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Z Back up RD > RD radiodiagnosis 2018 march: formatted > Flashcards

RD radiodiagnosis 2018 march: formatted Flashcards

1
Q
  1. Clinodactyly enlarged finger
    a. Macrodystrophia
    b. Turners
    c. Mucopolysaccharidosis
    d. Marfans
A

Macrodystrophia
? localised gigantism with clinodactylyl

**LJS - correct.
Macrodystrophia lipomatosa - localised gigantism. One of the many associations with clinodactyly (curved finger, usually little finger)
Also T21 and other aneuploidy, plus many other syndromes (but none of the other answers that I can find)
Soft marker in isolation

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2
Q
  1. RUL consolidation with haemoptysis, chronic disease young person, tram track lucency, DSA
    a. Dilated eroded vessel
    b. Aneurysm
    c. Dissection
A

b. Aneurysm

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3
Q
  1. Bladder injury least likely on cystogram
    a. Extraperitoneal
    b. Intra
    c. Extra intra
    d. Interstitial injury
    e. Mucosal tear
A

e. Mucosal tear ?

**LJS - agree. Radiopedia has interstitial tear as serosal surface tear. But stat dx/papers say it is intramural/partial thickness tear with intact serosa

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

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4
Q
  1. Chest pain high on NECT
    a. IMH
    b. Dissection
    c. Other crap
A

a. IMH

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5
Q
  1. 60 well marginated

a. High grade IDC
b. Fibroadenoma
c. Cyst
d. Sebaceous
e. Mucinous

A

could be anything

probably Mucinous

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6
Q
  1. Liver lesion hypervascular hepatobiliary delayed normal other delayed abnormal

a. One is FNH
b. Other is Adenoma (q said low on opp phase)

A

FNH

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7
Q
  1. Sclerotic 50 year old vertebral test

a. Bone scan
b. MRI
c. XR
d. CT

A

a. Bone scan

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8
Q
  1. 2 year old not intersusseption

a. HSP
b. Crohns
c. Lymphoma
d. Meckels

A

**LJS - Crohns. Seems least likely in a 2yo. HSP, Meckels, lymphoma can act as lead points.

  1. 2 year old not intersusseption

a. HSP
b. Crohns
c. Lymphoma
d. Meckels

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9
Q
  1. High MCA in baby, rh +

a. Parovirus
b. Rhesus incomp
c. Normal
d. CPAM

A

**LJS - disagree.
Parvovirus - infects erythroid precursors = aplastic fetal anaemia

Assuming Q states mother is Rh+ve. Rhesus incompatability occurs in Rh -ve mothers.

*LW:
Agree with LJS…
Would depend on rhesus status in question wording, as high MCA Vmax diagnoses fetal anaemia for which parovirus and rhesus incompatability are causes.
Also, would assume rhesus status refers to mother, as although possible to ante natally test fetal blood group, it is difficult and risky with amniocentesis / expensive with latest blood tests (not readily available in NZ / fair game in Oz).

Previous
b. Rhesus incomp

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10
Q
  1. Nuchal 4mm in first trimester

a. Normal
b. High risk 20/70
c. Confirms T21
d. TV scan needed
e. Associated with cardiac abnormality

A

B. high risk 20/70

Risk of nuchael translucency vs chromosomal defects:
< 95th centile : 0.2%
95-99th centile : 3.7%

3.5- 4.4mm : 21%
4.5-5.4 mm : 33.3%
5.5 - 6.4 mm : 50%
> 6.5 : 64.5% .

19% fetal death.
46.5% major fetal anomaly. The results of the nuchal translucency scan will not be used alone to calculate the risk of a chromosomal abnormality. All your first trimester screening is combined to calculate your risk. The calculation based on the mother’s age, the nuchal translucency measurement of your baby, the gestational age of the baby, blood tests and the baby’s nasal bone.If your risk is less than 1 in 1000, you are considered low risk. If it is between 1 in 50 and 1 in 1000 you are considered intermediate risk. If it is greater than 1 in 50 you are considered high risk.If abnormal and screening test results show increased risk of less than 1 in 300, further workup may be carried out based on patient’s desire after counseling and which includes:amniocentesis and/or chorionic villus samplingfetal echocardiography

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11
Q
  1. Men breast cancer

a. IDC
b. ILC

A

a. IDC

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12
Q
  1. Men painful unilateral mass, lobulated posterior margin

a. Gynaecomastia

A

a. Gynaecomastia

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13
Q
  1. 3 cystic masses 40 female in neck, one in parotid 2 in neck, breast cancer

a. Sjogrens
b. HIV
c. Mets

A

*LW:
Unsure, in setting of breast cancer could represent multiple nodal mets, with parotid met / intra parotid nodal met.

Multiple parotid lesions can be due to Sjogren or HIV epithelial lesions, however, question states 2 lesions in neck, i.e. external to parotid, thus assuming nodes.

**LJS - HIV lymphoepithelial lesions often ass/w cervical lymphadenopathy. And given cystic ?most likely. Breast ca mets to parotid is extremely rare according to google. Radiopedia - mets to intraparotid nodes: melanoma, SCC, rarely testicular seminoma

***Combined preferred answer thus = HIV

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14
Q
  1. Mandibular unilocular with nodule

a. OKC
b. Dentigerous
c. Odontoma
d. Ameloblastoma

A

*LW:
Favoured answer is ameloblastoma.

**LJS agree - 20% unilocular and other things wouldn’t have solid component

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15
Q
  1. Weak muscle baby, no testis best next test

a. US renal
b. US testes
c. CXR
d. AXR

A
  • *LJS - renal USS. Hypotonia + undescended testes ?prune belly syndrome. Look for evidence of renal dysplasia to complete the triad
  • LW: As always, agree with LJS…. I think this question is going for next step idea such as ?prune belly, why else would they mention weak muscles…..

b. US testes

UltrasoundUltrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localisation of an undescended testis and is more accurate than clinical examination 4,5

.MRI
MRI is the best cross-sectional modality to assess crypto-orchidism (replacing CT). It has a higher sensitivity than ultrasound (~90%) and a higher specificity (100%) 6.

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16
Q
  1. Kid unilateral lack of chest wall muscle

a. Polands

A

a. Polands

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17
Q
  1. 2cm mass in brain

a. Amyloid angiopathy

A

*LW:
Amyloid - possible if described blooming sequence, however unlikely if isolated mass as amyloid antipathy usually multi focal.

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18
Q
  1. Old guy confused BG mass int T1 high T2 what age bleed

a. 3hr
b. Sub early
c. Late sub
d. Chronic >14

A

*LW: unsure if correct signal details recalled:

Per the spiral graph:
Immediate / hyper acute is T1 iso, T2 iso, although T2 can be slightly hyper intense, with a peripheral rim of hypo intensity. So probably this is correct answer based on details recalled.

Acute (1-2days) is T1 iso, Low T2.
Early sub acute (2-7days) is high T1, low T2.
Late sub acute (7 days - 28days) is high T1 high T2.
Chronic: progressively reduces T1 signal and then T2 signal becoming low T1 and low T2.

previous answer:
a. 3hr

19
Q
  1. Fibrous dysplasia, which is false

a. Mono less earlier than poly
b. Leontisis ossea extra
c. Spinal involvement 10%
d. Unilateral in mccune albright
e. No calc or ossification distinguish from other bony lesions

A

c. Spinal involvement 10%

  • *LJS:
    a. Mono less earlier than poly - not sure exactly what this means. Type of abn depends on when in embryogenesis mutation happened. Polyostotic syndromic occurs earlier than mono. If this is what is meant then correct.
    b. Leontisis ossea extra - leontiasis ossea is a monoostotic form of FD (no extracranial lesions)
    c. Spinal involvement 10% - rare in monoostotic, bottom of list of Robbins frequency in polyostotic. So could be true.
    d. Unilateral in mccune albright - true
    e. No calc or ossification distinguish from other bony lesions - ?true, inadequately mineralised bone
20
Q

brain lesion cyst with a nodule

A

scolex = neurocysticercosis

21
Q
  1. Not MEN 1

a. Phaeo

A

a. Phaeo

22
Q
  1. Skull base lesion eroding jugular foramen

a. Paraganglioma

A

ok

23
Q
  1. Wrong sticker put on request, that patient came up what question to ask
    a. What are you having
    b. Whats you name
    c. DOB
    d. Ward
    e. NHI
A

b. Whats you nameuhhh

**LJS - what study are you having? Presume if the incorrect patient sticker is on the request form and that patient is brought to dept, then the name on form will match what they say and won’t pick up the error. Clinical hx/study requested won’t match pt hx. Hope the pt isn’t confused!

This happened to me once. 1st year colon heaven and this poor outpatient did full bowel prep as they received a letter stating they should, and didn’t question it. Something tweaked when I spoke to the patient, called the referrer and it was wrong sticker/patient put on form in OP clinic. Ooops.

24
Q
  1. Child tracheomalacia
    a. Expiratory wheeze
    b. Wide trachea
    c. Ballooning hypopharynx
A
  • LW:
  • no mention of clinical wheeze, but reports expiratory stridor….
  • Collapsed trachea in AP diameter
  • No mention of ballooning hypo pharynx
  • *LJS - wide trachea in inspiratory CT (posterior bowing of membranous portion) and narrow cresentic in expiratory.
  • Wheeze seems unlikely since it’s upper airway problem = stridor if anything.
  • Ballooning occurs in croup
25
Q
  1. SVC obstruction enhancing structure right hilum
    a. Lymph node
    b. Azygous
    c. Tumor
A

c. Tumor

26
Q
  1. Antenatal echogenic lesion in right atrium
    a. Fibroma
    b. Rhabdomyoma
    c. Atrial myxoma
A

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

27
Q
  1. Vascular dilation proximal cavernous ICA
    a. Not clinically significant
    b. Urgent surgical referral due to risk of ICH
    c. Rupture may cause proptosis and vision loss
A

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]

28
Q

wells score

A

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

29
Q
  1. Reduce dose to baby in pregnancy
    a. Increase pitch
    b. Decrease MA
    c. Lead shielding to stomach
    d. Omit lateral scout
A

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

30
Q
  1. Question about DCIS appearances
    a. Calcification 1mm branching
    b. Mass like enhancement on MRI
A

a. Calcification 1mm branching

**LJS - non-masslike enhancement on MRI

31
Q
  1. Mammo screening fine calcification of different sizes

a. DCIS

A

a. DCIS

32
Q

pivot-shift injury : described

A

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

33
Q
  1. Male cholestasis bile duct not dilated

a. Anabolic steroid

A

a. Anabolic steroid

34
Q
  1. Discitis OM

a. Mimic modic 1

A

**LJS - true

35
Q
  1. Thymus false

a. Peaks mass by 10-15
b. Occurs in adolescence
c. XR anterolateral bulge normal variant
d. Decrease in size in stress

A

Answer - Decrease in size during stress - FALSE

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

36
Q
  1. Pulmonary oedema normal heart - false:

a. Acute MI
b. Chronic pericarditis
c. Hydrocephalus
d. Massive PE

A
  • 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

37
Q
  1. Blakes pouch

a. Normal vermis, normal post fossa, no bony expansion, large 4V
b. Variations eg enlarge post fossa = dandy walker, bony expansion = arachnoid cyst, vermian hypoplasia = dandy walker

A

Normal cerebellar vermis, communicates with 4th V (but not cisterna magna), nearly always hydrocephalus

38
Q
  1. Biopsy repeat

a. INR <1.6 >50000 plt

A

a. INR <1.6 >50000 plt

39
Q
  1. Pregnancy painless bleed

a. Previa
b. Acreta
c. Percreta
d. Abruption

A

a. Previa

40
Q
  1. Ectopic

a. Most common symptom is bleeding
b. Interstitial line positive in cornual pregnancy

A

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

41
Q
  1. Andes cyst with nodule

a. Cesticercosis

A

.

42
Q
  1. What other findings may be seen in a patient with patellofemoral arthropathy?

a. Periosteal reaction.
b. Symphysis pubis calcifications
c. T2 hyperintensity of the thigh muscles.
d. Renal mass

A

*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.

43
Q
  1. Air fluid level crossing thyrohyoid ligament

a. Laryngocelel
b. Tumor
c. Thyroglossal duct cyst

A

a. Laryngocelel

44
Q
  1. Phaeochromoscytoma

a. Carney

A

**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)

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