Q-21. A patient suffering from AIDS came with history of difficulty in breathing and non-productive cough. The X-ray showed bilateral peri-hilar region opacities. But there was no adenopathy or effusion. The likely cause of his problem is
a) Pneumocystis carinii pneumonia
b) Kaposi’s sarcoma
c) Tuberculosis
d) CMV
Answer: Pneumocystis carinii pneumonia
Explanation:
Pneumocystis pneumonia (PCP) is an atypical pulmonary infection and the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS).
X-ray appearance is normal early in the disease or may show bilateral diffuse infiltrates in peri-hilar region.
Q-22. In a patient with mitral stenosis will show all of the following findings on x-ray except:
a) Raising up of the left bronchus
b) Double atrial shadow
c) Kink (posterior displacement) in the esophagus in barium swallows
d) Obliteration of retro-sternal shadow on lateral x ray
Answer: Obliteration of retro-sternal shadow on lateral x ray
Explanation:
X-Ray Findings of MS:
Usually normal or slightly enlarged cardio-thoracic ratio
Straightening of left heart border
Convexity of left heart border secondary to enlarged atrial appendage–only in rheumatic heart disease
LA enlargement includes posterior esophageal displacement on barium swallow.
Small aortic knob from decreased cardiac output
Double density of left atrial enlargement
Cephalization
Elevation of left main-stem bronchus (especially if 90° to trachea)
With severe, chronic disease enlargement of the main pulmonary artery from pulmonary arterial hypertension
Q-23. Egg shell calcification is characteristically seen in
a) Silicosis
b) Sarcoidosis
c) Asbestosis
d) Berylliosis
Answer: Silicosis
Explanation:
Egg shell calcification in hilar region-
Calcification around the periphery of lymph nodes
Reason for this pattern of calcification is not known.
Most commonly seen in silicosis and coal-worker’s pneumoconiosis (3-6%)
Also seen in sarcoidosis (5%)
Rarely in post-irradiated Hodgkin disease, blastomycosis, scleroderma, amyloid, fibrosing mediastinitis, tuberculosis, coccidiomycosis and histoplasmosis
Q-24. A patient with solitary pulmonary nodule. The best investigation to come to a diagnosis would be
a) MRI
b) CT scan
c) Ultrasound
d) Imaging guided FNAC
Answer: Imaging guided FNAC
Explanation:
Solitary nodule on X-ray→ CT Scan→ Image guided biopsy (The best investigation to come to a diagnosis)
Q-25. Neuro-endocrinal tumors can be best detected by
a) PET scan
b) HRCT Scan
c) MRI
d) Radio-nucleotide Scan
Answer: Radio-nucleotide Scan
Explanation:
Neuro-endocrine tumors are a heterogeneous group of malignancies that present a diagnostic challenge. The majority of patients (more than 60%) present with metastatic disease at diagnosis.
The diagnosis is based on histopathology, imaging, and circulating biomarkers. The histopathology should contain specific neuro-endocrine markers such as chromogranin A, synaptophysin, and neuron-specific enolase and also an estimate of the proliferation by Ki-67 (MIB-1). Standard imaging procedures consist of computed tomography or magnetic resonance imaging together with somatostatin receptor scintigraphy (Now the imaging modality of choice for localizing both primary and metastatic NET tumor).
68Ga-DOTA-octreotate scans will in the future replace somatostatin receptor scintigraphy because they have higher specificity and sensitivity.
Q-26. Para meningeal Rhabdomyosarcoma is best diagnosed by
a) MRI
b) SPECT
c) PET
d) CT scan
Answer: MRI
Explanation:
Para meningeal Rhabdomyosarcoma
MR imaging is the technique of choice for evaluation of the primary tumor site because of its superior ability to characterize soft tissues. MR imaging can aid physicians in accurately assessing tumor origin and size, local extent, invasiveness, and nodal and lepto-meningeal spread. It is also useful after surgery for identifying residual or recurrent tumor in the surgical bed.
Q-27. A boy presented in the OPD with minimal pleural effusion on the right side. The best method to detect this would be:
a) Left side chest X-ray
b) Right side chest X-ray
c) Right lateral decubitus chest X-ray
d) Left lateral decubitus chest X-ray
Answer: Right lateral decubitus chest X-ray
Explanation:
The primary goal of performing the lateral decubitus projection is to demonstrate fluid in the pleural cavity (a pleural effusion), which is otherwise not clearly visible on a supine or upright chest radiograph.
Lateral decubitus films are helpful for determining if effusion is free flowing, and are also used to determine whether there is enough fluid to sample by thoracentesis. A lateral decubitus projection can also be helpful in showing small amounts of air in the pleural cavity (a pneumothorax) as well as air fluid levels in other cases.
Q-28. CT scan of head showing a Tram track appearance in-
a) Neurofibroma
b) Tuberous sclerosis
c) Von Hippel Lindau disease
d) Sturge weber syndrome
Answer: Sturge weber syndrome
Explanation:
CT scanning is more sensitive than plain skull radiography and MRI in the detection sub-cortical calcifications. However MRI with contrast is probably the best imaging test. It is superior to CT in the demonstration of abnormal myelination, and it is more sensitive in the demonstration of lepto-meningeal enhancement, particularly in the presence of dense cortical calcification on CT scans. In addition, orbital associated malformations are well depicted on contrast-enhanced orbital MRI.
CT scan findings:
Tram-track calcifications
Cortical atrophy
Abnormal draining veins
Enlarged choroid plexus
Blood-brain barrier breakdown (during seizures)
Contrast enhancement
Q-29. Which of the following is the most radio-sensitive tumor?
a) Ewings tumor
b) Hodgkin’s disease
c) Carcinoma cervix
d) Malignant Fibrous Histio-cytoma
Answer: Ewings tumor
Explanation:
Radio-sensitivity of different tumor:
Highly sensitive
Lymphoma
Seminoma
Myeloma
Ewings tumor
Wilms tumor
Moderate sensitive
Small cell Ca of lung
Breast cancer
Basal cell cancer
Medulloblastoma
Teratoma
Ovarian cancer
Relative resistant
Squamous carcinoma of lung
Hyper-nephroma
Rectal carcinoma
Bladder carcinoma
Soft tissue carcinoma
Carcinoma of cervix
Highly resistant:
Melanoma
Osteosarcoma
Q-30. Which of the following techniques in best for differentiating recurrence of brain tumor from radiation therapy induced necrosis?
a) MRI
b) Contrast enhanced MRI
c) PET scan
d) CT scan
Answer: PET scan
Explanation:
PET and SPECT have ancillary roles in the imaging of the brain tumors, primarily in distinguishing tumor recurrence from tissue necrosis that can occur after radiation.
Biopsy is frequently required to establish the correct diagnosis.