RD 2018 August Flashcards
(70 cards)
1
Q
MSK: Typical appearance of gout: Para-articular corticated erosions Juxta-articular osteopaenia Ill defined erosions
A
*LW:
Para-articular corticated erosions
2
Q
Chronic Recurrent Multifocal OM:
Outer third of clavicle
5 or more lesions on bone scan diagnostic
Tibia most common site
A
*LW:
Tibia most common Site.
Clavicle involvement is a characteristic finding as is uncommon in haematogenous OM.
Bone scan shows multifocal uptake in keeping with multi focal nature of disease.
*AJL - agree with above.
Tibia is most frequent location (favoured answer).
Other two options are classic descriptors however as stated on RP, imaging findings are suggestive rather than pathognomonic.
3
Q
40yo female, knee pain for 6 weeks. Tender medial tibial plateau
Subchondral fracture
Osteoarthritis
A
*LW: Favoured answer is OA
Sub chondral fracture; is usually insufficiency, and commonly occurs Females aged 55yrs or older, and although can occur in tibia, is more common in femur..
4
Q
Erosive oa Doesn’t have synovitis Equal DIP and PIP joint involvement Doesn’t usually involve MCPs Has no genetic component
A
*LW:
Erosive oa:
- Proliferative synovitis
- Distal distribution of DIP, PIP and 1st CMC.
- Multi genetic trait.
5
Q
Osteosarcoma medullary or cortical Metaphyseal cortical Metaphyseal medullary Epiphyseal medullary Diaphyseal medullary Diaphyseal cortical
A
*LW:
Conventional OS:
- Originates in intra medullary space
- Metaphysis 91%.
Paraosteal OS:
- Surface OS
- Metaphyseal (posterior femoral metadipahyseal cortex)
Periosteal osteosarcoma:
- Surface osteosarc.
- Commonly dipahysis or meta diaphsysis of long bones.
High grade surface OS:
- Diaphyseal surface.
6
Q
Low T1 and low T2 lesion in a Bakers cyst, no calcification:
Synovial sarcoma
PVNS
A
*LW:
PVNS, low signal implying heamosiderin layering within joint and thus extending out into Bakers cyst.
Low T1 and low T2 lesion in a Bakers cyst, no calcification
Synovial sarcoma
PVNS
7
Q
Definition of bakers cyst:
Medial gastric and semimembranosus
A
*LW:
Baker cysts, or popliteal cysts, are fluid-filled distended synovial-lined lesions arising in the popliteal fossa between the medial head of the gastrocnemius and the semimembranosus tendons via a communication with the knee joint.
8
Q
Regarding discitis:
T1 contrast helps make endplate changes more conspicuous
Staph is the most common organism in a 70yo female
A
*LW:
Regarding discitis:
T1 contrast helps make endplate changes more conspicuous: seem true
Staph is the most common organism in a 70yo female: true.
9
Q
Which is a stable fracture: Odontoid 1 Odontoid 2 Odontoid 3 Hangmans Extension tear drop
A
*LW:
Odointoid type 1
Which is a stable fracture: Odontoid 1: stable (although rare) Odontoid 2: unstable Odontoid 3 relatively stable if non displaced. Hangmans: unstable Extension tear drop: unstable
10
Q
What injury is not associated with a pivot shift mechanism ACL PCL Medial meniscus LCL
A
*LW:
Pivot shift ligamentous injuries include:
- ACL
- Posterior capsule and arcuate ligament
- Posterior horn lateral or medial meniscus
- MCL.
Thus from below recalls, either PCL or LCL are not commonly associated with pivot shift.
11
Q
Which doesn’t cause basilar invagination: Hypoparathyroidism OI Pagets Cleidocranial dysostosis Klipel Feil
A
*LW:
Which doesn’t cause basilar invagination:
Hypoparathyroidism: false - (Hyper parathyroidism)
OI: true
Pagets: true
Cleidocranial dysostosis: true
Klipel Feil: true
12
Q
McCune Albright
unilateral ?.
A
*LW:
McCune Albright:
endocrinopathy: precocious puberty
polyostotic fibrous dysplasia: more severe than in sporadic cases, and tends to be unilateral.
cutaneous pigmentation: coast of Maine ‘cafe au lait’ spots
13
Q
Colon: Angiodysplasia Right colon antimesenteric Left colon mesenteric Right colon mesenteric Left colon antimesenteric
A
*LW:
Right colon antimesenteric
14
Q
Most common ileocolic fistula
Crohns
A
Crohns
15
Q
Spincteric abscesses, 2 questions one was define 3, one was similar
A
*LW:
St James’s University Hospital classification 1:
grade 1: simple linear intersphincteric
grade 2: intersphincteric with abscess or secondary tract
grade 3: transsphincteric
grade 4: transsphincteric with abscess or secondary tract within the ischiorectal fossa
grade 5: supralevator and translevator extension
16
Q
Hep bil: 20yo woman, most common pancreatic lesion: SPEN IPMN Mucinous Serous Neuroendocrine
A
*LW:
SPEN - Solid pseudopapillary Neoplasm.
17
Q
40yo women, Large cystic lesion with peripheral calcification in pancreas IPMN Mucinous Serous micro Serous macro SPEN
A
*LW:
Mucinous “Mother lesion”.
18
Q
Panc: Calcification centrally, lots of cysts <2cm, old. Macrocystic serous adenoma Microcystic serous adenoma Mucinous SPEN IPMN
A
*LW:
Microcystic serous adenoma
19
Q
Todani for multiple saccular intrahepatic 1 2 3 4 5
A
*LW:
Todani for multiple saccular intrahepatic
Todani type I: Fusiform dilation of the extrahepatic bile duct. this is the most common form of choledochal cyst.
Todani type II: Diverticulum of the extrahepatic bile duct. This is a rare type of choledochal cyst.
Todani type III: A diverticular expansion of the distal bile duct within the duodenal wall, termed a choledochocele. This is a rare type of choledochal cyst.
Todani type IVa: Cystic dilation of the intrahepatic and extrahepatic bile ducts. This is the second most common type of choledochal cyst.
Todani type IVb: Cystic dilation of the cystic duct and extrahepatic bile ducts.
Todani type V: Cystic dilation of the intrahepatic bile ducts. This is synonymous with Caroli disease.
20
Q
Neuro: Aneurysm 3mm High risk – needs to be expedited Unlikely to cause symptoms If enlarges, could cause cranial nerve symptoms Should talk to a neurosurgeon
A
*LW:
Favoured answer is unlikely to cause symptoms currently.
Aneurysm 3mm:
High risk – needs to be expedited: False: low risk of rupture until > 7mm
Unlikely to cause symptoms: correct, as vast majority are assymptomatic, especially small lesions.
If enlarges, could cause cranial nerve symptoms: unlikely, cranial neuropathy is uncommon, but possible, so would dependent on lesion location and size.
Should talk to a neurosurgeon: not immediately.
21
Q
Autoimmune encephalitis: VGKC encephalitis Mesial temporal Habenulae Others
A
*LW: favoured answer is - VGKC encephalitis.
Autoimmune encephalitis:
VGKC encephalitis:
Voltage gated potassium channel (VGKC) antibody encephalitis is an autoimmune encephalitis with antibodies against the voltage gated potassium channel. It is one of the most common forms of autoimmune limbic encephalitis in the absence of primary extra-CNS tumours.
Mesial temporal: commonly due to reactivation of HSV encephalitis.
Habenulae: part of the epithalamus,.
Others
22
Q
Diffuse midbrain glioma
Usually pontine without enhancement or dwi
Medulla most common site
Avid enhancement
DWI restriction
A
*LW: Favoured answer: Usually pontine without enhancement or dwi
Diffuse intrinstic pontine glioma:
- Expansile mass centered in pons with indistinct margins & no enhancement
- Tumor often extends into brainstem/medulla or middle cerebellar peduncle
- Diffusion restriction uncommon; ADC signal usually much brighter than adjacent brain
- Fibrillary tumors: Variable enhancement, usually none or minimal
- Focal areas of enhancement → worse prognosis (higher grade)
Glioblastoma: Often has focal areas of enhancement with central necrosis
23
Q
Varicella
Spinal cord lesions
Various other ones
A
*LW:
Varicella-zoster virus (VZV):
Varicella: May affect multifocal areas of cortex
Zoster: Brainstem/cortical GM, cranial nerves
VZ can result in viral myelitis also.
24
Q
DAI sensitivities and adc
MRI is 90% sensitive to non-haemorrhagic
CT is 60% sensitive
Whole brain ADC is not useful in prognosis
Corpus callosum rarely involved
A
*LW: MRI is 90% sensitive to non-haemorrhagic: TRUE, Radiopedia states T2 weighted sequences has a 92% sensitivity for non haemorrhagic lesions.
Dai sensitivities and adc:
MRI is 90% sensitive to non-haemorrhagic: TRUE, Radiopedia states T2 weighted sequences has a 92% sensitivity for non haemorrhagic lesions.
CT is 60% sensitive: False, CT head normal in upto 80% of cases.
Whole brain ADC is not useful in prognosis: unsure but dont think so.
Corpus callosum rarely involved: FALSE - 20% involvement
25
Dwi abscess and methaem:
- intracellular methaem May cause low dwi.
- dwi around the abscess - is it normal ?
- Normal diffusion restriction around an abscess
- High ADC in infarct
Methaemoglobin causes something…
*LW:
Dwi abscess and methaem:
intracellular methaem May cause low dwi:
- early subacute (3 to 7 days)
- intracellular methaemoglobin
- T1 signal gradually increases (T1 shortening) to
- become hyperintense
- low signal on isotropic DWI and reduced ADC values
dwi around the abscess - is it normal ?
- peripheral or patchy restricted diffusion may also be seen; however not that constant with up to half of rim-enhancing lesions demonstrating some restriction not proving to be abscesses.
High ADC in infarct:
- Low in the first 7 days, with pseudonormalisation in 2nd week.
- Becomes high after 3 weeks.
Methaemoglobin causes something:
- Late subacute (7 to 14-28 days)
- extracellular methaemoglobin: over the next few weeks, as cells break down, extracellular methaemoglobin leads to an increase in T2 signal
- high signal on isotropic DWI and reduced ADC values
26
```
Petrous apex lesion. Bony destruction. Low T1, T2, enhancing. No DWI.
Diagnosis:
Petrous apicitis
Metastases
Chondrosarcoma
Cholesterol granuloma
Cholesteatoma
```
*LW: unsure given low signals....
Petrous apex lesion. Bony destruction. Low T1, T2, enhancing. No DWI.
Diagnosis:
Petrous apicitis: boney destruction, enhancing thick dura, non enhancing pus which would be DWI bright.
Metastases: bone destruction, intermediate T1 and T2, enhances, may restrict diffusion.
Chondrosarcoma: invasive bony margins, should have chondroid matrix, high T2 signal, mixed enhancement.
Cholesterol granuloma: Smooth expansile bone remodelling, High T1 and T2.
Cholesteatoma: smooth expansile, low T1 and high T2, non enhancing, DWI bright.
(seems odd as low on both..)
27
Painless proptosis, preseptal swelling and lacrimal swelling.
TED
Idiopathic
Mets
*LW:
| Favour thyroid eye disease given proptosis and lacrimal gland swelling. Unsure of pre septal swelling.
28
```
Face:
Where will pterygopalatine lesion least likely spread
Anterior into sinus
Posterior into middle cranial fossa
Medial into nose
Lateral into subtemporal fossa
Suprior into orbit
```
*LW:
Answer: Anterior into sinus - this is favoured option being least likely spread.
medially:
- nasal cavity via the sphenopalatine foramen
laterally:
- masticator space (or infratemporal fossa) via the pterygomaxillary fissure
anteriorly:
- orbit via the inferior orbital fissure (superiorly)
posteriorly and superiorly:
- Meckel cave and cavernous sinus (of the middle cranial fossa) via the foramen rotundum
posteriorly and inferiorly:
- middle cranial fossa via the vidian canal
posteriorly and medially:
- palatovaginal canal to the nasopharynx.
inferiorly:
- palate via the greater and lesser palatine canals
Where will pterygopalatine lesion least likely spread
Posterior into middle cranial fossa
Medial into nose
Lateral into subtemporal fossa
Suprior into orbit
29
Inverting papilloma
| Associated with squamous cancer
*LW:
Inverting papilloma
Associated with squamous cancer
Inverted papillomas are a type of Schneiderian papilloma.
Most commonly lateral wall of the nasal cavity, most frequently related to the middle turbinate/middle meatus and maxillary ostium
Malignant transformation occurs in a variety of histologies, including keratinising and non-keratinising squamous cell carcinoma
CT:
Soft tissue density mass with some enhancement. The location of the mass is one of the few clues toward the correct diagnosis. As the mass enlarges, bony resorption and destruction may be present, with a similar pattern to that seen in patients with squamous cell carcinoma 2.
Intralesional calcifications representing residual bone fragments are observed in ~40% of cases.
The presence of a focal, often cone-shaped, hyperostosis correlate with the point of origin of the lesions.
30
Neck:
Jaw cyst with enhancing nodule
Ameloblastoma
*LW:
Jaw cyst with enhancing nodule
Ameloblastoma
31
```
Neck lymph node anterior to submandibular gland – what level?
1
2
3
4
```
Neck lymph node anterior to submandibular gland – what level?
1
32
```
ZMC fracture spares what:
Orbital roof
Orbital floor
Anterior maxilla
Arch
Lateral orbital wall
```
*LW
Sapres orbital roof.
ZMC fracture = tripod fracture:
- zygomatic arch
- inferior orbital rim, and anterior and posterior maxillary sinus walls
- lateral orbital rim
33
Cystic lesion with fluid level going through thyrohyoid membrane
Laryngocele
Dermoid
4th branchial cleft cyst
*LW:
Laryngocele
- Mixed laryngocele: Extends from paraglottic space through thyrohyoid membrane to low submandibular space (SMS)
34
```
Thyroid cancer papillary which is least likely:
Papillary Calcified nodes
Papillary Cystic nodes
Papillary calcified
Follicular met to nodes
```
*LW:
Thyroid cancer papillary which is least likely:
Papillary Calcified nodes: false, usually cystic, septated, thick walled.
Papillary Cystic nodes: true
Papillary calcified: true
Follicular met to nodes: likely false, as haematogenous spread more common early.
Papillary thyroid cancer:
- Most common
- Solitary mass, with irregular margin, vascularity.
- Mass may show Small punctate regions of echogenicity representing microcalcifications (psammoma bodies) may be present
- Mets to nodes commonly
- Nodal disease commonly shows cystic components, with thick nodular walls and septa.
- Purely cystic nodes uncommon.
Follicular thyroid cancer:
- Haematogenous spread more common.
- lesion lacks cystic change.
- Concentrates pertechnetate, not radioiodine.
NOT SURE ABOUT THESE OPTIONS
35
Cystic lesions in neck of 40yo woman non-smoker, one in parotid two outside:
```
Most likely:
Warthins
Pleomorphic adenoma
Sjogrens
Mets
Lymphoepithelial lesions
```
*LW: Unsure of correct answer, likely need further discriminators
Cystic lesions in neck of 40yo woman non-smoker, one in parotid two outside
Most likely:
Warthins: Unlikely as usually elderly male smoker
Pleomorphic adenoma: Unlikely as Usually single lesion
Sjogrens: possible, correct demogrpahics, usually multiple cystic lesions
Mets: possible with other nodal station involvement.
Lymphoepithelial lesions: also possible, bilateral solid cystic lesions, lack Ca++.
36
Womens:
Torsion
Vascularity excludes torsion
Fallopian can twist with it or sometimes doesn’t
*LW:
Torsion ;
Vascularity excludes torsion: False
Fallopian can twist with it or sometimes doesn’t: true.
37
Endometrial ca
| endometrial atrophy is one of the commonest causes of post menopausal bleeding
*LW:
Endometrial ca:
endometrial atrophy is one of the commoners causes of post menopausal bleeding, accounting for 60-75% of cases: true
38
4 Chamber view of heart:
VSD can be diagnosed by seeing unidirection flow across the septum
VSD good to assess with septum verticle
LV anterior most to ventricle wall
2mm fluid both sides of heart is physiological
*LW:
Per R.B:
Preferred answer is A: VSD can be diagnosed by seeing unidirection flow across the septum
4 Chamber view of heart:
VSD can be diagnosed by seeing unidirection flow across the septum: Likely not completely correct, as Right/left ventricular pressures similar in fetus → shunt bidirectional.
If unidirectional shunt, look for other anomalies altering balance of ventricular pressures (e.g., outflow tract obstruction).
VSD good to assess with septum verticle: False, image perpendicular to ventricular septum.
LV anterior most to ventricle wall: False, right ventricle more commonly anterior to IVS.
2mm fluid both sides of heart is physiological: pericardial effusion is > 2mm in thickness. is thus FALSE.
39
```
Torch microcephalic - cmv is more common but not sure if can distinguish
Options were:
CMV
Toxo
Zika
Rubella
Other
```
*LW:
Would favour CMV from probability, however other details may beable to distinguish as per below:
CMV infection:
27% have microcephaly,
ventriculomegaly, cotical dysplasia, intra parenchymal cysts.
Hepatospleenomegaly,
calcification both visceral and intra cranial.
Hydrops.
Most common congenital infection world wide.
Congenital rubella:
commonly associated with VSD and / or TOF.
IUGR
Congenital sensorneural hearing loss, cataract.
Zika:
Intracranial calcifications typically more florid than caused by the TORCH infections and also characteristically at the grey-white matter interface, which is unusual for other congenital viral diseases
Corpus callosum abnormalities.
40
Suspected calcifications in 3rd trimester:
Cannot have TORCH in 3rd trimester so if previous scans normal then infection excluded
If cephalic should do a transvaginal scan to further assess
*LW:
Toxo in utero infection:
- first trimester: fetal death
- second trimester: retinochoroiditis, microcephaly, and intellectual disability
- third trimester: lymphadenopathy, hepatosplenomegaly, eye injuries, and brain calcifications, where most casesinfection transmitted in 3rd trimester.
Suspected calcifications in 3rd trimester:
Cannot have TORCH in 3rd trimester so if previous scans normal then infection excluded: FALSE
If cephalic should do a transvaginal scan to further assess: Probably true.
41
Fetal hydronephrosis which is false
Dilatation implies obstruction
Ectopic ureterocele, spefically in a female for some reason, implies duplex
*LW:
Fetal hydronephrosis which is false
Dilatation implies obstruction: False - other causes other than obstruction can cause dilation, e.g. reflux, megaureter, prune belly etc.
Ectopic ureterocele, spefically in a female for some reason, implies duplex: TRUE.
- Females more commonly affected by uretoceles, with most being congenitial secondary to ectopic insertion with associated duplex.
42
Nuchal. Is associated with aneurploidy and heart disease
*LW:
```
Nuchal translucency late first trimester and early second trimester (11.3-13.6 weeks).
a value of less than 2 mm in thickness is not associated with increased risk.
Associations:
- trisomies (including Down syndrome)
- Turner syndrome
- congenital diaphragmatic herniation
- congenital heart disease
- omphalocele
- skeletal dysplasias
- Smith-Lemli-Opitz syndrome
- VACTERL association
```
Nuchal fold is a normal fold of skin seen at the back of the fetal neck during the second trimester of pregnancy
Nuchal fold thickness of >6 mm is abnormal on a routine morphology ultrasound performed at 18-22 weeks.
Associations:
- t21
- Turner syndrome
- congenital heart disease
- Klippel-Feil syndrome
43
In polyhydramnios which is true:
Abdomen must be assessed for duodenal atresia
Visible stomach exludes oesophageal atresia
*LW
In polyhydramnios which is true:
Abdomen must be assessed for duodenal atresia: true
Visible stomach excludes oesophageal atresia: false, although it may be suspected in the context of non visualisation of the stomach.
44
something about deep endometriosis?
*LW:
Options:
- Deeply infiltrating endometriosis or adenomyosis.
Likely deeply infiltrating endometriosis:
- Deep involvement of pelvic organs with endometriosis
- anterior cul de sac
- Posterior cul de sac
- uterine ligaments
- Pelvic side wall
- Bowel / bladder.
Adenomyosis.
Appearances:
- generalised, affecting large portions of the uterus (typically the posterior wall), but sparing the cervix
- Venetian blind
- Irregular endometrial myometrial junction
45
Breast:
Type 2 diabetes more commonly associated with lymphocytic mastitis or diabetic mastopathy or something?
*LW:
Lymphocytic mastitis, also known as lymphocytic mastopathy, is a rare benign inflammatory disease of the breast that can mimic breast cancer.
Diabetic mastopathy is a closely-related entity although it is sometimes used synonymously in the literature.
Lymphocytic mastitis is associated with autoimmune disease.
Thus DM-2 would not be associated with lymphocytic mastitis.
Type 1 may be as is a auto immune condition.
46
Flame shaped retroareolar density unilateral pain man
Gynaecomastia
Pseudogynascomastia
Flame shaped retroareolar density unilateral pain man
Gynaecomastia
Pseudogynascomastia (this just means cancer)
**LJS - Pseudogynaecomastia - increase in fat tissue only (no glandular tissue). i.e. flabby man boobs
47
```
Regarding lobular cancer:
MRI good for local staging
Usually shows non-mass enhancement
Shows gradual enhancement
Well seen on USS and Mammograms
Often calcifies
```
*LW:
Regarding lobular cancer:
MRI good for local staging: true
Usually shows non-mass enhancement: false
Shows gradual enhancement: true
Well seen on USS and Mammograms: true, but can be occult.
Often calcifies: false, rarely calcifies.
Lobular CA
Most common mamm appearance is spiculated mass.
16% mm occult.
Micro Ca++ < 10%
MRI most sensitive for detection, and will identify additional occult lesions.
Most common enhancement pattern is heterogenous enhanement.
Non mass enhancement 20-40%.
Slow initial phase kinetics, more likely to have persistent or plateau kinetics.
48
Breast ultrasound features most benign 2 questions, answer to both was the hyperechoic one
Breast ultrasound features most benign 2 questions, answer to both was the hyperechoic one
49
```
Radial scar management:
Return to screening
Follow-up imaging in 12 months
Hookwire localization and open biopsy
Or hookwire localization and surgical excision and node biopsy
```
*LW:
Radial scar management:
Hookwire localization and open biopsy
50
Radial scar:
Completely obliterates central fat
Doesn’t relate to ischaemia
Long spicules?
*LW:
Radial scar:
Completely obliterates central fat: false, lucent centre.
Doesn’t relate to ischaemia: False, likely does to chronic ischaemia with slow infarction.
Long spicules: true, longer and more gracile than carcinoma.
51
Something about phyllodes
*LW:
Large, fast growing mass that forms from the periductal stroma of the breast.
benign, borderline, or malignant depending on histologic features including stromal cellularity, infiltration at the tumour edge, and mitotic activity.
Fine needle aspiration is inaccurate, and even core biopsy has moderate sensitivity due to tumour heterogeneity causing inadequate sampling.
non-specific large rounded oval or lobulated, generally well circumscribed, lesions with smooth margins. A radiolucent halo may be present. Calcification (typically coarse and plaque like) may be seen in a very small proportion.
General sonographic features are non-specific and can mimic that of a fibroadenoma .
On ultrasound, an inhomogeneous, solid-appearing mass is the most common manifestation. A solid mass containing single or multiple, round or cleft like cystic spaces and demonstrating posterior acoustic enhancement strongly suggests the diagnosis of phyllodes tumour. Vascularisation is usually present in the solid components.
Treatment is usually with surgical excision.
52
Vascular:
Endoleak - don’t know if it was a or b
Unopposed at the neck and leaking??
*LW:
| 1A
53
Renal artery stenosis:
20% is caused by fibromuscular hyperplasia
An acceleration index >3m/s is significant
Renal : Aortic ratio >2.5 significant
Distal to stenosis usually shows high resistance waveform
*LW: Possible poor recall of all details: (*AJL subsequently changed an option so there was one correct option)
Renal artery stenosis:
20% is caused by fibromuscular hyperplasia: TRUE- 20%, involves distal artery, younger population.
An acceleration index >3m/s is significant: Likely false, an acceleration index LOWER than 3m/s is significant. Intra parenchymal acceleration time > 0.07s.
Renal : Aortic ratio >2.5 significant: FALSE: > 3.5 is most commonly accepted value.
Distal to stenosis usually shows high resistance waveform: FALSE - Parvus Tardus distal to stenosis.
54
```
Bilateral internal carotid artery beading or stenoses or something
Fibromuscular dysplasia
PAN
Atherosclerosis
Giant cell arteritis
```
*LW:
Bilateral internal carotid artery beading or stenoses or something
Fibromuscular dysplasia
55
```
Which isn’t associated with carotid dissection:
AV fistula
Pseudoaneurysm
Vessel enlarged
Hyperdense crescent
```
*LW:
```
Which isn’t associated with carotid dissection:
AV fistula: Likely false.
Pseudoaneurysm: true
Vessel enlarged: true
Hyperdense crescent: true
```
56
Heart:
```
Atrial myxoma which is false
Enhance homogeneously
Low T2
Associated with carney complex
Is 50% of benign tumours
```
**LJS - favour low T2 to be most incorrect. Enhancement is a differentiating feature from thrombus. Myxomatous components are T2 hyper
Atrial myxoma which is false:
Enhance homogeneously: FALSE - heterogenous low grade enhancement.
Low T2: FALSE - Usually hyperintense T2, but can have low signal foci.
Associated with carney complex: TRUE (beware of carney complex vs carney syndrome)
- rare multiple endocrine neoplasia syndrome characterised by: cardiac myxoma, skin pigmentation, extracardiac myxoma, primary pigmented nodular adrenocortical disease (PPNAD),
pituitary adenoma, Sertoli cell testicular tumours.
Is 50% of benign tumours: TRUE.
57
Definition of malignant coronary artery course
*LW:
Interarterial course of the right coronary artery, may occur if the right coronary artery (RCA) has an aberrant origin from the left coronary sinus. The interarterial course occurs because the artery passes between the ascending aorta and the pulmonary trunk.
An interarterial course of the left coronary artery is defined as origination of the left main or left anterior descending coronary artery from the right coronary sinus of Valsalva, with a course between the ascending aorta and the pulmonary artery trunk.
58
Endocarditis findings – which is false:
| Fusion of leaflets
*LW:
| Fusion of leaflets
59
Which is true?
| Left atrial appendage thrombus easily diagnosed on TOE
*LW:
| Left atrial appendage thrombus easily diagnosed on TOE: TRUE
60
Chest:
| Pneumatocele drug, and other drug associations
*LW:
Chest:
methotrexate and pneumatoceles: ?F = NSIP is the most common pattern of methotrexate-induced lung disease; also common is hypersensitivity reaction; usually cause diffuse reticulonodular opacities with lower zone predominance; usually subacute allergic response
amiodarone and interstitial infiltrates T = 18% get lung toxicity, esp. chronic interstitial pneumonitis; upper zones
cyclosporine and mass T = drug-induced lymphoproliferative disorder which may appear as solitary mass, multiple lung nodules & hilar nodes
methotrexate and pneumatoceles ?F = NSIP is the most common pattern of methotrexate-induced lung disease; also common is hypersensitivity reaction; usually cause diffuse reticulonodular opacities with lower zone predominance; usually subacute allergic response
phenytoin and pleural effusions = vasculitis, drug-induced SLE; Pleural effusion is a rare complication of phenytoin use that usually occurs early in the course [Chest 2009].
hypersensitivity reaction T: cromolyn sodium, erythromycin, nitrofurantoin, isoniazid, penicillin, sulfonamides, bleomycin, methotrexate, procarbazine, penicillamine; features incl. Interstitial and/or alveolar opacities, patchy peripheral airspace opacities, basilar reticulonodular interstitial opacities (opacities may be fleeting)
61
```
7yo with 1 week SOB and non-productive cough, patchy consolidation and linear atelectasis:
Mycoplasma
Staph
Strep
Haemophilus
PCP
```
*LW:
7yo with 1 week SOB and non-productive cough, patchy consolidation and linear atelectasis:
Mycoplasma
62
```
Cf with haemoptysis
Most likely finding on bronchial artery angiogram:
Multiple small vessels
Dissection
Aneurysm
```
*LW:
Cf with haemoptysis
Most likely finding on bronchial artery angiogram:
Multiple small vessels: FALSE
Dissection: FALSE
Aneurysm: TRUE - shows bronchial artery aneurysms. May also see bronchial artery enlargement.
63
```
8mm nodule in a man:
Do an FNA
Do a PET
Image in 12 months
If has been stable for 30 months, then the likelihood of malignancy is low (<2%)
```
*LW:
8mm nodule in a man:
If has been stable for 30 months, then the likelihood of malignancy is low (<2%): Favour this answer, likely testing Fleischner guidelines, and if was a solid nodule, if stable with follow up at 24 months, usually minimal risk.
Notes:
Solitary solid nodule 6-8 mm:
low-risk patients: CT at 6-12 months, then consider CT at 18-24 months
high-risk patients: CT at 6-12 months, then CT at 18-24 months
Single ground glass nodule ≥6 m:
CT at 6-12 months, then if persistent, CT every 2 years until 5 years
Single part-solid nodule ≥6 mm:
CT at 3-6 months, then if persistent and solid component remains <6 mm, annual CT until 5 years
64
Which is true re TCC:
Most renal TCC are sessile
Most papillary lesions are high grade
Most ureteric lesions are papillary
*LW:
Tcc papillary sessile:
Which is true re TCC:
Most renal TCC are sessile: FALSE - 85% are papillary.
Most papillary lesions are high grade: FALSE - tend to be low grade.
Most ureteric lesions are papillary: TRUE - 60%, and tend to be low grade.
*AJL - for completeness, most bladder TCC are also papillary (70%)
65
Which is true:
Testicular microlithiasis and klinefelters associated
Testicular cyst uncommon
Testicular lymphoma spares cord and epididymis
*LW:
Which is true:
Testicular microlithiasis and klinefelters associated: TRUE.
Testicular cyst uncommon:
Testicular lymphoma spares cord and epididymis: FALSE can involve the the epidymis.
66
Which do you get phaeos with:
NF2
Carney syndrome
*LW:
Which do you get phaeos with:
NF2
Carney triad - TRUE
67
Echogenic cord seen. Diagnosis:
Biliary atresia
Allagille
*LW:
Echogenic cord seen.
Diagnosis:
Biliary atresia - TRUE.
68
What supports a diagnosis of Biliary atresia on USS?
Dilated ducts
Increased vascularity peripherally
*LW:
What supports a diagnosis of Biliary atresia on USS?
- Dilated ducts - No
- Increased vascularity peripherally : Favoured to be TRUE answer. - Larger hepatic artery calibre
* AJL - and subcapsular hepatic arterial flow on doppler (RP).
69
```
How does stir work
Fat suppression by chemical shift
Fat suppression by relaxation
Water suppression by chemical shift
Water suppression by relaxation
Other
```
*LW:
Fat suppression by relaxation (I think)
70
```
Which of the following indicates significant neck trauma:
Spinous process fracture
Rotatory subluxation of peg view
Atlantodental interval >2mm
20mm prevertebral soft tissue at C7
```
*LW: difficult question, unsure of exact answer....
Which of the following indicates significant neck trauma:
Spinous process fracture: in isolation not necessary, such as Clay Shovlers fracture. However may also be associated with PLC rupture....
Rotatory subluxation of peg view: unsure....
Atlantodental interval >2mm: debatable (StatDx states C1 arch to dens < 2mm in adults) (Radiopedia normal values, male < 3mm, female < 2.5mm) (Ortho bullets > 3.5mm considered unstable)
20mm prevertebral soft tissue at C7: upper limits of normal.
