Radiology

Question 1

What is the investigation done in acoustic neuroma?

Answer 1

MRI of the cerebellopontine.

Question 2

What are the investigations done in ascending cholangitis?

Answer 2

1st line
- Ultrasound

Inconclusive ultrasound
- MRCP or CT scan

Gold standard
- ERCP

Question 3

DDx of the images results seen in the following diseases:
- PCOS
- Molar pregnancy
- Dermoid cyst
- Ovarian endometrioma (chocolate cyst)
- Tubo-ovarian abscess

Answer 3

PCOS
- Multiple follicles in the ovary
- Enlarged ovary

Molar pregnancy
- Snowstorm / grapes
- Enlarged uterus

Dermoid cyst
- Tip of the iceberg sign

Ovarian endometrioma
- Ground-glass echoes
- Thick walled unilocular cyst

Tubo-ovarian abscess
- Multilocular septations
- Irregular thick walls

Question 4

What is the investigation in malignant spinal cord compression?

Answer 4

MRI of the whole spine.

Question 5

What is the investigation in cauda equina syndrome?

Answer 5

MRI of spine.

Question 6

What is the investigation done in lumbar spinal stenosis?

Answer 6

MRI of spine.

Question 7

How to differentiate empyema from pleural effusion on an X-ray?

Answer 7

Empyema
- Convex (out)

Pleural effusion
- Concave (in)

Question 8

What is the investigation done in superior vena cava syndrome?

Answer 8

Investigation of choice:
- CT with contrast

Other (maybe initial)
- X-ray (looking for a tumour)

Question 9

How to describe Pancoast tumour radiologically?

Answer 9

Superior sulcus or apical tumour causing compression of nearby structures.

Question 10

What are the symptoms of Pancoast tumour?

Answer 10

Horny PAMELa
1. Horner’s syndrome
- Ptosis
- Anhidrosis
- Myosis
- Enopthalmos
- Loss of cilliospinal reflex

2. Shoulder and arm pain
3. Atrophy of intrisic muscles of hand
4. SVC syndrome

Question 11

Radiology

What should be done in PE before CTPA?

Answer 11

X-ray
- To rule out other causes of SOB.

Question 12

DDx of fetal ultrasound:
- Oesophageal atresia
- Duodenal atresia

Answer 12

Oesophageal atresia
- No bubble sign

Duodenal atresia
- Double bubble sign

Question 13

Radiology

Describe what is Sialography.

Answer 13

• Dye is injected into a salivary gland and x-ray images are taken.
• It is used to diagnose cases of sialolithiasis (obstruction of salivary glands).

Question 14

Describe the x-ray of a COPD patient.

Answer 14

• Lung hyperinflation;
• Flattened hemidiaphragms;
• ⬆︎ bronchovascular markings;

Question 15

On a X-ray, how to evaluate if a nasogastric tube is well placed?

Answer 15

• The tube remains on the midline down to the level of the diaphragm;
• The tube bisects the carina (T4 level);
• Tip of the tube seen below the left hemidiaphragm;
• Tip of the tube seen 10 cm beyond the gastroesophageal junction.

Question 16

How to confirm NG placement with pH aspirate?

Answer 16

pH > 5.5
- X-ray to confirm placement.

pH < 5.5
- Correct placement.

Question 17

Radiological DDx between:
- Normal pressure hydrocephalus;
- Alzheimer’s disease.

Answer 17

Normal pressure hydrocephalus
- CT showing enlarged ventricles;

Alzheimer’s disease
- CT showing cortical atrophy and enlarged ventricles.

Question 18

What is the radiological management of lipoma?

Answer 18

• Lipoma mass that has NOT been growing ➝ Reassure;
• Unsure if it is lipoma or liposarcoma ➝ Ultrasound scan;
• Ultrasound reveals features of liposarcoma ➝ MRI scan.