Daily Archives: August 12, 2014

Radiology for boards

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1) Should be able to identify stone – hypoechoic shadow is a clue

2) Should be able to identify ADPKD, Aquired cystic disease of dialysis (history will be helpful), Benign cyst and RCC  – Understanding Bosniak classification of cyst is helpful for diagnosis

3) Irregular margin and contrast enhancing cyst is RCC

4) US screening for Renal artery stenosis –  RA/A >3.5/1

RA velocity>2mps

It is also useful to understand the downstream waveform in the lobar and lobular arteries- Tardus parvus waveform and loss of ESP(early systolic peak) notch suggests significant RAS

5) Should be able to identify hydronephrosis

6) RI in normal kidney is<75 and Transplant kidney is<80  . RI is systolic/systolic +diastolic flow. RI of1 indicates no diastolic flow.

7) Granulomatous pyelonephritis – easily identified. Needs nephrectomy!

8) Non contrast CT stone protocol has 98%PPV and 98%NPV

9) Calcification – Medullary calcification and cortical calcification is easily recognized by location. Irregular bilateral asymmetric medullary calcification is usually Medullary sponge kidney

10) In post transplant kidney – elevated RI and Elevated Peak systolic velocity in Renal artery >300 cm/sec doen not indicate stenosis and it should normalize within 72 hours of transplant.

 

These are some of the high yield points in imaging. Please tag other points you may consider worthwhile revising or for understanding.(tag to this post)

Yuvaraj

Answers to Day 1 questions (10 questions)

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1) C – ANCA vasculitis treatment  – prednisone and Cyclophosphamide. There is plasmapheresis in the choice . If they specifically ask for initial therapy, then prednisone and plasmapheresis could be considered. This patient did not have pulmonary hemorrhage and was not sick !

2) B – Fabry disease. This is an X linked recessive disease which predominantly affects male ! Deficiency of Alpha galactosidase A causes accumulation of sphingolipids(glycolipids and in this disease specifically galactoacylcerebrosidase) in blood vessels , nerves kidney and heart. The manifestations are neurological(pain and tingling in extremities, progressive CKD-especially in 3 decade, Cardiac hypertrophy, abdominal pain(accumulation of sphingolipids in blood vessels supplying intestines) and skin rash(especially around the umbilicus)

3) D – Sickle cell/Tylenol/NSAID combination should raise suspicion about papillary necrosis

4)A – Arterial line is negative pressure and is causes dialysis catheter to flatten out!

5) B – most common cause of intradialytic hypotension is diastolic dysfunction. I was tempted to choose pericardial effusion given the stem of the case .

6) E – Hyperglycemia- very common cause of PD ultrafiltration failure since it decreases the solute gradient dramatically!

7) C – Isolated scrotal swelling should raise concerns about patent processes vaginalis in a new PD patient

8) E  -Gentamycin toxicity- hypomagnesemia

9) C – Cyclosporine toxicity causes hirsutism

10) B – Increased urine oxalate -pathogenesis for calcium oxalate stone in Chron’s disease

 

Hope the explanation helps!

Yuvaraj