Radiology mcq -- neuro module

Q1.  A 50 yr old patient with AIDs presents with an insidious onset of dementia . Visual loss, weakness, ataxia, and speech disturbances are also noted  .The patients died within six months . Brain biopsy shows confluent areas of demyelination,distributed throughout the cerebral white matter .Microscopically, there are multiple foci of demyelination. There are atypical oligodendrocytes containing large, swollen nuclei with basophilic / eosinophilic inclusion bodies and  reactive astrocytes .What is the most likely diagnosis

a.PML        

b.lymphoma

c.toxoplasmosis

d.HIV-1 encephalopathy

e.CMV

Q2.All features are suggestive of PML except

a. more frequent involvement of parietal white matter

b.usually absent enhancement  on MR

c. posterior fossa involment

d. absent  optic nerve involvement

e. spinal cord involvement common

ANS--

Q1---a

Q2---e

                       

Spinal cord involvement is extremely rare in PML. Mass effect is more common with lymphoma and toxoplasmosis but can occasionally be present in PML. Encephalitides, including  cytomegalovirus, toxoplasmosis, or HIV-1 encephalopathy may mimic PML in case of AIDS patients.

"IGNITED MIND" --NO MORE

"IGNITED MIND" --NO MORE 
"WINGS OF FIRE" --
NOW ON VOYAGE OF UNIVERSE -----
MISSILE WILL HIT WHICH HIM?
NONE-----
BUT HIS PASSION,HIS GUIDANCE --
WILL HIT EVERYONE
YES --EVERYONE.

NO TIME IS THE BEST TIME

NO TIME IS THE BEST TIME

You have three time dimension---past ,present and future .Which one is the best time to live-in?
Live-in the time which gives you pleasure ----be past or present or future .Only thing to remember is to remain in the time dimension which gives you pleasure,---which makes you happy----which gives you energy---which empowers you.
If present is troubling--switch to future (imagine of beautiful ,energizing future ) or past (recall pleasurable moments) to achieve state of happiness.
If thinking of past is imparting a sense of uneasiness---move to present or future to achieve a state of joy.
If thinking of future appears gloomy , come to present or roam about in the past to bring yourself in the state of pleasure.
So,no time is the best time ----rather best time is one which empowers you---which makes you happy

What is état-criblé

40.All are true regarding Virchow-Robin spaces except

a.refers to  dilated perivascular spaces

b.prominent Virchow-Robin spaces is referred as   état-criblé 

c.Virchow-Robin spaces tend to be smaller (2 × 2 mm or less by 

MR)

d. the signal intensity virtually always differ somewhat from that of

 CSF

e. classically situated at the anterior commissure or radiating out 

from the ventricles

40.---d

Signal intensity of lacunes virtually always differ somewhat from that of CSF

Radiology mcq--multiple sclerosis

Q.Features of plaques that strongly suggest the diagnosis of multiple sclerosis are all except

a. a multiple in number

b.different stages

c. variable size and shape

d. markedly symmetric involvement

e. subpial cortical plaques

ANS.----d

In general, a combination of multiple plaques in different stages, plaques of variable size and shape, markedly asymmetric involvement, and subpial cortical plaques strongly suggest the diagnosis of multiple sclerosis

RADIOLOGY MCQ ----MR SEQUENCE FOR MYELINATION

Q. The most useful MR sequence for evaluating the progression of myelination during the first 6 months of life is

a.T1W
b.T2W
c.FLAIR
d.SW images
e.MR tractography

Ans.---a



During the first 6 months of life, T1-weighted images are most useful for evaluating the progression of myelination. Inversion recovery images also provide improved T1-weighted contrast differences between tissues. After 6 months of age, most cerebral white matter appears high in signal intensity on the T1-weighted images, and beyond this time the T2-weighted images are generally relied on to further evaluate myelin progression. By 24 months of age, the process of myelination is essentially complete except for the terminal zones of myelination found in the occipital-parietal periventricular white matter

MYELINATION

Progression of Myelination

Proximal pathways before distal (e.g., brainstem before supratentorial brain) Sensory (visual and auditory) before motor Central white matter before peripheral Posterior before anterior Myelinated Regions at Birth (or Shortly After Birth) Dorsal brainstem Inferior, superior cerebellar peduncles Perirolandic region Corticospinal tract Central portion of centrum semiovale Posterior limb of internal capsule to cerebral peduncle Ventrolateral thalamus Optic nerve, chiasm, tract

FRCR ---ANATOMY

NAME THE STRUCTURE INDICATED BY ARROW ?





ANS--

VERTEBRAL ARTERY 

IMAGE BASED QUESTION----NEURO MODULE

A case of head injury,what is H and C?

H--- large subacute posterior fossa venous epidural hematoma (EDH)  

The EDH displaces the venous confluence (curved arrows), transverse sinus, and dura mater away from the occipital bone. The EDH is noted to extend across the midline, posterior to the venous confluence, a point  differentiating it from a subdural hematoma.

C---- an extensive cerebellar contusion .

MCQ FRCR -- DISC HERNIATION

16.All are features of herniated disc except

a. focal contour abnormality along the posterior disc margin

b. may displace the epidural fat, nerve root, epidural veins, or thecal sac

d. On GRE images, it is easy to visualize the herniated disc in the epidural space

e. Herniated discs typically have very low signal intensity on sagittal and axial T2-weighted FSE images

e. Nerve root and thecal sac compression are well shown on T1-weighted SE images, particularly in the axial plane

16.---d

On GRE  images, it is difficult to visualize the herniated disc in the epidural space because the signal intensity of fat and disc material is similar. However, annular tears may be better seen with FSE or GRE sequences . GRE images show bone abnormalities better than do conventional 

FRCR MCQ---CERVICAL SPINE

4. The Gold standard for evaluation of the cervical neural foramen is

a. CT using 1 mm or less section and 3D reformatting

b.CT using 2 mm or less section and 3D reformatting

c. 2D FT FSE MR

d. 3D FT FSE MR

e. 3D FT GRE MR

4.—a

Computed tomography (CT) using thin sections (1 mm or less) and 3D reformatting remains the gold standard for evaluation of the cervical neural foramen, 3D FT GRE MR of the cervical neural foramen has become an acceptable alternative.

MCQ FRCR --SPINE

9.All are true regarding intervertebral disc except

a. annular rim and the ossification centers in the vertebrae of newborn  have low signal intensity on T1- and T2-weighted images

b. nucleus and annulus are sharply demarcated in the newborn.

c. during the first two decades of life, the disc develops the fibrous structure that characterizes the adult disc

d. The vertebral body and the ring apophysis at time of  transitional disc is not  ossified completely

e. small concentric and transverse tears are degenerative changes

9.---e

With aging, small concentric and transverse tears develop in the annulus . The former is characterized as delamination of the lamellae in the annulus fibrosus with the development of a mucoid substance or fluid in the space. These tears may be visualized on MR as a narrow band of higher-intensity signal, indicating the location of the mucoid substance or fluid. The latter are short disruptions in the annulus near the insertion of Sharpey fibers.

MR SEQUENCE FOR DEGENERATIVE SPINE DISORDERS

Q.- In the lumbar spine, the SE and FSE imaging sequences are optimal for evaluating degenerative spine disorders.Why?

The major reason for the success of SE imaging in the lumbar spine is that epidural and foraminal fat is abundant and stands out as high intensity on T1-weighted SE images compared with the relatively lower intensity of the adjacent thecal sac, herniated disc, or other tissue.

On most T2-weighted GRE and FSE images, the intensity of the epidural fat is similar to or less than that of CSF and does not always provide adequate contrast between the other tissues in the spinal canal. This is especially true in the lumbar neural foramen, where lateral herniated may be very difficult to visualize on T2-weighted FSE images and the same disc fragment is obvious on the T1-weighted SE image.

Q.Why is GRE sequence preferred in imaging of cervical spine?

The epidural space in the cervical and thoracic spine has little epidural fat. In the cervical spine, contrast is provided by the signal intensity differences related to the presence of prominent epidural veins and from CSF in the thecal sac. Therefore, GRE imaging is an important tool in the cervical spine for defining epidural disease.

In the cervical and thoracic spine, disc spaces are thinner and the neural foramina are smaller, so thinner slice thicknesses are necessary. Cervical spine imaging requires the use of contiguous slices, a factor that  favors GRE sequences, because contiguously acquired conventional SE

scans may be degraded by cross-excitation artifacts (“cross-talk”) or necessitate very long scan times.

What is the stage of DAI injury?

What is the stage of DAI injury?

ANS----

It is stage 3 diffuse axonal injury (DAI) .Sagittal T1-weighted magnetic resonance (A) demonstrates hemorrhagic contusions along the vertex. Axial T2-weighted, fast spin echo (B–D) images and fluid-attenuated inversion recovery (FLAIR) (E–G) images demonstrate focal lesions in the right lateral aspect of the brainstem and splenium of the corpus callosum and a hemorrhagic lesion in the body of the corpus callosum from severe DAI. Smaller DAI lesions are present in the supratentorial white matter as well.  FLAIR shows these lesions with apparently greater conspicuity. Primary brainstem DAI is invariably accompanied by similar lesions in the corpus callosum and deep lobar white matter (stage 3 DAI).

In patients with mild head trauma, DAI lesions may be confined to the white matter of the frontal and temporal lobes (stage 1) . Patients with more-severe rotational acceleration may develop lesions in the lobar white matter and the posterior half of the corpus callosum (stage 2).If the trauma is of even greater severity, DAI lesions is also  found in the dorsolateral aspect of the midbrain and upper pons (stage 3).

FRCR ANATOMY

What is  the location of lesion indicated by curved arrow and arrowhead ?

HAPPY NATIONAL DOCTORS DAY

HAPPY NATIONAL DOCTORS DAY 
NATIONAL DOCTORS DAY is . celebrated on July 1 all across India to honour the legendary physician and the second Chief Minister of West Bengal, Dr Bidhan Chandra Roy. He was born on July 1, 1882 and died on the same date in 1962, aged 80 years. Dr Roy was honoured with the country's highest civilian award, Bharat Ratna on February 4, 1961.

FRCR MCQ ---DIFFUSE AXONAL INJURY

Q.All are true regarding diffuse axonal injury except
a. severe loss of consciousness  at the moment of impact
b. stage 3 DAI involves the dorsolateral aspect of the midbrain and upper pons
c. Most callosal lesions  occur anteriorly  
d. Stage 1 DAI typically involves the parasagittal regions of the frontal lobes

e. The corpus callosum is the second-most-common area involved with DAI 


ANS ---b
The corpus callosum is the second-most-common area involved with DAI (21% of DAI lesions) . DAI of the corpus callosum invariably occurs in conjunction with DAI of the lobar white matter (stage 2 DAI). Most callosal lesions (72%) occur in the posterior body and splenium.