Radiographic Anatomy — MCQs
Digital radiography differs from conventional in
Best imaging modality for acute pulmonary embolism
Which of the following conditions characteristically causes bilateral hypertranslucency of lung fields on chest X-ray?
"String of beads" appearance on horizontal abdominal view X-ray is suggestive of:
Which Salter-Harris fracture type involves a metaphyseal fragment?
The following are direct signs of lung collapse seen on a chest X-ray, which one of the following is NOT a direct sign?
Thumb print sign in a plain X-ray is seen in:
Which of the following features is used to identify the colon on an X-ray?
The right border of the heart in a chest X-ray is formed by which of the following?
In a radiograph of suspected non-accidental injury, which of the following fractures is LEAST specific for child abuse?
Radiographic Anatomy Indian Medical PG Practice Questions and MCQs
Question 1: Digital radiography differs from conventional in
- A. X-rays are not required for imaging
- B. Images cannot be printed
- C. Radiation receptors are different (Correct Answer)
- D. Uses radiation other than X-rays
Explanation: ***Radiation receptors are different*** - Digital radiography uses **digital sensors** (e.g., CCD, CMOS, flat panel detectors) or **photostimulable phosphor plates** (PSP) to capture the X-ray image directly, unlike conventional radiography which uses film. - This fundamental difference in **receptor technology** allows for immediate image display, digital storage, and post-processing capabilities. *X-rays are not required for imaging* - Digital radiography is still a form of **X-ray imaging**; it uses X-rays to penetrate the body and create an image. - The difference lies in how these X-rays are **detected and processed**, not in their absence. *Images cannot be printed* - Digital images can be easily **printed** if desired, although they are primarily viewed and stored digitally. - The ability to print allows for physical copies, but the main advantage is digital storage and sharing. *Uses radiation other than X-rays* - Digital radiography exclusively uses **X-radiation** to generate images. - Techniques like MRI use radiofrequency waves and magnetic fields, and ultrasound uses sound waves; these are distinct modalities, not digital radiography.
Question 2: Best imaging modality for acute pulmonary embolism
- A. V/Q scan
- B. CT pulmonary angiogram (Correct Answer)
- C. Chest X-ray
- D. MRI
Explanation: ***CT pulmonary angiogram*** - This is the **gold standard** imaging modality for diagnosing acute pulmonary embolism due to its high sensitivity and specificity in visualizing pulmonary arteries. - It rapidly provides detailed images of the pulmonary vasculature, allowing for direct visualization of **thrombi**. *V/Q scan* - A **V/Q scan** measures ventilation and perfusion of the lungs and is less definitive than CTPA, especially in patients with pre-existing lung disease. - It is often considered when **CTPA is contraindicated**, such as in cases of severe renal impairment or contrast allergy. *Chest X-ray* - A **chest X-ray** is generally used to rule out other causes of chest pain and shortness of breath, such as pneumonia or pneumothorax, rather than to diagnose PE directly. - It has **low sensitivity and specificity** for pulmonary embolism, as findings are often non-specific or normal even in the presence of PE. *MRI* - **Magnetic resonance angiography (MRA)** can be used, but it is typically reserved for patients who cannot undergo CTPA or V/Q scan due to contraindications like **pregnancy** or **renal failure**. - It often takes longer to perform and has lower spatial resolution compared to CTPA for pulmonary artery visualization.
Question 3: Which of the following conditions characteristically causes bilateral hypertranslucency of lung fields on chest X-ray?
- A. Mcleod syndrome
- B. Poland syndrome
- C. Emphysema (Correct Answer)
- D. Pneumothorax
Explanation: ***Correct: Emphysema*** - **Emphysema** causes destruction of alveolar walls, leading to enlarged air spaces and **air trapping**, making both lungs appear hypertranslucent on X-ray - This **bilateral hypertranslucency** is due to reduced lung tissue density, decreased vascular markings, and increased air volume - Classic radiographic features include flattened diaphragms, increased retrosternal space, and hyperlucent lung fields *Incorrect: Mcleod syndrome* - Also known as **Swyer–James–MacLeod syndrome**, this condition causes **unilateral** lung or lobe hyperlucency due to post-infectious obliterative bronchiolitis - The key differentiating feature is that it's **unilateral**, whereas the question asks for bilateral hypertranslucency - Affected lung shows air trapping on expiratory films *Incorrect: Pneumothorax* - A **pneumothorax** presents as a **unilateral** or focal hypertranslucent area due to air in the pleural space - Characterized by **absence of lung markings** beyond the visceral pleural line and associated lung collapse - This is a pleural space abnormality, not a bilateral parenchymal lung disease *Incorrect: Poland syndrome* - **Poland syndrome** is a congenital condition with absence or underdevelopment of the pectoralis major muscle - Can lead to **unilateral** apparent hyperlucency on the affected side due to missing chest wall muscle - This is a **chest wall anomaly**, not a parenchymal lung disease causing bilateral hypertranslucency
Question 4: "String of beads" appearance on horizontal abdominal view X-ray is suggestive of:
- A. Intussusception
- B. Sigmoid volvulus
- C. Small bowel obstruction (Correct Answer)
- D. Large bowel obstruction
Explanation: ***Small bowel obstruction*** - A "string of beads" appearance on a horizontal abdominal view X-ray refers to small gas bubbles trapped between the valvulae conniventes in a dilated small bowel loop. - This finding is highly suggestive of **complete small bowel obstruction**, particularly when accompanied by multiple air-fluid levels and dilated bowel loops. *Intussusception* - While it causes obstruction, intussusception usually appears as a **target sign** (doughnut sign) on ultrasound or a **meniscus sign** on barium enema, not a string of beads on plain X-ray. - Plain X-rays may show signs of **bowel obstruction**, but the string of beads is not characteristic. *Sigmoid volvulus* - Sigmoid volvulus is characterized by a **dilated loop of colon** forming an inverted U-shape, often described as a **coffee bean sign** or **omega sign**, on plain X-ray. - This involves the large bowel, and the "string of beads" specifically relates to gas in the small bowel. *Large bowel obstruction* - Large bowel obstruction typically presents with a **dilated colon** proximal to the obstruction and a collapsed distal colon, often with absent or minimal gas in the rectum and sigmoid. - While air-fluid levels can be present, the "string of beads" is a specific sign of gas within dilated small bowel loops, distinguishing it from most large bowel obstructions.
Question 5: Which Salter-Harris fracture type involves a metaphyseal fragment?
- A. Type I
- B. Type II (Correct Answer)
- C. Type III
- D. Type IV
Explanation: **Type II** - **Type II Salter-Harris fractures** involve a fracture line that extends through the growth plate (physis) and then exits through the metaphysis, carrying a portion of the metaphysis with it. - This is the most common type of Salter-Harris fracture, characterized by the presence of a **metaphyseal fragment** attached to the epiphysis. *Type I* - **Type I Salter-Harris fractures** involve a complete separation of the epiphysis from the metaphysis through the physis, without any bone fracture. - There is no involvement of the metaphysis or epiphysis in the fracture line itself, making it difficult to detect on X-ray unless displacement is significant. *Type III* - **Type III Salter-Harris fractures** involve a fracture line that extends through the growth plate and then exits through the epiphysis, extending into the joint. - This type does not involve a metaphyseal fragment; instead, a portion of the **epiphysis is fractured**. *Type IV* - **Type IV Salter-Harris fractures** involve a fracture line that passes through the epiphysis, across the growth plate, and then through the metaphysis. - This type extends through all three components (epiphysis, physis, and metaphysis) as a single fracture line, but it does not specifically involve a detached metaphyseal fragment in the way Type II does.
Question 6: The following are direct signs of lung collapse seen on a chest X-ray, which one of the following is NOT a direct sign?
- A. Crowding of the vessels
- B. Loss of aeration
- C. Mediastinal shift (Correct Answer)
- D. Displacement of the fissure
Explanation: ***Mediastinal shift*** - While mediastinal shift can occur with lung collapse, it is an **indirect sign** caused by the volume loss in the affected hemithorax, pulling the mediastinum towards the collapsed lung. - Direct signs refer to changes observed *within* the collapsed lung tissue itself, such as increased density or displaced structures, whereas mediastinal shift is a secondary effect. *Crowding of the vessels* - This is a **direct sign** of lung collapse, as the pulmonary vessels become compacted due to the loss of lung volume. - The vessels appear closer together and more prominent in the area of collapse. *Loss of aeration* - This is a **direct sign** of lung collapse, as air is expelled or resorbed from the affected lung tissue, leading to increased opacity. - The collapsed lung appears denser and whiter on the X-ray compared to normally aerated lung. *Displacement of the fissure* - This is a **direct sign** of lung collapse, as the interlobar fissures are pulled towards the collapsed lobe due to volume loss. - The displacement of the fissure indicates the location and extent of the collapse.
Question 7: Thumb print sign in a plain X-ray is seen in:
- A. Ulcerative colitis
- B. Pseudomembranous colitis
- C. Appendicitis
- D. Ischemic colitis (Correct Answer)
Explanation: ***Ischemic colitis*** - The **thumbprint sign** on a plain X-ray or CT scan is characteristic of ischemic colitis, resulting from submucosal edema and hemorrhage. - This appearance is due to the thickened, edematous **haustral folds** projecting into the colonic lumen. *Ulcerative colitis* - While it affects the colon, classic imaging findings for ulcerative colitis include **loss of haustral folds** (lead pipe sign) and pseudopolyps, not the thumbprint sign. - **Toxic megacolon** is a severe complication, identifiable by colonic dilation and wall thickening, distinct from thumbprint sign. *Pseudomembranous colitis* - This condition is caused by *Clostridioides difficile* infection and typically manifests with **thickened, nodular colonic walls** or inflammatory pseudomembranes on imaging. - It does not typically present with the classic "thumbprint" appearance indicative of ischemic changes. *Appendicitis* - Appendicitis is an inflammation of the appendix, diagnosed usually by findings like a **dilated appendix** with surrounding fat stranding on imaging. - The imaging findings are localized to the right lower quadrant and do not involve diffuse colonic changes like the "thumbprint sign."
Question 8: Which of the following features is used to identify the colon on an X-ray?
- A. Haustra (Correct Answer)
- B. Valvulae conniventes
- C. String of beads sign
- D. More number of loops
Explanation: ***Haustra (Correct Answer)*** - **Haustra** are sacculations or pouches of the colon created by the uneven contraction of the **taeniae coli** - They are THE characteristic feature that helps distinguish the large bowel from the small bowel on an X-ray - These indentations typically do **not cross the entire width** of the bowel lumen, unlike the valvulae conniventes of the small intestine - Haustra appear as incomplete septations on plain radiographs *Valvulae conniventes (Incorrect)* - **Valvulae conniventes** (also known as plicae circulares) are large, circular folds of the **small intestine** mucosa that project into the lumen - They extend **completely across the lumen** of the small bowel, making them easily distinguishable from haustra which only partially traverse the colon - This is a feature of small bowel, not colon *String of beads sign (Incorrect)* - The "**string of beads sign**" is a **pathological radiographic finding** associated with small bowel obstruction - It refers to multiple small, gas-filled loops of small bowel stacked on top of each other, often with small pockets of fluid or air trapped between the folds, resembling beads on a string - This is not a normal anatomical feature used to identify the colon *More number of loops (Incorrect)* - The number of loops is **not a primary distinguishing feature** between the large and small bowel on an X-ray - While the small intestine generally has more convolutions or loops than the colon, this is a **less reliable and specific sign** compared to the presence of haustra - Haustra remain the gold standard feature for colon identification
Question 9: The right border of the heart in a chest X-ray is formed by which of the following?
- A. Right ventricle
- B. Pulmonary artery
- C. Right atrium (Correct Answer)
- D. Superior vena cava
Explanation: ***Right atrium*** - The **right atrium** forms the major portion of the heart's **right cardiac border** on a standard posteroanterior (PA) chest X-ray. - Its position allows it to be the most lateral structure on the right side of the heart silhouette. *Right ventricle* - The **right ventricle** primarily forms the **anterior surface** of the heart. - While it contributes to the anterior cardiac outline, it rarely forms the right border on a PA chest X-ray unless there is significant enlargement. *Pulmonary artery* - The **pulmonary artery** typically forms the **left upper cardiac border** in the region below the aortic knob. - It does not contribute to the right border of the heart. *Superior vena cava* - The **superior vena cava (SVC)** lies superior and medial to the right atrium. - It forms part of the **right superior mediastinal border**, but not the actual right border of the heart itself.
Question 10: In a radiograph of suspected non-accidental injury, which of the following fractures is LEAST specific for child abuse?
- A. Metaphysis corner fracture
- B. Costochondral & rib junction fracture
- C. Parietal bone fracture (Correct Answer)
- D. Sternal fracture
Explanation: ***Parietal bone fracture*** - While **parietal bone fractures** are commonly seen in both accidental and non-accidental pediatric head trauma, they are **less specific for child abuse** compared to the classic skeletal injuries listed below. - Isolated skull fractures, particularly **simple linear parietal fractures**, can result from accidental falls and require additional clinical context (age, mechanism, associated injuries) to determine if abuse is suspected. - Complex, multiple, or depressed skull fractures are more concerning, but a simple parietal fracture alone is less diagnostic than the pathognomonic fractures of NAI. *Metaphyseal corner fracture* - Also known as **"bucket handle"** or **"corner" fractures**, these are **highly specific and virtually pathognomonic** for **non-accidental injury** in infants and young children. - They result from violent **shaking, twisting, or pulling forces** applied to the extremities, causing avulsion at the metaphyseal-epiphyseal junction. - These fractures are rarely seen in accidental trauma. *Costochondral & rib junction fracture* - **Posterior rib fractures** and **costochondral junction fractures** are **highly specific for NAI** in infants. - They result from **anteroposterior chest compression** during forceful squeezing or gripping of the thorax. - Accidental rib fractures in children are rare due to chest wall elasticity, making these fractures particularly suspicious. *Sternal fracture* - **Sternal fractures** are extremely rare in children due to the **flexibility of the pediatric sternum** and chest wall. - Their presence, especially without a history of **severe high-impact trauma** (e.g., motor vehicle collision), is **highly suspicious for non-accidental injury**. - Often result from direct forceful blows or severe compression injuries.
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