Download First Part Exam 2009

FIRST PART RADIOLOGY EXAM 2009
1- The left sided SVC drains into:
A-left brachiocephalic vein
B-right atrium
C- coronary sinus
D- left atrium
E- IVC
The persistent left SVC represents failure of obliteration of the left anterior cardinal vein present in early
embryological development. In 90% of cases the persistent left-sided SVC connects to the right atrium via
the coronary sinus. In 10% the left SVC connects to the left atrium, resulting in a right-to left shunt.
Applied Radiological Anatomy (2nd edition), pg 131.
2- which of the following accessory bones lies JUST posterior to tibia:
A. Os navicularis
B. Os trigonum
C. Os tibilis externum
D. Os acromiale
E. Os perineum
May be written incorrectly, may be just posterior to the talus. If that, the answer would be B.
The posterior process of talus is grooved and may be separate as the os trigonum.
Applied Radiological Anatomy (2nd edition), Pg 360.
http://www.medscape.com/viewarticle/564711_8
This link explain the os navicularis and tibialis.
3- At birth, conus medullaris ends at the level of:
A) T12
B) L1
C) L2
D) L3
The spinal cord extends from the medulla oblongata at the foramen magnum to the conus medullaris
distally. It extends the entire length of the vertebral canal in a 3-month-old fetus but, because of greater
growth in length of the vertebral column than in the spinal cord, the conus lies at the level of the L3 vertebra
at birth and at the lower limit of L1 or upper limit of L2 at the age of 20. The conus may lie even higher in
the flexed position that may be used during myelography
SR p 94 (2nd edition)
4- lateral to false vocal cord:
infratemporal fossa
pyrifirom fossa
On both sides aryepiglottic folds extend from the lateral surface of the epiglottis and attach posteriorly to the
superior process of the arytenoid. The inferior margin of the aryepiglottic fold is free and the mucosal
surface of the aryepiglottic folds forms the false cords.
The boundaries of the pyriform sinus are laterally the posterior thyroid lamina, posteriorly the lateral aspect
of the posterior pharyngeal wall and anteromedially the aryepiglottic fold, which separates it from the larynx
Applied Radiological Anatomy (2nd edition), Pg 71,73.
5- vas deferns (ends ) at
- tail of epididimys
- head of epididimys
- body of epididimys
- testis
- appendix of testis
The vas deferens This extends from the tail of the epididymis through the scrotum, inguinal canal and pelvis
to fuse with the duct of the seminal vesicle to form the ejaculatory duct in the prostate gland.
SR p 233 (2nd edition)
6- The pancreatic duct in ERCP reached up to:
A) 4 mm.
B) 2 mm.
C) 1 mm.
ERCP visualizes the pancreatic duct by injection of contrast after cannulation via duodenal endoscopy. The
duct is 16 cm long and measures up to 4 mm in diameter in the head.
SR p 185 (2nd edition)
7- Which of the following has a direct relation to the diaphragm:
A-duodenal cap
B-left adrenal gland
C-pancreas
D-ascending colon
E- caecum
F- IMA.
G-Splenic vein.
left adrenal gland is related to the left hemi- diaphragm, tail of the pancreas and splenic artery.
Adrenal Glands: Diagnostic Aspects and Surgical Therapy (google books).
8- boundries of the lesser sac:
The posterior wall of the lesser sac is formed by the peritoneum over the pancreas and the left adrenal and
upper pole of the left kidney, whereas its anterior wall is formed by the peritoneum over the posterior wall
of the stomach and the lesser omentum. It is limited laterally by the spleen and its attached gastrosplenic and
splenorenal ligaments. The lesser sac is partially divided by the fold of peritoneum over the left gastric
artery, the pancreatogastric fold. Medially the lesser sac communicates with the general cavity of the
peritoneum via the epiploic foramen (of Winslow).
SR p 203 (2nd edition)
9- Which artery is a direct branch of ICA:
A-A COM
B-AICA
C- meningohypopheseal artery
D-PICA
E-middle meningeal artery
F- internal maxillary a
G- frontopolar a
H- suoerficial temporal a
Branches of the internal carotid artery
The cervical portion has no branches. Two small branches each arise from the petrous and cavernous parts
of the internal carotid artery but are seldom visible on angiography.
These are:
• The caroticotympanic artery to the ear drum;
• The pterygoid artery to the pterygoid canal and plate;
• The cavernous artery to the walls of the cavernous sinus; and
* The meningohypophyseal artery which supplies the dura of the anterior cranial fossa and sends branches
to the pituitary.
SR p 74 (2nd edition)
10- Which of the following is a common NON ENHANCING brain lesion in AIDS patient :
A-lymphoma
B-toxoplasmosis
C-progressive multifocal leukoencephalomalacia (PML)
D-cryptococcosis
E- abscess
F-none of the above
Progressive multifocal leukoencephalopathy (PML)
Imaging Features
• Posterior centrum semiovale is the most common site.
• Bilateral but asymmetrical
• Begins in subcortical WM; spreads to deep WM
• T2W bright lesions (parietooccipital)
• No enhancement (key distinguishing feature from infections and tumors)
• May cross corpus callosum
• No mass effect
Primer pg 403 (5th edition).
11-The spermatic cord CONTAINS:
A-inferior epigastric artery.
B-lymph vessels . ??
C-femoral branch of genitofemoral nerve
D- cremastric muscle.
E-testicular artery.
Spermatic Cord
= testicular+ deferential +cremasteric aa., pampiniform plexus of veins, vas deferens, nerves, lymphatics
wolfgang 7th edition pg 933
12- Separate relation to sciatic nerve:??????
A) Sup. Gluteus
B) Inf. Gluteus
C) Piriforms muscle
D) Obterator internous
E) Quadratous femoris
Which lateral rotator of the thigh has a variable relationship to the sciatic nerve?
The piriformis, inferior to which the sciatic nerve emerges, may be pierced by the fibular component of the
sciatic nerve. The piriformis is the key to the relationships in the gluteal region.
http://www.dartmouth.edu/~humananatomy/part_3/chapter_14.html
13- Appearance of posterior mediastinal mass lesion on a PA CXR:
A) Retrosternal obliteration
B) Para tracheal widening
C-displacement of azygoesophageal line
D-obliteration of cardiophrenic angle
E- obliteration of AP window
Posterior Mediastinum On conventional radiographs look for:
Cervicothoracic Sign
Widening of the paravertebral stripes
A and D for anterior mediastinum
B, C and E for middle mediastinum
http://www.radiologyassistant.nl/en/p4620a193b679d/mediastinum-masses.html
14- contraindication to ERCP:
sclerosing cholangitis
previous gastric surgery
ca. of ampulla of vater
post cholecystectomy syndrome
http://emedicine.medscape.com/article/1829797-overview#a01
15- mortise view, there is overlap in the tibia and fibula:
>0
>1 mm
>5 mm
>15mm
(1) a tibiofibular "clear space" on the anterior-posterior and mortise views of less than approximately 6 mm;
(2) tibiofibular overlap on the anterior-posterior view of greater than approximately 6 mm or 42% of fibular
width; (3) tibiofibular overlap on the mortise view of greater than approximately 1 mm.
http://www.ncbi.nlm.nih.gov/pubmed/2613128
16- Atrophy of the deltoid muscle is due to impingement of ….. nerve:
A) Long thoracic
B) Suprascapular
C) Median
D)Ulnar
E) Axillary
deltoid muscle is innervated by axillary nerve (C5);
http://www.wheelessonline.com/ortho/deltoid_muscle
17- RT VU junction is seen in IVP by:
A) Raising RT side
B) Raising LT side
The right posterior oblique, i.e. left side raised, will show the right vesico-ureteric junction, a common place
for small ureteric calculi to lodge.
Clarks p347 (12 EDITION)
18- 2 yr old child with signs of intestinal obstruction and mass in the RIF by examination and abdominal Xray, what’s the 1st modality you’ll recommend to do:
A) CT abdomen
B) Abdominal Xray
C) Ultrasound abdomen
D) Nuclear medicine
Intussusception occurs most commonly between the ages of 6 months and 3 years of age. This is usually
ileocolic. ultrasound is the first investigation to confirm the diagnosis and assess viability before attempted
air reduction.
Pediatric Ultrasound, How, Why and When pg 203
19- The most common cause of large bowel obstruction in adults :
A- adhesion
B- carcinoma
C-polyps
D- intussusceptions
E-celiac disease
F- volvulus
G- diverticulitis
Approximately 60% of mechanical large-bowel obstructions (LBOs) are caused by malignancies, 20% are
caused by diverticular disease, and 5% are the result of colonic volvulus.
http://emedicine.medscape.com/article/774045-overview#aw2aab6b2b3
20- the most common cause of intracranial hemorrhage is adult is:
A. Aneurysm
B. Hypertension
C. AVM
D. Meningioma
E- vasculitis
F. None of the above
Nontraumatic intracerebral hemorrhage most commonly results from hypertensive damage to blood vessel
walls (eg, hypertension, eclampsia, drug abuse).
http://emedicine.medscape.com/article/1163977-overview#a0104
21- Best view for cuniform/cuboid bones?
Dorsiplantar oblique.
Dorsiflexion.
Planter flexion.
Lateral.
AP.
Iam not sure.
http://www.wikiradiography.com/page/Podiatry+X-ray+Positioning
22- Msticator space contains:
A-lateral pterygoid muscle
B-branches of V3
C-ascending pharyngeal artery
D-branches of V2
E- external carotid artery
f- mylohyoid
g-none of the bove
Contents:
muscles of mastication (medial + lateral pterygoid
muscles, masseter, temporalis muscle)
ramus + body of mandible
cranial nerve V3
ParapharyngealSpace
Contents:
- fat - internal maxillary artery - ascending pharyngeal artery - pharyngeal venous plexus
- branches of cranial nerve V3
wolfgang p 374 (7th edition)
23- The coronoid process of the mandible gives attachment for :
A-temporalis muscle
B-masseter muscle
C-lateral pterygoid muscle
D-medial pterygoid muscle
E-myelhoid muscle
The coronoid process gives attachment to the temporalis muscle
SR p 13 (2nd edition)
24- which artery usually punctured during angiogram:
a- common femoral artery
b- common iliac artery
c- external iliac artery
d- deep femoral artery
e- internal iliac artery
25- In a nuclear scan tc-99 labeled RBC is attracted to:
A) Apha Hemoglobin
B) Beta haemoglobin
C) Mitochondria
D) Reticuloendothelium
E) Cell membrane
99mTc-Labeled Red Blood Cells
nearly 80% of which then binds to the beta chain of the globin part of hemoglobin and 20% to heme.
Fundamentals of Nuclear Pharmacy, Fifth Edition, pg 135
26- The limbic system. one of the following is true:
A) Ext. capsule
B) Globus pallidus
C) Mammillary bodies
D) Dentate nucleus
The limbic system: its core components:
• hippocampal formation
• parahippocampal gyrus
• amygdala
• hypothalamus.
The limbic lobe refers to the cortical parts of the limbic system. It forms a border (limbus) around the
diencephalon and midbrain,
which is composed of three C-shaped arches one inside the other, viewed from a lateral perspective.
Outer arch:
• parahippocampal gyrus
• cingulate gyrus
• subcallosal gyrus
Middle arch:
• hippocampus proper (cornu ammonis)
• dentate gyrus
• indusium griseum (supracallosal gyrus)
• paraterminal gyrus
Inner arch:
• fornix and fimbria.
The mamillary bodies (or nuclei) are part of the hypothalamus and are situated at the ends of the columns of
the fornices. They relay impulses from the hippocampal formation and amygdala nuclear complexes to the
thalamus (along the mammillothalamic tract.
Applied Radiological Anatomy (2nd edition), pg 34.
27- In the left posterior oblique view you will see all of the following except:
A) Rt. sacroiliac joint
B) Lower part of the Rt. ureter
C) Lt. pubic bone
D) Rt. anterior part of the acetabulum
E)left pars and pedicle of L5
Iam not sure.
The right posterior oblique, i.e. left side raised, will show the right vesico-ureteric junction, a common place
for small ureteric calculi to lodge.
Clarks p347 (12 EDITION)
The posterior (external) oblique projection delineates the posterior column and the anterior acetabular rim.
AUNTMINNIE.COM X-RAY PATIENT POSITIONING MANUAL
28- All the following are indications for saline infusion hysterosalpingogaphy except:
A- Infertility
B- 1ry amenorrhea
C- Retained product of the placenta
D- Recurrent miscarriage
E-PV bleeding
http://www.jultrasoundmed.org/content/23/1/97.full
29- one of the following causes anterior displacement of the IVC:
A) renal artery stenosis .
B) left IVC sarcoma.
C) duodenal divertiuculum
D)Enlarged testicular vein.
E) Aneurysm of the Rt. renal A
http://quizlet.com/12851871/mass-displacement-of-anatomical-structures-flash-cards/
30- Patient with altered coagulation profile and needs biopsy:
a. tru cut biopsy using 16Gu
b. tru cut using 18Gu
c. tru cut using 22Gu
d. brush biopsy by large needle through the IVC
Because hemorrhage is the single most feared complication of transcutaneous liver biopsy and
patients suffering from severe coagulation disorders attributable to hepatic and other diseases are
common candidates for histologic assessment, transvenous liver biopsy was developed. The
transvenous liver biopsy is usually obtained through a right-sided puncture of the internal jugular
vein, and rarely through a transfemoral route. The internal jugular vein is cannulated and a sheath
inserted using the Seldinger technique. A catheter is then guided through the right atrium into the
inferior vena cava. In patients with coagulation disorders, liver biopsy coupled with embolization of
the puncture canal (plugged biopsy) is an alternative and has been shown to be a safe procedure.
Zakim and Boyer’s Hepatology: A Textbook of Liver Disease
31- Apical lordotic view:
A) Pt. pressed against the Bucky to stress on head, neck & chest
B) Caudally 45
C) Cranial 15
D) Cranial 45...
E) pt erect ?? the patient is erect but is leaning back.
With the patient in the position for the antero-posterior projection, the central ray is angled 30
degrees cephalad towards the sternal angle.
clarcks pg 212
32- For US in the early pregnancy, best examined by:
A-5 and above MHz transvaginal
B-3-8MHz trans abdomianal
C-13 MHz transvaginal ...
The transvaginal probe can utilize ultrasound frequencies of 7.0–8.0 MHz because the probe can
be placed in close proximity to the organ of interest, namely the uterus. It is therefore the preferred
method of pregnancy assessment in the first 9 weeks of gestation.
Obstetric Ultrasound pg 30
33- In pelvic US all of the following are true except:
A) Retroverted uterus can mimic a pathology
B) Retroverted uterus can be difficult to examine by abdominal US.
C) Minimal pelvic fluid in menstrual age can be a normal finding.
D) Endometrial thickness should be less than 10 premenopausal....
E) small cysts are usually seen in both ovaries.
In a premenopausal menstruating woman, endometrial thickness varies from a mean of 4 mm in the
early follicular phase to 11.5 mm just before menses.
Ginecologia Women's Imaging Obstetrics and Gynecology
34- In order to visualize the right bronchial artery which artery to cannulate 1st?
A) Aortic arch
B) Descending aorta
C) Ascending aorta
D) Superior intercostal artery.
The branches of the descending aorta are: Two to three bronchial arteries, the origins of which are
variable. The right bronchial artery usually arises from the third posterior intercostal artery and the
two left bronchial arteries from the aorta itself. The upper left usually arises opposite T5 and the
lower left bronchial artery below the left main bronchus.
SR p 135 (2nd edition)
35- The main art that give a blood supply of ant wall of the heart is:
a) RCA
b) Left ant descending art
c) Left circumflex art
Coronary Artery Territory
septum
anterior wall
LAD
LAD
lateral wall
posterior wall
inferior I diaphragmatic wall
apex + inferolateral wall
LCx
RCA
RCA
watershed areas
wolfgang 7th edition pg 612
36- in angiography of hepatic artery , the right hepatic artery was not visualized ,which artery that u
will cannulate next:
SMA
lt gastriic art
splenic art
IMA...
right renal artery
A replaced right hepatic artery may be seen arising from the right of the proximal SMA, running
towards the liver between the portal vein and the IVC.
SR p 184 (2nd edition)
37- One of the following passes through the caval opening of the diaphragm:
A) Inferior phrenic A.
B) Rt. phrenic nerve.
C) Lt. phrenic nerve
D) Vagal trunk...
Openings in the diaphragm
These are as follows:
• Aortic - at level T12: in fact the aorta passes behind the median arcuate ligament rather than
through the
diaphragm. The thoracic duct and the azygos vein pass with the aorta;
• Oesophageal hiatus - at level T10: this is to the left of the midline but is surrounded by fibres of
the right crus. With the oesophagus it transmits the vagal trunks, branches of the left gastric artery,
veins and lymphatics;
• Caval opening - at level T8: transmits the inferior vena cava, whose adventitial wall is fused with
the central tendon, and the right phrenic nerve;
• Behind the medial arcuate ligament - the sympathetic trunk;
• Behind the lateral arcuate ligament - the subcostal nerves and vessels; and
• Between sternal and costal origins - the superior epigastric vessels.
SR p 112 (2nd edition)
38- All of the following pass through the lateral wall of the cavernous sinus except:;
A) 3rd CN
B) 4th CN
C) 5th CN 1
D) 5th CN 2...
E) 6th CN
SR p 59 (2nd edition)
39- What mostly favour a PA over an AP view of CXR?
A) both scapula are moved away from the FOV
B) the heart and mediastinum are magnified
C) the clavicles are more vertical
D) less difficult to perform...
E) the ribs are more vertical
The postero-anterior projection is generally adopted in preference to the antero-posterior because
the arms can be arranged more easily to enable the scapulae to be projected clear of the lung fields.
Heart magnification is also reduced significantly compared with the antero-posterior projection.
Clarks pg 198 (12 EDITION)
40- Regaeding CT abdomen all the following are true except:
a) Diluted barium can be used to opacity bowel
B) portal vein is more dense than the liver on non enhanced CT
C) GB wall enhance with IV contrast
D) intra hepatic duct are not seen normally...
E) small bowel can be normally measured
41- In double contrast barium enema all true except :
A) Can cause transit bacteremia
B) Not preferred in children
C) Transverse colon is filled in supine position
D) Toxic mega colon is absolute contraindication
Once the barium has reached the mid-transverse colon, the patient is turned PRONE. Let the barium
bag down on the floor with the tube open. Ask the patient to ‘bear down’ (i.e. push the barium out
into the bag). This will advance the transverse colon barium into the right colon, and clear the rectal
and sigmoid of barium.
http://individual.utoronto.ca/ecolak/gi_techniques/techniques/colon/dcbe_digital_no_overhead_vie
ws.htm
42- One of the following passes through the optic canal:
A) Sup. Ophthalmic V.
B) 4th CN
C) 5th CN
D) Frontopolar A
E) ophthalmic artery
The optic canals run from the sulcus chiasmaticus anterior to the tuberculum sellae,
anteroinferolaterally to the orbital apex. They transmit the optic nerves and ophthalmic arteries.
SR p 6 (2nd edition)
43- The lead apron thickness is about :
A-,5mm
B-,7mm
C-1cm
D-12 mm
Lead is an effective protective barrier (i.e., it has a high attenuation coefficient) be-cause of its high
density and high atomic number. Lead aprons used in diagnostic radiology should have 0.25 or 0.5
mm equivalents of lead.
huda p 164 (2nd edition)
44- Unilateral optic nerve lesion causes:
Homonymous hemianopia
Unilateral visual loss
Temporal vision loss bilaterally.
45- moderate band is found in:
A. Right atrium
B. Right ventricle
C. Left ventricle
D. Left atrium...
The morphological right ventricle has a ventricular wall that is more trabeculated than the left
ventricle and has a moderator band at its apex.
Applied Radiological Anatomy (2nd edition), pg 381.
46- Right adrenal vein drains into:
A-right renal vein
B-right testicular vein
C-IVC
D-right inferior phrenic vein
One vein drains the adrenal gland on each side. The right adrenal vein drains to the IVC and the left
adrenal vein drains to the left renal vein.
SR p 197 (2nd edition)
47- The highest dose of radiation is in one of the following:
A) Conventional angiography
B) Coronary CT angiography
C) Thallium 2 days
D) Calcium scoring CT
Diagnostic procedures using ionizing radiation are the highest source of man-made radiation
exposure. The highest contributor to medical exposure is computed tomography (CT),
huda p 168 (2nd edition)
one question from that chapter was:
30. Which imaging modality results in the highest collective medical dose?
(A) Chest x-rays
(B) Fluoroscopy
(C) Interventional radiology
(D) Mammography
(E) CT
CT is by far the largest contributor to the collective dose from medical exposures and will continue
to grow in importance for the foreseeable future.
http://pubs.rsna.org/doi/abs/10.1148/radiol.2261011365
48- To differentiate between graves and sub-acute thyroiditis:
????
Radioactive Iodine Uptake (RAIU): (b) increased: in Graves disease (c) decreased: in subacute
thyroiditis
wolfgang pg 1113 (7th edition)
49- Localization of parathyroid gland in pt with hypercalcemia we use:
Tc-99m sestamibi.
PARATHYROID SCINTIGRAPHY
for the evaluation of primary hyperparathyroidism after other causes for hypercalcemia have been
excluded.
Technetium-thallium Subtraction Imaging or Technetium-99m Sestamibi
wolfgang pg 1113 (7th edition)
50- Positioning in cardiac scintigraphy:
A) Rt. 70 anterior-oblique.
B) Lt. 70 anterior-oblique.
C) Rt. 45 anterior-oblique.
(a) Standard
180° acquisition extending from 45° RAO to 45° LPO for single-head camera.
wolfgang pg 1122 (7th edition)
51- During performing CT pulmonary angiogram the pulmonary artery was faintly opacified with
well enhanced SVC and aorta ,the explanation is :
A-right to left shunt
B- left to right shunt
C- PDA
D- fast injection rate
The authors discuss a contrast material enhancement pattern seen at computed tomographic (CT)
pulmonary angiography. In 45 of 289 patients in the study population, they found that the
attenuation values in the main pulmonary artery were less than or equal to those in the aorta, despite
the presence of contrast material in the superior vena cava. Their explanation of this attenuation
pattern was a shunt between the right and left atria due to a patent foramen ovale or atrial septal
defect.
http://pubs.rsna.org/doi/full/10.1148/radiol.2293030474
52- Regarding the middle lobe of the lung:
-Lies between the oblique and transverse fissure
53- All of the following cause obliteration of the diaphragm except:
A) Atelectasis in the lower lobe
B) Atelectasis in the mid lobe
C) Pleural effusion
D) Mass adjacent to the diaphragm
54- The normal pulmonary pressure of pulmonary artery:
A- 20-28 mmHg
B- 15-20 mmHg
C- 8-12 mmHg
D- 12-25 mmHg
E- 10-15 mmHg
PULMONARY HYPERTENSION =sustained pulmonary arterial pressure in systole >25 mm Hg
at rest I >30 mm Hg during exercise (normal levels, 10 and 15 mm Hg)
wolfgang pg 594 (7th edition)
55- To R/O appendicitis you perform CT scan in one of the following:
A) Rigid non-compressable abdomen
B) Thin adult
C) Young women
D) Paediatric pt.
56- Structure pass in gastrosplenic ligament:
Short gastric a.
Short gastric and lt gastroepiploic a.
Lt gastric a.
The gastrosplenic ligament is composed of two layers of dorsal mesentery, which separate the lesser
sac posteriorly from the abdominal cavity (greater sac) anteriorly. The splenic vessels and the
pancreatic tail pass towards the spleen in the former and the short gastric and left gastroepiploic
vessels pass in the latter.
SR p 186 (2nd edition)
57- 25 non-smoker male pt. did a CT abdomen & was found to have a 3mm non-calcified nodule in
the lower cuts of the chest, a complete chest CT scan was done & showed no other nodules, what is
the next step:
A) F/U 3M
B) F/U 6M
C) F/U 12M
D) No F/U
Fleischner Society Recommendations, Incidental Pulmonary Nodule Follow-up
58- Single fatty lesion in the lung, best seen by:
A) Bone window.
B) Lung window.
C) Sharp 1mm soft tissue window.
D) Soft tissue + contrast
HAMARTOMA OF LUNG. HRCT: './ fat density detectable in 34% (-80 to -120 HU) './ calcium+
fat detectable in 19%
wolfgang pg 506 (7th edition)
Thin-collimation CT minimizes partial volume effect and improves spatial resolution.
Fat-containing Lesions of the Chest
http://pubs.rsna.org/doi/abs/10.1148/radiographics.22.suppl_1.g02oc08s61
59- K/C of lung CA is about to do surgery, they found 1.5 adrenal lesion what to do?
A) Proceed for OR
B) Palliative Radiation
C) Biopsy
D) In and out of phase MRI
Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental
Findings Committee
http://www.google.com.sa/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=5&ved=0CEcQF
jAE&url=http%3A%2F%2Fwww.medpagetoday.com%2Fupload%2F2010%2F10%2F29%2FPIIS1
546144010003303.pdf&ei=-cg_U6v-KtODhQfTyoGwBw&usg=AFQjCNFGyoMraXSeJG71edrClryLC7ezw
60- nephrogenic systemic fibrosis, due to one of the following:
A) Ionic gad
B) Non-ionic gad
C) High dose of gad ??
D) Previous renal disease
depends on the question, dose it ask about the cause or the risk factors..
Cause: gadolinium-based contrast agents
Risk factors:
(1) High dose gadolinium-based contrast agent
(2) Acute I chronic renal failure: esp. hepatorenal syndrome, perioperative liver transplantation
period, renal transplant failure
(3) Venous thrombosis
(4) Vascular surgery
wolfgang pg 1151 (7th edition)
To date, has only occurred in patients with kidney disease.
primer pg 686 (5th edition).
61- Preparation of diabetic Pt. using metformin with GFR > 60 for CT with contrast:
A) Don’t stop medication
B) Stop meds 48h after exam
C) Stop meds 48h b4 & after
Category I
In patients with normal renal function and no known comorbidities, there is no need to discontinue
metformin prior to intravenously administering iodinated contrast media, nor is there a need to
check creatinine following the test or
procedure before instructing the patient to resume metformin after 48 hours.
Category II
In patients with multiple comorbidities who apparently have normal renal function, metformin
should be discontinued at the time of an examination or procedure using IV iodinated contrast
media and withheld for 48 hours.
Category III
In patients taking metformin who are known to have renal dysfunction, metformin should be
suspended at the time of contrast injection, and cautious follow-up of renal function should be
performed until safe reinstitution of metformin can be assured.
ACR Manual on Contrast Media PG 34.
62- Renal failure happened after contrast injection:
A) Immediately
B) In hypertensive Pt.
C) Diabetic patient
D) Due to meds after examination
50% of CIN occurs in diabetic
pocedures p 29
63- Contraindication to give contrast when GFR:
A) 120-90
B) 60-30
C) <10
Patients with CKD 4 or 5 (eGFR <30 ml/min/1.73 m2) administration of iodinated contrast media
for CT could worsen renal function and lead to the need for dialysis, while administration of GBCM
for MRI could lead to NSF.
It is recommended that any contrast media administration be avoided in this group of patients, if
feasible.
64- To visualize the lower ureter all of the following except:
A) Erect
B) Supine
C) Both decubitus
???
65- Regarding the protocol of HRCT all are true except:
A) Maximum matrix
B) Collimation…
C) Bone algorithm
(HRCT) Technique
• 1- to 1.5-mm thin collimation
• High spatial frequency reconstruction
• Optional Increase in kVp or mA (140 kVp, 170 mA).Targeted image reconstruction (one lung
rather than both to improve spatial resolution)
primer pg 4 (5th edition)
66- Wrap around artifacts are corrected by:
A. Decrease field of view
B. Large matrix
C. Increase sampling
D. All of the above
Wraparound artifact occurs when the FOV is smaller than the structure, and im-aged objects outside
the FOV are mapped to the opposite side of the image. -Wraparound is caused by undersampling
(aliasing) and can be corrected by in-creasing the sampling rate (e.g., increase number of phaseencode steps).
WH pg 204
67- Claustrophobic pt doing MRI to R/O vertebral body deposit chose one sequence:
Sag T1.
Sag T2.
Sag T1+C.
Stair sag. ??
68- Claustrophobic pt doing MRI to R/O spinal cord compression chose one sequence:
Sag T1.
Sag T2.
Sag T1+C (T).
Stair sag.
MRI has a high sensitivity for identifying metastatic disease within bone when the correct
sequences are used (sagittal T1 and/or STIR (Short T1 Inversion Recovery)). MRI can also show
any soft tissue component of the mass and the degree of spinal cord compression (sagittal T2
supplemented with axial T1 or T2 weighted scans).
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032978/
69- A patient had gastric surgery found to have bilateral lung infiltrate post op and he was given
antibiotics ,after 2 weeks post op came with decrease O2 saturation and left leg swelling ,what is the
best next step to done :
A-pulmonary angiography
B-pulmonary CT angiogram
C- Doppler US
D-CXR
E-non enhanced CT chest
diagnosis of PE depends on the clinical probability, if highly probable pulomnary CTA is the
modality of choice unless contraindicated.
Challenges, Controversies, and Hot Topics in Pulmonary Embolism Imaging
AJR:196, March 2011
70- The following are ways to drain pelvic abscesses with ultrasound guidance, EXCEPT:
A) Transabdominal
B) Transvaginal
C) Transrectal
D) Transvsical
E) Transgluteal
Abscesses in locations that are difficult to access, such as those deep in the pelvis, subphrenic
regions, or epigastric region, can be drained by using the appropriate approach—transrectal,
transgluteal, intercostal, or transhepatic.
http://pubs.rsna.org/doi/abs/10.1148/rg.243035107
The success, safety, and advantages of US-guided transvaginal drainage in our early experience
suggest its use as an alternative to standard percutaneous catheter procedures to diagnose and drain
certain pelvic abscesses and fluid collections.
http://www.ncbi.nlm.nih.gov/pubmed/1887056
71- In SPECT images, every pixel represents:
A) Image attenuation (CT)
B) Image density
C) Concentration & radionuclide
D) All of the above
E) A + B
A88. Pixel values in single positron emission computed tomography (SPECT) images represent:
(A) densities
(B) absorption factors
(C) attenuation factors
(D) radioisotope concentrations
(E) projection data
A88-D. Pixel values are proportional to the ra-dioisotope concentration.
WH p 219
72- Breast, which of the following is false?
A) Lobes 10-20
B) UOQ attach with the pectoralis major to the axilla
C) Supplied by axillary & internal thoracic
All are true.
breast arranged in to 15-20 lobes which drain in single lacteferous duct
the fascia form septa called coopers lig ,which attach to skin of breast ant and to fascia of pectoralis
ms post((((no specific area is mentioned )))
bl.supply :
branches of internal mammary thoracic artery ,,,,60% CENTRAL AND MEDIAL PORTION
lateral thoracic br. of axillary art ,,,,30% ROQ
perforating branches of ant.intercostal artery
S.R pg 313
73- Tc-99m MDP = 150 afternoon in lab at 8am, how much activity:
A) 9
B) 17
C) 19
D) 23
E) 30
??? depends on the question, they may mean 8 a.m. next day.
Tc-99m: 140 keV, half-life of 6.01 hr
74- The largest US reflection occur between:
A. Blood and muscle
B. Water and muscle
C. Blood and kidney
D. Blood and brain
E. Muscle and kidney
another similar Q has these choices:
A) Fat & liver
B) Blood & water
C) Muscle & kidney
-Most tissues have acoustic impedance values of about 1.6 X 106 kg/m2/second (Rayl).
-The differences between acoustic impedance values at an interface determines the amount of
energy reflected at the interface.
WH pg 174
75- US velocity:
Frequency x wave length
For sound waves, the relation between velocity (v), measured in m/second, fre-quency, and
wavelength is v = f x λ (m/second).
WH pg 173
76- which structure is anterior to the left renal vein:
A) 3rd part of duodenum
B) SMA
C) renal artery
The left renal vein courses anteriorly, between the superior mesenteric artery and aorta.
Applied Radiological Anatomy (2nd edition), pg 231.
77- CT pelvis was done ,and the CT numbers between the two hips was found to be high ,what is
the best explanation :
A-beam hardening
B- volume average
???
Beam-hardening artifacts, or "cupping" artifacts, are caused by the polychro-matic nature of the
x-ray beam (beam hardening).
-As the lower-energy photons are preferentially absorbed, the beam becomes more penetrating,
causing underestimation of the attenuation coefficient (HU).
one Q was:
B79. CT beam-hardening artifacts:
(A) reduce CT numbers in the image center
(B) are independent of x-ray beam filtration
(C) reduce all CT numbers
(D) do not occur with fourth-generation scanners
(E) do not occur on multi-slice scanners
B79-A. Beam-hardening artifacts occur because the average photon energy of an x-ray beam increases as it passes through the patient. The pref-erential loss of lower energy x-rays depresses the
CT numbers because of an apparent increase in x-ray beam penetration.
so, if the answer is beam hardening, the Q should be: decreased CT number in between.
WH PG 130 AND 232
78- 16 Y/o trauma pt. cystic lesion with sclerotic margins in the cortex of the proximal tibia:
A) ABC
B) Cortical defect
C) GCT
D) Osteoid osteoma
I'm not sure... depends on the exact description mentioned.
BENIGN CORTICAL DEFECT Site: metaphysis of long bone
-1/ well-defined intracortical round I oval lucency
-1/ usually <2 em long
-1/ sclerotic margins
Cx: pathologic I avulsion fracture following minor trauma (infrequent)
wolfgang pg 56 (7th edition)
79- Anterior relation to esophagus:
-aorta
-left atrium
- right bronchus
-right ventricle
In the chest it passes behind the trachea, left main bronchus, left atrium and upper part of the left
ventricle
from above downward; it then passes behind the posterior sloping part of the diaphragm before
traversing this at the level of T10.
SR pg 136 (2nd edition)
80- Posterior mediastinal lesion:
A) Oesophagus
B) Azygos
C) Cardiac
E) Phrenic
Azygous is post mediastinal structure ,, according to ddx p 110 no Azygous lesion.
81- sensitivity is:
A. False positive
B. False negative
C. True positive
D. True negative
E. false positive and true negative
Sensitivity is the ability to detect disease and is TP/(TP + FN), also known as the true-positive
fraction, A sensitive test has a low false-negative rate.
W.H pg 76
21. Sensitivity is given by the:
(A) False positive fraction
(B) True positive fraction
(C) False negative fraction
(D) True negative fraction
(E) Area under ROC curve
21-B. Sensitivity is TP/(TP + FN), or the true-positive fraction.
82- all reduces temperature except
???
83- The period between 90 degree pulse and MR signal is:
A. TR
B. TE
C. T2
D. T1
TE (time to echo) time from the initial 90 degree radiofrequency pulse to the echo signal in
magnetic resonance spin-echo sequences.
W.H pg 254
84- Gradient coil is used to:
A. Increase T2
B. Shorten T1 values
C. Localize MR signal source
D. Increases signal in large patients
E. reduce electronic noise
10. Gradient fields in MR are used most commonly to:
(A) Increase T2
(B) Shorten T1 values
(C) Localize MR signal source
(D) Increase signal in large patients
(E) Reduce electronic noise
10-C. Gradients define the MR image plane and are used for frequency and phase encoding to determine the spatial origin of the detected signals.
208-210 WH
85- Chemical shift artifact is:
A. Difference of resonant frequencies of protons in fat and water
B. Foreign chemical agents in patients
C. Magnetic field gradient
D. Contrast agents
E. Spin-lattice interactions
slight difference in resonance frequency of protons in water and in fat.
21. Chemical shift artifacts are caused by:
(A) Different resonant frequencies of 1H in water and fat
(B) Foreign chemicals agents in the patient
(C) Magnetic-field gradients
(D) Contrast agents
(E) Spin-lattice interactions
21-A. Chemical shift artifacts arise because of the slightly differing resonance frequencies of proton in different molecules.
WH PG 204
85- Exposure is:
A. The energy deposited from a photon beam to any material
B. Defined for charged particles below 3MEV
C. The absorbed dose multiplied by the quality factor
D. Number of photons crossing unit area
E. The electrical charge liberated by photons in a mass of air
Exposure is given by the charge liberated in air by photons per unit mass and is expressed in
coulomb per kilogram.
WH P.46 - 47
86- Scanning at matrix of 256 requires 6 minutes, decreasing matrix to 168 the time will be:
A. 3min
B. 6min
C. 12min
D. 15min
E. 20min
The time required to acquire an image is equal to TR X No. of Phase Encode Steps X No. of Signal
Averages For instance, in a spin echo sequence for a 256 X 192 image matrix and two averages per
phase encode step with a TR = 600 msec, the imaging time is approximately equal to 0.6 seconds X
192 X 2 = 230.4 seconds = 3.84 minutes.
Bushberg (2nd edition) pg 451
87- Which of the following x-ray interactions contributes to patient dose:
a) Compton scattering
b) Pair production
c) Photoelectric effect
d) Coherent scattering
e) Auger electron
The photoelectron loses energy by ionizing other atoms in the tissue and contributes to patient dose.
WH Pg 35
88- The early manifestation of skin following high dose of radiation is:
a) Itching
b) Erythema
c) Ulcer
d) Pain
e) Hotness
The first evidence of biologic effects of ionizing radiation appeared on exposed skin in the form of
erythema and acute radiation dermatitis.
Bushberg (2nd edition) pg 848
Best Wishes
Samah Faqeeh :)