What is your diagnosis?

J Am Vet Med Assoc. 2008 Nov 1;233(9):1401-2

Authors: Baron ML, Morandi F, Hecht S, Leblanc AK

PMID: 18980487 [PubMed - in process]

What is your diagnosis? Benign true cementoma (benign cementoblastoma).

J Am Vet Med Assoc. 2008 Oct 1;233(7):1063-4

Authors: Levine DG, Orsini JA, Foster DL, Leitch M, Engiles J

PMID: 18828713 [PubMed - indexed for MEDLINE]

Persistent Mullerian Duct Syndrome in a Miniature Schnauzer Dog with Signs of Feminization and a Sertoli Cell Tumour.

Reprod Domest Anim. 2008 Oct 10;

Authors: Vegter AR, Kooistra HS, van Sluijs FJ, van Bruggen LW, Ijzer J, Zijlstra C, Okkens AC

Contents A 5-year-old male Miniature Schnauzer was presented with unilateral cryptorchidism and signs of feminization. Abdominal ultrasonography revealed an enlarged right testis and a large, fluid-filled cavity that appeared to arise from the prostate. Computed tomography revealed the cavity to be consistent with an enlarged uterine body, arising from the prostate, and showed two structures resembling uterine horns that terminated close to the adjacent testes. The dog had a normal male karyotype, 78 XY. Gonadohysterectomy was performed and both the surgical and the histological findings confirmed the presence of a uterus in this male animal, resulting in a diagnosis of persistent Mullerian duct syndrome (PMDS). The enlarged intra-abdominal testis contained a Sertoli cell tumour. Computed tomography proved to be an excellent diagnostic tool for PMDS.

PMID: 18954385 [PubMed - as supplied by publisher]

Tips for Passing the Radiology Boards - Part I
Tips for Passing the Radiology Boards - Part II

2008 was the first year that the written exam was taken at the end of the second year, rather than in the third year of the residency. This meant that everyone had to be that much more organized in their strategy early on in the residency program. I interviewed two residents who successfully completed the written exam in 2008; Matt Cannon from UC Davis, and Sophie Dennison from the University of Wisconsin, Madison. Randi Drees from the University of Wisconsin, Madison, wrote the exam in 2007 and was kind enough to contribute her advice as well.

This week I’m publishing part I of the interview for you. Matt, Sophie and Randi share their timelines for studying and their approach to reviewing the literature. Next week you’ll be able to read part II, including the residents’ top three tips for preparing for the written board exam and their favorite study resources.

If other residents have tips for the exam, please post them in the comments section! You can’t have enough good advice from people who have been through the process, so I welcome your contributions to the conversation.

AZ:How many months ahead of the exam did you start preparing?

Matt:

I started studying lightly after Christmas during my first year. I also had several weeks off in the spring and summer of my first year that I used to organize material and begin studying. However, I also made it a point to read recent VRU and other classic articles from the beginning so that I did not have to cram too much in at the last minute. I found this practice really helpful from a clinical perspective as well. I began more focused studying of the exam objectives 4-5 months before the exam. I had 5 weeks off before the exam that I used primarily to review material and fill in any holes in my knowledge.

Sophie:

Actually I worked pretty much from the start of the residency to get up to date with literature and get back in the swing of pathophysiology, but 5 months before was the hard core summarizing notes and learning period.

Randi:

January 1st thorugh May 2nd, that makes 4 months.

During the Residency I had gone through some what I thought would be pertinent books such as Bushberg, Thrall, Butler, Zagzebski, Nyland/ Matoon, etc. And tried to read through the previously written objectives. And read some papers.

AZ:What did you start with and how much time did you study per week?

Matt:

I began by reading certain foundation textbooks and taking some notes on pertinent sections. I did this to get an overall understanding of the material, especially physics. The second time around I read with an eye toward answering individual objectives. Initially I studied for several hours in the mornings on weekends when I wasn’t busy or on-call. I treated off-clinics time like workdays for the most part, studying from about 9-5 with a lunch break. About 4-5 months before the exam, I began studying about 10-15 hours per week, in the evenings and on the weekends. During the 5 weeks before the exam, I spent each day as a full workday, studying from about 8-5. I then would typically take a break for dinner and then spend an hour or two in the evening reviewing the day’s material or studying anatomy ( I didn’t actually allot any days of studying for anatomy, as I figured this section would take the least amount of time and doesn’t require a lot of thought). During this review period, I spent 1 week each on pathophysiology, alternate imaging, physics, special procedures, and radiation biology. I had several days left over at the end for last minute review and memorization.

Sophie:

Pathophys, physics and literature; 1-2 hours a night of objectives study regardless of what other work needed to be done. Once within 5 months of the exam, minimum of 3 hours a night plus 4-6 hours each weekend day.

Randi:

I tried starting to just work down the objective list but there is repetition and not the chronology I liked, I figured that won’t work. I tried reading though the notes written up by previous residents, that is excellent supply, but I could not study directly from that.

Study time: I had 4 weeks off clinics before the exam.

• reading papers and supplying with Guyton / Ettinger / etc.: good 3 Month with ~3 hrs Mo-Fri, up to 10hrs on Sat / Sun during clinics time
• All physics including alternate imaging: 2 weeks in the off time (off time study time ~ 4-12hrs / day, depending on mood)
• Rad Bio: 2 days in off time
• Specials: 2 days in off time
• Anatomy: 2 days in off time
• Melt down: 2 days in off time.

AZ:What was your approach to reviewing the literature? (which journals, which years, any software, etc)

Matt:

As mentioned above, I tried to read VRU and other classic articles throughout my residency instead of cramming at the last minute. After reading each article I would write several sentences at the top of the article summarizing the basic gist and any essential points to remember. Therefore when I went back through the articles later I could quickly get a feel for the important points of the paper. When reviewing in the last several weeks I spent the vast majority of time reading the last 8 years of VRU. I did skim other journals including JVIM, JAVMA, AJVR, and Vet Surgery and read pertinent articles but I did not find this particularly helpful. Overall, I did not spend that much time reviewing literature and instead spent the majority of time reviewing the individual objectives.

Sophie:

I searched the last five years of JAVMA, JAAHA, JSAP and last 8 years of Vet Rad. If something sparked an interest then I looked up other refs using pubmed or google scholar search engines. I copied and pasted the title, ref and abstract plus any images which would spark memory onto a word doc page, printed the page and added hand written notes about the article to the sheet. This ensured I read the article, proved to me at a later date I had read the article and provided something for my mind to go back to when trying to recall information.

Example of Sophie’s literature summaries

Randi:

During the residency I had started to collect interesting articles in a simple windows file system, pdf’s filed by organ system. I additionally downloaded the last ~ 5 yrs of VRU, and imaging related things out of JVIM, JVS, JAAHA, JSAP, JAVMA, JVR and added that to the files. Then I started reading by organ system. With Adobe I copied title, abstract and pictures that I thought would help onto a single page per article and printed that and summarized on this page what I thought was important in handwriting. That way the highlights are on the pdf and I know where to find it, but I don’t have that overwhelming amount of papers to print out. Those summary pages made up about 4 folders in the end and are organized the same way as the pdf-files on my computer. Nice and handy. Reading the papers I covered a lot of relevant physiology, pathophysiology, anatomy and physics. Areas I felt weak on or couldnt answer an objective after doing this I supplied mostly with Guyton and Ettinger for pathophys. Doing all this took the longest time.

Physics: I had fought my way through Bushberg before, and that went very much faster for the real preparation as I anticipated. Same for NucMed, I used the handbook and papers. For US Physics Zagzebski, for MRI physics I read also books for technicians, they break things down a little more user friendly and applicable.

Special procedures: very good what’s written up in the previous residents notes, papers and books like Thrall.

Anatomy: looking at pictures in Miller and other Anatomy books and normal Radiographs in Thrall, papers.

I then I got some summarized notes (pretty and colorized, very soothing to the eye, and very good for memorizing) from one of my fellow residents. I took additionally about 3 days to write a short answer to all the objectives to make sure I know at least something for every one on the list and don’t miss anything.It is great if you manage to compile this huge amount of information into some smaller format, such as 2-3 folders. Otherwise I felt I sit in front of “extraordinary large piles” and can’t look up things fast or can’t even transport all that to where I was supposed to take the exam.

Omasal ultrasonography in cows and buffaloes.

Vet Radiol Ultrasound. 2008 Sep-Oct;49(5):495; author reply 495-6

Authors: Buczinski S

PMID: 18833963 [PubMed - in process]

99mTc-labeled dextran for mammary lymphoscintigraphy in dogs.

Vet Radiol Ultrasound. 2008 Sep-Oct;49(5):487-91

Authors: Pereira CT, Luiz Navarro Marques F, Williams J, Wlademir De Martin B, Primo Bombonato P

Lymphoscintigraphy is the technique of choice for sentinel lymph node detection in women with early breast cancer, but there is limited information evaluating the value of this technique in animals. We investigated mammary lymphatic drainage in 25 young female mongrel dogs by intramammary injection of 18.5 MBq of 99mTc-dextran (70,000 Da). Lymph node anatomical referencing was obtained using an external marker, bone scintigraphy, or scintiscanning the body contour. Cranial and caudal thoracic mammary glands drained into the cranial sternal lymph node and axillary lymph center. The cranial thoracic mammary gland also drained into the superficial cervical lymph node in two of five animals. The cranial abdominal gland was drained by the axillary lymph center. The caudal abdominal mammary gland was drained by the superficial inguinal lymph node in all animals and simultaneously by medial iliac lymph nodes in four of five animals. In one dog, this mammary gland was also drained by the mediastinal and the superficial cervical lymph nodes. The inguinal mammary gland was drained by superficial inguinal lymph nodes and simultaneously via the medial iliac lymph node in one animal. Lymphatic communications between lymph nodes were identified in 11 of 25 (44%) animals. 99mTc-dextran mammary lymphoscintigraphy was easy and rapid to perform and may provide valuable information for further studies.

PMID: 18833961 [PubMed - in process]

Statistical briefing: the normal distribution.

Vet Radiol Ultrasound. 2008 Sep-Oct;49(5):492-3

Authors: Lamb CR

PMID: 18833962 [PubMed - in process]

Mature domstic short hair cat with 3 week history of respiratory distress

Thoracic radiographs showed a flattened diaphragm and hyperlucent lungs. On the d/v projection, the ribs were nearly perpendicular to the spine and the diaphragm had scalloped edges. The esophagus was markedly dilated with air, as was the stomach and small intestine. These findings of hyperinflation and aerophagia suggested an upper airway obstruction so neck radiographs were requested. In the larynx, there was a soft tissue opacity mass that was responsible for the upper airway obstruction. Differential diagnoses included neoplasia (lymphoma, squamous cell carcinoma), granulomatous disease, and edema. Diagnosis: lymphoma.

9 month old domestic long hair cat with a heart murmur

The heart was markedly enlarged on both the lateral and d/v projections. The shape of the cardiac silhouette resembled a peanut with a waist between the enlarged atria and ventricles. The heart occupied more than 50% of the thorax on the d/v projection. The pulmonary arteries and veins were enlarged. On the edge of the radiograph, the fundus of the stomach was visible on the right side. Differential diagnoses included congenital heart disease such as vsd and abnormal valves, as well as PDA or VSD causing a left to right shunt. Secondary diagnosis: Situs inversus. Echocardiography revealed a single atrium and single ventricle with a VSD. Note: This type of case is not well diagnosed on radiographs beyond severe, congenital heart disease. Complex cardiac anomalies can be associated with situs inversus.

23 year old Morgan gelding with anorexia and weight loss

Thoracic ultrasound: There was marked echogenic pleural effusion with visible strands of the pericardial-diaphragmatic ligament. In the cranial thorax, there was a lobular mass with relatively uniform echogenicity. Differential diagnoses for the mass were neoplasia, most likely lymphoma, hemangiosarcoma, melanoma, or other neoplastic disease. Pleural fluid was non-diagnostic. A tissue sample was obtained by thoracoscopy. Diagnosis: anaplastic carcinoma.

What is your diagnosis? Caudodistally displaced lateral humeral epicondylar fracture.

J Am Vet Med Assoc. 2008 Sep 15;233(6):873-4

Authors: Bordelon KL, Mathis SC, Munroe JL

PMID: 18795845 [PubMed - in process]

What is your diagnosis? Benigh true cementoma (benign cementoblastoma).

J Am Vet Med Assoc. 2008 Oct 1;233(7):1063-4

Authors: Levine DG, Orsini JA, Foster DL, Leitch M, Engiles J

PMID: 18828713 [PubMed - in process]

Contrast harmonic imaging characterization of canine splenic lesions.

J Vet Intern Med. 2008 Sep-Oct;22(5):1095-102

Authors: Ohlerth S, Dennler M, Rüefli E, Hauser B, Poirier V, Siebeck N, Roos M, Kaser-Hotz B

Background: Although B-mode ultrasound is very sensitive for the detection of splenic lesions, its specificity is low. Contrast harmonic imaging is used successfully to differentiate benign from malignant liver lesions in humans and dogs. Hypothesis: Contrast harmonic imaging could be useful to differentiate benign and malignant splenic lesions in dogs. Animals: Sixty dogs (clinical patients) with splenic abnormalities detected during abdominal ultrasonography. Methods: A prospective study was performed with a Philips ATL 5000 unit for contrast pulse inversion harmonic imaging (mechanical index: 0.08, contrast medium: SonoVue). Perfusion was assessed subjectively and quantitatively. Results: Cytology or histology identified 27 benign (hyperplasia, extramedullary hematopoiesis, hematoma) and 29 malignant (hemangiosarcoma, malignant lymphoma, malignant histiocytosis, mesenchymal tumors without classification, mast cell tumors, and others) lesions and 4 normal spleens. Except for 1 benign nodule, extensive to moderate hypoechogenicity was only seen in malignant lesions during wash-in, at peak enhancement, and during wash-out (P= .0001, odds ratios: 37.9 [95% CI 4.5-316.5], 66.4 [95% CI 8.0-551.1], and 36.9 [95% CI 4.4-308.4]). Although all but 1 benign lesion enhanced well and were mildly hypo-, iso-, or hyperechoic in comparison with the normal spleen during all blood pool phases, marked enhancement occurred both in benign as well as in malignant splenic lesions. Quantitative perfusion values did not differ significantly between benign and malignant lesions. Conclusions and Clinical Importance: Moderate to extensive hypoechogenicity clearly identifies canine splenic malignant lesions. In nodules with marked enhancement, contrast harmonic ultrasound is of limited value and histology is needed.

PMID: 18681923 [PubMed - in process]

Analysis of Blood Flow in a Third Ventricular Ependymoma and an Olfactory Bulb Meningioma by using Perfusion Computed Tomography.

J Vet Med Sci. 2008 Sep;70(9):981-3

Authors: Kishimoto M, Yamada K, Seok JS, Shimizu J, Kobayashi Y, Akiba Y, Morishita Y, Iwasa A, Iwasaki T, Miyake Y

Brain perfusion computed tomography (CT) scanning was performed in a mongrel dog and a golden retriever that were diagnosed with third ventricular tumor and olfactory bulb tumor, respectively, by contrast-enhanced CT. The tumors were pathologically diagnosed as ependymoma and meningioma, respectively. Perfusion CT results revealed that the ependymoma in this study had a lower blood flow, higher blood volume, and greater transit time of blood than the adjacent brain tissue. Further, the meningioma in this study had a higher blood flow, higher blood volume, and greater transit time of blood than the adjacent brain tissue. Perfusion CT can potentially be used for the grading of brain tumors and narrowing differential diagnosis, provided the perfusion CT data of animals are accumulated.

PMID: 18840975 [PubMed - in process]