Leicester course notebook notes Flashcards
1
Q
Iodine 131 is used. If seen in another organ of a patient post thyroidectomy which organ would make you suspect there is malignant spread? (Options: Lung, Liver, bladder, stomach, salivary gland)
A
Lung does uptake but only minimally.
Liver, gb, urinary tract,
stomach, breast.
2
Q
High DWI signal and Low ADC in frontal parietal lobe. High DWI and high ADC signal in medial posterior temporal lobe
What are the locations of insult.
What are the timeframes of the insult
A
Fronto parietal - MCA
Medial posterior temporal- PCA
High DWI and Low ADC - acute infarct
High DWI and High ADC - old
3
Q
Temporal lobe blood supply
A
anterior portion is MCA
posterior is PCA
4
Q
Patient with a facial rash, seizures and splenic adenoma. What is the other associated finding?(options: bilateral scwhanomas, optic glioma, angioma, haemangioblastoma, SEGA
A
(Answer: ?Giant cell astrocytoma secondary to tuberous sclerosis) (tuberous scerlosis was not mentioned in the stem)
5
Q
Tarlov Cyst?
A
also called perineural cysts
Extra dural, but contain neural tissue
common 5%, mostly women.
6
Q
wyrinx ax to
A
myelomeningocele and ciahri I and II
Dandy walker syndrome
Klipper-Feil
7
Q
do mucoceles enhance
A
in the peripherary only (variable if they do not)
8
Q
Peripheral enhancement of mass in maxillary sinus with dumbbell protrusion from osteum.
A
peripheral enhacning mass in the sinus is a mucocele
dubell protrusion would be considered an atrochonal mass but these require no contrast, expand the ostium rather than be a dumbell
9
Q
Juvenile nasopharyngeal angiofibroma
A
asphenopalatine foramen
which is the medial border of the pterygoopalatine fossa
10
Q
what are the MRI features of saggital sinus thrombosis
A
iso T1, hypo T2 (mimic a flow void)
subacute will be high T1.
11
Q
carotid dissection best MR iaging
A
T1 - no contrast
12
Q
CT haemorrhage, how does density change
A
blood is iso to brain at 2 weeks.
13
Q
MRI findings of mesial temporal sclerosis
A
reduced hippocampal volume: hippocampal atrophy
increased T2 signal
14
Q
what are the fisher scores for sub arachnoid haemorrhage
A
1 - no blood seen
2 - <1mm
3 - >1mm
4 - intraventricular
15
Q
Carotid artery stenosis score
A
Normal - <125cm/s
50% - 130cm
> 230cm /s 70% stenosis .
16
Q
skull fracture, likley nerves to damage
A
1 and 2
17
Q
Thyroid US parameters for U5 badnessx
A
solid hypoechoic with a lobulated or irregular outline and microcalcification
papillary carcinoma
solid hypoechoic with a lobulated or irregular outline and globular calcification
medullary carcinoma
intranodular vascularity
taller than wide axially (AP>ML)
characteristic associated lymphadenopathy
18
Q
normal pituitary on MRI
A
The posterior pituitary has
-intrinsic high T1 signal
- hypointense signal on T2 weighted images
Anterior is iso on both T1 and T2
19
Q
craniopharyngioma in kids
A
Adamantinomatous craniopharyngiomas are WHO grade 1 tumors of the pituitary region typically presenting as cystic masses with peripheral calcifications in children.
wet keratin
20
Q
papillary craniopharyngioma
A
adults
21
Q
plagiocephaly
A
lamboid and/or coronal
22
Q
chiari 1 is ax to
A
Klippel Feil
23
Q
how does penumbra relate to DWI and PWI
A
Penumbra is PWI area that is bigger than the DWI
24
Q
cn7 NORMAL ENHANCEMENT LOCATION for normal nerve
A
CANICULAR
and between tympanic and mastoid
25
MS plaques on T2
bright
26
rubella infction congenital
deaf and blind
VSD and Tet of Fallot
ventricular megaly with periventricular calc
27
CMV brain infeciton congential
basal calc
periventricular calc
cerebral atrophy
28
do meningiomas haemorrhage
nno
29
do meningiomas cause local oedema
60% of them do yes
30
describe anatomy of the basal ganglia
caudate nucleus, pallidus and putamen
Striatum - all three
Lentifrom nucleus is - pallidus and putamen
Neostriatum is caudate and pallidus.
31
Toxo post contrast enhacnement
nodular and ring pattern
32
what are the liver fatty lesions
HCC
Adenoma
AML
33
types of hepatic adenoma
inflammatory - common and bleedy
HNF1alpha - second commonest, ax with the pill
b catenin - ax with FAP and anabolic steroids
34
Adenoma contrast enhancenemt
arterial enhance, hold onto the contrast until delayed when they go iso
35
Is AFP alwasys high in HCC
no
only 60%
36
Liver differentials for a hypervascular lesion
HCC
FNH
Adenoma
NET
37
cholangiocarcinoma enhancement pattern
gradual
irregular peripheral enhancement at beginning
capsular retraction and intra hepatic duct dilatation
38
why does a cirrhotic liver not get mets
portal hypertension
39
autoimmune pancreatitis - symptoms
no pain
weight loss
jaundice
new dm
40
bowel accordiion sign
pseudomembranous colitits
41
oesophagus stricture in upper oesophagus
plummer vinson - risk of cancer
iron deficient anaemia
42
HNPPC is ax with what syndrome
Lynch
43
Paeds UTI - what is counted as repeat UTI
3 lower
2 upper
1 upper and 1 lower
44
what constitutes paeds UTI atypical
non ecoli
not responded to abx
high Cr
45
brachicephaly
loss of coronol sutures
46
oxycephaly
coronol and saggital is lost
47
turricephaly
all of them
48
when to do a 1hr paeds CT head
?NAI
seizure
GCS low
?fracture
neuro deficit
or multiple of
- mechanism
- >3 vomitting
- LOC
49
paeds trauma - CT abdo if
bruising
tenderness
tachy unexplained
50
cystic bones lesions
FOGMACHINES
FD
Osteblastoma
GCT
Mets
ABC
Chondroblastoma
Hyperparathyroidism browns tumour
Infection
NOF
EG / Enchondroma
Simple bone cyst
51
Sequestrations difference in arterial feeding
INtra - one large systemic feeding
Extra - systemic but multiple small ones
52
CPM
intra seq
extra seq
which will appear as an echogenic mass
CPM
Extra
53
cut offs for secondary sexual charachteristics for boys and girls by age
boys < 8
girls <9
54
where is a cannatal cyst found
at the level of the frontal horns
anterior to foramen of munro
need to differentiate from periventricular leukomalacia and pseudocysts of the germinal matrix
55
what are pseudocysts of the germinal matrix
next to the foramen munro
pre term or term
caviating cysts of the germinal matrix, often due to haemorrhage.
56
where are subependymal cysts found
under/by the germinal matrix (under the ventricles)
57
PVL nenoate has to be under how many weeks
34
58
who looks after LCH patients
oncology
59
differential for infundibulum thickneing
Germinoma
LCH
in adults
neurosarcoid
mets
lymphoma
hypophysitis
60
causes of vertebra plana
infection
mets/myeloma
EG
Lymphoma
Trauma
61
atrial appendages - which is tubular
LEFT
62
hyparterial bronchus is found
polysplenia
ie in L heterotaxy
Hyparterial means bronchus under the artery.
higher left hilum as pulmonary vessel rides over the top
63
baby
group b strep cxr appearance
patchy bilateral
?effusion
64
posterior vertebrla scalloping and middle beaking
achondroplasia
65
small SI joints with notches
achondroplasia
66
hypoplasia of C1 arch
downs
67
rectosigmoid junction ratio should be
>1
68
what is a rhabdoid tumour?
in kidneys affects kids age 1-2
big mass, v aggressive.
69
how to differnetiate rhabdoid from WIlms
when differentiating from Wilms
subcapsular fluid collections
tumour lobules separated by hypoattenuating areas of necrosis or haemorrhage
calcifications
70
liver
mesenchymal hamartoma has what appearance
cystic
71
mesenchymal hamartoma lesions are found in what age group
infant
72
doulbe aortic arch impression is higher on the
right
73
features of decreased success rate in intusseption
trapped fluid
low vascularity
pathological leadpoint
sbo
old child
rectal bleeding
long duratin of symptoms
74
what is the imaging pattern for skeletal survey
do within 72hours and follow up in 11-14 days.
75
is CT head a part of the skeletal survey dfor NAI
only if under 1
(otherwise only if head trauma exists)
76
Berry aneurysms are ax with
Marfans
PCKD
Ehlos Danlos
NF1
77
does toxoplasmosis have an irregular nodular ring
yes
78
autoimmune limbic encephalitis ax to
Non small cell lung cancer
79
Cord ependymoma vs astrocytoma
astrocytoma is ECCENTRIC (ependymoma is middle)
Ependymoma has a haemosiderin cap. also adults.
80
Progressive supranuclear palsy get what in midbrin
atrophy - hummingbird
Mickey mouse sign
81
Flattening of the hippocampal digitations
Medial temporal sclerosis
82
leriche syndrome
abdominal aorta constriction
83
investigate May Thurners
do MR
84
Intermittent claudication treatment
conservative exercise programme
85
CIA occlusion
stent
86
CFA stenosis or occlusion
surgery CFA endarterectomy
87
INfrainguinal occlusion / stenosis tx
ANGIOPLASTY
88
FRESH OCCLUSION WHAT TO DO ?
bypass and thrombectomy
can't go IR as risk of showering
89
global endocardial
cardiac mri
AMyloid
systemic sclerosis
post transplant
90
MRI
IRON OVERLOAD HAEMOCHROMATOSIS/
SSC/THAL
VARIABLE T2 STAR – DECAY TIME
TE <10ms severe
>20 ms normal
T2 hypointesity of
liver
91
Cardiac MRI tehcniques
Shimming
Parallel imaging
Phase swap
Prospective triggering
Shimming - reduce susceptibility artefact
Parallel imaging - reduce acquisition time
Phase swap - to reduce wrap
Prospective triggering = address heart rate variability
92
black blood sequence is what type
TSE
93
White blood seqwuences are what type
SSFP
94
what is given for stress MRI
Adenosine
95
myxoma preferred location
interatrial septum
96
cardiac sarcoma preferred location
right atrium
97
* Thymoma vs thymic/lymphoid hyperplasia
– MR in characterizing
lesion – please note thymic hyperplasia may be demonstrate increased uptake on FDG PET
thymic hperplasia has fat
98
bronchogenic vs oesophageal duplication cyst
ODC - thicker wall, contain gastric mucosa. closer to oesophagus
99
the dilated chamber is the chamber that receives the most blood in
diastole
100
does LAM have ax to smoking
NO
101
LAM can be ax with
TS and AML
102
Birt dog dubbe get what?
Birt Hogg Dube - Very rare, recurrent pneumothoraces, cysts in the lower zones, clear cell RCC,
fibrofolliculomas
103
eligibility of Nintedanib
vital capacity (FVC) decline ≥10%,
death, lung transplantation, or any 2 of: relative FVC decline ≥5 and
<10%, worsening respiratory symptoms, or worsening fibrosis on
computed tomography of the chest, all within 24 months of diagnosis.
104
Talcosis can cause emphysema where
lower lobes
105
names of pancreatitis collections
non infected
Acute pancreatic collection
Pseudocyst at 4 weeks
infected
Acute necrotic collection
wall off necrotic colleciton
105
Paroxysmal nocturnal haemoglobulinuria can predispose to what
Budd Chiari
106
Uniclocular pnacreatic cyst with amylase
pseudocystn
107
Corkscrew oesophagus /rosary beadss
Diffuse oesophageal spasm
108
hot drinks improve what oesophagus condition
achalsia
109
carcinoid causes what in the mesentry
reaction
sharp edges to the bowel
110
Ventral pancreas is the
uncinate and major papilla santorini
111
Dorsal pancreas form
the body and the wirsrung small pappila
112
Cronkite canda
polyps and diarrhead
113
Amyloid causes liver to what
decrease in density
114
actinomycosis love what in the bowle
the appendix
115
Tylosis causes
hand and feet
scc oesophagus
116
Histoplasmosis have what kind of calcification
central calcification
117
Commonest ype of FMD
medial fibroplasia
118
malignany in trachea
scc
then adenoid cystic
119
factors increasing risk of contrast reaction
atopy
asthma
Beta blockers
HF
Age over 50
shelffish allergy
120
Pancoast tumour is most commonly
SCC
121
If PA over 2.9cm then
pulmonary hypertension is very likely
122
appearance of chronic DVT
low size of blood vessel
less echongenic than acute thrombus
123
RECIST criteria
Complete - gone
Partial - decrease by 30%
progresison - increase by 20%
if multiple lesion can do by sum of the long axis
124
common posterior spine lesions
Osteblastoma
mets
abc
125
which arthritis goes for the feet
reactive
126
causes of erlenmeyer flask
low phosphate
RA
leukaemia
achondroplasia
sickle
thalassaemia
rickets
127
Synovial osteochondromatosis
vs
Osteochondra Dissecians
OCD is end result of osteochondral defect
synovial osteochondromatosis
- characterised by loose cartilaginous bodies which may, or may not be calcified or ossified. Primary small and non calcified. Secondary they are calcified.
128
elastofibroma affect who
midlde aged women
129
what is POEMS
Polyneuropathy
Monoclonal gammopathy
skin
endocrine
130
Nail Patella
posterior iliac horns
atrophy patella
renal dysfuctino
hypoplasia of the radial head
131
causes of lucent ribs
scurvy
cushings
acromegaly
132
pectus excavatum is ax with
prem babies
downs
marfans
haemocystinuria
133
type of ulnar variance in Kienbock
ax with negative ulnar variance
134
what are the sclerotic mets
prostate
carcinoid
breast
TCC
medulloblastoma
colon
135
age for Ewings
under 10
136
disc bulge vs herniation
90 degrees plus is big old bulge
less is herniation
137
what is pachydermoperiostosis?
Primary hypertrophic osteopaty
stops spontaneously.
bilaterally lower limb periosteal reaciton
138
Does PVNS erode
not really
139
do chordoma mets
no
140
pelvic fractures
malaigne
two fractures same side. vertical fracture.
141
Chondroblastoma affect who and where
under 30
in the physis.
142
size of osteoid osteoma
less than 1.5cm
143
Tranient osteoporosis more common in
men
ax with pregnant women though
144
Trident hand
achondroplasia
145
PET SUV values for being partial repsons
15% if 1 cycle chemo
25% if 2 cycles
inverse for progression
146
oesophageal diverticulum by location
superior - structural like
Midle - traction from mediastinal lung pathology
Inferior - pulsion
147
liver transplant is considered with what HCC lesion criteria
upto 3 if <3cm
1 if <5cm
148
CMV favours the c
colon
149
Slow transit and multiple bowel thin bowel lines
Systemic sclerosis
150
Caroli ax with
medullary sponge kidney
hepatic fibrosis (caroli syndrome)
ADPCKD
ARPCKD
151
“central dot” sign: enhancing dots within the dilated intrahepatic bile ducts, representing portal radicles 1
Caroli disease
152
certain cancers spread by plugging the lymphaTICS
Cervix, Colon, Stomach, Breast, Pancreas, Thyroid, Larynx
153
Takayasus arteritis
young women
prepulesless phase
pulseless phase
Aorta
The pulmonary arteries are also commonly involved, with the most common appearance being peripheral pruning.
154
which lung malignancy causes SVCO
bronchogenic
155
GCA affects who and how
Old patients
Medium to large vessels
lng and smooth
circumferential wall thickening
156
Hodkins lymphoma typically what Cell
T
157
NHL typically
B cell
158
ANti basement membrane
pulmonary haemorrhage
glomerulonephritis
Good pastures
159
H shaped sacrum uptake
insufficiency fracture
160
PET signal during a seizure
avid areas
cold when not seizing
161
Flattening of the hippocampal digitations
Mesial temporal sclerosis
162
Optic Neuritis unilateral or bilateral
compare it to NMO and anti-MOG encephalitis
Unilateral optic neuritis (and MS if that is the cause)
other ytwo are bilateral
163
acquaporin 4 is ax with which disese
NMO
autoantibody to it
164
contraindications for thrombin pseudo aneurysm tx
3mm neck
5cm size
active bleeding
av fistula
165
Splenic truama scale and treatment
1 - 1cm 10% haematoma
2 - 2cm, 10-50% haematoma.
Above two treat conservatively
3 - laceration of 3cm, haematoma over 50%. ruptured subcapsule.
intervention if patient stable
4 - devascularised
5- shattered
last two need surgery
166
signs of haemodynamic instability
cool, calmmy, decreased cap refill,
altered conscious
SOB
bp above >90 but needing trasnfusions support.
Transient response
above mean dodoy for intervention
167
May thurners is what combo
right artery over left vein
168
IVC filter insertion location
distal to renal arteries
169
IVC indications
pregnant near delivery
pre operative with prox dvt to stop anticoagulation
170
stomach fundus is supplied by what arteries
short gastric arteries given off by the splenic artery
171
what is salpingitis isthmic nodosa
nodularity of the isthmic fallopian tube.
ax with inflammaiton and tubual pregnancy
diverticula along the tube
172
how do you stage cervical cancer - what imaging
MRI with contrast
2b can't operate on. has gone north
173
normal endometrial thickness
up to 15mm
174
post menopausal endometrium should be less than
5mm
unles son tomoxifen - get a pass up to 8mm
175
ovarian germ cell tumours typically in
kids
176
Breast screening age range
47 - 73
every 3 years
177
what is Li Fraumeni syndrome
what imaging do they get
TP53 gene mutated
super sensitive to radiation.
get annual MRI from 20 to 70.
178
phyllodes on US
posterior acoustic enhancenemtn
179
age for fibroadenoma
20-40
180
breast in a breast
hamartoma
181
periductal mastitis is ax with
smoking and diabetes
182
silicone that has travelled into the lymph node will appear as
snowstorm
doesn't mean the implant is ruptured
183
smooth C shaped tracheal thickening
relapsing polychondritis
184
trachea
strictures and webbs
GPA
185
speckled slat and pepper appearance of a mass think
paraganglioma
186
thyomoma vs thymic hyperplasia
in and out
hyperplasia is normal fatty tissue and so will dorp out
187
enhancement of neurofibromas and schwannomas
neuro - homongenous
schwannomas - hetero
188
which is more symtpomatic
osephageal or beronchogenic duplication cyst
bronchogneic
189
size of vessels in chronic PE
small !
190
PE
poorest predictor on CT
RV LV ratio
191
pulmonary veno occlusive disease
what is it
PCWP -
extensive occlusion of pulmonary veins by fbrious tissue
heart failure depsite normal LV. Veins get mashed.
Pulmonary capillary wedge pressure (PCWP) is usually normal
192
what is pulmonary capillary haemangiomatosis
occlusive disesae causing pul HTN
proliferating capilleries. enlarged central arteries
193
if a nodule is perifissural otr subpleural what size can you not follow up
10mm
194
asbestos
hairy plaques and pleural effusion
EXPOSURE
195
mesothelioma sign
invasion of the fissueres
mediastinum thickening
196
spares the lung bases
LCH
hypersensitivity
197
young women
cysts
pneumthoroax
LAM
also spares costophrenic receess
198
birt dog dubbe get cysts where
LLZ
Chromophobe RCC
repeated pneumothorax
fibrofolliculomas on skin.
199
Solitary fibrous tumour of lung ax with
hypoglycaemia
hypertrophic pulmonary osteoarthropathy - periosteal reaction of long bones
200
immunotherapy induced pneumonitis pattern
OP
201
immunotherapy - pseudo progression
cna get bigger. or new lesions.
need clincial status.
need serial imaging to count on progression for immunothrapy.
202
black pleura sign is seen in
Pulmonary alceolar microlithiasis
subpleuiral sparing of the microlithiaissois
203
what is keratosis obturans
expansino and occluisino of EAC by a keratin plug.
younger patients under 40
severe pain and conductive hearing loss
NO bony erosion. compared to EAC cholesteatoma which is soft tissue density
Otitis externa will have surrounding inflammatory fat stranding
204
why is incus most at risk during choleateatoma
has worxst blood supply
205
apperance of aberrant internal carotid artery
large vessel in the middle ear
206
enhancement of cholestrol granuloma
it doesn't
207
what is tolosa hunt
idopathic infalmmatory
cavernous sinus and orbital apex.
painful eye movements
208
scirrus breast mets in the eye
will pull in
209
lymphangio malformaiton what sign
fluid fluid levels
210
orbital cavernous haemagnioma what compartment
intraconal
211
defect in nasal septum thnik
GPA
212
orbital sarcoid - what sign
anterior uveitis
can get enhacning lacrimal gland with contrast, hypo T1 adn T2.
213
signs of inverted papilloma
cerebreform enhacnement (brian like)
bone reaction
214
perineural dsease think
adenoid cystic loves the nerves
215
pleomorphic mass has what imaging appearance
parotid
lobulated and homogenous enhancement
216
complete ptosis requires involvement of
sympathetic AND third nerve
217
myelofibrosis in bones appearance
diffusesly sclerotic
low signal on imaging
218
Haemachromatosis bones findings
Chondrocalcinosis - TFCC and knees
symmetrical joint loss.
hooks to the m radial ends of 2nd and 3rd metacarpals
219
what is dermatomyostitis
sheets of calc around muslce plane s
220
what to do with a lipoma over 6cm
refer to tertiary centre and do an MRI scna
221
Giant cell tumour (PVNS)
vs
Glomangioma
Glomangioma - vascular, painful. bright on T2 and high enhacnement.
Giant Cell tumour - low T1 and T2, low enhancement, blooming
222
Cardiac myxoma
more common is sessile or pedunculated
peddunculated
223
When to use a treadmill test for a patient?
used for risk stratisfication
if angina
can also do calcium scoring
224
cardiac functional testing can do what
dobutamine stress echo
rhobydicin nuclear medicine study
225
Contraindications to BB in cardiac studuies
HB 2 and 3
Sick sinus
severe asthma
phaeo
226
MR heart circle view - territories
A L I S clockwise for anterior, lateral, inferior, Superior
227
post TAVI hyperattneutating leaflet thickening
Pannus
a vegetation would be mobile
228
Gorlin syndrome
BCC
medullobasltoma
calcified falx?
odonteogenic keratosis
229
Cowdens
dysplastic cerebellum gangliocytoma when in association with lermitte duclos
230
Walls of abscess vs met
thick met
thin avscess
231
NAA
Cholin
Cr
NAA - stability
Cholin - turnover
Cr - metabolism?
232
MS high spec peaks are
high Beta glutamic
look this up
233
GBM
Multifocal
Multicentric
Multifocal - from one source
Multicentrice - number of different sources
234
cord lesions
myxopapillary ependymoma is found where
in the cord conus
more bleedy
235
go over the leucodsystrophires
236
leucodystrophy
X linked
enhancing peri trigonal white matter
237
leucodystrophy
thalamic calcification
optic nerve
Krabbe
238
Japanese encephalitis
bilateral thalamic oedema is classic
239
Cavernous haemagnioma MRI appearance
T2 btight but haemosiderin rim
popcorn calc in it
240
PML - after MRI what to do
can biopsy
241
what can toxoplasma do after treatment
bleed"
242
atypical teratoid / rhaboid tumour
very agressive quick growing.
kids under 2
haemorrhage
can look similar to medulloblastoma but seen in older kids
243
subependymoma
age group
enhancement
distinguish from subependymal giant cell astrocytoma.
older patients
doesnt enhacne
Size is the most important distinguishing feature compared to SEGA
244
how does a pilocystic astrocystoma enhacne
nodule and the wall of the cystic component enhances
in comparison to haemangioblastoma which will have only the nodule enhacnign
245
tx of haemangioblastoma
can embolise and then resect
246
how to categorise uterine abnormalities
which imaging modality
MR
247
hydatiform mole
complete
partial
invasive
complete mole
- no foetal parts. complete absence of baby.
- 46XX. super high bcg
partial mole
- foetal parts
- triploid karyotype
counseling and genetic tests looking for triploidy should be offered (chorionic villus sampling or amniocentesis).
248
