Day 1: MSK, GI, cards, neuro

Question 1

What are T1 bright substances in imaging?

Answer 1

Fat and hemorrhage

Fat saturation sequences are used to differentiate between them.

Question 2

What is a lymphatic malformation characterized by?

Answer 2

Complex cystic solid structure

Question 3

What condition is associated with nodules in the trachea and small cystic/solid nodules in lower lobes?

Answer 3

Tracheobronchial papillomatosis

Usually due to HPV, often acquired during birth.

Question 4

What mutation is associated with a poor prognosis in midline glioma?

Answer 4

H3K27 mutation

Question 5

What could a hyperechoic renal mass on ultrasound be?

Answer 5

Angiomyolipoma or renal cell carcinoma

Question 6

What does a progressively enhancing intrahepatic mass with central enhancement indicate?

Answer 6

May represent:
* Intrahepatic cholangiocarcinoma (solitary mass with infiltrating margins and associated intrahepatic biliary ductal dilatation)
* Epithelioid hemangioendothelioma (usually composed of multiple peripheral masses)
* Hepatocellular carcinoma (arterial enhancement, washout on delayed phases )

Question 7

What is the imaging feature of pheochromocytoma?
and what nuc study

Answer 7

Extremely high T2 signal adrenal lesion
MIBG for adrenal
(Ind 111 pentetreotide for extra adrenal)

Question 8

How does myelolipoma appear on fat suppression images?

Answer 8

Hypointense

Question 9

What are the key features of adenomyosis?

Answer 9

Uterine enlargement, irregular margins of endometrial myometrial interface, diffuse heterogeneity including microcyst formation

Question 10

What is the most common extratesticular neoplasm?

Answer 10

Lipoma

Question 11

What is the most common neoplasm of the epididymis?

Answer 11

Adenomatoid tumor

Question 12

What type of tumor has the best prognosis in osteosarcoma?

Answer 12

Parosteal osteosarcoma

Question 13

Where does parosteal osteosarcoma typically occur?

Answer 13

On long bone metaphyseal surface

Question 14

What is the most common subtype of liposarcoma?

Answer 14

Well differentiated liposarcoma

Question 15

Where does chondroblastoma typically occur?

Answer 15

Epiphysis or apophysis of skeletally immature patient, eccentric

Question 16

What are the two types of femoroacetabular impingement and their associations?

Answer 16

CAM type and Pincer type
CAM associated with non spherical femoral head
Pincer associated with acetabula protrusio

Question 17

What is another name for tenosynovial giant cell tumor and what does it feature?

Answer 17

Pigmented villonodular synovitis (PVNS)
contains hemosiderin

Question 18

What is the earliest sign of impending articular surface collapse in avascular necrosis?

Answer 18

Crescent sign

Question 19

What does thymic rebound appear as on imaging? And in what patients

Answer 19

Chevron pattern over mediastinum in post chemo patients

Question 20

What is the most common type of benign and malignant cardiac tumor?

Answer 20

Myxoma is benign, sarcoma/angiosarcoma is malignant

Question 21

What does CPT stand for in medical terminology?

Answer 21

Current Procedural Terminology

Question 22

What is SNOMED clinical terms used for?

Answer 22

Computer processable terms for clinical documentation and reporting

Question 23

What does ICD stand for and what is it used for?

Answer 23

International Classification of Diseases for diagnosis for patient encounters

Question 24

What does DRG stand for and what is it used for?

Answer 24

Diagnosis Related Group for inpatient hospital service insurance billing

Question 25

What imaging feature is associated with neurocysticercosis?

Answer 25

Starry sky appearance multifocal parenchymal calcifications

Question 26

What is a characteristic of Sturge-Weber syndrome?

Answer 26

Focal parenchymal atrophy calcifications usually peripheral and curvilinear/gyriform with tram tracks

Question 27

What are the features of biliary atresia?

Answer 27

Jaundiced neonate/hyperbilirubinemia, abnormal gallbladder, echogenic triangular cord due to fibrosis ## Footnote Treatment involves kasai portoenterostomy and is associated with congenital anomalies like heterotaxy and malrotation.

Question 28

What type of bone does Ewing sarcoma typically involve?

Answer 28

Flat or tubular bones, with permeative pattern

Question 29

Which cranial nerve is superior most within the lateral dural wall of the cavernous sinus?

Answer 29

Oculomotor (CN3)

Question 30

Which cranial nerves follow the oculomotor nerve in the lateral wall of the cavernous sinus?

Answer 30

Trochlear (CN4), ophthalmic division of trigeminal (CNV1), maxillary division of trigeminal nerve (CNV2) Abducens is within cavernous sinus itself with carotid artery

Question 31

What are the divisions of the trigeminal nerve?

Answer 31

CN5 1) ophthalmic 2) maxillary 3) mandibular

Question 32

what is the gallbladder ghost triad seen in and what is it? how is it treated

Answer 32

Biliary atresia Less than 19 mm, irregular margins, discontinuous echogenic wall kasai portoenterostomy

Question 33

Which of the following is the correct definition of an isobar?

Answer 33

Same atomic mass but different number of protons

Question 34

Where does the piriformis muscle originate?

Answer 34

Anterior sacrum ## Footnote The piriformis muscle is a small muscle located in the gluteal region.

Question 35

Where does the piriformis muscle insert?

Answer 35

Greater trochanter of the femur ## Footnote The greater trochanter is a prominent bony projection on the femur.

Question 36

What is the unit of radioactivity?

Answer 36

The becquerel (Bq) or the curie (Ci) ## Footnote 1 Ci = 3.7 x 10^10 Bq and 1 Bq = 1 disintegration per second

Question 37

Fill in the blank: 1 Ci = _______ Bq.

Answer 37

3.7 x 10^10

Question 38

True or False: 1 Bq represents one disintegration per minute.

Answer 38

False

Question 39

What does 1 Bq measure?

Answer 39

1 disintegration per second

Question 40

What is best next imaging study for patient with monoarticular hip disease and radiograph showing effusion and subchondral cysts

Answer 40

MRI without contrast to assess for pigmented villonodular synovitis vs osteochondromatosis

Question 41

What do recommended discharge criteria suggest regarding the level of consciousness?

Answer 41

The level of consciousness should return to acceptable levels for a period of 2 hours from the time of administration of the reversal agent ## Footnote This criterion is important to ensure patient safety before monitoring ends.

Question 42

How long should vital signs be monitored after administration of the reversal agent?

Answer 42

Vital signs should return to acceptable levels for a period of 2 hours ## Footnote Monitoring vital signs is crucial for assessing the patient's recovery.

Question 43

Fill in the blank: Recommended discharge criteria suggest that the level of consciousness and vital signs should return to acceptable levels for a period of _______ from the time of administration of the reversal agent.

Answer 43

2 hours

Question 44

True or False: Monitoring ends immediately after the administration of the reversal agent.

Answer 44

False ## Footnote Monitoring continues for 2 hours to ensure safety.

Question 45

What are the national patient safety goals mandated by the Joint Commission to improve patient safety and reduce risk of errors

Answer 45

-reporting of critical results in a timely manner -use of at least 2 patient identifiers -‘time-out' before ALL procedures -compliance with evidence-based hand-hygiene guidelines

Question 46

What does a rising PSA level usually prompt in patient with previously treated prostate cancer?

Answer 46

A bone scan ## Footnote If PSA <20, rules out osseous mets

Question 47

What does CPAM stand for?

Answer 47

Congenital pulmonary airway malformation ## Footnote CPAM is a developmental abnormality of the lungs.

Question 48

What type of tissue proliferation is associated with CPAM?

Answer 48

Hamartomatous proliferation of small airways ## Footnote This proliferation connects with the bronchial tree and forms cysts.

Question 49

What is the blood supply source for CPAM?

Answer 49

Pulmonary circulation ## Footnote This indicates that the blood supply is derived from the lungs.

Question 50

What characterizes sequestration in the lungs?

Answer 50

Aberrant lung tissue with systemic blood supply ## Footnote This means that the affected lung tissue receives blood from systemic circulation instead of the pulmonary circulation.

Question 51

Where is sequestration typically located?

Answer 51

Left lower lobe ## Footnote This is the most common site for lung sequestration.

Question 52

What imaging characteristic may indicate lung sequestration?

Answer 52

Echogenic mass at left lung base ## Footnote This finding can help in the diagnosis of sequestration.

Question 53

Sequestration can sometimes be found in which anatomical location and what can it mimic?

Answer 53

Subdiaphragmatic (Can mimic adrenal mass)

Question 54

what exits through the superior orbital fissure

Answer 54

ophthalmic division of trigeminal (CNV1) trochlear (CN4) and abducens (CN6) nerves

Question 55

what exits through the inferior orbital fissure/foramen rotundum

Answer 55

maxillary division of the trigeminal CNV2

Question 56

what exits through the foramen ovale and spinosum

Answer 56

mandibular division of the trigeminal (CNV3) with accessory meningeal artery middle meningeal artery

Question 57

what is the order within the internal auditory canal

Answer 57

7 up coke down facial (CN7) and cochlear (CN8) are anterior to superior and inferior vestibular nerves (CN8)

Question 58

what exits through the jugular foramen

Answer 58

glossopharyngeal (CN9) in the pars nervosa and vagus (CN10) and spinal accessory (CN11) in the pars vascularis

Question 59

features of NF1

Answer 59

-nonspecific T2/Flair bright parenchymal foci typically in globes pallidus and cerebellar hemisphere -juvenile pilocytic astrocytoma -optic nerve gliomas -hamartomas of eye (lisch nodules) -neurofibromas -skin nodules, cafe au lait spots (peri areolar breast nodules)

Question 60

features of NF2

Answer 60

multiple schwannomas, meningiomas, and ependymomas bilateral vestibular schwannomas

Question 61

features of PHACES

Answer 61

posterior fossa malformations hemangiomas arterial cerebrovascular anomalies cardiac defects eye abnormalities sternal/ventral defects

Question 62

What is the appropriate area of coverage needed in a contrast-enhanced CT for a patient who presents with right vocal cord paralysis? Left vocal cord paralysis?

Answer 62

Skull base to clavicles Skull base to left pulmonary artery for left recurrent laryngeal nerve

Question 63

aminophylline

Answer 63

nonselective adenosine receptor antagonist

Question 64

granulomatosis with polyangiitis

Answer 64

wegener granulomatosis: nasal septal perforation/erosion and sinusitis solid and cavitated pulmonary nodules septic emboli

Question 65

features of round atelectasis

Answer 65

comet tail sign (curved pulm vessels and bronchi) must contact pleura pleural abnormality

Question 66

where are artery, veins, bronchus, and lymphatics located in lung

Answer 66

intralobular: artery and bronchus interlobular: vein and lymphatics

Question 67

What is groundglass consolidation associated with in the central region?

Answer 67

edema, hemorrhage, pcp, alveolar proteinosis ## Footnote PCP stands for Pneumocystis pneumonia, a type of lung infection caused by a fungus.

Question 68

What conditions are related to groundglass consolidation in the peripheral region?

Answer 68

Organizing pneumonia, chronic eosinophilia pna, atypical/viral pna, edema ## Footnote Organizing pneumonia is a type of lung inflammation that leads to the formation of granulation tissue in the alveoli.

Question 69

What does interlobular septal thickening indicate?

Answer 69

edema, alveolar proteinosis, hemorrhage, pcp ## Footnote Interlobular septal thickening can be a sign of various lung conditions, often related to fluid accumulation.

Question 70

Which conditions are associated with nodular groundglass consolidation?

Answer 70

lymphangitic carcinomatosis, sarcoid ## Footnote Lymphangitic carcinomatosis refers to the spread of cancer through the lymphatic system.

Question 71

What is crazy paving associated with?

Answer 71

alveolar proteinosis, pcp, organizing pna, bronchioalveolar carcinoma, hemorrhage, ards ## Footnote ARDS stands for Acute Respiratory Distress Syndrome, a severe lung condition.

Question 72

What conditions are indicated by centrilobular nodules?

Answer 72

TB or atypical mycobacteria/mycoplasma pna, hypersensitivity pneumonitis, hot tub lung, RB-ILD, silicosis ## Footnote Tb refers to Tuberculosis, an infectious disease that primarily affects the lungs.

Question 73

What are perilymphatic nodules associated with?

Answer 73

sarcoid, pneumoconioses, lymphangitic carcinomatosis ## Footnote Pneumoconioses are a group of lung diseases caused by inhaling various types of dust.

Question 74

What presents with 'random nodules'?

Answer 74

Hematogenous mets, septic emboli, pulmonary langerhans cell histiocytosis ## Footnote Hematogenous mets refer to metastases that spread through the bloodstream.

Question 75

what presents as lower lobe fibrosis

Answer 75

-UIP: basal predominant honeycombing -NSIP: basal predominant groundglass w sub pleural sparing and without honeycombing -asbestosis: pleural effusions and plaques -panlobular/acinar emphysema -rheumatoid

Question 76

what presents with upper lobe fibrosis

Answer 76

inhalation, silicosis, coal workers Cystic fibrosis, RBILD sarcoid Ank spondy

Question 77

What does the hepatic venous waveform look like and its components?

Answer 77

atrial contraction (away from heart toward liver/above baseline) ventricular systole (move toward heart) atrial overfilling (direction aligns with heart) tricuspid valve opening

Question 78

What condition is characterized by tree-in-bud nodules and bronchiectasis of the right middle lobe or lingula?

Answer 78

MAC/lady windermere

Question 79

What are the radiological findings associated with asbestosis?

Answer 79

Irregular inter and intralobular septal thickening * Subpleural curvilinear opacities * Parenchymal bands * Peripheral and posterior lower lung zones

Question 80

What is the reverse halo sign associated with?

Answer 80

AKA Atoll sign Cryptogenic organizing pneumonia (COP) ## Footnote Consolidative ring surrounding central groundglass

Question 81

What does the halo sign look like and indicate?

Answer 81

characterized by groundglass halo surrounding consolidation Invasive aspergillus ## Footnote The halo sign is a radiological feature often seen in cases of invasive aspergillosis.

Question 82

What does LIP appear as what is it associated with

Answer 82

Diffuse or lower lobe ground glass with perivascular cysts Sjogren or HIV ## Footnote This description may indicate specific pathological findings in lung imaging.

Question 83

What is hypersensitivity pneumonitis characterized by?

Answer 83

Air trapping, mosaic attenuation, centrilobular nodules ## Footnote Hypersensitivity pneumonitis is an inflammatory response in the lungs due to inhaled organic antigens.

Question 84

What imaging findings are associated with RB-ILD?

Answer 84

Ground glass and centrilobular nodules in the upper lung and smoking ## Footnote RB-ILD stands for Respiratory Bronchiolitis Interstitial Lung Disease, often seen in smokers.

Question 85

What are the key features of pulmonary Langerhans cell histiocytosis? what does it spare? who does it affect?

Answer 85

Upper lobe predominant bizarre irregular cysts and cavitary nodules, spares costophrenic recesses young adults who smoke.

Question 86

what presents with eggshell calcifications of the lymph nodes

Answer 86

silicosis, sarcoid, coal workers pneumoconiosis

Question 87

What are the conditions associated with low attenuation lymph nodes?

Answer 87

* Active tuberculosis * Fungal infection * Lymphoma * Mets (squamous cell) ## Footnote 'Mets' refers to metastatic disease.

Question 88

Which conditions are characterized by avid lymph node enhancement?

Answer 88

* Castleman disease * Sarcoidosis * Tuberculosis * Vascular Mets ## Footnote 'Vascular Mets' refers to vascular metastases.

Question 89

What types of cancers are included in hypervascular Mets?

Answer 89

* Renal cell carcinoma) * Thyroid (papillary) * Lung * Breast * Melanoma * Neuroendocrine * Choriocarcinoma

Question 90

What is the characteristic imaging phase for hepatic metastases?

Answer 90

Hypovascular so best on portal venous phase ## Footnote Hepatic metastases typically show decreased vascularity, making the portal venous phase ideal for assessment.

Question 91

What are the imaging characteristics of hepatocellular carcinoma (HCC) and serum marker?

Answer 91

Enhances on arterial and washout with local venous invasion AFP elevated

Question 92

What is the imaging feature of a hemangioma?

Answer 92

Discontinuous progressive peripheral nodular enhancement ## Footnote No internal Doppler flow

Question 93

What are key imaging features of focal nodular hyperplasia (FNH)?

Answer 93

Central stellate scar Avid enhancement and washout Isoechoic with spoke wheel vessels Positive on sulfur colloid

Question 94

What is positive in the liver on HIDA scan

Answer 94

FNH (compared to adenoma) ## Footnote FNH has functional bile ducts that can be visualized on HIDA scans, which is not the case for adenomas.

Question 95

What demographic is commonly associated with hepatic adenomas? what features are found in hepatic adenomas

Answer 95

Women on birth control Fat or hemorrhage Cold on sulfur colloid scan

Question 96

features of Budd chiari

Answer 96

Venous outflow obstruction with edematous liver Sparing of caudate bc direct ivc drainage Nodular regenerative hyperplasia

Question 97

What are the types of choledochal cysts? what is done with them

Answer 97

1) Fusiform CBD 2) Saccular CBD 3) Duodenal 4) Multiple 5) Intrahepatic/Caroli (with central dot sign) resected due to cholangiocarcinoma risk

Question 98

What is seen with ascending cholangitis?

Answer 98

Obstruction of biliary tree, likely choledocholithiasis Charcots triad Thickening and hyperenhancement bile duct walls ## Footnote Ascending cholangitis is often caused by gallstones blocking the bile duct.

Question 99

What are the components of Charcot's triad?

Answer 99

Fever, abdominal pain, jaundice ## Footnote Charcot's triad is a classic presentation of ascending cholangitis.

Question 100

What is primary sclerosing cholangitis? what are the characteristic imaging findings

Answer 100

Idiopathic inflammation, fibrosis, and destruction of bile ducts Beaded intrahepatic ducts and CBD Associated with UC and men Looks similar to aids cholangiopathy but with papillary stenosis

Question 101

How does primary biliary cirrhosis differ from primary sclerosing cholangitis?

Answer 101

Inflammation and destruction of smaller bile ducts Middle-aged women with pruritus Lace like fibrosis Antimitochondrial antibodies Regenerative and dysplastic nodules

Question 102

What is a biliary cystadenoma?

Answer 102

Large multiloculated cystic mass with enhancing septations in middle aged women If nodular solid enhancing component-> cystadenocarcinoma

Question 103

What does cholangiocarcinoma result in and its causes

Answer 103

Hilar tumor (Klatskin) Results in intrahepatic ductal dilatation Chronic biliary disease in US Liver fluke

Question 104

What are the solid pancreas tumors? how is the most common one characterized

Answer 104

Adenocarcinoma and acinar carcinoma ## Footnote Adenocarcinoma characterized by the double duct sign, Sma encasement, venous invasion, and metastasis are typically unresectable.

Question 105

What are the key features of acinar carcinoma?

Answer 105

solid tumor Aggressive, affects elderly males, associated with lipase hypersecretion syndrome

Question 106

What is a serous cystic neoplasm also known as and characterized as?

Answer 106

Cystadenoma (grandmother lesion) It is characterized by multiple small cysts and a stellate central scar and calcification. typically in the head

Question 107

What is the mucinous cystic neoplasm?

Answer 107

mother lesion Typically presents as unilocular with a capsule, usually located in the body and tail of the pancreas has malignant potential

Question 108

What distinguishes solid and papillary epithelial tumors?

Answer 108

Daughter lesion Large mass with solid and cystic areas, thick capsule, hemorrhage present Malignant

Question 109

What is an intraductal papillary mucinous neoplasm (IPMN) known for?

Answer 109

Grandfather lesion Malignant potential

Question 110

Fill in the blank: The double duct sign is associated with _______.

Answer 110

Adenocarcinoma ## Footnote This sign indicates the involvement of both the pancreatic and bile ducts.

Question 111

True or False: Mucinous cystic neoplasms are typically found in the head of the pancreas.

Answer 111

False ## Footnote They are usually located in the body and tail of the pancreas.

Question 112

What type of pancreas tumor is characterized by multiple small cysts?

Answer 112

Serous cystic neoplasm ## Footnote Also known as cystadenoma.

Question 113

What is a common demographic characteristic of acinar carcinoma?

Answer 113

Elderly males ## Footnote This type of tumor has a high incidence in older male patients.

Question 114

VHL associated with

Answer 114

hemangioblastoma w drop mets Clear cell rcc serous cystadenoma pancreatic neuroendocrine

Question 115

What can present with fatty atrophy of pancreas What are their characteristics

Answer 115

cystic fibrosis with fibrosing colonopathy and congenital abscence of vas deferens Schwachman diamond (inherited disorder with childhood pancreatic atrophy, diarrhea, short stature, eczema)

Question 116

sausage shaped pancreas

Answer 116

autoimmune pancreatitis

Question 117

How does spleen hemangioma appear on CT and MRI?

Answer 117

Hypoattenuating and hyperenhancing. T2 bright

Question 118

What is Kasabach Merritt syndrome.

Answer 118

spleen hemangioma or liver hemangioma associated with anemia, thrombocytopenia, and coagulopathy

Question 119

What is Klippel Trenaunay Weber syndrome?

Answer 119

spleen hemangioma associated with cutaneous hemangiomas Port wine nevi varicose veins/venous malformation extremity hypertrophy (localized gigantism)

Question 120

What does a spleen hamartoma appear as and what is it associated with?

Answer 120

Hypoattenuating mass with heterogeneous enhancement. associated with tuberous sclerosis

Question 121

how does splenic lymphoma appear

Answer 121

hypoenhancing POST CONTRAST on CT and MRI

Question 122

triplane fracture vs juvenile tillaux

Answer 122

*Coronal plane through metadiaphysis* Horizontal plane through lateral and anterior physis Sagittal plane through epiphysis

Question 123

fibroid imaging features

Answer 123

T2 dark, variable T1 enhancing

Question 124

contrast progression through tubes during salpingogram

Answer 124

intramural->ostium->isthmus->ampulla->infundibulum-> ovary/free spill

Question 125

what agent is dotatate and what is it used for

Answer 125

somatostatin binding agent neuroendocrine tumors

Question 126

what are the characteristics of giant cell tumors how do they appear on MRI

Answer 126

eccentric lytic epiphyseal lesion arising from metaphysis and crossing closed epiphyseal plate in skeletally mature patients low signal T2 Associated with paget disease or hyperparathyroidism

Question 127

what is the most common retroperitoneal tumor order of retroperitoneal spaces anterior to posterior

Answer 127

liposarcoma Anterior pararenal, gerotas fascia, perirenal space, zuckerkandls fascia, posterior pararenal space

Question 128

What is the positioning of vacuum assisted tip in breast biopsy?

Answer 128

The vacuum assisted tip should be past the lesion so that it can fall into the aperture ## Footnote This is in comparison to spring-loaded techniques.

Question 129

What are the malignant potentials of PASH and complex sclerosing lesion?

Answer 129

PASH is benign without malignant potential CSL/radial scar is benign with upgrade potential-> must be surgically excised (appears as spiculated mass or architectural distortion)

Question 130

What syndrome is associated with breast hamartoma?

Answer 130

Cowden syndrome Fat and glandular tissue "Breast within breast"

Question 131

What is Mondor's disease? Which vein is most commonly involved in Mondor's disease?

Answer 131

Superficial thrombophlebitis, most commonly from superficial epigastric vein Beaded tubular structure

Question 132

proper positioning on MLO view

Answer 132

-Pec muscle is widened at axilla and extend to nipple, convex anterior margin -Breast pulled up and out -Infra-mammary fold open on MLO and neutral on CC -Small amount of belly should be visible on MLO -1 cm difference on posterior nipple line on MLO and CC

Question 133

when start screening in patient with Known genetic mutation or lifetime risk ≥ 20%

Answer 133

MG annually starting at age 30 MRI annually starting at age 25-30

Question 134

when start screening in patient with breast cancer history

Answer 134

MG and MRI annually starting at the time of diagnosis

Question 135

when start screening in patient with hx of chest radiation therapy before age 30

Answer 135

MG annual at age 25 or 8 years after radiation MRI annually starting at age 25-30

Question 136

when start screening in patient with hx of ALH, ADH, or LCIS

Answer 136

MG and MRI annually starting at the time of diagnosis

Question 137

What is Addison disease?

Answer 137

Chronic insufficiency due to autoimmune destruction or sequela of infection

Question 138

What causes Waterhouse-Friderichsen syndrome?

Answer 138

Post hemorrhagic failure due to Neisseria meningitidis ## Footnote This condition is often associated with severe adrenal gland hemorrhage.

Question 139

What is the characteristic feature of an adrenal adenoma?

Answer 139

Lipid rich, less than 10 HU (drop out mri) and greater than 60% washout

Question 140

What is an adrenal myelolipoma?

Answer 140

Presence of macroscopic fat

Question 141

What progression of ductal breast pathology?

Answer 141

normal>FEA>ADH>DCIS>IDC ## Footnote Flat Epithelial Atypia

Question 142

What is the most common type of invasive carcinoma and its prognosis?

Answer 142

Invasive Ductal Carcinoma Not Otherwise Specified (IDC NOS) is the most common and has the worst prognosis compared to special types.

Question 143

What characterizes Ductal Carcinoma In Situ (DCIS)?

Answer 143

DCIS is a clonal proliferation of malignant epithelial cells originating in the terminal ductal lobular unit of the breast without invasion of the basement membrane.

Question 144

What is the progression of lobular carcinoma?

Answer 144

Normal > atypical lobular hyperplasia (ALH) > lobular carcinoma in situ (LCIS) > invasive lobular carcinoma (ILC).

Question 145

Describe the cellular characteristics of invasive lobular carcinoma. how does it compare to IDC

Answer 145

-Dark star, shrinking breast, shadowing on US -Presents later in life/older than IDC -more likely to be bilateral, multifocal, and multicentric -without calcifications

Question 146

What are the common mammographic mass margins?

Answer 146

* Circumscribed * Obscured * Microlobulated * Indistinct * Spiculated

Question 147

What are the categories of mammographic density?

Answer 147

* Fat * Low * Equal * High

Question 148

What shapes can mammographic masses take? Ultrasound masses?

Answer 148

(ROI) * Round * Oval * Irregular

Question 149

What is the difference between asymmetry and focal asymmetry in mammography? what is developing asymmetry

Answer 149

Asymmetry is seen in a single view, while focal asymmetry is seen on two projections. Developing asymmetry indicates an increase in size.

Question 150

What does global asymmetry refer to?

Answer 150

Global asymmetry refers to one breast appearing more dense compared to the other.

Question 151

appearance of IDC and ILC on ultrasound

Answer 151

ILC well differentiated with posterior shadowing IDC poorly differentiated with posterior acoustic enhancement

Question 152

Benign birads 2 calcifications

Answer 152

-Popcorn calcs= involuting fibroadenoma -Large rod like/secretory= pointing towards nipple, duct etasia -Milk of calcium= free floating calcium in cysts -Dystrophic calcs= geometric calcs related to fat necrosis -Round -egg-shell/rim calcs= fat necrosis

Question 153

Intermediate birads 4 calcs

Answer 153

-Amorphous/indistinct: “powdered sugar”; suspicious if clustered/grouped, linear or segmental -Coarse heterogeneous= “dull tip”; irregular, smaller than dystrophic, >0.5 mm

Question 154

Higher suspicion birads 4/5 calcs

Answer 154

-Fine pleomorphic: “sharp tip”; dot-dash -Fine linear or branching: “sharp tip”

Question 155

Architectural distortion

Answer 155

Radiating linear densities emanating from central point Tethering of normal fibroglandular tissue

Question 156

suspicious vs benign breast US findings

Answer 156

suspicious: hypoechoic with posterior shadowing, hyperechoic halo (can also be seen in abscess) benign: hyperechoic

Question 157

What is a galactocele? Where is it located

Answer 157

Cystic collection of milk, typically subareolar ## Footnote Characterized by fat fluid level, and appears as a well circumscribed macrolobulated mass.

Question 158

Describe the characteristics of a fibroadenoma.

Answer 158

Palpable mass in young women Popcorn calcifications in older women Homogenous hypoechoic, circumscribed parallel oval with hyperechoic fibrous bands

Question 159

What is the most common cause of nipple discharge? how does it appear? what to do with it

Answer 159

Intraductal papilloma Appears as a round or oval circumscribed mass in the subareolar region, isochoic on ultrasound, and may be located within the duct. surgical excision

Question 160

What is a phyllodes tumor and what does it look like? What to do with it

Answer 160

Large and rapidly growing tumor that can recur Oval or lobular circumscribed mass with heterogeneous echotexture Require wide surgical excision (some are benign and others malignant)

Question 161

What is a characteristic feature of tubular carcinoma?

Answer 161

Small irregular spiculated mass

Question 162

What imaging characteristic is associated with mucinous carcinoma?

Answer 162

T2 hyperintense mucin and progressive enhancement

Question 163

T2 hyperintense breast lesion with enhancement

Answer 163

Large: angiosarcoma (Primary or secondary to prior breast conservation therapy and radiation) multiple circumscribed: RCC or melanoma mets

Question 164

breast MRI features

Answer 164

focus: enhancement without precon correlate, <5 mm non mass like enhancement: clustered ring enhancment suggestive of malignancy; clumped enhancement suggestive of DCIS

Question 165

appearance of breast implant types

Answer 165

saline: denser rim with folds and valve silicone: homogeneous density throughout

Question 166

intracapsular rupture signs

Answer 166

linguini sign, salad oil sign on mri Step ladder sign on US

Question 167

fibrocystic change is most common in

Answer 167

premenopausal women

Question 168

lymphangioleiomyomatosis

Answer 168

thin walled cysts chylothorax

Question 169

fourth ventricle lesions in peds

Answer 169

ependymoma (like toothpaste, squeeze through foramen luschka/magendie, calcs) medulloblastoma (roof, diffusion restriction, avid enhance, necrosis and calcs) pilocytic astrocytoma (NF1)

Question 170

fourth ventricle lesion in adults

Answer 170

subependymoma (no enhancement) hemangioblastoma metastases

Question 171

F18 FDG pet glucose level

Answer 171

should be less than 200 NPO for 4 hrs prior to exam

Question 172

FDG F18 PET normal distribution

Answer 172

brain Liver Ovaries Muscle concentrated in urine

Question 173

FDG F18 PET is not useful for

Answer 173

HCC, RCC, prostate bronchioloalveolar cell carcinoma or carcinoid/neuroendocrine

Question 174

myocardial stress/"exercise" agents

Answer 174

-adenosine: contraindicated in asthma, COPD, caffeine use -regadenoson (adenosine agonist) -dipyridamole (adenosine deaminase inhibitor): aminophylline is antidote -dobutamine (beta 1 agonist): used when adenosine is contraindicated

Question 175

myocardial perfusion agents

Answer 175

-Tc99 sestamibi: perfusion at the time of injection -rubidium82: half life 75 s -N13 ammonia: half life 10 m

Question 176

myocardial imaging to assess

Answer 176

-acute chest pain -hemodynamic significance of coronary stenosis -post MI risk stratification -viability prior to revascularization -surgery preop risk assessment -post CABG revascularization

Question 177

fixed myocardial perfusion defect on stress and rest

Answer 177

either hibernating myocardium or scar -> FDG PET uptake=hibernating myocardium -> if no FDG PET uptake= nonviable scar

Question 178

what does cardiac ischemia look like on perfusion

Answer 178

perfusion defect on stress imaging which is reversible on rest

Question 179

dilation of the left ventricle present on stress imaging

Answer 179

transient ischemic dilation= three vessel disease

Question 180

gold standard for myocardial viability

Answer 180

F18 FDG PET (but cannot evaluate perfusion) Thallium can evaluate viability (hibernating vs scar post redistribution) and perfusion but dose is too high and half life too long

Question 181

thyroid imaging with what agents

Answer 181

Tc99 pertechnetate, I123 and I131 I123: shorter half life and pretty picture but expensive I131: long half life and ugly picture, cheap Tc99m: trapped but not organified

Question 182

graves looks like

Answer 182

hyper thyroid: thyromegaly, diffusely increased activity, visualization of the pyramidal lobe

Question 183

Hashimoto looks like on pet

Answer 183

mostly hypothyroid: thyromegaly, patchy increased activity

Question 184

thyroiditis looks like

Answer 184

Subacute or de Quervain silent OR swollen and painful decreased uptake Hyperthyroid then hypothyroid

Question 185

parathyroid imaging

Answer 185

Tc99m sestamibi thyroid washes out, remaining parathyroid adenoma

Question 186

Tc99m sulfur colloid scan of liver demonstrates

Answer 186

photopenic defect: cyst decreased uptake: HCC, adenoma, abscess increased uptake: FNH, regenerative nodule, Budd chiari

Question 187

colloid shift on sulfur colloid scan

Answer 187

liver dysfunction (cirrhosis) increased uptake in spleen and bone marrow

Question 188

what radionuclide for meckel scan?

Answer 188

Tc99 Pertechnetate omphalomesenteric duct remnant located in distal ileum w gastric mucosa which can bleed

Question 189

HIDA requirements

Answer 189

NPO 6 hrs, but has eaten in 24 hrs

Question 190

HIDA visualization

Answer 190

liver in 5 min, gallbladder in 15 min if no visualization, morphine to contract sphincter of oddi

Question 191

acute chole on HIDA

Answer 191

no visualization of gallbladder after morphine admin or rim sign (increased hepatic activity at the fossa)

Question 192

Ventilation scan performed with

Answer 192

Xenon 133 (inhaled gas, performed first) or Tc 99m DTPA (aerosol)

Question 193

V/Q perfusion scan performed with? when contraindicated? right to left shunt?

Answer 193

Tc 99m MAA severe pulmonary hypertension immediate renal and brain uptake

Question 194

bone scan agent: what phases:

Answer 194

Tc99m MDP (chemisorption) Blood flow, blood pool, delayed

Question 195

what is positive on all 3 phases of bone scan? positive 2 phases? double density sign?

Answer 195

3: fracture, osteomyelitis, septic arthritis 2: cellulitis (non positive on delayed) dd: osteoid osteoma

Question 196

Tc99m MDP superscan looks like and due to

Answer 196

diffusely increased osseous uptake hyperparathyroidism or metastatic prostate cancer

Question 197

osseous Paget on bone scan and xray

Answer 197

lytic lesions are positive on bone scan sclerotic lesions are positive on X-ray

Question 198

renal nuc agents and what they evaluate

Answer 198

Tc99m DMSA: cortical agent for scarring/pyelonephritis Tc99m DTPA: GFR and perfusion Tc99m MAG3: renal plasma flow and perfusion (diuretic renogram with lasix for obstruction)

Question 199

evaluate pediatric reflux

Answer 199

radionuclide cystography Tc99m pertechnetate, Tc99m DTPA, Tc99m SC

Question 200

Thallium and gallium diseases

Answer 200

Kaposi sarcoma: thallium avid tuberculosis: gallium avid lymphoma: both avid

Question 201

I123 MIBG vs I111 pentetreotide

Answer 201

I123: primary pheochromocytoma, neuroblastoma I111: extra adrenal pheo, carcinoid

Question 202

gallium 67 MOA and uses

Answer 202

binds transferrin (inflam, infection, neoplasm) -first line spinal osteomyelitis -panda sign and lambda: sarcodiosis -pcp and pneumonia

Question 203

WBC imaging

Answer 203

spleen>liver>bone marrow In111 WBC Tc99m HMPAO (physiologic GI/GU and renal uptake)

Question 204

crossed cerebellar diaschisis

Answer 204

supratentorial lesion decreased radio tracer uptake of CONTRALATERAL cerebellum interrupted corticopontine pathways

Question 205

RCC types

Answer 205

-clear cell: (most common, hypervascular) Von hippel lindau vhl cystic w enhancing part -papillary: (hypovascular) transplant -chromophobe: (best prognosis) birt hogg dube -medullary: (aggressive) sickle cell -translocation: kids w prior chemo

Question 206

renal angiomyolipoma composition and appearance

Answer 206

macroscopic fat, muscle, and blood vessels risk of hemorrhage avid enhancement hyperechoic WITHOUT calcifications (think Rcc otherwise)

Question 207

oncocytoma apperance

Answer 207

central scar homogeneous enhancement Spoke wheel vascular pattern on US

Question 208

von hippel lindau vhl

Answer 208

AD -Clear cell RCC, pheochromocytoma -CNS hemangioblastoma -pancreatic neuroendocrine tumor -Serous cystadenoma -renal, liver, pancreatic cysts and epididymal cysts

Question 209

birt hogg dube

Answer 209

chromophobe RCC, lung cysts, fibrofolliculomas AD

Question 210

tuberous sclerosis

Answer 210

AD -cortical tubers, subependymal nodules, SE giant cell astrocytoma (foramen of monro w homogenous enhancement) -cystic lung LAM and chylothorax -cardiac rhabdomyoma -bilateral AMLs, renal cysts, rccs

Question 211

multilocular cystic nephroma

Answer 211

Michael Jackson lesion (young boys and middle age women) herniate into renal pelvis Thick fibrous capsule w enhancing septa

Question 212

acquired cystic kidney disease associated with

Answer 212

AKA uremic cystic disease dialysis and increased risk of RCC (compared to ADPKD)

Question 213

xanthogranulomatous pyelonphritis what associated sign and micro

Answer 213

chronic renal obstruction 2/2 obstructive calculi bear paw sign: fatty replacement of parenchyma proteus mirabilis and e coli

Question 214

what is putty kidney and what is it associated with

Answer 214

calcified atrophic kidney with scarring and necrosis autonephrectomy in end stage renal tuberculosis

Question 215

molar tooth sign seen where

Answer 215

extraperitoneal bladder rupture in space of retzius (conservative management vs surgery in intraperitoneal rupture) Joubert syndrome in brain

Question 216

male urethra anatomy

Answer 216

prostatic (transitional)->membranous->bulbous->penile (squamous)->fossa navicularis

Question 217

urethral glands

Answer 217

male: cowpers glands in the membranous urethra female: paraurethral skene glands

Question 218

bph vs prostate adenocarcinoma location and appearance

Answer 218

bph transitional zone adeno in peripheral zone (T2 dark, diffusion restriction, early enhancement/washouts)

Question 219

prostate staging

Answer 219

T1 only on biopsy, T2 confined to prostate, T3 extend through capsule and to seminal vesicles, T4 invades adjacent structures N1 nodal involvement M0 no met, M1 extra pelvic mets

Question 220

uterus MRI appearance

Answer 220

endocervical canal T2 bright junctional zone T2 dark myometrium intermediate

Question 221

adenomyosis MRI features

Answer 221

thickening of myometrium/junctional zone (T2 dark) with ectopic endometrial gland small t2 hyperintense foci

Question 222

endometriosis MRI features and next step

Answer 222

tiny T1 hyperintense foci (hemorrhagic implants) T1 bright (light bulb bright) endometrioma w T2 shading ->laparoscopy

Question 223

fibroid MRI and US appearance what can't UAE treat

Answer 223

T1 and T2 hypointense, with enhancement hypoechoic with venetian blin UAE not effective for necrotic or hemorrhagic fibroids

Question 224

endometrial carcinoma MRI appearance and stages

Answer 224

T2 hypointense, hypoenhancing 1) confined to uterus, 2) spread to cervix, 3) spread to adnexa, vagina, nodes, 4) spread to bladder/bowel

Question 225

cervical carcinoma stages and significance

Answer 225

1) confined to uterus/cervix 2a) spread to upper vagina 2b) parametrial invasion (NON surgical) 3a) spread to lower vagina 3b) pelvic sidewall or node 4) bladder or rectum

Question 226

uterine anomalies

Answer 226

separate fundi (failure to fuse with fundal cleft): didelphys->bicornuate-> single external fundus (failure to cleave): septate->arcuate

Question 227

dermoid cyst

Answer 227

mature cystic teratoma T1 bright (like endometrioma) but fat sat lesions rokatinsky nodule: hair, teeth

Question 228

ovarian metastases from where

Answer 228

gastric (krukenberg), colon, pancreas, breast

Question 229

where is CSF produced and reabsorbed

Answer 229

choroid plexus: lateral ventricle body to temporal horns, roof of third and fourth ventricles arachnoid granulations

Question 230

flow of CSF

Answer 230

frontal horn-> body-> atrium-> occipital and temporal horns lateral ventricles-> foramen of monro-> third-> cerebral aqueduct-> fourth-> luschka and magendie, obex to canal

Question 231

What is cytotoxic edema?

Answer 231

Damaged NaK ATPase ion pumps leading to cell death, primarily affecting gray and white matter interface in infarct leading to an imbalance of ions and water influx into cells

Question 232

What causes vasogenic edema?

Answer 232

Increased capillary permeability due to neoplasm, infection, or infarct, primarily affecting white matter conditions that disrupt the blood-brain barrier, allowing fluids to accumulate in the extracellular space.

Question 233

What is interstitial edema?

Answer 233

Cerebrospinal fluid flow imbalance, as seen in obstructive hydrocephalus resulting in transependymal/periventricular flow ## Footnote Interstitial edema can occur due to conditions that block normal CSF flow, leading to fluid buildup in brain interstitial spaces.

Question 234

What is subfalcine herniation and what are the consequences

Answer 234

Cingulate gyrus herniation under the falx cerebri * ACA compression leading to infarct * Contralateral hydrocephalus due to foramen of Monro obstruction

Question 235

What is transtentorial herniation?

Answer 235

Uncal herniation Herniation of the medial temporal lobe

Question 236

What are the effects of transtentorial herniation?

Answer 236

* PCA/SCA compression (ptosis and pupil dilation) * Ipsilateral CN3 compression causing oculomotor dysfunction * Shearing of perforating basilar branch vessels leading to upper brainstem Duret hemorrhages * Contralateral cerebral peduncle compression causing hemiparesis

Question 237

What is cerebellar tonsillar herniation? What is prone to herniation and what can it lead to

Answer 237

Herniation of the cerebellar tonsils due to limited volume in the posterior fossa cerebellar infarcts are prone to herniation can cause compression of the medulla

Question 238

What is communicating hydrocephalus? and what are examples

Answer 238

AKA Non-obstructive hydrocephalus Extraventricular hydro 2/2 subarachnoid hemorrhage impeding arachnoid granulation resorption or meningitis Or NPH

Question 239

what differentiates intra axial from extra axial pachymeninges vs leptomeninges

Answer 239

pia membrane pia and arachnoid are lepto, dura is pachy

Question 240

what do T1 and T2 represent on MRI

Answer 240

T1: longitudinal relaxation T1 short=bright, T1 long=dark T2: transverse relaxation T2 short=dark, T2 long=bright

Question 241

What substances are T1 short? T2 short/long

Answer 241

T1 short: blood, fat, melanin, protein/minerals T2 short: blood, calc, vascular flow void, cellular tumor T2 long: water/edema, mucin

Question 242

what brain lesions restrict diffusion

Answer 242

stroke, abscess, lymphoma, epidermoid, herpes encephalitis, choroid plexus cyst/xanthogranuloma

Question 243

MRI spectroscopy peaks

Answer 243

choline 3.2 creatinine 3.0 NAA 2.0

Question 244

normal enhancement in brain

Answer 244

no blood brain barrier choroid plexus, pituitary and pineal glands,

Question 245

periventricular subependymal enhancement can be seen with

Answer 245

ventriculitis (CMV) lymphoma (hyperattenuating on CT, T2 dark, diffusion restriction) glial tumor

Question 246

what can demonstrate gyriform enhancement nodular enhancement?

Answer 246

-herpes encephalitis, meningitis -hematogenous mets at gray white junction

Question 247

what can demonstrate ring enhancement (neuro)

Answer 247

-abscess (diffusion restriction) -demyelinating disease (incomplete C ring) -glioma (surrounding infiltrative tumor does not enhance) -lymphoma in immunocompromised (basal ganglia) -subacute contusion -mets -radiation necrosis

Question 248

what can pachymeningeal enhancement represent

Answer 248

dural enhancement: -intracranial hypotension (sagging tonsils and enlarged pituitary) -meningioma -granulomatous disease

Question 249

what can leptomeningeal enhancement represent

Answer 249

pial and arachnoid enhancement: -bacterial/fungal meningitis -viral encephalitis -carcinomatosis (GBM, ependymoma, medulloblastoma, lymphoma) -slow vascular flow is a mimic -moya moya ivy sign

Question 250

brain tumors are typically what on MRI what are exceptions

Answer 250

typically T1 dark and T2 bright T1 bright: melanoma, hemorrhagic mets, teratoma/dermoid T2 dark: hypercellular lymphoma, medulloblastoma, germinoma

Question 251

cowden syndrome associated with

Answer 251

breast hamartoma (breast within a breast) lhermitte duclos (corduroy or tiger striped cerebellar gangliocytoma)

Question 252

differential for CNS cystic mass with enhancing nodule

Answer 252

-hemangioblastoma (VHL) -juvenile pilocytic astrocytoma (kids, posterior fossa, NF1) -pleomorphic xanthoastrocytoma (temporal lobe) -ganglioganglioma (young adult, refractory temporal lobe epilepsy)

Question 253

differential for crossing midline/corpus callosum lesion

Answer 253

-glioblastoma multiforme (infiltrative surrounding T2 tumor) -lymphoma (avid homogeneous enhancement) -demyelinating disease

Question 254

gliomatosis cerebri looks like

Answer 254

T2 signal affecting multiple lobes no enhancement infiltrative astrocytoma

Question 255

What is an oligodendroglioma and associations?

Answer 255

A slow growing cortical based mass with CALCS primarily young to middle-aged individuals and associated with seizures.

Question 256

what do intramedullary spinal cord tumors look like and what kinds?

Answer 256

cause expansion and enhancement of the cord Ependymoma (adult): well defined w syrinx and hemorrhage Astrocytoma (kid): more eccentric and irregular Hemangioblastoma: wide cord with edema demyelinating lesion

Question 257

What types of conditions can cause cord enhancement?

Answer 257

Ependymoma, astrocytoma, viral myelitis (cord and cauda equina enhancement compared to cauda enhancement in Guillain Barre)

Question 258

intraventricular lesions include

Answer 258

-neurocytoma (young adult): bubbly appearance (Swiss cheese) attached to septum pellucidum with cystic areas, calcs, necrosis -choroid plexus papilloma (4th vent adults, lateral vent children): avid enhancement -meningioma: atrium -SEGA: foramen of monro; TS; homogenous enhancement -subependymoma: don’t enhance

Question 259

meningioma features and nuc activity

Answer 259

enhancing diffusion restriction osseous hyperostosis calcs NF2 Take up octreotide and T99m MDP

Question 260

what lesions can be seen in the cerebellopontine angle

Answer 260

-epidermoid cyst: diffusion restrict, csf signal but does not suppress on flair, cauliflower like borders -vestibular schwannoma: avid enhancement, expands porus acousticus like ice cream cone -meningioma: enhance and diffusion restrict -aneurysm: vertebrobasilar flow voids

Question 261

pseudotumor cerebri

Answer 261

idiopathic intracranial hypertension -overweight black female -flattening of sclera, optic disc protrusion, nerve sheath tortuosity/edema -empty sella, enlarged meckels cave -slit like ventricles -can compress CN6

Question 262

pituitary lesions and features

Answer 262

-craniopharyngioma (kids): cystic mass w calcs -rathke cleft cyst (adults): claw sign -pituitary adenoma: T1 dark, slow enhancement -pituitary apoplexy: T1 bright -lymphocytic hypophysitis: IgG4

Question 263

what does pineal gland secrete What can happen if the mass of the pineal gland compresses the tectal plate?

Answer 263

Melatonin Parinaud syndrome * Upward gaze paralysis * Nystagmus * Pupillary light disassociation

Question 264

pineal gland tumors can cause what? and how to distinguish?

Answer 264

parinaud syndrome: vertical gaze palsy Germinoma: Central calcification 'engulfed' Pineoblastoma: exploded calcifications, invades adjacent structures, diffusion restriction

Question 265

What is the relationship between bilateral retinoblastomas, trilateral, and quadrilateral retinoblastomas?

Answer 265

-unilateral is spontaneous (leucokoria white pupil reflex) -bilateral is familial -pineoblastoma with bilateral retinoblastomas=trilateral retinoblastoma -pineoblastoma with bilateral retinoblastomas and sella involvement=quadrilateral retinoblastomas

Question 266

What is the association of quadrigeminal plate lipoma?

Answer 266

Associated with agenesis or hyperplasia of corpus callosum

Question 267

What may affect all of Waldeyer lymphatic ring (and what does it involve)?

Answer 267

Non Hodgkin lymphoma The Waldeyer lymphatic ring includes the lingual, palatine, and adenoidal lymphatic tissues.

Question 268

subarachnoid hemorrhage locations:

Answer 268

typically due to aneurysm rupture in non trauma cases -ACA: interhemispheric fissure -MCA: sylvian fissure -PCOM: basal cistern -basilar tip: interpeduncular cistern

Question 269

subarachnoid hemorrhage grading and complications

Answer 269

hunt and hess score for mortality -vasospasm 7 days post (Fisher scale for severity) -acute hydrocephalus (communicating extraventricular) -superficial siderosis: iron overload-> sensorineural deafness and ataxia

Question 270

What can cause nontraumatic nonaneurysmal SAH?

Answer 270

Prolonged but reversible cerebral vasoconstriction syndrome Or perimesencephalic SAH

Question 271

What causes an epidural hematoma? What is the primary cause of a subdural hematoma?

Answer 271

-Fracture of squamous temporal bone and tearing of MMA -Tearing of cerebral veins

Question 272

What leads to intraventricular hemorrhage and what complication?

Answer 272

Tearing of subependymal veins May result in ependymal scarring which obstructs the cerebral aqueduct-> obstructive hydrocephalus

Question 273

What is associated with parenchymal hemorrhage in younger individuals?

Answer 273

AVM Enlarged artery feeding the hemorrhage and adjacent encephalomalacia Spetzelr martin scale evaluate surgical risk for AVM resection

Question 274

Where can dural arteriovenous fistulas (DAVF) be located?

Answer 274

Posterior fossa or adjacent to cavernous sinus enlarged meningeal artery or cortical vein

Question 275

What features and apperance are associated with cavernous malformation?

Answer 275

popcorn calc, dark hemosiderin rim Associated with developmental venous anomaly (DVA): caput medusae It is typically low flow and angiographically occult.

Question 276

What type of hemorrhage is commonly seen in young females

Answer 276

bilateral thalamus hemorrhage in venous thrombosis

Question 277

What are the types of intracranial hemorrhagic neoplasms?

Answer 277

Glioblastoma and vascular metastases (melanoma, RCC, thyroid, breast, lung)

Question 278

What characterizes the Chiari malformations?

Answer 278

1) Downward displacement of tonsils +/- syrinx 2) Downward displacement of tonsils and cerebellum, low lying torcula, tectal beaking, towering cerebellum, hydrocephalus, +/- lumbar myelomeningocele 3) low occipital/high cervical encephalocele, may be associated with tethered cord, agenesis of corpus callosum

Question 279

What do Le Fort fractures involve and what are the types?

Answer 279

Pterygoid plates 1) Floating palate: Horizontal through all maxillary walls 2) Pyramidal fracture: Central midface, nose, and hard palate move together; orbit and maxilla are involved 3) Complete midface dissociation: fractures through orbits and zygomatic arches

Question 280

segments of the ICA

Answer 280

1) cervical 2) petrous 3) lacerum 4) cavernous 5) clinoid 6) supraclinoid (ophthalmic at the dural ring) 7) communicating (PCOM and anterior choroidal artery) MCA and ACA

Question 281

circle of willis

Answer 281

Question 282

What does the recurrent artery of Heubner supply and where does it originate?

Answer 282

The recurrent artery of Heubner supplies the caudate head and anterior limb of the internal capsule. A1 artery

Question 283

What supplies the caudate and lentiform nucleus?

Answer 283

Medial lenticulostriate perforators from A1 Lateral lenticulostriate perforators from MCA (including putamen, external capsule, posterior limb)

Question 284

What does the Pcomm travel alongside?

Answer 284

3rd cranial nerve A Pcomm aneurysm can lead to CN3 palsy.

Question 285

What type of infarction is associated with a V shaped bilateral ventromedial thalamic infarction?

Answer 285

Artery of Percheron infarction ## Footnote This variant features a single dominant thalamic perforator from the PCA.

Question 286

What structures does the anterior choroidal artery supply?

Answer 286

Optic chiasm, hippocampus, posterior limb of internal capsule

Question 287

Fill in the blank: Chronic infarct is associated with _______.

Answer 287

Wallerian degeneration (Atrophy of ipsilateral cerebral peduncle and ventral pons) and cortical laminar necrosis

Question 288

What vascular anomaly can cause high output cardiac failure in childhood?

Answer 288

Vein of galen malformation (AV fistula from thalamoperforator branch into deep venous system, with enlarged median prosencephalic vein) Hepatic hemangioendothelioma and sacrococcygeal teratoma

Question 289

What can be seen in cases of cavernous carotid fistula?

Answer 289

enlarged/engorged superior ophthalmic vein Proptosis and CN palsy

Question 290

What is capillary telangiectasia and describe its appearance?

Answer 290

A condition characterized by dilated capillaries Brush stroke like enhancing lesion in brainstem or pons, no mass effect ## Footnote It is typically low flow and angiographically occult.

Question 291

intracranial anuerysms causes and locations

Answer 291

Saccular aneurysm: hypertension at branch points, anterior Fusiform aneurysm: atherosclerosis or chronic dissection at vertebrobasilar system Mycotic aneurysm: from septic emboli, typically distal arterial beyond circle of Willis Oncotic aneurysm: neoplasm, embolus from left atrial neoplasm

Question 292

deep intracranial veins

Answer 292

Question 293

What is the venous angle?

Answer 293

Intersection of septal vein and thalamostriate veins to form the internal cerebral veins angiographic landmark for foramen of Monro

Question 294

What does the vein of Trolard connect? What does the vein of Labbe connect?

Answer 294

Superficial cortical veins to superior sagittal sinus Temporal lobe veins to transverse or sigmoid sinus

Question 295

What is the empty delta sign?

Answer 295

Filling defect in superior sagittal sinus from venous thrombosis

Question 296

What conditions can lead to venous thrombosis? What are potential complications

Answer 296

* Pregnancy * Oral contraceptives * Malignancy can lead to venous hypertension and infarct or hemorrhage.

Question 297

venous thrombosis results in infarct where: -Superior sagittal sinus thrombosis -Deep venous thrombosis -Transverse sinus thrombosis

Answer 297

-> infarct of parasagittal high convex cortex -> infarct of bilateral thalami -> infarct of posterior temporal lobe

Question 298

cervical lymph nodes

Answer 298

1A/1B separated by digastric 2A/2B separated by IJV 2/3 separated by inferior hyoid 3/4 separated by inferior cricoid

Question 299

What is the most common childhood soft tissue sarcoma in the head and neck?

Answer 299

Rhabdomyosarcoma affects orbit>sinus>ear>neck

Question 300

What are the variants of Multiple Sclerosis (MS)?

Answer 300

* Concentric balo sclerosis: alternating concentric bands of normal and abnormal myelin (onion) * Marburg: fulminant form of MS leading to death in months * Devic disease (neuromyelitis optica): optic nerves and spinal cord transverse myelitis with antibodies to aquaporin 4

Question 301

What demyelinating disease affects the corpus callosum in male alcoholics?

Answer 301

Marchiafava-bignami

Question 302

T2 bright medial thalamus and periaqueductal gray matter mammillary body enhancement

Answer 302

Wernicke encephalopathy: * Ataxia * Confusion * Oculomotor dysfunction

Question 303

What is the imaging finding in PRES?

Answer 303

Symmetric posterior subcortical white matter T2 hyperintensity ## Footnote Often associated with conditions like hypertension, eclampsia, and sepsis.

Question 304

symmetric anterior subcortical white matter T2 hyperintensity, specifically in the anterior temporal lobe or paramedian frontal lobe

Answer 304

CADASIL (cerebral autosomal dominant arteriopathy w subcortical infarcts and leukoencephalopathy) characterized by recurrent stroke and migraine in younger pt

Question 305

What does progressive multifocal leukoencephalopathy (PML) involve vs HIV encephalitis

Answer 305

Asymmetric T2 signal of bilateral white matter, involving arcuate subcortical U fibers in PML HIV is symmetric and spares the subcortical U fibers

Question 306

What causes subacute sclerosing panencephalitis (SSPE) and how does it appear?

Answer 306

Reactivation of measles periventricular white matter lesions with surrounding edema.

Question 307

What is acute disseminated encephalomyelitis (ADEM) associated with? What does it involve/spare?

Answer 307

Post viral infection or vaccination in children Ring enhancing T2 bright lesions WITHOUT involvement of callososeptal interface

Question 308

What is the primary feature of Cryptococcus infection in the brain?

Answer 308

Basilar meningitis and leptomeningeal enhancement gelatinous pseudocysts along basal ganglia spaces dilated perivascular spaces

Question 309

What is the cause of Neurocysticercosis and appearance?

Answer 309

Taenia solium parasite with cysts, ring enhancing lesions, or parenchymal calcs causing seizures

Question 310

What imaging finding is associated with Toxoplasmosis in the brain?

Answer 310

Ring enhancing lesions and calcifications in basal ganglia; no diffusion restriction or FDG uptake Hydrocephalus

Question 311

What are the imaging characteristics in Herpes encephalitis?

Answer 311

Mesial temporal lobe, insular cortex T2 signal; gyral enhancement

Question 312

What are the imaging characteristics of HIV encephalopathy?

Answer 312

Symmetric T2 signal in periventricular and deep white matter; cerebral atrophy

Question 313

What imaging findings are associated with CMV encephalitis?

Answer 313

Ventriculitis with subependymal flair hyperintensity and enhancement

Question 314

What is a characteristic imaging finding in Creutzfeldt Jakob disease?

Answer 314

Cortical ribboning and basal ganglia/thalami flair and restricted diffusion caused by prions and associated with DWI and FLAIR pulvinar sign and hockey stick sign of dorsomedial thalamus

Question 315

What neuro imaging characteristic is associated with liver disease?

Answer 315

T1 hyperintense in globus pallidus and substantia nigra due to manganese deposition

Question 316

What MRI findings are indicative of hypoglycemia?

Answer 316

Bilateral T2 hyperintense in cortex gray matter, hippocampi, and basal ganglia

Question 317

What are the MRI characteristics for HIE and how to distinguish from hypoglycemia?

Answer 317

Hypoxic-Ischemic Encephalopathy T2 hyperintense cortex gray matter, hippocampi, and basal ganglia white cerebellum sign distinguishes from hypoglycemia: sparing the cerebellum

Question 318

What are the MRI findings associated with carbon monoxide exposure?

Answer 318

Symmetric T2 hyperintense and restricted diffusion in globus pallidus with symmetric confluent cerebral white matter involvement

Question 319

What does methanol poisoning look like?

Answer 319

hemorrhagic necrosis of putamen (T1 bright CT dense) optic neuritis/nerve atrophy white matter edema

Question 320

What is the order of neck fascia?

Answer 320

retropharyngeal space->alar fascia->danger space->prevertebral fascia->prevertebral space

Question 321

What is Ludwig angina?

Answer 321

Infection of the floor of the mouth

Question 322

What is Lemierre syndrome?

Answer 322

Septic thrombophlebitis of tonsillar and peritonsillar veins with spread to the internal jugular vein and septic emboli Recent infection or ent surgery Fusobacterium necrophorum

Question 323

What is a Bezold abscess?

Answer 323

Complication of otomastoiditis; opacification of middle ear and mastoid air cells with erosion

Question 324

What is a ranula?

Answer 324

A mucous retention cyst from the sublingual gland

Question 325

What is a dermoid cyst?

Answer 325

A midline floor of mouth fluid lesion with the appearance of a sack of marbles (fat globules)

Question 326

What is a thyroglossal duct cyst?

Answer 326

A midline cyst, typically infrahyoid From base of cecum to thyroid

Question 327

If a cystic lesion is seen near the angle of the mandible in a child, what is the most likely diagnosis? in an adult, what is the most likely diagnosis?

Answer 327

Branchial cleft cyst Cystic papillary thyroid metastasis or squamous cell carcinoma metastasis

Question 328

What is a Thornwaldt cyst?

Answer 328

A cyst located in the midline of the nasopharynx

Question 329

What is vocal cord paralysis characterized by vs laryngocele?

Answer 329

Medialized aryepiglottic fold and enlargement of pyriform sinus Dilation of laryngeal ventricle

Question 330

What is the agger nasi cell and concha bullosa?

Answer 330

Most anterior ethmoid air cell, can obstruct frontal recess Pneumatization of middle turbinate

Question 331

What is Potts puffy tumor?

Answer 331

Complication of sinusitis resulting in osteomyelitis of the frontal bone with subgaleal abscess and soft tissue edema

Question 332

What is the difference between chronic allergic fungal sinusitis and acute invasive fungal sinusitis

Answer 332

Chronic allergic: central curvilinear/serpiginous hyperdense material; deossified walls Acute invasive: no hyperdensity; aggressive with local invasion, bony destruction, intracranial/orbital spread

Question 333

What is an antrochoanal polyp vs inverting papilloma?

Answer 333

Extend from maxillary sinus into nasal cavity with widening of ostium; NO erosion of bone Papillomas demonstrate cerebriform pattern of enhancement; remodel bone WITH erosion

Question 334

What is a mucocele?

Answer 334

Expanded sinus with thinned walls and osseous erosion due to obstruction of ostia; Most common frontal sinus

Question 335

What do the middle, superior and inferior meatus drain

Answer 335

Superior: Posterior ethmoids and sphenoids Middle: Anterior ethmoids, frontal and maxillary sinuses drain from middle meatus via hiatus semilunaris and ostiomeatal unit Inferior: Lacrimal duct

Question 336

parotid gland normally contains

Answer 336

contain facial nerve lymphoid tissue

Question 337

parotid gland tumors

Answer 337

benign: -pleomorphic adenoma (enhances, T2 bright) -warthins tumor (does not enhance, T2 bright) malignant: -mucoepidermoid carcinoma (enhances) -adenoid cystic carcinoma (enhances): perineural invasion -lymphoma

Question 338

What is a characteristic symptom of sarcoidosis vs Sjogren's syndrome?

Answer 338

Sarcoid: Bilateral painless parotid swelling Sjogren's syndrome: primarily affects salivary and lacrimal glands (dry mouth and dry eyes)

Question 339

What are the symptoms of uveoparotid fever?

Answer 339

Uveitis, parotid enlargement, facial nerve palsy

Question 340

Answer 340

pterygopalatine fossa pterygomaxillary fissure, sphenopalatine fossa, inferior orbital fissure, pterygopalatine canal to oral cavity

Question 341

sublingual and submandibular glands

Answer 341

Question 342

What is juvenile nasopharyngeal angiofibroma?

Answer 342

benign vascular tumor with nasal obstruction and epistaxis avid enhancement mass expands the pterygopalatine fossa and causes anterior bowing/displacement of the posterior maxillary sinus wall skull base erosion

Question 343

What is the most common malignant neoplasm of the anterior skull base in children and adults?

Answer 343

Rhabdomyosarcoma in children Squamous cell carcinoma in adults, often presenting with bony destruction and intensely enhancing maxillary antrum.

Question 344

What is the most common malignant neoplasm of the anterior skull base in adults?

Answer 344

Squamous cell carcinoma

Question 345

What are the CT characteristics of Esthesioneuroblastoma (olfactory neuroblastoma)?

Answer 345

Slight hyperattenuating mass; Intermediate on T1 and T2; Peripheral tumor cysts at the margins of the intracranial portion of the mass Bimodal age distribution in teenagers and middle age

Question 346

What is the key characteristic and signal appearance of Adenoid cystic carcinoma on MRI? Where do they typically arise from?

Answer 346

Perineural spread Water signal with enhancement T1 and T2 Minor salivary glands

Question 347

Retropharyngeal abscess most commonly from

Answer 347

suppurative pharyngitis

Question 348

Middle ear consists of what

Answer 348

tympanic membrane ossicles (malleus, incus, stapes) stapedius facial nerve oval window between air filled middle and fluid filled inner ear

Question 349

What is EAC atresia?

Answer 349

Abnormal malleus and incus

Question 350

What is EAC exostosis characterized as and commonly known as?

Answer 350

characterized by bony outgrowths in the external auditory canal, often associated with frequent exposure to cold water Surfers ear

Question 351

What condition is referred to as swimmers ear?

Answer 351

External otitis inflammatory condition of the external ear canal, frequently caused by water exposure and infections.

Question 352

What is necrotizing external otitis?

Answer 352

Malignant otitis externa serious infection typically seen in diabetic or immunocompromised patients, characterized by extensive enhancement and bony erosion.

Question 353

What does keratosis obturans involve?

Answer 353

Keratin plugs bilaterally ## Footnote Keratosis obturans is a condition characterized by the accumulation of keratin in the external auditory canal, leading to blockage.

Question 354

What are the key features of a facial nerve schwannoma?

Answer 354

Enlargement of bony canal, Brisk contrast enhancement, Facial nerve palsy or conductive hearing loss

Question 355

Red vascular mass behind tympanic membrane->

Answer 355

Glomus tympanicum: Extra-adrenal pheo aka paraganglioma Pulsatile tinnitus or conductive hearing loss or hemangioma or aberrant carotid artery

Question 356

Blue mass behind tympanic membrane->

Answer 356

Cholesterol granuloma/cyst: Soft tissue middle ear mass with bony erosion T1 and T2 hyperintense

Question 357

White mass behind tympanic membrane->

Answer 357

Cholesteatoma (congenital in middle ear, acquired anywhere else): Well circumscribed soft tissue mass with bony erosion, blunting of scutum, and erosion of the ossicles Involvement of lateral semicircular canal, tegmen tympani, and facial nerve Diffusion restriction but no enhancement, T2 bright

Question 358

inner ear components

Answer 358

Labyrinth, utricle, saccule, vestibular and cochlear aqueduct Labyrinth (Contained within otic capsule): -cochlea (2.5 turns) -vestibule (balance) -semicircular canals (percept movement)

Question 359

what is cochlear dysplasia vs michel aplasia

Answer 359

incomplete development of the normal 2.5 turns vs complete lack of inner ear development

Question 360

otosclerosis/otospongiosis

Answer 360

Bone dysplasia of otic capsule replaced by spongy bone classic hearing loss in young and middle aged women Bilateral

Question 361

types of labyrinthitis

Answer 361

Acute: pus with diffuse enhancement of inner ear Fibrous: replacement of endolymph & perilymph with fibrous strands; Decreased fluid signal and enhancement Labyrinthitis ossificans: replacement of endo and peri lymph with calcified debris

Question 362

types of t bone fractures

Answer 362

Longitudinal (most common): Involve ossicles-> conductive hearing loss Transverse (perpendicular to long axis): Involve bony labyrinth-> sensorineural hearing loss; 50% with facial nerve or vascular injury

Question 363

petrous apex lesions

Answer 363

-Cholesterol cyst/granuloma: T1 and T2 bright -Cholesteatoma: T1 dark and T2 bright w diffusion restriction -Apical petrositis (petrous apicitis): Opacification of petrous apex air cells w bony demineralization and enhancement -cephalocele: meckel cave herniation into petrous apex, cystic -LCH: well circumscribed destructive lesion with nonsclerotic margins, and marked enhancement -Schwannoma: intralesional cysts, smooth enhancement, Bony remodeling

Question 364

Gradenigo triad:

Answer 364

otomastoiditis, facial pain (meckels cave trigeminal neuropathy) and lateral rectus palsy (dorellos canal CN6 palsy)

Question 365

midline clivus or petrous apex lesions

Answer 365

Chondrosarcoma: -Ring and arc chondroid matrix on CT -Lobular, cauliflower mass, T2 bright, off midline Chordoma: -T2 bright w bony destruction and enhancement -Arises from midline axial skeleton

Question 366

paraganglioma appearance

Answer 366

salt and pepper appearance highly vascular and enhance avidly associated with MEN 1 and NF1 Octreotide positive

Question 367

paraganglioma types

Answer 367

-glomus jugulare: pulsatile tinnitus and hearing loss w moth eaten bony destruction of middle ear floor -glomus tympanicum: pulsatile tinnitus and hearing loss w red retrotympanic mass (middle ear preserved) -glomus caroticum: SPLAYS ICA and ECA -glomus vagale: displaces ICA and ECA anteriorly

Question 368

What does the cavernous sinus connect with via the superior orbital fissure?

Answer 368

CN3 oculomotor, CN4 trochlear, CNV1 ophthalmic trigem, CN6 abducens, superior ophthalmic vein ## Footnote CN3 controls superior, medial, inferior rectus and inferior oblique; CN4 controls superior oblique; CNV1 provides sensory innervation to the upper face; CN6 controls lateral rectus.

Question 369

What does the foramen rotundum connect with via the inferior orbital fissure?

Answer 369

CNV2 maxillary trigeminal ## Footnote CNV2 provides sensory innervation to the inferior eyelid, upper lip, and nose.

Question 370

What is a potential sequela of orbital infection?

Answer 370

Cavernous sinus thrombosis

Question 371

What characterizes an orbital cavernous hemangioma in adults?

Answer 371

Typically intraconal with vascular channels and slow moving blood, bony remodeling and patchy enhancement

Question 372

What are the characteristics of capillary hemangioma in pediatric patients?

Answer 372

Skin lesions like strawberry hemangiomas, enlarge over first months then involute

Question 373

How does orbital lymphoma typically present?

Answer 373

Painless downward proptosis, typically involving the lacrimal gland ## Footnote It molds to the globe rather than deforming it and appears T1 and T2 hypointense on imaging.

Question 374

What is the presentation of orbital pseudotumor?

Answer 374

Painful proptosis, affects lacrimal gland and extraocular muscles without sparing myotendinous junction ## Footnote Involves lymphocytes, plasma cells, and macrophages; similar pathologic process to Tolosa Hunt syndrome.

Question 375

What characterizes orbital lymphangioma?

Answer 375

Typically extraconal with multilocular cystic mass and internal fluid levels from hemorrhage

Question 376

Where do orbital schwannomas/neurofibromas typically occur?

Answer 376

Superior orbit due to CNV1 nerve involvement ## Footnote Appears T1 hypointense and T2 hyperintense with enhancement.

Question 377

What types of cancer commonly metastasize to the orbit?

Answer 377

* Breast * Lung * Thyroid * Renal cell carcinoma (RCC) * Melanoma

Question 378

What is metastatic ophthalmopathy characterized by?

Answer 378

Fibrosis of extraocular muscles, typically bilateral ## Footnote It prevents exophthalmos due to the fibrosis.

Question 379

What is optic nerve glioma associated with in children?

Answer 379

Astrocytoma associated with NF1, typically bilateral

Question 380

What is the typical presentation of meningioma affecting the optic nerve?

Answer 380

Circumferential thickening of nerve sheath with uniform enhancement, tram track sign with nonenhancing nerve (donut sign) ## Footnote Most commonly seen in middle-aged females.

Question 381

What is retinopathy of prematurity?

Answer 381

Prolonged oxygen therapy affecting premature infants ## Footnote It can lead to hemorrhage, retinal detachment, and microphthalmia with increased attenuation due to prior hemorrhage.

Question 382

What is associated with coloboma?

Answer 382

It leads to a cone-shaped or notch-shaped deformity associated with trisomy 13, 18, CHARGE, and VATER.

Question 383

What characterizes Coat disease?

Answer 383

Vascular abnormalities of the retina affecting boys, with lipoproteinaceous subretinal exudates which do not enhance ## Footnote This condition can result in retinal detachment.

Question 384

What defines septo-optic dysplasia?

Answer 384

Optic nerve hypoplasia and agenesis of septum pellucidum ## Footnote It is associated with schizencephaly.

Question 385

what are the layers in the spine

Answer 385

Dura/arachnoid-> subarachnoid-> pia-> cord

Question 386

intradural extramedullary spinal lesions

Answer 386

Schwannoma/neurofibroma: involve neuroforamina myxopapillary ependymoma: only conus or filum Meningioma Drop Mets: zuckerguss epidermoid cyst: CSF signal but doesn't suppress, restricts diffusion

Question 387

where is chordoma typically located and how does it appear

Answer 387

sacrococcygeal>clivus>spine C2 T2 bright and enhancing Irregular scalloped borders may have internal calcs

Question 388

spinal nerve roots exit where

Answer 388

Cervical: nerve root exits above vert body C1-C7 C8 nerve root exit below C7 vert body Thoracic and lumbar: nerve roots exit below vert body 31 paired nerves

Question 389

modic type changes 1-3

Answer 389

1) edema: T1 dark, T2 bright 2) fat: T1 bright, T2 bright 3) fibrosis/sclerosis: T1 dark, T2 dark

Question 390

What is a synovial cyst vs tarlov cyst?

Answer 390

Synovial cyst is associated with facet arthropathy ## Footnote Synovial cysts often form due to degeneration of facet joints.

Question 391

What does T2 signal along the annulus fibrosis indicate?

Answer 391

a high intensity zone/annular fissure

Question 392

What spinal condition spares discs? what is the associated wedge shaped compression of the anterior vertebral body called

Answer 392

Pott disease/tuberculous osteomyelitis Gibbus deformity

Question 393

What is the predominant blood supply of the distal spinal cord? What is complication of aortic stent graft

Answer 393

Artery of Adamkiewicz Cord infarct: T2 bright cord with diffusion restriction

Question 394

What is diastematomyelia?

Answer 394

Congenitally split spinal cord

Question 395

What is a Dysembryoplastic neuroepithelial tumor (DNET)?

Answer 395

Lobular bubbly intramural mass typically in temporal lobe, Low rCBV

Question 396

What are the features of Osteoarthritis?

Answer 396

Older, Asymmetric joint space narrowing, osteophytes, Sclerosis of subchondral bone and cystic change, DIP>1st CMC> PIP, Inferior portion of SI joint (the only synovial joint)

Question 397

What are the characteristics of Erosive Osteoarthritis?

Answer 397

Elderly females, DIP> 1st CMC> PIP, Swelling and gull wing appearance, Central erosion and marginal osteophytes

Question 398

What are the characteristics of Rheumatoid arthritis?

Answer 398

Periarticular osteopenia Symmetric joint space narrowing, marginal erosions, PIP, MCP, Carpals, ulnar styloid, All three compartments affected in knee, High riding humeral head on shoulder with penciling of clavicle

Question 399

True or False: Osteoarthritis typically presents with symmetric joint space narrowing.

Answer 399

False ## Footnote Osteoarthritis is characterized by asymmetric joint space narrowing.

Question 400

What are Boutonniere deformity and swan neck deformity associated with? what are Heberden and Bouchard nodes associated with? Ulnar subluxation at the MCPs?

Answer 400

(PIP flex & DIP ext) (PIP ext & DIP flex) Rheumatoid arthritis (DIP and PIP) osteoarthritis rheumatoid arthritis

Question 401

Superolateral or medial migration of hip vs Axial migration of hip-> protrusio deformity

Answer 401

osteoarthritis rheumatoid arthritis

Question 402

Periarticular osteopenia and joint subluxations is associated with? Atlantoaxial subluxation in spine is associated with?

Answer 402

rheumatoid arthritis NO periarticular osteopenia in osteoarthritis rheumatoid arthritis

Question 403

What are the seronegative spondyloarthropathies and what are they associated with?

Answer 403

Psoriatic arthritis (asymmetric) Ankylosing spondylitis (symmetric) IBD related (symmetric) Reactive arthritis (asymmetric) HLA B27 positive and inferior sacroiliitis

Question 404

What is a Romanus lesion? What does the shiny corner sign indicate? What are they associated with

Answer 404

Erosion of margin of vertebral body at disc junction Sclerosis of margin of vertebral body at disc junction ankylosing spondylitis

Question 405

Define bamboo spine, Andersson lesion, and dagger sign what are they associated with

Answer 405

Diffuse syndesmophytes with undulating contour Pseudoarthrosis in ankylosed spine Fusion of spinous processes ankylosing spondylitis

Question 406

What are the inflammatory bowel diseases (IBD) associated spondyloarthropathies

Answer 406

* Ulcerative Colitis * Crohn's Disease * Whipple's Disease * Gastric Bypass

Question 407

What are the characteristics of psoriatic arthritis?

Answer 407

* Asymmetric sacroiliitis * Diffuse soft tissue swelling * Sausage digit * Pencil in cup erosions affecting DIPs * Asymmetric but bilateral involvement * Arthritis mutilans variant * Ivory phalanx * Plantar calcaneal spur with periosteal reaction

Question 408

What is the arthritis mutilans variant in psoriatic arthritis?

Answer 408

Telescoping digits/main-en-lorgnette (opera glass hand) deformity

Question 409

What is a characteristic feature of reactive arthritis?

Answer 409

Diarrhea, urethritis, or cervicitis Aggressive marginal erosions, joint space loss, swelling, osteopenia

Question 410

what is acroosteolysis and what can it be seen in

Answer 410

distal resorption of distal phalanx scleroderma: collagen deposition in skin and tissues with periarticular calcifications hajdu cheney: short stature, craniofacial changes Pyknodysostosis: Wormian bones, Osteopetrosis, wide angle mandible

Question 411

what can present with periarticular osteopenia and soft tissue calcifications

Answer 411

dermatomyositis and polymyositis

Question 412

periarticular calcifications can be seen in

Answer 412

dermatomyositis/polymyositis scleroderma HADD CPPD

Question 413

crystal deposition in Supraspinatus tendon, Prevertebral longus coli muscle, Triangular fibrocartilage complex

Answer 413

calcium hydroxyapetite deposition disease (periarticular, globular) x2, calcium pyrophosphate deposition disease (intraarticular)

Question 414

What is Kummel disease?

Answer 414

Gas in vertebral body compression fracture due to osteonecrosis

Question 415

What is gout?

Answer 415

Crystal arthropathy with sodium urate deposition in joints ## Footnote Gout is identified by the presence of negative birefringent crystals, primarily affecting the great toe, and leads to sharply marginated erosions.

Question 416

What are the key features of hemochromatosis?

Answer 416

Bronze diabetes, cirrhosis, CHF, arthropathy Deposition of iron T1 and T2 dark liver and spleen T2 liver is darker than muscle

Question 417

What condition is characterized by enlargement of articular cartilage and widened joint spaces in early disease?

Answer 417

Acromegaly

Question 418

What is shoulder pad sign associated with?

Answer 418

bulky soft tissue nodules and atrophic muscles associated with amyloid arthropathy Infiltration of bones and joints by beta-pleated sheets of amino acids

Question 419

What are the characteristics of hemophilic arthropathy?

Answer 419

Enlarged radial head and widened trochlear notch; Squaring of patella and widened intercondylar notch

Question 420

What can be seen in juvenile idiopathic arthritis (JIA).

Answer 420

Under 16 yo; Abnormal bone length or morphology from epiphyseal overgrowth Atlantoaxial subluxation

Question 421

What is neuropathic arthropathy (Charcot)?

Answer 421

Hypertrophic destruction, dislocation, debris, disorganization

Question 422

What are the features of sarcoidosis?

Answer 422

Polyarthritis with bilateral ankle involvement or with erythema nodosum; Lace-like lytic bone lesions particularly in the middle or distal phalanges.

Question 423

What is an aneurysmal bone cyst (ABC)?

Answer 423

Associated with giant cell tumor; Lytic expansile lesion in posterior elements expansive thin-walled blood-filled cavities with fluid-fluid levels.

Question 424

What does an osteoid lesion look like?

Answer 424

Fluffy cloud like bone

Question 425

What characterizes a chondroid lesion?

Answer 425

Ring and arc or popcorn-like appearance enchondroma, osteochondroma, chondroblastoma, chondrosarcoma

Question 426

What is fibrous dysplasia?

Answer 426

Ground glass matrix appearance with blurring of the trabeculae

Question 427

The fallen fragment sign refers to a

Answer 427

unicameral bone cyst with pathologic fracture.

Question 428

What osseous lesions are typically concentric vs eccentric?

Answer 428

Simple bone cyst, enchondroma, fibrous dysplasia

Question 429

What is enostosis?

Answer 429

Bone island, arise from medulla, normal on bone scan

Question 430

What is osteopoikilosis?

Answer 430

Multiple bone islands and keloid ## Footnote autosomal dominant

Question 431

What is an osteoma?

Answer 431

Slow-growing lesion from cortex of skull frontal/ethmoid

Question 432

What is Gardner syndrome?

Answer 432

Multiple osteomas, intestinal polyposis and soft-tissue desmoid tumors ## Footnote autosomal dominant condition

Question 433

What characterizes melorheostosis?

Answer 433

Proliferation of thickened and irregular cortex with candle-wax appearance

Question 434

What is an osteoid osteoma?

Answer 434

Nidus of tissue surrounded by reactive bone sclerosis; Night pain relieved by aspirin typically in the diaphyses of long bones

Question 435

What defines an osteoblastoma?

Answer 435

Same as OO but greater than 2 cm can be associated with painful scoliosis Not relieved by aspirin

Question 436

What is osteosarcoma?

Answer 436

Malignant with osteoid matrix Bony destruction, periosteal reaction, soft tissue mass primary or secondary, often arising from conditions like Paget disease or following radiation.

Question 437

Wunderlich syndrome

Answer 437

Spontaneous perinephric hemorrhage in the absence of trauma

Question 438

What defines telangiectatic osteosarcoma bone lesions?

Answer 438

Vascular with large cystic spaces filled with blood, may mimic ABC but with solid nodular components

Question 439

Where do parosteal lesions arise from?

Answer 439

Juxtacortical arising from outer periosteum cauliflower-like exophytic morphology.

Question 440

What is a key feature of periosteal lesions?

Answer 440

Juxtacortical arising from inner periosteum, chondroid differentiation, may metastasize to lungs which calcify

Question 441

What is the appearance and characteristic MRI signal of an enchondroma?

Answer 441

Serpiginous in femoral long bone or geographic lytic lesion in the hand Characteristic lobulated hyperintense T2 signal helps differentiate enchondroma from infarct on MRI

Question 442

What is Ollier disease associated with? What characterizes Maffucci syndrome?

Answer 442

Multiple enchondromas Multiple enchondromas and venous malformations producing phleboliths

Question 443

What is an osteochondroma? familial osteochondromatosis

Answer 443

(arises from the metaphysis and grows away from the epiphysis) often pedunculated with cartilagenous cap <2 cm is autosomal dominant

Question 444

what lesion is seen eccentric and crossing the physis of skeletally immature patients

Answer 444

chondroblastoma

Question 445

What is a key feature of chondrosarcoma?

Answer 445

Exophytic, expansile lesion continuous with intramedullary cavity thickening and endosteal scalloping of the cortex with a soft tissue mass

Question 446

What is a Non ossifying fibroma/fibroxanthoma/fibrous cortical defect?

Answer 446

Radiolucent lesion with faint sclerotic rim and cortical thinning

Question 447

What characterizes Fibrous dysplasia?

Answer 447

Replacement of bone with fibrous tissue metadiaphyseal and central multiseptated lucent lesion, can be cystic or ground glass

Question 448

What are the components of McCune Albright syndrome?

Answer 448

Fibrous dysplasia, precocious puberty, cafe au lait spots

Question 449

What defines Mazabraud syndrome?

Answer 449

Fibrous dysplasia and intramuscular myxomas

Question 450

What features are associated with Eosinophilic granuloma?

Answer 450

AKA LCH Lytic lesion with beveled edge in skull floating tooth from alveolar bone resorption in mandible vertebra plana complete collapse in spine destructive lucent aggressive lesion, often lamellated in long bones primarily affects young children 5-10 years old

Question 451

What is Ewing sarcoma?

Answer 451

Aggressive with permeative bone destruction, periosteal reaction, soft tissue mass

Question 452

What are the characteristics, demographic, and nuclear activity of Multiple myeloma/plasmacytoma?

Answer 452

Multiple lytic, diffuse myelomatosis with endosteal scalloping negative on bone scan most common primary bone tumor over 40

Question 453

osseous lesion with fluid fluid levels on MRI

Answer 453

ABC, SBC, GCT, telangiectatic osteosarcoma

Question 454

Tibia diaphysis w soap bubble appearance

Answer 454

Adamantinoma well-circumscribed, expansile and multiloculated with a thin sclerotic rim

Question 455

What is vertebral osteomyelitis/discitis primarily caused by in adults?

Answer 455

Hematogenous arterial spread, spinal surgery, or GU infection spread through the epidural venous Batson plexus

Question 456

What is the Wimberger ring sign associated with? What type of fracture is a Pelkins fracture?

Answer 456

Increased epiphyseal sclerosis Metaphyseal corner fracture with a dense metaphyseal line due to scurvy (Vitamin C deficiency)

Question 457

What are some skeletal changes associated with acromegaly?

Answer 457

* Frontal sinus enlargement * Cranial bone thickening * Enlarged jaw * Beak-like osteophytes of metacarpal heads * Spade-like growths of distal phalanges

Question 458

What are the skeletal manifestations of hyperparathyroidism?

Answer 458

* Subperiosteal resorption * Scalloping with bony denimineralization of 2nd and 3rd middle phalanges * Brown tumors * Salt and pepper appearance of skull

Question 459

What is renal osteodystrophy characterized by?

Answer 459

Osteomalacia and secondary hyperparathyroidism due to hypocalcemia in renal failure presents with a rugger jersey spine.

Question 460

deposition of calcium in subcutaneous tissue and basal ganglia?

Answer 460

Hypoparathyroidism from parathyroid resection

Question 461

What is pseudohypoparathyroidism and what does it present with?

Answer 461

Defect of PTH receptor It presents with obesity, round facies, short stature, and brachydactyly.

Question 462

What is Paget's disease?

Answer 462

* Osteolytic, Mixed, Sclerotic phase cotton wool skull picture frame vertebral body Thickening of iliopectineal and ilioischial lines w acetabular protrusio Blade of grass or flame shaped margin in long bone

Question 463

What is the Erlenmeyer flask deformity associated with?

Answer 463

Gaucher disease (autosomal recessive disorder involving glucocerebrosidase macrophages) thalassemia (can be alpha or beta type and is also an autosomal recessive disorder)

Question 464

What is sickle cell disease in the skeletal system?

Answer 464

Dactylitis/hand-foot syndrome soft tissue swelling and periosteal reaction ## Footnote Sickle cell disease is an autosomal recessive condition affecting beta chain hemoglobin.

Question 465

What are the skeletal features of thalassemia?

Answer 465

* Prominent marrow expansion/hyperplasia * Hair-on-end striations in the skull * Rodent-like facies * Erlenmeyer flask deformity

Question 466

What is a Freiberg infarction?

Answer 466

Infarction of the 2nd metatarsal

Question 467

What is the talar beak sign associated with?

Answer 467

Talocalcaneal coalition

Question 468

What is the anteater sign associated with?

Answer 468

Calcaneonavicular coalition

Question 469

H shaped/lincoln log vertebral body and AVN/bone infarct

Answer 469

Sickle cell with splenic auto infarction vs gaucher disease where there is splenomegaly, hepatomegaly, and erlenmeyer flask shaped femurs

Question 470

ankle tendons and order

Answer 470

Ant: Tom Harry Dick Post: Tom Dick And Nervous Harry

Question 471

deltoid and spring ligaments are where

Answer 471

spring: calcaneonavicular deltoid: tibiocalcaneal, tibionavicular, tibiotalar

Question 472

what causes flat foot

Answer 472

posterior tibial tendon tear

Question 473

ankle fracture weber classification maissoneuve fracture

Answer 473

Weber A: distal fib fx with intact syndesmosis Weber B: proximal transyndesmotic fracture w syndesmosis rupture Weber C: high fibular fracture above syndesmosis w total syndesmotic rupture and ankle instability (maissoneuve with medial malleolar space widening)

Question 474

pilon fracture

Answer 474

distal tibia comminuted vertical fx of tibial plafond

Question 475

next step knee dislocation with palpable distal pulses

Answer 475

CTA to rule out popliteal artery injury

Question 476

what is a segond fracture and what is it associated with

Answer 476

avulsion of lateral tibial plateau associated with ACL tear (edema in lateral femoral condyle and posterior lateral tibial plateau)

Question 477

Pelligrini stieda lesion?

Answer 477

Post traumatic calcification medial to medial femoral condyle, may be MCL avulsion injury

Question 478

difference between osgood schlatter and jumper's knee

Answer 478

trauma at patella tendon insertion on tibial tubercle trauma at patella tendon insertion on inferior patella

Question 479

What is pigmented villonodular synovitis? associated with?

Answer 479

Benign hyperplastic proliferation of synovium PD dark and susceptibility artifact from hemosiderin Dark brown effusions from prior hemorrhage

Question 480

MRI imaging of arthroplasties, how to improve

Answer 480

Low field strength, fast spin echo Increased receiver bandwidth and increase number of acquisition (NEX) Decrease voxel size (decrease slice thickness and increase matrix size)

Question 481

Answer 481

chance fracture distraction flexion injury Three column unstable fracture

Question 482

Answer 482

1) transverse process 2) pedicle 3) superior articular surface 4) pars interarticularis 5) lamina 6) inferior articular surface 7) spinous process

Question 483

facet dislocation types and mechanism

Answer 483

bilateral interfacetal dislocation: hyperflexion, disruption of posterior ligament w cord injury unilateral interfacetal dislocation: hyperflexion and rotation

Question 484

Answer 484

jefferson fracture=C1 axial loading

Question 485

avulsion fractures off the hip

Answer 485

Question 486

what is odontoid fracture

Answer 486

C2 dens (hyperflexion)

Question 487

what is hangman's fracture

Answer 487

C2 arches/pedicles (hyperextension/distract) Chin hits dashboard or direct blow to face

Question 488

what is complication of this

Answer 488

teardrop FLEXION fracture with bony retropulsion -> Anterior cord syndrome of pyramidal and anterior spinothalamic tracts (Complete paralysis and loss of pain/temp), Dorsal column intact (touch and vibration) compared to teardrop EXTENSION avulsion fracture

Question 489

what is clay shovelers fracture

Answer 489

spinous process (flexion avulsion fx)

Question 490

anterior shoulder dislocation

Answer 490

Hillsachs fracture (posterolateral humeral head depression) Bankart (anteroinferior rim of glenoid)

Question 491

posterior shoulder dislocation

Answer 491

fixed light bulb sign on internal/external rotation

Question 492

biceps tendon injury with relation to rotator cuff

Answer 492

tendon subluxation or displacement: subscapularis tear tendon tear: supraspinatus tear

Question 493

What is an Essex Lopresti fracture?

Answer 493

Radial head fracture and tearing of interosseous membrane with ulnar dislocation at the DRUJ

Question 494

What characterizes a Monteggia fracture dislocation?

Answer 494

Mid diaphyseal ulnar fracture and radial head dislocation at elbow

Question 495

What is a Galeazzi fracture dislocation?

Answer 495

Radius fracture distal third with ulnar dislocation at DRUJ

Question 496

What defines a Colles fracture?

Answer 496

Distal radius with dorsal angulation from FOOSH

Question 497

Answer 497

Hutchinson/chauffeurs fracture Radial aspect of distal radius fracture extending into radial styloid and radiocarpal joint

Question 498

kienbocks disease?

Answer 498

Avascular necrosis of lunate with negative ulnar variance

Question 499

What is mallet finger?

Answer 499

Extension tendon injury of the distal phalanx

Question 500

What injury is described by the term 'Gamekeeper's thumb'?

Answer 500

Ulnar collateral ligament injury at the base of the first proximal phalanx with avulsion fracture

Question 501

What characterizes Mirizzi syndrome?

Answer 501

Stone in cystic duct with external compression of the common hepatic duct ## Footnote This condition may lead to complications like cysto-choledochal fistula.

Question 502

What should be considered if there is dirty shadowing in the liver?

Answer 502

Pneumobilia (central) or portal venous gas (peripheral)

Question 503

What are the ultrasound features indicative of liver disease?

Answer 503

increased echogenicity= fat steatosis increased heterogeneity and nodular surface= cirrhosis/fibrosis

Question 504

What is the water lily sign associated with?

Answer 504

undulating membrane within cyst Hydatid disease (echinococcal cyst with large liver cyst and peripheral daughter cysts) treated with albendazole or mebendazole.

Question 505

multiple tiny targetoid lesions involving the liver and spleen

Answer 505

Candidiasis, commonly seen in immunocompromised individuals

Question 506

What presents with pain and lesion in the dome of the right lob?

Answer 506

Amebic abscess Entamoeba histolytica

Question 507

What is a cavernous hemangioma characterized by on US?

Answer 507

Echogenicity with posterior acoustic enhancement and no flow on color Doppler ## Footnote It is a benign vascular liver lesion.

Question 508

What does a biliary cystadenoma appear as? what finding is concerning?

Answer 508

A multi-septated cystic mass ## Footnote Mural nodules may suggest potential malignant transformation into cystadenocarcinoma.

Question 509

what is target sign on liver ultrasound?

Answer 509

hypoechoic rim concerning for hepatic metastases

Question 510

Doppler flow in venous clot suggests?

Answer 510

tumor thrombus iso HCC propensity for venous invasion

Question 511

hypoechoic liver lesion in post transplant patient

Answer 511

post transplant lymphoproliferative disorder caused by EBV

Question 512

right congestive heart failure or tricuspid regurgitation on hepatic venous waveform

Answer 512

Accentuated A wave D wave becomes deeper than S wave

Question 513

portal hypertension causes/location flow direction?

Answer 513

Presinusoidal: portal vein thrombosis Sinusoidal: hepatic in origin, like schistosomiasis, cirrhosis Post sinusoidal: hepatic vein or IVC thrombosis (Budd Chiari) toward liver= hepatopetal away from liver= hepatofugal (reversed flow)

Question 514

RCC ultrasound

Answer 514

Isoechoic to renal cortex with hypoechoic rim Propensity for venous invasion

Question 515

reversal of flow in renal artery transplant kidney

Answer 515

renal vein thrombosis

Question 516

Bilateral hypoechoic testicular masses

Answer 516

Congenital adrenal rests: embryonic adrenal tissue

Question 517

epididymal cystic lesion internal echoes

Answer 517

Epididymal cyst: anechoic fluid Spermatocele: internal low level echoes (Cystic dilation of epididymis with spermatozoa, typically in head)

Question 518

lower extremity deep venous system

Answer 518

External iliac vein-> common femoral vein-> deep femoral and femoral vein-> popliteal vein-> anterior tibial, peroneal, and posterior tibial veins

Question 519

What is the effect of outflow stenosis and waveform characteristics?

Answer 519

downstream/distal to the transducer High resistance and high velocity, decreased diastolic flow Normal rapid systolic upstroke

Question 520

What are the ultrasound characteristics of thyroid carcinoma?

Answer 520

Solid hypoechoic with punctate calcs and irregular margins ## Footnote These features can indicate malignancy.

Question 521

What is the effect of inflow stenosis and waveform characteristics?

Answer 521

upstream/proximal to the transducer Low resistance and low velocity, increased diastolic flow tardus et parvus waveform

Question 522

Tc99m sestamibi scan false negatives and positives for parathyroid

Answer 522

-: multigland disease, parathyroid hyperplasia +: thyroid nodule, lymph node

Question 523

How does tamoxifen affect breast and uterus?

Answer 523

Estrogen antagonist at breast and agonist at endometrium ## Footnote Tamoxifen can lead to endometrial hyperplasia, metaplasia, and carcinoma.

Question 524

What is concerning for endometrial cancer in postmenopausal women? Next steps?

Answer 524

Endometrium >8mm or >5mm with bleeding biopsy, MRI for extent, PET for mets

Question 525

What are two complications associated with C-section?

Answer 525

* Bladder flap hematoma (vesicouterine space) * Subfascial hematoma (prevesical space)

Question 526

What are paraovarian and parapelvic cysts?

Answer 526

Separate from but near the ovary/renal pelvis

Question 527

On which day does ovulation typically occur?

Answer 527

Day 14

Question 528

What is a Corpus hemorrhagicum?

Answer 528

physiological bleeding into the follicle called after ovulation This structure eventually becomes the corpus luteum.

Question 529

What causes theca lutein cysts? what is the appearance on US

Answer 529

Elevated hCG These cysts are seen in hyperstimulation syndrome, molar pregnancy, multiple gestations, and infertility patients. multilocular spoke wheel pattern on US

Question 530

What is ovarian hyperstimulation syndrome characterized by?

Answer 530

* Ovary enlargement * Ascites or hydrothorax/pleural effusions ## Footnote This condition is related to VEGF dysregulation due to fertility treatment.

Question 531

What are the main features of polycystic ovarian syndrome?

Answer 531

* Obesity/Insulin resistance * Anovulation * Hirsutism * >12 small follicles * string of pearls

Question 532

What is a dermoid cyst also known as? What is a characteristic feature of a dermoid cyst on imaging?

Answer 532

Mature cystic teratoma Complex ovarian cyst with echogenic Rokitansky nodule, contain hair and teeth on MRI T1 and T2 bright

Question 533

What is the tip of the iceberg sign and dot dash sign related to?

Answer 533

Dermoid cyst Obscuration of deeper contents from high attenuation material dot dash pattern represents keratin fibers

Question 534

What is Struma ovarii?

Answer 534

a rare form of mature teratoma containing thyroid tissue in an ovarian teratoma

Question 535

What triad characterizes Meigs syndrome?

Answer 535

* Fibroma (T1 and T2 dark, hypoechoic) * Ascites * Pleural effusion

Question 536

when should gestational sac, yolk sac, and embryo be seen by?

Answer 536

GS: by 5 weeks, hcg >1500 YS: by GS MSD >8 mm Embryo: by 6 weeks, GS MSD >16 mm

Question 537

What is a single umbilical artery associated with?

Answer 537

Trisomy 13 and 18

Question 538

What does placental thickening indicate?

Answer 538

Fluid overload state of fetal hydrops It can manifest as ascites, pericardial effusion, skin thickening, polyhydramnios, and placental enlargement.

Question 539

What is vasa previa? placenta previa?

Answer 539

umbilical cord vessels run accross cervix to placenta placenta covers the cervix, should be >3 cm from the os

Question 540

What is placental abruption?

Answer 540

Premature separation of placenta from uterus can result in subchorionic hematoma (hypoechoic crescent around gestational sac)

Question 541

What characterizes placenta creta?

Answer 541

Deep attachment of placenta into myometrium Moth eaten/swiss cheese placenta with vascular channels Scarring from c-section, D&C, endometritis, adenomyosis

Question 542

What are the types of placental attachment?

Answer 542

* Accreta: attaches to myometrium but no invasion * Increta: placenta invades myometrium * Percreta: placenta penetrates through myometrium and into serosa

Question 543

What does fetal pleural effusion typically indicate if isolated?

Answer 543

Congenital chylothorax iso thoracic duct or lymphatic malformation.

Question 544

What can cause oligohydramnios and it result in?

Answer 544

from renal agenesis, bladder outlet obstruction, ureteropelvic junction obstruction, or ARPKD. Results in Intrauterine growth restriction (IUGR) Potter syndrome (facial dysmorphism, pulmonary hypoplasia, club feet, and musculoskeletal contractures)

Question 545

What are potential causes of polyhydramnios?

Answer 545

* Idiopathic * Diabetes * GI obstruction/atresia

Question 546

What is anencephaly, what is it associated with?

Answer 546

Lack of development of cerebral cortex and calvarium above orbits, absent defect at top of head associated with elevated AFP 2/2 neural tissue exposure to amniotic fluid

Question 547

What is cephalocele?

Answer 547

Midline neural tube defect with protrusion of intracranial structures outside of calvarium most commonly involving the occipital skull

Question 548

What is Dandy-Walker malformation? And association

Answer 548

Dilated fourth ventricle Torcular lambdoid inversion Hypoplastic cerebellar vermis agenesis of corpus callosum

Question 549

What is heterotopic pregnancy?

Answer 549

Simultaneous IUP and ectopic in assistive reproduction

Question 550

What are the characteristics of gestational trophoblastic disease/hydatidiform molar?

Answer 550

Hyperemesis, marked hcg elevation, enlarged uterus, snowstorm appearance

Question 551

What defines a complete mole vs partial mole in gestational trophoblastic disease?

Answer 551

No fetal parts, diploid: 46XX or 46XY (fertilization of egg without chromosome) Fetal parts, triploid: 69XXX, 69XXY, or 69XYY (2 separate sperm fertilize egg) Cystic placenta

Question 552

What is a dizygotic and monozygotic twin?

Answer 552

fraternal: Arise from individually fertilized eggs, 2 eggs from different sperm, always diamniotic/dichorionic identical: Arise from single egg fertilized with single sperm, same sex, genetically identical

Question 553

What does chorionic vs amniotic refer to in twin pregnancies?

Answer 553

Chorion is the outermost membrane, contains placenta amnion is innermost membrane containing embryo

Question 554

What characterizes twin-twin transfusion syndrome? What is a stuck twin?

Answer 554

Disproportionate blood flow, donor is small with oligohydramnios, recipient is large with polyhydramnios (results in hydrops/death) Donor with shrink wrapped amnion

Question 555

What are acardiac twins?

Answer 555

Twin reversed arterial perfusion (TRAP), one twin develops without a functioning heart; reversed flow in acardiac twin

Question 556

What do the arteries and veins do in an acardiac twin situation?

Answer 556

Arteries carry poorly oxygenated blood into fetus, vein carries deoxygenated blood out of fetus ## Footnote Normally, umbilical arteries carry deoxygenated blood away from the fetus and umbilical vein carries oxygenated blood into the fetus.

Question 557

What is the occipital frontal diameter (OFD)? What is the biparietal diameter (BPD)?

Answer 557

Middle of frontal skull to middle of occipital skull Outer edge of skull to inner edge of skull at level of thalami and cavum septum pellucidum

Question 558

what do the banana and lemon signs refer to

Answer 558

chiari 2 malformation -flattened cerebellar hemispheres in posterior fossa with bilobed appearance -calvarium w flattening of frontal bones

Question 559

what is Holoprosencephaly and the types

Answer 559

Failure of midline cleavage (back to front) Alobar holoprosencephaly, semi lobar and lobar holoprosencephaly

Question 560

What is agenesis of corpus callosum associated with?

Answer 560

Absence of cavum septum pellucidum teardrop morphology of lateral ventricles with colpocephaly widely separated ventricular frontal horns (steer horn) parallel configuration of lateral ventricles concave medial borders of lateral ventricles midline interhemispheric cyst

Question 561

What is the absence of cavum septum pellucidum without corpus callosum agenesis known as?

Answer 561

Septo Optic dysplasia

Question 562

What causes hydranencephaly?

Answer 562

Absence of the cerebral hemispheres with CSF filling the cranial cavity Cortical destruction due to infarct or infection

Question 563

What is colpocephaly?

Answer 563

dilation of the occipital horns of the lateral ventricles associated with agenesis of the corpus callosum

Question 564

twin type based on timing of split in MONOZYGOTIC twins

Answer 564

Di/di if split 0-4 days Monochorionic/diamniotic if split 4-8 days Mono/mono if split >8 days Conjoined if split >13 days

Question 565

congenital diaphragmatic hernia locations and associations

Answer 565

Bochdalek hernia of left posterior thorax Morgagni hernia on anterior right Associated with gut malformation and pulmonary hypoplasia

Question 566

enlarged bilateral echogenic kidneys

Answer 566

HIV nephropathy in adult ARPKD in kid (cysts are too small to resolve)

Question 567

What is meconium ileus?

Answer 567

Impacted meconium in the ileum with bowel obstruction, related to cystic fibrosis

Question 568

What is a duplicated collecting system?

Answer 568

inferior and medial ectopic insertion of the superior pole moeity ureter with intramural ureterocele-> obstruction at UVJ Superior and lateral insertion of the inferior pole moiety ureter-> vesicoureteral reflux Contralateral VUR

Question 569

What are posterior urethral valves?

Answer 569

A membranous flap in the proximal urethra causing bladder outlet obstruction This condition can lead to hydronephrosis, hydroureter, and a dilated bladder.

Question 570

What is the keyhole sign?

Answer 570

Dilation of the proximal urethra

Question 571

How does ARPKD differ from ADPKD?

Answer 571

ARPKD is associated with liver fibrosis (inverse relationship), while ADPKD features cysts in the liver

Question 572

What characterizes osteogenesis imperfecta?

Answer 572

Abnormal type 1 collagen leading to Otosclerosis Lucent skull Fibula>tibia Blue sclera decreased bony mineralization

Question 573

What is thanatophoric dysplasia?

Answer 573

A lethal skeletal dysplasia characterized by telephone receiver femurs Rhizomelia platyspondyly cloverleaf skull Normal bony mineralization

Question 574

What are the main features of trisomy 13?

Answer 574

Holoprosencephaly, midline facial anomalies, encephalocele, congenital heart disease, omphalocele, horseshoe kidney, polycystic kidney, polydactyly

Question 575

What is the strawberry sign associated with?

Answer 575

Trisomy 18 Inward bowing of frontal bones of calvarium with the strawberry tip projecting anteriorly

Question 576

What is Beckwith-Wiedemann syndrome?

Answer 576

A condition with increased risk of Wilms tumor and hepatoblastoma characterized by hemihypertrophy, macroglossia, and omphalocele

Question 577

What are the stages of germinal matrix hemorrhage?

Answer 577

1. Confined to matrix 2. Extends into ventricles without ventriculomegaly 3. Extends into ventricles with ventriculomegaly 4. Extends out of ventricles into parenchyma

Question 578

platyspondyly and cloverleaf skull are associated with

Answer 578

Thanatophoric dysplasia -Platyspondyly: flattening of the ossified portion of vertebral bodies -Cloverleaf skull: protrusion of frontal and temporal lobes

Question 579

What is circumferential subendocardial delayed enhancement associated with?

Answer 579

Amyloidosis, systemic sclerosis, cardiac transplant

Question 580

What condition is associated with subendocardial/transmural delayed enhancement?

Answer 580

Ischemic cardiomyopathy

Question 581

What conditions are related to mid myocardial delayed enhancement?

Answer 581

* Dilated cardiomyopathy * Hypertrophic cardiomyopathy * Myocarditis * Sarcoid * Chagas

Question 582

What conditions are associated with epicardial enhancement delayed?

Answer 582

* Viral myocarditis * Sarcoid * Chagas

Question 583

What does left atrium enlargement indicate if the cardiac silhouette is enlarged?

Answer 583

Mitral regurgitation

Question 584

What does left atrium enlargement indicate if the cardiac silhouette is normal?

Answer 584

Mitral stenosis

Question 585

What does aortic enlargement indicate if the cardiac silhouette is enlarged?

Answer 585

Aortic regurgitation

Question 586

What does aortic enlargement indicate if the cardiac silhouette is normal?

Answer 586

Aortic stenosis

Question 587

What is the association of left ventricular aneurysm?

Answer 587

True aneurysm involving all walls with broad neck LAD occlusion

Question 588

What is the association of LV pseudoaneurysm?

Answer 588

False aneurysm with narrow neck, does not involve myocardium Circumflex or RCA occlusion

Question 589

What is right-sided valvular disease associated with?

Answer 589

Tricuspid regurge associated with Carcinoid mets to liver Systemic serotonin degrades valves

Question 590

What characterizes myocardial noncompaction?

Answer 590

Left ventricle heavy trabeculation and thin wall

Question 591

What genetic inheritance pattern is associated with hypertrophic cardiomyopathy?

Answer 591

Autosomal dominant (AD)

Question 592

What can systolic anterior motion of the mitral valve anterior leaflet cause?

Answer 592

* Mitral regurgitation * Left atrial enlargement

Question 593

What heart shape is associated with hypertrophic cardiomyopathy?

Answer 593

Spade shaped heart

Question 594

What method best stratifies risk of sudden death in patients with hypertrophic cardiomyopathy?

Answer 594

Quantitative LGE

Question 595

What are the causes of restrictive cardiomyopathy?

Answer 595

* Idiopathic * Sarcoid * Hemochromatosis * Amyloid

Question 596

What characterizes dilated cardiomyopathy?

Answer 596

Idiopathic concentric enlargement with impaired systole

Question 597

What is the most useful method in quantifying aortic stenosis?

Answer 597

Direct planimetry of aortic valve orifice

Question 598

What is contraindicated for MR examination?

Answer 598

LVAD

Question 599

What does the Oreo cookie sign indicate?

Answer 599

Epicardial fat, effusion, and pericardial fat stripe

Question 600

Where does congenital absence of pericardium typically affect?

Answer 600

Left pericardium near left atrial appendage results in rotation of the heart towards the left

Question 601

What happens when blood pool nulls first?

Answer 601

Myocardium nulls first, due to protein replacement in amyloid

Question 602

What is a thymoma and its associations?

Answer 602

* Invasive * Drop metastases along pleural and pericardial surfaces * Associated with myasthenia gravis * Typically occurs in middle-aged or older patients

Question 603

What are the types of endoleak?

Answer 603

* Type 1: around graft * Type 1a: proximal * Type 1b: distal * Type 2: collateral to excluded aneurysm * Type 3: through graft defect * Type 4: through graft below resolution * Type 5: leak but without definite source

Question 604

What characterizes Takayasu arteritis?

Answer 604

* Long segment stenoses * Younger middle-aged Asian female patients * Involves the aorta and pulmonary artery

Question 605

What characterizes giant cell arteritis (GCA)?

Answer 605

* Long smooth stenoses * Older male patients * temporal artery * armpit area arteries: subclavian, axillary, brachial

Question 606

At what vertebral level is the celiac artery located?

Answer 606

T12

Question 607

At what vertebral level is the SMA located?

Answer 607

T12-L1

Question 608

At what vertebral level are the renal arteries located?

Answer 608

L1-L2

Question 609

At what vertebral level is the IMA located?

Answer 609

L3

Question 610

What is the typical pathway of the right hepatic artery?

Answer 610

Celiac -> common hepatic -> proper hepatic

Question 611

What are the sources of replaced right hepatic artery (RRHA) and accessory right hepatic artery (RHA)?

Answer 611

From SMA

Question 612

What are the supplies of the SMA?

Answer 612

* Distal duodenum * All small bowel * Cecum to transverse colon

Question 613

What arteries are branches of the SMA?

Answer 613

* Inferior pancreaticoduodenal artery * Middle colic artery * Right colic artery * Ileocolic artery

Question 614

What vessels does the IMA supply?

Answer 614

* Left colic artery * Sigmoid arteries * Superior rectal artery

Question 615

What are the branches of the internal iliac artery's posterior division?

Answer 615

* Superior gluteal * Iliolumbar * Lateral sacral

Question 616

What are the branches of the internal iliac artery's anterior division?

Answer 616

* Inferior rectal * Vesicle * Uterine * Obturator * Inferior pudendal * Inferior gluteal

Question 617

What are the branches of the external iliac artery?

Answer 617

* Inferior epigastric * Deep circumflex * Femoral artery

Question 618

What is cystic adventitial disease?

Answer 618

Mucoid adventitial cysts compress popliteal artery ## Footnote This condition involves the formation of cysts in the adventitia of blood vessels, leading to vascular obstruction.

Question 619

What is Paget-Schroetter syndrome?

Answer 619

Compression and thrombosis of subclavian vein in muscular young men ## Footnote This condition is often associated with strenuous upper limb activities.

Question 620

What is subclavian steal syndrome?

Answer 620

Proximal stenosis of subclavian artery results in reversal of vertebral artery flow into the distal subclavian

Question 621

What is a dialysis fistula?

Answer 621

Better long term but must mature before use ## Footnote Dialysis fistulas can have lower flow rates and remain patent. Less intimal hyperplasia

Question 622

What are the characteristics of a dialysis graft?

Answer 622

Worse long term but can be used earlier; require high flow rates to remain patent ## Footnote Dialysis grafts are usually synthetic and can be placed immediately.

Question 623

What is hypothenar hammer syndrome?

Answer 623

Ulnar artery microtrauma at hamate with ischemia of 4-5th digits ## Footnote This syndrome is often seen in individuals who perform repetitive gripping activities.

Question 624

What are the signs of hepatoblastoma?

Answer 624

RUQ calcification, propensity for portal vein and hepatic vein invasion, AFP is elevated ## Footnote Hepatoblastoma is a rare liver cancer in children, often associated with beckwith wiedemann and hemihypertrophy

Question 625

What is Poland syndrome?

Answer 625

Complete or partial unilateral congenital absence of the pectoralis major muscle ## Footnote It is an autosomal recessive condition associated with anomalies of the ipsilateral arm and hand.

Question 626

What does MRI TE stand for?

Answer 626

Echo time ## Footnote It is the interval between radiofrequency pulse application and the collection of the signal.

Question 627

What does MRI TR stand for?

Answer 627

Repetition time ## Footnote It is the interval between sequential radio frequency pulses.

Question 628

What characterizes Swyer-James syndrome?

Answer 628

Hyperlucent unilateral lung, NOT expanded; associated with Mycoplasma ## Footnote This condition results from a previous lung infection leading to airway obstruction.

Question 629

If there is a mirror image right arch, what condition is likely?

Answer 629

Tetralogy of Fallot ## Footnote Patients with truncus arteriosus also likely with mirror image right arch

Question 630

What is D-transposition of the great arteries?

Answer 630

Aorta on right; RV to aorta with PDA; arterial switch procedure ## Footnote This condition results in a parallel circulation instead of a series circulation.

Question 631

What is L-transposition of the great arteries?

Answer 631

Aorta on left; LA to RV to aorta; atrioventricular and ventricular-vessel discordance ## Footnote This condition is also known as congenitally corrected transposition.

Question 632

If there are pericardial metastases, what is the most likely source?

Answer 632

Pulmonary cancer ## Footnote Patients with melanoma also frequently have pericardial metastases

Question 633

What is cardiac angiosarcoma?

Answer 633

involving the right atrium and pericardium; sun ray appearance ## Footnote This aggressive tumor is often associated with radiation exposure.

Question 634

What is myxoma?

Answer 634

Benign cardiac tumor involving the left atrial/interatrial septum; t2 bright myxoid content; enhances compared to thrombus ## Footnote Myxomas are the most common primary cardiac tumors.

Question 635

Where does rhabdomyoma prefer to grow?

Answer 635

Left ventricle; associated with tuberous sclerosis ## Footnote This tumor is the most common primary cardiac tumor in children.

Question 636

Where is cardiac fibroma typically located?

Answer 636

Interatrial septum; dark on T1 and T2 and enhances

Question 637

What is fibroelastoma?

Answer 637

Prefers valves; can cause systemic emboli

Question 638

What is pyriform aperture stenosis associated with?

Answer 638

Central megaincisor holoprosencephaly pituitary dysfunction

Question 639

What does CHARGE stand for?

Answer 639

Coloboma, heart defects, choanal atresia, retarded growth, GU abnormalities, ear anomalies

Question 640

What does VACTERL stand for?

Answer 640

Vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities

Question 641

What is phlebectasia?

Answer 641

Dilated jugular vein, worse with Valsalva; NOT related to stenosis

Question 642

What is fibromatosis coli?

Answer 642

Torticollis away from lesion two heads of sternocleidomastoid muscle ## Footnote think neuroblastoma if calcifications or lesion is external to SCM

Question 643

What is are the types of gastric volvulus?

Answer 643

Organoaxial: older, greater curvature flips over lesser curvature Mesenteroaxial: kids, antrum flips above GE junction along short axis

Question 644

What is a meconium plug associated with?

Answer 644

intestinal obstruction in newborns NOT associated with cystic fibrosis associated with diabetic mothers and magnesium sulfate for eclampsia

Question 645

What is necrotizing enterocolitis characterized by?

Answer 645

Unchanging bowel pattern and focal bowel dilation in the RLQ; common in cardiac patients, premies, and Hirschsprung disease

Question 646

What is dorsal pancreatic agenesis?

Answer 646

Only central bud, no tail associated with diabetes and polysplenia

Question 647

Hepatic lesion in 0-3 yo

Answer 647

Hemangioma: -Chf and ^EGF Hepatoblastoma: -Associated with Wilms and hemihypertrophy, ^AFP, calcs -Premies and precocious puberty 2/2 bHCG Mesenchymal hamartoma: -Cystic mass with feeding vein 

Question 648

Caroli disease associations

Answer 648

AR Intrahepatic biliary ductal dilitation-> liver fibrosis Polycystic kidney disease and medullary sponge kidney Central dot sign

Question 649

What is hereditary hemorrhagic telangiectasia associated with?

Answer 649

Osler-Weber-Rendu syndrome Multiple AVMs of lung and liver cirrhosis dilated hepatic artery Brain abscess

Question 650

What is a consequence of neonatal renal vein thrombosis?

Answer 650

Acute: renal enlargement Chronic: renal atrophy ## Footnote Related to maternal diabetes

Question 651

What causes neonatal renal artery thrombosis?

Answer 651

Due to umbilical artery catheters ## Footnote It can lead to severe hypertension

Question 652

What are the features of prune belly syndrome?

Answer 652

Pear shaped deficiency of abdominal musculature hydroureteronephrosis and cryptorchidism

Question 653

What types of bladder urachus remnants are there?

Answer 653

Patent urachus, sinus, cyst, and diverticulum ## Footnote These are associated with adenocarcinoma

Question 654

What is nephroblastomatosis?

Answer 654

Nephrogenic rests from birth precursor to Wilms so followed up hypodense rind ## Footnote Typically occurs in children aged 0-3 years

Question 655

What is mesoblastic nephroma?

Answer 655

Hamartoma that involves renal sinus Can be present from birth occurs in children aged 0-3 years

Question 656

What is Wilms tumor typically associated with?

Answer 656

Associated conditions include Beckwith-Wiedemann, Sotos, and WAGR syndrome Around 4 years old Mets to lungs clear cell metastasizes to bone rhabdoid metastasizes to brain

Question 657

What are the characteristics of neuroblastoma?

Answer 657

Calcifications, hypervascular T2 bright encases but does not invade opsoclonus-myoclonus stage 4s has favorable prognosis Younger than Wilms

Question 658

What are the physical features of achondroplasia?

Answer 658

Frontal bossing trident hands narrowing of interpedicular distance tombstone pelvis rhizomelia

Question 659

What is the characteristic thoracic shape in Jeune syndrome?

Answer 659

Bell shaped thorax with short ribs ## Footnote Also known as asphyxiating thoracic dystrophy

Question 660

What are the features of Gorlin syndrome?

Answer 660

Medulloblastoma Multiple odontogenic keratocysts calcifications of the dura/falx basal cell cancer bifid ribs

Question 661

What does 'bone in bone' or 'picture frame vertebra' indicate?

Answer 661

Osteopetrosis

Question 662

What is Klippel-Feil syndrome?

Answer 662

Congenital fusion of cervical spine

Question 663

What is a key characteristic of xenon as a medical imaging agent?

Answer 663

Fat soluble, requires special xenon trap ## Footnote It has a high sensitivity for COPD but a short biological half-life

Question 664

What is Tc99 DTPA used for?

Answer 664

Radiolabeled aerosol that crosses alveolar capillary membrane and is renal filtered ## Footnote Clumping can occur in the mouth, airways, and stomach

Question 665

What is thallium produced in and most sensitive for?

Answer 665

Cyclotron ## Footnote It is most sensitive for CNS lymphoma

Question 666

What is the most common subtype of thyroid cancer? Which subtype has the worst prognosis

Answer 666

Papillary subtype is the most common and does the best with I131 treatment Anaplastic has the worst prognosis, poor response to treatment Medullary has poor response to treatment and is associated with MEN2

Question 667

What is cold on thyroid scans?

Answer 667

Thyroid carcinoma-> Octreoscan/octreotide

Question 668

What can treatment for thyroid cancer lead to?

Answer 668

Pulmonary fibrosis in lung metastases Salivary gland damage in sjogrens

Question 669

When is thyroid cancer considered treatment resistant?

Answer 669

* Medullary subtype * Prior treatment with methimazole * Prior I131

Question 670

What is the dosing for HIDA scan?

Answer 670

0.02 microgram CCK and 0.02 mg morphine

Question 671

What conditions can cause decreased asymmetric renal flow?

Answer 671

* Renal artery or vein thrombosis * Obstruction * Acute rejection or pyelonephritis

Question 672

Normal perfusion and delayed excretion is suggestive of what in the immediate postoperative renal transplant period vs longstanding?

Answer 672

ATN in renal transplant immediately postoperative cyclosporine toxicity in longstanding period

Question 673

In the immediate postoperative renal transplant patient, what does Normal perfusion and delayed excretion suggest? Delayed perfusion and delayed excretion?

Answer 673

ATN Acute rejection

Question 674

What types of fluid collections can occur post renal transplant?

Answer 674

within the first two weeks: * Hematoma * Urinoma (hot on renal scan) late: * Lymphocele with no tracer uptake

Question 675

What conditions are hot on MDP?

Answer 675

* Fibrous dysplasia * Giant cell tumor * Osteoid osteoma * Osteoblastoma * Aneurysmal bone cyst * Meningioma

Question 676

What is the size range of MAA?

Answer 676

10-100 micrometers

Question 677

What is the size range of Y90?

Answer 677

20-40 micrometers

Question 678

What is the size range of sulfur colloid?

Answer 678

0.1-1 micrometers

Question 679

What is the size range of sulfur colloid lymphoscintigraphy?

Answer 679

0.01-0.1 micrometers

Question 680

What are the uses of Sestamibi?

Answer 680

* Parathyroid * Breast * Heart

Question 681

What does lymph node uptake during Sestamibi imaging mean? What affects Sestamibi uptake

Answer 681

cancer background hormone levels

Question 682

What does a false positive in Sestamibi imaging include?

Answer 682

* Fibroadenoma * Fibrocystic change

Question 683

What is a MUGA scan? How is this affected by inclusion of LA or using spleen as background ROI?

Answer 683

Radiolabeled RBCs with cardiac gating for EF false low EF false high EF

Question 684

What is Y90 classified as? Half life? What to assess before Y90 treatment?

Answer 684

Beta emitter 64 hours TcMAA hepatic arterial injection to assess lung shunt Can prophylactically embolize right gastric/gda to prevent ulcers

Question 685

What premedication is used for biliary atresia imaging? What is biliary atresia imaging?

Answer 685

Phenobarbital 5 mg/kg for 5 days 24 hour scan HIDA scan

Question 686

What is the epidemiology of esophageal adenocarcinoma?

Answer 686

White, PPI use, lower esophageal stricture/ulcer chronic reflux leading to Barrett's esophagus

Question 687

What is the epidemiology of esophageal squamous cell carcinoma?

Answer 687

Black, drinking and smoking, alkaloid exposure, mid esophageal stricture

Question 688

Transient fine folds in lower ⅔ that go away with swallowing?

Answer 688

feline esophagus

Question 689

Discrete plaque-like lesions with shaggy irregular luminal surface?

Answer 689

candidiasis

Question 690

What is glycogenic acanthosis?

Answer 690

elevated nodules in asymptomatic elderly patients mimics candidiasis

Question 691

What is the appearance of small ulcers with halo of edema in the esophagus?

Answer 691

herpes

Question 692

What is the appearance Large flat ovoid ulcers in the esophagus?

Answer 692

CMV/HIV

Question 693

What aphthous ulcers are characteristic of?

Answer 693

Crohn's disease

Question 694

Posterior through Killian triangle hypopharynx?

Answer 694

zenker diverticulum

Question 695

Anterolateral below cricopharyngeal muscle in cervical esophagus?

Answer 695

Killian Jamieson pulsion diverticulum

Question 696

What is the location of epiphrenic diverticula?

Answer 696

Pulsion diverticula on the right side

Question 697

What is the difference between pulsion diverticulum and traction diverticulum?

Answer 697

* Pulsion do not empty * Traction will empty mid esophageal triangular related to granulomatous disease

Question 698

What causes esophageal pseudo diverticulosis?

Answer 698

Dilated excretory submucosal glands causing multiple tiny outpouchings related to chronic reflux and strictures

Question 699

What is jejunal diverticulosis associated with?

Answer 699

Bacterial overgrowth and malabsorption

Question 700

What are the characteristics of eosinophilic esophagitis?

Answer 700

Concentric ringed esophagus, young patients, atopy, dysphagia

Question 701

What causes dysphagia lusoria?

Answer 701

Compression from aberrant right subclavian artery

Question 702

What to suspect in dilated esophagus?

Answer 702

* Achalasia * LES does not relax * Absent primary peristalsis * Increased risk of candida similar finidngs in Chagas disease

Question 703

What is pseudoachalasia?

Answer 703

Secondary to cancer at GE junction compared to true achalasia, it never relaxes

Question 704

What is the characteristic of scleroderma related to esophagus and lung?

Answer 704

Incompetent LES with chronic reflux NSIP (ground glass with subpleural sparing)

Question 705

What causes varices in the lower vs upper sophagus?

Answer 705

Portal hypertension leading to uphill varices SVC obstruction leads to downhill varices

Question 706

What is linitis plastica?

Answer 706

contracted desmoplastic deformity of the stomach resembling a leather bottle can be seen in breast and lung cancer met or lymphoma

Question 707

what does melanoma mets of the stomach look like

Answer 707

Multiple button type soft tissue nodules

Question 708

Multiple gastric ulcers = Multiple duodenal ulcers = Multiple marginal ulcers post roux en y =

Answer 708

-chronic aspirin use -zollinger ellison (Duodenal ulcers never malignant and NOT caused by aspirin) -chronic jejunal ischemia

Question 709

What is Menetriers?

Answer 709

Rugal thickening involving fungus, sparing antrum

Question 710

What condition is indicated by isolated gastric varices?

Answer 710

Splenic vein thrombus iso pancreatitis/pancreatic cancer

Question 711

What are the potential complications of Bilroth/Roux en Y surgery?

Answer 711

* Bile reflux gastritis: fold thickening and filling defects in stomach * Increased risk of adenocarcinoma 15 yrs later in gastric remnant * Internal hernia

Question 712

What does small bowel loops separation with tethering indicate?

Answer 712

Carcinoid, typically involves distal ileum

Question 713

What condition is characterized by sand-like nodules in the small bowel?

Answer 713

Whipple or pseudo-whipple (MAC)

Question 714

What is indicated by uniform small nodules in the small bowel?

Answer 714

Lymphoid hyperplasia

Question 715

What does multiple varying size nodules in the small bowel suggest?

Answer 715

Metastasis (melanoma)

Question 716

What does a ribbon-like small bowel appearance indicate?

Answer 716

Graft versus host disease

Question 717

What does the clover leaf sign indicate?

Answer 717

Healed peptic ulcer of duodenal bulb

Question 718

What are the signs of celiac sprue?

Answer 718

* Malabsorption of gluten * Associated iron deficiency anemia * Pulmonary hemosiderosis * Dermatitis herpetiformis * TTG antibody * Cavitary lymph nodes * Splenic atrophy * Increased risk of bowel lymphoma

Question 719

What is gallstone ileus?

Answer 719

Erodes through duodenum and causes distal obstruction at the IC valve w rigler's triad

Question 720

What are the components of Rigler's triad?

Answer 720

* Pneumobilia * Obstruction * Ectopic gallstone location

Question 721

What is the shock complex associated with severe hypotension?

Answer 721

* Thickened bowel loops with diffuse enhancing mucosa * Flat IVC * Delayed nephrograms * Hyperenhancing adrenals * Hypoenhancing liver/spleen

Question 722

Mesenteric mass with starburst appearance and desmoplastic stranding?

Answer 722

carcinoid tumor

Question 723

What type of hernia is a Spigelian hernia?

Answer 723

Along semilunar line (lateral ventral hernia), typically above arcuate line

Question 724

What is a Richter hernia?

Answer 724

Only 1 wall of bowel; no obstruction but risk of strangulation

Question 725

What is an obturator hernia?

Answer 725

Occurs in old ladies with increased intraabdominal pressure; causes paresthesia along inner thigh to knee from obturator nerve compression

Question 726

What is a femoral hernia?

Answer 726

Occurs in old ladies; located below pubic tubercle inferior to inferior epigastric, medial to common femoral vein

Question 727

What defines a direct hernia?

Answer 727

Above pubic tubercle medial and anterior to inferior epigastric artery; defect in Hesselbach’s triangle

Question 728

What characterizes an indirect hernia?

Answer 728

Most common; lateral and superior to inferior epigastric artery; failure of processus vaginalis to close, covered by spermatic fascia

Question 729

What are the symptoms and types of internal hernia?

Answer 729

Paraduodenal is most common Stomach pain after eating, improves with rubbing Lanzert fossa defect (left) Waldeyer fossa defect (right) sac like cluster of dilated small bowel

Question 730

Crohn's disease?

Answer 730

Entire GI tract involvement particularly terminal ileum skip lesions, creeping fat, cobblstoning, string sign fistulas and abscesses

Question 731

What is a significant complication of ulcerative colitis? what is contraindicated?

Answer 731

Toxic megacolon ## Footnote Toxic megacolon carries a risk of perforation (no enema) and is associated with an ahaustral colon.

Question 732

What is ulcerative colitis?

Answer 732

continuous involvement of colon, including the rectum lead pipe sign: Ahaustral colon with granular appearing mucosa associated with colon cancer and primary sclerosing cholangitis

Question 733

What is Behçet's disease characterized by?

Answer 733

* Pulmonary artery aneurysm * Mouth and penis ulcers * Turkish descent

Question 734

What is the ultrasound appearance of an appendix mucocele?

Answer 734

Onion sign

Question 735

What condition is associated with small cysts throughout the colon?

Answer 735

Colitis cystica ## Footnote This condition is often linked with sprue and vitamin deficiencies.

Question 736

What is characteristic of Entamoeba histolytica?

Answer 736

SPARES terminal ileum Bloody diarrhea coned cecum, flask-shaped ulcers liver and spleen abscesses

Question 737

How does colonic tuberculosis typically present?

Answer 737

Involves terminal ileum coned cecum, fleischner sign (inverted umbrella)

Question 738

What is a characteristic imaging feature of C-diff infection?

Answer 738

Accordion sign with contrast trapped inside mucosal folds thumb printing and ulceration

Question 739

What is the significance of large bowel intussusception?

Answer 739

Suspected malignancy, such as adenocarcinoma

Question 740

What is an adenoma (GI)?

Answer 740

can cause mucus diarrhea and severe electrolyte abnormalities Most common benign tumor Villous adenomas have the largest risk for malignancy

Question 741

What is the epiploic foramen of Winslow?

Answer 741

Conduit between Greater and lesser/omental bursa sacs

Question 742

How does the female peritoneum communicate with the extraperitoneal pelvis?

Answer 742

Via fallopian tubes

Question 743

What is the most common location for peritoneal carcinomatosis?

Answer 743

Most common location for peritoneal implants is retrovesical space

Question 744

What is scalloped appearance of the liver and complex ascites?

Answer 744

Pseudomyxoma peritonei Can be seen with mucinous neoplasm from ovary or stomach or appendix mucocele/mucinous cystadenoma perforation

Question 745

What condition is characterized by limited colitis to the cecum?

Answer 745

Neutropenic colitis/typhlitis

Question 746

what is the significance of dual liver blood supply?

Answer 746

compensatory relationship between hepatic artery and portal vein results in peripheral subcapsular transient hepatic attenuation differences (THAD)

Question 747

portal hypertensive colopathy and gastropathy

Answer 747

right colon edema gastric thickening and bleed

Question 748

HCC mechanism

Answer 748

hepatocyte injury-> regenerative nodules (T2 dark)-> dysplastic nodules (bigger, T1 bright/T2 dark)-> HCC

Question 749

HCC imaging characteristics

Answer 749

T2 bright dark on delayed hepatocyte specific Eovist scan (lose function of bile uptake transporter OATP) Exception is well differentiated HCC which retains OATP function and is bright on delayed eovist

Question 750

What must be biopsied in cases of FNH?

Answer 750

Central scar

Question 751

Fibrolamellar HCC typically occurs in? what imaging features

Answer 751

in patients under 35 yo in patients without cirrhosis central scar, calcifications gallium avid

Question 752

Fibrolamellar HCC compred to HCC and FNH?

Answer 752

Normal AFP in fibrolamellar HCC compared to elevated AFP in HCC Scar is dark without enhancement compared to FNH scar with enhancement

Question 753

What is the primary difference between Cholangiocarcinoma and HCC regarding the portal vein?

Answer 753

Encases portal vein vs invades portal vein

Question 754

What is the most common source of liver metastases? what type of neoplasm for calcified liver mets?

Answer 754

Colon mucinous neoplasm

Question 755

Elevated CEA and CA19-9 elevated CA19-9 elevated CEA

Answer 755

cholangiocarcinoma pancreatic cancer colon cancer

Question 756

What does a double target sign on CT indicate?

Answer 756

Pyogenic abscess ## Footnote A single target sign is associated with Klebsiella, while multiple targets are associated with E. coli.

Question 757

What does a bulls eye appearance on liver ultrasound indicate?

Answer 757

Candida

Question 758

What is a potential complication of an amebic abscess in the left lobe?

Answer 758

Can rupture into pericardium ## Footnote This condition requires emergent drainage.

Question 759

What does the tortoise shell liver sign indicate?

Answer 759

Schistosomiasis

Question 760

What does the hot quadrate sign signify?

Answer 760

Focal segment of contrast secondary to SVC obstruction ## Footnote The hot caudate sign is observed in Budd-Chiari syndrome.

Question 761

Enhancement of anterior liver capsule, ascites, peritoneal septations in RUQ?

Answer 761

Fitz Hugh Curtis syndrome ## Footnote This finding is seen in the context of pelvic inflammatory disease.

Question 762

What is the primary and secondary cause of hemochromatosis?

Answer 762

1) Inherited and involves pancreas 2) Acquired related to inflammation/transfusions and involves spleen

Question 763

How do regenerative nodules appear on T1 and T2 in Budd-Chiari syndrome and HCC?

Answer 763

T1 bright in Budd-Chiari and T2 bright in HCC

Question 764

What does the biliary necrosis indicate in a transplant liver?

Answer 764

Hepatic artery thrombosis as the biliary system relies on for blood supply

Question 765

What is the normal resistive index range for the hepatic artery? What is the peak velocity of the hepatic artery typically less than?

Answer 765

0.5-0.7 <200 cm/s

Question 766

What is Aids cholangiopathy similar to?

Answer 766

Primary sclerosing cholangitis but it demonstrates papillary stenosis focal strictures of the extrahepatic ducts greater than intrahepatic.

Question 767

What is recurrent pyogenic cholangitis characterized by?

Answer 767

Dilated ducts full of pigmented stones ## Footnote It is associated with cholangiocarcinoma in the East.

Question 768

What are the main anatomical components of the gallbladder?

Answer 768

* Spiral valves of Heister-> * Neck-> * Body-> * Fundus->

Question 769

Cholelithiasis in kids?

Answer 769

Sickle cell

Question 770

What is a finding in gangrenous cholecystitis? What is emphysematous cholecystitis associated with?

Answer 770

Absent Murphy sign, sloughed membranes/cobwebs on ultasound elderly diabetics with increased risk of perforation

Question 771

What are pancreatic neuroendocrine/Islet cell tumors and what do they demonstrate?

Answer 771

Hypervascular with brisk enhancement -Insulinoma: benign, solitary, small -Gastrinoma: increased gastric acid output and ulcers (Zollinger Ellison syndrome and MEN1)

Question 772

Intrapancreatic spleen imaging features? what study to order

Answer 772

Dark T1, bright T2 tiger stripe mass on arterial restrict diffusion ->Heat treated RBCs and sulfur colloid

Question 773

What is the Whipple procedure?

Answer 773

Pancreatic head, duodenum, gastric antrum, and gallbladder resection

Question 774

What are the complications of the Whipple procedure?

Answer 774

Delayed gastric emptying and pancreatic fistula

Question 775

What condition is characterized by splenomegaly with occasional discrete hypodense nodules?

Answer 775

Spleen Sarcoidosis

Question 776

What are Gamna gandy bodies?

Answer 776

Foci of hemosiderin T2 dark on gradient in the spleen ## Footnote These are siderotic nodules seen in portal hypertension

Question 777

What can cause multiple splenic calcifications?

Answer 777

Sequela of infection, most commonly histoplasmosis

Question 778

What are the causes of a small spleen?

Answer 778

* Sickle cell disease * Radiation * Thorotrast exposure * Ulcerative colitis

Question 779

What conditions are associated with a large spleen?

Answer 779

* Lymphoma * Leukemia * Congestion * Gaucher's disease * Felty's syndrome

Question 780

What is Felty's syndrome?

Answer 780

Splenomegaly, rheumatoid arthritis, neutropenia

Question 781

What distinguishes epidermoid cysts from pseudocysts?

Answer 781

Epidermoid cysts are true cysts with epithelial lining ## Footnote Pseudocysts lack this lining and often arise from inflammation

Question 782

Where are hydatid cysts most commonly found?

Answer 782

* Liver * Lung * Spleen ## Footnote These cysts are caused by Echinococcus infection

Question 783

What is the most common malignant tumor of the spleen?

Answer 783

Splenic lymphoma ## Footnote Characterized by splenomegaly, low density on CT, T1 dark, PET hot

Question 784

What are common sources of splenic metastases?

Answer 784

* Melanoma * Breast cancer * Lung cancer

Question 785

What is unilateral renal agenesis associated with?

Answer 785

* Unicornuate uterus * Mayer-Rokitansky-Küster-Hauser syndrome/mullerian agenesis * Absent epididymis or vas deferens

Question 786

What are the characteristics of renal cell carcinoma (RCC)?

Answer 786

* Calcifications in a fatty, enhancing mass * Mets are hypervascular and lytic * Increased risk in patients on dialysis

Question 787

What does lymphoma/leukemia present as in the kidneys?

Answer 787

Bilateral enlarged kidneys with cortically based nodules or masses

Question 788

What are the categories in the Bosniak cyst classification?

Answer 788

* 1: simple * 2: hyperdense or thin calcs/septa * 3: thick septations/calcs, mural nodules * 4: enhancement

Question 789

If a renal cyst is homogenously >70 HU, what is its likely classification?

Answer 789

Benign proteinaceous/hemorrhagic cyst

Question 790

What characteristics are associated with ADPKD?

Answer 790

Progressive cyst enlargement and loss of function * Liver cysts * Seminal vesicle cysts * Berry aneurysms

Question 791

What are the characteristics of autosomal recessive polycystic kidney disease (ARPKD)?

Answer 791

Smaller cysts initially too small to resolve, increased echogenicity with loss of corticomedullary differentiation ## Footnote Associated with congenital hepatic fibrosis

Question 792

What is Lithium nephropathy characterized by?

Answer 792

Diabetes insipidus and renal insufficiency ## Footnote Often presents with small kidneys and numerous tiny cysts

Question 793

What is the main distinction between pyelonephritis and infarct?

Answer 793

Wedge shaped area of decreased perfusion Infarct spares the cortex (cortical rim sign)

Question 794

What does 'flip flop enhancement' refer to in imaging?

Answer 794

Hypodensity becomes hyperdense on delayed imaging in infarct

Question 795

What defines emphysematous pyelitis?

Answer 795

Gas localized to collecting system

Question 796

What is lobster claw sign in renal imaging?

Answer 796

Necrotic cavity in papillae with linear streaks of contrast in the calyx Ischemic necrosis of renal papillae medullary pyramids in papillary necrosis ## Footnote It is most commonly seen in diabetics and individuals with sickle cell disease.

Question 797

What is the earliest described sign of renal tuberculosis?

Answer 797

Calyceal blunting

Question 798

What is a phantom calyx?

Answer 798

Focal infundibulum stenosis leading to abnormal calyx appearance ## Footnote This is a potential complication of tuberculosis.

Question 799

What is a putty kidney?

Answer 799

Extensive renal calcifications with calcified lymph nodes ## Footnote This is associated with tuberculosis.

Question 800

What are the risk factors for contrast-induced nephropathy?

Answer 800

Renal insufficiency, diabetes, CHF ## Footnote Allergic reactions are not considered risk factors.

Question 801

What is the most common type of nephrolithiasis?

Answer 801

Calcium oxalate

Question 802

Which type of nephrolithiasis is associated with staghorn calculi?

Answer 802

Struvite

Question 803

What type of nephrolithiasis is invisible on X-ray? on CT?

Answer 803

Uric acid Indinavir ## Footnote Uric acid stones can be treated with pH medications to dissolve them.

Question 804

What is cortical nephrocalcinosis?

Answer 804

Sequela of cortical necrosis after drop in BP ## Footnote It presents as a hypodense non-enhancing rim with thin calcifications.

Question 805

What characterizes medullary nephrocalcinosis?

Answer 805

Hyperechoic renal papilla/pyramids ## Footnote This condition is often seen in hyperparathyroidism and medullary sponge kidney, lasix in kids

Question 806

What is the consequence of a Page kidney?

Answer 806

subcapsular hematoma or collection-> Compression leading to hypertension

Question 807

What is a delayed nephrogram vs a persistent nephrogram?

Answer 807

Asymmetric non-enhancement of the kidney bilateral retained/delayed enhancement 2/2 shock or hypotension ## Footnote This can suggest renal ischemia or obstruction.

Question 808

What is a significant indicator of a sick transplant kidney?

Answer 808

Swollen, Increased RI > 0.7 ## Footnote This is a sign of possible complications such as rejection.

Question 809

What is the risk associated with transplant patients?

Answer 809

Significant increase in cancer risk: skin, lymphoma, colon ## Footnote Annual skin checks are recommended for early detection.

Question 810

What is PTLD in the context of transplants?

Answer 810

Mass encasing hilum ## Footnote It is associated with EBV and often requires prophylactic treatment with rituximab.

Question 811

What are post-transplant complications related to steroids?

Answer 811

Reactivation of BK virus, Femoral head AVN ## Footnote Immunosuppression increases the risk of these complications.

Question 812

What associations are there with ureter calcifications?

Answer 812

TB and schistosomiasis

Question 813

What is ureteritis cystica?

Answer 813

Tiny subepithelial cysts associated with diabetics and chronic inflammation

Question 814

What is retroperitoneal fibrosis associated with?

Answer 814

IgG4 disorders (autoimmune pancreatitis) ## Footnote It presents as medial deviation/waisting of ureters.

Question 815

True or False: Allergic reactions are a risk factor for contrast-induced nephropathy.

Answer 815

False ## Footnote Risk factors include renal insufficiency, diabetes, and CHF.

Question 816

transplant complications in first week: MAG3 poor flow, delayed uptake, and slow excretion  MAG3 normal flow, normal uptake, delayed excretion in a month: MAG3 normal flow, normal uptake, delayed excretion MAG3 poor flow, delayed uptake, and slow excretion

Answer 816

elevated RIs Acute rejection: antibody mediated Acute tubular necrosis: ischemia during harvest Cyclosporin toxicity: nephrotoxic reaction Chronic rejection: T-cell mediated

Question 817

Leukoplakia vs malakoplakia

Answer 817

Leukoplakia: chronic irritation-> squamous metaplasia (Premalignant for squamous cell) Malakoplakia: chronic irritation/UTIs (E coli), immunocompromised women (NOT premalignant)

Question 818

AAST kidney trauma

Answer 818

Grade 1: subcapsular hematoma Grade 2: subcapsular hematoma and <1 cm laceration Grade 3: >1 cm laceration w/o involving renal pelvis; active bleed within perirenal space Grade 4: laceration into hilum (fracture); bleeding outside perirenal space; segmental infarcts related to vascular injury Grade 5: shattered kidney, urine leak or main vessel injury; devascularized kidney

Question 819

renal transplant Vascular complications

Answer 819

Renal allograft compartment syndrome (Immediately): when kidney too larg Renal artery thrombosis (Within first moments): due to kinking/torsion of the vessel Renal vein thrombosis (Within first week): see reversal of diastolic flow in ARTERY Renal artery stenosis (Within first year): results in refractory hypertension, most common complication

Question 820

what is diffuse nonperfusion, wedge shaped perfusion defect, and persistent nephrogram indiate in the setting of trauma

Answer 820

Diffuse nonperfusion: devascularized kidney Wedge shaped perfusion defect: segmental arterial injury Persistent nephrogram: renal vein injury/thrombosis

Question 821

What is involved in urinary TCC?

Answer 821

Bladder > renal pelvis > ureter lower > upper ureter prostatic urethera ## Footnote where urine sits static the longest

Question 822

Which substances are associated with TCC?

Answer 822

* Smoking * Arsenic * Aniline * Benzidine * Bladder diverticulum

Question 823

What conditions are associated with bladder SCC? how does it apear

Answer 823

* Schistosomiasis * Suprapubic catheters * Leukoplakia Heavily calcified bladder and ureters

Question 824

Where is urinary adenocarcinoma?

Answer 824

* Urachus * Bladder exstrophy * Urethral diverticulum

Question 825

paratesticular mass in children

Answer 825

rhabdomyosarcoma

Question 826

Grape-like polypoid mass ?

Answer 826

sarcoma botryoides variant of rhabdomyosarcoma

Question 827

Pine cone shaped bladder?

Answer 827

neurogenic bladder

Question 828

What type of cancer is typically found in the urethra?

Answer 828

Squamous cell carcinoma ## Footnote Transitional cell carcinoma may occur in the prostatic urethra, while adenocarcinoma is found in urethral diverticulum.

Question 829

What type of cancer occurs in the bladder?

Answer 829

most commonly transitional cell (include bladder divert) squamous cell (schisto, suprapub catheter) adenocarcinoma (urachus, urethral diverticulum, extrophy)

Question 830

turner syndrome is associated with

Answer 830

Aortic coarctation horseshoe kidneys streaky ovaries prepubertal uterus (tube-like shape, cervix and uterus same size)

Question 831

what develops from the mullerian ducts

Answer 831

uterus, fallopian tubes, upper ⅔ vagina

Question 832

what develops from the Urogenital sinus:

Answer 832

lower ⅓ vagina and prostate

Question 833

what develops from the wolffian ducts

Answer 833

vas deferens, seminal vesicles, epididymis

Question 834

hysterosalpingogram findings

Answer 834

-Tubal occlusion iso PID: dilated tubes w abrupt cutoff/obstruction and no spill of contrast -Salinities isthmica nodosa Nodular scarring of fallopian tubes -Ashermans (intrauterine adhesions): Irregular linear filling defects

Question 835

What is the increased risk associated with hereditary non polyposis colon cancer (HNPCC)?

Answer 835

Increased risk of endometrial cancer ## Footnote HNPCC is also known as Lynch syndrome

Question 836

thickened endometrium and ovarian lesion

Answer 836

Granulosa theca cell tumor of ovary or endometrial cancer w ovarian met ## Footnote Granulosa cell tumors are a type of sex-cord stromal tumor that can produce estrogen and affect the endometrial lining.

Question 837

rapid enlargement of fibroid with necrosis

Answer 837

Malignant transformation of fibroid ## Footnote Leiomyosarcoma

Question 838

What characterizes a peritoneal inclusion cyst?

Answer 838

Entraps ovary, lacks discrete walls, conforms to surrounding shape

Question 839

What type of cancer is endometrial cancer classified as? Cervical cancer?

Answer 839

Adenocarcinoma Squamous cell (HPV)

Question 840

What are the types of cancers associated with vaginal cancer?

Answer 840

* Squamous cell carcinoma (most common) * Clear cell carcinoma (associated with DES) * Rhabdomyosarcoma (in children)

Question 841

simple paraovarian cyst next step

Answer 841

no follow up required, regardless of size

Question 842

post menopausal ovary

Answer 842

should be less than 6 cc and cold on PET

Question 843

premenopausal ovary next step

Answer 843

If <3 cm: normal follicle If >3 cm: get US-> if >7 cm needs 3 mo f/u

Question 844

postmenopausal ovary next step

Answer 844

If <1 cm: normal cyst If >1 cm: get US-> if >5 cm needs 3 mo f/u If not simple, w septations, projections, solid elements-> Gyn

Question 845

What type of ovarian tumor is described as unilocular with few septations, papillary projections, and ascites?

Answer 845

Serous ovarian cystadenocarcinoma/cystadenoma ## Footnote This is typically bilateral and malignant.

Question 846

What type fo ovarian tumor is described as multiloculated with thin septations and low level echoes

Answer 846

mucinous ovarian cystadenocarcinoma

Question 847

What condition is associated with postpartum pelvic pain and fever?

Answer 847

Ovarian vein thrombosis ## Footnote It typically presents as a tubular structure with an enhancing wall and low attenuation thrombus.

Question 848

True or False: Serous ovarian cystadenocarcinoma is typically unilateral.

Answer 848

False ## Footnote It is described as bilateral.

Question 849

increasing hcg following evacuation of mole

Answer 849

choriocarcinoma very vascular and bloody echogenic

Question 850

prostate anatomy

Answer 850

fibromuscular zone (anterior) central zone (transitional gland and central gland) peripheral zone (adenocarcinoma)

Question 851

early enhancement and washout cancers

Answer 851

prostate, breast and HCC

Question 852

seminal vesicle cysts associated with

Answer 852

congenital: polycystic kidney disease, renal agenesis, vas deferens agenesis acquired: prostate hypertrophy or surgery

Question 853

testicular artery flow in torsion and pitfall

Answer 853

Absence of arterial flow Monophasic arterial flow High resistance arterial flow with low or reversed diastolic flow note testicular artery NOT cremasteric artery

Question 854

epididymitis spread and causes

Answer 854

Spreads tail to body to head Chlamydia/gonorrhea in younger E. coli from uti in older

Question 855

orchitis causes

Answer 855

spread from epididymitis mumps

Question 856

Age 18-35 w undescended testicle

Answer 856

seminoma

Question 857

Age 18-35 w retro peritoneal adenopathy

Answer 857

testicular cancer

Question 858

Multiple hypoechoic masses or enlarged hypoechoic testicle

Answer 858

lymphoma

Question 859

how do testicular/ovarian cancers metastasize

Answer 859

through paraaortic and caval lymphatics except choriocarcinoma (hematogenous)

Question 860

germ cell testicular tumor appearance

Answer 860

Seminoma (middle aged white male): Most common, best prognosis with radiation Homogenous T2 dark, hypoechoic Non seminoma (teenager): Heterogenous w calcs and cystic spaces

Question 861

Causes of Infertility:

Answer 861

Pituitary adenoma (prolactin) Kallman syndrome (anosmia and infertility) Klinefelters (tall, gynecomastia, infertile) Zinner syndrome (renal agenesis and seminal vesicle cyst)

Question 862

types of abortion:

Answer 862

Threatened (bleeding w closed cervix) Inevitable (dilated cervix w tissue hanging out) Incomplete (residual products in uterus) Complete (all products out) Missed (fetus dead but in uterus)

Question 863

double bleb sign in pregnancy

Answer 863

Yolk sac and amniotic sac within the chorionic cavity

Question 864

amniotic band syndrome

Answer 864

If amnion is disrupted before 14-16 weeks, fetus gets into chorionic cavity

Question 865

prognostic factor most associated with fetal demise in subchorionic hemorrhage

Answer 865

percentage of placental detachment

Question 866

pregnancy failure classified as

Answer 866

-CRL crown rump length >7 mm w/o heartbeat -MSD mean sac diameter >25 mm w/o embryo -No embryo or heartbeat ->2 weeks after US showing gestational sac w/o yolk sac ->11 days after US showing gestational sac w yolk sac

Question 867

What indicates an empty uterus in the context of ectopic pregnancy?

Answer 867

-pregnancy/yolk sac out side of uterus -Empty uterus with anything on adnexa -empty uterus with moderate free fluid

Question 868

What is the most common site for an ectopic pregnancy?

Answer 868

Fallopian tube ampulla

Question 869

What is the tubal ring sign?

Answer 869

Echogenic ring specific for ectopic

Question 870

Fetal growth parameters

Answer 870

Biparietal (outer edge of skull to inner table) Head circumference (not including skin) Abdominal circumference (not including soft tissues) Femur length (femoral shaft not including femoral epiphysis)

Question 871

increase diastolic flow and decreased resistance of intrauterine MCA doppler

Answer 871

Abnormal brain sparing reflex Normal: high resistance waveform with continuous diastolic forward flow

Question 872

Increased peak systolic flow of MCA intrauterine doppler

Answer 872

Fetal anemia--> hydrops enlarged liver and spleen Maternal immunization or parvovirus

Question 873

what does elevated systolic/diastiolic ratio of umbilical artery indicate

Answer 873

high resistance =preeclampsia and IUGR

Question 874

oligohydramnios causes

Answer 874

renal failure (cannot pee to make urine/amniotic fluid) placental insufficiency-> growth restriction

Question 875

polyhydramnios causes

Answer 875

GI issue (cannot swallow amniotic fluid) gestational diabetes

Question 876

one vessel visualized lateral to bladder

Answer 876

umbilical artery in two vessel cord

Question 877

What is the significance of cystic rhombencephalon in the posterior fossa at 6-8 weeks?

Answer 877

It is normal.

Question 878

What does midgut herniation at 9-11 weeks indicate?

Answer 878

Normal physiologic rotation.

Question 879

What do echogenic foci in the ventricle indicate?

Answer 879

Papillary muscle calcification, which can be seen in Down syndrome.

Question 880

What is a chorioangioma in the placenta and what are the imaging features?

Answer 880

A hamartoma of the placenta near the cord insertion. well circumscribed, hypoechoic with pulsating doppler flow which matches fetal heart rate

Question 881

How is hydrops diagnosed?

Answer 881

By subcutaneous edema plus: pleural effusion, pericardial effusion, or ascites. secondary to rh sensitization, TORCHS can see increased peak systolic MCA flow

Question 882

What does HELLP syndrome stand for and what is it associated with?

Answer 882

Hemolysis, elevated liver enzymes, low platelets DIC and subcapsular hematoma

Question 883

In which syndromes is Twin oligohydramnios polyhydramnios sequence seen and not seen?

Answer 883

* Twin-twin transfusion syndrome * Twin reversed perfusion syndrome not seen: * Twin anemia polycythemia sequence * Twin embolization syndrome

Question 884

what is the normal appearance of the adrenal gland

Answer 884

y shaped with triple stripe (oreo) appearance

Question 885

discoid adrenal gland

Answer 885

congenital pancake shape in kidney agenesis

Question 886

Horseshoe adrenal gland

Answer 886

associated with right isomerism/asplenia/trilobed lung

Question 887

adrenal cyst next step

Answer 887

in adult: nothing (benign) in kid: resected (cannot distinguish from cystic neurblastoma)

Question 888

what does adrenal hyperplasia look like and what can it be due to

Answer 888

enlarged and wrinkly with gyri/sulci (looks like brain) -congenital adrenal hyperplasia (genital ambiguity with testicular adrenal rests and salt loss) -cushing disease (excess ACTH and cortisol) -cushing syndrome (excess cortisol)

Question 889

imaging features of pheochromocytoma on CT and pitfall

Answer 889

avid enhancement >120 HU regardless of washout, cannot be adrenal adenoma

Question 890

what is pheochromocytoma associated with

Answer 890

VHL, MEN2a and MEN2b

Question 891

what can adrenal calcifications represent?

Answer 891

infection, TB myelolipoma, neuroblastoma, cortical carcinoma

Question 892

MEN1

Answer 892

parathyroid hyperplasia, pituitary adenoma (prolactinoma), pancreatic tumor (gastrinoma: zollinger ellison syndrome & duodenal ulcers)

Question 893

MEN2A

Answer 893

parathyroid hyperplasia, pheochromocytoma, medullary thyroid cancer

Question 894

MEN2B

Answer 894

pheochromocytoma, medullary thyroid cancer, neuromas (mucosal and intestinal), marfanoid

Question 895

multiple paragangliomas (head and neck glomus tumors) is suggestive of

Answer 895

hereditary paraganglioma/pheochromocytoma syndrome

Question 896

hallmark of papillary thyroid carcinoma

Answer 896

microcalcifications

Question 897

thyroid nodules: Peripheral flow and hypoechoic halo Solid hypoechoic w central flow

Answer 897

-benign -suspicious

Question 898

acute suppurative thyroiditis in kids spreads from

Answer 898

fourth branchial cleft anomaly

Question 899

delphian node

Answer 899

level 6 nodule=laryngeal cancer met

Question 900

central sulcus homunculus

Answer 900

omega sign corresponds to hand motor function ACA territory corresponds to leg

Question 901

virchow robin spaces can be seen with

Answer 901

dilated perivascular spaces along basal ganglia -mucopolysaccharidoses (hunters and hurlers) -gelatinous pseudocysts (cryptococcal meningitis) -age

Question 902

Answer 902

1) cavum septum pellucidum 2) cavum et vergae 3) cavum velum interpositum

Question 903

basal cisterns

Answer 903

Suprasellar cistern: look like a star Interpeduncular cistern Sylvian cisterns (2) Ambient cisterns (2) Quadrigeminal plate cistern smile/moon

Question 904

which cranial nerve is contained within a sleeve

Answer 904

CN3 within CSF sleeve/oculomotor cistern

Question 905

order of the cranial nerves

Answer 905

oh oh oh to touch and feel very good velvet ah olfactary, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory spinal, hypoglossal

Question 906

what travels in the optic canal

Answer 906

optic nerve (CN2) and ophthalmic artery

Question 907

what travels in meckels cave

Answer 907

trigeminal ganglion

Question 908

what travels in dorello's canal

Answer 908

abducens nerve (CN6)

Question 909

branches of ECA

Answer 909

Some Administrators Love Fucking Over Poor Medical Students Superior thyroid; Ascending pharyngeal; Lingual; Facial; Occipital; Posterior auricular; Maxillary; Superficial temporal

Question 910

what does middle meningeal artery arise from

Answer 910

off of maxillary artery from ECA

Question 911

ECA vs ICA

Answer 911

external: anterior and high resistance internal: posterior and low resistance

Question 912

what do the pericallosal and callosomarginal arteries originate from?

Answer 912

A2 segment of ACA

Question 913

what does acute unilateral pupil dilation suggest

Answer 913

oculomotor CN3 palsy PCOM or basilar aneurysm

Question 914

what does acute lateral rectus palsy suggest

Answer 914

abducens CN6 palsy increased ICP with inferior herniation stretches CN6

Question 915

what is fetal origin of PCA And complication

Answer 915

PCA is fed by PCOM P1 segment is absent or diminutive Ipsilateral anterior and posterior stroke

Question 916

superficial cerebral veins

Answer 916

vein of trolard and vein of labbe (inverse relationship) superficial middle cerebral vein

Question 917

myelination pattern what is myelinated at birth and what is last to myelinate

Answer 917

-immature myelin (water): T1 dark and T2 bright -mature myelin: T1 bright and T2 dark -myelination occurs inferior to superior, posterior to anterior, central to peripheral -brainstem and posterior limb internal capsule at birth; subcortical white matter last

Question 918

order of corpus callosum formation

Answer 918

genu->body->isthmus->splenium->rostrum

Question 919

agenesis/dysgenesis of the corpus callosum is associated with

Answer 919

colpocephaly intracranial lipoma absent splenium

Question 920

what is iniencephaly

Answer 920

NEURAL tube defect, at posterior cervical region/occipital bone with enlarged foramen magnum Star gazing fetus due to hyperextended contortion

Question 921

Joubert syndrome

Answer 921

Molar tooth appearance of superior cerebellar peduncles Large fourth ventricle with absent/small vermis, small cerebellum Absent fastigial point and primary fissure

Question 922

increased posterior fossa cystic space ddx

Answer 922

-dandy walker, chiari 2, Joubert syndrome -Blake pouch (Sac like cystic protrusion of fourth ventricle through foramen of magendie, sometimes w choroid projecting into pouch) -Mega cisterna magna (Focal enlargement of retrocerebellar CSF space)

Question 923

lobar holoprosencephaly?

Answer 923

front/fornix is mildly fused Mild fusion frontal horns, incomplete septum, partial corpus callosum

Question 924

semilobar holoprosencephaly?

Answer 924

front fused, back cleaved Body of lateral ventricles is 1 chamber cleft lip/palate Absent/partial septum, corpus callosum, anterior interhemispheric fissure, anterior falx cerebri

Question 925

alobar holoprosencephaly?

Answer 925

zero midline cleavage Fused cerebral hemispheres and single midline mono ventricle Monster cyclops, single nostril, solitary mega incisor, pyriform aperture stenosis, do not survive Absent septum, corpus callosum, interhemispheric fissure, falx cerebri

Question 926

What is hemimegalencephaly?

Answer 926

Enlargement/disproportionate growth of all parts of one cerebral hemisphere

Question 927

What distinguishes hemimegalencephaly from Rasmussen's encephalitis?

Answer 927

Dilated ventricle and enlarged hemisphere vs large ventricle and small hemisphere (atrophy with ex vacuo dilation)

Question 928

What is Dyke Davidoff Masson syndrome?

Answer 928

Similar to Rasmussen’s encephalitis but with unilateral skull thickening and expanded sinuses

Question 929

Define lissencephaly type 1.

Answer 929

undermigration Reverse migration outside-in pattern: neurons deposit between ventricle/pial surfaces without cortical folding smooth surface and thick cortex colpocephaly figure 8 shape

Question 930

What characterizes double cortex band heterotopia?

Answer 930

undermigration Disorganized migration results in second layer of cortical neurons deep to true cortex (double cortex appearance)

Question 931

Define lissencephaly type 2.

Answer 931

overmigration Additional layer of cortex consisting of nodules, typically adjacent to sylvian fissures (cobblestoned cortex appearance) ## Footnote This type is associated with muscular dystrophy and retinal detachment.

Question 932

What occurs in periventricular nodule heterotopia?

Answer 932

failed migration Neurons in periventricular region do not migrate and deposit along ventricle borders ## Footnote Grey matter nodules do not enhance, compared to subependymal tubers of tuberous sclerosis.

Question 933

What is polymicrogyria?

Answer 933

Overfolding of superficial layers leading to fine undulating/bumpy cortex ## Footnote This condition can be associated with Zika virus, TORCH infections, and toxic exposure.

Question 934

Describe schizencephaly.

Answer 934

Cleft lined with grey matter between ventricle and pia ## Footnote It can present as open lip (CSF filled cleft extending) or closed lip (no CSF filled cleft).

Question 935

What is a porencephalic cyst?

Answer 935

Brain cleft from prior ischemic event leading to encephalomalacia ## Footnote This cyst is not lined by grey matter.

Question 936

What causes hydranencephaly?

Answer 936

Bilateral ICA occlusion leading to destruction of bilateral hemispheres ## Footnote The cerebellum, midbrain, and falx remain intact in this condition.

Question 937

Differentiate between meningocele and encephalocele.

Answer 937

Meningocele: meninges and csf, no brain Encephalocele: BRAIN, meninges, and csf

Question 938

What is a cystocele?

Answer 938

VENTRICLE, brain, meninges, and csf

Question 939

What is a myelocele?

Answer 939

A myelocele indicates a defect involving the spinal cord

Question 940

What is Mesial temporal sclerosis characterized by?

Answer 940

Hippocampal volume loss with T2 bright gliosis/scar atrophy of ipsilateral fornix and maxillary body contralateral amygdala enlargement ## Footnote Results in seizures/epilepsy.

Question 941

What are the features of Intracranial hypotension?

Answer 941

Meningeal engorgement/enhancement dural venous sinus distention intracranial vessel prominence engorgement of pituitary subdural hematoma/hygroma

Question 942

What are the classic symptoms and appearance of Normal pressure hydrocephalus?

Answer 942

Wet, wacky, wobbly (urinary incontinence, ataxia, confusion) Ventricles out of proportion to atrophy, upward bowing of the corpus callosum.

Question 943

What is Pontine osmotic demyelination?

Answer 943

overcorrection of low sodium levels slurred speech, labile emotional response T2 bright central pons w peripheral sparing diffusion restriction of pons

Question 944

What does Thiamine B1 deficiency result in?

Answer 944

wenicke encephalopathy memory loss and confabulation/Korsakoff

Question 945

What is Marchiafava Bignami characterized by?

Answer 945

T2 bright acute demyelination of the corpus callosum sandwich sign preference for central fibers on sagittal imaging Chronic phase demonstrates thinned corpus callosum with cystic genu and splenium cavities

Question 946

What are the features of PRES (posterior reversible encephalopathy syndrome)?

Answer 946

Asymmetric cortical and subcortical white matter edema without diffusion restriction.

Question 947

What are the early and late features of Post radiation changes on imaging?

Answer 947

Early: T2 flair signal in periventricular white matter Late: mosaic pattern with sparing of U-fibers and corpus callosum.

Question 948

What criteria define Multiple sclerosis?

Answer 948

Separated in time and space perivascular pattern (periventricular and juxtacortical) involvement of the calloso-septal interface.

Question 949

What does MR spectroscopy reveal in Multiple sclerosis plaques?

Answer 949

Reduced NAA peaks within the plaques.

Question 950

What is a common appearance of active Multiple sclerosis plaques?

Answer 950

Restrict diffusion incomplete ring enhancing lesions.

Question 951

Who and what does Subcortical arteriosclerotic encephalopathy (SAE) primarily affect?

Answer 951

Old people with hypertension White matter disease of centrum semiovale, spares cortical U-fibers.

Question 952

What are the main features of Alzheimer’s dementia?

Answer 952

Amyloid cascade neurofibrillary tangle tauopathy Down syndrome

Question 953

What imaging findings are associated with Alzheimer’s dementia?

Answer 953

Hippocampal and temporal atrophy low uptake in posterior temporoparietal region on FDG PET.

Question 954

What characterizes Multiinfarct/vascular dementia?

Answer 954

Cortical and lacunar infarcts with brain atrophy scattered areas of decreased activity on FDG PET

Question 955

What is Lewy body dementia?

Answer 955

alpha synuclein and synucleinopathy Visual hallucinations, spontaneous parkinsonism, fluctuating alertness.

Question 956

What is the imaging finding in Lewy body dementia?

Answer 956

Decreased FDG uptake in lateral occipital cortex, sparing mid posterior cingulate gyrus (cingulate island sign)

Question 957

What are the clinical features of Frontotemporal dementia/Picks?

Answer 957

Compulsive and inappropriate behaviors low FDG uptake in frontal and temporal lobes

Question 958

Neurodegenerative disease with Extensive calcification of basal ganglia and thalami

Answer 958

Fahr disease

Question 959

Upper motor neuron loss.

Answer 959

ALS

Question 960

What imaging finding is characteristic of Huntington disease?

Answer 960

Caudate atrophy with convex enlarged frontal horns.

Question 961

What does Leigh disease involve?

Answer 961

Mitochondrial disorder with T2 lesions in brainstem, basal ganglia, cerebral peduncles, periaqueductal gray.

Question 962

What syndrome is MELAS ?

Answer 962

mitochondrial encephalomyopathy, lactic acidosis, seizures, strokes

Question 963

What is the I123 DAT scan finding in Parkinson's disease?

Answer 963

loss of normal comma shape

Question 964

Mickey mouse sign

Answer 964

PSP progressive supranuclear palsy tauopathy atrophy of tegmentum w sparing of tectum and peduncles

Question 965

What characterizes Wilson disease and what appearance?

Answer 965

Copper accumulation, Kayser Fleischer rings on slit lamp. T1 bright basal ganglia, and panda sign (T2 bright tegmentum w normal red nuclei and substantia nigra)

Question 966

What is the next step in adults with a solitary CNS mass?

Answer 966

Look for primary since likely to be metastasis.

Question 967

Where are metastases most likely located in the brain?

Answer 967

At grey-white junction.

Question 968

What does the PDOG mnemonic stand for in regards to cortically based masses?

Answer 968

Pleomorphic xanthoastrocytoma, Dysembryoplastic neuroepithelial tumor, Oligodendroglioma, Ganglioglioma.

Question 969

What is the appearance of Pleomorphic xanthoastrocytoma (PXA)?

Answer 969

Cyst with enhancing nodule and dural tail in temporal lobe.

Question 970

What is the imaging appearance of Dysembryoplastic neuroepithelial tumor (DNET)?

Answer 970

Bubbly T2 bright lesion with FLAIR rim in temporal lobe, no enhancement.

Question 971

What is the characteristic of Oligodendroglioma?

Answer 971

Astrocytoma expanding the cortex in frontal lobe with ribbon calcifications.

Question 972

What is the presentation of Desmoplastic infantile ganglioglioma?

Answer 972

Rapidly increasing head circumference < age 1, large cystic tumor involving cortex.

Question 973

What imaging finding is Zuckerguss icing enhancement associated with?

Answer 973

drop metastases medulloblastoma Breast cancer

Question 974

hummingbird sign

Answer 974

PSP progressive supranuclear palsy tauopathy midbrain volume loss w concave upper surface and sparing of pons

Question 975

what is the characteristic of ganglioglioma

Answer 975

cystic and solid with focal calcifications in temporal lobe

Question 976

rhabdoid tumor/atypical teratoma

Answer 976

infratentorial large heterogeneously enhancing mass w necrosis and calcs (vs medulloblastoma which is typically younger (age 2) and with calcs)

Question 977

Answer 977

hypothalamic hamartoma at the tuber cinereum (between mammillary bodies and optic chiasm precocious puberty and gelastic seizures

Question 978

MRI spectroscopy represents

Answer 978

Differences in resonance frequency choline: cell membrane turnover NAA: neuronal viability tumor with increased choline and decreased NAA necrosis with decreased choline meningioma with alanine

Question 979

what is the most common TORCH infection and when are they the most harmful

Answer 979

CMV: periventricular calcifications and thin ependymal enhancement; microgyria most harmful in the second trimester

Question 980

toxoplasmosis vs lymphoma

Answer 980

ring enhancing lesions toxo is thallium cold and does not restrict diffusion lymphoma is thallium hot and restricts diffusion

Question 981

what does swirl sign indicate

Answer 981

active bleeding central hypodense hyper acute blood surrounded by hyperdense acute clotted blood

Question 982

appearance of blood on MRI

Answer 982

IB, ID, BD, BB, DD (T1 and T2) hyperacute, acute, early subacute, late subacute, chronic

Question 983

what situations can pseudo subarachnoid hemorrhage be seen?

Answer 983

iffuse cerebral edema and compression of subarachnoid spaces iso anoxic brain injury like near drowning or hanging

Question 984

stroke enhancement timing and fogging

Answer 984

seen in 3 days, peaks at 3 weeks, resolves by 3 months fogging occurs 2-3 weeks post infarct when brain looks normal

Question 985

what does aspect score apply to

Answer 985

acute MCA stroke only

Question 986

MR perfusion for infarct core and penumbra

Answer 986

core: low CBV and CBF penumbra: high CBV and low CBF with high MTT

Question 987

CNS lesions w calcifications

Answer 987

Old Elephants Age Gracefully Oligodendroglioma Ependymoma Astrocytoma Ganglioglioma

Question 988

crescent sign intravascular

Answer 988

dissection represents T1 bright intramural hematoma

Question 989

watershed territory infarct in kid

Answer 989

suggest Moya moya nonatherosclerotic stenosis puff of smoke on angiogram

Question 990

anatomy of the ear

Answer 990

outer ear to tympanic membrane middle ear contains epitympanum, mesotympanum, and hypotympanum, with ossicles inner ear past round/oval windows, with vestibular apparatus and cochlea

Question 991

facial nerve enhancement

Answer 991

bells palsy, Lyme Ramsay hunt

Question 992

What skull lesion is characterized by a thickened and expanded skull in the sclerotic phase?

Answer 992

Pagets disease ## Footnote Involves both inner and outer tables of the skull.

Question 993

What skull lesion presents as ground glass appearance?

Answer 993

Fibrous dysplasia in individuals younger than 30 ## Footnote Favors the inner table of the skull.

Question 994

What is the primary arterial source for posterior epistaxis? and next step

Answer 994

Sphenopalatine artery-> embolization ## Footnote Terminal branch of the internal maxillary artery.

Question 995

What ducts are associated with sialolithiasis?

Answer 995

Wharton's duct in submandibular Stenson's canal in parotid gland

Question 996

What is the characteristic appearance of a keratogenic odontogenic tumor?

Answer 996

Multilocular keratocyst without cortical expansion ## Footnote Associated with Gorlin syndrome.

Question 997

What type of tumor is an ameloblastoma?

Answer 997

Locally aggressive multicystic tumor of the mandible

Question 998

What is sunburst pattern in the mandible?

Answer 998

osteosarcoma

Question 999

What condition is linked to osteonecrosis of the mandible?

Answer 999

Prior radiation, licking radium paint brush, or bisphosphonate treatment

Question 1000

What structures are found in the parotid space?

Answer 1000

Parotid gland, CN7 facial nerve, retromandibular vein

Question 1001

What is found in the carotid space?

Answer 1001

carotid artery, jugular vein, CN9, 10, 11, lymph nodes Paraganglioma, schwannoma, neurofibroma

Question 1002

What is the most common mass found in the masticator space?

Answer 1002

Odontogenic infection otherwise masticator muscles

Question 1003

What condition presents with diffusely enlarged parotid glands and bilateral mixed solid/cystic lesions?

Answer 1003

Benign lymphoepithelial disease

Question 1004

What is the difference between schwannoma and neurofibroma?

Answer 1004

Schwannoma: cystic & solid, hyperenhancing; NF2 Neurofibroma: T2 target sign (bright rim, dark middle); NF1 ## Footnote Schwannoma is associated with NF2, while neurofibroma is associated with NF1.

Question 1005

What can cause necrotic cervical lymph nodes? necrotic lymph nodes with calcifications

Answer 1005

Squamous cell carcinoma in adults can be infectious in kids thyroid carcinoma

Question 1006

Hoarseness with expanded ventricle on ipsilateral side

Answer 1006

vocal cord paralysis if on left, think recurrent laryngeal nerve

Question 1007

What is Coats disease characterized by?

Answer 1007

unilateral small globe WITHOUT CALCIFICATION Retinal telangiectasia leading to retinal detachment in young boys

Question 1008

What are the symptoms of metastatic neuroblastoma?

Answer 1008

Periorbital tumor infiltration with bilateral proptosis-> raccoon eyes involvement of sphenoid wing

Question 1009

What is the Graves thyroid orbitopathy? and order of involvement

Answer 1009

painless and spares myotendinous insertion, with enlargement of muscle belly IMSLO: inferior, middle, superior, lateral, oblique

Question 1010

What is tolosa hunt syndrome

Answer 1010

IgG4 disease involving the cavernous sinus -painful, multiple cranial nerve palsies

Question 1011

What separates the preseptal and postseptal space in the orbit? Intraconal vs extraconal?

Answer 1011

Orbital septum Preseptal infections: from adjacent structures, treated medically; Postseptal infections: from paranasal sinusitis, treated surgically Intraconal: space inside rectus muscle pyramid; extraconal: outside

Question 1012

What does optic nerve enhancement indicate if the nerve is enlarged? or isn't enlarged?

Answer 1012

Glioma (NF1) optic neuritis (devic disease)

Question 1013

What is a Schmorls node?

Answer 1013

Herniation of disc material into vertebral body endplate

Question 1014

What is the defining characteristic of Brown-Sequard syndrome?

Answer 1014

Hemi motor deficit and contralateral hemi sensory deficit

Question 1015

swollen and increased T2 of cord with serpentine flow voids along surface of cord?

Answer 1015

Dural AVF

Question 1016

What does bilateral symmetric increased T2 of dorsal columns indicate?

Answer 1016

HIV myelopathy or vitamin B12 deficiency (subacute combined degeneration)

Question 1017

Extramedullary intradural lesion with central necrosis or hemorrhage

Answer 1017

Schwannoma Solitary, dumbbell appearance t1 dark t2 bright, enhancing does not envelop nerve root

Question 1018

What is the significance of the aortic isthmus?

Answer 1018

It is the segment of the aorta between the left subclavian and ligamentum arteriosum most common area of traumatic pseudoaneurysm

Question 1019

What is the anatomical significance of the ductus bump?

Answer 1019

Contour bulge just distal to the isthmus, a normal structure

Question 1020

What branches does the superior mesenteric artery (SMA) give off?

Answer 1020

Inferior pancreaticoduodenal, middle colic, right colic, ileocolic, appendicular

Question 1021

What condition results in multiple wedged vertebral bodies leading to kyphosis in teens?

Answer 1021

Scheuermann's disease multilevel with associated schmorl's nodes

Question 1022

What distinguishes a herniation from a disc bulge?

Answer 1022

Herniation: >25% displacement; Disc bulge: <25% displacement

Question 1023

What is the typical imaging appearance of a vertebral hemangioma?

Answer 1023

T1 dark, T2 bright

Question 1024

What is a limbus vertebra?

Answer 1024

Result of herniated disc material between unfused apophysis and vertebral body (mimics fracture)

Question 1025

What is the classic appearance of a neurofibroma on imaging?

Answer 1025

T2 bright rim and central low signal, often enveloping the nerve root

Question 1026

skull lesions

Answer 1026

-Pagets: thickened expanded skull in sclerotic phase involving inner and outer table -Fibrous dysplasia: ground glass in younger than 30, favors inner table

Question 1027

what are Enthesioneuroblastomas and what do they appear as

Answer 1027

olfactory cells with dumbbell shape from waisting at cribiform plate Homogenous enhancement neural crest cells, octreotide positive

Question 1028

nasal epistaxis next step

Answer 1028

-anterior: involves kiesselbach plexus, -posterio:r involves sphenopalatine (terminal internal maxillary artery) artery-> embolization

Question 1029

sialolithiasis locations

Answer 1029

submandibular= Whartons duct parotid= stenson canal

Question 1030

Odontogenic infection is more common in what scenario?

Answer 1030

in extracted teeth vs intact tooth with abscess ## Footnote More common than in intact teeth with abscess.

Question 1031

Where do infections from anterior mandibular teeth spread? Where do infections from mandibular molars spread?

Answer 1031

Sublingual space (ABOVE mylohyoid muscle) Submandibular space (BELOW mylohyoid muscle) ## Footnote Above the mylohyoid muscle.

Question 1032

What is a periapical cyst?

Answer 1032

Odontogenic cyst at apex of tooth with border.

Question 1033

What is a dentigerous or follicular cyst?

Answer 1033

Cyst around crown of unerupted tooth.

Question 1034

Extramedullary intradural lesion with T2 bright rim and central low signal

Answer 1034

neurofibroma (target sign) -solitary or plexiform (bulky multilevel nerve enlargement pathognomonic for NF1) envelops nerve root

Question 1035

IMA branches?

Answer 1035

left colic, sigmoid branches, superior rectal

Question 1036

arc of riolan

Answer 1036

connects left colic from ima to middle colic on sma

Question 1037

where do ovarian arteries arise from

Answer 1037

anteromedial aorta and anastomose w uterine artery from internal iliac anterior branch

Question 1038

Periventricular Cystic changes in newborn=

Answer 1038

periventricular leukomalacia

Question 1039

T1 dark bone marrow=

Answer 1039

fatty marrow replacement= leukemia

Question 1040

t2 bright and enhancing nidus in posterior elements of spine

Answer 1040

osteoid osteoma/osteoblastoma

Question 1041

”onion bulb” nerve roots with diffuse thickening

Answer 1041

Chronic inflammatory demyelinating polyneuropathy (CIDP) w protracted weakness

Question 1042

orbital cystic structure which distends with valsalva

Answer 1042

-orbital varix: weakness in venous wall; most common cause of spontaneous hemorrhage -orbital lymphangioma: does NOT distend; venous and lymphatic malformation; infiltrative, multispatial (septal/conal), fluid fluid levels;

Question 1043

carotid cavernous fistula and types

Answer 1043

-pulsatile exophthalmos -direct: secondary to trauma -indirect: post menopausal women

Question 1044

dacrocryocystitis

Answer 1044

inflammation of lacrimal sac medially (NOT the gland laterally); well circumscribed rim enhancing lesion

Question 1045

drusen

Answer 1045

calcification/mineralization of optic disc

Question 1046

focal discontinuity of globe

Answer 1046

coloboma; failure of choroid fissure to close

Question 1047

normal conus medullar is terminates at

Answer 1047

Conus medullaris terminates around L1; think tethered cord if below L2/L3

Question 1048

osteophytes vs syndesmophytes

Answer 1048

-osteophytes: horizontal/claw like/oblique (in DJD & spondylosis) -syndesmophytes: thin, vertical, symmetric ossification of the annulus fibrosus (in ankylosing spondylitis with fusion of facets)

Question 1049

ossification of the anterior longitudinal ligament w/o significant disc disease

Answer 1049

DISH

Question 1050

disc impingment on spinal nerves

Answer 1050

-foraminal disc will impact the exiting nerve at that level -subarticular/central disc will impact the descending nerve exiting below that level

Question 1051

LP/myelogram indications:

Answer 1051

-advanced degen spondylosis, post surgical changes, fat, mri contraindication -don’t need to hold aspirin/nsaids

Question 1052

LP/myelogram contraindications

Answer 1052

-increased ICP or obstructed CSF flow, bleeding, contrast allergy

Question 1053

increased distance of lateral masses on odontoid view

Answer 1053

Jefferson fracture (axial loading on C1)

Question 1054

Orthotopic vs dystopic dens:

Answer 1054

orthotopic ossicle is located at odontoid tip while dystopic ossicle is fused to clivus

Question 1055

anterior arch-dens distance > 5mm

Answer 1055

Atlantoaxial instability: associated with down syndrome and juvenile RA

Question 1056

vessel through strait sign=

Answer 1056

vessel in ligamentum venosum fissure (likely replaced or accessory left hepatic artery) replaced left hepatic artery from left gastric artery

Question 1057

Collateral pathways:

Answer 1057

Celiac-> common hepatic-> GDA-> superior pancreaticoduodenal-> inferior PDA-> SMA Arc of riolan: SMA-> middle colic-> arc of riolan-> left colic-> IMA IMA-> superior rectal-> inferior rectal-> internal pudendal-> anterior division internal iliac

Question 1058

marginal artery of drummond

Answer 1058

along inner border of colon; terminal branches of SMA’s ileocolic, right and middle colic, and IMA’s left colic and sigmoid branches form continuous arterial circle (always present)

Question 1059

parapharyngeal space contains and is affected by:

Answer 1059

ball of fat with branches of trigeminal nerve -parotid mass pushes it medially -carotid mass pushes it anteriorly -mucosal mass pushes it laterally -masticator space mass pushes it posteromedially

Question 1060

enhancing T1 bright mass in back of eye, “collar button shaped”

Answer 1060

Melanoma: -most common intraocular lesion in adult -next step liver MRI for mets

Question 1061

disc herniation types and classification

Answer 1061

-protrusion: wider base than herniated disc -extrusion: neck narrower than herniated disc -sequestration: broken off disc fragment

Question 1062

post op spinal surgery enhancing lesion in operative bed

Answer 1062

-recurrent/residual disc: DOES NOT enhance -epidural fibrosis: scar enhances homogeneously

Question 1063

what is the anterior cord vs posterior cord responsible for

Answer 1063

Anterior cord: motor function and pain/temperature sensation Posterior cord: proprioception and vibration Anterior cord syndrome from flexion injuries can lead to immediate paralysis

Question 1064

Demyelinating disease in the cord imaging characteristics

Answer 1064

-MS: most common; short segment lesion with partial cord involvement -transverse myelitis: long segment, involving full transverse diameter of cord with swelling -NMO: long segment, involving full transverse diameter of cord with swelling; NMO IgG attacks periventricular aquaporin 4 channels -ADEM: post viral kid or YA, favor dorsal white matter, with brain lesions

Question 1065

thoracic outlet triangle of nerves and vessels Thoracic outlet syndrome:

Answer 1065

Anterior scalene, middle scalene, and first rib form triangle containing: -subclavian artery and brachial plexus -subclavian vein runs anterior to triangle compression of subclavian vessels through thoracic inlet, typically by anterior scalene muscle

Question 1066

Upper extremity artery anatomy

Answer 1066

subclavian artery-> axillary artery (at the first rib)-> brachial artery (at the inferior border of the teres MAJOR)-> ulnar and radial at the radial head

Question 1067

what supplies the superficial palmar arch

Answer 1067

ulnar larger and gives off the common interosseous artery radial supplies the deep arch

Question 1068

lower extremity artery anatomy

Answer 1068

External iliac artery-> common femoral (after giving off inferior epigastric)->deep and superficial femoral artery->popliteal-> anterior tibialis and tibioperoneal trunk-> peroneal and posterior tibialis

Question 1069

arteries at the ankle

Answer 1069

-anterior tibialis traverses interosseous membrane and terminates as dorsalis pedis -posterior tibialis is most medial artery, felt at medial malleolus

Question 1070

What is the response level for conscious/moderate sedation?

Answer 1070

Should respond briskly to verbal commands or light touch ## Footnote This indicates the level of sedation where the patient is still able to interact and respond appropriately.

Question 1071

What is the reversal agent for Versed/midazolam? for opioids?

Answer 1071

Flumazenil Narcan ## Footnote Flumazenil is used to reverse the effects of benzodiazepines like midazolam.

Question 1072

What is a contraindication for IVC filter placement?

Answer 1072

Total IVC thrombosis

Question 1073

What are the contraindications for fistulography?

Answer 1073

Right to left shunt, uncorrectable coagulopathy, fistula infection ## Footnote These conditions increase the risk of complications during the procedure.

Question 1074

What are the contraindications for TIPS?

Answer 1074

Right heart failure, severe encephalopathy, severely progressing liver failure ## Footnote These conditions indicate that the risks of the TIPS procedure outweigh the potential benefits.

Question 1075

Which procedures are contraindicated with uncorrectable coagulopathy?

Answer 1075

Fistulography, percutaneous transhepatic cholangiography, percutaneous nephrostomy NOT a contraindication to percutaneous biliary drainage/cholecystostomy ## Footnote Uncorrectable coagulopathy increases the risk of bleeding during these procedures.

Question 1076

What do duplicated SVC and IVC drain into what is duplicated IVC associated with

Answer 1076

SVC into coronary sinus IVC into left renal vein horseshoe kidney and cross fused renal ectopic

Question 1077

what is significance of circumaortic renal collar

Answer 1077

accessory left renal vein passes posterior to aorta

Question 1078

heterotaxy:

Answer 1078

right isomerism: asplenia, trilobed right lung, horseshoe adrenal left isomerism: polysplenia,

Question 1079

Azygos continuation of IVC

Answer 1079

absence of hepatic segment of IVC, azygos continues inferiorly to abdomen

Question 1080

what determines Type A vs Type B dissection

Answer 1080

based on relative position to left subclavian takeoff

Question 1081

-saccular morphology above diaphragm= -saccular morphology below diaphragm=

Answer 1081

penetrating ulcer septic/mycotic aneurysm from hematogenous seeding with saccular morphology

Question 1082

penetrating ulcer vs dissection

Answer 1082

penetrating ulcer: atheromatous plaque erodes through intima and forms hematoma in media dissection: hypertension results in intimal tear

Question 1083

which lumen is true vs false in dissection which contains left renal artery

Answer 1083

-false lumen: larger than true lumen; contains origin of left renal artery

Question 1084

static dissection vs dynamic dissection

Answer 1084

-static dissection flap: extends into feeding artery (treat by stenting) -dynamic dissection flap: dangles in front of artery (treat by fenestration)

Question 1085

pseudoaneurysm demonstrates what kind of flow at the neck

Answer 1085

to and fro

Question 1086

Answer 1086

Impending rupture: draped aorta sign and hyperdense crescent sign

Question 1087

what can cause pulmonary artery aneurysm

Answer 1087

swan ganz catheter, behcets, chronic PE, TB (called rasmussens aneurysm)

Question 1088

tulip bulb annuloaortic ectasia

Answer 1088

Marfan aortic valve insufficiency

Question 1089

Loeys dietz syndrome

Answer 1089

hypertelorism (frog eyes), bifid uvula or cleft palate, tortuous arteries (aortic rupture, vertebral arteries)

Question 1090

what is inflammatory aneurysm associated with

Answer 1090

young men, elevated ESR, smoking, associated with hydronephrosis or renal failure

Question 1091

figure 3 sign on CXR

Answer 1091

aortic coarctation

Question 1092

pseudocoarctation

Answer 1092

narrowing and kinking of aorta without pressure gradient, collaterals, or rib notching

Question 1093

chronic mesenteric ischemia

Answer 1093

food fear, crampy pain after eating; most common affects splenic flexture

Question 1094

acute mesenteric ischemia

Answer 1094

Arterial clot/thrombus: thin bowel wall without dilation Venous mesenteric ischemia: dilated bowel w wall thickening, fat stranding/ascites

Question 1095

nutcracker syndrome

Answer 1095

SMA compresses renal vein, affects gonadal vein vs SMA syndrome which compresses the duodenum

Question 1096

renal artery narrowing causes and differences

Answer 1096

Renal artery stenosis: atherosclerosis, narrowing at the ostium; medical treatment or can stent Fibromuscular dysplasia (FMD): stricturing and beading of artery; young white women, sparing ostium, NOT related to atherosclerosis Do not stent, can angioplasty

Question 1097

serpiginous structures in myometrium next step

Answer 1097

uterine AVM-> needs embolization can be acquired or congenital

Question 1098

painful bloody diarrhea, intussusception, massive skin edema overlying scrotum in child

Answer 1098

henoch schonlein Purpura

Question 1099

Churg strauss:

Answer 1099

necrotizing vasculitis eosinophilic lung disease and asthma eosinophilia + transient peripheral lung consolidation/ground glass

Question 1100

strawberry tongue, rash of palms and soles, sore throat in children

Answer 1100

Kawasaki

Question 1101

carotid artery doppler with stenosis

Answer 1101

prestenosis: decreased peak systolic velocity and diastolic flow stenosis: increased peak systolic velocity poststenosis: tarsus parvus

Question 1102

what does parvus tardus waveform in the unilateral carotid artery mean what about the bilateral carotid arteries

Answer 1102

upstream innominate stenosis aortic stenosis

Question 1103

what does reversal of diastolic flow in the bilateral carotid arteries mean what about loss of diastolic flow

Answer 1103

aortic regurgitation brain death

Question 1104

measuring catheter sizes gauge and french

Answer 1104

-Gauge: bigger number=smaller size -French: bigger number=bigger size; -3 French=1 mm -add 2 French to inner diameter for outer diameter

Question 1105

What is designated by outer diameter: What is designated by inner lumen diameter:

Answer 1105

-needles, wires, catheter, dilator -sheaths

Question 1106

IR instrument package labeling

Answer 1106

outer diameter (Fr), length (cm), inner diameter (in)

Question 1107

what size guidewires can an 18G and 19G needle accept? 21G micropuncture?

Answer 1107

0.038 and 0.035 in (fits in 4 Fr catheter) 0.018 in

Question 1108

IR vessel flow rates

Answer 1108

1-2 ml/s: bronchial artery, intercostal artery 4-8 ml/s: carotid, subclavian, IMA, renal, femoral, celiac, SMA 20-30 ml/s: aorta, arch, pulmonary artery, IVC

Question 1109

pseudoanuerysm treatment tree

Answer 1109

compression <2 cm thrombin (>2 cm) surgery (if thrombin fails, there is tissue breakdown/infection, or aneurysm neck too wide)

Question 1110

if you tilt II toward head and needle gets longer: if you tilt II toward head and needle gets shorter: if you tilt II toward feet and needle gets longer: if you til II toward feet and needle gets shorter:

Answer 1110

-deep -superficial -superficial -deep

Question 1111

IR fluoro II positioning based on target

Answer 1111

-typically ipsilateral to what you want to see, ie aorta-> LAO -iliac bifurcation is exception-> contralateral oblique (left iliac bifurcation-> RAO)

Question 1112

fibroid treatment based on location

Answer 1112

Submucosal: do the best with UAE Intracavitary: hysteroscopic resection Subserosal fibroid-> myomectomy Cervical: do not respond to UAE bc different blood supply

Question 1113

types of stents and their uses

Answer 1113

-self expandable stents for superficial locations that get compressed -balloon expandable for precise deployment -closed cell stent: every segment is connected; more radial force -open cell stent: some segments are open; less radial force, more flexible

Question 1114

if trying to cross tight stenosis and see spiral of wire

Answer 1114

dissection

Question 1115

endovascular stenting vs open repair

Answer 1115

Endovascular repair: less 30 day mortality but higher graft complications and reintervention same long term aneurysm related mortality

Question 1116

stent/graft patency staging

Answer 1116

Primary patency: patency of original graft without additional intervention Assisted primary patency: patency maintained by prophylactic measures/interventions Secondary patency: patency is lost but restored by second intervention

Question 1117

what is contraindicated in varicose vein treatment

Answer 1117

DVT bc need superficial veins

Question 1118

antegrade vs retrograde access

Answer 1118

based on direction of flow antegrade is further in flow direction retrograde is backwards in flow direction

Question 1119

indications for IVC filter placement

Answer 1119

-pts with DVT but contraindication to anticoagulation -pts on anticoagulation with known PE

Question 1120

pulmonary collection IR intervention

Answer 1120

drain pleural empyema do NOT drain lung abscess (risk of bronchopleural fistula)

Question 1121

What is intimal hyperplasia?

Answer 1121

Healing response to blood vessel wall damage leading to restenosis ## Footnote Intimal hyperplasia is a common response after vascular injury that can lead to narrowing of the vessel.

Question 1122

What is Polyarteritis nodosa (PAN) associated with?

Answer 1122

Men and hep B; renal, cardiac, and GI artery microaneurysms-> infarction (wedge-shaped renal infarct)

Question 1123

What are the primary organs affected by Microscopic polyangiitis?

Answer 1123

Kidney and lung, leading to pulmonary hemorrhage

Question 1124

What is the biggest risk factor for infectious aortitis?

Answer 1124

Atherosclerosis, seeding of plaques

Question 1125

What is Subclavian steal syndrome?

Answer 1125

Proximal left subclavian stenosis causing reversal of vertebral artery flow to distal subclavian ## Footnote Early steal waveform looks like a rabbit.

Question 1126

Where is the intraaortic balloon pump typically placed?

Answer 1126

Distal to left subclavian and proximal to renal arteries

Question 1127

When does the intraaortic balloon pump inflate?

Answer 1127

In early diastole, right after aortic valve closes, to displace maximum blood available (assisted peak on doppler)

Question 1128

What is the function of a Left Ventricular Assist Device (LVAD)? and what does doppler look like?

Answer 1128

Pumps blood from left ventricle to aorta Mostly flat, almost tardus parvus

Question 1129

What is a recurved catheter?

Answer 1129

A catheter with primary and secondary curves in opposite directions

Question 1130

What is a curved catheter?

Answer 1130

A catheter with primary and secondary curves in the same direction

Question 1131

What test is performed before radial access?

Answer 1131

Allen test

Question 1132

Is bedrest required after radial access compression?

Answer 1132

No

Question 1133

What is the protocol if there is an infection at the access site?

Answer 1133

No closure device should be used

Question 1134

What is primary stenting?

Answer 1134

Angioplasty first, stent after to prevent recoil

Question 1135

What is the purpose of anticoagulation after stenting?

Answer 1135

To avoid thrombosis after intimal injury ## Footnote Usually involves aspirin or clopidogrel for 1-3 months.

Question 1136

What do drug-eluting stents do?

Answer 1136

Retard intimal hyperplasia

Question 1137

What are particulate agents used in embolization?

Answer 1137

Gelfoams, blood clot, PVA particles (permanent)

Question 1138

What are mechanical agents used in embolization?

Answer 1138

Coil, amplatzer vascular plug

Question 1139

Why should coils not be used for bronchial artery embolization?

Answer 1139

They block reaccess and should not be used for things that may rebleed

Question 1140

What should be checked before IVC placement?

Answer 1140

angiogram run prior to IVC placement to assess IVC patent status, size, duplication, renal vein position

Question 1141

Where is the IVC typically placed?

Answer 1141

Infrarenal unless contraindicated by pregnancy (avoid compression), renal/gonadal vein clot, duplicated IVC (bilateral filter or suprarenal)

Question 1142

What is a contraindication to access for fistulogram?

Answer 1142

Infection

Question 1143

What is the access method for a fistulogram?

Answer 1143

Access the venous side (anterograde) and obstruct venous outflow to visualized the arterial side

Question 1144

What is the direction to access the right portal vein during TIPS?

Answer 1144

Turn anterior when in the right hepatic vein

Question 1145

What is Balloon occluded retrograde transverse obliteration (BRTO)?

Answer 1145

Scleroses gastric varices through gastrorenal shunt, driving blood into the liver

Question 1146

How does BRTO differ from TIPS?

Answer 1146

BRTO can worsen esophageal varices and ascites but improve hepatic encephalopathy; TIPS diverts blood around the liver; treats esophageal varices and ascites, but can result in worsening encephalopathy

Question 1147

What is the normal biliary ductal anatomy?

Answer 1147

Left hepatic duct (horizontal; supplies lobes 2 & 3) Right hepatic duct-> splits into anterior (vertical; supplies lobes 5 & 8) and posterior (horizontal; supplies lobes 6 & 7)

Question 1148

What is Chilaiditi syndrome?

Answer 1148

Bowel in front of liver, a relative contraindication for PTBD

Question 1149

What should be done if a patient experiences rigors after injection for PTBD?

Answer 1149

Evaluate for cholangitis

Question 1150

When is a transjugular liver biopsy indicated?

Answer 1150

Significant ascites, uncorrectable coagulopathy, and thrombocytopenia

Question 1151

how to biopsy a peripheral or subcapsular liver mass

Answer 1151

through normal liver tissue

Question 1152

What does mild shoulder pain post-liver biopsy indicate?

Answer 1152

normal but if prolonged >5 min may suggest Kehr sign bleeding; evaluate with ultrasound

Question 1153

What is TACE and its complications?

Answer 1153

trans arterial chemoembolization with hepatic arterial lipiodol High risk of biliary abscess sterile/chemical cholecystitis: when lipiodol is injected into the hepatic artery before the cystic artery takeoff

Question 1154

What are the differences between Microwave and Radio Frequency Ablation?

Answer 1154

Microwave is for bigger lesions, less ablation time, less affected by heat sink, does not need grounding pad

Question 1155

How does Cryoablation work?

Answer 1155

Thawing kills cancer cells, not the freezing

Question 1156

What is the most common source of upper GI bleed?

Answer 1156

Left gastric artery may be prophylactically embolized if no bleed is visualized

Question 1157

What is a Dieulafoy's lesion?

Answer 1157

Large subdural stomach artery which tears the wall and bleeds

Question 1158

What should be avoided during lung biopsy?

Answer 1158

Crossing fissures; lower lungs affected by respiratory motion

Question 1159

What is a risk associated with UAE?

Answer 1159

DVT/PE

Question 1160

What is post-embolization syndrome?

Answer 1160

Low grade fever <3 days after procedure

Question 1161

What characterizes pelvic congestion syndrome?

Answer 1161

Dilated ovarian and periuterine veins

Question 1162

What does aspirin do?

Answer 1162

Binds irreversibly to platelets

Question 1163

How is heparin monitored?

Answer 1163

By PTT and reversed by protamine sulfate

Question 1164

How is Coumadin/warfarin monitored?

Answer 1164

By INR and reversed by vitamin K or immediately by cryoprecipitate

Question 1165

What are the pre-IR procedure requirements?

Answer 1165

Correct INR <1.5, platelets >50,000, hold plavix/clopidogrel 5 days, no hold on aspirin

Question 1166

the shrinking breast

Answer 1166

sign of invasive lobular carcinoma

Question 1167

steps of localizing breast lesions

Answer 1167

On MLO draw line through lesion paralleling posterior nipple line; On frontal clockface draw line parallel to and above or below PNL (oriented from upper inner through nipple to lower outer) On CC view determine if medial or lateral and peripheral or central

Question 1168

rolled breast view is performed how

Answer 1168

Rolled view direction refers to top of breast superior lesions move in direction of rolling inferior lesions move the opposite direction

Question 1169

BIRADS classification for screening mammo

Answer 1169

-BIRADS 0: needs additional imaging (suspicious finding or technical issue) -BIRADS 1: negative -BIRADS 2: benign findings (cysts, lipoma, galactoceles, hamartoma, multiple well circumscribed similar BILATERAL masses, or unchanged previously worked up lesion)

Question 1170

BIRADS classification for diagnostic mammo

Answer 1170

-BIRADS 2: work up is benign -BIRADS 3: 2 year follow up, <2% chance of malignancy -BIRADS 4: 2-95% chance of malignancy, could be benign -BIRADS 5: >95% chance of malignancy, cannot accept benign result -BIRADS 6: biopsy proven cancer

Question 1171

Anterior mediastinal mass in kids Posterior mediastinal mass in kids

Answer 1171

-lymphoma -neuroblastoma

Question 1172

what descriptors are used for mammogram masses? for ultrasound masses?

Answer 1172

-shape, margin, density -shape, margin, orientation, echo pattern, posterior features

Question 1173

what descriptors are used for mass margins on mammogram? on ultrasound?

Answer 1173

(COMIS): circumscribed, obscured, microlobulated, indistinct, spiculated (CAMIS): circumscribed, angular, microlobulated, indistinct, spiculated

Question 1174

what do egg-shell calcifications indicate? if large? if multiple?

Answer 1174

-oil cyst/fat necrosis -macrocystica liponecrosis -steatocystoma multiplex

Question 1175

what do damaged RBC vs tagged RBCs target

Answer 1175

-spleen -heart (blood/bleeding and hemangioma)

Question 1176

Gallium 67 vs indium 111 WBC scan differences

Answer 1176

-Indium better at evaluating intraabdominal abscess -Gallium better at evaluating spine (osteo) and lungs

Question 1177

Tc99m WBC vs Indium 111 WBC

Answer 1177

-Tech 99m WBC: visualize renals and GI -Indium 111 WBC: localize to spleen

Question 1178

HMPAO vs Indium 111 WBC

Answer 1178

-HMPAO better at evaluating inflammatory bowel, children, and extremity osteomyelitis -In WBC better at evaluating fever of unknown origin

Question 1179

Inflammatory breast cancer/peau de orange:

Answer 1179

presents as hot swollen red breast -skin thickening without focal palpable mass -may improve but does not resolve with antibiotics (vs mastitis) -chemo/radiation prior to surgery

Question 1180

high risk breast lesions:

Answer 1180

-radial scar (complex sclerosing lesion): dense fibrosis around ducts w appearance of dark scar -atypical ductal hyperplasia: DCIS but <2 ducts involved-> excised -atypical lobular hyperplasia: excised -lobular carcinoma in situ: occult on mammogram -papilloma: intraductal mass lesion in subareolar region; causes bloody discharge; duct dilation on US

Question 1181

most suspicious breast discharge? non suspicious discharge?

Answer 1181

-spontaneous bloody discharge from single duct: suspicious for papilloma or DCIS -non milky non bloody discharge: fibrocystic change or ductal ectasia

Question 1182

describe characteristics of invasive ductal carcinoma on physical exam and MG

Answer 1182

-physical exam: hard, non mobile, painless mass -MG: high density irregular w spiculated or indistinct margins, w pleomorphic calcs

Question 1183

Multifocal breast cancer vs Multicentric breast cancer:

Answer 1183

-multiple primaries in same quadrant -multiple primaries in different quadrants

Question 1184

cardiac MRI first pass perfusion vs delayed gadolinium enhancement

Answer 1184

Microvascular obstruction: first pass perfusion Ischemia: delayed enhancement

Question 1185

T1 bright lesion of ventricle wall on cardiac MRI

Answer 1185

Arrhythmogenic right ventricular dysplasia fat within ventricle

Question 1186

cardiac MRI infarct appearance

Answer 1186

Acute MI: T2 bright edema Chronic MI: T2 dark fibrous scar

Question 1187

pericardial and pleural effusions

Answer 1187

Lupus

Question 1188

what kind of pulmonary association do Scleroderma and Sjogren's have

Answer 1188

NSIP dilated esophagus LIP (ground glass and cysts)

Question 1189

mediastinal lesions

Answer 1189

Normal thymus: homogeneous without mass effect Lymphoma: mass effect with SVC compression and lymph nodes Teratoma: calcs, fat, cystic Seminoma: lobulated bulky midline lesion Non seminoma germ cell tumor: necrosis and hemorrhage

Question 1190

mammoplasty and mastoplexy

Answer 1190

-swirled appearance of inferior breast related to keyhole incision -mammoplasty: reduce breast size -mastopexy: removal of skin

Question 1191

breast cancer staging

Answer 1191

-T1-3 based on size -T4 if invades chest wall, skin, or is inflammatory breast carcinoma (BC) -T4 excludes paget disease skin changes

Question 1192

breast cyst vs mass on US-> what steps

Answer 1192

try to aspirate lesion-> -if non bloody and lesion disappears-> toss fluid -if bloody and lesion disappears-> cytology -if purulent and lesion disappears-> microbiology culture -if fluid and lesion does NOT disappear-> core biopsy solid mass

Question 1193

what is the Mammography quality standards act (MQSA) and who governs it

Answer 1193

under FDA -recall rate should be less than 10% -required consumer complaint mechanism in mammo facilities -interpreting physician is responsible for quality control -phantom dose should be less than 3 mGy per image

Question 1194

What is injected in lymphangiography?

Answer 1194

ethiodol To opacify lymph vessels and nodes ## Footnote Ethiodol is a contrast agent used in imaging studies.

Question 1195

What is the structure of the breast anatomy at the level of the ducts?

Answer 1195

Terminal duct lobular unit -> lobules -> major duct -> lactiferous sinus ## Footnote This pathway is crucial for understanding breast milk production and drainage.

Question 1196

Where do most breast cancers originate?

Answer 1196

In the TDLU and upper outer quadrant ## Footnote This information is critical for screening and diagnostic imaging.

Question 1197

What imaging modality is most sensitive in lactating patients?

Answer 1197

Ultrasound ## Footnote Ultrasound can better visualize breast tissue changes during lactation.

Question 1198

What is a risk associated with biopsy of a lactating breast?

Answer 1198

Risk of milk fistula ## Footnote Milk fistula can complicate healing and require further management.

Question 1199

In MLO view, what happens to medial and lateral lesions on true lateral imaging?

Answer 1199

Medial lesions rise and lateral lesions sink ## Footnote This principle is important for accurate interpretation of mammographic images.

Question 1200

What is MRI background parenchymal enhancement identified on?

Answer 1200

Based on first post-contrast sequence ## Footnote This enhancement pattern can aid in differentiating between benign and malignant lesions.

Question 1201

What are dermal calcifications indicative of?

Answer 1201

Benign; stay in same place on both views ## Footnote Tangential views can help confirm their benign nature.

Question 1202

What is Pseudoangiomatous stromal hyperplasia (PASH)?

Answer 1202

Benign myofibroblastic hyperplastic process with big solid oval, well-defined borders ## Footnote PASH can mimic malignancy but is not cancerous.

Question 1203

What is Paget's disease of the breast associated with?

Answer 1203

DCIS; carcinoma in situ of nipple ## Footnote Skin changes and palpation findings are critical for diagnosis.

Question 1204

What is the purpose of pulmonary artery banding?

Answer 1204

To treat CHF or single ventricle iso pulmonary overcirculation due to left to right shunt ## Footnote This procedure manages blood flow and pressure in congenital heart defects.

Question 1205

What are the three types of arterial switch procedures?

Answer 1205

Jatene, Senning, Mustard ## Footnote These procedures are used for transposition of the great arteries.

Question 1206

What does the Fontan procedure do?

Answer 1206

Bypasses SVC to pulmonary artery ## Footnote This procedure is associated with specific cardiac conditions.

Question 1207

What is the association of right-sided total anomalous pulmonary venous return?

Answer 1207

Associated with ASD sinus venosis ## Footnote Understanding this association aids in diagnosis and management.

Question 1208

What does signal dropout on in and out of phase imaging indicate?

Answer 1208

Microscopic fat ## Footnote This finding can be relevant in characterizing certain lesions.

Question 1209

List causes of terminal ileitis.

Answer 1209

* Tuberculosis * Crohn's * Ulcerative colitis * Yersinia ## Footnote Differential diagnosis is essential for appropriate treatment.

Question 1210

When should a lymph node be biopsied?

Answer 1210

If thick cortex, loss of central fatty hilum, irregular margins ## Footnote These features suggest malignancy or significant pathology.

Question 1211

What does gold therapy indicate in lymph nodes?

Answer 1211

Dense calcifications within lymph node ## Footnote This is a characteristic finding in certain conditions.

Question 1212

What are the key imaging findings in DIP?

Answer 1212

* Apical emphysema * Basilar ground glass * Peripheral basilar reticulation ## Footnote These findings are associated with smoking and RB-ILD.

Question 1213

What are the characteristics of LAM?

Answer 1213

Thin wall cysts, even distribution ## Footnote LAM is often associated with tuberous sclerosis.

Question 1214

What is the imaging pattern of eosinophilic pneumonia?

Answer 1214

Reverse edema pattern peripherally with ground glass and consolidation ## Footnote This pattern helps differentiate it from other forms of pneumonia.

Question 1215

What is the difference between male breast anatomy and female breast anatomy?

Answer 1215

Male breast does not have ducts or lobules ## Footnote This difference influences the pathology that can occur in males.

Question 1216

What is nodular gynecomastia?

Answer 1216

Physiologic enlargement of epithelial & stromal elements, centered behind nipple ## Footnote It often presents with radiation.

Question 1217

What are the types of implant placement locations?

Answer 1217

* Subglandular/retromammary * Subpectoral/retropectoral ## Footnote Each placement has implications for imaging and complications.

Question 1218

How can saline implant rupture be detected?

Answer 1218

Can be seen on mammogram ## Footnote This is important for monitoring implant integrity.

Question 1219

What characterizes silicone implant rupture?

Answer 1219

Forms capsule around implant; extra or intra rupture ## Footnote Extracapsular rupture shows “snow storm” on ultrasound.

Question 1220

What are contraindications to breast-conserving therapy (BCT)?

Answer 1220

* Inflammatory cancer * Large cancer size * Multicentric cancer * Prior radiation therapy or contraindication to radiation therapy ## Footnote These factors influence treatment decisions.

Question 1221

What is the local recurrence rate of cancer with BCT therapy? local recurrence w/o radiation?

Answer 1221

6-8% 35% ## Footnote Without radiation, the local recurrence rate is 35%.

Question 1222

Close margins of mass/calcs to edge of tissue in breast cancer excision?

Answer 1222

concerning for incomplete excision ## Footnote This raises the suspicion of incomplete excision.

Question 1223

skin thickening and trabecular thickening post radiation?

Answer 1223

expected findings unless gets worse over time, c/f recurrent disease or inflammatory BC ## Footnote If these changes worsen over time, it may indicate recurrent disease.

Question 1224

What is secondary angiosarcoma after radiation therapy?

Answer 1224

Presents as red plaques or skin nodules with skin thickening (T2 bright) ## Footnote This condition can develop years after radiation treatment.

Question 1225

What is the most important predictor of survival in breast cancer?

Answer 1225

Axillary status ## Footnote This factor significantly influences prognosis.

Question 1226

What are the most common metastases to the breast?

Answer 1226

* Lymphoma * Melanoma ## Footnote Recognizing these can aid in diagnosis and treatment planning.

Question 1227

What is the most significant on MRI breast?

Answer 1227

Suspicious morphology trumps kinetics (spiculated=80% malignancy) ## Footnote This principle helps in assessing breast lesions.

Question 1228

What does the MRI breast enhancement curve look like?

Answer 1228

Initial upslope (slow, medium, rapid) followed by secondary curve (continued rise, plateau, or rapid washout) ## Footnote Different curves indicate varying levels of malignancy risk.

Question 1229

Which washout curve has the highest cancer risk?

Answer 1229

Rapid washout curve ## Footnote This finding necessitates further investigation.

Question 1230

What factors increase the risk of breast cancer related to estrogen exposure?

Answer 1230

* Early menarche * Late menopause * Late pregnancy * No pregnancy * Fat * Alcohol * Hormone replacement ## Footnote Screening recommendations may apply to transgender women.

Question 1231

What is the imaging recommendation for bilateral or unilateral cyclical breast pain?

Answer 1231

No imaging is appropriate ## Footnote Cyclical pain is common and typically benign.

Question 1232

What should be done for noncyclical breast pain?

Answer 1232

Ultrasound ## Footnote This helps evaluate potential underlying issues.

Question 1233

What is the imaging recommendation for newly diagnosed stage 1 breast cancer?

Answer 1233

No imaging is appropriate ## Footnote Initial management focuses on treatment rather than further imaging.

Question 1234

What is the imaging recommendation for gynecomastia/pseudogynecomastia?

Answer 1234

No imaging is appropriate ## Footnote Imaging is not routinely needed unless there is suspicion of cancer.

Question 1235

If there is concern for cancer in a male with gynecomastia, what imaging should be performed?

Answer 1235

Always get mammogram in addition to ultrasound ## Footnote Gynecomastia can mimic cancer on ultrasound.

Question 1236

What is the imaging recommendation for indeterminate breast palpation in patients under 25?

Answer 1236

Ultrasound ## Footnote Younger patients typically require less invasive evaluation.

Question 1237

What is the imaging recommendation for indeterminate breast palpation in patients over 25?

Answer 1237

Mammogram; if indeterminate, ultrasound ## Footnote This age group requires more thorough investigation.

Question 1238

What is the next step of breast palp with mammogram findings of lipoma?

Answer 1238

No ultrasound, no further imaging is appropriate ## Footnote Lipomas are generally benign and do not require additional imaging.

Question 1239

What is the procedure for stereotactic biopsy?

Answer 1239

Performed in compression; if breast compresses too small <20 mm, place wire localization for excisional biopsy ## Footnote This prevents negative stroke margin issues.

Question 1240

What are the requirements to read a mammogram?

Answer 1240

* Formal 3 months training * 60 hrs of education * Read 240 studies in last 2 years ## Footnote These standards ensure competency in mammogram interpretation.

Question 1241

What must be provided to the patient after reading a mammogram?

Answer 1241

Lay summary of mammogram within 30 days ## Footnote This is part of patient communication and care.

Question 1242

What are the daily QA requirements for mammography?

Answer 1242

* Processor QC * Darkroom cleanliness ## Footnote These checks are essential for maintaining imaging quality.

Question 1243

What are the weekly QA requirements for mammography?

Answer 1243

* Viewbox conditions * Phantom evaluation ## Footnote Regular assessments help ensure accurate imaging results.

Question 1244

What are the quarterly QA requirements for mammography?

Answer 1244

Repeat analysis ## Footnote This helps identify any long-term trends in imaging quality.

Question 1245

What are the semiannual QA requirements for mammography?

Answer 1245

* Compression test * Dark room fog * Screen film contrast ## Footnote These evaluations are crucial for patient safety and image clarity.

Question 1246

What is Wilms tumor characterized by?

Answer 1246

Solid tumor, acquired; grows like solid ball, invades vessels ## Footnote It is one of the most common kidney tumors in children.

Question 1247

presents with * Renal cysts and masses * Pancreatic cysts and masses * Adrenal masses

Answer 1247

von hippel lindau ## Footnote This genetic disorder has multiple tumor associations.

Question 1248

presents with * Renal cysts * AML * Lung cysts

Answer 1248

tuberous sclerosis ## Footnote Tuberous sclerosis is a genetic disorder that affects multiple organ systems.

Question 1249

presents with * Small calcified spleen * Bone infarcts * Gallstones

Answer 1249

sickle cell ## Footnote These findings can arise from vaso-occlusive crises.

Question 1250

presents with * Large spleen and liver * Extramedullary hematopoiesis * Bone infarcts

Answer 1250

gaucher ## Footnote Gaucher disease is a lysosomal storage disorder.

Question 1251

prsents with * Fatty pancreatic atrophy * Small bowel stool * Fatty liver

Answer 1251

cystic fibrosis ## Footnote These findings are due to pancreatic insufficiency.

Question 1252

presentation of * Renal and adrenal masses * Skin nodules * Scoliosis

Answer 1252

neurofibromatosis type 1 (NF1) ## Footnote NF1 is a genetic disorder characterized by skin and nervous system tumors.

Question 1253

presentation of * Liver vascular malformation * Bowel angiodysplasia * Lung AVM * Brain abscess

Answer 1253

hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu) ## Footnote This condition leads to abnormal blood vessel formation and bleeding risks.

Question 1254

tagged rbc scan with focal activity in liver

Answer 1254

hemangioma

Question 1255

granular opacities and low lung volumes

Answer 1255

surfactant deficient disease GBS pneumonia both in premies but GBS pneumonia with pleural effusion

Question 1256

cystic bubbly lucencies

Answer 1256

PIE (with pneumothorax) bronchopulmonary dysplasia both related to ventilator but BPD/CLD is chronic 3-4 weeks postnatal

Question 1257

ropy appearance with hyperinflation

Answer 1257

meconium aspiration post mature babies

Question 1258

transient tachypnea of the newborn

Answer 1258

coarse interstitial markings and fluid in fissures c section birth or maternal sedation

Question 1259

pulmonary hamartoma

Answer 1259

macroscopic fat in pulm nodule sometimes with dystrophic calcs no further follow up required

Question 1260

age of solid kidney tumors

Answer 1260

from birth: mesoblastic nephroma and nephroblastomatosis age 4: wills teenager: RCC and lymphoma

Question 1261

when should transplant be considered for HCC

Answer 1261

patients <65 yo with limited tumor burden

Question 1262

anatomy of cerebellum

Answer 1262

Question 1263

Answer 1263

elastofibroma dorsi

Question 1264

Answer 1264

column of bertin

Question 1265

Answer 1265

Paget disease associated with mickey mouse sign

Question 1266

what disease and associations?

Answer 1266

cleidocranial dysostosis complete or segmental absence of clavicles, wormian bones, and deficiency/absence of the pubic bodies

Question 1267

what is coarctation associated with

Answer 1267

bicuspid aortic valve (50-85%), posterior ductus arteriosus (66%), ventricular septal defect (33%), transposition of the great vessels, and Turner syndrome

Question 1268

Testicular microlithiasis is associated with

Answer 1268

germ cell tumor

Question 1269

well defined cortical based metaphyseal lesion

Answer 1269

NOF/fibrous cortical defect benign do not touch vertical orientation with thin rim

Question 1270

Answer 1270

Lipomatous hypertrophy of the interatrial septum (LHIAS): high signal T1 common incidental finding on imaging require no further work-up in an asymptomatic patient with a normal sinus rhythm

Question 1271

epiphyseal/apophyseal lesion in child

Answer 1271

chondroblastoma, LCH, aneurysmal bone cyst, or infection

Question 1272

germinal matrix hemorrhages

Answer 1272

1) subependymal only 2) ventricular extension 3) ventricular enlargement 4) intraparenchymal hemorrhage

Question 1273

hamstring attachment site

Answer 1273

Question 1274

what sign does this indicate what does the patient present with

Answer 1274

"signet ring sign"  of cystic bronchiectasis, in which the "ring" represents the dilated airway Chronic productive cough

Question 1275

Answer 1275

anterior to posterior: lingual tonsils palatine tonsils adenoids

Question 1276

Answer 1276

pes anserine bursitis

Question 1277

Answer 1277