Radiodx Flashcards
Weightlifter on steroids, has scleral icterus and hyperechoic liver, Dx
Fatty liver
Cirrhosis
Steatohepatitis
Steatohepatitis
Male, obese, breast lump that is lucent with a thin rim, ultrasound is intensely hyperechoic
Gynaecomastitia
Pseudogynaecomastitia
Lipoma
Breast cancer
Lipoma – typically iso but can be hyper
Beta decay is
Nucleus has too many neutrons
Nucleus has too many protons
Shell has too many electrons
Emits gamma radiation
Emits X-rays
Nucleus has too many neutrons
Regarding technetium :
Half life of 8 hours is useful
Decay product Mo99 does not confer additional radiation to the patient
Produces energies 50-5000keV
Energy produced is high enough to pass through patient tissue
Produces beta and gamma rays
Energy produced is high enough to pass through patient tissue
ARPKD associations:
Caroli
Congenital hepatitic fibrosis
Von Meyenburg complexes
Congenital hepatitic fibrosis - the best one
VQ :
1 or more filling defects is high risk on PIOPED
Low risk excludes PE
Over 90% of changes resolve over 12 months
Unilateral loss of perfusion is more likely due to bronchial obstructing tumour than massive PE
Unilateral loss of perfusion is more likely due to bronchial obstructing tumour than massive PE
Some dude has CNS symptoms, MRI shows mixed signal cystic structures in bilateral thalami, some rim enhancing, basal meningeal enhancement
TB -
Cryptococcosis
HSV
Toxoplasmosis
Answe: Cryptococcosis
TB - probably not, because T2 dark
Racemose neurocysticercosis: cystic grape like structures in the basal cisterns
25 yo male tourist visiting friends, 2 days cough, fine subtle reticular opacities, right mid zone thin walled cyst, dx most likely
Mycoplasma
TB
PCP
Streptococcus?
Mycoplasma - pneumotocele can occur, walking pneumonia
37 yo woman undergoing IVF with multiple cystic lesions left adnexa, right ovary normal
Normal response
Hyperstimulation
PCOS
Tuboovarian abscess
Cystadenoma
Cystadenoma
Which rules determine ankle imaging in acute staging
Nexus
Ottowa
Montreal
Wisconsin
Gabes Lau
Ottowa
67 yo man in MVA haemodynamically stable but with chest pain. CTA chest shows 2 mm smooth outpouching just beyond the left subclavian artery:
Aortic pseudoaneurysm
Ductus diverticulum
Traumatic dissection
Others?
Ductus diverticulum
Ductus diverticulum: a developmental outpouching of the thoracic aorta, at the anteromedial aspect of the aorta - at the site of the aortic isthmus, where the ligamentum arteriosum attaches
The differential is an aortic pseudoaneurysm, which forms sharp margins with the aorta, the ductus diverticulum usually appears as a smooth focal bulge with gentle obtuse angles with the aortic wall
Young guy twisting injury with proximal fibulae fracture and lateral talar shift
Weber A
Weber B
Weber C
Maisonneuve
Tillaux
Answer:Maisonneuve: combination of a fracture of the proximal fibula with an unstable ankle injury = ligamentous injury and/or fracture of the medial malleolus
Tillaux: Salter Harris III fracture through the anterolateral aspect of the distal tibial epiphysis with variable displacement
- The anterior tibiofibular ligament avulses the anterolateral corner
- vertical fracture through the distal tibial epiphysis, with horizontal extension through the lateral aspect of the physis
- Differential is a triplanar fracture, which will have a metaphyseal fracture in coronal
Young man MVA with fracture anterior and posterolateral maxillary sinus, zygomaticofrontal region, zygomaticotemporal, zygomatic arch
Tripod
Lefort 1
Lefort 2
Lefort 3
Nasoethmoidal fracture
Tripod - does not mention pterygoid, otherwise would be Lefort3
Most likely to cause cyanosis :
PDA
VSD
ASD
Transposition of the great arteries
Patent foramen ovale
Transposition of the great arteries
Cyanotic CHD: the 5Ts
TAPVR
Transposition of the great arteries
Truncus arteriosus
Tetralogy of Fallot
Tricuspid valve abnormalities and hypoplastic right heart syndrome
Ebstein anomaly
Acyanotic CHD:
VSD
ASD
AVSD
PDA
Coarctation
Pulmonary stenosis
Renal transplant :
High RI is specific for rejection
Reversed diastolic flow indicates venous thrombosis
Lymphoceles accumulate radiotracer
Lymphoceles develop in the first few days
Answer: Reversed diastolic flow indicates venous thrombosis – true but not specific
High RI is not specific
A lymphocele may occur from 2 weeks to 6 months after transplantation with a peak incidence at 6 weeks
FSE TSE question which limits scan speed
TE
TR
TI
SAR
Answer: TR – echo train length
SAR – this depends on the strength of the magnet
40 yo with sacral destructive lesion with rings and arcs:
Chordoma
GCT
Chondrosarcoma
Answer: Chondrosarcoma
Chordoma common but no rings and arcs
Long stem about DOPS and shoulder ultrasound, which is best position to have arm for infraspinatus tendon
Internal rotation arm touching opposite shoulder
External rotation arm behind back
Abducted arm
Internal rotation arm touching opposite shoulder
Woman from med onc outpatients with RIF pain, enterocolitis with trilaminar appearance and middle layer 35 HU, most likely
Typhlitis
Crohn disease
Ischaemic
Radiation
Typhlitis
Patient brought to department for investigation over liver lesion. Patient says he’s in hospital for hernia repair and has no liver lesion. On checking it is the correct patient who’s been brought down
Wrong sticker on form
Patient is lying
Trolley bay mix up
CA has brought wrong patient
CT techs got it wrong
Wrong sticker on form
5 yo child with bilateral perihilar streaky opacities, pneumonia, organism
Mycoplasma
Streptococcus
Staphylococcus
Mycoplasma
Down screening which is used in 1st trim
Nasal bone length
Alpha fetoprotein
Twin vs singleton
Parity
Alpha fetoprotein – second trimester, none of the other make sense
1ST TRIMESTER: Combined serum screening
Performed at 9-12 weeks
Better detection rate the earlier its performed
Measures free B-HCG and PAPP-A
2nd TRIMESTER: Maternal serum screening
Performed at 14-20wks, ideally 15-17
Measures Alpha fetoprotein (AFP), free B-HCG, unconjugated oestriol +/- inhibin A
1ST TRIMESTER
Nuchal translucency
The fluid-filled subcutaneous space at the back of the fetal neck
Different to the nuchal fold = seen in the second trimester
Thickening is thought to relate to dilated lymphatic channels, a non-specific sign of generalised abnormality
Associations:
Aneuploidy :
Trisomies
Turner
Non-aneuploidy:
Congenital heart disease
Noonan syndrome
Congenital diaphragmatic hernia
Omphalocele
Skeletal dysplasia
VACTERYL
Miscarriage/fetal demise
Intrauterine infection - Parvovirus B19
<3mm is normal
3.4mm = risk of 7%, >8,5mm has a risk >75%
Correlate with serum markers
Further workup with amniocentesis and or chorionic villus sampling, as well as fetal echo
Technique:
Mid-sagittal plane, nasal bone, tip of nose, hard palate and diencephalon must be seen
Calipers are placed inside the hyperechoic edges
2nd TRIMESTER
Chorionic villus sampling: 11-12 wks
Amniocentesis: 15-18 wks
Foetal hydrops, chest lesion, stomach bubble normal place, see a vessel from below diaphragm in lesion
Sequestration
Congenital diaphragmatic hernia
Congenital adenomatoid malformation
Sequestration
Gastroschisis which is true :
Small defect 2-4 cm
Liver herniated 40-50%
Associated with chromosomal abnormalities
Covered by membrane
Small defect 2-4 cm - tends to be about 4cm, rare to have liver – should never have liver
30 year old male with a lump in soft tissues high signal on T1 weighted imaging without fat suppression
Lipoma
Liposarcoma
Haemangioma
Lipoma - High T1, if no fat sat…if says High T1 post FS, then think liposarcoma.
Long winded question about comparing US vs MRI for assessing haemangioma of liver, if TP=a, FP=b, TN=c, FN=d, how to calculate prevalence in their study population (I’m only sure on the last opDon, not sure if the other 4 are accurate)
a/b+d
a/a+c
b/a+c
b/c+d
a+d/a+b+c+d
a+d/a+b+c+d - prevalence is the number of cases / everyone in the population
True about PCP
Affects upper lobes more than lower
Commonly associated with pleural effusion
Often coexists with CMV
Often coexists with CMV - Cytomegalovirus (CMV) pneumonia is a complication presented by these patients when they are in a state of severe immunosuppression.
Patient during angiogram feels unwell with HR 50, BP 80/50
IV atropine 0.6 mL (dose?)
IM adrenaline 0.5 mL
IV adrenaline 1 mL (dose?)
Hydrocortisone?
Antihistamine?
IV atropine 0.6 mL (dose?)
Anaphylactic reaction 3 minutes after scan
IM adrenaline
IV adrenaline
Hydrocortisone
Antihistamine
Pretend you didn’t hear the code (I made this one up)
IM adrenaline
You find 1 cm nodule on routine preoperative X-ray in patient awaiting suspicious for cancer, what do you do (something about according to college guidelines)
Call referrer
Make sure secretary faxes report to GP
Fax report to GP and cardiothoracic surgeon
Tell referrer to read your report
Close the study and let someone else sort it out (I made this one up)
Call referrer
Most often proposed mechanism for NSF :
Free gadolinium gets into tissues and incites fibrotic response
Free Gd chelate gets into soft issues
Albumin bound Gd gets into issues
Some other combinations of chelated and otherwise bound Gd
Free gadolinium gets into tissues and incites fibrotic response
Nephrogenic systemic fibrosis
Occurs almost exclusively in patients with renal impairment + gad based contrast agents
May be due to transmetallation - the replacement of the gadolinium from the chelate and forming a free gadolinium ion, free gadolinium ions may then deposit in different tissues and result in inflammation and fibrosis
50 yo non smoker with 7 mm nodule
Do nothing
Follow up in 12 months and stop if unchanged
Follow up in 3-6, 9-12 and 24 months
Follow up in 6-12 months, then 18-24 months if no change
Further work up with other imaging
Follow up in 6-12 months, then 18-24 months if no change
Post menopause woman with 7.6 cm simple ovarian cyst
Refer to gynaecologist
Follow up in 6 weeks
Ultrasound guided aspiration
Do nothing
Follow up in 1 year?
Follow up in 1 year?
Post menopausal
3 - 5cm, F/U in 3-6mo for resolution
>5cm: F/U in 3 - 6mo for resolution/recharacterise or in 6-12 mo for growth assessment
Young woman 2.4 cm cystic ovarian lesion
Do nothing this is normal
Follow up in 1 year
Follow up in 6 weeks
Aspiration
Do nothing this is normal
Tubular breast cancer
Typically has 5 y survival of 70%
Is associated with further lesion in same or other breast in <5%
Can be essentially unchanged over several years
Can be essentially unchanged over several years
Most likely spiculated lesion
Fibroadenoma
Papillary neoplasm
Mucinous
Medullary
Tubular
Tubular
Spiculated lesion :
Sclerosing adenosis
Post surgical scar
Radial scar
Fat necrosis
IDC, DCIS
ILC
Tubular carcinoma
Bilateral renal ostial stenosis
Takayasu
PAN
FMD
NF-1
NF-1 - Renal artery stenosis in NF1 is usually ostial in location,
The most common vascular abnormality in patients with NF1 is bilateral or unilateral renal artery stenosis
FMD in comparison: 95% of all stenoses are found in the distal 2/3rds of the renal artery, more than 50% of all NF1 stenoses are located in the ostia
Renal nuclear medicine scans
DTPA has 100% glomerular filtration
MAG3 good for pseudotumour
MAG3 good for calculating GFR
Renal scan has blood pool, parenchymal and excretory phases
DTPA has 100% glomerular filtration
Phaeochromocytoma imaging
MIBG can tell benign from malignant
Octreotide can tell benign from malignant
PET can tell benign from malignant
Pheo does not drop signal on out of phase
Pheo does not drop signal on out of phase – Markedly hyperintense on T2 (light bulb
PHEO MRI
T1: slightly hypo to the remaining adrenal
More heterogenous if necrotic/haemorrhagic
T2: markedly hyperintense (light-bulb sign) ~1/3 will not have this
Necrosis and haemorrhage will alter the signal
In-phase/out of phase: no signal loss. Pheos do not contain a large amount of intracellular lipid
Heterogenous enhancement - prolonged, often up to 50min
Which determines cardiac artery dominance
Posterior descending artery
SA node supply?
AV node supply?
Posterior descending artery
Suspect implant rupture, best initial investigation
Mammography
US
MRI
CT?
Clinical exam?
US
Most recurrent breast cancers after treatment detected by
Patient self-examination
Surgeon
Mammography
Ultrasound
Patient self-examination
Young girl (21 perhaps) with long history of headache, with cystic frontal lobe lesion containing a calcified mural nodule
Ganglioglioma
Pilocytic astrocytoma
Oligodendroglioma
Ganglioglioma - common in younfer patients
GANGLIOGLIOMA
A partially cystic mass with an enhancing mural nodule is seen in ~45% of cases
Frequently calcified
65 yo woman with arm symptoms (?). MRI spine shows a 6.5 mm intramedullary lesion at the C6 level, slightly to the left, and a further 5 mm lesion at T6, in the central cord. Both enhance after gadolinium:
Astrocytoma
Ependymoma
Haemangioblastoma?
Metastases
Metastases
Cystic lesion deep to parotid extending to parapharyngeal space
1st brachial cleft cyst
2nd branchial cleft cyst
3rd branchial cleft cyst
Lymphangioma
1st brachial cleft cyst
Harlequin eye. Which fusion likely?
Metopic
Coronal
Sagittal
Mendosal
Lambdoid
Coronal
65 yo man with mass centred on cribriform plate, growing/invading into anterior cranial fossa and upper nasal cavity (?). Dx?
Esthesioneuroblastoma
Lymphoma
Esthesioneuroblastoma - bimodal (10-20, 50-60)
15 yo girl with right sided abdominal pain. Mildly to moderately tender right iliac fossa. Ultrasound shows enlarged mesenteric lymph nodes. Appendix not seen. What is true of intussusception :
12 hour duration is contraindication to pneumatic reduction
X-rays usually demonstrate no abnormality
Viral gastroenteritis is a recognized risk factor
Small bowel obstruction is a contraindication to pneumatic reduction
Viral gastroenteritis is a recognized risk factor
Performed in paediatric patients with an ileocolic intussusception
A catheter is inserted into the rectum, and under fluoroscopic guidance air is instilled into the large bowel
IV access, staff and equipment for fluid resuscitation with the back up of a paediatric surgeon
Pressure 60-100mmHg are used: 3 attempts lasting 3 minutes
Success is achieved which reduction of the mass and air refluxes into the terminal ileum
Contraindications:
Signs of peritonitis
Perforation
Complications:
Less likely to be successful if:
Associated SBO
Over 24hrs of symptoms
lethargy
Best way to tell infection from Charcot joint :
Effusion with thin rim of enhancement
Sinus tract to bone
Sinus tract to bone
CHARCOT JOINT
Density change (subchondral osteopenia or sclerosis)
Destruction (osseous fragmentation and resorption)
Debris (intra-articular loose bodies)
Distension (joint effusion)
Disorganisation
Dislocation (joint mal-alignment due to ligamentous laxity
Patient with past history of metastatic breast cancer. Constant shoulder pain. Normal x-ray. Best test
Ultrasound
CT
MRI
NM bone scan
?
MRI
14 yo fat kid has a sore knee. Third presentation, previously x-rays of knee normal. For repeat knee xray. What would you do?
AP and lateral knee x-ray
AP and lateral hip x-ray
AP and lateral hip x-ray ? SCFE
Regarding non-accidental injury
Bone scan will become positive after x-ray changes are visible
Anterior rib fractures are more common than posterior
Long bone spiral fractures are typical
Metaphyseal corner fractures associated with twisting injuries
Long bone spiral fractures are typical? if non ambulatory very sus….
Patient from rheumatology clinic with infraspinatus wasting. Most likely
Ganglion cyst at suprascapular (?) notch
Ganglion cyst at spinoglenoid notch
Ganglion cyst at spinoglenoid notch
Traumatic knee dislocation:
Common peroneal nerve is more commonly injured than Tibial nerve
DSA is necessary in all patients to rule out vascular injury
Can occur without fractures
Patellar tendon is always completely torn
Answer: Common peroneal nerve is more commonly injured than Tibial nerve
Can occur without fractures
Child with previous history of meningococcal meningitis, now with unilateral sensorineural hearing loss
Otosclerosis
Some other kind of otosclerosis
Labyrinthitis ossificans
Labyrinthitis ossificans
Thyroid nuclear medicine imaging :
De Quervain shows low uptake initially
High uptake in factitious thyroiditis
Low uptake in TSH driven thyroidititis
Toxic nodule demonstrates increased uptake of surrounding thyroid tissue
Answer: De Quervain shows low uptake initially - The initial thyrotoxic phase is associated with thyroid pain, high serum thyroid hormone levels with a low radioiodine uptake.
High uptake in factitious thyroiditis – Will be low
Low uptake in TSH driven thyroidititis – No it is high
Toxic nodule demonstrates increased uptake of surrounding thyroid tissue
Nigerian man with bladder calcifications and a soft Tissue mass. Most likely?
SCC
TCC
Adenocarcinoma
SCC
Best sequence for assessing bladder cancer invasion
T1
T2
PET/CT
CECT
US
T2 - this is best, T1 rubbish in pelvis ex for l/nodes!
55 year old male with basal ganglia haemorrhage.
Hypertension
Amyloid angiopathy
Underlying lesion
Hypertension
Young female with positive beta-HCG. Has pain and ultrasound shows a 5cm heterogeneous mass in the adnexa. Trace fluid in the pelvis
Haemorrhagic corpus luteal cyst
Ruptured ectopic pregnancy
Unruptured ectopic pregnancy
Normal corpus luteum
Haemorrhagic cyst
Unruptured ectopic pregnancy
Biopsy proven radial scar, next step
a. WLE + SLNBx
b. Hook wire + Open biopsy
c. Nothing
d. Follow-up imaging
b. Hook wire + Open biopsy
Considered a high-risk breast lesion. Core and FNA underestimate the underlying associated malignancy and are controversial > the lesion is biopsied and removed
PASH benignity?
a. Always benign
Pseudoangiomatous stromal hyperplasia. Benign stromal proliferation
likely hormonal driven as only seen in premenopausal women or post-menopausal
women on HRT.
Proliferation of myofibroblasts and stromal elements.
Can mimic a mass.
Lobular ca
Only visible on one view –
Not visible on US -
Answer: Only visible on one view –
most commonly seen as a spiculated mass on mammography (50-68%) but other findings include occult mass, only-visible-on-one view focal density (3-19%) or architectural distortion (20%). ILC represents 10-15% of breast carcinomas. Sensitivity on mammography is 71%.
Not visible on US - Usually a mass lesion with irregular borders and acoustic shadowing 60%. Sensitivity is 88%. (MRI 93%).
Some breast lesion complicated by some other lesion due to radiotherapy, what do to
Total mastectomy
Cut out the lesion
Answer: Total mastectomy – If suspect angiosarcoma -> core -> mastectomy
Secondary angiosarcoma, related to prior therapy of breast cancer, has an estimated incidence of ~0.09-0.16% and occurs in older women (peak age 6th decade).
Can be occur on mammography
Surgical excision with wide margin is the standard of care, typically a mastectomy.
Patient presents to breast screen with symptoms, which is most concerning?
Bilateral nipple retraction
Cyclical pain
Focal pain
Serous nipple discharge
Milky nipple discharge
ANSWER: Serous nipple discharge - Likely a DCIS esp unilateral
Bilateral nipple retraction – can be pre-existing
Cyclical pain - Pain less concerning, especially cyclical
Focal pain - Less concerning
Milky nipple discharge Normal during pregnancy
Tubular breast cancer most true
Can be stable on imaging over years
Comprised of >90% well-formed tubules.
70% 10 yr survival
ANSWER: Can be stable on imaging over years - slow growing with low metastatic potential.
70% 10 yr survival : False higher survival rates (95-98% at 5 years)
Obese lady, cant get pregnant what will you find
10 (!) cysts, small
Bilateral mixed echoic lesions
Hydrosalpynx
ANSWER: Bilateral mixed echoic lesions (chose that for endometrioma, but might be wrong)
The most common overall cause of female infertility is the failure to ovulate, which occurs in 40% of women with infertility issues. Not ovulating can result from several causes, such as: Ovarian or gynecological conditions, such as primary ovarian insufficiency (POI) or polycystic ovary syndrome (PCOS)
Rotterdam criteria, what is not included?
Cysts individually >10mm
> 12 cysts
Hyperandrogenism
Anovulation
Peripherally distributed cysts
ANSWER: Cysts individually >10mm – they are small cysts
> 12 cysts - True then however no longer true
Hyperandrogenism - True
Anovulation - True
Peripherally distributed cysts - True
The diagnosis of PCOS generally requires any two of the following three criteria for the diagnosis, as well as the exclusion of other aetiologies (e.g. congenital adrenal hyperplasia, Cushing syndrome, and/or an androgen-secreting tumour):
- ovulatory dysfunction (oligo- or anovulation)
- clinical and/or biochemical hyperandrogenism
- polycystic ovarian morphology on ultrasound
Features include:
increased follicle number per ovary (FNPO) - usually 20 or greater
individual follicles are generally similar in size and measure 2-9 mm in diameter
peripheral distribution of follicles; this can give a “string of pearls” appearance
background ovarian enlargement (volume greater than 10 mL)
central stromal brightness +/- prominence
Antenatal scan at 7 weeks gives gestational age of 35 weeks. Scan at second trimester gives gestational age of 33 weeks. Foetus currently measuring 32 weeks. Most correct:
Use 7 week scan, foetus small for gestational age
Use 2nd trimester scan, foetus is within normal size limit
Use 2nd trimester scan, foetus is small for dates
Use 7 week scan, foetus small for gestational age
Middle aged woman with 1.5cm echogenic renal lesion on ultrasound. On MR lesion is T1 and T2 intense with no enhancement. MOST LIKELY
Haemorrhagic cyst
Proteinaceous cyst
Angiomyolipoma
Renal cell carcinoma
ANSWER: Proteinaceous cyst
Haemorrhagic cyst - Should have a fluid-fluid level.
Angiomyolipoma - Heterogenous on T1 and T2 imaging due to variable amounts of fat and muscle. Variable enhancement, usually hypoenhancing relative to renal parenchyma.
Renal cell carcinoma – unlikely to have no enhancement
HSV encephalitis
HSV 1 most common in adults
Haemorrhagic necrosis common
HSV 1 most common in kids less than 10
ANSWER: HSV 1 most common in kids less than 10 True - Neonatal HSV is HSV-2 but childhood is usually HSV-1.
HSV 1 most common in adults True
Haemorrhagic necrosis common True
NF1, false
Lisch nodules
Meningioma
Neurofibroma
Freckles
Meningioma - False
15 yo with seizure. Hypodense cortical lesion. Cystic
ANSWER: DNET Multicystic
WHO grade 1, sharply demarcated and often points towards the ventricle, temporal lobe most common.
30% demonstrates focal or ring enhancement.
Very T2 bright.
Teenager with cystic lesion under chin with multiple hypodense nodules (repeat)
ANSWER: Dermoid (ranula just fluid, won’t have fat)
- Patient with hyperthyroidism, next step
Tc99 Pertechnetate
MRI
US
CT with contrast
I131 diagnostic test
Tc99 Pertechnetate
Pancreatic lesion. Hepatic lesions: one heterogenous, one hyperdense, one hypodense, which one biopsy? (repeat)
ANSWER: Heterogenous hepatic lesion
Pancreatic lesion with multiple cysts (more than 6), measures 4 cm. Location not mentioned. Age not mentioned. Most likely?
IPMN
SPEN
MCN
SCN
ANSWER: SCN
IPMN Possible but less likely
SPEN Usually more solid/cystic with haemorrhagic component
MCN Multiloculated but usually large (up to 12cm)
Gallbladder ca least likely :
Generalised thickening
Old person with otherwise normal
ANSWER: Old person with otherwise normal
Virtually all have gallstones
20% polypoid mass
Mass replacing gallbladder invading liver 2/3
Irregular focal or diffuse GB wall thickening 20%
Calcified gallstones or porcelain gallbladder
Elderly females
Usually asymptomatic – often an incidental finding or found due to disseminated metastatic disease
Very poor survival rates, 4% 5 year survival
DDx:
Xanthogranulomatous cholecystits
Adenomyomatosis
Chronic cholecystitis
Chest lesions after trauma
Splenosis - can occur in the thorax if there is diaphragmatic injury
Associations, true
This strange worm with duodenal obstruction
Strongyloidiasis produces duodenal dilatation and wall thickening
ANSWER: This strange worm with duodenal obstruction - Ascaris Lumbricoides known for causing biliary tract and small bowel dilatation, can also cause hepatic abscesses and ascaris pneumonitis
Ascaris Lumbricoides
Large round worm – can block the bowel
Severe cases such as hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), can involve pulmonary manifestations.
Spectrum of changes that can involve the lung include
pulmonary infiltrates with eosinophilia
asthma without infiltrates
haemoptysis: from alveolar haemorrhage
hyperinfection syndrome
acute respiratory distress syndrome
lung abscess formation
interstitial infiltrates/fibrosis
cavitary lesions
Todani classification, dilation of intra-duodenal bile duct?
1
2
3
4
5
3
1: Fusiform dilatation of the extrahepatic bile duct
A - entire duct
B - focal segment
C - common bile duct
2: Bile duct diverticulum - saccular outpouching arising from the supraduodenal extrahepatic bile duct or the intrahepatic bile ducts
3: Choledochocele - protrusion of a focally dilated, intramural segment of the distal common bile duct into the duodenum
4: Intra and extra-hepatic duct cysts
4a - Fusiform dilatation of the entire extrahepatic duct with dilataion of the intrahepatic bile ducts
4b - multiple cystic dilations involving only the extrahepatic bile duct
5: Caroli disease, cystic dilation of the intrahepatic ducts
Young Asian girl, right iliac fossa pain, on US see pouch like structure arising from anterior caecal wall, with highly echogenic structure within, most likely
Appendicitis
Crohns
Caecal Diverticulitis
Mesenteric adenitis enlarged lymph nodes
Appendicitis
Old guy, CT abdomen shows fusiform AAA with thick wall, raised ESR, most likely
Inflammatory aortitis
Mycotic aneurysm
ANSWER: Inflammatory aortitis
Mycotic typically a saccular aneurysm, 75% due to salmonella . 95% are AVSD – usually fusiform
Inflammatory aneurysm – patients typically around 10 years younger (50s), risk of rupture is less, they are symptomatic before rupture with back pain, 90% have an elevated ESR, inflammatory change centred on the adventitial with infiltrate of inflammatory cells including lymphocytes, macrophages and plasma cells and fibrosis. Often relative sparing of the posterior wall of the aorta. Can be isolated and may be autoimmune, or part of IgG-4 disease with renal hydronephrosis.
Multiple hyperdense nodules in lung most likely?
Renal osteodystrophy
Sarcoid
Mets
ANSWER: Renal osteodystrophy Could be metastatic calcification
Sarcoid Less likely. Lymph nodes – 20% calcify. Lung nodules less frequent
Mets Could be
Sarcoid least likely
Lower lobes affected
Upper lobes affected
Some other stuff???
ANSWER: Lower lobes affected
TB T/F
Calcified apical
Ghon focus
Miliary lung lesions
ALL TRUE
Elderly male CTA post AAA stent. Mildly hyperdense leak thought to be due to graft porosity
Endoleak, which one?
1
2
3
4
5
ANSWER: 4
A common complication of EVAR, found in 30-40% intra-operatively, and 20-40% post operatively
Several causes:
1 - leak at graft attachment site
1A - proximal
1B - distal
1C - iliac occluder
2 - aneurysm sac filling via branch vessels
2A - single vessel
2B - two vessels or more
3 - leak through defect in the graft
3A - junctional separation of the modular components
3B - fracture or holes involving the endograft
4 - leak through graft fabric as a result of graft porosity, often intraoperative and resolves with cessation of anticoagulants
5 - continued expansion of aneurysm sac without demonstrable leak on imaging
Regarding berry aneurysms, not true?
Most are anterior
Complication due to vasospasm in first 24 hours
ANSWER: Complication due to vasospasm in first 24 hours False 4-14 days post SAH, peaking at 7 days typically
Newborn (sex not provided), brother DDH, best management (rep)
US in 6 weeks
Xray in 2 month
ANSWER: US SIX WEEKS
Newborn, no meconium, ileum meconium filled. Microcolon. Most likely
Meconium ileus
Meconium plug syndrome
Hirschprungs
Ileal atresia
ANSWER Meconium ileus
Indicative of cystic fibrosis
Newborn with lung lesion and feeding vessel
Sequestration
CPAM
CDH
ANSWER: Sequestration Depends where vessel coming from – sequestration is systemic arterial supply and variable venous drainage (systemic extralobar and pulmonary intralobar)
T21 associated with
Hirschprungs
Others include:
- 40% congenital heart disease – ASD (ostium primum), VSD, endocardial cushion defect
- Oesophageal atresia
- Duodenal atresia
- Imperforate anus
- 10-20x increased risk of childhood acute leukemia (both ALL and AML)
- Early onset Alzheimers disease
- Autoimmune disease and infections
- Umbilical hernias
- Hearing loss (conductive, middle ear infections)
- Atlanto-axial instability
- Moya moya disease
Kid with posterior fossa tumour extending through the 4th ventricle foramina
Hemangioblastoma
Medulloblastoma
Pilocytic astrocytoma
Ependymoma
ANSWER Ependymoma
6 months old with eventration of the right hemidiaphragm. Previous cxr normal. Cause?
Mixed CPAM / sequestration
CPAM
Lobar emphysema
Bronchial atresia
ANSWER: None of the above
T/F: Neuroblastoma can spontaneously resolve even if metastasised.
ANSWERTrue – neuroblastoma, ganglioneuroblastoma and ganglioneuroma can demonstrate spontaneous or therapy induced differentiation into mature neural elements, regression and a wide range of clinical behaviour and aggressiveness.
T2 signal in anterior aspect of medial tibia and femur of the medial condyle. ? mechanism
Hyperextension and varus
Hyperextension and valgus
Flexion and varus
Flexion and valgus
Pivot shift ACL
ANSWER: Hyperextension and varus
Flexion and valgus – This is ACL mechanism. Kissing contusion is posterolateral tibial plateau and lateral femoral condyle
Pivot shift ACL – a valgus load applied to a flexed knee with a variable degree of internal rotation of the femur
Unicameral bone cyst involves :
Epiphyseal location
Metaphyseal intramedullary
Are more common in the femur than the humeru
Usually contain fluid fluid level on MRI
ANSWER: Metaphyseal intramedullary – usually central, metaphyseal and medullary
Epiphyseal location - False
Are more common in the femur than the humerus False. Humerus is the most common location.
Usually contain fluid fluid level on MRI – only if there has been a fracture
Unicameral bone cyst, which is most correct: (TW) 2005, 2006
Are more common in the femur than the humerus
Involve the epiphysis in about 30% of cases
Contain fluid fluid levels on MRI in greater than 50% of cases
Arise eccentrically in the metaphysis
Migrate into the diaphysis with time
Arise in the metaphysis
Fallen fragment sign may be seen in half of cases
ANSWER: Arise in the metaphysis True
Migrate into the diaphysis with time True – grows with the child, does not cross the physeal Plate
Are more common in the femur than the humerus False – humerus most common location (although calcaneus is the most common in adults)
Involve the epiphysis in about 30% of cases False
Contain fluid fluid levels on MRI in greater than 50% of cases False – this is seen in SBC with a pathologic fracture
Arise eccentrically in the metaphysis False – central lesion
Fallen fragment sign may be seen in half of cases False
Best test for check of infected prosthesis (repeat)
MRI
White cell scan
White cell scan
Otherwise healthy man with sudden back pain during gardening. What to do next?
No imaging for 6 weeks
MRI
Xray - the other option
CT lumbar spine
No imaging for 6 weeks – if no red flags present otherwise do an x-ray
Young female runner, hip pain for several months, impacting on her professional running. Improves with rest. MR shows high signal in region of anterior femoral neck which tracks toward lesser trochanter, most likely?
Snapping gluteus maximus
Trochanteric bursitis
Tear at iliopsoas
ANSWER: Tear at iliopsoas
Snapping gluteus maximus – happens externally over greater trochanter
Trochanteric bursitis - Unlikely to cause bone marrow oedema. Does improve with rest.
Avascular necrosis, which one is not a cause?
Thalassemia Major
Sickle cell anaemia
Caisson
Gaucher
Subcapital femoral fracture
ANSWER: Thalassemia Major
Aetiology
Traumatic - usually unilateral
Chronic corticosteroid therapy
Alcoholism
Smoking
Systemic lupus erythematosus (SLE)
Hyperlipidaemia
HIV
Haemoglobinopathies
Chronic renal failure
Diabetes Mellitus
Pregnancy-related
Define Prevalence a true positive b true negative, c false positive, d false negative, n total population
a / a+b
b / a+c
a + d / n
a +c / n
ANSWER: a + d / n
number of cases (true positive+false negative)/total population)
You want to MR with contrast on a patient with egfr 29, what to do
Macrocyclic gadolinium
Linear gadolinium
Do not give contrast
ANSWER: Macrocyclic gadolinium (true) true – cyclic contrast agents reduce risk
Linear gadolinium false – linear agents are less stable and increase risk to dialysis immediate after
Can be considered hemodialysis reduces amount of gad by 75% but no proof it reduces chance of NSF
Do not give contrast False – risk of NSF is sGll low at <0.1% per dose
You do a lung biopsy, as you withdraw stylet patient coughs and has a seizure ? cause
Air embolus
Anaphylaxis
Air embolus
IV contrast anaphylaxis post CT, what to give?
IM adrenaline 1:1000, 0.5ml
IV adrenaline 1:1000, 0.5ml
Chlorprometazine
Other drugs
IM adrenaline 1:1000, 0.5ml
Access for permacath type of tunnelled CVL
Right IJV
Leo IJV
Right suclavian
Leo subclavian
Right IJV
Man with suspected pancreatic cancer is coming for an image guided biopsy. He is a type 2 diabetic on metformin and also on clopidogrel and clexane. Normal renal function. What advice do you give prior to biopsy.
Stop clopidogrel 10 days? prior, clexane 12 hours prior.
Stop clopidogrel 12 hours prior and clexane 10 days prior
Stop metformin 48hrs prior and clopidogrel 10 days prior?
Stop metformin 24hrs prior
Stop metformin 48 hrs prior and clexane 12 hrours prior?
ANSWER Stop clopidogrel 10 days? prior, clexane 12 hours prior. Answer (although usually only need to stop clopidogrel for 5 days)
Mag 3 scan for renal function, what do you explain to the patient (repeat)
Injection, immediate imaging for 30 minutes
Injection, immediate imaging for 3 hours
Injection, scan after 24 hours
Injection scan after 48 hours
Injection, immediate imaging for 30 minutes True
Young chap with cough and fever, what would the VQ scan look like
Multiple matched defects
Multiple mismatched defects
Intact perfusion, decreased ventilation
ANSWER: Multiple matched defects - seen in Pneumonia
35 yo male lesion inferior to lesser trochanter peripheral cal, centrally hypodense, faint curvilinear calcs, femoral cortex intact:
Osteosarc -
Periosteal chondroma
Osteochondroma
(? myositis ossificans)
ANSWER: (? myositis ossificans)
Osteosarc - unlikely
Periosteal chondroma – saucerisation : possible
Osteochondroma - also unlikely
Acute onset confusion in 65 yo female, inferior mesial temporal lobe with DWI restriction and T2 high signal:
MCA stroke
HSV
paraneoplastic syndrome
CADASIL
ANSWER: HSV: only if it spares the basal ganglia
Young guy with grey white matter differentiation, partying, thunderclap headache, LP had nothing, CT had grey white matter loss in frontal lobe:
Cerebral venous thrombosis
RCVS
Berry aneurysm
ANSWER: RCVS - thunderclap headache makes this possible, but CVT also possible
Stented left ICA, bilateral frontal infarcts repeat:
Azygos vessel A1
Kid with seizures, T2 high signal, bubbly:
DNET
35 yo repeated seizures, T2 high signal mesial temporal lobe, assoc:
Ipsilateral fornix atrophy
contra fornix atrophy
mamillary body hypertophy
choroidal atrophy
Ipsilateral fornix atrophy
Tectal beaking is assoc with what:
Chiari 2
Chiari 1
DWM
Agenesis of CC
Holoprosencephaly
Chiari 2
5 yo girl with midline 4th ventricle tumour extending through foramina with some calc:
Ependymoma
JPA
Medullo
Ependymoma ( calc 30-40%)
Most likely tumour arising from septum pellucidum in lateral ventricle in 40 yr old:
Central neuryoctyoma
Meningioma
metastasis
Choroid plexus lesion
Central neuryoctyoma
Most likely tumour arising from septum pellucidum in lateral ventricle in 40 yr old:
Central neuryoctyoma
Meningioma
metastasis
Choroid plexus lesion
Central neurocytoma
5 yr old with lump mixed echos
dermoid
Ranula
4th BCC
Lymphangioma
dermoid if its this repeat one
Location of a lymph node between hyoid and base of skull anterior to post SCM
2a
Young guy with SOB, CL nodules and GG change non-smoker:
Sarcoid
HP
OP
DIP
NSIP
HP
What’s the appearance on VQ in pneumonia:
recall, reverse mismatch, matched multiple perfusion, large, etc
multiple matched perfusion
V/Q: Results -
Ventilation Scan is abnormal but perfusion scan is normal indicating abnormal airway suggesting COPD or ASTHMA.
Ventilation Scan is normal but perfusion is abnormal indicating any obstruction to the blood flow (perfusion), may be because of the PULMONARY EMBOLISM obstructing the flow.
Both scans are abnormal. It may be found in PNEUMONIA or COPD.
24 yo female marathon runner VQ scan low probability and CXR normal:
No further imaging
CTPA,
VQ in 1 wk,
Do US bilateral legs
no further
Young fit guy with back pain while gardening, afebrile, otherwise well:
Do nothing
MRI
XR
CT
do onthign
Soft hard q about 1.5T vs 3T:
More susceptibility weighted artefact,
Dropout on out of phase on 3t is higher,
300 Gauss is further from the bore,
Fluid higher on T1 GRE than grey maber on 3T
300 Gauss is further from the bore,
Mid ileal dilation and 5cm strIcturing distally:
Crohns
Carcinoid,
Coeliac,
Scleroderma,
Lupus
Crohns
Lesion in ileum with desmoplastic reaction:
Carcinoid,
Adenocarcinoma,
Carcinoid,
Repeat: re barium study:
Increase jejunal folds in coeliac
Whipples has thickened nodular folds
Haematogeneous mets occur at mesenteric border
ANSWER: Whipples has thickened nodular folds
Increase jejunal folds in coeliac, F (jejunal smooth, ileum folded)
Haematogeneous mets occur at mesenteric border -F
Intraduodenal cyst continuous with CBD:
I,
II,
III
IV,
V
3
Which is more common in UC vs CD:
Pseudopolyps
Episcleritis,
Nephrophthisis,
Pseudopolyps
Least common with Ank spond:
MTP involvement
Uveitits
MTP involvement
Prevalence calculation a= TP b=FP, c= TN, d = FN, N = total number:
a+b/N,
a+d/N
b+c/N, c+d/d, etc
a+d/N
Thickening of gastric rugal folds with preservation - recall:
MALToma –
gastric adenocarcinoma intestinal type,
gastric adeno ca infiltrating (linitis plastica),
GIST
MALToma –
Rpt about pancreatic ca:
> 90% can detect unresectale on CT
Vascular and perineural invasion,
Most commonly in the head - 70%
body and tail are spared
ANSWER >90% can detect unresectale on CT
OR Most commonly in the head - 70%
Porosity leak in aortic graft. what is the most common endoleak (very sneaky quesGon)
Type I,
II
III,
IV,
V
4
Repeat about guy with MEN and diffuse dense pulmonary nodules with uptake on bone scan:
Metastatic pulmonary calcification, -
Sarcoid,
Aleveolar microlithiasis,
Other
Metastatic pulmonary calcification, -
Knee injury, contusions on anterior medial femur and medial tibia:
Valgus with extension,
Varus with ext
Valgus with lfexion,
Varus with flexion,
Pivot shio
Varus with ext
CT cystogram with contrast in perineum and extraperitoneal space, most likely injury to:
Bladder base,
Bladder dome,
prostatic urethra,
bulbous,
Membranous
Membranous
- if perineum + extra peritoneal = membranous
Rpt about diffusely thickened and irregular uterus:
Adenomyosis,
Fibroids,
some others
Fibroids,
Guy with previous rheumatic fever, presents with heart failure, fever, meningeal symptoms, what is most likely:
Ring enhancing cerebral lesions,
Leptomeningeal enhancement, ??
Ring enhancing cerebral lesions,
Lady with sudden onset headache, diplopia, ct shows nodular thickening of lateral rectus with no enhancement:
Spontaneous lateral rectus haematoma,
Inflammatory pseudotumour,
Sarcoid,
Thyroid ophthalmopathy
Spontaneous lateral rectus haematoma,
Lady with medial canthus thickening and pain, CT shows ring enhancing hypodense lesion in medial canthus:
Dacrocystocele –
Inflammatory pseudotumour,
Thyroid?
Dacrocystocele
High T3, high T4, low TSH, next test?
US .
NM- pertecnetate study
MRI,
CT
NM- pertecnetate study. Patient has Graves
Inflammatory pseudotumour involves all except? rpt:
Brain
Cavernous sinus,
Lacrimal gland,
Orbital apex,
Orbital muscles (
Brain
What is the most common tumour of the distal small bowel?
Carcinoid
Subperiosteal resorption on radial side of fingers, other HPTH things, most likely:
Osteopetrosis,
Pyknodysostosis,
Renal osteodystrophy
Renal osteodystrophy
Rpt most true about cholesteatoma:
Small most commonly in prussak space
Scutum of erosion should think of different pathology
Small most commonly in prussak space
Rpt: guy with headache, expansion of petrous apex, high T1 and T2 lesion:
Cholesterol granuloma
Metastasis,
Chondrosarcoma,
Petrous apicitits,
High jugular bulb
Cholesterol granuloma
Rpt about spine least likely:
one of the answers was about limbus vertebra being anterosuperior, - typically
chance fracture always assoc with neurology
flexion injury with ventral cord injury
chance fracture always assoc with neurology
Kid with no passed meconium, contrast enema shows microcolon with filing defects in ileum and asC colon:
meconium plug - “syndrome”
meconium ileus
hirschsprungs, ileal atresia
meconium ileus – Ans, commonly in TI, CF
Expected AXR findings in NEC:
various answers to do with bowel wall thickening,
Intramural gas
Intramural gas
Immigrant 5 yr old with lucent lung, which is true to identify abnormal lung:
Increased vasc = normal side ( in swyer james)
Enlarged PA = abnormal side,
Change on exp = abnormal side,
If lung herniates to one side that side is abnoral,
If lucent side is on side of caridac apex, that is abnormal
Increased vasc = normal side ( in swyer james)
Which is not a part of PCOS:
> 12 follicles (now 20),
Follicle > 10mm size
Peripheral distribution of follicles,
Hyperandrogenism,
Anovulation
Follicle > 10mm size
25 yo girl unable to get pregnant (rpt) what is most likely on tVUS:
varieties of anechoic cysts on one or both ovaries, and >10 follicles on both ovaries
Cant remember stem, might be part of 2qs:
OA involves medial and lateral equally
CPPD preferentially involves PFJ
Early articular cartilage degeneration in ?CPPD, involves both sides of joint
CPPD preferentially involves PFJ
35 yo guy with pain in elbow while lifting weight, has bruising and limited elbow flexion:
Biceps tendon musculotendinous junction tear,
Biceps tendon insertion tear
Brachialis tear,
CFO/CEO tear?
Biceps tendon musculotendinous junction tear,
Kid with ulnar coronoid fracture, radial head fracture, elbow dislocation, what is most likely injured:
RCL ,
CEO,
Lat ulnar collatera
Lat ulnar collateral (unhappy triad)
Atypical ductal hyperplasia, had breast MR which was normal, what to do next:
back to normal screening,
6 months and yearly screening,
mastectomy,
some type of excision biopsy after localisation - hook wire and something
some type of excision biopsy after localisation - hook wire and something
Trauma, guy has haematuria, no perinephric collection but there is reduced attenuation of kidney, next step:
Cath angiogram
Thrombolysis,
repeat CT tomorrow,
some other treatment
Cath angiogram - CT angiogram if an option
Not spiculated:
Tubular,
Medullary
ILC,
??IDC
Medullary
Someone with AML, most likely assoc?
LAM
Cutaneous angioma,
Ependymoma,
Phaeochromaocytoma (may be path)
LAM
Regarding AVN (RPT):
MRI picks up changes earlier than Tc99m,
Early xr change is subchondral lucency,
Early cartilage loss, most get degen on both sides of joint
MRI picks up changes earlier than Tc99m
RPT true re parathyroid:
T2 best at finding parathyroid adenoma,
Most common ectopic parathyorid is superior to thyroid,
T2 best at finding parathyroid adenoma,
RPT UBC is most commonly:
Intramedullary metaphyseal,
Epiphyseal,
some others
Intramedullary metaphyseal,
Most common cause of pseudomyxoma peritonei
Appendiceal mucocele
Appendiceal mucinous cystadenocarcinoma
Mucinous ovarian tumour
Appendiceal mucinous cystadenocarcinoma
Least associated with NEC
Premature
Initiation of enteral feeding
Intramural gas descending and sigmoid
Intramural gas descending and sigmoid
Ischaemic bowel, most specific finding
Bowel dilation
Intramural gas
Fixed small bowel
Intramural gas
6 months old – posterior and medial bowing of tibia and fibula
NF
Physiological (peak 6-12 mo)
Fibrocartilaginous dysplasia - varus deformity
Blounts
NF - if pseudoarthrosis basically NF1, anterolateral
Blounts
Congenital assoc with leg length discrepancy (post medial likely congenital)
Anterior is bad, posterior is good
Recurrent lateral ankle inversion and posterior and lateral swelling, most likely injury
ATFL
AInferior TFL
Spring ligament
Deltoid
PTFL
PTFL
65M with knee pain, most likely association
Asymmetrical patellofemoral suggests CPPD
OA affects medial and lateral comps evenly
Ossification of the meniscus with HADD
Asymmetrical patellofemoral suggests CPPD
Parathyroid adenoma, most useful for localising
MRI with T2 most sensitive
Don’t demonstrate gad uptake
Tech 99 pertechnetate
US
MRI with T2 most sensitive
Most likely for gout
Aspiration was clear
Gouty tophi within 1-2years
First episode polarticular
Myelogenous disease recognised cause of gout
Myelogenous disease recognised cause of gout
6yr M – bone resorption radial 2nd and 3rd phalanges, prominent trabeculae, widening of epiphysis
Renal osteodystrophy
40M – HIV – multiple small hyperdense nodules liver and spleen – most likely
Hydatid
Amoeba
Candidiasis
Karposi sarcoma
Gram positive
Candidiasis
History of preeclampsia. Relevance of uterine artery dopplers
Second trimester should be low resistance
No predictive value for pre-eclampsia
High resistance near cord insertion placenta
RI <0.9 is normal
Second trimester should be low resistance
3yr child, left sided sensorineural hearing loss, CT showed cochlear and vestibule in figure of 8 formation. Cochlear missing septation
Cystic vestibulocholear malformatioN
Large vestibular aqueduct
Cochlear hypoplasia
Cystic vestibulocholear malformatioN
Least likely associated
Limbus vertebrae most likely anterior superior endplate
Chance fracture nearly always a/w neurological injury
Cervical flexion teardrop fracture a/w ventral cord injury
Chance fracture nearly always a/w neurological injury
Ankylosing spondylitis, least likely associated
Hip, shoulder and knee involvement
MTP/MCP involvement
Inflammation of annulus fibrosis
MTP/MCP involvement
IVDU. Headache. Normal CT brain. No bleed on LP. Presents with stroke like symptoms
RCVS
SAH
RCVS
MRI brain. High T2 signal spaces, non-enhancing. Leptomeningeal enhancement/thickening around the base of skull
Cryptococcosis
Neurocysticercosis
Metastases
Lymphoma
Toxoplasmosis
Cryptococcosis
CNS cryptococcosis
Epi: AIDS or people with bird contact
There are three dominant CNS forms to the disease depending on which part of the brain is affected:
meninges: meningitis (leptomeningeal enhancement and pachymeningeal enhancement)
parenchyma: cryptococcomas
perivascular spaces: gelatinous pseudocysts
Meningitis and cryptococcomas are seen in immunocompetent hosts usually and gelatinous pseudocysts are more common in patients with HIV/AIDS.
Post partum woman with headache. Bilateral low density thalami on MRI. Most likely cause?
Cerebral venous thrombosis
MCA infarcts
Lymphocytic hypophysitis
Cerebral venous thrombosis
Cystic lesion adjacent to submandibular gland, between internal and external carotid artery, anterior to SCM
1st branchial cleft cyst
2nd branchial cleft cyst
3rd branchial cleft cyst
4th branchial cleft cyst
2nd branchial cleft cyst
Painful eye in female. Diffuse thickening of the medial rectus with surrounding fat stranding, (didn’t state enhancement characteristics)
Thyroid eye disease
Idiopathic inflammatory disease
Systemic connective tissue disease/sarcoidosis
Lymphoma
Rectus sheath haematoma
Idiopathic inflammatory disease
ZMC/Tripod fracture, which is TRUE
Medial canthus inferiorly displaced
Upgaze palsy due to entrapment inferior oblique muscle
Ipsilateral facial numbess due to facial nerve involvement
Zygomaticofrontal suture involvement
Facial numbness is as a result of facial nerve injury
Zygomaticofrontal suture involvement
Smoker, has bilateral parotid lesions, cystic with fluid levels
Sjogren’s
Warthin’s
Pleomorphic adenoma
Warthin’s
Regarding arterial dissections in the neck, which one is true?
Can be traumatic or spontaneous
Most commonly affect the vertebral arteries -
Can be traumatic or spontaneous
Which is most likely to have cervical lymphadenopathy
Papillary thyroid cancer
Follicular thyroid cancer
Medullary thyroid cancer
Anaplastic thyroid cancer
Lymphoid something
Papillary thyroid cancer – most common, most likely to go to nodes
Least likely cause of pituitary fossa enlargement
Craniopharyngioma
Meningioma
Germinoma
Macroadenoma
Lymphocytic hypophysitis
Aneurysm
Lymphocytic hypophysitis
Least likely to be an intraventricular mass?
PXA
Meningioma
Ependymoma
Central neurocytoma
Metastases
PXA
Pleomorphic xanthoastrocytoma
Pleomorphic xanthoastrocytomas (PXA) are a type of rare, low-grade astrocytoma (WHO Grade II) found in young patients who typically present with temporal lobe epilepsy.
They usually present as cortical tumours with a cystic component and vivid contrast enhancement. Features of slow growth may be present, such as no surrounding oedema and scalloping of the overlying bone. A reactive dural involvement expressed by a dural tail sign can be found. Calcifications are rare.
Typically these tumours are found in young patients (children or young adults), with a peak incidence in the second and third decade of life (10-30 years).
Old woman. Expanded cord with high T2 signal from C7 to T6, with small enhancing foci
Transverse myelitis
Haemangioblastoma
Metastases
Ependymoma
Metastases
TM - no expansion
HGB - no VHL
Epen - different enhancement
Lesions at anterior commissure, non-enhancing, patchy restriction, T2 hyperintense, basal leptoeningeal enhancement (and didn’t mention immunosuppression) (in ?adult male)
Cryptococcus
Toxoplasmosis
Lymphoma
TB
Cryptococcus
Young dude, weak left arm. Party and alcohol the night before. No blood on LP. Early loss of grey-white differentiation in the precentral gyrus. What is the most likely diagnosis?
Reversible cerebral vasoconstriction syndrome
PRES
Subarachnoid haemorrhage
CADASIL
Demyelination
PML
Reversible cerebral vasoconstriction syndrome
Small tooth like fragment surrounded by an expansile (?lucent/sclerotic) lesion
Odontoma
Dentigerous cyst
KCOT
Ameloblastoma
ABC
Metastasis
Ameloblastoma
70yo, posterior fossa mass with vasogenic oedema on CT. What is the most likely diagnosis?
Haemangioblastoma
Meningioma
Metastasis
Medulloblastoma
Pilocytic astrocytoma
Metastasis
NMO, which is ?true
Commonly presents with bilateral optic neuritis
Short segment spinal involvement
Strong predilection for males
Simultaneous brain and spinal cord lesions
A: Commonly presents with bilateral optic neuritis
Short segment spinal involvement
At least three vertebral segments = “longitudinally extensive”
Strong predilection for males
Older than MS, and female
Simultaneous brain and spinal cord lesions
Often concurrent, but may preceed each other by up to several weeks
Described a petrous apex expansile mass. Low ADC. Low T1, high T2.
Cholesterol granuloma
Abscess
Cholesteatoma
Metastasis
Schwannoma
Meningioma
Cholesteatoma
Petrous apex lesions :::
Asymmetrical marrow/asymmetrical pneumatisation
- Non expansile
- Fat intensity on all sequences
Petrous apex cephalocele
- CSF signal intensity on all sequences
Petrous apicitis
Congenital cholesteatoma
- Restricted diffusion
Cholesterol granuloma
- Most common cystic appearing lesion
- High T1 and T2, without fat saturation
Mucocele of the petrous apex
- CT opacification of the petrous apex air cells with expansion of cortical margins
- Hyperintense T2 signal and variable T1
- Possible peripheral enhancement
Benign tumours
- Meningioma
- Schwannoma
- Paraganglioma
Malignant tumours
- Chondrosarcoma
- Chordoma
- plasmacytoma
Regarding parathyroid disease
Most common ectopic location is above superior pole of thyroid
Most sensitive sequence is T2 on MRI
Most sensitive sequence is T2 on MRI
Parathyroid adenomas are seen best on which MRI sequence? (repeat)
T1
T2
DWI
Contrast enhanced study
T2
Inverted papilloma
Associated with squamous cell carcinoma
Arises from the bony nasal septum
Arises from the olfactory bulbs
Can cause isolated unilateral frontoethmoidal sinus obstruction
Associated with squamous cell carcinoma
20 year old male in an MVA, complains of chest pain immediately. CT shows pulmonary contusion and small smooth outpouching at the aortic isthmus with no mediastinal fat stranding or haematoma. Most likely cause?
Ductus diverticulum
Aortic isthmus
Pseudoaneurysm
Aortic transection
Penetrating aortic ulcer
Ductus diverticulum
Bicuspid aortic valve with systolic murmur. Most likely associated finding
LV hypertrophy and dilatation
No flow void in aorta
Decreased gradient across aortic valve
LV hypertrophy and dilatation
Which is NOT part of the Wells criteria
Pleuritic chest pain
Haemoptysis
Signs/symptoms of DVT
Malignancy
Pleuritic chest pain
Lady with left lower leg DVT, gets IVC filter, adequately anticoagulated. 2 days later, complains of SOB/chest pain and has new PE on CTPA. Most likely explanation
Duplicated IVC
Azygos continuation of IVC
Retroaortic left renal vein
Circumaortic left renal vein
Duplicated IVC
Post carotid endarterectomy, has new posterior/occipital stroke. Most likely cause
Azygos circulation
Hypoglossal artery
Trigeminal artery
Persistent foetal PCOM
Hypoglossal artery
Arises from the distal cervical ICA, usually between C1 and C3.
Passes through an enlarged hypoglossal canal, joints the basilar artery inferiorly
70 year old male 6 months post AAA repair for routine CT, which shows a blush of contrast in the aneurysm sac, in keeping with graft porosity. What type of endoleak is this?
Type I
Type II
Type III
Type IV
Type V
Type IV
A 40 year old man MEN I has multiple tiny pulmonary nodules on CXR.
Metastatic pulmonary calcification
Sarcoid
Pulmonary alveolar microlithiasis
Metastatic pulmonary calcification
Most associated with cystic fibrosis
Imperforate anus
TOF-OA
Ileal/jejunal atresia
Hypertrophic pyloric stenosis
Ileal/jejunal atresia - cystic fibrosis: ~25% of cases
Regarding aortic dissection
5-10% no intimal tear is seen
Intimal tear is usually at the junction of the aortic arch and descending aorta
Tear is between the intima and inner third of the media
5-10% no intimal tear is seen
Which is true about SVC syndrome?
It is an acute medical emergency
It can result in acute respiratory distress
Endovascular stents are of little use
Pemberton’s sign is negative
It can result in acute respiratory distress - Patients typically present with shortness of breath along with facial and upper extremity edema.
Which of the following does NOT cavitate?
Mycoplasma
Lymphomatoid granulomatosis
Lymphoma
Mycoplasma
Which is true?
Aspergillus is associated with colonization of bronchi
Aspergillus can be mistaken for mucormycosis in immunosuppressed
both
What disease is not associated with cystic airspaces?
LAM
Emphysema
Emphysema
In a patient that needs a dialysis catheter, what vein should be used? (repeat)
Right IJV
Left IJV
Right subclavian vein
Left subclavian vein
Right IJV
Regarding sequestration
Intralobar sequestration has its own pleural covering
Intralobar sequestration is supplied by the pulmonary arteries
Extralobar sequestration usually occurs in the left lower lobe
Extralobar sequestration usually occurs in the left lower lobe
65-90%
does subclavian artery dissection cause cause thoracic outlet syndrome (repeat from 2012 paper with options like pec minor tunnel)
no? this recall sucks ass
HIV patient. Multiple hypodense nodules in liver and spleen
Candida
Necrotic metastases
Pyogenic abscesses
Candida
Regarding small bowel tumours, most common
Carcinoid in ileum
Lymphoma in proximal jejunum
SB tumour presents with intussusception
SB tumours are mostly benign
Carcinoid in ileum
50 yo man 2 weeks post return from Thailand. Febrile. Liver multiseptated lesion.
Amoebic abscess
Hydatid cyst
Pyogenic abscess
Hydatid cyst
45F PHx rectal cancer. MRI liver with hepatobiliary contrast. Lesion is arterially enhancing, demonstrates signal drop out on out of phase, and hypodense to liver on delayed phase
FNH
Adenoma
Hypervascular metastasis
HCC
Adenoma
35yo with a smooth narrowing at T11 on barium swallow, with proximal oesophageal dilatation
Achalasia
Eosinophilic oesophagitis
Zenker diverticulum
Cricopharyngeus spasm
Barrett’s oesophagus
Scleroderma
SCC
Scleroderma
Otherwise achalasia, but complete closure, not narrowing
2 years post treatment for colorectal cancer. Pre sacral soft tissue thickening/mass. Next best test
MRI pelvis
PET/CT
Repeat imaging in 3-6 months
CT guided biopsy
PET/CT
Dilation of the intraduodenal portion of the common bile duct. What Todani classification is this?
Type I
Type II
Type III
Type IV
Type V
Type III
35 year old male recently immigrated from Singapore presents with fever and RLQ pain. CT shows several 1 cm areas of fat stranding posterolateral to the right side of the colon, measuring 0 to -300 HU. Most likely cause?
Epiploic appendagitis –
Diverticulitis
Appendicitis
Colitis
Epiploic appendagitis – omental infarct is >3cm
Multiple is odd
Most common cause of acute diffuse small bowel ischaemia
SMA thrombus
SMA embolus
SMV thrombus
Aortic dissection
IMA thrombus
SMA embolus
Pancreatic head mass, 3 liver lesions. Which lesion(s) should be biopsied? (repeat)
Pancreatic lesion
Heterogeneous liver lesion
Hypoechoic liver lesion
Hyperechoic liver lesion
All of the liver ones
Heterogeneous liver lesion
Thickened jejunal folds
Scleroderma
Coeliac disease
Whipple disease
Crohn’s disease
Lymphoma
Coeliac disease
Reversal of jejunal-ileal folds, and bowel wall oedema = thickening
Whipple disease
Nodular thickening
Which is most likely to present as a pancreatic head lesion in a male?
IPMN
Serous cystadenoma
Mucinous cystadenoma
Solid pseudopapillary epithelial neoplasia
IPMN
Trans-sphincteric anal fistula with abscess
Type 1
Type 2
Type 3
Type 4
Type 5
Type 4
1 - simple linear intersphincteric
2 - intersphincteric with abscess or secondary tract
3 - transsphincteric
4 - transsphincteric with abscess or secondary tract within the ischiorectal fossa
5 - supralevator and translevator extension
Calcified bladder with mass, African
TCC
SCC
Adenocarcinoma
SCC
What condition causes medialisation of the ureters?
Abdominoperineal resection
Prune belly syndrome
Herniation of the ureter through the sacrosciatic foramen
Abdominoperineal resection
Medial displacement:
Upper ureter
- Retrocaval ureter
- Retroperitoneal fibrosis
Lower ureter
- Lymphadenopathy
- Iliac artery aneurysm
- Bladder diverticulum
- Post-surgical esp. AP resection
- Pelvic lipomatosis
Lateral displacement or deviation
Upper ureter
- Lymphadenopathy
- Aortic aneurysm
- Retroperitoneal haematoma
Lower ureter
- Pelvic mass e.g. uterine fibroid
Renal stones in a leukaemia patient are most likely to be of which type?
Uric acid
Cystine
Struvite
Calcium phosphate + calcium oxalate
Pure calcium phosphate
Uric acid
Renal lesion, T1 hyperintense, T2 hyperintense, with no enhancement
Haemorrhagic cyst
Proteinaceous cyst
AML
Clear cell carcinoma
Proteinaceous cyst
Next best test for intra and extraperitoneal bladder rupture (repeat)
Retrograde cystogram
Urethrogram and cystogram
Urethrogram and cystogram
Regarding osteosarcoma, FALSE
50% around knee
Periosteal osteosarcoma has best prognosis
Older individuals get it in mandible
Involves (?metaphysis/metadiaphysis) of long bones
Telangiectatic usually demonstrates fluid-fluid levels on MRI
FALSE: Periosteal osteosarcoma has best prognosis
Parosteal DOES
What is the angle in scoliosis?
5 degrees
10 degrees
15 degrees
20 degrees
25 degrees
10 degrees
Patient with patellofemoral joint space loss, meniscal chondrocalcinosis. What is another expected finding?
Calcification of pubic symphysis
Rotator cuff calcification
MTP joint erosion
MCP joint erosion
Calcification of pubic symphysis
Regarding HADD
Periarticular calcifications
1st MTP juxta-articular erosion
MCPJ destruction
Identified within soft tissue calcifications of scleroderma
Identified within soft tissue calcifications of dermatomyositis
Periarticular calcifications
Shoulder MRI. No trauma. High T2 signal in supraspinatus, infraspinatus, teres minor. Normal T1 signal.
Brachial neuritis
Suprascapular nerve compression in spinoglenoid notch
Suprascapular nerve compression in suprascapular notch
Quadrilateral space compression
Chronic ?denervation
A: Brachial neuritis - parsonage turner syndrome
Suprascapular nerve compression in spinoglenoid notch - Just infraspinatus
Suprascapular nerve compression in suprascapular notch - Both supraspinatus and infraspinatus
Quadrilateral space compression - axillary nerve: teres minor and, or deltoid muscle
Chronic ?denervation
Woman with PHx breast cancer. Hip pain. MRI shows psoas tendon retraction + anterior soft tissue oedema.
Lesser trochanter metastasis
Iliopsoas tendon tear
Subtrochanteric fracture
Stress fracture
Iliopsoas tendon tear
Regarding shoulder ultrasound
Assess supraspinatus in flexion
Subscapular tears are often associated with long head biceps tendon tears
Assess long head of biceps tendon in extension
Subscapular tears are often associated with long head biceps tendon tears
Which is INCORRECT about MRI knee
PCL is affected by magic angle
Posterior horn medial meniscal tear more common than anterior
MCL and LCL on same coronal plane
MCL and LCL on same coronal plane
Popliteal artery entrapment – false?
Popliteal artery aneurysm does not occur
Lateral (?medial) deviation of popliteal artery on extension
Posterior tibial artery low arterial waveform (?if leg is contracted)
Popliteal artery aneurysm does not occur
Soft tissue mass on palm. T1 hyperintense, T2 hyperintense, patchy fat saturation and heterogeneous enhancement
Haemangioma
Lipoma
Schwannoma
Venous malformation
?Haematoma
Haemangioma
Where is fatty marrow most likely to be found? (repeat)
Femoral diaphysis
Ribs
Pelvis
Vertebra
Proximal humeral epiphysis
Femoral diaphysis -in kids
Proximal humeral epiphysis
Which is not an epiphyseal lesion?
ABC
GCT
Chondroblastoma
CMF
CMF
Most chondromyxoid fibromas are located in the metaphyseal region of long bones (60%)
Old lady with THR, hot on bone scan and ?loosening or infection. What should you do next? (repeat)
Aspiration + arthrogram
White cell scan
White cell scan
Hypoechoic, compressible mass in the subcutaneous tissues in the plantar aspect of the foot, overlying the 2nd, 3rd and 4th metatarsal heads
Adventitial bursitis
Intermetatarsal bursitis
Morton neuroma
Adventitial bursitis - Adventitious bursae are not permanent native bursae. They can develop in adulthood at sites where subcutaneous tissue becomes exposed to high pressure and friction.
INTERMET: BW
MORTONS: BW
12 year old girl. Lucent left hemithorax on CXR. CT shows endobronchial lesion, with some peripheral calcification and homogenous enhancement.
Pleuropulmonary blastoma
Carcinoid
Bronchial adenoma
Adenoid cystic carcinoma
Mucoepidermoid carcinoma
Carcinoid
Bronchial carcinoid is the most common primary endobronchial neoplasm; it makes up about 80% of malignant pulmonary neoplasm in children.
3 year old male with leukocoria, orbital lesion with calcifications
Retinoblastoma
Neuroblastoma metastasis
Lymphoma
Coats disease
Retinoblastoma
Leukocoria - abnormal white reflection from the retina
Top 4 causes:
Retinoblastoma 58%
Persistent hyperplastic primary vitreous 28%
Coats disease 16%
Larval ganulomatosis 16%
Normal sized eye:
Calcified - retinoblastoma
Non calcified - coats disease
Microphthalmia
Unilateral - persistent hyperplastic primary vitreous
Bilateral - retinopathy of prematurity, bilateral PHPV
Coats disease:
A disorder of weak retinal capillaries resulting in progressive retinal detachment due to exudative sUbretinal collection
CT: margins of the exudate may have a V-shaped pattern similar to retinal detachment
MRI:
T1 high - due to proteinaceous nature of the exudates
T2 high - due to proteinaceous nature of the exudates
Paediatric CXR. Normal pulmonary vascularity.
Coarctation of aorta
TOF
VSD
?AP window
ASD
Truncus arteriosus
Coarctation of aorta
3yo with macrocephaly, high signal associated with the anterior commissure, bilateral T2 thalamic high signal, forceps minor T2 hyperintensity and developmental delay. Cause
Alexander disease
Castleman disease
Adrenal leukodystrophy
Canavan
Alexander disease
Alexander disease
- Bifrontal white matter which tends to be symmetrical
- Caudate head > globus pallidus > thalamus > brainstem
- Periventricular rim
- Anterior dominance
Canavan:
- Mainly subcortical white matter, involves the subcortical U-fibres
- Globus pallidus and thalami are involved
- Spares the corpus callosum, caudate nucleus, putamen and internal capsule
Adrenoleukodystrophy
- Spares the subcortical U fibres
- Characteristic occipitoparietal periventricular distribution
Metachromatic leukodystrophy
- Spares subcortical U-fibres
- Characteristic butterfly pattern
2 day old, distal bowel obstruction, sacral abnormality
Hirschsprung’s
Ileal atresia
Meconium ileus
Imperforate anus
Meconium plug
Imperforate anus
The Currarino syndrome is a complex condition variably comprised of characteristic congenital anomalies of the sacrum, anorectum and presacral soft tissues.
Brainstem mass in 9 y/o
Pilocytic astrocytoma
Fibrillary astrocytoma - old term for diffuse astrocytoma
Medulloblastoma
Ependymoma
Pleomorphic xanthoastrocytoma
Medulloblastoma
15yo Fibrillary astrocytoma (repeat)
Pilocytic astrocytoma
Craniopharyngioma
Ependymoma
Ganglioglioma
Pilocytic astrocytoma - A pilocytic astrocytoma is most commonly found in the cerebellum. They can also occur near the brainstem, in the cerebrum, near the optic nerve, or in the hypothalamic region of the brain.
Most sensitive for diagnosis of HIE on MRI in a neonate in the first 24hrs of life (repeat)
ADC
T2
DWI
Spectroscopy
DWI
HYPOXIC ISCHAEMIC ENCEPHALOPATHY
DWI is the first to become positive
Diffuse oedema with effacement of the CSF-containing spaces
Decreased cortical grey matter attenuation with a loss of normal grey-white differentiation
Decreased bilateral basal ganglia attenuation
Wilms - spontaneous regression can be seen in infants with metastatic disease t/f
TRUE
Normal pulmonary flow in kid - ?TOF or coarctation
coarctation
Which of the following findings on a 20 week scan would you be MOST likely to perform amniocentesis for?
Choroid plexus cyst measuring 6mm
Lateral ventricles measuring 14mm
Renal pelvis measuring 5-10mm
Lateral ventricles measuring 14mm should be <7mm AHW neonate <3mm
Which placental abnormality is LEAST likely to be associated with complications
Bilobed
Succenturiate lobe
Circumvallate
Placenta praevia
Membranacea
Velamentous cord insertion
ANSWER: Succenturiate lobe
- Increased risk of type II vasa previa
- Increased incidence of PHH from RPOC
Bilobed
- Velamentous cord insertion
- Increased incidence of type II vasa previa
- May increase PPH risk due to RPOC
Circumvallate
- Higher incidence of placental abruption
- Increased risk of IUGR
20 year old G1P0 presents for 20 week scan. US shows mass at the cord/foetal abdomen junction. The cord inserts to the side of the mass. Most likely cause?
Cord AVM
Gastroschisis
Omphalocele
Pseudoomphalocele
Physiological herniation
Gastroschisis
Large multilocular cystic mass occupying most of the pelvis, most likely diagnosis?
Mucinous cystadenoma
Serous cystadenoma
Dermoid
Brenner tumour
Mucinous cystadenoma
Haemorrhagic appearing 5.6cm ovarian cyst in a young female. Appropriate follow-up?
Follow up US in 4 weeks
Follow up US in 6 weeks
No follow up required
Gynaecological referral
MRI
Follow up US in 6 weeks
DCIS common appearance
On ultrasound, hypoechoic and hypervascular
A cluster of indeterminate microcalcifications on MMG
Mass on MRI
Architectural distortion on MMG
A cluster of indeterminate microcalcifications on MMG
Regarding papillary breast cancer
Mixed cystic cut surface on gross specimen
Spiculated margins on imaging
Mixed cystic cut surface on gross specimen
Radial scar diagnosed following biopsy. Most appropriate course of action?
Return to routine screening
Repeat mammo in 6 months
Hookwire and surgical biopsy
Hookwire, WLE and sentinel node biopsy
Mastectomy
Hookwire and surgical biopsy
Phyllodes tumour diagnosed on biopsy. Most appropriate course of action?
Return to routine screening
Repeat mammo in 6 months
Hookwire and surgical biopsy/simple excision
Hookwire and WLE
Mastectomy + SLNBx
Hookwire and WLE
Hypoechoic mass on ultrasound and well circumscribed on mammogram
Invasive ductal cancer
Invasive lobular cancer
Mucinous
Phylloides
DCIS
Phylloides
Which does NOT present as a spiculated mass on mammography?
Tubular carcinoma
Invasive ductal carcinoma
Medullary carcinoma
Invasive lobular carcinoma
Fat necrosis
Medullary carcinoma
Stellate lesion with long spicules without a central mass
Radial scar
Invasive ductal carcinoma
Radial scar
Least associated with BRCA1
Colorectal carcinoma
Pancreatic carcinoma
Ovarian carcinoma
Male breast carcinoma
Prostate carcinoma
Male breast carcinoma
Why is Pagets disease of the nipple occult on mammography (repeat)
a. DCIS cells spread via the lactiferous ducts to the nipple
MEN syndrome + calcified nodules with bone scan uptake
Metastatic calcification in the lungs
Which does NOT occur in pseudohypoparathyroidism
Dentate nucleus calcification
Flask deformity of long bones
Coned epiphyses
Abnormal dentition
?short 4th metacarpal
Normal calcium
Normal calcium
Pseudohypoparathyroidism
- Short stature
- Brachydactyly
- Short metacarpals
- Short metetarsals
- Soft tissue calcification
- Exostoses: short metapyseal or more central and perpendicular to long axis of a bone
- Broad bones with coned epiphyses
CNS
- Basal ganglia calcification
- Sclerochoroidal calcification
- Deep white matter calcification
Clinical presentation:
- Hypocalcaemia and tetany
- Short stature
- Developmental delay
Lead GNOME - causes of erlyenmeyer flask deformity
- Lead: lead poisoning
- G: Gaucher disease
- N: Niemann-Pick disease
- O: osteopetrosis, osteochondromatosis
- M: metaphyseal dysplasia (Pyle disease) and craniometaphyseal dysplasia
- E: ‘ematological, e.g. thalassaemia
How many x-rays is the equivalent of a PET/CT, with a low dose CT
700
1500
2000
700
Long question about a research study, if TP=a, FP=b, TN=c, FN=d, how to calculate prevalence in their study population (repeat)
a/b+d
a/a+c
b/a+c
b/c+d
a+d/a+b+c+d
a+d/a+b+c+d
Most often proposed mechanism for NSF (repeat):
Free gadolinium gets into tissues and incites fibrotic response
Free Gd chelate gets into soft tissues and incites fibrotic reaction
Albumin bound Gd gets into tissues
Some other combinations of chelated and otherwise bound Gd
Free gadolinium gets into tissues and incites fibrotic response
Increase the signal to noise ratio on MRI
Reduce voxel size
Increase field of view
Decrease number of excitations
Increase field of view
Inversion injury of the ankle. What is the most likely ligament involved?
Anterior talofibular ligament
Posterior talofibular
Deltoid ligament
Spring ligament
Anterior talofibular ligament
A patient has erythema/eczema of the nipple and a normal mammogram and ultrasound. What is the most appropriate next management?
Referral to a breast surgeon
Referral to a dermatologist
Repeat imaging in 3-6 months
MRI with contrast
Referral to a breast surgeon
MRI with contrast
Right lower quadrant pain USS demonstrates blind ending tubular structure with echogenic focus
Appendicitis
Haemorhagic corpus luteum
Appendicitis
What is the most likely appearance of a radial scar on mammogram?
Ill defined stellate mass
Architectural distortion
Amorphous calcifications
Architectural distortion
A 40 year old female has a low density pancreatic lesion. What is the most likely diagnosis?
Mucinous cystadenoma
IPMN
Serous cystadenoma
Mucinous cystadenoma
A middle aged patient has a barium swallow. It demonstrates a posterior outpouching at C5/6. What is the most likely diagnosis?
Zenker diverticulum
Cricopharyngeus
Epiphrenic diverticulum
Zenker diverticulum
A patient has a barium follow through study. There is a narrowing at D2 secondary to external mass effect. What is the most likely diagnosis?
Annular pancreas
Pancreas divisum
Pancreatic atrophy
Annular pancreas
PET scan is commonly used to image patients with lymphoma. Which type of lymphoma is least likely to be avid on PET scan?
a. Mycosis fungoides
b. Follicular lymphoma
c. Diffuse large B cell lymphoma
a. Mycosis fungoides
What is phaeochromocytoma least likely to be associated with?
VHL
Tuberous sclerosis
NF1
MEN?
Tuberous sclerosis – extra-adrenal paragangliomas
MEN - if MEN1 then this is true
A patient has an ankle injury where there is disruption of the ankle syndesmosis and a fibula fracture 5cm proximal to the ankle joint. What is the most likely injury?
Weber A
Weber B
Weber C
Maisonneuve fracture
Weber C
Which is the least likely cause of intussusception in a 2 year old?
Crohn disease
Henoch-Schonlein purpure
Lymphoma
Intraluminal lipoma
Meckel’s diverticulum
Crohn disease
Which of the following cannot be excluded on ultrasound?
AVN of the hip
Septic arthritis
Transient synovitis
AVN of the hip
A 12 year old boy presents with a 3 month history of knee pain with a normal xray. What is the next investigation?
Hip x-ray
Knee MRI
Bone scan
Hip x-ray
Which is least likely to give endplate signal changes with are low on T1 and high on T2?
Modic type II
Spondylodiscitis
Tuberculosis
Disc herniation
Ankylosing spondylitis
Modic type II
Modic changes
1 - oedema and inflammation
T1 low, T2 high
2 - conversion into yellow fat
T1 high, T2 iso - high
3 - subchondral bony sclerosis
T1 low, T2 low
Which is the most likely right atrial lesion in a young child?
Atrial myxoma
Rhabdomyoma
Rhabdomyoma
What is the most common orbital lesion in a child?
Cavernous haemangioma
Retinoblastoma
Lymphoma
Melanoma
Coats disease
Retinoblastoma - one out of every 16,000–18,000 live births in the global population
Coats disease is a rare eye disorder involving abnormal development of blood vessels in the retina. Located in the back of the eye, the retina sends light images to the brain and is essential to eyesight. In people with Coats disease, retinal capillaries break open and leak fluid into the back of the eye.
Most pediatric orbital tumors are benign; developmental cysts comprise half of orbital cases, with capillary hemangioma being the second most common orbital tumor. The most common orbital malignancy is rhabdomyosarcoma. The most common intraocular malignant lesion is retinoblastoma.
Cavernous hemangiomas are usually encountered in the orbit as primary tumors in adults. Patients with orbital cavernous hemangiomas typically present in the fourth and fifth decade of life. Lesions are rare in childhood. On the other hand, capillary hemangioma is the most common benign orbital tumor in children.
A man has a headache a few days following an all-night party. CT demonstrates slight loss of grey-white matter differentiation in the left fronto-parietal region. LP is negative for RBCs and bilirubin. What is the most likely cause?
Ischaemia due to venous thrombosis
Encephalitis
Subarachnoid haemorrhage secondary to ruptured berry aneurysm
Ischaemia due to venous thrombosis
Which is true regarding tuberculosis?
Calcified cavitating lesion in primary tuberculosis
Lymphadenopathy is more associated with secondary tuberculosis
Pleural effusion is more associated with primary tuberculosis
Pleural effusion is more associated with primary tuberculosis
A cholangiocarcinoma involves the primary confluence and extends to the left secondary confluence. What is the stage as per the Bismuth-Corlette criteria?
1
2
3a
3b
4
3b
Which is not a hamartomatous polyp syndrome?
Gardner syndrome
Peutz-Jegher syndrome
Cowden syndrome
Cronkite-Canada syndrome
Gardner syndrome
Which liver injury is most likely to be caused by an overdose of analgesia?
Hepatocellular necrosis
Hepatitis
Cholestasis
Hepatocellular necrosis
Which is not a risk factor/cause of pre-eclampsia?
Materal diabetes mellitus
Maternal pre-existing glomerulonephritis
Anti-phospholipid syndrome
?Liver disease on previous recall
?Liver disease on previous recall
A first trimester ultrasound demonstrates a twin peak sign. Which is most correct?
There are two separate placentas - dichorionic
There is a risk of twin-twin transfusion
Diamniotic, monochorionic
Monoamniotic, monochorionic
Dizygotic, monochorionic
There are two separate placentas - dichorionic
A patient has an enhancing, vascular mass in the epididymis. What is the most likely diagnosis?
Adenomatoid tumour
Lipoma
Teratoma
Epididymal cyst
Adenomatoid tumour
Which is the most likely pure germ cell tumour to be found in an elderly patient?
Spermatocytic seminoma
Embryonal cell carcinoma
Teratoma
Spermatocytic seminoma
BPH arises in the peripheral zone T/F
F
A patient with an EVAR has a contrast filling the aneurysmal sac supplied by a lumbar artery. Which type of endoleak is this?
Type 1
Type 2
Type 3
Type 4
Type 5
Type 2
Type 1 - leak at graft attachment site
Type 2 - aneurysm sac filling via branch vessel
Type 3 - leak through a defect in the graft
Type 4 - leak through graft fabric as a result of graft porosity
Type 5 - continued expansion of the aneurysm sac without demonstrable leak on imaging
Which is the best radiological finding for the detection of bowel trauma?
Bowel wall thickening
Mucosal hyperenhancement and mural oedema
Mesenteric congestion
Free fluid
Free fluid
Which is most correct regarding sedation in an elderly patient?
250mcg of fentanyl should be the a maximum dose
5mg of midazolam is an appropriate starting dose
There is a prolonged half life of midazolam in elderly patients
The most common side effect of midazolam is hypotension
There is a prolonged half life of midazolam in elderly patients -
Plasma half-life was approximately two-fold higher in the elderly.
Which is least associated with von Hippel Lindau?
Phaeochromocytomas
Haemangioblastomas
Pancreatic cysts
Renal cell carcinoma
Phaeochromocytomas -30%
A 30 year old man has a soft tissue mass which has high T1 fat sat signal. What is the most likely diagnosis?
Melanoma
Lipoma
Haemangioma
Melanoma
A patient has high density military nodules throughout the lungs with a ‘black pleura’ sign. What is the most likely diagnosis?
Alveolar microlithiasis
Hypersensitivity pneumonitis
Metastatic pulmonary calcification
Alveolar microlithiasis
An elderly male presents with painless hematuria. What is the best sequence to show tumour invasion?
T2
T1 with fat sat
T1 without fat sat
DWI
T2
Slightly hyperintense compared to muscle, useful in determining the low signal muscle layer and its discontinuity when muscle wall invasion
A 3 year old patient presents with ataxia. Imaging shows a posterior fossa tumour with a low density enhancing mass in the vermis. What is the most likely diagnosis?
Hemangioblastoma
Metastataic neuroblastoma
Medulloblastoma
Ependymoma
Fibrillary astrocytoma
Medulloblastoma
What is the most common appearance of lobular carcinoma on mammogram?
Architectural distortion
Microlobulated mass
Well- defined mass
Architectural distortion
Lucent, well-defined lesion in S1 in young adult patient. ( No other feature mentioned)
Chordoma
ABC
Giant cell tumour
Metastasis
ABC
Best way for local staging of DCIS
Mammo
Mammo + US
Contrast enhanced MRI
? open biopsy
Contrast enhanced MRI
A patient has left superior cerebellar and left parietal infarct after stenting the extracrainal left ICA. What is the most likely explanation?
Persistent hypoglossal artery
Persistent trigeminal artery
Fetal origin of PCOMs
Persistent hypoglossal artery
A 37 yr old is undergoing IVF treatment. She has bilateral ovarian cysts and extensive ascites. What is the most likely diagnosis?
Theca lutein cysts
Normal ovarian cysts
Ovarian hyperstimulation
Ovarian hyperstimulation
Which is not associated with an ACL tear?
Medial meniscus injury
Lateral meniscus injury
Anterior medial femoral (?)
Segond fracture
MCL tear
Anterior medial femoral (?)
Which is (not) a consequence of raised intracranial pressure?
Diffuse axonal injury
PCA infarction
ACA infarction
Duret haemorrhage
Kernohan’s notch
Diffuse axonal injury
Which is most correct regarding small bowel barium studies?
Thickening of the jejunal folds is coeliac
Nodular thickening of the jejunal folds in Whipples
Nodular thickening of the jejunal folds in Whipples
Cystic ovarian lesion, 10cm (not sure), unilateral, most likely:
Serous cystadenoma
Mucinous cystadenoma
Mucinous cystadenoma
Regarding melorrheostosis - which is not a feature?
Contractures
Thickened irregular bone cortex
Muscle atrophy
Scleroderma skin changes
ALL FEATURES
60 cyst ill defined, non expansile, adjacent to root of tooth, no tooth and no expansion no nonerupted teeth
Metastases
Ameloblastoma
Dentigerous cyst
Fibrous dysplasia
Odontoma
Metastases
34 male ataxia, right cerebellar low density striated mass
Cowden
Basal cell naevus
Encephalocraniocutaneous lipomatosis
Cowden
An older male patient has a mass encasing the kidney and adrenal gland, with Housfield density between -60 and +60 units. What is the most likely diagnosis?
Myxoid liposarcoma
A woman has a 15mm well defined breast mass. What is the most likely diagnosis?
Fibroadenoma or phyllodes
t/f midline sagittal best prenatal assessment of cleft lip?
false
Which is most correct regarding meningioma?
En plaque
Expansion of sella
Destruction of bone
Intense contrast enhancement
Intense contrast enhancement
4cm well circumscribed hypodense mass in the pancreas with peripheral calcification. Most likely:
Mucinous cystadenoma
Serous cystadenoma
IPMN
SPEN
Mucinous cystadenoma
Which is the best investigation for a thyroid lesion?
Iodine 131 scan
Tc99 Pertechtenate scan
Tc99 Pertechtenate scan
A jaundiced woman has a normal liver ultrasound and normal bile ducts. What is the most likely diagnosis?
Cholestasis
Fatty liver
NASH
Hepatitis
Cholestasis
Lung biopsy of a lesion in the posterior right mid lung is complicated by perilesional haemorrhage and haemoptysis. What is the next appropriate step?
Right side down
Left side down
Supine
Prone
Head up
Right side down
On CXR, there is a structure paralleling right heart border. What is the most likely diagnosis?
PAPVR
Which liver lesion is least likely to have a central scar
Fibrolamellar HCC
HCC
FNH
Adenoma
Haemangioma
Adenoma
What is most associated with thyroid eye disease?
Pseudotumour
Graves disease
Hashimotos
Thyroiditis
Graves disease
Which is least likely to be associated with azygous continuation of the IVC?
Dextrocardia
Polysplenia
Gonadal veins draining into the ipsilateral renal veins
Hepatic veins draining into the IVC?
None of the above
Hepatic veins draining into the IVC?
A thyroid biopsy demonstrates medullary carcinoma. What is the next most appropriate investigation?
DMSA
DTPA
MAG-3
I-131
Tc99m-Pertechnetate
DMSA
A woman has intense pain in her knee after she walks her dog. There is intense oedema in the medial femoral condyle. What is the most likely diagnosis?
Radial tear medial meniscus
Medial ligament tear
Chondral defect - SONK
Loose body
Dog bite
Chondral defect - SONK
A young male patient has a renal lesion which is high T1, low T2, and intensively enhancing. What is the most likely diagnosis?
AML
Proteinaceous cyst
Haemorrhagic cyst
Lymphoma
Clear cell carcinoma
Clear cell carcinoma - actually papillary
MRI is not only excellent at imaging the kidneys and locally staging tumours, but is also able to suggest the likely histology, on the grounds of T2 differences.
T1: often heterogeneous due to necrosis, haemorrhage, and solid components
T2: appearances depend on histology 6
clear cell RCC: hyperintense
papillary RCC: hypointense
T1 C+ (Gd): often shows prompt arterial enhancement
A 3 week old neonate has jaundice, hypoplastic kidneys and an H shaped vertebra. The liver appears normal on ultrasound and the gallbladder is small.
What is the most likely diagnosis?
Caroli disease
Biliary atresia
Allagile syndrome
Bile plug syndrome
Allagile syndrome
20yo acetabular fracture, most likely injury
Bladder injury
Pelvic haematoma
Sacral injury
Pelvic haematoma
Which is true regarding fibromuscular dysplasia?
Most common cause of hypertension in children and young adults
Does not respond well to angioplasty
Only affects media
none
Which is most useful for differentiating between a ranula and lymphangioma?
Extension into paraphyrngeal space
Extension into retropharyngeal space
Extension into infrahyoid tissues
Extension into infrahyoid tissues
A hysteroscopy study for infertility shows two holes in the cervix. Which is the most likely diagnosis?
Bicornuate
Didelphys
Unicornuate
Septate
Bicornuate - more common
What is the best position to examine the subscapularis muscle on ultrasound?
External rotation with the elbow flexed
Internal rotation with the arm touching the opposite shoulder
External rotation arm behind the back
Abducted arm
External rotation with the elbow flexed
Child with previous history of bacterial meningitis, now with unilateral sensorineural hearing loss. What is the most likely diagnosis?
Otosclerosis
Labyrinthitis ossificans
Labyrinthitis ossificans
Which is incorrect regarding DVTs? (March 2016)
Most DVTs start in the soleal ‘sinusoids’
Most below knee DVTs will propagate to the surface without intervention
In ambulatory patients, only 5-10% of DVTs will result in PEs
Most patients with DVTs in the community are asymptomatic
Most below knee DVTs will propagate to the surface without intervention
Which is the most common infection associated with cystic fibrosis?
ABPA
Klebisiella
Pseudomonas
Pseudomonas
Rugby player kicked in scrotum with pain. Ultrasound shows intact tunica with heterogenous echogenic testes.
Rupture
Haematoma
Fracture
Abscess
Torsion
Haematoma
24 y.o. Obese male with retroareolar pain. Ultrasound shows hypoechoic mass under areola with lobulated posterior margins. Most likely option:
Gynaecomastia
Pseudo-gynaecomastia
Male breast cancer
Lipoma
Gynaecomastia
Which association is least likely:
Methotrexate and pneumatocoele
Phenytoin and eosinophilic lung disease
Amiodarone and interstitial infiltrate
Cyclosporine and pulmonary mass – due to fungal pneumonia
Sulfasalazine and eosinophilic lung disease
Methotrexate and pneumatocoele
Methotrexate
inflammatory: fibrotic disease
superimposed pulmonary infection: from immunosuppression
pulmonary lymphoproliferative disease: from immunosuppression
Regarding fibroadenoma which is FALSE.
Can contain invasive foci
Commonly involutes
Smooth mass on mammography
Commonly presents in <30
Common in post-menopausal women
Common in post-menopausal women
Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women.
Regarding radial scar which is true?
Requires further management.
Should be re-biopsied
Has short spicules.
Palpable as a clinical mass.
The central fat is often replaced by soft tissue
Requires further management.
45 m with neck lump which extends through thyrohyoid membrane and had an air fluid level and thin rim.
Laryngocoele
Epidermoid cyst
Abscess
Thyroglossal duct cyst
Lymphatic malformation
Laryngocoele
1.5cm well defined breast lesion in a 50yo F - what is least likely
Mucinous cancer
High grade IDC
Fibroadenoma
Simple cyst
Sebaceous cyst
High grade IDC – typically spiculated
Most likely appearance of medullary ca
Well defined mass
Spiculated mass
Mass with cystic spaces
Fine branching calcs
Thick calcs
Well defined mass
Most likely to involve epiphyses?
Osteoid osteoma
ABC
Clear cell chondrosarcoma.
Chondromyxoid fibroma.
Fibrosarcoma.
Clear cell chondrosarcoma.
Epiphyseal, unlike the conventional chondrosarcoma which is usually metaphyseal-diaphyseal
Least likely to be associated with RCC.
VHL
CRF on renal failure
NF1
Obesity
Smoking.
NF1
Least likely to affect basal ganglia.
Amyloid angiopathy.
Hypertension.
Ischaemic encephalopathy.
Amyloid angiopathy.
34yr female known twins presents for ultrasound. Twin peak sign. Which is most likely?
Monochoriotic diamniotic
Monochoriotic monoamniotic
There are two placentas
The twins are at risk of twin twin transfusion
There are two placentas
Neonate in cyanosis. Echocardiogram shows right atrial lesion. What is most likely
Haemangioma
Fibroma
Rhabdomyoma
Atrial myxoma
Lipoma
Rhabdomyoma – monitor and they go away, associated with TS
45yr female. Hypodense lesion in Pancreas with enhancing nodule. Peripheral calcification. Which is most likely?
Serous microcystic
Serous macrocystic
Mucinous cystadenoma
IPMN
SPEN
Mucinous cystadenoma
What is least like to present as a cystic lung lesion?
Mycoplasma pneumonia
Pulmonary lymphoma
Neurofibromatosis
Lymphoid granulomas
Tuberous sclerosis
Mycoplasma pneumonia
Pulmonary manifestations of NF-1, which usually include bilateral basal reticulations and apical bullae and cysts, are reported in 10-20% of adult patients.
40yr female. Right angle of jaw lesion. Painless non smoker. On ultrasound mixed solid and cystic change that involves part of the parotid gland and 2 other lesions in the adjacent soft tissue. What is most likely?
Lymph nodes
Sjogrens
Warthins tumour
Benign mixed lesion - oncogenic simian virus (SV40)
Lymphoepithelial cysts
Warthins tumour
They may be bilateral or multifocal in up to 20% of cases and are the most common neoplastic cause of multiple solid parotid masses.
Associated with smoking
Painless enlargement
50 yo male non-smoker no history of occupational exposure. CT Chest shows a 5mm non-calcified nodule in LUL. What does the Fleischner society guidelines recommend?
No follow up
Follow up in 12 months then stop if no change
Initial follow up in 6-12 months then in 18-24 months, then stop if no change
Initial follow up in 3-6 months then in 9-12 months and 18-24 months, then stop if no change
Follow up in 3, 9 and 12 months with dynamic post-contrast CT Chest and PET/CT +/- biopsy
No follow up
Low risk = no routine follow up required
47yo male (smoking history not specified) with persistent cough. Ill-defined non-calcified 8mm nodule in RUL. Which is MOST correct:
PET/CT to assess for malignancy
CT-guided FNA to assess for malignancy
Enhancement by greater than 35HU post IV contrast is associated with greater than 97% risk of malignancy
Likely benign (<2% risk of malignancy) if the lesion has remained stable in the last 30 months
Follow up in 12 months and 24 months
Follow up in 12 months and 24 months
F/U 6-12, then every 2 yrs for 5 if persistent – if subsolid, if solid, 12 mo then 24mo
10y boy with fever and cough. CXR shows bilateral lower zone opacities and linear atelectasis. Which is most likely cause (REPEAT):
Chlamydia pneumonia
Mycoplasma pneumonia
Pneumocystis jirovecii pneumonia
Staphylococcus pneumonia
Tuberculosis
Mycoplasma pneumonia
88y woman with dementia in nursing home, found collapsed. CT Brain shows a 2cm elliptical highattenuation lesion superficially in the right middle frontal gyrus. What is the MOST likely cause?
Hypertensive hemorrhage
Berry aneurysm
Hemorrhagic neoplasm
Amyloid angiopathy
Trauma
Amyloid angiopathy
What is most likely mammographic appearance of papilloma (REPEAT)
Spiculated mass
Well defined mass with microlobulated contours
Amorphous calcification
Dense linear calcs
Fine linear branching calcs
Well defined mass with microlobulated contours
With regards to osteomyelitis, which is true ?
Gadolinium helps to make the endplate changes more conspicuous on T1WI
Staph aureus is the most common cause in a 75 year old
MRI appearances can mimic modic type 1 changes
The presence of a paraspinal mass suggests malignancy.
Gadolinium helps to make the endplate changes more conspicuous on T1WI
Staph aureus is the most common cause in a 75 year old
MRI appearances can mimic modic type 1 changes
In screening mammography, granular microcalcifications of variable size and shape is suggestive of?
DCIS
LCIS
Papilloma
Milk of calcium
Oil cyst
DCIS - pleomorphic
Patient with a chance fracture of T12. Which is the most common associated injury ?
Renal laceration
Splenic laceration
Duodenal contusion
Mediastinal haematoma
Rib fracture.
Duodenal contusion
65 year old male with back pain and a T8 sclerotic lesion on xray. Most appropriate next management?
No further investigation required.
Bone scan
MRI.
CT.
Skeletal survey.
CT.
Patient with acute pulmonary oedema. Normal heart size. Which is Least likely?
Massive PE.
AMI.
Chronic pericarditis.
Mediastinal fibrosis.
Neurogenic cause.
Massive PE.
Pseudomyxoma peritoneii is most common in?
Appendiceal mucocoele
Mucinous cyst adenocarcinoma of the ovary.
Mucinous carcinoma of the appendix.
Mucinous carcinoma of the appendix.
Mr. John’s is supposed to get a PICC line. Mr Smith is supposed to get a CT Scan. Mr. John’s details are attached to Mr. Smith’s request form and he is sent for his PICC line. What is the best question to ask?
What is your name.
What is your MRN
What is your date of birth.
What is your understanding of what procedure you are getting today?
What is your understanding of what procedure you are getting today?
