VRU 2016

Question 1

94% of lesions overlying a vertebral body are more likely to be diagnosed as what?

A) Ischemic myelopathy
B) Acute non-compressive nucleus pulpous extrusion (ANNPE)

Answer 1

Answer = A

Question 2

What characteristics of a spinal cord lesion are more seen in ischemic myelopathy injuries?

A) Overlying a vertebral body
B) Lateralized intramedullary lesion
C) Larger lesion length
D) associated extradural material or extradural changes
E) A and C
F) B and D
G) A,B,C
H) B,C,D

Answer 2

Answer = E

More likely to be ischemic myelopathy (e.g. FCE) = overlying vertebral body, NO lateralization, & larger lesion length

More likely to be ANNPE = focal intramedullary T2 hyperintensity over IV disc space, lateralized lesion, reduced volume of IV disc, narrowed disc space, extradural material or extradural changes

Question 3

Following dexmedetomidine administration, which of the following is seen on thoracic radiography and echocardiography?

A) Fractional shortening increased
B) False positive mitral & pulmonic valve regurgitation
C) Increased VHS and cardiac size on lateral & VD views
D) B and C
E) All the above

Answer 3

Answer = D
Following dexmed administration:
- Increased VHS and cardiac size on rads
- E point to septal separation & LV internal diameter in both systole/diastole increased
- Fractional shortening decreased
- Mitral & pulmonic regurgitation seen

Dexmed may cause false positive valve regurgitation & cardiomegaly

Question 4

T or F, the number of tracheal bends in whooping cranes is NOT associated with age?

Answer 4

False.
# of tracheal bends is age-related, but NOT sex-related

Question 5

A 3 yo dog with a palpable neck mass presents with lethargy, fever, neck pain, and bloodwork shows leukocytosis and neutrophilia. A cervical MRI shows very enlarged medial retropharyngeal lymph nodes. The most likely DDX is?

A) Metastatic thyroid carcinoma
B) Reactive granulomatous disease
C) Suppurative lymphadenitis
D) there is not information to tell, must aspirate.

Answer 5

Answer = C

Inflammatory lymphadenitis more likely in younger patients & present with LETHARGY, leukocytosis/neutrophilia (100% PPV), pyrexia (100% PPV), pain

Question 6

Neoplastic cervical masses on MRI have greater ______ and ______ than inflammatory masses or inflammatory lymphadenitis.

Answer 6

Greater height and width

Question 7

Which of the following accurately describes the expected lesions seen in tick-borne meningoencephalomyelitis?

A) Multifocal diffuse T2 grey matter hyper intensities of the midbrain, perilesional edema & meningeal enhancement
B) Bilateral symmetric, non-enhancing grey matter T2 hyper intensities of thalamus, hippocampus, and spinal cord without meningeal enhancement
C) Bilateral symmetric T2 hyperintensities of the lentiform nuclei
D) Bilateral, asymmetric periventricular T1 white matter hyperintensities

Answer 7

Answer = B

Tick-borne meningoencephalomyelitis is caused by a Flavivirus

MRI findings = bilateral, symmetrical GREY matter T2/FLAIR hyperintensities (to white matter), T1 iso/hypo, NON-enhancing lesions involving thalamus, hippocampus, brainstem, basal nuclei, cerebellum, & ventral horn of spinal cord with minimal to no mass effect,meningeal enhancement or perilesional edema

Question 8

Smaller optic nerve sheath diameters are found in (young or adult) horses? and normal foal measurement is ____?

A) Adults, < 6.5mm
B) Foals, < 6.5mm
C) Foals, < 5mm
D) Adults, < 5mm

Answer 8

Answer = C

Question 9

T or F, optic nerve sheath diameter varies with age.

Answer 9

FALSE.

No significant difference in optic nerve sheath diameter with weight or age

Question 10

Which of the following is FALSE regarding U/S findings in horses with multicentric lymphoma?

A) Mediastinal and tracheobronchial lymphadenopathy is common
B) Abdominal lesions include hypoechoic hepatic & splenic nodules
C) Pleural & peritoneal effusion are seen in all horses
D) Alimentary lymphoma is more common in Standardbreds

Answer 10

Answer = C

PLeural effusion is seen in 31% but no reports of peritoneal effusion

U/S findings with multicentric lymphoma = multifocal lymphadenopathy (62%) - caudal deep cervical (at thoracic inlet), intrathoracic, intraabdominal (medial iliac/cecal), peritoneal effusion (46%), splenomegaly with hypoechoic nodules (46%), hepatomegaly with hypoechoic nodules (38%), focal small/large GI hypoechoic thickening (15%), pleural effusion (31%), pulmonary parenchymal changes (23%)

Question 11

Describe the MRI imaging findings that may be seen in horses with trigeminal neuritis?

Answer 11

T1/T2 hypointense thickening with heterogeneous peripheral enhancement

DDx = PNST

Question 12

Which is the most appropriate window setting for viewing nasal conchae on CT?

A) Narrow window width, ST reconstruction
B) Wide window width, ST reconstruction
C) Narrow window width, Bone/lung reconstruction
D) Wide window width, Bone/lung reconstruction

Answer 12

Answer = A

• conchae are inconspicuous when using a wide window, the conchae are visualized clearly when using a narrower window
• conchae are only faintly visible in CT images obtained with a wide window because they are so thin
• When intranasal air is replaced by exudate or tissue, the nasal epithelium/air interface is obliterated, but intact conchae will remain faintly visible & better with a narrow window (e.g. soft tissue) versus a wide window (e.g. lung or bone)

Question 13

What is the major determinant of contrast enhancement in feline nasopharyngeal polyps?

Answer 13

inflammation is the major determinant of contrast medium accumulation in feline nasopharyngeal polyps, and the tendency for inflammation to affect predominantly the superficial stroma explains the frequent observation of a rim in postcontrast CT images. Conversely, more marked edema in the superficial stroma of polyps will tend to diminish the appearance of a rim in postcontrast CT images

Question 14

Which of the following combination of factors will artifactually increase tympanic bulla thickness on CT?

A) Thin slices, narrow window, high frequency reconstruction
B) Thin slices, wide window, low frequency reconstruction
C) Thick slices, narrow window, low frequency reconstruction
D) Thick slices, wide window, high frequency reconstruction

Answer 14

Answer = C

Thick slices, low frequency reconstruction algorithm, & narrow window settings (which are necessary for ST evaluation) cause an increase in tympanic bulla thickness

Question 15

T or F, wide window settings on CT enhance visibility of noise?

Answer 15

FALSE, wide window setting suppress visibility of noise

Question 16

On CT, structures such as bone, nasal turbinates, and lungs have _______ inherent object contrast and should be viewed with _____ window settings.

Answer 16

Wide; wide

Question 17

Which of the following most accurately describes the CT appearance of tympanic canal/bullae in brachycephalic dogs?

A) Large luminal volume & caudoventral thickening compared to non-brachycephalics
B) Smaller luminal volume & rostroventral thickening compared to non-brachycephalics
C) Similar luminal volume but diffuse thickened with increased prevalence of luminal debris compared to non-brachycephalics
D) No significant differences compared to non-brachycephalics

Answer 17

Answer = B

Brachycephalics have significantly thicker bulla wall & smaller luminal volume as well as thicker soft palates ​

36% of brachycephalics have bulla debris vs 0% nonbrachycephalic​

Significant difference in mean soft palate thickness for dogs with material in the middle ear (12.2 mm) vs. air-filled bullae (9 mm)​

Brachycephalic dogs have greater prevalence of subclinical middle ear effusion and smaller bulla luminal size than nonbrachycephalic dogs​

Rostroventral margin of bullae thicker & thinner caudoventral in brachcephalics

Question 18

T or F, dual phase contrast-enhanced CT is helpful in differentiating benign from malignant hepatic and splenic masses in dogs?

Answer 18

FALSE.

Question 19

All of the following except which, are the most common findings associated with spinal lymphoma in MRI?

A) Multifocal locations affecting more than 1 compartment (e.g. intramedullary, extradural, paraspinal)
B) Spinal cord compression
C) Cortical vertebral osteolysis
D) STIR hyperintensity

Answer 19

Answer = C

Most common MRI characteristics of lymphoma affecting the spine and paraspinal soft tissues included multifocal lesions affecting one or more vertebrae, extension into the paraspinal soft tissues, and extension into the vertebral canal resulting in a variable degree of spinal cord compression

NO cortical vertebral osteolysis, changes confined to medullary cavity

Question 20

A small ruminant presents with acute neurological signs. MRI shows asymmetrical, focal T2/FLAIR hyperintense brainstem lesions. The most likely differential diagnosis is what?

A) Suppurative inflammation (e.g. parasitic migration)
B) Listeric encephalitis
C) Enterotoxemia
D) None of the above

Answer 20

Answer = B

Toxic-metabolic disease -> bilaterally symmetrical GRAY matter (poliocephalomalacia cerebrum & forebrain) or WHITE matter (enterotoxemia – basal nuclei, corticospinal tracts of thalamus/midbrain/brainstem) lesions ​

Suppurative inflammation -> ASYMMETRIC FOCAL BRAINSTEM lesions (Listeria encephalitis), or lesions typical of intradural or dural abscess

Question 21

Poliocephalomalacia in small ruminants is usually associated with ________ deficiency.

Answer 21

Thiamine deficiency

Question 22

What is the typical distribution of brain MRI lesions in small ruminant with toxic or metabolic disease?

Answer 22

Bilaterally symmetrical gray matter (polioencephalomalacia) or white matter (enterotoxemia) lesiosn

Question 23

What is the most common feline sinonasal neoplasm?

Answer 23

Nonepithelial origin tumor (e.g. lymphoma)

2nd most common = epithelial origin tumors such as adenocarcinoma, SCC, or undifferentiated carcinoma

Question 24

Which of the following is NOT a common feature associated with nasal/paranasal neoplasia in cats?

A) Unilateral ethmoturbinate lysis
B) Unilateral ocular discharge
C) Soft tissue/fluid accumulation in sphenoid or frontal sinus
D) Lysis of the nasal septum or cribriform plate

Answer 24

Answer = D
- Common characteristics of nasal and paranasal neoplasia included osteolysis of the paranasal bones and nasal septum (particularly unilateral lysis of the maxilla or ethmoturbinates, bilateral lysis of the orbital lamina), turbinate destruction, soft tissue mass, soft tissue or fluid accumulation in the sphenoid or frontal sinuses, and extension of disease into orbital or facial soft tissues
- C/S significantly associated with neoplasia were unilateral ocular discharge & presence of a nasopharyngeal mass during endoscopic examination
- CT characteristics significantly associated with neoplasia included: unilateral lysis of ethmoturbinates, unilateral lysis of the dorsal and lateral maxilla, lysis of the vomer bone and ventral maxilla, and bilateral lysis of the orbital lamina; unilateral abnormal soft tissue/fluid within the sphenoid sinus, frontal sinus, and/or and retrobulbar space.
- Lysis of the maxillary turbinates, nasal septum, nasal bone, palatine bone, and cribriform plate were NOT significantly associated with sinonasal neoplasia.

Question 25

What is the difference between calvarial hyperostosis syndrome and craniomandibular osteopathy? Which breeds are predisposed to each condition, respectively?

Answer 25

- Calvarial hyperostosis does NOT affect the mandibules/mandibular rami as craniomandibular osteopathy does. - Craniomandibular osteopathy = bilateral, irregular, nonneoplastic osseous proliferative disease of young dogs usually affecting multiple bones of the cranium, occasionally extending to the metaphyses of long bones​; Frontal, parietal, and occipital bones, tympanic bullae, mandibular rami, and the TMJs - Calvarial hyperostosis seen in Bullmastiffs & English Springer Spaniels - Craniomandibular osteopathy seen in Cairn Terriers, WHWT, Scottish terriers

Question 26

Which of the following statement(s) is/are true regarding heart size and dexmedetomdine administration in cats? A) VHS is increased on left lateral views following sedation B) VHS is increased on right lateral views following sedation C) VHS is increased on all views following sedation D) Cardiac width is increased on VD/VD views following sedation E) A & D F) B &D G) C & D

Answer 26

Answer = F VHS on right lateral view significantly INCREASED after dexmed​ Cardiac width INCREASED on VD/DV viewws ICNREASED after dexmed

Question 27

A young horse presents for difficulty chewing. CT showed globoid-shaped mandibular condyles with coalescing hypodense regions. What is the most accurate conclusion regarding this finding? A) The horse likely has evolving OC lesions of the condyles B) The horse has degenerative bone cysts C) The horse has evolving septic TMJ arthritis D) The CT appearance of the horse is normal.

Answer 27

Answer = D Horses < 1 yo commonly have altered shape & density of mandibular condyle (coalescing hypodensities) ​ Older horses commonly have ovoid hypodensities within mandibular condyles with surrounding sclerosis consistent with bone cysts (57% > 1 yo) & hyperdense intra-articular disc regions consistent with dystrophic mineralization almost exclusively occurred in ROSTRODORSAL lateral to mid region of disc ​ Bone cysts either present as small, single discrete foci in caudal aspect of condyle with little sclerosis & no articular communication OR as large irregular hypodense regions with or w/o articular communication and variable sclerosis in LATERAL aspect of condyle (NONE SEEN MEDIALLY)​ 90% lesions within condyle, 10% mandibular fossa of temporal bone ​ MALES more likely to have defined hypodensiites more than females ​ Association between disc mineralization and an inability to delineate the caudal aspect of the intra-articular disc in the soft tissue window​ Disc mineralization significantly affected by age (0% in horses < 1 yo and increasing dramatically > 10 yo)​ Bone cyst prevalence NOT associated with age

Question 28

Intra-articular disc mineralization in the TMJ of an older horse is most likely located where? A) Rostrodorsal B) Caudodorsal C) Rostroventral D) Caudoventral

Answer 28

Answer = A hyperdense intra-articular disc regions consistent with dystrophic mineralization almost exclusively occurred in ROSTRODORSAL lateral to mid region of disc ​

Question 29

T or F, subchondral bone cysts within the TMJ of horses are age-related changes.

Answer 29

FALSE. Disc mineralization significantly affected by age (0% in horses < 1 yo and increasing dramatically > 10 yo)​ Bone cyst prevalence NOT associated with age

Question 30

What are the two CT appearances of bone cysts within the TMJ in older horses? Is there a sex predisposition - yes or no?

Answer 30

Bone cysts either present as small, single discrete foci in caudal aspect of condyle with little sclerosis & no articular communication OR as large irregular hypodense regions with or w/o articular communication and variable sclerosis in LATERAL aspect of condyle (NONE SEEN MEDIALLY)​ 90% lesions within condyle, 10% mandibular fossa of temporal bone ​ MALES more likely to have defined hypodensiites more than females ​

Question 31

Which of the following statement(s) is/are false? A) Genetic predisposition for equine melanoma in gray -coated horses B) Melanomas are usually numerous, well-defined heterogeneous hyperattenuating masses C) Most common locations = mandibular salivary gland, near the larynx/pharynx, guttural pouches & adjacent to the tongue base D) Up to 20% of masses may have regions of mineralization and hypoattenuating necrotici regions

Answer 31

FALSE answers = B and C Common melanoma location in horse head = PAROTID salivary gland, guttural pouches, surrounding larynx/pharynx, & adjacent to HYOID apparatus ​ Other common locations = perineal region, tail base, lips, prepuce, eyes/eyelid​ Genetic predisposition associated with gray hair coat​ All melanomas HYPERattenuating precontrast compared to masseter muscles (HU 113) - HYPERattenuation likely due to melanin content​ 26% of melanoma masses mineralized & 20% had hypoattenuating regions (necrosis)​ Usually NUMEROUS masses, well-defined & HOMOGENEOUS

Question 32

Which horse breed is more likely to have an anomalous C6 vertebra?

Answer 32

Warmbloods

Question 33

Anomalous C6 vertebra in horses is NOT significantly associated with all of the following EXCEPT...... A) Increased likelihood of cervical pain B) Articular process OA C) Sex/gender D) Intravertebral sagittal ratios

Answer 33

Answer = A Anomalous C6 vertebrae more common in Warmbloods No association with sex, intravertebral sagittal ratios, or between C6 morphology & articular process OA​ Anomalous C6 associated with increased liklihood of cervical pain (possibly associated with altered biomechanics & decreased ROM)​ Higher proportion of horses with anomalous C6 had an intravertebral sagittal ratio < 0.5 which may indicate association with other C6 vertebral anomaly,

Question 34

T or F, an anomalous C6 vertebra is a common finding?

Answer 34

TRUE. Found in up to 24% of horses

Question 35

Which statement is correct? A) Quadrigeminal cistern is H-shaped on volume-rendered images and is separated from the 3rd ventricle by a thin membrane that is isointense to brain parecnhyma on MRI & isoattenuating to soft tissues on CT B) Supracollicular fluid accumulation is more common in young, female brachycephalic dogs C) Predisposition for supracollicular fluid accumulation in Shih-Tzu, Maltese & Chihuahua D) None of the above are true

Answer 35

Answer = C Normal quadrigeminal cistern is H-shaped on dorsal images & separated from 3rd ventricle by a thin membrane (membrane isoattenuating to soft tissues on MDCT and isointense on MRI to brain parenchymaa;best appreciable on midsagittal plane)​ On volume-rendered images, the cistern has a pyramid shape (aboral base, cranial apex) Dogs with supracollicular fluid accumulations (SFA) significantly YOUNGER & SMALL BREED​ Shih-Tzu, Chihuahua & Maltese predisposition for SFA​ 3 patterns of SFA: 1) 3rd ventricle -50%, 2) Quadrigeminal cistern – 14%, 3) Both 3rd ventricle & quadrigeminal –37%​ SFA prevalence in male, brachycephalic dogs​

Question 36

Which MRI sequence is most beneficial for evaluation of supracollicular fluid accumulations? A) T1 B) STIR C) 3D FISP D) Balance steady-state free precession

Answer 36

Answer = D Balance steady-state free precession MR sequence was particularly useful in this study to obtain high quality MPR images of the subarachnoid spaces

Question 37

T or F, fluoroscopic measurements of tracheal stent size are not statistically different than CT measurements although there is greater inter- and intraobserver variability.

Answer 37

FALSE. Fluoroscopic measurements are ~0.2mm SMALLER in height and width versus CT. Greater tracheal diameter & lower measurement variability with CT indicates this may be the best modality for appropriate stent selection​ Tracheal stents are typically 10-20% greater than the largest tracheal diameter during max inflation

Question 38

Low-attenuation filling defect occupying the entire lumen of the pulmonary artery and increased diameter of the pulmonary arteries with extensive filling defects are the two most common CT findings associated with _________ disease reported in human patients

Answer 38

Pulmonary artery sarcoma these findings are NOT seen with pulmonary embolic disease

Question 39

Describe the MRI findings commonly seen with spinal lymphoma on MRI?

Answer 39

- T1 hypo, T2/ASTIR hyperintense lesions with strong uniform enhancement - usually multifocal and affecting more than one component of the spinal cord/vertebrae (e.g. vertebral body, cord compression, paraspinal involvement) - NO cortical lysis - STIR medullary hyperintensity

Question 40

Regarding the effect of food bolus size and consistency during deglutition, which of the following statements is true? A) Dogs positioned in lateral recumbency experience faster cervical esophageal transit times versus sternal recumbency B) Max pharyngeal contraction and primary versus secondary peristalsis are affected by recumbency C) Maximum pharyngeal contraction occurs earlier/faster with liquid food boluses versus solid food D) Thoracic esophageal transit time is longer with small size solid food versus liquid boluses

Answer 40

Answer = D However, NO significant difference in cervical or total esophageal transit time based on size or consistency - A is false because sternal recumbency has faster transit time - B is false because max pharyngeal contraction, mode of peristalsis & esophageal transit time are affected by bolus consistency (e.g. solid versus liquid) - C is false because max pharyngeal contraction occurs later/slower with medium size solid food boluses versus liquid - Additionally, primary peristalsis occurs more frequently with solid food boluses versus liquid

Question 41

Which of the following is more sensitive and specific for recommending surgery associated with small intestinal mechanical obstruction, radiographs or CT?

Answer 41

Answer = radiographs Radiography more sensitive (92% vs 83%) & specific (83% vs 72%) versus CT for recommending surgery [ but NOT statistically significant]​

Question 42

Which of the following is more sensitive and specific for detecting small intestinal mechanical obstruction, radiographs or CT?

Answer 42

Answer = CT CT more sensitive (96% vs 79%) & specific (81% vs 69%) versus radiographs for detection of mechanical obstruction [NOT statistically significant]

Question 43

Bowel diameter greater than _____times the L5 height has 50% probability of obstruction & greater than ______ times L5 height has 80% probability A) 1.7 and 1.9 B) 1.5 and 1.8 C) 1.5 and 2.0 D) 1.6 and 2.2

Answer 43

Answer = A (technically 1.73 & 1.95)

Question 44

Main pulmonary artery to aortic measurement ratio is performed on what echo view?

Answer 44

Right parasternal short axis view

Question 45

Which echocardiographically derived measurement of main pulmonary artery to aorta ratio has 100% specificity for distinguishing normal dogs from those with pulmonary hypertension? A) 0.98 B) 1.0 C) 1.14 D) 1.23

Answer 45

Answer = C echocardiographic ratio of MPA:Ao exceeding 0.98 indicates MPA enlargement supportive of pulmonary hypertension (Se = 0.73; Sp = 0.76)

Question 46

T or F, CT measurement of main pulmonary artery to aorta ratio is greater on expiratory views versus inspiratory?

Answer 46

FALSE. Expiratory views have LOWER main pulmonary artery:aorta ratios versus inspiratory views

Question 47

For which of the following disease processes is CT/CT arthrography LESS diagnostic compared to arthroscopy or U/S in the diagnosis of stifle disease in equines? A) Subchondral cystic lesions of the proximal tibia B) Articular cartilage defects of the medial femoral condyle C) Ligament entheses of the cranial or caudal cruciates or craniomedial meniscotibial ligament D) None of the above, CT or CT arthrography has no difference in diagnostic accuracy versus U/S or arthroscopy

Answer 47

Answer = B - CT arthrography detected more defects in the cruciate ligaments, proximal tibia (subchondral cysts), & ligament entheses but was NOT reliable for medial femoral condyle articular cartilage defects - Medial femoral cartilage defects most detected on arthroscopy (96%) & 60% on CTA

Question 48

Describe the difference between central tarsal bone fractures in racehorses versus nonracehorses.

Answer 48

Central tarsal bone fractures in racehorses = slab fractures oriented in a dorsal plane with minimal to no displacement & best seen on lateromedial radiograph Central tarsal bone fracture in NON racehorses = minimally or non-displaced slab fractures in a DORSOMEDIAL TO PLANTAROLATERAL orientation & only seen on plantarolateral-dorsomedial oblique views

Question 49

Does dynamic subtraction imaging or paired pre- and postcontrast gadolinium images have better sensitivity for inflammatory intra-axial lesions?

Answer 49

Dynamic subtraction imaging has higher sensitivity 65% versus pre/postcontrast gadolinium images 48%

Question 50

T or F, meningeal lesions are more frequently observed in both dynamic subtraction imaging and pre/postcontrast gadolinium images than intra-axial inflammatory lesions?

Answer 50

FALSE. Intra-axial lesions were observed more frequently than meningeal lesions in both C-/C+ (43% vs. 31%) and DS images (61% vs. 22%).

Question 51

Match the following to intervertebral disc protrusion or extrusion: A) Lateralization of herniated disc material B) Longer duration of C/S C) Herniated material confined to disc space D) Midline location E) Partial disc degeneration F) Single site affected

Answer 51

Disc protrusion = B, C, D, E Disc extrusion = A, F Disc protrusion = Longer duration of C/S, multiple sites, midline location, & partial disc degeneration ​ Disc extrusion = Single site herniation, lateralized location, & dispersed IV disc material not confined to the disc space, complete disc degeneration

Question 52

T or F, a smartphone provides an acceptable interface for accurate diagnosis of small intestinal mechanical obstruction in dogs and cats​

Answer 52

TRUE

Question 53

With regards to diagnosis of small intestinal radiographic diagnosis of mechanical obstruction, what is the difference between recently qualified and more experienced radiologists? A) Recently qualified radiologists have higher sensitivity and specificity B) More experienced radiologists have higher sensitivity and specificity C) Recently qualified radiologists have higher sensitivity and lower specificity compared to experienced radiologists D) There is no difference between the two groups

Answer 53

Answer = C Recently qualified radiologists have a high sensitivity and lower specificity. Specificity and thus overall accuracy tend to increase with experience

Question 54

A dog presents with signs of lethargy, nasal discharge & coughing. Thoracic radiographs & other diagnostics are performed and the dog tests positive for canine influenza virus. Which of the following will most likely not be identified on radiographs? A) Cranioventral distribution of parenchymal changes B) Intrathoracic lymphadenopathy C) Pleural effusion D) Interstitial to alveolar pattern within multiple lung lobes

Answer 54

Answer = B - Pleural effusion is possible, but uncommon - NO dogs had intrathoracic lymphadenopathy or cranial mediastinal widening/pleural effusion - Unstructured interstitial to alveolar pattern distributed within multiple lobes (right & left cranial, right middle) distributed cranioventrally, or less likely diffuse or caudodorsally

Question 55

When using CT to screen for tooth resorption in cats, which of the following statements is FALSE? A) Lesions are most commonly located at mandibular premolar 3 B) Lesions mostly involve the tooth roots and the cementoenamel junction C) CT has good specificity and sensitivity for tooth resorptive lesions D) Resorptive lesions are irregularly marginated, hypoattenuating defects

Answer 55

Answer = C CT has poor sensitivity but excellent specificity for resorptive lesions

Question 56

What is the optimal level of positive pressure that should be used to minimize hyperinflation & reduce effects of anesthesia-induced hypoinflation/atelectasis when performing thoracic CT breath hold techniques? A) 8-10cm H20 B) 10-12cm H20 C) 15-17cm H20 D) 18-20 cm H20

Answer 56

Answer = B

Question 57

Homeotic and/or homologous variations of the cervical vertebral column in horses on CT may be seen in up to what percent of horses? A) < 25% B) 29% C) 33% D) > 45%

Answer 57

Answer = C 33% homologous transposition of C6 transverse process

Question 58

Transposition of the ventral transverse process of C6 is common in what breed of horse?

Answer 58

Warmbloods

Question 59

T or F, the presence of a homologous cervical vertebral change in horses is significantly increased in horses with C/S of cervical pain?

Answer 59

FALSE. No significant difference in the # of cervical vertebral anomalies between horses with or without C/S nor between mature or juvenile horses

Question 60

Which of the following is TRUE regarding equine stifle osteoarthritis? A) Stifle OA has no association with bone mineral density B) There is low sensitivity and specificity on radiographs & CT for the detection of subchondral bone sclerosis & femoral condylar flattening C) Lateral femorotibial joint is most commonly affected D) Caudo-10°proximo-5°lateral-craniodistomedial oblique (Ca10Pr5L-CrDiMO) radiographic projection is helpful for detection of medial femoral condyle osteophytes​

Answer 60

Answer = B A is false because OA does has an association with DECREASED bone mineral density C is false because the medial femorotibial is most affected D is false because that view is helpful for detection of intercondylar osteophytes

Question 61

Which of the following has the most accurate measurement of cartilage thickness of the equine metacarpophalangeal joint compared to gross measurements? A) MRI B) MR arthrography C) CT arthrography D) None of the above have measurements significantly consistent with gross measurements

Answer 61

Answer = D - No modality had measurements that were consistent with gross cartilage thickness - Both MR & CTA measurements subjectively smaller than gross measurements

Question 62

T or F, diagnostic accuracy of thoracolumbar intervertebral disk protrusion versus extrusion is significantly influenced by degree of experience

Answer 62

True

Question 63

Using the guidelines that midline location & partial disk degeneration were associated with disc protrusion versus presence of a single disk herniation & disk material dispersal are associated with disk extrusion​, what is the relationship between accuracy and interobserver agreement on the diagnosis of thoracolumbar IV disc protrusion versus extrusion?

Answer 63

Both accuracy & interobserver agreement IMPROVE when the guidelines are used in the diagnosis of thoracolumbar IV disc disease. Accuracy improves from 71 to 80% and interobserver agreement increased from fair to moderate

Question 64

Regarding ultrasonography of small intestinal wall layering in dogs, which of the following is true? A) 100% had hyperechoic muscularis line parallel to the serosa consistent with fibrous tissue B) There is significant difference between U/S and histology measurements of the small intestine C) 1/3 of all ileal samples showed an asymmetric hypoechoic extra submucosal layer consistent with lymphoid tissue/Peyer's patches D) Dual mucosal echogenicity is due to intestinal villi which create an inner mildly echogenic layer and outer hypoechoic lamina propria

Answer 64

Answer = D A is false because this hyperechoic line represents the interface between the longitudinal & circular muscularis layers consistent with the myenteric plexus B is false because there is NO significant difference in layer measurements aside from the serosa C is false because in dogs the additional layer is circumferential and is a hyperechoic mucosal line parallel to the submucosa representing Peyer's patches. The asymmetric hypoechoic extra submucosal layer is lymphoid tissue in CATS

Question 65

T or F, intestinal mucosal echogenicity can be increased following food intake, regardless of fat content.

Answer 65

TRUE

Question 66

T or F, hepatic portal and parenchymal gas can result from GI translocation of gas if mucosal integrity is compromised

Answer 66

TRUE

Question 67

Describe the gastrointestinal transit time(s) for the following in habituated Labrador Retrievers on GI positive contrast fluoroscopy? 1) T1/2 gastric emptying time 2) Time at which barium is 1st seen in small intestine 3) Peak filling time of small intestine & proximal large intestine 4) Distal large intestinal filling time & peak filling

Answer 67

1) T1/2 gastric emptying time = 1-2 hours post ingestion 2) Time at which barium is 1st seen in small intestine = 30 min post ingestion 3) Peak filling time of small intestine & proximal large intestine = 3 hours post ingestion 4) Distal large intestinal filling time & peak filling = large intestine empty for first 2 hours, progressive filling between 2-5 hours post ingestion, & peak filling from 6 hours onward

Question 68

In dogs with medial compartment elbow erosion, which of the following is FALSE? A) < 25% have concomitant flexor enthesopathy B) There is no agreement between CT and arthroscopy for presence of medial humeral condyle subchondral bone defect C) Significant agreement between CT & arthroscopy for a fragmented medial coronoid process D) Three most common findings are periarticular osteophytosis, abnormally shaped medial coronoid process & medial humeral condyle subchondral bone defect

Answer 68

Answer = A A is false because up to 71% have abnormal appearance of medial humeral epicondyle consistent with concomitant flexor enthesopathy NOTE: Accurate assessment of the extent of elbow cartilage lesions still requires arthroscopy and CT CANNOT replace arthroscopy for diagnosis of medial compartment erosion

Question 69

Truncation or Gibb's artifact occurs as a result of __________.

Answer 69

Truncation artifact = abnormal signal intensity that occurs parallel to an interface of tissues of markedly different signal intensities (e.g. tissue-fluid interface on T2W images)

Question 70

Which of the following is TRUE regarding truncation artifact? A) In low-resolution images, the artifact appears as multiple hyperintense zones on T2W images B) In high-resolution images, the artifact appears as a single wide central hyperintense zone on T2W images C) Artifact is minimized by decreasing pixel size, decreasing FOV, or increasing matrix size D) Artifact can be completely eliminated by increasing spatial resolution

Answer 70

Answer = C On low resolution images, the artifact is a single wide hyperintense zone on T2 On high resolution images, the artifact is multiple narrower hyperintense zones on T2 On T1 images the artifact is HYPOintense Artifact CANNOT be completely eliminated but can be minimized by increasing spatial resolution (e.g. decreasing pixzel size, inc matrix size, dec FOV)

Question 71

Magnetic susceptibility artifact is seen on _____ sequences, but never on _____ sequences.

Answer 71

Seen on gradient recall echo sequences (GRE) but never on fast spin echo (FSE) - Gradient recall echo sequences more senstiive to magnetic susceptibility than spin echo b/c the dephasing & rephasing of the FID signal occur in the same direction relative to the main magnetic field, owing to the absence of the 180° refocusing pulse, consequenctly cancelling the effects of magnetic field inhomogenities on spin dephasing does not occur

Question 72

Magnetic susceptibility artifacts increase with ___________ (what technical parameter).

Answer 72

Increasing magnetic strength

Question 73

Regarding MRI evaluation of hepatocellular carcinoma in dogs, which of the following statements is FALSE. A) No enlarged hepatic lymph nodes were found in any dog B) Time to maximum enhancement of normal liver parenchyma is ~20min C) All hepatocellular carcinoma lesions were hypointense to normal parenchyma on T1 and T2 postcontrast GRE sequences D) Hepatic lesions not identified on other imaging modalities were seen on MRI in 43% of cases E) B & C are false F) B,C, & D are false G) All statements are false

Answer 73

Answer = E B is false because time to maximum enhancement is ~10min not 20min C is false because all hepatocellular carcinoma lesions are hypointense to normal parenchyma on postcontrast T1W GRE sequences, no mention of T2W postcontrast sequences Hepatic lesions NOT identified on previous imaging were found using Gd-EOB-DTPA in 43% of cases​ NO enlarged hepatic lymph nodes in any dog. Non-lymph node extrahepatic lesions were found in 28% of dogs

Question 74

Which of the following is TRUE regarding articular cartilage studies in canine stifle joints? A) Articular cartilage is accurately evaluated on radiographic images B) MRI overestimates cartilage defect depth & width, but correlation between MRI and histopath is better for lesion width > depth C) Cartilage defects result in significantly greater T2 relaxation times D) 90% of cartilage defects are correctly identified on small FOV 3T MRI

Answer 74

Answer = C (significantly greater T2 relaxation time = more hyperintense lesion) A is false because articular cartilage CANNOT be evaluated on radiographs B is false because correlation is better for lesion depth > width C is false because 98% of cartilage defects are correctly identified

Question 75

Which modality is 100% sensitive and specific for gallbladder wall rupture & necrosis? A) Post contrast T1 MRI B) Nuclear scintigraphy C) Conventional U/S D) Contrast-enhanced U/S

Answer 75

Answer = D

Question 76

In dynamic sonography of the equine metacarpo(tarso)phalangeal digital flexor tendon sheath, those horses affected with palmar/plantar annular ligament desmitis had ________ gliding motion between the annular ligaments and flexor tendons and _______angulation of the long linear echoes of the tendon compared to the normal horses. A) Restricted; increased B) Restricted; decreased C) Unrestricted; increased D) Unrestricted; decreased

Answer 76

Answer = A Controls = unrestricted gliding and 0-13 degrees of angulation of long linear echoes Affected desmitis horses = restricted gliding and increased long linear echo angulation up to 20-35 degrees

Question 77

T or F, a gap between the DDFT and SDFT is found in normal horses on U/S of the digital flexor tendon sheath however a larger percentage of horses with palmar annular ligament desmitis show evidence of this.

Answer 77

TRUE. Finding of a gap between DDFT and SDFT was found in a lower % of control horses (25%) versus affected desmitis horses (75%) however the gap size is slightly larger in control horses & likely represents normal physiology

Question 78

The major component of pathologic dystrophic and metastatic calcification is ________(which mineral) which can lead to accumulation of 99mTc-MDP on nuclear scintigraphy studies.

Answer 78

Calcium phosphate

Question 79

Pilomatricoma is a follicular tumors originating from cells of the hair bulb. Up to 1/3 tumors of these tumors are malignant with a predilection for _____ metastasis.

Answer 79

bone metastasis

Question 80

T or F, synthetic progesterone administration for contraceptive use in dogs has minimal to no side effects and can safely be administered long term?

Answer 80

FALSE. Synthetic progesterone (medroxyprogesterone acetate) results in endometrial proliferation & inhibits myometrial motility leading to weight gain, diabetes mellitus, mammary gland tumors, endometrial hyperplasia & pyometra Dystrophic endometrial mineralization should be considered on the DDX list when multiple hyperechoic foci accompanied by acoustic shadowing are observed along the uterine wall in dogs with a long-term synthetic progesterone treatment history