Random_8 Flashcards
When to aspirate a breast cyst demonstrated on US
- A cyst should be aspirated if there are internal echoes (ie. when it is unclear whether it is a cyst or solid) or if the patient seeks relief from symptoms.
- Cysts get larger and smaller, come and go. –> Enlargement of a simple cyst is not in and of itself an indication for aspiration.
Good oral boards tip
Special Oral Boards Note: BEWARE of the case with more than one finding!
A good practice is to identify the obvious finding… “I see a 2cm round mass in the central breast”
and diligently search the rest of the breast tissue… “I am looking for any other finding.”
IF you don’t see anything else then… “I don’t see anything else, so we have a round mass with smooth margins in the…”
IF you see a second finding… “I also see a second finding which looks more suspicious. I’ll first describe the more suspicious area: a 1.5cm spiculated mass is present in the…”
There is no concept if intra- vs. extra-capsular rupture with saline implants, so there is no need to perform MRI for evaluation of saline implants. MRI is reserved for evaluation of silicone implant rupture
There is no concept if intra- vs. extra-capsular rupture with saline implants, so there is no need to perform MRI for evaluation of saline implants. MRI is reserved for evaluation of silicone implant rupture
Breast feeding patient noticing rapidly enlarging breast mass

Statistically, the most likely diagnosis of a well-defined hypoechoic mass with thin septations and a thin echogenic rim is a fibroadenoma. However, with the history of a rapidly enlarging palpable mass during pregnancy, this most likely represents (and was found to be) a lactating adenoma.
Lactating adenomas tend to be large well-defined lobulated masses with fibrotic septae which can appear as echogenic bands within the mass. They are benign, but are usually removed surgically because of their large size and rapid growth.

Breast mammogram screening guidelines
- no recommendations for 40-49y/o
- but if they do screening, then q1yr
- screening for everyone 50-74y/o
- q2yr
What additional views to get for
query architectural distortion?
Rolled biplane (CC/ML) spot compression views
DDx of restricted diffusion on brain MR
- ischemia
- abscess
- empyema
- epidermoid cyst
Configuration of cerebral lesiosn that demosntrate restricted diffusio
- rounded, diffuse restriction –> infectious etiology - abscess or septic emboli
- restriction only in the walls and projections of the lesion (not in its core)–> fungal abscesses
- special with fungal (esp with aspergillosis infection/abscess): T2-hypointense zones and magnetic susceptibility within the wall of cerebral Aspergillus lesions can be attributed to a dense population of Aspergillus paramagnetic hyphal elements, especially iron and magnesium, which are essential for hyphal growth. It has also been postulated that this MR finding may correspond to hemorrhage in the capsular wall.
LATERAL lesion moves LOWER on true LATERAL projection on mammo
LATERAL lesion moves LOWER on true LATERAL projection on mammo
Cancers in younger women tend to be more aggressive, therefore need yearly screening in order to catch interval cancers
But stage by stage, the prognosis is the same, if not better
Cancers in younger women tend to be more aggressive, therefore need yearly screening in order to catch interval cancers
But stage by stage, the prognosis is the same, if not better
Screening for high risk patients
- lifetime risk > 20% –> MRI screening
- lifetime risk 15-20% –> may add U/S screening
What type of breast cancer can be barely detectable now but become a 5-cm mass 5 months later?
Lobular carcinoma
What features help confirm male gynecomastia?
- Flame shaped fibrogladular tissues
- Concave borders - lack of mass effect
From an epidemiologic standpoint, the most common fungal infections to cause brain abscesses are aspergillosis, candidiasis, and mucormycosis.
From an epidemiologic standpoint, the most common fungal infections to cause brain abscesses are
aspergillosis,
candidiasis,
and mucormycosis.
Cerebral aspergillosis
- Cerebral aspergillosis is seen in approximately 10-20% cases of invasive aspergillosis.
- The usual primary site of aspergillosis infection is the lungs and paranasal sinuses, since the route of transmission is via spore inhalation.
- CNS involvement occurs via hematogenous spread from the lungs or direct invasion via the paranasal sinuses.
- Invasive aspergillosis involving the CNS is rare but occurs with increased frequency in immunosuppressed individuals.
TB vs
Fungal vs
Pyogenic
cerebral abscesses

- TB
- TB meningitis way more common than TB abscess (tuberculoma)
- tuberculoma
- T2 hyper, with T2 hypo rim
- NO retricted diffusion!
- generally solitary
- Pyogenic abscess
- staph, strep, GNB
- “light bulb bright” restricted diffusion
- Fungal abscess
- T2 hyper
- may have some T2 hypointensity, due to microhemorrhage or Fe/Mg containing hyphae
- mild restricted diffusion involving the rim or projections

What is normal post void residual volume?
<10%
or
< 50cc

Epididymis anatomy
- A - head of epididymis
- B - body of epididymis
- C - tail of epididymis
- D - vas deferens

Normal
- cervical length
- distance b/t placenta and cervix
- normal cervical length > 2.5cm
- normal distance b/t placenta and cervix > 2.0cm
Leiomyoma
- a benign smooth muscle neoplasm
- most common locations
- uterus
- esophagus
- small bowel
- leimyoma vs leiomyosarcoma
- cytologic atypia
- increased or atypical mitoses or necrosis
Layers of scrotum
from superficial tu deep
- skin
- dartos fascia
- external spermatic fascia
- cremaster muscle
- internal spermatic fascia
- parietal layer of tunica vaginalis.
Where does scrotal leiomyoma arise from?
Scrotal leiomyoma arises from the dartos muscle fascia, which is composed of smooth muscle fibers in a scattered arrangement forming a poorly defined muscle layer in the scrotum.
Incidence vs Prevalence of breast cancer
- prevalence screening
- number of women living with breast cancer at any given time
- prevalence screening = 1st mammogram performed in previsouly unscreened women
- rate = 6-10/1000 (higher than incidence screening)
- incidence screening
- number of new cases of breast cancer over a specific period
- incidence rate = number /per100000ppl over 1 year
- rate = 3/1000
Cerebral cavernomas
- most often intra-axial, extra-axial cavernomas are very rare
- exophytic cavernous malformations are most often asymptomatic; when they beome symptomatic, the most common symptom is focal neurological signs (as opposed to seizures)
- cavernous malformations may develop after radiation therapy to the brain
- high-resolution, SWI MRI is a 3-D, gradient echo (GRE) imaging technique based on blood oxygen level dependent (BOLD)-induced phase effects between venous blood and the adjacent brain parenchyma. It allows noninvasive visualization of small veins in the brain at higher spatial resolution and with greater detail than standard MRI, thus allowing enhanced visualization of deoxyhemoglobin within the intralesional tubular structures
- size of a cavernous malformation did NOT affect rates of hemorrhage













