Mcqs In Radiology For Residents And Technologists [2 ed.] 9386217635, 9789386217639

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MCQs in

MCQs in .RADIOLOGY_ with Explanatory Answers Second Edition

Satish K Bhargava

MBBS; MD (Radio Diagnosis); MD (Radiotherapy}; DMRD;.FICRI; FIAMS; FCCP; FUSI; FIMSA; FAMS

Professor and Head, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University) _and G'I'B Hospital, Delhi

Sumeet Bhargava

MBBS; DNB (Radio Diagnosis); FCGP; FICRI; MNAMS

Department of Radiology and Imaging University College qf Medical Sciences (Delhi University) and GTB Hospital, Delhi

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTCJ . New Delhi • Panama City • London

Published by Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24, Ansari Road, Daryaganj, New Delhi 110 002, India Phone: +91-11-43574357, Fax: +91-11-43574314 Website: www.jaypeebrothers.com Offices in India • Ahmedabad, e-mail: [email protected] • Bengaluru, e-mail: [email protected] • Chennai, e-mail: [email protected] • Delhi, e-mail: [email protected] • Hyderabad, e-mail: [email protected] • Kochi, e-mail: [email protected] • Kolkata, e-mail: [email protected] • Lucknow, e-mail: [email protected] • Mumbai, e-mail: [email protected])rn • Nagpur, e-mail: [email protected] Overseas Offices • Central America Office, Panama City, Panama, Ph: 001-507-317-0160 e-mail: [email protected], Website: www.jphmedical.com • Europe Office, UK, Ph: +44 (0) 2031708910 e-mail: [email protected] MCQs in Radiology with Explanatory Answers © 2011, Jaypee Brothers Medical Publishers All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher. This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi Jurisdiction only. First Edition: 2006 Second Edition: 2011 ISBN 978-93-5025-428-8 Typeset at JPBMP typesetting unit Printed in India

To

My Loving Late Wife Kalpana and My Late Parents Shri ]agannath Bhargava and Mrs Brahma Devi Bhargava Whose Inspiration and Sacrifice have made possible to bring out this book

List of Contributors AK Srivastava Physicist and Radiation safety Officer, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University} Delhi

Sumeet Bhargava Resident, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University) Delhi

P.ackia Agnes Vimalan Resident, Department of Radiology and Imaging, University College of - Medical Sciences (Delhi University) Delhi

Shuchi Bhatt Reader, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University) Delhi

Rajul Rastogi Senior Resident, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University) Delhi Ravi Dutt Resident, Department of Radiology and Imaging,_University College of Medical Sciences (Delhi University) Delhi Satish K Bhargava Head, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University) Delhi

~-

Shiva Rastogi Ex Senior Resident, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University) Delhi Swati Gupta Resident, Department of Radiology and Imaging, University College of Medical Sciences (Delhi University) Delhi

Preface The overwhelming response and the input from the readers along with new development in the field of Radiology and Imaging has prompted us to add more questions so as to keep pace with the technological advancements. I am sure the sincere· effort made by the contributors will be further appreciated and critically analyzed. The book will definitely be useful to improve the general understanding of the subject and ·also to provide an in depth knowledge of Radiology and Imaging not just to clear various PG Entrance Exams but also to become better clinicians. Satish K Bhargava Sumeet Bhargava

Acknowledgments I am grateful to my colleagues and friends who gave timely support and stood behind me in our joint endeavor of bringing out this book which was required keeping in view of the fact that no such book is available in an Indian perspective and wide acceptability of this imaging modality for _the diagnosis and staging of the disease. My special thanks are due tp sincere and hardworking staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, particularly Shri Jitendar P Vij, Chairman and Managing Director, Mr Tarun Duneja, Director (Publishing), Mr Bhupesh '!, Arora, General Manager and Ms Mubeen Bano and the contributors who have always been keen desire to work with smiling faces and with soft and polite voices, as a result of which this book has seen the light of the day. Satish K Bhargava Sumeet Bhargava

Referenced Books 1.

Radiological Differential Diagnosis, 1st Edition by Satish K Bhargava. Published_ by. Jaypee Brothers. Medical Publishers (P) Ltd.

2.

Computed Body Tomography with Mri Correlation, 3rd Edition by Lee, Sagel, Stanley and Heiken. Published by -Lippincott and Raven. 3. Diagnostic Radiology, 4th Edition by Grainger, Allison, Adamand Dixon. Published by Churchill Livingstone. 4.. Textbook of Radiology and Imaging, 7th Edition by David Sutton. Published by Churchill Livingstone. 5. Head and Neck Imaging, 4th Edition by Som and Curtin. · Published by Mosby. 6. Textbook of Radiology for Residents and Technicians, 2nd Edition by Satish Kumar Bhargava. Published by CBS Publishers. 7. Textbook of Medical Imaging, 3rd Edition by JT Bushberg. 8. Christensen's Physics of Diagnostic Radiology, 3rd Edition by Curry and Dowdy. Published by Lippincott and Raven. 9. Diagnostic Neuroradiology, 1984, Osborne Anne G Published by Mosby.

Contents 1.

Brainand Spine .......................................................... 1-53 Satish K Bhargava, Raju Rastogi, Swati Gupta

2.

Para nasal Region ..................................................... 54-6 6 Raju Rastogi, Satish K Bhargava, Packia Agnes Vimalan

3.

Orbit ...................................................................... 67-86 Satish K Bhargava, Raju Rastogi, Packia Agnes Vima/an

4.

Neck :.................................................................... 87- 9 7 Satish K Bhargava, Raju Rastogi, Packia Agnes Vimalan

.

5.

Ear ........................................................................ 98-117 Sumeet Bhargava, Raju Rastogi, ,fackia Agnes Vimalan

6.

Respiratory system . . . .. . . . . . . . . .. . ... ... ........... 118-148 Satish K Bhargava, Swati Gupta, Raiu Rastogi

7.

Cardiovascular System .......................................... 149-169 Raju Ra!>lugi, Swali Gupta, Shiva Rastogi

8.

Hepatobiliary and GIT.......................................... 170-198 Sumeet Bhargava, Raju Rastogi, Packia Agnes Vima/an

9.

Retroperitoneum and Mesentery ........................... 199-210 Satish K Bhargava, Raju Rastogi, Packia Agnes Vimalan

10.

Genitourinary System ........................................... 211-240 Sumeet Bhargava, Satish K Bhargava, Suchi Bhatt, Packia Agnes Vimalan

11.

Obstetrics and Gynecology................................. 241-258 Suchi Bhatt, Sumeet Bhargava, Satish K Bhargava, Swati Gupta

12.

Musculoskeleral syscem ........................................ 259-298 Suchi Bhatt, Shiva Rastogi, Satish K Bhargava, Swati Gupta

13.

Soft Tissues and Breast ......................................... 299-322 Suchi Bhatt, Ravi Dutt, Packia Agnes Vimalan

14.

Endocrine System ................................................. 323-352 Raju/ Rastogi, Puneet Kocher, Satish K Bhargava, Swati Gupta

15.

Radiophysics and Radiotherapy··············-············· 353~377 · AK Srivastava, Raju/ Rastogi, Swati Gupta

D 1.

2.

3.

4.

5.

6.

'Swirl Sign' is seen: A As hypodense area within hyperdense acute hematoma B. Old calcified hematoma C. Blood in sylvian fissure D. Rehemorrhage within an organized hematoma (Osborne 1994, Page-158) Acute ICH appears isodense in: A Extreme anemia (Hb less than 8 gm %) B. Coagulation disorder C. After thrombolytic therapy D. All of the above (Osborne 1994, Page-159) Cephalhematoma is most common in: A Occipital region B. Frontal region C. Parietal region D. Temporal region (Osborne 1994, Page-174) The most common location of ICH with traumatic delivery is the: A Subdural space B. Subarachnoid space C. Extradural space D. Intraventricular space (Osborne 1994, Page-174) Most common non-traum:,tic cause of intracranial hemorrhage in adults: A Trauma B. Hypertension C. Aneurysm D. Arteriovenous malformation (Osborne 1994, Page-174) Most common site of hypertensive bleed is: A Putamen B. Thalamus C. Pons D. Cerebellum (Osborne 1994, Page-175) Answer- lA

2D

3C

4A

5B

6A

7.

Which condition can mimic SAH on CT scan: A. Extremely premature B. C. D.

Grossly unmyelinated brain Diffuse cerebral edema All of the above

(Osborne 1994, Page-182) All these conditions cause very low-density brain, so the surrounding blood appear hyperdense compared to brain, which may be confused with SAH .. 8.

Focal, anterior interhemispheric bleed is usually due to aneurysmal bl~ed from: A. Anterior comm1.1nieating artery B. lpsilateral internal carotid artery C. D.

9.

Posterior communicating artery Middle cerebral artery

(Osborne 1994, Page-182) Which type of skull fracture is more often associated with epidural and subdural hematoma: A. Linear fracture B. Depressed fracture C. Diastatic fracture D. All of the above

(Osborne 1994, Page-203) 10. Which is false about EDH: A. EDH may cross duml attllchmcnt, but not Guturcn EDH may cross sutures, but not dural attachments It is biconvex on cross section imaging Associated fracture in 85% to 95% cases (Osborne 1994, Page-204) 11. White cerebellum" sign is seen in: A. Diffuse cerebral edema B. Extensive subdural hematoma C. Premature brain D. Largely unmyelinated brain (Osborne 1994, Page-231) Diffuse cerebral edema typically exhibits homogeneously decreased attenuation of cerebral hemispheres on CT. Hence the normal cerebellum appears relatively hyperdense, the so-called white cerebellum sign. B.

C. D.

Answer- 7D

SA

9A

llA

12. Growing fracture is synonymous with: A. Leptomeningealcyst B. Post-traumatic leptomeningeal cyst ·C. · Crista galli fracture · D. None of the above (Osborne 1994, Page-243)

13. Which type of intracranial hemorrhage seen in Battered baby syndrome: B. Extradural A. Subdural hemorrhage C. Subarachnoid D. lntraventricular (Osborne 1994, Page-245)

Shaking injuries tear bridging veins.

14. "String of beads" appearance of carotid angiogram is classic for: A. Fibromuscular dysplasia B. Connective tissue disorder C. Spontaneous arterial dissection D. All of the above (Osborne 1994, Page-251)

15. Which one is the leading cause of disability and death from aneurysm rupture: A. Vasospasm B. Rebleeding C. Mass effect D. None (Osborne 1994, Page-254)

Vasospasm is more important cifuse of death than rebleed. Mass effect only occurs in giant aneurysm (>2.5 cm).

16. Which one is the pathognomonic sign of aneurysm rupture: A. Contrast extravasation B. Surrounding clot seen in CT /MR C. Configuration (irregular, lobulated) D. Localized vasospasm (Osborne 1994, Page-260)

Contrast extravasation is pathognomonic for aneurysm rupture though it is found rarely; B and C are very helpful signs while D is relatively less helpful.

Answer-12B

13A

14A

15A

16A

I

17. Which is not seen in an intracranial aneurysm? A. Normal angiographic findings B. Contrast filled outpouching on angiography _ C. Mural calcification on CT D. Bone erosion on CT E. None of the above (Osborne 1994, Page-259, 262)

18. Which is false about pseudoaneurysm? A. Superficial °temporal artery is most· commonly involved in scalp trauma B. May be caused by missile injuries C. Lacks any eomponent of a vessel wall D. Meningeal vessels are commonly involved (Osborne 1994, Page-270) Meningeal vessels are uncommon site for traumatic aneurysm .

.

19. Which one is most common cause of 'early draining' veins on angiogram? A. Cerebral infarction B. Contusion C.

Infections

D. Postictal (Osborne 1994, Page-288) Thou~ 'e11fl}"dt~}f yems __are most_ commonlyseenin'.AV malformation but in the given tpti.i~ c'er~bral infarction is most common.

20. False about CT findings of patent A VM: A. Mass that enhance strongly after contrast administration B. Hyperdense mass that does not enhance C. AVM may be represented by a small nidus with enlarged draining vein D. Calcification is seen (Osborne 1994, Page-294) 21. Which of the following is not found in cavernous angiomas? A. Isodense lesion on noncontrast CT B. Calcification C. Minimal enhancement D. Moderate edema (Osborne 1994, Page-288) Cavernous angiomas show minimal or absent enhancement but are usually not associated with edema or mass effect.

-

I

Answer-17E

18D

19A

20B

21 D

22. 'Popcorn' appearance on MRI is: A Cavernous angioma ·B. Capillary telangiectasia C. AVM D. All of the above (Osborn~ 1994, Page-313) "Popcorn appearance' arises · dUl!'''~"4'le:rno:r;rhage in .different. stage of evolution.

23. 'Medusa head' is classic for. A Venous malformation B. Cavernous angioma C. Capillary telangiectasia D.

AVM

.

(Osborne 1994, Page-316) It is angiographic finding of venous malformation characterised by a collection of dilated medullary veins (the so called Medusa head) converging in an enlarged transcortical draining vein..

24. All of the following findings are suggestive of carotid artery stenosis, except A Increased flow velocity at the site of stenosis B. Narrowing of spectral waveform C. Color shift from red to light pink D. Turbulent flow in poststenotic zone (Osborne 1994, Page-332-333) Broadening rather than narrowing.is seen in spectral waveform in cases of artery stenosis. ·

..,

25. Sign of cerebral infarction on angiography include: A Vessel occlusion B. Slow antegrade flow with delayed arterial emptying C. Early draining vein D. All of the above (Osborne 1994, Page-343) 26. All are true about CT findings of cerebral infarction except: A NormalCT B. Hyperdense MCA sign C. Insular nbbon sign D. None of the above (Osborne 1994, Page-345) Answer- 22A

23A

24B

25D

26D

27. Which of the following is seen in subacute infarct except? A. Ring enhancement B. Edema C. Mas~ effect D. CSF density

(Osborne 1994, Page-345) Mass effect, edema and enhancement may persist up to 2 months. ·

28. Most common site of lacunar infarct is: A. Basal ganglia B. Cortex C. Brainstem D. Cerebellum (O~hnrnP 1994,. Page-.1SS.)

29. Empty delta sign is seen in: A. Superior sagittal sinus thrombosis B. Middle cerebral artery thrombosis C. Cortical vein thrombosis ~D. None of the above

(Osborne 1991,, Page-388) Empty -delta sign is.seen on postcon:ti"ast''E'F"in"patients•with•1'1trombosed· dural sinus due to enhancing dura surroundin~ the • nonenhancin~ thrombus.

30. Pseudodelta sign is seen in all except: A. B. C.

D. E.

31

Noncontrast CT in SAH Contrast CT in SDH Normal infants High splitting tentorium on contrast CT None

(Osborne 1994, Page-388) The investigation of choice for acute SAH is: A. C.

Noncontrast CT MRI

B. Contrast CT D. CSF examiriation

(Osburne 1994, Page-182 32. The investigation of choice for diagnosis of acoustic schwannoma is: A. CECT B. Gd enhanced MRI C. SPECT D. PETScan

(Sutton, 7th edition, Page-1598) Answer- 27D

28A

29A

30C

31A

32B

33. Which of the following is classic CT appearance of an acute SDH: A. Lentiform hyperdense collection B. Crescentic hypodense collection C. Crescentic hyperdense collection D. Lentiform shaped hypodense collection (Osborne 1994, Page-207) 34. Most common primary brain tumor is: A. Glioma B: Meningioma C. Craniopharyngioma D. Pinealoma (Osborne 1994, Page-404) Of all the brain tumors l/3rd are metastases and 2/3rd are primary tumors,.Of all primary tumors, 50% are glioma and 15% are meningioma. Meningioma is 2nd most common tumor of brain.

35. Which is the most common intracranial tumor in a neonate? A. PNEf B. Astrocytoma C. teratoma · D. Oloroid plexus papilloma (Osborne 1994, Page-406)

36. Which one is the most common intracranial neoplasm in children? A. Glioma B. PNEf C. Ependymoma D. Craniopharyngioma (Osborne 1994, Page-406)

Approximately half of the intracranial neoplasms in children are glioma. i;

37. Which one is the most common posterior fossa tumor in children? A. Cerebellar astrocytoma B. Medulloblastoma C. Ependymoma D. Glioma (Osborne 1994, Page-407)

Medulioli>1astema,is 2nlli·most common tumor of children,

38. Which is the most common 4th ventricular neoplasm in an adult? A. Metastases B. Hemangioblastbma C. Olronic plexus papilloma D. Dermoid (Osborne 1994, Page-436)

Primary neoplasm in 4th ventricle is rare in adults. Hemangioblastoma is the most common among these uncommon lesions.

Answer- 33 D

34A

35C

36A

37A

38A

39. Which one is the least specific sign for cerebellopontine angle cistern lesion? A. Ipsilateral CPA cistern enlarged CSF/vascular cleft between mass and cerebellum Brainstem rotated D. 4th ventricle compressed

B. C.

(Osborne 1994, Page-438)

40. Which is the most common mass of cerebellopontine angle cistern lesion? A.

Acoustic neuroma

B. Meningiorrut C. Epidermoid D. Metastases (Osborne 1994, Page-441) ~eOT!fstic .n:ew,oma •is 75%·•of all massel in CPA cistern followed by mmringi.0ma 8-'1-0%and,epiderm0id 5%.

41. Which one is false about Acoustic Neuroma? A. It is the most common mass in cerebellopontine angle cistern B. It is hypointense on TlW images and show enhancement after Gadolinium injection C. It is hyperintense on Tl images and do not take enhancement D. Calcification is very rare (Osborne 1994, Page-450) Acoustic neuroma is hypo to isointense on TlW images and hyperintense on T2Wimages.

42. Which one is true about pituitary macroadenoma? A. Calcification is common B. Hyperintense on TIW C. Hyperintense on TIW D. Isodense of NCCT (Osborne 1994, Page-474) Hyperintensity on TlW images is seen in cases of hemorrhagic adenoma when a mixed signal is seen on T2W images. Nonhemorrhagic adenoma appears isointense on Tl W images.

Answer- 39D

40D

41C

42A

43. Which one is true about meningioma? A Hypodense on noncontrast CT B. lsoint'ense on TlWI C. No contrast enhancement on contrast CT D. Calcification is rare (Osborne 1994, Pag~-474) Meningioma is hyperdense on noncontrast CT and commonly shows calcification. It shows homogeneous contrast enhancement on postcontras:t" CT/MR.

44. Most common brain tumor to calcify is: A Craniopharyngioma B. Glioma C. Meningioma D. Pituitary macroadenoma (Osborne 1994, Page-475)

Jtealcifies in:90%·,of cases; 45. Which one is most common primary to metastasize in pituitary gland? A Breast B. Pancreas C. Stomach D. Uterus (Osborne 1994, Page-477-478) ln female: Breast > Lung > Stomach> Uterus. ln male: Lting > Prostate> Blad~r >Stomach. 46. Which one of the following is not associated with diffuse thickening of skull vault? A Normal variant B. Orronic Phenytoin therapy C. Microcephalic brain D. Fibrous dysplasia (Osborne 1994, Page-515) First 3 causes diffuse thickening while the 4th one will cause focal/regional thickening.

Answer- 43 B

44A

45A·

46D

47. All of the following are causes of generalized thinning of skull

bones except: A Osteoporosis_ circurnscripta B. Cushing's syndrome C. Normal variant D. Long standing hydrocephalus (Osborne 1994, Page-515) · ~er-•,;~+-,0p~ons.,·•pr0duee -··•.ge.neralizee:,,:,,~, ••whiie-•"''osteop@rosis cittumseripta (Paget's disease; causes focal thinning.

48. Which is not a.feature of normal meningeal enhancement?

A

Thin

B. C. D. E.

Smooth Continuous Less intense than cavernous sinus " Most prominent near vertex (Osborne 1994, Page-520)

Normal meningeal enhancement is discontinuous. QI

....i:::

~

"C

;

.5IC ~

49. All are the causes of diffuse meningeal enhancement except: A Infectious meningitis B. Carcinomatous meningitis C. Dural sinus thrombosis D. Meningioma (Osborne 1994, Page-520) First 3 causes diffuse while meningioma causes focal meningeal enhancement.

50. Which is not true about the frequency of occurrence of brain tumors? A Two-third of all brain neoplasms are primary neoplasms B. Almost half of all primary brain tumors are glioma C. Three-fourth of all gliomas are astrocytoma D. One--fourth of all astrocytoma are anaplastic astrocytoma and glioblastoma multiforme (Osborne 1994, Page-529) Nearly three-fourth of all astrocytoma are anaplastic or GBM.

Answer- 47 A

48C

49D

50D

51. Which is false about low grade astrocytoma? A. Focal/ diffuse mass B. Hypodense on noncontrast CT C. 15-20 % calcify D. Edema and hemorrhage is common (Osborne 1994, Page-531) Edema and hemorrhage is rare in low grade gliomas. 52. Which is false about anaplastic astrocytoma? A. Inhomogeneous mixed density mass B. Calcification is uncommon C. Edema common D. No enhancement seen (Osborne 1994, Page-537) ~~ticrastroeytom~showc5;,i,:-~~qt.c:lfflsal,cistem is

-~~§i.te: 77. Commonest primary to metastasize to brain is: A Lung B. Breast C. Malignant melanoma D. Gltract (Osborne 1994, Page-660) These four are the common site for metastases to brain in decreasing order of frequency. 78. Which is the commonest site for metastases to brain? A Gray matter B. White matter . C. Junction of gray and white matter D. Intraventricular (Osborne 1994, Page-661) ·:fflflim;ooau~ll.e11e, wt junctiOl'l•is the commonest site:

Answer- 740

75A

76A

77 A

78C

n

10 Cll

79. Which is not true about brain metastases? A. 80% are multiple B. Calcification is common C. Shows strong enhancement D. Iso to hyperdense on NCCT

(Osborne 1994, Page-662)

In parenchymal metastases calcification is rare in untreated cases. 80. Metastases in brain most likely to bleed include except: A. Renal B. Breast C. Melanoma D. Gastric adenocarcinoma (Osborne 1994, page -663) Any metastases in brain can bleed, first, three and choriocarcinoma are most likely metastases to bled. 81. Which is the most sensitive imaging procedure for evaluating intracranial metastases? A. Noncontrast CT B. Contrast CT C. Noncontrast MRI D. Contrast MRI

(Osborne 1994, Page-665) 82. Which is the most frequent cause of congenital CNS infection? A. CMV B. Toxoplasmosis C. Rubella D. Herpes (Osborne 1994, Page-674) ·is•2nd,most ColI!J.'lron·cause of congenital infection.

~•~is

83. Which is false about CNS CMV infections? A. Shows macrocephaly B. Periventricular calcifications are common C. Many show encephalomalacia D. Neuronal migration anomaly are common (Osborne 1994, Page-674) Microcephaly is seen in congenital CMV infections.,

Answer- 79B

80D

81 D

82A

83A

84. Imaging features of toxoplasmosis include all except: A Hydrocephalus B. Bilateral chorioretinitis C. Intracranial calcification D. Neuronal migration anomaly (Osborne 1994, Page-675)

85. Which is false about congenital rubella? A. Microcephaly · B. Parenchymal calcification C. Delayed myelination D. None of the above (Osborne 1994, Page-677/

86. Ependymal enhancement is seen in: A Sturge Weber syndrome B. Anaplastic astrocytoma C. Dural sinus thrombosis D. All of the above (Osborne 1994, Page-682)

87. Which one is not a complication of meningitis? A Hydrocephalus B. Epei:tdymitis C. Venous infarct D. None of the above (Osborne 1994, Page-680)

88. Which one is not a ring enhancing lesion? A Anaplastic astrocytoma" B. Focal cerebritis C. Granuloma D. Multiple sclerosis (Osborne 1994, Page-690-691)

89. Immature tuberculoma are seen on noncontrast CT as: A lsodense B. Hypodense C. Do not take contrast on CECT D. All of the above (Osborne 1994, Page-706) Tuberculoma is isodense or slightly hyperdense on noncontrast images and show postcontrast enhancement.

Answer- .84 D

85D

86D

87D

88B

89A

90. Which one is the commonest site for cysticercus in brain? A Corticomedullary junction in brain parenchyma B. Intraventricular C. Subarachnoid space D. Gray matter of spinal cord (Osborne 1994, Page-710) "91. Which stage of cysticercus do not show enhancement? A Colloid vesicular stage B. Granular nodular stage C. Vesicular stage · D. Nodular calcified stage (Osborne 1994, Page-711-712) Enhancement is rare in vesicular stage, but it is typically absent in nodular calcified stage. 92. Which is false? A Prominent CSF spaces are common in children under one year ufage B. Craniocorti~al width up to 4 mm is normal C. Interhemispheric width up to 16 mm is normal D. Under normal condition the ventricular system has a volume of 20 25ml

(Osborne 1994, Page-752) Interhemispheric width up to 6 mm is normal. 93. Alzheimer disease shows severe atrophy of: A Frontal lobe B. Parietal lobe C. Occipital lobe D. Temporal lobe

(Osborne 1994, Page-772) ~-®•.1,of,sthe,,brain>show· atrophy~but tempotal· ·fo~'"iltrwphy, ,is•· the Severest. 94. The anteroposterior diameter of cervical canal at the level of Cl and C2 is - mm: · · A 10 - 12 B. 12- 14 C. 15-16 D. 18-20 (Osborne 1994, Page-798) Answer. 90A

91 D

92C

93D

94C

95. Which of the following structures in an adult enhance on MR? A. Meninges B. Dorsal root ganglia C. Marrow D. Both A and B

(Osborne 1994, Page-799) Intervertebral disc enharice in children.· 96. Myelomeningocele is associated with all except: A. Oliari I malformation B. Oliari II malformation C. Hydrocephalus · D. Diastematomyelia

(Osborne 1994, Page-801) 97. Which is a part of Chiari II malformation? A. Llpomyelomeningocele B. Myelomeningocele C. Both D. None

~

(")

IO Ill

(Osborne 1994, Page-801) Lipomyelomeningocele is not associated with Chi~>Il malformation but has been reported With Chiari I malformation," 98. Which is the commonest site of tuberculosis in spine? A. Dorsolumbar B. Cervical C. Thoracic D. Lumbosacral (Osborne 1994, Page-822) 99. In cervical spine commonest site of disc herniation is: A. C6-C7 B. CS-C6 C. C4-C5 ~ D. C3-C4 (Osborne 1994, Page-840) ~onsubcortical white matter and li~tn 'semi\5vale~te acnormalMR finding.

Answer- 129 C

130 A

131 C

132C

133. Normal pressure hydrocephalus on CT/MR is characterised by: A. Normal imaging B. Accentuated CSF flow voids on MR C. Ventricular dilatation less than that of sulcal enlargement D. None of the above (Osborne 1994, Pag~-754) NPH is characterised by ventricular dilatation out of proportion to the sulcal enlargement.

134. All are true statements regarding multiple sclerosis except: A. It is an autoimmune mediated demyelinating disease B. Most common demyelinating disease C. It has a female preponderance D. Callososeptal interface is a typical location (Osborne 1994, Page-756) Mostcommondeil'tyelinating·disease•is·~antt~Je]l;i~i:J.eTnyelinatioTh

135. Imaging features of multiple sclerosis include all except: A. Ovoid hyperintense lesions on T2WI B. Ring enhancement of the lesions C. Dawson's finger are characteristic D. Persistent enhancement of the lesions is characteristic (Osborne 1994, Page-756-757) Enhancement of multiple sclerosis lesions is highly vapable and typically transient and seen during the active demyelinating stage.

136. The commonest cause of toxic demyelination: A. Alcohol B. Lead C. Immunosuppressive therapy D. Storage diseases (Osborne 1994, Page-761) 137. Imaging manifestation of pontine myelinolysis include all

except: A. NormalCT B. Hyperintense foci on T2WI C. Descending corticospinal tracts are most often affected D. Most lesions do not enhance (Osborne 1994, Page-763) Transverse. pqntine fibers are most often affected"while .descending c&rticospinal tracts are typically spared.

Answer- 133 B

134 B

135 D · · 136 A

137 C

.1

138. Marchiafava-Bignami disease is characterised by: A. Callosal atrophy B. Cerebellar atrophy C. Brainstem atrophy D. Cerebral peduncular atrophy (Osborne 1994, Page-763) •

139. Periventricular leukomalacia is seen in: A. Term inf~ts B. Premature infants C. Young children D. Adolescents (Osborne 1994, Page-767)

140. Imaging findi.ngs in a case of periventricular leukomalacia is often: A. Unilateral B. Bilateral and symmetric C. Bilateral and asymmetric D. Diffuse and multifocal (Osborne 1994, Page-767)

141. Which of the following is not a common causes of multifocal white matter hyperintensities on MR? A. Arteriosclerosis B. Multiple sclerosis C. Metastases D. Vasculitis (Osborne 1994, Page-m) Vasculitis, primary CNS lymphoma, glioma and gliomatosis cerebri are uncommon causes.

142. Mucopolysaccharidoses and Glycogen storage diseases primarily involve: A. Gray matter B. White matter C. Both gray and white matter D. Basal ganglia (Osborne 1994, Page-772)

143. Wilson disease primarily affects the: A. Gray matter B. White matter C. Both gray and white matter D. Basal ganglia (Osborne 1994, Page-772) Answer- 138 A

139 B · 140 C

141 D

142 A

143 D

144.Binswanger disease refers to: A. Subcortical arteriosclerotic encephalopathy B. Hippocampal atrophy

C. Multiple cortical infarcts D. Extrapyrarnidal dementia (Osborne 1994, Page~774)

'i~sm:,~~~~~~~irl,farctor a vascular.clemen~. 145. Which of the following is associated with bilateral hyperintense basal ganglia lesions on TlWI? A. Neurofibromatosis

B. Venous infarction C. Toxic encephalopathy D. Leigh disease

~.... C1l

(Osborne 1994, Page-777) All the other three options are associated with hypointense lesions on Tl WI.

146. Which of the following is associated with bilateral hyperintense basal ganglia lesions on T2WI? A. Hypoxic ischemic encephalopathy B. Aging

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189. Gyral enhancement is seen commonly in all except: A Stroke B. Encephalitis D. Metastases C. Contusion (Osborne 1994, Page-385) ~"~iinc:~l'll.ent 1§,'5.1:11:).~~nly•with.s:uhf>ial met,ts$.a.se&.

190. The commonest differential diagnosis of dural sinus thrombosis on MR imaging is: A Imaging artifact B. Tumor C. Vessel D. Normal variation (Osborne 1994, Page-395) The imaging artefacts can mimic intravascular clot. 2D PC MRA with low velocity encoding obviates these difficulties. 191. True about parenchymal A VMs are all except: A They are congenital and usually solitary B. Multiple 1esions are associated with Osler-Weber-Rendu syndrome C. Majority are seen in infratentorial compartment D. Noncontrast CT may be normal (Osborne 1994, Page-286) Majority (80%) are seen in the supratentorial compartment. 192. Which lobe of the cerebral hemisphere is most commonly involved in posttraumatic cerebral infarction? A Frontal B. Temporal C. Parietal D. Occipital (Osborne 1994, Page-230) 193. The most accepted imaging technique for documentation of brain death is: A Four-vessel cerebral angiography B. Contrast enhanced CT C. Contrast enhanced MR D. Scintigraphic perfusion using 99Tc-HMPAO (Osborne 1994, Page-232) Answer- 189 D

190 A

191 C

192 D

193 D

194. All are the posttraumatic sequelae in brain except: A.

Atrophy

B. Pneumatocele C.

Cephaloceles

D. Diabetes mellitus (Osborne 1994, Page-240) Diabetes insipidus is posttraumatic sequelae.

195. The commonest cranial manifestation of abuse in infants is: A. Cerebral edema with mass effect B. Subdural hematomas C. Skull fracture D. Cortical contusions (Osborne 1994, Page-245) 196. All are true about the MR appearance of intracerebral hematoma except: A. Hyperacute hematoma is hypointense on TIWI and hyperintense on 12WI B. Acute hematoma is isointense on TIWI and hypointense on 12WI C. Early subacute hematoma are hyperintense on both Tl and 12WI D. Chronic hematoma are hyperintense on both Tl and 12WI (Osborne 1994, Pagr-166-167) ilalJ:y.,,suba®'te,bema~a·,is•,hyperintense . ol;lj.•TlWil and h~il:ltefi'sE!'•o:n •Wl;whi}e,liite stibacute·hematoma is hyperint~ on: both Tl and T2WI:c 197. The commonest site of lesion in eclamptic patients is: A. Frontallobe B. Parietal lobe C. Temporal lobe D. Occipital lobe

(Osborne 1994, Page-178) 198. Majority of hemorrhagic infarctions are identified - - - - hours after the ischemic event: A. 6-12 B. 24-48 C. 72-96 D. After% (Osborne 1994, Page-180)

·I

Answer- 194 D

195 A

196 C

197 D

198 B

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22. Parathyroid cysts are characterized by all except: A. Most commonly occur in inferior parathyroid glands

B.

More common in females

C. . Present in 4th-5th decade of life

D. Usually smaller than 1 cm (Som Curtin, Volume-2, Page-2169)

Parathyroid cysts are usually large 1-4 cm. 23. Features s/o retropharyngeal infection are: A. Prevertebral space thickening B. Loss of normal cervical lordosis C. Air in prevertebral soft tissue D. All of the above (Som Curtin, Volume-2, Page-1504) 24. Salivary gland calculi occur most commonly in: A. Parotid B. Sub mandibular C. Sub lingual D. Palatal glands (Som Curtin, Volume-2, Page-2034) 80-90% salivary gland stones occur in sub mandibular gland. 25. Only systemic disease known to cause salivary calculi: A. Diabetes mellitus B. Chronic renal failure C. Gout D. Hyperparathyroidism (Som Curtin, Volume-2, Page-2040) Gout is the only systemic disease known to cause salivary calculi. 26. Ranula most commonly results from: A. Trauma · B. Infection C. Obstruction D. Congenital (Som Curtin, Volume-2, Page-2065) Ranula most commonly results from trauma.

Answer- 21 C

22D

23D

24B

25C

26A

27. Most common salivary gland tumor is: A. Pleomorphic adenoma B. Warthin tumor C. Adenoid cystic carcinoma ,~:,,,.J~;.~_dHP{,;. Jffl'$t,,~,·stru~N~~e,,,in,, aceustm mel!&'0ma.

Ref:- Diagnostic Imaging-Head and neck (1st Ed, 2004) : Harnsberger 1'1 Ed, 2004 (Page I. 1. 2).

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69. A 40 year old man presented with dizziness; MRI showed cerebello-pontine angle mass, which is iso-intense to CSF on 'fl weighted images, iso to hyper intense to CSF on 'f2 weighted images, high signal on diffusion MR, engulfing 7th and 8th nerve, on FLAIR showed incomplete attenuation; what is the most probable diagnosis? A. Arachnoid cyst. B. Neuroenteric cyst. C. Epidermoid cyst. D. Cystic neoplasm. ARACHNOID CYST: fully attenuates on FLAIR. Doesn't engulf nerve, Only displaces. Tumor which engulfs the nerves is epidermoid cyst. NEC:~~tinecltl.!llation, i!!t : Harnshagl'T 1•1 F.d, 2004 page I. 1. 7.

timtscof pleu11alfl~~y;,be,deteeted by. decubitus view of 41hec·chest with the af:fectedside dependent; Answer- ID

2B

3D

4C

SC

6.

In a case of suspected inhaled foreign body, films are exposed in: A. Inspiration B. Expiration C. All of the above D. None of above ·(Sutton, 7th edition, Page-5) · Paired inspiratory and expiratory films demonstrated air trapping and diaphragm movements. 7. . Small pneumothorax is best demonstrated on - - film of the chest: A. Expiratory B. Inspiratory C. Both A and B D. None of the above (Sutton, 7th edition, Page-5) ~fi\\niiallyit kas been-.taugltt that ~'~~,i$-"ll'\Qf~~~t:l'lt ~~~tory•fimis~btit•n~.-,msp1i'ato'ry"fflffi'is''e"'·.l\

11 . . L, . .

j

10. Effacement of right heart border is the sign of: A. Upper lobe collapse B. Middle lobe collapse C. . Lower lobe collapse D. All of the above

(Grainger, 4th edition, Page-308) 11. Effacement of retrocardiac. aspect of left hemidiaphragm is an important sign of: A. Upper lobe collapse B. C.

Lower lobe disease Both of the above

D. Lingular collapse

(Grainger, 4th edition, Page-309) 12. Spherical lesions containing air bronchogram includes which of

the following: A. Alveolar cell carcinoma B. Lympho:µ1a C. Sarcoidosis D. All of the above

(Sutton, 7th edition, Page-16) 13. Miliary nodules in the pulmonary parenchyma is seen in: A.

Sarcoidosis

Tuberculosis C. Pneumoconiosis D. All of the above B.

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(Sutton, 7th edition, Page-18) 14. Charai:teristic feature of Macleod's syndrome is: A. Unilateral hypertransradiant lung B. Enlarged ipsilateral pulmonary artery C. Paradoxical movement~ of the ipsilateral hclni-diaphragm D. All of the above

(Sutton, 7th edition, Page-171) There is maldevelopment of lung following childhood viral infection. Affected lung shows emphysema;bronchiolitis obliterans and reduction in vascularity.

Answer- 10B

11B

12D

13D

14A

15. Poland's syndrome is characterised by all except: A. Congenital absence of pectoralis 1:11uscles

B. Syndactyly C. Rib anomalies

D. None of the above

. (Sutton, 7th edition, Page-SO) '~~,ist~be,keptm:mindiin·c~,h~mifflSmtifarit-hemithorax•.OIT

"a!~raarograph: 16. Bilateral inferior rib notching is seen· in all of the following except: A. Aortic coarctation B. Subclavian artery occlusion C. Fallot' s tetralogy D. Superior vena caval obstruction (Sutton, 7th edition, Page-48) 17. Commonest primary malignant-tumor of rib is: A. Chondrosarcoma B. Liposarcoma C. Fibrosarcoma D. 0steosarcoma (Grainger, 4th edition, Page-321) 18. Commonest malignant tumor of rib is: A. Metastases B. Multiple myeloma C. Chondrosarcoma D. Fibrosarcoma (Grainger, 4th edition, Page-309) 19. Lateral end of clavicle is hypoplastic in which of the following: A. . Oeidocranial dysplasia B. Rheumatoid arthritis C. Rickets D. Poland's syndrome (Grainger, 4th edition, Page-323) 20. Which of the following is true about miliary tuberculosis? A. Multiple 3-4 mm discrete nodules are seen in both lungs B. More commonly seen as a post primary process C. Calcification in nodules is common D. Have no residual changes (Grainger, 4th edition, Page-390) Answer-. 15 D

16B

17 A

18A

19A

20B

21. Water Lily sign on chest radiograph is suggestive of: A. Hydatid disease B. Bronchiectasis C. Bronchopleural fistula D. Sequestration cyst of lung (Grainger, 4th edition, Page-401) Floating membrane arising due to the separation-of the inner layers in the hydatid cyst results in water lily or Camalote sign.

22. 'Rising sun' sign is seen: A. Sequestration cyst of lung B. Bronchogenic cyst C. Lung abscess D. Hydatid disease (Grainger, 4th edition, Page-401) 1ii~~st witlr,~1~1m~~\?1.';;we-Jts,bottom giv:es.Jising sun sign.

23. Golden S-sign is associated following: A. Right upper lobe collapse B. Left upper lobe collapse C. Right middle lobe collapse D. Left lower lobe collapse

with

which

of

the

(Sutton, 7th edition, Page-27)

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This sign is seen in right upper lobe collapse caused by a central mass. The latter gives a convexity to the concave displaced fissure forming the shape of 'S'.

24. All are signs of collapse of the pulmonary parenchyma except: A. Displacement of interlobar fissures B. Depressed hemidiaphragm C. Crowding of blood vessels D. Displaced hilum (Sutton, 7th edition, Page-175) ~'is"relev~tion;of,the;henudia~;due,to'iheiess0ofvolume-~

Answer- 21A

22D

23A

24B

25. Luftsichel appearance of lung is seen in: A. Left upper lobe collapse B. Left lower lobe collapse C. Right middle lobe collapse D. Right lower lobe collapse

· (Grainger, 4th edition, Page-442) This refers to the appearance arising due to overinflated superior segment.of the ipsilateral lower lobe located l::ietween,Jhe mediastinum and the medial surface of the collapsed upper lobe.

26. Cavitation is commonly associated with which of the following pulmonary neoplasm? A. Adenocarcinoma . B. Squamous cell carcinoma C. Large cell carcinoma D. Bronchioloalveolar cell carcinoma (Grainger, 4th edition, Page-464) 27. Comet tail sign is seen in: A. Miliary tuberculosis B. Rounded atelectasis C. Pleural effusion D. Pulmonary collapse (Sutton, 7th edition, Page-35) Rounded atelectasis is seen as round or oval subpleural opacity in the posterior or posterolateral part of the lower lobes. Converging vessels and airways enter the opacity in helical fashion usually from below giving rise to the comet tail sign. 28. Investigation of choice for bronchiectasis is: A. Bronchography B. HRCT C. Chest radiograph D. MR 29. Modality of choice superior sulcus tumor: A. CXR B. USG C. CT D. MRI

for

(Sutton, 7th edition, Page-163) demonstrating extent of

(Grainger, 4th edition, Page-475) . Answer- 25 A

26B

27B

28B

29D

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30. Popcorn calcification on chest radiograph is pathognomonic of which of the following? A. Pulmonary hamartoma B. Pulmonary hemangioma · C. · Pleural e:tnpyema · D. Pulmonary granuloma (Grainger, 4th edition, Page-478)

31. Cavitation in pulmonary metastases is a feature of: A. Squamous cell carcinoma B. Adenocarcinoma C. Sarcoma D. Osteosarcoma (Grainxer, 4th edition, Page-483)

32. Calcified pulmonary metastases 1.:an be seen in which of the following'! A. Osteosarcoma B. Renal cell carcinoma D. Giant cell tumor C. Thyroid carcinoma (Grainger, 4th edition, Page-483) it~fma~;,;ilfl,,metastasis iS!t'We:ry unusual except in ostensarr~m.a,,andw ~iiliiltosaw©fflai

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33. Bilateral and symmetrical hilar enlargement on a chest radiograph is characteristic of: A. Sarcoidosis B. Silicosis C. Tuberculosis D. Histoplasmosis (Sutton, 7th edition, Page-188)

34. Subpulmonary effusion and raised hemidiaphragm can be differentiated by: A. PA view of the chest B. Oblique view of the chest C. Lateral decubitus view of the affected side D. Lordotic view of the chest (Grainger, 4th edition, Page-326) Subpulmonary effusion unless loculated will form a layer of fluid along the dependent chest wall.

Answer- 30 A

31A

32A

33A

34C

I

35. Displaced crus sign on CT helps in distinguishing between:

A. Pleural effusion and ascites B. Exudative and transudative pleural effusion C. Pleural and pulmonary neoplasm D. Between two crux of diaphragm

(Grainger, 4th edition, Page-330) Pleural fluid displaces the diaphragmatic crus away from the adjacent vertebral body whereas the ascites has the reverse effect. 36. Egg shell calcification is characteristically seen in: A. Sarcoidosis B. Rheumatoid arthritis C. Asbestosis D. Tuberculosis

(Sutton, 7th edition, Page-25) It is also seen in silicosis. 37. All are true regarding Bochdalek hernia except: A. It occurs through pleuroperitoneal canal B. It is commonly seen along posterior aspect of diaphragm C. It is commoner on right side D. It contains retroperitoneal fat or portion of kidney or spleen

(Grainger, 4tfz edition, Page-345) 38. An increase of greater than - - cm in the transverse cardiac diameter on comparable serial chest radiographs is considered significant. A. 0.5 B. 0.75 C. 1.0 D. 1.5

(Sutton, 7th edition, Page-5) 39. Wave sign of Mulvey is seen in which of the following: A. Normal thymus B. Pleural mass C. Pancoast' s tumor

D. Round atelectasis

(Sutton, 7th edition, Page-6) ,'ihjs\'Si@l'rcefer,5'!'.0' the wav1¥ o~,\:>ilata-al .tkyrn~,'~4e,1:sdµ~. to ffleitentati~'by oostal camlag~•b~:• ~g:~m. Answer- 35 A

36 A

37C

380

39A

l,

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40. Which of the following pneumoperitoneum? A. Erect abdominal film B. Erect chest film C. Supine abdominal film D. Supine chest film

is

best

for

diagnosis

of

the

(Sutton, lth·edition, Page-10) 41. Chilaiditis' syndrome refers to the interposition of whi.ch of the

following between dome of diaphragm and liver? A. Air B. Colon C Smr1ll howel D. Stomach

(Sutton, 7th edition, Page-11) 42. The upper limit of normal dimensions for retrostemal space on a lateral chest radiograph is:

A. 2

B.

3

4

D.

s·

C.

(Sutton, 7th edition, Page-13) 43. Silhouette sign was given by which of the following scientists? A. Felson B. Seldinger C. Golden D. Fleischner (Sutton, 7th edition, Page-14) This sign is defined as the loss of an interface by adjacent disease and fl}

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localization of a lesion on a chest radiograph by studying the diaphragm, cardiac and aortic outlines. 44. Which of the following does not show air bronchogram? A. Pleural effusion B. Sarcoidosis

Consolidation D. Lymphoma

C.

(Sutton, 7th edition, Page-15-16) Air bronchogram refers to the visualization of the intrabronchial air secondary to the loss of air from the adjacent pulmonary parenchyma.

Answer- 40B

41 B

42B

43A

44A

45. Bronchocele refer to which of the following? A. Cysts in the bronchus B. Mucus filled bronchus C. Bronchiectasis D. Dilated bronchial artery (Sutton, 7th edition, Page-19) 46. Fleischner Jines refer to which of the following? A. Round atelectasis B. Round pneumonia C. Plate atelectasis D. Lobar collapse (Sutton, 7th edition, Page-19) 47. Which of the following is the most accurate imaging technique for the staging of primary pulmonary tumors? A. CT ·B. MRI C. SPECT D. PET (Sutton, 7th edition, Page-43) 48. Which of the following is not a indication of pulmonary angiography? A. Diagnosis of pulmonary embolism B. Evaluation of the pulmonary hypertension C. Diagnosis and treatment of the pulmonary vascular lesions D. None of the above (Sutton, 7th edition, Page-46) 49. Erosion of the outer ends of the rib is seen in which of the following connective tissue disorder? A. SLE B. Rheumatoid arthritis C. Scleroderma D. Dermatomyositis (Sutton, 7th edition, Page-47) ' ~ f ~ d i s i n is,also. a,common cause ~ a t the o~te:r'l!Hd,,of tlii\l!>clavicle.

Answer- 45 B

46C

47D

48D

49B

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