RD 2017

Question 1

2. 60 year old woman with new well defined mass on mammogram

a. IDC
b. ILC
c. Phyllodes
d. FA
e. Mucinous

Answer 1

*AJL - Answer may be mucinous as these are typically well-defined whereas IDC is typically described as spiculated (though has a variety of appearances). Against this is classic age of mucinous is 75y and IDC 50-60y. Hopefully there are more clues in the question.

• LW - agree with mucinous appearances logic. To blurr the waters….mucinous comparitvely very rare 3% vs common IDC (76%)
• AJL - yes good point, IDC is more common therefore probably most correct
• RY - Could also be phyllodes

a. IDC yes
2. 60 year old woman with new well defined mass on mammogram

a. IDC yes
b. ILC
c. Phyllodes
d. FA
e. Mucinous

*LW: breast cancer subtype frequency:
●Infiltrating ductal – 76 percent
●Invasive lobular – 8 percent
●Ductal/lobular – 7 percent
●Mucinous (colloid) – 2.4 percent
●Tubular – 1.5 percent
●Medullary – 1.2 percent
●Papillary – 1 percent

Question 2

3. MRI knee in a young man, which is true?

a. Medial and lateral collaterals are not in the same plane

Answer 2

3. MRI knee in a young man, which is true?
   a. Medial and lateral collaterals are not in the same plane

*AJL - MCL is more anterior.
Not relevant for this queswtion but… if LCL is seen on a single coronal plane then it is suggestive of anterior tibial translation.

Question 3

4. Woman with phyllodes

a. Simple excision
b. WLE
c. Follow-up
d. Mastectomy

Answer 3

b. WLE yes
4. Woman with phyllodes

a. Simple excision
b. WLE yes
c. Follow-up
d. Mastectomy

Question 4

5. 2 year old with increasing head size, increased T2 in forceps minor

a. Adrenoleukodystrophy
b. Alexander
c. Canavan

Answer 4

b. Alexander yes
5. 2 year old with increasing head size, increased T2 in forceps minor

a. Adrenoleukodystrophy
b. Alexander yes
c. Canavan

• *LJS - Canavan also has a big noggin and presents in infancy. Can;t find anything specific about forceps minor for either
• ESG - forceps minor = anterior white matter. X-linked adrenoleukodystrophy (and Krabbe) are posterior predominant, Alexander (and metachromatic leukodystrophy) are anterior, and Canavan is diffuse. Both Alexander and Canavan have big heads, Alexander due to obstruction of CSF from swelling of periaqueductal region and basal ganglia

*SCS see summary table in crack the core.
StatDx: canavans:
Congenital: fatal 1st few days
infantile canavans (3-6 months). Fatal in “second year” of life… ? Therefore best available answer as question is written -> Alexander.

Question 5

6. Person with NMO (T)

a. More likely to be bilateraly
b. More common in males
c. Short segment spinal cord

Answer 5

a. More likely to be bilateraly yes

Devic disease. AP4IgG. Bilateral optic neuritis and longitudinally extensive myelitis. F>M

Question 6

7. 70 year old woman with Spinal enlargement from C7-T6, one week leg weakness. High T2 some minor enhancement

a. Tx Myelitis
b. Mets
c. Haemangioblastoma
d. Astrocytoma

Answer 6

a. Tx Myelitis yes
7. 70 year old woman with Spinal enlargement from C7-T6, one week leg weakness. High T2 some minor enhancement

a. Tx Myelitis yes
b. Mets
c. Haemangioblastoma
d. Astrocytoma

Question 7

8. 70 year old woman with 2cm mass in the cerebellum

a. Haemangioblastoma
b. Metastasis
c. Lymphoma

Answer 7

b. Metastasis yes
8. 70 year old woman with 2cm mass in the cerebellum

a. Haemangioblastoma
b. Metastasis yes
c. Lymphoma

Question 8

9. 20 year old guy with 2cm vascular epididymal mass

a. Adenomatoid
b. Lipoma

Answer 8

a. Adenomatoid

WJI: most common paratesticular solid mass is lipoma but this is typically avascular.
Adenomatoid tumour is second most common.
Leiomyoma or sperm granuloma are rarer and heterogeneous.

ADB-> Adenomatoid most common tumour of the “epididymis”, and occur more often in the lower pole than in the upper pole by a ratio of 4:1.

Cystic:
spermatocoele, epididymal cyst, papillary cystadenoma
Hydroceoele, pyocoele, haematocoele, varicocoele

Mets are hypoechoic and you can get cord liposarcoma. Everything else is benign

Question 9

10. 35 year old asian man with multiple fat density lesions posterior and lateral to the caecum and ascending colon, recently returned from singapore

a. Epiploic appendigitis
b. Crohns
c. Diverticulitis
d. Pseudomembranous

Answer 9

a. Epiploic appendigitis yes
10. 35 year old asian man with multiple fat density lesions posterior and lateral to the caecum and ascending colon, recently returned from singapore

a. Epiploic appendigitis yes
b. Crohns
c. Diverticulitis
d. Pseudomembranous

• ESG disagree - “Asian” is a buzzword for right-sided diverticulitis. Epiploic appendagitis usually left-sided, omental infarct right-sided.
• WJI yeah but “fat density” doesnt really suggest diverticulitis

Question 10

11. Which placenta has the least risk of complications

a. Bilobed
b. Succinturiate
c. Membranous
d. Circumvellate
e. Velamentous

Answer 10

a. Bilobed yes
11. Which placenta has the least risk of complications

a. Bilobed yes
b. Succinturiate
c. Membranous
d. Circumvellate
e. Velamentous

Question 11

12. 30 year old woman presents with PV bleeding and pain with hypoechoic region behind the placenta

a. Vasa previa
b. Placenta previa
c. Abruption

Answer 11

c. Abruption yes
12. 30 year old woman presents with PV bleeding and pain with hypoechoic region behind the placenta

a. Vasa previa
b. Placenta previa
c. Abruption yes

Question 12

13. 18 month year old lower leg deformity with anterolateral bowing of the tibia

a. Physiological
b. Blounts

Answer 12

*LW:
Favour this to be incomplete recall:
Bowing refers to which direction the apex of the deformity points.
Stem states tibial bowing (not knee), and anterolateral bowing.
Normal physilogical bowing at knee - genu varum upto 2yrs, then brief valgus angulation upto 3 yrs before normalisation.
Most likely implying normal physiological, although anterolateral tibial bowing is associated with NF1 and pseudo arthorosis.

a. Physiological yes
13. 18 month year old lower leg deformity with anterolateral bowing of the tibia

a. Physiological yes
b. Blounts

*ESG agree NF1. StatDx:

Congenital/Infantile Tibial Bowing
Typically unilateral congenital or infantile diaphyseal deformity
3 classic patterns characterized by direction of apex

Posteromedial
Typically physiologic
Secondary to intrauterine positioning
± associated calcaneovalgus foot deformity

Anteromedial
Associated with fibular hemimelia (range of fibular abnormalities from hypoplastic to absent)

Anterolateral
High association with neurofibromatosis type 1
Bowing is typically at junction of mid to distal 1/3 of tibia
Often with narrowing, sclerosis, or cystic change at apex
May develop fracture & pseudarthrosis

Question 13

14. 20 week scan

a. No follow up of renal pelvises 5-10mm

Answer 13

*LW:
16-28 weeks: AP renal pelvis dilation < 4mm without peripheral calyceal dilation normal and no follow up.
> 28 weeks: AP renal pelvis dilatoin < 7mm without peripheral dilatoin NORMAL with no follow up.
Anything else basically gets follow up imaging, usually at 32 weeks.

14. 20 week scan
    a. No follow up of renal pelvises 5-10mm - no

*ESG mnemonic 4 x 7 = 28

Question 14

15. 30 year old woman with 5.6cm haemorrhagic cyst

a. No follow-up
b. Follow-up 4 weeks
c. Follow-up 6 weeks
d. Surgery

Answer 14

c. Follow-up 6 weeks 8wks
15. 30 year old woman with 5.6cm haemorrhagic cyst

a. No follow-up
b. Follow-up 4 weeks
c. Follow-up 6 weeks 8wks
d. Surgery

WJI: radiopaedia O-rads: 6-12 week FU for haemorrhagic cyst >5cm

Question 15

17. Medialisation of the ureters

a. AP resection
b. Prostate enlargement
c. Ureterocoele

Answer 15

a. AP resection yes
17. Medialisation of the ureters

a. AP resection yes
b. Prostate enlargement
c. Ureterocoele

Causes of medial deviation:

Upper ureter
Retrocaval ureter
Retroperitoneal fibrosis

Lower ureter
Lymphadenopathy
Iliac artery aneurysm
Bladder diverticulum
Post-surgical (esp. AP resection)
Pelvic lipomatosis

Question 16

18. 3cm pancreatic mass with hypoechoic well defined lesion in segment 4b, hypoechoic irregular lesion in segment 6 and hyperechoic lesion segment 8. Best to biopsy

a. Pancreatic mass
b. Segment 4 lesion
c. Segment 8 lesion
d. Segment 6 lesion

Answer 16

*LW:
Would favour segment 6 lesion first, easier biopsy, if it proves to be non hepatic malignancy, would aid next step decision with regards to pancreas.

*AJL - Agree with LW. (Have d/w abdo boss)

Previous answer
a. Pancreatic mass yes

18. 3cm pancreatic mass with hypoechoic well defined lesion in segment 4b, hypoechoic irregular lesion in segment 6 and hyperechoic lesion segment 8. Best to biopsy

a. Pancreatic mass yes
b. Segment 4 lesion
c. Segment 8 lesion
d. Segment 6 lesion ?

Question 17

16. 45 year old lady with 20cm multilocular pelvic mass

a. Mucinous cystadenocarcinoma
b. Serous cystadocarcinoma
c. Sertoli-leydig
d. Granulosa

Answer 17

a. Mucinous cystadenocarcinoma yes
16. 45 year old lady with 20cm multilocular pelvic mass

a. Mucinous cystadenocarcinoma yes
b. Serous cystadocarcinoma
c. Sertoli-leydig
d. Granulosa

Question 18

19. 3 cm mass in a 45 year old woman with breast cancer. Hypervascular, suppresses on opposed phase, hypointense on delayed (MRI)

a. Mets
b. Adenoma
c. FNH
d. HCC

Answer 18

b. Adenoma yes
19. 3 cm mass in a 45 year old woman with breast cancer. Hypervascular, suppresses on opposed phase, hypointense on delayed (MRI)

a. Mets
b. Adenoma yes
c. FNH
d. HCC

Question 19

20. HIV positive man (50 year old) with multiple hypodense lesion in the liver and spleen

a. Lymphoma
b. Candidiasis
c. Sarcoid
d. SLE

Answer 19

b. Candidiasis yes

WJI: candidiasis would be classic given history of HIV. Lymphoma (larger, less well defined) or sarcoid (more commonly diffuse enlargement) could also have this appearance.

Question 20

21. 35 year old woman with 3mm lumen of distal oesopahgus, smoothly tapered, 3cm dilatation proximally

a. Barrets
b. Carcinoma
c. Achalasia

Answer 20

c. Achalasia yes

WJI: perhaps incomplete recall. This is most characteristic of peptic stricture: 1-4cm long 0.2-2cm wide smooth tapered narrowing of distal oesophageal with some upstream dilatation.
Barrett’s: mid oesophageal stricture typically above a HH
Achalasia: upstream dilatation should be >4cm
Carcinoma: upstream dilatation less pronounced than achalasia but typically irregular and shouldered

Question 21

21. 35 year old woman with 3mm lumen of distal oesopahgus, smoothly tapered, 3cm dilatation proximally

a. Barrets
b. Carcinoma
c. Achalasia

Answer 21

c. Achalasia yes
21. 35 year old woman with 3mm lumen of distal oesopahgus, smoothly tapered, 3cm dilatation proximally

a. Barrets
b. Carcinoma
c. Achalasia yes

Question 22

23. Pain 2nd/3rd intermetatarsal spaces with compressible hypechoic pockets in the subcutaneous fat overlying metatarsal heads

a. Adventitial bursitis
b. Intermetatarsal bursitis
c. Mortons neuroma

Answer 22

a. Adventitial bursitis yes
23. Pain 2nd/3rd intermetatarsal spaces with compressible hypechoic pockets in the subcutaneous fat overlying metatarsal heads

a. Adventitial bursitis yes
b. Intermetatarsal bursitis
c. Mortons neuroma

IVM: Disagree. Favour intermetatarsal bursitis.
Adventitial bursitis: anechoic, affects plantar fat pad near MT head 1st and 5th
Intermetatarsal bursitis is between 2 metatarsal heads dorsal to the intermetatarsal ligament. Hypoechoic. Compressible/resolves with compression.
Mortons neuroma : perineural fibrosis around the plantar digital nerve. Nodule plantar to the intermetatarsal ligmament. Hypoechoic. Not compressible according to RD. Most common sites 2nd and 3rd intertarsal spaces

Question 23

24. MRI, what increases signal to noise ratio

a. Decreasing voxel size
b. Decreasing field strength
c. Increased phase encoding gradients

Answer 23

all wrong

24. MRI, what increases signal to noise ratio

a. Decreasing voxel size - no, SNR linearly proportional to voxel volume. Increasing FOV or reducing matrix size would incr SNR (by incr voxel volume)
b. Decreasing field strength - F
Although a number of complex factors determine image quality, signal-to-noise is approximately proportional to field strength. All other things being equal, therefore, the signal-to-noise ratio will be smaller in a lower-field scanner. Consequently, to maintain equivalent signal-to-noise, more signal averages and longer imaging times will be necessary in a lower-field scanner.
c. Increased phase encoding gradients

Question 24

25. Sequestration

a. Intralobar drains to pulmonary veins
b. Extralobar supplied by coeliac axis
c. Most common LUL
d. Most common RML

Answer 24

a. Intralobar drains to pulmonary veins yes
25. Sequestration

Systemic arterial supply:
Thoracic or abdominal aorta (80%)
Other (15%): Splenic, gastric, subclavian, intercostals
Multiple arteries (20%)

WJI: can be supplied by coeliac trunk but agree with a as most correct

Question 25

26. Endoleak due to porous graft a. Type 1 b. Type 2 c. Type 3 d. Type 4 e. Type 5

Answer 25

d. Type 4 yes 26. Endoleak due to porous graft a. Type 1 b. Type 2 c. Type 3 d. Type 4 yes e. Type 5

Question 26

27. Type of Choledocal cyst that bulges into duodenum a. Type 1 b. Type 2 c. Type 3 d. Type 4 e. Type 5

Answer 26

c. Type 3 yes 27. Type of Choledocal cyst that bulges into duodenum a. Type 1 b. Type 2 c. Type 3 yes d. Type 4 e. Type 5

Question 27

28. Nigerian man with calcified bladder wall and sessile mass a. SCC b. Adenocarcinoma c. TCC

Answer 27

a. SCC yes 28. Nigerian man with calcified bladder wall and sessile mass a. SCC yes b. Adenocarcinoma c. TCC **SCS: [StatDx] associated with Schistosomiasis (Bilharzia of bladder). Fluke worm. Best clue: curvilinear bladder wall calcification in px from endemic area - ie Africa, India, Middle East. Can also involve Ureters. Acute and Chronic phases (contracted shrunken bladder, curvi calcification = eggs). DDX of bladder wall calc: includes TB, urolithiasis. **Associated with SCC** - chronic inflammation. Urachal remnant = adeno. TCC most common type of bladder ca

Question 28

29. Small bowel true a. Benign mass more common than malignant b. Carcinoid most common malignancy in the distal small bowel c. P-J adenomatous polyposis syndrome d. Lymphoma most common proximal small bowel e. Intusseption the most common presentation

Answer 28

*LW: b. Carcinoid most common malignancy in the distal small bowel: TRUE; with regards to distal small bowel most at risk for carcinoid and lymphoma, with carcinoid more common than lymphoma. (- Mets are more common than primaries. Adenocarcinoma 30-50%, carcinoid 25-30%, leiomyosarcoma 10%, lymphoma 15-20%.) 29. Small bowel true a. Benign mass more common than malignant: If referring to neoplasms, this is false with approx. 60% of small bowel neoplasms being malignant. b. Carcinoid most common malignancy in the distal small bowel: TRUE; with regards to distal small bowel most at risk for carcinoid and lymphoma, with carcinoid more common than lymphoma. (- Mets are more common than primaries. Adenocarcinoma 30-50%, carcinoid 25-30%, leiomyosarcoma 10%, lymphoma 15-20%.) c. P-J adenomatous polyposis syndrome: FALSE, Peutz jehgers syndrome is non neoplastic multiple hamartomatous polyps, being one of the polyposis syndromes. Although polyps are not malignant them selves, there is an increased risk of adenocarcinoma. d. Lymphoma most common proximal small bowel: FALSE - ileum. e. Intusseption the most common presentation: FALSE - Abdominal pain, weight loss, nausea, and vomiting were the most common presenting symptoms for small bowel tumors, radiologically: masses, concentreic lumen narrowing, complete bowel obstruction, circumfrential wall thickening of lymphoma, ulceration. Atypical imaging findings include intussecption. (https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3473441/) Previous answers; 29. Small bowel true a. Benign mass more common than malignant -yes b. Carcinoid most common malignancy in the distal small bowel -yes c. P-J adenomatous polyposis syndrome d. Lymphoma most common proximal small bowel e. Intusseption the most common presentation

Question 29

30. Well circumscribed breast mass containing fat and stroma Fibroadenoma Hamartoma PASH Oil cyst

Answer 29

30. Well circumscribed breast mass containing fat and stroma Hamartoma **SCS: added extra distractors.

Question 30

1. Test with MRI as gold standard, how to calculate prevalence disease by total population

Answer 30

*LW; Prevalence is a measure of disease that allows us to determine a person's likelihood of having a disease. Therefore, the number of prevalent cases is the total number of cases of disease existing in a population. A prevalence rate is the total number of cases of a disease existing in a population divided by the total population. So, if a measurement of cancer is taken in a population of 40,000 people and 1,200 were recently diagnosed with cancer and 3,500 are living with cancer, then the prevalence of cancer is 0.118. (or 11,750 per 100,000 persons) Incidence is a measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time. Therefore, incidence is the number of newly diagnosed cases of a disease. An incidence rate is the number of new cases of a disease divided by the number of persons at risk for the disease. If, over the course of one year, five women are diagnosed with breast cancer, out of a total female study population of 200 (who do not have breast cancer at the beginning of the study period), then we would say the incidence of breast cancer in this population was 0.025. (or 2,500 per 100,000 women-years of study)

Question 31

31. T3b N0 M0 rectal mass resected and irradiated 2 years ago, best next step a. MRI b. CT in 3 months c. PET/CT d. Biopsy

Answer 31

c. PET/CT yes 31. T3b N0 M0 rectal mass resected and irradiated 2 years ago, best next step * AJL - previous versions of this question have said 'CT shows presacral mass, next best step?' a. MRI b. CT in 3 months c. PET/CT yes d. Biopsy

Question 32

32. Shortness of breath, MEN, positive lungs on bone scan a. Alveolar microlithiasis b. Haemosiderosis c. Metastatic calcification

Answer 32

**LJS - disagree Metastatic calcification - secondary to HPT due to parathyroid adenoma. Get uptake on bone scan - often before CXR abn *LW - agree with LJS Previous answer: a. Alveolar microlithiasis yes 32. Shortness of breath, MEN, positive lungs on bone scan a. Alveolar microlithiasis yes b. Haemosiderosis c. Metastatic calcification

Question 33

33. Cystic lesion in a young male anterior to SCM, posterior to the angle of the mandible tail extending between the carotid and jugular vein a. 1st branchial cleft cyst b. 2nd branchial cleft cyst c. 3rd brancial cleft cyst d. Lymphangioma

Answer 33

b. 2nd branchial cleft cyst yes 33. Cystic lesion in a young male anterior to SCM, posterior to the angle of the mandible tail extending between the carotid and jugular vein a. 1st branchial cleft cyst b. 2nd branchial cleft cyst yes c. 3rd brancial cleft cyst d. Lymphangioma

Question 34

34. Young man with jaw lesion, partially formed tooth within cystic lesion displacing the roots of the molar a. Odontoma b. KCOT c. Dentigerous cyst d. Fibrous dysplasia

Answer 34

*AJL - Ondontoma. Gary agreed (essentially tooth hamartoma). **LJS - unsure. Dentigerous cyst surrounds crown of unerrupted tooth. Cyst encloses crown rather than being around roots I think odontoma - most common odontogenic tumour, contains tooth components, cystic early on Otherwise KCOT, displaces roots but ?doesn't contain partially formed tooth ***LW: difficult question, hope another dsicriminator would be present. I favour odontoma, as approx. half are associated with unerupted tooth (i.e. partially formed tooth stem), and initially begin as lucent (cytic component of stem). Pre test probability also favors odontoma, being most common lesion. Without mentioning crown, it makes me exclude dentigerous. c. Dentigerous cyst yes 34. Young man with jaw lesion, partially formed tooth within cystic lesion displacing the roots of the molar a. Odontoma b. KCOT c. Dentigerous cyst yes d. Fibrous dysplasia

Question 35

35. ZMC fracture a. Diplopia suggests inferior oblique entrapment b. ZF suture involvement means may be le fort III c. Downwards displacement of the medial canthus d. Facial numbness suggests facial nerve involvement e. Orbital floor involvement is rare

Answer 35

*AJL unsure. ZF suture involvement is typical of tripod fracture and le forte 3, the latter is is distinguished by involving nasofrontal suture, medial orbit, pterygoid plates etc. Either inferior oblique or inferior rectus may be trapped in an orbital floor fracture so this is probably the most likely? b. ZF suture involvement means may be le fort III -yes 35. ZMC fracture a. Diplopia suggests inferior oblique entrapment - no, inferior rectus b. ZF suture involvement means may be le fort III -yes c. Downwards displacement of the medial canthus - lateral d. Facial numbness suggests facial nerve involvement - V2 e. Orbital floor involvement is rare - no *ESG - agree b), diplopia due to IR entrapment is more classic for orbital floor blowout fracture, ZMC can get lateral rectus entrapment in the lateral wall fracture causing diplopia

Question 36

36. Young man with palm mass, patchy T1 high signal with partial suppression, patchy enhancement a. Haemangioma b. Lipoma

Answer 36

a. Haemangioma yes 36. Young man with palm mass, patchy T1 high signal with partial suppression, patchy enhancement a. Haemangioma yes b. Lipoma

Question 37

37. Twin peak sign in a pregnancy a. MCDA b. MCMA c. 2 placentas

Answer 37

c. 2 placentas yes 37. Twin peak sign in a pregnancy a. MCDA b. MCMA c. 2 placentas yes Twin peak sign: Wedge of chorionic tissue extending into base of intertwin membrane

Question 38

38. Older man with bicuspid valve, expected finding on MRI | a. Dilatation and hypertrophy of the left ventricle

Answer 38

38. Older man with bicuspid valve, expected finding on MRI | a. Dilatation and hypertrophy of the left ventricle

Question 39

39. Infective endocarditis, not an expected finding a. Perforated leaflets b. Thickened chordae c. Fusion of leaflets d. Perivalve abscess e. Annular pseudoaneurysm

Answer 39

**LJS -disagree. Chordae tendinae are involved (Robbins does not mention but radiopedia and papers do). I think fusion of leaflets if characteristic of chronic RHD and unexpected in infective endocarditis *LW: RObbins states infective endocarditis can affect the chordae or myocardium, resulting in destruction (figure 11.20 pg 428) Preferred answers: a. Perforated leaflets - true b. Thickened chordae - thickened and then can rupture c. Fusion of leaflets - think this is false, occurs in chronic rheumatic heart disease d. Perivalve abscess - true e. Annular pseudoaneurysm - true *AJL - To confuse things, one could argue that RHD causes fusion of the leaflets and therefore is not an unexpected finding in infective endocarditis even if not caused by endocarditis (what I'm trying to say is it's a stupid question) Previous answer: b. Thickened chordae no spared 39. Infective endocarditis, not an expected finding a. Perforated leaflets b. Thickened chordae no spared c. Fusion of leaflets d. Perivalve abscess e. Annular pseudoaneurysm

Question 40

40. Least likely place for red marrow a. Femoral diaphysis b. Ribs c. Spine d. Skull

Answer 40

a. Femoral diaphysis yes 40. Least likely place for red marrow a. Femoral diaphysis yes b. Ribs c. Spine d. Skull

Question 41

41. Inverted papilloma a. Associated with SCC b. Starts in nasal septum c. Cause of isolated frontal sinus opacification

Answer 41

a. Associated with SCC yes 41. Inverted papilloma a. Associated with SCC yes b. Starts in nasal septum c. Cause of isolated frontal sinus opacification *LW: Inverted papillomas most commonly occur on the lateral wall of the nasal cavity, most frequently related to the middle turbinate/middle meatus and maxillary ostium, although they are seen elsewhere in the nasal passage. As the mass enlarges it results in bony remodelling and resorption and often extends into the maxillary antrum. 10% either degenerate into or coexist with SCCa

Question 42

42. Mass in pterygopalatine fossa, where is it least likely to spread a. Into cranium b. Nose c. Infratemporoal fossa d. Maxillary sinus

Answer 42

d. Maxillary sinus yes 42. Mass in pterygopalatine fossa, where is it least likely to spread a. Into cranium b. Nose c. Infratemporoal fossa d. Maxillary sinus yes *LW: Pterygopalatine communications: - medially: communicates with the nasal cavity via the sphenopalatine foramen, which transmits the sphenopalatine artery, the nasopalatine nerve and the posterior superior nasal nerves - laterally: communicates with the masticator space (or infratemporal fossa) via the pterygomaxillary fissure - anteriorly: communicates with the orbit via the inferior orbital fissure (superiorly) - posteriorly and superiorly: communicates with the Meckel cave and cavernous sinus (of the middle cranial fossa) via the foramen rotundum - posteriorly and inferiorly: communicates with the middle cranial fossa via the vidian canal, which transmits the Vidian nerve - posteriorly and medially: the palatovaginal canal transmits the pharyngeal nerve and the pharyngeal branch of maxillary artery to the nasopharynx. - inferiorly: communicates with the palate via the greater and lesser palatine canals (often these canals arise from the one canal, referred to as either the greater palatine canal or the pterygopalatine canal)

Question 43

43. Post partum woman with hypodense thalami | a. Central venous sinus thrombosis

Answer 43

43. Post partum woman with hypodense thalami a. Central venous sinus thrombosis WJI: differential for thalamic lesions: wernickes, artery or Percheron infarct, central venous sinus thrombosis, CJD

Question 44

44. 30 year old guy, subtle loss of grey white differentiation in the right frontoparietal region. Sudden onset headache after all night party 1 week ago a. RCVS b. Dural venous sinus thrombosis

Answer 44

a. RCVS? * LW: ? implying cocaine use on a all night bender, and resultant reversible cerebral vasoconstriction syndrome, with resultant ischaemic changes... **LJS - could also consider venous infarct due to dural venous sinus thrombosis due to dehydration from boozing all night. How many different ways can we connect the dots? *AJL - Maybe he was a dick when he was drunk, got in a fight and has thrombosis secondary to trauma (though given it's one sided doesn't fit super well with sinus thrombosis) 44. 30 year old guy, subtle loss of grey white differentiation in the right frontoparietal region. Sudden onset headache after all night party 1 week ago a. RCVS? b. Dural venous sinus thrombosis

Question 45

45. 40 year old woman with headache post MVA, infarct in the frontal region on MRI a. Carotid artery injury

Answer 45

45. 40 year old woman with headache post MVA, infarct in the frontal region on MRI a. Carotid artery injury

Question 46

46. 40 year old woman with enlargement of the medial rectus muscle with mild stranding a. TED b. Orbital pseudotumour c. Lymphoma d. Metastases

Answer 46

b. Orbital pseudotumour ? 46. 40 year old woman with enlargement of the medial rectus muscle with mild stranding a. TED b. Orbital pseudotumour ? c. Lymphoma d. Metastases

Question 47

47. 3 year old with a calcified retinal mass a. Retinoblastoma b. Coats disease c. PPV

Answer 47

a. Retinoblastoma yes RB: enhancing calcified mass age <5 normal globe size Coat: exudate retinopathy. Slightly Small eye, hyper dense sub retinal exudate, rare to calcify ROP: bilateral, small eyes, increased attenuation due to haemorrhage, calcifies PPV: martini glass central stalk, increased attenuation vitreous, small eye, doesn’t calcify

Question 48

48. Regarding dissections (T) a. Expands the out diameter b. Intracranial more common c. Vertebral more common than carotid d. Spontaneous or due to injury

Answer 48

* AJL - also expands the outer diameter. d. Spontaneous or due to injury yes 48. Regarding dissections (T) a. Expands the out diameter b. Intracranial more common c. Vertebral more common than carotid d. Spontaneous or due to injury yes

Question 49

49. 40 year old woman with sinusitis and hypertension, vasculitis of medium and small renal vessels a. PAN b. Granulomatosis with polyangiitis c. Takayasu

Answer 49

b. Granulomatosis with polyangiitis yes 49. 40 year old woman with sinusitis and hypertension, vasculitis of medium and small renal vessels a. PAN b. Granulomatosis with polyangiitis yes c. Takayasu

Question 50

50. Regarding thymus a. Thymolipoma doesn’t compress the mediastinal structures b. Benign lesions spread along the pleura c. Hyperplasia most common form of enlargement in adolescents

Answer 50

**LJS - unsure. Thymolipoma commonly asx and conforms to surrounding structures, but when they have sx, it is due to mass effect on heart and lung (stat dx) Thymic hyperplasia is rare during adolescence (most anterior mediastinal masses are neoplasms) *AJL - Thymic hyperplasia is relatively uncommon so I would favour thymolipoma option overall. Don't really know though. a. Thymolipoma doesn’t compress the mediastinal structures yes 50. Regarding thymus a. Thymolipoma doesn’t compress the mediastinal structures yes b. Benign lesions spread along the pleura c. Hyperplasia most common form of enlargement in adolescents

Question 51

51. Plasma cell mastitis

Answer 51

51. Plasma cell mastitis Benign inflammatory condition typically in non-pregnant and non-lactating population. Rod like or cigar shaped calcifications due to inspissated secretions in or immediately adjacent to ectatic ducts.

Question 52

52. DCIS – (Mass on MRI, amorphous calcification

Answer 52

52. DCIS – (Mass on MRI, amorphous calcification * WJI disagree DCIS most commonly non mass like enhancment on MR with fine linear or non branching calcifications on mammogram

Question 53

53. ILC presentation a. Mamms >75% b. US <15 %

Answer 53

b. US <15 % no 53. ILC presentation a. Mamms >75% b. US <15 % no WJI: Statdx up to 30% occult on MG, 10% occult on US Most common: Irregular, hypoechoic mass with posterior shadowing (60%) Posterior shadowing in 77% of ILC vs. 56% of IDC IVM: RP 16% ILC mammo occult

Question 54

54. Medullary a. Poor prognosis b. Elderly c. Well defined d. Spiculated

Answer 54

c. Well defined 54. Medullary a. Poor prognosis b. Elderly c. Well defined d. Spiculated IVM: Agree. Medullary thyroid cancer typically has a worse prognosis cf papillary and follicular subtypes (RP), but overall 5yr survival 72% and 10yr 56% (statDx). Worst prognosis is anaplastic thyroid ca which occurs in older population and has a 5% 5yr survival. **SCS: Referring to breast ca.? Partially circumscribed on mammo. (Not spiculated- StatDx: irregular or spiculated border unusual for MC) Age: mean 54 (30-86). Mucinous typically elderly age group. Prognosis better than IDC. BRCA 1, triple neg “basal type”

Question 55

55. 50 year old Woman with well defined masses in the superficial parotids bilaterally, partially cystic with debris and septa on USS a. Sjogrens b. Mikulicz c. Pleomorphic adenoma d. Warthins e. Adenoid cystic carcinoma

Answer 55

a. Sjogrens yes 55. 50 year old Woman with well defined masses in the superficial parotids bilaterally, partially cystic with debris and septa on USS a. Sjogrens yes b. Mikulicz (IgG4 disease with non-specific enlargement of 2 or more salivary/lacrimal glands and xerostomia (dry mouth)) c. Pleomorphic adenoma d. Warthins e. Adenoid cystic carcinoma

Question 56

56. Which of these would you do an amniocentesis for (at 20 weeks)? a. Cisterna magna 8mm b. Renal pelvis 4mm c. Cerebellum 19mm d. Lateral ventricles 14mm

Answer 56

d. Lateral ventricles 14mm yes 56. Which of these would you do an amniocentesis for (at 20 weeks)? a. Cisterna magna 8mm b. Renal pelvis 4mm c. Cerebellum 19mm d. Lateral ventricles 14mm yes

Question 57

57. Hydroxyapatite presents as a. Periarticular foci of calcification b. Intraarticular calcification

Answer 57

a. Periarticular foci of calcification yes 57. Hydroxyapatite presents as a. Periarticular foci of calcification yes b. Intraarticular calcification IVM: More commonly peri-articular, but can be intra-articular. When intra-articular causes joint destruction i.e. Milwaukee shoulder

Question 58

58. Man getting stent post failed endarterectomy of extracranial internal carotid with PCA infarct. Most likely: a. Trigeminal artery b. Hypoglossal c. Fetal Pcom d. Azygous artery

Answer 58

c. Fetal Pcom yes 58. Man getting stent post failed endarterectomy of extracranial internal carotid with PCA infarct. Most likely: a. Trigeminal artery b. Hypoglossal c. Fetal Pcom yes d. Azygous artery

Question 59

59. 25 year old male post MVA with chest pain. Left sided pulmonary contusions. Smooth bulge at the anterior medial aspect of the aortic isthmus. No mediastinal haematoma, normal vital signs. a. Ductus diverticulum b. Transection c. Pseudoaneurysm d. Dissection

Answer 59

a. Ductus diverticulum yes 59. 25 year old male post MVA with chest pain. Left sided pulmonary contusions. Smooth bulge at the anterior medial aspect of the aortic isthmus. No mediastinal haematoma, normal vital signs. a. Ductus diverticulum yes b. Transection c. Pseudoaneurysm d. Dissection

Question 60

60. 35 year old from africa with T2 hyperintense regions surrounding the anterior commissure, some with diffusion restriction, basal meningeal thickening, mild hydrocephalus a. Cystercercosis b. Cryptococcus c. Lymphoma

Answer 60

b. Cryptococcus yes 60. 35 year old from africa with T2 hyperintense regions surrounding the anterior commissure, some with diffusion restriction, basal meningeal thickening, mild hydrocephalus a. Cystercercosis b. Cryptococcus yes c. Lymphoma

Question 61

61. What is least likely to cause T2 hyerintensity and T1 hypointensity of the L5/S1 endplates a. Modic type 2 b. Infection c. TB d. Ankylosing spondylitis e. Intravertebral disc herniation

Answer 61

a. Modic type 2 yes 61. What is least likely to cause T2 hyerintensity and T1 hypointensity of the L5/S1 endplates a. Modic type 2 yes b. Infection c. TB d. Ankylosing spondylitis e. Intravertebral disc herniation

Question 62

62. Least likely to have abnormal pulmonary vasculature a. TOF b. Coarctation c. PDA d. ASD e. VSD

Answer 62

b. Coarctation yes 62. Least likely to have abnormal pulmonary vasculature a. TOF b. Coarctation yes c. PDA d. ASD e. VSD

Question 63

63. Most likely with regard to TB a. Secondary not uncommonly presents with pneumothorax b. Primary associated with effusions c. Primary associated with cavitation

Answer 63

* LW: a. Secondary not uncommonly presents with pneumothorax: FALSE, no mention of penumothorax in radiopedia. b. Primary associated with effusions: TRUE - radiopedia states primary can present with effusions. c. Primary associated with cavitation: FALSE, usually dense consolidation mid - lower zones, peripherally. Primary pulmonary tuberculosis manifests as five main entities: 1) parenchymal disease: usually manifests as dense, homogeneous parenchymal consolidation in any lobe however, predominance in the lower and middle lobes (subpleural sites) is suggestive of the disease, especially in adults 1 2) lymphadenopathy 3) miliary opacities 4) Clustered parenchymal opacification may give a galaxy sign 5) pleural effusion Post primary / secondary: Parenchymal disease - ill-defined patchy consolidation - clustered parenchymal opacification may give rise to a galaxy sign - cavitation usually develops within the consolidation - fibroproliferative disease with coarse reticulonodular densities - endobronchial spread with "tree-in-bud" appearance, - healing results in fibrosis, volume loss and traction bronchiectasis - lymphadenopathy occurs only in 5% cases Airway disease - Central airway involvement results in bronchial stenosis which may lead to lobar collapse associated with traction bronchiectasis and mucoid impaction. Pleural disease - occurs in a minority of cases (18%) - small pleural effusion - pleural thickening - pleural calcification Previous answers: a. Secondary not uncommonly presents with pneumothorax yes 63. Most likely with regard to TB a. Secondary not uncommonly presents with pneumothorax yes b. Primary associated with effusions c. Primary associated with cavitation

Question 64

64. Most true regarding popliteal artery entrapment a. Reduced doppler waveform in posterior tibial artery with calf activation b. Medial displacement of the popliteal artery with knee extension

Answer 64

a. Reduced doppler waveform in posterior tibial artery with calf activation yes 64. Most true regarding popliteal artery entrapment a. Reduced doppler waveform in posterior tibial artery with calf activation yes b. Medial displacement of the popliteal artery with knee extension - no, medial displacement on ankle plantarflexion

Question 65

65. Young person inversion injury of ankle with anteriolateral pain most likely injured: a. Deltoid ligament b. ATFL c. PTFL d. Tibiofibular ligament

Answer 65

b. ATFL yes 65. Young person inversion injury of ankle with anteriolateral pain most likely injured: a. Deltoid ligament b. ATFL yes c. PTFL d. Tibiofibular ligament

Question 66

66. Older person with patellofemoral dominant arthropathy, most likely associated: a. Shoulder destruction b. Erosions of MCPJ’s c. Well corticated metatarsal erosions d. Sacroilitits e. Pubis symphysis calcification

Answer 66

e. Pubis symphysis calcification yes 66. Older person with patellofemoral dominant arthropathy, most likely associated: a. Shoulder destruction b. Erosions of MCPJ’s c. Well corticated metatarsal erosions d. Sacroilitits e. Pubis symphysis calcification yes **SCS: implying CPPD. Chondrocalcinosis: Meniscus. TFCC. Pubic symphysis. Retro-odontoid (if chronic), intervertebral discs. CPPD occurs in weird non weight bearing joints : patellofemoral, radiocarpal, talonavicular, shoulder, elbow. Cf OA.

Question 67

67. True regarding shoulder ultrasound a. Subscapularis injury associated with long head of biceps rupture b. Rotator cuff tear excluded if no fluid in subdeltoid bursa c. Long head of biceps best viewed with shoulder extension d. Supraspinatus best view with shoulder in flexion

Answer 67

a. Subscapularis injury associated with long head of biceps rupture yes * LW: can be associated with both long head biceps tear or dislocation. 67. True regarding shoulder ultrasound a. Subscapularis injury associated with long head of biceps rupture yes b. Rotator cuff tear excluded if no fluid in subdeltoid bursa c. Long head of biceps best viewed with shoulder extension (No. Shoulder neutral. Elbow flexed. Supinated wrist) d. Supraspinatus best view with shoulder in flexion (No. extension and internally rotated -arm behind back) **SCS: also SSC tears associated with bicep tendon dislocation/subluxations (medial)- anterior fibres contribute to the transverse ligament.

Question 68

68. Young man with low T1, High T2 expansile lesion with diffusion restriction in the petrous apex a. Cholesteatoma b. Cholesterol granuloma c. Petrous apicitis d. Hamartoma

Answer 68

a. Cholesteatoma yes 68. Young man with low T1, High T2 expansile lesion with diffusion restriction in the petrous apex a. Cholesteatoma yes b. Cholesterol granuloma c. Petrous apicitis d. Hamartoma

Question 69

69. Most true at anatomy scan a. Single vessel cord associated with renal or CHD in the absence of chromosomal abnormality b. Echogenic bowel is insignificant if normal chromosomes

Answer 69

a. Single vessel cord associated with renal or CHD in the absence of chromosomal abnormality yes *LW: Agree: Isolated finding in approx 65% of time. Can be associated with chromosomal abnormalities. In absence of chromosomal abnormalities, can result in IUGR. Other associations include renal anomalies / agrenesis, usually on same side as absent renal artery 69. Most true at anatomy scan a. Single vessel cord associated with renal or CHD in the absence of chromosomal abnormality yes b. Echogenic bowel is insignificant if normal chromosomes

Question 70

70. Spondyloepiphyseal dysplasia a. Bilateral asymmetric b. Delayed bone age c. Early osteoarthritis

Answer 70

* SD - technically bone age would be delayed too as ossification is delayed. c. Early osteoarthritis 70. Spondyloepiphyseal dysplasia a. Bilateral asymmetric b. Delayed bone age c. Early osteoarthritis