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WlwG Old > WlwG Revision & Mnemonics > Flashcards

WlwG Revision & Mnemonics Flashcards

1
Q

Lung ILD Upper Conditions

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

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2
Q

Lung ILD Diffuse Conditions

A

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

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3
Q

Lung ILD Lower Conditions

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

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4
Q

Lung Paeds Lucencies

A

“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

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5
Q

Trachea Narrowing/Dilated Conditions

A
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6
Q

Anterior Mediastinum

A

(“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

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7
Q

Middle Mediastinum

A

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

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8
Q

Posterior Mediastinum

A

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

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9
Q

Oesophageal Dilations

A

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

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10
Q

Stomach Ulcers

A

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

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11
Q

Gastric Polyps

A

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”)

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12
Q

GIT Ulcers and Colitis

A

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

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13
Q

Liver Summary by Age/Bloods

A

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)

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14
Q

Liver Diffuse Diseases

A

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

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15
Q

Liver Disease by Shapes

A

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

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16
Q

Liver Conditions MRI

A
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17
Q

Pancreas Focal Cystic or Solid Neoplastic conditions

A

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

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18
Q

Adrenal Tumours

A

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

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19
Q

Peritoneal Conditions

A

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

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20
Q

Kidney Conditions

A

**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

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21
Q

Renal Paediatric Solid conditions

A

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

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22
Q

Renal Paediatric Cystic/Misc conditions

A

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

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23
Q

Testes Paeds conditions

A

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

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24
Q

Testes Adult conditions

A

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

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25
Q

Ovarian Conditions

A

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

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26
Q

Ortho Muscle Attachments

A

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)

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27
Q

Ortho US Shoulder

A

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

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28
Q

Ortho Bone Neoplastic: Lucent-Narrow

A

***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”)

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29
Q

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

A

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)

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30
Q

Ortho Bone Neoplastic: Sclerotic-Narrow

A

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

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31
Q

Ortho Bone Neoplastic: Wides

A

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

32
Q

Ortho Bone Neoplastic: Multiple/Diffuse conditions

A

“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.

33
Q

Ortho Bone Neoplastic: Benign Lytic lesions

A
34
Q

Ortho Soft Tissue Masses

A

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

35
Q

Ortho Joint Disease - Degenerative

A

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”)

36
Q

Ortho Joint Disease - Inflammatory

A

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”)

37
Q

Ortho Joint Disease - Metabolics

A

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).

38
Q

Ortho Marrow Diseases

A

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”)

39
Q

Ortho Paediatric Non-accidental Injury Suspicions

A

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)

40
Q

Ortho Paediatric Non-accidental Injury Investigations

A

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.

41
Q

Spine Inflammation

A

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”)

42
Q

Spine Demyelination

A

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)

43
Q

Spine Tumours

A

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

44
Q

Spine Dermatomes

A

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

45
Q

Spine Myotomes

A

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”)

46
Q

Spine Reflexes

A

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

47
Q

Neuro Neoplastic: General

A

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

48
Q

Neuro Neoplastic: Child Temporal Lobe

A

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

49
Q

Neuro Neoplastic: Adult

A

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

50
Q

Neuro Neoplastic: Child Infra-Tentorial

A

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”)

51
Q

Neuro Neoplastic: CPA

A

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)

52
Q

Neuro Neoplastic: Ventricles/Choroid

A

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”)

53
Q

Neuro Neoplastic: Skull Base

A

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

54
Q

Neuro Foramen

A

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)

55
Q

Neuro Grey Matter Issues

A

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.

56
Q

Neuro White Matter Issues

A

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

57
Q

Neuro Basal Ganglia Issues: T1-hypers

A

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”)

58
Q

Neuro Basal Ganglia Issues: T2-hypers

A

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.

59
Q

Neuro Basal Ganglia Issues: Smalls

A

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.

60
Q

Neuro Toxins

A

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

61
Q

Neuro Paeds Developmental Disorders

A

(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)

62
Q

Ear Pulsatile Tinnitis

A

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)

63
Q

Ear Inflammation

A

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

64
Q

Sinus Conditions

A

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

65
Q

Neck Branchial Cleft Anomalies

A

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”)

66
Q

Neck: Para-Pharyngeal Space Displacemet

A
67
Q

Cardio: Congenital Heart Disease

A
68
Q

Cardio: Congenital Heart Disease part 2

A
69
Q

Cardac Tumours

A

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

70
Q

Cardiomyopathy

A

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

71
Q

Cardiac MRI

A
72
Q

Cardiac Investigations

A

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

73
Q

Vasculitis

A

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

74
Q

IR Which Vessel

A

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

75
Q

Nuclear Medicine Summary

A

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”)

76
Q

Nuclear Medicine: Recognising Tracer based on highest organ uptake

A

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).

77
Q

Kidneys: Enlarged Kidneys & Cortical Rim Sign

A

WlwG Old (22 decks)

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