VRU 2015 Flashcards
Which modality has the lowest sensitivity, but highest specificity for detecting presence/absence of shoulder OC/OCD?
A) U/S
B) Radiographs
C) MRI
D) Arthroscopy
Answer = B
Rad: 88% SN, 90%SP
U/S: 92% SN, 60%SP
MRI: 96%SN, 89% SP
True or False, odds of correct dx for shoulder OC/OCD are significantly higher for MRI compared to rads or U/S?
TRUE.
Odds of correct dx for MRI were ~3x higher than U/S & 2x higher than rads
True or False, radiographic visualization of duodenal Peyer’s patches/pseudoulcers is uncommon?
FALSE
Common to see Peyer’s patches/pseudoulcers on rads
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 = B
Dogs placed in LEFT LATERAL recumbency FIRST more likely to have duodenal gas (& larger volume of gas) on subsequent projections
T or F, on computed tomography the prevalence of subclinical middle and external ear changes is significant?
True.
Prevalence rate of 12.5% of subclinical middle ear changes
~82% have external ear lesions & 20% have middle ear lesions
What are 2 differential diagnoses for mineral attenuating “drum-stick” like hyperostoses within the tympanic bullae in dogs on CT?
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
Which sex and age of dog are more likely to have eosinophilic bronchopneumopathy?
Young adult dogs, FEMALES > males
What is the characteristic CT finding of eosinophilic pulmonary granulomatosis?
Multiple pulmonary masses with HONEYCOMB-LIKE ENHANCEMENT (hyperattenuating rims with central hypoattenuating regions)
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 = 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
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 = F (contrast CT/radiography)
Diagnostic accuracy of hemipenes: contrast CT (100%) & contrast radiography (95%)
POOR accuracy of U/S (64%) & non-contrast CT (63%)
T or F, premedication with Fentanyl/Midaz vs Dexmed causes significant changes in heart rate and visibility of coronary artery anatomy on CT angiography?
FALSE.
No significant difference in heart rate or vessel visibility between different anesthetic protocols.
Mean BP HIGHER with Dexmed
True or False: Nitroprusside has no significant effect on length/diameter of visualization of the coronary arteries but does causes profound hypotension.
True
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 = B
Pancreatic nodules more clearly demarcated AFTER contrast, but 3 different enhancement patterns – markedly hyperechoic for 5s, slightly hyperechoic for 1s, & hypoechoic for > 30s
Pancreatic insulinomas are tumors of which cell type?
Beta cell tumors
What percentage of hypercalcemic dogs have thyroid nodules on cervical U/S?
A) < 10%
B) 15%
C) 25%
D) > 25%
Answer = B
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 = 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
T or F, many horses with ultrasonographic findings of septic arthritis or tenosynovitis have normal radiographs?
True
Only 1/23 horses had radiographic changes. Radiographic changes likely take 2-3 wks between onset of C/S and appearance on rads.
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 = C
83% have prostatomegaly & 50% have UTIs
- os penis agenesis is possible but is UNCOMMON
What is the embryological origin of uterus masculinus?
Remnant of paramesonephric duct system
Persistent Mullerian duct
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 = 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
True or False, paragangliomas may have a T1/T2 hypointense capsule
True, hypointense capsule is suggestive of hemosiderin deposition
Describe the appearance of a cauda equina paragnaglioma
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
What are the 4 subgroups of paragangliomas based off anatomic location?
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
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 = 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
Tumors can cause paraneoplastic HYPOglycemia by what 3 methods?
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)
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 = C
For abdomen – DORSAL recumbency least displacement except for liver & UB
Ventral recumbency preferred for liver & UB
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 = A
T or F, CT arthrography of the canine elbow joint slightly overestimates articular cartilage thickness compared to histopathology.
True
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 = D
Peripheral enhancing rim on delayed images associated with fibrous encapsulation (more frequent in LOW-GRADE tumors e.g. adenoma)
On CT, heterogeneous delayed enhancement of an adrenal gland mass is associated with what?
Hemorrhage /infarction
A “golf tee” sign on MT myelography is suggestive of what?
An intradural extramedullary lesion