Radiology: AIIMS NOV 2014

Q-1. A neonate presented on day 1 of life with bilious vomiting. What investigation will you do?
a) Ultrasound
b) Baby-gram
c) Chest Skiagram
d) CT scan

Answer: Baby-gram
Duodenal atresia of newborn infants is typically characterized by onset of vomiting within hours of birth. While vomitus is most often bilious, it may be non-bilious because 15% of defects occur proximal to the ampulla of Vater.
When duodenal atresia is suspected, erect and recumbent plain radiography of the abdomen should be the first imaging study obtained.
A characteristic finding of duodenal obstruction is the double-bubble image of an air-filled stomach proximal to an air-filled first portion of the duodenum.
Important points:
The use of modern ultra-sonography has allowed many infants with duodenal obstruction to be identified prenatally.
Duodenal obstruction is characterized by a double-bubble sign on prenatal ultra-sonography. The first bubble corresponds to the stomach and the second to the post-pyloric and pre-stenotic dilated duodenal loop.

Q-2. Investigation of choice for acute appendicitis in children
a) USG
b) MRI
c) CT scan
d) X-ray

Answer: USG
Because of concerns about patient exposure to radiation during CT scans, ultra-sonography has been suggested as a safer primary diagnostic modality for appendicitis with CT scanning used secondarily when ultra-sonograms are negative or inconclusive.
Important point:
Ultrasound with its lack of ionizing radiation should be the investigation of choice in young patients.

Q-3. A person has an injury in the forefinger with glass and it is suspected that he has a retained piece of glass in his finger. Which is the first investigation you will do?
a) Plane radiograph
b) Ultrasound
c) Ct scan
d) MRI

Answer: Plane radiograph
Radiologic evaluation of soft tissue injuries plays an important role in detecting, evaluating, and planning the potential removal of a foreign body.
Radiographs are most useful in detecting radiopaque foreign bodies. However, for the detection of non-radiopaque foreign bodies (eg, wood, rubber, plastic), the sensitivity of radiography is low.

Q-4. What is the investigation of choice in a patient for evaluation of acute head injury?
a) Non contrast CT
c) MRI
d) CT angiography

Answer: Non contrast CT
Non-contrast CT scan is the modality of choice for the initial evaluation of acute head injury because it is fast, widely available and highly accurate in the detection of skull fractures and acute intracranial hemorrhage.
Important points:
Non hemorrhagic parenchymal injury is difficult to diagnose on CT scan. Non hemorrhagic contusions are better visualized on MRI.

Q-5. A 3 months old baby presented with clay colored stools and dark yellow urine. On further investigation he was found to have direct bilirubin of 6 mg %. Which is the most sensitive investigation to diagnose the above condition?
a) HIDA Scan
b) USG
c) Liver function tests
d) CT abdomen

Answer: HIDA Scan
Ultra-sonography is often the initial investigation in patients with suspected biliary atresia, followed by hepato-biliary scintigraphy (HIDA), a study that has been used effectively for many years.
If the diagnosis remains elusive after these studies, magnetic resonance cholangiopancreatography (MRCP) may be helpful.
Percutaneous liver biopsy is most valuable procedure in the evaluation of neonatal hepato-biliary diseases and provides the most reliable discriminatory evidence.
USG > HIDA > MRCP> Percutaneous liver biopsy
Important point:
Typical symptoms of biliary atresia include variable degrees of jaundice, dark urine, and light or clay colored stools.
Direct hyper-bilirubinemia is always an abnormal finding. Consider biliary atresia in all neonates with direct hyper-bilirubinemia.

Q-6. Investigation of choice for bronchiectasis
b) Chest X-ray
c) Bronchoscopy
d) MRI

Answer: HRCT
High-resolution computed tomography (HRCT) is the diagnostic modality of choice in bronchiectasis.
Bronchiectasis is diagnosed when there is bronchial wall dilatation, defined as the internal lumen of the bronchus being greater than that of the accompanying pulmonary artery.