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153 Cards in this Set
- Front
- Back
What percent of esophageal cancer in SCC
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85-90%
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What type of cancer results from esophageal cancer after barretts
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adeno (10%)
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What are the 4 basic radiographic patterns of esophageal cancer
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annular constricting
polypoid infiltrative ulcerated mass |
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What is the least common pattern of esophageal cancer
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ulcerated mass
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What is the appearance of the annular constricting pattern
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irregular ulcerated stricture
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What is the appearance of the polypoid pattern of esophageal cancer
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intraluminal filling defect
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What is the appearance of the infiltrative pattern of esophageal cancer
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grows in the submucosa and may simulate a benign stricture and may also have a varicoid appearance
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What is the most common pattern of esophageal cancer
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annular constricting (ulcerated mass is the least commmon)
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What is the ddx of a large intraluminal esophageal neoplastic mass
4 |
spindle cell ca, squamous cell ca, leiomyosarcoma, fibrovascular polyp
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Are fibrovascular polyps diffuclt to diagnose with an esophagram
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yes, Pedunculated fibrovascular polyps are rare lesions, that are difficult to diagnose on esophagrams. Their movement during the examination producing an inconstant position and shape may be suggestive. The stalk is often difficult to identify.
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What are the findings in a patients that has an esophageal leimyoma
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intramural mass
calcification ulcerations possible |
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What is the most common benign esophageal mass
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leiomyoma (50%)
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What is the ddx of a leiomyoma
8 |
fibroma
neuroma neurofibroma lipoma hemangioma enetric duplication cyst lymphoma |
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can a leimyoma have an exophytic component
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yes (outside the esophagus lumen)
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What does a GIST arise from
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smooth muscle of the stomach wall
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Where with in the stomach wall can a GIST be located
3 |
submucosal
subserosal exophytic |
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What is common characteristic of a GIST
2 |
large and ulcerated
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Do GIST tumors commonly bleed
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yes
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What is the DDX of a solitary doudenal mass
9 |
Met
adenocarcinoma lymphoma leiomyoma GIST adenoma prolapsing gastric mucosa brunner gland adenoma ectopic pancreatic rest gastric polyp |
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What does a ectopic pancreatic commonly have
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a central dimple
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What is the DDx of nodular doudenal mucosa
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ectopic gastric mucosa
brunner gland hyperplasia nodular lymphoid hyperplasia villous adenoma varicies edema/hematoma doudenitis |
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Name 3 types of internal hernias
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paraduodenal (left or right)
paracecal lesser sac transmesenteric |
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What is the most common internal hernia
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paradoudenal (left)
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What is the cause of a paraduodenal hernia
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related to abnl development of transverse mesocolon, with bowel loops becoming trapped
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Where is the location of a right and left paraduodenal hernia
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R: lies behind hepatic flexure, extends through fossa of Waldeyer
L: extends through fossa of Landzert, with jejunal loops in the LUQ |
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Where is the pathway of a direct inguinal hernia
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Direct: passes medial to inferior epigastric vessels
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What is the pathway fo an indirect inguinal hernia
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Indirect: more frequent, 15% of all SBOs, passes lateral to inferior epigastric vessels
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What is a paradoudenal hernia
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Protrusion of bowel loops through mesenteric defect within abdominal cavity
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What are the pathways of a left and right paradoudenal hernia
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Left: Herniation via abnormal mesenteric fossa of Landzert
Right: Herniation via abnormal mesentericoparietal fossa of Waldeyer |
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What is the appearance of a paradoudenal hernia
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it appears as if the bowel loops are in a sac
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If a patient has mass affect on the cecum and wbc what should be suspected
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mass effect from abscess from diverticulitis or appendicitis
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What muscle margings might be obscured with appendicitis on KUB
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psoas or obturator margins
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What might percent of normal be will showing non-filling of the appendix
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20%
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What are some radiographic of appendinx in a barium enema
2 |
mass effect on medial cecum or TI
non-filling of appendix |
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What is considered an enlarged appendix by CT
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diameter of >6mm
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What are the CT findings of appendicitis
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thick walled/dilated appendix
wall enhancement periappenciceal stranding appendicolith abscess/phlegmon |
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What are three descriptive terms for an adenoma
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tubular
villous tubulovillous |
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What type of adenoma has the highest malignant potential
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villous
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Describe a villous adenoma
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Adenomatous polyp that contains predominantly villous ("shaggy" surface) elements
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What does a villous adenoma look like on a CT or BE
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Polypoid lesion with nodular or frond-like surface on BE or CT colonography
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What is frond like
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the leaves of a fern
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Are villous adenomas almost alway sessile
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yes
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Where do 50% of adenomas occur
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the rectosigmoid
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What is the colon cancer risk with a villous adenoma
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< 5 mm = < 0.5%
5-10 mm = 1% 10-20 mm = 10% > 2 cm = 50% |
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What does sessile refer to
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a broad based lesion (not on a stalk)
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What is a bowlers had a sign of in a double contrast study
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a sessile polyp
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What is the mexican hat a sign of in a double contrast study
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Pedunculated polyps: Arise from narrow stalk
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Do villous adenoma have a bowlers had sign
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no they have a fern like luminal margin
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Where do 50% of adenomas occur
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recto-sigmoid
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What are the risk factors for colon cancer
7 |
adenomatous polyps
family history crohns UC breast cancer endometrial cancer pelvic irradiation |
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What causes a greater increase of colon ca; UC or Crohns
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UC
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What is the duke staging criteria of colon ca (a-d)
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A: limited to mucosa
B: into (B1) or through (B2) muscularis propria w/o nodes C: with nodes (C1 and C2 as in B) D: distant mets |
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What is BI in the duke staging criteria
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into the muscularis propia
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What is B2 in the duke staging criteria
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through the muscularis propia
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What is C in the duke staging for colon ca
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Nodes
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What is by far the MC of an annular constricting lesion of the colon
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colon ca
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What is the ddx of annular constricting lesion of the colon
3 |
colon ca
ameboma mets |
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What is the ddx of colonic mass or filling defect
9 |
benign tumor
malignant tumor colitis cystica profunda pseudopolyps normal lymphoid tissue post inflammatory polyps endometriosis mucocele pneumotosis coli |
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Name 2 benign colonic masses
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polyp
lipoma |
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Name 3 malignant tumors of the colon
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adenoCa
lymphoma mets |
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What demographic most commonly gets hyperplasia of normal lymphoid tissue
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children
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What part of the colon will typically get endometriosis
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inferior sigmoid
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Describe the classic findings of a mucocele of the colon
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smooth filling defect at the base of the cecum
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Is the 'mass' caused by endometrosis in the colon intraluminal
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no,it is extrinsic mass effect associated with colonic implant
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What is the density of a mucocele on CT
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low density (less than muscle more than fat)
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What is another name of postinflammatory polyps
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filiform polys
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What patient will classicaly have filiform polyps
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UC
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Do filiform polyps occur in crohns patients
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yes
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What is a filiform polyp
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A projection of normal mucosa, which is usually comma shaped left by UC or other inflammatory condition
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What is thumbprinting a sign of
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submucosal edema or hemorrhage
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What study do you classically see thumbprinting
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single contrast barium enema
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What is the accordion sign
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this is what is seen on oral/barium contrast CT when there is significant wall thickeing
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Is it OK to do a barium enema if a patient has Pseudomembranous colitis
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NO! (risk of perf)
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What are the barium enema findings if one happend to be done in pseudomembranous colitis
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BE: shaggy, irregular colonic contour due to pseudomembranes w/barium filling clefts b/w them
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What is the DDX of pseudomembranous colitis
3 |
DDx: ischemia, UC, other infectious colitis
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What is the accordian sign
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CT: accordion sign (intraluminal contrast interposed b/w markedly thickened haustra), marked bowel wall thickening involving entire colon, low attenuation bowel wall
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What are the radiographic findings of CMV colitis
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Marked ulceration and nodularity of mucosal surface, similar to Crohn disease.
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What finding in a DC BE for UC
5 |
granular or stippled appearance
distribution of dz is continous from rectum with out skip lesion Circumferential bowel wall symmetry is maintained Mucosal ulcerations affect both sides of the bowel with equal severity Lead-pipe colon: short, narrow, tubular, and lacks haustrations |
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Do pt with UC have increased risk of colon ca
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yes
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What is the DDX of an ahaustral colon
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cathartic colon
infectious colitis |
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What are the extraintestinal manifestations of UC
8 |
Erythema nodosum
pyoderma gangrenosum Primary sclerosing cholangitis cholangioCA Arthritis sacroiliitis spondylitis Iritis |
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What are the MSK of UC
3 |
arthritis
sacroilitis spondylitis |
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What is mirizzi syndrome
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large stone at the junction of cystic and common hepatic duct resulting in obstruction of both these ducts
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Describe the narrowing of mirizzi syndrome
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Usually narrowing is eccentric, worse on the right side
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Do pt with mirizzi syndrome usually have cholecystitis
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yes
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Is there intrahepatic duct dilation in mirizzi syndrome
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yes
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What is an annular pancreas
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a pancreas that encircles the 2nd portion of the doudenum
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What are complications of annular pancreas
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pancreatitis, obstruction
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What are 3 causes of liver abscess
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pyogenic
amebic echinococcal |
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Where do most pyogenic abscess originate
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the billiary tree
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What are other areas of origin for pyogenic abscess
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portal vein
hepatic artery direct spread from adjacent organ |
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What do pyogenic liver abscess look like on CT
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hypoattenuating lesion with rim enhancement
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What percent of hepatic pyogenic abscess have gas
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20%
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Are septations common in pyogenic liver abscess
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yes
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What percent of pyogenic liver abscess are right lobe
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80%
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What percent of pyogenic liver abscess are multiple
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66%
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What is the mc location of amebic abscess of the liver
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Usually peripheral, in right lobe
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Do amebic abscess tend to be unilocular or multilocular
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unilocular
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What is the configuration of echinococcal cyst
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usually have smaller daugther cyst within a larger cyst
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What is the water lily sign of hydatid cyst
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detached cyst membrane may float inside the cyst
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What is another name for echinococcus
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hydatid
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What is generally seen surrounding an amebic abscess on CECT
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low attenuation rim of edema
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Where are the daughter cyst in relation to a hydatid cyst
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peripheral “daughter” cysts
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What neoplasm is in the ddx for hydatid cyst
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biliary cystadenoma will be multilocular with peripheral cyst.
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What should you suspect if a pancreas does not enhance post contrast
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necrotizing pancreatitis
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What is necrotizing pancreatisis
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Devitalized pancreatic tissue secondary to acute pancreatitis and resultant ischemia
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Describe necrotizing pancreatitis finding on NCCT
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Diffuse or localized decrease in density of pancreatic parenchyma
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Does necrotizing pancreatitis require surgery for debridement
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yes
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What is a good way to differentiate steatosis of the liver from a mass
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look for normal branching vessels traversing the fatty area.
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What do you expect to see in out of phase GRE in fatty areas
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loss of signal in high fat areas.
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What is the causes of hepatic steatosis
8 |
DM, pancreatitis, obesity, alcoholism, malnutrition, steroids, glycogen storage disease, chemotherapy
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What are the 2 most common areas of fatty liver (and fat sparring)
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adjacent to the ligamentum teres and GB fossa
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Name 5 characteristics that might help differentiate focal fat from tumor
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geographic borders
interdigitation of borders with adjacent nl liver lack of mass effect normal branching vessels rapid change over time |
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If extensive retroperitoneal LAD is seen what should be suspected
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lymphoma
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What does lymphoma look like on CT or MRI
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Multiple enlarged individual nodes or conglomerate nodal masses
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What organ is commonly enlarged in lymphoma
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the spleen.
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Can lymphoma encase vessels, displace organs, or obstruct ureters
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yes
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What are the 3 spaces of the retroperitoneum
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perirenal
anterior pararenal posterior pararenal |
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What is the difference between the radiographic appearance of a pneumoperitoneum and a pneumretroperitoneum
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Retroperitoneal air is more fixed in location than peritoneal air and tends to be linear in shape
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What type of enhancement does a cavernous hemangioma have on CECT
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nodular pattern of enhancement with central fill in
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What is the 2nd mc liver mass
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cavernous hemangioma
(mets mc) |
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Can lymphoma encase vessels, displace organs, or obstruct ureters
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yes
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What are the 3 spaces of the retroperitoneum
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perirenal
anterior pararenal posterior pararenal |
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What is the difference between the radiographic appearance of a pneumoperitoneum and a pneumretroperitoneum
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Retroperitoneal air is more fixed in location than peritoneal air and tends to be linear in shape
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What type of enhancement does a cavernous hemangioma have on CECT
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nodular pattern of enhancement with central fill in
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What is the 2nd mc liver mass
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cavernous hemangioma
(mets mc) |
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Do women tend to get hemangiomas more
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yes
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What percent of pt with hemangiomas have multiple liver hemangiomas
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10%
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Describe the findings of a hemangioma on CT
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Well-defined hypodense mass
Peripheral globular enhancement with gradual filling in Retention of contrast on delayed imaging |
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Describe the findings of a liver hemangioma on MR
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bright T2
same contrast findings as CT |
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What is DDX of a bright T2 liver lesion on MR
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cyst
cystic mets neuroendocrine mets |
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What is the ddx for the nodular peripheral enhancement as seen in a cavernous hemangioma
3 |
treated met
hemangioendothelioma angiosarcoma |
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What is the ddx for calcified liver lesions
10 |
ovarian cancer mets
granulomatous dz parasites pcp multiple abscesses echinococcus mucinous tumors melanoma osteosarcoma HCC hemangioma cyst multiple aneurysms |
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What is the ddx for mucinous tumors
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colon
breast ovary stomach |
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Type 3 choledochal cyst
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dilated at the ampula
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Type 1 choledochocele cyst
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fusiform dilation of CBD
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type 2 choledochocele cyst
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CBD diverticulum
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type 4a choledochocele cyst
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intrahepatic and extrahepatic
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type 5 choledochocele cyst
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intrahepatic only
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What is type 5 choledochocele cyst also known as
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caroli disease
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Is TB associated with a psoas abscess
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yes
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What are common causes of psoas abscess
5 |
TB
surgery hematogenous spread IVDA colonic process |
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What are 4 colonic processes that may lead to a psoas abscess
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diverticulitis
crohns appendicitis perforating neoplasm |
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Is it possible to definitively differentiate from hepatic adenoma, FNH and HCC reliably on US
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no
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How often is fat, calcification, and hyperdense hemorrhage seen in a hepatic adenoma
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Fat is demonstrated on CT in 7% of cases; coarse calcifications seen on CT in 5%; hyperdense hemorrhage is seen in up to 40%.
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Do hepatic adenomas have prompt arterial enhancement and wash out
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yes, and this makes it difficult to differentiate from HCC
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What demographic tends to get a hepatic adenoma
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females on OCP
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Are hepatic adenomas usually big or small
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big often >10cm and are often solitary
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What is a concern about a hepatic adenoma
|
bleeding (usually bleed internaly but can rupture into the peritoneum)
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What are the findings on NCCT in pts with hepatic adenoma
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usually hypodense (often very hypodense, almost like fat), but can have hyperdense areas related to hemorrhage
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What are the findings in CECT in a pt with a hepatic adenoma
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peripheral and then centripetal enhancement similar to hemangioma, except there is rapid washout
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What are the findings on MR in pts with hepatic adenoma
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T1: usually bright due to fat, may have additional bright areas related to hemorrhage
Often heterogeneous due to hemorrhage and necrosis Helpful feature is dilated vessels at the periphery |
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What are the findings on US in pts with hepatic adenoma
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More often hyperechoic, and can have central hypoechoic areas of necrosis and hemorrhage
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