RADIOLOGY MCQ--Yo-Yo reflux and Weigert-Meyer law

Yo-Yo reflux  and Weigert-Meyer law

Q1.Yo-Yo reflux is noted in

a.incomplete duplication of pelvis

b.hydronephrosis

c.ectopic insertion of ureter

d.crossed fused ectopia

Q2.Weigert-Meyer law is related to 

a.incomplete duplication of pelvis
b.duplex collecting system with incomplete duplication of ureter
c.duplex collecting system with complete duplication of ureter
d.complete duplication of ureter only

ANS.1==a==incomplete duplication of pelvis
        2==c==duplex collecting system with complete     duplication of ureter

www.urology-textbook.com 

•  Duplication of the upper collecting system is one of the most common of  renal anomalies
• Complete duplication is associated with ectopic ureter, ureterocele or vesicoureteral reflux. 
•  The incomplete duplication of the upper collecting system rarely causes urinary symptoms and usually does not carry clinically importance 
•  Reflux of the urine from one limb of the collecting system to the other limb, rather than down towards the bladder  is called yo-yo reflux (saddle reflux) 
•  Cause : Disorders in ureteric peristalsis at the site of ureteric fusion may cause yo-yo reflux.
•  Another explanation of yo-yo reflux is the pressure gradient between two ureteric  segments. The pressure of the lower moiety is generally  higher than the upper moiety and therefore the urine  generally refluxes from the lower moiety to the upper moiety 

Weigert-Meyer law

• Weigert-Meyer law applies to duplex collecting systems, when complete, duplicated ureters insert separately into the bladder.
•  The Weigert-Meyer rule states that. the upper pole ureter is the ectopic ureter and its orifice inserts inferomedially in the bladder in relationship to the lower pole normal ureter 
• When duplicated ureters insert separately into the bladder, the laterocranial ostium corresponds to the caudal renal pelvis and the medio caudal ostium the cranial renal pelvis.

RADILOGY MCQ---view of chest x ray

MCQs on view of chest x ray 

Q1.The chest view which is often useful to determine whether pleural abnormalties represent freely flowing fluids
a.The PA view
b. The lateral view
c.Lateral decubitus view
d.Apical lordotic view


Q2. For  visualization of diseases of lung apices,which view of chest is preferred
a. PA View
b.Lateral view
c.Lateral decubitus view
d.Apical lordotic view



ANS---1===C==LATERAL DECUBITUS POSITION
             2===D==APICAL LORDOTIC VIEW

PA vs AP

This is the simulated patient in PA (posterioranterior) position.
Note that the x-ray tube is 72 inches away.

Left, in the supine AP (anteriorposterior) position the x-ray tube is 40 inches from the patient. 

This is a PA film on the left compared with a AP supine film on the right.
The AP shows magnification of the heart and widening of the mediastinum.  Whenever possible the patient should be imaged in an upright PA position.  AP views are less useful and should be reserved for very ill patients who cannot stand erect.

PA VIEW  ---

• X ray pass from posterior to the anterior of the paients .
• Edges of scapula are retacted laterally with only small portion projected over the lung field.
• It assess the cardiac size more acurately

AP VIEW ---

• X ray pass from  anterior to posterior of  the patients.
• Scapula is not retarcted laterally and remain projected over the lung field.
• Here cardiac size is exaggerated.

Lateral decubitus position

The patient can also be examined in a lateral decubitus position. This could be heThe patient can also be examined in a lateral decubitus position. This could be helpful to assess the volume of pleural effusion and demonstrate whether a pleural effusion is mobile or loculated.s air trapping.

REF 

RADIOLOGY MCQ --DEMENTIA

DEMENTIA

Q1.All are neuroimaging feature suggestive of dementia exept
a.Alzheimer’s disease---hippocampal atrophy and posterior dominant cortical atrophy
b.Fronto-temporal lobe degenaration(FTD)—frontal,insular and or temporal atrophy,spares posterior parietal lobule
c.Dementia with Lewy body(DLB)—posteror parietal atrophy,hippocampi larger than AD,greater involvemet of amygdale than hippocampi
d.Cruetzfeld -Jacob diseases(CJD)—cortical ribboning , basal ganglia or thalamus hypointensity on diffusion or FLAIR MRI

ANS---d===Cruetzfeld -Jacob diseases(CJD)—cortical ribboning,  basal ganglia or thalamus hyperintensity on diffusion or FLAIR MRI

Alzheimer’s disease

www.proprofs.com

•  the most common cause of primary degenerative dementia,
•  incidence increases with age, rising sharply over 70 years.
• It is a generalized disorder, although in its early stages it may affect the medial part of the temporal lobe, especially the hippocampus, more than elsewhere.

Structural imaging

• This is usually normal, although occasionally accentuated atrophy medially in the temporal lobe is indicated by widening of the perihippocampal CSF spaces, which should be both bilateral and symmetrical

Functional imaging

• In established disease, characteristic symmetrical posterior temporal and parietal perfusion defects on regional cerebral blood flow (rCBF) SPECT have a predictive value for the diagnosis of AD of over 80% and the severity of rCBF reduction correlates with the degree of cognitive decline
•  [¹⁸F]deoxy-d-glucose (FDG)-positron emission tomography (PET) studies show reduced glucose uptake that is not explained by atrophy
•  Receptor imaging using radioligands for central benzodiazepine receptors has shown a similar distribution of deficits in AD

Frontotemporal dementia

• These comprise less than 10% of the primary degenerative dementias. They include Pick's disease.
• MRI and even CT show atrophy in the anterior and medial parts of the temporal lobe, which usually is markedly asymmetric (right or left)  and diminishes posteriorly. Asymmetric frontal lobe atrophy may also be present

Functional imaging Perfusion deficits on rCBF SPECT are predominantly frontal and anterior temporal with preserved perfusion posteriorly.

• Reduced frontal perfusion is not specific to frontotemporal dementia and can occur in a variety of other conditions, such as schizophrenia, depression, human immunodeficiency virus (HIV) encephalopathy, Creutzfeldt–Jacob disease (CJD) and in some cases of AD

Lewy body dementia

• Lewy body dementia is now recognized as the second most common degenerative dementia after AD and it accounts for approximately 20% of all dementia.
• 
  
•  Neither structural imaging nor rCBF SPECT can reliably distinguish between Lewy body dementia and AD on subjective assessment, as posterior temporoparietal defects occur in both. However, reduced frontal perfusion with HMPOA SPECT and reduced uptake in the cerebellum and visual cortex with FDG-PET is seen in Lewy body dementia compared with AD.

Vascular dementia

• This is the clinical diagnosis in about 20% of all dementias. Evidence of ischaemic damage on CT or MRI is mandatory for diagnosis,

Prion diseases

• These mainly comprise CJD (sporadic, iatrogenic, familial) and very recently in Europe (especially in the UK) new variant CJD (nvCJD). Rapidly progressive dementia, often with myoclonus, is the usual clinical picture, often preceded by behavioural disturbances, especially in nvCJD.
• Structural imaging usually appears normal in early stages, but rapidly progressive atrophy soon develops.
•  Symmetrical increases in signal in the putamen and caudate nuclei may be shown by MRI in about 10% of sporadic CJD, and in the posterior part of the thalami in over 50% of nvCJD;

REF

Adam: Grainger & Allison's Diagnostic Radiology, 5th ed.

EXPERIENCE

 EXPERIENCE

DEAR FRIENDS ,

      HOW ARE YOU?

 MANY OF YOU WOULD  BE APPEARING FOR ONLINE ONGOING PG EXAM .MANY HAS ALREADY CROSSED THE  TEST OF EXAM.I AM SURE OF MIXED FEELING YOU MIGHT BE GOING THROUGH BECAUSE I TOO WAS ALSO PART OF THIS ORDEAL SOMETIME BACK.

MY DEAR FRIENDS, PLEASE SHARE YOUR EXPERIENCE ON THIS BLOG. YOUR SHARING OF EXPERIENCE WOULD BE OF GREAT HELP .

PL POST RADIOLOGY QUESTIONS ALSO  ----THAT WILL BENEFIT ALL OF US.

WISHING U BEST OF LUCK FOR PG EXAM.


YOUR'S FRIEND

NAGENDRA

RADIOLOGY MCQ --BOLD, SYLVIAN DOT SIGN AND DELTA SIGN

?ARE YOU BOLD WITH SYLVIAN DOT SIGN AND  DELTA SIGN 

Q1.BOLD(blood oxygen dependent level) effect is used in

a.MR perfusion imaging

b.MR spectroscopy

c.PET

d.functional MRI

Q2.Sylvian dot sign on CT  is noted in

a.cerebral ischemia

b.intracranial haemorrhage

c.cerebral vein thrombosis

d.oligodendroglioma

Q3.Delta sign is noted in

a.cerebral arterial ischemia

b.cerebral venous thrombosis

c.meningioma

d.optic glioma

ANS:1---d===functional MRI

         2---a===cerebral ischemia

         3---b===cerebral venous thrombosis

                               BOLD EFFECT 

• Functional MRI techniques is used to study cortical activation. 
• The most commonly applied technique is measurement of a tiny increase in signal intensity on T2^*-weighted acquisitions in the relevant cortex during neuronal activation. 
• This occurs as a result of the magnetic susceptibility effects of oxyhaemoglobin. 
• Oxyhaemoglobin is diamagnetic while deoxyhaemoglobin is paramagnetic. 
• During cortical activation there is an increase in rCBF and thus an increase in oxygen delivery to the activated brain, which exceeds the local oxygen metabolic requirement. There is, therefore, a net increase in oxyhaemoglobin concentration in the venules and veins in the vicinity of the activated brain, which results in a tiny increase in MR signal, the so called blood oxygenation level dependent or BOLD effect.
• The magnitude of this MR signal change is field dependent, being greater at higher field strengths. 
• Although fMRI is being increasingly used for brain mapping, the technique has limited clinical applications and is used primarily for the identification of eloquent cortex, particularly the motor strip, prior to surgery in patients with structural lesions and arteriovenous malformations

SYLVIAN DOT SIGN 

• A dense artery is the earliest detectable change on CT in cerebral ischemia 
• Dense artery is caused by fresh thrombus occluding the vessel. 
• Thrombus in MCA artery in sylvian fissure is known as sylvian dot sign.

DELTA SIGN 

• Causes of cerebral venous thrombosis include trauma, infection (particularly subdural empyema) and hypercoagulability disorders including those due to oral contraceptives.
• Venous infarcts do not conform to arterial territories and are often haemorrhagic and multifocal. 
• The superior sagittal sinus is most commonly involved, which can lead to bilateral parasagittal infarcts. 
•  On unenhanced CT acute thrombosis will cause a venous sinus to appear expanded and hyperdense. IV contrast medium causes more intense enhancement of the walls of the sinuses than of their contents, the so-called DELTA sign’ 

REF:

Adam: Grainger & Allison's Diagnostic Radiology, 5th ed.

RADIOLOGY MCQ--.HONDA SIGN AND LIGHT BULB SIGN

.HONDA  SIGN AND LIGHT BULB SIGN 

Q1.Honda sign on scintigraphy of pelvis is noted in

a.ilaic fracture

b.pubic bone ftracture

c.sacral insufficiency fracture

d.ischial spine fracture

Q2.Light bulb sign on x ray of shoulder  is seen in

a.anterior dislocation  of shoulder joint 

b.posterior dislocation of shoulder joint

c.fracture of neck of humerous

d.fracture of shaft of humerous

ANS.    1-----c===sacral insufficiency

             2----b===posterior dislocation of shoulder

  HONDA SIGN   

• In the elderly, insufficiency fractures of the pelvis are common in the sacral alae. 
• They are difficult to identify on radiographs because of complex anatomy and overlying bowel, but are easily recognized on skeletal scintigraphy or MRI  as an area of increased activity in the shape of a capital letter ‘H’ (this is referred to as the HONDA sign’)

www.learningradiology.com

LIGHT BULB SIGN

• Posterior shoulder dislocations account for about 5% of shoulder dislocations.
• Approximately half of these are related to seizures or electrocutions; simultaneous and bilateral injuries may occur in this circumstance. 
• A direct blow to the anterior humeral head can also cause a posterior shoulder dislocation.
•  Diagnosis of a posterior shoulder dislocation on the routine anteroposterior shoulder radiograph is often difficult. 
• Typically, the humerus is in fixed internal rotation, causing the head and neck of the humerus to appear like an electric light bulb—the ‘light bulb sign'

www.learningradiology.com 

REF;

Adam: Grainger & Allison's Diagnostic Radiology, 5th ed.

RADIOLOGY ---FAST

Time for Focused assessment with sonography for trauma (FAST)

The primary objective of FAST is to identify hempoperitoneum in patients with suspected intraabdominal injury.

Indications:

• Blunt abdimonal trauma(BAT)
• Stable penetrating trauma
• Assessment of the degree of intraperitoneal free fluid
• Views;

Focused assessment with sonography for trauma (FAST) should include views of
(1) the hepatorenal recess (Morison pouch), 
(2) the perisplenic view, 
(3) the subxiphoid pericardial window, and 
(4) the suprapubic window (Douglas pouch). 

• In extended FAST (E-FAST) examination , views of (1) the bilateral hemithoraces and (2) the upper anterior chest wall is also  obtained.

The benefits of the FAST examination include :

• Decreases the time to diagnosis for acute abdominal injury in BAT
• Helps accurately diagnose hemoperitoneum
• Helps assess the degree of hemoperitoneum in BAT
• Is noninvasive
• Can be integrated into the primary or secondary survey and can be performed quickly, without removing patients from the clinical arena
• Can be repeated for serial examinations
• Is safe in pregnant patients and children

TOTAL TIME TAKEN FOR FAST IS 4 T0 8 MINUTES 

REF:

Focused Abdominal Sonography in Trauma (FAST)
Col R Chaudhry, VSM*
, Lt Col A Galagali+
, Maj RV Narayanan#
MJAFI 2007; 63 : 62-63

RADIOLOGY MCQ--RADIONUCLIDES

MCQs on radionuclide 

AND 

RADIONUCLIDES ------HALF-LIFE ,MAIN EMMISSIONS   AND ITS USES 

(VERY IMPORATANT FOR EXAM) )

Q1.The ideal agent of choice for ventilation imaging

a._81mKr

b. _99mTc DTPA

c.₁₃₃ Xe

d._99mTc- technegas

Q2.Radionuclide used for ventilation imaging are all except

a. _99mTc DTPA

b.₁₃₃ Xe

c._99mTc- technegas

d._99mTc MAG3

Q3.Which is used for perfusion scintigraphy

a._99mTc  labelled protein microparticles

b._81mKr

c.₁₃₃ Xe

d._99mTc DMSA

ANS  1---a===_81mKr

          2,---d===_99mTc MAG3

          3----a===_99mTc  labelled protein microparticles

 PHYSICAL PROPERTIES OF SOME COMMONLY USED RADIONUCLIDES

			Main emissions (keV)
Radionuclide	Half-life	Main use	Gamma or X	Beta (Emax)
Carbon-11 11C	20 min	p	511	960
Carbon-14 14C	5730 years	n	–	157
Chromium-51 51Cr	27.7 d	n	320	–
Cobalt-57 57Co	270 d	n	122	–
Cobalt-58 58Co	71 d	n	811	475
Fluorine-18 18F	109 min	p	511	634
Gallium-67 67Ga	78 h	g	93, 185, 300	–
Indium-111 111In	67 h	g	171, 245	–
Iodine-123 123I	13.2 h	g	159	–
Iodine-125 125I	60 d	n	27, 31	–
Iodine-131 131I	8 d	t (g)	365	606
Krypton-81m 81mKr	13.5 s	g	191	–
Nitrogen-13 13N	10 min	p	511	1199
Oxygen-15 15O	2 min	p	511	1732
Selenium-75 75Se	120 d	g	136, 265, 401	–
Strontium-89 89Sr	50.7 d	t	–	1492
Technetium-99m 99mTc	6 h	g	140	–
Thallium-201 201Tl	3 d	g	71	–
Xenon-133 133Xe	5.2 d	g	31, 81	346
Yttrium-90 90Y	2.7 d	t	–	2284

Main use: g = gamma camera, n = nonimaging diagnosis, p = PET, t = therapy. Beta (Emax): maximum energy of continuous spectrum; mean energy = approximately one-third of Emax. Main source of decay data1.

Technetium compounds useful for imaging

1.methylene diphosphonate (MDP) for bone imaging

2.hexamethyl  propylene amine oxime (HPMAO) for cerebral imaging

3.dimercaptosuccinic acid (DMSA) and dimercaptoacetyltriglycine (MAG3) for renal studies

4.iminodiacetic acid (HIDA) for biliary studies

5.human serum albumin(HSA) colloidal particles ,0.5micro in size ,which are phagocytosed in  reticuloendothelial studies---imaging of liver,spleen,and bone marrow

6.HSA macroaggregates --15 to 100 micospheres that temporarily block a small fraction of the capillaries in lung perfusion

7.diethylene triamine pentacetic acid (DTPA) aerosol (5 microparticles) in ling ventilation studies

8.autologous red cells ,for cardiac function

9.heat damaged autologous red cells for imaging spleen

10.sestamibi or tetrafosmin for cardiac perfusion studies

 RADIOPHARMACEUTICALS COMMONLY USED FOR A RANGE OF CLINICAL PROBLEMS

Clinical problem		Imaging technique	Radiopharmaceutical	Biological behaviour
Head
Cerebrovascular accident		Cerebral perfusion SPECT	99mTc HMPAO	Uptake proportional to blood flow
Hydrocephalus
CSF rhinorrhoea		Cerebrospinal fluid (CSF) study	111In DTPA (intrathecal)	Marker of CSF flow.
Encephalitis		Blood–brain barrier (BBB) study	99mTc HMPAO	Passage across disrupted BBB
Dementia		Cerebral perfusion SPECT	99mTc HMPAO	Uptake proportional to blood flow
		Cerebral metabolism PET	18F fluorodeoxyglucose	Marker of glucose metabolism
Epilepsy (presurgical localization)		Ictal SPECT	99mTc HMPAO	Uptake proportional to blood flow
		Interictal PET	18F fluorodeoxyglucose	Marker of glucose metabolism
Neck
Thyrotoxicosis			123I sodium iodide	Active uptake (123I and 99mTc) followed by organification (123I)
Thyroid nodule		Thyroid scintigraphy	99m Tc pertechnetate
Ectopic thyroid
Hyperparathyroidism (presurgical localization)		Parathyroid scintigraphy	99mTc MIBI	Differential expression of p-glycoprotein between parathyroid adenoma and thyroid
Dry mouth (connective tissue disease)		Salivary gland study	99mTc pertechnetate	Secretion in saliva
Musculoskeletal system
Tumour
Fracture
Avascular necrosis		Bone scintigraphy	99mTc polyphosphate compounds	Osteoblastic response (+ vascularity on early phases)
Arthropathy
Metabolic bone disease
Painful prosthesis
Osteomyelitis			99mTc polyphosphate	Osteoblastic activity
		Bone scintigraphy + white cell or gallium scintigraphy	99mTc- or 111In-leucocytes	Leucocyte migration
			67Ga gallium citrate	Binds to transferrin and leaks into extravascular space
Lymphoedema		Lymphoscintigraphy	99mTc nanocolloid	Lymphatic uptake and trapping
Cardiovascular system
Chest pain		Myocardial perfusion scan	201Tl (thallous chloride)	K+ analogue indicating perfusion (ischaemic heart disease) (delayed uptake reflects viability)
			99mTc isonitriles	Cationic complexes taken up by myocytes in proportion to blood flow
			99mTc teboroxime	Lipophilic compound which accumulates by diffusion
			99mTc phosphines	Uptake proportional to blood flow
Cardiac failure		Cardiac ventriculography (gated study)	99mTc red blood cells	Blood pool label
		Myocardial viability study	18F fluorodeoxyglucose	Demonstrates shift from metabolism of fatty acids to glucose
Pulmonary embolism		Ventilation/perfusion (V/Q) scan	123I fatty acids
			Perfusion: 99mTc albumin	Pulmonary arteriole blockade
			Macroaggregates
			Ventilation: 99mTc aerosols	Distributes in lungs in proportion to gas regional ventilation
			133Xe gas, 81mKr gas
Congenital heart disease		Quantitative shunt study	99mTc red blood cells	Blood pool label
Pulmonary system
Solitary pulmonary nodule		Tumour imaging	18F fluorodeoxyglucose	Marker of glucose metabolism
Occult lung disease (alveolitis)		Alveolar permeability study	99mTc DPTA aerosol	Passage across alveolar membrane into blood
Gastrointestinal system
Difficulty in swallowing		Oesophageal transit and reflux	99mTc sulphur colloid	Transit of labelled material
Gastrointestinal haemorrhage		GI bleed study	99mTc sulphur colloid	Blood pool label extravasating into bowel
			99mTc labelled red cells
Ectopic gastric mucosa		Meckel's diverticulum scintigraphy	99mTc pertechnetate	Active uptake by ectopic gastric mucosa
Diarrhoea (inflammatory bowel disease)		White cell scintigraphy	99mTc leucocytes	Leucocyte migration
Vomiting (gastroparesis)			99mTc sulphur colloid in egg (solid phase)
		Gastric emptying study		Compartmental localization of labelled material
Dumping			111In DTPA in orange juice (liquid phase)
Focal liver lesion (haemangioma)		Red blood cell study	99mTc labelled red blood cells	Red cell pooling
Cholecystitis
Biliary dyskinesia
		Hepatobiliary study	99mTc iminodiacetic acid derivatives	Uptake by hepatocytes and excretion into bile
Biliary atresia
Bile leak (post-op)
Abdominal sepsis			99mTc or 111In leucocytes	Leucocyte migration
		White cell or gallium scintigraphy
Pyrexia of unknown origin			67Ga gallium citrate	Binds to transferrin and leaks into extravascular space
Ectopic splenic tissue		Splenic scintigraphy	Heat damaged 99mTc labelled red blood cells	Splenic trapping of damaged cells
Urological, adrenal and genitourinary systems
Hypertension (renovascular disease)		Captopril renography	99mTc MAG3	Captopril-induced change in renal transit time and/or function
Renal tract obstruction		Diuresis renography	99mTc DTPA	Glomerular filtration
			99mTc MAG3	Proximal tubular secretion
Renal scarring		Static renal scintigraphy	99mTc DMSA	Glomerular filtration and proximal tubular uptake
Vesicoureteric reflux		Indirect micturating cystogram	99mTc MAG3	Compartmental localization
Adrenal medullary tumour		Adrenal study	123I MIBG	Uptake by noradrenaline transporter
Adrenal cortical tumour		Adrenal study	123I iodocholesterol	Incorporation into hormone metabolism
Cancer
Space occupying lesion in brain (SOL)		Tumour imaging	201Tl (thallous chloride)	K+ analogue indicating perfusion
			18F fluorodeoxyglucose	Marker of glucose metabolism
Thyroid cancer		Whole body iodine scintigram	131I sodium iodide	Uptake by Na/I transporter
Skeletal metastases		Bone scintigraphy	99mTc polyphosphate	Osteoblastic response
Soft tissue mass (sarcoma)		Tumour imaging	201Tl (thallous chloride)	K+ analogue indicating perfusion
			18F fluorodeoxyglucose	Marker of glucose metabolism
Tumour staging
Tumour recurrence		Tumour imaging	18F fluorodeoxyglucose	Tumour glucose metabolism
Tumour response assessment
Insulinoma		Somatostatin receptor study	111In pentetreotide (Octreotide®)	Binds to somatostatin receptors
Carcinoid tumour
Neuroblastoma		MIBG scintigram	123I MIBG	Uptake by noradrenaline transporter
Tumour hypoxia		Hypoxia imaging	18F fluoromisonidazole	Trapped in hypoxic cells
Sentinel node detection		Lymphoscintigraphy	99mTc nanocolloid	Lymphatic uptake and trapping

REF;

1.Adam: Grainger & Allison's Diagnostic Radiology, 5th ed.

2.Farr's physics for medical imaging ,second edition