DIP Episode 26 - USMLE Radiology

Okay, welcome. My name is Devine. I am a fourth-year medical student. This is the 26th episode of the Divine Intervention Podcasts. This review is actually super high yield but kind of unusual because I'm just gonna go over signs in radiology that are very high yield to know for the USML Expo step one, two and three. I will highly encourage you to go through this multiple times. It's just something you have to sort of look at stare at, maybe make flashcards off and you should be good to go. And I would like to thank Radiopedia for the many images I was able to pull off of that website. And again, big thing I will say is just go through this multiple times. This is not certainly all you need to know but these are very very important to know. So I'll just go through these relatively quickly. So the first slide, right? So you can see a bamboo spine, okay. This classically here is one of the seronegative spondylathropathes, right? So this is an chelousine spondylathes. Remember it's HLAB27 positive and it has that association with secret lightis. Okay, next one. So you can see this apple core lesion. So 55 year old male with him positive stool, he more globin of 6.9, right? If you ever see iron deficiency anemia in patient that is greater than 50, right? Your next step in management is to get a colonoscopy because you're worried about colon cancer, okay? Classically it shows up as an apple core lesion on exams, okay?

And just real quick, is there a particular bug you could see in a person's blood that will lead you to get a colonoscopy? Good, right? So that's strebobus. Strebobus. Okay, now next slide presents with this phasia to solids and liquids, right? So you can see the classic bird's beak sign, okay? So this is a chelizia, okay? Remember you get this from impaired relaxation of the esophagus, the distal esophagus. Don't forget that tripe, an osumacruzia, it can also cause this presentation. It's a secondary cause of ecalasia. Remember that t-cruzia causes big everything, right? You can cause ecalasia, big esophagus, it can cause a big heart, the elithec cardiomyopathy, and it could also cause a big GI tract, right? You can cause a herch bronch disease. Okay, next one. So this child was born with hypocalcymic seizures, right? So you can see this butch shaped heart, okay? That's the tetralogy of phyllo. Don't forget your full findings, right? So like your pomonix stenosis, right? Ventricular hypertrophy, overriding the odor and a VSD, okay? Has a very strong association with the catch 22 syndrome, right? So the George syndrome, okay? Remember they get the hypocalcemia because the apathiric glands do not develop and they get t-cell problems, right? Because the athymus doesn't develop, right? So classically, you may not also see a phymiac shot on newborn chest x-ray in this patient population, but if you see butch shaped heart, think about the tetralogy of phyllo.

And also don't forget that the George syndrome also has an association with tricospida, sorry, with truncus arteriosus. Now next one, this child had a white reflex at birth, right? So you can see the sunburst pattern, okay? That's an osteosarcoma, okay? The white reflex at birth, I'm trying to get you to think of a retinoblastoma, okay? RBG mutations increase your risk of retinoblastomas and osteosarcomas, okay? Don't forget your sunburst pattern, okay? There is also the codmin sign. If you take a look at the next slide, you can see like the triangular elevation of the periostia, okay? So let's go to the next one. At gas cores, we're 9 and 10 at 1 and 5 minutes respectively, you can see the sale, you can see that big thin in the anterior medias thineum, okay? This newborn, okay? That's the thymic shadow, okay? Every now and then you get the exam questions that want you to identify that. So just to keep that in mind, remember the thymic shadow will be absent in kids with skid, right? So we are combining minute efficiency from an adenosine diamines, the efficiency or interlooking two receptor defect, like the gamma chain, okay? You could also observe a similar finding in the George syndrome because again the thymus does not develop them, okay? So that's the thymic sale sign, okay? Next one, right? So you can see the stipple sign, so if they give you a question about the kid that has a weezen, right?

Young kid, if they show you this extra, you see this stipple sign, so people call it the wine bottle sign, that's pretty classic for croop, okay? Remember it's a subglotic stenosis, classically it's caused by the pyrrhen influenza virus. It's a subglotic stenosis contrast that with epiglotitis that is more of a superglotic stenosis. Okay, next one, right? So you can see the thymprinth sign, okay? This shadow is rolling, has a temperature of 104 weezen, right? So that's your thymprinth sign, classically that's epiglotitis. You'll be back in the day used to be caused by H-fluteybe, right? But now we've vaccinated against those stints. Again, it's a very high-youtu notice, it's a superglotic obstruction, okay? And in general on exams, your next step in management is not to perturb the child, okay? Call your friendly anesthesiology store ENT doc to help you go ahead and into beta this kid because they can have respiratory failure very quickly. Okay, good. Next one, right? So this vision has a B12 deficiency, right? So you can see the strenx sign, okay? In the in the in the GI tract, okay? The strenx sign is pretty classic for like stenosis of the bowel wall. It's something you'll find in Crohn's disease. Remember, Crohn's tends to torch the terminal helium. Okay, remember, the terminal helium is where B12 an intrinsic factor is absorbed, okay? So strenx sign Crohn's disease, you know, absorbing B12, so you have a B12 deficiency, right?

So you can have like a mega-loblastic anemia or you can have like a subacute combined degeneration of the court where the corticospinal tracks and the dorsal columns are destroyed. Also, the B12 deficiency of pressing could potentially have methyl-mallonic acidemia, right? Because methyl-malono coimuteus uses B12 as a cofactor. Okay, good. Next one. So red-coronjelly stools in a child, right? So you see this target sign, right? So red-coronjelly stools, they'll describe a kid that like curls up in a ball and then feels fine for a few minutes, curls up in a ball. Hopefully you're thinking of intrudersuception. Okay, remember, mechols that in particular can actually serve as a leap point. Okay, so again, this is a target sign intrudersuception. I'll talk about another GI pathology that also has this relationship. But the target sign looks a little different, okay? But this is intrudersuception. Again, think more of your coronjelly stools in a young kid. And in general, for these kids, you want to go ahead and avoid the rotavirus vaccine. It's one of those weird, high-yield things they love to test on exams. And while we're on the topic of coronjelly, if you see coronjelly sputum in an alcoholic, what's the bug you're thinking of? I hope you're thinking about clapsilla pneumonia. Okay, clapsilla pneumonia. Good. Next one. So 200 packier smoking history, right? So you can see this coin lesion, okay? That's pretty classic for, pretty classic for, for lung cancer.

I mean, it could be many things, but it could also be a primary lung malignancy. I'll need to insert a slide here about Pylox stenosis. I missed that for some reason. Okay, but that'll be slide 11. The 200 packier smoking history is a coin lesion that's lung cancer. Okay, now let's jump to the next one, right? So you can see this stomach. The wall looks very thick. Okay, that's a letter bottle stomach. Hopefully you're thinking of like 90s plastic. Okay, that's pretty classic for diffuse type gastric cancer. Usually has no association with Hitchpilory, okay? But it has a strong association with e-cadherin mutations. And if they give you a histology question, or you'll see your signet ring cells on histology. Okay, good. Next one. So this patient has a histro CHF, right? And you notice this person's heart looks like a water bottle. It's pretty classic for a periodical effusion. Okay, so this is the water bottle sign. Okay, remember, it can cause cardiac tamponad, right? And don't forget your backstrad with that, right? So like muffled heart sounds. They go test that by showing you an EKG, where you see electrical alternates, or you see your low voltage EKG. Okay, so muffled heart sounds, hypertension and JVD. That's a backstrad of cardiac tamponad. It could arise from a periodical effusion, a massive periodical effusion. Excuse me? Okay, let's do the next one. Now, severe abdominal pain and constipation, right? And you can see this coffee bean side.

Okay, that's pretty classic for a sigmoid volulosis. It's just one of those things you definitely want to be able to recognize for exams. This is all over many NVMA exams. Okay, next one. We have a 12-year-old with a two-month history of fever and leg pain. Okay, so you can see this onion skin in pattern. Okay, pretty classic for e-wink sarcoma. Don't forget your 11-22 translocation. Don't confuse that with the 9-22 translocation of CML. This is 11-22. You make the EWS FLI fusion protein. This is e-wink sarcoma. You classically, you can treat this on exams with ductino mice and remember it's that chemotherapy drug that treats a lot of childhood cancers. Okay, next one. This child has a history of trisomy-21, right? So, Down syndrome and bilia is vomited, right? So, you can see this double bubble sign. Okay, that's pretty classic for for drug and all that trecia. Okay, remember it has an essential trisomy-21. Don't forget your other hyalurthrysomy-21 findings, right? So, they can have a primal ASD, okay, because they get into cardio-cushion defects.

They can get at low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-calorie, low-cal If you're secreting even more than normal amounts of beta-hesi, you can see how it can present as a high-premises or a gravity-dark And in fact, on the next slide, you see the snowstorm appearance.

Again, this is pretty classic for, I guess, in this case, you'll go more with, with, uh, uh, uh, molar pregnancy or something, but this could also be an imaging finding in a, in a high-datetiform mole. Okay, next one. So you can see these, uh, batwing opacities in this vision that has a history of CHF. This is pretty classic for, for Pomona edema, okay? There's fluid in the lungs. Okay, next one. Severe headache over the past six months, right? So you can see this butterfly-shaped lesion. You can see a lot of, like, central necrosis and surrounding edema. Uh, this is pretty classic for, uh, for, for glioma, okay? A butterfly glioma, okay? Uh, classically on exams, this is a glioblastoma multiformy. Remember, it's a type IV astrocytoma, classically, crosses the corpus calosa. And usually on exams, they'll say, oh, central necrosis with a ton of edema. You really want to think about GBM with that. Very nasty prognosis. Uh, remember the tumor marker, okay? It's, uh, gliophibularia acetic protein, okay? GFP. Okay, next one. This vision also has a history of primary sclerosin colangitis, okay? So you can see this colon that looks like a lead pipe, okay? So lead pipe colon. Uh, so hopefully you're thinking about obstratif colitis, right? So there's a loss of, uh, hostromach, uh, markings, uh, with this, uh, image. Uh, okay. Next one. Mom took lithium when she was pregnant for bipolar disorder. So you can see this heart to shape like a box, okay?

Uh, this is the box shape heart sign, okay? It's pretty classic for Epstein's anomaly, okay? Uh, remember, in Epstein's anomaly has an association with maternal lithium use during pregnancy, okay? You basically have an epico displacement of the tricospit valve, and the buzzword you're looking for in the exam is a utilization of the right ventricle. Okay, next one. So you can see this person has chest pain relief with nitroglycerin. Uh, this person doesn't have an MI or Prinsmedals angina. You can see the cox-screwed shape of the esophagus, okay? It's pretty classic for the fuses of a geospasm, okay? You can treat that with, uh, with a nitrate or calcium channel blocker, okay? Uh, remember, these people present with, uh, this feature to both solids and liquids, but it's intermittent. Okay, next one. Newborn with cyanosis, okay? You can see this heart, uh, it's like an egg on a string. So I hope you think about transposition of the grade vessels. Uh, remember, these patients, classically, have a single S2 heart sound on a scotation, because they're just here in the order, okay? So they have, uh, like, a failed spin of the aortic opulmonary septum, okay? So they get a transposition with that. So egg on a string sign transposition of the grade vessels. Now, 65-year-old male with a six-month history of exercise intolerance, okay? So you can see this honeycomb bin of the lung on, uh, CT. Uh, so this is pretty classic for idiopathic pulmonary fibrosis.

Remember, it presents with a restrictive pattern of lung disease. So the FEV1 to every C ratio will be normal or slightly increased, okay? And the DLC will be decreased, okay? Very high, you'll to know that, for example. Next one. Three months old with bilios vomitting, right? So you can see this whirlpool sign, okay? So this is a malrotation with a mid-golf ovulus. In fact, if you see bilios vomitting in a young kid, uh, like, first, uh, like few days or weeks of life, uh, think of blood and allotrygia, but usually they will tell you something about Down syndrome in that question. But another thing you really want to take to the top of your differential, in fact, maybe the highest on your differential is malrotation with a mid-golf ovulus, okay? So the whirlpool sign. Okay, good. So the next one is, uh, patient has a history of toner syndrome and let me give you some other details. Let's assume they have an evidated blood pressure in the arms and almost, you can't detect any pulses in the legs, right? So this is a partition of the order. Remember the association of the three signs because you are basically like, notching the ribs, okay? Because you establish in all this collateral blood vessels around the partition. Okay, so this is the three sign, the order of the partition. Next one, new born with cyanosis, right? So you can see this lesion that looks like a snowman, okay? It's the snowman sign. It's pretty classic for total anomalous pulmonary venus return.

Okay, so in this case, the pulmonary veins, they drain into the right eaterm through the ears, we see instead of drain to the left eaterm. Okay, remember your terrible teeth, okay? Those are your cyanotic congenital heart defects, right? So snowman sign, uh, TAPVR, right? So total anomalous, anomalous pulmonary venus return. Okay, next one, signal rings sign, right? So this is long, okay? Special has a history of CF, okay? So this is classically bronchitisis, okay? So remember, signal rings sign on imaging, uh, in the long, think about bronchitisis, okay? And it could happen in patients with cystic fibrosis or in like a primary ciliary dyskinesia, like a touch in a syndrome, okay? Okay, now let's jump to the next one. Elevated PTH, low calcium and low phosphate, and you can see the srolzury, right? So this is the rachitic rosary on imaging. It's pretty classic for recats. Okay, remember that's a vitamin D deficiency. Okay, and remember, they will basically have a secondary hyperparthyroidism, right? Because if you have a vitamin D deficiency, you're not reabsorbing calcium and phosphate in the gut. So your calcium goes down, so your PTH will go up to try to compensate for that. Okay, now next one, you can see the spenciling cup deformity, it's a seronegative spondylathropathy. Hopefully you're thinking about psoriatric arthritis. Remember, it's one of those things that are positive for HLE B27. Okay, next one. Now, you can see a ladder, right?

So I didn't even put any caption here. So you basically have like a laddering of the person's GI tract. It's pretty classic for a small bowel obstruction, although you could also shop in a large bowel obstruction, okay? But this is the classic step ladder sign that you see in a small bowel obstruction. Now, this is an icy, the next question, right? So icy patient placed an event, right? So you can see basically why it's out long. It's pretty classic for ARDS, okay? Accura respiratory distress syndrome. Remember, this is a kind of non-cardiogenic pulmonary edema. So the pulmonary capillary wedge pressure will be less than 18, okay? Because it's not the heart that's causing this pulmonary edema. Basically, you want to treat this people with like low tidal volumes and adequate peep, okay? Now, next one. Lessifin to sphingomiling ratio is one, right? So you can see the ground glass or pacification of the lungs by laddering. Let's call this kid a preemie, okay? It's pretty classic for neonatal respiratory distress syndrome, okay? Remember, if you're lessifin to sphingomiling ratio is greater than two to one, then you're more assured that the phyto lungs have immature. And to prophyloxagins this, you could try to give mom up like steroids to try to promote differentiation of the tytonium inside. So you make a non-stereffectant and prevent this from happening. Okay, next slide, right? So a newborn with severe respiratory distress at birth, right?

So you can see bowel in the thoracic cavity. It's pretty classic for congenital diaphragmatic hernia, okay? So the classic Boswark description on the exams is a scalfoid abdomen, very high you to know that. A scalfoid abdomen, it's pretty classic for congenital diaphragmatic hernia, right? And this kid will have lung hypoplesia, right? Because the bowel has taken up space that the lungs could have expanded into. That's why the kid has respiratory distress. Okay, next one. So the nasogastric tube is curling in the upper thorax, right? So hopefully you're thinking of a like a vasogilatrizia with a T-fistula. Actually the most common type I believe is the H type. Remember this has a very classic association with the Vactyl syndrome if you make. I'll encourage you to make sure you know what Vactyl stands for, what charge stands for. I believe I talked about that in a previous podcast. Now this next one, and I believe it's our last one, yep, it's our last one. So this was obtained from a patient with a CD4 count less than 200, right? So you can see the intestinal infiltrates, right? So hopefully you know that this patient has a newocystis-dravacy, okay? HIV patient. And in general, right? If a CD4 count is less than 200, you want to profile out to the bathroom, right? So trimethylprim, so from the foxes, I remember trimethylprim inhibits dihydrofolioreductase. And then a softened thoxazole inhibits dihydrophorixinthethys.

But if a patient comes down with this in general, you want to go ahead and give them IV back trim, okay? If that's not an answer choice on an exam, you may want to think of like a pentamidine, like aerosolide pentamidine, for that treatment purpose, okay? And just for people that are taking step 2, CK, or the medicine shelf, you really want to remember the criteria for people that have to get like steroids if they have this kind of presentation, right? Remember if the A gradient is greater than 35, or the oxygen saturation is less than 92%, or the oxygen partial pressure is like less than 70 millimeters of mercury, those patients should get steroids, so they don't go into hypoxic respiratory failure with a newocystis-dravacy pneumonia, okay? So that is the end of this podcast. I really hope you find this useful, I think you will. If you spot any errors or you have any questions, feel free to send me a message or make a comment below, and I'll be more than happy to point you in the right direction. Have a wonderful new week, it's Monday, the 7th of May, and I will see you in the next podcast. God bless, thank you.

Seronegative spondyloarthropathy, such as Psoriatic Arthritis or Ankylosing Spondylitis.

Colonoscopy to rule out colorectal cancer (Apple core lesion).

Achalasia (Impaired relaxation of the distal esophagus).

Tetralogy of Fallot, hypocalcemia, and T-cell immunodeficiency.

The "snowman sign" on chest X-ray/imaging.

Intussusception.

Bowel wall thickening/inflammation; Crohn's disease (especially terminal ileum).

Total Anomalous Pulmonary Venous Return (TAPVR).

Muffled heart sounds, JVD, and low voltage EKG.

Epstein's anomaly (associated with box-shaped heart).

Stipple sign or "wine bottle" appearance.

Achalasia involves impaired relaxation of the distal esophagus (Bird's beak); Trachea/Bronch disease can cause massive dilation but lacks the specific functional obstruction pattern.

Bowel wall thickening/inflammation; Crohn's disease (especially terminal ileum).

Total Anomalous Pulmonary Venous Return (TAPVR).

Muffled heart sounds, JVD, and low voltage EKG.

Epstein's anomaly (associated with box-shaped heart).

Stipple sign or "wine bottle" appearance.

Achalasia involves impaired relaxation of the distal esophagus (Bird's beak); Trachea/Bronch disease can cause massive dilation but lacks the specific functional obstruction pattern.