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1

Sjogren syndrome

  • salivary gland, lacrimal gland
    • keratoconjunctivitis sicca (dry eyes)
    • xerostomia (dry mouth).
  • LIP - lymphocytic interstitial pneumonia
    • cysts
    • GGO
    • solid-appearance consolidations
  • retroperitoneal fibrosis
    • bilateral hydronephrosis or hydroureter
    •  

2

Klippel-Feil syndrome

  • Sprengel deformity of shoulder - hypoplastic scapula
  • cervical fusion
  • hemivertebrae
  • kyphoscoliosis
  • rib anomaly
  • anamalies of aortic arch and branching vessels

3


Types of screws

4


How to protocol a CT for

lower GI bleed?


CT angiogram

- plain (rule out hyperdense bowel contents)

- arterial phase - active extrav

- venous phase - bleeding bigger?

5


Most common locations for

carotid artery

vertebral artery

dissection?


Carotid

- just below the skull base

Vertebral artery

- 4th portion as it coming out

 

Classification of segments of the VA:

V1 is proximal to entry into the transverse foramen of C6. V2 is within the transverse foramen from C6 to C2. V3 is from the transverse foramen of C2 but before entry into the dura. V4 is after entry into the dura.

6


IV contrast and GFR


GFR

normal > 60

lower limit for diabetics > 50

lower limit for normal pts > 30

7


Perimesencephalic SAH


Venous bleed

usually benign

8


Anterior choroidal artery arises superior/later

than take off of PCOMM

Anterior choroidal artery arises superior/later

than take off of PCOMM

9

Hangman's fracture

A hangman's fracture is the colloquial name given to a fracture of both pedicles or pars interarticularis of the axis vertebra (C2).

 

10

Unilateral opacification of mastoid air cells?


Look for obstructing tumor in the nasopharyngeal space

blocking the opening of the Eustachian tubes at the Fossa of Rosenmuller

11

If you see some apparent abnormality on GI fluroscopy

e.g. apparent esophageal narrowing

what do you do?

 

  • Confirm its persistent (not transient)
  • Comment on mucosal abnormality

12

Renal Calyceal Diverticulum

  • focal eventration/outpouching of the renal calyx into the renal parenchyma
  • usually incidental and asymptomatic
  • may have stone formation due to stasis, infection, hematuria
  • mimics renal cyst on unenhanced images
  • delayed post contrast image - layering/pooling of contrast medium on delayed images - pathognomonic

13

Ovarian cyst follow up guidelines

In premenopausal women, follow-up of a simple cyst (thin-walled, round, and without internal echoes):

  • < 5 cm, no follow-up;
  • > 5 cm but < 7 cm, yearly follow-up.

In postmenopausal women with a simple ovarian cyst measuring > 1 cm but < 7 cm, yearly follow-up is recommended.

For patients of any age, further evaluation with MRI or surgical consultation should be considered for a simple cyst > 7 cm.

For any cyst containing septations (other than a single thin septation) or nodules, surgical consultation or further evaluation with MRI should be considered regardless of patient age.

  • Thin septations (< 3 mm) and nodules without vascular flow suggest neoplasms that are likely benign;
  • thick septations and nodules with vascular flow suggest malignancy. 

14

Outlets of the

Pterygopalatine Fossa

  • anterior - inferior orbital fissure - infraorbital nerve and artery (infraorbital canal)
  • medial - sphenopalatine foramen - nasal cavity
  • lateral - pterygomaxillary fissure - infratemporal fossa
  • inferior - greater/lesser palatine canal
  • posterior - foramen rotundum - V2 - middle cranial fossa
  • posterior - pterygoid canal/Vidian canal - froamen lacerum/middle cranial fossa
  • posterior - platovaginal canal (pharyngeal) - nasal cavity/nasopharynx

15

Contents of 

Pterygopalatine Fossa

  • terminal third of the maxillary artery
  • maxillary (V2) of the trigeminal nerve
  • pterygopalatine ganglion pass.

16

A young man presenting with epistaxis and a pterygopalatine mass

Dx?

Juvenile nasopharyngeal angiofibroma

  • is the most common benign tumor of the nasopharynx
  • Most commonly presenting in young men
  • typically originates from the posterolateral wall of the nasal cavity and extends through the sphenopalatine foramen into the PPF.
  • From the fossa, the tumor can then spread to the sphenoid, cavernous, or paranasal sinuses, or, rarely, to the parapharyngeal space or pterygoid muscle region. 

17

DDx for persistent umbilical discharge

in a newborn?

  • persistent urachal tract - urine leakage from bladder
    • A voiding cystourethrogram would demonstrate if there is a fistulous connection from the bladder to the umbilicus
  • persistent vitelline tract - fluid and feces leakage from the GI tract

 

  • A Meckel diverticulum is a remnant of the vitelline duct protruding from the ileum.

18

Multiloculated cystic nephroma

  • cystic mass
  • may be septated and displacing the normal collecting system.
  • compressed collecting system

DDx

  • renal cyst
  • cystic RCC
  • cystic partially differentiated nephroblastoma (CPDN)

19


Most common breast neoplasm associated with

breast implants?


Anaplastic large cell lymphoma

  • T-cell origin, indolent
  • capsular mass
  • peri-implant seroma

20


Mycotic aneurysm

  • usually peripehral in location
  • look for areas of infarction/hemorrhage
  • only evident weeks out from endocarditis
  • Rx: Abx +/- vessel sacrifice

21


Indications for V/Q scan

  • contrast allergy
  • renal failure
  • to decrease dose to the breasts - pregnancy or postpartum

22


When to reduce Tc-99 MAA?

  • pulmonary arterial hypertension
  • only one lung
  • pediatric patients
  • right to left shunt
  •  
  • usually only 1/1000 arterioles are occluded

23


Triple scan


abnormal matched

ventilation

perfusion

CXR

= very low probability

24


Reverse mismatch


ventilation defects

normal perfusion

= very low probability

causes

  • bronchial obstruction, mucus plug
  • COPD
  • pleural effusion
  • atelectasis
  • pneumonia

25


PTC


percutaneous transhepatic cholangiography

26


Parallel ventricle configuration

racecar appearance


absence of corpus callosm

associated with lipoma

  • curvilinear
  • tubulonodular

27


Signs of intracranial hypotension

  • diffuse pachy meningeal enhancement
  • subdural effusions
  • brain swelling
  • sagging brain
  • corpus callosum - drooping penis sign
  • rounding of the dural venous sinuses
  • tonsillar ectopia
  • rounded pituitary gland

28


Enhancement pattern of CNS lymphoma

  • immunocompetent - diffuse enhancement
  • immunosuppressed - rim enhancement

29

Weber ankle fracture classification

30


Types of gastric volvulus

- organoaxial - higher risk of vascular compromise; associated with diaphragmatic defect

- mesenteroaxial - short axis