
Dysgerminoma
Granulosa cell tumour
Brenner
Fibroma
Thecoma
Dysgerminoma
Ovarian tumours false– possibly 2 questions
Borderline serous tumours are treated with surgery alone
Benign teratomas have a 1% risk of malignant transformation
Ovarian choriocarcinoma has a better prognosis than placental choriocarcinoma
Teratoma is more commonly mixed rather than pure
Choriocarcinoma secretes beta HCG
Ovarian choriocarcinoma has a better prognosis than placental choriocarcinoma
70 year old male with scrotal mass? MOST LIKELY?
Lymphoma
Seminoma
Lymphoma
Interstitial pregnancy- which is false?
Pregnancy within the intramural portion of the tube
Not continuous with the endometrial pregnancy
Double decidual reaction
Interstitial line sign is a sign
<5 mm myometrial thickness
Double decidual reaction
Placental accreteta false?
Placental lacunae are associated
Increta is more common
Previous myomectomy is a risk factor
Indistinction of the endometrium and myometrial junction
Previous myomectomy is a risk factor
Least likely route of a lesion within the pterygomaxillary fissure
Anteriorly to the maxillary sinus
Through sphenopalatine foramen into nasal cavity
Lateral to temporal fossa
Posteriorly to intracranial
Superior to orbit
Anteriorly to the maxillary sinus
Medial canthus rim enhancement and erythema, periorbital swelling, cystic
dacrocystitis
HIV patient with punctate echogenic foci in kidneys with posterior shadowing
HIV nephropathy
PJP nephropathy
CMV
PJP nephropathy
CMV
Paget’s disease of the bone
Can cause high output cardiac failure
Bimodal age distribution
Predominantly affects osteoclasts
Monoostotic
Bones are soft
Can cause high output cardiac failure
Gestational trophoblastic disease
Choriocarcinoma can occur months after pregnancy
Complete has maternal and paternal genetic material
Invasive penetrates uterus but does not metastasize
Occurs in young people
Choriocarcinoma can occur months after pregnancy
Which one is correct?
Achondroplasia has reduced life expectancy
OI type 1 is fatal
Thanatophoric dysplasia die in infancy from multiple fractures
Mucopolysaccharidosis interferes with osteoblasts
Osteopetrosis can be cured with stem cell transplant
Osteopetrosis can be cured with stem cell transplant
Which is false?
Prion is abnormal protein
Can be sporadic, familial or transmi_ed
CJD tends to occur slowly over years
Variant CJD tends to affect young adults
CJD tends to occur slowly over years
Which is true?
Lewy body excludes Parkinson’s
Frontotemporal affects >65yo
Huntington causes caudate atrophy
Alzheimer’s spares hippocampus until late
Amyotrophic lateral sclerosis spares cortex
Huntington causes caudate atrophy
In regards to pregnancy – what is TRUE?
HELLP can cause thrombocytopenia
Eclampsia is ‘something’ – clowng
Fatty liver disease occurs in 1st trimester
Cholangitis is a common complication of cholestasis of pregnancy
HELLP can cause thrombocytopenia
Emphysema
Paraseptal is a risk factor for pneumothorax
Pneumonectomy causes panlobular emphysema
Alpha 1 anti-trypsin causes compensatory emphysema
Other wrong causes
Paraseptal is a risk factor for pneumothorax
1 year post pneumonectomy and the mediastinum has returned to the midline – WHAT IS MOST LIKELY?
Normal and common post pneumonectomy
Normal and uncommon post pneumonectomy
Developing post pneumonectomy syndrome
Pleural or local recurrence
Pleural or local recurrence
Which one is least likely to cause pneumatosis intestinalis?
Cystic fibrosis
Peutz-Jeghers disease
SMA stenosis
MI
Peutz-Jeghers disease
t/f Beta-catenin mutated hepatic adenomas are associated with malignancy
true
Chronic renal failure causes which of these conditions most?
Thrombocytopaenia
Polycythaemia
Hypercalcaemia
Hypophosphatasemia
Thrombocytopaenia – true
Which is most true regarding ovarian tumours?
Brenner is cystic and bilateral
Most common type is germ cell tumour
Mucinous is mostly seen in postmenopausal women
Most common type is germ cell tumour
Which one of these is least likely to cause craniosynostosis?
Hypothyroidism
Rickets
Previous ventricular drain insertion
Crouzon Syndrome
Thalassaemia
Hypothyroidism
Patient post op had PE then had IVC filter. Patient had another episode of PE. What is the most likely explanation?
Double IVC
Azygous continuation
Retro-aortic renal vein
Double IVC
Postmenopausal patient had a breast ultrasound. 1.8 cm new well defined hypoechoic lesion found. Which is most likely?
DCIS
IDC
Phyllodes
Fibroadenoma
DCIS
Which one is most correct regarding epidural disc migration?
No enhancement
Disc can sequestrate
Disc can sequestrate
Re: thyroid ca. Which is most true?
Medullary thyroid cancer is a neuroendocrine tumour
Most common type is follicular
Anaplastic is seen in young patients
Medullary thyroid cancer is a neuroendocrine tumour
Young patient with recurrent chest infection. CT left lung air-trapping, small pulmonary artery and small left lung. What is most likely?
Swyer-James
Pulmonary atresia
Swyer-James
what is the carpal angle and what cuases increase or decreases
Carpal angle is defined by two intersecting lines, one in contact with the proximal surface of the scaphoid and the lunate and the other line through the proximal margins of the triquetrum and the lunate. Its normal value is between 130° and 137°.
It is increased (>139°) in:
- bone dysplasia
- Down syndrome
- Pfeiffer syndrome
It is decreased (<124°) in:
- Hurler syndrome
- Madelung deformity
- Turner syndrome
- Morquio syndrome
- multiple exostoses
Whooshing sound in the ear with red mass behind the eardrum. Mass in hypotympanum associated with bony destruction. Most likely?
Cholesteatoma
Glomus tumour
Schwannoma
Glomus tumour
Regarding doppler US which is most true?
In a fasting patient coeliac artery has low resistance
In a fasting patient SMA has low resistance
In a fasting patient coeliac artery has low resistance
Regarding dopplers in pregnancy. Which is true?
If the MCA PI is low, then check the ductus venosus waveform
Umbilical artery has high resistance pattern
Doppler of both umbilical arteries should always be checked
UA dopplers are checked twice- if one PI is normal but the other is abnormal, use the normal one.
If the MCA PI is low, then check the ductus venosus waveform
Young male patient. MRI shows 3 cm high T1, low T2 avidly enhancing renal mass. Which is most likely?
AML
Clear cell renal carcinoma
Haemorrhagic cyst
Proteinaceous cyst
AML - Although the detection of fat is a well-established diagnostic imaging feature of classic angiomyolipoma, a hyperattenuating appearance on unenhanced CT and a T2-hypointense appearance at MRI both correspond to the smooth muscle component, are important diagnostic clues to the types of angiomyolipomas that contain few or no fat cells.
Shoulder US
Calcific tendinitis best treated conservatively.
US is enough for impingement
Pt with painful abduction- if US is ok then no need for MRI
Acute tear shown as hyperechoic gap
Subscapularis tear is associated with long head of biceps tear
Subscapularis tear is associated with long head of biceps tear
Regarding endometriosis. Which is most true?
Presents with bulky uterus
Older patient
Precursor to endometrial malignancy
Presents with an ovarian mass
Presents with an ovarian mass - The most common location for endometriotic deposits is in the ovaries.
endometriomas
- <5 mm: early-stage disease; >15 mm: advanced disease
- shading sign: may be less likely to respond to medical treatment
- low T1 and T2 due to tissue and haemosiderin-laden macrophages
diagnostic criteria:
- multiple cysts with T1 hyperintensity OR
- one or more cysts with high T1 and shading on T2
haemorrhagic “powder burn”
- lesions appear bright on T1 fat-saturated sequences
- small solid deep lesions
- may be hyperintense on T1 and hypointense on T2
Renal cystic disease
Medullary sponge kidney is a disease of childhood
MCDK is associated with lower urinary tract problems
ADPKD has higher risk of RCC
ARPKD juveniles need transplant
Dialysis associated cysts same as simple renal cysts for risk of RCC
ADPKD has higher risk of RCC - Patients with ADPKD have a 50x increased risk of renal cell carcinomas, which typically manifest as atypical renal cysts.
Which is most true regarding diffusion weighted imaging? REPEAT
Abscess does not show peripheral restricted rim
Intracellular methaemoglobin is low on DWI
Intracellular methaemoglobin is low on DWI
Bone oedema anterior medial femoral condyle and medial tibial plateau, likely mechanism:
Hyperextension with valgus
Hyperextension with varus
Hyperflexion with valgus
Hyperflexion with varus
Pivot shift
Hyperextension with varus
Most likely site of intestinal injury in blunt trauma
Duodenum and proximal jejunum
Distal jejunum and ileum
Caecum
Sigmoid colon
Duodenum and proximal jejunum
Which of the following is LEAST correct regarding diabetic mastopathy?
Dense posterior acoustic shadowing on ultrasound
Lymphadenopathy
Asymmetric density on mammogram
Nonspecific stromal enhancement on MRI
Poorly defined hypoechoic mass on ultrasound
Lymphadenopathy
Diabetic mastopathy
- Characterised by the presence of a benign tumour like breast masses in women with long-standing type 1 or type 2 insulin-dependant diabetes mellitus.
- The condition has also been reported in men.
- A similar condition is lymphocytic mastitis but this occurs in non-diabetics.
- It is a form of lymphocytic mastitis and stromal fibrosis. There is dense fibrosis, and predominantly B-cell lymphocytic infiltrate surrounding the ducts, lobules and vessels.
- Appearance:
- Mammography: Asymmetric densities
- Ultrasound: Irregular hypoechoic masses with marked posterior acoustic shadowing
What is true regarding MRI safety?
A patient with ferromagnetic ear piercing that they cannot remove is disqualified from entering a 1.5T magnet
A patient with a copper IUD is disqualified from entering a 1.5T magnet
A patient with a cochlear implant is disqualified from entering a 1.5T magnet
A diabetic patient can enter a 1.5T MRI while connected to their external insulin pump
A patient with metallic shrapnel foreign bodies from combat injury is disqualified from entering a 1.5T magnet even if they are far from vital organs
A patient with ferromagnetic ear piercing that they cannot remove is disqualified from entering a 1.5T magnet
MOST CORRECT in testicular ultrasound
Use a 6mHz linear transducer
Colour Doppler is more sensitive for low flow states than power Doppler
Reversed diastolic flow is normal
Low resistance waveform in intratesticular arteries is normal
Low resistance waveform in intratesticular arteries is normal
Lady presents with discharge from umbilicus with mass extending from bladder
Adenocarcinoma
Squamous carcinoma
Transitional cell carcinoma
Adenocarcinoma
Paediatric lateral condyle fracture (something about displaced)– Salter Harris what
I
II
III
IV
IV - if type 1 lateral to the groove, II if type 2 - through the groove
A (?50) year old male patient has a right pneumonectomy for lung cancer. Follow-up radiographs 1 year later demonstrates return of the mediastinum to the midline.
Normal and common finding
Normal but uncommon finding
Post pneumonectomy syndrome
Local or pleural recurrence
Local or pleural recurrence
A 9 year old child presenting with abdominal pain, has ultrasound for ? appendicitis. Has a history of treated stage 3 neuroblastoma. The last staging study was performed 3 years ago. Ultrasound demonstrates 3 new low density liver lesions between 1-4cm. Which of the following is most likely?
Neuroblastoma Metastasis
FNH
Adenoma
Haemangiomas
Biliary hamartomas
Neuroblastoma Metastasis
A 50 year old male presents with fever and right upper quadrant pain 6 months post abdomino-peroneal resection. New 6cm irregular low density lesion in liver with thick enhancing rim. Which is most likely?
Necrotic metastasis
Pyogenic abscess
Amoebic abscess
Hydatid disease
Candidiasis
Pyogenic abscess
A patient is referred for gadolinium-enhanced MRI for evaluation of a renal lesion. They have a history of type 2 diabetes and an eGFR of 29. Which of the following is the best course of action?
Linear chelate gadolinium
Macrocyclic gad
Non-ionic gad
No contrast
Refer for haemodialysis immediately after the scan and at 24 hours
Macrocyclic gad - could be considered
No contrast
A patient with a history of prior gastric surgery presents for a Barium swallow. The control image demonstrates surgical clips at the level of the diaphragm. A column of contrast is held up within the oesophagus for 2 minutes. Contrast eventually passes into a loop of small bowel. What surgery have they had?
Bilroth II with afferent limb syndrome
Total gastrectomy with anastomotic stricture
Sleeve gastrectomy with stricture
Slipped gastric band
Unwrapped fundiplication
Total gastrectomy with anastomotic stricture
11month old presenting with abdominal distension. Midline posterior cranial fossa mass. Renal lesion 10cm. What is the renal lesion most likely?
Wilms
Mesoblastic nephroma
RCC
Clear cell sarcoma
Rhabdoid tumour
Rhabdoid tumour- Unlike mesoblastic nephroma, rhabdoid tumors may present with tumors in other tissues including in ~13% of cases, the brain.
too young for wilms, too young for vhl/rcc, sarcoma and nephroma are furphys
Least likely in bronchiolitis obliterans
RA
Upper zone predominant
Cystic fibrosis
Seen following lung transplant
Mosaic attenuation in inspiration on HRCT
Upper zone predominant
A young man presents with pneumonia and is treated with oral antibiotics for 7 days. A follow-up radiograph demonstrates a thin-walled cyst in the lower lobe with air fluid level. What is most likely?
Malignancy
Pulmonary abscess
Pneumatocele
Bronchogenic cyst
Necrotising pneumonia
Pneumatocele - thin walled cyst.
Appear within the first week of infection, resolve by week 6. Thin walled cystic spaces within the lung, containing gas.
Little, if any, fluid content favours a pneumatocele
Least likely in thoracic outlet obstruction
Elongated transverse process of C6
Cervical rib
Acromioclavicular dislocation
Hyperostosis of the clavicle
First rib ?osteochondroma
Elongated transverse process of C6
or maybe First rib ?osteochondroma
A CXR of a 20 year old patient shows a retrocardiac density and splaying of the carina. What is the most likely cause?
Bronchogenic cyst
Neurenteric cyst
Left atrial enlargement
Hiatus hernia
Tumour
Bronchogenic cyst
A young patient presents with a large cystic structure in the right neck. Extension into which of the spaces best distinguishes a ranula from a lymphatic malformation?
Sublingual space
Submandibular space
Parapharyngeal space
Anterior cervical space
Posterior cervical space
Sublingual space
Marker most associated with T21?
Hypoplastic nasal bone
Aberrant right subclavian artery
Choroid plexus cyst
Single umbilical artery
Echogenic intra-cardiac focus
Hypoplastic nasal bone
A patient presents with postpartum PV bleeding. Which of the following is most likely?
Bilobed placenta
Succenturiate lobe
Placenta membranacea
Circumvallate placenta
Velamentous cord insertion
Succenturiate lobe
Which is not a feature of pseudohypoparathyroidism?
Cone shaped epiphyses
Dentate nucleus calcification
Metaphyseal flaring
Early closure of epiphyses
Metaphyseal flaring - Erlenmeyer flask deformity
PSEUDOHYPOPARATHYROIDISM
MSK
Short stature, obesity
Brachydactyly
Short metacarpals. Including 4th and 5th
Short metatarsals
Soft tissue calcification
Exostoses
CNS
Basal ganglia calcification
Sclerochoroidal calcification
Deep white matter calcification
10 year old follow up MRI for previous medulloblastoma. MRI demonstrates high T1 signal in basal ganglia and thalamus. Most likely cause?
Radiation change
Medulloblastoma metastases
Gadolinium retention
Gadolinium retention
A young patient presents with headache and ear pain. CT demonstrates smooth expansion of the petrous apex. MRI demonstrates high T1/T2 signal in petrous apex, no enhancement. Most likely cause?
Cholesteatoma
Cholesterol granuloma
Asymmetric normal fatty marrow
Petrous apicitis
Cholesterol granuloma (expansile)
Which is most likely to be observed in patients with Paget’s disease?
Increased fatty marrow signal on MRI
Lower rate of non-union following fracture
Minimal risk of heterotopic ossification following surgery
Up to 75% of patients are symptomatic at time of diagnosis
Most common in Asians and Africans
Increased fatty marrow signal on MRI
Young patient (?25yo) presents with a “whooshing” sound. On otoscopy there is a red mass behind the lower half of the tympanic membrane. CT demonstrates permeative lesion involving the middle ear and extending into the jugular fossa. What is the most likely diagnosis?
Haemangioma
Paraganglioma
Metastases
Chondrosarcoma
Dural AVF
Paraganglioma
40 yr old female with a history of rectal cancer undergoes liver MRI with a hepatocyte specific agent. There is a 1 cm lesion in liver with arterial enhancement and no central scar, no signal loss on out of phase and isointense on delayed (hepatobiliary) phase. Most likely?
FNH
Adenoma
Metastasis
Hemangioma
HCC
FNH
Patient with idiopathic intracranial hypotension. Which is not a feature?
Hyperaemia of the pituitary gland
Dural enhancement and subdural collections
Effacement of the chiasmatic cisterns
Leptomeningeal enhancement
Leptomeningeal enhancement
Intracranial hypotension
- CSF pressure < 6 cmH2O
Types:
- Primary aka spontaneous
- Secondary: Typically iatrogenic or traumatic
Epi: Middle aged females
Presentation: Positional headache typically. When more significant decreased GCS.
Pathology:
- Monro-Kellie hypothesis is a pressure-volume relationship that aims to keep a dynamic equilibrium among the essential non-compressible components inside the rigid compartment of the skull.
- Spontaneous intracranial hypotension (SIH) usually is the result of a CSF leak in the spine. Causes include:
- spontaneous dural dehiscence of meningeal diverticula (perineural cyst)
- secondary to degenerative dural tears (typically related to calcified thoracic disc protrusions)
- congenital focal absence of dura (nude nerve root) – rare
Associations:
- Marfan syndrome
- Ehlers-Danlos syndrome (type II)
- autosomal dominant polycystic kidney disease (ADPKD)
Appearance:
- Described features of intracranial hypotension include:
- subdural collection
- acquired tonsillar ectopia
- dural venous sinus distention
Mnemonic
- S: subdural fluid collections
- E: enhancement of the pachymeninges
- E: engorgement of the venous sinuses
- P: pituitary hyperaemia
- S: sagging brain
Which is the least common site to be affected in CRMO?
Thoracic spine
Distal metatarsals
Lateral clavicle
Distal tibial metaphysis
Mandibular condyle
Lateral clavicle
Chronic recurrent multifocal osteomyelitis (CRMO)
- Chronic recurrent multifocal osteomyelitis (CRMO) is an idiopathic inflammatory bone disorder seen primarily in children and adolescents. There is a female predominance, with 85% of cases reported in women.
Pathology:
- As the condition can be associated with skin conditions, like psoriasis, or inflammatory bowel disease an autoimmune cause is thought likely.
Initially to examine the symptomatic site:
- Early stages: osteolytic lesion
- Later stages: progressive sclerosis
Appearance:
- Typically metaphyseal
- Medial but not lateral clavicular involvement
Forearm mass in a 65 yo male, high T1 signal with partial suppression on fat suppression, patchy contrast enhancement. Most likely?
Vascular malformation
Melanoma
Haematoma
Schwannoma
Lipoma
Melanoma
Which is not a cause of tinnitus?
Small vestibular aqueduct
FMD of the ICA
Paget’s disease
Paraganglioma
Dural AVF
Small vestibular aqueduct– large vestibular aqueduct is generally an issue (should be no larger than the posterior semicircular canal).
Which is false regarding coalition?
Bilateral in 25%
Talocalcaneal best visualised in coronal plane on CT
Talonavicular is best seen on oblique radiographs
Talar beaking most associated with talocalcaneal
95% are talo-calcaneal or calcaneo-navicular
Bilateral in 25%- 50% are bilateral (even if symptomatic only on one side).
A patient has disc herniation on MRI. Which is false?
Far lateral L4/5 would impinge L4
Posterolateral L3/4 would impinge L4
Focal herniation is <25% of disc circumference
Broad-based herniation is 25-50%
Annular fissure/tear is traumatic in aetiology
Annular fissure/tear is traumatic in aetiology - degenerative
Which is false regarding HADD?
Most common in hand
No bony erosion
Periarticular calcification
Can erode into bursae and cause acute inflammation
Commonly incidental in an asymptomatic patient
Most common in hand– The shoulder is the most commonly affected joint.
ILC – best way to determine local extent?
Tomography and US clearly define ILC
Contrast enhanced MRI
Commonly associated with calcification on mammography
Contrast enhanced MRI- Due to its propensity for multicentricity, breast MRI is usually recommended in many countries when histology of a lesion reveals invasive lobular carcinoma.
Radial scar which is true?
Most common age 40-60
Commonly associated with lobular breast cancer
Usually / frequently spiculated mass
Presents with calcification on mammogram
Most common age 40-60
30 year old female with 2 months diarrhoea. Small bowel follow through shows featureless jejunum which is distended to 4cm, and an increased number of ileal folds. What is the most likely diagnosis?
Celiac disease
Scleroderma
Crohn’s disease
Celiac disease
Celiac disease, also known as non-tropical sprue, is the most common gluten-related disorder and is a T-cell mediated autoimmune chronic gluten intolerance condition characterized by a loss of villi in the proximal small bowel and gastrointestinal malabsorption (sprue).
Features present on CT enteroclysis may include:
- jejunoileal fold pattern reversal: thought to have the highest specificity is considered the most discriminating independent variable for the diagnosis of uncomplicated celiac disease
- ileal fold thickening
- vascular engorgement
- prominent mesenteric lymph nodes may cavitate with a fluid-fat level
- submucosal fat deposition in long-standing cases
- splenic atrophy
Patient with ataxia telangiectasia. Most likely on imaging?
Preserved NAA on MR spectroscopy
No significant white matter change surrounding telangiectasia
Posterior frontal lobe atrophy early feature
SWI is not useful
some option on MIP reformats
Preserved NAA on MR spectroscopy
The cerebellar metabolic pattern revealed significantly increased Cho/Cr and reduced NAA/Cho in the A-T patients, implying an increase in the choline signal intensity, with NAA/Cr showing no significant difference from that of the controls.
Ataxia telangiectasia
- Ataxia-telangiectasia is a rare multisystem disorder that carries an autosomal recessive inheritance, sometimes classified as a phakomatosis. It is characterized by multiple telangiectasias, cerebellar ataxia, pulmonary infections, and immunodeficiency.
- On brain imaging, it usually demonstrates vermian atrophy, compensatory enlargement of the fourth ventricle, cerebral infarcts and cerebral hemorrhage secondary to ruptured telangiectatic vessels.
Imaging in prion disease / CJD
Bilateral thalamic involvement is pathognomonic for variant CJD (pretty sure this is wrong in retrospect)
DWI changes can precede those on EEG
Early posterior parietal atrophy is an early feature in Heidenhain variant CJD
Abnormal signal intensity is seen in the inferior colliculi in FFI
DWI changes can precede those on EEG
Proximal jejuno-jejunual intussusception. Which of the following is most likely associated?
Dorsal pancreatic agenesis
Ectopic pancreas
Annular pancreas
Pancreatic divisum
Pancreatic agenesis
Ectopic pancreas
Adult intussusception caused by EP represents 5% of all cases of intussusception.
Which of the following is not a cause of craniosynostosis?
Thalassemia
Hypothyroidism
Crouzon syndrome
Prior shunt procedure
Rickets
Hypothyroidism– hyper but not hypo
Craniosynostosis refers to the premature closure of the cranial sutures. The skull shape then undergoes characteristic changes depending on which suture(s) close early.
Epidemiology: There is a 3:1 male predominance with an overall incidence of 1 in 2000-2500. 8% of cases are syndromic or familial.
Primary forms are either sporadic or familial. Secondary craniosynostosis occurs in relation to a variety of causes:
- endocrine disorders
- hyperthyroidism
- hypophosphataemia
- vitamin D deficiency
- hypercalcaemia
- haematologic disorders causing bone marrow hyperplasia
- sickle cell
- thalassaemia
- inadequate brain growth
- microcephaly
- shunted hydrocephalus
A 5 year old child presents with a cough. Obscuration of the right heart border seen on CXR. Most likely cause?
Thymus
RML collapse
Large epicardial fat pad
Pectus carinatum
Ganglioneuroma
RML collapse
Causes of DECREASED resistive index in kidneys
ATN - increase
Pyelonephritis - increase
Hepatorenal syndrome - increase
Diabetes - increased
Ureteric obstruction - increase
The renal arterial resistive index (RI) is a sonographic index of intrarenal arteries defined as (peak systolic velocity - end-diastolic velocity) / peak systolic velocity. The normal range is 0.50-0.70.
Reasons for elevated values
- medical renal disease
- ureteric obstruction
- extreme hypotension
- very young children
- perinephric fluid collection
- abdominal compartment syndrome
Reasons for elevated values in a transplant kidney
- acute tubular necrosis (ATN)
- acute or chronic transplant rejection
- renal vein thrombosis
- drug toxicity
- ureteric obstruction
- perinephric fluid collection
Reasons for decreased values
- renal artery stenosis
Complex jaw lesion mandible with centrally rudimentary tooth, surrounding lucency. Displaces adjacent roots away. Most likely?
Ameloblastoma
OKC
Odontogenic cyst
Odontoma
Dentigerous cyst
Odontoma
A young girl is noted to have a horseshoe kidney on renal ultrasound. The parents remember that she had puffy hands and feet at the time of birth. Which of the following is most likely?
Turners
Noonans
Edwards syndrome
Prader-Willis
Turners
Which is least likely to be associated with azygos continuation of the IVC?
Dextrocardia
Polysplenia
Gonadal veins draining into ipsilateral renal veins
Left sided SVC
Hepatic veins draining into azygos vein
Hepatic veins draining into azygos vein– in azygos continuation hepatic veins usually drain directly in the right atrium.
Which is true about para-ovarian cysts?
<1% occurrence
Always unilateral
Can undergo rupture and haemorrhage
Have a small risk of malignancy if complex features
Require annual follow up
Can undergo rupture and haemorrhage
Paraovarian cysts are remnants of Wolffian duct in the mesosalpinx that do not arise from the ovary. They account for ~10-20% of adnexal masses.
They usually occur around the broad ligament and arise from paramesonephric, mesothelial, or mesonephric remnants. They are usually simple cysts (although some authors include paraovarian cystadenomas under the umbrella of paraovarian cysts).
Paraovarian cysts occasionally can be complicated by rupture, torsion, or haemorrhage. Large or symptomatic cysts often undergo surgical resection. Smaller asymptomatic ones are treated conservatively.
Given a small chance of representing neoplasm, paraovarian cystic lesions may be recommended for follow-up imaging.
The 2010 Society of Radiologists in Ultrasound consensus statement recommends follow-up of simple paraovarian cysts in situations similar to that of simple ovarian cysts:
- 5-7 cm simple cyst in premenopausal women: yearly ultrasound
- 1-7 cm simple cyst in postmenopausal women: yearly ultrasound
- >7 cm simple cyst in any age: further imaging (e.g., MRI) or surgical evaluation
A woman presents with pleuritic chest pain after running a marathon. The chest x-ray is normal. VQ showed “low probability of PE”. What is the next step?
Repeat VQ in 3 months
CTPA
No further imaging required
Quantitative D-Dimer
Lower limb Doppler
No further imaging required
A lady presents with multiple fractures in the spine, T3,6,7 and 11. Bone scan shows symmetrical and moderately increased uptake at T3 and 7 lesion and physiological uptake elsewhere. Which is true?
T3 and 7 lesions are metastases
T3 and 7 lesions are acute or non-united
All are chronic fractures
T3 and 7 lesions are acute or non-united
US carotid doppler, which is true?
Ulcerating plaque can be well characterised on Doppler
Origin of the right common carotid cannot be reliably seen on Doppler
Pulse pressure of ICA is more than ECA
Symptomatic plaque is hyperechoic
Intimal thickness should be measured on the anterior wall of the proximal ICA
Ulcerating plaque can be well characterised on Doppler– but not always
origin of left not well seen
exa high pulse pressure
tend to be hypo
intimal thickn measure at posterior wall
A 60 year old man with recent sore throat and chest pain. CT chest demonstrates a complex cystic pleural lesion which extends through the intercostal space, and an airspace opacity in lower lobe. Most likely?
Pleural metastasis
TB - still the most common cause of empyema necessitans
Cryptococcus
Hydatid
Actinomycosis
Actinomycosis
- Aspiration of oropharyngeal/GI secretions into the respiratory tract
- Tends to be lower zones
Empyema necessitans causative organisms:
- Mycobacterium tuberculosis: thought to be most common cause and may account for ~70% of cases
- Actinomyces spp.: considered second most common cause (see: thoracic actinomycocis infection)
- Blastomycosis spp.
- Aspergillus spp.
- Nocardia: see pulmonary nocardiosis
- Mucormycosis spp.
- Fusobacterium spp.
CT performed in the setting of trauma. There is a smooth outpouching from the inferior aortic arch at the level of the aortic isthmus. No adjacent haematoma or fat stranding is seen. What is most likely?
Ductus diverticulum
Aortic pseudoaneurysm
Aortic spindle
Traumatic aortic dissection
Ductus diverticulum
Patient presents with chest pain patient radiating to back. CT shows focal contrast within the media. What is most likely?
Intramural hematoma
Aortic dissection flap
Aneurysm
Aortitis
Ulcerating atheromatous plaque
Ulcerating atheromatous plaque - since focal
Following a CT scan, a patient complains of moderate forearm swelling and arm pain. Which of the following is appropriate management for IV contrast extravasation?
Immediate review by plastics registrar
Compression bandage, notify the GP and GP review in 1 week
Attempt aspiration, compression bandage, ice and elevation, and regular neurovascular observations
Compression bandage, local anaesthetic cream, elevation
Attempt aspiration, compression bandage, ice and elevation, and regular neurovascular observations
Screening spine US in neonate. There is a cystic lesion at the distal end of the cord ?filum which slightly splays the cauda equia nerve roots. The conus terminates at a normal level. Next best step?
GA and MRI at 2 years of age
Immediate feed and wrap and MRI
Follow up US at 3 months of age
Immediate paediatric neurosurgical referral
No further imaging required
No further imaging required
A filar cyst is an incidental finding on neonatal lumbar sonography located in the filum terminale of the spinal cord.
It is considered a normal variant and is often confused for a ventriculus terminalis, a smooth dilated cavity of the central canal, located within the conus medullaris.
A 55 year old man with presents with jaundice and epigastric pain. He has had a cholecystectomy 2 years ago. On ultrasound, the common hepatic duct measures 8mm but the pancreas is not visualised. Liver appears normal. What is the most appropriate next step?
MRI/MRCP
ERCP
AXR
CT
PTC
MRI/MRCP
Which of the following is true regarding venous infarct? (Context was pretty clearly about intracranial)
Grey and white matter oedema and haemorrhage
Dense cord sign is seen in cortical venous thrombus <5% of cases
Can be associated with hydrocephalus
Dural venous sinus thrombus is directly identified in most cases
Grey and white matter oedema and haemorrhage
A 20 Asian female patient has a pouch like structure arising from the anterior aspect of the caecum with central echogenic focus. What is the most likely cause?
Acute appendicitis
Caecal diverticulitis
Typhlitis
Epiploic appendagitis
Caecal diverticulitis
Middle aged male patient with right iliac fossa pain and fever. Area of fat standing posterior to the ascending colon. It has a region of fatty density (-80HU) measuring 3 cm with central small focus measuring 100HU. What is the most likely diagnosis?
Acute appendicitis
Caecal diverticulitis
Typhlitis
Epiploic appendagitis
Epiploic appendagitis
Fetal echocardiogram. Three vessel view shows:
Aorta, pulmonary artery and SVC from left to right
Aorta diameter is usually larger than pulmonary artery
In Tetralogy of Fallot, the pulmonary artery is significantly smaller than the aorta
In Tetralogy of Fallot, the pulmonary artery is significantly smaller than the aorta
A patient has an incidental hypoechoic renal lesion which was indeterminate on ultrasound. MRI shows T1 low, T2 high, no enhancement.
Simple renal cyst
Proteinaceous cyst
Hemorrhagic cyst
RCC
AML
Simple renal cyst
Fibroadenoma appearance in a 40 year old female.
Invariably solitary lesion on US and MMG
Echogenic areas with shadowing on US-
Mass with no enhancement on MRI
If malignancy arises within, it is most likely to be IDC
in premenopausal women classically seen as coarse calcification within a mass on mammo
Echogenic areas with shadowing on US- Typically seen as a well-circumscribed, round to ovoid, or macrolobulated mass with generally uniform hypoechogenicity. Intralesional sonographically detectable calcification may be seen in ~10% of cases 2. Sometimes a thin echogenic rim (pseudocapsule) may be seen sonographically.
Fibroadenoma is a common benign breast lesion and results from the excess proliferation of connective tissue. Fibroadenomas characteristically contain both stromal and epithelial cells.
They usually occur in women between the ages of 10 and 40 years. It is the most common breast mass in the adolescent and young adult population. Their peak incidence is between 25 and 40 years. The incidence decreases after 40 years.
The typical presentation is in a woman of reproductive age with a mobile palpable breast lump. Due to their hormonal sensitivity, fibroadenomas commonly enlarge during pregnancy and involute at menopause.
Hence, they rarely present after the age of 40 years.
The lesions are well defined and well-circumscribed clinically and the overlying skin is normal. The lesions are not fixed to the surrounding parenchyma and slip around under the palpating fingers, hence the colloquial term a breast “mouse”.
What is DMSA used for?
Cortical scarring in recurrent UTI
Calculation of renal function
Evaluating for renal obstruction
Cortical scarring in recurrent UTI
Tc-99m DMSA (2,3 dimercaptosuccinic acid) is a technetium radiopharmaceutical used in renal imaging to evaluate renal structure and morphology, particularly in paediatric imaging for detection of scarring and pyelonephritis.
MAG3 for function.
Young female patient presents with a thunderclap headache, orbital pain and diplopia. CT demonstrates nodular thickening of lateral rectus muscle which does NOT enhance. What is the cause?
Idiopathic inflammation (didn’t use the word pseudotumour)
Sarcoid
Metastases
Haematoma
Lymphoproliferative disorder
Haematoma
Which of the following is most likely to be found in a patient with hemifacial spasm?
Vascular loop of AICA
Pericallosal septal lesion
Diffusion restricting lesion at the CP angle
Frontal lobe mass
Demyelination in the brainstem/pons
Vascular loop of AICA
A young patient presents with right sided sensorineural hearing loss. There is a past history of haemophilus meningitis. CT demonstrates increased density surrounding the cochlea, vestibule and semicircular canals. Which is most likely?
Labyrinthitis ossificans
Cholesteatoma
Fenestral otosclerosis
Antefenestral otosclerosis
Labyrinthitis ossificans– It the depends on the question alternatively retrofenestral/cochlear otosclerosis
Lucent, well-defined 4cm lesion in S1 in young adult. What is the most likely diagnosis?
Chordoma
Aneurysmal bone cyst
Giant cell tumour
Metastasis
Ewings
Aneurysmal bone cyst
Well defined, lucent
A third trimester growth scan demonstrates EFW <5th centile and AC on 20th centile. Which of the following statements is true?
IUGR is more likely than SGA
If MCA PI <5th centile should assess the ductus venosus
Usually see forward flow in a wave in ductus venosus of severely growth restricted foetus
UA doppler should be taken with vessel at right angle to US beam
If UA doppler is normal in one vessel, must do the other vessel also
If UA doppler is normal in one and abnormal in the other, take the abnormal measurement
If MCA PI <5th centile should assess the ductus venosus
Regarding fetal MCA Doppler.
Measurement is taken > 2cm from MCA origin
The Doppler box should be more than 3mm
Angle correction should be used when Doppler angle is greater than 0
If the PI <5th centile then repositioning and repeat measurement taken
MCA furthest away from the transducer
If the PI <5th centile then repositioning and repeat measurement taken
Which of the following is true regarding management of contrast reactions?
1:10,000 intramuscular adrenaline is contraindicated
Interlukin 2 reduces the risk of adverse reactions
Hypersensitivity to iodinated contrast is seen in 5% of the general population
Reduced efficacy of adrenaline in patients taking beta-blockers
Reduced efficacy of adrenaline in patients taking beta-blockers
Thyroid papillary cancer least correct:
Calcifications within the lesion
Lymph nodes have calcifications
Lymph nodes can show cystic change
Characteristically hypovascular thyroid lesion on US
Hypoechoic thyroid lesion
Characteristically hypovascular thyroid lesion on US
Which of the following is NOT associated with nasal dermoid?
Nasal cavity mass
Enlarged foramen caecum
Bifid crista galli
Fat/fluid attenuation
Lesion enhancement
Lesion enhancement
Young female patient presents with hip pain. X-ray demonstrates a lucent lesion below the lesser trochanter of femur, with saucerisation of the femoral cortex. There is a thin rim of cortical uptake on bone scan. Most likely?
Metastasis
Parosteal osteosarcoma
Periosteal chondroma
Chondrosarcoma
Osteochondroma
Periosteal chondroma
Juxtacortical chondromas, also known as periosteal chondromas, are rare benign chondral tumours that arise from the periosteum of tubular bones. They are thought to account for ~2% of benign bone tumours.
Plain radiograph
- may be seen as a saucerisation of the adjacent bony cortex with a sclerotic periosteal reaction
- distinct soft tissue mass may be difficult to identify
- matrix calcification may be seen in ~50% of cases; as with all chondroid lesions, this tends to be ring and arc
- most lesions are <3 cm in size
Which of the following is commonly associated with diffuse midline glioma?
T2 hyperintense with necrosis and haemorrhage
Avid contrast enhancement
Leptomeningeal infiltration is commonly seen
Invasion of the basilar artery
Most commonly involve the hypothalamus and thoracic cord
Leptomeningeal infiltration is commonly seen- Extensive spread is relatively frequent, both craniocaudally to involve the cerebral hemispheres and spinal cord, as well as leptomeningeal spread.
Young male vomiting after binge drinking alcohol. Morning pain and blood stained vomiting. Barium swallow is normal. Most likely
Mallory Weiss tear
Boerhaave syndrome
Reflux oesophagitis
Varices
infection ? candida oesophagitis
MWT
Young male (?20) with hypertension and bilateral renal artery stenosis (no mention of ostia involvement). On examination has reduced lower [?groin ?femoral] limb pulses. Most likely diagnosis.
Takayasu
Coarctation
Fibromuscular dysplasia
GCA
PAN
Takayasu
In regards to spine disease (stem was longer…) on MRI, which is LEAST likely?
Modic II is high T1 and low T2
Modic I is low T1 and high T2
Modic III is low T1 and low T2
Schmorl’s node is herniation of disc into the vertebral endplate
Something about limbus vertebra is an unfused ring hypophysis
Modic II is high T1 and low T2 - high, high
65 year old female with pancreatic cystic lesion. Demonstrates 2 cysts measuring 3 cm each. No central calcification or scar. Which is most likely?
Mucinous cystic neoplasm
Pauci-cystic serous
Serous cystic neoplasm
SPEN
Adenocarcinoma
Serous cystic neoplasm
Regarding 2nd branchial cleft cyst. Which is LEAST CORRECT?
Can extend to the supraclavicular region
More common than 1st branchial cleft cyst
Present with otorrhoea
Classically located in the parotid gland
Located posterior to the submandibular gland
Classically located in the parotid gland
Coronary artery dominance is defined by origin of:
Posterior descending artery
Diagonal arteries
Circumflex arteries
Posterior descending artery
In trisomy 21 which is the most common atrial septal defect?
Large PFO
Primum ASD
Secondum ASD
Sinus venosus ASD
Unroofed ASD
Secondum ASD
Small bowel ischemia least likely to present with:
SMA occlusion
IMA occlusion
AAA
AMI
SMV occlusion
IMA occlusion
Mucinous breast cancer most likely to present as:
Spiculated mass on mammography
Solid lesion within cyst on ultrasound*
Circumscribed mass (?)
Calcification on mammo
Circumscribed mass (?)
What is false regarding appendicitis in pregnancy (repeat)
More likely to rupture
More common in 3rd trimester
Most common cause of surgical intervention during pregnancy
Differential diagnosis is ovarian torsion
Red fibroid degeneration can be a mimic
More common in 3rd trimester– second trimester
Most correct option regarding bowel ischemia (least correct)
Acute bowel ischaemia is associated with 60% mortality
SMA occlusion is well tolerated if there are adequate collaterals
Venous ischaemia has less well defined borders than arterial
Hepatic flexure is mostcommon watershed area
Hepatic flexure is common watershed area - least correct, splenic flexure
Primary haemochromatosis. Least likely involved
Spleen
Liver
Pancreas
Heart
Joints
spleen
Which is false
SDH mass effect is increased with white matter oedema
Subfalcine herniation is associated with anterior callosal artery infarct
Duret haemorrhage is secondary to tearing of small vessels
Uncal herniation with ipsilateral PCA infarct
Kernohans notch is compression of the ipsilateral peduncle secondary to uncal herniation on the falx
Kernohans notch is compression of the ipsilateral peduncle secondary to uncal herniation on the falx
Kernohans notch: indentation in the contralateral cerebral crus by the tentorium cerebelli
Which is an incorrect line placement in neonate ?
Left PICC in left brachiocephalic vein and SVC confluence
NGT below diaphragm
UVC tip at junction of diaphragm and RA
ETT 1.5 cm above the carina
UAC at the level of aortic arch
UAC at the level of aortic arch
The tip of the catheter should thus be placed in one of two locations:
1. high position: at T6 to T10 level
2. low position: at L3 to L5 level
Least correct regarding vascath placement?
Tunnelled vascath associated with lower infection rate compared with non-tunnelled
Tunnelled femoral vascath can be left in situ for several months
Vascath line tip optimally positioned at brachiocephalic and SVC confluence.
Vascath line tip optimally positioned at brachiocephalic and SVC confluence.
Patient investigated for infertility issues. Under direct examination there were two uterine cavities and two cervices. Which is the most likely?
Didelphys
Bicornuate
Septat
Unicornuate
Bicornuate - could be didelphys but bicorn more likely
Which does not cause pneumatosis intestinalis? (TWO questions)
SMA occlusion
MI
COPD
CF
Diverticulosis
Diverticulosis
Which does not cause pneumatosis intestinalis? (TWO questions)
SMA stenosis
MI
COPD
Asthma
Puetz-Jegher
Puetz-Jegher
Question about susceptibility-weighted imaging
Sensitive to paramagnetic, diamagnetic and ferromagnetic materials
SWI uses a maximum intensity projection
Sensitive to paramagnetic, diamagnetic and ferromagnetic materials
65 y.o.female, pancreas cystic lesion; 6cm, has 2x 3cm cyst, DIAGNOSIS
Macrocystic serous
Microcystic serous
Mucinous
Pseudopapillary
Macrocystic serous
Most correct regarding umbilical artery doppler
Should be measured in a segment of the umbilical cord at 90degrees to the transducer
If two measurements are obtained of UmbA PI, one is normal and one is abnormal, the abnormal result should be reported
PI should be measured in both umbilical arteries, even if the first measurement is normal.
Should be measured in a segment of the umbilical cord at 90degrees to the transducer
Older patient (60 yo??) with chronic umbilical discharge. CT shows soft tissue mass associated with the umbilicus and bladder dome. Most likely cause
SCC
Adenocarcinoma
TCC
Abscess
Adenocarcinoma
Most accurate regarding femoral avascular necrosis
Linear lucent band is an early finding on XR
Osseous changes are seen on both sides of the acetabular joint
MRI is more sensitive than TC-99m
MRI is more sensitive than TC-99m
G1P0 20 something year old with positive beta HCG. Transvaginal ultrasound shows cystic structure in endometrium. No gestational sac or free fluid
MSD measuring 22 mm with an empty sac is a non-viable pregnancy
Not definite for loss, needs repeat ultrasound to assess
Not definite for loss, needs repeat ultrasound to assess
Nasal dermoid
Doesn’t enhance
Nasal passage lesion
Enlarged foramen caecum
Bifid crista galea
Bifid crista galea
Papillary thyroid cancer
Calcification
Hypovascuarity
Calcification - psammoma bodies
CTA - aortic graft with contrast leak from lumbar artery. Which type
1
2
3
4
2
Continuation of L SVC. MOST LIKELY drains to
Right atrium
Left atrial appenage
Hemiazygous vein
Coronary sinus.
Coronary sinus.
1 year old infant with enlarging abdomen/ hepatic origin mass. Has solid and cystic components. AFP is normal for age. What is the MOST likely cause
Mesenchymal hamartoma
Hepatoblastoma
Caroli Disease
HCC
Mesenchymal hamartoma
Which one of the following is Thoracic outlet syndrome is not seen:
AC dislocation
Elongated transverse process of C6
Cervical rib
Bony callus of the first rib
Elongated transverse process of C6 (YES IT SAID C6)
Which best describes segment 3 of the liver?
Above the portal vein, between right and middle hepatic vein
Below the portal vein, located left to the left hepatic vein
Above the portal vein, located right to the right hepatic vein
Below the portal vein, between the left and middle hepatic vein
Above the portal vein, between the left and middle hepatic vein
Below the portal vein, located left to the left hepatic vein
Man found confused. CT demonstrates unilateral thalamic haemorrhage. MRI demonstrates T1 iso, T2 high. Most likely age of the haemorrhage?
Less than 24hrs
1-3 days
3-7 days
7-14 days
More than 14 days
Less than 24hrs
Neuromyelitis. Least likely finding?
Short segment cord lesions
Bilateral optic nerve involvement
Short segment cord lesions
Neuromyelitis. Least likely finding?
Short segment cord lesions
Bilateral optic nerve involvement
Short segment cord lesions
Patient with tinnitis. MRI demonstrates CPA lesion with small cystic components, T2 high signal, peripheral enhancement and restricted diffusion
Dermoid cyst
Schwannoma
Meningioma
Epidermoid
Epidermoid - would fit all but for the small cystic components
MRI demonstrates high T1/T2 signal in the petrous apex, no enhancement, no expansion. Most likely cause?
Cholesteatoma
Cholesterol granuloma
Normal fatty marrow
Petrous apicitis
Normal fatty marrow
Shouldn’t be expansile
Diabetic patient with history of nasal obstruction. CT demonstrates orbital stranding, hyperattenuating maxillary sinus lesion. Most likely diagnosis?
Invasive fungal sinusitis
Lymphoma
Allergic sinusitis
Antrochoanal polyp
Inverted papilloma
Invasive fungal sinusitis
Adult patient presents with a painful eye. CT demonstrates hypoattenuating lesion near the medial canthus with peripheral enhancement. What is the most likely diagnosis?
Dacryocystitis
Dacryoadenitis
Orbital cellulitis
Dacryocystitis
Well-circumscribed round lesion with peripheral enhancement around the inner canthus, with adjacent soft tissue thickening and fat stranding
Cystic lesion deep to parotid and extending into right parapharyngeal space. Most likely diagnosis?
1st branchial cleft cyst
2nd branchial cleft cyst
3rd branchial cleft cyst
Lymphatic malformation
1st branchial cleft cyst
1st branchial cleft:
Above the level of the manidble near the external auditory canal within or close to the parotid
2nd branchial cleft:
Between the angle of the mandible and carotid bifurcation, deeper than platysma and superficial layer of the deep cervical fascia
3rd branchial cleft:
Infrahyoid neck
4th branchial cleft: infrahyoid neck, usually adjacent to the thyroid gland
Trauma. Fractures on only one side, involving orbital floor, maxillary sinuses, zygomatic arch. Widening of zygomaticofrontal? sutures.
Tripod
Nasoethmoid
Lefort 1
Lefort 2
Lefort 3
Tripod
Repeat. Man with back pain following gardening. No focal neurology. Most likely management?
No further imaging
X-ray
CT
MRI
No further imaging
Most likely cause for lower back and bilateral lower limb pain in a patient with achondroplasia?
Posterior vertebral scalloping
Short pedicles
Small sciatic notches
Short pedicles
Achondroplasia
Pelvis and hips:
- Horizontal acetabular roof
- Tombstone/mickey mouse ear iliac wings
- Trigent acetabulum
- Champagne glass pelvic inlet
- Small sacroiliac notches
Spinal:
- Posterior vertebral scalloping
- Progressive decrease in the interpedicular distance in the lumbar spine
- Gibbus
- Short pedicle canal stenosis
- Laminar thickening
- Widening of intervertebral discs
- Increased angle between the sacrum and lumbar spine
Limbs:
- Metaphyseal flaring “trumpet bone” appearance
- Rhizomelic shortening – femora and humeri
- Long fibula – the fibula head is at the level of the tibial plateau
- Bowing to medial segment of legs
- Trident hand
- Chevron sign
- Shortened metacarpals and metatarsals – of similar length
Repeat. Most likely location of lesions?
Myxopapillary ependymoma and filum terminale
Central neurocytoma in parietal lobe
DNET in Frontal lobe
Myxopapillary ependymoma and filum terminale
Repeat. Smoker with shortness of breath. Most likely appearance?
RB ILD
UIP
NSIP
LIP
RB ILD
Lesion most likely to cause lobar expansion?
Melioidosis
Radiation
COVID 19
Sequestration
Adenocarcinoma
Adenocarcinoma
Repeat. Coronary artery dominance. Related to which artery?
PDA
Conus branch
Circumflex artery
Diagonal artery
PDA
Patient with rheumatic heart disease. Next step?
Echo
CT coronary angiogram
MRI cardiac
Non-contrast CT chest
Echo
Repeat. Patient with hemiplegia. Doppler demonstrates reversal of diastolic flow in ICA. Most likely cause?
CCA occlusion
CCA stenosis
ICA occlusion contralateral
ICA stenosis
ICA occlusion contralateral
Repeat. Most likely tool to remove foreign body.
Goose neck snare
Forceps
Goose neck snare – intended for use in the CVS or hollow viscus to retrieve and manipulate foreign objects
Repeat. Patient presents with DVTs and PEs. IVC filter inserted. Represents with new symptoms and is found to have new PEs. What is the most likely explanation?
Duplicated IVC
Azygos continuation of IVC
Duplicated IVC
45 years old male non smoker with 3 mm nodule in the lung, what to do next?
No follow up
6 month follow up 12 months follow up Biopsy
No follow up
Repeat. Least likely associated with central scar?
Hepatocellular carcinoma (HCC)
Cholangiocarcinoma
Focal nodular hyperplasia (FNH)
Adenoma
Haemangioma
Adenoma
Most likely pancreatic variant?
Pancreatic divisum
Annular pancreas
Pancreatic divisum - ~5%, most common
Pancreatic lesion with arterial phase enhancement, and PV I delayed washout, and hypodense on non con. Which is most likely?
Islet cell tumour
Ductal carcinoma
Adenocarcinoma
Hepatoid carcinoma of the pancreas
Islet cell tumour
Repeat. Previous gastric surgery. Presents with reflux. Fluoroscopy demonstrates surgical clips at the diaphragmatic hiatus, hold-up of a column of contrast jn oesophagus for 2 min which eventually drains into a loop of bowel.
Unwrapped fundoplication
Sleeve gastrectomy, stricture
Total gastrectomy, anastomotic stricture
Slipped gastric band
Billroth II, afferent loop syndrome
Total gastrectomy, anastomotic stricture
Man with AIDS. Recurrent Candida infection in oesophagus. Previous oesophageal dilatations 2 years back. Patient had head and neck tumour 18 months earlier which was resected and radiotherapy. Fluoroscopy demonstrates oesophageal thin projections/folds and jet of contrast. Most likely diagnosis?
Oesophageal web
Cricopharyngeal spasm
1ry oesophageal cancer
2ndry metastasis from head and neck
Oesophageal web
Associations:
- Plummer-Vinson syndrome
- Graft vs host disease
- GORD
- External beam radiation
“jet effect” of contrast passing distally
Oesophageal constriction caused by a thin mucosal membrane projecting into the lumen
Most specific finding of traumatic bowel injury?
Mucosal hyperenhancement.
Submucosal oedema
Pneumatosis
Portal venous gas
Submucosal oedema
Man presents with right lower quadrant pain. CT demonstrates ovoid lesion adjacent to the ascending colon which is hypoattenuating (-80 HU) and has central hyperattenuating focus (100HU) and adjacent fat stranding. Most likely diagnosis?
Epiploic appendagitis
Appendicitis
Diverticulitis
Epiploic appendagitis
Best sequence to assess bladder tumour invasion?
T1 without fat saturation
T1 with fat saturation
T2
DWI
T2
Man from Nigeria.Most likely bladder tumour? (did the stem mention schistosomiasis?)
Adenocarcinoma
Squamous cell carcinoma (SCC)
Transitional cell carcinoma (TCC)
Squamous cell carcinoma (SCC)
Repeat. 20 year old with well defined lucent lesion in sacrum.
ABC
Giant cell tumour (GCT}
Chordoma
Chondrosarcoma
Giant cell tumour (GCT}
Chronic shoulder pain. US demonstrates thickening of the supraspinatus muscle, hyperechoic foci in bursal surface with hypoechoic foci more deeply.
Complete tear
HADD
CPPD
Articular surface partial tear
Bursal surface partial tear
HADD
20 year old patient with enlarging chest wall mass. CT demonstrates rib lesion, right pleural effusion, pulmonary lesions. Most likely diagnosis?
Ewing sarcoma
Knee pain for weeks. On clinical examination, joint is warm and swollen with decreased ROM. CT demonstrates symmetrical loss of joint space, articular erosions
Infection
Rheumatoid arthritis (RA)
Seronegative arthropath
Seronegative arthropathy – for weeks
Knee pain. MRI demonstrates lesion in lateral knee, T2 hypointense. CT demonstrates calcification. Most likely diagnosis?
Gouty tophi
Desmoid
Fibroma
PVNS
Giant cell tumour
Gouty tophi
Low signal on T1, heterogenous high signal on T2
Only one to have calcification
Knee pain. MRI demonstrates lesion in lateral knee, low in T1 and high in T2 with peripheral enhancement. Most likely diagnosis?
Cyst
Repeat. Runner with shin pain. NM bone scan demonstrates uptake along the posteromedial aspect of the tibia.
Fracture
Medial tibial stress syndrome
Normal
Medial tibial stress syndrome:
- Shin splints – stress induced injury
- Periosteal fluid and marrow oedema
- Occurs at the medial surface of the distal 2/3rds of the tibial shaft
Repeat. Compressible mass in subcutaneous tissues, plantar aspect, overlying 2nd, 3rd and 4th metatarsal heads. Most likely diagnosis?
Adventitial bursitis
lntermetatarsal bursitis
Plantar fasciitis
Morton neuroma
Adventitial bursitis - overlying the metatarsal heads
Girl from Tibet? MRI demonstrates (something about suprasellar cistern), mild hydrocephalus, basal enhancement. Most likely diagnosis?
tb
Repeat. Which is most true regarding juvenile nasopharyngeal angiofibroma?
Males and females equal incidence
Commonly supplied by the internal maxillary artery
Commonly in 20-30 yo
Centred in the anterior nasal cavity
Commonly supplied by the internal maxillary artery
Chest xray in inspiratory and expiratory phases demonstrates right hilar density, hyperinflation of right lung.
Inhaled foreign body
Most likely cause of cyanosis on day 2?
Delayed closure of ductus arteriosus causing a right to left shunt
Repeat. 9 yo girl with abdominal pain. History of neuroblastoma when she was 3. US when she was 7 normal. Now, ultrasound demonstrates multiple new hypoechoic hepatic lesions. Most likely diagnosis?
Neuroblastoma metastases
Multiple FNH
Multiple adenomas
Multiple haemangiomas
Neuroblastoma metastases
Repeat. What is TRUE about lateral condyle fractures of the humerus?
If non-displaced, considered to be Salter-Harris Type 2
Displacement of <2 mm is associated with a good prognosis
Occurs close to age of physeal closure
Displacement of <2 mm is associated with a good prognosis
If non-displaced, considered to be Salter-Harris Type 2 - Depends on the relationship with the trochlear groove
- Type I, lateral to the groove - Salter-Harris 4, stable
- Type 2, through the groove - Salter-Harris 2, unstable
Repeat. What is TRUE about a 20 week foetus?
Cisterna magna imaged equally well on coronal as axial
The fornices may be mistaken for cavum septum pellucidum
Cingulate gyrus is usually seen
CSP can’t be seen until 24 weeks
Head circumference is measured on the outer edge of the skull including the soft tissues
The fornices may be mistaken for cavum septum pellucidum
CSP can’t be seen until 24 weeks - false, <18 weeks - >37 weeks
Pregnant woman presents with PV bleeding. US demonstrates an anechoic lesion with septations in the retroplacental region. Most likely diagnosis?
Placental abruption
Placenta accreta
Placental lake
Placental lake
Premenopausal woman with simple 2.5 cm paraovarian cyst. Most likely management?
Follow up
No follow up
No follow up
12 year old girl with a unilateral palpable breast lump. Most likely diagnosis?
Normal breast lump
Fibroadenoma
Normal breast lump
30-40 year old woman with fibroadenoma. Most likely appearance?
Mammo - ovoid lesion with coarse calcifications
Mammo - ovoid lesion with fine calcifications
US – hyperechoic
MRI - delayed and persistent mass like enhancement
MRI - delayed and persistent mass like enhancement
Variable, but most show persistent delayed enhancement
Most likely associated with diabetes?
Mastopathy
PASH
Mastopathy
Woman with previous mammogram overseas which demonstrates calcifications. Told they were “OK”. Mammogram demonstrates pleomorphic calcifications of varying size and shape. Next step?
Biopsy
Further work up
Short term imaging follow up
Return to routine screening
Further work up
Contrast reaction. Dose of adrenaline?
1:100 IM in 0.5 ml
1:100 IM in 2 ml
1:1000 IM in 0.5 ml IM
1:1000 IM in 2 ml
1:1000 IM in 0.5 ml IM
Patient on peritoneal dialysis. Requires MRI with intravenous contrast. Next step?
Contrast is contraindicated
Withhold dialysis until after MRI
Intravenous hydration prior to contrast administration
It’s ok to proceed unless diabetic
Contrast is contraindicated
A HRCT chest in a 45yo female demonstrates patchy bilateral ground glass opacities with surrounding smooth interlobular septal thickening. Which of the following is least likely to be the underlying cause?
Pulmonary haemorrhage
Subacute hypersensitivity pneumonitis
Pulmonary alveolar proteinosis
Pneumocystis jiroveci infection
Acute pulmonary oedema
Subacute hypersensitivity pneumonitis (least likely, all others are established causes of crazy pavy- see Webb, STATDx)
A CXR performed in a 70yo male who presented with 2 day history of shortness of breath and fever shows RUL consolidation with inferior bulging of the horizontal fissure. Sputum analysis is most likely to show which of the following organisms?
Gram positive cocci
Gram negative cocci
Gram positive bacilli
Gram negative bacilli
Acid fast bacilli
Gram negative bacilli (most likely Klebsiella pneumonia, clue is bulging fissure- STATDx, Webb)
A 50 year old female with multiple myeloma presents with worsening shortness of breath and stridor. A CT scan demonstrates a long segment of nodular soft tissue thickening surrounding the trachea with foci of calcifications and involvement of the posterior tracheal membrane. What is the most likely diagnosis?
Relapsing polychondritis
Sarcoidosis
Amyloidosis
Tuberculosis
Granulomatosis with polyangiitis
Amyloidosis (most likely, nodular thickening and posterior involvement with calcifications typical- STATDx, Webb)
A 25 yo tennis player has an MRI of the shoulder due to worsening shoulder pain. The referring doctor suspects they have internal impingement. Which of the following is least likely to be present?
Supraspinatus tendinosis
Greater tuberosity cysts
Posterosuperior labral tear
Infraspinatus articular surface tear
Thickened axillary recess
Thickened axillary recess (least likely, more commonly seen in adhesive capsulitis, STATDx, MSK requisites)
An elderly patient has a foot x-ray for acute atraumatic heel pain which demonstrates an avulsion fracture of the calcaneal tuberosity. Routine blood tests are most likely to show which abnormality?
Reduced haemoglobin
Elevated HbA1c
Elevated thyroid stimulating hormone
Reduced thyroid stimulating hormone
Elevated sodium
Elevated HbA1c (most likely, association with diabetes- STATDx)
Which of the following stages of neurocysticercosis is associated with the MOST prominent oedema and enhancement on imaging?
Nodular calcified False.
Vesicular
Racemose
Colloidal vesicular
Granular nodular
Colloidal vesicular True. Larvae dies an incites an inflammatory response from by the body
Which of the following intracranial abnormalities is LEAST likely to demonstrate abnormally increased diffusion restriction?
Cerebral lymphoma
Cerebral abscess
Adenocarcinoma metastasis
Medulloblastoma
Creutzfeldt-Jakob disease
Adenocarcinoma metastasis True
Which of the following bone lesions is LEAST likely to occur in the metaphysis?
Chondroblastoma
Chondrosarcoma
Osteosarcoma
Osteochondroma
Enchondroma
Chondroblastoma True. Occurs almost exclusively in the epiphysis of skeletally immature patients
Which of the following locations DOES NOT form part of the dissemination in space component of the 2017 McDonald criteria for the diagnosis of multiple sclerosis?
Periventricular
Juxtacortical
Optic nerve
Infratentorial
Spinal cord
Optic nerve True
Which of the following is NOT a sign of idiopathic intracranial hypertension?
Distended optic nerve sheaths
Dural thickening
Partially empty sella
Presence of meningocoeles
Venous sinus stenosis
Dural thickening True. A sign of intracranial hypotension
Which of the following is LEAST LIKELY to be an imaging feature of gout?
Involvement of the first metatarsophalangeal joint
Preservation of articular cartilage
Reduced bone density
Para-articular erosions
Amorphous soft tissue density
Reduced bone density True. Bone density usually preserved
Which of the following injuries is LEAST LIKELY to be associated with anterior cruciate ligament tear?
Segond fracture
Posterior cruciate ligament tear
Posterolateral corner injury
Medial collateral ligament tear
Medial meniscus tear
Posterior cruciate ligament tear True
Which of the following is LEAST LIKELY to be the aetiology of isolated subarachnoid haemorrhage at the vertex?
Dural venous sinus thrombosis
Cerebral amyloid angiopathy
Mycotic aneurysm
Cocaine use
Reversible cerebral vasoconstriction syndrome (RCVS)
Cocaine use True. Produces haemorrhages from systemic hypertension or rupture of pre-existing aneurysm (unlikely to occur at the vertex)
Which of the following is not a typical feature of autosomal recessive polycystic kidney disease on mid-trimester ultrasound? (US requisites and statdx)
Enlarged fetal kidneys
Hypoechoic fetal kidneys
Oligohydramnios
Pulmonary hypoplasia
Limb contractures
Hypoechoic fetal kidneys - kidneys are typically more hyperechoic
A woman undergoes a routine second trimester ultrasound at 20 weeks that shows herniation of liver and small bowel through the anterior abdominal wall with a normal length umbilical cord inserted onto the membrane. Which is the most likely diagnosis? (StatDx)
Gastrochisis
Omphalocele
Physiological midgut herniation
Duodenal atresia
Body stalk anomaly
Omphalocele
A woman undergoes a routine second trimester ultrasound at 20 weeks that shows a monoventricle, fused thalami and a proboscis. What is the most likely associated chromosomal anomaly? (StatDx, ultrasound requisites, alobar holoprosencephaly)
Trisomy 13
Trisomy 18
Trisomy 21
Turner XO
Klinefelter XXY
Trisomy 13
A 65-year-old man undergoes endovascular aneurysm repair (EVAR) of the infrarenal abdominal aorta. On follow-up CT 1 month later, there is no contrast opacification of the aneurysm sac, however on CT 6 months later there has been expansion of the sac, without contrast opacification. Which is the most appropriate designation?
Type I endoleak
Type II endoleak
Type III endoleak
Type IV endoleak
Type V endoleak
Type V endoleak
A 39-year-old woman presents for a pelvic ultrasound with symptoms of abdominal pain, distension and nausea. Ultrasound shows bilateral massive ovarian enlargement with numerous enlarged follicular cysts and ascites. What is the most likely diagnosis? (StatDx, ultrasound requisites)
Polycystic ovaries
Polycystic ovarian syndrome
Pelvic inflammatory disease with Fitz-Hugh-Curtis syndrome
Bilateral serous ovarian tumours
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome
A 21-year-old female professional rower presents with unilateral arm swelling, pain and venous thrombosis. Digital subtraction venography shows normal flow through the ipsilateral subclavian vein with the arm in a neutral position by her side. Your supervisor suggests repeating the venography with the upper limb in a different position. Which is best? (Paget-Schroeter, statdx, IR books)
Internal rotation
External rotation
Cross-body adduction
Hyperabduction
Extension
Hyperabduction
Which of the following is not in keeping with the common imaging features of acute pyelonephritis? (StatDX)
Normal ultrasound appearance of the kidney
Wedge-shaped area of hypoenhancement on CT
Small rim of peripheral cortical enhancement on CT
Inflammatory stranding in perinephric fat
Increased T2 signal intensity on MRI
Small rim of peripheral cortical enhancement on CT
Which is the most common site for deposits in benign metastasising leiomyoma? (StatDX)
Peritoneal
Abdominal lymph nodes
Central nervous system
Retroperitoneum
Lungs
Lungs
The following statement is false in regards to breast MRI:
Pre-menopausal women should be scanned in the second half of the menstrual cycle
Marked background parenchymal enhancement is associated with a higher likelihood of malignancy.
Most cancers will show peak enhancement at 60-90 seconds post gadolinium injection.
Lobular cancer can have a Type 1 washout curve.
Malignancy such as DCIS can be detected as non-mass enhancement.
Pre-menopausal women should be scanned in the second half of the menstrual cycle (FALSE).
Transiently enhancing lesions can be seen in healthy women in second half of cycle therefore in pre-menopausal women MRI should be performed in first half of menstrual cycle to reduce rate of false positives.
The following are indications for breast MRI except:
Patient has been diagnosed with metastatic cancer restricted to regional lymph nodes.
Women with a lifetime risk of >20% due to genetics or family history.
Prior chest wall radiotherapy between ages 10-30.
Evaluation after removal of silicone breast implants
Pre-operative evaluation in patients diagnosed with invasive lobular cancer.
Evaluation after removal of silicone breast implants (FALSE. Evaluation OF implants but not post removal).
In regards to breast ultrasound, the following statement is true:
DCIS is more readily detected than mass lesion on second look ultrasound following breast MRI.
Galactography is more sensitive than ultrasound in detection of causative lesion for nipple discharge.
Ultrasound is useful for assessment of chest wall invasion with a sensitivity of 70%.
Focal zone should be set to the layer of subcutaneous fat.
Supine is the best patient positioning for assessment of the medial breast
Supine is the best patient positioning for assessment of the medial breast
The following statement is true in regards to screening mammography:
Pushback views are only necessary in patients with implants and a palpable lesion.
Increased rate of false positives in younger women
Screening mammography is not performed in women over 75 years of age.
Breast density is an objective evaluation of the amount of fibroglandular tissue
The K-edge of molybdenum used in modern MMG x-ray tubes is approximately 40 keV.
Increased rate of false positives in younger women (TRUE).
Which of the following is the LEAST LIKELY causes for skin thickening on mammography:
Inflammatory breast cancer.
Lymphatic obstruction due to metastatic axillary lymphadenopathy.
Prior chest wall radiotherapy.
CCF.
Lactational breast changes.
Lactational breast changes.
In Autosomal recessive polycystic kidney disorder the following are true EXCEPT:
US shows massively enlarged bilateral kidneys.
Kidneys are diffusely high signal on T2 MRI sequences.
Cysts are usually > 1 cm in size
Prenatal US may show oligohydramnios.
Systemic hypertension is seen in 75% patients.
Cysts are usually > 1 cm in size (FALSE usually < 1 cm).
In regards to Ewings sarcoma, which statement is false?
Almost never seen in flat bones
Ewings sarcoma has the highest standard uptake value of malignant primary bone tumours.
May present as a febrile illness.
CT is usually performed to assess for lung metastases.
Is the second most common bone sarcoma in children.
Almost never seen in flat bones (FALSE it 25% percent)
The following are causes of dense metaphyseal bands except:
Growth arrest lines.
Hypoparathyroidism.
Congenital infection.
Rickets.
Medications such as fluoride and Vit B
Medications such as fluoride and Vit B (FALSE its Vitamin D).
In regards to congenital cholesteatoma, which is false?
More common in males than females.
Otomastoiditis is a potential complication of larger lesions.
Rhabdomyosarcoma is a differential for the imaging appearances.
May have peripheral enhancement on contrast MRI.
Often fills the entire middle ear cavity
Often fills the entire middle ear cavity (FALSE : rarely does).
