auckland course 2022 Flashcards
A 25 year=old woman presents with amenorrhoea and hyperandrogenism, US identifies a 4cm ovarian mass. This is most likely in keeping with:
• Sertoli-Leydig tumour
• Granulosa cell tumour
• Dermoid cyst
• Serous cystadenoma
• Mucinous cystadenoma
• Sertoli-Leydig tumour
A newborn presents with an enlarged scrotum. On ultrasound, multiple irregular calcifications are noted within the scrotum. Which of the following is the most likely diagnosis?
• Tuberculous peritonitis
• Meconium peritonitis
• Neuroblastoma
• Haemangiomatosis
• Teratoma
Meconium peritonitis
**SCS: Radiopaedia. if the processus vaginalis is patent at time of perforation, calcification may also be seen in scrotum.
A 45 yr old man with ulceration of the nasal septum was investigated further with CT sinuses. CT shows bone destruction involving the nasal cavity, turbinates and paranasal sinuses without associated soft tissue masses. CXR done to exclude infection showed multiple nodules , masses of varying sizes. Which is the most likely diagnosis?
• Granulomatosis polyangitis
• Churg-Strauss syndrome
• Leprosy
• Ethmoid carcinoma
• Polyarteritis nodosa
Granulomatosis polyangitis
A contrast enhanced CT abdomen shows an incidental renal cyst that is hyperdense with thick septations and a mural nodule. What is the Bosniak classification of the cyst?
• Type 2F
• Type 1
• Type 3
• Type 2
• Type 4
Type 3
SCS: Radiopaedia
B1: benign
B2: benign “minimally complex”
B2F: minimally complex
B3: indeterminate: thick septa w enhancement.
B4: clearly malignant
IV with mural nodule
A 25 year-old woman with multiple skin lesions presents to ophthalmologist with worsening of vision. MRI brain and orbits reveal a thickened enhancing right optic nerve with further focal areas of T2 hyperintensities in the brain stem and basal ganglia. What is the most likely diagnosis?
• Tuberous sclerosis (TS) - Optic neuritis
• Neurofibromatosis type 1 (NF1) - Optic glioma
• Neurofibromatosis type 2 (NF2) - Optic tract meningioma
• Von Hippel-Lindau (VHL) - Optic haemangioblastoma
- Multiple sclerosis (MS) - Optic neuritis
• Neurofibromatosis type 1 (NF1) -
**SCS: skin neurofibromata, optic nerve glioma (indolent. pilocytic Astro) and FASI lesions - commonly identified in the basal ganglia (often the globus pallidus), thalamus, brainstem (pons), cerebellum, and subcortical white matter in children with neurofibromatosis type 1 (NF1)(Radiopaedia).
Which of the following is correct in regard to Morton’s neuroma?
• Symptoms improve with activity
• Are generally poorly defined and echogenic on ultrasound
• Show little to no enhancement with gadolinium
• Are male predominant
• Are most common in the web space between the third and fourth metatarsals
Are most common in the web space between the third and fourth metatarsals
SCS: radiopaedia.
-chronic entrapment of the nerve by intermetatarsal ligament.
-Variable enhancement
-Well defined on USS (hypoechoic, dumbellshaped, non-compressible, sono-Mulder sign- displacement in plantar direction on MT squeeze)
3-4MT space most common location
10% bilateral.
More common in women
White matter signal abnormalities seen on T2-weighted MR images of the brain in children with sensorineural hearing loss are most often attributed to:
• Cytomegalovirus infection
• Hypoxic ischemic encephalopathy
• Birth trauma
• Leukodystrophy
• Associated inner ear malformation
Cytomegalovirus infection
A patient with a lung mass consistent with an extralobar pulmonary sequestration demonstrates:
• None of the above
• Systemic blood supply and systemic venous drainage
• Pulmonary arterial supply and systemic venous drainage
• Pulmonary arterial supply and pulmonary venous drainage
• Systemic blood supply and pulmonary venous drainage
Systemic blood supply and systemic venous drainage
An 80 year-old female presented with jaundice and symptoms of biliary colic. She has a history of cholelithiasis and previously underwent ERCP with sphincterotomy. On T2 images of MRCP, there is evidence of pneumobilia and gravel-like gallstones in the gallbladder. In the moderately dilated distal CBD, there is a flow void measuring 4 mm. Which of the following would support this being a locule of gas?
• The signal void is high signal on gradient-echo T1 images
• The signal void has an angulated outline
• The signal void is outlined by high T2 signal
• The signal void is at the dependent aspect of the bile duct
• The signal void shows blooming on dual echo gradient-echo T1 images
The signal void shows blooming on dual echo gradient-echo T1 images
A 20 year-old presents with a partially cystic cortically based mass in the frontal lobe with a mural nodule and calcification. Most likely diagnosis is:
• Oligodendroglioma
• Dysembryoplastic neuroepitheliel tumour (DNET)
• Gangiolioma
• Low grade astrocytoma
• Pilocytic astrocytoma
Oligodendroglioma
wji- ganglioglioma is a pretty reasonable alternative. More commonly temporal lobe but 50% calcify and more commonly described as cyst with a nodule than oligodendroglioma (partially cystic mass).
What is the most common anomalous drainage of the biliary system?
• Drainage through the ducts of Luschka
• Trifurcation of the confluence
• None of the above
• Right posterior duct insertion into left hepatic duct above the confluence
• Cystic duct insertion into left hepatic duct
Right posterior duct insertion into left hepatic duct above the confluence
SCS: radiopaedia agrees.
RPSD draining to LHD = ~15%
Extra trivia:
option A = subvesical bile ducts = cholecysto-hepatic ducts (usually to segment 5). Cause of bile leak post cholecystectomy.
As the senior radiology registrar, you are requested to conduct the ICU conference. Which of the following lines and tubes are considered to be abnormally positioned in chest / abdominal radiographs?
• A caval filter with its tip at the level of the 3rd lumbar vertebra
• Intra-aortic balloon pump with its tip at the level of 8th thoracic vertebra
• Nasogastric tube with its tip in the left upper quadrant
• Central venous catheter with its tip at the same level as the carina
• Endotracheal tube with its tip between the medial ends of clavicles
Intra-aortic balloon pump with its tip at the level of 8th thoracic vertebra
-Loo low: obstructs splanchnic circulation.
-L3 IVC filter: typically infra-renal. Renal veins at L2- correct.
ETT, NGT ans IJV are satisfactory
A 15 year0old boy with haemophilia presents to his GP with progressive worsening of right knee pain. Plain radiographs excluded a fracture. All of the following are features of haemophilic arthropathy affecting the knee except:
• Flattened femoral condyles
• Squared patella
• Widened intercondylar notch
• Epiphyseal enlargement
• Erlenmeyer flask deformity
Erlenmeyer flask deformity
What aortic segment is most often affected by Takayasu’s arteritis?
• Descending thoracic aorta
• Ascending thoracic aorta
• Abdominal aorta
• Aortic root
• Aortic arch
SCS: favour arch
-Stat dx location: thoracic aorta and arch branches.
-L SCA- most commonly involved (Dahnert corroborates this)
-Big robbins 9th Ed “ transmural fibrous thickening of the aorta PARTICULARLY aortic arch and great vessel
-this is wrong in the Auckland answers
Additionally (Big robbins)
- 1/3 affects remainder of aorta, pulmonary artery/ coronary and renals in half of these cases
-Histology is indistinguishable from GCA. Distinction is made based primarily on Age. >50 GCA, <50 TA.
A 50 year-old woman with a long standing history of Crohn’s disease is referred for CT enterography for assessment of disease status. Which of the following statements regarding the CT evaluation of Crohn’s disease is TRUE?
• A thickened hyperenhancing bowel wall is a sign of active disease
• Mural stratification is characteristic of Crohn’s disease
• Perianal disease is uncommon
• Submucosal fat deposition is an early sign of Crohn’s disease
• The comb sign is a non specific sign of Crohn’s disease
• A thickened hyperenhancing bowel wall is a sign of active disease
comb sign:The sign may be seen on both CT and MRI. It is not pathognomonic of Crohn disease; however, in a known case of Crohn disease would suggest that the disease was extensive, advanced and active. However, the comb sign can be seen in other acute inflammatory conditions of bowel and lupus mesenteric vasculitis.
With regard to Gadolinium brain deposition, which of the following is true?
• All Gadolinium based products can cause brain deposition
• It is not related to the total dose of contrast given
• It causes a movement disorder similar to Parkinson’s disease
• It can be prevented by giving pre-hydration
• It can cause T1 shortening in the dentate nuclei
It can cause T1 shortening in the dentate nuclei.
SCS:
T1 shortening confusingly means more signal.
Stat dx: gad deposition causes intrinsic T1 hyperintensity in Dentate nucleus and globus pallidus. Normal T2. No blooming/DWI.
RF= Repeated exposure
Dechelation from its ligand plays a role
WJI:
other answer that seemed reasonable was that all gad agents cause deposition but this is incorrect there’s no evidence of deposition with macrocyclics
Which of the following pulse sequences is most appropriate to confirm chronic muscle denervation?
• STIR
• Gadolinium enhanced fat suppressed T1
• T1
• Gradient echo
• T2
T1
**SCS: T1- fatty atrophy
Acutely, muscle bulk preserved, high T2 signal = oedema. Think Parsonage Turner etc.
A 42 yr old man presents with severe headache and is sent for a CT scan of the brain which was normal. MRI shows loss of normal flow voids in vessels in the basal cisterns with intense enhancement along the cisterns on post contrast scans. Which is the most likely diagnosis?
• Ruptured dermoid cyst
• Lymphoma
• Subarachnoid haemorrhage
• Creutzfeldt-Jakob disease
• Tuberculous meningitis
Tuberculous meningitis
Which of the following is LEAST likely to cause a “super scan” appearance on a 99Tc MDP bone scan?
• Widespread bone metastasis from prostate cancer
• Hyperthyroidism
• Mastocytosis
• Renal osteodystrophy
• Multiple myeloma
Multiple myeloma
40 year-old male in MVA has distal transection of the pancreatic tail that involves the distal duct. What grade injury is it as per AAST?
• Grade 2
• Grade 5
• Grade 1
• Grade 3
• Grade 4
Grade 3
**SCS AAST:
Grade 1: haematoma with minor contusion
Grade 2: major contusion or laceration without duct injury
Grade 3: distal transection or deep parenchymal injury with duct injury
Grade 4: proximal transection or deep parenchymal injury involving ampulla (and/or intra-pancreatic CBD)
Grade 5: massive disruption of pancreatic head (shattered panc).
Which of the following is FALSE regarding normal progression of myelination in a newborn?
• Central to peripheral
• Sensory & projectional pathways before association pathways
• Motor to sensory
• Dorsal to ventral
• Caudal to rostral
Motor to sensory
central to peripheral “inside out”
caudal to rostral “bottom up”
dorsal to ventral “back to front”
sensory then motor
normal at birth:
dorsal brainstem
posterior limb internal capsule
perirolandic gyri
CC FORMS from genu to splenium (then rostrum last) but MYELINATES from splenium to genu
Moyà Moyà disease is less likely to occur in which of the following disease ?
• Neurofibromatosis type 1
• Radiation injury
• Sickle cell disease
• Down syndrome
• Amyloidosis
Amyloidosis -FALSE.
**SCS: Nb: moyamoya disease should be reserved for an idiopathic, sometimes familial condition which leads to the characteristic vascular changes…
Other causes (listed above) = MM syndrome (or phenomenon/pattern).
Just thought I’d flex given they put cute wee the macros in…
Radiation induced vasculopathy- true
NF1- true (also TS, Ehlers-Danlos/Marfans)
Downs- true
Sickle cell- true
Additional causes:
CTD: SLE, antiphospholipid
Blood dyscrasias: sickle cell, PCV, ET, aplastic anaemia
Infection: TB
Less common causes: Downs, UC, Graves
A 55 year-old woman with abdominal pain and bloody diarrhoea is undergoing imaging for suspected inflammatory bowel disease. Which of the following is more common in ulcerative colitis than Crohn disease?
• Fissuring ulcers
• Vitamin B12 malabsorption
• Toxic megacolon
• Colovesical fistula
• Fibrosing strictures
Toxic megacolon
A 2 yr old presents with fever, erythema of oral mucosa and cheat and abdominal pain. Echocardiogram reveals the presence of coronary artery aneurysms. An underlying vasculitis is suspected. Which of the statements is LEAST accurate in this clinical setting?
• Multiple coronary artery aneurysms are more common than isolated aneurysms
• The most common site of coronary aneurysm is the left anterior descending artery
• Aneurysms are typically seen in the proximal segments of the coronary arteries
• Aneurysms less than 5 mm in diameter are considered small
• Smaller aneurysms have a higher likelihood of thrombosis
smaller aneurysms have higher likelihood of thrombosis.
In a 3 month old, what is the most likely aetiology of an echogenic renal mass?
• Multicystic dysplasia
• Mesoblastic nephroma
• Rhabdoid tumour
• Neuroblastoma
• Wilm’s tumour
Mesoblastic nephroma
A middle aged man is diagnosed on imaging with suspected laryngeal carcinoma. Which of the following factors would favour a diagnosis of adenoid cystic carcinoma over squamous cell carcinoma?
• Propensity of nerve invasion
• Invasion through the laryngeal cartilage
• Supraglottic extension
• Involvement of regional neck lymph nodes
• A history of long term smoking
Propensity of nerve invasion
Which is the most important anatomical land mark in the paediatric upper GI examination ?
• Gastric fundus
• Gastric antrum
• Pyloric canal
• Gastro-oesophageal junction
• Duodenojejunal junction
Duodenojejunal junction
A 30 year-old presents with a foot injury with Lisfranc fracture dislocation confirmed on plain films. Which two bones does the Lisfranc ligament attach to?
• First metatarsal and medial cuneiform
• First and second metatarsals to the medial and intermediate cuneiform
• Second metatarsal and intermediate cuneiform
• First metatarsal and intermediate cuneiform
• Second metatarsal and medial cuneiform
Second metatarsal and medial cuneiform
An ICU patient who suffered a PEA cardiac arrest had fixed pupils. She was subjected to CT head and dual phase CT angiogram (at 20 and 60 sec delays) to assess for brain death. Which of the following is the most specific and sensitive sign of brain death?
• Non opacification of posterior circulation and dural venous sinuses
• Diffuse loss of grey-white differentiation of the entire brain
• Non opacification of cortical segments of MCA s and internal cerebral veins
• White cerebellar sign
• Loss of arterial flow beyond the ICA termini
• Loss of arterial flow beyond the ICA termini
Course answer: Non opacification of cortical segments of MCA s and internal cerebral veins
statdx: No flow in intracranial arteries or venous sinuses
**SCS: these answers are taken from radiopaedia [Brain Death]
C - is what Radiopaedia says on CTA
E- seem right but is a DSA finding.
Not sure why the two are different… make your own mind up
A 30 year-old woman presents acutely with seizure, fever and headaches followed by rapid deterioration to coma. MRI shows asymmetrical swelling of the anterior temporal lobes on T1W. T2W images reveal concordant asymmetrical but bilateral areas of high signal in the anterior temporal lobes, insular cortices and hippocampi. There is no enhancement following administration of intravenous gadolinium. What is the most likely condition?
• Herpes simplex encephalitis
• Cytomegalovirus encephalitis
• Lymphoma
• HIV encephalitis
• Toxoplasmosis
Herpes simplex encephalitis
wji - enhancement often absent in first week. DWI is more sensitive than T2.
A middle aged woman presents with headaches and papilloedema and is suspected of having idiopathic intracranial hypertension. Which of the following are true features of this entity?
• MRI reliably diagnoses the condition
• Ventricles are always small
• Cranial nerve palsies do not occur
• Subarachnoid fluid is decreased
• Spontaneous remission often occurs
Course answer: Spontaneous remission often occurs
Prior answers:
SCS: All seem false, maybe MRI reliably diagnoses the condition.
-Radiopaedia: “slit like ventricles (relatively uncommon cf. other findings “. StatDx says this is a poor imaging finding of IIH).
-Neuro exam often normal but can get 6th nerve palsy sometimes.
-MRI may be reliable incorrect demographic, but they get sent to IR for stabby in the back for manometry…
-Subarachnoid fluid - doesn’t decrease, just under increased pressure.
*WJI: I would chose subarachnoid fluid is decreased. Statdx describes “tight subarachnoid spaces”
Pathological lead points are found in what percentage of paediatric intussusception?
• 25%
• 1%
• 95%
• 40%
• 5%
5%
RP: “In children, a lead point is not identified in 90% of cases, and this is most frequently thought to relate to hypertrophic lymphoid tissue following an infection”. 90% infants and adults have lead point
A 22 year-old woman who had undergone a Caesarean section presents with cyclic voiding symptoms but no haematuria. Cystoscopy revealed no abnormality. Diagnosis of bladder wall endometriosis was made following pelvic MRI. Which of the following statements is FALSE regarding deep pelvic endometriosis?
• Low signal nodular thickening of uterosacral ligaments on T2W images
• Ureteric endometriosis is mostly intrinsic
• Endometriotic nodules can have high T2 signal
• Obliteration of pouch of Douglas is seen in advanced disease
• Subperitoneal invasion of endometriotic tissue must exceed 5 mm
Ureteric endometriosis is mostly intrinsic
The LEAST common cause of neonatal distal bowel obstruction is:
• Hirschsprung disease
• Meconium ileus
• Colonic atresia
• Meconium plug
• Ileal atresia
Colonic atresia
Barium swallow of a 61 year-old man who presented with dysphagia showed a smooth filling defect in the mid oesphagus with mild hold up contrast and proximal oesophageal dilation. CT chest performed did not show any extra oesophageal organ involvement or lymphadenopathy. The most common mesenchymal tumour of the oesophagus is:
• Gastrointestinal stromal tumour
• Leiomyoma
• Leiomyosarcoma
• Lipoma
• Haemangioma
Leiomyoma
While performing shoulder ultrasound, how would you position the patient for optimal assessment of the subscapularis tendon?
• External rotation with elbow flexed at 90 degrees
• Abduction, elbow extended
• Internal rotation with arm behind back
• Hand touching opposite shoulder
• Neural position with elbow flexed at 90 degrees
External rotation with elbow flexed at 90 degrees
Regarding trans-jugular intrahepatic portosystemic shunts (TIPS), which of the following is FALSE?
• Haemobilia is an early complication
• Right-sided heart failure is a relative contraindication
• Embolisation of varices can be performed as part of the procedure
• The aim is to produce a portosystemic shunt gradient of approximately 5mm Hg
• Ultrasound is accurate in the assessment of shunt patency
The aim is to produce a portosystemic shunt gradient of approximately 5mm Hg
WJI <12mmHg.
TUS: According to Core, right-sided heart failure is an absolute contraindication.
At the weekly general medicine conference, a question was raised with regard to the association of cardiac disease with situs anomalies. Which of the following presents with more serious congenital heart disease?
• Situs inversus with dextrocardia
• Situs solitus
• Situs ambiguous with polysplenia
• Situs ambiguous with asplenia
• Situs inversus with levocardia
Situs ambiguous with asplenia
12 year old presenting with a seizure and MRI showing a solid, cortically based temporal lobe mass. What is the most likely diagnosis?
• Ependymoma
• Anaplastic astrocytoma
• Pilocytic astrocytoma
• Dysembryoplastic neuroepithelial tumors (DNET)
• Pleomorphic xanthoastrocytoma
• Pleomorphic xanthoastrocytoma
SCS: Additional notes:
PXAs very often have cystic component. But may be solid. They haven’t given us enhancement characteristics which would help distinguish.
PXA StatDx:
“ cyst and enhancing mural nodule typical”
“Enhancing nodule abuts Paul surface”
Radiopaedia also mentions cyst w mural nodule.
DNET: bubbly CYSTIC.
Ependymoma: Posterior fossa.
JPA: cyst w C+ mural nodule.
A 38 year old woman presents with abdominal pain. She has previously had a gastric lap band procedure. Fluoroscopy demonstrates a 90 degree phi angle, an air fluid level, and gastric emptying at 30 minutes. Which of the following is most likely?
• Erosion of band into stomach
• Normal appearances
• Overinflated band
• Improper initial placement of band
• Slipped gastric band
Slipped gastric band
**SCS: phi angle 4-58 deg = normal
Greater than 60 deg ABNORMAL.
Measured on AP view, relative to a vertical line/ie the spine.
