Angiographic Anatomy — MCQs
Superior vena cava develops from?
The "string of beads or sausage appearance" of the renal artery is due to:
All of the following arteries are branches of ECA that supply nasal septum except:
Which one of the following is the most preferred route to perform cerebral angiography?
A cerebral angiogram shows stenosis of the terminal internal carotid arteries with an abnormal network of collateral vessels. Which finding is most characteristic of moyamoya syndrome?
The tributaries of the inferior vena cava include all of the following, except:
Investigation of choice for vascular ring around airway:
A child presents with respiratory distress. A vascular ring is suspected. Investigation of choice is -
What is the Investigation of Choice (IOC) for Acute Aortic Dissection?
Which of the following statements about the umbilical cord is incorrect?
Angiographic Anatomy Indian Medical PG Practice Questions and MCQs
Question 1: Superior vena cava develops from?
- A. Right anterior cardinal vein (Correct Answer)
- B. Left anterior cardinal vein
- C. Left common cardinal vein
- D. Right subcardinal vein
Explanation: Right anterior cardinal vein - The superior vena cava (SVC) forms from the right anterior cardinal vein and the common cardinal vein. - The right anterior cardinal vein directly contributes to the upper portion of the SVC. Left anterior cardinal vein - The left anterior cardinal vein typically regresses or becomes minor tributaries like the left SVC (if persistent) or the coronary sinus. - It does not form the main superior vena cava. Left common cardinal vein - The left common cardinal vein forms the coronary sinus and an oblique vein of the left atrium. - While major vessels drain into it, it does not directly form the superior vena cava. Right subcardinal vein - The right subcardinal vein is primarily involved in the development of the inferior vena cava (IVC), particularly its renal segment. - It does not contribute to the formation of the superior vena cava.
Question 2: The "string of beads or sausage appearance" of the renal artery is due to:
- A. Subadventitial fibrosis
- B. Fibromuscular dysplasia (Correct Answer)
- C. Outercoat fibrosis with aneurysms
- D. Medial fibroplasia with aneurysms
Explanation: ***Fibromuscular dysplasia*** - This is the **general term** for a group of non-atherosclerotic, non-inflammatory arterial diseases that cause the classic **"string of beads"** or **"sausage appearance"** on angiography - The most commonly affected artery is the **renal artery** (60-75% of cases), but it can also involve carotid, vertebral, and other arteries [1] - While **medial fibroplasia** (a subtype of FMD) is the specific histologic type most commonly responsible, the broader term **fibromuscular dysplasia** is the accepted answer as it encompasses the disease entity - The string of beads results from **alternating areas of stenosis and aneurysmal dilatation** in the arterial wall [1] *Subadventitial fibrosis* - This refers to fibrosis in the **subadventitial layer** (between media and adventitia) of the arterial wall - This is actually a rare subtype of FMD but does not typically produce the prominent string of beads appearance - Represents <1% of FMD cases *Medial fibroplasia with aneurysms* - This is the **most common histologic subtype** of fibromuscular dysplasia (60-80% of cases) and is indeed the specific type that produces the string of beads appearance - While this is the most accurate specific diagnosis, in the context of this question, **fibromuscular dysplasia** is the preferred answer as it represents the disease category - Affects the **media layer** with alternating areas of thinned media (causing aneurysms) and fibromuscular ridges (causing stenosis) *Outercoat fibrosis with aneurysms* - Refers to **perimetric or periadventitial fibrosis**, rare subtypes of FMD affecting the outer arterial layers - These subtypes typically cause **smooth stenosis** rather than the beaded appearance - Account for <10% of FMD cases combined **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 510-511.
Question 3: All of the following arteries are branches of ECA that supply nasal septum except:
- A. Facial artery
- B. Superior labial artery
- C. Anterior ethmoidal artery (Correct Answer)
- D. Sphenopalatine artery
Explanation: ***Anterior ethmoidal artery*** - The **anterior ethmoidal artery** is a branch of the **ophthalmic artery**, which itself is a branch of the **internal carotid artery (ICA)**, not the external carotid artery (ECA). - It supplies the **upper anterior nasal septum** and lateral wall of the nasal cavity. *Facial artery* - The **facial artery** is a direct branch of the **external carotid artery (ECA)**. - It contributes to the blood supply of the nasal septum through its septal branches. *Superior labial artery* - The **superior labial artery** is a branch of the **facial artery**, meaning it indirectly originates from the **external carotid artery (ECA)**. - It sends a septal branch to supply the **anterior inferior part of the nasal septum**. *Sphenopalatine artery* - The **sphenopalatine artery** is a direct terminal branch of the **maxillary artery**, which is one of the terminal branches of the **external carotid artery (ECA)**. - It is the major blood supply to the **posterior nasal septum** and lateral wall, forming part of Kesselbach's plexus.
Question 4: Which one of the following is the most preferred route to perform cerebral angiography?
- A. Direct carotid puncture
- B. Transaxillary route
- C. Transfemoral route (Correct Answer)
- D. Transbrachial route
Explanation: **Transfemoral route (Correct Answer)** - The **transfemoral** route is the **most preferred** and widely used method for cerebral angiography due to its **safety**, ease of access, and lower complication rates. - It allows for the safe cannulation of **cerebral vessels** using a catheter inserted into the **femoral artery** and advanced up to the aortic arch. - This is the **gold standard approach** (Seldinger technique) for diagnostic and interventional cerebral angiography. *Direct carotid puncture (Incorrect)* - This method is more invasive and carries a higher risk of complications, such as **hematoma**, **stroke**, or **carotid artery dissection**. - It is typically reserved for cases where other routes are inaccessible or when very specific and localized imaging is required. - Largely of **historical significance** now that safer endovascular techniques are available. *Transaxillary route (Incorrect)* - The **transaxillary** route is an alternative but carries a higher risk of complications like **brachial plexus injury** and **bleeding** compared to the transfemoral approach. - It may be considered when the femoral access is not feasible, for example, in patients with severe peripheral vascular disease affecting the femoral arteries. *Transbrachial route (Incorrect)* - The **transbrachial** (or **transradial**) route is also an alternative but is generally less preferred due to the risk of **radial or brachial artery spasm** or damage, and it can be technically more challenging. - This route is typically avoided if possible, especially when the transfemoral route is readily available and safe. - May be considered in patients with severe aortoiliac disease or morbid obesity.
Question 5: A cerebral angiogram shows stenosis of the terminal internal carotid arteries with an abnormal network of collateral vessels. Which finding is most characteristic of moyamoya syndrome?
- A. Corkscrew vessels
- B. Serpentine collaterals
- C. Spider vessels
- D. Lenticulostriate collaterals (Correct Answer)
Explanation: ***Lenticulostriate collaterals*** - Moyamoya syndrome is characterized by **stenosis or occlusion of the supraclinoid internal carotid arteries** and the development of an abnormal network of collateral vessels, particularly the **lenticulostriate arteries**, to compensate for decreased blood flow. - These collaterals appear as a "puff of smoke" or **"moyamoya" vessels** on angiography, which are distinct from the "string of beads" typically seen in fibromuscular dysplasia. *Corkscrew vessels* - **Corkscrew vessels** are not typically associated with Moyamoya syndrome but are more characteristic of other conditions like **vasculitis** or **atherosclerosis** in some contexts. - This term usually describes tortuous and dilated vessels, which differ from the specific collateral development in Moyamoya. *Serpentine collaterals* - While Moyamoya involves collateral formation, the term **"serpentine collaterals"** is a general description for tortuous vessels and not specific to the unique pathology or anatomical location of collaterals in Moyamoya. - The distinctive feature of Moyamoya is the involvement and hypertrophy of small, deep collaterals such as the lenticulostriate arteries. *Spider vessels* - **Spider vessels** (telangiectasias or spider angiomas) are cutaneous findings associated with conditions like **hepatic cirrhosis** or hereditary hemorrhagic telangiectasia, not a cerebral angiographic sign of Moyamoya syndrome. - This term refers to superficial vascular lesions composed of a central arteriole surrounded by radiating capillaries.
Question 6: The tributaries of the inferior vena cava include all of the following, except:
- A. Left renal vein
- B. Left gonadal vein (Correct Answer)
- C. Hepatic vein
- D. Right suprarenal vein
Explanation: ***Left gonadal vein*** - The **left gonadal vein** (either testicular or ovarian) drains into the **left renal vein** before reaching the inferior vena cava. - It is **NOT a direct tributary** of the IVC, which is why it is the correct answer to this "except" question. - This anatomical arrangement distinguishes it from the **right gonadal vein**, which drains directly into the IVC. *Left renal vein* - The **left renal vein** is a **direct and major tributary** of the inferior vena cava (IVC). - It receives blood from the **left gonadal vein** and the **left suprarenal vein** before emptying into the IVC. [1] - This vein crosses anterior to the aorta to reach the IVC. *Hepatic vein* - The **hepatic veins** (typically three major veins: right, middle, and left) drain blood from the liver **directly into the IVC**. - They are essential for returning filtered blood from the liver to the systemic circulation. [2] - These veins have a very short course before entering the IVC just below the diaphragm. *Right suprarenal vein* - The **right suprarenal vein** drains **directly into the IVC**, similar to the right gonadal vein. [3] - In contrast, the **left suprarenal vein** drains into the left renal vein (indirect tributary), following the same asymmetric pattern as the gonadal veins.
Question 7: Investigation of choice for vascular ring around airway:
- A. PET
- B. Catheter directed angiography
- C. MRI
- D. CT (Correct Answer)
Explanation: ***CT*** - **CT angiography (CTA)** is the **investigation of choice** for diagnosing vascular rings due to its ability to provide detailed anatomical visualization of the great vessels and their relationship to the trachea and esophagus. - It offers high spatial resolution, allowing precise identification of the type of vascular anomaly, the degree of **airway and esophageal compression**, and guiding surgical planning. *PET* - **PET scans** are primarily used for assessing **metabolic activity**, particularly in oncology or to evaluate organ function, and do not provide sufficient anatomical detail for vascular rings. - While it can detect metabolically active lesions, it is **not suitable** for visualizing the structural abnormalities of blood vessels and their compressive effects on the airway. *Catheter directed angiography* - **Catheter-directed angiography** is an **invasive procedure** involving radiation and contrast, primarily used for assessing blood flow dynamics, identifying stenosis, or guiding interventions. - While it can visualize vessels, CTA is **less invasive**, provides comparable or superior anatomical detail for vascular rings, and is generally preferred for initial diagnosis. *MRI* - **MRI** can provide good soft tissue contrast and visualize vascular structures without radiation, but it is often **less readily available** and can be more challenging for pediatric patients due to the need for sedation and longer scan times. - For comprehensive anatomical detail including bone and calcifications, and in patients who might struggle with breath-holding, **CT angiography** often offers clearer and more consistent images of complex vascular anatomy.
Question 8: A child presents with respiratory distress. A vascular ring is suspected. Investigation of choice is -
- A. Angiography
- B. MRI (Correct Answer)
- C. CT
- D. PET
Explanation: ***MRI/MRA*** - **Magnetic Resonance Imaging (MRI) with MR Angiography** provides excellent visualization of the **aortic arch** and its branches without ionizing radiation, making it ideal for pediatric patients with suspected **vascular rings**. - MRI clearly delineates **vascular anatomy, tracheal and esophageal compression**, confirming the diagnosis and guiding surgical planning. - Particularly preferred when **radiation-free imaging** is prioritized in children. *CT Angiography* - **CT Angiography (CTA) with 3D reconstruction** provides excellent vascular imaging and is widely used for vascular ring diagnosis in many centers. - **Advantage**: Faster acquisition time, less need for sedation, excellent anatomical detail with 3D reconstruction. - **Disadvantage**: Involves **ionizing radiation** exposure, which is a concern in pediatric patients when equally diagnostic radiation-free alternatives exist. - Both MRI and CTA are considered appropriate first-line investigations; choice depends on institutional expertise and clinical context. *Conventional Angiography* - **Catheter angiography** is invasive, involves radiation, and has been largely replaced by non-invasive cross-sectional imaging (MRI/CT). - May be reserved for cases requiring intervention or when non-invasive imaging is inconclusive. *PET* - **Positron Emission Tomography (PET)** detects metabolic activity and is used for cancer or inflammation, not for **anatomical vascular anomalies**. - Not indicated for vascular ring diagnosis.
Question 9: What is the Investigation of Choice (IOC) for Acute Aortic Dissection?
- A. USG
- B. Doppler
- C. CT-Angio (Correct Answer)
- D. MR-Angio
Explanation: ***CT-angio*** - **Computed tomography angiography (CTA)** is considered the **gold standard** imaging modality for diagnosing acute aortic dissection due to its rapid acquisition, wide availability, and excellent visualization of the aorta and its branches. - It precisely demonstrates the **intimal flap**, true and false lumens, and assesses the extent of the dissection and involvement of major branch vessels. *Usg* - **Ultrasound (USG)**, specifically **transesophageal echocardiography (TEE)**, is highly sensitive and specific for proximal aortic dissections. - However, its utility is operator-dependent and it has limitations in visualizing the entire aorta, especially the distal descending aorta. *Doppler* - **Doppler ultrasound** is used to assess blood flow velocity and patterns within vessels. - While it can detect flow disturbances, it is not the primary imaging modality for diagnosing the anatomical extent and characteristics of an aortic dissection flap. *Mr-Angio* - **Magnetic resonance angiography (MRA)** provides excellent soft tissue contrast, no radiation exposure, and detailed anatomical information for aortic dissection. - However, it is often less accessible, time-consuming, and contraindicated in patients with certain metallic implants or claustrophobia, making it less ideal for an acute emergency setting compared to CTA.
Question 10: Which of the following statements about the umbilical cord is incorrect?
- A. Two arteries and one vein
- B. Contains Wharton's jelly
- C. Typically 50 to 60 cm long
- D. Two veins and one artery (Correct Answer)
Explanation: ***Two veins and one artery*** - This statement is incorrect because the typical umbilical cord contains **two umbilical arteries** and **one umbilical vein**. - **Two veins and one artery** would represent a rare anomaly, often associated with other congenital malformations. *Two arteries and one vein* - This is the **normal anatomical configuration** of the umbilical cord, consisting of **two umbilical arteries** and **one umbilical vein**. - The arteries carry deoxygenated blood and waste products from the fetus to the placenta, while the vein carries oxygenated blood and nutrients from the placenta to the fetus. *Contains Wharton's jelly* - **Wharton's jelly** is a gelatinous substance found within the umbilical cord, surrounding the blood vessels. - Its primary function is to protect the umbilical vessels from compression and knotting, ensuring continuous blood flow. *Typically 50 to 60 cm long* - The average length of a term umbilical cord is indeed between **50 and 60 centimeters**. - Variations in length can occur, with excessively short or long cords potentially leading to obstetric complications.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free