RD radiodiagnosis 2018 march: formatted Flashcards

Question

37. SVC obstruction enhancing structure right hilum a. Lymph node b. Azygous c. Tumor

Answer 1

b. Rhabdomyoma- cardiac rhabdomyoma: considered the commonest fetal cardiac tumor - cardiac fibroma: considered second commonest fetal cardiac tumor 3 - cardiac teratoma: considered third commonest fetal cardiac tumor 3 fetal pericardial teratoma- cardiac myxoma- cardiac hemangioma

Answer 2

Cavernous carotid aneurysms (CCAs) constitute 2%–9% of all IC aneurysm.[1] These aneurysms are can be idiopathic, traumatic, iatrogenic, or infectious in etiology. Traumatic, iatrogenic, and infectious aneurysms have an aggressive course and need urgent intervention.[2] The natural history of idiopathic cavernous aneurysms is not well known. They often remain asymptomatic and are detected incidentally. They tend to become large to giant in size when they manifest with features of mass effect in the form of cranial nerve palsies of adjacent nerves. This could be in the form of diplopia, ptosis, ophthalmoplegia, or pain or paresthesia along the fifth nerve distribution. A Large transitional variant of these aneurysms which have an intradural component can press against the optic nerve and result in visual symptoms. These intradural variants also carry a risk of subarachnoid hemorrhage (0.2%–0.4%).[3,4] Intracavernous rupture can result in direct caroticocavernous fistula although such instances are rare.[2] Rarely, these aneurysms can erode into the sphenoid sinus and rupture resulting in fatal epistaxis. Spontaneous thrombosis of these aneurysms has also been reported as have been thromboembolic strokes originating from intra-aneurysmal thrombus.[5,6]

Answer 3

Criteria clinical signs and symptoms of DVT = 3 an alternative diagnosis is less likely than PE = 3 heart rate more than 100 = 1.5 immobilization for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5 previous objectively diagnosed PE or DVT = 1.5 hemoptysis = 1 malignancy (on treatment, treatment in last 6 months or palliative) = 1 ``` Risk either 3 level or 2 levels 3 levels Score 0-1 low 2-6 moderate >6 high ``` 2 levels <4 low >4.5 high

Answer 4

* AJL - Favour pitch or mA. (tricky to look up so based on prior knowledge as outlined below, let me know if you disagree) - Increased pitch will decrease dose. - Decrease mA will decrease dose, this is used in lung cancer screening CT, however typically mA is modulated and automatic. You can reduce the automated minimum amperage. - Lead shielding - most of the dose to the abdomen come from scatter within the patient (talking about CTPA presumably) therefore lead shield doesn't do much. - Lateral scout is used for dose modulation of mA so omitting that may actually lead to an overall increase in dose. Previous answer: The answer is controversial Probably C or D a - increase pitch -> increase distance between each slice -> decrease dose b - decrease MA -> decrease dose c - lead shielding has research evidence to suggest decreased dose d - omit lateral scout will obviously decrease dose who knows

Answer 5

a. Calcification 1mm branching **LJS - non-masslike enhancement on MRI

Answer 6

valgus stress to flexed and externally rotated knee contusion pattern: posterolateral tibial plateau and mid part of lateral femoral condyle associated with anterior cruciate ligament (ACL) tears see also: contrecoup injury of the knee

Answer 7

a. Anabolic steroid

Answer 8

**LJS - true ``` SD: Modic type I T1: low signal T2: high signal represents bone marrow edema and inflammation T1+C: enhancement Modic type II T1: high signal T2: iso to high signal represents normal red haemopoietic bone marrow conversion into yellow fatty marrow as a result of marrow ischemia Modic type III T1: low signal T2: low signal represents subchondral bony sclerosis ```

Answer 9

Answer - Decrease in size during stress - FALSE * LW: - -> with regards to thymus, this is TRUE - in periods of stress thymus may shrink to approx 40% of its size, while in recovery phase may grow back even larger. Thymus maximal weight in adolescence between 12 and 19 years (35 g) Fatty replacement starts at puberty and occurs more rapidly in males than females The thymus is seen as a triangular sail (thymic sail sign) frequently towards the right of the mediastinum Thymoma > 40 yr (70% present in 40s and 50s) Thymic hyperplasia is a differential for thymic mass - non neoplastic diffuse enlargement. Enlargement due to stress - rebound after chemo/steroids, burns, severe systemic stress * *LJS - did they mean thymus - false? * AJL - I was equally confused and have changed the question to Thymus. Question previously read: 23. Thymoma false a. Peaks mass by 10-15 b. Occurs in adolescence c. XR anterolateral bulge normal variant d. Decrease in size in stress

Answer 10

* LW: a. Acute MI - TRUE b. Chronic pericarditis - more commonly causes right sided failure and peripheral oedema than pulmonary oedema, so out of options listed, this is my preferred incorrect answer. c. Hydrocephalus - Rare but true (e.g. obstructed shunt) d. Massive PE - TRUE Causes of pulmonary oedema: 1) Hydrostatic edema - Cardiogenic edema: left-sided heart failure - Fluid overload: Renal failure - Pulmonary edema associated with acute asthma - Postobstructive pulmonary edema - Pulmonary edema associated with acute and chronic thromboembolism - Pulmonary edema associated with pulmonary venoocclusive disease - Near drowning 2) Permeability edema with diffuse alveolar damage (DAD) - Acute respiratory distress syndrome (ARDS) 3) Permeability edema without DAD - Opiate overdose edema - Transfusion-related lung injury (TRALI) - High-altitude pulmonary edema (HAPE) 4) Mixed edema: Both hydrostatic and permeability edema - Neurogenic pulmonary edema - Reexpansion pulmonary edema - Reperfusion edema - Edema following lung transplantation - Postpneumonectomy pulmonary edema

Answer 11

Normal cerebellar vermis, communicates with 4th V (but not cisterna magna), nearly always hydrocephalus WJI: in blakes pouch cyst will have normal vermis with sharp fastigial point but vermis is superiorly rotated with increased tegmentovermian angle. Vermian dysgenesis will have superior rotation with deficient vermis and loss of sharp fastigial point. DW shows findings of vermian dysgenesis with elevation of torcula. Mega cisterna magna and posterior fossa arachnoid cyst have normal vermis and tegmentovermian angle with enlarged cisterna magna.

Answer 12

a. INR <1.6 >50000 plt | * SCS I have added values to obscure the answer

Answer 13

b. Interstitial line positive in cornual pregnancy **LJS though depends, some people use "cornual pregnancy" to mean pregnancy in cornua of septate or unicornuate uterus. Can also be used to refer to ectopic pregnancy in cornua of uterus *LW: interstitial line sign: an echogenic line from the mass to the endometrial echo complex reportedly has high sensitivity (80%) and specificity (98%), for an interstitial ectopic, which shouldnt be used interchangable with cornual, as are separate per radiopedia (Robbins clumps them together). I think pain is most common sx

Answer 14

*LW: b. Symphysis pubis calcifications Likely inferring CPPD disease, as common cause for patellofemoral arthopathy in isolation, so see other areas of chondrocalcinosis **AJL - I added some other options to the question to help with learning. 'b' was the only original option. Feel free to edit.

Answer 15

a. Laryngocelel

Answer 16

**LJS true ``` Phaeo associations: VHL NF1 MEN2A and 2B (not MEN1) TS Sturge-Weber Carney syndrome - pulmonary chondroma, gastric leiomyosarcoma, pheo ``` *LW: Carney triad: 1) extra-adrenal paraganglioma (e.g. spinal paraganglioma) 2) gastric gastrointestinal stromal tumours (GIST) 3) pulmonary chondroma Carney syndrome: familial paraganglioma and gastric stromal sarcoma. *AJL (just to complete the Carneys...) Carney complex - Cardiac myxoma and skin pigmentation (blue naevi)