Everything Else Flashcards

Question

Most common intramedullary spinal cord tumour in kids

Answer 1

Astrocytoma • 60% of paeds spinal tumours (2nd most common overall) • Peak age is 30 yrs • Longer (average length 4-7 vertebrae)

Answer 2

**Fibromatosis colli** Compartment syndrome > pressure necrosis > fibrosis of sternocleidomastoid Present at few weeks of age. May be little to see on US.

Answer 3

Meningioma

Answer 4

Prune belly syndrome A.k.a Eagle-Barrett syndrome Wrinkled/shrivelled abdomen - looks like a prune

Answer 5

Down’s syndrome Malrotation

Answer 6

**Deposition of fat** in multiple organs. **Hepatosplenomegaly** and **enlarged calcified adrenals**. Usually **fatal** with death in infancy.

Answer 7

Myxopapillary ependymoma Average age 35 yrs. Most common lumbar spinal tumour.

Answer 8

HSV encephalitis Stroke mimic but basal ganglia spared

Answer 9

**W** - Wilms tumour **A** - Aniridia (absence of iris) **G** - Genitourinary anomalies **R** - Retardation

Answer 10

• Left sided in 85% (Bochda-L-ek) • Posterolateral (Back-dalek) • Pulmonary hypoplasia

Answer 11

• **Right** sided 95% • Anterior • Rare

Answer 12

• Small **right sided defect** (~4cm) • _No_ surrounding membrane • Malrotated • Association with **raised AFP**

Answer 13

A.k.a. Exomphalos • **Midline** • **Larger defect** • **Covering membrane** (may be ascites) • **Liver herniation** more common • Association with **other anomalies** (Downs, Turners, Klinefelters, Beckwith-Wiedman and other issues) • **Worse prognosis**

Answer 14

Progressive multifocal leukoencephalopathy

Answer 15

Breast cancer Infiltrative retrobulbar mass. Enophthalmos is characteristic.

Answer 16

Ameloblastoma

Answer 17

**DENTIGEROUS CYST** • Cyst **encloses the crown** • Association with **ameloblastoma** and can become one

Answer 18

Post-viral or vaccination. Typically 1-2 weeks. Autoimmune demyelination that improves with steroids. Very difficult to differentiate from MS.

Answer 19

Posterior white matter + cerebellum + spinal cord Crabs are SLOW (posterior) and low (inferior)

Answer 20

Osmotic demylination syndrome/central pontine myelinolysis • Low density CROSSING MIDLINE • Restricted diffusion • High T2 trident shaped May also be **extrapontine** which can occur simultaneously or in isolation.

Answer 21

Neuromyelitis optica Longitudinally extensive spinal cord lesion with expansion from swelling.

Answer 22

**Arachnoiditis** Nerve roots adhere to dura. Can alternatively clump together mimicking a mass. **Iatrogenic** and **infectious** eg TB causes.

Answer 23

Wernicke’s encephalopathy

Answer 24

Canavan’s Gaucher’s disease Tay-Sachs disease

Answer 25

• Accumulation of fatty substance in **RETICULOENDOTHELIAL SYSTEM**. • **ERLENMEYER flask** deformity. • Diagnosed by **BONE MARROW ASPIRATE**. • Cause of **MASSIVE SPLENOMEGALY**. 95% have splenomegaly. • Anaemia, large joint stiffness and pain if symptomatic.

Answer 26

RCC (also expansile) Lung Cancer Thyroid Cancer Melanoma Breast Cancer (typically mixed) NHL

Answer 27

**Rickets** Also: Delayed fontanelle closure Poor epiphyseal mineralisation Bowing deformity

Answer 28

Pear shaped Communication with urethra Intraprostatic

Answer 29

**I’M SLow** Inferior rectus Medial rectus Superior rectus Lateral rectus **Tendinous insertions spared.**

Answer 30

**”Old Elephants Age Gracefully”** **O** - Oligodendroglioma **E** - Ependymoma **A** - Astrocytoma **G** - Glioblastoma (In order of **decreasing** incidence)

Answer 31

**CAFE SPOT** **C**: Café-au-lait spot (>6 in 1 yr) **A**: Axillary or inguinal freckling **F**: Fibromas (& FASI) **E**: Eye hamartomas (Lisch nodules) **S**: Skeletal abnormality eg sphenoid wing **P**: Positive family history **OT**: Optic Tumour F: **2 neurofibromas** or **1 plexiform neurofibroma**

Answer 32

Isthmus (Distal to left subclavian artery origin)

Answer 33

Löeffler’s syndrome (simple pulmonary eosinophilia)

Answer 34

• Cancer mimic in mediastinum. **Often calcified**. • **Compression or occlusion** of mediastinal structures eg SVCO. • Causes include: - TB - Histoplasmosis - IgG4

Answer 35

Pulmonary oedema

Answer 36

Metastatic osteosarcoma

Answer 37

**”Certain Cancers Spread By Plugging The Lymphatics”** **C** - cervix **C** - colon **S** - stomach **B** - breast (2nd) **P** - prostate and pancreas **T** - thyroid **L** - lung (1st) and larynx

Answer 38

**Sjögren’s** *for this reason LIP is more common in women as Sjögren’s is 9x more common in females *NSIP still most common pattern in Sjögren’s

Answer 39

Straddle injury

Answer 40

Pelvic fracture “U hurt ur **Pee Pee**”

Answer 41

Single muscle thickness >3mm Longitudinal length >14/15 Pyloric volume >1.5cm ³ *remember Pi (3.1415)

Answer 42

<200 Ground glass and cysts

Answer 43

29mm If 30 or above = PAH

Answer 44

Squamous cell carcinoma

Answer 45

Brock model Herder score takes into account FDG PET findings too

Answer 46

Central Retroareolar Flame shaped An ECCENTRIC position is highly suspicious for cancer.

Answer 47

Extension beyond Gerota’s fascia

Answer 48

Extension beyond kidney but WITHIN Gerota’s fascia: • T3a - renal vein • T3b - IVC below diaphragm • T3c - IVC above diaphragm or IVC wall

Answer 49

Invades perinephric fat or into adjacent organs

Answer 50

**Peyronie’s disease** Fibrous tissue plaques within **tunica albuginea** causing bent penis with painful erections

Answer 51

**Testicular torsion** High insertion of **tunica vaginalis** on spermatic cord. Predisposes to torsion. **Bilateral in 65-90%**.

Answer 52

• Compression of left renal vein between overlying SMA and aorta. • Haematuria and loin pain.

Answer 53

Temporal lobe lesion S is next to T

Answer 54

Parietal lobe IP

Answer 55

Triad of: 1. Otitis media 2. Retroorbital pain 3. Abducens (VI) nerve palsy - eye deviated medially

Answer 56

**“U DON’T want HIV”** • **U fibres spared** in HIV. Involved in PML. • **Cortical atrophy** in HIV. • HIV is **symmetrical**. PML asymmetrical.

Answer 57

**PRES** Failure of posterior circulation to auto-regulate with **acute changes in BP**. Extensive **cerebral oedema**. Sometimes **infarcts** or **haemorrhages**. *not always posterior or reversible

Answer 58

**Papillary** • Hypoechoic on US. Punctate calcification. Sometimes cystic. • Association with bowel polyposis syndromes.

Answer 59

Neurocysticercosis

Answer 60

Get To Fuck | Chinese Communist Party **G** - Gardner’s syndrome **T** - Turcot syndrome **F** - FAP ____________________________ **C** - Cowden’s syndrome **C** - Cronkhite-Canada syndrome **P** - Peutz-Jegher’s syndrome

Answer 61

50-70 *>70s can request screening every 3 years too **400-800** cancers detected for every cancer induced. **20% reduced mortality**.

Answer 62

Papillary necrosis

Answer 63

HIV on indinavir Antibiotics eg amoxicillin, cipro, nitro Allopurinol

Answer 64

Schistosoma haematobium affects urinary tract

Answer 65

• **Accreta** - villi **ATTACH** to myometrium • **Increta** - villi partially **INVADE** myometrium • **Percreta** - villi **PENETRATE** through beyond serosa A-I-P

Answer 66

Trisomy 18 (Edward’s syndrome)

Answer 67

Prostate - TCC Elsewhere - SCC

Answer 68

Congenital absence of the uterus and upper 2/3 vagina. BUT Normal ovaries and fallopian tubes

Answer 69

• Endometrial **polyps** (8-36%) • Endometrial **hyperplasia** (1-20%) • **Cystic endometrial atrophy** • **Endometriosis** (increased risk endometrial carcinoma)

Answer 70

**PREVALENT** **Screening starts at 50** so will be 50-53. **Incident** is any subsequent screening.

Answer 71

**_Serous_** • Most common malignant ovarian mass • More likely **bilateral** • **Peritoneal carcinomatosis** **_Mucinous_** • More likely **unilateral** & multiloculated. • **Stained glass** appearance from varying mucin content of cysts. • **Pseudomyxoma peritonei** • Can rupture

Answer 72

NM study for **bile salt malabsorption••. Used in investigation of diarrhoea.

Answer 73

PPP | Pi-Par-Panc Pituitary adenoma Parathyroid adenoma/hyperplasia Pancreatic neuroendocrine tumour

Answer 74

PPM Phaeochromocytoma Parathyroid hyperplasia Medullary thyroid cancer

Answer 75

**PMMM** Phaeochromocytoma Medullary thyroid cancer Marfanoid habitus Mucosal neuromas/ganglioneuromas

Answer 76

Riedel thyroiditis

Answer 77

**UU** | **IR** **_Upper moiety_** - UU / UI • **Ureterocoele** and **obstruction**. • Ectopic insertion of ureter medial and inferiorly. Upper pole - **inferior** insertion. **_Inferior moiety_** - IR • **Reflux** • Normal insertion

Answer 78

**_SCC_** • Associated with **HPV** • Enhances but less so than corpus cavernosum & spongiosum

Answer 79

**MISME** Multiple Inherited Schwannomas, Meningiomas and Ependymomas

Answer 80

>7mm diameter

Answer 81

**Ascariasis** Intestinal worms with **central alimentary tract**. Will ingest barium. **Tapeworms** are much longer and have **no alimentary tract** so cannot ingest barium.

Answer 82

**UFO** **Up** - Caudal to cranial **Forwards** - Posterior to anterior **Outwards** - Deep to superficial *completes at ~9 months

Answer 83

>5.5cm inner to inner Refer to vascular. >3cm is abnormal.

Answer 84

**>5.5cm** inner to inner Refer to vascular. **>3cm** is abnormal. If grown by >1cm in 1 yr may also intervene.

Answer 85

• **Subperiosteal haematoma** of the outer skull following **birth trauma**. • **Cannot cross sutures** - this distinguishes them from subgaleal haematoma.

Answer 86

**Internal maxillary artery** - branch of ECA

Answer 87

2nd branchial cleft cyst

Answer 88

**”T10 to L3 - gets a _NO_ from me!!”** • May be placed high or low as long as **not around abdominal aorta branches**. • **Dips down** into pelvis through umbilical artery -> internal iliac.

Answer 89

**”T8 or T9? Everything’s FINE!”** • Umbilical vein -> left portal vein -> ductus venosus -> hepatic vein -> IVC • Tip at junction of IVC and RA. • Thrombus and liver injury possible.

Answer 90

Width 8HU / Centred at 32 HU Sensitivity increases from 57% to 71% compared to normal window setting.

Answer 91

1. Medial temporal sclerosis (70%) 2. Ganglioglioma (most common tumour)

Answer 92

Meningioma

Answer 93

**Pericallosal** Associated with corpus callosum agenesis.

Answer 94

**Cubital tunnel syndrome** Seen in **throwing sports**, tennis, volleyball.

Answer 95

**MÉNÉTRIER’S DISEASE** • Present with symptoms of **gastritis** and **oedema**. • **”GIANT rugal folds.”**

Answer 96

Intra-orbital retrobulbar segment

Answer 97

**Cardiac Amyloid** Systemic process involving **ALL 4 chambers**. Most common cause of **RESTRICTIVE** cardiomyopathy.

Answer 98

Cervical spine *usually <2 vertebral lengths *MS in spine usually peripheral

Answer 99

**Type I** (80-90%) **Fusiform dilatation** of **extrahepatic bile duct**. Theorised result of reflux of pancreatic secretions. Pts may present with jaundice and palpable mass.

Answer 100

**Diverticulum** D = Duo = Type II 3% of bile duct cysts. Saccular outpouching.

Answer 101

**Type III** choledochal cyst (~5%). Protrusion of a dilated distal CBD into the **duodenum**. May be repaired by **ERCP or surgery** if severe.

Answer 102

**MULTIPLE** intra **AND** extrahepatic cysts. **2nd most common** ~10%. Type V ONLY intrahepatic (Caroli disease). Will have cystic renal disease too.

Answer 103

II if <3cm / IIF if >3cm

Answer 104

Leak through defect in graft wall. May be fracture or small hole.

Answer 105

Sparing of posterior wall = condition which is confined to the cartilage **_Relapsing polychondritis_** - smooth thickening - dense tracheal cartilage calcification **_Tracheobronchopathia osteochondroplastica_** - irregular and nodular thickening - often calcified nodules Both cause **SUBGLOTTIC STENOSIS**

Answer 106

• Post-intubation stenosis - focal, HOURGLASS shaped • GPA - may cause ULCERS • Tracheobronchial amyloidosis - circumferential CALCIFICATION, focal or diffuse

Answer 107

• Amiodarone - basal distribution, high density • Ritalin lung - talcosis • Nitrofurantoin - UIP/NSIP/OP/HP • Methotrexate - NSIP • Adalimumab and other immunomodulators • Chemotherapy

Answer 108

NSIP RA is UIP

Answer 109

• Right sided aortic arch (1 in 4) • ASD/PDA • Coronary artery anomalies • Chromosomal anomalies eg Downs, DiGeorge, Alagille syndromes

Answer 110

Rule of 3s 3 attempts each lasting 3 mins. Less likely to be successful if <3 months. 120mmHg max pressure.

Answer 111

**Type C (85%)** Proximal oesophageal atresia with distal fistula from airway to distal oesophageal segment.

Answer 112

Hypoattenuating Can mimic air with dry pine as low as -600HU. More water increases attenuation. Look for geometric shape.

Answer 113

1. Uncooperative 2. Extrahepatic biliary dilatation (relative) 3. Bacterial cholangitis (relative) 4. Abnormal coagulation INR >1.5 5. Thrombocytopenia <60 Plts 6. Ascites 7. Cystic lesion

Answer 114

**Schistosomiasis** **Dystrophic calcification** within **polygonal** network of fibrous septa. Pathognomic for *Japonicum* and *Mansoni* types.

Answer 115

1. Wilm’s tumour 2. Male pseudohermaphroditism 3. Progressive glomerulonephritis

Answer 116

**Type A (8%)** “A is for Atresia” Isolated atresia. No fistula.

Answer 117

C - coloboma (may be visual impairment) H - heart defects A - atresia choanae (nasopharynx) R - retarded growth and development G - genital hypoplasia E - ear abnormalities/deafness eg semicircular canal dysplasia/aplasia

Answer 118

Locate INFERIOR EPIGASTRIC artery • DIRECT is MEDIAL to it. Passes through defect in Hesselbach’s triangle. • INDIRECT is LATERAL to it. Passes through deep inguinal ring and down inguinal canal.

Answer 119

To look for STENER lesion. Will not heal without surgery.

Answer 120

Cortical laminar necrosis. Seen as early as 3-5 days but often ~2 weeks later. Usually resolves by 3 months. Possible due to lipid laden macrophages.

Answer 121

Right atrium

Answer 122

• Sickle cell - autosplenectomy (infarcts) • Polysplenia (multiple small spleens) • Traumatic fragmentation • Wandering spleen (wrong place)

Answer 123

Alexander disease *A is at the start of the alphabet*

Answer 124

X linked adrenoleukodystrophy *X at the back of the alphabet*

Answer 125

Reduces **anisotropy artefacts** as needle **more perpendicular** to beam so easier to see.

Answer 126

• Simultaneous renal transplantation (78%) • Curative T1DM treatment • Usually grafted to external iliac vessels

Answer 127

Hepatic adenoma *subcapsular haematoma suggest haemorrhage or rupture

Answer 128

Antegrade = with the flow = down the leg Retrograde = against the flow = up the leg - used for iliac/aortic intervention

Answer 129

High flow oxygen and left lateral positioning to keep air in right atrium.

Answer 130

Infrarenal *exceptions may include: • Pregnancy (avoids compression) • Renal/gonadal vein clot (above clot) • Duplicated IVCs

Answer 131

**Pachydermoperiostosis** Self limiting condition that requires no treatment. Autosomal dominant inheritance.

Answer 132

• >25mm • Portal hypertension • Female of child bearing age with pseudoaneurysm (risk of rupture during pregnancy) * coil embolisation usual Rx

Answer 133

**PEG** **P** - pulmonary chondroma **E** - extra-adrenal paraganglioma **G** - GIST * "T" in GIST = Triad

Answer 134

**SEEPS** **S** - subdural hygromas > haemorrhage **E** - enhancement of pachymeninges **E** - engorgement of venous sinuses **P** - pituitary hyperaemia & enlargement **S** - sagging brain - midbrain & tonsils Other clues: • **Postural/orthstatic headache** which improves lying down (opposite to intracranial hypertension) • **CSF leak** - lumbar puncture, trauma eg from sharp osteophyte, CSF/venous fistula, meningeal diverticulum • Distended **rounded venous sinuses** • **Layer cake skull** (hyperostosis)

Answer 135

• Football sign • Falciform ligament • Lucency over liver • Continuous diaphragm sign • Rigler’s sign • Triangular gas *can do lateral shoot through/lateral decubitus

Answer 136

**Intralipid** **Propofol** **Benzodiazepines** *want to give drugs that lower seizure threshold and lipid emulsion to bind free circulating lidocaine *cardiovascular toxicity eg arrhythmias

Answer 137

Intralipid Propofol Benzodiazepines *want to give drugs that **lower seizure threshold** and lipid emulsion to **bind free circulating lidocaine** *cardiovascular toxicity eg arrhythmias

Answer 138

2% of population 2 inches long 2 ft from IC valve (antimesenteric border) *40% contain gastric mucosa - Tc pertechnetate scan

Answer 139

Recent ACS Uncontrolled HF Arrhythmia Myasthenia gravis

Answer 140

Foregut duplication cyst Small bowel most common. Oesophageal duplication cyst 2nd most common . Has **muscular layer** causing **thicker wall**.

Answer 141

**_Adults_** 5 cm (+/- 2cm) proximal to carina. Approximately at T2 **_Neonates_** 1.5cm above carina OR T1 OR inferior clavicles

Answer 142

Granulomatous prostatitis **Biopsy needed** to differentiate. RFs: **Intravesical BCG therapy** for bladder Ca, **TURP**, sarcoid, TB

Answer 143

**Pseudomyxoma peritonei** Look for the **appendiceal mucocoele.**

Answer 144

_Extraperitoneal_ - **Conservative Rx** **More common** Bladder base puncture - pelvic fracture Contrast in retroperitoneum, thighs, scrotum, anterior abdominal wall _Intraperitoneal_ - **Surgical Rx** **Less common** Bladder dome from increased pressure Contrast around bowel loops and collecting in paracolic gutters

Answer 145

_Por_ tal venous gas = _Per_ ipheral. Imagine blood pushing gas from the hilum out to the periphery.

Answer 146

Aka cutaneous haemangioma–vascular complex syndrome or Pascual-Castroviejo type II syndrome. **P** - posterior fossa (e.g. Dandy-Walker malformation) **H** - haemangiomas **A** - arterial anomalies **C** - coarctation and cardiac anomalies **E** - eye (ocular) anomalies

Answer 147

Pseudomembranous *(C. diff)* colitis

Answer 148

• *Yersinia enterocolitica* - non stenotic terminal ileal ulcers • *Salmonella*

Answer 149

Fibroid detachment May occur with **superficial submucosal** fibroids abutting the endometrial cavity.

Answer 150

Intraductal papilloma Discharge may be slightly bloody.

Answer 151

**Mounier-Kuhn syndrome** (Tracheobronchomegaly) Tracheal diameter **>3 cm**

Answer 152

**Acquired (uraemic) cystic kidney disease** >3 simple appearing cysts in each kidney.

Answer 153

Long course around midbrain through ambient cistern, cavernous sinus. Look for aneurysm.

Answer 154

**Atrophic gastritis** • Linitis plastica usually nodular and have weight loss & IDA.

Answer 155

• **”I’M SLow”** - spares tendinous insertion • Usually develops within 1 year • Increased density of orbital fat • Superior ophthalmic vein may be dilated due to compression

Answer 156

**Congenital adrenal hypertrophy** **21-Hydroxylase deficiency** cause in >90% of cases. Genital ambiguity in girls. **Salt wasting** in boys. Adrenal limb **>4 mm**.

Answer 157

Thyroid lymphoma

Answer 158

**Papillary fibroelastoma** 75% of valvular tumours. **Aortic** and **mitral** valve most common. Intermediate to high T2 signal. **”Sea anemone” on echo.**

Answer 159

Rare type of **MEN syndrome** **Cardiac myxoma** **Skin lesions** - blue naevi, skin myxomas **Pituitary adenoma** **Sertoli cell** testicular tumours Ovarian masses Thyroid disease Fibroadenomas of the breast Melanotic Schwannomas

Answer 160

Phyllodes tumour (cystosarcoma phyllodes) • Large, fast growing, oval or lobulated solid mass. • Posterior acoustic enhancement. • **Radiolucent halo** on mammography. • Occasionally **calcify**. • May undergo **malignant degeneration**.

Answer 161

**_Kids (6 months - 2 yrs)_** **Ileo-colic** most common in kids Usually **idiopathic** ie no lead point seen. **_Adults and young neonates_** In adults and very young infants (<3 months) no real pattern of distribution but **will have a lead point**.

Answer 162

**_Polyarteritis nodosa_** **Renal (~90%)** - microaneurysms Cardiac (70%) GI tract, liver, spleen, pancreas CNS **_Kawasaki disease_** **Coronary vessels** Can affect any organ Erythematous rash, fever, cervical lymphadenopathy & strawberry tongue

Answer 163

**Hallervorden-Spatz disease** Now called **pantothenate kinase-associated neurodegeneration (PKAN)** • Usually <6 yrs. • **Iron deposition** in globi pallidi, substantia nigra, red nuclei - calcification on CT. • Classic “eye of the the tiger” is central high T2 signal in otherwise low signal globus pallidus and can also be seen in Wilson’s and Parkinson plus in adults.

Answer 164

**Grade IV and V** **I** - ureter only **II** - reflux into kidney **without dilatation** **III** - **mild** pelvicalyceal dilatation **IV** - **moderate** dilatation & **clubbed calyces** **V** - **severe** with a **tortuous ureter**

Answer 165

Proximal to the origin of left subclavian

Answer 166

**Distal** to the origin of the left subclavian

Answer 167

**BAD** **B = Both** ascending and descending aorta

Answer 168

**BAD** **A = Ascending** aorta

Answer 169

**BAD** **D = Descending** aorta only **Only one which is Stanford type B**

Answer 170

Kidney and ureter • Usually **unilateral** (75%) • **Putty kidney** (autonephrectomy) - small, shrunken kidney with dystrophic or amorphous calcification Other features: • Infundibular strictures • Amputated or moth eaten calyces • Sawtooth, corkscrew or beaded calcified ureter

Answer 171

Porencephalic cysts: • Usually **no mass effect** • Lined by **white matter** • Often confined to a **vascular territory** • Usually **communicates with ventricles**

Answer 172

**Cavernous angioma** • CT - **hyperdense** with **speckled calcification**. No mass effect or oedema. • MRI - **mulberry** or **popcorn appearance**, hypointense T2 rim and **blooming** from blood products. *AVMs will be **serpiginous**.

Answer 173

• Atherosclerosis (75%) • Fibromuscular dysplasia (20%) - younger - distal renal artery • Polyarteritis nodosa - microaneurysms • Takayasu • NF-1 - involves ostium • Coarctation • Williams syndrome

Answer 174

**HIPPEL** **H** - haemangioblastoma **I** - increased risk **RCC** **P** - phaeochromocytoma **P** - pancreatic cysts, tumours, NETs **E** - eyes & ears - haemangioblastoma, endolymphatic sac tumours (deafness) **L** - liver and **renal cysts**

Answer 175

Creatinine peak occurs at **48-72 hrs**. Relative: **50% rise** in Cr over baseline Absolute: increase in Cr of **>27** **Evidence is weak** and likely not even a thing.

Answer 176

**Lymphocele** • Typically occur within **1-2 months**. • Well defined, anechoic and may have septations. • Urine leaks are comparatively rare and usually in first week or two.

Answer 177

1. Vermian hypoplasia 2. Cystic dilatation of 4th ventricle 3. Enlarged posterior fossa with torcular-lambdoid inversion (torcula above lamdoid suture due to superiority displaced tentorium) Often secondary hydrocephalus (80%). Scalloping of the occiput from pressure. Hypoplastic cerebellar hemispheres.

Answer 178

MR enteroclysis requires **nasoduodenal tube** so is invasive. Provides superior detection of **mild superficial mucosal disease**.

Answer 179

**4-58°** Angle between axis of band and vertical line. **Stomal stenosis** is the most common complication.

Answer 180

Macroglossia Omphalocele Localised gigantism Organomegaly Ear pits Associated with: Wilm’s tumour Neuroblastoma Hepatoblastoma Rhabdomyosarcoma

Answer 181

**_Adult_** • **0.5ml of 1:1000** adrenaline IM (0.5mg) **_Child_** • If 12+ same as adult • If 6-12 yrs **0.3ml of 1:1000** (0.3mg) • If <6 yrs **0.15ml of 1:1000** (0.15mg) I.e. always 1:1000! Increments 0.5 -> 0.3 -> 0.15.

Answer 182

For drainage: • **Lower pole posterior calyx** For access to PUJ/ureters: • **Mid-upper pole posterior calyx** **Always posterior**. Brödel bloodless zone. Nephrostomies are on pt’s back. Large tubes (12-14F) may be necessary for pus or gross haematuria with clots. Further imaging via nephrostomy **delayed by 24-48 hrs** after placement in cases of infected urine.

Answer 183

**Fracture** - tunica albuginea is **intact**, no surgery **Rupture** - tunica albuginea **disrupted**, **need surgery** to salvage testicle *Isolated epididymal injuries are rare.

Answer 184

ToxOplasmosis = hydrOcephalus HSV = Haemorrhage +/- infarction CMV = Calcification (periventricular) Rubella = microcephaly, periventricular calcification, cardiac anomalies

Answer 185

**No More Spinal Masses** **N** - Neurofibroma **M** - Meningioma **S** - Schwannoma **M** - Metastases Order of frequency is **MNM**. Meningioma, nerve sheath tumour, mets.

Answer 186

• Multiple **pulmonary AVMs** which can cause **cyanosis and high output heart failure** due to shunting. • Epistaxis due to **nasal telangiectasia**. • **Autosomal dominant** inheritance.

Answer 187

**Hampton's** line = **Harmless** **Carman** meniscus = **Carcinoma** Other malignant features: Greater curve Endoluminal (protrude into stomach) Irregular gastric folds

Answer 188

**Lymphoma (most common)** Melanoma (2nd most common) More rarely: Choriocarcinoma RCC Prostate

Answer 189

>12mm is abnormal and suggests adenomyosis

Answer 190

**_O-O_** Old = Organo-axial (2/3 of cases) **_M-M_** Midget (kids) = Mesentero-axial (60%)

Answer 191

**_Sigmoid volvulus_** • **Ahaustral** in appearance • **Distal obstruction**; ascending, transverse and descending colon may be dilated • Few gas-fluid levels may be seen **_Caecal volvulus_** • Arises in the right lower quadrant • **Haustral pattern is maintained** • Distal colon usually collapsed and the small bowel is distended • Single gas-fluid level may be seen

Answer 192

• Aka pharyngeal pouch • Posterior and midline of hypopharynx • Through Killian dehiscence • Pulsion type pseudodiverticulum

Answer 193

Triad of: Situs inversus Chronic sinusitis or nasal polyps Bronchiectasis

Answer 194

**MELAS** (mitochondrial encephalomalacia with lactic acidosis and stroke like episodes) • **Stroke-like episodes** or dementia in **kids/young adults**. • **Parieto-occipital** and **parieto-temporal** infarcts and secondary atrophy/encephalmomalacia. • **Elevated lactate** peak on MR spectroscopy.

Answer 195

Cerebral autosomal dominant arteriolathy with subcortical infarctions and leukoencephalopathy • Recurrent TIA/stroke in **middle aged patients** (30s-50s) • Looks like small vessel disease beyond expected for age • Occurs **without vascular risk factors** • **Anterior temporal lobe** and **external capsule** most common

Answer 196

Amyloidosis

Answer 197

3mg/kg up to 200mg Equates to: **20 mls of 1%** 10mls of 2% *max dose for lidocaine with adrenaline is 7mg/kg

Answer 198

• Acute clinical presentation of systemic **sarcoidosis** that manifests with: - Lymphadenopathy - Fevers - Erythema nodosum - Polyarticular arthritis. *Not to be confused with Löffler syndrome (Simple pulmonary eosinophilia)

Answer 199

TACE (transcatheter arterial chemoembolisation) • Either as palliative Rx or to bide time for curative transplant. • Also used for **hepatic mets**. • Not suitable for patients with **severe cirrhosis** (Child-Pugh C). **Portal vein must be patent** or normal liver can infarct.

Answer 200

**Duodenal web** May be complete or incomplete obstruction.

Answer 201

• *Mycoplasma pneumoniae* • *Strep pneumoniae* (pneumococcus) • Influenza A

Answer 202

• Rare **Marfan-like** connective tissue disorder • **Tortuous arteries**, aneurysms, bifid uvula & hypertelorism

Answer 203

• **Basal predominant panlobular emphysema** (identical to Ritalin lung) • **Cirrhosis** with expected increased risk of HCC • Can be confirmed with blood test for a-1-a. Will be <1.1.

Answer 204

Haemochromatosis Amiodarone Thorotrast Wilson disease Thalassaemia **NOT AMYLOID**

Answer 205

Both cause **periventricular calcification** and **microcephaly**. **Rubella** associated with **congenital cardiac anomalies** (VSD, TOF).

Answer 206

**Vegans Can’t Get Neurocysticercosis** 1. Vesicular 2. Colloidal vesicular 3. Granular nodular 4. Nodular calcified • Tapeworm *Taenia Solium* found in pork (and humans) • Cysts can appear in brain, CSF spaces, ventricles and spinal cord. • Look for rice grain calcification in skeletal muscle. **1. Vesicular** Viable parasite with intact membrane so no host reaction. Cyst with dot sign. No oedema. **2. Colloidal vesicular** Symptomatic stage. Parasite dies and membrane becomes leaky. Cyst becomes thickened and hyperattenuating. Enhancement and oedema. May restrict on DWI. **3. Granular nodular** Cyst retracts into small enhancing nodule. Oedema reduces. Enhances but less marked. **4. Nodular calcified** Calcified nodule remains. No oedema or enhancement.

Answer 207

*Taenia solium* (Species of tapeworm)

Answer 208

*Trypanosoma cruzi* Endemic to Central & South America. • Myocarditis and eventually dilated cardiomyopathy. • Meningoencephalitis • Oesophageal dysmotility • Skin lesions • Conjunctivitis

Answer 209

**Focal areas of signal intensity (FASI)** Focal T2 hyperintensities found in up to 86% of patients.

Answer 210

*Echinococcosis granulosus* Most common species. Hosts are dogs and wolves. Sheep become infected and pass on to humans. * *alveolaris* & *multilicularis* from foxes is less common but more invasive

Answer 211

**Type 1** (70% of cases) 1 or 2 large dominant cysts (2-10cm) surrounded by smaller cysts.

Answer 212

**_Type 2_** • 2nd most common (15-25%) • Smaller cysts (<2cm) • Other lung, cardiac, renal anomalies **_Type 3_** • 10% cases • Microcysts (<5mm) • Poorer prognosis *Type 0 is not compatible with life. Type 4 looks like 1 on imaging. Only epithelial lining which is different.

Answer 213

1. LUL (45%) 2. RML (30%) 3. RUL (20%) *CPAMs have no lobar predominance

Answer 214

Right ventricular hypertrophy

Answer 215

Tetralogy of Fallot Transposition of the great arteries Truncus arteriosus TAPVR Tricuspid valve abnormalities and hypoplastic right heart syndrome

Answer 216

**PORK CHOP** **P** - pyknodysostosis **O** - osteogenesis imperfecta **R** - rickets **K** - kinky hair syndrome **C** - cleidocranial dysostosis **H** - hypothyroid, hypophosphatasia **O** - one too many chromosomes (Downs) **P** - primary acro-osteolysis

Answer 217

Parry-Romberg syndrome Skin, soft tissues and bone.

Answer 218

**POTTER** **P** - pulmonary hypoplasia **O** - oligohydramnios **T** - twisted skin (wrinkly skin) **T** - twisted face (Potter facies: low set ears, retrognathia, hypertelorism) **E** - extremity deformities (club hands and feet, joint contractures) **R** - renal agenesis (bilateral); restricted growth (IUGR)

Answer 219

**HAMARTOMA** **H** - hamartomas (CNS, retina, skin) **A** - angiofibroma/adenoma sebaceum **M** - mitral regurgitation **A** - angiomyolipoma **R** - rhabdomyoma **T** - tubers (cortical, subcortical) **O** - autOsomal dominant **M** - mental impairment **A** - ash leaf spots **S** - Shagreen patches, seizures

Answer 220

**HAM HOP** **H** - hyperparathyroidism **A** - acidosis (renal tubular) **M** - medullary sponge kidney, milk-alkali syndrome **H** - hypercalcaemia, hypercalciuria **O** - oxalosis **P** - papillary necrosis

Answer 221

**COAG** **C** - cortical necrosis **O** - oxalosis **A** - Alport syndrome **G** - glomerulonephritis

Answer 222

**Gruesome Masses Progressively Extend Caudally** **G** - GBM, germinoma **M** - medulloblastoma **P** - pineocytoma, PNET **E** - ependymoma **C** - choroid plexus carcinoma

Answer 223

**CAVITY** **C** - cancer (SCC primary/mets) **A** - autoimmune (GPA, RA) **V** - vascular (bland/septic emboli) **I** - infection (TB, abscess) **T** - trauma (pneumatocoele) **Y** - young (CPAM, sequestration, cyst)

Answer 224

**POSTCARDS** **P** - pyelonephritis **O** - obstruction **S** - sickle cell disease **T** - TB **C** - cirrhosis **A** - analgesics (NSAIDs, paracetamol) **R** - renal vein thrombosis **D** - diabetes mellitus **S** - systemic vasculitides Signs include: • Ball on tee • Lobster claw sign of forniceal excavation • Signet ring • Sloughed papilla with clubbed calyx

Answer 225

**Pleuropulmonary blastoma** • Usually R sided & complete whiteout • **No rib invasion** • Association with CPAM Differential would be **Askin tumour** • **Ewing’s sarcoma family** of tumours • Usually older (Ewing’s age) • Rib invasion

Answer 226

**Pleuropulmonary blastoma** • Usually R sided & complete whiteout • **No rib invasion** • Association with CPAM Differential would be **Askin tumour** • **Ewing’s sarcoma family** of tumours • Usually older (Ewing’s age) • Rib invasion

Answer 227

**Foetal cardiomegaly** • Cause of high output cardiac failure. • High flow shunting from high pressure choroidal arteries to low pressure Veins of Galen.

Answer 228

**Marchiafava-Bignami disease** Starts at body then extends to genu and splenium. Vitamin B deficiency.

Answer 229

**Corpus luteal cyst** Thick walled with intense peripheral vascularity. No follow up.

Answer 230

Most common **overall**: Insulinoma Most common in **MEN-1**: Gastrinoma

Answer 231

Paralysis of upward gaze Suggests pineal lesion.

Answer 232

Both may communicate with the ventricles but… • Porencephalic cysts are **lined by white matter**. • Schizencephaly lined by **cortical grey matter**. • Open vs closed lip refers only to the degree of apposition of the two walls.

Answer 233

• NF-1 • Hyperparathyroidism • Osteogenesis imperfecta • Connective tissue disease - RA, SLE, Sjögren’s, Marfan’s, scleroderma

Answer 234

• **Enlarged collateral vessels** - coarctation, TOF, Takayasu, subclavian stenosis, SVCO, AVM • Neurogenic tumours - schwannoma, neurofibroma • NF-1 • Hyperparathyroidism

Answer 235

NF-1 (ribbon ribs) Hyperparathyroidism

Answer 236

• Pineoblastoma - young children • Germinoma - <20 yrs (most common) • Pineocytoma - adults (20-60 yrs)

Answer 237

**Primary is rare** as kidneys **don’t contain lymphoid tissue**. Secondary (NHL) much more common. Typically **renal contour is preserved** unlike RCC.

Answer 238

Lissencephaly

Answer 239

**Leiomyoma** Virtually pathognomic and benign.

Answer 240

**Septum pellucidum** Alobar type has no corpus callosum

Answer 241

**Mucoepidermoid carcinoma** • FS T1 + C to look for **perineural spread** • **Adenoid cystic carcinoma** is 2nd most common

Answer 242

**Fat embolism syndrome** Contusions/lacerations would be present on initial imaging

Answer 243

**Plummer-Vinson syndrome** *IDA seems to be the cause and reduced incidence means PVS is now rare.

Answer 244

**Tracheobronchial injury** Usually near carina. Lung unable to inflate.

Answer 245

**Pleomorphic xanthoastrocytoma** Reactive rather than dural invasion.

Answer 246

**Mesenteric panniculitis** Immediate perivascular sparing within region of haziness

Answer 247

**Acute haemorrhagic leukoencephalitis (Hurst disease)** • Most severe form of ADEM. • Increased oedema, mass effect and microhaemmorhages. • Usually fatal. Unlike ADEM which improves with steroids.

Answer 248

**Bimodal age distribution** • Children and middle aged females. • Partial nephrectomy usually performed.

Answer 249

**D** - Desmoid tumour **O** - osteoma **P** - papillary thyroid cancer **E** - epidermoid cyst

Answer 250

**Hereditary non-polyposis colorectal cancer (HNPCC)** • Most common cancer syndrome • **5x more common than FAP** • Adenomatous bowel polyps leading to colorectal cancer • Associated with a **huge list** of malignancies including: - endometrial - ovarian - GBM - TCC *if question mentions lots of different cancers in FH pick this!

Answer 251

**Cryptococcus** Toxoplasmosis is most common overall.

Answer 252

**_Empyema_** • Split pleura sign • Obtuse angle with pleura • Lenticular shape • Pleural enhancement • Smooth walled • Hazy extrapleural fat **_Abscess_** • Acute angle with pleura • Thick walls • Abruptly interrupts bronchi/vessels

Answer 253

• Often coexists with HIV • Lepto & pachymeningitis • Arteritis leading to infarcts • *Treponema pallidum* causative species

Answer 254

Phlebolith

Answer 255

Calculus Rim represents the oedematous ureteric wall.

Answer 256

**_ARPKD_** (affects kids) • Smaller cysts (usually <1-2cm) • Enlarged echogenic kidneys • Reniform shape preserved • **Hepatic fibrosis & Caroli disease** • Poor prognosis due to pulmonary hypoplasia from oligohydramnios **_ADPKD_** (affects adults) • More common (10% of all ESRF) • Kidneys normal at birth • Gradually replaced by large cysts • **Berry aneurysms & hypertension** • Cysts in liver, pancreas, seminal vesicles

Answer 257

Ganglioglioma more likely to **calcify** (35%). Rare with PXA.

Answer 258

• No communication with duct • Glycogen-rich cysts • Association with VHL • No malignant potential (unlike mucinous types eg mucinous cystadenoma, IPMN)

Answer 259

Follicle suddenly disappears or regresses Irregular margins Internal echoes Free fluid in pouch of Douglas Increased perifollicular blood flow • Follicular monitoring is a vital part of **IVF**. • **Clomiphene citrate** used to induce ovulation.

Answer 260

• Reduce field strength • Increase bandwidth • Increase matrix size • Use spin echo (FSE) over GRE • Thinner slices • Increase no. excitations (increases SNR)

Answer 261

Struma ovarii • Type of teratoma and appear as such • May also contain follicles and colloid

Answer 262

Pulmonary oedema Although classically associated with pulmonary alveolar proteinosis

Answer 263

• Fine, silvery and brittle hair • Seizures and developmental delay • Progressive cerebral & cerebellar atrophy • Wormian bones, metaphyseal widening, tibial and femoral spurs

Answer 264

Dermoid cyst

Answer 265

Baló concentric sclerosis • Rare, rapidly progressive and invariably fatal form of MS. • Similar presentation to **Marberg type MS** which is typically seen in **younger** patients

Answer 266

**Elastofibroma dorsi** • Classically deep to serratus anterior and latissimus dorsi. • Possibly caused by friction of scapula against chest wall. • Mixed fibrous/fatty components. • Often asymptomatic but may have pain. • Mild-mod uptake on FDG PET.