Cardiovascular Radiology Practice Questions

Q: Which one of the following is used in Cardiovascular imaging?

Multidetector CT. **Explanation:** **Multidetector CT (MDCT)** is the gold standard for cardiovascular imaging because it overcomes the two biggest challenges in cardiac radiology: **cardiac motion** and **respiratory motion**. 1. **Why MDCT is correct:** MDCT utilizes multiple rows of detectors, allowing for sub-millimeter isotropic resolution and high temporal resolution. When combined with **ECG-gating** (synchronizing data acquisition with the diastolic phase of the cardiac cycle), it allows for motion-free imaging of the coronary arteries. Modern MDCT (64-slice and above) can image the entire heart in a single breath-hold, making it essential for Coronary CT Angiography (CCTA). 2. **Why other options are incorrect:** * **Second and Third Generation CT:** These are historical iterations. Second-generation used a "translate-rotate" motion with a fan beam, and Third-generation used a "rotate-rotate" motion. While Third-generation is the basis for modern scanners, the basic configuration lacked the speed and detector density required to freeze cardiac motion. * **Spiral (Helical) CT:** While a prerequisite for MDCT, early single-slice spiral CTs were too slow to capture the heart without significant motion artifacts and could not provide the necessary spatial resolution for small vessels like the coronary arteries. **High-Yield Clinical Pearls for NEET-PG:** * **Temporal Resolution:** The time required to acquire data for one image. High temporal resolution is vital to "freeze" the heart. * **Electron Beam CT (EBCT):** Historically known as the "Ultrafast CT," it was the previous gold standard for Calcium Scoring but has been largely replaced by MDCT. * **Calcium Scoring (Agatston Score):** Performed on MDCT to predict the risk of future adverse cardiac events. * **Beta-blockers:** Often administered before a Cardiac CT to lower the heart rate (ideally <60-65 bpm) to improve image quality.

Q: Which of the following is NOT a characteristic feature of mitral stenosis on X-ray?

Prominence of veins in the lower lobes. In Mitral Stenosis (MS), the narrowing of the mitral valve leads to increased pressure in the left atrium (LA), causing **Left Atrial Enlargement (LAE)** and subsequent pulmonary venous hypertension. ### Why Option D is the Correct Answer In MS, pulmonary venous hypertension leads to a phenomenon called **Cephalization** (Antler sign). Due to perivascular edema in the lower lobes, there is reflex vasoconstriction of the lower lobe veins and compensatory dilatation of the **upper lobe veins**. Therefore, prominence of veins in the *lower* lobes is incorrect; they are actually constricted, while upper lobe veins are prominent. ### Explanation of Incorrect Options (Features of LAE) * **Double contour of the right border:** As the LA enlarges, its right border pushes toward the right and overlaps the right atrium, creating a "double shadow" or "double density" sign on a PA view. * **Elevation of the left main bronchus:** An enlarging LA pushes the left main bronchus upward, making it more horizontal. * **Widening of the carinal angle:** The subcarinal angle (normally 60–75°) increases to >90° as the LA expands superiorly between the two main bronchi. ### High-Yield Clinical Pearls for NEET-PG * **Straightening of the left cardiac border:** This occurs due to a prominent pulmonary artery segment and an enlarged left atrial appendage (filling the "mitral surf"). * **Kerley B Lines:** Horizontal lines at the lung bases indicating chronic pulmonary venous hypertension and interstitial edema. * **Most sensitive view for LAE:** Lateral view with barium swallow (shows posterior indentation of the esophagus). * **Walking Man Sign:** On a lateral X-ray, the posterior displacement of the left main bronchus resembles a person walking.

Q: Transesophageal echocardiogram (TEE) is preferred to transthoracic echocardiogram (TTE) in which of the following evaluations?

Evaluation of left atrial appendage thrombi. **Explanation:** The preference for Transesophageal Echocardiography (TEE) over Transthoracic Echocardiography (TTE) is primarily determined by the anatomical proximity of the esophagus to the posterior structures of the heart. **Why Option D is Correct:** The **Left Atrial Appendage (LAA)** is a posterior structure that is difficult to visualize clearly on TTE due to its depth and interference from ribs and lung tissue. TEE uses a high-frequency transducer positioned in the esophagus, directly behind the left atrium. This provides superior spatial resolution, making TEE the **gold standard** for detecting LAA thrombi, especially in patients with atrial fibrillation prior to cardioversion. **Analysis of Incorrect Options:** * **A. Pericardial diseases:** TTE is the initial investigation of choice for pericardial effusion and tamponade as it provides an excellent global view of the pericardial space and hemodynamics. * **B. Tricuspid wall vegetations:** The tricuspid valve is an anterior structure. While TEE is more sensitive for small vegetations, TTE is generally sufficient and preferred as the first-line evaluation for right-sided valves. * **C. Left ventricular (LV) apical thrombi:** The LV apex is the structure furthest from the TEE probe but closest to the TTE transducer (apical four-chamber view). TTE (often with contrast) is superior for visualizing the LV apex. **High-Yield Clinical Pearls for NEET-PG:** * **TEE is superior for:** Left atrial appendage thrombi, prosthetic valve dysfunction, infective endocarditis (detecting small vegetations/abscesses), and aortic dissection. * **TTE is superior for:** Routine screening, apical thrombi, and initial assessment of pericardial effusions. * **Rule of Thumb:** If the structure is **posterior** (LA, LAA, Mitral Valve, Aorta), think **TEE**. If the structure is **anterior** (RV, LV apex, Pericardium), think **TTE**.

Q: A patient presents with chest pain. What is the diagnosis?

Ascending aortic aneurysm. ***Ascending aortic aneurysm*** - Chest X-ray shows **widened mediastinum** and **prominent right paracardiac border** due to dilatation of the ascending aorta. - Often presents with **chest pain** and may cause compression of surrounding structures, leading to characteristic radiological findings. *Acute pulmonary embolism* - Chest X-ray is typically **normal** or may show subtle signs like **Westermark sign** (oligemia) or **Hampton's hump** (wedge-shaped opacity). - Diagnosis primarily relies on **CT pulmonary angiogram (CTPA)** or **V/Q scan**, not chest X-ray findings. *Hypertrophic cardiomyopathy* - Chest X-ray may show **left ventricular enlargement** with a **boot-shaped heart** configuration. - Lacks the characteristic **mediastinal widening** seen with aortic pathology, instead showing cardiac silhouette changes. *Coarctation of the aorta* - Chest X-ray demonstrates **rib notching** due to collateral circulation and **figure-of-3 sign** from pre- and post-stenotic dilatation. - Shows **left heart enlargement** but lacks the prominent right paracardiac border characteristic of ascending aortic aneurysm.

Question 1

Which one of the following is used in Cardiovascular imaging?

Accepted Answer

Multidetector CT

Answer

Second generation CT

Answer

Third generation CT

Answer

Spiral CT

Question 2

Which of the following is NOT a characteristic feature of mitral stenosis on X-ray?

Accepted Answer

Prominence of veins in the lower lobes

Answer

Double contour of the right border

Answer

Elevation of the left main bronchus

Answer

Widening of the carinal angle

Question 3

Transesophageal echocardiogram (TEE) is preferred to transthoracic echocardiogram (TTE) in which of the following evaluations?

Accepted Answer

Evaluation of left atrial appendage thrombi

Answer

Evaluation of pericardial diseases

Answer

Evaluation of tricuspid wall vegetations

Answer

Evaluation of left ventricular apical thrombi

Question 4

Which of the following statements is true regarding cardiac MRI?

Accepted Answer

Viable myocardium can be differentiated from infarcted myocardium.

Answer

Infarcted myocardium is hypointense on T2-weighted MRI.

Answer

Prosthetic heart valves are an absolute contraindication for MRI.

Answer

Cardiac MRI is better than CT for the non-invasive assessment of coronary arteries.

Question 5

A patient presents with chest pain. What is the diagnosis?

Accepted Answer

Ascending aortic aneurysm

Answer

Acute pulmonary embolism

Answer

Hypertrophic cardiomyopathy

Answer

Coarctation of the aorta

Cardiovascular Radiology — MCQs

Cardiovascular Radiology — MCQs

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