MRI Scan

MRI Scan

Q. 1 Double line sign on MRI is seen in:
 A AVN of hip
 B SCFE
 C TB hip
 D DDH
Q. 1 Double line sign on MRI is seen in:
 A AVN of hip
 B SCFE
 C TB hip
 D DDH
Ans. A

Explanation:

AVN of HIP

Clinically sectorial sign

X rays – crescent sign

MRI – double line sign

Treatment – core decompression/osteotomies/vascularized bone graft/replacement


Q. 2

A 20year female patient with 6th cranial nerve palsy on T2 weighted MRI shows a hyperintense lesion in cavernous sinus which shows homogenous contrast enhancement. Most probable diagnosis is?

 A

schwannoma

 B

meningioma

 C

cavernous sinus hemangioma

 D

astrocytoma

Q. 2

A 20year female patient with 6th cranial nerve palsy on T2 weighted MRI shows a hyperintense lesion in cavernous sinus which shows homogenous contrast enhancement. Most probable diagnosis is?

 A

schwannoma

 B

meningioma

 C

cavernous sinus hemangioma

 D

astrocytoma

Ans. A

Explanation:

Schwannoma [Ref:- Osborn Neuroradiology lle p501; CT and MRI of the Whole Body 4/e p162, 166; http://www.ajnr.org/cgi/content/full/25/2/280; http://www.ajnr.org/cgi/content/full/24/6/1148%5D

  • Common tumors within cavernous sinus are: Schwannoma, Meningioma and Metastasis. (Ref: Osborn Neuroradiology)
  • Cavernous sinus hemangioma is a very rare tumor of this region. (http://www.ajnr.org/cgi/content/ful1/24/6/1148)
  • All the cavernous sinus tumors can cause sixth nerve palsy (and proptosis). So the diagnosis is to be made on the basis of incidence and MR chaaracterstics.
  • MR characteristics:
  • Menigioma

Usually hypointense to isointense on TI-weighted and isointense to hyperintense with T2-weighted images. – Somebooks write that it is mostly isointense on T2 wt sequences.

Enhances homogenously on post contrast scans.

  • Schwannoma

– Mostly hypointense on T1 and hyperintense on T2.

Smaller tumors show homogenous density and strong homogenous enhancement. Larger tumors demonstrate heterogeneity of both density and contrast enhancement because of the presence of intratumoral cystic degeneration & xanthomatous changes.

  • Cavernous hemangioma

– Mostly hypointense on T1 and hyperintense on 72.

– Shows good homogenous contrast enhancement.

  • Thus meningioma can be ruled out as it usually isointense on T2. We are left with Schwannoma and Cavernous hemangioma. We would personally like to go with Schwannoma as it is one of the commonest tumors of the cavernous sinus and smaller tumors have homogenous enhancement. Cavernous hemangioma though matches more with the contrast enhancement characteristics, is a very rare tumor of this region.

Q. 3

20 yrs old female presents with proptosis and Abducens nerve palsy. On MRI scan, hyperintense lesions is seen on T2 weighted images within cavernous sinus which showed intense homogenous contrast enhancement. Most probable diagnosis is:

 A

Meningioma

 B

Astrocytoma

 C

Schwannoma

 D

Cavernous hemangioma

Q. 3

20 yrs old female presents with proptosis and Abducens nerve palsy. On MRI scan, hyperintense lesions is seen on T2 weighted images within cavernous sinus which showed intense homogenous contrast enhancement. Most probable diagnosis is:

 A

Meningioma

 B

Astrocytoma

 C

Schwannoma

 D

Cavernous hemangioma

Ans. A

Explanation:

 

Common tumors within cavernous sinus are: Schwannoma, Meningioma and Metastasis. (Ref. . Osborn Neuroradiology) Cavernous sinus hemangioma is a very rare tumor of this region. (hop://www.ajnr.orglegikontenilfid1/24/6/1148)

AU the cavernous sinus tumors can cause sixth nerve palsy (and proptosis). So the diagnosis is to be made on the basis of incidence and MR characteristics.

MR characteristics:

Mostly hypointense on T1 and hyperintense on T2.

Smaller tumors show homogenous density and strong homogenous enhancement. Larger rumors demonstrate heterogeneity of both density and contrast enhancement because of the presence of intratumoral cystic degeneration & xanthomatous changes.


Q. 4

An absolute contraindication of MRI is:

 A

Pacemaker

 B

Prosthetic cardiac valves

 C

Insulin pump

 D

Choclear implants

Q. 4

An absolute contraindication of MRI is:

 A

Pacemaker

 B

Prosthetic cardiac valves

 C

Insulin pump

 D

Choclear implants

Ans. A

Explanation:

Pacemaker [Ref: Harrison 17/e p2494; Grainger Diagnostic Radiology 4/e p122;

various websites-http://www.mr-tip.com/servl.php?ope=dbl &dbs=Prosthetic%20Heart%20Valves

http://www. imrser.org/PDF/Shellock.HeartValves.JMRLpdf; http ://www. mr­tip. com/se ry 1.php ?type = dh 1 &dbs= Prosthetic %20Heart %20Valves

;and journal- _RadioGraphic s 2004 ;24 : 1257- 1267

  • MR is considered among the safest imaging modalities for patients, even at very high field strengths, more than 3-4 tesla.
  • But Ferromagnetic objects under magnetic field can be vulnerable to

4 adverse effects:

  • Movement (causing structural injury),
  • Current conduction (potentially causing electrical shock),
  • Heating (possibly causing burn injury), and
  • Artifact generation
  • Serious injuries can be caused by attraction of ferromagnetic objects into the magnet, which would act as missiles if brought too close to the magnet.
  • Ferromagnetic implants, such as aneurysm clips, may torque (turn or twist) due to the magnetic field, causing damage to vessels and even death.
  • Metallic foreign bodies in the eye have moved and caused intraocular hemorrhage.
  • Pacemakers and pacemaker leads are a contraindication, as the pacemaker can malfunction and cause arrhythmia or even death.
  • However with growing expansion of MR, increasing number of implant medical devices are being MR safe. So newer pacemaker and aneurysm clips are being made which are MR safe.

Absolute Contraindications for the MRI scan:

  • Electronically, magnetically, and mechanically activated implants
  • Ferromagnetic or electronically operated active devices like automatic cardioverter defibrillators
  • Cardiac pacemakers
  • Metallic splinters in the eye
  • Ferromagnetic haemostatic clips in the central nervous system (CNS)

Patients with an implanted cardiac pacemaker have been scanned on rare occasions, but pacemakers are generally considered an absolute contraindication.

Relative Contraindications for the MRI scan:

  • Cochlear implants
  • Other pacemakers, e.g. for the carotid sinus
  • Insulin pumps and nerve stimulators
  • Lend wires or similar wires (MRI Safety risk)
  • Prosthetic heart valves (in high .fields, if dehiscence is suspected)
  • Haemostatic clips (body)
  • Nonierromagnetic stapedial implants
  • Women with a.first-trimester pregnancy
  • Tattoos (only a problem in higher-strength magnetic .field i.e. more than 3 tesla)

1Reflittp://www.mr-tip.com/se ry 1 .php?type=dbl &dbs= Prosthetic %20Heart%20Valvesi


Q. 5

The working of an MRI machine is based on the properties of which of the follwoing?

 A

Protons

 B

Electrons

 C

CO2

 D

O2

Q. 5

The working of an MRI machine is based on the properties of which of the follwoing?

 A

Protons

 B

Electrons

 C

CO2

 D

O2

Ans. A

Explanation:

The patient is placed in a strong magnetic field.

The protons (H-atoms) in the body align themselves in the body either in the same direction or in the opposite direction.

A strong radio signal is sent at the level where an image needs to be taken.

The vibration or spin of te atoms is used to record the tissue images. It is best suited for non-calcified tissue.

It is contraindicated with pacemaker and chips. It has no ionising radiation. It is generally not useful for lung and bone pathology.


Q. 6

Which is the absolute contraindication of MRI?

 A

Pacemaker

 B

Prosthetic cardiac valves

 C

Insulin pump

 D

Cochlear implants

Q. 6

Which is the absolute contraindication of MRI?

 A

Pacemaker

 B

Prosthetic cardiac valves

 C

Insulin pump

 D

Cochlear implants

Ans. A

Explanation:

MR imaging is contraindicated for patients with metal implants or foreign bodies, such as intracranial aneurysm clips, intraorbital metallic foci, cardiac pacemakers, or specific types of cardiac valves. 

In these instances, these objects may be dislodged or damaged by the magnetic field.
MR imaging may also be contraindicated for claustrophobic or uncooperative patients who may not respond to conscious sedation protocols.
 
Ref: Chen M.Y., Whitlow C.T. (2011). Chapter 1. Scope of Diagnostic Imaging. In M.Y. Chen, T.L. Pope, D.J. Ott (Eds), Basic Radiology, 2e.

Q. 7

A 25 year old female, known to be infected with HIV and a CD4 count 90 presented with complaints of altered sensorium following a partial seizure. Gadolinium enhanced MRI scan showed multiple ring enhancing lesions in both hemispheres, thalamus, pons, basal ganglia and cerebellum. The most probable diagnosis in this scenario is?

 A

Mycobacterium tuberculosis

 B

Multiple brain metastases

 C

Cryptococcal meningitis

 D

Pneumocystis infiltration of brain

Q. 7

A 25 year old female, known to be infected with HIV and a CD4 count 90 presented with complaints of altered sensorium following a partial seizure. Gadolinium enhanced MRI scan showed multiple ring enhancing lesions in both hemispheres, thalamus, pons, basal ganglia and cerebellum. The most probable diagnosis in this scenario is?

 A

Mycobacterium tuberculosis

 B

Multiple brain metastases

 C

Cryptococcal meningitis

 D

Pneumocystis infiltration of brain

Ans. A

Explanation:

HIV patients with low CD 4 counts if presents with multiple ring enhancing lesions is suggestive of Tuberculoma, Primary CNS lymphoma and Toxoplasmosis. In this scenario only TB is the given choice and hence the answer.


Q. 8

Which among the following appears as spinal cord edema in MRI scan?

 A

Myelodysplasia

 B

Spinal cord infarctions

 C

Myeloschisis

 D

Cord tumors

Q. 8

Which among the following appears as spinal cord edema in MRI scan?

 A

Myelodysplasia

 B

Spinal cord infarctions

 C

Myeloschisis

 D

Cord tumors

Ans. B

Explanation:

Most spinal cord infarctions are detected by MRI.
After a few days, there are obvious lesions on the T2 sequences, presumably reflecting edema that extends over several levels.
There may be slight enhancement after infusion of gadolinium.
MRI taken in the first hours or day is often normal.
In the chronic stages, the infarcted region collapses and has an attenuated signal on MRI.
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 44. Diseases of the Spinal Cord. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor’s Principles of Neurology, 9e.

Q. 9

A 40-years-old female patient presented with recurrent headaches. MRI showed an extra-axial, dural based and enhancing lesion. The most likely diagnosis is:

 A

Meningioma

 B

Glioma

 C

Schwannoma

 D

Pituitary’ adenoma

Q. 9

A 40-years-old female patient presented with recurrent headaches. MRI showed an extra-axial, dural based and enhancing lesion. The most likely diagnosis is:

 A

Meningioma

 B

Glioma

 C

Schwannoma

 D

Pituitary’ adenoma

Ans. A

Explanation:

Meningioma can present with headaches, seizures, or focal neurologic deficits.
On imaging studies they have a characteristic appearance usually consisting of a partially calcified, densely enhancing extra axial tumor arising from the dura.
Occasionally they may have a dural tail, consisting of thickened, enhanced dura extending like a tail from the mass.
 
Ref: DeAngelis L.M., Wen P.Y. (2012). Chapter 379. Primary and Metastatic Tumors of the Nervous System. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

Q. 10

A 36-year-old man with AIDS develops right-sided weakness involving the lower, but not the upper, limb. MRI scans reveal a ring-enhancing lesion within the white matter of the left frontal lobe. A biopsy showed coagulative necrosis of brain parenchyma with macrophage-rich chronic inflammatory infiltration admixed with microscopic cysts that contain characteristic bradyzoites. Which of the following is the most common source of this type of infection?

 A

Anopheles mosquitoes

 B

Bird droppings

 C

Cats

 D

Cooling systems

Q. 10

A 36-year-old man with AIDS develops right-sided weakness involving the lower, but not the upper, limb. MRI scans reveal a ring-enhancing lesion within the white matter of the left frontal lobe. A biopsy showed coagulative necrosis of brain parenchyma with macrophage-rich chronic inflammatory infiltration admixed with microscopic cysts that contain characteristic bradyzoites. Which of the following is the most common source of this type of infection?

 A

Anopheles mosquitoes

 B

Bird droppings

 C

Cats

 D

Cooling systems

Ans. C

Explanation:

Clues to the correct answer are the underlying disease (AIDS), which predisposes to opportunistic infections, the typical MRI appearance of the lesion (ring-enhancing mass), and the histopathologic features (presence of encysted bradyzoites).
In short, this patient has cerebral toxoplasmosis, which represents one of the most common opportunistic infections in AIDS. Toxoplasma gondii is a protozoan that infects humans who ingest the oocysts from cat feces or incompletely cooked lamb or pork.
Only immunosuppressed patients and fetuses are vulnerable to this infection. In the fetus, toxoplasmosis causes extensive damage to brain parenchyma and retina.

Toxoplasmosis associated with AIDS manifests with necrotizing lesions surrounded by chronic inflammation. A ring-enhancing lesion is a mass that contains a rim of contrast enhancement (bright signal on MRI) surrounding a dark core corresponding to central necrosis. In AIDS, the most frequent causes of a ring-enhancing lesion are primary brain lymphoma and toxoplasmosis.
 

Anopheles mosquitoes  transmit malaria parasites. Cerebral malaria is caused by Plasmodium falciparum, which is able to adhere to endothelial cells of small cerebral vessels. Vascular occlusion ensues, resulting in numerous small infarcts.
 
Bird droppings represent the vehicle of infection for two of the most common opportunistic fungal infections affecting immunocompromised patients: cryptococcosis and histoplasmosis. Cryptococcus neoformans causes meningoencephalitis, not intracerebral necrotic lesions. Histoplasma capsulatum rarely affects the brain. These fungi can be visualized in tissue sections by silver stains.
 
Cooling systems may harbor Legionella pneumophila, spreading the bacteria in aerosolized form. L. pneumoniae is a gram-negative bacterium that causes Legionnaire’s disease, a fatal form of pneumonia that first struck participants at a meeting of the American Legion. It has been reported in immunocompromised patients as well.
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 50. Sporozoa. In C.G. Ray, K.J. Ryan (Eds),Sherris Medical Microbiology, 5e.

Q. 11

Which of the following is the investigation of choice for assessment of depth of penetration and perirectal node involvement in rectal cancer?

 A

MRI scan

 B

CT scan pelvis

 C

Double contrast barium enema

 D

Transrectal ultrasound

Q. 11

Which of the following is the investigation of choice for assessment of depth of penetration and perirectal node involvement in rectal cancer?

 A

MRI scan

 B

CT scan pelvis

 C

Double contrast barium enema

 D

Transrectal ultrasound

Ans. A

Explanation:

Investigations for rectal carcinoma:

For Diagnosis:
  • Best diagnosed by sigmoidoscopy (rigid not flexible) and biopsy of tumour
  • Barium enema
For Staging:
  • TRUS (transrectal ultrasonography)
  • CT
  • MRI
TRUS (Transrectal Ultrasonography)
The depth of the tumour invasion can be accurately determined by TRUS, but it cannot detect cancer metastasis in lymph nodes (though it can detect enlarged lymph nodes, but it cannot predict if- cancer infiltration is present or not).
 
CT Scan
CT scan is also helpful for cancer extension, but again CT scan also cannot tell clearly about node invasion by cancer cell.
 
MRI Scan
It has become the most useful investigation tool (specially with the use of transrectal coils) for rectal carcinoma.

It can very well predict the invasion of tumour in rectum as well as lymph node invasion with high accuracy.
 
Ref: Maingot’s 11/e, Page 701.

Q. 12

A six year old boy presents to the emergency department with a painful limp. Clinical examination reveals tenderness in the femoral triangle and some limitation of hip movements. An X-ray was done which was normal. Which of the following should be the next course of action?

 A

Wait and Watch/Observation

 B

Ultrasonography

 C

Aspiration

 D

MRI Scan

Q. 12

A six year old boy presents to the emergency department with a painful limp. Clinical examination reveals tenderness in the femoral triangle and some limitation of hip movements. An X-ray was done which was normal. Which of the following should be the next course of action?

 A

Wait and Watch/Observation

 B

Ultrasonography

 C

Aspiration

 D

MRI Scan

Ans. D

Explanation:

Painful limp in a six year old boy with limitation of hip movements and tenderness in the groin region confirms a diagnosis of Perthe’s disease. MRI is the investigation of choice to include/exclude a diagnosis of Perthe’s disease.

Ref: A practical guide to pediatric emergency in medicine: caring for children in the emergency department, by N. Ewen Amieva Wang, Jamie Shandro, Page 490.


Q. 13

A 25 year old person presents with acute onset of fever and focal seizures. MRI scan shows hyperintensity in the temporal lobe and frontal lobe with enhancement. The most likely diagnosis is:

 A

Meningococcal Meningitis

 B

Herpes simplex Encephalitis

 C

Japanese Encephalitis

 D

None of the above

Q. 13

A 25 year old person presents with acute onset of fever and focal seizures. MRI scan shows hyperintensity in the temporal lobe and frontal lobe with enhancement. The most likely diagnosis is:

 A

Meningococcal Meningitis

 B

Herpes simplex Encephalitis

 C

Japanese Encephalitis

 D

None of the above

Ans. B

Explanation:

Person presenting with acute onset of fever, focal seizures and MRI showing  hyperintensity in the temporal lobe and frontal lobe is suffering from herpes simplex encephalitis.

It is the most common form of acute viral encephalitis. In adults it is caused by HSV1, in neonates and immunocompromised patients its caused by HSV2. Patients present with fever, headache, seizures and drowsiness. Which later evolves into stupor and coma. Lesions are primarily seen in the temporal lobe and ventral parts of frontal lobe.

EEG shows slow wave complexes at a frequency of 2-3 Hz,CSF- shows increased pressure, lymphocytosis and increased protein. PCR analysis of CSF for HSV provides definitve diagnosis. Treatment with antiviral can influence the prognosis and survival when started early.

Ref: Neuroimaging in Dementia By Frederik Barkhof, Page 247; Atlas of Human Infectious Diseases By Heiman, Page 229; Immunization in Practice: A Practical Guide for Health Staff By World Health Organization; Medicine By John S. Axford, C. A. O’Callaghan, Page110


Q. 14

Which of the following statements are FALSE about acoustic neuroma?

 A

Arises from the vestibular nerve

 B

Accounts for 10% of intracranial tumour in adults

 C

Dural tail present on MRI scan

 D

Originate in the internal auditory canal

Q. 14

Which of the following statements are FALSE about acoustic neuroma?

 A

Arises from the vestibular nerve

 B

Accounts for 10% of intracranial tumour in adults

 C

Dural tail present on MRI scan

 D

Originate in the internal auditory canal

Ans. C

Explanation:

Vestibular schwannomas or acoustic neuromas originate in the internal auditory canal from the inferior or superior portion of the vestibular nerve.

Acoustic neuromas account for 8% to 10% of all intracranial tumours in adults.

The lack of a dural tail on MRI differentiates acoustic neuromas from cerebellopontine angle meningiomas.

Most tumours are unilateral. Genetic association is with a lack of tumour suppressor gene on Chromosome 22


Q. 15

In MRI, images are produced due to 

 A

CO2

 B

N20

 C

K+

 D

H+ (proton)

Q. 15

In MRI, images are produced due to 

 A

CO2

 B

N20

 C

K+

 D

H+ (proton)

Ans. D

Explanation:

D i.e. H+ (proton)


Q. 16

In MRI the field used is

 A

0.05 tesla

 B

100 tesla

 C

1.1 tesla

 D

11 tesla

Q. 16

In MRI the field used is

 A

0.05 tesla

 B

100 tesla

 C

1.1 tesla

 D

11 tesla

Ans. C

Explanation:

C i.e. 1.1 tesla

– MRI is based on gyromagnetic property of proton (or hydrogen nucleus)Q, which is particularly favourable nucleus from MRI stand point and is present in virtually all biological material. Other nuclei of interest include- carbon (13C), phosphorus (31P), Sodium (23Na), Potassium (39K), helium (3He) & Xenon (129Xe) (all have odd number of protons or neutrons & possess a net charge).

– Magnetic field strength used for clinical imaging currently range from 0.02 Tesla (7) to 87Y2 as compared with earth’s magnetic field of 0.5 GaussQ. According to old books, MRI use magnetic field of 0.15 to 1.5 T (1,500 to 15,000 gauss).

M.C. contrast agent in MRI is Gadolinium DTPAQ.


Q. 17

MRI is not better than CT for detection of :

 A

Ligament Injury

 B

Soft tissue tumors

 C

Meningeal pathology

 D

Calcified lesions

Q. 17

MRI is not better than CT for detection of :

 A

Ligament Injury

 B

Soft tissue tumors

 C

Meningeal pathology

 D

Calcified lesions

Ans. D

Explanation:

D i.e. Calcified lesions


Q. 18

All of the following about MRI are correct except: 

 A

MRI is contraindicated in patients with pacemakers 

 B

MRI is useful for evaluating bone marrow

 C

MRI is better for calcified lesions

 D

MRI is useful for localizing small lesione in the brain

Q. 18

All of the following about MRI are correct except: 

 A

MRI is contraindicated in patients with pacemakers 

 B

MRI is useful for evaluating bone marrow

 C

MRI is better for calcified lesions

 D

MRI is useful for localizing small lesione in the brain

Ans. C

Explanation:

C i.e. MRI is better for calcified lesions

– MRI is very poor in detection of calcification. It is inferior to CT scan, mammography and x-ray in detecting calcification. That is why it lags behind mammography in early detection of noninvasive ductal carcinoma in situ (DCIS)Q, which most commonly has microcalcification as its only presenting feature. And similarly it has a very limited role in detection of renal stones and gall stonesQ. However, it is important to note that only upto 60% of gall stones have enough calcium density (more than that of bile) to get visualized on CT. Becaus of its superior calcification detection abilities, MDCT is used in Agatston scoring (Coronary calcium scoring) of calcified plaques of coronary artery using coronary calcium as a surrogate marker to detect the presence and measure the amount of coronary atherosclerosis. Because with exception of patients with renal failure calcification of arteries occurs exclusively in context of atherosclerosis.

Similarly nonenhanced helical CT is superior to all other imaging modalities in diagnosis of urinary tract calculiQ but at the cost of higher radiation exposure.

Now there is no need to say that MRI is better that CT for evaluation of bone marrow, small brain lesions, meniscus/ ligament injuries, soft tissue tumors and meningeal pathology. But MRI is very poor in detection of calcification.


Q. 19

An absolute contraindication of MRI is:

 A

Pacemaker wires

 B

Intravascular stents

 C

Prosthetic cardiac valves

 D

Severe hypertension

Q. 19

An absolute contraindication of MRI is:

 A

Pacemaker wires

 B

Intravascular stents

 C

Prosthetic cardiac valves

 D

Severe hypertension

Ans. A

Explanation:

A i.e. Pacemaker Wires


Q. 20

Absolute C/I of MRI is-

 A

Pacemaker

 B

Preganancy at 1st trimester

 C

Aneurysmal clip

 D

a and c

Q. 20

Absolute C/I of MRI is-

 A

Pacemaker

 B

Preganancy at 1st trimester

 C

Aneurysmal clip

 D

a and c

Ans. D

Explanation:

A i.e. Pacemaker; C i.e. Aneurysmal clip


Q. 21

MRI rooms are shielded completely by a continuous sheet or wire mesh of copper or aluminum to shield the imager from external electromagnetic radiations, etc. It is called.

 A

Maxwell cage

 B

Faraday cage

 C

Edison’s cage

 D

Ohms cage

Q. 21

MRI rooms are shielded completely by a continuous sheet or wire mesh of copper or aluminum to shield the imager from external electromagnetic radiations, etc. It is called.

 A

Maxwell cage

 B

Faraday cage

 C

Edison’s cage

 D

Ohms cage

Ans. B

Explanation:

B i.e. Faraday cage

Faraday cage is an electrical apparatus designed to prevent the passage of electromagnetic wavesQ, either containing them in or excluding them from its interior space.

Mu – Copper foils, which can be applied as wall paper for electromagnetic shielding of rooms (MR1 Rooms, faraday chamber, computer rooms, EMC – test rooms, anechoic chambers etc), an existing room can be transformed easily into a Faraday cageQ with an attenuation level of 40 to 80 dB

For magnetic shielding, monitor protection & shielding of transformers & cable trunks MU- Ferro plates are 


Q. 22

Which of the following is not a MRI feature of Mesial temporal sclerosis?

 A

Atrophy of mammilary body

 B

Atrophy of fornix

 C

Blurring of Grey white matter junction of ipsilateral temporal lobe

 D

Atrohy of hippocampus

Q. 22

Which of the following is not a MRI feature of Mesial temporal sclerosis?

 A

Atrophy of mammilary body

 B

Atrophy of fornix

 C

Blurring of Grey white matter junction of ipsilateral temporal lobe

 D

Atrohy of hippocampus

Ans. C

Explanation:

C i.e. Blurring of Grey white matter junction of ipsilateral temporal lobe

Atrophy of hippocampus, fornix and mamillary body are established MRI findings in Mesial Temporal Sclerosis. Blurring of grey white matter at junction of ipsilateral temporal lobe is not listed as a feature of mesial temporal sclerosis.


Q. 23

Epidermoids can be differentiated from arachnoid cyst on MRI by:

 A

Contrast enhancement

 B

Smooth margins

 C

Restricted diffusion

 D

CSF signal on FLAIR

Q. 23

Epidermoids can be differentiated from arachnoid cyst on MRI by:

 A

Contrast enhancement

 B

Smooth margins

 C

Restricted diffusion

 D

CSF signal on FLAIR

Ans. C

Explanation:

C i.e. Restricted diffusion

Epidermoids can be differentiated from arachnoid cyst characteristically by hyper-intense diffusion weighted images because of restricted diffusion of epidermoid cystQ. FLAIR and proton images are less specific than DWI.


Q. 24

True about MRI/CT appearance of lateral meningocele:

 A

Solid dural masses

 B

Usually outside the spinal canal

 C

Widened neural foramen

 D

Generally there is no spinal cord compression & deformity

Q. 24

True about MRI/CT appearance of lateral meningocele:

 A

Solid dural masses

 B

Usually outside the spinal canal

 C

Widened neural foramen

 D

Generally there is no spinal cord compression & deformity

Ans. C

Explanation:

C i.e. Widened neural foramen 

–  Lateral meningocele is non solid, CSF containing leptomeningeal outpouching through widened neural foramen usually into paraspinal, intrathoracic spaceQ. And it is generally associated with spinal deformities like, posterior (dorsal) scalloping, erosion of pedicles, thinning of neural arch & ribs, widening of spinal canal & neural foramen and kyphoscoliosis.


Q. 25

Which of the following is the investigation of choice for assessment of depth of penetration and perirectal nodes in rectal cancer –

 A

Trans rectal ultrasound

 B

CT Scan pelvis

 C

MRI Scan

 D

Double contrast Barium enema

Q. 25

Which of the following is the investigation of choice for assessment of depth of penetration and perirectal nodes in rectal cancer –

 A

Trans rectal ultrasound

 B

CT Scan pelvis

 C

MRI Scan

 D

Double contrast Barium enema

Ans. C

Explanation:

Ans. is ‘c’ i.e., M.R.I. Scan


Q. 26

T1 and T2 images are a feature of which diagnostic test-

 A

Ultrasound

 B

C.T. scan

 C

Duplex scan

 D

MRI scan

Q. 26

T1 and T2 images are a feature of which diagnostic test-

 A

Ultrasound

 B

C.T. scan

 C

Duplex scan

 D

MRI scan

Ans. D

Explanation:

Ans. is ‘d’ i.e., MRI scan 


Q. 27

Acoustic neuroma of 1 cm diameter, the investigation of choice:

 A

CT Scan

 B

MRI Scan

 C

Plain X-ray Skull

 D

Air encephalography

Q. 27

Acoustic neuroma of 1 cm diameter, the investigation of choice:

 A

CT Scan

 B

MRI Scan

 C

Plain X-ray Skull

 D

Air encephalography

Ans. B

Explanation:

Q. 28

A young women with secondary amenorrhea and galactorrhea. MRI shows a tumour of < lOmm diameter in the pituitary fossa. Treatment is:

 A

Hormonal therapy for withdrawal bleeding

 B

Radiotherapy

 C

Chemotherapy

 D

Bromocriptine

Q. 28

A young women with secondary amenorrhea and galactorrhea. MRI shows a tumour of < lOmm diameter in the pituitary fossa. Treatment is:

 A

Hormonal therapy for withdrawal bleeding

 B

Radiotherapy

 C

Chemotherapy

 D

Bromocriptine

Ans. D

Explanation:

Answer is D (Bromocriptine):

Secondary Amenorrhea and galactorrhea in a young women with evidence of microadenoma (tumor I Omm) in the pituitary fossa suggest a diagnosis of prolactinoma.

Oral dopamine agonists (Dopamine or Cabergoline) are the treatment of choice for patients with prolactinomas.


Q. 29

A 25 year old person presents with acute onset of fever and focal seizures.

MRI scan shows hyperintensity in the temporal lobe and frontal lobe with enhancement.

The most likely diagnosis is:

 A

Meningococcal Meningitis

 B

Herpes simplex Encephalitis

 C

Japanese Encephalitis

 D

All

Q. 29

A 25 year old person presents with acute onset of fever and focal seizures.

MRI scan shows hyperintensity in the temporal lobe and frontal lobe with enhancement.

The most likely diagnosis is:

 A

Meningococcal Meningitis

 B

Herpes simplex Encephalitis

 C

Japanese Encephalitis

 D

All

Ans. B

Explanation:

Answer is B (Herpes simplex Encephalitis):

Hyperintensity in the temporal lobe and inferior frontal lobe on T2 weighted images with contrast enhancement is a charachteristic neuroanatomic pattern of involvement in Herpes simplex Encephalitis and in the presence of suggestive clinical features (fever / focal seizures) specifically suggests the diagnosis of HSV Encephalitis

‘Suspect Herpes Simplex Encephalitis in the setting of T2 rolon in lesions with enhancement in the temporal lobe in a patient presenting with altered mental status, seizures and /or fever’- Teaching Atlas of Brain Imaging ,2nd / 159

Herpes Simplex Encephalitis: Characteristic Anatomic Localization

HSV encephalitis has a charachteristic neuroanatomic pattern of involvement affecting primarily the temporal lobe and inferior frontal lobe (cingulate gyrus).

The virus preferentially involves the temporal lobes and often the frontal lobes (especially the cingulate gyrus)

(In most cases the involvement is unilateral, but contralateral involvement may also be seen and patient may present with asymmetric bilateral temporal lobe involvement)

  • Herpes Encephalitis is also often haemorrhagic although not always
  • This characteristic neuroanatomic pattern of involvement in Herpes Simplex Encephalitis can help in specifically suggesting the diagnosis of HSV encephalitis on MR scans.

MRI Scan Features of H.S.V. Encephalitis

  • Hyperintensitv on T2- wei2hted sequences (T2 prolonging lesions) within the medial temporal lobes (insula) and inferior frontal lobes (cingulate gyrus region)

(Note: Hypointensity is seen on T1 weighted images)

  • Enhancement of lesions with contrast. Enhancement of the meninges, cortex and white matter (Enhancement means that blood brain barrier has broken down and that the process is biologically active)

Q. 30

A middle aged female presents with prolonged history of back pain followed by slowly progressive weakness of both lower limbs, spasticity and recent onset difficulty in micturation. On neurological examination there is evidence of dorsal myelopathy. MRI scan of spine shows a well-defined mid-dorsal intradural homogenous contrast enhancing mass lesion. The likely diagnosis is:

 A

Intradural Lipoma

 B

Dermoid cyst

 C

Epidermoid cyst

 D

Spinal meningioma

Q. 30

A middle aged female presents with prolonged history of back pain followed by slowly progressive weakness of both lower limbs, spasticity and recent onset difficulty in micturation. On neurological examination there is evidence of dorsal myelopathy. MRI scan of spine shows a well-defined mid-dorsal intradural homogenous contrast enhancing mass lesion. The likely diagnosis is:

 A

Intradural Lipoma

 B

Dermoid cyst

 C

Epidermoid cyst

 D

Spinal meningioma

Ans. D

Explanation:

 

Answer is D (Spinal meningioma):

The clinical picture and MR] findings of an intradural, contrast-enhancing lesion in the dorsal spine are typical of spinal meningiontas.

`The typical clinical scenario of intraspinal meningiomas is a middle aged woman with signs and symptoms of cord or nerve root compression. The dorsal (Thoracic) spine is most commonly involved. At MR1 scan, the tumor typically appears as a well-circumscribed lesion iso-intense or slightly hypotense to the spinal cord. On T1 and T2 sequences with homogenous gadolinium (contrast) enhancement’ -Learning Musculoskeletal Imaging (Springer) 2010/101

Meningiomas are typically characterized by isointense homogenous contrast enhancement. Epidermoid cyst, Dermoid cysts and Lipomas do not show contrast enhancement.

Characteristic Features of Benign Extramedullary Spinal Tumors:

Characteristic

Meningioma

Schwannoma

Neurofibroma

Age of presentation

5th-7th decade

Sth decade

4th decade

Spinal level predominance

Thoracic (80%)

All levels evenly

Cervical (66%)

Multiplicity

Ito 2%

Rare unless NF2 associated

Common

Proportion or primary spinal

tumors

25%

–33%

3.5%

Gender predominance

Female (75-80%)

None

None

Associations

More commonly psammomatous

or transitional histologies

NF2, merlin/schwannomin

gene on chromosome 22

NF1, neurofibromin gene

on chromosome 17

NF1, neurofibromatosis type 1; NF2, neurofibromatosis type 2

Spinal Meningiomas: Review

  • Spinal meningiomas are believed to originate from arachnoid cap cells of neural crest or mesodermal origin (meningiomthelial cells).
  • Spinal meningiomas are primarily intradural tumors, although extradural meningiomas have been reported in 3-15% of cases.
  • Majority of spinal meningiomas are extramedullary intradural tumors.Q
  • Spinal meningiomas are the second most common spinal intradural tumors after nerve sheath tumors (Schwannomas) Schwannomas are the most common intradural spinal tumors.
  • Spinal meningiomas are rare in children and are primarily believed to be tumors of Adults. Spinal meningiomas can be found at any age but they are most commonly seen in the 5th to 7th decade. The mean age of diagnosis is –50 years. Most spinal meningiomas occur in woman (75-85%) Spinal meningiomas are most commonly seen in middle aged femalese
  • Spinal meningiomas may be seen in the cervical spine, thoracic spine or the lumbar spine, but are most frequently seen in the thoracic spine.
  • Within the spinal axis, meningiomas are most frequently seen in the thoracic/dorsal spine (70-80%)
  • Most meningiomas are slow growing benign tumors, however higher grade tumors with more aggressive behaviour compose as many as 10% of all meningiomas.
  • The most common and initial symptom of intraspinal meningiomas is pain’. This is followed by variable degree of neurological deterioration, causing defecits depending on tumor location.

Impairment of Autonomic pathways are generally uncommon but bowel or bladder involvement can occur as late findings with meningiomas

  • MRI is the investigation of choice for diagnosis of spinal meningiomas

At MRI the tumor typically appears as a well-circumscribed lesion iso-intense or slightly hypo-intense to the spinal cord on T I and T2 weighted images. MRI typically shows intense and near homogenous enhancement after contrast (homogenous gadolinium enhancement)

The ‘dural tail sign ‘ consisting of dural enhancement adjacent to dural attachment may he seen in spinal meningiomas but this is not specific to meningiomas and may be seen in other conditions like metastasis, sarcoidosis, lymphomas etc.

 


Q. 31

A patient presented with unilateral proptosis, which was compressible and increases on ending forward. No thrill or bruit was present. MRI shows a retro-orbital mass with enhancement. The likely diagnosis is:

 A

AV malformations

 B

Orbital encephalocoecle

 C

Orbital varix

 D

Neurofibromatosis

Q. 31

A patient presented with unilateral proptosis, which was compressible and increases on ending forward. No thrill or bruit was present. MRI shows a retro-orbital mass with enhancement. The likely diagnosis is:

 A

AV malformations

 B

Orbital encephalocoecle

 C

Orbital varix

 D

Neurofibromatosis

Ans. C

Explanation:

Ans. Orbital varix


Q. 32

Best diagnostic modality to diagnose avascular necrosis is:          

March 2007

 A

MRI scan

 B

CT scan

 C

X-ray

 D

USG

Q. 32

Best diagnostic modality to diagnose avascular necrosis is:          

March 2007

 A

MRI scan

 B

CT scan

 C

X-ray

 D

USG

Ans. A

Explanation:

Ans. A: MRI Scan

Avascular necrosis/ osteonecrosis/ aseptic (bone) necrosis/ ischemic bone necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. There are many causes of avascular necrosis such as:

  • Alcoholism
  • Excessive steroid use
  • Post trauma
  • Caisson disease (decompression sickness)
  • Vascular compression
  • Vasculitis
  • Thrombosis
  • Damage from radiation
  • Bisphosphonates (particularly the mandible)
  • Sickle cell anaemia
  • Gaucher’s Disease
  • Idiopathic (no cause is found).

Rheumatoid arthritis and lupus are also common causes of AVN.

Avascular necrosis most commonly affects the head of femur. Other common sites include the talus, scaphoid and the jaw. Avascular necrosis usually affects people between 30 and 50 years of age.

When it occurs in children at the femoral head, it is known as Legg-Calve-Perthes syndrome.

It is most oftenly diagnose clinically.

Because early X-rays are usually normal in the early stage of the disease, bone scintigraphy and MRI are the diagnostic modality of choice since both can detect minimal changes at early stages of the disease.

Late radiographic signs include a radiolucency area following the collapse of subchondral bone (crescent sign) and ringed regions of radiodensity


Q. 33

Contrast used for MRI:

September 2012, March 2013 (f, g)

 A

Iodine

 B

Gadolinium

 C

Metrazamide

 D

Omnipaque

Q. 33

Contrast used for MRI:

September 2012, March 2013 (f, g)

 A

Iodine

 B

Gadolinium

 C

Metrazamide

 D

Omnipaque

Ans. B

Explanation:

Ans. B i.e. Gadolinium

MRI

  • MC contrast agent used in MRI: Gadolinium DTPA

C/I to MRI:

– Cardiac pacemakers,

– Aneurysmal clips etc.

  • Faradays cage: MRI rooms are shielded by continuous sheets of copper or aluminium from interference by external electromagnetic radiation.

Q. 34

Initial IOC for intussesception is:  

March 2003

 A

X-ray

 B

USG

 C

Barium enema

 D

CT scan

Q. 34

Initial IOC for intussesception is:  

March 2003

 A

X-ray

 B

USG

 C

Barium enema

 D

CT scan

Ans. B

Explanation:

Ans. B i.e. USG


Q. 35

Investigation of choice in a patient brought with traumatic paraplegia:

March 2005

 A

Plain X-ray

 B

Myelography

 C

CT scan

 D

MRI scan

Q. 35

Investigation of choice in a patient brought with traumatic paraplegia:

March 2005

 A

Plain X-ray

 B

Myelography

 C

CT scan

 D

MRI scan

Ans. D

Explanation:

Ans. D: MRI Scan

Radiological examination shows no correlation between the severity of the injury on the X-rays and the degree of the neurological deficit.

CT scan may be indicated in cases with incomplete and increasing paralysis.

MRI scan has become the imaging modality of choice for these cases.

MRIs of the thoracolumbar spine provide information that is not available using CT scans.

Early in an injury, T1-weighted spin-echo (SE) axial and sagittal images may demonstrate the high signal intensity related to acute hemorrhage, including the rare complicating epidural hemorrhage.

Both T2-weighted fast SE (FSE) and fluid-attenuated inversion recovery (FLAIR) images demonstrate the high signal intensity associated with edema of bone marrow fat.

Gradient-echo T2-weighted images best outline the shape and structure of the vertebral body and the posterior spinal

elements.

These MRI sequences are superior to CT scans for detection of a posttraumatic herniated disk, ligamentous edema, and spinal cord compression.

The resolution of MRI used in the detection of spinal fractures is limited.

Although gradient-echo and T1-weighted SE images outline fractures well, minimally displaced fractures are difficult to see.


Q. 36

Radiation exposure occurs in all of the following except:    

September 2005

 A

CT scan

 B

MRI scan

 C

Fluoroscopy

 D

X-ray

Q. 36

Radiation exposure occurs in all of the following except:    

September 2005

 A

CT scan

 B

MRI scan

 C

Fluoroscopy

 D

X-ray

Ans. B

Explanation:

Ans. B: MRI Scan

MRI is a noninvasive imaging technique that does not involve exposure to ionizing radiation.

MR images of the soft-tissue structures of the body — such as the heart, liver and many other organs — is more likely in some instances to identify and accurately characterize diseases than other imaging methods. This detail makes MRI an invaluable tool in early diagnosis and evaluation of many focal lesions and tumors. MRI has proven valuable in diagnosing a broad range of conditions, including cancer, heart and vascular disease, and muscular and bone abnormalities. MRI enables the discovery of abnormalities that might be obscured by bone with other imaging methods. MRI allows physicians to assess the biliary system noninvasively and without contrast injection. The contrast material used in MRI exams is less likely to produce an allergic reaction than the iodine-based contrast materials used for conventional x-rays and CT scanning. MRI provides a noninvasive alternative to x-ray, angiography and CT for diagnosing problems of the heart and blood vessels.


Q. 37

Investigation of choice for diagnosing intra abdominal bleeding in an unstable patient:

September 2007

 A

CT scan omit

 B

MRI scan

 C

USG

 D

Diagnostic peritoneal lavage

Q. 37

Investigation of choice for diagnosing intra abdominal bleeding in an unstable patient:

September 2007

 A

CT scan omit

 B

MRI scan

 C

USG

 D

Diagnostic peritoneal lavage

Ans. C

Explanation:

Ans. C: USG


Q. 38

Ideal investigation for fistula-in-ano is:

March 2008

 A

Endoanal ultrasound

 B

MRI

 C

Fistulography

 D

CT scan

Q. 38

Ideal investigation for fistula-in-ano is:

March 2008

 A

Endoanal ultrasound

 B

MRI

 C

Fistulography

 D

CT scan

Ans. B

Explanation:

Ans. B: MRI

A fistula in ano is a tract lined by granulation tissue which connects the anal canal mucosa with the skin around the anus. The fistula continues to discharge and the constant reinfection from the anal canal prevents healing of the fistula. Identification of fistulous tract:

  • Physical examination – Digital Rectal Examination, Proctoscopy, Probe test
  • Injection technique – Dye injection (methylene blue or Indigo carmine), Hydrogen peroxide
  • Fistulography
  • Endoanal ultrasound gives important information about sphincter integrity. Endoanal ultrasound, especially with hydrogen peroxide, can also be used to delineate fistulae, although definition of sepsis outside or above the sphincters is limited by the probe’s focal range and scarring makes interpretation difficult.
  • MRI is acknowledged to be the gold standard for fistula imaging but it is limited by availability and the cost and is usually reserved for difficult recurrent cases.
  • CT scan and fistulography both have limitations but are useful if extrasphincteric fistula is suspected.

Q. 39

Contrast used for MRI:

September 2012, March 2013

 A

Iodine

 B

Gadolinium

 C

Metrazamide

 D

Omnipaque

Q. 39

Contrast used for MRI:

September 2012, March 2013

 A

Iodine

 B

Gadolinium

 C

Metrazamide

 D

Omnipaque

Ans. B

Explanation:

Ans. B i.e. Gadolinium

MRI

  • MC contrast agent used in MRI: Gadolinium DTPA
  • C/I to MRI:

– Cardiac pacemakers,

–   Aneurysmal clips etc.

  • Faradays cage: MRI rooms are shielded by continuous sheets of copper or aluminium from interference by external electromagnetic radiation.

Q. 40

A bone bruise or contusion is best identified using:

COMEDK 14

 A

Conventional X-ray

 B

CT scan

 C

MRI scan

 D

PET scan

Q. 40

A bone bruise or contusion is best identified using:

COMEDK 14

 A

Conventional X-ray

 B

CT scan

 C

MRI scan

 D

PET scan

Ans. C

Explanation:

Ans. MRI scan


Q. 41

Investigation of choice in SAH:

NIMHANS 07; FMGE 11

 A

CT scan

 B

MRI

 C

X-ray skull

 D

Radionuclide scan

Q. 41

Investigation of choice in SAH:

NIMHANS 07; FMGE 11

 A

CT scan

 B

MRI

 C

X-ray skull

 D

Radionuclide scan

Ans. A

Explanation:

Ans. CT scan


Q. 42

CSF on MRI appears:

 A

Hyperintense on T1 weighed image and hypointense on T2 weighed image

 B

Hypointense on T1 weighed image and hyperintense on T2 weighed image

 C

Hyperintense on T1 and T2 weighed images

 D

Hypointense on T1 and T2 weighed images

Q. 42

CSF on MRI appears:

 A

Hyperintense on T1 weighed image and hypointense on T2 weighed image

 B

Hypointense on T1 weighed image and hyperintense on T2 weighed image

 C

Hyperintense on T1 and T2 weighed images

 D

Hypointense on T1 and T2 weighed images

Ans. B

Explanation:

Ans. Hypointense on T1 weighed image and hyperintense on T2 weighed image


Q. 43

Best imaging modality in patients with breast implants is:

 A

MRI scan

 B

   CT scan

 C

Mammography

 D

Radionuclide scan

Q. 43

Best imaging modality in patients with breast implants is:

 A

MRI scan

 B

   CT scan

 C

Mammography

 D

Radionuclide scan

Ans. A

Explanation:

Ans. MRI scan


Q. 44

Investigation of choice for a pregnant lady with upper abdominal mass

 A

Barium meal

 B

MRI

 C

CT scan

 D

DSA

Q. 44

Investigation of choice for a pregnant lady with upper abdominal mass

 A

Barium meal

 B

MRI

 C

CT scan

 D

DSA

Ans. B

Explanation:

Ans. MRI


Q. 45

In aortic dissection most accurate investigation is :

 A

ECG

 B

CT scan

 C

Aortography

 D

MRI scan

Q. 45

In aortic dissection most accurate investigation is :

 A

ECG

 B

CT scan

 C

Aortography

 D

MRI scan

Ans. D

Explanation:

Ans. MRI scan


Q. 46

The most sensitive and specific investigation in renal artery hypertension is:

 A

Captopril-enhanced renal scan

 B

Doppler ultrasound

 C

MRI

 D

CT scan

Q. 46

The most sensitive and specific investigation in renal artery hypertension is:

 A

Captopril-enhanced renal scan

 B

Doppler ultrasound

 C

MRI

 D

CT scan

Ans. C

Explanation:

Ans. MRI


Q. 47

All of the following are correct about radiological evaluation of a patient with cushing’s syndrome except:

 A

     MRI of the sena tursica will identify the cause of cushing’s syndrome

 B

MRI of the adrenal glands may distinguish adrenal adenoma from carcinoma

 C

Adrenal CT scan distinguishes adrenal tumour from cortical hyperplasia

 D

Petrosal sinus sampling is the best way to distinguish the tumour from an ectopic ACTH producing tumour

Q. 47

All of the following are correct about radiological evaluation of a patient with cushing’s syndrome except:

 A

     MRI of the sena tursica will identify the cause of cushing’s syndrome

 B

MRI of the adrenal glands may distinguish adrenal adenoma from carcinoma

 C

Adrenal CT scan distinguishes adrenal tumour from cortical hyperplasia

 D

Petrosal sinus sampling is the best way to distinguish the tumour from an ectopic ACTH producing tumour

Ans. A

Explanation:

Ansa. MRI of the sena tursica will identify the cause of cushing’s syndrome


Q. 48

In MRI, strength of magnetic field is:

 A

0.5 Tesla

 B

1.1 Tesla

 C

5 Tesla

 D

11 Tesla

Q. 48

In MRI, strength of magnetic field is:

 A

0.5 Tesla

 B

1.1 Tesla

 C

5 Tesla

 D

11 Tesla

Ans. B

Explanation:

Ans. 1.1 Tesla


Q. 49

Which of the following is the best choice to evaluate radiologically a posterior fossa tumor?

 A

CT scan

 B

MRI

 C

Angiography

 D

Myelography

Q. 49

Which of the following is the best choice to evaluate radiologically a posterior fossa tumor?

 A

CT scan

 B

MRI

 C

Angiography

 D

Myelography

Ans. B

Explanation:

Ans. MRI


Q. 50

A patient is suspected to have vestibular Shwanomma, the investigation of choice for its diagnosis is:

 A

Contrast enhanced CT scan

 B

Gadolinium enhanced MRI

 C

SPECT

 D

PET scan

Q. 50

A patient is suspected to have vestibular Shwanomma, the investigation of choice for its diagnosis is:

 A

Contrast enhanced CT scan

 B

Gadolinium enhanced MRI

 C

SPECT

 D

PET scan

Ans. B

Explanation:

Ans. Gadolinium enhanced MRI


Q. 51

Best diagnosis for dissecting aorta is:

 A

CT scan

 B

MRI

 C

Angiography

 D

X-ray

Q. 51

Best diagnosis for dissecting aorta is:

 A

CT scan

 B

MRI

 C

Angiography

 D

X-ray

Ans. B

Explanation:

Ans. MRI


Q. 52

Which one of the following imaging techniques gives maximum radiation exposure to the patient?

 A

Chest X-ray

 B

MRI

 C

CT scan

 D

Bone scan

Q. 52

Which one of the following imaging techniques gives maximum radiation exposure to the patient?

 A

Chest X-ray

 B

MRI

 C

CT scan

 D

Bone scan

Ans. C

Explanation:

Ans. CT scan


Q. 53

A 40-year-old female patient on long term steroid therapy presents with recent onset of severe pain in the right hip. Imaging modality of choice for this problem is:

 A

CT scan

 B

Bone scan

 C

MRI

 D

Plain X-ray

Q. 53

A 40-year-old female patient on long term steroid therapy presents with recent onset of severe pain in the right hip. Imaging modality of choice for this problem is:

 A

CT scan

 B

Bone scan

 C

MRI

 D

Plain X-ray

Ans. C

Explanation:

Ans. MRI


Q. 54

A 25-yrs-old female presented with lower limb weakness, spasticity, urinary hesitancy, mid-dorsal intradural enhancing mass seen in MRI. What is the diagnosis?

 A

Intradural lipoma

 B

Meningioma

 C

Dermoid cyst

 D

Neuroepithelial cyst

Q. 54

A 25-yrs-old female presented with lower limb weakness, spasticity, urinary hesitancy, mid-dorsal intradural enhancing mass seen in MRI. What is the diagnosis?

 A

Intradural lipoma

 B

Meningioma

 C

Dermoid cyst

 D

Neuroepithelial cyst

Ans. B

Explanation:

Ans. Meningioma


Q. 55

Current gold standard to detect ductal carcinoma in situ breast is:

 A

Mammography

 B

MRI

 C

USG

 D

CT/PET

Q. 55

Current gold standard to detect ductal carcinoma in situ breast is:

 A

Mammography

 B

MRI

 C

USG

 D

CT/PET

Ans. B

Explanation:

Ans. MRI


Q. 56

A 14 yr old boy with abnormal movements. MRI shows involvement of bilateral striatum, thalami, puns, centrum semiovale and asymmetrical diffuse white matter involvement. What could be the possible diagnosis?

 A

Wilson’s disease

 B

Hallevordon spatz disease

 C

Nigrostriatal degeneration

 D

Parkinsonism

Q. 56

A 14 yr old boy with abnormal movements. MRI shows involvement of bilateral striatum, thalami, puns, centrum semiovale and asymmetrical diffuse white matter involvement. What could be the possible diagnosis?

 A

Wilson’s disease

 B

Hallevordon spatz disease

 C

Nigrostriatal degeneration

 D

Parkinsonism

Ans. A

Explanation:

Ans. Wilson’s disease


Q. 57

Penetrating iron particle in eye which of the following investigation will not be used ‑

 A

X- ray

 B

CT scan

 C

MRI

 D

USG

Q. 57

Penetrating iron particle in eye which of the following investigation will not be used ‑

 A

X- ray

 B

CT scan

 C

MRI

 D

USG

Ans. C

Explanation:

Ans. is ‘c’ i.e., MRI

MRI is contraindicated in presence of metalic (magnetic) foreign body.


Q. 58

Investigution of choice for spinal TB‑

 A

X-ray

 B

CT Scan

 C

MRI

 D

PET Scan

Q. 58

Investigution of choice for spinal TB‑

 A

X-ray

 B

CT Scan

 C

MRI

 D

PET Scan

Ans. C

Explanation:

Ans. is ‘c’ i.e., MRI


Q. 59

A 60-year old female had fallen in the bathroom and she is not able to stand on her feet. On examination, her right leg was in external rotation and was not able to move her leg. There was tenderness in Scarpa’s triangle. There is no history of fever. X-ray shows no fracture line. What is the nest step of management

 A

MRI

 B

Strict bed rest for 10 days and repeat X-ray

 C

Joint Aspiration

 D

Start proper anlgesia and start mobilization to prevent stiffness

Q. 59

A 60-year old female had fallen in the bathroom and she is not able to stand on her feet. On examination, her right leg was in external rotation and was not able to move her leg. There was tenderness in Scarpa’s triangle. There is no history of fever. X-ray shows no fracture line. What is the nest step of management

 A

MRI

 B

Strict bed rest for 10 days and repeat X-ray

 C

Joint Aspiration

 D

Start proper anlgesia and start mobilization to prevent stiffness

Ans. A

Explanation:

Ans. a. MRI

History of fall followed by tenderness in Scarpa’s triangle and leg in externally rotated position is suggestive of fracture neck of femur. An impacted, undisplaced fracture is likely to be missed on an X-ray. An MRI or a bone scan would be needed to diagnose the lesion.

“Impacted fractures may be extremely difficult to discern on plain X-ray. If there is a fracture it will show up on MRI or a bone scan after few days.


Q. 60

Investigation of choice for spinal tuberculosis

 A

X-ray

 B

CT-Scan

 C

Open biopsy

 D

MRI

Q. 60

Investigation of choice for spinal tuberculosis

 A

X-ray

 B

CT-Scan

 C

Open biopsy

 D

MRI

Ans. D

Explanation:

Ans. is ‘d’ i.e., MRI

Investigations in musculoskeletal system

  • Investigation of choice for AVN Hip MR1
  • Best initial test for osteomyelitis -9 Plain x-ray
  • Best second line test for osteomyelitis (if there is high clinical suspician and x-ray is negative) —> MRI
  • Most accurate diagnostic test for osteomyelitis                      Bone biopsy and culture.
  • Best view for scaphoid fracture —> Oblique (scaphoid) view of wrist.
  • Best view for C1-C2 vertebrae & junction -* Open mouth odontoid (Pegs) view.
  • Investigation of choice for ACL & PCL injury MRI
  • Investigation of choice to detect calcification —> CT scan
  • Investigation of choice for prolapsed intervertebral disc —> MRI
  • Investigation of choice for spinal tuberculosis -4 MRI
  • Investigation of choice for traumatic paraplagia —> MRI
  •  Gold standard and investigation of choice for osteoporosis —> Dual energy x-ray absorptiometry (DEXA).


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