NEET-PG 2013 - Radiology Practice Questions

Q: Hose pipe appearance of intestine is a feature of

Ulcerative colitis. ***Crohns disease*** - The **hose pipe appearance** of the intestine on imaging is due to **transmural inflammation** and **strictures**, characteristic of Crohn's disease [1]. - This feature indicates a **narrowed lumen** due to fibrosis, often affecting the small intestine or colon [1]. *Malabsorption syndrome* - This condition is primarily associated with **nutrient absorption issues**, not structural changes in the intestine. - It typically presents with **diarrhea**, **weight loss**, and **malnutrition**, lacking the characteristic imaging findings. *Ulcerative colitis* - Usually presents with **continuous lesions** confined to the colonic mucosa, leading to ulcers and inflammation but not a **hose pipe appearance**. - Symptoms include **bloody diarrhea** and **abdominal pain**, distinctly different from Crohn's disease. *Hirsprung disease* - A congenital condition causing **intestinal obstruction** due to the absence of ganglion cells, leading to **dilated proximal bowel** rather than a hose pipe appearance. - Typically presents in infants with **severe constipation** and **abdominal distension**, unrelated to imaging features seen in Crohn's disease. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 366-367.

Q: Which CT view is best for visualizing paranasal polyps?

Coronal view. ***Coronal*** - The **coronal view** provides the best visualization of the **ostia of the paranasal sinuses**, which are crucial for assessing the extent and obstruction caused by polyps. - This orientation effectively demonstrates whether polyps are **protruding into the nasal cavity** or obstructing the drainage pathways. *Axial view* - The axial view is useful for evaluating **posterior structures** and **bony erosion** but is less optimal for assessing the vertical extent of polyps or ostial obstruction. - It can show the **anteroposterior dimensions** of polyps but does not offer the same clarity for sinus outflow tracts as the coronal view. *Sagittal view* - The sagittal view is good for showing the **craniocaudal extent** of lesions and differentiating between the nasal cavity and sphenoid sinus, but it is not ideal for comprehensive paranasal sinus polyp evaluation. - It can help in localizing some polyps but does not provide a clear overview of **sinus ostia** or lateral extension. *3D view* - A 3D reconstruction can be helpful for a general overview and surgical planning but does not offer the fine detail and specific orientation needed for primary polyp detection and ostial assessment as effectively as direct 2D views. - It is a derived image rather than a primary acquisition plane and might obscure smaller polyps or subtle anatomical relationships.

Q: What is the investigation of choice for nasopharyngeal angiofibroma?

Contrast-enhanced CT. ***Contrast-enhanced CT*** - A **contrast-enhanced CT** scan is the investigation of choice for **nasopharyngeal angiofibroma** due to its ability to clearly delineate the extent of the tumor, its vascularity, and its bony involvement. - The contrast highlights the **highly vascular nature** of the angiofibroma, which is crucial for surgical planning and embolization. *X-ray* - **X-rays** provide limited detail of soft tissue structures and mass lesions in the complex anatomy of the nasopharynx. - They are generally not sensitive enough to characterize a tumor like **angiofibroma** or determine its exact extent. *Plain CT* - A **plain CT** (non-contrast CT) can show soft tissue masses and bony erosion but lacks the ability to assess the **vascularity** of the tumor. - Without contrast, it's difficult to differentiate the tumor from surrounding tissues or identify its blood supply, which is critical for **angiofibroma** management. *MRI* - While **MRI** offers excellent soft tissue contrast and is valuable for assessing intracranial extension or perineural spread, **contrast-enhanced CT** is generally preferred as the primary imaging modality for angiofibroma. - **CT with contrast** is superior for demonstrating **bony erosion** and the characteristic **vascularity** of this tumor.

Q: Tear drop sign is seen in?

Blow out fracture. ***Blow out fracture*** - The **tear drop sign** on imaging (often CT scan) is characteristic of an **orbital blow-out fracture**, indicating herniation of orbital contents (fat, muscle) into the maxillary sinus. - This fracture typically involves the **orbital floor** or medial wall, often caused by a blunt force trauma to the eye. *Fracture zygomatic arch* - A fracture of the zygomatic arch is often associated with a **flattening of the malar prominence** rather than a "tear drop" sign. - It might lead to restricted jaw movement if the arch impinges on the coronoid process. *Fracture maxilla* - Maxillary fractures (e.g., Le Fort fractures) involve the midface bones and cause **facial deformity**, malocclusion, and mobility of the maxilla. - The tear drop sign is not a primary diagnostic feature of maxillary fractures. *Fracture mandible* - Mandibular fractures present with pain, swelling, and **malocclusion** of the teeth. - Imaging would reveal a break in the mandible, not a tear drop sign associated with orbital contents.

Q: What is the best imaging view for assessing the nasal bone in X-ray?

Lateral. ***Lateral*** - The **lateral view** provides a clear profile of the nasal bones, allowing for the best assessment of fractures, displacement, and angulation. - It visualizes the nasal bone in relation to other facial structures, which is crucial for treatment planning. *Towne's* - The **Towne's view** is primarily used to visualize the **occipital bone** and the **foramen magnum**, not the nasal bones. - It projects the petrous pyramids inferiorly, which would obstruct the view of the nasal region. *Caldwell* - The **Caldwell view** is primarily used to assess the **frontal sinuses**, **ethmoid sinuses**, and **orbits**. - While it offers some visualization of the nasal region, it does not provide the detailed lateral projection needed for optimal nasal bone assessment. *Submentovertical* - The **submentovertical view** (also known as the **basal view**) is primarily used to visualize the **base of the skull**, **sphenoid sinuses**, and **zygomatic arches**. - This view does not offer a direct or clear projection of the nasal bones themselves.

Q: Which condition is associated with the pencil in cup deformity?

Psoriatic arthritis. ***Psoriatic arthritis*** - The **pencil-in-cup deformity** is a classic radiographic finding in advanced psoriatic arthritis, occurring due to **periarticular bone erosion** and phalangeal telescoping. - This specific deformity is characterized by the proximal phalanx eroding and fitting into the expanded distal phalanx, resembling a "pencil in a cup." *Rheumatoid arthritis* - While rheumatoid arthritis causes significant joint destruction, it typically presents with **periarticular erosions** and **joint space narrowing**, but not the characteristic pencil-in-cup morphology. - Common deformities include **swan-neck** and **boutonnière** deformities, and ulnar deviation. *Ankylosing spondylitis* - This condition primarily affects the **axial skeleton**, leading to spinal fusion and **sacroiliitis**. - Peripheral joint involvement is less common and typically does not result in the pencil-in-cup deformity; instead, it can cause **syndesmophytes**. *Avascular necrosis* - **Avascular necrosis** (AVN) involves the death of bone tissue due to lack of blood supply, primarily affecting the femoral head or other major joints. - Radiographic findings include **subchondral collapse**, crescent sign, and eventual joint destruction, but not the specific deformities seen in inflammatory arthritis like pencil-in-cup.

Q: What is the standard radiation dose to point A in the cervix for brachytherapy in the treatment of cervical cancer?

8000 rad. ***8000 rad*** - The standard **total cumulative radiation dose** to **Point A** in the cervix for the treatment of cervical cancer is approximately **8000 rad (80 Gy)**. - This represents the **combined dose** from external beam radiation therapy (EBRT, typically 45-50 Gy) plus intracavitary brachytherapy (typically 30-40 Gy to Point A). - Point A is a classical reference point defined as **2 cm superior to the external cervical os and 2 cm lateral to the uterine canal**, representing the location where the uterine artery crosses the ureter. - This total dose aims to provide adequate tumor control while minimizing toxicity to surrounding organs like the bladder and rectum. *6000 rad* - A total dose of **6000 rad** is insufficient for definitive local control of cervical cancer. - This dose is below the therapeutic threshold and would result in significantly higher rates of local recurrence and treatment failure. - Adequate doses are essential for curative intent in cervical cancer management. *10000 rad* - A dose of **10000 rad** to Point A would be excessively high and significantly increase the risk of severe acute and late toxicities to surrounding tissues. - Such a high dose could lead to serious complications including **rectovaginal or vesicovaginal fistulas, proctitis, cystitis, bowel strictures, and tissue necrosis**. - The therapeutic window would be exceeded, causing more harm than benefit. *4000 rad* - A dose of **4000 rad** would be substantially lower than the standard therapeutic dose for cervical cancer. - This suboptimal dose would likely result in **inadequate tumor control and increased risk of local recurrence**. - It is far below the dose required for curative treatment of cervical cancer.

Q: Which condition is characterized by a 'moth-eaten' appearance of the bones?

Multiple myeloma. ***Multiple myeloma*** [1][2] - Characterized by **punched-out lytic lesions** in bones, often described as **moth-eaten** appearance on imaging [1]. - Associated with **elevated serum proteins** and **Bence Jones proteins** in urine, confirming the diagnosis [2]. *Eosinophilic granuloma* - Usually presents with **solitary bone lesions** and is linked to **Langerhans cell histiocytosis** rather than the moth-eaten pattern. - Does not typically cause generalized **lytic bone lesions** seen in cases of multiple myeloma. *Chondromyxoid fibroma* - Generally appears as a **well-defined cortical lesion** and is not associated with a moth-eaten appearance. - It predominantly affects the **metaphysis** of long bones and shows a characteristic **cartilaginous matrix**. *Osteoid osteoma* - Presents with a **nidus** of osteoid formation, leading to localized bone pain, and does not exhibit a moth-eaten consistency. - Tends to cause **cortical bone thickening** rather than the diffuse lytic lesions associated with multiple myeloma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 608. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Q: Gyromagnetic property of proton is seen in -

MRI. ***MRI*** - Magnetic Resonance Imaging (MRI) relies on the **gyromagnetic properties of protons**, primarily hydrogen nuclei in water and fat. - These protons align with a strong magnetic field and, when pulsed with radiofrequency waves, emit detectable signals that form the image. *CT* - Computed Tomography (CT) utilizes **X-rays** and their differential absorption by various tissues to create cross-sectional images. - It does not involve the gyromagnetic properties of protons. *PET scan* - Positron Emission Tomography (PET) scans detect **gamma rays** emitted from radiotracers, typically radionuclides like Fluorine-18, that accumulate in metabolically active tissues. - This imaging modality is based on radioactive decay, not proton spin. *USG* - Ultrasonography (USG) generates images by sending **high-frequency sound waves** into the body and detecting the echoes that bounce back from various tissues. - It relies on acoustic properties and tissue interfaces, not magnetic properties of protons.

Q: Which imaging modality delivers the highest dose of radiation?

Cardiac perfusion scan. ***Cardiac perfusion scan*** - A **cardiac perfusion scan (nuclear cardiology)** involves the administration of a radioactive tracer, and the radiation dose can be significant due to the nature and energy of the isotopes used. - While varying, the effective dose for these scans can range from **10 to 30 mSv**, placing it among some of the highest radiation exposures from medical imaging. *CT scan of the chest* - A **CT scan of the chest** provides a relatively high radiation dose compared to plain X-rays, typically ranging from **5 to 7 mSv**. - This is generally lower than some nuclear medicine studies, particularly complex or prolonged cardiac perfusion scans. *Mammogram* - A **mammogram** involves a relatively low dose of radiation, typically in the range of **0.2 to 0.7 mSv**. - Its objective is to image the breast tissue with minimal exposure, making it one of the lower-dose imaging modalities available. *CT scan of the brain* - A **CT scan of the brain** usually delivers a moderate radiation dose, estimated to be around **1 to 2 mSv**. - This is often less than a chest CT due to the smaller volume and different shielding considerations, and significantly less than a cardiac perfusion scan.

Question 1

Hose pipe appearance of intestine is a feature of

Accepted Answer

Ulcerative colitis

Answer

Malabsorption syndrome

Answer

Crohn's disease

Answer

Hirschsprung disease

Question 2

Which CT view is best for visualizing paranasal polyps?

Accepted Answer

Coronal view

Answer

Axial view

Answer

Sagittal view

Answer

3D view

Question 3

What is the investigation of choice for nasopharyngeal angiofibroma?

Accepted Answer

Contrast-enhanced CT

Answer

Plain CT

Answer

X-ray

Answer

MRI

Question 4

Tear drop sign is seen in?

Accepted Answer

Blow out fracture

Answer

Fracture zygomatic arch

Answer

Fracture maxilla

Answer

Fracture mandible

Question 5

What is the best imaging view for assessing the nasal bone in X-ray?

Accepted Answer

Lateral

Answer

Towne's

Answer

Submentovertical

Answer

Caldwell

Question 6

Which condition is associated with the pencil in cup deformity?

Accepted Answer

Psoriatic arthritis

Answer

Rheumatoid arthritis

Answer

Ankylosing spondylitis

Answer

Avascular necrosis

Question 7

What is the standard radiation dose to point A in the cervix for brachytherapy in the treatment of cervical cancer?

Accepted Answer

8000 rad

Answer

6000 rad

Answer

10000 rad

Answer

4000 rad

Question 8

Which condition is characterized by a 'moth-eaten' appearance of the bones?

Accepted Answer

Multiple myeloma

Answer

Osteoid osteoma

Answer

Eosinophilic granuloma

Answer

Chondromyxoid fibroma

Question 9

Gyromagnetic property of proton is seen in -

Accepted Answer

MRI

Answer

CT

Answer

PET scan

Answer

USG

Question 10

Which imaging modality delivers the highest dose of radiation?

Accepted Answer

Cardiac perfusion scan

Answer

CT scan of the chest

Answer

Mammogram

Answer

CT scan of the brain

NEET-PG 2013 — Radiology