This document provides advice and tips for the FRCR 2A exam, including: - Make prayers and prepare well in advance by sleeping well the day before. - Carefully read the question and scan the scenario to find key details. - Take breaks between questions to take deep breaths. - Stick closely to the answer choices provided rather than outside knowledge. - Remain logical and imagine applying the scenario to real life. - The exam is long so bring water and food for breaks.

1. 100 SLIDES ON
FRCR 2A EXAM
(NEW SYSTEM)
DON’T MISS THEM
Dr.Mahmoud Rezk
MD,PhD,EDIR, FRCR2A
Medical 1430@gmail.com

2. • Make Dua and Prayers, ASK Allah
• Take care of time of exam is VVVV imp, In general you
will not have time to regain back to one question again,
answer then if you find something you need to revise
make sign if you have time to come back.
• Try to sleep well the day before exam
• Read carefully the request (the final sentences before
choices), then scan the scenario and details to find the
keys.
• Take care of differences
• Don’t forget your keys
• You should to check the age & sex in every question,
type of work or region if mentioned
SOME ADVICES

3. • Take deep breath many times between questions
• Don’t fail while the exam if you find it hard, remember that it
will be hard for all and it is linked to score, so try to do your
best.
• this presentation is trial to cover most important or tricky
points that you should to hear about before exam with it main
reference summarized from crack the core
• However, the knowledge is not every thing, stick to the
choices of the question and try to exclude or include what
mentioned in the scenario of question to choose one of
choices not one of your minded scenarios you know before. In
summary you will write one answer of choices, try to find the
most similar answer you know before.
• In next step question try to be logic and imagine yourself in
the real life , Don’t be rushed in unusual or something
complicated.
• The exam is exhausting, try to take some waters and in break
eat something supportive

4. DIFFERNCES (D)
• High lung voume:
• • Meconium Aspiration
• • Transient Tachypnea
• • Neonatal Pneumonia
• Low lung voume
• Neonatal Pneumonia (Beta-Hemolytic Strep): Often has
• SDD: no pleural effusion

5. THINK IN (T)
• The School Aged CXR: Things to look for:
• • Big Heart - Probably showing you a sickle cell case. Look
for bone infarcts in shoulders.
• • Lucent Lung - Think foreign Body (air trapping).
Remember you put the affected side down (if it remains
lucent- that confirms it).

6. (D)
• Intralobar Sequestration= Left Lower Lobe
• Congenital Lobar Emphysema (CLE) = Left Upper Lobe
• CCAM =No Lobar Preference
• (D)
• Duplication Cysts -These fall into three categories (a) bronchogenic,
(b) enteric, (c) neuroenteric
• neuroenteric. posterior mediastinal,
• Bronchogenic -close to the trachea or bronchus. middle mediastinal
• Enteric -water attenuation close to the esophagus middle
mediastinal

7. • Cysts
• • If midline think Thyroglossal cyst.
• • If lateral think branchial cleft cyst.
• lntralobar is seen older kid (10 year old with recurrent
pneumonia)
• Extralohar is seen in infants with co-morhids
• **CLE is in the upper lobe

8. • Round Pneumonia –
• Younger than 8
• S. Pneumonia being the culprit. The PhD trivia is that
• is usually solitary, and the posterior lower lobes.
• Next step No CT to exclude cancer , just get a follow up x-ray.
• Note: Askin Tumor (Primitive Neuroectodermal tumor of the
chest wall): considered part of the Ewing Sarcoma spectrum

9. D
• Anterior Mediastinal Mass
• Under 10 =Thymus, Over 10 =Lymphoma.
• Lymphoma - In a kid just assume it's Hodgkins
• Thymic Rebound - history of chemo" or corticosteroids"
• density:
Soft Tissue - Homogeneous = Think Lymphoma or Hyperplasia
Fat = Germ Cell Tumor
Water = Lymphangiomas

10. D
• The Posterior Mediastinal Mass
• Under 1O -, Malignant
• Think neuroblastoma.
• 10- 20 - Think benign.
• H it's a round mass- Think about Ganglioneuromas &
Neurofibromas
• If it's cystic (and there is scoliosis) think Neuroenteric Cyst
• H they show you coarse bone trabeculation - with an adjacent
mass (or a history of anemia) – Think Extramedullary
Hematopoiesis

11. • Intussusception 3 3 3
• 3 months - 3 years,
• USULALLY NO lead points
• in most cases- enterocolic )
• usually small bowel-small bowel may reduce spontaneously
• targets or pseudo kidneys,
• leads points - like HSP (vasculitis), meckles diverticulum, enteric
duplication cysts.
• Reducing Intussusception:
• Contraindications: Free Air (check plain film). Peritonitis (based
on exam)
• Recurrence: Usually within 72 hours
• Success Rates - 80-90% with air
• Risk of Perforation- 0.5%
• Air causes less peritonitis (spillage of feca material) than barium
• Pressure should NOT exceed 120mmHg

12. • Mayer-Rokitansky-KustcrHauser-Mullerian duel anomalies
including absence or atresia of the uterus I unicornuate
uterus. Associated with unilateral renal agenesis
• Prune Belly (Eagle Barrett Syndrome)- This malformation
complex occurs in males and includes the following triad:
• Crappy Abdominal Musculature
• Hydroureteronephrosis
• Cryptorchidism (bladder distention interferes with descent of
testes)

13. • Pycnodysostosis - Osteopetrosis + Wonnian Bones+ Acro-
Osteolysis. also have ''wide (or obtuse) angled mandible",.
• Klippel Feil- You get congenital fusion of the cervical spine
(like JRA). There is often a sprengel deformity (high riding
scapula). omovertebral bone –
• Gauchers gives you a big spleen (vs small in sickle cell) and
big liver among a few bone signs.
•AVN of the Femoral Heads
• H Shaped Vertebra
•Bone Infarcts (lots of them)
•Erlenmeyer Flask Shaped Femurs

22. SALTER-
HARRIS
CLASSIFIC
ATION
LENDS
ITSELF
WELL TO
MULTIPLE
CHOICE:

24. Neuroblastoma
• STAGE 4 S - Less than 1 year old Distal Mets are Confined to Skin,
Liver, and Bone Marrow ,
• Excellent Prognosis.
- "Next Step" Adrenal mass of a neonate.
the first step is going to be follow up by ultrasound imaging
- Next Step" - Isolated right sided varicocele
Abdomen CT.

28. • Next step for Septic Arthritis
• 1. X-Ray Hip series (AP, Lateral, and Frog
Leg).
• 2. Ultrasound which will show an effusion.
• 3. Then a clinical decision and to Aspirate
• 4. MRI would only be used if/when hip
aspiration can't/hasn't been performed.

29. • Non-Accidental Trauma (NAT)
• skeletal survey Suspicious fractures would include highly specific fractures
(metaphyseal comer fracture, posterior rib fractures), toddler :fracture in a
non-ambulatory child.
• Skull Fracture: The general idea is anything other than a parietal bone
fracture (which is supposedly seen more with an actual accident) is
concerning.
• Solid Organ and Lumen Injury - Don't forget about this as a presentation for
NAT.
• Duodenal hematoma and pancreatitis (from trauma) in an infant - should
get you to say NAT.
• Low lying/tethered cords are closely linked with Spina Bifida (tufts of
hair)
• Anal Atresia =High Risk For Occult Cord Problems (including
tethering)- should get Screened
• Low Dimples (below the gluteal crease) Do NOT need
screening,
• High Dimples (above the gluteal crease) DO need screening.

30. Guess and think inWhen mentioned
PHACES SyndromeSubglottic Hemangioma
Meconium AspirationPost Term Delivery
Transient TachypneaFluid in the Fissures
History of c-section
Maternal sedation
Pneumonia not Beta-Hemolytic StrepGranular Opacities+ Term+ High Lung Volume,“
B-Hemolytic
Strep
Granular Opacities+ Term+ Low Lung Volume
Primary Ciliary DyskinesiaLower lobe bronchiectasis
CFUpper lobe bronchiectasis,
Lipomatous pseudohypertrophy of the pancreas
Gasless Esophageal Atresia (A ,B)No air in the stomach
"H" Type TE fistulaExcessive air in the stomach",

31. Guess and think inWhen mentioned
pulmonary slingAnterior Esophageal Impression
Hypertrophic Pyloric Stenosis"Non-bilious vomiting
Paradoxial aciduria
Mid Gut VolvulusBilious vomiting
Corkscrew Duodenum
MalrotationReversed SMA and SMV
cyanotic heart diseaseAsplenia"
Sickle CellInfarcted Spleen
Gall Stones
Hand or Foot Pain I Swelling in an Infant
H shaped vertebra
Colonic Atresia"Short Microcolon,
Meconium ileus or distal ileal atresiaLong Microcolon
Meconium
Peritonitis
Calcified mass in the mid abdomen of a newborn
HirschsprungSaw tooth colon,"
Distal Intestinal Obstruction
Syndrome (CF).
"Meconium ileus equivalent
Hepatic
Hemangioendothelioma
Abrupt caliber change of the aorta below the celiac
axis"
Mesenchymal HamartomaCystic mass in the liver of a newborn

32. unicornuate uterusUnilateral Renal Agenesis
bladder AdenocarcinomaUrachus,"
Mesoblastic NephromaSolid Renal Tumor of Infancy
WilmsSolid Renal Tumor of Childhood
embryonal rhabdomyosarcomaExtratesticular scrotal mass
AchondroplasiaNarrowing of the interpedicular distance
ThanatophoricPlatyspondyly (flat vertebral bodies)
Neuroblastomamost common posterior mediastinal mass in child
under 2
AppendicitisMost common cause of bowel obstruction in
child over 4
Trauma (seatbelt)Most Common cause of pancreatitis in a kid
Sacrococcygeal TeratomaMost common tumor of the fetus or infant
Posterior Urethral ValveHydro on Fetal MR
Lemierre syndromeJugular vein thrombosis –chest will have septic
emboli).
epiglottislateral soft tissue neck x-ray … thumb sign
retropharyngeal abscesslateral soft tissue neck x-ray…. the super wide pre
vertebral
soft tissues
Beckwith-WiedemanWi1ms, emphalocele, Hepatoblastomta

33. CNS

36. Vocal Cord Paralysis
vs Cancer
• ·Affected side is
dilated with vocal
cord paralysis
• •Opposite side is
dilated with cancer

39. Guess and think inWhen mentioned
NF-1cervical kyphosis
"lateral thoracic meningocele
bilateral optic nerve gliomas,
NF-2bilateral vestibular schwannoma
TS"retinal hamartoma
V HLretinal angioma
lymphomabrain tumor with restricted diffusion
GBM (or lymphoma)"brain tumor crossing the midlin
Pilocystic AstrocytomaCyst and Nodule in Child,
Hemangioblastoma"Cyst and Nodule in Adult
Von Rippel Lindaumultiple hemangioblastoma
central neurocytomaSwiss cheese tumor in ventricle
posterior communicating artery aneurysmCN3 Palsy
increased ICPCN6 Palsy
NPHVentricles out of size to atrophy

40. MethanolHemorrhagic putamen
Lewy Body
Dementia
Decreased FDG uptake in the lateral occipital cortex
CMVTORCH with Peri ventricular Calcification,
ToxoplasmosisTORCH with hydrocephalus
HSVTORCH with hemorrhagic infarction
HIVNeonatal infection with frontal lobe atrophy
CJDRapidly progressing dementia+ Rapidly progressing
atrophy
OligodendrogliomaExpanding the cortex
EpidermoidTumor acquired after trauma (LP)
LeFort 1The Palate Separated from the Maxilla I Floating
Palate
Lefort 2The Maxilla Separated from the Face" or "Pyramidal
Lefort 3The Face Separated from the Cranium
mucoceleAirless expanded sinus
cavernous malformation nearbyDVA,"
Capillary Telangiectasia"Single vascular lesion in the pons
CanvansElevated NAA peak,"
Metachromatic Leukodystrophy"Tigroid appearance
V HLEndolymphatic Sac Tumor
CholesteatomaRestricted diffusion in the petrous apex

41. Guess and think inWhen mentioned
Cholesterol GranulomaTl Bright in the petrous apex
Grandenigo Syndrome"Lateral rectus palsy+ otomastoiditis
Labrinthitis"Cochlea and semicircular canal enhancement
OtosclerosisConductive hearing loss in an adult
Superior Semicircular Canal dehiscenceNoise induced vertigo
Antrochonal PolypWidening of the maxillary ostium
squamous cell CA (10%)"Inverting papilloma
perineural spreadAdenoid cystic
look in the AP windowLeft sided vocal cord paralysis
CHARGE syndromeBilateral coloboma
PHPV"Retinal Detachment+ Small Eye
Retinopathy of Prematurity"Bilateral Small Eye,
RetinoblastomaCalcification in the globe of a child,"

42. Guess and think inWhen mentioned
LymphangiomaFluid-Fluid levels in the orbit
VarixOrbital lesion, worse with ValsaJva,
NF-1 and CC FistulaPulsatile Exophthalmos
NF-1"Sphenoid wing dysplasia
Superior Semicircular Canal dehiscenceNoise induced vertigo
Currarino TriadScimitar Sacrum
Bl2 (or HIV)"bilateral symmetrically increases T2 signal in the
dorsal columns
spinal cord infarct"Owl eye appearance of spinal cord,
Guillain
Barre
"Enhancement of the nerves root of the cauda equina
TB"Subligamentous spread of infection
NF2MSME (schwannoma
> meningioma > ependymoma).
Sturge WeberMaldeveloped draining veins
AstrocytomaMost Common Primary Brain Tumor in Adult

43. Schwannoma
Schwannoma with NF2
CP Angle - Invades Internal Auditory
Canal
CP Angle - Invades Both Internal
Auditory Canals
EpidermoidCP Angle - Restricts on Diffusion
MedulloblastomaPeds - Arising from Vermis
EpendymomaPeds- 4th ventricle "tooth paste" out of
4th ventricle
PANMost Common systemic vasculitis to
involve the CNS
MelanomaMost common intra-occular lesion in
an adult
Bl2 (or HIV)"bilateral symmetrically increases T2 signal in the
dorsal columns
spinal cord infarct"Owl eye appearance of spinal cord,
Guillain
Barre
"Enhancement of the nerves root of the cauda
equina
TB"Subligamentous spread of infection
NF2MSME (schwannoma
> meningioma > ependymoma).
Sturge WeberMaldeveloped draining veins
AstrocytomaMost Common Primary Brain Tumor in Adult

44. • All phakomatosis (NF 1, NF -2, TS, and VHL) EXCEPT Sturge Weber are autosomal
dominant - family screening is a good idea.
• "Calcifies 90% of the time"= Oligodendroglioma
• Restricted Diffusion in Ventricle = Watch out for Choroid Plexus
Xanthogranuloma (not a brain tumor, a benign normal variant)
• Pituitary - T l Big and Bright =Pituitary Apoplexy
• Pituitary - T2 Bright = Rathke Cleft Cyst
• Suprasellar & Pituitary - Calcified = Craniopharyngioma
• Persistent trigeminal artery (vertebral to carotid) increases the risk of aneurysm
• Subfalcine herniation can lead to ACA infarct
• ADEM lesions will NOT involve the calloso-septal interface .
• Hippocampal atrophy is first with Alzheimer Dementia
• Putamen is the most common location for hypertensive hemorrhage
• Restricted diffusion without bright signal on FLAIR should make you think
hyperacute (< 6 hours) stroke.
• Scaphocephaly is the most common type of crainosynostosis
• Currarino Triad: Anterior Sacral Meningocele, Anorectal malformation,
Sarcococcygeal osseous defect
• Type 1 Spinal AVF ( dural AVF) is by far the more common .

45. • Herpes spares the basal ganglia (MCA infarcts do not)
• PRES does NOT restrict
• Osmotic Demyelination Syndrome (CPM): rapid correction of sodium (usually in a drunk). T2 bright in the
central pons (spares the periphery).
• Wernickc Encephalopathy: Caused by thiamine deficiency. contrast enhancement of the mammillary
bodies
• (carbon monoxide causes "globus" pallidus 2 words)
• Methanol: hemorrhagic putamin (1 word), Optic nerve atrophy,
• Marchiafava-Bignami : drunks. Swelling and T2 bright signal affecting the corpus callosum
• Crossed Cerebellar Diaschisis (CCD): affecting the cerebellar hemisphere after a contralateral
supratentorial insult (infarct, tumor resection, radiation)
• CMV = Most Common. Periventric:ular Calcffications, Polymicrogyria
• Toxo =Hydrocephalus, Basal Ganglia Calcifications
• Rubella = Vasculopathy I lschemia. Iligh T2 signal - less Calcifications
• HSV I hemorrhagic Infarct, and lead lo had encepha/omalacia
hydranencephaly)
• HIV =Brain Atrophy in frontal lobes
• HIV Encephalitis: spare the subcortical U-fibers
• Progressive Multifocal Leukoencephalopathy (PML): predilections for the subcortical U-fibers
• Abscess will classically have RING pattern.
• MS will classically have an Incomplete RING pattern.
• HSY: medial temporal lobe, which will be T2 bright. Earliest sign is actually restricted diffusion
• Limbic Encephalitis: Not an infection, but a mimic. It is a paraneoplastic syndrome (usually small cell lung
cancer), that looks very similar to HSV

46. • - Most common CNS met in a kid= neuroblastoma (BONES, DURA, ORBIT - not brain)
• Most common location for mets= Supratentorial at the Grey-White Junction
• MRCT in the mnemonic for bleeding mets (Melanoma, Renal, Carcinoid Choriocarcinoma,
Thyroid
• Cortically Based tumros Pleomorphic Xanthoastrocytoma (PXA), Dysembryoplastic
Neuroepithelial Tumor (DNET), Oligodendroglioma,, Ganglioglioma
• Craoiopharyngioma - (a) Papillary and (b) Adamantinomatous. The kid type is the
Adamantinomatous form. calcified (papillary is not). And recur more (Papillary does less
- because it has a capsule).
• Pineoblastoma: childhood., pineocytoma older , associated with retinoblastoma.
• Lhermitte-Duclos (Dysplaslic cerebellar ganglioicyloma, Next Step – Mammogram,..guess
she has breast CA, Cowdens syndrome
• Meckel-Gruber Syndrome: Classic triad: Holoprosencephaly, Multiple Renal Cysts and
Polydactyly
• Small Side + Big Ventricle = Atrophy with Rasmussen Encephalitis)
• Big Side + Big Ventricle =Hemimegalencephaly
• Carotid Body Tumor =Carotid Bifurcation (Splaying !CA and ECA)
• Tolosa Hunt Syndrome: orbital pseudotumor involves the cavernous sinus

49. GIT

51. • H Pylori Gastritis - Usually in Antrum
• Menetrier's - Usually in the Fundus (classically spares the antrum)
• Zollinger-Ellison - Ulcerations in the stomach (jejunal ulcer
• Lymphoma - "Crosses the Pylorus
• Herpes Esophagitis = Multiple Small Ulcers
• CMV and AIDS = Solitary Large Ulcer
• Squamous Cell = Black Guy who drinks and smokes - mid
esophagus
• Adenocarcinoma =White Guy with reflux (history of PPis), - lower
esophagus

52. • This vs That - Esophageal Hernias
• Sliding - GE Junction Above the Diaphragm
• Rolling - GE Junction Below the Diaphragm

57. • Toxic Megacolon: Ulcerative colitis, and to a lesser degree
Crohns is the primary cause. C-Dif also cause it. Lack of
haustra
• presence of normal hausta excludes the diagnosis.
• Don't do a barium enema because of
• peritonitis can occur without perforation.
• Colonic Pseudo-Obstruction (Colonic Ileus, Ogilvie
Syndrome): Usually serious medical conditions.
• It progress to bowel necrosis and perforation.
• marked diffuse dilation of the large bowel, without a
discrete transition point

59. • Next Step Amebic Abscess: A special situation (potentially
testable) is the amebic abscess in the left lobe. Those needs
to be emergently drained (they can rupture into the
pericardium).

60. SALMONELLA IS THE CLASSIC BUG - WHICH DEVELOPS IN THE SETTING
OF UNDERLYING SPLENIC DAMAGE
(TRAUMA, OR SICKLE CELL)
• Who gets a "nutmeg liver" flip-flop pattern"
• Budd Chiari
• Hepatic Veno-occlusive disease
• Right Heart Failure (Hepatic Congestion)
• Constrictive Pericarditis
• Lymphoma is the most common malignant tumor of the spleen,

61. LIVER TRANSPLANT
• the hepatic artery is the king will undergo necrosis with
hepatic artery failure. Hepatic artery thrombosis :
• early (<15 days),
• late (years). chronic rejection and sepsis.

62. • Pancreatitis terms
Suspected Pancreatic Duct Injury Next Step - MRCP or ERCP

64. IPMNS COMMUNICATE WITH THE
PANCREATIC DUCT OTHERS NO .
• Islet Cell I Neuroendocrine:
• Insulinoma: The most common type, benign
• Gastrinoma: The second most common type overall, but most common type associated with MEN.
Zollinger-Ellison syndrome
• Non-Functional: The 3rd most common type, usually malignant (80%),

65. Schatzki (Schat"B "ki Ring)narrowed B Ring
Eosinophilic Esophagitisesophageal concentric rings
Candidiasis"shaggy" or "plaque like" esophagus
Barrettsreticular mucosal pattern
"high stricture with an associated hiatal hernia
Achalasia"bird's beak,
Zenker DiverticulumKillian Dehiscence
Medication
induced
ulcers at the level of the arch or distal esophagus
CowdensBreast Cancer+ Bowel Hamartomas
GardnersDesmoid Tumors +Bowel Polyps
TurcotsBrain Tumors+ Bowel Polyps
Gastro-Gastro FistulaWeight gain years after Roux-en-Y,"
Afferent Loop Syndromepancreatitis after Billroth 2,"
CeliacFold Reversal - of jejunum and ileum
Cavitary (low density) Lymph nodes
Moulage Pattern
Graft vs Host"Ribbon-like bowel,"
healed peptic ulcerClover Leak Sign - Duodenum
splenic vein thrombus"isolated gastric varices
Virchow Node (GI Cancer)enlarged left supraclavicular node
Sclerodermahide bound" or "Stack or coins
Megaduodenurn,"
SMA SyndromeDuodenal obstruction, with recent weight loss,

66. AmebiasisConed shaped cecum
Ulcerative ColitisLead Pipe
CrohnsString Sign
LymphomaMassive circumferential thickening, without obstruction
MelanomaMultiple small bowel target signs
Femoral HerniaObstructing Old Lady Hernia
Paraduodenal herniasac of bowel
Pseudomyxoma Peritoneiscalloped appearance of the liver
Hepatitis BHCC without cirrhosis
CholangiocarcinomaCapsular retraction
Kaposi'sPeriportal hypoechoic infiltration+ AIDS
Budd Chiari"sparing of the caudate lobe
Hyperplastic noduleslarge T2 bright nodes+ Budd Chiari
fatty liver"liver high signal in phase, low signal out phase
hemochromatosis"liver low signal in phase, and high signal out phase,"
PSCmultifocal intrahepatic and extrahepatic stricture,"
AIDS Cholangiopathymultifocal intrahepatic and extrahepatic strictures+
papillary stenosis
Recurrent Pyogenic Cholangitis"bile ducts full of stones
AdenomyomatosisGallbladder Comet Tail Artifact,"

67. autoimmune pancreatitissausage shaped pancreas
IgG4autoimmune pancreatitis
RP Fibrosis, Sclerosing Cholangitis, Fibrosing
Medianstinitis,
Inflammatory Pseudotumor
Pancreatic CancerWide duodenal sweep
Serous CystadenomaGrandmother Pancreatic Cyst
MucinousMother Pancreatic Cyst
Solid PseudopapillaryDaughter Pancreatic Cyst
GISTMost common mesenchymal tumor of the GI tract
StomachMost common location for GIST
Krukenberg TumorStomach (GT) met to the ovary
Left sided paraduodenalMost common internal hernia,
retrovesical spaceMost common site of peritoneal carcinomatosis
Insulinomathe most common islet cell tumor
Gastrinomathe most common islet cell tumor with MEN
Hepatic Angiosarcomathe most
common primary sarcoma of the liver
mucinous neoplasm (colon, ovary, pancreas).Calcified liver mets
Caroli ‘s Choledochal Cysts type 5central dot sign

68. GU

69. • Bosniak VVV IMP

70. Think inIn question title
neurogenic bladderbladder stones
pine cone appearance
RCCcalcifications in a fatty renal mass
transitional cell CAurethra cancer
prostatic portion
adenocarcinoma"urethra cancer - in a diverticulum
squamous cell CAurethra cancer any other portion
Multilocular cystic nephromaprotrude into the renal pelvis
Multicystic Dysplastic Kidneyno functional renal tissue
contralateral renal anomalies
Emphysematous Pyelonephritis
Papillary Necrosis
diabetic
Xanthogranulomatous Pyelonephritisstaghom stone
TBshrunken calcified kidney
Medullary Sponge Kidney"bilateral medulla nephrocalcinosis
Page Kidneyhistory of lithotripsy
Medullary Sponge Kidneycortical rim sign,
AVFhistory of renal biopsy
renal vein thrombosisreversed diastolic flow
squamous cell bladder CSchistosomiasis
"entire bladder calcified

71. Gonococcallong stricture in urethra
Straddle Injury"short stricture in urethra
Peritoneal inclusion cysts("history of abdominal surgery“
from adhesions).
Granulosa Cell Tumors (estrogen making).ovarian mass and a thickened endometrium
cervix is obstructed (either by cancer, or more commonly
stenosis
fluid in the endometrial canal of a post menopausal women
moles and multiple pregnancy (twins).elevated B-hCG
hyperemesis"
Look at kidneysUnicornuate Uterus
AdenomyosisMarked enlargement of the uterus,thickening of the
junctional zone(> 12mm)
moles and multiple gestationsTheca Lutein Cysts
Hyperstimulation
Syndrome (patient on fertility meds).
Theca Lutein Cysts +Pleural Effusions
EndometriomaLow level internal echoes
Shading Sign, T2 Shortening
Hemorrhagic CystFishnet appearance
Meigs SyndromeOvarian Fibroma + Pleural Effusion
Complete Mole - 1st TrimesterSnow Storm Uterus
Prostatic Utriclemidline cystic structure near the back of the bladder of a
man
Seminal Vesicle Cystlateral cystic structure near the back of the bladder of a man

72. epidermoid cystonion skin appearance,"
Lymphomamultiple hypoechoic masses in the testicle
Mumpsisolated orchitis,"
Mixed Germ
Cell Tumor
cystic elements and macro-calcifications in the
testicle
Seminomahomogenous and microcalcifications
Sertoli Leydiggynecomastia +testicular tumor,
Maternal Diabetesfetal macrosomia
placenta previapainless vaginal bleeding in the third trimester
placenta abruptionmom doing cocaine
placenta cretathinning of the myometrium - with turbulent doppler
placenta chorioangiomamass near the cord insertion, with flow pulsating at
the fetal heart rate
cystic hygromaCystic mass in the posterior neck -antenatal period
ARPKD"Massively enlarged bilateral kidneys
Complete Mole - 1st TrimesterSnow Storm Uterus
RCCFat with Calcifications =,
Probably AMLFat with No Calcifications =
UPJ ObstructionThis is the most common congenital anomaly of the
GU tract
in neonates.

73. • Post menopausal ovaries should NOT be hot on PET.
• The fibroids with higher T2 signal respond better to IR treatment
• Extraperitoneal bladder rupture - This one is more common (80-90%).
Almost always associated with pelvic fracture. This can be managed
medically. Molar Tooth Sign.
• the most sensitive imaging feature on MRI for the diagnosis of
malignancy in an endornetrioma An enhancing mural nodule, (usually
endometrioid or clear cell carcinoma).
• the most constant finding in ovarian torsion is a large ovary.
• Prostate CA: Cancer is dark on T2 (background is high) , restricts on
diffusion (low on ADC), and enhances early and washes out (type 3
curve - just like a breast cancer).
• If you see an aplastic or hypoplastic humeral head I glcnoid in a kid,
you
• should immediately think about an Erbs Palsy
Uterine AVM
Intrauterine Adhesions (Ashermans
previous dilation and curettage
Ultrasound, Too Thick = Biopsy
Extent of Disease = MRI
First Step Post Menopausal Bleeder =

74. NOTES VVV IMP
• RCC bone mets are "always" lytic
• Most common location for TCC is the bladder then renal pelvis then in the lower third of
the ureter then Middle then Proximal is Third
• Weigert Meyer Rule - Upper Pole inserts medial and inferior, associated with incontinence in
women
• Leukoplakia is pre-malignant; Malakoplakia is not pre-malignant
• Extraperitoneal bladder rupture is more common, and managed medically
• Intraperitoneal bladder rupture is less common, and managed surgically
• Indinavir stones are the only ones not seen on CT .
• Uric Acid stones are not seen on plain film .
• Apex of Fundal Contour > 5mm Above Tubal Ostia = Septate
• Apex of Fundal Contour < 5mm Above Tubal Ostia =Bicornuate
• The Gartner duct cyst is above the pubic symphysis (Bartholin is below it).
• Prostate CA is usually in the peripheral zone (not the central zone). When it is in the central
zone it's T2 "smudgy" or charcoal.
• -BPH nodules are usually in the central zone, and they have a sharp border. You can "draw a
line around them with a pencil.
• Molar Tooth Sign: Contrast surrounding the bladder, in the prevesicle space of Rezius. This
indicated extraperitoneal bladder rupturea

75. • Symmetrical IUGR is a "baby problem." The head is NOT spared. It's seen early, including the first
trimester. Causes include TORCHS, Fetal EtOH, and Chromosomal Abnormalities. Asymmetrical is a
"placenta problem." The head is spared. It's normal until the 3rd trimester. Causing include Maternal
Hypertension, Severe Malnutrition, and Ehler-Danlos.4
• Arcuate Uterus does NOT have an increased risk of infertility (it's a normal variant)
• Fibroids with higher T2 signal respond better to UAE
• Cervical Cancer that has parametrial involvement (2B) - is treated with chemo/radiation .
• Cervical Cancer without parametrial involvement (2A) - is treated with surgery
• Transformation subtypes: Endometrioma = Clear Cell, Dermoid = Squamous
• congenital hepatic fibrosis is ALWAYS present in
• ARPKD.
• Nuchal lucency is measured between 9-12 weeks, and should be < 3mm. More than 3mm
• Aquaductal Stenosis is the most common cause of non-communicating hydrocephalus in a neonate
• Von Hippel Lindau -Autosomal dominant multi-system disorder. renal cysts. RCC (clear cell) .
Pancreas: Cysts, Serous Microcystic Adenomas, Neuroendocrine (islet cell) tumor Adrenal:
Pheochromocytoma (often multiple) CNS: Hemangioblastoma of the cerebellum, brain stem, and
spinal cord
• Tuberous Sclerosis -Autosomal dominant multi-system disorder. hamartomas
• everywhere (brain, lung, heart, skin, kidneys). bilateral multiple angiomyolipomas. renal cysts, and
occasionally RCC • Lung-LAM-thin walled cysts and chylothorax Cardiac - Rhabdomyosarcoma
(typically involve cardiac septum) Brain -Giant Cell Astrocytoma, Cortical and subcortical tubers,
subependymal nodules Renal -AMLs, RCC (in younger patients)
NOTES VVV IMP

76. • Renal Artery Stenosis -Typically
seen within the first year the
most common vascular
complication
• This usually occurs at the
anastomosis (especially end-to-
end "refractory hypertension.
Criteria include:
• PSV > 200-300 emfs.
•PSV ratio> 3.0 (External Iliac Artery
IRA)
• Tardus Parvus: Measured at the
Main Renal Artery Hilum (NOT at
the arcuates)
• Anastomotic Jetting

78. • Carcinoid Syndrome: Flushing, diarrhea, pain, right heart failure from
serotonin manufactured by the carcinoid tumor. The syndrome does
not occur until the lesion mets to the liver (normally the liver
metabolizes the serotonin).

79. CHEST
CARDIAC

80. LIPLungs Cysts
PCPLungs Cysts + Ground Glass + Pneumothorax
= Castlemans or KaposiHypervascular Nodes
Strep PneumoniaMost common airspace opacity
Kaposi Sarcoma"Flame Shaped" Perihilar opacity
LymphomaPersistent Opacities
= Scleroderma with NSCP lungsDilated Esophagus on CT
InfectionHOT PET GGO ground glass opacity
Cancer (BAC)COLD GGO
collapsePost intubation
Placement of central line
ICU patient with no other details (mucous plugging)
Outpatient with no history (cancer).
aberrant right subclavianobliteration of Raider's Triangle
left lower lobe collapseflat waist sign
Actinomycosis.dental procedure gone bad, now with jaw osteo and
pneumonia
Klebsiellabulging fissure
Hypersensitivity PneumonitisChot-tub,
Fungal Pneumonia - Invasive Aspergillushalo sign,
COPreverse halo or atoll sign
ABPA"finger in glove, Asthma
Lemierreseptic emboli +jugular vein thrombus

81. Small Cell Lung CAParaneoplatic syndromes with SIADH
Squamous Cell CAParaneoplatic syndromes with PTH,
Lambert EatonSmall Cell Lung CA+ Proximal Weakness
Bronchopleural FistulaCavity fills with air, post pneumonectomy
carcinoidmalignant bronchial tumor
Adenoid Cysticmalignant tracheal tumor
LymphomaAIDS patient with lung nodules, pleural effusion, and
lymphadenopathy,
KaposiGallium Negative
PCPThallium Negative,"
HamartomaMacroscopic fat and popcorn calcifications
LCHBizarre shaped cysts
LAMLung Cysts in a TS patient,
Alpha 1,"
Ritalin Lung
Panlobular Emphysema
UIPHoneycombing,
NSIPGround Glass with Sub pleural Sparing
AsbestosisUIP Lungs+ Parietal Pleural Thickening
Chronic
Rejection I Bronchiolitis Obliterans Syndrome
Air trapping seen 6 months after lung transplant
PAPCrazy Paving,"
Lipoid Pneumonia - inferring mineral oil
use I aspiration
History of constipation

82. Chronic Hypersensitivity PneumonitisUIP +Air trapping,
Scleroderma (with NSIP)Dilated Esophagus+ ILD
Hepatopulmonary syndromeShortness of breath when sitting up
solitary fibrous tumor of the pleura"Episodic hypoglycemia
Pulmonary Venoocclusive
disease.
Pulmonary HTN with Normal Wedge Pressure
(Yellow Nail
Syndrome).
Yellow Nails, Edema and Chylous Pleural Effusions
Extrapleural Hematoma"persistent fluid collection after pleural drain/tube
placement
Extrapleural Hematoma"Displaced extrapleural fat
bronchial or tracheal
llljury
Massive air leak, in the setting of trauma
pulmonary infarctHot of PET - around the periphery
sarcoid"Multi-lobar collapse
TBClassic bronchial infection
tree in bud (not centrilobular or random nodulesPanbronchiolitis
Mucinous BACBronchorrhea,",
PCP.Most common opportunistic infection in AIDS
Steal SyndromeALCAPA,"
Williams SyndromeSupra-valvular Aortic Stenosis"
Turners SyndromeBicuspid Aortic Valve and Coarctation
Mitra] RegurgitationIsolated right upper lobe edema

83. Alagille SyndromePeripheral pulmonary stenosis
Ebsteins"Box shaped heart
congenital heart"Right Arch with Mirror Branching
Holt Oramhand/thumb defects + ASD,"
Downsostium prim.um ASD (or endocardial cushion defect)
Sinus Venosus ASDRight Sided PAPVR
Rheumatic Heart DiseaseCalcification in the left atrium wall,"
Amyloid"difficult to suppress myocardium
blood pool suppression on delayed enhancement
constrictive pericarditissepta! bounce
Hypertrophic Cardiomyopathy
Sarcoid.
focal thickening of the septum
Tako-Tsuboballooning of the left ventricular apex
Arrhythmogenic Right
Ventricular Cardiomyopathy (ARVC)
fat in the wall of a dilated right ventricle
Muscular
Dystrophy
kid with dilated heart and mid wall enhancement
Tuberous SclerosisCardiac Rhabdomyoma
Eosinophilic Cardiomyopathy.Bilateral Atrial T hrombus
Cardiac AmyloidDiffuse LY Subendocardial enhancement not restricted to a
vascular
distribution,
acquired pulmonary AVMsGlenn P rocedure
Ablation for A-FibPulmonary Vein Stenosis
Carney's ComplexMultiple Cardiac Myxomas

84. BIRT HOGG DUBE
(BHD

85. • A part solid nodule with a ground glass component is the most suspicious morphology
• Pleural effusion is the earliest and most common finding with asbestosis exposure.
• Pleural plaque of asbestosis typically spares the costophrenic angles.
• Pleural effusion is the most common manifestation of mets to the pleura.
• Cavitation in the primary T.B is NOT common
• Leiomyoma is the most common benign esophageal tumor (most common in the distal third. •
Esophageal Leiomyomatosis may be associated with Alport's Syndrome
• Carcinoid is COLD on PET
• True ventricular aneurysm: Mouth is wider than body. Myocardium is intact. Usually anterior-lateral
wall. False: Mouth is narrow compared to body. Myocardium is NOT intact (pericardia} adhesions
contain rupture). Usually posterior-lateral wall. Higher risk of rupture .
• Round atelectasis - which is associated with pleural findings is sometimes called the '"asbestos
pseudotumor.
• Klippel-Trenaunay Syndrome (KTS) - This is often combined with Parkes-Weber whichis a true high
flow AV malformation, KTS =Low Flow (venous) Parks Weber= High Flow (arterial)
• Takayasu - "The pulse-less disease." This vasculitis loves young Asian girls, vasculitis involving the
aorta
• Giant Cell - The most common primary system vasculitis. This vasculitis loves old men
• PAN (polyarteritis nodosa) -This is one of two vasculitides (the other being Buergers) that is more
common in men, microaneurysm formation

86. • The right atrium is defined by the IVC.
• The right ventricle is defined by the moderator band.
• The tricuspid papillary muscles insert on the septum (mitral ones do not).
• Lipomatous Hypertrophy of the Intra-Atrial Septum - can be PET Avid (it's brown fa
• Most common location of myocardial bridging is in the mid portion of the LAD.
• Coronary Artery Aneurysm - most common cause in child = Kawasaki
• Coronary Artery Aneurysm - most common cause in adult = Atherosclerosis
• Most common congenital heart disease is a VSD
• L" Transposition type is congenitally corrected (they are "L"ucky).
• D" Transposition type is doomed.
• Rib Notching from coarctations spares the 1st and 2nd Ribs
• Most common neoplasm to involve the cardiac valves = Fibroelastoma
• Giant Coronary Artery Aneurysms (>8mm) don't regress, and are associated with M
.
• Most common primary cardiac tumor in children = Rhabdomyoma.
• 2°d most common primary cardiac tumor in children = Fibroma
• Endoleaks: - There are 5 types, and type 2 is the most common
• May Thurner -resulting in DVT of the left common iliac vein. compression of the left
common iliac vein by the right common iliac artery

87. • T.B Primary= No Cavity, Post Primary I Primary Progressive=
Cavitym Bulky Hilar and Paratracheal Adenopathy = Kids
• part solid lesion with a ground glass component is the most
suspicious morphology. Non-solids (only ground glass) is
intermediate. Totally solid is the least likely morphology to be cancer
• Atypical Adenomatous Hyperplasia of Lung (AAH): This is a precursor
of adenocarcinoma of the lung. Adenocarcinoma in situ (ACIS),
Minimally Invasive Adenocarcinoma (MIA)
• AVM The rule of treating once the·afferent vessel is 3mm
• Poland - Unilateral absence
• of a pectoral muscle

93. MSK

96. • SLAC Wrist (Scaphoid-Lunate Advanced Collapse) occurs with injury (or degeneration via
CPPD) to the S-L ligament
• SNAC Wrist (Scaphoid Non-Union Advanced Collapse) occurs with a scaphoid fracture.
• Steuer Lesion is when the Adductor tendon gets caught in the torn edges of the UCL. The
displaced ligament won't heal right, and will need surgery.
• Radial Head Fracture is most common in adults 􀀁is most common in PEDs)
• Monteggia Fracture (MUGR), Galeazzi Fracture
• Segond Fracture: associated with ACL tear (75%), Reverse Segond Fracture: associated with
a PCL tear, and medial meniscus injury
• Pilon Fracture (Tibial plafond fracture, Tillaux Fractures: This a salter-harris 3, Triplane
Fracture: This is a salter-harris 4
• Maisonneuve Fracture; "next step?" x ray for fracture of the proximal fibular shaft
• Casanova Fracture - bilateral calcaneal fractures, you should "next step?" look at the spine
for a compression or burst fracture
• LisFranc Injury: This is the most common dislocation of the foot (1) "Homo-lateral" -
everyone moves lateral,(2) "Divergent" - the I st MT goes medial,
• SONK (Spontaneous Osteonecrosis of the Knee): insufficiency fracture. old ladies with
history of "sudden pain after rising
• score> 1.0 =Normal, -1.0 to -2.5 = Osteopenia, < -2.5 Osteoporosis
• Kienbocks: AYN of the lunate
• De Quervain's Tenosynovitis: "Washer Woman's Sprain" or "Mommy Thumb" "new mom -
holding a baby.“first dorsal (extensor) compartment (extensor pollicis brevis and abductor
pollicis longus).

97. • Glomus Tumor: This is a benign, painful, ascular tumor (hamartoma) tips of fingers, T2
bright, and enhance avidly.
• Giant Cell Tumor of the Tendon Sheath: PVNS of the tendon. erosions on the underlying
bone. T2 dark , bloom on gradient
• Fibroma: Favors the flexor tendons low T2. NOT bloom.
• Lateral Epicondylitis in Tennis Players
• The most common the Supraspinatus - most tear at "critical zone" - 1-2cm from the tendon
footprint. articular surface is more common (3x more) than the bursal surface
• Subscapularis Tear= Medial Dislocation of the Long Head of the Biceps Tendon.
• Quadrilateral Space Syndrome: Compression of the Axillary Nerve with atrophy of the teres
minor. Parsonage-Turner Syndrome: two or more nerve
• the anterior talofibular ligament is the weakest ligament and the most frequently injured
• Xanthoma of Achilles tendon fusiform thickened. with familial hypercholesterolemia, and is
often bilateral.
• Morton's Neuroma: Soft tissue mass shown between the 3 and 4 metatarsal heads, It's a
scar.
• Pott's Disease: TB spine , spare the disc space It tends to have multi-level thoracic "skip"
involvement. Large paraspinal abscess. Calcified Psoas Abscess“. Gibbus Deformity
• wide zone of transition is the best sign that a lesion is aggressive
• Osteosarcoma met to the lung cause of occult pneumothorax.
• Permeative lesion in the diaphysis of a child = Ewings (could also be infection, or EG).

98. • Chordoma most common sacrum, second most common clivus, third most common vertebral body),
very-T2 bright, Midline, NEVER EVER seen off the midline
• Enchondroma: in Humerus or Femur= Rings and Arcs, in Fingers or Toes = Lytic
• Eosinophilic Granuloma (EG): Vertebra plana in a kid, Skull with lucent "beveled edge" lesions (also in a
kid)., Floating Tooth" with lytic lesion in alveolar ridge
• Osteoid Osteoma:"large amount of edema for the size of the lesion.“
• Lucent Lesion in Posterior Elements: Osteoblastoma, ABC, TB
• Next Step - Prostate Met vs Bone Island: Bone Scan Bone Island should be mild (or not active) Prostate
Met should be HOT
• "Long Lesion in a Long Bone" = Fibrous Dysplasia, Ground Glass
• Epiphyseal Tibial Lesion in a Teenager = Chondroblastoma Epiphyseal
• Equivalent Lesion = Chondroblastoma or Giant Cell Tumor
• Lucent Lesion in the Greater Trochanter = Chondroblastoma
• Lucent Lesion with a Fracture (Fallen Fragment) in the Humerus= Solitary Bone Cyst
• Calcaneal Lesion with Central Calcification = Lipoma
• Vertebra Plana in an Adult= Mets
• Sequestrum I Nidus in the Tibia I Femur = Osteoid Osteoma , Painful Scoliosis" = Osteoid Osteoma
• Calcified Lesion in the Posterior Element of the C-Spine = Osteoblastoma
• Erosive Osteoarthritis (Inflammatory Osteoarthritis). "gull wing’
• Hooked Osteophytes-CPPD vs Hemochromatosis
• Hyperparathyroidism: Subperiosteal Resorption, Tuft Resorptionand brown tumors, Rugger Jersey Spine
• Juvenile Idiopathic Arthritis: "Epiphyseal Overgrowth, premature fusion of growth plates)

99. • Paget ‘.s Wide Bones with Thick Trabecula, Blade of Grass Sign:
Lucent leading edge in a long bone, Osteoporosis Circumscripta,
Picture Frame Vertebra: Cotton Wool Bone, Banana Fraclure:
Saber Shin: Bowing of the tibia, Ivory Verlebra, Deafness is the
most common complication