WlwG Revision & Mnemonics

Question 1

Lung ILD Upper Conditions

Answer 1

“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

Question 2

Lung ILD Diffuse Conditions

Answer 2

“COP DAALE”
(“CDGGCCG”)
COP = Cop noD/Ggo
DIP = Ggo
Acutes = Ggo/consolidation
Alveolar bat
LIP = Cyst/ggo
LAM = Cyst/cav
Eosinophilic = ggo/peripheral consolidation

Question 3

Lung ILD Lower Conditions

Answer 3

“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

Question 4

Lung Paeds Lucencies

Answer 4

“ABCDEF PS”:
Asthma = Tram-tracking with otherwise normal
Bronchial atresia = Segmental hyper-expanded lung
CPAM = Multiple pulmonary cysts
Dysplasia/Bronchopulmonary dysplasia = Band-like lucencies hyper-expanded lung 1 mth after RDS
Emphysema/Congenital Lobar Emphysema/Over-inflation (CLO/CLE) = “CHLOE” = Child with Hyper-expanded Lucent lung after Opacification
Foreign body = Expiratory air-trapping
PIE = Linear lucencies with pneumos 1 wk after RDS (“Slice of PIE is acute line”)
Swyer-James “Young Soya James” = Young child with black/soya-sauce lung after viral infn

Question 5

Trachea Narrowing/Dilated Conditions

Answer 5

Question 6

Anterior Mediastinum

Answer 6

(“Thymoma, Thyroid, T-cell lymphoma, Teratoma”):
Child without LN = Thymus
Thymus enlargement after chemo/RT/steroids = Thymic rebound hyperplasia
Fat/Calcs = Teratoma
Lobular and mild enhancing = Thymoma (“thymus adenoma”) (Myasthenia gravis/aplastic anaemia)
Fatty beef = Thymolipoma (“thymus lipoma”)
Low attenuation with well-defined margin = Thymic cyst
Lymph nodes only, reed-steinberg cells = Hodgkins Lymphoma (B-cell lymphoma)
Lymph nodes and other organs = NHL
Big & Lobulated +/- testicle atrophy = Seminoma
Necrotic/haemorrhagic, Elevated AFP/bHCG/LDH = Non-Seminomatous Germ cell (ChorioCa/Yolk sac tumour)
ACTH = Carcinoid

Question 7

Middle Mediastinum

Answer 7

Thin wall cyst: Bronchogenic (duplication) cyst
Painless, asymptomatic LN: Castleman’s (“CAsTLE” = Calcs, ASymptomatic Thoracic LN, Enhancing with washout)
Mass with calcs, right heart dilation/SVCO: Fibrosing Mediastinitis/Sclerosing Mediastinitis
Heterogeneous enhancing ++, I-131/MIBG: Paraganglioma
Others: Oesophagus/Vascular/LN

Question 8

Posterior Mediastinum

Answer 8

Child = NeuroBLASToma (“NeuB = Newborn”)
Round in teen/young adult = GanglioNeuroma (“GANG = Guys and girls”)
Para-spinal = Schwannoma (“Schwan = Spine”)
Neural foramen = NeuroFibroma (“NF = Neural foramen”)
Cystic with scoliosis/spina bifida = NeuroEnteric cyst (foregut duplication)
Bone trabeculation = Extra-medullary haematopoiesis
Vertebral end-plate destruction = TB paraspinal abscess

Question 9

Oesophageal Dilations

Answer 9

Upper Focal = Divert (“Front Kill, Phar side, Back to Zen”)
Lower Focal = Hiatal hernia
Whole dilated = Scleroderma (“Sclero = Clear all dilated”)
Beak sign/tapered = Achalasia
Colon + Heart + Achalasia = Chagas (“CHA”)
DM, alcoholic, bulbar palsy = Neuropathic

Question 10

Stomach Ulcers

Answer 10

Top/Fundus with large gastric folds = Menetriers (“Men have big folds & on top”)
Side/Greater curvature = NSAID/aspirin PUD (“Tablet rests on greater curvature”)
Diffuse with base/antrum involved = H. Pylori (“Infection, thus diffuse”)
Involvement of proximal small bowel with Gastrinoma = Zollinger-Ellison
Involvement of whole small bowel +/- large bowel = Crohn’s

Question 11

Gastric Polyps

Answer 11

Whole GIT = FAP (“FAP oral”)
Breast/Thyroid = Cowden (“Cow breasts”)
Brain = Turcot (“Turcot fish brain”)
Skin/reproductive = Peutz-Jegher (“Peutz like breast peau-d-orange, so skin”)
Bone/Connective tissue = Gardner (“Garden grass and mushrooms”)

Question 12

GIT Ulcers and Colitis

Answer 12

CrohnSSS = Skip lesion, String sign Small bowel, Stricture, Stones, Spondylitis, Sacroilitis, Sizeable LN.
Ulcerative Colitis = Continuous Ulcers in the Colon and “all the -itis”.
Behcets “Bae playing GAMES” = Genitals, Aneurysms, Mouth, Eyes, Skin
Entamoeba = Bloody diarrhoea
Pseudomembranous = Thumb-printing
Infective colitis = Right/Ascending (“Food” Salmonella/Shigella), Left/Descending (“Worms” Schistosomiasis), Rectosigmoid Gonorrhoea/Herpes/Chlamydia), Diffuse (“HIV” CMV)
Diverticular disease = Concentric SIGMOID wall thickening, steroid use

Question 13

Liver Summary by Age/Bloods

Answer 13

By Age/Bloods:
<6 months: Raised endothelial growth factor (“more skin”) with skin haemangiomas = Infantile haemangioma
<5 year old: Raised AFP = Hepatoblastoma. Normal AFP cystic mass = Mesenchymal hamartoma
5-20 year old: Raised AFP = Classic HCC (aka Hepatoma), Normal AFP with central non-enhancing scar = Fibrolamellar HCC. Heterogeneous solid-cystic mass = Embryonal sarcoma. Multiple = Mets (neuroblastoma/Wilms)
Raised LFT = Hepatitis, NASH (fatty liver with hepatitis), HELLP syndrome (pregnancy)

Question 14

Liver Diffuse Diseases

Answer 14

US-Hyper (“stiff deposits”) = Cirrhosis, Fatty liver, Iron liver, Glycogen liver
Hepatomegaly (“storages”) = As above plus Gauchers disease minus Fatty liver
Hepatomegaly and ascites (“vascular issues”) (“Buddy in VedCon/Vietcong from small to large veins”):
SMALL veins/IVC = Budd-Chiari (DVT in pregnancy thus veins small”)
NORMAL veins/IVC = Hepatic Veno-Occlusive Disease (stem cell TRANSPLANT resulting in fibrosis of hepatic veins “fibrosis so normal size”)
LARGE veins/IVC = Hepatic congestion (Right heart failure “backflow”)
CT-Hypo, In-high, out-low = Fatty liver (“High In Fat. Fat floats on water, so hypodense”)
CT-Hyper, In-low, out-high, T1/T2-hypo = Haemochromatosis (“Iron sinks, so hyperdense”)
CT-Hyper = Glycogen Storage Disease (“Plants sink, so hyperdense”)
CT Nodular, left lobe hypertrophy, T1/T2-iso = Cirrhosis
CT Nutmeg-appearance with peripheral enhancement = Budd-Chiari (DVT in pregnancy)
***CT-Hypo/US-hypo/MRI-hypo ALL sequences diffuse nodules, raised serum ACE = Sarcoid liver

Question 15

Liver Disease by Shapes

Answer 15

Starry sky on US ‘fat dots within liver oedema’ = Viral hep (Hep A/B, CMV/EBV)
Sandstorm/multilocular cyst with wall calcs on US = Hydatid
Target on CT with ring enhancement = Pyogenic abscess (E. coli/Strep)
Bullseye on US = Candida
Tortoise shell = Shistosomiasis
Wedge shape CT hypo, T1-hypo, T2-hyper = Focal Confluent Fibrosis
Wedge shape CT enhancing = Arterio-portal shunt

Question 16

Liver Conditions MRI

Answer 16

Question 17

Pancreas Focal Cystic or Solid Neoplastic conditions

Answer 17

Cystic:
Recent pancreatitis/pancreas trauma = Pseudocyst
Involves PD >1cm = Main branch IPMN
HEAD, small grapes, NO PD communication, +/- scar/calcs = Serous CystAdenoma (aka Serous Cystic Neoplasm)
HEAD/UNCINATE, PD communication, small grapes = Side branch IPMN
BODY/TAIL, Large, NO PD communication, +/- calcs = Mucinous cystic

Solid-cystic:
TAIL, Solid-cystic, ENHANCING, +/- calcs, teen girl = SPEN
(“Grandma/head/senior SC, Mother/body/middle MC, Daughter/tail SPEN, PD involved = main/side IPMN”)

Solid:
Solid child = PancreatoBlastoma
Solid adult with HYPO-enhancement = PDAC (adenoCa)
Solid with hyper-enhancement = Islet cell

Question 18

Adrenal Tumours

Answer 18

Pre-natal = neuroblastoma,
fat = myelolipoma,
anechoic = haemorrhage,
large enhancing = Ca,
calc = TB,
hyper-enhancement medullary = pheochromocytoma

Question 19

Peritoneal Conditions

Answer 19

Cancers: Male = Peritoneal mesothelioma, Female = Peritoneal Ca, both also mets
Liver scalloping and peritoneal thickening = Pseudo-Myxoma Peritonei
Thick omentum with posterior displaced bowel = Omental seeding from mets
Fatty/thickened mesentery = Sclerosing Mesenteritis/Mesenteric Panniculitis
Peritoneal dialysis with thickened peritoneum + SBO = Sclerosing Peritonitis
Acute inflammation and infarction of appendages, LEFT lower quadrant along colon = Epiploic Appendagitis (“Epiploic = Epic Left Lower Infarct”)
Large oval hypodense mass in RIGHT lower quadrant = Omental Infarct
SMA occlusion with gas in intra-mural, portal vein +/- pneumoperitoneum = Mesenteric Ischaemia

Question 20

Kidney Conditions

Answer 20

**Bilateral enlarged kidneys = AD (ADult) or AR (infant) PCKD
**Bilateral small kidneys = Medullary Cystic Disease (MCD) (“Mcdonalds for small kidneys”).
Kidney + pancreas + adrenal (cysts) = Von Hippel Lindau (“HiPPEL” = Haemangioma, Pheo, Pancreatic cysts, Eye haemangioblastoma, Liver cysts”)
Kidney + adrenal + skin (solids) = NF1
Bilateral AML with hamartoma = Tuberous Sclerosis (“TUBAH = Tubers, AML, Hamartomas”).
Bilateral hypoechoic hypodense solid = Lymphoma
Bilateral ESRF = Uremic Cystic Disease
Single Fatty/Vascular = AML
Single Scar = Oncocytoma
Single Solid in cortex = RCC (Calcs = Clear cell, Renal transplant = Papillary)
Single Solid in renal pelvis/ureter = TCC

Question 21

Renal Paediatric Solid conditions

Answer 21

0 age (congenital) solid = Mesoblastic Nephroma (“Mesoblast = New child ie congenital”)
<1, nodular = Nephroblastomatosis (“Blastomosis = Young child ie infant”)
1-3 with calcs = Nephroblastoma (“Blast = Child”)
3-5 years old without calcs = Wilms
Teen = RCC
Multiple = NHL

Question 22

Renal Paediatric Cystic/Misc conditions

Answer 22

Dilated ducts with calcs = Sponge
Many cysts in infant = Multi-cystic dysplastic kidney
Multi-septated cysts in 3-5 yo child = Multi-locular cystic nephroma
Dilation of Lymphatics = Lymphangioma
Haemolytic anaemia = HUS
Hearing loss = Alports

Question 23

Testes Paeds conditions

Answer 23

Child, raised AFP with enlarged testicle, no focal mass: Yolk sac
Child, normal AFP with focal mass, calcs ++: Teratoma
**Adult, Homogeneous with bHCG = Seminoma (“Homos like semen”)
Adult, Heterogeneous with bHCG, Mets ++ = ChorioCa
**Bilateral testes with Peutz-Jeghers and gynaecomastia = Sertoli cell
***Multiple/bilateral hypoechoic lesions = Lymphoma
Child paratesticular scrotal mass = RhabdoMyoSarcoma

Question 24

Testes Adult conditions

Answer 24

Absent = Cryptorchidism
Painless enlargement = Hydrocele
Painful arterial = Epididymo-Orchitis
***Painful venous = Varicocele
Painful with reduced arterial flow = Torsion

Anechoic simple cyst with posterior acoustic enhancement: Epididymal cyst or Tunica albuginea (surrounding testes) cyst
Multiple cysts with internal echoes: Tubular ectasia (rete testes)/Spermatocoele (epididymis)
Onion-skin alternating rings of hypo and hyper, non-vascular cyst: Epidermoid cyst

Question 25

Ovarian Conditions

Answer 25

T1-hyper, T2-hypo, fat-suppressed: Germ cell/dermoid/teratoma T1-hyper, T2-hypo, not fat-suppressed: Endometriosis/endometrioma T1-hyper, T2-hypo, not fat-suppressed, not enhancing, non-doppler: Haemorrhagic cyst T1/T2-hypo = Ovarian fibroma/thecoma/fibrothecoma Unilateral enlarged painful ovary: Ovarian torsion High bHCG and progesterone with ABSENT foetus in uterus, 'US tubal ring sign' = Ectopic pregnancy Cyst with peripheral VASCULARITY: Corpus luteum cyst Anechoic round LARGE 3+cm unilateral cyst: Follicular cyst Multiple 'STRING of pearls' cysts in BILATERAL enlarged ovaries: PCOS Theca lutein cyst + ascites/pleural effusion: Ovarian hyper-stimulation syndrome Cyst in childbearing age = Serous CystAdenoma (SCA) Raised CA125 in older women with mass = Serous CystAdenoCa (SCAC) Ovarian tumour + pleural effusion + ascites = Meigs (“Mekong delta = lots of water = pleural effusion and ascites”) Ovarian mets from GIT = Krukenburg tumour ***Multiple cysts with elevated bHCG: Theca lutein cyst (“TLC Multi-Cyst HCG”) Large ovarian mass with snowstorm appearance, raised bHCG = Gestational Trophoblastic Disease/GTD/Hydatidiform Mole Ovarian myometrium mass 3 months after removal of GTD, US-hyper, raised bHCG = ChorioCa ***Young with solid mass, raised AFP: Yolk sac tumour

Question 26

Ortho Muscle Attachments

Answer 26

Deltoid: Clavicle/acromion/scapula to deltoid tuberosity humerus Teres major: Scapula to intertubucular groove humerus Rotator cuff except subscapularis: Scapula to greater tubercle humerus Subscapularis: Scapula to lesser tubercle humerus ASIS: Sartorius (“Superior Sartorius, Inferior femorIS”) AIIS: Rectus femoris Pubic ramus/Symphysis: Adductors (magnus/longus/brevis/gracilis) (“Public Ads”) Greater trochanter: Gluteus medius/minimus (“Great butt”) Lesser trochanter: Iliopsoas Ischial tuberosity: Hamstrings (Biceps femoris, SemiT/SemiM)

Question 27

Ortho US Shoulder

Answer 27

Subscapularis: External rotation and Adduction (“X and +”) Supraspinatus: Internal rotation (hand at back) Subacromial impingement: Internal rotation and Abduction (“A BIN”) Biceps: Point to contralateral knee Infraspinatus & Teres minor: Hand on contralateral shoulder

Question 28

Ortho Bone Neoplastic: Lucent-Narrow

Answer 28

***Lucent-Narrow (“BoBo CDEE GGH = Choke Child with Anal, oral with HJ, reverse cowgirl with doggie, HJ in public”) BrOwn tumour (HyperPTH, anywhere) BOne cyst (young limbs with fracture) Chordoma (old sacrum) (“Chord = sacrum”) Desmoplastic fibroma (mandible) (“Desmond = desMAND”) Enchondroma (young fingers) Eosinophilic/EG/LCH (All young skull/hips/spine) GCT (All adult sacrum/arms/legs) Glomus (old fingers) Haemangioma (sun-burst in all adult skull/spine) (“Haeman = Head and spine”)

Question 29

Ortho Bone Neoplastic: Mixed Lucent with Rim-sclerosis or Fibrous - Narrow

Answer 29

Fibrous: <20yo Fibrous Dysplasia, >20yo MFT ("MFT = Mixed fibrous, femur trochanter") Fibromas (rim-sclerosis, asymptomatic): <3cm under 20yo Focal CD. >3cm above 20yo Non-ossifying fibroma A's (Septated): ABC in <20yo with fluid level/pain/lump. Ada-MAN-TI-noma in >20yo, mandible and tibia Blasts (Pain/swelling): OO <2cm, OB >2cm (periosteal reaction), CB in knee cartilage (scalloping)

Question 30

Ortho Bone Neoplastic: Sclerotic-Narrow

Answer 30

"MOB/ONE” = Ossifying fibroma (ossify thus sclerotic, in mandible/legs), Neuroma (feet), Enostosis (bone island)

Question 31

Ortho Bone Neoplastic: Wides

Answer 31

Single Sarcoma/Plasmacytoma, Multiple Myeloma = “Ewings in child, OS/CS/FS in adult by tissue involvement, MM in old”

Question 32

Ortho Bone Neoplastic: Multiple/Diffuse conditions

Answer 32

“Multiple MMMM = Myeloma (lytic), Mastocytosis (GIT/skin), Myelofibrosis (sclerotic), Mets” Diffuse LyTiK = MM (bone scan -ve) + LTK mets (bone scan +ve). Diffuse mixed = Mastocytosis + Breast mets (“Mixed mast mammary”). Diffuse sclerotic = Myelofibrosis + Uro mets.

Question 33

Ortho Bone Neoplastic: Benign Lytic lesions

Answer 33

Question 34

Ortho Soft Tissue Masses

Answer 34

T1-hyper, not fat suppressed = Liposarcoma T1-hyper, fat suppressed = Lipoma T1-hypo/iso, T2-hyper = Nodular fasciitis T1/T2-hypo, painless well-circumscribed in arm = Fibroma ***T2-hyper, aggressive = Malignant Fibrous Histiocytoma aka Pleomorphic Sarcoma (“M-Fker is too low”) T2-hyper, US-hypo benign cyst in wrist = Ganglion cyst Posterior chest wall = ElastoFibroma ***Calcs from trauma = Myositis ossificans Recurrent soft tissue bleed from haemophilia = Haemophilic PseudoTumour

Question 35

Ortho Joint Disease - Degenerative

Answer 35

DEGENERATIVE - Normal bone density with normal inflm markers: Symmetric joint degen: OA (“LOSS” = Loss of joint space + subchondral sclerosis + subchondral cysts + osteophytes). Asym joint degen (Painless oedematous joint with effusion, without raised inflm markers or warmth) (“DDDDD = Deformity, destruction, dislocation, density normal, do not feel pain”) DM Charcot joint (“DM has foot problems, thus Feet/Ankle”) Syphilis Charcot joint (“Give BJ, so on Knees”) Syringomyelia (“Pull string, so Upper Limbs”)

Question 36

Ortho Joint Disease - Inflammatory

Answer 36

INFLAMMATION - Reduced bone density (osteoporosis) with raised inflammatory markers: Small joint inflm (MCPJ/PIPJ) (“DSLR”): Dermatomyositis (SKIN rash, proximal limb myopathy, soft tissue CALCS) Systemic Sclerosis (Soft tissue fibrosis/calcs with finger joint EROSIONS, CREST organ involvement) Lupus/SLE (FACE rash, mouth ulcer, deformed hands without erosions) Small & Large joint inflm: RA (EXTENSIVE erosive deformity in HANDS & LIMBS, Caplan's = RA + Pneumoconiosis (“RAP”). Felty's = RA + Neutropenia + Splenomegaly (“RANS”) Widening of the intercondylar notch: JIA/RA, Psoriatic arthropathy, TB and haemophilia Large joint inflm (SI-joint/spine/DIPJ, periosteal reaction) (“Junior RAPE”): Juvenile idiopathic arthritis (CHILD hand and knee deformities after INFN) Reiters (LOWER BODY, with urethritis/conjunctivitis AFTER INFN Ank spond (AXIAL SKELETON/SI-joints/vertebra) Psoriatic (HAND deformities with SKIN psoriasis, no osteoporosis) Enteropathic arthritis (AXIAL & LIMBS with GIT issues) *****Sacroilitis: Bilateral symmetrical: Ank Spond, RA and Enteropathic (“Bilateral Symmetrical EAR”) Bilateral asymmetrical: Reiters, Psoriatic, Gout (“RPG not symmetrical”) Unilateral: ("TICS unilateral") TB, Infn, Cancer, SAPHO (less likely also bl asym causes) HLA-B27: Ank Spond > Enteropathic > Psoriatic (“BL symmetric conditions excluding RA – Rheumatoid factor”)

Question 37

Ortho Joint Disease - Metabolics

Answer 37

Non-calcium extra-articular depositionals: Gout: 1st TOE MTPJ juxta-articular erosions Amyloidosis: Shoulders/hips/knees/wrists in DIALYSIS, organ involvement Wilsons: Copper in knee/wrist/liver/basal ganglia/eyes Hyper-PTH: Sub-periosteal BONE RESORPTION, salt-and-pepper skull, BROWN tumours Haemochromatosis: Iron deposition Calcium extra-articular depositionals: ***CPPD/Pseudogout: Wrist (TFCC calcs) + Knee (LOSS OF PATELLO-FEMORAL joint space (compared to OA) Calcium Hydroxyapatite Deposition Disease/Milwaukee shoulder: Supra-spinatous tendon, flexor carpi ulnaris, MCP joints following TRAUMA Alkaptonuria/Ochronosis: Chondrocalcinosis with EARLY OA/heart failure/kidney failure ***Calcific tendinitis: ROTATOR CUFF with subsequent resorption of calcium, thus TEMPORARY pain Nutritional: Osteopenia/Osteoporosis: Low PTH/Vit D/Vit C, hyper-thyroid/cushings/acromegaly/marfans/ehlers-danlos/menopause/wilsons. Osteomalacia (adults)/Rickets (children): Low Vit D/Calcium/Phosphorus, renal failure, liver disease. Generalized osteopenia with looser zones (pseudofractures), fraying/cupping of physeal margin of knees and wrists. Scurvy: Low Vit C. Generalized osteopenia with pathological fractures and HEMARTHROSIS (joint bleeding).

Question 38

Ortho Marrow Diseases

Answer 38

Marrow diseases: Jew (Israel/America) with hepatosplenomegaly, osteopenia, pancytopenia: Gauchers Black with pain everywhere, marrow hyperplasia, bone infarcts: Sickle cell Asian with marrow hyperplasia, bone infarcts, cardiomegaly: Thalassaemia Dense bones with splenomegaly: MyeloFibrosis Cotton-wool skull with mixed lytic/sclerotic bone remodelling: Pagets (“Gaucher = Mainly organs, Thal = Mainly bones, Sickle cell = everything”)

Question 39

Ortho Paediatric Non-accidental Injury Suspicions

Answer 39

Non-accidental injury suspicions: Lower limb injuries in a non-ambulant child Discrepancy between the history and apparent injuries Delay seeking medical attention Metaphyseal fractures (corner or bucket-handle) Multiple fractures of different ages Scapula/Posterior rib/Sternal fractures Skull fractures (especially non-parietal, or crossing sutures)

Question 40

Ortho Paediatric Non-accidental Injury Investigations

Answer 40

Non-accidental injury investigations: Skeletal survey (Skull, chest, spine, hips, limbs – 'everything except abdomen') to be done IMMEDIATELY & AFTER 11-14 DAYS. Neurological survey (CT Head) to be done in all under 1 year old once stable, or those with suspected brain trauma if above 1 year old. Ultrasound can be considered for metaphyseal and rib fractures if x-ray normal. Keep child in ward until social worker has found a safe plan.

Question 41

Spine Inflammation

Answer 41

Spine (disc & cord) Inflammation (Enhancement): Single disc enhancement, anterior disc only, no calc, reduced disk height = Staph Spondylo-discitis Multi-level disc enhancement with CALCS, anterior & POSTEIOR disc = TB discitis Clumping of cord with empty thecal sac appearance: Arachnoiditis Acute <2 months cauda equina enhancement and thickening = Guillain-Barre (“William's bar, thus thick, glistening and short-term”) Chronic >2 months cauda equina enhancement and thickening = CIDP (“Chronic”)

Question 42

Spine Demyelination

Answer 42

Spinal Cord Demyelination (T2/Flair-HYPER signal): Multiple Scattered white = MS (also white in brain) Diffuse Posterior white/dorsal columns = SACD (Vit B12 deficiency) (“Sacked in back/black and white”) Anterior grey = Infarct Diffuse grey = Ischaemia (transverse myelitis post-infn, neuromyelitis if optic nerves as well)

Question 43

Spine Tumours

Answer 43

In Cord, Child, Thoracic, T1-hypo = Astrocytoma In Cord, Adult, Cervical, T1-hypo = Ependymoma In Cord, Adult/Child, T1-hypo = HaemangioBlastoma In Canal, T1-hypo, T2-hyper: Nerve sheath tumour (Schwannoma with target sign) Inferior to Conus, extremely enhancing vascular = Para-Ganglioma In Thoracic Canal: Homogeneous enhancement T1/2-var = Meningioma Multiple: Consider Drop metastases (“GGEM = Glioblastoma, Germinoma, Ependymoma, MedulloBlastoma”) Extra-dural CSF-filled cyst at dorsal root ganglion = Tarlov cyst/Peri-neural cyst

Question 44

Spine Dermatomes

Answer 44

Dermatomes: C4 - Regimental badge/Shoulder (“C4 - army”) C5 - Lateral upper arm C6 - Thumb C7 - 3rd finger C8 - 5th finger T1 - Medial upper arm T2 - Axilla L1 – Waist (“1 waist, 2 legs”) L2 - Lateral upper thigh L3 - Anterior upper thigh L4 - Medial lower leg L5 - Lateral lower leg S1 - 5th toe S2 - Posterio-medial upper thigh

Question 45

Spine Myotomes

Answer 45

Myotomes: C1/2 - Neck flexion/extension C3 - Neck lateral movement C4 - Shoulder elevation (“shoulders as per dermatomes”) C5 - Shoulder abduction C6 - Elbow flexion C7 - Elbow extension C8 - Finger flexion T1 - Finger abduction L1/2 - Hip flexion L3 - Knee extension L4 - Ankle dorsiflexion & foot inversion L5 - Big toe extension S1 - Ankle plantarflexion & foot eversion (“Lumbar related to kicking, Sacrum related to standing”)

Question 46

Spine Reflexes

Answer 46

Reflexes: S1-2 Buckle my shoe (achilles) L3-4 Kick the floor (patella) C5-6 Pick up sticks (biceps) C7-8 Lay them straight (triceps) L1-2 Testicles S3-4 Anal

Question 47

Neuro Neoplastic: General

Answer 47

Multiple “MMMM” = MS, Mets, Malignancy, Multi-focal syndromes Mets “GBK + LM” = GIT, Breast, Kidney, Lung, Melanoma Calcific tumours “Old MAGE” = OligodendroGlioma, Meningioma, Astro, Ependy, Glioblastoma Dural and leptomeningeal enhancement/lesions, very symptomatic: NeuroSarcoidosis Skull-invasive: HaemangioPeriCytoma

Question 48

Neuro Neoplastic: Child Temporal Lobe

Answer 48

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

Question 49

Neuro Neoplastic: Adult

Answer 49

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

Question 50

Neuro Neoplastic: Child Infra-Tentorial

Answer 50

Infra-tentorial Child = Teratoma/Rhabdoid (hetero enhancement), MedulloBlast aka PNET (homo enhancement, midline cerebellum/4th vent with hydrocephalus), ***Pilocytic astro (“pillon cystic, so child at back and solid-cystic”), Midline glioma (“midline, so brainstem”)

Question 51

Neuro Neoplastic: CPA

Answer 51

CPA = Schwannoma (invasive), Meningioma (non-invasive, calcs), Dermoid (T1-hyper), Lipoma (Fat-sat hypo), Arachnoid cyst (CSF so T1-hypo, Flair-hypo), Epidermoid (T1-hypo, Flair-hyper)

Question 52

Neuro Neoplastic: Ventricles/Choroid

Answer 52

Lateral Ventricles “SIDE-cytoma” = NeuroCytoma (adult), SEGA (child) Midline Ventricles “MID-moma” = SubEpendymoma(adult), Ependymoma (child), also Colloid cyst (T1-hyper) and MedulloBlastoma (T1-hypo, T2-hetero cerebellum/roof 4th ventricle) Choroid plexus “Choroid PL-loma” (with hydrocephalus) = Papilloma (non-invasive, homogeneous enhancement), Carcinoma (invasive, cystic/necrotic, heterogeneous enhancement), XanthoGranuloma (bilateral “And 2 lomas”)

Question 53

Neuro Neoplastic: Skull Base

Answer 53

Skull base = Chordoma (midline), ChondroSarcoma (para-midline) Pineal = Cyst, PineoCytoma (adenoma), Teratoma (hetero), Germinoma (fatty enhancing), PineloBlastoma (enhancing with calcs) Pituitary = Adenoma (T1-var, T2-hyper), Rathke cleft cyst (T2-hypo), Sheehan/Apoplexy (T1-hyper after pregnancy), Autoimmune/lymphocytic hypophysitis (T2-hypo during pregnancy) Supra-sellar “Cranium + Pharynx” = CranioPharyngioma (T1/T2-hyper, enhancing, IUGR/CNS issues, extra-axial

Question 54

Neuro Foramen

Answer 54

Optic canal: 2 (vision) Superior orbital fissure: 3, 4, V1, 6 (eye movements, pupil constriction) Cavernous sinus: 3, 4, V1, V2, 6 (“Rat & Cave with V2”) with carotid Foramen rotundum: V2 (mid-face sensory) (“R2 V2 or rotun2um”) Foramen ovale: V3 (lower face sensory, anterior tongue sensory) (“oVal3”) Foramen spinosum: MMA (“spinosuMM”) Meckels: CN5 ganglion (“meckel5”) CerebelloPontine Angle: 5, 7, 8 with AICA Dorello's canal: 6 (opposite of CPA) (“dorello = dorel6”) IAM: 7, 8 (anterior tongue taste, facial movements, hearing, balance) Jugular foramen: 9 in pars nervosa (posterior tongue sensory and throat), 10 (autonomic) & 11 (shoulder and neck movement) in pars vascularis Hypoglossal canal: 12 (tongue movement)

Question 55

Neuro Grey Matter Issues

Answer 55

Grey Matter (Peripheral) Issues (Dementias): Frontal = FrontoTemporal dementia/Pick's disease: FRONTAL & TEMPORAL atrophy. Mainly irritability and LOSS OF INTEREST (“being a Prick”). Middle = Alzheimers: Atrophy of TEMPOROPARIETAL, disproportionate HIPPOCAMPUS and sylvian fissures. Mainly FORGETFULNESS. General + brainstem but sparing hippocampus = Lewy Body dementia: Visual HALLUCINATION + PARKINSONISM + fluctuating concentration. Dementia comes before parkinsonism, unlike Parkinson's dementia (“Lewy not hippie”). Scattered general = Vascular dementia/Multi-infarct dementia: VASCULAR territory infarcts with generalized atrophy. HTN/Cadasil/smoking.

Question 56

Neuro White Matter Issues

Answer 56

Child after virus/immunisation: ADEM Lady disseminated in space/time: MS Adult with diffuse strokes, migraine/dementia/atrophy excl occipital: Cadasil Old with white matter dementia: SCARED

Question 57

Neuro Basal Ganglia Issues: T1-hypers

Answer 57

T1-hypers (“Metals”): Melanin in MIDBRAIN substantia nigra, TRAP = Tremor, Rigidity, Akinesia, Postural instability: Parkinsons. Copper in PUTAMEN/THALAMUS, weak limbs/liver disease: Wilsons. Calcification in BASAL GANGLIA/THALAMUS, dementia/psychosis/movement disorder: Fahrs (“Far-fetched thinking, can't move far, can't remember far”). Iron in GLOBUS PALLIDUS in child/young adult with rigidity/bradykinesia, T2-hypo: Hallervorden Spatz (“Children behave like Hell and then spit at GP”)

Question 58

Neuro Basal Ganglia Issues: T2-hypers

Answer 58

T2-hypers (“LLL = Leighs in infant BG/brainstem, aLs in internal capsule, Leuko-dystrophy in infant peri-ventricular”): Bilateral peri-ventricular white matter in INFANT who can't walk/swallow/see/remember: Metachromatic Leuko-dystrophy Basal ganglia/brainstem in INFANT: Leighs Basal ganglia with orogenital ulcers, eye problems: Behcets PD/Flair-hyper INTERNAL CAPSULE, muscular symptoms (twitching/stiffness/cramps/weakness/swallowing): ALS/Amyotrophic Lateral Sclerosis.

Question 59

Neuro Basal Ganglia Issues: Smalls

Answer 59

Smalls: Small 'hot-cross-bun' PONS/cerebellum with normal midbrain, autonomic function affected 'like adrenaline': MSA/Multi-system atrophy. Small 'hummingbird' MIDBRAIN with normal pons, can't look up: PSP/Progressive Supranuclear Palsy. Small CAUDATE, choreiform movements, genetic: Huntingtons.

Question 60

Neuro Toxins

Answer 60

Posterior/Occipital = PRES Periventricular after chemo/RT/heroin = Leukoencephalopathy Pons = Osmotic demyelination syndrome Thalamus, small posterior = Wernicke/Korsakoff Corpus callosum = Marchiafava Insula = Hepatic encephalopathy Bilateral diffuse SYMMETRICAL, with brain atrophy = HIV encephalopathy Bilateral diffuse ASYMMETRICAL, no brain atrophy = Progressive Multi-focal Leuko-Encephalopathy (PML) BL asymmetrical periventricular T2-hyper = MS BL asymmetrical confluent T2-hyper after viral infn = ADEM BL symmetrical basal ganglia = Cryptococcus Unilateral medial temporal lobe/insular = Herpes simplex encephalitis

Question 61

Neuro Paeds Developmental Disorders

Answer 61

(Small skull = Chiari “Kiara gives small head”. Small skull & brain = Microcephaly. Hernia = Encephalocoele) (Dilated 4th vent/Cisterna magna = Dandy-walker. 3rd vent = Agenesis of corpus callosum (“no connection, so dilated 3rd”), Lateral vent = HemiMegalEncephaly “half big brain ventricle”, fronto-temporal cleft = SchizEncephaly) (Fused midline = HoloProsEncephaly)

Question 62

Ear Pulsatile Tinnitis

Answer 62

Pulsatile Tinnitus: Increased bony formation involving middle ear structures = Otosclerosis Mass-like vessel = Persistent stapedial artery Very enhancing mass +/- bony erosion = Glomus tumour Enlarged inferior tympanic caniliculus = Aberrant ICA Enlarged middle ear endolymphatic spaces with ear fullness = Menieres ICA issues (ICA dissection/ICA aneurysm/Carotid stenosis/Carotid-cavernous fistula/Skull dural AVM)

Question 63

Ear Inflammation

Answer 63

EAC expansion without bony erosion = Keratosis obturans (“just keratin, no mass”) EAC/middle ear erosion, T1-hypo, T2-hyper, DR = Cholesteatoma EAC/middle ear erosion, T1-hyper = Cholesterol granuloma EAC/middle ear erosion in old/DM with mastoiditis = Malignant OE Fluid in middle ear = Otitis media Enhancement of middle ear = Labyrinthitis Ossification of middle ear = Labyrinthitis ossificans (chronic labyrinthitis) Fluctuating hearing loss/vertigo following cholesteatoma = Labyrinthine fistula Superior semicircular canal defect with vertigo/nystagmus = Superior SCC dehiscence Petrous apex inflm with CN 5/7 pain = Petrous apicitis Petrous apex inflm with CN 6 pain/palsy +/- CN 5/7 involvement = Gradenigo (“Graduate at the Apex vs To lose a hunt in the Cave”) Petrous temporal bone fracture = CN 7/8 affected with battle sign (post-auricular haematoma) Herpes simplex infn with CN 7 palsy = Bell's palsy Cavernous sinus/SOF inflm with CN 3/4/6 palsy, V1/V2/orbital pain = Tolosa-Hunt Cavernous sinus swelling with thrombus on CT/MRI, CN 3 palsy with eye swelling = Cavernous Sinus Thrombosis

Question 64

Sinus Conditions

Answer 64

Mucosal thickening = Sinusitis Small rounded = Mucous retention cyst Occupies entire sinus = Mucocoele ***Extends via ostium = Antrochoanal polyp (“Entero choana”) ***Erodes bone = Inverted papilloma ***Heterogeneous = Mycetoma (central dense)/fungal sinusitis (***NEED DIFFERENTIATION OF THESE) Very aggressive = SCC

Question 65

Neck Branchial Cleft Anomalies

Answer 65

Branchial Cleft Anomalies (LATERAL) 1 type 1: Adjacent to external auditory canal 1 type 2: Parotid (***Note still 1st branchial cleft***) 2: From mandible angle to carotid bifurcation 3: Infrahyoid neck along SCM 4: Infrahyoid neck adjacent to thyroid Cyst = no communication. Sinus = incomplete track. Fistula = communication (“LAP-MaST = Lateral Auditory canal, Parotid, Mandible, SCM, Thyroid”)

Question 66

Neck: Para-Pharyngeal Space Displacemet

Answer 66

Question 67

Cardio: Congenital Heart Disease

Answer 67

Question 68

Cardio: Congenital Heart Disease part 2

Answer 68

Question 69

Cardac Tumours

Answer 69

LA in adult = Myxoma = Mild (T2-hyper) (“From Malaysia/My to LA”) ***LV in child = Rhabdomyoma Sarcoma = Serious (T2-hyper) RA in adult = AngiosaRcoma (“saR = RA”) Ventricles in child = RhabdoMyoSarcoma (“saR + My, so mixed”) Valves = Fibro-elastoma Lipoma = T1-hyper, Fibroma = T1/T2-hypo, Thrombus = Non-enhancing

Question 70

Cardiomyopathy

Answer 70

Cardiomyopathy: LV thickened = Hypertrophic/HOCM and Sarcoid CM LV dilated after infection = Dilated CM LV dilated after menopause = Takotsubo LV narrow (amyloid/sarcoid/haemochromatosis) = Restrictive CM Pericardium calcified (Surgery/TB/radiation) = Constrictive CM Right ventricle = Arrhythmogenic Right Ventricle CM

Question 71

Cardiac MRI

Answer 71

Question 72

Cardiac Investigations

Answer 72

Low pretest probability of coronary artery disease: Treadmill test Intermediate probability: CT Coronary Angio or cardiac CT/MRI or Stress echo High probability: Cardiac MRI/MRA, if contraindicated, PET/SPECT (no valve disease) or Stress echo (suspect valve disease) Known: cardiac CT/MRI

Question 73

Vasculitis

Answer 73

Head Artery inflamed ie giant arteritis = GCA Aorta inflammed ie aortitis, pulmonary artery aneurysm/stenosis = Takayasu Aortitis Child aortitis = Cogan Many 'nodular micro-aneurysm' vessels affected ie polyarthritis with nodules = PAN Tiny vessel bleeds in lungs and kidney ie micro-angiitis = MPA Cute 'kawaii' child with CCA/calcified coronary artery aneurysm = Kawasaki Like Hitler with many holes in lungs, kidneys and nose = Wegeners/GPA Transient consolidations (ie take a short MC to Chuck out the Stress) = Churg Strauss Lung/Kidney/GI bleed (He got knocked) + scrotal (Schonlein) + skin Purpura = HSP Oral & genital ulcers cause Bae Cheated = Behcets Smoke, Drink (corkscrew collaterals) & eat Burgers with fingers = Buergers Glomerulonephritis + Pulmonary bleed + Anaemia, Anti-GBM (GPAA) = Goodpastures

Question 74

IR Which Vessel

Answer 74

Which Vessel: Haemoptysis: Bronchial artery Pulmonary AVM (from HHT/Osler Weber) or massive PE: Pulmonary artery Upper GI bleed: Left gastric artery Duodenal ulcer bleed: Greater duodenal artery Pancreas: Coeliac artery Renal HTN/Renal bleeds (trauma/aneurysm): Renal artery Middle GI bleed (Normal OGD/colono): Consider small bowel AVM Distal ileum: Consider Meckel's (diagnosed on 99mTc Pertechnetate) RIGHT Lower GI bleed (ascending colon): Angiodysplasia, Right colic artery LEFT Lower GI bleed (sigmoid): Diverticulosis Fibroids/post-partum haemorrhage: Uterine ARTERY Pelvic Congestion Syndrome: Ovarian & para-uterine VEINS Varicocele: Gonadal/Testicular/Spermatic VEINS

Question 75

Nuclear Medicine Summary

Answer 75

V/Q: MAA (“Shout MAA with lungs”) PE reduced perfusion ie VQ mismatch Atelectasis reduced ventilation ie reversed VQ mismatch COPD delayed ventilation washout with matching VQ) Heart or Parathyroid: Sestamibi (“Siesta at the Pit/PTH till heart attack”) GIT: Pertechnetate (“Protect ni de gut”) Kidney: Mag3 Bone: MDP (methylene diphosphonate) (“Like bisphosphonate, so bone”) Thyroid: I-131 > I-123 (“I11”) Carcinoid/Gastrinoma/Meningioma: Octeotride Other Cancers: PET Dementia/Seizure: HMPAO or ECD (“Hmm, let me try to remember”) CSF: DTPA (“DTF thus fluids”)

Question 76

Nuclear Medicine: Recognising Tracer based on highest organ uptake

Answer 76

Recognising Tracer based on highest organ uptake: Spleen: In-WBC Heart + Liver: MIBG Kidneys: MIBI Liver + Bone: Sulfur Colloid or Gallium Spleen + Kidney: Octreotide Thyroid: Iodine No focal uptake anywhere, including kidneys: Consider 'Super scan' with global diffuse uptake in diffuse mets or metabolic conditions (Pagets, hyper-PTH, hyper-T4). Also consider abnormal kidney position (eg. Horseshoe kidney in pelvis).

Question 77

Kidneys: Enlarged Kidneys & Cortical Rim Sign