GENITO-URINARY SYSTEM

Question 1

1. Which of the following are correct of multicystic dysplastic kidneys?
   (a) Antenatal ultrasound reveals a paraspinal mass with multiple communicating cysts.
   (b) Approximately 30% of contralateral kidneys are abnormal.
   (c) It is more common in infants of diabetic mothers.
   (d) Upto 20% of cases have residual renal function in the affected kidney on scintigraphy.
   (e) Nephrectomy is usually required, as it cannot be differentiated from cystic Wilms tumour.

Answer 1

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Antenatal ultrasound shows multiple non-communicating cysts of variable size. Serial ultrasound scans of multicystic
dysplastic kidney show renal involution. Nephrectomy is required if it fails to involute or if there is uncontrolled
hypertension.
Multicystic dysplastic kidney is the second most common cause of neonatal abdominal mass (first is hydronephrosis).

Question 2

2. Regarding medullary sponge kidney, which of the following are correct?
   (a) The cystic areas in the medulla do not communicate with the collecting ducts.
   (b) The changes are unilateral in 25% of cases.
   (c) It is a feature of Meckel-Gruber syndrome.
   (d) Medullary nephrocalcinosis is visible radiographically in 10% of cases.
   (e) There is an association with Ehlers-Danlos syndrome.

Answer 2

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Medullary sponge kidney is a common sporadic condition affecting young to middle aged adults. There is dysplastic
cystic dilatation of papillary and medullary collecting ducts.
Meckel- Gruber syndrome is an autosomal recessive syndrome comprising of multicystic dysplastic kidneys, occipital
encephalocele and polydactyly.
Medullary nephrocalcinosis is visible radiographically in 40% - 80%.

Question 3

3. Concerning renal papillary necrosis, which of the following are correct?
   (a) Necrosis involves the overlying cortex in 10% of cases.
   (b) It may result from aspirin use.
   (c) A single papilla is affected in approximately 15% of cases.
   (d) It is associated with a higher incidence of renal tract squamous cell carcinoma.
   (e) Medullary sponge kidney is a cause.

Answer 3

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Cortex is not involved in renal papillary necrosis. It involves pyramids and medullary papilla. Medullary sponge
kidney causes renal papillary calculi not necrosis.

Question 4

4. Which of the following are correct regarding renal cell carcinoma?
   (a) About 75% of tumours less than 3cm in size are hyperechoic on ultrasonography.
   (b) Von Hippel-Lindau syndrome is risk factor.
   (c) Calcification and cystic change occur in the minority of cases.
   (d) About 30% of tumours are hypovascular on angiography.
   (e) The lungs are the most common site for metastatic spread.

Answer 4

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
5% of RCC are hypovascular on angiography. Tumours cause neovascularity. Renal vein or IVC extension of tumour
is also seen on angiography.

Question 5

5. Concerning ureterocoeles, which of the following are correct?
   (a) About 80% of ectopic ureterocoeles occur in duplicated systems.
   (b) In children, a pseudoureterocoele most commonly results from an impacted stone.
   (c) They can be indistinguishable from bladder diverticula during voiding.
   (d) A simple ureterocoele never occurs in an ectopic ureter.
   (e) A single simple ureterocoele can cause bladder outlet obstruction

Answer 5

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Ureterocoele is a congenital dilatation of distal most portion of ureter. In minority of cases it is an isolated finding and
seen in adults. On IVP it shows ‘cobra head’ sign.
Complications include obstructive cystic renal dysplasia

Question 6

6. Which of the following are correct regarding retroperitoneal fibrosis?
   (a) When the ureters are involved, there is typically only mild pyelocalyectasis.
   (b) The fibrotic plaque usually originates around the aortic bifurcation.
   (c) On CT, the aorta is typically enveloped and anteriorly displaced by a fibrotic mass.
   (d) An increase in signal intensity on T2 weighted imaging indicates a good response to steroid treatment.
   (e) It is associated with primary sclerosing cholangitis.

Answer 6

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
On CT, the aorta is engulfed by the fibrotic mass but not displaced. Displacement is seen in malignancy.
Steroid treatment causes a decrease in signal intensity on T2WI indicating a good response

Question 7

7. In prune belly syndrome, which of the following are correct?
   (a) The condition is more common in females.
   (b) The inheritance is autosomal recessive.
   (c) It is characterised by markedly distended and obstructed ureters.
   (d) There is an association with Hirschsprung’s disease.
   (e) Death occurs within 1 year of birth in the majority of cases

Answer 7

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Prune belly syndrome is a sporadic nonhereditary condition, exclusively affecting males. It is characterized by triad
of absent anterior abdominal wall muscles, non-obstructed megaureters and cryptorchidism (due to bladder
distension).
In 20% cases death occurs in first month of life and another 30% within 2 yrs of life. Mild cases survive into
adulthood.

Question 8

8. Regarding testicular ultrasound, which of the following are correct?
   (a) Absent testicular blood flow on colour Doppler imaging is pathognomonic of testicular torsion.
   (b) There is an association between testicular microlithiasis and Klinefelter’s syndrome.
   (c) Testicular cysts are seen in upto 10% of testicular ultrasound studies.
   (d) The epididymis is typically enlarged, hypervascular and hyperechoic when inflamed.
   (e) The normal epididymis is slightly hypoechoic to the normal testis.

Answer 8

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
In paediatric patients intratesticular flow can be difficult to demonstrate on colour Doppler. Power Doppler may be
helpful in such cases.
When inflamed epididymis is typically enlarged, hypervascular and hypoechoic. Orchitis is seen in 20% cases and
shows similar appearance.
The normal epididymis is isoechoic to slightly hyperechoic to normal testis.

Question 9

9. Which of the following are correct regarding screening tests for breast cancer in the general population?
   (a) Screening mammography has been shown to reduce mortality from breast cancer.
   (b) Screening using ultrasound has been shown to reduced breast cancer mortality in patients less than 35 years
   old.
   (c) Two views of the breast are obtained for all screening assessments.
   (d) Cancers showing casting linear calcifications on mammography are associated with a poorer prognosis.
   (e) In the UK, mammographic screening is currently advocated for women aged over 40 years.

Answer 9

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Two views of each breast are taken as baseline, but single view is taken as follow up. However two views are
recommended as follow up as it increases lesion detection.
Ultrasound currently has no role as a screening tool in any age group.
In UK, screening is available for patients from 50-65 yrs.

Question 10

10. Which of the following are correct regarding invasive breast cancers?
    (a) Rim calcification is frequently seen in medullary carcinoma.
    (b) There is an association between tubular carcinoma and radial scar.
    (c) The most common invasive cancer in the male breast in invasive lobular carcinoma.
    (d) Colloid carcinoma has a worse prognosis than invasive ductal carcinoma.
    (e) The likelihood of axillary spread of invasive ductal carcinoma depends on the size of the tumour.

Answer 10

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Medullary carcinoma presents as well defined mass which may show lobulated margins or halo sign. Calcification is
not a feature.
The most common invasive cancer in male breast is invasive ductal carcinoma.
Colloid carcinoma is seen in older age group (over 60 yrs) and has a good prognosis as tumour is slow growing.

Question 11

11. Which of the following are correct regarding calcification detected on mammography?
    (a) Skin calcifications typically have central lucent centres.
    (b) Mild of calcium has a typical appearance on the cranio-caudal view.
    (c) “Bilateral scattered punctate calcifications are probably benign.
    (d) Rim calcification is a feature of fat necrosis.
    (e) Sutural calcification are usually linear in appearance.

Answer 11

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Milk of calcium appears amorphous and ill-defined on cranial caudal view.
On medial-lateral oblique view it is typically sharply defined, semilunar or crescent shaped and upwardly concave.

Question 12

12. Which of the following statements are correct regarding fibroadenomas?
    (a) They occur bilaterally in 25% of cases.
    (b) The incidence is higher in women receiving hormone replacement therapy.
    (c) The typically demonstrate posterior acoustic shadowing on ultrasonography.
    (d) Internal septations are typical on gadolinium-enhanced MRI.
    (e) They are clinically palpable in the majority of cases.

Answer 12

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Fibroadenomas are multiple in 10%- 20% of cases but are found bilaterally in only 4 % of cases.
They are well circumscribed masses with homogenous internal echoes but variable posterior acoustic pattern.

Question 13

13. Which of the following are correct regarding sclerosing adenosis?
    (a) It has an association with lobular carcinoma.
    (b) It is a condition with high premalignant potential.
    (c) Biopsy is required to make a definitive diagnosis.
    (d) It presents with a palpable mass in the majority of cases.
    (e) It commonly presents as focal or diffuse calcification.

Answer 13

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Sclerosing adenosis is only mildly associated (2.5 folds) with increase in risk of infiltrating breast cancer. The
condition in itself is non-malignant.
It is frequently detected only on mammography, though may present as a palpable mass.

Question 14

14. Regarding ultrasonography in the first trimester of pregnancy, which of the following are correct?
    (a) Gestational sac volume is the most accurate estimate of gestational age in the first 8 weeks of pregnancy.
    (b) The diameter of the yolk sac should not be more than 5mm.
    (c) The yolk sac is normally identified before the foetal pole.
    (d) A normal intrauterine gestational sac and foetal pole exclude an ectopic pregnancy.
    (e) Cardiac pulsation becomes visible at the beginning of the eighth postmenstrual week.

Answer 14

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Once the fetus can be identified (5-6wks) then crown to rump length (CRL) is the most accurate measurement.
The biparietal diameter becomes the most accurate towards end of the first trimester.
Cardiac pulsation is visualized as soon as a fetal pole is visualized i.e. at 6 weeks postmenstrual week on TAS.
A coexistent intrauterine and ectopic pregnancy (heterotopic pregnancy) is extremely rare (1 in 30000 pregnancy).

Question 15

15. Which of the following statements are correct?
    (a) An empty gestational sac with a mean sac diameter of 10mm and an elevated â human chorionic gonadotrophin
    (HCG) is consistent with a blighted ovum.
    (b) Beta-HCG levels double every week in the first 8 weeks of pregnancy.
    (c) An absent intrauterine pregnancy on ultrasonography and â-HCG levels between 1000 and 2000 IU is highly
    suspicious of an ectopic pregnancy.
    (d) Vaginal bleeding is not usually associated with an ectopic pregnancy.
    (e) The risk of a second ectopic pregnancy is 10%.

Answer 15

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Beta-HCG levels double every 2-3 days in the first 8 weeks of pregnancy.
Vaginal bleeding is seen in 75%-85% cases of ectopic pregnancies. The risk of second ectopic pregnancy is 25%.

Question 16

16. An axial ultrasonographic section through the foetal head measurement of the biparietal diameter (BPD)
    should include which of the following?
    (a) The third ventricle.
    (b) The thalami.
    (c) The cavum septum pellucidum.
    (d) A continuous echogenic midline.
    (e) The cerebellum.

Answer 16

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
BPD is used for estimating the gestational age after 12 weeks. Its accuracy declines after 28 weeks after which it is
combined with second measurement like femur length.

Question 17

17. Regarding uterine leiomyomas, which of the following are correct?
    (a) Simple leiomyomas can metastasise.
    (b) Cystic degeneration occurs in 30% of cases.
    (c) Red degeneration is associated with the contraceptive pill.
    (d) Calcification is usually peripheral.
    (e) They are typically of low T2 signal relative to the surrounding myometrium.

Answer 17

(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
In leiomyomas (fibroids) cystic degeneration is rare, seen only in 4 % cases.
Calcification is seen associated with red degeneration, and is typically scattered and amorphous marking the site of
hyaline degeneration.

Question 18

18. Which of the following statements are correct?
    (a) The risk of an ectopic pregnancy is higher in patients with a unicornuate uterus.
    (b) Nabothian cysts occur in the posterolateral wall of the lower third of the vagina.
    (c) The uterus is derived from the paired mullerian ducts.
    (d) A unicornuate uterus is rarely associated with other anomalies.
    (e) Gartner’s duct cysts are typically located anterolateral to the upper two thirds of the vagina.

Answer 18

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Bartholin’s cyst occurs in posterolateral wall of lower third of vagina.
Mucous retention within endocervical glands is known as nabothian cyst and can be seen in any wall of cervix.
40% cases of unicornuate uterus is associated with renal and ureteric anomalies.

Question 19

19. Which of the following statements are correct?
    (a) Haematocolpos refers to a uterine cavity distended with blood.
    (b) After puberty, the most common cause of haematocolpos is vaginal atresia.
    (c) A fluid collection within the endometrial cavity of a neonate is abnormal.
    (d) Congenital haematometrocolpos is usually associated with other anomalies.
    (e) Haematometra is a cause of ureteric obstruction

Answer 19

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Hematocolpos refers to vagina distended with blood and hematometra refers to uterine cavity distended with blood.
An imperforate hymen is the most common cause of hematocolpos.
Approximately 25% of neonates have a fluid collection within the endometrial cavity, thus a normal finding.

Question 20

20. Regarding polycystic ovaries, which of the following are correct?
    (a) Cysts of 5-8mm are characteristically present throughout the ovary.
    (b) They are seen in patients with trophoblastic disease.
    (c) There is an increased risk of endometrial carcinoma.
    (d) The ovaries are enlarged on ultrasonography in 95% of cases.
    (e) There is a decrease in the ratio of luteinising hormone to follicular stimulating hormone.

Answer 20

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanations:
The cysts are typically subcapsular in polycystic ovaries with central stroma showing increased echogenicity.
In 25% cases ovaries are hypoechoic with no demonstrable follicle. The ovaries are bilaterally enlarged (more than
14 cm3) in 70% cases and of normal size in 30% cases.
There is increase in ratio of luteinising hormone to follicular stimulating hormone resulting in immature follicles.
Trophoblastic disease typically causes hyperstimulation of ovaries with multiseptated cysts secondary to increased
HCG levels.

Question 21

21. Regarding foetal anomalies, which of the following are correct?
    (a) The nuchal-fold thickness is most prominent between 11 and 13 weeks.
    (b) Endocardial cushion defects are strongly associated with Down’s syndrome.
    (c) The triple screen for Down’s syndrome refers to the combination of maternal alpha-fetoprotein, oestriol and
    HCG levels.
    (d) Short femur and humerus lengths are indicators of Down’s syndrome.
    (e) Separation of the big toe from the remaining toes is a strong sign of Down’s syndrome

Answer 21

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Other associations with Down’s syndrome are membranous ventricular septal defects, ostium primum atrial septal
defects, cleft mitral valve, patent ductus arteriosus, 11 pairs of ribs and hypersegmented manubrium (90%).
Separation of the big toe from the remaining toes (sandal sign) is a weak sign of Down’s syndrome.

Question 22

22. The following are correct regarding transabdominal ultrasound in early pregnancy:
    (a) Yolk sac is only visible from 7 weeks onwards.
    (b) Gestational sac should be visible at 4 weeks.
    (c) The earliest ultrasound sign of pregnancy is fundal endometrial thickening.
    (d) Cardiac movement should be identifiable in the foetus at 6.5 weeks.
    (e) Biparietal diameter can be used to predict gestational age from 7 weeks.

Answer 22

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Yolk sac is visible from 6 weeks onwards and gestational sac from 5 weeks onwards.
Biparietal diameter is used to predict gestational age from 12 to 28 weeks.

Question 23

23. Which of the following are correct regarding xanthogranulomatous pyelonephritis:
    (a) Is more commonly diffuse than segmental.
    (b) May be caused by Proteus mirabilis infection.
    (c) Pyuria is associated in less than 50%.
    (d) Is not usually associated with calculi.
    (e) Causes reduced size of the affected kidney.

Answer 23

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Pyuria is associated in 95 % cases of xanthogranulomatous pyelonephritis. There is global enlargement of kidney with
centrally obstructing calculi seen in 75% of the cases.

Question 24

24. Which of the following are correct regarding pheochromocytoma:
    (a) Is associated with gastric haemorrhage.
    (b) Affects the bladder.
    (c) Is bilateral in 20-40% of cases.
    (d) Is extra-adrenal in 20-30% of cases.
    (e) Is associated with tuberous sclerosis.

Answer 24

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
The pheochromocytoma follows 10% rule. It is bilateral in 10% cases, 10% cases are extra adrenal, 10% are
malignant, 10% are in children, 10% are familial, 10% are not associated with hypertension and 10% show
calcification

Question 25

25. Which of the following are correct regarding schistosomiasis:
    (a) Calcification is the most important single imaging feature.
    (b) The bladder usually has a reduced capacity in the early stages.
    (c) Is endemic in parts of the Eastern Mediterranean.
    (d) Ureteral calculi are rarely seen.
    (e) In the earliest stage, dilatation of the ureter is confined to the upper third.

Answer 25

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Schistosomiasis is commonly associated with ureteric calculi, dilatation of lower ureter in early stage and reduced
bladder capacity in advanced stages.

Question 26

26. Features of von Hippel-Lindau (VHL) disease include:
    (a) Renal cysts are present in over 50%.
    (b) Renal angiomas may be distinguished from renal cell carcinoma by imaging.
    (c) Renal impairment is common.
    (d) Renal cell carcinomas are usually solitary.
    (e) A cyst with an enhancing nodule is suspicious for malignancy.

Answer 26

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Renal angiomas cannot be distinguished from renal cell carcinoma on imaging.
In VHL renal impairment is uncommon and renal cell carcinomas are usually bilateral and multicenteric.

Question 27

27. Concerning developmental abnormalities of the kidneys which of the following are correct:
    (a) Accessory renal arteries normally enter the upper and mid poles.
    (b) Duplication of the collecting system is seen in 10-12% of people.
    (c) Horseshoe kidney is seen in 1 in 200 births.
    (d) Horseshoe kidneys are more prone to trauma.
    (e) Accessory renal arteries are less common in patients with horseshoe kidney.

Answer 27

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Accessory renal arteries commonly enter the lower pole below the hilum and are more common in patients with
horseshoe kidney. Incidence of horseshoe kidney is 1 in 700 births.
Duplication of collecting system is seen in only 4% of people.

Question 28

28. Which of the following are correct regarding ovarian cancer:
    (a) It is the commonest gynaecological malignancy.
    (b) It is associated with colorectal cancer.
    (c) CA-125 is specific for ovarian cancer.
    (d) CT only has a pre-operative staging accuracy of 50%.
    (e) Doppler ultrasound may help with differentiating benign from malignant disease.

Answer 28

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Endometrial cancer is the most common gynaecological malignancy.
CA-125 is not specific for ovarian cancer, it is increased in benign conditions like fibroids, endometriosis and
inflammatory pelvic disease.
CT only has a pre-operative staging accuracy of 70% - 90%.

Question 29

29. Which of the following are correct regarding gestational trophoblastic disease:
    (a) Young maternal age is a risk factor.
    (b) It is associated with theca-lutein cysts.
    (c) A predominantly echo-poor mass is seen on ultrasound.
    (d) Invasive mole develops in approximately half of cases.
    (e) Raised human chorionic gonadotrophin is seen in upto 80% of cases.

Answer 29

(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Gestational trophoblastic disease is associated with increased maternal age, presents as an echogenic mass with
invasive mole developing in 12%-15% of cases.
Raised human chorionic gonadotrophin is seen in 100% cases.

Question 30

30. Which of the following are correct regarding pheochromocytoma:
    (a) Is bilateral in 25%
    (b) When symptomatic tends to be large at presentation.
    (c) Is associated with pulmonary hamartomas.
    (d) Usually has CT attenuation values of <10 Hounsfield units (HU) on unenhanced scans.
    (e) Is of high signal intensity on T2 weighted MR.

Answer 30

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Pheochromocytoma are bilateral in 10% cases, and symptomatic lesions tend to be smaller in size.
They rarely contain enough fat to reduce the attenuation value <10 HU units.

Question 31

31. Which of the following are correct regarding benign and malignant adrenal masses:
    (a) Chemical shift MR utilises T1 weighted sequences.
    (b) Approximately one third of benign adenomas have HU of >10 on unenhanced CT.
    (c) Adenomas tend to show delayed enhancement with IV contrast.
    (d) Adenomas tend to show delayed clearance of IV contrast.
    (e) Lesions >4cm tend to be malignant.

Answer 31

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Adenomas (benign) show rapid enhancement and rapid washout of contrast media on post contrast study.

Question 32

32. Which of the following are correct regarding concerning ovarian teratomas:
    (a) Mature teratomas are usually multi-loculated.
    (b) They are a known cause of peritonitis.
    (c) Fat attenuation on CT is diagnostic for mature cystic teratomas.
    (d) Sebaceous fluid has low signal on T1 weighted MR.
    (e) Calcification indicates a malignant teratomas.

Answer 32

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Mature Teratomas are unilocular.
Sebaceous fluid has high signal on T1WI.
Calcification outside the mural nodule is suspicious of malignancy

Question 33

33. Which of the following are correct regarding omphalocoele:
    (a) Is a midline abdominal wall defect.
    (b) Is usually an isolated abnormality.
    (c) Is associated with a normal umbilical cord insertion.
    (d) Has no covering over the herniated contents.
    (e) Is associated with Beckwith-Wiedemann syndrome

Answer 33

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Omphalocoele is usually associated with other anomalies in over 80% cases, with umbilical cord insertion at the
apex and covered by peritoneum and amnion.

Question 34

34. Which of the following are correct regarding multicystic dysplastic kidney:
    (a) Is the second commonest cause of a neonatal abdominal mass.
    (b) Is associated with PUJ obstruction.
    (c) Is usually unilateral.
    (d) The renal cysts communicate.
    (e) Intervening normal renal parenchyma is present.

Answer 34

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Multicystic dysplastic kidney shows non-communicating cysts with no normal renal parenchyma

Question 35

35. Which of the following are correct regarding metastases to breast:
    (a) Rhabdomyosarcoma is the most frequent primary in adolescent females.
    (b) Lymphoma is the most common primary in adults.
    (c) Are associated with skin changes in more than 75% of cases.
    (d) The majority are located in the lower outer quadrant.
    (e) Are characteristically hypoechoic and have a well-defined posterior wall on ultrasound examination.

Answer 35

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
50% of metastases are superficial with no associated skin changes. Diffuse skin involvement is seen in melanoma.
The metastases are more commonly located in outer upper quadrant, without speculation, calcifications or
desmoplastic reaction as in primary carcinoma.

Question 36

36. Which of the following are correct regarding urinary tract stones:
    (a) Craniocaudal size is underestimated on CT.
    (b) Urinary tract obstruction cannot be diagnosed on unenhanced CT.
    (c) Pure matrix stones are not visualized on unenhanced CT.
    (d) Renal failure is a common clinical presentation.
    (e) A plain abdominal X-Ray (KUB) has a sensitivity of 80%.

Answer 36

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Partial voluming tends to overestimate the size of stone on CT.
Unenhanced CT shows ureteric and collecting system dilatation, nephromegaly and perinephric and periureteric fat
standing, which are all signs of obstruction.
lain X-ray KUB has only 45% - 58% sensitivity.
Renal failure is rare and is secondary to bilateral obstructing calculi.

Question 37

37. Which of the following are correct regarding contrast media nephrotoxicity (CMN):
    (a) 0.45% saline infusion before and after contrast media injection reduces the risk of nephrotoxicity.
    (b) Nephrotoxic effect of contrast media is dose dependent.
    (c) Prophylactic haemodialysis prevents nephrotoxicity.
    (d) Is usually benign and resolves within 1-2 weeks.
    (e) Acetylcystein is a potent vasoconstrictor.

Answer 37

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Hemodialysis can induce hypovolaemia which worsens renal ischemia.
Acetylcystein is an antioxidant and scavenger of oxygen free radicals. It enhances the biological effect of the
endogenous vasodilator nitric oxide.

Question 38

38. Which of the following are correct regarding imaging of prostate cancer:
    (a) Can be reliably detected by transrectal ultrasound.
    (b) Intravenous contrast is used routinely in MRI.
    (c) Normal zonal anatomy of the prostate gland is best seen on T1 weighted MRI.
    (d) Usually appears as a high signal intensity lesion on T2 weighted MRI.
    (e) Is usually hypoechoic on TRUS

Answer 38

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Only cancer located in the peripheral zone can be reliably detected on TRUS, with 60%-70 % appearing hypoechoic,
40% are isoechoic and 1% - 5% are hyperechoic.
Intravenous contrast in not used routinely in MRI as it has no superiority of T2WI. T2WI best demonstrates zonal
anatomy with cancer appearing as lesion of low signal within the high signal of peripheral zone.
All the zones have intermediate signal on T1WI on MRI.

Question 39

39. Which of the following are correct regarding angiomyolipoma (AML):
    (a) Is the most common benign tumour of the kidney in adults.
    (b) A high attenuation lesion on unenhanced CT excludes the diagnosis.
    (c) The absence of fat-content on unenhanced CT excludes the diagnosis.
    (d) Prolonged enhancement on delayed post-contrast CT favours a diagnosis of AML rather than renal cell
    carcinoma.
    (e) Calcification is a common feature.

Answer 39

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
AML with minimal fat content can have high attenuation on unenhanced CT. Fat content is characteristic of AML but
5% have predominance of blood vessels or immature fat. Calcification is a rare feature of AML.

Question 40

40. Which of the following are correct regarding testicular microlithiasis:
    (a) Extratesticular scrotal calcification is usually benign.
    (b) Acoustic shadowing is observed in most cases.
    (c) Is associated with infertility.
    (d) Is usually unilateral.
    (e) May be associated with neurofibromatosis.

Answer 40

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Acoustic shadowing is not seen due to small size of calcification. Infertility is not associated with microlithiasis
(association is 1% same as general population).
Unilaterality is seen only in 2.7% to 27%.

Question 41

41. Which of the following are correct regarding testicular epidermoid cysts:
    (a) Are usually multiple and bilateral.
    (b) The majority occur in the elderly.
    (c) Concentric layers of calcification are characteristic on ultrasound.
    (d) A bull’s eye pattern is a recognized appearance on MRI.
    (e) Are typically treated by orchidectomy.

Answer 41

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
1% of intratesticular tumours are epidermoid and most commonly seen between 20-40 yrs.
They are usually solitary and unilateral, but cases of multiplicity and bilaterality have been recognized.

Question 42

42. Which of the following are correct regarding phyllodes tumour:
    (a) Typically presents in women between 30 years and 50 years of age.
    (b) Benign phyllodes tumours do not recur after excision.
    (c) Axillary nodal metastases are common at presentation.
    (d) Calcifications are commonly seen at mammography.
    (e) 1-5% contain areas of malignant degeneration at histology.

Answer 42

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Phyllodes tumour presents as a large well circumscribed oval or lobulated mass which may have radiolucent halo on
mammography. Coarse plaque like calcification is rare. On ultrasound it appears as inhomogeneous solid appearing
mass. Cystic spaces within the mass with posterior acoustic enhancement are typical of phyllodes tumour.
On histology is appears like a giant fibroadenoma, with upto 25% containing areas of malignant degeneration with
infiltrative borders. 10% of phyllodes tumours are true sarcomas presenting with hematogeneous spread. Nodal
spread is rare. Both benign and malignant have a tendency to reoccur if not widely excised.

Question 43

43. Which of the following are correct regarding mullerian duct abnormalities:
    (a) The upper two thirds of the vagina arise from the mullerian ducts.
    (b) Affect 1-5% of women of reproductive age.
    (c) Uterus didelphys is the most common anomaly.
    (d) Septate uterus is associated with infertility.
    (e) Are associated with renal agenesis.

Answer 43

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
0.1% to 0.5% women of reproductive age are affected by congenital abnormalities of uterus. Approximately 25% of
patients with anomaly have sub-fertility.

Question 44

44. Which of the following are correct regarding characteristic MRI features of adenomyosis:
    (a) Foci of high signal within the myometrium on T1 weighted MRI.
    (b) Focal thickening of the junctional zone.
    (c) Foci of high signal within the myometrium on T2 weighted MRI.
    (d) Significant displacement of the endometrial cavity.
    (e) Large feeding vessels.

Answer 44

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
On MRI adenomyosis and leiomyoma have overlapping features. Features favouring adenomyosis are:
1) poorly defined borders
2) oval shaped lesion along endometrium
3) minimal mass effect on endometrium relative to size of lesion
4) linear striations perpendicular to endometrium radiating into myometrium
5) absence of large feeding vessels.

Question 45

45. Which of the following are correct regarding imaging of silicone-gel breast implants:
    (a) The incidence of rupture increases with increasing implant age.
    (b) A reverberation band parallel to the anterior surface of the implant is a sign of on ultrasound.
    (c) The majority of ruptures are extracapsular.
    (d) Water-suppressed inversion-recovery T2 weighted MRI images are useful.
    (e) The linguine sign on MRI implies intracapsular rupture.

Answer 45

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
A band of linear striated reverberation in the anterior aspect of implant approximately equal in thickness to the breast
tissue overlying the implant is a normal finding indicating an intact silicone gel implant.
Ultrasound signs of intracapsular rupture include the ‘stepladder sign’ (a series of parallel horizontal echogenic lines
indicating a collapsed implant shell).
A ‘snowstorm’ pattern has been described in extracapsular rupture indicating free silicone droplets within the breast
tissue.
22% of ruptures are extracapsular.

Question 46

46. Which of the following are correct regarding genitourinary tuberculosis (TB):
    (a) Is the most common manifestation of extrapulmonary TB.
    (b) In renal TB: calyceal dilatation is usually accompanied by pelvic dilatation
    (c) The endometrium is affected in >70% of women with genital TB.
    (d) Papillary necrosis is a recognized feature.
    (e) A raised CA-125 level excludes tubo-ovarian TB.

Answer 46

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
In renal TB earliest IVU abnormality is a ‘moth eaten’ calyx due to erosion, followed by papillary necrosis.
Dilatation of one or more calyces without pelvic dilatation typically occurs due to infundibular stenosis.
Tubo-ovarian involvement is usually caused by hematogenous or lymphatic spread, mimicking ovarian cancer
clinically and radiologically. Diagnosis is generally made post-operatively.

Question 47

47. The following transvaginal ultrasound findings are compatible with pregnancy failure:
    (a) Double decidual reaction.
    (b) A 2mm embryo lacking a cardiac heartbeat.
    (c) A gestational sac of 20mm containing no yolk sac.
    (d) Grossly distorted sac shape.
    (e) A gestational sac of 25mm containing no embryo.

Answer 47

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Double decidual reaction consists of two concentric rings surrounding the intra-endometrial fluid and is a sign of
normal pregnancy.
Cardiac activity begins by 5 weeks of gestation hence heartbeat is seen in 5 mm or bigger embryo on transvaginal
scan. Thus in embryos smaller than 5 mm repeat ultrasound is suggested.

Question 48

48. Which of the following are correct regarding autosomal dominant polycystic kidney disease (ADPKD):
    (a) 35-50% of patients develop end-stage renal failure.
    (b) 2.5% of nephrons are affected by cystic change.
    (c) Hepatic cysts are seen in 5-10% by 60 years of age.
    (d) 2-10% of patients sustain subarachnoid haemorrhage.
    (e) Cyst density >30 HU on post-intravenous contrast CT suggests malignant change.

Answer 48

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

Explanation:
Hepatic cysts are seen in 70%-75% by 60 yrs of age.
The most common cause of increased density of cyst is haemorrhage (HU of 50-90). ADKPD patients on dialysis
have an increased risk of cancer relative to population.

Question 49

49. Which of the following are correct regarding causes of cortical nephrocalcinosis:
    (a) Chronic glomerulonephritis.
    (b) Hyperparathyroidism.
    (c) Chronic transplant rejection.
    (d) Acute cortical necrosis.
    (e) Hypervitaminosis D.

Answer 49

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Medullary nephrocalcinosis is seen in hyperparathyroidism, hypervitaminosis D, renal tubular acidosis, medullary
sponge kidney, renal papillary necrosis, hypercalciuria and primary hyperoxaluria.