RD MCQ april 2013 VIC: Formatted Flashcards
With regards to I-131 vs I-123, which of the following statements is MOST TRUE
a. I-131 is cheaper than I-123
b. I 131 has a higher dose
c. I 131 can afford higher doses
d. SPECT I-131 has better spatial resolution
e. I-131 has a shorter imaging time, at 4-8 hours post injection
b. I 131 has a higher dose
Iodine-123
- pure gamma emitter
- excellent characteristics for imaging with modern scintillation cameras.
- lower dose
I131
- higher dose
- for treatment of thyroid cancer and MNG
*ESG I-131 also cheaper than I-123 as it comes from a nuclear reactor rather than a cyclotron. Whether this conventional wisdom applies to nuclear free NZ is undefined and unknowable.
- V/Q scanning, which is MOST TRUE
a. PIOPED high probability defined as one or more unmatched perfusion defects
b. complete absence of perfusion to one lung is more commonly secondary to extrinsic compression from lung carcinoma than massive pulmonary embolus
c. Technegas is give at 5 times the dose of macro-aggregated albumin
d. Technegas given after macro-aggregated albumin
e. 90% of perfusion defects resolve on repeating imaging in 12 months
complete absence of perfusion to one lung is more commonly secondary to extrinsic compression from lung carcinoma than massive pulmonary embolus
*LW agrees, based on the high end research of a single 1987 Radiographic paper where there 8 cases of lung cancer vs 3 cases of PE accounting for complete absence of perfusion.
*Prometheus - agree with LW, see p485 of my book where I state that a unilateral perfusion defect without a ventilation defect is due to central obstructing mass more commonly than fibrosing mediastinitis and central PE.
**LJS - agree. Also, ventilation scan done before perfusion.
Common dose 37MBq technegas vs 150MBq MAA
Perfusion scintigraphy
- microembolization with 99mTc-labeled macroaggregates of human albumin (MAA).
ventilation studies
- inert gas 81mKr or - DTPA or- (Technegas; Cyclomedica Ltd.) are currently recommended (11).
81mKr is of limited use because of its high cost and short half-life.
Ventilation (Xe-133) before perfusion (Tc-99m MAA) because Tc-99m has a longer half life and higher energy - doing perfusion first would interfere with a subsequent ventilation scan. Because physics. And Prometheus.
- V/Q scanning, which is MOST TRUE
a. the PIOPED reporting criteria includes a “normal scan” category
b. A rim of pleural perfusion overlying a central perfusion defect is a high probability finding
c. a “low probability” V/Q scan completely excludes pulmonary embolism
d. is absolutely contraindicated in pregnancy
e. something about ventilation or perfusion performed first.
a. the PIOPED reporting criteria includes a “normal scan” category
**LJS:
Revised PIOPED 2:
PE present (high probability)
Non-diagnostic (low/int prob)
PE absent (normal or very low probability)
Ventilation performed first
- DTPA scan is for
a. renal scarring
b. renal obstruction
c. renal artery stenosis
d. renal function
e. renal cell carcinoma metastases
d. renal function
- DTPA scan is for
a. renal scarring DMSA (can also assess differential function)
b. renal obstruction MAG3,
c. renal artery stenosis MAG3 with captopril
d. renal function - “true GFR” (not eGFR)
e. renal cell carcinoma metastases
*RY - Removed incorrect indications for DMSA (is used to look at cortex, not as a dynamic renogram). DTPA can also be used instead of MAG3 for renal obstruction (with frusemide) or renal artery stenosis (with ACEi), but is generally worse because it almost exclusively filtered (i.e. significantly worse when there is poor renal function). DTPA mainly used for calculating GFR. (Crack the core, radprimer)
- MAG 3 with captopril for
a. renal scarring
b. renal obstruction
c. renal artery stenosis
d. renal function
e. renal cell carcinoma metastases
c. renal artery stenosis
. Regarding multislice CT scanning and dose, most correct
a. Automated dose modulation technique may minimise dose
b. Dose is proportional to kVP
c. the mAs should not be altered regardless of body size
d. the efficiency of radiation is increased with less slices
e. isotropic voxels in multislice CT increases the dose
a. Automated dose modulation technique may minimise dose
- Regarding multislice CT scanning and dose, most correct
a. Automated dose modulation technique may minimise dose
b. Dose is proportional to kVP proportional to kVp squared (roughly)
c. the mAs should not be altered regardless of body size ramp that shit up in fatties.
d. the efficiency of radiation is increased with less slices possibly?? - *ESG - no, reduced, something to do with a bit of unavoidable wasted radiation at both ends of the beam, so (assuming a constant slice width): the more slices, the greater the collimated beam width, the less proportion wasted, the greater the efficiency of the dose
e. isotropic voxels in multislice CT increases the dose
- Regarding fat suppression techniques, which is TRUE
a. Inversion recovery techniques are very suspectible to static magnetic field inhomogeneity
b. Inversion recovery is lipid specific
c. Inversion recovery is better on lower magnet strength MR
d. a typical adenoma show lower signal on out of phase imaging than fat suppressed image
e. fat suppression cannot be applied to T2 weighted imaging
d. a typical adenoma show lower signal on out of phase imaging than fat suppressed image
- Regarding fat suppression techniques, which is TRUE
a. Inversion recovery techniques are very suspectible to static magnetic field inhomogeneity - F, relatively insensitive to magnetic field inhomogeneity (radiopaedia)
**SCS: hence STIR is used if metalware is in situ…
b. Inversion recovery is lipid specific - F if this means it can only be used for fat suppression, and can’t be used for fluid (FLAIR) - also F if it’s saying that only lipids will be nulled because anything that happens to have the same T1 will also be nulled (can’t do IR post-gad due to T1 shortening and inadvertently nulled tissue)
c. Inversion recovery is better on lower magnet strength MR (SCS -false asked a tech)
d. a typical adenoma show lower signal on out of phase imaging than fat suppressed image
e. fat suppression cannot be applied to T2 weighted imaging (FLAIR, STIR)
- Most frequently accepted theory of NSF mechanism
a. free gadolinium reaches soft tissues and activates fibroblasts
b. free chelate reaches soft tissues and activates fibroblasts
c. chelated gadolinum reaches soft tissues and activates fibroblasts
d. antibody bound chelated gadolinium reaches soft tissues and activates fibroblasts
e. antibody bound free gadolinium reaches soft tissue and activates fibroblasts
a. free gadolinium reaches soft tissues and activates fibroblasts
- Which is the correct association
a. I 131 Sodium iodide is used for the diagnosis of papillary thyroid cancer
b. I 131 penteotide is used for diagnosis of medullary thyroid cance
c. MIBG for adrenal cortical adenocarcinoma
d. something-Onco-scan for ovarian cancer
e. 99mTc-antiCEA is used for diagnosis of breast cancer
d. something-Onco-scan for ovarian cancer Onco-scint for ovarian and colon cancer
Which of the following is TRUE regarding safety issues with 1.5 T MRI
a. Pt with ferromagnetic body piercing not able to be removed is disqualified from entering the magnet
b. A patient with a copper IUCD is disqualified from entering the magnet
c. External insulin pump which is connected to the patient can get into the magnet
d. A patient cochlear implant is disqualified from getting into magnet
e. Person with metallic sharpnel foreign bodies from combat is disqualified from getting into magnet even if they are not near vital organs
**LJS - see www.mrisafety.com
-piercing can be stuck down or cooled with ice pack to avoid heating. Not contraindication
-Cochlear implant - these days can remove outer part and wrap head. Some are now MRI compatible. But this would recently have been most true
d. A patient cochlear implant is disqualified from getting into magnet probably this one although there are some devices that have received FDA approval now.
a. ferromagnetic body piercing not being able to removed - not sure
b. IUCD is safe
c. MRI can damage insulin pump
d. cochlear implant may need to be removed
e. metallic shrapnel is ok if not the region of interest imaged
Patient requires CT contrast injection: least likely to predict renal impairment
a. Myeloma
b. Gout
c. Thyrotoxicosis
d. CHF
e. Previous renal disease
Thyrotoxicosis relative contraindication because of iodine dose (can exacerbate thyrotoxicosis) not because of renal impact
- Diabetic man presents with first seizure, is requested for an MRI. The patient has bad renal function with an estimated GFR of 28. What is the MOST APPROPRIATE approach to MRI contrast.
a. Haemodialysis immediately after the study and again within 24 hours
b. Use a linear gadolinium
c. Use a non-ionic gadolinium
d. Use a macrocyclic gadolinium
e. Do not give contrast
. Do not give contrast screening examination, don’t give contrast straight up. If absolutely required, use macrocyclic and dialyse afterwards (risk still <1%). Also at increased risk with liver disease.
**LJS - see RANZCR guideline.
At GFR 15-30 ml/min are low risk for NSF (0.1% per dose of higher risk agent). High risk agent (linear Gad agents) contraindicated.
Haemodialysis only recommended for high risk patients (GFR <15 ml/min)
Need to balance risk of NSF vs risk of misdiagnosis.
Answer = low risk agent (macrocyclic or gadobenate) in this setting
https://www.ranzcr.com/college/document-library/gadolinium-containing-mri-contrast-agents-guidelines
- 54yo man with diabetes with ischaemic foot. Very low GFR. Vascular surgeon requests an angiogram. Best contrast agent:
a. non ionic iodine based contrast
b. carbon dioxide
c. nitrogen
d. oxygen
e. lipidol
b. carbon dioxide Co2 is a technique used in 60s and 70s
Regarding rheumatic heart disease, which of the following is TRUE:
a. aortic valve is most commonly affected
b. mitral stenosis is due to thickened shortened chordae
c. myocarditis is typically fatal
d. chronic rheumatic valve disease is due to group A streptococcus endocarditis in childhood
e. infective endocarditis is relatively common complication
*LW:
If wording is accurate: Option E would be preferred option, although unsure of “common”
Ensure correct wording of option D - if states strep endocarditis = FALSE, if Strep Pharyngitis = this would be most correct option.
**LJS - infective endocarditis is a complication, due to abn valves of chronic RHD. Not sure what constitutes “relatively common” but I think this is most correct of options given
Regarding rheumatic heart disease, which of the following is TRUE:
a. aortic valve is most commonly affected: False Mitral
b. mitral stenosis is due to thickened shortened chordae: False - commissural fusion of valve leaflets is a characteristic feature.
c. myocarditis is typically fatal: false
d. chronic rheumatic valve disease is due to group A streptococcus endocarditis in childhood: group A beta haemolytic streptococcus pharyngitis that evokes a immune reaction against valves, myocardium and pericardium.
e. infective endocarditis is relatively common complication: False.
- 60 year old non-smoking male. SOB, restrictive lung function tests. HRCT has posterobasal predominant interlobular septal thickening with subplueral cysts, mild bronchial dilatation and mild ground glass opacity
a. Respiratory bronchiolitis - interstitial lung disease
b. Desquamative interstitial lung disease
c. Cryptogenic organising pneumonia
d. Non-specific interstitial pneumonitis
e. Usual interstitial pneumonitis
. Usual interstitial pneumonitis
- Which of the following regarding pulmonary amyloidosis is FALSE: .
a. multiple nodules
b. bronchial obstruction
c. bronchopleural fistula
d. pulmonary ossification
c. bronchopleural fistula
- 50 year old man with 4/12 of haemoptysis. CXR shows perihilar infiltrates, with three nodules, one of which is cavitating. Most likely diagnosis:
a. Sarcoidosis
b. Wegeners
c. Septic emboli
b. Wegeners
. 55yo man with intermittent claudication, 3cm long <50% stenosis SFA - first line treatment
a. embolectomy
b. angioplasty
c. bypass surgery
d. exercise program
e. stent graft
d. exercise program
Assuming this will stimulate collaterlisation?
- 80 year old male with enlarging abdominal aortic aneurysm despite treatment with stenting. A CT angiogram demonstrates filling of the aneurysm from a lumbar artery, what is the likely cause:
a. type I endoleak
b. type II endoleak
c. type III endoleak
b. type II endoleak
- Which of the following regarding acute aortic syndrome in relation to penetrating ulcer is FALSE?
a. penetrating aortic ulcer extends to at least the media (macroscopic penetration)
b. acute aortic syndrome from intramural haematoma
c. most commonly occurs in the abdominal aorta
d. acute aortic syndrome from aortic rupture
e. acute aortic syndrome from dissection
c. most commonly occurs in the abdominal aorta - mid and distal thoracic.
- Young guy with hypertension. Elevated left apex. Irregular rib margins. Indentation of the left lateral border of the aorta. Retrosternal soft tissue mass. Most likely
a. Aortic coarctation
b. TAPVR
c. Aortic insufficiency
a. Aortic coarctation
- Regarding dissection, which is TRUE
a. requires visualisation of the dissection flap on MRA for diagnosis
b. dissection is a cause of spinal dural AV fistula
c. high attenuation within the lumen is a CT sign of dissection
d. vertebral artery dissection more common than carotid artery dissection
e. dissection is not a cause of subarachnoid haemorrhage
c. high attenuation within the lumen is a CT sign of dissection if within false lumen on non-contrast. (talking about IMH)
- Regarding dissection, which is TRUE
a. requires visualisation of the dissection flap on MRA for diagnosis No. Not visualised in intramural haematoma.
b. dissection is a cause of spinal dural AV fistula
**LJS - cause usually unknown. Can’t find any paper suggesting dissection as cause
c. high attenuation within the lumen is a CT sign of dissection -if within false lumen on non-contrast.
d. vertebral artery dissection more common than carotid artery dissection- carotid more common.
e. dissection is not a cause of subarachnoid haemorrhage -yes it is.
- Patient being prepared for a left AV fistula for dialysis. Has never had a dialysis catheter before. Best place to site a tunnelled catheter in the interim:
a. right IJV
b. right subclavian vein
c. left IJV
d. left subclavian vein
e. femoral vein
a. right IJV
- Correct statement regarding three vessel runoff :
a. Doppler ultrasound is more sensitive for demonstrating three vessel run off than DSA
b. CT angiogram is more sensitive for demonstrating three vessel run off than DSA
c. MRA is more sensitive for demonstrating three vessel run off than DSA
d. in phase (or similary) MR is more sensitive for demonstrating three vessel run off than DSA
e. catheter angiography is more sensitive than non-invasive methods for demonstrating three vessel run off
e. catheter angiography is more sensitive than non-invasive methods for demonstrating three vessel run off
- Regarding CTPA for pulmonary embolus, what does NOT form a criteria of the Well’s score
a. Tachycardia > 100 bpm
b. PE most likely diagnosis
c. haemoptysis
d. previous history of DVT/PE
e. OCP use
e. OCP use
clinical signs and symptoms of DVT = 3
an alternative diagnosis is less likely than PE= 3
heart rate more than 100 = 1.5
immobilisation for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5
previous objectively diagnosed PE or DVT = 1.5
haemoptysis = 1
malignancy (on treatment, treatment in last 6 months or palliative) = 1
- Which of the following is not a sign of progressive congestive cardiac failure?
a. vascular cephalisation
b. perihilar bat-wing opacity
c. pulmonary calcification
d. increasing definition of pulmonary vessels
e. interstitial opacities
d. increasing definition of pulmonary vessels
- Young man, testicular ultrasound shows 2cm intratesticular hypoechoic lesion with internal debris and increased peripheral vascularity associated with acute pain. Best management:
a. core biopsy in theatre
b. antibiotics and clinical review in 72hrs
c. surgical referral in one week
d. US in 3 months
e. orchidectomy
antibiotics and clinical review in 72hrs
- 50yo man, 4cm mass in small bowel with stranding radiating into the mesentery. Mild proximal small bowel dilatation. Most likely
a. carcinoid
b. GIST
c. lymphoma
a. carcinoid
- 55 year old from Nigeria. Continuous linear calcification along the bladder with sessile mass. Most likely
a. adenocaricnoma
b. transitional cell carcinoma
c. squamous cell carcinoma
d. schistosomiasis
c. squamous cell carcinoma probably from schistosomiasis
- Rectal mass detected on DRE. MR rectum shows eccentric mass with intact muscularis layer. CT abdomen/pelvis shows no lymphadenopathy or metastases. What is the stage after imaging?
a. stage 1
b. stage 2a
c. stage 2b
d. stage 3
e. stage 4
a. stage 1
Stage groupings
stage I: T1-2, N0 M0
stage
IIa: T3, N0, M0
IIb: T4a, N0, M0
IIc: T4b, N0, M0
stage
IIIa: T1-2, N1, M0
IIIb: T3-4, N1, M0
IIIc: T3-4b, N2, M0
stage IV: any T, any N, M1
- 40 year old male with RIF pain and fever. CT shows inflammatory stranding surround a 1cm lesion at the caecal tip, which has a CT density of 345 HU. Most likely diagnosis:
a. appendicitis
b. diverticulitis
c. epiploic appendagitis
d. crohn’s disease
e. pseudomembranous colitis
**LJS - “lesion” is probably an appendicolith, which could have this density. Answer = appendicitis.
*LW: agree with above.
DDx: If HU was -45, this implies fat, and is normally a rounded lesion of approx 1cm = Epiploic appendicitis.
Previous answer:
a. appendicitis
. Regarding prostate cancer, which is TRUE
a. doesn’t arise from the peripheral zone
b. typically more often hypoechoic than hyperechoic compared to surrounding parenchyma
c. PSA correlates directly to tumour load
d. PSA does not relate to prostate size
e. PSA is elevated in <50% of patients with prostate cancer
. typically more often hypoechoic than hyperechoic compared to surrounding parenchyma
- Adult male, blunt trauma, which is FALSE regarding bowel injury
a. interloop fluid is a strong predictor
b. pneumoperitoneum is seen in almost all cases on CT
c. bowel loops may show increased enhancement
d. duodenum and jejunum are commonly affected
e. focal bowel wall thickening is sometimes seen
pneumoperitoneum is seen in almost all cases on CT
- 30 year old woman with abdominal pain. Barium follow through shows proximal jejunum dilated to 4cm diameter and featurelesss before a 5 cm stricture with fistula to the terminal ileum. What is the most likely diagnosis?
a. Crohns disease
b. carcinoid
c. lymphoma
d. scleroderma
e. SLE
a. Crohns disease