Differential Diagnosis Flashcards
(308 cards)
1
Q
Nephrocalcinosis differential
A
Medullary sponge kidney
Renal tubular acidosis
HyperParathyroidism
TB - end stage (putty kidney)
2
Q
Sacral tumours
A
Chordoma
Plasmacytoma
3
Q
Diffusely sclerotic bone thickened trabecular markings
A
Paget’s
Fibrous dysplasia
SAPHO - hyperostosis
Thalassaemia
4
Q
Lytic bone mets?
A
Renal
Lung
Thyroid
Melanoma
Breast
5
Q
Differential for AVN in adults
A
Diabetes
Steroids
Sickle cell
6
Q
Miliary nodules?
A
TB
Varicella
Sarcoidosis
Thyroid
Ovarian
Renal
7
Q
Cavitating lung lesions
A
Infection:
Septic emboli, TB, Klebsiella,
Aspergillosis
Malignancy:
Squamous lung ca
Vascular:
Granulomatosis with polyangitis
LCH
8
Q
Distal ureteric stricture
A
Tb
Schistosomiasis
Congenital mega ureter
9
Q
Congenital multi cystic mass on CXR
A
CPAM - Can have connection to bronchial tree
Bronchogenic cyst - No communication with the bronchial tree
Pleuropulmonary blastoma - malignant
10
Q
Cerebral processes involving at least two lobes of the brain
A
Gliomatosis cerebri
Lymphoma
Encephalitis
11
Q
Interstitial lung disease and soft tissue calcification?
A
Scleroderma
Dermatomyositis
12
Q
Multifocal splenic lesions
A
TB
Lymphoma
Sarcoidosis
Siderosis (sickle cell)
13
Q
Differential for demyelinating lesions in the brain?
A
Multiple Sclerosis
ADEM - post infection
Progressive multifocal leukoencephalopathy - fronal and parietal lobes, AIDS related.
14
Q
Differential for eggshell calcification mediastinal lymph nodes?
A
Sarcoidosis
Silicosis
Pneumoconiosis
Healed TB / Lymphoma
15
Q
Differential for neonatal unilateral hyperinflated lung
A
Congenital lobar overinflation - associated with aberrant left pulmonary artery
Bronchial atresia - distal air trapping
Swyer James - post infective obliterative bronchiolitis
Pulmonary hypoplasia - contralateral lung smaller or missing
16
Q
Signs to look for to help you find a primary lesion if you find metastases?
A
Mastectomy
Surgical clips
Post radiation changes
Nephrectomy
17
Q
Differential for neonatal large multi cystic liver masses
A
Infantile hepatic hemangioma - benign, solid, normal AFP, often no treatment required
Mesenchymal hamartoma - benign, cystic, normal AFP, surgical resection
Hepatoblastoma - malignant, raised AFP, surgical resection +/- chemo
Hepatic abscess
18
Q
Neuroblastoma Vs Wilms?
A
Neuroblastoma
- Poorly marginated
- Calcification
- Bone metastasis
- Encases vessels
- Spinal canal extension
Wilms
- Well circumscribed
- No calc
- Lung metastasis
- Displaces vessels
19
Q
Differential for white out?
A
Collapse
Consolidation
Pleural effusion
Pneumonectomy
Combination of multiple
20
Q
Differential for enlarged pulmonary arteries
A
COPD
CTEPH
Chronic left heart failure
Becet disease
21
Q
Massive mediastinal lymph nodes compared to the size of the lung cancer. Diagnosis?
A
Small cell lung cancer
22
Q
Most common mets to bowel?
A
Melanoma
Breast
23
Q
Differential for necrotic lymph nodes?
A
TB
Lymphoma
Squamous cell cancer
24
Q
What are 5 types of choledochal cysts?
A
1 - focal dilatation of the CBD
2 - bile duct diverticulum
3 - dilation of CBD within the duodenal wall (choledochocele)
4 - focal intra and extra hepatic dilatation
5 - Carolis disease (intrahepatic only)
25
Differences between metabolic and metastatic superscan
Metastatic - axial skeleton and proximal limbs. More heterogeneous
Metabolic - axial skeleton, distal limbs, calvarium and mandible
26
Causes of metabolic superscan?
Hyperparathyroidism
Renal osteodystrophy
Osteopetrosis
27
Differential for soft tissue calcification?
Autoimmune - scleroderma, dermatomyositis
Trauma - myositis ossificans
Vascular - arterial calcification
Metabolic - CPPD
Malignancy - osteosarcoma
28
Fat containing renal lesions
AML
RCC
Oncocytoma
Wilms (Paeds)
29
What is Ying Yang sign mean for arterial Doppler?
Aneurysm
Sharp systolic upstroke as blood enters the aneurysm. Then sharp reversal of flow as blood leaves the aneurysm.
30
Difference between inguinal, femoral, and obturator hernia?
Inguinal Vs femoral - femoral remains lateral to the pubic tubercle and compresses the femoral vein
Obturator hernia goes through obturator canal
31
Differential for multiple testicular lesions?
Lymphoma
Sarcoidosis
Multifocal seminoma
Mets - prostate, penile
32
What shows uptake on ocreotide or gallium DOTATATE scan?
Neuroendocrine tumours:
- Carcinoid
- Paraganglioma
- Phaeochromocytoma
- Small cell lung cancer
33
Scan to look for Meckel's diverticulum?
Tc99m Pertecnitate scan
34
What are the abnormal oesophageal indentations?
Anterior - aberrant left pulmonary artery
Posterior - aberrant right subclavian artery
35
Diagnostic measurements for pyloric stenosis?
Pyloric length - >15mm
Transverse diameter - >12mm
Pyloric thickness - >3mm
36
Differential for double bubble sign on abdo film?
Duodenal web / atresia / stenosis,
Annular pancreas
Midgut volvulus
37
RDS Vs TTN Vs Meconium aspiration on neonatal CXR?
RDS - pre term, bilateral ground glass opacities, reduced lung volume
TTN - coarse interstitial marking, fluid in horizontal fissure. Resolves in 48hrs
Meconium aspiration - term, asymmetric "ropy" densities", increased lung volume
38
Duplex kidney pattern of insertion and pathology?
Upper pole insert lower and obstructs + ureterocele
Lower pole inserts higher and refluxes
39
Graf method for assement of DDH?
Grade 1 - Alpha angle >60⁰ (normal)
Grade 2 - Alpha angle <60, centered hip
Grade 3+4 - Alpha angle <60, decentered hip
40
Differential for lung mass with separate systemic arterial supply
AVM
Pulmonary sequestration
41
Differential for calcification on cranial USS?
Infection:
- Toxoplasmosis - random distribution
- Cytomegalovirus - periventricular distribution
Teratoma
Sturge Weber - curvilinear cortical calcification
42
Things to look for if you suspect NF1
SNAP
Skeletal displasias - look at bones
Neurofibromas - look at spine and soft tissues
Astrocytomas + optic tract gliomas- MR brain
Pheochromocytoma - MR Adrenal
43
Differential for cerebral calcification?
Vascular - AVM, Amyloid, Sturge Weber.
Infection - TORCH
Trauma - healed infarct, bleed or abscess
Tumour - meningioma, oligodendroglioma
44
Causes of colonic intussusception in adults?
Lipoma
Colorectal carcinoma
Polyps
45
Causes of intussusception in a child?
Peyers patches (lymph tissue)
Duplication cyst
Meckel diverticulum
46
Upper lobe pulmonary fibrosis differential?
STRAP C
Sarcoid
TB/ MAC
Radiation fibrosis
ABPA
Pneumoconiosis/silicosis (progressive massive fibrosis
Chronic hypersensitivity pneumonitis
47
Cardiac uptake on bone scan?
Cardiac amyloid
48
Causes of hook like osteophytes
Haemochromotosis
CPPD
49
Appearance of appendiceal pseudomyxoma peritonei
Tubular appendix with curvilinear calc
Loculated low attenuation fluid
Scalloped visceral surfaces
50
Causes of pseudodiverticulosis of the oesophagus?
-Reflux
-Candidiasis.
Cause strictures in 90% of cases
51
Posterior mediastinal massess?
Oesophagus
Aorta
Infection - Paraspinal abscess
Neural tumours:
- Schwannoma
- Neurofibroma
- Paraganglioma
Osteosarcoma
Lymphoma
Extramedullay haematopoesis
52
Causes of ribbon ribs?
NF1
Osteogenesis imperfecta
53
Causes of acro-osteolysis
Scleroderma
Psoriatic arthritis
Raynauds
54
Causes of pneumocephalus?
Trauma
Iatrogenic
Meningitis - sinusitis/mastoiditis
55
Middle mediastinal mass differential?
Lymphadenopathy
Pericardial cyst
Cardiac/aortic aneurysm
56
Causes of small bowel strictures?
Crohns
TB
Ischaemia
Radiotherapy
57
Causes of bilateral pneumothoraces?
Cystic lung diseases
- LAM/LCH
- TB, Klebsiella, Staph aureus
- PCP pneumonia
Osteosarcoma mets
58
Cystic lung disease differential?
LAM - female, thin walled cysts, tuberous sclerosis
LIP - lower lobe predominant, sjogrens,
LCH - bizarre cysts, nodules, smoker
Birt Hogg Dube - lung cysts, rcc, skin lesions
PCP - ground glass and small cysts (pneumatoceles), AIDS, no pleural effusions
59
Diffuse muscle oedema differential?
Polymyositis
Dermatomyositis (if skin involvement)
Pyomyositis if infective
60
Differential for bladder diverticulosis?
Bladder outflow obstruction
Neurogenic bladder
Posterior urethral valves
61
Management of tuberous sclerosis?
MDT approach with regular follow up with
MRI brain (tubors, SEGA, chiari malformation),
MRI kidneys (AML, oncocytoma)
Echocardiogram (Rhabdomyoma)
62
Management of osteoid osteoma?
Can do further imaging with CT or bone scan.
Radio frequency ablation.
63
Centrilobular ground glass nodules differential?
- Hypersensitivity pneumonitis
- RB-ILD (smokers)
- TB, Aspergillosis
64
Causes of PRES?
Severe hypertension
Drugs - Chemotherapy
Thrombotic thrombocytopenic purpura
65
Fleeting pulmonary opacities differential?
COP - Atoll sign
ABPA - asthma, finger in glove
Eosinophilic pneumonia - reverse bat wing sign.
66
Clival masses differential?
Chordoma - high T2
Chondrosarcoma - high T2 and calc
Plasmacytoma - low/intermediate T2
67
Features of chiari 2 malformation?
Tonsilar and torcular descent
Thinned corpus callosum
Tectal beaking
Myelomeningocele (spina bifida)
68
Corpus callosum lesions?
Tumours:
- Butterfly glioma
- Gliomatosis cerebri
- Lymphoma
Demyelination:
- MS
- NMO
- Machiafava Bignami
Congenital
- Agenesis of the corpus callosum
69
High FLAIR signal in lentiform nucleus differential?
Carbon monoxide poisoning - Globus pallidus (inner strip)
Methanol poisoning - Putamen (outer strip)
Wilsons disease, Huntington's disease - Lentiform and caudate
70
Ring enhancing lesions MRI brain differential?
Abscess - thin wall, lots of oedema, Double rim sign: outer low signal rim (fibrous capsule), inner high signal rim (enhancing capsule)
Tumour (mets, glioblastoma, lymphoma) - thick wall
Tumourfactive demyelination (MS, ADEM) - incomplete wall, little oedema
71
Glioblastomas and intestinal polyps?
Turcot syndrome
72
Cortical based neuro tumours differential?
P-DOG
Pleomorphic xanthoastrocytoma - supratentorial cyst with enhancing nodule
DNET - bright and bubble, do not enhance
Oligodendroglioma - cortical expansion, ribbon calc
Ganglioglioma - temporal lobe, teenagers, seizures, mixed solid cystic.
73
Intraventricular tumours?
MESS-C
Medulloblastoma - 4th vent roof, spinal mets
Ependymoma - 4th vent floor, blood+calc
Subependymoma - subependymal, adults
SEGA - subependymal, kids, tuberous sclerosis
Central neurocytoma - swiss cheese, calc
74
CP angle massess differential?
Vestibular scwannoma - NF2
Meningioma - dural tail
Epidermoid - avid restriction
Dermoid - contain fat
75
Pineal lesion differential?
GPPP
Germinoma - fat and calc
Pineoblastoma - Heterogenous, "exploded" calc, hydrocephalus
Pineocyteoma - homogenous
Pineal cyst
76
Common brain mets?
Lung
Renal
Breast
77
Suprasella lesions?
SATCHMOE
S - sarcoid
A - aneurysm
T - teratoma, TB
C - chordoma, craniopharyngioma, cleft cyst (rathke)
H - hypothalamic hamartoma/glioma
M - meningioma, metastases, myeloma
O - optic nerve glioma
E - Eosinphilic granuloma, epidermoid/dermoid
78
Aging blood on MRI
T1 signal only becomes high after a couple days
T2 only high immediately and then after a week
79
What are the intradural but extramedullary tumours?
No more spinal masses
Neurofibroma
Meningioma
Schwannoma
Metastases
80
Amyloid vs hypertensive micro haemorrhage?
Hypertensive micro-haemorrhage typically affects the basal ganglia.
Amyloid micro-haemorrhage spares the basal ganglia
81
Spinal ependymoma vs astrocytoma?
Ependymoma - centrally within cord, haemorrhage, adults, NF2
Astrocytoma - eccentric within cord, kids, NF1
82
Lung cancer staging?
T1 - 1-3cm
T2 - 3-5cm, trachea or pleura
T3 - 5-7cm, chest wall, pericardium
T4 - >7cm, carina, mediastinum, oesophagus, vessels, diaphragm, vertebra.
N0
N1- ipsilateral hilar
N2 - ipsilateral mediastinal
N3 - contralateral nodes
M0
M1a - tumour in contralateral lobe
M1b - single extrathoracic met
M1c - multiple extrathoracic mets
83
Features of malignant mesothelioma?
Pleural thickening extending to medial pleura
Fissural extension
Pleural thickeness >1cm
84
Anterior mediastinal masses?
TTTT
Terrible lymphoma
Thyroid
Thymoma - myasthenia gravis
Teratoma - fat containing
85
Congenital heart diseases CXR appearances?
Transposition - Egg on string
Tetralogy - Boot shaped heart
TAPVR - Snowman heart
Epstein anomaly - Box heart.
86
Modified PIOPED criteria for VQ scan?
High probability - Two or more large (>75% of segment) segmental defects
Low probability - Upto 3 small (<25% segment) subsegmenal defects
Intermediate - anything inbetween
87
What is Caplan syndrome?
RA and pneumoconiosis.
88
Groundglass opacification differential?
Acute:
- Viral infection, (PCP, HSV, CMV, peribronchovascular)
- Hypersensitivity pneumonitis (centrilobular gg nodules)
- ARDS, dependant gradient
- Goodpastures, ground glass to crazy paving
Chronic:
- ILD, (NSIP, UIP, RB-ILD)
89
Bronchiectasis differential?
Upper lobe:
- CF - upper lobe
- ABPA - asthma, finger in glove
- Mycobacterium avium complex - upper lobe, cavitating lesions
- Fibrosis - radiation, pneumoconiosis, chronic hypersensitivity
Lower lobe:
- Primary ciliary dyskinesia - lower lobe
90
What is this condition?
Bronchiectasis
Situs invertus
Sinusitis
Kartageners syndrome
91
Eisenmenger syndrome?
Uncorrected left to right shunt.
Chronic pulmonary hypertension.
Pressure reveral to right to left.
92
True vs false cardiac aneurysms?
True - broad neck, mural thrombus
False - rupture of myocardium but containd by pericardium.
93
Reverse batwing appearance differential?
Peripheral opacities sparing the perihilar region.
- Chronic eosinophilic pneumonia.
- Eosinophilic polyangitis
- COVID pneumonitis
- PCP pneumonia
- Organising pneumonia.
94
BTS solid nodule follow up guidelines?
>5mm - discharge.
5-6mm - 12 month CT
6-8mm - 3 month CT
>8mm
Brock model risk assess:
- low risk - 12 month CT
- high risk - PET CT
95
Rib notching differential?
Superior:
- Osteogenesis imperfecta
- Connective tissue (Marfan, scleroderma)
Inferior:
- Coarctation of aorta
- Neurofibroma
- Schwannoma
Both (Ribbon ribs)
- NF1
96
Most common metastases to oesophagus?
Bronchial - local
Breast - distant
97
Narrow tubular stomach differential?
Atrophic gastritis
Linitis plasica - nodular
98
What are the radiological features of haemochromatosis?
Hepatomegaly (90%)
CT - Increased liver density.
MR - Low liver signal on T2
Hook like osteophytes 2nd+3rd metacarpals. Chondrocalcinosis.
Restrictive cardiomyopathy
99
Associations with Sjogrens disease?
NSIP
LIP
Primary biliary cholangitis
Bilateral parotid cysts
100
Appearances of thalassaemia?
ThalaSSSSaemia
Skull:
- Skull hair on end appearance
- Sinus hypopneumatisation
Spine:
- Scoliosis
- Expansion of ribs, with rib within a rib appearance
Spleen:
- Splenomegaly
101
Classification of renal trauma?
AAST kidney score
Grade 1 - subcapsular haematoma without laceration
Grade 2 - superficial laceration <1cm, perirenal haematoma
Grade 3 - laceration >1cm, vascular injury/active bleeding
Grade 4 - laceration involving the collecting system
Grade 5 - shattered kidney
102
Classification of liver trauma?
AAST liver score
Grade 1 - <1cm
Grade 2 - 1-3cm
Grade 3 - >3cm, contained active bleed
Grade 4 - 25-75% of a lobe, bleed into peritoneum
Grade 5 - >75% of a lobe
103
Scimitar syndrome?
PAPVR
+
Pulmonary hypoplasia
104
Best imaging for carcinoid tumours?
Gallium DOTATATE PET
105
Large vessel vasculitides?
Giant cell arteritis - older than 50
Takayasu arteritis - younger than 50
Becets disease (not limited to large vessels) - aorta, SVC, pulmonary artery aneurysms
106
Medium vessel vasculitides?
Polyarteritis nodosa
Granulomatosis with polyangitis
Eosinophilic granulomatosis
107
What is RBC scan used to image?
GI bleeding
Splenosis
108
How are parathyroid adenomas imaged?
Tc99m Sestamibi - delayed phase
4d CT
109
What is PI-RADS score?
Use T2 to look at transitional zone.
Uncapsulated intermediate T2 signal is bad
Score can be upgraded with DWI
Use DWI to look at peripheral zone.
Avid restriction is bad.
Score can be upgraded with dynamic contrast enancment.
Dynamic contrast enhancment.
Enhancment earlier than normal prostate is bad.
110
Differntial for sacroiliitis?
Bilateral symettrical:
- Ank spond
- UC/Crohns
- Rheumatoid
Bilateral asymettrical:
- Psoriatic
- Osteoarthritis
Unilateral:
- Septic arthritis
111
Carney triad?
Extra adrenal phaeochromocytoma
GIST
Pulmonary chondroma
112
Common oesophageal pathology appearances on barium swallow?
Barretts - reticular mucosal pattern, caused by reflux
Pseudodiverticulosis - tiny outpouching and stricture, caused by reflux
Herpes oesophagitis - small ulcers with halo of oedema
Candidiasis - discrete plaques
Glycogenic acanthosis looks similar
113
Types of gastric volvulus
Organoaxial - gastric antrum lies below the fundus as normal. Twisted on the axis of the stomach.
Mesenteroaxial - Gastric antrum is at the level of the fundus. Stomach twists in half along the perpendicular axis.
114
Terminal ileitis differential?
Typhylitis - neutropaenic colitis
Inflammatory bowel disease - Crohns
Infectious - C.Diff, TB.
Ishaemic
Malingnacy - adenocarcinoma, lymphoma
115
Difference between FNH and Fibrolamellar HCC?
FNH scar is T2 bright and enhances.
Fibrolamellar HCC scar is T2 dark and does not enhance
116
How can you assess difference between FNH and Adenoma?
FNH - centrifugal enhancement (inside out)
Adenoma - centripetal fill in (outside in)
Primovist - delayed phase.
- FNH - mild enhancement compared to background liver.
- Adenoma - hypointense to background liver
Tc99m Sulfur Colloid:
- FNH - normal or increased uptake
- Adenoma - reduced uptake
HIDA:
- FNH - prompt hepatic uptake, delayed clearance
117
Imaging findings for cholangiocarcinoma?
Capsular retraction.
Dilated billiary ducts.
Delayed persistent enhancement.
118
What is pseudocirrhosis of liver?
Treated breat cancer mets to the liver
119
Primary biliary cholangitis imaging findings?
Lace like pattern of fibrosis
Periportal halo sign
Intrahepatic duct dilatation
Increased risk of HCC
120
Different types of pancreatic lesions?
Ductal adenocarcinoma - head of pancreas, blocks pancreatic duct
Serous cystadenoma - grandmother lesion, head of pancreas, bunch of grapes with central calc
Mucinous cystadenoma - mother lesion, body and tail of pancreas, uni/multi locular cyst peripheral calc
Solid pseudopapilliry tumour of pancreas - Daughter lesion, tail of pancreas, mixed solid cystic.
IPMN - main brain and side branch
121
What are the polyposis syndroms?
Familial adenomatous polyposis syndromes:
- Turcot - GI polyps + CNS tumours
- Gardners - GI polyps + Osteomas
Cowdens - GI polyps + Breast cancer
Peutz Jeghers - GI polyps + seminoma/adenoma malignum, skin pigmentation of fingers and toes
Juvenile polyposis - <20y.o, rectal bleeding, intusseception.
122
GI bleeding differential?
Vascular - AVM, angiodysplasia
Enterocolitis - infective, diverticulisis, UC, Crohns
Tumour - adenocarcinoma
Peptic ulcer disease
Meckels diverticulum
123
Benign causes of pneumatosis?
PSI
Pulmonary disease
Scelroderma
Inflammation
124
Pancreatic calcification differential?
Chronic pancreatitis
Pancreatic neoplasms - cystadenomas
Hyperparathyroidism
Hereditary pancreatitis
125
Stages of renal TB?
Early - papillary necrosis
Progressive - strictures and hydronephrosis
Late - thinned cortex, dystrophic calc (Putty kidney)
126
Diffuse oesophageal dilatation differential?
Upper
- stricture
- malignancy
- achalasia
Lower
- sclerodema, distal two thirds
127
Difference between omphalocele and gastroschisis?
Omphalocele surrounded by membrane Omphalocele can contain other organs
Gastroschisis is on the right of midline, only bowel
128
How do you assess haemangioma on multiphase contrast imaging?
Peripheral nodular discontinuous ehnancment with progressive centripetal fill in.
Matches the blood pool.
129
Hypervascular liver lesions?
Benign
- FNH
- Adenoma
- Haemangioma
Malignant
- HCC
- Mets
130
Hypo-vascular liver lesions?
Cyst
Cholangiocarcinoma - delayed phase enhancement due to fibrous tissue
131
T2 dark renal lesions?
1. Lipid poor AML
2. Haemorrhagic cyst
3. Papillary RCC
132
Bladder calc differential?
Chronic cystitis
Schistosomiasis
TB
Radiation
133
Difference between utricle cyst or mullerian duct cyst on urethrogram?
M is above P
Mullerian duct cyst can extend above the Prostate
Utricle cyst does not extend above the prostate.
134
How do you differentiate AD-PKD Vs AR-PKD
AD - round cysts distributed throughout the kidneys, occurs in adults
AR - tubular cysts sparing the cortex, occurs in kids
135
Posterior vertebral scalloping differential?
Intra dural spinal masses - neurofibromatosis, ependymoma, astrocytoma
Dural ectasia - Marfan's disease, ehlers danlos
Congenital - achondroplasia, osteogenesis imperfecta
136
Name some causes of anterior vertebral scalloping?
AAA
Lymphoma
Downs syndrome
137
Causes of Chondrocalcinosis?
C,C,Cs
Crystals - gout, pseuodogout (CPPD)
Cation - calcium, copper, iron
Cartilage degeneration - OA
138
Haemarthrosis differential?
Vitamin C deficiency
Trauma
Haemophylia
Tenosinvial giant cell tumour (PVNS)
139
Paediatric femoral head irregularity differential?
Juvenile Idiopathic artheritis
Perthes disease
Infection
140
Osteoid osteomas are considered osteoblastomas when over what size?
>2cm
141
Segond fracture vs arcuate sign?
Segond - Lateral tibeal plateau #, ACL rupture
Arcuate - Proximal fibular head #, PCL tear
142
Subacute combined degeneration of the cord differential?
Vit b12 dificiency - caused by Crohn's, PPIs, coeliac.
Demyelination - MS
Infection - Herpes myelitis
Inflammatory - sarcoid
143
DISI vs VISI?
DISI - lunate tilts dorsally, increased scapho/capito-lunate angle
VISI - lunate tilts volar, decreased scapho/capito-lunate angle
144
What is a perilunate dislocation and what is it associated with?
Associated with scaphoid fractures
145
What are the associated injuries for positive and negative ulnar variance?
Positive - Lunate degeneration (Ulnar impaction syndrome)
Negative - Lunate AVN (Kienbock disease)
146
What is a Barton fracture Vs reverse Barton
Intra articular fracture of the distal radius extending to the dorsal surface. With dorsal radial carpal dislocation.
Reverse Barton is to the volar surface.
147
Different C Spine fractures?
Clayshoverlers - hyperextention, fracture of spinous process
Chance - hyperflexion, anterior wedge # and fracture of posterior elements. Highly unstable
Jefferson fracture - C1 blowout, axial loading
Hangmans - Bilateral pars C2 #
148
What is Gamekeepers thumb?
Chronic avulsion fracture of the ulnar collateral ligament of the 1st MCP joint
Acute avulsion fracture is skiiers thumb.
Creates a Stener lesion if the abductor polisis muscle gets caught in the torn UCL.
149
Monteggia vs Galeazzi fracture?
GRUesome MURder
G: Galeazzi R: radius fracture U: ulna dislocation
M: Monteggia U: ulna fracture R: radial head dislocation
150
SALTER Harris fractures?
1 - Straight through physis
2 - Above (metaphyseal)
3 - Below (epiphyseal)
4 - Through (both metaphysis and epiphysis.
5 - Rammed
151
Name the attachments:
Illiac crest
ASIS
AIIS
Greater trochanter
Lesser trochanter
Ischial tuberosity
Pubic symphysis
Illiac crest - abdominal muscles
ASIS - Sartorius
AIIS - Rectus femoris
Greater trochanter - Gluteal muscles
Lesser trochanter - Illiopsoas
Ischial tuberosity - Hamstrings
Pubic symphysis - ADDuctors
152
What is a Masonneuve fracture?
Widened medial malleolus/medical malleolus fracture + proximal fibular fracture.
153
What other injury is associated with bilateral calcaneal fractures?
Bilateral"Lover's fractures" should prompt looking at the spine for burst fractures
154
Gibbous deformity differential?
Congenital:
- Achondroplasia
- Mucopolysaccharides
Aquired:
- Trauma
- Infection - pyogenic discitis, TB
155
Vertebra planar differential?
Trauma
LCH
Mets, myeloma, lymphoma
Osteomyelitis
156
What are the different bone lesions that can have multiple fluid-fluid levels?
Telangiectatic osteosarcoma
Aneurysmal bone cyst
Giant cell tumour
157
How to differentiate Osteosarcoma from Ewing's Sarcoma?
Ewing's:
- Diaphysis femur
- Rarely calcifies
- Onion skin periosteal reaction
- Mets to bones and lung
Osteosarcoma:
- Metaphysis distal femur
- Amorphous calcification
- Sun burst periosteal reaction
- Mets to bones and lung with pneumothorax
158
How to differentiate enchondroma from chondrosarcoma?
Chondrosarcoma:
Cause pain,
Cortical destruction/scalloping,
Typically >5cm in size.
159
What are the epiphyseal lesions?
CGI
Chondroblastoma - T2 low, <30yo
GCT - >30
Geode - degenerative disease
Infection - brodies abscess crosses physis
160
What are the lucent bone lesions?
F - Fibrous dysplasia
E - Enchondroma, eosinophilic granuloma
G - GCT
N - NOF
O - Osteoblastoma
M - Myeloma, metastases
A - ABC
S - Simple bone cyst
H - Hyperparathyroidism
I - Infection
C - Chondroblastoma
161
Polyostotic fibrous dysplasia syndromes?
MC Cune Albright - also gets Cafe au lait spots and precocious puberty + GI polyps and IMPN
Mazabraud - also gets soft tissue myxomas
162
What is the difference between Olliers and Maffucci syndrome?
Both are multiple Enchondromas
Maffucci also have haemangiomas and increased risk of chondrosarcoma
163
What is Undifferentiated Pleomorphic Sarcoma?
Malignant transformation of benign tumours
Pagets disease, fibrous dysplasia, GCT, enchondroma
164
Classic imaging findings of Synovial sarcoma?
Young people
Periphal limb (Knee/foot)
T2 "triple sign" - necrosis, soft tissue, calc
Bowl of grapes - blood, fluid fluid levels
165
What are the differences between RA and Psoriatic arthritis?
RA - symmetric, proximal (MCP), osteoporosis instead of bone proliferation.
PA - Asymettric, distal (IPJs), boneproliferation instead of osteoporosis (periostitis), enthesitis.
166
Classic imaging features of skeletal sarcoidosis?
Lace like honeycomb destruction of phalanges. Preservation of joint space
Lytic lesions in the skull and spine. Preservation of disc spaces
167
Classic imaging features of Rickets?
Fraying and cupping of the metaphyses.
Bowed legs with looser zones - pseudofracture of the compression side.
168
Primary myelofibrosis imaging findings?
Extramedullary haematopoesis
Splenomegally
Diffuse sclerotic bone
169
Diffuse sclerotic bone differential?
Osteopetrosis
Hyperparathyroidism/Renal osteodystrophy
Mets, myelofibrosis, mastocytosis
170
Rugger jersey spine differential?
Pagets disease
Osteopetrosis
Hyperparathyroidsm/renal osteodistrophy
171
Most common patella tumour?
Giant Cell Tumour >30yo
Chondroblastoma <30yo
172
Typical imaging features of a chondroblastoma?
Epiphyseal
Lucent
Narrow zone of transition
Cloud like with rings and arcs
T2 LOW - The only epiphyseal lesion that is NOT high T2 signal
173
Features of acromegally?
Skull and spine:
- Calvareal thickening
- Vertebral body fractures without loss of mineral density
Hand and feet:
- Spade like phalanx
- Heel pad thickness >25mm
174
Secondary complications of Pagets disease?
Conductive hearing loss - otosclerosis
Hydrocephalus - basilar invagination
Osteosarcoma - 1% of patients
175
Features of Rheumatoid Arthritis?
Hands, elbows, shoulder
Hands:
- marginal erosion MCP joints
- juxta-articular osteoporosis
Elbows/knees:
- Joint effusion
Shoulder:
- Erosion of distal clavicle
176
How do you differentiate between Morquio and Hurler syndrome?
Both are mucopolysaccharidoses (lysosomal storage disorder).
Both have platyspondyly.
Morquio has anterior CENTRAL vertebral body beaking.
Hurler has anterior INFERIOR vertebral body beaking.
Remember H comes before I (Hurler Inferior).
177
Types of tenosynovial giant cell tumour and most common joints affected.
Diffuse tenosynovial giant cell tumour (PVNS) - knee joint most affected
Localised tenosynovial giant cell tumour - fingers most affected
178
Dermatomyositis appearance and associations?
Sheet like calcification in soft tissues
Associated with interstial lung disease and generalised increase risk of malignancy
179
Different subtypes of femoro acetabular impingement syndrome?
Cam type - anterior superior bump on femoral neck causing impingement
Pincer type - over coverage of the femoral head by the acetabulum causing impingement. (Coxa profunda, or protrusion acetabulum are potential causes)
180
How can you differentiate coxa profunda and protrusio acetabuli?
Protrusio acetabuli - the femoral head projects beyond the ilioischial line (i.e. into the pelvis)
181
Unilateral testicular lesions differential?
Seminoma
Epidermoid - onion skin
Abscess
Adrenal rests
Metastases - retroperitoneal
182
Bilateral testicular lesions differential?
Lymphoma
TB
Sarcoidosis - testicular and epididymal masses
Multifocal seminoma
183
Ovarian mass, ascites, pleural effusion differential?
Meigs syndrome - Ovarian fibroma, Ascites, Pleural effusion.
Ovarian hyperstimulation syndrome - Theca lutein cysts, ascites, pleural effusion
184
What is Salpingitis Ithmica Nodosa (SIN)
Nodular scarring of the fallopian tube. Basically it's diverticulosis of the fallopian tubes secondary to inflammation/infection.
High association with infertility and ectopic pregnancy
185
What is Ashermans syndrome?
Intrauterine adhesions.
Secondary to prior surgery, infection, or pregnancy.
Clinically can result in infertility.
186
Classic imaging features of adenomyosis?
Thickening of the junctional zone >12mm
Can have high T2 signal in junctional zone or myometrium (cystic change)
187
How does endometrial cancer typically enhance?
Typically enhances less than the myometrium
188
Hyperechoic endometrial lesions?
Endometrial polyp -Single feeding vessel on Doppler
Blood clot
Retained prodeuct of pregnancy
189
What are the simple ovarian cyst follow up criteria?
Pre menopausal:
<3cm - normal
3-5cm - report presence, no follow up
>5cm - follow up in 3-12 months based on suspicion
Postmenopausal:
<1cm - normal
1-3cm - report presence, no follow up
>3cm - follow up in 3-12 months based on suspicion
190
Ovarian cystic mass differential?
Haemorrhagic cyst - lace like, no flow
Endometrioma - ground glass cyst
Teratoma - cyst with nodule (rokitansky)
Ovarian serous/mucinous tumours
191
Seminoma vs non seminoma USS findings
Seminoma - Hypoechoic, homogenous, microcalc
Non seminoma - Heterogenous with cystic spaces and calc (teratoma is differential)
192
Testicula tumours hormone markers?
bHG - Seminoma, Choriocarcinoma
AFP - Mixed germ cell, Yolk sac
193
Fibroid vs leiomyosarcoma MRI?
Fibroid- T1 + T2 dark, homogenous enhancment
Leimyosarcoma - same, but with central necrosis
194
Normal endometrial thickness in postmenopausal women vs tamoxifen thickness?
<4-5mm
Tamoxifen - 12mm
195
Cervical cancer staging, most important part?
FIGO staging
2a spread beyond the cervix, NO parametrial invasion - Surgery
2b spread beyond the cervix, WITH parametrial involvement - Chemo radiotherapy
196
Ring of fire ovarian lesion differential?
Ectopic - thick echogenic rim, ring of fire, separate from ovary
Corpus luteum - thin echogenic rim, ring of fire, moves with ovary
197
What are the causes of hydrosalpinx?
PID
Endometriosis
Torsion
Tubal cancer
Post hysterectomy
198
What is a peritoneal inclusion cyst?
Occurs when adhesions envelope an ovary.
Adhesions cannot absorb the normal secretions of the ovary and so they collect and form a cyst.
Risk factors include:
PID
Endometriosis
Surgery
199
What day of the hormone cycle is MRI and Mammography best performed?
Follicular phase - day 7-14
200
Benign vs malginant mammogram calcification?
Benign - popcorn (fibroadenoma), vascular, egg shell (oil cyst)
Malignant - pleomorphic, linear calc (DCIS)
201
Linear calc mammogram differenatial?
DCIS
Plasmacell mastitis
202
Indications for breast MRI?
Intralobular carcinoma - can be bilateral, difficult to see on mamogram
DCIS - see extent of disease
203
Renal artery aneurysm differential?
Fibromuscular dysplasia
Polyarteritis nodosa
Marfans, ehlers danlos
204
Classic triad of organ involvement for Granulomatosis with polyangitis?
Sinuses - sinusitis
Lungs - cavitating nodules
Kidneys - glomerulonephritis
205
Thyroid calcification differential
Microcalcification - papillary thyroid carcinoma
Coarse calcification - medullary thyroid carcinoma
206
BTA classification of thyroid nodules?
U1 - normal
U2 - benign - hyperechoic / ring down / microcystic
U3 - indeterminate - hypoechoic with equivocal echogenic foci (calc)
U4 - suspicuous - solid hypoechoic
U5 - malignant - solid hypoechoic, lobulated, with microcalc/macrocalc, taller than wide, vascularity, lymphadenopathy
207
Further investigation of U3-5 thyroid lesions?
FNA
MDT discussion
Repeat FNA in instances of thy1 (non-diagnostic), thy3a/thy3f (neoplasm possible) or thy4 (suspicious) results.
208
Midline neck mass differential?
Lymphadenopthy
Thyroglossal duct cyst
Thyroid/parathyroid lesion
Ranula
Cystic hygroma
Vascular malformation
209
Graves vs Hashimotos thyroiditis imaging appearances?
Graves - hyperthyroidism, thyroid inferno doppler, increased uptake on Tc99m pertechnetate
Hashimotos - HYPOthyroidism, heterogenous, giraffe skin, low on pertechnetate, high on PET
210
Medullary thyroid cancer associations?
MEN IIa and MENIIb
211
Antrochoanal polyp vs mucocele
Antrochoanal polyp
- Widening of the maxillary ostium and extention into nasopharynx,
- enlargment of sinus,
- no bony destruction
Mucocele
- Contained within maxillary sinus
- can have bony destruction
212
Inverted papiloma vs esthesioneuroblastoma
Cribiform plate lesions
Inverted papilloma - cerebreform appearance
Esthesio - dumbell shape, extends upwards towards brain.
213
Ranula vs plunging ranula
Ranula - sublingual mucous retention cyst
Plunging ranula - crosses the mylohyoid into the submandibular space
214
Parotid gland tumours?
Benign:
Pleomorphic adenoma
Warthin tumour
Malignant:
Mucoepidermoid
Adenoid cystic carcinoma
Lymphoma
215
Warthin vs Pleomorphic adenoma
Warthin has increased uptake on Tc99m Pertechnetate.
216
Bilateral parotid tumours?
Warthins
Lymphoma
(Sjogrens, HIV, sarcoidosis)
217
Where do mucoepidermoid and adenoid cystic carcinoma typically affect?
Minor salivary glands - the small and unnamed salivary glandular tissue scattered throughout the oral cavity
218
Masticator spaces malignancy/infection can spread to which other structures?
Cavernous sinus or orbital apex via the pterygopalatine fossa
219
What 4 spaces surround the parapharyngeal space?
Anterior - masticator space
Lateral - parotid space
Posterior - carotid space
Medial - superficial mucosal space
220
Necrotic retro pharyngeal lymph nodes suggest what pathology?
SCC metastatic nodal disease
Papillary thyroid carcinoma nodal disease
221
What Tolosa Hunt syndrome?
Cavernous sinus and orbital apex inflammation
222
Intraconal lesions?
Nerve:
Optic nerve glioma
Optic nerve meningioma
Vessels:
Cavernous haemangioma (AMV)
Orbital varix
Muscles:
Orbial pseudotumour
Globe:
Retinoblastoma
223
Extraconal lesions?
- Infection
- Osteoma
- Dermoid cyst
- Lacrimal gland lesions
- Capillary/cavernous haemangioma
224
Lacrimal gland lesions?
Benign - pleomorphic adenoma, dermoid cyst
Malignant - Adenoid cystic, mucoepidermoid, lymphoma
Inflammatory - sarcoid, sjogrens
225
What is the most common malignant orbital tumours in childhood?
Rhabdomyosarcoma
Retinoblastoma
226
Children with bilateral retinoblastomas are also at risk of which other tumours?
Trilateral renitoblastoma - Bilateral retinoblastoma and pineoblastoma
Quadrilateral retinoblastoma - Bilateral retinoblastoma, pineoblastoma, suprasella tumour.
Osteosarcoma
227
What order does thyroid eye disease affect the eye muscles?
IM SLO
Inferior
Medial
Superior
Lateral
Oblique
228
Vascular malformations of the eye differential?
Venous varix - increase size on straining
Cavernous haemangiomas - slow irregular enhancment
Carotocavernous fistula - pulsatile expothalmous
229
What is the most common cause of exophthalmos after a viral illness in children?
Orbital lymphangioma
230
Cholesteatoma vs cholesterol granuloma
Cholesteatoma - low T1, high T2, restricts
Granuloma - high T1, high T2, no restriction
231
Thing to assess when looking at cholesteatoma?
Oscicles
Scutum
Tegmen tympani
232
Classic imaging appearance of ameloblastoma?
"Soap bubble" appearance
Resorption of adjacent teeth
Avidly enhancing papillary projections are common
233
Age group of capillary Vs cavernous hemangiomas of the orbit?
Capillary hemangioma - child
Cavernous hemangioma - adults
(You take blood from children's capillaries)
234
Typical appearance of a cricopharyngeal bar?
Posterior oesophageal indentation at C5-C6.
235
Cavernous hemangioma MRI appearance?
T1 - iso to muscle
T2 - hyperintense to muscle, dark capsule
Gd - slow irregular enhancement
236
Papilliary necrosis differential?
Diabetes
TB - early phase
Sickle cell
237
How can you tell the difference between pleomorphic xanthoastrocytoma, pilocytic astrocytoma, and haemangioblastoma?
All 3 appear as cyst with enhancing nodule.
Pleomorphic xanthoastrocytoma - Supratentorial, in temporal lobe
Pilocytic astrocytoma - Posterior fossa in kids (NF1)
Haemangioblastoma - Posterior fossa in adults (VHL)
238
Posterior fossa masses?
4th ventricle tumours - ependymoma, medulloblastoma
Cyst with nondules - haemangioblastoma adult, pilocytic astrocytoma child
Brain stem gliomas
239
Pheochromocytomas are associated with what conditions?
NF1
MEN IIa + MEN IIb
VHL
240
Mosaic attenuation differential?
Air trapping - hypersensitivity, CF, MAI
Vascular occlusive disease - CTEPH
Parenchymal disease - ground glass (infection, haemorrhage)
241
Soft tissue sarcoma differential?
SLUR
Synovial sarcoma
Liposarcoma
Undifferentiated pleomorphic sarcoma
Rhabdomyosarcoma
242
Most common HIV related abscess in brain?
Toxoplasmosis
243
How to differentiate between CNS Toxoplasmosis Vs Lymphoma in HIV patients?
Toxoplasmosis - multiple lesions, peripheral haemorrhage, ring enhancement, restricted diffusion
Lymphoma - single lesion, no haemorrhage, solid enhancement, facilitated diffusion.
244
How does coarctation or aorta cause rib notching?
If the stenosis occurs distal to either subclavian artery, collateral pathways form via the internal mammary - intercostal artery - descending thoracic aorta, to supply the rest of body.
If the stenosis occurs between the subclavian arteries, then you get unilateral right sided collateral formation.
245
Types of breast cancer?
DCIS
Intraductal carcinoma
Intra lobular carcinoma
Phyloides tumour
246
Signal characteristics of endometrioma?
T1 high
T2 low (shading)
May have wall enhancement
247
Brain stem high signal?
Demyelination - MS, subacute combined degeneration, osmotic degeneration (alcoholics)
Brain stem stroke.
Infection - herpes myelitis
Syrinx
248
Adrenal tumours?
Adrenal cortical carcinoma - large heterogenous lesions
Phaechromocytoma - smaller heterogenous lesion
Adrenal myelolipoma - fat containing
Adenoma - small, <10 HU non-contast CT
249
Choroid plexus tumours?
Choroid plexus papilloma
Choroid plexus carcinoma
250
Types of osteochondromatosis?
Primary
Secondary - caused by degeneration
251
Tamoxifen endometrium changes?
Thickness upto 12mm
Sub endometrial cysts
Endometrial polyps
252
Calcified brain tumours differential?
Supratentorial - oligodendroglioma, ganglioglioma, cavernous haemangioma
Ventricular - ependymoma, subependymoma, central neurocytoma, choroid plexus papilloma
Pineal - pineoblastoma
253
Bilateral thalamic infarcts differential?
Cerebral vein thrombosis
Artery of Percheron infarct
254
H shaped vertebrae differential?
Sickle cell
Gaucher's
255
Calcified pulmonary metastasis differential?
Sarcomas - Osteosarcoma, chondrosarcoma
Mucinous - Ovarian/appendix
Medullary thyroid cancer
256
Pseudoarthrosis differential?
NF1
Fracture non union
Ehlers danlos
Osteogenesis imperfecta
257
Bowed leg differential?
Rickets
NF1
Osteogenesis imperfecta
Blount disease (Tibia vara)
258
Globe calcification differential?
Retinoblastoma
Choroidal osteoma (tuberous sclerosis)
Drusen
259
Klippel trenaunay syndrome triad?
Limb hypertrophy
Varicose veins/vascular malformations (GI bleeding)
Port wine naevi
260
Calcified adrenal glands differential?
Previous TB
Neuroblastoma
Haemorrhage
Wolman disease
261
Bilateral CPA angle masses differential?
Scwannoma - NF2
Sarcoidosis
Metastases
262
Non accidental injury skeletal survey protocol?
Chest with oblique rib views
Abdomen and pelvis
Whole spine view
Limb views
CT Head all children <1yo
CT Head children >1yo if suspicion of head injury
Repeat skeletal survey in two weeks:
Any suspicious areas
Chest with oblique rib views
Limb views
263
Non accidental injury highly suspicious injuries?
Posterior rib fractures
Metaphyseal corner fractures
Scapula
Spinous process
Sternal fracture
Subdural haematoma
Retinal haemorrhage
264
Neonatal bowel obstruction differential?
Proximal:
- Oesophageal atresia
- Duodenal atresia, stenosis, web
- Annual pancreas
- Malrotation
Distal:
- Hernia
- Ileal atresia
- Colonic atresia, stenosis
- Meconium ileus, plug syndrome (CYSTIC FIBRROSIS)
- Hirschprung disease
- NEC
265
Manifestations of cystic fibrosis?
ulmonary:
- Bronchiectasis
Abdominal:
- Pancreatitis
- Fatty replacement of pancreas
- Distal intestinal obstruction syndrome
- Meconium ileus/plug
266
Imaging findings of autoimmune pancreatitis?
Sausage shaped pancreas
Minimal peripancreatic fat stranding
Peripancreatic low attenuation halo
267
Management of lung cancer on CXR
CT Thorax and upper abdomen including liver and adrenals
Lung MDT discussion
MRI Brain
Biopsy, coaxial needle 16- 18 gauge
268
Lytic bone lesion management
Compare previous
Chest Xray if in the department or CT TAP
269
Well defined lung lesion with central calcification differential
Hamartoma
Lipoma
Carcinoid tumour
270
Benign narrow zone of transition bone tumour differential?
ABC / Simple bone cyst
Brown tumour
Chondroblastoma
Enchondroma/Eosinophilic granuloma
NOF
271
Wide zone of transition bone pathology differential?
Mets
Myeloma
Lymphoma
LCH
Osteosarcoma
Osteomyelitis
272
Rib lesion differential?
FAMES
Fibrous dysplasia
ABC
Mets/myeloma
Enchondroma/eosinophilic granuloma
Sarcoma
273
Management of suspected sarcoma Vs mets/myeloma?
Sarcoma:
- Refer sarcoma centre
- Don't biopsy
- Look for skip lesions (MR entire bone)
- Look for mets - CTTAP
Mets/myeloma:
- Oncology MDT
- Look for primary - CTTAP
- Myeloma screen
- Biopsy
274
Causes of perfusion defect Vs matched defect on VQ scan?
Perfusion - PE, Vasculitides
Matched - Asthma, pneumonia
275
How do you define recurrent UTI?
3 or more episodes of lower UTI
1 episode lower UTI + 1 pyelonephritis
2 episodes of pyelonephritis
276
Paediatric NICE guidlines UTI follow up imaging guidelines?
Younger than 6 month with recurrent or atypical UTI:
- USS
- DMSA
- MCUG
Between 6 months and 3 years
- DMSA
- MCUG only if hydronephrosis, NON Ecoli infection, or reduced urine flow
Over 3 years:
- DMSA with recurrent UTI
Perform the DSMA scan 4-6 months post UTI
277
Germinal matrix haemorrhage grading?
Grade 1 - confined to Germinal matrix
Grade 2 - extension into ventricles <50%
Grade 3 - extension into ventricles >50%, or dilated ventricles
Grade 4 - extension into venous infarction
278
Optic nerve glioma Vs optic nerve sheath meningioma?
Optic nerve glioma
- optic nerve thickening
- kinking and buckling of the optic nerve
- no calc
- variable enhancement
Optic nerve sheath meningioma
- nerve sheath thickening, sparing of nerve (tram track sign)
- calcification is common
- bright enhancement
279
Differential for Charcot joint
Diabetes
Syringomyelia
Spinal cord injury
MS
280
Batwing pulmonary opacification differential
Pulmonary oedema
Pneumonia
Pulmonary alveolar proteinosis
Pulmonary haemorrhage
281
Bowel ischaemia - things to review?
Pneumatosis
Portal veinous gas
Free gas
Free fluid
Arteries
Veins - venous ischaemia
282
Para-aortic mass encasing aorta differential?
Lymphoma
Neuroblastoma
Retroperitoneal fibrosis
Aortitis
283
UK breast screening programme?
All women aged 50 up to 71 are invited for breast screening every 3 years.
284
Non radiological tests for:
- TB
- Sarcoid
- Gout
- Rheumatoid
- Granulomatosis with poly angitis
- TB - Sputum sample, acid fast bacilli
- Sarcoid - Serum ACE
- Gout - Uric acid levels
- Rheumatoid - Anti CCP, rheumatoid factor
- GPA - cANCA
285
Omental cake differential?
Metastatic disease - ovarian, gastric, colon.
Pseudomyxoma peritonei
Lymphoma
TB
286
4th ventricle tumours, Ependymoma Vs Medulloblastoma
Both classically 4th ventricle tumours.
Ependymoma arises from the floor of 4th ventricle, squeezing out of it (toothpaste sign). Calc + haemorrhage - enhance heterogeneously.
Medulloblastoma arises from the roof of 4th ventricle, protruding into it. Enhance more homogenously.
287
What is Osler Weber Rendu syndrome?
Hereditary haemorrhagic telangiectasia. Autosomal dominant
Characterised by multiple AVMs.
Typically:
- Nasal 90%
- Skin 90%
- Liver 70-80%
288
What is a paraganglioma and what are its classical imaging appearances on MRI?
They are also called glomus tumours.
Neuroendocrine tumor.
Highly vascular, containing micro haemorrhages, causing salt and pepper appearance on MRI.
289
MRI signs for:
- multisystem atrophy
- Progressive supranuclear palsy
- Corticobasal degeneration
- Multisystem atrophy - hot cross bun sign, cruciate high T2 signal at the pons.
- Progressive supranuclear palsy - Mickey mouse sign, midbrain atrophy with sparing of the pedicles. Huming bird sign, flattening of the superior aspect of the midbrain.
- Corticobasal degeneration - asymmetric cortical atrophy, basal ganglia atrophy, and atrophy of the corpus callosum.
290
Acute stroke findings on MRI?
T2 bright
Restricted diffusion
ADC values pseudo-normalise as time progresses (~2 weeks)
291
Intramedullary spinal neoplasms?
Ependymoma (60%) - NF2
Astrocytoma (33%) - NF1
Haemangioblastoma (2%) - VHL
Ganglioglioma (1%)
292
Interstitial lung disease differential?
- UIP - Honey combing
- NSIP - ground glass with sub pleural sparing
- RA - UIP/NSIP pattern. Pleural thickening/effusion. Pneumoconiosis (Caplan).
- Ank spond - upper lobe fibrocystic disease
- Scleroderma - pneumonitis and fibrosis
293
How to differentiate HCC from Cholangiocarcinoma?
HCC invades the portal vein.
Cholangiocarcinoma encases the portal vein
294
Classic imaging features of Primary Sclerosing Cholangitis, and what is its association?
Multifocal strictures of the intra and extra hepatic bile ducts.
Cirrhosis with regenerative nodules.
Associated with UC.
295
Typical imaging features of chronic Budd Chiari syndrome?
Nutmeg liver - mottled contrast enhancment
Caudate lobe hypertrophy
Regenerative nodules
Ascites - Rapid onset
296
MRI findings for phaeochromocytoma?
T1 - low
T2 - high
Gd - heterogenous enhancement
Out of phase - no signal loss
297
Normal liver MRI appearance Vs spleen?
T1 - Liver > Spleen
T2 - Liver < Spleen
In/out - No change
298
Lymphoma staging:
Lugano classification:
Stage I - One node/group of node.
Stage 1e - One extra-lymphatic site only (i.e. hepatic lymphoma, small bowel lymphoma WITHOUT nodal disease)
Stage II - two nodal groups on SAME side of diaphragm
Stage IIe - extralymphatic spread from a node
Stage III - nodes both sides of the diaphragm
Stage IV - nodal and separate extra nodal disease/ multiple extra nodal disease
A - absence of symptoms
B - presence of symptoms
Bulky - Single nodal mass >10cm, or 1/3 of thoracic diameter
299
What is neonatal pulmonary interstitial emphysema?
Ventilator pressure associated.
Cystic / linear radio lucencies with hyperinflation.
Sign of impending pneumothorax.
300
Correct positions for UVC and UAC?
UVC - atriocaval junction
UAC - initially travels inferiorly, then turns superiorly, with tip ending at T7
301
How can you differentiate Pleuropulmonary blastoma from pulmonary Ewing's sarcoma?
Both present as massive thoracic masses.
Ewing's destroys ribs.
302
What are the 5 types of tracheosophageal fistula?
A - isolated esophageal atresia
B - proximal fistula with distal atresia
C - distal fistula with proximal atresia (85%)
D - proximal and distal fistula
E - H type, isolated fistula
303
What are the different diagnosis for short microcolon vs long microcolon?
Short microcolon - colonic atresia
Long microcolon - meconium ileus (CF patients), ileal atresia
304
What are the five grades for vesico ureteric reflux?
1- halfway up the ureter
2 - reflex into non-dilated collecting system
3 - reflex into dilated collecting system
4 - mildly tortuous ureter
5 - very tortuous ureter
305
Unilateral paediatric cystic kidney differential?
Muliloculated cystic nephroma
Multicystic dysplatic kidney - non functioning kidney on DSMA/MAG3
306
What is associated with CPAM?
Renal agenesis
Pleuropulmonary blastoma
Mucinous adenocarcinoma
307
What are:
Sequestrum
Involucrum
Sinus tract
Cloaca
Sequestrum - piece of necrotic bone surround by granulation tissue
Involucrum - thickened bone overlying chronic bone infection
Sinus tract - channel from bone to skin lined by granulation tissue
Cloaca - defect in the periosteum caused by infection
308
Paraganglioma differential?
Schwannoma
Lymphadenopathy
