Contrast and Radiological Procedures — MCQs

Contrast and Radiological Procedures Indian Medical PG Practice Questions and MCQs

Question 211: Even conventional radiological procedures are contraindicated in which neurological disease?

A. Cockayne Syndrome
B. Gorlin Syndrome
C. Ataxia telangiectasia (Correct Answer)
D. All of the options

Explanation: ***Ataxia telangiectasia*** - Patients with **ataxia telangiectasia** have a defect in the **ATM gene**, leading to extreme sensitivity to **ionizing radiation**, making conventional radiological procedures unsafe. - This increased radiosensitivity can result in severe adverse reactions, including increased risk of **malignancy** and neurological damage if exposed to routine diagnostic radiation. *Cockayne Syndrome* - **Cockayne Syndrome** is characterized by a defect in **DNA repair**, specifically **transcription-coupled repair**, leading to pronounced sun sensitivity and premature aging. - While these patients are sensitive to UV radiation, they do not have the profound hypersensitivity to **ionizing radiation** that contraindicates conventional X-ray imaging, distinguishing them from ataxia telangiectasia. *Gorlin Syndrome* - **Gorlin Syndrome** (Nevoid Basal Cell Carcinoma Syndrome) is associated with an increased risk of developing various cancers, including **basal cell carcinomas**, and is linked to the **PTCH1 gene**. - Although individuals with Gorlin Syndrome have an increased lifetime risk of developing tumors with **ionizing radiation exposure**, it does not typically contraindicate conventional diagnostic imaging, unlike the extreme radiosensitivity seen in ataxia telangiectasia. *All of the options* - This option is incorrect because while Cockayne Syndrome and Gorlin Syndrome involve heightened cancer risks or sensitivities, only **ataxia telangiectasia** presents a direct and severe contraindication to conventional radiological procedures due to extreme **radiosensitivity**.

Question 212: What is the investigation of choice in a patient with blunt abdominal trauma with hematuria?

A. USG of the abdomen
B. Retrograde urogram
C. IVP
D. CECT (Correct Answer)

Explanation: ***Correct Answer: CECT*** - **Contrast-enhanced computed tomography (CECT)** is the investigation of choice for evaluating blunt abdominal trauma with hematuria as it accurately assesses the extent of injury to the **kidneys, ureters, bladder**, and surrounding structures. - It provides detailed images for detecting **renal lacerations, hematomas, urine extravasation**, and other abdominal organ injuries. - **Gold standard** in trauma protocols for comprehensive evaluation of renal and abdominal injuries. *Incorrect: USG of the abdomen* - **Ultrasound** can identify gross abnormalities like large hematomas or free fluid but is less sensitive than CECT for subtle renal injuries or collecting system disruptions. - It is often used as an initial screening tool (FAST exam) but not the definitive investigation of choice in this context. *Incorrect: Retrograde urogram* - A **retrograde urogram** primarily evaluates the **lower urinary tract** (ureters and bladder) by injecting contrast directly into the urethra. - It is not suitable for assessing the extent of renal parenchymal injury or other abdominal organ damage in blunt trauma. *Incorrect: IVP* - **Intravenous pyelogram (IVP)** uses intravenous contrast to visualize the kidneys, ureters, and bladder, but it has largely been replaced by CECT due to its lower sensitivity and specificity for traumatic injuries. - It provides less detailed anatomical information about surrounding soft tissues and can miss subtle parenchymal or vascular injuries.

Question 213: Regarding contrast radiography which among the following is FALSE?

A. Distal part of duodenum has a cap (Correct Answer)
B. Ileum is featureless
C. Colon has haustrations
D. Jejunum is feathery

Explanation: ***Distal part of duodenum has a cap*** - The "cap" refers to the anatomical bulging found in the **duodenal bulb** (first part of the duodenum), not the distal part. - The distal duodenum (third and fourth parts) has a more tubular appearance on contrast radiographs. *Ileum is featureless* - This statement is **true**. On contrast radiographs, the ileum typically appears relatively smooth and featureless, lacking the prominent folds seen in the jejunum. - The mucosal pattern of the ileum is generally less complex compared to other small bowel segments. *Colon has haustrations* - This statement is **true**. The colon is characterized by sacculations known as **haustra**, which give it a segmented appearance on contrast radiographs. - Haustrations are due to the arrangement of the taeniae coli and contribute to the churning and mixing of colonic contents. *Jejunum is feathery* - This statement is **true**. The jejunum is known for its prominent, closely packed circular folds (plica circulares or **valves of Kerckring**), which give it a characteristic **feathery or herring-bone appearance** on contrast studies. - These folds increase the surface area for absorption.

Question 214: All of the following statements about spontaneous CSF leak are true, except:

A. Fluorescin Dye can be used intrathecally for diagnosis of site of leak
B. MRI (Gadolinium enhanced) T1 images are best for diagnosis of site of leak
C. Most common site of CSF leak is fovea ethmoidalis (Correct Answer)
D. Beta 2 transferrin estimation is highly specific for diagnosis

Explanation: ***Most common site of CSF leak is fovea ethmoidalis*** - The **fovea ethmoidalis** is actually the **most common site for iatrogenic injury** during sinus surgery, but is **rarely the source of spontaneous CSF leaks.** - **Spontaneous CSF leaks** typically occur in the **cribriform plate** or the **sphenoid sinus**, usually due to congenital defects or increased intracranial pressure. *Fluorescin Dye can be used intrathecally for diagnosis of site of leak* - **Intrathecal fluorescein** can be used to visually locate the site of a CSF leak during endoscopy. - However, it carries a small risk of **neurotoxicity**, including seizures, and is therefore used cautiously and often diluted. *MRI (Gadolinium enhanced) T1 images are best for diagnosis of site of leak* - **High-resolution CT cisternography** with intrathecal contrast is generally considered the **gold standard** for precisely localizing CSF leaks, especially bony defects. - While MRI can show fluid collections and some dural defects, it is often **less definitive** for pinpointing the exact leak site compared to CT cisternography. *Beta 2 transferrin estimation is highly specific for diagnosis* - **Beta-2 transferrin** is a highly specific marker for CSF, as it is found almost exclusively in CSF, perilymph, and aqueous humor. - Its presence in nasal or ear discharge definitively confirms the fluid as CSF, making it a very reliable diagnostic test.

Question 215: Phlebography refers to the contrast examination of which of the following?

A. Veins (Correct Answer)
B. Lymphatics
C. Pulmonary circulation
D. Arteries

Explanation: ***Veins*** - **Phlebography**, also known as venography, is a medical imaging technique that uses a **contrast medium** injected into a vein to visualize the venous system. - This procedure is primarily used to detect conditions such as **deep vein thrombosis (DVT)** or venous insufficiency. *Lymphatics* - The contrast examination of lymphatic vessels is called **lymphography** or lymphangiography, which is distinct from phlebography. - Lymphography helps to visualize the **lymphatic system** to detect conditions like lymphoma or lymphatic obstruction. *Pulmonary circulation* - The examination of pulmonary circulation typically involves techniques like a **pulmonary angiogram** or **CT pulmonary angiography (CTPA)**, which are used to visualize the pulmonary arteries and veins. - These methods are distinct from phlebography and focus on detecting conditions such as **pulmonary embolism**. *Arteries* - The contrast examination of arteries is known as **arteriography** or angiography, which involves injecting contrast into an artery. - Angiography is used to diagnose arterial diseases like **atherosclerosis**, aneurysms, or blockages.

Question 216: I/V contrast is not used in -

A. IVP
B. Myelography (Correct Answer)
C. MRI
D. CT scan

Explanation: ***Myelography*** - Myelography involves injecting contrast material directly into the **subarachnoid space** of the spinal canal to visualize nerve roots and the spinal cord, and therefore does not use intravenous contrast. - The contrast in myelography is typically **iodinated non-ionic contrast** injected intrathecally, not intravenously. *IVP* - **Intravenous Pyelogram (IVP)** is a radiological procedure that specifically uses **intravenous iodinated contrast** to visualize the kidneys, ureters, and bladder. - The contrast is excreted by the kidneys, highlighting the urinary tract structures on X-ray images. *MRI* - While many MRI scans do not require contrast, **intravenous gadolinium-based contrast agents** are commonly used to enhance visualization of certain pathologies like tumors, inflammation, or vascular anomalies. - The contrast is administered intravenously to accumulate in areas with increased vascularity or disrupted blood-brain barrier. *CT scan* - **CT scans** frequently utilize **intravenous iodinated contrast** to improve the visibility of blood vessels, organs, and various lesions like tumors or inflammatory processes. - The contrast enhances density differences between tissues, making pathologies more conspicuous.

Question 217: Angiographically, the typical "beaded" or "pile of plates" appearance involving the internal carotid artery is seen in -

A. Fibromuscular dysplasia (Correct Answer)
B. Takayasu's Disease
C. Non-specific aorto-arteritis
D. Rendu-Osler-Weber Disease

Explanation: ***Fibromuscular dysplasia*** - This condition is characterized by **abnormal cell growth within the walls of arteries**, leading to areas of narrowing (**stenosis**) and widening (**aneurysms**), which creates the classic "**beaded**" or "**pile of plates**" appearance on angiography. - While it can affect various arteries, the **renal arteries** and **internal carotid arteries** are most commonly involved. *Takayasu's Disease* - This is a **granulomatous vasculitis** primarily affecting the aorta and its major branches, leading to **stenosis, occlusion, or aneurysm formation**. - It does not typically present with the "beaded" appearance; instead, it causes more **long-segment, smooth narrowing or occlusion** of vessels. *Non-specific aorto-arteritis* - This is a general term often used synonymously with Takayasu's arteritis, referring to **inflammation of the aorta and large arteries**. - The angiographic findings would be similar to Takayasu's, including **stenosis and occlusion** of large vessels, without the characteristic "beaded" pattern. *Rendu-Osler-Weber Disease* - Also known as **hereditary hemorrhagic telangiectasia**, this is an **autosomal dominant disorder** characterized by the formation of **arteriovenous malformations (AVMs)** and **telangiectasias** in various organs. - The vascular abnormalities are **dilatations and direct connections** between arteries and veins, not stenotic and aneurysmal segments producing a "beaded" appearance.

Question 218: A dense persistent nephrogram may be seen in all of the following except:

A. Severe hydronephrosis
B. Dehydration
C. Acute ureteral obstruction
D. Systemic hypertension (Correct Answer)

Explanation: ***Systemic hypertension*** - **Systemic hypertension** is not typically associated with a dense, persistent nephrogram on imaging. While chronic hypertension can cause renal damage, it does not directly lead to the characteristic prolonged parenchymal enhancement. - A dense, persistent nephrogram suggests impaired contrast excretion or increased reabsorption, neither of which is a primary manifestation of systemic hypertension itself. *Severe hydronephrosis* - **Severe hydronephrosis** leads to impaired urine flow and delayed transit of contrast medium through the renal tubules, resulting in a persistent nephrogram. - The dilated collecting system and compressed parenchyma can retain contrast for an extended period due to reduced glomerular filtration rate (GFR) in the affected kidney. *Dehydration* - In cases of **dehydration**, the kidneys attempt to conserve water, leading to increased reabsorption of water from the renal tubules. - This process can concentrate the contrast medium within the tubules, resulting in a denser and more persistent nephrogram as it slowly transits through the kidney. *Acute ureteral obstruction* - **Acute ureteral obstruction** causes a build-up of pressure within the renal collecting system, impairing glomerular filtration and slowing the passage of contrast. - The contrast medium remains within the renal parenchyma for a prolonged period due to the blockage, leading to a dense and persistent nephrogram and delayed excretion.

Question 219: A 45-year-old patient presents with jaundice, and an MRI shows a dilated common bile duct. Which modality is preferred for further evaluation and management?

A. Ultrasound
B. CT scan
C. ERCP (Correct Answer)
D. HIDA scan

Explanation: ***ERCP*** - **Endoscopic retrograde cholangiopancreatography (ERCP)** allows direct visualization of the **biliary and pancreatic ducts** and can simultaneously be used for therapeutic interventions like **stone removal** or **stent placement** in cases of obstruction. - Given the patient's **jaundice** and a **dilated common bile duct (CBD)** on MRI, ERCP is the most appropriate next step for definitive diagnosis and treatment of potential CBD obstruction. - ERCP combines diagnostic capabilities with therapeutic options, making it the preferred choice when intervention is likely needed. *Ultrasound* - An initial ultrasound is often used to detect **biliary dilation** and obvious stones, but it does not provide the detailed luminal view of the bile duct needed for definitive diagnosis or intervention in a dilated CBD. - Its sensitivity can be limited by **bowel gas** and **operator dependence**, and it cannot perform therapeutic maneuvers. - In this case, ultrasound would add little value since MRI has already demonstrated CBD dilation. *CT scan* - A **CT scan** can provide excellent anatomical detail of the abdomen and help identify the cause of **CBD dilation**, such as a **pancreatic head mass** or **large gallstones**. - However, it has limitations in detecting small **intraductal stones** or subtle strictures compared to direct cholangiography and cannot perform therapeutic interventions. - CT would be redundant after MRI in most cases. *HIDA scan* - A **HIDA scan** (hepatobiliary iminodiacetic acid scan) is primarily used to assess **gallbladder function** and diagnose **acute cholecystitis**. - It is not the preferred modality for evaluating the cause of **biliary obstruction** when dilatation of the CBD is already confirmed, as it does not provide detailed anatomical information about the stricture or stone and offers no therapeutic capability.

Question 220: Which imaging modality is the most sensitive for detecting early ectopic pregnancy?

A. Transabdominal ultrasound
B. Transvaginal ultrasound (Correct Answer)
C. MRI
D. CT scan

Explanation: ***Transvaginal ultrasound*** - **Transvaginal ultrasound (TVUS)** provides higher resolution imaging of pelvic organs due to closer proximity to the uterus and adnexa. - This allows for earlier and more accurate detection of an **extrauterine gestational sac** or adnexal mass characteristic of an early ectopic pregnancy. *Transabdominal ultrasound* - **Transabdominal ultrasound (TAUS)** offers lower resolution compared to TVUS, especially in early pregnancy. - It may miss small ectopic pregnancies or fail to accurately characterize a subtle adnexal mass. *MRI* - **MRI** is not typically the first-line imaging modality for suspected ectopic pregnancy due to its higher cost, longer scan time, and limited accessibility in emergency settings. - While it can provide detailed anatomical information, its sensitivity for very early ectopic pregnancies is not superior to TVUS. *CT scan* - **CT scans** involve ionizing radiation, which is generally avoided in pregnancy unless absolutely necessary. - It is not as effective as ultrasound in visualizing the early gestational sac or adnexal structures for ectopic pregnancy diagnosis.

Practice by Chapter

Iodinated Contrast Media

Practice Questions

MRI Contrast Agents

Practice Questions

Ultrasound Contrast Agents

Practice Questions

Adverse Reactions to Contrast Media

Practice Questions

Management of Contrast Reactions

Practice Questions

Contrast-Induced Nephropathy

Practice Questions

Barium Studies

Practice Questions

Intravenous Urography

Practice Questions

Angiography Techniques

Practice Questions

Lymphangiography

Practice Questions

Contrast Administration Protocols

Practice Questions

Pretesting and Premedication

Practice Questions

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