ACR ITE 2002 Questions

True or False

Regarding fractures of the hand and wrist,


11. the fifth metacarpal is a common site for a Boxer's fracture.

12. Gamekeeper's thumb is rarely associated with a fracture.

13. fractures of the triquetrum are best seen in the posteroanterior projection.

14. delayed diagnosis of scaphoid fractures is a risk factor for osteonecrosis.

15. in a Colles's fracture, dorsal angulation of the distal radius of more than 20 degrees needs to be reduced.






True or False

Regarding sacroiliitis,


16. symmetric sacroiliitis is diagnostic of ankylosing spondylitis.

17. enteropathic arthritis has a similar appearance to that of psoriatic arthritis.

18. it usually affects the superior half of the sacroiliac joint.

19. septic sacroiliitis is usually unilateral.

20. MRI is more sensitive than CT for the diagnosis of sacroiliitis.







True or False

Regarding the osteochondroses,


21. bone scan in the early phase of Legg-Calve-Perthe's disease usually shows decreased uptake in the femoral head.

22. Panner's disease involves the capitellum.

23. Freiberg's disease affects the second metacarpal heads.

24. increased T2 signal surrounding a focus of osteonecrosis is an indication of fragment stability.

25. Kienbock's disease is associated with negative ulnar variance.







True or False

Regarding the rotator cuff,


26. the subscapularis tendon inserts on the greater tuberosity

27. trauma is the cause of most rotator cuff tears.

28. intrasubstance rotator cuff tears usually result in fluid in the subacromial/subdeltoid bursa.

29. teres minor tears are associated with dislocation of the biceps tendon.

30. the infraspinatus muscle lies posterior and inferior to the supraspinatus muscle.







True or False

Regarding spine fractures,


31. clay shoveler's fractures are hyperextension injuries.

32. both flexion and extension lateral views are needed to completely evaluate type II odontoid fractures.

33. Chance fractures are associated with duodenal injuries.

34. Jefferson fractures are usually associated with neurologic compromise.

35. in the evaluation of a burst fracture, CT is superior to MRI in visualizing bone fragments in the spinal canal.






True or False

Regarding cartilaginous tumors of bone,


36. enchondromas of the hand are usually calcified.

37. most chondrosarcomas are low-grade neoplasms.

38. growth of an osteochondroma after skeletal maturity is suspicious for malignant change.

39. clear cell chondrosarcoma is usually diaphyseal in location.

40. in Ollier's disease, cortical disruption is indicative of malignant transformation.







True or False

Regarding vascular lesions of the musculoskeletal system,


41. extension into the paraspinal soft tissues excludes the diagnosis of vertebral hemangioma.

42. multicentric involvement is characteristic of hemangioendothelioma.

43. oncogenic osteomalacia is commonly associated with hemangiopericytoma.

44. Gorham's disease is associated with antecedent trauma to the affected area.

45. phleboliths in the soft tissue are pathognomic of soft tissue hemangioma.






True or False

Regarding osteomalacia,


46. the term osteomalacia indicates normal mineralization but a subnormal volume of lamellar bone.

47. Looser's zones occur in areas of chronic stress.

48. subperiosteal resorption at the radial aspect of the middle phalanges is diagnostic of hyperparathyroidism.

49. radiographic changes of tertiary hyperparathyroidism resolve after renal transplantation.

50. anticonvulsant therapy is a cause of osteomalacia.






True or False

Regarding film quality,


56. quantum mottle is due to inadequate exposure.

57. unsharpness is caused by radiation scatter.

58. collimation is recommended when obtaining spot magnification views.

59. unsharpness is caused by poor film-screen contact.

60. reciprocating grids improve spatial resolution.








True or False

A surgical excision should follow stereotactic core biopsy when the histologic results of the core samples yield


61. sclerosing adenosis.

62. atypical ductal hyperplasia.

63. Phylloides tumor.

64. ductal carcinoma in situ.

65. radial scar.







True or False

Regarding complications of breast implants,


66. the "linguine" sign is an indication of intracapsular rupture.

67. MRI is routinely used to diagnose saline implant rupture.

68. calcification in the fibrous capsule is a sign of a silicone gel bleed.

69. intracapsular rupture is a rupture that extends beyond the implant shell.

70. "implant-displaced views" are used to diagnose implant rupture.







True or False

Regarding breast lesions in the male patient,


71. gynecomastia is most commonly a bilateral finding on mammography.

72. gynecomastia most commonly presents clinically as a unilateral finding.

73. breast cancer is associated with BRCA-1 gene.

74. men with gynecomastia are at an increased risk of developing breast cancer.

75. on mammography, gynecomastia usually appears as "fan-shaped" density in the immediate subareolar region.






True or False

Adequate positioning in mammography requires which of the following?


76. the length of the posterior nipple line on the craniocaudal (CC) view to be within 1cm of the length of posterior nipple line on the mediolateral oblique MLO view

77. a vertical configuration of the pectoralis muscle on the mediolateral oblique (MLO) view

78. extension of the pectoralis muscle to the posterior nipple line on the MLO view

79. visualization of the pectoralis muscle on the craniocaudal (CC) view

80. visualization of the nipple in profile on both the craniocaudal (CC) and mediolateral oblique (MLO) projection





True or False

Regarding women who have undergone a lumpectomy and radiation therapy,


81. dystrophic calcifications usually arise within one year.

82. trabecular thickening is noted on follow-up mammography.

83. benign calcifications tend to occur earlier than malignant calcifications.

84. approximately 25% of women develop seromas.

85. the treated breast appears denser than the non-treated breast.







True or False

Regarding the BI-RADS lexicon,


86. Category 1 includes abnormal screening mammograms.

87. Category 2 includes solitary masses that are present in the skin.

88. Category 2 includes simple cysts.

89. Category 3 includes lesions that have a 15% probability of malignancy.

90. Category 4 includes spiculated masses associated with pleomorphic calcifications.







True or False

Factors associated with an increased risk for breast cancer include


91. multiple breast cysts.

92. first degree relative with breast cancer.

93. early menarche.

94. radial scar.

95. mediastinal radiation therapy for lymphoma.








True or False

Concerning vascular rings,


101. a cervical arch is associated with symptoms of stridor.

102. magnetic resonance angiography is superior to transesophageal sonography in the diagnosis of vascular rings.

103. double aortic arch is the most common cause of a vascular ring.

104. in double aortic arch, the right arch is usually larger than the left arch.

105. aortography is necessary in the pre-operative evaluation of vascular rings.






True or False

Regarding septation defects,


106. a ventricular septal defect associated with tetralogy of Fallot has a high incidence of spontaneous closure.

107. in adults atrial septal defects are more common than ventricular septal defects.

108. the size of the left atrium is normal in the presence of an atrial septal defect.

109. in newborns with ventricular septal defects, the pulmonary vascularity is usually normal.

110. endocardial cushion defects are associated with partial anomalous pulmonary venous return.





True or False

Regarding cyanotic heart disease,


111. a right arch with aberrant left subclavian artery is usually associated with congenital heart disease.

112. increased fat in the right atrioventricular groove is characteristic of tricuspid atresia.

113. prostaglandin E1 administration is used to maintain ductal patency in transposition of great arteries.

114. type IV truncus is a severe form of tetralogy of Fallot.

115. a snowman configuration on chest radiography is characteristic of total anomalous venous return below the diaphragm.





True or False

Regarding cardiac neoplasms,


116. the majority of primary tumors of the heart are benign.

117. primary pericardial tumors are more common than pericardial metastases.

118. tumor can be distinguished from thrombus based on MR signal intensity characteristics.

119. myxomas most commonly arise from the atrioventricular grooves.

120. the sensitivity of Doppler sonography for detection of cardiac neoplasms is less than 25%.






True or False

Findings more characteristic of the right ventricle than the left ventricle:


121. larger cross sectional diameter

122. moderator band

123. separation of the in-flow and out-flow valves

124. higher ejection fraction

125. more anteriorly located








True or False

Regarding the pericardium,


126. in constrictive pericarditis, diastolic filling is impaired.

127. the atria are enlarged in constrictive pericarditis.

128. on T1-weighted images, pericardial fibrosis usually has a signal intensity similar to that of simple fluid.

129. the normal pericardial space contains up to 50 mL of fluid.

130. absence of pericardial calcification on CT excludes constrictive physiology.






True or False

Regarding the coronary arteries,


131. dipyridamole is a coronary vasoconstrictor.

132. catheter-induced coronary spasm is more common in the right than the left coronary artery.

133. the right coronary artery is more commonly occluded than the left in aortic dissection.

134. the sensitivity of multi-row detector and electron beam CT scanning is comparable in the detection of coronary calcium.

135. the frequency of stenosis is less in internal mammary artery grafts than in saphenous vein grafts.







True or False

Regarding cardiac MR imaging,


136. cardiac pacemakers are a contraindication for imaging.

137. the posterolateral portion of the pericardium is better visualized than the anterior portion.

138. gradient-echo images are superior to spin-echo images in assessing ventricular function.

139. myocardial iron overload results in decreased signal intensity in both T1 and T2- weighted images.

140. in ECG-gated multislice acquisition, each image is acquired during a different phase of the cardiac cycle.






True or False

Concerning thoracic germ cell tumors,


146. mature teratoma is the most common form.

147. the majority are located in the middle mediastinum.

148. embryonal cell tumors are the most common malignant germ cell tumors.

149. pleural effusions are common.

150. the combination of soft-tissue, fluid, calcification and fat is specific for teratoma.






True or False

Concerning empyema,


151. it is commonly associated with parenchymal consolidation.

152. gas in the pleural space without prior thoracentesis is a finding associated with Clostridium perfringens infection.

153. it has a low protein content (< 3 grams).

154. empyema necessitans refers to the extension of empyema into the chest wall.

155. absence of pleural enhancement excludes the diagnosis.







True or False

Concerning a foreign body in the airway,


156. empyema is a late complication of chronic obstruction.

157. on an ipsilateral decubitus radiograph, the lung distal to the foreign body collapses.

158. air-trapping is a finding on expiratory radiography.

159. the majority are radio-opaque.

160. the diagnosis is often delayed in adults.







True or False

A unilateral hyperlucent hemithorax is associated with


161. Poland's syndrome.

162. mastectomy.

163. pulmonary sling.

164. lymphangioleiomyomatosis.

165. pulmonary embolism.








True or False

Concerning pleural calcification,


166. multifocal bilateral calcification along the diaphragmatic pleura is highly specific for asbestos exposure.

167. apical calcification usually is secondary to tuberculosis.

168. calcification due to asbestos-exposure is usually associated with asbestosis.

169. it is found in 80% of patients with malignant mesothelioma.

170. unilateral calcification is a sequela of hemothorax.








True or False

Causes of unilateral elevation of the diaphragm include,


171. phrenic nerve paralysis.

172. subpulmonic effusion.

173. pulmonary hypoplasia.

174. diaphragmatic rupture.

175. pulmonary sling.







True or False

Concerning interstitial lung disease,


176. upper lobe predominance is characteristic of Langerhan's cell histiocytosis.

177. a bronchovascular distribution is characteristic of sarcoidosis.

178. lymphangioleiomyomatosis is associated with spontaneous pneumothorax.

179. nodules in silicosis have a predilection for the lower lobes.

180. in a patient with honeycombing, the combination of a subpleural and basilar distribution is specific for usual interstitial pneumonitis.






True or False

Concerning community-acquired pneumonia,


181. the most common cause of lobar pneumonia is Streptococcus pneumoniae.

182. the most common cause of bronchopneumonia is Staphylococcus aureus.

183. most deaths occur in people 65 years of age or older.

184. lung abscess is more common with aerobic than anaerobic organisms.

185. in Mycoplasma pneumoniae, the extent of radiographic abnormality is usually disproportionate to the clinical severity.






True or False

Regarding esophageal anatomy,


191. the Z line demarcates the squamocolumnar juncture.

192. the A ring is formed by a transient muscular contraction.

193. striated muscle predominates in the distal 1/3 of the esophagus.

194. the B ring occurs at the gastroesophageal juncture.

195. Killian's dehiscence occurs just below the cricopharyngeus.







True or False

Regarding esophageal pathology,


196. adenocarcinoma has decreased in incidence in the past 20 years.

197. leiomyoma is the most common submucosal tumor.

198. scleroderma causes a patulous lower esophageal sphincter.

199. esophageal perforation in Boerhaave's syndrome typically occurs adjacent to the tracheal carina.

200. the double contrast esophagram is a sensitive test for Barrett's esophagus.







True or False

Regarding gastric pathology,


201. organoaxial gastric volvulus requires emergent decompression.

202. ectopic pancreatic rests are most common in the fundus of the stomach.

203. projection beyond the expected contour of the stomach is characteristic of malignant ulcers.

204. gastric lymphoma makes up approximately 30% of all malignant gastric neoplasms.

205. metastatic breast cancer is a cause of a linitis plastica appearance.





True or False

Regarding benign small bowel pathology,


206. Brunner's gland hyperplasia is most common in the ileum.

207. fold thickening in the proximal small bowel is associated with Giardia infection.

208. both cecal retraction and straightening of the angle at the ileocecal juncture are associated with tuberculosis.

209. duodenal dilatation is a finding of scleroderma.

210. transient intussusceptions are associated with sprue.







True or False

Regarding small bowel malignancy,


211. lymphoma is a cause of aneurysmal dilatation.

212. leiomyosarcoma is associated with an exoenteric growth pattern.

213. a spiculated mesenteric mass is associated with Burkett's lymphoma.

214. most carcinoid tumors present as annular strictures.

215. melanoma is associated with multiple "target" lesions.







True or False

Regarding colonic pathology,


216. rectal carcinoid tumors rarely cause carcinoid syndrome.

217. endometriosis is a cause of mucosal pleating and spiculation.

218. appendiceal mucoceles typically appear as tubular low density masses on contrast-enhanced CT.

219. cystic pneumatosis implies ischemic or necrotic bowel.

220. cecal perforation is a complication of colonic pseudoobstruction.







True or False

Regarding hepatic pathology,


221. primary hepatic neoplasms typically derive their blood supply from the portal vein.

222. in Budd-Chiari syndrome, the enhancement pattern of the caudate lobe is normal.

223. hepatic steatosis has a high signal intensity on both in-phase and out-of-phase T1-weighted MR images.

224. amebic liver infection typically presents as multiple, small hypodense lesions.

225. a very low signal intensity on T2-weighted images in the liver and pancreas but not the spleen suggests primary hemochromatosis.





True or False

Regarding the biliary tree,


226. intra- and extrahepatic strictures are characteristic of primary sclerosing cholangitis.

227. an abrupt caliber change in the common bile duct is characteristic of a benign stricture.

228. a crescent sign in the distal common bile duct is characteristic of an intraluminal stone.

229. segmental gall bladder narrowing is associated with adenomyomatosis.

230. small intramural diverticuli are associated with cholesterolosis.






True or False

Concerning genitourinary injuries following blunt abdominal trauma,


236. extravasation of contrast material from the renal collecting system on a delayed CT scan is an indication for surgery.

237. absence of renal parenchymal enhancement on a contrast-enhanced CT scan is suggestive of a vascular pedicle injury.

238. a large perirenal hematoma (>4 cm in diameter) is usually an indication for surgery.

239. renal pedicle injuries are associated with a large retroperitoneal hematoma in approximately 60% of cases.

240. on delayed CT images, contrast in the space of Retzius is diagnostic of an intraperitoneal bladder rupture.





True or False

Concerning the adrenal gland,


241. most adrenal myelolipomas do not require percutaneous biopsy for a specific diagnosis.

242. adrenal adenomas typically lose signal intensity on out-of-phase MR images compared to in-phase images.

243. aldosteronomas are usually >2.0 cm in diameter at presentation.

244. adrenal cortical carcinomas are usually >4.0 cm in diameter at presentation.

245. the most common cause of endogenous Cushing's syndrome in adults is bilateral adrenal hyperplasia.






True or False

Concerning retroperitoneal anatomy,


246. the lateroconal fascia is defined as the fusion of the posterior renal fascia and transversus abdominus.

247. fluid collections from pancreatitis usually track into the anterior pararenal space.

248. the adrenals are in the pararenal space.

249. the space of Retzius is limited superiorly by the umbilicus.

250. the perirenal space is closed inferiorly at the level of the iliac crest.






True or False

Concerning renal masses,


251. percutaneous biopsy is usually required to differentiate renal adenoma from adenocarcinoma.

252. peripheral calcifications are more often seen in benign than malignant renal masses.

253. increase in the attenuation value of a renal mass by more than 10 HU after administration of intravenous contrast material is considered a sign of malignancy.

254. Bosniak type IV cysts should be referred for percutaneous biopsy.

255. xanthogranulomatous pyelonephritis has peripheral calcifications in >50% of cases.





True or False

Concerning urinary tract infection,


256. bladder calculi are present in the majority of cases of tuberculous cystitis.

257. Escherischia coli is the most common organism associated with emphysematous pyelonephritis.

258. emphysematous pyelitis is best diagnosed with sonography.

259. ureteritis cystica has no malignant potential.

260. the characteristic sonographic findings of pyonephrosis are low level echoes in a dilated renal collecting system.







True or False

Concerning the urethra,


261. "watering can perineum" is most commonly associated with inadequately treated gonorrhea.

262. the glands of Littre are located in the anterior urethra.

263. strictures due to instrumentation are usually found at the bulbomembranous junction.

264. most primary urethral calculi originate in urethral diverticula.

265. a type 1 urethral injury is characterized by extravasation of contrast material above the genitourinary diaphragm.






True or False

Common clinical indications for performing both non contrast and contrast-enhanced CT images include


266. evaluation of a cystic renal mass detected on sonography.

267. evaluation of renal stone burden after lithotripsy.

268. multiple severe urinary tract infections.

269. hematuria and abdominal pain following a motor vehicle accident.

270. staging of prostate carcinoma.







True or False

Concerning urinary tract calcification,


271. cortical nephrocalcinosis is usually due to renal tubular acidosis.

272. pure cystine stones are characteristically faintly opaque on abdominal radiographs.

273. the CT attenuation value of uric acid stones is >150 HU.

274. xanthogranulomatous pyelonephritis is usually associated with a staghorn calculus.

275. on CT, the "soft tissue rim sign" is a sign of a ureteral calculus rather than a pelvic phlebolith.






True or False

Regarding abdominal arterial anatomy,


281. the left hepatic artery arises from the inferior phrenic artery in about 25% of people.

282. the right hepatic artery arises from the superior mesenteric artery in about 15% of people.

283. the Arc of Riolan is a persistent embryonic anastomosis between the celiac axis and superior mesenteric artery.

284. there are multiple renal arteries supplying at least one kidney in 50-60% of people.

285. the inferior hemorrhoidal artery arises from the internal iliac artery.





True or False

Regarding the use of trans-catheter embolic agents,


286. gelatin sponge is appropriate to use when the underlying lesion is likely to heal.

287. polyvinyl alcohol is an appropriate agent with which to sclerose venous malformations.

288. n-Butyl cyanoacrylate is indicated to treat intracranial arterio-venous malformations.

289. metallic coil placement is appropriate to close arteriovenous fistulae.

290. embolic particles that are 150-250 microns in diameter are likely to traverse a normal capillary bed.






True or False

Regarding vascular diseases that affect the kidney,


291. stenosis isolated to the mid-portion of the renal artery is most likely due to atherosclerotic disease.

292. renal artery aneurysm is a finding associated with fibromuscular disease.

293. nephrosclerosis appears as pruning of intraparenchymal renal artery branches.

294. polyarteritis nodosa is a cause of spontaneous renal artery dissection.

295. abdominal aortic coarctation is a cause of orificial renal artery stenosis.





True or False

Regarding medications used in the interventional radiology suite,


296. acetylcysteine diminishes the nephrotoxic effects of iodinated contrast in patients with renal dysfunction.

297. a side effect of meperidine hydrochloride is spasm of the Ampulla of Vater.

298. a patient allergic to lidocaine is likely to be allergic to bupivacaine.

299. Flumazenil is indicated to treat the respiratory depressant effect of morphine.

300. Abciximab is indicated to treat systemic lytic effects of alteplase.






True or False

Regarding fluoroscopic radiation exposure to the patient in the interventional radiology suite,


301. the threshold dose for radiation induced skin injury is 2OOcGy.

302. the most significant operator-controlled factor affecting patient dose is fluoroscopy time.

303. use of magnification mode decreases dose rate to the patient's skin.

304. use of field collimation decreases dose rate to the patient's skin.

305. skin entrance dose increases with patient thickness.






True or False

Regarding complications of percutaneous transhepatic biliary drainage,


306. pancreatitis is a complication.

307. hemobilia occurs in about 3% of patients.

308. the source of hemobilia is most likely a communication between the transhepatic tract and the portal vein.

309. sepsis is more common in patients with benign disease than in those with cancer.

310. 50-70% of patients experience delayed tube-related complications.





True or False

Regarding inferior vena cava filter placement,


311. propagation of DVT due to inadequate anticoagulation is an indication.

312. a circumaortic left renal vein is a contraindication.

313. deployment in the gonadal vein is a possible complication of transfemoral placement.

314. pulmonary embolus occurs in about 3% of patients subsequent to filter placement.

315. chronic leg swelling occurs in about 5% of patients.







True or False

Regarding infra-inguinal arterial angioplasty,


316. a typical balloon size for angioplasty of the superficial femoral artery is 6mm by 4 cm.

317. the three year patency rate of superficial femoral artery angioplasty is about 40-60%.

318. superficial femoral artery patency following a successful angioplasty is improved by stent placement.

319. cystic adventitial disease is an indication for popliteal artery angioplasty.

320. suction embolectomy is an appropriate way to treat distal embolization that occurs as a complication of angioplasty.






True or False

Regarding carotid artery disease,


326. time of flight magnetic resonance angiography underestimates carotid stenosis compared with conventional angiography.

327. sonography is used to measure the diameter of stenotic segments.

328. chronic occlusion of the internal carotid artery is associated with an increased incidence of ipsilateral hemispheric stroke.

329. fibromuscular dysplasia affects the internal carotid arteries more commonly than the vertebral arteries.

330. endarterectomy is indicated for symptomatic patients with 70% stenosis of the proximal internal carotid artery.





True or False

Regarding diffusion-weighted MR imaging,


331. acute stroke is hyperintense to normal parenchyma.

332. abscess shows decreased signal compared with normal parenchyma.

333. chronic infarction shows decreased signal on the apparent diffusion coefficient (ADC) map.

334. changes of acute stroke occur on diffusion weighted imaging before they occur on T2-weighted images.

335. the presence of blood products makes it less reliable for the diagnosis of acute stroke.






True or False

Regarding white matter disease,


336. in approximately 40% of patients with multiple sclerosis, the spinal cord is the only site of involvement.

337. ring enhancement on MR imaging is typical of the plaques in acute multiple sclerosis.

338. progressive multifocal leukoencephalopathy is caused by the HIV virus.

339. angiography is abnormal in about 50% of patients with cerebral vasculitis.

340. in adrenal leukodystrophy, MR findings are typically present at birth.






True or False

Regarding spinal injury,


341. cervical spine fractures in children occur more commonly at C2 than C7.

342. increased signal within the spinal cord on T1-weighted images indicates a higher likelihood of paraplegia.

343. Chance fracture is associated with the use of a lap safety belt.

344. normal cervical spine radiographs exclude the possibility of cord injury.

345. a fracture of the spinous process (Clay-shoveler's fracture) is a stable spine injury.






True or False

Regarding CNS neoplasms,


346. the spinal cord is the most common site of origin of hemangioblastomas in patients with Von Hippel-Lindau disease.

347. pilocytic astrocytomas usually show contrast enhancement on MR imaging.

348. choroid plexus papilloma is the most common intraventricular neoplasm in children.

349. drop metastases are a characteristic finding of medulloblastoma.

350. recurrent glioblastoma multiforme can be differentiated from radiation necrosis by MR imaging.






True or False

Regarding head injuries,


351. CT is more sensitive than MR for hemorrhage associated with diffuse axonal injury.

352. subdural hematomas do not cross suture lines.

353. epidural hematomas are associated with skull fractures in 85% of cases.

354. carotid dissection is associated with embolic infarction.

355. longitudinal fractures of the temporal bone are more often associated with conductive than with sensory hearing loss.






True or False

Regarding nasopharyngeal neoplasms,


356. esthesioneuroblastoma typically has an intracranial component.

357. a squamous neoplasm directly invading the cribriform plate is staged as a T4 lesion.

358. squamous cell carcinoma is markedly hyperintense on T2-weighted images.

359. most recurrent squamous neoplasms are diagnosed within 2 years of therapy.

360. fluid in the mastoid air cells is a common finding in patients with posterior nasopharyngeal masses.





True or False

Regarding diseases of the orbits,


361. retinoblastoma is the most common cause of orbital calcifications in children.

362. orbital pseudotumor most commonly involves the optic nerves.

363. ophthalmopathy due to Graves' disease most commonly involves the extraocular muscles.

364. gliomas of the optic nerve are associated with neurofibromatosis type I.

365. intraorbital abscess is associated with ethmoid sinusitis.







True or False

Concerning gated blood pool (MUGA) cardiac imaging in patients receiving cardiotoxic chemotherapeutic agents,


371. chemotherapy is contraindicated if the left ventricular ejection fraction is < 50%.

372. a serial drop in the left ventricular ejection fraction of > 5 percentage points is significant.

373. doxorubicin cardiac toxicity usually occurs after doses of > 550 mg/m2.

374. doxorubicin cardiac toxicity is reversible if chemotherapy is discontinued.

375. regional wall motion abnormalities typically occur with doxorubicin cardiac toxicity.





True or False

Concerning radionuclide therapy for painful skeletal metastases,


376. bone marrow depression following Sr-89 therapy is irreversible.

377. development of leukemia is a clinically significant complication of radionuclide therapy for painful bone metastases.

378. an advantage of Sm-153 compared with Sr-89 is the presence of a gamma photon emission permitting skeletal scintigraphy.

379. life expectancy < 3 months is a contraindication.

380. a pain "flare" several days following treatment indicates a higher likelihood of treatment failure.






True or False

Concerning parathyroid scintigraphy,


381. benign thyroid adenomas do not accumulate Tc-99m sestamibi.

382. the sensitivity for localization of hyperfunctioning parathyroid tissue is greater in patients with primary hyperparathyroidism than in those with secondary hyperparathyroidism.

383. approximately 85% of patients with primary hyperparathyroidism have a solitary parathyroid adenoma.

384. Tc-99m sestamibi uptake in the salivary glands is pathologic.

385. parathyroid scintigraphy is not indicated in patients with persistent hypercalcemia following a negative neck exploration for parathyroid adenoma.





True or False

With respect to myocardial perfusion imaging in patients with acute chest pain,


386. use of Tc-99m sestamibi permits delayed onset of imaging after injection.

387. acute myocardial infarction and prior myocardial infarction can reliably be differentiated.

388. nitroglycerin administration immediately prior to injection decreases the sensitivity of the study.

389. detection of acute myocardial ischemia requires chest discomfort to be present at the time of injection.

390. gated SPECT imaging can help differentiate infarction from attenuation artifacts.





True or False

Concerning radionuclide captopril renography,


391. the usual dose of captopril used is 25-50mg orally.

392. captopril blocks vasoconstriction of the glomerular afferent arterioles.

393. patients should not receive angiotensin converting enzyme (ACE) inhibitor drugs for 2 weeks prior to the study.

394. Tc-99m glucoheptonate is the radiopharmaceutical of choice for the study.

395. use of captopril increases the specificity of renal scintigraphy in suspected renal artery stenosis.






True or False

With respect to F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in oncology,


396. glucose loading prior to imaging improves the sensitivity of the study.

397. solitary pulmonary nodules having a standardized uptake value (SUV) of> 2.5 are highly suspicious for malignancy.

398. PET is more accurate than CT for assessing the response to therapy in lymphoma.

399. PET is more sensitive than CT for the detection of recurrent colorectal carcinoma.

400. diabetic patients should not receive regular insulin subcutaneously within 4 hours of injection of FDG.






True or False

Concerning radionuclide assessment of cerebral perfusion and metabolism in patients with suspected dementia,


401. decreased metabolism in the frontal lobes is typical of Pick's disease.

402. multi-infarct dementia and Alzheimer's disease typically produce indistinguishable patterns of perfusion abnormalities on Tc-99m HMPAO imaging.

403. crossed cerebellar diaschisis is characteristic of Alzheimer's disease

404. FDG PET imaging is currently the screening modality of choice for the diagnosis of Huntington's disease.

405. abnormalities in both cortical and basal ganglia metabolism often occur in dementia associated with Parkinson's disease.




True or False

Concerning lymphoscintigraphy in cutaneous melanoma,


406. node biopsy guided by it helps to identify patients who do not need extensive lymph node dissection.

407. it is accurate in identifying lymph node metastases at presentation.

408. multiple sentinel nodes are frequently identified.

409. it should not be performed in patients who have already undergone excisional biopsy of the primary lesion.

410. it elucidates cutaneous lymphatic drainage patterns of lesions near Sappey's lines.






True or False

Regarding acute diseases of the pediatric airway,


416. airway involvement is at the supraglottic level in membranous croup.

417. intubation is usually necessary for patients with viral coup.

418. dysphagia is common in acute epiglottitis.

419. associated edema of the subglottic trachea is present in nearly all patients with acute epiglottitis.

420. prevertebral soft tissue thickening is frequent in epiglottitis.







True or False

Concerning mediastinal masses in children,


421. they are most frequently of neural origin.

422. the majority of teratomas are malignant.

423. about 30% of children with myasthenia gravis have thymomas.

424. thymic involvement by Hodgkin's disease usually produces diffuse enlargement of the gland.

425. mediastinal cystic hygroma rarely has a cervical component.







True or False

Regarding congenital lung lesions,


426. cystic adenomatoid malformation often produces mediastinal shift.

427. the most common plain radiographic finding of cystic adenomatoid malformation is that of a single large cyst.

428. lobar emphysema often appears as a radiodense lesion in the immediate neonatal period.

429. sequestration rarely involves the upper lobes.

430. intralobar sequestration is more commonly associated with congenital anomalies than extralobar sequestration.






True or False

Concerning congenital duodenal obstruction,


431. the most common cause of obstruction is duodenal atresia.

432. in duodenal atresia, the presence of air in the distal bowel implies an associated bile duct anomaly.

433. the "wind-sock" deformity on barium studies is a pathognomonic finding of duodenal membrane.

434. annular pancreas usually is associated with duodenal atresia.

435. duodenal membrane is usually located in the third duodenum.







True or False

Concerning renal tumors,


436. Wilms' tumor metastasizes to lung.

437. rhabdoid tumor is associated with embryonal brain tumors.

438. clear cell sarcoma metastasizes to bone.

439. mesoblastic nephroma commonly spreads to regional nodes.

440. multilocular cystic nephroma herniates into the renal pelvis.








True or False

Concerning pelvic masses in children,


441. in boys, rhabdomyosarcoma more commonly arises in the prostate gland than in the bladder.

442. sacrococcygeal germ cell tumors are usually diagnosed at birth.

443. a teratoma localized to the presacral space has a higher incidence of malignancy than one that extends into gluteus muscles.

444. benign sacrococcygeal teratomas are predominantly cystic.

445. sacral anomalies are a feature of an anterior meningocele.






True or False

Concerning imaging in children with acute pyelonephritis,


446. it is indicated after a single episode of infection.

447. the role of sonography is to confirm the diagnosis.

448. the sensitivity of gray-scale sonography is less than 50%.

449. the sensitivity of cortical scintigraphy exceeds 90%.

450. a striated nephrogram is seen on CT.








True or False

Concerning sonography of the hip,


451. there is an increased incidence of developmental dysplasia in infants with a family history of the condition.

452. in developmental dysplasia, the proximal femur typically dislocates laterally and superiorly.

453. radiographs are superior to sonography in evaluating developmental dysplasia in neonates.

454. a hip effusion is best demonstrated on sagittal images.

455. in the newborn, sonography can reliably distinguish between proximal focal femoral dysplasia and developmental dysplasia.






456. A film-screen AP lumbar spine radiograph is acquired on a small adult patient. Which one of the following is MOST likely regarding the radiation dose to the patient?


A. It is higher than that for a CT examination of the abdomen.

B. If a phototimer is used, the dose would be the same as that for a large adult patient.

C. It is independent of the speed of the film-screen system.

D. It is uniform from entrance to exit within the patient.

E. It is too low to cause non-stochastic biologic effects.







457. An over-exposed chest image is acquired using computed radiography. Which one of the following is the MOST likely concerning the appearance of the radiograph?


A. Too light

B. Too dark

C. Blurred

D. Noisy

E. Diagnostic








458. Which one of the following is the MOST likely regarding the attenuation of the ultrasound beam in tissue?


A. Increases with frequency and increases with distance traveled

B. Is independent of frequency

C. Decreases with frequency and increases with distance traveled

D. Is independent of distance traveled

E. Increases as the square of the distance traveled ((distance)2)









459. Which one of the following is the MOST likely regarding a scintigram acquired with a planar gamma camera?


A. The image quality is independent of thickness of the scintillation crystal.

B. The spatial resolution is determined by the diameter of the photomultiplier tubes (PMT's).

C. The system utilizes energy discrimination to form the image.

D. The system utilizes coincidence counting to form the image.

E. The purpose of a collimator is to improve contrast by reducing radiation scatter.






460. A bone radiograph is obtained with 40 keV, mono-energetic x-rays. Which one of the following is MOST likely to occur when the x-rays interact with bone?


A. The first half value layer thickness of bone will exceed the second.

B. Photoelectric attenuation will cause x-ray beam hardening.

C. Compton photons with energies lower than 40 keV will be produced.

D. Bremsstrahlung radiation will be produced.

E. Compton photons will be emitted isotropically.







True or False

Regarding spiral CT


461. both tube and table motion are continuous during data acquisition.

462. scan field of view can be changed using retrospective reconstruction.

463. choice of reconstruction algorithm affects level of image noise.

464. choice of mAs utilized affects level of image noise.

465. the computer storage required for a 40-image diagnostic CT study is two megabytes (2 MB) or less.







True or False

Regarding absorbed radiation dose in CT,


466. dose increases if mAs is increased.

467. dose for a pelvic CT examination is between 1 mGy and 6 mGy.

468. the dose for a head CT examination is typically greater than that for a chest CT examination.

469. the severity of a radiation-induced cancer depends on the radiation dose.

470. the likelihood of a radiation-induced skin burn is proportional to the radiation dose.





True or False

Regarding magnetic resonance imaging,


471. Intravoxel dephasing produces a bright blood signal.

472. motion artifacts generally occur in the frequency-encoded direction.

473. chemical shift artifact causes a mis-registration between fat and water in the frequency-encoded direction.

474. a 50% reduction in receiver bandwidth increases image signal to noise ratio by a factor of two.

475. for a fixed RF bandwidth, an increase in the slice selection gradient will increase the image slice width.






True or False

Two intensifying screens A and B are made of the same phosphor, but one is thinner than the other. The effect of the use of the thinner screen (using a properly and a fixed tube current (mA)) phototimed exposure) is


476. degraded spatial resolution.

477. higher patient dose.

478. higher conversion efficiency.

479. lower film density.

480. shorter exposure time.







True or False

Regarding plain film radiography,


481. the maximum energy of x-rays produced by an x-ray tube is determined by the amount of added beam filtration.

482. an intensifying screen generally absorbs 70% or more of the incident x-ray photons.

483. bone contrast is produced primarily by the Compton interaction.

484. the relative blurring attributable to the x-ray focal spot is worse at high magnification.

485. the removal of an anti-scatter grid with a Bucky factor of 4 will result in a reduction in radiation dose to the patient by a factor of 2.





True or False

In radiography, the effects of using a grid are,


486. improved image contrast.

487. increased patient dose.

488. an increase in the minimum available exposure time.

489. increased X-ray tube heat loading.

490. improved spatial resolution.








True or False

Concerning fluoroscopy,


491. operation at reduced frame rates allows dose reduction at the expense of temporal resolution.

492. setting the aperture to a smaller size in the fluoroscopic imaging chain results in reduced image noise.

493. the image intensifier limits the system's overall spatial resolution when operated in 525-line, 23cm FOV mode.

494. the predominant source of noise in a fluoroscopic image is electronic noise contributed by the camera.

495. scattered radiation from the patient is the predominant source of occupational dose.






True or False

Regarding mammography,


496. a Rhodium target with a Molybdenum filter is a common target-filter combination.

497. image blurring due to the focal spot varies along the anode-cathode axis.

498. the Heel Effect causes a variation in x-ray intensity in the direction perpendicular to the anode-cathode axis.

499. a small focal spot is generally not used for routine mammography because exposure times would be too long.

500. MQSA requires that failure of daily sensitometry tests be fixed within (a maximum of) 30 days.





True or False

Regarding hepatic anatomy,


506. Couinaud-Bismuth segment I is the lateral segment of the left lobe, superior aspect.

507. Couinaud-Bismuth segment IVA is the medial segment of the left lobe, inferior aspect.

508. in the Coumaud-Bismuth classification, the right portal vein defines the plane that separates segments V and VI from segments VII and VIII in the right lobe of the liver.

509. within the porta hepatis, the hepatic artery is located anteromedially to the portal vein.

510. the caudate lobe is bordered by the fissure for the ligamentum venosum and the inferior vena cava.





True or False

Regarding sonography of the fetal genitourinary system,


511. an amniotic fluid index between 10 and 20 cm is almost always within normal limits.

512. prior to 16 weeks gestation, a normal volume of amniotic fluid excludes bilateral renal agenesis.

513. prior to 20 weeks gestation, a renal pelvic diameter of 3 mm is diagnostic of hydronephrosis.

514. a solid renal mass associated with polyhydramnios is usually a mesoblastic nephroma.

515. the kidneys in fetuses with autosomal recessive polycystic disease typically have multiple large cysts.





True or False

Regarding first trimester sonography,


516. embryonic heart activity is usually identifiable on endovaginal sonography when the crown rump length is >5 mm.

517. the yolk sac is nearly always visualized on endovaginal sonography when the mean sac diameter is >10 mm.

518. the risk for aneuploidy increases in fetuses when the nuchal lucency exceeds 3 mm.

519. in a patient with a β-hCG of 2300 mIU/ml and no detectable intrauterine gestation on transvaginal ultrasound, the finding of echogenic cul-de-sac fluid suggests an early normal pregnancy.

520. estimation of gestational age at 9 weeks via crown rump length is not as accurate as an estimation performed at 20 weeks using full fetal biometry.





True or False

Regarding sonography of thyroid nodules,


521. a predominantly hyperechoic nodule is likely to be benign.

522. a thin, complete peripheral halo surrounding a nodule indicates a high likelihood of malignancy.

523. peripheral or eggshell-like calcification surrounding a nodule most likely indicates a benign etiology.

524. approximately 40% of the United States population has nodular thyroid disease that can be revealed by sonography.

525. punctate microcalcification within a lesion is a sign of benignity.






True or False

Regarding musculoskeletal sonography,


526. on shoulder sonography, the finding of both bursal and intraarticular fluid collections strongly suggests a rotator cuff tear.

527. anisotropic tendon structure causes the normal tendon to appear hypoechoic when the ultrasound beam is oblique in relation to the tendon.

528. "jumpers knee" (patellar tendinopathy) typically presents as a diffusely hyperechoic tendon.

529. power Doppler imaging permits documentation of the response to therapy in patients with inflammatory lesions of periarticular soft tissues.

530. in a patient with a painful hip, the finding of hypoechoic fluid excludes septic arthritis.




True or False

Regarding scrotal sonography,


531. the accuracy of ultrasound in distinguishing intratesticular and extratesticular pathology is approximately 60%.

532. the spermatic cord contains three arteries.

533. most nonpalpable undescended testicles are intraabdominal.

534. a resistive index of 0.9 is normal in the post-pubertal testis.

535. the transmediastinal artery is often seen as a thin hypoechoic band running through the parenchyma.







True or False

Regarding sonography of the ovaries,


536. the finding of arterial waveforms in the ovary excludes the diagnosis of torsion.

537. ectopic pregnancies are intraovarian in 10% of the population.

538. parovarian cysts account for approximately 10% of adnexal masses.

539. the largest of the functional cyst group are the theca-lutein cysts.

540. cystic teratomas have a 10% risk of malignant transformation.







True or False

Regarding ultrasound technology,


541. tissue harmonic imaging is generally beneficial when evaluating the bile ducts.

542. extended field of view technology requires that a mechanical sensor be attached to the ultrasound transducer.

543. power Doppler imaging is less sensitive than conventional color Doppler for the detection of flow when the angle of insonation approaches 90 degrees.

544. the most common types of injected ultrasound contrast agents rely on stabilized microbubbles.

545. compound imaging uses multiple different angles of insonation.