Movember Quiz!

It's the 1st Sunday in December - that means it is quiz time!!!!!

1. Who is most likely to get frostbite? Why do you not want to be a runner in cold places like Alaska or Norway?

2. When the hand is affected by frostbite, which finger is typically spared?

3. Which patients with frostbite should not get thrombolysis?

4. What are some advantages of SPECT/CT in the evaluation of frostbite?

5. What is the definition of penile tear?

6. What is the imaging appearance of Peyronie's disease? What finding would suggest acute phase?

7. What are typical findings that separate liposarcoma from lipoma?

8. Most common bilateral testicular mass? What are the imaging findings?

9. What PET/CT is considered superior in sensitivity to bone scintigraphy for prostate cancer?

10. When should an MR be ordered to evaluate the prostate after a FDG PET/CT?

11. Uptake in the liver on a Choline exam should be considered ___

12. You see uptake in a focus near the aorta near the crura of the diaphragm on a Ga68 PSMA - This may represent?

Bonus:
"Had a dream, I wanted to lick your knees" was sung by:

A. Ariana Grande
B. The Weeknd
C. Camper Van Beethoven
D. Third Eye Blind
E.  The Cure

October Quiz Answers!

Great Job Drs. Dey, Bonney, Trace and Vosburg!  Below are the answers to the October Quiz

1. D (1 Point)

2. Extracapsular rupture and gel bleed (2 points)

3. It is an ultrasound artifact  (echogenic noise artifact) by free silicone. It is evidence of extracapsular rupture or gel bleed in either a silicone granuloma or lymph node. (2 points)

4. Keyhole (lasso, noose, inverted teardrop, dark open loop), subcapsular line sign, linguine sign (wavy line sign) - (3 points)

5. Screening mammography of an augmented breast with use of both implant-included and implant-displaced views has a 45% sensitivity for detection of cancer, compared with a 67% sensitivity in the nonaugmented breast (1 point)

6. Stability is typically achieved 2-3 years after treatment.(1 point)

7. Typically 2-4 weeks but can be up to 8 weeks. They recommend follow up at 6-8 weeks - if lesion is the same or bigger - biopsy (2 points)

8. Interval change (1 point)

9. Infection (mastitis +/- abscess) and locally advanced breast cancer (2 points)

10. Dermal lymphatic involvement (1 point)

11. Initial treatment and staging - primary lesion, skin involvement, lymph node extent (ipsilateral axillary and distal), distant mets (bone and soft tissue) (2 points).

12. Designate biopsy sites  and guide biopsy (2 points). 

Bonus: 
D. New Order - Blue Monday This has to one of my favorites songs by one of my favorite bands. Sorry - I am very 80's British heavy. It was my thing in middle and high school. 

21 total possible points

November (Movember) EVMS (not official) Journal Club Competition Articles

It is November! The unofficial grow your mustache month. So ladies stop waxing your lip and live a little! Below are some articles to enjoy the male pathology and an extra article on what might happen to you if you move to Alaska or Canada instead of staying warm in Virginia.

Frostbite - or Yoni keep your toes warm or they might look like this!

MRI of the Penis or Scrotum

Clinical PET in Prostate Cancer

October (unofficial) EVMS Journal Club Quiz!

It is time for the monthly quiz! I hope everyone had a great Halloween and now are waddling toward Thanksgiving. Let's see how you do!

1. Which of these is/are true?

a.  The low sensitivity of mammography is because of the relative radiolucency of silicone implants.

b.  Calcifications imply capsular contracture and/or implant rupture.

c.  Rounded implant over time may imply contracture and integrity issues of the implant

d.  Bulge or herniation may imply a focal point of weakness in the elastomer shell

e.  All of the above

2. Silicone are noted in axillary lymph nodes on mammogram. What are 2 possible etiologies?

3. What does a snowstorm appearance in a nodule on ultrasound mean?

4. What are 3 possible findings of intracapsular rupture on MRI?

5. What is the sensitivity for detecting malignancy in breast implants?

6. Mammographic stability is typically seen how long after treatment?

7. According to the article, "Assessment and management of challenging BIRADS-3 mammographic lesions", how long do the authors recommend follow up for suspected hematoms? How long do hematomas typically resolve?

8. What trumps or supersedes benign morphology?

9. What is the differential diagnosis for inflammatory breast cancer? 

10. What is the pathologic hallmark of IBC? 

11. What are the advantages of PET/CT?

12. What is the most important role of ultrasound in the pretreatment workup?

Bonus:

What song is currently the best selling 12 inch single of all time?

a. Billie Jean - Michael Jackson

b. Born in the U.S.A. - Bruce Springsteen

c. West End Girls - Pet Shop Boys

d. Blue Monday - New Order

e. Earned It - The Weeknd 

September EVMS (unoficial) quiz answers

Great Job everybody that participated - Dr. Dey, Dr. Trace, Dr. Bonney and Dr. Vosburg each scoring high marks!

1. Right atrium, right ventricle, coronary sinus. 3 pts

2. Swan Ganz Catheter - it is in a branch of the right pulmonary artery. It should be retracted. 2 pts

3. NG tube in a right lower lobe bronchus. 1 - reposition it. but they should be prepared for pneumothorax and possible need for chest tube placement and get a chest x-ray. 4 pts

4. Notice the right atrial lead is displaced from its position in the second image. So it needs to be resecured. 1 pt

5. Mediport - should have tip in the distal SVC. This is in an internal mammary vein. 2 points

6. Left subclavian line with tip near the coronary sinus in a retained left SVC. 2 points

7. Right mainstem intubation. 1 pt

8. Right sided PICC line with tip going into the neck. It should be in the SVC. 2 pts

9.  C - 1 pt. They are MR unsafe

10. LVAD (several answers acceptable); pericardial - 2 pt

11. Heart transplant (but could be resolution of prior problem). Used as a bridge. 2 pt

12. LA appendage clip (LAA closure device). Used for a. fib so doesn't need anticoagulation. yes; 3 pt

13. c - 1 pt

14. D - 1 pt

15. False - latent has positive lab findings with negative imaging and clinical findings - 1 pt

16.  D - a and b - 1 pt

Bonus - George Ezra

September EVMS (unofficial) Journal Club Quiz

What Time is It? Time for a Quiz! This quiz is based on the articles from September. May the best person win! Remember - EVMS residents - email me. Nonresidents - DM me on Twitter!

This month will be a little more visual based and will have more variable points.

1. Looking at these films - Where are the 3 leads placed?

2. Ignore the pacemaker. What is the other catheter? Is it placed appropriately? Where is it recommended to be?

3. Ignore the pigtail drain and ekg leads. There is an abnormally placed tube. What is it? Where is it? What do you tell the care team to do after removing and/or repositioning (2 things)?

4. Patient is symptomatic. The second image was obtained 1st. The images are separated by hours to a day. What is the finding?

5. What type of catheter is this? Where is it supposed to be? Is it where it is supposed to be?

6. Left Subclavian Line - Where is the tip? Why?

7. Ignore the mediport and EKG leads - What is wrong? What complication is present?

8. What is going on? Where should this line be?

9. Which of the following is false regarding LVAD?

A. Can be used as a bridge to recovery.

B.  Axial flow VADs are associated with nonsurgical bleeds such as GI bleed in avms or acquired von Willebrand disease. 

C. The majority of currently used versions are MR compatible

D. All of the above

10. What kind of device is this? Is the device pericardial or preperitoneal?

11. The next image is the same patient as in 10 several months later. What do you think happened? How do you think the device in 10 was used?

12. What is the marked device? What is it used for? Is it MR compatible?

13. Primary Tuberculosis

a. Thoracentesis of pleural effusions in TB commonly isolates m. tuberculosis

b. Ghon focus is an acute finding in primary TB.

c. Commonly involves right paratracheal and hilar lymph nodes

d. Empyema necessitatis is the result of an enteropleural fistula.

14. Postprimary Tuberculosis

a. Cavitation is rare postprimary tuberculosis.

b. Air-fluid level in a cavitation is almost always a sign of severe tuberculosis

c. Miliary tb is nosocomially spread

d. Poorly marginated opacities in the upper lobes and superior segment lower lobes are common

15. True or false: Latent tuberculosis has negative lab findings with positive imaging and negative clinical findings of tuberculosis. 

16. Tuberculosis

a. Inactive tuberculosis may have fibronodular changes in the upper lung fields but no evidence of active disease

b. Miliary tuberculosis can be seen in primary and postprimary tuberculosis especially in the setting of HIV.

c. Bronchial involvement can happen in primary or postprimary but especially postprimary

d. A and B

e. B and C

Bonus: Which of the following artists was endorsed by Magneto/Dumbledore? The songs are not the answer - but simply examples of the artists in action. I personally like all these artists especially Robert Post for personal reasons even though I should sue for using my name. We are both on instagram but I think mine is better - @robsradiology

A. Kongos Hey I Don't Know

B. George Ezra Shotgun

C. Robert Post Got None

D. Vampire Weekend Giving Up the Gun

E. Dashboard Confessional Hands Down

October EVMS Journal Competition Articles

It is October - Pink Ribbon Month - In honor of this month, let's review some articles in the field of Breast Imaging!

Multimodality Imaging of Single Lumen Silicone Breast Implants

Assessment and Management of Challenging BI-RADS 3 Lesions

What Radiologists Need to Know about Inflammatory Breast Cancer