1999 Board Questions

Total questions on exam: 250

Time allowed for exam: 5 hours

l. The posterior nipple line should differ in length by no more than …….on the MLO vs. the CC view.

a. .5 cm.

b. 1.0 cm.

c. 1.5 cm.

d. 2.0 cm.






2. Which of the following is a risk factor for the subsequent development of breast cancer?

a. Adenosis

b. Ductal ectasia

c. Multiple peripheral papillomas

d. Benign cystic hyperplasia










3.   Following a breast core biopsy, calcifications are visualized on the specimen radiograph of 2 of the 5 specimens. The pathologist reports that no calcification or malignancy is present. Your next course of action should be:

a. repeat the core biopsy

b. immediately repeat the mammogram

c. mammogram in 6 mos.

d. Mammogram in 1-2 years

e. Radiograph the paraffin









4 A core breast biopsy is performed on a region. containing calcifications. The pathologist reports LCIS and Adenosis is present. The next step in this patient's care should be:

a. unilateral mastectomy

b. bilateral mastectomy

c. lumpectomy and radiation tx.

d. F/U mammogram in 6 mos.

e. Excisional biopsy








5. A breast lesion is present superiorly on an MLO view. It is not seen on the CC view. On a true lateral, it moves superiorIy. 'The lesion occupies which breast quadrant?

a. Upper outer quadrant

b. Upper inner quadrant

c. Lower outer quadrant

d. Lower inner quadrant









6.   If performing an ultrasound guided bx on a mass within the right breast at the 9:00 O'clock position, the needle should enter the skin from which approach?

a. lateral

b: medial

c. superior

d. inferior










7. The most common fungal pulmonary infection in AIDS is secondary to:

a. cryptococcus

b. Candida

c. Cocci

d. Aspergillus










8. What pattern of esophageal involvement is present in HIV esophagitis?

a.) cobblestone

b.) giant ulcers












9. What is the most common cause of a colovesical fistula?

a. Crohn's disease

b. Radiation tx

c. ulcerative colitis

d. divertlculitis

e. Colon Cancer










10. The most common cause of air space opacity in Lupus is:

a. hemorrage

b. infection

c. lupus pneumonitis











11. Upper lung predominance is not present in:

a. Sarcoidosis

b. Silicosis

c. Alpha-1-antitrypsin deficiency

d. Centrilobular Emphysema

e. cystic fibrosis









12. The appropriate kVp to use for mammography is:

a. 19-23

b. 24-27

c. 28-32

d. 33-35

e. 36-39









13. Which of the following types of breast cancer is not a form of ductal CA?

a. comedo

b. cribriform

c. medullary

d. solid

e. papillary









14. What is the likelihood that a palpable, well circumscribed breast mass is malignant?

a. 1-2%

b. 3-10%

c. 11-20%

d. 21-30%

e. 31-40%









15. What would be the percent reduction in breast cancer detection if no clinical screening was performed (mammography only)?

a. 5-10%

b. 15-20%

c. 30-40%

d. 41-50%










16. What is the least likely cause of a RUL mass in a neonate?

a. congenetal lobar emphysema

b. CAM

c. pulmonary sequestration











17. What is the position of the pulmonary valve relative to the aortic valve?

a. inferior, anterior and to the left

b. inferior, anterior and to the right

c. inferior, posterior and to the right

d. superior, anterior and to the left .

e. superior, posterior and to the left









18. The KUB of a neonate demonstrates scattered plaquelike abdominal calcifications. The most likely cause is:

a Neuroblastoma

b Intrauterine bowel perforation

c. Nephroblastomatosis

d. Tuberculosis










19. What is the optimal position of an intra-aortic balloon pump?

a. just distal to the aortic valve

b. mid thoracic aorta

c. just distal to the aortic arch

d just above the diaphram

e. just distal to the right brachiocephalic artery









20. What is the normal position of the conus in an infant?

a. T 10

b. T 12

c. L2

d. L4










21. A cystic cerebellar mass containing a mural nodule is most likely:

a. glioma

b. ependymoma

c. cerebellar astrocytoma

d. medulloblastoma











22. What gives the best estimate of portal venous pressure?

a. hepatic vein free pressure

b. hepatic vein wedge pressure

c. hepatic vein free + wedge pressure

d. hepatic vein wedge - free pressure










23. What is the appearance of "shin splints" on 3 phase bone scan?

a. hot on all 3 phases

b. cold on all 3 phases

c. hot on dynamic & blood pool, cold on delayed

d. hot on delayed only










24. An ultrasound of a 3 cm liver hemangioma will most likely demonstrate:

a. presence in the left lobe

b. posterior acoustic enchancement

c. decreased echogenicity

d. irregular margins

e. increased central blood flow










25. A diffuse increase in attenuation of the liver on CT most likely results from:

a. Amiodarone toxicity

b. Fatty infiltration

c. Chemotherapy

d. Hepatitis










26. Which of the following is the least likely to give progressive parenchymal accumulation of Tc99m MAG3?

a. acute tubular necrosis

b. obstruction of the collecting system

c. venous thrombosis

d. pyelonephritis

e. renal artery stenosis with captopril








27. Which is false regarding color vs. power doppler?

a. both assess direction of flow

b. both are dependent upon angle of interrogation

c. both can determine velocity of blood flow

d. both give information about amplitude











28. Which of the following lies within the carpal tunnel?

A flexor carpi radialis

b. flexor carpi ulnaris

c. ulnar nerve

d. flexor pollicus longus

e. flexor palmaris longus









29. A patient presents with bilateral papilledema and 1 episode, of vomiting without nausea.  Imaging will most likely reveal:

a. hydrocephalus

b. periventricular hyperintensities












30. A seven year old boy presents with scoliosis, a sacral dimple containing a patch of hair, and a 2cm leg length discrepancy. He has experienced increasing lower extremity weakness over the past 6 mos. The most likely diagnosis is:

a. Chiari II with lipomyelomeningocele

b. Sacrococcygeal teratoma

c. Tethered cord










3l. Schizencephaly occurs as a result of

a. a neuronal migration anomoly

b. failure of cleavage

c. neural tube defect

d. failure of diverticulation










32. What is the most reliable sonographic finding of DVT?

a. no augmentation

b. loss of pulsatility

c. noncompressibility

d. echogenic material filling the lumen

e. absence of color on doppler interrogation









33. Which of the following is true regarding transient osteoporosis?

a. it most commonly affects patients between the ages of 1-4yrs.

b. subchondral bone resorption usually occurs

c. Bone marrow edema is present within the femoral head and neck on MRI











34. Which area of bone in children is first to demonstrate fat deposition in the marrow?

a. epiphysis

b. proximal metadiaphysis

c. diaphysis

d. distal metadiaphysis










35.What is the most common organism to cause non-bacterial pneumonia in an elderly patient?

a. Adenovirus

b. RSV

c. Mycoplasma

d. H. Influenza










36.  A 5O year old male presents with fever, cough, and elevated WBCs. Lab analysis reveals the presence of antineutrophil cytoplasimic Abs. He most likely has:

a. Legionella

b. Necrobiotic nodules

c. Wegener's

d. Lymphomatiod granulomatosis









37.  Which C-spine facture is most likely to cause acute, severe neurologic deficit?

a. pillar

b. Jefferson

c. Non-displaced fx of dens

d. flexion teardrop

e. extension teardrop









38.    T2 weight images of the brain demonstrate increased signal in the basal ganglia and cerebellum with increased size of the optic chiasm. What is the most likely diagnosis.

a. NF1

b. NF2

c. Tuberous Sclerosis

d. Sturge Weber









39.  What is the most likely cause of a conductive hearing loss in association with an ipsilateral facial nerve palsy?

a. vertical fracture of petrous bone

b. horizontal fx of petrous bone

c. epidural hematoma











40. Which is not a cause of a thick walled, small capacity bladder?

a. cyclophosphamide

b. radiation tx

c. spinal cord injury

d. neurogenic bladder

e. bladder sphincter dyssnergia










4l.  Regarding the urinary bladder, which of the following is considered pre-malignant?

a. cystitis granularis

b. cystitis cystica

c. malakoplakia










42.  Which of the following is not a cause of bladder diverticula?

a. schistosomiasis

b. congenital

c. neurogenic bladder












43.   Which of the following describes a normal pituitary gland?

a. enhances rapidly and brightly

b. it is the same signal intensity as gray matter

c. its superior margin is flat or concave

d. it enhances slightly less than adenomas










44What is the most reliable determinant of the location of the right atrium?

a. the position of the tricuspid valve

b. identification of the IVC

c. identification of the azygous vein

d. identification of the pulmonary veins

e. a smooth posterior wall









45. What is the most reliable sign of restrictive pericarditis?

a. pericardial calcification

b. myocardium thicker than 8 mm on CT

c. Decreased LV diastolic volume











46.   Which is diagnostic of situs inversus?

a. stomach on right, apex of heart on left

b. stomach on right, aortic arch on right

c. stomach on left, aortic arch on right












47. Which of the layers of the heart are absent in a ventricular pseudoaneurysm?

a. endocardium only

b. myocardium only

c. myocardium + endocardium

d. myocardium + endocardium + epicardium









48.   Which of the following is most commonly associated with a seminal vesicle cyst?

a. renal agenesis

b. duplication of the upper urinary tract

c. contralateral cryptorchidism











49.   What is the most common testicular mass associated with cryptorchidism?

a. seminoma

b. teratoma

c. choriocarcmonia

d. yolk sac tumor










50.     Which tumor, is not of germ cell origin?

a. embryonal

b. yolk sac

c. seminoma

d. leydig cell

e. choriocarcinoma









5l.    A 45 year old man presents with a long stricture of his penile urethra with reflux into the glands of littre on RUG. These findings are most likely secondary to:

a. Neisseria

b. latrogenic

c. Congenital

d. Saddle injury









52.    What is the most common cause of post-menopausal vaginal bleeding?

a. endometrial polyps

b. CA

c. endometrial hyperplasia

d. endometrial atrophy










53.    Renal oncocytoma is of what cell origin?

a. hamartoma

b. epithelial

c. sarcoma











54.     Which is not true of Type II pneumocytes?

a. they produce surfactant

b. they are separated by intercellular bars.

c. they can produce DNA

d. they increase in # when alveoli are damaged











55.       Which of the following structures demonstrate the least pressure gradient from apex to base?

a. pulmonary arteries

b. pulmonary veins

c. pleural space

d. alveoli










56.   What is true regarding splenic epidermoid cyst?

a. it occurs secondary to blunt trauma

b. it is usually symptomatic by the 2nd decade

c. it is secondary to echinococcus

d. it demonstrated high density on CT

e. it contains internal trabeculations









57.     Characteristics of solid and papillary pancreatic neoplasms include:

a. most common in young women

b. most common in pancreatic head












58.      What is the most common cause of an isolated lesser trochanteric fx?

a. avulsion injury

b. pathologic fx












59.      The most accurate predictor of the likelihood of a fx secondary to a lesion which produced endosteal erosion is:

a. thickness of cortex involved

b. length of cortex involved

c. % of circumference involved











60.     The most common origin of an entrapped fragment following reduction of an elbow fx in an adult is:

a. medial condyle of humerus

b. radial head

c. olecranon

d. capitellum










6l.     At what site is a Salter Harris IV fx more common than a Salter Harris II?

a. base of 1st metacarpal

b. distal radius

c. supracondylar fx of humerus

d. lateral femoral condyle










62.    A 2 y.o. child presents with increasing stridor and hoarseness. Radiographs demonstrate eccentric narrowing of the subglottic trachea. The most likely etiology is:

a. hemangioma

b. papilloma

c. rhabdomyosarcoma










63.     What is the most common cause of tracheal stenosis after double aortic arch?

a. left arch with aberrant right SCA

b. right arch with aberrant left SCA

c. pulmonary artery sling

d. left arch with aberrant right brachiocephalic artery










64.      Which is the correct location of a popliteal cyst?

a. between the medial gastrocnemius head & semitendinosis

b. between the medial gastrocnemius head & semimembranosis

c. between the lateral gastrocneimius head & semitendinosis

d. between the lateral gastrocnemius head and semimembranosis










65.   What is the most likely cause of diffuse bilateral nodular pulmonary infiltrates in an asymptomatic child with HIV?

a. varicella pneumonia

b. miliary TB

c. PCP

d. LIP

e. Lymphoma









66.     Which bone scan finding is most suggestive of spinal mets?

a. increased uptake in the vertebral body and lamina

b. increased uptake in the vertebral body and pedicle

c. vertebral body expansion

d. uptake isolated to the vertebral body










67.     Routine F/U of scoliosis should be performed:

a. A-P to minimize magnification of the vert. Bodies

b. A-P to minimize exposure to the ovaries

c. P-A to minimize exposure to the breast

d. P-A to best define the curvature










68.      Choroid plexus cysts, although most often a normal finding, are associated with:

a. Trisomy 13

b. Trisomy 18

c. Trisomy 21

d. Turner's syndrome










69.    The most helpful ratio in evaluation for IUGR is:

a. BPD to head circumference

b. Head circumference to abdominal circumference

c. S/D ratio in the umbilical artery

d. Head circumference to femur length











70.    Which should not affect reliability of the tardus parvus waveform on doppler interrogation?

a. moderate renal artery stenosis

b. captopril administration prior to U/S

c. Long standing diabetes mellitus

d. Elderly patient

e. Hypertension








7l.    A HIDA scan performed on a neonate with elevated Bili demonstrates no bowel activity after 4 hours. The most appropriate next step is:

a. administer CCK

b. administer morphine

c. premeditate with phenobarbitol and repeat the study

d. continue study and image at 24 hours









72.     Why is it important to prevent Molybdenum contamination of Tc 99m

a. Mb is cytotoxic

b. Mb localizes in CNS

c. Mb has a half-life of 60 hrs.

d. Mb interferes with interpretation of study

e. Mb is a beta emitter









73.    What is the most common location of extra-adrenal pheochromocytoma?

a. thoracic sympathetic chain

b. lumbar sympathetic chain

c. celiac axis











74.     An enhancing posterior fossa mass in a child arising from the cerebellar vermis and extending into the 4th ventricle is most likely:

a. medulloblastoma

b. ependymorna

c. glioma

d. astrocytoma










75.    Homonomous hemianopsia most likely results from a lesion involving which anatomic location?

a. anterior optic chiasm

b. posterior optic chiasm

c. lateral geniculate body

d. optic nerve









76.     What is the most echogenic structure on ultrasound of the neonatal brain?

a. cerebellar vermis

b. cerebellum

c. thalamus

d. caudate nucleus

e. cingulate gyrus









77.      What distinguishes HIV from other types of medical renal disease?

a. renal enlargement

b. echogenicity












78.  What is the most likely cause of unilateral edema of the interureteric ridge?

a. bladder calculus

b. seminal vesiculitis

c. cystitis











79.  Which is the most commonly associated with Luckenschadel (craniolacunia)? Is this remembered correctly?

a. craniosynostosis

b. prematurity

c. chiari II











80.     A 5 y.o. girl has soft tissue and bony enlargement of the 2nd and 3nd fingers. The most likely cause is?

a. macrodystrophia lipomatosa

b. neurofibromatosis

c. Paget's

d. Psoriasis










8l.    Which is true of coronary artery calcifications on CT?

a. involves proximal more commonly than distal

b circumflex is more commonly involved than the LAD

c. most occur within 2 cms of the ostia

d. they are diagnostic of coronary artery occlusion










82.     What is the best test to evaluate inversion of the right hemidiaphragm secondary to massive pleural effusion?

a. U/S

b. Right lateral decubitus view

c. CT

d. MR










83.    Which is true of high resolution CT of the chest?

a. algorithm with high spacial resolution is needed

b. a very low window level is needed (-300 to -400)

c. helical CT is necessary











84.     Which of the following tumors does not take up octreotide?

a. lymphoma

b. breast CA

c. prostate CA

d. melanoma










85.       Which of the following is not true of PE?

a. most commonly multiple

b. central embolus more commonly causes infarct than peripheral thrombus

c. cough, SOB and hemoptysis is the classic presentation

d. rarely results in infarction











86.     What is the most common presentation of bronchoalveolar carcinoma?

a. segmental consolidation

b. patchy areas of ASO

c. multiple nodules










87.     A 71 year old diabetic man develops scrotal pain and swelling. Ultrasound and CT show normal testes and epididymis and gas within the scrotum. The most likely diagnosis:

a. hernia and air-filled loops

b. gas-containing scrotal abscess

c. fournier gangrene

d. Bowel perforation and air extension to scrotum










88.     What is the most sensitive test for nephroblastomatosis?.

a. contrast enhanced CT

b. ultrasound

c. excretory urography

d. DMSA renal scintigraphy

e. Ga67 scintigraphy









89.   MIBG imaging is able to detect all of the following EXCEPT:

a. pheochromoblastoma

b. neuroblastoma

c. aldosteronoma

d. carcinoid

e. medu1lary thyroid carcinoma









90.     A sagittal MR image of the cervical spine reveals a vertical linear high signal in the cord. This artifact likely represents:

a. chemical shift

b. truncation

c. N/2 phenomenon

d. Aliasing

e. Ghosting









9l.    Unilateral lymphangitic spread of cancer is most typical of which primary tumor type?

a. breast

b. gastric

c. pancreatic

d. testicular

e. lung









92.     The pes anserinus is comprised of

a. sartorius, gracilis, and semimembranosus

b. sartorius, gracilis, and semitendinosis

c. lateral head gastrocnemius and semimembranosus

d. biceps femoris and fibulocollateral ligament

e. rectus femoris and quadriceps complex









93.     A density is present anteriorly in the right breast on the MLO view, but not seen on the CC view. What view should be obtained?

a. exaggerated CC

b. 90 degree lateral

c. tangential

d. cleavage










94.     Which structure does not lie in the anterior pararenal space?

a. duodenum

b. pancreas

c. descending colon

d. adrenal










95.      At what T4 count does a patient with HIV first have a high risk of developing PCP?

a. 2000

b. 1000

c. 500

d. 200

e. 100









96.     What is the definition of vital capacity?

a. amount of air that can be expired after maximal inspiration

b. amount of air remaining in lung after quiet expiration

c. amount of air in lung after maximal inspiration

d. amount of air remaining in lung after maximal expiration










97.     Which is the worst prognostic factor 3 days s/p acute MI?

a. persistent pulmonary edema

b. cardiomegaly

c. pleural effusion

d. pneumothorax











98.      A 60 year old man 2 yrs. S/p nondominant RCA bypass surgery for ischemia now complains of chest pain and has a reversible defect on SPECT in the inferior wall. This likely represents:

a. LAD ischemia

b. Ischemia of native RCA proximal to graft

c. infarct of native RCA distal to graft

d. Circumflex ischemia

e. Infarct of RCA graft








99.    A renal cell carcinoma extends into the IVC and the RA. Which of the following is associated with the poorest prognosis?

a. involvement of lymph nodes

b. ipsilateral adrenal involvement

c. extent of IVC thrombus

d. capsular invasion

e. contralateral kidney involvement









100.     In which case is angioplasty contraindiccted in SFA occlusion?

a. fresh clot

b. 5 cm chronic occlusion

c. extends into popliteal artery

d. at site of calcified plaque

e. poor distal run-off










10l.     Regarding the cricopharyngeus muscle, which is true?

a. important for phonation

b. at the C2 level

c. at the posterior-inferior margin of the hypopharynx











102.    Which places the patient at most risk during a pulmonary arteriogram?



c. PA pressure 25/12

d. Previously placed IVC filter










103.     A 28 year old woman presents with a 4 week history of sore throat, cough, and nervousness. Thyroid uptake of I-131 is <1%. The most likely diagnosis is:

a. Graves disease

b. Hashimoto's thyroiditis

c. Acute suppurative thyroiditis

d. Subacute thyroiditis









104.      Which of the following polyposis syndromes is not inherited?

a. Peutz-Jeger

b. Gardener

c. Turcot

d. Cronkhite-Canada

e. Familial polyposis









105.    What is the most common cause of unilateral pulmonary- lymphangitic spread?

a. breast

b. colon

c. stomach

d. lung

e. skin









106.     Which has the highest rate of associated cancer?

a. Celiac disease

b. Gardener’s

c. Barrrett’s esophagitis

d. Scleroderma










107.      On a 4 chamber view of the heart, which congenital heart lesion can be most confidently diagnosed?

a. secundum ASD

b. double outlet right ventricle

c. AV canal

d. Transposition of the great vessels

e. Outlet VSD









108.     A 60 year old woman complains of itching and crustiness around the nipple. Mammogram shows a few subareolar calcifications. The most likely diagnosis is:

a. intraductal papilloma

b. Paget's disease of the Breast

c. pylloides tumor

d. invasive ductal carcinoma










109.  The most common etiology of Wallenberg syndrome is:

a. superior cerebellar artery occlusion

b. ipsilateral PICA occlusion

c. contralateral PICA occlusion











110.    The most common cause of pancreatitis in a child is:

a. mumps

b. familial

c. cystic fibrosis

d. trauma










11l.  Percutaneous transluminal angioplasty would be least successful for:

a. fibromuscular dysplasia of a renal artery

b. calcified infrarenal aortic stenosis

c. 7cm superficial femoral artery stenosis












112.     A 20yr old woman presents with a 5 cm firm mass within one of her breasts. The most appropriate course of action is:

a. mammogram

b. breast ultrasound

c. excisional biopsy










113.     A bronchogenic carcinoma extends to involve the ipsilateral (parietal or visceral) pleura. What is the lowest stage this can represent?

a. 1

b. 2

c. 3a

d. 3b

e. 4









114 What is the blood supply for the superior 1/3 of the rectum?


a. IMA

b. Internal iliac

c. External iliac

d. Internal pudendal









115.  Which portion of the bowel is the least likely to become ischemic?

a. Cecum

b. ascending colon

c. transverse colon

d. splenic flexure

e. rectum










116.   Which portion of the GI tract does Glucagon affect least?

a. eosophagus

b. stomach

c. small intestine

d. colon










117.  What is the treatment of choice for thrombosis of the splenic vein with gastric varices


b. Splenectomy

c. Splenorenal shunt











118.     From what embryological structure does the pulmonary system arise?

a. primitive foregut

b. branchial. clefts 3-5












119.      Fracture of which portion of the scaphoid is most likely to lead to AVN?

a. proximal pole

b. distal pole

c. waist

d. avulsion










120.  What is the risk of malignancy of a 2 cm colon polyp?

a. 1-5%

b. 10-15%

c. 50%

d. 90%










12l.   Which of the following structures does not abut the caudate lobe of the liver

a. Right lobe

b. left lobe

c. ligamentum venosum

d. ligamentum teres

e. main portal vein









122.     What is not the normal signal of the vertebral body marrow on T1 weighted imaging?

a. increased compared with CSF

b. increased relative to disc

c. increased relative to spinal cord

d. increased relative to fat










123.    How can aliasing be minimized in ultrasound?

a. decrease gain

b. narrow focal zone

c. increase frequency











124 What is the most common cause of pyelonephritis in renal infection with high anal atresia?

a. posterior urethral valves

b. VUR

c. Rectourethral fistula











125.    With what condition will microcolon most likely result?

a. meconium ileus

b. duodenal atresia

c. hirschprung's ds

d. Meconium plug










126.    Which is true of fractures of the Triquetrum

a. volar surface most commonly involved

b. dorsal surface most commonly involved

c. usually avulsion injury











127.      5mm calcification is present posterior to the vertebral bodies at the C3-C5 levels. The most likely cause is:


b. herniated disc

c.  chordoma

d.  Griesel's syndrome










128.     Which of the following is not association with Kawasaki disease?

a. renal failure

b. gallbladder hydrops

c. pericardial effusion











129.    Which of the following is not true of gallstone ileus?

a. 2/3 of pts. have gas in the portal veins

b. usually obstructs in the mid jejunum

c. the gallstone is usually identified on plain films












130.  Scanning must be performed to this level inferiorly in the evaluation of left vocal cord paralysis?

  1. thoracic inlet
  2. A-P window
  3. Diaphragm












13l.  A patient presents with SOB and syncope when in the left lateral decubitus position. The most appropriate evaluation is:

    a.   carotid ultrasound

    b.   cardiac catheterization

    c.   echocardiogram.











132.    What is the most common pattern of esophageal involvement in HIV?

  1. cobblestone
  2. plaque
  3. giant ulcer











133.     A contraindication to the use of Sr 89 in a patient with bone pain secondary to metastasis is:

  1. less than 3 mo life expectancy
  2. primary tumor is not breast or prostate
  3. prior radiation tx
  4. thrombocytopenia











134.    Respiratory distress syndrome may be distinguished from meconium aspiration on the basis of:

  1. air bronchograms
  2. hypoventilation













135. What is true of a duplicated renal collecting system?

  1. upper pole ureter inserts inferiorly and usually obstructs
  2. lower pole ureter inserts inferiorly and refluxes
  3. upper pole ureter inserts inferiorly and refluxes
  4. lower pole ureter inserts inferiorly and obstructs











136.   Failure of normal formation of the pelvi-infundibular region during embryologic development will most likely lead to:

  1. megacalyces
  2. multicystic dysplastic kidney













137.   When performing an ultrasound guided breast core biopsy, which is the ideal needle position prior to firing?














138.   A man developed sudden lower leg pains while playing basketball without sustaining trauma. Which of the following structures was most likely injured?

  1. peroneal tendon
  2. achilles tendon
  3. talofibular ligament
  4. tibio-talar ligament










139.  In which portion of the breast is CA most likely to develop?

  1. terminal duct lobular unit
  2. central duct













140.     What is the location of a Tillaux fracture?

a. talar dome

b. distal fibula

c. anterior process of calcaneus

d.  lateral tibial plafond










14l.     What is not true of the use of Thallium vs. Sestimibi in cardiac imaging?

a.  MIBI has higher extraction than Thallium

b.  MIBI has less redistribution than Thallium












142.    What is the most likely cause of dilatation of the prostatic urethra?

a.  bladder sphincter dysenergia

b.  chronic prostatitis

 c.  dysreflexia

d.   pelvic lipomatosis










143.    Most common community acquired pneumonia in elderly?

  1. Strep
  2. Klebsiella
  3. Pseudomonas
  4. Staph












144.      A lesion is present in the suprascapular notch. What is this associated with?

  1. infraspinatous
  2. subscapularus
  3. deltoid muscle atrophy












145. What is shoulder impingement associated with?

  1. Hooked acromion, acromial-clavicular osteophyte
  2. Bankart lesion

    c.    Hill sacks deformity












146. With which of the following is unilateral rib notching not associated?

  1. aberrant right subclavian artery with coarctation
  2. coarctation of the aorta occurring between the origins of the BCA and SCA
  3. stenosis of the brachial artery

    d.   AVM of the arm











147.     Smoking is associated with:

  1. centrilobular emphysema
  2. basilar emphysema












148.     Which is not associated with an apical predominance?

  1. Silicosis
  2. TB
  3. Alpha 1 antitrypsin
  4. EG












149.   What spinal lesion is hyperintense on both TI and T2 ?

  1. hemangioma
  2. metastasis
  3. abscess












150.    This RNEF graph most likely results from:

a. severe dysrythmia

b. right to left shunt












15l.  Concerning "sharps":

  1. most sticks are in dominant hand
  2. one hand method should be used for recapping













152.    What is the most characteristic US appearance of hemangioma?
  1. hypoechoic
  2. central flow
  3. slight posterior acoustic enhancement













153.     An endocardial cushion defect may involve all except:

  1. atrial septum
  2. ventricular septum
  3. mitral valve
  4. infundibular septum












154.      Mass seen on Pre/Post Contrast CT scan. Most common characteristics of malignancy is:

  1. Pre to post increase in HU from 10 to 49
  2. Pre to post no change in HU
  3. Single calcification in rim
  4. Septations











155.   Something about increased intracranial pressure causing decreased cerebral perfusion:

  1. lowering of cerebellar tonsils
  2. decreased size of suprasellar cistern
  3. enhancement of dural meninges












156.     . Pediatric patient with bubbly gas pattern seen in RLQ and abdominal bowel dilatation. Next best test.

  1. Ct with oral/IV contrast to r/o free air
  2. Cross table lateral view of abdomen to r/o free air
  3. UGI
  4. BE











157.      Spiculated breast mass seen mammo. Core biopsy readout says fibroadenoma. Next step:

  1. 6 mo follow-up
  2. 1 year follow up
  3. 2 year follow up
  4. excisional biopsy











158.     What is associated with increased velocity in ICA on carotid ultrasound:
  1. cardiomyopathy
  2. ipsilateral CCA stenosis
  3. ipsilat ICA occlusion distal to measurement
  4. contralateral ICA Obstruction
  5. contralateral ECA stenosis











159.   After injection of common carotid artery the ipsilateral ICA shows occlusion just distal to the carotid bifurcation with opacification of the ipsilateral cerebral vessels (ACA). How?


  1. Filling of cerebral vessels by retrograde flow through ophthalmic artery from ipsilateral ECA












160.     What is the chance of malignancy in a well-circumscribed, non-calcified breast mass?

  1. 2%
  2. 5%
  3. 10%
  4. 25%
  5. 4 0%










16l.     Pt is receiving local lidocaine anesthesia prior to angio and the lidocaine infiltrates. Pt's heart rate drops to 40 with decreased blood pressure. After airway check, elevating legs, next step is:

  1. subcut. Epi (1 mg, 1/1000)
  2. iv atropine
  3. slow epi N (1 mg, 1/10000)
  4. rapid infusion of 0.9 NS
  5. rapid infusion of LR










162.     Pt is undergoing angio procedure and suddenly heart rate increases and blood pressure decreases. Should give:

  1. epinephrine
  2. atropine
  3. nitroglycerine












163.     In a child who is receiving long term prostaglandins, one may expect to see:

  1. subperiosteal hemorrhage
  2. diffuse sclerosis
  3. osteopenia
  4. periostitis











164.   Male patient with high attenuation liver on non-contrast CT, skin pigmentation, and (? Increased LFTs):

  1. hemachromatosis
  2. Wilson's disease












165.    On compression mammography, the number of pounds administered to breast is:

  1. 10-15
  2. 20-24
  3. 25-30
  4. 31-35











166.   Substance that increases pancreatic enzyme secretion:

  1. CCK
  2. secretin













167.   The vasoactive substance that decreases after captopril administration:

a.   renin

b.   angiotensin I

c.   angiotensin II











168.   Azygos vein inserts:
  1. superior to RMSB and dorsal to SVC
  2. superior to RMSB and ventral to SVC
  3. inferior to RMSB and dorsal to SVC
  4.  inferior to RMSB and ventral to SVC












169. F-18 can be used to detect all of the following except:
  1. lung ca
  2. breast ca
  3. prostate ca












170.    All of the following are causes of delayed nephrogram except:

    a.   RVT

    b.   RAS

    c    Acute pyelo

    d.   chronic glomerulonephritis










171.     Pt with decreased pain/temp on left extremities and right face with uvula deviation to (RorL?):

a. Wallenberg syndrome secondary to vertebral artery occlusion

b. Parinaud syndrome secondary to pinealoma












172.  Something about a hot nodule (?autonomous) (sorry, just cannot remember):














173.     Pt undergoing dipyramidole study develops sudden severe chest pain. You should next:

    a.    stop test give nitro

    b.   stop test give aminophylline

    c.   slowly titrate down to stop

    d. keep going because you need a complete exam to get full reimbursement










174.   Relative contraindication for Strontium 89 therapy:
  1. platelet count less than 100K
  2. not breast or prostate CA
  3. patient has less than 3 months to live












175.   Most common cause of linnitis plastica:
  1. Melanoma
  2. breast ca
  3. lung ca
  4. leiomyosarcoma












176.     Most likely cause of hypoxemia in patient with lung disease:
  1. hypoventilation
  2. diffusion abnormality
  3. shunt
  4. VQ mismatch












177.  Woman with diseased tricuspid and pulmonic valves. Most likely cause:
  1. carcinoid with liver mets

    b. pulmonary carcinoid

    c. rheumatic heart disease











178.     Enlargement of meningohypophyseal trunk most likely due to:

a. dural avm

b. ??













179.      Most commonly associated with scaphoid fracture:

    a.   Perilunate dislocation

    b.  Lunate dislocation

  1. ?












180.     Woman with increased signal intensity in subcortical regions of occipital lobes on T2WI. Follow-up MRI two weeks later is normal.

  1. tip of basilar syndrome
  2. sagittal sinus thrombosis
  3. preeclampsia











18l.    Pt with facial fractures and central cord syndrome after mva. Most likely mechanism:
  1. Hyperextension
  2. Hyperflexion
  3. hyperflexion with rotation
  4. axial loading











182.    Most likely cause of mass in neonate:

    a.  Burkitt's lymphoma

    b.   Nephroblastomatosis

    c.   Wilm's tumor

    d.   Rhabdomyosarcoma

    e.   Mesoblastic nephroma











183. All are associated with renal cysts except:
  1. tuberous sclerosis
  2. chronic hemodialysis
  3. neurofibromatosis
  4. VHL
  5. Echinococcal disease










184. According to April 1999 standards, phantom images must be checked:
  1. daily
  2. Weekly
  3. Monthly
  4. semi-annually
  5. annually











185.     Woman develops RUQ pain/jaundice following lap chole. US shows biliary dilatation and two stones in distal CBD. Next treatment?

    a.   biloma drainage

    b.   oral administration of urso

    c.   Lithotripsy

    d.   Stone removal and stenting

    e.   Endoscopic papillotomy and stone basketing










186.     Which of following is incorrect concerning adenomyosis:
  1. can be difficult to visualize by ultrasound
  2. more common in nulliparous women
  3. can be focal or diffuse
  4. two other choices we cannot remember











187.     75 year-old male found down. MR shows lesion in temporal lobe, with central decreased signal intensity on T2 and peripheral bright signal intensity on T1. It most likely is:
  1. oxyhemoglobin
  2. deoxyhemoglobin
  3. intracellular methemoglobin
  4. extracellular methemoglobin
  5. hemosiderin










188.     Which is the least likely cause of a cavitary mass in the colon?

  1. adenocarcinoma
  2. lymphoma
  3. melanoma












189.   A patient undergoes scout KUB for BE after having an IVP. This reveals bilateral dense kidneys. The most likely cause is:

  1. contrast induced renal failure
  2. hypotension













190.    All of the following are true of angiodysplasia of the colon except:

    a. active bleeding is usually seen during angio













19l.    Which is true of massive GI bleeding?

  1. 60% occurs in UGI
  2. 20% occurs in small bowel
  3. Vasopressin infusion is a useful Tx
  4. Arterial infusion of Vasopressin is as helpful as venous infusion












192. An HIV + patient presents with cutaneous lesion and a lytic lesion of the Tibia. The most likely dx is:

  1. Kaposi's Sarcoma
  2. Chordoma
  3. Osteosarcoma












193.    Which is the least likely to produce a hyervascular liver lesion?

  1. Carcinoid
  2. Thyroid CA
  3. Melanoma
  4. Lung CA
  5. Choriocarcinoma











194.    What is true of pulmonary AVM vs. systemic AVM?














195.  What is true of Achondroplasia?














196.  When performing a nuclear medicine study, what is the lowest percent of desired activity of the radiopharmaceutical that may be administered.


  1. 5%
  2. 10%
  3. 15%
  4. 20%
  5. 25%










197.      A 50 yr. Old woman presents with bilateral check swelling, dry mouth and cystic lesions in the parotid on MRI. The most likely diagnosis is:

  1. bilateral warthin tumors
  2. lymphoepithelial cyst
  3. pleomorphic adenoma
  4. Sjorgren's











198.     What is the average systolic and diastolic pressure in the pulmonary arteries?

  1. 20/0
  2. 20/5
  3. 25/10
  4. 120180











199.    The majority of prostatic tissue removed in a TURP for BPH is from which zone?

  1. central
  2. periurethral
  3. transitional
  4. peripheral











200.     Which of the following is true regarding solid and papillary pancreatic tumors?

  1. usually involve the head
  2. usually involve the tail
  3. occur most commonly in young women
  4. hihgly malignant












20l.    What is the most likely cause of a choledochal cyst

  1. intrahepatic duct dilatation
    b.   choledochal cyst

    c.   Caroli's ds.

    d.   CBD dilatation










202.    What is associatited with lymphoid hyperplasia of the bowel?

    a.   tropical sprue

    b.   blind loop syndrome

    c.   carcinoma

    d.   dysgammaglobulinemia











203.     Salpingitis isthmica nodosa is most commonly associated with:

a.   hydrosalpinx

b.   endometriosis












204An elderly patient presents with pyelonephritis, with sepsis and distal ureteral obstruction. A percutaneous nephrostomy is requested. The appropriate response is:

a.  refuse to perform procedure

b.  agree to perform the procedure after warning the clinician of the risk of worsening sepsis

c.  inject contrast to distend the collection system well during the procedure










205.       By how how many weeks of pregnancy does a corpus Luteal cyst resolve

  1. 5
  2. 10
  3. 15
  4. 20
  5. 25











206.      What is the most likely finding on cardiac MR with arrythmogenic right ventricle?

  1. thickened intermembranous septum
  2. blurring of heart
  3. lipoid infiltration












207.     Which is true of the short axis view of the heart?














208. A child's elbow radiograph demonstrates a posterior fat pad. Also, the anterior humeral line lies anterior to the capitellum. The most likely diagnosis is:

    a.   fx of medial epicondyle

    b.   fx of.lateral epicondyle

    c.   radial head fx

    d.   radial head dislocation










209.  Which ossifies first?


  1. medial epicondyle
  2. lateral epicondyle
  3. capitellum
  4. radial head










210.    The most common cause of community acquired PNA in the elderly is:

  1. Strep pneumonia
  2. Klebsiella
  3. Pseudomonas aeringosa
  4. Staph aureus












21l.    Which is the most sensitive test for nephroblastomatosis
  1. US
  2. DMSA renal scintigraphy
  3. Ga67 scintigraphy
  4. Contrast CT











212.   Type II pneumocytes do not:

  1. synthesize DNA
  2. produce surfactant
  3. increase in number following lung injury
  4. have intercellular bridges













213.   What is the relative position of the pulmonary to aortic valve ?













214.     What is the most common location of extra-adrenal pheochromocytoma?

  1. celiac
  2. thoracic sympathetic chain
  3. lumbar sympathetic chain
  4. thyroid / parathyroid












215.    Pancreatitis in children is most likely secondary to:

  1. trauma
  2. CF
  3. Biliary ds
  4. Familial
  5. Mumps











216.     Concerning "sharps"

a. most sticks are in non-dominant hand

b. one hand method should be used for recapping












217.   A cystic mass with a mural nodule in a child's cerebellum most likely represents:

a. astrocytoma

b. hemagioblastoma

c. choroid plexus papilloma

d. pilocytic astrocytoma










218.     An endocardial cushion defect will result with abnormalities of all but:

  1. atrial septum
  2. ventricular septum
  3. mitral valve
  4. infundibulum











219.    What is the most reliable sign of DVT on US?

  1. absence of flow
  2. echogenic material within lumen
  3. non compressibility













220.    Which structure is parallel to the anterior cruciate ligament?

a. medial femoral condyle

b. lateral femoral condyle

c. B1umenstat's line











22l.    Which is not true regarding central line placement?


a.  there is a greater rate of infection with placement in angio suite vs. OR

b.  tunneling of the catheter reduces the risk of infection

c.  PICC line is appropriate for intermediate length tx (2-48wks)









222.     Which is true regarding tagged RBC scan in upper GI bleed?


a.  no utility

b.  Comparable to angio for identification

c.  in vivo tagging of RBCs is acceptable









223.    Which is the most likely cause of reversal of flow during diastole in the renal artery following renal transplant?

a.  renal vein thrombosis

b.  renal artery stenosis

c.  obstruction of the collecting system

d.  ATN











224.     What is the most reliable sign of PTX on supine CXR?


a.  deep sulcus sign

b.  hilum overlay sign

c.  ipsilateral lucency at lung base










225. What is not a finding of Pulmonary Venous Hypertension?


a.  redistribution

b.  Kerley B lines

c.  Peripheral pruning










226. Which is the most likely etiology of a well circumscribed breast mass?

a.  medullary CA

b.  invasive lobular CA

c.  invasive ducal CA

d.  papillary Ca










227.  The stripe sign on VQ scan is secondary to:


a.  PE

b.  Emphysema

c.  Pleural effusion










228.     Which is true regarding lower extremity atherosclerosis?


    a.   the earliest sign is leg pain at rest

    b.   typical findings are pallor, absent pulse

    c.   LE claudication is an independent risk factor for CAD

    d. Only 15% will experience improvement in symptoms with smoking cessation and exercise

    e. Smokers have a higher 5 yr. amputation risk than pts' with DM








229.   Osteomeatal complex disease is associated with opacification of:


a.  frontal sinus only

b.  maxilarry sinus only

c.  frontal and ethmoid sinuses

d.  all paranasal sinuses









230A spiculated breast mass is biopsied. The path result is fibroadenoma. The next step is:


a.  excision

b.  re-biopsy

c.  F/U mammography 6 mos

d.  F/U mammography 1 yr.









231What is the most likely cause of placenta accreta?


a.  s/p C-section

b.  fibroids

c.  prior PID










232 What is contraindication to cardiac bypass?


a.  PDA

b.  ASD

c.  VSD

d.  Aortic stenosis