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A program of continuing medical education based on readings from Computerized radiology
!SCHOOLOF MEDICINE Office of Continuing Education
GEORGETOWN -ITY
Announces
A PROGRAM OF CONTINUING MEDICAL EDUCATION BASED ON READINGS FROM
Computerized Radiology
Barn up to 12 credit hours in Category I of the Physician’s Recognition Award of the American Medical Association. This comprehensive reader/study program is available to all radiologists and technologists within the medical imaging field. As an organization accredited for continuing medical education, the Office of Continuing Medical Education, Georgetown University School of Medicine certifies that this continuing medical education activity meets the criteria for up to 2 credit hours (per issue) in Category I of the Physician’s Recognition Award of the American Medical Association and ACCME Category I, provided that it is completed as designed.
How the Program Works
Select articles of particular interest to you and answer the questions pertaining to your selected articles at the end of the issue. The cost of the program is $5.00 per issue which covers Georgetown University’s expenses for processing your answers. For this issue and the five other issues of the volume, answer the questions of your choice for four articles in each &we, returning the enclosed answer sheet and your check in the amount of $5.00 made payable to: Georgetown University School of Medicine Office of Continuing Medical Education First Floor Hospital 3800 Reservoir Road, NW Washington, DC Unxn, USA
If you have not yet subscribed, or need back issues of the journal, please contact the Journals Department, Pergamon Press, Fairview Park, Elmsford, NY 10523; or Headington Hill Hall, Oxford OX3 OBW, England. If at least 80% of your answers to the questions in each of the six issues of Volume 6, 1982 are correct, you will receive the maximum of 12 hours of CME credit, which will be on record at the Georgetown Office of CME. All studying is accomplished through readings in Computerized Radiology at your leisure. Unlike most continuing education programs, there are no costly materials to buy nor travel and housing expenses to incur.
...
111
Continued Medical Education Questions Computerized Radiology Vol. 6, No. 5, 1982 0 Comparison of Urographic and Cholegraphic Contrast Enhanced CT Liver Scanning Stephenson et al., pp. 257-262 1. A a. b. c. d.
perceptible increase in the CT density of the liver may result from which of the following: Metastatic disease of the liver Intravenous urographic contrast material Intravenous cholegraphic contrast material All of the above
2. Which of the following statements is true? a. Hepatic lesions may be denser than the surrounding hepatic parenchyma b. The common hepatic and common bile ducts may be opacified on CT examination by intravenous cholegraphin c. On unenhanced scans most hepatic lesions are seen as areas of lesser density than the surrounding normal hepatic parenchyma d. All of the above 3. Intravenous urographic contrast material a. Improves CT visualization of hepatic metastases b. Obscures CT visualization of hepatic metasteses c. Has a variable effect on CT visualization of hepatic metastases d. All of the above 0 CT Diagnosis of Torn Meniscus DeRamos, pp. 263-264 4. Types of meniscal injuries include all of the following except: a. Anterior tab tear b. Posterior tab tear c. Peripheral men&al detachment d. Central meniscal detachment e. Bucket-handle tear 5. Which of the following statements is true: a. The medial meniscus is injured much more commonly than the lateral meniscus b. The lateral meniscus is fixed to both capsule and lateral collateral ligament c. Meniscal injuries are common in middle-aged women d. MacMurray’s maneuver is always helpful in the diagnosis of meniscal tears e. Meniscectomy is rarely indicated in acute meniscal injuries 6. Torn meniscus is diagnosed by all of the following except: a. Arthroscopy b. Arthrography c. Arthrotomy d. Computed tomography e. Conventional tomography
?? Another Potential Pitfall in Computerized Tomography of the Body Newmark et al., pp. 265-267 7. Abdominal CT studies are very helpful in evaluation of: a. Periaortic adenopathy b. Transitional cell carcinoma of the ureter c. Pancreatic masses d. Varices e. aandc 8. A a. b. c. d. e.
left sided periaortic mass might be: Metastasis Displaced inferior vena cava secondary to scoliosis Displaced inferior vena cava secondary to tortuous abdominal Congenital transposition of the inferior vena cava All of the above iv
aorta
9. If a. b. c. d. e.
the abdominal aorta is displaced, what are ominous signs? Loss of the retroperitoneal fat interface Loss of its silhouette The inferior vena cava to the the right of it All of the above aandb
0 CT Appearance of Transposition of the Inferior Vena Cava Parikh et al., pp. 269-274 10. The normal right-sided inferior vena cava (IVC) is formed by all of the following except: a. Bight subcardinal vein b. Bight supracardinal vein c. Bight hepatic vein d. Bight posterior cardinal vein 11. In a. b. c. d.
transposition of the IVC: The left supracardinal vein persists while the right regresses The left subscardinal vein persists while the right regresses The left posterior cardinal vein persists while the right regresses None of the above occurs
12. At a. b. c. d.
the level of the renal veins the transposed IVC is usually To the left of the aorta To the right of the aorta Anterior to the aorta Posterior to the aorta
0 Complementary Role of CT and Ukrasonography in the Diagnosis of Desmoid Tumor of Abdominal Wall Yeh et al., pp. 275-280 13. CT and ultrasonography are similar in that a. They both demonstrate true cross-sectional anatomy of the body b. They both demonstrate density of the tissue c. A sonographic cystic lesion always shows cystic features in CT and vice versa d. All of the above 14. The following features are correct for desmoid tumor: a. May have sonographic features of a cyst b. May have CT features of a cyst c. A mesenteric desmoid may be highly echogenic d. aandc 15. CT and ultrasonography are complementary a. Lymphoma b. Desmoid of abdominal wall c. Adenocarcinoma of pancreas d. All of the above e. a and b
to each other in determining the tissue characteristics
0 Ophthalmoplegia as an Initial Symptom of Burkitt’s Lymphoma in a Child Mulligan et al., pp. 281-285 16. The differential diagnosis of acquired ophthalmoplegia in a child should include: a. Juvenile diabetes b. Skull fracture c. Intracranial aneurysm d. Brain tumor e. All of the above 17. Which of the following inflammatory a. Encephalitis b. Meningitis c. Varicella d. Infectious mononucleosis e. Hepatitis
conditions is not known to cause ophthalmoplegia?
18. Which isotope scan is best able to identify disseminated a. Bone scan (Tc 99 PYP) b. Brain scan (DTPA) c. Gallium 67 d. Liver-spleen scan (Tc 99 S-C)
lymphomatous
masses?
of
Cl Tuberous Scelerosis Evaluated by Computerized Tomography Newmark et al., pp. 287-293 19. The differential diagnosis of heterogeneous, a. Hypernephromas b. Renal abscesses c. Angiomyolipomas d. Renal sinus lipomatosis e. a through c
enhancing renal masses seen on CT should include:
20. Conditions associated with tuberous sclerosis are: a. Emphysema b. Degenerative joint disease c. Gout d . Seizures e. Calcific tendonitis 21. The diagnosis of tuberous sclerosis can be made if a. Intracranial calcifications are seen b. A pneumothorax is present c. Angiomyolipomas of the kidney are seen d. a through c e. a and c
0 CT of Mediastinal Pancreatic Fluid Collections Ball and Clark, pp. 295-300 22. The most common locations of an extrapancreatic a. Anterior pararenal space and perirenal space b. Anterior and posterior pararenal spaces c. Perirenal space and posterior pararenal space d. Lesser sac and anterior pararenal space e. Mediastinum and lesser sac
fluid collection are in
23. Extension of pancreatic fluid through the diaphragm most often occurs a. At the aortic hiatus b. At the esophageal hiatus c. At both the aortic hiatus and the esophageal hiatus d. By direct extension throught the diaphragm e. Through the foramen of Morgagni 24. In regard to mediastinal extrapancreatic fluid collections, ultrasound demonstrating: a. The superior extent of a mediastinal fluid collection b. The exact nature of a mediastinal ‘mass c. The relationship of a mediastinal mass to other structures d. The cystic nature of a mediastinal mass
is better than computed tomography
?? Lipoma of the Corpus Callosum: A Case Report with a Review Fujii et al., pp. 301-304 25. Intracranial lipoma is most frequently found in which of the following? a. Cerebellar vermis b. Choroid plexus of the lateral ventricle c. Base of the cerebrum d. Corpus callosum e. Pituitary gland 26. Lipoma of the corpus callosum is often associated with which one of the following? a. Agenesis of the corpus callosum b. Cerebral cortical atrophy c. Arterio-venous malformation d. Hemangioma 27. CT finding of the intracranial lipoma is: a. High density .area b. Low density area with the attenuation value consistent with that of ventricles c. Very low density area with the attenuation value between -5- and -100 d. No abnormal findings can be obtained without using contrast media
• i Calcified Iatraspinal Meningioma Detected by Computed Tomography Garfinkle and Yudd, pp. 305-307
Vi
in
28. Spinal meningiomas are frequently found in: a. Young males b. Elderly males c. Young females d. Elderly females e. No predilection for age or sex 29. Meningiomas a. 2-S% b. 510% c. 1020% d. 20-30’70 e. 3040%
comprise what percent of all spinal tumors?
30. The differential diagnosis of a calcific density in the spinal canal is a. Meningioma b. Neurofibroma c. Disc d. a and b e. aandc Cl Recognition of Subdural Hematomi Secondary to Ruptured Aneurysm by Computerized Tomography Eggers et al., pp. 309-313 31. The majority of subdural hematomas are secondary to: a. Trauma b. Ruptured intracranial aneurysms c. Ideopathic d. Other 32. Subdural hematomas secondary to rupture of an intracranial aneurysm are: a. Virtually unheard of b. Present at least half the time c. Present in approximately 4-5070of patients with aneurysms that have bled d. Unknown incidence 33. The primary aid in recognition of a subdural hematoma secondary to an aneurysm rupture is: a. CT number differential b. Presence of both subdural hematoma and subarachnoid hemorrhage in the same patient c. Specific correlation with h/o trauma and angiography in suspicious cases d. All of the above
vii
GEORGETOWN -ITY
Announces
A PROGRAM OF CONTINUING MEDICAL EDUCATION BASED ON READINGS FROM
Computerized Radiology
Barn up to 12 credit hours in Category I of the Physician’s Recognition Award of the American Medical Association. This comprehensive reader/study program is available to all radiologists and technologists within the medical imaging field. As an organization accredited for continuing medical education, the Office of Continuing Medical Education, Georgetown University School of Medicine certifies that this continuing medical education activity meets the criteria for up to 2 credit hours (per issue) in Category I of the Physician’s Recognition Award of the American Medical Association and ACCME Category I, provided that it is completed as designed.
How the Program Works
Select articles of particular interest to you and answer the questions pertaining to your selected articles at the end of the issue. The cost of the program is $5.00 per issue which covers Georgetown University’s expenses for processing your answers. For this issue and the five other issues of the volume, answer the questions of your choice for four articles in each &we, returning the enclosed answer sheet and your check in the amount of $5.00 made payable to: Georgetown University School of Medicine Office of Continuing Medical Education First Floor Hospital 3800 Reservoir Road, NW Washington, DC Unxn, USA
If you have not yet subscribed, or need back issues of the journal, please contact the Journals Department, Pergamon Press, Fairview Park, Elmsford, NY 10523; or Headington Hill Hall, Oxford OX3 OBW, England. If at least 80% of your answers to the questions in each of the six issues of Volume 6, 1982 are correct, you will receive the maximum of 12 hours of CME credit, which will be on record at the Georgetown Office of CME. All studying is accomplished through readings in Computerized Radiology at your leisure. Unlike most continuing education programs, there are no costly materials to buy nor travel and housing expenses to incur.
...
111
Continued Medical Education Questions Computerized Radiology Vol. 6, No. 5, 1982 0 Comparison of Urographic and Cholegraphic Contrast Enhanced CT Liver Scanning Stephenson et al., pp. 257-262 1. A a. b. c. d.
perceptible increase in the CT density of the liver may result from which of the following: Metastatic disease of the liver Intravenous urographic contrast material Intravenous cholegraphic contrast material All of the above
2. Which of the following statements is true? a. Hepatic lesions may be denser than the surrounding hepatic parenchyma b. The common hepatic and common bile ducts may be opacified on CT examination by intravenous cholegraphin c. On unenhanced scans most hepatic lesions are seen as areas of lesser density than the surrounding normal hepatic parenchyma d. All of the above 3. Intravenous urographic contrast material a. Improves CT visualization of hepatic metastases b. Obscures CT visualization of hepatic metasteses c. Has a variable effect on CT visualization of hepatic metastases d. All of the above 0 CT Diagnosis of Torn Meniscus DeRamos, pp. 263-264 4. Types of meniscal injuries include all of the following except: a. Anterior tab tear b. Posterior tab tear c. Peripheral men&al detachment d. Central meniscal detachment e. Bucket-handle tear 5. Which of the following statements is true: a. The medial meniscus is injured much more commonly than the lateral meniscus b. The lateral meniscus is fixed to both capsule and lateral collateral ligament c. Meniscal injuries are common in middle-aged women d. MacMurray’s maneuver is always helpful in the diagnosis of meniscal tears e. Meniscectomy is rarely indicated in acute meniscal injuries 6. Torn meniscus is diagnosed by all of the following except: a. Arthroscopy b. Arthrography c. Arthrotomy d. Computed tomography e. Conventional tomography
?? Another Potential Pitfall in Computerized Tomography of the Body Newmark et al., pp. 265-267 7. Abdominal CT studies are very helpful in evaluation of: a. Periaortic adenopathy b. Transitional cell carcinoma of the ureter c. Pancreatic masses d. Varices e. aandc 8. A a. b. c. d. e.
left sided periaortic mass might be: Metastasis Displaced inferior vena cava secondary to scoliosis Displaced inferior vena cava secondary to tortuous abdominal Congenital transposition of the inferior vena cava All of the above iv
aorta
9. If a. b. c. d. e.
the abdominal aorta is displaced, what are ominous signs? Loss of the retroperitoneal fat interface Loss of its silhouette The inferior vena cava to the the right of it All of the above aandb
0 CT Appearance of Transposition of the Inferior Vena Cava Parikh et al., pp. 269-274 10. The normal right-sided inferior vena cava (IVC) is formed by all of the following except: a. Bight subcardinal vein b. Bight supracardinal vein c. Bight hepatic vein d. Bight posterior cardinal vein 11. In a. b. c. d.
transposition of the IVC: The left supracardinal vein persists while the right regresses The left subscardinal vein persists while the right regresses The left posterior cardinal vein persists while the right regresses None of the above occurs
12. At a. b. c. d.
the level of the renal veins the transposed IVC is usually To the left of the aorta To the right of the aorta Anterior to the aorta Posterior to the aorta
0 Complementary Role of CT and Ukrasonography in the Diagnosis of Desmoid Tumor of Abdominal Wall Yeh et al., pp. 275-280 13. CT and ultrasonography are similar in that a. They both demonstrate true cross-sectional anatomy of the body b. They both demonstrate density of the tissue c. A sonographic cystic lesion always shows cystic features in CT and vice versa d. All of the above 14. The following features are correct for desmoid tumor: a. May have sonographic features of a cyst b. May have CT features of a cyst c. A mesenteric desmoid may be highly echogenic d. aandc 15. CT and ultrasonography are complementary a. Lymphoma b. Desmoid of abdominal wall c. Adenocarcinoma of pancreas d. All of the above e. a and b
to each other in determining the tissue characteristics
0 Ophthalmoplegia as an Initial Symptom of Burkitt’s Lymphoma in a Child Mulligan et al., pp. 281-285 16. The differential diagnosis of acquired ophthalmoplegia in a child should include: a. Juvenile diabetes b. Skull fracture c. Intracranial aneurysm d. Brain tumor e. All of the above 17. Which of the following inflammatory a. Encephalitis b. Meningitis c. Varicella d. Infectious mononucleosis e. Hepatitis
conditions is not known to cause ophthalmoplegia?
18. Which isotope scan is best able to identify disseminated a. Bone scan (Tc 99 PYP) b. Brain scan (DTPA) c. Gallium 67 d. Liver-spleen scan (Tc 99 S-C)
lymphomatous
masses?
of
Cl Tuberous Scelerosis Evaluated by Computerized Tomography Newmark et al., pp. 287-293 19. The differential diagnosis of heterogeneous, a. Hypernephromas b. Renal abscesses c. Angiomyolipomas d. Renal sinus lipomatosis e. a through c
enhancing renal masses seen on CT should include:
20. Conditions associated with tuberous sclerosis are: a. Emphysema b. Degenerative joint disease c. Gout d . Seizures e. Calcific tendonitis 21. The diagnosis of tuberous sclerosis can be made if a. Intracranial calcifications are seen b. A pneumothorax is present c. Angiomyolipomas of the kidney are seen d. a through c e. a and c
0 CT of Mediastinal Pancreatic Fluid Collections Ball and Clark, pp. 295-300 22. The most common locations of an extrapancreatic a. Anterior pararenal space and perirenal space b. Anterior and posterior pararenal spaces c. Perirenal space and posterior pararenal space d. Lesser sac and anterior pararenal space e. Mediastinum and lesser sac
fluid collection are in
23. Extension of pancreatic fluid through the diaphragm most often occurs a. At the aortic hiatus b. At the esophageal hiatus c. At both the aortic hiatus and the esophageal hiatus d. By direct extension throught the diaphragm e. Through the foramen of Morgagni 24. In regard to mediastinal extrapancreatic fluid collections, ultrasound demonstrating: a. The superior extent of a mediastinal fluid collection b. The exact nature of a mediastinal ‘mass c. The relationship of a mediastinal mass to other structures d. The cystic nature of a mediastinal mass
is better than computed tomography
?? Lipoma of the Corpus Callosum: A Case Report with a Review Fujii et al., pp. 301-304 25. Intracranial lipoma is most frequently found in which of the following? a. Cerebellar vermis b. Choroid plexus of the lateral ventricle c. Base of the cerebrum d. Corpus callosum e. Pituitary gland 26. Lipoma of the corpus callosum is often associated with which one of the following? a. Agenesis of the corpus callosum b. Cerebral cortical atrophy c. Arterio-venous malformation d. Hemangioma 27. CT finding of the intracranial lipoma is: a. High density .area b. Low density area with the attenuation value consistent with that of ventricles c. Very low density area with the attenuation value between -5- and -100 d. No abnormal findings can be obtained without using contrast media
• i Calcified Iatraspinal Meningioma Detected by Computed Tomography Garfinkle and Yudd, pp. 305-307
Vi
in
28. Spinal meningiomas are frequently found in: a. Young males b. Elderly males c. Young females d. Elderly females e. No predilection for age or sex 29. Meningiomas a. 2-S% b. 510% c. 1020% d. 20-30’70 e. 3040%
comprise what percent of all spinal tumors?
30. The differential diagnosis of a calcific density in the spinal canal is a. Meningioma b. Neurofibroma c. Disc d. a and b e. aandc Cl Recognition of Subdural Hematomi Secondary to Ruptured Aneurysm by Computerized Tomography Eggers et al., pp. 309-313 31. The majority of subdural hematomas are secondary to: a. Trauma b. Ruptured intracranial aneurysms c. Ideopathic d. Other 32. Subdural hematomas secondary to rupture of an intracranial aneurysm are: a. Virtually unheard of b. Present at least half the time c. Present in approximately 4-5070of patients with aneurysms that have bled d. Unknown incidence 33. The primary aid in recognition of a subdural hematoma secondary to an aneurysm rupture is: a. CT number differential b. Presence of both subdural hematoma and subarachnoid hemorrhage in the same patient c. Specific correlation with h/o trauma and angiography in suspicious cases d. All of the above
vii