General

Question 1

6) Into which structure does the thoracic duct normally drain?

a. left brachiocephalic vein

b. left internal jugular vein

c. left subclavian vein

d. superior vena cava

e. junction of left subclavian and internal jugular veins

Answer 1

e. junction of left subclavian and internal jugular veins

The thoracic duct starts at the cisterna chyli at the level of T12. It passes behind the right diaphragmatic crus and crosses right to left in the thorax behind the esophagus. It terminates by draining into the junction between the left subclavian and internal jugular veins, usually as two or three branches

Question 2

@# 24) The bronchial tree receives blood from one right and two left bronchial arteries. From which vessel does the single right artery usually arise?

a. aorta

b. joint origin with left bronchial arteries

c. second posterior right intercostal artery

d. third posterior right intercostal artery

e. fourth posterior right intercostal artery

Answer 2

d. third posterior right intercostal artery

The bronchial tree derives its arterial supply via bronchial arteries. The two left-sided vessels arise direct from the aorta. The solitary right artery usually arises from the right third posterior intercostal artery. These vessels supply the bronchi from the carina to the respiratory bronchioles.

Question 3

66) A 56-year-old male has a cough. A chest radiograph and CT chest show a 2 cm rounded mass in the apex of the left lung not amenable to biopsy. An 18FDG PET/CT scan is arranged for further assessment. Which technique may help to improve characterization of the lesion as benign or malignant using the standardized uptake value (SUV)?

a. maximum SUV corrected for lean body mass

b. maximum SUV corrected for body weight

c. metabolic tumor burden (volume _ average SUV)

d. dual time point assessment of SUV

e. assessment of SUV centrally and peripherally in the lesion

Answer 3

d. dual time point assessment of SUV

Dual time point assessment involves measuring the SUV at two time points to assess for change. In malignant lesions the SUV rises with time, whereas with benign lesions this tends to remain static.

The maximum SUV corrected for lean body mass or weight is the standard measurement used for assessment of metabolic activity of lesions on PET.

The metabolic tumor burden is currently not used in clinical practice.

The assessment of uptake in the peripheral and central areas of a lesion is not a recognized technique.

Question 4

75) Which lung segments are separated by the superior accessory fissure?

a. apical segment of lower lobes from other lower lobe segments

b. apical segment of right upper lobe from other upper lobe segments

c. superior segment of lingula from inferior segment of lingula

d. lingular segment of upper lobe from remainder of left upper lobe

e. right middle lobe from right lower lobe

Answer 4

a. apical segment of lower lobes from other lower lobe segments

The superior accessory fissure can be seen on both frontal and lateral radiographs. It is seen inferior to the horizontal fissure on the frontal projection and extends to the posterior chest wall on the lateral projection, whereas the horizontal fissure extends to the anterior chest wall. Other common accessory fissures are the inferior accessory fissure (between the medial basal segment of the lower lobe and other basal segments) and the azygos fissure (invagination of pleura into the upper lobe containing the azygos vein).

Question 5

76) In normal anatomy, which vascular structure lies most anteriorly at the level of the thoracic inlet, posterior to the manubrium?

a. left common carotid artery

b. brachiocephalic artery

c. superior vena cava

d. left brachiocephalic vein

e. right brachiocephalic vein

Answer 5

d. left brachiocephalic vein

In the superior mediastinum, the venous structures lie most anteriorly. The superior vena cava does not extend up to reach the thoracic inlet but is formed inferiorly by the convergence of the brachiocephalic veins. The right has a short vertical course to the right of the midline, while the left crosses from the root of the neck on the left to the right side of the superior mediastinum behind the manubrium, where it lies anterior to all of the other vascular structures.

Question 6

78) In persistent left-sided superior vena cava, drainage usually occurs into which structure?

a. left atrium

b. right atrium

c. normal right superior vena cava

d. hemizygous vein

e. coronary sinus

Answer 6

e. coronary sinus

Persistent left-sided superior vena cava occurs in 0.3% of the general population and in 4.3–11% of patients with congenital heart disease. It is associated with atrial septal defects and azygos continuation of the inferior vena cava. It lies lateral to the aortic arch and anterior to the left hilum. It usually drains into the coronary sinus, but rarely drains into the left atrium, causing a left-to-right shunt. The normal right-sided superior vena cava is absent in 10–18% of cases of left-sided superior vena cava.

Question 7

86) In an adult patient, which structure, along with the right atrium and superior vena cava, forms the right mediastinal border?

a. right brachiocephalic vein

b. inferior vena cava

c. right ventricle

d. trachea

e. brachiocephalic artery

Answer 7

a. right brachiocephalic vein

In an adult, the right mediastinal border normally comprises the right brachiocephalic vein, the superior vena cava and the right atrium. In young patients, the thymus may produce a characteristic sail-shaped opacity over the right mediastinal border. The right tracheal wall can be seen as the paratracheal stripe through the right brachiocephalic vein and superior vena cava. The right ventricle does not form any part of the cardiac silhouette on a frontal chest radiograph. The brachiocephalic artery lies medial to the right brachiocephalic vein and does not form any part of the mediastinal border.

Question 8

84) In normal anatomy, which structure lies immediately anterior to the left main bronchus at the left hilum?

a. left pulmonary artery

b. left inferior pulmonary vein

c. left superior pulmonary vein

d. left phrenic nerve

e. left vagus nerve

Answer 8

c. left superior pulmonary vein

The left pulmonary artery crosses over the superior aspect of the left main bronchus giving off the upper lobe artery and the inferior pulmonary artery, and then lies posterior to the left main bronchus.

The left inferior pulmonary vein drains into the left atrium and does not reach the level of the left main bronchus.

The vagus nerve lies posterior to the hilum adjacent to the esophagus.

The phrenic nerve lies anterior to all of the left hilar structures on the pericardium.

Question 9

87) In bronchopulmonary sequestration, which of the following features would be more suggestive of Intralobar than extralobar type?

a. enclosed in visceral pleura

b. no connection to bronchial tree

c. systemic venous drainage

d. presentation in infancy

e. systemic arterial supply

Answer 9

a. enclosed in visceral pleura

Bronchopulmonary sequestration is a malformation consisting of a nonfunctioning lung segment with no communication to the bronchial tree and a systemic arterial supply.

The Intralobar type accounts for 75% of cases. It is enclosed in visceral pleura and presents in adulthood with pain, repeated infection, cough and hemoptysis.

The extralobar type is enclosed in its own pleura and presents in infancy with feeding difficulties, respiratory distress, cyanosis and congestive heart failure (due to shunting).

Systemic venous drainage is seen in 80% of cases of extralobar type, but only in 5% of cases of intralobar type.

Question 10

@# 88) In anatomy of the aortic arch, after the normal configuration of vessels (brachiocephalic, left common carotid and left subclavian arteries), what is the next most common configuration seen?

a. left vertebral artery arising from the arch between left common carotid and subclavian arteries

b. common origin of the brachiocephalic artery and left common carotid artery

c. right subclavian arising distal to the left subclavian artery

d. common origin of left common carotid and left subclavian arteries

e. double arch with common carotid and subclavian arteries arising from each side

Answer 10

b. common origin of the brachiocephalic artery and left common carotid artery

The so-called normal aortic arch anatomy is seen in only 65% of people. The next most common configuration is where the left common carotid artery arises with the brachiocephalic artery in a common origin, seen in 13%, followed by the left common carotid arising from the brachiocephalic artery (bovine origin), seen in 9%. The left vertebral artery arising direct from the arch is seen in 2.5%, and the aberrant right subclavian artery (option c) occurs in 0.5%.

Question 11

92) A 23-year-old female who is 23 weeks’ pregnant presents with pleuritic chest pain, and pulmonary embolus is suspected. She asks about the relative radiation doses for CT pulmonary angiogram and ventilation–perfusion (_V = _ Q) scintigraphy. What is the dose for a CT pulmonary angiogram relative to a _V= _Q scan?

a. CT pulmonary angiogram has a higher total body dose but a lower uterine dose

b. CT pulmonary angiogram has the same total body dose but a lower uterine dose

c. CT pulmonary angiogram has a higher total body dose and uterine dose

d. CT pulmonary angiogram has a lower total body dose and uterine dose

e. CT pulmonary angiogram has a higher total body dose but the same uterine dose

Answer 11

a. CT pulmonary angiogram has a higher total body dose but a lower uterine dose

The total body dose for CT pulmonary angiogram is approximately 2–3 times higher than for _V=_Q scanning. However, the uterine, and therefore fetal, dose has been found to be higher with _V=_Q scanning. A low-dose_V =_Q technique can reduce this, but the uterine dose still remains higher. Regardless of technique used, there remains a risk, but the risk of death from pulmonary embolus far outweighs any radiation risk to patient or fetus.

Question 12

95) In the left lower lobe of the lung, the bronchi to which segments share a common origin?

a. posterior basal and lateral basal

b. lateral basal and anterior basal

c. anterior basal and medial basal

d. medial basal and posterior basal

e. apical and posterior basal

Answer 12

c. anterior basal and medial basal

There are five segments to the lower lobes of both lungs, but, unlike on the right, the medial basal and anterior basal segmental bronchi on the left usually have a common origin. The medial basal segment is small due to the cardiac indentation.

Question 13

11- Which of the following sequelae of intravenous contrast medium is not dose dependent?

(a) Anaphylactoid reaction

(b) Bradycardia

(c) Nausea & vomiting

(d) Nephropathy

(e) Metallic taste

Answer 13

(a) Anaphylactoid reaction

Anaphylactoid reactions mimic anaphylactic reactions but do not involve lgE and are not true hypersensitivity reactions. They may occur with as little as 1 ml of contrast medium and do not require pre- sensitization; patients may not have the same reaction after a second exposure- The remaining features are dose-dependent reactions to intravenous contrast medium.

Question 14

@# 20- With regards to the anatomy seen on a normal plain chest radiograph, which of the following is incorrect?

(a) The anterior junctional line is formed by the apposition of the visceral and parietal pleura of the anteromedial aspect of the lungs, separated by mediastinal fat

(b) The anterior junctional line extends more cranially than the posterior junctional line

(c) The right paratracheal stripe measures up to 4 mm

(d) The left paratracheal stripe is seen less commonly than the right paratracheal stripe

(e) The left paraspinal line is seen more commonly than the right paraspinal line

Answer 14

(b) The anterior junctional line extends more cranially than the posterior junctional line

The posterior junctional line is formed by the junction between the lungs posterior to the esophagus and anterior to the 3rd — 5th thoracic vertebrae. It appears as a straight or mildly leftward convex line seen projected over the trachea. Unlike the anterior junctional line, it can extend above the clavicles.

Question 15

44- A 32-year-old lady, 27 weeks pregnant, is referred for a CT pulmonary angiogram. Which of the following technique modifications would not be appropriate?

(a) Reduced tube current

(b) Reduced tube voltage

(c) Reduced z-axis

(d) Reduced pitch

(e) Increased collimation thickness

Answer 15

(d) Reduced pitch

If anything the pitch should be increased to reduce dose. Breast shields, abdominal shielding and increased collimation thickness should also be considered in an effort to reduce dose.

Question 16

47- With regard to ventilation/perfusion (V/Q) studies, which of the following statements is not true?

(a) Ventilation should be performed with the patient upright

(b) A low probability study is associated with a PE in around 100/0 of cases

(c) Perfusion images should be acquired with the patient upright

(d) A high probability study is associated with no PE in around 10% of cases

(e) Technetium agents have better imaging characteristics than Krypton for the ventilation phase

Answer 16

(e) Technetium agents have better imaging characteristics than Krypton for the ventilation phase

Krypton has better imaging characteristics with a short half-life (13 secs) and better penetration (it is a gas). Technetium is widely used for its low cost and ready availability

Question 17

11 A 67 year old lady presents with chest pain and shortness of breath ten days after hip replacement surgery. She is known to have COPD. A CT-pulmonary angiogram is requested. Which of the following factors is more likely to increase the risk of a severe idiosyncratic reaction to iodinated contrast medium?

(a) Asthma

(b) Creatinine > 133 μmol/L

(c) Metformin

(d) NSAIDs.

(e) Type-2 diabetes mellitus

Answer 17

(a) Asthma

Factors that increase the risk of an idiosyncratic contrast reaction include: Atopy, asthma, B-blockers (all increase x3), cardiac disease (x5), age >50 years (x2) and previous allergic reaction to iodine or shellfish (x10). The other listed answers will increase the chance of contrast-related nephrotoxicity rather than allergic reaction.

Question 18

21 A 58 year old patient has a chest CT 6 months after. Resection of a primary lung tumour. There are noted to be new ipsilateral superior mediastinal and supraclavicular lymph nodes measuring 6-8 mm. An 18FDG-PET/CT is reqaested for further evaluation. Which of the following is not a routine part of the pre-scan preparation?

(a) Inject FOG tracer 15 minutes prior to imaging

(b) Check blood glucose level prior to tracer injection

(c) No food for 6 hours prior to imaging

(d) No talking for 30 minutes prior to imaging

(e) No jogging for 24-48 hours prior to imaging

Answer 18

(a) Inject FOG tracer 15 minutes prior to imaging

Imaging should not be performed until at least 30 minutes, and more typically 60 minutes after tracer administration to allow clearance from the background blood pool. Patient preparation is key in order to minimise artefacts from physiological uptake. Muscle uptake is reduced by keeping serum insulin levels low, thus patients are fasted for 6 hours prior to the study. It is important to check blood glucose prior to the study as elevated blood glucose competes with FOG for transport, increasing background activity; above a certain level (often quoted as 13 mmol/ml) the procedure may have to be postponed. For imaging in the head/neck region it is advisable to avoid talking for 30-60 minutes prior in order to minimise muscle uptake in this region, similarly strenuous exercise should be avoided 24-48 hours prior to reduce whole-body muscle uptake. Additional avoidance of caffeine is recommended in cardiac/chest imaging as it will increase heart rate, hence increasing heart size and myocardial uptake.

Question 19

63 A 48-year-old man undergoing a CT of the abdomen has an anaphylactoid reaction to i. v. contrast medium, with bronchospasm and hypotension. You need to administer. adrenalin. What dose and via which route should this be done?

(a) 0.15 mg 1: 1,000 (0.15 mls) intravenously

(b) 0.15 mg 1: 10,000 (0.15 mis) intramuscularly

(c) 0.15 mg of 1: 10,000 (0.15 mis) subcutaneously

(d) 0.5 mg of 1: 1,000 (0.5 mis) intramuscularly

(e) 0.5 mg of 1: 10,000 (0.5 mis) intravenously

Answer 19

(d) 0.5 mg of 1: 1,000 (0.5 mis) intramuscularly

Intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. Adrenaline i. v. must only be given in certain situations and by those skilled and experienced in its use. The recommended intramuscular dose is 0.5 mg of 1 :1,000 (0.5 mis) for those> 12 years, 0.3 mg for those 6-12 years and 0.15 mg for those < 6 years.

Question 20

69 Which of the following is not a cause of a mismatch on V/Q imaging?

(a) Acute pulmonary embolism

(b) Pulmonary hypertension

(c) Bronchial carcinoma

(d) Pneumothorax

(e) Idiopathic pulmonary fibrosis

Answer 20

(d) Pneumothorax

A pneumothorax will be neither ventilated nor perfused and thus would give a matched defect.

Question 21

71 Which of the following is not a feature of high kV chest radiographs?

(a) Greater detail of the airways

(b) Sharper outline of pulmonary structures

(c) Increased focus-to-film distance with an air gap

(d) Reduced obscuration of lung by skeletal structures

(e) Better delineation of calcified pleural plaques

Answer 21

(e) Better delineation of calcified pleural plaques

High kV radiographs penetrate the skeleton and mediastinum better, enabling improved lung images; a shorter exposure time gives sharper images. Low kV images allow better appreciation of calcified nodules or pleural plaques.

Question 22

3. A 40 year old has a routine chest radiograph as a part of pre-immigration work up. This demonstrates a mass on the left with loss of the upper left heart border. The descending aorta can, however, be seen despite the mass. Which of the following is the most likely location of the mass?

a. Apico-posterior segment

b. Lingula

c. Anterior segment of the upper lobe

d. Posterior basal segment of the lower lobe

e. Lateral basal segment of the lower lobe

Answer 22

3. b. Lingula

This is an example of the silhouette sign where an anteriorly located lingular mass results in loss of the upper left heart border but preservation of the outline of the posterior descending aorta.

Question 23

30. A 46-year-old man presents with fever and cough. A frontal chest radiograph shows loss of the lower part of the left heart border with hazy shadowing in the region. The most likely site of infection in the lung is?

(a) Lingula

(b) Apicoposterior segment of left upper lobe

(c) Apical segment of left upper lobe

(d) Medial basal segment of left lower lobe

(e) Lateral basal segment of left lower lobe

Answer 23

30. (a) Lingula

The lingular segment in the left lung lies adjacent to the heart and collapse/ consolidation in this segment leads to loss of the lower part of left heart border.

Question 24

QUESTION 2
A 40-year-old woman has been admitted to the Intensive Therapy Unit (ITU) with severe pancreatitis. She is currently being ventilated but has worsening respiratory failure, refractory to oxygen therapy. In addition, she has a normal capillary wedge pressure. Which of the following is the most likely radiological feature on portable CXR?

A Cardiomegaly

B Mediastinal lymphadenopathy

C Patchy peripheral airspace opacification

D Pleural effusions

E Well-defined lobar airspace opacification

Answer 24

C Patchy peripheral airspace opacification

Direct and indirect insults to the lung can result in increased permeability of the pulmonary vasculature allowing protein-rich fluid to pass into the alveolar spaces at normal hydrostatic pressures. ARDS is the more severe form of this disease and the earliest radiographic findings are patchy ill-defined airspace opacities in both lungs.

Question 25

QUESTION 16
Interstitial lung disease is suspected in a 3-year-old child who has a long history of breathlessness on exertion. A chest radiograph reveals interstitial change at the lung bases. The clinical symptoms are more severe than the radiographic changes appear to suggest and a diagnosis is yet to be established. Which one of the following would be the next appropriate investigation?

A Bronchoscopy

B Contrast-enhanced chest CT

C HRCT

D MRI

E Noncontrast chest CT

Answer 25

C HRCT

HRCT should ideally be performed in order to determine the extent and distribution of disease. Breathing can be controlled under anaesthesia to ensure adequate inspiration.

Question 26

70. A patient is being investigated by his GP due to a history of dysphagia and occasional stridor. A CXR has been requested, which is reported as showing possible tracheal abnormality. A lateral CXR is requested and this shows an abnormality in the retro-tracheal space (Raider triangle). Using your knowledge of the anatomy of this space and the diseases that may affect it, which of the following statements correctly describes an abnormality in this area and the effect it will have radiologically on the retro-tracheal space?

A. A thickened tracheo-oesophageal stripe of 11mm will displace the trachea posteriorly.

B. An enlarged aorta bulges into the inferior aspect of the retro-tracheal space.

C. A subclavian artery aneurysm will be noted posterior to the tracheo-oesophageal stripe and will displace this anteriorly.

D. Mediastinal extension of a retropharyngeal abscess will widen the tracheo-oesophageal stripe superiorly.

E. A thyroid goitre extending retrosternally will displace the trachea posteriorly.

Answer 26

70. B. An enlarged aorta bulges into the inferior aspect of the retro-tracheal space.

Whilst lateral CXRs are seldom requested, when they are requested it is often the retro-tracheal space that requires assessment and thus knowledge ofits borders and pathological conditions is relevant.

The retro-tracheal space is bounded anteriorly by the posterior border of the trachea and posteriorly by the vertebrae. The inferior margin is the aortic arch.

The space is of low density, being created by the lung posterior to the trachea.

The posterior tracheal line is usually 2.5 mm thick, but can be 5.5 mm thick if the anterior wall of the oesophagus lies adjacent to the posterior wall of the trachea (the tracheo-oesophageal line (TOL)).

Thus an enlarged aorta would be noted inferiorly.

Extension of retro-pharyngeal abscesses usually occurs along the prevertebral space, posteriorly in the retro-tracheal space, thus not affecting the TOL.

A normal retro-sternal goitre extending anterior to the trachea is not located in the retro-tracheal space.

A normal subclavian artery is not present in the retro-tracheal space, but an aberrant left or right subclavian artery may be identified in the position described.

Question 27

@# 64 A 70-kg patient with no relevant comorbidities underwent an abdominal percutaneous drain insertion. At the start of the procedure 10 mL of 1 % lidocame hydrochloride was infiltrated subcutaneously. The patient developed further pain as dilators and a stiff guidewire were inserted. How much more 1 % lidocaine can safely be administered?

a None

b 5mL

c 10 mL

d 20 mL

e 40 mL

Answer 27

64 Answer C: 10 mL

Lidocaine hydrochloride (xylocaine, lignocaine) is routinely used for local anaesthesia. 1 % means 1 g in 100 mL, that is 10 mg/mL. In a typical adult a maximum dose of 3 mg/kg is appropriate. (In solutions containing adrenaline, the maximum dose is higher: 7 mg/kg.)

Question 28

25 With regard to imaging with PET-CT and the use of F-18 labelled FDG, which of the following is the most accurate statement relating to the behaviour of the radioisotope and acquisition of counts?

a F-18 has a half-life of approximately 60 minutes

b F-18 decays by electron capture

C Annihilation with an electron produces photons with an energy of 115 mBq

d The point source resolution of PET is approx 1 mm

e The dominant annihilation photon interaction in tissue is Compton scatter

Answer 28

25 Answer E: The dominant annihilation photon interaction in tissue is Compton scatter

The range of resolution of positron emission tomography is 5-10 mm, much less than that of CT which can resolve points of less than 1 mm, which limits its use in detecting sub-5 mm lesions.

F-18 is a positron emitter (hence positron emission tomography) and has a half-life of 109 minutes.

During FDG positron decay the nuclide decays into a proton and neutron with the emission of a positron with a range of approximately 1 mm.

This interacts with an electron to produce two annihilation photons (511 keV) travelling in opposite directions. These photons form the images of tracer concentration.

Question 29

29 A journal published details of the ages of a series of 11 patients presenting for lung biopsy. Their ages are listed as 28, 30, 32, 55, 66, 67, 70, 70, 72, 83 and 87. What is their median age?

a 60

b 63

c 65

d 67

e 70

Answer 29

29 Answer D: 67

The median is the middle of the dataset. If there is an even number of data points then the median is the average of the middle two. The mode is the most frequently occurring number and the arithmetic mean is the sum of all the values divided by the number of data points included.

Question 30

25 A patient suffering from type 1 diabetes underwent a whole body PET CT for the staging of cancer. What is the most appropriate advice to optimise the quality of their scan?

a Caffeine should be avoided as it can increase or decrease cardiac FDG uptake

b Blood sugar should be below 3 mg/L

C The patient should be nil by mouth for 24 hours

d The patient can be given 2-5 u insulin immediately prior to FDG injection

e Uptake in smooth muscle should be ignored if the haemoglobin Al c (HbAlc) level is higher than expected

Answer 30

25 Answer A: Caffeine should be avoided as it can increase or decrease cardiac FDG uptake

Patients must be nil by mouth for four hours to maintain the blood glucose level, which will affect the rate of FDG 18 uptake by cells. High levels of glucose can compete with FDG uptake and degrade image quality and results, hence the glucose level should ideally be below 10 mg/L. Type 1 diabetic patients should be starved overnight and imaged first thing in the morning. If insulin is to be used, it should be administered at least one hour prior to FDG injection. Insulin increases FDG uptake in the heart, muscle and liver and can degrade image quality. Stimulants such as caffeine can have a variable effect on uptake. HbAl c has no effect on imaging.

Question 31

60 The Royal College of Radiologists and the General Medical Council provide guidance on the obtaining of written consent. When is it considered acceptable not to obtain written consent?

a A complex procedure with significant side-effects

b A non-therapeutic procedure

C A procedure where the patient’s actions imply consent

d A procedure that may have consequences on the patient’s social life

e A procedure that is part of a research programme

Answer 31

60 Answer C: A procedure where the patient’s actions imply consent

Most radiological examinations involve minimal risk and the patient’s actions are taken to represent implied consent. If there is any doubt as to the patient’s understanding of the involved risk, formal verbal or written consent should be obtained. The GMC suggests that written consent should be taken in cases where: the treatment or procedure is complex and involves significant risk and/ or side effects, where providing clinical care is not the primary purpose of the investigation or procedure (in particular, where the examination or procedure is for non-therapeutic purposes), if the treatment is part of a research programme or if there may be significant consequences for the patient’s employment, social or personal life. Written consent for some procedures is also required by the
Mental Health Act and the Human Fertilisation and Embryology Act.

Question 32

2. In a case of anaphylaxis, the proper dose of intramuscular adrenaline injection is?

(a) 1 mL of 1:1000 adrenaline

(b) 0.5 mL of 1:1000 adrenaline

(c) 1 mL of 1:10,000 adrenaline

(d) 1 mL of 1:10,000 adrenaline

(e) 10 mL of 1:1000 adrenaline

Answer 32

2. (b) 0.5 mL of 1:1000 of adrenaline intramuscular injection

This is the recommended dose in cases of anaphylactic contrast reaction as recommended by the Royal College of Radiologists.

Question 33

31. A right-sided subclavian line was inserted in a patient on chemotherapy. On a frontal chest radiograph, the acceptable position of the tip of the line would be?

(a) Right distal internal jugular vein

(b) Lower part of right heart border

(c) Just above the level of right anterior first intercostal space

(d) Upper part of right heart border, at the level of right hilum

(e) Distal part of right subclavian vein

Answer 33

31. (d) Upper part of right heart border, at the level of right hilum

The tip of the subclavian line must be distal to the valves and in the superior venacava. The last valves in the subclavian and internal jugular veins are 2.0–2.5 cm proximal to their union. The brachiocephalic vein and superior vena cava do not contain valves. The superior vena cava commences at the level of right first intercostal space and tip of lines above this lie in the distal internal jugular vein. A catheter tip in right atrium or right ventricle may cause arrhythmias.

Question 34

36. A 62-year-old smoker presents with haemoptysis. The chest radiograph shows a mass in right paracardiac region with loss of right heart border. The lesion is most likely to be in?

(a) Right middle lobe

(b) Apical segment of right lower lobe

(c) Posterior segment of right upper lobe

(d) Medial basal segment of right lower lobe

(e) Anterior basal segment of right lower lobe

Answer 34

36. (a) Right middle lobe

The right middle lobe lies adjacent to the right heart border and disease of the right middle lobe (e.g. collapse/consolidation) results in loss of normal sharp outline of the right heart order.

Question 35

36. Which of the following are correct regarding ventilation / perfusion imaging: (T/F)

(a) The 99Tc-DTPA aerosol scan is performed before the perfusion study.

(b) 81m-Krypton is the cheapest available aerosol for ventilation scanning.

(c) Severe pulmonary hypertension is a contraindication to ventilation / perfusion scanning.

(d) For the perfusion scan, the patient must remain in position for 15-20 minutes before particles become fixed in the lungs.

(e) Blood should be drawn into the syringe prior to injection of radioisotope for perfusion scanning.

Answer 35

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct

Explanation:
81m-Krypton is expensive with limited availability, but allows for a simultaneous V/Q scan.
Blood should not be drawn prior to injection of isotope to prevent clumping.
The patient should be in position for 2-3 minutes and then imaged in sitting position.