1
Q
anaphylaxis adrenaline
A
dose 1mg/ml or 1:1000
12+ years: 500 mcg
6-12 years: 300 mcg
6 months - 6 years: 150mcg
0-6 months: 100-150mcg
fluid bolus
adults: 0.5-1L
children: 10ml/kg
2
Q
U classification thyroid
A
U1 (no FNA C)
normal thyroid
U2 (no FNA C)
isoechoic or slightly hyper echoic
hypoechoic halo
hypoechoic (cystic) nodule with colloid
-(normal thyroid hormone store - dense comet tail)
spongiform/honeycomb
peripheral egg shell
peripheral vascularity
U3 (indeterminate - needs FNA C)
homogeneous hyper echoic
echogenic solid component
mixed vascularity (peripheral and central)
U4 (suspicious - needs FNA C)
solid hypoechoic
incomplete ring calc
lobulated outline
U5 (malignant - needs FNA C)
solid hypoechoic lobular outline
papillary - microcalc
medullary - macro/globular calc
taller than wide
internal vascularity
U2 needs FNA C if it has suspicious clinical features:
Age <20 or > 60 years
firm
fast growing
vocal cord paralysis
regional LNs
previous neck RT
fam hx of thyroid cancer
3
Q
most sensitive and specific indicator of thyroid malignancy
A
microcalc
4
Q
Li Fraumeni syndrome
A
mutation of the tumour suppressor gene TP53
invasive cancer by age 30
can’t give ionising X-ray in this mutation
sarcomas
gliomas
choroid plexus carcinoma
medulloblastoma
neuroectodermal tumours
leukaemia
breast cancer
adrenal cortical carcinoma
Annual breast MRI from 20 to 70
mammogram is contraindicated
if breast irradiated between 10-20
annual MRI from age 25 or 8 years after first irradiation, whichever is the later
if breast irradiated between 20 and 36
annual MRI from age 30 or 8 years after first irradiation, whichever is the later
5
Q
perimesencephalic SAH with normal CT angiogram
anterior to pons and midbrain
A
no further test or imaging needed
perimesencephalic is non aneurysmal
venous bleed related
CT should have been within 3 days
can settle in occipital ventricles
6
Q
most common salter Harris fracture
A
type 2
7
Q
SALTER fracture with the worst prognosis
A
type 5
8
Q
how long to hold THERAPEUTIC LMWH before TACE
A
24 hour hold - therapeutic LMWH - all moderate or high risk interventions
12 hour hold - prophylactic LMWH
moderate risk (arterial intervention, embolisation, TACE, UAE, PAE, dialysis lines, tunnel lines).
high risk (large arterial intervention, aortic stent, tumour ablation, nephrostomy, renal liver biopsy, biliary intervention)
9
Q
Bosniak
A
2f - thick and nodular calc
FU 6 months, 12 months, then annually for 5 years
3 - measurable enhancement
4 - solid component
bosniak 3 - measurable enhancement of walls - partial nephrectomy or RFA
10
Q
LCH
A
irregular nodules
irregular cysts
normal or large lung volumes
CP angles spared
11
Q
LAM vs emphysema
A
emphysema has central dot
LAM causes lymphatic obstruction - chylous effusion
12
Q
RB-ILD
A
The nodules are centrilobular
13
Q
teratoma vs thymoma
A
teratoma is slow growing and long standing
thymoma appears and causes pleural effusion
thymoma spreads to pleura
14
Q
obscures left heart border
A
anterior mediastinal mass
15
Q
military TB
A
immunocompromised
random nodules 1-3mm
happens in primary and post primary TB when it spreads haematogeneously
splenomegaly
16
Q
PJP
A
perihilar and upper zone ground glass
no lymphadenopathy
17
Q
castleman
A
angioimmunoblastic
intensely enhances unlike lymphoma
18
Q
swyer James
A
air trapping
hypoplasia
small pulmonary vessels
underdeveloped lung
19
Q
HP
A
granulomatous involvement of small airways
air goes in but gets trapped
20
Q
superior mediastinal mass that fades above the clavicle
A
retrosternal goitre
posterior mediastinal masses well defined above the clavicle
21
Q
high attenuation lesions in the brain on non con CT
A
most likely is melanoma
22
Q
axillary clips
A
breast cancer in a woman
melanoma in a man
23
Q
liver biopsy
A
large volume ascites is a contraindication (risk of bleed and harder to target)
trans jugular liver biopsy - for non targeted biopsy
24
Q
need 6 core biopsies
A
use coaxial needle - minimises bleed risk (only one puncture of the liver capsule)
biopsy edge of lesion (less vascular)
ascites and IHBD is a CI
25
clotting pre-IR
platelets >80,000
INR <1.3
clopidogrel - stop for 5 days
aspirin - don't stop
LMWH - 12/24 hours proph/thera
DOAC - 48 hours
26
IR procedure meds
midazolam - sedative - 1mg increments
fentanyl - analgesia - 25mcg increments
flumezanil - reverses midazolam - 200mcg
naloxone - reverses fentanyl - 200mcg
MFFN
27
Midazolam
Sedative of choice
Rapid onset
Short half-life (1–4 hours)
Dose: 1–2 mg IV
Reversal agent: Flumazenil
100–200 µg IV
Every 1 minute
MF
28
Fentanyl
Opioid of choice
Rapid onset
Short half-life
Dose: 25–100 µg IV
Reversal agent: Naloxone
100–200 µg IV
Every 2–3 minutes
29
bradycardia
500mcg atropine IV
30
lidocaine dose
200mg alone
500mg with adrenaline
31
EIA
retroperitoneal - no compression if it's bleeding
32
greater curvature bleeding
angiogram of CT - hepatic artery - GDA
33
buttock claudication
internal iliac - common iliac angioram
34
calf claudication
external iliac - femoral - tibial arteries
35
rectus sheath haematoma
inferior epigastric artery
36
antegrade puncture
hard if patient is very fat
37
AVF for dialysis
<50% is not significant stenosis
38
AVF
bleeding post dialysis
swollen arm
prominent superficial veins
outflow stenosis
CT thorax PV
39
IVC filter
prevents large PE
Place infra renal
supra renal in pregnancy/double IVC
indications
CI to AC
complication while on AC
recurrent/progression despite AC
40
dissection
true lumen supplies CT SMA and rt renal artery
false lumen left renal artery
41
carotid dissection on MRI
axial T1FS
42
GCA
1st line is US - halo sign, non compressible hypoechoic wall
2nd line MRI + c
gold standard is TA biopsy
43
Takayasu
MRI
or
CTA + FDG PET
stenoses and occlusions
44
aortic insufficiency murmur
takayasu
quiet murmuring Chinese
45
GCA TAKA rx
steroids first then biologics like TNFa
46
RCC stage 1 (<4cm)
CXR for staging
47
RCC staging
3a renal vein
3b infra diaphragm IVC
3c supra diaphragm IVC
T4 adrenal gland or beyond gerota
48
when to do partial nephrectomy
VHL - further risk of kidney function decline
single kidney
49
CT urogram
non con - stones
15-25 - vascular anomalies
nephrographic 80-140 - parenchyma
excretory - 4-8 mins
50
bladder cancer
CT TAP for muscle invasive bladder cancer
CT can differentiate T3b and T4 (adjacent structures)
early T1 T2 - cystoscopy and urogram
51
renal artery stenosis
pulsus tardus trace = severe RAS
peak aorta to peak RA ratio 3.5
post stenotic turbulent flow
GAD enhanced MRI
Parvus weak
Tardus slow
52
prostate cancer most important phases
T2 coronal and axial, DWI and dynamic contrast
T1 not needed in pirates
DWI good for peripheral zone
T2 good for central zone
T1 for blood/nodes/bone mets
T3 - beyond capsule, seminal vesicles
T4 - adjacent organ
53
phaeo
heterogeneous mass with delayed washout
54
testicular torsion
can look normal on US early on
55
PSMA PET
patient had radical prostatectomy but biochemical recurrence
expression is positively correlated with tumour grade, pathological stage and degree of disease recurrence
expression is observed in normal tissue
e.g. lacrimal glands, salivary glands including the parotid glands, duodenum, renal tubules, ileum
56
bosniak 2f
perceived enhx
calc
hyperdense cyst >3cm
57
bosniak 3
thick walls
measurable enhx
58
bosniak 4
enhancing soft tissue components
59
can't do a partial nephrectomy in
locally advanced tumour (T3/T4)
Tumour invades renal vein, IVC, or beyond
High surgical risk patient
Patient unfit for prolonged surgery or bleeding risk too high
Solitary functioning kidney with unresectable tumour Removing tumour would leave no viable renal tissue
Tumour location precluding safe margin
60
scrotal ultrasound post vasectomy
epididymal head cyst
tubular ectasia within the epididymis
granuloma with active inflammation
epididymitis
echogenic material - stagnant sperm
dancing megasperm
tubular ectasia
61
ranulas
simple ranula: confined to the sublingual space by mylohyoid
plunging ranula: extends into the submandibular space
rx - drain/excise the cyst AND REMOVE SUBLINGUAL GLAND
62
painful proptosis
cellulitis
orbital pseudotumour
CCF
sarcoidosis (lacrimal gland first to be affected)
wegners (infiltrative mass)
63
painless proptosis
thyroid eye disease
optic nerve tumours
pleomorphic adenoma of the lacrimal gland
64
cholesteatoma
DWI with non-EPI
65
mass displacing the CCA anteriorly and IJV laterally
it has cystic areas
vagal schwannoma
vagal nerve sheath tumour
pushes CCA anteriorly
carotid body splays the
66
sialography
contraindicated in acute sialadenitis - spread infection
jaw pain first line is US ? sialadenitis
67
hoarse voice
tongue atrophy
difficulty swallowing
jugular foramen paraganglioma
CN 9 10 11
68
parapharyngeal fat displaced posteriorly
pharyngeal mucosal space issue
69
subclavian steal
severe proximal subclavian artery stenosis or occlusion
70
CD4
>200 bacterial
<200 PCP
<100 CMV
71
plasmocytoma
solitary tumour
monoclonal plasma cells
pain
bone destruction
well defined punched out
soft tissue masses
Rx RT
72
medication 2hrs before and 24 hours after DAT scan
potassium iodide 120mg
all taken up by thyroid so the thyroid doesn't take up the radioactive i123
73
parkinsons DAT
loss of uptake in 1) putamen then 2) caudate
false results - cocaine fentanyl methylphenidate amphetamines, these all reduce DAT binding
74
PSP
mid brain atrophy
75
decreased FDG uptake in bilateral medial occipital lobe
preserved of the posterior cingulate cortex (cingulate island sign)
LBD
76
normal uptake PET
brain - active
KUB - excretion
liver - breakdown glucose
heart - active
brown fat
pneumonia
colitis
healing wounds
hyperglycaemia - increase muscle uptake
metformin - colonic uptake
77
alzheimer's FDG
bilateral temporal parietal
precuneus
posterior cingulate
78
hypothyroid
anti-TPO +ve
diffuse reduced uptake in thyroid I123
primary lymphoma from hashimotos
13x risk
gold standard for hashimotos - histology
most specific- thyroid peroxidase
79
hashimotos on I131
increased uptake early
reduced uptake later cold spots
cold nodule more concerning - dysfunctional - could be malignant
80
meckels scan
Tc99m
but increased uptake in anterior mediastinum
ectopic thyroid
normal
stomach thyroid testes salivary
81
tc99m for testes
reduced uptake centre - missed torsion
diffuse uptake epididymo orchitis
82
VQ scan
ventilation DTPA
perfusion MAA
83
patchy reduced ventilation and perfusion on VQ
non segmental
emphysema
84
matched defects VQ
pneumonia
emphysema
COPD
ILD
lobectomy
body recognises pathological lung so diverts blood away
85
perfusion defect
PE
vasculitis
extrinsic compression of vessel
86
DMSA
S for structure and scarring
Static scan
absorbed by the proximal tubules
no absorption = no renal function
87
DMSA reduced uptake bilaterally
pyelonephritis
pt on gentamicin/cisplatin
diffuse bl reduced uptake
gent is nephrotoxic (measure gent levels)
drug induced low cortical uptake
88
horseshoe kidney
down
turner
Edward
patau
increased risk TCC renal pelvis
89
MAG3
urinary secretion
Better than DTPA in people with poor renal function
DTPA is best for egfr - glom filtration only
has a perfusion then excretion phase
90
PSMA scan aka glutamate carboxypeptidase II
BL uptake at T12 L1 anterolateral to aorta
physiological uptake of coeliac ganglia
also in HN glands, liver spleen KUB GB SB
91
PSMA
Ga-68 - most sensitive for prostate
F-18
92
penile fracture
Penile fracture is defined as a tear in the tunica
albuginea with resultant rupture of the corpus
cavernosum
focal disruption of the T1- and
T2-hypointense tunica albuginea, usually with
an adjacent T2-hyperintense hematoma
93
meds in HIDA
CCK - contracts GB
Glucagon - relaxes sphincter of oddi, promotes drainage
Morphine - contracts sphincter of oddi, causes back pressure into GB, confirms blockage of cystic duct
phenobarbital - enhances bile production, ensures good quality scan
94
HIDA uptake in the GB fossa, not GB itself
gangrenous and perforated GB
95
HIDA scan times
GB in 30-60mins
acute cholecystitis - no uptake at 4 hours (cystic duct obstructed so HIDA can't enter)
96
HIDA
curvilinear pericholecytic rim of increased tracer activity next to photogenic GB
acute cholecystitis with risk of GB perf/gangrene because the surrounding liver is inflamed so uptakes more - needs surgery
97
HIDA
chronic cholecystitis
no uptake in GB 30-60 mins, give CCK and you get GB before 4 hours, because no blockage but wall of GB fibrosed so needs a push
if still no uptake at 4 hours - acute cholecystitis
98
causes of gastroparesis
alcohol
opiates
infection - chagas - mega oesophagus/ureter/bowel - T.cruzi, myocarditis and dilated cardiomyopathy
defined as >10% retained at 4 hours
rapid emptying <70% at 30mins
99
sensitivity for GI bleeding
1 - tc99m rbc
2 - CT
3 - DSA -
100
indium 111 oxine labelled WBC
evaluates disease activity in crohns
localises inflammation / infection
uses patients blood
normal - spleen liver and bone
good scan for PUO
101
ectopic splenic tissue
1st line test is the sulphur colloid scan, only works if >2cm
gold standard - more specific/sensitive - heated damaged RBCs
102
blood tests for neuro endocrine tissue
24 hr urinary 5 HIAA
serum CgA
103
investigation of NET
calculate Ki67 mitotic score
<2% means well differentiated = octreotide PET CT
>20% = poorly differentiated = 18 FDG PET (very active)
104
most common receptors in NET
SST2 and 5
105
gallium-68 dotatate
way more sensitive than octreotide
106
bone scan
uptake at sites of increased bone turnover
107
increased uptake in all 3 phases
OM
108
bone scan phases
flow - blood flow
soft tissue/blood pool - capillary perm
delayed - osteoblastic activity
109
bone scan summary
all 3 phases - OM
first 2 phases - cellulitis
only last phase - aseptic loosening (OB repair)
periprosthetic infection - all 3
110
clinically a breast cancer but normal biopsy
repeat biopsy
111
stellate appearance with central lucency
radial scar - increased risk of ca , needs biopsy
aw DCIS or tubular ca
high risk lesion
112
T4 breast cancer
skin/chest wall
113
BRCA1/2
Annual MRI
mammograms from age 40
114
segond
lateral plateau - ACL MCL
reverse segond
medial plateau - PCL MCL and MM
115
central cord syndrome
contusion to the cord
hyperextension in a degenerative neck
bright intramedullary T2 STIR
116
EUS
12-20 MHz
117
sulfur colloid
half life 6 hours
all hepatic masses cold except FNH
118
amoebic liver abscess
single lesion
right lobe
thin or non enhancing wall
chocolate fluid
metronidazole
119
hyper vascular liver lesions
HCC
NET
adenoma
120
liver lesion T1 bright T2 dark
adenoma
contains fat and blood
drop out on IPOP
121
GB polyps
>1cm suspicious - cholecystectomy
122
When conventional imaging (CT/MR) is negative but suspicion is high for pancreatic NET
arterial stimulation + selective venous sampling may help localize hormone-secreting lesions
insulinoma - GLP1 receptor imaging
123
PNET
insulinoma 10% ca - small, arterial hyperenhancement, homo enhx
glucagonoma 80% ca - large, heterogeneous, malignant
gastrinoma 60% ca - can be in duodenum, delayed enhancement, ring enhx (gastric ring)
non functioning 100% ca - large, heterogeneous, no hormonal effect
124
VIPoma
WDHA syndrome
watery diarrhoea, hypokalaemia, and achlorhydria (no hcl in stomach)
125
GB polyps
extremely low risk - ball on wall or thin stalk
low risk - thick stalk
focal GB wall thickening - intermediate risk >4mm
126
gastric adenocarcinoma
high attenuation
127
leg dermatomes
L2 thigh
L3 knee
L4 medial leg
L5 lateral leg
S1 lateral foot heel sole
S2 hamstrings
128
Spinal cord lesions
(transverse myelitis covers MS NMO and MOGAD)
MS - diffuse or focal, GM involved, posterolateral cord, T2 bright, ring/intense nodular enhx, cord atrophy, patchy faint enhx
MS focal peripheral
NMO - aquaporin 4 - middle aged women, LETM (>3 VB's) + optic neuritis, swelling (2/3 involved), strong enhx
NMO LETM and ON
MOGAD - kids, central grey matter, grossly swollen
monad - gross swollen central monster
ADEM non enhancing with skip lesions
129
CC lesion
FLAIR bright
homogeneous enhancement
Lymphoma
GBM has rim enhancement and may/may not restrict
130
posterior fossa lesion with calcification
ependymoma
131
pupil down and out
CN3 palsy
PCOM aneurysm
132
right temporal lesion
left superior quadrantanopia
133
vertigo
rapid involuntary eye movements
swallowing difficulties
drooping eyelid - RIGHT
ipsilateral horners
right PICA
branch of the VA
affects same side medulla (swallowing)
134
superior cerebellar artery infarct
branch of the basilar
same sided horners
contralateral pain temp of face
135
CC involvement
genu and splenium - CC and marchiafava bingami
136
Marchiafava bignami
demylination then necrosis of the CC
front to back - body genu splenium
137
TB meningitis
vs neurosarcoid
can affect cranial nerves like sarcoidosis, just not as common
cough
ring enhancing lesions - tuberculoma
sarcoidosis- pituitary enhx, cranial nerve lesions much more common, lesions enhance homogeneously
138
diagnosis of MS
5 spaces now including optic nerve
4 or more gives dx even if no dissemination in time
spinal cord, optic nerve, periventricular, juxtacortical, infratentorial
CSF kappa free-light chains (kFLC) as a marker, equivalent to CSF oligoclonal bands
central vein sign - vein in an MS plaque
paramagnetic rim on SWI supports but doesn't aid diagnosis
if there is dissemination in space, 2 or more places, a central vein sign removes need for DIT or CSF diagnosis
139
uterine mass ? malignant
LN's or peritoneal mets?
solid enhancing nodule
intermediate signal
DWI brighter than endometrium
ADC <0.9
140
paeds ET tube
T1-T3
141
NAI
SS
CT head <1
siblings <2 years same house
MRI brain and spine if CT head +ve
Repeat SS in 11-14 days
142
echogenic mass on antenatal US
normal CXR
needs CT to see extent of cysts
risk of ca - needs resection
needs upper abdomen CT for arterial anomaly
down to renal vessels
CT chest + abdomen + C
143
neonate will small lung and PLEURAL EFFUSION
infection group B strep 1st week
no pl eff in RDS
144
ileocolic
can have air reduction
ileoileal cannot be reduced - needs surgery
145
GI perf in neonate
1) left lateral decubitus
2) HBL
146
li fraumeni
annual MRI surveillance
SLAB
sarcoma
lymphoma/leukaemia
adrenals
breast
147
kids trauma
C spine and chest x ray
CT head and CT AP
148
mitral valve disease
LAA
compresses recurrent laryngeal nerve
change in voice
cardiovocal syndrome
149
young pt chest pain
incidental finding
RCA from left sinus going between aorta and PA
150
upper lobe odema post MI
papillary muscle rupture
151
HCM
systolic anterior motion of the anterior mitral valve leaflet
152
chagas
latin america
dilated LV
153
fdg uptake between atrium
lipomatous hypertrophy of the inter atrial septum
brown fat
154
right atrial lesions
lymphoma
angiosarcoma
155
left atrial
myxoma
thrombus
156
ventricles
fibroma
rhabdomyoma
157
perilunate dislocation associated with
scaphoid fracture
158
lunate dislocation
injury of the dorsal radiolunate ligament
median nerve injury
159
VISI DISI
SLT in order
S wants to go volar
T wants to go dorsal
VISI - ulnar injury, LT ligament, lunate moves volar with scaphoid, <30
DISI - radial injury, SL ligament, dorsal dislocation, >60
160
pelvic avulsions
ASIS - ST (sartorius, TFL)
AIIS - R (rectus femoris)
greater trochanter - glutes
lesser trochanter - hamstrings
161
segond
lateral plateau
ACL
reverse segond
medial plateau
PCL
Medial meniscus
162
osteoporosis
transient OP - later pregnancy - joint space preserved, self resolves
regional migratory OP - idiopathic in men, moves around to different bones, avoid WB, self limits
163
AVN
rim sign or double line sign
means unstable
needs surgery
164
autoimmune arthritides
RA
Scleroderma: acro osteolysis, soft tissue calc, contractures, myositis, bursitis
SLE: reducible deformities, no erosion or narrowing, lax ligaments
165
PAIR
RF -ve
HLA B27 +ve
AS: SIJ first before spine, upper lung
166
CPPD
SLAC wrist
isolated joints - PF, elbow,
167
calcific tendinitis
shoulder supraspinatus
longus collis muscle C1 T3 neck pain
renal disease
hypervit D
tumoral calcinosis
168
CPPD
index and middle finger
haemachromatosis affects all
169
GCT
low t1
low t2
blooming
170
pagets
hot on all 3 phases of bone scan
high ALP in the mixed phase
171
MINOCA
MI with no obstructed coronary arteries (no stenosis >50%
coronary plaque disruption
CA dissection or spasm
shock/arrhythmia causing supply mismatch
172
freidrich ataxia
thinning of cervical cord and MO
cerebral cerebellar atrophy
4 limb ataxia
173
kaposi
low to intermediate grade sarcoma of lymphatic system
CD4 <200
peri hilar flame shaped opacities
ILST
LNs
Pl eff
thallium positive gallium negative (lymphoma positive in both)
174
PAPVR
PV drain into RA instead of LA
175
infantile coarctation
a/w PDA
176
coeliac
jejunisation of the ileum - more folds in the ileum to make up for villous atrophy of the duodenum
Flocculation = progressive dilution of the barium contrast column due to poor fluid absorption by the inflamed duodenal epithelium.
-Moulage = featureless appearances of the small bowel segments affected (mainly duodenum) secondary to a reduction in number of mucosal folds
177
cowden
breast disease, trichilemmomas (skin lesions) and CNS tumours
178
Blake pouch vs mega cisterna magna
BP communicates with 4th and has HC
MCM no HC and no communication
179
alzheimers in FDG PET
bilateral temporoparietal, precuneus and posterior cingulate hypometabolism
180
tests for Alzheimers
F18-fluorodeoxyglucose (FDG)
Tc-99m HMPAOC
Tc-99m Bicisate (Ethyl cysteine dimer)
181
liver lesion matches blood pool on all T1 post con
hyper echoic on US
can restrict
haemangioma
182
what confirms benign adenoma
>60% absolute washout and/or >40% relative washout
183
TS brain lesions
SEGA, near foramen of Monroe, HC, avid enhx
central neurocytomas are attached to the septum pellucidum
184
caudate head supplied by
heubner artery
185
no thrombectomy in ASPECTS
<7
also needs to be a proximal occlusion - ica m1 and proximal m2
NIHSS >5
mrs <3
186
most in favour of tb discitis
subligamentous spread
187
ABC
fluid fluid level
low signal rim
188
HCC
hypervascularity in the arterial phase with rapid contrast washout and/or the appearances of a perilesional capsule, “the appearance has a near 100% specificity for HCC
cholangiocarcinoma enhances in the delayed phase
189
moiety's
upper inferomedial
lower superiolateral
190
renal vein thrombosis
reversal of diastolic flow
191
bone lesion
anaemia
hypercalcaemia
various uptake on bone scan
MM
192
superior rib notching
marfans
193
rt vs left subclavian artery
aberrant right - right rib notching
aberrant left - left notching
194
TGA
L type sorts itself out congenitally
D type needs PDA to keep open to maintain life
D needs help!
195
post pneumonectomy
progressive filling with fluid - normal
progressive filling with air - BP fistula. xenon confirms leak into pleural space
196
osteoid osteoma vs osteomyelitis
both same on MRI
needs bone scan to distinguish
OO - vascular nidus - increase uptake in nidus and sclerosis - double density sign
OM - no uptake in the nidus
197
distal ureter filling defects that cause obstruction
TCC
ureteritis cystica does not cause obstruction
198
tumoural calcinosis
periarticular calc
199
SNHL and branch retinal artery occlusions
Susac
200
femoral pseudo aneurysm
<1cm watch and wait
>1cm us guided thrombin
201
thyroid infection
post viral - de quervains - hyper thyroid then hypo then eu thyroid. avascular cold nodules with hyperaemic parenchyma
acute suppurative thyroiditis - euthyroid, more un well
graves - hot on radio dine
Hashimoto - hyper then hypo, homogeneously hyper echoic white knight nodules - lymphoma
riedels - igg4 - fibrous replacement, enlarged, less vascular, t1 dark t2 dark
202
sinuses
Anodi cells (risk to optic nerve and ICA during FESS).
Agger nasi air cells- anterolateral and inferior to the frontal recess and anterior and above the middle turbinate (the orbit, lacrimal sac and nasolacrimal duct lie lateral to them) and can lead to frontal sinusitis.
Fovea ethmoidalis is a normal structure representing the superior portion of the ethmoid bone.
Concha bullosa is middle turbinate pneumatisation, usually associated with nasal septum deviation but rarely of clinical significance.
203
tennis
swollen upper limb
paget schrotter syndrome
compression and thrombus of subclavian vein
upper limb DVT
204
caput medusa
DVA
do not touch
can be seen on angiography - AVM, not DVA
205
SVCO
azygous, hemi azygous, lateral thoracic, internal thoracic and thoraco-acromioclavicular venous complex.
206
bone pain
exopthalmos
neurological symptoms
like pagets - cortical thickening and thick trabecuale
symmetrial
epiphyseal sparing
erdheim Chester
207
malignant breast calc
a group or cluster of calc - starts in a duct
rod like calc - benign, plasma cell mastitis, involuted ducts post menopause
208
shoulder ultrasound
Arm in slight internal rotation, elbow flexed to 90 degrees, palm up. - long head biceps
Arm adducted and in internal rotation –“hand in back pocket” - supraspinatus
Arm in external rotation, elbow flexed to 90 degrees, palm up - subscapularis
Place arm on opposite shoulder - infraspinatus/teres minor
209
invasive thymoma
myasthenia gravis
phrenic nerve involvement- elevated hemidiaphragm
210
what is still ok for pancreatic adenocarcinoma resection
panc LN's
duodenal invasion
GDA involvement
SMA <180
no liver or peritoneal mets
211
implanted insulin pump
MRI contraindicated
212
acutely inflamed GB
can't operate - needs PCT
213
HVOD
jamaican bush tea
chemo
stem cell transplant
GB thickening
214
pineal lesion
pineoblastoma. large. high grade. heterogeneous
pineocytoma. small. benign. homo enhx.
215
AIP
symmetric
lower lobe predominant
sparing of bases
late phase of AIP, architectural distortion, traction bronchiectasis, and honeycombing
216
orbital sarcoid
involves lacrimal glands
217
neurosarcoidosis
needs CXR for bl hilar ln
involves pituiatry
blood tests to look for diabetes insipidus and SIADH
218
T3 and T4 prostate cancer
bone scan and TRUS biopsy
CT not used in staging
trans perineal biopsy if small and anterior
219
rectosigmoid ratio
<1 abnormal
normally the rectum is larger than sigmoid
reversal seen in hirschprungs
220
meconium plug
left colon
meconium ileus - cf - terminal ileum
221
organs affected in blunt trauma
Spleen, liver, kidneys, diaphragm, pancreas
SLKDP
222
hyper vascular liver mets
late arterial
223
facial rash
cortica tubers
sub ependymal nodules
enhancing SEGA
TS - cardiac rhabdomyomas - TOE
224
Thickening of the interatrial septum > 6mm
highly specific for cardiac amyloidosis.
225
SLAC
FOOSH
CPPD
SL >3mm
SLAC VS DISI
Both SL >60
DISI CL >30
CL normal <30 in SLAC
226
SNAC
AVN of scaphoid
227
liver lesion
central area of high T2-weighted pre-contrast
intense enhancement with IV gadolinium on T1-weighted at 25 seconds
isodensity with normal liver on T1-weighted at 75 seconds after IV gadolinium.
FNH
228
bowel blood supply
coeliac axis - upper GI
transverse colon - SMA
distal colon - IMA
229
most likely cause of brisk GI bleeding
angiodysplasia causing shock
Villous adenomas cause chronic blood loss, often leading to iron deficiency, not acute hemorrhagic shock
230
Radiation history + elderly woman
insufficiency fractures
231
Post-prandial abdominal pain
Mesenteric hypoperfusion during digestion
severe vasculopath
causes weight loss
mucosal ischaemia causes microbleeds and anaemia
poor nutrition - low albumin
bowel thickens from hypo perfusion
232
hypoechoic lobulated lesion in submandibular gland
pleomorphic adenoma
233
gyrus rectus SAH
A com
234
GBM
supratentorial >90% of the time
235
rim enhancing posterior fossa lesion
mets - can be a necrotic met
mets to cerebellum very common
236
prostate cancer
T2 to T3
extra prostatic extension
resect NVB
ED
more risk of recurrence and mets
specific - seminal vesicle invasion
sensitive - broad capsular contactc>10mm
asymmetry of NVB
loss of retroprostatic fat
237
endoleaks
1 - needs correction
2 - follow up and embolism lumbar/IMA
3 - intervene
4 - do nothing
238
dashboard injury
PCL
239
amyloid arthropathy
large joint
symmetric bilateral
shoulder pain and carpal tunnel
primary or 2 to HD (CKD)
joint space preserved
congo red stain of synovial fluid
low T1 T2 intra articular nodules - enhance
240
cartilage pigmentation
ochronosis
accumulates in discs
241
synovial pigmentation
PVNS - haemosiderin staining
242
CCF
CN 3 and 6
243
CT reveals multiple
perihilar and peribronchovascular ill-defined nodular opacities with surrounding ground glass
opacification and marked bilateral ENHANCING hilar lymph node enlargement
kaposi
flame shaped
gallium negative
lymphoma gallium avid
244
psoriatic arthritis
distal joints, marginal erosions, periostitis, joint space widening and preserved bone density
symmetric
245
lidocaine
1%
3mg/kg
210mg
20ml
or up to 4mg/kg - 30ml
7mg/kg with adrenaline
246
phaeochromocytoma
no fat signal in IP/OP
247
pituitary apoplexy
peripheral enhancement
248
Cronkite canada
GI polyps
nail atrophy
alopecia
249
cowden
breast and thyroid cancers
250
BL dense renal lesions
with splenic lesion
melanoma
251
neonate ETT
1.5cm above carina T3/4
251
T2 hyperintensity in the caudate nuclei, lateral thalami, putamina and tegmentum with sparing of the red nuclei and substantia nigra
wilson
copper deposition
no affect on CT
252
The anterior pituitary, choroid plexus and pineal gland are all common sites of deposition.
haemachromatosis
253
pneumonia
neonates - group B strep
pre school - pneumococcus RSV haemophilia
254
cervical cancer staging
FGD PET and MRI pelvis
254
osteoporosis circumscripta
pagets
Lucent leading edge
increased uptake
255
sjogrens
NSIP in 45%
LIP in 15%
255
tailgut cyst
multilocular, retrorectal cystic mass.
256
double cortex
band heterotopia
257
gynae malignancy
higher grade has lower ADC
With a cut-off ADC value of 1.15×10−3 mm2/s, there was a sensitivity of 74% and a specificity of 80% for differentiating benign from malignant
1.15 is the cut off. closer to 0 or less is darker and malignant
258
Lhermitte duclos
Dysplastic cerebellar gangliocytom
thick and T2 bright cerebellar folia
259
Xanthogranulomatous cholecystitis
hypodense intra mural nodules
260
rodent facies
thallasaemia major
261
malignant breast calc
clustered
pleomorphic
branching linear
262
PML
restricted diffusion at the leading edge
263
PMF
more likely in silicosis than coal workers
264
seroma
regress
lymphoceles persist
265
peutz jehgers
spares mouth and oesophagus
colon, stomach, SI cancer in that order
Sertoli cell tumour of testes
breast ductal most common
266
syndromes and cancer risk
Lynch/HNPCC - endometrial, GBM, TCC
fallopian tube serous - BRCA1 and 2
Cowden - breast thyroid endometrial
FAP - hepatoblastoma, JNAF, Desmoid
fap hap Desmond
267
neurosarcoid
BL facial, optic nerves, and hearing CN8
bilateral facial weakness
268
leptomeningeal carcinomatosis
breast lung melanoma
269
Acute eosinophilic pneumonia
consol
GG
eosinophils not raised in blood in acute
raised eosinophils in bronchoalveolar fluid
270
pneumonia
strep most common
staph debilitated
legionella spreads to other lobes
271
low T1 and T2 with blooming
tenosynovial giant cell tumour
272
neuroblastoma
stage 4S
locally advanced with mets to skin, liver, bone marrow
if there are skin liver or bone mets it confers a greater prognosis
273
rectal cancer drainage
dentate line
above = internal iliac vessels
below = superficial inguinal
274
rectal cancer
regional vs metastatic LNs
metastatic if:
external iliac
common iliac
inguinal (if tumour above the dentate line)
above metastatic
below regional
275
anal cancer
metastatic LNs if they are :
common iliac or para-aortic
the rest are regional
276
De Quervain tenosynovitis
1st extensor compartment of the wrist
APL EPB
pain on passive ulnar deviation
pain over radial styloid
intersection syndrome if pain 4cm above lister tubercle
intersects with extensor carpi radials brevis and longus
277
classification tool for biliary atresia
kasai
echogenic fibrous tissue anterior to the PV
hepatic artery gets larger
subcapsular hepatic arterial flow on Doppler
right proximal hepatic artery diameter >1.5 mm
hepatic artery to portal vein diameter ratio >0.45
ghost gallbladder
atretic, length less than 19 mm
irregular contour
lack of complete echogenic lining
278
cervical to 2a to 2b
parametrial invasion - coronal best view
T1 large FOV needed to look for LNs
metastatic LN's - all para aortic above the renal vein and inguinal
279
cervical cancer - fertility can be preserved
no LNs
no parametrial invasion
stage IB1 or lower, <2cm in size
>1cm from the internal os
<50% cervical stromal invasion
280
gold standard for splenic tissue
Tc-99m-tagged heat-damaged RBC scan (Tc-99m-DRBC)
281
penile fracture
t2 bright signal breach of tunica albuginea
282
littres hernia
are inguinal
283
lady windermere
MAC infection
284
CPAM
needs arterial CT chest
identify blood supply
285
medial epicondyle avulsion
flexor carpi radialis
286
risk factors for neuroblastoma
* A: Encasement of abdominal aorta >50%
* B: Flattening of the renal vessels
* C: Infiltration of body of pancreas
* D: Compression of trachea
* E: Infiltration into spinal canal >1/3 diameter
287
TOF
type c most common
288
PXA
enhancing nodule
dural tail
289
cholesteatoma vs cholesterol granuloma
ADC differentiates
cholesteatoma dark on ADC
290
bilateral, symmetric metaphyseal and diaphyseal sclerosis
distal fib proximal tib
erhheim Chester
291
klippel feil
vertebral fusion: fused facets and spinous processes
anteroposterior narrowing of the vertebral bodies
hemivertebrae
omovertebral bone
spina bifida
associated scoliosis
Sprengel deformity
292
scleroderma
loss of lamina dura
293
crohns fistula types
inter sphincteric
trans sphincteric
supra sphincteric - involves internal sphincter and puborectalis
extra sphincteric - involves levator ani complex
294
caffey disease
infantile cortical hyperostosis
first 5 months
painful soft tissue swelling
periosteal reaction
new bone formation
bone expansion
Umair's 2A
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