Radiology MCQs-Maharashtra Mch Exam

Q- Pseudo billroth sign is present in
Crohns
ca stomach
 ulcer

Answer

The earliest radiographic sign in Crohn's disease is aphthous ulcers. The most common radiologic findings in gastroduodenal Crohn's disease are mucosal nodularity, or “cobblestoning,” thickened folds, and ulcerations. A pseudo-Billroth I appearance of involved antrum and proximal duodenum has been described. A rare but classic radiographic finding is the funnel-shaped deformity of diseased antrum and duodenal bulb, known as the “ram's horn” sign

Q-scimitar sign is present in

 1 ca rectum 

2 chordoma 

3 sacrococcgeal teratoma

 4 anterior meningocele

Answer-

Anterior sacral meningocele is an unusual lesion that usually presents as a presacral mass. Radiography of the pelvis demonstrates a sacral deformity or “scimitar sign” that is pathognomonic for anterior sacral meningocele.

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.

MPPG-2011 Radiology questions

Questions submitted by students of DAMS by memory recall 
Q1 Non ionic iv iodinated contrast agents are better than ionic contrast due to:


[a]reduced rate of adverse reaction 
[b]improve imaging due to increase concentration of contrast in collecting system
[c] both
[d] none

Answer is a)  Non-ionic compounds have a lower rate of adverse reactions, but in IVP their concentration is lower than ionic.

Q2 Minimal ascitis best detected by-


a] USG [b] x ray [c]MRI [d] CT

Answer- A ) USG

Q 3. when x ray or gamma rays enter a material/tissue in its path ,all possible except:
[a] intensity of radiation fall by at least 80%
 [b]radiation may travel without any interaction
 [c] radiation may be completely absorbed by interaction 
[d] the radiation is partially attenuated and result in scattered radiation

Answer- a)
Reference- http://www.sprawls.org/ppmi2/INTERACT/#Photon%20Interactions

As an x-ray beam or gamma radiation passes through an object, three possible fates await each photon, as shown in the figure below:
1. It can penetrate the section of matter without interacting.
2. It can interact with the matter and be completely absorbed by depositing its energy.
3. It can interact and be scattered or deflected from its original direction and deposit part of its energy.


Q4 The highly accurate imaging modality in investigation of ureteric colic
a X ray 
b Spiral ct 
c USG 
d IVU

Answer- Spiral CT

Q5 Cancer cells are LEAST SENSITIVE to Radiotherapy -


a) G1
b) G2
c) M phase
d) Later phase of S phase.

answer-d)
The cell cycle phase also determines a cell's relative radiosensitivity, with cells being most radiosensitive in the G(2)-M phase, less sensitive in the G(1) phase, and least sensitive during the latter part of the S phase.

PGI Nov 2010-Radiology Recalled Questions

Few Radiology  recall questions from PGI Nov 2010 examination.



Metastases to bones is infrequent in
1. Spine
2. Proximal long bones
3. Hands and feet
4. Not recalled
5. Pubic bones

Answer- Hand and Feet.  Secondaries distal to the knee and elbow are uncommon. Only three tumours BBC, Bronchus, Bladder and Colon may show secondaries to small bones of hand and feet. Spine, proximal long bones and flat bones are marrow containing areas in adult skeleton, so metastatis is common in this bones.

Bare orbit is seen in
1. Neurofibromatosis
2. osteomyelitis
3. Metastasis
4. Meningioma
5. Hemangioma

Answer 1, 3, 4.
Bare orbit appearance is seen in the NF due to sphenoid dysplasia, Mets due to destruction and meningioma due to sclerosis. Reference -Chapman's Differential diagnosis book.

Heterotopic ossification is seen in 
1. Gout
2.  Revision surgery
3. Reiters
4. prolonged surgery 
5. Forresteir disease

Answer- All

Isotope in external beam therapy
1. cs 137
2. co 60
3. radium 226
4. I-131
5. iridium

1, 2, 5.

Screenin of prostate ca.
1. transrectal usg
2. digital exam
3. PSA
4. Not recalled
5. ct scan

Answer 2, 3. CT scan has not role in diagnosis of prostatic malignancy.

Radiology MCQs from AIIMS November-2010

 These MCQs were sent to us by our students from DAMS and are based on memory recall.  We will be releasing fully solved version of all subjects with detailed explanation with Elsevier within 10 days. 

DAMS (Delhi Academy of Medical Sciences [p] Ltd) is the leader in the PG medical entrance preparation currently in the country. 

AIIMS November 2010 Radiology

Radiation exposure is the least in the following procedure:
a. micturating cystourethrogram
b. IVP
c. bilateral nephrostomogram
d. Spiral CT for stones

Answer-A) MCU

 IVP radiation exposure is 2.5mSv (125CXR), Spiral CT abdomen for abdomen-10mSv( 500CXR), MCU-1.7mSv.  Bilateral nephrostomogram is a procedure will require fluoroscopy twice, once for each kidney and possibly will have higher radiation.

A 35 yr old lady with chronic backache. On X ray she had a D12 collapse. But Intervertebral disc space is maintained. All are possible except 
a.) multiple myeloma 
b.) osteoporosis 
c.) metastasis
d) tuberculosis

Answer-d) Tuberculosis

As a rule neoplastic and traumatic/osteoporotic collapse show sparing of the intervertebral disc, while tuberculosis classically is paradiscal, involvement of disc is usual. Common neoplasms in adult causing disc collapse are metastasis and multiple myeloma, while in children vertebral collapse may indicate histiocytosis (vertebra plana). This question has been asked previously in AIIMS but with different framing of the question.

 Bone marrow transplant receipient patient developed chest infection. ON chest Xray Tree on Bud appearance . The cause of this is
a.) klebsiella
b.) pneumocystis 
c.) TB 

Reference- March 2002 Radiology, 222, 771-772.

Answer-b) Pneumocystis carnii

The tree-in-bud sign is a finding seen on thin-section computed tomographic (CT) images of the lung.  Peripheral (within approximately 3–5 mm of the pleural surface), small (2–4 mm in diameter), centrilobular, and well-defined nodules of soft-tissue attenuation are connected to linear, branching opacities that have more than one contiguous branching site, thus resembling a tree in bud. Pulmonary infectious disorders involving the small airways are the most common causes of the tree-in-bud sign.  Any infectious organism, including bacterial, mycobacterial, viral, parasitic, and fungal agents, can involve the small airways and cause a tree-in-bud pattern. In pulmonary infectious disorders, the tree-in-bud sign has most commonly been described in patients with endobronchial spread of M tuberculosis. However,  bronchogenic dissemination of atypical mycobacterial organisms or pyogenic bacteria can result in tree-in-bud opacities. Less frequently, the tree-in-bud sign is seen with viral and fungal infections (eg, invasive aspergillosis of the airways) and Pneumocystis carinii pneumonia.

Frontal Sinus can be best visualised by :
a. Caldwell's view
b. Water's view
c. Towne's view
d. Schuller's view

Answer-A) Caldwell’s view

The Waters view or occipitomental projection is taken at an angle 37° caudal to the canthomeatal line. This view optimally visualizes the superior and inferior orbital rims, nasal bones, zygoma, and maxilla. The Caldwell view, angled 15° caudal to the canthomeatal line, allows additional views of the frontal sinus and superior orbital rim. The 6-ft Caldwell view is helpful intraoperatively for frontal sinus obliteration surgeries.

Most sensitive test to detect ductal carcinoma in situ is-

a.       Mammography

b.      MRI

Answer-b) MRI

Researchers from Germany have reported that MRI (magnetic resonance imaging) detects almost twice as many DCIS as mammography and is especially effective for detecting high-grade DCIS. The details of this study appeared in the August, 2007 issue of Lancet Oncology.This data was also presented at the 2007 meeting of the American Society of Clinical Oncology.

The goal of cancer screening is to detect cancer at an early stage, when treatment will be most successful. For the early detection of breast cancer, the American Cancer Society recommends an annual mammogram and clinical breast exam starting at the age of 40. In addition to mammography, women at high-risk of breast cancer are advised to receive annual screening with breast MRI. Although MRI has been reported to detect more breast cancers than mammography, it is also much more expensive and more likely to produce false-positive test results. Although it has been demonstrated that MRI is more sensitive than mammography in detecting invasive breast cancers, MRI's ability to detect DCIS has been doubted since this technique does not detect calcium.

However, this study suggests that MRI may be better than mammography at detecting DCIS—particularly high-grade DCIS. These findings can only lead to the conclusion that MRI outperforms mammography in tumour detection and diagnosis. MRI should thus no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer in its earliest stage.

Reference: [1]  Kuhl CK, Schrading S, Wardelmann E, Braun M, Kuhn W, Schild HH. Magnetic resonance imaging versus mammography for diagnosing ductal carcinoma in situ. Proceedings of the American Society of Clinical Oncology. Chicago/ IL.  2007. Abstract # 1504.

[2] Boetes C, Mann RM. Ductal carcinoma in situ and breast MRI. Lancet Oncology. 2007; 370:459-460.

Patient with 6th cranial nerve palsy on T2 weighted MRI Hyperintense shadow which shows homogenous contrast enhancement. most probable diagnosis is?
 a)schwannoma b)meningioma c)cavernous sinus hemangioma 


Answer is c )cavernous sinus hemangioma.
Schwannoma are heterogenously enhancing, while meningiomas usually are isointense on both T1 and T2 weighted images. Although both meningiomas and hemangiomas will have homogenous enhacement better answer is haemangioma.Cavernous hemangiomas occur very rarely in the cavernous sinus and are difficult to diagnose preoperatively.  MR images showed hypointensity on T1-weighted images and well-defined hyperintensity on T2-weighted images with marked homogeneous enhancement after contrast material administration. AJNR Am J Neuroradiol 2003 Jun-Jul;24(6):1148-51.

Which one of the following is not a CT feature of Adrenal adenoma?



a. Low attenuation
b. Homogeneous density and well defined borders
c. Enhances rapidly, contrast stays in it for relatively longer time and washes out late
d. Calcification is rare.
 
Adenoma have early washout of contrast not delayed also low attenuation is because of fat content. Well defined border is obvious as it is benign, and calcification is rare.
Reference-December 2000 Radiology, 217, 629-632.
Rapid early CT enhancement washout is a highly sensitive and specific feature of adrenal adenomas; with nonenhanced CT densitometry in the depiction of lipid-rich adenomas, it makes CT the most useful and accurate imaging method in the characterization of adrenal masses. In our department, we first evaluate known adrenal masses by using nonenhanced CT. If the attenuation of the mass is 10 HU or less, we make a diagnosis of lipid-rich adrenal adenoma (a small fraction of these will be cysts rather than adenomas), and no further evaluation is advised

Pt goin for coronary angiography and now to prevent contrast nephropathy what is not needed to be done



a. fenlodopam
b. N acetylcystine
c. hemofilteration
d. NS
 
Answer-c)Hemofiltration


Several investigators have suggested that ICM nephrotoxicity can be reduced with the use of oral or intravenous theophylline, acetylcysteine, fenoldopam, or bosentan (an endothelin antagonist). Some prospective studies have suggested that prophylactic administration of 600 mg acetylcysteine twice daily in combination with hydration reduces the incidence of ICM nephrotoxicity. Hemodialysis is required only in treatment of extreme cases. In this case more or less prophylaxis is required not treatment. NS means normal saline

Radiology MCQs for FRCR

Here is an excellent link for Radiology MCQs especially useful for residents preparing for FRCR. Radiology MCQs

Here is an example from the site-

Regarding pancreatic adenocarcinoma, (***)
Cigarette smoking is thought to be a significant risk factor
Whipple's procedure, a radical surgery for pancreatic carcinoma, carries a risk of mortality of 20%
Overall 5 year survival rate is 20%
In approximately 80%, the carcinoma arises from the head
Carinomas arising from the head carry worse prognosis than those arising from the body or tail
Answers: T, F, F, T, F
Regarding resectability of pancreatic adenocarcinoma, (***)
Tumour size more than 3cm is likely to be unresectable
Peripancreatic lymphadenoapthy is absolute contraindication for surgery
The tumour is likely to be irresectible if the contiguity between tumour and major vessel is more than 50%
Vascular occlusion makes the tumour irresectible
Invasion of splenic vessels is absolute contraindication for surgery

Answers: T, F, T, T, F
Notes: Cigarette smoking is thought to account for 30% of deaths from pancreatic adenocarcinoma. Diabetes and chronic pancreatitis are also associated with increased risk of pancreatic adenocarcinoma. Whipple's procedure carries a risk of 5% mortality. The survival rate, including the ones undergone Whipple's, is not more than 5%. 80% of carcinomas arise from the head. The carconomas arising from body, tail and uncinate process carry worse prognosis than those arising from the head, because of late presentation.
Tumours more than 3cm are unlikely to be resectable. Peripancreatic lymphadenopathy is relative contraindication for surgery. Contuguity of 25-50% is equivocal for resectability, where as more than 50% makes it irresectable. Vascular encasement, occlusion or alterationin contour or caliber makes the tumour irresectable. Involvement of gastroduodenal, celiac or superior mesenteric artery is indicator of advanced disease, where as invasion of splenic vessels or spleen is not absolute contraindication for surgery.
Reference: Smith Sl et al. Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT . Clinical Radiology 59 (January 2004): 26-38