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SAM > Self Assessment Modules > Flashcards

Self Assessment Modules Flashcards

1
Q

Which of the following is a normal maternal physiologic or anatomic change of pregnancy?
A. Increased elasticity of the abdominal wall musculature.
B. Increased WBC count.
C. Decreased cholesterol synthesis.
D. Downward displacement of the appendix.

A

B. Increased WBC count

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2
Q

In the sonographic evaluation of placental abruption, why is the finding of a subchorionic hematoma important?
A. It suggests chronic placental abruption.
B. It identifies a risk for premature labor.
C. It correlates with intrauterine growth retardation.
D. It reveals the need for MRI evaluation.

A

B. It identifies a risk for premature labor

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3
Q

A pregnant patient is diagnosed with an adnexal mass. The sonographic appearance of this mass is nonspecific. What is the next best course of management?
A. Watchful waiting until the end of pregnancy.
B. CT.
C. MRI.
D. Biopsy of the mass.
E. Immediate surgical removal of the mass.

A

C. MRI

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4
Q 
Which of the following sonographic findings is most commonly seen with ovarian torsion?
A. Ovarian enlargement.
B. Absence of arterial flow. 
C. Pelvic free fluid.
D. Twisted vascular pedicle.
A

A. Ovarian enlargement

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5
Q 
On MR images of a patient with acute appendicitis, what is the signal intensity of the appendiceal lumen?
A. High signal intensity on T2 imaging. 
B. High signal intensity on T1 imaging. 
C. Low signal intensity on T2 imaging. 
D. Low signal intensity on T1 imaging.
A

A. High signal intensity on T2 imaging.

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6
Q 
All of the following are imaging manifestations of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome EXCEPT:
A. Hematoma. 
B. Edema.
C. Rupture.
D. Steatosis.
A

D. Steatosis

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7
Q

All of the following techniques optimize the ultrasound examination for obstructive urolithiasis EXCEPT:
A. Performing Doppler intrarenal resistive index measurements of the kidneys.
B. Performing transvaginal pelvic ultrasound.
C. Scanning with the patient in the contralateral decubitus position.
D. Measuring pre- and postvoid bladder volumes.

A

D. Measuring pre- and postvoid bladder volumes

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8
Q 
A pregnant patient has a distal obstructing ureteral calculus that is not visible on transabdominal ultrasound. What examination should be performed next?
A. CT.
B. Transperineal ultrasound. 
C. Transvaginal ultrasound. 
D. MR urography.
A

C. Transvaginal ultrasound

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9
Q

MR urography reliably provides information for all of the following EXCEPT:
A. Differentiation between physiologic and obstructive hydronephrosis.
B. Characterization of the size and shape of calculi.
C. Identification of the level of ureteral obstruction.
D. Depiction of complications of pyelonephritis.

A

B. Characterization of the size and shape of calculi

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10
Q

A 25-year-old pregnant woman has a 2.5-cm splenic artery aneurysm incidentally detected on contrast- enhanced CT of the abdomen and pelvis. Which of the following is a reason to electively treat the aneurysm?
A. Risk of infection.
B. Risk of splenic infarction.
C. Risk of splenic arteriovenous fistula.
D. Risk of rupture.

A

D. Risk of rupture

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11
Q 
In a postmenopausal woman with abnormal vaginal bleeding who is not receiving hormone replacement therapy, which of the following endometrial thickness cutoff criteria is used to optimize accuracy for detecting cancer?
A. ≥ 4 mm.
B. ≥ 5 mm.
C. ≥ 6 mm.
D. ≥ 7 mm.
E. ≥ 8 mm.
A

B. > 5 mm. (96% sensitivity, 92% specificity)

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12
Q 
In a postmenopausal woman with abnormal vaginal bleeding who is undergoing hormone replacement therapy, which of the following endometrial thickness cutoff criteria is used to optimize accuracy for detecting cancer?
A. ≥ 4 mm.
B. ≥ 5 mm.
C. ≥ 6 mm.
D. ≥ 7 mm.
E. ≥ 8 mm.
A

B. >5 mm.

*(A thickness of 8 mm is considered the upper limit of normal if the patient is asymptomatic)

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13
Q 
All of the following increase a woman’s risk for endometrial hyperplasia and cancer EXCEPT which one?
A. Multiparity.
B. Obesity.
C. Diabetes.
D. Hypertension.
E. Tamoxifen exposure.
A

A. Multiparity

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14
Q

Which of the following statements regarding women receiving tamoxifen is FALSE?
A. Tamoxifen causes an increase in the prevalence of endometrial polyps, hyperplasia, and carcinoma.
B. Postmenopausal women taking tamoxifen usually show endometria that are thicker than in control subjects.
C. Endovaginal sonography is an accurate tool for diagnosing endometrial abnormalities in this patient population.
D. Subendometrial cystic changes can often simulate
endometrial thickening on transvaginal sonography.
E. What should be considered normal endometrial
thickness in asymptomatic women on tamoxifen is controversial.

A

C. Endovaginal sonography is an accurate tool for diagnosing endometrial abnormalities in this patient population (FALSE)

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15
Q 
The differential diagnosis of focal endometrial abnormality seen on sonohysterography includes which of the following?
A. Polyp.
B. Hyperplasia.
C. Carcinoma.
D. Subendometrial fibroid. 
E. All of the above.
A

E. All of the above.

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16
Q

In differentiating focal endometrial disorders (e.g., polyp) from a subendometrial disorder (e.g., fibroid) on sonohysterography, which of the following statements is FALSE?
A. Polyps are frequently multifocal, whereas fibroids are usually solitary.
B. Polyps usually show a narrow base, whereas fibroids have a broad base of attachment to the uterine wall.
C. Polyps are typically echogenic like normal endometrium, whereas fibroids are typically hypoechoic like normal myometrium.
D. The normal endometrial lining underlies the base of a polyp, whereas it overlies the surface of a fibroid.
E. On color Doppler imaging, polyps show a single feeding vessel, whereas fibroids show a diffuse network of vessels.

A

A. Polyps are frequently multifocal, whereas fibroids are usually solitary. (FALSE)
Whether a focal lesion is solitary or multiple on US does not distinguish between an endometrial or subendometrial process.

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17
Q 
Figure 1 (shows multiple hypoechoic cystic structures at the endometrium) from an endovaginal sonography examination depicts the endometrium of a postmenopausal woman with vaginal bleeding and a history of several years of tamoxifen exposure. Which of the following is the LEAST LIKELY diagnosis?
A. Polyp.
B. Hyperplasia.
C. Carcinoma.
D. Subendometrial fibroid. 
E. Subendometrial cysts.
A

D. Subendometrial fibroid. (Would appear hypoechoic, homogeneously solid, and well circumscribed)

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18
Q 
Figure 2 (shows hypoechoic subendometrial mass) from a sonohysterography examination depicts a focal lesion. Which of the following is the MOST LIKELY diagnosis?
A. Polyp.
B. Hyperplasia.
C. Carcinoma.
D. Subendometrial fibroid.
A

D. Subendometrial fibroid

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19
Q

Which of the following statements regarding diagnostic tools for endometrial disorders is TRUE?
A. Nonfocal biopsy to detect cancer should be performed after a negative workup for a focal abnormality.
B. Sonohysterography is more accurate than hysteroscopy for detecting focal endometrial disorders.
C. Endovaginal sonography is the most sensitive test for endometrial cancer detection in postmenopausal
women.
D. Endovaginal sonography is highly sensitive in detecting endometrial disorders in the premenopausal woman.
E. MRI is replacing sonohysterography as a diagnostic tool for endometrial disorders.

A

C. Endovaginal sonography is the most sensitive test for endometrial cancer detection in postmenopausal women. (using a thickness cutoff of >= 5 mm)

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20
Q

Sonohysterography can be appropriately used in evaluating women with abnormal bleeding for all of the following purposes EXCEPT which one?
A. Evaluate endometrium not visualized or poorly visualized on endovaginal sonography.
B. Evaluate women with abnormal vaginal bleeding and normal findings on endovaginal sonography for underlying endometrial disorders.
C. Distinguish abnormality seen on endovaginal sonography as endometrial versus subendometrial.
D. Determine the size and location of focal lesions to plan hysteroscopic resection.
E. Characterize an endometrial lesion as benign or malignant.

A

E. Characterize an endometrial lesion as benign or malignant. (FALSE)

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21
Q

Regarding MRI of the bone marrow, which sequence is LEAST helpful in differentiating neoplastic from non-neoplastic entities?
A. Inversion recovery.
B. T1-weighted.
C. Conventional gradient-echo.
D. Opposed-phase or chemical shift imaging.
E. T2-weighted, fat-suppressed.

A

C. Conventional gradient-echo. (least helpful)

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22
Q

Regarding red bone marrow, which of the following is TRUE?
A. Red marrow can be focal and mass-like.
B. Red marrow reconversion always progresses in a consistent, predictable pattern.
C. Red marrow in adults typically persists in the
hands and feet.
D. Red marrow does not contain fat cells.
E. Red marrow is easily differentiated from neoplasm on MRI.

A

A. Red marrow can be focal and mass-like.

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23
Q

Which of the following characteristics of normal bone marrow is TRUE?
A. Marrow in long-bone diaphyses matures last.
B. Once red marrow has matured to yellow marrow, it cannot become hematopoietic.
C. Yellow or fatty marrow consists entirely of fat.
D. Macroscopic foci of fat in normal marrow can be visible on MRI.
E. Red marrow begins converting to yellow marrow at 5 years of age.

A

D. Macroscopic foci of at in normal marrow can be visible on MRI.
(E. Red marrow can begin converting at less than 1 year of age)

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24
Q

What are the typical MRI characteristics of neoplastic marrow involvement?
A. Isointense to muscle on T1, lack of signal dropout on out-of-phase imaging.
B. Hyperintense to muscle on T1, lack of signal drop- out on out-of-phase imaging.
C. Isointense to muscle on T1, signal dropout on out-of-phase imaging.
D. Hyperintense to muscle on T1, signal dropout on out-of-phase imaging.
E. Hypointense to muscle on T2, lack of signal drop- out on out-of-phase imaging.

A

A. Isointense to muscle on T1, lack of signal dropout on out-of-phase imaging.

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25
Q 
All of the following can cause red marrow reconversion EXCEPT:
A. Physiologic stress. 
B. Smoking.
C. Aging.
D. Marrow-stimulating medication. 
E. Living at high altitude.
A

C. Aging.

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26
Q

Regarding bone marrow necrosis, which statement is FALSE?
A. Its MRI appearance can simulate extensive avascular necrosis.
B. Bone marrow necrosis is the same pathologic entity as avascular necrosis.
C. Bone marrow necrosis is typically associated with a poor prognosis.
D. Bone marrow necrosis can be seen after chemotherapy.
E. Bone marrow necrosis should initiate search for occult malignancy.

A

B. Bone marrow necrosis is the same pathologic entity as AVN. (FALSE)

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27
Q

In pediatric femora, the conversion of red to yellow marrow has all of the following characteristics EXCEPT:
A. Earliest conversion in the proximal and distal epiphyses.
B. Beginning as early as 6 months of age.
C. Following a predictable sequence.
D. Completion after the age of 10 years.

A

D. Completion after the age of 10 years (FALSE)

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28
Q

Which of the following is TRUE regarding marrow imaging?
A. The adult marrow imaging pattern is typically achieved by the age of 25 years.
B. Red marrow contains no fat or protein content.
C. The presence of red marrow in unexpected areas is always abnormal.
D. Red marrow in the adult knee should be considered malignant until proven otherwise.
E. Red marrow has a relatively short T1 because of its high percentage of fat.

A

A. The adult marrow imaging pattern is typically achieved by the age of 25 years. (TRUE)

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29
Q 
In asymptomatic marathon runners, hemato­poietic hyperplasia in bone marrow is attribut­able to all of the following EXCEPT:
A. Hemolysis.
B. Hematuria.
C. Gastrointestinal bleeding. 
D. Increase in plasma volume. 
E. Stress fracture.
A

E. Stress fracture.

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30
Q 
In the average adult, all portions of the skeleton contain hematopoietic marrow EXCEPT the:
A. Pelvis. 
B. Femora.
C. Ribs. 
D. Hands. 
E. Skull.
A

D. Hands.

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31
Q 
In the current zonal description of prostate anatomy, all of the following are recognized components EXCEPT:
A. Central zone.
B. Anterior fibromuscular stroma. 
C. Transition zone
D. Anterior lobe.
E. Peripheral zone.
A

D. Anterior lobe

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32
Q 
What percentage of adenocarcinomas of the prostate arise in the peripheral zone?
A. 20%. 
B. 30%. 
C. 50%. 
D. 70%.
A

D. 70%

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33
Q 
On MR images of the prostate, all of the following are indicative of prostate cancer extracapsular extension EXCEPT:
A. Irregular prostate capsular bulge. 
B. Neurovascular bundle encasement. 
C. Seminal vesicle invasion.
D. Rectoprostatic angle obliteration. 
E. Ill-defined central gland mass.
A

E. Ill-defined central gland mass

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34
Q 
What percentage of adenocarcinomas of the prostate arise in the transition zone?
A. 10%. 
B. 20%. 
C. 30%. 
D. 50%.
A

B. 20% (70% in PZ, 10% in central zone)

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35
Q 
When using MRI to evaluate for prostate cancer, which of the following best depicts tumor vascularity?
A. Diffusion-weighted imaging.
B. Three-dimensional MR spectroscopy. 
C. Dynamic contrast-enhanced MRI.
D. T2-weighted imaging.
A

C. Dynamic contrast-enhanced MRI.

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36
Q 
Which imaging modality is most effective in detecting prostate cancer?
A. Ultrasound. 
B. MRI.
C. CT.
D. Radiography.
A

B. MRI

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37
Q

Which MR spectroscopy feature is characteristic of prostate cancer?
A. High choline plus creatine (Ch + Cr) to citrate (Ci) ratio.
B. High creatine-to-citrate ratio.
C. High citrate (Ci) to choline plus creatine (Ch + Cr) ratio. D. High polyamine-to-creatine ratio.

A

A. High choline plus creatine (Ch + Cr) to citrate (Ci) ratio

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38
Q 
Which of the following Gleason scores represents the worst prognosis?
A. 3+4=7. 
B. 4+3=7. 
C. 3 + 3 = 6. 
D. 3+2=5.
A

B. 4+3=7

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39
Q 
A 60-year-old man who has undergone prostate biopsy undergoes conventional MRI that shows diffuse low signal on T2-weighted images in the prostate mid gland, peripheral zone bilaterally. All of the following can be concluded about his condition EXCEPT:
A. He has a postbiopsy hemorrhage. 
B. He has a tumor.
C. He has prostate cancer.
D. He has metastases.
A

D. He has metastases

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40
Q 
A 45-year-old man with prostate cancer undergoes prostate preoperative staging. T1- and T2-weighted MR images show low-signal distention of the seminal vesicles. What is most likely the TNM stage of his disease?
A. T1. 
B. T2a. 
C. T2c. 
D. T3b.
A

D. T3b

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41
Q

Immediately after biopsy, while still on the CT table, a patient becomes acutely dyspneic, hypoxic, tachycardic, hypotensive, and uncon- scious. What is the next step in treatment?
A. Send the patient to the emergency department.
B. Intubate the patient.
C. Perform unenhanced CT of the biopsy area.
D. Monitor the patient in the holding area.
E. Begin cardiopulmonary resuscitation.

A

C. Perform unenhanced CT of the biopsy area

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42
Q 
After percutaneous liver biopsy, what is the most common indication for patient admission?
A. Septic shock. 
B. Bile leak.
C. Subcapsular hematoma.
D. Peritonitis.
E. Nonspecific abdominal pain.
A

E. Nonspecific abdominal pain.

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43
Q 
In which of the following situations does CT- guided percutaneous lung biopsy reduce the risk of pneumothorax?
A. A lesion close to the pleura.
B. Bullous emphysema.
C. Coaxial technique.
D. Multiple single passes. 
E. A lesion
A

C. Coaxial technique.

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44
Q

Regarding complications of percutaneous nephrostomy tube placement, which statement is TRUE?
A. The overall major complication rate is about 5%.
B. Hematuria typically requires intervention, often
surgical.
C. Renal vein laceration is the most common cause of
persistent bleeding.
D. The use of smaller-bore needles reduces the complication rate.

A

A. The overal major complication rate is about 5%.

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45
Q 
Which one of the following types of periappendiceal abscesses can be effectively treated with percutaneous drainage without surgery?
A. Small, well-circumscribed. 
B. Small, poorly defined.
C. Large, well-circumscribed. 
D. Large, poorly defined.
A

C. Large, well-circumscribed.

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46
Q 
What is the approximate rate of enteric fistulization from periappendiceal abscesses?
A. 1%. 
B. 10%. 
C. 50%. 
D. 90%.
A

C. 50%

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47
Q

What is the main differentiating feature between a myelocele and a myelomeningocele?
A. Presence or absence of a subcutaneous mass.
B. Exposure of a neural placode through a midline skin defect.
C. Presence or absence of a dilated central canal.
D. Position of the neural placode relative to the skin surface.

A

D. Position of the neural placode relative to the skin surface.

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48
Q

All of the following describe characteristic features of an intradural lipoma EXCEPT:
A. Located along the dorsal midline.
B. Situated within the dural sac.
C. Most commonly in the lumbosacral region.
D. Exclusively involves the filum terminale.

A

D. Exclusively involves the filum terminale.

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49
Q

All of the following describe characteristic features of a dermal sinus EXCEPT:
A. May be associated with a hairy nevus, hyperpigmented patch, or capillary hemangioma.
B. Most frequently occurs in the cervicothoracic region.
C. Often associated with a spinal dermoid or epidermoid.
D. Complications may include abscess formation or meningitis.

A

B. Most frequently occurs in the cerrvicothoracic region. (FALSE, most commonly occurs on the lumbosacral region)

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50
Q

What is the main differentiating feature between type 1 and type 2 diastematomyelia?
A. Presence or absence of scoliotic spine curvature.
B. Presence or absence of tethered-cord syndrome.
C. Individual versus single dural tube.
D. Presence or absence of cutaneous findings.

A

C. Individual vs. single dural tube (In type 1 diastematomyelia, the two hemicords are located within individual dural tubes separated by an osseous or cartilaginous septum. In type 2 diastematomyelia, the two hemicords are located within a single dural tube, sometimes with an intervening fibrous septum.)

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51
Q

The neural plate bends and folds to form the neural tube
during which stage of spinal development:
A. Gastrulation.
B. Primary neurulation.
C. Secondary neurulation.
D. Retrogressive differentiation.

A

B. Primary neurulation.
During primary neurlation, the notochord and overlying ectoderm interact to form the neural plate, which then bends and folds to form the neural tube, which then closes bidirectionally in a zipper-like manner.

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52
Q 
Caudal agenesis may be associated with all of the following EXCEPT:
A. Anal imperforation.
B. Genital anomalies.
C. Renal dysplasia or aplasia.
D. Endocrine dysfunction.
A

D. Endocrine dysfunction

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53
Q

All of the following are features of lipomas with a dural
defect EXCEPT:
A. Caused by a defect in primary neurulation whereby mesenchymal tissue enters the neural tube and forms lipomatous tissue.
B. Presents clinically with a subcutaneous fatty mass above the intergluteal crease.
C. Includes both lipomyeloceles and lipomyelomeningoceles.
D. With a lipomyelocele, the placode-lipoma interface lies outside of the spinal canal due to expansion of the subarachnoid space.

A

D. With a lipomyelocele, the placode–lipoma interface lies outside of the spinal canal due to expansion of the subarachnoid space. (FALSE, the interface lies within the spinal canal)

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54
Q

Which of the following describes a meningocele?
A. Herniation of a CSF-filled sac lined by dura and arachnoid mater.
B. Abnormal connection between the skin surface and bowel.
C. Exposure of neural placode through a midline skin defect on the back with neural placode protruding above the skin surface.
D. Dilated central canal herniating through a posterior spina bifida defect.

A

A. Herniation of a CSF-filled sac lined by dura and arachnoid mater.

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55
Q

All of the following are features of a neurenteric cyst EXCEPT:
A. Neurenteric cysts represent a more localized form of dorsal enteric fistula.
B. Abnormal connection between the skin surface and bowel.
C. Lined with mucin secreting epithelium similar to the GI tract.
D. Typically located in the cervicothoracic spine anterior to the spinal cord.

A

B. Abnormal connection between the skin surface and bowel.

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56
Q

All of the following are features of a filar lipoma EXCEPT:
A. Characterized by hypertrophy and shortening of the filum terminale.
B. Characterized by fibrolipomatous thickening of the filum terminale.
C. Appears as a hyperintense strip of signal on T1-weighted MR images within a thickened filum terminale.
D. Considered a normal variant if there is no clinical evidence of tethered-cord syndrome.

A

A. Characterized by hypertrophy and shortening of the filum terminale. (FALSE)

57
Q

Regarding coronary artery anomalies, which statement is TRUE?
A. Anomalous origin of the right coronary artery from the left sinus of Valsalva is clinically benign.
B. The stress ECG is highly sensitive in detecting coronary artery anomalies.
C. Catheter angiography is the imaging technique of choice for a suspected coronary artery anomaly.
D. Myocardial bridging manifests as fixed narrowing of the affected coronary artery segment.
E. Anomalous origin of the left coronary artery from the right sinus of Valsalva is a high-risk lesion for sudden death.

A

E. Anomalous origin of the LCA from the right sinus of Valsalva is a high-risk lesion for sudden death.

58
Q

Regarding coronary artery aneurysms, which statement is TRUE?
A. Atherosclerosis is the most common cause worldwide.
B. The left main coronary artery is the most common site of occurrence.
C. Eighty percent of patients with Kawasaki disease develop coronary artery aneurysms.
D. Catheter angiography is the gold standard for determining their true size.
E. Myocardial infarction may be caused by secondary
thromboembolism.

A

E. MI may be caused by secondary thromboembolism.

59
Q

After a myocardial infarction, which imaging technique
is most likely to distinguish irreversibly injured myocardium from dysfunctional but viable myocardium?
A. Unenhanced CT for calcium scoring.
B. Enhanced CT with pharmacologic stress.
C. Delayed contrast-enhanced MRI.
D. Echocardiography.
E. Catheter angiography.

A

C. Delayed contrast-enhanced MRI.

60
Q

Regarding the technique of delayed contrast-enhanced
MRI, which of the following statements is TRUE?
A. With delayed enhancement imaging, fibrous tissue actively takes up gadolinium.
B. Delayed enhancement imaging typically uses a T1-weighted spin-echo sequence.
C. With an appropriate inversion time, the signal intensity of normal myocardium should be close to null.
D. A 2D sequence results in more motion artifact than a 3D sequence.
E. IV-injected gadolinium remains in the intravascular space unless there is capillary leakage.

A

C. With an appropriate inversion time, the signal intensity of normal myocardium should be close to null.

61
Q

Regarding CT angiography technique, which of
the following is TRUE?
A. Beta-blockers may improve image quality by decreasing a patient’s heart rate.
B. The right coronary artery is best depicted in images reconstructed in late or end-diastole.
C. In patients with high calcium scores (> 75th percentile), CT angiography is accurate for evaluating coronary artery
stenosis.
D. The effective radiation dose from uncomplicated conventional angiography is greater than CT angiography.
E. CT angiography has a higher spatial and temporal resolution than conventional catheter angiography.

A

A. Beta-blockers may improve image quality by decreasing a patient’s heart rate.

62
Q

When is contrast-enhanced CT angiography of the
coronary arteries NOT indicated?
A. Evaluation of the patency of a coronary artery bypass graft.
B. Noninvasive detection of coronary artery stenosis.
C. Suspected coronary artery anatomic anomalies.
D. Acute myocardial infarction with elevated cardiac enzymes and diagnostic ECG changes.
E. Pulmonary vein imaging in the context of ablation therapy for ectopic electrical activity.

A

D. Acute MI with elevated cardiac enzymes and diagnostic ECG changes. (Coronary artery CT has no role in the management of acute myocardial infarction when the diagnosis can be established by clinical features, elevation of cardiac enzymes, and typical ECG changes)

63
Q

Regarding coronary CT angiography (CTA) as a triage tool for acute chest pain in the emergency department, which statement is TRUE?
A. Single-detector CT is adequate to assess the coronary
arteries in the emergent setting.
B. It is indicated in patients with a high pretest probability of coronary artery disease.
C. Extending the protocol to include the pulmonary arteries and the thoracic aorta is an area of current investigation.
D. Negative findings on coronary CTA require conventional catheter angiography to exclude significant coronary artery disease.
E. Acute chest pain as a presenting symptom is usually caused by a coronary syndrome.

A

C. Extending the protocol to include the pulmonary arteries and the thoracic aorta is an area of current investigation.

64
Q 
Among patients with extravasation of iodinated contrast medium, what percentage is likely to have minimal or no adverse effects?
A. 5% or fewer.
B. 25%.
C. 50%.
D. 75%.
E. 95% or greater.
A

E. 95% or greater

65
Q 
All of the following are known complications of iodinated contrast medium extravasation EXCEPT:
A. Skin ulceration.
B. Soft-tissue necrosis.
C. Compartment syndrome.
D. Nephrogenic sclerosing fibrosis.
A

D. NSF

66
Q

Which of the following has been associated with an increased risk of contrast medium extravasation?
A. Injection rate of less than 2 mL/s.
B. Antecubital fossa injection site.
C. Use of an indwelling IV line.
D. Catheter or needle size larger than 23 gauge.

A

C. Use of an indwelling IV line

67
Q

Which of the following is characteristic of the radiographic appearance of subfascial (intracompartmental) extravasation in the upper extremity?
A. Infiltrating margins.
B. Distribution above and below the elbow.
C. Confinement to a known compartment.
D. Subcutaneous location.

A

C. Confinement to a known compartment

68
Q

Which of the following is characteristic of the radiographic
appearance of subcutaneous (extracompartmental)
extravasation in the upper extremity?
A. Sharp margins.
B. Distribution confined below the elbow.
C. Outlining of compartments by contrast.
D. Confinement to a known compartment.

A

C. Outlining of compartments by contrast

69
Q

Signs or symptoms at the injection site that suggest that
extravasation has occurred include all of the following
EXCEPT:
A. Swelling.
B. Pallor.
C. Burning pain.
D. Tenderness.

A

B. Pallor

70
Q

What is the rationale for using cold compresses or ice
packs after extravasation of contrast medium into an
extremity?
A. Limiting development of inflammation.
B. Increasing blood flow.
C. Reducing capillary hydrostatic pressure.
D. Improving absorption of contrast medium.

A

A. Limiting development of inflammation

71
Q 
What is the volume threshold of contrast extravasation
injury above which moderate or severe injury will usually
occur?
A. 10 mL.
B. 50 mL.
C. 100 mL.
D. 150 mL.
E. No threshold.
A

E. No threshold

72
Q

Once extravasation has occurred, all of the following
patient factors increase the risk of severe extravasation
injury EXCEPT:
A. Hypertension.
B. Arterial insufficiency.
C. Venous insufficiency.
D. Connective tissue disease.

A

A. Hypertension

73
Q 
For skull lesions, MRI is useful for:
A. Detecting infiltration of the diploe
B. Identifying Fibrous Dysplasia
C. Assessing the mineralization of a lesion
D. Identifying Paget Disease
A

A. detecting infiltration of the diploe

74
Q 
The most common cancer causing multiple skull metastases is:
A. Renal Cell Carcinoma
B. Neuroblastoma
C. Lung Cancer
D. Breast Cancer
A

D. Breast Cancer

75
Q

Which of the following statements is true regarding Multiple Myeloma in the skull?
A. Diffuse skull osteopenia is frequently encountered
B. It is the most common primary malignant bone lesion
C. The osseous margins are sclerotic
D. Plasmacytomas are common in the skull

A

B. It is the most common primary malignant bone lesion

76
Q

All of the following are included in the Ewing sarcoma
family of tumors (ESFT) EXCEPT:
A. Askin tumor.
B. Endothelioma of bone.
C. Primitive neuroectodermal tumor (PNET).
D. Lymphoma.

A

D. Lymphoma

-B is incorrect. Ewing sarcoma was initially called “endothelioma of bone” by James Ewing.

77
Q 
All of the following make significant contributions to the
formation of Baker cysts EXCEPT:
A. Increasing age.
B. Total knee replacement.
C. Posterior meniscal tear.
D. Presence of tumor.
A

D. Presence of tumor

78
Q

In a Brodie abscess, there is a layer of hyperintense T1
signal peripheral to the abscess cavity. What is the term
used to describe that layer?
A. Sequestrum.
B. Penumbra sign.
C. Target appearance.
D. Halo sign.

A

B. Penumbra sign.

79
Q

Which of the following changes to the first dorsal
compartment of the wrist best describes de Quervain
tenosynovitis?
A. Chronic degeneration of tendon sheaths.
B. Acute inflammation of extensor tendons.
C. Enlargement of extensor pollicis longus and abductor pollicis brevis tendons.
D. Atrophy of tendons.

A

A. Chronic degeneration of tendon sheaths.
de Quervain tenosynovitis is chronic degeneration of tendon sheaths in the first dorsal compartment of the wrist. Acute inflammation is not a common feature seen on pathologic examination.

80
Q

The type of Kaposi sarcoma that appears in American
men with AIDS is classified as what pattern of occurrence?
A. Endemic.
B. Classic.
C. Epidemic.
D. Iatrogenic.

A

C. Epidemic

81
Q 
MR and CT images of Maffucci syndrome may show
all of the following findings EXCEPT:
A. Multiple enchondromas.
B. Soft-tissue hemangiomas.
C. Lymphangiomas.
D. Chondrosarcomas.
E. Myxomas.
A

E. Myxomas (associated with Mazabraud syndrome: multiple fiborus dysplasia and myxomas)

82
Q

Which of the following is a low-grade fibromyxoid
tumor characterized by multiple recurrences and distal
metastases?
A. Evans tumor.
B. Codman tumor.
C. Morel-Lavallée lesion.
D. Kaposi sarcoma.

A

A. Evans tumor is a low-grade fibromyxoid tumor characterized by multiple recurrences and distal metastases.
*Codman tumor refers to chondroblastoma,
a benign cartilaginous bone tumor.

83
Q

Which disorder of the interdigital nerve is called a
Morton neuroma?
A. A painful nerve sheath tumor.
B. Chronic hematoma.
C. Perineural fibrosis and degeneration of the nerve.
D. Fatty hypertrophy.

A

C. Perineural fibrosis and degeneration of the nerve.

84
Q

What imaging finding is diagnostic of Ollier disease?
A. Sarcomatous transformation of enchondroma.
B. Multiple enchondromas.
C. Multiple enchondromas and hemangiomas.
D. Multiple enchondromas and chondrosarcomas.

A

B. Multiple enchondromas

85
Q

All of the following signs are associated with Paget
disease EXCEPT:
A. Blade-of-grass appearance in long bones.
B. Hole-within-hole appearance in long bones.
C. Cotton-wool appearance in the skull.
D. Osteoporosis circumscripta in the skull.
E. Ivory vertebra.

A

B. Hole-wthin-hole appearance in long bones (associated with eosinophilic granuloma; refers to coalesced lytic lesions on radiographs)

86
Q

Concerning a unicornuate uterus, which of the following is correct?
A. It is the most common of the müllerian duct anomalies.
B. The minority of cases of unicornuate uterus have a rudi-
mentary horn.
C. It is associated with poor pregnancy outcomes.
D. Unicornuate uterus with a rudimentary horn does not require surgical correction.
E. Itisleastcommonlyassociatedwithrenalanomalies.

A

C. It is associated with poor pregnancy outcomes.

87
Q

Concerning uterus didelphys, which of the following is correct?
A. It is the most common congenital uterine anomaly.
B. It can be confused with a unicornuate uterus on
hysterosalpingograms.
C. The minority of cases have an associated longitudinal
vaginal septum.
D. It is caused by complete failure of resorption of the
uterovaginal septum.
E. Symptoms are common in non-obstructive forms of uterus didelphys.

A

B. It can be confused with a unicornuate uterus on hysterosalpingograms.
(These longitudinal vaginal septae may be further complicated by a transverse septum obstructing one hemivagina.)

88
Q

Concerning a bicornuate uterus, which of the following is correct?
A. It is more common than a septate uterus.
B. It can reliably be differentiated from a septate uterus on routine hysterosalpingography.
C. It is differentiated from a septate uterus on MRI by identifying myometrium between the two uterine horns.
D. It is often complicated by cervical insufficiency.
E. It is caused by failure of resorption of the uterovaginal septum during fetal development.

A

D. It is often complicated by cervical insufficiency.

89
Q

Concerning a septate uterus, which of the following is correct?
A. Diagnosis is excluded on MRI by any concavity in the external uterine fundal contour.
B. It is the least common of the congenital uterine anomalies.
C. It is associated with the worst obstetric outcomes of the müllerian duct anomalies.
D. Surgical correction requires a transabdominal metroplasty.
E. Resection of the septum does not improve reproductive outcome.

A

C. It is associated with the worst obstetric outcomes of the mullerian duct anomalies

90
Q 
ACR guidelines divide an MR site into four conceptual zones with progressive restriction of access. Which is the highest zone into which ferromagnetic objects and equipment may be safely taken?
A. Zone I. 
B. Zone II. 
C. Zone III. 
D. Zone IV.
A

B. Zone II

91
Q

Which of the following is considered a safe practice for the operation of a free-standing MR center?
A. Low-field scanners can be operated by personnel who are not radiologic technologists.
B. The scanner room (Zone IV) should be marked with a red light and a lighted sign stating, “The Magnet is On.”
C. A conventional metal detector at the entrance to Zone II or Zone III is adequate for screening patients for ferromag- netic objects and implanted devices.
D. In the event of a cardiac arrest in a superconducting magnet, the magnet should be quenched before cardiopulmonary resuscitation is initiated.

A

B. The scanner room (Zone IV) should be marked with a red light and a slighted sign stating, “The Magnet is On.”

92
Q

If MR safety data are not prospectively available for a given metallic device and negligible attractive forces are observed with a handheld magnet (1,000 gauss), which label should be attached to the device?
A. Round green “MR safe” label.
B. Square green “MR conditional” label.
C. Square red “not MR safe” label.
D. Triangular yellow “MR conditional” label.

A

D. Triangular yellow “MR conditional” label.

93
Q

With regard to the Lenz’s forces on a metallic nonferrous infusion pump, what is considered best practice?
A. Cancel the study immediately, before the patient enters Zone III.
B. If the presence of the infusion pump is determined only after the patient is in Zone IV, remove the patient as quickly as possible.
C. Slowly move the patient into and out of the magnet bore and proceed with the examination.
D. The device poses a projectile hazard and the patient should be barred from Zones III and IV.

A

C. Slowly move the patient into and out of the magnet bore and proceed with the examination.

94
Q 
If, through a failure of the cryogen vent or quench pipe, cryogenic liquids are released into the magnet room (Zone IV), which of the following potential safety concerns is LEAST likely to occur?
A. Asphyxiation.
B. Fire hazard.
C. Frostbite.
D. Positive pressure entrapment.
A

D. Positive pressure entrapment.

95
Q

Concerning pregnancy and MR scanning, which statement is TRUE?
A. Pregnant MR technologists are not permitted to work in the MR environment during the first trimester of their pregnancy.
B. Pregnant patients should not undergo MR scanning at any stage of their pregnancy.
C. Pregnant patients may routinely be administered gadolinium-based MR contrast agents.
D. The risk to the fetus posed by gadolinium-based MR contrast agents is unknown.

A

D. The risk to the fetus posed by gadolinium-based MR contrast agents is unknown.

96
Q

Concerning the possibility of tissue heating and thermal injury during MR scanning, all of the following statements are true EXCEPT:
A. Cold compresses or ice packs should be placed on extensive or dark tattoos during scanning.
B. The tips of implanted neurologic stimulators may heat up and injure tissue during scanning.
C. A monitoring lead or wire that is safe during scanning at 1.5 T should be safe at other field strengths.
D. Tissue heating may result during scanning when body tissues are in direct contact with the inner bore of certain MR scanners.

A

C. A monitoring lead or wire that is are during scanning at 1.5 T should be safe at other field strengths.

97
Q

Patients with poor renal function may develop nephrogenic systemic fibrosis (NSF) after the administration of gadolinium contrast agents. All of the following are thought to possibly reduce the risk of NSF in patients with severely impaired renal function undergoing contrast-enhanced MRI EXCEPT:
A. Administering the lowest dose of gadodiamide that would provide the diagnostic benefit being sought.
B. Premedicating the patient with corticosteroids and diphenhydramine hydrochloride
C. Timing the administration of gadodiamide to immediately precede hemodialysis.
D. Refraining from administering any gadolinium contrast agent.

A

B. Premeditating the patient with corticosteroids and diphenhydramine hydrochloride

98
Q

Concerning MRI of patients with intracranial aneurysm clips, which of the following statements is TRUE?
A. MRI is safe for these patients so long as the body part being scanned is not the head.
B. Some nonferromagnetic aneurysm clips are not detectable on routine radiographs of the skull.
C. Aneurysm clips that are composed of titanium or a titanium alloy are always safe in the MR scanner.
D. Insufficient data regarding an individual patient’s aneurysm clip is an absolute contraindication for MRI.

A

C. Aneurysm clips that are composed of titanium or a titanium alloy are always safe in the MR scanner

99
Q

Concerning MRI of cardiac pacemakers and implantable cardioverter defibrillators (ICDs), which of the following statements is TRUE?
A. Some ICDs have been labeled by the FDA as safe for low-field MRI but not for high-field MRI.
B. No deaths have been reported as a result of scanning patients with ICDs, only as a result of scanning patients with pacemakers.
C. The presence of a pacemaker or an ICD is an absolute contraindication to MRI.
D. Life-threatening arrhythmias and serious device malfunction may occur.

A

D. Life-threatening arrhythmias and serious device malfunction may occur.

100
Q 
Necrotizing fasciitis can be defined as an infection of any 
of the following types of tissue EXCEPT:
A. Dermis.
B. Deep fascia.
C. Muscle.
D. Cartilage.
A

D. Cartilage

101
Q 
Which of the following organisms is most commonly 
involved in necrotizing fasciitis?
A. Staphylococcus
B. Streptococcus
C. Escherichia coli
D. Clostridium
A

B. Streptococcus

102
Q

All of the following are clinical features of necrotizing
fasciitis EXCEPT:
A. It can affect any part of the body.
B. Pain is disproportionate to local findings.
C. Crepitus is always palpable.
D. Systemic shock can occur at a late stage

A

C. Crepitus is always palpable.

103
Q 
Which of the following clinical findings is a late finding of 
necrotizing fasciitis?
A.  Cellulitis.
B.  Tachycardia.
C.  Skin anesthesia.
D.  Skin discoloration
A

D. Skin discoloration

104
Q 
What is the most common radiographic finding of 
necrotizing fasciitis?
A.  Normal.
B.  Soft-tissue swelling.
C.  Ulcer in the soft tissue.
D.  Gas in the soft tissue.
A

B. Soft-tissue swelling

105
Q

When necrotizing fasciitis is suspected, which of the
following CT findings is important in making a definitive
diagnosis?
A. Gas tracking with fluid collection along fascial planes.
B. Asymmetric fascial thickening with fat stranding.
C. Thickening and enhancement of the superficial or deep fascial layers.
D. Reactive lymphadenopathy

A

A. Gas tracking with fluid collection along fascial planes.

106
Q

Using ultrasound to diagnose necrotizing fasciitis, all of
the following statements are true EXCEPT:
A. Ultrasound is not useful in the pediatric age group.
B. Sonographic findings include turbid fluid collection in the fascial layers.
C. The examination may be limited by soft-tissue gas.
D. Ultrasound may be used to guide fluid aspiration

A

A. Ultrasound is not useful in the paediatric age group. (Ultrasound has been most useful in the pediatric age
group.)

107
Q

When using MRI to diagnose necrotizing fasciitis, which
of the following will support the diagnosis?
A. Subcutaneous edema.
B. Fluid in the deep fascia.
C. Enhancement of muscle.
D. Intramuscular abscess.

A

B. Fluid in the deep fascia.

108
Q

When suspicion is high for necrotizing fasciitis, the
following actions should be performed EXCEPT:
A. Immediate resuscitation.
B. Administration of empiric broad-spectrum antibiotics.
C. Surgical fasciotomy and débridement.
D. CT and MRI assessment

A

D. CT and MRI assessment.

109
Q 
Which of the following factors is associated with a poor 
outcome?
A.  Diverticulitis.
B.  Furuncles.
C.  Insect bites.
D.  Diabetes.
A

D. Diabetes.

110
Q 
What is the acceptable range of likelihood of malignancy for BI-RADS category 3 lesions on screening breast ultrasound?
A. > 0 but ≤ 2%
B. > 3 but ≤ 10%
C. > 10 but ≤ 20%
D. > 20 but ≤ 30%
A

A. 0-2%

111
Q

What is the imaging feature on follow up ultrasound of a BI-RADS category 3 lesion that would prompt an ultrasound-guided biopsy (upgrade to BI-RADS category 4)?
A. Interval resolution
B. Interval increase in echogenicity
C. Interval increase in volume of ≥ 20%
D. Interval increase in through transmission

A

C. Interval increase in volume >20% (conversely, if there is an interval decrease in volume by 20% then patient can return to routine screening [downgrade to BIRADS 2])

112
Q 
What is the reported additional cancer yield per 1000 women, with the use of supplemental ultrasound screening?
A. 3-6/1000
B. 7-10/1000
C. 11-14/1000
D. 15-18/1000
A

A. 2-6/1000

113
Q 
In a 42 year-old woman with mammographically dense breast, supplemental screening ultrasound identified multiple bilateral (two in each breast) similar appearing oval masses with circumscribed margins. What would be an appropriate follow up interval to minimize the false positive rate without impacting the cancer detection rate?
A. Diagnostic ultrasound in 6 months
B. Diagnostic ultrasound in 1 year
C. Screening ultrasound in 1 year
D. Screening ultrasound in 2 years
A

B. Diagnostic US in 1 year
Multiple bilateral similar appearing circumscribed masses on screening mammography have been shown to have a significantly low likelihood of malignancy (0.14%). This has justified the BI-RADS assessment category 2 (Benign) and follow up recommendation of routine screening. Yet, the current data on screening ultrasound is not sufficient to justify a BI-RADS assessment category 2 on the initial ultrasound screening round. In a prospective multicenter trial, multiple bilateral similar appearing circumscribed masses on supplemental screening ultrasound had no recorded malignancy (0%) as such, the authors proposed 1-year follow up ultrasound (BI-RADS assessment category 3) and if all the masses are stable then that patient may return to routine screening (downgrade to BI-RADS 2).

114
Q

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis, which is characterized by:
Select one:
A. HIStOR, which summarizes the five cardinal features of AIP through histology, imaging, steroid therapy response, other organ involvement, and refractory course
B. Lack of focal mass lesions and ductal dilitation, unlike pancreatic ductal adenocarcinoma (PDAC)
C. Abundant lymphoplasmacytic infiltration, interstitial fibrosis, obliterative venulitis, and elevated serum levels of IgG4
D. Disseminated benign satellite lesions, especially in the liver that may mimic metastases

A

C. Abundant lymphoplasmacytic infiltration, interstitial fibrosis, obliterative venulitis, and elevated serum levels of IgG4

115
Q

The characteristic imaging findings of AIP are most commonly described as diffuse sausage-like enlargement of the pancreas with a capsule-like rim and irregular narrowing of the main pancreatic duct (MPD). In addition, AIP appearing as a mass-like focal lesion is:
Select one:
A. Not rare, accounting for 33% to 41% of cases of AIP
B. Often found in combination with pancreatic ductal adenocarcinoma (PDAC)
C. Very common and seen in almost all cases (>86%)
D. Not usually present (

A

A. Not rare, accounting for 33% to 41% of cases of AIP

116
Q

Which of the following clinical situations would require a contrast enhanced CT in a pregnant patient?
Select one:
A. Diagnosing the etiology of abdominal pain
B. Assessment of acute trauma
C. Tumor staging
D. Assessing for post-operative complications

A

B. Assessment of acute trauma

117
Q 
In which timeframe do majority of delayed reactions to IV contrast occur?
A. Between 10-30 min
B. Between 30 min – 1 hr
C. Between 30 min and 7 days
D. Between 3 hours and 2 days
A

D. Between 3 hours and 2 days

nearly all life-threatening reactions to contrast material occur within the first 20 min after injection

118
Q

What positional treatment is the most appropriate when treating an acute anaphylactoid reaction in a pregnant patient?
A. Right lateral decubitus
B. Left lateral decubitus position
C. Supine with a rightward tilt using a wedge
D. Supine with manual right uterine displacement

A

B. Left lateral decubitus position

119
Q 
The systolic blood pressure cut-off that initiates treatment for maternal hypotension is:
A. 80 mm Hg
B. 90 mm Hg
C. 100 mm Hg
D. 110 mm Hg
A

C. 100 mm Hg

120
Q

The classic MRI appearance of an endometrioma manifested as “shading” is seen on which of the following imaging sequences?
A. A T1-weighted sequence with fat suppression.
B. An out-of-phase T1-weighted sequence.
C. A T2-weighted sequence.
D. A contrast-enhanced T1-weighted sequence.

A

C. A T2-weighted sequence.

121
Q 
Which of the following is the current imaging investigation of choice for achieving the radiologic diagnosis of endometriosis?
A. Hysterosalpingography. 
B. MRI.
C. CT.
D. Transvaginal sonography.
A

B. MRI

122
Q 
Which one of the following bowel segments is most frequently affected by endometriosis?
A. Rectosigmoid. 
B. Terminal ileum. 
C. Cecum.
D. Appendix.
A

A. Rectosigmoid

123
Q 
Which of the following is the most common site of malignant transformation of endometriosis?
A. Ovary.
B. Cul-de-sac. 
C. Rectum.
D. Vagina.
A

A. Ovary. Malignant transformation is rare (

124
Q

All of the following are imaging features seen more typically with bowel involvement of endometriosis than with primary bowel pathologies EXCEPT:
A. Barium enema that reveals extrinsic mass effect on the sigmoid colon.
B. T2-weighted MR images that show hypointense nodules adhering to the bowel wall.
C. Transvaginal ultrasound that shows irregular hypoechoic masses in the uterosacral ligament, penetrating the bowel wall.
D. CT that shows a circumferential mass involving the bowel wall and mucosa causing obstruction.

A

D. CT that shows a circumferential mass involving the bowel wall and mucosa causing obstruction.

125
Q 
Which of the following components of the urinary bladder wall is most commonly involved in bladder endometriosis?
A. Mucosa.
B. Submucosa. 
C. Muscularis. 
D. Serosa.
A

D. Serosa

126
Q 
All of the following are hallmarks of endometriosis EXCEPT:
A. Endometriomas.
B. Peritoneal implants. 
C. Ascites.
D. Adhesions.
A

C. Ascites

127
Q

All of the following are characteristic sonographic findings of endometriomas EXCEPT:
A. Low-level homogeneous echoes.
B. Echogenic wall foci.
C. Both uni- and multilocular appearance.
D. Large, solid, vascular components.

A

D. Large, solid, vascular components.

128
Q 
In the setting of a double-contrast barium enema, all of the following can be mistaken for endometriosis EXCEPT:
A. Metastatic carcinoma.
B. Pelvic abscess.
C. Pelvic inflammatory disease. 
D. Diverticulosis.
A

D. Diverticulosis.

129
Q

Which of the following imaging findings should raise concern for malignant transformation of endometriosis on contrast-enhanced T1-weighted imaging?
A. Lack of peripheral rim enhancement.
B. Enhancing mural nodule.
C. Decrease in size of the endometrioma.
D. Loss of shading within the lesion.

A

B. Enhancing mural nodule.

130
Q 
A 75-year-old man has been taking 20 mg of rivaroxaban daily since a hip replacement 8 weeks ago. He needs to undergo a percutaneous biopsy of a liver mass. Before the procedure, this medication should be held for:
A. 12 hours
B. 24 hours
C. 48 hours
D. 96 hours
A

C. 48 hours.

131
Q

A 79-year-old woman on warfarin therapy for atrial fibrillation with an international normalized ratio of 3.2 needs to undergo emergent placement of a percutaneous nephrostomy tube. The most appropriate next step in management is:
A. Reversal with vitamin K, fresh frozen plasma, and four-factor prothrombin complex concentrate
B. Hold warfarin for 5 days before the procedure
C. Reversal with protamine
D. Reversal with desmopressin acetate

A

A. Reversal with vitamin K, FFP, and four-factor prothrombin complex concentrate (PCC)

132
Q 
Subcutaneous enoxaparin was held before a patient underwent biopsy of a retroperitoneal lymph node. The procedure was uncomplicated. After the procedure, the patient can resume taking the enoxaparin in:
A. 1 hour
B. 6 hours
C. 24 hours
D. 48 hours
A

B. 6 hours.
Low-molecular-weight heparins (LMWHs) enoxaparin (Lovenox, Sanofi), dalteparin (Fragmin, Eisai), and tinzaparin (Innohep, Leo Pharma) are derived from unfractionated heparin and are administered either IV or subcutaneously. The use of these medications is primarily in the subcutaneous administration for treatment of and prophylaxis against venous thromboembolism. The duration is approximately 12 hours for enoxaparin and more than 12 hours and more than 24 hours for dalteparin and tinzaparin, respectively. The last dose of all formulations of LMWHs should be held for 12 hours before moderate-risk procedures and for 24 hours before high-risk procedures. All LMWHs can resume within 6 hours after all procedures.

133
Q 
Clopidogrel is:
A. A direct thrombin inhibitor
B. A cyclooxygenase (COX) inhibitor
C. A direct factor Xa inhibitor
D. An adenosine diphosphate (ADP) receptor antagonist
A

D. An adenosine diphosphonate (ADP) receptor antagonist.
Clopidogrel (Plavix, Bristol-Myers Squibb), prasugrel (Effient, Daiichi Sankyo and Eli Lilly and Company), and ticagrelor (Brilinta, AstraZeneca) are all oral antiplatelet agents that inhibit binding of adenosine diphosphate (ADP) to the platelet P2Y12 receptor. These agents are used for a variety of antithrombotic indications.

134
Q 
A 40-year-old man on argatroban needs to undergo an urgent diagnostic paracentesis. The appropriate interval between the last dose of argatroban and the paracentesis is:
A. None
B. 8 hours
C. 12 hours
D. 24 hours
A

A. None.
Argatroban is administered IV and is used in the setting of heparin-induced thrombocytopenia. All three drugs have an immediate onset of action, and their half-lives range between 25 and 120 minutes. There is no reversal agent for these medications. These drugs are not held before low-risk procedures (e.g., paracentesis) but are held 4 hours before moderate- and high-risk procedures. These medications can be resumed within 1 hour after all procedures.

135
Q

Which liver lesion is most likely to appear as hyperdense or perhaps even calcified on unenhanced CT?
A. Hepatocellular carcinoma.
B. Intrahepatic cholangiocarcinoma.
C. Metastasis from mucinous gastrointestinal primary tumor.
D. Hemangioma.

A

C. Metastasis from mucinous GI primary tumor

136
Q 
Which of the following is a risk factor for the development of hepatocellular carcinoma?
A. Hepatitis A.
B. Alcoholic hepatitis.
C. Hormone replacement therapy. 
D. Low α-fetoprotein level.
A

B. Alcoholic hepatitis.

137
Q

Which CT feature is characteristic of hepatocellular carcinoma?
A. Delayed peripheral enhancement.
B. Central scar, sometimes with calcification.
C. Fibrosis with capsular retraction.
D. Hypodensity on unenhanced CT.

A

D. Hypodensity on unenhanced CT.

138
Q 
Which benign lesion has an appearance on CT that is the most similar to that of hepatocellular carcinoma?
A. Hepatic adenoma.
B. Focal nodular hyperplasia. 
C. Regenerative nodule.
D. Hemangioma.
A

A. Hepatic adenoma.

139
Q

What are the typical MRI signal characteristics of hepatocellular carcinoma?
A. High T2 signal and variable (high or low) T1 signal.
B. Low T2 signal and low T1 signal.
C. Variable (high or low) T2 signal and high T1 signal.
D. Variable (high or low) T2 signal and variable (high or
low) T1 signal.

A

A. High T2 signal and variable (high or low) T1 signal.

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