INI-CET 2017 - Radiology PYQs Practice Questions

Q: The digital subtraction angiography given below shows? (AIIMS Nov 2017)

Carotid-cavernous fistula. ***Carotid-cavernous fistula*** - The image shows early opacification of the **cavernous sinus** and cerebral veins (indicated by the arrow) directly from the internal carotid artery, which is characteristic of a carotid-cavernous fistula. - This high-flow shunt between the arterial and venous systems leads to venous congestion and often presents with **pulsatile exophthalmos**, chemosis, and ophthalmoplegia. *Intra-cranial pseudo-aneurysm* - A pseudo-aneurysm typically appears as a sac-like outpouching from an artery, lacking a true vessel wall, and would not show direct early venous filling. - Pseudo-aneurysms are often caused by **trauma** or infection and may present with signs of hemorrhage if ruptured. *Angiofibroma tumor blush* - An angiofibroma would appear as a **hypervascular mass** with a dense, persistent tumor blush on angiography, but it would not show early direct shunting into veins. - These tumors are typically found in the nasopharynx and present with symptoms like **epistaxis** and nasal obstruction. *Vein of Galen malformation* - A **Vein of Galen malformation** is a developmental anomaly involving an arteriovenous fistula that drains into a dilated median prosencephalic vein, often presenting in infants with high-output heart failure. - While it is an arteriovenous malformation, its typical location and presentation are different from the findings shown in this image, which demonstrates shunting in the region of the cavernous sinus. [Practice more Radiology PYQs on OnCourse]

Q: Comment on the diagnosis from the thyroid scan shown below. (AIIMS May 2017)

Hypersecreting adenoma. ***Hypersecreting adenoma*** - The thyroid scan shows a **single, intensely "hot" nodule**, indicating increased uptake of the radioactive tracer in a localized area. - This pattern is characteristic of a **hyperfunctioning thyroid adenoma**, where the adenoma produces hormones independently, leading to suppression of the rest of the normal thyroid tissue (which appears "cold" or has reduced uptake). *Papillary cancer thyroid* - Papillary thyroid cancer typically appears as a **"cold" nodule** on a thyroid scan, meaning it has reduced or no tracer uptake. - Malignant nodules generally do **not accumulate iodine** as efficiently as normal thyroid tissue or hyperfunctioning benign nodules. *Grave's disease* - Grave's disease presents with **diffuse uptake of the tracer** throughout the entire thyroid gland, not a single localized hot nodule. - The entire gland is generally enlarged and hyperactive, showing **symmetrically increased uptake**. *Lateral aberrant thyroid* - A lateral aberrant thyroid refers to **ectopic thyroid tissue** usually found in the neck, often in lymph nodes due to metastatic papillary carcinoma. - While it involves thyroid tissue outside the normal gland, it wouldn't typically manifest as a single hyperfunctioning nodule within the main thyroid gland, and most ectopic thyroid tissue would show varying uptake depending on its function or if it's metastatic cancer. [Practice more Radiology PYQs on OnCourse]

Q: A patient presented with sudden onset difficulty in breathing with RR 28/min, normal blood pressure. X-ray was taken which is given below. What is the diagnosis?

Hydro-pneumothorax. ***Hydro-pneumothorax*** - The chest X-ray clearly shows a **horizontal air-fluid level** in the right hemithorax, indicating the presence of both air (pneumothorax) and fluid (hydrothorax) within the pleural space. - The patient's sudden onset **difficulty in breathing** and **tachypnea (RR 28/min)** are consistent with significant lung pathology like a hydropneumothorax, which compromises lung function. *Pneumothorax* - A simple pneumothorax would show only **air in the pleural space**, characterized by a visible visceral pleural line and absence of lung markings beyond it. - While there is air present, the prominent **fluid level** rules out a diagnosis of pneumothorax alone. *Pleural effusion* - Pleural effusion presents as a **blunting of the costophrenic angles** and a meniscus sign, where fluid conforms to the shape of the thorax. - This image shows a **straight air-fluid level**, not a typical meniscus, indicating the presence of air in addition to fluid. *Consolidation* - Consolidation refers to the **filling of alveolar spaces with fluid or exudate**, appearing as an opacification within the lung parenchyma. - Consolidations typically do not present with a **horizontal fluid level** in the pleural space; they are intraparenchymal. [Practice more Radiology PYQs on OnCourse]

Q: A 50-year-old man went for his annual medical check-up. CT scan is shown below. Diagnosis is?

Renal angiomyolipoma. ***Renal angiomyolipoma*** - The CT scan shows a renal mass with areas of **macroscopic fat density**, which is the hallmark of an angiomyolipoma. - Angiomyolipomas are **benign renal tumors** composed of variable amounts of smooth muscle, vascular tissue, and mature adipose tissue. *Renal cell carcinoma* - While renal cell carcinoma can present as a solid renal mass, it typically does **not contain macroscopic fat**. - It usually enhances heterogeneously with contrast and may show areas of necrosis or hemorrhage, but the presence of fat rules out typical RCC. *Renal cyst* - Renal cysts are typically **simple fluid-filled structures** with very low attenuation values (close to water) and **do not contain solid components or fat**. - They also have thin, imperceptible walls and do not enhance with contrast. *Rhabdomyosarcoma* - Rhabdomyosarcomas are **malignant soft tissue tumors** rarely found in the kidney, and would appear as a solid, often heterogeneous mass on CT. - They do **not contain fat** and are aggressive tumors, often associated with a different patient demographic (e.g., children). [Practice more Radiology PYQs on OnCourse]

Question 1

The digital subtraction angiography given below shows? (AIIMS Nov 2017)

Accepted Answer

Carotid-cavernous fistula

Answer

Intra-cranial pseudo-aneurysm

Answer

Angiofibroma tumor blush

Answer

Vein of Galen malformation

Question 2

Which is not a finding of the Chest X-ray shown below? (AIIMS May 2017)

Accepted Answer

Narrow vascular pedicle

Answer

Pulmonary venous hypertension

Answer

Increased CT ratio

Answer

Acute cardiophrenic angle

Question 3

Comment on the diagnosis from the thyroid scan shown below. (AIIMS May 2017)

Accepted Answer

Hypersecreting adenoma

Answer

Papillary cancer thyroid

Answer

Grave's disease

Answer

Lateral aberrant thyroid

Question 4

A patient presented with sudden onset difficulty in breathing with RR 28/min, normal blood pressure. X-ray was taken which is given below. What is the diagnosis?

Accepted Answer

Hydro-pneumothorax

Answer

Pneumothorax

Answer

Pleural effusion

Answer

Consolidation

Question 5

A 50-year-old man went for his annual medical check-up. CT scan is shown below. Diagnosis is?

Accepted Answer

Renal angiomyolipoma

Answer

Renal cell carcinoma

Answer

Renal cyst

Answer

Rhabdomyosarcoma

INI-CET 2017 — Radiology