Written 2000 Answers

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

Answers- a

Notes-

Analgesic abuse is a risk factor for transitional cell carcinoma

Analgesic nephropathy reveals bilateral medullary calcinosis and small scarred kidneys

 

2. A post menopausal woman has a 3.5 cm cyst in the ovary with very fine thin septation. Which of the following is the next most appropriate step?

 

a. Surgery

b. 3 month follow up

c. Immediate CT scan

 

 

Answers- b

If less than 5cm, contains no septations or mural nodules, and is not associated with ascites, chances of malignancy low

Note that these criteria are for abdominal scanning, question probably stated if this was transvaginal or not

Transvaginal scanning may show fine internal echoes or thin septations that are not seen with abdominal scanning

However, Dahnert p838 states that a cyst >3cm or a septated cyst warrants CA-125 levels + surgical exploration

 

 

 

3. A postmenopausal woman has bleeding and 4 mm endometrial stripe. Which of the following is the most likely cause of the bleeding?

 

a. Endometrial polyp

b. Endometrial hyperplasia

c. Endometrial atrophy

d. Endometrial cancer

 

 

Answers- c

Normal endometrial stripe in postmenopausal woman is 4-8mm

If less than 5mm, probably due to endometrial atrophy

If greater than 8mm, biopsy is needed to exclude polyp, hyperplasia, or carcinoma

 

 

 

4. At what size is an ovarian follicle most likely to rupture?

 

a. 20mm

b. 15mm

c. 10mm

d. 25mm

 

Answers- d

 

 

 

 

 

 

 

5. Concerning obstructing ureterolithiasis. Which is true?

 

a. obliteration of the angle between bladder and the seminal vesicle

b. tissue rim sign

c. comet tail sign

d. perinephric hemorrhage

 

Answers- b

Ureteric rim sign = ureter edema around an impacted stone, seen in 77% of cases on CT

 

 

 

 

 

 

6. Congenital lower urinary tract obstruction in a child is at what level:

 

a. Membranous urethra

b. Prostatic urethra

c. Trigone of the bladder

 

Answers- b

Dahnert says they occur in the prostatic and membranous portions of the posterior urethra

Also say they most commonly originate from the caudal aspect of the veromontanum, in the prostatic portion

This most common type is Type I

Type II extend superiorly from the veromontanum to the neck of the bladder

 

 

 

 

7. Cystitis glandularis is associated with?

 

a. Lymphogranuloma Venereum

b. Pelvic Lipomatosis

c. Retroperitoneal Fibrosis

 

Answers- b

Cystitis Glandularis is a premalignant condition of the bladder that is associated with pelvic lipomatosis

 

 

 

 

 

 

 

8. On contrast enhanced CT there is a mass in the kidney with a 60 HU. What should be the next step:

 

a. Biopsy

b. Nephrectomy

c. Non contrast CT

 

Answers- c

Consensus -- Could this be hemorrhage, fungus ball, etc...

 

 

 

 

 

 

 

9. Patient with cancer. Contrast CT shows an incidental adrenal mass having 30 HU. Which should be the next step?

 

a. Biopsy

b. Surgery to remove the mass

c. MRI

d. Delayed scanning to further evaluate it

 

Answers- d

10 minutes after bolus washout to less than 50% with adenoma- this is more sensitive than MRI

 

 

 

 

 

 

10. Patient with pelvic fracture has supra pubic mass with blood at the urethral meatus. What is the next appropriate step?

 

a. IVP

b. Catheterization of bladder

c. Retrograde urethrogram

d. CT scan

 

Answers- c

 

 

 

 

 

 

 

11. Regarding acquired renal cystic disease:

 

a. cyst are found in the renal medulla

b. increase in proportion to the duration of dialysis

c. cysts tend to be large

 

Answers- a, b

Cysts are small early (5mm), grow up to 3cm late in dialysis

Cysts are scattered throughout the renal parenchyma

7% of patients with acquired renal cysts will develop a renal cell carcinoma

 

 

 

 

 

12. Regarding adenomyosis of the uterus which is true?

 

a. Ectopic endometrial tissue in the adnexa

b. Appears hypointense on MRI

 

Answers- b

Not as hypointense as a leiomyoma on T2

Small hyperintense foci often seen representing hemorrhage or island of endometrial tissue

 

 

 

 

 

 

 

13. Regarding urethral diverticulum in females, which is true?

 

a. They are most often congenital

b. They are located off the posterior wall of the urethra

c. They are treated by marsupialization of the diverticulum

d. Associated with long term catheterization

e. They present with stress incontinence

 

Answers- b, d

The female urethra is 2.5-4cm in length, ovoid or tubular, containing Skenes glands and periurethral glands. Diverticula are usually acquired after infection followed by obstruction of Skenes glands. If nonobstructed, 75% will be seen on post void IVP film, 90% on VCUG, the remainder require double-balloon catheter positive pressure urethography. Calculi in 5-10%. Most common tumor is adenocarcinoma.  Male patients who are catheterized for an extended time may develop a diverticulum as a result of pressure necrosis. ??females

 

 

 

14. There is a mass in the kidney, which displaces the bifid collecting system and enhances as much as the surrounding renal tissue. Diagnosis:

 

a. TCC

b. Normal renal tissue

c. RCC

 

Answers- b

Normal parenchyma invaginates and separates the duplicated pelvis

 

 

 

 

 

 

 

15. There were two questions on Conns disease. Which is false?

 

a. more likely to be due to adenoma than carcinoma of the adrenal gland

b. hypokalemia

c. hypernatremia

d. are associated with increased renin levels

e. easily distinguishable histologically from cortisol secreting tumors

 

Answers- d

Conn syndrome = Primary Hyperaldosteronism

Usually due to adenoma, then bilateral adrenal hyperplasia, adrenocortical carcinoma in less than 1%

Aldosterone leads to hypernatremia (and thus hypertension) and hypokalemia

Suppresses renin levels

 

 

 

16. What is a reliable distinguishing feature of AIDS nephropathy from other renal disease?

 

a. hypoechoic cortex

b. contour of the kidney

c. Doppler wave form

d. Cortical hyperechogenicity with increase or normal size

 

Answers- d

States that US is best screening exam, shows bilateral cortical hyperechogenicity with global renal enlargement

 

 

 

 

 

 

17. What is the cause of scarring in reflux nephropathy?

 

a. pylosinous backflow

b. pylovenous backflow

c. pylolymphatic backflow

d. pylotubular backflow

 

Answers- d

Most common cause of a small scarred kidney!

 

 

 

 

 

 

18. Which of the following can cause a striated nephrogram?

 

a. Renal infarction

b. Renal vein thrombosis

c. Renal vascular hypertension

d. Acute bacterial nephritis

e. Obstruction by Tamm-Horsfall protein

 

Answers- b, d, e

A striated nephrogram consists of fine linear bands of alternating lucency and density parallel to the axis of the tubules and collecting ducts from:

systemic hypotension

obstruction by Tamm-Horsfall protein

acute bacterial nephritis / pyelonephritis

renal contusion

medullary sponge kidney

medullary cystic disease

infantile polycystic kidney disease

renal vein thrombosis

acute extrarenal obstruction.

CHOIR BOY = Contusion, Hypotension, Obstruction, Intratubular obstruction, Renal vein thrombosis, Bacterial nephritis, Obstruction, Yes also cystic diseases

 

 

 

 

19. Which one of the following is least likely to be ischemic?

 

a. hepatic flexure

b. rectum

c. splenic flexure

d. cecum

e. sigmoid

 

Answers- b

Any portion of the colon and rectum can be affected, but the splenic flexure, descending colon, and sigmoid colon are the areas most commonly involved. Rectum usually spared.

 

 

 

 

 

20. A 15mm polyp is found in a colon of an elderly gentleman, what are the chances of malignancy?

 

a. 1%

b. 50%

c. 35%

d. 10-20%

 

Answers- d

15mm = 15% rule

 

 

 

 

 

 

21. A 60-year-old female has a mass in the head of pancreas with central stellate scar and calcification. Review of CT scan done 5 years back had the same mass which has not changed. Diagnosis:

 

a. Islet cell carcinoma

b. Adenocarcinoma

c. Macrocystic adenoma

d. Microcystic adenoma

 

Answers- d

 

 

 

 

 

 

22. A female has diarrhea with albumin is 4.5g/dl. GI studies shows dilation of bowel, with transient intussusception, fragmentation and segmentation of barium. Diagnosis?

 

a. Crohns disease

b. Whipples disease

c. Sprue

d. Mastocytosis

 

Answers- c

segmentation and breakup of normal continual column of barium is seen in Sprue, due to hypersecretion

Common intussusception in both Sprue and Whipples

segmentation, fragmentation, and hypersecretion is less pronounced, but seen with hypoproteinemia in Whipples

Whipples 8 times more common in males

Sprue more common in females 30-40 years old, more common in males in other age groups

Fragmentation, segmentation, and dilatation more pronounced in Sprue

Normal albumin is 3.2-4.5 g/dl -- They originally put 4.5mg/dl in the question... probably remembered wrong

Female + Pronounced Findings + Normal Albumin suggests Sprue over Whipples.

 

 

 

 

 

 

23. A patient has a non-obstructing, excavating mass in the terminal ileum. Diagnosis:

 

a. Carcinoid

b. Lymphoma

c. Adenocarcinoma

 

Answers- b

Lymphoma is the most common malignant small bowel tumor, and 50% involve the ileum, there is ulceration with considerable excavation.  Desmoplastic response is common looks like Crohns disease with barium studies, usually involves 5cm or more of bowel

Carcinoid is most common in appendix, second most common in small bowel, 33% of cases in small bowel, 90% of small bowel carcinoids in ileum.  Small smooth submucosal mass impinging on the lumen eccentrically.  Spiculated and tethering of the mucosal folds

Adenocarcinoma is more common in the duodenum, least common in the ileum.  Has a sessile mass with annular stricture

 

 

 

24. An elderly man presents with severe abdominal pain, bleeding per rectum and plain film shows thickening of the folds of the transverse colon. The likely diagnosis:

 

a. granulomatous colitis

b. pseudomembranous colitis

c. ulcerative colitis

d. ischemic colitis

 

Answers- ?b, ?d

Age + symptoms extremely suspicious for ischemic colitis, as others rarely have bleeding per rectum although this is usually left sided

However, ischemic colitis usually in left colon or sigmoid

Crohns disease of the colon = granulomatous colitis, usually on the right, onset 15-30 years of age

Pseudomembranous colitis in the rectum 95% of cases, confined to right and transverse colon 5-27%, can have fecal blood

Ulcerative colitis should have abnormal left colon... no skip lesions...

Also, plain film usually normal in ischemic colitis, whereas pseudomembranous reveals thumbprinting particularly in the transverse colon

 

 

 

 

25. An immunocompromised patient develops multiple spleen hypodense lesions. Which is the most likely diagnosis?

 

a. disseminated PCP infection

b. fungal microabscesses

c. infarcts

 

Answers- b

Fungus abscesses comprise 25% of splenic abscesses, predisposed in immunocompromised host

PCP also causes multiple hypo attenuating splenic lesions, uncertain which is most common....

PCP lesions subsequently calcify

If calcifications are present, answer is PCP

 

 

 

 

26. Barretts esophagus:

 

a. is in response to irritation of the squamous epithelium

b. can revert to normal after therapy

c. causes an increased incidental of squamous cell carcinoma of the esophagus

d. metaplasia of the squamous epithelium

 

Answers- a, b, d

 

 

 

 

27. In a patient with AIDS which organism is not found in small bowel?

 

a. Candida albicans

b. MAI infection

c. Cryptosporidium

 

Answers- a

Cryptosporidium is one of the most common causes of enteric disease in AIDS patients

MAI is the most common opportunistic infection of bacterial origin in AIDS patients, frequently jejunum

Candidiasis is usually in the oral cavity and esophagus

 

 

 

 

28. Mallory Weiss tear: Which vessel is the bleeding most likely coming from?

 

a. Inferior phrenic artery

b. Gastric artery

c. Left gastric artery

 

Answers- c

None of these... Bleeding is from venous plexus!

If an artery, likely Left Gastric artery?

 

 

 

 

29. Regarding adenomyosis of the gallbladder:

 

a. associated with Rokitansky/Aschoff sinuses

b. rarely associated with the comet tail sign

c. one of the hypercholesteroloses

d. tends to be focal

e. premalignant

 

Answers- a, c, d

Adenomyosis of Gallbladder:

- exaggeration of normal infolding of luminal epithelium (Rokitansky- Aschoff sinuses)

- associated with proliferation of smooth muscle

- causes marked thickening of GB wall

- can involve entire GB, more commonly segmental (fundus)

- can be confused with cholecystitis or gall bladder carcinoma

- cystic spaces - ring down (comet tail) artifact on ultrasound - projects from nondependent surface of GB wall

- spaces fill on oral cholecystogram

Carcinoma of the gallbladder has been reported anecdotally in adenomyosis but risk of neoplasm is usually not sufficient to indicate prophylactic surgery.

Hyperplastic cholecystoses are benign non neoplastic noninflammatory gallbladder abnormalities which include adenomyomatosis, cholesterolosis, cholesterol polyps.

 

 

 

 

30. Regarding Crohns disease?

 

a. jejunum frequently involved

b. asymmetric mural involvement

c. colon and small bowel involved equally

 

Answers- a, b

Transmural involvement, asymmetric?

jejunum is frequently involved

small bowel in 80%, colon in 55%

 

 

 

 

 

31. Regarding hepatic cirrhosis:

 

a. hepatic venous wedge injections demonstrate increased opacification of the portal vein

b. hepatofugal flow demonstrated on ultrasound helps to guide treatment

c. the intrahepatic portion of the IVC typically demonstrates decreased pressures

d. the angiographic findings of corkscrew vessels and railroad track calcifications can be used to stage cirrhosis

 

Answers- a ,b, d

Angiographic features in cirrhosis & Panhepatic arteriographic staging of cirrhosis and portal HTN

Hepatofugal flow demonstrated on ultrasound helps to guide treatment. The intrahepatic portion of the IVC typically demonstrates decreased pressures. Hepatic venous wedge injections demonstrate increased opacification of the portal vein. US chief role in management of cirrhosis is dx of portal HTN. Doppler identifies flow direction.

Stage II cirrhosis on angio is characterized by corkscrew appearance of hepatic artery branches. Portal flow is bidirectional. Stage III has wide spread corkscrewing of arteries and increased arterial flow.

Stage II, wedged hepatic venography, Stage IIA show opacification of portal vein for 2-4 seconds but eventual drainage into hepatic vein. With Stage IIB, opacification of the main or segmental portal vein for more than 4 seconds. Normal; liver shows drainage into hepatic vein. Wedge hepatic venography gives sinusoidal pressure. Portal HTN: hepatic wedge pressure>10mm Hg.

Collateral pathways lead to the IVC. increased pressure.

 

 

 

 

 

32. Regarding islet cell tumor of the pancreas, which is true?

 

a. Majority of insulinomas are malignant

b. Most nonfunctioning islet cell tumor are not metastatic at the time of presentation

c. Association with von Hippel Lindau disease

 

Answers- c

Insulinoma most common islet cell tumor, followed by gastrinoma and non-functioning tumors

Malignant insulinomas comprise 5-10% of insulinomas

80-100% of nonfunctioning tumors have malignant transformation with regional and hepatic mets

Von Hippel-Lindau is associated with islet cell tumors of the pancreas!

 

 

 

 

33. Regarding leiomyosarcoma of the stomach which is true?

 

a. Treated with radiation and chemotherapy

b. With increasing size there is more cystic area and necrosis

 

Answers- b

Surgery is only treatment option

 

 

 

 

 

 

 

 

34. Serum gastrin is increased in:

 

a. Gastric polyps

b. Retained gastric antrum

c. Zollinger-Ellison syndrome

d. Menetriers disease

e. Atrophic gastritis

 

Answers- b, c, ?d

 

 

 

 

35. The following agents can result in cathartic colon:

a. castor oil

b. mineral oil

c. podophyllum

d. senna

e. cascara

 

Answers- a, c, d, e

Prolonged use of stimulant-irritant cathartics (> 15 years) results in neuromuscular incoordination from clinically increased muscular activity and tonus. This is exclusively a radiographic diagnosis. Involvement is often proximal to distal, with the first changes in the cecum and iliocecal valve. The former often appears conical, while the latter is flattened and gaping. There is general loss of haustration which may extend to the distal colon: Additional agents which might cause it: phenophthalein, aloin

 

 

 

 

 

36. The middle hepatic vein divides the:

 

a. the right and left lobe of liver

b. the left and right segment of the left lobe of liver

c. the anterior and posterior segment of the right lobe of liver

 

Answers- a

 

 

 

37. There are multiple liver lesion in a patient. Some of which are pure water attenuation. Some have high attenuation foci, which shows contrast enhancement. What is the diagnosis?

 

a. Von Meyenburgs complex

b. multiple hepatic abscesses

c. Polycystic disease

d. Carolis disease

 

Answers- a

Von Meyenburg complex = Multiple Bile Duct hamartomas

Usually associated with polycystic liver disease

Relatively common, in up to 2.8% of autopsies

Usually small, 0.1 - 10mm

 

 

 

38. What is the most appropriate initial study in a patient with massive hematemesis and hypotension?

 

a. Upper GI examination

b. Tc-99m RBC study

c. Angiography

d. Endoscopy

 

Answers- d

Diagnostic and therapeutic (banding). Endoscopy is successful in localizing the hemorrhagic site in 80% to 90% of patients with upper GI bleeding.

 

 

 

39. Where would you not see peritoneal mets on the colon?

 

a. Medial surface of the cecum

b. Anterior surface of the rectum

c. Lateral surface of the ascending colon

d. Superior surface of the transverse colon

e. Superior surface of the sigmoid colon

 

Answers- c

Ascending colon is retroperitoneal... consensus

 

 

 

 

 

40. Which is true about Barrets esophagus?

 

a. Associated with GE reflux

b. Can be evaluated easily with double contrast barium swallow

c. Under endoscopy, area of columnar metaplasia cannot be seen

 

Answers- a

 

 

 

41. Which is true about viral esophagitis?

 

a. More common than candidial esophagitis

b. Seen in immunocompromised patients

 

Answers- b

Candida esophagitis is the most common cause of infectious esophagitis

 

 

 

 

 

42. Which of the following are true regarding ulcerative colitis?

 

a. the ileum is involved in 10%

b. the colonic mucosa is hypovascular

c. the rectum is involved in 25%

 

Answers- a

The rectosigmoid is involved in 95%. The mucosa is hyperemic and bleeds easily. The ileum is involved in 10-25% (backwash ileitis).

 

 

 

43. Which of the following best helps to differentiate typhlitis from other causes of colonic inflammatory disease?

 

a. Acholic stool

b. Immunosuppressed patient

c. Positive PPD

d. clostridium difficile in the stool

 

Answers- b

Typhlitis is a necrotizing process of multifactorial origin that predominantly involves the right colon, although it may extend to other areas of the intestine. It is most commonly found in children with leukemia, but may also occur in adults with hematologic malignancy or, less commonly, aplastic anemia or lymphoma. Multiple factors such as intestinal ischemia, neoplastic infiltrate, mucosal hemorrhage, and colonic ulceration may contribute to the pathogenesis. Pathologically, typhlitis is characterized by bowel wall thickening, mucosal ulceration, intramural hemorrhage, and necrosis. Secondary colonization of mucosal ulcers by colonic flora commonly leads to septicemia and pyrexia. The clinical symptoms of typhlitis typically begin 1 to 2 weeks following the initial course of chemotherapy and consist of a variable complex of fever, nausea, vomiting, and abdominal pain. Plain abdominal radiographs show progressive dilatation of an atonic cecum and right colon, accompanied by prominent haustrations and a thickened bowel wall.

 

 

 

 

44. Which of the following disease is most malignant?

 

a. Cronkite Canada syndrome

b. Juvenile polyposis

c. Peutz Jeghers syndrome

d. Gardners syndrome

 

Answers- d

100% malignant transformation of Gardners

Death in Gardners at an average age of 41

Risk of cancer in Peutz Jeghers approaches 40% by age 40

Cronkhite-Canada tends to remit in males

Juvenile Polyposis 15% acquire colorectal cancer by age 35

 

 

 

45. Which of the following esophageal strictures is associated with the lowest rate of success with balloon dilatation?

 

a. lye stricture

b. tracheoesophageal fistula repair

c. chronic granulomatous infection

d. epidermolysis bullosa

e. Nissen fundoplication

 

Answers- e

Success of initial intubation depends on location, lesions distal to esophagus are more difficult to intubate and get balloon for dilatation to. Proximal esophageal strictures tend to be more difficult to dilate than distal strictures. Once successful intubation and dilatation have been achieved, location does not have a major effect on long term outcome. Malignant strictures are less likely to respond than benign. Patients with anastomotic strictures are reportedly more difficult to intubate.

 

 

 

46. Which of the following is a cause of benign ulcer on the greater curvature of the stomach?

 

a. Aspirin

b. Alcohol

c. H pylori

d. Potassium tablets

 

Answers- a

Aspirin/NSAIDS are distal stomach/greater curvature...

 

 

 

 

 

47. Which of the following is H. pylori gastritis not associated with?

 

a. Gastric ulcer

b. Adenocarcinoma

c. ZE syndrome

d. Lymphoma

 

Answers- c

 

 

 

 

48. Which of the following is least likely to be associated with hypervascular liver metastases?

 

a. Islet cell tumor

b. Bronchogenic CA

c. Thyroid CA

d. Melanoma

e. Carcinoid

 

Answers- b

Hypervascular liver metastasis: RCC, Carcinoid, colon, choriocarcinoma, breast, melanoma, pancreatic islet cell tumor, ovarian cystadenocarcinoma, sarcomas, and pheochromocytoma.

 

 

 

 

 

49. Which of the following spares the rectum?

 

a. Diverticulitis

b. Lipoma

c. Colitis cystica profunda

 

Answers- a

 

 

 

 

 

50. With regard to laryngeal papillomatosis, the most common associated neoplasm in the lungs is:

 

a. adenocarcinoma

b. lymphoma

c. small cell

d. squamous cell

e. carcinoid

 

Answers- d

Notes-

 

 

 

 

 

 

51. 50 yo female with fever, increased WBCs, and bilateral pulmonary opacities. Serum analysis is positive for antinuclear cytoplasmic antigen (c-ANCA). What is the most likely etiology?

a. Eosinophilic pneumonia

b. Legionella pneumonia

c. Wegeners

d. Goodpastures disease

e. Rheumatoid necrobiotic nodules

 

Answers- c

Rheumatoid Arthritis pulmonary necrobiotic rheumatoid nodules are rare manifestations of rheumatoid disease, they are among the more common pulmonary manifestation. Radiographically, rheumatoid nodules are usually discrete, round, and possibly lobulated pulmonary masses, which may be tiny to several centimeters in diameter. Usually multiple, although solitary nodules have been reported. May cavitate.

The classic form of Wegeners granulomatosis is a systemic necrotizing granulomatous process with destructive angiitis, involving the upper respiratory tract and the lung and accompanied by necrotizing glomerulonephritis of the kidneys. A limited form of the disease has been defined in which the kidneys, and often the upper respiratory tract, are spared. Women are affected more often than are men. Variable involvement of many other organs has been documented, including the heart, pericardium, and eyes, and the disease may be accompanied by arthritis. The destructive process of the upper respiratory tract is similar to that in lethal midline granuloma complex, which has multiple causes. The immune mechanism that may be involved is most unclear; cell-mediated immunity is suggested by the granulomatous pulmonary disease, but immune complexes could be involved and the renal disease is strikingly similar to that in Goodpastures syndrome, which produces a type II process in the lung. The principal chest roentgenogram manifestations are identical for the two forms and reflect the type IV immune mechanism. In early and mild cases, interstitial or reticular nodular infiltrates may be present, especially at the bases. These progress to the more frequently seen manifestations of multiple masses and nodules of varying sizes and with frequent cavitation. The masses predominate in the lower lung fields, are sharply demarcated, and have smooth walls. Although pleural effusions are seen in 20% to 25% of cases, lymph node enlargement is exceedingly rare. Originally described as a variant of Wegeners granulomatosis, lymphomatoid granulomatosis is clearly different from the other angiitis granulomatosis disorders. A systemic vasculitis is accompanied by a dense lymphocytic cellular infiltrate involving lungs, kidneys, central nervous system, skin, and, less often, other organs. Vessel necrosis, common in Wegeners granulomatosis minimal, if present, and there is no glomerulonephritis. The roentgenographic chest film findings are virtually identical to those in Wegeners granulomatosis. Cavitation of masses and nodules is somewhat less common, and more cases are manifest as interstitial and reticular nodular infiltrates. Lobular parenchymal masses appear to often represent infarcts. Lymph node enlargement is again remarkable by its absence.

In 1953 Caplan first described rheumatoid nodules in the lungs in coal miners, and the condition has been referred to as Caplans syndrome or rheumatoid pneumoconiosis. The opacities that are seen on the radiograph tend to be rounded and peripherally situated. They can occur within a few weeks, most often with a background of category 0 or 1 simple CWP. They may occur in conjunction with progressive massive fibrosis. The rheumatoid nodules vary from 0.5 cm to 5 cm in diameter and most often develop concomitantly with clinical joint manifestations of rheumatoid arthritis. Infrequently they may even precede the arthritis by several years. New groups of nodules often occur at intervals coinciding with an exacerbation of arthritis, whereas other rheumatoid nodules may have regressed. Calcification within the nodules is fairly frequent and pleural effusions may occur. There is a definite association between the nodules occurring in the lung and other systemic rheumatoid nodules. Only patients with a classic appearance of Caplans syndrome are found to have rheumatoid factor in their serum. A medline search showed me that C-ANCA is classically associated with Wegeners, but may be present in RA also (Antineutrophil cytoplasmic antibodies in patients with early rheumatoid arthritis: an early marker of progressive erosive disease.

 

 

 

 

 

52. A 60-year-old man has parallel shadows of the perihilar vessel in the left upper lobe. What next?

 

a. Bronchoscopy

b. Video thoracoscopy

c. Chest tube placement

 

Answers- a

 

 

 

53. A child who had recent BMT (bone marrow transplant) develops fever. Chest x-ray shows a pulmonary nodule. Diagnosis:

 

a. Invasive aspergillosis

b. Lymphoproliferative disorder

c. Bacterial pneumonia

 

Answers- a

Angioinvasive aspergillosis 2-3 weeks after transplantation shows nodule surrounded by ground glass halo

 

 

 

 

 

54. A finding that is diagnostic in differentiating a lung tumor from radiation pneumonitis is:

 

a. broncho-pleural fistula

b. pleural effusion

c. square margins

d. nodules

e. cavitation

 

Answers- c

Radiation pneumonitis- rare with <2000 rads (20Gy), single large dose and concomitant use of chemo are more likely to cause it; Acute phase- 4-12 weeks after radiation, sharply marginated area of ASD; Chronic- fibrosis, 9-12 months after Rx cavitation and BP fistula may occur, pleural and pericardial effusions are uncommon but may occur;

 

 

 

 

55. A man presents acutely with flu like symptoms. Chest x-ray reveals massive bilateral hilar lymphadenopahy. Diagnosis:

 

a. Inhalation anthrax

b. Acute silicoproteinosis

c. Burkitts lymphoma

d. Interstitial pneumonitis

 

Answers- a

Still, in endemic areas, the presence of either isolated intrathoracic lymphadenopathy or focal or diffuse pulmonary opacities associated with intrathoracic lymphadenopathy should be viewed as suggestive evidence of possible tularemia, brucellosis, plague, or anthrax. Burkitts appears to be abdominal.

 

 

 

 

56. After right upper lobectomy, which of the following is the cause of right middle lobe gangrene?

 

a. Interruption of the segmental pulmonary artery

b. Torsion

c. Infection

 

Answers- b

Diagnosis: Torsion of RML with Infarction

Radiologic Findings

CT scanogram shows a large increased density occupying right upper and mid-lung zone. Considering the past medical history of right upper lobectomy, the increased density suggests volume-expanding consolidation in right middle lobe (RML).

Contrast-enhanced chest CT scans show RML consolidation.

Brief Review

Torsion of the lung, although relatively rare, can occur under three sets of circumstances:

i) spontaneously, usually in association with some other pulmonary abnormality;

ii) following traumatic pneumothorax; and

iii) as a complication of thoracic surgery.

Felson (1) analyzed nine cases of pulmonary torsion.

The radiographic findings are

a collapsed or consolidated lobe that occupies an unusual position;

hilar displacement in a direction inappropriate for that lobe;

alteration in the normal position and sweep of the pulmonary vasculature; rapid opacification of an ipsilateral lobe following trauma or thoracic surgery; marked change in position of an opacified lobe on sequential radiographs; bronchial cutoff with no evidence of a mass; or lobar air trapping. Mortality is high if the torsion goes unrecognized and surgical fixation is delayed.

 

 

 

 

57. At what CD-4 count is infection with PCP most likely?

 

a. 200

b. 1000

c. 5000

d. 2000

e. 400

 

Answers- a

 

 

 

58. Commonest cause of mediastinal adenopathy and SVC syndrome in a child:

 

a. TB

b. EG

c. Lymphoma

d. Castlemans disease

e. Histoplasmosis

 

Answers- c

Malignant causes SVC more commonly than benign (fibrosing mediastinitis) causes in adults. Kirks states that Lymphoma causes mediastinal lymph nodes + SVC syndrome

Castleman disease = angiofollicular lymph node hyperplasia, usually older patients ; Histiocytosis lung involvement leads to granulomatous bronchial invasion, usually 3rd - 4th decade Non-Hodgkins is 3rd most common malignancy of childhood, causes SVC syndrome + adenopathy

TB is common in children and young adults, with hilar more common than mediastinal lymph nodes, no mention of SVC

 

 

 

 

 

59. In heart transplant which native structure is left behind?

 

a. Coronary cusps

b. Non coronary cusps of valsava

c. Pulmonary valve

d. Coronary sinus

e. Posterior wall of the left atrium

 

Answers- e

parts of right and left atrium

 

 

 

 

60. Lymphatics can be found with each except:

 

a. visceral pleura

b. interlobular septa

c. bronchial

d. pulmonary vein

e. alveoli

 

Answers- e

Lymph definitely follows the pulmonary artery, vein, and bronchi

Subpleural lymph vessels are present

 

 

 

 

61. Mesothelioma of the pleural looks like which tumor histologically and grossly:

 

a. Metastatic melanoma

b. Tb

c. Adenocarcinoma

d. Invasive thymoma

e. Urinoma

 

Answers- c

The histochemical basis for the distinction between mesothelioma and metastatic adenocarcinoma rests on the identification of neutral mucins or hyaluronic acid in the histologic sections.

It resembles hemangiopericytoma of the lung

 

 

 

 

62. PCP is not usually seen until the CD4 count falls to what level?

 

a. 2000

b. 1000

c. 500

d. 200

 

Answers- d

100-200/mm3 have PCP, Herpes simplex, chronic, ulcerative; disseminated Histo; Kaposis sarcoma, viscedral/ Progressive multifocal leukoencephalopathy; lymphoma, non-Hodgkins;

Characteristic opportunistic infections in AIDS occur in those with a CD4 count of < 200-250. At the CDC, CD4<200 is dx of AIDS.

 

 

 

 

 

 

63. Regarding RDS:

 

a. associated with pleural effusion

b. is associated with hypoinflation in the early stage

c. peak lung abnormality/opacity around 6 or 7 days

d. A normal chest X-ray at 6 hours excludes the diagnosis

e. intravenous surfactant is useful

 

Answers- b, d

In mild to moderate RDS the peak is at 3-5 days.

Aerosolized surfactant is used successfully.

Pure RDS is not associated with pleural effusions.

Hypoinflation is due to alveolar collapse.

The important pathologic characteristics of RDS are alveolar collapse and

dilatation of terminal airways rather than hyaline membranes. The terminal airways can

rupture leading to pneumothorax, pneumomediastinum, and pulmonary interstitial

emphysema.

Incidence of RDS in baby <1000 g = 65%

1000 g = 50 % (27 weeks)

1500 g = 16% (31 weeks)

2000 g = 5 % (34 weeks)

2500 g = 1% (36 weeks)

Males are almost twice as likely to get RDS

CXR findings: reticulogranular infiltrates with generalized hypoventilation and air

bronchograms, pneumothorax, and pneumomediastinum. Pulmonary interstitial

emphysema can be superimposed. Clearing is from the periphery and upper to lower.

 

 

 

 

64. The number of alveoli in the lung reach a maximum at what age?

 

a. 1 year

b. 5 years

c. 2 months

d. 8 years

 

Answers- d

 

 

 

 

65. What is the acinus in the lung?

 

a. Distal to the terminal bronchial

b. Distal to the respiratory bronchial

 

Answers- a

Acinus is distal to the terminal bronchiole, includes alveoli and respiratory bronchioles

 

 

 

 

 

 

66. Which cell type regenerates in response to injury:

 

a. Type 1 pneumatocytes

b. Type 2 pneumatocytes

c. Macrophages

d. Kupffer cells

 

Answers- b

 

 

 

 

67. Which is common about the toxicity of phenytoin and cyclosporine on the lungs?

 

a. Hypersensitivity pneumonitis

b. Noncardiogenic pulmonary edema

c. Cardiogenic pulmonary edema

d. Pulmonary vasculitis

 

Answers- a

 

 

 

 

 

 

68. Which is the commonest mediastinal mass in a child 6 to 12?

 

a. Neuroblastoma

b. Germ cell tumor

c. Lymphoma

 

Answers- c

Lymphoma is the third most common neoplasm of childhood after leukemia and central nervous system (CNS) tumors (1). It is the most common anterior mediastinal mass accounting for a quarter of all mediastinal masses (2).

 

 

 

 

69. Which nerve can be seen at the level of the ap window?

 

a. Left recurrent laryngeal nerve

b. Vagus nerve

c. Right laryngeal nerve

 

Answers- a

 

 

 

 

 

 

70. Which of the following causes increased compliance of the lungs:

 

a. Scleroderma

b. Alpha 1 anti trypsin deficiency

c. Idiopathic pulmonary fibrosis

d. Pulmonary embolism

 

Answers- b

 

 

 

 

 

 

71. Which of the following causes increased lung volumes:

 

a. EG

b. Pulmonary fibrosis

c. Lymphatic spread of the tumor

 

Answers- a

EG hyperinflation in 1/3 of cases. LAM would be a good answer too...

 

 

 

 

72. Which of the following is least likely with rheumatoid lung disease?

 

a. bibasilar fibrotic change

b. interstitial lung disease with basal prominence

c. nodules

d. pleural effusion

e. hilar lymphadenopathy

 

Answers- e

basilar interstitial fibrosis, pleural abnormalities, and necrobiotic nodules

no mention of hilar lymphadenopathy

 

 

 

 

73. A patient receives 5000 rads to the L3 vertebral body over 4 weeks. Which of the following radionuclide uptake patterns is seen on a bone scan 6 months later?

 

a. decreased activity at L3

b. increased activity in the entire lumbar spine

c. increased activity at L3

d. decreased activity in the entire lumbar spine

 

Answers- a

Following XRT, there is an initial (first few weeks) increase in activity in the

portal. If >2000 rads have been given, there is a subsequent decrease in activity within 2-

3 months. This persists for at least 12 months.

The answer to the above question assumed that the entire L-spine was not in the

radiation portal.

 

 

 

 

 

 

74. A young woman presents with sore throat, neck pain, restlessness, T4 is elevated and her thyroid uptake is low. The most likely etiology is:

 

a. sub acute thryroiditis

b. graves disease

c. acute suppurative thyroiditis

d. Hashimoto thyroiditis

e. factitious thyroiditis

 

Answers- a

De Quervain = Subacute thyroiditis

2-3 weeks after upper respiratory infection, viral, with painful/tender gland with fever

Destruction of thyroid gland causes increase T4 and decreased uptake

 

 

 

 

 

 

75. For gastric emptying study, which is true?

 

a. For proper calculation of the half-life. The geometric mean of the anterior and posterior projection is taken

b. Liquids have a linear curve

c. It cannot be used to follow patients with gastroparesis because of poor reproducibility

d. The half time for solids is 30 minutes

 

Answers- a

Solid 50% at 90min - linear

Liquid 50% at 30min - exponential

Calculation of the Geometric Mean

The geometric mean is the square root of the product of the anterior and posterior counts.

Geometric Mean = square root (anterior counts x posterior counts)

For example, assume the anterior counts collected for an image taken one minute after the patient finished consuming the standard meal were 102 764 cpm while the corresponding posterior counts collected were 128 842 cpm. The geometric mean is calculated as:

Geometric Mean = sqrt (102 764 x 128 842)

= sqrt (1.32403 x 1010)

= 115 067 cpm

 

 

 

 

76. For pharmacological augmentation for detection of Meckel's diverticulum. Which drugs act by inhibition of secretion of pertechnetate from the gastric mucosa in the Meckel's?

 

a. Pentagastrin

b. Viagra

c. Cimetidine

 

Answers- c

Cimetidine inhibits secretion

Pentagastrin stimulates uptake

 

 

 

 

 

77. Octreotide scanning is useful for all the listed tumors except:

 

a. carcinoid

b. renal cell carcinoma

c. gastrinoma

d. Meningioma

e. medullary carcinoma of the thyroid

 

Answers- b

Octreotide = Somatostatin

 

 

 

 

78. On renal scintigraphy, what would be the response to Captopril in a patient with right renal artery stenosis?

 

a. increased initial uptake on the right side

b. no change

c. decreased activity on the left side

d. decreased initial uptake on the right side

 

Answers- d

You would expect excretion of radionuclide to decrease after administration of Captopril -- increasing T1/2

 

 

 

 

79. One would prefer In 111 WBC to Gallium scanning in:

 

a. lung fungal infection

b. vertebral osteomyelitis

c. inflammatory bowel disease

 

Answers- c

Lung is Gallium

 

 

 

 

80. Regarding diuretic renal scintigraphy. Which is essential?

 

a. absence of renal calculi

b. increase creatinine

c. absence of history of previous obstruction

d. normal renal function

 

Answers- d

 

 

 

81. Regarding liver scintigraphy?

 

a. Sulfur Colloid is taken up by hepatocytes

b. bowel transit in HIDA scan can differentiate between neonatal hepatitis and biliary atresia

c. HIDA is taken up by Kupffer cells

 

Answers- b

HIDA extracted by hepatocytes

Sulfur Colloid taken up by RES / Kupffer cells

 

 

 

 

82. Regarding treatment for thyroid cancer post op. which of the following is false:

 

a. A dose of 200 mCi for lung mass can cause pulmonary fibrosis

b. Two doses of 100 mCi is contraindicated because of leukemia

 

Answers- b

Greater risk above 200mCi for pulmonary fibrosis

Guidelines for maximum dose administration

The guidelines regarding the maximum activity which can safely be administered are:

1- Blood dose should be no more than 200 rads

This limit is set to reduce marrow toxicity. Frequently (90%) doses of this level are associated with mild, transient decreases in blood cell counts, but no instances of permanent suppression have been reported.

2- Retained whole body activity of no more than 120 mCi at 48 hours (or 80 mCi in patients with lung metastases to avoid potential pulmonary fibrosis)

A- Leukemia

The risk for AML is only minimally increased above the general population with a peak incidence 2 to 10 years post therapy (0.5% increased risk). Patients at risk are generally above the age of 50 and have received a dose of approximately 900 mCi. The risk is greatest when this large dose has been given over a short period of time (6 to 12 weeks). These patients have usually received a blood dose greater than 200 rads. It may also be possible that patients with thyroid cancer are at an increased risk for this type of malignancy regardless of the type of therapy they receive.

To minimize the risk for leukemia,  a 1 year interval between therapies and a total cumulative dose of administered activity not to exceed 800 mCi is recommended.  It is important to note that the mortality from recurrence exceeds that from leukemia by 4 to 40 fold.

 

 

 

 

 

83. There was a question on oriental cholangiohepatitis, advantage of tc99m DTPA as a ventilation agent, how to determine field uniformity in nucs camera, technical question regarding dedicated pet scanner vs. dual head SPECT camera (with coincidence counting software)?

 

 

 

 

 

 

 

 

84. What is the advantage of sulphur colloid nucs scanning over Tc rbc scanning for GI bleed?

 

a. Better for bleed in the splenic flexure

b. Better for UGI bleeds

c. More sensitive

d. Can be prepared quickly and hence the study can be done quickly

 

Answers- d

 

 

 

 

85. Which is the most common cause of hepatic uptake during Tc99m MDP study:

 

a. metastatic disease

b. active hepatitis

c. abscess

d. massive hepatic necrosis

 

Answers- a

 

 

 

 

 

86. Which of the following causes the greatest v/q mismatch?

 

a. fibrosing mediastinitis

b. radiation changes

c. hilar bronchogenic carcinoma

 

Answers- a

 

 

 

87. A baseball pitcher with deltoid weakness, pain and parathesias over the shoulder region. Cause:

 

a. Brachial plexus injury

b. Entrapment of the axillary nerve in the quadrilateral space

c. DJD of the spine with encroachment of the nerve in the neural foramina

 

Answers- b

Entrapment of axillary nerve in the quadrilateral space leads to parasthesias, weakness of teres minor and deltoid, and tenderness upon palpation of the quadrilateral space

 

 

 

 

88. A patient has chronic wrist pain particularly with ulnar deviation. Plain x-ray demonstrates cystic changes in the carpal bones particularly in the lunate with cystic changes also seen in the ulna:

 

a. RA

b. lunate malacia

c. rupture of the lunato triquetral ligament

d. gout

e. ulnar impaction syndrome

 

Answers- e

Ulnar impaction syndrome = degenerative disorder with ulnar pain and swelling secondary to chronic impaction against the TFCC and ulnar=sided carpal bones resulting in progressive deterioration of the TFCC, chondromalacia of the lunate and head of the ulna, and attrition of the lunotriquetral ligament. Always associated with a positive ulnar variance, with sclerosis and cysts in the lunate, triquetrum, and ulnar head.

 

 

 

89. A patient has repeated episodes of GI bleeding and has rash on the skin. Plain x-rays show focal areas of sclerosis and diffuse areas of sclerosis especially in the innominate bones:

 

a. Mastocytosis

b. Sprue

c. Whipples disease

d. Gardners syndrome

 

Answers- a

Mastocytosis = Urticaria Pigmentosa

Dahnert says patients <6 months of age in 50%, Resnick speaks of Systemic Mastocytosis in older patients

Scattered well-defined sclerotic foci with focal/diffuse involvement, particularly in the skull, spine, ribs, pelvis

 

 

 

 

90. A woman who has diabetes develops pes planus and periosteal reaction over the medial side of the ankle. Which of the following is the likely etiology:

 

a. Rheumatoid Arthritis

b. Rupture of the Achilles tendon

c. Posterior tibialis tendon rupture

 

Answers- c

Posterior Tibialis inserts on navicular, can rupture

Posterior Tibialis commonly inflammed and can rupture in Rheumatoid Arthritis

I think the diabetes is supposed to suggest trauma as the cause of rupture due to decreased sensation

Pes Planus = heel valgus with forefoot eversion

 

 

 

 

 

91. A young woman with a 3.5 cm sclerotic lesion, blends with the adjacent cortex in the proximal end of the humerus...bone scan shows slightly increased activity:

 

a. Osteoid osteoma

b. Mets

c. Bone island

d. Osteosarcoma

e. Osteoblastoma

 

Answers- c

About 30% of bone islands will demonstrate increased uptake- particularly large lesions.

 

 

 

92. All except the following is located in the tarsal tunnel:

 

a. Sural nerve

b. Tibialis Posterior

c. Posterior tibial nerve

d. Flexor Hallucis Longus

e. Flexor Digitorum Longus

 

Answers- a

Also, the posterior tibial artery and vein course within the tarsal tunnel

Compromise of the Posterior tibial nerve yields pain and parasthesias in the plantar aspect of the foot

 

 

 

93. Biciptal tendon dislocation associated with?

 

a. Supraspinatous tendon rupture

b. Rupture of superior glenohumeral ligament

c. Subscapularis tendon rupture

d. Rupture of the inferior glenohumeral ligament

 

Answers- c

Commonly associated with massive tears of the rotator cuff and with avulsion or tear of the subscapularis tendon.

 

 

 

 

94. Ganglion cyst of the shoulder joint associated with?

 

a. Atrophy of teres major

b. Atrophy of the infraspinatous muscle

c. Tear of labrum lip

d. Atrophy of the supraspinatous muscle

 

Answers- b, c, d

Ganglion arises from tendon, muscle, or semilunal cartilage

Remember supraspinatus superior, infraspinatus and teres minor posterior, and subscapularis anterior

 

 

 

 

95. How does phenytoin cause osteomalacia?

 

a. Impaired metabolism of vitamin D in the kidneys

b. Impaired absorption of calcium from the intestines

c. Inhibition of hydroxylation of vitamin D in the liver

 

Answers- c

Phenytoin interferes with vitamin D action on bowel...

ACR syllabus states that is is due to impaired metabolism in the liver....

Osteomalacia has been associated with phenytoin therapy and is considered to be due to phenytoins interference with vitamin D metabolism.

There have been a number of reports of rickets, reduced bone density, and osteomalacia in patients taking phenytoin, probably due to the induction, by phenytoin of liver enzymes involved in the metabolism of vitamin D.

 

 

 

 

96. In a pediatric patient, C1-2 instability may be caused by all except?

 

a. trauma

b. juvenile RA

c. hypothyroidism

d. down syndrome

e. spondyloepiphyseal dysplasia

 

Answers- c

Spondyloepiphyseal dysplasia causes dens hypoplasia.... cause instability?

 

 

 

 

97. Swelling of the wrist and SLAC deformity associated with?

 

a. GOT

b. Calcium pyrophostate crystals

c. RhA

d. OA

e. HIAA disease

 

Answers- b

Not much out there on SLAC - Scapho Lunate Advanced Collapse

There is destruction of the Scapholunate ligament by either trauma or crystal deposition, usually CPPD

 

 

 

98. The most common cause of fracture of the medial patellar lip?

 

a. lateral patellar dislocation

b. direct trauma

c. medial patellar dislocation

 

Answers- a

 

 

 

 

 

99. The most common site to develop post traumatic osteolysis:

 

a. proximal femur

b. tibia

c. rib

d. humerus

e. clavicle

 

Answers- e

 

 

 

 

 

100. Translocation of the ulna:

 

a. CPPD

b. GOUT

c. RA

d. Psoriasis

 

Answers- c

Ulnar translocation occurs when the carpus shifts in an ulnar direction , which may follow severe capsular injury or articular disorders such as rheumatoid arthritis.

 

 

 

 

101. Triangular fibro cartilage divides which spaces?

 

a. Scapholunate and radioulnar

b. Radioulnar and radiocarpal

c. Radiocarpal and scapholunate

 

Answers- b

 

 

 

 

102. Ultrasound of the rotator cuff injury, which is false?

 

a. complete nonvisualization of the rotator cuff

b. convex appearance of the subdeltoid subacromion bursa

c. fluid in the bicipital tendon and subdeltoid subacromion bursa

d. partial visualization of the rotator cuff

 

Answers- d

Major findings are nonvisualization, focal loss of tendon substance, and fluid-filled defects in the tendon

Frequently, there is fluid in the bicipital tendon and subdeltoid bursa

 

 

 

 

103. Which is the commonest complication of a fracture of the growth plate of the distal phalanx of the great toe?

 

a. Infection

b. AVN

c. Growth disturbances

d. Subungal exostosis

 

Answers- a

 

 

 

 

 

 

104. Which muscle attaches to the lesser tuberosity?

 

a. supraspinatous

b. teres minor

c. infraspinatous

d. subscapularis

 

Answers- d

 

 

 

 

105. Which muscle group constitutes the pes anserinus?

 

a. gracilis, sartorius, and semitendinosis

b. semimembranosus, illiotibial band, and semitendinosis

c. sartorius, gracilis, and semimembranosus

d. popliteus, gracilis, and biceps femoris

 

Answers- a

Pes anserinus = gooses foot, insert onto the anteromedial aspect of the tibia in a fan shaped manner

 

 

 

 

 

106. Which of the following is least likely to be multifocal:

 

a. Enchondroma

b. Fibrous dysplasia

c. Chondroblastoma

d. Fibrous cortical defect

 

Answers- c

Syndromes are associated with all the others

 

 

 

 

 

107. Which of the following is the commonest cause of failed hip prosthesis?

 

a. Loosening

b. Cement disease

c. Infection

 

Answers- a

Loosening is the most common cause of arthroplasty failure in cemented prosthesis.

Bone scan activity patterns differentiate loosening from infection.

Infection is most common in the first postoperative year

 

 

 

 

 

108. Which of the following is the commonest tarsal coalition?

 

a. Talocalcaneal at middle facet of subtalar joint

b. Calcaneonavicular

c. Talocalcaneal at posterior facet of subtalar joint

d. Talonavicular

 

Answers- a

Calcaneonavicular is second

 

 

 

 

 

109. Which of the following tumors can cause osteomalacia?

 

a. Chondroblastoma

b. Hemangioperictyoma

c. Hemangioma

 

Answers- b

Hemangiopericytoma is most frequent tumor to cause osteomalacia

Others include NOF, GCT, osteoblastoma

 

 

 

 

110. Doppler ultrasound of the portal vein shows no flow. What do you do to image slow flow in it?

 

a. Quit

b. Scan in such a way as to decrease the Doppler angle

c. Increase pulse repetition frequency

d. Switch to lower transducer

 

Answers- b

Small angles improve low flow measurements

Perhaps a better choice would be to switch to power doppler...

Color flow Doppler sensitivity should be adjusted to detect anticipated velocities such that if slow flow in a preocclusive carotid lesion is sought, low flow settings with decreased sampling are employed. However, the system will then alias at lower velocities because of the decrease in the Pulse Repetition Frequency (PRF). In addition to changes in the PRF, optimization of the Doppler angle, gain and power settings, a decrease in the wall filter, and increase in the persistence, and an increase in ensemble or dwell time can be used to optimize low flow detection.

Optimization of low flow velocities

- Decreased sampling rate (i.e., decreased PRF)

- Doppler angle as low as possible (60 degrees or less)

- Decreased wall filter

- Increased persistence

- Increase in dwell time

- Increase gain

- Increased power

 

 

 

 

111. OB-US in patient with Downs syndrome demonstrates all except:

 

a. cerebral ventriculomegaly

b. pyelectasis

c. echogenic bowel

d. none of the above

e. short femurs and humerus

 

Answers- d

Shortened femurs, no mention of humerus

There is mild ventriculomegaly and mild fetal pyelectasis

 

 

 

 

112. On OB-US the pulmonary artery and the ascending aorta are seen in parallel. What is the diagnosis?

 

a. transposition of the great vessels

b. tetrology of fallot

c. truncus arteriosus

d. tricuspid atresia

 

Answers- a

 

 

 

 

 

113. Regarding carotid ultrasound. Which is false?

 

a. Patient with hypertension would have increased blood velocities across a stenosis

b. Patient with bradycardia have decreased systolic velocity and increase diastolic velocity across a stenosis

c. Patient with AI would have absent or reversal of diastolic flow

d. Patients with occluded ICA would have increased velocity in the contralateral ICA

e. Patient with proximal ICA stenosis would have decreased velocity at the distal tandem stenosis

 

Answers- b

Variations in cardiovascular physiology may affect carotid velocity measurements. For example, velocities produced by a stenosis in a hypertensive patient will be higher than those in a normotensive individual with a comparable narrowing. On the other hand, a reduction in cardiac output will diminish both systolic and diastolic velocities. ... Bradycardia, for example, produces increased stroke volume, causing systolic velocities to increase, but prolonged diastolic runoff causes spuriously decreased end diastolic values. Patients with isolated severe or critical aortic stenosis may demonstrate duplex waveform abnormalities, including prolonged acceleration time, decreased peak velocity, delayed upstroke, and rounded waveforms. However, mild or moderate aortic stenosis usually results in little or no sonographic abnormality. Frequently, an image/Doppler mismatch alerts the examiner to potential pitfalls.  Patient with hypertension would have increased blood velocities across a flow limiting stenosis.

 

 

 

 

114. Regarding the umbilical cord:

 

a. Arterial blood flow is from the placenta to the fetus

b. A systolic/diastolic ratio of 5 is normal in the third trimester

c. There are two veins and one artery

d. Blood sampling should be done close to the fetal insertion

 

Answers-

Notes-

In the normal fetus there is a progressive reduction in placental resistance in the fetoplacental circulation with advancing gestational age. Therefore, the upper limits of normal for umbilical artery A/B ratios changes throughout gestation, progressively decreasing as the pregnancy approaches term. We use the guidelines listed in Table 1 for determining which umbilical artery A/B ratios are abnormal, but as a general rule an A/B ratio of 2 .5 or less is normal at any stage of gestation and if the ratio is greater than 4 at any time after 28 weeks gestation, it is abnormal. The most worrisome result is when end-diastolic flow is absent or reversed, as this has been associated with a high risk for impending in utero fetal demise.   Cordocentesis is preformed from 17 weeks to term. The needle is inserted into the umbilical artery 2-3cm from the placental insertion.

 

 

 

 

115. Sonographic evaluation of an a-v fistula, except:

 

a. may resolve spontaneously

b. central vein shows pulsatile increased velocity

c. distal artery shows increased velocity

d. proximal artery looses it triphasic waveform

e. speckled echoes in the soft tissue at the level of the fistula

Type- US

Answers- c

Notes-

by KW

US Requisites p 483

Distal artery shows reversal of diastolic flow

speckled echoes represent tissue vibration

I think the resolve spontaneously, need to check...

2000 Board Question

116. Ultrasound in a 2-week neonate showing hypoechoic regions in the basal ganglia bilaterally, lateral to the thalamus. Most likely cause:

a. anoxic injury

b. intraventricular hemorrhage

c. intraparenchymal hemorrhage

Type- US

Answers- a

Notes-

by KW

2000 Board Question

A study that appeared in a recent (2001) American Journal of Obstetrics and Gynecology issue presents Dr. Naeyes current thinking on the determination of the timing of fetal brain damage from hypoxemia-ischemia. His study analyzed 55 children with cerebral palsy to evaluate methods for determination of the time before birth at which antenatal hypoxemia-ischemia damaged the brain. He found that basal ganglia lesions predominated when bradycardia (slow heart rate) lasted less than 30 minutes before birth. As the bradycardia duration lengthened, white matter and eventually watershed brain lesions predominated.

117. Which are commonly associated with oligohydramnios?

a. Skeletal dysplasia

b. Transplacental infection

c. Amniotic fluid index of 20 or greater

d. IUGR

e. Meningomyelocele

Type- US

Answers- a,b,d

Notes-

US requisties 277.

D826. IUGR-reduced renal perfusion. 20-fold increase in incidence of fetal anomalies with oligohydramnios.

1998 Board Question

Polyhydramnios is defined as an amniotic fluid volume >1500-2000cc at term; AFI >20cm. There is a 64% perinatal mortality with severe polyhydramnios. (D612)

by KH

118. Which lesion is most likely to be hypoechoic within the liver?

a. hemangioma

b. lymphoma

c. adenoma

d. focal nodular hyperplasia

e. regenerating nodule

Type- US

Answers- b

Notes-

by KW

Dahnert p548,578; US Requisites p9

Lymphoma is usually hypoechoic, looks like cyst, but with no through transmission

Hemangioma, FNH, and adenoma are hyperechoic

Regenerating nodules are likely isoechoic

2000 Board Question

119. Which of the following does not affect the Doppler frequency?

a. Angle of incidence

b. Frequency of the transducer

c. Pulse repetition frequency

d. Velocity of the target

e. Velocity of the sound in the medium

Type- US

Answers- c

Notes-

by KW

2000 Board Question

120. Which of the following is not associated with IUGR?

a. Decrease velocity in the umbilical cord

b. Change in HC/AC ratio

c. Increased velocity in the carotid arteries

d. An amniotic fluid index of 20

Type- US

Answers- d

Notes-

by KW

Dahnert p869-870

AC is the most effective parameter for evaluation of IUGR.

There is oligohydramnios, with decreased AFI

There is decrease in diastolic flow in the umbilical cords

Per memory, IUGR shunts blood to critical organs (brain, kidneys, etc...), so I would expect increase in carotids...

2000 Board Question

121. A 2 year old girl develops flank pain, burning micturation, fever, has pyuria. What is the next appropriate study?

a. Contrast enhance ct

b. IVP

c. Ultrasound of kidney and bladder

Type- Pediatrics

Answers- c

Notes-

by KW

2000 Board Question

122. A child with nursemaids elbow. What are the findings?

a. Dislocation of radial head from the annular ligament

b. Entrapment of the lateral collateral ligament between capitilleum and

c. Posterior dislocation of the elbow

Type- Pediatrics

Answers- a

Notes-

Pulling childs arm - dislocated the radial head

by KW

2000 Board Question

123. A child with pustule on the hand, develops axillary and neck lymphadenopathy:

a. Kawasakis disease

b. Lymes disease

c. Rocky mountain spotted fever

d. Cat scratch disease

Type- Pediatrics

Answers- d

Notes-

Robbins p367

by KW

2000 Board Question

124. Patient with skin rash, cervical lymphadenopathy, cardiomegaly, intestinal pseuodobstructions and gall bladder hydrops:

a. Kawasakis diseases

b. LGV

c. Lymes disease

d. Henoch schonlein purpura

Type- Pediatrics

Answers- a

Notes-

by KW

Verified Kirks p578,Dahnert p528

2000 Board Question

125. The most common cause of precocious puberty in children:

a. hypothalamic hamartoma

b. pituitary microadenoma secreting prolactin

c. rahtke cleft cyst

d. hypothalamic glioma

e. craniopharyngioma

Type- Pediatrics

Answers- a

Notes-

by KW

Dahnert p235,244

2000 Board Question

Multiple sources list precocious puberty as presenting complaint for hamartomas

Also present with laughing fits (gelastic seizures)

126. The most common solid renal mass in a child less the 3 month old?

a. Wilms tumor

b. Mesoblastic nephroma

c. Renal Cell Carcinoma

Type- Pediatrics

Answers- b

Notes-

by KW

Verified Dahnert p728, Kirks 1120

nephroblastoma = Wilms tumor

2000 Board Question

127. Which of the following has abnormalities of the conal septum:

a. ebsteins abnormality

b. tricuspid atresia

c. tetrology of fallot

Type- Pediatrics

Answers- c

Notes-

Supracristalar VSD

by KW

2000 Board Question

Tetrology is the most common cyanotic congenital heart disease associated with decreased pulmonary vascularity and it is the most common cause of cyanotic congenital heart disease beyond the neonatal period (representing 75% of all cyanotic heart disease). The degree of cyanosis is dependent upon the severity of right ventricular outflow tract obstruction and associated pulmonic stenosis. Cyanosis is not detected in most patients until at least 3-4mo. of age, but it may not present until early childhood if the obstruction is mild. Tetrology consists of: 1- VSD (High), typically a large membranous defect (anterior conal septum below right aortic cusp); 2- Overriding Aorta: The aorta overrides the VSD and in combination with pulmonic stenosis results in right ventricular outflow tract obstruction; 3- Pulmonic Stenosis: The stenosis is subvalvular (infundibular) in 90% of cases, but occasionally may be both valvular and infundibular. The pulmonic stenosis exacerbates the degree of right to left shunting. If the stenosis is mild, however, patients may only be cyanotic following exercise. The pulmonic valve may be stenotic or bicuspid. About 40% of patients have an associated stenosis of the origin of the left or right pulmonary artery; and 4- Right Ventricular Hypertrophy. Pentalogy of Fallot consists of the above plus an ASD.

128. Which of the following is the cause of cone shaped epiphysis in a child?

a. leukemia

b. congenital syphilis

c. heavy metal poisoning

d. cleido-cranial dysplasia

Type- Pediatrics

Answers- d

Notes-

by KW

2000 Board Question

129. What causes loss of signal on t2 weighted images?

a. manganese chelates

b. gadolinium chelates

c. iron oxide chelates

Type- Physics

Answers- a,b,c

Notes-

Not Verified

by KW

2000 Board Question

130. A man sustains a trauma at a nuclear facility and is brought to the ER. What is the first step in the management of the patient:

a. try to decontaminate him

b. attend to his medical needs

c. determine the source of the contamination

Type- Physics

Answers- b

Notes-

by KW

Check Mettler

2000 Board Question

131. A cluster of 4/cc calcification is seen on screening mammogram. Diagnosis:

a. Benign findings

b. Category 0 needs additional imaging

c. Suspicious findings

d. Highly suggestive of malignancy

Type- Mammography

Answers- b

Notes-

Should not charaterize microcalcification on screening mammogram.

D452? should be 5 per cc

by KW

2000 Board Question

132. A diagram of the biopsy needle during stereo tactic biopsy was given. You have to localize the needle point in relation with the lesion:

a. needle to the left of the lesion

b. needle too deep

c. needle too superficial

d. needle to the right of the lesion

Type- Mammography

Answers-

Notes-

by KW

2000 Board Question

Have to know about z, y and x error

133. A diagram of the MLO and CC view was given with a lesion situated in the lower half on both view. Where is the lesion situated:

a. lower inner

b. lower outer

c. upper inner

d. upper outer

Type- Mammography

Answers- a

Notes-

by KW

Concensus...

2000 Board Question

134. A mammogram shows motion unsharpness. Which of the following is least appropriate step to eliminate it:

a. Increase KVP

b. Increase compression

c. Increase the density setting on the automatic exposure

Type- Mammography

Answers- c

Notes-

by KW

It seems that increasing the AEC would cause the exposure time to increase, and increase motion...

2000 Board Question

135. According to the Mammographic Quality Standards Act (MQSA), as of April 1999, phantom testing should be done at least:

a. Weekly

b. Monthly

c. Annually

d. Daily

Type- Mammography

Answers- a

Notes-

Cardenosa31.2001

Daily: darkroom cleanliness, processor quality control. Weekly: screen cleanliness, viewboxes and viewing conditions, phantom images. Monthly: Visual checklist. Quarterly: Repeat analysis, fixer retention analysis. Semi-annually: darkroom fog, screen-film contact, and compression. Physicists responsibility: mammo unit assembly evaluation, columniation assessment, focal spot size, kVp accuracy/reproducibility, beam quality assessment, AEC performance, uniformity of screen speed, breast entrance exposure and average glandular dose. (AFIP-2000)

1999 Board Question

by AE

136. After biopsing a cluster of calcification which were seen on specimen radiograph the pathology report comes back no calcification seen. What do you do next?

a. Repeat the biopsy

b. Radiograph the paraffin block

c. Excisional biopsy

Type- Mammography

Answers- b

Notes-

by KW

2000 Board Question

137. At breast biopsy, the diagnosis of atypical ductal hyperplasia comes back. What is the next step?

a. I year follow up

b. 6 months follow up

c. Excisional biopsy

d. Repeat core biopsy

Type- Mammography

Answers- c

Notes-

by KW

Per Ginger

2000 Board Question

138. Breast Cancer is most likely to occur in which site?

a. Lobule

b. Terminal Duct Lobular Unit

c. Major breast duct

Type- Mammography

Answers- b

Notes-

It is not known why the cells of the terminal duct appear to be the site of origin for breast cancer, kopan page 1.

The TDLU (AFIP 2000)

1999 Board Question

by KH

139. Breast screening trial is best assessed by:

a. survival rate

b. interval cancer rate

c. number of new cancers picked up each year for every 1000 woman screened

d. mortality rate

Type- Mammography

Answers- d

Notes-

old cardenosa p7

by KW

Kopans 80-88, Dahnert p463

Survival statistics may merely reflect the detection of a lesion earlier in its growth and not necessarily indicate a benefit from a particular detection/treatment strategy (lead time bias).

Mortality indicates who actually lived longer. For instance, in the study, a woman who had her cancer found 10 years earlier would still have to outlive (in total chronological age) her matched cohort. As a group, the study patients would live longer than the control patients and thus have a lower mortality rate. (Not merely live longer

after their tumors were found!)

Reference: Kopans 1989, pp. 9-10.

2000 Board Question

140. During an initial screening mammogram a well circumscribed mass is seen which is not seen on ultrasound. What is the appropriate recommendation?

a. 6 months follow up

b. Benign

c. Stereotatic biopsy

d. Needle localization

Type- Mammography

Answers- a

Notes-

by KW

2000 Board Question

141. If a mass is seen medially only on the CC projection. Which is the next best step?

a. Stereotactic needle localization

b. Reversed CC projection

c. LM view

d. Ultrasound

Type- Mammography

Answers- b

Notes-

exaggerated CC, verses LM view

kopans727 cardenosa 141.

by KW

2000 Board Question

142. In 2000, how many new cases of breast cancer and breast cancer deaths were there?

a. 24,000 and 20,000

b. 140,000 and 34,000

c. 182,000 and 41,200

d. 80,000 and 67,000

e. 210,000 and 98,000

Type- Mammography

Answers- c

Notes-

Excluding skin cancers, breast cancer is the most frequently diagnosed malignancy (30% of all cancers detected). 182,800 new cases of invasive breast cancer are expected in the year 2000 among women and 1,400 in men. Second leading cause of cancer mortality (15% of all cancer deaths) in women. 41,200 deaths related to breast cancer expected in 2000 (40,800 in women and 400 in men). Incidence rates have leveled at approximately 110 cases per 100,000 after increasing 4% per year in the 1980s. lifetime risk to age 85; 1 in 8 women (12.5%). Cardenosa page2.

1993 c PreTest Single Best Answer Question

by KH

143. In breast biopsy, the diagnosis of radial scar comes back. What should be the next step?

a. 1 year follow up

b. Repeat core biopsy

c. Excisional biopsy

d. 6 months follow up

Type- Mammography

Answers- c

Notes-

by KW

Dahnert p473 - excision is required for definate diagnosis

2000 Board Question

144. Patient is status post excisional biopsy of a cluster of microcalcifications. Pathology is positive for adenosis and LCIS. What is the most appropriate management?

a. Unilateral mastectomy

b. Lumpectomy and RT

c. Screening mammogram in 2 years

d. Bilateral mastectomy

e. Screening mammogram in 1 year

Type- Mammography

Answers- d

Notes-

Controversial; choices are bilateral mast., unilateral mast., or close f/u. I am aggressive.

1999 Board Question

LCIS is not detectable on physical examination or mammogram, it is always an incidental pathologic finding; bilateral in 23-35%. 17-37% incidence of invasive breast cancer in both breasts within 24 years. Usually develops into ductal. Clinical treatment: close observation, bilateral total mastectomy, or ipsilateral mastectomy with contralateral biopsy leading to total mastectomy if LCIS is found. (AFIP-2000)

by MH

145. The American Cancer Society (ACS), as of 1997, recommends screening mammography:

a. Every other year after 40, and every year after 50

b. Every year after 40

c. Every year after 50

Type- Mammography

Answers- b

Notes-

by KW

Verified Dahnert p463

American Cancer Society, ACR: women at normal risk should begin annual breast cancer screening at age 40. Earlier than age 40: personal history of breast cancer, family history of premenopausal breast CA, BRCA positive, breast radiation (Hodgkins), high risk lesion at biopsy (LCIS, ductal atypia, Radial scar) (AFIP-2000).

1999 Board Question

146. The area least well visualized on an MLO view of the breast is:

a. lower inner

b. lateral quadrant

c. upper inner

d. lower outer

e. upper outer

Type- Mammography

Answers- c

Notes-

by KW

Kopans 185

Medial inferior tissues are tethered to the sternum, and special attenion on CC view to this region is needed

2000 Board Question

147. What are the chances of malignancy in a well-circumscribed mass in breast?

a. 10%

b. 1 to 2 %

c. 50%

d. 5%

Type- Mammography

Answers- b

Notes-

by KW

Dahnert p461 - a mammographically benign mass has a 2% chance of being malignant

2000 Board Question

148. Which cancer is most likely to be intra-cystic?

a. DCIS

b. Medullary

c. Mucinous

d. Papillary

e. Tubular

Type- Mammography

Answers- d

Notes-

Dahnert p459

by KW

2000 Board Question

149. Which carcinoma is most likely to be missed?

a. Ductal carcinoma in situ

b. Lobular carcinoma

c. Tubular carcinoma

Type- Mammography

Answers- b

Notes-

by KW

Dahnert p459

2000 Board Question

150. Which is most often missed on mammography?

a. Colloid carcinoma

b. Invasive lobular carcinoma

c. Invasive ductal carcinoma

d. Medullary carcinoma

e. Tubular carcinoma

Type- Mammography

Answers- b

Notes-

LCIS is not detectable on physical examination or mammogram; it is always an incidental pathologic finding; bilateral in 23-35%. There is a 17-37% incidence of invasive breast cancer in both breasts within 24 years. Usually develops into ductal. Clinical treatment: close observation, bilateral total mastectomy, or ipsilateral mastectomy with contralateral biopsy leading to total mastectomy if LCIS is found. (AFIP-2000)

1998 Board Question

by CM

151. Which is the most important reason for x-raying the surgical specimen?

a. To document the removal of a non palpable lesion

b. To see if the tumor extends to the surgical margin

Type- Mammography

Answers- a,b

Notes-

Cardenosa p363

by KW

2000 Board Question

152. Which of the following is diagnostic of a lymph node in breast sonography?

a. notched margin

b. lobulated

c. hyperechoic center

d. well circumscribed margin

Type- Mammography

Answers- c

Notes-

by KW

Dahnert p451

Hyperechoic lesion has a sensitivity of 100% for detecting benign lesions

Greater than 3 lobulations suggests malignancy

Hyperechoic center with hypoechogenic periphery is a lymph node

2000 Board Question

153. Which of the following is not an indication for breast cyst aspiration:

a. pain

b. increased size

c. low level echoes within it

d. lobulated margin

e. uncertainty whether the cyst corresponds to the mammogram abnormality

Type- Mammography

Answers- b

Notes-

Symptomatic, atypical us features, pain, low-level echoes

by KW

2000 Board Question

154. Which of the following is not the cause of ductal calcification:

a. Pagets disease

b. DCIS

c. Adenosis

d. Secretory disease

Type- Mammography

Answers- c

Notes-

by KW

2000 Board Question

155. Which of the following is the most consistent feature of inflammatory carcinoma of the breast?

a. Multicentric and multifocal carcinoma

b. Inflammatory reaction to the carcinoma

c. Invasion of the dermal lymphatics

Type- Mammography

Answers- c

Notes-

by KW

2000 Board Question

156. Which of the following may not be the appropriate step to decrease dose in mammogram?

a. Increase compression

b. Use faster screen film combination

c. Change to tungsten target

d. Decrease kvp

Type- Mammography

Answers- d

Notes-

by KW

Decreasing the kvp would increase exposure time and increase the dose, as more photons would be absorbed...

2000 Board Question

by CM

157. Which of the following should be checked monthly in mammography?

a. View box cleanliness

b. Darkroom cleanliness

c. Film-screen contact

d. Phantom

e. Visual checklist

Type- Mammography

Answers- e

Notes-

cardenosa31

e. Daily: darkroom cleanliness, processor quality control. Weekly: screen cleanliness, viewboxes and viewing conditions, phantom images. Monthly: Visual checklist. Quarterly: Repeat analysis, fixer retention analysis. Semi-annually: darkroom fog, screen-film contact, and compression. Physicists responsibility: mammo unit assembly evaluation, columniation assessment, focal spot size, kVp accuracy/reproducibility, beam quality assessment, AEC performance, uniformity of screen speed, breast entrance exposure and average glandular dose. (AFIP-2000)

1998 Board Question

by KH

158. A patient who has PE and is on heparin at 1000units/hr and PTT of 80. Now develops a cold, pale and swollen left lower extremity. What should be done?

a. Increase the heparin drip to 1500

b. Do a venogram

c. Do a arteriogram

d. Stop the heparin

Type- Angio

Answers- d

Notes-

by KW

Greenfield p106

Heparin induced thrombocytopenia, aggregate platelets causes embolic episodes..

2000 Board Question

159. A patient who uses crutch comes with blue tinge hands, intact pulses. Bounding axillary pulses and pain, tenderness and indurations in the axillary region:

a. Axillary artery thrombosis with distal microemboli

b. Axillary artery pseudoaneurysm with distal micro emboli

c. Reflex sympathetic dystrophy

Type- Angio

Answers- b

Notes-

by KW

2000 Board Question

160. Causes of unilateral rib notching except:

a. blalock taussig shunt

b. brachial stenosis

c. AVM of the extremity

d. left aortic arch with aberrant right subclavian artery.

e. coarctation between innominate and left common carotid

Type- Angio

Answers- b

Notes-

by KW

Dahnert p14

Peripheral AVM - specifically chest wall AVM

2000 Board Question

161. For catheter induced vasospasm in the popliteal artery. Treated best with intraarterial infusion of:

a. vasopressin

b. papaverine

c. nitroglycerine

d. tolazoline

Type- Angio

Answers- c

Notes-

by KW

IR Essentials p253 - Nitryo preferred for many reasons- short acting, safety, and established effectiveness

Papaverine vs nitroglycerine - Zeni likes nitro because it is short acting

2000 Board Question

162. In the figure of 8 configuration or snowmans heart, what causes the left bulge in the superior mediastinum (Patient with TAPVR) ?

a. Vertical vein

b. SVC

c. Pulmonary artery

Type- Angio

Answers- a

Notes-

by KW

Abrhams

2000 Board Question

163. One might encounter the highest pulmonary vascular resistance in:

a. Capillary bed

b. Muscular arterioles

c. Main pulmonary artery

d. Segmental pulmonary artery

Type- Angio

Answers- a

Notes-

by KW

Consensus needed....

2000 Board Question

Distribution of pulmonary resistance: about 30% arteries, 40% capillaries; 30% veins. This can change with lung inflation or during hypoxia.

Pulmonary vascular resistance

Resistance 1/10-1/15 of systemic

- allows high flow (ie. 100% of CO) without high input pressure (~15 vs ~100 mmHg)

high pressure

pulmonary hypertension

pulmonary edema

- Resistance in pulmonary circulation due mainly to capillaries c.f. systemic circulation:

muscular arterioles partially vasoconstricted; regulates blood flow

through different organs

164. Patient with pelvic fracture has large hematoma in the pelvis. Angio reveals bleeding from the obturator artery. What do you do next?

a. Peripheral embolization of obturator artery with gel foam and PVA

b. Emboilization of the origin of the internal iliac artery by GDC coils

c. Surgical ligation of the internal iliac artery

Type- Angio

Answers- a

Notes-

Per Phil Zeni

by KW

2000 Board Question

165. Regarding coronary artery calcification which is true?

a. It can happen without atherosclerosis if seen in patient over 70 years of age

b. Gated CT is not required if done fast enough

c. More severe the stenosis, more likely the calcification

Type- Angio

Answers- c

Notes-

by KW

2000 Board Question

166. Regarding effort thrombosis which is false?

a. Common in old woman

b. Occurs after a strenuous arm exercise

c. Thrombolysis of the clot is an acceptable treatment

d. Due to thoracic outlet syndrome

Type- Angio

Answers- a

Notes-

by KW

2000 Board Question

167. Regarding FMD of the carotid arteries. Which of the following is false:

a. Intracranial saccular aneurysm

b. Unilateral

c. String of beads appearance

d. ICA more common than ECA

Type- Angio

Answers- b

Notes-

by KW

Dahnert p233

Associated with aneurysms in 30%

String of beads of several cm is classic finding

Often bilateral in renal FMD

2000 Board Question

168. Regarding glucophage and contrast what is true?

a. Glucophage causes lactic acidosis in a patient with renal insufficiency

b. You cannot give contrast to someone who has not stopped glucophage 48 hours before the test

c. It causes renal failure if contrast is given

Type- Angio

Answers- a

Notes-

by KW

Consensus, previous question

2000 Board Question

169. Regarding transvaginal and transrectal abscess drainage which is false?

a. Crohns is a relative contraindication

b. Antibiotic should not be given before obtaining a sample for Culture and Sensitivity

c. Bleeding diathesis is a relative contraindication

Type- Angio

Answers- b

Notes-

Valji p393

by KW

2000 Board Question

170. The most specific sign for pericardial effusion is:

a. dilated azygos vein

b. non visualization of cardiac pulsation

c. bottle shaped heart

d. cephalization of cardiac vasculature

Type- Angio

Answers- b

Notes-

by KW

2000 Board Question

171. The reason why post MI pseudoaneurysm is important clinically is because:

a. can cause arrhythmias

b. cause systolic dysfunction

c. cause cardiac emboli

d. they can rupture

Type- Angio

Answers- d

Notes-

by KW

Dahnert p544

High risk of delayed rupture in pseudoaneurysms, less likely in true aneurysms

2000 Board Question

172. Trauma patient with holosystolic murmur and pulmonary edema:

a. Rupture of the papillary muscle

b. Rupture of the AV septum

Type- Angio

Answers- a

Notes-

by KW

Per Andy Ellzey

2000 Board Question

To date, only a few dozen reports of post-traumatic VSD can be found in the English literature.

Acute mitral regurgitation secondary to rupture of papillary muscle:

a) Trauma

b) Acute MI

c) Myocardial abscess

173. What is the absolute contraindication for transcatheter thrombolysis?

a. CVA in past 2 months

b. Pregnancy

Type- Angio

Answers- a

Notes-

by KW

IR Essentials p195

2000 Board Question

( This was one of the choices and I believe the correct answer also)

Contraindications and Cautions for Thrombolytic Use

Contraindications

- Previous hemorrhagic stroke at any time; other strokes or cerebrovascular events

within 1 year

- Known intracranial neoplasm

- Active internal bleeding (does not include menses)

- Suspected aortic dissection

Cautions/relative contraindications

- Severe uncontrolled hypertension on presentation (blood pressure .180/110 mm Hg)

- History of prior cerebrovascular accident or known intracerebral pathology not covered in contraindications

- Current use of anticoagulants in therapeutic doses (INR 2-3); known bleeding diathesis

- Recent trauma (within 2-4 weeks), including head trauma or traumatic or prolonged (.10 min) CPR or major surgery (,3 wk)

- Noncompressible vascular punctures

- Recent (within 2-4 weeks) internal bleeding

- For streptokinase/anistreplase: prior exposure (especially within 5 d-2 y) or prior allergic reaction

- Pregnancy

- Active peptic ulcer

- History of chronic severe hypertension

174. What is the indication for TIPS:

a. Variceal bleeding which has failed sclerotherapy

b. Hepatic encephalopathy

Type- Angio

Answers- a

Notes-

by KW

Dahnert p609

Indications

Gastric and variceal hemmorhage

Refractory ascites

Hepatorenal syndrome

2000 Board Question

175. Which disease causes abnormality of the cardiac valves:

a. Insulinoma

b. Hepatoma

c. Carcinoid tumor

Type- Angio

Answers- c

Notes-

by KW

Dahnert p665,591,601

Carcinoid with increased serotonin causes endocardial fibroelastosis, pulmonary valve stenosis, and right heart failure

2000 Board Question

176. Which does not have effect on the heart size?

a. KVP

b. Phase of respiration

c. Oblique positioning

d. Phase of cardiac cycle

e. Pa vs. ap

Type- Angio

Answers- a

Notes-

by KW

Consensus

2000 Board Question

177. Which is likely to cause a symptomatic vascular ring?

a. left aortic arch with aberrant right subclavian

b. right aortic with aberrant left subclavian

c. left pulmonary artery arising from the right pulmonary artery

d. mirror imaging branching

Type- Angio

Answers- c

Notes-

by KW

Dahnert p483,486

Mirror image branhing is asymptomatic

Right Arch with aberrant Left subclavian artery usually asymptomatic

Left Arch with aberrant Right subclavian artery usually asymptomatic

2000 Board Question

178. Which is not associated with left atrial enlargement:

a. Atresia of the mitral valve

b. Atrial fibrillation

c. Decreased compliance of the left ventricle

d. Atrial myxoma

Type- Angio

Answers- a

Notes-

by KW

Dahnert p531

2000 Board Question

Hypoplastic left heart syndrome

Mitral valve atresia and or aortic valve atresia result in a hypoplastic left heart (underdeveloped left heart). During fetal life the ductus arteriosus perfuses the aorta (including retrograde supply of the aortic arch and coronary arteries) and, thus, the right side of the heart performs the job of both sides of the heart. The outlook is poor for a baby with this condition.

179. Which is not true about post cardiac injury syndrome [Dresslers syndrome]:

a. Fever

b. Transient pulmonary infiltrates

c. Pericardial effusion

d. Pleural effusion

Type- Angio

Answers- b

Notes-

by KW

Dahnert p531

2000 Board Question

180. Which is the absolute contraindication for TIPS?

a. Portal vein thrombosis

b. Hepatic encephelopathy

c. Variceal bleeding

d. Ascitis

e. None of the above

Type- Angio

Answers- d

Notes-

by KW

IR Essentials p298

Abolute contraindications include Right Heart Failure, Polycystic Liver Disease, and Severe Hepatic Disease

Relative contraindications include Active Infection, Severe Hepatic Encephalopathy, and Portal Vein Thrombosis

Consensus

2000 Board Question

181. Which is the best MRI sequence for evaluating the flow dynamics in the heart?

a. T1 weighted spin echo

b. Gradient echo

c. Time of flight

d. ECG gated T2

e. T2 weighted spin echo

Type- Angio

Answers- b

Notes-

by KW

2000 Board Question

182. Which is the most sensitive sign of left atrial enlargement on frontal radiograph:

a. Double contour

b. Elevation of left main stem bronchus

c. A bump in the left heart border below the left hilum

Type- Angio

Answers- a

Notes-

double contour of right heart border

by KW

2000 Board Question

183. Which is true about angioplasty of renal artery stenosis?

a. FMD has a 30 % rupture rate

b. Ostial lesion respond better than non ostial lesion

c. Hypertension cure in 90% of the cases

d. Hypotension is a complication

e. Should not be performed if renin levels do not lateralize

Type- Angio

Answers- d

Notes-

by KW

Dahnert p792,794

Ipsilateral renin level increased 1.5/1 suggests significant stenosis

Angioplasty success 80% in non-ostial lesion, 25-30% in ostial lesions

2000 Board Question

184. Which is true about atrial myxoma?

a. Attached to mitral valve leaflets

b. Presents clinically similar to aortic stenosis

c. It is mobile and attaches to the atrial septum

Type- Angio

Answers- c

Notes-

by KW

Dahnert p531

attached to atrial septum by stalk near fossa ovalis

may protrude into the ventricle causing partial obstruction of the atrioventricular valve

2000 Board Question

185. Which of the following causes abnormal anterior motion of the anterior mitral valve leaflet?

a. mitral valve prolapse

b. mitral valve stenosis

c. IHSS

d. AS

Type- Angio

Answers- c

Notes-

by KW

Dahnert p513

2000 Board Question

186. Which of the following does not cause pulmonary arterial hypertension?

a. Chronic PE

b. COPD

c. Pulmonary AVM

d. Eisenmenger complex

Type- Angio

Answers- c

Notes-

by KW

Dahnert p405,524

+/- Pulmonary arterial hypertension in Emphysema

No mention of Pulmonary hypertension in Dahnert with Chronic PE

2000 Board Question

187. Which of the following is true regarding thyroglossal duct cysts?

a. Commonly demonstrate thick rim enhancement

b. Most often superficial to the strap muscles

c. Most often septated

d. Papillary carcinoma is the most common tumor to arise in these cysts

Type- Neuro

Answers- d

Notes-

D332

Thyroglossal duct cysts on CECT appear as a low density mass with a uniformly thin peripheral rim of enhancement. Septations occasionally are seen. located at or below the level of the hyoid bone are embedded in the strap muscles adjacent to the outer margin of the thyroid cartilage. Unlike, the thyroglossal duct cyst, other lesions found in this area are superficial to the strap muscles. Papillary carcinoma is the most common tumor to arise from these cysts(Head & Neck Imaging-Som p532-3).

Thyroglossal duct cysts are midline masses lined by squamous cell mucosa; suprahyoid 20%, hyoid 15%, infrahyoid 65%. Usually a midline / paramediancystic mass 2-4cm with infrahyoid strap muscles beaking over the edge of the cyst. Complications include infection, and duct carcinoma (<1%). (D254)

They appear on MR scan as well-circumscribed fluid-density structures in the midline. (TF)

Thickening and enhancement of the wall indicates infection.

AJNR Am J Neuroradiol 2000 Apr;21(4):770-4

Thyroglossal duct carcinoma should be suspected in an adult patient in the presence of a solid nodule or invasive features in association with a thyroglossal duct lesion visible on CT scans or MR images. The presence of calcification, which is seen best on CT scans, may be a specific marker for carcinoma.

Arch Pathol Lab Med 2000 Jan;124(1):139-42

The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occurs in about 1 % of thyroglossal duct cysts. Only 17 such cases diagnosed with fine-needle aspiration biopsy have been previously reported in the English-language literature, with a diagnostic rate of 53%.

Radiographics 1999 Jan-Feb;19(1):121-46; quiz 152-3

Cervical congenital cystic masses constitute an uncommon group of lesions usually diagnosed in infancy and childhood. The most common congenital neck mass is the thyroglossal duct cyst. The diagnosis is easily established from the presence of a cystic lesion in the anterior midline portion of the neck. The vast majority of branchial cleft cysts arise from the second branchial cleft. They can occur anywhere from the oropharyngeal tonsillar fossa to the supraclavicular region of the neck. Cystic hygroma is the most common form of lymphangioma. In the neck, cystic hygromas are most commonly found in the posterior cervical space. They typically extend into adjacent structures without respecting the fascial planes. Dermoid and epidermoid cysts result from sequestration of ectodermal tissue. The floor of the mouth is the most common location in the neck. Cervical thymic cysts are very uncommon lesions and are found anywhere from the angle of the mandible down to the sternum. Laryngoceles are classified into internal, external, and mixed types and have a frequent association with laryngeal carcinoma.

1998 Board Question

by CM

188. Which tumor is most likely to have drop mets:

a. Medulloblastoma

b. Ependymoma

Type- Neuro

Answers- a

Notes-

by KW

Dahnert p172

Up to 33% of Medulloblastomas have drop mets

Check Osborne

2000 Board Question

189. A 40 year old comes in with seizures. CT shows hypodensity in bilateral temporal lobe and cingulate gyrus without any mass effect. Most likely cause?

a. Low-grade glioma

b. Mesial temporal sclerosis

c. Herpes encephalitis

Type- Neuro

Answers- c

Notes-

by KW

Herpes usally associated with mass effect, classic location for herpes however.

Mesial temp sclerosis usually unilateral, after long standing epilepsy

2000 Board Question

190. A hyperdense mass with attenuation of 30-50 with surrounding well defined thin enhancement:

a. abcess

b. Lymphoma

c. high-grade glioma

d. aging hematoma

Type- Neuro

Answers- d

Notes-

by KW

Dahnert p238,248

Lymphoma could have this appearance... can have little edema.... check Osborne

2000 Board Question

191. A right paracentral L4/L5 disc herniation causes most likely causes which nerve impingement:

a. S-1

b. right l5

c. right l4

d. none

e. right l4 and l5

Type- Neuro

Answers- b

Notes-

by KW

Multiple repeats...

2000 Board Question

192. A young woman comes in with sudden onset of blurred vision. CT shows a pituitary mass with suprasellar extension. This mass has area of high attenuation and fluid level. Cause:

a. pituitary apoplexy

b. craniophyrangioma

c. sarcoidosis

d. germinoma

e. metastatic disease

Type- Neuro

Answers- a

Notes-

by KW

Dahnert p266

Pituitary apoplexy = massavie hemorrhage into pituitary adenoma with sudden infarction of pituitary gland

Patients present with headache, nausea, vomiting, acute visual defects

Sheehan syndrome = pituitary infarct of anterior pituitary gland post-partum

2000 Board Question

193. About posttraumatic vertebral collapse, which is true:

a. Development of large osteophytes

b. Involvement of the adjacent disc space

c. The vertebral body becomes increasing dense

d. Juxtaarticular erosions

Type- Neuro

Answers- c

Notes-

by KW

2000 Board Question

194. Brain MR reveals multiple bright areas of T2 signal intensity within the cortical and subcortical white matter of the occipital lobes bilaterally in a young woman. There is no evidence of hemorrhage or significant mass effect. Repeat MR imaging in 2 weeks is normal. This is most consistent with which of the following?

a. Superior sagittal sinus thrombosis

b. Eclampsia/Pre-eclampsia

c. Tip of the basilar artery syndrome

d. Herpetic encephalopathy

e. Progressive multifocal leukomalacia

Type- Neuro

Answers- b

Notes-

Progressive multifocal leukoencephalopathy (PML) produced by papova viruses is an uncommon progressive subacute demyelinating disorder of the CNS affecting immunologically compromised patients, commonly with chronic lymphocytic leukemia or Hodgkins disease. The diagnosis rests on the histopathologic examination of brain tissue since laboratory methods are of low yield. The lesions of PML tend to affect the subcortical white. CT may demonstrate an ill-defined low-density areas. Usually there is no significant enhancement or mass effect. A differentiation between PML and lymphoma or leukemic infiltration must be made because they are commonly associated. The lesions on MRI are seen as high-intensity areas limited to the white matter. At first the lesions are round or oval, then confluent and large, with no mass effect. The involvement is most often asymmetric. The findings are nonspecific; hence, demyelination, infarction, other infections, and malignant processes should be considered in the differential diagnosis.

The etiology of eclampsia and the other hypertensive encephalopathies is similar. The brain normally is protected by an autoregulation system that ensures constant perfusion over a range of systemic pressures. If these autoregulatory limits are exceeded, passive overdistention of the cerebral arterioles may occur and blood-brain barrier breakdown ensues. Interstitial extravasation of proteins and fluid results in multiple foci of reversible vasogenic edema. The posterior circulation is particularly prone to develop hypertensive encephalopathy related lesions. (D p857, Osborn p177-8).

Top of the basilar syndrome refers to occlusion of the distal basilar artery. The predominant lesions are found in the thalami, posterior limb of the internal capsule, mesencephalon, pons and posterior temporal and occipital lobes (Osborn p365).

Venous sinus thrombosis (D p275, Osborn p385-95). Herpes Encephalitis (D p230).

1999 Board Question

MR T2 -weighted image (TR 2000 msec, TE 70 msec) of acute sagittal sinus thrombosis with associated deep venous hemorrhagic infarct. The sagittal sinus is low in signal intensity because the clot is deoxyhemoglobin (white arrow). The venous infarction is hemorrhagic. (TF)

by CM

195. Branchial cleft cyst, which is true?

a. 1st Branchial arch more common

b. Commonest at the angle of mandible

c. Commonly presents in adolescent

d. Commonly multilocular

Type- Neuro

Answers- b

Notes-

by KW

Dahnert p301

Commonly in young to middle-aged adults

Second branchial cleft cyst is most common, 95%

They are commonly in the parotid space at the angle of the mandible and paraphyrangeal space

2000 Board Question

196. Child with dehydration and mental status changes. CT showing bilateral thalamic hemorrhage with mass effect. Cause:

a. basilar artery thrombosis

b. hemmorhagic PNET

c. deep vein thrombosis

Type- Neuro

Answers- c

Notes-

by KW

Dahnert p274

Dehydration in children is a risk for Sinus Thrombosis

Hemmorhage in gray and white matter unilateral in 2/3, bilateral in 1/3 of cases

Check Osborne for more specific findings

2000 Board Question

Straight sinus/Vein of galen thrombosis with bilateral thalamic infarction

197. Infants of diabetic mother can get which congenital abnormality:

a. meningomyelocele

b. caudal regression syndrome

c. renal agenesis

Type- Neuro

Answers- b,c

Notes-

by KW

Dahnert p161,791

Caudal regression associated with diabetic mothers in ~20% of cases

2000 Board Question

198. On SPECT imaging (ECD), which pattern does patient with Alzheimer have:

a. decreased activity in the parietal lobe

b. increased activity in the temporal lobe

c. increased activity in frontal lobe

Type- Neuro

Answers- a

Notes-

by KW

Per Tim Baker

Decreased uptake in the temporoparietal region

Check source

2000 Board Question

199. Patient with neurofibromatosis and has pulsatile exophthalmos:

a. Meningioma

b. Sphenoid wing dysplasia

c. CC fistula

d. Enlargement of the optic foramina

Type- Neuro

Answers- b

Notes-

by KW

Dahnert p261

Pulsitile exopthalmos due to herniation of subarachnoid space and temporal lobe into orbit...

Could be enlargement of the optic foramina or Sphenoid wing dysplasia...

But p260 states that defect in sphenoid bone leads to extension of middle cranial fossa into orbit

Also states that there is concentric enlargement of optic foramen due to optic glioma

2000 Board Question

Patients with neurofibromatosis may be pulsatile exophthalmos due to absence of the greater wing of sphenoid bone. The pulsation results from transmitted cranial pulsation

200. Patient with small subcortical shear injury. Which is the best MR sequence for evaluating it:

a. T1, T2 spin echo

b. Flair sequence

c. Gradient echo T2

Type- Neuro

Answers- c

Notes-

by KW

2000 Board Question

201. Patient with wernicks encephalopathy would have atrophy of which cranial structure:

a. caudate lobe

b. hippocampus

c. mamillary body

d. substantia niagra

Type- Neuro

Answers- c

Notes-

Osborn p764

by KW

2000 Board Question

202. Regarding anatomy of the orbit:

a. the trochlea is situated on the lateral side of the orbit

b. annulus of zinn divides the globe into anterior and posterior compartment

c. the ophthalmic artery is situated inferior to the superior opthalmic vein

d. the inferior oblique is supplied by the trochlear nerve

Type- Neuro

Answers- c

Notes-

by KW

See figure on Dahnert p285

Lateral Rectus - Abducens nerve

Superior Rectus Oblique - Trochlear nerve

2000 Board Question

203. Submental lymph node is classified as what level node:

a. 2

b. 1

c. 3

Type- Neuro

Answers- b

Notes-

by KW

Som p564

I - submental and submandibular

II - Suprahyoid IJ chain

III - Infrahyoid IJ chain to level of omohyoid

IV - Infraomohyoid IJ chain

V - Posterior triangle

VI - Thyroid nodes

VII - Tracheoesophageal nodes

2000 Board Question

204. The anterior longitudinal ligament is disrupted in which fracture?

a. pillar fracture

b. hyperextension strain

c. hyperextension dislocation

Type- Neuro

Answers- c

Notes-

by KW

Dahnert p169

Hyperextension teardrop fracture = avulsion of anteroinferior corner by anterior ligament (longitudinal?)

2000 Board Question

Whiplash or Hyperextension Strain

Whiplash or hyperextension strain is manifested on the x-ray by kyphotic angle of greater than 10 degrees and a fanning of interspinous process of 12 mm or more. On MRI examination whiplash injuries may show separation of the disc from the vertebral end-plate, anterior longitudinal ligament injuries, anterior annular tear, occult anterior vertebral end-plate fracture.

Hyperextension Dislocation

Hyperextension injuries have two mechanisms, direct anterior craniofacial trauma and rear-end motor vehicle collision resulting in forceful extension of the head (whiplash). It may be associated with disruption of the anterior longitudinal ligament and rupture of the adjacent disc. This injury is associated with significant morbidity and mortality due to the spinal cord damage. Older patients with spondylosis are more likely to have this injury because of the limited elasticity of the soft tissues. The majority of this injury appears in the neck and lower cervical spine. Radiographically, the changes are subtle, wide disc space, small avulsion fracture of the anterior-inferior end-plate, prevertebral soft tissue swelling is seen. MRI shows disruption of the anterior longitudinal ligament, disc disruption, prevertebral fluid and cord injury. This is an unstable and significant trauma.

205. The cause of the wallenburg syndrome is:

a. occlusion of ICA

b. occlusion of ipsilateral PICA

c. occlusion of superior cerebellar artery

d. occlusion of contralateral PICA

Type- Neuro

Answers- d

Notes-

Ipsi face, Contra body findings

by KW

Osborne p368

2000 Board Question

206. The most like location for an intraventricular Meningioma is:

a. aqueduct of sylvius

b. atria of the lateral ventricle

c. third ventricle

Type- Neuro

Answers- b

Notes-

by KW

Osborn 587,900

Intraventricular meningiomas typically occur around the choroid in the trigone of the

lateral venticle esp the left lat ventricle, p 68-73 Requisites

2000 Board Question

207. There was a simple question regarding the location of the facial nerve in the IAC:

a. Inferior to crista falciformis

b. Inferior to cochlear nerve

c. Superior to the cochlear nerve

Type- Neuro

Answers- c

Notes-

by KW

2000 Board Question

Dahnert p311

The facial nerve is superior and anterior in the IAC. So the facial nerve is

superior to crista falciformis and anterior to Bills Bar.

208. What is true about parotid gland tumors?

a. warthin tumors are more common in females

b. pleomorphic adenoma usually is located deep to the facial nerve

c. pleomorphic adenoma is the commonest

d. warthin tumors spread via perineural route

Type- Neuro

Answers- c

Notes-

by KW

Verified Dahnert p335, Som 321-325

Pleomorphic adenoma is most common benign tumor, more common in women greater than 40, is lateral to the facial nerve in greater than 80% of cases

Warthins more common in men

2000 Board Question

209. Which is false regarding Dyke Davidoff Mason syndrome or unilateral atrophy:

a. Enlargement of one side ventricles

b. Unilateral thick skull

c. Large paranasal sinuses

d. Underpneumatazition of mastoids

e. Unilateral decrease in size of cranial fossa

Type- Neuro

Answers- d

Notes-

by KW

Dahnert p229

This syndrome is an insult to immature brain resulting in neuronal loss and impaired brain growth

May be prenatal - congenital malformation, infection, or vascular insult

May be perinatal - birth trauma, anoxia and hypoxia, intracranial hemmorhage

May be postnatal - trauma, tumor, infection, prolonged febrile seizures

The above entail most of the findings, with contraction of a hemisphere or lobe

2000 Board Question

210. Which is most likely to cause acute neurological sequela:

a. Atlanto occipital dislocation

b. Isolate fracture of the posterior arch of C1

c. Hyperextension tear drop

Type- Neuro

Answers- a

Notes-

by KW

Verified Baby Resnick 800, 805, Dahnert p168

Check .... which has worse and more acute neurological sequela....

Both Hyperextension injury and AtlantoOccipital Dislocation share these findings

However, Atlantooccipital dislocation is rarely due to trauma (rheumatoid, downs, CPPD, etc)

Hyperextension injury is much more common, accounting for 25% of all cervical trauma cases

Could they have forgot the choice of hyperflexion tear drop, the most sever and unstable C-Spine injury...

2000 Board Question

211. Which is the most benign feature of thyroid mass?

a. Punctate calcification

b. Peripheral eggshell calcification

c. Multinodularity

Type- Neuro

Answers- c

Notes-

by KW

Ultrasound Requisites p450, Dahnert p304

Peripheral calcification more likely benign, small punctate calcification more likely malignant

I dont know how periphral calcification compares with multiplicity

A cold nodule in a multinodular thyroid carries a 1-6% risk of carcinoma, compared to 15-25% for solitary cold nodule

2000 Board Question

212. Which of the following is a contraindication for performing a MRI:

a. Stuart Edwards valve

b. Greenfield filter

c. hip prostheses

d. metallic foreign body within the eye

Type- Neuro

Answers- d

Notes-

by KW

2000 Board Question

Consensus...

Absolute contraindication means that the patient absolutely should not be scanned. This includes cardiac pacemakers, automatic internal defribrillators, implanted infusion pumps, implanted insulin pumps, bone growth stimulators, non-removable neurological stimulators, cochlear implants, metal in the eyes, shrapnel in vital locations, and tattooed eyeliners or lipsticks.

Relative contraindication means that some of these devices may and some may not be scanned. This includes aneurysm clips, penile prostheses, cardiac valve prostheses, middle ear prostheses, and shrapnel or foreign bodies in non-vital locations. Safe means that the device may be scanned without any problems. This typically includes orthopedic prostheses, pins, rods, plates, surgical clips (2-3 months post surgery), dental fillings, orthodontics, braces, root canal work, intrauterine devices, and contraceptive diaphragms. Controversial means that there is no general consensus on the safety of the device. This includes such things as Gianturco embolization coils, inferior vena cava filters, and endovascular stents. Dr. Frank Shellock, who has done a great deal of research regarding the MR compatability of various implants, cautions that his list cannot be taken as the final word. It is prudent to assume that no list of supposedly MR compatible devices is absolutely correct. Paraphrasing Dr. Shellock from his latest pocket guide on MR procedures, ... a manufacturer may change the composition of the implant, material, device or object without going back to the FDA for new approval as long as the function of the device remains the same ... Of course the final decision, when there is a question of safety, is the responsibility of the physician.

Contraindicacions of MRI exam:

-Pacemakers, defibrillators or neurostimulators

-CNS surgical clips

-Ocular implants or foreign bodies

-Metallic fragments near a vital structure

-Othologic implants or hearing aids

-Starr-Edwards mitral prosthetic heart valve pre-6000 series

-Claustrophobia

-Thermodilution catheters, pulse oximeters, standard ECG wires and leads

-Pregnancy (controversial)