FRCR 2A Flashcards by Lili Kafee

Solid intrarenal tumour of infancy

Mesoblastic nephroma

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Which single chest x-ray view would you advise to maximise the chances of confirming foreign body inhalation in the paediatric Group?

Expiratory Scan

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Regarding germinal matrix haemorrhage

Intraventricular with no dilation

Grade 2

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GMH: intraventricular haemorrhage with dilation

Gade 3

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GMH: intraparenchymal haemorrhage

Grade 4

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Which of the following is not a cause of secondary craniodysostosis?

Crouzon’s syndrome
Hypothyroidism
previous shunt procedure
Ricketts
thalassaemia

Hypothyroidism

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18 month old boy presents with fever and watery diarrhoea. Hypertension. Palpable mass superior to left kidney containing hypoechoic area ultrasound and low density areas on CT.

Adrenocortical carcinoma
adrenal haemorrhage
neuroblastoma
TB
Wilm’s

Neuroblastoma

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Regarding enteric duplication cyst, which one is true?

most commonly located in duodenum
Majority communicate with lumen
Usually calcification in the wall
Located on the anti mesenteric side
Capsule contains two Wall

Capsule contains two Wall

Most commonly located in TI.
Located on the mesenteric side
No communication
No calcification

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What is the commonest presenting feature of a Meckel’s diverticulum?

Obstruction
Volvulus
Bleeding
Diverticulitis
Perforation

Bleeding

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Which of the following features not a typical finding of normal thymus on CXR

Wavy inferior margin
Change in inspiration and expiration
No mass effect
convex lateral borders
Homogenous density

Wavy inferior margin

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Which of the following is not a risk factor for neonatal renal vein thrombosis?

Birth trauma
Dehydration
Diabetic mother
Right adrenal haemorrhage
Sepsis

Right adrenal haemorrhage

Left adrenal haemorrhage is the cause of renal vein thrombosis. The left adrenal vein drains to the left renal vein. The right adrenal drains directly into IVC

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Which of the following favours a diagnosis of chronic periventricular leucomalacia over porencephaly?

anechoic cyst
persistence of cysts on follow-up
Separated cyst
Symmetrical distribution
Watershed territory

Symmetrical distribution

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Neonate with a history of IUGR has bilateral deformity of the knees. X-ray shows dense femoral diaphysis with alternating Lucent/ dense Lines through the metaphysics. No periosteal reaction

Achondroplasia
Ricketts
Rubella
Scurvy
Syphilis

Rubella

Celery stalk

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What future would make the diagnosis of SUFE more likely than Perthes?

Bilateral changes
Fragmented epiphyses
Reduced epiphysis height
Subchondral fissure
Widened growth plates

Reduced epiphysis height

Early signs of SUFE:
Widened growth plates and reduced epiphysis height.

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Which of the following should be avoided prior to Pertechnetate studies for Meckel’s diagnosis.

Cimetidine
Glucagon
Pentagastrin
Perchlorate
Pertechnetate

Perchlorate

This is usually given after this study to protect the thyroid gland from accumulation of tracer. However if this is given prior to scanning it will block tracer uptake by gastric mucosa

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Which is abnormal in the context of traumatic injury in a 10 year old child?

Anterior wedging of C3 vertebral body.
Anterior list thesis in flexion at C2/3
Pre vertebral soft tissue thickness of 15 mm at C6
Predental space of 6 mm in flexion
Predental space of 3mm in neutral

Predental space of 6 mm in flexion

The maximum space is 2.5- 3 mm in adults and 5 mm in children. Any widening suggests injury to the alar ligamentous complex in the context of trauma.

Other causes of widening: down syndrome, rheumatoid arthritis, neurofibromatosis and OI.

Anterior wedging C3 and pseudosubluxation at C2/3 and C3/4 are within normal limits in children

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15 year old female whose father had progressive renal failure presents the anaemia, polyuria and haematuria. Ultrasound kidneys are small and smooth. Which associated finding is most likely?

Pancreatic cysts
Posterior fossa haemangioblastoma
Cystocoel
Nerve deafness
Hypertension

Nerve deafness

Alports syndrome. Ocular abnormalities can occur including congenital cataracts, Nystagmus, myopia. Hypertension is not feature.

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Bilateral bowing of femoral and tibia. Generalised osteopenia, deficient trabeculation, multiple fractures, Cortical thinning. Diagnosis?
Ricketts
Blounts
OI
Neurofibromatosis
Yaws

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Test used for detection of accessory spleen

Sulfor colloid

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Small foci of haemorrhage in spleen , signs of P HTN. T2 dark

Diagnosis?

Gamma Gandy Bodies- sideritic nodule

Gradient is the most sensitive sequence

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Triad of Felty’s syndrome

Splenomegaly
rheumatoid arthritis
neutropenia

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abnormal loops of bowel bwn PV and IVC. What type of hernia?

Foramen of Winslow
Lt paraduodenal
Transmesenteric
Rt Paraduodenal
Intersigmoid

Foramen of Winslow

Lt Paraduodenal: defect in the descending colon and lie to the left of D4.

Rt paraduodenal: behind SMA and is associated with malrotation

Trans mesenteric hernia commoner following surgery

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MRI shows fluid tracks extending from the perineum on the right running medial the External anal sphincter throughout its course on entering the anus at 6 o'clock position. How should you report this?
Horseshoe fistula
Extra sphincteric fistula
Trans sphincteric fistula
Supra sphincteric fistula
Inter sphincteric fistula

Inter sphincteric fistula-this is the only one that doesn’t pass through the external sphincter (always medial to it).

If a fistula extends around both sides of the anal canal it’s called horseshoe extension.

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Which of the following condition it Is not associated with Helicobacter pylori colonisation?

Oesophageal carcinoma
gastric ulcer
gastric carcinoma
MALT lymphoma
Du ulcer

Oesophageal carcinoma

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MRI liver: smooth contour, Dark T1/T2. What is the diagnosis? - acute hepatitis - focal fatty liver - haemochromatosis - autoimmune liver disease - Wilson disease

haemochromatosis

A 32-year-old man undergoes an MRI scan for back pain. The MRI scan demonstrates a split cord with a bony bar in the canal. Which of the following is NOT associated with diastematomyelia? ``` Spinal cord lipoma Scoliosis Tethered cord Clubfoot Narrowed interpeduncular distance ```

Narrowed interpeduncular distance ``` asso with Meningocoele Hemivertebrae and scoliosis Widened interpeduncular distance (as opposed to narrowed distance) Neurenteric cyst Talipes equinovarus Dermoid Spinal haemangioma Spinal cord lipoma ```

What is a typical feature of the joint affected by gout? Joint space preserved until late in disease No joint effusion Periarticular de mineralisation Erosion with thick sclerotic margin Chondrocalcinosis in the majority of cases

Joint space preserved until late in disease Effusion is the earliest sign with periarticular swelling and preservation of joint space until late in the disease

``` What findings would be typical for haemochromatosis? Osteosclerosis Geodes Chondrocalcinosis Asymmetrical joint space narrowing Narrowing of metacarpal head ```

Chondrocalcinosis Skeletal features include: generalised osteoporosis small subchondral cyst like lesions in the metacarpal heads colour uniform joint space narrowing, Enlargement of metacarpal heads, Osteophyte formation and chondrocalcinosis Differentials include psoriatic arthritis, OA, RA and gout

What future would be in keeping with a charcot joint? - Juxta-articulate is the process - loose bodies - severe pain - blunted shape of metatarsal heads - widened joint space

Loose bodies

Middle aged man presented to ED with right hip pain that started suddenly a few weeks previously and resulted in reduced range of movement. X-ray: osteoporosis of the hip joint and loss of subchondral cortex of the femoral head with preservation of joint space. What's diagnosis? ``` Avascular necrosis Transient osteoporosis Sinovial chondromatosis Disuse atrophy Villonodular synovitis ```

Transient osteoporosis Loss of subchondral cortex is pathognomonic. No joint space narrowing. No collapse.

46-year-old man presented with back pain and was noted to have marked calcification and loss of height of multiple intervertebral discs predominantly in the lumbar spine. Previous radiograph of his knee also shows premature osteoarthritic changes with pronounced chondrocalcinosis. What's your diagnosis? ``` Ankylosing spondylitis Ochronosis Hyperparathyroidism Wilsons disease Reiters syndrome ```

Ochronosis or alkaptonuria he is an inherited enzyme deficiency resulting in the deposition of black pigment in cartilage. The features described are typical and they may also suffer from renal and cardiac failure.

What finding would be most consistent with hibernating myocardium? ``` 75% subendocardial delayed enhancement Normal myocardial contractility at rest No myocardial delayed enhancement Epicardial hyper enhancement Patchy hyper enhancement of my recording ```

No myocardial delayed enhancement

43 year old female presented with fatigue and dyspnoea to her GP who requested chest x-ray. This showed an enlarged heart and pulmonary outflow tract with a small aorta and pulmonary plethora. What is the diagnosis? ``` VSD ASD Aortic regurgitation Pulmonary stenosis Epstein Anomaly ```

ASD | Enlarged heart and pulmonary plethora suggests a left-to-right shunt. At this age the only that likely cause is an ASD

Six weeks echo post MI : akinetic portion of left ventricular wall and delayed enhancement cardiac MR images shows high signal at 10 minutes in the same area of LV wall. What is the cause? ``` LV aneurysm Stunned myocardium Focal myocarditis Focal myocardial fibrosis Hibernating myocardium ```

Focal myocardial fibrosis

A 53-year-old man has AP and lateral radiographs of the right ankle after twisting it whilst playing football. There is no fracture seen, however a central, triangular radiolucent area is seen on the lateral projection in the talar dome. It is well defined with a narrow zone of transition and communicates with the joint space. What is the most likely diagnosis? Select ONE answer only. ``` Pseudo-cyst of calcaneus Geode Intraosseous lipoma Chondroblastoma Unicameral bone cyst ```

Geode This is a subchondral cyst associated with OA which should have communication with the joint space and be present in an older patient.

A 15-year-old boy who plays rugby for his local club injures his leg following a particularly hard tackle. He makes a good recovery initially but three months later is still experiencing symptoms at the site of bruising and he undergoes an x-ray. The x-ray points to a diagnosis of myositis ossificans which is subsequently confirmed with CT. Which of the following patterns of calcification would be most specific for myositis ossificans? 1. Poorly defined mass with marginal calcification 2. Well-defined mass with central calcification 3. Poorly defined mass with diffuse calcification 4. Poorly defined mass with central calcification 5. Well-defined mass with marginal calcification

Well-defined mass with marginal calcification

A 53-year-old man collides with one of the hurdles during his son’s sports day. Two months later he is still noticing a lump around the distal femur and undergoes an x-ray. There is a well defined partly calcified soft tissue mass underlying the tender area. There is cortical erosion of the underlying bone. What is the most likely diagnosis? ``` Osteosarcoma Tumoral calcinosis Gout Myositis ossificans Malignant fibrous histiocytoma ```

Malignant fibrous histiocytoma Cortical erosion of the underlying bone is an important diagnostic feature. On MRI it returns high signal on both T1 and T2 weighted sequences.

Based on age alone, what's the most likely primary Bone tumour in 45 year old male? ``` Osteosarcoma Chondrosarcoma Giant cell tumour Aneurysmal bone cyst Osteoid osteoma ```

Chondrosarcoma

Which areas is most likely to be involved in spinal cord astrocytoma? ``` Brainstem Cervical spine Thoracic spine Lumbar spine Sacrum ```

Thoracic spine Eccentric location Long segments

``` 38-year-old man presented with a lump on the dorsal aspect of his hand that moved with the tendon on flexion and extension of his fingers. X-ray and MRI performed. Expected? Dense calcified mass Low signal on T2 High signal on T1 No internal septation Periosteal bone formation ```

Periosteal bone formation This is ganglion attached to tendon Low T1, high T2, internal septation and periosteal new bone formation

What distribution of involvement is typical in haemochromatosis? ``` Interphalangeal joint of thumb PIP of all fingers DIP middle and ring MCP index and middle finger MCP ring and little fingers ```

MCP index and middle finger

``` Patient is in the wheelchair and is complaining of sore knee. X-ray shows Long gracile femur and tibia indicating under tabulation. What is the most likely cause? Dwarfism Gauchers disease cerebral palsy Juvenile rheumatoid arthritis ```

cerebral palsy

What radiographic features are consistent with hypertrophic pulmonary osteoarthropathy? Metaphyseal lamellar periosteal reaction Irregular epiphyseal periosteal proliferation Asymmetrical feathery periosteal reaction Cortical thickening and coarsening Symmetrical solid periosteal and new bone formation

Metaphyseal lamellar periosteal reaction Symmetrical solid periosteal and new bone formation- seen in hypervit A

Which of the following findings considered pathognomonic for nail patella syndrome? ``` Patellar hypoplasia Lateral elbow hypoplasia Posterior iliac horns calcanea valgus feet Madelung deformity ```

Posterior iliac horns

Which of these features is atypical of rheumatoid arthritis? Symmetrical disease Synovitis on ultrasound but no erosions radiologically Erosions in radioulnar joint andradiocarpal joint preceding MCP erosion Bony ankylosis of the carpal bones Peri articular osteoporosis

Bony ankylosis of the carpal bones

25 man presented with a painful knee. An x-ray shows Lucent area with wide zone of transition in the distal femoral metaphysis. MRI shows fluid fluid levels. Diagnosis? ``` Aneurysmal bone cyst GCT Osteosarcoma Chondroblastoma Osteoblastoma ```

Osteosarcoma

35-year-old man sprained ankle and attended ED. X-ray shows no fracture. the lateral view shows well defined radiolucent lesion with a faint sclerotic margin in the mid calcaneus. Some central classification within the lesion. Diagnosis? ``` Simple bone cyst Normal variant Enchondroma Intraosseous lipoma Bone infarcts ```

Intraosseous lipoma Central dystrophic calcification in 62% of cases is considered to to be pathognomonic. Simple bone cyst does not contain Central classification.

30-year-old runner presented with history of pain in legs on Running. X-rays unremarkable. Isotope bone scan shows a subtle longitudinal linear uptake on the delayed bone can images with normal angiogram and blood pool images. What is the diagnosis? ``` Stress fracture Shinsplints Osteoid osteoma Osteomyelitis Hypertrophy osteoarthropathy ```

Shinsplints In stress fracture angiogram and blood pool images are abnormal with hyperperfusion and hyperaemia. On delayed images focal fusiform uptake is seen stress fracture.

39-year-old man presents with gradually enlarging swelling in the upper lateral aspect of right calf. Ultrasound and MRI shows well-defined, thinly septated cystic lesion intimately related to proximal tibiofibular joint and extending into the adjacent soft tissue. It measures approximately 4 cm in maximum diameter. No enhancement of soft tissue component postinjection Gd. What is the diagnosis? ``` Para meniscal cyst Bursitis Focal Tenosynovitis Ganglion cyst Chronic seroma ```

Ganglion cyst This is a ganglion cyst adjacent to tibiofibular joint causing comment peroneal nerve palsy.

Middle aged man with no significant medical history undergoes Xray of pelvis following a fall. Multiple longitudinally orientated 2 - 10 mm roundup density similar to cortical bone are seen throughout the cancellous bone in a diffuse symmetrical pattern concentrated around the acetabulum. No fractures. What is the most likely diagnosis? ``` Osteopathia striata Osteopetrosis Bony metastasis Melorrrhoestosis Osteopoikilosis ```

Osteopoikilosis This is causing multiple bone islands which are asymptomatic and usually have no clinical significance. They represent deposits of normal cortical bone within cancellous bone. Osteopathic striata- this is similar but it consists of linear longitudinal or sunburst striation rather than rounded densities. Osteopetrosis causes generalised increase in bone density

30 year old man undergoes shoulder MRI for chronic anterior pain. No history of trauma. Sag images showed absent anterior Labrum and thickend middle glenohumeral ligaments. Diagnosis? ``` Anterior labral tear Bankart lesion SLAP lesion GH tendinitis Normal variant ```

Normal variant This is Buford complex- absent anterior Labrum with thickened cord liked middle GH ligament.

List the differential diagnosis for lytic expansile metastatic deposits (4)

Renal Thyroid Melanoma Pheochromocytoma

Volar tilt of lunate seen as a triangular or pie shaped lunate on AP projection of the wrist is most commonly a feature which of the following? ``` scapholunate dissociation Perilunate dislocation Lunate dislocation VISI DISI ```

Lunate dislocation

Which MRI finding is the most specific indication of an unstable osteochondral fragment? ``` Joint effusion Subfragmental bone resorption 3mm cyst deep to the lesion Underlying linear high signal on T2 WI Multiple lesions ```

Underlying linear high signal on T2 WI Other signs include: Cartilaginous defect on T1 weighted images. Hi signal in articular cartilage and a cystic lesion in the bed (>5mm)

``` Gastroduodenal artery has its origin from which vessel? SMA Common Hepatic Artery Left gastric artery coeliac axis Aorta ```

Common Hepatic Artery

CT shows multiple irregular calcified low-density lesions in the liver suggestive of metastasis. What's the most likely primary lesion? ``` IDC Breast Mucinous adenocarcinoma of GI track Osteosarcoma Non small cell lung cancer Carcinoid ```

Mucinous adenocarcinoma of GI track Is most commonly seen with mucinous carcinoma of gastrointestinal tract.

A 50-year-old woman has an USS thyroid which shows a mixed cystic and solid region in the left lobe with low reflectivity overall. There are associated malignant looking lymph nodes in the left cervical chain. What is the most likely diagnosis ``` Papillary thyroid cancer Anaplastic thyroid cancer De-Quervain thyroiditis Hashimoto thyroiditis Lymphoma ```

Papillary thyroid cancer

A 48-year-old man undergoes a CT scan for follow up at 12 months post resection of an adrenal malignancy. His past surgical history also includes resection of a parathyroid tumour. The CT shows a solitary pancreatic mass with significant enhancement on the arterial phase. What is the most likely diagnosis? ``` Adenocarcinoma Choledochal cyst Glucagonoma VIPoma Adrenal metastasis ```

Glucagonoma ``` 4 Ds: Diabetes, Deep vein thrombosis, Depression and Dermatitis although this is relatively rare. ``` necrolytic erythema migrans which is an intensely itchy maculopapular rash. Although less common than insulinomas and gastrinomas, glucagonomas are associated with MEN as well. VIPomas cause a watery diarrhoea and hypokalaemia termed Verner-Morrison syndrome. They are NOT associated with MEN.

A 23-year-old man suffers an injury to the knee whilst playing basketball. Plain radiographs demonstrate a small flake of bone adjacent to the fibular head. What is the most likely underlying ligamentous injury? ``` Posterior Cruciate Ligament Injury Lateral meniscus tear Anterior Cruciate Ligament Injury Posterolateral Corner injury Medial collateral ligament tear ```

Posterior Cruciate Ligament Injury The ‘arcuate sign’ is an avulsion of the proximal fibula due to the insertion of the arcuate ligament. 90% of these are associated with a PCL injury.

A 55-year-old lady with a worsening headache has an MRI scan which shows enlargement of optic nerve. On the post-contrast sequences there is linear peripheral enhancement with central non-enhancement. What is the most likely diagnosis? ``` Orbital pseudotumour Sarcoidosis Optic neuritis Meningioma Orbital lymphoma ```

Meningioma The tram-track sign refers to enhancement of the optic nerve sheath post-contrast. Optic neuritis can sometimes be seen as high T2 signal within the optic nerve as opposed to post-contrast enhancement. Glioma: causes kinking or buckling of the optic nerve which a meningioma does not.

A 76-year-old gentleman known to have type 2 diabetes and receiving haemodialysis for renal failure attends his GP surgery. He is a retired manual labourer and is complaining of back pain. His GP believes his back pain to be degenerative in nature but none the less requests a lumbar spine x-ray anyway. This shows end-plate sclerosis but also bilateral calcification projected over the renal outline. What is the most likely diagnosis? ``` Secondary Hyperparathyroidism Sclerosing encapsulating peritonitis Primary Hyperparathyroidism Renal papillary necrosis Medullary sponge kidney ```

Secondary Hyperparathyroidism This patient has renal osteodystrophy as evidenced by his history of dialysis x-ray findings. Secondary hyperparathyroidism goes hand in hand with renal osteodystrophy and medullary nephrocalcinosis is a finding in hyperparathyroidism.

Contrasts in the Midcarpal compartment can be explained by which of the following structures? ``` Triangular fibrocartilage Lunotriquetral ligament Dorsal distal radioulnar ligament Flexor retinaculum Radio scapha lunate ligament ```

Lunotriquetral ligament

``` BM oedema in vertebra (low T1, Bright T2), is seen in all but which of the following? Degenerative disc disease Multiple myeloma Osteoporotic collapse Spondylolitis AS ```

Multiple myeloma

``` Which of the following fractures is most likely to Indicate a significant injury to the underlying intrathoracic structures? Glenoid Scapula blade Clavicle First rib Sternum ```

First rib

All of the following are associations of chairi II malformations except.... ``` Dysgenesis of corpus callous Klippel Feil syndrome Syringomyelia Meningomyelocele Tectal beaking ```

Klippel Feil syndrome

All of the following features of contrast induced nephropathy except.... Alternative major insults to kidneys pulled out Increase in serum Cr of 0.5 mg/dL Rise in serum Cr level by more than 50% of baseline Increase in Cr 48 to 72 hours after administration contrast Raised Cr persists for 2 to 5 days

Rise in serum Cr level by more than 50% of baseline Diagnostic criteria include exposure to contrast agent, increase in serum level of Cr 0.5 mg/dL or 25% greater than baseline, increase in level a Caring 1472 hours after administration persisting for 2 to 5 days

Central mass with a homogenous Signal intensity on MRI in the fourth ventricle in a 4yr child. Which of the following is the most likely diagnosis? ``` Astrocytoma Medulloblastoma Ependymoma Pontine glioma Tectal plate glioma ```

Medulloblastoma Most common infratentorial brain tumour. Presents as a midline non-calcified solid mass obstructing the fourth ventricle. It typically arises from the roof of the fourth ventricle and is midline in location in 75 to 90% of cases. It is hyperdense relative to brain on CT shows restricted diffusion on DWI.

36-year-old woman with small cystic lesion in the liver had a CT KUB for suspected stone. CT shows speckled calcification in medulla of both kidneys. Review of an old IVU showed striated nephrogram and filling defect in the proximal right ureter. What's the most likely diagnosis? ``` HyperPTH Medullary sponge kidney Medullary cystic disease Acquired renal cystic disease PCKD ```

Medullary sponge kidney This involves dysplastic dilatation of medullary and papillary collecting ducts. It is associated with Ehlers Danlos syndrome, Parathyroid adenoma, Caroli's disease. Bunch of flower appearance and dense striated nephrogram

46-year-old woman with a constant headache has a CT which shows suprasellar solid cystic lesion with some calcification. MRI shows high signal in both T1 and T2. Marginal enhancement of the peripheral solid rim portion of the lesion is also noted. Diagnosis? ``` Craniopharyngioma Pituitary adenoma Pineoblastoma Meningioma Dermoid cyst ```

Craniopharyngioma

25 yr old man progressive pain in knee. X ray: OA with increased soft tissue swelling and density. Tomorrow: diffuse low signal on T2 with large joint effusion. Diagnosis? ``` Amyloid Haemophilia PVNS Primary Sinovial osteochondromatosis Rapidly destructive articular disease ```

Haemophilia Haemorrthrosis- joint effusion ] synovial inflammation and hyperaemia- osteoporosis and epiphyseal overgrowth. Subchondral erosion Joint space narrowing Osteophytosis Widening of intercondylar notch, Flattening of condylar surface and squaring patella are very characteristics of chronic haemarthrosis of the knee.

Regarding malignant thyroid nodules which of the following statement is true? Punctate calcification is feature of papillary carcinoma Anaplastic carcinoma is associated with MEN syndrome Echogenic foci in medullary carcinoma are due to calcitonin deposit. Characteristic lymphadenopathy in medullary carcinoma is hypoechoic to muscle Follicular carcinoma can be differentiated from follicular adenoma on ultrasound

Punctate calcification is feature of papillary carcinoma Microcalcifications appears as punctate hyper echoic foci without shadowing. Coarse Ca is seen in medullary type.

``` All of the following causes BG Ca except... PseudohypoPTH Lead poisoning Aging HypoTSH Wilson's disease ```

Wilson's disease

FRCR 2A Flashcards

(72 cards)