2010 INSERVICE

REVIEW

 DIRTY ECHOGENIC SHADOWING IS SEEN IN A . HEMORRHAGIC CYST B. DERMOID C. OVARIAN CARCINOMA D. OVARIAN TORSION

 DOPPLER SHOWS NO DIAGNOSTIC FLOW

IN CCA AND REVERSAL OF FLOW IN ICA IPSILATERAL A. SUBCLAVIAN STEAL B. VASCULITIS C.ICA STENOSIS/OCCLUSION D. AI

 SINGLE UMBILICAL ARTERY IS SEEN.WHAT

IS TRUE A. NO SIGNIFICANT ASSOCIATION WITH OTHER FETAL ANAMOLIES B. STRONG ASSOCIATION WITH CORD CYSTS C CO-TWIN DEMISE D FOUND IN 1% OF PREGNANCIES

 REGARDING AIDS CHOLANGITIS WHAT IS

TRUE? A. U/S FINDINGS MIMIC PSC B. DUE TO ANTI VIRAL RX C. ASSYMPTOMATIC PATIENTS D. RARELY OCCURS IN PATIENTS WITH CD4<100

 MIRROR IMAGE ARTIFACT IS LIKELY

SECONDARY TO A.EXTENSIVE FATTY MOIETY IN LIVER B. AIRPOCKETS IN SOFT TISSUE OF LUNG C.ECHOGENIC TISSUE NEAR DIAPHRAGM D. RAPIDLY MOVING RBC DURING DOPPLER

 ULTRASOUND MODE TO HELP REDUCE

ECHOGENIC CLUTTER PROXIMAL TO THE TISSUES ADJACENT TO THE SKIN TRANSDUCER INTERFACE IS KNOWN AS: A. HARMONIC IMAGING B.DOPPLER C.COMPUND IMAGING D. TIME GAIN COMPENSATION

 REGARDING PERITONEAL INCLUSION CYST

WHICH IS CORRECT? A.RoUND OR OVAL CYST SEPARATE FROM OVARY B. TUBULAR CYSTIC ADNEXAL STRUCTURE ADJACENT TO OVARY C. SIMPLE CYST ARISING FROM OVARY D. FLUID COLLECTION ENCASING THE OVARY WITH MARGINS FOLLOWING CONTOUR OF ADJACENT PELVIS.

 A/D

 REGARDING SUCCENTURATE LOBE OF

PLACENTA, WHICH IS CORRECT. A. POTENTIAL COMPLICATION IS PLACENTA PREVIA B. OCCURS IN 1/3 PREGNANCIES C. APPEARS AS ROLLED UP EDGE OF PLACENTA D. HIGH RISK FOR ABRUPTIO

 WHICH OF THE SCROTAL VARICOCELE

NEEDS FURTHER EVALUATION FOR NEOPLASM A.UNILATERAL LEFT VARICOCELE B. UNILATERAL RIGHT VARICOCELE C.DECOMPRESSIBLE VARICOCELE D. NEW DIAGNOSIS OF ANY VARICOCELE

 CONCERING PCOD WHAT IS TRUE??? A.DIAGNOSIS IS MADE WITH

TRANSABDOMINAL AND TRANSVAGINAL U/S B. MARKEDLY ENLARGED OVARIES WITH OVARIAN VOLUME >50CC WITH MULTIPLE CYSTS >2.5CM IS HIGHLY SUGGESTIVE OF PCOD C. INCREASED ECHOGENIC STROMA D.INCREASED VASCULARITY OF STROMA ON DOPPLER IS INTEGRAL PART OF DIAGNOSIS OF PCOD

 CONCERNING RENAL AVF WHICH IS TRUE? A. AVF ARE UNCOMMON IN TRANSPLANT

KIDNEY B. ASSOCIATED WITH OSLER WEBER RENDU C. AVF ARE ASSOCIATED WITH COLOR BRUIT CAUSED BY VIBRATION OF ADJACENT RENAL PARENCHYMA D. ALL RENAL AVF SHOULD BE EMOLIZED

 REGARDING ENDOMETRAIL ABNORMALITIES IN POST MENOPAUSAL WOMEN, WHICH IS

TRUE. A. THICKNESS IS BEST MEASURED IN CORONAL AND TRANSVERSE B. FLUID IS INCLUDED IN THE MEASUREMENT OF ENDOMETRIUM C. ALL POST MENOPAUSAL WOMEN WITH BLEEDING NEED TISSUE SAMPLING REGARDLESS OF THICKNESS TO R/O CANCER D. <7MM THICKNESS WITH NO BLEEDING IS NORMAL IN POSTMENOPAUSAL

 MAMMOGRAM SHOW ASSYMETRy IN

PATIENT WITH COMPLAINTS OF ASSYMTERICAL BREAST THICKENING. WHAT IS THE MOST LIKELY DIAGNOSIS A. INFLAMMATORY BREAST CANCER B. INVASIVE LOBULAR CANCER C. DCIS D. MUCINOUS

 WHEN DIGITAL MAMMOGRAMS ARE REVIEWED ON SOFT COPY DISPLAY WRK

STATION,WHICH OF THE FOLLOWING PROBLEMS IS LIKELY TO BE FACED FROM EXCESS AMBIENT LIGHT A. CONTRAST REDUCTION AT LOW LUMINANCE LEVEL B.CONTRAST REDUCTION IN HIGH LUMINANCE C. VEILING GLARE D. INCREASED NOISE

 COMPLEX SCLEROSING LESIONS? A. MRI DIFFERENTIATES CANCER FROM CSL B.PRESENTS AS PALPABLE MASS C. INCREASED RISK FOR LOBULAR CANCER D. WHEN FOUND AT BX ITS FREQUENTLY

INCIDENTAL

 HELPFUL TO EVALUATE CLUSTER OF

CALCIFICATIONS IN UPPER INNER QUADRANT OF RIGHT BREAST? A. CLEAVAGE VIEW B. CC MAG VIEW C. TANGENTIAL MAG VIEW D. LATERAL MAG VIEW

 ABCD

 WHEN DIGITAL IMAGE IS VIEWED WHICH

INDICATES THAT IMAGE IS OVER EXPOSED? A. IMAGE IS DARK B. CONTRAST IS DECREASED C. RESOLUTION IS DECREASED D. EXPOSURE INDEX VALUE

 BX OF INDETERMINATE CALCIFCATIONS

COMES BACK AS LCIS.WHAT IS THE NEXT STEP? A. EXCISION B. MASTECTOMY C.XRT AND SURGERY D. FOLLOW UP IN 6 MONTHS

 CONCERINING STAGING U/S IN A PATIENT

WITH BREAST CANCER? A. LYMPHNODE SIZE IS THE MOST SENSITIVE FOR METATSTATIC DISEASE B. CAN IDENTIFY SENTINEL NODE C. NORMAL LYMPHNODE MORPHOLOGY EXCLUDES METS D. ASSYMTERICAL CORTICAL THICKENING IS INDICATOR FOR BX

 CONCERINING IMAGING OF LACTATING

PATIENT, WHAT IS TRUE A.BREAST TISSUE SHOWS DECREASED VASCULARITY ON U/S B.RADIOGRAPHIC BREAST DENSITY DECREASES C.U/S IS MORE SENSITIVE THAN MAMMOGRAPHY D.RETURN TO BASE LINE AFTER LACTATION TAKES 6MON

 WHAT MUST BE ASSESED DAILY? A. DARKROOM CLEALINESS B.SCREEN FILM CONTACT C.REPEAT ANALYSIS D.PHANTOM IMAGES

 CONCERING TUMOR RECURRANCE AFTER

BREAST CONSERVATION RX WHAT IS TRUE? A.RISK OF LOCAL RECURRANCE IS 5%/YR B.EXTENSIVE INTRADUCTAL INVOLVEMENT INCREASES RECURRANCE C.NEW CALCIFICATIONS AT LUMPECTOMY REGARDLESS OF TYPE WARRANT BX D.BREAST RADIATION INCREASES RISK FOR CANCER

 Concerning prostate cancer which is true? A. stage c disease is by extension of tumor

through capsule B. extension through capsule is suspected on mri or u/s when tumor touches the capsule C. majority of carcinomas occur in central zone D. major carcinomas are high on t2

 Concering most common form of extravesical

ectopic ureteral insertion of the upper pole A ectopic ureter is almost always associated with upper pole moiety B. in male insertion is below sphincter C. in females insertion is aside the sphincter and are continent D. most cases are associated with partial duplication

 Concering an adnexal mass, which is true. A. a high signal on t1 is diagnostic of

teratoma B. a low signal on t2 is diagnostic of endometrioma C. extraovarian masses are likely benign D . Mucinous neoplasms are less complex then serous

 Risk of prenatal; death from radiation is

highest at what stages ? A preimplantation 0-2 wk B organogenisis 2-8 wk C fetal growth 8-40 wk D all stages 0-40 weeks

 Regarding RCC what is true? A. papillary appear typically hypervascular on

CT/mri B. renal medullary carcinoma is aggressive C. rcc with IVC invasion and retroperitoneal adenopathy with out distant mets is stage 3 b D. oncocytomas are easily distinguished from rcc

 Concerning pheochromacytomas, whats

true? A. Greater than 90% are light bulb bright on T2 MR B. they are associated with MEN 2 and NF C. histological analysis needed to determine malignancy D. cystic degeneration and necrosis is common

 With regard to NSF?whats true. A. in patients on hemodialysis,current reccomendations include dialysisis with in 48 hr B. lowering the dose Gd has no effect on NSF C.minimal risk for pt on peritoneal dialysis D. self limiting disease and responds to steroids E. patients with recent surgery and renal insufficiency are at greater risk

 Regarding female urethral diverticulum

whats true? A.20% has incontinence B. mostly congenital C. saddle bag configuration D most sensitive test is VCUG

 C Mostly acquired, incontinence is common

and positive pressure urethrography is most sensitive

 Regarding VUR what's true? A. children with UTI 20-25% have VUR B. voiding is not necessary for radionuclide

cystography C. reflux nephropathy is characterized by calyceal blunting with normal thickness of cortex D. asymptomatic siblings of children with VUR are at 5to10% increased risk for VUR

 Regarding urinary diversions what is true? A . Small bowel obstruction is early post op

complication B. urinary obstruction occurs in first 30 days C. parastomal hernias are common late complication with 10% requiring surgical repair D. local tumor recurrence is fairly common

 Which is associated with DES exposure in

utero? A T shaped uterine cavity B Uterine didelphis C Bicornuate uterus D renal agenisis

 Regarding appendiceal tumors? A. most common in distal appendix B often occur in elderly C. worse prognosis than other gi tumors

 38 yr old status post gastric bypass after 3 yr

has a gastrogastric fistula is most likely presenting with symptoms of ? A. acute abdominal pain B regained weight C.dyspepsia D vommiting

 During Gi fluoroscopy the FOV is changed

from 15 in to 12 inches, assuming its on AEC, the effect on skin exposure rate? A unchanged B increase C decreases D cannot be determined

 What is the implication of non reducible

hiatal hernia in a patient being conisdered for reflux surgery? A contraindication for laproscopic surgery B pre disposes to post op dysphagia C may suggest need for collis gastroplasty D surgery unlikely to improve symptoms

 Which of the following Gd based contrast has

highed biliary excretion? A Eovist (gadoxetate) B Multienhance (Gadobenate dimeglumine) C Vasovist (Gadofosveset trisodium) D Magnevist (Gadopentate dimeglumine)

 Most common variant of biliary system? A. trifurcation of intrahepatic biliary radicals B. right posterior segmental branch emptying

into the left hepatic duct C. right posterior branch emptying into the GB D left lateral segmental emptying into right hepatic duct

 B The most common anatomic variants in the branching of

the biliary tree described involve the right posterior duct and its fusion with the right anterior or left hepatic duct [2, 3]. As mentioned earlier, the right posterior duct normally passes posteriorly to the right anterior duct and joins it from the left to form the right hepatic duct, which then forms a junction with the left hepatic duct to form the common hepatic duct. Drainage of the right posterior duct into the left hepatic duct before its confluence with the right anterior duct is the most common anatomic variant of the biliary system and reported to occur in 13-19% of the population [

 Concerning NASH non alcoholic steato

hepatitis? A. can progress to cirrhosis and fibrosis B associated with normal insulin metabolism C it irreversible D common in lean patients

 Concering the pharynx and cervical

esophagus A hypopharynx extends from soft palate to cricopharyngeus B cricopharyngeus is cranial to cervical esophagus C upper esophageal sphicter is at c3-4 D during swallowing the larynx moves caudally

 Concerning esophageal motility? A primary peristalisis is contraction wave in

aboral direction B secondary peristalisis is initiated by secondary swallow C normal resting LES pressure is 40-50 D diffuse esophageal spasm demonstrates non propulsive esophageal contractions

 a/d

 What is typical lead equivalency of aprons A 0.1mm B 0.5mm C 1cm D 0.5cm

 Concerning splenic lesion A congenital cysts are more common than

traumatic B early peripheral contrast enhancement is characteristic of hemangioma C melanoma is the most common primary neoplasm to metastasize to spleen D spleenic sarcoidsis presents are solitary splenic mass

 Interposition of lung tissue between the aorta

and the main PA indicates? A pulmonary agenisis B pulmonic stenosis C svc thrombosis D Absent pericardium

 For a 3d ct image acquired at 0.5mm

thickness which of the following is likely to occur if reconstruction interval is altered from 0.5 to 0.3mm? A increased pt dose B decreased pt dose C increased data set D increased scan time

 Which is associated with dissection? A hypertension B bicuspid valve C marfans D prior cardiac surgery

 a/c

 Where is crista supraventricularis located A junction of LA appendage and left

pulmonary vein B right ventricle free wall and the interventricular spetum C between inflow and outflow of the right ventricle D between right atrial appendage and right atrium

 What is the most common cause for MS A left atrial myxoma B endocarditis C calcification D Rheumatic

 Regarding congenital absence of

pericardium? A right pericardial defects are common B associated cardiopulmonary defects C total absence of pericardium is common D partial defects risk herniation and strangulation

 Regarding myocardial bridging ? A circumflex is commonly effected B require surgery c C T is better than angiography D they occur in less than 10% autopsy

 Which is a reliable sign of pulmonary valve

stenosis? A enlarged right PA B enlarged left PA C enlarged right ventricle D enlarged main PA

 Which contributes to posterior border of

mediastinum on lateral chest x ray A svc B ivc C main pulmonary artery D right atrium

 Which is seen in constrictive pericarditis A atrial collapse B globular venticles C dilation of ivc D left ventricle hypertrophy

 Diffuse subendocardial enhancement of the

left ventricle? A amylodosis B infarction C ischemia D assymetrical septal hypertrophy

 Regarding the sinus of the valsalva

aneurysms which is true A .rarely involve the left sinus B hypertension is the cause C rupture causes tamponade D majority are acquired

a Unruptured SVA is usually asymptomatic and is often detected serendipitously by routine 2dimensional echocardiography, even in patients older than 60 years. Most ruptured SVAs occur from puberty to age 30 years and are often diagnosed or presented clinically at this age. A retrospective review of an institutional database identified 86 patients who underwent SVA repair from 1956-2003 found the median age to be 45 years (range 5-80 y).6 Approximately 65-85% of SVAs originate from the right sinus of Valsalva, while SVAs originating from noncoronary (10-30%) and left sinuses (<5%) are exceedingly rare.2 Associated structural defects in congenital SVAs included supracristal or perimembranous ventricular septal defect (3060%), bicuspid aortic valve (15-20%) and aortic regurgitation (44-50%). Approximately 10% of patients with Marfan syndrome have some form of SVA. Less commonly observed anomalies include pulmonary stenosis, coarctation, and atrial septal defects Untreated SVAs may rupture, and patients with ruptured SVAs die of heart failure (with left-toright shunting) or endocarditis within 1 year after onset of symptoms of ruptured SVA.

 You are shown a Ct scan with presence of

osseous and cartilaginous nodules in the tracheobronchial tree. What is the diagnosis? A relapsing polychondritis B rhinoscleroma C Tracheobronchopathia osteochrondroplastica D wegeners granulomatosis

 Which is true regarding LCH A most of the are smokers B lower lobe predominates C well defined round cysts D proliferation of smooth muscle

 Organism involved with fibrosing

mediastinitis A histoplasmosis B actinomyces C treponema pallidum D coccidiodes immitis

 Which is true regarding the pleural effussion A split pleura sign is specific for empyema B lung cancer with malignant effusion is stage

3b C transudate effusion is seen in asbestosis related D cirrhosis has exudative effusion

 Which is true regarding kaposis A seen exclusively in iv drug abusers B gallium positive C imaging shows peribronchovascular

distribution D caused by HPV infection

 What is the average energy of 100kvp beam? A 10 kev B 20 kev C 40 kev D 80 kev

 ACR guidelines indicate the next step in

evaluation of chest pain and dissection? A chest x ray B Aortogram C mri chest D chest ct with iv contrast

 Regarding FAT embolism? A it occurs in 20% of long bone fractures B radiographically as wedge defects C patient with hypoxia,rash, AMS D low attenuation defects in the pulmonary

arteries

 A chest xray appears very dark on a PACS

station due to? A image processing failure B over exposure C underexposure D incorrect kvp selection

 What is true about lung nodules? A presence of calcification suggest benignity B transthoracic needle bx has greater the

90% diagnostic accuracy for all nodules C granulomas can be +ve on PET like malignant nodules D doubling time of <1month higly suggests cancer

 C Lung nodule doubling time ranges from 15

days to 450 days

 What is true about bronchogenic cysts? A low signal on T1 and T2 MR images B well defined subcarinal mass C demonstrates enhancement on iv contrast D more common in the left lower lobe

 Regarding retinoblastoma? A calcifications are seen in 30% B hereditary form is unilateral and unifocal C Autosomal dominant D trilateral form is associated with

neuroectodermal pineal tumors

D There are two forms of the disease; a genetic, heritable form and a non-genetic, non-heritable form. Approximately 55% of children with Rb have the nongenetic form. If there is no history of the disease within the family, the disease is labelled "sporadic", but this does not necessarily indicate that it is the nongenetic form. In about two thirds of cases,[2] only one eye is affected (unilateral retinoblastoma); in the other third, tumours develop in both eyes (bilateral retinoblastoma). The number and size of tumours on each eye may vary. In certain cases, the pineal gland is also affected (trilateral retinoblastoma). The position, size and quantity of tumours are considered when choosing the type of treatment for the disease. Genetic forms of retinoblastomas are more likely to be bilateral; in addition, they may be associated with pinealoblastoma (also known as trilateral retinoblastoma) with a dismal outcome.[5] The genetic codes found in chromosomes control the way in which cells grow and develop within the body.[7] There are hereditary and nonhereditary forms of retinoblastoma. Twothirds of patients with retinoblastoma have a sporadic postzygotic somatic mutation, 20%25% have a sporadic germ line mutation, and the remaining 5% 10% have the autosomal-dominant familial type

 MR shows sacrococcygeal tumor extending

mostly outside the patient. This would be considered as ? A type 1 B type 2 C type 3 D type 4

B Altman type I entirely outside, sometimes attached to the body only by a narrow stalk Altman type II mostly outside Altman type III mostly inside Altman type IV entirely inside; this is also known as a presacral teratoma or retrorectal teratoma The Altman type is significant in the contexts of management of labor and delivery, surgical approach, and complications of SCT. Serial ultrasound and MRI monitoring of SCTs in fetuses in utero has demonstrated that the Altman type can change over time. As the tumor grows, it can push between other organs and through the perineum to the body surface where the tumor appears as a bulge covered only by skin. Sometimes, the tumor bulge later slips back inside the perineum. Like all teratomas, a sacrococcygeal teratoma has the potential to be malignant, and the standard of care requires long-term followup by an oncologist.

 A 7 yr old with limp, most likely diagnosis? A Development hip dysplasia B leukemia C legg-perthes D child abuse

 In crossed fused renal ectopia, what is true? A two orthotopic ureteral orifices B left ureteral orifice is ectopic C right ureteral orifice if ectopic D bladder has one orifice

 Most effective strategy to reduce pediatric

dose? A tube current modulation B using low pitch values C using smooth reconstruction algorythm D using high KVP

 Regarding holoprosencephaly? A septum pellucidum is absent in all forms B interhemispheric fissure is absent in all

forms C In semilobar kind only genu is present D cyclopia is associated with lobar kind

A On CT scan images, alobar holoprosencephaly results in a horseshoe-shaped monoventricle, an absent interhemispheric fissure, fused thalami, an absent falx, agenesis of the corpus callosum, an absent septum pellucidum, and absent olfactory bulbs. Semilobar holoprosencephaly is characterized by partial ventricular differentiation but with a single ventricular cavity, a partial interhemispheric fissure and falx (posterior-ventral axis), partial or incomplete formation of the corpus callosum, and a variable degree of thalamic fusion. The olfactory bulbs are often absent. The abnormality is more severe anteriorly, with partial cleavage and lateral differentiation occurring posteriorly. In these individuals, the posterior portion of the corpus callosum is present, and the more anterior portion, where failure of cleavage has occurred, is absent. Lobar holoprosencephaly occurs with partial fusion of the frontal lobe with an otherwise normally formed interhemispheric fissure, lateral ventricular formation, variable and incomplete absence of the anterior corpus callosum and/or septum pellucidum, and separate thalami. The olfactory tracts are present

 Regarding NF 1 which is true? A 3 or more criteria are needed for diagnosis B long bones are not involved C axillary freckling is seen frequently in young D a single neurofibroma is pathognomic

C NF1 is present in a patient who has two or more of the following signs: Six or more caf-au-lait macules > 5 mm in greatest diameter in prepubertal individuals or > 15 mm in greatest diameter after puberty. Two or more neurofibromas of any type or one or more plexiform neurofibromas. Freckling in the axilla or inguinal region. A tumor of the optic pathway. Two or more Lisch nodules. A distinct osseous lesion, such as sphenoid wing dysplasia or thinning of the cortex of the long bones (with or without pseudoarthrosis). A first-degree relative (parent, sibling, offspring) with NF1 by the above criteria.

 Which of the following indicated CHD? A 50% coverage of femoral head by

acetabular roof B . alpha angle of 50 C anterior motion of head on stress D very thin pulvinar

 B An angle of 60 or greater indicates

acetabular maturity. Coverage of 58% or greater is considered normal.

 Which of the following develops in

progressive skeletal changes aftr 1st yr of life A Achondrogenesis B morquios C Thanatophoric dysplasia D jeunes syndrome

B Patients with Morquio's syndrome appear healthy at birth. They often present with spinal deformity, there is growth retardation or genu valgus in the second or third year of life. Short stature (flat vertebrae cause a short trunk), short neck Moderate kyphosis or scoliosis Mild pectus carinatum (pigeon chest) Cervical spine: odontoid hypoplasia, atlanto-axial instability; may be associated with myelopathy with gradual loss of walking ability Joint laxity, mild dysostosis multiplex, dysplastic hips, large unstable knees, large elbows and wrists, and flat feet The combined abnormalities usually result in a duck-waddling gait Mid-face hypoplasia and mandibular protrusion Thin teeth enamel Corneal clouding Mild hepatosplenomegaly

 MR of fetus relies heavily on? A GRE B SSFSE C STIR D Echoplanar

 Regarding congenital adrenal hyperplasia.

What is true? A common is 11 bet hydroxylase deficiency B elevation of serum cortisiol C inherited as autosomal dominant D can present with life threatening salt wasting crisis

Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands (steroidogenesis).[1] Most of these conditions involve excessive or deficient production of sex steroids and can alter development of primary or secondary sex characteristics in some affected infants, children, or adults.[2] Only a small minority of people with CAH can be said to have an intersex condition, but this attracted American public attention in the late 1990s and many accounts of varying accuracy have appeared in the popular media. Approximately 95% of cases of CAH are due to 21-hydroxylase deficiency. The symptoms of CAH vary depending upon the form of CAH and the gender of the patient. Symptoms can include: Due to inadequate mineralocorticoids: vomiting due to salt-wasting leading to dehydration and death Due to excess mineralocorticoids: hypertension (11beta[OH] deficiency) Due to excess androgens: ambiguous genitalia, in some females, such that it can be initially difficult to determine sex

early pubic hair and rapid growth in childhood

precocious puberty or failure of puberty to occur (sexual infantilism: absent or delayed puberty) excessive facial hair, virilization, and/or menstrual irregularity in adolescence infertility due to anovulation Cortisol is an adrenal steroid hormone that is required for normal endocrine function. Production begins in the second month of fetal life. Poor cortisol production is a hallmark of most forms of CAH. Inefficient cortisol production results in rising levels of ACTH, which in turn induces overgrowth (hyperplasia) and overactivity of the steroid-producing cells of the adrenal cortex. The defects causing adrenal hyperplasia are congenital (i.e., present at birth).

 Most likely consequence from radiation

exposure of 10msv to fetus during 2-8weeks gestation A prenatal death B microcephaly C childhood cancer D heart disease

 Which of these needs surveillance imaging

due to high risk for wilms? A WAGR syndrome B glomerunephritis C horseshoe D infants of DM mothers

 Which is true regarding renal scarring A does not occur in absence of reflux B can cause htn C most common in boys D older children greater risk

 Regarding sequestration what is true? A sequestered lung communicates with

bronchial tree B extra lobar is associated with multiple anomalies C majority are extra lobar D intra lobar drains via azygous system

Intrapulmonary sequestration occurs within the visceral pleura of normal lung tissue. Usually, no communication with the tracheobronchial tree occurs. The most common location is in the posterior basal segment, and nearly two thirds of pulmonary sequestrations appear in the left lung. Venous drainage is usually via the pulmonary veins.4 Foregut communication is very rare, and associated anomalies are uncommon. Extrapulmonary sequestration is completely enclosed in its own pleural sac. It may occur above, within, or below the diaphragm, and nearly all appear on the left side. No communication with the tracheobronchial tree occurs. Venous drainage is usually via the systemic venous system. Foregut communication and associated anomalies, such as diaphragmatic hernia, are more common. Intrapulmonary sequestrations are the most common form, and 60% of these are found in the posterior basal segment of the left lower lobe. Overall, 98% occur in the lower lobes. Bilateral involvement is uncommon. About 10% of cases may be associated with other congenital anomalies.6 A case of intrapulmonary sequestration associated with a bronchogenic cyst has been reported.7 Extrapulmonary sequestrations occur on the left in 95% of cases. Of these, 75% are found in the costophrenic sulcus on the left side. They may also be found in the mediastinum, pericardium, and within or below the diaphragm. They are associated with other congenital malformations in more than 50% of cases, such as congenital diaphragmatic hernias, congenital cystic adenomatoid malformation (CCAM) type II (hybrid lesions), and congenital heart disease.

 In PJ syndrome, what is true? A stomach polyps are the most common B increased risk of malignancy C most patients are symptomatic in 1st

decade D adenomatous polyps are common

b
Gastrointestinal polyps are the most problematic aspect of PJ.

The polyps are called hamartomas. They often are multiple and usually occur in the small intestine. Less commonly they are found in the colon and stomach. Most PJ patients will experience abdominal pain due to polyps in the small intestine. The polyps can also cause an intestinal blockage, called an obstruction or intussusception. Half of Peutz-Jeghers patients have the onset of symptoms and many have needed surgery due to a bowel blockage by the age of 20. Recent studies have documented that a patient with PJ has an increased risk of cancer. The cancers can occur within the intestinal tract. Tumors may occur in other areas of the body also. These include unusual tumors of the reproductive system in men (testicles) and women (ovaries) called SCTAT (sex cord tumors with annular tubules). Breast, pancreas, cervix and thyroid malignancies occur more commonly in PJ patients than in the general population.

 Mortons neuroma is secondary to? A congential deformity B compression neuropathy C crystal deposition D benign neoplasia

 Regarding pvns ? A there is a focal and diffuse form B shoulder is commonly involved C radical excision with joint replcaement is

preffered D commonly present with hemorrhagic effusion

Pigmented villonodular synovitis, described distinctly in 1941 by Charles J. Sutro, L. Lichtenstein, and H.L. Jafe,[1] comes in two forms: localized and diffuse. Diffuse PVNS affects the entire synovium and typically occurs in large joints such as the knee or hip. Localized, or nodular, PVNS is less common than the diffuse form and typically occurs in smaller joints such as the hands and feet. Localised PVNS often arises in the form of a large benign tumour on the tendon sheaths of the joint.[2] As the tumor grows in the joint, it damages the surrounding bone and tissues.[3] Localized PVNS is predominantly found in females and is frequently found in the fingers. Although rare, localized PVNS may develop in large joints. In either case, the knee is the most commonly affected joint (80% of cases), followed by the hip, and less commonly the ankles and shoulders.[2] PVNS is generally found more in men than women.[4] 2 cases per million population; incidence of the localized form is 9 cases per million. In general, pigmented villonodular synovitis often manifests initially as sudden onset, unexplained joint swelling and pain; the joint swelling is disproportionate to the amount of pain the patient feels at first. Decreased motion and increased pain occur as the disorder progresses as well as locking of the joint. The localized form often manifests initially as a painless, slow-growing mass and progresses to the other common symptoms of PVNS. The swelling often feels warm to the touch.[2] Diffuse PVNS symptoms are often confused with those of Rheumatoid arthritis.[3] While pigmented villonodular synovitis can occur in both pediatric and geriatric patients, it is more common with ages 2050.[2

 Regarding de quervians tenosynovitis? A imaging is essential B u/s shows edema of the extensor carpi

ulnaris tendon C condition common in women 30-50 yr d May lead to palmar fibromatosis

De Quervain syndrome (French pronunciation: [d kv] ; also known as washerwoman's sprain, Radial styloid tenosynovitis, de Quervain disease, de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis or mother's wrist), is an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.[1] The two tendons concerned are the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. These two muscles, which run side by side, have almost the same function: the movement of the thumb away from the hand in the plane of the handso called radial abduction (as opposed to movement of the thumb away from the hand, out of the plane of the hand (palmar abduction)). The tendons run, as do all of the tendons passing the wrist, in synovial sheaths, which contain them and allow them to exercise their function whatever the position of the wrist. Evaluation of histological specimens shows a thickening and myxoid degeneration consistent with a chronic degenerative process.[3] The pathology is identical in de Quervain seen in new mothers.[4] De Quervain is potentially more common in women; the speculative rationale for this is that women have a greater styloid process angle of the radius

 Regarding rupture of ACL? A more common in men B avulsion of ant tibial spine may occur C mostly associated with bone contusions D mostly associated with segonds

 Concerning AS which is commonly involved A hip B shoulder C ankle D knee

 which one of the following conditions is

associated with joint space widening of the adult hip? A effusion B PVNS C RA D acromegaly

 Which one of the following is feature of

synovial chondromatosis and pvns? Calcification Hemorrhage Neoplasia inflammation

 Which is not a complication of osteoid

osteoma A overgrowth B malignant transformation C synovitis D OA

 Associated with compression neuropathy of

median nerve? A ligament of osborne B ligament of struthers C anconeus epitrochlearis D arcade of frohse

- Anconeus epitrochlearis - anomalous muscle which arises from medial border of olecranon & adjacent triceps & inserts into the medial epicondyle; - may be found in about of 10% patients undergoing cubital tunnel release; - it crosses ulnar nerve posterior to the cubital tunnel, and may cause ulnar neuritis Arcade of Struthers Positioned in the anterior compartment of thearm, the ligament is a tendinous band extending from an anomalous spur, the supracondylar process, located 3 to5 cm above the medial epicondyle in 1% of limbs [33], to the junction of the medial epicondylar ridge with the medialepicondyle. The median nerve and usually the ulnar artery pass through this fibro-osseous tunnel. Sometimes, theligament of Struthers can be associated with a high median nerve entrapment syndrome. Cubital tunnel (FCU Aponeurosis) - roof of cubital tunnel is formed by aponeurosic attachment of 2 heads of FCU, which spans in arcade like manner from medial epicondyle of humerus to the olecranon process of the ulna (also known as Osborne's ligament); - cubital tunnel begins where the ulnar nerve passes beneath Osborne's ligament; - aponeurosis of origin of the flexor carpi ulnaris;

Arcade of Frohse, (radio tunel synndrome) sometimes called the supinator arch, is the most superior part of the superficial layer of the supinator muscle, and is a fibrous arch over the posterior interosseous nerve. The arcade of Frohse is the most frequent site of posterior interosseous nerve entrapment, and is believed to play a role in causing progressive paralysis of the posterior interosseous nerve, both with and without injury

 Concerning soft tissue sarcomas? A Liposarcoma has a charecteristic MR

appearance B synovial sarcoma is mostly intrarticular mass in the knee C myxoid subtypes may appear cystic D MFH is rare in adults

 When all others are held constant during mri

acquisition, SNR will be increased by A decrease phase encoding steps B decrease slice thickness C Increasing TE D Decreasing BW

where the constant K includes hardware dependent factors such as coil, pre-amp and noise power spectrum, field strength dependent factors, and pulse sequence type parameters (TR, TE etc), and tissue dependent parameters (spin density, T1, T2). This expands to for 2D SNR where K is a constant, FOVx and FOVy are the field-of-view in the x and y directions, Nx and Ny are the number of frequency and phase encoding steps, z is the slice thickness, NEX is the number of signal averages, and BW is the receive bandwidth. If your SNR gets to be above 20:1, any further increase is not likely to produce a benefit to the observer. In this case, you'd be better off making savings in the scan time or increasing the matrix size instead. SNR proportional = 1/ square root of BW

 Concering chondroblasromas? A MR imaging shows marrow edema B lesions are metaphyseal prior to closure of

plate C middle age individuals are effected D calcification is rare

 A In contrast to chondroblastomas, the signal intensities of

enchondromas, osteochondromas, and well-differentiated osteosarcomas tend to be high on T2-weighted images. Clear cell chondrosarcomas, however, show characteristics similar to those of chondroblastomas, and the signal intensity on T2-weighted images varies with the cellularity of the tumor and the extent of the adjacent inflammatory change. The adjacent inflammatory changes, not seen with standard radiography or CT scans, are usually hyperintense on T2-weighted MRIs. This adjacent signal-intensity abnormality may be misleading because its extent is discordant with the radiographic appearance. When such discordance is encountered, the radiographic findings should be the basis for the diagnosis.

 Concerning melorheostosis? A asymptomatic B AD transmission C effects older adults D associated with endosteal hyperostosis

This disease was described by Leri and Joanny in 1922. It is a rare, non-hereditary lesion. It is usually apparent in early childhood and even in the first few days of life. About 50% of persons affected will develop the symptoms by 20 years of age. Adults generally complain of pain, joint stiffness, and progressive deformity. In children the condition affects mainly the bones of the extremities and pelvis, and may result in limb length inequality, deformity, or joint contractures. Joint contractures may be accompanied by extraosseous bone formation. The classic radiographic appearance is that of sclerotic lesions of bones that look like wax dripping down the side of a candle. The clinical course is slowly progressive. Severe symptoms may require treatment by sympathectomy or even amputation. It is usually apparent in early childhood and even in the first few days of life. About 50% of persons affected will develop the symptoms by 20 years of age. It is apparent in both sexes. With an estimated incidence of 0.9 cases per million persons, it can be calculated that there are approximately 1,000,000 to 1,500,000 persons with meloreostosis currently alive. However, only about 300 cases have been reported in the literature.

 Transient hyperattenuation difference is seen

in A SVC syndrome B liver laceration C Regenerating nodule D focal fatty sparing

 Connection between middle colic and the left

colic arteries? A Arc of riolan B arc of buhler C arc of Barkow C Drummond arteries

The arc of Buhler is a persistent embryologic connection between the coeliac artery and superior mesenteric artery. It travels vertically, ventral to the abdominal aorta. It is present in 1-3% of individuals and provides a collateral pathway between the two vascular territories

The marginal artery of Drummond is also known as the marginal artery of the colon.The anastomoses of the terminal branches of the ileocolic, right colic and middle colic arteries of the SMA, and of the left colic and sigmoid branches of the IMA, form a continuous arterial circle or arcade along the inner border of the colon known as the marginal artery of Drummond
Arc of Barkow: Greater omental arcade: collateral between spleenic,hepatic,SMA and epiploics Rio Branco: The pancreaticoduodenal arcades; Buhler: The anastomosis between Celiac and SMA; Riolan: The anastomosis between middle colic artery and left colic artery; Villemin: The direct anastomosis between Superior mesenteric artery and IMA; Drummond: The peripheral anastomosis between the branches of superior mesenteric artery and IMA

Buhler is a persistent embryologic connection between the coeliac artery and superior mesenteric artery.

 Regarding UAE for rx of adenomyosis A procedure is different from fibroid

emboization B dose to varies is 5-10mgy C success depends on presence of fibroids D effective for symptomatic relief

 d Uterine artery embolization is a promising

nonsurgical alternative for patients with menorrhagia and adenomyosis. Significant improvement in presenting symptoms and in quality of life is associated with decreases in uterine size and junctional zone thickness. Larger prospective studies are needed to establish the safety and efficacy of this procedure for patients with adenomyosis.

AJR

 Occlusion of which of these arteries results in

severe mobidity A SFA B GDA C Right hepatic D Inferior epigastirc

 Which is true regarding Trans jugular liver bx A left jugular vein is accessed B contraindicated if ascites C lower incidence of post bx hemorhage D tissue sample next to IVC are obtained

 Advantage of surgically placed endogenous

AV fistula for dialysis A longevity B pt comfort C ease of insertion D immediate use after placement

 Exchange of nephrostomy tubes every? A 2 weeks B 3-4 weeks C 2-3 mon D not unless a problem

 Peritovenous shunt is used for A CHF B Chronic renal failure C refractory ascites D hydrocephalus

 Carotid doppler reports ICA stenosis is 50-

69%. What parameter is reduced? A Pressure B diameter C crosectional area of artery D flow velocity

 The annual permissible effective dose

equivalent for worker in us A 1 msv B 5msv c 10 msv D 50 msv

 In a patient with AVN of the hip first test A MRI B cross table x rays C bone sacan D AP pelvis

 According to ACGME imparting cost

awareness in patient care is part of A system based approach B professionalism C communication skills D practice learning and improvement E medical knowledge

 Which of the following tools of ACGME best

describes or represents the residents ability A reliability B validity C formative evaluation D summative evaluation

 Concerning HIPPA which of the following

requires written authorization prior to disclosing of information A treatment payment and operations B marketing and fundraising activities C cadaveric organ donations D specific research activity with IRB waiver

 ROC curve is straight line? What best

describes? A area under the curve is 1 B perfect imaging modality C poor imaging modality D threshold criteria were high

 ACR guidelines with regard to pregnant and young women with ionizing radiation state that A informed consent for imaging with radiation should be obtained in patients who r pregnant B negative pregnancy test would allow tech to forgo standard screening procedures for

pregnancy C a screening policy which will detect 100% pregnancies should be developed D majority of the diagnostic tests deliver 20mgy dose to uterus

 In a middle aged patient with suspected rib

fracture, next best step? A CT chest B PA chest C Rib views D U/s chest E bone scan

 CPT code? A Current procedural and terminology codes B critical policy and treatment codes C CT processing and trauma codes D Clinical patient and technology codes

 ACR guideline for screening and diagnostic mammography A Diagnostic mammogram should be done under supervision of a qualified under MQSA B Asymptomatic women should get screening mammogram from 40 to 80 yr C Breast implant patiets are not candidates for screening and need diagnostic D Screening mammogram can be done on a symptomatic patient if she has not seen her

physician for 6 months

 ACR use of information technology is a part

of what competency A system based approach B professionalism C communication skills D practice learning and improvement E medical knowledge

 Post menopausal lady with bleeding what is

the next step? A MRI B CT C US pelvis D US hysterosonogram

 ACR code of ethics states that A Member should understand limitations and

take consults appropriately B report illegal or unethical conduct only to ACR body C Disclose limitations to physicians not to patients D Physician who has not personally interpreted a scan cannot take attribution of an interpretation made by another physician

 Legal basis for action filed against any person

who submits a claim to the federal gov that he or she should know, is incorrect is called the : A deficit reduction act B starks law C False claims act D Whistleblower reward act

c
Stark 2 law prohibits self referals Deficit reduction act-The Act saves nearly $40 billion

over five years from mandatory spending programs through slowing the growth in spending for Medicare and Medicaid, changing student loan formulas, and other measures. Whistle blower reward act-

 Pharmaceutical charge generated from IV

contrast use from a single vial, whats appropiate A entire amount with in the container B only the amount utilized C Average amount single amount based on protocol

 70 yr old woman with rapidly progressive

decline in cognitive function and myoclonic jerks. MRI FLAIR shows bilateral symmetrical high signal in basal ganglia and thalamus A Deep vein thrombosis B CJD C HIE encephalopathy D Bilateral MCA infarcts

 Soft tissue material in the posterior and

superior aspect of the eadrum A congenital type B acquired type C G tympanicum D Acute otitis media

b
There are two types: congenital and acquired. Acquired cholesteatomas, which are more

common, can be caused by a tear or retraction of the ear drum. Less commonly the disease may be congenital, when it grows from birth behind the eardrum. Congenital cholesteatomas are more often found in the anterior aspect of the ear drum, in contrast to acquired cholesteatomas that usually arise from the pars flaccida region of the ear drum in the posterior-superior aspect of the ear drum.

 condition in which the cerebral hemispheres

are absent and replaced by sacs filled with CSF A Alobar holoproencepahly B Severe hydrocephalus C Open lip schizencephaly D Hydranencephaly

 Moyamoya ? A children tend to present with SAH and IVH B Cervical carotid stenosis and occlusion is

common C Lenticulo striate often occlude over time D Associated with Sickle cell

 Regarding IAC schwannoma A most common after meningioma as cp

angle mass B If bilateral as part of NF1 C most common cause of sensory neural hearing loss unilaterally D arise in the cochlear segment

 Regarding mets to brain? A difficult to identify cortical mets on T2 so

contrast needed B seen in deep white matter C As solitary in <10% cases D scant vasogenic edema

 Advantage for 0.625mm instead 1.25

thickness A higher z axis resolution B decrease beam hardening C decreased radiation D more anatomy covered per tube rotation

 What is likely to cause widening of disc space A sickle cell B CPPD C Osteromyelitis and discitis D osteoarthropathy neuropathica

 A Biconvex disc spaces with H shaped vertebra

 Pick the true statement regarding acute

infarction A non enhanced ct does not show changes in first 6 hr B variable window settings in pacs allow detection of early edema C enhancement occurs in first 3 days D mass effect in 7-10 days

 Acute fracture secondary to osteoporosis

whats the best sequence? A t2 B STIR C DWI D T1 FSE

 Atrophy of this structure is seen with

huntingtons A spinal cord B Substantia nigra C Globus pallidus D caudate

 Tb of spine involves A body B meninges C disc

 Polymicrogyria is seen with A cmv B toxo C hsv 2 D rubella

 A pathogenesis of polymicrogyria is still mysterious. It

is known that intrauterine cytomegalovirus infections can cause PMG. However, it is also known that genetic causes do exist for polymicrogyria. Several familial cases of PMG could be X-linked. In certain families, only males are affected whereas in others, males are more severly affected than females. Others pedigrees suggest autosomal dominant or autosomal recessive inheritance. Thus, it seems that polymicrogyria is genetically heterogeneous.

 A 24 hr iodine 123 scan in a patient with

hyperthyroidism shows increased focal uptake , her 24 hr uptake is likely A 5% B 15% C 30% D 60%

C Normal Results Normal Results 6 hours: 3 - 16% 24 hours: 8 - 25% Note: Some laboratories only measure at 24 hours. Values may vary depending on the amount of iodine in your diet. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

 Prior to administration of Y90 for treatment

of HCC, patient underwent the following ? A Tc99mm MAA injection via the right HA B Tc99 MAA via common HA C TC99 sulphur colloid via right HA D Tc 99m sulphur colloid via common

 FDG pet performed in patient with h/o

treated thyroid cancer and thyroidectomy. Why was the PET done A routine 1 yr follow up B Initial staging of medullar cancer C follow on focal findings on I131 scan D Negative I131 and raising thyroglobulin levels

 On DISIDA scan which is associated with

chronic cholecystitis A delayed blood pool B Increase renal excretion C prolonged biliary to bowel transit D rim sign

 Timing for I 131 scan after treatment with I

131 in patient with thyroid cancer. A Immediately after treatement B 5-7 days C 3 months post rx D 24 hr post rx

 NRC regulations indicate safe exposure level

after radio I131 rx ? A 1 msv B 3 msv C 5 msv D 7 msv

 A women after a PET scan can breast feed

after A 12 hr B 24 hr C 48 hr D no need to stop

 Increase axillar uptake after a Bone scan due

to ? A metastatic disease B melanoma C extravasation at injection site D Intra arterial injection

 Regarding Ga 67 scan? A superior fort discitis B In111 wbc is superior for chronic osteo C Tc99 bone scan is superior to both with

underlying post surgical changes D False positive are less common with In111 wbc imaging

 Regarding v/q scan which is associated with

higher likely hood for acute PE A triple match in upper lobes B triple match in lower lobes C whole lung v/q match with normal chest x ray D perfusion defect with pleural effusion

 Best imagin for reducing artifactual cardiac

PET perfusion defects from breast A Tc99 sestamibi SPECT B Dual isotope thallium 201/Tc99 sestamibi SPECT C F 18 FDG pet D rubidium PET

 WHO reccomends the following is diagnostic

for osteoporosis Z score < 2.5 B Z score <-2.5 C T score <2.5 D T score < -2.5

 radiochemical impurity in TC 99 labeled

pharmaceuticals ? A determined by ratio of Mo-99 to Tc 99m in generator eluate B Determined by amount of Allumina in the eluate C Thin layer chromatography is used D Caloric spot test is done

 Seizures and radiopharmaceutical uptake

during interictal A focal area of increased perfusion B focal area of decreased perfusion C Focal area of increase FDG uptake on PET D Crossed cerebellar diaschisis on FDG PET

end - 2010

2009

 35 yr old with functioning adenoma, I131 dose

? A 2 mci B 10 mci C 25 mci D 100 mci

 A woman received 10mci of 131 for graves 3

weeks and was found to be pregnant later and currently 7 weeks pregnant. You should A recommend abortion as her fetus will be hypothyroid B recommend abortion because risk of leukemia increased by 50% C no action necessary D administer 130mg of KI to block fetal thyroid

c
Thyroid embryogenesis is largely completed by 1012-

week gestation. At 10-week gestation, the thyroid gland is able to trap and concentrate iodine and synthesize thyroid hormones thyroxine and triiodothyronine [6]. Iodine, including radioactive isotopes, is readily transferred across the placenta [7]. After 10-week gestation, significant exposure to the fetal thyroid can occur from therapeutic doses to the mother, resulting in hypothyroidism and cretinism [8]. There have been no reports of birth defects or childhood malignancy in children born to the mothers who received radioactive iodine for Graves disease before the 10th week of pregnancy [9]. We believe the infants thyroid gland was not affected by the I-131 therapy because he was exposed prior to 10-week gestation.

 In patients with thyroid cancer which of the

following is used in conjunction with I131 ablation to detect recurrent disease? A T4 B TSH C Thyroglobulin D Thyroid peroxide antibody

 Which of the following is used for renal

scarring A DTPA B DMSA C MAG3 D glucoheptonate

 With regard to v/q scan the ventilation

portion of the study is to increase? A sensitivity B specificity C NPV D Reproducibility

 In MUGA scan which of the following is done

to increase seperation of LV from LA A LAO 70 deg B RAO 45 deg C 30 deg cephalic D 10 deg caudal

 abcd

 With regard to radio rx with zevalin for

lymphoma A contraindicated if prior chemotherapy B contraindicated if prior ritumiximab rx C contraindicated with PLT <100000 D B cell histology is a contraindication

 According to NRC the following needs written

authorization A 5mci of 131 B 100mci of 123 C 25mci if Tc MDP

 Which one of the following will result in

increased focal uptake in FDG PET of lung A hamrtoma B calcified granuloma C lung abscess D av malformation

 Tc 99 m MDP scan shows increase uptake in

the stomach and thyroid due to? A chemical impurity B radiochemical impurity C radionuclide impurity D biological impurity

 60yr old with progressive dementia and

incontinence /gait disturbance should be imaged by? A F 18 PET B In 111 DTPA C Tc HMPOA D Tc 99m DTPA

 Which of the following ligaments border

supraspinatus outlet? A coraco acromial B coraco humeral C superior glenohumera D coracoclavicular

 Which of the following causes supraspinatus

atrophy? A quadrilateral space mass B supracondylar process C spinoglenoid notch D suprascapular notch ganglion cyst

 Which of the following is stable A bankart B GLAD glenoid labrum articular disruption C perthes D Humeral avulsion gleno humeral ligament

(HAGL)

 Concering ABC whats true? A gaint cell tumor is common associated

neoplasm B Thick sclerosis at margin of lesion C preexisting lesion in 75% case D primary lesion is epiphyseal

 A Metaphyseal lesion with thin sclerotic rim

 Concerning pagets whats true? A incidence is 10% among elderly >80 yr B monostotic is more common than

polyostotic C secondary sarcomas are low grade D does not occur in bones formed by intramembranous ossification

a
Prevalence of Paget's disease ranges from 1.5

to 8.0 percent, depending on age and country of residence. Sarcomas are high grade and pagets can occur in any bone. Polyostotic is more common

 Concerning soft tissue hemangiomas which is

true? A phleboliths are seen equally with MRI and CT B Intralesional fat is seen well with MRI/CT C Bone involvement is a sign of malignancy D lesion decreases in size during pregnancy

 Concerning bone marrow which is true A hematopoietic active marrow is 5% fat B conversion begins in metaphysis C epiphyssis and apophysis are active

through out life D residual red marrow is common in proximal and distal femurs

d
During infancy red marrow occupies the entire ossified

skeleton except for epiphyses and aphophyses. Gradually red marrow 'retreats' centrally, such that by adulthood it is essentially confined to the axial skeleton (pelvis, spine, shoulder girdle, skull). Frequently the proximal humeri and neck of femurs have residual red marrow2. Hematopoietically active bone marrow is referred to as hematopoietic marrow or red marrow. Red marrow contains approximately 40% water, 40% fat, and 20% protein. Hematopoietically inactive marrow is referred to as yellow marrow or fatty marrow. It contains approximately 15% water, 80% fat, and 5% protein.

 Regarding stress fracture? Whats true? A edema is seen in marrow,periosteal surface

and adjacent soft tissues B bone marrow edema is less prominent on water sensitive images than T1 C a hypointensive line is early finding D lack of Gad enhancement

 Uniform joint space narrowing is

charecteristic of ? A OA B RA C CPPD D PVNS

 Concerning CPPD deposition whats correct? A flexor carpi ulnaris is comonly involved B It commonly involves the burs C Associated with tumoral calcinosis D does not occur in joint

Calcium pyrophosphate dihydrate crystal deposition disease mainly affects middle aged and elderly people, with a female preponderance (5). Pseudogout most often involves the knee and less commonly the wrist or ankle with the sudden onset of severe pain, swelling and redness (6). However tophaceous pseudogout is common in the temporomandibular joint. Calcium pyrophosphate dihydrate crystal deposition disease is known to be associated with hyperparathyroidism, hypoparathyroidism, hemochromatosis and hemosiderosis (7). The clinical features that should alert one to the likelihood of CPPD arthropathy include the following: an unusually severe or destructive arthropathy, a history of other joint involvement or of a previous joint operation, clinical evidence or a history of a disorder known to be associated CPPD and a family history of joint disease. There may also be evidence of chondrocalcinosis or other distinctive radiological signs of CPPD (3). Our patient was an elderly male who presented with symptoms of osteoarthritis with no other associated clinical conditions. Approximately 20% of the patients with CPPD calcium pyrophosphate dihydrate have hyperuricaemia and some have coexistent gout. Though clinically CPPD crystal deposition disease mimics various arthropathies the gross and histological features are characteristic. Grossly, the chalky white deposits on the synovial villi produce an appearance which can be likened to snow covered whiskers (3). Pseudogout exhibits nodular deposits of CPPD crystals which are similar to tophaceous gout and tumoral calcinosis. The CPPD crystals range in size from 2 to 40 micrometres. They are pleomorphic and are mostly rhomboid shaped,although long or short rods and small squares are also seen (8),(9). However, the sheaf like arrangement is never observed,which distinguishs them from sodium urate crystals. Unlike urate crystals, CPPD crystals are retained in tissues after fixation with formaldehyde and after processing with alcohol. By polarized light microscopy, these crystals are found to have weaker birefringence in contrast to the stronger birefringence of urate crystals. The calcified material in tumoral calcinosis is amorphous granular and lacks crystalline material. The exact nature of these crystals can be determined by radiographical diffraction or electron probe analysis

 Concering loosers zones which is correct A associated with pagets B usually unilateral C considered stress related D progress to completer fractures

 Which of the following pulse sequences is

shortest A gre B spin echo C STIR D Inversion recovery

 Regarding SLE arthopathy A similar to Jaccods arthopathy B Deforming and erosive C Charecterised by soft tissue calcifications D very uncommon manifestation of SLE

 Concerning AS which is true A Anterio corner osteitis is hallmark of

disease B it is most common in children C ossification predominates in ALL D Erosion occur early at the ilium side

Imaging Findings for Ankylosing spondylitis Radiograph indistinct joints joints widen before narrow

subchondral erosions, sclerosis, and proliferation on iliac side of SI joints

at endstage, sacroiliac joint may be a thin line or not visible in the spine, early spondylitis is characterized by small erosions at the corners of vertebral bodies with reactive sclerosis squaring of the vertebral body syndesmophyte formation, with bridging of the corners of one vertebra to another ossification of paravertebral connective tissue fibers, including posterior interspinous ligaments as well as linking of spinous processes leads to an appearance of a solid midline vertical dense line on AP projection may see associated pseudoarthroses (discovertebral destruction with adjacent sclerosis) and enthesopathic changes (ill-defined erosions with adjacent sclerosis at sites of ligamentous and tendenous attachments) hip involvement is generally bilateral and symmetric, with uniform joint space narrowing, axial migration of the femoral head, and a collar of osteophytes at the femoral head-neck junction knees demonstrate uniform joint space narrowing with bony proliferation hands are generally involved asymmetrically, with smaller, shallower erosions and marginal periostitis.

radiographs of the lungs may demonstrate progressive fibrosis and bullous changes at the apices. These lesions may resemble TB infection and bullae may become infected.

 Regarding acquired cholesteatomas? Whats

true A pars tensa type are common B middle ear ossicles are displaces laterally in par flacida type C scutum is blunted in pars tensa type D A fistula to sermicircular canal includes the lateral segment

 D Pars flaccida Is more common and pushes the

ossicles more medially Pars flaccida blunts the scutum

 Laryngocele arises from what anatomic

structure? A larygeal ventricle B true vocal cords C false cords D arytenoid cartilages

 Images from MR are suffering from motion ?

Which of the following sequences reduces Involuntary motion ? A FlAIR B STIR C FSE D EPI

d
A good cooperation between the patient and the operator is the

best way to avoid these artifacts, in difficult cases a sedative may help. If a compliance of the patient is not possible (e.g. pain, stroke, or consciousness), choose fast scan methods like gradient echo or single shot technique. See also Motion Artifact and Phase Encoded Motion Artifact. (EPI Factor) The imaging speed in Echo Planar Imaging (EPI) depends on many factors. Single shot EPI should provide images within 100 ms or less. Because of this limitations, a multi shot EPI approach is in most cases preferred. The parameter 'EPI Factor' is used to specify the number of k-space profiles collected per excitation. The EPI factor 64 means a measurement time 64 times faster than a normal gradient echo sequence. See also Echo Planar Imaging.

 Which of the following causes decreased

signal intensity in vertebral body T 1 sequence A spinal radiation B Mets C Type 2 modic changes D hemangioma

 B Type II - the most common type Increased signal on T1, and isointense or

slightly hyperintense signal on T2. Represents fatty degeneration of subchondral marrow. Associated with a chronic process. Histological examination shows endplate disruption with yellow marrow replacement in the adjacent vertebral body. Type I changes convert to Type II changes with time, while Type II changes seem to remain stable.

 Which of the following is abnormal finding in

lumbar myelography? A contrast collection pooling in the posterior spinal canal on lateral view B gradual visualization of nerve roots of cauda equina C free flow of contrast from needle tip D clear flow of csf from hub

 Which of the following is a characteristic

benign osteoporotic compression fracture A convex bulge involving the posterior convex of vertebral body B complete or near complete replacement of marrow with decreased signal on T1 C Band like focus of increased t2 weighted and decreased t1 weighted signal adjacent to endplate D a large epidural mass

c
C - describes modic type 1 changes of enplate

 Which one of the following is true regarding

Tarlov cysts A freely communicate with subarachnoid space B mostly occur in thoracic spine C wall contain only arachnoid matter D may produce symptoms

 Which of the following arises from intradural

internal carotid A opthalmic B trigeminal C vidian D meningohypophyseal artery

 Which is true with regard to vein of galen aneurysm A present with Ataxia in adult hood B females are commonly effected C 1/3 patients has osler weber rendu syndrome D fistulous variety results from persistant embryonic median prosencephalic vein of morkowski E Arteriovenous malformation variety is more common

 Which of the following is a superficial

intracranial draining vein? A Basal vein of rosenthal B Internal cerebral vein C vein of trolad D vein of Galen E Thalamostriate vein

 Which is true regarding artery of

Adamkiewicz? A supplies posterior spinal cord B enters spinal canal from left side C arises from supreme intercostal artery D visualized by catheter angiography not CT or MRA E hairpin turn on this indicates mass effect

typically arises from a left posterior intercostal artery, which branches from the aorta, and supplies the lower two thirds of the spinal cord via the anterior spinal artery The Spinal Cord vasculature, has a complex and highly variable anatomy[8]. In a study of approximately 70 people that examined the spinal cord's blood supply it was found that[7]: The Adamkiewicz artery sometimes arises from a lumbar vessel. In approximately 30% of people it arises from the right side. One quarter of people have two large anterior segmental medullary arteries. In 75% of people, the artery of Adamkiewicz originates on the left side of the aorta between the T9 and T11 vertebral segments[9]. In a extensive literature review, recognition of the AKA using CT and/or MR was achieved in 466 of 555 cases (83.96%)and in 384 (83.3%) cases the AKA originated from a left intercostal artery[10]. A video showing the Adamkiewicz artery can be seen here: AKA finding using OsiriX [edit] Clinical significance

"Great radicular artery of Adamkiewicz ... provides the major blood supply to the lumbar and sacral cord." [11]
When damaged or obstructed, it can result in anterior spinal artery syndrome,[12] with loss of urinary and fecal continence and impaired motor function of the legs; sensory function is often preserved to a degree. It is important to identify the location of the artery when treating a thoracic aortic aneurysm or a thoraco-abdominal aortic aneurysm.[13] Its location can be identified with computed tomographic angiography

 Which of the following you would expect to

find 1 hr after cerebral artery occlusion on CT perfusion scan? A decrease time to peak B increase CBV C decreased CBF D decreased MTT

 What is the location of obstruction to csf flow

in communicating hydrocephalus A arachnoid granulation B cerebral aqueduct C 4th ventricle D foramen of monroe

 What MRI sequence is most sensitive to acute

SAH AT 1 B T2 C FLAIR D DWI

 Which is true regarding warthins tumor A usually malignanr B most common neoplasm of parotids C bilateral 10% D present as painful masses

 What is the most likely etiology for

calcifications noted on scout KUB and tomogram performed as part of excretory urogram on a 54 yr old woman complaining of flank pain. A hypercalcemia B chronic glomerulonephritis C acute cortical necrosis D hyperoxaluria

 What is the most common cause for addison

disease? A granulomatous disease B adrenal gland infarction C adrenal hemorrhage D autoimmune disorders

 Concerning ureterocele what is true? A simple ureterocele is focal dilation of the

mucosal portion of the distal ureter B an ectopic ureterocele is almost always associated with lower pole moiety C majority of the ectopic ureteroceles are associated with reflux of the associated moiety D A pseudoureterocele can be caused by impacted or recently passed stone.

 In a patient with a previously documented contrast reaction, what is true? A pretreatment of patient with steroids is a well established effective in preventing contrast reactions B iv steroids given an hour before is effective in

preventing reactions C may be beneficial to use different contrast agent then the kind he reacted previously to D adequate hydration can prevent significant reaction

 What is the most common cause for papillary

necrosis? A CIN B renal vein thrombosis C analgesic abuse D DM

 Regarding trauma to urinary tract, whats

true? A most renal injuries are major and require surgery B intraperitoneal bladder rupture is common then extraperitoneal C type 3 urethral injury there is extravasation into perinieum D extraperitoneal bladder rupture is surgical case

C classification system of Goldman et al (6) is as follows: Type I injury: The posterior urethra is stretched and elongated but intact. The prostate and bladder apex are displaced superiorly due to disruption of the puboprostatic ligaments and resulting hematoma. Type II injury: Disruption of the urethra occurs above the urogenital diaphragm (UGD) in the prostatic segment. The membranous urethra is intact. Type III injury: The membranous urethra is disrupted with extension of injury to the proximal bulbous urethra and/or disruption of the UGD. Type IV injury: Bladder neck injury with extension into the proximal urethra. Type IVA injury: Injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury. Type V injury: Partial or complete pure anterior urethral injury.

 Diagnosis of renal hypoplasia is made by? A a decrease in number of normal

morphology calyces B absent function C decrease in number of abnormal morphology calyces D bilateral process

 Concerning urachus whats true? A a patent urachus is more common in

females B failure of closure in any part of urachal duct results in urachal cyst C closure of urachus at bladder attachment results in urachocele D urachus arises from bladder base

 Concering undescending testis? A often larger than normal testis B not subject to torsion C higher incidence in premature infants D most commonly found in abdomen

 Concerining unicornuate uterus? What is true A rarely associated with redumentary horn B more common than septate C strong association with renal anamolies D rarely requires surgical intervention

 Concerning renal cortical neoplasms? Whats

true? A clear cell is the most common type B papillary has worse prognosis compared to clear cell C Vhl is responsible for minority of cases of renal cell carcinoma D chromophobe RCc has worse prognosis

 A Most common is clear cell, papillary has

better prognosis than clear cell, chromophobe type has better prognosis VHL causes clear cell subtype

 Concerning ovarian malignancy whats true A most commonly detected in early stages B CA 125 is effective screening tool C most common cell type is germ cell D commonly presents as a complex cystic

mass

 Which part of prostate is most commonly

involved in BPH A peripheral B central C transition D fibromuscular zone

 Most common cause of multiple strictures in

bulbous urethra in a young man A TB B Gonococcal C post trauma D iatrogenic

 Concerning hemangiomas on u/s liver A typically associated with enlarged hepatic

artery with increased flow due to shunt B homogenous and hyperechoic with acoustic shadowin C increased flow on doppler u/s d larger lesion may be heterogenous due to presence of scar or thrombosis

 In real time u/s how is lateral resolution

effected with decrease In depth and same frame rate A remains same B improves C degrades D not enough information

 Regarding regarding normal renal anatomy,

whats true? A medullary pyramids are echogenic compared to cortex in adults B kidneys are fixed in position C collumn of bertin does not contain pyramids D right kidney Is smaller than left.

 Concerning hyperechogenicity of fetal bowel

what is true A considered significantly hyperechoiec if greater than liver B pathognomic of cystic fibrosis C no association with aneuploidy D increased risk of IUGR

Fetal echogenic bowel refers to increased echogenicity or brightness of the fetal bowel noted on second trimester sonographic examination (picture 1AB). Hyperechogenicity can be diffuse or focal, is uniform over a well-defined area that does not shadow, and is located primarily in the lower fetal abdomen and pelvis. Various criteria for diagnosis of bowel echogenicity have been suggested. The simplest criteria, and the one that we use, is echogenicity similar to or greater than that of adjacent bone with the ultrasound gain set to the lowest point at which bone appears white [1]. The iliac wing is the usual standard for comparison. Some authors have defined grades of echogenicity, with the most severe form (grade 3) being as bright as bone, while grades 1 and 2 are mildly or moderately echogenic [2]. Transducer frequency is important when considering the diagnosis of echogenic bowel. Higher frequency transducers can make the differentiation between normal and abnormal bowel echogenicity difficult, leading to overdiagnosis of the latter. As an example, a study using both 8 and 5 MHz transducers sequentially on the same fetuses found the frequency of echogenic bowel was 31 and 3 percent, respectively [3]. For this reason, we only diagnose echogenic bowel when using a transducer frequency of 5 MHz or below. As discussed above, echogenicity similar to or greater than adjacent bone is a subjective determination, therefore prone to interobserver and intraobserver variability [4].

 How is anencephaly is diagnosed on ultrasound? A diagnosed in second trimester with absence of

telencephalon and cranial vault B diagnosed in first trimester as absence of fetal head with rudimentary skull base C diagnosed in first trimester by complete absence of fetal brain but presence of cranial vault D diagnosed in 2nd trimester by presence of cranial vault but absence of rhombocephalon

 Concerning massive ovarian edema, which is

correct A predominantly effect s post menopausal B likely secondary to intermittent torsion of ovary C resolves with medical rx with beta blocker D felt to be a precursor for epithelial tumors

 Which is true regarding the Gamma Gandy

bodies in spleen A they occur only in spleen B appear echogenic foci on u/s C demonstrate increased vascularity on doppler D donot contain calcifications

 Regarding ultrasound evaluation of

hemodialysis access graft, whats true A stenosis occurs along the arterial anastomosis B hemodialysis grafts mature slower than native AV grafts C wave form with in graft is high resistance D peak velocity ranges from 100-400cm/sec

 Concerning adenomyosis of the uterus which

one is true? A adenomyosis cannot be diagnosed on ultrasound B myometrial cysts are caused by dilated glands in the ectopic endometrial tissue C diagnosed with well defined myometrial masses D adenomyosis and fibroids rarely coexist

 Regarding u/s of a 38 yr old G0P0 woman who

has been married for 5 yr with bilateral enlarged ovaries with multiple anechoic cyst and moderate amount of abdominal fluid. The right ovary 7x8x8 cm left ovary 9x8x8 which one is likely diagnosis A hyperstimulation syndrome B PCOD C ovarian mets D endometriomas

 Regarding sonographic dx of liver mass which is

true? A diagnosis of hemangioma should be raised only in the presence of well defined echogenic mass B FNH is easily detected on gray scale U/s based on hypoehoic scar with in the lesion C diagnosis of cholangiogram should be raised if both right and left ductal system is dilated centrally D presence of hypoechoic rim around a hepatic mass increases the likely hood of lesion being benign

 Right gonadal vein is normally a tributary of

what other vein A ivc B renal vein C iliac vein D portal vein

 Which of the following options has the

largest impact in reducing the dose to patient during CT fluroscopy A Reducing the fov B reducing ma C partial gantry rotation D increasing scan time

 Rutherford and fontaine staging are useful for

what clinical condition? A PAD B venous insufficiency C encephalopathy D osteomalacia

a
The Rutherford categories are a severity classification scale

for PAD that can be used to evaluate clinical improvement. Symptomatic improvement is an upward shift of at least 1 category, for example, from category 2, moderate claudication, to category 1, mild claudication. However, a patient in category 5 or 6, indicating actual loss of tissue, cannot be deemed to show clinical improvement unless the upward change is at least to stage 3, indicating claudication but no resting ischemic pain. The Fontaine stages are a classification system similar to the Rutherford categories that can also be used to monitor therapeutic interventions. Change in the ABI can be used as an objective measure of improvement.

 Concerning TACE and Rf ablation for HCC

what is true? A RF will control disease locally but not prolong life B TACE is no better the chemo in prolonging survival C TACE followed RF is contraindicated D TACE followed by RF will prolong survival

 Er requests nephrostomy in transplant

kidney what is true? A procedure is easy to perform B procedure can be done but probably complicated C put pt In prone position D procedure is contraindicated

 A emergency IR procedure is indicated and

you discover that the patient has HIT, what action should u take A transfuse platelets B transfuse FFP C vit k D do the procedure

 Tumescent anaesthesia is used for A saphaneous vein reflux B dyspareunia C priapism D conscious sedation

a
Tumescent anesthesia is technique for delivery of local anesthesia that maximizes safety by

using pharmacokinetic principles to achieve extensive regional anesthesia of skin and subcutaneous tissue.[1] The subcutaneous infiltration of a large volume of very dilute lidocaine and epinephrine causes the targeted tissue to become swollen and firm, or tumescent, and permits procedures to be performed on patients without subjecting them to the inherent risks of local anesthesia and blood loss

 What is the primary x ray interaction for

fluoroscopy of iodine filled vessels A rayleigh scatter B compton scatter C PE effect D pair production

 Concerning of f label use of FDA approved

devices? Whats true A it criminal misconduct B its medical malpractise C requires IRB D may be standard of care

 Which is true in magnification mode? A increased FOV decreased resolution and

increased dose B increased FOV decreased resolution and decreased dose C decreased FOV decreased resolution and decreased dose D increased FOV increased resolution and increased dose

 What is the diameter of 3 french picc line? A 1mm B 3mm C 5mm D 10mm

 Which of the arteries is most medially located

in leg? A ATA B PTA C peroneal

 Carotid arteries are evaluated by doppler by

CABG . A peak systolic velocity 312cm/sec measured in left carotid indicates A 15-49% B 50-69% C 70-99% D obstruction

 By which day most GMH appear in premature A day 1 B Day 21 C day 7 D day 4