RD MCQ 2013 september recalls - NSW: Formatted

Question 1

53. Which type of Non Hodkins lymphoma is PET not useful for
    a. T cell
    b. lymphocyte rich
    c. nodular sclerosing
    d. mycosis fungoides
    e. diffuse large B cell

Answer 1

*LW:

d. mycosis fungoides (also known as cutaneous T cell lymphoma, NHL type),
- this is my favoured answer as although FDG PET results are positive in most T cell lymphomas, except indolent cutaneous T cell lymphoma.

PRevious answer:
a. T cell

53. Which type of Non Hodkins lymphoma is PET not useful for
    a. T cell

b. lymphocyte rich
c. nodular sclerosing

d. mycosis fungoides (also known as cutaneous T cell lymphoma, NHL type),
- this is my favoured answer as although FDG PET results are positive in most T cell lymphomas, except indolent cutaneous T cell lymphoma.

e. diffuse large B cell: TRUE

Question 2

63. A patient how has previously been treated for prostate cancer now has lower leg weakness and can’t walk. MRI no structural abnormality.(repeat)
    a. Transverse myelitis
    b. Post radiotherapy
    c. Leptomeningeal recurrence

Answer 2

*LW:
Post radiation therapy can occur short term and long term.
Transverse myelitis is possible, as can occur in setting of malignancy, favours anterior cord.
*AJL agree with above. additional note: Radiation to the spine in the previous 10 yrs excludes a diagnosis of transverse myelitis (RP).

b. Post radiotherapy although depends on time course (could be transverse myelitis if acute)

Question 3

67. Which is not an associated drug reaction?
    a. Methotrexate and lung mass
    b. Cyclosporin and pneumatocoele
    c. Amiodarone and pulmonary fibrosis
    d. Phenytoin and pleural effusion

Answer 3

b. Cyclosporin and pneumatocoele

methotrexate can get fibrosis -> conglomeration which may probably produce mass like appearance

Question 4

75. Technitium is useful in medical imaging. Which is true?
    a. half life of 90 min
    b. its daughter, molybdenum is not radioactive
    c. produces gamma and beta radiation
    d. produces energy from 5 keV to 5000 keV, which suits the detectors well

Answer 4

c. produces gamma and beta radiation

**LJS - Tc-99m (metastable) to Tc-99 gamma decay to ground state, releasing 140keV gamma photon, plus a little bit of internal conversion (also releasing gamma photon)
i.e. no beta emission.
Check of my physics notes and googling confirms this. But maybe someone who’s more of a physics buff understands this better?
Poor recall? Unrecalled option correct?

If there were beta emission wouldn’t radiation dose be high, and hence not as clinically useful as it is?

*AJL - I agree with LJS above.

However, other answers all false:

a. half life of 90 min - no, 6 hours
b. its daughter, molybdenum is not radioactive - Mo is the parent, not the daughter. 99Mo decays by beta emission to 99mTc
d. produces energy from 5 keV to 5000 keV, which suits the detectors well - produces 140 keV gamma photon

Question 5

77. Which is true regarding diffuse axonal injury?
    a. Usually non-haemorrhagic
    b. Most common in the subcortical white matter of the frontal and temporallobes
    c. Susceptability weighted imaging is not helpful
    d. Diffusion weighted imaging is diagnostic

Answer 5

a. Usually non-haemorrhagic 80% non-haemorrhagic.
* AJL they are also most common in the grey-white (ie subcortical) white matter of the frontotemporal lobes. Seems there are 2 correct answers…

77. Which is true regarding diffuse axonal injury?
    a. Usually non-haemorrhagic 80% non-haemorrhagic.
    b. Most common in the subcortical white matter of the frontal and temporal lobes
    c. Susceptability weighted imaging is not helpful
    e. Diffusion weighted imaging is diagnostic kind of true although I guess other pathologies could simulate findings. Probably a better

Question 6

81. Which is least associated?
    a. Caroli’s disease and medullary sponge kidney
    b. NEC and maternal diabetes
    c. Hypercalcaemia and supravalvular aortic stenosis
    d. Typhlitis and haematological malignancy

Answer 6

• LW:
  b. NEC and maternal diabetes

81. Which is least associated?
    a. Caroli’s disease and medullary sponge kidney: True
    b. NEC and maternal diabetes: not associated.
    c. Hypercalcaemia and supravalvular aortic stenosis: technically true, supra valvular AS is very rare and is associated with Williams syndrome which includes hyper calcaemia.
    d. Typhlitis and haematological malignancy: true.

Question 7

82. In regards to second trimester screening

a. An echogenic intracardiac focus can be related to non-chromosomal cardiacdefects
b. Echogenic bowel is not pathological if there are no chromosomal anomalies
c. An isolated single umbilical artery is associated with cardiac anomalies
d. Choroid plexus cysts without any other abnormality are a strong indicatior ofchromosomal abnormalities

Answer 7

• LW: All answers false - likely incomplete recall.
  82. In regards to second trimester screening

a. An echogenic intracardiac focus can be related to non-chromosomal cardiac defects:
- False: no recognised direct association with congenital heart disease for an EIF on its own

b. Echogenic bowel is not pathological if there are no chromosomal anomalies:
- False:
- can be normal variant / isolated findings in up to 70% cases, however can be associated with intra amniotic haemorrhage, T21, (and less commonly T13, T18, XO), CMV infection, CF, IUGR, meconium peritonitis.

c. An isolated single umbilical artery is associated with cardiac anomalies:
- False.
- 65% occurs in isolation.
- Associations in 35% of cases and include, lesser umbilical coils, umbilical arterial aneursym, TRAPS, IUGR.
- If other abnormalities present, associations include trisomy, renal anomalies.
* *LJS - Can be ass/w renal/CHD even without chrm abn. As per discussion in other mcq. I would say this is most correct of the answers as given

d. Choroid plexus cysts without any other abnormality are a strong indicatior ofchromosomal abnormalities
- False
- Soft marker, as majority occur with no other associated abnormalities.
- Associations include: T18, T21, Klinefelter, Aicardi syndrome.

Question 8

84. In regards to lower limb angiography

a. The popliteal artery is best seen in lateral view if there is a total kneereplacement
b. The profunda femoris artery origin is best visualised in external rotation

Answer 8

a. The popliteal artery is best seen in lateral view if there is a total knee replacement

*AJL
Agree with above.
Profunda femoris courses posterior and lateral therefore internal rotation brings it out beside the superficial femoral artery.

Question 9

85. A young patient has left atrial enlargement, thickened interlobular septa,widespread dense pulmonary nodules and small pleural effusions. Which is most likely?
    a. Sarcoidosis
    b. Metastases
    c. Pulmonary haemosiderosis
    d. Talcosis

Answer 9

c. Pulmonary haemosiderosis