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EDIR Notebook > RESPIRATORY & CARDIOVASCULAR SYSTEM > Flashcards

RESPIRATORY & CARDIOVASCULAR SYSTEM Flashcards

1
Q
  1. Which of the following are correct regarding Adult respiratory distress syndrome (ARDS):
    (a) CXR is usually normal in the first 24 h.
    (b) The lung is uniformly abnormal on CT.
    (c) Has 50% mortality.
    (d) The most common CT abnormality in survivors in a reticular pattern.
    (e) Bronchial dilatation is seen frequently on CT.
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Lung involvement is heterogeneous with a gradient density. Dependent lung is more densely opacified than nondependent
lung

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2
Q
  1. Which of the following are correct regarding thoracic trauma:
    (a) A normal erect CXR virtually exclude acute thoracic aortic injury.
    (b) Uncomplicated pulmonary contusion on CXR begins to resolve after at least 7 days.
    (c) Air bronchograms are a common CXR feature of pulmonary contusion.
    (d) Pulmonary lacerations appear as ovoid lucent areas.
    (e) Main bronchial injuries are more common than tracheal injuries
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Air bronchograms are usually absent in pulmonary contusions as result of blood filling the airways.
Uncomplicated pulmonary contusions begin to resolve after 48-72 hrs. Complete resolution is seen usually by 10-14
days.

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3
Q
  1. Which of the following are correct about thoracic aorta:
    (a) Stanford type B dissection affects the ascending aorta.
    (b) Penetrating aortic ulcers are frequently multiple.
    (c) Mycotic aneurysms are usually fusiform in configuration.
    (d) Penetrating aortic ulcers usually progress to dissection.
    (e) Type A dissection is more common than Type B.
A

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Dissection affecting ascending aorta is classified as Stanford type A and accounts for 75% of aortic dissection. Acute
type A is a surgical emergency to avoid fatal complications. Stanford type B dissection affects the descending aorta.
Mycotic aneurysms are usually saccular and may grow rapidly.
Penetrating atherosclerotic ulcers usually progress to aneurysmal dilatation

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4
Q
  1. Regarding diagnosis of pulmonary embolism (PE):
    (a) A negative D-dimer test reliably excludes PE in patients with low clinical probability.
    (b) A positive D-dimer test is highly specific for PE.
    (c) A normal isotope lung scan reliably excludes PE.
    (d) Patients with a good quality negative CTPA do not require further investigation or treatment for PE.
    (e) Digital subtraction pulmonary angiography is the investigation of choice for patients with suspected massive
    PE.
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
A positive D-dimer test has a poor specificity for PE, especially in hospitalized patients.
CTPA or echocardiography is the investigations of choice in case of massive PE

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5
Q
  1. Which of the following are correct about pulmonary sarcoidosis:
    (a) Normal CXR excludes the diagnosis.
    (b) The large airways are involved in 4-5% of cases.
    (c) Subcarinal lymph nodes are characteristically spared.
    (d) Fibrosis occurs predominantly in the lower zones.
    (e) Pleural effusion is common CXR.
A

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Between 5% to 15% of patients have a normal CXR when first examined.
Pleural effusion is a rare finding (2%).
All mediastinal lymphnodes can be affected in sarcoidosis. On CT 50% of cases show enlarged subcarinal
lymphnodes.
Middle and upper zone fibrosis is characteristic.

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6
Q
  1. Which of the following are correct regarding cardiac myxoma:
    (a) Is the most common primary cardiac tumour.
    (b) 80-90% of patients have arrhythmias.
    (c) 70-80% are found in the right atrium.
    (d) Invasion of the myocardium is seen in >50% at presentation.
    (e) Have a low signal on gradient-echo MRI sequences
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Approximately 75% of myxomas are located in left atrium, 20% in right atrium and rare cases are found in ventricles.
The classical clinical triad of obstructive cardiac symptoms, embolic phenomena and constitutional symptoms has
been described and majority of the patients have atleast one of these symptoms at presentation.
Cardiac myxomas are endocardial based masses that do not infiltrate the underlying tissues.

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7
Q
  1. Which of the following are correct regarding pulmonary disease in AIDS patients:
    (a) Lymphocytic interstitial pneumonia usually progresses to lymphoma in children.
    (b) Bilateral perihilar infiltrates on CXR are diagnostic of Pneumocystis Carinii pneumonia.
    (c) The presence of Cytomegalovirus in bronchoalveolar lavage fluid indicates active infection.
    (d) Lymphadenopathy is seen in <5% of cases of Kaposi’s sarcoma.
    (e) Thick-walled cavities are a common HRCT finding of invasive pulmonary aspergillosis
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Bilateral perihilar infiltrates are a non-specific findings seen in other opportunistic infections as well like CMVand
Kaposi’s sarcoma. On HRCT, PCP is most commonly seen as bilateral, symmetric, patchy or confluent ground glass
opacity. Less common findings on CXR and HRCT include focal areas of consolidation, mass lesions, multiple lung
nodules, pleural fluid, pneumothorax, cavitation, lymphadenopathy and occasional nodal calcification.
CMV is the most common viral pathogen to cause morbidity and mortality in patients with AIDS. The HRCT findings
are heterogeneous and include bilateral ground glass opacities, multiple nodules or mass like areas of consolidations
and patchy bilateral consolidation.
Pulmonary KS occurs in 18% to 50% of patients with known cutaneous KS and can affect the lung parenchyma,
pleural or tracheobronchial tree. Bilateral perihilar pulmonary infiltrates is the most common finding. Other common
findings include intralobular septal thickening, lymphadenopathy and pleural effusion.
Lymphocytic interstitial pneumonia is a lymphoproliferative disorder seen with increased frequency in mainly
children affected by AIDS. It is mostly benign and regresses spontaneously or with treatment.

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8
Q
  1. Which of the following are correct regarding HRCT features of pulmonary alveolar proteinosis (PAP):
    (a) Usually shows a lower zone distribution.
    (b) Pleural effusion is common at presentation.
    (c) Lymphadenopathy is a common feature.
    (d) Regions of emphysema are commonly observed.
    (e) Crazy paving pattern is a specific feature.
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Pleural effusion is rare in untreated PAP.
Lymphadenopathy is uncommon.
Crazy paving pattern though suggestive of PAP, is also seen in ARDS, acute interstitial pneumonia and drug induced
pneumonias.

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9
Q
  1. Which of the following are correct regarding extrinsic allergic alveolitis (EAA):
    (a) A normal CXR excludes the diagnosis.
    (b) Smoking is a risk factor.
    (c) The upper zones are typically involved in acute EAA.
    (d) Ground-glass opacity is a characteristic HRCT finding.
    (e) Bronchiectasis is seen on HRCT in chronic EAA.
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
CXRs are generally normal in patients with mild symptoms and in some cases with severe symptoms.
Smokers are protected from EAA also called hypersensitivity pneumonitis. The most common forms are farmer’s lung
and bird fancier’s lung.
Typically mid to lower zones are affected with sparing of costophrenic angles. Presentation is like pulmonary oedema
with bilateral areas of increased opacity that may be heterogeneous or homogeneous.

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10
Q
  1. Which of the following are correct regarding Langerhans’ cell histiocytosis.
    (a) Primarily affects cigarette smokers.
    (b) Predominantly affects the lung bases.
    (c) Most patients are asymptomatic.
    (d) Nodular lesions frequently cavitate.
    (e) Lung volumes are reduced.
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
LCH mostly involves upper and mid zones with relative sparing of lung bases and characteristic appearance of
bilateral nodular and reticulo-nodular areas.
Most patients are symptomatic with non-productive cough and/or dyspnoea.
Lung volumes are characteristically normal or increased.

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11
Q
  1. Which of the following are correct regarding bronchopulmonary sequestration:
    (a) Intralobar sequestration (IS) typically presents in the neonatal period.
    (b) Extralobar sequestration (ES) is more common than intralobar sequestration.
    (c) The main blood supply is form bronchial arteries.
    (d) Most commonly affect the lower lobes.
    (e) Can cause recurrent chest infection in adults.
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Bronchopulmonary sequestration is a non-functioning sequestered lung segment which has no communication with the
tracheobronchial tree and has a systemic blood supply. Supply is commonly from a separate branch from the aorta and
sometimes from upper abdominal vessels or coronary arteries.
IS is more common (80%) and ES is found in (20%). IS typically presents in adulthood and is often an incidental
finding.

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12
Q
  1. When a solitary pulmonary nodule is seen on computed tomography (CT), which of the following
    radiological features suggested it is benign?
    (a) Amorphous calcification within the nodule.
    (b) Air bronchograms within the nodule.
    (c) CT attenuation of – 10 Hounsfield units (HU).
    (d) Lobulated outline of the nodule.
    (e) Enhancement of the nodule by less than 15 HU following intravenous contrast.
A

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Popcorn type calcification indicated benignity and is typical of hamartoma. Amorphous calcification is seen in upto
7% of lung carcinomas.
Air bronchograms may be seen within a tumour mainly bronchoalveolar carcinoma.
Lobulated outline and corona radiate on CT are typical of carcinoma.

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13
Q
  1. Which of the following are true regarding malignant mesothelioma?
    (a) Selective involvement of the parietal pleura is typical.
    (b) Pleural effusions are common.
    (c) Chest wall invasion occurs in 12% of cases at presentation.
    (d) Circumferential pleural thickening is typical.
    (e) It is a cause of hypertrophic osteoarthropathy.
A

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Nodular thickening of both parietal and visceral pleura is usual in mesothelioma.

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14
Q
  1. Which of the following are true regarding round pneumonia?
    (a) It is most commonly associated with Klebsiella infection.
    (b) It occurs most commonly in the second and third decades of life.
    (c) It is more common in the upper lobes.
    (d) It frequently progresses to cavitation.
    (e) It is a feature of Q-fever infection.
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
It is most commonly associated with Streptococcus pneumonia.
Round pneumonia occurs most frequently in children within first decade of life.
It is usually seen in lower lobes, often abutting pleural space.
Round pneumonia evolves rapidly over a few days into segmental consolidation (sometimes with air bronchograms).
Cavitation is unusual.

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15
Q
  1. Which of the following are true regarding silicosis?
    (a) It predominantly affects the lower lobes in acute silicoproteinosis.
    (b) Emphysema is associated with the development of progressive massive fibrosis.
    (c) It mimics sarcoidosis on high resolution computed tomography (HRCT).
    (d) It is a more frequent cause of nodal egg-shell calcification on radiograph than coal miner’s pneumoconiosis.
    (e) Impairment of the lung function test correlates best with the profusion of nodules.
A

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Acute silicoproteinosis has mid and upper zone predominance occurs from intense exposure to silica dust resulting in
alveolar exudates.
Impairment of the lung function test correlates best with the degree of emphysematous change. Nodular perfusion is a
weaker independent correlate.

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16
Q
  1. When a mass-like lesion is seen on CT, which of the following findings support the diagnosis of rounded
    atelectasis.
    (a) An anteromedial location of the mass.
    (b) An acute angle with the pleural margins.
    (c) Localized crowding of the pulmonary vasculature.
    (d) Adjacent pleural thickening.
    (e) Absence of enhancement following intravenous contrast
A

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Round atelectasis is usually seen in posterior or basal region of lower lobes and appears as a well-defined oval or
round mass in subpleural location.
On Ct the mass shows uniform post intravenous contrast enhancement

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17
Q
  1. Which of the following are true regarding usual interstitial pneumonitis (UIP)?
    (a) It is more common in females than males.
    (b) It occurs most frequently in the sixth decade of life.
    (c) It is the most common cause of cryptogenic fibrosing alveolitis.
    (d) Areas of ground glass attenuation on HRCT in the absence of parenchymal distortion indicate reversibility.
    (e) A confident diagnosis cannot be made on HRCT without lung biopsy.
A

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
UIP has no gender predilection. On HRCT temporal heterogeneity is characteristic of UIP and it refers to different
areas of lung demonstrating different stages of inflammation and fibrosis at the same time. This helps to make
confident diagnosis in majority of the cases.

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18
Q
  1. Which of the following are true regarding cryptogenic organising pneumonia (COP)?
    (a) The disease is rarely symptomatic.
    (b) An obstructive pattern of lung function impairment is typical.
    (c) Pleural effusions are common.
    (d) Radiographic clearing occurs following steroid treatment.
    (e) Bilateral basal peripheral consolidation is a common radiographic finding
A

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
50% of the patients are symptomatic presenting with fever, cough, breathlessness and malaise with peak incidence in
5th and 6th decades of life. COP is also known as BOOP (bronchiolitis obliterans organizing pneumonia) or
bronchiolitis obliterans with intramural polyps.
Pleural effusion is uncommon (5% cases).

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19
Q
  1. Which of the following are true regarding blunt pulmonary trauma?
    (a) Pulmonary contusions show radiographic resolution in 48 hours.
    (b) Bronchial rupture is always accompanied by pneumothorax.
    (c) Traumatic diaphragmatic rupture is more common on the left side.
    (d) A normal chest radiograph has a good negative predictive value for aortic rupture.
    (e) Aortic rupture most commonly occurs at the aortic root.
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanations:
Bronchial rupture is frequently (70%), not always associated with pneumothorax. The falling lung sign is typical and
refers to displacement of lung to the dependant position.
Aortic rupture is the most common at ductus arteriosus level.

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20
Q
  1. Which of the following are correct regarding fibromuscular dysplasia (FMD):
    (a) Is more common in males.
    (b) Usually affects the intimal layer.
    (c) Renal artery FMD is bilateral in 5% of cases.
    (d) Can occur in veins.
    (e) May present with a transient ischaemic attack
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
FMD is more common in females and presents between 15 to 50 yrs.
Medial fibroplasia is more common form of FMD with characteristic ‘strings of beads’ appearance. Intimal
fibroplasia occurs in 10% of cases and adventitial hyperplasia is the rarest form.
Renal artery FMD is bilateral in approximately 30% of cases

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21
Q
  1. Which of the following are correct regarding popliteal artery disease:-
    (a) The popliteal artery is superficial to the popliteal vein on ultrasound.
    (b) Popliteal artery entrapment syndrome (PAES) is a recognized condition in athletes.
    (c) Popliteal artery aneurysms are bilateral in 50-70% of cases.
    (d) Popliteal artery occlusion is seen in 30-50% of patients with complete knee dislocation.
    (e) Balloon mounted stents are usually preferred to self-expanding stents when treating popliteal artery disease
A

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Popliteal artery lies posterior to the femur and anterior to the vein, thus artery is deep to the vein when scanning the
popliteal fossa with ultrasound.
Stent placement in popliteal artery is reserved for cases of failed PTA when limb viability is threatened.
Self-expanding stents are preferred because of superficial location of artery and concerns about extrinsic
compression.

22
Q
  1. Vascular anatomy of the liver:
    (a) The middle hepatic vein divides the liver into anatomical right and left lobes (Couinard classification).
    (b) At microscopic level, centrilobular veins drain into the portal circulation.
    (c) The portal vein bifurcation is intrahepatic in 90% of cases.
    (d) The right hepatic artery arises solely from the superior mesenteric artery in 10-15% of individuals.
    (e) In the fetus, the ducutus venosus joins the right portal vein to the inferior vena cava.
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
The hepatic lobule is the basic histological unit. The triads of hepatic arterioles, portal venules and bile duct branches
run at the edge of the lobule. Blood flows from periphery inwards via hepatic sinusoids and is drained by
centrilobular veins which in turn drain into hepatic veins.
The portal bifurcation is extrahepatic in 40% - 80% cases.
Left portal vein is critical to fetal circulation as it receives blood from the placenta via the left umbilical vein and
delivers it across the liver to the IVC via ductus venosus.

23
Q
  1. Which of the following are correct regarding aortic dissection:
    (a) Type A dissection is usually treated surgically.
    (b) Type A dissection involves the ascending aorta.
    (c) The true lumen is usually smaller than the false lumen.
    (d) Diagnosis is most commonly made by digital subtraction angiography.
    (e) Treatment options for type B dissection include stent grafting and balloon fenestration
A

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Diagnosis is mostly done by cross sectional imaging (CT or MRI) both of which have high specificity and sensitivity
above 90%.

24
Q
  1. Which of the following are correct regarding bronchial artery embolization (BAE):
    (a) The smallest available polyvinyl alcohol (PVA).
    (b) Recurrence of haemoptysis after BAE is rare.
    (c) The bronchial arteries originate directly from the ascending thoracic aorta in 90% of cases.
    (d) An arch aortogram is usually performed prior to selective bronchial angiography.
    (e) Chest pain is the most common complication.
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Very small particles can freely flow through the microcirculation and shunts causing infarcts, thus 350 – 500 micro m
PVA particles are used.
Long term recurrence rates are between 10% - 52% with a mean follow up period of 1 to 46 months.
The bronchial arteries originate directly from the descending thoracic aorta most commonly between T5 and T6
vertebrae. The left main bronchus is a useful landmark in angiography, marking the origin of bronchial arteries in most
cases.
Descending thoracic aortogram is usually performed.

25
Q
  1. Which of the following are correct regarding causes of failure of uterine fibroid embolization (UFE):
    (a) Failure to catheterize both uterine arteries.
    (b) Collaterals supply from ovarian artery.
    (c) Use of a micro-catheter for particle delivery.
    (d) Embolization particle aggregation.
    (e) Use of glycerol trinitrate.
A

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanations:
Micro-catheters facilitate uterine artery catheterization and may help avoid spasm.
Glycerol trinitrate is a vasodilator.

26
Q
  1. Which of the following are correct regarding endoleaks following endovascular abdominal aortic aneurysm
    (AAA) repair:
    (a) Type I endoleaks present months or years after AAA repair.
    (b) Graft fracture can result in a Type III endoleak.
    (c) Type II endoleaks require urgent interventional management.
    (d) Type IV endoleaks are the result of graft porosity.
    (e) CT demonstrates the cause of Type V endoleak in 20-30% of cases.
A

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanations:
Type I endoleaks usually occur early and may be seen on the on-table angiogram immediately after stent-graft
deployment as they occur due to ineffective seal at the graft ends. It has poor prognosis if left untreated.
Type II endoleaks management is controversial, some favouring a conservative approach. Embolization of feeding
artery may be performed.
Type V endoleaks refers to endopressure /endotension which is basically aneurysm sac expansion in absence of
obvious endoleaks on follow up CT. it has been associated with aneurysm expansion and rupture.

27
Q
  1. Which of the following are correct regarding Thymic carcinoma:
    (a) Commonly presents with myasthenia gravis.
    (b) Extrathoracic metastases are an early feature.
    (c) The most common histology is adenocarcinoma.
    (d) Calcification is a recognized finding.
    (e) Vascular invasion on CT distinguishes thymic carcinoma from lymphoma.
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Thymic epithelial tumours are of three types; benign thymoma, type 1 malignant thymoma (showing local invasion or
metastasis) and type 2 malignant thymoma or thymic carcinoma (showing endothoracic metastasis without
extrathoracic involvement).
Thymic carcinoma is rarely associated with paraneoplastic syndromes like myasthenia gravis, pure red cell aplasia
and hypogammaglobulinaemia.
Various histopathological types are squamous cell (epidermoid 36%), lymphoepithelioma like (poorly differentiated
squamous cell 32%), undifferentiated (anaplastic 11%), small cell (8%), basaloid (4%), sarcomatoid (4%), clear cell
(2%), mucoepidermoid (2%), carcinoma and adenocarcinoma (1%).

28
Q
  1. Which of the following are correct regarding features of mycotic aneurysms include:
    (a) Gradual enhancement with contrast.
    (b) Fusiform structure.
    (c) Adjacent vertebral osteomyelitis.
    (d) Adjacent reactive lymph node enlargement.
    (e) Tuberculosis is the commonest infective organism.
A

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanations:
Mycotic aneurysms are saccular types showing rapid enhancement and most commonly associated with
Staphylococcus aureus (IV drug abuse and subacute bacterial endocarditis).

29
Q
  1. Which of the following are correct regarding Buerger’s disease (thrombo-angitis obliterans):
    (a) Is associated with cigarette smoking in 90-95%.
    (b) Initially affects the proximal vessels and progresses distally.
    (c) More commonly affects the upper limb.
    (d) Has multiple corkscrew-shaped collaterals on angiography.
    (e) Has skip lesions as a recognised feature.
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanations:
Buerger’s disease initially affects the distal vessels and progresses proximally affecting the lower limbs more
commonly.

30
Q
  1. Which of the following are correct regarding aortic dissection:
    (a) The Stanford Classification Type B aortic dissection involves the ascending aorta.
    (b) Aortic dissections involving the ascending aorta account for 60-70%.
    (c) There is an increased risk in Ehlers-Danlos syndrome.
    (d) Contrast-enhanced CT is more accurate than transoesophageal echocardiography at identifying aortic
    dissections.
    (e) Displacement of calcification in the aortic knuckle by >10mm is a useful sign.
A

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanations:
Type A dissection involves the ascending aorta.
Ehlers-Danlos syndrome is associated with increased risk of aortic aneurysms and not dissection.

31
Q
  1. Which of the following are correct regarding renal artery stenosis:
    (a) There is an association with neurofibromatosis.
    (b) Fibromuscular dysplasia causes stenosis of the proximal renal artery.
    (c) There is elevation of the rennin levels on renal vein sampling of the affected kidney by 50%.
    (d) Duplex ultrasound is the investigation of choice.
    (e) On IVU, there is early appearance of contrast material in the affected kidney.
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanations:
In FMD stenosis is more common in mid and distal renal artery. In atherosclerotic stenosis proximal artery is
involved.
MRI is investigation of choice. Ultrasound is inadequate in 50% cases.
On IVU, there is delay due to reduced glomerular filtration rate.

32
Q
  1. Causes of oligaemia (decreased pulmonary blood flow) with cyanosis include:
    (a) Aortic atresia.
    (b) Truncus arteriosus.
    (c) Transposition of great vessels.
    (d) Total anomalous pulmonary venous return.
    (e) Tetralogy of Fallot.
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Aortic atresia, Truncus arteriosus, TGA and TAPVR show plethora with cyanosis.

33
Q
  1. Which of the following are correct regarding Goodpasture’s syndrome:
    (a) Hilar lymph nodes may be enlarged.
    (b) Changes are commonly unilateral.
    (c) Prognosis is good.
    (d) Acute presentation is with air-space consolidation typically at the lung apices.
    (e) Signs of renal failure precede pulmonary complaints.
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Goodpasture’s syndrome is bilateral with poor prognosis and death usually within 3 yrs of diagnosis.
Pulmonary involvement is before renal involvement with relative sparing of lung apices.

34
Q
  1. The following statements regarding pulmonary hamartomas are correct:
    (a) 5-10% undergo malignant transformation.
    (b) Calcification is seen in 30-35%
    (c) 80% are located endobronchially.
    (d) Central fat density is identified on Ct imaging.
    (e) 95% are identified in patients over 40 years
A

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanations:
Pulmonary hamartomas are purely benign lesions with 90% presenting as intrapulmonary lesions within 2 cm of the
pleura. Less than 10% of lesions are endobronchial.

35
Q
  1. Which of the following are correct regarding lymphangioleiomyomatosis (LAM):
    (a) Pulmonary abnormalities are similar to those seen in tuberous sclerosis.
    (b) It is found exclusively n females.
    (c) Cysts commonly have a bizarre outline.
    (d) Cysts show sparing of the apices.
    (e) There is an association with chylothorax.
A

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanations:
In LAM cysts are usually uniform and round with uniform distribution. Cysts in LCH have bizarre irregular outlines
and show apical sparing.

36
Q
  1. Which of the following are correct regarding ventilation / perfusion imaging:
    (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.
A

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.

37
Q
  1. Causes of eggshell calcification of lymph nodes include:
    (a) Rheumatoid arthritis.
    (b) Silicosis.
    (c) Scleroderma.
    (d) Histoplasmosis.
    (e) Amyloidosis
A

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Rheumatoid arthritis rarely shows lymphnodal calcification.

38
Q
  1. Which of the following are correct regarding squamous cell carcinoma (SCC) at the lung:
    (a) Is the commonest long tumour to cavitate.
    (b) Has the highest incidence of distant metastases.
    (c) Is the most likely cell type to cause a Pancoast tumour.
    (d) Is the most likely cell type to cause superior venous obstruction.
    (e) Is most often centrally located.
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Lung SCC has lowest chances of distant metastasis.
Small cell carcinoma is most likely to cause superior venous obstruction.

39
Q
  1. Which of the following are correct regarding bronchogenic cysts:
    (a) They are associated with spina bifida.
    (b) Mediastinal bronchogenic cysts account for 85-90%.
    (c) They may contain air fluid levels.
    (d) Mediastinal bronchogenic cysts are more common on the left.
    (e) Intrapulmonary bronchogenic cysts are found more commonly in the lower lobes.
A

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Mediastinal bronchogenic cysts are more common on the right side.
Intrapulmonary cysts are more common in upper lobes.

40
Q
  1. Features of pulmonary asbestosis include:
    (a) Increased severity in sub-pleural zones.
    (b) Hilar adenopathy.
    (c) Upper lobe massive fibrosis.
    (d) Thickened interlobular septa on HRCT.
    (e) Increased incidence of bronchio-alveolar cell carcinoma
A

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Asbestosis shows lower lobe fibrosis with no hilar lymphadenopathy.

41
Q
  1. Causes of inferior rib notching include:
    (a) Coarctation of the aorta.
    (b) Systemic sclerosis.
    (c) Blalock-Taussig shunt.
    (d) Superior vena caval obstruction.
    (e) Neurofibromatosis Type 1
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Systemic sclerosis does not cause inferior rib notching.

42
Q
  1. Which of the following are correctconcerning lymphoma:
    (a) Lymph node calcification occurs.
    (b) Hodgkin’s disease is more common in the chest than non-Hodgkin’s disease.
    (c) Posterior mediastinal lymph nodes favour lymphoma rather than Sarcoidosis.
    (d) Intrapulmonary lymphoma can present with massive pneumonia – like lobar infiltrates.
    (e) Miliary nodules can be the presenting appearance on chest X-Ray.
A

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
In lymphoma anterior mediastinal lymphnodes are seen.

43
Q
  1. Which of the following are correct regarding Takayasu’s arteritis:
    (a) External carotid artery branches are most commonly affected.
    (b) The mean interval between symptom onset and diagnosis is 2-4 months.
    (c) It is a recognised cause of fusiform aortic aneurysms.
    (d) Stenotic lesions are more commonly seen in the thoracic than abdominal aorta.
    (e) Ultrasound of the proximal common carotid artery shows circumferential thickening of the vessel wall.
A

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Takayasu’s arterits mainly affects main aortic branches and pulmonary arteries. External carotid artery involvement is
seen in temporal arteritis. Internal between symptom onset and diagnosis is 8 yrs.

44
Q
  1. Which of the following are correct regarding pericardial disease:
    (a) Rheumatoid arthritis is a cause of pericarditis.
    (b) Elevation of the jugular venous pressure on inspiration is a sign of chronic pericarditis.
    (c) A pericardium of 3mm thickness is normal.
    (d) In chronic pericarditis, CT shows curvature of the interventricular septum to the right.
    (e) Renal failure is a cause of pericardial effusion.
A

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Curvature of the interventricular septum to the left is seen in chronic pericarditis on CT.

45
Q
  1. Which of the following are correct regarding features of polyarteritis nodosa (PAN) include:
    (a) Multiple aneurysms.
    (b) Luminal irregularities.
    (c) Involvement of small veins.
    (d) Necrotising vasculitis involving the small and medium sized arteries.
    (e) Involvement of kidneys in 70-80%.
A

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
PAN is a systemic inflammatory disease, commoner in males and presents around 5th to 7th decade of life. Main
differentials include microscopic polyangitis and SLE.

46
Q
  1. Regarding aortic transection (traumatic aortic injury), which of the following are correct?
    (a) The descending aorta is rarely involved.
    (b) The most common site is the ascending aorta.
    (c) The chest radiograph is normal in 30% of cases at presentation.
    (d) The ‘left apical cap’ sign is highly specific for aortic transection.
    (e) Chronic false aneurysm develops in 5% of cases.
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanations:
The most common site is aortic isthmus (95%). The ascending aorta is involved in 1% of cases.
The ‘left apical cap’ sign refers to mediastinal hematoma with extrapleural extension of blood (only 15% of
mediastinal hematomas are due to aortic tear).

47
Q
  1. The following statements regarding alveolar cell carcinoma are correct:
    (a) Air bronchograms are a feature of both forms.
    (b) Growth is rapid.
    (c) It is associated with underlying pre-existing lung fibrosis.
    (d) The diffuse pneumonic form is commoner than the local mass form.
    (e) It is usually located subpleurally.
A

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Doubling time of alveolar cell carcinoma is longer than 18 months, thus slow growing.
Local mass form is more common. Pneumonic form accounts for 10% - 40 %.

48
Q
  1. The following statements regarding lymphangitis carcinomatosis are correct:
    (a) Chest X-Ray appearances are of multiple reticulonodular opacities.
    (b) It is associated with gastric cancer.
    (c) Kerley A and B lines are seen.
    (d) Radiological changes usually precede symptom onset.
    (e) Hilar adenopathy is seen in 80-90%
A

(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Lymphangitis carcinomatosis presents with shortness of breath before radiological changes. Hilar adenopathy is seen
in 20% - 50%.

49
Q
  1. Which of the following are correct regarding transposition of the great arteries (TGA)?
    (a) Pulmonary stenosis is an associated feature.
    (b) In the D loop of TGA the atria and ventricles have a normal morphological relationship.
    (c) Dextrocardia is associated with L loop of TGA.
    (d) Chest radiograph shows pulmonary plethora in D loop of TGA.
    (e) In the L loop (corrected) transposition there is physiologically corrected circulation.
A

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
In the D loop of TGA the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. A
normal relationship exists between the atria and the ventricles.
In the L loop of TGA, there is transposition of the aorta and pulmonary arteries in addition to inversion of the left and
right ventricles. The atria and coronary arteries are associated with their corresponding ventricles.

50
Q
  1. Regarding total anomalous pulmonary venous drainage (TAPVD), which of following are correct?
    (a) The supracardiac type is the most common.
    (b) The left atrium is not enlarged.
    (c) The infracardiac type may drain into hepatic veins.
    (d) There is an association with Scimitar syndrome.
    (e) Pulmonary oedema in presence of normal sized heart is a feature of Cardiac type TAPVD.
A

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Scimitar syndrome is the association of hypogenetic lung with congenital pulmonary venolobar syndrome where all or
part of hypogenetic lung is drained via an anomalous vein into the subdiaphragmatic IVC, hepatic veins, portal vein or coronary sinus.
Pulmonary oedema is a characteristic feature of infracardiac type TAPVD.

51
Q
  1. Which of the following are correct regarding coarctation of the aorta?
    (a) Adult coarctation is commonly associated with cardiac anomalies.
    (b) It is a rare cause of infantile heart failure.
    (c) The ductus arteriosus usually remains patent in adult type coarctation.
    (d) Rib notching is usually present by 1 yr of age.
    (e) A short segment of narrowing of ascending aorta is seen in infantile coarctation.
A

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Adult coarctation is short narrowing at ligamentum arteriosum. It is rarely associated with cardiac anomalies and the
ductus arterosium is usually closed.
Aortic coarctation is second most common cause of infantile heart failure (most common is hypoplastic left heart).
Rib notching involves 3rd to 8th ribs and in 75% of cases seen in over 6 yrs of age.

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