Radiology MCQs- AIIMS May 2011

Questions submitted by DAMS students

Q1 Contrast radiography all are true EXCEPT:

a)      Jejunum has feathery appearance.

b)      Ileum is featureless

c)       Colon shows asymmetric haustrae.

d)      Distal duodenum shows a cap like appearance

Answer-  d) Distal duodenum shows a cap like appearance

Reference -  Review of Radiology- Sumer Sethi, 5^th edition.

Proximal duodenum called as duodenal bulb is shaped like a cap. The duodenal cap or duodenal ampulla is the very first part of the duodenum which is slightly dilated.It is the part which is intraperitoneal and is about 2 cm long. It is mobile and has a mesentery. It is also smooth walled.

Q2 All the following are pure beta emitters EXCEPT

a)      Yttrium-90

b)      Phosphorus-32

c)       Strontium- 89

d)      Samarium 135

Answer- d) samarium

Reference -  Review of Radiology- Sumer Sethi, 5^th edition. Pg 122

Radioisotopes in Treatment of Osseous Metastases

PHOSPHORUS 32--Radiophosphorus-labeled phosphates were the first radionuclides used to treat bone metastases. Since then, many reports have been published about the use of 32P in patients with prostate and breast carcinoma. The currently available product, 32P orthophosphate, is economically priced compared with similar beta-emitting radionuclides used for this purpose, but it has fallen into disuse because of the widely held impression that current 32P approaches are too toxic.

STRONTIUM 89 CHLORIDE--Although 89Sr is, like 32P, a pure betaemitting radioisotope, it has several theoretical advantages as a treatment agent for bony metastases. Strontium is found in the same periodic table family as is calcium and is metabolized in a similar fashion, with significant concentrations found in the skeleton and small amounts elsewhere in the body.

SAMARIUM 153 LEXIDRONAM-- The US Food and Drug Administration has recently approved samarium 153 lexidronam chelated to ethylenediamene-tetramethylenephosphonic acid (153Sm-EDTMP) for the relief of pain in patients with osteoblastic bone metastases. This radioisotope, like 32P and 89Sr, emits low-energy electrons. Unlike the other approved agents, however, 153Sm has a shorter half-life (less than 2 days) and gamma emission suitable for imaging and prospective dose estimation.

RHENIUM 186 AND RHENIUM 188--- Rhenium 186 (Sn) hydroxyethylidene diphosphonate (186Re-HEDP) has characteristics similar to those of 153Sm-EDTMP, with a beta emission half-life of 90.64 hours and a gamma emission suitable for imaging.

YTTRIUM 90- is also beta emitter.

Q3 Protein loosing enteropathy is diagnosed by all EXCEPT:

a)      Tc 99 Sotisumab

b)      Tc 99 Dextran

c)       Tc 99 Albumin

d)      In 111 Transferrin

Answer- a )  Tc 99 Sotisumab

Reference –

 Semin Nucl Med 37:269-285- 2007

The diagnosis of protein losing enteropathy was first performed using 131I polyvinyl pyrrolidone. It was replaced by131-I albumin, which was considered to be more physiologic. This marker was limited by 131I thyroid uptake and absorption of 131I albumin into the intestinal tract sometimes yielding indeterminate results.69 51Cr labeled albumin overcame difficulties associated with 131I albmumin and became the radionuclide of choice for these studies.

99mTc-labeled albumin has been used for diagnosis of protein losing enteropathy, but has the added advantage of permitting imaging of the gastrointestinal tract with potential localization of a site of protein loss, thereby, assisting in the diagnosis of the underlying condition, or directing resectionfor surgically correctable causes of enteric protein loss. 99mTc- HSA scans were more likely positive in patients with lower albumin and total protein levels, possibly related to higher rates of protein loss.

99mTc-dextran was evaluated for its use in detecting protein losing enteropathy. The findings suggested improved sensitivity compared with previous documented studies using 99mTc-HSA, possibly because of faster background clearance, less electrostatic repulsion from vascular endothelium, less hepatic uptake, and better in vivo stability.

111-In transferrin was evaluated for its ability to provide both imaging and detection of protein-losing enteropathy through one examination.Other possible advantages of 111In transferrin imaging includes its stability with significantly less likelihood for urinary excretion compared with 99mTc HSA.

Q4  Central Dot sign is seen in

a)      Caroli Disease

b)      Polycystic liver disease

c)       Primary sclerosing cholangitis

d)      Liver hamartoma

Answer-a )  Caroli Disease

Reference- Hepatobiliary CME-AIIMS-MAMC –PGI series for radiology Post graduates

Computed tomographic (CT) scans of the liver shows tiny dots with strong contrast enhancement within dilated intrahepatic bile ducts (the central dot sign). These intraluminal dots on CT scans corresponded to intraluminal portal veins on sonograms, findings indicating portal radicles surrounded by dilated intrahepatic bile ducts. This is a classical sign for Caroli’s disease

Q5 In Left ventricular failure which of the following is not found:

a)      Kerley B lines

b)      Oligaemic lung fields

c)       Increased vascularity in upper lobes

d)      Increase pulmonary capillary wedge pressure

Answer- b) Oligaemic lung fields

Reference- Pg 32-33 Review of Radiology, Sumer Sethi, 5^th edition.  

Pulmonary Edema or LVF

PCWP(mmHg)	Pathology	CXR
9-12	Normal
12-19	Early Pulm Edema/Cardiac Decompensation	Dilated UL Pulm Veins
20-24	Interstitial Edema	Kerley Lines
>25	Alveolar edema	Batwing Appearance, Perihilar Fluffy opacities

Q6  Gold standard investigation for recurrent gastrointensinal stromal tumour is :

a)      MRI

b)      MIBG

c)       USG

d)      PET

Answer- d) PET

Reference- The radiology of gastrointestinal stromal tumours (GIST). D Michael King. Cancer Imaging. 2005; 5(1): 150–156.The management of malignant GISTs has been revolutionised by the development of Imatinib  which is, uniquely, a therapeutic agent that targets a specific abnormal intracellular signalling molecule. The effective management of patients with these tumours requires regular imaging assessment for which CT has conventionally been the method of choice. Whilst it remains most valuable in the initial diagnosis and staging of GISTs, it is now clear that PET imaging, preferably combined with CT is the gold standard method for assessment of response by virtue of its unique dynamic functional characteristic which, when combined with CT, provides a more accurate assessment and prediction of the quality of response.

Q7 On abdominal ultrasound gall bladder shows diffuse wall thickening with hyperechoic nodule at neck with comet tail artifacts. The most likely diagnosis is :

a)      Adenomyomatosis

b)      Adenocarcinoma of gall bladder

c)       Xanthogranulomatous cholecystitis

d)      Porcelain gall bladder

Answer-a ) Adenomyomatosis

Reference- DAMS class test. Repeat from AIIMS November 2008.

Cholesterol crystals within Rokitansky- Aschoff sinuses produce the characteristic ‘comet tail’or ring-down artifact seen in adenomyomatosis. Both gallbladder, carcinoma and adenomyomatosis can cause focal wall thickening in the gallbladder, but the visualization of hyper echoic sinuses is typical of the latter. A porcelain gallbladder is a complication of chronic cholecystitis causing mural calcification: the gallbladder wall appears hyperechoic with marked  acoustic shadowing.