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2003 practice questions


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Ebstein’s anomaly is associated with an abnormality of which valve?
a. Aortic

b. Pulmonic

c. Tricuspid

d. Mitral
C. Tricuspid
The umbilical cord has

a. 1 artery, 1 vein
b. 2 arteries, 1 vein
c. 1 artery, 2 veins
d. 2 arteries, 2 veins
b. 2 arteries, 1 vein
A rim of increased activity is seen near the gall bladder fossa on a HIDA scan in a patient with cholecystitis. What causes this?

a. Uptake in the GB wall
b. Hyperemia in the adjacent liver parenchyma
c. Bile leak
b. Hyperemia in the adjacent liver parenchyma
Metastasis to the ovary can simulate stage III cancer. Which of these primary cancers would not give drop metastases to the ovary?

a.Renal cell
b.Adeno CA of colon
a. Renal Cell??
Reversal renal artery diastolic flow on US shortly after transplant
a. rejection
b. obstruction
c. renal art stenosis
d. renal vein thrombosis
Choice D.
Ultrasound, the requisites, pg. 113. “Totally occlusive renal vein thrombosis produces an enlarged kidney on gray scale. The venous outflow obstruction results in diminished arterial inflow and causes a high resistance arterial waveform. In some instances, pandiastolic flow reversal occurs, and this should always raise a suspicion of underlying renal vein thrombosis.” Most commonly occurs in the first three days post transplant.
Patient is two days s/p renal transplant and is anuric. Renal US shows swollen kidney with reversal of diastolic flow in the renal artery. What is the most likely cause?
Most clinically significant abnormality detected on venogram before filter placement
a. retroaortic left renal vein
b. circumaortic left renal vein
c. duplicated IVC
d. left IVC
e. azygous continuation
Choice C.
This is in Beall’s Sourcebook, pg. 68. Common sense: two IVC’s, two filters. It talks about recurrent PE’s in Dahnert as well as a resulting complication .(pg 585) However, it also mentions the problematic access of transjugular access for filter placement with a left IVC (pg 586). Most clinically significant would be the one that doesn’t fix the problem (duplicated IVC’s) if you only put in one filter, and not one that is a little more tricky to do?!
3 cm mass in endometrial cavity found on HSG, low T1 and T2 on MRI most likely:
a. endometriosis
b. adenomyosis
c. polyp
d. endometrial ca
Choice B.
Dahnert, Pg. 1022 Adenomyosis is hypointense on all pulse sequences, and can be focal (2-7 cm) in 33%. Endometriosis interna IS adenomyosis, but given adenomyosis is a choice, this is a better answer. Endometrial Ca has lower signal than endometrium, but higher than the myometrium on T2WI. Pg 1032, Dahnert.
Indium INFERIOR to Gallium for which:
a. prosthetic loosening
b. acute inflammatory discitis
c. acute osteomyelitis of foot
d. intrapelvic abscess
e. inflammatory bowel disease
Choice B.
Aunt Minnie’s Nuclear Medicine On-line reference states that Indium has a high false negative rate up to 80% in the spine.
Discitis most often involves the lumbar spine. However, there is increased incidence of cervical spine discitis in IVDU, and TB likes the thoracic spine. Multiple levels are also affected with TB, as the infection extends underneath the longitudinal ligament. Staph is the most common organism, and kids are more prone secondary to vascular supply of the spine. Dahnert and On-line Aunt Minnie.
All of the following a/w tuberous sclerosis EXCEPT:
a. AML
b. Renal cystic disease
c. Rhabdomyoma
d. Sphenoid wing dysplasia
e. Giant cell astrocytoma
Choice D.
ZITS, FITS, NITWITS (all my ex’s must have had a variant of this.)
Autosomal Dominant
Giant Cell Astrocytomas in 15%, subependymal location with most common locale near the foramen of Monro.
Cortical tubers in 56% with masslike, curvilinear calcification, and large, misshapen broadened gyri.
Adenoma Sebaceum (the zits part of above) 80-90%, wart like. Bimalar distribution “butterfly rash”. Can also have Shagreen patches (desc as pigskin), Ash Leaf patches, Café Au Lait spots (that is right, just like NF1), and ungal fibromas (15-50%)
Subependymal Hamartomas along ventricular surface of caudate, and on lamina of sulcus thalamostriatus immediated posterior to foramen of Monro
Heterotopic Gray Matter in up to 93%. Gray matter in the white matter. No shit, Sherlock.
Rhabdomyoma, most commonly in the ventricle (70%), seen in 5-30% of the T.S. pts.
Angiomyolipoma, 38-89%. Usually multiple and bilateral, with biggest complication being hemorrhage.
Renal Cystic Disease, 15%. Can mimic ADPCKD.
These kids can also get renal cell carcinoma, with bilateral involvement in 40%. Overall incidence is low though, with only 1-3%.
Bones show periosteal thickening of the long bones, and 45% have sclerotic calvarial patches.

Dahnert, of course. Pg 326.
Pulmonary capillary wedge pressure at which interstitial edema is seen:
a. 0-5 (mm of Mercury)
b. 5-10
c. 10-15
d. 20-25
e. 30-40
Choice D.
TJ actually talks about this pearl all the time. Who knew he actually had some wisdom underneath all those dirty jokes? Unfortunately, not me, so I had to go look it up. Clinical Medicine, pg 684, by Kumar and Clark states interstitial edema occurs with pressures greater than 20mmHg, and alveolar edema occurs at pressures greater than 30mmHg, when capillary pressures exceed the oncotic pressures.
Kerley B lines and pleural effusions in neonate all EXCEPT
a. hypoplastic left heart
b. Tetrology of Fallot
c. Wet lung
Choice B.
Tet babies have pulmonary stenosis with decreased pulmonary markings and decreased pulmonary flow. HLHS babies, on the other hand, have aortic outflow problems, and demonstrate CHF findings with pulmonary vascularity engorgement and edema. What part of wet lung doesn’t sound like effusion and CHF, hmmm?
Woman has XRT and radiation for breast CA which is true:
a.needs q 6 mo mammo f/u for 4 years
b. most local recurrences within first 2 years
c. most dystrophic calcs develop after 2-3 years
d. F/U mammo 85-90 % sensitivity for detecti
Choice C.
Primer says (pg 733 in the new fat version, or phat version, whichever you prefer)
“The postradiation mammograms should be performed 6 months after initiation of therapy and followed annually” So A. choice is out. Although the AFIP breast chic said that you can do them q 6months for 2-3 years. Mendelson , in “Evaluation of the postoperative breast.”Radiol Clin North Am. 1992 Jan;30(1):107-38. Review, recommends 6 month follow up q 6 months until radiolgraphic stability is established.
FYI, Dose is 50Gy and boosting 60-75 Gy at lumpectomy site.
The Purple Primer also states that benign dystrophic calcifications arise 2-4 years after XRT, and appear large with a central lucency. In Petropoulou terms, that makes choice C particularly sexy.
I had a hell of a time finding anything about sensitivity, but I doubt it’s that high. Why would MRI be so popular post operatively if the sensitivity was so great? Comparison of magnetic resonance imaging and conventional triple assessment in locally recurrent breast cancer.Br J Surg. 1997 Aug;84(8):1147-51 is an article I found that cited MR sensitivity of 93%, and Mamm sensitivity of 50%.
. Which is LEAST LIKELY to be associated with increased risk of radiation induced thermal injury:
a. Use of magnification
b. changing angles of C arm
c. use of pulsed fluoro
d. distance pt to II
e. distance pt to tube
Choice B.
Everything that I found referenced 200mR per view as standard. SO⬦ if there is the same dose with different views, changing the angles of the C arm to get the different views must not change the dose.
Ack! Physics, Schmysics.
And for those of your particularly freakish about dosage to your little grandmother who has had a million mammograms, the risk of 1 mammography study is equivalent to eating 40 TBSP of peanut butter. Take that, Peter Pan. Jelly not included. (Pg 709 of the primer, for all you non-believers out there.)
Seminal Vesicle cysts are most commonly associated with:
a. Ipsilateral renal agenesis
b. Ipsilateral renal ectopia
c. Ipsilateral Inguinal hernia
d. Ipsilateral Renal cystic disease
e. Contralateral cryptorchidism
Choice A.
If you ask Dr Dan, I’m sure the answer is promisicuity. However, since that isn’t an option…
Dahnert, pg 965. Acquired cysts are associated with ADPCKD, Bladder Cancer, BPH, Infection and Ejaculatory Duct Obstruction. Congenital cysts are associated with Ectopic ureter (92%), Ipsilateral renal dysgenesis (80%) –same as agenesis?!, Duplicated System, and Agenesis of the Vas Deferens. Given the choices, renal agenesis is probably the most appropriate answer, since ADPCKD usually affects both kidneys. Unless the question was remembered wrong, and ureteral ectopia was option B. Then that is the answer.
MALT lymphoma is associated most commonly with
b. H. Pylori
c. Menetrie’s Disease
Choice B.
Dahnert, pg 841. MALT (low grade mucosa-associated lymphoid tissue) B-cell lymphoma has a 90% association of H. Pylori gastritis, and represents 50-72% of all primary gastric lymphomas.
Menetrier’s Disease is characterized by lots o’ mucus, with the TRIAD of giant mucosal hypertrophy, hypochlorydia, and hypoproteinemia.
A Blalock-Taussig shunt is an anastamosis of:
a. right subclavian artery to the right pulmonary artery.
b. Right subclavian artery to the left pulmonary artery.
c. SVC to the right pulmonary artery
d. Ascending aorta to the right pulm
Choice A.
Old question. Just for giggles:
Fontan procedure (definitive repair in older patients for tricuspid atresia)-connects RA to main PA and closes the ASD
Blalock Taussig (palliative repair in tricuspid atresia with pulmonary stenosis and TET)
Blalock Hanlon (palliative repair of transposition)-creation of an ASD
Glenn Shunt (palliative repair in tricuspid atresia)-connects the SVC to the RPA. Like the Blalock Taussig, but different.
AP Window Shunt (reversible repair of TET)-connects the asc. Aorta to the LPA.
Oz Procedure- gives the tinman the heart, you fool!
Norwood Procedure (Hypoplastic Left Heart repair)-creates a “neoaorta” but is way too tiring for me to explain how. Ask Knott-Craig. Also makes a shunt between the inominate and the right main pulmonary artery.
POTT shunt-(TET repair)-descending aorta connected to the left pulmonary artery
Repair of Transposition can be done by the Rashkind or the Rastelli procedures. Hearts R ASs backwards with transposition. Mustard repair is another for complete transposition.
RAShkind-balloon atrial septostomy for complete transposition
RAStelli-RV connected to the pulmonary trunk via an external coduit (porcine valve) for transposition.
Mustard- atrial septum removed, and “pericardial baffle” placed into common atrium.
In a Patient with Schizencephally, what lines the cleft?
a. Gray matter
b. White matter
c. Arachnoid
Choice A.
Dahnert, pg 319. Gray matter lining the cleft is pathognomonic for schizencephaly, which is a full-thickness CSF filled cleft extending from the lateral ventricle to the subarachnoid space.
Patient is a 24 year old female with palpitations and family history of heart disease. Patient’s brother died from sudden cardiac death at age 28. On T1 weighted MR images, the patient has several foci of high signal within the free wall of the right v
Choice D.
I got this answer from the site. MR findings characteristic for RV dysplasia are fatty infiltration of the right ventricle. Also mentioned were the family history and sudden cardiac death in 5% of those under 65, and 3-4% during sports. Palpitations of the patient also tip you off to the arrhythmia part. (It’s so nice of them to drop a few hints now and then.)
Patient is an adult male with left lower quadrant pain. There is a 2 cm focus of fat attenuation adjacent to the descending colon with a well defined rim and adjacent fatty stranding. The most likely etiology is:
a. Descending colon diverticulitis.<
Choice C.
Alright, the tip off to this is the fat characteristic, and associated inflammation, although that doesn’t help much because all the answers are “itis” variants.
Once again, Dahnert, said it, pg 817-818. CT shows fat attenuation (-60 HU) of a pericolic pedunculated mass 1-4 cm with a hyperattenuating peripheral rim and internal fat stranding is also seen. Pretty good fit for choice C.

Meckels-nah. Bad age, given that this is an adult, and most are <10 years upon diagnosis. Male gender is good, as meckels are more often in men than women 3:1. Bad locale. Usually within 2 feet of the ileocecal valve. Dahnert says within 6 feet of the terminal ileum.

Diverticulitis would explain the itis part of it, but fat attenuation is more characteristic of epiploic appendagitis.
Vital capacity is defined as:
a. Maximum amount of air that can be exhaled following maximum inspiration.
b. Volume of lungs following maximum inspiration
c. Volume of lungs following maximum espiration
d. Volume between end normal in
Choice A.
Basic physiology 101. They like this, though. It is on some old recalls. However, if you would like a reference, see They describe it as the maximum amount of air exhaled following a maximal inspiration. Choice A.
You have three mammography machines and on one day you note that the films from all of the machines have low contrast. The most likely etiology is:
a. Power supply
b. Fixer
c. Developer temperature
d. Wrong kvp
e. AEC
Choice C.
I hate physics. Common sense says this isn’t KVp, which would be inherent to a particular machine. Power supply? No. Machine is on, or it isn’t. AEC would also be inherent to the machine, so the likelihood for problems on all three machines at the same time would be too weird. That leaves film problems, which is either B or C. Developer Temperature, when increased, increases contrast but increases fog as well. I would expect a decrease in temperature to do the opposite. I choose C for $500 Alex.
Chance fracture is caused by:
a. Lateral rotation
b. Anterior distraction
c. Posterior distraction
d. Posterior compression
e. Axial compression
C. Posterior distraction per learning radiology.Classically, this is a seatbelt type injury, before they started using the across the chest type belts. If your car is 1974… beware the chance fracture!! Flexion distratction is the mechanism, and usually is posterior in location, given that the car stops and your upper half continues to move ahead at 70mph. This was confirmed with the good Dr Sweet, but you can look elsewhere if you like. Just don’t drive with your lapbelt at 70 mph to get to the reference
55 year old male has atypical chest pain. Electron Beam CT reveals no coronary artery calcifications. The chance that he has significant coronary artery stenosis is:
a. 0-15%
b. 20-25%
c. 30-40%
d. 50-60%
e. 70-85%
Choice A.
The key word is significant and stenosis. A calcification score <20 strongly correlated with the absence of significant luminal narrowing, and a 0 calcification score had a negative predictive value of 87.5, and AFIP guy Boxt, quoted a less than 5% chance of significant CAD with a calcium score of 0. He also said that the converse of this, calcium score and positive predictive value, sucks overall.
Constrictive Pericarditis is clinically most similar to which of the following?
a. Restrictive cardiomyopathy
b. Aortic insufficiency
c. Aortic stenosis
d. Mitral stenosis
Choice A.
Restrictive Cardiomyopathy: Etiology in Dahnert, pg 622 is listed as idiopathic (endomyocardial fibroelastosis), infiltrative (amyloid, hemachromatosis, sarcoidosis), or for #3, CONSTRICTIVE PERICARDITIS. So I’m not sure what they’re asking. If one causes the other, than heck yes, they’ll look the same. They are the same in that case?! Lipton, AFIP guy on pericardial disease, stated the difference in the two entities being signs of restriction with restrictive, where constrictive is thickening without the “restrictive” signs, such as loss of the triangular configuration of the ventricle. Calcium can be seen in both
Patient is a 77 year old female with chronic dry cough. On CT, there is bronchiectasis and patchy ASD/nodular opacities greatest in the RML and lingua. The most likely etiology is:
a. MAI
This is the only remembered answer. Here’s a little ditty on MAI:
E-medicine, topic 413. Nontuberculous mycobacteria infections.
Mycobacterium Avium-intracellulare Complex
More prevalent in whites, unless you have AIDS, then it’s anyone’s game.
“ Two typical patterns of NTM infections of the lung have been noted. Elderly males with chronic obstructive pulmonary disease (COPD) are more commonly affected with the more prevalent pattern that mimics TB, whereas middle-aged to elderly women characteristically have focal bronchiectasis and scarring in absence of underlying pulmonary disease”
“… patients with MAI infection may be distinguished from those with MTB by the presence of widespread bronchiectasis, particularly if it involves the right middle lobe and the lingula. Cavitation is usually associated with positive sputum results.”
Cortical Atrophy and pial enhancement is seen on MRI with abnormal low T1 foci in the subcortical region. The most likely etiology is:
a. Sturge weber
b. Osler Weber Rendu
c. Tuberous sclerosis
d. VHL
Choice A.
Low T1 Foci most likely represent subcortical calcification. Leptomeningial enhancement involving the Pia only is also mentioned, and these guys get cortical atrophy as well.
VHL-cerebellar hemangioblastomas, usually multiple. Cystic with mural nodule most common.
Osler-Webber Rendu-multiple telangiectasias. AVMs, too.
Tuberous Sclerosis-gray matter heterotopia, subcortical tubers and ZITS and FITS, too. (I gave a ditty on this one already.)
What is the most characteristic feature of thyroid malignancy?
a Peripheral egg-shell calcifications
b Punctuate calcifications
c Hypervascularity
d Heterogeneous echoes
Choice B.
Hypervascularity, yes. But so is everything else. Punctate calcifications are characteristic.
Dahnert, pg 396. Papillary Carcinoma is the most common (70%), with mixed papillary/follicular the next most common. 5th decade, F>M. (This is also true for follicular type) Punctate/Linear psammomatous calcifications at tumor periphery.
For some reason, in the intro part to Dahnert, it lists thyroid cancer stats as being M>F and less than 30yrs. MAYBE they mean if you’re less than 30, and you get cancer of the thyroid, chances are you are also male. Who knows…
RUL edema. What are possible causes?
a Mitral stenosis
b Tricuspic regurg
c Mitral regurg
d Aortic stenosis
Choice C.
PATHOGNOMOIC, according to Dahnert, pt 635. Why? Preferential flow of regurgitant jet into pulmonary vein of RUL. Seen in 9%.
Absolute contraindication to pulmonary angiogram.
Pulmonary hypertension. There is a relative contraindication as well to LBBB as well.
Repeat with a twist: 62 yo man s/p ACA aneurysm clip 2 weeks ago presents with lower extremity weakness and decreased arousability. Most likely cause?
I looked this up and consulted with various and sundry people, but we’re scratching our heads. Vasospasm is a well known post procedural cause with possible subsequent stroke and focal neurological deficits. Comments from the peanuts in the gallery?
60 yo man presents with acute appendicitis. What plain film finding is most specific for ruptured appendicitis? (or something like that)
In conjunction with abdominal pain, an appendicolith gives a 90% probability of acute appendicitis. There is also an associated high probability of perforation. Appendicolith is seen in only 7-15% of patients.
Other fingings:
Cecal wall thickening
Paucity of intestinal gas in the RLQ (seen in 24% of perforations)
SBO appearance (seen in 43% of perforations)
Free air in 33% of perforations
Loss of fat planes.
Multiple (10 or so) small 2-3 mm ulcers in the mid-esophagus in an HIV+ patient. Most likely etiology
a. herpes
b. candida
c. CMV
d. Reflux
Choice A.
Small plaques would be great for candida, especially given immune compromised status. However, they are not usually ulcerative. This is more typical for CMV and HSV. CMV prevalence in comparison to herpes is 40% vs 5%. Both do not usually occur until CD4 counts are below 100. HSV is best for this appearance, giving rise to multiple small ulcers, where CMV ulcers are usually large. Wilcox on “Diagnosis and mgmt of esophageal disease in AIDS patients” Current Concepts of the Southern Medical Journal, 1998, Vol 91, No. 11
Most specific sign on plain film of chest dehisence following sternotomy for CABG
Acute break of sternotomy wire
Rotation of sternotomy wires
Displacement, Rotation and then Disruption, in that order, account for radiographic findins of sternal dehiscence.
“The chest radiographs revealed sternal wire abnormalities in 17 (89%) of 19 patients with sternal dehiscence, including displacement in 16 (84%) of 19 patients, rotation in 10 (53%) of 19 patients, and disruption in four (21%) of 19 patients. The mean number of displaced wires per patient was 2.3 (range, 1-5).” Wandering wires: frequency of sternal wire abnormalities in patients with sternal dehiscence. AJR Am J Roentgenol. 1999 Sep;173(3):777-80. PMID: 10470922 [PubMed - indexed for MEDLINE]
Hayward, in his article, Sternal dehiscence. Early detection by radiography. J Thorac Cardiovasc Surg. 1994 Oct;108(4):616-9. PMID: 7934093 basically says the same thing, and reiterates that this often precedes clinical findings.
In 2002, Boiselle mentions the midsternal stripe sign, but then goes on to conclude that its appearance is infrequent enough to not help out anybody a whole lot.
Pt presents with inward rotation of foot, foreshortening of leg, and adduction. What is most likely cause?
a Anterior dislocation
b Posterior dislocation
c Femoral neck fx
Choice B. E-Medicine for hip dislocation.
• Posterior hip dislocations
o The affected limb is shortened, adducted, and internally rotated, with the hip and knee held in slight flexion.
o Patient may be unable to walk or adduct the leg.
o Signs of vascular or sciatic nerve injury may be present.
 Pain in hip, buttock, and posterior leg
 Loss of sensation in posterior leg and foot
 Loss of dorsiflexion (peroneal branch) or plantar flexion (tibial branch)
 Loss of deep tendon reflexes (DTRs) at the ankle
 Local hematoma
• Anterior hip dislocation
o The leg is externally rotated, abducted, and extended at the hip. The femoral head may be palpated anterior to the pelvis.
o Signs of injury to the femoral nerve or artery may be present.
 Paresis of lower extremity
 Dull, aching pain in lower extremity
 Weak or absent DTR at knee
 Lower extremity pale and/or cool to touch
 Paresthesias of lower extremity
• Central dislocation
o The leg is shortened, abducted or adducted, and internally or externally rotated depending on the type and extent of penetration into the pelvis.
o The typical posture of the leg with anterior or posterior hip dislocation may not be seen if an associated femoral shaft fracture is present. The leg distal to the fracture assumes a neutral position, masking the usual rotation seen with a dislocation. The incidence of missed hip dislocation is much higher in the presence of a femoral shaft fracture.
Cronkite Canada and the nail dysplasia.
Cronkhite-Canada Syndrome—
nonneoplastic nonhereditary hamartomatous polyps associated with ectodermal abnormalities and no familial predisposition
62 yrs, M<F
nail atrophy
weight loss and anorexia
thickened gastric rugae
multiple polyps, can be cystic degeneration filled with mucinous material.
brownish macules of hands and feet
stomach 100%, colon 100%, and small bowel <50%
Chicks die in 6-18 months from cachexia, and the boys do okay for some reason.
Which of the following is least likely to be seen with intracranial hypotension?
Dural (or meningeal) enhancement
Peg-like tonsils
Effaced subarachnoid cisterns
Positional headache
Choice A.
From Amersham health website “SIH is similar to postlumbar puncture postural headache in that it is aggravated by sitting or standing and relieved by lying down. Other associated symptoms, seen less commonly, include stiff neck, nausea and vomiting, diplopia and cranial neuropathies, producing vertigo, tinnitus, photophobia and changes in hearing…The diagnostic intracranial imaging findings include diffuse, intense pachymeningeal enhancement on post contrast T1-weighted sequences (Fig.1) with characteristic continuous involvement of the dura and sparing of the leptomeninges. The cause of intracranial pachymeningeal enhancement is postulated to be vascular dilatation within the dura mater secondary to pressure imbalances. Other intracranial MR findings include subdural fluid collections, thought to result from hydrostatic pressure changes in the CSF, and downward displacement of the brain structures seen on midsagittal images, presumably caused by low CSF pressure. Slit-like ventricles and small basal cisterns and sylvian fissures have also been described on cross-sectional imaging studies.”
. Which of the following does not cause thickening of the endometrial stripe?
Endometrial hyperplasia
Endometrial cancer
Endometrial polyp
Choice A. Adenomyosis.
Old Dahnert, page 853. States that Adenomyosis is invasion of myometrium with endometrium with abnormalities seen within the myometrium and loss of the junctional zone.
Complete cartilaginous tracheal rings are associated with which of the following?
Double arch
Pulmonary sling
Posterior right aortic arch
Posterior left aortic arch
Aberrant subclavian artery
Choice B.
Pg 505 in the old Dahnert. Pulmonary slings are associated with “napkin ring” trachea in approximately 50%. (Pulmonary sling=aberrant left pulmonary artery)
The esophagus does not contain which of the following?
Longitudinal muscle
Circular muscle
Muscularis mucosa
Choice A.
Selective catheter-directed thrombolysis is absolutely contraindicated with which of the following?
Stroke in past 2 weeks
Heme positive stools
INR 1.4
Platelet count 125,000
Given the list below, Choice B. is the best absolute contraindication.

Absolute contraindications to thrombolysis, include the following:
1. Previous hemorrhagic stroke at any time
2. Other strokes or cerebrovascular events, within one year
3. Known intracranial neoplasm
4. Active internal bleeding (except menses)
5. Suspected aortic dissection
6. Acute pericarditis
Relative contraindications to thrombolysis, include the following:
1. Severe, uncontrolled hypertension on presentation (i.e., blood pressure >180/110 mm Hg)
2. Current use of anticoagulants in therapeutic doses
3. Known bleeding problems
4. Recent trauma (i.e., within 2 to 4 weeks) including head trauma or traumatic or prolonged (i.e., >10minutes) cardiopulmonary resuscitation (CPR)
5. Recent major surgery (i.e., within 3 weeks)
6. Non-compressible vascular punctures
7. Recent internal bleeding (i.e., within 2 to 4 weeks)
8. Prior exposure to streptokinase, if that agent is to be administered (i.e., 5 days to 2 years)
9. Pregnancy
10. Active peptic ulcer
11. History of chronic, severe hypertension
12. Age >75 years
13. Stroke Risk Score > 4 risk factors:
o Age >75 years
o Female
o African American descent
o Prior stroke
o Admission systolic blood pressure >160 mm Hg
o Use of alteplase
o Excessive anticoagulation (i.e., INR >4; APTT >24)
o Below median weight (<65 kg for women; <80 kg for men)
Catheter directed embolization of either AVM or a bronchial artery?
Small particles
Choice A. Coils are best for bronchial artery embolization, because absolute alcohol, boiling contrast or particulate powders produce occlusion at the level of the smallest vessels and accomplish tissue necrosis. This is bad. Also, in bronchial artery embolization there is associated risk of bronchial or esophageal infarction or spinal cord damage with the above technique.

Interventional handbook.
I123 in thyroid cancer screening
Cost prohibitive in most clinical situations
Thyroid suppression form high proton flux
Kev suboptimal for imaging
I’d assume it is a., because it is produced by a cyclotron and therefore expensive. (Purple Primer, pg 923)
What is the arterial supply to the hippocampus?
Anterior choroidal
Choice D. The answer I found was the anterior division of the cortical branches of the PCA. So the first three are out. Beyond that, if I was going to do Vegas, I’d have to say Anterior choroidal. Plus, it says so at this website:
In a patient with a right renal artery stenosis, what is the finding one hour after a captopril DTPA study?
Increased initial uptake in right kidney
Decreased initial uptake in right kidney
Increase in GFR
Choice B. Per Dahnert, criteria for high probability with a Captopril enhanced renography,
reduction in relative uptake with a >10% change after ACE inhibition
prolongation of parenchymal transit time and delayed excretion
prolongation of Tmax>2 minutes
Doming of the aortic valve on cardiac MR cine images is associated with which of the following?
Bicuspid valve
Aortic insufficiency
Supravalvular stenosis
Tricuspid atresia
Choice A. E-medicine article says that the bicuspid valve demonstrates a dome shape during systole due to limited opening.
With regards to pancreatic divisum
a Most common cause of pancreatitis
b Stenosis of the minor papilla is associated with pancreatitis
c Major papilla drains the dorsal duct
d Increased incidence of pancreatic cancer
Choice B. Dahnert, pg 599 (old version)
Pancreatic Divisum occurs about 3-7% in the normal population. The Santorini (dorsal) duct drains through the minor papilla and the Wirsung (ventral) duct drains through the major papilla. Minor papilla stenosis predisposes to nonalcoholic recurrent pancreatitis in dorsal segment.
No mention of associated cancer.
After injecting IV contrast for a CT scan, the patient becomes hypotensive and bradycardic. What is the most appropriate next step? (doses were also given)
a Atropine
b Epinephrine
c Norepinephrine
d Benadryl
e Elevated patients
Choice A.
Give the patient atropine with bradycardia and hypotension, but first you should elevate the legs, trenelenberg them, and give volume expanders (saline). Back page of Dahnert.
Which of the following is a clinically significant complication of pseudoaneurysm following myocardial infarction?
A. Life threatening arrhythmias
B. Thrombotic emboli
C. Tendency to rupture
Choice C.
Relatively high incidence of delayed rupture is seen with pseudoaneurysm following MI. Ruptures through three layers with containment via the pericardial sac and surrounding supportive tissue. Posterior wall is most frequent.
Which of the following modalities is most useful in diagnosing Asherman's (intrauterine synaechie)
A. Hystersalpingogram
B. Pelvic Ultrasound
C. Pelvic MRI
D. Pelvic CT
Choice A.
Asherman’s syndrome:
Intrauterine adhesions with menstrual dysfunction and infertility, secondary to endometrial trauma during postpartum or post abortion period (Dahnert) Diagnosed by HSG, showing solitary or multiple filling defects, bands of tissue traversing the uterine cavity, and partial or near complete obliteration of uterine cavity.
Which of the following is most likely to have drop mets. (2000)
A. Epidermoid
C. Medulloblastoma
D. Brain Stem Glioma
E. Choriod Plexus Papilloma
Choice C.
Dahnert, NEW ed. Pg 299
Drop mets seen with Medulloblastoma in 40%, with subarachnoid metastatic spread.
Post surgical mets can occur outside the CNS in the lung, lymph nodes and axial skeleton.
Which of the following is NOT true regarding GB cancer.
A. Poor 5 year prognosis
B. Contiguous invasion of the liver.
C. Most common presentation is a polypoid lesion
D. Usually associated with Gallstones
E. More common in women
Choice C. Dahnert, pg 705. Most common presentation is a mass replacing the gallbladder, with 75% having extension/mets at time of diagnosis. Having said that, a polyp larger than 2cm better come out, because it has a greater chance of being malignant. Cholelithiasis is associated with 74-92%, but only 1% of those with cholelithiasis will have cancer. Women are more commonly affected, because they have the higher incidence of gallbladder stones.
. Which of the following are true about carcinoid
A. Appendiceal carcinoid are usually benign
B. Patients with carcinoid tend not to have distant mets
C. Majority of patients get carcinoid syndrome
D. Patients with carcinoid present w
Choice A.
Appendiceal carcinoma is usually benign, with metastasis in only 3%. They also demonstrate slow growth. Of all carcinoids, the appendiceal ones comprise 30-45%. Pg 802, Phat Dahnert.

This is the tumor of 1/3:
1/3 occur in small bowel (1/3rd will have mets in this group)
1/3 are multiple
1/3rd have a second malignancy

Endocardial fibroelastosis does occur with liver mets and with primary pulmonary or ovarian carcinoids. However, it is on the right side rather than the left. This is part of carcinoid syndrome, which presents in only 7% of those with carcinoid.

Mets tend to be in the liver, lung, bone and lymph nodes, so yeah, they’re distant.
Which of the following is TRUE about the MLO view of the breast. (2001,1997,1995)
A Should be obtained 45 degrees from the horizontal
B. More likely to get undercompression on MLO than the CC
Choice A. is false, according to AFIP chic giving the breast talks. She said that angulation depends on the height of the patient. I would assume that the MLO view would be more difficult to compress, but I can’t find a source on this.

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