Contrast and Radiological Procedures Practice Questions

Q: Vesicoureteric reflux is diagnosed by which of the following methods?

Micturating cystography. ***Micturating cystography*** - **Micturating cystography** (also known as voiding cystourethrography or VCUG) is the gold standard for diagnosing and grading **vesicoureteric reflux (VUR)**. - It involves filling the bladder with contrast medium via a catheter and taking X-ray images during bladder filling and **voiding** to visualize the retrograde flow of urine into the ureters. *Ultrasound bladder* - While ultrasound can assess bladder shape, emptying, and the presence of hydronephrosis (dilation of the renal pelvis and calyces due to urine obstruction), it **cannot directly visualize urine reflux** from the bladder to the ureters. - It is often used as a screening tool or to assess for complications of VUR but not for diagnosis of VUR itself. *Intravenous pyelogram* - **Intravenous pyelogram (IVP)**, also known as intravenous urography (IVU), involves injecting contrast material into a vein and taking X-rays as it's filtered by the kidneys and passes through the urinary tract. - While it can assess kidney structure, collecting systems, and patency of ureters, it is **not ideal for demonstrating VUR** because it primarily visualizes antegrade flow and is not performed during the critical voiding phase. *Magnetic resonance imaging* - **Magnetic resonance imaging (MRI)** provides detailed anatomical information and can be used to evaluate renal parenchyma or complex urinary tract anomalies. - However, MRI is **not the preferred or standard method for diagnosing VUR** due to its limitations in visualizing dynamic reflux during voiding and its higher cost and longer imaging time compared to micturating cystography.

Q: The Barium Swallow examination shows a filling defect in the esophagus. What is the most probable diagnosis?

Esophageal Carcinoma. ***Esophageal Carcinoma*** - A filling defect on a barium swallow study, especially with irregular borders and luminal narrowing, is highly suggestive of an **esophageal carcinoma**. - The image appears to show an **irregular, obstructing lesion** that displaces the barium column, characteristic of a mass. *Esophageal Ring* - An esophageal ring, such as a **Schatzki ring**, typically presents as a thin, circumferential narrowing of the distal esophagus, forming a smooth, shelf-like indentation, which is not seen here. - Esophageal rings usually cause **intermittent dysphagia** to solids but do not present as a large, irregular filling defect. *Esophageal Tear* - An esophageal tear (e.g., **Mallory-Weiss tear**) is a mucosal laceration that would present with **hematemesis** and would typically appear as a linear defect or streak on a barium swallow if visible, not a filling defect. - A tear is not usually associated with a persistent mass effect or irregular luminal obstruction seen in the image. *Achalasia Cardia* - **Achalasia** is characterized by the failure of the lower esophageal sphincter to relax and **absent peristalsis** in the esophageal body, leading to a classic "bird's beak" or "rat tail" appearance on barium swallow due to distal narrowing and proximal dilation. - While it causes luminal narrowing, it does not typically present as an irregular filling defect within the lumen, but rather as a smooth tapering of the distal esophagus.

Q: Barium meal follow through is helpful in diagnosing -

Ileal stricture. ***Ileal stricture*** - A **barium meal follow-through** visualizes the small intestine, including the ileum, making it ideal for detecting **strictures** in this region. - The barium contrast can highlight narrowings or areas of abnormal transit time indicative of a stricture. *Colonic obstruction* - **Colonic obstruction** is better diagnosed with a **barium enema** (lower GI series) or a **CT scan**, as barium meal follow-through primarily evaluates the upper GI tract and small intestine. - Barium would typically not reach the colon in a timely or sufficient manner to definitively diagnose an obstruction originating there. *Rectal obstruction* - Similar to colonic obstruction, **rectal obstruction** is best assessed by a **barium enema** or **sigmoidoscopy/colonoscopy**, which directly visualize the rectum and distal colon. - A barium meal follow-through is unlikely to provide adequate detail for a definitive diagnosis in the rectum. *Esophageal obstruction* - **Esophageal obstruction** is primarily diagnosed with an **esophagram** (barium swallow), which specifically focuses on the esophagus. - While a barium meal often starts with an esophagram component, the "follow-through" aspect is for the small intestine, and dedicated esophageal imaging is more appropriate for obstruction.

Q: Percentage of renal stones which are radio-opaque:

80. ***80*** - Approximately **80%** of renal stones are radio-opaque, making them visible on X-rays and CT scans [1]. - This high percentage is primarily due to the composition of most stones, such as **calcium oxalate** and **calcium phosphate** [1]. *20* - Only **20%** of renal stones are typically radio-opaque, which is significantly lower than the actual statistic. - This option fails to account for the majority of stones that are indeed visible on radiographic imaging. *40* - A **40%** radio-opacity would indicate a much larger proportion of stones being less visible on imaging, which is inaccurate. - The range for radio-opaque stones is considerably higher, primarily due to common stone types. *60* - While **60%** might suggest a considerable portion of stones are radio-opaque, it still underestimates the actual prevalence. - The more accurate figure reflects that at least **80%** of stones show radio-opacity which aids in diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 491-492.

Q: Which of the following is NOT an indication for a barium meal X-ray?

Ischemic Colitis. ***Ischemic Colitis*** - Barium studies are **contraindicated** in suspected ischemic colitis due to the risk of **perforation** and the poor resolution of mucosal changes. - **CT angiography** or colonoscopy are preferred for diagnosing ischemic colitis. *Duodenal ulcer* - A barium meal X-ray can demonstrate the presence of a **duodenal ulcer** as a niche or crater, and also identify associated deformities like a **cloverleaf sign**. - While endoscopy is more definitive, barium studies were historically important for initial evaluation. *Carcinoma stomach* - Barium meal can reveal filling defects, **mucosal irregularities**, and **loss of distensibility** in the stomach, suggesting gastric carcinoma. - However, **endoscopy with biopsy** is the gold standard for definitive diagnosis. *Carcinoma head of pancreas* - Barium meal can indirectly show signs of a pancreatic head mass, such as a **widened duodenal C-loop** or a **"reversed 3" sign** (Frohberg's sign) due to extrinsic compression. - This is an indirect sign, and cross-sectional imaging like **CT or MRI** is superior for direct visualization and characterization of pancreatic masses.

Q: What is the primary purpose of the Caldwell view in radiology?

To visualize the frontal sinus. ***Correct: To visualize the frontal sinus*** - The Caldwell view, also known as the **occipitomental view with 15-23 degree caudal angulation**, is specifically designed to best demonstrate the **frontal sinuses and anterior ethmoid air cells**. - This projection minimizes superimposition of the **petrous ridges** over the frontal sinuses by projecting them below the level of the frontal sinuses, allowing for clear visualization. - The Caldwell view is a **PA (posteroanterior) projection** of the skull used primarily in sinus imaging. *Incorrect: To visualize the sphenoid sinus* - The sphenoid sinus is best visualized with the **lateral view** or the **submentovertex (SMV) view**. - The Caldwell view provides poor projection of the sphenoid sinus due to overlying bony structures. *Incorrect: To visualize the maxillary sinus* - The **Waters view** (occipitomental projection at 37-45°) is the primary projection for visualizing the maxillary sinuses, as it projects the petrous ridges below them. - While the maxillary sinuses are visible on a Caldwell view, they are often partially obscured by the petrous ridges. *Incorrect: To visualize the ethmoid sinus* - The ethmoid sinuses (particularly anterior ethmoid cells) are visible on the Caldwell view but are typically best evaluated with both **Caldwell and lateral views** together. - However, the **primary purpose** of the Caldwell view is frontal sinus visualization, not ethmoid assessment.

Q: A delayed intravenous urogram of a patient is given below. What is the likely diagnosis?

Pelviureteric junction obstruction. ***Pelviureteric junction obstruction*** - The image shows marked **dilatation of the renal pelvis and calyces** on the right side, with a relatively abrupt narrowing at the junction of the pelvis and ureter. - The delayed nature of the urogram suggests **impaired drainage** of contrast from the renal pelvis, accumulating proximal to the obstruction. *Putty kidney* - A "putty kidney" (or **autonecrotic kidney**) refers to a chronic, severely diseased kidney, often seen in end-stage **renal tuberculosis**, that has become calcified and non-functional. - This image demonstrates active contrast excretion and pelvicalyceal dilatation, not a calcified, non-functional organ. *Staghorn calculus* - A staghorn calculus is a **large, branched kidney stone** that occupies a significant portion of the renal collecting system. - While it can cause hydronephrosis, the image does not show a dense, radiopaque calculus filling the collecting system. *Cystic kidney* - **Cystic kidneys**, such as in polycystic kidney disease, are characterized by multiple fluid-filled sacs within the kidney parenchyma. - The image depicts dilatation of the collecting system, not diffuse cystic changes throughout the renal parenchyma.

Q: Identify the imaging modality and the location of pathology shown in the image.

MCU with Bulbar urethral stricture. ***MCU with Bulbar urethral stricture*** - The image shown is a **Micturating Cystourethrogram (MCU)** because the bladder is filled with contrast and the urethra is being visualized during urination. - There is a clear **narrowing (stricture)** in the **bulbar portion of the urethra**, appearing as a segment with reduced caliber, consistent with a bulbar urethral stricture. *MCU with penile stricture* - While it is an MCU, the stricture is located in the **bulbar urethra**, which is proximal to the penile (pendulous) urethra. - A penile stricture would be seen further distally in the urethra. *RGU with membranous stricture* - This is an **MCU**, not a Retrograde Urethrogram (RGU), which is performed by inserting contrast from the urethral meatus. In an MCU, the contrast flows antegrade from the bladder. - A **membranous stricture** would be located more proximally, within the deep perineal pouch, between the bulbar urethra and the prostatic urethra. *RGU with prostatic stricture* - As mentioned, this is an **MCU**, not an RGU. - A prostatic stricture would be located within the **prostatic urethra**, which is much more proximal than the stricture seen in this image.

Question 1

Vesicoureteric reflux is diagnosed by which of the following methods?

Accepted Answer

Micturating cystography

Answer

Ultrasound bladder

Answer

Intravenous pyelogram

Answer

Magnetic resonance imaging

Question 2

Which imaging modality is preferred for diagnosing placenta accreta in a 25-year-old pregnant woman at 20 weeks with a history of a previous cesarean delivery?

Accepted Answer

Transabdominal ultrasound

Answer

MRI

Answer

Transvaginal ultrasound

Answer

CT scan

Question 3

The Barium Swallow examination shows a filling defect in the esophagus. What is the most probable diagnosis?

Accepted Answer

Esophageal Carcinoma

Answer

Esophageal Ring

Answer

Esophageal Tear

Answer

Achalasia Cardia

Question 4

Barium meal follow through is helpful in diagnosing -

Accepted Answer

Ileal stricture

Answer

Colonic obstruction

Answer

Rectal obstruction

Answer

Esophageal obstruction

Question 5

Percentage of renal stones which are radio-opaque:

Accepted Answer

80

Answer

20

Answer

60

Answer

40

Question 6

Early and late suspected instrumental perforation of the oesophagus should first be assessed using?

Accepted Answer

Water soluble contrast swallow

Answer

CT Scan

Answer

MRI

Answer

Dilute barium swallow

Question 7

Which of the following is NOT an indication for a barium meal X-ray?

Accepted Answer

Ischemic Colitis

Answer

Duodenal ulcer

Answer

Carcinoma stomach

Answer

Carcinoma head of pancreas

Question 8

What is the primary purpose of the Caldwell view in radiology?

Accepted Answer

To visualize the frontal sinus

Answer

To visualize the sphenoid sinus

Answer

To visualize the maxillary sinus

Answer

To visualize the ethmoid sinus

Question 9

A delayed intravenous urogram of a patient is given below. What is the likely diagnosis?

Accepted Answer

Pelviureteric junction obstruction

Answer

Putty kidney

Answer

Staghorn calculus

Answer

Cystic kidney

Question 10

Identify the imaging modality and the location of pathology shown in the image.

Accepted Answer

MCU with Bulbar urethral stricture

Answer

MCU with penile stricture

Answer

RGU with membranous stricture

Answer

RGU with prostatic stricture

Contrast and Radiological Procedures — MCQs

Contrast and Radiological Procedures — MCQs

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