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211 Cards in this Set
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1. What is associated with pincer type femoro-acetabular impingement?
A. Protrusio acetabuli. B. Congenital hip dislocation. C. Heterotopic ossification. |
1. What is associated with pincer type femoro-acetabular impingement?
A. Protrusio acetabuli. B. Congenital hip dislocation. C. Heterotopic ossification. Answer: A – Protrusio acetabuli Pincer type femoroacetabular impingement: (http://www.orthosupersite.com/view.aspx?rid=25278#ans) • Caused by acetabular overcoverage with normal femoral head sphericity • Pincer effect is the linear contact between a normal neck and an overcovering acetabular rim, which can lead to labral damage • More common in middle-aged women with abnormalities of acetabular morphology • Predisposing conditions: o Legg-Calve-Perthes disease o Congenital hip dysplasia o Slipped capital femoral epiphysis o Avascular necrosis of the femoral head o Ununited femoral neck fractures o Coxa profunda o Coxa vara o Protrusio acetabuli o Acetabular retroversion Protrusio Acetabuli: • Deformity of the medial wall of the acetabulum with progressive migration of the femoral head into the pelvic cavity, resulting in mechanical disorders, pain and limited limb hip movement • Occurs most often with rheumatoid arthritis • Also occurs with: o Osteoporosis o Osteomalacia o Paget’s o Idiopathic • Defined as 3mm or more between acetabular line and ilioischial line in men and 6 mm or more in women • Erosion of cartilage in RA usually results in axial migration of head with uniform loss of joint space • Usually bilateral • Occurs more often in patients with RA who are on steroids |
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2. 75 year old female presents with a 9 cm mass in the head of the pancreas with central calcifications. This is unchanged from prior CT 5 years ago. Etiology?
A. Chronic focal pancreatitis. B. Pseudocyst C. Serous cystadenoma D. Solid and papillary neoplasm. |
2. 75 year old female presents with a 9 cm mass in the head of the pancreas with central calcifications. This is unchanged from prior CT 5 years ago. Etiology?
A. Chronic focal pancreatitis. B. Pseudocyst C. Serous cystadenoma D. Solid and papillary neoplasm. Answer: C – Serous cystadenoma |
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. What best describes the type of study that takes the results of many other clinical studies on the same subject to come to a conclusion?
A. Case Control B. Decision analysis C. Cohort D. Meta-analysis |
3. What best describes the type of study that takes the results of many other clinical studies on the same subject to come to a conclusion?
A. Case Control B. Decision analysis C. Cohort D. Meta-analysis Answer: D – Meta-analysis |
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4. What is the best estimate of portal vein pressure?
A. Free hepatic vein pressure. B. Wedged hepatic vein pressure. C. Wedged hepatic vein pressure - Free hepatic vein pressure D. Free hepatic vein pressure – Wedged hepatic vein pressure |
4. What is the best estimate of portal vein pressure?
A. Free hepatic vein pressure. B. Wedged hepatic vein pressure. C. Wedged hepatic vein pressure - Free hepatic vein pressure D. Free hepatic vein pressure – Wedged hepatic vein pressure Answer: C - Wedged hepatic vein pressure – Free hepatic vein pressure |
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5. 3D liver ultrasonography shows a cyst on the axial image. What is true of the reconstructed image?
A. difficult to distinguish a cyst because acoustic enhancement appears at a different location from the cyst B. too much noise created within the cyst to conclude that the structure is actually a cyst. C. Reconstruction causes irregularity of the walls. |
5. 3D liver ultrasonography shows a cyst on the axial image. What is true of the reconstructed image?
A. difficult to distinguish a cyst because acoustic enhancement appears at a different location from the cyst B. too much noise created within the cyst to conclude that the structure is actually a cyst. C. Reconstruction causes irregularity of the walls. Answer: A – difficult to distinguish cyst because acoustic enhancement appears at a different location from the cyst |
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6. Patient undergoing coronary CTA is given a beta blocker and his heart rate drops from 70 to 38. What do you do?
A. Give atropine. B. Saline. C. Adenosine. D. Epinephrine. |
. Patient undergoing coronary CTA is given a beta blocker and his heart rate drops from 70 to 38. What do you do?
A. Give atropine. B. Saline. C. Adenosine. D. Epinephrine. Answer: A – Give atropine ( no info given about if the patient was symptomatic) |
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7. Patient has a contrast reaction and develops bradycardia and hypotension.
A. Atropine B. Other answers. |
7. Patient has a contrast reaction and develops bradycardia and hypotension.
A. Atropine B. Other answers. Answer: A - Atropine |
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8. Patient develops paroxysmal atrial tachycardia with placement of a guidewire in the right ventricle. What to do? (Retract guidewire not an option).
A. Metoprolol B. Labetolol C. Adenosine. D. Digoxin. |
8. Patient develops paroxysmal atrial tachycardia with placement of a guidewire in the right ventricle. What to do? (Retract guidewire not an option).
A. Metoprolol B. Labetolol C. Adenosine. D. Digoxin. Answer: A - Metoprolol |
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9. Patient has acute subclavian vein thrombosis with unilateral arm swelling.
A. Anticoagulate with Coumadin. B. Thrombolysis with balloon angioplasty. C. Thrombolysis with stent. D. Thrombolyis with decompression. |
9. Patient has acute subclavian vein thrombosis with unilateral arm swelling.
A. Anticoagulate with Coumadin. B. Thrombolysis with balloon angioplasty. C. Thrombolysis with stent. D. Thrombolyis with decompression. Answer: D - Thrombolysis and decompression since usually caused by thoracic outlet syndrome which needs surgical decompression. |
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Abdominal layer continuous with external spermatic fascia
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External oblique
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11. Most common breast cancer in males?
A. Invasive lobular. B. Ductal carcinoma in situ. C. Invasive ductal |
11. Most common breast cancer in males?
A. Invasive lobular. B. Ductal carcinoma in situ. C. Invasive ductal Answer: C - Invasive ductal |
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12. In the BIRADS lexicon of MRI findings, a “focus” is defined as what?
A. Slowly enhancing lesion > 1cm in size. B. Enhancing lesion < 5mm. C. Non enhancement D. Linear enhancement 5-10 mm |
12. In the BIRADS lexicon of MRI findings, a “focus” is defined as what?
A. Slowly enhancing lesion > 1cm in size. B. Enhancing lesion < 5mm. C. Non enhancement D. Linear enhancement 5-10 mm Answer: probably B. (Focus and foci are enhancements measuring less than 5 mm that cannot be otherwise specified). |
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13. Which of the following is least likely to present as a breast mass?
A. Medullary. B. Tubular. C. Mucinous. D. Papillary. |
13. Which of the following is least likely to present as a breast mass?
A. Medullary. B. Tubular. C. Mucinous. D. Papillary. Answer: ? (Not sure… Looked all four of these up on StatDx, and all of them can present as a mass. However, if one of the choices is PAPILLOMA rather than papillary carcinoma - this presents typically as BLOODY NIPPLE DISCHARGE, rather than mass. Maybe this question wasn't fully recalled in terms of the answer choices.) |
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14. Which of the following is least malignant?
A. Medullary B. Tubular C. Mucinous D. Papillary |
14. Which of the following is least malignant?
A. Medullary B. Tubular C. Mucinous D. Papillary Answer: B - Tubular carcinoma |
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15. What is the mammographic appearance of a radial scar?
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15. What is the mammographic appearance of a radial scar?
A. Spiculated mass with lucent center. |
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16. On initial screening mammogram a 3 cm well-circumscribed mass containing fat and soft tissue density is identified. What is the next appropriate action?
A. Follow-up mammogram in 1 year. B. 6 month followup C. Ultrasound D. Biopsy |
16. On initial screening mammogram a 3 cm well-circumscribed mass containing fat and soft tissue density is identified. What is the next appropriate action?
A. Follow-up mammogram in 1 year. B. 6 month followup C. Ultrasound D. Biopsy Answer: A - This a hamartoma, a benign finding. |
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17. A lesion is seen on the MLO view but not seen on CC. On a true lateral, the lesion moves superiorly. Where is it located?
A. Upper inner. B. Upper outer. C. Lower inner. D. Lower outer. |
17. A lesion is seen on the MLO view but not seen on CC. On a true lateral, the lesion moves superiorly. Where is it located?
A. Upper inner. B. Upper outer. C. Lower inner. D. Lower outer. Answer: A - Upper inner (muffins rise and lead sinks). |
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18. For which of the following presentations is ductography recommended?
A. Bilateral milky discharge. B. Bilateral greenish discharge. C. Unilateral serous discharge. |
18. For which of the following presentations is ductography recommended?
A. Bilateral milky discharge. B. Bilateral greenish discharge. C. Unilateral serous discharge. Answer: C - Unilateral serous discharge |
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19. What does a negative stroke margin on stereotactic biopsy mean?
A. The needle will hit the detector when it fires. B. The lesion will be missed. |
19. What does a negative stroke margin on stereotactic biopsy mean?
A. The needle will hit the detector when it fires. B. The lesion will be missed. Answer: A - Needle will hit the detector when it fires |
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20. Breast conservation surgery is contraindicated in which of the following?
A. Contralateral mastectomy 2 years prior. B. 10 level 1 axillary nodes. C. Multicentric calcifications. |
20. Breast conservation surgery is contraindicated in which of the following?
A. Contralateral mastectomy 2 years prior. B. 10 level 1 axillary nodes. C. Multicentric calcifications. Answer: C - Multicentric calcifications |
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21. Follow-up mammography is obtained post lumpectomy prior to radiation for what reason?
A. Establish new baseline. B. Evaluate for residual calcifications. |
21. Follow-up mammography is obtained post lumpectomy prior to radiation for what reason?
A. Establish new baseline. B. Evaluate for residual calcifications. Answer: B – Evaluate for residual calcifications |
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22. Rod-shaped, casting type calcifications on mammography are most likely to represent what?
A. Secretory disease B. Malignancy |
22. Rod-shaped, casting type calcifications on mammography are most likely to represent what?
A. Secretory disease B. Malignancy Answer: A – Secretory disease |
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23. Which calcifications on mams are most worrisome?
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23. Which of the following calcifications are most worrisome?
A. Segmental, linear, pleomorphic |
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24. Which ossification center is present in a neonate?
A. Proximal femur. B. Distal femur. C. Distal tibia. D. Distal radius. E. Capitellum |
24. Which ossification center is present in a neonate?
A. Proximal femur. B. Distal femur. C. Distal tibia. D. Distal radius. E. Capitellum Answer: B - Distal femur |
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25. 5 year old presents with diabetes insipidus and enhancing suprasellar mass.
A. Pituitary adenoma B. Craniopharyngioma C. Germninoma D. Hypothalamic hamartoma |
25. 5 year old presents with diabetes insipidus and enhancing suprasellar mass.
A. Pituitary adenoma B. Craniopharyngioma C. Germninoma D. Hypothalamic hamartoma Answer: B - Craniopharyngioma |
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26. Where is a Hill-Sachs lesion located?
A. Anterior inferior humeral head. B. Anterior inferior glenoid C. Posterior superior humeral head. D. Posterior glenoid. |
26. Where is a Hill-Sachs lesion located?
A. Anterior inferior humeral head. B. Anterior inferior glenoid C. Posterior superior humeral head. D. Posterior glenoid. Answer: C – Posterior-superior humeral head |
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27. Post reduction of posterior elbow dislocation in an adult, fracture of what is most likely to result in an intra-articular fragment?
A. Coronoid process. B. Radial head. C. Other answers |
27. Post reduction of posterior elbow dislocation in an adult, fracture of what is most likely to result in an intra-articular fragment?
A. Coronoid process. B. Radial head. C. Other answers Answer: A - Coronoid process |
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28. Segond fracture is associated with what?
A. Lateral capsular ligament B. Lateral collateral ligament C. Other answers. |
28. Segond fracture is associated with what?
A. Lateral capsular ligament B. Lateral collateral ligament C. Other answers. Answer: A – Lateral capsular ligament |
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29. Anterior thigh mass in a child with a “target” or bull’s eye appearance on MRI:
A. Lymphatic malformation. B. Neurofibroma. C. Other answers. |
29. Anterior thigh mass in a child with a “target” or bull’s eye appearance on MRI:
A. Lymphatic malformation. B. Neurofibroma. C. Other answers. Answer: B - Neurofibroma |
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30. What is associated with a myelomeningocele?
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30. What is associated with a myelomeningocele?
A. Obliterated cisterna magna |
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31. Trauma patient with acute epidural hematoma which shows areas of low attenuation within the hematoma on CT scan. What is the likely cause?
A. Organizing thrombus. B. Acute on chronic hematoma C. Active bleeding. |
31. Trauma patient with acute epidural hematoma which shows areas of low attenuation within the hematoma on CT scan. What is the likely cause?
A. Organizing thrombus. B. Acute on chronic hematoma C. Active bleeding. Answer: C - Active bleeding. They’re probably describing swirl sign. |
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32. Hyperextension injury would result in which of the following:
A. Widening of the interspinous distance. B. Endplate avulsion fracture. C. Anterolisthesis. |
32. Hyperextension injury would result in which of the following:
A. Widening of the interspinous distance. B. Endplate avulsion fracture. C. Anterolisthesis. Answer: B - Endplate avulsion fracture |
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33. Patient presenting with central cord syndrome has which type of cervical spine injury?
A. Jefferson fracture. B. Hyperflexion. C. Hyperextension. D. Dens fracture. |
33. Patient presenting with central cord syndrome has which type of cervical spine injury?
A. Jefferson fracture. B. Hyperflexion. C. Hyperextension. D. Dens fracture. Answer: C - Hyperextension |
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34. Most common tumor found in the pineal region in children?
A. Pineoblastoma B. Pineocytoma C. Teratoma. D. Germinoma. |
34. Most common tumor found in the pineal region in children?
A. Pineoblastoma B. Pineocytoma C. Teratoma. D. Germinoma. Answer: D - Germinoma |
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35. Most common primary intracranial tumor in adults?
A. Pilocytic astrocytoma. B. Oligodendroglioma C. Glioblastoma multiforme. D. Anaplastic astrocytoma. |
35. Most common primary intracranial tumor in adults?
A. Pilocytic astrocytoma. B. Oligodendroglioma C. Glioblastoma multiforme. D. Anaplastic astrocytoma. Answer: C – Glioblastoma multiforme |
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36. Neonatal ultrasound shows absence of the cavum septum pellucidum. What other abnormality would be present?
A. Chiari II B. Hypotelorism. C. Agenesis of the corpus callosum. |
36. Neonatal ultrasound shows absence of the cavum septum pellucidum. What other abnormality would be present?
A. Chiari II B. Hypotelorism. C. Agenesis of the corpus callosum. Answer: C – Agenesis of the corpus callosum |
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37. Choroid plexus cysts are associated with which congenital abnormality?
A. Trisomy 13. B. Trisomy 18. C. Trisomy 21. D. Turner’s |
37. Choroid plexus cysts are associated with which congenital abnormality?
A. Trisomy 13. B. Trisomy 18. C. Trisomy 21. D. Turner’s Answer: B - Trisomy 18 |
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38. Choroid plexus is not present in which location?
A. Atria of the lateral ventricles. B. 4th ventricle. C. Frontal horns of the lateral ventricles. |
38. Choroid plexus is not present in which location?
A. Atria of the lateral ventricles. B. 4th ventricle. C. Frontal horns of the lateral ventricles. Answer: C – Frontal horns of the lateral ventricles |
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39. MRI shows enlargement of the optic nerves bilaterally and the optic chiasm. What is the most likely association?
A. Neurofibromatosis. B. Tuberous sclerosis. C. Von Hippel lindau. |
39. MRI shows enlargement of the optic nerves bilaterally and the optic chiasm. What is the most likely association?
A. Neurofibromatosis. B. Tuberous sclerosis. C. Von Hippel lindau. Answer: A – Neurofibromatosis. Sounds like bilateral optic gliomas (NF 1). |
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40. Retinal detachment is not seen in which of the following:
A. Diabetic retinopathy. B. Choroidal melanoma. C. Retinoblastoma. D. Rhabdomyosarcoma. E. Coates disease. |
40. Retinal detachment is not seen in which of the following:
A. Diabetic retinopathy. B. Choroidal melanoma. C. Retinoblastoma. D. Rhabdomyosarcoma. E. Coates disease. Answer: D - Rhabdomyosarcoma |
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41. 55 y.o. has abnormal signal in the conus and flow voids posterior to the cord.
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41. 55 y.o. has abnormal signal in the conus and flow voids posterior to the cord.
A. Spinal dural AVM. |
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42. What is associated/or what is the most common cause of epidural lipomatosis?
A. Cushings B. Exogenous steroid use C. Hypothyroidism. |
42. What is associated/or what is the most common cause of epidural lipomatosis?
A. Cushings B. Exogenous steroid use C. Hypothyroidism. Answer: B - Exogenous steroid use |
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43. Patient presents with hypertension and hypokalemia. Cause?
A. Adrenal adenoma. B. Adrenal hyperplasia. C. Adrenal carcinoma. |
43. Patient presents with hypertension and hypokalemia. Cause?
A. Adrenal adenoma. B. Adrenal hyperplasia. C. Adrenal carcinoma. Answer: A – Adrenal adenoma (sounds like hyperaldosteronism – Conn’s syndrome) |
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44. A patient with leptomeningeal carcinomatosis would present with what complaint?
A. Headache. B. Seizures. C. Cranial nerve palsies. |
44. A patient with leptomeningeal carcinomatosis would present with what complaint?
A. Headache. B. Seizures. C. Cranial nerve palsies. Answer: C (I think it’s A – Headache. This seems to be the most common presenting complaint. See http://emedicine.medscape.com/article/341389-overview) |
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45. MRI shows a right central disk protrusion at L4-L5. The patient probably has symptoms in what nerve root distribution?
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45. MRI shows a right central disk protrusion at L4-L5. The patient probably has symptoms in what nerve root distribution?
A. Right L4 radiculopathy. B. Right L5 C. Left L4 D. Left L5. Answer: B - Right L5 |
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46. Patient with subarachnoid hemorrhage 1 week post AcoA aneurysm clipping develops lower extremity weakness and confusion. Cause?
A. Vasospasm. B. Hydrocephalus. C. Other answers. |
46. Patient with subarachnoid hemorrhage 1 week post AcoA aneurysm clipping develops lower extremity weakness and confusion. Cause?
A. Vasospasm. B. Hydrocephalus. C. Other answers. Answer: A - Vasospasm |
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47. Deep cerebral vein occlusion would affect which structures?
A. Thalami B. Midbrain C. Posterior temporal lobes |
. Deep cerebral vein occlusion would affect which structures?
A. Thalami B. Midbrain C. Posterior temporal lobes Answer: A – Thalami (internal cerebral veins, vein of Galen and straight sinus are considered the “deep cerebral veins”; thrombosis would affect the thalami & basal ganglia) see http://radiopaedia.org/articles/deep-cerebral-vein-thrombosis |
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48. Small thymus would be seen in which condition?
A. HIV. B. T-cell lymphoma. C. Myasthenia gravis. D. Hypothyroidism. E. DiGeorge syndrome. |
48. Small thymus would be seen in which condition?
A. HIV. B. T-cell lymphoma. C. Myasthenia gravis. D. Hypothyroidism. E. DiGeorge syndrome. Answer: E – DiGeorge syndrome (CATCH – 22: Cardiac Abnormality (especially tetralogy of Fallot), Abnormal facies Thymic aplasia/hypoplasia, Cleft palate, Hypocalcemia; chromosome 22 deletion) |
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49. Which of the following lymphomas is not FDG-avid?
A. Mantle cell. B. Cutaneous T cell. C. MALT D. NHL E. Nodular sclerosing NHL |
49. Which of the following lymphomas is not FDG-avid?
A. Mantle cell. B. Cutaneous T cell. C. MALT D. NHL E. Nodular sclerosing NHL. Answer: ?Low Grade NHL and the listed subtypes such as MALT are all low pet/fdg sensitive. NHL Low Grade Terminology • Small lymphocytic lymphoma (SLL); chronic lymphocytic leukemia (CLL) • Marginal zone lymphoma (MZL) • Mucosal associated lymphoid tissue (MALT) • Cutaneous T-cell lymphoma (CTCL) • Low grade follicular B-cell lymphoma (FL) • Low grade lymphomas: Slow growing, indolent non-Hodgkin lymphoma Imaging Findings • PET/CT: Enlarged LN, extranodal mass with low to moderate FDG uptake • PET/CT: Marked FDG uptake = higher grade transformation • CLL/SLL: PET of limited use in staging 2° ↓ FDG uptake (sens 58%) • MZL: FDG PET staging sens 71% (lower for extranodal) • FL: FDG PET useful in staging all grades (sens 94%, spec 100%) Top Differential Diagnoses • Granulomatous Disease • Reactive Lymph Node Hyperplasia • Cardiac Failure, Edematous State • Higher Grade Lymphomas on Therapy • Other Malignancy Diagnostic Checklist • PET/CT useful for staging FL • PET/CT: Intense uptake should suggest higher grade transformation, identify site to biopsy Nuclear Medicine Findings • PET o CLL/SLL: PET of limited use in staging 2° ↓ FDG uptake (sens 58%) SUV > 3.5 suggests Richter transformation of CLL/SLL → diffuse large B-cell lymphoma (sens 91%, spec 80%, PPV 53%, NPV 97%) o MZL: FDG PET staging sens 71% (lower for extranodal) MALT lymphoma: Typically no or low FDG uptake; SUV > 3.5 suggests plasmacytic differentiation o FL: FDG PET useful in staging all grades (sens 94%, spec 100%) Wide overlap between FDG uptake by lower (SUV 2.3-13) and higher grade (SUV 3.2-43) FL Emergence of sites of ↑ FDG uptake (SUV > 10): Transformation to higher grade (spec 81%) o CTCL: FDG PET useful in staging, especially in suspected single cutaneous site CTCL: Intense nodal sites suspicious for large cell transformation • Tl-201, Tc-99m sestamibi: Superseded by PET/CT • Ga-67 o Poor sensitivity for low grade lymphomas; increased uptake indicative of higher grade transformation o Poor sensitivity in abdomen (due to colon uptake) o Many false positives: Granulomatous, inflammatory, infectious, normal physiologic |
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50. F-18 fluorine is used to image which of the following?
A. Bone B. Brain. C. Liver |
50. F-18 fluorine is used to image which of the following?
A. Bone B. Brain. C. Liver Answer: A – Bone (per Dr. Arnold) |
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51. Which of the following is used to treat bone metastasis?
A. Sa 153 B. Yttrium C. Phosphorus |
51. Which of the following is used to treat bone metastasis?
A. Sa 153 B. Yttrium C. Phosphorus Answer: A – Samarium 153 (or strontium, but not a choice) |
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52. Regarding parathyroid adenoma imaging with sestamibi, which of the following is true?
A. Related to hypervascularity. B. Size of the adenoma does not matter. C. Related to mitochondrial uptake. |
52. Regarding parathyroid adenoma imaging with sestamibi, which of the following is true?
A. Related to hypervascularity. B. Size of the adenoma does not matter. C. Related to mitochondrial uptake. Answer: C – Related to mitochondrial uptake |
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53. 50% of the annual allowed dose to the nuclear medicine technologist is from which of the following?
A. Radiopharmaceutical preparation. B. Administration of radiopharmaceutical. C. Imaging |
53. 50% of the annual allowed dose to the nuclear medicine technologist is from which of the following?
A. Radiopharmaceutical preparation. B. Administration of radiopharmaceutical. C. Imaging Answer: B – Administration of radiopharmaceutical |
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54. Which quality check in nuclear medicine is required daily?
A. accuracy. B. constancy C. linearity D. geometry |
54. Which quality check in nuclear medicine is required daily?
A. accuracy. B. constancy C. linearity D. geometry Answer: B - Constancy |
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55. Sensitivity and specificity of MRI relates to:
A. diagnostic accuracy. B. diagnostic confidence. C. therapeutic accuracy |
55. Sensitivity and specificity of MRI relates to:
A. diagnostic accuracy. B. diagnostic confidence. C. therapeutic accuracy Answer: A - Diagnostic accuracy |
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. In orthotopic liver transplant, what type of anastomosis used?
• Hepaticojejunostomy • Choledochocholedochostomy • Choledochoduodenostomy • Choledochojejunostomy • Choledochogastrostomy |
56. In orthotopic liver transplant, what type of anastomosis used?
• Hepaticojejunostomy • Choledochocholedochostomy • Choledochoduodenostomy • Choledochojejunostomy • Choledochogastrostomy Answer: With adult OLTXs, a primary, end-to-end choledocostomy is performed after donor cholecystectomy. In most cases of LDLTX, a biliary-enteric hepatojejunostomy is used to reconstitute bile drainage. (emed radiology) |
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57. Abnormality of the conal septum is associated with what congenital cardiac abnormality?
A. Tetralogy of Fallot B. Truncus arteriosus |
57. Abnormality of the conal septum is associated with what congenital cardiac abnormality?
A. Tetralogy of Fallot B. Truncus arteriosus Answer: ? (I think it’s most frequently associated with an arch abnormality, e.g. coarctation; see http://emedicine.medscape.com/article/900108-overview; but I also saw sources that linked it with truncus arteriosus) Not recalled on OSU IN Truncus: • As truncal septum fuses with conal septum, right and left ventricular origins are established • If truncal septum fails to fuse to conal septum a ventricular septal defect is present IN TOF: Underdevelopment of pulmonary infundibulum due to unequal partitioning of conal truncus resulting in subvalvular or valvular right ventricular (RV) outflow tract (RVOT) stenosis, subaortic ventricular septal defect (VSD), overriding aorta and RV hypertrophy |
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58. What is the best way to determine if a chamber is the left ventricle?
A. Position on the left side of the body. B. Trabeculation at the apex. C. Muscular infundibulum. D. Fibrous connection between the inflow and outflow tracts. |
58. What is the best way to determine if a chamber is the left ventricle?
A. Position on the left side of the body. B. Trabeculation at the apex. C. Muscular infundibulum. D. Fibrous connection between the inflow and outflow tracts. Answer: ? ALT: The imaging finding most specific for the Left ventricle is: • Presence of the moderator band • Heavy trabeculation near the apex • Fibrous continuity of the inflow and outflow tracts (???or was it continuity of aortic and mitral valves) • Location on the left side of the patient I would probably venture that the answer has something to do with inflow and outflow tracts given that in times of uncertainty one should resort to the loop rule discussed below. - Moderator band: specific to right vent - In the right ventricle, the trabeculae are coarse, and the presence of an apical moderator band is characteristic. - The trabeculae of the left ventricle are thin and delicate, and the septal surface is smooth - the papillary muscles of the right ventricle are attached to both the interventricular septum and the free wall, whereas the two papillary muscles of the left ventricle are attached only to the free wall - In complex cases, it may be difficult to determine which ventricle is the morphologic right ventricle and which is the morphologic left ventricle. In such cases, the identification may be based on the assumption that in the presence of a right-sided aortic valve, the right ventricle is located to the right of the left ventricle (D-loop), and in the presence of a left-sided aortic valve, the right ventricle is located to the left of the left ventricle (L-loop). This is known as the loop rule (3). |
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60. Parallel pulmonary artery and aorta on ultrasound of neonate?
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60. Parallel pulmonary artery and aorta on ultrasound of neonate?
A. Transposition of the great arteries. B. Truncus arteriosus. Answer: A – Transposition of the great arteries |
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61. Sinus venosus ASD related to?
A. PAPVR. B. VSD. C. Other answers |
61. Sinus venosus ASD related to?
A. PAPVR. B. VSD. C. Other answers Answer: A – PAPVR Image Interpretation Pearls • Discovery of PAPVR, look carefully for ASD: Cause of paradoxical emboli and stroke |
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62. Molecular probe best images which receptor?
A. Cell membrane receptors B. Other stuff inside the cell like nuclear membrane receptors, etc |
62. Molecular probe best images which receptor?
A. Cell membrane receptors B. Other stuff inside the cell like nuclear membrane receptors, etc Answer: A - Cell membrane receptor |
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63. Increase of which finding indicates the worst prognosis in pulmonary embolism?
A. Clot burden B. Pulmonary artery diameter. C. RV/LV diameter ratio |
63. Increase of which finding indicates the worst prognosis in pulmonary embolism?
A. Clot burden B. Pulmonary artery diameter. C. RV/LV diameter ratio Answer: ? (Radiographics article says presence of pericardial effusion implies a worse prognosis. See http://radiographics.rsna.org/content/29/1/31.full.pdf+html) OSU recalled: What is the etiology of pulmonary physiologic malfunction in fat embolism synbdrome: • Pulmonary hypertension • Neurogenic • Decreased Capillary permeability • Pulmonary vascular obstruction Decreased Capillary permeability: • Etiology • No specific pathologic features diagnostic of fat embolism • Release of fat globules or fatty bone marrow into venous system o Usually due to long bone fracture o Occurs during placement of intra-medullary rods • Fat embolism syndrome o Fat droplets act as emboli within the pulmonary microvasculature and other microvascular beds, such as the skin and brain o Initial symptoms are considered due to a mechanical occlusion from fat globules that are too large to pass through the capillaries o Because of their fluid nature, fat globules do not completely obstruct capillary blood flow o Hydrolysis of intravascular fat into more irritating free fatty acids by intra-pulmonary lipase o Free fatty acids cause endothelial damage and permeability edema |
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64. Which abnormality is seen in pericardial tamponade?
A. RV diastolic dysfunction B. RV systolic C. LV diastolic D. LV systolic |
64. Which abnormality is seen in pericardial tamponade?
A. RV diastolic dysfunction B. RV systolic C. LV diastolic D. LV systolic Answer: A – RV diastolic dysfunction |
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65. Enlargement of the left PA is seen in which condition?
A. Patent ductus arteriosus. B. Pulmonic stenosis. C. Other answers |
65. Enlargement of the left PA is seen in which condition?
A. Patent ductus arteriosus. B. Pulmonic stenosis. C. Other answers Answer: B – Pulmonic stenosis (due to post stenotic dilation from jet through valve) |
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66. Determination of the difference in pulmonary flow and systemic flow (Qp/Qs) is useful for which of the following:
A. ASD B. pulmonic stenosis |
66. Determination of the difference in pulmonary flow and systemic flow (Qp/Qs) is useful for which of the following:
A. ASD B. pulmonic stenosis Answer: ? (I think it’s A – ASD; Qp/Qs is used to assess intracardiac shunts, e.g. ASD, VSD, PDA) |
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67. Which of the following organisms would affect the terminal ileum?
A. Giardia B. Yersinia C. Campylobacter? |
67. Which of the following organisms would affect the terminal ileum?
A. Giardia B. Yersinia C. Campylobacter? Answer: B - Yersinia |
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68. 65 yr old male with abdominal pain and CT showing mural thickening in the transverse colon. Likely etiology?
A. C diff colitis. B. Ischemic colitis. |
68. 65 yr old male with abdominal pain and CT showing mural thickening in the transverse colon. Likely etiology?
A. C diff colitis. B. Ischemic colitis. ALT: Bowel wall thickening only involving the transverse colon in a middle-aged man is most likely due to: a. Ischemic colitis b. Pseudomembranous colitis c. 2 other choices Fractured recall. In 65 yo with not other history other than pain and CT showing anything localized to transverse colon, I would think Ischemic colitis since the distal end is in the watershed zone. Pseudomembranous is usually a pancolitis with colonic wall thickening and nodularity - accordion sign and abdominal ascites. |
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69. Which of the following malignancies is associated with H. pylori?
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69. Which of the following malignancies is associated with H. pylori?
A. MALT |
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70. Most common malignancy in an undescended testicle?
A. Embryonal cell B. Yolk sac tumor C. Seminoma |
70. Most common malignancy in an undescended testicle?
A. Embryonal cell B. Yolk sac tumor C. Seminoma Answer: C - Seminoma |
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71. Patient presents with gynecomastia. Testicular ultrasound shows a hypoechoic mass. Most likely?
A. Seminoma B. Embryonal Cell C. Leydig cell D. Sertoli cell |
71. Patient presents with gynecomastia. Testicular ultrasound shows a hypoechoic mass. Most likely?
A. Seminoma B. Embryonal Cell C. Leydig cell D. Sertoli cell Answer: C - Leydig cell tumor (especially if solid-appearing; Sertoli cell tumor more likely to be mixed solid/cystic) STATDX: • Testicular carcinoma • Gynecomastia occurs in up to 10% of patients with malignant testicular tumors • Functioning tumors only: Increase serum estrogens • Leydig cell or germ cell most commonly |
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72. 20 something male presents with acute onset of scrotal pain. Ultrasound reveals hydrocele but is otherwise unremarkable. Next step?
A. Repeat ultrasound in 6 months to determine if hydrocele is enlarging. B. Repeat ultrasound if the pain returns. C. Do nothing. D. Surgery. |
72. 20 something male presents with acute onset of scrotal pain. Ultrasound reveals hydrocele but is otherwise unremarkable. Next step?
A. Repeat ultrasound in 6 months to determine if hydrocele is enlarging. B. Repeat ultrasound if the pain returns. C. Do nothing. D. Surgery. Answer: D - Surgery (bell clapper deformity) |
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73. What is the likelihood that a pulmonary nodule < 5mm in size is malignant?
A. 1% B. 5% C. 20% D. 30% |
73. What is the likelihood that a pulmonary nodule < 5mm in size is malignant?
A. 1% B. 5% C. 20% D. 30% Answer: probably A – this article says less than 1% (http://radiology.rsna.org/content/237/2/395.full) |
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74. What is the frequency of pneumothorax with lung biopsy?
A. 5% B. 20% C. 50% D. 80 % |
74. What is the frequency of pneumothorax with lung biopsy?
A. 5% B. 20% C. 50% D. 80 % Answer: probably A? (I think it’s B – 20%; see this article http://www.ajronline.org/cgi/content/abstract/172/4/1049; a more recent AJR article from March 2010 says 42%) |
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75. What is the CT appearance of an intrapulmonary lymph node?
A. 10 mm ill-defined nodule adjacent to the hilum B. 5mm intraparenchymal ground glass opacity C. 8 mm triangular shaped nodule adjacent to the fissure |
75. What is the CT appearance of an intrapulmonary lymph node?
A. 10 mm ill-defined nodule adjacent to the hilum B. 5mm intraparenchymal ground glass opacity C. 8 mm triangular shaped nodule adjacent to the fissure Answer: C – 8 mm triangular shaped nodule adjacent to the fissure |
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76. In V/Q scanning, Tc DTPA is better than Xe133 for what reason?
A. Higher counts obtained B. Technically easier for the patient C. Better depiction of obstructive lung disease. Answer: ? |
B. Technically easier for the patient
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77. Vertebra plana is associated with which condition?
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77. Vertebra plana is associated with which condition?
A. Langerhans cell histiocytosis |
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78. LAM has a similar appearance to which of the following?
A. UIP B. Sarcoid C. LCH |
78. LAM has a similar appearance to which of the following?
A. UIP B. Sarcoid C. LCH Answer: C - LCH |
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79. Which of the following findings is associated with massive pulmonary fibrosis?
A. Sharp lateral margin. B. Spherical C. Lower lobes |
79. Which of the following findings is associated with massive pulmonary fibrosis?
A. Sharp lateral margin. B. Spherical C. Lower lobes Answer: A - Sharp lateral margin |
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80. What finding is associated with fibrous tumor of the pleura?
A. Calcifications. B. Pleural effusion. C. Rib erosion D. Pedunculated. |
80. What finding is associated with fibrous tumor of the pleura?
A. Calcifications. B. Pleural effusion. C. Rib erosion D. Pedunculated. Answer: D - Pedunculated |
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81. CT colonoscopy is performed in what position?
A. Supine and prone B. Supine and right lateral decubitus C. Supine and left lateral decubitus. D. Prone and right lateral decubitus. E. Prone and left lateral decubitus. F. Sitting up in the CT scanner (j/k) |
81. CT colonoscopy is performed in what position?
A. Supine and prone B. Supine and right lateral decubitus C. Supine and left lateral decubitus. D. Prone and right lateral decubitus. E. Prone and left lateral decubitus. F. Sitting up in the CT scanner (j/k) Answer: A – Supine and prone (to be able to differentiate stool vs. polyp) |
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82. What is seen with positive vascular remodeling of plaque?
A. Decreased visibility of the plaque. B. Increased vascular diameter. C. Decreased vascular diameter. |
82. What is seen with positive vascular remodeling of plaque?
A. Decreased visibility of the plaque. B. Increased vascular diameter. C. Decreased vascular diameter. Answer: B – Increased vascular diameter (see http://content.onlinejacc.org/cgi/content/full/42/5/811) |
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83. What is characteristic of bronchiolitis obliterans following lung transplantation?
A. Associated with EBV. B. Centrilobular nodules with tree-in-bud C. Post transplant FEV decreased by more than 20% |
83. What is characteristic of bronchiolitis obliterans following lung transplantation?
A. Associated with EBV. B. Centrilobular nodules with tree-in-bud C. Post transplant FEV decreased by more than 20% Answer: C – Post transplant FEV decreased by more than 20% |
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84. Patient with upper lobe lucency and a branching suprahilar mass.
A. Intralobar sequestration B. Pulmonary AVM C. Segmental bronchial atresia |
84. Patient with upper lobe lucency and a branching suprahilar mass.
A. Intralobar sequestration B. Pulmonary AVM C. Segmental bronchial atresia Answer: C – Segmental bronchial atresia |
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85. Neonate with hyperlucent lungs. Etiology?
A. Foreign body aspiration B. Viral bronchiolitis |
85. Neonate with hyperlucent lungs. Etiology?
A. Foreign body aspiration B. Viral bronchiolitis Answer: B – Viral bronchiolitis |
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86. An infant with symptomatic diffuse hemangioendothelioma. What is the best treatment?
A. Hepatic artery embolization. B. Particle embolization C. Chemoembolization D. Alcohol |
86. An infant with symptomatic diffuse hemangioendothelioma. What is the best treatment?
A. Hepatic artery embolization. B. Particle embolization C. Chemoembolization D. Alcohol Answer: maybe B (maybe D - there is an article which used either polyvinyl alcohol or gelfoam+coils, see http://www.springerlink.com/content/y87216n00877vhwu/; see also http://emedicine.medscape.com/article/177106-treatment) |
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86. An infant with symptomatic diffuse hemangioendothelioma. What is the best treatment?
A. Hepatic artery embolization. B. Particle embolization C. Chemoembolization D. Alcohol |
86. An infant with symptomatic diffuse hemangioendothelioma. What is the best treatment?
A. Hepatic artery embolization. B. Particle embolization C. Chemoembolization D. Alcohol Answer: maybe B (maybe D - there is an article which used either polyvinyl alcohol or gelfoam+coils, see http://www.springerlink.com/content/y87216n00877vhwu/; see also http://emedicine.medscape.com/article/177106-treatment) This is a rare bird. According to radiographics you could make an argument for A or C. Treatment is determined on the basis of the tumor size and the severity of symptoms (congestive heart failure, arteriovenous shunting, coagulopathy). Intervention is necessary only if the lesion is symptomatic and cannot be managed conservatively while the expected involution occurs. Surgical resection is indicated if life-threatening symptoms are present or if the mass cannot be distinguished from a malignant tumor radiologically (3). Medical therapy includes steroid and interferon therapy to accelerate the natural involution of the mass and radiation therapy or chemotherapy, as well as supportive care for congestive heart failure and coagulopathy (3,5,6,10). Hepatic artery embolization to reduce tumor vascularity and arteriovenous shunting may be performed prior to surgical intervention in patients who fail to respond to conventional medical treatment. |
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87. Which of the following is least likely to result in permanent vascular occlusion?
A. coils B. gelfoam C. alcohol D. polyvinyl spheres E. gel spheres |
87. Which of the following is least likely to result in permanent vascular occlusion?
A. coils B. gelfoam C. alcohol D. polyvinyl spheres E. gel spheres Answer: B - gelfoam |
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88. Which provides the best spatial resolution in imaging a child’s hips?
A. SPECT B. Pinhole collimator? |
88. Which provides the best spatial resolution in imaging a child’s hips?
A. SPECT B. Pinhole collimator? Answer: B - Pinhole collimator. SPECT increases contrast but not spatial resolution. Spatial resolution function on intrinsic resolution of the collimator. SPECT uses the same collimator as planar imaging while pinhole collimator is a different collimator. |
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89. What results in loosening following hip replacement?
A. Cement B. Metal components C. Polyethylene |
89. What results in loosening following hip replacement?
A. Cement B. Metal components C. Polyethylene Answer: C - Polyethylene |
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90. Which is the best method for evaluating infected hip prosthesis?
A. bone scan and sulfur colloid B. sulfur colloid and In 111 WBC’s C. 3 phase bone scan and In 111 WBC’s |
90. Which is the best method for evaluating infected hip prosthesis?
A. bone scan and sulfur colloid B. sulfur colloid and In 111 WBC’s C. 3 phase bone scan and In 111 WBC’s Answer: C – 3 phase bone scan and In 111 WBC’s |
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91. Which type of RBC labeling achieves the best tag?
A. in vivo B. modified in vivo C. in vitro D. modified in vitro |
91. Which type of RBC labeling achieves the best tag?
A. in vivo B. modified in vivo C. in vitro D. modified in vitro Answer: D – modified in vitro |
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92. What is required in a diuretic renography study to determine functional stasis from obstruction?
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92. What is required in a diuretic renography study to determine functional stasis from obstruction?
A. Preserved renal function |
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93. Percutaneous biliary drainage is not indicated for which of the following?
A. Pruritus B. Bile leak C. Stone removal D. Cholecystitis |
93. Percutaneous biliary drainage is not indicated for which of the following?
A. Pruritus B. Bile leak C. Stone removal D. Cholecystitis Answer: D (answer should be A- pruritis; this can be caused by other entities besides obstructive jaundice; see this article http://emedicine.medscape.com/article/1828091-overview) |
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94. Pt with pancreatic cancer presents with recurrence post Whipple resulting in intra and extra hepatic ductal dilatation. What is the appropriate intervention?
A. Endoscopy with stent placement. B. Percutaneous drainage |
94. Pt with pancreatic cancer presents with recurrence post Whipple resulting in intra and extra hepatic ductal dilatation. What is the appropriate intervention?
A. Endoscopy with stent placement. B. Percutaneous drainage Answer: B - percutaneous drainage (answer should be A – endoscopy with stent placement) |
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95. 45 y.o. presents with progressive dysphagia, food regurgitation, halitosis and recurrent pneumonias. Etiology?
A. Epiphrenic diverticulum B. Achalasia |
95. 45 y.o. presents with progressive dysphagia, food regurgitation, halitosis and recurrent pneumonias. Etiology?
A. Epiphrenic diverticulum B. Achalasia Answer: B - Achalasia |
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96. Which of the following is least specific for aortic trauma?
A. Mediastinal hematoma B. Periaortic hematoma C. Active contrast extravasation |
96. Which of the following is least specific for aortic trauma?
A. Mediastinal hematoma B. Periaortic hematoma C. Active contrast extravasation Answer: A – Mediastinal hematoma |
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97. What is the most appropriate initial step for massive upper GI bleeding?
A. CT B. Angiography C. Endoscopy |
97. What is the most appropriate initial step for massive upper GI bleeding?
A. CT B. Angiography C. Endoscopy Answer: C – Endoscopy |
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98. Fetal ultrasound reveals in utero oligohydramnios and renal cysts?
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98. Fetal ultrasound reveals in utero oligohydramnios and renal cysts?
A. MCDK |
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99. Fetal ultrasound reveals tiny echogenic foci over the liver. Etiology?
A. Mets B. Meconium peritonitis |
99. Fetal ultrasound reveals tiny echogenic foci over the liver. Etiology?
A. Mets B. Meconium peritonitis Answer: B – Meconium peritonitis |
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100. Which of the following sonographic findings would be consistent with FNH?
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. Incidental demonstration of hypoechoic lesion with central echogenicity.
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101. A lesion on the liver which is isointense to spleen on both T1 and T2?
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101. A lesion on the liver which is isointense to spleen on both T1 and T2?
A. Hemangioma B. Mets C. Adenoma D. FNH Answer: Mets |
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102. Neonate with multiple renal masses?
A. Mesoblastic nephroma B. Nephroblastomatosis |
102. Neonate with multiple renal masses?
A. Mesoblastic nephroma B. Nephroblastomatosis Answer: B – Nephroblastomatosis: Terminology • Multiple or diffuse nephrogenic rests in kidneys • Precursor to Wilms tumor • Most spontaneously regress • Some syndromes have higher incidence Imaging Findings • Best diagnostic clue: Homogeneous multifocal ovoid or subcapsular rind-like renal masses • Best imaging tool: MR (T1 C+) or CECT Clinical Issues • Currently, no specific treatment protocol advocated • Children with syndromes at risk for Wilms tumor typically screened regularly for development of nephroblastomatosis/Wilms tumor Diagnostic Checklist • Nephroblastomatosis appears homogeneous on all imaging modalities (US, CECT, MR) • Wilms tumor tends to be heterogeneous |
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103. Adult female with post void dribbling, UTI and incontinence?
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103. Adult female with post void dribbling, UTI and incontinence?
A. Urethral diverticulum: Terminology • Localized outpouching of urethra Imaging Findings • Best diagnostic clue: Multiseptated cystic lesion adjacent or surrounding urethra • Location: Most commonly occurs in mid-urethra and on posterolateral wall rather than on anterior wall • MR is superior to other imaging modalities in demonstrating urethral diverticulum because of its multiplanar capabilities and excellent soft tissue contrast • MR allows direct visualization of diverticulum and evaluation of anatomic relationship to urethra or adjacent structures • MR is very useful in diagnosing inflammation and tumor of diverticulum Pathology • Congenital urethral diverticula are rare • Most are acquired resulting from inflammation of periurethral glands and ducts leading to local glandular dilatation and subsequent rupture into urethra • Other etiologies include urethral injury during childbirth, surgery or catheterization Clinical Issues • The classical presentation of post-void dribbling, urethral pain, tender periurethral mass and/or expression of pus from the urethra on physical examination is uncommon • Gender: More common in women than in men |
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104. What is the most specific indication of sternal dehiscence?
A. Lucent line in the sternum B. Rotation of a wire C. Lateral displacement of wire D. Fractured wire |
104. What is the most specific indication of sternal dehiscence?
A. Lucent line in the sternum B. Rotation of a wire C. Lateral displacement of wire D. Fractured wire Answer: C – Lateral displacement of wire |
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105. What modality of choice for imaging a foreign body in the foot?
A. CT B. MRI C. US D. Radiography |
105. What modality of choice for imaging a foreign body in the foot?
A. CT B. MRI C. US D. Radiography Answer: C - US |
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106. What structure anchors the lung to the mediastinum?
A. Inferior pulmonary ligament B. Phrenic nerve C. Inferior pulmonary vein. |
106. What structure anchors the lung to the mediastinum?
A. Inferior pulmonary ligament B. Phrenic nerve C. Inferior pulmonary vein. Answer: C – Inferior pulmonary vein |
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107. Which of the following nodes are not accessible by mediastinoscopy?
A. Right paratracheal B. Left paratracheal C. Subcarinal D. AP window |
107. Which of the following nodes are not accessible by mediastinoscopy?
A. Right paratracheal B. Left paratracheal C. Subcarinal D. AP window Answer: D - AP window |
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108. Patient with lung cancer has an enlarged supraclavicular node. What is the cancer stage?
A. IIA B. IIB C. IIIB D. IV |
108. Patient with lung cancer has an enlarged supraclavicular node. What is the cancer stage?
A. IIA B. IIB C. IIIB D. IV Answer: C – IIIB (supraclavicular node = N3 = stage IIIB) |
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109. T2 rectal cancer involves which layer?
A. Submucosa B. Muscularis propria C. Muscularis mucosa D. Serosa |
109. T2 rectal cancer involves which layer?
A. Submucosa B. Muscularis propria C. Muscularis mucosa D. Serosa Answer: B – Muscularis propria (stage T2 extends to musclaris propria) |
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110. How does DCIS present mammographically?
A. Spiculated mass B. Microcalcifications |
110. How does DCIS present mammographically?
A. Spiculated mass B. Microcalcifications Answer: B - Microcalcifications |
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111. Patient with a suspicious finding on mammogram. Post biopsy results are LCIS. What type of result is the mammogram?
A. False negative B. False positive C. True positive D. True negative |
111. Patient with a suspicious finding on mammogram. Post biopsy results are LCIS. What type of result is the mammogram?
A. False negative B. False positive C. True positive D. True negative Answer: B - False positive (mammo called cancer, but no cancer was present). |
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112. Biopsy returns atypical ductal hyperplasia. Next step?
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112. Biopsy returns atypical ductal hyperplasia. Next step?
A. Excisional biopsy |
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113. Neonatal ultrasound shows a lymphatic malformation of the head and neck. Association?
A. Down’s B. Turner’s |
113. Neonatal ultrasound shows a lymphatic malformation of the head and neck. Association?
A. Down’s B. Turner’s Answer: B – Turner’s (cystic hygroma) |
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114. What is the most common ankle ligament injured?
A. Anterior talofibular. B. Posterior talofibular. C. Anterior tibiofibular. D. Posterior tibiofibular. |
114. What is the most common ankle ligament injured?
A. Anterior talofibular. B. Posterior talofibular. C. Anterior tibiofibular. D. Posterior tibiofibular. Answer: A – Anterior talofibular |
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115. Which of the following findings best indicates the potential for instability for an osteochondral defect?
A. osteonecrosis of the fracture fragment B. intactness/thickness of the overlying articular cartilage C. depth of fracture line |
115. Which of the following findings best indicates the potential for instability for an osteochondral defect?
A. osteonecrosis of the fracture fragment B. intactness/thickness of the overlying articular cartilage C. depth of fracture line Answer: ? (neither of the above answers. Stability must be assessed via MR. MR findings of instability include: pockets of fluid around undetached and undisplaced osteochondral fragment, displaced osteochondral fragment. See this article: http://en.wikibooks.org/wiki/Diagnostic_Radiology/Musculoskeletal_Imaging/Trauma/Osteochondritis_dissecans) Staging, Grading, or Classification Criteria • International Cartilage Repair Society: Classifies OCD at surgery o Stage I: Stable lesion in continuity with host bone, covered by intact cartilage o Stage II: Partial discontinuity, stable on probing o Stage III: Complete discontinuity of the "dead in situ" lesion, but fragment not dislocated o Stage IV: Dislocated fragment |
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116. Pt with symptoms of hemoptysis and a positive c-ANCA?
A. Wegener’s B. Goodpasture’s |
116. Pt with symptoms of hemoptysis and a positive c-ANCA?
A. Wegener’s B. Goodpasture’s Answer: A – Wegener’s |
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117. During a transgluteal approach for pelvic abscess which of the following approaches is best?
A. through lesser sciatic foramen B. through sacrotuberous ligament C. through sacrospinous ligament D. through piriform E. adjacent ischial spine |
117. During a transgluteal approach for pelvic abscess which of the following approaches is best?
A. through lesser sciatic foramen B. through sacrotuberous ligament C. through sacrospinous ligament D. through piriform E. adjacent ischial spine Answer: C Whenever possible, the catheter route should pass inferiorly in the foramen, through the sacrospinous ligament or below it, because the incidence of pelvic and leg pain increases as the catheter is placed more superiorly, through the piriformis muscle and near the sacral plexus [1–3]. |
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118. Which of the following is the best indicator of chronic vs acute venous thrombosis?
A. Compressibility B. Echogenicity of the clot C. Enlarged vein |
118. Which of the following is the best indicator of chronic vs acute venous thrombosis?
A. Compressibility B. Echogenicity of the clot C. Enlarged vein Answer: probably C – Enlarged vein Imaging Findings • Acute thrombosis (~ 14 days) o Low echogenicity or nearly anechoic thrombus; flow may be seen within recanalized thrombus o Venous distension: Recently thrombosed veins distended; substantially larger than adjacent artery o Loss of compressibility: Thrombus excluded if vein can be completely compressed o Free floating thrombus: Most recently formed clot may not adhere to vein wall o Collateralization: Tortuous collateral veins, usually smaller than normal vein |
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119. A patient presents with ischemic stroke. What is the window for TPA administration?
A. 1 hour B. 3 hours C. 6 hours D. 8 hours |
119. A patient presents with ischemic stroke. What is the window for TPA administration?
A. 1 hour B. 3 hours C. 6 hours D. 8 hours Answer: C - 6 hours (now its B – 3 hours) |
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120. Thrombolytics are contraindicated for all the following except:
A. Infected venous thrombus B. Stroke in prior 3 months C. Major surgery in prior 3 months D. Active bleeding E. Hypercoagulable state. |
120. Thrombolytics are contraindicated for all the following except:
A. Infected venous thrombus B. Stroke in prior 3 months C. Major surgery in prior 3 months D. Active bleeding E. Hypercoagulable state. Answer: E – Hypercoagulable state |
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121. Patient with right lower quadrant pain and signs of appendicitis. US shows 10 wk live IUP. Next step?
A. CT without contrast B. CT with contrast C. MRI without gad D. MRI with gad |
121. Patient with right lower quadrant pain and signs of appendicitis. US shows 10 wk live IUP. Next step?
A. CT without contrast B. CT with contrast C. MRI without gad D. MRI with gad Answer: C - MRI without gad |
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122.Which of the following is true regarding the yolk sac?
A. intrauterine fluid collection and a yolk sac is a sign of pregnancy B. located in the amniotic sac C. large yolk sac is a good prognostic sign in pregnancy |
122.Which of the following is true regarding the yolk sac?
A. intrauterine fluid collection and a yolk sac is a sign of pregnancy B. located in the amniotic sac C. large yolk sac is a good prognostic sign in pregnancy Answer: B – Located in the amniotic sac |
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123. Which of the following is associated with elevated AFP?
A. Down’s B. Molar pregnancy C. Twins |
123. Which of the following is associated with elevated AFP?
A. Down’s B. Molar pregnancy C. Twins Answer: C – Twins (Down’s has low AFP, neural tube defects also have elevated AFP but that isn’t one of the choices given) |
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124. Study shows mitral valve calcifications, left atrial enlargement, and a normal LV.
A. Mitral regurgitation B. Mitral stenosis |
124. Study shows mitral valve calcifications, left atrial enlargement, and a normal LV.
A. Mitral regurgitation B. Mitral stenosis Answer: B - Mitral stenosis |
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125. Which of the following results in increased EF?
A. Aortic insufficiency B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis |
A. Aortic insufficiency
B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis Answer: A - Aortic insufficiency |
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126. Which is associated with coarctation of the aorta?
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126. Which is associated with coarctation of the aorta?
A. bicuspid aortic valve. |
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127. What causes increased flow in the ICA?
A. Distal occlusion. B. Aortic stenosis C. Occlusion of the contralateral ICA |
127. What causes increased flow in the ICA?
A. Distal occlusion. B. Aortic stenosis C. Occlusion of the contralateral ICA Answer: C – Occlusion of the contralateral ICA (multiple prior recalls) |
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128. Periostitis is associated with which of the following conditions?
A. Lupus B. Juvenile arthritis C. Jaccoud D. Osteoarthritis |
128. Periostitis is associated with which of the following conditions?
A. Lupus B. Juvenile arthritis C. Jaccoud D. Osteoarthritis Answer: ? (answer should be B - Juvenile Rheumatoid Arthritis; see this cool website http://cueflash.com/Decks/MSK_radiology%3A_DDx_and_disease_properties/) |
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129. Which of the following is more commonly seen in secondary hyperparathyroidism than primary hyperparathyroidism? (or it could have been the other way around)
A. chondrocalcinosis B. brown tumor C. subperiosteal resorption D. vascular calcifications |
129. Which of the following is more commonly seen in secondary hyperparathyroidism than primary hyperparathyroidism?
A. chondrocalcinosis B. brown tumor C. subperiosteal resorption D. vascular calcifications Answer: Probably subperiosteal bone resorption which is not as often seen in secondary Secondary: Terminology • Bony changes due to chronic, end-stage renal disease • Secondary hyperparathyroidism (HPT), osteomalacia, bone sclerosis, aluminum toxicity contribute to findings Imaging Findings • Osteosclerosis and/or osteopenia • Rugger jersey spine • Changes of hyperparathyroidism • Changes of osteomalacia/rickets Top Differential Diagnoses • Primary hyperparathyroidism • Osteomalacia and rickets • Dialysis arthropathy • Osteopetrosis • Paget disease • Discogenic sclerosis Primary: Terminology • Increased levels of hyperparathyroid hormone Imaging Findings • Osteopenia • Cortical thinning • Subperiosteal bone resorption • Sacroiliac joint erosions • Rare: Brown tumor (osteoclastoma) • Soft tissue calcifications Top Differential Diagnoses • Multiple myeloma • Renal osteodystrophy • Senile osteoporosis • Seronegative spondyloarthropathy |
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130. What is seen with pyrophosphate arthropathy?
A. Joint space narrowing B. Juxtaarticular erosions C. Soft tissue calcifications |
130. What is seen with pyrophosphate arthropathy?
A. Joint space narrowing B. Juxtaarticular erosions C. Soft tissue calcifications Answer: ? STATDX on pyrophosphate arthropathy Radiographic Findings • Chondrocalcinosis (usually, not invariably, present) o Need not be present radiographically for arthropathy to develop o May line hyaline cartilage In knee, particularly along femoral condyles In wrist, particularly at lunate-triquetral articulation o May be easiest to see in fibrocartilage Triangular shape in menisci Triangular or amorphous shape in TFCC (triangular fibrocartilage complex) o Less frequently seen in synovium & joint capsule • Arthropathy appearance o Arthropathy is generally productive "Hook-like" or "drooping" osteophytes are distinctive at metacarpal heads o Early arthropathy may be mixed or even purely erosive (1/8 will show an erosion) o Rare pseudoneuropathic appearance, with fragmentation & severe destruction • Arthropathy location: Quite specific o Hand & wrist: Radiocarpal & MCP (2nd & 3rd > others) o Knee: Patellofemoral compartment significantly more affected than medial or lateral • Cartilage narrowing • Normal bone density maintained • Sclerosis, loose bodies later in disease • Subchondral cysts: Common o Well-delineated, with sclerotic margin o May be large, simulating neoplasm • Malalignment o Radial deviation MCPs is common o SLAC (scapholunate advanced collapse) is common Separation of scaphoid and lunate, with capitate migrating proximally, forcing itself between them Scaphoid erodes into distal radial articular surface |
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131. Ischemia in the inferolateral wall would be related to which artery?
A. LAD B. Circumflex C. Ramus intermedius D. RCA Answer: B - Circumflex |
131. Ischemia in the inferolateral wall would be related to which artery?
A. LAD B. Circumflex C. Ramus intermedius D. RCA Answer: B - Circumflex |
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132. Which is a branch of the circumflex?
A. Obtuse marginal B. Acute marginal C. Ramus intermedius D. Septal perforators |
132. Which is a branch of the circumflex?
A. Obtuse marginal B. Acute marginal C. Ramus intermedius D. Septal perforators Answer: A – Obtuse marginal |
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133. How long following contrast administration is cardiac MRI performed?
A. 5 minutes B. 10 minutes C. 30 minutes D. 50 minutes |
133. How long following contrast administration is cardiac MRI performed?
A. 5 minutes B. 10 minutes C. 30 minutes D. 50 minutes Answer: B - 10 min |
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134. FDG PET of the heart is used for evaluation of?
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134. FDG PET of the heart is used for evaluation of?
A. Hibernating myocardium |
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135. Decreased perfusion with normal viability indicates what?
A. Hibernating myocardium B. Scar C. Stunning |
135. Decreased perfusion with normal viability indicates what?
A. Hibernating myocardium B. Scar C. Stunning Answer: A – Hibernating myocardium |
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136. TIPS is contraindicated for which of the following?
A. splenic vein thrombosis B. Budd Chiari C. refractory ascites |
136. TIPS is contraindicated for which of the following?
A. splenic vein thrombosis B. Budd Chiari C. refractory ascites Answer: A – Splenic vein thrombosis Absolute contraindications include the following: • Right-sided heart failure with increased central venous pressure • Polycystic liver disease • Severe hepatic failure Relative contraindications include the following: • Active intrahepatic or systemic infection (bacteria can colonize the stent, causing persistent infection) • Severe hepatic encephalopathy poorly controlled with medical therapy • Hypervascular hepatic tumors • PV thrombosis (Although PV thrombus may make the procedure more technically demanding, it is not an absolute contraindication to TIPS placement.) |
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137. Mass at the gastric fundus with pancreatic calcifications is most likely due to what?
A. Gastric carcinoma B. Mets C. Varices |
137. Mass at the gastric fundus with pancreatic calcifications is most likely due to what?
A. Gastric carcinoma B. Mets C. Varices Answer: C - Varices |
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138. From which artery does an accessory right hepatic artery arise?
A. celiac B. SMA C. Common hepatic D. Left hepatic |
138. From which artery does an accessory right hepatic artery arise?
A. celiac B. SMA C. Common hepatic D. Left hepatic Answer: B - SMA (Michel’s class 6) |
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139. The left gastroepiploic arises from which artery?
A. SMA B. Left gastric C. Gastroduodenal D. Splenic |
139. The left gastroepiploic arises from which artery?
A. SMA B. Left gastric C. Gastroduodenal D. Splenic Answer: D - Splenic |
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140. On CTA of aortic graft, there is contrast accumulation around the origin of the IMA. Which type of endoleak?
A. I B. II C. III D. IV |
Answer: B - Type II
Type I endoleak: blood flow into the aneurysm sac due to incomplete seal or ineffective seal at the end of the graft. This type of endoleak usually occurs in the early course of treatment, but may also occur later. Type II endoleak: blood flow into the aneurysm sac due to opposing blood flow from collateral vessels. In some circumstance when there are two or more patent vessels a situation of inflow and outflow develops creating an actively blood flow within channel created within the aneurysm sac. Type III endoleak: blood flow into the aneurysm sac due to inadequate or ineffective sealing of overlapping graft joints or rupture of the graft fabric. Again, this endoleak usually occur early after treatment, due to technical problems, or later due to device breakdown. Type IV endoleak: blood flow into the aneurysm sac due to the porosity of the graft fabric, causing blood to pass through from the graft and into the aneurysm sac. |
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141. Gastrin secretion causes what?
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A. Acid secretion
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142. During HIDA, what does CCK administration cause?
A. Relaxes sphincter of Oddi B. Contracts sphinter of Oddi |
142. During HIDA, what does CCK administration cause?
A. Relaxes sphincter of Oddi B. Contracts sphinter of Oddi Answer: A – Relaxes sphincter of Oddi |
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143. What is a Brescia-Cimino fistula?
A. Brachial artery to cephalic vein B. Brachial artery to basilic vein C. Brachial artery to axillary vein D. Radial artery to cephalic vein E. Radial artery to basilic vein |
143. What is a Brescia-Cimino fistula?
A. Brachial artery to cephalic vein B. Brachial artery to basilic vein C. Brachial artery to axillary vein D. Radial artery to cephalic vein E. Radial artery to basilic vein Answer: D - Radial artery to cephalic vein |
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144. Which drug is given to increase sensitivity in a Meckel’s scan?
a. Morphine b. Insulin c. Glucagon d. Cimetidine e. Other choice |
144. Which drug is given to increase sensitivity in a Meckel’s scan?
a. Morphine b. Insulin c. Glucagon d. Cimetidine e. Other choice Answer: d |
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145. What is the most common presentation of Meckel’s in an adult?
A. Anemia B. Intussusception |
45. What is the most common presentation of Meckel’s in an adult?
A. Anemia B. Intussusception Answer: Fractured recall. Adults present with diverticulitis or obstruction Terminology • An ileal outpouching, due to persistence of the congenital omphalomesenteric or vitelline duct Imaging Findings • True diverticulum (contains all layers of bowel wall) • Seen in 2% of population (approximately) • Located within 2 feet of ileocecal valve • Length of 2 inches (on average) • Symptomatic usually before age 2 • Two main complications in adults: Diverticulitis (20%); intestinal obstruction (40%) • CT for symptomatic (pain, tenderness) adults • Tc99m scintigraphy in bleeding cases (children) Top Differential Diagnoses • Appendicitis • Crohn disease • Mesenteric adenitis • Cecal diverticulitis Pathology • Composed of all layers of GI tract (true diverticulum) • Ectopic gastric or pancreatic mucosa may be seen Clinical Issues • Children: Present with GI bleeding before age 2 • Adults: Present with diverticulitis or obstruction Diagnostic Checklist • Enteroclysis: Blind-ended sac on antimesenteric border of ileum with a broad base or a narrow neck • Meckel diverticulitis: CT shows mural thickening, perimesenteric fat infiltration & fluid ± enteroliths |
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146. How long after an error in nuclear medicine must it be reported to NRC?
A. 1 day B. 2 days C. 7 days D. 10 days |
146. How long after an error in nuclear medicine must it be reported to NRC?
A. 1 day B. 2 days C. 7 days D. 10 days Answer: A - 1 day |
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147. Goals of a quality assurance program include all the following except:
A. Coming up with a plan B. Implementing the plan C. Evaluating the plan D. Identifying individual’s mistakes. |
147. Goals of a quality assurance program include all the following except:
A. Coming up with a plan B. Implementing the plan C. Evaluating the plan D. Identifying individual’s mistakes. Answer: D – Identifying individual’s mistakes |
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148. Regarding pseudodiverticulosis of the ureter:
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148. Regarding pseudodiverticulosis of the ureter:
A. Associated with malignancy |
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149. TB is associated with all the following except:
A. Papillary necrosis B. Renal calcifications C. Bladder calcifications D. Ureteral strictures E. Urethral strictures |
149. TB is associated with all the following except:
A. Papillary necrosis B. Renal calcifications C. Bladder calcifications D. Ureteral strictures E. Urethral strictures Answer: E – Urethral strictures |
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150. On cardiac CT, there is a dumbbell shaped mass of -40 HU in the interatrial septum. Next step?
A. surgery B. ablation C. do nothing |
150. On cardiac CT, there is a dumbbell shaped mass of -40 HU in the interatrial septum. Next step?
A. surgery B. ablation C. do nothing Answer: C – Do nothing. (lipomatous hypertrophy of the interatrial septum) |
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151. What is true regarding lateral chest xray?
A. RUL bronchus is more often seen than the LUL bronchus B. The pulmonary veins are inferior to both the right and left mainstem bronchi C. The anterior aspect of the bronchus intermedius is not normally seen D. The left pulmonary artery is under the left lobe bronchus |
151. What is true regarding lateral chest xray?
A. RUL bronchus is more often seen than the LUL bronchus B. The pulmonary veins are inferior to both the right and left mainstem bronchi C. The anterior aspect of the bronchus intermedius is not normally seen D. The left pulmonary artery is under the left lobe bronchus Answer: B – The pulmonary veins are inferior to both the right and left mainstem bronchi (mult old recalls) |
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152. In an AML with little or no fat, what would be the most prominent MRI characteristics?
A. High T1 signal B. High T2 signal C. Brisk enhancement |
152. In an AML with little or no fat, what would be the most prominent MRI characteristics?
A. High T1 signal B. High T2 signal C. Brisk enhancement Answer: C? Enhancement is variable and dependent on the amount of fat vs vascular components. |
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153. What does chronic muscle atrophy look like on MRI?
A. High T1 signal, no abnormality on STIR images B. High T1 and High STIR C. High T2 and low T1 |
153. What does chronic muscle atrophy look like on MRI?
A. High T1 signal, no abnormality on STIR images B. High T1 and High STIR C. High T2 and low T1 Answer: A – High T1 signal, no abnormality on STIR images |
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154. MRI of the uterus shows irregular thickening and low signal in the junctional zone with punctuate areas of high T2 signal.
A. focal adenomyosis B. endometrial cancer C. submucosal fibroid |
154. MRI of the uterus shows irregular thickening and low signal in the junctional zone with punctuate areas of high T2 signal.
A. focal adenomyosis B. endometrial cancer C. submucosal fibroid Answer: A – Focal adenomyosis |
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155. Where do ovarian mets occur?
A. Para-ovarian lymph nodes. B. Pelvic organs. C. Peritoneum |
155. Where do ovarian mets occur?
A. Para-ovarian lymph nodes. B. Pelvic organs. C. Peritoneum Answer: C - Peritoneum |
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156. Which of the following would present as a pelvic mass with edge shadowing?
A. Leiomyoma B. Krukenberg tumor C. Ovari strumi D. Dermoid |
156. Which of the following would present as a pelvic mass with edge shadowing?
A. Leiomyoma B. Krukenberg tumor C. Ovari strumi D. Dermoid Answer: D tip of the iceberg |
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157. Which of the following US features of a breast mass are concerning for malignancy?
A. Posterior enhancement B. Pseudocapsule C. Irregular borders |
157. Which of the following US features of a breast mass are concerning for malignancy?
A. Posterior enhancement B. Pseudocapsule C. Irregular borders Answer: C – Irregular borders |
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158. What is the abnormality with clubfoot?
A. Increased calcaneal pitch B. Hindfoot varus C. Hindfoot valgus |
158. What is the abnormality with clubfoot?
A. Increased calcaneal pitch B. Hindfoot varus C. Hindfoot valgus Answer: B – Hindfoot varus |
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159. What is a complication of Roux-en-Y gastric bypass?
A. transmesenteric hernia B. transmesocolon hernia C. paraduodenal hernia |
159. What is a complication of Roux-en-Y gastric bypass?
A. transmesenteric hernia B. transmesocolic hernia C. paraduodenal hernia Answer: B figure 1. Schematic of the Roux-en-Y GBP procedure. A small gastric pouch (GP) is created and anastomosed to a Roux-en-Y limb, which has been passed in a retrocolic retrogastric fashion through a surgical defect (straight arrow) in the transverse mesocolon. The Roux-en-Y limb is anastomosed side to side (curved arrow) with more distal small bowel. |
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160. Which of the following are not associated with ulcerative colitis?
A. Iritis B. Pyoderma gangrenosum C. Sclerosing cholangitis D. Osteomas |
160. Which of the following are not associated with ulcerative colitis?
A. Iritis B. Pyoderma gangrenosum C. Sclerosing cholangitis D. Osteomas Answer: D - Osteomas |
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161. What is associated with scaphoid fracture?
A. Lunate dislocation B. Peri-lunate dislocation |
161. What is associated with scaphoid fracture?
A. Lunate dislocation B. Peri-lunate dislocation Answer: B – Peri-lunate dislocation |
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162. Small kidneys on ultrasound in a neonate:
A. Medullary cystic kidney disease B. Medullary sponge kidney |
162. Small kidneys on ultrasound in a neonate:
A. Medullary cystic kidney disease B. Medullary sponge kidney Answer: A – Medullary cystic kidney disease |
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163. Imaging of an infant shows hyperinflation, bronchial wall thickening and interstitial markings. Etiology?
A. Chlamydia B. Parainfluenza C. Other organisms |
163. Imaging of an infant shows hyperinflation, bronchial wall thickening and interstitial markings. Etiology?
A. Chlamydia B. Parainfluenza C. Other organisms Answer: B - Parainfluenza |
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164. In111 is better than gallium in which of the following?
A. Discitis B. Inflammatory bowel disease |
164. In111 is better than gallium in which of the following?
A. Discitis B. Inflammatory bowel disease Answer: B – Inflammatory bowel disease |
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165. Most common mediastinal tumor in a 12 year old.
A. Lymphoma B. Neuroblastoma |
165. Most common mediastinal tumor in a 12 year old.
A. Lymphoma B. Neuroblastoma Answer: A - Lymphoma |
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166. The umbilical cord contains:
A. 2 veins and 1 artery B 1 vein and 1 artery C. 2 arteries and 1 vein |
166. The umbilical cord contains:
A. 2 veins and 1 artery B 1 vein and 1 artery C. 2 arteries and 1 vein Answer: C – 2 arteries and 1 vein |
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167. Regarding MRI of prostate cancer:
A. Detection is easy B. Hyperintense on T2 C. Disruption of the capsule indicates extraglandular extension. |
167. Regarding MRI of prostate cancer:
A. Detection is easy B. Hyperintense on T2 C. Disruption of the capsule indicates extraglandular extension. Answer: probably C |
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168. Reversal of diastolic flow in a segmental artery of a renal graft in the
immediate posttransplant period is most likely related to: A. Renal artery stenosis/thrombosis B. Renal vein thrombosis C. Acute rejection D. ATN E. Normal finding |
168. Reversal of diastolic flow in a segmental artery of a renal graft in the
immediate posttransplant period is most likely related to: A. Renal artery stenosis/thrombosis B. Renal vein thrombosis C. Acute rejection D. ATN E. Normal finding Answer: B – Renal vein thrombosis |
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169. Renal stone formation in Crohn’s disease is related to:
A. increased pH of the urine. B. increased resorption of oxalate |
169. Renal stone formation in Crohn’s disease is related to:
A. increased pH of the urine. B. increased resorption of oxalate Answer: B – Increased resorption of oxalate |
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170. What reduces accuracy of cardiac CT?
A. SBP > 200 B. HR > 90 C. Calcium scoring > 400 |
???
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171. Phase contrast MRI using Modified Bernoulli equation allows you to assess:
A. pressure gradient B. stroke volume C. cardiac output D. blood flow |
171. Phase contrast MRI using Modified Bernoulli equation allows you to assess:
A. pressure gradient B. stroke volume C. cardiac output D. blood flow Answer: A - Pressure gradient |
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172. Which does not present with a shrunken, small bladder?
A. Diabetic neurogenic bladder. B. Detrussor dyssynergia C. Cyclophosphamide D. Radiation cystitis. |
172. Which does not present with a shrunken, small bladder?
A. Diabetic neurogenic bladder. B. Detrussor dyssynergia C. Cyclophosphamide D. Radiation cystitis. Answer: A – Diabetic neurogenic bladder |
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174. Next appropriate step in patient with bilateral pubic rami fractures?
A. Cystogram B. Cystoscopy C. Retrograde urethrogram |
174. Next appropriate step in patient with bilateral pubic rami fractures?
A. Cystogram B. Cystoscopy C. Retrograde urethrogram Answer: C – Retrograde urethrogram |
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175. What is the mechanism for pulmonary compromise in fat embolism?
A. Abnormal capillary permeability B. Vascular compromise C. Increased hydrostatic pressure |
175. What is the mechanism for pulmonary compromise in fat embolism?
A. Abnormal capillary permeability B. Vascular compromise C. Increased hydrostatic pressure Answer: A |
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176. Long segment necrosis of the small bowel. What is the cause?
A. morphine B. cocaine C. other drugs |
176. Long segment necrosis of the small bowel. What is the cause?
A. morphine B. cocaine C. other drugs Answer: B - Cocaine |
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177. Which is associated with the shortest mortality? (worst prognosis)
A. COP B. DIP C. UIP |
177. Which is associated with the shortest mortality? (worst prognosis)
A. COP B. DIP C. UIP Answer: C - UIP |
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178. What is true regarding the ureters in crossed fused ectopia?
A. The lower ureter inserts ectopically B. The upper ureter inserts ectopically C. Both ureters insert ectopically D. Both ureters insert normally |
178. What is true regarding the ureters in crossed fused ectopia?
A. The lower ureter inserts ectopically B. The upper ureter inserts ectopically C. Both ureters insert ectopically D. Both ureters insert normally Answer: D – Both ureters insert normally |
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179. Patient has prostate CA with a Gleason score of 3T/3 and PSA of 4.3. Bone scan shows focal hot spot at L4. Etiology?
A. Prostate met B. Degenerative spondylosis |
179. Patient has prostate CA with a Gleason score of 3T/3 and PSA of 4.3. Bone scan shows focal hot spot at L4. Etiology?
A. Prostate met B. Degenerative spondylosis Answer: A – Degenerative spondylosis |
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180. Where do you ablate for SVT?
A. sinus node B. pulmonary vein ostia C. bundle of His D. AV node |
180. Where do you ablate for SVT?
A. sinus node B. pulmonary vein ostia C. bundle of His D. AV node Answer: B – Pulmonary vein ostia |
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181. Child with fever (and other symptoms). CT shows 4cm fluid collection next to the appendix. Next step?
A. Percutaneous drainage B. Surgery C. Trial of oral antibiotics D. Trial of IV antibiotics. |
181. Child with fever (and other symptoms). CT shows 4cm fluid collection next to the appendix. Next step?
A. Percutaneous drainage B. Surgery C. Trial of oral antibiotics D. Trial of IV antibiotics. Answer: A |
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182. Most common etiology of epidural abscess?
A. Sinusitis B. Dental disease C. Brain surgery |
182. Most common etiology of epidural abscess?
A. Sinusitis B. Dental disease C. Brain surgery Answer: A Causes Because the intracranial epidural space is only a potential space and the dura is essentially adherent to the inner table of the skull, infection in the epidural space can result from the following: Sinusitis (mastoid, ethmoid, sphenoid, and frontal sinusitis); trauma associated with skull fracture; and following craniotomy, orbital cellulitis, cranial osteomyelitis, sagittal sinus phlebitis, fetal monitoring, and mucormycosis. |
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183. Which of the following is most likely associated with a vertebral fracture? (Don’t think Ankylosing Spondylitis was a choice)
A. DISH B. spondylosis deformans C. scoliosis |
183. Which of the following is most likely associated with a vertebral fracture? (Don’t think Ankylosing Spondylitis was a choice)
A. DISH B. spondylosis deformans C. scoliosis Answer: ? |
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184. 1 day old has a mass between the rectum and bladder on US?
A. teratoma B. hydrometrocolpos C. other answers |
184. 1 day old has a mass between the rectum and bladder on US?
A. teratoma B. hydrometrocolpos C. other answers Answer: B - Hydrometrocolpos |
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185. Which of the following mimics cirrhosis?
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185. Which of the following mimics cirrhosis?
A. treated breast cancer mets (“pseudocirrhosis”: desmoplastic breast cancer can mimic cirrhosis) |
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186. Rim sign on HIDA scan indicates what?
A. Hyperemia B. A good prognostic indicator C. Activity in the gall bladder wall |
186. Rim sign on HIDA scan indicates what?
A. Hyperemia B. A good prognostic indicator C. Activity in the gall bladder wall Answer: A - Hyperemia in the liver due to inflammation from adjacent cholecystitis |
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187. Most likely cause of biloma after lap chole?
A. Leak at the ligated cystic duct. B. Other answers |
187. Most likely cause of biloma after lap chole?
A. Leak at the ligated cystic duct. B. Other answers Answer: A? |
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188. Regarding AVM’s of the right colon, what is true?
A. See early draining vein in 4-6 seconds. B. Can see on angiography. C. Occur in older patients D. More arteries on the anti-mesenteric side. ALT: All of the following are true regarding angiodysplasia EXCEPT? a. Often seen with right sided bleed b. Commonly seen to bleed/extravasate at angiography c. Presents in the elderly d. Occurs on the anti-mesenteric wall of the colon e. Prominent draining vein usually present on angiography within 4-6 seconds |
188. Regarding AVM’s of the right colon, what is true?
A. See early draining vein in 4-6 seconds. B. Can see on angiography. C. Occur in older patients D. More arteries on the anti-mesenteric side. Answer: ? ALT: All of the following are true regarding angiodysplasia EXCEPT? a. Often seen with right sided bleed (Y) b. Commonly seen to bleed/extravasate at angiography (F) c. Presents in the elderly (y) d. Occurs on the anti-mesenteric wall of the colon (Y) e. Prominent draining vein usually present on angiography within 4-6 seconds (Y) Fractured recall. However, if one of the choices is commonly seen to bleed during angiography (probably on any question really) then this is likely to be the false (or the answer in this case) |
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189. What is the earliest sign of NEC?
A. portal venous gas. B. thumbprinting C. free air D. bowel distention |
9. What is the earliest sign of NEC?
A. portal venous gas. B. thumbprinting C. free air D. bowel distention Answer: D – Bowel distention |
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190. Cause of cerebral abscess in 30 year old female?
A. Pulmonary AVM Also recalled as: Patient presents with hypoxia, something else and cerebral abscess. Most likely cause a. Hereditary Hemorrhagic telangiectasia b. CCAM |
190. Cause of cerebral abscess in 30 year old female?
A. Pulmonary AVM Also recalled as: Patient presents with hypoxia, something else and cerebral abscess. Most likely cause a. Hereditary Hemorrhagic telangiectasia b. CCAM Straight out of STATDX: HHT: • Pulmonary AVMs (30%) • Dyspnea, cyanosis, fatigue, polycythemia • Majority of patients with pAVM do not present with respiratory symptoms • PAVMs may hemorrhage • Neurological sequelae (cerebral emboli/abscess) due to paradoxical embolism • 36% are multiple and 50% bilateral |
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191. How to treat post pericardiotomy symptoms
A. oral antiinflammatory B. pericardial stripping C. pericardiocentesis D. antibiotics |
191. How to treat post pericardiotomy symptoms
A. oral antiinflammatory B. pericardial stripping C. pericardiocentesis D. antibiotics Answer: A – Oral antiinflammatory |
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192. 30 y.o. female with “snapping hip”. Which tendon would be abnormal on US?
A. iliopsoas B. biceps femoris C. Sartorius D. adductor longus |
192. 30 y.o. female with “snapping hip”. Which tendon would be abnormal on US?
A. iliopsoas B. biceps femoris C. Sartorius D. adductor longus Answer: A - Iliopsoas (dancer’s hip) |
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193. What is the most common location of elastofibroma?
A. sole of foot B. palm C. anterior thigh D. posterior chest wall |
193. What is the most common location of elastofibroma?
A. sole of foot B. palm C. anterior thigh D. posterior chest wall Answer: D - Posterior chest wall Terminology • Benign fibroblastic proliferations • Fibromatosis (desmoid tumors) Imaging Findings • Best diagnostic clue: Solitary or multiple soft tissue masses • Classification based on pathology, histology, clinical presentation, natural history, and patient age at presentation • Soft tissue mass that may be hypodense, isodense or hyperdense relative to muscle • Poorly defined margins • May enhance after injection of IV contrast material • Extra-abdominal desmoids are often hypervascular Top Differential Diagnoses • Soft Tissue Sarcomas • Primitive Neuroectodermal Tumor (Askin Tumor) • Inflammatory and Infectious Processes Pathology • 18-20% of patients with Gardner syndrome develop desmoid tumor Clinical Issues • Wide surgical resection is the treatment of choice Diagnostic Checklist • Clinical presentation, natural history, and patient age at presentation • Usually solitary soft tissue lesions |
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194. Mammography has increased breast cancer survival by what percentage?
A. 10% B. 30% C. 50% |
94. Mammography has increased breast cancer survival by what percentage?
A. 10% B. 30% C. 50% Answer: B - 30% |
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195. Where does pars flaccida cholesteatoma occur?
A. Facial nerve recess B. Oval window C. Prussak’s space |
195. Where does pars flaccida cholesteatoma occur?
A. Facial nerve recess B. Oval window C. Prussak’s space Answer: C – Prussak’s space |
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196. What is not associated with pulmonary artery hypertension?
A. Mitral stenosis B. Eisenemenger’s C. Schistosomiasis D. Pulmonary AVM |
196. What is not associated with pulmonary artery hypertension?
A. Mitral stenosis B. Eisenemenger’s C. Schistosomiasis D. Pulmonary AVM Answer: D – Pulmonary AVM Also recalled as: What is NOT associated with pulmonary HTN: a. Mitral Stenosis b. Schistosomiasis c. Ebsteins d. Pulmonary AVM In either case I would still go with pulmonary AVM. |
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97. What causes acoustic shadowing in the caudate lobe on ultrasound?
A. IVC B. Ligamentum venosum C. focal fatty liver infiltration |
197. What causes acoustic shadowing in the caudate lobe on ultrasound?
A. IVC B. Ligamentum venosum C. focal fatty liver infiltration Answer: B – Ligamentum venosum |
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198. Fibromuscular dysplasia of the renal arteries is best treated how?
A. Stent B. Angioplasty and stent C. Angioplasty |
198. Fibromuscular dysplasia of the renal arteries is best treated how?
A. Stent B. Angioplasty and stent C. Angioplasty Answer: C - Angioplasty |
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199. What is true regarding MUGA and chemotherapy treatment?
A. Contraindicated if EF < 55% B. Doxirubicin effect is reversible C. See cardiac toxicity on MUGA before development of CHF. |
199. What is true regarding MUGA and chemotherapy treatment?
A. Contraindicated if EF < 55% B. Doxirubicin effect is reversible C. See cardiac toxicity on MUGA before development of CHF. Answer: C – See cardiac toxicity on MUGA before development of CHF |
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200. Median nerve is at risk of injury when trying to approach which vessel?
A. Basilic vein B. Brachial vein C. Cephalic vein D. Subclavian vein |
200. Median nerve is at risk of injury when trying to approach which vessel?
A. Basilic vein B. Brachial vein C. Cephalic vein D. Subclavian vein Answer: B – Brachial vein |
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201. Which structure is most echogenic on neonatal brain US?
A. cerebrum B. thalami C. vermis |
201. Which structure is most echogenic on neonatal brain US?
A. cerebrum B. thalami C. vermis Answer: C - Vermis |
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202. Pt with left vocal cord paralysis. Image to what level?
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202. Pt with left vocal cord paralysis. Image to what level?
A. To level of AP window |
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203. Huntington disease associated with abnormality in what structure?
A. Caudate B. other choices |
203. Huntington disease associated with abnormality in what structure?
A. Caudate B. other choices Answer: A - Caudate |
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204. Cowper’s glands are located where?
A. Membranous urethra B. Prostatic urethra C. Bulbar urethra D. Penile urethra |
204. Cowper’s glands are located where?
A. Membranous urethra B. Prostatic urethra C. Bulbar urethra D. Penile urethra Answer: A – Membranous urethra |
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205. If 512 x 512 matrix takes 12 min to acquire, how long does it take to acquire 256 x 256?
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205. If 512 x 512 matrix takes 12 min to acquire, how long does it take to acquire 256 x 256?
A. 6 min |
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206. Which polyp has the highest malignant potential?
A. tubular B. tubulovillous C. villous |
206. Which polyp has the highest malignant potential?
A. tubular B. tubulovillous C. villous Answer: C - Villous |
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207. Placenta percreta is associated with what risk factors?
A. Mulitparity B. Previous C-section |
207. Placenta percreta is associated with what risk factors?
A. Mulitparity B. Previous C-section Answer: B – Previous C-section |
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208. Concerning BIRADS 3 what is true?
A. Simple cyst falls in this category B. Associated with 5% risk of malignancy C. Need to followup every 6 months for 4 years D. Diagnosed without previous mammograms for comparison |
208. Concerning BIRADS 3 what is true?
A. Simple cyst falls in this category B. Associated with 5% risk of malignancy C. Need to followup every 6 months for 4 years D. Diagnosed without previous mammograms for comparison Answer: D – Diagnosed without previous mammograms for comparison |
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209. What is true regarding I131 tx of thyroid cancer?
A. doses >200mCi in patients with pulmonary mets may result in pulmonary fibrosis. B. All doses < 200 mCi may be administered as outpatient C. other answers. |
209. What is true regarding I131 tx of thyroid cancer?
A. doses >200mCi in patients with pulmonary mets may result in pulmonary fibrosis. B. All doses < 200 mCi may be administered as outpatient C. other answers. Answer: A – doses > 200 mCi in patients with pulmonary mets may result in pulmonary fibrosis |
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210. What is characteristic of Whipple’s disease
A. Low attenuation lymph nodes B. Other choices |
210. What is characteristic of Whipple’s disease
A. Low attenuation lymph nodes B. Other choices Answer: A – Low attenuation lymph nodes |
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211. Alzheimers is associated with decreased radiopharmaceutical uptake in what
A. Parietal lobes B. Frontal lobes C. Other choices |
211. Alzheimers is associated with decreased radiopharmaceutical uptake in what
A. Parietal lobes B. Frontal lobes C. Other choices Answer: A – Parietal lobes |
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212. Which of the following are seen with intracapsular rupture on MRI
A. Curvilinear low signal thin bands surrounded by high signal intensity B. Thin bands which are contiguous with and extending from the implant edge C. Other choices describing extracapsular rupture |
212. Which of the following are seen with intracapsular rupture on MRI
A. Curvilinear low signal thin bands surrounded by high signal intensity B. Thin bands which are contiguous with and extending from the implant edge C. Other choices describing extracapsular rupture Answer: A – Curvilinear low signal thin bands surrounded by high signal intensity Intracapsular Rupture • Usually appears intact on mammography • US: Findings of rupture can be quite subtle o Folds of intact implant can → complex echotexture, difficult to distinguish from collapsing shell • MR: Motion artifacts can mimic o Complex radial folds extend to implant surface, more hypointense than collapsing shell as folds represent double layer of shell Extracapsular Silicone • Herniation (bulge) of gel through focally weakened capsule, implant intact o Mammographically can resemble extracapsular rupture • Extracapsular rupture o Silicone extruded through both implant shell and fibrous capsule • Residual silicone from prior implant rupture • Direct injections of silicone oil • Extremely rare: Gel bleed alone, without rupture |
