Answers August Journal Club Quiz

Great job everyone - Drs. Dey, Lazarow, Bulzan, and Trace got 12/13 possible points. Dr. Bonney got 11/13 points. Also congrats to @hopeforfuture3 who got 11/13. Thank you for your work and dedication! The current standings - 1. Dey (24/26), 2. Dr. Bonney (23/26). 3. Dr. Hampton (13/26). Everyone else is still in the hunt! On the nonresident hunt - Congrats to @hopeforfuture3 with 11/26 points.

1. C - per the article regarding Acute Mesenteric Ischemia- "The imaging findings are similar to  and indistinguishable from acute superior mesenteric arterial thrombosis" that throws out option D. "Typically, patients over 60 (female predominant) with postprandial pain" - that rules out B and rules in C. Notice -  B has preprandial pain

2. D - per the above article - "The severity of the injury depends on the extent of reduction of blood flow, number of vessels involved, the duration of the ischemia, and the development of collateral circulation".

3. A - per the above article - "Emboli...often enlarge the SMA...the diameter of the SMA is often larger than that of the SMV...relationship  is reversed in normal healthy individuals"

4. C. - at multiple points in the above article - it is listed as a finding associated with irreversible ischemia.

5. B - per the Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury - Shearing forces are most pronounced at locations where the bowel is fixed, including the Ligament of Treitz, the ileocecal valve, and sigmoid colon. This rules in option B but excludes A, C and D.

6. C. - Granted this is tricky - but A is out as you could have pneumoperitoneum from penetrating injury in addition to blunt and many other options as described in the article; B is retroperitoneal; D is extraperitoneal and unless air was present in the bladder at the time of injury shouldn't have air to track to the peritoneum - intraperitoneal rupture in the setting of a Foley in bladder is associated with pneumoperitoneum as per article; Therefore C is left over as mentioned in the article as an acceptable answer.

7. D. - fluid should be simple to be possibly normal. It is only normal in 3% of normal males. Morrison's pouch is between the liver and kidney - it is a place to look for abnormal fluid in setting of trauma or other etiologies.

8. C - per the article - "When diffuse small bowel wall thickening of more than 10 mm is seen, it should be considered a sign of shock bowel"

9. D. Per Emergent and Nonemergent Nonbowel Torsion article - "Although ovarian torsion occurs in women of all ages, it most commonly affects the reproductive age group". I realize, there is a discussion of torsion of the normal ovary is more common prior to puberty - but abnormal ovaries torse more commonly than normal ovaries etc.

10. C. per the article, ovaries are usually greater than 4 cm, string of pearls increases specificity, endometriosis decreases the likelihood of torsion. "Pregnancy, particularly in the 1st trimester, is a risk factor for ovarian torsion."

11. A - Per the article - It is associated with elderly women with kyphoscoliosis and cystic artery calcification. No mention of obesity or fertility. Porcelain gallbladder and gallstones are not mentioned as associated per the article.

12. A - long ureteral length is associated with torsion as are the other listed items.

Bonus - D. Mad World by Tears for Fears

September EVMS Journal Competition Articles

Thoracic Imaging - It"s September and time for the 3rd set of articles! This month, we will focus on some basics.

Current Therapeutic and Monitoring Devices in the Chest

AJR - Chest Radiography in the ICU part 1; Airway, Enteric, Pleural Tubes

AJR - Chest Radiography in the ICU Part 2; Cardiovascular Lines and other Devices

Pulmonary TB - Role of the Radiologist

August EVMS (not official) Journal Club Quiz!

Welcome to the 2nd EVMS (not official) quiz. Remember if you are an EVMS resident to email your answers to the quiz master. Non residents can DM your answers to @robsradiology on Twitter.

1. Most correct statement regarding Acute Mesenteric Ischemia

A. The mortality rate on average is 23.2%
B. Typical patient is male aged 72 and complains of preprandial pain
C. Typical patient is female over 60 with postprandial pain
D. Chronic mesenteric ischemia and mesenteric arterial thrombosis are easily distinguished from each other

2. Severity of injury in acute mesenteric ischemia  depends on

A. Extent of reduction in blood flow
B. Number of vessels involved
C. Duration of ischemia and development of collaterals
D. All of the above.

3. Filling defect in the SMA with mild enlargement, this is most consistent with

A. Mesenteric arterial embolism
B. Mesenteric arterial thrombosis
C. Mesenteric Venous Thrombosis
D. Nonocclusive Mesenteric Ischemia (NOMI)

4. Paper thin wall

A. Associated with excellent outcomes.
B. Specific finding for NOMI
C. A finding associated with irreversible ischemia
D. All of the above.

5. Shearing injuries are:

A. Commonly found in ascending colon, mid jejunum, and 3rd portion of the duodenum injuries
B. Commonly found at places such as injury at the ileocecal valve
C. Both of the above
D. None of the above.

6. Pneumoperitoneum

A. Always associated with blunt bowel injury
B. Most commonly seen in the setting of 2nd portion duodenal perforation.
C. Can be seen in the setting of chest tube placement.
D. Can be seen in the setting of extraperitoneal Bladder rupture

7. Free fluid

A. Can be a normal finding in 5% of men.
B. The fluid when normal is found in Morrison's pouch
C. Even hyperattenuating free fluid should be considered physiologic in premenopausal woman
D. Free intraperitoneal fluid is the most sensitive sign of bowel injury, especially when hyperattenuating fluid is present.

8. A 2 cm long segment of bowel wall thickening are found in the jejunum

A. 90% specificity and 55-75% sensitivity for acute bowel injury
B. Finding associated with need for revascularization
C. Likely related to shock bowel.
D. In association with hyperattenuation on noncontrasted images, this is a good sign for reperfusion

9. Ovarian Torsion would more likely be diagnosed in a:

A. 15 yo Male
B. 73 yo female radiologist
C. 3 yo girl
D. 25 yo female astrophysicist

10. Which statement is true regarding ovarian torsion

A. The ovary is often small especially less than 3 cm
B.  Endometriosis increases the likelihood of ovarian torsion
C.  1st trimester pregnancy is a risk factor for ovarian torsion
D.  String of Pearls sign increases the sensitivity of ultrasound

11. In regards to gallbladder torsion, which statement is true

A. Ectopic location of the GB with anterior and inferior displacement can be seen
B. Majority of the patients are larger BMI, forty, and fertile
C. Cholelithiasis is strongly associated with this disease
D. Porcelain gallbladder is commonly seen

12. Which statement is false regarding renal transplant torsion

A. Short renal transplant ureteral length increases the risk of torsion
B.  Lack of postoperative adhesions because of steroid therapy increases the risk of torsion
C. Ascites increases the risk for torsion
D. Doppler finding includes increased peak systolic velocities or reversal of diastolic flow


Bonus
"The dreams in which I'm dying are the best I've ever had"

A. Let it be - The Beatles
B. Ana Ng - They Might be Giants
C. Please, Please, Please, Let Me Get What I Want - The Smiths
D. Mad World - Tears for Fears