Radiodx Flashcards

Question

30 year old male with a lump in soft tissues high signal on T1 weighted imaging without fat suppression Lipoma Liposarcoma Haemangioma 

Answer 1

Lipoma - High T1, if no fat sat…if says High T1 post FS, then think liposarcoma.

Answer 2

a+d/a+b+c+d - prevalence is the number of cases / everyone in the population

Answer 3

Often coexists with CMV - Cytomegalovirus (CMV) pneumonia is a complication presented by these patients when they are in a state of severe immunosuppression. 

Answer 4

IV atropine 0.6 mL (dose?)

Answer 5

IM adrenaline

Answer 6

Call referrer

Answer 7

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

Answer 8

Follow up in 6-12 months, then 18-24 months if no change

Answer 9

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

Answer 10

Do nothing this is normal

Answer 11

Can be essentially unchanged over several years

Answer 12

Tubular Spiculated lesion : Sclerosing adenosis Post surgical scar Radial scar Fat necrosis IDC, DCIS ILC Tubular carcinoma  

Answer 13

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

Answer 14

DTPA has 100% glomerular filtration

Answer 15

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

Answer 16

Posterior descending artery

Answer 17

Patient self-examination

Answer 18

Ganglioglioma - common in younfer patients GANGLIOGLIOMA A partially cystic mass with an enhancing mural nodule is seen in ~45% of cases Frequently calcified

Answer 19

Metastases 

Answer 20

1st brachial cleft cyst

Answer 21

Esthesioneuroblastoma - bimodal (10-20, 50-60)

Answer 22

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

Answer 23

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

Answer 24

AP and lateral hip x-ray ? SCFE

Answer 25

Long bone spiral fractures are typical? if non ambulatory very sus….

Answer 26

Ganglion cyst at spinoglenoid notch

Answer 27

Answer: Common peroneal nerve is more commonly injured than Tibial nerve Can occur without fractures

Answer 28

Labyrinthitis ossificans

Answer 29

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

Answer 30

T2 - this is best, T1 rubbish in pelvis ex for l/nodes!

Answer 31

Hypertension

Answer 32

Unruptured ectopic pregnancy

Answer 33

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

Answer 34

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.

Answer 35

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%).

Answer 36

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.  

Answer 37

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

Answer 38

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)

Answer 39

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)

Answer 40

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  

Answer 41

Use 7 week scan, foetus small for gestational age

Answer 42

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

Answer 43

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

Answer 44

Meningioma - False

Answer 45

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.

Answer 46

ANSWER: Dermoid (ranula just fluid, won’t have fat)

Answer 47

Tc99 Pertechnetate

Answer 48

ANSWER: Heterogenous hepatic lesion

Answer 49

ANSWER: SCN IPMN Possible but less likely SPEN Usually more solid/cystic with haemorrhagic component MCN Multiloculated but usually large (up to 12cm)

Answer 50

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

Answer 51

Splenosis - can occur in the thorax if there is diaphragmatic injury

Answer 52

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

Answer 53

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

Answer 54

Appendicitis

Answer 55

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.

Answer 56

ANSWER: Renal osteodystrophy Could be metastatic calcification Sarcoid Less likely. Lymph nodes – 20% calcify. Lung nodules less frequent Mets Could be

Answer 57

ANSWER: Lower lobes affected

Answer 58

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

Answer 59

ANSWER: Complication due to vasospasm in first 24 hours False 4-14 days post SAH, peaking at 7 days typically

Answer 60

ANSWER: US SIX WEEKS

Answer 61

ANSWER Meconium ileus Indicative of cystic fibrosis

Answer 62

ANSWER: Sequestration Depends where vessel coming from – sequestration is systemic arterial supply and variable venous drainage (systemic extralobar and pulmonary intralobar)

Answer 63

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  

Answer 64

ANSWER Ependymoma

Answer 65

ANSWER: None of the above

Answer 66

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.

Answer 67

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

Answer 68

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

Answer 69

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

Answer 70

White cell scan

Answer 71

No imaging for 6 weeks – if no red flags present otherwise do an x-ray

Answer 72

ANSWER: Tear at iliopsoas Snapping gluteus maximus – happens externally over greater trochanter Trochanteric bursitis - Unlikely to cause bone marrow oedema. Does improve with rest.

Answer 73

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  

Answer 74

ANSWER: a + d / n number of cases (true positive+false negative)/total population)

Answer 75

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

Answer 76

Air embolus

Answer 77

IM adrenaline 1:1000, 0.5ml

Answer 78

ANSWER Stop clopidogrel 10 days? prior, clexane 12 hours prior. Answer (although usually only need to stop clopidogrel for 5 days)

Answer 79

Injection, immediate imaging for 30 minutes True

Answer 80

ANSWER: Multiple matched defects - seen in Pneumonia

Answer 81

ANSWER: (? myositis ossificans) Osteosarc - unlikely Periosteal chondroma – saucerisation : possible Osteochondroma - also unlikely

Answer 82

ANSWER: HSV: only if it spares the basal ganglia

Answer 83

ANSWER: RCVS - thunderclap headache makes this possible, but CVT also possible

Answer 84

Azygos vessel A1

Answer 85

Ipsilateral fornix atrophy

Answer 86

Ependymoma ( calc 30-40%)

Answer 87

Central neuryoctyoma

Answer 88

Central neurocytoma

Answer 89

dermoid if its this repeat one

Answer 90

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.

Answer 91

no further

Answer 92

do onthign

Answer 93

300 Gauss is further from the bore,

Answer 94

Carcinoid,

Answer 95

ANSWER: Whipples has thickened nodular folds Increase jejunal folds in coeliac, F (jejunal smooth, ileum folded) Haematogeneous mets occur at mesenteric border -F

Answer 96

Pseudopolyps

Answer 97

MTP involvement

Answer 98

MALToma –

Answer 99

ANSWER >90% can detect unresectale on CT OR Most commonly in the head - 70%

Answer 100

Metastatic pulmonary calcification, -

Answer 101

Varus with ext

Answer 102

Membranous  - if perineum + extra peritoneal = membranous

Answer 103

Ring enhancing cerebral lesions,

Answer 104

Spontaneous lateral rectus haematoma,

Answer 105

Dacrocystocele

Answer 106

NM- pertecnetate study. Patient has Graves

Answer 107

Renal osteodystrophy

Answer 108

Small most commonly in prussak space

Answer 109

Cholesterol granuloma

Answer 110

chance fracture always assoc with neurology

Answer 111

meconium ileus – Ans, commonly in TI, CF

Answer 112

Intramural gas

Answer 113

Increased vasc = normal side ( in swyer james)

Answer 114

Follicle > 10mm size

Answer 115

varieties of anechoic cysts on one or both ovaries, and >10 follicles on both ovaries

Answer 116

CPPD preferentially involves PFJ

Answer 117

Biceps tendon musculotendinous junction tear,

Answer 118

Lat ulnar collateral (unhappy triad)

Answer 119

some type of excision biopsy after localisation - hook wire and something

Answer 120

Cath angiogram - CT angiogram if an option

Answer 121

MRI picks up changes earlier than Tc99m

Answer 122

T2 best at finding parathyroid adenoma,

Answer 123

Intramedullary metaphyseal,

Answer 124

Appendiceal mucinous cystadenocarcinoma

Answer 125

Intramural gas descending and sigmoid

Answer 126

Intramural gas

Answer 127

NF - if pseudoarthrosis basically NF1, anterolateral Blounts Congenital assoc with leg length discrepancy (post medial likely congenital) Anterior is bad, posterior is good

Answer 128

Asymmetrical patellofemoral suggests CPPD

Answer 129

MRI with T2 most sensitive

Answer 130

Myelogenous disease recognised cause of gout

Answer 131

Renal osteodystrophy  

Answer 132

Candidiasis

Answer 133

Second trimester should be low resistance

Answer 134

Cystic vestibulocholear malformatioN

Answer 135

Chance fracture nearly always a/w neurological injury

Answer 136

MTP/MCP involvement

Answer 137

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.

Answer 138

Cerebral venous thrombosis

Answer 139

2nd branchial cleft cyst

Answer 140

Idiopathic inflammatory disease

Answer 141

Zygomaticofrontal suture involvement

Answer 142

Warthin’s

Answer 143

Can be traumatic or spontaneous

Answer 144

Papillary thyroid cancer – most common, most likely to go to nodes

Answer 145

Lymphocytic hypophysitis

Answer 146

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).

Answer 147

Metastases TM - no expansion HGB - no VHL Epen - different enhancement

Answer 148

Cryptococcus

Answer 149

Reversible cerebral vasoconstriction syndrome

Answer 150

Ameloblastoma

Answer 151

Metastasis

Answer 152

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

Answer 153

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

Answer 154

Most sensitive sequence is T2 on MRI

Answer 155

Associated with squamous cell carcinoma

Answer 156

Ductus diverticulum

Answer 157

LV hypertrophy and dilatation

Answer 158

Pleuritic chest pain

Answer 159

Duplicated IVC

Answer 160

Hypoglossal artery Arises from the distal cervical ICA, usually between C1 and C3. Passes through an enlarged hypoglossal canal, joints the basilar artery inferiorly

Answer 161

Metastatic pulmonary calcification

Answer 162

Ileal/jejunal atresia - cystic fibrosis: ~25% of cases

Answer 163

5-10% no intimal tear is seen

Answer 164

It can result in acute respiratory distress - Patients typically present with shortness of breath along with facial and upper extremity edema.

Answer 165

Mycoplasma

Answer 166

Extralobar sequestration usually occurs in the left lower lobe 65-90%

Answer 167

no? this recall sucks ass

Answer 168

Carcinoid in ileum

Answer 169

Hydatid cyst

Answer 170

Scleroderma Otherwise achalasia, but complete closure, not narrowing

Answer 171

Epiploic appendagitis – omental infarct is >3cm Multiple is odd

Answer 172

SMA embolus

Answer 173

Heterogeneous liver lesion

Answer 174

Coeliac disease Reversal of jejunal-ileal folds, and bowel wall oedema = thickening Whipple disease Nodular thickening

Answer 175

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

Answer 176

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

Answer 177

Proteinaceous cyst

Answer 178

Urethrogram and cystogram

Answer 179

FALSE: Periosteal osteosarcoma has best prognosis Parosteal DOES

Answer 180

10 degrees

Answer 181

Calcification of pubic symphysis

Answer 182

Periarticular calcifications

Answer 183

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  

Answer 184

Iliopsoas tendon tear

Answer 185

Subscapular tears are often associated with long head biceps tendon tears

Answer 186

MCL and LCL on same coronal plane

Answer 187

Popliteal artery aneurysm does not occur

Answer 188

Haemangioma

Answer 189

Femoral diaphysis -in kids Proximal humeral epiphysis

Answer 190

CMF Most chondromyxoid fibromas are located in the metaphyseal region of long bones (60%)

Answer 191

White cell scan

Answer 192

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

Answer 193

Carcinoid Bronchial carcinoid is the most common primary endobronchial neoplasm; it makes up about 80% of malignant pulmonary neoplasm in children.

Answer 194

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

Answer 195

Coarctation of aorta

Answer 196

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  

Answer 197

Imperforate anus The Currarino syndrome is a complex condition variably comprised of characteristic congenital anomalies of the sacrum, anorectum and presacral soft tissues.

Answer 198

Medulloblastoma

Answer 199

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.

Answer 200

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

Answer 201

coarctation

Answer 202

Lateral ventricles measuring 14mm should be <7mm AHW neonate <3mm

Answer 203

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

Answer 204

Gastroschisis

Answer 205

Mucinous cystadenoma

Answer 206

Follow up US in 6 weeks

Answer 207

A cluster of indeterminate microcalcifications on MMG

Answer 208

Mixed cystic cut surface on gross specimen

Answer 209

Hookwire and surgical biopsy

Answer 210

Hookwire and WLE

Answer 211

Phylloides

Answer 212

Medullary carcinoma

Answer 213

Radial scar

Answer 214

Male breast carcinoma

Answer 215

a. DCIS cells spread via the lactiferous ducts to the nipple

Answer 216

Metastatic calcification in the lungs

Answer 217

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

Answer 218

a+d/a+b+c+d

Answer 219

Free gadolinium gets into tissues and incites fibrotic response

Answer 220

Increase field of view

Answer 221

Anterior talofibular ligament

Answer 222

Referral to a breast surgeon MRI with contrast

Answer 223

Appendicitis

Answer 224

Architectural distortion

Answer 225

Mucinous cystadenoma

Answer 226

Zenker diverticulum

Answer 227

Annular pancreas

Answer 228

a. Mycosis fungoides

Answer 229

Tuberous sclerosis – extra-adrenal paragangliomas MEN - if MEN1 then this is true

Answer 230

Crohn disease

Answer 231

AVN of the hip

Answer 232

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  

Answer 233

Rhabdomyoma

Answer 234

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.

Answer 235

Ischaemia due to venous thrombosis

Answer 236

Pleural effusion is more associated with primary tuberculosis

Answer 237

Gardner syndrome

Answer 238

Hepatocellular necrosis

Answer 239

?Liver disease on previous recall

Answer 240

There are two separate placentas - dichorionic

Answer 241

Adenomatoid tumour

Answer 242

Spermatocytic seminoma

Answer 243

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

Answer 244

Free fluid

Answer 245

There is a prolonged half life of midazolam in elderly patients - Plasma half-life was approximately two-fold higher in the elderly.

Answer 246

Phaeochromocytomas -30%

Answer 247

Alveolar microlithiasis

Answer 248

T2 Slightly hyperintense compared to muscle, useful in determining the low signal muscle layer and its discontinuity when muscle wall invasion

Answer 249

Medulloblastoma

Answer 250

Architectural distortion

Answer 251

Contrast enhanced MRI

Answer 252

Persistent hypoglossal artery

Answer 253

Ovarian hyperstimulation

Answer 254

Anterior medial femoral (?)

Answer 255

Diffuse axonal injury

Answer 256

Nodular thickening of the jejunal folds in Whipples

Answer 257

Mucinous cystadenoma

Answer 258

ALL FEATURES

Answer 259

Metastases

Answer 260

Myxoid liposarcoma

Answer 261

Fibroadenoma or phyllodes

Answer 262

Intense contrast enhancement

Answer 263

Mucinous cystadenoma

Answer 264

Tc99 Pertechtenate scan

Answer 265

Cholestasis

Answer 266

Right side down

Answer 267

Graves disease

Answer 268

Hepatic veins draining into the IVC?

Answer 269

Chondral defect - SONK

Answer 270

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

Answer 271

Allagile syndrome

Answer 272

Pelvic haematoma

Answer 273

Extension into infrahyoid tissues

Answer 274

Bicornuate - more common

Answer 275

External rotation with the elbow flexed

Answer 276

Labyrinthitis ossificans

Answer 277

Most below knee DVTs will propagate to the surface without intervention

Answer 278

Pseudomonas

Answer 279

Gynaecomastia

Answer 280

Methotrexate and pneumatocoele Methotrexate inflammatory: fibrotic disease superimposed pulmonary infection: from immunosuppression pulmonary lymphoproliferative disease: from immunosuppression

Answer 281

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.

Answer 282

Requires further management.

Answer 283

Laryngocoele

Answer 284

High grade IDC – typically spiculated

Answer 285

Well defined mass

Answer 286

Clear cell chondrosarcoma. Epiphyseal, unlike the conventional chondrosarcoma which is usually metaphyseal-diaphyseal

Answer 287

Amyloid angiopathy.

Answer 288

There are two placentas

Answer 289

Rhabdomyoma – monitor and they go away, associated with TS

Answer 290

Mucinous cystadenoma

Answer 291

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.

Answer 292

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

Answer 293

No follow up Low risk = no routine follow up required

Answer 294

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

Answer 295

Mycoplasma pneumonia

Answer 296

Amyloid angiopathy

Answer 297

Well defined mass with microlobulated contours

Answer 298

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

Answer 299

DCIS - pleomorphic

Answer 300

Duodenal contusion

Answer 301

Massive PE.

Answer 302

Mucinous carcinoma of the appendix.

Answer 303

What is your understanding of what procedure you are getting today?

Answer 304

Macrodystrophia lipomatosa Clinodactyly – radial angulation at an interphalangeal joint in the radio-ulnar or palmar planes Typically affects the 5th finger Varied aetiology, ranging from congenital to acquired Aneuploidic syndromic - Down syndrome - Klinefelter syndrome - Trisomy 18 - Turner syndrome Non-aneuploidic syndromic - Cornelia de Lange syndrome - Feingold syndrome - Roberts syndrome - Russell-Silver syndrome - Fanconi anaemia Non-syndromic - Macrodystrophia lipomatosa - Brachydactylyl type A3

Answer 305

Oral contraceptive pill

Answer 306

If the baby is in a cephalic presentation do a TV study.

Answer 307

Calcification is an incidental finding.

Answer 308

Adrenoleukodystrophy Adrenoleukodystrophy - Characterised by a lack of oxidation of very long chain fatty acids (VLCFAs) that results in severe inflammatory demyelination typically of the periventricular deep white matter with posterior-predominant pattern and early involvement of the splenium of the corpus callosum and parietal white matter changes. - There tends to be cortical and subcortical U-fibre sparing. Alexander disease - There are three clinical forms: infantile/childhood-onset (most common), juvenile onset and adult onset (AOAD). - Mutation in the coding region, mapped to chromosome 17q21, of GFAP an astrocyte-specific intermediate filament protein. - Macrocephaly is typically present, and other clinical features include progressive quadriparesis and intellectual failure. - Most of the cases are sporadic. However, familial disease has also been reported. - The disease begins in the frontal region and extends posteriorly. Hurler syndrome - One of the mucopolysaccharidoses. - It manifests in the first years of life with intellectual disability, corneal clouding, deafness, and cardiac disease. - It carries an autosomal recessive inheritance. - Hydrocephalus, J-shaped sella, cord compression at the craniovertebral junction, shortening and widening of long bones, pointing of proximal metacarpals, widening of anterior ribs, thoracolumbar kyphosis, anterior inferior vertebral body beaking. Leigh syndrome - Leigh syndrome, also known as subacute necrotising encephalomyelopathy (SNEM), is a mitochondrial disorder with progressive neurodegeneration that invariably leads to death, usually in childhood. Tay Sachs - Tay-Sachs disease is a hereditary neurodegenerative disorder resulting from excess storage of GM2 ganglioside within the lysosomes of cells. - MRI is superior to CT in delineating deep white matter demyelination. - Thalami may show changes consistent with calcification, best seen on T2* weighted sequences. - No abnormal contrast enhancement is described.

Answer 309

The trachea is extremely dilated. - Plain inspiratory radiographs are usually normal or may demonstrate a dilated trachea.

Answer 310

Most common type is invasive ductal cancer. 85-90%

Answer 311

Association with SCC.

Answer 312

Dilated azygos vein.

Answer 313

External rotation with elbow flexed.

Answer 314

Pubic symphysis calcification.

Answer 315

Thymoma is most common in adolescence. - The typical presentation is in the 5th to 6th decades, without gender predilection.

Answer 316

Crohn’s disease

Answer 317

Bilateral theca lutein cysts.

Answer 318

Biliary atresia

Answer 319

Staph aureus is most common in 75 y.o. Most common of all, 80-90%

Answer 320

?Maybe thyroid

Answer 321

1st branchial cleft cyst

Answer 322

Orbital roof. Le Fort Type 1 - Horizontal maxillary fracture, separating the teeth from the upper face - Fracture line passes through the alvoelar ridge, lateral nose and inferior wall of the maxillary sinus Type 2 - Pyramidal fracture, with teeth at the pyramidal base, and nasofrontal suture at its apex - Fracture arch passes through the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bone - Uppermost fracture line can pass through the nasofrontal junction Type 3 - Craniofacial disjunction - Transverse fracture line passes through the nasofrontal suture, maxillo-frontal suture, orbital wall and zygomatic arch/zygomaticofrontal suture - Risk of temporalis muscle impingement

Answer 323

Zenker’s diverticulum Rarely found <40yo

Answer 324

Technegas given before perfusion Used during the ventrilation phase, performed before the perfusion phase

Answer 325

Lymphoma – but not a great answer

Answer 326

Adenocarcinoma

Answer 327

Normal vermis, enlarged 4th ventricle, hydrocephalus, no occipital dysplasia.

Answer 328

Chrondoblastoma

Answer 329

Between metatarsal shafts.

Answer 330

Stromal tumour

Answer 331

Poland syndrome

Answer 332

Renal artery stenosis

Answer 333

Praevia Low lying placenta – close to, or covering the internal cervical os

Answer 334

Mucinous cystadenoma

Answer 335

Amelloblastoma

Answer 336

Warthins tumours

Answer 337

Choroid plexus cyst

Answer 338

Can occur in monozygotic dichorionic

Answer 339

Lymphoma Primary lymphoma of the orbit is one of the commonest orbital tumours and accounts for as much as half of all orbital malignancies. It is a B-cell non-Hodgkin lymphoma, and in most cases arises from mucosa-associated lymphoid tissue (MALT).

Answer 340

Mucosal tear.

Answer 341

Hypertrophic pyloric stenosis. – T18 or Tuners

Answer 342

Eversion of the ipsilateral hemidiaphragm.

Answer 343

Intramural hematoma.

Answer 344

Monitor over next few months.

Answer 345

Secondary osteoporosis occurs most commonly at knee.

Answer 346

Cortical echogenicity equal to or greater than liver Tamm-Horsfall proteins, also known as uromodulin, may be a cause of echogenic renal pyramids in a neonate.

Answer 347

Hippocampus – amygdala without hippocampus

Answer 348

Desmoid - right age, right signal

Answer 349

Cyst at porta hepatic hepatic ducts absent absent gb dilated ha

Answer 350

Intracellular methaemoglobin is low on DWI

Answer 351

Renal pelvis more likely papillary type

Answer 352

Dilated ureter implies obstruction

Answer 353

Uniform low T2 signal - Can be variable due to heterogeneity in tumour components; e.g. calcific components > low signal; myxomatous components > high signal

Answer 354

Cardiac myxomas account for 50% of primary cardiac tumours

Answer 355

Local staging best by MRI

Answer 356

Tibial location is most common

Answer 357

Lymphoproliferative

Answer 358

Right colon antimesenteric

Answer 359

Elevated aortic ratio greater than 2.5cm/s

Answer 360

Interstitial ectopic has thinning of myometrium but sac is continuous with endometrial cavity

Answer 361

Calcification – occurs in 15%

Answer 362

Can be generalised in systemic viral infection – true

Answer 363

Slight enlargement Sub-acute thyroiditis can either be granulomatous (De Quervain) or lymphocytic. Granulomatous - F>M, ages 40-50 - Probably triggered by viral infection - ‘Unilaterally or bilaterally enlarged and firm’, ‘Is painful with variable enlargement of the gland’ - Radiopaedia ‘thyroid gland is mostly normal in size but can be enlarged or smaller in size’ - Usually have elevated T3 and T4 and low TSH - Radioactive iodine uptake is diminished Lymphocytic - Usually middle aged females or in post-partum state - Painless - Thyroid appears normal side from possible mild symmetric enlargement - Can present with hypertrhyoidism with most patients euthyroid by 1 year, can develop hypothyroidism - D is favoured (mild enlargement)

Answer 364

HSV1 encephalitis inferior temporal lobes HSV1 typically leads to bilateral and asymmetric involvement of the limbic system, mesial temporal lobes, insular cortices and inferolateral frontal lobes. Basal ganglia typically spared. - Robbins ‘inferomedial temporal lobes and orbital gyri of frontal lobes’ . Perivascular infiltrate with Cowdry A intranuclear viral inclusion bodies.  PML relates to oligodendrocyte infection by the JC virus in immunosuppressed patients. - Typically bilateral asymmetric supratentorial white matter and thalamic involvement. - Subcortical frontal and parieto-occipital regions are common locations. Both are correct, B maybe more specific  

Answer 365

No zonal predilection of plaques

Answer 366

PSC UC is associated with PSC, 7.5% of patients with UC have PS, 70% of those with PSC have IBD. PSC affects both the intra and extra-hepatic ducts resulting in a beaded appearance. There is often a +ve p-ANCA. Increased risk of chronic pancreatitis, cholangiocarcinoma and HCC.  PBC is mostly middle-aged females with other autoimmune disorders (Sjogrens in 70%, scleroderma in 5%). 95% of patients are AMA positive. Radiology can be normal as only small intra-hepatic ducts are affected

Answer 367

Endodermal sinus tumour (other name for yolk sac - yolk sac name not given)

Answer 368

Infertility common in chronic (40% chance of 3 episodes of PID) 8% after the first episode to as high as 40% after three Over time the infecting organisms can disappear leaving the sequelae of chronic follicular salpingitis which is where the tubal plicae adhere to each other and fuse in a scarring process. PID is generally an ascending infection, often beginning in the vulva or vagina. This can then lead to endometritis, salpingitis and later infect contiguous structures (TOA). Gonococcus infection usually starts in the endocervical mucosa. Non-gonococcal infections following instrumentation more likely spread from the uterus upward through the lymphatics and venous channels rather than on the mucosal surface. Causes include: - Neisseria gonorrhoeae - Chlamydia trachomatis - Polymicrobial infections in up to 35% - Rarer aetiologies include TB and actinomyces - Can be sexually transmitted or relate to delivery, abortion or instrumentation.

Answer 369

Community acquired disease originates in the uterus FALSE The infection generally ascends from the vagina or cervix (cervicitis) to the endometrium (endometritis), then to the fallopian tubes (salpingitis, hydrosalpinx, pyosalpinx), and then to and/or contiguous structures (oophoritis, tubo-ovarian abscess, peritonitis). Research shows tubal scarring caused by PID can lead to tubal factor infertility (a condition in which the fallopian tubes are blocked or damaged) in between 8% (after one PID occurrence) and 40% of women (after three or more occurrences).

Answer 370

Appendicitis

Answer 371

Most patient die from local complications TRUE Most die from local tumour extension rather than distant metastases Improved rates post HSV vaccination (yes HSV...trick, didn’t mention HPV) Improved post HPV vaccination- most closely associated with HPV 16 and 18 II - beyond the uterus, but not to the pelvic side wall A - Involvement of the upper 2/3 of vagina B - involvement of the parametrium III - involvement of the lower 1/3 of vagina, pelvic side wall, hydronephrosis or pelvic/para-aortic node involvement Incorrect, usually iliac and obturator nodes first > common iliac > para-aortic

Answer 372

Uveal melanoma metastases to liver Most common intra-ocular malignancy in adulthood is uveal mets (typically to choroid). Most common intra-ocular primary is uveal / choroidal melanoma. Breast cancer followed by prostate, melanoma and lung are most likely to metastasise to the orbit. Cavernous malformations / haemangiomas, although not true neoplasms, are the most common benign adult orbital tumour. Orbital lymphoma is the most common orbital neoplasm in older adults (>60) Retinoblastoma - Bilateral 30-40% of cases - always have a germline mutation - Unilateral 60-70% - are a germline mutation in 15% of cases, 85% sporadic - So ~55% are related to a germline mutation

Answer 373

Contains adipose tissue Represents microscopic fat globules with or without haematopoietic marrow elements

Answer 374

none, infection Pigment stones can be black or brown. These account for 10% of stones and have a low cholesterol content <20%. Black pigment stones relate to chronic haemolysis, cirrhosis or intestinal malabsorption. Brown stones relate to bacterial infection, parasitic infection (Clonorchis) and biliary stasis. They can be formed where there is intraductal stasis and chronic colonisation of bile with bacteria i.e. postsurgical strictures, choledochal cysts. Most (80%) stones are mixed and only 10% considered cholesterol stone (i.e. >50% cholesterol content). Risk factors for cholesterol and mixed stones include female gender, older age, diet, rapid weight loss, obesity, OCP and TPN.

Answer 375

Permeative (moth eaten) margins on xray A fibrous cortical defect is a fibroxanthoma, identical to a NOF although are < 3 cm. They are very common, most typically seen between 2 – 15 yrs of age. There is a slight male predilection. Typically in the metaphysis or diametaphysis and most common in the distal femur or tibia. Much less common in the upper limb. They are lucent cortical defects with a thin rim of sclerosis. There is no involvement of the medullary cavity and no periosteal reaction.

Answer 376

Associated with NF1 Multiple in MEN1 (or maybe it said NF1?) Associated with NF1, Carney triad and Carney-Stratakis syndrome

Answer 377

Leydig Leydig cell tumours account for 2% of testicular tumours. Mostly occur between 20 – 60. Can produce oesotrogens and/or corticosteroids. 10% are invasive and metastatic. GCTs account for 95% of testicular tumours and are generally malignant. The sex cord stromal tumours are usually benign. Most GCTs are mixed (60%), containing a mix of seminoatous and non-seminomatous components. Seminomas account for 50%, peak incidence 30 – 40. Spermatocytic seminomas are rare (1-2%) and mostly in patients > 65. They have a good prognosis and are not associated with intra tubular germ cell neoplasia (a precursor to GCTs).

Answer 378

Thyroid eye

Answer 379

Epispadias and sterility – Sterility is not infertility Fertility is lower with epispadias

Answer 380

Both are true - Likely A Struvite (MAP) stones are associated with chronic infection by urea splitting organisms and staghorn calculi. Proteus is one of these organisms that can convert urea to ammonia. These calculi tend to precipitate in alkaline urine. Most stones are calcium containing and associated with hypercalcaemia or hypercalcuria (60%). Other conditions that can contribute include hyperoxaluria and hyperuricosuria. Up to 20% have no demonstrable metabolic activity.

Answer 381

Most commonly involves 4th and 5th MCPJs Usually 2nd and 3rd MCPs

Answer 382

Focal periarticular calcification Peri-articular > intra-articular deposition of HA crystals. More appropriately called calcific periarthritis / enthesitis / tendinitis. Foci are typically round – ovoid and either ill or well defined. Can be intra-articular. 

Answer 383

Anaplastic better prognosis - worst prognosis

Answer 384

Papillary associated with something (?MEN1) or Medullary associated with MEN2 Most cases of medullary are sporadic, but also associated with MEN 2 A and B

Answer 385

MRI most sensitive ~98%

Answer 386

Trachea (maybe upper airway) Wegner is a multisystem non caseating necrotising granulomatous cANCA positive vasculitis affecting small – medium sized arteries, capillaries and veins. The triad is classically: - Lung involvement - Upper respiratory tract / sinus involvement - Renal involvement Can range from focal or segmental to crescenteric / proliferative glomerulonephritis GI and cardiac involvement is uncommon.

Answer 387

BRCA 2 Li Fraumeni - AD inherited mutation in p53 - Increased risk of breast cancer, sarcoma, leukemia, multiple CNS tumours, adrenocortical carcinoma BRCA 2 - Breast cancer (30-90%) by aged 70 - Ovarian - Male breast - Prostate - Pancreas - Stomach - Melanoma - GB and bile duct - Pharyngeal - Note BRCA1 is less associated with male breast cancer but more associated with ovarian ca. MEN 1 ‘3 P’ - Parathyroid hyperplasia > adenoma > carcinoma - Pituitary adenoma - Pancreatic neuroendocrine tumours Carney triad ‘Carney’s eat garbage’ - Chondroma (pulmonary) i.e. hamartoma - Extra-adrenal phaeochromocytoma - GIST peutz jegher even higher

Answer 388

Secondary biliary cirrhosis

Answer 389

Looks like ulcerating SCC Eczema rather than ulcerating

Answer 390

Traditional staging included axillary node dissection

Answer 391

PASH PASH is not commonly a spiculated mass, normally it is a circumscribed or partly circumscribed mass. - Can mimic a fibroadenoma on ultrasound. ILC is often multicentric and bilateral. - Sensitivity of mammogram for ILC is up to 80%. - It most commonly appears as a spiculated mass. - Less commonly asymmetric density, architectural distortion or region of microcalcifications. - Up to 16% are occult or benign appearing. Tubular carcinoma is a subtype occurring in younger women with a good prognosis. - It is usually a small <1cm spiculated mass. - They are associated with radial scars. Adenosis can be difficult to distinguish from an infiltrating carcinoma. - It can appear as a mass, region of architectural distortion or demonstrate microcalcifications (up to 55%).

Answer 392

Can mimic Neuroblastoma – histologically yes

Answer 393

true Beta catenin have the highest rate of malignant transformation of the adenoma subtypes. Inflammatory type is most common and has the highest bleed rate. HNF1 alpha Is second most common type and most often multiple Beta-catenin mutated are the least common. Seen in men on anabolic steroids, glycogen storage disease and with FAP

Answer 394

Leptomeningeal angiomatosis Associated with Sturge-Webber, NF-1

Answer 395

Subependymoma TS is associated with subependymal giant cell astrocytomas (SEGA). - These are WHO grade 1 lesions most commonly seen in age group 8 – 18 with TS. - They are most commonly located near the Foramen of Monro and can be differentiated from subependymomas by larger size (>1 cm), interval growth, marked enhancement. Subependymomas are more common in middle – older aged patients and are more commonly located in the 4th ventricle and frontal horns of lateral ventricles.

Answer 396

Worse prognosis than traditional HCC - Better prognosis than HCC FL HCC – most common aged 20-40, - Often well-differentiated, and - Usually don’t produce AFP elevation. - May contain a central scar which is usually hypointense on all phases.

Answer 397

Can have pulmonary nodules at presentation More common with longstanding disease

Answer 398

Takayasu Hypertrophic cardiomyopathy eosinophilic Churg Strauss cardiomyopathy Can cause a cardiomyopathy in up to 60%, most common cause of death

Answer 399

Neovascularity Haemoptysis usually arises from the bronchial arteries due to changes in the terminal vascular bed aneurysm second most likely (TB)

Answer 400

Asbestosis

Answer 401

Commonly associated with smoking- false “Mesothelioma of the thorax is a malignant neoplasm that involves the parietal pleura to a greater extent than the visceral pleura (,1). There is a significantly increased risk of developing this disease in those individuals with prior exposure to asbestos. The lifetime risk of developing mesothelioma in heavily exposed individuals is as high as 10%. There is a long latent period of approximately 35–40 years for the development of asbestos-related mesothelioma (,1). However, there has been no evidence to suggest smoking plays any role in the development of mesothelioma. This is in contrast to the significantly increased risk for development of adenocarcinoma in those patients who both smoke and have been exposed to asbestos”

Answer 402

Dysgerminoma MEIGS: Defined by the presence of ascites, pleural effusion (usually right sided) in associated with a benign usually solid ovarian tumour. In the vast majority of cases (up to 90%), the primary tumour is an ovarian fibroma. Other primary tumours include: - Fibrothecoma - Thecoma - Granulosa cell tumours of the ovary - Brenner tumour A dysgerminoma is the most common malignant germ cell tumour (only 1%). Usually occur in the 2nd and 3rd decades. Thought to be the ovarian counterpart of the seminoma in the testis.

Answer 403

false, 75%

Answer 404

2-3% choriocarcinoma in partial mole Never proven

Answer 405

Gallstones

Answer 406

Juxta-articular erosions closer to 10%

Answer 407

Symmetric enlargement of the uterus - as opposed to nodular thickening Enlargement can be diffuse or more focal

Answer 408

No association with malignancy of GB - Not premalignant, but found in associated with chronically inflammed gallbladder Adenomyomatosis is common, 9% of autopsy specimens. More common in females at 3:1. Pathologically involves formation of Rokitansky – Aschoff sinuses, intramural diverticula lined by mucosal epthelium, which penetrate into the muscular wall of the GB. Cholesterol crystals precipitate in the bile trapped in these sinuses.

Answer 409

Females more than males 3-5:1 Major risk factors are female gender, age and chronic biliary inflammation i.e. gallstones present in 95% of cases

Answer 410

detrusor muscle involvment Although lamina propria involvement worsens prognosis, involvement of the muscularis propria / detrusor is the major determinant of outcome as can be treated with BCG, where if invaded through needs cystectomy Staging of bladder cancer Tis – in-situ T1 – through lamina propria T2 – into muscularis propria T3 – invasion into perivesical tissues T4 – direct invasion into adjacent structures including prostate, uterus, vaginal vault

Answer 411

T3 is extraprostatic extension T3: localised extra-prostatic extension

Answer 412

both incorrect Stage II involves pelvic sidewall - False - III: low 1/3 of vagina, extends to pelvic sidewall or causes hydronephrosis or has para-aortic/pelvic nodal disease - II: tumour beyond the uterus, but not into the lower 1/3 of the vagina or pelvic side wall SCC worse than neuroendocrine - False, Neuroendocrine has worse prognosis

Answer 413

dnet DNET is a cortically based tumour. Mnemonic is DOG Pee - DNET - Oligodendoglioma - Ganglioglioma - Pleomorphic xanthoastrocytoma

Answer 414

Pulmonary emboli – less likely as 75% are in the left atrium

Answer 415

bilateral adrenelectomy causing pit macroadenoma

Answer 416

10% have positive BCs In 10% no organism is identified

Answer 417

Lymphocytic hypophysitis More common in women 8:1M Most common ~35yo Commonly presents in the peripartum period with headache and endocrine deficiencies Can cause DI

Answer 418

yeah pretty much A mature teratoma is a dermoid, a benign ovarian germ cell tumour. Congenital cystic tumour composed of well differentiated derivations of at least 2 germ cell layers. Bilateral in 20% of patients. They represent the most common benign ovarian tumour in women < 45 years. Risk of malignant transformation is <2% and most commonly an SCC. Usually occurs in the 6th – 7th decades of life in larger tumours <10 cm.

Answer 419

Idiopathic UIP has a better prognosis than NSIP

Answer 420

true Leading causes of neonatal cirrhosis include: - Biliary atresia - Choledochal cysts - Viral hepatitis - Alpha 1 antitrypsin deficiency - Alagille syndrome - proximal biliary duct obliteration, Liver disease - Progressive familial intrahepatic cholestasis “Alpha-1-antitrypsin deficiency is a commonly inherited genetic disorder, affecting up to 1 in 1,600 to 1 in 2,000 live births[1,2], most common in those of Northern European heritage. Individuals who are homozygous for the mutant Z allele (PiZZ) or are PiSZ are at risk for the development of liver disease. Although emphysema is rarely detectable before the third decade of life, liver disease can present at any age and can be evident as early as 1-2 months after birth. Four to ten percent of children with alpha-1-antitrypsin deficiency develop clinically significant liver disease during their first twenty years of life, making alpha-1- antitrypsin deficiency the most common genetic cause of pediatric liver disease and the most frequent inherited indication for liver transplantation in the pediatric population”

Answer 421

Elevated serum ceruloplasmin reduced atp7b gene

Answer 422

Parkinsonism is associated Primary haemochromatosis – AR disorder with mutation in HFE gene, regulating iron absorption from the GIT. This leads to reduced hepcidin synthesis. Iron accumulates as haemosidein in various tissues including liver, pancreas, myocardium, endocrine glands, joints and skin. CNS involvement is relatively less common. It can present with hypopituitarism or movement disorders such as Parkinsonism due to basal ganglia.

Answer 423

Hutchinsons Neuroblastoma syndrome Wilms is a malignant tumour of primitive metanephric blastema. It is associated with a predisposing syndrome in 10%: - Bewkwith-Wiedemann - WAGR - Denys-Drash - Sotos - Pearlman syndrome Other isolated abnormalities – cryptorchidism, hemihypertrophy, hypospadias, aniridia

Answer 424

Tendon hands wrist 85% around the fingers, with a volar/flexor surface Most commonly superficial and near the IP joints of the index and long fingers Hand > wrist > ankle/foot > knee

Answer 425

Most diabetics get retinopathy True, 78% of type 2 they also can have mononeuropathy

Answer 426

Pre eclapsia is associated with seizures False, seizures occur in eclampsia Gestational hypertension is associated with proteinuria False, proteinuria = pre-eclampsia Gestational hypertension is characterised by the new onset of hypertension after 20 weeks gestation without any maternal or fetal features of preeclampsia, followed by return of blood pressure to normal within 3 months post-partum. At first presentation this diagnosis will include some women (up to 25%) who are in the process of developing preeclampsia but have not yet developed proteinuria or other manifestations. Some women initially diagnosed in this category will manifest persistent blood pressure elevation beyond 12 weeks postpartum and eventually be classified as having chronic hypertension. Gestational hypertension near term is associated with little increase in the risk of adverse pregnancy outcomes “ Pre-eclampsia usually occurs after the 34th week of pregnancy. It is associated with hypertension and microalbuminuria in 20% post delivery as well as an increase in risk for heart and CNS vascular disease.

Answer 427

Chiari 1.5 - complex chiari malformation, low opex

Answer 428

Moderator bands can mimic masses Morphological part of the right ventricle. Extends from the IV septum to the margin of the RV, contacting/joining the base of the anterior papillary muscle

Answer 429

Turner syndrome is 45 XO Skeletal deformities include a short 4th metacarpal, - Madelung’s deformity, - narrowing of the scapholunate angle, - short stature, - webbed neck, - abnormal medial femoral condyle, and - cubitus valgus.

Answer 430

AICA loop Hemifacial spasm can occur due to irritation of the facial nerve usually at the root exit zone. An aberrant vascular structure is often a cause. The vessels most commonly implicated are AICA, PICA and the vertebral artery. Other causes include cholesteatoma, schwannoma, meningioma, intracranial lipoma and AV malformation.

Answer 431

Suppressing fat based on relaxation time a- STIR is ‘short Tau inversion recovery’ and is a fat suppression technique. It is a similar technique to FLAIR which is used to suppress water. Inversion recovery imaging allows homogenous and global fat suppression and can be used with low field strength magnets.

Answer 432

Decreased response to adrenaline in patients on Beta blockers A reduction in response to adrenaline is expected in patients on beta-blockers

Answer 433

Deciduous reaction (double decidual sign) of endometrium “In normal pregnancies, transvaginal US can demonstrate an intradecidual sign approximately 4.5 weeks after the last menstrual period (,12). The intradecidual sign is a small collection of fluid that is eccentrically located within the endometrium and is surrounded by a hyperechoic ring. At approximately 5 weeks, the double decidual sac sign can be visualized. The double decidual sac sign consists of two concentric hyperechoic rings that surround an anechoic gestational sac in a normal intrauterine pregnancy. The absence of the double decidual sac sign helps distinguish a pseudo–gestational sac from a true viable gestational sac”. Note interstitials have a higher propensity to rupture due to later presentation and ability to grow to larger size. Major risk factor is previous instrumentation.

Answer 434

Eosinophilic granuloma

Answer 435

<5mm diameter artery contraindicated for suture devices

Answer 436

Nodular interlobular septal thickening Features include: - Most commonly – patchy, migratory subpleural and / or peribronchovascular consolidation - Less commonly – single pulmonary nodule or mass, multiple pulmonary nodules, parenchymal bands, basilar reticular opacities. Bronchial dilatation within consolidation or GGO is listed as a HRCT manifestation on StatDx. - Tends to be a middle lobe, lingular and lower lobe predominance - Most frequent finding is GGO (90%) - Reverse halo ‘atoll’ sign seen in 19% of cases – ring of parenchymal consolidation surrounding GGO - Classic for COP. Also seen in invasive fungal infection including aspergillosis and mucormycosis, pulmonary infarction, Wegeners, infection, sarcoid

Answer 437

Indeterminate - needs repeat if CRL is < 7 mm and no heart beat this is suspicious but not diagnostic of pregnancy failure. Follow up in 7 – 14 days would be appropriate. If it were 7 mm, it would be diagnostic. Findings diagnostic of pregnancy failure - CRL >/= 7 mm and no HR - MSD OF >/= 25 mm and no embryo - absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac - absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac - pregnancy with an embryo with no heart activity on initial scan and repeat scan ≥7 days later - sac with no embryo and an MSD <12 mm on initial scan that fails to double in size on a scan ≥14 days later - sac with no embryo and an MSD ≥12 mm on initial scan with no embryo heart activity on a scan ≥7 days later 2 Findings suspicious but not diagnostic of pregnancy failure - CRL < 7 mm and no HR - MSD 16 – 24 mm and no embryo - Absence of embryo > 6 weeks post LMP - Large yolk sac > 7 mm - Small GS in relation to size of embryo i.e. < 5mm difference between MSD and CRL - Amnion seen adjacent to YS but no embryo i.e. empty amnion sign - Absence of embryo with heartbeat 7-13 days after a scan that showed a gestational sac without a yolk sac - Absence of embryo with heartbeat 7-10 days after a scan that showed a gestational sac with a yolk sac - Large amniotic cavity

Answer 438

EFW <5% and AC <5% (parvo also correct) Fetal MCA doppler used for - Assessment of fetal cardiovascular distress, anaemia and hypoxia - IUGR - Assessment of possible monochorionic twin related pregnancies including TTTS and TAPS Accurate measurement - Fetal head in transverse - Cross section including the thalami and sphenoid bone wings magnified - MCA found with colour or power doppler - Obtain measurement as close to its origin in the ICA (systolic velocity decreased away from this point) - Angle of insonation of < 15 degrees Parameters - PI (pulsatility index) - PSV (peak systolic velocity) - S/D ratio (systolic/diastolic) – a normal MCA S/D ratio should ALWAYS be higher than the UA S/D ratio - CPR (cerebroplacental) ratio – ratio of MCA PI and UA PI Interpretation Normal - High resistance flow i.e. minimal antegrade flow in fetal diastole - CPR > 1:1 - The PI is calculated by (PSV – EDV) / TAV (time averaged velocity) It normally has a high value and slowly decreases through gestation from around 28 weeks onwards. A low PI reflects redistribution of cardiac output to the brain. Abnormal - Fetal anaemia - Elevation of PSV in MCA - Elevated is > 1.5 MoM for gestational age (multiple of the median) - Fetal head sparing theory, MCA becomes a low resistance vessel IUGR - Asymmetric is the more common form and usually presents in T3. AC is reduced out of proportion to other fetal biometric parameters. AC is < 5 - 10th centile. There is often associated oligohydramnios. - A PI is recommended in the MCA if the EFW or AC are < 10 %, The PI is normally high and will slowly decrease through gestation from 28 weeks onwards. If it is low, this represents redistribution of cardiac output to the brain due to the fetal head sparing theory (low PI think low resistance therefore redistribution) Brain sparing physiology will be adapted, with an increase in MCA diastolic flow and a reversal of the normal ratio between the MCA S/D and UA S/D CPR is a ratio of the PI in the MCA vs the UA. An abnormal ratio is low and again reflects brain sparing. If the ratio is low it can indicate either an increase in placental resistance or a reduction in cerebral resistance. An abnormal CPR can thus occur even if the UA and MCA parameters are within normal limits, i.e. the MCA would be lower normal range and the UA PI at the upper normal range. Abnormal is < 5th centile or based on MoMs. Generally < 1:1 is abnormal.

Answer 439

Cervical length 27mm Best measured in TV with an empty bladder Normal >30mm The presence of a full bladder can increase the length, esp on a TA study

Answer 440

In all cases where a multilobed or succenturiate placenta or low lying placenta or velamentous cord insertion is identified, a TV scan with assessment of the lower uterus / cervix should be performed to assess for vasa previa. There are two main types of previa: Type 1 – 90% of cases. Vasa previa with velamentous cord insertion. Low-lying vessels from low cord insertion. Type 2 – 10%. Low lying vessels connect bilobed or succenturiate lobes.

Answer 441

Pressure gradient across aortic valve is mostly used as a marker of aortic stenosis, where there would be an elevated pressure across the valve (i.e. higher in the ventricle). Core (p 681): If the aorta is enlarged and the cardiac silhouette is, this suggests AR. If the aorta is enlarged and the cardiac silhouette is not, this suggests AS. Pansystolic murmur seen in MR, TR and VSD. AS typically has an ejection systolic murmur but could result in exertional syncope and a dilated ascending aorta. Upturned cardiac apex implies right ventricular enlargement – secondary to PAH, PV, ASD/ VSD, TR, DCM or TOF. Not sure what the answer or question is here.

Answer 442

Reflux of contrast into the IVC and dilated hepatic veins 

Answer 443

Fibroadenoma

Answer 444

AC dislocation

Answer 445

Simple Renal Cyst

Answer 446

Clear cell RCC

Answer 447

Anteriorly to maxillary sinuses

Answer 448

Nasal dermal sinus - Represents defective embryogenesis of the anterior neuropore - Any mixture of dermoid, epidermoid or sinus tract - A fluid tract signal in the septum, from nasal dorsum to skull base The foramen caecum represents a primitive tract between the anterior cranial fossa and the nasal space. It is located along the anterior cranial fossa, anterior to the cribriform plate of the ethmoid bone and posterior to the frontal bone, within the frontoethmoidal suture. It lies at a variable distance anterior to the crista galli. A variety of midline nasal pathologies may occur along this transient embryologic communication: - nasal encephalocele T2 hyperintense - extension of brain - epidermoid or dermoid cyst - associated with skin sinus tract or dimple, extends along foramen cecum, and - nasal glioma isointense to normal brain, no tract, extra bit of brain without continuation of cortex 

Answer 449

Chondroblastoma - soft tissue expansion rare. Usually epiphyseal in young patients

Answer 450

ANSWER: Brachial neuritis - Suprascapular nerve is involved in almost all cases - Axiallary and subscapular nerves can also be involved Quadrilateral space syndrome - Humerus laterally, long head of triceps medial, teres major and minor superior and inferior - Axillary nerve and posterior humeral circumflex artery - Results in teres minor +/- deltoid involvement Acute Suprascapular nerve impingement at spinoglenoid notch - Spinoglenoid notch - below the scapular spine, results in infraspinatus atrophy Acute Suprascapular nerve impingement at suprascapular notch - Suprascapular notch, medial to the coracoid, results in supra and infraspinatus atrophy

Answer 451

Laryngocele

Answer 452

Lymphatic malformation This is favoured as it is a trans-spatial process. Lymphangiomas are cystic lesions, 90% are in the head and neck.

Answer 453

This is most likely nodular fasciitis – a non-neoplastic soft tissue lesion most commonly located on the volar aspect of the forearm. Usually patients 20 – 40 years of age. Can be mistaken for an aggressive lesion on imaging and histology.

Answer 454

SPEN SPEN most common in non-Caucasian females around the 2nd – 3rd decades of life. Often large heterogenous solid cystic tumours with a median size at diagnosis of 8 cm. Most are benign but up to 15% are malignant.  

Answer 455

Calcific foci in the cortex are typical of PCP renal infection. They were initially thought to be pathognomonic but have also been seen in MAC and CMV infection.

Answer 456

Crohns Propensity to cause fistulae

Answer 457

supralevator Perianal fistula grading: - 1 – Intersphincteric - 2- Intersphincteric with abscess - 3- Transphincteric - 4 – Transphincteric with abscess - 5 – Supralevator or translevator

Answer 458

EG MRI: T2 high, T1 low to iso, and often diffusely enhancing Inner table can be eroded more than the outer - hole within a hole Center of the lesion can contain a sequestrum

Answer 459

thymus Both A and B are correct, maybe more in thymus “A number of physiologic variants are commonly encountered, including normal physiologic uptake in the head and neck, heart, breast, thymus, liver, spleen, gastrointestinal tract, genital system, urinary collecting system, bone marrow, muscles, and brown adipose tissue Bone marrow activity that is more intense than liver activity is considered abnormal. Normal accumulation is generally homogeneous, with more extensive distribution in children than in adults. The normal distribution of 18F FDG uptake in children is unique and may differ from that in adults, such as the physiologic activity of the lymphatic tissue in the Waldeyer ring, as well as uptake in the ileocecal region, thymus, hematopoietic bone marrow, and skeletal growth center”.

Answer 460

Cherubism Autosomal dominant, historically considered a variant of fibrous dysplasia. Radiographic features are of lucent expanded regions within the maxilla and mandible with soap bubble appearance.

Answer 461

Auto antibodies against myelin sheath - No testable antibody, thought to relate to cellular immune response directed against myelin - Mostly mediated by CD4+ Th cells Bimodal age distribution - Peak onset is childhood and age 50, average age 35. Not really bimodal

Answer 462

FMD - Usually medial dysplasia - Most commonly affects the mid-segment of vessels, spares the ostium - Renal > extracranial ICA and vertebral > iliac > others - Can be associated with aneurysms \ Polycystic kidney disease - False, AD PCKD is associated with renal insufficiency, but usually presents later - 6% association with berry aneurysms

Answer 463

NF1 Renal artery stenosis may be caused by several pathological processes: - Atherosclerosis (~75% of cases) involves the proximal renal artery - Fibromuscular dysplasia (~20%) involves the distal renal artery, younger population - Vasculitides (especially polyarteritis nodosa-causing multiple microaneurysms, Takayasu arteritis, radiation) - Neurofibromatosis type 1- most commonly involves the ostium - Abdominal aortic coarctation - Aortic dissection - Segmental arterial mediolysis

Answer 464

With a R sided arch, trachea is on the left (of the DA presumably) on the 3 vessel view (as opposed to being to the right of the DA on a standard view with a left arch. this also presumes drainage to a right arterial duct).

Answer 465

Hirschprung Occurs in 10% of patients with T21

Answer 466

Cardiomyopathy

Answer 467

Thymoma in 10% Occur in ~15% of patients with MG 30-50% of patients with a thymoma have MG

Answer 468

false: Drains to pulmonary veins Usually to systemic veins, can be pulmonary

Answer 469

Congenital lobar emphysema (CPAM can also be fluid filled in early stages. Subtle lucency sounds like CPAM ) The affected lobe tends to appear opaque and homogeneous because of fetal lung fluid or it may show a diffuse reticular pattern that represents distended lymphatic channels filled with fetal lung fluid. appears as an area of hyperlucency in the lung with oligaemia (i.e. paucity of vessels) mass effect with mediastinal shift and hemidiaphragmatic depression lateral decubitus film with the patient lying on the affected side will show little or no change in lung volume lateral film may show posterior displacement of the heart

Answer 470

Barrets is intestinal metaplasia - Intestinal metaplasia of the oesophagus - Squamous epithelium becomes columnar

Answer 471

Polyps in stomach ZE is a syndrome secondary to a gastrinoma with subsequent gastrin hypersecretion. Gastrinomas are usually multiple and typically located in the duodenum. Associated with MEN1. More than half have metastatised by presentation. Findings include thickened gastric folds/gastritis, erosions and ulcers (particularly in atypical locations).

Answer 472

Reflux oesophagitis Thickened and irregular oesophageal mucosal folds, ulcers/erosions, strictures and a reticular pattern if associated Barretts

Answer 473

Ischaemic hepatitis - Possibly true - could potentially precipitate ischaemic hepatitis Thrombocytopenia - Possibly true, due to hypersplenism and sequestration - Aetiology of thrombocytopenia in liver disease may just relate to reduced TPO production

Answer 474

Alcohol is more related to chronic than acute pancreatitis - biggest risk factor

Answer 475

Biliary atresia

Answer 476

false Central stellate or non-enhancing scar is seen in 1/3 of cases. Associated with Birt-Hogg- Dube syndrome and TS. Typically a ‘spoke-wheel’ pattern on angio.

Answer 477

radial scar

Answer 478

Marrow oedema posteromedial tibial plateau Classic contusion pattern is posterolateral tibial plateau and mid-part of lateral femoral condyle 

Answer 479

false. most common mech is anterior force to proximal tibia with knee in flexion

Answer 480

Graded by the Quintero staging: I – oligo / polyhydramnios II – bladder not visible in donor twin III – abnormal Dopplers in either twin IV – hydrops V – in-utero death

Answer 481

US often normal Can be sonographically occult

Answer 482

Changes often extend beyond macroscopically evident extent

Answer 483

Chondrosarcoma and enchondroma can be impossible to distinguish on imaging and path Factors favouring chondrosarcoma include large size, cortical breach, deep endosteal scalloping, presence of a soft-tissue mass and increased uptake on bone scan. Chondrosarcoms are also more likely to have pain, be in older patietns and less likely to occur in the hands or feet.

Answer 484

Diabetes The list is: - Hypercalcaemia / hyperPTH - Wilson - Haemochromatosis - Ochronosis - Hypothyroidism - Oxalosis - Acromegaly - ? gout ? arthritides HOGWASH

Answer 485

Thrombocytopaenia

Answer 486

Slowly progressive disease false It is rapidly progressive with dementia, cerebral atrophy,y myocolonus and death. MRI shows high signal in basal ganglia, thalamus and cortex with diffusion restriction. The thalamic signal abnormalities ‘hockey stick and pulvinar’ signs in vCJD. Sporadic form accounts for up to 90% of cases. vCJD is seen in younger patients and is the bovine to human transmission of bovine spongiform enecphelopathy. There is a familial form which accounts for 10% of cases.

Answer 487

Invasive fungal sinusitis Favours chronic invasive fungal sinusitis. This is usually > 12 weeks in duration and usually are immunocompetent or have a milder level of immunocompromise. Acute fungal sinusitis should NOT show high density content in the sinuses. Common in those with diabetes, especially ketoacidosis. It is also seen in neutropenic patients and thosewith advanced AIDS. Zygomycetes classically seen in diabetic patients. Aspergillus more so in neutropenia. Imaging shows low density mucosal thickening and soft tissue attenuation in the sinuses. Nasal septal ulceration and bone destruction may be present.

Answer 488

SCC Inverted papillomas mostly seen in men aged 50. They most commonly occyr on the lateral wall of the nasal cavity, most frequently related to the maxillary ostium +/- the middle turbinate. Mucocele formation associated is uncommon. They can undergo malignant transformation, mostly commonly to SCC (10%). Can also transform to adenocarcinoma, mucoepidermoid and verrucous carcinoma.

Answer 489

Acquired is due to overproduction of protein rich surfactant Associated with lipoprotienaceous material filling the alveoli with is PAS +ve The material is derived from pulmonary surfactant and the disorder is one of surfactant turnover

Answer 490

Adrenaline Prevent further air embolism Fi02 100% Venous air embolism – place in left lateral decubitus and Trendeleburg position Arterial – keep flat supine as head down can worsen cerebral oedema CPR if needed Advanced techniques including vasopressors

Answer 491

NM Ventriculography doesn’t reflux into ventricles

Answer 492

Liquefactive six type - Coagulative – most common, seen in infarcts (not in brain), tissue appears firm, cell outlines preserved - Liquefactive – cerebral infarcts and abscess - Caseous – soft, cheesy-looking material. Seen in TB and maybe syphilis or certain fungal infections - Fat – acute pancreatitis - Fibrinoid necrosis – immune reactions in vessels - Gangrenous – coagulative necrosis in an ischaemic limb

Answer 493

Fusiform aneurysmal disease is most common in the posterior circulation Most common in vertebrobasilar circulation

Answer 494

Children more prone to subdural haemorrhage maybe 

Answer 495

Can look like cancer True, can be multicentric and bilateral

Answer 496

Post gastro infection True, enteric of sexually transmitted infection Commonly yersinia, salmonella, shigella, campylobacter

Answer 497

B is false, it is more common in women with a F:M ratio of 4:1, usually > 60 years of age. Mostly related to chronic inflammatory states including cholecystitis, gallstones (70-90%). Other RF include IBD, FAP, PSC, porcelain gallbladder, fhx, obesity, certain ethnicities, carcinogen exposure.

Answer 498

Dissection

Answer 499

Maisonneuve fracture Maisonneuve is a fracture of the proximal fibula with an unstable ankle injury (widening of mortise). This can be either ligamentous injury and / or fracture of the medial malleolus. It is caused by pronation and external rotation mechanism.

Answer 500

PHACE syndrome - Posterior fossa malformations e.g. DW malformation - Haemangiomas - Arterial anomalies e.g. dysplasia / hypoplasia / absence of intracranial vessels - Cardiac anomalies including coaractation - Eye / ocular anomalies

Answer 501

Fibroids more commonly dystrophic calcification post menopause They typically involute and can calcify post menopause

Answer 502

Inclusion cysts are more common premenopausal Serous cystadenomas account for 60% of serous tumours, are bilateral in 15% and usually appear as a unilocular simple cyst with or without small papillary projections. - They can be difficult to distinguish from simple cysts but are usually larger (approximately 10 cm). Functional cysts should be smaller and would be more likely at a size of 4 cm. Inclusion cysts - almost exclusively occur in pre-menopausal women with a history of prior surgery, PID, endometriosis or trauma. Results from entrapment of ovarian fluid contained within peritoneal adhesions. They lack a discrete limiting wall. Many benign lesions do shadow including a dermoid and those along the fibrothecoma spectrum.

Answer 503

Most in bladder are papillary - True, mostly superficial (70-80%), with 20-30% being invasive - Most superficial lesions are papillary 70% - The bladder is the most common site of TCC more commonly papillary, which is lower grade than sessile

Answer 504

true, normal is no perfusion defects

Answer 505

Microlobulation

Answer 506

Dilated radicular arteries Defined as cerebrospinal fluid (CSF) pressure <6 cm H2O in patients with clinical presentation compatible with intracranial hypotension, namely, postural headache, nausea, vomiting, neck pain, visual and hearing disturbances, and vertigo Findings include: - Pachymeningeal enhancement - Increased venous blood volume - Distesion of dural venous sinuses - Pituitary gland enlargement - Subdural collections - Diffuse cerebral oedema - Sagging brainstem and acquired tonsillar ectopia - Reduced fluid in optic nerve sheath - Pontomesencephalic angle < 50 degrees Work up is with: - MRI brain with contrast - Speculative epidural blood patch - MRI spine with FS TS sequences looking for CSF in the epidural space or CT myelography 

Answer 507

Not sure of the exact wording of this question. Paragangliomas are associated with four clinical syndromes: - von Hippel-Lindau syndrome - multiple endocrine neoplasia types 2A and 2B - neurofibromatosis type 1 - Carney-Stratakis syndrome (also carneys triad) von Hippel-Lindau syndrome and neurofibromatosis type 1 are more commonly associated with phaeochromocytomas

Answer 508

Lucency in on CXR around lesion due to gelatinous exudate

Answer 509

Features of bowel injury include contrast extravasation, free gas, mural haematoma, fluid, abnormal enhancement. Bowel injury most commonly involves the jejunum near the DJ flexure > ileum > colon The CT hypoperfusion complex is: - Small calibre aorta - Collapsed IVC - Low density fluid surrounding the IVC ‘halo-sign’ - Thickened bowel loops >3 mm with enhancing walls - Most commonly involves jejunum - Shock pancreas – heterogenous enhancement - Bilateral adrenal hyperenhancement, particularly useful in paediatrics

Answer 510

interstitial An interstitial injury would not be identified. This is also called a subserosal bladder reupture. Extraperitoneal rupture is most common (85%) followed by intraperitoneal (15%). Other injuries include a bladder contusion or combined rupture.

Answer 511

Pituicytoma Ddx for suprasellar mass with high T1 signal - Macroadenoma with haemorrhage / nerosis - Craniopharyngioma - Rathke’s cleft cyst - Thrombosed aneurysm - Fat containing lesion including teratoma / dermoid cyst - Ectopic posterior pituitary A pituicytoma is a low grade glial tumour found in the neurohypophysis and infundibulum of the pituitary gland. They are typically t1 isointense, t2 heterogenous with bright contrast enhancement.

Answer 512

could be either a. Cholesterol granuloma - Typically expansile, well-marginated and thin the overlying bone - May cause bony erosion at the petrous apex, mimic an aggressive lesion b. Dipole fat - Asymmetric marrow is common - fat intensity on all sequences - May be the correct answer 

Answer 513

Adamantoid tumour these are benign, solid extratesticular lesions of the epididymis, tunica vaginalis or spermatic cord. They are the most common extratesticular neoplasm and most common tumour of the epipdidymis. They are more common at the lower pole with a ratio of 4:1. They are usually incidental, unilateral and mostly in males age 20 – 50.

Answer 514

GCT of the tendon sheath fits this description. Demonstrated as low t1/t2 signal nodules with moderate enhancement. There is a slight female predilection. Can erode bone. Divided into localised or diffuse forms. Ddx include ganglion cyst, PVNS, desmoid tumours and fibromas of tendon sheath.

Answer 515

Atrophy is decrease in size by programmed cell death

Answer 516

Left coronary artery intra-arterial - left main or LAD arises from right coronary sinus and courses between the ascending aorta and pulmonary arterial trunk

Answer 517

Dysplasia inevitably leads to malignancy

Answer 518

HSV1 affects frontal and temporal lobes

Answer 519

Similar lesion on other side

Answer 520

Enhancing solid nodule

Answer 521

Enhancing solid nodule

Answer 522

Renal vein invasion has 35% 5 year survival

Answer 523

Gastrinoma

Answer 524

Gastric ulcer

Answer 525

Chronic renal failure

Answer 526

Macroadenoma can occur post adreneclectomy

Answer 527

Recurrent PE

Answer 528

Can occur in cervical LN

Answer 529

Overcouch VS undercouch

Answer 530

Abdominal lead shield

Answer 531

Deterministic effects predominate

Answer 532

Budd Chiari

Answer 533

Steatohepatitis without cirrhosis

Answer 534

Intra-hepatic has better prognosis than Klatskin

Answer 535

Noonan Noonan syndrome (NS) is a genetically and phenotypically heterogeneous non-aneuploidic congenital RASopathy. Affected individuals can bear some clinical features similar to that of Turner syndrome.

Answer 536

More common in females than males Although the genetic defect is distributed equally among men and women, the iron loss as a result of menstruation is protective, resulting in a clinical male predilection (M:F ~ 2:1). Radiographic features - chondrocalcinosis: particularly knees and triangular fibrocartilage - arthropathy - symmetrical loss of joint space, subchondral cysts - close association with CPPD which is often seen concurrently - most commonly hands (MCP, carpal, PIP) with the characteristic hook like/ beak-like osteophytes projecting from radial ends of 2nd and 3rd metacarpals - more extensive involvement from the second to the fifth MCP and radial hook-like/drooping osteophytes are more characteristic than in CPPD 3 - can also affect the knee, hip, and elbow - generalised osteoporosis (~25%) or osteopaenia (~40%)

Answer 537

Secondary biliary cirrhosis

Answer 538

Oesophageal atresia is usually associated trachea-oesophageal fistula

Answer 539

Whipple’s get nodular folds mucosa

Answer 540

Pseudopolyps

Answer 541

Radial scar

Answer 542

Stromal component causes the metastases - It is generally thought that it is the stromal component that becomes malignant

Answer 543

Phylloides is about 1% of all breast cancers

Answer 544

Pancreatic adenocarcinoma

Answer 545

Both chiari associated with syringomyelia

Answer 546

Subpial grey matter

Answer 547

Anterior-inferior cerebellar artery looping course – more classically associated Restricted diffusion at CP angle – rare with schwannoma

Answer 548

Neurofibromas consist of Schwann cells - Neurofibromas are benign neoplasms composed of Schwann cells and fibroblasts, containing a rich network of collagen fibres.

Answer 549

Bronchial dilatation

Answer 550

Centrilobular nodules

Answer 551

Acute silicosis can look like PAP

Answer 552

Dilated cardiomyopathy

Answer 553

Lung cancer seen in never smokers is more likely to have an eGFR muta6on

Answer 554

Actinomyeces TB

Answer 555

Klebsiella in haemoptysis

Answer 556

Empyema has more than 1000ml

Answer 557

Can cause direct mediastional invasion

Answer 558

Upper airway

Answer 559

Takayasu presents as pulseless disease

Answer 560

Pulmonary arteries are rarely affected

Answer 561

Goose neck snare

Answer 562

Hickmann line tip should be at junction of right brachiocephalic and SVC

Answer 563

NF - NF-1–associated stenoses often occur in patients younger than 50 years, spare the renal artery origin, are long and tapered, and extend into segmental and intrarenal branches

Answer 564

UAC at aortic arch

Answer 565

diabetes Aetiology - Fibromuscular dysplasia (FMD): 35% - Degenerative aneurysm: 25% - Vasculitides, e.g. Behcet disease - Phakomatoses, e.g. tuberous sclerosis, neurofibromatosis - Intrinsic collagen deficiency, e.g. Marfan syndrome, Ehlers-Danlos syndrome - Trauma

Answer 566

Venous angiomas prone to cause haemorrhage - Developmental venous anomalies are usually incidental findings. However, patients can present with intracranial haemorrhage (1-5%). An association has also been described with ischaemic stroke and epilepsy.

Answer 567

Cystic medial necrosis is a precursor

Answer 568

ICA peak systolic is better than ICA:CCA

Answer 569

Pulmonary artery small Pulmonary hypoplasia +/- atresia TOF - VSD - RVOTO - overriding aorta - late RVH

Answer 570

Valve gradient is greater than 50 mmHg

Answer 571

Bronchogenic cyst

Answer 572

Mitral stenosis invariably caused by RHD

Answer 573

Pericardial effusion

Answer 574

Cor triatriatum

Answer 575

Diverticulitis

Answer 576

Typhilitis

Answer 577

Arterial ischaemia

Answer 578

Most likely to occur in 3rd trimester

Answer 579

Left sided tumours are much more common than right

Answer 580

H. pylori is associated with gastric adenocarcinoma

Answer 581

Barretts oesophagus

Answer 582

Uveal melanoma metastasizes to the liver

Answer 583

Sentinel node biopsy is most important for prognosis

Answer 584

Lung Hydatid disease - Hydatid cysts result from infection by the Echinococcus tapeworm species and can result in cyst formation anywhere in the body. There are two main species of the Echinococcus tapeworm: - Echinococcus granulosus - more common - pastoral: the dog is the main host; most common form - sylvatic: the wolf is the main host - Echinococcus alveolaris/multilocularis - less common but more invasive - fox is the main host Definitive hosts are carnivores (e.g. dogs, foxes, cats), and the intermediate hosts are most commonly sheep. Humans are accidental hosts, and the infection occurs by ingesting food contaminated with Echinococcus eggs. Cyst structure The cysts usually have three components: - pericyst: composed of inflammatory tissue of host origin - exocyst - endocyst: scolices (the larval stage of the parasite) and the laminated membrane are produced here Location - hepatic hydatid infection: most common organ (76% of cases) - pulmonary hydatid infection: second most common organ (15% of cases) - splenic hydatid infection: third most common organ (5% of cases) - cerebral hydatid infection - spinal hydatid infection - retroperitoneal hydatid infection - renal hydatid infection - musculoskeletal hydatid infection - mediastinal hydatid infection (very rare) Markers - Casoni skin test

Answer 585

Sickle cell anaemia

Answer 586

Congestive is the most common cause of hypersplenism

Answer 587

Hepatitis D superinfection causes decompensa6on in chronic Hepatitis B

Answer 588

Positively birefringent crystals

Answer 589

Staghorn stones and infection

Answer 590

Proteus causes struvite

Answer 591

Acute spinal cord infarct Ventral cord syndrome (also known as anterior cord syndrome) is one of the incomplete cord syndromes and affects the anterior parts of the cord resulting in a pattern of neurological dysfunction dominated by motor paralysis and loss of pain, temperature and autonomic function. Anterior spinal artery ischaemia is the most common cause.

Answer 592

Immunocompetent patients have multifocal involvement

Answer 593

Neurosyphillis is the most common cause

Answer 594

Osteomyelitis - 50% have negative blood cultures

Answer 595

Focal periarticular calcification

Answer 596

MRI is more sensitive than bone scan Classification stage 0 - plain radiograph: normal - MRI: normal - clinical symptoms: nil stage I - plain radiograph: normal or minor osteopenia - MRI: oedema - bone scan: increased uptake - clinical symptoms: pain typically in the groin stage II - plain radiograph: mixed osteopenia and/or sclerosis and/or subchondral cysts, without any subchondral lucency (crescent sign: see below) - MRI: geographic defect - bone scan: increased uptake - clinical symptoms: pain and stiffness stage III - plain radiograph: crescent sign and eventual cortical collapse - MRI: same as plain radiograph - clinical symptoms: pain and stiffness +/- radiation to knee and limp stage IV - plain radiograph: end-stage with evidence of secondary degenerative change - MRI: same as plain radiograph - clinical symptoms: pain and limp

Answer 597

Rectus femoris

Answer 598

Child with chondroid tumour in phalanx with invasive component likely chondrosarcoma - Invasive infiltration of the bone marrow spaces is not a characteristic of benign enchondromas, and this is probably the most helpful microscopic feature in distinguishing an enchondroma from a low-grade chondrosarcoma. also Enchondroma and chondrosarcoma can be similar radiologically and histologically

Answer 599

Foci of PD increase signal within tendon can be normal

Answer 600

Subscap tear + long head biceps tear

Answer 601

US can diagnose frozen shoulder - Rotator cuff interval capsule can be identified by ultrasound. A thickened rotator cuff interval capsule (≥2.8 mm) is suggestive of frozen shoulder.

Answer 602

Periosteal chondroma

Answer 603

Osteochondral defect

Answer 604

Anteromedial femoral condyle bone oedema – usually lateral The O'Donoghue unhappy triad comprises three types of soft tissue injury that frequently tend to occur simultaneously in knee injuries. O'Donoghue described the injuries as: - anterior cruciate ligament tear - medial collateral ligament injury - medial meniscal tear (lateral compartment bone bruise)

Answer 605

Intramedullary

Answer 606

Most commonly occurs in children

Answer 607

Rheumatoid nodules in 25% Rheumatoid nodules are common in RA and appear in approximately 25% of patients. Rheumatoid nodules favor subcutaneous tissues at pressure points, such as adjacent to bony protuberances.

Answer 608

Haemorrhage without infarct in pulmonary emboli affecting medium sized vessels

Answer 609

Urogenital diaphragm - membranous urethra

Answer 610

Mallory Weiss Mucosal and submucosal tear with involvement of the venous plexus

Answer 611

Adenocarcinoma

Answer 612

Nodal spread is the strongest prognostic factor

Answer 613

Gleason 3+4 = 7 has a better prognosis than Gleason 4+3=7

Answer 614

Diabetes HTN Ethnicity Risk factors - increasing age - family history - race: blacks > whites > Asians - cardiovascular disease - use of beta-blockers - metabolic syndrome: diabetes, hypertension, obesity

Answer 615

Mortality is secondary to effects of local invasion

Answer 616

Type 2 has a poorer prognosis

Answer 617

Associated with lung, pituitary and adrenal tumours

Answer 618

Composed primarily of adipose tissue

Answer 619

Dysgerminoma

Answer 620

Ovarian choriocarcinoma has a better prognosis than placental choriocarcinoma

Answer 621

Double decidual reaction

Answer 622

Previous myomectomy is a risk factor

Answer 623

Anteriorly to the maxillary sinus

Answer 624

dacrocystitis

Answer 625

PJP nephropathy CMV

Answer 626

Can cause high output cardiac failure

Answer 627

Choriocarcinoma can occur months after pregnancy

Answer 628

Osteopetrosis can be cured with stem cell transplant

Answer 629

CJD tends to occur slowly over years

Answer 630

Huntington causes caudate atrophy

Answer 631

HELLP can cause thrombocytopenia

Answer 632

Paraseptal is a risk factor for pneumothorax

Answer 633

Pleural or local recurrence

Answer 634

Peutz-Jeghers disease

Answer 635

Thrombocytopaenia – true

Answer 636

Most common type is germ cell tumour

Answer 637

Hypothyroidism

Answer 638

Double IVC

Answer 639

Disc can sequestrate

Answer 640

Medullary thyroid cancer is a neuroendocrine tumour

Answer 641

Swyer-James

Answer 642

Carpal angle is defined by two intersecting lines, one in contact with the proximal surface of the scaphoid and the lunate and the other line through the proximal margins of the triquetrum and the lunate. Its normal value is between 130° and 137°. It is increased (>139°) in: - bone dysplasia - Down syndrome - Pfeiffer syndrome It is decreased (<124°) in: - Hurler syndrome - Madelung deformity - Turner syndrome - Morquio syndrome - multiple exostoses

Answer 643

Glomus tumour

Answer 644

In a fasting patient coeliac artery has low resistance

Answer 645

If the MCA PI is low, then check the ductus venosus waveform

Answer 646

AML - Although the detection of fat is a well-established diagnostic imaging feature of classic angiomyolipoma, a hyperattenuating appearance on unenhanced CT and a T2-hypointense appearance at MRI both correspond to the smooth muscle component, are important diagnostic clues to the types of angiomyolipomas that contain few or no fat cells.

Answer 647

Subscapularis tear is associated with long head of biceps tear

Answer 648

Presents with an ovarian mass - The most common location for endometriotic deposits is in the ovaries.  endometriomas - <5 mm: early-stage disease; >15 mm: advanced disease - shading sign: may be less likely to respond to medical treatment - low T1 and T2 due to tissue and haemosiderin-laden macrophages diagnostic criteria: - multiple cysts with T1 hyperintensity OR - one or more cysts with high T1 and shading on T2  haemorrhagic “powder burn” - lesions appear bright on T1 fat-saturated sequences - small solid deep lesions - may be hyperintense on T1 and hypointense on T2

Answer 649

ADPKD has higher risk of RCC - Patients with ADPKD have a 50x increased risk of renal cell carcinomas, which typically manifest as atypical renal cysts.

Answer 650

Intracellular methaemoglobin is low on DWI

Answer 651

Hyperextension with varus

Answer 652

Duodenum and proximal jejunum

Answer 653

Lymphadenopathy Diabetic mastopathy - Characterised by the presence of a benign tumour like breast masses in women with long-standing type 1 or type 2 insulin-dependant diabetes mellitus. - The condition has also been reported in men. - A similar condition is lymphocytic mastitis but this occurs in non-diabetics. - It is a form of lymphocytic mastitis and stromal fibrosis. There is dense fibrosis, and predominantly B-cell lymphocytic infiltrate surrounding the ducts, lobules and vessels. - Appearance: - Mammography: Asymmetric densities - Ultrasound: Irregular hypoechoic masses with marked posterior acoustic shadowing

Answer 654

A patient with ferromagnetic ear piercing that they cannot remove is disqualified from entering a 1.5T magnet

Answer 655

Low resistance waveform in intratesticular arteries is normal

Answer 656

Adenocarcinoma

Answer 657

IV - if type 1 lateral to the groove, II if type 2 - through the groove

Answer 658

Local or pleural recurrence

Answer 659

Neuroblastoma Metastasis

Answer 660

Pyogenic abscess

Answer 661

Macrocyclic gad - could be considered No contrast

Answer 662

Total gastrectomy with anastomotic stricture

Answer 663

Rhabdoid tumour- Unlike mesoblastic nephroma, rhabdoid tumors may present with tumors in other tissues including in ~13% of cases, the brain. too young for wilms, too young for vhl/rcc, sarcoma and nephroma are furphys

Answer 664

Upper zone predominant

Answer 665

Pneumatocele - thin walled cyst. Appear within the first week of infection, resolve by week 6. Thin walled cystic spaces within the lung, containing gas. Little, if any, fluid content favours a pneumatocele

Answer 666

Elongated transverse process of C6 or maybe First rib ?osteochondroma

Answer 667

Bronchogenic cyst

Answer 668

Sublingual space

Answer 669

Hypoplastic nasal bone

Answer 670

Succenturiate lobe

Answer 671

Metaphyseal flaring - Erlenmeyer flask deformity PSEUDOHYPOPARATHYROIDISM MSK Short stature, obesity Brachydactyly Short metacarpals. Including 4th and 5th Short metatarsals Soft tissue calcification Exostoses CNS Basal ganglia calcification Sclerochoroidal calcification Deep white matter calcification  

Answer 672

Gadolinium retention

Answer 673

Cholesterol granuloma (expansile)

Answer 674

Increased fatty marrow signal on MRI

Answer 675

Paraganglioma

Answer 676

Leptomeningeal enhancement Intracranial hypotension - CSF pressure < 6 cmH2O Types: - Primary aka spontaneous - Secondary: Typically iatrogenic or traumatic Epi: Middle aged females Presentation: Positional headache typically. When more significant decreased GCS. Pathology: - Monro-Kellie hypothesis is a pressure-volume relationship that aims to keep a dynamic equilibrium among the essential non-compressible components inside the rigid compartment of the skull. - Spontaneous intracranial hypotension (SIH) usually is the result of a CSF leak in the spine. Causes include: - spontaneous dural dehiscence of meningeal diverticula (perineural cyst) - secondary to degenerative dural tears (typically related to calcified thoracic disc protrusions) - congenital focal absence of dura (nude nerve root) – rare  Associations: - Marfan syndrome - Ehlers-Danlos syndrome (type II) - autosomal dominant polycystic kidney disease (ADPKD)  Appearance: - Described features of intracranial hypotension include: - subdural collection - acquired tonsillar ectopia - dural venous sinus distention Mnemonic - S: subdural fluid collections - E: enhancement of the pachymeninges - E: engorgement of the venous sinuses - P: pituitary hyperaemia - S: sagging brain

Answer 677

Lateral clavicle Chronic recurrent multifocal osteomyelitis (CRMO) - Chronic recurrent multifocal osteomyelitis (CRMO) is an idiopathic inflammatory bone disorder seen primarily in children and adolescents. There is a female predominance, with 85% of cases reported in women. Pathology: - As the condition can be associated with skin conditions, like psoriasis, or inflammatory bowel disease an autoimmune cause is thought likely. Initially to examine the symptomatic site: - Early stages: osteolytic lesion - Later stages: progressive sclerosis Appearance: - Typically metaphyseal - Medial but not lateral clavicular involvement

Answer 678

Small vestibular aqueduct– large vestibular aqueduct is generally an issue (should be no larger than the posterior semicircular canal).

Answer 679

Bilateral in 25%- 50% are bilateral (even if symptomatic only on one side).

Answer 680

Annular fissure/tear is traumatic in aetiology - degenerative

Answer 681

Most common in hand– The shoulder is the most commonly affected joint.

Answer 682

Contrast enhanced MRI- Due to its propensity for multicentricity, breast MRI is usually recommended in many countries when histology of a lesion reveals invasive lobular carcinoma.

Answer 683

Most common age 40-60

Answer 684

Celiac disease Celiac disease, also known as non-tropical sprue, is the most common gluten-related disorder and is a T-cell mediated autoimmune chronic gluten intolerance condition characterized by a loss of villi in the proximal small bowel and gastrointestinal malabsorption (sprue). Features present on CT enteroclysis may include: - jejunoileal fold pattern reversal: thought to have the highest specificity is considered the most discriminating independent variable for the diagnosis of uncomplicated celiac disease - ileal fold thickening - vascular engorgement - prominent mesenteric lymph nodes may cavitate with a fluid-fat level - submucosal fat deposition in long-standing cases - splenic atrophy

Answer 685

Preserved NAA on MR spectroscopy The cerebellar metabolic pattern revealed significantly increased Cho/Cr and reduced NAA/Cho in the A-T patients, implying an increase in the choline signal intensity, with NAA/Cr showing no significant difference from that of the controls. Ataxia telangiectasia - Ataxia-telangiectasia is a rare multisystem disorder that carries an autosomal recessive inheritance, sometimes classified as a phakomatosis. It is characterized by multiple telangiectasias, cerebellar ataxia, pulmonary infections, and immunodeficiency. - On brain imaging, it usually demonstrates vermian atrophy, compensatory enlargement of the fourth ventricle, cerebral infarcts and cerebral hemorrhage secondary to ruptured telangiectatic vessels.

Answer 686

DWI changes can precede those on EEG

Answer 687

Ectopic pancreas Adult intussusception caused by EP represents 5% of all cases of intussusception.

Answer 688

Hypothyroidism– hyper but not hypo Craniosynostosis refers to the premature closure of the cranial sutures. The skull shape then undergoes characteristic changes depending on which suture(s) close early. Epidemiology: There is a 3:1 male predominance with an overall incidence of 1 in 2000-2500. 8% of cases are syndromic or familial. Primary forms are either sporadic or familial. Secondary craniosynostosis occurs in relation to a variety of causes: - endocrine disorders - hyperthyroidism - hypophosphataemia - vitamin D deficiency - hypercalcaemia - haematologic disorders causing bone marrow hyperplasia - sickle cell - thalassaemia - inadequate brain growth - microcephaly - shunted hydrocephalus

Answer 689

RML collapse

Answer 690

The renal arterial resistive index (RI) is a sonographic index of intrarenal arteries defined as (peak systolic velocity - end-diastolic velocity) / peak systolic velocity. The normal range is 0.50-0.70. Reasons for elevated values - medical renal disease - ureteric obstruction - extreme hypotension - very young children - perinephric fluid collection - abdominal compartment syndrome Reasons for elevated values in a transplant kidney - acute tubular necrosis (ATN) - acute or chronic transplant rejection - renal vein thrombosis - drug toxicity - ureteric obstruction - perinephric fluid collection Reasons for decreased values - renal artery stenosis

Answer 691

Hepatic veins draining into azygos vein– in azygos continuation hepatic veins usually drain directly in the right atrium.

Answer 692

Can undergo rupture and haemorrhage Paraovarian cysts are remnants of Wolffian duct in the mesosalpinx that do not arise from the ovary. They account for ~10-20% of adnexal masses. They usually occur around the broad ligament and arise from paramesonephric, mesothelial, or mesonephric remnants. They are usually simple cysts (although some authors include paraovarian cystadenomas under the umbrella of paraovarian cysts). Paraovarian cysts occasionally can be complicated by rupture, torsion, or haemorrhage. Large or symptomatic cysts often undergo surgical resection. Smaller asymptomatic ones are treated conservatively. Given a small chance of representing neoplasm, paraovarian cystic lesions may be recommended for follow-up imaging. The 2010 Society of Radiologists in Ultrasound consensus statement recommends follow-up of simple paraovarian cysts in situations similar to that of simple ovarian cysts: - 5-7 cm simple cyst in premenopausal women: yearly ultrasound - 1-7 cm simple cyst in postmenopausal women: yearly ultrasound - >7 cm simple cyst in any age: further imaging (e.g., MRI) or surgical evaluation

Answer 693

No further imaging required

Answer 694

T3 and 7 lesions are acute or non-united

Answer 695

Ulcerating plaque can be well characterised on Doppler– but not always origin of left not well seen exa high pulse pressure tend to be hypo intimal thickn measure at posterior wall

Answer 696

Actinomycosis - Aspiration of oropharyngeal/GI secretions into the respiratory tract - Tends to be lower zones Empyema necessitans causative organisms: - Mycobacterium tuberculosis: thought to be most common cause and may account for ~70% of cases - Actinomyces spp.: considered second most common cause (see: thoracic actinomycocis infection) - Blastomycosis spp. - Aspergillus spp. - Nocardia: see pulmonary nocardiosis - Mucormycosis spp. - Fusobacterium spp.

Answer 697

Ductus diverticulum

Answer 698

Ulcerating atheromatous plaque - since focal

Answer 699

Attempt aspiration, compression bandage, ice and elevation, and regular neurovascular observations

Answer 700

No further imaging required A filar cyst is an incidental finding on neonatal lumbar sonography located in the filum terminale of the spinal cord. It is considered a normal variant and is often confused for a ventriculus terminalis, a smooth dilated cavity of the central canal, located within the conus medullaris.

Answer 701

Grey and white matter oedema and haemorrhage

Answer 702

Caecal diverticulitis

Answer 703

Epiploic appendagitis

Answer 704

In Tetralogy of Fallot, the pulmonary artery is significantly smaller than the aorta

Answer 705

Simple renal cyst

Answer 706

Echogenic areas with shadowing on US- Typically seen as a well-circumscribed, round to ovoid, or macrolobulated mass with generally uniform hypoechogenicity. Intralesional sonographically detectable calcification may be seen in ~10% of cases 2. Sometimes a thin echogenic rim (pseudocapsule) may be seen sonographically. Fibroadenoma is a common benign breast lesion and results from the excess proliferation of connective tissue. Fibroadenomas characteristically contain both stromal and epithelial cells. They usually occur in women between the ages of 10 and 40 years. It is the most common breast mass in the adolescent and young adult population. Their peak incidence is between 25 and 40 years. The incidence decreases after 40 years. The typical presentation is in a woman of reproductive age with a mobile palpable breast lump. Due to their hormonal sensitivity, fibroadenomas commonly enlarge during pregnancy and involute at menopause. Hence, they rarely present after the age of 40 years. The lesions are well defined and well-circumscribed clinically and the overlying skin is normal. The lesions are not fixed to the surrounding parenchyma and slip around under the palpating fingers, hence the colloquial term a breast "mouse".

Answer 707

Cortical scarring in recurrent UTI Tc-99m DMSA (2,3 dimercaptosuccinic acid) is a technetium radiopharmaceutical used in renal imaging to evaluate renal structure and morphology, particularly in paediatric imaging for detection of scarring and pyelonephritis. MAG3 for function.

Answer 708

Vascular loop of AICA

Answer 709

Labyrinthitis ossificans– It the depends on the question alternatively retrofenestral/cochlear otosclerosis

Answer 710

Aneurysmal bone cyst Well defined, lucent

Answer 711

If MCA PI <5th centile should assess the ductus venosus

Answer 712

If the PI <5th centile then repositioning and repeat measurement taken

Answer 713

Reduced efficacy of adrenaline in patients taking beta-blockers

Answer 714

Characteristically hypovascular thyroid lesion on US

Answer 715

Lesion enhancement

Answer 716

Periosteal chondroma Juxtacortical chondromas, also known as periosteal chondromas, are rare benign chondral tumours that arise from the periosteum of tubular bones. They are thought to account for ~2% of benign bone tumours. Plain radiograph - may be seen as a saucerisation of the adjacent bony cortex with a sclerotic periosteal reaction - distinct soft tissue mass may be difficult to identify - matrix calcification may be seen in ~50% of cases; as with all chondroid lesions, this tends to be ring and arc - most lesions are <3 cm in size

Answer 717

Leptomeningeal infiltration is commonly seen- Extensive spread is relatively frequent, both craniocaudally to involve the cerebral hemispheres and spinal cord, as well as leptomeningeal spread.

Answer 718

Modic II is high T1 and low T2 - high, high

Answer 719

Serous cystic neoplasm

Answer 720

Classically located in the parotid gland

Answer 721

Posterior descending artery

Answer 722

Secondum ASD

Answer 723

IMA occlusion

Answer 724

Circumscribed mass (?)

Answer 725

More common in 3rd trimester– second trimester

Answer 726

Hepatic flexure is common watershed area - least correct, splenic flexure

Answer 727

Kernohans notch is compression of the ipsilateral peduncle secondary to uncal herniation on the falx Kernohans notch: indentation in the contralateral cerebral crus by the tentorium cerebelli 

Answer 728

UAC at the level of aortic arch The tip of the catheter should thus be placed in one of two locations: 1. high position: at T6 to T10 level 2. low position: at L3 to L5 level

Answer 729

Vascath line tip optimally positioned at brachiocephalic and SVC confluence.

Answer 730

Bicornuate - could be didelphys but bicorn more likely

Answer 731

Diverticulosis

Answer 732

Puetz-Jegher

Answer 733

Sensitive to paramagnetic, diamagnetic and ferromagnetic materials

Answer 734

Macrocystic serous

Answer 735

Should be measured in a segment of the umbilical cord at 90degrees to the transducer

Answer 736

Adenocarcinoma

Answer 737

MRI is more sensitive than TC-99m

Answer 738

Not definite for loss, needs repeat ultrasound to assess

Answer 739

Bifid crista galea

Answer 740

Calcification - psammoma bodies

Answer 741

Coronary sinus.

Answer 742

Mesenchymal hamartoma

Answer 743

Elongated transverse process of C6 (YES IT SAID C6)

Answer 744

Below the portal vein, located left to the left hepatic vein

Answer 745

Less than 24hrs

Answer 746

Short segment cord lesions

Answer 747

Short segment cord lesions

Answer 748

Epidermoid - would fit all but for the small cystic components

Answer 749

Normal fatty marrow Shouldn't be expansile

Answer 750

Invasive fungal sinusitis

Answer 751

Dacryocystitis Well-circumscribed round lesion with peripheral enhancement around the inner canthus, with adjacent soft tissue thickening and fat stranding

Answer 752

1st branchial cleft cyst 1st branchial cleft: Above the level of the manidble near the external auditory canal within or close to the parotid 2nd branchial cleft: Between the angle of the mandible and carotid bifurcation, deeper than platysma and superficial layer of the deep cervical fascia 3rd branchial cleft: Infrahyoid neck 4th branchial cleft: infrahyoid neck, usually adjacent to the thyroid gland

Answer 753

No further imaging

Answer 754

Short pedicles Achondroplasia Pelvis and hips: - Horizontal acetabular roof - Tombstone/mickey mouse ear iliac wings - Trigent acetabulum - Champagne glass pelvic inlet - Small sacroiliac notches Spinal: - Posterior vertebral scalloping - Progressive decrease in the interpedicular distance in the lumbar spine - Gibbus - Short pedicle canal stenosis - Laminar thickening - Widening of intervertebral discs - Increased angle between the sacrum and lumbar spine Limbs: - Metaphyseal flaring "trumpet bone" appearance - Rhizomelic shortening – femora and humeri - Long fibula – the fibula head is at the level of the tibial plateau - Bowing to medial segment of legs - Trident hand - Chevron sign - Shortened metacarpals and metatarsals – of similar length

Answer 755

Myxopapillary ependymoma and filum terminale

Answer 756

Adenocarcinoma

Answer 757

ICA occlusion contralateral

Answer 758

Goose neck snare – intended for use in the CVS or hollow viscus to retrieve and manipulate foreign objects

Answer 759

Duplicated IVC

Answer 760

No follow up

Answer 761

Pancreatic divisum - ~5%, most common

Answer 762

Islet cell tumour

Answer 763

Total gastrectomy, anastomotic stricture

Answer 764

Oesophageal web Associations: - Plummer-Vinson syndrome - Graft vs host disease - GORD - External beam radiation "jet effect" of contrast passing distally Oesophageal constriction caused by a thin mucosal membrane projecting into the lumen

Answer 765

Submucosal oedema

Answer 766

Epiploic appendagitis

Answer 767

Squamous cell carcinoma (SCC)

Answer 768

Giant cell tumour (GCT}

Answer 769

Ewing sarcoma

Answer 770

Seronegative arthropathy – for weeks

Answer 771

Gouty tophi Low signal on T1, heterogenous high signal on T2 Only one to have calcification

Answer 772

Medial tibial stress syndrome: - Shin splints – stress induced injury - Periosteal fluid and marrow oedema - Occurs at the medial surface of the distal 2/3rds of the tibial shaft

Answer 773

Adventitial bursitis - overlying the metatarsal heads

Answer 774

Commonly supplied by the internal maxillary artery

Answer 775

Inhaled foreign body

Answer 776

Delayed closure of ductus arteriosus causing a right to left shunt

Answer 777

Neuroblastoma metastases

Answer 778

Displacement of <2 mm is associated with a good prognosis If non-displaced, considered to be Salter-Harris Type 2 - Depends on the relationship with the trochlear groove - Type I, lateral to the groove - Salter-Harris 4, stable - Type 2, through the groove - Salter-Harris 2, unstable

Answer 779

The fornices may be mistaken for cavum septum pellucidum CSP can't be seen until 24 weeks - false, <18 weeks - >37 weeks

Answer 780

Placental lake

Answer 781

No follow up

Answer 782

Normal breast lump

Answer 783

MRI - delayed and persistent mass like enhancement Variable, but most show persistent delayed enhancement

Answer 784

Mastopathy

Answer 785

Further work up

Answer 786

1:1000 IM in 0.5 ml IM

Answer 787

Contrast is contraindicated

Answer 788

Subacute hypersensitivity pneumonitis (least likely, all others are established causes of crazy pavy- see Webb, STATDx)

Answer 789

Gram negative bacilli (most likely Klebsiella pneumonia, clue is bulging fissure- STATDx, Webb)

Answer 790

Amyloidosis (most likely, nodular thickening and posterior involvement with calcifications typical- STATDx, Webb)

Answer 791

Thickened axillary recess (least likely, more commonly seen in adhesive capsulitis, STATDx, MSK requisites)

Answer 792

Elevated HbA1c (most likely, association with diabetes- STATDx)

Answer 793

Colloidal vesicular True. Larvae dies an incites an inflammatory response from by the body

Answer 794

Adenocarcinoma metastasis True

Answer 795

Chondroblastoma True. Occurs almost exclusively in the epiphysis of skeletally immature patients

Answer 796

Optic nerve True

Answer 797

Dural thickening True. A sign of intracranial hypotension

Answer 798

Reduced bone density True. Bone density usually preserved

Answer 799

Posterior cruciate ligament tear True

Answer 800

Cocaine use True. Produces haemorrhages from systemic hypertension or rupture of pre-existing aneurysm (unlikely to occur at the vertex)

Answer 801

Hypoechoic fetal kidneys - kidneys are typically more hyperechoic

Answer 802

Omphalocele

Answer 803

Trisomy 13

Answer 804

Type V endoleak

Answer 805

Ovarian hyperstimulation syndrome

Answer 806

Hyperabduction

Answer 807

Small rim of peripheral cortical enhancement on CT

Answer 808

Pre-menopausal women should be scanned in the second half of the menstrual cycle (FALSE).  Transiently enhancing lesions can be seen in healthy women in second half of cycle therefore in pre-menopausal women MRI should be performed in first half of menstrual cycle to reduce rate of false positives. 

Answer 809

Evaluation after removal of silicone breast implants (FALSE. Evaluation OF implants but not post removal).  

Answer 810

Supine is the best patient positioning for assessment of the medial breast

Answer 811

Increased rate of false positives in younger women (TRUE). 

Answer 812

Lactational breast changes. 

Answer 813

Cysts are usually > 1 cm in size (FALSE usually < 1 cm). 

Answer 814

Almost never seen in flat bones (FALSE it 25% percent)

Answer 815

Medications such as fluoride and Vit B (FALSE its Vitamin D). 

Answer 816

Often fills the entire middle ear cavity (FALSE : rarely does). 

Radiodx Flashcards

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