File 16

Question 1

Pericardial effusion what is the next step modality?
A) Echocardiography
B) CT
C) MRI

Answer 1

A) Echocardiography

Notes:
- Echocardiography is the method of choice to confirm the diagnosis, estimate the volume of fluid and most importantly assess the hemodynamic impact of the effusion.

Question 2

A 32-year-old patient, medically free with lower limb claudication and
decrease pulses on the lower limb, there is figure 3 sign and inferior rib
notching what is the diagnosis:

A) Cortication of the aorta
B) Aortic dissection

Answer 2

A) Cortication of the aorta

Question 3

Patient with shortness of breath on x-ray there is double atrial sign and calcification over the heart chambers, on the right there is a double cardiac sign, with calcification of cardiac shadow, which of the following is the diagnosis: (They mentioned history of rheumatic fever)

A) Mitral stenosis
B) Aortic stenosis
C) Aortic Regurge
D) Tricuspid stenosis

Answer 3

A) Mitral stenosis

Question 4

Patient with x-ray shows right heart apex and right sided aortic arch left sided gastric bubble what is the diagnosis?

A) Situs inversus
B) Dextrocardia
C) Situs solitus

Answer 4

B) Dextrocardia

Question 5

Patient with dysphagia and posterior indentation on the esophagus what
is the cause?

A) Aberrant subclavian artery
B) Pulmonary sling
C) Dilated left atrium
D) Dilated right atrium

Answer 5

A) Aberrant subclavian artery

Question 6

Patient with elevated left hemi diaphragm on chest X-ray and on
fluoroscopy there is paradoxical movement of the diaphragm what is the
diagnosis?

A. Cerebrovascular disease
B. Inferior mediastinal tumor
C. Pancoast tumor
D. Mass in the left lower lobe

Answer 6

C. Pancoast tumor

Question 7

Female not smoker with right bronchus mass?

A) Carcinoid
B) Small cell cancer
C) Bronchogenic cyst
D) Adenocarcinoma

Answer 7

D) Adenocarcinoma

Question 8

Patient has anterior mediastinal mass on CT and renal dysfunction. They want to do a Chest MRI for further evaluation. What is the appropriate thing to do?

A) Repeat CT
B) Do it if GFR >30
C) Do it then immediate hemodialysis

Answer 8

B) Do it if GFR >30

Question 9

Patient with trauma there is shortness of breath and hyperresonance on examination patient cannot stand because of fracture what can you see on supine x ray?

A) Deepened left CP angle
B) Left pleural cap
C) Increase heart angle

Answer 9

A) Deepened left CP angle

Question 10

Patient with MVA present with chest trauma x-ray shows rib fracture
and air space opacities after two days follow-up x-ray shows improved
opacities with large cyst with air fluid level. What is the diagnosis?

A) Pulmonary laceration
B) Bronchopulmonary fistula
C) Abscess
D) Atypical infection

Answer 10

A) Pulmonary laceration

Regions of pulmonary contusion with added blebs (pneumatoceles)
with air-fluid levels.

Question 11

Unilateral lung findings of septal thickness and polygonal shape with budding?

A) Lymphangiomatosis carcinomatosis
B) Idiopathic lung fibrosis

Answer 11

A) Lymphangiomatosis carcinomatosis

Question 12

Patient with tumor extending around the arch of aorta and pulmonary
vessels without invasion what do you suspect his symptom?

A) Hoarseness of voice
B) Dysphagia
C) Swelling in face and neck

Answer 12

A) Hoarseness of voice

Notes:
- Due to recurrent laryngeal nerve injury.
- The rest of the options mainly involve the upper.

Question 13

Elderly patient with cough and fever x ray shows right middle zone
opacity on lateral x ray it appears to be at the apical segment of the right
lower lobe with oblique fissure is displaced away from the opacity with
pleural effusion what is the causative organism?

A) Klebsiella pneumoniae
B) Streptococcal pneumonia
C) Legionella
D) Hemophilus influenzae

Answer 13

A) Klebsiella pneumoniae

Question 14

Patient with SOB and lower limb edema, what is the earliest sign to suggest pulmonary edema?

A) Measure of upper pulmonary vein is larger than lower
B) Perihilar airspace opacities
C) Fine lines

Answer 14

A) Measure of upper pulmonary vein is larger than lower

Answer: A
Notes:
- Aka cephalization.
- 1s􀭑 → UPV > LPV.
- 2ɴᴅ → Fine lines aka Kerley B lines.
- 3ʀᴅ → Perihilar airspace opacities.

Question 15

Patient with tail of pancreas traumatic injury which of the following is
the most appropriate next step?

A) US to assess the pancreatic duct integrity
B) ERCP
C) Laparotomy
D) Supportive management

Answer 15

B) ERCP

Answer: B
Notes:
- Suspected pancreatic injury → ERCP or MRCP → assess pancreatic duct patency.

Question 16

Hepatoduodenal ligament suspend which part of the duodenum?

A) I
B) II
C) III
D) IV

Answer 16

A) I

Question 17

Cystic artery is a branch of:
A) Hepatic artery
B) Celiac artery

Answer 17

A) Hepatic artery

Answer: A
Notes:
- Hepatic artery proper → Right hepatic artery → Cystic artery, ant & post. segmental artery of
liver, right artery of caudate lobe.

Question 17

Patient with lung CA he did CT, and it shows well-defined adrenal lesion HU is 17 absolute washouts is 55% what is the next step?

A) Do MRI
B) Nothing it is adenoma
C) Nothing it is metastasis

Answer 17

A) Do MRI

Question 18

After colonoscopy the patient has abdominal pain what to do?

A) Water soluble oral contrast
B) Double contrast barium
C) Single contrast barium

Answer 18

A) Water soluble oral contrast

To rule out perforation.

Question 19

What is the lesser sac boundaries?

A) Lesser omentum, splenorenal ligament, and gastrosplenic ligament.
B) Lesser omentum, umbilical ligament, and duodenum
C) Lesser omentum, duodenum, and triangular ligament

Answer 19

A) Lesser omentum, splenorenal ligament, and gastrosplenic ligament.

• Anterior
  o lesser omentum
  o visceral peritoneum along posterior stomach
  o gastrocolic omentum (between greater curvature of stomach and transverse colon)
• Left lateral
  o gastrosplenic and splenorenal ligaments

Question 20

Early sign for Crohn’s disease?

A) Prominent vasa recta
B) Mural stratification

Answer 20

A) Prominent vasa recta

√ Asymmetric bowel wall thickening.
- Comb sign → engorgement of the vasa recta.

Question 21

Synovial plicae:

A) Moderate intensity in high resolution
B) High in T2, low in T1
C) At the junctional zone

Answer 21

B) High in T2, low in T1

Synovial remnants → ↓ PD/T2.

Question 22

A picture of hysterosalpingogram (it shows multiple small filling defects at the uterus cavity the contrast is spelled in the peritoneal cavity bilaterally). What is the diagnosis?

A) Intrauterine polyposis
B) Underfilled uterus
C) Intrauterine synechiae
D) Abscess/PID

Answer 22

C) Intrauterine synechiae

Question 23

You did US for a patient, and it shows 3 cm echogenic renal mass what is the next step?

A) CT without contrast
B) CT with contrast
C) Non enhanced MRI
D) Enhanced MRI

Answer 23

B) CT with contrast

Question 24

Female patient with left renal colic and hematuria; culture is negative for urine and blood on CT there is perinephric edema and fat stranding what is the diagnosis?

A) Pyelonephritis
B) Nutcracker syndrome
C) RCC

Answer 24

B) Nutcracker syndrome