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266 Cards in this Set
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1. Radiofrequency ablation for Atrial Fibrillation should be performed at?
a. SA node b. AV node c. Bundle of HIS d. Bachmann Bundle e. Pulmonary vein ostia |
e. Pulmonary vein ostia
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2. In cardiac tamponade, what is the primary problem? riw
a. LV diastolic dysfunction b. RV diastolic dysfunction c. LV systolic and diastolic dysfunction d. LV and RV diastolic dysfunction |
b. RV diastolic dysfunction
These results show that high pericardial pressure exerts its main effect by impeding filling of the right side of the heart, with much of the effect on the left side being secondary and due to underfilling. In studies employing regional tamponade the greater importance of right-heart compression was confirmed and it was also shown that compressions of the right atrium and segments of the caval vessels within the pericardial sac are independent components of the response to a pericardial effusion. These observations also provide a mechanism for the observations that atrial and ventricular diastolic collapse detected in tamponade are usually confined to the right side of the heart. |
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3. A persistent left sided SVC drains where?
a. Coronary sinus b. Sinus venosus c. Left atrium d. Right atrium |
a. Coronary sinus
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4. Sinus venosus congenital defect is associated with?
a. Anomalous pulmonary venous return b. IVC interruption with azygous continuation c. Lt sided SVC d. Pulmonary valve defect e. Double IVC |
aAnomalous pulmonary venous returnSINUS VENOSUS ASD (5%)
=defect of the superior inlet portion of the atrial septum Location:superior to fossa ovalis near entrance of superior vena cava (SVC straddles ASD) Associated with:partial anomalous pulmonary venous return in 90% (RUL pulmonary veins Connect to SVC / right atrium), Holt-Oram syndrome, Ellis-van Creveld syndrome |
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6. Regarding pectus excavatum: riw
a. Best diagnosed with US b. Involves manubrium only c. Can appear like a RML pneumonia on frontal CXR d. Hypersegmented manubrium |
c. Can appear like a RML pneumonia on frontal CXR
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5. What is the relationship of the pulmonic valve with respect to the aortic valve?
a. Anterior, superior and to the left b. Anterior, superior and to the right c. Posterior, superior and to the left d. Posterior, inferior and to the right e. Anterior, inferior and to the left |
a. Anterior, superior and to the left
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7. Congenitally corrected transposition is associated with?
a. Arterioventricular discordance and atrioventricular concordance b. Arterioventricular discordance and atrioventricular discordance c. Arterioventricular concordance and atrioventricular concordance d. Arterioventricular concordance and atrioventricular discordance |
b. Arterioventricular discordance and atrioventricular discordance
blood flows RA to LV to PA to LA to RV to Aorta |
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8. D- Transposition is associated with?
a. AV concordance, great vessel discordance b. AV discordance, great vessel discordance c. AV concordance, great vessel concordance d. AV discordance, great vessel concordance |
. AV concordance, great vessel discordance
blood flows RA to RV to aorta systemic and LA to LV to PA pulmonic - stay alive via shunt. |
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9. In Cardiac MRI, what is the best imaging sequence for estimating LVEF? riw
a. Short axis fast spin echo b. Short axis cine GRE c. Long axis fast spin echo d. Long axis Cine |
b. Short axis cine GRE
The short-axis plane is obtained when images are prescribed perpendicular to left ventricular long axis seen on a two-chamber view. It shows the true cross-sectional dimensions of cardiac chambers. Initial images in this plane are performed through the papillary muscles, with subsequent images performed toward the heart apex and base. In this plane the left ventricular myocardium is displayed as a doughnut-shaped ring. Cine GRE images allow visualization and quantification of systolic myocardial wall thickening. This plane can also be used for quantifying left and right ventricular volume and mass and ventricular ejection fraction when the appropriate software is available. Differences between right and left ventricular stroke volumes can be used to estimate valvular regurgitation or shunt ratios. |
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10. Which is the best MRI sequence for evaluating the flow dynamics in the heart:
a. T1 weighted spin echo b. T2 weighted spin echo c. ECG gated T2 d. Phase contrast e. Gradient echo |
d. Phase contrast
Cardiovascular MRI: (Society of Thoracic Radiology) Pulse Sequence Selection: -Three basic sequences are utilized using cardiac gating and respiratory compensation: 1. T1-weighted spin echo (SE): This is the predominant sequence in CV MRI and provides the best anatomic detail and morphologic information ("black-blood images"). 2. T2-weighted spin echo (SE): Provides some tissue characterization. 3. Gradient echo: Provides information regarding blood flow, valvular competence, and cardiac function, and can be obtained in cine-loop format ("bright-blood images"). |
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11. A young female whose brother died of sudden cardiac arrest at age 28 presents with foci of increased
signal on T1WI in the right ventricle. This represents: a. Arrhythmogenic ventricular dysplasia b. Previous infarct c. IHSS d. Aortic stenosis e. Pulmonary hypertension |
Arrhythmogenic right ventricular dysplasia (ARVD) is a heart muscle disorder of unknown cause that is characterized pathologically by fibrofatty replacement of the right ventricular myocardium. Clinical manifestations include structural and functional malformations of the right ventricle, electrocardiographic abnormalities, and presentation with ventricular tachycardias with left bundle branch pattern or sudden death. The disease is often familial with an autosomal inheritance. In addition to right ventricular dilatation, right ventricular aneurysms are typical deformities of ARVD and they are distributed in the so-called "triangle of dysplasia", i.e., right ventricular outflow tract, apex, and infundibulum. Ventricular aneurysms at these sites can be considered pathognomonic of ARVD. Another typical hallmark of ARVD is fibrofatty infiltration of the right ventricular free wall. These functional and morphologic characteristics are relevant to clinical imaging investigations such as contrast angiography, echocardiography, radionuclide angiography, ultrafast computed tomography, and magnetic resonance imaging (MRI). Among these techniques, MRI allows the clearest visualization of the heart, in particular because the right ventricle is involved, which is usually more difficult to explore with the other imaging modalities. Furthermore, MRI offers the specific advantage of visualizing adipose infiltration as a bright signal on T1 of the right ventricular myocardium. MRI provides the most important anatomic, functional, and morphologic criteria for diagnosis of ARVD within one single study. As a result, MRI appears to be the optimal imaging technique for detecting and following patients with clinical suspicion of ARVD.
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12. What is the best way to diagnose situs inversus?
a. Right stomach bubble and right cardiac apex b. Right stomach bubble and right aortic knob c. Right stomach bubble and left cardiac apex d. Stomach on the right side and cardiac apex on the left side e. Stomach on the left side and cardiac apex on the right side |
a. Right stomach bubble and right cardiac apexNormal situs is inferred when the aortic arch, cardiac apex, and stomach bubble are all located on the left. When these structures are positioned on the right or reversed, situs inversus is present. When any other situation is seen, an indeterminate situs or heterotaxy is inferred.
Radiographics. 1999;19:837-852 We believe that the aortic arch position will be more constant than cardiac apex, the position of which may be obscured by hypertrophy, etc. Therefore we choose b. (DW) I choose A because I think its right but not for any real intelligent reason. |
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13. What is left behind during harvest for orthotopic heart transplant? This should be left
a. Posterior wall of right atrium b. Posterior wall right ventricle c. Left atrium d. Coronary sinus |
a. Posterior wall of right atrium
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14. Ebstein’s anomaly associated with which valve
a. Tricuspid b. Mitral c. Aortic d. Pulmonic |
a. Tricuspid
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15. What is commonly mistaken for a mass in the right atrium:
a. Papillary muscle b. Right atrial appendage c. Crista supraventricularis d. SA something (not node) e. Crista terminalis f. Sinus venosum |
. Crista terminalis
Normal structures within the right atrium, such as the crista terminalis and Chiari network, may be seen more commonly with MRI than with other imaging modalities. An appreciation of the frequency with which these findings are seen should prevent inappropriate misdiagnosis of pathological masses when none is present. The crista terminalis marks the dividing line between the posterior, smooth sinus venarum - the remains of the developmental right horn of the sinus venosus - and the anterior, rough part of the right atrium. It is locared on the lateral wall. |
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16. Which is not a typical complication of true ventricular aneurysms?
a. Distal embolization b. Rupture c. Arrythmias |
b. Rupture
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17. A patient has a pseudoaneurysm after MI. What is the most worrisome complication?
a. Rupture b. Thrombus c. Arrhythmia d. Embolism |
a. Rupture
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18. Patient with NL arterial CO2 and decreased arterial O2 on ABG. After 100% O2, the arterial
oxygen concentration does not improve. What is the reason? a. Right to left shunt b. Left to right shunt c. VQ mismatch (PE) d. Diffusion abnormality e. COPD |
Right to left shunt
[Regarding] hypoxia secondary to right-to-left extrapulmonary shunting…PaO2 cannot be restored to normal with inspiration of 100% O2. Harrison’s Principles of Internal Medicine, 15th Ed., 2001, p. 214.- L to R shunts can also be associated with cyanosis if paired with R to L shunt (admixture lesions). Dänhert 4th ed. CD version Hypoxemia associated with PE and COPD is typically caused by V/Q mismatch and would therefore improve with supplemental 100% O2 |
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19. A patient with tricuspid and pulmonic valve replacement most likely has:
a. Bronchial carcinoid b. Midgut carcinoid with liver mets |
b. Midgut carcinoid with liver metsAn early and frequent symptom of carcinoid tumors, especially those of midgut with metastasis, is cutaneous flushing, typically of the head and neck, with striking color changes ranging from pallor or erythema to cyanosis. Other symptoms include a profuse and often colicky diarrhea, asthmatic wheezing, and symptoms of valvular heart lesion.
Cardiac manifestation is observed in as many as 60% of the patients. Fibrosis of endocardium, often involving the right heart, is observed. The fibrous deposit usually involves ventricular aspect of the tricuspid valve and associated chordae. Less commonly, fibrosis of the pulmonic valve is seen, resulting in regurgitation or stenosis. Cardiac lesions may lead to heart failure. The mitral valve is less frequently involved. eMedicine |
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20. What is associated with left atrial enlargement?
a. Right atrial myxoma b. Atrial fibrillation c. Pulmonary artery hypertension d. Constrictive/restrictive pericarditis |
b. Atrial fibrillation
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21. A patient with prior non-dominant right coronary bypass 5 years earlier now has reversible ischemia
in the inferior wall. This is most likely due to: a. Thrombosed bypass b. New clot in stent c. New left disease d. Disease in the right coronary distal to the bypass. |
c. New left disease
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22. Patient with acute chest pain. What is appropriate treatment for an antero-apical ventricular wall
abnormality that is dyskinetic on Nucs and then demonstrated delayed transmural wall enhancement after Gadolinium? a. Medical management b. RCA stent/pca c. LAD stent/pca d. Circumflex stent/pca e. CABG |
a. Medical management
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23. What is most commonly associated with Juxtaductal aortic coarctation? riw
a. Turner’s b. Down’s c. Trisomy 18 d. Holt-Oram e. Tuberous Sclerosis |
a. Turner’s(DW) Turner’s can have coarctation, bicuspid valve and dissecting aortic aneurysms.
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24. A middle-aged male is set to undergo CT coronary angiography. Preliminary evaluation reveals a
resting heart rate of 90 bpm. Which of the following is the most appropriate management? a. Cancel the CT angiogram. The patient will need a noninvasive scintigraphic perfusion exam or catheter angiography. b. Administer a beta-blocker. c. Proceed with CT angio. Do not use ECG gating. |
b. Administer a beta-blocker.
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25. Which is not associated with endocardial cushion defect?
a. Ostium secundum ASD b. Ostium primum ASD c. Cleft mitral valve d. High posterior VSD |
Ostium secundum ASD
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26. Which abnormality is best seen on a 4 chamber view?
a. AV canal defect b. Double outlet RV c. Transposition d. Aortic stenosis |
a. AV canal defect
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27. Which of the following is the most common vascular ring?
(Double AA not an option) a. Right arch with aberrant left subclavian b. Rightt arch with mirror branching c. Pulmonary sling d. Left arch with aberrant right subclavian |
Right arch with aberrant left subclavianThe two most common anatomic variants of true vascular rings, occurring in nearly equal frequency, are persistent double aortic arch and right aortic arch with anomalous origin of the left subclavian artery. Cincinnati Children’s Hospital
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28. Ascending aortic aneurysm most commonly associated with?
a. Aortic valvular disease (stenosis/bicuspid?) b. Dissection c. Atherosclerotic disease d. Cystic medial necrosis/degeneration |
Ascending Thoracic Aneurysm cystic medial degeneration (necrosis) - breaking down of the tissue of the aortic wall. This is the most common cause of this type of thoracic aortic aneurysm.
genetic disorders which affect the connective tissue, such as Marfan syndrome and Ehlers-Danlos syndrome family history of thoracic aortic aneurysm with no incidence of Marfan syndrome atherosclerosis - hardening of the arteries caused by a build-up of plaque in the inner lining of an artery. This is a rare cause of ascending thoracic aortic aneurysm. infection, syphilis (rare causes of thoracic aortic aneurysm) |
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29. Tracheal cartilage calcification and stenosis (Napkin Ring Trachea) associated with anomaly?
a. Right arch with aberrant left subclavian b. Right arch with mirror image branching c. Anomalous left pulm artery arising from Right PA (Pulmonary Sling) d. Ellis-van Creveld Syndrome e. Left arch with aberant right subclavian f. Double aortic arch |
c. Anomalous left pulm artery arising from Right PA (Pulmonary Sling)
ABERRANT LEFT PULMONARY ARTERY =PULMONARY SLING = failure of development / obliteration of left 6th aortic arch followed by development of a collateral branch of right pulmonary artery to supply the left lung Site: left PA passes above right mainstem bronchus + between trachea and esophagus on its way to left lung Age at presentation: neonate / infant / child Associated with: (1) "napkin-ring trachea" = absent pars membranacea (50%) (2) PDA (most common), ASD, persistent left SVC stridor (most common), wheezing, apneic spells, cyanosis respiratory infection feeding problems deviation of trachea to left "inverted-T" appearance of mainstem bronchi = horizontal course secondary to lower origin of right mainstem bronchus anterior bowing of right mainstem bronchus "carrot-shaped trachea" = narrowing of tracheal diameter in caudad direction resulting in functional tracheal stenosis obstructive emphysema / atelectasis of RUL + LUL low left hilum separation of trachea + esophagus at hilum by soft-tissue mass anterior indentation on esophagram |
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30. What occurs to the pulmonary vasculature during exercise? riw
a. Muscular arteriole dilatation b. Capillary dilatation c. Recruitment of new vessels d. Pulm venule dilation |
c. Recruitment of new vessels
With exercise, pulmonary arterial pressure tends to rise causing recruitment and distension of pulmonary vessels leading to a fall in pulmonary vascular resistance. |
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31. Regarding the lateral view on chest radiograph, which is true?
a. The confluence of pulmonary veins is inferior to both right and left upper lobe bronchi. b. The right upper lobe bronchus is better visualized than the left. |
a. The confluence of pulmonary veins is inferior to both right and left upper lobe bronchi.
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What structure is immediately anterior to the left pulmonary bronchus?
a. Left pulmonary artery b. Ascending aorta c. Left atrial appendage d. Left superior pulmonary vein |
d. Left superior pulmonary vein
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Regarding what is seen on lateral CXR:
a. Anterior wall of the bronchus intermedius is commonly seen b. The RUL bronchus seen more often than the LUL bronchus c. The confluence of pulmonary veins are below the main bronchi d. Left bronchial artery is superior to the left bronchus |
c. The confluence of pulmonary veins are below the main bronchi
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True regarding the lateral chest radiograph?
a. The anterior wall of the bronchus intermedius is commonly visualized b. The left upper lobe bronchus is seen above the left main pulmonary artery c. The pulmonary venous confluence is seen below both the left upper and right upper lobe bronchi d. A dilated azygos is seen as a stripe immediately posterior to the esophageal shadow e. RUL bronchus is more commonly seen than LUL bronchus |
c. The pulmonary venous confluence is seen below both the left upper and right upper lobe bronchi
(a) false – the posterior wall of the bronchus intermedius is usually visualized on a lateral. (b) False – “the left main pulm art. is seen as a longitudinal structure arching over and passing posterior to the LUL bronchus” (c) true – not directly below, but more inferior (d) False – This is theoretically possible, but I could find no references that validate this. In general, the esophagus shadow is usually not one of the usual landmarks on a lateral CXR. Frandics agrees and thinks this answer is bogus. (e) False – LUL is more commonly seen. It is inferior to the RUL bronchus. |
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32. What is vital capacity? riw
a. Volume of gas remaining in lungs at the end of quiet expiration b. Maximal amount of gas expired after a maximal inspiration. c. Gas contained in lung at the end of a maximal inspiration d. Amount of gas remaining in lung after a maximal expiration |
b. Maximal amount of gas expired after a maximal inspiration.
Vital capacity is the maximum amount of air a person can expel from the lungs after a maximum inspiration. It is equal to the inspiratory reserve volume plus the tidal volume plus the expiratory reserve volume. |
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33. An elderly patient with fever and cough has a CT scan revealing bronchiectasis and consolidation in
the middle lobe. What is the likely etiology? a. TB b. Mycoplasma pneumonia c. S. pneumonia d. Mycobacterium Avium Intracellulare e. Chronic aspiration |
d. Mycobacterium Avium IntracellulareMycobacterium Avium Complex (MAC) (aka MAI) usually affects patients with abnormal lungs or bronchi.
The right middle lobe and left lingula of the lung are served by bronchi that are oriented downward when a person is in the upright position. As a result, these areas of the lung may be relatively more dependent upon vigorous voluntary expectoration (cough) for clearance of bacteria and secretions. Since the six patients in their retrospective case series were older females, Drs. Reich and Johnson propose that patients without a vigorous cough may develop right middle lobe or left lingular lung infection with MAC. They propose that this syndrome be named Lady Windermere Syndrome, after the character Lady Windermere in Oscar Wilde's play Lady Windermere's Fan. |
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34. A 35 year old presents with a three week history of cough and low grade fever. Chest CT
demonstrates an area of consolidation in the left lower lobe and a left posterior chest wall soft tissue mass. Which is the most likely diagnosis? a. Bacterial pneumonia b. Actinomycosis c. Nocardia d. Mycoplasma e. TB |
b. Actinomycosis
Thoracic actinomycosis accounts for 15-20% of cases of actinomyces infections. Aspiration of oropharyngeal secretions containing actinomycetes is the usual mechanism of infection. Occasionally, thoracic actinomycosis may result from the introduction of organisms via esophageal perforation, by direct spread from an actinomycotic process of the neck or abdomen, or via hematogenous spread from a distant lesion. Thoracic actinomycosis commonly presents as a pulmonary infiltrate or mass, which, if left untreated, can spread to involve the pleura, pericardium, and chest wall, ultimately leading to the formation of sinuses that discharge sulfur granules. Emedicine |
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35. Most common germ cell tumor in mediastinum? riw
a. Seminoma b. Choriocarcinoma c. Embryonal d. mature teratoma e. Sertoli cell |
d. mature teratoma
most common is mature teratoma…after that is seminoma |
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36. Lung mass with metastasis to the ipsilateral supraclavicular lymph node. What is the stage? riw
a. NX b. N1 c. N2 d. N3 e. M1 |
N0: No mets to nodes
N1: Mets to peribronchial, ipsilateral hilar region or both, including direct extension N2: Mets to ipsilateral mediastinal nodes and subcarinal nodes N3: Mets to contralateral mediastinal or hilar nodes, ipsilateral or contralateral scalene or supraclavicular nodes |
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37. The mean capillary wedge pressure seen with interstitial pulmonary edema: riw
a. 5- 10 mmHg b. 12- 17 mmHg cephilization c. 20- 25 mmHg interstital d. 30- 40 mmHg alveolar e. 40- 50 mmHg |
c. 20- 25 mmHg interstital
Normal: 5-10 mmHg Vascular redistribution (grade 1 PVH): 10-18 mmHg Interstitial edema (grade 2 PVH): 18-25 mmHg Alveolar edema (grade 3 PVH): >25 mmHg [Primer, Dahnert] |
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38. Which medication causes bilateral mediastinal/hilar adenopathy?
a. Diphenylhydantoin (Dilantin) b. Bromocriptine c. Valium d. INH e. Phenobarbital |
Mediastinal adenopathy may be a complication of dilantin, cyclosporin, or methotrexate.
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39. Which of the following is not associated with smoking?
a. Laryngeal CA b. Centrilobular emphysema c. EG d. Respiratory bronchiolitis e. Extrinsic allergic alveolitis |
e. Extrinsic allergic alveolitis
More than 95 percent with laryngeal SCCA are smokers Eosinophilic granuloma, also known as pulmonary histiocytosis X (PHX) or pulmonary Langerhans cell histiocytosis X (PLCH), is an uncommon interstitial lung disease that is epidemiologically related to tobacco smoking. Emedicine Respiratory bronchiolitis-associated interstitial lung disease (RBILD) can be viewed as an exaggerated respiratory bronchiolitic response to cigarette smoke. Non-smoking was significantly associated with allergic alveolitis in men and the three cases in women were all non-smokers. Thorax 1977 Oct;32(5):567-9. |
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40. Regarding usual interstitial pneumonia (idiopathic pulmonary fibrosis), which is true? riw
a. Subpleural fibrosis must be present to make the diagnosis. b. Apical involvement is characteristic c. Centrally > peripherally |
a. Subpleural fibrosis must be present to make the diagnosis.
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41. What is the most common first symptom in a patient with UIP?
a. Dyspnea b. Fatigue c. Cough d. Fever e. Weight loss |
a. Dyspnea
Dyspnea is the most frequent symptom, but chronic cough, wheezing, hemoptysis, and chest pain can occur. Emedicine |
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42. Idiopathic interstitial pulmonary fibrosis begins where? riw
a. Alveolar wall b. Interlobular septae c. Pulmonary lymphatics d. Terminal bronchiole e. Bronchovascular bundles |
a. Alveolar wall
An emerging body of literature that has accumulated in recent years suggests that alveolar type II cell injury and apoptosis may be an important early feature in the pathogenesis of pulmonary fibrosis. Ultrastructural studies have demonstrated alveolar type II cell injury and apoptosis in lung biopsies from patients with IPF. Studies from Kuwano et al demonstrated increased expression of pro-apoptotic proteins in alveolar epithelial cells and bronchoalveolar lavage from patients with IPF. |
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43. 30 year old man is status post bone marrow transplant, now with slowly increasing SOB. Chest x-
ray and conventional chest CT are normal. What is the appropriate next study: riw a. MRA pulmonary angiogram b. CT pulmonary angiogram c. Conventional catheter-directed angiogram d. Transesophageal echo e. HRCT with expiration |
HRCT
HRCT is useful in detection of the variety of pulmonary abnormalities that occur in bone marrow transplant recipients, but these findings are generally non-specific. These complications reflect the immunologic status of the patients and occur in three phases. This phasic pattern can be used to interpret CT scans. The neutropenic phase, up to 3 weeks after BMT, is characterized by fungal infections, alveolar haemorrhage, pulmonary oedema, and drug reactions. The second phase, 3 weeks to 100 days after BMT, is dominated by cytomegalovirus pneumonia and pneumocystis carinii pneumonia. The late phase (more than 100 days after BMT) is characterized by bronchiolitis obliterans revealing bronchial dilatation and a mosaic pattern of attenuation, bronchiolitis obliterans with organizing pneumonia, and chronic graft-versus-host disease. By interpreting the CT findings in relation to the time elapsed after BMT, diagnostic options can be narrowed sufficiently to enable accurate diagnosis. RSNA 2004 abstract |
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44. Congenital gastric diverticula most commonly occur where?
a. Posterior wall of fundus b. Cardia c. Lesser curvature d. Greater curvature e. Antrum |
a. Posterior wall of fundus
) Juxtacardiac on posterior wall is stated location in Dahnert Two types of gastric diverticula generally occur in two different locations of the gastric wall. Congenital gastric diverticula comprise about 72% of all gastric diverticula; they are true full-thickness diverticula most commonly found within 2 cm to 3 cm of the gastroesophageal junction, along the posterior wall of the stomach. The cause of congenital gastric diverticula may relate to a defect in the gastric wall musculature caused by the division of the longitudinal fibers (5). A lack of peritoneal covering along the posterior wall and the presence of arterial perforators also are thought to contribute to gastric wall weakness. Congenital gastric diverticula can be found in conjunction with other gastrointestinal tract abnormalities, including other diverticula, peptic ulcer disease, malignancy, cirrhosis, gastroesophageal reflux disease, pancreatitis, hepatitis, and cholecystitis (1,6-8). Riw Acquired gastric diverticula are pseudodiverticula present near the antrum and found in association with peptic ulcer disease, pancreatitis, cholecystitis, malignancy, or gastric outlet obstruction (1,9). Gastric diverticula are usually single lesions and range in size from 1 cm to 5 cm in diameter with occasional reports describing lesions of 10 cm to 11 cm |
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45. Delayed images on contrast enhanced CT of the liver are useful for detecting which of the following:
a. Colon CA metastases b. Cholangiocarcinoma c. HCC (hepatoma) d. RCC metastases e. FNH |
b. CholangiocarcinomaAt CT, peripheral cholangiocarcinoma has been described as an irregular mass with markedly low attenuation, minimal peripheral enhancement, and focal dilatation of intrahepatic ducts around the tumor. At spiral CT, peripheral cholangiocarcinoma usually demonstrates thin, incomplete rim enhancement during both the arterial and portal venous phases. The central part of the tumor does not enhance during these phases, whereas there may be prolonged enhancement at delayed-phase CT.
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46. What is least likely to have posterior acoustic enhancement?
a. Lymphoma b. Hepatic adenoma c. HCC d. Focal fatty infiltration e. Mets |
d. Focal fatty infiltration
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47. In a post liver transplant patient, ultrasound demonstrates bile duct dilatation.
What should you evaluate for next in this patient? a. Hepatic artery thrombosis b. Portal vein thrombosis c. Bile leak d. Hepatic vein thrombosis |
a. Hepatic artery thrombosis
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48. Regarding carcinoid disease: riw
a. Most appendiceal carcinoids are benign b. Most present with carcinoid syndrome c. Most are asymptomatic |
a. Most appendiceal carcinoids are benign
In the appendix, carcinoids appear as discrete yellow nodules within the lumen. Diffuse wall thickening lesions are less common. Carcinoid tumors commonly affect the tip of the appendix. Most carcinoid tumors invade the wall of the appendix, and lymphatic involvement is nearly universal. In 75% of cases, evidence of peritoneal involvement is present; however, only a few patients have regional or distant dissemination. eMedicine 90% of patients with carcinoid syndrome have liver mets. Primer |
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49. Which is a factor considered in MELD (model for Endstage Liver Disease)? riw
a. AST b. Ascites c. Encephalopathy d. Albumin e. Creatinine |
e. Creatinine
The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially described by Kamath et al in 2001 and modified by Wiesner et al, also in 2001. It uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. This score is also used by the United Network for Organ Sharing (UNOS) for prioritizing allocation of liver transplants. It is calculated according to the following formula: MELD = 3.8[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.6[Ln serum creatinine (mg/dL)] + 6.4 |
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50. On T2 weighted images of the abdomen, you see splenomegaly along with low signal intensity
within the liver and pancreas. This most likely is related to: riw a. Amyloidosis b. Primary hemachromatosis c. Secondary hemochromatosis d. Wilson's disease e. Gaucher’s disease |
b. Primary hemachromatosis
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51. Which of the following will least likely mimic primary achalasia? riw
a. Chagas b. Dermatomyositis c. Lung cancer d. Long standing DM e. Gastric cardia adenocarcinoma |
c. Lung cancer
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What is not associated autoimmune pancreatitis?
a. Elevated IG and autoab b. Lymphocytic infiltration and fibrosis c. Diffuse ductal irregularity and narrowing d. Severe pain and fever e. Enlargement of the pancreas |
d. Severe pain and fever
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53. Which organism does not typically produce ileocecal involvement?
a. Mycobacterium b. Yersinia c. Campylobacter d. Giardia e. Salmonella |
d. Giardia
Giardia - thickened distorted mucosal folds in duodenum + jejunum (mucosal edema) with normal ileum Giardia: Giardia Lamblia may cause narrowing secondary to thickening of folds in the duodenum and proximal jejunum. TB causes narrowing and sometimes marked distortion of the ileocecal region. Other infections in which fold thickening and luminal narrowing are usually localized to the distal ileum include Camplyobacter, Yersinia, and Salmonella. GI Requistes 107 |
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54. Which entity is H. pylori not associated with? riw
a. Gastric ulcer b. Gastric lymphoma c. Gastric adenocarcinoma d. Zollinger-Ellison syndrome |
d. Zollinger-Ellison syndrome
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55. Of the following pancreatic neoplasms, which is least likely to be hypervascular?
a. Islet cell tumor b. Insulinoma c. Metastatic RCC d. Glucagonoma e. Adenocarcinoma f. Microcystic adenoma |
e. Adenocarcinoma
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56. What is false regarding enteric duplication cysts.
a. Muscular layer hyperechoic, mucosa hypoechoic b. Associated with anterior vertebral body defect c. May contain gastric mucosa d. May not connect with true lumen |
a. Muscular layer hyperechoic, mucosa hypoechoic
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57. Hereditary non-polyposis colon cancer is not/least associated with what type of cancer? riw
a. Endometrial b. Ovarian c. Cholangiocarcinoma d. Breast e. Gastric/gastrinoma |
d. Breast
Hereditary nonpolyposis colorectal cancer, often called HNPCC or Lynch syndrome, is a type of inherited cancer of the digestive tract, particularly the colon (large intestine) and rectum. People with hereditary nonpolyposis colorectal cancer have an increased risk of cancers of the stomach, small intestine, liver, gallbladder ducts, upper urinary tract, brain, skin, and prostate. Women with this disorder also have a greatly increased risk of endometrial and ovarian cancer. Even though the disorder is described using the term nonpolyposis, people with hereditary nonpolyposis colorectal cancer may have occasional noncancerous growths called colon polyps. These colon polyps occur at an earlier age than do colon polyps in the general population. Although the polyps do not occur in greater numbers than in the general population, they are more prone to become cancerous. |
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58. What is the most common cause of spontaneous pneumoperitoneum in an adult? riw
a. Mesenteric ischemia b. Diverticulitis c. Median arcuate ligament syndrome d. Duodenal ulcer e. Appendicitis |
d. Duodenal ulcer
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59. Primary sclerosing cholangitis is associated with:
a. IBD b. Budd-Chiari c. Breast CA mets d. Colon CA mets e. Post transplant liver |
a. IBD
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60. What is the most likely factor in a neutropenic patient with symptoms and CT findings consistent
with colitis: a. Immunocompromised patient b. Crohns c. Ulcerative colitis d. Amoebic e. C. diff |
a. Immunocompromised patient
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61. Post-transplant lymphoproliferative disorder most commonly affects where in the GI tract?
a. Stomach b. Colon c. Small intestine d. Eesophagus |
c. Small intestine
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62. What it true regarding the cricopharyngeus muscle?
a. Located inferior to the mouth of the Zenker’s diverticulum b. Utilized in phonation c. Located in inferior cervical esophagus d. Always causes impression on esophagus |
a. Located inferior to the mouth of the Zenker’s diverticulum
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63. In left testicular seminoma, to which nodal chain would you first see metastases?
a. Obturator b. Internal Iliac c. Common Iliac d. Retroperitoneal/paraaortic e. Perirenal f. Ingiunal |
d. Retroperitoneal/paraaortic
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64. Neonate with increased renal pyramid echotexture seen in all except?
a. ATN/RTA b. Prune Belly Syndrome c. Lasix therapy d. Hyperparathyroidism e. Fanconi’s |
b. Prune Belly Syndrome
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65. A smooth mass in the ureter is most likely:
a. malakoplakia b. cystitis c. leukoplakia |
a. malakoplakia
malakoplakia - multiple dome-shaped smooth mural filling defects cystitis - nonspecific inflammatory process of bladder wall; multiple small round cystlike mucosal elevations leukoplakia - corrugated / striated irregularities of pelvicaliceal walls, localized / generalized |
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66. Which ureteral calculus has the lowest density on CT?
a. Uric acid b. Struvite c. Indinavir |
c. Indinavir
(DW) From lowest to highest…indinavir/matrix/xanthine/uric acid, cystine, struvite, calcium |
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67. What tumor is most associated in a young male with sickle cell trait?
a. RCC b. Medullary carcinoma c. AML d. Lymphoma e. TCC |
b. Medullary carcinoma
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68. Cowpers glands are located where?
a. Bulbous urethra b. Membranous urethra c. Proximal to postatic urethra d. Posterior to fossa navicularis |
b. Membranous urethra
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Alt: The ducts of the Cowper’s glands are seen posterior to which structure on retrograde urethrogram? riw
a. Prostatic urethra b. Membranous urethra c. Bulbous urethra d. Penile urethra |
c. membranous
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69. An IVP demonstrates a filling defect within the renal pelvis in a patient with history of hematuria. A
follow-up nonenhanced CT scan demonstrates this lesion to be 75 HU. Most likely etiology a. Blood clot b. Fungal ball c. TCC d. Urate stone |
a. Blood clot
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70. Most common cause of bilateral smoothly enlarged kidneys in a young adult male?
a. Pyelonephritis b. Renal vein thrombosis c. HIV nephropathy |
c. HIV nephropathy
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71. Which among the following is the most common location for ectopic (extraadrenal)
pheochromocytoma (paraganglioma)? a. Bladder b. Cardiac c. Mediastinum d. Pituitary e. Organ of Zukerkandl f. Carotid body |
e. Organ of Zukerkandl
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72. Which will stimulate the renal juxtaglomerular apparatus? riw
a. Hypokalemia b. Decreased renal artery pressures |
b. Decreased renal artery pressures
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73. Which is the most important factor in determining whether a renal mass is renal cell carcinoma?
a. Cystic components b. Internal septations c. Enhancement d. Hemorrhage within the mass |
c. Enhancement
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74. Which is not a cause of bladder calcification? riw
a. TB b. TCC c. Malakoplakia d. Schistosomiasis |
c. Malakoplakia
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75. Most common non-primary neoplasm to involve the testes.
a. Lymphoma b. Prostate c. Lung d. Liver e. Stomach |
a. Lymphoma
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76. A man with longstanding hypertension presents with an adrenal mass with decreased signal on out of
phase. This lesion is most likely: a. Adenoma and essential HTN b. Pheochromocytoma c. Aldosteronoma d. Met |
a. Adenoma and essential HTN
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A 70 y/o man with hypertension presents with an adrenal nodule that demonstrates decreased signal on out phase MRI imaging compared to in phase images. The most likely etiology of this patient’s hypertension is:
a. Hyperfunctioning adrenal nodule- Conn’s syndrome b. Essential hypertension c. Nonfunctioning adrenal nodule d. Cushing’s syndrome |
b. Essential hypertension
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77. ARPKD is associated with: riw
a. RCC b. Periportal fibrosis c. Parents should be screened d. UPJ obstruction e. Pelvicalyceal abnormalities |
b. Periportal fibrosis
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78. Which of the following is associated with squamous cell CA?
a. Malakoplakia b. Analgesic abuse c. Infected staghorn calculus d. TB |
c. Infected staghorn calculus
The association between staghorn calculus of the kidney long-standing and urothelial tumors of the renal pelvis is well documented. Urologia Internationalis 2005;75:17-20 |
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79. Von Hippel Lindau is not associated with:
a. Angiomyolipoma b. Renal cyst c. Pheo d. RCC |
a. Angiomyolipoma
DW) This is the best choice but Dahnert says that even VHL can have AML’s |
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80. All are associated with renal cysts except:
a. NF1 b. Chronic renal failure c. Von Hippel Lindau d. Tuberous Sclerosis |
a. NF1
Syndromes With Multiple Cortical Renal Cysts 1.Von Hippel-Lindau syndrome 2.Tuberous sclerosis 3.Meckel-Gruber syndrome 4.Zellweger syndrome = cerebrohepatorenal syndrome 5.Jeune syndrome 6.Conradi syndrome = chondrodysplasia punctata 7.Oro-facial-digital syndrome 8.Trisomy 13 9.Turner syndrome 10.Dandy-Walker malformation |
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81. Dialysis patient with acquired renal cystic disease has a solid renal mass:
a. Cystic lesions regress after transplant b. Solid mass regresses after transplant c. Greater incidence of cancer than background population |
c. Greater incidence of cancer than background population
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82. Increased risk of Ureteral CA is most associated with which of the following?
a. Bladder CA b. Malacoplakia c. TB d. Ureteritis cystica |
a. Bladder CA
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83. If a breast mass is located at the nipple line on the MLO view and in the far lateral aspect on the CC
view of the left breast, at what clock position is the mass? a. 2:00 b. 3:00 c. 4:00 d. 7:00 e. 9:00 |
c. 4:00
Using the triangulation method, place the MLO and CC views side-by-side, with the CC view to the right of the MLO (hopefully, the nipples at same level. An imaginary line is drawn from the lesion seen on the CC view through the lesion seen on the MLO view. This line is then extended to indicate the expected location of the lesion on the yet-to-be-obtained ML view.In this case the lesion is in the lateral half of the breast on the CC view, and projects at mid-breast level on MLO view. Thus, an imaginary line drawn through the lesion on these two views is inferior to nipple level when extended to the ML view. Hence, this is a lower outer quadrant lesion source: ACR Breast Syl pp 2-6 |
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84. Picture of a left breast on mammography with a lesion in the medial breast on CC and almost
posterior to the nipple on the MLO view. Ask where is the lesion a. Upper outer b. Upper inner c. Lower outer d. Lower inner e. Subareolar |
b. Upper inner
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85. Of 500 screening mammograms, 50 are called back for biopsy. You perform 40 imaging guided
biopsies (10 malignant, 30 benign). Surgical biopsy is performed on 8 (3 malignant and 5 benign). What is the PPV of the screening mammogram? riw a. 27% b.13% c. 40% |
a. 27%
True positive (13) divided by all positive (48 got biopsy) = 27% The positive predictive value of a test is the probability that the patient has the disease when restricted to those patients who test positive. PPV = TP / (TP + FP). |
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86. A stereotactic biopsy of pleomorphic breast calcifications is performed, and the specimen
radiograph shows calcifications. Pathology is negative for calcifications or CA. What is your next step? a. Polarized light microscopy of specimen b. Repeat diagnostic mammogram c. Repeat excisional biopsy |
a. Polarized light microscopy of specimen
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87. What is true for a biopsy that returns ADH?
a. Biopsy must have been done for mammo microcalcifications rather than for a mass. b. X% chance of cancer in adjacent tissues. c. Increased breast cancer risk by X% d. Patient should be referred for additional surgery |
d. Patient should be referred for additional surgery
(DW) If B is 5-10% it is correct. If C is increased risk is 5x greater than it is correct. |
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88. What can be done to correct blurring on mammographic magnification views:
a. Grid b. Decrease focal spot c. Increase compression d. Increase kVp |
c. Increase compression
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Blurring in a mag spot view for calc’s. How do you decrease blurring?
f. Increase kvP g. Use grid h. Use larger compression paddle i. Change focal spot to 0.3mm |
f. Increase kvP
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89. A well-circumscribed 1 cm mass is found on routine screening mammography. The next step is:
a. Birads 3 – probably benign, with 6 month followup. b. Spot compression and magnification views. c. Birads 0 – return for further imaging - US |
c. Birads 0 – return for further imaging - US
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90. Regarding breast MRI, which is true: riw
a. Fat suppressed contrast enhanced sequences are essential for evaluation of malignancy. b. Contrast is necessary for evaluation of breast implant leakage. c. Contrast is optional |
a. Fat suppressed contrast enhanced sequences are essential for evaluation of malignancy.
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91. Malignant calcifications within the breast are most commonly in which location:
a. Segmental b. Regional c. Diffuse d. Bilateral and diffuse unilateral and diffuse |
a. Segmental
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92. According to the MQSA, once done with residency, how many mammograms in 24 months must
you read to stay certified? a. 240 b. 480 c. 960 d. 1200 |
c. 960
Following the second anniversary date of the end of the calendar quarter in which the requirements of paragraph (a)(1)(i) of this section were completed, the interpreting physician shall have interpreted or multi-read at least 960 mammographic examinations during the 24 months immediately preceding the date of the facility’s annual MQSA inspection or the last day of the calendar quarter preceding the inspection or any date in-between the two. |
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93. What is true about statistics of breast cancer? riw
a. Incidence has decreased in last 5 years b. 1 in 8 risk for a woman at age 40 c. Greater mortality rate in African American women d. Most common cause of death in women e. Mortality has increased since 1990 |
c. Greater mortality rate in African American women
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94. Ultrasound features of breast cancer can include all the following except: riw
a. Hypoechoic b. Taller than wider c. Pseudocapsule d. Posterior shadowing e. Posterior acoustic enhancement |
c. Pseudocapsule
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95. A cluster of pleomorphic microcalcifications undergoes excisional biopsy and
the pathology for this “suspicious finding” returns as sclerosing adenosis and lobular carcinoma in situ. For the purposes of mammography audit, how is this classified? riw a. True positive b. False positive c. True negative d. False negative |
b. False positive
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96. Repeat mammogram after radiation and surgical excision is done at 3-6 months because?
a. Re-establish baseline b. To see if microcalfications still present c. To eval for hematoma d. Routine follow-up |
a. Re-establish baseline
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What is the reasoning behind performing a mammogram after lumpectomy, but before radiation therapy? (UT Baylor 2004)
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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97. What is true regarding the Bi-Rads 3 category?
a. Can change Bi-Rad 3 category lesion at 6 month follow up to a Bi-Rad 2 if it’s stable b. Chance of malignancy 5-10% c. 3 month follow-up interval d. Applicable if prior imaging is unavialable |
a and c
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98. Which cancer most often arises in a cyst?
a. Medullary b. Mucinous c. Papillary d. Tubular |
c. Papillary
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99. Which of the following is the most common cause of a well-circumscribed
breast malignancy? a. Medullary b. Tubular c. Colloid d. Invasive ductal carcinoma e. Mucinous |
Invasive ductal carcinoma shows up most commonly as a spiculated and nodular growth but since it is the most common cancer it is the most common circumscribed cancer (Diagnostic Breast Imaging 2nd ed. Pg 276) .“…in fact, due to its frequency, the usual ductal type of carcinoma (NOS) makes up the majority of carcinomas that have circumscribed margins…” Bassett p. 477.
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100. The goal of a randomized trial study on a screening mammography program is to determine: riw
a. Detection rate b. Impact on mortality c. Impact on survival d. Incidence e. Prevalence |
b. Impact on mortality
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101. In an patient with known diagnosis of breast cancer, followup mammogram demonstrates that the
breast mass has decreased in size. The correct BIRADS category is: a. Category 1 b. Category 2 c. Category 4 d. Category 5 e. Category 6 |
CAT 6
BI-RADS O --incomplete assessment BI-RADS 1 --negative findings (within normal) BI-RADS 2 --benign findings BI-RADS 3 --probably benign, 6-month follow-up BI-RADS 4 --suspicious abnormality, biopsy recommended BI-RADS 5 --highly suggestive of malignancy BI-RADS 6 –biopsy proven malignancy |
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102. What is true about sentinel lymph node biopsy in breast cancer? riw
a. Correlates with axillary lymph node dissection in 95% of cases b. If postive, excludes lumpectomy, requires mastectomy. c. Need to do it with DCIS d. Not indicated if there is palpable axillary lymphadenopathy e. Performed with Ultrasound guidance in OR. |
a. Correlates with axillary lymph node dissection in 95% of cases
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103. A woman presents with breast cancer diagnosed five years ago which was treated conservatively,
has normal mammograms and then presents with a new finding that showed skin thickening and thick fibroglandular pattern. This most likely represents: a. Recurrence b. Lymphoma c. Post Radiation changes. |
a. Recurrence
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Patient 6 months status post lumpectomy and radiation has skin thickening on mammo. Most likely cause:
a. Recurrent carcinoma b. Inflammatory carcinoma c. Post-radiation changes d. Congestive heart failure |
c. Post-radiation changes
The postradiation mammograms should be performed 6 months after initiation of therapy and followed annually. Radiographic features of postradiation breast include diffuse density of entire breast, unilateral (edema); most pronounced at 6 months, nearly gone at 24 months. Skin thickening is the most common change in the screening mammogram after breast conserving therapy and has been reported in up to 90% of cases. [normal in 2-3 yrs. in 46-60%] Source: Primer 2nd ed. p.679; Bassett p. 554. |
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104. Which is true concerning ultrasound guided breast biopsy? riw
a. The biopsy needle is parallel to the transducer b. Skin entry site is 1mm from the transducer c. Correct pre-fire position is 1 cm from mass |
a. The biopsy needle is parallel to the transducer
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105. Proximal lunate cystic lesions and sclerosis with Triangular Fibrocartilage Tear Associated with?
a. Ulnar impaction syndrome b. Keinbock’s dz c. SLAC wrist d. CPPD |
a. Ulnar impaction syndrome
Chronic impaction between the ulnar head and the TFC complex and ulnar carpus results in a continuum of pathologic changes: degenerative tear of the TFC; chondromalacia of the lunate bone, triquetral bone, and distal ulnar head; instability or tear of the lunotriquetral ligament; and, finally, osteoarthritis of the ulnocarpal and distal radioulnar joints. Radiographics. 2002;22:105-121 |
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106. What part of the long bone first demonstrates fatty marrow replacement in children?
a. Epiphysis b. Metaphysis c. Diaphysis |
a. Epiphysis
Conversion of hematopoietic to fatty marrow in the femur followed a well-defined sequence, occurring first in the proximal and distal epiphyses, followed by the diaphysis, distal metaphysis, and then the proximal metaphysis. |
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107. A disease entity which normally causes coxa valga and dislocation of the hip is:
a. Legg-Calve-Perthes disease b. Cerebral palsy c. Spina bifida |
b. Cerebral palsy
Cerebral palsy, a central nervous system disorder associated with premature delivery and low birth weight, occurs in 1-5 per 1000 live births. Placental infarction, congenital infections, intrauterine asphyxia, and occlusion of a cerebral vessel have also been implicated. Spastic diplegia is the more common form, mainly affecting the lower extremities and consisting of spasticity, motor weakness, impaired sensory perception, and resultant joint and muscle contractures. After equinus deformity (plantar-flexed calcaneus), hip subluxation and dislocation are the most common deformities in patients with spastic cerebral palsy, with a reported prevalence of up to 28%. The typical finding, an increased femoral neck-shaft angle with subluxation, is termed coxa valga, though this term is not strictly correct. The projectional effects that femoral anteversion and rotation have on the measurement of the neck-shaft angle tend to exaggerate the measurement, so some clinicians prefer the term “apparent neck-shaft angle on the AP radiograph”. A normal neck-shaft angle is 125°–130°, while the average in patients with cerebral palsy is 147°–154°. For this to occur, the spastic flexors and adductors force the femoral head in a superolateral direction, with the increased femoral anteversion helping to displace the femoral head. Surgery is undertaken to maintain reduction of the hips for good sitting balance and prevention of pain and pelvic obliquity. |
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108. High signal is present at the lateral epicondyle. Which structure is most likely involved? riw
a. Radial collateral ligament b. Annular ligament c. Extensor carpi radialis brevis d. Ulnar collateral ligament |
c. Extensor carpi radialis brevis
DW) Radial collateral can also be avulsed with lateral epicondylitis. |
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109. What is least likely in Ewing’s Sarcoma?
a. Associated usually with large soft tissue mass b. Osteoblastic bone respone (sclerotic) c. In older children affects flat bones (<20 yo affects long bones, >20 yo affects flat bones, Dahnert p. 73) d. Painful, warm to touch e. Responsive to radiation therapy |
b. Osteoblastic bone respone (sclerotic)
(DW) I think these all can be true but is much more likely to be permeative and lytic rather than blastic. Riw: only believe this answer if it say most common, flat bones in oler than 18 not rall child more adult |
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110. Morton’s neuroma is?
a. Spindle cell tumor b. Hamartoma c. Reactive pseudotumor |
c. Reactive pseudotumor
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111. What is a contraindication to intraarticular injection of steroid for shoulder pain?
a. Septic arthritis b. Frozen shoulder c. Labral tear |
a. Septic arthritis
Absolute contraindications to intra-articular corticosteroid injection are suspected infection, bacteremia, the presence of a prosthetic joint, and preceding injury or fracture. POSTGRAD MED. 1998:103(2) |
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112. Periprosthetic loosening in a total knee replacement with giant cell response is most commonly a
result of? riw a. Foreign body reaction to abraded polyethylene particles b. Foreign body reaction to cement |
Both a and b can cause particle disease, but some sources say that polyethylene debris is the
primary cause. Particle disease Extensive localized areas of bone resorption around joint prostheses. Either polymethylmethacrylate cement or polyethylene can incite a giant cell response. In this disease, osteolytic lesions appear on radiographs as well-defined focal areas of bone resorption that do not conform to the shape of the prosthesis. In the hip, these lesions occur most often near the tip of the femoral component or along its medial border. |
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113. What is true about the growth plate of the knee? (age was not given) riw
a. Impervious to infection b. Widened with lead poisoning c. Most susceptable to injury during rapid growth d. Shares blood supply from metaphysis |
c. Most susceptable to injury during rapid growth
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114. Which of the following is a long-term sequealae of prostaglandin therapy to
maintain a patent ductus arteriosus? a. Periosteal reaction |
a. Periosteal reaction
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115. Regarding fractures of the patella, which is FALSE? riw
a. Bipartite patella frequently occurs in upper outer quandrant b. Inferior accessory ossification center may be mistaken for fracture c. Superior accessory ossification center may be mistaken for fracture d. Division of a bipartite patella may be horizontal e. Multisegmented patella can exist |
d. Division of a bipartite patella may be horizontal
bipartite patella – usually unilateral and the superolateral aspect of the patella is affected. The bipartite patella is generally diagnosed when a second centre of ossification affects the superolateral quadrant of the bone. Radiographically, a bipartite patella may need to be distinguished from a patellar fracture. 1% of population, M>F True patellar fractures are usually horizontal riw |
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116. A 10 year old boy with chronic knee pain and MRI with high T2 signal in the proximal patellar
tendon. Which is the most likely diagnosis? riw a. Haglund’s deformity b. Osgood schlatter c. Jumper’s knee d. Patellar sleeve avulsion |
c. Jumper’s knee
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117. Which inserts on the lesser tuberosity?
a. Subscapularis b. Supraspinatus c. Infraspinatus d. Teres minor |
a. Subscapularis
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118. What comprises the pes anserinus? riw
a. Semimembranosus, gracilis, sartorius b. Gastrocnemius, semimembranosus, sartorius c. Semitendinosus, sartorius, gracilis |
c. Semitendinosus, sartorius, gracilis
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119. Injury to the growth plate of the great toe is most commonly associated with:
a. Growth plate disturbance b. Osteomyelitis c. subungual exostosis d. AVN |
b. Osteomyelitis
Of particular importance are… in children, physeal injuries of the distal phalanx (the stubbed great toe, which may be open and accompanied by osteomyelitis).” Resnick 2nd p. 790 |
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120. What is the least common acetabular fracture?(anterior column)
a. Posterior column b. Anterior column c. Both columns d. T-shaped |
b. Anterior column
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121. Most likely fracture to cause neurologic injury?
a. Hangman’s b. Flexion teardrop c. Clay shovelers |
Flexion Teardrop Fx (above) -- Hyperflexion teardrop fracture: most severe + unstable injury of C-spine
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122. Regarding pediatric C-spine fractures:
a. C1-2 fractures are more common that C5/6 fractures b. Flexion teardrop injuries frequently missed c. Fractures are more common than ligamentous injury |
a. C1-2 fractures are more common that C5/6 fractures
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123. A suprascapular notch mass is most likely to cause:
a. Labral tear b. Atrophy of the teres major c. Infraspinatous atrophy d. Suprapinatus spasm |
c. Infraspinatous atrophy
A mass in the suprascapular notch would compress the suprascapular nerve and affect both the supraspinatus and infraspinatus muscles. Infraspinatus atrophy, however would be the most prominent or first finding. The subscapularis muscle is innervated by the upper and lower subscapular nerves, which do not run through the suprascapular notch. Clemente 4th Plate 20.If a mass is located in the spinoglenoid notch, only the infraspinatus muscle is affected. The most common cause of compression is a ganglion cyst. Kaplan 215; Resnick 925 |
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124. A pitcher with deltoid weakness and paresthesia most likely has: riw
a. Cervical radiculopathy b. Axillary nerve entrapment in the quadrilateral space c. Suprascapular notch ganglion d. Infraspinatous tear |
b. Axillary nerve entrapment in the quadrilateral space
Quadrilateral (quadrangular) space syndrome: Pathology: Nerve & vessel damaged or occluded in quadrangular space Distal branch of axillary nerve ± Posterior humeral circumflex artery Increased by abduction & external rotation of arm Tenderness Quadrilateral space Near insertion of teres minor muscle Paresthesias: Lateral shoulder; Upper posterior arm Weakness Muscles: Teres minor ± Deltoid External rotation ± Abduction of arm |
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Of the following activities, what is the most likely etiology of superior labral tear?
a. Weight lifting b. Baseball c. Rowing d. Bowling |
b. Baseball
Superior and anterosuperior labral tears are most commonly associated with traction injuries as in throwing sports. In addition, compression injuries such as fall on outstretched arm may cause similar injury. |
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On shoulder MRI, a ganglion cyst is identified and is most associated with what pathology?
a. Labral tear b. Anterior dislocation c. Biceps tendon tear d. Axillary nerve entrapment |
a. Labral tear
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125. Most common adult benign rib lesion?
a. Giant Cell Tumor b. Fibrous Dysplasia c. Aneurysmal Bone Cyst d. Simple Cyst e. Eosinophilic Granuloma |
b. Fibrous Dysplasia
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126. Diffusely increased T2 marrow signal of femoral head, neck and intertrochanteric regions in adult
with hip pain is most likely secondary to: a. Transient osteoporosis b. Avascular necrosis/osteonecrosis c. Insufficiency fracture d. Osteomyelitis |
a. Transient osteoporosis
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Regarding the appearance of acute osteoporosis, what is it not associated with? riw
a. Subperiosteal/Periosteal reabsorption b. Cortical thinning c. Ground glass d. Insufficiency fracture e. Subchondral lucency |
c. Ground glass
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Alt: Regarding transient hip osteoporosis, which statement is false?
a. Commonly see in 4- & 5-year-olds b. Subperiosteal bone resorption c. Represent bone edema in the hip & femoral head d. Often present w/ femoral neck fracture |
a. Commonly see in 4- & 5-year-olds
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127. Which of the following is a cause of fusiform soft tissue masses at the PIPs: riw
a. RA b. OA c. Scleroderma d. Reiters syndrome |
a. RA
Remember that Psoriatic Arthritis looks like RA in 38%, pts. may have sausage digits and the effected joints include: MCP, PIP, DIP. |
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A pt has fusiform swelling of the DIP and PIP:
a. RA b. CPPD c. OA d. Psoriasis |
d. Psoriasis
If DIP and PIP are effected, this is less likely RA (RA tends to spare the DIP). Psoriasis effects PIPs and DIPs. Bouchard’s nodes and Haberdene’s nodes are seen in the PIPs and DIPs and also give a fusiform appearance. |
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128. Acroosteolysis and subligamentous periosteal resorption are seen in:
a. Hyperparathyroidism b. Frostbite c. Pyknodysostosis d. Scleroderma |
a. Hyperparathyroidism
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129. A girl has asymmetric enlargement of two digits on one hand. The most likley diagnosis is?
a. Macrodystrophia lipomatosa b. NF-1 c. Mafucci's syndrome d. Ollier's disease e. Klippel-Trennaunay-Webber |
a. Macrodystrophia lipomatosa
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130. Which tendon is associated with avulsion fracture of the proximal 5th metatarsal?
a. Posterior tibila tendon b. Flexor hallucis longus c. Flexor hallucis brevis d. Plantar aponeurosis e. Peroneus longus f. Peroneus brevis |
f. Peroneus brevis
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131. MRI shows contusion of the lateral femoral condyle and the medial patellar facet. What is a likely
associated abnormality? a. Tear of the medial patellar retinaculum b. ACL tear c. lateral collateral ligament tear |
a. Tear of the medial patellar retinaculum
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132. What is most true regarding epidural hematomas?
a. Most are associated with fracture b. May cross suture lines c. Forms between the pia and dura d. Bleeding from dural veins |
a. Most are associated with fracture
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133. A 51 year old woman with lid lag and an ipsilateral small pupil likely has:
a. Opthalmoplegic migraine b. ICA dissection c. Ophthalmic artery aneurysm/occlusion |
b. ICA dissection
Horner syndrome may result from a lesion of the primary neuron; brainstem stroke or tumor or syrinx of the preganglionic neuron; trauma to the brachial plexus; tumors (eg, Pancoast) or infection of the lung apex; a lesion of the postganglionic neuron; dissecting carotid aneurysm; carotid artery ischemia; migraine; or middle cranial fossa neoplasm. |
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134. Which part of the ventricle system is devoid of choroid plexus?
a. Temporal horn b. Occipital horn c. Atrium d. Third ventricle e. Frontal horn |
e. Frontal horn
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Identify the ant. Choroidal artery (only AP angio view provided for exam).
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Anterior Choroidal Artery
Last branch to originate from Internal Carotid Artery. Cisternal segment: Artery passes through crural cistern, supplies optic tract, posterior limb of internal capsule, branches to midbrain, and lateral geniculate nucleus. Plexal segment: Supplies choroid plexus of anterior portion of temporal horn of lateral ventricles. |
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136. A 40 yo man with increased T2 signal in bilateral temporal lobes and cingulate gyrus without
contrast enhancement. What is most likely? a. Herpes encephalitis b. Low grade glioma c. Mesial temporal sclerosis d. Bilateral infarcts |
. Herpes encephalitis
Mesial temporal sclerosis: increased signal intensity + decreased volume of hippocampus compared to contralateral side on T2WI |
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137. Concerning cranial nerve VII: riw
a. Exits via the stylomastoid foramen b. Carries gustatory to the posterior 2/3 of the tongue c. Uniformly enhances on Gd-MR |
a. Exits via the stylomastoid foramen
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138. Regarding sellar/parasellar masses, which is true? riw
a. In older males, prostate cancer is the most common metastasis. b. Rathke cleft cysts typically calcify. c. Craniopharyngiomas usually calcify. |
c. Craniopharyngiomas usually calcify.
Craniopharyngiomas -- marginal hyperdense lesion (calcification / ossification) in 70-90% in childhood tumors + 30-50% of adult tumors Suprasellar Mass With Calcification A.CURVILINEAR 1.Giant carotid aneurysm 2.Craniopharyngioma B.GRANULAR 1.Craniopharyngioma 2.Meningioma 3.Granuloma 4.Dermoid cyst / teratoma 5.Optic / hypothalamic glioma (rare) Infundibular tumor metastasis: (esp. breast); glioma; lymphoma / leukemia; histiocytosis X; sarcoidosis, tuberculosis |
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139. An older male who has had prior treatment for lung cancer presents with a few month history of
memory loss and seizures. T2W MR shows high signal in the bilateral medial temporal lobes without contrast enhancement. What is the most likely diagnosis? a. Herpes encephalitis b. Alzheimer’s c. Limbic encephalitis d. Leptomeningeal carcinomatosis |
c. Limbic encephalitis
Limbic encephalitis - "A paraneoplastic syndrome marked by degeneration of neurons in the medial temporal lobe. Clinical features include behavioral changes, HALLUCINATIONS, loss of short-term memory, anosmia, AGEUSIA, and DEMENTIA. |
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140. Alzheimer’s disease – increased T2 signal in something
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Some Alzheimer’s disease patients show hyperintense sylvian and/or hippocampaluncal cortex on long TR sequences on MRI. This signal reflects an increase in water content due to many of the histological substrates of Alzheimer’s disease
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Alt: Regarding orbital hemangiomas, which is false?
a. Frequently hemorrhage. b. Usually well-defined c. Usually retrobulbar d. Avid early arterial enhancement this is false |
a. Frequently hemorrhage.
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142. Concerning MR spectroscopy, which is TRUE: riw
a. NAA is associated with neurons and axons. b. NAA’s highest concentration is seen in white matter c. Creatine is the highest peak in normal brain tissue. d. Choline stays constant despite a pathologic process. e. Increased Creatinine with increased cell membrane turnover. |
a. NAA is associated with neurons and axons.
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Regarding MR Spectroscopy which is false:
b) Creatinine has its highest concentration in gray matter. c) The highest peak in normal brain tissue is NAA. d) Choline increases with tumor, decreases with necrosis (radiation) e) Increased choline is associated with increased cell membrane turnover. |
b) Creatinine has its highest concentration in gray matter.
NAA: Decreased in Tumor, Radiation Necrosis. Sign of neuronal integrity. Choline: Increase in Tumor, Decrease in Necrosis. Sign of cell turnover Creatine: Assoc with cell metabolism Lactate: Increased in Tumor |
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143. Normal degrees of C1 on C2 rotation? riw
a. 25 b. 35 c. 45 d. 55 e. 65 |
c. 45
From 65 degrees onward, C1 and C2 move in exact unison (the unison-motion phase) with a fixed, maximum separation angle of approximately 43 degrees, head rotation being carried exclusively by the subaxial segments. Neurosurgery. 55(3):614-626, September 2004 |
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144. Older man with acute headache, non-enhanced CT of brain shows increased attenuation in
paramesencephalic (and basilar?) cisterns. Negative 4-vessel angio. Positive lumbar puncture for hemorrhage. What is the cause? riw a. Basilar artery aneurysm rupture b. ACOM aneurysm c. Non-aneurysmal subarachnoid hemorrhage d. Rupture of dural AVM/AVF |
c. Non-aneurysmal subarachnoid hemorrhage
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What is the pattern of distribution with Tc99m HMPAO in Alzheimers?
a. Increased perfusion in frontal lobes b. Increased perfusion in the basal ganglia c. Decreased perfusion in the parietal lobes d. Decreased perfusion in the calcarine fissure e. Decreased perfusion in the frontal lobes |
c. Decreased perfusion in the parietal lobes
Tc-99m HMPAO is a lipophilic agent that crosses BBB with rapid first-pass uptake and then is metabolized to a hydrophilic form that can’t diffuse out of the brain. Peak uptake is several min after injection. Highest activity in gray matter and proportional to rCBF. |
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146. In the evaluation of the lumbar spine, which contributes least significantly to spinal stenosis? riw
a. Facet degenerative changes b. Hypertrophy of the ligamentum flavum c. Disk bulge d. Dentate ligaments |
d. Dentate ligaments
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. The lining of the schizencephaly cleft consists of:
a. white matter b. abnormal gray matter c. Choroid d. Arachnoid |
b. abnormal gray matter
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148. What nerve is located between the Posterior Cerebral and Superior Cerebellar arteries? riw
a. CN III b. CN IV c. CN V d. CN VI e. CN VII |
a. CN III
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149. A cortical stroke is greater than 12 hours old. What is not seen? riw
a. Increased T2 signal b. Restricted water diffusion c. Avid peripheral cortical enhancement post-contrast d. Gyral effacement/swelling |
c. Avid peripheral cortical enhancement post-contrast
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150. What is seen in Huntington’s chorea on Tc-99 HMPAO Spect imaging? riw
a. Increased uptake in caudate nucleus b. Decreased uptake in caudate c. Decrease in parietal lobes d. Increased in frontal lobes |
b. Decreased uptake in caudate
Huntington's chorea is an autosomal dominant inherited disease with a chronic course and atrophy of the corpus striatum. Huntington's disease (HD) is pathologically characterized by neuronal loss and neuroreceptor alterations in the striatum, including a reduction in dopamine receptor density. Technetium 99m hexamethylpropylene-amine oxime (HMPAO) is trapped by cerebral grey matter and the basal ganglia on its first pass through the brain. PET examination shows reduced glucose metabolism in the caudate nucleus. Most studies referenced on web show decreased caudate activity, but one mentioned increased. |
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151. Which is not associated with high T1 signal in the basal ganglia?
a. Basal ganglia calcification b. Leigh’s disease c. Neurofibromatosis d. Hepatocerebral degeneration |
b. Leigh’s disease
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152. With an L4-L5 right paracentral disc bulge, what nerve root is most likely affected?
a. Right L4 root b. Right L3 root c. Right L5 root d. Right S1 root e. Cauda equina |
c. Right L5 root
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Posterior vertebral scalloping not associated with? riw
a. Acromegaly b. Marfans c. NF d. Osteopetrosis e. Intraspinal tumor |
d. Osteopetrosis
Differential of posterior vertebral body scalloping are: Incr spinal pressure: spinal canal tumors, syrinx, communicating hydrocephalus Dural extasia: NF, Marfan syndrome, Ehlers-Danlos syndrome Congenital: Achondroplasia, Mucopolysaccharidoses, Osteogenesis Imperfecta Bone resorption: Acromegaly |
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154. What is true about cerebral venous malformation?
a. Areas of decreased T2 signal b. Best visualized on T1 non-contrast c. Occult on angiography d. Associated with cavernous malformations |
d. Associated with cavernous malformations
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155. In the setting of biliary scintigraphy (HIDA): riw
a. A rim sign may be seen in early, uncomplicated cholecystitis b. Sensitivity in gallstone pancreatitis exceeds US c. Administration of morphine enables evaluation of partial obstructions d. Cholecytokinin (CCK) is given as a bolus |
b. Sensitivity in gallstone pancreatitis exceeds US
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During the early phase of a HIDA scan there is increased uptake in the gallbladder fossa.
What is the most likely cause? riw a. Cholecystitis b. Increased vascularity of the gallbladder wall c. Increased vascularity of the surrounding hepatic parenchyma d. Bile leak |
a. Cholecystitis
Gallbladder hyperperfusion on flow/early images is a marker for complicated or late stage cholecystitis. Rim sign in the liver occurs later during the study (Dr. Joseph, PubMed). Another entity associated with increased IDA uptake on flow images is focal nodular hyperplasia (NMR 2nd 246). |
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. Delayed, persistent MAG3 activity is seen with each except: riw
a. ATN b. RAS premedicated with captopril c. Hypotension d. Acute pyelonephritis e. Renal vein thrombosis |
d. Acute pyelonephritis
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All of the following are true regarding a solitary pulmonary nodule seen on FDG-PET scan except: riw
a. Granulomatous disease can demonstrate increased uptake b. SUV greater than 2.5 is highly suspicious for malignancy c. Less sensitive for SCLC d. Malignant nodules are detected in approximately 60% of patients with cancer |
. Less sensitive for SCLC
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Which of the following is true in regards to a solitary pulmonary nodule evaluated by PET Scan (FDG-18 PET).
a. Small cell cancer has decreased uptake b. Sarcoid has decreased uptake c. Tuberculoma has increased uptake d. Malignant nodules are detected in approximately 60 % of patient’s with cancer. |
c. Tuberculoma has increased uptake
Active granulomatous diseases such as tuberculosis and sarcoidosis frequently cause high FDG uptake that is well into the range of FDG uptake observed with FDG-avid malignancy such as lung cancer (Wahl 129). Specificity of FDG-PET for lung cancer is about 80% (Wahl 167). |
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158. Of the following lung cancers, which is least likley to be positive on FDG-PET? riw
a. Small Cell b. Bronchoalveolar Cell c. Squamous d. Metastatic breast e. Adenocarcinoma f. Large Cell |
b. Bronchoalveolar Cell
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159. Indium preferred over Gallium for: riw
a. Splenic abscess b. Endocarditis c. Discitis d. Pulmonary infection e. Infected aortic vascular graft |
e. Infected aortic vascular graft
INDIUM HAS HIGH NORMAL SPLEEN UPTAKE – SO BAD FOR SPLENIC ABSCESS Gallium is extreted in bowel and will obscure abdominal findings |
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What are the advantages of In-WBC scan over gallium scan?
a. Preferred for spinal osteomyelitis imaging b. Evaluation of splenic abscess c. Evaluation for Inflammatory bowel disease d. Evaluation for Malignant otitis media |
Evaluation for Inflammatory bowel disease
111In WBC imaging has a higher sensitivity and specificity for the diagnosis of acute osteomyelitis than combined bone/Gallium imaging. A normal Gallium scan virtually excludes the diagnosis of acute osteomyelitis with a high degree of certainty (negative predictive value 90-100%) Although the sensitivity of 111In WBC scanning in an acute infection is in the range of 100%, the sensitivity decreases to 73% in chronic disease. 67Ga scanning is probably more sensitive, and with this method, activity returns to normal after effective treatment. Data indicates that 111In leukocyte imaging is not as sensitive for infection of the spine as for other musculoskeletal infections and may be falsely negative in up to 80% of cases. MR imaging is probably the modality of choice when evaluating patients for suspected vertebral osteomyelitis. In patients that cannot undergo an MR exam, then bone-gallium imaging should be performed (overall accuracy is between 65-80%). Gallium is probably the agent of choice for the evaluation of pulmonary inflammatory abnormalities. Any Indium WBC uptake in abdomen is abnormal |
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60. Regarding high dose I-131 treatment in well-differentiated thyroid cancer, which is false? riw
a. Treatment of pulmonary mets can cause fibrosis b. Only allowed in agreement states c. Contraindicated for ages <18 yrs old (children) d. Not good for papillary thyroid carcinoma e. Causes leukemia in 5% |
d. Not good for papillary thyroid carcinoma
Medullary and anaplastic thyroid carcinoma do not concentrate 131I and are therefore not detectable by thyroid scanning. Follicular, mixed papillary-follicular, and a high percentage of papillary carcinomas concentrate sufficient 131I to be demonstrated |
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161. Octreotide (In-111 Pentatreotide) scan is least/not useful for?
a. Pulmonary Adenocarcinoma b. Non-small cell CA c. Small cell lung CA d. Pituitary Adenoma e. Islet cell tumor f. Pheochromocytoma |
a. Pulmonary Adenocarcinoma
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An octreotide scan is good for all of the following except:
a. Neuroblastoma b. Pheochromocytoma c. Adrenal Adenoma d. Medullary thyroid CA |
c. Adrenal Adenoma
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Which of the following shows no uptake on an octreotide scan?
a. Meningioma b. Renal cell carcinoma c. Carcinoid d. Medullary thyroid Ca |
b. Renal cell carcinoma
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162. What decreases the sensitivity of gated SPECT? riw
a. Thalium-201 has less resolution than Tc-99 sestamibi b. Significant extra-cardiac activity c. Specific gating protocol described |
b. Significant extra-cardiac activity
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163. Indications for FDG-PET include the following except:
a. Restaging colon ca b. Bronchgenic CA c. Seizure focus in temporal lobe d. Differentiating GBM from abscess |
d. Differentiating GBM from abscess
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164. Using PIOPED criteria, what is the probability estimate for pulmonary embolism
in a ventilation-perfusion scan demonstrating one large and one moderate area of mismatch, with a corresponding normal chest radiograph? a. Low probability b. Intermediate probability c. High probability d. Indeterminate |
b. Intermediate probability
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165. Regarding V/Q scans, which is true?
a. Saddle embolus causes central defect b. Multiple small PE’s cause fissural markings c. Hilar irregularity is a normal finding on oblique views d. 20-30% of normal people have subsegmental defects |
d. 20-30% of normal people have subsegmental defects
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166. Tc-99 MDP bone scan shows increased activity post chemotherapy. What is this most likely
related to? a. Non-response to chemo b. Healing osteoblastic activity (flare) c. MDP uptake is proportional to bood flow |
b. Healing osteoblastic activity (flare)
However, for several months following systemic therapy healing bone lesions may have increased osteoblastic activity, therefore producing more intense uptake of MDP and more lesions may become apparent. This is known as the “flare phenomenon” and may be misinterpreted as progressive disease. A period of 6 months is recommended following such therapy before assessment of response is attempted with an isotope bone scan. Following radiotherapy high uptake related to abone metastasis will decrease, as will uptake in normal bone within the treatment field, with a characteristic appearance. |
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167. Increased radiotracer uptake is seen in all phases of a 3-phase bone scan in all of the following
except? a. Two weeks after bone fracture b. Neuropathic/diabetic foot c. Toe osteomyelitis associated with peripheral vascular disease d. Osteomyelitis after 1 week of antibiotics |
c. Toe osteomyelitis associated with peripheral vascular disease
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168. In a patient with suspicion of lower GI bleeding, a Tc-99m sulfur colloid and a Tc-99m tagged
RBC scan are performed, sequentially, in close succession. The sulfur colloid study demonstrates no evidence for GI bleeding, but the RBC study does in the colon. Which is the most likely explanation? a. RBC scan is more sensitive b. Intermittent bleeding c. Longer half life d. Hepatic activity |
b. Intermittent bleeding
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Which is true regarding Tc99m sulfur colloid detection of GI bleed
1. More sensitive than angiography 2. Best for upper GI bleeding 3. Useful for intermittent bleeding 4. Requires labeling of RBC’s |
1. More sensitive than angiography
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169. A neonatal DISIDA scan at four hours demonstrates liver activity, but no biliary or bowel uptake.
What is the next best step? a. Repeat the exam after administering Phenobarbital b. Administer morphine c. Obtain delayed images at 24 hours |
. Obtain delayed images at 24 hours
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170. Endometriosis implant appearance in small bowel is similar to?
a. Intraperitoneal mets b. Melanoma mets c. Lymphoma d. Adenocarcinoma e. GIST |
. Intraperitoneal mets
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171. What is true regarding ovarian cysts in postmenopausal women?
a. Most less than 5cm are benign. b. Intervention required for cysts greater than 10cm. c. Responsive to cyclic hormones |
a. Most less than 5cm are benign.
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172. Nuchal translucency (skin thickness): when is the best time/appropriate age to measure?
a. After 16 weeks b. 13-16 wks c. 8-13 wks d. 0-8 wks |
c. 8-13 wks
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A chart is shown which demonstrates a linear increase in ventricular size versus age in a
neonate. The size goes from 15 to 22 mm and the age goes from 16 to 20 weeks. It is also stated that the child’s head circumference on U/S does not change. What is the most likely diagnosis ? (this is a recall from 2001 which is a similar question) a. Normal b. Hydranencephaly c. Holoprosencephaly d. Chiari II e. ACC |
d. Chiari II
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174. Which of the following is associated with twin- twin transfusion and stuck twin phenomenon?
a. Monochorionic, diamnionic b. Dichorionic, diamnionic c. Dichorionic, monoamnionic d. Monochorionic, monoamnionic |
a. Monochorionic, diamnionic
STUCK TWIN = one twin with IUGR residing within an oligo- / anhydramniotic sac of a diamniotic twin pregnancy - amnion invisible secondary to close contact with fetal parts - fetus fixed relative to the uterine wall without change during shift in maternal position - diminished / absent active fetal motion - absence of intermingling of fetal parts between twins - Prognosis: fetal death in utero Twin-twin transfusion requires a monchorionic configuration |
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175. Asherman syndrome (uterine synechiae) is best diagnosed by:
a. HSG b. U/S c. CT d. MRI |
a. HSG
Asherman syndrome is the association of intrauterine synechiae with menstrual dysfunction + infertility. It is usually due to prior rigorous instrumentation (D&C) or severe endometritis. Dx is by HSG or Hysterosonography. Both of these modalities demonstrate bands of tissue traversing the uterine cavity |
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176. In the evaluation of adenomyosis, what is true?
a. Readily distinguished from leiomyoma on US. b. On MRI, predominantly iso T1, low T2 signal with bright T2 foci. c. Best seen with hysterosalpingogram d. Ecopic endometrial tissue within ovaries e. Treated with diltaion and curretage |
b. On MRI, predominantly iso T1, low T2 signal with bright T2 foci.
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177. Ovarian follicle will rupture at what size?
a. 10mm b. 20mm c. 30mm d. 40mm e. 50mm |
b. 20mm
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178. Which of the following is not true regarding paraovarian cysts?
a. They are subject to hormonal stimulation b. They are not Mullerian duct remnants c. Located along the broad ligament d. May torse e. Represent 5-10% of ovarian cysts (or masses) |
a. They are subject to hormonal stimulation
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179. When measuring for abdominal circumference on fetal US, what must be identified?
a. Umbilical connection to abdomen b. Kidneys c. Liver d. Left portal vein |
d. Left portal vein
measured at level of vascular junction of umbilical vein with left portal vein |
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180. Which of the following is true regarding the umbilical cord?
a. One artery, two veins b. Two arteries, one vein c. Two arteries, two veins d. One artery, one vein |
b. Two arteries, one vein
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181. Regarding intrauterine ultrasound evaluation of posterior urethral valves, which of the following
portends the most favorable prognosis? a. Bilateral dilated, cystic kidneys b. Urinary ascites c. Diagnosis before 24 weeks d. Oligohydramnios |
a. Bilateral dilated, cystic kidneys
Poor prognostic signs are oligohydramnios, lack of caliectasis, urine ascites, dystrophic calcification, renal dysplasia, associated multisystem abnormalities, and abnormal karyotype. |
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182. Karyotype of partial mole:
a. Triploidy b. Diploidy c. 45 XO d. 47 XXX |
a. Triploidy
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183. In a postmenopausal woman the endometrial stripe measures 10 mm on ultrasound. What is least
likely the cause? a. Atrophic endometrium b. Endometrial polyp c. Endometrial cancer d. Tamoxifen therapy |
Atrophic endometrium
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184. A young adult female is noted to have a 2 cm simple ovarian cyst on abdominal CT. What is the
next most appropriate step? a. Do nothing. b. Short interval US follow-up. c. MRI d. Surgical consult e. Check B-hCG f. Methotrexate |
a. Do nothing.
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185. What is the main reason to perform US in neonate with acute UTI?
a. Cortical thinning b. Congenital abnormality c. Scarring d. Reflux |
b. Congenital abnormality
c. Scarring The ultrasound reveals any upper tract abnormalities (hydronephrosis, dilated ureter) that would predispose a patient to persistence of bacteriuria. The VCUG is used to evaluate the presence of reflux, a risk factor for upper tract scarring when coexistent infection is present. Young children with UTI’s have a relatively high incidence of anatomic abnormalities (5,6). In addition, renal scarring in common in the pediatric age group, most frequently in the subpopulation with reflux (7,8). For these reasons, anatomic evaluation by ultrasound and evaluation for reflux by voiding cystourethrogram (VCUG) is recommended for all pediatric patients with their first episode of UTI |
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186. What most commonly connects to the bronchi?
a. Intralobar sequestration b. Extralobar sequestration c. Bronchogenic cyst d. CCAM In the neonatal period, what congenital abnormality is most likely to have gas (can be aerated)? a. CCAM b. Pulmonary sequestration c. Congenital Lobar Emphysema d. Duplication cyst e. Bronchial atresia/cyst f. Enteric cyst |
CCAM
CYSTIC ADENOMATOID MALFORMATION =CAM = congenital cystic abnormality of the lung characterized by an intralobar mass of disorganized pulmonary tissue communicating with bronchial tree + having normal vascular supply + drainage but delayed clearance of fetal lung fluid Incidence: 25% of congenital lung disorders; 95% of congenital cystic lung lesions Cause: arrest of normal bronchoalveolar differentiation between 5th-7th week of gestation with overgrowth of terminal bronchioles Path: proliferation of bronchial structures at the expense of alveolar saccular development, modified by intercommunicating cysts of various size (adenomatoid overgrowth of terminal bronchioles, proliferation of smooth muscle in cyst wall, absence of cartilage) TYPE I (50%): Histo: single / multiple large cyst(s) >20 mm lined by ciliated pseudostratified columnar epithelium, mucus-producing cells in 1/3 Prognosis: excellent following resectionC TYPE II (40%): Histo: multiple cysts 5-12 mm lined by ciliated cuboidal / columnar epithelium Prognosis: poor secondary to associated abnormalities TYPE III (10%): Histo: solitary large bulky firm mass of bronchus like structures lined by ciliated cuboidal epithelium with 3-5 mm small microcysts Prognosis: poor secondary to pulmonary hypoplasia / hydrops |
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187. Which complication of abdominal radiation occurs more frequently in children
than adults? a. Abdominal sarcoma b. Radiation-induced osteonecrosis c. Scoliosis |
Skeletal sequelae of radiation, including scoliosis or kyphosis, result from uneven growth when the radiation was unilaterally targeted to the vertebral bodies and the dose was higher than 2000 rads. eMedicine
Patients receiving radiation therapy for retinoblastoma are prone to develop sarcomas. ( I think also for neurofibroma) |
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188. A 12-month-old presents with recurrent vomiting and pancreatic pseudocyst seen on U/S. Likely
etiology? a. Non accidental trauma b. Cystic fibrosis c. Henoch-schonlein purpura c. Congenital cyst d. Von-hippel Lindau Syndrome |
Pancreatitis is uncommon in children, with a rate of 2.7 cases per 100,000 in children younger than 15 years. The leading cause of acute pancreatitis in children is blunt trauma, which occasionally is associated with child abuse. eMedicine
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189. The earliest radiographic finding in necrotizing enterocolitis (NEC) is:
a. Portal venous air b. Bowel thickening c. Pneumotosis intestinalis d. Diffuse small bowel dilatation e. Pneumoperitoneum |
d. Diffuse small bowel dilatation
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190. Which of the following conditions places a pediatric patient at high risk for latex sensitivity?
a. Asthma b. Myelomeningocele c. Allergy to penicillin d. Contrast allergy |
b. Myelomeningocele
Allergy to latex is common in patients with myelomeningocele who are examined in our department. We have developed a policy designed to prevent exposure of such patients to latex during imaging studies. Pediatr Radiol 1996 Jul;26(7):450-4 |
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191. A frontal chest radiograph of an eight-year old boy demonstrates hyperlucency of the left upper
lobe with branching left suprahilar densities. Which is the most likely diagnosis? a. Congenital lobar emphysema b. Sequestration c. Swyer-James syndrome d. Segmental bronchial atresia |
d. Segmental bronchial atresia
BRONCHIAL ATRESIA =local obliteration of proximal lumen of a segmental bronchus Proposed causes: (a) local interruption of bronchial arterial perfusion >15 weeks GA (when bronchial branching is complete) (b) tip of primitive bronchial bud separates from bud and continues to develop Path: normal bronchial tree distal to obstruction patent and containing mucus plugs; alveoli distal to obstruction air-filled through collateral air drift Associated with: lobar emphysema, cystic adenomatoid malformation minimal symptoms, apparent later in childhood (most by age 15) / adult life Location: apicoposterior segment of LUL (>>RUL / ML) decreased perfusion overexpanded segment (collateral air drift with expiratory air-trapping) fingerlike opacity lateral to hilum (= mucus plug distal to atretic lumen) is CHARACTERISTIC OB-US (detected >24 weeks MA): large echogenic fetal lung mass = fluid-filled lung distal to obstruction dilated fluid-filled bronchus Rx: no treatment because mostly asymptomatic DDx: Congenital lobar emphysema (no mucus plug) |
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192. Most common renal mass in newborn?
a. Mesoblastic nephroma b. Wilm’s c. Neuroblastoma d. RCC e. Medullary cystic disease |
a. Mesoblastic nephroma
Mesoblastic nephroma Incidence: most common renal neoplasm in neonate; 3% of all renal neoplasms in children Age: 3 months mean age at presentation; may occasionally go undetected until adulthood; M >F Histo: smooth muscle cells + immature fibroblasts resembling leiomyoma containing trapped islands of embryonic glomeruli, tubules, vessels, hematopoietic cells, cartilage In 14% associated with: prematurity, polyhydramnios, GI + GU tract malformations, neuroblastoma Large flank mass Hematuria (20%) / hypertension (4%), anemia Usually replaces 60-90% of renal parenchyma Usually solid but may produce multiple cystic spaces NO sharp cleavage plane toward normal parenchyma, may extend beyond capsule Calcifications (rare) NO venous extension (DDx from Wilms tumor) IVP: Large noncalcified renal mass with distortion of collecting system Usually NO herniation into renal pelvis (DDx from MLCN) US: Evenly echogenic tumor with concentric echogenic + hypoechoic rings resembling uterine fibroids Complex mass with hemorrhage + cyst formation + necrosis Angio: Hypervascular mass with neovascularity + displacement of adjacent vessels Cx: transformation to metastasizing spindle cell sarcoma (rare) Rx: complete resection Prognosis: excellent |
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193. There is a 12-year-old child with back pain with an area of sclerosis in the pedicle of L4. The most
likely etiology is: a. Osteomyelitis b. EG c. Contralateral pars defect d. Metastasis |
c. Contralateral pars defect
DW) In child also have to think about osteoid osteoma. Secondary radiographic signs exist that occasionally are seen in association with spondylolysis. These include sclerosis of the contralateral pedicle and the presence of spina bifida occulta at the level of the lysis. eMedicine |
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194. Unilateral MCDK is associated with what?
a. Contralateral UPJ obstruction b. PUV c. Contralateral ureteral duplication/ectopic d. Periportal fibrosis |
a. Contralateral UPJ obstruction
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195. What distinguishes meconium aspiration from hyaline memebrane disease in a newborn?
a. Pneumothorax b. Pleural effusion c. Lower lobe consolidation d. Hyperinflation |
d. Hyperinflation
Meconium: Chest radiography typically shows hyperinflation with patchy opacities. These findings represent areas of atelectasis mixed with areas of air trapping. As mentioned above, air leaks are common, leading to pneumothorax, pneumomediastinum, pneumopericardium, and/or pulmonary interstitial emphysema. Pleural effusions may be present. Transient tachypnea of the newborn: usually has patchy opacities caused by pulmonary fluid in the process of resorption. Follow-up radiographs show rapid clearing of infiltrates, in contrast with meconium aspiration syndrome or pneumonia. Neonatal pneumonia usually has patchy opacities representing consolidation, with pleural effusion present in up to two thirds of cases. Lung volumes are usually normal, but they may be hyperinflated. Respiratory distress syndrome usually has a uniform distribution of opacities, classically with a ground-glass appearance and decreased lung volumes due to alveolar collapse. Air bronchograms may be seen. Pleural effusions are rare. This is most often seen in preterm infants (in contrast to those with meconium aspiration syndrome). In addition to persistent pulmonary hypertension of the newborn (PPHN), other issues of neonates should be considered, including sepsis, pulmonary hypoplasia, congenital anatomic pulmonary anomalies, congenital diaphragmatic hernia, and congenital heart disease. |
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196. What is true of a Branchial cleft cyst?
a. Arise from first branchial arch b. Most commonly located at mandibular angle c. Are septated/multilocular d. Present as painful mass |
b. Most commonly located at mandibular angle
The second branchial cleft accounts for 95% of branchial anomalies. Most frequently, these cysts are identified along the anterior border of the upper third of the sternocleidomastoid muscle, adjacent to the muscle.. Branchial cleft cysts are the most common congenital cause of a neck mass. Identified most often in the second to fourth decades. May present as painful mass with inflammation or superinfection. First branchial cleft cysts are divided into type I and type II. Type I cysts are located near the external auditory canal. Most commonly, they are inferior and posterior to the tragus (base of the ear), but they may also be in the parotid gland or at the angle of the mandible. Type 2 is most common type of branchial cleft cyst (95%) and occurs in the parotid space near the angle of mandible. Usually unilocular. Insinuation between the ICA and ECA is pathognomonic. Presents in young to middle-aged adults. Type 1 occurs near EAC or parotid gland and usually occurs in middle aged women. |
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197. Pediatric cerebellar cystic lesion with a mural nodule:
a. Astrocytoma b. Medulloblastoma c. Ependymoma |
Juvenile pilocytic astrocytoma
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198. Best U/S transducer for near field?
a. Linear b. Curved array c. Curvilinear d. Phased array |
a. Linear
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199. 500 patients are screened. 40 have excisional biopsy with 10 showing cancer, 30 are negative, 8
core needle biopsies are performed, resulting in 3 cancer, 5 negative. What is the PPV? a. 27% b. 23% c. 18% d. 90% e. 73% |
PPV = TP / (TP+FP)
PPV = 13 / (13+35) = .27 |
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200. There is a radioactive spill in the nuclear med department. Best course of initial action:
a. Place paper towels over spill b. Evacuate department c. Call housekeeping to arrange for special cleanup d. Take immediate measurements with geiger meter |
. Evacuate department
For major spills, the area is cleared immediately. Attempts are made to prevent further spread with absorbent pads and, if possible, the radioactivity is shielded. The room is sealed off and the radiation safety officer is notified immediately. The radiation safety officer typically directs further response, including when and how to proceed with cleanup and decontamination. In both minor and major spills, an attempt is made to keep radiation exposure of patients, hospital staff, and environment to a minimum. The radiation safety officer restricts access to area until it is safe for patients and personnel. All contaminated material is disposed of carefully. The area is continually surveyed with a Geiger counter until measured levels of radioactivity on the meter are comparable to background levels. All personnel involved are monitored, including shoes, hands, and clothing. (Thrall JH, Ziessman HA, Nuclear Medicine: The Requisites. |
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201. Doppler ultrasound demonstrates aliasing. What maneuver can be used to correct this?
a. Decrease the Doppler angle b. Increase the pulse repetition frequency c. Increase the transducer frequency d. Decrease the gain |
b. Increase the pulse repetition frequency
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202. Use of CT for lung cancer screening is dependent on:
a. Patient outcomes b. Diagnostic efficiency c. Technical efficiency |
a. Patient outcomes
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2. P value saying there is a difference when there really is not a difference:
a. Gamma error b. Type I c. Type II |
b. Type I
A type I error occurs when one rejects the null hypothesis when it is true. The probability of a type I error is the level of significance of the test of hypothesis, and is denoted by alpha. A type II error occurs when one fails to reject the null hypothesis. |
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204. A study is performed to determine the association between exposure to black dust and respiratory
disease in a group of workers. Of 500 workers exposed, 250 developed disease. Of 200 unexposed workers, 50 developed disease. What is the odds ratio between exposed and unexposed workers? a. 1:1 b. 2:1 c. 4:1 d. 3:1 |
d. 3:1 Exposed Unexposed
Diseased 250 50 No Disease 250 150 250 x 150 / 250 x 50 = 3 The exposed group is three times more likely to develop disease. The odds ratio is a way of comparing whether the probability of a certain event is the same for two groups. An odds ratio of 1 implies that the event is equally likely in both groups. An odds ratio greater than one implies that the event is more likely in the first group. An odds ratio less than one implies that the event is less likely in the first group. |
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205. Risk assessment is not associated with which of the following?
b. Odds ratio c. Relative risk d. Absolute risk e. Hazard ratio f. Cumulative risk |
e. Hazard ratio
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206. A doctor wants to examine the mortality of his patients 5 years after a new procedure. What test
should be used? a. Student’s t test b. Linear regression c. Chi square test d. Kaplan-Meier survival curve |
d. Kaplan-Meier survival curve
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207. Regarding patients taking Glucophage:
a. Iodinated contrast agents are contraindicated. b. May cause lactic acidosis in the setting of diminshed renal function c. In combination with iodinated contrast, increases risk of renal failure. d. Must stop Glucophage 48 hours prior to IV contrast study |
b. May cause lactic acidosis in the setting of diminshed renal functionIntravascular contrast studies with iodinated materials can lead to acute alteration of renal function and have been associated with lactic acidosis in patients receiving GLUCOPHAGE. Therefore, in patients in whom any such study is planned, GLUCOPHAGE should be discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstated only after renal function has been re-evaluated and found to be normal.
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208. Thin layer chromatography. How to test for chemical impurity
a. Free Tc migrates on Acetone b. Stannous iron in saline |
a. Free Tc migrates on Acetone
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209. Which one of the following is true?
a. Maximum amount of Moly breakthrough 10 Ci per mCi of Tc-99m b. Aluminum contamination forms an insoluble colloid when combined with Tc99m c. +7 oxidation state of Tc is required for labeling d. Chromatography is used to remove insoluble contaminants from free Tc04 |
c. +7 oxidation state of Tc is required for labeling
The only desired radionuclide in the Mo-99/Tc-99m generator eluate is Tc-99m. Any other radionuclide in the sample is considered a radionuclidic impurity and is undesirable since it will result in additional radiation exposure to the patient without clinical benefit. The NRC limit for Mo-99 is 0.15 Ci of Mo-99 activity per 1.0 mCi of Tc-99m activity in the administered dose. Aluminum levels in excess of 10 g/mL have been shown to interfere with the normal distribution of certain radiopharmaceuticals such as Tc-99m sulfur colloid (increased lung activity) and Tc-99m MDP (increased liver activity). The expected valence state of Tc-99m, as eluated from the generator, is +7 in the chemical form of pertechnetate (TcO4-). The clinical use of sodium pertechnetate as a radiopharmaceutical and the preparation Tc-99m-labeled pharmaceuticals, typically from commercial kits, is predicated on the +7 oxidation state. One exception to the need to reduce technetium from the +7 oxidation state is in the preparation of Tc-99m sulfur colloid. Thin layer chromatography is used to evaluate for radiochemical purity (by detecting levels of impurities). |
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205. Risk assessment is not associated with which of the following?
b. Odds ratio c. Relative risk d. Absolute risk e. Hazard ratio f. Cumulative risk |
e. Hazard ratio
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206. A doctor wants to examine the mortality of his patients 5 years after a new procedure. What test
should be used? a. Student’s t test b. Linear regression c. Chi square test d. Kaplan-Meier survival curve |
d. Kaplan-Meier survival curve
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207. Regarding patients taking Glucophage:
a. Iodinated contrast agents are contraindicated. b. May cause lactic acidosis in the setting of diminshed renal function c. In combination with iodinated contrast, increases risk of renal failure. d. Must stop Glucophage 48 hours prior to IV contrast study |
b. May cause lactic acidosis in the setting of diminshed renal functionIntravascular contrast studies with iodinated materials can lead to acute alteration of renal function and have been associated with lactic acidosis in patients receiving GLUCOPHAGE. Therefore, in patients in whom any such study is planned, GLUCOPHAGE should be discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstated only after renal function has been re-evaluated and found to be normal.
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208. Thin layer chromatography. How to test for chemical impurity
a. Free Tc migrates on Acetone b. Stannous iron in saline |
a. Free Tc migrates on Acetone
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209. Which one of the following is true?
a. Maximum amount of Moly breakthrough 10 Ci per mCi of Tc-99m b. Aluminum contamination forms an insoluble colloid when combined with Tc99m c. +7 oxidation state of Tc is required for labeling d. Chromatography is used to remove insoluble contaminants from free Tc04 |
c. +7 oxidation state of Tc is required for labeling
The only desired radionuclide in the Mo-99/Tc-99m generator eluate is Tc-99m. Any other radionuclide in the sample is considered a radionuclidic impurity and is undesirable since it will result in additional radiation exposure to the patient without clinical benefit. The NRC limit for Mo-99 is 0.15 Ci of Mo-99 activity per 1.0 mCi of Tc-99m activity in the administered dose. Aluminum levels in excess of 10 g/mL have been shown to interfere with the normal distribution of certain radiopharmaceuticals such as Tc-99m sulfur colloid (increased lung activity) and Tc-99m MDP (increased liver activity). The expected valence state of Tc-99m, as eluated from the generator, is +7 in the chemical form of pertechnetate (TcO4-). The clinical use of sodium pertechnetate as a radiopharmaceutical and the preparation Tc-99m-labeled pharmaceuticals, typically from commercial kits, is predicated on the +7 oxidation state. One exception to the need to reduce technetium from the +7 oxidation state is in the preparation of Tc-99m sulfur colloid. Thin layer chromatography is used to evaluate for radiochemical purity (by detecting levels of impurities). |
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213. Portal venous pressure is most accurately estimated how?
a. Free hepatic vein pressure b. Hepatic vein wedge pressure c. Hepatic vein wedge minus the free hepatic vein pressure. d. Additive free hepatic vein and wedge pressures. |
c. Hepatic vein wedge minus the free hepatic vein pressure.
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214. In a patient with lower extermity claudication, what is the appropriate MR sequence:
a. MRA 3D TOF w/o gating b. MRA 3D TOF with cardiac gating c. GRE axial post contrast d. Gadolinium MRA with multistation runoff e. Black blood sequence |
d. Gadolinium MRA with multistation runoff
Contrast-enhanced 3D MRA has become the method of choice. The technique relies on the detection of contrast enhancement in the vascular lumen to produce findings that are comparable to those of conventional catheter angiography. The current technique uses the bolus-chasing method material in which vessels are imaged sequentially as contrast flows distally. Multiple overlapping fields of view are used, and images are obtained in the coronal or sagittal planes (usually in 3 coronal stations). This technique also uses subtraction to improve the resultant vascular images by suppressing the background and reducing the volume averaging. |
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215. Which of the following is an absolute contraindication to TIPS?
a. Right heart failure b. Portal vein thrombosis c. Budd chiari syndrome |
a. Right heart failure
Absolute contraindications are progressive liver failure, decompensation of the right ventricle, pulmonary hypertension, and higher degree hepatic encephalopathy. Wien Klin Wochenschr 2000 Nov 24;112(22):947-54. |
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216. Regarding the TIPS procedure, which one of the following is true:
a. Gastric varices from splenic vein thromosis is an indication for TIPS b. The shunt is placed between the left hepatic vein and left portal vein c. Flow in the main portal vein is hepatopedal d. Flow in the right portal vein is hepatopedal |
c. Flow in the main portal vein is hepatopedal
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In a normal functioning TIPS right hepatic vein to right portal vein, flow in the left portal
vein is: a. Hepatopedal b. Hepatofugal c. Biphasic d. Erratic |
b. Hepatofugal
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217. Pseudocirrhosis is associated with?
a. Primary Sclerosing Cholangitis b. IBD c. Budd-Chiari d. Breast CA mets e. Colon CA mets f. Post transplant liver |
d. Breast CA mets
Pseudocirrhosis -- a phenomenon of posttreatment metastatic breast cancer whereby regions of retracted tumor tissue and scarring delineate areas of regeneration, producing an appearance that resembles macronodular cirrhosis. -- Radiology 2002;225:917-918 |
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218. On vascular US evaluation of the carotids there is bilateral reversal of flow in diastole, what is the
most likley etiology? a. Aortic insufficiency b. Aortic stenosis c. Pulmonary hypertension d. VSD e. Cerebral edema |
a. Aortic insufficiency
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219. During placement of a dialysis catheter through a peel-away sheath, the patient becomes
tachycardic and hypoxemic. Which is the most likely explanation a. Air embolism b. Catheter fracture c. Pneumothorax |
a. Air embolism
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220. What will increase velocity in the ipsilateral ICA?
a. cerebral AVM b. Common carotid artery stenosis c. ICA occlusion |
a. cerebral AVM
The average blood flow velocity in ICA feeding AVMs was found to be 90 cm/sec., which is about twice as high as blood flow velocity in the contralateral ICA. |
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221. A type 2 endoleak of repaired AAA involves?
a. Proximal graft anastomoses leak b. Distal graft anastomoses leak c. Aneurysmal component fed from native artery d. Leak at surgical sutures e. At junction of aortic and iliac component |
c. Aneurysmal component fed from native artery
Type I endoleak comprises a failure to seal the attachment sites of the endograft to the native vessels. These are widely recognized as the endoleaks most closely linked to rupture and are the most aggressively treated.8,13 Type I endoleaks can occur at proximal or distal attachment sites, and have been correlated to short aneurysm neck, large vessel diameter, aneurysm neck angulation, and tortuosity of the iliac arteries.14,15 Type II endoleaks are a result of retrograde flow from small arteries such as the lumbars or the inferior mesenteric artery (IMA) into the aneurysmal sac, and many will resolve/regress spontaneously. Type III endoleaks arise from a defect within the graft. This flaw can be a disjunction between modular components (type IIIA), or a hole in the fabric of the graft (type IIIB). Type III endoleaks are very graft-specific and can be serious because they are invariably associated with a sudden elevation of intrasac pressure. Type IV endoleaks are caused by fabric porosity and subside within 30 days. No specific treatment is necessary. |
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222. Which is not an indication for tips?
a. Varices resistant to sclerotherapy b. Ascites c. Thrombosed splenic vein with gastic varices |
c. Thrombosed splenic vein with gastic varices
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223. Which is appropriate first line treatment for hepatic hydrothorax?
a. Chest tube drainage. b. TIPS c. Surgical shunt treatment d. Diuresis and salt restriction |
d. Diuresis and salt restriction
A pleural effusion noted in cirrhotic patients in the absence of primary cardiac or pulmonary disease is most likely a hepatic hydrothorax. This complication is noted in approximately 6% of cirrhotic patients and is also an infrequent complication of continuous ambulatory peritoneal dialysis. Although the effusion may be bilateral or left-sided, the majority (67%) are right-sided. Unidirectional transdiaphragmatic defects allowing peritoneopleural communication are believed to play a role in the transit of the transudative ascites into the thorax, and there is debate as to whether these communications are congenital or acquired. Along with the identified diaphragmatic defects, other proposed etiologies are transdiaphragmatic lymphatics and Hypoalbuminemia. Applied Radiol Online Volume: 32 Number: 7 July 2003 Conservative treatment (single session thoracocentesis and diuretics) should be tried first. If this fails, the liver function and life expectancy should be considered. Depending on this assessment TIPS, single session thoracovideoscopy with closure of diaphragmatic defects and/or pleurodesy can be considered. Placement of chest tubes should be avoided. If they are placed and cannot be removed due to high fluid output, high dose octreotide should be tried. Like ascites, hydrothorax carries a poor prognosis and should lead to consideration of liver transplantation in suitable patients. |
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224. The left gastroepiploic artery is supplied by:
a. Splenic Artery b. SMA c. Right Hepatic Artery d. Gastroduodenal e. Left Gastric Artery |
a. Splenic Artery
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225. The Uterine Artery arises as a branch of:
a. Pudendal Artery b. Posterior division of the Internal Iliac c. Anterior division of the Internal Iliac d. External Iliac |
c. Anterior division of the Internal Iliac
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Which of the following is not associated with Budd-Chiari syndrome:
a. Behcet’s b. Paroxysmal nocturnal hemoglobinuria c. Chronic viral infection d. Protein C deficiency |
c. Chronic viral infection
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227. What is the appropriate embolic material in the treatment of a pulmonary AVM in a child?
a. Coils b. Alcohol c. Gelfoam d. Embospheres |
a. Coils
Pulmonary AVM's are associated with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendau syndrome) in one third of patients with a solitary lesion, and in over 50% of patients with multiple AVM's. This hereditary disorder (autosomal dominant [chromosome 9]) is characterized by a general vascular dysplasia with AVM's of multiple organs including the nose, CNS, GI tract, and lungs. Telangiectasias often do not appear until the 3rd decade of life. Approximately 5-15% of HHT patients have pulmonary AVM's [5] and there is usually a family history of pulmonary AVM's in these patients. Pulmonary AVM's can be classified as simple- a single feeding artery or draining vein, or complex- multiple feeding arteries. Simple lesions account for 80% of cases [5]. All lesions with feeding arteries larger than 3mm should be embolized due to the risk of paradoxical embolizm [7]. Particulate agents should not be used because of the obvious risk of systemic embolization [5]. Stainless steel coils or silicon or latex balloons are commonly used [5]. When treating the lesions with coil embolization, it is essential to thrombose all of the feeding arteries, as recurrence is usually secondary to enlargement of a secondary feeder that was missed at the time of embolization. On plain films, AVM's generally appear as a solitary or multiple pulmonary nodules. Classically one should be able to identify the enlarged vessel entering the lesion. The lesion will be noted to change size with inspiration and expiration, or supine versus erect films. CT and helical CT can also be used to demonstrate the presence of a feeding artery. Most of these lesions have a single feeding artery and draining vein, however, they may be multiple. Spiral CT with contiguous images and overlapping reconstructions is more sensitive than angiography for detecting and displaying the vascular connections of pulmonary AVM's- the angio-architecture can be identified in 76 to 95% of lesions [5]. Contrast enhancement of the lesion may not be seen if the lesion is thrombosed. AuntMinnie. |
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228. A patient becomes hypotensive and bradycardic after the administration of iodinated contrast agent.
What is the appropriate management? a. Administer atropine b. Administer epinephrine c. Reverse Trendelenburg position d. Administer phentolamine e. Administer benadryl and zantac |
a. Administer atropine
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229. A thrombocytopenic patient needs a liver abscess drainage. When should platelets be administered?
a. 4h before b. 2h before c. 1h before d. Start of procedure e. After procedure done |
It is inappropriate to assume that a hemostatic platelet count level has been achieved simply because a platelet transfusion was administered. Posttransfusion counts obtained 10 minutes after transfusion can be helpful in this regard. The platelet transfusion must therefore be closely coordinated with the timing of the planned surgical intervention. J Clin Oncol Vol 19, Issue 5 (March), 2001: 1519-1538
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230. What is the cause of blue toe syndrome?
a. Atheroembolism b. Vasculitis c. Popliteal artery aneurysm d. Multiple areas of stenosis |
a. Atheroembolism
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231. A parvus-tardus Doppler waveform indicates:
a. A stenosis proximal to the interrogated segment b. A stenosis distal |
a. A stenosis proximal to the interrogated segment
Severe stenosis in the innominate artery may manifest as a tardus-parvus waveform (a prolonged systolic acceleration time with low peak systolic velocity) in the right CCA and ICA. This waveform generally indicates a severe stenosis proximal to the point of sampling. Imaging with an alternative modality may be recommended to determine the exact location of the stenosis. RadioGraphics 2005; 25:1561-1575 |
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232. Regarding abdominal aortic aneurysms, all are true except?
a. 90% are infrarenal b. At 4 cm diameter, rate of rupture exceeds rate of surgical mortality c. IMA is frequently thrombosed d. Frequently involves the iliac arteries |
b. At 4 cm diameter, rate of rupture exceeds rate of surgical mortality
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233. Which artery supplies the cecum?
a. Ileocolic artery b. Right colic artery c. Inferior mesenteric artery d. Celiac |
a. Ileocolic artery
The Right Colic Artery arises from about the middle of the concavity of the superior mesenteric artery, or from a stem common to it and the ileocolic. It passes to the right behind the peritoneum, and in front of the right internal spermatic or ovarian vessels, the right ureter and the Psoas major, toward the middle of the ascending colon; sometimes the vessel lies at a higher level, and crosses the descending part of the duodenum and the lower end of the right kidney. At the colon it divides into a descending branch, which anastomoses with the ileocolic, and an ascending branch, which anastomoses with the middle colic. These branches form arches, from the convexity of which vessels are distributed to the ascending colon. |
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234. A patient has selective embolization in the SMA and then becomes hypotensive after the procedure
No groin hematoma is seen. What is the most likely etiology of the hypotension? a. AV fistula at puncture site b. Puncture too high c. Puncture too low d. Rupture of coiled vessel post angio |
b. Puncture too high
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A patient with a hemorrhagic duodenal ulcer is embolized with coils. Two hours later the patient goes into shock (no vitals given). There is no hematoma at the groin stick site, nor hematochezia. What is the etiology of the shock?
a. Delayed contrast rxn. b. Retroperiotoneal hemorrhage from high arterial groin stick. c. Proximal SMA dissection with intraperitoneal rupture. d. SMA occlusion from an intimal flap. e. Stick site leaking pseudoaneurysm. f. Rupture at site of metallic coil. |
b. Retroperiotoneal hemorrhage from high arterial groin stick.
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235. In a dialysis patient, what is the most likely sign of fistula malfunction?
a. A palpable thrill b. Pulsatile at arterial anastamosis c. Diminished flow rates during dialysis d. Low venous pressures during dilaysis |
c. Diminished flow rates during dialysis
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: Which one of the following is true regarding dialysis fistulae
a. Dysfunction typically due to arterial stenosis b. Dysfunction typically due to venous stenosis c. Increased resistance of arterial flow d. Thrombosis is usually secondary to a traumatic puncture |
b. Dysfunction typically due to venous stenosis
The mean problem-free patency period after creation of native fistulas is approximately 3 years, while prosthetic PTFE grafts last 1-2 years before indications of failure or thrombosis are noted. Long-term secondary patency rates are reportedly 7 years in forearm, 3-5 years in the upper arm for native fistulas, and as long as 2 years for prosthetic grafts after multiple interventions to treat the underlying stenosis and thrombosis. Fistula failure and eventual occlusion occur most commonly as a result of the progressive narrowing of the venous anastomosis in prosthetic grafts and the outflow vein in native fistulas. The primary underlying pathophysiologic mechanism responsible for causing the failure is intimal hyperplasia at the anastomotic site. Additional causes include surgical and iatrogenic trauma such as repeated venipunctures. |
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236. All of the following are true regarding carotid fibromuscular dysplasia except:
a. Usually unilateral b. Associated with aneurysms c. More common in ICA than ECA d. Associated with string of pearls sign e. More common in women |
a. Usually unilateral
FIBROMUSCULAR DYSPLASIA =nonatherosclerotic angiopathy of unknown pathogenesis Incidence:<1% of cerebral angiographies Age :2/3 >50 years; M:F = 1:9 Associated with:brain ischemia (up to 50%), intracranial aneurysms (up to 30%), intracranial tumors (30%), bruits, trauma Location: cervical + intracranial ICA (85%), vertebral artery (7%); both anterior + posterior circulation (8%); bilateral (60-65%) simultaneous involvement of renal / muscular arteries in 3% Angio: length of affected vessel from 0.5 cm to several cm Types: 1.Medial fibroplasia = fibromuscular hyperplasia (80%) string of beads = alternating zones of widening + narrowing tubular narrowing 2.Intimal fibroplasia smooth concentric tubular narrowing (DDx: Takayasu arteritis, sclerosing arteritis, vessel spasm, arterial hypoplasia) 3.Subadventitial hyperplasia 4.Atypical fibromuscular dysplasia (= ? variant of intimal fibroplasia) web = smooth / corrugated mass involving only one wall of vessel + projecting into lumen (DDx: atherosclerotic disease, posttraumatic aneurysm) Cx: dissection (in 3%), macroaneurysm Prognosis: tends to remain stable / minimal progression Rx: only when symptoms progress |
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237. In May-Thurner syndrome, what compresses the left iliac vein?
a. Sacral promontory b. Left iliac artery c. Right iliac artery d. Aortic bifurcation |
c. Right iliac artery
Compression of left common iliac vein by crossing right iliac artery. In contrast to the right common iliac vein, which ascends almost vertically to the inferior vena cava, the left common iliac vein takes a more transverse course. Along this course, it underlies the right common iliac artery, which may compress it against the lumbar spine. This compression causes stasis of the blood, which is one element of Virchow's triad that precipitates deep vein thrombosis. |
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238. Regarding chest CT angiography, which finding is most typical of acute pulmonary embolism?
a. Mural thrombi b. Webs c. Filling defects |
c. Filling defects
Man I hope I get a few like this |
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4. Most common involvement of PTLD (post transplant lymphoproliferative disorder) in GI tract of a post transplant patient:
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d. Small bowel
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5. P value saying there is a difference when there really is not a difference:
a. Gamma error b. Type I c. Type II |
c. Type II
Type I is when you reject the hypothesis when it is actually true Type II is when you accept the hypothesis when it is not true |
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8. What does not cause pulmonary arterial HTN?
a. Schisto b. Hypoxia c. MS d. Eisenmenger’s e. Pulmonary AVM |
e. Pulmonary AVM
Eisenmenger's syndrome (or Eisenmenger's reaction) is defined as the process in which a left-to-right shunt caused by a ventricular septal defect in the heart causes increased flow through the pulmonary vasculature, causing pulmonary hypertension,[1][2] which in turn, causes increased pressures in the right side of the heart and reversal of the shunt into a right-to-left shunt. Eisenmenger's syndrome specifically refers to the combination of systemic-to-pulmonary communication, pulmonary vascular disease and cyanosis. |
