VIQ - Exam 1 Flashcards
@#e1 15. Malignant fibrous histiocytoma: (T/F)
a) Is the commonest soft tissue sarcoma in adults >45 years of age
b) Presents as a painless soft tissue mass
c) Rarely calcifies
d) Is most commonly found in a retroperitoneal location
e) Angiomatoid malignant fibrous histiocytoma is frequently seen in <20-year-olds
15.
a) True
b) True - imaging features of low signal on T1 /high signal on T2 with variable contrast enhancement
c) True
d) False - 75% are found in the extremities, lower limb > upper limb
e) True
@#e1 9. The following statements regarding splenic lymphoma are true: (T/F)
a) The spleen is involved at presentation in 30-40% of patients with non-Hodgkin’s lymphoma
b) Focal splenic deposits are usually well defined, round lesions of increased brightness on ultrasound
c) When there is lymphomatous involvement of the spleen, splenomegaly is seen in 70-80%
d) Splenic lymphoma deposits commonly calcify
e) Lymph nodes are seen in the splenic hilum in 50% of patients with Hodgkin’s lymphoma
9.
a) True - slightly higher for Hodgkin’s lymphoma
b) False - reduced echogenicity
c) False -50%
d) True
e) False - uncommon
@#e1 14. Regarding Budd-Chiari syndrome: (T/F)
a) It can be caused by obstruction of the suprahepatic IVC
b) On early CT images, the central liver enhances prominently and the peripheral liver weakly
c) The caudate lobe is markedly atrophic
d) On MRI images ‘comma-shaped’ intrahepatic collateral vessels are seen
f) A ‘spider’s web’ appearance at hepatic venography is characteristic
14.
a) True - this is primary obstruction. Secondary obstructions commoner and are due to thrombosis in hepatic veins
b) True - ‘flip-flop’ pattern. On late images the central liver has washed out and peripherally there is enhancement
c) False - caudate lobe is enlarged
d) True
e) True
@#e1 32.Where do gastrointestinal stromal tumours (GIST) most commonly arise?
(a) Esophagus
(b) Stomach
(c) Small intestine
(d) Colon
(e) Appendix
(b) Stomach
Approximately 60% arise in the stomach, 30% in the small bowel, 7% in the ano-rectal region and the remainder in the oesophagus and colon .
@#e1 QUESTION 5
A 25-year-old man presents with a tender right scrotum. Which one of the following statements best describes
the expected ultrasound findings in acute, uncomplicated epididymo-orchitis?
A A small atrophic right testis
B A well-defined testicular mass of mixed echogenicity that has a whorled appearance and reduced flow on colour
Doppler
C Multiple small (approx. 1 mm) echogenic foci scattered throughout the
D Patchy areas of increased echogenicity within the testis with reduced flow on colour Doppler
E Well-defined, patchy areas of decreased echogenicity within the right
E Well-defined, patchy areas of decreased echogenicity within the right
In the early phase of acute orchitis, there is oedema of the testis leading to swelling and diffuse low reflectivity
on ultrasound. The ultrasound appearances then evolve to increasingly well-defined areas of patchy low
reflectivity. Colour Doppler flow is typically increased within these areas of low reflectivity.
@#e1 (GU) QUESTION 15
A 29-year-old man has an IVU performed following an episode of haematuria. This demonstrates complete
right-sided ureteric duplication. Which one of the following statements is true?
A If present, an ectopic ureterocoele is usually related to the lower moiety
B The lower moiety ureter usually obstructs at the vesicoureteric junction.
C The upper moiety calyces are prone to vesicoureteric reflux.
D The upper moiety ureter is prone to ureteric obstruction.
E The upper moiety ureter usually inserts into the bladder superior to the lower moiety ureter
D The upper moiety ureter is prone to ureteric obstruction.
@#e1 (GU) QUESTION 30
Which one of the following radiological findings is a recognised feature of Von Hippel Lindau (VHL) disease?
A Bilateral adrenal masses that yield a high signal on T2w sequences
B Cerebral aneurysms on CT angiography
C Evidence of calcified subependymal nodules on CT head
D Polymicrogyria and corpus callosum agenesis on MRI brain
E Unenhanced CT head demonstrating a midline, hyperdense vermian mass abutting the roof of the 4th ventricle
A Bilateral adrenal masses that yield a high signal on T2w sequences
Phaeochromocytomas are hyperintense on T2w sequences and iso- or hypointense to the liver on Tlw sequences.
@#e1 QUESTION 34
A 68-year-old man is involved in a traffic accident and sustains a pelvic fracture, head and limb injuries.
Attempted urethral catheterisation in the Emergency Department is unsuccessful and a cystourethrogram is
requested to exclude urethral injuries. Regarding urethral injuries, which one of the following statements is
correct?
A Anterior urethral injury is more commonly due to iatrogenic or penetrating trauma than to blunt traiima.
B Cystography should precede a retrograde urethrogram in a patient with suspected urethral injury.
C In men, on digital rectal examination the prostate is lower than normal in patients with urethral trauma.
D Urethral injuries occur in 50% of major pelvic fractures.
E Urethral injury due to blunt trauma more commonly affects the penile urethra.
A Anterior urethral injury is more commonly due to iatrogenic or penetrating trauma than to blunt traiima.
@#e1 QUESTION 35
A 24-year-old motorcyclist is involved in a high-speed accident and is brought to the Emergency Department. He has abdominal guarding and is haemodynamically unstable. An ultrasound abdomen performed in the Emergency Department demonstrates free peritoneal fluid and a laparotomy is performed. In addition to liver and splenic lacerations, the surgeon finds a left retroperitoneal haematoma. Postoperatively, the on-call urologist requests a CT abdomen to assess the left renal injury. Which one of the following findings would indicate a Grade 4 renal laceration?
A Extravasation of contrast from the pelvicalyceal system on delayed phase (5 min) images
B Large (2-cm) subcapsular haematoma
C Perinephric haematoma that extends into the pararenal spaces
D Ill-defined low attenuation change in the lower pole renal cortex
E Segmental renal infarction
A Extravasation of contrast from the pelvicalyceal system on delayed phase (5 min) images
A deep renal laceration that extends into the collecting system is indicative of a grade 4 injury
@#e1 QUESTION 63
A 53-year-old man has an MRI of his pelvis as a staging investigation for bladder cancer. The request card also
states that the prostate is mildly enlarged on digital rectal examination and the serum prostate specific antigen
(PSA) level is borderline elevated. The reporting radiologist reviews the prostate in detail. Which one of the
following statements best describes the MRI findings of a normal prostate gland?
A On Tlw images, the central zone is of higher signal intensity than the peripheral zone.
B On Tlw images, the central zone is of lower signal intensity than the peripheral zone.
C On T2w images, the peripheral zone is of lower signal intensity than the central and transitional zones
D The peripheral zone is of higher signal intensity than the central zone on T2w images.
E The seminal vesicles are hypointense on T2w images.
D The peripheral zone is of higher signal intensity than the central zone on T2w images.
@#e2 31. Which of the following are correct regarding benign and malignant adrenal masses: (T/F)
(a) Chemical shift MR utilises T1 weighted sequences.
(b) Approximately one third of benign adenomas have HU of >10 on unenhanced CT.
(c) Adenomas tend to show delayed enhancement with IV contrast.
(d) Adenomas tend to show delayed clearance of IV contrast.
(e) Lesions >4cm tend to be malignant.
Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Adenomas (benign) show rapid enhancement and rapid washout of contrast media on post contrast study.
@#e2 A 60-year-old nulliparous woman presents with postmenopausal bleeding. On transvaginal ultrasound, her endometrium is 8 mm thick and the endomyometrial junction appeared indistinct. The radiologist suspects invasive endometrial cancer and refers her for an MRI examination. What are the likely findings on MRI?
A On unenhanced Tlw images the endometrial cancer appears of high signal intensity compared to the surrounding myometrium.
B On contrast-enhanced Tlw images, endometrial cancer shows avid enhancement compared with surrounding myometrium.
C On T2w images the normally high signal junctional zone is disrupted.
D Tlw fat-saturated sequences are best used to assess the junctional zone.
E The endometrial cancer demonstrates delayed/little enhancement compared to the normal surrounding myometrium on postcontrast Tlw images
E The endometrial cancer demonstrates delayed/little enhancement compared to the normal surrounding myometrium on postcontrast Tlw images
@#e2 QUESTION 79
A 28-year-old woman has a strong family history of breast cancer and is referred for an MRI examination of the breasts. Regarding MRI of the breast, which one of the following statements is correct?
A Breast MRI should be performed during the middle of the menstrual cycle to improve sensitivity.
B Malignant lesions tend to show poor enhancement following intravenous contrast, compared with surrounding breast tissue.
C MRI has a high sensitivity and specificity for the detection of invasive breast cancer.
D Post radiotherapy, abnormal enhancement patterns return to normal within 3—6 months.
E The patient is imaged in a supine position with the breasts placed in adedicated breast coil to improve signal to noise ratio.
D Post radiotherapy, abnormal enhancement patterns return to normal within 3—6 months.
Malignant breast lesions enhance postcontrast; however, normal hormonally active breast tissue can also enhance, particularly during the middle of the menstrual cycle (6th—17th days). In younger patients it may be helpful to repeat the scan earlier or later in the menstrual cycle to improve specificity
@#e2 28. Which of the following are correct regarding ovarian cancer: (T/F)
(a) It is the commonest gynaecological malignancy.
(b) It is associated with colorectal cancer.
(c) CA-125 is specific for ovarian cancer.
(d) CT only has a pre-operative staging accuracy of 50%.
(e) Doppler ultrasound may help with differentiating benign from malignant disease.
Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Endometrial cancer is the most common gynaecological malignancy. CA-125 is not specific for ovarian cancer, it is increased in benign conditions like fibroids, endometriosis and inflammatory pelvic disease. CT only has a pre-operative staging accuracy of 70% - 90%.
@#e1 13. Regarding endometriosis: (T/F)
a) Most commonly affects the fallopian tubes
b) 20% of infertile women are affected
c) Endometrioma is rarely anechoic on ultrasound
d) May present with pneumothorax
e) Cystic masses seen are typically hypointense on T1 weighted images
13.
a) False - 80% affects the ovaries
b) True
c) True - classically has diffuse low-level internal echoes
d) True
e) False - homogenously hyperintense on T1 weighted images
