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Em Es Kay > Random Shii > Flashcards

Random Shii Flashcards

1
Q

Most common type of endoleak?

A

Type 2

Filling of sac by feeder artery eg IMA or lumbar artery

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2
Q

Type 4 endoleak

A

“4 is through the pores”

Doesn’t happen in modern stents.

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3
Q

Endoleak requiring urgent intervention

A

Type 1 & 3

High flow types. Most common type 2 often managed expectantly.

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4
Q

Type of embolisation for embolising a tumour…

A

Liquid agent.

Blocks all end arterioles.

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5
Q

Why do you do angio run before placing IVC filter?

4 reasons…

A
  1. Confirm IVC patency
  2. Measure size needed
  3. Confirm no double (left sided) IVC
  4. Check renal vein position

*Infrarenal filter placement preferred

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6
Q

Contraindications for TIPS

A

Severe (right) heart failure. (Need an echocardiogram prior to undertaking).

Severe encephalopathy.

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7
Q

Best response to fibroid embolisation…

A

• Submucosal (subserosal do poorly).

• Enhancing “cellular” type (degenerated do poorly).

• Small fibroids.

particle embolisation usually (not coils or glue)

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8
Q

Fibroids which can’t be emobilised and need surgery

A

Pedunculated

Risk of detachment

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9
Q

Snowman sign on CXR

A

TAPVR

AKA figure of 8 sign.

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10
Q

Rheumatic heart disease:

What valves are affected?

A

Mitral stenosis
Aortic stenosis

“Rheu-MA-tic”

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11
Q

String of beads sign - brain MRI

A

Watershed infarcts

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12
Q

Massive splenomegaly

A

• CML
• Myelofibrosis
• Gaucher’s
• Malaria

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13
Q

Meigs syndrome

A

• Ovarian fibroma
• Ascites
• Pleural effusion

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14
Q

Most common site of ectopic pregnancy

A

Ampullary portion of fallopian tube

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15
Q

Cystic lesion anterolateral wall of the upper vagina

A

Gartner duct cyst

• May contain proteinaceous fluid with variable T1.
• Association with Wunderlich syndrome (renal agenesis/ectopia)

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16
Q

Feeding vessel or vascular pedicle

(Gynae)

A

Endometrial polyp

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17
Q

Breast cancer type with Paget’s disease of the breast

A

DCIS

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18
Q

PDOG lesions with drug resistant epilepsy (3)

A

PD-G

  1. PXA (pleomorphic xantho)
  2. DNET
  3. Ganglioglioma

*Oligo does not as grows too fast

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19
Q

Peripheral lobar microbleeds and convexity SAH

A

Cerebral amyloid angiopathy

• Friable leptomeningeal/cortical vessels.
• Common cause of lobar ICH in elderly.
• BP is NORMAL. Hypertensive angiopathy is CENTRAL.

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20
Q

Hypertensive vs amyloid angiopathy

A

Hypertensive is central.
———————————-
Amyloid is peripheral.

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21
Q

Old lady. Oestrogen producing ovarian tumour.

A

Thecoma

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22
Q

Ovarian tumour in child with precocious puberty

A

Granulosa cell tumour

• Subtype of sex cord stromal tumour.
• Sponge-like appearance on MRI.
• Association with Maffucci’s & Ollier’s

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23
Q

Brain tumours associated with Turcot’s syndrome

A

Medulloblastoma
Glioblastoma

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24
Q

Most common intramedullary spinal cord tumour in adults

A

Ependymoma

• 60% of adult spinal tumours
• Average 4 vertebral body lengths
• T2 hyperintense and enhances

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25
Q

Most common intramedullary spinal cord tumour in kids

A

Astrocytoma

• 60% of paeds spinal tumours (2nd most common overall)
• Peak age is 30 yrs
• Longer (average length 4-7 vertebrae)

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26
Q

Forceps delivery and neck swelling

A

Fibromatosis colli

Compartment syndrome > pressure necrosis > fibrosis of sternocleidomastoid

Present at few weeks of age. May be little to see on US.

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27
Q

Most common lesion in trigone of lateral ventricle in an adult

A

Meningioma

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28
Q

Triad of:

  1. Abdominal wall hypoplasia
  2. Bilateral cryptorchidism
  3. Pelvicalyceal dilatation and renal dysplasia
A

Prune belly syndrome

A.k.a Eagle-Barrett syndrome

Wrinkled/shrivelled abdomen - looks like a prune

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29
Q

Prune belly syndrome associations

A

Down’s syndrome
Malrotation

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30
Q

Wolman disease

A

Deposition of fat in multiple organs.

Hepatosplenomegaly and enlarged calcified adrenals.

Usually fatal with death in infancy.

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31
Q

Spinal lesion occurring at the conus or filum terminale

A

Myxopapillary ependymoma

Average age 35 yrs. Most common lumbar spinal tumour.

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32
Q

Low density in temporal lobe, insula and inferolateral frontal lobe but sparing of basal ganglia

A

HSV encephalitis

Stroke mimic but basal ganglia spared

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33
Q

WAGR syndrome

A

W - Wilms tumour
A - Aniridia (absence of iris)
G - Genitourinary anomalies
R - Retardation

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34
Q

Most common congenital diaphragmatic hernia

A

Bochdalek

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35
Q

Bochdalek hernia location

A

• Left sided in 85% (Bochda-L-ek)

• Posterolateral (Back-dalek)

• Pulmonary hypoplasia

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36
Q

Morgagni hernia

A

• Right sided 95%

• Anterior

• Rare

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37
Q

Gastroschisis

A

• Small right sided defect (~4cm)
• No surrounding membrane
• Malrotated
• Association with raised AFP

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38
Q

Omphalocele

A

A.k.a. Exomphalos

• Midline
• Larger defect
• Covering membrane (may be ascites)
• Liver herniation more common
• Association with other anomalies (Downs, Turners, Klinefelters, Beckwith-Wiedman and other issues)
• Worse prognosis

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39
Q

JC virus

A

Progressive multifocal leukoencephalopathy

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40
Q

Adult. Female. Retrobulbar mass with enopthalmos.

A

Breast cancer

Infiltrative retrobulbar mass. Enophthalmos is characteristic.

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41
Q

Lesion of mandible with tooth resorption

A

Ameloblastoma

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42
Q

Radiolucency around the CROWN of an unerupted/impacted tooth

A

DENTIGEROUS CYST

• Cyst encloses the crown
• Association with ameloblastoma and can become one

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43
Q

ADEM
(Acute disseminated encephalomyelitis)

A

Post-viral or vaccination. Typically 1-2 weeks.

Autoimmune demyelination that improves with steroids.

Very difficult to differentiate from MS.

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44
Q

Krabbe disease

A

Posterior white matter + cerebellum + spinal cord

Crabs are SLOW (behind) and low (inferior)

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45
Q

Metabolic disturbance and mimic of infarct in pons

A

Osmotic demylination syndrome/central pontine myelinolysis

• Low density CROSSING MIDLINE
• Restricted diffusion
• High T2 trident shaped

May also be extrapontine which can occur simultaneously or in isolation.

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46
Q

Bilateral optic neuritis + transverse myelitis + aquaporin 4 antibodies

A

Neuromyelitis optica

Longitudinally extensive spinal cord lesion with expansion from swelling.

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47
Q

Empty thecal sac

A

Arachnoiditis

Nerve roots adhere to dura.

Can alternatively clump together mimicking a mass.

Iatrogenic and infectious eg TB causes.

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48
Q

Involvement of medial thalami, periaqueductal grey matter and mamillary bodies

A

Wernicke’s encephalopathy

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49
Q

Ashkenazi Jews are predisposed to…

A

Canavan’s
Gaucher’s disease
Tay-Sachs disease

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50
Q

Gaucher’s disease

A

• Accumulation of fatty substance in RETICULOENDOTHELIAL SYSTEM.

• ERLENMEYER flask deformity.

• Diagnosed by BONE MARROW ASPIRATE.

• Cause of MASSIVE SPLENOMEGALY. 95% have splenomegaly.

• Anaemia, large joint stiffness and pain if symptomatic.

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51
Q

Lytic bone mets

A

RCC (also expansile)
Lung Cancer
Thyroid Cancer
Melanoma
Breast Cancer (typically mixed)
NHL

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52
Q

Widened growth plate and metaphyseal cupping in child

A

Rickets

Also:
Delayed fontanelle closure
Poor epiphyseal mineralisation
Bowing deformity

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53
Q

Prostatic utricle cyst

A

Pear shaped
Communication with urethra
Intraprostatic

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54
Q

Order of occular muscle involvement in thyroid eye disease

A

I’M SLow

Inferior rectus
Medial rectus
Superior rectus
Lateral rectus

Tendinous insertions spared.

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55
Q

Mnemonic for calcified glial tumours

A

”Old Elephants Age Gracefully”

O - Oligodendroglioma
E - Ependymoma
A - Astrocytoma
G - Glioblastoma

(In order of decreasing incidence)

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56
Q

NF-1 mnemonic

A

CAFE SPOT

C: Café-au-lait spot (>6 in 1 yr)
A: Axillary or inguinal freckling
F: Fibromas (& FASI)
E: Eye hamartomas (Lisch nodules)

S: Skeletal abnormality eg sphenoid wing
P: Positive family history
OT: Optic Tumour

F: 2 neurofibromas or 1 plexiform neurofibroma

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57
Q

Most likely site of tear/transection of aorta?

A

Isthmus

(Distal to left subclavian artery origin)

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58
Q

Transient non-segmental peripheral consolidation with eosinophilia

A

Löeffler’s syndrome (simple pulmonary eosinophilia)

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59
Q

Fibrosing mediastinitis

A

• Cancer mimic in mediastinum. Often calcified.
• Compression or occlusion of mediastinal structures eg SVCO.
• Causes include:
- TB
- Histoplasmosis
- IgG4

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60
Q

Smoke inhalation imaging features

A

Pulmonary oedema

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61
Q

Child with calcified lung mets and pneumothorax

A

Metastatic osteosarcoma

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62
Q

Mnemonic for lymphangitis carcinomatosis

A

”Certain Cancers Spread By Plugging The Lymphatics”

C - cervix
C - colon
S - stomach
B - breast (2nd)
P - prostate and pancreas
T - thyroid
L - lung (1st) and larynx

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63
Q

Child presenting with LIP

A

HIV

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64
Q

Associated with LIP in an adult

A

Sjögren’s

*for this reason LIP is more common in women as Sjögren’s is 9x more common in females

*NSIP still most common pattern in Sjögren’s

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65
Q

Traumatic urethral stricture:

Anterior

A

Straddle injury

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66
Q

Traumatic urethral stricture:

Posterior

A

Pelvic fracture

“U hurt ur Pee Pee”

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67
Q

Pyloric stenosis measurements

A

Single muscle thickness >3mm
Longitudinal length >14/15
Pyloric volume >1.5cm 3

*remember Pi (3.1415)

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68
Q

Ground glass and cysts

A

PCP

LIP

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69
Q

PCP CD4 count

A

<200

Ground glass and cysts

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70
Q

Main pulmonary artery max diameter

A

29mm

If 30 or above = PAH

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71
Q

Lung cancer with cavitation

A

Squamous cell carcinoma

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72
Q

Scoring system for malignant probability of pulmonary nodules

A

Brock model

Herder score takes into account FDG PET findings too

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73
Q

Dilated thoracic duct

A

LAM

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74
Q

Gynaecomastia in a man

A

Central
Retroareolar
Flame shaped

An ECCENTRIC position is highly suspicious for cancer.

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75
Q

T4 RCC

A

Extension beyond Gerota’s fascia

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76
Q

T3 RCC

A

Extension beyond kidney but WITHIN Gerota’s fascia:

• T3a - renal vein
• T3b - IVC below diaphragm
• T3c - IVC above diaphragm or IVC wall

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77
Q

T4 renal pelvis cancer eg TCC

A

Invades perinephric fat or into adjacent organs

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78
Q

Penile calcification

A

Peyronie’s disease

Fibrous tissue plaques within tunica albuginea causing bent penis with painful erections

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79
Q

Bell clapper deformity

A

Testicular torsion

High insertion of tunica vaginalis on spermatic cord. Predisposes to torsion. Bilateral in 65-90%.

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80
Q

Nutcracker kidney

A

• Compression of left renal vein between overlying SMA and aorta.
• Haematuria and loin pain.

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81
Q

Superior quadrantanopia

Aka “pie in the sky”

A

Temporal lobe lesion

S is next to T

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82
Q

Inferior quadrantanopia

A

Parietal lobe

IP

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83
Q

Gradenigo syndrome

A

Triad of:
1. Otitis media
2. Retroorbital pain
3. Abducens (VI) nerve palsy - eye deviated medially

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84
Q

HIV vs PML

A

“U DON’T want HIV”

• U fibres spared in HIV. Involved in PML.
• Cortical atrophy in HIV.
• HIV is symmetrical. PML asymmetrical.

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85
Q

Pregnant pt with preeclampsia. Bilateral occipital hypo-attention.

A

PRES

Failure of posterior circulation to auto-regulate with acute changes in BP. Extensive cerebral oedema. Sometimes infarcts or haemorrhages.

*not always posterior or reversible

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86
Q

Most common thyroid cancer

A

Papillary

• Hypoechoic on US. Punctate calcification. Sometimes cystic.

• Association with bowel polyposis syndromes.

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87
Q

Parasitic infection from pigs

A

Neurocysticercosis

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88
Q

Adenomatous vs hamartomatous polyps

A

Get To Fuck | Chinese Communist Party

G - Gardner’s syndrome
T - Turcot syndrome
F - FAP
____________________________

C - Cowden’s syndrome
C - Cronkhite-Canada syndrome
P - Peutz-Jegher’s syndrome

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89
Q

Breast cancer screening age

A

50-70

*>70s can request screening every 3 years too

400-800 cancers detected for every cancer induced. 20% reduced mortality.

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90
Q

Lobster claw sign (kidney)

A

Papillary necrosis

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91
Q

Radiolucent renal calculi

A

HIV on indinavir
Antibiotics eg amoxicillin, cipro, nitro
Allopurinol

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92
Q

Schistosomiasis organism

A

Schistosoma haematobium affects urinary tract

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93
Q

Placenta accreta spectrum

A

• Accreta - villi ATTACH to myometrium

• Increta - villi partially INVADE myometrium

• Percreta - villi PENETRATE through beyond serosa

A-I-P

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94
Q

Single umbilical artery

A

Trisomy 18 (Edward’s syndrome)

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95
Q

Urethral cancer histology

A

Prostate - TCC

Elsewhere - SCC

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96
Q

Mayer-Rokitansky-Küster-Hauser syndrome (MRKH)

A

Congenital absence of the uterus and upper 2/3 vagina.

BUT

Normal ovaries and fallopian tubes

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97
Q

Tamoxifen associated endometrial changes

A

• Endometrial polyps (8-36%)
• Endometrial hyperplasia (1-20%)
• Cystic endometrial atrophy
• Endometriosis (increased risk endometrial carcinoma)

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98
Q

Name of first breast screening

A

PREVALENT

Screening starts at 50 so will be 50-53.

Incident is any subsequent screening.

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99
Q

Endometrial thickness in postmenopausal woman

A

<5mm

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100
Q

Serous vs mucinous cystadenocarcinoma of the ovary

A

Serous
• Most common malignant ovarian mass
• More likely bilateral
• Peritoneal carcinomatosis

Mucinous
• More likely unilateral & multiloculated.
• Stained glass appearance from varying mucin content of cysts.
• Pseudomyxoma peritonei
• Can rupture

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101
Q

SeHCAT scan

A

NM study for **bile salt malabsorption••. Used in investigation of diarrhoea.

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102
Q

MEN-1

A

PPP | Pi-Par-Panc

Pituitary adenoma
Parathyroid adenoma/hyperplasia
Pancreatic neuroendocrine tumour

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103
Q

MEN-2a

A

PPM

Phaeochromocytoma
Parathyroid hyperplasia
Medullary thyroid cancer

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104
Q

MEN-2b

A

PMMM

Phaeochromocytoma
Medullary thyroid cancer
Marfanoid habitus
Mucosal neuromas/ganglioneuromas

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105
Q

Fibrosing thyroiditis, IgG4, euthyroid, painless thyroid mass

A

Riedel thyroiditis

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106
Q

Weigert-Meyer law

A

UU | IR

Upper moiety - UU / UI
• Ureterocoele and obstruction.
• Ectopic insertion of ureter medial and inferiorly. Upper pole - inferior insertion.

Inferior moiety - IR
• Reflux
• Normal insertion

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107
Q

Penile cancer

A

SCC
• Associated with HPV
• Enhances but less so than corpus cavernosum & spongiosum

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108
Q

NF-2 mnemonic

A

MISME

Multiple Inherited Schwannomas, Meningiomas and Ependymomas

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109
Q

Megaureter

A

> 7mm diameter

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110
Q

Most common parasitic infection worldwide

A

Ascariasis

Intestinal worms with central alimentary tract. Will ingest barium.

Tapeworms are much longer and have no alimentary tract so cannot ingest barium.

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111
Q

Pattern of infant myelination

A

UFO

Up - Caudal to cranial
Forwards - Posterior to anterior
Outwards - Deep to superficial

*completes at ~9 months

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112
Q

Max aortic aneurysm diameter before intervention

A

> 5.5cm inner to inner

Refer to vascular.

> 3cm is abnormal.

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113
Q

Max aortic diameter before intervention needed

A

>5.5cm inner to inner

Refer to vascular.

>3cm is abnormal. If grown by >1cm in 1 yr may also intervene.

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114
Q

Cephalohaematoma

A

• Subperiosteal haematoma of the outer skull following birth trauma.
• Cannot cross sutures - this distinguishes them from subgaleal haematoma.

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115
Q

Vessel feeding nasopharyngeal juvenile angiofibroma

A

Internal maxillary artery - branch of ECA

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116
Q

Lateral neck cyst with beak pointing between ICA and ECA

A

2nd branchial cleft cyst

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117
Q

UAC position

A

”T10 to L3 - gets a NO from me!!”

• May be placed high or low as long as not around abdominal aorta branches.

• Dips down into pelvis through umbilical artery -> internal iliac.

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118
Q

UVC position

A

”T8 or T9? Everything’s FINE!”

• Umbilical vein -> left portal vein -> ductus venosus -> hepatic vein -> IVC

• Tip at junction of IVC and RA.

• Thrombus and liver injury possible.

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119
Q

Stroke window level

A

Width 8HU / Centred at 32 HU

Sensitivity increases from 57% to 71% compared to normal window setting.

120
Q

Most common causes of temporal lobe epilepsy

A
  1. Medial temporal sclerosis (70%)
  2. Ganglioglioma (most common tumour)
121
Q

Brain tumour post-radiotherapy

A

Meningioma

122
Q

Intracranial lipoma:

Most common location

A

Pericallosal

Associated with corpus callosum agenesis.

123
Q

Most common entrapment neuropathy of the elbow

A

Cubital tunnel syndrome

Seen in throwing sports, tennis, volleyball.

124
Q

Thickened gastric folds. Low albumin.

A

MÉNÉTRIER’S DISEASE

• Present with symptoms of gastritis and oedema.

• ”GIANT rugal folds.”

125
Q

Optic neuritis most commonly affects which portion of the optic nerve?

A

Intra-orbital retrobulbar segment

126
Q

Thickened atrial septum >6mm

A

Cardiac Amyloid

Systemic process involving ALL 4 chambers.

Most common cause of RESTRICTIVE cardiomyopathy.

127
Q

Most common site of MS in spinal cord

A

Cervical spine

*usually <2 vertebral lengths
*MS in spine usually peripheral

128
Q

Most common type of choledochal cyst

A

Type I (80-90%)

Fusiform dilatation of extrahepatic bile duct.

Theorised result of reflux of pancreatic secretions. Pts may present with jaundice and palpable mass.

129
Q

Type II choledochal cyst

A

Diverticulum

D = Duo = Type II

3% of bile duct cysts. Saccular outpouching.

130
Q

Choledochocele

A

Type III choledochal cyst (~5%).

Protrusion of a dilated distal CBD into the duodenum.

May be repaired by ERCP or surgery if severe.

131
Q

Type IV choledochal cyst

A

MULTIPLE intra AND extrahepatic cysts.

2nd most common ~10%.

Type V ONLY intrahepatic (Caroli disease). Will have cystic renal disease too.

132
Q

Hyperdense renal cyst Bosniak classification

A

II if <3cm / IIF if >3cm

133
Q

Type III endoleak

A

Leak through defect in graft wall. May be fracture or small hole.

134
Q

Tracheobronchial abnormalities sparing posterior wall

A

Sparing of posterior wall = condition which is confined to the cartilage

Relapsing polychondritis
- smooth thickening
- dense tracheal cartilage calcification

Tracheobronchopathia osteochondroplastica
- irregular and nodular thickening
- often calcified nodules

Both cause SUBGLOTTIC STENOSIS

135
Q

Tracheobronchial abnormalities that INVOLVE the posterior wall

A

• Post-intubation stenosis
- focal, HOURGLASS shaped

• GPA
- may cause ULCERS

• Tracheobronchial amyloidosis
- circumferential CALCIFICATION, focal or diffuse

136
Q

Medications associated with drug induced lung injury/fibrosis

A

• Amiodarone - basal distribution, high density
• Ritalin lung - talcosis
• Nitrofurantoin - UIP/NSIP/OP/HP
• Methotrexate - NSIP
• Adalimumab and other immunomodulators
• Chemotherapy

137
Q

Most common fibrotic pattern in CTD-related interstitial lung disease

A

NSIP

RA is UIP

138
Q

Tetralogy of Fallot associations

A

• Right sided aortic arch (1 in 4)
• ASD/PDA
• Coronary artery anomalies
• Chromosomal anomalies eg Downs, DiGeorge, Alagille syndromes

139
Q

Reduction of intussusception rules

A

Rule of 3s

3 attempts each lasting 3 mins. Less likely to be successful if <3 months.

120mmHg max pressure.

140
Q

Most common TOF

A

Type C (85%)

Proximal oesophageal atresia with distal fistula from airway to distal oesophageal segment.

141
Q

Wooden FB on CT

A

Hypoattenuating

Can mimic air with dry pine as low as -600HU. More water increases attenuation. Look for geometric shape.

142
Q

Contraindications for liver biopsy

A
  1. Uncooperative
  2. Extrahepatic biliary dilatation (relative)
  3. Bacterial cholangitis (relative)
  4. Abnormal coagulation INR >1.5
  5. Thrombocytopenia <60 Plts
  6. Ascites
  7. Cystic lesion
143
Q

Tortoiseshell liver

A

Schistosomiasis

Dystrophic calcification within polygonal network of fibrous septa.

Pathognomic for Japonicum and Mansoni types.

144
Q

Denys-Drash syndrome

A
  1. Wilm’s tumour
  2. Male pseudohermaphroditism
  3. Progressive glomerulonephritis
145
Q

2nd most common TOF

A

Type A (8%)

“A is for Atresia”

Isolated atresia. No fistula.

146
Q

CHARGE syndrome

A

C - coloboma (may be visual impairment)
H - heart defects
A - atresia choanae (nasopharynx)
R - retarded growth and development
G - genital hypoplasia
E - ear abnormalities/deafness eg semicircular canal dysplasia/aplasia

147
Q

Direct vs indirect inguinal hernia

A

Locate INFERIOR EPIGASTRIC artery

• DIRECT is MEDIAL to it. Passes through defect in Hesselbach’s triangle.

• INDIRECT is LATERAL to it. Passes through deep inguinal ring and down inguinal canal.

148
Q

Role of US in skiers (gamekeepers) thumb

A

To look for STENER lesion. Will not heal without surgery.

149
Q

Serpiginous cortical T1 hyper intensity after stroke

A

Cortical laminar necrosis.

Seen as early as 3-5 days but often ~2 weeks later. Usually resolves by 3 months.

Possible due to lipid laden macrophages.

150
Q

Most common chamber of angiosarcoma in heart

A

Right atrium

151
Q

Causes of unidentifiable spleen on US

A

• Sickle cell - autosplenectomy (infarcts)
• Polysplenia (multiple small spleens)
• Traumatic fragmentation
• Wandering spleen (wrong place)

152
Q

Leukodystrophy with frontal distribution

A

Alexander disease

A is at the start of the alphabet

153
Q

Leukodystrophy involving splenium of corpus callosum and parietal/peritrigonal white matter

A

X linked adrenoleukodystrophy

X at the back of the alphabet

154
Q

Heel-toe manoeuvre during US biopsy

A

Reduces anisotropy artefacts as needle more perpendicular to beam so easier to see.

155
Q

Pancreatic transplant

A

• Simultaneous renal transplantation (78%)
• Curative T1DM treatment
• Usually grafted to external iliac vessels

156
Q

Liver lesion:

Increase in size during pregnancy

A

Hepatic adenoma

*subcapsular haematoma suggest haemorrhage or rupture

157
Q

Angiography approach terminology

A

Antegrade = with the flow = down the leg

Retrograde = against the flow = up the leg - used for iliac/aortic intervention

158
Q

Management of air embolism

A

High flow oxygen and left lateral positioning to keep air in right atrium.

159
Q

IVC filter placement

A

Infrarenal

*exceptions may include:
• Pregnancy (avoids compression)
• Renal/gonadal vein clot (above clot)
• Duplicated IVCs

160
Q

Mimic of HPOA in adolescent males with symmetrical bilateral tibial and fibular periosteal reaction

A

Pachydermoperiostosis

Self limiting condition that requires no treatment. Autosomal dominant inheritance.

161
Q

Indications for splenic artery aneurysm intervention

A

• >25mm
• Portal hypertension
• Female of child bearing age with pseudoaneurysm (risk of rupture during pregnancy)

  • coil embolisation usual Rx
162
Q

Carney triad

A

PEG

P - pulmonary chondroma
E - extra-adrenal paraganglioma
G - GIST

  • “T” in GIST = Triad
163
Q

Mnemonic for intracranial hypotension

A

SEEPS

S - subdural hygromas > haemorrhage
E - enhancement of pachymeninges
E - engorgement of venous sinuses
P - pituitary hyperaemia & enlargement
S - sagging brain - midbrain & tonsils

Other clues:
• Postural/orthstatic headache which improves lying down (opposite to intracranial hypertension)
• CSF leak - lumbar puncture, trauma eg from sharp osteophyte, CSF/venous fistula, meningeal diverticulum
• Distended rounded venous sinuses
• Layer cake skull (hyperostosis)

164
Q

Signs of perforation in kids

A

• Football sign
• Falciform ligament
• Lucency over liver
• Continuous diaphragm sign
• Rigler’s sign
• Triangular gas

*can do lateral shoot through/lateral decubitus

165
Q

Management of lidocaine toxicity

A

Intralipid
Propofol
Benzodiazepines

*want to give drugs that lower seizure threshold and lipid emulsion to bind free circulating lidocaine

*cardiovascular toxicity eg arrhythmias

166
Q

Management of lidocaine toxicity

A

Intralipid
Propofol
Benzodiazepines

*want to give drugs that lower seizure threshold and lipid emulsion to bind free circulating lidocaine

*cardiovascular toxicity eg arrhythmias

167
Q

Rule of 2s Meckel’s diverticulum

A

2% of population
2 inches long
2 ft from IC valve (antimesenteric border)

*40% contain gastric mucosa - Tc pertechnetate scan

168
Q

Buscopan contraindications

A

Recent ACS
Uncontrolled HF
Arrhythmia
Myasthenia gravis

169
Q

Looks like bronchogenic cyst but has thicker walls

A

Foregut duplication cyst

Small bowel most common. Oesophageal duplication cyst 2nd most common .

Has muscular layer causing thicker wall.

170
Q

Normal ETT position

A

Adults
5 cm (+/- 2cm) proximal to carina.
Approximately at T2

Neonates
1.5cm above carina OR T1 OR inferior clavicles

171
Q

Mimics the presentation, PSA rise and MRI findings of prostate cancer including DWI & ADC

A

Granulomatous prostatitis

Biopsy needed to differentiate.

RFs: Intravesical BCG therapy for bladder Ca, TURP, sarcoid, TB

172
Q

Gelatinous ascites

A

Pseudomyxoma peritonei

Look for the appendiceal mucocoele.

173
Q

Intra vs extraperitoneal bladder rupture

A

Extraperitoneal - Conservative Rx
More common
Bladder base puncture - pelvic fracture
Contrast in retroperitoneum, thighs, scrotum, anterior abdominal wall

Intraperitoneal - Surgical Rx
Less common
Bladder dome from increased pressure
Contrast around bowel loops and collecting in paracolic gutters

174
Q

Pneumobilia vs portal venous gas

A

Por tal venous gas = Per ipheral.

Imagine blood pushing gas from the hilum out to the periphery.

175
Q

PHACE syndrome

A

Aka cutaneous haemangioma–vascular complex syndrome or Pascual-Castroviejo type II syndrome.

P - posterior fossa (e.g. Dandy-Walker malformation)
H - haemangiomas
A - arterial anomalies
C - coarctation and cardiac anomalies
E - eye (ocular) anomalies

176
Q

Accordion sign (colitis)

A

Pseudomembranous (C. diff) colitis

177
Q

Colitis affecting right colon and ileum

A

• Yersinia enterocolitica - non stenotic terminal ileal ulcers

• Salmonella

178
Q

Obstructed cervical canal following fibroid embolisation

A

Fibroid detachment

May occur with superficial submucosal fibroids abutting the endometrial cavity.

179
Q

Benign retro-areolar mass with dilated ducts and nipple discharge

A

Intraductal papilloma

Discharge may be slightly bloody.

180
Q

Markedly dilated trachea and central airways, with recurrent infection

A

Mounier-Kuhn syndrome (Tracheobronchomegaly)

Tracheal diameter >3 cm

181
Q

New renal cysts in dialysis patient

A

Acquired (uraemic) cystic kidney disease

> 3 simple appearing cysts in each kidney.

182
Q

Trochlear nerve palsy

A

Long course around midbrain through ambient cistern, cavernous sinus.

Look for aneurysm.

183
Q

Featureless stomach, B12 deficiency

A

Atrophic gastritis

• Linitis plastica usually nodular and have weight loss & IDA.

184
Q

Thyroid eye disease

A

• ”I’M SLow” - spares tendinous insertion
• Usually develops within 1 year
• Increased density of orbital fat
• Superior ophthalmic vein may be dilated due to compression

185
Q

Genital ambiguity

A

Congenital adrenal hypertrophy

21-Hydroxylase deficiency cause in >90% of cases.

Genital ambiguity in girls. Salt wasting in boys.

Adrenal limb >4 mm.

186
Q

Hashimoto’s predisposes to…..

A

Thyroid lymphoma

187
Q

Cardiac mass arising from valve

A

Papillary fibroelastoma

75% of valvular tumours. Aortic and mitral valve most common.

Intermediate to high T2 signal. ”Sea anemone” on echo.

188
Q

Carney complex

A

Rare type of MEN syndrome

Cardiac myxoma
Skin lesions - blue naevi, skin myxomas
Pituitary adenoma
Sertoli cell testicular tumours
Ovarian masses
Thyroid disease
Fibroadenomas of the breast
Melanotic Schwannomas

189
Q

Fibroadenoma with multiple round or cleft like cystic spaces

A

Phyllodes tumour (cystosarcoma phyllodes)

• Large, fast growing, oval or lobulated solid mass.
• Posterior acoustic enhancement.
• Radiolucent halo on mammography.
• Occasionally calcify.
• May undergo malignant degeneration.

190
Q

Intussusception:

Child vs adult

A

Kids (6 months - 2 yrs)
Ileo-colic most common in kids
Usually idiopathic ie no lead point seen.

Adults and young neonates
In adults and very young infants (<3 months) no real pattern of distribution but will have a lead point.

191
Q

Medium vessel vasculitis

A

Polyarteritis nodosa
Renal (~90%) - microaneurysms
Cardiac (70%)
GI tract, liver, spleen, pancreas
CNS

Kawasaki disease
Coronary vessels
Can affect any organ
Erythematous rash, fever, cervical lymphadenopathy & strawberry tongue

192
Q

Brain MRI in a child with “eye of the tiger” sign

A

Hallervorden-Spatz disease

Now called pantothenate kinase-associated neurodegeneration (PKAN)

• Usually <6 yrs.
• Iron deposition in globi pallidi, substantia nigra, red nuclei - calcification on CT.
• Classic “eye of the the tiger” is central high T2 signal in otherwise low signal globus pallidus and can also be seen in Wilson’s and Parkinson plus in adults.

193
Q

When is surgery performed for vesicoureteric reflux?

A

Grade IV and V

I - ureter only
II - reflux into kidney without dilatation
III - mild pelvicalyceal dilatation
IV - moderate dilatation & clubbed calyces
V - severe with a tortuous ureter

194
Q

Stanford Type A aortic dissection

A

Proximal to the origin of left subclavian

195
Q

Stanford Type B aortic dissection

A

Distal to the origin of the left subclavian

196
Q

Debakey Type A aortic dissection

BAD

A

BAD

B = Both ascending and descending aorta

197
Q

Debakey Type B aortic dissection

A

BAD

A = Ascending aorta

198
Q

Debakey Type C aortic dissection

A

BAD

D = Descending aorta only

Only one which is Stanford type B

199
Q

Most common site of TB after the lungs

A

Kidney and ureter

• Usually unilateral (75%)
• Putty kidney (autonephrectomy) - small, shrunken kidney with dystrophic or amorphous calcification

Other features:
• Infundibular strictures
• Amputated or moth eaten calyces
• Sawtooth, corkscrew or beaded calcified ureter

200
Q

Arachnoid vs porencephalic cyst

A

Porencephalic cysts:

• Usually no mass effect
• Lined by white matter
• Often confined to a vascular territory
• Usually communicates with ventricles

201
Q

“Mulberry shaped” cerebral vascular malformation

A

Cavernous angioma

• CT - hyperdense with speckled calcification. No mass effect or oedema.
• MRI - mulberry or popcorn appearance, hypointense T2 rim and blooming from blood products.

*AVMs will be serpiginous.

202
Q

Renal artery stenosis

A

• Atherosclerosis (75%)
• Fibromuscular dysplasia (20%)
- younger
- distal renal artery
• Polyarteritis nodosa
- microaneurysms
• Takayasu
• NF-1
- involves ostium
• Coarctation
• Williams syndrome

203
Q

VHL mnemonic

A

HIPPEL

H - haemangioblastoma
I - increased risk RCC
P - phaeochromocytoma
P - pancreatic cysts, tumours, NETs
E - eyes & ears - haemangioblastoma, endolymphatic sac tumours (deafness)
L - liver and renal cysts

204
Q

CI-AKI

A

Creatinine peak occurs at 48-72 hrs.

Relative: 50% rise in Cr over baseline
Absolute: increase in Cr of >27

Evidence is weak and likely not even a thing.

205
Q

Most common peri-graft fluid collection after renal transplant

A

Lymphocele

• Typically occur within 1-2 months.
• Well defined, anechoic and may have septations.
• Urine leaks are comparatively rare and usually in first week or two.

206
Q

Dandy-Walker malformation triad

A
  1. Vermian hypoplasia
  2. Cystic dilatation of 4th ventricle
  3. Enlarged posterior fossa with torcular-lambdoid inversion (torcula above lamdoid suture due to superiority displaced tentorium)

Often secondary hydrocephalus (80%).
Scalloping of the occiput from pressure.
Hypoplastic cerebellar hemispheres.

207
Q

MR enteroclysis vs enterography

A

MR enteroclysis requires nasoduodenal tube so is invasive.

Provides superior detection of mild superficial mucosal disease.

208
Q

Phi angle gastric band

A

4-58°

Angle between axis of band and vertical line.

Stomal stenosis is the most common complication.

209
Q

Beckwith-Wiedemann syndrome

A

Macroglossia
Omphalocele
Localised gigantism
Organomegaly
Ear pits

Associated with:
Wilm’s tumour
Neuroblastoma
Hepatoblastoma
Rhabdomyosarcoma

210
Q

Management of anaphylaxis to contrast

A

Adult
• 0.5ml of 1:1000 adrenaline IM (0.5mg)

Child
• If 12+ same as adult
• If 6-12 yrs 0.3ml of 1:1000 (0.3mg)
• If <6 yrs 0.15ml of 1:1000 (0.15mg)

I.e. always 1:1000!
Increments 0.5 -> 0.3 -> 0.15.

211
Q

Percutaneous renal intervention puncture sites

A

For drainage:
• Lower pole posterior calyx

For access to PUJ/ureters:
• Mid-upper pole posterior calyx

Always posterior. Brödel bloodless zone. Nephrostomies are on pt’s back.
Large tubes (12-14F) may be necessary for pus or gross haematuria with clots.
Further imaging via nephrostomy delayed by 24-48 hrs after placement in cases of infected urine.

212
Q

Testicular fracture vs rupture

A

Fracture - tunica albuginea is intact, no surgery

Rupture - tunica albuginea disrupted, need surgery to salvage testicle

*Isolated epididymal injuries are rare.

213
Q

TORCH infections

A

ToxOplasmosis = hydrOcephalus

HSV = Haemorrhage +/- infarction

CMV = Calcification (periventricular)

Rubella = microcephaly, periventricular calcification, cardiac anomalies

214
Q

Intradural extramedullary spinal lesion

A

No More Spinal Masses

N - Neurofibroma
M - Meningioma
S - Schwannoma
M - Metastases

Order of frequency is MNM. Meningioma, nerve sheath tumour, mets.

215
Q

Osler-Weber-Rendu syndrome (hereditary haemorrhagic telangiectasia)

A

• Multiple pulmonary AVMs which can cause cyanosis and high output heart failure due to shunting.

• Epistaxis due to nasal telangiectasia.

• Autosomal dominant inheritance.

216
Q

Benign vs malignant gastric ulcers

A

Hampton’s line = Harmless
Carman meniscus = Carcinoma

Other malignant features:
Greater curve
Endoluminal (protrude into stomach)
Irregular gastric folds

217
Q

Most common source of mets to the breast

A

Lymphoma (most common)
Melanoma (2nd most common)

More rarely:
Choriocarcinoma
RCC
Prostate

218
Q

Junctional zone thickening

A

> 12mm is abnormal and suggests adenomyosis

219
Q

Commonest gastric volvulus by age

A

O-O
Old = Organo-axial (2/3 of cases)

M-M
Midget (kids) = Mesentero-axial (60%)

220
Q

Sigmoid vs caecal volvulus

A

Sigmoid volvulus

• Ahaustral in appearance
• Distal obstruction; ascending, transverse and descending colon may be dilated
• Few gas-fluid levels may be seen

Caecal volvulus

• Arises in the right lower quadrant
• Haustral pattern is maintained
• Distal colon usually collapsed and the small bowel is distended
• Single gas-fluid level may be seen

221
Q

Zenker diverticulum

A

• Aka pharyngeal pouch
• Posterior and midline of hypopharynx
• Through Killian dehiscence
• Pulsion type pseudodiverticulum

222
Q

Kartagener syndrome

A

Triad of:
Situs inversus
Chronic sinusitis or nasal polyps
Bronchiectasis

223
Q

Similar presentation and appearance to CADASIL but younger patient

A

MELAS (mitochondrial encephalomalacia with lactic acidosis and stroke like episodes)

• Stroke-like episodes or dementia in kids/young adults.
• Parieto-occipital and parieto-temporal infarcts and secondary atrophy/encephalmomalacia.
• Elevated lactate peak on MR spectroscopy.

224
Q

CADASIL

A

Cerebral autosomal dominant arteriolathy with subcortical infarctions and leukoencephalopathy

• Recurrent TIA/stroke in middle aged patients (30s-50s)
• Looks like small vessel disease beyond expected for age
• Occurs without vascular risk factors
• Anterior temporal lobe and external capsule most common

225
Q

Congo red staining on histopathology

A

Amyloidosis

226
Q

Maximum lidocaine dose that can be given safely

A

3mg/kg up to 200mg

Equates to:
20 mls of 1%
10mls of 2%

*max dose for lidocaine with adrenaline is 7mg/kg

227
Q

Löfgren syndrome

A

• Acute clinical presentation of systemic sarcoidosis that manifests with:
- Lymphadenopathy
- Fevers
- Erythema nodosum
- Polyarticular arthritis.

*Not to be confused with Löffler syndrome (Simple pulmonary eosinophilia)

228
Q

Most common metastasis to the spleen

A

Melanoma

229
Q

Treatment option for unresectable HCC and intrahepatic cholangiocarcinoma

A

TACE (transcatheter arterial chemoembolisation)

• Either as palliative Rx or to bide time for curative transplant.
• Also used for hepatic mets.
• Not suitable for patients with severe cirrhosis (Child-Pugh C). Portal vein must be patent or normal liver can infarct.

230
Q

Windsock appearance of D2 of duodenum

A

Duodenal web

May be complete or incomplete obstruction.

231
Q

Most common causes of pneumonia in school aged kids

A

• Mycoplasma pneumoniae
• Strep pneumoniae (pneumococcus)
• Influenza A

232
Q

Loeys-Dietz syndrome

A

• Rare Marfan-like connective tissue disorder
• Tortuous arteries, aneurysms, bifid uvula & hypertelorism

233
Q

Alpha-1-antitrypsin deficiency

A

• Basal predominant panlobular emphysema (identical to Ritalin lung)

• Cirrhosis with expected increased risk of HCC

• Can be confirmed with blood test for a-1-a. Will be <1.1.

234
Q

Causes of increased liver attenuation

A

Haemochromatosis
Amiodarone
Thorotrast
Wilson disease
Thalassaemia

NOT AMYLOID

235
Q

Rubella vs CMV

A

Both cause periventricular calcification and microcephaly.

Rubella associated with congenital cardiac anomalies (VSD, TOF).

236
Q

Neurocysticercosis stages

A

Vegans Can’t Get Neurocysticercosis

  1. Vesicular
  2. Colloidal vesicular
  3. Granular nodular
  4. Nodular calcified

• Tapeworm Taenia Solium found in pork (and humans)
• Cysts can appear in brain, CSF spaces, ventricles and spinal cord.
• Look for rice grain calcification in skeletal muscle.

1. Vesicular
Viable parasite with intact membrane so no host reaction.
Cyst with dot sign. No oedema.

2. Colloidal vesicular
Symptomatic stage. Parasite dies and membrane becomes leaky.
Cyst becomes thickened and hyperattenuating. Enhancement and oedema. May restrict on DWI.

3. Granular nodular
Cyst retracts into small enhancing nodule. Oedema reduces. Enhances but less marked.

4. Nodular calcified
Calcified nodule remains. No oedema or enhancement.

237
Q

Neurocysticercosis organism

A

Taenia solium

(Species of tapeworm)

238
Q

Chagas disease organism

A

Trypanosoma cruzi

Endemic to Central & South America.

• Myocarditis and eventually dilated cardiomyopathy.
• Meningoencephalitis
• Oesophageal dysmotility
• Skin lesions
• Conjunctivitis

239
Q

Most common neuroimaging feature of NF-1

A

Focal areas of signal intensity (FASI)

Focal T2 hyperintensities found in up to 86% of patients.

240
Q

2nd most common site of hydatid disease after the liver

A

Lung

241
Q

Causative organism in hydatid disease

A

Echinococcosis granulosus

Most common species.
Hosts are dogs and wolves. Sheep become infected and pass on to humans.

  • alveolaris & multilicularis from foxes is less common but more invasive
242
Q

Most common type of CPAM

A

Type 1 (70% of cases)

1 or 2 large dominant cysts (2-10cm) surrounded by smaller cysts.

243
Q

Types 2 and 3 CPAM

A

Type 2
• 2nd most common (15-25%)
• Smaller cysts (<2cm)
• Other lung, cardiac, renal anomalies

Type 3
• 10% cases
• Microcysts (<5mm)
• Poorer prognosis

*Type 0 is not compatible with life. Type 4 looks like 1 on imaging. Only epithelial lining which is different.

244
Q

Congenital lobar overinflation locations

A
  1. LUL (45%)
  2. RML (30%)
  3. RUL (20%)

*CPAMs have no lobar predominance

245
Q

Uplifted cardiac apex

A

Right ventricular hypertrophy

246
Q

5 Ts of cyanotic congenital heart defects

A

Tetralogy of Fallot
Transposition of the great arteries
Truncus arteriosus
TAPVR
Tricuspid valve abnormalities and hypoplastic right heart syndrome

247
Q

Wormian bones mnemonic

A

PORK CHOP

P - pyknodysostosis
O - osteogenesis imperfecta
R - rickets
K - kinky hair syndrome

C - cleidocranial dysostosis
H - hypothyroid, hypophosphatasia
O - one too many chromosomes (Downs)
P - primary acro-osteolysis

248
Q

Progressive atrophy of half of the face

A

Parry-Romberg syndrome

Skin, soft tissues and bone.

249
Q

Potter sequence mnemonic

A

POTTER

P - pulmonary hypoplasia
O - oligohydramnios
T - twisted skin (wrinkly skin)
T - twisted face (Potter facies: low set ears, retrognathia, hypertelorism)
E - extremity deformities (club hands and feet, joint contractures)
R - renal agenesis (bilateral); restricted growth (IUGR)

250
Q

Tuberous sclerosis features

A

HAMARTOMA

H - hamartomas (CNS, retina, skin)
A - angiofibroma/adenoma sebaceum
M - mitral regurgitation
A - angiomyolipoma
R - rhabdomyoma
T - tubers (cortical, subcortical)
O - autOsomal dominant
M - mental impairment
A - ash leaf spots
S - Shagreen patches, seizures

251
Q

Medullary calcinosis causes

A

HAM HOP

H - hyperparathyroidism
A - acidosis (renal tubular)
M - medullary sponge kidney, milk-alkali syndrome

H - hypercalcaemia, hypercalciuria
O - oxalosis
P - papillary necrosis

252
Q

Cortical nephrocalcinosis causes

A

COAG

C - cortical necrosis
O - oxalosis
A - Alport syndrome
G - glomerulonephritis

253
Q

Drop metastases mnemonic

A

Gruesome Masses Progressively Extend Caudally

G - GBM, germinoma
M - medulloblastoma
P - pineocytoma, PNET
E - ependymoma
C - choroid plexus carcinoma

254
Q

Cavitating lung lesions

A

CAVITY

C - cancer (SCC primary/mets)
A - autoimmune (GPA, RA)
V - vascular (bland/septic emboli)
I - infection (TB, abscess)
T - trauma (pneumatocoele)
Y - young (CPAM, sequestration, cyst)

255
Q

Mnemonics for the causes of renal papillary necrosis

A

POSTCARDS

P - pyelonephritis
O - obstruction
S - sickle cell disease
T - TB
C - cirrhosis
A - analgesics (NSAIDs, paracetamol)
R - renal vein thrombosis
D - diabetes mellitus
S - systemic vasculitides

Signs include:
• Ball on tee
• Lobster claw sign of forniceal excavation
• Signet ring
• Sloughed papilla with clubbed calyx​

256
Q

Extremely large lung mass in an infant

A

Pleuropulmonary blastoma
• Usually R sided & complete whiteout
• No rib invasion
• Association with CPAM

Differential would be Askin tumour
• Ewing’s sarcoma family of tumours
• Usually older (Ewing’s age)
• Rib invasion

257
Q

Extremely large lung mass in an infant

A

Pleuropulmonary blastoma
• Usually R sided & complete whiteout
• No rib invasion
• Association with CPAM

Differential would be Askin tumour
• Ewing’s sarcoma family of tumours
• Usually older (Ewing’s age)
• Rib invasion

258
Q

Vein of Galen malformation

A

Cardiomegaly

259
Q

Alcoholic with necrosis and demyelination of the corpus callosum

A

Marchiafava-Bignami disease

Starts at body then extends to genu and splenium.

Vitamin B deficiency.

260
Q

Cystic ovarian lesions with ring of fire vascularity

A

Corpus luteal cyst

Thick walled with intense peripheral vascularity. No follow up.

261
Q

Most commonly injured duodenal segment

A

D2/D3

262
Q

Most common pancreatic neuroendocrine tumour

A

Most common overall: Insulinoma

Most common in MEN-1: Gastrinoma

263
Q

Parinaud syndrome

A

Paralysis of upward gaze

Suggests pineal lesion.

264
Q

Porencephaly vs schizencephaly

A

Both may communicate with the ventricles but…

• Porencephalic cysts are lined by white matter.
• Schizencephaly lined by cortical grey matter.
• Open vs closed lip refers only to the degree of apposition of the two walls.

265
Q

Superior rib notching

A

• NF-1
• Hyperparathyroidism
• Osteogenesis imperfecta
• Connective tissue disease
- RA, SLE, Sjögren’s, Marfan’s, scleroderma

266
Q

Inferior rib notching

A

• Enlarged collateral vessels
- coarctation, TOF, Takayasu, subclavian stenosis, SVCO, AVM

• Neurogenic tumours
- schwannoma, neurofibroma

• NF-1
• Hyperparathyroidism

267
Q

Superior AND inferior rib notching

A

NF-1 (ribbon ribs)
Hyperparathyroidism

268
Q

Pineal lesions by age

A

• Pineoblastoma - young children
• Germinoma - <20 yrs (most common)
• Pineocytoma - adults (20-60 yrs)

269
Q

Primary vs secondary renal lymphoma

A

Primary is rare as kidneys don’t contain lymphoid tissue. Secondary (NHL) much more common.

Typically renal contour is preserved unlike RCC.

270
Q

Smooth featureless brain contour

A

Lissencephaly

271
Q

Calcifying oesophageal mass

A

Leiomyoma

Virtually pathognomic and benign.

272
Q

Missing structure in holoprosencephaly

A

Septum pellucidum

Alobar type has no corpus callosum

273
Q

Most common malignant parotid tumour

A

Mucoepidermoid carcinoma

• FS T1 + C to look for perineural spread
• Adenoid cystic carcinoma is 2nd most common

274
Q

Worsening oxygenation and new ground glass/consolidation 48hrs after major trauma with multiple fractures

A

Fat embolism syndrome

Contusions/lacerations would be present on initial imaging

275
Q

Dysphagia, upper oesophageal webs, iron deficiency anaemia

A

Plummer-Vinson syndrome

*IDA seems to be the cause and reduced incidence means PVS is now rare.

276
Q

Fallen lung sign

A

Tracheobronchial injury

Usually near carina. Lung unable to inflate.

277
Q

Paediatric temporal lobe cortical lesion with dural tail

A

Pleomorphic xanthoastrocytoma

Reactive rather than dural invasion.

278
Q

Fat ring sign CT abdomen

A

Mesenteric panniculitis

Immediate perivascular sparing within region of haziness

279
Q

“ADEM on steroids”

A

Acute haemorrhagic leukoencephalitis (Hurst disease)

• Most severe form of ADEM.
• Increased oedema, mass effect and microhaemmorhages.
• Usually fatal. Unlike ADEM which improves with steroids.

280
Q

Age range for multilocular cystic nephroma

A

Bimodal age distribution

• Children and middle aged females.
• Partial nephrectomy usually performed.

281
Q

“DOPE”
Gardner’s syndrome

A

D - Desmoid tumour
O - osteoma
P - papillary thyroid cancer
E - epidermoid cyst

282
Q

Lynch syndrome

A

Hereditary non-polyposis colorectal cancer (HNPCC)

• Most common cancer syndrome
• 5x more common than FAP
• Adenomatous bowel polyps leading to colorectal cancer
• Associated with a huge list of malignancies including:
- endometrial
- ovarian
- GBM
- TCC

*if question mentions lots of different cancers in FH pick this!

283
Q

Most common fungal infection of CNS in HIV

A

Cryptococcus

Toxoplasmosis is most common overall.

284
Q

Empyema vs pulmonary abscess

A

Empyema
• Split pleura sign
• Obtuse angle with pleura
• Lenticular shape
• Pleural enhancement
• Smooth walled
• Hazy extrapleural fat

Abscess
• Acute angle with pleura
• Thick walls
• Abruptly interrupts bronchi/vessels

285
Q

Neurosyphilis

A

• Often coexists with HIV
• Lepto & pachymeningitis
• Arteritis leading to infarcts
• Treponema pallidum causative species

286
Q

Ureteric calculus vs phlebolith:

Comet tail sign

A

Phlebolith

287
Q

Ureteric calculus vs phlebolith:

Soft tissue rim sign

A

Calculus

Rim represents the oedematous ureteric wall.

288
Q

ARPKD vs ADPKD

A

ARPKD (affects kids)
• Smaller cysts (usually <1-2cm)
• Enlarged echogenic kidneys
• Reniform shape preserved
• Hepatic fibrosis & Caroli disease
• Poor prognosis due to pulmonary hypoplasia from oligohydramnios

ADPKD (affects adults)
• More common (10% of all ESRF)
• Kidneys normal at birth
• Gradually replaced by large cysts
• Berry aneurysms & hypertension
• Cysts in liver, pancreas, seminal vesicles

289
Q

Ganglioglioma vs pleomorphic xanthoastrocytoma

A

Ganglioglioma more likely to calcify (35%). Rare with PXA.

290
Q

Serous cystadenoma

(random trivia)

A

• No communication with duct
• Glycogen-rich cysts
• Association with VHL
• No malignant potential (unlike mucinous types eg mucinous cystadenoma, IPMN)

291
Q

Signs of ovulation on US

A

Follicle suddenly disappears or regresses
Irregular margins
Internal echoes
Free fluid in pouch of Douglas
Increased perifollicular blood flow

• Follicular monitoring is a vital part of IVF.
• Clomiphene citrate used to induce ovulation.

292
Q

Reducing MR artefact from hip prosthesis

A

• Reduce field strength
• Increase bandwidth
• Increase matrix size
• Use spin echo (FSE) over GRE
• Thinner slices
• Increase no. excitations (increases SNR)

293
Q

Ovarian tumour containing thyroid tissue

A

Struma ovarii

• Type of teratoma and appear as such
• May also contain follicles and colloid

294
Q

Most common cause of crazy paving pattern on HRCT

A

Pulmonary oedema

Although classically associated with pulmonary alveolar proteinosis

295
Q

Kinky hair syndrome

A

• Fine, silvery and brittle hair
• Seizures and developmental delay
• Progressive cerebral & cerebellar atrophy
• Wormian bones, metaphyseal widening, tibial and femoral spurs

Em Es Kay (5 decks)

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