Rock the boards Flashcards
what effect does RP fibrosis have on kidneys
bilateral ureteral obstruction
where does right pulmonary vein drain in scimitar syndrome
infracardiac
what cells does GIST arise from
interstitial cells of canal
what is another name for scrotal pearl
scrotolith
what are the 5P causes of Budd chiari
polycythemia vera, pills (OCP), pregnancy, PNH, platelets (thrombocytosis)
what intracranial conditions are associated with persistent trigeminal artery
aneurysms, CCF, moyamoya
what percent of post menopausal bleeding is due to endometrial polyp
30%
what value of Mo break thru is important - amount at administration or amount at time of elution? what is the half life of Mo?
amount at administration. half life is 67 hrs.
what are absolute CI for IV tPa therapy in stroke?
stroke more than 1/3 vascular territory, hemmorhage, endocarditis, CNS lesion with high propensity to bleed
what is the dose of CCK in HIDA and over what time is it given? what is dose of morphine given?
0.02 ug/kg over 60 mins. Morphine: 0.04mg/kg or 2 mg is dose of morphine over 2/3 mins.
how long do u need to stop breast feeding after bone scan with Tc 99 MDP? how long do u need to stop after FDG PET?
do not need to stop for Tc 99m MDP. stop for 6 hours after FDG PET
what is the max HU value to say something is a simple/b9 renal cyst?
10 HU
what are the findings of organoaxial vs mesentery axial gastric volvulus?
organoaxial: rotation along long axis of stomach, see greater creature “flipped over” lesser curvature, less pain. mesentery-axial: more common in kids, along short axis, see pylorus superior to funds - more risk of strangulation
where does the tip of a cecal volvus vs a sigmoid volvus point on X-ray?
cecal: tip to the LUQ, sigmoid: tip to the RUQ
what is the most common cause of a rectus sheath hematoma?
spontaneous due to anticoagulation
what are the US and MRI features of the parotid glands in Sjogrens?
US: enlarged, multiple cystic spaces, MRI: salt and pepper appearance
what is the most common extra testicular neoplasm?
adenomatoid tumor of the scrotum
what are cannonball lung mets?
multiple lung mets due to RCC, breast, thyroid, sarcoma, endometrial ca
Define connections in Fontan, Glenn, BT shunt
Fontan:right atrium to pulmonary trunk, Glenn: SVC to PA, BT shunt: subclavian a to PA
how do u manage a 4 mm lung nodule in a high risk patient? what is the age requirement in the Fleshier recs?
follow up CT at 12 months. applies to older than 35 yo
what is the rx for an aspergilloma?
nothing, unless it is bleeding then do bronchial a embolization, systemic anti fungal won’t help bc it has its own blood supply
what is the most common type of ccam?
type 1
what is the paraneoplastic syndrome associated with bronchial carcinoid
cushings (ACTH)
where does NB 4S go to? where does it NOT go to?
skin, liver, bone marrow. does NOT go to lungs in 4S.
how do u differentiate bone marrow mets vs bone cortical mets in a kid with NB?
do MIBG and bone scan - if only positive on MIBG then its bone marrow mets
what is the diff in invasion pattern of NB vs wilms?
Wilms displaces, NB encases
what is the projection used to map uterine artery for UAE?
45 degree oblique in the contralateral side (e.g. if u want to see right uterine artery, image 45 degrees LAO)
what is the rate and amount of contrast used for an IVC venogram
15cc per second for a total of 30 cc
what is the bleeding risk of a liver biopsy? what is the goal INR? what is the goal INR for placement of an IVC filter?
moderate risk of bleeding, want INR to be less than 1.5. for IVC filter want INR less than 2.0
what shape should the pectoralis have on the MLO view
convex
what are the MR imaging features of a fibroadenoma?
high T2 with non enhancing internal septations, persistent kinetics
is it the inner or outer diameter that is measured in a sheath vs catheter?
sheath: inner diameter, catheter: outer diameter
what is the conversion for french to diameter?
french = diameter in mm * 3
what are the absolute contraindications to hepatic Y90 therapy?
Lung shunt fraction more than 20 % or significant GI shunt - can cause pulm fibrosis or gastric ulceration
what is a terminal ventricle in the spine?
CSF filled cavity of conus
what syndromes is absent posterior pit associated with?
septo optic dysplasia, Joubert, hypoglycemia
what is the Rx of a PA pseudo aneurysm?
coil embo
what defines a massive PE? what is RV to LV enlargement defined as?
systemic hypotension less than 90mmHg, or a decrease in 40mmHg from baseline. RV:LV ratio greater than 0.9
what is the antidote for fentanyl? what is the antidote for midazolam?
naloxone (opiate antagonist), flumenazil (benzo antag)
what material causes a drop in IN PHASE on MRI?
iron deposition (e.g. in sickle cell, PNH, prosthetic valve)
where in the bone does a chondroblastoma arise?
epiphyses
which side of the elbow is affected in throwers (baseball) and which side is affected in tennis?
medial - baseball, lateral - tennis
what type of injury (values or varus) causes injury in baseball/overhead throwing? what does it cause?
valgus stress injury causes calcific tendinitis of the ulnar collateral ligament or avulsion of the medial epicondyle
what aspect of the patella is a bipartite fragment seen in? what percent is bilateral?
superolateral, 43 percent bilateral
what are the causes of pes planus?
PTT tear and spring ligament injury
what is hand schuller christian disease?
LCH with diabetes insipidus and lytic skull lesions
what is nail patella syndrome?
flaring of iliac wings, patella and nail hypoplasia
what is a persistent trigeminal artery?
connection btw cavernous ICA and basilar a
what is Fahr disease? what nuc med imaging shows uptake?
congenital disorder with calcification of the bilateral basal ganglia and in the cerebellar hemispheres, can be hot on PET
what is hyperostosis frontalis?
b9 overgrowth of inner table of frontal bones
what genetic syndrome are pilocytic astrocytomas associated with?
NF1
what is the most common shatzker type of tibial plateau fracture and how does it look?
type 1 - split and depression of the lateral tibial plateau
what is an absolute contraindication for PV embolization?
portal HTN
where does a left IVC drain into?
left renal vein to IVC proper
what is a type 3 endoleak? what is a type 1 endoleak?
due to separation of a graft component. type 1 is due to failure of distal or proximal component attachment
what entrance skin dose causes dry desquamation
14 Gy
what is osteopathic striata?
Voorgaven syndrome - sclerotic lines in long bones, related to bone growth, no lab abnormalities
what are common causes of chondrocalcinosis?
hyperPTH, wilsons, hemochromatosis, hypothyroid, trauma
what is tremors disease
dysplasia hemimelica - osteochondromas of the epiphyses
what type of calcium is deposited in calcific tendinosis?
calcium hydroxyapetite
what type of erosions are seen in erosive arthritis
central subchondral erosions -> gull wing deformity
what type of calcium is deposited in pseudo gout?
calcium pyrophosphate - positive befrignece
what is deposited in gout?
monosodium urate crystals
how do u diagnose triangular fibrocartilage tear on arthrogram of the wrist
should not see contrast in the distal radioulnar joint, mid carpal space, and radiocarpal spaces
what do u see in a perches lesion?
labrum stopped off periosteum of the glenoid with an associated osseous defect
what is the association btw length of septa, hole diameter, and sensitivity/resolution of a collimator?
short septa = high sensitivity, poor resolution. wide holes = high sensitivity, poor resolution
what effect does a pinhole collimator have on the image?
magnifies and inverts it
what is the threshold for non-uniformity of a gamma camera used for spect?
not more than 5 percent.
the reported dose from an ionization chamber should be what percent of actual dose?
must be within 5% of actual dose
what does CFR 19 deal with? 20? 35?
inspections (19), radiation protection (20), human use of radioisotopes(35)
how do u test for radionuclidic purity? how do u test for chemical purity?
testing for Mo breather - test with dose calibrator with a lead shield. chemical purity - with pH paper.
when should a woman start mammo screening if her mother got breast ca at 35?
a woman should start screening: 8 years after XRT, 10 years before first degree relative got it, but in either case not before the age of 25.
what is the pneumonic POST CARD? what happens when papilla slough off?
its the ddx of papillary necrosis: pyelo, obstruction, sickle cell, TB, cirrhosis, analgesics, RV thrombosis, DM. when papilla slough off they can cause filling defects in the ureter and obstruction.
for the US diagnosis of PCOS, how many follicles do u need and of what size
12 follicles 2-9 mm in size
what is ideal position of UAC catheter? what is the course of the UVC?
T6 to T10 or L3 to L4. Umbilical vein to left portal vein to ductus venosus to left hepatic vein to IVC
what is associated with cavernous in the brain?
dev venous anomaly, superficial siderosis
what percent of pituitary adenomas are hormonally active?
75%, most secrete prolactin
where are mycotic aneurysms located in the brain?
mostly peripheral
what percent of patients that get tPa bleed?
10%
what percent of patients with PE have a LE DVT?
70%
what is the diff btw strangulated and incarcerated hernia?
strangulated has no blood flow, both cannot be reduced
what part of the stomach does menetriers spare?
antrum
what are the abdominal manifestations of LAM?
LAD (can look like lymphoma), AMLs in the kidney, lymphangioma
what is pseudogynecomastia?
enlargement of the breast secondary to weight gain or obesity, no assocaited breast tissue increase/mass on mammo
which side of the TFC in the wrist is more easily repaired - ulnar or radial?
ulnar bc it is more vascular
what are the PET findings in primary progressive aphasia?
asymmetrically decreased activity in the left frontal, temporal, and parietal lobes
what type of sarcoma is associated with AML? where are they seen?
myeloid sarcoma AKA chloroma or granulocytic sarcoma. seen in brain, LN, peritoneum, skin, orbits, get LAD and hyper dense brain lesions
what is the most common location of GIST? what does presence of KIT indicate? what syndrome is GIST associated with?
duodenum. KIT indicates better prognosis. NF1.
what percent of patients with popliteal aneurysms have AAA?
50%
what muscles comprise the pes anserine?
Say Grace Before Tea - semitendinosis, gracilis, sartorial
what percent of fetuses have two vessel cord?
1%
what is the appearance of malakoplakia?
inflammatory condition that causes filling defects in the bladder with a flat border/cobblestone appearance
what is the most common b9 rib lesion?
FD
what is a common effect of XRT seen in the spine (more in kids).
scoliosis (often with films tumor)
what is the crista terminals? crista supraventricularis?
terminalis: in RA from mouth of SVC to mouth of IVC. crust supraventricularis: moderator band
what meds is brown fat blocked by?
diazepam and beta blockers, low carbs
what effect does oral hypoglycemic agent have on PET uptake?
causes bowel uptake but not too much muscle uptake
where do u see PET uptake after GCSF?
v intense spleen and bone marrow uptake - wait 3 to 5 days
what is the wall echo shadow complex?
hyper echoic wall, hypo echoic compressed GB lumen, hyperechoic stones - indicates GB full of stones NOT porcelain GB
what is porcelain GB? what is the mgmt?
calcified GB wall - remove bc of increased risk of ca
what does the GB wall look like when it is edematous?
thick, striated appearance
if u see cysts bigger than 10 mm in PVL, what is it highly predictive of?
cerebral palsy
what is meckel gruber
bilateral renal cysts, polydactyly, holopros
where does HIE affect a PT or FT neonate (what part of brain)?
basal ganglia and subcortical GM
what do the micro calcifications of papillary thyroid ca look like?
non shadowing
in a patient with HIV and GB wall thickening, what are two common causes?
CMV and crypto
what is dilated in tubular ectasia of testes?
cystic dilation of efferent ductules
what is the mgmt of a testicular epidermoid?
ennucleation
what are the two most common germ cell tumors of the testicle?
seminoma and mixed type
how do u tell the diff btw a stellar meningioma and pituitary tumor in terms of its effect on the vasculature?
meningioma encases and narrows, pituitary tumor encases without narrowing
what type of aneurysm causes lateral rectus palsy?
ICA aneurysm
what nerves do not exit the SOF
V2 (from f rotunda) and V3 (F oval)
what is the diff in mgmt for tonsillar access for edema?
drainage vs abx
where does EsthesioNB originate from? where does it extend into?
olfactory mucosa, and has peritumoral cysts, extends into anterior cranial fossa
what ligament is ruptured with a wide atlanto dental interval?
transverse ligament
what is the most sensitive sequence for meningitis
DWI
what type of HC does periventricular edema imply?
obstructive HV
which facial fx doesn’t involve the orbit?
le fort 1
what orbital walls does le fort 2 involve? le fort 3?
le fort 2: medial and inferior, lefort 3: lateral and medial
what fx does tripod/ZMC fx consist of?
lateral and inferior orbital walls
what is the enhancement pattern of fungal invasive sinusitis?
it does not enhance like the normal sinus mucosa (so lack of enhancement suggests this etiology)
which way does the ulna sublet (dorsal or ventral) in made lungs?
dorsal
what are causes of made lungs deformity
turners, trauma, olliers,
what is seen in primary vs secondary HPOA?
primary: tuft hypertrophy, secondary, acro-osteolysis
what is the effect on the spinal canal in bilateral spondylolysis?
widens the AP diameter of the canal
at what level does the thecal sac end?
S2/3
what type of dens fx has highest rate of non union?
type 2 (base of dens)
what is scheuermanns disease?
focal kyphosis, anterior wedging of the VB, schmorl nodes, endplate irregularity
what type of edema is seen in PRES?
vasogenic - loss of cerebral auto regulation
what is seen in whiplash injury?
mild T2 edema
what are the imaging features of a hyper flexion fx in the spine?
anterior compression fx, jumped or locked facets, interspinous distance wide, kyphosis
what is a mucocele?
expanded sinus secondary to chronic obstruction
what is the most symptomatic type of fibroid?
submucosal
what is the tx of bicornuate uterus? septet?
metroplasty, hysteroscopic resection for septate
at what phase of cycle should u do US to see uterus didelphys?
secretory (endometrium is thickest)
what is the ddx of starry sky liver on US
hepatitis, fibrosis, toxic shock syndrome, biliary/PV gas (it is mobile), lymphoma,
what is the “reverse target sign” seen on US that can be present with a hemangioma
inner hyPOechoic, outer hyPERechoic
what gender gets emphysematous cholecystitis? what is most common organism?
older DM men, E coli, see comet tail artifact , dirty shadowing
what is SPECT used for in the brain - tumor, epilepsy or dementia?
epi and dementia
what b9 mass can show FDG uptake in the brain?
pituitary adenoma (micro or macro)
what are the findings of TB in the testicle?
hypoechoic epic with no flow, normal flow in testicle, bilateral
what is the lower limit for velocity of TIPS occlusion?
0.5 m/s
what mets produce hyper echoic hepatic masses
mets - mucinous, kaposis, neuroendocrine mets
what is the ddx for a thick cystic endometrium
polyp, tamoxifen, GTD, endometrial cancer
what gestational age do u measure nuchal thickness? how much should it measure?
18-21 weeks, measure from PF to calvarium should not be more than 6 mm
what portends a good prognosis in omphalocele?
liver only herniation
what is the percent of CP cysts in fetus? what week should they resolve by?
1 %. should resolve by week 26.
what tumors do 10 percent of beckwith wideman kids get?
hepatoblastoma, wilms or NB
what is an airway condition in which u see bilateral echogenic lungs that are big
congenital high airway obstruction (CHAOS) - tracheal stenosis or atresia results in CHAOS
what is the most lethal in utero condition?
diffuse lymphangectasia, highly associated with turner and noonan. see a lot of pl fluid, marked skin thickening, cystic hygroma,
which trisomy is assoc with biliary atresia
18
what nerve and what artery travel thru the quadrilateral space
axillary n and posterior circumflex humeral a
what malignancies is limbic encephalitis assoc with?
small cell lung ca and testicular germ cell ca
in what patients does anaplastic large cell lymphoma of the breast occur?
ppl with silicone breast implants, don’t send the biopsy in formalin
in US guided breast biopsy, which has less incidence of hematoma: spring loaded or vacuum assisted biopsy? which has a smaller gauge?
spring loaded, spring has Smaller gauge
in a patient with nipple discharge, what is the diff in appearance on galactogram for DCIS vs papilloma?
DCIS: multiple filling defects, papilloma: one filling defect
what percent of warthins tumors are multi FOCAL (either ipsi or contralateral)
20%
what is a richter hernia
hernia in which only one wall of the bowel loop is involved
what percent of SMG lesions are malignant
45%
what is the most common location for a clavicular fx? what percent shows non-union?
middle third is most common, 5% non union rate
what is hemangiomas of the liver assoc with?
FNH and kasabach merrit (thrombocytopenia)
what percent of paragangliomas are multi centric in non familial conditions?
2-10 %. 50% in familial conditions.
what is NOT seen in MEN1? what is NOT seen in MEN2B?
MEN1: no pheo, MEN2B: no parathyroid adenoma
what is the max limit for endometrial thickness in a post menopausal woman that is not bleeding vs is bleeding?
8 mm, 5 mm
where does the IT band insert?
at gerdys tubercle in the anterolateral tibia
what is the thyroid nodule size limit for biopsy in the case of co-existing microcalcs vs coarse calcs?
with microcalcs: more than 1 cm, with coarse calcs: 1.5 cm
what diseases show abnormal DaT scan?
parkinsons, PSP, multi system atrophy
what is the most common ligament to tear with an inversion injury?
anterior talofibular
is grade 1 AC joint separation seen on normal radiographs? what view shows it?
only seen on stress views, with widening of the joint more than 3 mm
what fractures are associated with lisfranc ligament disruption?
fractures of the cuboid and navicular
in what type of coalition is the C sign seen on lateral X-ray
talocalcaneal
what is normal range of boehlers angle
20-40 degrees
where is the impaction in a reverse hill sachs fracture
anteromedial humeral head
what is the percent of pox in lung biopsies? what gauge needle do u use for a lung biopsy?
20-25%, use 20 gauge needle
where in the uterus is an interstitial ectopic located?
cornea of the uterus
what type of enhancement curve do u see in fibroadenoma
type 1
in birads lexicon for MRI, a focus is defined as less than what measurement?
less than 5 mm
what is the most common location for spondylolysis
95% at L5
does a just culture follow zero tolerance or no blame model
zero tolerance
what does a bar phantom test for a gamma camera test?
spatial resolution and linearity
what is the calculation for collimator resolution of a gamma camera?
FWHM
what are the agents used to test for brain death
Tc 99m HMPAO, Tc 99m ECD, Tc99m DTPA
within what time frame does a level one finding have to be reported? level 2?
level 1: 30-60 mins, level 2: 6-12 hours
which type of testicular torsion is associated with bell clapper deformity? more common in adults or infants?
intravaginal - more common in adults. extra vaginal involves twisting of spermatic cord proximal to the tunica vaginalis
what bone is spared in a zygomatic complex fx?
palatine bone
in ACR appropriateness criteria what is 1-3, 4-6 and 7-9?
1-3: usually not app, 4-6: may be app, 7-9: usually app
what is the most common cause of spontaneous peri-renal hemorrhage?
AML
what is the most common clinical symptom in males with breast cancer?
bloody nipple discharge
what is method used to eliminate truncation/gibbs artifact?
oversample the periphery of k space
what are the two nuc med tests used to diagnose neuroblastoma in a child
1-123 MIBG and Tc 99 MDP. Octreotide is not specific for NB
what is the recommendation for cessation of breast feeding after I-123 scan?
stop for 24 hours
what are the mammo findings after reduction mammoplasty?
nipple is elevated, retroareolar band of fibrotic tissue, residual breast tissue is shifted more inferiorly,
what is the most common cause of UPJ obstruction? UVJ obstruction?
UPJ: crossing vessel. UVJ: abnormally short ureter or abnormally angulated ureter into bladder
in duplicated IVC, where should both IVC filters be placed?
at or just below the renal vein ostia
what is the diagnosis if renal activity is seen on a gallium scan at 72 hours?
up to 24 hours renal activity is normal. if seen at 72 hours, its acute interstitial nephritis.
does gynecomastia have a relationship with risk for breast cancer?
no
what condition is relative contraindication to IV contrast?
myasthenia gravis
what is the total effective dose for a head ct/chest ct/abdo ct/pelvis?
head: 1-2 msV, chest, abdo: 5-7 mSv, pelvis: 3-4mSv
how much does an embryo get when a female undergoes an ado/pelvis ct?
30 mGy
what is the formula for effective mAs?
ratio of mAs to pitch
what is the ACR documented CTDI vol for head, abdo, and pelvis ct?
head: 75mGy, abdomen: 25mGy, pelvis: 20 mGy
what is the max rad for a “radiation” area, “high radiation” area, and “very high radiation” area?
radiation: 0.05 mSv/hr, high radiation: 1mSv/hr, very high radiation: 5 Gy/hr
what is the focal spot for mammo normal and mag views? what is the focal spot used in X-ray normal and mag views?
mammo: 0.3 mm and 0.1 mm. x ray: 06.mm and 1.2 mm
what are the occupational dose limits?
body: 50mSv, lens: 20mSv, organ or skin: 500 mSv, embyo: 0.5mSv
what are the lower and upper limits for TIPS malfunctioning? what are the other signs of TIPS malfunctioning?
less than 90 or more than 190. abnormal change in velocity more than 50 cm/s from prior, intrahepatic PV flow that becomes hepatopedal (RPV and LPV becoming hepatopedal is not normal), main portal vein velocity
what happens to SNR, dose, and temporal resolution if u decrease CT scan time by 1/2?
patient dose goes down by one half, SNR goes down by 70% (square root relationship), temporal resolution goes up by 2
what does air gap do to scatter and blur?
decreases scatter by increases magnification which increases blur
when is epi used, when is atropine used?
epic used for hypotension and tachycardia, atropine used for hypotension and bradycardia
what does air gap do to scatter and blur?
decreases scatter by increases magnification which increases blur. decrease scatter to detector causes automatic exposure to increase exposure rate -> increased dose to patient
when is epi used, when is atropine used?
epi used for hypotension and tachycardia, atropine used for hypotension and bradycardia
what two drugs does theophylline reverse?
adenosine and dipyramidole
what birads lesions does PQRS track?
birads 3 in screening patients (these are the lesions that require followup so these are tracked)
what false defect can u see on myocardial scan in a patient with LBBB? what agents can u use to “stress” these patients?
septal defect . can use adenosine, regadenosine, dipyramidole NOT dobutamine
what is the best parameter to change in order to reduce metallic artifact on CT from arthroplasty?
increase kV
what is the best parameter to change in order to reduce metallic artifact on CT from arthroplasty?
increase kVp
what is the Y90 treatment for unresectable HCC? for liver mets?
HCC: thera sphere. for mets: SIR
what effect do vitamin D and calcium have on breast density?
decrease
what is the most common cause of herpes encephalitis in adults?
HSV 1 (neonates is HSV 2)
what is the phi angle? what is the normal value?
the angle made by the long axis of the spine and the long axis of a gastric band should be btw 4-58 degrees
what happens to HVL and patient dose when u move from Al filter to Cu filter?
the HVL increases (bc the average energy increases - Cu takes away more low photons than Al) and the patient dose decreases
