NJ Questions
1. All of the following regarding focal nodular hyperplasia are true except
A) It is more common than hepatocellular adenoma.
B) On contrast-enhanced CT, a transient hyperdensity on bolus injection is followed by isodensity.
C) Most cases are associated with the use of oral contraceptives.
D) It typically shows normal activity on Tc-99m sulfur colloid scintigraphy.
E) Calcifications are not associated with focal nodular hyperplasia.
2. Which one of the following statements regarding Budd-Chiari syndrome is true?
A) Periodicity within the hepatic veins is usually normal with Doppler interrogation.
B) In the acute stage, abdominal pain and hepatomegaly are prominent findings; however, ascites is seen only in the chronic stage.
C) The caudate lobe is the one most frequently involved.
D) Magnetic resonance imaging shows reduction in caliber or complete absence of hepatic veins.
E) The most common cause is a hypercoagulable state.
3. All of the following are typically associated with irregular, distorted small-bowel folds except
A) Non-Hodgkin's lymphoma:
B) Henoch-Schonlein purpura.
C) Giardiasis.
D) Crohn's disease.
E) Whipple's disease.
4. Concerning fibrolamellar hepatocellular carcinoma, which of the following is (are) true? (select all correct answers)
A) It is not associated with underlying cirrhosis or other risk factors.
B) The test for serum alpha-fetoprotein is negative.
C) Spontaneous rupture does occur but in less than 10% of cases.
D) Overall resectability is the same as for a conventional hepatoma.
E) A prominent depressed central fibrous scar is characteristic.
5.Of the following, which is (are) associated with Sipple's syndrome_ (multiple endocrine neoplasia, type II syndrome)?
(X-type question - select all correct answers)
A) Pancreatic islet cell tumor.
B) Parathyroid hyperplasia.
C) Medullary carcinoma of the thyroid.
D) Oral and intestinal ganglioneuromatosis.
E) Carcinoid tumors.
6. Of the following, choose the correct statement regarding mucinous cystic neoplasm of the pancreas.
A) Like microcystic adenoma of the pancreas, the lesion does not have malignant potential.
B) The most common location is the pancreatic head.
C) The lesion is predominantly hypovascular with sparse neovascularity.
D) Cysts are less than 2 cm in size, with septations.
7. Regarding Whipple's disease, which of the following is true?
A) Ulcerations are a prominent feature of this disease.
B) It is more common among AIDS patients than other patient groups.
C) It is associated with low-density lymph nodes.
D) It is more common among females.
E) The etiology is presumed to be associated with the autoimmune system.
8. Concerning ulcerative colitis, which of the following is true?
A) It affects predominantly the right side of the colon.
B) "Backwash ileitis" occurs in more than 75% of cases.
C) Toxic megacolon is the most common cause of death in these patients .
D) Ulcers of the colon tend to be deep and confluent.
E) The anus is the first site of involvement in ulcerative colitis; it then tends to spread proximally.
9. The most likely diagnosis of the condition depicted in Figure is:
Solitary large high attenuation lesion in liver
A) Hepatic adenoma.
B) Hepatocellular carcinoma.
C) Cavernous hemangioma.
D) Hepatic abscess.
10. A 30-year-old female presented to the emergency department with vomiting of 24 hours' duration. Based on findings from Figure, what is the most likely diagnosis?
"kidney-shaped" distended cecum, rotated up into the left upper quadrant and associated with small-bowel obstruction.
A) Cecal volvulus.
B) Appendicitis.
C) Sigmoid volvulus.
D) Acute cholecystitis.
E) Duodenal ulcer.
11.For each numbered item (1-4), select the one most closely associated classification of choledochal cysts (A-E).
A) Type I
B) Type II
C) Type III
D) Type IV-B
E) Type V
1) Rounded widening of the common bile duct
2) Multiple dilatations of extrahepatic bile ducts
3) Normal caliber common bile duct with diverticula
4) Caroli's disease
12.For each numbered item (1-4), select the one most closely associated gastrointestinal hormone.
(Select the answer that corresponds to the highlighted line)
1) Potent smooth muscle spasmolytic used in radiologic procedures
2) Produced in g-cells of the pancreas
3) Causes relaxation of the sphincter of Oddi
4) Produced by a-cells of the pancreas
A) Glucagon
B) Secretin
C) Gastrin
D) Cholecystokinin
13. For each numbered item (1-4), select the one most closely associated syndrome (A-D).
A) Sipple's syndrome
B) Mirizzi syndrome
C) Wermer's syndrome
D) Budd-Chiari syndrome
1) Multiple endocrine neoplasia (MEN) I
2) MEN IIA
3) Pancreatic islet cell tumor
4) Gallstone impaction in cystic duct
14. For each numbered item (1-4), select the one most closely associated polyposis syndrome (A-E).
A) Turcot's syndrome
B) Peutz-Jeghers syndrome
C) Cronkhite-Canada syndrome
D) Gardner's syndrome
E) Multiple hamartoma syndrome
1) Osteomas
2) Breast lesions
3) Brain tumors
4) Nonhereditary polyposis
15. For each numbered item (1-4), select the one most closely associated type of hernia.
(Select the answer that corresponds to the highlighted line)
1) Stretched phreno-esophageal membrane
2) Posterolateral defect
3) Bergquist triad
4) Anteromedial defect
A) Bochdalek's
B) Morgagni's
C) Traumatic diaphragmatic rupture
D) Hiatal
E) Spigelian
16. Which of the following is least likely to cause hepatic calcification?
A) Echinococcal cyst.
B) Metastatic ovarian carcinoma.
C) Histoplasmosis.
D) Sarcoidosis.
E) Cavernous hemangioma.
17.Toxic megacolon is a feature of:
A) Ulcerative colitis.
B) Pseudomembranous colitis.
C) Amebic colitis.
D) Crohn's colitis.
E) All of the above.
18. Concerning von Hippel-Lindau disease, which of the following is (are) associated?
(X-type question - select all correct answers)
A) Renal cell carcinoma.
B) Pheochromocytoma.
C) Hepatocellular carcinoma.
D) Pancreatic islet cell tumor.
E) Pancreatic cysts.
19.Regarding Figure, which of the following is (are) true?
Air in biliary tree, gallstone in RLQ
(X-type question - select all correct answers)
A) The most common site of obstruction is the distal jejunum.
B) The disease is associated with the Rigler triad.
C) The biliary tree always contains air.
D) Small-bowel obstruction is common.
E) There is commonly a fistula to the duodenum.
20.In regard to Figure, which of the following is the most likely diagnosis?
Multiple loops of dilated bowel
Clear lung bases
A) Pyloric stenosis.
B) Annular pancreas.
C) Imperforate anus.
D) Duodenal atresia.
E) Bochdalek's hernia.
21. Regarding achondroplasia, which of the following statements is (are) true? (select all correct answers)
A) Patients demonstrate normal intelligence.
B) It is the prototype of mesomelic dwarfism.
C) The pelvis demonstrates a "champagne-glass" appearance.
D) Mode of inheritance is autosomal recessive.
E) Complications include hydrocephalus.
22. The most common cause of neonatal hydronephrosis is:
A) Posterior urethral valves.
B) Vesicoureteral reflux.
C) Ureteropelvic junction obstruction.
D) Multicystic dysplastic kidney.
E) Ectopic ureterocele.
23.Regarding necrotizing enterocolitis (NEC), which of the following is (are) true? (select all correct answers)
A) It is associated with prematurity.
B) Pneumatosis intestinalis is a radiologic feature of NEC.
C) The jejunum and transverse colon are most frequently involved in NEC.
D) There is poor correlation between plain film radiographic findings and patient outcomes.
E) Barium enemas are contraindicated in patients with documented NEC.
24. Concerning congenital lobar emphysema, which of the following is (are) true? (select all correct answers)
A) It involves predominantly the lower lobes.
B) It is associated with a male : female ratio of 3:1.
C) It is associated with Down's syndrome in more than 40% of cases.
D) Bronchoscopy is contraindicated.
E) It requires surgical resection of the distended lobe.
25. For each of the following (1-4) select the most closely associated tumor (A-E).
A) Neuroblastoma
B) Wilm's tumor
C) Nephroblastomatosis
D) Mesoblastic nephroma
E) Rhabdomyosarcoma
1) Subcapsular
2) Aniridia
3) Hamartoma
4) Paraneoplastic syndromes
26. Concerning multicystic dysplastic kidney, which of the following is (are) true?
A) There is normal union between the mesonephros and metanephros.
B) The pattern of inheritance is autosomal recessive.
C) It is characterized by a collection of large, communicating cysts separated by fibrous tissue.
D) Although distorted, there is functioning renal parenchyma.
E) None of the above.
27.Which of the following is the most useful in differentiating meconium aspiration from hyaline membrane disease?
A) Air bronchograms.
B) Pneumomediastinum.
C) Over inflation.
D) Pneumothorax.
E) Interstitial emphysema.
28.Of the following, which is (are) neonatal renal characteristics on ultrasound?
(X-type question - select all correct answers)
A) Hypoechoic pyramids.
B) Good corticomedullary junction definition.
C) Hyperechoic renal sinus compared with an adult.
D) Cortical echogenicity is isoechoic compared with livers in most neonates.
E) Hyperechoic pyramids.
29.Infants of diabetic mothers demonstrate an increased incidence of: (select all correct answers)
A) Bilateral adrenal hemorrhage.
B) Sacral agenesis.
C) Papillary necrosis.
D) Renal vein thrombosis.
E) Ureteritis cystica.
30. For each numbered item, select the one most closely associated condition,
1) Spherical opacities
2) Ground glass opacities
3) Asymmetric nodular opacities with atelectasis and air trapping
4) Interstitial edema
A) Hyaline membrane disease
B) Transient tachypnea of the newborn
C) Pneumococcal pulmonary infection
D) Congenital lobar emphysema
E) Meconium aspiration
31.True statements concerning transcranial ultrasound for germinal matrix hemorrhage include all of the following except:
A) Possible complications include germinal matrix destruction, periventricular hemorrhagic infarction, and hydrocephalus.
B) Following germinal matrix hemorrhage, ventricular enlargement may result from impaired CSF resorption, obstruction of the aqueduct or expansion by blood volume.
C) Grade II hemorrhage implies extension of hemorrhage into the adjacent lateral ventricle without hydrocephalus.
D) The germinal matrix is a relatively avascular structure.
E) The incidence of long term neurologic sequela, especially cerebral palsy and mental retardation increase with higher grades of hemorrhage.
32. A 3-year-old boy presents with an adrenal mass on ultrasound, which is subsequently biopsied, and demonstrates small blue cells. The Oncology Service wishes to rule out metastases. Which agent would be the most useful in this setting?
A) Ga-67 citrate.
B) Oncoscint.
C) In-111 oxine.
D) I-131 metaiodobenzylguanidine (MIBG).
E) l-131 NP-59.
33. Regarding the use of bone scanning in cases of suspected child abuse (nonaccidental trauma), which of the following is (are) true? (select all correct answers)
A) Scintigraphy is more sensitive for finding rib fractures than plain film radiography.
B) The diagnosis of skull fracture is more accurate with scintigraphy than with plain film radiography.
C) Metaphyseal fractures may be difficult to diagnose due to normal growth plate activity.
D) Diaphyseal periosteal abnormalities are better diagnosed with scintigraphy than with plain film radiography.
E) Old rib fractures are better diagnosed with scintigraphy than with plain film radiography.
34. The trough line is a compression fracture of which aspect of the humerus?
A) Posterolateral.
B) Posteromedial.
C) Anterolateral.
D) Anteromedial.
E) Lateral.
35. True statements concerning posterior shoulder dislocation include: (select all correct answers)
A) A positive rim sign may be present.
B) It accounts for 20% of all shoulder dislocations.
C) Associated fractures of the greater tuberosity occur 15% of the time.
D) Epileptic convulsive seizures are a common cause.
E) The head of the humerus is locked in internal rotation.
36. The most common meniscal tear involves the:
A) Posterior horn of the medial meniscus.
B) Anterior horn of the medial meniscus.
C) Posterior horn of the lateral meniscus.
D) Anterior horn of the lateral meniscus.
E) Peripheral lateral meniscus.
37. Findings characteristic of calcium pyrophosphate deposition disease include: (select all correct answers)
A) Predilection for the patellofemoral joint space in the knee.
B) Calcification of the triangular fibrocartilage in the wrist.
C) Calcification of the nucleus pulposus.
D) Preservation of joint spaces.
E) Association with hemochromatosis.
38. True statements concerning gout include: (select all correct answers)
A) Gout is more common in overproducers than underexcretors of uric acid.
B) Gout is more common in females than in males.
C) Gout most commonly affects the first metatarsophalangeal joint space.
D) There is joint space narrowing early in the disease.
E) Bilateral effusions of the olecranon bursae are pathognomonic.
39. True statements concerning sarcoidosis include: (select all correct answers)
A) In the hands, involvement of the metacarpals and proximal phalanges is more common than involvement of the middle and distal phalanges.
B) A lattice-work configuration of the trabecular pattern is characteristic.
C) Periostitis is common.
D) Acro-osteosclerosis may occur.
E) Nasal bone destruction is characteristic.
40. For each sign/symptom (1-4), select the most closely associated condition (A-E).
A) Psoriatic arthritis
B) Ankylosing spondylitis
C) Rheumatoid arthritis
D) Diffuse/disseminated idiopathic skeletal hyperostosis
E) Erosive osteoarthritis
1) Pseudoarthrosis
2) Mouse ears
3) Gullwing deformity
4) Protrusio acetabuli
41. For each of the numbered descriptions (1-4), select the most closely associated condition (A-E).
A) Achondroplasia
B) Klippel-Feil syndrome
C) Sickle cell anemia
D) Ankylosing spondylitis
E) Morquio's syndrome
1) Central tongue protruding from the anterior surface of the vertebral bodies
2) Interpediculate distance narrowing in the lumbar spine
3) H-shaped vertebral body
4) Congenital vertebral body fusions
42. For each numbered item (1-4), select the most closely associated syndrome or abnormality (A-E).
A) Cleido-cranial dysostosis
B) Ulna-minus variant
C) Holt-Oram syndrome
D) Nail-patella syndrome
E) Achondroplasia
1) Avascular necrosis
2) Radial ray abnormality
3) Trident hand
4) Wide pubic symphysis
43. Of the following statements regarding renal osteodystrophy, which is (are) true?
A) This disease is defined as osteomalacia and hyperparathyroidism.
B) Spontaneous ligament ruptures can occur.
C) Subperiosteal resorption occurs most frequently along the lateral aspect of the proximal tibia.
D) Lytic carpal lesions may contain amyloid.
44. Fusion across the distal interphalangeal joints can occur with which of the following? (select all correct answers)
A) Reiter's disease.
B) Rheumatoid arthritis.
C) Erosive osteoarthritis.
D) Gouty arthritis.
45. Chondroblastomas: (select all correct answers)
A) Can be represented by periostitis.
B) May demonstrate low-signal intensity on T1-weighted and T2-weighted MRI sequences.
C) Can originate in an apophysis.
D) Have little soft tissue edema.
46. Figure 42 demonstrates findings consistent with:
(Calcified spleen)
A) Lymphoma.
B) Sickle cell disease.
C) Renal osteodystrophy.
D) Cystic fibrosis.
47. The radiography of the wrist demonstrated in Figure shows:
(Subchondral cyst of proximal carpal row)
A) Gouty arthritis.
B) Erosive osteoarthritis.
C) Rheumatoid arthritis.
D) Calcium pyrophosphate deposition arthropathy.
48. Figure demonstrates the findings of:
(Honeycomb lucencies of fingers)
A) Systemic lupus erythematosus.
B) Sarcoidosis.
C) Hemochromatosis.
D) Pulmonary osteoarthropathy.
49. Regarding eosinophilic granuloma: (select all correct answers)
A) It refers to disease limited to bone or lung.
B) It is the most common form of Langerhans' cell histiocytosis.
C) Prognosis is poor.
D) Can be confused clinically and radiographically with infection.
E) Usually develops in patients younger than 2 years of age.
50. Match the following types of arthritic disease (1-4) with associated signs/symptoms (A-E).
A) Pencil in cup deformity
B) Heberden's and Bouchard's notes
C) Atlanto-axial instability
D) Deformity without erosion
E) Phemister's triad .
1) Jacoud's arthropathy
2) Osteoarthritis
3) Psoriatic arthritis
4) Rheumatoid arthritis
51. Concerning the Mammography Quality Standards Act (MQSA) of 1992, the interpreting physician must: (select all correct answers)
A) Be a radiologist.
B) Document 40 hours of continuing medical education (CME) in mammography or equivalent time devoted to mammography in residency.
C) Document experience in reading 240 patient mammograms in the 6 months prior to the facility's application for accreditation or any 6-month period before or after October 1, 1994 under the supervision of a qualified interpreting physician.
D) Document continuous reading of mammograms with an average of at least 40 patients per month over 24 months.
E) Document an average of 5 CME credits per year in mammography over 3 years beginning October 1, 1994.
52.Regarding phantom images, criteria for the minimum number of objects to pass the ACR Mammography Accreditation is a minimum of:
A) 4 fibers, 3 speck groups, and 3 masses.
B) 3 fibers, 3 speck groups, and 3 masses.
C) 4 fibers, 2 speck groups, and 2 masses.
D) 4 fibers, 4 speck groups, and 4 masses.
53. The average glandular dose to an average (4.2-cm compressed) breast should not exceed 10 mGy (1.0 rads) per view for screen-film image receptors.
A) True.
B) False.
54. Processor quality control should be performed:
A) Daily prior to processing patients' films.
B) 2 hours after beginning processing of the clinical images when processor temperature has stabilized.
C) Only by a physicist.
D) Only if needed.
E) Weekly.
55. Standard positioning for mammography includes: (select all correct answers)
A) Caudal cranial.
B) Craniocaudal.
C) Lateromedial oblique.
D) Mediolateral oblique.
E) Mediolateral.
56. Regarding spiculated lesions, which of the following is (are) true? (select all correct answers)
A) Radial scar can be reliably differentiated from carcinoma by mammography.
B) Postsurgical scar can be difficult to distinguish from breast cancer.
C) Ultrasound can reliably differentiate asymmetric glandular tissue from breast cancer.
D) The most common spiculated lesion is invasive lobular carcinoma.
E) The differential diagnosis includes granular cell myoblastoma.
57. Regarding ductal carcinoma in situ, which of the following is (are) true? (select all correct answers)
A) The comedo subtype is more likely associated with invasion.
B) Most commonly, it appears as a lobulated mass on mammography.
C) Paget's disease of the nipple is a variant.
D) First arises in lobular units and subsequently invades terminal ducts.
E) May develop into phylloides tumor.
58.Regarding fibroadenomas, which of the following is (are) true?
(select all correct answers)
A) They are hormone dependent.
B) They are the most common benign breast tumor.
C) Fibroadenomas rarely occur before 35 years of age.
D) The pattern of microcalcifications is almost pathognomonic.
59. All of the following regarding phylloides tumor are true except:
A) The most common manifestation is a large, rapidly enlarging mass.
B) Its peak incidence occurs between 20 and 30 years of age.
C) 5% to 10% are malignant and can metastasize.
D) Ultrasound may show small fluid-filled spaces within the tumor.
E) It is locally invasive if not widely excised.
60.Regarding hamartomas, all of the following are true except:
A) Surrounded by a pseudocapsule composed of fibrous tissue.
B) Frequently calcify.
C) Often soft and nonpalpable.
D) Composed of lipid, glandular, and fibrous tissues.
E) Ultrasound evaluation is usually not indicated.
61. Regarding normal intramammary lymph nodes, which of the following is false ?
A) They should not be larger than 1 cm.
B) They are often located in the upper outer quadrant.
C) They contain fat in the hilum.
D) Calcification is common.
E) Lymph nodes can enlarge in patients with connective tissue disorders.
62. Concerning lymphoma of the breast, all of the following are true except
A) Secondary involvement is more common than primary.
B) It represents 5% of primary breast malignancies.
C) Mammography reveals discrete nodules or diffuse increase in radiographic density.
D) It is indistinguishable radiographically from diffuse ductal cancer.
E) A solid hypoechoic mass is typically seen on ultrasound.
63.Which of the following is the most common tumor to metastasize to the breast?
A) Cervical.
B) Colonic.
C) Melanoma.
D) Lung.
E) Basal cell.
64.Regarding mammographic appearance of the radiated breast, all of the following are true, except:
A) Radiation changes include skin thickening and diffuse increase in breast density.
B) The severity of the mammographic changes is related to the radiation dose.
C) The changes are most pronounced on the initial post-treatment mammogram.
D) Differential diagnosis includes inflammatory breast cancer, mastitis, and lymphoma.
E) Calcifications may develop up to 5 years after treatment.
65. Regarding the postlumpectomy breast, an increase in density and architectural distortion is suspicious for tumor recurrence when present at:
A) 1 month.
B) 2 months.
C) 4 months.
D) 6 months.
E) 12 months.
66.Regarding the American College of Radiology Breast Imaging Reporting and Data System's definition of a mass, which of the following is (are) true? (select all correct answers)
A) A mass can be seen in one projection.
B) Description of shape includes round, oval, lobular, and irregular.
C) Margins of the mass can be described as circumscribed, microlobulated, obscured, indistinct, or spiculated.
67. Regarding breast sonography: (select all correct answers)
A) Most infiltrating carcinomas are isoechoic.
B) Fibroadenomas are smooth, hypoechoic, or isoechoic masses.
C) Most important role is distinguishing cystic versus solid nature of a lesion.
D) Represents the initial imaging study in a 25-year-old with a palpable mass.
E) Highly sensitive and specific for detecting implant rupture.
69.Regarding intracystic masses, all of the following are true except
A) A 6-month follow-up ultrasound is indicated.
B) Histologic evaluation is indicated.
C) Differential diagnosis includes papilloma, intracystic papillary carcinoma, and blood clot.
D) Intracystic papillary lesions are usually found in women older than 50 years of age.
E) Intracystic tumors rarely have calcifications.
70. Concerning constrictive pericarditis which of the following is (are) true? (select all correct answers)
A) Causes include trauma, infection, and radiation.
B) Severe cardiomegaly is associated with it.
C) Pericardial calcifications are present on fewer than 10% of plain films.
D) Hepatic enlargement and ascites may be present.
E) Venous pressure is elevated.
71. Choose the one correct answer concerning congenital pericardial defects.
A) Most arise on the right.
B) They are more common in females.
C) CT scanning is diagnostic.
D) They are not associated with valvular abnormalities.
E) "Boot-shape" configuration of the heart is present.
72. Which of the following congenital heart defects is the most common?
A) Endocardial cushion defect.
B) Tetralogy of Fallot.
C) Atrial septal defect.
D) Ventricular septal defect.
E) Patent ductus arteriosus.
73. The findings shown in Figure are associated with which of the following? (select all correct answers)
Rib notching
A) Bicuspid aortic valve.
B) Ehlers Danlos syndrome.
C) Systemic lupus erythematosus.
D) Turner's syndrome.
E) Polyarteritis nodosa.
74. Regarding Figure, choose the single best answer.
There is an intimal flap in the ascending aorta with blood in the pericardial space.
A) Pericardial effusion.
B) Aortic dissection type B.
C) Hemopericardium.
D) Aortic dissection type B with hemopericardium.
E) Aortic dissection type A with hemopericardium.
75. Regarding the disease shown in Figure, which of the following statements is (are) true?
Renal artery stenosis due to FMD
A) Stenting is necessary.
B) About 1% to 5% of hypertensive patients have the disease.
C) The average age of the patient at presentation is 30 to 40 years.
D) The disease is bilateral in 5% of patients.
E) The disease involves only the renal arteries.
76. Figure is of the venous phase of a superior mesenteric artery angiogram. The lesion between the four arrows represents:
A normal portal vein is not visualized in Figure;
A) Cavernous hemangioma.
B) Focal nodular hyperplasia.
C) Cavernous transformation of the portal vein.
D) Acute occlusion of the portal vein.
77. In Figure, the metallic stent in the right upper quadrant is appropriate for:
A) Benign biliary stricture.
B) Malignant biliary stricture.
C) Benign or malignant biliary stricture.
D) None of the above.
78. Which of the following is the most appropriate range for the post-transjugular intrahepatic portosystemic shunt (TIPS) portosystemic gradient?
A) 4 to 7mmHg.
B) 8 to 12 mm Hg.
C) 13 to 16 mm Hg.
D) 17 to 20 mm Hg.
79. Concerning embolotherapy, all of the following are true except:
A) Patients with the highest complication rate are those with tumor embolization.
B) Gas in the embolized tissue is indicative of infection.
C) Postembolization syndrome is characterized by fever, elevated white blood cell count, and patient discomfort.
D) Postembolization syndrome occurs in about 40% of cases.
80. Concerning the percutaneous drainage of abdominal abscesses and collections, which of the following is (are) true? (select all correct answers)
A) The Gram stain may be negative if the dependent part of the abscess is not sampled.
B) It is accepted practice to use a guide wire or catheter to break up loculations.
C) All drainage catheter side holes need not be in the collection.
D) The success rate for percutaneous drainage approaches 100% for unilocular collections.
E) The abscess cavity should be injected at the time of initial catheter insertion for the purpose of demonstrating a fistulous connection with the bowel.
81. Concerning arterial access for angiography or intervention, which of the following is (are) true? (select all correct answers)
A) The inguinal skin crease is a reliable indicator for the position of the inguinal ligament.
B) Antegrade femoral puncture should be at about 45 degrees, using the femoral head as a landmark.
C) When a double-wall puncture is used, hemorrhage from the posterior wall of the artery is more likely in an axillary artery than a femoral artery.
D) Axillary arterial puncture has a lower complication rate than translumbar puncture of the aorta.
E) Hemorrhage around the axillary artery should be avoided to prevent fibrosis that causes damage to the median and ulnar nerves.
82. Regarding inferior vena cava (IVC) filters, which of the following is (are) true? (select all correct answers)
A) A caval diameter greater than 28 mm is a contraindication to filter placement.
B) A filter should never be placed about the renal veins.
C) IVC filters reduce the risk for recurrent pulmonary embolism to about 2%.
D) IVC filter migration is reported rarely.
E) Patients with pulmonary arterial hypertension and deep venous thrombosis should be considered for filter placement with concurrent anticoagulation therapy because they are much less able to tolerate recurrent pulmonary embolism.
83. Regarding vascular stents, which of the following is (are) true?. (select all correct answers)
A) Placement is contraindicated when an intimal flap exists.
B) One-year patency in the iliac vessels is 80% without reintervention (for treatment of peripheral vascular disease).
C) One-year patency in the femoral vessels is 60% without reintervention (for treatment of peripheral vascular disease).
D) Long-term patency of stenosis is significantly improved over percutaneous transluminal angioplasty alone (for treatment of peripheral vascular disease).
84. Match the following diseases (1-4) with the appropriate associations (A-E).
A) Impotence
B) Oral contraceptives
C) Angiographic appearance may mimic intravenous drug abuse
D) Involves only the aorta
E) None of the above
1) Budd-Chiari syndrome
2) Leriche's syndrome
3) Polyarteritis nodosa
4) Takayasu's arteritis
85. Concerning pulmonary angiography, which of the following is (are) true? (select all correct answers)
A) The overall mortality is 5%.
B) The risk for death is increased with pulmonary arterial pressure greater than 70 mm Hg, when the right ventricular end diastolic pressure is 20 mm Hg or higher.
C) Left bundle-branch block is a contraindication.
D) A high-quality pulmonary angiogram excludes a clinically significant pulmonary embolism.
86. Which of the following conditions typically presents with lower extremity ischemic symptoms in an individual under the age of 45?
A) Thromboangiitis obliterans
B) Popliteal artery aneurysm
C) Popliteal artery entrapment
D) Cystic advential disease
E) Fibromuscular dysplasia
F) Behcet's disease
87. Which of the following statements are true about renal artery aneurysms ?
A) Most are found incidentally
B) Risk of rupture for aneurysm > l0 mm is 30%
C) Most common non-aortoiliac aneurysms in the abdomen
D) May be associated with flank pain, hypertension, and hematuria
E) Rupture risk is elevated by pregnancy
88. A 70-year-old male presents with hypotension, right ventricular hypertrophy, and shortness of breath. A lung scan is requested. Using the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) criteria, which of the following patterns would be indicative of a high probability for pulmonary embolism?
A) One segmental ventilation/perfusion (V/Q) mismatch and one lobar V/Q match.
B) Five small subsegmental V/Q mismatches.
C) Two segmental V/Q mismatches.
D) Three large lobar matched defects.
E) None of the above.
89. A myocardial perfusion scan is performed on a 64-year-old female. The patient underwent an exercise treadmill test, during which she achieved 100% of the age-predicted maximum heart rate. Stress images revealed a defect involving the entire septum. Resting images showed no defect in this location. The best explanation for these findings is:
A) Attenuation artifact (breast tissue).
B) Infarction.
C) Ischemia.
D) Left bundle-branch block.
E) Right bundle-branch block.
90. A 32-year-old female presents with flushing and diarrhea and has an elevated serum 5hydroxyindoleacetic acid (HIAA) level. Which radiopharmaceutical agent would be the most useful in the evaluation of this patient?
A) Ga-67 citrate.
B) I-131 metaiodobenzylguanidine (MIBG).
C) In-111 octreotide.
D) Oncoscint.
E) Tc-99m sestamibi.
91. A 39-year-old male presents with high-output cardiac failure and an elevated serum alkaline phosphatase. A Tc-99m-methylene diphosphate (MDP) bone scan reveals increased activity involving the pelvic brim. The most likely diagnosis is:
A) Metastatic renal cell carcinoma.
B) Previous trauma.
C) Paget's disease.
D) Previous radiation therapy.
E) Fibrous dysplasia.
92. A 55-year-old man presents with back pain and elevated serum calcium. A Tc-99m-methylene diphosphate (MDP) bone scan is performed. The scan shows increased tracer uptake in a linear fashion along the long bones of the lower extremities but is otherwise unremarkable. Which of the following would be the next procedure of choice?
A) Renal ultrasound.
B) MRI of the lumbar spine.
C) Lower extremity Doppler ultrasound.
D) Radiographs of the lower extremity.
E) Chest x-ray.
93. A patient in the medical intensive care unit has right upper quadrant pain. An ultrasound demonstrates cholelithiasis. Total bilirubin is 30 mg/dL. Nuclear imaging is requested for further evaluation. The most appropriate radiopharmaceutical agent to use is:
A) I-131 rose bengal.
B) Tc-99m-mebrofenin.
C) Tc-99m-diisopropyliminodiacetic acid (DISIDA).
D) Tc-99m-sulfur colloid.
E) Tc-99m-hepatic 2,6-dimethyliminodiacetic acid (HIDA).
94. When analyzing a multigated radionuclide angiocardiogram, which of the following could cause the calculated ejection fraction to be falsely elevated?
A) End systolic region of interest includes the left atrium.
B) Insufficient background subtraction.
C) Improper R-R interval set.
D) Poor red blood cell label.
E) Background region of interest includes the spleen.
95. The major reason for checking the amount of Mo-99 in the eluate of the technetium generator is because Mo-99:
A) Has beta emission.
B) Has a long half-life (60 days).
C) Interferes with localization of Tc-99m compounds.
D) Has central nervous system localization.
E) Interferes with labeling of Tc-99m compounds.
96. Which of the following conditions necessitate increasing the therapeutic dose of I-131 for hyperthyroidism?
(X-type question - select all correct answers)
A) Large size of the gland.
B) Hyperthyroidism refractory to propylthiouracil treatment.
C) Prior treatment with beta-adrenergic blockers.
D) An autonomous functioning nodule.
E) Presence of ophthalmopathy.
97. A patient with refractory hypertension has known renal artery stenosis on the right. A captopril renogram was performed, and the baseline study was normal. Assuming this patient has renovascular hypertension, the captopril portion of the examination will most likely demonstrate:
A) Normal and symmetric renogram curves bilaterally.
B) Absent perfusion to the right kidney with no extraction of the radiotracer on the renogram curves.
C) Increased extraction of the radiotracer by the right kidney with hyperaccelerated excretion.
D) Delayed extraction of the radiotracer with delayed excretion.
E) Normal renogram curves bilaterally; however, the left kidney exhibits a higher relative percent function.
98. A 67-year-old male with a history of aortic stenosis presents with bright red blood per rectum. A tagged red blood cell gastrointestinal (GI) bleeding scan was performed. Considering the patient's presentation, the most probable site of a GI bleed would be , and the minimum rate of bleeding required for a positive result would be
A) sigmoid colon; 1.0 mL/min.
B) cecum; 0.1 mL/min.
C) small bowel; 0.05 mL/min.
D) cecum;1.0 mL/min.
E) sigmoid colon; 0.05 mL/min.
99. What is the method of localization of pertechnetate in scanning for a Meckel's diverticulum?
A) Secreted by mucin cells in ectopic gastric mucosa.
B) Secreted by serous cells in ectopic gastric mucosa.
C) Hydrolysis by the chief cells of ectopic gastric mucosa.
D) Protein binding.
E) Binding to beta-chain of red blood cells.
100. Which of the following would be a contraindication to the use of morphine in hepatobiliary imaging?
A) Pancreatitis.
B) Common bile duct dilatation.
C) Presence of renal impairment.
D) Heart failure.
E) Cholelithiasis.
101.For each nuclear examination, choose the appropriate target organ. (Select the answer that corresponds to the highlighted line)
1) Ga-67 tumor imaging
2) T1-201 tumor imaging
3) Tc-99m-methylene diphosphate (MDP) bone scan
4) Tc-99m-pertechnetate thyroid imaging
5) Cerebral blood flow study using Tc-99m-diethylenetriamine pentaacetic acid (DTPA)
102. Match the following radiopharmaceutical agents (A-E) used in renal imaging with the listed properties (1-5).
A) Tc-99m-diethylenetriamine pentaacetic acid (DTPA)
B) Tc-99m-glucoheptonate
C) Tc-99m-dimercaptosuccinic acid (DMSA)
D) Tc-99m-mercaptoacetylglycylglycylglycine (MAG3)
E) I-131 orthoiodohippurate
1) Critical organ is the kidney
2) Used to evaluate glomerular filtration rate
3) Excreted by glomerular filtration and tubular secretion
4) Delivers the highest dose to the kidney in a patient with acute tubular necrosis
5) Fifteen percent binding to proximal tubules
103. For each half-life, choose the appropriate radioisotope. (Select the answer that corresponds to the highlighted line
1) 73 hours
2) 78 hours
3 ) 13 hours
4) 110 minutes
5) 67 hours
A) In-111
B) Ga-67
C) T1-201
D) I-123
E) F-18
104. Which of the following would typically cause the pattern as shown in the Ga-67 scan in Figure? (select all correct answers)
The abnormal uptake in the lungs
A) Bleomycin toxicity.
B) Adriamycin toxicity.
C) Kaposi's sarcoma.
D) Pneumocystis carinii pneumonia.
E) Image obtained prior to 24 hours after tracer injection.
105. Regarding Figure, which of the following statements is (are) true? (select all correct answers)
The subtraction scan shows evidence of an adenoma in the inferior parathyroid gland on the left.
A) The abnormality shown is the most common cause of primary hyperparathyroidism.
B) The parathyroid gland is derived from the third branchial pouch.
C) A thyroid nodule may show this scan pattern.
D) This patient should be evaluated for multiple endocrine neoplasia (MEN) IIB syndrome.
E) The inferior parathyroid glands are more likely to be in an ectopic location than are the superior glands.
106. Select the most appropriate condition (A-D) for the specific state of myocardium (1 or 2). (Select the answer that corresponds to the highlighted line)
1) Stunned myocardium
2) Hibernating myocardium
A) Chronically hypoperfused myocardium
B) Ischemic but viable myocardium
C) Nonrecoverable myocardium
D) Associated with stable angina
107.Regarding bone scans, which of the following is (are) true? (select all correct answers)
A) Splenic uptake can be seen in sickle cell disease.
B) There may be uptake by liver metastases from mucin-producing colonic carcinoma.
C) The vast majority of multiple myeloma lesions appear as areas of increased radionuclide uptake.
D) The increased radionuclide uptake on a bone scan is due to increased activity of osteoclasts.
E) Bone scans can be used to assess the response of Paget's disease to treatment.
108.Regarding myocardial imaging, which of the following is (are) true? (X-type question - select all correct answers)
A) 18-Fluoro-2-deoxyglucose can be used to detect myocardial viability.
B) A high-energy collimator is needed to image 18-fluoro-2-deoxyglucose.
C) 18-Fluoro-2-deoxyglucose emits positrons that undergo annihilation and emit the energy that is used for imaging.
D) The concept of myocardial viability is based on patent circulation to the myocardium and myocardial utilization of glucose.
E) The sensitivity and specificity of 18-fluoro-2-deoxyglucose in detecting viable myocardium is higher than that of T1-201 reinjection.
109.Match the following condition or agent with the most closely associated choice. (Select the answer that corresponds to the highlighted line)
1) Ovarian and rectal carcinoma metastatic disease
2) Treatment of painful metastases to bone
3) Tc-99m-labeled red blood cells
4) Neuroendocrine tumors bearing somatostatin receptors
5) Tc-99m-labeled pertechnetate
A) Strontium-89 therapy
B) Oncoscint (In--111-labeled monoclonal antibodies)
C) Agent used to detect upper gastrointestinal bleeding
D) Meckel's diverticulum
E) In-111-labeled octreotide
110. Which of the following is (are) least likely to cause a photopenic area on a bone scan?
A) Multiple myeloma.
B) Aggressive osteomyelitis in children.
C) Purely lytic metastases.
D) Fibrous dysplasia.
E) Simple bone cyst.
111. A 43-year-old white female underwent thyroid scanning with Tc-99m-pertechnetate. Based on the findings shown in Figure, the least likely diagnosis is:
The image shows significantly decreased uptake by the entire thyroid gland, rather than a focal lesion.
A) Subacute thyroiditis.
B) Contrast administration in the past 6 weeks.
C) Exogenous thyroid hormone administration.
D) Consumption of diet rich in iodine.
E) Cold nodule.
112. Figure 68 is from a 21-year-old woman 6 hours after the oral administration of 300 mCi I123. Clinically, the gland was three times normal size and nontender. The 6-hour radioiodine uptake was 86%. What is the best diagnosis?
The glands are moderately enlarged and demonstrate a homogeneous distribution of activity.
A) Graves' disease.
B) Hashimoto's thyroiditis.
C) Plumber's disease (toxic nodular goiter).
D) Multinodular goiter.
113. Concerning the risk for thyroid malignancy, which of the following statements is (are) true?
A) Multinodular glands have a higher risk for malignancy than uninodular glands.
B) Hyperfunctioning nodules have a greater than 10% risk for malignancy.
C) Appearance of a single nodule in a woman younger than age 40 years is a significant risk factor for malignancy.
D) A single dose of I-131 for the treatment of hyperthyroidism confers a small increased risk for the development of leukemia with a lag of longer than 20 years.
114. What is the rim sign and what does it mean regarding hepatobiliary scintigraphy?
A) Rim of increased activity around the liver and is a sign of fatty infiltration.
B) Rim of decreased activity in the gallbladder fossa and a useful indicator of chronic cholecystitis.
C) Rim of increased activity in the gallbladder fossa and an indicator of complicated acute cholecystitis.
D) Rim of increased activity around the caudate lobe and a sign of Budd-Chiari syndrome.
115. Concerning the radionuclide diagnosis of an acute scrotum, which of the following is (are) true?
A) Mumps orchitis commonly demonstrates increased activity in the involved testicle.
B) The presence of increased peripheral scrotal activity indicates epididymitis and virtually excludes torsion.
C) A torsed appendix testes is frequently demonstrated by a photopenic defect slightly superior to the testicle on that side.
D) The peak age for acute testicular torsion is between 16 and 18 years of age.
116. Concerning myocardial perfusion imaging, which of the following is (are) true? (select all correct answers)
A) Four-hour T1-201 redistribution imaging is a useful indicator for myocardial viability.
B) Reverse redistribution on stress 3-hour redistribution T1-201 images usually represents a scar.
C) Tc-99m-sestamibi myocardial extraction is linearly proportional to blood flow.
D) Increased T1-201 lung uptake (lung : myocardium ratio >0.5) is a useful prognostic factor in patients following recent myocardial infarction.
E) Expected inability to sufficiently exercise for a maximal stress test contraindicates stress myocardial perfusion imaging.
117. Regarding Ga-67, which of the following is (are) true?
A) It is the most successful radionuclide infection localization scan available for the abdomen.
B) Its primary in vivo behavior is as an iron analogue.
C) It is specific for Pneumocystis carinii pneumonia in immunocompromised patients.
D) It is more sensitive for parenchymal sarcoidosis than plain chest radiographs.
E) It is very useful as a tumor localizing agent in patients with lymphoma, melanoma, and Kaposi's sarcoma.
118. Regarding varicoceles, which of the following is (are) true? (select all correct answers)
A) Unilateral varicocele is more common on the left side.
B) Associated with infertility.
C) Decrease in size during the Valsalva maneuver.
D) Occurs in approximately 50% of adult males.
E) Can be associated with scrotal pain.
118a.Concerning renal cell carcinoma, which of the following is (are) true? (select all correct answers)
A) More common in females.
B) Associated with von Hippel-Lindau syndrome.
C) Associated with erythrocytosis.
D) Associated with varicoceles.
E) Tumor thrombus extending to the right atrium represents stage IV disease.
119.Regarding xanthogranulomatous pyelonephritis, which of the following is (are) true? (select all correct answers)
A) Associated with an obstructing calculus.
B) Usually segmental in adults.
C) Often contains stippled parenchymal calcifications.
D) More common in females.
E) Affected kidneys usually maintain normal function.
120.Regarding the lesion shown in Figure, which of the following is (are) correct? (select all correct answers)
Figure is a noncontrast CT scan with a small, low attenuation lesion in the anterior aspect of the right kidney. A cursor in this lesion demonstrates fat attenuation of the mass consistent with angiomyolipoma.
A) Associated with von Hippel-Lindau syndrome.
B) Sporadic form is more common in females.
C) Can have high-signal intensity on T1-weighted MRI.
D) Ultrasound is diagnostic.
E) Malignant degeneration is a common complication.
121. Regarding the entity shown in Figure, which of the following is (are) correct? (select all correct answers)
Figure shows an irregularly thickened, contracted bladder with air within the bladder wall.
A) More common in females.
B) Associated with diabetes mellitus.
C) Frequently involves the renal parenchyma.
D) Involvement of the bladder lumen is diagnostic.
E) Best treated with surgery.
122.Cowper's glands drain into which one of the following?
A) Prostatic urethra.
B) Bulbous urethra.
C) Seminal vesicles.
D) Ejaculatory ducts.
E) Verumontanum.
123.All of the following regarding genitourinary tract trauma are true except
A) There is a high association of extraperitoneal bladder rupture with pelvic fractures.
B) Most renal trauma injuries are classified as minor.
C) Horseshoe kidneys are stabilized by their attachment and are less prone to traumatic injury.
D) Straddle injuries involve the anterior urethra.
E) CT is superior to intravenous urography in characterizing traumatic renal injuries.
124. Which of the following regarding the entity shown in Figure is (are) true?
Figure is a nonenhanced CT demonstrating multiple solid renal masses in the right kidney with pancreatic cysts noted as well. The patient's status is post-left nephrectomy (for renal cell carcinoma).
A) Associated with intracerebral aneurysms.
B) Related to pulmonary lymphangioleiomyomatosis.
C) May develop multiple and bilateral angiomyolipomas.
D) Associated with ataxia.
E) Related to chronic renal dialysis.
125. Regarding the intravenous urogram shown in Figure, the most likely diagnosis is:
The intravenous urogram demonstrates visualization of only the lower pole calyces on the left with a filling defect in the bladder.
A) Multicystic dysplastic kidney.
B) Transitional cell carcinoma.
C) Ectopic ureterocele.
D) Primary megaloureter.
E) Schistosomiasis.
126.Correct statements regarding bladder diverticula include all of the following except
A) Hutch diverticula are associated with reflex.
B) Increased incidence of calculus formation.
C) Carcinomas within diverticula tend to metastasize late.
D) Most are due to bladder outlet obstruction.
E) A solitary diverticulum at the dome is usually a patent urachus.
127.Possible causes of the abnormality shown in Figure include which of the following? (select all correct answers)
The CT shows a left perinephric collection, which is approximately isodense with muscle. The density suggests that the collection is most likely blood, which was in fact the case in this patient with post-traumatic renal laceration.
A) Polyarteritis nodosa.
B) Ureteral calculus.
C) Trauma.
D) Renal cell carcinoma.
E) Angiomyolipoma.
128.A large perirenal hematoma in a patient who sustained only minimal trauma is least likely attributable to:
A) Occult renal cell carcinoma.
B) Angiomyolipoma of the kidney.
C) Polycystic disease of the kidney.
D) Polyarteritis nodosa.
E) Multicystic dysplastic kidney.
129. The principle factor causing autonephrectomy in renal tuberculosis is:
A) Cicatricial changes of the ureter in the healing phase of tubercular ulcerations causing back pressure.
B) Coagulation necrosis from the inflammatory process involving renal parenchyma.
C) Shrinkage of the bladder due to tuberculous cystitis.
D) Extensive calcifications in the kidney.
E) Reflux secondary to fibrotic changes involving the bladder and trigone area.
130.The rim opacification of renal infarcts often seen on dynamic CT is most likely attributable to:
A) Subcapsular hematoma.
B) Perinephric hematoma.
C) Early calcifications in the rim of the infarct.
D) Collateral flow via the capsular arteries.
E) A dense cortical scar.
131. Extraperitoneal rupture of the bladder is evaluated well on all of the following except
A) CT cystogram.
B) Fully distended phase of a cystogram, anterior-posterior projection.
C) Postvoiding phase of a cystogram.
D) Lateral projection of the cystogram.
E) Double-contrast air cystogram.
132.Asbestos exposure is associated with all of .the following except
A) Calcified pleural plaques.
B) Benign mesothelioma.
C) Rounded atelectasis.
D) Diffuse pleural thickening.
E) Benign pleural thickening
133.Regarding pleural calcification, all of the following are associations except
A) Chronic empyema.
B) Asbestos exposure.
C) Berylliosis.
D) Talcosis.
E) Tuberculosis
134.Concerning pulmonary alveolar proteinosis, all of the following are true except
A) It most commonly occurs in patients 30 to 50 years of age.
B) Male predominance.
C) It may be asymptomatic.
D) Pulmonary function tests show an obstructive pattern of disease.
E) Nocardia infection is common.
135.A 55-year-old woman presents with a 4-cm right upper lung mass that is more than 2 cm from the carina. Obstructive pneumonitis and ipsilateral mediastinal lymphadenopathy are also present. What is the primary tumor (T), nodal involvement (N), and distant metastasis (M) for this tumor?
A) T2, N2, M0.
B) T2 N3, M0.
C T3, N1, M0.
D) T3, N2, M0.
E) T3, N3, M0.
136.For each numbered item (1-4), select the most closely associated primary lung neoplasm.
1) Less than 5 % of pulmonary tumors
2) Cavitating mass
3) Massive mediastinal adenopathy
4) Scar carcinoma
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Small cell carcinoma
D) Bronchial carcinoid
E) Large cell carcinoma
137. Concerning superior sulcus tumor, which of the following is (are) true?
(X-type question - select all correct answers)
A) It is also known as Pancoast's tumor.
B) Parasympathetic chain involvement is associated with Horner's syndrome.
C) Chest x-rays may demonstrate asymmetric apical pleural thickening.
D) All four major cell types of bronchogenic cancer can manifest themselves in this manner.
E) CT is the best imaging modality to demonstrate the superior extent of the lesion.
138. Concerning tracheal neoplasm, which of the following is (are) true?
(X-type question - select all correct answers)
A) Squamous cell carcinomas often present as tracheoesophageal fistulas.
B) Mucoepidermoid is the most common primary carcinoma.
C) Adenoid cystic carcinomas develop at an earlier age than squamous cell carcinomas.
D) Squamous papillomas are the most common tumors in children.
E) Adenoid cystic carcinomas may calcify
139. For each numbered item (1-4), select the single most closely associated type of emphysema.
1) Associated with pulmonary fibrosis
2) Strongly associated with smoking and bronchitis
3) Basic lesion in bullous lung disease
4) Associated with alpha 1- antitrypsin deficiency
A) Panacinar
B) Centriacinar
C) Periacinal
D) Cicatricial
E) Unclassified
140.Regarding alpha 1-antitrypsin deficiency, which of the following is (are) true?
A) It is closely associated with centriacinar emphysema.
B) There is no association with bronchitis and asthma.
C) Symptoms develop earlier in smokers.
D) It is associated with bronchogenic carcinoma.
E) There is a marked female predominance.
141.For each numbered condition (1-4), select the type of atelectasis associated with it.
1) Pulmonary fibrosis
2) Hyaline membrane disease of the newborn
3) Mucous plugging
4) Asbestos exposure
A) Adhesive
B) Cicatrization
C) Compressive
D) Round
E) Obstructive
142. Regarding extralobar pulmonary sequestration, which of the following is (are) correct?
A) Associated congenital anomalies are rare.
B) Drainage is via the pulmonary venous system.
C) It occurs more frequently in the right lung.
D) The male: female ratio is 4:1.
E) Infection is common.
143.The chest x-ray (Figure 16) from a 50-yearold male with persistent cough and recurrent pulmonary infections suggests which of the following as the most likely diagnosis?
A) Multiple bullae
B) Septic emboli
C) Cystic bronchiectasis
D) Metastatic disease
144.The CT scan (Figure 18) from a 52-yearold male with a history of cough suggests which one of the following as the most likely association?
A) Sinusitis.
B) Meckel's diverticulum.
C) Cystic hygroma.
D) Renal stones.
145.Concerning ciliary dyskinesia syndrome (CDS), which of the following is (are) true?
(X-type question - select all correct answers)
A) CDS has an autosomal-recessive transmission.
B) CDS is a cause of bronchiectasis.
C) Twenty-five percent of patients with CDS have Kartagener's syndrome.
D) Ciliary function is abnormal throughout the body.
E) Males with CDS are infertile
146.Concerning cystic fibrosis, which of the following is the best single description?
A) It is an X-linked recessive disease.
B) Pneumothorax is a complication.
C) The disease is common across all races.
D) Bronchiectasis affects primarily the lower lobes.
E) Hilar enlargement is uncommon
147.For each organism (1-4), select the one most commonly associated pneumonia.
1) Mycoplasma pneumoniae
2) Staphylococcus aureus
3) Streptococcus pneumoniae
4) Klebsiella
A) Lobar pneumonia
B) Bronchopneumonia
C) Interstitial "bacterial" pneumonia
D) Friedlander's pneumonia
E) Aspiration pneumonia
148. As visualized in Figure 10, which one of the following is the most likely diagnosis?
A) Reactivation tuberculosis.
B) Squamous cell carcinoma.
C) Lung abscess.
D) Empyema.
E) Liposarcoma.
149. A 72-year-old man presented with dysphagia. As visualized in the chest CT that was obtained from the patient (Figure 11), which one of the following is the most likely diagnosis?
A) Esophageal adenocarcinoma.
B) Post-traumatic aortic laceration.
C) Aberrant right subclavian artery.
D) Aberrant left subclavian artery.
E) Achalasia.
150. Figure 12 is from a 46-year-old man following right lower lobe pneumonectomy (postoperative day 5). Which one of the following is the most likely diagnosis?
A) Normal postoperative chest x-ray.
B) Large right residual bullae.
C) Tension pneumothorax.
D) Mucous plugging.
E) Compensatory emphysema.
151. Figure 14 is from an 11-year-old female with myasthenia gravis. Of the following, which does the anterior mediastinal mass most likely represent?
enlargement of both lobes of an otherwise normally shaped gland with density consistent with normal thymus
A) Thymoma.
B) Thymic hyperplasia.
C) Thymolipoma.
D) Thymic lymphoma.
E) Thymic cyst.
152. A chest x-ray (Figure 15) from a 5-year-old female who presented with shortness of breath suggests which of the following?
A) Pneumonia.
B) Pneumomediastinum.
C) Pneumothorax.
D) Normal chest.
E) Discoid atelectasis.
153. The CT scan (Figure 17) from a 71-year-old female with chest pain suggests which one of the following as the most likely diagnosis?
dilated fluid and food filled esophagus shadow projecting to right of mediastinum AFL in dilated esophagus, long narrowed segment of esophagus at GE junction
A) Colonic interposition.
B) Teratoma.
C) Achalasia.
D) Neurofibroma.
E) Pericardial cyst.
154. For each numbered item (1-4), select the condition with the appropriate sonographic artifacts (A-E).
A) Increased through-transmission
B) Mirror-image artifact
C) Acoustic shadowing
D) Speed-propagation artifact
E) Comet-tail artifact
1) Adrenal myelolipoma
2) Gallbladder adenomyomatosis
3) Cavernous hemangioma
4) Uric acid ureteral stone
155. With respect to cystic adnexal masses: (select all correct answers)
A) Postmenopausal cysts should all be removed in view of the high risk for malignancy.
B) A hemorrhagic cyst can appear solid and mimic malignancy.
C) A high-resistive index is a reliable indicator of benignancy.
D) A low-resistive index is a reliable indicator of malignancy.
E) Hydrosalpinx must be considered in the differential diagnosis.
156. Which of the following regarding carotid Doppler is (are) true? (select all correct answers)
A) The internal carotid artery lies medial to the external carotid.
B) Abnormally rapid flow can be due to ipsilateral carotid disease.
C) Abnormally rapid flow can be due to contralateral carotid disease.
D) Reversed flow at the carotid bulb indicates plaque-induced turbulence.
E) Flow velocity can be normal at the site of a high-grade stenosis.
157. Findings associated with liver lesions that allow confident distinction between benign and malignant include:
A) Multiplicity of lesions.
B) Perilesional halo.
C) Presence of arterial flow within the lesion.
D) Hepatofugal flow in the adjacent portal vein.
E) None of the above.
158. Clinically pertinent findings in acute pancreatitis identifiable with abdominal sonography include: (select all correct answers)
A) Splenic vein thrombosis.
B) Pancreatic necrosis.
C) Gallstones.
D) Pseudoaneurysm.
E) Fluid collection.
159.Sonographic signs that indicate with certainty the presence of ectopic pregnancy in a patient with a positive pregnancy test include: (select all correct answers)
A) Spalding's sign.
B) A cystic mass with peripheral hypervascularity in the ovary.
C) Echogenic fluid in the cul-de-sac.
D) An empty 30-mm intrauterine sac.
E) A solid extraovarian adnexal mass.
160.The duplex Doppler tracing of the middle hepatic vein (Figure) shows which associated disease?
The waveform shows flow toward the transducer (ie, away from the inferior vena cava), representing reversed hepatic vein flow.
A) Rheumatic fever.
B) Hepatitis B.
C) Cystic fibrosis.
D) Polycythemia vera.
E) Osteogenesis imperfecta.
161.Structures that may be normally identified posterior to the inferior vena cava with sonography include: (select all correct answers)
A) Right adrenal gland.
B) Right renal artery.
C) Lymph node.
D) Circumaortic left renal vein.
E) Right gonadal vein.
162. Of the following complications of liver transplantation, which can be diagnosed with sonography?
(select all correct answers)
A) Hepatic artery occlusion.
B) Portal vein occlusion.
C) Biliary obstruction.
D) Rejection.
E) Cyclosporine toxicity.
163.Causes of the appearance of the right upper quadrant in Figure might include: (select all correct answers)
The image in figure reveals branching linear structures that are highly echogenic most likely representing air in the biliary tree.
A) Pneumonia.
B) Cholangiography.
C) Liver transplantation.
D) Diabetes.
E) Cholelithiasis.
164.Likely causes of the appearance of the right adnexa in Figure include: (select all correct answers)
The image in Figure shows a large cystic adnexal mass containing a fluid-debris level. Posterior to the mass is a dilated tubular structure representing a hydrosalpinx.
A) Cystic teratoma.
B) Pelvic inflammatory disease.
C) Mucinous cystadenoma.
D) Perforated appendicitis.
E) Endometriosis.
165.A tubular hypoechoic adnexal structure visualized on sonography may be a: (select all correct answers)
A) Dilated fallopian tube.
B) Inflamed appendix.
C) Segment of ileum.
D) Portosystemic varix.
E) Thrombosed ovarian vein.
166.The condition in Figure is commonly associated with anomalies of which of the following structures?
The image in Figure is a transverse section of the fetal head, showing ventricular dilatation as well as a "lemon sign" (inward scalloping of the frontal bones), findings associated with Chiari ll malformation.
A) Stomach.
B) Neck.
C) Femur.
D) Spine.
E) Heart.
167.Structures posterior to the superior mesenteric artery include: (select all correct answers)
A) Fourth portion of the duodenum.
B) Splenic vein.
C) Left renal vein.
D) Pancreatic uncinate process.
E) Aorta.
168.Regarding juvenile pilocytic astrocytomas, which of the following is (are) true? (select all correct answers)
A) They are considered "astrocytoma grade I" according to the World Health Organization classification.
B) Cerebellar juvenile pilocytic astrocytomas almost invariably have an enhancing portion.
C) They account for the majority of brainstem gliomas.
D) They are typically solid when occurring in the cerebellum.
E) They tend to grow out of the fourth ventricular outlet foramina and are referred to as "plastic astrocytomas."
169. Regarding Sturge-Weber syndrome, which of the following is (are) true? (select all correct answers)
A) Enhancement of the superficial angioma is commonly seen on MRI.
B) Calcification of the superficial angioma is commonly seen on CT.
C) Choroid plexus enlargement is associated.
D) Ocular choroidal angiomas are associated.
E) Enlargement of the ipsilateral paranasal sinuses is associated.
170. True statements about optic neuritis include which of the following?
A) It is an uncommon initial manifestation of multiple sclerosis.
B) When blood-brain barrier breakdown is present it decreases the signal on postcontrast short T1-inversion recovery (STIR) images.
C) In acute stages it enhances, but does not result in enlargement of the optic nerve.
D) Unlike meningioma it does not produce "tram track" enhancement.
E) The risk of eventually developing multiple sclerosis is equally high regardless of visualization of concomitant brain lesions on MRI.
171. For each numbered item (1-4), select the most closely associated infection (A-E).
A) Cryptococcus
B) Toxoplasmosis
C) HIV encephalitis
D) Progressive multifocal leukoencephalopathy
E) Herpes simplex virus
1) Infectious agent involves the oligodendroglia
2) Predilection for endothelial cells is associated with characteristic complications
3) Most common central nervous system infection in AIDS
4) Infectious agent involves perivascular spaces
172.For each numbered item (1-4), select the most closely associated cerebellopontine angle mass (A-E).
A) Meningioma
B) Medulloblastoma
C) Arachnoid cyst
D) Vestibular schwannoma
E) Epidermoid
1) Widens internal auditory canal
2) Most common nonenhancing CPA lesion
3) Most common CPA lesion
4) Calcification
173. Regarding sellar masses which of the following is (are) true? (select all correct answers)
A) The finding of an intrasellar mass along with an elevated prolactin is diagnostic of a prolactinoma.
B) A pituitary mass can be caused by excess aldosterone levels.
C) A pituitary mass can be caused by decreased thyroid hormone levels.
D) Panhypopituitarism is associated with an ectopic neurohypophysis.
E) The finding of a pituitary mass that is hyperintense on T1 is diagnostic of pituitary apoplexy.
174.Regarding pineal region tumors, which of the following is (are) true?
A) The tumors of pineal parenchymal cells (pinealocytoma and pinealoblastoma) constitute the majority of pineal region tumors.
B) Blood levels of specific tumor products can be followed to detect recurrence of certain germ cell tumors.
C) Germinomas usually occur after 30 years of age.
D) Pineal cysts should be followed since many actually represent germinomas.
E) Astrocytomas in the pineal region should be assumed to have arisen in adjacent structures since astrocytes are not found in the pineal.
175.Smooth, diffuse meningeal enhancement is the least closely associated with:
A) Meningeal carcinomatosis.
B) Normal T1-weighted, gradient-echo MRI.
C) Benign intracranial hypotension.
D) Ventriculo-peritoneal shunting.
E) Cerebral venous thrombosis.
176. For each lymph node level (1-4), choose the classic nodal group (A-E) that best matches it.
A) Jugulodigastric
B) Lateral retropharyngeal
C) Spinal accessory
D) Submental
E) Internal jugular, below hyoid, above cricoid
1) Level 1
2) Level 2
3) Level 3
4) Level 5
5) Not included in the level classification system
177.For each structure (1-4), match the most closely associated "space" (A-E).
A) Sublingual space
B) Submandibular space
C) Carotid space
D) Parotid space
E) Masticator space
1) Facial nerve
2) Submandibular duct
3) Motor division of the trigeminal nerve
4) Vagus nerve
178.Regarding orbital pseudotumor, which of the following is (are) true? (select all correct answers)
A) It typically occurs in obese women with headaches.
B) It is the second most common cause of painless proptosis in adults.
C) A lack of response to steroids rules out the diagnosis.
D) It commonly involves multiple compartments of the orbit.
E) Chronic orbital pseudotumor tends to be markedly hyperintense to fat on conventional T2-weighted MRI.
179. Regarding temporal bone pathology, which of the following is (are) true? (select all correct answers)
A) Most acquired cholesteatomas involve the epitympanic recess or attic.
B) Malignant otitis externa typically metastasizes to lung.
C) Giant cholesterol cysts are hyperintense on T1- and T2-weighted MRI because they contain subacute blood.
D) Glomus tympanicum can usually be distinguished clinically from intratympanic carotid.
E) The early form of cochlear otosclerosis results in demineralization of the otic capsule.
180. Regarding cystic neck lesions, which of the following statements is (are) true? (select all correct answers)
A) The most common congenital cystic neck lesion to develop during adulthood is a cyst of the first branchial cleft.
B) The most common cystic lesion to be "nestled" beneath the infrahyoid strap muscles is a thyroglossal cyst.
C) Approximately two thirds of cystic hygromas are present at birth.
D) Ranulas are retention cysts originating in the sublingual space.
E) Cystic-appearing metastatic nodes are characteristic of papillary thyroid carcinoma.
181. Regarding the tumor, node, metastasis classification of cancer staging, for each numbered item (1-4), choose the most closely associated disease stage (A-D).
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
1) T1, N2, M0
2) T3, N0, M0
3) T1, N0, M1
4) T2, N0, M0
182. From the following, choose the single item that is not associated with the ostiomeatal unit (or ostiomeatal complex).
A) Uncinate process.
B) Hiatus semilunaris.
C) Superior meatus.
D) Maxillary sinus infundibulum.
E) Maxillary sinus ostium.
183. For each numbered item (1-3), choose the most closely associated condition (A-E).
A) Dandy-Walker
B) Schizencephaly
C) Porencephaly
D) Ulegyria
E) Chiari II
1) Migration disorder
2) Torcular-lambdoid inversion
3) Zig-zag interhemispheric fissure
184.For each structure (1-3), choose the usual age (A-E) at which it first appears myelinated (on T1weighted conventional spin-echo images).
A) Birth
B) 2 months
C) 4 months
D) 8 months
E) 24 months
1) Splenium of corpus callosum
2) Posterior limb of internal capsule
3) Adult pattern except for most peripheral white matter
185. Regarding clival chordomas which of the following is (are) true? (select all correct answers)
A) The clivus is the most common site of all chordomas.
B) Calcification is evident in about 10%.
C) On T2-weighted MRI, their signal intensity is similar to cerebral spinal fluid.
D) The spheno-occipital synchondrosis is typically spared.
E) They are thought to be of notochordal origin.
186.Regarding tuberous sclerosis, which of the following is (are) true? (select all correct answers)
A) The majority of cortical tubers calcify by 3 months of age.
B) Enhancement of subependymal nodules on MRI indicates degeneration into giant cell astrocytomas.
C) The most common location for subependymal nodules is near the foramen of Monro.
D) Moya-moya phenomenon due to vascular dysplasia is associated with tuberous sclerosis.
E) The main clinical importance of giant cell astrocytomas is their malignant potential.
187.MRI-detectable atrophy of which of the following structures is associated with chronic temporal lobe seizures? (select all correct answers)
A) Hippocampus.
B) Parahippocampal gyrus.
C) Fornix.
D) Mamillary body.
E) Mammillothalamic tract.
188. For each age and contents of cerebral hematomas (1-4), choose the image appearance that best describes it (A-D).
A) Isointense on T1, isointense on T2
B) Hypointense on T2 with surrounding hyperintensity
C) Hyperintense on T1, hyperintense on T2
D) Hyperintense on TI, hypointense on T2
1) 12-hour-old hematoma (deoxyhemoglobin)
2) 4-day-old hematoma (intracellular methemoglobin)
3) 10-day-old hematoma (extracellular methemoglobin)
4) 1-year-old hematoma (hemosiderin)
189. Regarding congenital spinal anomalies, indicate which of the following statements is (are) true. (select all correct answers)
A) Diastematomyelia is a bone spur in the spinal canal.
B) Dorsal dermal sinus is associated with epidermoid cysts.
C) Lipomyelomeningocele are commonly associated with Chiari II malformations.
D) Myelocystocele is a herniated syrinx.
E) Intradural lipomas are almost never completely encircled by the cord.
190.Regarding multiple sclerosis which of the following is (are) true? (select all correct answers)
A) Most enhancing lesions detected on MRI are symptomatic.
B) There is a poor correlation between enhancement and "active inflammation" at pathology.
C) The detectability of enhancement is increased with triple-dose gadolinium.
D) Viral encephalomyelitis may result in identical changes at autopsy.
E) In the brainstem, lesions characteristically extend to the ventricular or cisternal surfaces.
191.For each lesion (1-4), choose the most closely associated intraventricular location (A-D).
A) Posterior third ventricle
B) Anterior third ventricle
C) Inferior third ventricle
D) Lateral ventricle
1) Colloid cyst
2) Craniopharyngioma
3) Subependymoma
4) Choroid plexus papilloma
192. Regarding head trauma, which of the following is (are) incorrect ?
A) Epidural hematomas can cross sutures when there is a diastatic fracture.
B) With subdural collections, veins are pressed against the brain. With atrophy, veins cross through the CSF.
C) When CT reveals a hematocrit effect in a cerebral hemorrhage, this suggests a poorer prognosis.
D) Because it is typically hemorrhagic, diffuse axonal injury is better visualized with CT than MRI.
193.Considering Figure 46, the most likely diagnosis is:
A) "Trapped ventricle."
B) Ependymal cyst.
C) Arachnoid cyst.
D) Periventricular leukomalacia.
E) Polymicrogyria.
194.Regarding Figure 47, the most likely diagnosis is:
The MRI shows a markedly enlarged sella (normally the base of the pons is about three or four times the height of the pituitary) containing a mass with a fluid level.
A) Craniopharyngioma.
B) Dermoid cyst.
C) Lipoma.
D) Thrombosed giant aneurysm.
E) Hemorrhagic pituitary adenoma.
195.Regarding the condition in Figure 48, choose the best answer.
The findings on this gradient-echo MRI are destruction of two adjacent endplates and intervening disk associated with large paraspinal masses.
A) The condition is linked to chromosome 17.
B) The spinal findings are typically the result of "axial loading."
C) It is commonly associated with calcified paraspinal masses.
D) It is one of the most common primaries to metastasize to the brain.
E) It is often associated with diffuse bony metastases in infancy.
196. Regarding Figure 49, which of the following statements is (are) true?
The patient has a massive infarction due to occlusion of the right internal carotid artery. The curvilinear hyperdense structure represents the intraluminal thrombus.
A) The low density in the left hemisphere represents vasogenic edema.
B) The head CT from a week earlier would have shown most of the same findings.
C) The curvilinear structure of increased attenuation on the right represents subarachnoid hemorrhage.
D) The sparing of the medial aspect of the right frontal lobe and involvement of the occipital lobe are compatible with a carotid occlusion.
197. Regarding Figure 52, a coronal postcontrast T1-weighted MRI, what is the best diagnosis?
The lesion has a smooth ring of enhancement,
A) Abscess.
B) Multiple sclerosis.
C) Hematoma.
D) Glioblastoma.
E) Metastatic disease.
198.Regarding the condition in Figure 53, which single statement is incorrect ?
The finding is hypointensity covering the surfaces of the brain, involving the brainstem, the cerebellar folia, and the temporal poles.
A) It typically is manifested by sensorineural hearing loss.
B) It is most easily diagnosed on T2-weighted fast spin-echo.
C) It is associated with conus ependymomas.
D) Typically, the cerebellum is involved the most severely.
E) It can be associated with cerebral arteriovenous malformation.
199.The pathology shown in Figure 55 did not enhance with contrast. Which single statement is false?
The scan demonstrates bilateral posterior circulation edema,
A.) In most cases the symptoms are irreversible.
B.) The condition is likely to be related to hypertension.
C.) Patients are often cortically blind.
D.) Pregnancy is commonly the cause.
E.) Cerebral autoregulation protects the anterior circulation.