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274 Cards in this Set
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. May-Thurner syndrome:
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1. May-Thurner syndrome: May-Thurner Syndrome (aka Crockett's Syndrome)
presents with chronic or acute venous thrombosis. The underlying abnormality is compression of the left common iliac vein between the right common iliac artery and lumbosacral spine. The typical patient is between the 2nd through 4th decade, with F:M ratio of 3:1. The three stages are: 1) asymptomatic compression of left common iliac vein without filling of collaterals and a pressure gradient < 2 mmHg; 2) intraluminal webs; and 3) thrombosis. Although a trial of thrombolysis may be beneficial, stent placement is considered the primary treatment and is usually attempted before surgery. Surgical treatment options for iliac vein occlusion include femoral to femoral venous or CFV to IVC bypass. Surgical results for May-Thurner are better than those with chronic venous thrombosis. |
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2. Brescia-Cimino AV fistula connects the: riw
A. Brachial artery to basilic vein B. Brachial artery to cephalic vein C. Brachial artery to brachial vein D. Radial artery to basilic vein E. Radial artery to cephalic vein |
E. Radial artery to cephalic vein
2. Brescia-Cimino AV fistula connects the: riw A. Brachial artery to basilic vein B. Brachial artery to cephalic vein C. Brachial artery to brachial vein D. Radial artery to basilic vein E. Radial artery to cephalic vein Brescia and colleagues constructed the first natural AV fistula between the radial artery and cephalic vein. The Brescia-Cimino shunt is still considered the gold standard for dialysis access. Source: 17th edition of Sabiston Textbook of Surgery (2004) pgs. 2081 and 2084. |
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3. The following statement regarding ABI is true: riw
A. Increased with exercise in patient with peripheral vascular disease B. Increased in normal patient post exercise (not during?) C. Best measured standing up D. Select higher pressure of the dorsalis pedis or post tibialis E. Select lowest pressure for brachial artery |
D. Select higher pressure of the dorsalis pedis or post tibialis
. The following statement regarding ABI is true: riw A. Increased with exercise in patient with peripheral vascular disease B. Increased in normal patient post exercise (not during?) C. Best measured standing up D. Select higher pressure of the dorsalis pedis or post tibialis E. Select lowest pressure for brachial artery ABI is decreased with exercise in patients with peripheral vascular disease. I believe it is increased in normal patients with exercise due to increased flow of blood to the extremities. ABI is measured lying down. For the ankle, you typically select the higher pressure between the dorsalis pedis and posterior tibial arteries. For the brachial, the blood pressure in both arms is measured and the higher of the two is used. |
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4. Regarding aortic dissection:
A. Most start at the left subclavian and extend to the diaphragm B. Separate the adventitia and media C. Something about ulcer |
A. Most start at the left subclavian and extend to the diaphragm
4. Regarding aortic dissection: A. Most start at the left subclavian and extend to the diaphragm B. Separate the adventitia and media C. Something about ulcer Aortic dissection is separation of the intima from the adventitia by blood within the medial layer. Blood is presumed to enter the media via a defect in the intima from either a linear tear or a penetrating ulcer from atherosclerosis. The incidence of aortic dissections are as follows: origin in descending aorta distal to left subclavian is 50% (DeBakey III with subtype IIIA extending to the diaphragm and IIIB below the diaphragm or Stanford B); origin in ascending with extension to descending aorta is 35% (DeBakey I or Stanford A); origin in and isolated to the ascending aorta is 15% (DeBakey II or Stanford A). I believe the IIIA subtype is more common. |
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5. Second most common origin of the left vertebral artery is: riw
A. Off aortic arch between the left subclavian and left carotid B. Off of left coronary C. Off aortic arch distal to subclavian artery D. Off of thyrocervical artery E. Off aortic arch proximal to left carotid |
A. Off aortic arch between the left subclavian and left carotid
5. Second most common origin of the left vertebral artery is: riw A. Off aortic arch between the left subclavian and left carotid B. Off of left coronary C. Off aortic arch distal to subclavian artery D. Off of thyrocervical artery E. Off aortic arch proximal to left carotid The vertebral arteries arise from the proximal subclavian arteries in 95% of cases. In 5% of people, the left vertebral artery arises directly from the aortic arch between the left common carotid and the left subclavian arteries. |
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6. Regarding the structure of the aorta:
A. The endothelium is 5-10 cells thick B. An ulcer presents as a focal contrast collection C. The serosa is composed of smooth muscle |
6. Regarding the structure of the aorta:
A. The endothelium is 5-10 cells thick B. An ulcer presents as a focal contrast collection C. The serosa is composed of smooth muscle (DW) This recall is incomplete and likely includes a correct answer about vasa vasorum I cannot find the thickness of the aortic endothelium anywhere. My gut feeling is that 5- 10 cells is too thick. On contrast CT, a penetrating aortic ulcer presents as a focally ulcerated plaque, which I guess could be a focal contrast collection. Lastly, I do not believe the serosa is composed of smooth muscle, but again I am not certain. |
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7. What do the vasa vasorum do?
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7. What do the vasa vasorum do?
Vasa vasorum means vessel within a vessel. In large and medium sized arteries, the cell layers of the media near the lumen are fed by diffusion. Because diffusion of oxygen from the lumen is inadequate to supply the outer cell layers of the media, arterioles arising from the adventitia send vascular twigs to the outer one-half to two-thirds of the media. These vessels are called the vasa vasorum. Interruption of flow in the vasa vasorum may lead to medial necrosis and aneurysm formation. Much basic science is being performed on the effects on the vasa vasorum from angioplasty and stent placement. Stents and angioplasty may lead to a temporary proliferation of the vasa vasorum. Sources: 5th edition of Robbins Pathologic Basis of Disease page 468 Cragg et al. The vasa vasorum and angioplasty. Radiology, 1983;148:75-80 Pisco et al. Vasa vasorum changes following stent placement in experimental arterial stenoses. JVIR 1993;4:269-73 |
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8. A plain film taken of a patient 24 hours post gastrostomy tube placement shows pneumoperitoneum. What should the radiologist do? Riw
A. Inform the clinicians that this is a normal finding and give fluids B. Confirm the position of the side holes C. Some other choices |
A. Inform the clinicians that this is a normal finding and give fluids
8. A plain film taken of a patient 24 hours post gastrostomy tube placement shows pneumoperitoneum. What should the radiologist do? Riw A. Inform the clinicians that this is a normal finding and give fluids B. Confirm the position of the side holes C. Some other choices Pneumoperitoneum 24 hours after placement of a percutaneous gastrostomy tube is a normal finding. |
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9. A patient that has just undergone right lower lobe lung biopsy begins to
cough up blood. What is the next step? Riw A. Put patient in left lateral decubitus position B. Intubate the right mainstem bronchus C. Put patient in right lateral decubitus position D. Bronchoscopy |
C. Put patient in right lateral decubitus position
9. A patient that has just undergone right lower lobe lung biopsy begins to cough up blood. What is the next step? Riw A. Put patient in left lateral decubitus position B. Intubate the right mainstem bronchus C. Put patient in right lateral decubitus position D. Bronchoscopy Always place the biopsied lung in the dependent position to prevent aspiration of blood into the contralateral lung. In this case, you would place the patient in the right lateral decubitus position. |
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10. Regarding splenic artery aneurysms:
A. More common in men B. Rupture in pregnancy C. Present with left upper quadrant mass D. Rarely calcify E. Highly associated with polyarteritis nodosa |
B. Rupture in pregnancy
10. Regarding splenic artery aneurysms: A. More common in men B. Rupture in pregnancy C. Present with left upper quadrant mass D. Rarely calcify E. Highly associated with polyarteritis nodosa Of more than 400 cases of ruptured splenic artery aneurysms in the literature, about 100 cases of ruptured splenic artery aneurysm during pregnancy have been reported, with only 12 cases of maternal and fetal survival.[42] Rupture occurred during the third trimester in two thirds of the cases and was typically misdiagnosed as splenic rupture or uterine rupture. Maternal mortality was 75% with a fetal mortality of 95%. Increased portal pressures, high splenic artery flow due to distal aortic compression, and progressive arterial wall weakening are contributing factors. Multiparity may increase the risk; 78% of patients with ruptured splenic artery aneurysms have been in their third pregnancy. Survival is most likely related to a "two-stage rupture," in which the lesser sac temporarily tamponades the bleeding aneurysm. Townsend: Sabiston Textbook of Surgery, 17th ed E. Highly associated with PAN - Not quite right. PAN (Polyarteritis Nodosa)- findings include luminal irregularities, occlusive lesions/stenosis (most common) and aneurysms. Affected areas tend to be visceral arteries, extremities and small branches of aorta. Not specifically associated with splenic artery. Also found in many diseases, not just PAN, including pancreatitis, pregnancy, portal hypertension, liver transplantation. Stanson et al PAN: Spectrum of Angiographic Findings RadioGraphics 2001; 21: 151. |
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11. A woman undergoing evaluation for liver transplant has a scan which shows
the hepatic artery filling from collaterals from the gastroduodenal artery. riw This is most likely due to: A. Congenital anomaly/normal variant B. FMD of the celiac artery C. Atherosclerosis of celiac artery D. Medial arcuate ligament compression E. Portal hypertension |
D. Medial arcuate ligament compression
Probably not a question anymore since this is a controversial topic |
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12. What presents as heart failure in a child? Riw
A. Tetralogy of Fallot B. Absent pulmonic valve C. Bicuspid aortic valve D. Right ventricular muscle band E. Aberrant left coronary artery |
C. Bicuspid aortic valve
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13. Neonate with enlarged scrotum with calcifications:
A. Neuroblastoma B. Meconium peritonitis C. Tuberculous peritonitis D. Hemangiomatosis E. Teratoma |
B. Meconium peritonitis
A. Neuroblastoma - the most common solid abdominal mass of infancy, the third most common malignant tumor of infancy (after leukemia and CNS tumors), and the second most common tumor in childhood (after Wilms). Neuroblastoma can occur anywhere along the sympathetic chain, although the majority are adrenal. The majority have calcifications. B. Meconium peritonitis - sterile chemical peritonitis due to perforation of bowel after third month of gestation due to high-grade or complete obstruction (atresia, meconium ileus, volvulus). On plain film, meconium peritonitis is characterized by intraabdominal calcifications, which may manifest as a peripherally-calcified pseudocyst, small scattered calcifications, large calcifications along the inferior surface of the liver and along the flanks, processus vaginalis, and in the scrotum. Calcifications are not typically seen in patients with CF. If the perforation event occurs close to birth, mortality is higher due to active leak from the perforation. Generally prognosis is good if the perforation site is completely healed, and surgery may not be required. C. Tuberculous peritonitis - most common presentation of widespread abdominal disease. The source of infection may be hematogenous or from rupture of a mesenteric lymph node. Peritonitis may manifest as ascites (loculated or free-flowing), necrotic lymphadenopathy, adhesions, and/or omental/mesenteric masses. Calcifications are not characteristic. D. Hemangiomatosis - characterized by multiple small superficial and visceral hemangiomas. Visceral hemangiomas may involve the liver, bowel, airway and brain. Patients may present with superficial hemangiomas plus jaundice (from liver involvement), GI bleeding (from intestinal involvement) or stridor (from airway involvement). E. Teratoma - second most common testicular tumor in young boys (after yolk sac tumor). Teratomas contain elements from more than one germ cell layer. Benign teratomas typically arise in the first four years of life. Teratomas may undergo malignant transformation in adulthood. Although sacrococcygeal teratomas are often discovered in newborns, testicular teratomas are not found in the neonatal period. Ultrasound demonstrates a well-circumscribed, heterogeneous, complex mass with calcifications. |
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14. Cause of echogenic cortex in kidneys in neonate: riw
A. ATN B. Renal artery stenosis C. Hypercalciuria D. Furosemide therapy E. Renal vein thrombosis |
A. ATN
A. ATN - temporary, reversible reduction in tubular flow. In children, ATN is usually caused by drugs (contrast, aminoglycosides, NSAIDs), ischemia, or myoglobin (following seizures). On ultrasound, the medulla demonstrates normal- to-decreased echogenicity with normal-to-increased echogenicity of the renal cortex. The pyramids are sharply delineated, and resistive indices are elevated. B. RAS - not common in the neonate. Renal artery stenosis most commonly occurs due to atherosclerosis, but may also occur due to fibromuscular dysplasia and arteritis. Physiologically, decreased perfusion pressure at the glomerulus results in increased release of renin by the juxtaglomerular apparatus and angiotensin II by the kidney, which cause increased aldosterone levels. Aldosterone increases salt and water retention to increase blood volume, and both angiotensin II and aldosterone act on the efferent arteriole, causing it to vasoconstrict and increase perfusion pressure to the glomerulus. On Doppler ultrasound, peak systolic velocity of the renal artery >200cm/s, ratio of peak renal artery velocity to peak aortic velocity >3.5, post-stenotic spectral broadening, tardus-et- parvus waveform in intrarenal arteries, and resistive indices <0.56 in intrarenal arteries are suggestive of renal artery stenosis. The absence of blood flow during diastole suggests >50% stenosis. C. Furosemide therapy - long-time furosemide therapy in premature infants and neonates with congestive heart failure results in hypercalciuria (see below). D. Hypercalciuria - increased calcium excretion in the urine. Causes of hypercalciuria include idiopathic and familial, medications (furosemide), immobilization, malignancy, and renal tubular acidosis. Hypercalciuria is associated with increased echogenicity of the renal pyramids and renal stone formation. E. RVT - can occur antenatally and in neonates/children. Causes include placental abruption, prematurity, birth trauma, dehydration, glycosuria (infants of diabetic mothers) and sepsis. Renal vein thrombosis occurs more commonly on the left due to the longer left renal vein. The radiographic appearance varies with acuity, extent, and collateral formation. Ultrasound usually shows an enlarged kidney with thrombus in a distended renal vein. Other findings may include focal areas of increased echogenicity due to hemorrhage and loss of corticomedullary differentiation. |
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15. All the following are associated with NEC except:
A. Most commonly involves the right colon and ileum B. Late finding is right sided stricture (should be left sided stricture for true) C. Associated with bacterial infection D. Pneumatosis E. Assoc with hyperosmolar feedings |
B. Late finding is right sided stricture (should be left sided stricture for true)
The complications of NEC are strictures, enterocyst formation, malabsorption, inflammatory polyps, and enteric fistulae. Intestinal strictures may follow either medical or surgical management of NEC and occur in 10% to 20% of survivors. Although NEC mostly affects the distal ileum and right colon, most strictures occur in the left colon, and most often occur in or adjacent to the splenic flexure. Colonic strictures are multiple in 30% of cases. Strictures can be treated more conservatively by balloon catheter dilatation. In children who have had diversion ileostomy or colostomy, it is important to evaluate the distal defunctionalized bowel with contrast enema to rule out strictures before reanastomosis. Necrotizing enterocolitis is bowel ischemia and necrosis, which may occur secondary to hypoxia, stress, infection/endotoxin (answer C), or congenital heart disease. It usually develops 2-3 days after birth, and 90% of cases develop within the first ten days of life. Premature and low-birth-weight infants are predisposed, as are patients with Hirschsprung disease and any type of bowel obstruction. Symptoms include abdominal distention, bilious emesis, diarrhea, bloody stools, and sepsis. On plain film, signs include small bowel distention, a disorganized bowel gas pattern, tubular bowel loops, thumbprinting (bowel wall edema), pneumatosis intestinalis/portal venous gas, pneumoperitoneum, and ascites. NEC usually involves the terminal ileum, cecum, and right colon (answer A). It rarely involves the stomach or proximal small bowel. Complications include bowel perforation in 10-30%, which is treated by surgical resection. If large amounts of bowel are resected, short bowel syndrome (diarrhea, malnutrition) may result. Inflammatory strictures develop in 80% of patients, characteristically in the left colon. |
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155 Regarding mesoblastic nephroma, which is false? riw
A is a malignant tumor B is most common renal mass in newborn C looks like Wilms tumor on US D Spreads by local invasion E Can be diagnosed in utero |
A is a malignant tumor
AFIP notes (Agrons): MN most common renal neoplasm infants < 3 mo old. May be detected by antenatal US. Infiltrative growth pattern. Varied appearance on post-natal US. Rx: nephrectomy with wide margins. Overall prognosis excellent. Mesoblastic nephroma (fetal renal hamartoma) is the most common renal tumor in infants. Mesoblastic nephroma is benign and typically occurs in the first four months of life. On prenatal ultrasound, an enlarged kidney may be seen in an infant with polyhydramnios. On renal ultrasound, mesoblastic nephroma typically appears as a hypoechoic mass without posterior enhancement, sometimes with cystic areas. CT demonstrates a solid mass which distorts the intrarenal collecting system. Mesoblastic nephroma appears hypointense on T1-weighted MR. Because the imaging appearance may overlap that of Wilms tumor, surgical resection is performed and the two tumors can be differentiated histologically. Although most cases are benign, rarely metastases have been reported in incompletely- resected tumors, with spread to the heart, lungs, brain and bone. In contrast, Wilms tumor has a peak incidence at 2-3 years of age, but is rare in neonates. Wilms tumor is the most common abdominal tumor and the most common renal malignancy in children. Wilms tumor may occur with certain syndromes, such as WAGR (Wilms, aniridia, GU anomalies, and mental retardation) and Beckwith-Weidemann syndrome (hemihypertrophy, macroglossia, abdominal wall defects). The majority of patients present with an abdominal mass. A solid mass with areas of necrosis may be identified on ultrasound. Typically CT is performed to evaluate for extension of tumor into the renal vein and IVC or heart, and to evaluate for pulmonary metastases. With multi-modality therapy, overall survival is 90%. |
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17. Neonate with large mass between bladder and rectum on ultrasound: riw
A. Sacrococcygeal teratoma B. Rhabdomyosarcoma C. Neuroblastoma D. Hydrometrocolpos E. Duplicated rectum |
D. Hydrometrocolpos
A. Sacrococcygeal teratoma - most are diagnosed neonatally. Sacrococcygeal teratoma occurs in the presacral space and may extend into the pelvis or protruding from the sacral area. If diagnosed prenatally, sacrococcygeal teratoma may be associated with polyhydramnios and tumor hemorrhage, which may result in anemia and hydrops. Delivery is recommended as soon as lung maturity is documented. If hydrops occurs before 30 weeks' gestation, mortality is greater than 90%. Cesarean section should be considered for large tumors to prevent rupture. The coccyx should be included in surgical resection, as failure to resect the coccyx results in a 35-40% recurrence rate. B. Rhabdomyosarcoma - most common soft tissue sarcoma in children. Rhabdomyosarcomas may arise in many locations, including the head and neck, orbit, extremities, trunk, genitourinary tract, and retroperitoneum. Within the genitourinary system, tumors may involve the bladder, uterus, cervix, vagina, prostate, and paratesticular region. GU rhabdomyosarcomas typically present in children between 2 and 6 years of age, typically as a painless mass or with bowel or bladder problems. Sarcoma botryoides refers to grapelike clusters of tumor masses that occur in the bladder or vagina. C. Neuroblastoma - most common tumor in infants. Neuroblastoma has several presentations. The most common presentation is bone pain and limp from distant bony metastasis. Two-thirds of patients have abdominal primaries (usually older children), and may present with an abdominal mass (adrenal, paravertebral, or presacral). Tumors arising in paraspinal sympathetic ganglia may cause neurologic symptoms, including Horner syndrome. In infants younger than 6 months, neuroblastoma may manifest as a small primary tumor with metastatic disease to the liver, bone marrow, and skin in neonates, the skin lesions may be confused with congenital rubella ("blueberry muffin"). Some patients may present with paraneoplastic syndromes, including myoclonus and diarrhea. D. Hydrometrocolpos - manifestation of imperforate hymen in neonates. The imperforate hymen obstructs the flow of mucoid secretions, which are under the influence of maternal estrogens. The retention of secretions (hydro) in the uterus (metro) and vagina (colpos) can cause mass effect, and may be discovered as a bulging hymen or palpable abdominal mass. Imperforate hymen is usually diagnosed in adolescents, and the mass effect is the result of retention of menstrual products (hematometrocolpos). E. Duplicated rectum - represents 5% of gastrointestinal duplications. Duplication of the rectum occurs in the presacral space (behind the rectum), and symptoms include constipation, bleeding, abscess, and fistula formation. GI tract duplications are characterized by a coat of smooth muscle, an epithelial lining, and an attachment to the GI tract. The most common site for GI duplication is the small intestine. |
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20. When can you see normal (physiologic) periosteal reaction in the long
bones? A. 1 month B. 3 months C. 12 months D. 2-5 years E. Puberty |
B. 3 months
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21. A child that has undergone no treatment presents with a calcified
mediastinal mass. The LEAST likely cause: riw A. Teratoma B. Thyroid carcinoma C. Lymphoma(only calcifies with treatment) |
C. Lymphoma(only calcifies with treatment)
21. A child that has undergone no treatment presents with a calcified mediastinal mass. The LEAST likely cause: riw A. Teratoma B. Thyroid carcinoma C. Lymphoma(only calcifies with treatment) Regarding lymphoma in general, according to Fraser and Pare's Chest textbook, "After treatment, particularly radiotherapy, dystrophic calcification may occur, most commonly in the anterior mediastinum. Rarely, nodal calcification is present at the time of diagnosis." A. Again, according to Fraser and Pare's Chest textbook, 21% of teratomas present with calcifications (in a series of 66 patients). B. Once again, according to Fraser and Pare's Chest textbook, thyroid carcinomas commonly calcify, but this is a rare pediatric disease. |
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22. Precocious puberty in a young girl with a left adnexal mass is most likely
caused by: riw A. Granulosa Cell Tumor B. Brenner Tumor C. Krukenberg Tumor |
A. Granulosa Cell Tumor
22. Precocious puberty in a young girl with a left adnexal mass is most likely caused by: riw A. Granulosa Cell Tumor B. Brenner Tumor C. Krukenberg Tumor Adnexal masses in children, generally: 60% are germ cell tumors, higher incidence of malignancy than adults 10-25% are sex cord stromal tumors (juvenile granulosa cell tumors, fibrothecomas) 15-20% are surface epithelial tumors, usually benign DD: neuroblastoma, Ewings/PNET, adnexal gland carcinoma, rhabdomyosarcoma, intraabdominal desmoplastic small cell tumor |
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24. 70 year old male falls and develops neck pain. Initial radiographs show
widening of anterior space of C4-5 and prevertebral soft tissue swelling. The most likely injury is: riw A. Hyperextension sprain B. Flexion teardrop fracture C. Bilateral interfacetal dislocation D. Traumatic spondylolysthesis E. Jefferson burst fracture |
A. Hyperextension sprain
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25. What is most likely to cause a neurologically devastating fracture in a child? riw
A. Anterior teardrop fracture (C5) B. Jefferson Burst C. Hangman's fracture D. UID E. Dens fracture |
A. Anterior teardrop fracture (C5)
A. Anterior teardrop fracture: If one assumes flexion teardrop injury, then this is a commonly neurologically devastating injury with instantaneous quadriplegia. This does not occur 100% of the time but significant neurological symptoms are very common in this unstable injury. Hyperflexion mechanism is seen with 46-79% of cervical spine injury. If one assumes hyperextension teardrop fracture, the most common location is at C2-3. 11% of patients have cervical myelopathy and upper neck pain. Hyperextension mechanism is seen with 20-38% of cervical spine injuries. |
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26. SLAC wrist is associated with:
A. CPPD crystals B. Scapholunate ligament tear C. Hydroxyapatite crystals D. TFCC tear |
B. Scapholunate ligament tear
26. SLAC wrist is associated with: A. CPPD crystals B. Scapholunate ligament tear C. Hydroxyapatite crystals D. TFCC tear (DW) This is assoc with CPPD but the ultimate causative insult is a SLL tear |
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27. Most severe wrist injury:
A. Perilunate dissociation B. Lunate dissociation C. Mid-carpal dissociation D. Scapholunate dissociation E. Lunate-triquentral dissociation |
B. Lunate dissociation
Injuries are described as those involving lesser or greater arcs. Pure greater arc injuries consist of trans-scaphoid, transcapitate, transhamate and transtriquetral fracture/dislocations. Pure lesser arc injuries consist of perilunate or lunate dislocations. Lesser arc injuries occur in 4 stages, with each successive stage indicating increased carpal instability. - Stage I = scapholunate dissociation with rotary subluxation - Stage II = perilunate dislocation - Stage III = triquetrolunate joint which may accompany triquetral malrotation, triquetrolunate diastasis, or triquetral fracture - Stage IV = lunate dislocation |
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28. Beta pleated sheets on histology most commonly associated with:
A. Amyloidosis B. Gout C. PVNS |
A. Amyloidosis
28. Beta pleated sheets on histology most commonly associated with: A. Amyloidosis B. Gout C. PVNS Amyloid: Beta-2 microglobulins are found in serum of normal individuals and in the urine in elevated amounts in patients with Wilson's disease, cadmium poisoning and other conditions leading to renal tubular dysfunction. Like immunoglobulins, prealbumin and beta protein found in amyloid, beta-2 microglobulin has a predominantly beta-pleated sheet structure that may adopt the fibrillar configuration of amyloid in certain pathologic states. Hemodialysis-related amyloidosis (HRA) is a form of systemic amyloidosis with a predilection for the synovium and bone that occurs with a high frequency among patients on long-term hemodialysis. Gejyo et al (1985) found that protein that accumulates in amyloid-laden tissues obtained from chronic hemodialysis patients was identical to B2M. Gout: Over production of uric acid, increased turnover of nucleic acids, increased synthesis of purines, defect in renal excretion of urates. On histology, tophi contain urates with highly vascular tissue and giant cells. PVNS: On histology, hyperplasia of undifferentiated cells. Connective tissue with multinucleated large cells ingesting hemosiderin lipoid foam/giant cells ¥ Villonodular appearance of synovial membrane + fibrosis. Pressure erosion/invasion of adjoining bone. |
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29. Patient presents with horizontally oriented superior and inferior pubic
rami fractures. Most likely mechanism is: A. AP compression B. Lateral compression C. Chronic stress fracture D. Vertical shear |
B. Lateral compression
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30. What is associated with posterior shoulder dislocation? Ask dan
A. Lesser tuberosity fracture B. Glenoid rim fracture C. SLAP D. Hill-Sachs E. Biceps tendon dislocation |
B. Glenoid rim fracture
# Posterior shoulder dislocation * Reverse Hill Sachs (anteromedial impaction fx) * Posterior band of IGHL is primary capsuloligamentous restraint & most at risk * Labrum (posterior; reverse Bankart) * Capsular tear or laxity * Fracture or ectopic calcification of posterior glenoid rim * Fracture lesser tuberosity * Teres minor lesion (partial tear/edema) |
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31. Gas in which of the following places most likely represents infection:
A. Intervertebral disk spaces B. Pubic symphysis C. Muscle D. Sacroiliac joints E. Vertebral body |
C. Muscle
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84. 12 yo girl with painless soft tissue calcifications around the shoulders, hips, and knees? riw
A) Juvenile gout B) Lesch-Nyhan C) Polymyagia rheumatica D) Tumoral calcinosis E) Myositis ossificans |
D) Tumoral calcinosis
D. Tumoral calcinosis: deposits of calcium salts in normal tissue. Seen in second-third decades. Autosomal dominant, M=F. Trauma is RARELY present. +family hx. PAINLESS SWELLING ABOUT THE HIPS AND THE SHOULDERS,ELBOWS AND ANKLES. MASSES OF CALCIUM SEEN AROUND JT. Resnick pg 1259. |
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33. Reasons to obtain post-contrast MR images with fat saturation include:
A. Differentiation of benign vs. malignant bone lesions B. Differentiation of benign vs. malignant soft tissue lesions C. Differentiation of abscess versus edema D. Differentiation of lipoma vs. subcutaneous fat |
C. Differentiation of abscess versus edema
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34. Which of the following is disrupted in an intraarticular biceps tendon
dislocation? A. Supraspinatus muscle B. Infraspinatus muscle C. Subscapularis muscle D. Teres minor muscle |
. Subscapularis muscle
34. Which of the following is disrupted in an intraarticular biceps tendon dislocation? A. Supraspinatus muscle B. Infraspinatus muscle C. Subscapularis muscle D. Teres minor muscle The long head of biceps muscle is attached to the anterosuperior aspect of the glenoid rim with fibers to anterior superior labrum, posterior superior labrum, supraglenoid tubercle and base of coracoid process. It exits the joint through intertubercular groove and is secured to intertubercular groove by transverse ligament. |
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35. 2 years after total hip arthroplasty, diffuse MDP uptake around the
prosthesis is most associated with: riw A. Loosening B. Osteomyelitis C. Fracture D. Heterotopic ossification |
B. Osteomyelitis
Increased uptake may be seen 12-24 months following implantation of a total hip prosthesis because of bone remodeling. The appearance of abnormal uptake surrounding a painful prosthesis has been used to differentiate loosening from infection. Loose prostheses tend to show increased uptake in the trochanters, at the stem tip, and possibly the acetabular shell. Bone scintigraphy is sensitive for infection but lacks specificity. Singular finding of a focal concentration at the stem tip in the absence of other abnormalities after one year is likely to be a normal variant rather than a sign of loosening, and it is also possible that a combination of stem tip and trochanteric uptake is normal. The probability of loosening is greatly increased by the presence of enhanced uptake around the femoral component. In cemented hip prostheses, the abnormally elevated uptake generally disappears within 6-12 months of surgery, and if persistent increased uptake is found, loosening or infection should be suspected. |
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36. Diffuse T2 high signal in the femoral head and neck, subchondral low
intensity rim and joint effusion: (compare to Q from 2005 that states presence of subchondral rim in transient osteoporosis) A. Transient osteoporosis B. Osteonecrosis C. Infection |
B. Osteonecrosis
A. Transient osteoporosis - Self-limited condition characterized by localized osteoporosis and pain. Unknown etiology. Joint space and articular cartilage preserved, in contrast to septic arthritis. Subdivided into regional migratory osteoporosis and transient osteoporosis of the hip. Transient osteoporosis of the hip affects middle-aged men, first described in women in their first trimester of pregnancy. MR appearance: low signal intensity on T1WI, and increased signal intensity on T2WI and STIR. Acetabulum is not usually involved, joint effusions common. AVN may present with similar MR findings, so look for an osteonecrotic focus. B. Osteonecrosis - Also known as avascular necrosis. Usually caused by trauma. Results when the vascular supply to the femoral head is disrupted during injury. Nontraumatic AVN - alcoholism, hypercortisolism, Gaucher's, obesity, hemoglobinopathies. MR imaging more sensitive then CT or Radionuclide bone scintigraphy. Specificity 98%, sensitivity 97%. Stage 0 - no clinical or radiographic changes. Stage I - trabeculae appear normal or slightly porotic. May show single line on T1WI and double line on T2WI (double line sign specific and pathognomonic for AVN, consists of concentric low and high signal intensity bands on T2WI) Stage II - progression to diffuse porosis and sclerosis. Shell of reactive bone demarcates the area of infarct. Stage III - loss of the spherical shape of the femoral head. Stage IV - femoral head undergoes further collapse, leading to articular destruction and joint space narrowing. Joint effusions are also seen. |
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37. All of the following are associated with EG except: riw
A. Diabetes insipidus B. Renal failure C. Thymus D. Lytic skull lesion E. Vertebra plana |
B. Renal failure
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38. Anistropy on US is seen in:
A. Tendon B. Muscle C. Cartilage D. Bone E. Synovium |
A. Tendon
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39. Posterior (extensor) compartment of the forearm shows T2 hyperintensity in the
muscles. Which nerve is compressed? A. Radial nerve B. Ulnar nerve C. Interosseous nerve (actually post interosseus) D. Median nerve E. Axillary nerve |
39. Posterior (extensor) compartment of the forearm shows T2 hyperintensity in the
muscles. Which nerve is compressed? A. Radial nerve B. Ulnar nerve C. Interosseous nerve (actually post interosseus) D. Median nerve E. Axillary nerve (DW) Post interosseus, a branch of radial, supplies extensors A. Radial nerve - Radial tunnel syndrome occurs in the elbow affecting the extensor muscles of the forearm. Typically caused by elbow fracture/dislocation, rheumatoid arthritis, tumor, fibrous band, and vigorous exercise. The nerve supplies motor innervation to the extensor carpi radialis longus, extensor carpi radialis brevis, and the supinator before splitting into deep and superficial branches. B. Ulnar nerve - Supplies the flexor muscles of the forearm flexor carpi ulnaris, flexor digitorum profundus, hypothenar. C. Interosseous nerve - The Radial nerve turns into the posterior interosseous nerve and supplies sensation to the dorsal aspect of the carpal joints. D. Median nerve - Pronator syndrome affects thenar muscles, wrist flexors. Carpal tunnel syndrome affects abductor pollicis brevis, opponens pollicis, flexor pollicis brevis. E. Axillary nerve |
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40. Which of the following is a contraindication to breast conservation
therapy? riw A. Prior radiation B. Positive margins after lumpectomy C. Multifocal tumors D. Mass greater than 3 cm E. Positive palpable axillary nodes |
A. Prior radiation
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41. Which of the following are characteristics of malignancy with dynamic
breast MRI imaging? A. Enhances more slowly than glandular tissue B. Early washout C. Increasing enhancement with delayed images D. Early enhancement |
The most predictive sign of malignancy with
dynamic breast MR imaging is early washout of contrast. |
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42. Regarding saline implant rupture:
A. Need MR to diagnose if intracapsular B. Can diagnose extracapsular rupture by mammogram C. Appears as a collapsed shell on mammography D. Presents as fluid collections around implant E. Patients are typically asymptomatic |
C. Appears as a collapsed shell on mammography
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116. What is true about saline implant rupture?
A) cannot diagnose with mammography B) need MRI to identify intracapsular rupture C) decompressed implant on mammography D) cystic collections of increase T2 on MRI |
C) decompressed implant on mammography
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43. Which of the following is a characteristic finding two years after a
benign breast biopsy? A. Calcified sutures B. Thickening of the skin can last for years post-biopsy C. Ill-defined mass at the site of previous biopsy is suggestive of biopsy D. Milk of calcium E. Calcified intrascrotal mass (was this meant to be intraductal mass?) |
B. Thickening of the skin can last for years post-biopsy
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44. Motion artifact of the breast most likely to be seen on the:
A. CC view medially B. CC view laterally C. CC view centrally D. MLO superiorly E. MLO inferiorly |
E. MLO inferiorly
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45. A patient has a negative mammogram. 9 months later the patient has a
palpable mass. The lesion is removed and is positive for intraductal carcinoma. The negative mammogram was: A. False positive B. False negative C. True positive D. True negative |
B. False negative
45. A patient has a negative mammogram. 9 months later the patient has a palpable mass. The lesion is removed and is positive for intraductal carcinoma. The negative mammogram was: A. False positive B. False negative C. True positive D. True negative A false negative screening mammogram is defined in Dahnert's as a pathologic diagnosis of breast cancer within 1 year after a negative mammogram with the following three types of misses. The lesion could not be seen in retrospect (25-33%). This is an "acute cancer" Ð cancer surfacing in the screening interval. The cancer was undetected by the first reader but correctly identified by a second reader (14%). Finally, the lesion was visible in retrospect on prior mammogram (61%). Mammographically missed cancers can be due to a large number of reasons, including technically inadequate films, failure to image region, observer error, benign appearance to a malignant lesion, and tumor biology (small size, failure to incite desmoplastic reaction or lack of calcifications). Malignant calcifications may not change for up to 63 months and a malignant mass may not change in size for up to 4.5 years. |
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46. What is the reasoning behind performing a mammogram after lumpectomy, but
before radiation therapy? A. Reestablish baseline B. Make sure calcification resected C. Make sure mass is resected D. To aid in selection of a radiation port |
B. Make sure calcification resected
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47. A lesion in the upper breast on MLO is not seen on CC. It moves higher on
ML view. Where is it located? A. Upper inner B. Upper outer C. Lower inner D. Lower outer |
A. Upper inner
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48. Cluster of microcalcifications is seen only on the CC view but not on the
MLO view. Reasons for this include all of the following except: riw A. Milk of Calcium B. Dermal calcification C. Artifact D. Noise E. Not included on MLO view |
A. Milk of Calcium
Dermal calcifications may be a cluster of small calcifications when imaged directly that are not seen when the skin is imaged tangentially on a different view. Microcalcifications excluded from one view and included on another will obviously not be seen on the film they are excluded from. The MLO is susceptible to missing lesions in the medial breast, so the CC view should include the medial breast. |
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49. All the following are MQSA guidelines except:
A. Physicist comes once a month B. Mechanism for addressing complaints C. Must give lay report to the patient in 30 days D. Phantom testing must be done weekly E. Something about two film sizes |
A. Physicist comes once a month
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50. When performing a needle localization for breast biopsy, where should the
hook be? A. In the lesion B. Just proximal to the lesion C. 1 cm distal to the lesion D. Somewhere else |
C. 1 cm distal to the lesion
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. Excisional biopsy within the right breast returned LCIS and sclerosing
adenosis. Next step A. Bilateral mastectomies B. Right-side mastectomy C. Lumpectomy and radiation D. 6 month mammography E. Annual mammograms |
E. Annual mammograms
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20) Regarding ultrasound-guided core biopsy:
A) Uses 18-gauge needles B) Cheaper than stereotactic C) Unable to biopsy superficial masses D) Should xray specifmen to ensure inclusion of target |
B) Cheaper than stereotactic
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53. In patient with small bowel bypass, what is the most common type of stone?
A. Struvite B. Calcium oxalate C. Calcium phosphate D. Matrix E. Urate |
B. Calcium oxalate
The most common cause of secondary oxalosis is small bowel disease, especially after bypass operations for morbid obesity. |
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54. 40 year old with hypertension, hypokalemia, and metabolic acidosis(should be alkalosis). What
is the most likely cause? A. Adrenal adenoma B. Pheochromocytoma C. Juxtoglomerular tumor D. FMD |
A. Adrenal adenoma
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55. Which is true about urethral stricture in a male?
A. Catheter-induced stricture is at the peno-scrotal junction B. GC causes focal short segment stenosis C. Anterior urethra extends from urethral meatus to the peno-scrotal junction |
Catheter induced strictures are long, irregular and at the penoscrotal
junction. GC strictures are several centimeters long and typically in the anterior urethra. |
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56. All the following is associated with retroperitoneal fibrosis except:
A. Lymphoma B. AAA C. Methysergide D. Hematoma E. XGP |
E. XGP
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57. Post-partum female with flank pain and fever. 24-hour delayed nephrogram,
no caliectasis: riw A. Obstructive nephropathy B. ATN C. RVT D. Cortical necrosis |
C. RVT
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54) Adenomyosis, what is false?
a) sharply defined b) may be focal c) may be diffuse d) can get areas of high signal intensity e) widened junctional zone |
a) sharply defined
* Thickening of junctional zone on T2WI o Low signal zone represents inner layer of myometrium o > 12 mm is diagnostic o 8-12 mm is suggestive o < 8 mm is normal o Junctional zone to myometrial thickness > 40% * Focal areas of bright T2 signal o Dilated endometrial glands * Focal areas of bright T1 signal o Foci of hemorrhage * Adenomyoma o Oval ill-defined mass + Often within junctional zone o Low signal intensity on T2 + From smooth muscle hypertrophy * Gadolinium not helpful o Adenomyomas and fibroids both enhance |
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59. In a male with a history of self catheterization, where is the most likely
place for a stricture to form? A. Penoscrotal junction B. Anterior urethra C. Other places |
A. Penoscrotal junction
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60. Regarding epidermoid cyst of the testis:
A. It is post-traumatic B. Can be biopsied by transscrotal approach C. Has alternating hyperechoic and hypoechoic rings on ultrasound D. Is predominantly cystic with multiple tiny echogenic foci on US E. Is hyperechoic |
C. Has alternating hyperechoic and hypoechoic rings on ultrasound
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60. Regarding epidermoid cyst of the testis:
A. It is post-traumatic B. Can be biopsied by transscrotal approach C. Has alternating hyperechoic and hypoechoic rings on ultrasound D. Is predominantly cystic with multiple tiny echogenic foci on US E. Is hyperechoic |
C. Has alternating hyperechoic and hypoechoic rings on ultrasound
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61. Regarding renal lymphoma:
A. Is predominantly associated with Hodgkin's B. Is multifocal C. Has increased through transmission D. Is hyperechoic |
B. Is multifocal
61. Regarding renal lymphoma: A. Is predominantly associated with Hodgkin's B. Is multifocal C. Has increased through transmission D. Is hyperechoic (DW) Assoc with non-hodgkins, is hypoechoic like cyst but no through transmission |
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62. Multilocular cystic nephroma:
A. Has a stellate central scar B. Can be diagnosed in utero C. Is premalignant D. Commonly presents with lymph node mets E. Protrudes into collecting system F. Shows homogeneous contrast enhancement |
. Protrudes into collecting system
Contrast enhanced CT scan shows well-defined intrarenal, multilocular mass that compresses or displaces the adjacent renal parenchyma. The septations enhance but the cysts do not. They are typically unilateral. There is no renal parenchyma within the cysts and no connection to the collecting system, although the cysts can herniate into the renal pelvis, which is a pathognomonic finding. It may then present with hydronephrosis and/or hematuria. Calcification is uncommon (10%). The uninvolved kidney is generally normal. Other characteristics: Sometimes difficult to distinguish from cystic renal cell cancer that usually has thick nodular septa. Multilocular cystic nephromas are congenital lesions characterized by large (>10 cm) cystic spaces. The cysts are lined by cuboidal epithelium. Two distinct histological entities: Cystic nephroma without blastema elements within septa; and partially differentiated nephroblastoma with blastema elements within septa. Both are indistinguishable by imaging. Multilocular cystic nephromas are surgically removed because distinction from cystic Wilm's tumor is not possible by imaging modalities. |
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63. Urethral diverticulum in females:
A. Arises from posterior wall B. Associated with stress incontinence C. Congenital abnormality D. Usually associated with recurrent infection |
D. Usually associated with recurrent infection
D. Usually associated with recurrent infection - true. Complications of urethral diverticula include recurrent infection, stone formation (10%) and adenocarcinoma/malignant degeneration (5% of all urethral carcinomas). |
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64. Pseudodiverticula of the ureter are: riw
A. Associated with/secondar to TB B. Commonly located in the distal ureter C. Prone to rupture D. Prone to malignancy E. More common in elderly |
D. Prone to malignancy
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103. Pseudodiverticula of the ureter in an adult
A) seen with tuberculosis B) seen with malignancy C) are congenital D) in the distal ureters |
B) seen with malignancy
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65. In a postmenopausal woman not on HRT, at what thickness is an endometrial
biopsy indicated? A. 3 mm B. 5 mm C. 7 mm D. 9 mm E. 11 mm |
B. 5 mm
Criteria for thickened endometrial stripe: - >5mm in postmenopausal women not taking hormonal therapy. - >14 mm in premenopausal women (varies with stage of cycle). Causes: |
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66. Regarding hysterosonography:
A. It is best performed during the secretory phase of the menstrual cycle B. It is performed to differentiate types of endometrial pathology C. It is performed transabdominally D. Iodinated contrast is used |
B. It is performed to differentiate types of endometrial pathology
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67. Ovarian torsion:
A. Cannot be present with Dopplerable blood flow B. Seen most commonly in postmenopausal females C. Can be present without masses or cysts D. Is more common on the left |
C. Can be present without masses or cysts
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170. True in ovarian torsion
A) not associated with ovarian masses B) flow means no torsion C) enlarged ovary D) usually in elderly |
C) enlarged ovary
Torsed ovaries are often enlarged (>4 cm in diameter), vary in appearance from cystic to solid, and in echogenicity. In many instances, there is an associated ovarian mass. Doppler flow is of limited value (it’s appearance and intensity is variable); documentation of blood flow in an ovary does not exclude torsion, and presence of arterial and/or venous flow does not exclude torsion. Torsion usually occurs in women during the fertile years and frequently occurs during pregnancy. |
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139. Which is most associated with ovarian torsion?
A. ovarian malignancy B. enlarged ovary C. torsion more often on left than right |
B. enlarged ovary
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68. Most common testicular cancer in a 30 year old:
A. Seminoma B. Lymphoma C. Choriocarcinoma D. Teratoma |
A. Seminoma
Germ cell tumors (GCTs) have the following subtypes and frequencies: seminoma (40%), embryonal (25%), teratocarcinoma (25%), teratoma (5%), and choriocarcinoma (pure) (1%). (DW) Lymphoma is most common in > 60 yo. Teratoma in very young patients. |
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69. DWI restricted mass with rim enhancement:
A. Abscess B. GBM C. Chronic lacunar infarct D. Hematoma |
A. Abscess
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70. Patient with focus of DWI change and normal T2 signal:
A. Acute bleed/stroke (<6 hours) B. Subacute bleed/stroke (6-24 hours) C. 1-7 days post bleed or 1-7 day old stroke D. 7-30 days post bleed or 7-30 day old stroke |
A. Acute bleed/stroke (<6 hours)
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MRI demonstrates area of bright signal on diffusion, low signal on ADC and normal T2 in insular cortex.
a. Herpes b. Acute infarct (minutes to hours) c. Subacute infarct (days to weeks) d. Chronic infarct (months to years) |
b. Acute infarct (minutes to hours)
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71. A man has a history of hepatocerebral disease. Findings in the basal
ganglia on MRI include: A. High T1 B. Low T1 C. High T2 D. Low T2 |
A. High T1
- Low T1 Basal Ganglia: Leigh Disease, venous infarction, hypoxic ischemia encephalopathy, toxic encephalopathy. - High T1 Basal Ganglia: Hepatocellular degeneration, parenteral nutrition. - Low T2 Basal Ganglia: Normal aging, degenerative diseases (MS, Parkinson). - High T2 Basal Ganglia: Mitochondrial cytopathy, venous infarction, hypoxic ischemia encephalopathy, toxic encephalopathy. Leigh Disease: subacute necrotizing encephalomyelopathy, autosomal recessive disorder, due to deficiency in pyruvate carboxylase, pyruvate dehydrogenase, and cytochrome c oxidase, resulting in anaerobic ATP production and lactic acidosis. |
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72. Lateral Wallenberg Syndrome is associated with:
A. Ipsilateral PICA B. Contralateral PICA C. Ipsilateral AICA D. Contralateral AICA |
A. Ipsilateral PICA
The PICA supplies blood to the lateral portion of the medulla, which includes the inferior cerebellar peduncle, vestibular nuclei, descending sympathetic and trigeminal tracts, spinothalamic tracts and the nucleus ambiguus and solitary tract and nucleus. Lateral medullary infarction produces Wallenberg's syndrome of ipsilateral limb and gait ataxia, dizziness, nystagmus, loss of pain and temperature sensation on the face with loss of corneal reflex, Horner's syndrome, hoarseness and palatal weakness with loss of taste and contralateral loss of pain and temperature sensation on the body. |
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73. Most common presentation of neurocysticercosis: riw
A. Women more frequent than men B. Seizure C. More commonly seen in the immunocompromised D. Intraventricular E. The organism is a fungus |
B. Seizure
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74. A patient with NF 2 is most likely also to have: riw
A. Meningioma B. Optic glioma C. Chromosome 17 D. Lateral meningocele E. Cafe au lait spots |
A. Meningioma
NF 2 is linked to chromosome 22 (NF2 = 22) and is autosomal dominant with a high penetrance. The patient will also have a predisposition to developing CNS tumors (meningiomas, schwannomas). It typically presents as bilateral vestibular schwannomas in >90% of the gene carriers. Unlike NF 1, these patients do not typically manifest cafe-au-lait spots or peripheral neurofibromas. NF 1 is a congenital disease causing benign tumors of peripheral nerves. NF 1 is disease with autosomal dominant inheritance involving an NF-1 gene on chromosome 17 (NF1 = 17). The diagnosis is generally made in childhood or adolescence due to the appearance of cafe-au- lait macules. The disfiguring cutaneous neurfibromas appear a few years later. Criteria can be met with two of the following: six or more cafe-au-lait macules; two or more neurofibromas of any type or one plexiform neurofibroma; axillary or inguinal freckles; bilateral optic glioma; two Lisch nodules (iris hamartomas); osseous dysplasia (sphenoid wing, occipital, or tibial pseudoarthrosis). Furthermore, there is an increased incidence of certain tumors (including optic gliomas, acoustic neuromas, pheochromocytomas, and astrocytomas). T2-weighted MRI is generally the best study for imaging neurofibromas due to a large amount of water in the lesions. |
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75. Most common location for intraventricular meningioma: riw
A. 4th ventricle B. Foramen of Monro C. Anterior portion of the lateral ventricle D. Atrium of the lateral ventricle E. Posterior aspect of the 3rd ventricle |
D. Atrium of the lateral ventricle
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76. Wernicke's encephalopathy is associated with:
A. Caudate nucleus atrophy B. Atrophy of the mamillary bodies C. Temporal lobe atrophy D. Hippocampal atrophy |
B. Atrophy of the mamillary bodies
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77. Most likely to be associated with meningomyelocele:
A. Obliterated cisterna magna B. Hypertelorism C. Enlarged posterior fossa |
A. Obliterated cisterna magna
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78. A child with tethered cord is most likely to present with:
A. Paralysis B. Scoliosis C. UTI D. Constipation |
B. Scoliosis
(DW) Many different recalls of this question. The bottom line is that these kids present with lower extremity weakness (70%) and scoliosis (20%). Not paralysis. |
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79. A woman who is 2 weeks post partum presents with headache, pituitary mass,
and hypopituitarism. Scans show a homogeneously enhancing pituitary gland. A. EG B. Pituitary apoplexy C. Craniopharyngioma D. Rathke cleft cyst E. Lymphocytic hypophysitis F. Glioma G. Arachnoid cyst |
E. Lymphocytic hypophysitis
Presentation * Most common signs/symptoms: Headache, visual impairment * Clinical profile: Peripartum female with headache, multiple endocrine deficiencies Terminology * Lymphocytic hypophysitis (LH); adenohypophysitis; primary hypophysitis; stalkitis * Idiopathic inflammation of the anterior pituitary gland Imaging Findings * Best diagnostic clue: Thick nontapered stalk, +/- pituitary mass Top Differential Diagnoses * Pituitary hyperplasia * Macroadenoma (prolactinoma) * Metastasis * Sarcoid Clinical Issues * Most common signs/symptoms: Headache, visual impairment |
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80. Which one represents the Vein of Galen? (In 2002, they asked which one was
the basal vein of Rosenthal.) |
80. Which one represents the Vein of Galen? (In 2002, they asked which one was
the basal vein of Rosenthal.) A = inferior sagittal sinus B = internal cerebral vein C = thalamostriate vein D = straight sinus E = basal vein of Rosenthal Vein of Galen is formed by B+E. |
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81. All the following are absolute indications to decrease the dose of
perfusion agent for a V/Q scan except: riw A. Left to right shunt B. Pediatric patient C. Pneumonectomy D. Pulmonary arterial hypertension E. Prior PE |
A. Left to right shunt
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82. A patient who has been treated with ablation for thyroid cancer now
presents with rising thyroglobulin levels. I-131 scan is negative. What is the next step? A. FDG PET scan B. Second ablation therapy C. Repeat study 6 months later D. Surgery |
A. FDG PET scan
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83. Nuclear medicine quality control procedures. Which one is correct: riw
A. Bar phantom: Pixels B. Extrinsic Flood: Collimator C. Intrinsic Flood: Linear homogeneity |
B. Extrinsic Flood: Collimator
The extrinsic (collimator on) and intrinsic (collimator off) floods are used to assess field uniformity, and one of these floods is performed daily. Intrinsic testing uses a point source at 5 ft or greater from the crystal while extrinsic testing uses a disc source of cobalt 57 or phantom filled with Tc99m solution at the collimator face. The bar phantom is used weekly to test spatial resolution/linearity and is positioned on the collimator. |
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84. Contraindication to administration of adenosine during a nuclear cardiac
stress test: riw A. Heart Block B. Iodine allergy C. Claudication D. Exertional angina E. Status post CABG F. Angina at rest |
A. Heart Block
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85. An asymptomatic man with prostate cancer with rising PSA. A bone scan shows
a single focus of Tc99m-MDP uptake in a posterior rib. riw A. Osseous metastasis B. Rib fracture C. Artifact caused by muscle insertion D. Multiple myeloma |
B. Rib fracture
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154. A patient with prostate CA has a rising PSA and no bone pain. Tc-99m MDP bone scan shows single, solitary focus of uptake in a single posterior rib. This is most likely:
A) Metastatic disease B) Fracture (?old trauma) C) Multiple myeloma D) Osteomyelitis E) fibrous dysplasia F) Pagets disease |
B) Fracture (?old trauma)
B) Rib Fracture The majority of solitary rib lesions on bone scans in patients with cancer are benign in origin (plurality= rib fractures), especially if they are focal (vs. linear) and located at the anterior rib end. The likelihood of metastatic disease with a new focal uptake in a single rib in a patient with known cancer is <20%. In contrast, the likelihood of metastatic disease with new solitary spine lesions in > 40%. |
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86. All of the following are true regarding PET scan in the interictal period
except: A. Has a 90% sensitivity in localizing seizure focus B. Greater asymmetry in temporal lobes better postoperative outcome C. If basal ganglia have low activity, then that indicates poorer postoperative outcome D. Low signal in seizure focus E. Common in frontal and temporal lobe |
A. Has a 90% sensitivity in localizing seizure focus
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142. Regarding imaging with F-18 FDG PET in a patient with refractory seizures in an interictal period which is FALSE:
A) The seizure focus with appear hypometabolic B) Temporal and frontal lobe foci are most common. C) If the basal ganglia also appear hypometabolic, this is associated with an increased incidence of post-surgical seizures. D) Imaging is approximately 90% effective at isolating the seizure focus. |
D) Imaging is approximately 90% effective at isolating the seizure focus.
FDG PET imaging can play an important role in localization of seizure focus and pre-surgical evaluation in patients with partial seizure disorders. PET imaging with FDG will demonstrate focus of decreased glucose utilization at the site of interictal seizure focus in 60 to 70% of patients with normal MRIs (1). In the ictal state, PET FDG imaging will reveal focus of increased glucose uptake.” |
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87. In a MUGA scan, a spuriously high EF can be caused by:
A. Placing background over spleen B. Placing background over fluid-filled stomach C. Placing background outside patient D. Including left atrium within LV ROI E. Including descending aorta within LV ROI |
A. Placing background over spleen
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88. All of the following are true concerning Tc99m sestamibi in parathyroid
imaging except: riw A. Uptake is dependent largely on hypervascularity B. Thyroid cancer is a false positive C. Sensitivity is dependant on size of the lesion D. Intraoperative proble will improve detection E. Will not be detected if washes out early |
A. Uptake is dependent largely on hypervascularity
Lesion size plays an important role in scintigraphic detection. Prolonged Tc-Sestamibi retention within the parathyroid adenoma is felt by some to be related to the presence of mitochondrial rich oxyphil cells within the lesion (remember that Tc-Sestamibi is felt to localize within mitochondria). Tc-sestamibi uptake within a thyroid adenoma or thyroid carcinoma, or a cervical lymph node can produce a false-positive exam. False negative exams occur in patients with parathyroid hyperplasia. When feasible, concomitant suppression of thyroid uptake (induced by exogeneous thyroid hormone administration) can improve localization of parathyroid lesions with Tc-sestamibi. Sestamibi imaging in conjunction with an intraoperative probe (gamma camera) provides both localization information of a suspected parathyroid adenoma and facilitates its surgical removal by reducing operation time (decreased surgical time correlates with decreased associated peri-surgical morbidity).(The Requisites) Benign and malignant thyroid nodules are the most common false positive in parathyroid imaging. Uptake relates to the presence of mitochondria-rich oxyphil cells and possibly to lesion size, but references don't mention hypervascularity as a correlation. |
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147. Regarding hepatobiliary imaging with Tc-99m DISIDA:
A) DISIDA is passively transported into hepatocytes and is then excreted into bile unconjugated B) DISIDA is actively transported into hepatocytes and is then excreted into bile conjugated C) DISIDA is actively transported into hepatocytes and is then excreted into bile unconjugated D) DISIDA is actively transported into reticuloendothial cells and is then excreted into bile unconjugated E) DISIDA is passively transported into reticuloendothial cells and is then excreted into bile unconjugated |
C) DISIDA is actively transported into hepatocytes and is then excreted into bile unconjugated
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90. Power analysis is used to:
A. Determine sample size B. Double confidence interval for 2 SD C. Test experimental hypothesis D. Look for bias (unsure which one) |
A. Determine sample size
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185. In epidemiology, regarding the power of a study, which is true?
A) number of subjects incorporated into study B) Two standards of confidence interval C) Secondary verification of null hypothesis |
A) number of subjects incorporated into study
Power is intricately bound to sample size—too small a sample and the potential to miss a significant difference is too great (Type II error). Too large a sample and the risk of detecting a trivial difference as significant is too great (Type I error). Power analysis is a procedure to balance between Type I and Type II error. Researchers always face the risk of failing to detect a true significant effect. The probability of this risk is called Type II error, also known beta. In relation to Type II error, power is defined as 1 - beta. In other words, power is the probability of detecting a true significant difference. To enhance the chances of unveiling a true effect, a researcher should plan a high-power and large-sample-size test. However, when the test is too powerful, even a trivial difference will be mistakenly reported as a significant one. In other words, you can prove virtually anything with a very large sample size (Type I error). Power is intricately bound to sample size - too small a sample and the potential to miss a significant difference is too great (Type II error). Too large a sample and the risk of detecting a trivial difference as significant is too great (Type I error). |
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91. A test for Alzheimer's has a specificity of 99.9% and a sensitivity of
50%. Your patient has a positive test. Which one of the following is true: A. The patient most likely has the disease B. You need to know prevalence of the disease before deciding if the patient has the disease C. The negative predictive value is no better than a coin flip. D. You need a more sensitive test before you diagnose Alzheimer's |
A. The patient most likely has the disease
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181. Specific test for Alzheimer’s disease has 99.9% specificity and 50% sensitivity. Your patient has a positive test. Which of the following are true?
A) negative predicative value is a coin flip B) positive predictive is too low to make a decision C) need to know the prevalence D) your patient likely has Alzheimer’s Disease E) you need a more sensitive test. |
D) your patient likely has Alzheimer’s Disease
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92. To be useful, a diagnostic test must: riw
A. Change management B. Be minimally painful C. Be inexpensive D. Be non-invasive |
A. Change management
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93. Which one of the following is true regarding Gadolinium DTPA:
A. Dosage is 0.1 mmol/kg B. Dosage is 1 mmol/kg C. Isoosmolar D. Same allergic profile as iodinated contrast E. Crosses the intact blood-brain barrier |
A. Dosage is 0.1 mmol/kg
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94. Which of the following is not a contraindication to MRI:
A. Non-ferrous staples do not get hot B. Non-functioning cardiac pacemaker C. Patient with an aneurysm clip who has successfully/uneventfully undergone prior MRI |
C. Patient with an aneurysm clip who has successfully/uneventfully undergone prior MRI
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96. All of the following are true regarding MR artifacts except:
A. Aliasing is due to something out of FOV (due to smaller FOV than a the body part imaged) B. Chemical shift occurs in the frequency encoding direction C. Pulsation occurs in frequency encoding direction D. Chemical shift is more prominent in higher magnetic field E. Chemical shift occurs between fat and water interfaces |
C. Pulsation occurs in frequency encoding direction
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97. In Cardiac MRI, which plane is best to see both the tricuspid and mitral
valves? riw A. Sagittal B. Coronal C. Horizontal long axis D. Short axis E. Vertical long axis |
C. Horizontal long axis
Horizontal long axis, also known as the 4 chamber view, is best to evaluate both the tricuspid and mitral valves. The short axis view (doughnut) is best to evaluate myocardial mass, chamber volume and aortic / mitral valves. The vertical long axis, also known as the right anterior oblique, best evaluates the interventricular septum. - Short axis: assessment of regional ventricular function quantification of LV and RV volumes, ejection fractions and mass - Three chamber view: assessment of anteroseptal and inferolateral walls of the LV (left ventricular assessment of mitral and aortic valves outflow tract) - Two chamber view:evaluation of anterior and inferior wall motion (vertical long axis) assessment of LA appendage - Four chamber view: evaluation of septal and lateral walls (horizontal long assessment of size and function of RV and tricuspid valve axis) |
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98. In Cardiac MRI, which plane is best for left ventricular volume?
A. Sagittal B. Coronal C. Short axis D. Horizontal long axis E. Vertical long axis |
C. Short axis
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99. In Cardiac MRI, 20-minute delayed post-gadolinium images are acquired to:
A. Predict functional recovery after infarct B. Predict functional recovery after therapy C. Evaluate mitral valve after mitral valvuloplasty D. Predict future MI E. Predict future ischemia F. Assess normal regional function after revascularization |
A. Predict functional recovery after infarct
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100. MR findings of valvular disease: rw
A. Systolic jet with aortic stenosis B. Diastolic jet with mitral insufficiency C. Diastolic jet with pulmonic stenosis D. Systolic jet with tricuspid stenosis |
A. Systolic jet with aortic stenosis
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101. Which of the following is a branch of the left circumflex?
A. Diagonal B. Acute Marginal C. Obtuse Marginal D. Septal Perforator |
C. Obtuse Marginal
RCA- Conal, Acute marginal, AV nodal, sinoatrial, pda LAD- septal and diagonal LCA- Obtuse marginal |
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102. Focal ischemia of the interventricular septum is associated with:
A. Left anterior descending B. Left circumflex C. Left acute marginal D. Left obtuse marginal E. Right coronary artery |
A. Left anterior descending
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103. Blood supply to the interventricular septum:
A. Circumflex B. RCA C. LAD D. Posterior descending |
C. LAD
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104. On gadolinium-enhanced MR angiography, focal signal dropout in vessels
can be caused by all of the following except: A. Part of artery outside field of view B. Slow flow in vessel C. Metallic clips adjacent to artery D. Occlusion E. Stenosis |
B. Slow flow in vessel
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105. Calcification in the coronary artery on CT:
A. Absence of calcification is less likely to have significant atherosclerotic disease B. Don't need cardiac gating if CT is fast enough C. Patients over 70 years can have Ca without atherosclerotid disease |
A. Absence of calcification is less likely to have significant atherosclerotic
disease Trivia: Frequency of vessel involvement Ð LAD (93%) > LCx (77%) > LMain (70%) > RCA (69%) |
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106. A 40 year old male presents with newly diagnosed calcific aortic
stenosis. This finding is most likely secondary to: A. Rheumatic valvular disease. B. Atherosclerosis. C. Bicuspid aortic valve. |
C. Bicuspid aortic valve.
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107. The most likely cause of restrictive cardiomyopathy is:
A. Idiopathic hypertrophic subaortic stenosis (IHSS). B. Amyloidosis. C. Sarcoidosis. D. Alcoholic cardiomyopathy. |
B. Amyloidosis.
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108. Regarding true LV aneurysm, which of the following is true:
A. Most commonly located at the apex. B. Commonly rupture. C. Commonly calcify. |
A. Most commonly located at the apex.
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109. Which of the following is most commonly seen in aortic stenosis:
A. LV dilatation. B. Angina pectoris. C. Prominent aortic knob. |
B. Angina pectoris.
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11. Aortic stenosis is commonly associated with:
A) angina B) dilated left ventricle C) sinus of valsalva aneurysm D) aortic knob enlargement |
A) angina
A) Angina Angina seen in 30% -40%. Asymptomatic latent period of 10-20 years, then see classic triad of chest pain, heart failure, and syncope. Instead of a bounding pulse, get carotid pulsus parvus et tardus. The ascending aorta dilates, not usually the knob. The left ventricle can be normal, small and thick; dilatation is usually a late complication. |
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110. Bowel protruding laterally to rectus abdominus: riw
A. Spigelian hernia B. Femoral hernia C. Obturator hernia D. Incisional hernia E. Lumbar hernia |
A. Spigelian hernia
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45. A lesion in the liver is isointense on T1 and T2 to the spleen. What is the most likely diagnosis?
A) Adenoma B) FNH C) HCC D) Hemangioma E) Metastasis |
E) Metastasis
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112. Arterial and portal phase enhanced images are most useful for assessing:
A. Metastatic disease B. HCC C. FNH |
B. HCC
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168) For which of the following would obtaining a CT with arterial and PV imaging be useful?
a. Metastatic transitional cell ca b. HCC c. FNH d. Lymphoma |
b. HCC
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113. The most specific finding of acute mesenteric ischemia:
A. Mesenteric venous gas B. Occlusion of SMA C. Pneumoperitoneum D. Dilated bowel E. Ascites F. Concentric thickening of bowel wall (target appearance) |
A. Mesenteric venous gas
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114. 34 year old woman presents with RUQ pain, hepatomegaly, and ascites.
Transjugular biopsy of the liver shows hepatic necrosis: A. Budd Chiari syndrome B. HELPP C. Autoimmune hepatitis D. Primary biliary cirrhosis |
C. Autoimmune hepatitis
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115. Right lower quadrant fluid filled mass with peripheral calcification:
A. Pseudomyxoma peritonei B. Appendiceal mucocoele C. Chronic appendicitis D. Loculated ascites E. Cecal diverticulitis |
B. Appendiceal mucocoele
Appendiceal mucocele is caused by distention of the appendix with sterile mucus. The mean age at diagnosis is 55, and females are affected four times more commonly than males. It is associated with a 6-fold increased risk for developing adenocarcinoma of the colon. Patients may be asymptomatic or may present with a palpable mass and acute or chronic RLQ pain. Peripheral punctate or rim-like calcifications are common. |
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Which finding is most characteristic of intraductal papillary mucinous tumor of the pancreas?
a. Diffuse pancreatic ductal dilatation b. 5 or more macrocysts c. multiple microcysts d. 5 cm mass |
a. Diffuse pancreatic ductal dilatation
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117. Most common lesion seen in the pancreas in a patient with Von Hippel
Lindau: A. Islet cell carcinoma B. Hemangioma C. Cyst D. Microcystic adenoma E. Pancreatic adenocarcinoma |
C. Cyst
Approximately 72 % of the people with Von Hippel Lindau have simple pancreatic cysts. Also associated, but less commonly, are ductal cell adenoma, ampullary carcinoma, hemangioblastoma, microcystic adenoma, and nonfunctional islet cell tumor. |
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118. Gastrin stimulates:
A. Emptying of the gallbladder B. Polypeptide secretion from stomach C. Polypeptide secretion from pancreas D. Bicarbonate secretion E. Gastric acid secretion |
E. Gastric acid secretion
In other recalls stated as stimulates parietal cells to secrete acid CCK stimulates pancreatic enzyme secretion and gallbladder contraction. VIP and secretin stimulate bicarbonate secretion. |
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119. ERCP shows contrast in the pancreatic acini. This is most associated
with: A. Chronic pancreatitis B. Obstruction of the pancreatic duct C. Malignancy of the pancreatic ducts D. Post-procedure pancreatitis |
D. Post-procedure pancreatitis
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120. MRCP cannot evaluate:
A. Pancreatic divisum B. CBD stone C. Primary biliary cirrhosis D. Pseudocyst E. Choledochocele |
C. Primary biliary cirrhosis
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121. Parietal pleural involvement by lung cancer. At least a stage:
A. II B. IIIa C. IIIb D. IV |
B. IIIa
(DW) This would be a T3 at least and if pleural effusion a T4 and then IIIb. If only visceral pleura it’s a T2 and without any other info can be as low as IB and as high as IIIA given LN status. |
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122. Lymphangitic carcinomatosis most characteristically shows:
A. Centrilobular ground glass opacities B. Beaded septal interstitium with polygonal arcades C. Uniform septal thickening D. Perihilar bronchovascular interstitial thickening E. Some other distribution of ground glass opacity |
B. Beaded septal interstitium with polygonal arcades
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123. Sarcoid granulomas most typically occur.
A. Bronchopulmonary lymphatics B. Centrilobular interstitium |
A. Bronchopulmonary lymphatics
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124. A patient with multiple focal pulmonary densities. Open lung biopsy
revealed alveolar hemorrhage and small vessel vasculitis. Most likely cause: A. Alveolar proteinosis B. Pulmonary emboli C. Goodpasture's D. Wegener's |
D. Wegener's
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106) See bilateral lower lobe multifocal opacities, biopsy reveals necrosing angitis
a) Wegener’s b) Goodpasture’s c) TB |
a) Wegener’s
Ans: A. Although according to Dr. Galvin, all 5 lobes are equally affected in Wegener’s. Differential diagnosis of necrotizing angitis includes Churg Straus (fleeting infiltrates), Necrotizing Sarcoid Granulomatosis (which is not caused by Sarcoid, but by aspergillous, and has hilar adenopathy), and Lymphomatoid Granulomatosis (a pre-B cell lymphoma, with multiple bilateral nodules and rapid death). Dannert: early findings at bases, progessing to nodules and masses, typically sparing the apices p 534 |
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A lung biopsy in a 35 y/o female shows alveolar hemorrhage and small vessel vasculitis:
a. Wegener’s granulomatosis b. Goodpasture’s syndrome c. Idiopathic pulmonary hemosiderosis d. Needle contamination with cat feces |
a. Wegener’s granulomatosis
Answer D: (Fraser and Pare's Diagnosis of Diseases of the Chest, 4th edition, page: 1494-1499). Wegener's is a small and medium sized vasculitis involving both arteries and veins. Grossly there are pulmonary nodules and masses (1-10 cm). The nodules can become necrotic and sometimes the alveoli surrounding them are blood filled. The typical radiographic picture is of nodules ranging in size from a few millimeters to 10 cm. Cavitation eventually occurs in 50% of the cases. The second most common finding is air space disease from pulmonary hemorrhage. This can be local, adjacent to a nodule, involve a whole lobe or both lungs, diffusely. |
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112 Open lung biopsy demonstrates hemorrhage in alveoli and small vessel vasculitis. Most likely cause?
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B Goodpasture’s syndrome
Goodpasture’s: Lung biopsy shows extensive hemorrhage with accumulation of hemosiderin-laden macrophages within alveolar spaces. Neutrophilic capillaritis, hyaline membranes, and diffuse alveolar damage may also be found. Medium-vessel or large-vessel vasculitis is not a feature. In Wegener's granulomatosis, the entire respiratory tract from nasal septum to pleura can be involved with necrotizing inflammation. The typical pathologic features seen on open lung biopsy are (1) parenchymal necrosis, (2) vasculitis, and (3) granulomatous inflammation. |
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125. 24 year old confused, disoriented male has Cheyne-Stokes respiration and
bilateral upper lobe opacities. Most likely cause: A. Septic emboli B. Aspiration C. Neurogenic pulmonary edema D. Pneumonia |
C. Neurogenic pulmonary edema
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126. All of the following are associated with Swyer-James except: riw
A. Increased lung volumes B. Hyperlucency C. Hypoplastic pulmonary artery D. Air-trapping E. Bronchiectasis |
A. Increased lung volumes
Swyer-James syndrome (SJS) is a manifestation of postinfectious obliterative bronchiolitis. In SJS, the involved lung or portion of the lung does not grow normally and is slightly smaller than the opposite lung. The characteristic radiographic appearance is that of pulmonary hyperlucency, caused by overdistention of the alveoli in conjunction with diminished arterial flow |
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127. Acquired bronchiectasis is seen in all of the following except:
A. Pulmonary hemosiderosis B. Immotile cilia C. CF D. Immune problems |
A. Pulmonary hemosiderosis
Idiopathic pulmonary hemosiderosis is an old term, nowadays referred to as idiopathic pulmonary hemorrhage (IPH). Radiographically it is indistinguishable from Goodpasture's. There are recurrent bouts of pulmonary hemorrhage resulting in airspace disease. As it resolves one can see numerous centrilobular tiny nodules on HRCT. With recurrent bouts of hemorrhage, hemosiderin is deposited in the interstitium and can result in progressive fibrosis. I realize that any pulmonary fibrosis can result in traction bronchiectasis, but bronchiectasis is not described with IPH and even if one may theoretically see them, they will not form the predominant pattern. In all of these, the patient is born without bronchiectasis and develops them later. In the immotile cilia syndrome there is abnormal mucociliary transport, stasis of mucous in bronchi, blocking them leading to bronchiectasis. In cystic fibrosis there are abnormal tenacious secretions, blocking the bronchi leading to bronchiectasis and recurrent infections that also lead to bronchiectasis. With immune problems such as IgG deficiency, CGD of childhood there are recurrent infections leading to bronchiectasis |
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128. 34 year old untreated patient presents with a calcified anterior
mediastinal mass. Least likely diagnosis: A. Lymphoma B. Thymoma C. Aorta D. Germ cell tumor E. Thyroid goiter |
A. Lymphoma
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129. In Boerhaave's syndrome:
A. Pneumomediastinum is an early finding B. Bilateral pleural effusions are more common than unilateral C. Occurs in the mid-thoracic esophagus D. Barium swallow is the first indicated test E. Pain is a delayed finding |
A. Pneumomediastinum is an early finding
Boerhaave syndrome: Spontaneous perforation of the thoracic esophagus due to a sudden increase in intraluminal esophageal pressure. This is usually due to forceful vomiting with sudden onset of pain. There is a rent of 2-5cm in length, 2-3 cm above the GE junction, predominantly on the left posterolateral wall. Thus blood escapes usually into the left pleural space; only rarely involving the right pleura. Mortality is high up to 35% as often diagnosis is delayed due to atypical presentations. Pneumomediastinum is a very important finding. On e-medicine was described as seen in 20% of cases. It is unclear to me if this percent refers to clinical sign of Hamman crunch (pneumomediastinum detected with a stethoscope) or if this is the percentage detected by imaging and then with what imaging: CXR or CT? However it is an early finding. |
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130. In the lower mediastinum, the thoracic duct is located:
A. To the left of the aorta. B. Adjacent to the azygos vein. C. Anterior to the esophagus. D. Adjacent to the IVC. |
B. Adjacent to the azygos vein.
Course of the thoracic duct: it originates in the abdomen from the cisterna chyli at the level of L1 (L1/L2). It traverses the diaphragm via the aortic hiatus along with the aorta, and the azygos and hemiazygos veins. It ascends through the posterior mediastinum along the right paravertebral space adjacent to the azygos vein, to the right of and posterolateral to the descending aorta (between the aorta and the azygos vein), and posterior to the esophagus. At the level of T6 (T4-T6), it crosses from R -> L posterior to the esophagus, and then ascends along the left side of the esophagus. At the thoracic inlet, the duct lies to the left and posterolateral to the esophagus, arches forward/anteriorly above the left subclavian artery, and enters the posterior aspect of the left IJ and subclavian veins at their confluence forming the left brachiocephalic vein. Disruption of the upper/distal portion of the thoracic duct causes a left chylothorax. Disruption of the lower/proximal portion causes a right chylothorax. |
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131. Regarding hepatic hydrothorax, which of the following is true:
A. Cirrhosis is not necessary. B. It is more common on the left than the right. C. Can present with minimal ascites. |
C. Can present with minimal ascites.
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29. Hepatic hydrothorax
A) can be seen with minimal ascites B) treated with pleurodesis C) most common on the left side D) seen with minimal cirrhosis |
A) can be seen with minimal ascites
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174) Which are the following are characteristics of a hepatic hydrothorax?
A. Occurs more commonly on the left B. Can occur even with minimal ascites C. The presence of cirrhosis is not necessary |
B. Can occur even with minimal ascites
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132. Elevated Alpha-fetoprotein level is associated with all of the following
except: A. Down's syndrome B. Anencephaly C. Gastroschisis D. Multiple gestation E. Fetal demise |
A. Down's syndrome
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. Woman with shortness of breath and chest pain when lying on left side. What is best study to evaluate?
A) Echo B) Coronary angio C) left ventriculogram D) nucs ? E) carotid us F. contrast CT |
A) Echo
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4. Which finding is not commonly seen in a penetrating atherosclerotic ulcer?
A) intramural contrast collection B) ectatic aorta C) small intramural hematoma D) extension of intimal flap from left subclavian to diaphragm E) atherosclerotic disease of aorta |
D) extension of intimal flap from left subclavian to diaphragm
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6. 28 year old brother and sister develop arrhythmia. MRI shows a focal T1 high signal in right ventricle.
A) Lipoma B) Myxoma C) Arrythmogenic RV dysplasia D) Infarction E) Hypertrophic cardiomyopathy |
C) Arrythmogenic RV dysplasia
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10. Atrial myxoma question from old exams
A) Resemble mitral valve dz on CXR B) Arises from anterior leaflet mitral valve C) If arise from septum is usually not mobile D) usually arises from the atrial wall E) has decreased echogenecity on ultrasound |
A) Resemble mitral valve dz on CXR
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14. Pneumomediastinum
A) Alveolus rupture B) PTX C) Bleb rupture D) Extension of pneumoperitoneum |
A) Alveolus rupture
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18. Cause of CHF (or LV failure) in person with emphysema ask dan
A) Ischemic cardiomyopathy B) IHSS C) athersclerosis D) cor pulmonale |
A) Ischemic cardiomyopathy
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2. Repeat: What makes up part of the “head of the snowman” in TAPVR?
a. Left vertical vein b. Intercostals vein c. Duplicated svc d. Subclavian vein e. Pulmonary artery |
a. Left vertical vein
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21. Which sequence is best to study blood flow dynamics on cardiac MR?
A) STIR B) Gradient recalled echo C) T1 D) T2 E) Phase contrast F. TOF |
E) Phase contrast
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22. Concerning cardiac surgery, which of the following are true:
A) mitral annuloplasty reverses the effects of calcific mitral stenosis. B) Coronary ostial markers are not necessary when the coronary ostia are occluded C) In repairing VSD’s, the patches are on the low pressure RV side D) The Jantene or switch procedure for transposition involves switching of the venous inflow to the atria |
C) In repairing VSD’s, the patches are on the low pressure RV side
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23. Angina in a patient with an aberrant left coronary artery originating from the pulmonary artery is most likely due to:
A) poorly oxygenated blood B) steal phenomenon C) decrease diastolic flow D) abnormal vascular territory |
B) steal phenomenon
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31. Which is true of blood vessels?
A) vasa vasorum supplies the outer layers B) epithelium is 5-10 cells thick. C) Dissection occurs between media and adventitia |
A) vasa vasorum supplies the outer layers
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33. Patient with proximal muscle weakness and nodular pleural masses
A) thymoma B) metastatic adenoca C) benign fibrous tumor of pleura |
A) thymoma
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35. Construction worker with pleural effusion, presents 6 months later with pulmonary nodule.
A) Lung cancer B) Mesothelioma C) TB D) Sarcoid E) Asbestosis |
C) TB
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40. Which does not have an upper lobe predominance:
A) EG B) Silicosis C) Sarcoidosis D) Alpha 1 anti-trypsin E) Centrilobular emphysema |
D) Alpha 1 anti-trypsin
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41. Which of the following increase lung compliance:
A) CHF B) Alpha1 Antitrypsin Def. (panacinar emphysema) C) Pulm. Embolism D) Scleroderma |
B) Alpha1 Antitrypsin Def. (panacinar emphysema)
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42. IVDU patient presents with fever, cough, and CXR with multiple bilateral pulmonary opacities. Most likely:
A) Bacterial endocarditis B) Metastasis C) Staph PNA D) Strep PNA |
A) Bacterial endocarditis
Bacterial endocarditis (usually due to S. Aureus) typically affects the tricuspid valve in IV drug users, serving as a nidus for further infection of the lungs, brain or other sites. Septic emboli in the lung appear as multifocal ill-defined lung nodules that cavitate over a period of days |
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43. True of Hirschsprung's disease
A) The dilated bowel is proximal to the aganglionic segment B) The dilated bowel is distal to the aganglionic segment C) Associated with Meconium plug D) Associated with Downs syndrome |
A) The dilated bowel is proximal to the aganglionic segment
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46. Hypervascular met to the liver. The least likely primary is?
A) Renal cell B) Thyroid C) Islet cell D) Colon |
D) Colon
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47. What is the most common lesion to manifest as linitis plastica?
A) Bronchogenic carcinoma B) Leiomyoma C) Leiomyosarcoma D) Breast mets |
D) Breast mets
Other causes-Scirrhous cancer most common, lymphoma, direct invasion by pancreatic CA, erosive gastritis, XRT, sarcoid, amyloid(rare), TB, Syphilis Linitis Plastica describes marked thickening and irregularity of the gastric wall (diffuse infiltration), rigidity, narrowing, and nondistensibility; peristalsis does not pass through linitis |
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49.What disease has the highest rate of malignancy?
A) Gardner’s B) Menetrier's disease C) Barrett's esophagus D) Peutz-Jegher's |
A) Gardner’s
Gardner’s – 100% (see primer table pg 181). Peutz –Jegher’s-rare, Menetrier’s –gastric CA 10%, Barret’s -30-40x risk of developing adenoCA – 15% prevalence of AdenoCA in Barrett’s |
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50. 65 year old male with a solid mobile mass seen on small bowel series in the terminal ileum. What is most likely?
A) Lymphoma B) Adenocarcinoma C) Carcinoid D) Crohn's Disease |
A) Lymphoma
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51. What is the most common cause of a colovesical fistula?
A) Diverticulitis B) Crohn’s Disease C) Ulcerative Colitis D) Aggressive TURP E) Colonic neoplasm |
A) Diverticulitis
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52. What is the typical appearance of hemangioma on US?
A) Lobulated and hypoechoic B) Well circumscribed and hyperechoic C) Ill defined and hyperechoic D) Increased through transmission |
B) Well circumscribed and hyperechoic
Well defined and hyperechoic (80% of patients), usually no Doppler signal b/c of slow flow; posterior acoustic enhancement is common but not increased through transmission |
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60. The region of bowel least likely affected by ischemia is?
A) Sigmoid B) Ascending colon C) Rectum D) Splenic flexure E) Hepatic flexure |
C) Rectum
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61. Which of the following is most characteristic of malrotation?
A) Duodenal-jejnual junction inferior and medial B) Cecum elevated and medial to its normal location C) Jejunum within the right abdomen D) Twisted gastric fundus |
A) Duodenal-jejnual junction inferior and medial
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62. Which of the following structures does NOT contact the caudate lobe?
A) Left lobe of the liver B) Right lobe of the liver C) IVC D) Fissure of ligamentum venosum E) Fissure of ligamentum teres |
E) Fissure of ligamentum teres
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65. Man presents with low back pain and posterior lateral extradural mass with fluid signal intensity and rim enhancement, these findings suggest:
A) Tarlov cyst B) Synovial cyst C) Sequestered disc D) Cystic schwanoma |
B) Synovial cyst
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67. Man found down with MRI showing large area of marked T2 hypointensity surrounded be a rim of T2 hyperintensity in the temporal lobe, this area appeared isointense on T1 weighted images. These findings are consistent with:
A) parenchymal hematoma B) abscess C) subarachnoid hemorrhage D) glioma E) cavernoma |
A) parenchymal hematoma
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78. Third lesion in trilateral retinoblastoma:
A) Pineal gland B) Anterior pituitary C) Posterior pituitary D) Hypothalamus E) Adrenal gland |
A) Pineal gland
A) Pineal gland Familial retinoblastoma is an autosomal dominant trait, with bilaterality or multifocality in 30%. Retinoblastoma may spread directly into the subarachnoid space via the optic nerve (occasionally producing spinal implants), hematogenously, or via lymphatics and has a propensity to hemorrhage. There is a high incidence of nonocular tumors in the hereditary form, these include midline, primitive neuroectodermal , pineal tumors, osteogenic and soft tissue sarcoma, malignant melanoma, basal cell carcinoma, and rhabdosarcoma. Pineoblastoma is usually associated with bilateral retinoblastoma and thus has been named “trilateral” retinoblastoma. |
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79. A lytic lesion with well-defined sclerotic borders in the skull is most likely?
A) Metastasis B) Epidermoid C) Myeloma D) Eosinophilic granuloma E) Venous lake |
B) Epidermoid
Intraosseous epidermoid cysts arise almost exclusively in the skull and phalanges of the hand. It is a well-marginated lucent lesion with a sclerotic margin. Multiple myeloma is characterized by multiple “punched out”, non-marginated lesions with a narrow zone of transition. Langerhans cell histiocytosis (EG) of the skull typically has a narrow zone of transition with nonuniform involvement of the inner and outer tables, giving a “beveled-edge” appearance. The lesions tend not to have a sclerotic margin. EG can be seen with a button sequestrum, a radiodense focus within a lytic cranial lesion. In the healing phase EG may develop a sclerotic border. Venous lakes are well defined lucent lesions without a rim of sclerosis Mnemonic—solitary lucent skull lesions: “HELP ME” Hemangioma, Epidermoid/dermoid, Leptomeningeal cyst / Lambdoid suture defect, Paget’s (osteoporosis circumscripta) / Post-surgical, Metastasis, Eosiniphilic granuloma, Encephalocele. |
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81. Most likely to be associated with a pathologic fracture in an adult.
A) spiral fracture of the humerus B) lumbar compression fracture C) greater tuberosity avulsion D) lesser trochanter avulsion |
D) lesser trochanter avulsion
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82. A nuclear scan for shin splints will show the following:
A) normal B) hot first and second phases, normal third C) hot first and second phases, fades on third D) normal first and second phases, hot on third E) hot on all three phases. |
D) normal first and second phases, hot on third
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82. A nuclear scan for shin splints will show the following:
A) normal B) hot first and second phases, normal third C) hot first and second phases, fades on third D) normal first and second phases, hot on third E) hot on all three phases. |
82. A nuclear scan for shin splints will show the following:
A) normal B) hot first and second phases, normal third C) hot first and second phases, fades on third D) normal first and second phases, hot on third E) hot on all three phases. Shin splints are stress rxn with subperiosteal hemorrhages occurring at muscle insertion sites and are usually elongated (stress FX is more focal and is small cortical FX.) The distinctive scintigraphic features reflect the periosteal disruption, appearing as linear elongated, narrow homogeneous accumulations extending along the bone in a superficial site. It is most unusual for any local hyperemia to be demonstrated w/ three-phase studies in “shin splints”, in contrast to the increase local vascularity typically seen in stress FX. In patients with shin splints, Radionuclide angiograms and blood pool images are normal, whereas on delayed images, a longitudinally oriented area of increased Radionuclide accumulation is seen in the posteromedial cortex of the tibia (along at least one third the length of the posteromedial tibial cortex at the insertion of the soleus muscle or tibialis posterior on delayed images). |
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83. A 58-year-old diabetic female presents with chronic foot pain, a pes planus deformity, as well as periosteal reaction along the distal aspect of the medial malleolus on plain film. The most likely diagnosis is:
A) charcot joint B) Plantar fascitis C) Posterior tibial tendon rupture D) Peroneus longus tendon rupture E) Stress fracture |
Typically, tibialis posterior tendon pathology is related to RA or a seronegative spondyloarthropathy and altered mechanics of the foot. Spontaneous rupture classically occurs in the 5th or 6th decade of life in women. Symptoms include pain and swelling. Late changes include pes planus. (Resnick p. 872)
A charcot joint is trauma secondary to alterations in sensory innervation to a joint. Bony changes include the 5 D’s: dense subchondral bone, destruction of articular cortex, deformity, debris and dislocation. |
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86. Recurrent hip dislocations after total hip arthroplasty are most likely secondary to: riw
A) loosening B) malpositioning of the acetabular component C) improper gluteal reattachments D) bad femoral component E) Traumatic joint capsule rupture |
B) malpositioning of the acetabular component
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88. Fracture of the medial patellar facet can be seen in:
A) lateral patellar dislocation B) avulsion of various muscles C) quadriceps tendon insertion injury D) medial meniscus tear E) ACL tear F. Avulsion from the inferior patellar tendon. |
A) lateral patellar dislocation
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89. The following could be used to describe a medial meniscal tear on a T2 sequence except:
A) globular signal within the posterior horn meniscal substance B) blunted appearance of free margin C) irregular appearing meniscus truncated appearance of the medial meniscus D) linear T2 signal in the meniscus involving the inferior articular surface |
A) globular signal within the posterior horn meniscal substance
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93. 48 year-old female patient presents with wrist pain, which is exacerbated with ulnar deviation. A radiograph of the wrist demonstrates cystic lucencies within the lunate, triquetrium and distal ulna. The most likely diagnosis is:
A) rupture of the lunatotriquetral ligament B) RA C) Gout D) lunatomalacia E) ulnar impaction syndrome |
E) ulnar impaction syndrome
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95. The appearance of telangiectatic osteosarcoma can best be described as:
A) often mistaken for ABC B) most commonly diaphyseal C) Homogenously isointense on MRI D) Commonest in the elderly E) Low signal on t1 and t2 |
95. The appearance of telangiectatic osteosarcoma can best be described as:
A) often mistaken for ABC B) most commonly diaphyseal C) Homogenously isointense on MRI D) Commonest in the elderly E) Low signal on t1 and t2 Telangiectatic osteosarcoma is a rare variant that is difficult to dx as it is >90% cystic and appears much less aggressive than the conventional osetosarcoma. Same age range (mean 20 yr) and location (distal femur and proximal tibia) as conventional osteosarcoma. It differs in radiographic appearance, being primarily geographic rather than permeative, and there may be a wide zone of transition. Cortical break through and soft tissue mass may be present. The lesion is highly vascular and contains necrotic tissue and large pools of blood with tumor located only at the periphery and along septations. May show subtle osteoid matrix and also enhances in most cases. Fluid-fluid levels on MRI. Differential diagnosis includes aneurysmal bone cyst or giant cell tumor |
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96. After an elbow fracture in an adult, a bone fragment within the joint most likely originates from:
A) coronoid process B) medial epicondyle C) radial head D) lateral epicondyle E) olecranon |
A) coronoid process
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98. Not seen with physiologic periostitis:
A) Lamellated B) Smooth C) Interrupted D) Symmetric E) Affects long bones first |
A) Lamellated
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100. Fracture at the growth plate at the base of the first distal phalanx of the foot is most associated with what complication?
A) Osteomyelitis B) Growth disturbance C) Non union D) Osteonecrosis E) Subuncal hyperostosis F. Subuncal exostosis |
A) Osteomyelitis
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18. Intramuscular phleboliths in a 10 year old are most likely due to:
A. Capillary hemangioma B. Venous malformation C. AVM D. Lymphangioma |
Note (JAC): The most common cause is actually a cavernous hemangioma which has
a phlebolith in up to 50% of cases. This was not listed here, but I've seen it as a choice on other recalls and it is likely the correct answer. A. Capillary hemangioma - benign vascular tumor composed of capillaries with sparse fibrous stroma. Typically hemangiomas develop in neonates, undergo proliferation until 9-10 months of age, and then involute starting at 1 year of age. Hemangiomas are rare after 5 years of age. B. Venous malformation - most common symptomatic vascular malformation. Venous malformations usually become symptomatic in older children and young adults, with bluish discoloration, local swelling, and pain. The characteristic finding on exam is a spongy, bluish soft tissue mass which is easily compressible and becomes more engorged with dependent position. Soft tissue phleboliths are characteristic. Venous malformations can occur as part of Maffucci syndrome (enchondromatosis with vascular malformations) and Klippel- Trenaunay-Weber syndrome (cutaneous vascular malformations, varicose veins, soft tissue and bone hypertrophy). C. AVM - abnormal communication between arteries and veins without intervening capillaries. AVMs may present with a bruit/thrill, pain, and a pulsatile mass. Increased warmth of the involved extremity may be present. Complications include hemorrhage, overgrowth of the extremity, and heart failure. MR is usually indicated to define the extent of the lesion, and angiography with embolization is the preferred therapy. D. Lymphangioma - uncommon hamartomas of lymphatic tissue. Lymphangiomas can involve the skin and mucous membranes. They are characterized by clusters of cysts or lymphatic vessels, usually filled with serous fluid. Cystic hygroma is a variant of lymphangioma. They are not associated with phleboliths. |
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19. A child with HIV has a CXR that shows reticulonodular infiltrates.
Clinically, the child is not ill. Most likely cause of these findings: riw A. PCP B. LIP C. Parainfluenza |
B. LIP
19. A child with HIV has a CXR that shows reticulonodular infiltrates. Clinically, the child is not ill. Most likely cause of these findings: riw A. PCP B. LIP C. Parainfluenza A. PCP - most common opportunistic infection in children before universal prophylaxis. Pneumocystis carinii pneumonia typically presents with fever and tachypnea. CXR may show reticulonodular infiltrates or may be normal. Diagnosis is made by sputum or BAL antigen detection. Infants between 6 weeks and 1 year of age require prophylaxis regardless of CD4 count; otherwise, recommendations for prophylaxis are based on CD4 count and history of prior PCP infection. B. LIP - second most common AIDS-defining illness in children. Lymphoid interstitial pneumonitis typically occurs in children with relatively high CD4 counts. CXR demonstrates reticulonodular opacities +/- hilar lymphadenopathy that persists for two months despite adequate treatment. Patients are usually asymptomatic initially, but may develop cough and shortness of breath as the disease progresses. LIP increases susceptibility to bacterial pneumonia pathogens, especially Haemophilus influenzae and pneumococcus. C. Parainfluenza - etiologic viral agent of croup. Children with HIV may also suffer from common childhood infections, but may have more frequent and severe episodes of illness. Parainfluenza may account for bronchiolitis in infants and children younger than 2 years. Clinically patients will present with fever, tachypnea and retractions. Typical radiographic features of bronchiolitis include hyperinflation of the lungs, perihilar infiltrates, atelectasis, and reticular interstitial opacities. Bacterial superinfection may occur. |
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107. Regarding paraovarian cysts, which is false?
A) Can be complicated by torsion B) Located within the broad ligament C) Demonstrate cyclical change D) Represent 10% of adnexal masses |
Demonstrate cyclical change
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108. A small, trabeculated bladder is associated with all of the following except:
A) Spinal trauma B) Diabetes mellitus C) Detrusor-sphincter dyssynergy D) Radiation cystitis |
) Diabetes mellitus
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111. Most aggressive form of DCIS
A) medullary B) papillary C) comedo D) tubular E) mucinous |
C) comedo
Tubular: well differentiated, favorable prognosis, low met potential Papillary: slow growth rate, favorable prognosis Mucinous: greater degree of differentiation, better survival Medullary: favorable prognosis |
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112. Well-circumscribed, solid, noncalcified, nonpalpable mass found on a baseline mammogram
with negative ultrasound. What is the cancer risk? A) <2 B) 5-10% C) 10-20% D) 20-30% E) >30% |
A) <2
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113. The appearance of the skin in a patient with inflammatory breast carcinoma is due to which of the following?
A) inflammatory cells within the breast. B) Obstruction of dermal lymphatics by tumor cells C) Local invasion of the dermis D) thrombosis E) angioinvasion |
B) Obstruction of dermal lymphatics by tumor cells
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114. The most common appearance of tubular carcinoma on mammography is: riw
A) Microcalcifications B) Well-defined mass C) Spiculated mass D) Trabecular thickening |
C) Spiculated mass
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115. What characteristics do breast cysts demonstrate on MRI?
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A) Increased T2 signal
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117. Enhancement characteristics of breast cancer on MRI
A) delayed washout B) requires fat-saturation C) early peak enhancement D) continual rising enhancement |
C) early peak enhancement
Dynamic MR of breast cancer shows rapid initial enhancement , likely due to tumor angiogenesis. Some benign lesions will also enhance with gad, but the initial enhancement rate is usually less rapid than in malignancy. Breast cancer also tends to demonstrate early washout. (Kopans p629) |
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121. Why do you use surfactant?
A) Further expand alveoli that are already open B) Open/recruit atelectactic alveoli |
A) Further expand alveoli that are already open
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122. Infants of diabetic mothers have the highest association with: riw
A) sacral agenesis B) ARDS C) Myelomeningocele D) Lymphoma |
A) sacral agenesis
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124. Which of the following is not a cause of nonimmune hydrops?
A) Trisomy 13 B) CMV infection C) Turner syndrome D) Erythroblastosis fetalis |
D) Erythroblastosis fetalis
All are causes of hydrops, but this is a question of immune vs non-immune hydrops. Erythroblastosis fetalis is immune hydops (Rh isoimmunization). The most common causes of non-immune related hydops are cardiovascular abnormalities, followed by chromosomal abnormalities (including Turner’s, Trisomy 13, 18, 21, etc) and infection (including CMV and remaining TORCH infections). |
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125. Latex allergy in a child is most associated with
A) Myelomeningocele B) Asthma |
A) Myelomeningocele
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129. Regarding embolization, the following is most true
A) use the smallest particles possible to avoid necrosis B) use absolute alcohol for bronchial artery embolization C) use gianturco coils for diverticular bleeds D) make sure to completely occlude a varicocele E) the most important measure in ablating periperal AVMs is to embolize all of the feeding vessels |
D) make sure to completely occlude a varicocele
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130. Approach for nephrostomy tube placement
A) aim for anterior calyx B) aim for posterior calyx C) aim for mid kidney parenchyma to avoid the calyx |
B) aim for posterior calyx
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131. A patient undergoing placement of a tunneled catheter suddenly develops acute hypoxia, tachycardia, and agitation.
A) air embolism B)pneumothorax C) pulmonary embolism D) mediastinal hematoma |
A) air embolism
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133. Not an indication for TIPS
A) gastric varices and splenic vein thrombosis due to chronic pancreatitis B) medically refractory ascites with portal hypertension C) variceal bleeding and medically refractory ascites |
A) gastric varices and splenic vein thrombosis due to chronic pancreatitis
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137. The most common hypercoagulable state is:
A) Protein S deficiency B) Protein X deficiency C) Factor V-Leiden |
C) Factor V-Leiden
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138. May-Thurner syndrome is
A) edema and stasis of the left lower extremity due to left iliac vein compression from the right iliac artery B) related to recurrent DVT and stasis ulcers C) hypercoagulability associated with cancer |
A) edema and stasis of the left lower extremity due to left iliac vein compression from the right iliac artery
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140. What is the use of acetazolamide in cerebral imaging?
A) tumor vs. XRT necrosis B) assess cerebrovascular blood flow reserve C) assess for TIA D) assess for stroke |
B) assess cerebrovascular blood flow reserve
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146. Which tumor has the least uptake/sensitivity for In-111 octreotide?
A) Carcinoid B) Small cell carcinoma C) Pituitary adenoma D) Pheochromocytoma E) Renal cell CA |
E) Renal cell CA
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149. Which of the following is TRUE regarding a gastric emptying study?
A) solid phase is more sensitive than liquid phase B) need to obtain anterior and posterior imaging and compute the geometric mean to calculate the half-time C) the study is not reproducibly accurate enough to assess response to therapy D) half-time for solids is approximately 10-20 minutes |
A) solid phase is more sensitive than liquid phase
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30) Which of the following is TRUE regarding gastric emptying studies in nuclear medicine? riw
a) fluids show a linear emptying curve b) there is exponential emptying with solids c) demonstration of 50% emptying at 25 min for fluids is a normal study d) lipids increase the rate of emptying |
c) demonstration of 50% emptying at 25 min for fluids is a normal study
d) a geometric mean of the anterior and posterior counts is necessary for accurate calculation of emptying half time |
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156. Regarding ventilation studies done with Tc-99m DTPA rather than Xe-133, all are true EXCEPT:
A) Requires less patient cooperation B) There are more counts C) Don’t need a well ventilated room D) There may be higher doses to the lung parenchyma |
D) There may be higher doses to the lung parenchyma
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157. Regarding cardiac imaging with Tc-99m MIBI, all are true EXCEPT:
A) The target organ is the colon B) It rapidly redistributes C) It passively diffuses into cells D) It is excreted in the bile |
B) It rapidly redistributes
Obviously, the colon is not the target imaging organ for Tc-99m MIBI, but rather the target dose organ. (0.18 rad/mCi; 0.05mGY/mBq at rest). Dosimetry results specify primary, secondary and tertiary target organs as the 3 organs getting the highest absorbed radiation dose. Often, the "dose target" is also the "imaging target" but, as in the case of Tc-99m MIBI, it is not. The upper large intestine specifically gets the highest dose because of the biliary excretion of MIBI, resulting in accumulation in the small intestine and colon, but longer residence time in colon. riw Uptake of Tc-99m MIBI in the myocardium is rapid; however the clearance half-time from the myocardium is quite long. There is minimal recirculation or redistribution of Tc-99m MIBI after initial uptake in the heart so that there is a several hr time window after tracer administration in which to accomplish imaging. Tc-99m sestamibi diffuses passively out of the blood and apparently localizes in mitochondria on the basis of their negative electrical potentials. Progressive clearance of liver and lung activity with excretion of the tracer through the kidneys and via the biliary system results in better myocardium-to-background activity ratios at 60-120 minutes than immediately after tracer administration (The REQ ed1, p71-72). |
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159. Choose the correctly matched QC test with what it assesses:
A) Intrinsic Uniformity - Problem with Photomultiplier tube B) Extrinsic Uniformity - Problem with the Collimator C) Center of Rotation Error - Image Data Acquisition D) Pixel Size - Attenuation Correction E) Line Phantom - Spatial Resolution and Linearity |
159. Choose the correctly matched QC test with what it assesses:
A) Intrinsic Uniformity - Problem with Photomultiplier tube B) Extrinsic Uniformity - Problem with the Collimator C) Center of Rotation Error - Image Data Acquisition D) Pixel Size - Attenuation Correction E) Line Phantom - Spatial Resolution and Linearity |
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160. Regarding imaging of solitary pulmonary nodules with 18-F FDG PET, all true except:
A) Granulomatous disease can give a false positive B) Sensitivity is decreased for small cell CA compared to other cell types C) PET is better than CT for staging of NSCLC D) An SUV of > 2.5 is highly suspicious for malignancy E) Lesions < 1cm may underestimate the SUV |
B) Sensitivity is decreased for small cell CA compared to other cell types
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165. Parvus tardus in carotids bilaterally on US:
A) Aortic stenosis B) Aortic regurgitation C) Volume overload (CHF) D) Coarctation |
A) Aortic stenosis
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167. A rounded focus of decreased echogenicity is seen in the upper pole on one of two kidneys on prenatal ultrasound examination. What is the most likely diagnosis?
A) ARPCKD B) ADPCKD C) Medullary cystic disease D) Multicystic dysplastic kidney E) Obstruction of the upper pole moiety |
E) Obstruction of the upper pole moiety
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168. Choroid plexus cyst is associated with
A) tri 13 B) tri 18 C) tri 21 D) XXY |
B) tri 18
• Epidemiology • Most common type of neuroepithelial cyst o 1% of all pregnancies on routine US o 50% of fetuses with T18 o Small asymptomatic CPCs found incidentally in > 1/3 of all autopsied adults • Associated abnormalities • Fetal CPC o Trisomy 18 (mildly increased risk < 2x baseline risk) o Trisomy 21 (only if other markers present) • Adult CPC: May cause obstructive hydrocephalus (rare) |
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169. Myelomeningocoele is NOT associated with riw
A. obscuration of cisterna magna B. flattening or concavity of bilateral frontal bones (“lemon” sign) C. decrease in size and curve of the cerebellum (“banana” sign) D. hydrocephalus E. choroid plexus cyst |
E. choroid plexus cyst
Myelomeningocele (and any other neural tube abnormality) is associated with Chiari II malformation, features of which are listed in A-D) It can also be occasionally associated with intraspinal a fatty tumor (lipoma) or hyperechoic bony spur with shadowing (diastematomyelia). Don’t mix up the “lemon” sign with “strawberry” sign seen in Trisomy 18, in which flattening of frontal bones occurs together with flattening of occiput due to hypoplasia of the hindbrain. (The Requisites of US, pp 402-6). |
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171. Bradycardia is associated with riw
A) increased systolic flow B) increased diastolic flow C) decreased systolic flow D) decreased diastolic flow |
D) decreased diastolic flow
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173. Which of the following is true of hepatic hydrothorax?
A) effusion resolves spontaneously B) seen in association with ascites C) treat with pleurodesis D) usually an exudates |
B) seen in association with ascites
Pleural effusions occur in approx. 5% of patients with cirrhosis and ascites. The effusion is usually right-sided and frequently large. Best treatment is liver transplantation. If a patient is not a candidate, TIPS may help. Effusion does not resolve without treatment of underlying liver diseasE) (Harrison’s, p. 1514). |
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174. Renal cortical hyperechogenicity in neonate is NOT associated with
A hypercalciuria B nephroblastomatosis C chronic Lasix therapy D medullary cystic disease |
B nephroblastomatosis
174. Renal cortical hyperechogenicity in neonate is NOT associated with A hypercalciuria B nephroblastomatosis C chronic Lasix therapy D medullary cystic disease This question blows. Terminology • Multiple or diffuse nephrogenic rests in kidneys • Precursor to Wilms tumor • Most spontaneously regress • Some syndromes have higher incidence Imaging Findings • Best diagnostic clue: Homogeneous multifocal ovoid or subcapsular rind-like renal masses • Best imaging tool: MR (T1 C+) or CECT Clinical Issues • Currently, no specific treatment protocol advocated • Children with syndromes at risk for Wilms tumor typically screened regularly for development of nephroblastomatosis/Wilms tumor Diagnostic Checklist • Nephroblastomatosis appears homogeneous on all imaging modalities (US, CECT, MR) • Wilms tumor tends to be heterogeneous |
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175. To reduce some artifact on US, wrap around?
A) reduce angle of transducer B) reduce power C increase frequency D Increase pulse repetition frequency E change depth F Increase gain |
D Increase pulse repetition frequency
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3. The corpus luteum cyst of pregnancy resolves by:
a. 5 weeks b. 10 weeks c. 15 weeks d. 20 weeks e. 25 weeks |
c. 15 weeks
d. 20 weeks Natural History & Prognosis • May enlarge initially with fertilization and pregnancy o Peak size usually around 7 weeks • Should diminish in size with progression of pregnancy • Most no longer seen by sonography by early second trimester • If persists after pregnancy, may represent ovarian neoplasm |
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179. To decrease aliasing one can:
A) decrease the transducer frequency B) decrease the pulse repetition frequency C) decrease the Doppler angle D) decrease the gain |
A) decrease the transducer frequency
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180. Decreased diastolic flow in the CCA on carotid Doppler US is seen with all of the following except: riw
A) Bradycardia B) Aortic Insufficiency C) Cerebral AVM D) Ipsilateral ECA stenosis E) Ipsilateral ICA stenosis |
C) Cerebral AVM
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183. As you increase the sensitivity of a test, which decreases riw
A) false negatives B) positive predictive value C) negative predictive value D) cost of the test |
A) false negatives
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1. Luckenschadel skull associated with:
a. chiari II b. dandy walker malformation c. holoprosencephaly |
a. chiari II
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2. Pseudodiverticulosis of the esophagus is associated with riw ask dan
a. gastroesophageal reflux b. Candida c. Congenital variant |
a. candida
Pseudodiverticulosis has numerous small esophageal outpouchings representing dilated glands interior to the muscularis. Underlying diseases: candida, EtOH, DM. Associated with esophagitis. (Primer 160) |
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3. Mammography performed 3-6 months after surgical biopsy(need to know if had radiation)
a. establish baseline b. evaluate for residual calcifications c. evaluate for post-biopsy hematoma |
a. establish baseline
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4. Pt with HIV undergoes esophagram for dysphagia
a. giant ulcer b. shaggy mucosa c. multiple plagues |
a. giant ulcer
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5. Precocious puberty in female presents with pelvis mass
a. granulosa cell tumor b. Meigs syndrome c. Polycystic ovarian disease d. Endometrium cancer |
a. granulosa cell tumor
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6. Best position for intraaortic balloon pump
a. ascending aorta b. just distal to acortic knob beyond the left subclavian artery take off c. mid aspect of descending aorta d. just proximal to left subclavian artery |
b. just distal to acortic knob beyond the left subclavian artery take off
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7. Primary cancer of male urethra is most likely riw
a. adenocarcinoma b. squamous cell c. transitional cell |
b. squamous cell
Male urethra tumor is rare: SCC (80%), TCC (15%), associated with stricture. |
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Young kid with tumor in testicle, most likely:
a) seminoma b) yolk sac tumor c) mixed germ cell tumor d) choriocarcinoma e) embyronal tumor riw |
Ans: B) This is a tricky question. The most common tumor in childhood for boys is a yolk sac tumor. Other tumors that occur in childhood are Sertoli and Leydig (the hormone-producing tumors). Then, the most common tumor in young men (20’s) is the Mixed Germ Cell Tumor. Finally, Seminoma is most common in older men (30’s). In old men (70’s) lymphoma is most common. Additionally, most tumors in the testicles are mixed, with a predominant component of one type or the other. Of the tumors that are NOT mixed at all, seminoma is the most common. (Woodward, AFIP notes pg 535).
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8. Stanford type B dissection associated with which
a. surgical emergency b. atherosclerosis in elderly pt c. coronary artery involvement |
b. atherosclerosis in elderly pt
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1) The arterial supply to the AV node is from:
A) left coronary artery B) branch of the LAD C) distal right coronary artery D) proximal right coronary artery E) conus branch of the right coronary artery |
distal right coronary artery
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2) A parallel configuration of the aorta and pulmonary artery is seen with which congenital anomaly?
A) Truncus B) Tetralogy of Fallot C) TAPVR D) Transposition of the great vessels |
D) Transposition of the great vessels
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4) Which of the following is false regarding pulmonary embolism?
A) infarcts not very common with PE B) distal emboli are more likely to cause infarcts C) rare from upper extremity D) the clinical triad of cough, chest pain, and hemoptysis is present in a majority of patients with angiographically proven emboli |
D) the clinical triad of cough, chest pain, and hemoptysis is present in a majority of patients with angiographically proven emboli
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5) The patient is status post RUL lobectomy now has RML gangrene, what is the cause?
A) aspiration B) RML torsion C) thrombosis of right superior pulmonary vein D) ligation of interlobar artery E) Surgical interruption of PA f. Surgical interruption of pulmonary vein g. Ligation of bronchus intermedius |
B) RML torsion
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6) Most common radiologic finding for a bronchoalveolar cell carcinoma is?
A) Solitary pulmonary nodule B) Peripheral focal infiltrate |
A) Solitary pulmonary nodule
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7) Which of the following is not a feature of Oriental Cholangitis?
A) Stones B) Jaundice C) RUQ pain D) Elderly Asians E) Fever F) Causes biliary dilatation |
D) Elderly Asians
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8) A 30yo female presents with diarrhea, a serum protein of 4.5ng/100dl, a small bowel follow through demonstrates dilated bowel, hypersecretion, variable thickened folds with an intussuception appearance.
A) Sprue B) Scleroderma C) Whipple’s disease D) Gardner’s E) Familial polyposis |
A) Sprue
Sprue is characterized by dilated small bowel loops, hypersecretion, and malabsorption. Transient intussusceptions are typical. The jejunal fold pattern is decreased (ilealization of the jejunum) and the ileal fold pattern becomes prominent (jejunization of the ileum). Whipple’s disease is caused by Gram-positive rods. Irregularly thickened folds are present, most prominent in the jejunum, with tiny nodules spread throughout the mucosa. CT demonstrates enlarged low density mesenteric lymph nodes |
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9)A 50 yo man presents with bloody stools after acute onset of abdominal pain. Films shows thickened folds of the transverse colon. Diagnosis?
A) Ischemic colitis B) Pseudomembranous colitis C) Ulcerative colitis D) Granulomatous colitis E) Colon cancer f. IBD g. Diverticulitis h. Yersinial Colitis i. Embolic |
A) Ischemic colitis
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10) Regarding aphthous ulcers in Crohn’s disease:
A) are usually specific for the disease B) usually painful C) irreversible D) bleed E) denote involvement of the circular muscle layer |
) usually painful
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11) Conjugated bile salts are resorbed where? riw
A) terminal ileum by active transport B) terminal ileum by passive diffusion C) jejunum by active transport D) jejunum by passive diffusion E) colon |
A) terminal ileum by active transport
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12) Which of the following is the most likely cause of a liver with increased attenuation on non-contrasted CT?
A) steatosis B) chemotherapy (e.g., cyclophosphamide) C) radiation D) amiodarone E) amyloid f. lymphoma |
D) amiodarone
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23) What does not run in the tarsal tunnel?
A) posterior tibial tendon B) Tibial nerve C) sural nerve D) flex dig longus E) flex hallucis longus |
C) sural nerve
C) Sural Nerve Tarsal tunnel (TT): located behind and below the medial malleolus; its floor is bony [talus/calcaneus] and its roof is formed by the flexor retinaculum Contains: “Tom, Dick, ANd Harry” posterior Tibial tendon flexor Digitorum longus Artery-posterior tibial Nerve-posterior tibial nerve (compression = TT syndrome) flexor Hallucis longus muscles |
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24) What is essential for the use of MAG-3 lasix renal scintigraphy to differentiate functional versus anatomic obstruction?
A) Absence of stone B) Increased CR C) Preserved renal function D) Dehydration prior to study E) New onset obstruction |
C) Preserved renal function
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25) Most commonly seen in fetus of DM mother: riw
A) sacral teratoma B) myelomenigocele C) lateral meningocele D) syrngohydromyelia E) encephalocele F. filum lipoma G. caudal regression syndrome |
G. caudal regression syndrome
Also seen with greater incidence in infants of diabetic mothers: meconium plug syndrome, subvalvular aortic stenosis (hypertrophic obstructive cardiomyopathy), hyaline membrane disease, adrenal hemorrhage, MCDK, renal vein thrombosis Caudal regression syndrome is hypoplastic/absent distal spine and sacrum due to mesodermal insult during 4th week of gestation. There is high correlation with maternal diabetes. [Brant and Helms, Fundamentals of Diagnostic Radiology, 1999. p.271] |
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26) Most common cause of pulmonary hypoplasia:
A) Diaphragmatic hernia B) Adult Polycystic kidney disease C) Sequestration |
A) Diaphragmatic hernia
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) What is not associated with post bone marrow transplant complications:
a) adrenal hemorrhage b) graft versus host disease c) hepatic veno-occlusive disease d) CMV |
a) adrenal hemorrhage
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11) 34 yo female with hepatosplenomegaly and RUQ pain. Liver biopsy demonstrates liver necrosis. What is the diagnosis?
a. autoimmune hepatitis b. Primary Biliary Cirrhosis c. Budd Chiari d. Ascending cholangitis |
a. autoimmune hepatitis
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12) . Regarding angiodysplasia of the colon, which of the following is false?
a) Commonly see bleeding with angiography(or may say contrast extravasation) b) Located on the antimesenteric border c) Early filling vein |
a) Commonly see bleeding with angiography(or may say contrast extravasation)
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14) Regarding heart size in CXR, which is not true?
a) related to phase of cardiac cycle b) related to kvp peak c) related to PA vs. AP technique |
b) related to kvp peak
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15) Ankle Brachial Index; which of the following is true?
a) numerator contains arm readings b) denominator contains ankle readings c) in patients with peripheral vascular disease, ABI decreases after exercise d) with patients who have peripheral vascular disease, increases after exercise e) in patients without peripheral vascular disease, increases after exercise |
) in patients with peripheral vascular disease, ABI decreases after exercise
A lower ABI is worse. You want the ABI to be > 0.95. An ankle-brachial index below 0.95 at rest or following exercise is considered abnormal. An ankle-brachial index between 0.8 and 0.5 is consistent with intermittent claudication, and an index of less than 0.5 indicates severe disease. |
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4. Helicobacter pylori is associated with all the following, EXCEPT: riw
a. GI lymphoma b. Gastric ulcer c. Duodenal ulcer d. Gastric leiomyosarcoma e. Gastric adenocarcinoma |
d. Gastric leiomyosarcoma
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5. Repeat: Which of the following is not a cause of persistent dense nephrogram on IVP?
a. Hypotension b. ATN c. Pyelonephritis d. Contrast nephropathy e. Renal vein thrombosis |
c. Pyelonephritis
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6. Repeat: Which of the following structures is the most medial in the cavernous sinus
a. CN III b. CN IV c. CN V – maxillary division d. CN VI |
d. CN VI
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7. Round atelectasis is most often associated with which of the following?
a. Pleural plaques b. Pleural effusion c. Mesothelioma d. Bronchogenic carcinoma |
b. Pleural effusion
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4). According to the Nuclear Regulations Committee (NRC), the allowable dose administration for nuclear medicine is within what percent of the calculated dose?
A) 1% B) 5% C) 10% D) 20% E) 50% |
C) 10%
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4) The posterior nipple line (PNL) on an MLO view should not differ from the AP dimension of a CC view by more than: riw
A) 0.5 cm B) 1cm C) 2cm |
B) 1cm
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163) A patient has multiple segmental strictures of the intra- and extra- hepatic biliary system along with papillary stenosis. This mostly represents
a) AIDS cholangitis b) Primary sclerosing cholangitis c) Ascending cholangitis d) Recurrent pyogenic cholangitis |
PSC involves both intra and extra 70-90% of the time, with the CBD always and papillary stenosis. Papillary stenosis is related to stones and other inflammatory conditions. AIDS cholangitis is an infectious thing related to opportunistic infections with inflammatory changes, looks like PSC but also shows papillary stenosis. RPC can cause marked distortion of intrahepatic ducts with decreased arborization and dilatation and multiple calcified filling defects. Multifocal strictures in 22%, no mention of papillary stenosis.
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213) Status-post aortic dissection, which of the following is least likely to communicate with the false lumen?
A) Left coronary artery B) Left renal artery C) Right common carotid artery D) Left common iliac |
A) Left coronary artery
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214. Which of the following anatomic relationships is correct? riw
A) SVC is anterior to the right pulmonary artery B) Left renal vein is posterior to the aorta C) Gonadal vein is deep to the ureter D) Common iliac artery is posterior to the common iliac vein E) Gastroduodenal artery is posterior to the portal vein |
A) SVC is anterior to the right pulmonary artery
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Not associated with pulsatile tinitus
Jugular bulb dehiscence CC fistula Aberrant carotid Glomus tympanicum Cholesteotoma |
Cholesteotoma
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219. An abdominal aortic stent is placed. Which of the following statements is false?
A) 1-2% infection rate can be expected B) 30-70% mortality rate with infection C) If gas is seen within the graft after 3 weeks of the operation, it is indicative of infection D) If paraaortic fluid is seen after 3 months of the operation, it is indicative of infection |
C) If gas is seen within the graft after 3 weeks of the operation, it is indicative of infection
D) If paraaortic fluid is seen after 3 months of the operation, it is indicative of infection |
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220) Which of the following are true regarding PDA:
A) Calcifications of the ductus indicates pulmonary artery hypertension B) Indomethacin can be used to keep a ductus open C) The right recurrent laryngeal nerve hooks around the ductus D) A widened pulse pressure can be seen with a PDA |
D) A widened pulse pressure can be seen with a PDA
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277)Two siblings have splenic abscesses and recurrent pneumonias. Which of the following do they have?
a. DiGeorge syndrome b. Agammaglobinemia c. Chronic granulomatous disease d. Sickle cell disease e. Toxic myelitis |
c. Chronic granulomatous disease
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) Which of the following can have communication with the central airways??
A) Extralobar sequestration B) Intrapulmonary bronchogenic cyst C) Mediastinal bronchogenic cyst D) CCAM E) Congenial emphysema |
D) CCAM
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287. Where would one initially see fatty marrow development in a child?
A) Epiphysis B) Metaphysis C) Metadiaphysis D) Diaphysis |
A) Epiphysis
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292. Regarding the signs of a carotid-cavernous fistula: riw
a. Reversal of flow in the ipsilateral ophthalmic artery b. Prominent Vein of Galen c. Marked filling of the superior sagittal sinus d. Retrograde filling of the ipsilateral superior ophthalmic vein |
d. Retrograde filling of the ipsilateral superior ophthalmic vein
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76 Helical CT which is positive for a ureteral calculus demonstrates which of the following positive findings: riw
A. perinephric hemorrhage B. hyperattenuating lesion with a hypoattenuating center C. tissue rim sign |
C. tissue rim sign
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All of the following demonstrate echogenic cortex on renal ultrasound except vs true?
a) Alport's b) Lymphoma c) Acute pyelonephritis d) HIV nephropathy e) Chronic pyelonephritis |
b) Lymphoma
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