RD MCQ 2013 September WA: Formatted Flashcards

1
Q
  1. Woman with gastric band with abdominal pain. UGI shows phi angle 90, emptying time 90 mins
    a. Normal
    b. Slippage
    c. Over inflation
    d. Erosion into stomach
A

b. Slippage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. 99m - what does ‘m’ mean
    a. Metastable
    b. Man made
    c. Molybdenum
    d. Mass
A

a. Metastable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. Which of the following lymphomas shows low PET uptake
    a) Mycosis fungoides
    b) B cell modular sclerosis
    c) T cell burkitt peripheral T cell and indolent B cell (such as marginal zone, SLL, primary FL)
    d) Burkitts
    e) Nodular sclerosis
A

c) T cell burkitt peripheral T cell and indolent B cell (such as marginal zone, SLL, primary FL)

*LW:
Types of lymphoma that can be false negative on PET.
MZLs, peripheral T-cell lymphomas, small lymphocytic lymphomas, and primary FLs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. Tc99m Regarding imaging with Tc 99m, which is FALSE?
    a. The half-life of Tc 99m is 8 hours, making it suitable for imaging
    b. The decay product, Tc 99, doesn’t cause additional radiation to the patient.
    c. Tc 99m emits only gamma radiation.
    d. The range of energies emitted is 50 kev to 5000 kev
A

*LW:
Needs review:

a. The half-life of Tc 99m is 8 hours, making it suitable for imaging: FALSE - 6 hrs, but this makes it ideal for imaging.
b. The decay product, Tc 99, doesn’t cause additional radiation to the patient. Also false although minimal.
c. Tc 99m emits only gamma radiation: false. Also internal conversion (high energy electrons). Gamma is 88%.
d. The range of energies emitted is 50 kev to 5000 kev: 99 % are at 140 keV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. Boy with bone pain, cardiomegaly, wide ribs, decreased vertebral height
    a. Sickle
    b. Thalassaemia
    c. Aplastic anaemia
    d. Glycogen storage
A

a. Sickle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. Eosinophilic granuloma in a child – which is least supportive?
    a) Associated with mass
    b) Involvement of posterior elements
    c) Wedge shaped compression
    d) Involvement of other bones
A

*LW: Preferred answer is B:

A. Small Paraspinal soft tissue has common.
B. Involvement of posterior elements is rare / excitedly unusual / uncommon finding. Thus favoured answer being least supportive.
C. Vertebral plana is a common feature, while wedge compression or uneven lateral compression is enchanted in early stages.
(radiographics 1992)

Radiographic states: EG can initially cause wedge like or uneven lateral compression of vertebral bodies, before developing complete vertebra plana.
Often multifocal
Commonly small para spinal soft tissue mass.
Involvement of posterior elements uncommon / destruction of posterior elements is atypical - hence most unlikely.

b) Involvement of posterior elements

Also no wedging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. Patient with known prostate cancer presents with back pain and leg weakness (note that no history of radiation was given). By the time patient presents to the scanner, he is catheterized and power in the legs is 2/5. Which of the following is most likely?
    a) Cord infarct
    b) Transversemyelitis
    c) Leptomeningeal metastases
    d) Radiation myelitis
A
  • LW:
    a) Cord infarct: possible, but no vascular risk factors provided, so less likely. Presents abruptly with acute onset. May be answer if question stem provides an abrupt time frame.

b) Transversemyelitis: favoured Dx given acute onset and sphincter and motor involvement. Usually presents over days to weeks. Can also be associated with known malignancy.
c) Leptomeningeal metastases: unlikely.
d) Radiation myelitis: delayed onset radiation myelitis, possible, given malignancy Hx, but less likely given no mention of treatment.

Previous answers:
a) Cord infarct because of time course

  1. Patient with known prostate cancer presents with back pain and leg weakness (note that no history of radiation was given). By the time patient presents to the scanner, he is catheterized and power in the legs is 2/5. Which of the following is most likely?

a) Cord infarct because of time course
b) Transversemyelitis could be.
c) Leptomeningeal metastases
d) Radiation myelitis too fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. Tarlov cyst
    a) Most commonly S1,4
    b) Causes bone erosion
    c) Confused for mets on CT
    d) More than one indicates genetic disease
A

b) Causes bone erosion

*LW: causes boney remodelling not erosion per say.
Most common S2 S3
Hopefully not confused for Mets
Can be multiple in absence of genetic disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Portovenous CT of renal trauma with laceration into pelvis, no contrast blush, surrounding collection. What is next best step?
    a) CT angiogram
    b) Catheter angiogram
    c) Excretory CT
    d) Repeat scan tomorrow
    e) Drain the collection
A

c) Excretory CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Liver biopsy patient hypotensive
    a) Atropine 0.6mg
    b) Lignocaine
    c) Various doses of adrenaline but none according to RANZCR guidelines.
A

a) Atropine 0.6mg Assuming that they are bradycardic. Never actually seen this being done, usually trendelenburg, O2, time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Lung biopsy of cavitary lesion, as you remove inner stylet, patient coughs and develops seizures
    a) Air embolism
    b) Pericardial tamponade
A

a) Air embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. Following contrast CT, you notice lucent (this was the word used) area in the right atrium. Which of the following is not a recognised treatment?
    a) Trendenlenburg
    b) 100%oxygen
    c) Left lateral decubitus
    d) Restore cardiopulmonary circulation
A

All are I would have thought.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Elderly man falls down a ladder. CXR shows several left sided rib fractures and a pneumothorax. Which of the following is an indication for urgent treatment of the pneumothorax?
    a) Diaphragmatic depression
    b) Sharp pleural line
    c) Air fluid level
    d) Ipsilat mediastinal shift
    e) No peripheral lung markings
A

*LW:
Majority of options describe a PTx, no indication as listed under the BTS are listed here.
If there was contra lateral shift - this would require active intervention.
Patient symptomatic regardless of size - requires active treatment.
Diaphragmatic depression, is likely most suggestive of developing tension out of optins listed - hence preferred option.

a) Diaphragmatic depression: sign of PTx - favoured option
b) Sharp pleural line : sign of a PTx
c) Air fluid level : sign of a haemoPTx
d) Ipsilat mediastinal shift: not tension, not usually associated with PTx.
e) No peripheral lung markings: sign of Ptx.

**LJS - agree. Suspect diaphragmatic depression is supposed to indicate increasing pressure in that pleural space and suggest a degree of tension

a) Diaphragmatic depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. Patient with bladder dome tumour. Which is best method for TNM staging?
    a) PET CT
    b) MRI pelvis
    c) CT pelvis
    d) Cystoscopy
    e) TRUS
A
  • LW: B - MRI pelvis.
    a) PET CT: FALSE - urinary excretion of radio tracer into bladder.
    b) MRI pelvis: true, T stage deemed most important and treatment altering, for which MRI best at. Can also detect nodal disease in similar / slightly better confidence than CT.
    c) CT pelvis: MR felt superior
    d) Cystoscopy: can’t appreciate serosal or peritoneal spread.
    e) TRUS
    https: //pubs.rsna.org/doi/full/10.1148/rg.322115125

**LJS - the above paper says MRI is “moderately accurate in the diagnosis and local staging of bladder cancer, with cystoscopy and pathologic staging remaining the standards of reference”. Assuming answer d) cystoscopy includes biopsy - ?this remains best local staging method
https://www.ajronline.org/doi/full/10.2214/AJR.16.17114 This more recent (2017) paper says same thing - progress has been made with MRI but there are limitations to its use in local staging
Statdx: cystoscopy and bx for T stage. If there is muscle invasive disease - get imaging as well. MRI is the best imaging modality

Standard CT for N and M staging (though since this isn’t an option I assume the are asking about T staging)
RP says PET is no good for local disease but “has a role to play in the assessment of nodal or distant metastases”

Previous answer:
a) PET CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. Woman with recurrent mid-trimester miscarriage. HSG shows y shaped uterine cavity with single cervix.
    a) Bicornuate
    b) Didelphys
    c) Arcuate
    d) (No septate option)
A

a) Bicornuate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. Which of the following is an indication for chorionic sampling as an isolated 20 wk abnormality?
    A) Clinodactyly
    b) Echogenic cardiac focus
A

Neither are concerning in isolation.

A) Clinodactyly soft sign
b) Echogenic cardiac focus soft sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  1. 28 yo young woman, her mother died of breast ca in her 30’s, her sister has breast ca in her 20’s. Genetic analysis shows she has BRCA2. Based on multicentre trials, what screening advice would you give?

a) No hard evidence that any strategy improves mortality, discuss her risks of increased cancer and ongoing screening needs (No specific screening method was mentioned)
b) Various combinations of mammo, uss, physical at various ages
c) No option of MRI was given

A

*LW:
Hopefully poor recall:

Literature review states annual MRI starting age 25, with annual Mammorgraphy +/- tomo starting from 30.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315500/

Further reading:
https://pubs.rsna.org/doi/full/10.1148/radiol.2019181814

a) No hard evidence that any strategy improves mortality, discuss her risks of increased cancer and ongoing screening needs (No specific screening method was mentioned)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

26, 27. This was actually 2 different questions. I don’t remember which options were in which question. Regarding angiography

a) Profunda best seen in external rotation
b) Adductor canal is in lower thigh
c) With TKR, popliteal best visualised in lateral
d) Peroneal ends above ankle
e) 5 fr sheath sufficient for most diagnostic studies
f) Ant tibial and ?peroneal seen separately in lower leg on AP projection
g) SFA origin best seen on AP projection - ipsilateral anterior oblique.

A

b) Adductor canal is in lower thigh
c) With TKR, popliteal best visualised in lateral
d) Peroneal ends above ankle; true dividing into calceneal branches at the inferior tibio-fibular syndesmosis.
e) 5 fr sheath sufficient for most diagnostic studies
f) Ant tibial and ?peroneal seen separately in lower leg on AP projection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  1. Shoulder uss position to visualise subscapularis
    a) Elbow flexed, shoulder external rotation
    b) Supination, shoulder neutral
    c) Arm across chest
    d) Internal rotation
A

a) Elbow flexed, shoulder external rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  1. Regarding bone lesions, which is incorrect?
    a) Calcified rim is marker of benign lesion
    b) Wide zone of transition is marker of malignant
    c) Bone expansion is marker of aggressive lesion
A

c) Bone expansion is marker of aggressive lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  1. Postpartum woman with confusion. CT shows swollen bilateral basal ganglia and thalami
    a) Venous sinus thrombosis
    b) Reversible cerebral vasoconstriction syndrome
    c) Posterior reversible encephalopathy syndrome
A

a) Venous sinus thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  1. Which is false regarding demyelinating diseases?
    a) ADEM is seen following bacterial infections
    b) DAI causes demyelination
    c) Dawson’s fingers are peri medullary
    d) MS is perivenular
    e) DAI causes demyelination
A

*LW:
Options A and B are likely most correct answers of being false……
unsure which is more false

a) ADEM is seen following bacterial infections: technically true, but viral is the most common cause (https://www.sciencedirect.com/science/article/pii/S0733861908000364)
b) DAI causes demyelination: contentious: Actual complete tearing of the axons is only seen in severe cases. It is also known that some neurones may undergo degeneration in the weeks or months after trauma, it is called secondary axonotmesis. Axonal depolarisation and swelling is most common histological feature. In agreement with LJS, there is likely an element of demyleinisation associated with these tearing injuries……
c) Dawson’s fingers are peri medullary: TRUE, referring to peri medullary veins.
d) MS is perivenular: TRUE

**LJS - I think demyelination does occur secondary to DAI:
“Two to three weeks later however there is decrease in the number of retraction balls with predominance of microglial cells followed by astrocytosis and demyelinization.” Then even later there is Wallerian degeneration. From this paper: 10.15406/frcij.2015.01.00026.

Is this or ADEM with bacterial infection more false??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  1. Which of the following is NOT a characteristic CT feature of acute herpes simplex encephalitis
    a) Sparing of the basal ganglia
    b) Unilateral changes seen on MRI
    c) Evidence of hemorrhage on MRI
    d) Involvement of the limbic system
    e) Mass effect
A

b) Unilateral changes seen on MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
3. Study looking at uss in liver haemangioma with MRI as gold standard. 
a is true positive,
 b false positive, 
c true negative, 
d false negative. 

Calculate the specificity.

a) a/(a+b)
b) Various other combinations of a b c and dc)

A

c) Correct answer is: true negative / (true negative + false positive) The odd that patient without disease is identified as without disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
  1. 10 year old with cough, bibasal atelectasis, no lobar consolidation. What is most likely organism?
    a) Mycoplasma
    b) Staph
    c) Strep
    d) PCP
A

a) Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q
  1. Child with recurrent pneumonia represents and is treated with antibiotics. One week later, there is RLL opacity but the child is otherwise well
    a) BPS
    b) Resolving pneumonia
    c) Pneumatocoele
    d) Abscess
    e) (No round pneumonia option)
A

a) BPS ( i think this means sequestration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q
  1. Which is TRUE?
    a) I-123 MIBG is used to diagnose adrenocortical carcinoma
    b) Tc 99m CEA is used to diagnose thyroid cancer
    c) Onco-Scint is used to diagnose ovarian cancer
    d) I-131 Pentetreotide is used to diagnose medullary thyroid cancer
A

c) Onco-Scint is used to diagnose ovarian cancer (and 95% of colon cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
  1. Not associated with ACL rupture
    a) Lat meniscus tear
    b) Medial meniscocapsular separation
    c) MCL tear
    d) Bone bruise posterolateral tibial plateau
A

*LW:
All occur with ACL rupture, hopefully non recalled option E was the correct option.

A - Lateral meniscal injury is more commonly associated with acute ACL injury, while medial meniscal injury more commonly associated with Chronic ACl injury and resulting instability. (multiple references)

b) Medial meniscocapsular separation TRUE (uncommon, but true)
c) MCL tear TRUE
d) Bone bruise posterolateral tibial plateau - TRUE

Previous efforts:

  • *LJS (al Al agrees) - lateral meniscus least correct
  • AJL on further review agree that all are associated and have no idea what the answer should be.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
  1. Young man presents with sudden onset of pain. MRI shows soft tissue lesion with high t1, high t2, with and without fat sat.
    a) Myosotis ossificans
    b) Haematoma
    c) Lipoma
    d) Liposarcoma
A

b) Haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q
  1. Equivalent number of CXRs for CT Chest with contrast, for young adult using 16 slice scanner.
    a) 50
    b) 100
    c) 300
    d) 1000
    e) 5000
A

c) 300

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  1. CT chest, abdo, pelvis
    a) 50
    b) 100
    c) 300
    d) 1000
    e) 5000
A

1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q
  1. Child in MVA needs urgent angiographic intervention. His mother died in the same accident.His father died many years ago. Who is the most appropriate person to give consent?
    a) mother’s defacto (yes, this was all that was written, but in previous years, defacto partner was written)
    b) Hospital Medical Director
    c) grandmother
    d) 16 year old sister
    e) public advocate office
A

c) grandmother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

43, 44. This question was repeated twice! Patient with chronic renal failure has stricture of the arterial anastomosis of mature forearm fistula. Which of the following would give longest patency?

a) Balloon angioplasty
b) Covered stent
c) Bare metal
d) Non covered
e) Laser angioplasty

A

a) Balloon angioplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q
  1. You suspect discitis on plain X-ray. Which of the following would favour TB over pyogenic?
    a) Noncontiguous vertebral involvement rules out TB
    b) Discs can be affected late in TB
    c) TB only seen if there is an associated lung lesion
    d) Cold abscess is high T1, low T2
    e) Subligamentous spread
A

b) Discs can be affected late in TB

e) Subligamentous spread

35
Q
  1. Patient with vague breast mass, history of trauma 3 weeks ago, architectural distortion onmammo, normal uss. Biopsy shows radial scar. What would you recommend at MDT?
    a) Hook wire and open biopsy
    b) Mastectomy
    c) Follow up mammogram
    d) WLE + sentinel lymph node Bx
A

a) Hook wire and open biopsy

36
Q
  1. Woman with hemiparesis. ICA Doppler shows systolic dampening, reversal in early diastole
    a. Normal
    b. ICA stenosis distally
    c. ICA occlusion
    d. CCA stenosis
    e. CCA occlusion
A
  • *LJS - ICA occlusion - at the site of occlusion get “thud flow” - damped systolic flow and early diastolic reversal. https://pubs.rsna.org/doi/pdf/10.1148/rg.256045013
  • LW - sounds awesome - great job :)

Previous answer: (only one definitely wrong)
b. ICA stenosis distally

37
Q
  1. Regarding DAI
    a) non haemorrhagic
    b) mainly in frontal and temporal grey white matter jcn
    c) DWI not useful
    d) SWI not useful
    e) accurately staged with CT
A

*LW:

A) non haemorrhage: true 80% are non haemorrgic lesions.

b) mainly in frontal and temporal grey white matter jcn: true - grade 1

38
Q
  1. Regarding myelination

a) Myelinated white matter appears dark on T1.
b) Myelination can be present in the posterior limb of internal capsule at birth
c) Myelination is complete in optic pathway at 4 months
d) Myelination starts in the splenium and progresses anteriorly in the corpus callosum.

e) Between 24 -30 months myelinated white matter is isointense to grey matter on T2.

A

b) Myelination can be present in the posterior limb of internal capsule at birth yes the posterior part d) Myelination starts in the splenium and progresses anteriorly in the corpus callosum.
52. Regarding myelination
a) Myelinated white matter appears dark on T1.
b) Myelination can be present in the posterior limb of internal capsule at birth yes the posterior part
c) Myelination is complete in optic pathway at 4 months occipital white matter T2 dark >1 year.
d) Myelination starts in the splenium and progresses anteriorly in the corpus callosum.
e) Between 24 -30 months myelinated white matter is isointense to grey matter on T2.

39
Q
  1. On scan for dementia, 10mm lesion in atrium of ventricle. Marginal enhancement.
    a) Choroid plexus cyst
    b) Ependymoma
    c) Meningioma
    d) Ependymal cyst
    e) Metastases
A

a) Choroid plexus cyst

40
Q
  1. Not associated.
    a) NEC and diabetes.
    b) Fap and desmoids.
    c) Msk and caroli.
A

a) NEC and diabetes. Not convincingly

**LJS - variable reports in papers. Caution - is the most correct answer in other MCQs

41
Q
  1. Regarding hepatic gas

a) Gas in liver can be seen after tumour chemoembolisation
b) PV gas is central
c) Biliary gas is recognised feature of bowel ischaemia
d) PV gas seen in haemorrhagic pancreatitis
e)

A

a. Gas in liver can be seen after tumour chemoembolisation

42
Q
  1. Weightlifter on steroids. Plain ct liver shows low density lesion with streaky hyperdensities.
    Heterogenous arterial and pv enhancement.

a) Adenoma
b) hcc
c) fnh
d) haemangioma

A

Adenoma

43
Q
  1. 3 incidental liver nodules on CT. All hot on red cell scan.
    a) Fnh
    b) Adenoma
    c) Haemangioma
    d) Mets
    e) HCC
A

c) Haemangioma

44
Q
  1. Not congenital
    a) Fistula bet portal vein and IVC
    b) Portal vein aneurysm
    c) Duplicated portal vein
    d) Intrahepatic portosystemic shunts
    e) SMA/SMV reversal in malrotation
A

a) Fistula between portal vein and IVC

45
Q
  1. Most common D2 extrinsic compression on barium study.
    a) Annular pancreas
    b) Pancreatic divisum
    c) Ectopic pancreas
    d) Pancreas head agenesis
A

a. Annular pancreas

46
Q
  1. G1P0 woman attends for 11+3 week nuchal scan. Bowel is seen between abdominal wall andumbilical cord
    a) Normal gut herniation
    b) Exomphalos
    c) Pseudoexomphalos
    d) Gastroschisis
    e) Cord AVM
A

a) Normal gut herniation

**LJS - getting pretty late for physiological herniation. Some say can’t diagnose until 12 weeks. Others say 11.4 weeks, which is pretty much 11+3. Stat dx says can dx at nuchal translucency scan. I’d be suspicious and looking carefully at descriptors in the question to differentiate at this gestation

47
Q
  1. Highest risk of post partum haemorrhage
    a) Bilobed placenta
    b) succemturiate
    c) marginate
    d) velamentous
    e) circumvallate
A

b) succinturiate lobe

***LJS - agree. Placental previa and accreta spectrum have highest risk PPH (along with things that cause atonic uterus like twins, polyhydramnios etc). And anything that increases risk of placental tissue remaining in uterus e.g. succenturiate lobe. Not really sure what marginate means - circummarginate or marginate cord insertion.

48
Q
  1. Low lying placenta with cervix measuring 6 cm long.
    a) Over distended bladder
    b) Placenta praevia
A

a. Over distended bladder

**LJS - bladder distention overestimates cervical length on TA scanning

49
Q
  1. Fleishner guidelines for 7mm nodule in non smoker
    a) No need to follow
    b) follow CT at 12 months, if stable no further monitoring
    c) follow CT at 6-12 months and 18-24 months, if stable no further monitoring
    d) Follow CT at 9-12, 18 and 24 months if stable no further monitoring
    e) Follow CT at 3-6, 9-12, 18-24 months, biopsy and PET
A

c. follow CT at 6-12 months and 18-24 months, if stable no further monitoring

50
Q
  1. Regarding UBC
    a) Metaphyseal
    b) Femur more common than humerus
    c) Fluid-fluid levels in 50%
A

a) Metaphyseal

51
Q
  1. Regarding cortical lesions
    a) Benign lesions can cause periosteum thickening
    b) Benign lesions can erode periosteum
    c) Can’t remember rest of options
A

a) Benign lesions can cause periosteum thickening

52
Q
  1. Adolescent with skateboard injury, deformity forearm, pain in elbow. Regarding radiographs
    a) Perform after IV analgesia
    b) Include elbow
    c) Views in pronation and supination
    d) Opposite side for comparison
    e) Scaphoid views
A

b. Include elbow

53
Q
  1. 50 year old, CT demonstrates long segment distal ileal target sign appearance with milddilatation of proximal small bowel. Likely cause
    a) long segment intussusception
    b) short segment intussusception
    c) carcinoma
    d) Meckel’s diverticulum
    e) lymphoma
A

a) long segment intussusception

c) carcinoma malignancy 30 percent of small bowel (66% of large bowel).
Most common malignant lead point in small bowel is mets. Meckels and diverticulum make up half of the benign cases (35% each overall). Lipomas most common benign in colon

54
Q
  1. PASH (pseudo angiomatous stromal hyperplasia)

a) Most common presenting as palpable mass
b) 5-10% upgrade on open biopsy
c) 5-10% progress to cancer in 10 years
d) Often an incidental finding and needs no treatment
e) Is malignant and needs to be removed

A

a) Most common presenting as palpable mass

55
Q
  1. Headache for 26 hrs. Normal CT. CSF analysis shows copious RBC but no xanthochromia or bilirubin on spectroscopic analysis. Most likely
    a) Traumatic tap
    b) SAH due to berry aneurysm
    c) SAH due to perimesencephalic bleed
    d) Venous sinus theombosis
    e) Reversible cerebral vasoconstriction syndrome
A

a) Traumatic tap

56
Q
  1. Regarding seminoma
    a) Homogenous on USS
    b) Most common childhood tumour
    c) Invades tunica vaginalis
    d) Not radiosensitive
A

a) Homogenous on USS

57
Q
  1. Which of the following is true? (Please see answers in mrisafety.com)
    a) A patient with a ferromagnetic piercing which can’t remove it can safely have an MRI at1.5T if the piercing can be secured
    b) A patient with a copper IUD is excluded from 1.5T MRI
    c) A patient with an insulin pump can have a 1.5T MRI while the external pump is stillattached
    d) A patient with a cochlear implant is not excluded from having a 1.5T MRI
    e) A patient with combat shrapnel in their body cannot have a 1.5T MRI, even if theshrapnel is not near a vital organ
A

a. A patient with a ferromagnetic piercing which can’t remove it can safely have an MRI at 1.5T if the piercing can be secured
* AJL - A patient with a cochlear implant is not excluded from having a 1.5T MRI. I think this is also true. (it is conditional but they are not excluded completely).

58
Q
  1. Which of the following is not associated with alcohol?
    a) HOCM
    b) Parotitis
    c) Communicating hydrocephalus
    d) SDH
    e) AVN
A

a. HOCM

59
Q
  1. Regarding phaeochromocytoma. Which is false? (I think there was more than one questionon phaeo)

a) MRI good for diagnosis
b) Does not show signal loss on out of phase scan
c) MIBG is good for diagnosis
d) Some radiopharmaceutical good for benign phaeos
e) Some radiopharmaceutical good for malignant phaeos
f) PET CT is good for differentiating between benign and malignant phaeos

A
  • LW:
    a) MRI good for diagnosis: TRUE

b) Does not show signal loss on out of phase scan: FALSE - May demonstrate signal loss on opposed-phase chemical shift imaging due to presence of intracellular fat
Can be confused with adrenal adenoma

c) MIBG is good for diagnosis: Reasonably true - MIBG has almost 100% specificity but limited sensitivity ~ 80% for PHs
d) Some radiopharmaceutical good for benign phaeos: unsure what this is asking…. *AJL - LJS has previously said MIBG for benign (has a B in it)
e) Some radiopharmaceutical good for malignant phaeos: unsure what this is asking… *AJL - LJS has previously said pentetreotide for malignant (has an N which is almost an M in it)
f) PET CT is good for differentiating between benign and malignant phaeos: Reasonably true….FDG uptake is found in greater percentage of malignant than benign PHs

Previous Answer:
c) MIBG is good for diagnosis

60
Q
  1. Lateral dislocation patella not associated with
    a) PLC injury
    b) Patella alta
    c) Bone bruise medial patella facet
    d) Bone bruise lateral femoral condyle
    e) Haemarthrosis
A

a. PLC injury

61
Q
  1. Which of the following is true?
    a) CRL is more accurate marker than 2nd trimester dating
    b) CRL should include chorionic thickening
A

a. CRL is more accurate marker than 2nd trimester dating

62
Q
  1. Which of the following is false?
    a) Obstruction at the level of the urethra has high mortality
    b) PUJ obstruction bilateral in 70%
    c) Bilateral renal agenesis associated with oligohydramnios
A

b. PUJ obstruction bilateral in 70% 30%

63
Q

Single umbilical artery is associated with anomalies – cardiac anomalies.

A

Single umbilical artery is associated with anomalies – cardiac anomalies.

64
Q
  1. Fracture of tip of lateral malleolus below ankle joint
    a) Weber A
    b) Weber B
    c) Weber C
    d) Maisonneuve
    e) Dupuytren
A

a. Weber A

65
Q
  1. Woman with well defined breast lesion. Further work up shows fat and parenchymal stroma.
    a) Lipoma
    b) Hamartoma
    c) Phylloides
A

b) Hamartoma

66
Q
  1. Which of the following is false?
    a) TAPVR is non cyanotic
    b) Ebstein anomaly is a cause of cardiomegaly
    c) VSD shunt is highest in first week
A

a) TAPVR is non cyanotic

67
Q
  1. Middle aged man with known cardiac disease develops portal hypertension.
    a) ASD
    b) VSD
    c) Mitral stenosis
    d) Aorticstenosis
A

I think it is ASD -> cause right heart failure

  • LW agrees ASD most likely.
  • *LJS - unsure. Most common cause RVF is LVF, and ASD is simple fix, seems unlikely somebody would have “known cardiac disease” and it not be treated for so long that they develop portal HTN. ?AS correct
  • AJL thinks this is a stupid question as it requires mind reading. It could be any of these things though you’d think AS or MS would be the slowest to be fixed. Hopefully there were some other clinical details provided.
  • ***LW: further go, although I shouldnt be doing this a few days before, UTD lists restrictive and constrictive as common causes, while MS and Trsicupid regurg….So maybe MS (if only they told us the auscultation findings….)
  1. Middle aged man with known cardiac disease develops portal hypertension.
    a. ASD
    b. VSD
    c. Mitral stenosis
    d. Aortic stenosis ? Most common cause of right heart failure is left heart failure, aortic stenosis more common than mitral stenosis.
68
Q
  1. 18 month old child with undisplaced spiral fracture of tibia. Which is the likely mechanism?
    a) NAI
    b) Fall from 10 stairs
    c) Fall from high chair
    d) Fall whilst walking
    e) Direct impact
A

d. Fall whilst walking

69
Q
  1. Drowsy child with fever and neck stiffness and aversion to light, what should be the next appropriate investigation
    a) LP
    b) NCCT
    c) CECT
    d) MRI
A

The child is drowsy - need CT first. Could be an intracranial abscess
CONCLUSIONS:In adults with suspected meningitis, clinical features can be used to identify those who are unlikely to have abnormal findings on CT of the head.

**LJS - high risk features for having raised ICP dictate CT prior to LP: decreased LOC, focal neurological signs, papilloedema etc.

70
Q
  1. Regarding bloody nipple discharge
    a) Papilloma is most common
    b) Malignant cause most common
    c) In pregnancy, suggestive of malignancy
    d) Seen with dilated ducts (?duct ectasia)
    e) Normal ultrasound and mammogram excludes papilloma
A

a. Papilloma is most common

71
Q
  1. What defines coronary artery dominance? Origin of
    a) Posterior descending artery
    b) Obtuse marginal
    c) Ramus intermedius
    d) Conus
A

a) Posterior descending artery

72
Q

86 Young man presents with binge drinking preceding night and bloodstained vomitus in the morning, now pain on swallowing. Barium examination shows extravasation of barium at the GOJ. What is the most likely diagnosis? (note change from previous years, where barium examination was normal)

a) Mallory Weiss tear
b) Boerhaave syndrome
c) reflux esophagitis
d) esophageal varices
e) Barrett’s esophagus

A

b) Boerhaave syndrome

73
Q
  1. 3 month old child with posterior neck mass present since birth. Doppler shows low flow, compressible.
    a) Infantile haemangioma
    b) Congenital lymphagioma
    c) Lymphangioma
    d) Venous malformation
    e) AVM
A

d) Venous malformation

74
Q
  1. Which perfusion parameter is most useful to assess for cerebral autoregulation in cerebral ischaemia?
    a) MTT
    b) CBV
    c) CBF
A

b) CBV

**LJS - penumbra has normal or slightly increased CBV due to auto-regulatory vasodilatation

75
Q
  1. Left sided SVC drain into:
    a) Right atrium
    b) Right ventricle
    c) Coronary sinus
    d) IVC
A

c) Coronary sinus

76
Q
  1. Melorrheostosis
    a) Sclerotomal distribution
    b) Malignant transformation
    c) Joint contractures
    d) Soft tissue calcification
A
  1. Melorrheostosis
    a) Sclerotomal distribution: TRUE
    b) Malignant transformation: FALSE
    c) Joint contractures: TRUE
    d) Soft tissue calcification: TRUE
77
Q
  1. Not associated with portal vein thrombosis
    a) Abdominal sepsis
    b) Islet cell transplant
    c) HCC
    d) Haemorrhagic pancreatitis
A
  1. Not associated with portal vein thrombosis

a. Abdominal sepsis yes
b. Islet cell transplant yes
c. HCC yes
d. Haemorrhagic pancreatitis yes

so i’m not sure

78
Q
  1. Anaphylactic reaction is clinically defined. Which of the following combination is most appropriate?
    a) Swelling of mucosal tissues and hypotension
    b) Skin rash and hypertension
    c) Various other choices with either normotension or hypertension
A

a. Swelling of mucosal tissues and hypotension

79
Q
  1. Churg Strauss
    Also known as eosinophilic granulomatosis with polyangiitis or allergic granulomatosis

Caused by fungal infection

Not associated with eosinophilia

A

a. Also known as eosinophilic granulomatosis with polyangiitis or allergic granulomatosis

80
Q
  1. Peripheral venogram (didn’t specify upper or lower limb), how many frames a second?
    a) 0.5
    b) 1
    c) 2
    d) 3
    e) 4
A

c) 2

81
Q
  1. Gestational trophoblatic disease
    a) Partial mole is diploid
    b) Complete mole is triploid
    c) Partial mole has 5-10% risk of choriocarcinoma
    d) Abortion accounts for 25%
    e) Gestational and non-gestational choriocarcinoma have same prognosis
A

d. Abortion accounts for 25%
gestational choriocarcinoma may look identical to hydatidiform mole
arises following known molar pregnancy (50%), miscarriage (30%), normal pregnancy (20%)

82
Q
  1. Regarding V/Q scan in a young patient with cough, temperature, and right pleuritic chestpain, what is the expected finding? (that was all the information given)

a) Wedge shaped segment of non-ventilation, with preserved perfusion
b) Central accumulation of tracer, with non uptake in periphery
c) Multiple large matched perfusion defects
d) Multiple small unmatched perfusion defects
e) I’m not sure I remember the wording correctly.

A

**LJS:
Pneumonia - most common finding is matched defect of V/Q (shunting of blood away from poorly ventilated lung
When perfusion partly preserved - get reversed mismatch
Commonly get stripe sign - preserved perfusion at pleural border (makes PE very unlikely)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065883/

*LW - agree with LJS, and likely incomplete recall on wording of correct answer.

Previous answer:
a) Wedge shaped segment of non-ventilation, with preserved perfusion - I think sounds like an infection

83
Q
  1. Type 3 peri-anal fistula
    a) Translevator extension
    b) Intersphincteric
    c) Trans-sphincteric
    d) Intersphincteric with abscess
A

c) Trans-sphincteric

grade 1: simple linear intersphincteric
grade 2: intersphincteric with abscess or secondary tract
grade 3: transsphincteric
grade 4: transsphincteric with abscess or secondary tract within the ischiorectal fossa
grade 5: supralevator and translevator extension