Contrast and Radiological Procedures — MCQs

Contrast and Radiological Procedures Indian Medical PG Practice Questions and MCQs

Question 191: Second swallowing in barium meal studies is found in-

A. Scleroderma
B. Reflux esophagitis
C. Pharyngeal pouch (Correct Answer)
D. Achalasia cardia

Explanation: ***Pharyngeal pouch*** - A pharyngeal pouch, specifically a **Zenker's diverticulum**, can lead to food or barium pooling within the pouch. - This pooling can cause a sensation of retained material, prompting a **second swallow** to clear the pharynx and esophagus. *Scleroderma* - Leads to **esophageal dysmotility** due to smooth muscle atrophy and fibrosis, primarily affecting the lower two-thirds of the esophagus. - This manifests as difficulty moving food down the esophagus, but not typically as the need for a second swallow to clear a pouch. *Reflux esophagitis* - Characterized by **inflammation of the esophagus** due to gastric acid reflux. - Symptoms include heartburn and dysphagia, but it does not cause the pooling of barium requiring a second swallow as seen with a pharyngeal pouch. *Achalasia cardia* - Involves the **failure of the lower esophageal sphincter to relax** and loss of peristalsis in the esophageal body. - This results in significant delayed emptying and a "bird's beak" appearance on barium swallow, but not the specific finding of a second swallow to clear a localized pouch.

Question 192: CECT is least useful as a diagnostic tool for:

A. Glomus jugulare
B. Carotid body tumor
C. Juvenile angiofibroma
D. Subclavian steal syndrome (Correct Answer)

Explanation: ***Correct: Subclavian steal syndrome*** - **Doppler ultrasound** is the primary and most effective diagnostic method for real-time assessment of blood flow velocity and direction in the vertebral and subclavian arteries, directly demonstrating the **"steal" phenomenon** - While **Computed tomography angiography (CTA)** with contrast can visualize the subclavian artery anatomy, it is **not optimal** for evaluating the hemodynamic flow dynamics that define this condition - The diagnosis relies on demonstrating **reversed vertebral artery flow**, which is best assessed with duplex Doppler ultrasound *Incorrect: Glomus jugulare* - **CECT is highly useful** for identifying the characteristic **vascular nature** and **bone erosion** associated with glomus jugulare tumors in the temporal bone - CECT allows for detailed visualization of tumor extent, particularly its relationship to surrounding structures and bony labyrinth - Shows intense enhancement due to the highly vascular nature of this paraganglioma *Incorrect: Carotid body tumor* - **CECT is highly effective** in diagnosing carotid body tumors, which are paragangliomas with **hypervascularity** leading to intense contrast enhancement - Provides excellent anatomical detail, showing the characteristic **splaying of the carotid bifurcation** (Lyre sign) - Clearly demonstrates tumor vascularity and relationship to great vessels *Incorrect: Juvenile angiofibroma* - **CECT is crucial** for diagnosing and staging juvenile angiofibromas, which are **highly vascular tumors** of the nasopharynx that show avid contrast enhancement - Helps delineate the tumor's extent, including involvement of the pterygopalatine fossa, sphenoid sinus, and potential intracranial extension - Essential for pre-operative planning due to the tumor's vascularity

Question 193: Which of the following is best suited for detection of calculi in the submandibular gland?

A. Lower oblique occlusal
B. Lower true occlusal (Correct Answer)
C. Lower topographic occlusal
D. Vertex occlusal

Explanation: ***Lower true occlusal*** - This is the **standard radiographic view** for detecting submandibular calculi (sialoliths). - Provides excellent visualization of the **floor of the mouth and the course of Wharton's duct** (submandibular duct). - The **superior-inferior angulation** projects the submandibular gland and duct optimally, allowing clear detection of radiopaque calculi. - Used in combination with lateral oblique views for comprehensive assessment. *Lower oblique occlusal* - This projection is primarily used for **localization of objects** in the buccal-lingual dimension, not for optimal calculus detection. - The oblique angulation may cause **overlapping structures** that obscure the submandibular duct region. *Lower topographic occlusal* - This view is used to examine the **entire mandibular arch** and is less specific for submandibular gland pathology. - Does not provide the focused detail needed for calculus detection in the submandibular duct. *Vertex occlusal* - The vertex occlusal projection visualizes the **zygomatic arches and skull base**. - Not appropriate for imaging the **salivary glands or oral cavity floor** where submandibular calculi occur.

Question 194: "Adder Head" appearance is found in:

A. X-ray
B. CT
C. USG
D. IVP (Correct Answer)

Explanation: ***IVP*** - The **"Adder Head" appearance** is a classic radiological sign observed on an **Intravenous Pyelogram (IVP)**. - This sign is characteristic of a **ureterocele**, where the distal ureter prolapses into the bladder, causing a characteristic filling defect that resembles the head of an adder or cobra within the bladder. *X-ray* - While X-rays are used to image the urinary tract, a plain X-ray alone would **not clearly visualize a ureterocele** with the distinct "Adder Head" appearance. - Plain X-rays primarily show **calcifications** or gross anatomical changes, not the detailed soft tissue contrast needed to identify this specific sign. *CT* - **CT scans** provide excellent anatomical detail of the urinary tract and can image a ureterocele. - However, the "Adder Head" sign is **specifically described in the context of an IVP**, which relies on contrast excretion and distension of the ureterocele within the bladder. *USG* - **Ultrasound (USG)** can effectively identify a ureterocele as a **cystic structure within the bladder**. - While it provides good visualization, the term "**Adder Head**" appearance is traditionally and specifically associated with the contrast-filled image on an **IVP**.

Question 195: Reverse 3 sign in barium swallow is seen in:

A. Patent ductus arteriosus
B. Double aortic arch
C. Aberrant right subclavian artery
D. Coarctation of aorta (Correct Answer)

Explanation: ***Coarctation of aorta*** - The **reverse 3 sign** (also known as the **figure 3 sign**) on a barium swallow or chest X-ray is characteristic of postductal coarctation of the aorta. - This sign is formed by the **prestenotic dilatation** of the aorta, the indentation at the site of coarctation, and **poststenotic dilatation**, resembling the numeral '3' or its reverse. *Patent ductus arteriosus* - A patent ductus arteriosus typically causes a **left-to-right shunt**, leading to pulmonary hypertension and potentially left heart enlargement. - It does not directly produce the reverse 3 sign, which is specific to aortic narrowing. *Double aortic arch* - A double aortic arch forms a **vascular ring** around the trachea and esophagus, often causing dysphagia or stridor. - Imaging would typically show **two distinct aortic arches** and associated tracheal/esophageal compression, not the '3' configuration. *Aberrant right subclavian artery* - An aberrant right subclavian artery usually originates from the descending aorta and passes *behind* the esophagus. - It can cause **dysphagia lusoria** due to esophageal compression but does not create the characteristic "reverse 3" indentation pattern.

Question 196: Deep vein thrombosis post-operatively is diagnosed by:

A. Clinically
B. Ascending venography
C. USG (Correct Answer)
D. X-ray

Explanation: ***USG*** - **Duplex ultrasonography** is the preferred and most common imaging modality for diagnosing deep vein thrombosis (DVT) due to its non-invasive nature, accessibility, and high accuracy. - It visualizes the **vein lumen** and assesses **compressibility**, a key diagnostic feature for DVT. *Clinically* - Clinical diagnosis of DVT is unreliable, as symptoms like **leg swelling, pain, and tenderness** are non-specific and can be caused by other conditions. - While clinical suspicion can warrant further investigation, it is **insufficient for definitive diagnosis**. *Ascending venography* - **Ascending venography** was once considered the gold standard but is now rarely used due to its invasive nature, use of ionizing radiation, and potential complications. - It involves injecting **radiocontrast dye** into a foot vein and taking X-rays, making it less practical for routine use compared to ultrasound. *X-ray* - **X-rays do not directly visualize veins** or blood clots and are therefore not useful for diagnosing DVT. - They may be used to rule out other causes of leg pain or swelling, such as **bone fractures** or **arthritis**, but offer no diagnostic value for DVT itself.

Question 197: Aortic calcification is diagnosed on fluoroscopy by identifying:

A. Dense rim-like calcifications (Correct Answer)
B. Eggshell calcification pattern
C. Punctate calcifications in aortic wall
D. Linear calcifications along aortic contour

Explanation: ***Dense rim-like calcifications*** - Aortic calcification on fluoroscopy typically appears as a **dense, rim-like structure**, particularly visible around the aortic valve or along the aortic wall. - These calcifications indicate deposits of **calcium salts** within the aortic tissue, often associated with aging or degenerative processes. *Eggshell calcification pattern* - **Eggshell calcification** is more characteristic of conditions like **hydatid cysts** or certain **lymph node calcifications**, not typically seen within the aortic wall itself. - This pattern refers to a thin, curvilinear rim of calcification surrounding a lesion. *Punctate calcifications in aortic wall* - While calcifications can be punctate early in their development, the definitive fluoroscopic sign for significant aortic calcification is more often a **dense, rim-like appearance**, indicating more extensive deposition. - **Punctate calcifications** may be subtle and less clear for definitive diagnosis on fluoroscopy compared to the more pronounced rim-like pattern. *Linear calcifications along aortic contour* - While calcifications can follow the aortic contour, the term **"linear calcifications"** is broad and less specific for the characteristic fluoroscopic appearance of significant aortic calcification than "dense rim-like." - **Linear calcifications** might be seen in other vascular structures or soft tissues and may not always imply the same degree of calcific burden or morphology as a dense rim.

Question 198: The technique involving injection of contrast material for evaluation of salivary glands is called:

A. Angiogram
B. Tomography
C. Ultrasound
D. Sialography (Correct Answer)

Explanation: **Sialography** - This technique specifically involves the injection of **radiopaque contrast material** into the salivary ducts (typically Stensen's or Wharton's ducts). - It is used to visualize the **ductal system and parenchyma** of the major salivary glands, aiding in the diagnosis of conditions like **sialolithiasis**, strictures, or tumors. *Angiogram* - An angiogram is a medical imaging technique used to visualize the **blood vessels**, including arteries and veins, using contrast material. - It is primarily for evaluating **vascular pathology** and not the ductal system of salivary glands. *Tomography* - Tomography is a general term for imaging techniques (like CT or MRI) that produce **cross-sectional images** of the body. - While it can visualize salivary glands, it does not involve the direct injection of contrast into the salivary ducts for ductal evaluation unless specifically combined with sialography. *Ultrasound* - Ultrasound uses **sound waves** to create images of internal body structures. - It is a useful non-invasive tool for evaluating salivary glands for masses or inflammation but does not involve **contrast injection into the ducts** to map the ductal system.

Question 199: On barium swallow the grade IV esophageal varices appear as

A. Mucosal folds at the carina
B. Mucosal folds above the carina
C. A thick band
D. Mucosal folds below the carina (Correct Answer)

Explanation: ***Mucosal folds below the carina*** - Grade IV esophageal varices represent the **most severe degree** of variceal enlargement on barium swallow - They appear as **large, tortuous, serpiginous mucosal folds** that predominantly involve the **distal and middle esophagus** (below the level of the carina) - The carina (tracheal bifurcation at T4-T5) serves as an **anatomical landmark** - severe varices (Grade III-IV) typically manifest most prominently in the **lower two-thirds of the esophagus**, which lies below this level - These appear as **filling defects** with a characteristic worm-like or serpentine pattern *Mucosal folds at the carina* - While varices can extend to the mid-esophagus at the carinal level, the **most prominent manifestations** of Grade IV varices are typically **more distal** - Describing varices specifically "at" the carina is less characteristic of the severe, extensive involvement seen in Grade IV disease *A thick band* - This description is too **non-specific** and does not capture the characteristic **serpiginous, tortuous appearance** of esophageal varices - Varices appear as **multiple irregular filling defects**, not a uniform thick band - The term "band" suggests a smooth, linear structure rather than the dilated, convoluted veins seen in varices *Mucosal folds above the carina* - Esophageal varices primarily affect the **distal and middle thirds** of the esophagus due to portosystemic collateral circulation - The upper esophagus (above the carina) is **less commonly** involved in significant variceal disease - Grade IV varices, being the most severe, would show maximal changes in the **gastroesophageal junction and lower esophagus**, not primarily above the carina

Question 200: Which one of the following investigations is considered to be "Gold standard" technique for diagnosis of arterial occlusive disease –

A. Doppler ultrasound blood flow detection
B. Treadmill
C. Duplex imaging
D. Digital subtraction angiography (DSA) (Correct Answer)

Explanation: ***Digital subtraction angiography (DSA)*** - **DSA** is considered the **gold standard** because it provides highly detailed, real-time images of arterial anatomy and blood flow within the vessels. - It allows for precise localization and characterization of **stenosis**, **occlusions**, and other vascular abnormalities, which is crucial for treatment planning. *Doppler ultrasound blood flow detection* - While useful for measuring blood flow velocities and identifying areas of stenosis, **Doppler ultrasound** is operator-dependent and less accurate than DSA for detailed anatomical mapping. - It provides functional information but lacks the comprehensive anatomical detail necessary to be the gold standard. *Treadmill* - A **treadmill test** is a functional assessment used to evaluate exercise-induced symptoms and the physiological impact of arterial occlusive disease. - It does not directly visualize the arterial pathology but rather assesses the patient's functional capacity and symptom response to exertion. *Duplex imaging* - **Duplex imaging** combines B-mode ultrasound (for anatomical visualization) with Doppler ultrasound (for blood flow assessment). - It is a very good non-invasive screening tool, but it is not as precise or comprehensive as DSA, particularly for complex anatomies or smaller vessels, and can be limited by factors such as obesity or bowel gas.

Practice by Chapter

Iodinated Contrast Media

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MRI Contrast Agents

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Ultrasound Contrast Agents

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Adverse Reactions to Contrast Media

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Management of Contrast Reactions

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Contrast-Induced Nephropathy

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Barium Studies

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Intravenous Urography

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Angiography Techniques

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Lymphangiography

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Contrast Administration Protocols

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Pretesting and Premedication

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