rapids and cases

Question 1

Perthes lesion

2 mc after bankart

Answer 1

labroligamentous avulsion with medially stripped periosteum

Question 2

ALPSA

ant labrolig periosteal sleeve avulsion

Answer 2

tear of anteroinf labrum without rupture of scapular periosteum; inf GH, labrum and periosteum are stripped

Question 3

GLAD lesion

glenolabral articul disruption

Answer 3

superfic tear of ant labrum attached to fragment of articu cartilage without stripping

Question 4

Scurvy bone findings

Answer 4

osteoporosis
subperiost haemor
wimberger sign - line around epi
white line of frankel - meta
metaphyseal beaking - pelkan

Question 5

Kummell disease

Answer 5

delayed post traumatic collapse
intravertebral vacuum cleft ( osteonecrosis
steroids

Question 6

congenital unilat pedicle absence

Answer 6

overgrowth/sclerosis of contralate
asympto
widening of neural foramen
TP always abnormal

Question 7

sarcoid in bones

Answer 7

10% affected
lacelike phalangeal
acro osteolysis
soft tissue swelling
rapidly destructive
ask for CXR!

Question 8

thalassaemia bone findings

Answer 8

MC/MT/phala widening, squaring, thinned cortices, coarse trabeculae

Skull- widened diploe, hair on end

PNS - obliterated sinuses, incisors pushed forward ‘ rodent facies’

Question 9

dens fracture types

Answer 9

A - tip LC
B- across base of dens : MC, high rte of non , C1-2 fusion
C- subdental across body of axis; Rx halo

Question 10

gamekeepers, skiers thumb - do MRI

steners

Answer 10

tear of UCL of 1st MCPJ

if torn ligament is superficial to Adductor policis aponeurosis > Steners lesion > prevents apposition to bone >surgery

Question 11

maisonneuve #

Answer 11

prox fibular #

wideneing of medial mall jt space, post malleolar #

Question 12

leptomeningeal cyst

Answer 12

growing #
< 3y, depressed skull #
pia arach herniates through tear
elliptical with bevelled edges

DDx - dermoid, epidermoid, encephaloceo, post surgical defect

Question 13

calcaneonavicular coalition

talocalcaneal coa

Answer 13

young,
osseos, cartila, both

calcaneonavicu - anteater nose sign

talocalc -
c sign,
talar beak ( due to stress on talonav joint)

Question 14

pincer type FA impingement

Answer 14

acetabular over coverage

anterior margin of acet projecting lateral to post margin ( cross over sign )

Question 15

boeler angle

Answer 15

line anterior cal facet - post calcan facet - post cal tuberosity
20-40 deg

Question 16

calcaneal pitch

Answer 16

angle formed by intersection of line along plantar aspect of calcaneus and line parallel to floor
normal 20-30
< 20 hindfoot equinus
>30 hindfoot calcaneus

Question 17

Haglund Xd

Answer 17

retrocalcaneal bursitis
achilles tendionopathy
retroachilles bursitis
exostosis of posterosuperior calcaneus

Question 18

macrodactyly
cong 6
acq 3

Answer 18

congenital
lymphangioma, haemangioma
klippel trenauny
weber
Ollier
NF1
proteus

Acquired:
dactylitis
osteoid osteoma
melorheostosis

Question 19

features of metastatic vertebral #

Answer 19

T1 low/T2 high, T2 high halo ( fluid in osteo)
posterior bulging
no fracture line
soft tissue componenet
 DWI +ve
CE +ve
multiple levels, also abnormal signal without #
any vertebrae can be involved
posterior elements involved
out phase - high SI - no fat
cortical destruction

Question 20

superficial siderosis brain

Answer 20

ch recurrent haemorrhages - AVM, tumours, post op

hearing loss, cerebellar dysfunc
pyramidal tract signs
mental deterio

Question 21

H & N dermoid cyst

Answer 21

2-3rd decades
m=f
7% H & N
lateral eyebrow MC
10% floor of mouth
5% malignant change to SCC
excise - above myol- intraoral

CT : ‘marbles’ due to coalescence of fat - pathognomonic

Question 22

Huntington disease

Answer 22

diffuse cortical atrophy
caudate and putamen most affected
heart shaped frontal horns

Question 23

Temporal bone #

types 2

Answer 23

Longitudinal 70-90%
parallels long axis of PTB
conductive hearing loss, disloc ossicl, CSF otorhinorrhoea

Tranverse #
perpendicular 
occiput/frontal blow
sensorineural HL
sev vertigo, nystagmus FN palsy 30-50%

Question 24

DNET

Answer 24

benign supratentorial
partial complex seizures
occ cystic
focal cortical lesion MC temporal 
hypodense CT
T1 hypoin, T2 hyper
bright rim sign FLAIR
minimal CE
bubbly appearance

DDx ganglioglioma, low grade astro, PXA

Question 25

spinal cord infarction

Answer 25

artery of Adamkiwicz T8- conus central high T2 signal initial cord expansion later atrophy owl eye appearance

Question 26

Cowden disaese

Answer 26

``` Lhermitte duclos disease ( cerebell gangliocytoma - striated mass) half have cowden AD phakomatosis colonic polyps cutaneos tumours meningioma glioma thyroid/Br neoplasms ```

Question 27

adrenoleukodystrophy

Answer 27

XL R nl head size 5 -10 yrs adrenal insuff, abnormal sk pigmentation periatrail WM + splenium No grey matter involvement

Question 28

Lemierre Xd

Answer 28

``` septic jugular vein thrombophelbitis after oropharyngeal infections tonsillitis etc life threatening young ```

Question 29

MEN 2

Answer 29

medullary thyroid ca - always phaeochromocytoma - common a - parathyroid hyperplasia b - mucosal neuromas

Question 30

septo optic dysplasia

Answer 30

``` mildest form of holoprosencephaly hypoplas ON absence of septum pel squared off frontal horns endocrine abnormlaities migration anomalies schizencepha 50% periventricular cysts ```

Question 31

Bilateral coloboma

Answer 31

outpouching of posterior globe | CHARGE Xd

Question 32

clay shoveller #

Answer 32

``` # one or more spinous processes mc C7 ```

Question 33

Hoffa #

Answer 33

posterior tangential # of one or both femoral condyles | can be invisible on frontal

Question 34

Chauffeur # aka Hutchisons

Answer 34

radial styloid #

Question 35

Tillaux # | Maisonneuve

Answer 35

avulsion of anterolateral margin of distal tibia SalterH type 3 Maisonneuve medial malleolus Prox fibula

Question 36

Cottons #

Answer 36

Trimalleolar #

Question 37

Aviators #

Answer 37

neck of talus

Question 38

Hangmans #

Answer 38

``` C2 hyperentension pedicles of C2 with anterolisthesis of C2 on C3 no deficit teardrop # inferior aspect of C2/3 ```

Question 39

Malgaigne #

Answer 39

unstable pelvic # 14% vertical shearing ant + post arches pubic rami and sacral #

Question 40

Chopart fracture

Answer 40

fracture dislocation of midtarsal joints (sup disloc navi and cuboid

Question 41

Jefferson #

Answer 41

burst fracture of C1 bilateral lateral mass offset no neuro deficit

Question 42

Barton

Answer 42

Dorsal rim distal radius with intraarticular ext

Question 43

Potts #

Answer 43

lower end of fibula and medial malleolus

Question 44

non traumatic ICH

Answer 44

Underlying lesion : tumour, AVM, cavernoma, aneurysm Amyloid angio Dural VT Hypertensive angio coagulopathy

Question 45

capillary telangiectasia

Answer 45

``` do not touch brainstem radiation no T2 brush like CE dark on SWI ```

Question 46

caroticocavernous fistula

Answer 46

``` dilated SOV proptosis enlarged EOM retrobulbar FS bowed CS can be indirect - low flow ```

Question 47

miliary mets

Answer 47

``` thyroid ca RCC breast melanoma pancreatic osteosarc trophoblastic ```

Question 48

Miliary opacities | Afebrile

Answer 48

``` (TB) both (fungal) both varicella healed mets sarcoid pneumoconiosis -siol/Cwp haemosiderosis HP can be febrile LCH PAProteinosis multifocal micronod pneumocyte hyperplasia ```

Question 49

cannonball mets | 5

Answer 49

``` RCC chorio prostate synovial endometrial ```

Question 50

primaries which freq met to lungs | 6

Answer 50

``` chorio ewings melanoma osteo testicular thyroid ```

Question 51

MC primaries which give pulmonary mets

Answer 51

``` Breast CRC RCC uterine leiomyo H + N SCC ```

Question 52

Bezolds abscess

Answer 52

rare complication of acute suppurative mastoiditis infection erodes mastoid tip and extends into neck/SCM Abscess formation torticollis also ass with cholesteatomas

Question 53

Basilar invagination | PF ROACH

Answer 53

``` PAgets FD Rickets/OM/ Osteogenesis Achondroplasia Cleidocranial Hyperpara ```

Question 54

posterior vertebral body scalloping congenital dural ectasia increased canal pressure

Answer 54

OI mucopolysacc achondroplasia NF Ehlers Marfan Syrinx spinal canal tumour

Question 55

cholesteatoma | key sequence

Answer 55

DWI restriction beware epidermoid

Question 56

subchondral osteonecrosis of knee now called subchondral insufficiency # of knee

Answer 56

post op stress related diff location to OCD but similar appearance

Question 57

Hemitruncus arteriosus

Answer 57

main PA continues as LPA | RPA arises from Asc Ao

Question 58

Xd associated with gallstones

Answer 58

Bouveret - gastric outlet obstruction from GS Mirizzi Gilbert - congenital enzyme def > GS

Question 59

Modified Fisher Scale Grading for SAH

Answer 59

I - thin < 1mm , no IVH/ICH 2 - thin < 1mm, IVH 3 - thick > 1 mm, no IVH 4 - thick , IVH

Question 60

AICA vascular loops in CP angle | Types

Answer 60

I - lying in CPA not entering IAC II - extending < 50% of length of IAC III - > 50% of length of IAC

Question 61

Achondroplasia key findings ``` Skull Chest Limbs/hands Spine Pelvis ```

Answer 61

``` Skull : macrocephaly Frontal bossing NARROWED FM comm hydrocephalus large AF ``` Chest: ant rib flaring Short AP Diameter ``` Pelvis Tombstone ilia horizontal acetabulum champagne pelvis trident acetabulum ``` ``` Limbs/hands Rhizomelic shortening/ bowing/ shortening MC/MT Trumpet shaped tubular bones Trident hand Chevron sign ( inverted V epiphyses) ``` Spinal bullet shaped vertebra posterior vertebral scalloping prog decrease in interpedicular distance check for FM narrowing!

Question 62

MRI features of adhesive capsulitits | 4

Answer 62

Capsular thickening > 9mm T2 high in axillary recess Abnormal ST in rotator interval Thickening of coracohumeral ligament > 4mm

Question 63

Vascular malformation types Tumours low flow vascul mal high flow vasc

Answer 63

Tumours: infantile haemangioma - involute Low flow: Venous : phleobliths, CE Lymphatic perc sclerotherapy High flow AVM - embolisation

Question 64

Muller Weiss Syndrome | Adult Kohler

Answer 64

adult onset osteonecrosis of navicular | affects lateral aspect

Question 65

BIRADS risk of malignancy

Answer 65

``` 0 - incomplete 1 - 0% 2 - 0 % - routine FU 3 - < 2% prob benign - 6/12 FU 4a - low suspicion >2 < 10% 4b - mod susp >10<50% 4c - high suspicion > 50 < 95% 5 highly suggestive > 95% 6 bx proven ```

Question 66

Biliary hamartomas | von meyenburg complexes

Answer 66

``` incidental 1-5% small < 1cm benign lesions CT : hypo US hypo, may contain echogenic cholesterol MR : high T2, no or rim CE ```

Question 67

Focal hepatic hot spot sign | "hot quadrate (IV)"

Answer 67

``` SVC obstruction (collateral venous pathway : int mamm>paraumbil>left portal vein) ``` Focally inc bld flow to segment IV Tc99m sulphur colloid inc activity Intense early CE on CT

Question 68

flip flop enhancement of the liver

Answer 68

Budd Chiari

Question 69

pancreatic lipomatosis | causes 5

Answer 69

``` CF Steroids DM Cushings Scqachman diamond Xd ```

Question 70

Fat ring sign

Answer 70

mesenteric panniculitis | fat rim around vessels

Question 71

hepatic honeycomb sign

Answer 71

hepatic melioidosis abscess

Question 72

Right paraduodenal hernia

Answer 72

through fossa of waldeyer | located behind SMA

Question 73

Left paraduodenal hernia

Answer 73

fossa of landzert IMV lies in its anterior wall

Question 74

MR spect finding in CNS Tuberculosis

Answer 74

``` Inc lipid lactate peak Reduced NAA (mets, other tumours) ```

Question 75

Erlenmeyer flask def | CHONG

Answer 75

``` C - craniometaphyseal dysplasia H -haemoglobinopathies Osteopetrosis Nieman-Pick Gauchers ```

Question 76

Glutaric aciduria Type 1

Answer 76

B/L widened sylvian fissures mitochondrial macrocephaly symm BG lesions

Question 77

atretic parietal cephalocoele

Answer 77

underlying anomalies : persistent falcine sinus, sinus pericranii, absence of straight sinus Ass with mat folate def/ valproate use

Question 78

Leukoencephalopathy with anterior temporal cysts | 3

Answer 78

Congenital CMV infection ( periven Ca) megalencephalic leukoencephalopathy vanishing white matter disease

Question 79

Radial scar of the breast | complex sclerosing lesions

Answer 79

Idiopathic not related to surgery trauma ``` archi distortion, central lucency, black star appearance may contain micro ca different on diff projections Ddx - ca, surgical,fat necro Excision biopsy ``` ass atypical ductal hyper/ca ? upto 50%

Question 80

bilateral breast skin thickening

Answer 80

``` CHF nephrotic dermatologic SVC obst lymphatic obstruction scleroderma dermatomyositis ```

Question 81

unilat breast skin thickening

Answer 81

``` inflamm cancer radiation infection/inflamm axillary lLN obstruction occ CHF ```

Question 82

reduction mammoplasty | mmg findings

Answer 82

``` elevated, flatter breast more tissue in LQ elevatged nipple swirled pattern fat necrosis dystrophic ca suture ca skin thickening subareolar fibrotic band ```

Question 83

H Shaped vertebrae

Answer 83

SCD spherocytosis Gaucher Thalassaemia

Question 84

Nail patella Xd (Fong disease) 4 features

Answer 84

fingernail dysplasia, triangular lunula absent/hypo patella posterior iliac horns ( 80%) dysplastic radial head

Question 85

centre edge angle for femoral head coverage

Answer 85

vertical line from centre of FH second line through edge of acetabular roof angle between them shd be more than 25 degrees. If less then DDH

Question 86

Rf for HCC

Answer 86

``` cirrhosis haemachromatosis aflatoxin alpha 1 hepatitis Wilsons ```

Question 87

patella baja associations

Answer 87

polio ch juvenila idio pathic arthirtis achondroplasia

Question 88

Bilroth types | 2

Answer 88

I - gastroduodenal end-end anastamosis II - gastrojejunal side-side anastamosis. prox duodenal loop closed off

Question 89

CT sign of unequivocal prostate enlargement

Answer 89

> 1cm above symphysis pubis

Question 90

Chest uses of Ga 67 scintigraphy

Answer 90

Sarcoid disease activity Lymphoma staging P carinii pneumonia early detection

Question 91

111 indium oxine WCC scanning

Answer 91

detects areas of infection/inflammation 18-24hrs after injection superior to Ga67 ( excreted by colon) in abdo imaging highest radiation dose to spleen ( hotter) donor blood may be used esp in sev neutropenia but usually own cells

Question 92

MIBG | 'hot' scans

Answer 92

``` all NET Phaeochromocytoma carcinoid ganglioneuroma medullary thyroid ca neuroblastoma ``` labelled wiht I 123 or 131 image 4-24 hrs (123) or 1-4 days (131) preferable to octreotide due to renal accumulation of oct

Question 93

Tc pertechnetate or DTPA in testicular torsion

Answer 93

reduced activity cf thigh/contralteral nubbin sing - increased activity in internal pudendal artery with abrupt cutoff at testis ring/bullseye sign - inc activity in dartos muscle with central photpenia

Question 94

lymphoscintigraphy

Answer 94

Tc nanocolloid web interspace dx congenital lymphoedema ( milroys - pooling in foot) in venous obs - increased drainage not sensitive for malignant LN but sentinel node is useful

Question 95

nuclear cisternography

Answer 95

111 in or Tc DTPA injected into subarachnoid space in LS imaged sequentially up spine basal cisterns in 2-4 hrs vertex - 24-48 hrs normally no or minimal reflux into lateral ventricles ( transient is ok)

Question 96

scheuermans disease

Answer 96

``` adolescents thoracic kyphosis > 40 thoracolumbar kyphosis > 30 > 3 vertebral bodies disc narrowing ante disc invagination scoliosis 25% >75 deg surgery ```

Question 97

PHACE syndrome

Answer 97

``` posterior fossa malformation - dandy walker H aemangioma A rterial anomalies C oarctation E ye anomalies S ternal cleft ```

Question 98

early u fibre involvement

Answer 98

``` MS ADEM Alexandre disease PML galactosemia ``` Late : Canavan

Question 99

medulloblastoma | assoc Xd

Answer 99

Turcot - colon plyps/brain tum Cowden Li Fraumeni Gorlin Goltz