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CDHB RD > RD 2014 August recalls- WA: formatted > Flashcards

RD 2014 August recalls- WA: formatted Flashcards

1
Q

Young man, neuro symptoms in legs, MRI spine shows lesion which is isointense to csf on t1 and t2, vertebral segmentation anomaly
A) neurenteric cyst
B) Arachnoid cyst

A

neurenteric cyst

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2
Q

20 week anatomy scan, abdominal wall mass, cord inserting at the apex
A) omphalocele
B) Gastroschisis
C) Pseudo-omphalocele

A

omphalocele

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3
Q 
24 week scan, echogenic bowel 
A) not associated with Trisomy 21 
B) Associated with trisomy 18
C) Associated with cystic fibrosis
 D) Not infection
A

Associated with cystic fibrosis

WJI: Associations include T21,T13, T18, Turners, CMV, ingestion of blood, meconium peritonitis, CF, IUGR and foetal demise

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4
Q

Patient in MVA, initial CT normal, has dysarthria, right limb symptoms, MRI shows left cerebral ischaemia, Associated findings:

  • Subdural haematoma
  • Extradural haematoma
  • Skull fracture
  • Mural irregularity of left CCA
A

d. Mural irregularity of left CCA

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5
Q

70 yr old, lower limb symptoms worsening over 1 week, cord signal change from c7 to t6, cord expansion, minimal enhancement:

  • Transverse myelitis
  • Metastasis
  • Astrocytoma
  • Ependymoma
A

a. Transverse myelitis because of onset, length and minimal enhancement.

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6
Q

Lucent lesion surrounding the root of a tooth, ill defined margin, not associated with unerupted tooth or tooth like:

  • Ameloblastoma
  • Metastasis
  • Dentigerous cyst
  • Odontoma
A
  • LW:
  • Ameloblastoma: unlikely, i would expect descriptors of multi cystic, solid components, expansion mandible, extensive root absorption etc
  • Metastasis: possible
  • Dentigerous cyst: FALSE - associated with un erupted crown of tooth
  • Odontoma: Unlikely: usually radiodense, adjacent to but not surrounding tooth root, although do start off lucent.

so…..options are: mets, or correct answer not recalled.
Kind of sounds like a peri apical cyst / radicular cyst: located apex of non vital tooth, round, with well corticated border (this factor doesnt fit with stem sadly), usually <2cm…

*AJL - agrees with above. Of the options available I would favour mets.

Previous answer:
a. Ameloblastoma

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7
Q

Features to suggest pilocytic astrocytoma:

  • Hyperdense, solid mass with enhancement in left cerebellum
  • Hyperdense, solid mass in vermis
  • Hypodense, enhancing nodule, left cerebellum
A

c. Hypodense, enhancing nodule, left cerebellum

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8
Q

5 yr old, physiological uptake on PET:

  • Thymus
  • Pancreas
  • Bone marrow
  • Adrenals
A

a. Thymus

c. Bone marrow to lesser extent (see aug 2014 WA)

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9
Q

Succenturiate lobe, consultant asks which is the commonest association with vasa previa:

  • Succenturiate
  • Velamentous insertion
  • Circumvellate
A

b. Velamentous insertion

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10
Q

Placenta rolled edges, basal plate larger than the chorionic plate:

  • Circumvellate
  • Succenturiate
  • Placenta previa
A

a. Circumvellate

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11
Q

20 weeks scan, placenta covering os, when you go and check its normal:

  • Large bladder
  • Placenta previa
  • Braxton hicks contractions
  • Vasa previa
A

a. Large bladder

c. Braxton hicks contractions can as well

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12
Q

Questions on technetium
Mass number
Number of protons or neutrons or something

A
  1. Mass number 99

13. Number of protons or neutrons or something 43 (atomic/proton number), 56 neutrons

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13
Q
  1. Difference between i123 and I 131
A

**SCS: radiopaedia article I-131:
I-131 - cheaper- poorer resolution (higher energy gamma 364keV), - increased dose - longer half-life -8 days.
used for ablation post total thyroidectomy to mop up/look for remnant thyroid tissue/occult mets.

**SCS: Radiopaedia article trivia I-123:
I-123: Used in DAT scans for parkinsons, (look for comma cs fullstop sign)
AKA: Ioflupane
High affinity for presynaptic dopamine transporters.
Cyclotron product.
Decay by electron capture to Tellurium-123
T1/2= 13.22 Hours
Gamma energy predominantly 159keV

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14
Q

60 yr old, knee pain worsening over 2 years, medial joint involvement, osteophytes:

  • OA
  • Septic
  • Rheumatoid
  • Psoriasis
A

a. OA

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15
Q

40 yr old, acute knee pain, knee swelling, effusion on X-ray:

  • Septic
  • OA
  • Psoriasis
  • Rheumatoid
A

-Septic

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16
Q

Incidental echogenic renal lesion on ultrasound, T1 bright and T2 low:

  • Proteinaceous cyst
  • Haemorrhagic cyst
  • RCC
A

-Haemorrhagic cyst

  • Proteinaceous cyst - T1, T2 high
  • Haemorrhagic cyst - T1 high, T2 low or high
  • RCC - T1 low, T2 variable (clear vs papillary)
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17
Q

25 yr old, infertility, previous ectopic surgery, left ovary not seen. Right ovarian cystic lesion:

  • Dermoid
  • Cystadenoma
  • Tuboovarian abscess
  • Simple cyst
A

c. Tuboovarian abscess

???? how is this the answer?

WJI: I think it is suggesting prior PID as cause for infertility. Other options not really associated with infertility.

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18
Q

Haemorrhagic ovarian cyst, can’t remember size, management:

  • Follow up in 4 weeks during same time of menstruation
  • Follow up 6-12 weeks during different cycle of menstruation
  • 12 month follow up
  • Referal to gynae
A

b. Follow up 6-12 weeks during different cycle of menstruationif >5cm an pre-menopausal or if perimenopausal. Any size post menopausal needs MRI +/- surgery.

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19
Q

Chin lump, CT shows attenuation of 20 units and -50 nodules:

  • Dermoid
  • Laryngocele
  • Thyroglossal cyst
  • 4th Branchial cleft cyst
A

-Dermoid

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20
Q

Previous left lower chest trauma, CT shows nodules pleural and fissural nodules: what is it???

A

Splenosis

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21
Q

40 yr old, hyper vascular lesion on CT, MRI with gad shows isointense T2, high arterial, low portal venous, low on delayed images:

  • HCC
  • Adenoma
  • FNH
  • Fibrolamellar
A

-HCC washout

*LW: unsure of this, HCC is usually T2 hyperintense, however other factors are suggestive.
-Adenoma technically remains a possibility.
Hopefully more discriminating features in acutal question, e.g. primovist used, scar, etc…..

*AJL - Also unsure. HCC should be T2 high. Adenoma should be portal venous iso. Neither quite fits.

*IVM: could also be FLHCC (clasically heterogeneous enhancement).
Adenoma often cannot/should not be (depending on what you read) dx on enhancement pattern alone and need sequence to confirm intracellular fat.

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22
Q

Worsening proptosis, thickening of medial Rectus with adjacent fat stranding:

  • Thyroid eye disease
  • Peri orbital cellulitis
  • Pseudo tumor
  • Lymphoproliferative disorder
A

orbital pseudotumour. Unilateral single muscle inflammation with tendon involvement is most common.- medial > superior > lateral > inferiorvs thyroid eye disease- im slow

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23
Q

Painful eye, CT shows low attenuation of the lacrimal gland, peripheral enhancement
-Dacrocystitis?

A

Dacrocystitis

**LJS - Lacrimal gland involvement dacroadenitis, dacrocystitis is nasolacrimal duct

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24
Q

Abdominal pain, CT shows small bowel mass plus mesenteric mass with calcification, surrounding extension
:-Carcinoid
-Small bowel cancer
-Small bowel lymphoma

A

-Carcinoid

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25
Q

Colpocephaly association, most likely:

  • Agenesis of corpus callosum
  • Dandy walker
  • Arnold chiari 1
  • Arnold chiari 2
A

Agenesis of corpus callosum

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26
Q

Ultrasound features suggesting benign breast lesion:

  • Hypoechoic lesion with internal vascularity
  • Hypoechoic lesion with ill defined margins
  • Hypoechoic lesion, microlobulation
  • Hyper echoic lesion, more echogenic than fat
A

d. Hyper echoic lesion, more echogenic than fat - i.e calcilum (fat necrosis or oil cyst)

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27
Q

Radial scar on biopsy, further management:

  • Follow up mammogram 6 months
  • Hook wire, open biopsy
  • Hook wire, WLE, sentinel node biopsy
  • Mastectomy
A

-Hook wire, open biopsy

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28
Q

Previous left breast cancer, operated. New palpable lump in right breast, best management:

  • Ultrasound of any palpable abnormality
  • Follow up mammogram in 6 months
  • Follow up mammogram in 1 year-MRI
A

a. Ultrasound of any palpable abnormality I would get a mammo and USS now.

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29
Q

Bloody nipple discharge, common cause

A

**LJS - intraductal papilloma common cause of bloody discharge. Papilloma twists on stalk = infarction and bleeding. Doesn’t indicate malignancy. Benign but increased risk of breast ca (often contains ductal hyperplasia - proliferative disease without atypia)

Previous
Bloody discharge indicates malignancy Benign Papilloma is the common cause

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30
Q

Facial fracture, pyramidal shape, base is the teeth, frontonasal junction, pterygoid plate, lateral wall of orbit, anterior and posterior walls of maxilla:

  • Le fort 1
  • Le fort 2
  • Le Fort 3
  • Nasoethmoid
  • Tripod
A

-Le fort 2

**LJS - ?poor recall
Pterygoids involved = Le Forte. Frontonasal suture involvement = must be 2 or 3. Lateral wall of orbit would make it Le Forte 3, however base of teeth and ant/post maxillary sinus walls would be 2. Probably 2 with poor recall of lateral orbital rim (inferior orbital rim would be part of 2)
*AJL agree

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31
Q

Renal impairment, angiogram shows bilateral renal artery stenosis, carotid vascular abnormality, segmental narrowing of intracranial vessels:

  • Fibromuscular dysplasia
  • Atherosclerosis
A

-Fibromuscular dysplasia

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32
Q

Kicked in balls, ultrasound of testis shows abnormal looking testis, abnormal reflectivity, intact tunica albuginea:

  • Haematoma
  • Rupture
  • Fracture
  • Torsion
A

-Haematoma

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33
Q

Routine CXR, cord like structure on right side, separate from the right heart border, association:

A

-Partial anomalous pulmonary venous return
**SCS: Stem is Describing scimitar sign. Anomalous vein usually drains into the IVC
Associated with: ASD, systemic blood supply to lung, extra lobar sequestration, horseshoe lung (StatDx article on PAPVR)

*IVM: RP also includes; VSD, TOF, Patent ductus, vertebral anamolies

34
Q

5 yr old, Dyspnoea, CXR shows increased lung volumes, streaky lucenies in the mediastinum:

  • Asthma
  • Mycoplasma
  • Foreign body
A

a. Asthma probably. Sounds like pneumomediastinum and this is a (the most?) common cause.

35
Q

New born collapsed and cyanosed, CXR pulmonary plethora:

  • TOF
  • Transposition
  • VSD
  • Tricuspid atresia
A

-Transposition

**LJS - tricuspid atresia also presents with early cyanosis but pulmonary appearance depends on size of the associated VSD: small - decreased pulmonary vascularity; large - increased vascularity

**SCS:
this is testing causes of cyanotic HD.
Categorised by:
Increased pulmonary vascularity: TAPVR (snowman), TGA (egg on a string w narrow mediastinum), truncus arteriosus (think DiGeorge), LARGE AVSD.

VERSUS reduced pulmonary vascularity:
ToF, hypoplastic right heart (includes tricuspid atresia), ebstein anomaly (massif ‘box shaped’ heart), and other rando ones…

VSD is left to right shunt, but not a cyanotic presentation typically (if small).

36
Q

Characteristic feature of meconium aspiration:

  • Increased lung volumes
  • Consolidation
A

-Increased lung volumes

37
Q

MAG 3 scan, instructions to patient:

  • Injection, immediate scan for half an hour
  • Injection, immediate scan for 1 hour
  • Injection, scan at 3 hours for half n hour
  • Injection, scan at 3 hours for 1 hour
  • Injection, return next day, scan at 24 hours
A

a. Injection, immediate scan for half an hour flow at 60 seconds then every 5 mins for 25 or so minutes

38
Q

Bone scan, instructions to patient:(asking about scanning procedure
- how often scan occurs and at what frequency)

A

Every 5s or so for 60secs (flow)5mins (pool) 2-4hourssometimes 24hrs (if doing 4 phase).

39
Q

Bone scan radiation dose compared to chest X-ray:

  • 15 times
  • 200 times
  • 50 times
A

b. 200 times

6mSv for bone scan

40
Q

Risk of solid cancer when exposed to 10sv radiation:

  • 1 in 100
  • 1 in 1000
  • 1 in 10000
  • 1 in 100000
A

b. 1 in 1000

WJI *disagree. This is too low. Firstly LD50 approx 3-4sv so 10sv would kill you. Cancer risk approx 5%/sievert so approx 50% or 1 in 2 assuming you could somehow not die.
Probably a typo. Risk for 10MILLIsieverts as below:
1Sv = 5/100
0.1Sv = 5/1000
0.01Sv = 10mSv =5/10000 = 1 in 2000; so 1 in 1000 best answer for 10mSv

41
Q

Young female, limb pain worse at night:

  • Osteoid osteoma
  • Osteoblastoma
A

a. Osteoid osteoma

42
Q

Forefoot pain, female, ultrasound shows compressible hypoechoic area in the subcutaneous fat at the level of 2nd to 4th metatarsal heads:

  • Adventitial bursitis
  • Intermetatarsal bursitis
  • Morton neuroma
  • Stress fracture
  • Synovitis
A

-Adventitial bursitis

**SCS agree
NOTE: This has been recalled slightly differently on RD 2017.
I have pasted the question and relevant discussion FROM THAT recall below:

a. Adventitial bursitis yes
23. Pain 2nd/3rd intermetatarsal spaces with compressible hypechoic pockets in the subcutaneous fat overlying metatarsal heads

a. Adventitial bursitis yes
b. Intermetatarsal bursitis
c. Mortons neuroma

*IVM: Unsure how you can differentiate between intermetatarsal and adventitial bursitis?
Adventitial bursitis: anechoic, affects plantar fat pad near MT head 1st and 5th
Intermetatarsal bursitis is between 2 metatarsal heads dorsal to the intermetatarsal ligament. Hypoechoic. Compressible/resolves with compression.
Mortons neuroma : perineural fibrosis around the plantar digital nerve. Nodule plantar to the intermetatarsal ligmament. Hypoechoic. Not compressible according to RD. Most common sites 2nd and 3rd intertarsal spaces

MM - I think key words here are non compressible (so not Morton) and its overlying bony prominence so would agree with adventitial bursitis rather than intermetatarsal bursitis.

43
Q

Fall onto hip, greater trochanter fracture on X-ray, MRI shows oedema in the femur neck:

  • Subtrochanteric fracture
  • Intertrochanteric fracture
  • Stress fracture of femoral neck
  • Lesser trochanter fracture
A

b. Intertrochanteric fracture

WJI: This would suggest neck of femur fracture rather than intertrochanteric fracture; but unlikely to be an incidental stress fracture. ?incorrect wording recalled

44
Q

Young child, CXR shows hyperlucent left hemithorax, CT shows no discernible right pulmonary artery
:-Some Tracheal sling
-Pulmonary agenesis
-Swyer James

A

Pulmonary agenesis

CT will confirm the absence of lung parenchyma and mediastinal ipsilateral shift. Contralateral lung hyperinflation is usual with herniation of the normal lung into the contralateral hemithorax. Also, there is an ipsilateral absence of pulmonary artery. It may also show other cardiac congenital malformations and ipsilateral bronchus remnant.

**LJS - swyer-james would have small PA on the same side as hyperinflation
WJI - not true, not hyperinflated. I think Lotte means hyperlucency. Swyer james is SMALL, hyperlucent lung with reduced vascularity

45
Q

Contrast swallow oesophagus appearance:

  • Double aortic arch with reverse S indentation
  • Right main bronchus indents oesophagus
  • Abberant right subclavian courses between trachea and oesophagus
  • Web seen in vertical configuration
A

a. Double aortic arch with reverse S indentation

46
Q

Patient with liver disease, ascites, portal hypertension. Rounded density above the right hilum:

  • Azygous vein
  • Mass
A

-Azygous vein

47
Q

Breast lesion metastatic carcinoid on biopsy, mammogram features:

  • Well defined margin
  • Microlobulated margin
  • Ill defined margin
  • Spiculated
A

a. Well defined margin I think so. See aug 2014 WA

**LJS - agree, typically well defined
Their typical presentation as sharply circumscribed masses can lead to misinterpretation as a fibroadenoma, medullary carcinoma, mucinous carcinoma, or cyst

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993447/#:~:text=Metastatic%20carcinoid%20to%20the%20breast,lump%20or%20an%20abnormal%20mammogram.

48
Q

Mammography:

  • Screening mammo is one view, diagnostic is 2 views
  • Skin line should not be visible
  • Pectoral line should not be seen till the level of nipple
  • medial lesion is inferior on the oblique view than on the lateral
  • Retroareolar lesions are commonly missed
A

d. medial lesion is inferior on the oblique view than on the lateral yes. Muffins rise.
51. Mammography:
a. Screening mammo is one view, diagnostic is 2 views -false
b. Skin line should not be visible - didn’t used to be with film, is with digital
c. Pectoral line should not be seen till the level of nipple - yes it should

d. medial lesion is inferior on the oblique view than on the lateral - yes. Muffins rise.
WJI - muffins rise from oblique to lateral. Confusing as asking inverse.

e. Retroareolar lesions are commonly missed trueish, depends what you mean by common.

49
Q

Patient with diarrhoea, hypokalaemia:

  • VIPoma
  • Glucagonoma
  • Somatostatinoma
  • Insulinoma
  • Gastrinoma
A

-VIPoma

WJI: WDHA syndrome watery diarrhoea, hypokalaemia, achlorhydria

50
Q

Anatomy, can’t remember the right answer:

  • SVC is in the same plane as trachea on coronal slice
  • Right pulmonary artery is anterior to right main bronchus
  • Distal oesophagus is posterior to aorta at the diaphragmatic hiatus
  • IJV and subclavian veins join behind sternoclavicular joint
A
  • Right pulmonary artery is anterior to right main bronchus
  • WJI: -IJV and subclavian veins join behind sternoclavicular joint is also correct. Straight outta Lasts 9th ed (OG) page 258
51
Q

Smoker, Dyspnoea, cough. CT shows ground glass infiltrates and bronchovascular nodules, predominantly in upper lobes:

  • RB ILD
  • NSIP
  • UIP
  • Lymphocytic pneumonitis
  • COP
A

-RB ILD

52
Q

Patient in MVA, left hemithorax fluid with HU of 50:

  • Transection of thoracic duct
  • Haemothorax
  • Pleural effusion
A

-Haemothorax

53
Q

Patient in MVA, contrast extravasation at aortic isthmus:

  • Aortic transection
  • Aortic dissection
  • Penetrating ulcer
  • Aortic aneurysm
A

-Aortic transection

54
Q

Previous endoluminal graft repair, CT shows the sac is filling with contrast outside the graft, the graft is not opposed to the aneurysm neck:

  • Endoleak 1
  • Endoleak 2
  • Endoleak 3
  • Endoleak 4
  • Endoleak 5
A

-Endoleak 1

55
Q

Multiple intrahepatic cystic dilatation of ducts, todani classification:

  • Type 1
  • Type 2
  • Type 3
  • Type 4
  • Type 5
A

-Type 5

56
Q

Type 4 perianal fistula:

  • Intersphincteric
  • Intersphincteric with abscess
  • Transsphincteric
  • Transsphincteric with abscess
A

d. Transphincteric with abscess

*LW:
St James’s University Hospital classification:

grade 1: simple linear intersphincteric
grade 2: intersphincteric with abscess or secondary tract
grade 3: transsphincteric
grade 4: transsphincteric with abscess or secondary tract within the ischiorectal fossa
grade 5: supralevator and translevator extension

57
Q

Staging of anal carcinoma, 2-5 cm lesion, ipsilateral iliac nodes:

  • Stage 1
  • Stage 2
  • Stage 3a
  • Stage 3b
  • Stage 4
A

T2N1 = 3A

Stage 1 - T1 
Stage 2 a - T2
stage 2 b - T3
stage 3 a - T1-2 N1 
Stage 3 b - T4 
Stage 3 c - T3-4 N1
Stage 4 - M

SCS:
Vast majority are SCC
Occur between anorectal juction ans anal verge
RFs: HIV, HPV, anal sex, smoking.

58
Q

Patient with deranged LFT, suspicious of CBD lesion, gastroenterologist unable to put a stent. PTC performed and able to get wire past the mass. Staging not performed:

  • Leave a pigtail catheter with tip in second part of duodenum
  • Pigtail catheter in CBD
  • Biliary drain
  • Bare metallic stent
  • Covered metallic stent
A
  • Leave a pigtail catheter with tip in second part of duodenum
    d. Bare metallic stent only if non-resectable

**SCS Disagree:
Pigtail catheter, WTF, no side holes in intrahepatic portion…
Would need a biliary catheter (internal/external drain.
Or stenting is an option

CCF - The answer is Biliary drain (external).
(Technically internal-external biliary drain means drain is in the duodenum, which would require crossing the lesion)
Agree with Saj re pigtail - cannot curl in CBD - madness/rupture.
All other options would require you to cross the lesion with a wire and therefore impossible in this setting (testing if you have a rough idea of how these are placed).
**SCS; note wire WAS able to be passed… so int-external drain would be best IMO +|- stent.
- CCF ^ Fair - I miss read that.

59
Q

Ultrasound Doppler:

  • Colour coding depends on the velocity of blood
  • Colour coding depends on the direction of flow
  • Colour coding depends on the angle
A

ALL TRUE

WJI: all true for colour doppler, none are true for power doppler

60
Q

PETCT can differentiate between:

  • Uterine cancer and physiological uptake
  • Between treated cancer and post surgical changes
A

b. Between treated cancer and post surgical changes I think, depending on how long post surgery it has been.

61
Q

16 yr old with fall, unusual findings on the X-ray:

  • Dorsal swelling over the carpal bones
  • Fracture of triquetrum
  • Fracture scaphoid
  • Fracture Ulna styloid process
  • Fracture distal radius growth plate
A

b. Fracture of triquetrum ? Least frequent. Carpals much less common than distal forearm, triquetrum less than scaphoid

**SCS: distal radius growth plate closes ~17 years according to a quick and dirth google search. Earlier in girls.
- It feels wierd to be calling a SH # in a 16 year old?
^ its only weird if you make it weird

62
Q

Lady with shoulder pain, ultrasound shows echogenic structure in the supraspinatus tendon with hypoechoic area deep to this, the tendon is thickened:

  • Hydroxyappatite deposition
  • CPPD
  • Partial tear
  • Complete tear
A

-Hydroxyappatite deposition

63
Q

MRI of shoulder, most likely:

  • Fluid in sub deltoid bursa indicates rotator cuff tear
  • Fluid in biceps tendon sheath indicates biceps tendon pathology
  • Post surgical improvement depends on the extent of rotator cuff tear
A

no answer

  1. MRI of shoulder, most likely:
    a. Fluid in sub deltoid bursa indicates rotator cuff tear no. Bursitis as well. Contrast in here indicates tear
    b. Fluid in biceps tendon sheath indicates biceps tendon pathology also associated with rotator cuff tears, calcific tendonitis, adhesive capsulitis. . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553284/
    c. Post surgical improvement depends on the extent of rotator cuff tear doesn’t appear to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503607/#!po=40.9091
64
Q

Lung nodule 7 mm. Non contrast CT performed. Which is most likely:

  • CT guided biopsy
  • More than 35 units enhancement with contrast indicates 97% chance of malignancy
  • Stability on scan in 30 months is a good indicator of it being benign
  • Follow up at 12 months
A

c. Stability on scan in 30 months is a good indicator of it being benign see answers for aug 2014 WA ??would f/u - dimming depending on solid/solid ground glass or ground glass

**LJS - could also be f/u at 12 months if single solid nodule (both low and high risk)

65
Q

Known metastatic disease, bone lesion in ilium, how to biopsy:

  • FNA in an approachable path
  • Core in an approachable path
  • FNA posterior approach avoiding gluteal muscles
  • Core posterior approach avoiding gluteal muscles
A

b. Core in an approachable path

SCS weakly disagree:
Crack the core MSK chapter says something about avoiding the gluteal muscles as they are often used in reconstruction.
I favour Core posterior approach avoiding gluteal compartment if possible.

66
Q

Bone scan:

-Flare phenomenon is the appearance of chemotherapy resistant metastasis - false

A

a. Flare phenomenon is the appearance of chemotherapy resistant metastasis - False

It is the formation of sclerotic rim around previously occult lesions with treatment, not a sign of progression.
Usually seen 2 weeks to 3 months (occasionally as late as 6 months).
Flare phenomenon or osteoblastic flare phenomenon refers to interval visualization of lesions with a sclerotic rim around an initially lytic lesion or sclerosis of lesions previously undetected on radiograph or CT in the setting of follow-up of an oncological patient with other signs of partial response to treatment. It does not indicate disease progression but the healing of previously inconspicuous lesions.
As it can be misinterpreted as progression in bone metastasis, follow up bone scintigraphy for 6 months or more is the rule. If there is a subsequent decrease uptake in these lesions on repeat exam in 2-3 months, it then likely represents a flare phenomenon. If there is a continued increase in the number and intensity of lesions beyond 6 months, it is then usually indicative of disease progression.i.e need f/u to exclude malignancy

67
Q

Post uterine fibroid embolisation, patient has low grade fever, mildly raised leucocytes, CRP, no tachycardia, no hypotension:

  • Pseudoaneurysm
  • Post embolisation syndrome
  • Bleeding
  • Infection
A

b. Post embolisation syndrome

Post-embolisation syndrome (PES) is one of the commonest side effects of transarterial embolisation and chemoembolisation. It comprises of a constellation of fever, nausea/vomiting, and pain. It usually occurs within the first 72 hours after embolisation (liver lesion or uterine fibroids) and then starts to subside after 72 hours

  1. It is not to be mistaken for a predictor of impending infection. Hence performing blood cultures in the absence of other factors is unnecessary
  2. This condition is more often associated with large fibroids or large tumour embolisation.
68
Q

Previous right pneumonectomy, shifted mediastinum to the right. Now the mediastinum is in the centre:

  • Post pneumonectomy complication
  • Cancer recurrence
  • Pleural effusion
A

-Post pneumonectomy complication

69
Q

Post lung biopsy, pneumothorax with more than 50% collapse of lung, patient well. Next step:

  • Oxygen
  • Immediate chest drain
  • Chest drain on the same day
  • X-ray in 4 hours
  • X-ray in 24 hours
A
  • Immediate chest drain
  • LW: agree one would likely place chest drain sooner rather than later, but wouldnt one give oxygen while setting up for chest drain…so the first next step would be oxygen….. the dark side only confuses matters
  • AJL - yes….. well that made it complicated.
  • WJI I would chose drain. I think choosing oxygen suggests this as appropriate management of the problem.
70
Q

Patient on DSA table for angiogram, injected contrast. Patient feels sick, pale, hypotension 90/50, heart rate 50, no rash:

  • 1:1000 adrenaline IM
  • 1:1000 adrenaline IV
  • Head end elevation
  • Foot end elevation
  • Oral antihistamine
A

-Foot end elevation

71
Q

Craniopharyngioma:

  • Cystic in adults
  • Shows nodular and marginal calcification
  • Solid with enhancement in kids
  • Mainly intrasellar
A

b. Shows nodular and marginal calcification
* IVM: as of 2021 WHO classification adamantinomatous and papillary now considered separate entities - previously thought of as sub-types of craniopharyngiomas

72
Q

L5/S1 end plate changes, low T1, high T2. Not due to..

  • Modic type 2
  • Discitis
  • Disc herniation
A

-Modic type 2

73
Q

Breast Ultrasound shows a solid cystic lesion which appears to be a intraductal papilloma:

  • Hook wire with open biopsy
  • Hook wire with WLE, sentinel node
  • Routine screening mammo
  • 6 monthly screen
A

-Hook wire with open biopsy

74
Q

CPAM:

  • majority are dense
  • Commonly have more than 1 big cyst
  • Have well defined internal bronchial tree
  • Supplied by systemic vessel
A

b. Commonly have more than 1 big cyst

  • *LJS - 70% are type 1
  • AJL Type 1 = large cysts, Type 2 = small cysts, Type 3 = tiny/micro cysts
75
Q

Voluntary service in Philippines, patient with left iliac fossa pain. Ultrasound shows thickened multicystic adnexal abnormality:

  • Poly cystic ovarian disease
  • Tuberculous salpingitis
  • Tub ovarian abscess
  • Endometriosis
A

b. Tuberculous salpingitis

76
Q

Child with biliary dilatation, predominantly fluid mass with projections into the biliary tree:

  • Haemangioendothelioma
  • Mesenchymal hamartoma
  • Heptoblastoma
  • Fibrolamellar HCC
A

b. Mesenchymal hamartoma

SCS: Ummm what?
Could this be incomplete recall?
I favour choledochal cysts.

77
Q

Child with skull lesions centered in the diploid spaces, well defined, can’t remember the MR signal characters:

  • Dermoid
  • Pachonian granulations
A

Depends on what it looks like

78
Q
  1. Child with cardiomegaly, expanded ribs, vertebral bodies but the end plates are preserved:
    a. Thalassemia
    b. Sickle cell disease
    c. Fibrous dysplasia
A

a. Thalassemia

79
Q

Female, Dyspnoea, tachycardia, ECG shows S1Q3T3 pattern, D dimer positive. VQ scan shows:

  • Multiple segmental perfusion defects
  • Multiple tiny perfusion defects
  • Matched defects
A

-Multiple segmental perfusion defects

80
Q

VQ scan, pioped criteria:

  • More than one mismatched defect is suggestive of PE
  • Low probability excludes PE
  • Absence of perfusion in one lung is more suggestive of compressing brochogenic tumor than a large embolus
  • 90% resolve
A

c. Absence of perfusion in one lung is more suggestive of compressing brochogenic tumor than a large embolus

High probability- two or more large mismatched segmental defects or equivalent moderate/large defects with a normal x-ray- any perfusion defect substantially larger than the radiographic abnormality

Low probability- nonsegmental defects: small effusion, blunting costophrenic angle, cardiomegaly, elevated diaphragm, ectatic aortaany perfusion defect with a substantially larger radiographic abnormality- matched ventilation and perfusion defects with a normal chest radiograph- small subsegmental perfusion defects

*ESG weakly disagree, favour the first option (as “more than one” defect fulfils criteria for “two or more”). Decent article regarding ddx for whole lung mismatched defects (ddx = PE, mediastinal fibrosis, obstructing hilar mass, pulmonary fibrosis, pulmonary vein stenosis, unilateral transplant with no perfusion in bad lung)

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194779/)
In our experience, perihilar tumors more often cause whole-lung matched perfusion defects than mismatched defects on V/Q scans. By the time a tumor is large enough to obstruct the central pulmonary vasculature and the perfusion of an entire lung; it usually has obstructed most of the central airways. Indeed, we have found that whole-lung mismatched perfusion defects are more often secondary to fibrosing mediastinitis and pulmonary vein stenosis than cancer.

81
Q

MVA, patient has pelvic fracture and bladder injury. CT cystogram is performed. Which type is not seen on CT?

  • Intraperitoneal
  • Extraperitoneal
  • Intra and extra combined
  • Mucosal laceration
  • Interstitial injury
A

d. Mucosal laceration

**LJS agree - interstitial injury shows intramural contrast without transmural extension

https://pubs.rsna.org/doi/10.1148/radiographics.20.5.g00se111373

Bladder contusion (type 1) has normal cystogram:
Incomplete or partial tear of bladder mucosa; ecchymosis of localized segment of bladder wall
82
Q

Pelvis X-ray: sclerosis on the ilial side of sacroiliac joint, inferiorly:

  • Ankylosing spondylitis
  • Septic arthritis
  • Psoriatic arthropathy
  • Osteitis ilii condensates.
A

Osteitis ilii condensates.

*LW:
Osteitis ilii condensates:
Sclerosis of the iliac side of the sacroiliac joint, typically bilateral, symmetrical, and triangular in shape
Lack of sacral involvement or joint space narrowing is considered diagnostic and may obviate the need for further imaging.

CDHB RD (28 decks)

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