Contrast and Radiological Procedures Practice Questions

Q: CECT is least useful as a diagnostic tool for:

Subclavian steal syndrome. ***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

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

Lower true occlusal. ***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.

Q: Which of the following investigations is contraindicated in patients with metallic foreign body?

MRI. ***MRI*** - Magnetic resonance imaging (MRI) uses a powerful **magnetic field** and radio waves to create detailed images of organs and tissues. - The strong magnetic field can cause **ferromagnetic metallic objects** to move, heat up, or malfunction, posing a significant safety risk. *CT Scan* - A CT scan uses **X-rays** to produce cross-sectional images of the body and is generally safe in the presence of metallic foreign bodies. - While metallic objects can cause **artifacts** (streaks or distortions) in CT images, this does not pose a direct safety risk to the patient. *VER* - **Visual Evoked Response (VER)**, also known as VEP (Visual Evoked Potential), is an electrophysiological test that measures the electrical activity of the brain in response to visual stimuli. - It does not involve strong magnetic fields or radiation and is therefore **safe** for patients with metallic foreign bodies. *ERG* - An **Electroretinogram (ERG)** measures the electrical responses of the retina to light stimulation, assessing retinal function. - It is a non-invasive test that does not use magnetic fields or X-rays and is **not contraindicated** in the presence of metallic foreign bodies.

Q: "Adder Head" appearance is found in:

IVP. ***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**.

Q: Reverse 3 sign in barium swallow is seen in:

Coarctation of aorta. ***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.

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

Sialography. **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.

Q: On barium swallow the grade IV esophageal varices appear as

Mucosal folds below the carina. ***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

Q: Which of the following is considered an absolute contraindication for MRI in most clinical scenarios?

Pacemaker. ***Pacemaker*** - The strong magnetic fields and radiofrequency pulses of **MRI** can interfere with the function of a **pacemaker**, potentially causing device malfunction, dislodgement, or heating of leads, which can be life-threatening. - While some newer pacemakers are MRI-conditional, the presence of an older or non-MRI-conditional pacemaker is an **absolute contraindication** to MRI. *Claustrophobia* - **Claustrophobia** is a relative contraindication or a challenge for MRI, often managed with sedation or open MRI scanners, but it does not pose an immediate physical threat. - It affects patient comfort and compliance but is not an **absolute contraindication** in terms of safety. *Penile prosthesis* - Most modern **penile prostheses** are made of MRI-compatible materials and are generally safe for MRI. - While some older devices might cause artifacts, they do not typically pose a significant safety risk during an **MRI** scan. *Joint replacement* - **Joint replacements**, especially newer ones, are often made of non-ferromagnetic materials and are increasingly becoming MRI-safe. - While older or certain types of metallic implants can cause **image artifacts**, they are not an **absolute contraindication** for MRI unless the material is known to be ferromagnetic and prone to movement or heating.

Q: All of the following are contrast radiographs except:

Tomography. ***Tomography*** - **Tomography** (e.g., CT scan) involves imaging structures in "slices" using X-rays but does not inherently require contrast medium for basic imaging. - While contrast material can be used in tomography to enhance specific structures, the technique itself is not exclusively a **contrast radiograph**. *Arthrography* - **Arthrography** is a type of contrast radiograph where a contrast medium is injected directly into a joint space to visualize soft tissue structures like ligaments, menisci, and articular cartilage. - The use of contrast is fundamental to distinguish these structures, which are not visible on plain X-rays. *Arthrotomography* - **Arthrotomography** combines arthrography with tomography, meaning a contrast agent is injected into a joint, and then tomographic slices are obtained. - This technique provides detailed cross-sectional images of the joint with enhanced contrast from the injected medium. *Sialography* - **Sialography** is a contrast radiograph procedure used to visualize the salivary ducts and glands. - A contrast medium is injected into the ductal system to identify obstructions, strictures, or inflammation within the salivary glands.

Q: All of the following are indications for cystogram, EXCEPT:

Polycystic kidney disease. ***Polycystic kidney disease*** - A cystogram evaluates the bladder and urethra, not the kidneys. **Polycystic kidney disease** primarily affects the **kidneys**, causing cysts to form within them, and is typically diagnosed with ultrasound, CT, or MRI. - A cystogram would not provide relevant information for the diagnosis or management of polycystic kidney disease. *Bladder rupture* - A cystogram is a primary diagnostic tool for **bladder rupture**, enabling visualization of contrast extravasation outside the bladder. - It helps determine the location and extent of the rupture, guiding subsequent management. *Stress incontinence* - A cystogram, particularly a **voiding cystourethrogram (VCUG)**, can be used to assess bladder and urethral function during voiding, which is relevant for evaluating **stress incontinence**. - It can help identify anatomical abnormalities or dynamic changes contributing to urine leakage. *Ca bladder* - A cystogram can reveal bladder wall irregularities, filling defects, or masses suggestive of **bladder carcinoma (Ca bladder)**. - While cystoscopy with biopsy is definitive, a cystogram can be a useful initial imaging study to delineate tumor extent or identify other suspicious areas.

Question 1

CECT is least useful as a diagnostic tool for:

Accepted Answer

Subclavian steal syndrome

Answer

Glomus jugulare

Answer

Carotid body tumor

Answer

Juvenile angiofibroma

Question 2

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

Accepted Answer

Lower true occlusal

Answer

Lower oblique occlusal

Answer

Lower topographic occlusal

Answer

Vertex occlusal

Question 3

Which of the following investigations is contraindicated in patients with metallic foreign body?

Accepted Answer

MRI

Answer

CT Scan

Answer

VER

Answer

ERG

Question 4

"Adder Head" appearance is found in:

Accepted Answer

IVP

Answer

X-ray

Answer

CT

Answer

USG

Question 5

Reverse 3 sign in barium swallow is seen in:

Accepted Answer

Coarctation of aorta

Answer

Patent ductus arteriosus

Answer

Double aortic arch

Answer

Aberrant right subclavian artery

Question 6

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

Accepted Answer

Sialography

Answer

Angiogram

Answer

Tomography

Answer

Ultrasound

Question 7

On barium swallow the grade IV esophageal varices appear as

Accepted Answer

Mucosal folds below the carina

Answer

Mucosal folds at the carina

Answer

Mucosal folds above the carina

Answer

A thick band

Question 8

Which of the following is considered an absolute contraindication for MRI in most clinical scenarios?

Accepted Answer

Pacemaker

Answer

Claustrophobia

Answer

Penile prosthesis

Answer

Joint replacement

Question 9

All of the following are contrast radiographs except:

Accepted Answer

Tomography

Answer

Arthrography

Answer

Arthrotomography

Answer

Sialography

Question 10

All of the following are indications for cystogram, EXCEPT:

Accepted Answer

Polycystic kidney disease

Answer

Bladder rupture

Answer

Stress incontinence

Answer

Ca bladder

Contrast and Radiological Procedures — MCQs

Contrast and Radiological Procedures — MCQs

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