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QuestionAnswer
What is the name of the destructive multi-species fungal infection of the foot, seen in tropical regions? Madura foot, aka mycetoma. May also be caused by Actinomyces israelii, which is not fungal but anaerobic higher bacterium, acid-fast “like,” often with clinical sulfur granules.
12yo girl with osteopathia striata, lobster-claw deformity, coloboma, multiple skin abnormalities. Dx? focal dermal hypoplasia (FDH), aka Goltz syndrome. X-linked dominant (lethal in males). FOCAL: Female, Osteopathia striata, Coloboma, Absent ectodermis-, mesodermis-, and neurodermis-derived elements; and Lobster claw deformity.
What are the features of Gorlin syndrome (aka NBCCS)? Odontogenic keratocyst (75% pts, most common finding, usually multiple in the mandible, 19yrs old avg). Frontal/temporopariental bossing, hypertelorism, and mandibular prognathism. Early calc of falx cerebri. Bifid ribs. Kyphoscoliosis. Multiple BCCs.
19yo with mandibular odontogenic cysts and prognathism, frontal bossing, hypertelorism, calcified falx, scoliosis, bifid ribs, multiple pearly nonmelanomatous skin cancers. Dx? Gorlin syndrome, aka nevoid basal cell carcinoma syndrome. One of the phakomatoses. Autosomal dominant inheritance.
12yo boy with numerous asymptomatic tiny discrete densely-sclerotic cortical bone growths within the medullary cavities of the pelvis and shoulders. Dx? osteopoikilosis, an autosomal dominant inherited condition with numerous asymptomatic bone islands. No malignant potential or effect on lifespan, QOL, bone strength, or fx risk.
What is osteopoikilosis? autosomal dominant inherited condition with numerous asymptomatic bone islands. No malignant potential or effect on lifespan, QOL, bone strength, or fx risk.
Radiograph shows celery stalk metaphyses of the proximal tibiae, also affecting the epiphyses. DDx? aka osteopathia striatum aka Voorhoeve disease. Rare, benign dysplasia that can be seen in congenital rubella/CMV/syphilis infection, Goltz syndrome, adult osteopetrosis, enchondromatosis, and normal variants.
What is pneumatosis cystoides intestinalis? Multiple, thin walled submucosal or subserosal cysts containing air with high hydrogen content, mostly in sigmoid and descending colon. May mimic polyps when they protrude into lumen on BE or endoscopy. CT is diagnostic. No tx needed usually.
On CT abd/pelv, you see multiple, thin walled submucosal or subserosal cysts containing air in the sigmoid and descending colon. Looks like a cluster of grapes. Dx? pneumatosis cystoides intestinalis. High hydrogen content. May mimic polyps when they protrude into lumen on BE or endoscopy. CT is diagnostic. No tx needed usually.
Muscle pain in an HIV+ patient. MR shows bright STIR signal in a large portion of the muscle. Likely Dx? pyomyositis
waterlily sign hydatid cyst (ruptured daughter cyst as seen floating at an air-fluid interface within the mother cyst)
T/F: Spinal sarcoid involvement looks like diffuse heterogeneous or mottled marrow signal intensity on T1WI. TRUE
Lattice-like lysis in multiple phalanges on x-ray. Acro-osteolysis with mixed acrosclerosis. Mottled marrow replacement in the spine. What nonneoplastic and noninfectious condition does this pattern indicate? sarcoidosis (musculoskeletal). Expect to see chest involvement (80%–90%). Myositis may occur (50%–80%).
BATMAN is mnemonic for what? Organisms involved in empyema necessitatis: Blastomyces, Actinomyces, Tuberculosis (75% of cases), Mucor, Aspergillus, and Nocardia.
CXR shows upper lobe predominance of fibrotic changes and mass. CT shows fibrosis, emphysema, cystic changes, and mass with coarse calcifications. Occupational history. Likely Dx? progressive massive fibrosis (PMF). Cancer-mimicking conglomeration of nodular lesions (especially silicotic and/or anthracotic nodules). Greek: anthrax=coal
What is the standard treatment for pulmonary alveolar proteinosis? How does this disorder present on CT? BAL/lavage. "Crazy paving."
What is the expected evolution of pulmonary contusion on imaging? Even without any further increase in bleeding, worsening opacification may be seen for up to 12-24 hrs d/t reaction, edema. After 24 hrs, new opacification likely has a different etiology (pneumonia, etc).
What are the most common sites for extrathoracic sarcoidosis? SELLS: Skin, Eyes, Liver, Lymph nodes, and Spleen.
47-year-old female with gradual onset of dyspnea over several months. CT shows symmetric, lower lobe predominant ground-glass opacities with subpleural sparing and reticular interstitial abnormalities. No consolidation, effusion, or LAD. Dx? nonspecific interstitial pneumonia (NSIP). GG opacities are salient feature of NSIP & are found in nearly all cases. Nodules, cysts, & air trapping are uncommon & suggest another dx. Subpleural sparing is NOT required; subpleural gg can predominate.
Young adult patient with chronic lung disease, compliance issues. CXR shows hyperinflation, diffuse bronchiectasis. CT further reveals mucus plugging, mosaic attenuation, marked bronchiectasis in the upper lobes. Most likely underlying dz? cystic fibrosis. Mostly upper lobe bronchiectasis, areas of mucus impaction. Autosomal recessive. Sweat chloride test for Dx.
What is the most common pulmonary abnormality in patients with ankylosing spondylitis? Upper lobe traction bronchiectasis and cyst formation. Can be nidus for mycetoma, hemoptysis.
What is the Garland triad? Mediastinal nodes, 3 nodes in right paratracheal, right and left hilar ditribution, often seen in thoracic sarcoid.
What single term describes a nonspecific esophageal motility disorder characterized by decreased primary peristalsis and frequent tertiary (nonpropulsive) contractions, increasing in prevalence with age? presbyesophagus
What is the primary differentiating feature between achalasia and scleroderma? "Bird'd beak" narrowing at the GE junction on esophagram, seen in achalasia, not in early scleroderma. Late scleroderma can mimic achalasia due to peptic stricture at the GE junction.
What are the two types right aortic arch, and why is it important to differentiate between the two? Right aortic arch with aberrant subclavian artery, and right aortic arch with mirror image branching. Mirror image branching is associated with congenital heart defects.
Coarctation is associated with what genetic condition and what cerebral vascular condition? Coarctation of the aorta is associated with Turner Syndrome (20%), and there is an increased risk of cerebral aneurysm (5-10%).
What is the main differentiating imaging feature between thymoma and thymic carcinoma? Thymic carcinoma has poorly defined borders (not smooth as in thymoma), heterogeneous enhancement, and necrosis.
What is "diffuse alveolar hemorrhage?" Pulmonary vasculitis spectrum including Wegener granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome. CT: nonspecific lobular gg opacities with consolidation; “crazy-paving” as the hemorrhage resolves. Hemoptysis in 2/3.
What anatomic variant does an "aortic nipple" suggest? partial anomalous venous return; most common is left superior pulmonary vein draining into the subclavian vein.
18yo with neurological sx, recently started tx for leukemia. MR shows restricted diffusion in the bilateral centrum semiovale. No enhancement. No low intensity GRE lesions. No increased intensity on T2. Most likely Dx? acute methotrexate toxicity. Typically occurs 10-11 days after IT methotrexate. Often no T2 prolongation.
Fetal germinal matrix normally involutes by what age? 32 weeks gestation (confirm)
Bright medullary pyramids on ultrasound. medullary nephrocalcinosis. Causes: any hypercalcemic condition, RTA type 1 (distal), medullary sponge kidney, others?
What is Leigh’s disease? aka subacute necrotizing encephalomyelopathy (SNEM). mtDNA dz, onset before age 2, fatal in childhood. T2 bright in periaqueductal gray, medulla, midbrain, putamen characteristic. NOT mammillary bodies (if so, think Wernicke encephalopathy).
Multiple cystic nodes in the neck in a 32yo woman. Most likely Dx? papillary thyroid carcinoma (nodal metastases)
Newborn with circular/rim calcifications in the abdomen. Dx? meconium peritonitis
What is Luckenschadel skull and what is it associated with? aka lacunar skull, dysplasia of cranial vault, assoc w/ Chiari II (up to 80% of cases). Inner table more affected than outer, regions of apparent thinning (nonossified fibrous bone). If severe w/ lacunae coallescing into larger defects = craniofenestra.
Term baby with bilateral diffuse opacities. Top 4 DDx? meconium aspiration, TTN, PNA, or cardiogenic edema.
Name the important metabolites in MR spectroscopy. "Lying Lazy No Good Crooks Collected My insurance": Lipid: abnormal, Lactate: abnormal, NAA, Glutamine/glutamate, CREAtinine/phosphocreatinine, CHOLine-containing compounds, Myoinositol.
What is the most common congenital heart defect in trisomy 21? VSD
30yo with painless geographic lytic lesion at the distal femur with expansion of the cortex, no matrix calcification, no sclerotic border, and mildly dark on T2 with a cystic component with fluid-fluid levels. Dx? giant cell tumor with component of aneurysmal bone cyst (commonly associated)
What is a giant cell reparative granuloma? GCRP = unusual benign bone lesion, most commonly maxilla and mandible; skull involvement is rare. Etiology uncertain, may be related to trauma and intraosseous hemorrhage. Difficult to distinguish from GCT of bone but has lower recurrence rate.
What is the characteristic triad of Dandy-Walker malformation? Complete or partial agenesis of the vermis, Cystic dilatation of the fourth ventricle, Enlarged posterior fossa with upward displacement of lateral sinuses, tentorium, and torcular herophili.
68yo woman with acute knee pain, xray shows linear sclerosis in the tibia. Dx? insufficiency fx
What calcaneal pathology are diabetics especially prone to? calcaneal insufficiency avulsion (CIA) fracture of the calcaneus
What is the triad of Beckwith–Wiedemann syndrome? exomphalos, macroglossia, and gigantism
Madelung deformity vs Madelung disease. What is the difference? Completely different entities. One is a deformity of the wrists associated with genetic disorders and presenting in adolescence, and the other is an adipose tissue disease of the neck in older men.
What is Madelung deformity? Volar-ulnar radial physis, ulnar tilted distal radial articular surf, volar transl'n of hand & wrist, & dorsally prominent distal ulna. Predom adolescent females. Pain, decr ROM, deformity. Often genetic, assoc'd w/ mesomelic dwarfism & X c'some mutation.
What genetic disorder is associated with Madelung deformity? Léri-Weill dyschondrosteosis. Mesomelic dwarfism (short forearms and legs), bowing of the radius and tibia with relative sparing of the ulna and fibula, Madelung deformity (bayonet-like deformity of the forearms). Rare pseudoAD-inh SHOX gene deletion.
What is the range of x-rays used in mammography? 15-25 pkV, created using combinations of molybdenum and rhodium targets and filters.
What are the different combinations of target and filter materials for mammography? molybdenum-molybdenum for thin breasts, molybdenum-rhodium for thicker breasts, and rhodium/rhodium for the thickest breasts.
What are the important points of the 4-chamber view on 2nd trimester ultrasound? PASSSS: Position (RV, LV, and LA in anterior left chest), Axis (45degr +/- 10), Size (1/3 of chest), Symmetry (RV=LV & RA=LA), Septum (septal view, no VSD), Squeeze (subjective).
What is the upper limit of normal thickness for POSTmenopausal endometrial complex? 5 mm
What is the differential (list 4) for thickened endometrial stripe in a postmenopausal woman? endometrial carcinoma, polyp, pedunculated submucosal fibroid (echo pattern), or hyperplasia (nonfocal). Mgt: SIS (saline infused sonohysterogram)
Over what internal carotid artery (ICA) peak systolic flow velocity (PSV) is there stenosis? PSV<125 cm/sec is NL. PSV 125-230 cm/sec indicates 50-69% stenosis. PSV>230 cm/sec indicates stenosis >70% but less than "near-occlusion." Near-occlusion --> variable PSV as flow velocities drop to 0. McGahan JP, Atlas of US Measurements, 2nd ed, pg 317.
What are the recommendations for simple ovarian cysts in premenopausal women? No need to mention if <3 cm. Mention but no f/u needed if <5cm. F/U yearly if 5-7cm. MRI and/or surg consult if >7cm.
What are the recommendations for simple ovarian cysts in postmenopausal women? F/U yearly if 1-7 cm. MRI and/or surg consult if >7cm.
What are the recommendations for hemorrhagic ovarian cysts in pre- and postmenopausal women? Premenopausal: No f/u needed if <5cm. No need even to mention if <3cm. For >5cm, f/u in 6-12 weeks to ensure resolution. ANY SIZE in a postmenopausal woman: f/u to ensure resolution.
What are 9 causes of renal papillary necrosis? POSTCARDS: Pyelonephritis, Obstruction, Sickle cell dz, TB, Cirrhosis, Analgesics, Renal vein thrombosis, Diabetes, Systemic vasculitis. Most common: Sickle in kids, diabetes in adults, and analgesics in middle-age women.
What is the most common effect of tamoxifen on the uterus? endometrial polyps. It can also cause subendometrial cysts and endometrial hyperplasia. Elevated risk for endometrial carcinoma.
What is the upper limit of normal for endometrial complex under effect of tamoxifen? <6 mm
What is Stein-Leventhal syndrome? polycystic ovaries, hirsutism, obesity, infertility
What are the most common cyst in the female fetal abdomen? ovarian cysts. These are usually UNILATERAL.
What condition(s) is/are associated with ADEM? Does this recur or progress? ADEM is post viral/vaccine demyelination, monophasic by definition, does not recur or progress, but may (10%) have residual neurologic deficits.
Lateral xray shows stairstepping of the metatarsals and paralleling of the talus and calcaneus. Dx? clubfoot (talipes equinovarus)
What can humeral head ossification (or lack thereof) tell you about gestational age or age of a newborn/infant? The humeral head is almost never present before 38 weeks of gestational age. It is seen in 15% of newborns at 38–39 weeks, 40% of infants at 40–41 weeks, and in 82% of newborns of 42 weeks or more gestational age.
Coarse calcifications in the abdomen with movement on serial exams in a newborn. Is this meconium peritonitis? No. This represents mixing of meconium and urine in the bowel, due to fistulization.
What are the causes of pediatric bowel obstruction? AIM TWICE: Appendicitis/Adhesions, Intussusceptions/Incarcerated inguinal hernia, Midgut volvulus/????? Meconium?
Buzzword: split cord. Dx? diastomatomyelia (septum, separate sacs) or diplomyelia (no septum, shared sac)
Large heart, very large hepatic veins, large SMA with marked of the aorta distally. Numerous hypoechoic lesions in enlarged liver. Dx? shunting hemangiothelioma
What is the precursor pathology for Wilms tumor? Nephroblastoma. Remnant nephroblastema tissue. Normal variant in preterm but should be gone by term age.
What is the triad of Leriche syndrome? buttock claudication, impotence, absent distal pulses
Triad: Buttock claudication, impotence, absent distal pulses. Dx? Leriche syndrome
What are the pathways for collateralization in the setting of distal aortic stenosis/occlusion? Posterior pathway: lumbar arteries to DCI (deep circumflex iliac arteries). Middle pathway: SMA to IMA to superior hemorrhoidal arteries. Anterior pathway: internal mammary arteries to inferior epigastrics to iliacs.
What is the anatomic cutoff for Stanford A-B dissection? left subclavian origin
FPC – familial polyposis coli (aka FAP – familial adenomatous polyposis), Gardner syndrome, Cowden syndrome, and Turcot syndrome all have what genetic defect in common? PTEN, a tumor suppressor gene. Loss-of-function mutations in PTEN lead to hyperactivity of the mTOR pathway, and tumors...
Buzzword: stack of coins (okay, buzz “term”). What 3 diseases should you consider if you see this on KUB or contrast fluoro? “SOS”: sprue, obstruction, scleroderma
Name 4 infectious agents responsible for colitis. CMV, histoplasma, Yersinia, and the classic bug: C-dif
What are the four main indications for TIPS? esophageal variceal hemorrhage, refractory ascites, hepatic hydrothorax, and Budd Chiari syndrome. Portal-systemic venous pressure gradient >5 mm Hg indicates portal HTN. Needs to be <12 mm Hg to stop bleed.
What defines portal venous hypertension? portal-systemic venous pressure gradient >5 mm Hg. When placing TIPS, gradient must be <12 mm Hg to stop acute variceal bleeding.
What are the 4 absolute contraindications to TIPS placement? right heart failure, severe liver failure, pulmonary HTN, splenic vein thrombosis
Buzzword: golfball on a T (on CT urogram or IVP). Dx? renal papillary necrosis
Pattern: Fish-type vertebral bodies. Dx? severe osteoporosis
What is important about the location of fracture line in scaphoid fractures? The closer a scaphoid fracture line is to the proximal pole, the higher likelihood of osteonecrosis.
What are the 2 most likely primary malignancies to have acral skeletal metastasis? breast and lung primaries
How can you differentiate osteonecrosis from enchondroma? enchondroma has endosteal scalloping, mass effect, “dots and commas” chondroid matrix mineralization, not seen in osteonecrosis.
What are the four main diseases to consider in the differential for a lytic lesion at end of bone? GCT (only if growth plates are closed), Brodie abscess, LCH (rare), chondroblastoma (should have chondroid matrix).
Buzzword: Ivory tufts. Dx? Psoriatic arthritis.
Buzzword: Vertebra plana. Dx? LCH. DDx: pagets.
Sprengel deformity, renal anomalies, and cervical vertebral fusions. Dx? Klippel-Feil (“file”) syndrome
What statistics and risks should be discussed with patients electing to undergo TIPS? 95% successfully placed. Most have resolution of ascites by 1 mo. Hepatic encephalopathy 30% of pts (most common complic’n, treatable). Hemolytic anemia 10%. 15% rebleed in 6 months. Stenosis: 25-37% by 6 months, 75% by 1yr, near 100% by 2yrs.
What direction is typical idiopathic scoliosis? Makes up what % of structural scolio in the US? What % of population? Rightward thoracic convexity. 80% of structural scolio in the US. 3% of population.
What is Chamberlain's line? Chamberlain's line: from dorsal aspect of hard palate to posterior edge of foramen magnum. If odontoid tip is > 6mm above this line, indicates cranial settling. May cause posterior headache d/t compression of greater occipital branch of C2.
Differential for causes of cystic bronchiectasis? Pneumonia, Chronic bronchitis, Asthma (allergic bronchopulmonary aspergillosis), Bronchial atresia
What % of giant cell tumors (GCT) are malignant? 5-10%
Differentiate Monteggia fx from Galleazzi fx. MUGR: Monteggia=ulna, Galleazzi=radius. Monteggia fx is associated with radial head dislocation. Galleazzi is associated with DRUJ dislocation.
What is the differential for causes of bone infarction? “ASEPTIC G”: Alcoholism, Sickle/Steroids/SLE, Environmental (frostbite), Pancreatitis/Pregnancy, Trauma (hip, scaphoid, talus), Infection/Idiopathic, Caisson's disease (dysbaric osteonecrosis), Gaucher dz
Unilaterally enlarged left pulmonary artery on radiograph is highly suggestive of what pathological condition? Pulmonary stenosis. Post-stenotic dilation of left PA in >80% of pts where the jet hits the left pulmonary arterial wall. The vast majority of pulmonary valvular stenosis is congenital.
What is another name for papillary cystadenoma lymphomatosum, adenolymphoma, or lymphomatous adenoma? Warthin tumor. 90% occur in smokers. Mean age = 60 years. M:F = 3:1. Increase incidence with radiation exposure.
2nd most common (benign) parotid tumor is _____? Warthin tumor. Cystic component in 30%. 20% are multicentric. 90% occur in smokers. Mean age = 60 years. M:F = 3:1. Increase incidence with radiation exposure.
T/F: Malignant transformation to carcinoma is exceedingly rare in Warthin tumor. True. It happens, but it is rare.
What % of breast cancers involved BRCA mutation? 10%. The other 90% are sporadic.
What are the two "bad" forms of LCH and which is worse? Acute disseminated LCH, aka Letterer-Siwe disease, is worst and rarest, with 75% mortality, rapid-onset hepatosplenomegaly, rash, LAD, marrow failure, and pulmonary dz. Hand-Schuller-Christian disease is the other bad type and has 15% mortality.
What is Hand-Schuller-Christian disease? Chronic form of LCH with visceral and skeletal involvement, with associated diabetes insipidus, exophthalmos, dermatitis, growth restriction. 15% mortality.
Describe the mortality figures associated with the 3 types of LCH. EG is most common and has excellent prognosis with spontaneous regression within 2 years. Letterer-Siwe disease is the worst with 75% mortality, but is rare. Hand-Schuller-Christian disease has visceral and skeletal involvement and a 15% mortality.
What is the name for the chronic form of LCH with visceral and skeletal involvement, diabetes insipidus, exophthalmos, dermatitis, and growth restriction? Hand-Schuller-Christian disease
What is the name for the acute disseminated form of LCH with 75% mortality, rapid-onset hepatosplenomegaly, rash, LAD, marrow failure, and pulmonary dz? Letterer-Siwe disease
What is Whipple disease? Rare systemic infection caused by Tropheryma whipplei, first described by G.H. Whipple in 1907, commonly considered a GI dz with characteristic malabsorption, but but may affect any part of the body including heart, lungs, brain, joints, skin, & eyes.
Name 9 complications of joint arthroplasty. Loosening, infection, small particle disease, dislocation or abnormal alignment, fractures, heterotopic bone formation, cement extrusion, polyethylene liner displacement, and metal arthropathy.
What are the numeric limits on periprosthetic lucency? No more than 2 mm, and should not progress after 6 months.
Describe the Brooker Classification for heterotopic bone after hip replacement. Class I: small islands of bone. Class II: bone projection from acetabulum or femur with >1 cm between osseous surfaces. Class III: <1 cm between opposing bridge surfaces. Class IV: osseous ankylosis bridging joint.
Describe 3 predisposing conditions or risk factors for heterotopic bone formation after joint prosthesis surgery. ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis (DISH), prior occurrence
Define osteoconduction and osteoinduction. osteoconduction = tissue ingrowth with prominent vascular and mesenchymal components. Osteoinduction = mesenchymal tissue differentiation into tissue capable of osteogenesis.
Describe the pathophysiology of renal osteodystrophy. Inability to excrete phosphate results in hyperphosphatemia, which causes hyperplasia of parathyroid chief cells and increased parathormone (PTH), reduced degradation of PTH, and clinical secondary hyperparathyroidism.
When you see rib scalloping, what should be the FIRST disease you think of? Renal osteodystrophy/secondary hyperparathyroidism. More common than coarctation and NF1.
Why do renal failure patients get osteomalacia? Failed kidneys are unable to adequately hydrolate vitamin D to its active form. In kids with renal failure, this leads to rickets; in adults, osteomalacia. Osteomalacia contributes to osteoporosis and renal osteodystrophy.
You see a wrist radiograph in a patient with chronic renal insufficiency, showing multiple punched-out lytic lesions in the carpal bones. What is the likely cause of these lesions? amyloid deposition is most likely, vs Brown tumors from secondary hyperthyroidism
Who gets “destructive spondyloarthropathy” and what is its underlying cause? Chronic renal insufficiency patients. Amyloid deposition. Looks like infection on radiographs, but sterile, afebrile, usually more chronic than discitis/osteomyelitis.
Why do chronic renal insufficiency patients have increased risk of tendon rupture? Excess parathormone and chronic acidosis cause tendon calcification and accelerated degeneration, resulting in decreased tendon tensile strength and increased joint laxity.
Brown tumors are more common in ___primary vs secondary___ hyperparathyroidism. Brown tumors are more common in primary hyperparathyroidism (but pretty common in both).
T/F: Osteosclerosis is common in primary hyperparathyroidism. False. It is very common in secondary hyperparathyroidism, but rare in primary.
Chondrocalcinosis is more common in ___primary vs secondary___ hyperparathyroidism. Chondrocalcinosis is more common in primary hyperparathyroidism.
Periostisis is more common in ___primary vs secondary___ hyperparathyroidism. Periostisis is more common in secondary hyperparathyroidism.
Define May-Thurner syndrome. Clot down left leg due to stasis caused by pressure on the left common iliac vein from the crossing right common iliac artery.
FAP, body wall desmoid tumors (fibromatosis), and facial osteomas. Dx? Gardner syndrome. Note that FAP is often called familial polyposis coli.
Define Gardner syndrome. FAP with extracolonic benign and malignant masses: Osteomas, dental abnormalities, desmoid tumors/mesenteric fibromatosis, epidermoid cysts and dermal fibromas, adrenal/ thyroid/ ampullary/ liver carcinomas, and congenital pigmented lesions of retina.
Circumferential soft tissue mass within medullary bone with serpiginous pattern of marrow replacement and tumor "percolating" through cortex without overt destruction is typical and highly suggestive what disease? lymphoma
Rare AD-inherited disorder: Macrocephaly, hamartomatous GI polyps, benign skin tumors (trichilemmomas, papillomatous papules, acral keratoses), dysplastic cerebellar gangliocytoma and high risk of breast ca, follicular thyroid ca, & endometrial ca. Cowden syndrome, associated with loss-of-function mutations in PTEN, a tumor suppressor gene, leading to hyperactivity of the mTOR pathway. Isolated dysplastic gangliocytoma of the cerebellum is called Lhermitte-Duclos disease.
What are the features of chondromyxoid fibroma? Benign, 89% in LE: prox tib>dist femur>pelvis>foot. Diagnostic: nearly hemispherical "bite" from cortical margin without periosteal reaction. Sclerotic margins w/ scalloped borders, ± mild cortical expansion. Matrix calc rare.
Name 3 cystic bone lesions that can have fluid-fluid levels on MRI. ABC, GTC w/ 2° ABC, CMF w/ 2° ABC, and telangiectatic OS.
What is Jaffe-Campanacci syndrome? Mental retardation, numerous fibroxanthomas (NOFs) of long bones and mandible, hypogonadism/cryptorchidism, giant cell granulomas of the jaw, and café au lait macules (CALMs) ± axillary freckling. M>F, usually 5-15yo. May be a form of NF1.
Cystic masses completely surrounding bilateral ovaries. H/o surgery or pelvic inflammation. Most likely dx? peritoneal inclusion cysts
What is the Larmor frequency? Use the equation to explain. f= [γ/2π] * Bzero, where [γ/2π]= gyromagnetic ratio [Hertz/Tesla] of nucleus, Bzero= applied magnetic field strength [Tesla], and f= cycles/sec or Hertz. Since [γ/2π] for 1H is 42.58 MHz/T, & H-1 = 99.99% of all H, f=42.58 MHz for proton in 1 Tesla field.
Define T1 relaxation time. T1 is the time it takes the longitudinal magnetization vector Mz to grow to 63% of its maximum value. Different tissues exhibit uniquely different T1 relaxation times when exposed to the same static field.
What is the most likely/common source for any masticator space infection? dental
What are the typical TE and TR ranges for PD MRI? TE= 5–30 msec, TR= 2000–4000 msec for PD
What are the typical TE and TR ranges for T1W MRI? TE= 5–30 msec, TR= 400–800 msec for T1WI.
What are the typical TE and TR ranges for T2W MRI? TE= 60-120 msec, TR= 2000–4000 msec for T2WI.
What exactly is "T1 shortening" and why does it result in brighter signal on T1WI? T1 is a measure of relaxation resulting in re-establishment of Mz magnetization (parallel to Bzero) after a 90-degree RF pulse. At shorter TE typical of T1WI, tissues (or gad) with shorter T1 have higher measured signal than tissues with longer T1.
What exactly is "T2 prolongation" and why does it result in brighter signal on T2WI? T2 is a measure of relaxation resulting in decay of Mxy magnetization (perpendicular to Bzero) after a 90-degree RF pulse. At longer TE typical of T2WI, tissues (or gad) with longer T2 have higher measured signal than tissues with shorter T2.
Describe Bzero dependence of T1 and T2. T1 of all tissues increases with increasing Bzero. T2 is independent of Bzero.
T1 signal intensity is proportional to ____. (what is the equation?) T1 signal intensity ∝ 1 – e^(-TR/T1)
T2 signal intensity is proportional to ____. (what is the equation?) T2 signal intensity ∝ (e-TE/T2)
Biliary hamartomas are also known as _______. (an eponym) von Meyenburg complexes
What is pituitary apoplexy? Bleeding into or impaired blood supply of pituitary gland, usually tumor related, most common initial symptom is sudden headache, often with rapidly worsening visual field defect or double vision, often followed by acute adrenal insufficiency.
Features: low lumbar spinal stenosis, sharpening of sacrosiatic notch, champain glass pelvis, clublike femoral neck/coxa valga, genu varum, proximal bone shortening. Dx? achondroplasia
Features: telephone receiver femur, die soon after birth. Dx? thanatomorphic dwarfism
Features: stippled epipphyses, rhizomelic bone dyslasia. Dx? chondrodysplasia punctata
Features: bent bone, tibial soft tissue pit. Dx? camptomelic dysplasia
What bone dysplasia is particularly known among Amish? chondroectodermal dysplasia, aka mesoectodermal dysplasia, aka Ellis–van Creveld syndrome. Founder effect genetics.
Name this rhizomelic dwarfism: short ribs, polydactyly, malformation of the wrist bones (fusion of the hamate and capitate bones), congenital heart defects (most commonly ASD, 60%), pre-natal tooth eruption, fingernail dysplasia, and cleft palate. Ellis–van Creveld syndrome, aka chondroectodermal dysplasia, aka mesoectodermal dysplasia. Autosomal recessive. Founder-effect genetics.
What are the two main critical issues for patients with MHE? Osteochondroma growth into spinal canal with neurologic dysfunction, other nerve impingement, potential for malignant degeneration.
T/F: Ollier disease is almost always symmetrical. False. It is usually asymmetrical.
Name a synonym for dysostosis muliplex. What are 3 specific diseases? mucopolysaccaridoses. Morquio, Hunter, and Hurler syndromes. Also Sanfilippo syndrome.
Xrays show hypoplastic/absent clavicles, Wormian bones, large head, thin calvarium, narrow bell-shaped thorax, small scapulae, spondylosis, hyperkyphosis/lordosis, hemivertebrae, coxa vara, pseudoepiphyses of metacarpal bases, short/absent radius. Top Dx? cleidocranial dysostosis. Also look for metopic suture, brachycephaly/bossing, lg mandible, cleft palate, retained baby teeth, too many ribs, widened symphysis, small iliacs/sacrum, accessory epiphyses (hands/ft), short distal phalanges, pointed tufts.
What is the DDx for wormian bones? "PORK CHOPS": pyknodysostosis, OI, rickets, kinky hair syndrome, cleidocranial dysostosis, hypothyroidism, hypophosphatasia, otopalatodigital syndrome, primary acroosteolysis (Hajdu-Cheney syndrome), pachydermoperiostosis, progeria, syndrome of Down
What is the DDx for pituitary region masses (sellar and suprasellar)? "SATCHMO": S (sarcoid, sellar/pit tumor), A (aneurysm), T (teratoma, TB & other granulomatous diseases), C (craniopharyngioma, cleft cyst Rathke, chordoma), H (hypothalamic glioma, hamartoma, histiocytosis), M (meningioma, metastasis), O (optic glioma).
What are the underlying causes of AVN? Name 7. ASEPTIC: A- Alcoholism, S- Sickle/Steroids/SLE, E- Ehrlenmeyer flask (marrow packing disorders e.g. Gaucher's), P- Pancreatitis, T- Trauma (Hip, Scaphoid, Talus), I- Infection/Idiopathic, C- Caisson's disease (dysbaric)
What is Bertolotti syndrome? Low back pain due to congenital transitional L5 vertebra w/ sacralization, "spatulated" transverse process on one side, articulation w/ sacrum and/or ilium. Results in L5 radiculopathy and sciatic pain, plus accelerated degen at L4-5.
Name the 4 most common classic flat-bone tumors. Ewing sarcoma, chondrosarcoma, myeloma, and metastases
What is the name for calcific deposits at the proximal end of the MCL? (usually asymptomatic, may reflect prior trauma) Pellegrini-Stieda lesion/sign
What is Pellegrini-Stieda syndrome? Pellegrini-Stieda lesion/sign combined with pain. These calcific deposits at the proximal end of the MCL are usually asymptomatic, but can be treated with resection of calcific deposits.
What is phosphaturic mesenchymal tumor? Benign mesenchymal neoplasm which causes paraneoplastic osteomalacia by secreting phosphatonin (fibroblast growth factor FGF-23), inhibiting renal tubular reabsorption of phosphate and renal conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D.
Adult rickets, low serum phosphate. What tumor might be causing this? phosphaturic mesenchymal tumor. Secretes phosphatonin (FGF-23), inhibiting renal tubular reabsorption of phosphate and renal conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D, leading to the paraneoplastic syndrome. Get an octreotide scan.
T/F: Foot deformities are best initially evaluated with x-rays with the feet unaffected by gravity or weight. False. Foot deformities should not be diagnosed if the radiographs are not obtained in a weight-bearing position.
What is the most important disease entity to consider when you see stippled epiphyses on a child's radiograph? hypothyroidism. Although stippled epiphyses are seen with a variety of entities, the most important to consider is hypothyroidism, since that disease can be treated, salvaging a potentially devastating degree of retardation.
What is the classic cause of delayed bone maturation and fragmentation of the femoral capital epiphysis in a child, as seen on radiographs? hypothyroidism. This is the classic "cretinoid" hip.
What disease process does the constellation of diffuse and severe osteopenia with multiple lucent metaphyseal bands suggest? Relatively rapid development of the osteopenia, as can be seen in leukemia.
Sudden onset shoulder pain, normal shoulder radiographs, and edema in the supraspinatus and infraspinatus muscles on MR without change in muscle shape or tendon pathology. Normal glenoid; no trauma history. Dx? Parsonage-Turner syndrome (viral neuritis). Most frequently involves the suprascapular nerve. 90% w/ denervation edema of supraspinatus & infraspinatus muscles. 2/3 of cases show involvement of >/= 3 muscles; most commonly involved 3rd muscle is deltoid.
T/F: Stellate lesion (focal superior acetabular cartilage defect) with associated plica is a normal variant. True. If you see this, look for real pathology as a cause for the patient's pain. Avoid satisfaction of search.
Undertubulation and bone infarcts in bilateral distal femurs. Classic Dx? Gaucher disease, a sphingolipidosis, most common of lysosomal storage disease. Hereditary glucosylceramidase deficiency, glucosylceramide accumulates in macrophages in spleen, liver, kidneys, lungs, brain and bone marrow. "Erlenmeyer flask."
T/F: Müllerian duct anomalies are commonly associated with renal and ovarian anomalies. This statement is overall false, but contains some truth. While renal anomalies are commonly associated with MDAs (this part of statement is true; always check the kidneys), their is no documented association between MDAs and ovarian anomalies.
Buzzword: "hair on end" appearance of the cranial table. Dx? thalassemia
Differentiate Kohler disease from Mueller-Weiss disease. Kohler dz is osteonecrosis and flattening of tarsal navicular bone in children ("Kohler in Kids"). Mueller-Weiss disease is a chronic adult navicular disease with comma shape and fragmentation.
What is pycnodysostosis? aka Toulouse-Lautrec syndrome. Osteoclast disorder with osteosclerosis, brittle bones, short stature, delayed suture closure, frontal/occipital bossing. AR-inh lysosomal storage disease caused by cathepsin K (enzyme) gene mutation. Greek: pyknos (dense).
What causes melorheostosis? Mutation of LEMD3 gene. From Greek melo (limb, as in monomelic, rhizomelic, etc), rheo (flow, referring to dripping appearance), and ostosis (bone disease). aka Leri disease.
Buzzword: What disease "turns a man to stone?" fibrodysplasia ossificans progressiva (FOP)
Ovarian mass, ascites, and pleural effusion. What is the eponym for this condition? Miegs syndrome. Associated with ovarian fibroma/thecoma (benign).
Pelvic MR shows ascites and a T1 dark T2 hypointense mass associated with the ovary, no connection to the uterus. Most likely Dx? Ovarian fibrothecoma spectrum (includes ovarian fibroma and ovarian thecoma). Looks like fibroid in signal characteristics but not associated with myometrium. Can be associated with Miegs syndrome.
MR shows multilocular cystic ovarian mass with stained-glass appearance, no enhancing solid nodule or significant septal thickening. No ascites. Most likely Dx? mucinous cystadenoma. If there was a solid nodule, septal thickening, or ascites, consider mucinous cystadenocarcinoma more strongly.
1-day-old male with excessively short femur but normal contralateral leg. The distal portion of short femur is normal; the proximal portion of the shaft, as well as the neck, head, and trochanters, are absent. Dx? proximal femoral focal deficiency (PFFD). Rare skeletal disorder characterized by failure of development of proximal femur, with varying degrees of shortening.
Name the 3 bone tumors that involve predominantly the posterior processes of the vertebrae rather than the body. And name the 2 tumors that affect both. osteoblastoma, aneurysmal bone cyst, osteoid osteoma (and myeloma and metastases in both areas)
Name the 5 bone tumors that involve predominantly the vertebral body rather than the posterior processes. And name the 2 tumors that affect both. chordoma, giant cell tumor, Langerhans cell histiocytosis, Ewing sarcoma, lymphoma (and metastases and myeloma in both areas)
Dense bones with short stature, acroosteolysis, decreased angle of mandible. Dx? pycnodysostosis. Autosomal recessive inherited mutation in cathepsin K enzyme, required for bone turnover. Results in abnormal osteoclast activity, decreased bone resorption/turnover, brittle bones, similar to osteopetrosis but w/o marrow obliteration.
Bone-in-bone appearance in the vertebral bodies on spine radiographs, and sclerotic outlines within the iliac wing on pelvis radiograph. Dx? osteopetrosis
What is the name for right colonic neutropenic colitis? typhlitis
What distinguishes typhlitis from other types of colitis? neutropenia, cecal focus
What is the angle of Gissain? angle between the anterior and posterior articular surfaces of the calcaneus
What is the name for the angle between the anterior and posterior articular surfaces of the calcaneus? angle of Gissain
What joints are fused in a “triple arthrodesis” procedure? (ankle) subtalar, talonavicular, and calcaneocuboid joints
What is Paget Schroetter syndrome? aka effort thrombosis. Thoracic outlet syndrome resulting in thrombosis of the subclavian vein, often after overhead exercise. Presents as UE swelling, pain, history of overhead work or exercise in the days prior.
What is the preference order for PICC venous access? basilic vein >> cephalic vein >> brachial vein.
What is Wolf’s Law? Bone remodeling in response to stress: Increased bulk in areas of increased stress, bone resorption in areas of decreased stress. Explains the concept of stress shielding after placement of bone prosthetics.
What is Davis’s Law? In musculature, the response of lengthening and increased elasticity in response to increased repeated stretch on muscle, as well as the inverse response of shortening and decreased elasticity in response to decreased stretch (disuse, decreased motion).
Brilliant emerald-green bile in biliary drainage 1 day after biliary drain placement. Likely Dx? Enterobacter cloacae biliary infection. Culture and treat with Abx.
10yo boy with radiographs showing multiple fibroxanthomas (NOFs), history of delayed mental development and pigmented patch. Dx? Jaffe-Campanacci syndrome. The pigmented patches are café au lait macules (CALMs). Also may include hypogonadism/cryptorchidism, giant cell granulomas of the jaw, and axillary freckling. M>F, usually 5-15yo. May be a form of NF1.
Elderly woman with osteoporosis (on tx for several years with improved DEXA) and hip/leg pain. Radiographs show focal cortical thickening in the lateral cortex of the subtrochanteric femur, with transverse linear lucency. Dx? bisphosphonate fracture. Usually takes > 4 yrs of bisphosphonate therapy. Usually bilateral. Risk as high as 1/1000.
New onset of painful flatfoot in an older woman should raise the question of what abnormality? tibialis posterior (TP) injury. Expect radiographs to show loss of longitudinal arch with hindfoot valgus & midfoot sag. MR: enlarged TP with central high signal, talar bone edema. TP should be significantly larger than the adjacent flexor digitorum.
What T1 and T2 weighting options are available for Fast Relaxation Fast Spin Echo imaging? FRFSE is always T2. After signal decay at end of echo train, negative 90° pulse aligns spins with long T2 from transverse plane to longitudinal plane, --> much faster acquisition of T2WI; allows for breath-hold imaging.
On EVUS, at what Crown Rump Length can you confidently call nonviable pregnancy based on the latest recommendation by T. Bourne's group out of London? At what Mean Sac Diameter without yolk sac and embryo can you confidently call nonviable pregnancy? 7 mm CRL for heart beat. 25 mm MSD for absent yolk sac/embryo. Under these values, don't call it nonviable, and get a follow-up study in one week. Ref: Ultrasound Obstet Gynecol 2011; 38: 497–502. Memory tool: "to 25 alive, after 7 goes to heaven"
Differentiate osteopoikilosis from pycnodysostosis. Similar sounds, totally different diseases. One is an AD-inherited benign condition featuring multiple bone islands. The other is Toulouse-Lautrec syndrome, an AR inherited lysosomal storage disease of bone.
What organisms are most implicated in empyema necessitatis? "BATMAN": Blastomyces, Actinomyces, Tuberculosis, Mucor, Aspergillus, & Nocardia.
What is the lethal triad in trauma? hypothermia, coagulopathy, and acidosis
Suprasellar mass ddx in an adult. Glioma (of hypothalamus or optic chiasm), meningioma. In kids, also consider PNET (esp. in quadrilateral retinoblastoma).
MR shows a low signal mass in the sphenoid sinus (any age/sex). What is the recommended next modality, and why? CT. Look for fibrous dysplasia with groundglass matrix before you suggest a malignant mass.
Pachymeningeal enhancement, tonsillar herniation, and “brain sag” on MR. These findings are classic for what condition? intracranial hypOtension.
Expansile bony mandibular mass with predominantly soft tissue density on CT. No bony matrix at all. DDx? ameloblastoma or metastases (or dental abscess). Ameloblastoma is rarely malignant.
How does pituitary microadenoma appear on multiphase postcontrast MR? Tiny nonenhancing pituitary lesion on early dynamic imaging, filling in on delayed imaging. Because the adenohypophysis is somewhat horseshoe-shaped and curves laterally around the neurohypophysis, most microadenomas are off-midline.
What is the DDx for diffuse or multifocal cortical hyperintensity on MR? PRESS, postictal state, encephalomyelitis, embolic infarcts
What is CIDP? chronic inflammatory demyelinating polyneuritis. Acquired immune-mediated inflammatory d/o; a “chronic version” of Guillain-Barré. Sx similar to progressive inflammatory neuropathy. Asymmetrical variant: Lewis-Sumner syndrome.
What percent of patients with Gardner syndrome develop desmoid tumors in the mesentery or abdominal wall? 0.2
What syndrome is associated with desmoid tumors? Gardner syndrome. Desmoids occur in 20%.
What type of MR sequence is FIESTA and what T-weighting is involved? Balanced Coherent GRE. All three gradients are balanced such that dephasing of spins is compensated by an equal rephasing of spins. Image contrast includes T2/T1. Good contrast between blood and muscle.
In MR imaging, the inversion time (TI) chosen to suppress a particular tissue signal is based upon which property of that tissue? T1 relaxation time. After inversion of magnetization, T1 relaxation causes magnetization to shrink along -Z axis and pass through zero before regrowing along the +Z axis. T1 relaxation rate of tissue determines TI when the magnetization is near zero.
What connective structures (5) support the posterolateral corner of the knee? How many structures need to be completely torn to result in grade 3 instability? FCL, mid-third lateral capsular ligament, biceps femoris, popliteus tendon, & IT band. At least 2 must be torn for clinically relevant posterolateral instability, in particular the popliteus, FCL, or posterolateral joint capsule
Spoiled gradient echo MR images are weighted toward which: T1 or T2? SPGR (FLASH) is a technique to get very fast T1-weighted images, allowing for breath-hold T1 sequences.
What sequence attribute is used in 3D FSPGR to quickly produce these hi-res T1 weighted images? gradient echo train (using a preparatory inversion pulse to control T1 weighting). aka “Turbo FLASH”
Mineralizing vasculopathy. Lissencephaly. Clinical petichiae. Ventriculomegaly. Periventricular calcifications. Dx? in utero CMV infection (TORCH).
Floating tooth. Diabetes insipidus. Vertebra plana. Likely dx? Langerhans cell histiocytosis. Look for mass involvement of the pituitary infundibulum/stalk.
Myoclonic encephalopathy (dancing eyes, dancing feet). Multiple hot spots on bone scan including periorbital. Dx? neuroblastoma
Name 3 substances that are bright on T2 besides water/edema. blood, protein/debris, melanin (melanoma)
What is the obvious morphologic difference between porencephaly and schizencephaly? Gray matter lines schizencephaly, whereas porencephaly may have white matter
Bilateral low-attenuation of the globus pallidus on CT in an adult found down. DDx? carbon monoxide poisoning, barbiturate intoxication, cyanide poisoning, hydrogen sulfide poisoning, hypoglycemia, hypoxia, hypotension, Leigh disease, Wilson disease. cf: methanol intoxication --> putamenal hemorrhagic necrosis (more laterally)
Focal gyral calcification in only one hemisphere on head CT. Thickened clavarium. Hyperenhancement of ipsilateral atrial choroid plexus. Top Dx? Sturge-Weber syndrome, aka encephalotrigeminal angiomatosis or leptomeningocapillary angiomatosis. Look for capillary malformation on the face in trigeminal distribution.
What are the 5 gyri of the frontal lobe? Break them down into their parts (pars). Superior, middle, inferior, precentral, and orbital frontal. Inferior frontal gyrus includes the pars orbitalis, pars triangularis, and pars opercularis. Broca’s area includes the latter two. Orbital frontal gyrus includes 5 parts.
What two vascular anomalies are occult on angiography? Cavernous malformation and capillary telangiectasia. Since these are occult on angiography, angiography has no part in their therapy. (although direct-puncture venogram may have a role in tx of cav mal)
Categorize vascular anomalies. CNS: Shunts (classical AVM/nidus and CCF, pial AVF, dural AVF, Galenic shunt), Cav Mal, Cap Tele, VM, DVA, Mixed. Non-CNS: Hemang (prolif) vs Malformations (non-prolif, includes High flow (AVM) and Low Flow (Capillary vs Venous vs Lymphatic vs Mixed malf)
T/F: Klippel-Trenaunay syndrome includes limb overgrowth, slow-flow vascular anomalies, and spinal arteriovenous malformations. False. KTS is a rare limb overgrowth disorder with slow-flow vascular anomalies, but is not associated with spinal AVMs, contrary to previous erroneous literature. Ref: Am J Neuroradiol. 2010 Oct;31(9):1608-12. http://www.ncbi.nlm.nih.gov/pubmed/20651014
What is CLOVES syndrome? Congenital Lipomatous Overgrowth, Vascular malformations, Epidermal nevi, and Skeletal/Scoliosis and/or Spinal abnormalities. Rare complex overgrowth syndrome, serious morbidity. Only 100 cases identified. http://www.clovessyndrome.org
What is the name for the rare syndromic association of scoliosis, epidermal nevi, limb overgrowth with lipomatosis, and vascular malformations? CLOVES syndrome: Congenital Lipomatous Overgrowth, Vascular malformations, Epidermal nevi, and Skeletal/Scoliosis and/or Spinal abnormalities. Only 100 cases identified. http://www.clovessyndrome.org
What eponym is given to the anomaly of the spinal cord presenting as paralysis of arms and legs, numbness and loss of sensation and sphincter dysfunction, with H-shaped central cord T2 hyperintensity and flow voids posteriorly along the cord? Foix–Alajouanine syndrome, aka venous hypertensive myelopathy (from dAVF). Described in 1926.
What is Wyburn-Mason syndrome? aka Bonnet-Dechaume-Blanc syndrome, aka unilateral retinocephalic vascular malformation. Association of cerebral (diencephalic), retinal, & maxillofacial AV malformations. Now considered part of the cerebrofacial arteriovenous metameric syndromes (CAMS).
What is Bonnet-Dechaume-Blanc syndrome? aka Wyburn-Mason syndrome, aka unilateral retinocephalic vascular malformation. Association of cerebral (diencephalic), retinal, & maxillofacial AV malformations. Now considered part of the cerebrofacial arteriovenous metameric syndromes (CAMS).
What is unilateral retinocephalic vascular malformation? aka Wyburn-Mason syndrome, aka Bonnet-Dechaume-Blanc syndrome. Association of cerebral (diencephalic), retinal, & maxillofacial AV malformations. Now considered part of the cerebrofacial arteriovenous metameric syndromes (CAMS).
What is the new classification for the rare type III or juvenile spinal AVM syndromes such as cutaneomeningospinal angiomatosis, Cobb syndrome? spinal arteriovenous metameric syndromes (SAMS).
Define the Spetzler-Martin Scale for classic CNS AVMs. Size: small (< 3 cm) = 1, medium (3-6 cm) = 2, large (> 6 cm) = 3. Location: noneloquent = 0, eloquent = 1. Venous drainage: superficial = 0, deep = 1. Total points are added for final grade 0-5 (and a "6" designating inoperable AVM).
Enhancing “bag of worms” on postcontrast CT head or MR brain. Calcifications in 25%-30%. Variable hemorrhage, “blooming” on GRE, gliosis on T2. Enlarged arteries and draining veins on CTA. Dx? Classic AVM: Dysregulated angiogenesis, continued vascular remodeling, age 20-40, risk of hemorrhage: 2%-4%/year, 50% present with hemorrhage. Spetzler-Martin grading. 27%-32% have dual arterial supply.
What 2 additional vascular abnormalities are associated with classic AVMs? Intranidal aneurysm in > 50%. Flow-related aneurysm on feeding artery in 10%-15%. Vascular steal and ischemia in adjacent brain.
Among intracranial AVMs, which 3 locations have increased risk of hemorrhage? periventricular, basal ganglia, thalamus
What pathologic attribute of biliary cystadenocarcinoma strongly affects prognosis? Tumors with ovarian stroma found in women have indolent course and good prognosis. Tumors without ovarian stroma found in both sexes have an aggressive clinical course and poor prognosis.
Conventional angiogram on 40 yo man shows occlusions of the ulnar artery branches beginning at the level of the wrist. Ulnar branches of num. 3-4-5 finger proper digital arteries are not opacified. Normal radial artery circulation. Dx? DDx? hypothenar hammer syndrome. Look for h/o heavy vibrational manual labor. DDx includes hyperselective angiogram (technique related, or part of 1% with high takeoff radial artery), and consider Buerger dz (corkscrew collaterals, smoking hx).
What are the contraindications to PA angiogram? Complete LBBB. Severe R heart failure. Severe pulmonary HTN. Acute MI. Pulmonary edema. Contrast allergy.
What is the most likely complication of hereditary hemorrhagic telangiectasia? paradoxical strokes and brain abscesses from lung AVFs. HHT is aka Osler-Weber-Rendu syndrome.
Mid esophageal stricture with or without mucosal ulceration classic for what condition? Barrett esophagus
30yo woman with acute RUQ abdominal pain, R shoulder pain, and peritoneal signs following PID. CT shows inflammatory stranding along R paracolic gutter and inferior R hepatic lobe, with obscured fascial planes in the pelvis and enlarged cervix. Top Dx? Fitz-Hugh–Curtis syndrome. Almost exclusively in women, usually caused by gonorrhoea or chlamydia, resulting in PID and scar tissue on Glisson's capsule surrounding the liver.
What are the most common causes of ascending aortic aneurysm? "PAMS" : Post-CABG, Arteritis (Takayasu, giant cell, RA, AS), Marfan syndrome, Syphilis
Young renal transplant patient with abdominal pain. CT shows mass involving small bowel with aneurysmal dilation and cavitation in communication with the bowel lumen. Top Dx? DDx? intestinal lymphoma. Danger of perforation if the tumor is treated with chemo- or radiation therapy. DDx includes GIST and metastatic melanoma (also can cause aneurismal dilation of small bowel lumen).
Alcoholic with profound encephalopathy and gait difficulty. MR shows T1 hyperintensity and T2 hypointensity in the globus pallidus bilaterally, and no e/o susceptibility on GRE. Top Dx? What is the substance? Manganese deposition from hepatic encephalopathy in the setting of liver failure from EtOH cirrhosis. Chronic TPN hyperalimentation can also cause manganese deposition.
What is the dose of phenobarbital typically used during biliary atresia evaluation with hepatobiliary imaging? Pretreat with phenobarbital at 5 mg/kg/d orally divided in 2 doses daily for a minimum of 3–5 d before hepatobiliary imaging. Enhances biliary excretion of radiotracer and increases specificity of the test.
Young child with flank pain, palpable mass, and imaging showing kidney almost totally replaced by a well-defined mass made of multiple, noncommunicating anechoic cysts. Top Dx? multilocular cystic nephroma (MCN), rare benign purely cystic neoplasm. Related: cystic partially differentiated nephroblastoma (CPDN); septa contain foci of blastemal cells; indistinguishable, grouped together as multilocular cystic renal tumor (MCRT).
What is the age/sex distribution for multilocular cystic renal tumor (MCRT)? Bimodal, comprised of CPDN and MCN: cystic partially differentiated nephroblastoma (CPDN) occurs in children 3 mo to 2 yrs, whereas multilocular cystic nephroma (MCN) occurs in adult women in 40s-50s. Look similar on imaging; histologically distinguished.
What medication can be used to increase the sensitivity of a Meckel scan? H2 blockers (cimetidine/Tagamet, ranitidine/Zantac, famotidine/Pepcid) can block secretion from gastric cells and increase "hang time" of Tc99m pertechnetate in the Meckel diverticulum. Typically given 2 days prior (oral) or 1 hour prior (IV) to imaging.
Below what HU value on CECT can you confidently call an adrenal nodule BENIGN (adenoma)? less than 37 HU. Ref: StatDx. (in question --> Where is this in the literature?)
Junctional zone diffusely measuring greater than 12 mm on female pelvis MR. Dx? diffuse adenomyosis
What is the normal maximum width for juctional zone on female pelvis MR? less than 12 mm. If greater, think adenomyosis.
Woman with chronic pelvic pain, adnexal mass on MR with cystic architecture, incomplete septa, high signal on T1 and on T2, and no enhancement of the walls after contrast. Dx? Hematosalpinx. Could be due to intraluminal endometriosis, ectopic pregnancy, tumor, or torsion. Incomplete septa are characteristic of tubal architecture. High T1 and T2 signal are characteristic of blood products.
Name the inheritance pattern of congenital hepatic fibrosis and 3 major associated abnormalities. Congenital hepatic fibrosis is a fibropolycystic disease (along with ARPKD and ADPDK) with autosomal recessive inheritance, association with Caroli disease (thence called Caroli syndrome), portal hypertension, and renal cystic disease.
Patient with hepatic fibrosis, intrahepatic biliary ductal ectasia with numerous lamelated stones, renal cysts, and family history of same. Top dx? congenital hepatic fibrosis and Caroli disease (combination aka Caroli syndrome)
T/F: Hepatic adenomas do not have fat components. False. They can be fatty on MR and CT. The presence of a fat-containing or hemorrhagic mass in a young woman on oral contraceptives is virtually diagnostic of hepatic adenoma.
Name the rare autosomal recessive disorder characterized by exocrine pancreatic insufficiency, bone marrow dysfunction (cytopenias), leukemia predisposition, and skeletal abnormalities including short stature. Shwachman-Diamond syndrome, aka Shwachman–Bodian–Diamond syndrome. Associated with mutations in the SBDS gene, located on chromosome 7. Autosomal recessive inheritance.
60M with hematuria. CT shows trabecular thickening of the bladder wall and mass effect in the posterior bladder wall. Ureters are pushed upward into "J" shape. There is a densely calcified bladder calculus. Top Dx? Benign prostatic hypertrophy most likely, but cystoscopy recommended to exclude bladder-invasive prostate CA. Trabeculation and hematuria can be explained by bladder outlet obstruction and calculus. "J-shaped" ureters w/ upward deviation classic for BPH.
45M with migratory rash on legs; hyperglycemia. CT shows hypervascular pancreatic mass and multiple ring-enhancing hepatic masses. Dx? metastatic neuroendocrine tumor (specifically, glucagonoma, a subset of islet cell tumors)
DDx for renal artery stenosis? Atherosclerosis (ostial, older), FMD (nonostial), and NF1 intimal fibrosis (usually ostial, younger).
What is the eponym given to an appendix located within an inguinal hernia? Amyand hernia. Appendix may or may not be inflamed. Appendicitis is not a required feature.
What is the classic triad for Meckel-Gruber syndrome? cystic renal dysplasia (MCDK, 95-100%), Cephalocele or other CNS abnormality (90%), and Postaxial polydactyly (extra pinky, 55-75%). Should have at least 2 of 3. Also consider trisomy 13 (which has overlap but typically has holoprosencephaly).
Fetal ultrasound shows profound oliguria, lemon shaped skull, occipital cephalocele, abnormal large hyperechoic kidneys, and foot with 6 toes. Dx? Meckel-Gruber syndrome. Renal cystic dysplasia (95-100%), Cephalocele or other CNS abnormality (90%), and Postaxial polydactyly (55-75%). Should have at least 2 of 3 classic features.
What are the main features of a fetus/newborn with Patau syndrome? Trisomy 13. Holoprosencephaly (alobar, semilobar, lobar) is hallmark finding. Also cardiac (80% - HPLH + echogenic focus highly associated with T13), big echogenic kidneys (50%), popolydactyly (75%), IUGR (50% cases, 90% at 1st trimester screening).
1st trimester fetal U/S shows IUGR, holoprosencephaly, polydactyly, echogenic kidneys, and echogenic focus in the heart. Dx? Patau syndrome (T13) highly likely. Needs chromosomal confirmation. Top DDx? Meckel Gruber (but the holoprosencephaly is hallmark for T13).
Brachymetatarsia of the fourth rays in the hands and feet with hypoactive renal response to parathyroid hormone, elevated parathyroid hormone, and hypocalcemia. Dx? Gene mutation? Transmission? pseudohypoparathyroidism. Maternally transmitted mutation in gene encoding adenylate cyclase-stimulating G alpha protein (GNAS1). Compare to pseudopseudohypoparathyroidism, aka Albright's hereditary osteodystrophy.
Brachymetatarsia of the fourth rays in the hands and feet with normal renal response to parathyroid hormone and normal calcium homeostasis. Dx? Gene mutation? Transmission? Albright's hereditary osteodystrophy, aka pseudopseudohypoparathyroidism. Paternally transmitted mutation in gene encoding adenylate cyclase-stimulating G alpha protein (GNAS1).
Describe the characteristic osteodystrophy, gene mutation, and transmission patterns of pseudohypoparathyroidism and pseudopseudohypoparathyroidism. Congenitally short 4th metatarsus (brachymetatarsia), mutation in the gene encoding adenylate cyclase-stimulating G alpha protein (GNAS1), transmission: maternal (pseudo-) and paternal (pseudopseudo-).
What is the pattern of serum calcium, parathyroid, and phosphate levels in pseudohypoparathyroidism? Hypocalcemia, hyperphosphatemia, and high serum levels of parathyroid hormone are seen in patients with pseudohypoparathyroidism, along with brachymetatarsia of the fourth rays in the hands and feet. Maternal transmission of GNAS1 mutation.
What is the pattern of serum calcium, parathyroid, and phosphate levels in pseudopseudohypoparathyroidism? Normal. Patients with pseudopseudohypoparathyroidism have normal renal response to parathyroid hormone and preserved calcium homeostasis, but exhibit the characteristic 4th ray osteodystrophy of GNAS1 mutation (paternally transmitted).
Describe the anomalies strongly associated with T13, T18, and T21. Esophageal atresia, omphalocele, arthrogryposis, choroid plexus cysts and club foot suggest trisomy 18; combined esophageal and duodenal atresia suggests trisomy 21; omphalocele, holoprosencephaly spectrum, and polydactyl suggest trisomy 13.
T/F: Close (6-month) followup is recommended when benign papilloma is diagnosed by a core needle biopsy. False. Surgical excision is recommended when benign papilloma is diagnosed by a core needle biopsy, since there is a 15-20% risk of upgrade to carcinoma or high-risk lesion (e.g., atypical ductal hyperplasia). Ref: RadPrimer
T/F: Close (6-month) followup is recommended when LCIS is diagnosed by a core needle biopsy. False. Excision is recommended after core biopsy result of LCIS as there is upgrade to carcinoma in ~ 27%. The relative risk for developing cancer is about 8-12x. LCIS is usually an incidental finding on biopsy for amorphous calcifications. Ref: RadPrimer
T/F: A circumscribed invasive ductal carcinoma (IDC) is generally low grade. False. Due to the fast growth, an aggressive (high grade) invasive ductal carcinoma (IDC) does not cause as much desmoplastic stromal reaction and therefore may have a circumscribed appearance. Ref: RadPrimer.
What is Mondor disease? Superficial thrombophlebitis in the breast. Presents as a palpable cord, painful. Treat with pain relief and maybe warm compresses.
What is the eponym for superficial thrombophlebitis in the breast? Mondor disease
What is another name for hamartoma of the breast? fibroadenolipoma = lipofibroadenoma = adenolipofibroma = hamartoma
Which modality is preferred for evaluation of axillary lymph nodes for possible malignancy? Ultrasound allows for the most accurate feature analysis. Focal cortical thickening ( > 3mm), loss of the fatty hilum, and rounded shape (i.e., not reniform) are all features that suggest possible malignancy. Ref: RadPrimer.
What is the eponym for closed degloving shear injury associated with severe trauma which then presents as a seroma or hematoma? Morel-Lavallée lesion
What tendons insert at the pes anserinus? "SGS" sartorius, gracilis, and semitendinosus
What is "jumper's knee?" chronic patelllar tendonosis at the origin of the patellar tendon, at the inferior pole of the patella (in kids, usually). DDx: Sinding-Larsen-Johansson disease, Hoffa fat pad impingement syndrome
What is the term for chronic patelllar tendonosis at the origin of the patellar tendon, at the inferior pole of the patella (in kids, usually)? jumper's knee. DDx: Sinding-Larsen-Johansson disease, Hoffa fat pad impingement syndrome
What is Sinding-Larsen-Johansson disease? "SLJ" = Chronic traction patellar tendonosis at the immature osteotendinous junction of the patellar tendon origin. It is closely related to Osgood-Schlatter disease. Some authors class SLJ as jumper's knee in the pediatric setting. Ref: Radiopaedia
Define the node of Henry. Crossover between FHL and FDL in the plantar foot. Tendon intersection syndrome is when this region is painful, inflamed.
What is the name for the crossover between FHL and FDL in the plantar foot. node of Henry. Tendon intersection syndrome is when this region is painful, inflamed.
Knee radiograph shows nearly hemispherical "bite" from cortical margin of proximal tibia with sclerotic margins, scalloped borders, mild cortical expansion, but without periosteal reaction or matrix calcifications. Best Dx? chondromyxoid fibroma
What benign breast pathology often has associated apocrine metaplasia (AM), sclerosing adenosis, and columnar cell changes? fibrocystic changes
Dx mammo shows circumscribed oval mass 2 cm. Sono shows same mass to be circumscribed, solid, hypodense, wider than tall (parallel to skin). What is the BI-RADS category? BI-RADS category 3 -- six month followup. Assess for growth. Aggressive invasive ductal CA can have benign appearance (identical to fibroadenoma) on initial workup, but will grow. If no growth in 6, 12, and 24 months, then call benign, BI-RADS 2.
In screen-film mammography quality control, how often should the phantom image be checked? Weekly. MQSA states "Facilities with screen-film systems shall perform an image quality evaluation test, using an FDA-approved phantom, in each week that clinical mammography examinations are performed, prior to the performance of such examinations."
What is the DDx for an architectural distortion on mammogram? Name 5 possibilities. Hint: 2 are benign. Summation artifact (compresses out), radial scar, tubular carcinoma, infiltrating ductal carcinoma (IDC), and infiltrating lobular carcinoma (ILC).
What are the 3 most common appropriate indications for BI-RADS 3 assessment? Baseline mammo shows oval, circumscribed, nonpalpable mass, or a focal asymmetry that becomes less dense on spot compression view, or a cluster of punctate calcifications.
A cancer diagnosed within HOW LONG after a negative mammogram defines a "false negative" for medical audit purposes? A false negative is defined as a cancer diagnosed within 1 year of a negative mammogram, BI-RADS 1 or 2 on screening; BI-RADS 1, 2, or 3 on diagnostic.
T/F: In breast ultrasound, solid masses with posterior shadowing calcifications are considered malignant. TRUE
T/F: In breast ultrasound, solid masses with heterogeneous echotexture are considered malignant. FALSE
T/F: In breast ultrasound, solid masses with microlobulated margins are considered malignant. TRUE
What is the "Y" sign on spinal or CT myelography? "Y" shaped compression of the thecal sac is characteristic for lumbar epidural lipomatosis
What is the "whirlpool" sign in pediatric abdominal ultrasound and what does it mean? clockwise swirling of SMV around SMA on transverse abdominal ultrasound, indicating MIDGUT VOLVULUS
T/F: Vacuum phenomenon within a synovial joint is a sign of degenerative disease/osteoarthritis. False. Vacuum joint sign occurs from nitrogen gases that form upon traction in large joints and is a normal finding. Ref: LearningRadiology.com "vacuum joint sign"
What is the "tubular bulb sign?" appearance of dilated aortic root in sinotubular ectasia (seen mostly in Marfan syndrome)
What does the "snowman sign" indicated on pediatric CXR? type 1 supracardiac TAPVR. The dilated vertical vein and SVC form the head; the RA is the body.
What does the scimitar sign indicate? partial anomalous pulmonary venous return
What is the eponym used to describe a nodule bulging from the umbilicus as a result of peritoneal metastases (usually from GI tract tumors or ovarian carcinoma)? Sister Mary Joseph sign
What is the eponym for a shadowing echogenic mural nodule characteristic of mature cystic teratoma? Rokitansky plug
What is a Rokitansky plug? Shadowing echogenic mural nodule characteristic of mature cystic teratoma.
Slowly enlarging lobulated high T2 signal mass extending from the sacrum in a 29 yo male. Most likely Dx? chondroblastoma. Key here is high signal, slow growth, and age/sex of patient.
What is the term for a low density rounded mass-like material anterior to an ACL reconstruction graft within the notch, causing restricted extension? cyclops lesion (a type of arthrofibrosis). Small amount of linear arthrofibrosis in Hoffa fat pad is within normal variation after ACL graft reconstruction and does NOT constitute a cyclops lesion.
What is the eponym for erosion of a gallstone through the wall of the gallbladder into the duodenum? Bouveret syndrome
What is the differential for expansile lesion in the posterior vertebral elements? "GO APE" Giant cell tumor, Osteoblastoma, Aneurysmal bone cyst, Plasmacytoma, Eosinophilic granuloma
What is the difference between Boerhaave syndrome and Mallory-Weiss syndrome? Boerhaave syndrome is transmural rupture of esophagus after forceful emesis. Mallory-Weiss tear is a partial thickness mucosal tear after forceful emesis.
What is the difference between xanthogranulomatous pyelonephritis (XGP) and replacement (fibro)lipomatosis? The entities somewhat overlap. Both are result of multiple and chronic episodes of renal and ureteral calculi and infection. The inflammation related to XGP often extends through the perirenal space and may invade the posterior abdominal wall muscles.
What 3 malignancies are most likely to affect multiple abdominal viscera? Melanoma, non-Hodgkin lymphoma, and renal cell carcinoma. Ref: RadPrimer
What developing-world infectious disease can cause hematuria and calcified bladder wall? Schistosoma hematobium (think hematuria). Water snails are intermediate host. Dx by identifying ova in urine. Bladder SCC is late complication.
What bladder infection common in developing world increases risk of bladder SCC? schistosomiasis (Schistosoma hematobium)
Patient with longstanding renal failure and cysts on the native kidneys. What is the oncologic concern? There is an increased risk of renal carcinoma in patients with acquired cystic disease of uremia, which occurs in most patients treated with long-term dialysis. Cysts will persist even after renal transplantation.
What is the risk of ectopic pregnancy if no IUP is found in a patient with positive hCG and work up for ectopic? 55% likelihood. If IUP if found, risk drops to RARE (much less than 1%).
If free fluid is seen on u/s in a patient with positive hCG and work up for ectopic, what is the likelihood of ectopic pregnancy? 75%, same as if mass is seen. If no mass or fluid is seen, risk drops to 7-33%, but not zero.
If a mass is seen on u/s in a patient with positive hCG and work up for ectopic, what is the likelihood of ectopic pregnancy? 75%, same as if free fluid is seen. If no mass or fluid is seen, risk drops to 7-33%, but not zero.
What is the risk of ectopic pregnancy if no adnexal mass or fluid and no IUP is found in a patient with positive hCG and concern for ectopic? 7-33%. Risk goes up to 75% if mass or fluid is seen. If fetal pole or yolk sac if found, then 100% ectopic.
What is the sensitivity of u/s for ectopic pregnancy? only 15-35%.
What pathology is likely present in a patient with marked uptake in hepatic segment 4A/B relative to the rest of the liver on a Tc99m sulfur colloid scan? This is the "hot quadrate" sign, suggesting SVC syndrome. Collateral flow through the quadrate lobe (segment 4A and 4B) to return blood to the heart via the IVC causes this appearance.
What 2 diseases are most likely cause of hepatic segment IVC occlusion? Behcets disease (large vessel vasculitis) and Budd-Chiari (from segment 1/caudate hypertrophy and pressure on the IVC hepatic segment)
Name 3 infectious and 3 noninfectious causes of crazy paving on CT chest, besides the well-known pulmonary alveolar proteinosis. TB, PCP, Nocardia. ARDS/AIP/DAD, cardiogenic edema, diffuse alveolar hemorrhage.
What is the DDx for solitary lucent bone lesions? FOGMACHINES: FD, osteoblastoma/osteochondroma, GCT, mets/myeloma, ABC, chondroblastoma/chondromyxoid fibroma, hyperparathyroidism (brown tumors)/hemangioma, infection, NOF, EG/enchondroma, and solitary bone cyst
Back pain, renal failure, and medial deviation of the bilateral ureters with mantle of soft tissue encasing the aorta and ureters. This is a classic presentation for what disease? retroperitoneal fibrosis. Chronic inflammatory process within the retroperitoneum, most commonly idiopathic (likely autoimmune) or may be a secondary desmoplastic reaction to an inciting agent. Look for medial deviation of the bilateral ureters.
Name this entity: Nonencapsulated overgrowth of benign fatty tissue in perirectal and perivesical spaces, straightening and lifting the rectosigmoid colon and urinary bladder. pelvic lipomatosis (rare, benign)
Young woman with h/o endometrial instrumentation and HSG shows linear filling defects within the endometrial cavity. Dx? Asherman syndrome
Name 2 disease entities and one normal condition that result in theca lutein cysts? Ovarian hyperstimulation syndrome (OHSS) in the setting of infertility treatment, and high endogenous beta-hCG in the setting of molar pregnancy, or in the setting of twins (or other multiparity).
Perimenopausal female with large, multiloculated cystic mass that contains low-level internal echoes and irregular, mildly thickened septations. Best Dx? mucinous cystadenoma. These are less commonly malignant than serous cystadenoma which is more unilocular, especially concerning if any nodular component.
Which ovarian cystic neoplasm is more commonly malignant: mucinous cystadenoma or serous cystadenoma? Serous cystadenoma is more commonly malignant, usually unilocular, suspicious if any nodular component. Mucinous cystadenoma is benign; excision is curative. However, pseudomyxoma peritonei can be caused by mucinous cystadenocarcinoma, nonaggressive.
What term refers to the disproportionate enlargement of the occipital horns of the lateral ventricles, often associated with seizures, agenesis of the corpus callosum, Chiari malformation, lissencephaly, and microcephaly? colpocephaly
Name 4 other neurologic structural anomalies associated with colpocephaly. agenesis of the corpus callosum, Chiari malformation, lissencephaly, and microcephaly
What CNS tumor is associated with gelastic seizures? hamartoma of tuber cinerium, aka hypothalamic hamartoma. Often associated with precocious puberty.
Name the hollow eminence of gray matter situated between the mammillary bodies and the optic chiasm, part of the hypothalamus. tuber cinereum
The tuber cinereum lies between what two structures? mammillary bodies and optic chiasm (part of the hypothalamus)
Name the term for the rare type of seizure disorder characterized by sudden bursts of laughing or crying, usually many per day? gelastic seizures (gelastic epilepsy). "Gelos" is Greek for laughter. Associated with hypothalamic hamartomas as well as temporal and frontal lobe lesions (tumors, atrophy), tuberous sclerosis, hemangiomas, and post infectious foci.
I say "gelastic seizures," you say "_____" . "Hypothalamic hamartoma" should be the main knee-jerk thought here. Laughing seizures can also be associated with temporal and frontal lobe lesions (tumors, atrophy), tuberous sclerosis, hemangiomas, and post infectious foci.
What are Wormian bones? Small intrasutural bones usually at the lambdoid suture (DDx: PORKCHOPS). These bones are named after Ole Worm (1624-1639), Danish professor of anatomy who was supposed to have first described them. Ref: Dr Frank Gaillard et al of Radiopaedia.
What is another name (eponym) for chondroectodermal dysplasia? Ellis–van Creveld syndrome
What are the two types of craniopharyngioma? adamantinomatous (kids, teens) and papillary (adult usually >50y, "never" seen in children). Mixed form may occur (15%) but looks/acts like adamantinomatous. Papillary << adamantinomatous in recurrence, extensiveness, adherence.
What is meant by the term "scirrhous" when describing tumors? Scirrhous [skir´us] tumors tend to be very firm and are likely to constrict or obstruct structures that they involve. Loss of peristalsis contributes to obstruction.
What is the modifying term for gastric carcinoma that is very firm and constricts the lumen with loss of peristalsis causing gastric outlet obstruction? scirrhous [skir´us]
Liver transplant patient with new onset liver failure and CT showing fingerlike lakes of near-water density in the liver. Dx? biliary necrosis (consequence of hepatic artery occlusion)
Besides stomach (70%), what other primary tumors comprise Krukenberg ovarian metastases? Colon, appendix, and breast. "Tummy CAB"
"Shattered kidney" falls into what trauma grade? Grade III. Includes vascular injury, vascular pedical avulsions, segmental infarctions, extensive corticomedular lacerations, "cortical rim" sign from preserved subcapsular enhancement.
Avulsed renal hilum falls into what trauma grade? Grade IV. Complete transection (avulsion) or laceration at the UPJ causes large urinome, extravasation of contrast opacified urine from the collecting system. Cortical enhancement can intact, or there can be global infarction.
What is the stage of cervical cancer delineating change in management from surgical to chemotherapy and RT? Stage IIB: Stage II cervical cancer extends beyond the cervix. Stage IIA may still be treated surgically. Stage IIB tumor invades the parametrial fat, vessels, and uterine ligaments and is treated with chemotherapy and RT.
CT in a young sickle cell patient with hematuria but no fever or leukocytosis shows infiltrative, centrally located mass with preserved renal shape. Top Dx? renal medullary carcinoma. May form fistula between necrotic cavity & collecting system. Very rare, very poor prognosis. Mean survival = 15 wks, rarely survive >1 yr.
Multilocular cystic nephroma: is it only a pediatric disease? What other group can get this? Women peaking in 5th and 6th decades.
Name the benign renal tumor with multiple loculated cysts, pathological equivalent of nephroblastoma/hamartoma, arises from metanephric blastema, can occur in middle aged adults. multilocular cystic nephroma. Mostly a (very young) pediatric tumor, but can occur in women peaking in 5th and 6th decades. May coexist with angiomyolipoma or adrenal adenoma.
HIV+ patient with painless scrotal mass and U/S showing enlarged, heterogeneous hypervascular epididymis. Top Dx? TB epididymitis
Autosomal recessive enzyme defect causing a reduced output of cortisol, pituitary then responding with secretion of massive amounts of adrenocorticotrophin (ACTH), resulting in overproduction of other hormones, including those causing virilization. Dx? adrenogenital syndrome (cause of congenital adrenal hyperplasia)
What is the DDx for microcolon (pediatric)? "MI MCA" Meconium ileus/peritonitis (CF), Ileal (or jejunal) atresia, Megacystis-micorocolon-hypoperistalsis syndrome, Colonic atresia, Aganglionosis (Hirschsprung dz)
Chronic oral amphetamine abuser with numerous intraparenchymal renal artery aneurysms. Dx? speed kidney. Think also of vasculitis (PAN), mycotic (septic emboli), trauma, Ehlers-Danlos.
Young sickle cell patient with hematuria. Top tumor concern? renal medullary carcinoma. Looks like pyelonephritis (infiltrative, centrally located mass with preserved renal shape, but no fever or leukocytosis. Can fistulize to collecting system. Very rare, poor prognosis. Rarely survive >1 yr.
Young infertile woman. HSG shows smooth fundal indentation of the endometrium. MR shows normal convex external fundal contour. Dx? arcuate uterus, a class VI Müllerian duct abnormality. Similar prevalance as septate uterus, but no caudal extension of T2-dark fibrous septum. Arcuate uterus does not affect fertility and is variant of normal.
What are the 7 classes of müllerian duct anomalies? I-hypoplasia/agenesis, II-unicornuate, III-didelphus, IV-bicornuate (can be bicollis), V-septate, VI-arcuate, and VII-DES-related. Which 2 do NOT affect fertility? RadioGraphics 2003. Vol 23(6), p1401-1421. PMID: 14615553
Of the 7 classes of müllerian duct anomalies, which 2 do NOT affect fertility? III-didelphus, and VI-arcuate. RadioGraphics 2003. Vol 23(6), p1401-1421. PMID: 14615553
How do femoral and inguinal hernias track in relation to the femoral artery and vein? Femoral artery tracks medially. Inguinal hernia tracks laterally.
What two adrenal masses can cause hypertension and how do you tell them apart on MR? Pheochromocytoma (heterogeneous enhancement, "light bulb" bright on T2) and adrenal cortical carcinoma (heterogeneous enhancement with hemorrhagic, cystic, and calcific areas, relatively dark on T2). Beware "dark pheo;" not all pheos are T2 bright.
What is dysphagia lusoria? aka Bayford-Autenrieth dysphagia. Difficulty swallowing caused by aberrant right subclavian artery (aka arteria lusoria). Ref: Bayford D. An Account of a Singular Case of Deglutition. Memoirs Med Soc London 1794; 2:271.
What clinical swallowing problem is caused by aberrant right subclavian artery? dysphagia lusoria, aka Bayford-Autenrieth dysphagia. Lusoria comes from Greek phrase lusus naturae (freak of nature), referring to freaky course of aberrant artery.
What is the name of the intestinal obstruction syndrome that affects adult CF patients? distal intestinal obstruction syndrome (DIOS), caused by inspissated succus entericus (adult equivalent of meconium ileus)
Cystic bronchiectasis, lipomatous pseudohypertrophy of pancreas, and distal intestinal obstruction syndrome are all characteristic features of what disease? cystic fibrosis (esp. adults)
What aspect of an FNH shows "delayed persistent enhancement" and why? Central scar shows delayed persistent enhancement, especially with Eovist, due to functioning biliary excretion but disordered ductal clearance.
T/F: FNH is prone to hemorrhage and should be resected if large. False. "Do not touch."
Patient with hypotension a few hours following Caesarean section. CT shows hemorrhage at the site of recent Caesarean section, between the bladder and the uterus. Dx? bladder flap hematoma. Extraperitoneal blood collection at site of cesarian section incision, between lower uterine segment and posterior bladder. Less than 2 cm may be normal. Large hematomas or active bleeds may need to be evacuated or undergo UAE.
What cancers are Peutz-Jeghers syndrome patients prone to? GI (57% by age 70), pancreas (11% by age 70), lung, breast, uterus, and ovarian sex cord tumour with annular tubules (SCTAT). Cumulative risk for all cancers is 85% by age 70.
What is the most frequent complication of Peutz-Jeghers syndrome? intussusception
What is the most common cystic neoplasm in the pancreas? mucinous cystic pancreatic tumor. Macrocystic, septated. Usually occurs in middle-aged women in the body-tail segment, may have peripheral calcification. HOWEVER: 80-90% of cystic pancreatic lesions are pseudocysts or retention cysts.
How can you discern on esophagram between achalasia, tumor, and GERD-related stricture in a patient with progressive dysphagia and imaging findings of a very dilated esophagus with a smoothly tapered stricture or spasm of the lower esophageal sphincter? Total esophageal aperistalsis occurs "only" in achalasia.
Spokewheel pattern bilateral ovarian cysts is typical of what condition? Theca lutein cysts (high beta-HCG, in setting of twins or GTD (endogenous) or fertility tx (exogenous). What if the HCG is normal? Think bilateral ovarian cystic neoplasms.
What is the most common cardiac anomaly affecting patients with scimitar syndrome? atrial septal defect (ASD). Prognosis for [rare] scimitar patients (anomalous pulmonary venous return, occurring in 1/50,000 births) is dependent upon presence of concomitant cardiac pathology (25% of patients).
You see an adult patient with treated transposition of the great arteries, and imaging shows pulmonary artery lying anterior to the aorta and left and right pulmonary arteries draping over the aorta. What procedure has this patient had? Jatene switch, for D-transposition. L = life (can survive without correction) and D = death (fatal without correction)
Cardiac imaging shows parallel course of outflow arteries and AV concordance of the left and right heart. What anomaly is present? (Be precise.) D-transposition of the great arteries. This causes cyanosis and requires surgery for survival. L = life (can survive without correction) and D = death (fatal without correction)
Cyanotic newborn with parallel ventricular outflow tracts, ventriculoarterial discordance, and atrioventricular concordance. What condition does this patient have? How is it treated? D-transposition of the great vessels. Jatene switch. L = life (can survive without correction) and D = death (fatal without correction)
Newborn with parallel ventricular outflow tracts, ventriculoarterial discordance, and atrioventricular discordance. What condition does this patient have? L-transposition of the great vessels, aka "congenitally corrected" TGA. L = life (can survive without correction) and D = death (fatal without correction)
What layers of the heart are ruptured in a postinfarction myocardial pseudoaneurysm? Where do these typically occur? Endocardium and myocardium. Epicardium remains intact. Unlike true aneurysms which usually occur at the apex, pseudoaneurysms typically occur at the base, either inferior or inferolateral wall, along left circumflex coronary artery territory.
What is Bland-White-Garland syndrome? ALCAPA (Anomalous origin of Left Coronary Artery arising from the Pulmonary Artery)
What is the eponym for the condition characterized by anomalous origin of left coronary artery from the pulmonary artery? Bland-White-Garland syndrome, aka ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery)
What defines left ventricular non-compaction? Ratio of non-compacted to compacted myocardium of >2.3 at end diastole, and hypokinesis of the affected segments, should both be present. Rare congenital cardiomyopathy resulting from failure of normal myocardial development during embryogenesis.
Cardiac imaging in young patient shows solitary noncontractile mass in the myocardium with calcifications, but no necrosis, hemorrhage, cysts. Likely dx? Fibroma, a benign congenital cardiac neoplasm composed of fibroblasts and collagen. 2nd most common primary cardiac tumor (rhabdomyoma being the most common).
Multiple benign noncalcified cardiac tumors in a tuberous sclerosis patient. Most likely Dx? rhabdomyoma
Besides the anomalous right pulmonary venous connection to the inferior vena cava, what lung abnormality affects patients with scimitar syndrome? Pulmonary venolobar syndrome, aka scimitar syndrome, often (usually?) has associated hypoplastic right lung.
What is the most common cause of coronary artery aneurysms world-wide? What about in the United States? Kawasaki disease world-wide, atherosclerotic disease in the United States.
What benign tumor is commonly seen on the cardiac valves? papillary fibroelastoma, the most common primary valvular tumor and 2nd most common benign cardiac tumor after myxoma. AV>MV>TV>PV Aortic valve (29%), mitral valve (25%), tricuspid valve (17%), pulmonary valve (13%)
What cardiac tumor classically is seen in patients with nevoid basal cell carcinoma (Gorlin) syndrome? fibroma. Benign hamartoma. Solitary cardiac mass, may have calcifications. 2nd most common primary cardiac tumor in pediatric population, cardiac rhabdomyoma being the most common.
What is meant by "Page kidney?" HTN resulting from chronic compression of renal parenchyma by subcapsular haematoma, seroma, or urinoma, which causes activation of renin-angiotensin system. Described by Irvine H Page (1939) when he wrapped dog kidneys in cellophane.
What is HTN resulting from chronic compression of renal parenchyma by subcapsular haematoma, seroma, or urinoma? Page kidney. Chronic compression causes activation of renin-angiotensin system. Described by Irvine H Page (1939) when he wrapped dog kidneys in cellophane.
What is the DDx for multiple lucent bone lesions? FEEMMMHHI: Fibrous dysplasia, EG/Enchondroma, Mets/Myeloma, Hyperparathyroidism/Hemangioma, and Infection.
Older patient with progressive cardiac dysfunction, and MR findings of concentric ventricular myocardial hypertrophy and diffuse subendocardial enhancement. Dx? cardiac amyloidosis, the most common restrictive cardiomyopathy in the United States. If intraventricular thrombus is present, consider hypereosinophilic syndromes (endomyocardial fibrosis & Loeffler syndrome), which also cause these symptoms & findings.
What percent of atrial myxomas are found in the right atrium, and what about them is different from their left sided counterparts? Around 20% occur in the right atrium, and calcification is more commonly reported with right atrial myxomas.
What is Anderson-Fabry disease, aka angiokeratoma corporis diffusum, aka alpha-galactosidase A defiency? Simply known as Fabry disease, this is a rare X-linked inherited lysosomal storage disease, a sphingolipidosis, involving skin (angiokeratomas, dys-hidrosis, Raynaud's), peripheral nerves (pain, acroparesthesia), eyes, kidneys, and heart.
What 5 nonintrathoracic tumors are best known for endobronchial metastasis? RCC, thyroid, melanoma (notice that these 3 are hypervascular), colorectal, and breast (notice that these 2 are adenocarcinomas). The most common primary endobronchial lesions include carcinoid, SCC, and tumors of salivary rests.
What are the 4 most common primary endobronchial tumors? carcinoid, squamous cell carcinoma, and tumors of salivary rests (mucoepidermoid carcinoma and adenoid cystic carcinoma)
What other tumor is known to cause pleural encasement with hemithoracic constriction and bunching of the ribs, besides mesothelioma? advanced adenocarcinoma of the lung
What size criterion is recommended for surgical consultation for hepatic adenomas? Why? >5 cm. Risk of life-threatening hemorrhage.
What is the most common congenital cardiovascular abnormality? Congenital bicuspid aortic valve is most common, occurring in 1-2% of the population.
T/F: A fused, thickened raphe in a case of bicuspid aortic valve indicates an acquired, noncongenital disease. False. A fused, thickened raphe is present in approximately 50% of cases of congenital bicuspid aortic valve.
What is the structural anomaly associated with "spade-shaped heart?" apical myocardial hypertrophy (often with severe thinning of the extreme apex and obliteration of the apical LV chamber)
How can one differentiate an ostium secundum atrial septal defect (ASD) from an ostium primum ASD? Ostium secundum ASD occurs in the mid atrial septum, rather than the anteroinferior septum for ostium primum ASDs.
What is Eisenmenger phenomenon? Reversal of L to R shunt to R to L shunt, usually in setting of PDA and resulting chronic pulmonary HTN.
T/F: Delayed enhancement in a case of clinical cardiomyopathy with dilated LV is a sensitive and specific indicator for ischemic cardiomyopathy. False. Half of dilated cardiomyopathies can have delayed enhancement, but it is mid-myocardial rather than subendocardial as is seen in ischemic cardiomyopathy.
What are the delineating open area values that define mild, severe, and critical aortic valvular stenosis (characterized by thickening and calcification of all 3 leaflets)? Open area less than 2 cm2, less than 1 cm2, and less than 0.8 cm2, respectively.
Which type of PAPVR usually does not require treatment? Left sided PAPVR usually drains into the left brachiocephalic vein (or coronary sinus) and is an incidental finding, usually requires no treatment unless Qp/Qs > 2. Right sided PAPVR can drain to SVC (assoc with sinus venosus ASD) or IVC (scimitar).
You see an "aortic nipple" on CXR. What are you likely going to see on CT to explain this? left superior intercostal vein, or LSIV (connects with hemiazygous and with left brachiocephalic)
Name four types of ASDs. Which is most common? Ostium secundum is most common. Others are ostium primum (often large, near the AV groove), and the sinus venosus ASDs (SVC and IVC types, SVC type almost always associated with non-scimitar superior R-sided PAPVR).
Name this phenomenon: Reversal of L to R shunt to R to L shunt. Eisenmenger phenomenon, usually occurring in setting of PDA and resulting chronic pulmonary HTN.
Young patient with scimitar syndrome and recurrent strokes. What is likely the cause? Paradoxical emboli and strokes due to PAPVR-associated ASD.
Under what two circumstances should PAPVR patients undergo surgery? ASD closure may be neeed to eliminate risk of ASD-associated paradoxic emboli, and reimplantation, usually to left atrial appendage, may be needed if Qp/Qs >2. Note that left sided PAPVR is not associated with increased incidence of ASD.
What complication regarding the pulmonary veins can one encounter after RF ablation for atrial arrhythmias? Pulmonary vein stenosis and/or pulmonary vein thrombosis. Treat with angioplasty or stent.
Which type of PAPVR is NOT associated with an increased incidence of ASD? left sided PAPVR
Right ventricular dilation, right ventricular microaneurysms, scalloping, and increased trabeculation, RV dyskinesis, right ventricular fatty infiltration, and family history of sudden cardiac death. What is the Dx? arrhythmogenic right ventricular dysplasia (ARVD)
What is the most common cardiac abnormality found in patients with carcinoid triad (skin flushing, diarrhea, and cardiac problems due to circulating 5-hydroxytryptamine, aka serotonin)? Right sided heart failure from tricuspid (most commonly) or pulmonary valve regurgitation, due to thickened, retracted tricuspid or pulmonary valve leaflets from fibrous plaques of smooth muscle cells and mucopolysaccharide/collagen.
Patient with ileal tumor, hepatic metastases, clinical flushing, diarrhea, and right heart failure. Unifying Dx? metastatic carcinoid tumor and carcinoid triad
CXR shows combination of RA enlargement and decreased pulmonary vasculature. What cardiac anomaly should be considered? pulmonic valve stenosis
What is the most common cause of restrictive cardiomyopathy in the US? in the world? cardiac amyloidosis in the US, endomyocardial fibrosis worldwide (atria usually severey dilated; diffuse subendocardial DE)
What congenital anomaly is a Blalock-Taussig shunt used to treat? early management of tetralogy of Fallot
What percent of tetralogy of Fallot patients have right-sided aortic arch? What type of branching is involved (mirror-image or aberrant left subclavian)? 25% (with mirror image branching)
Calcification of the mitral valve in the setting of left atrial enlargement and a normal-sized left ventricle is highly suggestive of what abnormality of the mitral valve? mitral stenosis (not regurgitation, which leads to LV enlargement as well)
What is Takotsubo cardiomyopathy? aka transient apical ballooning, stress cardiomyopathy, broken heart syndrome, Gebrochenes-Herz syndrome. Non-ischemic cardiomyopathy, sudden temporary weakening of myocardium triggered by emotional stress --> CHF, lethal arrhythmia, ventricular rupture.
What is the DDx for acroosteolysis? "PINCH FO": Pyknodysostosis/Psoriasis, Injury (thermal burn, frostbite), Neuropathy (diabetes, leprosy), Collagen vascular dz (scleorderma, Raynaud's), Hyperparathyroidism, Familial (Hadju-Cheney, progeria), Occupational (polyvinyl chloride exposure).
MCL, ACL, and meniscal tear. Name this triad. O'Donoghue's unhappy triad
Define Essex-Lopresti fracture. Fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint with disruption of the interosseous membrane.
Radiographs show fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint with disruption of the interosseous membrane. Name this fracture. Essex-Lopresti fracture
Cotton wool cranium is classic for what disease? Paget disease
Geographic lucent subarticular bone lesion in skeletally immature patient. DDx? Chondroblastoma, EG, infection. NOT giant cell tumor (extremely rare in skeletally immature paitents).
What is Marine Lenhart syndrome? variant of Graves disease with co-existant TSH dependant cold nodules. Better name is nodular Graves disease, or Graves disease with multinodular goiter.
What is Plummer disease? autonomously functioning thyroid nodule ("hot" solitary nodule, suppression of remaining thyroid). Excellent candidate for radiotherapy with I-131 due to autoprotection of remaining thyroid gland.
Above what dose administration of I-131 sodium iodide must one have a written directive by an Authorized User? greater than 30 µCi (that's MICRO-Curies, 1.11 MBq) I-131 (and ANY therapeutic dose from ANY nuclear by-product source)
T/F: There are NO unsealed radioactive by-product materials for which one need not have a written directive from an Authorized User prior to giving therapeutic dose. True. Any therapeutic dose from by-product material must have a written directive, as well as any dose of I-131 greater than 30 µCi (1.11 MBq).
Which pharmaceutical is typically used to assess cerebrovascular reserve in nuclear imaging? Acetazolamide (Diamox), is a carbonic anhydrase inhibitor and causes an increase in cerebral blood flow in non-diseased portions (normal). Decreased flow indicates site of cerebral vascular disease.
What is the normal limit of diastolic to systolic volume on cardiac nuclear imaging? Which tracers can be used to assess this? <1.15 (above which indicates transient ischemic dilation). Only PET tracers (Rb-82 and in some institutions N-13 ammonia) can be used, since imaging is performed DURING stress.
What is the radiation dose RATE limit for areas accessible by the public? What is the annual radiation dose limit for the same areas? no more than 2 mrem/hr, no more than 0.1 rem/yr
What is the normal range for radioactive iodine uptake (RAIU)? not more than 30%, but at least 10%
What are the five D's of neuropathic joint? What is the other name for this (eponym)? Density (normal density for patient), Distention of joint, Debris, Destruction (cartilage), and Disorganization/Deformity. aka Charcot joint.
What is the appropriate per-kg dose for sincalide? What are 2 other names for this drug? 0.02 MICROgrams/kg (aka CCK, aka Kinevac)
What is the next thing you should look for if you see double bubble sign on a neonatal babygram? air in the rectum or colon will exclude duodenal atresia and raise question of midgut volvulus as cause of obstruction
Immature colonic ganglion syndrome with small meconium-filled left colon on x-ray. Dx? Small left colon syndrome, aka meconium plug. Gastrografin enema is therapeutic as well as diagnostic. Differentiate from meconium ileus (CF) by presence of normal distension of right colon, and from Hirschsprung disease by lack of sharp transition point.
What is megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIH syndrome)? aka Berdon syndrome, an autosomal recessive genetic disorder more prevalent in females, characterized by urinary retention, giant bladder (megacystis), hydronephrosis, constipation, microcolon, intestinal hypoperistalis, and dilated small bowel.
Newborn female with urinary retention, giant bladder, hydronephrosis, small bowel obstruction, microcolon, and intestinal hypoperistalis. Positive family history. Top Dx? megacystis-microcolon-intestinal hypoperistalsis (MMIH) syndrome, aka Berdon syndrome, an autosomal recessive genetic disorder more prevalent in females, characterized by giant bladder, hydronephrosis, dilated small bowel, microcolon, and hypoperistalis.
What is the critical organ for In-111 WBC scan? spleen
Name the two lipophilic brain perfusion agents. Ceretec (Tc-99m HMPAO) and Neurolite (Tc-99m ethyl cysteinate dimer [ECD], aka bicisate)
What is the name for the branches of LCx that course over the LV? obtuse marginal branches
What is the name for the branches of RCA that course over the RV? acute marginal branches
What is the name for the branches of LAD that course laterally over the LV? diagonal branches
What is the effect of glucagon on splanchnic blood flow? Increased or decreased? increased (vasodilation of portal system)
Bone scan shows diffuse bone uptake, bilateral renal cortical uptake, no activity in the bladder or renal collecting systems, and multiple degenerative joint uptake sites. Best Dx? Hyperparathyroidism best explains the renal cortical uptake and lack of renal excretion in the setting of diffuse bone uptake. The joint uptake is a red herring.
What FALSE POSITIVE abnormality can be seen particularly in LBBB patients undergoing exercise stress myocardial perfusion imaging? Relative reversible septal perfusion defect can be normal in LBBB patients under exercise stress. Thought to be due to functional effects of the LBBB rather than structural defect.
Unless directed by an authorized user, a licensee may not use a dosage if the dosage differs from the prescribed dosage by more than what percent? 20%
What is the occupational effeictve dose limit to the lens of the eye? 150 mSv = 0.15 Sv = 15 rem Note that this is 3x the occupational whole body effective dose limit.
What is the appropriate dose for morphine (if required) in the setting of hepatobiliary imaging? 0.04 mg/kg IV MSO4, given over 1-3 minutes
How many years must records of calibrating dose calibrators be kept? 3 years
Is it possible to perform any kind of imaging in a patient who has received Y-90? Yes. Bremsstrahlung imaging only. Yittrium-90 is a pure beta emitter.
What are the 2 classes of primary myelofibrosis: 2 classes and what major feature distinguishes the two? 1: Agnogenic myeloid metaplasia with myelofibrosis, an indolent myeloproliferative disorder, usually with splenomegaly; and 2: Acute myelofibrosis, usually without splenomegaly. BUT, most cases of myelofibrosis are SECONDARY.
What is POEMS syndrome? aka Crow–Fukase or Takatsuki disease: Polyneuropathy, Organomegaly, Endocrinopathy/Edema, Myeloma/M-protein, & Skin (hyperpigmentation, hypertrichosis). Rare, onset in 50s, M:F 2:1, 60% survival @ 5 yrs. Ref: 1980 Bardwick et al. PMID 6248720.
Name the intrinsic muscles of the foot, from lateral to medial, superficial to deep. (There are 10 named groups). Superficial: abductor digiti minimi, flexor digitorum brevis, abductor hallucis. Midlevel: quadratus plantae, lumbricals(FDL). Deep: flexor digiti minimi brevis, adductor hallucis transverse/oblique heads (2), flexor hallucis brevis, plantar interosseous.
What is Panner disease? In the elbow, capitellar osteochondral injury typically seen in young ball players. Related to "Little Leaguer's elbow." Look for loose body and/or contrast around the defect on MR arthrogram (unstable).
What is the eponym for humeral capitellar osteochondral injury typically seen in young ball players? Panner disease
What medication if taken during pregnancy can increase the risk of Ebstein anomaly? lithium
What congenital heart anomaly is strongly associated with oral lithium therapy during pregnancy? Ebstein anomaly
What is a "reverse Barton" fracture? volar lip intra-articular distal radius fracture
In what sites to enchondromas frequently lack a bony matrix? fingers and toes
What is the cut-off activity limit for minor-major spill in the case of Tc-99m and Tl-201? <100 mCi is a minor spill. At 100 mCi and above, it becomes a major spill.
What is the cut-off activity limit for minor-major spill in the case of Ga-67, In-111, and I-123? <10 mCi is a minor spill. At 10 mCi and above, it becomes a major spill.
What is the cut-off activity limit for minor-major spill in the case of I-131? <1 mCi is a minor spill. At 1 mCi and above, it becomes a major spill.
What is the maximum allowable radioactivity on the package surface for a Radioactive – White I label? (transportation index?) 0.5 mrem/hr (almost no radiation). No transportation index.
What is the maximum allowable radioactivity on the package surface for a Radioactive – Yellow II label? (transportation index?) 50 mrem/hr on the package surface, and 1 mrem/hr at three feet from the package (TI<1)
What is the maximum allowable radioactivity on the package surface for a Radioactive – Yellow III label? (transportation index?) 200 mrem/hr on the package surface, and 10 mrem/hr at three feet from the package (TI<10)
Name 3 diseases that can cause uptake in the heart on a bone scan. myocarditis, amyloidosis, and pericardititis
Greater than what activity of I-131 sodium iodide must a written directive must be dated and signed by an authorized user before administration? greater than 30 µCi (1.11 MBq). (MICROcuries)
What is the radiation dose RATE limit for a "radiation area" (not "high radiation")? 0.005 rem/hr (0.05 mSv/hr) at 30 cm
What is the radiation dose RATE limit for a "high radiation area"? 0.1 rem/hr (1 mSv/hr) at 30 cm
According to NRC regulations 10 CFR 35, the physician in charge may authorize the release of a patient who has received radiopharmaceuticals if the total effective dose equivalent to any other individual is not likely to exceed what level? 5 mSv (0.5 rem) (same as dose limit to a fetus)
Following a medical event involving radiopharmaceuticals, by what time must the NRC be notified by phone? by mail? (2 different limits) 1 day by phone, followed by 15 days by mail
10 CFR 35.75 establishes that any patient who may expose other individuals to an equivalent effective dose above [WHAT LEVEL?] must receive written instructions from the treating physician that fulfill the "ALARA" criteria. 1 mSv (100 mrem, or 0.1 rem)
Name the 4 tests required for dose calibrators, and their frequency. Geometry (at installation or after any movement or repair); Accuracy ("A" for "annual"); Linearity (quarterly: think "QuarterLine); and Constancy (daily: think "constantly checking").
What is Alagille syndrome? AD-inh disorder. Paucity or absence of intralobular bile ducts on path (no specific imaging features of the liver), with associated congenital heart disease (often ToF), skin xanthomas, butterfly vertebrae, and characteristic facial features.
What is the NRC allowable limit for occupational annual radiation dose equivalent to any individual organ or tissue other than the lens of the eye? 50 rems (0.5 Sv, or 500 mSv). This is 10x the whole-body limit, and equal to the limit for the skin or the extremities.
What is the NRC allowable limit for occupational annual radiation dose equivalent to the skin of the whole body? 50 rems (0.5 Sv, or 500 mSv). This is 10x the whole-body limit, and equal to the limit for any individual organ (except ocular lens) or the extremities.
What is the NRC allowable limit for occupational annual radiation dose equivalent to the extremities? 50 rems (0.5 Sv, or 500 mSv). This is 10x the whole-body limit, and equal to the limit for the skin or any individual organ (except ocular lens).
What is the maximal radiation dose rate limit for "Unrestricted" areas? 0.002 rem/hr, or 2 mrem/hr (0.02 mSv/hr) for waiting rooms, hallways, file space, and secretarial areas
What is the defining size difference between osteoid osteoma and osteoblastoma? osteoid osteomas are by definition LESS THAN 1.5 cm
What is Rosai–Dorfman disease? aka "sinus histiocytosis with massive lymphadenopathy." Rare disorder of unknown etiology characterized by abundant histiocytes in enlarged lymph nodes throughout the body.
What eponym is associated with "sinus histiocytosis with massive lymphadenopathy?" Rosai–Dorfman disease. Enlarged lymph nodes throughout the body, especially cervical (no specific imaging pattern). Rare dz, unknown etiology. Abundant histiocytes on path.
What is pulmonary veno-occlusive disease? PVOD is a rare disorder characterized by obstruction of the pulmonary veins and venules by intimal fibrosis, leading to pulmonary edema. Capillary wedge pressure is normal. No effective treatment. Usually fatal within a few years. Try lung txplant.
Adult with pulmonary hypertension. CT shows pulmonary edema, moderately enlarged lymph nodes, and normal LV, LA, and pulmonary veins. Swan-ganz catheterization shows normal pulmonary capillary wedge pressure. Top Dx? What does this patient need next? PVOD (pulmonary veno-occlusive disease) should be top Dx with pulmonary HTN, pulmonary edema, and normal wedge pressure. Biopsy to confirm.
Expansile lesion in the petrous apex on temporal bone CT. MR shows high T1 as well as high T2. Dx? petrous apex cholesterol granuloma. Classic boards pathology.
Expansile lesion in the petrous apex on temporal bone CT. MR shows low T1 and high T2. Top Dx? mucocele of the petrous apex (very rare). Differentiate from more common cholesterol granuloma by T1 signal (high in CG).
Fluid-attenuation CPA lesion displacing brachium pontis and cerebellum on head CT in patient with sensorineural hearing loss and HA. Cauliflower margins. Incomplete fluid suppression on FLAIR. Restricts on DWI. No enhancement. Dx? epidermoid cyst
Fluid-attenuation CPA lesion displacing brachium pontis and cerebellum on head CT in patient with sensorineural hearing loss and HA. Cauliflower margins. Suppresses on FLAIR. Does not restrict on DWI. No enhancement. Dx? arachnoid cyst
What antigen is responsible for the cross reactivivity between thyroid and extraocular muscles in patients with Graves disease and thyroid ophthalmopathy? thyrotropin. thyroid ophthalmopathy affects the EOMs in the following order of predominance: "I'M SlO" -- Inferior, Medial, Superior, Lateral, Oblique. The lateral and obliques are often spared. Disease is almost always bilateral but can be asymmetric.
Chronic headache in a patient with asthma. CT shows extensive polypoid soft tissue lesions involving the bilateral sinuses and nasal cavity. More questioning reveals aspirin sensitivity. Classic Dx? sinonasal polyposis
Enhancing mass in ethmoid cells crosses cribriform plate, with intracranial marginal cysts. Top Dx? esthesioneuroblastoma, aka olfactory neuroblastoma. Much better prognosis than SNUC (sinonasal undifferentiated carcinoma), which can look similar but has a rapid course and dismal prognosis.
An SCC with extensive neck level IV nodal metastasis is most likely to arise from which mucosal tumor?: Glottic, subglottic, hypopharyngeal, tongue base, or floor of mouth? Hypopharynx has rich vascular and lymphatic drainage, so SCC in this region tends to metastasize to nodes early.
What is the most common tumor to occur at the obex of the 4th ventricle? subependymoma. WHO grade I tumor. T2 hyperintense. Most occur at the 4th ventricle obex (inferior limit) and may extend through the foramen of Magendie.
What nerve is involved in Bell's palsy? Where is the compression? CN VII (facial nerve). Stylomastoid foramen.
What is the name for this triad?: Ptosis, myosis, anhydrosis. Horner syndrome (blockage of sympathetic innervation to face causing ipsilateral triad. Can be 1st order (hypothalamospinal tract, rare), 2nd order (stellate ganglion, Pancoast tumor), or 3rd order (ICA dissection, cavernous sinus tumor).
What is the triad for Horner syndrome? Ipsilateral ptosis, myosis, anhydrosis, from blockage of sympathetic innervation to face. Can be 1st order (hypothalamospinal tract, rare), 2nd order (stellate ganglion, Pancoast tumor), or 3rd order (ICA dissection, cavernous sinus tumor).
Created by: dudall