RD 2017 Flashcards
- 60 year old woman with new well defined mass on mammogram
a. IDC
b. ILC
c. Phyllodes
d. FA
e. Mucinous
*AJL - Answer may be mucinous as these are typically well-defined whereas IDC is typically described as spiculated (though has a variety of appearances). Against this is classic age of mucinous is 75y and IDC 50-60y. Hopefully there are more clues in the question.
- LW - agree with mucinous appearances logic. To blurr the waters….mucinous comparitvely very rare 3% vs common IDC (76%)
- AJL - yes good point, IDC is more common therefore probably most correct
- RY - Could also be phyllodes
a. IDC yes
2. 60 year old woman with new well defined mass on mammogram
a. IDC yes
b. ILC
c. Phyllodes
d. FA
e. Mucinous
*LW: breast cancer subtype frequency: ●Infiltrating ductal – 76 percent ●Invasive lobular – 8 percent ●Ductal/lobular – 7 percent ●Mucinous (colloid) – 2.4 percent ●Tubular – 1.5 percent ●Medullary – 1.2 percent ●Papillary – 1 percent
- MRI knee in a young man, which is true?
a. Medial and lateral collaterals are not in the same plane
- MRI knee in a young man, which is true?
a. Medial and lateral collaterals are not in the same plane
*AJL - MCL is more anterior.
Not relevant for this queswtion but… if LCL is seen on a single coronal plane then it is suggestive of anterior tibial translation.
- Woman with phyllodes
a. Simple excision
b. WLE
c. Follow-up
d. Mastectomy
b. WLE yes
4. Woman with phyllodes
a. Simple excision
b. WLE yes
c. Follow-up
d. Mastectomy
- 2 year old with increasing head size, increased T2 in forceps minor
a. Adrenoleukodystrophy
b. Alexander
c. Canavan
b. Alexander yes
5. 2 year old with increasing head size, increased T2 in forceps minor
a. Adrenoleukodystrophy
b. Alexander yes
c. Canavan
- *LJS - Canavan also has a big noggin and presents in infancy. Can;t find anything specific about forceps minor for either
- ESG - forceps minor = anterior white matter. X-linked adrenoleukodystrophy (and Krabbe) are posterior predominant, Alexander (and metachromatic leukodystrophy) are anterior, and Canavan is diffuse. Both Alexander and Canavan have big heads, Alexander due to obstruction of CSF from swelling of periaqueductal region and basal ganglia
*SCS see summary table in crack the core.
StatDx: canavans:
Congenital: fatal 1st few days
infantile canavans (3-6 months). Fatal in “second year” of life… ? Therefore best available answer as question is written -> Alexander.
- Person with NMO (T)
a. More likely to be bilateraly
b. More common in males
c. Short segment spinal cord
a. More likely to be bilateraly yes
Devic disease. AP4IgG. Bilateral optic neuritis and longitudinally extensive myelitis. F>M
- 70 year old woman with Spinal enlargement from C7-T6, one week leg weakness. High T2 some minor enhancement
a. Tx Myelitis
b. Mets
c. Haemangioblastoma
d. Astrocytoma
a. Tx Myelitis yes
7. 70 year old woman with Spinal enlargement from C7-T6, one week leg weakness. High T2 some minor enhancement
a. Tx Myelitis yes
b. Mets
c. Haemangioblastoma
d. Astrocytoma
- 70 year old woman with 2cm mass in the cerebellum
a. Haemangioblastoma
b. Metastasis
c. Lymphoma
b. Metastasis yes
8. 70 year old woman with 2cm mass in the cerebellum
a. Haemangioblastoma
b. Metastasis yes
c. Lymphoma
- 20 year old guy with 2cm vascular epididymal mass
a. Adenomatoid
b. Lipoma
a. Adenomatoid
WJI: most common paratesticular solid mass is lipoma but this is typically avascular.
Adenomatoid tumour is second most common.
Leiomyoma or sperm granuloma are rarer and heterogeneous.
ADB-> Adenomatoid most common tumour of the “epididymis”, and occur more often in the lower pole than in the upper pole by a ratio of 4:1.
Cystic:
spermatocoele, epididymal cyst, papillary cystadenoma
Hydroceoele, pyocoele, haematocoele, varicocoele
Mets are hypoechoic and you can get cord liposarcoma. Everything else is benign
- 35 year old asian man with multiple fat density lesions posterior and lateral to the caecum and ascending colon, recently returned from singapore
a. Epiploic appendigitis
b. Crohns
c. Diverticulitis
d. Pseudomembranous
a. Epiploic appendigitis yes
10. 35 year old asian man with multiple fat density lesions posterior and lateral to the caecum and ascending colon, recently returned from singapore
a. Epiploic appendigitis yes
b. Crohns
c. Diverticulitis
d. Pseudomembranous
- ESG disagree - “Asian” is a buzzword for right-sided diverticulitis. Epiploic appendagitis usually left-sided, omental infarct right-sided.
- WJI yeah but “fat density” doesnt really suggest diverticulitis
- Which placenta has the least risk of complications
a. Bilobed
b. Succinturiate
c. Membranous
d. Circumvellate
e. Velamentous
a. Bilobed yes
11. Which placenta has the least risk of complications
a. Bilobed yes
b. Succinturiate
c. Membranous
d. Circumvellate
e. Velamentous
- 30 year old woman presents with PV bleeding and pain with hypoechoic region behind the placenta
a. Vasa previa
b. Placenta previa
c. Abruption
c. Abruption yes
12. 30 year old woman presents with PV bleeding and pain with hypoechoic region behind the placenta
a. Vasa previa
b. Placenta previa
c. Abruption yes
- 18 month year old lower leg deformity with anterolateral bowing of the tibia
a. Physiological
b. Blounts
*LW:
Favour this to be incomplete recall:
Bowing refers to which direction the apex of the deformity points.
Stem states tibial bowing (not knee), and anterolateral bowing.
Normal physilogical bowing at knee - genu varum upto 2yrs, then brief valgus angulation upto 3 yrs before normalisation.
Most likely implying normal physiological, although anterolateral tibial bowing is associated with NF1 and pseudo arthorosis.
a. Physiological yes
13. 18 month year old lower leg deformity with anterolateral bowing of the tibia
a. Physiological yes
b. Blounts
*ESG agree NF1. StatDx:
Congenital/Infantile Tibial Bowing
Typically unilateral congenital or infantile diaphyseal deformity
3 classic patterns characterized by direction of apex
Posteromedial
Typically physiologic
Secondary to intrauterine positioning
± associated calcaneovalgus foot deformity
Anteromedial
Associated with fibular hemimelia (range of fibular abnormalities from hypoplastic to absent)
Anterolateral
High association with neurofibromatosis type 1
Bowing is typically at junction of mid to distal 1/3 of tibia
Often with narrowing, sclerosis, or cystic change at apex
May develop fracture & pseudarthrosis
- 20 week scan
a. No follow up of renal pelvises 5-10mm
*LW:
16-28 weeks: AP renal pelvis dilation < 4mm without peripheral calyceal dilation normal and no follow up.
> 28 weeks: AP renal pelvis dilatoin < 7mm without peripheral dilatoin NORMAL with no follow up.
Anything else basically gets follow up imaging, usually at 32 weeks.
- 20 week scan
a. No follow up of renal pelvises 5-10mm - no
*ESG mnemonic 4 x 7 = 28
- 30 year old woman with 5.6cm haemorrhagic cyst
a. No follow-up
b. Follow-up 4 weeks
c. Follow-up 6 weeks
d. Surgery
c. Follow-up 6 weeks 8wks
15. 30 year old woman with 5.6cm haemorrhagic cyst
a. No follow-up
b. Follow-up 4 weeks
c. Follow-up 6 weeks 8wks
d. Surgery
WJI: radiopaedia O-rads: 6-12 week FU for haemorrhagic cyst >5cm
- Medialisation of the ureters
a. AP resection
b. Prostate enlargement
c. Ureterocoele
a. AP resection yes
17. Medialisation of the ureters
a. AP resection yes
b. Prostate enlargement
c. Ureterocoele
Causes of medial deviation:
Upper ureter
Retrocaval ureter
Retroperitoneal fibrosis
Lower ureter Lymphadenopathy Iliac artery aneurysm Bladder diverticulum Post-surgical (esp. AP resection) Pelvic lipomatosis
- 3cm pancreatic mass with hypoechoic well defined lesion in segment 4b, hypoechoic irregular lesion in segment 6 and hyperechoic lesion segment 8. Best to biopsy
a. Pancreatic mass
b. Segment 4 lesion
c. Segment 8 lesion
d. Segment 6 lesion
*LW:
Would favour segment 6 lesion first, easier biopsy, if it proves to be non hepatic malignancy, would aid next step decision with regards to pancreas.
*AJL - Agree with LW. (Have d/w abdo boss)
Previous answer
a. Pancreatic mass yes
- 3cm pancreatic mass with hypoechoic well defined lesion in segment 4b, hypoechoic irregular lesion in segment 6 and hyperechoic lesion segment 8. Best to biopsy
a. Pancreatic mass yes
b. Segment 4 lesion
c. Segment 8 lesion
d. Segment 6 lesion ?
- 45 year old lady with 20cm multilocular pelvic mass
a. Mucinous cystadenocarcinoma
b. Serous cystadocarcinoma
c. Sertoli-leydig
d. Granulosa
a. Mucinous cystadenocarcinoma yes
16. 45 year old lady with 20cm multilocular pelvic mass
a. Mucinous cystadenocarcinoma yes
b. Serous cystadocarcinoma
c. Sertoli-leydig
d. Granulosa
- 3 cm mass in a 45 year old woman with breast cancer. Hypervascular, suppresses on opposed phase, hypointense on delayed (MRI)
a. Mets
b. Adenoma
c. FNH
d. HCC
b. Adenoma yes
19. 3 cm mass in a 45 year old woman with breast cancer. Hypervascular, suppresses on opposed phase, hypointense on delayed (MRI)
a. Mets
b. Adenoma yes
c. FNH
d. HCC
- HIV positive man (50 year old) with multiple hypodense lesion in the liver and spleen
a. Lymphoma
b. Candidiasis
c. Sarcoid
d. SLE
b. Candidiasis yes
WJI: candidiasis would be classic given history of HIV. Lymphoma (larger, less well defined) or sarcoid (more commonly diffuse enlargement) could also have this appearance.
- 35 year old woman with 3mm lumen of distal oesopahgus, smoothly tapered, 3cm dilatation proximally
a. Barrets
b. Carcinoma
c. Achalasia
c. Achalasia yes
WJI: perhaps incomplete recall. This is most characteristic of peptic stricture: 1-4cm long 0.2-2cm wide smooth tapered narrowing of distal oesophageal with some upstream dilatation.
Barrett’s: mid oesophageal stricture typically above a HH
Achalasia: upstream dilatation should be >4cm
Carcinoma: upstream dilatation less pronounced than achalasia but typically irregular and shouldered
- 35 year old woman with 3mm lumen of distal oesopahgus, smoothly tapered, 3cm dilatation proximally
a. Barrets
b. Carcinoma
c. Achalasia
c. Achalasia yes
21. 35 year old woman with 3mm lumen of distal oesopahgus, smoothly tapered, 3cm dilatation proximally
a. Barrets
b. Carcinoma
c. Achalasia yes
- Pain 2nd/3rd intermetatarsal spaces with compressible hypechoic pockets in the subcutaneous fat overlying metatarsal heads
a. Adventitial bursitis
b. Intermetatarsal bursitis
c. Mortons neuroma
a. Adventitial bursitis yes
23. Pain 2nd/3rd intermetatarsal spaces with compressible hypechoic pockets in the subcutaneous fat overlying metatarsal heads
a. Adventitial bursitis yes
b. Intermetatarsal bursitis
c. Mortons neuroma
IVM: Disagree. Favour intermetatarsal bursitis.
Adventitial bursitis: anechoic, affects plantar fat pad near MT head 1st and 5th
Intermetatarsal bursitis is between 2 metatarsal heads dorsal to the intermetatarsal ligament. Hypoechoic. Compressible/resolves with compression.
Mortons neuroma : perineural fibrosis around the plantar digital nerve. Nodule plantar to the intermetatarsal ligmament. Hypoechoic. Not compressible according to RD. Most common sites 2nd and 3rd intertarsal spaces
- MRI, what increases signal to noise ratio
a. Decreasing voxel size
b. Decreasing field strength
c. Increased phase encoding gradients
all wrong
- MRI, what increases signal to noise ratio
a. Decreasing voxel size - no, SNR linearly proportional to voxel volume. Increasing FOV or reducing matrix size would incr SNR (by incr voxel volume)
b. Decreasing field strength - F
Although a number of complex factors determine image quality, signal-to-noise is approximately proportional to field strength. All other things being equal, therefore, the signal-to-noise ratio will be smaller in a lower-field scanner. Consequently, to maintain equivalent signal-to-noise, more signal averages and longer imaging times will be necessary in a lower-field scanner.
c. Increased phase encoding gradients
- Sequestration
a. Intralobar drains to pulmonary veins
b. Extralobar supplied by coeliac axis
c. Most common LUL
d. Most common RML
a. Intralobar drains to pulmonary veins yes
25. Sequestration
Systemic arterial supply: Thoracic or abdominal aorta (80%) Other (15%): Splenic, gastric, subclavian, intercostals Multiple arteries (20%)
WJI: can be supplied by coeliac trunk but agree with a as most correct
- Endoleak due to porous graft
a. Type 1
b. Type 2
c. Type 3
d. Type 4
e. Type 5
d. Type 4 yes
26. Endoleak due to porous graft
a. Type 1
b. Type 2
c. Type 3
d. Type 4 yes
e. Type 5
- Type of Choledocal cyst that bulges into duodenum
a. Type 1
b. Type 2
c. Type 3
d. Type 4
e. Type 5
c. Type 3 yes
27. Type of Choledocal cyst that bulges into duodenum
a. Type 1
b. Type 2
c. Type 3 yes
d. Type 4
e. Type 5
- Nigerian man with calcified bladder wall and sessile mass
a. SCC
b. Adenocarcinoma
c. TCC
a. SCC yes
28. Nigerian man with calcified bladder wall and sessile mass
a. SCC yes
b. Adenocarcinoma
c. TCC
**SCS: [StatDx] associated with Schistosomiasis (Bilharzia of bladder). Fluke worm.
Best clue: curvilinear bladder wall calcification in px from endemic area - ie Africa, India, Middle East.
Can also involve Ureters.
Acute and Chronic phases (contracted shrunken bladder, curvi calcification = eggs).
DDX of bladder wall calc: includes TB, urolithiasis.
Associated with SCC - chronic inflammation.
Urachal remnant = adeno.
TCC most common type of bladder ca
- Small bowel true
a. Benign mass more common than malignant
b. Carcinoid most common malignancy in the distal small bowel
c. P-J adenomatous polyposis syndrome
d. Lymphoma most common proximal small bowel
e. Intusseption the most common presentation
*LW:
b. Carcinoid most common malignancy in the distal small bowel: TRUE; with regards to distal small bowel most at risk for carcinoid and lymphoma, with carcinoid more common than lymphoma.
(- Mets are more common than primaries. Adenocarcinoma 30-50%, carcinoid 25-30%, leiomyosarcoma 10%, lymphoma 15-20%.)
- Small bowel true
a. Benign mass more common than malignant:
If referring to neoplasms, this is false with approx. 60% of small bowel neoplasms being malignant.
b. Carcinoid most common malignancy in the distal small bowel: TRUE; with regards to distal small bowel most at risk for carcinoid and lymphoma, with carcinoid more common than lymphoma.
(- Mets are more common than primaries. Adenocarcinoma 30-50%, carcinoid 25-30%, leiomyosarcoma 10%, lymphoma 15-20%.)
c. P-J adenomatous polyposis syndrome: FALSE, Peutz jehgers syndrome is non neoplastic multiple hamartomatous polyps, being one of the polyposis syndromes. Although polyps are not malignant them selves, there is an increased risk of adenocarcinoma.
d. Lymphoma most common proximal small bowel: FALSE - ileum.
e. Intusseption the most common presentation: FALSE - Abdominal pain, weight loss, nausea, and vomiting were the most common presenting symptoms for small bowel tumors, radiologically: masses, concentreic lumen narrowing, complete bowel obstruction, circumfrential wall thickening of lymphoma, ulceration. Atypical imaging findings include intussecption.
(https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3473441/)
Previous answers;
29. Small bowel true
a. Benign mass more common than malignant -yes
b. Carcinoid most common malignancy in the distal small bowel -yes
c. P-J adenomatous polyposis syndrome
d. Lymphoma most common proximal small bowel
e. Intusseption the most common presentation
