Brockenbrough-Braunwald sign

Brockenbrough-Braunwald sign

Q1.Brockenbrough-Braunwald sign noted during cardiac catheterization is seen in

a.aortic  stenosis

b.hypertrophic obstructive cardiomyopathy

c.mitral stenosis

d.pericarditis

ANS.-----b====Brockenbrough-Braunwald sign noted during cardiac catheterization is seen in hypertrophic obstructive cardiomyopathy

• Upon cardiac catheterization, catheters can be placed in the left ventricle and the ascending aorta, to measure the pressure difference between these structures.
•  In normal individuals, during ventricular systole, the pressure in the ascending aorta and the left ventricle will equalize, and the aortic valve is open. 
• In individuals with aortic stenosis or with HCM with an outflow tract gradient, there will be a pressure gradient (difference) between the left ventricle and the aorta, with the left ventricular pressure higher than the aortic pressure. This gradient represents the degree of obstruction that has to be overcome in order to eject blood from the left ventricle.
• The Brockenbrough–Braunwald–Morrow sign is observed in individuals with HCM with outflow tract gradient. This sign can be used to differentiate HCM from aortic stenosis.
•  In individuals with aortic stenosis, after a premature ventricular contraction (PVC), the following ventricular contraction will be more forceful, and the pressure generated in the left ventricle will be higher. Because of the fixed obstruction that the stenotic aortic valve represents, the post-PVC ascending aortic pressure will increase as well. 
• In individuals with HCM, however, the degree of obstruction will increase more than the force of contraction will increase in the post-PVC beat. The result of this is that the left ventricular pressure increases and the ascending aortic pressuredecreases, with an increase in the LVOT gradient.
• While the Brockenbrough–Braunwald–Morrow sign is most dramatically demonstrated using simultaneous intra-cardiac and intra-aortic catheters, it can be seen on routine physical examination as a decrease in the pulse pressure in the post-PVC beat in individuals with HCM.

Ollier’s disease

Ollier’s disease/Maffuci’syndrome/Beckwith- Widerman’s syndrome /Klippel-trenaunay-Weber  syndrome

Q1.Enchondrma and heamangioma is found in

a.Ollier’s disease

b.Maffuci’syndrome

c.Beckwith- Widerman’s syndrome

d.Klippel-trenaunay –Weber  syndrome

ANS. b===MAFFUSI SYNDROME------ Maffucci syndrome is a congenital non hereditary mesodermal dysplasia  characterised by multiple enchondromas with soft  tissue cavernous haemangiomas. 

www.msdlatinamerica.com

• Ollier disease ( enchondromatosis) is a non-hereditary, sporadic, skeletal disorder characterised by multiple enchondromas that are principally located in the metaphyseal regions.

• Beckwith–Wiedemann syndrome  is an overgrowth disorder usually (but not always) present at birth characterized by an increased risk of childhood cancer and certain congenital features.
•  Five common features used to define the syndrome are: macroglossia, macrosomia (birth weight and length greater than the 90th percentile), midline abdominal wall defects (omphalocele/exomphalos, umbilical hernia, diastasis recti), ear creases or ear pits, and neonatalhypoglycemia (low blood sugar after birth).

• Klippel–Trénaunay–Weber syndrome is a rare congenital medical condition in which blood vessels and/or lymph vessels fail to form properly. 
• The three main features are nevus flammeus (port-wine   stain), venous and lymphatic malformations, and soft-tissue hypertrophy of the affected limb.

FRCR MCQ ---MRI (Inversion recovery)

MRI (Inversion recovery)

Q1. The MRI technique used to null signal from fluids is
a.FLAIR
b.STIR
c.GRE
d.HASTE

Q2.The MRI technique used to null signal from fat is
a.FLAIR
b.STIR
c.GRE
d.RARE

ANS.Q1===a----The MRI technique used to null signal from fluids                              is FLAIR(fluid attenuated inversion recovery )
        Q2===b---- The MRI technique used to null signal from fat is                               STIR(short-tau inversion recovery)

Inversion recovery

• In this sequence type, the magnetization is ‘prepared’ before the initial 90-degree excitation pulse by the addition of an 180-degree ‘inversion’ pulse. 
• The signal obtained will be influenced by the relative degree of recovery experienced by the spins along the z-axis. 
• The inversion time (TI) is the time allotted for this recovery process to evolve between the 180-degree inversion and 90-degree excitation pulses. The inversion pulse introduces heavy T1 weighting into this sequence.

Specific forms of the technique -



www.mriworld.org

• A== fluid attenuated inversion recovery (FLAIR) where the TI is chosen so that the magnetization from fluids is nulled (≈2200 ms) in the detection (x–y) plane and TE is long (80–100 ms), introducing a lot of T2 as well as T1 weighting. Thecombination  of fluid nulling with T2 weighting is particularly useful in assessing lesions with prolonged T2 adjacent to fluid structures (e.g. periventricular demyelination).

•  B====In short-tau inversion recovery (STIR), T1 is kept short, and is typically used to null signal from fat. An example of its use in this context is in the delineation of breast lesions and orbital pathology. 

RADIOLOGY MCQ----Drooping lily sign

Drooping lily sign

Q1.Drooping lily sign on IVU is seen in
a.Duplex kidney
b.Hydatid cyst of kidney
c.APKD
d.Multicystic kidney

ANS --1===Drooping lily sign on IVU is seen in Duplex kidney

• Drooping lily sign is  a urographic sign  of duplicated  renal collecting system. 
• It refers to the inferolateral displacement of the opacified lower pole moiety due to an obstructed (and relatively unopacified) upper pole moiety. The similarity to a lily is further strengthened by the small number of calyces the lower pole moiety has 
• In duplicated collecting system it is classically the upper pole ureter that is obstructed due to a ureterocoele and
•  the lower pole ureter that refluxes: as described by the Weigert-Meyer law. 

radiopaedia.org




emedicine.medscape.com

RADIOLOGY MCQ---Lemon sign and Banana sign

Lemon sign and Banana sign

Q1.Banana sign refers to 
a.flattening of cerebellar hemisphere
b.scalloping of frontal bones
c.flattening of cerebrum
d.none

Q2.Lemon sign and banana sign are found in 
a.open spina bifida
b.Arnold-Chiari malformation
c.both
d.none

ANS.1===a==Banana sign refers to flattening of cerebellar                                    hemisphere
         2===c==Lemon sign and banana sign are found in .open                                 spina bifida and Arnold-Chiari malformation


The banana sign refers to the shape of the cerebellum

 owing to caudal displacement; the lemon sign refers to the

 lemon-shaped head resulting from scalloping of the frontal

 bones.

RADIOLOGY MCQ---Prune- belly syndrome

Prune- belly syndrome

Q1.Prune- belly syndrome is characterized by all except
a.bilateral hydronephrosis and hydroureter
b.distended bladder
c.undescended testes
d.normal anterior abdominal wall

ANS--d===normal anterior abdominal wall

• ThePrune- belly syndrome   (PBS) is generally readily apparent clinically and consists of absent abdominal wall muscles, undescended testes, and renal dysplasia associated with gross dilatation of the collecting systems.
• All affected children have a universal mesentery with a mobile bowel.
• Plain abdominal radiographs show a protuberant abdomen resulting from the lack of abdominal musculature. In the most severely affected patients, there may be urethral obstruction with severe renal dysplasia, while less severely affected individuals demonstrate an array of urinary tract abnormalities.
• The characteristic features are small kidneys with abnormal minimally dilated calyces and upper ureters, while the lower ureters are tortuous and show disproportionate dilatation.
•  The bladder is thin walled, of large capacity without trabeculation, and has a wide neck.
•  A patent urachus or a urachal diverticulum may be present.
• The posterior urethra is dilated proximally with a typical conical narrowing and a poor stream in the distal urethra .
•  Occasionally, generalized or focal anterior urethral dilatation is present. Prognosis depends on the degree of renal dysplasia.

php.med.unsw.edu.au

www.pedsradiology.com


REF

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

RADIOLOCY MCQ--Sunburst sign / T sign / Lambda sign

Sunburst sign / T sign / Lambda sign

Q1.T- sign at two amnion junctions suggests of

a.dichorionic-diamniotic  twin

b.monochorionic-diamniotic  twin

c.monochorionic-monomniotic  twin

d.all

Q2.Lambda/Twin peak sign in USG of pregnancy is noted in

a.dichorionic-diamniotic  twin

b.monochorionic-diamniotic  twin

c.monochorionic-monomniotic  twin

d.all

Q3.Radial arrangement of medial sulci above the third ventricle(sunburst sign) on usg of cranium is seen in

a.corpus callosum agenesis

b.spinan bifida

c.Arnold-chiari malformation

d.Dandy-Walker malformation

ANS   Q1===b ------.monochorionic-diamniotic  twin

           Q2===a--------dichorionic-diamniotic  twin

           Q3===a-----corpus callosum agenesis

www.fetalultrasound.com

sites.google.com -

RADILOGY MCQ--Acromegalyand Hyperthyroidism

RADIOLOGICAL FEATURES OF ACROMEGALY,CUSHING SYNDROME,HYPERTHYROIDISM AND HYPOTHYROIDISM

Q1.Tufting of the terminal phalanges (arrow head appearance)  and increased heel pad thicknes is seen in

a.alkaptonuria

b.hyperthyroisism

c.acromegaly

d.cushing syndrome

Q2.Small or absent frontal sinuses are noted in all except

a.congenital absence

b.hyperthyroidism

c.Down’s syndrome

d.kartagener’s syndrome

ANS---1==c ===acromegaly

             2==b===hyperthyroidism

  RADIOLOGICAL FEATURES OF ACROMEGALY

pictures.doccheck.com

Skull	Vault thickened
	Paranasal and mastoid air cells enlarged
	Pituitary fossa enlarged
	Floor of the fossa asymmetrical or ballooned
Mandible	Prognathism with increased angle
Spine	Kyphosis
	Enlarged vertebral bodies
	Posterior scalloping of vertebral bodies
Chest	Increased antero-posterior diameter
	Ribs increased in calibre and length
Hands	General enlargement
	Enlarged bases of phalanges and terminal tufts, spade-like
	Enlarged muscle attachments
Feet	Thickening of ‘heel pad': M > 23 mm, F > 21.5 mm
Long bones	Thickened by periosteal new bone formation
Joints	Widening of joint spaces due to thickened cartilage
	Premature degeneration (OA) changes (shoulders, hips, knees)
	Chondrocalcinosis
Soft tissues	Enlarged heart, kidneys, liver
	Calcification of pinna of ears

 RADIOLOGICAL FEATURES OF CUSHING'S SYNDROME

Skull	Pituitary fossa usually normal
Skeleton	Osteoporosis
	Vertebral collapse
	Kyphosis
	Concave vertebral margins
	Wedged vertebral bodies
	Rib fractures—multiple, painless with excess callus
	Necrosis of femoral heads
	Secondary osteoarthritis

RADIOLOGICAL FEATURES OF HYPOPITUITARISM

Skull	Unfused sutures
Skeleton	Small but normal proportions (Lorain dwarf)
	Slender bones
	Small pituitary fossa
	Unfused epiphyses

RADIOLOGICAL FEATURES OF HYPERTHYROIDISM (THYROTOXICOSIS)

Skull	Exophthalmos
Skeleton	Osteopenia
	Cortical striation—acropachy
	In childhood, early appearance and accelerated growth of ossification centres
Heart	Cardiac enlargement
	Cardiac failure
Thymus	Enlargement

RADIOLOGICAL FEATURES OF HYPOTHYROIDISM (CRETINISM AND JUVENILE MYXOEDEMA)

Skull	Delayed closure of fontanelles
	Relatively large sella
	Poorly developed paranasal sinus
	Usually brachycephalic
	Dentition delayed: dental caries
	Wormian bones
Skeleton	Dwarfism
	Increased density
Ossification centres	Retarded growth
	Multicentric and irregular
	Bilateral and symmetrical
Epiphyses	Delayed fusion and appearance
	Inhomogeneous epiphyses
	Fine or coarse stippling
	Fragmentation
Spine	Kyphosis
	Flattening of bodies
	Increase in width of intervertebral space
	Bullet-shaped vertebral bodies, usually L1 and L2
Long bones	Short
	Dense transverse bands at metaphyseal ends M >23mm, F > 21.5mm
Pelvis	Narrow with coxa vara

 RADIOLOGICAL FEATURES OF MYXOEDEMA

Heart	Enlargement
	Pericardial effusion
	Heart failure
Body cavities	Pleural effusion
	Ascites
Gastrointestinal tract	Abnormalities of oesophageal peristalsis
	Decreased incidence of peristalsis
	Constipation
	‘Pseudo-obstruction’

REF:

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

RADILOGY MCQ--The 'wire spring' appearanc and Accordion sign

The 'wire spring' appearanc AND Accordion sign 

Q1.Pseudodiverticula,the ‘wire spring/hidebound ‘appearance on barium study of small intestine is noted in
a.progressive systemic sclerosis
b.nodular lymphoid hyperplasia
c.Whipple’s disease
d.intestinal lymphangiectasia

Q2.Accordion sign on CT scan of intestine is noted in
a.progressive systemic sclerosis
b.nodular lymphoid hyperplasia
c.Whipple’s disease
d.pseudomembranous colitis


ANS-1--a===.progressive systemic sclerosis
          2--d===pseudomembranous colitis

Progressive systemic sclerosis 

• In progressive systemic sclerosis barium examination shows dilatation of the duodenum and jejunum, diminished peristalsis, decreased motility and delayed transit. Sacculations, also known as pseudodiverticula, are seen frequently as large, broad-based outpouchings with a somewhat squared contour.
•  A characteristic sign of progressive systemic sclerosis is an increased number of mucosal folds – the ‘wire spring or ‘hidebound’ appearance 

Pseudomembranous colitis










eurorad.org

• Pseudomembranous colitis results from the effects of cytoplasmic endotoxins produced by overgrowth of Clostridium difficile, usually as a result of broad-spectrum antibiotic therapy.
• Plain radiographs may show a generalized ileus and nodular haustral thickening. 
• CT may show gross wall thickening, with marked mucosal enhancement and extensive low attenuation from submucosal oedema. This produces a very prominent target sign, often described as the accordion sign .
• The accordion sign  is typical of pseudomembranous colitis, but may be seen in acquired immune-deficiency syndrome (AIDS)-related or ischaemic colitis and in severe oedema from cirrhosis.

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