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Angiography
a. The testicular vein is easier to catheterise on the left than the right using a femoral approach
b. A non-covered stent in the iliac arteries is contraindicated at the bifurcation
c. Iliac artery stent has double the patency rate of angioplasty at one year
d. Iliac artery stents prevent neointimal hyperplasia
e. Following iliac artery stenting the patient should be heparinised for 24 hours
Answer:
a. T, on the right a jugular approach is usual
b. F, usually kissing stents are employed
c. T
d. F, the converse is true
e. T, most clinicians would, although not all Verified DJB 3/4/05
This question has appeared on several past papers
Popliteal artery entrapment syndrome
a. Displaces the popliteal artery laterally
b. Occurs over the age of 50 years
c. Post-stenotic dilatation of the artery is seen
d. Can cause distal embolisation
e. The artery lies posterior to the medial head of gastrocnemius
Answer:
a. F, medially. This is a rare syndrome
b. F, <35yrs in 68%; M:F=9:1; Bilateral= 66%
c. T
d. T
e. F Popliteal artery winds medially, then inferiorly, to the tendinous insertion of the medial head of gatrocnemius
This is a past FRCR question
Verified DJB 3/4/05 Ref: Dahnert 5th ed 2003 pp643
Regarding the course of the thoracic duct:
a. It arises from the cisterna chyli
b. It ascends in the thorax between the azygous vein and the aorta.
c. It lies just to the left of the mid line as it ascends in the thorax
d. It crosses to the left and lies anteriorly at the level of the aortic arch
e. It terminates at the root of the neck by emptying into the junction of the subclavian and internal jugular veins.
Answer:
a. T, and is 2-8 mm in diameter, often up to 8 separate channels, it cannot be seen on CXR or CT unless
lymphangiographic contrast is present
b. T
c. F, it lies just to the right of the midline
d. T
e. T, drains into a large central vein at or within 1cm of this junction Verified DJB 3/4/05
Ref: Applied Radiological Anatomy, Butler et al, 1999 pp141
Regarding Cardiac CT:
a. Can be performed using Electron Beam CT (EBCT).
b. A coronary calcium score (Agatston score) of 50 is highly predictive for coronary stenoses.
c. Coronary calcium deposition usually occurs adjacent to or within a significant stenosis.
d. Coronary calcium estimation cannot be calculated from the data set of a CT coronary angiogram.
e. Of the three main proximal vessels, the right coronary artery is usually the most difficult to image using CT coronary
angiography.
Answer:
a. T, although mostly performed using MSCT.
b. F, an Agatston score of >160 has a high sensitivity and specificity for predicting a >80% stenosis within the
coronary tree.
c. F, calcium is only an independent risk factor for stenoses and usually does not correspond to their location.
d. T, because an unenhanced CT is required for calcium measurements.
e. T, because is it the fastest moving (70mm/s vs. 22-48 mm/s for the left coronary system).
Regarding Smoking-related Interstitial Lung Diseases - Histopathological and Imaging Perspectives:
a. Presently, one in every fifteen deaths in Britain can be attributed to smoking
b. Over 90% of patients with pulmonary Langerhans cell histiocytosis are smokers
c. The appearances on plain chest radiography are generally non-specific
d. Respiratory bronchiolitis is a common but incidental abnormality in otherwise healthy young smokers
e. Lung involvement in DIP is generally more uniform and widespread
Answer:
a. F.Presently, one in every five deaths in Britain can be attributed to smoking: bronchogenic carcinoma, chronic
obstructive pulmonary disease and ischaemic heart disease accounting proportionately for the greatest smoking-
related mortality
b. T.
c. T.
d. T.Respiratory bronchiolitis (sometimes called "smoker's bronchiolitis") is a common but incidental abnormality in
otherwise healthy young smokers
e. T. Reference: S. R. Desaia, S. M. Ryana and T. V. Colbyb. Smoking-related Interstitial Lung Diseases:
Histopathological and Imaging Perspectives Clinical Radiology (2003). 58, 259268
Non-neoplastic lung disorders related to cigarette smoking include:
a. Emphysema
b. Respiratory bronchiolitis
c. Desquamative interstitial pneumonitis
d. Langerhans cell histiocytosis
e. Cryptogenic fibrosing alveolitis
Answer:
All are correct. Other disorders include - Chronic bronchitis, Eosinophilic pneumonia
Reference:S. R. Desaia, S. M. Ryana and T. V. Colbyb. Smoking-related Interstitial Lung Diseases: Histopathological
and Imaging Perspectives Clinical Radiology (2003). 58, 259268
Coarctation of aorta:
a. Has equal incidence in males and females
b. Rib notching is typically bilateral and symmetrical
c. In adults and older children, PA chest radiograph is always abnormal
d. Commonly associated with Fallot's tetralogy
e. There is an increased incidence of cerebral aneurysms
Answer:
a. F, more than 80% affect males
b. F, rib notching is typically bilateral and asymmetrical
c. F
d. F, the commonest association is bicuspid aortic valve (~50%); other associations include aortic stenosis and other
left heart obstructive lesions
e. T, death may occur due to intracranial bleed
Ref: Grainger & Allison's Diagnostic Radiology, 4th edition pp 948-951. Verified DJB 5/4/05
Concerning CT of the pericardium:
a. normal thickness on non-ECG gated studies should not exceed 4mm
b. absence of the left hemipericardium can be demonstrated
c. benign and malignant pericardial effusions can be distinguished by the attenuation values of the fluid
d. small effusions are typically seen as curvilinear collections anterior to the right ventricle
e. constrictive pericarditis characteristically causes diffuse pericardial thickening
Answer:
a) normal thickness on non-ECG gated studies should not exceed 4mm -T
b) absence of the left hemipericardium can be demonstrated - T
c) benign and malignant pericardial effusions can be distinguished by the attenuation values of the fluid - F
d) small effusions are typically seen as curvilinear collections anterior to the right ventricle _F
e) constrictive pericarditis characteristically causes diffuse pericardial thickening - T
Explanation
A. The pericardium can be identified on CT because of the presence of fat in the epicardial space and mediastinum. It
can be identified in 95% of adults, usually anterior to the ventricles and less commonly inferolaterally. The normal
pericardium may appear thickened if imaged tangentially, especially around the anterior sternopericardial ligaments.
Also, the pre- and retroaortic pericardial recesses may be seen at the level of the carina since they commonly contain
a small amount of fluid B. Congenital pericardial defects may be classified as partial (almost always on the left),
absence of the left hemipericardium (the commonest type) or total absence of the pericardium. The characteristic CT
signs of absent left hemipericardium include inability to identify the fibrous layer of the parietal pericardium along the
left heart border, displacement of the main pulmonary artery toward the left lung and direct contact of the lung with the
heart C. Most pericardial effusions appear as near-water-density collections between the niediastinal and epicardial
fat. Exudative or haemorrhagic effusions may have soft tissue densities but benign and malignant effusions cannot
reliably be differentiated by their CT numbers. Small soft-tissue-density effusions can be differentiated from pericardial
thickening since they change shape with position and do not enhance D. Pericardial thickening tends to occur over the
anterolateral surface of the heart, whereas small effusions typically collect behind the- left ventricle and to the left of
the left atrium. Pericardial effusions may occasionally be loculated due to adhesions, usually as a result of surgery or
pericarditis. These loculated effusions are commoner in a posterior or right anterolateral location E. Pericardial
thickening in constrictive pericarditis is typically diffuse but not necessarily regular. The pericardium may measure
from O.5cm to 2cm in thickness. CT will also demonstrate associated dilatation of the SVC and IVC, ascites and
pleural effusions and dilatation of the atria with small ventricles. Radiation, pericarditis and trauma are other causes of
pericardial thickening. Ref: mcqs.com web site
b. T
c. F, MRI is a poor technique for showing lung detail.
d. F, this invasive technique has largely been superseded by HRCT.
e. F, CTPA is performed to diagnose major pulmonary emboli using a cannula placed in any peripheral vein and is
relatively non-invasive compated to conventional pulmonary angiography.
Allergic Bronchopulmonary Aspergillosis:
a. It most typically occurs in acute asthma.
b. It is characterized by pulmonary infiltration with eosinophils, mucoid impaction and central bronchiectasis.
c. Radiological hallmark is peripheral bronchiectasis.
d. Bronchiectasis tends to predominate in the upper lobes.
e. Mucoid impaction is often a prominent radiological finding in patients with ABPA, causing the "gloved-finger appearance.
Answer:
F, T, F, T, T Ref: Grainger p428-429
Regarding pulmonary thromboembolism:
a. more than 90% of all PEs arise from thrombi within the large deep veins of the legs, typically the popliteal vein and the larger
veins above it.
b. conditions associated with an increased risk of thrombosis include DIC, nephrotic syndrome and hemophilia B.
c. treatment reduces the mortality rate from 87% to less than 10%
d. overall, age- and sex-adjusted annual incidence of DVT is approx. 50 cases per 100,000, and for PE 70 cases per 100,000.
e. advise your ED attendings that if the chest radiograph is abnormal, V/Q findings may be diagnostic; if the chest radiograph is
normal, helical CT should be performed
Answer:
a. True
b. False: hemophilia B, a bleeding disorder, is not associated with PE.
c. False: initial mortality is approx. 30% not 87% which would be way too high.
d. True
e. False: Opposite is true- if the chest radiograph is normal, V/Q findings may be diagnostic; if the chest radiograph is
abnormal, helical CT should be performed
Regarding sinus peicranii:
a. A vascular anomalie involving an abnormal communication between intra&extracranial circulation through dilated diploic
veins .
b. either congenital or post-tramatic .
c. presented as painfull soft tissue mass especially at the pediateric age group .
d. In CT & MRI there is thickening of the calavarium .
Answer:
a.True
b.True.
c.False .sinus pericranii presented as painless soft tissue mass
d.False .there is thinning of the calavarium .
Regarding CO2 angiography:
a. CO2 is nephrotoxic
b. air contamination is a potential hazard
c. image quality is superior to contrast angiography
d. COPD is a relative contraindication
e. Bolus segmentation artfact is recognized
Answer:
a) F, is used in renal failure
b) T
c) F
d) F, but pulmonary hypertension is
e) T Reference: http://www.emedicine.com/radio/topic870.htm
Regarding Bronchial Carcinoma:
a. adenocarcinoma are the most common
b. sqamous cell carcinoma are located peripherally
c. adenocarcinomas cavitates most often
d. large cell caecinomas have the fastest rate of growth
e. central lesions are more likely to cause lung collapse than peripheral lesions.
Answer:
a. F. squamous cell carcinomas are the most common accounting for 30-50% of cases
b.F. Suamous cell carcinomas are centrally located, while adenocarcinomas are peripheraly located.
c.F. squamous cell carcinomas cavitates most often
d.F. small cell carcinomas have the fastest rate of growth.
e.T. central lesions are more likely to cause collapse than peripheral lesions
Source. testbook of radiological imaging David Sutton page 399-401 6th edition
Concerning pulmonary haemorrhage:
a. haemoptysis is a common presentation
b. air-space shadowing tend to clear in 5-10 days
c. increase in KCO2
d. in goodpasture associated with antiglomeruler basement membrane antibodies
e. cardiac enlargment is an important sign when deciding the etiology
Answer:
a. F
b. T Pulmonary edema clears in 24-48 hrs.
c. F
d. T
e. F
Causes of calcified mediastinal lymhadenopathy include:
a. sarcoidosis
b. lymphoma
c. tuberculosis
d. pneumocysis carinii in AIDS patient
e. silicosis
Answer:
TFTTT
The left phrenic nerve:
a. Lies anterior to the left scalenus anterior
b. Lies posterior to the subclavian artery
c. Lies posterior to the brachial plexus
d. Traverses the diaphragm through the oesophageal hiatus
e. Passes posterior to the left hilum
Answer:
A. T
B. F
C. F
D. T
E. F
Regarding Pulmonary embolism:
a. CTPA should be performed in all cases as confirmation
b. V/Q scan has no role in diagnosis
c. Alteplase can be given as thrombolysis when suspected cardac arrest is due to PE during resuscitaion.
d. Recurrent PE reduces transfer factor
e. Some PE diagnosis confirmation needs conventional pulmonary angiogram
Answer:
a. F, V/Q can be confirmatory in a given case
b. F
c. T
d. T
e. F, CTPA has superceded conventional pulmonary angiogram now.
Regarding bronchpulmonary sequestration:
a. the intralobar type is commoner in males than females
b. the extralobar form presents in the neonatal period
c. the intralobar type is associated with other anomalies in 60%
d. is commoner on the right than the left
e. the extralobar form does not connect with the bronchial tree
Answer:
a. F
b. T
c. F
d. F
e. T
In Extrinsic Alergic Alveolitis
a. More than half are asymptomatic
b. Symptomatic after 6-8 hrs of exposure
c. Sudden onset of dyspnoea
Answer:
a. T
b. T
c. T
d. F
e. T
Regarding bronchogenic cysts:
a. They may be subpleural in location.
b. They may cause air trapping.
c. They are always symptomatic.
d. They can be found in the neck.
e. They are the most common type of fore gut duplication cyst.
Answer:
TTFTT
The Following are true of Angiodysplasia:
a. Commonly occurs in caecum
b. An association with Osler Weber Rendu syndrome
c. Associated with Tetralogy of Fallot
d. Is associated with cutaneous lesions in 40%
e. Diagnosis commonly made in 2nd and 3rd decades.
Answer:
a. T, Rt sided including ascending colon
b. T
c. F
d. F
e. F Ref Dahnert
False negatives on CT Pulmonary Angiogram may be caused by:
a. Hilar lymph nodes
b. Motion artefact
c. Partial voluming
d. PE nofined to subsegmental vessels
e. Low signal to noise ratio
Answer:
a. F, False positive maybe caused by lymph nodes.
b. T
c. T
d. T
e. T