Paediatrics - Practice papers

Question 1

@# 1. Ewing’s sarcoma:
a) Most commonly affects children and adolescents
b) Readily metastasises to bone
c) Is usually medullary in origin
d) Is of low signal on T1 weighted MRI
e) Is iso-intense to skeletal muscle on T2 weighted MRI

Answer 1

1.
a) True - 75% are <20 years of age, with most being 5-15
b) True
c) True - mostly diaphyseal in origin (25% metaphyseal)
d) True - allows the extent of marrow involvement to be assessed
e) False - hyperintense to skeletal muscle on T2 sequences

Question 2

2. Down’s syndrome is associated with:
   a) Accelerated sutural closure
   b) Atlanto-axial subluxation
   c) Anterior vertebral body scalloping
   d) Hirschsprung’s disease
   e) Annular pancreas

Answer 2

2.
a) False - delayed sutural closure, with a persistent metopic suture in 40-79%
b) True
c) True
d) True
e) True

Question 3

3. On neonatal cranial ultrasound:
   a) The cerebellar vermis is typically hypoechoic
   b) Choroid plexus is highly echogenic
   c) Ventricles are usually slit-like in the premature infant
   d) Cavum septum pellucidum is rarely seen in the term infant
   e) The caudothalamic groove is a rare place for intracranial haemorrhage

Answer 3

3.
a) False - the cerebellum is usually hypoechoic
b) True
c) False - ventricles are prominent in premature infants
d) False - seen in over 50% of term neonates
e) False - a common location for intracerebral haemorrhage

Question 4

@# 4. Clinical and radiological features of neurofibromatosis Type 1 include:
a) Unilateral limb overgrowth
b) Inferior rib notching
c) Pseudoarthroses of long bones
d) Coarctation of the aorta
e) Multiple meningiomas

Answer 4

4.
a) True
b) True
c) True
d) True
e) False - a feature of neurofibromatosis Type 2

Question 5

@# 5. Hypertrophic pyloric stenosis:
a) Hypertrophied pyloric muscle is hypoechoic on ultrasound
b) Pyloric muscle thickness >4 mm is abnormal
c) Pyloric transverse diameter of 12 mm is normal
d) Male infants are more frequently affected
e) The stomach is usually atonic

Answer 5

5.
a) True
b) True
c) True
d) True
e) False - exaggerated peristaltic waves

Question 6

@# 6. Regarding childhood liver tumours:
a) Hepatocellular carcinoma typically occurs over 5 years of age
b) Hepatoblastoma is more common <2 years of age
c) Hepatoblastoma is associated with hemihypertrophy
d) Hepatocellular carcinoma is a complication of biliary atresia
e) Hepatocellular carcinoma typically causes a cold spot on HIDA scanning

Answer 6

6.
a) True - peak age 12-14 years of age
b) True
c) True
d) True
e) False - hot spots, although atypical / cold spots may be seen

Question 7

@# 7. Concerning imaging of the testis:
a) An appendix testis is present in over 90% of males
b) Examination of the contralateral testis is mandatory in possible torsion
c) A hydrocele may cause false positive diagnosis of torsion on scintigraphic evaluation
d) A torted testis is usually of high echogenicity on ultrasound
e) Torsion is most common in the neonatal age group

Answer 7

7.
a) True
b) True
c) True
d) False - hypoechoic due to congestion, infarction and oedema
e) False - rare in neonates

Question 8

@# 8. Regarding imaging of the adrenal glands:
a) At birth, the adrenal glands are around one third the size of the adjacent kidney
b) The limb of a mature adrenal gland should not measure more than 5 mm
c) In renal agenesis, the adrenal gland assumes a discoid shape
d) Childhood adrenocortical neoplasms are hyperintense on T2 weighted MRI
e) Ectopic adrenal tissue is typically sited around the superior mesenteric artery

Answer 8

8.
a) True
b) True
c) True
d) True
e) False - around the adrenal bed, or the coeliac axis

Question 9

@# 9. Concerning imaging of the complications of renal transplantation:
a) Acute rejection occurs in up to 40% of cases
b) Ultrasound reliably differentiates acute rejection from tubular necrosis
c) On colour Doppler imaging, a resistive index of >0.9 is abnormal
d) Arterial thrombosis is more common than venous
e) Obstruction in the early postoperative period is usually due to the ureteric anastomosis

Answer 9

9.
a) True
b) False
c) True - this may occur in both acute tubular necrosis or acute rejection
d) False - arterial thrombosis is rare
e) False - obstruction within 72 hours is usually due to blood clots

Question 10

@# 10. Regarding solid abdominal malignancy in childhood:
a) Wilms’ tumours are bilateral in up to 25%
b) Neuroblastomas are associated with hemihypertrophy
c) Neuroblastomas calcify in over 80% on CT
d) Wilms’ tumours tend to encase the central vascular structures
e) Wilms’ tumours are more common in horseshoe kidneys

Answer 10

10.
a) False - bilateral in up to 10%
b) False - Wilms’ tumours are associated with hemihypertrophy
c) True
d) False - displace
e) True - also with aniridia, hemihypertrophy and cryptorchidism

Question 11

11. The following are features of osteogenesis imperfecta:
    a) Most cases involve an autosomal dominant mode of inheritance
    b) Multiple wormian bones
    c) Dense, sclerotic bones
    d) Exuberant callus formation around fractures
    e) Basilar invagination

Answer 11

11.
a) True
b) True
c) False - diffuse demineralisation and cortical thinning
d) True
e) True

Question 12

@# 12. Regarding developmental dysplasia of the hip:
a) The condition is more common in breech presentation
b) It is usually bilateral
c) Ultrasound is performed in the coronal plane
d) The acetabular labrum is hypoechoic on ultrasound
e) Hilgenreiners line should pass through both triradiate cartilages on plain films

Answer 12

12.
a) True
b) False - unilateral is 11 times more common
c) True
d) False - acetabular labrum is echogenic. Femoral head is hypoechoic
e) True

Question 13

@# 13. Radiological features of rickets include:
a) Radiological signs indicate the underlying aetiology
b) Widening of the growth plate as a late sign
c) Bulbous anterior rib ends
d) A sclerotic rim surrounding the epiphysis
e) Dense metaphyseal bands

Answer 13

13.
a) False - radiological features are similar regardless of underlying cause
b) False - an early sign
c) True - the ‘rachitic rosary’ sign
d) False - this is seen in scurvy
e) True

Question 14

@# 14. In craniosynostosis:
a) The skull vault is formed by membranous ossification
b) Single sutural synostosis is more common than multiple
c) Overall, 15% of cases are syndromic in nature
d) Sagittal synostosis results in a trigonocephalic skull
e) Bilateral coronal synostosis results in a brachycephalic skull

Answer 14

14.
a) True - enchondral ossification occurs in the skull base
b) True - 60% of cases
c) True
d) False - scaphocephalic skull
e) True

Question 15

@# 15. Radiological features of absent corpus callosum include:
a) Crescentic lateral ventricles
b) A high riding third ventricle
c) Enlargement of the occipital horns
d) Hypoplasia of the optic nerves
e) Separation of pericallosal arteries on angiography

Answer 15

15.
a) True
b) True
c) True
d) True
e) True

Question 16

@# 16. Concerning abnormalities of intestinal rotation:
a) The midgut extends from the duodenojejunal flexure to the ascending colon
b) During development, the midgut rotates 270 degrees clockwise around the superior
mesenteric artery axis
c) Ladd’s bands are a cause of low intestinal obstruction
d) The duodenojejunal flexure should lie at the level of the pylorus on barium studies
e) The superior mesenteric vein normally lies to the left of the artery

Answer 16

16.
a) False - duodenojejunal flexure to mid-transverse colon
b) False - anti-clockwise
c) False - high intestinal obstruction
d) True
e) False - superior mesenteric vein should lie to the right of the superior mesenteric artery

Question 17

@# 17. The normal thymus:
a) Develops from the third branchial pouch
b) May enlarge following illness
c) CT density (Hounsfield units) increases with increasing age
d) On T1 weighted MRI the gland is iso-intense to mediastinal fat
e) Reaches a maximum size in the 2nd decade

Answer 17

17.
a) True
b) True
c) False - decreases with age (fatty replacement)
d) False - hypointense to surrounding fat on T1 sequences
e) True

Question 18

@# 18. Regarding MRI signal characteristics:
a) T1 signal is produced by longitudinal relaxation
b) Cerebral grey matter has intermediate T1 signal intensity
c) Cerebrospinal fluid has a long T2 relaxation time
d) Spin echo sequences begin with a 180 degree radiofrequency pulse
e) Inversion recovery sequences begin with an initial 90 degree radiofrequency pulse

Answer 18

18.
a) False - T1 signal is produced by transverse relaxation
b) True
c) True
d) False - 90 degree pulse, with multiple subsequent 180 degree pulses
e) False - an initial 180 degree pulse

Question 19

@# 19. Radiological findings in tetralogy of Fallot typically include:
a) A large ASD
b) Overriding of the aorta
c) Right ventricular hypoplasia
d) Pulmonary plethora
e) Aortic valve stenosis

Answer 19

19.
a) False - a large (subvalvular) VSD is typical
b) True
c) False - right ventricular hypertrophy
d) False - pulmonary oligaemia
e) False - pulmonary stenosis

Question 20

@# 20. Radiological findings in sickle cell disease include:
a) ‘Hair-on-end’ skull appearance
b) Premature conversion of red to fatty bone marrow
c) Subperiosteal new bone formation in the tubular bones of the hand and feet
d) Salmonella osteomyelitis
e) Enlarged kidneys

Answer 20

20.
a) True
b) False - delayed conversion of red to fatty bone marrow
c) True - often the earliest radiological manifestation
d) True
e) True - due to increased perfusion secondary to anaemia. Also, reduced size in late disease
due to infarcts

Question 21

@# 21. Portal venous gas may be seen in which of the following conditions:
a) Pneumonia
b) Imperforate anus
c) Duodenal atresia
d) Necrotising enterocolitis
e) Umbilical catheterization

Answer 21

21.
a) True
b) True
c) True
d) True
e) True

Question 22

@# 22. Air trapping may be seen in:
a) Asthma
b) Bronchogenic cyst
c) Intralobar sequestration
d) Langerhans’ cell histiocytosis
e) Inhaled foreign body

Answer 22

22.
a) True
b) True
c) False
d) True
e) True

Question 23

@# 23. Features of Swyer-James syndrome include:
a) Increased lucency of a hemithorax
b) Increased hilar markings, with peripheral pruning
c) Air trapping during expiration
d) Mild bronchiectasis
e) Typically a lobar or segmental distribution

Answer 23

23.
a) True
b) False
c) True
d) True
e) False - usually the entire lung is affected

Question 24

@# 24. Regarding a double aortic arch:
a) It is the most common vascular ring
b) The descending aorta is usually on the left side
c) The left aortic arch is usually higher than the right
d) The left aortic arch is usually larger than the right
e) It is often associated with other congenital anomalies

Answer 24

24.
a) True
b) True - in 75%
c) False - the right arch normally lies higher than the left arch
d) False - the right arch is normally larger
e) False - it is usually an isolated anomaly

Question 25

@# 25. Regarding paediatric ependymomas:
a) Tumours usually arise from the cerebellar hemispheres
b) Tumours are more frequently supratentorial
c) Tumours commonly extend through the foramen of Magendie
d) MR signal is characteristic
e) Calcification is seen in up to 50%

Answer 25

25.
a) False - the 4th ventricle
b) False - infratentorial in 70%
c) True
d) False
e) True

Question 26

@# 26. Concerning intrahepatic interruption of the inferior vena cava:
a) It involves absence of the IVC between the renal vessels and right atrium
b) Venous drainage is predominantly via the left azygous system
c) The hepatic veins drain into the left atrium
d) There is an association with anomalous pulmonary venous drainage
e) There is an association with polysplenia

Answer 26

26.
a) True
b) False - the right azygous vein
c) False - the right atrium
d) True
e) True

Question 27

@# 27. Dysembryoplastic neuroepithelial tumours: corrected
a) Rarely present with seizures
b) Typically arise in the periventricular region
c) Usually arise in the parieto-occipital region
d) Are hypodense on unenhanced CT
e) Produce extensive surrounding oedema

Answer 27

27.
a) False - presentation is usually with refractory seizures
b) False - cortical and subcortical grey matter
C) False - temporal lobe in 60%, frontal in 30%
D) True
e) False - surrounding oedema is atypical

Question 28

@# 28. Regarding the Dandy-Walker malformation:
a) The posterior fossa is small
b) There is a high lying tentorium
c) The cerebellar vermis is normal
d) The corpus callosum is absent in up to 25%
e) There is inferior displacement of the vein of Galen

Answer 28

28.
a) False - the posterior fossa is enlarged
b) True
c) False - hypoplastic or absent vermis
d) True
e) False - superior displacement of the vein of Galen

Question 29

@# 29. The following cause anterior oesophageal impression on barium swallow: corrected
a) Aberrant left subclavian vein
b) Aberrant left pulmonary artery
c) Double aortic arch
d) Left atrial enlargement
e) Right aortic arch with mirror image branching

Answer 29

29.
a) False - posterior impression
b) True
c) True
d) False
e) False - normal barium swallow

Question 30

@# 30. Regarding congenital cystic adenomatoid malformation:
a) The abnormality is purely cystic in nature
b) Cysts usually communicate with the bronchial tree
c) Mediastinal shift is toward the affected lung
d) Abdominal radiographs reveal a scaphoid abdomen
e) It is associated with pulmonary sequestration

Answer 30

30.
a) False - solid and cystic elements
b) True
c) False - typically away from the affected side
d) False - a feature of congenital diaphragmatic hernias
e) True