1
Q
What’s your diagnosis?
A
Left lingula pneumonia because loss of left heart border (silouhette sign)
2
Q
What’s your diagnosis?
A
Right middle lobe pneumonia because loss of right heart border (silouhette sign)
3
Q
What’s your diagnosis?
A
Right lower lobe pneumonia because you have a right heart border (no silouhette sign) and a spine sign
4
Q
What are the five basic disease patterns of interstitial lung disease?
A
- Ground glass (cloudy-hazy): acute inflammation
- Nodular: miliary TB
- Reticular (network of linear opacities): pulmonary edema
- Reticulo-nodular (linear opacities with nodules): lymphangitic carcinomatosis
- Honeycombing (5-10 mm cysts): pulmonary fibrosis
5
Q
What are the two important signs in the evaluation of lung consolidation?
A
- The air bronchogram
- The sillhouette sign
6
Q
What’s your diagnosis?
A
Ground Glass: Hypersensitivity Pneumonitis
7
Q
What’s your diagnosis?
A
TB
8
Q
What’s your diagnosis?
A
Pulmonary edema
9
Q
What’s your diagnosis?
A
Reticulo-nodular: Lymphangitic carcinomatosis
10
Q
What’s your diagnosis?
A
Honeycombing: pulmonary fibrosis
11
Q
What is Atelectasis?
A
Atelectasis means there is volume loss of the lung, it can involve an entire lung, a lobe, a segment or subsegment
Types of atelectasis:
- Passive: pneumothorax
- Obstructive: endobronchial lesion
- Compressive: pleural effusion
- Adhesive: surfactant deficiency
- Cicatrisation: scarring
- Rounded: from underlying chronic pleural disease
12
Q
What’s your diagnosis?
A
Passive atelectasis caused by pneumothorax
13
Q
What’s your diagnosis?
A
Obstructive atelectasis because NO air bronchogram caused by bronchogenic carcinoma
Looks like pneumonia but there is NO air bronchogram
14
Q
What are the 3 common patterns of pneumonia on CXR?
A
- Lobar pneumonia: strep
- Bronchopneumonia: staf
- Interstitial pneumonia: viral and other organisms
15
Q
What’s your diagnosis?
A
Lobar Pneumonia: right middle lobe
16
Q
What’s your diagnosis?
A
Interstitial pneumonia: viral
Could be interstitial fibrosis if chronic
17
Q
What are the signs of pulmonary edema on a CXR?
A
- Cardiomegaly
- Kerley B ligns
- Interstitial infiltrates
- Blunted costophrenic angle (pleural effusion)
- Cephalization of vessels: redistribution of vessels
18
Q
What are the non-cardiogenic causes of pulmonary edema?
A
“NOT CARDIAC”
- N: Near drowning
- O: O2 therapy/post-intubation
- T: trauma/transfusion reaction
- C: CNS: neurogenic pulmonary edema
- A: Allergic alveolitis
- R: Renal failure
- D: Drugs
- I: Inhaled (toxins)
- A: Altitude (high altitude pulmonary edema, ARDS (acute respiratory distress syndrome)
- C: Contusion
19
Q
What’s your diagnosis?
A
ARDS
20
Q
What’s your diagnosis?
A
Right upper lobe pneumonia
21
Q
What’s your diagnosis?
A
Pneumothorax
22
Q
What’s your diagnosis?
A
Tension pneumothorax: EMERGENCY
23
Q
What are the possible causes of an anterior mediastinal mass?
A
- Thymic tumor
- Thyroid lesion
- Terrible lymphoma
- Teratoma
- Thoracic aortic aneurysm
24
Q
What are the possible causes of a posterior mediastinal mass?
A
- Neurogenic tumor
- Descending thoracic aortic aneurysm
- Para-spinal abscess
- Extra-medullary hematopoiesis
- Hernia
- Lymphadenopathy
- Esophageal neoplasm
- Thoracic meningocele
25
This person developed chest pain after vomiting. Why?
Pneumomediastanum from ruptured esophagus
26
Why does this person have abdominal pain?
Pneumoperitoneum caused by perforated abdominal organ (generally from a perforated peptic ulcer)
27
What's your diagnosis?
Bilateral pleural effusion
28
What's your diagnosis?
Aortic dissection
29
What are the possible causes of abdominal distention?
* Bowel obstruction
* Mass
* Constipation
* Ileus
* Ascite or other fluid
30
What's your diagnosis?
Large bowel ostruction (from colon cancer)
31
What is the modality of choice for suspected bowel pathologies?
CT
32
What is the modality of choice for biliary, gynecologic assessment, good for liver, kidneys, appendix?
Ultrasound
33
This patient presented with abdominal pain. What's your diagnosis?
Perforated duodenal ulcer
34
This patient presented with RUQ pain. What's your diagnosis?
Acute cholecystitis
35
This patient presented with RLQ pain. What's your diagnosis?
Acute apendicitis
36
What's your diagnosis?
Intussusception
37
What's your diagnosis?
Ectopic pregnancy until proven otherwise: US the ovaries and FT
38
What are the causes of dysphagia?
* Malignant mass
* Benign stricture (eg, postradiation, post caustic ingestion)
* Extrinsic compression
* Esophagitis
* Esophageal spasm
* Achalasia
* Scleroderma
* Diverticulum (eg Zenker’s)
39
What's your diagnosis?
Esophageal cancer (apple core sign)
40
What's your diagnosis?
Achalasia
41
83 y/o with distented abdomen, what's your diagnosis?
Sigmoid volvulus
42
When is it appropriate to request a radiological study?
1. An examination has not already been performed
2. Appropriate/complete clinical information is gathered
3. The type of study will answer the clinical question
4. The outcome of the exam will alter management
5. **The benefit of the exam outweighs its risks**
43
What are the elements of a good radiology request?
1. Study requested
2. HPI
3. Specifics: R/O XX
Ex: 34 y.o. female, with 3 day history of RUL pain, elevated ALP/GGT. R/O cholecystitis
44
What are the indications for a bone nuclear scan?
* Bone metastasis
* Occult fracture
* Osteomyelitis (+ gallium scan)
45
What are the indications for a gallium scan?
* Osteomyelitis (+ bone scan)
* Fever of unknown origin
* Occult abscess, infection
* Inflammation
46
What are the indications for a renal nuclear scan?
* Differential function
* Renal outflow obstruction
* Renovascular hypertension work-up (+ captopril challenge)
47
What are the indications for MUGA Scan?
LVEF in oncology patients
48
What are the indications for Thyroid Uptake & Scan?
**Evaluation of hyperthryroidism**
* Graves’
* Toxic multinodular goiter (tMNG)
* Thyroiditis
* Autonomous toxic functional adenoma
49
Which hyperthyroidic disease CANNOT be treated with radioactive iodine 131?
Thyroiditis (SELF-LIMITED)
50
What are the special “**do not FDG PET**” malignancies?
* Prostate carcinoma: PSMA PET (different radiopharmaceutical)
* Leukemia (except if choloroma)
* Non-solid bronchoalveolar carcinoma (MIA/AIC)
51
1 month old baby + projectile vomiting, what's your diagnosis?
Hypertrophic Pyloric Stenosis
52
What is Hirshsprung's Disease?
Also known as Aganglionic megacolon, is a birth defect in which nerves are missing from parts of the intestine.
**Symptom**: constipation, vomiting, abdominal pain, diarrhea and slow growth
**Complications**: enterocolitis, _megacolon_, bowel obstruction and intestinal perforation
53
What is a A Salter–Harris fracture?
A fracture that involves the epiphyseal plate or growth plate of a bone
54
What is the course of treatment for a suspected sublte scaphoid fracture?
Xray + Scaphoid cast + new Xray in 14 days
To see it right away, you need an MRI
55
What is the clinical sign of a scaphoid fracture?
Tenderness in the anatomical snuff box
56
What is a Bankart injury?
An injury of the **anterior (inferior) glenoid labrum** of the shoulder due to anterior shoulder dislocation
57
What is a a Hill–Sachs lesion?
A cortical **depression in the posterolateral head of the humerus.** It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly
58
What's your diagnosis?
Subtle Tibial Plateau fracture with HUGE Lipohemarthrosis
59
How do you describe a fracture?
1. What bone
2. Right or left
3. Which part: dyaphisis, metaphisis, head, base
4. Intra-articular or not
5. Displancement or not
6. Angluation or not
7. Comminuted or not
60
Appart from fracture, what can cause bone necrosis of the head of the femur?
Steroids
61
Trauma --\> lucid phase (3-6 hours) --\> deficits.
Where is the bleeding?
Epidural
62
63
Where is the bleeding?
Sub-arachnoid
64
Where is the bleeding?
Subdural
65
What's your diagnosis?
Disk herniation
66
What is the measurement of renal function to assess for contraindication during a CT?
eGFR
67
What can you do to prevent renal injury to the kidney from the contrast?
1. Mild-moderate renal impairment: Oral hydration
2. Severe renal impairment: Avoid contrast
3. If necessary: IV hydration / stop metformin if diabetic
68
Is there such a thing as an allergic reaction to contrast agent?
Yes, anaphylaxis reaction
69
What if the patient has a shellfish allergy, can he have a CT scan?
Yes; does not matter
70
What can you do to prevent allergic reaction before CT contrast?
Iodine preparation medication protocol
71
What are some contra-indications to MRI?
1. Ferromagnetic object (check consent form and online list)
2. Claustrophobic patient
3. Severe obesity
72
What can’t you bring with you inside the MRI room?
Any object containing iron
DIM Bloc TCP
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