Lisa Oakley:



The Written Board Questions 1997 by Dr. Oakley

1. Match anatomic structures:

a. Rectum

b. Anus

c. Pylorus

With:

1. Columns of Morgagni

2. Value of Houston

3. Twinings recess

ANS: a. b. c.

2. (SBA) Among posterior fossum masses in children, the least common is:

a. Ependynoma

b. Medulloblastoma

c. Juvenile pilocytic astercytoma

d. Coriplexus papilloma

ANS:

3. (SBA) On mammography, the normal MLO view misses which portion of the breast:

a. Upper outer

b. Upper inner

c. Lower outer

d. Lower inner

e. Lateral

ANS:

4. (SBA) As standard T2 weighted images:

a. Short TR, short TE

b. Long TR, short TE

c. Long TR, long TE

d. Short TR, long TE

ANS:

5. Match the approximate entrance skin dose:

a. 20 mgy

b. 200 mgy

c. 2,000 mgy

d. 20,000 mgy

e. 200,000 mgy

With:

1. 10 minutes of fluoroscopy

2. 1 slice of CT of the abdomen

3. Chest x-ray, PA view

4. Mammogram, one view

ANS: a. b. c. d. e.

6. (SBA) Cardiomegaly in infant:

a. Hypoplastic left heart

b. Total anomalous pulmonary venous return below the diaphragm

c. Transposition of the great vessels in (complete)

d. Anemia

ANS:

7. (SBA) The predominant suppression due to 100 rads of acute radiation:

a. Lymphacytic depression

b. GI tract

c. Cataracts

d. CNS system

ANS:

8. (SBA) What is the artifact that you can eliminate by increasing MRI matrix from 128 x 256 to 256 x 256, such as is seen in a long break signal in the middle of the cord ?

a. Phase

b. Truncation

c. Motion

d. Chemical shifts

e. Aliasing

ANS:

9. (SBA) Entities which can cause premature closure of the epiphyses?

a. Cushings

b. Hyperthyroid

c. Adrenal genital tumor

d. Ovarian tumor

e. Late excel tumor

ANS:

10. (SBA) What factors influence the attenuation of the sound beam in the ultrasound?

a. Density of tissue

b. Wave length

c. Elasticity of the tissues

d. Frequency

ANS:

11. Several questions were asked about various aspects of a ramp filter.

12. (SBA) Aspects of aldosterone secreting adenomas:

a. Decrease plasma ramen

b. Increase resorption of sodium at the kidney

c. Increase resorption of potassium at the kidney

d. Increase systolic and diastolic blood pressure

ANS:

13. (SBA) Cells of the mecosa of the gastrointestinal tract:

a. Mienteric plexus

b. Kulchistky cells

c. Lymphoid folicle

ANS:

14. Matching:

a. Internal carotid artery to jugular vein

b. Long portion of the facial nerve

c. Incus to malleous

With:

1. Anterior

2. Posterior

3. Medial

4. Inferior

5. Lateral

6. Superior

ANS: a. b. c. d. e. f.

15. (SBA) Where is lesion in the brain which would cause halmonymous:

a. Lateral geneculic ganglian

b. Occipital lobe

c. Interior optic kyasim

d. Posterior optic kyasim

e. Anterior optic nerve

ANS:

16. (SBA) Umbilical venous flow is:

a. To the baby

b. From the baby

ANS:

17. (SBA) Lateral medullary syndrome is caused by lesions in:

a. Pica

b. Aica

c. Pontine perferators of the basilar artery

ANS:

18. (SBA) The best sign of complete intracapsular breast implant rupture:

a. Linguini sign

b. Keyhole sign

c. Free silicone in the axilla

ANS:

19. (SBA) A solid renal mass in a two month old child is most likely:

a. Renal cell cancer

b. Mesoblastic nephroma

c. Oncocytoma

ANS:

20. (SBA) An abdominal mass is palpated and a newborn. What is this most likely?

a. Hydronephrosis with ureteral pelvic junction obstruction

b. Ovarian cyst

c. Duplication cyst

ANS:

21. (SBA) Label the anatomic structures (several saggital and axial images in US were provided):

a. Anterior branch of the right portal vein

b. Middle hepatic vein

c. Main right portal vein

d. Posterior branch of the right portal vein

ANS:

/svb

cc: Dr. Oakley

Oral Boards Recollections by Dr. Lisa Oakley - 1997

My experience on the hall was fairly positive. Eight out of ten of the examiners were very friendly and helpful. Most of them provided histories and helped you along. Two of the examiners were not as friendly, but helpful nonetheless. The Executive West Hotel is actually nicer than most people make it out to be. I found that it was most helpful to remain in my hotel room and order room service rather than run into various attending while eating in the hotel restaurants because that would make me more nervous.

Neurology Cases

1. Blastic mass lesion of the C2 spinous process. I mentioned that this may represent metastatic disease, aneurysmal bone cyst, osteoblastoma. He wanted me to mention what else it could be, especially if perhaps you would see the lesion in the vertebral body. At this point I mentioned osteoaosteoma although this was not a typical appearance and perhaps a hemangioma.

2. Edema seen on CT. At first I mentioned that this could be due to stroke because it looked like it extended through the cortex. On the subsequent images with contrast, this was an obvious meningioma with a dural tale seen on the tent. I believe this was seen on CT and MRI coronal images. Subsequent angiogram was provided with a single injection into the internal and external carotid arteries where there was feeding of the tumor from both vessels. Again he asked me if meningioma was the best diagnosis and I said yes.

3. An increased density lesion was seen in the cavernous sinus of a middle aged women with a third nerve palsy. I found it difficult to find exactly what the findings were, but mentioned that this could represent infection, tumor, and finally aneurysm. He asked me what would you tell the referring physician about biopsing it. I said that this was unwise to do because it could be an aneurysm and an MRI or some other study should be performed before that was done. He then flipped up an angiogram showing an obvious large aneurysm in the cavernous carotid.

4. Posterior fossa midline cystic mass with mural nodule in a young child. I mentioned that this could represent a juvenile pylocytic astercytoma, apendynoma, or possibly medulloblastoma. He then wanted me to come down hard on which of those it was and I felt that the mass was in the ventricle and that because of that it might be an apendynoma.

5. There was a large anterior temporal fossa cystic mass which I mentioned could represent an arachnoid cyst or epidermoid. It appeared that there was bone erosion and widening of the fossa and that because of this it was probably an arachnoid cyst.

6. A 46 year old with seizures and a ring enhancing mass in the right frontal lobe and a lot of surrounding vasogenic edema in midline chest. I mentioned that this may represent a glioma, metastatic disease, infection such as septic embolus from an I.V. drug abuser or perhaps lymphoma/toxoplasmosis if the patient had AIDS.

7. There was a CT with a snowman shaped sellar and suprasellar mass. The mass appeared to have high density hemorrhage within it. I mentioned that this most likely represented a macroadenoma but could also represent a craniophyrenogioma or possibly an aneurysm. He mentioned that the patient had problems with vision and why was this, and I showed him that the mass displaced and created mass effect on the optic kyasum.

Chest Cases

1. Multiple mass like areas of consolidation on AP and Lateral chest. CT showed air bronchograms and soft tissue fullness in the mediastinum. I gave the standard differential of tumor infection and acute/chronic entities. Because of the soft tissue fullness in the mediastinum, I mentioned that this could represent lymphoma.

2. Progressive massive fibrosis consistent with silicosis, or co-workers pneumoconiosis. I also mentioned that sarcoid could have this. Also I saw later that there were multiple calcific nodes in the mediastinum which were probably egg-shelled calcified.

3. Bullous changes in the apex of the lungs with COPD. There was also vague increased soft tissue thickening and consolidation at the right apex. I mentioned that this may represent a pancos tumor. He showed an MRI and wanted to know if there was chest wall invasion and then asked if this was important.

4. A chest x-ray was shown with diffuse interstitial lines with septal lines, small bilateral pleural effusions, and a normal heart size. I mentioned that this could represent lymphangietic spread or possibly interstitial edema. A HRCT was shown which showed septal and bronchovascular thickening. No peripheral fibrosis was seen and again I mentioned that this could represent interstitial edema or lymphangietic spread. I also mentioned that possibly a viral syndrome could do this although it was unlikely.

5. A chest x-ray was shown with a single peripheral small patch of consolidation. I mentioned infection, pulmonary embolism, septic embolus, and tumor.

6. A low density adrenal mass was shown about 2.5 cm in size and houndsfield units of -4. The patient has lung cancer and I was to state whether this represented metastatic disease. I mentioned that this was probably an adenoma, but an MRI with in and out of phase could help decide if it was crucial.

7. Anterior mediastinal mass on PA and lateral views. I gave the thyoma, lymphoma, teratoma differential. On the chest x-ray it didn’t look like the mass was contiguous with the thyroid, but did appear that way on the CT scan. At that point I added that it could represent lymphoma or a thyroid neoplasum.

Ultrasound Cases

I want to mention that several real-time images were shown especially of fetal ultrasound.

1. Fetal ultrasound through the head demonstrating a lobar hole of ______encephaly with fused thalidomide and amonoventricle. She asked me what specifically makes you certain of this diagnosis.

2. A midline abdominal mass was shown consistent with enphalocele or gastroskisis. Initially I had a difficult time determining where this mass was coming from and thought it might be posterior, and at this point she redirected me to realize this was an anterior mass.

3. Real-time images were provided through the placenta, baby, and cord. She wanted me to redemonstrate the structures that I recognized.

4. A gallbladder was shown with a stone within the fundus and a contracted, thickened gallbladder wall. What other things would I do to complete the exam? I mentioned a left lateral decubitus view, views of the gallbladder neck, and common bile duct.

5. Hypoechoic structure in the midabdomen with hyperechoic center in a 19 year old female. I mentioned that it looked like hypertrophic pyloric stenosis, but was in the wrong age group. This appeared to be a thickened gastric wall and at this point I mentioned that it could represent Crohn’s disease, lymphoma, infection. She asked me why it looked like the antrum and I mentioned that it hooked up to the stomach on real-time and was anterior to the pancreas.

6. A cystic mass with mural nodules in the pelvis in a 7 year old female. I thought that this was mostly likely ovarian cancer. She asked what else you could do to finish the exam and I mentioned that I would look at the other ovary as these are often bilateral, and then look into the abdomen for acities and metastatic disease.

7. Fetal ultrasound with acities. I mentioned that it may represent urine acities, meconium acities from obstructive bowel, ovarian cyst rupture, or hydrops. I was unable to appreciate whether this involved the baby more extensively.

GU Cases

1. Persistent nephrogram at 10 minutes. I mentioned that I be concerned about a contrast reaction, I would check the patient. If the patient was having a reaction, I would open the I.V. fluids, put the patient in trandulenberg, and start oxygen. He asked if the patient was hypotensive with a heart rate of 115 and then decreasing blood pressure to 60, what would I do? I said I would give dopamine and he asked how I would give it and had I ever given it.

2. Mass with calcifications in the left lower pole kidney. I mentioned that this may represent renal cell cancer and he showed me a CT which showed renal vein invasion. He asked me what stage it was and I mentioned “2A”. He then asked me what the stages were when I realized I had mis spoke and met “3A”. He asked which stage would I rather have “3A” or “3B”. I believe you would rather have “3A”.

3. Multiple bilateral filling defects are seen in the collecting system of a young female. I mentioned that this may represent a lucent stone, such as uric acid, struvite, or cystine. He asked me what I could do to work it up and I said a CT and this was shown to me. The stones appeared opaque on this and he asked me what it was and I thought it was a staghorn.

4. Bilateral mid ureteral smooth strictures with focal outpouching and tiny filling defects. I felt this could be post-inflammatory and possibly pseudodiverticulosis. However, I was concerned about transitional cell cancer because of the tiny filling defects. He asked what I would do and how could I work that up further.

5. I was shown a low density adrenal mass with houndsfield units of -4. I accidentally put this case previously in the wrong section.

6. Renal mass was seen extending into the collecting system. I thought that this might be transitional cell cancer or lymphoma.

7. A huge retroperitoneal mass with fat content was seen displacing Gerota’s fascia posteriorly. I felt this might represent a liposarcoma. This mass had a lot of soft tissue content.

8. Obvious adrenal myeolipoma. He asked if this was a malignant lesion. I said no.

Bone Cases

1. Absent pedicle. I mentioned metastatic disease or infection and he persisted until I mentioned that it could be a congenital absent. I think he wanted me to realize this earlier.

2. Extensive bone sclerosis. Differential included metastatic disease, myelofibrosis, massive cytosis, fluorosis, and osteopotrosis. He told me to look at the film again and tell me what else was wrong. I noticed a large spleen, and he asked me what the diagnosis was. I said myelofibrosis.

3. Posterior scalloping and absence of the left lumbar pedicles and associated scoliosis. I mentioned neurofibromatosis and tumor. I guess he wanted me to say Marfans.

4. Foot with the irregularity of the inferior calcaneous and a lucent defect in the soft tissues. I mentioned that this may represent infection from foreign body or perhaps Rieters disease. He pushed me until I finally noticed that there was a fracture through the calcaneous and that these changes were likely post-traumatic with possible foreign body and osteomyelitis of the inferior calcaneous.

5. A hand was shown with central (seagull) erosions and osteophytes of the proximal and distal anterior pharyngeal joints. I mentioned inflammatory osteoarthritis or psoriasis, but felt that inflammatory OA was more likely.

6. Bilateral distal clavicle osteolysis. I mentioned scleroderma, hyper parathyroidism, rheumatoid arthritis, and trauma. He then showed a pelvis with erosions of the sacroiliac joint. I mentioned rheumatoid or hyperparathyroidism. He then showed a tube within the abdomen and asked me what it was, I thought it could be a VP shunt which made him very unhappy at which time he flipped back to the chest x-ray and emphatically showed me that there was no VP shunt. I couldn’t think of what it was, and realized in retrospect it was a peritoneal dialysis catheter. He then showed a hand film with multiple lytic masses and radial erosion of the middle phalanges, consistent with hyperparathyroidism.

7. Posterior dislocation of the hip. Post reduction, I noticed some flex of bone and worried about fracture. He asked me what I would worry about. I said avascular necrosis (this was not what he wanted to hear). He said what do they need to know now? I finally asked for a CT at which point I realized there were intra-articular fragments and this is what he wanted to hear me say sooner. He was not pleased!!

8. A Montaggia fracture/dislocation was shown.

Cadiovascular Cases

1. Traumatic AV fistula with pseudoaneurysm of the subclavian vein. She initially gave me a history of “Knife wound” which made this case a “piece of cake”.

2. An 11 year old with enlarged heart and normal vascularity (?). There was slight narrowing of the vascular pedicle. She gave a history of “SVT”. I said perhaps this was a cardiomyopathy, but she wanted me to say something else and I’m not sure what it was.

3. Enlarged right heart with decrease pulmonary vascularity. I mentioned Epstein’s, tricuspid atresia, and pulmonic atresia.

4. Aortogram with a baronet right hepatic artery and absent right kidney. The x-ray was coned down so that only the left kidney was shown and at first I thought the replaced right hepatic artery was the right renal artery. The next image was a pelvis view with a right pelvic kidney.

5. Enlarged pulmonary outflow tract. I gave the pulmonary artery hypertension differential diagnosis.

6. Coarctation of the aorta on PA and Lateral views of the chest.

7. Bilateral SSA extensive disease with occlusion on one side. She asked me how I would treat it. I mentioned that the results with angioplasty and thrombolysis were not as good with such extensive disease and that surgery might be better. She asked me am I aware of “ABIs”. And then asked if an ABI of 0.54 and 0.60 was normal. I said no. That was not.

8. Complete occlusion of the aorta below the renal arteries with collateral vessels filling the distal iliac artery. She asked me if there was a syndrome associated with this and I was not aware of one, although now I know there is one. This is related to atherosclerosis.

GI Cases

1. First case is extensive sand-like nodules throughout the small bowel. I gave the differential of Whipples, histoplasmosis, lymphoid hypoplasia, lymphagectasia, massive cytosis, and amyloid.

2. Dilated small bowel with thin folds. I gave the scleroderma, sprue, obstruction differential. I said it was probably scleroderma due to the hide bound appearance. He asked me what you see in sprue.

3. Metaesophageal stricture which I felt could be due to medications, or perhaps reflux in the setting of barrette esophagus. He then showed an image of the stomach which I thought was showing some abnormality in the body, but later he said what else do you see on the image which could explain the findings and I noticed that there was reflux on the single image of the stomach.

4. Several plaques were seen in the esophagus, some of these were larger in size (5mm). I mentioned cannida and glycogenic acamphosis. He said what other infections could do this and I mentioned perhaps herpes. He asked me what else does that usually look like and then what if the patient was on steroids. He then asked me about CMV and HIV ulcers.

5. There was a colon with innumerable polyps in a 70 year old male. I mentioned that this could represent apolyposis syndrome, but I felt that it was somewhat unusual to discover in a 70 year old without having cancer develop by that time. He asked me what else and my mind was a blank for some reason and I’m not sure what he was getting at.

6. The next case was a 5 cm low density heterogeneous mass in the body of the pancreas with peripheral calcifications. I mentioned the micro/macro cystic adenomas and perhaps a non-functioning pancreatic islet cell tumor. He asked me why this was not pancreatic cancer (adenocarcinoma). I mentioned that it would be unusual to see the mass have calcifications, be this large, and not cause obstruction of the pancreatic or common bile duct by the time it was this size.

7. Colon with abscess ulcerations and storm like ulcerations which were patchy. I mentioned Crohns disease and also mentioned perhaps CMV ulcers could have a similar appearance.

8. KUB of the right upper quadrant demonstrating mottled over the liver. I mentioned that this could represent an abscess and that it was not a great appearance for pneumotosis. He asked me what else I saw and I think there was free air seen under the diaphragm. I did not see this at first because the film was burned out at this level.

9. An extrinsic mass at the cecum narrowing the terminal ileum. I think I saw the appendix, but wasn’t sure. I mentioned Crohn’s disease, T.B., and urasenia. He asked me what other infections in a young female could cause this and I thought for a while and mentioned Castrovascula amebia. I then also mentioned pelvic inflammatory disease and endometriosis.

10. At the end of this session, before I got up to leave, he asked me four questions quickly in a row, none of which I knew the answer for!

11. The end involved what densities of barium do we use for barium enemas and upper GI’s and how do we measure that. He then asked me what kVp we use for upper GI images. I think in retrospect that the right answer is 100 kVp.

Nuclear Medicine Cases

This examiner did not ask me any QA questions or KEV numbers. He did ask for a few dosages and asked me what types of radiopharmaceuticals we used for certain studies. He was very helpful, gave all the histories, and mentioned what type of exam was shown for each case. For the thyroid case all he mentioned, was this was “protectnitate” exam which I think he wanted me to confuse it with a testicle because they can look alike.

1. A heart study showing a large infralateral heart defect which was mostly fixed and slightly reversible. The heart was normalized to the anteroseptal region which was abnormal. He asked me how much was fixed and how much was reversible. He then showed a follow-up post CABG with normal perfusion to the heart. He asked me what a “stunned myocardium” was. He said how would you look for this. I then mentioned the 24-hour delay would help. He said what agent do you use at your institution. I mentioned thallium at the VA and Mibi at UCSD.

2. A protectnitate thyroid scan with a cold nodule in a young man. He asked me what form of iodine do you use if you were scanning. I mentioned I-123. He said what else could you do to work this up. I mentioned an US and that if it was cystic maybe you could avoid a biopsy. He said no US was done, but it was biopsied and was cancer. Thyroidectomy was done and this is the follow-up. An I-131 scan was shown, showing uptake in the thyroid bed and lungs. He asked me what dose we used for thyroid cancer scanning. I mentioned 5-10 mc and that this was somewhat controversial. He said why? And I mentioned that the fact that you want a good scan vs. “stunning” the tumor. He asked me what dose I would use to treat the patient and I mentioned 150 mc for known metastases, 175 mc for lung metastases, and 200 mc for bone metastases.

3. A gallium scan in a female with malaise. Uptake was seen in the mediastinum, neck/submandibular gland area, and bilateral inguinal regions. He asked me what I thought was going on and I mentioned lymphoma.

4. VQ scan. He asked me which radiopharmaceutical we used and I mentioned Zinone and aerosolized DPTA. He asked which this was and since it was a posterior view only, I assumed it was Zinone. On the ventilation scan there was patchy delayed uptake in the right upper lobe and left apex consistent with COPD. This was mostly matched on the perfusion images and I mentioned that this was an indeterminate scan. He said what would you tell the clinician, and I said to do an angiogram as needed. He asked me to tell him about the pioped and modified pioped criteria. I mentioned that we used the biello criterian (since this is the one that I memorized!). I started to cite the high probability criteria and then he stopped me and we moved on.

5. HIDA scan in a male with prior cholescystectomy and recent common bile duct exploration and stone removal. I mentioned that this was either a HIDA or cholotect scan which was the newer way to do it. He asked me what the difference was and I said I didn’t know. The scan showed excretion into the small bowel (no obstruction) and focal activity in the right lower quadrant. He asked me what that was and I wasn’t sure. I mentioned extravasation, but that was a little bit of an unusual appearance. We then moved on.

6. Renal scan with delayed flow to the left kidney and an abnormal access of the left kidney. I mentioned that the left kidney appeared displaced and he then showed me a CT scan with a large retroperitoneal mass seen and an obstructive, hydronephrotic left kidney. He asked me what agent we use for kidney scanning and I mentioned MAG3. He asked me the dose and I mentioned 5 mc per kidney.

7. A renal scan with a delayed right kidney and dilated collecting system. He asked me what would we do next and I mentioned lasix. He asked me the dose which I mentioned was 20-40 mg I.V. I’m not sure if he showed me a follow-up scan with lasix or not.

8. Brain scan with a thallium scan on the left and an HMPAO scan on the right. There was increase uptake in the right occipital region on both scans. He mentioned that the patient had a tumor with previous resection and what did the uptake mean. I mentioned that it meant that the patient had recurrence of disease. Before he showed the scan, he asked me if we used PET and I said no. I think this is way he showed me this scan instead of a PET scan.

Mammography Cases

1. Hamartoma. I was asked to describe what exactly a hamartoma is. I was also asked that if the patient was hysterical about the lump, should you biopsy it.

2. Ligament cluster of calcifications. I recommended biopsy.

3. Spiculated mass. I also recommended biopsy.

4. Focal architectural distortion with abnormal calcifications. Recommended biopsy.

5. Benign appearing mass, recommended US. Ultrasound showed a cyst with a nodule. I recommended resection due to the fact that the nodule could represent papilloma, papillary carcinoma, ductal carcinoma, or blood clot. He asked if I had aspirated it and it was clear fluid, what would I do? I recommend sending the fluid to cytology. He asked me how good cytology was for this, and I said probably not very good because it is a small sample.

6. With a biopsy, he asked me how you would do a needle localization. A spiculated mass was seen on the MLO and lateral, but not on the CC. I recommend doing an exaggerated CC. He gave me a cleavage view and the spiculated mass was seen medially. I described in detail how I would do a needle localization.

7. Secretory calcifications. He asked me if I was sure and if they were benign, I said yes. He asked what I would say to the clinician if the clinician was worried about these.

Pediatrics

1. Ultrasound of a multicystic kidney. I suggested multicystic dysplastic kidney vs. cystic realm vs. multilatcular cystic nephroma.

2. Talocalcaneal coalition seen on axial and coronal CT.

3. A knee for which I could not find an abnormality. I was shown a close-up view where I think there was a lucent metaphyseal band. I said you would worry about leukemia.

4. AP pelvis with flattening and irregularity of the femoral head and in retrospect slip capital femoral epiphysis. I kept thinking this was Legg-Perthes and he wasn’t happy with that answer. He then showed me multiple images including the hand which showed osteopenia, distal tibia and fibula which showed widened physis. I recommended rickets and he wanted me to put it all together. Now in retrospect, I realized that Scfe has an increased incidence with rickets.

5. Multiple hypoechoic masses in the liver of a baby on US and CT. I suggested hemangioendothelioma. He asked me about the treatment and I said usually nothing.

6. Neck mass on the left seen around the carotid and jugular vessels. The mass was low density and lobulated. This was seen on CT. I suggested that this could represent parenchyal crust cyst and he kept asking me over and over where should those appear. I’m not sure if I was correct or not. I then suggested infection or tumor.

7. There were bilateral apical opacities, pneumoparacardium, and questionable bilateral pneumothoraces with bilateral chest tubes in place. He asked me what might cause this and I recommended RDS. This is a newborn! At which point, I said how about pulmonary hyperplasia. He asked me if the rib cage small and I said yes. He then showed me an US with absent bilateral kidneys. There were linear lesions within the renal fossa which I thought might be colon. He help me along until I realized they were the prominent adrenal glands normally seen in newborns which had dropped to fill the renal fossa.

8. Bilateral hyperechoic kidneys. I suggested autosomal recessive polycystic kidneys disease. He asked me what these patients got in the liver and I suggested hepatic fibrosis. What else and I suggested Caroli’s disease.

9. Where multiple segmental spine defects and fused ribs. He asked what this might be and at first I mentioned Marfans which he wasn’t as happy with because he said that they don’t get fused ribs. Then mentioned the vacterl association.

10. Hypoechoic adrenal mass on US and the baby with anemia and jaundice. I suggested an adrenal hemorrhage.

/svb

cc: Lisa Oakley

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download