Module 1 : Chest and Vascular
Questions:
  1. The following are branches of the external carotid artery
    1. Lingual artery
    2. Ascending pharangeal artery
    3. Facial artery
    4. Superior thyroid artery
    5. Inferior thyroid artery
  2. Regarding cardiac anatomy
    1. The posterior aspect of the left atrium is adjacent to the oesophagus
    2. The left coronary artery arises from the anterior sinus of valsava
    3. The oblique sinus lies between the IVC and the pulmonary veins
    4. The aortic root is invested by pericardium
    5. The coronary sinus lies in the anterior atrioventricular groove
  3. Fibromuscular dysplasia
    1. Commonly involves the proximal third of the renal artery
    2. Is frequently unilateral
    3. Often associated with aortic fibromuscular dysplasia
    4. Has a string of beads appearance on angiography
    5. Responds poorly to angioplasty
  4. Regarding cardiac MRI
    1. Normal pericardium has a low signal on T1 and T2 imaging
    2. Cardiac iron deposition can be quantified by MRI
    3. Valvular regurgitation can be quantified
    4. Pericardial calcification can be accurately quantified
    5. The haemodynamic significance of aortic coarctation can be determined on cine MRI
  5. Regarding MRI artefact
    1. Motion artefact occurs in the frequency encoding direction
    2. Aliasing occurs when the field of view is too small
    3. Chemical shift artefact increases as the static field increases
    4. Chemical shift artefact can be reduced by using a narrower band width
    5. Chemical shift artefact occurs in the phase encoding direction
  6. Hypertrophic cardiomyopathy
    1. The left ventricle dilates
    2. Autosomal recessive transmission
    3. Systolic anterior motion of the mitral valve is seen at ECHO
    4. Mitral regurgitation is a feature
    5. Pericardial effusion is a frequent finding
  7. Causes of pericardial effusion include
    1. Tuberculosis
    2. Rheumatoid arthritis
    3. Aortic stenosis
    4. Irradiation
    5. Anticoagulation
  8. Causes of a localised bulge on the left heart border include
    1. Enlarged left atrial appendage
    2. Coronary artery aneurysm
    3. Pulmonary valve stenosis
    4. Pericardial sac defect
    5. Pulmonary artery stenosis
  9. Regarding Takayasu’s arteritis
    1. The superior mesenteric artery may be involved
    2. Commonly affects elderly patients
    3. Aortic dissection is common
    4. Mitral valve involvement is a common finding
    5. Is associated with night sweats
  10. Regarding congenital heart disease
    1. A right aortic arch with aberrant left subclavian artery is the commonest congenital aortic arch abnormality
    2. A right aortic arch with an aberrant left subclavian artery is usually symptomatic
    3. In left aortic arch with aberrant right subclavian artery, the right subclavian artery is the first branch from the proximal descending aorta
    4. Left aortic arch with aberrant right subclavian artery and right ductus/ligamentum is a cause of dysphagia
    5. A right aortic arch with mirror image branching is usually associated with an abnormal barium swallow
  11. Regarding the aorta
    1. Stanford type A aortic dissections do not involve the descending aorta
    2. Stanford type B aortic dissections usually require surgical intervention
    3. Inflammatory aortic aneurysms are usually large at presentation
    4. Pregnancy is a recognised cause of aortic dissection
    5. Atherosclerotic aneurysms are frequently saccular
  12. Causes of cyanotic heart disease and pulmonary plethora include
    1. Patent ductus arteriosus
    2. Single ventricle
    3. Truncus arteriosus
    4. Hereditary haemorrhagic telangiectasia
    5. Interrupted aortic arch
  13. Regarding Ultrasound scan
    1. Risk of aliasing can be reduced by using a higher frequency probe
    2. Aliasing can occur with continuous wave Doppler
    3. Acoustic enhancement is made worse by time gain compensation
    4. Maximal Doppler shift is obtained at a transducer angle of 0 degrees
    5. Resolution in the near field is improved by using a smaller transducer
  14. In Ultrasound scan of the neck vessels
    1. The internal carotid artery initially lies anteromedial to the external carotid artery
    2. The bifurcation of the common carotid artery occurs at the lower border of the thyroid cartilage
    3. The internal carotid artery does not have any branches in the neck
    4. The peak systolic velocity is usually higher in the internal carotid artery than the external carotid artery
    5. Low vascular resistance is seen in the external carotid artery
  15. Regarding thoracic anatomy
    1. The azygous vein ascends in the posterior mediastinum to the level of T2
    2. The left pulmonary artery crosses over the left main bronchus
    3. The right pulmonary artery lies anterior to the right bronchus at the hilium
    4. The aorta passes through the central tendon of the diaphragm at the level of T8
    5. The pretracheal space is continuous with the aortopulmonary window
  16. Regarding the thymus
    1. Hyperthyroidism is the most common cause of thymic hyperplasia
    2. Addison’s disease is a cause of thymic hyperplasia
    3. Over two thirds of patients with Myasthenia Gravis have a thymoma
    4. Most thymomas present with signs of mediastinal compression
    5. Thymic hyperplasia enlarges during treatment with steroids
  17. Regarding bronchial carcinoid
    1. Majority of patients present with carcinoid syndrome
    2. Patients may present with Cushing’s syndrome
    3. The majority of carcinoids occur peripherally
    4. Heavy calcification is a recognised feature
    5. Produces osteoblastic metastases
  18. Bronchopulmonary sequestration
    1. Intralobar sequestration most commonly presents in childhood
    2. In extralobar sequestration, venous drainage is mainly to the left side of the heart
    3. Intralobar sequestration most commonly has a systemic arterial supply
    4. Mucoid impaction of bronchus surrounded by hyperinflated lung is characteristic for intralobar sequestration
    5. Extralobar sequestration may appear on CT as a homogenous, well circumscribed soft tissue mass
  19. Sarcoidosis
    1. Predominantly involves the lower lobes
    2. Is associated with focal sclerotic bony lesions
    3. Is a cause for egg shell lymph node calcification
    4. Adenopathy commonly increases as the parenchymal disease deteriorates
    5. Non-caseous granulomas are seen on bronchial/transbronchial biopsy
  20. Traumatic diaphragmatic rupture
    1. The left hemidiaphragm arises from the anterior surfaces of L1-L2 vertebra
    2. The right hemidiaphragm is most commonly ruptured following blunt thoraco-abdominal trauma
    3. Following road traffic accidents, small bowel is the commonest organ to herniate
    4. Associated fractures of the lower ribs/pelvis is seen in 40%
    5. Following routine oesophagogastrectomy, the intrathoracic stomach usually lies in the left retrocardiac area
  21. The following are imaging features of Extrinsic Allergic Alveolitis
    1. Predominantly upper zone location
    2. Centrilobular nodules
    3. Ground glass appearance
    4. Relative sparing of lung apices
    5. Mediastinal adenopathy in over 50%
  22. Eggshell calcification occurs in
    1. Post radiotherapy lymphoma
    2. Silicosis
    3. Asbestosis
    4. Sarcoidosis
    5. Talcosis
  23. In Wegeners ganulomatosis
    1. Cavitating pulmonary nodules are seen
    2. Ground glass opacification is seen
    3. Stridor is a recognised feature
    4. Mediastinal lymphadenopathy is common
    5. Renal involvement is more common than pulmonary involvement
  24. Regarding asbestosis
    1. Pleural plaques usually originate in the visceral pleura
    2. Pleural plaques are usually less than a centimetre thick
    3. Pleural effusions are a common feature of asbestos exposure
    4. The earliest features of pulmonary asbestosis are peripherally at the bases
    5. Mesothelioma usually arises from pleural plaques
  25. The following drugs can cause lung fibrosis
    1. Tetracycyline
    2. Penicillin
    3. Methotrexate
    4. Cyclophosphamide
    5. Nitrofurantoin
  26. Pulmonary hydatid
    1. Are usually multiple
    2. Calcification of hydatid cysts is a frequent finding
    3. The water lily sign indicates rupture of one of the inner layers of the cyst
    4. A hypersensitivity reaction can develop if the cyst ruptures
    5. Most common cause is haematogenous spread from a liver lesion
  27. Regarding Langerhans Cell Histiocytosis
    1. Leads to increased lung volumes
    2. The majority of cases occur in smokers
    3. Has a basal predominance
    4. Recurrent pneumothorax occurs in 25%
    5. Small nodules are seen at an early stage of the disease
  28. Metastases to the lung
    1. Breast cancer is a cause of endobronchial metastases
    2. Metastases to lung frequently calcify
    3. Testicular metastases are a cause of calcified lung metastases
    4. Thyroid cancer is a cause of haemorrhagic lung metastases
    5. Renal cancer is a common cause of pleural metastases
  29. Crytogenic Organising Pneumonia
    1. Is associated with lung cancer
    2. Frequently affects upper zones
    3. Small nodules are seen on CXR
    4. Features are usually bilateral on HRCT
    5. Highly responsive to antibiotics
  30. Causes of bronchiectasis include
    1. Alpha-1-antitrypsin deficiency
    2. Allergic bronchopulmonary aspergillosis
    3. TB
    4. Scimitar syndrome
    5. Wegeners granulomatosis
  31. Features of pulmonary involvement of Rheumatoid arthritis include
    1. Lung involvement is more frequent in females than males
    2. Pleural disease is usually bilateral
    3. Interstitial fibrosis has an upper lobe predominance
    4. Cavitating pulmonary nodules may be seen
    5. Hilar lymph nodes frequently calcify
  32. Predmoninant upper zone pulmonary fibrosis is a feature of
    1. Asbestosis
    2. Chronic extrinsic allergic alveolitis
    3. Histoplasmosi
    4. Anklysosing spondylitis
    5. Systemic sclerosis
  33. Pulmonary hamartomas
    1. Usually present in children
    2. Never increase in size
    3. Are associated with functioning extra-adrenal paragangliomas
    4. Usually central
    5. The presence of fat excludes the diagnosis
  34. Ground glass appearance on HRCT is a feature of
    1. Crytogenic organising pneumonia
    2. Desquamative interstitial pneumonia
    3. ALymphangitis carcinomatosis
    4. Amyloidosis
    5. Alveolar proteinosis
  35. Regardings HIV
    1. Hilar lymphadenopathy is characteristic of pneumocystis carinii infection
    2. Pneumatocoeles are associated with Pneumocystis carinii pneumonia
    3. In the majority of HIV patients, TB is confined to the thorax
    4. Upper lobe cavitating disease in TB is infrequent
    5. Intrathoracic involvement is the most common manifestation of patients with Non-Hodgkins Lymphoma
  36. The following cause a false negative diagnosis of pulmonary embolus on CTPA
    1. Low signal to noise ratio
    2. Inadequate opacification of the pulmonary arteries
    3. Hilar and bronchopulmonary lymph nodes
    4. Emboli confined to subsegmental pulmonary arteries
    5. Motion artefact degrading image
  37. The following cause air trapping
    1. Bronchial atresia
    2. Congenital lobar emphysema
    3. Bronchiolitis obliterans
    4. Hypoplastic lung
    5. Atelectasis
  38. Inferior rib notching on a chest x-ray occurs in
    1. Neurofibromatosis
    2. Aortic thrombosis
    3. Pulmonary oligaemia
    4. Marfan’s syndrome
    5. Rheumatoid arthritiss
  39. Malignant features of a pleural lesion include
    1. Nodular pleural thickening
    2. Mediastinal pleural involvement
    3. Calcification
    4. 0.5cm pleural thickening
    5. Rind like pleural involvement
  40. Regarding imaging of thrombolembolic disease in preganancy
    1. The fetal dose is greater in CTPA than in perfusion scintigraphy
    2. D-Dimer levels usually rise during a normal pregnancy
    3. Reducing the pitch during CTPA will reduce the dose
    4. Non-ionic iodinated contrast crosses the placenta
    5. Reduced venous flow occurs during pregnancy
Answers:
  1. The following are branches of the external carotid artery:
    1. Lingual artery(T)
    2. Ascending pharangeal artery(T)
    3. Facial artery(T)
    4. Superior thyroid artery(T)
    5. Inferior thyroid artery(F)

    Inferior thyroid is a branch of the subclavian artery
    Reference: Butler, Applied Radiological Anatomy, page 116
  2. Regarding cardiac anatomy
    1. The posterior aspect of the left atrium is adjacent to the oesophagus(T)
    2. The left coronary artery arises from the anterior sinus of valsava(F)
    3. The oblique sinus lies between the IVC and the pulmonary veins(T)
    4. The aortic root is invested by pericardium(T)
    5. The coronary sinus lies in the anterior atrioventricular groove(F)

    The right coronary artery arises from the anterior sinus of valsava; the left coronary artery arises from the left posterior sinus of valsava. The coronary sinus lies in the posterior atrioventricular groove.
    Reference: Butler, Applied Radiological Anatomy, pages 156-166
  3. Fibromuscular dysplasia
    1. Commonly involves the proximal third of the renal artery(F)
    2. Is frequently unilateral(F)
    3. Often associated with aortic fibromuscular dysplasia(F)
    4. Has a string of beads appearance on angiography(T)
    5. Responds poorly to angioplasty(F)

    Proximal main renal artery spared in 98%. The condition is bilateral in 2/3. The aorta is spared, however, the external iliac artery may be involved. Transluminal balloon angioplasty has a 90% success rate
    Reference: Dähnert 5th edition, pages 949-950 Grainger and Allison’s Diagnostic Radiology 4th edition, page 1525
  4. Regarding cardiac MRI
    1. Normal pericardium has a low signal on T1 and T2 imaging(T)
    2. Cardiac iron deposition can be quantified by MRI(T)
    3. Valvular regurgitation can be quantified(T)
    4. Pericardial calcification can be accurately quantified(F)
    5. The haemodynamic significance of aortic coarctation can be determined on cine MRI(T)

    Myocardial iron deposition leads to shortening of T2 relaxation time. Both valvular regurgitation and stenoses can be quantified. Pericardial calcification can be accurately quantified on CT not on MR.
    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, pages 752-766
  5. Regarding MRI artefact
    1. Motion artefact occurs in the frequency encoding direction(F)
    2. Aliasing occurs when the field of view is too small(T)
    3. Chemical shift artefact increases as the static field increases(T)
    4. Chemical shift artefact can be reduced by using a narrower band width(F)
    5. Chemical shift artefact occurs in the phase encoding direction(F)

    Frequency encoding occurs quickly whereas phase encoding occurs slowly, therefore the effects of motion artefact are evident in the phase encoding direction. Chemical shift artefact occurs in the frequency encoding direction. Chemical shift artefact be reduced by using a wider receiver bandwidth, however, this leads to more noise or by usinga steeper gradient.
    Reference: Physics for medical imaging, Farr RF and Allisy-Roberts PJ, pages 243-245
  6. Hypertrophic cardiomyopathy
    1. The left ventricle dilates(F)
    2. Autosomal recessive transmission(F)
    3. Systolic anterior motion of the mitral valve is seen at ECHO(T)
    4. Mitral regurgitation is a feature(T)
    5. Pericardial effusion is a frequent finding(F)

    The left ventricles hypertrophies, does not dilate. Autosomal dominant transmission. Systolic anterior motion of the mitral valve is seen at ECHO And this causes a narrowed left ventricular outflow tract in systole. Pericardial effusion is unusual.
    Reference: Dähnert 5th edition, pages 621-2 Grainger and Allison’s Diagnostic Radiology 4th edition, pages 892-894
  7. Causes of pericardial effusion include
    1. Tuberculosis(T)
    2. Rheumatoid arthritis(T)
    3. Aortic stenosis(F)
    4. Irradiation(T)
    5. Anticoagulation(T)

    Reference: Dähnert 5th edition, pages 585 and 611-612
  8. Causes of a localised bulge on the left heart border include
    1. Enlarged left atrial appendage(T)
    2. Coronary artery aneurysm(T)
    3. Pulmonary valve stenosis(F)
    4. Pericardial sac defect(T)
    5. Pulmonary artery stenosis(F)

    Reference: Chapman and Nakielny, Aids to radiological differential diagnosis, 4th edition, page 201
    Grainger and Allison’s Diagnostic Radiology 4th edition, pages 812-813 and 816
  9. Regarding Takayasu’s arteritis
    1. The superior mesenteric artery may be involved(T)
    2. Commonly affects elderly patients(F)
    3. Aortic dissection is common(F)
    4. Mitral valve involvement is a common finding(F)
    5. Is associated with night sweats(T)

    The condition mainly affects the aorta, brachiocephalic branches and pulmonary arteries though other vessels may be involved. Patients are usually under 40 years. Aortic dissection is rare. Mitral valve involvement is rare and leads to mitral regurgitation. Aortic regurgitation is more common
    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, page 960
    Dähnert 5th edition, pages 648-649
    Spectrum of angiographic findings in aortoarteritis. Rathod KR et al. Clinical Radiology (2005) 60: 746-755
  10. Regarding congenital heart disease
    1. A right aortic arch with aberrant left subclavian artery is the commonest congenital aortic arch abnormality(F)
    2. A right aortic arch with an aberrant left subclavian artery is usually symptomatic(F)
    3. In left aortic arch with aberrant right subclavian artery, the right subclavian artery is the first branch from the proximal descending aorta(F)
    4. Left aortic arch with aberrant right subclavian artery and right ductus/ligamentum is a cause of dysphagia(T)
    5. A right aortic arch with mirror image branching is usually associated with an abnormal barium swallow(F)

    Left aortic arch with aberrant right subclavian artery is the commonest abnormality (0.4-2.3% of population). A right aortic arch with an aberrant left subclavian artery is usually asymptomatic as it forms a loose ring around trachea and oesophagus. In left aortic arch with aberrant right subclavian artery, the right subclavian artery is the fourth branch from the proximal descending aorta. Left aortic arch with aberrant right subclavian artery and right ductus/ligamentum is a cause of dysphagia due to anterior tracheal indentation and large posterior oesophageal impression. The barium swallow is usually normal as there is no vascular ring, no retrooesophageal component and no structure posterior to trachea
    Reference: Dähnert 5th edition, pages 577-581
  11. Regarding the aorta
    1. Stanford type A aortic dissections do not involve the descending aorta(F)
    2. Stanford type B aortic dissections usually require surgical intervention(F)
    3. Inflammatory aortic aneurysms are usually large at presentation(F)
    4. Pregnancy is a recognised cause of aortic dissection(T)
    5. Atherosclerotic aneurysms are frequently saccular(F)

    Stanford A involves the ascending aorta, with or without arch involvement, Type B begins beyond brachiocephalic vessels. Type B usually respond to reduction of peak systolic blood pressure alone, Type A require surgical intervention. Inflammatory aortic aneurysms are usually small at presentation due to early symptomology. Atherosclerotic aneurysms are 80% fusiform, 20% saccular.
    Reference: Dähnert 5th edition, pages 605-609
  12. Causes of cyanotic heart disease and pulmonary plethora include
    1. Patent ductus arteriosus(F)
    2. Single ventricle(T)
    3. Truncus arteriosus(T)
    4. Hereditary haemorrhagic telangiectasia(F)
    5. Interrupted aortic arch(T)

    Interrupted aortic arch predominantly causes congestive cardiac failure, but may be cyanotic.
    Reference: Chapman and Nakielny, Aids to radiological differential diagnosis, 4th edition, page 209
  13. Regarding Ultrasound scan
    1. Risk of aliasing can be reduced by using a higher frequency probe(F)
    2. Aliasing can occur with continuous wave Doppler(F)
    3. Acoustic enhancement is made worse by time gain compensation(T)
    4. Maximal Doppler shift is obtained at a transducer angle of 0 degrees(T)
    5. Resolution in the near field is improved by using a smaller transducer(T)

    Risk of aliasing can be reduced by using a lower frequency probe and occurs with pulsed Doppler. Acoustic shadowing and enhancement are both made worse by TGC. Resolution in the near field is improved by using a smaller transducer And also by focussing.
    Reference: Physics for medical imaging, Farr RF and Allisy-Roberts PJ, pg 204-212
  14. In Ultrasound scan of the neck vessels
    1. The internal carotid artery initially lies anteromedial to the external carotid artery(F)
    2. The bifurcation of the common carotid artery occurs at the lower border of the thyroid cartilage(F)
    3. The internal carotid artery does not have any branches in the neck(T)
    4. The peak systolic velocity is usually higher in the internal carotid artery than the external carotid artery(F)
    5. Low vascular resistance is seen in the external carotid artery(F)

    The external carotid artery lies anteromedial to the internal carotid artery. The bifurcation of the common carotid artery occurs at the upper border of the thyroid cartilage. The peak systolic velocity is usually lower in the internal carotid artery than in the common carotid artery and external carotid artery. High vascular resistance in the external carotid artery and low vascular resistance in the internal carotid artery
    Reference: Butler, Applied Radiological Anatomy, page 116 Grainger and Allison’s Diagnostic Radiology 4th edition, page 68
  15. Regarding thoracic anatomy
    1. The azygous vein ascends in the posterior mediastinum to the level of T2(F)
    2. The left pulmonary artery crosses over the left main bronchus(T)
    3. The right pulmonary artery lies anterior to the right bronchus at the hilium(T)
    4. The aorta passes through the central tendon of the diaphragm at the level of T8(F)
    5. The pretracheal space is continuous with the aortopulmonary window(T)

    The azygous vein ascends in the posterior mediastinum to the level of T4. The aorta passes behind median arcuate ligament at the level of T8.
    Reference: Butler, Applied Radiological Anatomy, pages 125-150
  16. Regarding the thymus
    1. Hyperthyroidism is the most common cause of thymic hyperplasia(T)
    2. Addison’s disease is a cause of thymic hyperplasia(T)
    3. Over two thirds of patients with Myasthenia Gravis have a thymoma(F)
    4. Most thymomas present with signs of mediastinal compression(F)
    5. Thymic hyperplasia enlarges during treatment with steroids(F)

    10-25% of patients with MG have thymoma, 65% of patients with MG have thymic hyperplasia. 50% are asymptomatic, 25-30% present with mediastinal compression, e.g. cough, dyspnoea, dysphagia. Steroids lead to a reduction in the size in the thymic hyperplasia.
    Reference: Dähnert 5th edition, pages 529-530
  17. Regarding bronchial carcinoid
    1. Majority of patients present with carcinoid syndrome(F)
    2. Patients may present with Cushing’s syndrome(T)
    3. The majority of carcinoids occur peripherally(F)
    4. Heavy calcification is a recognised feature(T)
    5. e. Produces osteoblastic metastases(T)

    Carcinoid syndrome is very rare if carcinoid is confined to lung. Cushing’s syndrome is caused due to ectopic ACTH production. The majority of carcinoids occur centrally: 10% peripheral, 90% central.
    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, page 477 Dähnert 5th edition, pages 463 and 801
  18. Bronchopulmonary sequestration
    1. Intralobar sequestration most commonly presents in childhood(F)
    2. In extralobar sequestration, venous drainage is mainly to the left side of the heart(F)
    3. Intralobar sequestration most commonly has a systemic arterial supply(T)
    4. Mucoid impaction of bronchus surrounded by hyperinflated lung is characteristic for intralobar sequestration(T)
    5. Extralobar sequestration may appear on CT as a homogenous, well circumscribed soft tissue mass(T)

    Intralobar sequestration most commonly presents in adulthood (50% >20 years). In extralobar sequestration, the veins drain to the right heart (IVC, azygous, hemiazygous, SVC, portal vein) in 80%. Intralobar sequestration commonly drains via normal pulmonary veins to the left atrium (in 95%) as well as via azygous, hemiazygous, intercostals veins, SVC into right atrium (in 5%). Intralobar sequestration most commonly has a systemic arterial supply via the distal thoracic aorta in 73%, proximal aorta in 22%.
    Reference: Dähnert 5th edition, pages 471-473
  19. Sarcoidosis
    1. Predominantly involves the lower lobes(F)
    2. Is associated with focal sclerotic bony lesions(T)
    3. Is a cause for egg shell lymph node calcification(T)
    4. Adenopathy commonly increases as the parenchymal disease deteriorates(F)
    5. Non-caseous granulomas are seen on bronchial/transbronchial biopsy(T)

    Sarcoidosis Predominantly involves the lower lobes mid zones. Adenopathy decreases as the parenchymal disease gets worse. Adenopathy does not develop subsequent to parenchymal disease
    Reference: Dähnert 5th edition, pages 522-524
  20. Traumatic diaphragmatic rupture
    1. The left hemidiaphragm arises from the anterior surfaces of L1-L2 vertebra(T)
    2. The right hemidiaphragm is most commonly ruptured following blunt thoraco-abdominal trauma(F)
    3. . Following road traffic accidents, small bowel is the commonest organ to herniate(F)
    4. Associated fractures of the lower ribs/pelvis is seen in 40% (T)
    5. Following routine oesophagogastrectomy, the intrathoracic stomach usually lies in the left retrocardiac area(F)

    The left hemidiaphragm arises from the anterior surfaces of L1-L2 vertebra and The right hemidiaphragm arises from L1-L3 and is slightly longer than the left. During blunt abdominal trauma the left hemidiaphargm is ruptured in 70-80%, the right in 15-24%. The frequency of herniation is Stomach 31.8%, Colon 27.2%, liver, kidney, spleen, and small intestine may also herniated. The intrathoracic stomach usually lies in the right paraspinal area. If left retrocardiac air lucency is seen, herniation of intestine should be considered
    Reference: Imaging of diaphragmatic rupture after trauma. Eren S et al. Clinical Radiology (2006) 61: 467-477
    Butler, Applied Radiological Anatomy, page 278
    Dähnert 5th edition, page 484
  21. The following are imaging features of Extrinsic Allergic Alveolitis
    1. Predominantly upper zone location(F)
    2. Centrilobular nodules(T)
    3. Ground glass appearance(T)
    4. Relative sparing of lung apices(T)
    5. Mediastinal adenopathy in over 50%(F)

    Extrinsic allergic alveolitis involves predominantly mid zones, occasionally lower zones, rarely upper zones. Poorly defined centrilobular micronodues (<5mm) and widespread patchy/diffuse ground glass attenuation in 52% are seen in subacute EAA. Adenopathy is unusual.
    Reference: Dähnert 5th edition, page 486-7
  22. Eggshell calcification occurs in
    1. Post radiotherapy lymphoma(T)
    2. Silicosis(T)
    3. Asbestosis(F)
    4. Sarcoidosis(T)
    5. Talcosis(F)

    Reference: Dähnert 5th edition, page 434
    Chapman and Nakielny, Aids to radiological differential diagnosis, 4th edition, page 148
  23. In Wegeners ganulomatosis
    1. Cavitating pulmonary nodules are seen(T)
    2. Ground glass opacification is seen(T)
    3. Stridor is a recognised feature(T)
    4. Mediastinal lymphadenopathy is common(F)
    5. Renal involvement is more common than pulmonary involvement(F)

    Cavitation of nodules with thick walls and irregular shaggy inner lining (25-50%). Stridor is seen due to tracheal inflammation and sclerosis. Hilar and mediastinal lymphadenopathy are rare. Pulmonary disease in 94% and renal disease in 85%
    Reference: Dähnert 5th edition, pages 534-544
    Grainger and Allison’s Diagnostic Radiology 4th edition, pages 597-8
  24. Regarding asbestosis
    1. Pleural plaques usually originate in the visceral pleura(F)
    2. Pleural plaques are usually less than a centimetre thick(T)
    3. Pleural effusions are a common feature of asbestos exposure(F)
    4. The earliest features of pulmonary asbestosis are peripherally at the bases(T)
    5. Mesothelioma usually arises from pleural plaques(F)

    Pleural effusion occurs in 3% of asbestos workers. Mesothelioma arises independently from a pleural plaque.
    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, pages 513-516
  25. The following drugs can cause lung fibrosis
    1. Tetracycyline(F)
    2. Penicillin(F)
    3. Methotrexate(T)
    4. Cyclophosphamide(T)
    5. Nitrofurantoin(T)

    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, page 506
  26. Pulmonary hydatid
    1. Are usually multiple(F)
    2. Calcification of hydatid cysts is a frequent finding(F)
    3. The water lily sign indicates rupture of one of the inner layers of the cyst(T)
    4. A hypersensitivity reaction can develop if the cyst ruptures(T)
    5. Most common cause is haematogenous spread from a liver lesion(T)

    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, pages 400-401
    Dähnert 5th edition, pages 493-4
  27. Regarding Langerhans Cell Histiocytosis
    1. Leads to increased lung volumes(T) - Increased lung volumes in a third, unlike most other fibrotic diseases which have decreased lung volumes
    2. The majority of cases occur in smokers(T) - Heavy cigarette smoking in young men
    3. Has a basal predominance(F) - Bilaterally symmetrical, upper lobe predominance, spares costophrenic angles
    4. Recurrent pneumothorax occurs in 25%(T) - This is characteristic
    5. Small nodules are seen at an early stage of the disease(T) - The nodules then cavitate to produce cysts

    Reference: Dähnert 5th edition, page 498
  28. Metastases to the lung
    1. Breast cancer is a cause of endobronchial metastases(T) - Along with bronchogenic ca, lymphoma, RCC, Colorectal cancer
    2. Metastases to lung frequently calcify(F) - Less than 1%
    3. Testicular metastases are a cause of calcified lung metastases(T) - Along with Breast, Osteochondroma, Papillary thyroid cancer, Ovarian, Colorectal cancer
    4. Thyroid cancer is a cause of haemorrhagic lung metastases(T) - Along with Angiocarcinoma, Choriocarcinoma, RCC, Melanoma
    5. Renal cancer is a common cause of pleural metastases(F) - Lung, Breast, Lymphoma, Ovary and Stomach are common causes

    Reference: Dähnert 5th edition, page 506
  29. Crytogenic Organising Pneumonia
    1. Is associated with lung cancer(T) - Also, post obstructive pneumonia, ARDS, EAA, collagen vascular disease, pulmonary drug toxicity, idiopathic in 50%
    2. Frequently affects upper zones(F) - Mid and lower zones
    3. Small nodules are seen on CXR(T) - 3-5mm nodules
    4. Features are usually bilateral on HRCT(T) - In 90%
    5. Highly responsive to antibiotics(F) - Unresponsive to antibiotics, usually improves with steroids

    Reference: Dähnert 5th edition, page 466
  30. Causes of bronchiectasis include
    1. Alpha-1-antitrypsin deficiency(T)
    2. Allergic bronchopulmonary aspergillosis(T)
    3. TB(T)
    4. Scimitar syndrome(F)
    5. Wegeners granulomatosis(F)

    Reference: Dähnert 5th edition, page 464
  31. Features of pulmonary involvement of Rheumatoid arthritis include
    1. Lung involvement is more frequent in females than males(F) - Lung involvement M:F = 5:1; Pleural disease M:F = 9:1
    2. Pleural disease is usually bilateral(F) - 92% unilateral
    3. Interstitial fibrosis has an upper lobe predominance(F) - Lower lobe predominance
    4. Cavitating pulmonary nodules may be seen(T) - Well circumscribed nodules of 3-70mm in size can cavitate with smooth symmetrical walls and smooth inner lining
    5. Hilar lymph nodes frequently calcify(F) - No calcification of hilar lymph nodes

    Reference: Dähnert 5th edition, page 521
  32. Predmoninant upper zone pulmonary fibrosis is a feature of
    1. Asbestosis(F) - Basal
    2. Chronic extrinsic allergic alveolitis(T)
    3. Histoplasmosi(T)
    4. Anklysosing spondylitis(T)
    5. Systemic sclerosis(F) - Basal

    Reference: Chapman and Nakielny, Aids to radiological differential diagnosis, 4th edition, page 151
  33. Pulmonary hamartomas
    1. Usually present in children(F) - Average age of presentation is 45-50
    2. Never increase in size(F) - Grow slowly (far slower than carcinoma of bronchus)
    3. Are associated with functioning extra-adrenal paragangliomas(T) - Triad of pulmonary chondroma, leiomyoblastoma and functing extra-adrenal paragangliomas is known as Carney’s triad
    4. Usually central(F) - 90% are peripheral (as opposed to bronchial carcinoid in which 90% are central)
    5. The presence of fat excludes the diagnosis(F) - Central fat on CT establishes the diagnosis

    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, pages 477-8
    Dähnert 5th edition, page 489
  34. Ground glass appearance on HRCT is a feature of
    1. Crytogenic organising pneumonia(T)
    2. Desquamative interstitial pneumonia(T)
    3. ALymphangitis carcinomatosis(F)
    4. Amyloidosis(F)
    5. Alveolar proteinosis(T)

    Reference: Dähnert 5th edition, pages 455 and 466
  35. Regardings HIV
    1. Hilar lymphadenopathy is characteristic of pneumocystis carinii infection(F) - Pleural effusions and lymphadenopathy are rarely seen
    2. Pneumatocoeles are associated with Pneumocystis carinii pneumonia(T) - Pneumatocoeles are seen in 10% of patients with P. carinii pneumonia
    3. In the majority of HIV patients, TB is confined to the thorax(F) - More than half of patients have extrapulmonary (especially lymph node) involvement
    4. Upper lobe cavitating disease in TB is infrequent(T) - Diffuse bilateral coarse reticulonodular opacities are typically demonstrated
    5. Intrathoracic involvement is the most common manifestation of patients with Non-Hodgkins Lymphoma(F) - Less than 10% of patients with NHL and HIV have thoracic involvement

    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, pages 401-411
  36. The following cause a false negative diagnosis of pulmonary embolus on CTPA
    1. Low signal to noise ratio(T)
    2. Inadequate opacification of the pulmonary arteries(T)
    3. Hilar and bronchopulmonary lymph nodes(F)
    4. Emboli confined to subsegmental pulmonary arteries(T)
    5. Motion artefact degrading image(T)

    Reference: Grainger and Allison’s Diagnostic Radiology 4th edition, page 529
  37. The following cause air trapping
    1. Bronchial atresia(T)
    2. Congenital lobar emphysema(T)
    3. Bronchiolitis obliterans(T) - Patchy air trapping seen on expiratory HRCT
    4. Hypoplastic lung(F) - Results in decreased lung volume
    5. Atelectasis(F) - Results in decreased lung volume

    Reference: Dähnert 5th edition, page 429, 464-5, 478
  38. Inferior rib notching on a chest x-ray occurs in
    1. Neurofibromatosis(T) - Ribbon ribs may also occur
    2. Aortic thrombosis(T) - Usually the lower ribs bilaterally
    3. Pulmonary oligaemia(T) - Any cause of decreased pulmonary blood supply
    4. Marfan’s syndrome(F) - Superior rib notching occurs
    5. Rheumatoid arthritiss(F) - Superior rib notching occurs

    Reference: Chapman and Nakielny, Aids to radiological differential diagnosis, 4th edition, pages 53-54
  39. Malignant features of a pleural lesion include
    1. Nodular pleural thickening(T)
    2. Mediastinal pleural involvement(T)
    3. Calcification(F)
    4. 0.5cm pleural thickening(F) - >1cm pleural thickening
    5. Rind like pleural involvement(T)

    Reference: Use of imaging in the management of malignant pleural mesothelioma.
    Benamore RE et al. Clinical Radiology (2005) 60: 1237-1247
    Grainger and Allison’s Diagnostic Radiology 4th edition, pages 513-514
  40. Regarding imaging of thrombolembolic disease in preganancy
    1. The fetal dose is greater in CTPA than in perfusion scintigraphy(F) - Estimated fetal dose in multisection CTPA is 0.01-0.02mSv compared to 0.2-0.6mSv in perfusion scintigraphy
    2. D-Dimer levels usually rise during a normal pregnancy(T)
    3. Reducing the pitch during CTPA will reduce the dose(F) - Increasing the pitch, reducing the kv, reducing the mAs will all reduce the dose
    4. Non-ionic iodinated contrast crosses the placenta(T) - If iodinated contrast has been administered during pregnancy then neonatal thyroid function should be checked during the first week of life to exclude hypothyroidism
    5. Reduced venous flow occurs during pregnancy(T)

    Reference: Diagnosis of suspected venous thromboembolic disease in pregnancy.
    Scarsbrook AF et al. Clinical Radiology (2006) 61: 1-12
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