NEET-PG 2012 - Radiology Practice Questions

Q: Which of the following conditions characteristically causes bilateral hypertranslucency of lung fields on chest X-ray?

Emphysema. ***Correct: Emphysema*** - **Emphysema** causes destruction of alveolar walls, leading to enlarged air spaces and **air trapping**, making both lungs appear hypertranslucent on X-ray - This **bilateral hypertranslucency** is due to reduced lung tissue density, decreased vascular markings, and increased air volume - Classic radiographic features include flattened diaphragms, increased retrosternal space, and hyperlucent lung fields *Incorrect: Mcleod syndrome* - Also known as **Swyer–James–MacLeod syndrome**, this condition causes **unilateral** lung or lobe hyperlucency due to post-infectious obliterative bronchiolitis - The key differentiating feature is that it's **unilateral**, whereas the question asks for bilateral hypertranslucency - Affected lung shows air trapping on expiratory films *Incorrect: Pneumothorax* - A **pneumothorax** presents as a **unilateral** or focal hypertranslucent area due to air in the pleural space - Characterized by **absence of lung markings** beyond the visceral pleural line and associated lung collapse - This is a pleural space abnormality, not a bilateral parenchymal lung disease *Incorrect: Poland syndrome* - **Poland syndrome** is a congenital condition with absence or underdevelopment of the pectoralis major muscle - Can lead to **unilateral** apparent hyperlucency on the affected side due to missing chest wall muscle - This is a **chest wall anomaly**, not a parenchymal lung disease causing bilateral hypertranslucency

Q: What is the most effective imaging method for the diagnosis of adenomyosis?

MRI. ***MRI*** - **MRI** offers superior soft tissue contrast, allowing for detailed visualization of the **junctional zone** and **myometrial thickening** characteristic of adenomyosis. - It can effectively differentiate adenomyosis from other uterine pathologies like **leiomyomas**, due to its ability to detect **heterogeneous myometrial signal** and small myometrial cysts. *CT scan* - **CT scans** have limited utility in diagnosing adenomyosis due to their **poor soft tissue contrast** in evaluating diffuse uterine conditions. - They expose the patient to **ionizing radiation** and are generally reserved for detecting calcifications or larger structural abnormalities in the pelvis. *Ultrasound* - **Transvaginal ultrasound** is often the first-line imaging modality due to its accessibility and non-invasiveness, but its diagnostic accuracy for adenomyosis is **operator-dependent** and can be limited in subtle cases. - While it can suggest adenomyosis through findings like **globular uterus** or **heterogeneous myometrium**, it often lacks the resolution to definitively characterize the extent and nature of the lesion compared to MRI. *Hysterosalpingography* - **Hysterosalpingography** is primarily used to evaluate the patency of the **fallopian tubes** and the contour of the uterine cavity, making it unsuitable for direct visualization of myometrial pathology. - While it might show an **irregular uterine cavity** if adenomyosis is severe and extends to the endometrium, it cannot definitively diagnose or characterize the condition within the myometrium.

Q: Investigation of choice for multiple sclerosis

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** is the investigation of choice for **multiple sclerosis** due to its superior ability to visualize **demyelinating plaques** in the brain and spinal cord. - It can detect both **new and old lesions**, crucial for diagnosis and monitoring disease progression, according to the **McDonald criteria**. *CT* - **Computed Tomography (CT) scans** are generally less sensitive than MRI in detecting the subtle **demyelinating lesions** characteristic of multiple sclerosis. - While it can sometimes show larger lesions, it often misses smaller or early-stage plaques, making it less suitable for initial diagnosis. *USG* - **Ultrasound (USG)** is primarily used for visualizing soft tissues and vascular structures, not for detailed imaging of the brain or spinal cord parenchyma. - It has no role in the diagnosis or monitoring of **multiple sclerosis**. *PET* - **Positron Emission Tomography (PET) scans** are used to assess metabolic activity and perfusion, often in oncology or certain neurological disorders like Alzheimer's or Parkinson's disease. - It is not routinely used for the diagnosis of **multiple sclerosis**, as it does not clearly visualize the **demyelinating lesions**.

Q: Rat tail appearance in contrast radiography is seen in?

Achalasia cardia. ***Correct: Achalasia cardia*** - The **"rat tail" or "bird's beak" sign** is the classic radiological appearance of **achalasia cardia** on barium swallow study - Shows **smooth, symmetrical, tapered narrowing** of the distal esophagus with proximal esophageal dilatation - Due to **failure of the lower esophageal sphincter (LES) to relax**, causing functional obstruction - The smooth tapering distinguishes it from irregular narrowing seen in malignancy *Incorrect: Carcinoma esophagus* - Esophageal carcinoma shows **"shouldered lesion"** or **"apple core" appearance** - Characterized by **irregular, shelf-like margins** with abrupt transition - Narrowing is **asymmetric and irregular**, not the smooth tapering of rat tail sign - May show mucosal destruction and filling defects *Incorrect: Plummer-Vinson syndrome* - Shows **postcricoid web** in the upper esophagus on barium swallow - Associated with iron deficiency anemia, glossitis, and increased risk of esophageal cancer - Presents as a thin, web-like membrane rather than distal narrowing *Incorrect: Diffuse esophageal spasms* - Shows **"corkscrew esophagus"** or **"rosary bead" appearance** on barium swallow - Multiple, **simultaneous, non-peristaltic contractions** create segmented appearance - Dynamic finding with normal segments between contractions - Represents uncoordinated muscular activity, not fixed narrowing

Q: Which of the following appears the same on both T1 and T2 weighted MRI sequences?

Fat. ***Fat*** - On both T1 and T2 weighted MRI sequences, fat appears **bright** (high signal intensity). - This consistent bright signal makes fat a useful internal reference point for signal interpretation. *Gall bladder* - The gall bladder is filled with **bile**, which appears bright on T2-weighted images due to its high water content, but can be variable on T1. - Bile does not maintain consistently the **same signal intensity** as fat on both sequences. *Kidney* - The renal parenchyma typically has **intermediate signal intensity** on both T1 and T2, but its signal characteristics are different from the consistently bright signal of fat. - The signal can vary depending on the specific sequence parameters and hydration status, unlike fat. *CSF* - **Cerebrospinal fluid (CSF)** appears dark (low signal) on T1-weighted images and bright (high signal) on T2-weighted images due to its high water content. - This distinct signal intensity difference between T1 and T2 is contrary to the shared bright appearance of fat on both sequences.

Q: Investigation of choice for screening of proximal internal carotid artery stenosis is :

Doppler ultrasound (USG). ***Doppler ultrasound (USG)*** - **Doppler ultrasound** is the investigation of choice for screening carotid artery stenosis due to its **non-invasive nature**, widespread availability, and cost-effectiveness. It provides excellent anatomical information and hemodynamics, including **blood flow velocity** and presence of **plaque**. - It can effectively estimate the degree of **stenosis** based on flow characteristics and is safe for serial monitoring. *CT angiography* - **CT angiography** provides detailed anatomical imaging of the carotid arteries but involves **ionizing radiation** and **iodinated contrast agents**, making it less suitable for routine screening, especially in patients with renal impairment or contrast allergies. - While it offers higher resolution for certain plaque characteristics, it’s typically reserved for cases where ultrasound findings are inconclusive or for surgical planning. *Magnetic resonance imaging (MRI)* - **MRI** and **MR angiography (MRA)** can visualize carotid stenosis without ionizing radiation but are more expensive and time-consuming than ultrasound, and can be limited by artifacts from patient movement. - Patients with **claustrophobia** or **metallic implants** may not be suitable for MRI, making it less ideal for general screening. *Digital subtraction angiography (DSA)* - **Digital subtraction angiography (DSA)** is the **gold standard** for diagnosing carotid stenosis as it provides the most detailed and accurate images of the arterial lumen. However, it is an **invasive procedure** associated with risks such as stroke, arterial dissection, contrast nephropathy, and radiation exposure. - Due to its invasiveness and potential complications, DSA is typically reserved for cases with **discordant non-invasive findings** or prior to intervention rather than as a primary screening tool.

Q: Which of the following techniques uses piezoelectric crystals?

Ultrasonography. ***Ultrasonography*** - **Piezoelectric crystals** are the core component of **ultrasound transducers**, which generate and detect ultrasonic waves. - These crystals convert electrical energy into mechanical vibrations (sound waves) and vice-versa, allowing for the creation of images. *NMR imaging* - **NMR imaging** (Nuclear Magnetic Resonance, now commonly known as **MRI**) uses strong magnetic fields and **radiofrequency pulses** to generate images. - It relies on the magnetic properties of atomic nuclei, particularly hydrogen, rather than piezoelectric effects. *X-ray diffraction* - **X-ray diffraction** is a technique used to study the atomic and molecular structure of materials, and it involves the interaction of **X-rays** with the electron clouds of atoms. - It does not involve piezoelectric crystals; instead, it uses an X-ray source and a detector to measure diffracted X-rays. *Xeroradiography* - **Xeroradiography** is an older imaging technique that used **xerographic plates** coated with a photoconductive material (like selenium) to capture X-ray images. - It relies on electrostatic charges and dry development rather than piezoelectric crystals to produce images.

Q: Which of the following conditions can cause periosteal reactions?

All of the options. ***All of the options*** - **Periosteal reactions** are non-specific findings that indicate periosteal irritation or inflammation, which can be caused by a wide range of pathologies including infection, neoplasia, and trauma. - This option correctly encompasses the various causes listed in the other choices, making it the most accurate answer. *Osteomyelitis* - **Osteomyelitis**, an infection of the bone, can cause inflammation of the surrounding periosteum, leading to periosteal new bone formation. - The type of periosteal reaction can vary, from **lamellated** to **solid**, depending on the chronicity and aggressiveness of the infection. *Syphilis* - **Congenital syphilis** and tertiary acquired syphilis can lead to significant bone involvement, including **periostitis**, which manifests as periosteal reactions. - The classic appearance in children with congenital syphilis is a **wavy** or **irregular cortical thickening** due to widespread periostitis. *Tumor* - Both **primary bone tumors** (e.g., osteosarcoma, Ewing's sarcoma) and **metastatic lesions** can elicit a periosteal response as they invade or irritate the periosteum. - The periosteal reaction in tumors can present as aggressive patterns like a **sunburst** or **Codman's triangle**, indicating rapid bone destruction and new bone formation.

Q: Rim sign in IVP is seen in

Hydronephrosis. ***Hydronephrosis*** - The **rim sign** in IVP (Intravenous Pyelography) refers to the opacification of the renal parenchyma surrounding a dilated pelvicalyceal system, forming a "rim" of contrast. - This sign is characteristic of acute obstruction leading to **hydronephrosis**, where the contrast accumulates in the compressed renal tissue and then slowly excretes into the dilated collecting system, outlining it. *Chronic Pyelonephritis* - Characterized by **focal cortical thinning**, scarring, and clubbing of the calyces, not a rim sign. - The kidney may appear small and irregularly outlined on IVP due to **parenchymal loss**. *Renal Cell Carcinoma* - Often presents as a **mass lesion** that distorts the collecting system, but typically does not cause a rim sign. - May show vascularity on imaging and can cause direct invasion or displacement of renal structures. *Polycystic Kidney Disease* - Involves multiple **cysts** of varying sizes throughout both kidneys, leading to significant renal enlargement and distortion of the collecting system. - The appearance is typically described as a "Swiss cheese" or "moth-eaten" pattern due to the numerous cysts, not a rim sign.

Q: A polytrauma patient's CT brain shows a crescent-shaped extra-axial collection with a concave inner margin. What is the most likely diagnosis?

SDH. ***SDH*** - The image shows a **crescent-shaped collection** of hemorrhage with a concave inner margin, consistent with a **subdural hematoma** (SDH). - SDHs result from the tearing of **bridging veins** and typically conform to the brain's surface, crossing suture lines but not limited by bony sutures. *EDH* - An **epidural hematoma (EDH)** characteristically appears as a **lenticular** or **biconvex** shape on CT, not crescent-shaped. - EDHs are typically caused by arterial bleeding, often from the **middle meningeal artery**, and are limited by cranial sutures. *Contusion* - A **contusion** is brain tissue bruising that appears as **heterogeneous areas** of hemorrhage and edema within the brain parenchyma itself. - It would not manifest as a distinct extra-axial collection with a smooth, concave margin. *Diffuse axonal injury* - **Diffuse axonal injury (DAI)** involves widespread microscopic damage to axons, often at the gray-white matter junction. - It may appear as *punctate hemorrhages* or **small lesions** at these junctions on CT, but often the CT can be normal, and it would not present as a large extra-axial collection.

Question 1

Which of the following conditions characteristically causes bilateral hypertranslucency of lung fields on chest X-ray?

Accepted Answer

Emphysema

Answer

Mcleod syndrome

Answer

Poland syndrome

Answer

Pneumothorax

Question 2

What is the most effective imaging method for the diagnosis of adenomyosis?

Accepted Answer

MRI

Answer

CT scan

Answer

Hysterosalpingography

Answer

Ultrasound

Question 3

Investigation of choice for multiple sclerosis

Accepted Answer

MRI

Answer

CT

Answer

USG

Answer

PET

Question 4

Rat tail appearance in contrast radiography is seen in?

Accepted Answer

Achalasia cardia

Answer

Carcinoma esophagus

Answer

Plummer-Vinson syndrome

Answer

Diffuse esophageal spasms

Question 5

Which of the following appears the same on both T1 and T2 weighted MRI sequences?

Accepted Answer

Fat

Answer

Gall bladder

Answer

Kidney

Answer

CSF

Question 6

Investigation of choice for screening of proximal internal carotid artery stenosis is :

Accepted Answer

Doppler ultrasound (USG)

Answer

CT angiography

Answer

Magnetic resonance imaging (MRI)

Answer

Digital subtraction angiography (DSA)

Question 7

Which of the following techniques uses piezoelectric crystals?

Accepted Answer

Ultrasonography

Answer

NMR imaging

Answer

X-ray diffraction

Answer

Xeroradiography

Question 8

Which of the following conditions can cause periosteal reactions?

Accepted Answer

All of the options

Answer

Osteomyelitis

Answer

Syphilis

Answer

Tumor

Question 9

Rim sign in IVP is seen in

Accepted Answer

Hydronephrosis

Answer

Chronic Pyelonephritis

Answer

Renal Cell Carcinoma

Answer

Polycystic Kidney Disease

Question 10

A polytrauma patient's CT brain shows a crescent-shaped extra-axial collection with a concave inner margin. What is the most likely diagnosis?

Accepted Answer

SDH

Answer

EDH

Answer

Contusion

Answer

Diffuse axonal injury

NEET-PG 2012 — Radiology