UPSC-CMS 2014 — Radiology
2 Previous Year Questions with Answers & Explanations
In an unconscious patient with multiple injuries, what is the best and reliable modality for assessment of cervical spine injury?
An air fluid level with dilated oesophagus and “bird beak” appearance in a barium swallow is diagnostic of:
UPSC-CMS 2014 - Radiology UPSC-CMS Practice Questions and MCQs
Question 1: In an unconscious patient with multiple injuries, what is the best and reliable modality for assessment of cervical spine injury?
- A. MRI scan
- B. While doing CT scan of brain take extra cuts at the cervical spine region (Correct Answer)
- C. Full AP and lateral radiographs of spine
- D. Rely only on clinical examination
Explanation: **While doing CT scan of brain take extra cuts at the cervical spine region** - For an unconscious patient, **CT scan** is the most reliable and rapid method for assessing cervical spine injuries, especially in a trauma setting. It is highly sensitive for detecting **fractures** and **misalignments**. - Taking extra cuts during a brain CT is efficient and avoids additional patient movement or delay, providing crucial information for immediate management. *MRI scan* - **MRI** is excellent for soft tissue injuries (ligaments, discs, spinal cord), but it is time-consuming and often not immediately available in acute trauma settings, especially for an unstable patient. - While valuable, it is usually performed after initial stabilization and when neurological deficits are specifically suspected, not as the first-line assessment for bony injury in an acute, unstable trauma patient. *Full AP and lateral radiographs of spine* - **Plain radiographs** have significant limitations in visualizing all cervical spine structures, particularly the **C1-C2 junction** and the **cervicothoracic junction**, which can be obscured. - They have a lower sensitivity for detecting subtle fractures and ligament injuries compared to CT scans, and overlying structures can obscure important details. *Rely only on clinical examination* - In an **unconscious patient**, a reliable clinical examination for cervical spine injury is impossible due to the inability to assess pain, tenderness, or neurological function. - Relying solely on clinical examination in such a patient puts them at **significant risk** for further spinal cord injury if an unstable fracture is present and goes undetected.
Question 2: An air fluid level with dilated oesophagus and “bird beak” appearance in a barium swallow is diagnostic of:
- A. Carcinoma oesophagus
- B. Barrett's oesophagus
- C. Achalasia cardia (Correct Answer)
- D. Hiatus hernia
Explanation: ***Achalasia cardia*** - The classic radiographic features of achalasia on a barium swallow include a **dilated esophagus** with proximal food retention (leading to an **air-fluid level**) and a characteristic narrowing at the gastroesophageal junction, creating a **"bird-beak" appearance**. - This appearance is due to the failure of the lower esophageal sphincter to relax during swallowing, combined with absent esophageal peristalsis. *Carcinoma oesophagus* - Oesophageal carcinoma typically presents as an **irregular, constricting lesion** or a **filling defect** on barium swallow, often with mucosal irregularity or shelf-like margins, rather than a smooth "bird beak." - While it can cause dysphagia and possibly proximal dilation, the specific "bird beak" morphology is not characteristic of cancer. *Barrett's oesophagus* - Barrett's esophagus is a histological diagnosis involving **metaplastic changes** in the esophageal lining, usually due to chronic GERD. - It does not have a distinct radiographic appearance on barium swallow, though it might be associated with reflux changes or **ulcerations**, but not a "bird beak" sign. *Hiatus hernia* - Hiatus hernias are characterized by the **protrusion of a portion of the stomach into the chest cavity** through the esophageal hiatus of the diaphragm. - On a barium swallow, this appears as an **accumulation of barium above the diaphragm**, often with a wide opening at the esophagogastric junction, which is distinct from the narrowed "bird beak" of achalasia.