VRU 2015

Question 1

Which modality has the lowest sensitivity, but highest specficity for detecting presence/absence of shoulder OC/OCD?

A) U/S
B) Radiographs
C) MRI
D) Arthroscopy

Answer 1

Answer = B

Rad: 88% SN, 90%SP
U/S: 92% SN, 60%SP
MRI: 96%SN, 89% SP

Question 2

True or False, odds of correct dx for shoulder OC/OCD are significantly higher for MRI compared to rads or U/S?

Answer 2

TRUE.

Odds of correct dx for MRI were ~3x higher than U/S & 2x higher than rads

Question 3

True or False, radiographic visualization of duodenal Peyer’s patches/pseudoulcers is uncommon?

Answer 3

FALSE

Common to see Peyer’s patches/pseudoulcers on rads

Question 4

When performing survey abdominal radiography, in what order should views be taken to increase the likelihood of gas presence within the duodenum?

A) Right lateral, left lateral
B) Left lateral right lateral
C) VD, right lateral
D) VD, left lateral

Answer 4

Answer = B

Dogs placed in LEFT LATERAL recumbency FIRST more likely to have duodenal gas (& larger volume of gas) on subsequent projections ​

Question 5

T or F, on computed tomography the prevalence of subclinical middle and external ear changes is significant?

Answer 5

True.

Prevalence rate of 12.5% of subclinical middle ear changes

~82% have external ear lesions & 20% have middle ear lesions

Question 6

What are 2 differential diagnoses for mineral attenuating “drum-stick” like hyperostoses within the tympanic bullae in dogs on CT?

Answer 6

Otoliths or hyperostotic tympanic bone spicules

20% Prevalence of hyperostotic tympanic bone spicules (HTBS)

Bilateral small tympanic bone spicules (pointed/clubbed tips) arising from free margin of the septum bullae in 100% necropsied dogs.

Spicules most likely due to physiological bone growth

Recommend using the terms “otolith(s)” or “otolithiasis” for stone-like mineral concretions of necrotic material within the bullae and “HTBS” for the stalked bony globular structures

Question 7

Which sex and age of dog are more likely to have eosinophilic bronchopneumopathy?

Answer 7

Young adult dogs, FEMALES > males

Question 8

What is the characteristic CT finding of eosinophilic pulmonary granulomatosis?

Answer 8

Multiple pulmonary masses with HONEYCOMB-LIKE ENHANCEMENT (hyperattenuating rims with central hypoattenuating regions)

Question 9

Which of the following is/are seen on CT of a dog with eosinophilic bronchopneumonopathy?

A) Pulmonary nodules
B) Bronchiectasis (cylindrical)
C) Peribronchial thickening & plugging
D) Pulmonary masses
E) Lymphadenopathy
F) All the above
G) B & C
H) A, B & C
I) A,B,C, E

Answer 9

Answer = I

Pulmonary parenchymal abnormalities (93%)- mostly peribronchial location & ground glass appearance, bronchial wall thickening (87%), bronchial plugging (73%), bronchiectasis (cylindrical) (60%), lymphadenopathy (67%); pulmonary nodules (33%) - 1 mass​

1 dog had a NORMAL CT

Question 10

Which modality/modalities have the HIGHEST ACCURACY for gender determination in lizards?

A) Ultrasound
B) Contrast CT
C) Contrast radiography
D) Noncontrast CT
E) Noncontrast radiography
F) B & C
G) D & E

Answer 10

Answer = F (contrast CT/radiography)

Diagnostic accuracy of hemipenes: contrast CT (100%) & contrast radiography (95%)​

POOR accuracy of U/S (64%) & non-contrast CT (63%)

Question 11

T or F, premedication with Fentanyl/Midaz vs Dexmed causes significant changes in heart rate and visibility of coronary artery anatomy on CT angiography?

Answer 11

FALSE.

No significant difference in heart rate or vessel visibility between different anesthetic protocols.

Mean BP HIGHER with Dexmed

Question 12

True or False: Nitroprusside has no significant effect on length/diameter of visualization of the coronary arteries but does causes profound hypotension.

Answer 12

True

Question 13

Using CEUS, what is the correct description of the U/S appearance of pancreatic insulinoma?

A) All nodules clearly hypoechoic post-contrast
B) Nodules more clearly demarcated postcontrast but have variable enhancement patterns
C) Nodules more clearly demarcated postcontrast and are hyperechoic
D) Nodules not clearly identified

Answer 13

Answer = B

Pancreatic nodules more clearly demarcated AFTER contrast, but 3 different enhancement patterns – markedly hyperechoic for 5s, slightly hyperechoic for 1s, & hypoechoic for > 30s​

Question 14

Pancreatic insulinomas are tumors of which cell type?

Answer 14

Beta cell tumors

Question 15

What percentage of hypercalcemic dogs have thyroid nodules on cervical U/S?

A) < 10%
B) 15%
C) 25%
D) > 25%

Answer 15

Answer = B

Question 16

A dog with hypercalcemia and no palpable cervical mass has a cervical U/S performed & a hypoechoic thyroid nodule is identified. What is the correct recommendation?

A) Recommend sampling as the nodule may be benign or malignant
B) Nodule should not be present and is therefore malignant - recommend surgery.
C) Nodule is likely benign nodular hyperplasia or a thyroid cyst - no further workup required.
D) Serial sonographic monitoring in 2-3 months to evaluate for progression.

Answer 16

Answer = A

Incidental thyroid nodules may be present in hypercalcemic dogs with no palpable neck mass & no C/S of thyroid disease; may nodules may be malignant therefore sampling recommended

Nodule diagnoses = thyroid cyst (33%), thyroid adenoma (33%), thyroid adenocarcinoma (22%), nodular hyperplasia (11%)​

U/S characteristics of thyroid adenoma, nodular hyperplasia & adenocarcinoma NOT distinctive ​

Question 17

T or F, many horses with ultrasonographic findings of septic arthritis or tenosynovitis have normal radiographs?

Answer 17

True

Only 1/23 horses had radiographic changes. Radiographic changes likely take 2-3 wks between onset of C/S and appearance on rads.

Question 18

Which of the following are common concomitant findings with uterus masculinus in male dogs?

A) Prostatomegaly & colonic distension
B) UTIs
C) UTIs & prostatomegaly
D) UTIs, prostatomegaly , & os penis agenesis

Answer 18

Answer = C

83% have prostatomegaly & 50% have UTIs
- os penis agenesis is possible but is UNCOMMON

Question 19

What is the embryological origin of uterus masculinus?

Answer 19

Remnant of paramesonephric duct system
Persistent Mullerian duct

Question 20

What is a characteristic finding associated with paragangliomas?

A) Strict intramedullary location
B) Hypervascularity leading to a T2W salt & pepper appearance
C) T1 & T2 hyperintense capsule
D) No evidence of vertebral invasion

Answer 20

Answer = B

In humans, hypervascularity results in punctuated areas of flow void, interspersed in a matrix of increased signal intensity caused by slow flow and tumor cells -> “salt and pepper” T2 appearance; characteristic of paragangliomas within head and neck, but also described in cauda equina lesions

Question 21

True or False, paragangliomas may have a T1/T2 hypointense capsule

Answer 21

True, hypointense capsule is suggestive of hemosiderin deposition

Question 22

Describe the appearance of a cauda equina paragnaglioma

Answer 22

well-defined, intramedullary lesion, T2 hyper, T1 hypo, T1 & T2 hypointense capsule (suggestive of hemosiderin), strongly enhancing, invading adjacent vertebral body & bilateral IV foramen infiltration

Intramedullary T2/T2 FLAIR hyperintense abnormalities can be in upper spinal cord segments due to edema or intramedullary cysts

hypervascularity results in punctuated areas of flow void, interspersed in a matrix of increased signal intensity caused by slow flow and tumor cells -> “salt and pepper” T2 appearance

Question 23

What are the 4 subgroups of paragangliomas based off anatomic location?

Answer 23

1) Branchiomeric - near aortic & carotid bodies
2) Intravagal - along vagus nerve
3) Aortico sympathetic - in retroperitoneum
4) Visceral autonomic - widely dispersed in thyroid, larynx, middle ear, intrathoracic region, GB, GIT, pancreas, prostate, & peripheral blood vessels

Question 24

Proliferative osseous lesions of the entire spine, more severe along the dorsal margins of the cervical/thoracic spine are seen in dog causing pseudoarthrosis of the spinous processes. What is the primary differential?

A) Diffuse idiopathic skeletal hyperostosis
B) Multiple cartilaginous exostoses
C) Hypervitaminosis A
D) Hepatozoonosis

Answer 24

Answer = A

Diffuse idiopathic skeletal hyperostosis should be suspected in any case of widespread extracortical, extra-articular ossification affecting entheses and soft tissues of the axial and/or appendicular skeleton

Question 25

Tumors can cause paraneoplastic HYPOglycemia by what 3 methods?

Answer 25

1) Tumors produce excess insulin (e.g. pancreatic insulinomas, ectopic insulin-producing masses)
2) Tumors infiltrate & destroy normal hepatic parenchyma
3) Tumors produce substances that interfere with glucose metabolism (e.g. cytokines, catecholamines, insulin-like growth factors)

Question 26

Which of the following is the best CT positioning for imaging the entire abdomen & specifically for the liver & UB?

A) Abdomen - Ventral recumbency; Liver/UB - ventral
B) Abdomen - Dorsal recumbency; Liver/UB - dorsal
C) Abdomen - Dorsal recumbency; Liver/UB - ventral
D) Abdomen - Ventral recumbency; Liver/UB - dorsal

Answer 26

Answer = C

For abdomen – DORSAL recumbency least displacement except for liver & UB​

Ventral recumbency preferred for liver & UB

Question 27

What is the best concentration of iodine for CT arthrography of the canine elbow?

A) 37.5 mg Iodine/mL
B) 150 mg Iodine/mL

Answer 27

Answer = A

Question 28

T or F, CT arthrography of the canine elbow joint slightly overestimates articular cartilage thickness compared to histopathology.

Answer 28

True

Question 29

On CT, a peripherally enhancing rim around an adrenal gland mass is associated with what & what is the relationship to the tumor grade?

A) Hemorrhage; high grade tumor
B) Hemorrhage; low grade tumor
C) Fibrous encapsulation; high grade tumor
D) Fibrous encapsulation; low grade tumor

Answer 29

Answer = D

Peripheral enhancing rim on delayed images associated with fibrous encapsulation (more frequent in LOW-GRADE tumors e.g. adenoma)

Question 30

On CT, heterogeneous delayed enhancement of an adrenal gland mass is associated with what?

Answer 30

Hemorrhage /infarction