Radiology

Question 1

Which side of hilum in a chest xray should never be higher than the other side?

Answer 1

The left and right hila can be equal height or left higher than right, but right hilum should never be higher than left= pathological

Question 2

If there is consolidation on the right side in a chest xray, how do you know whether it is in the middle lobe or lower lobe?

Answer 2

If the middle lobe is affected the right heart border will be obscured, not in lower lobe consolidation.

Question 3

Holly-lead shaped opacities in the lung fields are characteristic of what?

Answer 3

Thickened calcified pleura (plaques)

From asbestos exposure

Question 4

If there is a cavity with a mass and an air crescent sign what could be the cause?

Answer 4

Air crescent is a crescent of air within the cavity.
Aspergilloma
Necrotising tumour (as it dies it leaves space)
Blood clot

Question 5

Causes of small calcified nodules in the lung fields on xray (<5mm):

Answer 5

Sarcoid
past Varicella pneumonia
Calcified granulomata (secondary to TB)

Question 6

Akin to an air bronchogram, what do you call it if there’s air in the alveoli (and fluffy opacity of pulmonary oedema around it)?

Answer 6

Air alveologram

Question 7

On xray in a white out of the hemithorax why would the trachea be central?

Answer 7

If there was a combination of loss of density and gain, for example pleural effusion + collapse

(If severe fibrosis is thought to be the cause there should still be air bronchograms)

Question 8

On xray, tram line airways suggest what?

Answer 8

Bronchiectasis (in upper lobes with fibrosis you are thinking sarcoid, chronic allergic alveolitis, TB)

Question 9

A patient has cannonball mets on xray, what would the one differential be?

Answer 9

Rheumatoid nodules

Cannonball mets occur with renal and colon cancers commonly

Question 10

If on abdo xray you see dilated loops of bowel what might be the cause?

Answer 10

Obstruction
Ileus (can be due to peritonitis, post-op, tends to be small bowel)

Question 11

How can you differentiate ileus from obstruction on abdo xray with dilated loops of bowel?

Answer 11

Paucity of gas in the rectal area/lower pelvis suggests obstruction over ileus.
Also ileus tends to affect the small intestine more than large intestine

Question 12

How can you tell whether dilated bowel is small or large bowel?

Answer 12

Vulvuloconvenientes- more frequent and go all the way across the bowel compared to haustra (large bowel)
Central distribution

Question 13

Causes of large bowel obstruction in sigmoid colon?

Answer 13

Tumour
Inflammation (diverticulitis- common in sigmoid colon)
Volvulus?

Question 14

Causes of small bowel obstruction?

Answer 14

Adhesions
Internal hernias
Gallstone ileus

(Tumour not as common as large bowel)

Question 15

Who is predisposed to sigmoid volvulus?

Answer 15

Sigmoid volvulus

Young people with learning disabilities
Old people
Chronic constipation

Question 16

Who is predisposed to caecal volvulus?

Answer 16

Those with long mesentery, which enables it to be mobile

Question 17

3 causes of upper lobe fibrosis

Answer 17

1. TB
2. Chronic sarcoidosis
3. Chronic allergic alveolitis

Question 18

For lower lobe consolidation, what sign would be indicative?

Answer 18

Loss of the hemi-diaphragm on that side

Question 19

How would you determine whether heart failure was acute or chronic decompensation on an CXR?

Answer 19

Cardiomegaly would occur in chronic heart failure

In acute causes from an MI, there wouldn’t be enough time to accommodate

Question 20

A patient has leaf-life patches of consolidation on CXR, when would you say they have developed asbestosis?

Answer 20

Suggests calcified pleural plaques

Only diagnosed with asbestosis if parenchymal disease present

Question 21

On CXR a patient has surgical emphysema and reduced lung markings, with opacification obscuring the R heart border. What is the likely cause?

Answer 21

Pneumothorax with lung collapse leading to surgical emphysema

Watch out for the muscle fibres making the low density regions look less low density

Question 22

Name for tearing of the oesophagus causing surgical emphysema?

Answer 22

Boerhaave syndrome

Question 23

Cause of unilateral diffuse pleural thickening,

Might look like reduced lung volumes and apparent mediastinal widening from the thickening

Answer 23

1. Mesothelioma

2. Metastasis

Question 24

What is the difference in mechanism between NOACs and LMWH?

Answer 24

LMWH activates antithrombin to increase Factor Xa inhibition

NOACs like rivaroxiban directly inhibit Factor Xa

Question 25

How long should a patient be on warfarin if they have a DVT post-operatively?

Answer 25

3 months

Unless recurrent

Question 26

How long should a patient be on Warfarin if they have a first DVT and no cause is found?

Answer 26

6 months

Question 27

What INR should be aimed for in patients who have had a second DVT?

Answer 27

3-4

Question 28

Patient has bilateral ankle oedema and eczematous skin, what is the likely cause?

Answer 28

Venous insufficiency

(Valves dysfunctional due to hereditary cause or DVT destruction means blood pools and puts pressure on the walls of the veins, increasing hydrostatic pressure)

Question 29

How does the information differ that CRP and ESR (or plasma viscosity) gives you?

Answer 29

CRP is more sensitive to acute changes in the last 24 hours

PV + ESR are less affected by recent change giving a sign of a sightly more chronic inflammation.