Radiologic landmarks Practice Questions

Question 1

A 27-year-old male presents to the Emergency Room as a code trauma after being shot in the neck. En route, the patient's blood pressure is 127/73 mmHg, pulse is 91/min, respirations are 14/min, and oxygen saturation is 100% on room air with GCS of 15. On physical exam, the patient is in no acute distress; however, there is an obvious entry point with oozing blood near the left lateral neck above the cricoid cartilage with a small hematoma that is non-pulsatile and stable since arrival. The rest of the physical exam is unremarkable. Rapid hemoglobin returns back at 14.1 g/dL. After initial resuscitation, what is the next best step in management?

Accepted Answer

CT angiography

Answer

Bedside neck exploration

Answer

Conventional angiography

Answer

MRI

Answer

Plain radiography films

Question 2

A 36-year-old male is taken to the emergency room after jumping from a building. Bilateral fractures to the femur were stabilized at the scene by emergency medical technicians. The patient is lucid upon questioning and his vitals are stable. Pain only at his hips was elicited. Cervical exam was not performed. What is the best imaging study for this patient?

Accepted Answer

Computed tomography (CT) scan of cervical spine, hips, and lumbar area

Answer

AP and lateral radiographs of hips

Answer

Lateral radiograph (x-ray) of hips

Answer

Magnetic resonance imaging (MRI) of hips, knees, lumbar, and cervical area

Answer

Anterior-posterior (AP) and lateral radiographs of hips, knees, lumbar, and cervical area

Question 3

A 36-year-old woman comes to the physician for a 2-month history of urinary incontinence and a vaginal mass. She has a history of five full-term normal vaginal deliveries. She gave birth to a healthy newborn 2-months ago. Since then she has felt a sensation of vaginal fullness and a firm mass in the lower vagina. She has loss of urine when she coughs, sneezes, or exercises. Pelvic examination shows an irreducible pink globular mass protruding out of the vagina. A loss of integrity of which of the following ligaments is most likely involved in this patient's condition?

Accepted Answer

Cardinal ligament of the uterus

Answer

Infundibulopelvic ligament

Answer

Broad ligament of the uterus

Answer

Round ligament of uterus

Answer

Uterosacral ligament

Question 4

A 42-year-old woman comes to the physician because of a 12 month history of progressive fatigue and shortness of breath with exertion. Five years ago, she emigrated from Eastern Europe. She has smoked one pack of cigarettes daily for 20 years. She has a history of using methamphetamines and cocaine but quit 5 years ago. Vital signs are within normal limits. Physical examination shows jugular venous pulsations 9 cm above the sternal angle. The lungs are clear to auscultation. There is a normal S1 and a loud, split S2. An impulse can be felt with the fingers left of the sternum. The abdomen is soft and nontender. The fingertips are enlarged and the nails are curved. There is pitting edema around the ankles bilaterally. An x-ray of the chest shows pronounced central pulmonary arteries and a prominent right heart border. Which of the following is most likely to confirm the diagnosis?

Accepted Answer

Right-heart catheterization

Answer

CT angiography

Answer

Serologic testing

Answer

Doppler echocardiography

Answer

High-resolution CT of the lung

Question 5

A 65-year-old man with a 40-pack-year smoking history presents with hemoptysis and a persistent cough. Chest CT shows a 3.5 cm centrally located mass in the right main bronchus. Positron emission tomography confirms a malignant nodule. Bronchoscopy with transbronchial biopsy is performed and a specimen sample of the nodule is sent for frozen section analysis. The tissue sample is most likely to show which of the following tumor types?

Accepted Answer

Squamous cell carcinoma

Answer

Carcinoid tumor

Answer

Metastasis of colorectal cancer

Answer

Small cell lung carcinoma

Answer

Large cell carcinoma

Question 6

A 27-year-old soldier is brought to the emergency department of a military hospital 20 minutes after being involved in a motor vehicle accident during a training exercise. He was an unrestrained passenger. On arrival, he has shortness of breath and chest pain. He appears pale and anxious. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 100/65 mm Hg. He is alert and oriented to person, place, and time. Examination shows pale conjunctivae and mucous membranes. There is bruising on the chest, extremities, and abdomen. The lungs are clear to auscultation. He has normal heart sounds and flat neck veins. The abdomen is flat, soft, and mildly tender. The remainder of the physical examination shows no abnormalities. High-flow oxygen is applied, and intravenous fluid resuscitation is begun. A chest x-ray is obtained. Which of the following is the most appropriate next step in management?

Accepted Answer

CT scan of the chest with contrast

Answer

Placement of a chest tube

Answer

Pericardiocentesis

Answer

Abdominal ultrasonography

Answer

Intubation with positive pressure ventilation

Question 7

A 72-year-old man presents to his physician’s office with complaints of a cough and painful breathing for the last 2 months. He says that he has also observed a 5 kg (11 lb) weight loss during the past month. He is relatively healthy but the sudden change in his health worries him. Another problem that he has been facing is the swelling of his face and arms at unusual times of the day. He says that the swelling is more prominent when he is supine. He has also lately been experiencing difficulty with his vision. He consumes alcohol occasionally and quit smoking last year following a 25-year history of smoking. On examination, the patient is noted to have distended veins in the chest and arms. His jugular veins are distended. Physical examination shows ptosis of the right eye and miosis of the right pupil. His lungs are clear to auscultation. He is sent for an X-ray for further evaluation of his condition. Which of the following is the most likely site for the detection of the nodule on CT scan?

Accepted Answer

Right upper lobe

Answer

Brain stem metastasis

Answer

Left upper lobe

Answer

Central hilar region

Answer

Peripheral bronchial region

Question 8

A 40-year-old woman is brought to the emergency department by a paramedic team from the scene of a motor vehicle accident where she was the driver. The patient was restrained by a seat belt and was unconscious at the scene. On physical examination, the patient appears to have multiple injuries involving the trunk and extremities. There are no penetrating injuries to the chest. As part of her trauma workup, a CT scan of the chest is ordered. At what vertebral level of the thorax is this image from?

Accepted Answer

T8

Answer

T1

Answer

T6

Answer

T4

Answer

T5

Question 9

A 60-year-old post-menopausal female presents to her gynecologist with vaginal bleeding. Her last period was over 10 years ago. Dilation and curettage reveals endometrial carcinoma so she is scheduled to undergo a total abdominal hysterectomy and bilateral salpingo-oophorectomy. During surgery, the gynecologist visualizes paired fibrous structures arising from the cervix and attaching to the lateral pelvic walls at the level of the ischial spines. Which of the following vessels is found within each of the paired visualized structure?

Accepted Answer

Uterine artery

Answer

Vaginal artery

Answer

Superior vesical artery

Answer

Artery of Sampson

Answer

Ovarian artery

Question 10

A 21-year-old man comes to the physician for a follow-up examination. Four days ago, he injured his right knee while playing soccer. Increased laxity of the right knee joint is noted when the knee is flexed to 30° and an abducting force is applied to the lower leg. The examination finding in this patient is most likely caused by damage to which of the following structures?

Accepted Answer

Medial collateral ligament

Answer

Anterior cruciate ligament

Answer

Posterior cruciate ligament

Answer

Lateral collateral ligament

Answer

Lateral meniscus

Radiologic landmarks

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Lessons

Skeletal radiologic landmarks

Thoracic radiologic landmarks

Cardiac radiologic landmarks

Abdominal radiologic landmarks

Neurological radiologic landmarks

Pelvic radiologic landmarks

Spinal radiologic landmarks

Musculoskeletal radiologic landmarks

Vascular radiologic landmarks

Contrast-enhanced landmark identification

Practice Questions

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About Radiologic landmarks for USMLE

Lessons in Radiologic landmarks

Master Radiologic landmarks