WlwG Difficulties 2 Flashcards
1
Q
Lucent-Narrow: adult limbs/sacrum
A
GCT
2
Q
Mixed lucent/sclerosis/fibrous narrow: Fibrous, <20 year old (with pain/swelling)
A
Fibrous dysplasia (dysplasia, thus pain/swelling)
3
Q
Mixed lucent/sclerosis/fibrous narrow: Fibrous, >20 year old (with pain/swelling)
A
Myxofibrous tumour
4
Q
Mixed lucent/sclerosis/fibrous narrow: Rim sclerosis, <3cm, <20 year old (NO pain/swelling)
A
Focal cortical defect
5
Q
Sclerotic Narrow: 3 causes?
A
Morton’s neuroma, foot metatarsals
Ossifying fibroma, mandible and legs
Bone island/enostosis
6
Q
Diffuse lesions: Sclerotic
A
Myelofibrosis or Prostate/Urothelial mets (Lytic = MM, Sclerotic = Myelofibrosis, Mixed = Mastocytosis)
7
Q
Causes of raised: ACA
A
CREST sclerosis
8
Q
Soft tissue masses: T2-hyper, aggressive
A
Malignant Fibrous Histiocytoma aka Pleomorphic Sarcoma
9
Q
Soft tissue masses: Posterior chest wall
A
ElastoFibroma
10
Q
Metabolics: Location of Calcium hydroxyapatite deposition disease/Milwaukee
A
Supraspinatous, flexor carpi ulnaris, MCP
11
Q
Metabolics: Location of Alkaptonuria
A
Chondrocalcinosis with early heart and kidney failure
12
Q
Gaucher vs Sickle cell
A
Jew (Israel/America) with hepatosplenomegaly, osteopenia, pancytopenia: Gauchers
Sickle cell: Blacks
<5 year old = sequestration (blood pooling) causing splenomegaly, thus hypotension/cardiovascular collapse
> 5 year old = Splenic infarcts with autosplenectomy thus small calcified spleen
Systemic:
Hepatomegaly from iron deposition
Gallstones from calcium deposition
Anaemia, bone infarcts, extramedullary haematopoiesis
Cardiomegaly and sickle chest (consolidations)
(“Gaucher = Mainly organs, Thal = Mainly bones, Sickle cell = everything”)
13
Q
Wides: Adult, moth-eaten with soft tissue involvement
A
FibroSarcoma (aka fibrous histiocytoma)
14
Q
Wides: Adult, solitary punched out, bone erosion, soft tissue dense mass in elderly
A
Plasmacytoma
(Similar to MM but solitary)
15
Q
Inflammatory joint conditions: Small joint causes mnemonic
A
Small (ie MCPJ/PIPJ in hands)
“DSLR” = Dermatomyositis, Systemic sclerosis, Lupus, RA/JIA (RA both small and large)
Large (ie Axial skeleton, Sacroiliitis, Limbs
“RAPE” = RA/JIA, Reiters, AS, Psoriatic, Enteropathic
16
Q
Modic endplate changes Types 1-3 appearance on MRI
A
Modic endplate changes (MRI T1/T2): Type 1 (marrow oedema) = Low/High. Type 2 (fatty infiltration) = High/High. Type 3 (subchondral sclerosis) = Low/Low
17
Q
Spinal tumours: Cord, child, thoracic, T1-hypo
A
Astrocytoma
18
Q
Spinal tumours: Cord, adult, cervical, T1-hypo
A
Ependymoma
19
Q
Spinal tumours: Cord, adult/child, T1-hypo
A
HaemangioBlastoma
20
Q
Spinal tumours: Canal, T1-hypo, T2-hyper
A
Nerve sheath tumour/Schwannoma
21
Q
Spinal tumours: Thoracic, enhancing, T1/2-var
A
Meningioma
22
Q
Bleed: Epidural appearance
A
Biconvex, not crossing suture/falx/tentorium but can cross midline (as superficial), associated with skull fracture
23
Q
Bleed: Subdural
A
Crescent, crossing suture but not falx/tentorium
24
Q
Aneurysm at posterior circulation (small)
A
Fusiform aneurysm, from connective tissue disorders
25
Neuro enhancements: Intra-tentorial nodular in young
Pilocytic astrocytoma
26
Neuro enhancements: Multiple in basal ganglia with HIV
Toxoplasmosis
27
Neuro adult lesions: Cerebellar cyst with enhancing nodule
Haemangioblastoma (VHL)
28
Neuro child lesions: Intra-tentorial, homo enhancement, hydrocephalus, CT-hyper, no calcs
Medulloblastoma
(compare glioma/astrocytoma is CT-iso/hypo and with calcs)
29
Neuro child lesions: Cyst with enhancing nodule, focal
Pilocytic astrocytoma
(Compare medulloblastoma is CT-hyper. Compare diffuse midline glioma is diffuse)
30
Neuro child lesions: Brainstem with CN6/7 affected, CT-iso/hypo, calcs
Diffuse midline glioma/Pontine astrocytoma
(Compare medulloblastoma is CT-hyper. Compare pilocytic astrocytoma is focal)
31
Neuro lesions: Invades skull
HaemangioPeriCytoma
32
Neuro lesions: Cerebellum/roof 4th ventricle, CT-hyper
MedulloBlastoma (CT-hyper unlike astro, homo enhancement, midline cerebellum/4th vent with hydrocephalus)
33
Neuro lesions: Pituitary, T1-var-hyper, T2-hyper with T2-hypo central nodule, non-enhancing
Rathke cleft cyst
34
Neuro lesions: Pituitary, T1-hyper, after pregnancy
Sheehan/Apoplexy
35
Neuro lesions: Pituitary, T2-hypo during pregnancy
Autoimmune/lymphocytic hypophysitis
36
Neuro lesions: Craniopharyngioma vs pit adenoma
***
T1-var, T2-hyper: Adenoma (<1cm micro/functional, >1cm macro/non-functional but mass effect)
T1-hyper, T2-var solid-cystic with calcs, enhancing, CN palsy/headache/growth retardation: CranioPharyngioma
(Note: Suprasellar and calcs = Craniopharyngioma. Intra-sellar centered with pituitary fossa enlargement, no calcs = Macroadenoma)
37
Neuro child lesions: Child temporal lobe, cyst with nodule and dural tail
Pleomorphic XanthroAstrocytoma
38
Neuro lesions: Choroid plexus, Papilloma vs carcinoma vs xanthogranuloma
Papilloma = Unilateral, homogeneous enhancement
Carcinoma = Unilateral, heterogeneous enhancement, cystic/necrotic
Xanthogranuloma = Bilateral
39
Neuro lesions: Mnemonic for Adult tumours
"OLGGH” = Frontal Oligo, Peri-vent homogeneous lymphoma, Temporal GG, Cerebellar in adult Haemangioblast, Anywhere Astrocytoma/GBM (calcs/multi)
40
Neuro lesions: Mnemonic for Child temporal lobe
“GDPxa” = Pleomorphic XanthroAstrocytoma (nodulocystic with dural tail), GanglioGlioma (mixed cystic-solid/calcs) and DNET
DNET “DCBNET” = DNET, Child, Bubbly, Nodular-cystic, Epilepsy, Temporal lobe
41
Neuro lesions: Mnemonic for Infra-tentorial child
"TPM" = Teratoma (hetero enhancement), Pilocytic astro (solid-cystic nodular), MedulloBlast (homo enhancement)
42
MSK Injury name & stability: C1 compression from diving
Jefferson fracture, unstable
("Jefferson the diver")
43
MSK Injury name & stability: Tripod fracture components?
Zygomatico-frontal suture + posterior zygomatic arch + inferior orbital/lateral maxillary
44
MSK Injury name: Dorsal dislocation of 1st metacarpal
Bennett***
("Bend it/Bin it, thus bend thumb fracture")
(Compare Rolando with comminuted fracture "Roll on it")
45
MSK Injury name: Fracture of base of 1st proximal phalange, dx and ligament involved
Skier's thumb, Ulnar Collateral ligament involved***
(Compare Bennett/Rolando, fracture of 1st metacarpal)
46
MSK Injury name: Piriformis syndrome nerve involved
Sciatic nerve***
47
MSK Injury name: Transverse fracture of 5th metatarsal proximal shaft
Jones fracture
48
MSK Injury name: Dorsal dislocation of tarsometatarsal joint
Lisfranc
49
Salter Harris Mnemonic
S: Straight across / Separated growth plate
A: Above (ie metaphyseal)
L: Lower (ie epiphyseal)
T: Through (A + L)
E: Erasure of growth plate / merged growth plate
R: Reaction of periosteum
50
Many bone islands
Osteopoi-KILO-sis
51
Recurrent fractures, sclerotic bones
Osteopetrosis
52
Short with recurrent fractures
PyknoDysostosis
53
Shoulder Attachments: Teres major
Scapula to inter-tubercle groove humerus
54
Shoulder Attachments: Rotator cuff except subscapularis
Scapula to greater tubercle humerus
55
Shoulder Attachments: Subscapularis
Scapula to lesser tubercle humerus
56
Tendon involved in flat foot?
Posterior tibial tendon and spring ligament
57
Foot drop nerve?
Peroneal nerve
58
ACL insertions
ACL - Anteriomedial tibia plateau to lateral femoral condyle
PCL - posteriolateral tibia plateau to medial femoral condyle
59
Hill-sachs vs Bankart
Hill-sachs: Posterio-lateral humeral head depression fracture from anterior shoulder dislocation
Bankart: Anterio-inferior glenoid labrum from anterior shoulder dislocation
Reverse Bankart: Posterio-inferior glenoid labrum from posterior shoulder dislocation
60
Basal Ganglia: T1-hyper in putamen/thalamus
Wilsons, from copper
61
Basal Ganglia: T2-hyper in basal ganglia/brainstem in infant
Leighs
62
Toxic encephalopathies: Corpus collosum T2-hyper with seizures/AMS from alcohol/cirrhosis/TIPS
Marchiafava-Bignami syndrome
63
Toxic encephalopathies: Globus pallidus T2-hyper with headache, cerebral oedema, haemorrhages
Carbon monoxide (compare to thalamus/pons in alcoholic)
64
Toxic encephalopathies: Putamen T2-hyper with haemorrhages
Methanol
65
Toxic encephalopathies: Bilateral basal ganglia DWI/T2/Flair-hyper with dementia/psychosis
CJD
66
TORCHS organs involved?
“Organs affected from top to bottom:"
To/Toxoplasmosis = ventricles (hydrocephalus) & eyes
R/Rubella = eyes/ears/heart
C/CMV = liver/spleen
H/HSV2 = skin
S/Syphilis = premature and everywhere, lymph nodes
67
Paeds disorders: Dilated fronto-temporal cleft
SchizEncephaly
68
Paeds disorders: CranioSynostosis with closure of sagittal suture
Scaphocephaly ("Sagittal, Scaphocephaly")
COMMONEST craniosynostosis overall
69
Paeds disorders: CranioSynostosis with closure of coronal suture
Unilateral = plagiocephaly
Bilateral = brachycephaly
70
Neuro Basal Ganglia conditions by location: Mnemonic
From anterior to posterior: CLIT = Caudate, Lentiform, Insula, Thalamus, Midbrain, Pons, Medulla
("March my hall carbs & all her liver, we were far 'from' parking oddly, forget crying leh bae")
(Depository conditions are T1-hyper, rest are T2-hyper)
Caudate: T2 Marchiafava
Lent-Putamen: T2 Methanol
Lent-Globus Pallidus: T1 Haller, T2 CO
Insula: T2 ALS, Hepatic encephalopathy/liver, Unilateral Herpes
Thalamus: T1 Wilsons/Fahrs, T2 Wernicke-Korsakoff
Midbrain: T1 Parkinson
Pons: T2 Osmotic-demyelination/ODS
Whole BG: Infant T2 Leighs, Oro-genital T2 Behcets, Symmetrical T2 Cryptococcus, Dementia T2 CJD
71
Eye: Circumferential enhancement around optic nerve with linear bands of enhancement in adult
Optic nerve meningioma
72
Eye: Extra-ocular medial socket mass in child
RhabdoMyoSarcoma ("Lymphoma lateral, rhabdoMyosarcoma medial")
73
Eye: Extra-ocular lateral socket fatty mass in child
Dermoid
74
Eye: Extra-ocular lateral socket enhancing/diffusion restricted mass
Lymphoma ("Lymphoma lateral, rhabdoMyosarcoma medial")
75
Eye: Periorbital and surrounding optic nerve mass with proptosis
Neuroblastoma mets
76
Eye: Unilateral orbital muscle/lateral rectus thickening and inflamation, T2-hypo, not involving cavernous sinus
Orbital pseudo-tumour***
("Thickening, thus not real tumour")
77
Eye location vision: CN3
Down and out eye with ptosis and pupil dilation
78
Eye location vision: CN4
Cannot down and in (superior oblique, SOLAR)
79
Skull base/Nose: Olfactory groove/sphenoidal plane mass
Meningioma
80
Skull base/Nose: Heterogeneous enhancing mass at upper nose with bone erosion
Olfactory neuro-blastoma
81
Skull base/Nose: T1/T2-hypo bone lesion with enhancement and expansion
FibroDysplasia
82
Sinus: Involves ostium
Antrochoanal polyp
83
Skull base/Nose: Congenital obstruction in posterio-nose with breathing obstruction
Choanal atresia
84
Skull base/Nose: T2-hyper mass in maxillary sinus/nasal cavity
Sinonasal SCC
85
Skull base/Nose: Lateral nasal wall polypoid enhancing lesion with bony erosion
Inverted papilloma ***
86
Skull base/Nose: Sphenopalatine/pterygopalatine vascular mass with epistaxis in child
Juvenile angiofibroma
87
Sinus: Lesion with bone erosion
Inverted papilloma
88
Sinus: Enhancing T2-hyper aggressive and invasive lesion
Sinonasal SCC
89
Mouth/Pharynx: Aggressive enhancing mass with bone erosion
Oropharyngeal squamous cell ca / OPSCC, associated with HPV/smoking
90
Mandible/Maxilla: Round cyst in bone with dental infn
Odontogenic cyst
91
Mandible/Maxilla: Round cyst in bone with unerupted tooth
Dentigerous follicular cyst
92
Mandible/Maxilla: Soap bubble multilocular lucency in bone
Ameloblastoma (cementoma is opacity)
93
Mandible/Maxilla: Opacity with lucent surrounding halo at tooth root
Cementoma (ameloblastoma is lucency)
94
Mandible/Maxilla: Malformed tooth
Odontoma
95
Mandible/Maxilla: Multilocular painless bone lucency with scalloped margins
Giant cell granuloma
96
Mandible/Maxilla: Invasive lesion in child
Rhabdosarcoma
97
Mandible/Maxilla: Invasive lesion in adult
Chondrosarcoma
98
T2-extremely hyper with enhancement, US-hyper in infant/child
Infant haemangioma, associated with PHACES syndrome (posterior fossa, haemangioma, arterial anomaly, coarctation of aorta, eye anomaly, subglottic haemangioma).
99
Carotid space: Heterogeneous avid enhancement, T2-hyper mixed solid-cystic mass
Schwannoma, CN10 (NF homogeneous enhancement, Schwannoma heterogeneous enhancement)
100
Para-Pharyngeal space displacement: Anterio-medial
Parotid
101
Thyroid ca: Mets ++, ?I-131
Follicular, responsive
102
Thyroid ca: Post-RT, ?I-131
Anaplastic, unresponsive
103
Thyroid: T1/T2-hypo diffuse
Reidels Thyroiditis (fibrosis)
104
Salivary gland: T1/T2-var, heterogeneous enhancing solid-cystic mass in parotid, +/- calcs
Mucoepidermoid (Warthins is cystic +/- bilateral, pleomorphic is mixed lobulated mass with calcs and capsule)
Can be well or ill-defined.
105
Signs of aorto-iliac occlusion
Hip and thigh claudication, impotence, reduced femoral pulses. Ix arteriography.
106
Signs of abdominal aortic coarctation
<30 year old with HTN, claudication, abdominal angina, renal failure.
107
Signs of Paget-Schroetter syndrome
Upper limb DVT of axillary of subclavian VEIN due to repetitive shoulder sports, upper limb pain/swelling symptoms (“Page a SAD Sporter” = Subclavian/Axillary DVT in sports).
108
Signs of Subclavian steal syndrome
Subclavian artery occlusion with reversal of flow in vertebral artery. Results in dizziness/visual/motor/sensory changes, worst on neck movement. Tx angioplasty/stent.
109
Signs of Popliteal artery entrapment syndrome
In young athletes with cold feet/calf numbness/tingling. May also trap popliteal vein causing leg cramps/swelling. Due to gastrocnemius muscle abnormal positioning.
110
Signs of May Thurner
“LID” = Left common Iliac vein DVT from compression by right common iliac artery, thus swollen left leg +/- PE.
111
Vasculitis dx: Many nodular micro-aneurysms
PAN ("polyarthritis with nodules")
112
Vasculitis dx: Tiny vessel bleeds in lungs and kidney
MPA ("Micro-angiitis")
113
Vasculitis dx: Many holes in lungs, kidneys, nose
Wegeners/GPA ("Like Hitler")
114
Vasculitis dx: Glomerulonephritis + Pulmonary bleed + Anaemia
Goodpastures
115
Congenital heart: Wet, cyanotic causes
Fusions “T: TA TOGA TAP”
Truncus Arteriosus (“Artery trunk” so Aorta with PA, Mediastinum dilated)
TOGA (RV with Aorta, Upper heart dilated, egg)
TAPVC (“TAPV = RAPV”, so PV with RA instead of LA, Right heart dilated)
116
Congenital heart: Wet, acyanotic, causes
L2R shunt, septum “D: Defects”
PDA (Aorta dilated, machine murmur to left upper)
ECD/AVSD (“ASD + VSD” so All enlarged, Diastolic to left lower)
ASD (Right heart dilated,
split S2 to left upper)
VSD (Left heart dilated, systolic to left lower)
117
Congenital heart: Dry, cyanotic, right heart dilated
Ebsteins, large box heart
118
Congenital heart: Dry, cyanotic, causes
R2L shunt, valvE issues “E34”
Ebstein (Tricuspid defect with regurg, Right heart dilated, box)
TRIcuspid atresia (All dilated except small RV)
TETRAlogy (Lower heart dilated, boot)
119
Congenital heart: Dry, acyanotic, causes
Obstructions “S: Stenosis”
Coarc (Aorta dilated, 3 aorta sign)
PS (RV) AS (LV)
(Both mid-systolic to right upper)
120
Cardiomyopathy: LV thickened
HOCM and sarcoid CM
121
Cardiomyopathy: LV narrow dx and cause
Restrictive CM, amyloid/sarcoid
122
Cardiomyopathy: Calcified pericardium dx and cause
Constrictive CM, surgery/TB/radiation
123
Sus or benign: Grouped calcs
Suspicious
(“Be SusPiCious” = branching, segmental, pleomorphic, coarse”)
124
Sus or benign: Scattered distribution calcs
Benign (Fibrocystic change)
125
Male breast cancer dx
IDC
126
Bilateral breast cancer dx
ILC
127
Breast mass, no calcs, US posterior enhancement instead of shadowing dx
Medullary cancer
128
Slow growing mass with tubule formation dx
Tubular carcinoma
129
Heterogeneous fatty breast mass, well defined dx
Hamartoma
130
Encapsulated mass in 40-50 year old dx
Phyllodes
131
Organisms in bilateral pneumonia
Bronchopneumonia (Staph in adult, Haemophilis in child/immunocompromised)
132
Organisms in peri-bronchial or diffuse pneumonia
Viral (Influenza in adult, CMV in neonate/immunocompromised, Mycoplasma in autoimmune)
133
AIDS organisms: Lung with necrotic LN and effusion
Mycobacteria
134
Mnemonic for upper ILD
"Upper body, so Large space BREAASTS usually suck them silly"
("CDGGCDD")
LCH = Cyst/cav
Berrylosis = noD
RBILD = Ggo (“Rebuild the DIP pool while smoking without bros or honey”)
EAA = Ggo
AS = Cyst/cav
Aspergillosis/Sarcoid/TB = noD
Silly-cosis = opacities
135
Diffuse ILD: Mnemonic?
“COP DAALE”
("CDGGCCG")
COP = Cop noD-ggo
DIP = Ggo
Acutes = Ggo/consolidation
Alveolar batwing
LIP = Cyst/ggo
LAM = Cyst/cav
Eosinophilic = ggo/peripheral consolidation
136
Diffuse ILD: Cysts with pleural effusion +/- PTX
LAM (espc tuberous sclerosis)
137
Lower ILD: Mnemonic?
“A Lower Leg RUNSSS”
("CDGGG")
A1AT = Cysts/emphysema
RA = noD + Ggo/consolidation
UIP = HRCT
NSIP = Ggo (subpleural sparing)
Sclero = Ggo (NSIP + crest)
SLE = Sleffusion
aSbesStoSiS = Pleurals
138
Pneumonia relations: Young with autoimmune conditions (Stevens-Johnson, Haemolytic anaemia, meningoencephalitis)
Mycoplasma
139
Pneumonia relations: Cystic fibrosis
Salmonella or Pseudomonas
140
Pneumonia relations: Ventilator/ICU
Pseudomonas
141
Lung cancer: Lymphangitis carcinomatosis primary tumours?
Breast > GIT > Pancreas Ca
142
Tracheal conditions: Narrow trachea, no calcs, no thickening, prev intubation
TracheoBronchoMalacia
143
Tracheal conditions: Narrow trachea, Calcs, Thickening
TracheoBronchopathia OsteochondroPlastica (TBO)
144
Anterior Mediastinal Mass: Elevated AFP/bHCG/LDH
Non-Seminomatous Germ cell (ChorioCa/Yolk sac tumour)
145
Posterior Mediastinal Mass: Child
NeuroBlastoma
146
Posterior Mediastinal Mass: Round in teen/young adult
GanglioNeuroma
147
Paed lung lucencies: Segmental hyper-expanded lung
Bronchial atresia
148
Paed lung opacities: Bilateral small lungs with granular opacities in premature
RDS (aka Hyaline Membrane disease/HMD aka Surfactant Deficient Disease/SDD)
149
Paed lung opacities: Bilateral with complicated pregnancy
Pulmonary hypoplasia
150
Oesophageal Narrowing: Strictures with numerous outpouchings
Pseudo-diverticulosis
151
Oesophageal Narrowing: Multiple small ulcerations in immunocompromised
Herpes simplex ("H small")
152
Oesophageal Narrowing: Single large ulcer in immunocompromised
HIV/CMV ("H 1")
153
Oesophageal Narrowing: Low long stricture
Barretts (reflux oesophagitis)
154
Oesophageal Mass: Low oesophagus with calcs
Leiomyoma
155
Paeds Lower GIT: Dilated loops in distal ileum
Meconium ileus
156
Paeds Lower GIT: Dilated large bowel in Down's
Hirschsprung
157
Paeds Lower GIT: Dilated descending colon in DM
Meconium plug
158
Paeds Lower GIT: Perforations with pneumos in premature (pneumatosis/pneumoperitoneum)
NEC ("Necrotizing, thus NEonate, pNEumatosis, pNEumoperitonium")
159
Paeds GIT: What does VACTERL stand for?
Vertebra/Anal/Cardiac/Trachea/Esophageal fistula/Radius/Renal/Limbs
160
Signs of Crohns vs UC?
CrohnSSS: Skip lesion, String sign Small bowel, Stricture, Stones, Spondylitis, Sacroilitis, Sizeable LN
--> Several mucosa layers involved (Transmural) thus fistulas/abscesses.
-->Presents with abdo pain, no bloody diarrhoea.
--> Starts at terminal ileum
Ulcerative Colitis = Continuous Ulcers in the Colon and “all the -itis”.
-->Presents with bloody diarrhoea
--> Starts at rectum
161
Colon Ulcers/Colitis: Bloody diarrhoea
Entamoeba & UC
162
GIT: Causes of GI fistula
Divert & Crohns
163
Liver: Mass in <6 months old with raised endothelial growth factor
Infantile haemangioma
164
Liver: Mass in <5 year old with raised AFP
Hepatoblastoma
165
Liver: Mass in <5 year old with normal AFP
Mesenchymal hamartoma
166
Liver: Mass in 5-20 year old with raised AFP
Classic HCC (aka Hepatoma)
167
Liver: Solid-cystic mass in 5-20 year old
Embryonal sarcoma
168
Liver: Multiple liver masses in 5-20 year old
Mets from Neuroblastoma/Wilms
169
Liver:Hepatomegaly with small veins/IVC
Budd-chiari (DVT in pregnancy)
170
Liver: Hepatomegaly with normal veins/IVC following stem cell transplant
Hepatic Veno-Occlusive Disease (fibrosis of hepatic veins this normal size)
171
Liver: Sandstorm/multilocular cyst with wall calcs on US
Hydatid cyst
172
Liver MRI: Focal T1-hyper, T2-hypo, CT-hyper
Portal vein thrombosis
173
Liver MRI: Focal, T1-hypo, T2-hyper, enhancing
Haemangioma
174
Liver MRI: Focal, T1-hypo, T2-hyper, US-hyper
Haemangioma
175
Liver MRI: Focal, T1-hypo, T2-hyper, US-hypo
HCC
176
Liver MRI: T1/T2-hyper, US-hyper, focal
AML
177
Liver MRI: Multi-focal, T1-hypo, T2-hyper, enhancing
Haemangio-Endothelioma
178
Cause of intra-hepatic dilatation, cystic, polycystic kidneys
Carolis (“Caroline CCC = Congenital, Cholelithiasis, Cholangitis, Cystic-dilatation of Intra-hepatic Ducts”)
179
Cause of intra+extra hepatic dilatation, acute infection
E.coli/Kleb Cholangitis
180
Cause of intra+extra hepatic dilatation, recurrent infection, numerous stones
Clonorchis/Ascaris recurrent pyogenic cholangitis
181
Choledochal Cysts: Types 1-6 locations?
Type 1: CBD/extra-hepatic dilation (commonest type)
Type 2: CBD/extra-hepatic DIVERTICULUM
Type 3: Dilated extra-hepatic duct within duodenum (CHOLEDOCHOCELE)
Type 4: INTRA & EXTRA-HEPATIC duct dilation/cysts
Type 5: INTRA-HEPATIC duct dilation/cysts (i.e. Caroli disease with central dot sign)
Type 6: CYSTIC DUCT dilation
182
Pancreas: Chronic swelling with T1-hyper, T2-hypo
Cystic fibrosis
183
Pancreas: Child with pancreatic insufficiency
Schwachman-Diamond ("Short man PAEDS = Pancreatic insufficiency, Anaemia, Eczema, Diarrhoea, Short")
184
Pancreas: Small pancreas, PD dilatation, calcs
Chronic pancreatitis
185
Pancreas: Large pancreas, PD narrowing, no calcs
Auto-immune pancreatitis (increased IgG4 and ANA)
186
Pancreas Neoplastic: Solid in adult, hyper-enhancing
Islet cell (neuroendocrine tumour, eg insulinoma/gastrinoma)
187
Spleen: Focal US-hyper, CT-hypo, enhancing with delayed washout
Haemangioma
188
Spleen: Focal US-hyper, CT-hypo, heterogeneous enhancing
Hamartoma
189
Spleen: CT-hypo, poor enhancement
Angiosarcoma
190
Spleen: Sickle cell signs
<5 year old = sequestration (blood pooling) causing splenomegaly, thus hypotension/cardiovascular collapse
>5 year old = Splenic infarcts with autosplenectomy thus small calcified spleen
Systemic:
Hepatomegaly from iron deposition
Gallstones from calcium deposition
Anaemia, bone infarcts, extramedullary haematopoiesis
Cardiomegaly and sickle chest (consolidations)
191
Adrenal Neoplastic: T1-hyper
Myelolipoma (fatty)
192
Adrenal Neoplastic: Anechoic foci with enlarged spleen
Haemorrhagic (from trauma/sepsis/hypoxia)
If with meningitis = Waterhouse-Fridericksen
193
Peritoneum: Progression of mesenteric ischaemia and which is most worrying sign
Most worrying sign = Pneumoperitoneum/sepsis
SMA thrombus → bowel necrosis → Pneumatosis intestinalis/intra-mural bowel gas → Portal vein gas → Sepsis/Pneumoperitoneum → Death
194
Single solid in kidney cortex with calcs
Clear cell RCC
("Clear calcs, compare papillary pre renal")
195
Single solid in kidney cortex, prev renal transplant
Papillary RCC
("Papillary pre renal")
196
Single solid in renal pelvis/ureter
TCC
197
Cavitations/necrosis at renal papillae with linear streaky contrast filling
Renal papillary necrosis (lobster claw sign)
198
Paediatric kidney cystic: Dilated collecting ducts with calcs
Medullary sponge kidney
199
Paediatric kidney cystic: Multi-septated cysts in 3-5 year old
Multi-locular cystic nephroma
200
Bladder cystitis: Bacterial vs chronic vs emphysematous vs TB vs schistosomiasis signs?
Bacterial: Cobblestone mucosa with reduced bladder capacity (usually E.coli/staph/strep)
Chronic: May have cysts, due to prolonged reflux/divert/obstruction
Emphysematous: Gas in bladder wall in DM (E. coli)
TB: Small thick walled bladder with fibrosis
Schistosomiasis: Extensive calcs
201
Bladder cancer at anterior wall
Bladder/Urachal adenoCa
202
Bladder cancer at lateral walls
Squamous cell Ca (from Schistosomiasis/supra-pubic catheter, calcs ++
203
Bladder cancer in child
Rhabdomyosarcoma
204
Fracture of penis involves which layers?
Corpus cavernosa and tunica albuginea
205
Testes cancer: Adult, heterogeneous with bHCG, mets ++
ChorioCa
206
Testes cancer: Bilateral testes, peutz-jeghers
Sertoli cell
207
Testes cancer: Multiple/bilateral testes
Lymphoma
208
Cyst extending outside prostate, no urethra communication
Mullerian duct cyst
(Compare cyst communicating with prostatic urethra = Prostatic utricle cyst)
209
Cyst communicating with prostatic urethra
Prostatic utricle cyst
(Compare cyst extending outside prostate, no urethra communication = Mullerian duct cyst)
210
Gynae: Doppler flow ++ non-echoic structures in junctional zone/myometrium dx and cause?
AVM, from abortion/c-section/multiparity
211
Gynae: T1/T2-hyper mass in myometrium
LipoLeiomyoma (fatty fibroid)
212
Gynae: US-hyper mass in myometrium
LipoLeiomyoma (fatty fibroid)
213
Gynae: Similar to fibroid with internal necrosis and rapidly enlarging
LeiomyoSarcoma
214
Gynae: Appearance of bicornuate uterus & uterine horn angle?
Unicorn = 1 corn, Bicorn = 2 corn, 1 cervix, uterine horn angle >90 degrees
Septate uterus = Partial septum dividing uterus +/- cervix but not vagina (infertile), uterine horn angle <90 degrees
DiDelphine = 2 dolphins, thus 2 uterus, 2 cervix, 2 vagina
Arcuate = Apical only (fertile)
215
Gynae: Appearance of Didelphine uterus
DiDelphine = 2 dolphins, thus 2 uterus, 2 cervix, 2 vagina
Septate uterus = Partial septum dividing uterus +/- cervix but not vagina (infertile), uterine horn angle <90 degrees
Unicorn = 1 corn, Bicorn = 2 corn, 1 cervix, uterine horn angle >90 degrees
Arcuate = Apical only (fertile)
216
Ovary: T1-hyper, T2-hypo, non-fat-suppressed mass in ovary
Endometrioma (endometriosis in ovary)
217
Ovary: T1-hyper, T2-hypo, non-enhancing, non-doppler
Haemorrhagic cyst
218
Ovary: US-hyper myometrium mass 3 months after previous molar pregnancy, raised bHCG
ChorioCa
219
Obstetrics: Short femur, growth retardation, hydrops
Downs/Trisomy 21 (“Tri/321 CDEFGHI = Cardiac (ASD/VSD), Duodenal atresia, Echogenic bowel, Femur shortened, Growth retardation, Hydrops, Increased nuchal thickness”).
220
Obstetrics: Vascular malformation of placenta, pulsatile doppler
ChorioAngioma
221
Ovary: Multi-septated mass with pseudomyxoma peritonei (organ scalloping) in smoker
Mucinous CystAdenoCa
222
Generic Appearance: Fat
T1-hyper, CT-HYPO, PD hyper, IN-HIGH, out-low, Fat-suppressed hypo, US-var
223
Generic Appearance: Metal
T1-hyper, CT-HYPER, IN-LOW, out-high, Non-enhancing, T2-hypo (for calcium/wilsons/glycogen, NOT haemochromatosis)
224
Generic Appearance: Subacute blood/haemorrhagic
CT-hetero/hyper, US-hyper, T1-hyper
225
T1-hyper, T2-hyper, CT-hypo: Meaning and examples
Pure fat: Lipoma/AML/myelolipoma/lipoleiomyoma/liposarcoma (fat-suppressed hyper), adenoma (except pleomorphic adenoma), clear cell RCC, fatty regeneration nodule, craniopharyngioma
226
T1-hyper, T2-hypo, CT-hypo: Meaning and examples
(fatty with fibrosis/protein): Cystic fibrosis/germ cell/dermoid/teratoma/colloid, papillary RCC
227
T1-hyper, T2-hyper, CT-hyper, US-hyper: Meaning and examples
Bleeds/vascular: Bleeds, Bone/skull haemangiomas (high fat/fluid, not body haemangioma), Haemorrhagic mets in kidney/thyroid/carcinoid/chorioca
228
T1-hyper, T2-hypo, CT-hyper/hetero: Meaning and examples
Bleed/vascular with fibrosis/protein: Endometriosis, Haemorrhagic cyst
If GRE-hypo/contrast non-opacification also = thrombus
229
PD sequence in fat vs fluid vs cartilage/muscle differences
Hyper in Fat (T1-hyper) and fluid (T1-hypo). ("PDFF")
Cartilage/muscle hypo.
230
T2-hyper vs FLAIR differences and examples of FLAIR hyper/hypo
FLAIR = fluid-suppressed, thus T2 sequence minus fluid/CSF:
FLAIR-hyper: Bleed, Oedema, Epidermoid (T1-hypo, T2-hyper, compare Arachnoid cyst)
FLAIR-hypo: Fluid (Eg. CSF/Arachnoid cyst)
231
T1-hypo, T2-hyper, US-hyper: Meaning and examples
Vascular:
Peripheral fill-in enhancement to retaining (Haemangio-Endothelioma)
Very heterogeneously enhancing (Hamartoma)
Homogeneously enhancing (Haemangio-blastoma nodule, Body Haemangioma, notbone/skull haemangioma which are T1-hyper)
232
T1-hypo, T2-hypo, CT-hypo: Meaning and examples
Non-fatty Fibrosis: in Fibroid/Leiomyoma, Fibroma, Thecoma/Fibrothecoma
233
Examples ot T1/2 hypo, T1/2 normal and T1/2 hyper
T1 = T2: Both low in iron (and most fibrosis), both normal in cirrhosis/FNH, both high in fat (“Low iron, normal alcohol, high fat”)
234
US-hypo: Meaning and examples
US-Hypo +/- posterior enhancement (“loose in fluids/oedema”): Hypo in HCC, Anechoic in Cyst, Liquids eg Galactocoele, Medullary breast ca, gallbladder, urinary bladder
235
US-hyper: Meaning and examples
(“stiff in deposits”)
A = AML
B = Bleeds
C = Calcs
D = Deposits
E = mEts
F = Fat
G = Glycogen liver
H = Haems & Hams (HaemangioEndothelioma/Body haemangioma/hamartoma)
236
MRI appearance of brain bleed
(“1234 212 Both” = Hyper Iso-Bri, Acute T2 dark, Early sub T1-bright, Late sub T2-bright, Chronic both dark”) (“1234 IBID BaD BaBy DaD goodbye”):
<1 day hyperacute: T1-iso, T2-bright
2 days acute: T1-iso, T2-dark
>3 days early subacute: T1-bright, T2-dark
1-4 weeks late subacute: T1-bright, T2-bright
>4 weeks chronic T1-dark, T2-dark rim (may have bright center)
237
Mets: Intra-medullary spinal mets
GBK + LM (lung/melanoma)
238
Associations: Septic emboli + pharyngitis/tonsillitis
Lemierre's Syndrome
239
Associations: Kidney/adrenal + skin cafe spots + lung + CNS/eye/spine, plexiform neurofibroma
(all the SOLIDS, more PERIPHERAL) = NF1
240
Associations: Multiple meningiomas, schwanomas, ependymomas, bilateral acoustic neuromas, in brain and spine
(all the NEUROS, only CENTRAL) = NF2
“MMSE”
241
Comparison of Para-ganglioma vs Schwannoma vs Meningioma vs Neurofibroma on scans
All generally T1-hypo, T2-hyper, CT-hypo, enhancing.
Pheo/Para-ganglioma: Heterogeneous avid enhancement with FLOW VOIDS 'salt-and-pepper appearance'
Schwannoma: Heterogeneous avid enhancement with CYSTS ("Super avid enhancement, Cyst, Hetero")
Meningioma: HOMOgeneous enhancement with dural tail, calcs, non-invasive, T1-hypo-iso/T2-iso-hyper, CT-iso-hyper ("hoMogeneous Enhancement")
Neurofibroma: Poor heterogeneous enhancement with TARGET sign
242
Neuro Basal Ganglia conditions by location & mnemonic
From anterior to posterior: CLIT = Caudate, Lentiform, Insula, Thalamus, Midbrain, Pons, Medulla
("March my hall carbs & all her liver, we were far 'from' parking oddly, forget crying leh bae")
(Depository conditions are T1-hyper, rest are T2-hyper)
Caudate: T2 Marchiafava
Lent-Putamen: T2 Methanol
Lent-Globus Pallidus: T1 Haller, T2 CO
Insula: T2 ALS, Hepatic encephalopathy/liver, Unilateral Herpes
Thalamus: T1 Wilsons/Fahrs, T2 Wernicke-Korsakoff
Midbrain: T1 Parkinson
Pons: T2 Osmotic-demyelination/ODS
Whole BG: Infant T2 Leighs, Oro-genital T2 Behcets, Symmetrical T2 Cryptococcus, Dementia T2 CJD
243
Adrenals: Non-adrenal CT: 1-2 cm, no cancer history, >10HU on plain
12 month CT adrenal
All <1cm or non-enhancing = No further scan
1-4cm <10HU on plain = No follow up
Otherwise, 1-2 cm and no cancer history = 12 month CT adrenal
Otherwise = Early CT adrenal
244
Adrenals: Non-adrenal CT: 2+cm or >10HU on plain
Early CT adrenal
All <1cm or non-enhancing = No further scan
1-4cm <10HU on plain = No follow up
Otherwise, 1-2 cm and no cancer history = 12 month CT adrenal
Otherwise = Early CT adrenal
245
BIRADS: 3
Benign but 2 years of short-interval follow up (fibroadenoma/cluster of calcs, <2% chance of malignancy)
(“RNB 2BC Really normal but to be confirmed” = Repeat, Normal, Benign, 2 year F/U, Biopsy, Cancer)
246
NIRADS for post-treatment H&N cancer: When to do CT/PET?
CT neck and PET-CT at 3 months post treatment
CT neck and chest or PET-CT at 9 months post treatment (6 months after prior scan)
247
NIRADS for post-treatment H&N cancer: 2
Non-mass enhancement or LN +ve but no suspicious feature or mild avidity = 3 month CT follow up, consider PET
248
NIRADS for post-treatment H&N cancer: 3
Mass-like enhancement or LN with suspicious features or high avidity = Biopsy
249
Lung Fleischner nodules: Solid 9+mm
3 mth follow up or PET/CT or biopsy
250
Lung-Rads for cancer/cancer screen: Cat 3/4A meaning and management
251
Lung-Rads for cancer/cancer screen: Cat 4B/4X meaning and management
>15mm solid or >8mm solid component sub-solid or spiculation or LN +ve = PET-CT/biopsy
252
Liver LIRADS Mx: 1
LR1 = Routine follow up (completely benign eg cyst/haemangioma/scarring)
LR2 = 6 month follow up (atypical benign eg cirrhosis nodule)
LR3 = 3-6 month follow up (indeterminate)
LR NC (non-categorizable due to poor scan) = <3 month follow up
LR4 = Biopsy (suspicious)
LR5 = Treat (very suspicious)
253
Prostate PIRADS: 5, meaning and mangement?
P1 = normal/BPH
P2 (unlikely) = indeterminate
P3 (equivocal) = mild DR or T2-hypo -> Do Dynamic contrast enhancement (DCE): Type 3 curve ie EARLY enhancement is suspicious, hence upgrade to P4
P4 (suspicious) = moderate DR or T2-hypo, <1.5cm and no extra-prostatic extension
P5 (very suspicious) = P4 + >1.5 cm or extra-prostatic extension
Stage 2/Pirads 4 = within capsule, Stage 3/Pirads 5 = broken through capsule.
254
Kidney Bosniak meaning and management: 2F
(3+ cm, or 3+mm thick/4+ number enhancing septations) (“234”) = 6 months then yearly follow up
(“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)
255
Kidney Bosniak meaning and management: 3
(multi-loculated/complex septations/heavy calcifications) = Surgery
(“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)
256
Gallbladder Polyp Management: Management of 0-3 points
0 points = 0 follow up. 1 point = 1x/year f/u. 2 points = 2x/year f/u for first year (ie 6 monthly). 3 points = surgery.
257
Thyroid TIRADS: Mnemonic for management
(“Mnemonic = 1, 2, 2.5, 3, 4, 5, 6, 7”)
1: TR1 no follow up
2: TR2 no follow up
2.5: TR5 x 0.5 cm = follow up 5 years
3: TR4 x 1 cm = follow up 5 years
4: TR3 x 1.5 cm = follow up 5 years
5: TR5 x 1 cm = FNA
6: TR4 x 1.5 cm = FNA
7: TR3 x 2.5 cm = FNA
258
AAA Management: 3-3.9cm
3-3.9 cm = US every 2 years, conservative mx (smoking/HTN)
4-5.4 cm = US every 6-12 months, conservative mx (smoking/HTN)
5.5+cm = EVAR or surgical repair
Can consider repair if growing 0.5+ cm per 6 months
EVAR: Landing zone of >1cm length and <3.2cm wide (not dilated)
259
Aortic levels: T4, T5, T12-L5
T4: Aortic arch, Angle of louis
T5: Carina
T12: Coelac trunk
L1: SMA, D1
L2: Renal, D2, D4
L3: IMA
L4: Aortic bifurcation
L5: IVC bifurcation
260
Attachments: PSIS
Gluteus maximus
261
Attachments: PIIS
Superior gamelus
262
Attachments: Knee medial condyle
Adductor magnus
263
Attachments: Knee lateral condyle
Popliteus
264
Attachments: Base of thumb
Abd PL ("Eat Apple")
Compare base of 5th finger = "Easy promise = ECU")
265
Attachments: Base of 5th finger
"Easy promise = ECU"
Compare base of thumb = "Eat Apple = Abd PL
266
Attachments: Medial elbow epicondyle
Common flexors
267
Attachments: Lateral elbow epicondyle
Common extensors
268
Attachments: PSIS
Gluteus maximus
269
Attachments: PIIS
Superior gamelus
270
Attachments: Knee medial condyle
Adductor magnus
271
Attachments: Knee lateral condyle
Popliteus
272
Attachments: Base of thumb
Abd PL ("Eat Apple")
Compare base of 5th finger = "Easy promise = ECU")
273
Attachments: Base of 5th finger
"Easy promise = ECU"
Compare base of thumb = "Eat Apple = Abd PL
274
Attachments: Medial elbow epicondyle
Common flexors
275
Attachments: Lateral elbow epicondyle
Common extensors
276
ILD causes: Bronchiolitis related - Diffuse distribution
Diffuse distribution:
Pan-bronchiolitis = Haemophilus/Pseudomonas. Diffuse centrilobular tree-in-bud nodules, mosaic attenuation with expiratory air trapping, Thickened/dilated bronchi
Lower distribution:
Follicular Bronchiolitis = RA & Sjogren. Dilated bronchi, centrilobular GGO
277
Eye: Extra-conal lesions (x4)
(“Unilateral = Malformations/Mets, Bilateral = Thyroid eye”):
Orbital cavernous venous malformation: Well-defined T2-hyper benign vascular malformation in ADULT.
Orbital venous lymphatic malformation aka lymphangioma: Extra-conal cystic mass with haemorrhage in CHILD, T2-hyper.
Neuroblastoma mets: Periorbital/surrounding optic nerve mass causing PROPTOSIS and 'Raccoon eye' appearance.
278
Eye: Conal (aka muscular layer) lesions (x4):
RhabdoMyoSarcoma: Large SUPERIO-MEDIAL SOCKET malignant soft tissue mass in CHILD
(“RMS = Really malignant in medial socket”).
Dermoid: SUPERIO-LATERAL SOCKET benign FATTY mass in child.
Orbital lymphoma: Superio-lateral socket with homogeneous ENHANCEMENT and DR.
Orbital Pseudo-tumour: PAINFUL, unilateral extra-orbital muscle/LATERAL RECTUS thickening/inflm
- If involves cavernous sinus = Tolosa Hunt syndrome.
