neuroradiology Flashcards
- Which of the following is a risk factor for clinically evident neurologic complications
in the first 24 hours after cerebral angiography?
I. age over 70 years - duration of angiogram over 90 minutes
- history of transient ischemic attack (TIA) or stroke
IV. history of systemic hypertension
A. I, 11, 111
B. 1, I11
C. 11, IV
D. IV
E. all of the above
Jawabannya : E
Morris p. 63. Other risk factors include patients with more than 50 to 70%
stenosis of the cerebral vessels, patients whose angiograms require a higher
volume of contrast, and patients referred for subarachnoid hemorrhage or
who are immediately postoperative.
- The most common nonneurologic complication of cerebral angiography via
femoral artery approach is
A. angina
B. allergic reaction
C. hematoma
D. myocardial infarction (MI)
E. pseudoaneurysm
jawabannya : B
Morris p. 72: Significant hematoma formation occurs at a rate of approximately
6.9 to 10.7%. Angina, allergic reaction. and myocardial infarction (MI)
all occur with an incidence of less than 1 to 2%. Pseudoaneurysms are rare.
occurring 0.05 to 0.55% of the time.
- Branches of the meningohypophysial trunk include the
I. tentorial artery
11. inferior hypophysial artery
111. dorsal meningeal artery
IV. superior hypophysial artery
A. I, 11, 111
B. I, 111
C. 11, IV
D. IV
E. all of the above
Jawabannya : A
Osb p. 87. The meningohypophysial trunk, the largest and most proximal branch
of the cavernous carotid artery, typically has three branches: the tentorial artery
(of Bernasconi and Cassanari), the dorsal meningeal artery, and the inferior
hypophysial artery (the inferolateral trunk). The superior hypophysial artery
is a branch of the supraclinoid carotid artery.
For questions 4 to 6, match the persistent anastomoses with the description. Each
response may be used once, more than once, or not at all.
A. cervical intersegmental artery
B. proatlantal intersegmental artery
C. primitive hypoglossal artery
D. primitive otic artery
E. primitive trigeminal artery
- the most comrrlbn of the persistent anastomoses
- petrous internal carotid artery to the basilar artery
- proximal cavernous internal carotid artery to basilar artery
Jawabannya :
- E,
- D,
- E.
For questions.4-6 see Apuzzo pp. 749-754.
- The precentral cerebellar vein usually drains into the
A. internal cerebral vein
B. lateral mesencephalic vein
C. posterior mesencephalic vein
D. straight sinds
E. vein of Galen
Jawabannya : E
Osb p. 233. The precentral cerebellar vein is a midline vessel that courses
medially over the brachium pontis, parallels the roof of the fourth ventricle,
and curves upward behind the inferior colliculus and precentral lobule of the
vermis to drain into the vein of Calen.
- Anterior temporal lobe masses characteristically displace the
A. anterior choroidal artery laterally
B. anterior choroidal artery medially
C. anterior choroidal artery upward
D. posterior choroidal artery downward
E. posterior choroidal artery upward
Jawabannya B
Osb p. 318.
For questions 9 to 14, match the blood products with their appearance on magnetic
resonance imaging (MRI). Each response may be used once, more than once, or not
at all.
A. isointense on TI, isointense to hyperintense on T2
B. hyperintense on Tl and T2
C. hypointense on Tl and T2
D. isointense on TI, hypointense on T2
E. hyperintense on TI, hypointense on T2
F. hypointense on TI, hyperintense on T2
- oxyhemoglobin (0-24 hours)
- deoxyhemoglobin (1-3 days)
- intracellular methemoglobin (3-14 days)
- extracellular methemoglobin (>2 weeks)
- nonparamagnetic heme pigments
- hemosiderin around periphery
Jawabannya
- A,
- D,
- E,
- B,
- F,
- C.
For questions 9-14 see ACR Trauma case 811.
For questions 15 to 23, match the branch of the internal carotid artery with the
statement that best describes it.
A. caroticotympanic artery
B. inferior hypophysial trunk
C. inferolateral trunk
D. mandibulovidian artery
E. McConnell’s capsular vessels
F. tentorial artery
- potential supply to vascular tumors of the middle ear
- vestigial hyoid artery
- common supply to juvenile angiofibromas
- also called the artery of Bernasconi and Cassanari
- Together with the inferior hypophysial artery, these vessels supply the
pituitary gland. - Together with the caroticotympanic artery, it is a branch of the petrous internal
carotid artery. - anastomoses with the superior hypophysial artery
- remnant of the embryonic dorsal ophthalmic artery
- provides important branches to some of the cranial nerves
For questions 15-23 see Morris pp. 117-130.
Jawabannya :
- A,
- A,
- D,
- F,
- E,
- D,
- B,
- C,
- C.
- The correct order of the named segments of the anterior choroidal artery is
A. cisternal segment, plexal point, plexal segment
B. cisternal segment, plexal segment, plexal point
C. plexal point, cisternal segment, plexal segment
D. plexal point, plexal segment, cisternal segment
E. plexal segment, plexal point, cisternal segment
Jawabannya : A
Osb pp. 100-101. The anterior choroidal artery (AChA) is best seen on the anteroposterior angiogram arising from the medial internal carotid artery. The cisternal AChA curves medially and posteriorly around the uncus. An
abrupt “kink is seen at the plexal point where the AChA enters the choroidal fissure. The plexal AChA then courses through the temporal horn.
- In the most common anatomic variation, the named branches of the proximal
right subclavian artery from proximal to distal are
A. internal mammary artery, thyrocervical trunk, vertebral artery, costocervical trunk
B. internal mammary artery, vertebral artery, thyrocervical trunk, costocervical trunk
C. vertebral artery, internal mammary artery, costocervical trunk, thyrocervical trunk
D. vertebral artery, internal mammary artery, thyrocervical trunk, costocervical trunk
E. vertebral artery, thyrocervical trunk, internal mammary artery. costocervical trunk
Jawabannya : D
Morris p. 101. Although this is the most common variation, others include the
inferior thyroid artery sharing a common trunk with the vertebral artery,
the vertebral artery from the thyrocervical trunk, the vertebral artery from
the proximal common carotid artery, and the vertebral artery from the
subclavian artery distal to the thyrocervical trunk.
- The most common site of origin of the recurrent artery of Heubner is the
A. A1 segment,
B. A2 segment
C. internal carotid artery
D. Ml segment
E. M2 segment
Jawabannya : B
Osb p. 120. The recurrent artery of Heubner (one of the medial striate
arteries) takes origin from the A2 segment 34 to 50% of the time, from the
A1 segment 17 to 45% of the time, and from the anterior communicating
artery 5 to 20% of the time.
- lntracranial hypotension related to leakage or removal of cerebrospinal fluid
(CSF) is most closely associated with which magnetic resonance finding?
A. diffuse dural enhancement
B. ependymal enhancement
C pneumocephalus
D. slitlike ventricles
E. ventriculomegaly
Jawabannya : A
Yock p. 333. This enhancement is thought to represent an increase in blood
volume in the dura. Inferior displacement of the structures in the posterior
fossa may accompany this finding in such cases of intracranial hypotension.
- Which of the following imaging characteristics is least likely for pleomorphic
xanthoastrocytoma?
A. calcification
B. cyst formation
C. multiple lesions
D. superficial location
E. temporal lobe location
Jawabannya : C
Yock p. 72. This variant of astrocytoma usually presents as a large single mass in a
young patient with a long history of seizures. The other options listed are typical.
- Choroid plexus papillomas in children are most common in the
A. fourth ventricle
B. left lateral ventricle
C. right lateral ventricle
D. third ventricle
Jawabannya : B
Yock p. 204. This propensity to lateralize has not been explained. These large
bulky tumors usually arise in the tri
- Choroid plexus papillomas in adults occur most commonly in the
A. fourth ventricle
B. left lateral ventricle
C. right lateral ventricle
D. third ventricle
Jawabannya : A
Yock pp. 204-205. These tumors in the adult population are often found at
the caudal aspect of the fourth ventricle and frequently calcify
- Which one of the following white matter lesions usually initially involves the
parieto-occipital regions?
A. adrenoleukodystrophy
B. Canavan’s disease
C. metachromatic leukodystrophy
D. multiple sclerosis
E. Schilder’s disease
Jawabannya : A
Yock p. 252. The lesions of adrenoleukodystrophy are usually symmetrical,
begin in the parieto-occipital region, and spread anteriorly.
For questions 32 to 37, match the description with the malformation.
A. Chiari l malformation
B. Chiari II malformation
C. both
D. neither
- caudal displacement of cerebellar tonsils
- Beaking of the midbrain tectum is characteristic.
- A meningomyelocoele is virtually always present.
- Medullary kinking is seen.
- Occipital or high cervical encephalocele is present.
- usually presents in young adulthood
For questions 32-37 see Yock pp. 520-521. Chiari I malformations consist of inferior displacement of the cerebellar tonsils through the foramen magnum. They usually occur in early adulthood. In Chiari II malformations, the caudal displacement of the hindbrain is more severe, with beaking of the tectum and medullary kinking often seen. Myelomeningoceles are virtually always present. Chiari II malformations usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated with a high cervical or occipital meningocele.
Jawabannya :
- C,
- B,
- B,
- B,
- D,
- A.
- The term bovine arch refers to
A. bi-innominate arteries
B. left common carotid artery origin from the aortic arch
C. left common carotid artery origin from the right brachiocephalic trunk
D. right aortic arch
E. right subclavian artery distal to the left subclavian artery
Jawabannya : C
Morris pp. 99-101. The left common carotid artery usually arises from the aortic arch distal to the right brachiocephalic artery. In the bovine arch variant, the left common carotid artery arises from the proximal right brachiocephalic artery. Variant A is rare. A right aortic arch may be incidental or associated with congenital heart disease. Variant E is associated with Down syndrome
- The differential diagnosis of colpocephaly, or dilatation of the posterior portion of the lateral ventricles, includes
I. agenesis of the corpus callosum
II. Leigh’s disease
III. periventricular leukomalacia
IV. Hallervorden-Spatz disease
A. I, II. Ill
B. I, III
C. II, IV
D. IV
E. all of the abov
Jawabannya : B
Yock pp. 367.525. Agenesis of the corpus callosum and periventricular leukomalacia can both result in olpocephaly. Leigh’s disease and Hallervorden-Spatz disease can both cause symmetric lesions of the globus pallidus but are not associated with colpocephaly.
- Schizencephaly is essentially a
A. demyelinating illness
B. disease that first develops in the elderly
C. disorder of neuronal migration
D. neurodegenerative disorder
E. psychiatric disorder
Jawabannya C
Yock pp. 540-522. The cleft of schizoencephaly can be unilateral or bilateral,
but it usually involves the region near the central sulcus. Patients can present
with seizures or focal deficits
- The differential diagnosis of optic nerve thickening includes
I. optic nerve sheath meningioma
II. orbit4 pseudotumor
III. optic nerve glioma
IV. Graves’ disease
A. I,II,III
B. I, III
C. II. IV
D. IV
E. all of the above
Jawabannya E
Yock p. 305. Optic nerve thickening may be caused by nonneoplastic processes
like Graves’ disease, orbital pseudotumor, optic neuritis, papilledema, and vascular
malformations, or by tumors like gliomas, meningiomas, lymphomas,
leukemia, and metastases
- The most common primary benign tumor of the adult orbit is (a)
A. cavernous hemangioma
B. dermoid cyst
C. lymphangioma
D. optic nerve glioma
E. sarcoidosis
Jawabannya : A
Y p. 1373. Cavernous hemangiomas of the orbit are usually well demarcated,
vascular, intraconal lesions with smooth or lobulated borders
- Which of the following is a branch of the ophthalmic artery?
A. anterior ethmoidal artery
B. posterior ethmoidal artery
C. both
D. neither
Jawabannya : C
Morris pp. 135-137. The ethmoidal arteries are branches of the ophthalmic artery. They supply a portion of the anterior cranial fossa and the mucosa of the nasal septum. During embolization of the internal maxillary artery, dangerous potential anastomoses from the sphenopalatine branches of the internal maxillary to branches of the ophthalmic artery.
- Which of the following set of findings on a lumbar MRI scan performed immediately after contrast injection is most characteristic of a recurrent disk
herniation and epidural fibrosis, respectively?
A. a rim of enhancement in the recurrent disk, diffuse enhancement in the fibrosis
B. a rim of enhancement in the fibrosis, diffuse enhancement in the recurrent disk
C a rim of enhancement in the recurrent disk, no enhancement in the fibrosis
D. diffuse enhancement in the recurrent disk, no enhancement in the fibrosis
E. no enhancement of either the recurrent disk or fibrosis
Jawabannya : A
Yock pp. 582-583. Scar tissue contains vascular granulation tissue that
enhances more diffusely than a residual or recurrent disk.
- Lesions in diffuse axonal injury are commonly found in the
I. corpus callosum
II. gray-white junction
III. rostra1 brainstem
IV. temporal lobe
A. I, II, III
B. I. III
C. II, IV
D. IV
E. all of the above
Jawabannya : A
GIT p. 1426
- Acute subarachnoid hemorrhage is more difficult to diagnose on MRI than on computed tomography (m)be cause
A. Extracellular methemoglobin is isointense on TI and R.
B. Hemosiderin is isointense on TI and T2.
C. Most radiologists are not familiar with the appearance of acute subarachnoid hemorrhage on MRI.
D. The high oxygen tension in the subarachnoid space prevents conversion of oxyhemoglobin to deoxyhemoglobin.
E. The low oxygen tension in the subarachnoid space prevents conversion of deoxyhemoglobin to oxyhemoglobin.
Jawabannya : D
GlT pp. 1437-1438.
- Which of the following is true of the choroidal blush?
A. It is an indicator of the choroidal plexus in the lateral ventricle.
B. It is best seen on the anteroposterior projection.
C. It is from the posterior ethmoidal branches of the ophthalmic artery.
D. Its configuration is usually a thin, dense crescent.
E. Its presence usually indicates an elevated intraocular pressure.
Jawabannya D
Morris p. 137. The choroidal blush signifies the choroidal plexus of the eye and is supplied by the ciliary branches of the ophthalmic artery. It is characteristically seen as a thin crescent on the lateral projection of the internal carotid angiogram. Its absence can be an indirect sign of elevated intraorbital or intraocular pressure
For questions 48 to 109, match the figure with the most appropriate response
- The most likely etiology of this neonate’s pathology is
A. astrocytoma
B. metastatic tumor
C. Staphyloc~ccuas ureus
D. Citrobacter
Jawabannya D
CNBR Fig. 3-24A, p. 177. Large neonatal brain abscesses are usually caused by
Citrobacter, Bacteroides, hoteus, and various gram-negative bacilli
For questions 49 to 54, identify the lesions.
49.
A eosinophilic granuloma
B. epidermoid cyst
C. fibrous dysplasia
D. hemangioma
E. multiple myeloma
F. osteoma
Jawabannya C
Burg 3 Fig. 1.1, p. 2. (Courtesy of Dr. John A. Goree, Durham, NC.) Note involvement
of the left facial bones.
For questions 49 to 54, identify the lesions.
50.
A eosinophilic granuloma
B. epidermoid cyst
C. fibrous dysplasia
D. hemangioma
E. multiple myeloma
F. osteoma
Jawabannya : A
Burg Fig. 1.12, p. 5. (Courtesy of Dr. John A. Goree, Durham, NC.) A discrete
radiolucent area is seen
For questions 49 to 54, identify the lesions.
A eosinophilic granuloma
51.
B. epidermoid cyst
C. fibrous dysplasia
D. hemangioma
E. multiple myeloma
F. osteoma
Jawabannya : D
Burg 3 Fig. 1.38, p. 22. The honeycomb pattern is characteristic.
For questions 49 to 54, identify the lesions.
52
A eosinophilic granuloma
B. epidermoid cyst
C. fibrous dysplasia
D. hemangioma
E. multiple myeloma
F. osteoma
Jawabannya : F
Burg Fig. 1.52, p. 21. A discrete high-density lesion with smooth contours is seen.