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WlwG Old > WlwG Difficulties 2 > Flashcards

WlwG Difficulties 2 Flashcards

1
Q

Lucent-Narrow: adult limbs/sacrum

A

GCT

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2
Q

Mixed lucent/sclerosis/fibrous narrow: Fibrous, <20 year old (with pain/swelling)

A

Fibrous dysplasia (dysplasia, thus pain/swelling)

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3
Q

Mixed lucent/sclerosis/fibrous narrow: Fibrous, >20 year old (with pain/swelling)

A

Myxofibrous tumour

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4
Q

Mixed lucent/sclerosis/fibrous narrow: Rim sclerosis, <3cm, <20 year old (NO pain/swelling)

A

Focal cortical defect

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5
Q

Sclerotic Narrow: 3 causes?

A

Morton’s neuroma, foot metatarsals
Ossifying fibroma, mandible and legs
Bone island/enostosis

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6
Q

Diffuse lesions: Sclerotic

A

Myelofibrosis or Prostate/Urothelial mets (Lytic = MM, Sclerotic = Myelofibrosis, Mixed = Mastocytosis)

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7
Q

Causes of raised: ACA

A

CREST sclerosis

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8
Q

Soft tissue masses: T2-hyper, aggressive

A

Malignant Fibrous Histiocytoma aka Pleomorphic Sarcoma

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9
Q

Soft tissue masses: Posterior chest wall

A

ElastoFibroma

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10
Q

Metabolics: Location of Calcium hydroxyapatite deposition disease/Milwaukee

A

Supraspinatous, flexor carpi ulnaris, MCP

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11
Q

Metabolics: Location of Alkaptonuria

A

Chondrocalcinosis with early heart and kidney failure

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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”)

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13
Q

Wides: Adult, moth-eaten with soft tissue involvement

A

FibroSarcoma (aka fibrous histiocytoma)

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14
Q

Wides: Adult, solitary punched out, bone erosion, soft tissue dense mass in elderly

A

Plasmacytoma
(Similar to MM but solitary)

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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

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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

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17
Q

Spinal tumours: Cord, child, thoracic, T1-hypo

A

Astrocytoma

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18
Q

Spinal tumours: Cord, adult, cervical, T1-hypo

A

Ependymoma

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19
Q

Spinal tumours: Cord, adult/child, T1-hypo

A

HaemangioBlastoma

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20
Q

Spinal tumours: Canal, T1-hypo, T2-hyper

A

Nerve sheath tumour/Schwannoma

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21
Q

Spinal tumours: Thoracic, enhancing, T1/2-var

A

Meningioma

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22
Q

Bleed: Epidural appearance

A

Biconvex, not crossing suture/falx/tentorium but can cross midline (as superficial), associated with skull fracture

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23
Q

Bleed: Subdural

A

Crescent, crossing suture but not falx/tentorium

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24
Q

Aneurysm at posterior circulation (small)

A

Fusiform aneurysm, from connective tissue disorders

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25
Q

Neuro enhancements: Intra-tentorial nodular in young

A

Pilocytic astrocytoma

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26
Q

Neuro enhancements: Multiple in basal ganglia with HIV

A

Toxoplasmosis

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27
Q

Neuro adult lesions: Cerebellar cyst with enhancing nodule

A

Haemangioblastoma (VHL)

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28
Q

Neuro child lesions: Intra-tentorial, homo enhancement, hydrocephalus, CT-hyper, no calcs

A

Medulloblastoma
(compare glioma/astrocytoma is CT-iso/hypo and with calcs)

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29
Q

Neuro child lesions: Cyst with enhancing nodule, focal

A

Pilocytic astrocytoma
(Compare medulloblastoma is CT-hyper. Compare diffuse midline glioma is diffuse)

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30
Q

Neuro child lesions: Brainstem with CN6/7 affected, CT-iso/hypo, calcs

A

Diffuse midline glioma/Pontine astrocytoma
(Compare medulloblastoma is CT-hyper. Compare pilocytic astrocytoma is focal)

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31
Q

Neuro lesions: Invades skull

A

HaemangioPeriCytoma

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32
Q

Neuro lesions: Cerebellum/roof 4th ventricle, CT-hyper

A

MedulloBlastoma (CT-hyper unlike astro, homo enhancement, midline cerebellum/4th vent with hydrocephalus)

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33
Q

Neuro lesions: Pituitary, T1-var-hyper, T2-hyper with T2-hypo central nodule, non-enhancing

A

Rathke cleft cyst

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34
Q

Neuro lesions: Pituitary, T1-hyper, after pregnancy

A

Sheehan/Apoplexy

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35
Q

Neuro lesions: Pituitary, T2-hypo during pregnancy

A

Autoimmune/lymphocytic hypophysitis

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36
Q

Neuro lesions: Craniopharyngioma vs pit adenoma

A

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)

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37
Q

Neuro child lesions: Child temporal lobe, cyst with nodule and dural tail

A

Pleomorphic XanthroAstrocytoma

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38
Q

Neuro lesions: Choroid plexus, Papilloma vs carcinoma vs xanthogranuloma

A

Papilloma = Unilateral, homogeneous enhancement
Carcinoma = Unilateral, heterogeneous enhancement, cystic/necrotic
Xanthogranuloma = Bilateral

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39
Q

Neuro lesions: Mnemonic for Adult tumours

A

“OLGGH” = Frontal Oligo, Peri-vent homogeneous lymphoma, Temporal GG, Cerebellar in adult Haemangioblast, Anywhere Astrocytoma/GBM (calcs/multi)

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40
Q

Neuro lesions: Mnemonic for Child temporal lobe

A

“GDPxa” = Pleomorphic XanthroAstrocytoma (nodulocystic with dural tail), GanglioGlioma (mixed cystic-solid/calcs) and DNET
DNET “DCBNET” = DNET, Child, Bubbly, Nodular-cystic, Epilepsy, Temporal lobe

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41
Q

Neuro lesions: Mnemonic for Infra-tentorial child

A

“TPM” = Teratoma (hetero enhancement), Pilocytic astro (solid-cystic nodular), MedulloBlast (homo enhancement)

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42
Q

MSK Injury name & stability: C1 compression from diving

A

Jefferson fracture, unstable
(“Jefferson the diver”)

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43
Q

MSK Injury name & stability: Tripod fracture components?

A

Zygomatico-frontal suture + posterior zygomatic arch + inferior orbital/lateral maxillary

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44
Q

MSK Injury name: Dorsal dislocation of 1st metacarpal

A

Bennett***
(“Bend it/Bin it, thus bend thumb fracture”)
(Compare Rolando with comminuted fracture “Roll on it”)

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45
Q

MSK Injury name: Fracture of base of 1st proximal phalange, dx and ligament involved

A

Skier’s thumb, Ulnar Collateral ligament involved***
(Compare Bennett/Rolando, fracture of 1st metacarpal)

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46
Q

MSK Injury name: Piriformis syndrome nerve involved

A

Sciatic nerve***

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47
Q

MSK Injury name: Transverse fracture of 5th metatarsal proximal shaft

A

Jones fracture

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48
Q

MSK Injury name: Dorsal dislocation of tarsometatarsal joint

A

Lisfranc

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49
Q

Salter Harris Mnemonic

A

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

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50
Q

Many bone islands

A

Osteopoi-KILO-sis

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51
Q

Recurrent fractures, sclerotic bones

A

Osteopetrosis

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52
Q

Short with recurrent fractures

A

PyknoDysostosis

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53
Q

Shoulder Attachments: Teres major

A

Scapula to inter-tubercle groove humerus

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54
Q

Shoulder Attachments: Rotator cuff except subscapularis

A

Scapula to greater tubercle humerus

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55
Q

Shoulder Attachments: Subscapularis

A

Scapula to lesser tubercle humerus

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56
Q

Tendon involved in flat foot?

A

Posterior tibial tendon and spring ligament

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57
Q

Foot drop nerve?

A

Peroneal nerve

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58
Q

ACL insertions

A

ACL - Anteriomedial tibia plateau to lateral femoral condyle
PCL - posteriolateral tibia plateau to medial femoral condyle

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59
Q

Hill-sachs vs Bankart

A

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

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60
Q

Basal Ganglia: T1-hyper in putamen/thalamus

A

Wilsons, from copper

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61
Q

Basal Ganglia: T2-hyper in basal ganglia/brainstem in infant

A

Leighs

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62
Q

Toxic encephalopathies: Corpus collosum T2-hyper with seizures/AMS from alcohol/cirrhosis/TIPS

A

Marchiafava-Bignami syndrome

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63
Q

Toxic encephalopathies: Globus pallidus T2-hyper with headache, cerebral oedema, haemorrhages

A

Carbon monoxide (compare to thalamus/pons in alcoholic)

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64
Q

Toxic encephalopathies: Putamen T2-hyper with haemorrhages

A

Methanol

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65
Q

Toxic encephalopathies: Bilateral basal ganglia DWI/T2/Flair-hyper with dementia/psychosis

A

CJD

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66
Q

TORCHS organs involved?

A

“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

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67
Q

Paeds disorders: Dilated fronto-temporal cleft

A

SchizEncephaly

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68
Q

Paeds disorders: CranioSynostosis with closure of sagittal suture

A

Scaphocephaly (“Sagittal, Scaphocephaly”)
COMMONEST craniosynostosis overall

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69
Q

Paeds disorders: CranioSynostosis with closure of coronal suture

A

Unilateral = plagiocephaly
Bilateral = brachycephaly

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70
Q

Neuro Basal Ganglia conditions by location: Mnemonic

A

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

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71
Q

Eye: Circumferential enhancement around optic nerve with linear bands of enhancement in adult

A

Optic nerve meningioma

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72
Q

Eye: Extra-ocular medial socket mass in child

A

RhabdoMyoSarcoma (“Lymphoma lateral, rhabdoMyosarcoma medial”)

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73
Q

Eye: Extra-ocular lateral socket fatty mass in child

A

Dermoid

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74
Q

Eye: Extra-ocular lateral socket enhancing/diffusion restricted mass

A

Lymphoma (“Lymphoma lateral, rhabdoMyosarcoma medial”)

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75
Q

Eye: Periorbital and surrounding optic nerve mass with proptosis

A

Neuroblastoma mets

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76
Q

Eye: Unilateral orbital muscle/lateral rectus thickening and inflamation, T2-hypo, not involving cavernous sinus

A

Orbital pseudo-tumour***
(“Thickening, thus not real tumour”)

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77
Q

Eye location vision: CN3

A

Down and out eye with ptosis and pupil dilation

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78
Q

Eye location vision: CN4

A

Cannot down and in (superior oblique, SOLAR)

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79
Q

Skull base/Nose: Olfactory groove/sphenoidal plane mass

A

Meningioma

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80
Q

Skull base/Nose: Heterogeneous enhancing mass at upper nose with bone erosion

A

Olfactory neuro-blastoma

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81
Q

Skull base/Nose: T1/T2-hypo bone lesion with enhancement and expansion

A

FibroDysplasia

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82
Q

Sinus: Involves ostium

A

Antrochoanal polyp

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83
Q

Skull base/Nose: Congenital obstruction in posterio-nose with breathing obstruction

A

Choanal atresia

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84
Q

Skull base/Nose: T2-hyper mass in maxillary sinus/nasal cavity

A

Sinonasal SCC

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85
Q

Skull base/Nose: Lateral nasal wall polypoid enhancing lesion with bony erosion

A

Inverted papilloma ***

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86
Q

Skull base/Nose: Sphenopalatine/pterygopalatine vascular mass with epistaxis in child

A

Juvenile angiofibroma

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87
Q

Sinus: Lesion with bone erosion

A

Inverted papilloma

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88
Q

Sinus: Enhancing T2-hyper aggressive and invasive lesion

A

Sinonasal SCC

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89
Q

Mouth/Pharynx: Aggressive enhancing mass with bone erosion

A

Oropharyngeal squamous cell ca / OPSCC, associated with HPV/smoking

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90
Q

Mandible/Maxilla: Round cyst in bone with dental infn

A

Odontogenic cyst

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91
Q

Mandible/Maxilla: Round cyst in bone with unerupted tooth

A

Dentigerous follicular cyst

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92
Q

Mandible/Maxilla: Soap bubble multilocular lucency in bone

A

Ameloblastoma (cementoma is opacity)

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93
Q

Mandible/Maxilla: Opacity with lucent surrounding halo at tooth root

A

Cementoma (ameloblastoma is lucency)

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94
Q

Mandible/Maxilla: Malformed tooth

A

Odontoma

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95
Q

Mandible/Maxilla: Multilocular painless bone lucency with scalloped margins

A

Giant cell granuloma

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96
Q

Mandible/Maxilla: Invasive lesion in child

A

Rhabdosarcoma

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97
Q

Mandible/Maxilla: Invasive lesion in adult

A

Chondrosarcoma

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98
Q

T2-extremely hyper with enhancement, US-hyper in infant/child

A

Infant haemangioma, associated with PHACES syndrome (posterior fossa, haemangioma, arterial anomaly, coarctation of aorta, eye anomaly, subglottic haemangioma).

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99
Q

Carotid space: Heterogeneous avid enhancement, T2-hyper mixed solid-cystic mass

A

Schwannoma, CN10 (NF homogeneous enhancement, Schwannoma heterogeneous enhancement)

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100
Q

Para-Pharyngeal space displacement: Anterio-medial

A

Parotid

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101
Q

Thyroid ca: Mets ++, ?I-131

A

Follicular, responsive

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102
Q

Thyroid ca: Post-RT, ?I-131

A

Anaplastic, unresponsive

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103
Q

Thyroid: T1/T2-hypo diffuse

A

Reidels Thyroiditis (fibrosis)

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104
Q

Salivary gland: T1/T2-var, heterogeneous enhancing solid-cystic mass in parotid, +/- calcs

A

Mucoepidermoid (Warthins is cystic +/- bilateral, pleomorphic is mixed lobulated mass with calcs and capsule)
Can be well or ill-defined.

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105
Q

Signs of aorto-iliac occlusion

A

Hip and thigh claudication, impotence, reduced femoral pulses. Ix arteriography.

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106
Q

Signs of abdominal aortic coarctation

A

<30 year old with HTN, claudication, abdominal angina, renal failure.

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107
Q

Signs of Paget-Schroetter syndrome

A

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).

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108
Q

Signs of Subclavian steal syndrome

A

Subclavian artery occlusion with reversal of flow in vertebral artery. Results in dizziness/visual/motor/sensory changes, worst on neck movement. Tx angioplasty/stent.

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109
Q

Signs of Popliteal artery entrapment syndrome

A

In young athletes with cold feet/calf numbness/tingling. May also trap popliteal vein causing leg cramps/swelling. Due to gastrocnemius muscle abnormal positioning.

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110
Q

Signs of May Thurner

A

“LID” = Left common Iliac vein DVT from compression by right common iliac artery, thus swollen left leg +/- PE.

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111
Q

Vasculitis dx: Many nodular micro-aneurysms

A

PAN (“polyarthritis with nodules”)

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112
Q

Vasculitis dx: Tiny vessel bleeds in lungs and kidney

A

MPA (“Micro-angiitis”)

113
Q

Vasculitis dx: Many holes in lungs, kidneys, nose

A

Wegeners/GPA (“Like Hitler”)

114
Q

Vasculitis dx: Glomerulonephritis + Pulmonary bleed + Anaemia

A

Goodpastures

115
Q

Congenital heart: Wet, cyanotic causes

A

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
Q

Congenital heart: Wet, acyanotic, causes

A

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
Q

Congenital heart: Dry, cyanotic, right heart dilated

A

Ebsteins, large box heart

118
Q

Congenital heart: Dry, cyanotic, causes

A

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
Q

Congenital heart: Dry, acyanotic, causes

A

Obstructions “S: Stenosis”

Coarc (Aorta dilated, 3 aorta sign)

PS (RV) AS (LV)
(Both mid-systolic to right upper)

120
Q

Cardiomyopathy: LV thickened

A

HOCM and sarcoid CM

121
Q

Cardiomyopathy: LV narrow dx and cause

A

Restrictive CM, amyloid/sarcoid

122
Q

Cardiomyopathy: Calcified pericardium dx and cause

A

Constrictive CM, surgery/TB/radiation

123
Q

Sus or benign: Grouped calcs

A

Suspicious
(“Be SusPiCious” = branching, segmental, pleomorphic, coarse”)

124
Q

Sus or benign: Scattered distribution calcs

A

Benign (Fibrocystic change)

125
Q

Male breast cancer dx

A

IDC

126
Q

Bilateral breast cancer dx

A

ILC

127
Q

Breast mass, no calcs, US posterior enhancement instead of shadowing dx

A

Medullary cancer

128
Q

Slow growing mass with tubule formation dx

A

Tubular carcinoma

129
Q

Heterogeneous fatty breast mass, well defined dx

A

Hamartoma

130
Q

Encapsulated mass in 40-50 year old dx

A

Phyllodes

131
Q

Organisms in bilateral pneumonia

A

Bronchopneumonia (Staph in adult, Haemophilis in child/immunocompromised)

132
Q

Organisms in peri-bronchial or diffuse pneumonia

A

Viral (Influenza in adult, CMV in neonate/immunocompromised, Mycoplasma in autoimmune)

133
Q

AIDS organisms: Lung with necrotic LN and effusion

A

Mycobacteria

134
Q

Mnemonic for upper ILD

A

“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
Q

Diffuse ILD: Mnemonic?

A

“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
Q

Diffuse ILD: Cysts with pleural effusion +/- PTX

A

LAM (espc tuberous sclerosis)

137
Q

Lower ILD: Mnemonic?

A

“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
Q

Pneumonia relations: Young with autoimmune conditions (Stevens-Johnson, Haemolytic anaemia, meningoencephalitis)

A

Mycoplasma

139
Q

Pneumonia relations: Cystic fibrosis

A

Salmonella or Pseudomonas

140
Q

Pneumonia relations: Ventilator/ICU

A

Pseudomonas

141
Q

Lung cancer: Lymphangitis carcinomatosis primary tumours?

A

Breast > GIT > Pancreas Ca

142
Q

Tracheal conditions: Narrow trachea, no calcs, no thickening, prev intubation

A

TracheoBronchoMalacia

143
Q

Tracheal conditions: Narrow trachea, Calcs, Thickening

A

TracheoBronchopathia OsteochondroPlastica (TBO)

144
Q

Anterior Mediastinal Mass: Elevated AFP/bHCG/LDH

A

Non-Seminomatous Germ cell (ChorioCa/Yolk sac tumour)

145
Q

Posterior Mediastinal Mass: Child

A

NeuroBlastoma

146
Q

Posterior Mediastinal Mass: Round in teen/young adult

A

GanglioNeuroma

147
Q

Paed lung lucencies: Segmental hyper-expanded lung

A

Bronchial atresia

148
Q

Paed lung opacities: Bilateral small lungs with granular opacities in premature

A

RDS (aka Hyaline Membrane disease/HMD aka Surfactant Deficient Disease/SDD)

149
Q

Paed lung opacities: Bilateral with complicated pregnancy

A

Pulmonary hypoplasia

150
Q

Oesophageal Narrowing: Strictures with numerous outpouchings

A

Pseudo-diverticulosis

151
Q

Oesophageal Narrowing: Multiple small ulcerations in immunocompromised

A

Herpes simplex (“H small”)

152
Q

Oesophageal Narrowing: Single large ulcer in immunocompromised

A

HIV/CMV (“H 1”)

153
Q

Oesophageal Narrowing: Low long stricture

A

Barretts (reflux oesophagitis)

154
Q

Oesophageal Mass: Low oesophagus with calcs

A

Leiomyoma

155
Q

Paeds Lower GIT: Dilated loops in distal ileum

A

Meconium ileus

156
Q

Paeds Lower GIT: Dilated large bowel in Down’s

A

Hirschsprung

157
Q

Paeds Lower GIT: Dilated descending colon in DM

A

Meconium plug

158
Q

Paeds Lower GIT: Perforations with pneumos in premature (pneumatosis/pneumoperitoneum)

A

NEC (“Necrotizing, thus NEonate, pNEumatosis, pNEumoperitonium”)

159
Q

Paeds GIT: What does VACTERL stand for?

A

Vertebra/Anal/Cardiac/Trachea/Esophageal fistula/Radius/Renal/Limbs

160
Q

Signs of Crohns vs UC?

A

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
Q

Colon Ulcers/Colitis: Bloody diarrhoea

A

Entamoeba & UC

162
Q

GIT: Causes of GI fistula

A

Divert & Crohns

163
Q

Liver: Mass in <6 months old with raised endothelial growth factor

A

Infantile haemangioma

164
Q

Liver: Mass in <5 year old with raised AFP

A

Hepatoblastoma

165
Q

Liver: Mass in <5 year old with normal AFP

A

Mesenchymal hamartoma

166
Q

Liver: Mass in 5-20 year old with raised AFP

A

Classic HCC (aka Hepatoma)

167
Q

Liver: Solid-cystic mass in 5-20 year old

A

Embryonal sarcoma

168
Q

Liver: Multiple liver masses in 5-20 year old

A

Mets from Neuroblastoma/Wilms

169
Q

Liver:Hepatomegaly with small veins/IVC

A

Budd-chiari (DVT in pregnancy)

170
Q

Liver: Hepatomegaly with normal veins/IVC following stem cell transplant

A

Hepatic Veno-Occlusive Disease (fibrosis of hepatic veins this normal size)

171
Q

Liver: Sandstorm/multilocular cyst with wall calcs on US

A

Hydatid cyst

172
Q

Liver MRI: Focal T1-hyper, T2-hypo, CT-hyper

A

Portal vein thrombosis

173
Q

Liver MRI: Focal, T1-hypo, T2-hyper, enhancing

A

Haemangioma

174
Q

Liver MRI: Focal, T1-hypo, T2-hyper, US-hyper

A

Haemangioma

175
Q

Liver MRI: Focal, T1-hypo, T2-hyper, US-hypo

A

HCC

176
Q

Liver MRI: T1/T2-hyper, US-hyper, focal

A

AML

177
Q

Liver MRI: Multi-focal, T1-hypo, T2-hyper, enhancing

A

Haemangio-Endothelioma

178
Q

Cause of intra-hepatic dilatation, cystic, polycystic kidneys

A

Carolis (“Caroline CCC = Congenital, Cholelithiasis, Cholangitis, Cystic-dilatation of Intra-hepatic Ducts”)

179
Q

Cause of intra+extra hepatic dilatation, acute infection

A

E.coli/Kleb Cholangitis

180
Q

Cause of intra+extra hepatic dilatation, recurrent infection, numerous stones

A

Clonorchis/Ascaris recurrent pyogenic cholangitis

181
Q

Choledochal Cysts: Types 1-6 locations?

A

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
Q

Pancreas: Chronic swelling with T1-hyper, T2-hypo

A

Cystic fibrosis

183
Q

Pancreas: Child with pancreatic insufficiency

A

Schwachman-Diamond (“Short man PAEDS = Pancreatic insufficiency, Anaemia, Eczema, Diarrhoea, Short”)

184
Q

Pancreas: Small pancreas, PD dilatation, calcs

A

Chronic pancreatitis

185
Q

Pancreas: Large pancreas, PD narrowing, no calcs

A

Auto-immune pancreatitis (increased IgG4 and ANA)

186
Q

Pancreas Neoplastic: Solid in adult, hyper-enhancing

A

Islet cell (neuroendocrine tumour, eg insulinoma/gastrinoma)

187
Q

Spleen: Focal US-hyper, CT-hypo, enhancing with delayed washout

A

Haemangioma

188
Q

Spleen: Focal US-hyper, CT-hypo, heterogeneous enhancing

A

Hamartoma

189
Q

Spleen: CT-hypo, poor enhancement

A

Angiosarcoma

190
Q

Spleen: Sickle cell signs

A

<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
Q

Adrenal Neoplastic: T1-hyper

A

Myelolipoma (fatty)

192
Q

Adrenal Neoplastic: Anechoic foci with enlarged spleen

A

Haemorrhagic (from trauma/sepsis/hypoxia)

If with meningitis = Waterhouse-Fridericksen

193
Q

Peritoneum: Progression of mesenteric ischaemia and which is most worrying sign

A

Most worrying sign = Pneumoperitoneum/sepsis

SMA thrombus → bowel necrosis → Pneumatosis intestinalis/intra-mural bowel gas → Portal vein gas → Sepsis/Pneumoperitoneum → Death

194
Q

Single solid in kidney cortex with calcs

A

Clear cell RCC
(“Clear calcs, compare papillary pre renal”)

195
Q

Single solid in kidney cortex, prev renal transplant

A

Papillary RCC
(“Papillary pre renal”)

196
Q

Single solid in renal pelvis/ureter

A

TCC

197
Q

Cavitations/necrosis at renal papillae with linear streaky contrast filling

A

Renal papillary necrosis (lobster claw sign)

198
Q

Paediatric kidney cystic: Dilated collecting ducts with calcs

A

Medullary sponge kidney

199
Q

Paediatric kidney cystic: Multi-septated cysts in 3-5 year old

A

Multi-locular cystic nephroma

200
Q

Bladder cystitis: Bacterial vs chronic vs emphysematous vs TB vs schistosomiasis signs?

A

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
Q

Bladder cancer at anterior wall

A

Bladder/Urachal adenoCa

202
Q

Bladder cancer at lateral walls

A

Squamous cell Ca (from Schistosomiasis/supra-pubic catheter, calcs ++

203
Q

Bladder cancer in child

A

Rhabdomyosarcoma

204
Q

Fracture of penis involves which layers?

A

Corpus cavernosa and tunica albuginea

205
Q

Testes cancer: Adult, heterogeneous with bHCG, mets ++

A

ChorioCa

206
Q

Testes cancer: Bilateral testes, peutz-jeghers

A

Sertoli cell

207
Q

Testes cancer: Multiple/bilateral testes

A

Lymphoma

208
Q

Cyst extending outside prostate, no urethra communication

A

Mullerian duct cyst
(Compare cyst communicating with prostatic urethra = Prostatic utricle cyst)

209
Q

Cyst communicating with prostatic urethra

A

Prostatic utricle cyst
(Compare cyst extending outside prostate, no urethra communication = Mullerian duct cyst)

210
Q

Gynae: Doppler flow ++ non-echoic structures in junctional zone/myometrium dx and cause?

A

AVM, from abortion/c-section/multiparity

211
Q

Gynae: T1/T2-hyper mass in myometrium

A

LipoLeiomyoma (fatty fibroid)

212
Q

Gynae: US-hyper mass in myometrium

A

LipoLeiomyoma (fatty fibroid)

213
Q

Gynae: Similar to fibroid with internal necrosis and rapidly enlarging

A

LeiomyoSarcoma

214
Q

Gynae: Appearance of bicornuate uterus & uterine horn angle?

A

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
Q

Gynae: Appearance of Didelphine uterus

A

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
Q

Ovary: T1-hyper, T2-hypo, non-fat-suppressed mass in ovary

A

Endometrioma (endometriosis in ovary)

217
Q

Ovary: T1-hyper, T2-hypo, non-enhancing, non-doppler

A

Haemorrhagic cyst

218
Q

Ovary: US-hyper myometrium mass 3 months after previous molar pregnancy, raised bHCG

A

ChorioCa

219
Q

Obstetrics: Short femur, growth retardation, hydrops

A

Downs/Trisomy 21 (“Tri/321 CDEFGHI = Cardiac (ASD/VSD), Duodenal atresia, Echogenic bowel, Femur shortened, Growth retardation, Hydrops, Increased nuchal thickness”).

220
Q

Obstetrics: Vascular malformation of placenta, pulsatile doppler

A

ChorioAngioma

221
Q

Ovary: Multi-septated mass with pseudomyxoma peritonei (organ scalloping) in smoker

A

Mucinous CystAdenoCa

222
Q

Generic Appearance: Fat

A

T1-hyper, CT-HYPO, PD hyper, IN-HIGH, out-low, Fat-suppressed hypo, US-var

223
Q

Generic Appearance: Metal

A

T1-hyper, CT-HYPER, IN-LOW, out-high, Non-enhancing, T2-hypo (for calcium/wilsons/glycogen, NOT haemochromatosis)

224
Q

Generic Appearance: Subacute blood/haemorrhagic

A

CT-hetero/hyper, US-hyper, T1-hyper

225
Q

T1-hyper, T2-hyper, CT-hypo: Meaning and examples

A

Pure fat: Lipoma/AML/myelolipoma/lipoleiomyoma/liposarcoma (fat-suppressed hyper), adenoma (except pleomorphic adenoma), clear cell RCC, fatty regeneration nodule, craniopharyngioma

226
Q

T1-hyper, T2-hypo, CT-hypo: Meaning and examples

A

(fatty with fibrosis/protein): Cystic fibrosis/germ cell/dermoid/teratoma/colloid, papillary RCC

227
Q

T1-hyper, T2-hyper, CT-hyper, US-hyper: Meaning and examples

A

Bleeds/vascular: Bleeds, Bone/skull haemangiomas (high fat/fluid, not body haemangioma), Haemorrhagic mets in kidney/thyroid/carcinoid/chorioca

228
Q

T1-hyper, T2-hypo, CT-hyper/hetero: Meaning and examples

A

Bleed/vascular with fibrosis/protein: Endometriosis, Haemorrhagic cyst

If GRE-hypo/contrast non-opacification also = thrombus

229
Q

PD sequence in fat vs fluid vs cartilage/muscle differences

A

Hyper in Fat (T1-hyper) and fluid (T1-hypo). (“PDFF”)

Cartilage/muscle hypo.

230
Q

T2-hyper vs FLAIR differences and examples of FLAIR hyper/hypo

A

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
Q

T1-hypo, T2-hyper, US-hyper: Meaning and examples

A

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
Q

T1-hypo, T2-hypo, CT-hypo: Meaning and examples

A

Non-fatty Fibrosis: in Fibroid/Leiomyoma, Fibroma, Thecoma/Fibrothecoma

233
Q

Examples ot T1/2 hypo, T1/2 normal and T1/2 hyper

A

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
Q

US-hypo: Meaning and examples

A

US-Hypo +/- posterior enhancement (“loose in fluids/oedema”): Hypo in HCC, Anechoic in Cyst, Liquids eg Galactocoele, Medullary breast ca, gallbladder, urinary bladder

235
Q

US-hyper: Meaning and examples

A

(“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
Q

MRI appearance of brain bleed

A

(“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
Q

Mets: Intra-medullary spinal mets

A

GBK + LM (lung/melanoma)

238
Q

Associations: Septic emboli + pharyngitis/tonsillitis

A

Lemierre’s Syndrome

239
Q

Associations: Kidney/adrenal + skin cafe spots + lung + CNS/eye/spine, plexiform neurofibroma

A

(all the SOLIDS, more PERIPHERAL) = NF1

240
Q

Associations: Multiple meningiomas, schwanomas, ependymomas, bilateral acoustic neuromas, in brain and spine

A

(all the NEUROS, only CENTRAL) = NF2
“MMSE”

241
Q

Comparison of Para-ganglioma vs Schwannoma vs Meningioma vs Neurofibroma on scans

A

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
Q

Neuro Basal Ganglia conditions by location & mnemonic

A

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
Q

Adrenals: Non-adrenal CT: 1-2 cm, no cancer history, >10HU on plain

A

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
Q

Adrenals: Non-adrenal CT: 2+cm or >10HU on plain

A

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
Q

BIRADS: 3

A

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
Q

NIRADS for post-treatment H&N cancer: When to do CT/PET?

A

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
Q

NIRADS for post-treatment H&N cancer: 2

A

Non-mass enhancement or LN +ve but no suspicious feature or mild avidity = 3 month CT follow up, consider PET

248
Q

NIRADS for post-treatment H&N cancer: 3

A

Mass-like enhancement or LN with suspicious features or high avidity = Biopsy

249
Q

Lung Fleischner nodules: Solid 9+mm

A

3 mth follow up or PET/CT or biopsy

250
Q

Lung-Rads for cancer/cancer screen: Cat 3/4A meaning and management

A
251
Q

Lung-Rads for cancer/cancer screen: Cat 4B/4X meaning and management

A

> 15mm solid or >8mm solid component sub-solid or spiculation or LN +ve = PET-CT/biopsy

252
Q

Liver LIRADS Mx: 1

A

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
Q

Prostate PIRADS: 5, meaning and mangement?

A

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
Q

Kidney Bosniak meaning and management: 2F

A

(3+ cm, or 3+mm thick/4+ number enhancing septations) (“234”) = 6 months then yearly follow up

(“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)

255
Q

Kidney Bosniak meaning and management: 3

A

(multi-loculated/complex septations/heavy calcifications) = Surgery

(“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)

256
Q

Gallbladder Polyp Management: Management of 0-3 points

A

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
Q

Thyroid TIRADS: Mnemonic for management

A

(“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
Q

AAA Management: 3-3.9cm

A

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
Q

Aortic levels: T4, T5, T12-L5

A

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
Q

Attachments: PSIS

A

Gluteus maximus

261
Q

Attachments: PIIS

A

Superior gamelus

262
Q

Attachments: Knee medial condyle

A

Adductor magnus

263
Q

Attachments: Knee lateral condyle

A

Popliteus

264
Q

Attachments: Base of thumb

A

Abd PL (“Eat Apple”)
Compare base of 5th finger = “Easy promise = ECU”)

265
Q

Attachments: Base of 5th finger

A

“Easy promise = ECU”
Compare base of thumb = “Eat Apple = Abd PL

266
Q

Attachments: Medial elbow epicondyle

A

Common flexors

267
Q

Attachments: Lateral elbow epicondyle

A

Common extensors

268
Q

Attachments: PSIS

A

Gluteus maximus

269
Q

Attachments: PIIS

A

Superior gamelus

270
Q

Attachments: Knee medial condyle

A

Adductor magnus

271
Q

Attachments: Knee lateral condyle

A

Popliteus

272
Q

Attachments: Base of thumb

A

Abd PL (“Eat Apple”)
Compare base of 5th finger = “Easy promise = ECU”)

273
Q

Attachments: Base of 5th finger

A

“Easy promise = ECU”
Compare base of thumb = “Eat Apple = Abd PL

274
Q

Attachments: Medial elbow epicondyle

A

Common flexors

275
Q

Attachments: Lateral elbow epicondyle

A

Common extensors

276
Q

ILD causes: Bronchiolitis related - Diffuse distribution

A

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
Q

Eye: Extra-conal lesions (x4)

A

(“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
Q

Eye: Conal (aka muscular layer) lesions (x4):

A

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.

WlwG Old (22 decks)

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