UT

• MCQsin
Clinical Radiology
r --
(Question Bank for FRCR)
Prabhakar Rajiah
MBBS yfD FRCR
Senior Registrar in Radiology

Manchester "
. .
r
United Kingdom
unbridge Wells
Radiology is not just X-rays anymore. The rapid strides made in
imaging technology has revolutionised radiology with advent of
Ultrasound, Computed Tomography, Magnetic Resonance Imagin� PET
scanning and lnterventional Radiology. Integration of these recent
advances into the syllabus has increased the burden placed on radiology
trainees facing fellowship exams. There is a burning need for simple
and accurate resource to make the process of facing examinations a less
daunting task. .
· In preparing th.is book, Dr Prabhakar Rajiah has been successful in
developing a comprehensive practice resource for the fellowship exams.
This book is in the same format to the fellowship exams and has been
written using up to date and accurate information. This is easily_ the
most extensive and largest collection of MCQs in radiology available
today. The main strength of the book the· categorisation of questions
into related subtopics and the thorough,detailed explanation provided
with the answers at the end of each section. The questions are of varying
difficulty, covering amongst others, differential diagnosis, epidemio
logy, which is the staple of any fellowship exam and recent imaging
techniques. The questions cover the three key components, anatomy,
techniques and pathology. This should benefit everyone from the
beginner to the more accomplished.
I am in no doubt, that this book is an ideal way of revising for the
exams. It is also a good companion for self assessment and would be
of interest for senior radiologists who would like to update their
knowledge and stay informed about current practices and imaging
methods. This book is an ideal combination of information and revision
resource.
Dr Biswaranjan Banerjee MBBS FRCS FRCR
Consultant Radiologist,
Tameside General Hospital,
Manchester,
United Kingdom
Multiple choice questions (MCQs) have now become the standard and
the most preferred means o f assessing knowledge in all medical
specialities including radiology. Along with the tremendous advances
made in the various subspecialities of radiology, the level of knowledge
not just in depth but also in breadth and the skill required to sit MCQ
exams has increased as well. The fonnat of the fellowship exams over
the recent years has been changed to reflect these advances.
There is no gain saying the fact that the best method of preparing
for these exams is keeping abreast of recent advances reading the standard
radiology textbooks and journals. However there is a place for books
such as these, which can be used to develop knowledge and hone skills
necessary for success in these exams. This book has been written primarily
as a revision tool for those sitting MCQexams in Genitourinary, Obstetrics,
Gynaecology and Breast Radiology. This book can be approached in
two ways. The best way is to read a particular topic in a recognised
textbook or journal and subsequently test the knowledge gained usmg
the questions in the corresponding chapter of this book. Alternatively,
the book can be used first to identify lacunae in the knowledge base,
which can then be corrected using journals and textbooks. It is imperative
to realise that while this book cannot be a substitute for textbooks or
journals, it can be a valuable revision tool prior to exams. It can also
be used by those in an advanced stage, who don't have to stick to any
particular format as an informal and fun way of gaining and self testing
radiological knowledge.
The format in this book is the same as used in the fellowship exams
o f the Royal Colleges of UK, Ireland, Hong Kong, Australia and
NewZealand. The Royal College of tJK Exam has 40 questions to be
answered in two hours. Each question has five statements with true
or false answers. The book has more than 900 questions, each with five
statements. Detailed explanations have been provided for the questions
at the end of each chapter. The book has been divided into individual
chapters, which will enable the reader to assess his strength and
weakness, and correct deficiencies in knowledge. Due emphasis has
been given to Anatomy, Technique and Pathology, which are the
important components of the fellowship exam. A detailed bibliography
is provided at the end of this book for further reading.
Prabh :;Jl."
... 1
1. Kidneys, Congenital A nomalies ········································-········· 1
2. Renal Vascular Disease and Trauma ·······-·······················-······· 17
3. Renal Imaging ·······································-········································· 35
4. Infections ································· ··················································-······· 67
5. Obstruction, Interventions and Transplantation ... ......

. .... .. . .. 79
6. Bladder ································································-······························ 99
7. Renal Tumors ····················································-···························· 118
8. Adrenals . .............. ...... .... ... . ........ . .. . . ..... ... ....... ... .. .. .. 137
.. .. . . . . . . . ... . . . .. .. ... . .
9. Imaging of Prostate . ... ....... . . . ..... . . . .. . .. . . . ... .. .... 156

.. . . ... . . . ... ... . . . ... . .. .. .. ...
10. Imaging of Male Reproductive Tract .. .. ... ..... ... . . . ...... 169
... . .. . .. .. . ..
11. Breast Imaging . . .. .. . . ... . ... .... . .. . . .

. .. . ... ..... . . . . .... . ... ..... ..... . .. 189
.. . . .. . . . ... .. ... .
12. Obstetric and Fetal Ultrasound .. ... . . ..

. . .. . .... ... . . ...... . .... ... . . .. .. 221
. .. . .
13. Gynaecological Diseases .... .. . .... ....... ...

. .. . . . ... .... .... ..... .. .... . . .. .. 244
. ... .. .
14. Miscellaneous .... . ...... .. . .. . . . ... . .. ... .......... . .. ... .. . ... ..... 286
.. .. .. . . .. . ... . . . . .. . . ... . . . .
Bibliography ................... ... . . . . ........... ........................................ ..... . . ...... 291

1. Kidney development
A. The human kidney develops from pronephros
B. The ureter is derived from mesonephros
C. Proximal renal collecting system is derived from metanephros
D. Renal pelvis and calyces are formed from metanephric duct
E. Fetal lobulations usually disappears at three years of life
2. The following s�ctures are formed in mesonephros:

A. Efferent tubules of testis
B. Epoophoron
C. Epididymis
D. Vas deferens
E. Ejaculatory duct
3. Development of kidneys:
A. Duplex kidneys a r e formed due to double metanephric
budding
B. Cystic dilatation of metanephric tubules causes ARPKD
C. In duplex kidneys, the upper ureter enters the bladder above
the lower ureter
D. The ureteric buds and meson�phric ducts are incorporated into
bladder at 24 weeks
E. Supernumerary kidneys are more common in the right side
4. Genitourinary Structures and their embryological origin:

A. Bladder-urogenital sinus
B. Urethra-urogenital sinus
C. Bladder trigone-mesonephric duct wall
D. Vestibule of vagina-urogenital membrane
E. Efferent ductules of testis-Wolfian duct
2 Genitourinary, Obstetrics & Gynaecology and Breast Radiology
5. Renal techniques:
A. Posterior sections are required for demonstrating upper pole
in tomograms
B. Cranial angulation of tube helps in complete visualization of
the kidneys
C. For visualizing right kidney and ureter, left posterior oblique
view is used
D. Respiratory views are helpful in localizing renal calculi
E. Prone films help in ureteric emptying, in IVU
6. Kidneys:
A. The kidneys measure 11-15 cm
B. The right kidney is longer than the left kidney by 1.5 cm
C. The upper pole of kidneys lies medially and anteriorly than
the left kidney
D. The columns of Bertin separate the medulla into pyramids
- E. The renal papilla is a· component of the pyramid
7. Contents of anterior pararenal space:

A. Pancreas B. Ascending colon
C. Duodenum D. Proximal small bowel loops
E. Adrenal glands
8. Renal fas cia :

A. The anterior renal fascia is called Fascia of Toldt
B. The renal fasica is called Gerotas fascia
C. The suprarenals are within the perirenal space
D. The adrenals are in direct contact with the kidneys
E. The anterior pararenal space does not cross the midline
9. Renal fascia:
A. The posterior pararenal space does not communicate across the
midline
B. The posterior pararenal space continues anteriorly towards the
umbilicus
C. The posterior pararenal space is continuous laterally with the
extraperitoneal fat
D. The perirenal space is open superiorly
E. Medially the renal fascia blends with the fascia of aorta and IVC
10. Renal collecting system:

A. There are two infundibula, the upper and lower, in all patients
B. There are eight pairs of calyces
C. The lower three pairs of calyces always drain into the lower
infundibulum
D. Compound calyces predispose to reflux
E. The renal pyramid is a one-way valve
_ Kidneys, Congenital Anomalies 3
11. Perinephric space:

A. The weakest point of the perinephric space is the inferomedial
angle adjacent to the ureter
B. The perinephric space is broader inferiorly
C. Perinephric fat is maximal in the anterior and medial aspect
of the kidney
D. Inferiorly the perinephric fascia blend with the iliac fascia
E. Transperitoneal rupture occurs in the renal hilus when the
pressure is high in the perinephric space
12. Diaphragm:
A. The right crura is longer than the left crura
B. The crura becomes more prom inent during expiration
C. Median arcuate ligament is a condensation of psoas fascia
D. The central tendon of diaphragm is fused to the pericardium
E. The sternal part of the diaphragm attaches to the xiphoid
process
13. Kidneys:
A. The lower limit for renal length in ultrasound is 9 cm
B. In !VU, the kidney length is equal to the height of the first
three and half lumbar vertebra with discs
C. The measurement of kidneys in ultrasound is 20% more than
of !VU
D. A renal parenchymal thickness of less than 2.5 cm is abnormal
E. In renal failure, lesser the size of kidney and renal parenchymal
thickness, worse the prognosis
14. Retrograde pyelography:

A. Cystocopy is essential for retrograde pyelography
B. Contraindicated in renal infections
C. 30 ml of contrast is the maximum dose that should be used
D. Density of 300 or 370 mg/ml should be used for good
visualization of collecting system
E. In PUJ, the contrast should be given above the below the level
of obstruction
15. Retrograde pyelography:

A. Contrast should be injected forcefully to get good opacification
of the en tire ureter
B. If there is extravastation of contrast into collecting tubules, the
patient should be admitted and emergency management is
required ·
C. If a filling defect is seen in ureter in IVU, RGP is required for

further clarification
D. Contrast reactions similar to IVU cannot occur i...'l. RGP
E. Calyces are blunted normally in RGP
16. MCU:
A. Cystography can differentiate mechanical and neurogenic cause
of dysfunction
B. Stress incontinence is the most common indication o f
cystography in women
C. The bladder has more height than width in women
D. Oblique views are avoided during micturition
E. Dysuria following MCU suggests infection
17. Ascending urethrography:

A. Spasm is reduced by avoiding warm contrast medium
B. Balloon of cathether should be inflated in the membranous
urethra to retain the catheter
C. The best procedure for demonstrating prostatic urethra
D. 30 Degree .obliques are taken on both side
E. Urethral fistula is best seen in i.T1jection phase
18. Abdominal lymph nodes:

A. Presence of enlarged left gastric nodes indicates grave
prognosis in esophageal cancers
B. There are more than 100 lymph nodes in the mesentery
C. There are predominantly four group of mesenteric lymph
nodes
D. Epicolic nodes are close to the large bowel wall
E. Perirectal nodes are in the wall of the rectum
19. Paraa ortic nodes drain the following:

A. Posterior abdominal wall
B. Diaphragm
C. Testes
D. Pancreas
E. Adrenal
20. Lymph nodes of pelvis:

A. Obturator nodes can be differentiated from ovary by presence
of fat plane between the node and ilium
B. Medial group of external iliac nodes drain the abdominal wall
C. Cisterna chyli lies between the right crus and a ort a
D. Cisterna chyli continues into thorax as thoracic duct
E. Internal iliac nodes drain. the femoral muscles
21. Kidneys:
A. Compound · :ih _ :: are common in the poles
B. Intrarenal images the center of the papilla
C. About S '-- i ucts open on the surface of each pyramid
D. Pain fi · :lneys passes through T12-L2 nerves
E. Kidne :tion perfectly without nerve supply
Kidneys, Congenital Anomalies 5
22. External iliac group of lymph nodes drain the following

structures:
A. Glans penis
B. Membranous urethra
C. Bladder
D. Adductor compartment
E. Inguinal nodes
23. Sympathetic nerves in the abdomen:

A. The celiac plexus is visualized in high resolution CT scans
B. The celiac plexus is located. over the crura of diaphragm
C. The superior hypogastric plexus, is situated anterior to the
right common iliac vein
D. The inferior hypogastric plexus i s situated medial to the
internal iliac artery
E. The inferior hypogastric plexus is lateral to the rectum
24. Abdominal wall:

A. The medial arcuate ligament is derived from fascia of quadratus
lumborum muscle
B. Lateral arcuate ligament is condensation of psoas fascia
C. Lumbar plexus lies within the psoas
D. Sympathetic nerves lie within the psoas
E. Femoral nerve emerges from the lateral border of psoas
25. Abdominal wall:

A. Iliolumbar ligament is condensation of fascia of quadratus
lumborum
B. Thoracolumbar fascia is condensation of aponeurosis of external
oblique muscle
C. The femoral sheath separates the psoas fascia from the inguinal
ligament
D. Iliopsoas inserts into the lesser trochanter
E. Transverse abdominis is the deepest of the anterior abdominal
wall muscles
26. Structures seen in the retrocrural space:

A. Aorta B. Azygos
C. Hemiazygos D. Splanchnic nerves
E. IVC
27. The following structures are absent in majority of renal a ge ne sis :

A. Ureter
B. Vas deferens
C. Adrenal gland
D. Hemitrigone
E. Splenic flexure
28. Pelvis:
A. The femoral nerve is the largest nerve in the body
B. The pudenda! nerve enters perineum through the greater
sciatic foramen
C. The femoral nerve and obturator nerve can be visualized in
CT and MRI
D. Obturator and femoral nerve have the same nerve roots
E. The sciatic nerve enters the gluteal region through the lesser
sciatic foramen
29. R enal a genesis:

A. 70% of females have genital anamolies
B. Unicornuate uterus is characteristically associated
C. In Rokitansky syndrome uterus is hypoplastic
D. Seminal vesicle cyst is a common association
E. If splenic flexure is medial to the lesser curvature of stomach,
it is diagnostic of left renal agenesis
30. Duplex kidneys:

A. More common in females
B. Reflux is common in the upper moiety
C. 20% bilateral
D. 2% incidence
E. Usually incomplete
31. Retrocaval ureter:

A. Always seen on the right side
B. The ureter is seen medial to the pedicle
C. There is no associated hydronephrosis
D. Cobra head appearance of ureter is seen
E. Affects only the upper part of ureter
32. Pelvic kidney:

A. The most common blood supply to pelvic kidney is from
external iliac artery
B. 1/1500 incidence
C. Adrenals do not develop
D. Adrenals show abnormal shape
E. Kidney at the level of iliac crest is called abdominal ectopy
33. Congenital anomalies of kidney:

A. Intrathoracic kidney is commoner in the right side
B. Intrathoracic kidney is commoner in males
C. 50% of pelvic kidneys are associated with reflux or
hydronephrosis
D. In ectopic kidneys, 50% of the normally placed kidneys have
an anomaly
E. Pelvic kidney is associated with cardiac defects
34. The following are associations of pelvic kidney:

A. PUJ obstruction B. Omphalocele
C. Wilms tumour D. Malrotation of bowel
E. Un.descended testis
35. Horseshoe kidney:

A. Ascent is prevented by superior mesenteric artery
B. 1/10000 incidence
C. The upper poles never fuse in horseshoe type of ki dn ey
0. The isthmus is always functioning tissue, unless superimposed
by a tumour
E. It is twice as common in females as males
36. ADPKD (Autosomal dominant polycystic kidney disease):

A. Striated nephrogram is seen
B. Puddling of contrast is seen in delayed images
C. Spider leg deformity of collecting system
D. Contrast can opacify the cysts
E. The cysts communicate with each other in ultrasound
37. Multicystic kidney s:

A. Bilateral involvement occurs in 10%
B. Painful haematuria is a common pres entation
C. Proximal dilation of the affected ureter is due to associated
VUJ obstruction
D. Antenatal diagnosis is possible
E. R adioi sotop e scans show obstructive pattern
38. Adult polycystic kidney disease:

A. 10% risk of renal carcinoma
B. 50% en d on hemodialvsis ,
C. 100% of 30 year olds have cysts on ultrasound

D. Associated with bronchogenic cysts
E. Haematuria is a common presentation
39. ADPKD:
A. The cysts communicate with collecting tubules
B. Cysts lined by transitional epithelium
C. Cysts filled with urine
D. Intervening renal parenchyma normal
E. Stone forms inside the cysts
40. Horseshoe kidney s :

A. Increased incidence of renal cell carcinomas
B. Increased incidence of Wilms' tumour
C. Increased risk of transitional cell tumour
D. Renal cell carcinoma is the most common tumour
E. Increased incidence of carcinoids
41. ADPKD:
A. Incidence 1 /10000
B. 100% pene�ance
C. Mutation in chromosome 16
D. 90% have cysts by third decade
E. Not seen in antenatal ultrasound scans
F. Anemia seen in majority of patients due to haematuria
42. Associations of ADPKD:

A. Berry aneurysm
B. Coarcta tion aorta
C. Aortic stenosis
D. Mitral regurgitation
E. Retinal pigment changes
F. Colonic diverticula
43. Horseshoe kidneys:

- A. Carcinoid arising from horseshoe kidney is common in the
isthmus, but wilms is seen in the upper pole
B. Is due to abnormal migration of posterior nephrogenic cells
C. The commonest association is vesicoureteral reflux
D. Stone formation is due to PUJ obstruction
E. Usually the isthmus is posterior to the great vessels
44. Features of Eagle-Barrett syndrome:

A. Prostate is absent
B. Prostatic urethra is absent
C. Prostatic utricle is dilated
D. Urethral obstruction
E. Megalourethra
45. Cysts are seen in the following locations in ADPKD:

A. Pituitary
B. Pineal
C. Ovary
D. Thyroid
E. Seminal vesicles
46. ADPKD:
A. Hepatic cysts are seen in upto 50%
B. The incidence of hepatic cysts increases with severity of renal
disease
C. Pancreatic cysts are seen in 10%
D. Liver function is not affected like in autosomal recessive disease
E. Majority have renal failure by 60 years
_Kidneys, Congenital AnonwJics· 8
47. ADPKD:
A. Majority present by 20 years
B. Hypertension occurs before renal failure
C. Polycythemia is a presenting feature
D. Can be unilateral
E. Swiss cheese appearance in nephrogram
48. Medullary sponge kidney:

A. Autosomal dominant
B. Majority are asymptomatic
C. Dilated collecting tubules
D. Stone forms within collecting tubules
E. Kidneys small

A. Morbidity of disease higher in men
B. Growth failure is due to associated renal tubular acidosis
C. One of the common causes of nephrocalcinosis
D. Increased concentration of urine
E. Bilateral
50. ADPKD:
A. The cyst wall enhances in CT contrast
B. The renal outline is smooth even in late stages of disease
C. Thickened renal fascia indicates infection
D. Irregular thick walled cyst indicates malignancy in 100%
E. Calcification of cyst rules out ADPKD
51. Associations of medullary sponge kidney:

A. ADPKD
B. Beckwith-Wiedeman syndrome
C. Congenital hypertrophic pyloric stenosis
D. Parathyroid adenoma
E. Marfan syndrome
1O Genitourinary, Obstetrics & Gynaecology and Breast Radiolo9y
ANSWERS
1. A-F, B-F, C-T, D-T, E-F
The human kidney develops from metanephros, which also forms
the proximal renal collecting system.The metanephric duct gives
rise to the calyces, pelvis and ureter
Pronephros does not form anything in humans and mesonephros
forms parts of male genital system Fetal lobulations disappear by
one year, but persists to adulthood in some people.
2. A-T, B-T, C-T, D-T, E-T
3. A-T, B-T, C-F, D-F, E-F

Upper ureter drains below the lower one, in duplex kidneys. The
ureteric buds and mesonephric ducts are incorporated into bladder
at 6 weeks. Supernumerary kidneys are commoner in the left side.
4_. A-T, B-T, C-T, D-F,E-T

Vestibule is also formed from the urogenital sinus. Wolfian duct
forms efferent ductules of testes, epididymis and vasdeferens in
males, epoophoron and paroophoron in females.
5. A-T, B-F, C-F, D-T, E-T

Posterior cuts are helpful for upper pole and anterior cuts are
helpful for lower pole. In inspiration, stone moves alongwith
kidney.
Caudal angulation of tube helps to visualize entire kidneys,
especially in children. Ureters are in anterior plane henic prone
position drains it.
For the right kidney and ureter, RPO is helpful.
6. A-T, B-F, C-F, D-T, E-T

Usually the left kidney is longer than the right by 1.5 cm. The right
kidney should never be more than 1.0 cm longer than the left
kidney.The upper poles lie medially and more posterior. The renal
pyramids have a base, body, apex and papilla which projects into
the calyx.
7. A-T, B-T, C-T, D-F, E-F

Anterior pararenal space is between the Anterior layer of Gerotas
Fascia and peritoneum. Descending colon is another content.
8. A-T, B-T, C-T, D-F, E-F

The renal fascia is called the Gerotas Fascia . The anterior layer
is the Fascia of Toldt and the posterior layer is the Fascia of
Zuckerkandl. The kidneys, suprarenals and fat are within the
perirenal space. The kidneys are separated from the adrenals by
fat.
The anterior pararenal space is anterior to the anterior renal fascia

and it crosses the midline.
9. A-T, B-T, C-T, D-F, E-T

The posterior pararenal space is between the posterior renal fascia
and posterior abdominal muscles. The space is limited medially
by attachment of renal fascia to psoas fascia.
I The perirenal space is open inferiorly and the fascia fuse inferiorly
I-·
I
with iliac and periureteric fascia, superiorly with diaphragmatic

fascia, medially with fascia of aorta and IVC and laterally form
the lateroconal fascia.
10. A-F, B-F, C-F, D-T, E-T

Usually there are two infundibula, the upper and lower, but there
may be a third middle infundibulum.There are seven ventral and
dorsal pairs of calyces.The upper three pairs drain into the upper
and lower four drain into lower pole. If there is a middle
infundibulum, the upper 3 drain the upper, the next 2 drain the
middle and lower 2 drain the lower infundibulum. Compound
calyces have two papillae indenting them, and are poor in
preventing intrarenal reflux.The renal pyramid is a one way valve.
When renal filling pressure increases, it is closed b y the pressure,
and prevents reflux.
11. A-T, B-F, C-F, D-T, E-T

The perinephric space is like an inverted cone and is broader
superiorly and narrow inferiorly. The perinephric space is filled
with fat, which is abundant in the posterior and lateral aspect.
There are also blood vessels and lymphatics.
12. A-T, B-F, C-F, D-T, E-T

The r1ght crura extends upto L3, the left upto L2.The crura are
prominent during inspiration. Median arcuate ligament is formed
by the fusion of the crura of diaphragms in midline. Diaphragm
has a muscular part and a tendinous part. The muscular part has
a vertebral· component (crus and arcuate ligaments), costal element
and sternal element.
13. A-T, B-T, C-F, D-F, E-T

In IVU, the measurements are higher due to magnification. Renal
parenchymal thickness of 1.5 cm is considered as the lower limit.
In renal failure both the length and the renal parenchymal thickness
are reduced. The lesser the thickness, worse the prognosis. In
interstitial nephritis, there is greater loss of renal length for
corresponding decrease in renal parenchymal thickness
14. A-T, B-T, C-F, D-F, E-T

The catheter is placed inside the ureter through cystoscope. Usually
less than 10 ml is enough. Overdistending the ureter will produce
severe pain. Low density should be used to prevent obscuration
of small lesions. Supine and oblique films are acquired. In PUJ,
catheter has to be placed above the obstruction, 10 cm below PUJ
and just above ureteric orifice and pictures taken at these levels.
15. A-F, B-F, C-T, D-F, E-T

Contrast should not be forcefully injected. Normal calyces appear
blunted in RGP because of retrograde instillation under pressure.
Pyelosinus or pyelotubular or pyelovenous or pyelolymphatic
extravastation do not require emergency management. RGP is also
done when the ureters are not satisfactorily visualized in rvu or
haematuria with normal IVU or before biopsy of suspected
malignancy. Contrast reactions can occur since the contrast can be
- absorbed from the renal pelvis.
16. A-T, B-T, C-F, D-F, E-F

Reflux is the most common indication in children. Micturition
should take place in the LAOor RA.Oto visualize the lower ureter.
Dysuria can be due to traurna of catheter or secondary to infections.
Majority responds to simple analgesics. The bladder has more
height than width in males. It can be funnel shaped when patient
is in erect position.
17. A-F, B-F, C-F, D-T, E-F

Spasm is avoided by using warmed contrast. Balloon cathether
should be inflated in the navicular fossa. The best p rocedure for
demonstrating prostatic urethra is cystography. Urethrography is
good for distal urethra. Supine, 30 degrees LAO and RAO are
done. Urethral fistula is best seen in voiding films.
18. A-T, B-T, C-F, D-F, E-F

Mesenteric lymph nodes: There are three group
a) Mural-near the intestinal wall;
b) Intermediate-between the arcades;
c) Juxtaarterial-adjacent to SMA trunk
Colic nodes:
a) Epicolic-on the colonic wall
b) Paracolic-along the bowel wall
c) Intermediate-along colic arteries
d) Preterminal-adjacent to SMA and IMA
Perirectal nodes are seen close to the wall of rectum, not on the
wall.
19. A-T, B-T, C-T, D-F, E-T

Kidneys also drain into the paraaortic nodes, which eventually
drain into preaortic or retroaortic nodes.
20. A-F, B-T, C-T, D-F, E-T

Obturator nodes a r e identified by the absence of fat plane,
whereas ovary has a fat plane.
Internal iliac nodes also drain the perineum, gluteal muscles and
pelvic viscera.
21. A-T, B-T, C-F, D-T, E-F

Intrarenal reflux damages the papillary center, since the ducts are
perpendicular here.
Kidneys can function perfectly without nerve supply. Removing
the pain fibres will reduce renal pain without affecting function.12
collecting ducts open on the surface of each pyramid.
22 •
A-TI B-TI C-TI D-TI E-T
Deep layers of abdominal wall, pro.state, cervix and vagina are
also ·drained.
23. A-F, B-T, C-F, D-T, E-T

Because of their size and fat content, the celiac plexus is not
routinely visualized. This receives afferents from phrenic, vagus,
splanchnic and lumbar trunks and provides efferents to all
abdominal organs.The superior hypogastric plexus lies over the
left common iliac vein. Inferior hypogastric plexus gives the middle
rectal, prostatic, vesical and vaginal and uterine nerves
24. A-F, B-F, C-T, D-F, E-T

Medial arcuate ligament is from psoas fascia and lateral arcuate
ligament is from quadratus. Lumbar plexus is within psoas.
Sympathetic nerves lie over it.
25. A-T, B-T, C-T, D-T, E-T

External oblique and internal oblique are the other ;:ibdominal wall
muscles.
26. A-T, B-T, C-T, D-T, E-F

Sympathetic nerves and thoracic duct are also seen.
27. A-T, B-T, C-F, D-T, E-T

Adrenal gland is occasionally absent in 10% of patie nts It is n o t
.
common. The splenic flexure is located more m ed ially than normal

due to absence of left kidney, b ut it is present ·
28. A-F, B-F, C-T, D-T, E-F

Sciatic nerve is the largest nerve in the body. The pudendal ner·v-e
exits the pelvis through the greater sciatic foramen and enters the
perineum through the lesser sciatic foramen. The sciatic nerve �xits
the gluteal region through the greater sciatic foramen.
Femoral and obturator nerve are from L2,3,4
29. A-T, B-T, C-T, D-T, E-T

Female genital anomalies include hypoplastic or absent uterus or
vagina (Rokitansky-Kiister-Hauser syndrome), unicomuate uterus
and duplication anomalies.
30. A-T, B-F, C-T, D-T, E-T

Reflux is common in the lower moiety as it courses less obliquely
through the bladder.
31. A-T, B-T, C-F, D-F, E-T

Retrocaval ureter causes abrupt medial deviation of the upper
ureter. There i.s associated hydronephrosis. u(cobra head" is seen
in ureterocele).
32-. A-F, B-T, C-F, D-T, E-T

Pelvic kidney receives blood supply from internal iliac artery.
Ascent is prevented by the inferior mesenteric artery. Adrenals
develop normally in their usual positions, i.e, to the posterior
aspect of IVC in right and to left crus, on the left side. But the
shape will be abnormal due to absence of renal impression.
33. A-F, B-T, C-T, D-T, D-T

Intrathoracic kidney is commoner in the left side and in males.
The incidence of pelvic kidney is about 1/300-1/1200.
34. A-T, B-F, C-F, D-T, E-T
Hypospadias, absent vagina, imperforate anus, vertebral and
skeletal anomalies are also associated.
35 •
A-F B-F C-F D-F E-F
I I I I
Ascent is prevented by inferior mesenteric artery.1/400- 1/800

incidence. The upper poles can also .fuse occasionally.The isthmus
can b e fu nctioning renal tissue or just fibrous tissue. It is twice
as common in males as females.
36. A-F, B-T, C-T, D-T, E-F

Striated nephrogram is seen in ARP!g). The collecting system is
splayed and deformed. Occasionally the cysts can communicate
with the collecting system and contrast can be visualised within
the cysts. The cysts do not communicate with each other, which
is useful for differentiating from hydronephrosis.
37. A-F, B-F, C-F, D-T, E-F

Bilateral involvement is extremely rare and associated with bad
prognosis. Incidental mass is the commonest presentation. The
ureter is ab:::-2nt or hypoplastic
Isotope stuc :es show non-functioning kidneys.
38. A-F, B-T,C-T, D-F, E-T

There is a slightly increased incidence of renal cell carcinoma, but
ADPKD is not believed to be a cause of renal carcinoma. By 20
years, more than 60% have cysts. B y 30 years, 100% of patients
have cysts in ultrasound. By 60 years, 45% of ADPKD patients have
renal failure and majority of them end in hemodialysis. Haematuria
is �een in 50% of patients.
39-. A-T, B-F, C-T, D-T, E-F

The cysts are lined by flat or cuboidal epithelium. Unlike simple
cyst, this is filled with urine. Islands of normal parenchyma can
be seen. There is no stone formation within cyst.
40. A-F, B-T, C-T, D-T, E-T

Latest theories on formation of horseshoe kidneys implicate
teratogenic elements in the formation of the isthmus of horse shoe
kidney. Renal rumours constitute almost 50% of tumours that arise
in the horseshoe kidneys, but there is no increased incidence of
it in horseshoe kidney. The risk of developing Wilms tumour is
raised by 2 times, carcinoid by 60 times and Transitional cell
t umour by 3 times. Increased risk of TCCs is due to stone
f ormation and obstruction. Increased risk of Wilms and carcinoid
is due to the teratogenic elements in isthmus.
41. A-F, B-T, C-T, D-T, E-F, F-F

Incidence is 1/1000. It is autosomal dominant and has 100%
exp ressivity with variable penetrance. :tv1utation is seen in
chromosome 16 in 90% and there are three recognised genes which
are affected. Almost all develop cysts by eighth decade. It can be
diagnosed in antenatal scans, although it usually presents in
adulthood only. Haematuria is very common, but anemia is seen
in less than 25%, due to preservation of erythropoietin production
till late in the disease.
42. A-T, B-T, C-F, D-T, E-T, F-T

Aortic regtirgitation, bicuspid valve and aortic aneurysm are other
associations. The incidence of berry aneurysm is only 5%. 80% of
those with ESRD have colonic diverticula, but this may not be
linked uniquely to ADPKD. Mitral regurgitation is secondary to
mitral valve prolapse, which is seen in 25% of cases. Rare
associations are inguinal hernia, wnbilical hernia, ptosis, aortic root
dilation, dissection of brachiocephalic artery.
43. A-F, B:-T, C-;f, D-T, E-F

There are two theories for the formation of horse shoe kidneys.
The mechanical theory postulates that the lower poles of kidn:=ys
are held together during organogenesis. The teratogenic theory

says that it is due to abnormal migration of posterior nephrogenic
cells and this is responsible for the higher incidence of Wilrns
tumour a n d ca rcinoid . The commonest association i s PUJ
obstruction due to abnormal course of ureter. Stone formation is
also due to frequent infection and reflux. Usually the isthmus is
anterior to the great vessels. Only rarely it is situated posteriorly.
44. A-T, B-F, C-T, D-T, E-T

Eagle Barett syndrome is another name for prune belly syndrome.
Prostate is absent, because of which the prostatic urethra is dilated.
45. A-T, B-T, C-T, D-T, E-T

Parathyroid, ovary, uterus, spleen, testis and epididymis are other
locations. Pancreatic cysts are seen in 10%. Liver cysts are seen
in 10% by 30 years and 75% of those above 60 years. Arachnoid
-· cysts are seen in 5%.
46. A-T, B-F, C-T, D-F, E-T

Hepatic cysts are seen in upto 50%, pancreatic and splenic cysts
in 10%. Liver cysts do not have any correlation with severity of
renal disease. In late stages, the liver function is altered and portal
hypertension can be seen.
47. A-F, B-T, C-T, D-T, E-T

The usual age of presentation is 30-40 years. Polycythernia can be
seen due to erythropoietin production. Unilateral and segmental
forms are rare variants. Swiss cheese pattern is due to
radiolucencies in the nephrograrn.
48. A-F, B-T, C-T, D-T, E-F

I t is not inherited and usually sporadic. Cystic dilatation of
collecting tubules is the pathology. The affected kidneys are usually
of normal size or large.
49. A-F, B-T, C-T, D-F, E-T

Morbidity is higher in women. Can also cause haematuria, infection
and stones. Renal concentration is impaired. It is usually bilateral.
Unilateral and segmental forms occur occasionally.
50. A-F, B-F, C-T, D-F, E-F

There is no enhancement of cyst wall but calcification can be seen.
Thickened renal fascia indicates infection. Irregular thickened cyst
is more commonly due to infection rather than malignancy.
51. A-T, B-T, C-T, D-T, E-T

Also with horseshoe kidney, duplex system,· renal artery stcnosi.:,
renal tubular acidosis and Carolis disease.

1. Renal vasculature:
A. Right ren.al artery is shorter than the left renal artery.
B. The right renal artery has to pass posterior to the IVC.
C. The posterior division of the renal artery supplies the entire
posterior aspect of kidneys.
D. The arcuate arteries form anastomostic arcade at the base of
the pyramids
E. The efferent arterioles provide capillaries to renal cortex and
medulla
2. Renal artery stenosis:

A. Constitutes 1 % of all hypertensive cases.
B. 45% of malignant hypertension
C. 45% of those with peripheral vascular disease have stenosis
D. 50% are hypertensive after restoration of normal renal flow
E. Atherosclerosis constitutes 90% of causes of st eno sis
3. Renal veins: ·
A. The left renal vein is shorter than the right renal vein
B. The superior phrenic vein drains into the left renal vein
C. The right suprarenal vein drains into the right renal vein
D. The left gonadal vein drains into the left renal vein
E. The stellate venules are the earliest tributaries of th e renal
veins.
4. Blood supply of ureter is derived from the following arteries:

A. Renal artery B. Superior vesical A
C. ·Middle rectal A D. Ute rine A
E. Gonadal A
.s. Common causes of renal artery occ lusion:

A. Trauma B. Dissection
C. Vein thrombosis D. Vasculitis
E. Fibromuscular dysplasia
6. C auses of Renal artery stenosis:

A. Neurofibromatosis
B. Homocystinuria
C. Fibromuscular hyperplasia
D. Atherosclerosis
E. Pheochromocytorna
- 7. The following f eatures indicate significant renal arterial

stenosis:
A. 70% or more stenosis
B. Large kidneys
C. Pressure gradient > 20 mm Hg
D. Collateral vessels
E. Elevated renal vein renin > 1.5 :1
8. Indications for screening for renal arterial stenosis:

A. Hypertension refractory on 3 drug regimen.
B. Well controlled hypertension becoming refractory
C. Hypertension with anemia
D. Renal failure developing in a patient on ACE inhibitors for
hypertension
E. Patients with family history of renal arterial stenosis
9. Doppler of Renal arterial stenosis:

A. Peak systolic velociy > 230 cm/sec
B. Peak systolic velocity of renal artery I aorta > 3.5
C. Increased blood flow is seen during diastole
D. Spectral broadening distal to the stenosis
E. Flow reversal distal to stenosis
10. Doppler studies of renal arterial stenosis:

A. RI > 0.7 (Resistivity index}
B. Acceleration time >0.12 sec
C. Acceleration index > 3m/sec2
D. Absent early systolic peak
E. RI >5% between the two kidneys.
11. Nuclear medicine in renal artery stenosis:

A. Sensitivity of 95%
B. The isotope is injected 60 mins after administration of captopril
C. Delay in time to peak activity
D. <40% of total renal uptake
E. Residual cortical activity at 20 minutes > 50%
Renal Vascular Disease and Trauma 19
12. Fibromuscular hyperplasia:

A. Second commonest cause of renovascular hypertension in
young adults
i
B. 35% of renovascular hypertension
i C. Associated with disease in splenic and mesenteric arteries

D. Females are more commonly affected
I
'
E. There are six different types of fibromuscular hyperplasia
I 13. FMH(fibromuscular hyperplasia):

A. Intimal fibroplasia is the commonest type
B. String of beads is seen in medial fibroplasia
C. The main renal artery is involved in intimal fibroplasia
D. Mid and distal renal artery are involved in medial fibroplasia
E. Beading with aneurysmal formation is seen in_ the perimedial
fibroplasia
14. Treatment of renal arterial stenosis:

A. Most effective is a combination of three antihypertensive drugs
B. ACE inhibitors
C. Surgical revascularisation has 90% success rate
D. Renal angioplasty-80% success for ostial lesion.
E._ Renal angioplasty-25% success for non ostial lesion
15. Blood supply to kidneys during fetal life is derived from the
following structures:
A. Aorta
B. Common iliac artery
C. Renal artery
D. Middle sacral artery
E. Internal iliac artery
16. Renal hypertension in neurofibromatosis:

A. Pheochromocytoma is the main cause.
B. Renal artery stenosis is associated with NF
C. Mainly seen in children
D. Aneurysm commonly involves the intrarenal branches
E. Periarterial neurof ibroma is the ca use of renovascular
hypertension
17. Causes of renal artery stenosis:

A. Middle aortic syndrome
B. AV malformation
C. Throrribangitis obliterans
D. Retroperitoneal fibrosis
E. Renal tumours
18. Causes of extrarenal Renal artery aneurysms:

A. IV drug abuse B. Neurofibromatosis
C. Polyarteritis nodosa D. Angioplasty
E. Fibromuscular hyperplasia
19. Causes of intrarenal renal artery aneurysm:

A. Wegener's granulomatosis
B. Allergi c vasculitis
C. SLE
D. Polymyositis
E. Amyloidosis
20. Renal vein thrombosis:

A. Amyloidosis is the precursor in adults
B. Papillary necrosis like deformity occurs in children
C. There is an association with splenic vein thrombosis
D. Large kidney is seen in acute phase
E. Pre-existing renal disease is seen in infants
21. Causes of renal vein thrombosis in adults:

A. Membranous glornerulonephritis
B. Sickle cell disease
C. Sarcoidosis
D. IVC thrombosis.
E. Constrictive pericarditis
22. Doppler of renal arterial stenosis:

A. Normal tracings are seen in collateral vessels.
B. Multiple renal arteries produce technical difficulties.
C. Left renal artery difficult to visualise than right
D. Transmitted pulsations from aorta produce artefacts.
E. Reconstituted segments of main renal artery alter the doppler
tracings.
23. Extrinsic causes of renal vein ·thrombosis:

A. Malpositioned IVC filter
B. Carcinoma of pancreatic tail
C. Lymphoma
D. Duodenal carcinoma
E. Pancreatitis
24. IVU findings of renal arterial stenosis:

A. Delayed appearance of nephrograrn
B. Early washout of nephrogram
C. Progressively dense nephrogram
D. Notching of ureter
E. Collecting system not distended
1
,
Renal Vascular Disease and Traurna �·1
f
25. Causes of renal vein thrombosis in children:
A. Abruptio placentae B. Sepsis
:
C. Anemia D. Birth trauma

E. Right adrenal haemorrhage
26. Collateral channels are derived from the following vessels m
renal vein thrombosis:

A. Portal vein
B. Azygos vein
C. Gonadal vein
D. Inferior mesenteric vein
E. Adrenal vein
27. Features of acute renal vein ·thrombosis:

fI A. Smooth enlarged kidneys
B. Massive hematuria
?
C. Thrombocytopenia
D. Delayed dense nephrogram
E. Hypertension
28. Features of acute renal vein thrombosis:

A. S egmental veins show venous flow pattern.
B. Resistive index < 0.7
C. Thrombus extends into IVC
D. Pulmonary embolus develops in 50%
E. Dense pyelocalyceal ";isualisation.
29. Renal trauma:

A. Blunt trauma is common than penetrating trauma
B. Acute tubular necrosis is seen within 20 min utes
C. Grade IV injuries are managed by surgery
D. S hattered kidney can be managed by embolisation
E. Renal pedicle injuries comprise 3-5% of renal trauma
30. Features of L o b ar renal infarc ti o n :

A. Focal absence of nephrogram
B. Hypodense nonenhancing area
C. Dilated collecting system
D. Focal scarring
E. Interpapillary line is distorted
31. Chronic renal vein thrombosis:

A. Presents with massive proteinuria
B. 50% asymptomatic
C. Small echogenic kidney is seen
D. Notching of ureter
E. Normal IVU in 25%
32. CT scan features of chronic renal vein thrombosis:

A. Thick Gerotas fascia
B. No corticomedullary differentiation
C. IVC thrombosis.
D. Absent opacification of pyelocalyceal system
E. Collaterals are too small to be visualised in CT scan
33. The following are indications of renal venography:

A. Renal vein thrombosis
B. Renal vein hypertension
C. Portal hypertension treatment
D. RCC
E. Renal agenesis
34. Renal vein thrombosis:

A. Collateral vessels forms at 24 hours
B. Peak formation of collateral vessels is at 1 week after onset
of disease
C. Radiological appearance depends on the rapiditiy of occlusion
D. Extent of occlusion decides the radiological appearances
E. Appearances vary with the age
35. Features of Subacute renal vein thrombosis:

A. Small kidneys B. Compressed collecting system
C. Small main renal vein D. Normal nephrogram
E. Hyperechoic cortex
36. Causes of renal infarction:

A. Syphilis
B. Left atrial tumour
C. Umbilical artery catheter
D. Infective endocarditis
E. Diabetes
37. Radiological features of acute renal infarction:

A. Large kidney
B. Rim nephrogram
C. Hypoechoic kidney within 24 hours
D. Hyperechoic in 7 days
E. Collecting system opacified only by retrograde studies
38. Renal tr auma:

A. Infarcts are common in the interpolar region at the j unction
of vacular supply
B. Any renal infarct requires surgical management.
C. Contusions produce striated nephrogram.
D. Urinomas require surgical removal.
E. All perinephric haematomas require surgery and neplu2ct'.}ffty
39. Renal trauma:

A. The common site of renal artery occlusion is at the most distal
part.
B. Angiography is required in all cases of suspected renal arterial
occlusion.
C. In renal arterial occlusion, the rig h t renal veins are not
opacified.
D. Renal venous injury is more common than renal arterial injury
E. In active bleeding, extravastation of contrast can be seen.
I
I
40. Indications for screening for renal arterial stenosis:
A. Hypertension with abdominal bruit
!
\I B. Hypertension with raised creatinine
i C. Patients < 25 years developing hypertension
I D. Patients > 60 years developing hypertension.
E. Recent onset hypertension with diastolic pressure> 95 mmHg
41. Features of Chr onic infarcti on:

A. Scarred small kidney
B. Hyperechoic in 10 days
C. Focal wasting of parenchyma
D. Distorted venous architecture due to collaterals
E. Late visualisation of renal arteries in aortogram
42. Causes of peri renal haematoma:

A. Renal infarction
B. Renal cyst
C. Adrenal tumour
D. Aortic aneurysm
E. Retroperitoneal tumour
43. Renal trauma:

A. Vascular pedicle injury is classified as Type IV
B. 50% of renal injuries are minor and 50% are major
C. Small contusions resolve spontaneously
D. There is delay in appearance of nephrogram in subcapsular
haematoma
E. Page kidney indicates renal hypertension resulting from
subcapsular haematomas
44. Causes of chyluria:

A. Filariasis
B. Thor acic aortic aneurysm
C. Pelvic lipomatosis
D. Pregnancy
E. Schistosomiasis
45. Causes of renal vein thrombosis in children:

A. Advanced maternal age
B. Diabetic mothers
C. Sickle cell disease in mothers
D. Umbilical vein catheterisation
E. Diarrhoea
- 46. Lymphangiography is useful in the following cancers:

A. Testicular tumours B. Ovarian cancers
C. Cervical cancers D. Bronchogenic cancers
E. Prost<I te cancers
47. Spontaneous renal haemorrhage is seen in:

A. Polyarteritis nodosa
B. Tuberous sclerosis
C. AV malformation
D. Renal artery aneurysm
-- E. Renal vein thrombosis
48. Perinephric collection:

A. Page kidney is a long term sequela of perinephric haematoma
B. Renal angiography should be done, if CT shows perinephric
haematoma and no obvious cause for it
C. Acute Perinephric haematoma is hypodense in contrast
enhanced scans
D. Renal cell carcinoma is the commonest cause of perinephric
haemorrhage
E. Chronic haematoma show attenuation values equal to that of
water
49. The following are causes of acute renal ischemia in the presence
of normal renal arteries:
A. Aortic dissection
B. Thrombosis in renal artery aneurysm
C. Aortic occlusion
D. Takayasus arteritis
E. Trauma
50. The following are causes of acute renal arterial thrombosis:

A. Neurofibromatosis B. Polyarteris nodosa
C. Cocaine D. Nephrotic syndrome
E. TCC in renal pelvis
51. The following are clinical presentations of acute renal ischemia:

A. Fever B. Acute pulmonary edema.
C. Rash and myalgia D. Acute loiil pain
E. Jaundice
52. Indications of angiography in renal trauma:

A. Persistent haematuria
B. Hypotension following trauma
C. Hypertension after trauma
D. Segmental non-enhancement in CT
E. Retroperitoneal haematoma
53. Renal trauma:

A. Absence of haematuria excludes renal injury
B. CT is the imaging modality of choice
C. One shot IVU is used for unstable patient
D. Main renal artery occlusion presents with absent enhancement
in CT scan
E. Cortical rim sign due to collateral is seen within eight hours
of injury
54. Bladder injury:

A. Associated with pelvic fractures in 70%
B. Delayed CT after Iv contrast is as good as CT cystography
for detection of bladder injury
C. Bladder is injured in 50% of pelvic fractures
D. Cystogram should be deferred if vascular injury is suspected.
E. Cystogram should be done in all patients with haematuria and
pelvic fractures
55. Bladder injury:

A. Urethral injury is not a contraindication to cystography
B. 80% of bladder injuries are intraperitoneal
C. The commonest site of intraperitoneal rupture is the neck of
bladder.
D. In extraperitoneal rupture, contrast can outline the kidneys.
E. In extraperitoneal rupture, the contrast outlines the bowel
loops.
56. Urethral injury:

A. The penile urethra is the commonest site of urethra involved
in trauma.
B. Elevation of prostate in rectal examination indicates urethral
injury.
C. Not more than 50 ml of contrast is required for a satisfactory
cystrogram in a trauma setting.
D. Foleys catheter should be avoided for urethrogram in urethral
inJunes
E. Blunt injuries are more common than penetrating in injuries

of anterior urethra.
26 Genitourinary, Obstetrics & Gynaecology and Breast Rao'iology
57. Ureteral injury:

A. The most common part of genitourinary tract to be injured.
B. Haematuria is seen in 90% of cases.
C. Severe hyperextension injuries cause avulsion of ureter.
D. IVU detects the injury in 95% of cases.
E. The middle part is the most common site to be tom during
surgery.
58. Urinomas:
A. Obstruction is the only cause
B. Urine has a lipolytic effect on perinephric fat and urinoma is
forrneu after -urine extravastation in 4-5 days
C. Percutanous drainage alone is enough for all urinomas.
D. Cavity without communication with urinary tract closes in
three days.
E. Ureteric stent is indicated for persistent urinoma.
--
59. Renal arterial stenosis:

A. The most common site in transplant kidney is the site where
clamp is placed.
B. In atherosclerosis, abdominal aorta is always involved.
C. Only the kidney is involved in 20% of atherosclerosis.
D. MRI is good for showing distal arterial changes in FMH.
E. Intermittent renal arterial stenosis is produced by aortic
dissection.
60. Renal vascular disease:

A. MRI has 100% sensitivity for detecting tumor thrombus beyond
distal renal veins.
B. MRI cannot show the hemodynamic significance of renal
arterial stenosis.
C. Loss of corticornedullary differentiation indicates functional
loss.
D. 3D Phase contrast images are useful in assessing hemodynamics
of stenosis.
E. The spatial resolution of MRI is lmm3•
I Renal Vascular Disease and Trauma
ANSWERS
27
1. A-F, B-T, C-F, D-F, E-T

The right renal artery is longer and st raighter than the left renal
artery. The renal arteries divide into anterior and posterior
divisions. Then there are five segmental branches, interlobar
arteries, arcuate arteries, interlobular arteries, afferent arterioles,
capillaries and efferent arterioles. The posterior division supplies
the upper and mid regions of the posterior aspect. The entire
anterior aspect and posterior aspect of lower pole are supplied
by anterior division.The arcuate arteries do not anastomose
although they form arcs. Right renal artery passes behind IVC,
renal vein pancreas and 2nd part of duodenum.
2. A-T, B-T, C-T, D-F, E-T

15% are hypertensive after restoration of normal renal blood flow.
3 '
A-F B-F C-F D-T E-T
I I I I
The left renal vein is longer, and it receives the inferior phrenic
. vein, suprarenal vein and gonadal vein. The right renal vein has
no t ributaries. The stellate venules are the earliest tributaries,
which anastomose and form 6 interlobular veins, which join to
form the renal vein.
4. A-T, B-T, C-T, D-T, E-T

Also from common iliac and inferior vesical
5. A-T, B-T, C-F, D-T, E-F

Atherosclerosis and embolism are other causes.
6. A-T, B-F, C-T, D-T, E-T

The common causes of renal artery stenosis are atherosclerosis and
fibromuscular h yperpl as ia. Other lesser known causes are
neurofibromatosis, pheochromocytomas, AV malformation and
aneurysm, Arteritis (TAO, PA;,'J, Takayasu, syphilis), fibrous bands
(retroper itoneal fibrosis, congenital, radiation), Middle aortic
syndrome,· aortic dissection and thromboembolic disease, extrinsic
compression ( cysts, neoplasms, hematoma)
7. A-T, B-F, C-F, D-T, E-T

Pressure gradient more than 40 mm and small kidneys are
si gnifican t
8. A-T, B-T, C-F, D-T, E-F

Screening can be done by captopril scintigraphy /ultrasound/
angiography /MR angiograms/CT angiograms.
28 Genitourinary, Obstetrics & Gynaecology-and Breast Radiology
9. A-F, B-T, C-F, D-T, E-T

Peak systolic velocity is more than 150 cm/ sec. Decreased blood
flow during diastole
10. A-F, B-T, C-T, D-T, E-T

Rl < 0.56. Acceleration time and acceleration index are automatically
calculated from one of the peripheral renal arteries including the
arcuate arteries. The acceleration time is the time taken for reaching
the peak of the curve and acceleration index is the slope of the
curve.
11. A-T, B-T, C-T, D-T, E-F

Residual cortical activity is more than 30%
12. A-F, B-T, C-T, D-T, E-T

Intimal fibroplasia, medial fibroplasia, perimedial fibroplasia,
adventitial fibroplasia, medial hyperplasia and medial dissection
are the six types of FMH. Fibromuscular hyperplasia is the most
__
common cause of renovascular hypertension in young adults.
13. A-F, B-T, C-T, D-T, E-F

Medial fibroplasia is the commonest type and it involves the mid
and distal renal arteries. The changes are in the form of string of
beads with multiple narrowings and aneurysms.
In periadvential fibroplasia has beading, but there is no aneusymal
formation.
14. A-F, B-T, C-T, D-F, E-T
Renal angioplasty-SO% success for non ostial and 25% success for
ostial lesions.
15. A-T, B-T, C-T, D-T, E-F
The kidney is formed in the pelvis and ascends during
development. Initially it is supplied by middle sacral artery and
common iliac artery and later by aorta.
The renal artery develops from the 12th intrauterin e week.
16. A-T, B-T, C-T, D-F, E-F

Renal arterial hypertension can be caused by
A. Pheochromocytoma
B. Renal arterial stenosis-due to mesodermal dysplasia, very
rarely due to periarterial neurofibroma
Aneurysm if seen, will be seen in the main renal artery and not
in the intrarenal branches.
17. A-T, B-T, C-T, D-T, E-T
18. A-T, B-T, C-F, D-T, E-T
The causes of extrarenal renal artery aneurysms are atherosclerosis,
fibromuscular hyperplasia, congenital, neurofibromatosis, n-;.ycotic,
traumatic and post angioplasty.
-- Renal Vascular Disease and Trauma 29
19. A-T, B-T, C-T, D-F, E-F

The causes of intrarenal renal artery aneurysm, are Polyarteritis
nodosa, Wegener's granulomatosis, congenital, atherosclerosis,
Angiomyolipoma (in tuberous sclerosis and isolated), SLE, drug
abuse vasculitis, allergic vasculitis, renal cell carcinoma, transplant
rejection and neurofibromatosis.
20. A-T, B-T, C-T, D-T, E-F

In infants, the commonest cause is riehydration. Ninety percent
I occur in infants and 75% occur in neonates. Kidney is enlarged

and edematosis in acute phase. RVT can be associated with splenic
fi
vein/ portal vein thrombosis.
t
f 21. A-T, B-T, C-T, D-T, E-T

Pyelonephritis, amyloidosis, PAi"\I, diabetes, SLE, trauma are other
causes.
22. A-T, B-T, C-T, 0-T, E-T

These are some of the limitations of Doppler od renal vessels.
23. A-T, B-T, C-T, 0-F, E-T

Retroperitoneal sar coma, retroperitoneal fibrosis and other
retorperitoneal masses are recognised causes.
24. A-T, B-F, C-T, D-T, E-T

Delayed appearance is due to reduced GFR and the washout is
also delayed.
Notching is due to-..collateral vessel formation.
25. A-T, B-T, C-F, 0-T, E-F

Left adrenal haemorrhage, advanced maternal age, diabetic.
mothers, umbilical vein catheterisation, diarrhoea and polycythemia
cause renal vein thrombosis. Enterocolitis, sepsis, prematurity are
other causes.
26 •
A-T B-T C-T 0-F E-T
I I I I
27. A-T, B-T, C-T, 0-T, E-T

Inadequate collateral vessel formation is seen in acute renal vein
thrombosis.
28. A-T, B-F, C-T, 0-T, E-F

There is no flow in the renal veins. But occasionally flow can be
seen in the collateral veins and segmental veins. In angiography,
there will be no flow from the renal veins into the IVC. Resistive
index �s > 0.7. In IVU, the kidneys are smoothly enlarged, with
delayed dense nephrogram and non-visualisation of the collecting
system.
29. A-T, B-T, C-F, D-T, E-T

Grade IV injuries are managed conservatively in 60% of cases.
Grade V injuries require surgery or percutaneous ernbolisation.
30. A-T, B-T, C-F, D-T, E-F

The interpapillary line is normal. The collecting system is not
dilated, like chronic atrophic pyelonephritis, where the underlying
system is dilated opposite the scarring.
31. A-T, B-F, C-T, D-T, E-T

90% are asymptomatic. Majority present with nephrotic syndrome
which has proteir:mria, hypertension, hypercholesterolemia and
anasarca. The kidneys are small and echogenic . The IVU may be
normal with good collateral circulation, which notch the ureter and
collecting system.
32. A-T, B-F, C-T, D-T, E-F

-· Prolonged corticomed ullary differentiation. Delayed or absent
opacification of collecting system. Collaterals are seen in the
perirenal region and the retroperitoneum.
33. A-T, B-T, C-T, D-T, E-T

Renal vein hypertension can be caused by compression of the left
renal vein by the superior mesenteric artery against the abdominal
aorta. Left renal vein is used for making splenorenal shunt in
portal hypertension and assessment of renal vein is essential before
treatment. Renal vein involvement is essential in surgical planning
for renal carcinoma. Renal vein is absent in renal agenesis and is
a useful way of differentiating from acquired atrophy.
34. A-T, B-F, C-T, D-T, E-F

Peak formation is at 2 weeks.
35. A-F, B-T, C-T, D-T, E-T

Kidneys arc large. Nephrogram normal or decreased, but denser
with time.
Main renal vein small due to recanalisation
36. A-T, B-T, C-T, D-T, E-F

Thrombus and embolus are the commonest causes o f renal
infarction. Renal vein thrombosis, trauma, polyarteritis nodosa and
sarcoidosis are other causes..
37. A-T, B-T, C-T, D-F, E-T

The kidneys are hypoechoic within 24 hours and are normal within
a week.
The parenchymal thickness may be normal and the collecti�.�
system may be attenuated
38. A-F, B-F, C-T, D-F, E-F

Infarcts are seen as wedge shaped hypodensities and are seen in
the polar regions. I solated renal infarct are managed conserva
tively. Urinomas are managed conservatively. If they are infected,
percutaneous drainage is indicated. Perinephric haematomas are
managed conservatively. But if there is haemodynamic instability,
embolisation or nephrectomy are performed.
39. A-F, B-F, C-F, D-F, E-T

The most common site of arterial occlusion is between the proximal
and middle part. CT will show non contrast opacification in renal
arterial occlusion and if CT is indicative, renal angiography is not
required for confirmation, unless an intervention is planned. There
is no opacification of conti:ast in renal arteries and veins if there is
occlusion, but occasionally there can reflux of contrast from rvc into
the renal veins, especially on the right side. Renal venous injury is
very rare and cause perinephric haematoma. Active bleeding is
demonstrated by extravasation of contrast measuring of significantly
high density, usually more than 80 HU and more than old clot.
40. A-T, B-T, C-T, D-F, E-F

Recent onset hypertension with diastolic pressure > 105 mm Hg.
41. A-F, B-F, C-F, D-F, E-T

The kidney is small and smooth. There is no focal scarring. The
parenchymal thickeness may be reduced. Hyperechoic in 17 days.
Venous architecture is normal.
42. A-T, B-T, C-T, D-T, E-T

Also seen in trauma, bleeding diathesis, renal tumours, vasculitis
or idiopathic
43. A-F, B-F, C-T, D-T, E-T

Classification of renal trauma.
I- contusion or subcapsular haematoma, II- superficial laceration
without involvement of medulla or collecting system, III-deep
laceration with or without urine extravastation, IV-involvement of
collecting system and urine leak, V-shattered kidney, renal pedicle
injury, devacularised kidney. Seventy to eighty percent of renal
injuries are mild, requiring only conser vative management.
Subcapsular haem.atomas can apply resistance on the kidney, delaying
the perfusion.
44. A-T, B-T, C-T, D-T, E-F

Filariasis is the commonest cause. Other causes include those which
cause compression or narrowing of thoracic duct or fistula between
renal tract and lymphatics. Tuberculosis, trauma, s urge:y,
lymphoma and other neoplasms are recognised causes.
45 • A-TI B-TI C-FI D-Tf E-T

See Q 25.
46. A-T, B-F, C-T, D-F, E-T

Lymphangiography is very sensitive in finding lymph node
metastasis.
47. A-T, B-T, C-T, D-T, E-T

Angiomyolipomas are known for causing spontaneous massive
haemorrhage.
48. A-T, B-T, C-T, D-F, E-T

Page kidney is hypertension secondary to perinephric collection
due to compression of renal parenchyma and release of renin.
Acute haematoma is hyperdense in non contrast scans. In contrast
scans, the normal renal parenchyma enhances and the haemorrhage
a p pears h y podense relative to the kidney. Trauma is the
_.commonest cause of perinephric haemorrhage. Angiomyolipoma
is the commonest cause of a spontaneous perinephric haemor
rhage. The density of the haemorrhage decreases with time.
49. A-T, B-F, C-T, D-T, E-T

Embolisation from central thrombosis, acute thrombus due to
coagulation abnormality, bullet embolism and idiopathic are other
causes.
50. A-T, B-T, C-T, D-T, E-T

Trauma, oliguria, PAN, syphilis, exercise, hypercoagulable states,
sickle cell anemia, renal transplant are other causes.
51. A-T, B-T, C-T, D-T, E-F

Acute on chronic renal failure, acute renal failure, acute loin pain,
hematuria, neurological dysfunction are other causes.
52. A-T, B-T, C-T, D-T, E-T
53. A-F, B-T, C-T, D-T, E-F

Haematuria can be absent even in main pedicle injury. Cortical rim
sign is not seen before eight hours after injury. Sometimes normal
enhancement can be seen if there is partial occlusion or if there
is reformation of blood supply by collaterals.
54. A-T, B-F, C-F, D-T, E-T

CT cystography, with instillation of contrast is very accurate in
the diagnosis of bladder injuries and is far superior to cystogram
or delayed CT after iv contrast. Bladder is injured in 10-15% of
fractures. I n v ascular injuries, angiography is performed a:r.d
cystogram can be done after the angiography to prevent obscuring.
Renal Vascular Disease and Trauma 3�
55. A-F, B-F, C-F, D-F, E-F

.
Urethral injury is a contraindication to retrograde catherisatian
for cystogram. Only 10-25% of bladder injuries are intraperitoneal
and the commonest location is the dome of the bladder. In
intraperitoneal rupture, the contrast is seen outlining the bowei
loops. In extraperitoneal rupture, the contrast streaks and extends
to the prevescial space, abdominal wall, thigh, scrotum, perineum
and occasionally to the kidney retroperitoneally.
56. A-F, B-T, C-F, D-F, E-F

Posterior urethra is the commonest site of urethra involved in
trauma. It is i nvolved in 10% of pelvic fractures. It is very common
I
in males. There is characteristic blood in the urethral meatus,
inability of void and high riding rectum in per rectal examination.
I
l
250-300 ml of contrast is instilled into bladder for an adequate
� examination. Too little or too much of contrast will produce
spurious results. Foleys catheter can be introduced into the tip of
the urethra, ballon inflated and 30 ml of contrast instilled to assess
the urethra. Penetrating injuries are commoner than penetrating
· injuries in the anterior urethra.
57. A-F, B-T, C-T, D-T, E-F

Ureter is the least common part to be injured due to small caliber,
motility and peristalsis, protection by back muscles and retro
peritoneal fat. Penetrating trauma, high speed motor vehicle
injuries, sugeries (hysterectomy, oophorectomy, ureterolithotomy,
colectomy, appendectomy, aortoiliac bypass) are common causes.
The middle part is the most vulnerable part of urter due to vascular
supply. But the ureter is commonly injured at the pelvic brim, .
where it crosses iliac artery and is posterior to broad ligament
and ovarian vessels.
58. A-F, B-F, C-F, D-T, E-T

Obstruction, trauma are the common cause sof urinoma which is
also called urinferous pseudocyst. Diagnosis can bt-> confirmed by
presence of creatinine and ab sence of amylase in the fluid
collection. Once the urine extravastates, it has a lipolytic effect and
destroys the perinephric fat in 2-3 days, but it takes 3-4 weeks
for a fibrous capsule to form. Percutaneous drainage is enough if
there is urinoma without obstruction or communication with
collecting system. The cavity collapses in three days, after which
the drain can be removed. If there is communication, an ureteric
stent or nephrostomy is required for the fistula to heal.
59. A-F, B-F, C-T, D-F, E-T

In transplant, the commonest site is anastomostic site > cla1npc:l_
site > iliac arteries. Only the distal renal arterial F·=: .�ons �.:·'
34 Genitourinary, Obstetrics & Gynaecology- and Breast Radiology
involved in atherosclerosis. MRI is good for the proximal portions

of the renal artery, but not for distal portions of FMH. Aortic
dissection can extend into the renal artery of the renal artery can
be invovled in the dissected aorta.
60. A-T, B-F, C-T, D-T, E-T

MRI has 100% sensitivity for detecting tumour thrombus in large
vessels. MRI can show the hemodynamic significance of renal
arterial stenosis. 3D phase contrast images will show spin dephasing
at the site of stenosis. Cine Phase contrast images show altered
flow velocity curves. Temporal enhancement curves can be used
to assess functional state of the kidney. Asyrrurietrical enhancement
is another feature indicating loss of renal function. The normal
renal parenchymal thickness is 1.7 cm .±._0.3 cm.
1. IVU:
A. Post void film is an accurate method for assessment of residual
unne
B. Erect film is helpful for diagnosing nephroptosis
C. In obstruction, if no nephrogram or PCS (collecting system) is seen
after 24 hours, a delayed film should be done at 72 hours
D. If there is faint nephrogram and no PCS contrast after 24 hours,
obstruction is ruled out
E. Inferior calyces are best seen in prone films
2. IVU:
A. Films taken when the patient is breathing is useful in
perinephric inflammation
B. For acute renal colic, emergency IVU is performed with a
·
single film at 20 minutes

C. I n intermittent PUJ, large amount of water is given to
precipitate a n acute obstruction
D. The density of contrast in IVU is a good indicator of renal function
E. A dense excretion indicates good function, even in obstruction
3. IVU in patients with renal failure:

A. No contrast should be given after IVU for two days
B. Hydration is necessary before procedure, but not necessary
after procedure
C. Continue nephrotoxic drugs
D. Dehydration should be done with careful monitoring
E. Metforrnin should be stopped
4. IVU:
A. The most important factor in the quality of NU is concentration
·of contrast in kidney
B. The contrast material used for IVU bind to albumin
C. The l)ydronephrosis of pregnancy takes 6 weeks to resolve
after pregnancy
D. Reduce dose in congestive cardiac failure
E. Use non-ionic contrast in cardiac failure
5. Factors determining quality of IVU:

A. Integrity of tubules
B. Cardiac function
C. Anterior pituitary function
D. Volume of collecting system
E. Bladder capacity
-6. IVU:
A. A right angled pelvis is seen in polycystic kidney disease
B. Vascular impression is common in the upper infundibula
C. In bifid pelvis, the lower pelvis has more calyces
D. Upper and lower polar thickness are within one or two mm
of each other
E. Kinking of ureter is more common when the patient is prone
o r in inspiration
7. Patterns of calcification and causes:

-A. Fibroid is irregular and mottled
B. Tuberculosis of spleen-punctate
C. Cyst-curvilinear
D. Lucent center-vascular
E. Vas deferens-diabetes
8. IVU:
A. Senile lipomatosis produces trumpet shaped calyces
B. Replacement lipomatosis is seen after infection
C. Compensatory hypertrophy is more common in infants
D. Hypertrophied column of bertin is commoner in duplex kidney
E. Bertin columns are common at the junction of upper and mid
third of kidney and surrounded by fat
9. IVU:
A. Bladder hernia is best seen in oblique view
B. The kidney is a retroperitoneal organ and hence there is no
mo vement in respiration
C. The medial border of the k idney overlaps the psoas shadow
D. The renal length decreases upto 50% in old age
E. 70% of polar clyces are compound
10. Angiographic nephrogram:

A. Only the cortex is visualised
B. Seen for upto 90 seconds
C. 20% of renal flow is to the cortex and 80% to the medulla
D. In dynamic CT and angiography the angiographic nephrogram
is visible for 30 seconds
E. In urographic nephrogram, the entire kidney is opacified
Renal Imaging 37
11. Nephrogram:
A. Urographic nephrogram is useful for analysis of vascular
anomalies
B. In segmental arterial occlusion, it ta k e s three wee k s for
contour deformity to develop
C. A tram track type of perfusion is suggestive of acute cortical
necrosis
D. There is no vascular nephrogram in main renal artery occlusion
without collateral
E 1ri- acute fuourar-necros1s, frnmeaiate- ne-phrognrm indicates
normal GFR (Glomerular filtration rate)
12. Nephrogram:
A. Immediately dense persistent nephrogram in ATN indicates
return of filtered contrast to circulation
B. Striated nephrogram is due to hyperconcentration of contrast
in the medullary rays
C. Increasingly dense nephrogram in obstruction is due to
reabsorption of sodium and water
D. Multiple myeloma produces increasingly dense nephrogram
E. Slow tubular transit is a recognised causes of increasingly dense
nephrogram
13. Differe nti al diagnosis of rim nephrogram:

A. Acute cortical necrosis
B. Acute glornerulonephritis
C. Acute pyelonephritis
D. Acute tubular necrosis
E. Renal vein thrombosis
14. Normal phases of nephrograrn and their timing:

A. Vascular nephrogram-10-15 seconds
B. Interlobular artery-2 mins
C. Cortical nephrogram-20-45 seconds
D. Loops of Henle-5-10 minutes
E. Excretory phase-2-3 minutes
15. Excretion from kidney:

A. The pacemaker of ureteric peristalsis is situated in the proximal
part of PCS
B. The peristalsis is initiated by an imptilse passing from spinal
cord
C. The peristaltic wave spreads due to segmental innervation
D. At very high flow, the peristalsis is very fast
E. The first site at which movement of urine occurs by peristalsis
occurs is the pelviureteric junction
16. Collecting system:

A. Emptying of wide collecting system in upright position rules
out obstruction
B. The dilatation of collecting system is more in chronic than acute
obstruction
C. The tubules are damaged in chronic obstruction
D. The renal pelvic pressure is normal in chronic obstruction
E. The functional defect of obstruction is more in intrarenal than
extrarenal pelvis
17. The following are causes of compensatory hypertrophy:

A. Ureteric ligation B. Hyperthyroidism
C. Cushing' s syndrome D. Folic acid
E. High sodium and low potassium intake
18. IVU:
A. Contrast reactions are less in children
B. Bolus injection gives a denser nephrogram than drip infusion
C. 25 g I is t h e optimal contrast for filling of calyces, and
increasing the does beyond this, will not improve filling
D. There is a direct relation between the amount of contrast and
the incidence of serious contrast reactions
E. Pyelosinus extravasation can cause retr operitoneal fibrosis
19. IVU:
A. The tl /2 of contrast is two hours
B. Booster given after one hour gives maximal opacification
C. Peak plasma concentration is achieved at 10 minutes
D. Almost 100% of contrast is excreted by 6 hours
E. The rate of administration of contrast can be increased to give
better image, especially i n those with low GFR
20. IVU:
A. The density of IVU is less if there is calyceal diverticulurn
B. The density of IVU is higher with meglumine salts than sodium
C. The Calyceal distension is better with sodium salts
D. IVU should ideally be done before cystoscopy
E. Dehydration precipitates r enal failure in amyloidosis
21. Static radionuclide imaging of the kidney:

A. 99tnTc DMSA is the radionuclide of choice
B. 99mTc DMSA is the best for imaging pseudotumour of kidney
C. DMSA scanning can rr.easure relative tubular mass
D. DMSA scanning can c�tect of areas of renal ischaemia
E. Optimum time for DM3A scanning is one week after onset of
symptoms in infection
Renal Imaging 39
22. MAG 3 scintigraphy:

A. Best method for assessment of scarring in children
B. Prolonged transit time in dilated system
C. Reliable for diagnosis of obstruction in renal failure
D. Prolonged parenchymal transit time in renal artery stenosis
E. Patients are dehydrated before study
23. IVU:
A. In renal failure, the dose is half of normal adult person
B. 25 ml/ min is the GFR below which IVU is not useful
C. There is absolutely no use of performing an IVU with GFR of
0 ml/min
D. The normal adult dose for IVU is 300 mgI/kg
E. The quality of images is better in a patient after dialysis than
renal failure without dialysis
24. Asc ending urethrography:
A. Urinary tract infection is a contraindication
B. 20% incidence of rupture of urethra
C. Spasm is more with warm contrast
D. Catheter is inflated in the navicular fossa
E. Images are acquired in both the RAO and LAO
25. Genitourinary tract:
A. Transvaginal scans require full bla dder for satisfactory
evaluation of adnexa
B. Pain after hysterosalpingography can persist for two weeks
C. The corticomedullary phase of renal CT is after 100 seconds
D. Cortical phase is after 5 minutes
E. Adrenaline is contraindicated in renal arteriography when.
there is a renal tumour
26. MCU:
A. Retention of urine is a sequela of MCU
B. Presence of reflux in MCU is an indication of antibiotics
C. Cystitis is a r ec ognized complication
D. Micturition films should be obtained in the supine position
E. Full length film of abdomen is required for demonstrating
reflux
27. Genitourinary tract:

A. Pressure in renal pelvis more than 6 cm H20 is indicative of
obstruction
B. Vesicoureteric reflux should be excluded before pressure flow
studies are done
C. Selective renal catherisation is done with a pigtail catheter
D. Aneurysm is a complication of renal biopsy
E. Renal hydatid should n ev er b e pu nctur ed
28. IVU:
A. In a patien t with history of allergy, steroids should be
administered immediately before the procedure to avoid
reaction
B. Bowel gas can be reduced by moving about before the
procedure
C. If the five minute film does not show satisfactory opacification,
more contrast should be injected
D. Full length films are unnecessary in the post micturition phase
E. Better emptying of the ureters is obtained with prone films
29. Renal scintigraphy:

A. For captorpril test, ACE inhibitors should be stopped on the
day of test
B. MAG- 3 is used for assessing renal scarring
C. DMSA is superior to MAG- 3 for both dynamic and structural
assessment
D. Radiation dose is lower with MAG -3
E. 100% of MAG -3 is excreted by tubular secretion

A. DMSA images are acquired within one hour of injection to
avoid artifacts
B. DTPA is the isotope of choice for dynamic renal scans
C. Kidney I background ratio is better for MAG 3 than DTPA
D. I 123 can be produced only by cyclotrons
E. Hippuran is completely cleared by glomerular filtration

A. The glomerular filtration rate of DTPA is 500 ml/min
B. DTPA is completely cleared by tubular secretion
C. The maximum diuresis occurs within 2 minutes of diuretic
administration
D. Images are acquired between 5-10 mins for perfusion studies
in transplants
E. Post void films are indicated in cases of stasis
32. Static renal scans are indicated in the following instances:

A. Horseshoe kidney B. Renal agenesis
C. Column of bertin D. Individual renal function
E. UTis
33. Recognised indications of dynamic nuclear scanning:

A. Hypertension B. Renal transplantation
C. Renal trauma D. Reflux
E. Tumours
:/
i Renal Imaging 41
34. Direct radionuclide cystography:

A. Not useful for measuring residual volume
·
B. MAG-3 is used
C. If no reflux is demonstrated, repeat the procedure immediately
D. Sca nning at 20 hours will demonstrate intrarenal reflux
E. More radiation and less sensitive than conventional cystography
35. IVU:
A. There is no glomerular filtration when the blood pressure is
less than 70 mm Hg
B. Anxiety reduces the amount of contrast entering the kidney
C. GFR decreases with age
I
D. Dehydration increases tubular reabsorption
E. The density of IVU is twice in dehydration as in normal patient
I
36. Causes of radio-opacity in plain film:
A. Urate stones
B. Xanthine stones
C. Renal tubular acidosis
D. Sarcoidosis
E. Hyperoxaluria
37. Filling defects in the ureter occurs in:

A. Schistosomiasis
B. Renal vein thrombosis
C. Leukoplakia
D. Tuberculosis
E. Retroperitoneal fibrosis
38. Calyceal diverticulum:

A. Collection of stones in the periphery of kidney indicates
calyceal diverticulum
B. Type I extends from the pelvis
C. Type I is commoner in the upper pole
D. Reflux is a known cause for calyceal diverticulum
E. 50% of diverticulum have stones
39. Calyceal diverticulum:

A. The neck is not visualized in all cases
B. Caused by ureteral bud remnants that h a ve failed to
differentiate into fully formed calyces
C. Not visualized if there is infection of the diverticula
D. Persistent opacification after contrast has cleared from kidney
E. Milk of calcium changes shape with position
42 Genitourinary, Obstetrics & Gynaecology and Breast Rao'iology
40. Differential diagnosis of calyceal diverticulum:

A. Tuberculosis
B. Mild papillary necrosis
C. Medullary sponge kidney
D. Stones
E. Ruptured simple cyst
-41. Causes of medullary Nephrocakinosis:

A. Hypervitaminosis A
B. Hyperparathyroidism
C. Medullary cystic disease
D. Tuberculosis
E. Oxalosis
42. Causes of cortical nephrocalcinosis:

A. Acute tubular necrosis
B. Acute glomerulonephritis
-· C. Alports syndrome
D. Methanol poisoning
E. Renal transplant rejection
43. Dense persistent nephrogram is seen in:

A. Chronic obstruction
B. Contrast reaction
C. Acute tubular necrosis
D. Acute cortical necrosis
E. Papillary necrosis
44. Scarring:
A. DMSA scan is the gold standard for assessing renal scars
B. Calyceal clubbing is seen in ultrasound
C. Calyceal d i lation with overlying renal irregularity is
pathognomonic
D. Increased renal sinus fat is .seen in ultrasound
E. Scar tissue can he hyper or hypoechoic
45. Long-term effects of haemodialysis:

A. Tumoral calcinosis B. Carpal tunnel syndrome
C. Sacroilitis D. Ruptured tendons
E. Renal cysts
46. Abnormal bone scan uptake in kidneys:

A. Radiation
B. Chernot!-lerapy
C. Pa pillar·· necrosis
D . M ult.ip:: m ;·:':'oma
'
E. Arnylo
I Renal Imaging 43
I 4 7. Renal disease:
A. In type I diseases of renal parenchyma the corticomedullary
differentiation is preserved
B. Renal echogenicity equal to that of liver is neither spec ifi c or
sensitive
C. A specific pattern of diagnosis can be established on the basis
of echogenicity
D. Higher echogenicity correlates with higher creatinine values
E. Increased echogenicity is seen in interstitial fib rosis
48. Diseases with increased cortical echotexture with preservation

of corticomedullary differentiation:
l
A. Pyelonephritis
B. Glomerukmephritis
C. Diabetes
l; D. Hypertension
E. Transplant rejection
49. Differential diagnosis of unilateral, small, smooth ki d ney:

A. Lobar infarction
B. Chronic renal infarction
C. Radiation nephritis
D. Diabetes
E. Post obstructive atrophy
50. Differential diagnosis of unilateral small scarred kidney:

A. Chronic pyelonephritis
B. Tuberculosis
C. Chronic renal failure
D. Lobar infarction
E. Chronic renal infarction
51. Renal contrast can be ex creted m the following areas:

A. Sweat
B. Small intestinal mucosa
C. Gastric juice
D. Tears
E. CSF
52. IVU:
A. Loss of fomi ceal angle is the first sign of cakyceal abnormality
B. The anterior calyces are close to the pelvis than the posterior
calyces
C. Each minor calyx can cap more than one p apillae
D. The number of calyces and the number of pyramids are
essentially the same
E. Compound calyces do not have infundibula
53. IVU:
A. The size of the calyx varies between films due to peristalsis
B. 70% of polar calyces are compound
C. The posterolateral aspect of the bladder is best seen in oblique
view
D. 25% of pelvis are bifid
E. The cal yces are less well defined in children
54. Reflux nephropathy:

A. Presence of scar differentiates from papillary necrosis
B. The calyceal dilation is smooth
C. In lobar infarction, there is no calyceal dilatation
D. Scarring is earlier in tuberculosis than reflux
E. Focal hydronephrosis cannot be differentiated from reflux
55. Lobar infarction:

A. No scarring if the infarct is less than 5 mm
- B. Due to thrombosis in arcuate arteries
C. Surface depression on cortex is due to fibroblasts
D. The renal size and contour are normal for the first four weeks
E. A triangular defect is seen in nephrogram with base in the
subcapsular region
56. Unilateral small smooth kidneys:

A. The number of calyces is not altered in congenital hypoplasia
B. In chronic infarction, the kidney is not opacified
C. In ischemia, there is decreased urine volume and opacity
D. In post-obstructive and post-reflux atrophy, there is global
reduction and papillary necrosis
E. In ischemia, there is no opacification of kidneys
57. Kidneys:
A. Ask Upmark kidney is focal areas of renal wasting with
calycea1 dilatation
B. Right kidney is small if it is 2.0 cm smaller than left
C. Delayed opacification of contrast in the collecting system is the
most sensitive method for diagnosing ischemia
D. In arterial hypotension due to contrast reaction, the kidney
size decreases during the procedure
E. Persistent dense nephrogram can be seen in arterial hypoten.sion
58. Differential diagnosis of bilateral small smooth kidneys:

A. Acute glomerulonephritis
B. Nephrosclerosis
C. Renal papillary necrosis
D. Alpert's syndrome
E. Arterial hypotension
59. Hyperechoic rena·l nodule is seen m:
A. Renal cell carcinoma

B. Angiomyolipoma
C. Oncocytoma
D. Hemangioma
E. Lymphoma
60. H yperdense renal mass is seen m:
A. Haemorrhage
B. Proteinaceous cyst
C. Leiomyoma
D. Renal cell carcinoma
l
E. Thyroid carcinoma metastasis
61. Renal sinus mass:

I
'
A. Urinoma
B. Plasmacytoma
C. Transitional cell carcinoma
D. Cyst
. E. Metastasis
62. Bilateral small smooth kidneys:

A. Nephrosclerosis happens earlier than generalized arterio
sclerosis
B. Increasingly dense nephrogram is seen only i n arterial
hypotension
C. Calyceal abnormality is seen only in papillary necrosis
D. Hypertension is seen only in arteriosclerosis
E. No function i s seen in Alports syndrome and chronic
glomerulonephritis
63. Generalised arteriosclerosis:

A. Similar imaging findings are seen in scleroderma
B. Calcified intrarenal arteries
C. Increased sinus fat
D. Dilated collecting system
E. Presen ce of hypertension indicates superimposed
nephrosclerosis
64. Chronic glomerulonephritis:

A. The renal size is normal in membranous subtype of chronic
glomerulonephritis
B. Angiography shows lack of normal tapering of arteries
C. Always bilateral
D. Massive proteinuria is a common clinical fe:iture
E. Parenchymal thickness is not affected
65. Causes of renal pap ill a ry necrosis:

A. Congestive cardiac failure
B. Acidosis
C. Gastroenteritis
D. Wegeners
E. Renal tubular acidosis
66. Alports syndrome:

A. Parenchymal thickness is increased
B. More common in females
C. Upper respiratory infection is a recognized feature
D. Males die earlier than females in whom disease is non
progressive
E. Increased incidence of cataracts
67. Nephrosclerosis:
A. If there is se\•ere renal impairment, think of malignant
nephrosclerosis
B. Hypertension always associated
C. Nephrogram is dirninished in both benign and malignant types
D. Peticheal haemorrhages are seen in non-contrast CT scans only
in malignant types
E. Displacement of capsular artery is seen in both
68. Medullary cystic disease:

A. Cysts are seen in the corticomedullary junction ·
B. Cysts lined by transitional cells

C. Always autosomal dominant
D. Seen mainly in females
E. Presents with symptoms of diabetes
69. Kidneys:
A. In med ullary cystic diseas€, the kidney is enlarged and
bilateral
B. Medullary striations are seen in medullary cystic disease
C. In medullary sponge kidney, the cysts fill during RGP
D. In med ullary sponge kidney, the size is never decreased
E. The cavities are more numerous in medullary sponge kidney
than papillary necrosis
70. Renal papillary necrosis:

A. There is increased risk of transitional cell carcinoma
B. Tracts are common in heterozygous sicklers
C. The long axis of the cavity is parallel to the long axis of papillae
D. Slough is seen as a radioluce:nt filling defect in calyx
E. Calcification of sloughed papilla is never seen in heterozygous
sickle cell disease
Renal Imaging 47
71. Conditions with loss of corticomedullary differentiation:

A. Acute renal vein thrombosis
B. Infarcts
C. End stage kidney
D. Diabetes
E. Renal papillary necrosis
72. Hypercalciuria is seen in:

A. Cushing's syndrome B. Diabetes m ellitus
C. Sarcoidosis D. Hypervitaminosis D
E. Medullary sponge kidney
l
73. Acute tubular necrosis:
A. Associated with persistent nephrogram
B. Recognised complication of aminoglycoside therapy
i
C. Occurs with chronic pyelonephritis
D. Occurs with acute glomerulonephritis
E. Cortical calcification occurs on recovery
74. High resistive index in the renal arteries seen m:
A. Obstruction
B. Acute tubular necrosis
C. Prerenal failure
D. Rejection
E. Hemolytic uremic syndrome
75. Renal papillary necrosis is s e en in:

A. Thalassemia B. Analgesic abuse
C. Polyarteris nodosa D. Amyloidosis
E. Cirrhosis

A. IVU is the investigation of choice
B. Associated with sickle cell trait
C. Calcification is not seen in pa p il lary necrosis of sickle cell
disease
D. Streaking of contrast from the polar fornices is pathognomonic
E. Calcification indicates presence of proteus in the urine

A. Normal kidney size excludes the disease
B. Contrast streaking is seen perpendicular to the long axis of
papilla
C. Calyceal clubbing is seen
D. Renal enlargement indicates infection or obstruction
E. The earliest finding is contrast streaking
78. Si ckl e cell disease:

A. Hemosiderin deposited in kidney gives low signal in MRI
B. Diffuse increased signal seen in ultrasound due to hemosidem
deposition
C. The kidney is enlarged
D. Renal failure is not seen in sickle cell disease
E. Iron deposition produces focal high signal areas

A. Diagnosed with involvement of single renal pyramid
B. Calculi occur in ectactic tubules
C. Autosomal recessive
D. Cysts occur in other organs
E. Growing calculus sign is pathognomonic of medullary sponge
kidney
80. Fat containing renal masses:

-- A. Renal cell carcinoma
B. \tVilrns
C. Xanthogranulomatous pyelonephritis
D. Liposarcorna
E. Teratoma
81. Multiloculated renal tumours indicate:

A. RCC
B. Cystic nephroma
C. Mesoblastic nephroma
D. Wilms
E. Multicystic dysplastic kidney
82. Berlins pseudotumour.

A. Bertins column is commonly seen between interpolar region
and lower pole
B. Always less than 3 cm ·
C. Enhancement is similar to renal medulla

D. Does not deform calyces like a real mass
E. Associated with renal duplication
83. Rim nephrogram is seen in:

B. . Acute tubular necrosis
C. Total main renal artery occlusion
D. Chronic urinary obstruction
E. Acute pyelonephritis
Renal Imaging 49
84. Immediate faint, persistent nephrogram is seen in:

A. Chronic severe ischemia
B. Renal vein thrombosis
C. Acute hypotension
E. Acute glomerulonephritis
85. Immediate distinct, persistent nephrogram:

A. Acute hypotension
B. Severe obstruction
D. Acute renal failure
E. Rhabdomyolysis
86. Increasingly dense nephrogram is seen m:
A. Acute glomerulonephritis
B. Acute tubular necrosis
C. Acute pyelonephritis
D. Acute papillary nec rosis
E. Acute hypot ension
87. Striated nephrogram is seen m:
A. Acute papillary necrosis

B. Chronic obstruction
C. Medullary sponge kidney
D. Acute pyelonephritis
E. Adult polycystic kidney disease
88. Nonvisualisation of calyx:

A. Duplex kidney B. Transitional cell carcinoma
C. Tuberculosis D. Calculus
E. Papillary nec rosis
89. Long-term complications of hemodialysi s:

A. Amyloidosis
B. Sacroilitis
C. Spondyloarthropathy
D. Carpal tunnel syndrome
E. T endon rupture
90. Bilaterally enlarged kidneys are seen m:
A. Lymp homa
B. Chronic glomerulonephritis
D. Glornerulosclerosis
E. Arnyloid
91. Corticomedullary differentiation:

A. The cortex echogenicity is more than that of medulla in infants
B. Cortex reflectivity is greater than liver in autosomal recessive
polycystic kidney
C. The medulla is more echogenic than liver in adults
D. Renal cortical echotexture is increased in renal parenchymal
disease
E. The corticomedullary junction is identified by visualizing the
arcuate arteries
92. Contrast induced nephrotoxicity:

A. Contra�t reduces glomerular filtration rate
B. Decreases diuresis
C. Contrast raises renal \·ascular resistance by decreasing
production of nitric oxide and prostocyclins
D. High production of nitric oxide is seen in normal states
-· E. High production of prostacyclins seen in contrast nephro
toxicity
93. Contrast induced nephr o t o xicity:

A. Adenosine produces intrarenal \·asodilatation and causes renal
failure
B. Theophylline given prophylactically can reduce nephrotoxicity
C. Contrast causes increased production of endothelin in kidneys
D. Contrast induced renal failure seen in 15% of diabetic patients,
inspite of all precautions
E. Hydration reduces renal failure incidence in diabetic patients
94. Drugs causing nephrocalcinosis:

A. Allopurinol B. Aspirin
C. Frusemide D. Vitamin D
E. Bleomycin
95. Echogenic kidneys are seen m:

B. Angiomyolipoma
c. Lymphoma
D. Oncocytoma
E. Nephronia
96. Causes of hydronephrosis:

A. Polycalycosis
B. Megacalyces
C. Fraley's syndrome
D. Post-obstructive
E. Post-reflux
Renal Imaging_ 51
97. Causes of Medially placed ureter:

A. Retrocaval ureter
B. Abdomino perineal resect ion
C. Pelvic lipomatosis
D. Lymphoma
E. Aortic aneurysm
98. Common causes of medial deviation of ureter:

A. Retroperitoneal mass
B. Psoas hypertrophy
C. Horseshoe kidney
D. Hydronephrosis
E. Iliac artery aneurysm
99. Causes of filling defect in bladder:

A. Endometriosis B. Ureterocele
C. Catheter D. Tuberculosis
E. Schistosomiasis
100. Causes of Vicarious contrast excretion:

A. Uremia
B. Bilateral obstruction
C. Pyelonephritis
D. Renal vein thrombosis
E. Spontaneous urinary extravasation
101. Common causes of Avascular mass in kidney:

A. Transitional cell carcinoma
B. Abscess
C. Cyst
D. Haematoma
E. Pyelonephritis
102. Causes of depressed renal margins:

B. Fetal lobation
C. Renal infarct
D. Chronic renal ischernia
E. Chronic pyelonephritis
103. Causes of focal bulge in renal contour:

A. Hydronephrosis
B. Pseudotumour
C. Xanthogranulomatous pyelonephritis
D. Simple renal cyst
E. Transitional cell carcinoma
104. Hypoechoic renal sinus in ultrasound:

A. Duplex kidney
B. Hydronephrosis
C. Column of Bertin
0. TCC
E. Aneurysm
1'05. Common causes of filling defect inside the collecting system:

A. Fungal ball
B. Malakoplakia
C. Leukoplakia
0. RCC
E. Cyst
106. Causes of acute cortical necrosis:

A. Childbirth
B. Haemorrhage
C. Transplant rejection
0. Ethylene glycol
E. Chronic renal failure
107. Renal tubular acidosis:

A. Nephrocalcinosis de\·elops only in Type I RTA
B. Nephrocalcinosis and stone formation in RTA is due to high
citrate in urine
C. Kidneys are enlarged
0. The urine is highly acidified
E. Calcium level is low in urine
108. N ep hrocakinosis:
A. Nephrocalcinosis with bilateral small scarred kidneys indicate
medullary sponge kidney
B. Increased risk of pyelonephritis with medullary sponge kidney
C. Kidneys are large in analgesic nephropathy
D. Calcification in tuberculosis is unilateral and focal
E. Cortical nephrocalcinosis in transplant rejection, develops in
both transplanted and native kidneys
Renal Imaging 53
ANSWERS
1. A-F, B-T, C-F, D-T, E-T

Post void film is not accurate; ultrasound with volume
measurement is better. Erect film is also helpful for emptying in
hydronephrosis and perinephric inflammation to find air fluid level.
If there is no contrast in nephrogram or collecting system after
24 hours, IVU is not useful, and a retrograde pyelogram should
be done. If there I faint contrast in nephrogram and no contrast
in PCS, obstruction is excluded. If there is contrast in the
nephrogram and there is delayed visualization in the collecting
system, one more film should be done according to the rule of
eight. When patient is supine, the upper pole of the kidney is
posterior, lower pole and ureter anterior. So the inferior calyces,
pelvis, PUJ, ureter are best visualized in prone films.
2. A-T, B-T, C-T, D-F, E-F

In breathing films, two im ages of kidney, in inspiration and
expiration would be superimposed due to breathing. If there is
only one image, it indicates the kidney has been fixed during
breathing and indicates perinephric inflammation. Intermittent PUJ
is precipitated by diuresis, for which water or diuretics can be
used. The density of contrast depends on a lot of factors, and
hence is not a direct and reliable indicator of renal funcion. Dense
excretion may simply represent increased tubular reabsorption and
not necessarily good function.This happens in renal artery stenosi s.
3. A-T, B-F, C-F, E-F, E-T

Hydration should be performed for four hours before and a day
after procedure. Dehydration should be avoided, since it is of no
use, because the patient has osmotic diuresis due to urea load.
Dehydration al so precipitates renal failure, as a patient with
impaired renal function r e q u i res more fluid to excrete normal
solute load. Nephr ot oxic drugs sho uld be st opped.
4. A-T, B-F, C-F, D-F, E-T

The contrast agents used for IVU should not bind to albumin,
because album.in bi n d ing prevents glomerular filtration (unless
there is nephrotic syndrome). So the contrast agents for IVLJ ha v e
a prosthetic radical at CS of benzene r ing, wit h short side
chain, unlike the hep atic agents which do not have this prosthetic
radical and have long side chains. Hydronephrosis of pregnancy
improves immediately after delivery unlike other invobtionary
changes. I n c o nges tiv e cardiac failure, the GFR is low and the
extracellular volume is high, hence the dose has to be increased.
But non-ionic agents are used, since ionic contrast will cause
volume overload.
5. A-T, B-T, C-F, D-T, E-F

Factors determining quality of IVU. Amount entering kidney
GFR, plasma concentration
GFR-blood pressure, renal blood flow, renal disease, age.
Plasma concentration-dose, rate of administration, volume of ECF
compartment.
Intrarenal modification-integrity of tubules, hydration, osmotic
diuresis, posterior pituitary function.
Collecting system dynamics- rate of urinary flow, volume of
collecting system, ureteral dynamics.
6. A-T, B-T, C-T, D-T, E-T

Right angled pelvis is also seen in masses and in children. Vascular
impression will disappear with distension of the collecting system.
-·Upper polar thickness is a tleast 2.5 cm and the lower polar
thickness is 3 cm.
7. A-T, B-T, C-T, D-T, E-T

·Cysts show calcification of wall.
8. A-T, B-T, C-T, D-T, E-T

Lipomatosis can be senile, when it is bilateral and symmetrical.
The infundibula are stretched and calyces are trumpet shaped and
thin. Replacement lipomatosis is unilateral and is due to infection
and may mimick a mass. Hypertrophy can be obligatory or
compensatory as a response to loss. The hypertrophy is more
marked in infants due to presence of renotropin.
9 • A-F B-F C-F D-F E-T

I I . I I
Bladder hernia is best seen in prone films. The kidney moves upto
1-4 cm with respiration. The medial border of kidney is parallel
to the psoas border but it does not overlap the psoas. The renal
length decreases by 10% with age and renal mass decreases by
20%. Compound calyces are prone for intrarenal reflu x and
pyelonephritis.
10 •
A-T B-F C-F D-T E-T
I I , I
After contrast administration, initially only the glomeruli and hence

only the cotex is visualised. 80% of renal flow is to the cortex and
20% is to medulla. Hence for the first 30 seconds in all imaging,
including IVU, CT and angio, only the cortical or an.giographic
nephrogram is seen. The density depends on the amount of
contrast. Atleast 300 mg/kg is required for IVU, 200 mg/kg for
CT and 35 mg/kg in angiography. Subsequently the t1..Ibulcs cue
Renal Imaging 55
opacified and hence the entire kidney, including cortex and medull.:i
are opacified.
11. A-F, B-T, C-T, D-T, E-T

For analysis of vacular anomalies, a vascular nephrogram is
essential. Urographic nephrogram can find only parenchymal
lesions. In acute cortical necrosis a rim of blood supply is seen in
the subcapsular region and another rim in the corticomedullary
junction with no p erfurion in between.
12. A-T, B-T, C-T, D-T, E-T

In A1N, the increasing density is believed to be return of filtered
contrast to circulation by diffusion of tubular fluid into iterstitium
by veins or lymphatics. Increasingly dense nephrogram are seen
in acute obstruction, hypotension, A'IN, acute glomerular d isease,
acute renal vein thrombosis. The mechanism is increase in tubular
transit time, diminished clearance from plasma and leakage
ofcontrast into interstitium.
In obstruction, due to high hydrostatic pressure, fi l tr at io n is
d ecreased and hence GFR is decreased. That is why it is faint
initially. But subsequently, due to tubular reabsorption of sodium
and water due to prolonged tubular transit, there is continued
formation of iodine containing glomerular filtrate, progressi\·ely
increasing the density. Multiple myelorna has Tamm Horsfall
proteins which precipitate in the tubules causing intratubular
obstruction along with uric acid, acute papillary necrosis.
13. A-T, B-F, C-F, D-T, E-T

Acute renal arterial occlusion with subcapsular collaterals is
another common cause.
14. A-T, B-F, C-T, D-F, E-T

Vascular phase- glo m eruli, interlobular arteries 10-15 seconds
Cortical phase-cortical capillaries, tubules, peritubular areas- 20-
45 seconds
Parenchymal phase- Loops of Henle, collecting tubules- 1-2
minutes
Excretory phase- 2-3 minutes
15. A-T, B-F, C-F, D-F, E-T

The pacemaker is situated at one of the calyceal muscles. The
stimulus for peristalsi s is stretching of calyceal wall by urine. The
peristalsis spreads by smooth muscle junctions and there is no role
for nerves. It moves at the rate of 3-5 I minute, increasing with
increasing urine volume. But there is no peristalsis at high volumes.
which move due to gra vity The wave moves down the ureter but
.
56 Genitourinary, Obstetrics & Gyhaecology and Breast Radiology
does not propel the urine colwnn unless there is opposition of the
walls happens. This occurs first at the pelviureteric junction.
Therefore, the propulsion is a vicious cycle starting with passive
stretching leading to peristalsis, which causes bolus formation at
the site o f opposition of walls. This bolus then initiates further
peristalsis and thus the cycle continues. In high flow states,
propulsion does not depend on peristalsis but on nephronic
pressure and gravity.
16. A-T, B-F, C-T, D-T, E-T

In chronic obstruction, dilatation is more, tubular structural and
functional damage is seen and there is normal pelvic pressure. In
acute obstruction, the dilatation is less, there is no structural
damage, there is balanced function and markedly increased pelvic
pressure. I n intrarenal pelvis, there is less distensibiliy, hence
widening i s less but functional loss os more. But in extrarenal
pelvis, the distensibility is more, widening is more, hence
- functional loss is less.
17. A-T, B-T, C-T, D-T, E-T

Agenesis and nephrectorny are the commonest causes. Other
causes included acidosis and high proteins.
18. A-T, B-T, D-T, E-F, E-T

The dose of contrast in children is 0.5- 1 cc/ lb of body weight.
Neonates are given 1.5 cc/ lb. Bolus injection produces a higher
plasma concentration of the dye, and hence will produce higher
density and good quality nephrogram which will last for a short
time only. Drip infusion will last for a longer time, but will not
be as dense as bolus infusion. There is no correlation between the
dose o f the contrast and severity of the reacton. Pyelosinus
extravasation can occsionally produce a pseudocyst or
retroperitoneal fibrosis.
19. A-FI B-TI C-TI D-FI E-T

The t/2 of contrast in plasma is 30 mins. At 10 min12% of contrast
us excreted, at 1 hour, 38% is excreted, at 3 hours, 45%, 83% at
6 hours and 100% by 24 hours. Peak plasma concentration
occasionally takes upto 30 minutes. The amount of contrast entering
kidney depends on GFR and plasma concentration. The GFR
cannot be controlled, but when it is low, the plasma concentration
can be altered by increasing the dose or increasing the rate of
administration or reducing the volume of ECF concentration.
20. A-T, B-F, C-F, D-T, E-F

The density of rvu depends on the volume of the collecting syst.::� ...
If the volume of the collecting system is high, the contrast ',·.' :· �
Renal lmaaino rJ7
v ·�'-� : ·�
be diluted. Calyceal diverticulum and large communicating renal

cysts, increase the volume of the collecting system, hence diluting
the contrast. Sodium is reabsorbed in the tubules, reabsorbing
water along with this. This increases the concentration of iodine
in the collecting system, but with lesser distension. Meglumine is
not reabsorbed, hence it induces osmotic diuresis into the collecting
system, producing d ilution of the contrast and hence decreased
density. But the collecting system is well distended. Dehydration
precipitates renal failure in multiple myeloma by precipitation of
Tamm Horsfall protein and in diabetes mellitus.
21. A-T, B-T, C-F, D-F, E-F

DMSA detects scarring; Hence, it is not useful in the acute stage.
22. A-F, B-T, C-F, D-T, E-F .

DMSA scanning is the best method for assessing scarring in
children. The transit time is delayed in renal artery stenosis and
obstruction.
23. A-F, B-F, C-F, D-T, E-T

In renal failure, the dose is double normal. The normal adult dose
is lml/ kg or 300 mg I/kg of body weight. The dose in renal failure
is 600 mgl/kg. There is no absolute GFR value below which IVU
will not be useful. Even when the GFR is 0, the IVl.J may still be
useful. Ninety percent of IVUs are useful when GFR is 15 ml/min.
In renal failure, high urea causes osmotic diuresis, diluting the dye
and impairing quality. After dialysis, the urea is removed, there
is no osmotic diuresis and the density of dye is high.
24. A-T, B-F, C-F, D-T, E-T

There is no danger of rupture of urethra. Spasm is a voided by
using warm contrast. Images are acquired in supine, RAO and
LAO. 20 ml of contrast are used.
25. A-F, B-T, C-T, D-F, E-F

Transvaginal scans are acquired with empty blzidder. Cortical
phase of renal CT is after 30 seconds and corticomedullary phase
is after 100 seconds. Adrenaline is used for better delineation of
tumour vasculature as the new vessels have no smooth muscles
and hence stand out better than the normal vessels which will be
constricted.
26. A-T, B-T, C-T, D-F, E-T

Micturition films are acquired in the RAO or LAO position.
27. A-F, B-T, C-F, D-T, E-T
I
In pressure flow studies, normal pressure is 13 cm H�20. 14· :?O cn-t
is equivocal, > 20 is abnormal and indicates obst.uc:�on. SeL�c:.ivc

58 Genitourinary, Obstetrics & Gynaeco/ogY- and Breast Radiology_
renal catherisation is usually done with a sidewinder cathether.

Pigtail is used for flush aortography.
28. A-F, B-T, C-T, D-F, E-T

Steroids should be administered 12 hours and 2 hours before the
IVU. Immediate pre procedural steroids is of no use. Full length
films are done if there is obstruction and to evaluate the drainage
after the bladder pressure is relieved.
29. A-F, B-T, C-F, D-T, E-F

ACE inhibitors are stopped fi\·e days before the procedure. DMSA
is the commonest agent used for assessing scarring and other
structural .... nomalies. But MAG -3 , can be used for scarring and
for dynamic function evaluation. Radiation dose is lower with
MAG-3, 80% of which is excreted by tubular secretion. Visuali
zation of kidney in MAG-3 is slightly lesser than that of DMSA.
MAG-3 is better for dynamic purposes.
30. A- F, B-F, C-T, D-T, E-F

-.
DMSA images are static and are usually obtained after one hour
to avoid Free Tc in urine. DTPA, MAG-3 and Hippuran are used
for dynamic scans. MAG-3 has the highest kidney/background
ratio and is the agent of choice. But DTPA is cheaper and easily
available. Hippuran is completely cleared by tubular secretion
31. A-F, B-F, C-F, D-F, E-T

Filtration rate of DTP A is 125 ml/ min, MAG-3 370 ml/ min,
hippuran, 500 ml/min.
Hippuran is completely cleared by tubular secretion, DTP A
completely by glomerular filtration, MAG-3 by tubular secretion
(80%) and glomerular filtration (20%)
Maximum diuresis occurs 15 mins after administration of diuretic.
Images are acquired in the first minute for perfusion and flow
studies.
32. A-T, B-T, C-T, D-T, E T -
Common use, is in children, following reflux and scarring.
33. A-T, B-T, C-T, D-T, E-F

Obstruction, renal arterial stenosis are other indications.
34. A-F, B-F, C-T, D-T, E-F

Direct radionuclide cystography is mainly done in children to
assess reflux. It gives less radiation and equal sensitivity to that
of conventional MCU. Tc pertechnate diluted with saline is the
commonest isotope used. Posterior images are acquired in the
region of bladder and kidney, during filling and during
micturition.
Renal Imaging 59
35. A-T, B-T, C-T, D-T, E-T

Anxiety causes release of epinephrine which causes vasocons
,
triction, reducing the renal blood flow and hence GFR, and hence
the quality of IVU. Dehydration causes release of antidiuretic
hormone from the posterior pituitary, which causes tubular
reabsorption of water, resulting in increased density of contrast
and better quality IVU.
36. A-F, B-F, C-T, D-T, E-T

Urate and xanthine stones are not radioopaque.
37. A-T, B-T, C-T, D-T, E·F

Stones clots, fungal balls, tumours are common causes. Renal vein
thrombosis produces collaterals.
38. A-T, B-F, C-T, 0-T, E-T

There are two types of calyceal diverticulum. Type I extends from
the fomix into the upper pole. It has a narrow infundibulurn and
is bulbous. Type II extends from the pelvis, interpolar region, large
round, and short neck, which is usually not identified. Reflux,
infection, ruptured renal cyst or abscess, infundibular achalasia or
spam and hydrocalyx are other known causes.
39. A-F, B-T, C-T, D-T, E-T

The neck of the diverticulum can be visualized in the type I, but
n o t in type II. Some of these are developmental in nature and
caused by ureteral bud remnants that has failed to divide into fully
formed calyces or those which have not been assimilated during
calyceal lobar fusion.
40. A-T, B-T, C-T, 0-T, E-T

Ruptured simple cyst communicates with the collec ting system.
Ev a cua t e d abscess or hematoma, f ocal calectasis due t o TB
stricture, tumour, stone and vessel are other causes.
41. A-T, B-T, C-F, D-T, E-T

Hyperparathyroidism, medullary sponge kidney and renal tubular
acidosis are the commonest causes of medullar y nephrocalcinosis.
Hyperoxaluria, renal tuberculosis, chronic frusemide use are other
rarer causes.
42. A-F, B-F, C-T, D-F, E-T

Acute cortical necrosis and chronic glomerulonephritis are the
commonest causes of cortical nephrocalcinosis. Chronic transplant
rejectj.on, ethylene glycol poisoning, oxalosis, sickle cell disease are
other causes.
43. A-F, B-T, C-T, D-F, E-F

Dense persistent nephrogram is seen in acute obstruction, acute
tubular necrosis, contrast reaction producing hypotension, acute
infection. Papillary necrosis and infection are associated with this
finding only if it is associated with obstruction.
44. A-T, B-T, C-T, D-T, E-T

Other signs are thinning of renal parenchyma, loss of cortico
medullary differentiation, focal or diffuse renomegaly and dilated
renal pelvis.
45. A-T, B-T, C-T, D-T, E-T

CPPD- leods to sacroiliitis. Arnyloidosis causes carpal tunnel
syndrome.
46. A-T, B-T, C-F, D-T, E-F

Renal vein thrombosis, ATN, pyelonephritis, obstruction and iron
overload are other causes.
47. A-F, B-T, C-F, D-T, E-T

In type I renal parenchymal disease, there is increased cortical
echotexture with preservation of corticomedullary differentiation,
but in type II, the differentiation is lost. Normal renal cortical
echogenicity is lesser than that of liver of spleen. If it is equal to liver,
the finding is not specific or sensitive. If the criteria is kept at higher
than liver, it is specific, but not sensitive enough. A specific diagnosis
cannot be found, but there is correlation between the echogenicity
and the fibrosis, glomerular sclerosis and tubular atrophy.
48. A-F, B-T, C-T, D-T, E-T

Also seen in chronic renal disease, SLE nephritis, acute tubular
necrosis.
49 •
A-F B-T C-T D-F E-T
I I I I
Congenital hypoplasia, ischemia due to focal arterial disease,

chronic renal infarction, radiation nephritis, post obstructive
atrophy, reflux atrophy and post inflammatory atrophy are the
common causes of small smooth kidney.
50. A-T, B-F, C-F, D-T, E-F

Lobar infarction and chronic atrophic pyelonephritis are the only
two causes of unilateral small scarred kidneys.
51. A-T, B-T, C-T, D-T, E-F

Vicarious excretion of contrast occurs in renal failure. Liver is the
most common site of excretion.
52. A-T, B-F, C-T, D-T, E-T

There are three major calyces, which divided into minor calyces.
The branching points are called the infundibula. The anterior 111:::- .J:r.
Renal Imaging 61
calyces are close to the lateral cortex and are within 1.5- 2 cm of
them, and the posterior calyces are closer to the pelvis. Usually
each minor calyx caps one papillae, but occasionally they can cap
more than one papillae. There are 9-10 minor calyces in each kidney.
Compound calyces are multiple calyces wihout infundibula.
53. A-T, B-T, C-T, D-F, E-T

10% of calyces are bifid. The calyces are broad and less well
defined in children. Oblique view is also helpful for ureteral lesions
and extrinsic renal and ureteral masses.
54. A-T, B-T, C-T, D-F, E-F

These conditions are the commonest differential diagnosis for
reflux nephropathy
1. Lobar infarction-unilateral small kidney, broad contour
depression, no dilation of calyx.
2. Papillary necrosis-irregular dilation, no scar, papillary slough,
cavitation, calcification.
3. Tuberculosis-scarring late, in reflux earlier
4. Focal hydronephrosis-no scarring.
55. A-T, B-T, C-F, D-T, E-T

Scarring is seen only if the initial infarction is more than 5 mm.
It is due to thrombosis or embolus in the arcuate or interlobar
arteries. Surface depression is due to loss of ded tubules and
cellular elements, but not due to replacement by fibroblasts.
56. A-F, B-T, C-F, D-F, E-F

Congen ital hypoplasia-Decreased calyces and papillate.
Compensatory hypertrophy of opposite kidney always present.
Ischemia-Decreased urinary volume, with increased opaci t y .
Delayed calyceal opacification time and delayed washout of
opacified urine. Ureteral notching chronic infarction-No
opacification of kidney:Radiation nephritis- Changes in bone,
history of exposure.
Post obstructive/ reflux-global, papillary effacement, calyceal
dilation, no UTI. Post inflammatory atrophy- H/ o UTI, global
atrophy with papillary necrosis.
57 . A-T' B-T' C-T' D-T' E-T

Left kidney is smaller than right kidney if it is 1.5 cm shorter than
the right side.
Contrast reaction is a common cause of arterial hypotension and
is due to intrarenal hypovolemia and primary vasoconstriction and
reduced glomerular filtration, reducing tubular urine volume. Tnis
produces the characteristically increasing dense nephrognm .
Initially it is not dense because of low GFR. Later increasingly
dense due to tubular reabsorption o f sodi urn and water and

decreased filtration. Occasionally it can be persistent dense.
58 •
A-F B-T C-T D-T E-T
I I f f
Generalised arteriosclerosis, nephrosclerosis, atheroernbolic renal

disease, arterial hypotension, chronic glornerulonephritis, renal
papillary necrosis, Alport's syndrome, rnedullary cystic disease are
the differential diagnosis of bilateral small smooth kidneys.
59. A-T, B-T, C-T, D-T, E-T

Angiornytllipoma and hyperechoic renal cell carcinoma are two
lesions that need to be differentiated.
60. A-T, B-T, C-T, D-T, E-T
61. A-T, B-T, C-T, D-T, E-T

Sinus lipomatosis, lymphoma are other causes.
62. A-T, B-T, C-T, D-F, E-T

-
Generalised arteriosclerosis- Contrast excretion seen, > 60 years,
No hypertension
Benign nephrosclerosis-contrast excretion,< 50 years, hypertension,
Malignant nephrosclerosis/ chronic GN I Alport's-no function,
hypertension seen, deafness or blindness in Alport's.
Arterial hypotension- transient, increasingly dense nephrograrn,
no visualization of peh·icalyceal system.
63. A-T, B-T, C-T, D-F, E-T

Arteriosclerosis of interlobar and arcuate arteries, reducing blood
flow to renal parenchyrna. Similar changes are also seen in
polyarteries nodosa, scleroderma and gout. Seen after 60 years,
n o hypertension, if hypertensive indicates nephrosclerosis,
bilaterally small, smooth, decreased parenchymal thickness,
hyperechoic renal sinus, normal papillae.
64. A-T, B-T, C-T, D-T, E-F

Bilateral, small, smooth kidneys. Parenchymal thickness is reduced
with compe nsatory increase in renal sinus fat. Decreased
nephrographic density is seen cortical calcification can be seen.
65. A-T, B-T, C-T, D-F, E-F

See answer 75.
66. A-F, B-F, C-T, D-T, E-T

Also called hereditary chronic nephritis, it is more common in
males. The disease is characterized by episodic hernaturia and
upper respiratory tract infections. In males, it is progressive and
the patient dies of renal failure before 5th decade. In females, the
disease is not progressive. Sensorineural deafness, congenital
cataracts, nystagmus, myopia are associated features.
Renal Imaging 63
67. A-T, B-T, C-F, D-T, E-F

Benign nephrosclerosis is characterized b y thickening and
hyalinization of afferent arterioles. In malignant type there is
proliferative endarteritis of afferent arterioles and interlobular
arteries. It is commonly due to hypertension and seen before 50
years. Parenchymal thickness is reduced in both. The nephrogram
is normal in benign and diminished in malignant. _In malignant,
there are peticheal haemorrhages, retroperitoneal and subcapsular
r bleeding, which causes displacement of capsular arteries.
I
68. A-T, B-F, C-F, D-T, E-T
In medulllary cystic disease, cysts lmm- lcm are seen in the
medulla and corticomedullary junction. These are lined by tubular
cuboidal cells. They can be autosomal dominant or recessive. The
symptoms are polydipsia, polyuria, anemia, uremia, hypothenuria
and salt wasing.
69. A-F, .B-T, C-F, D-T, E-T

Medullary cystic disease is bilateral. Kidneys are normal to small,
not enlarged. Smooth contour. Parenchymal thickness is reduced.
Diminished density in nephrogram and thin walled radiolucenies
seen. Delayed persistent medullary striations are seen. Medullary
sponge kidney is a differential for renal papillary necrosis.
Medullary sponge kidney- kidney is never small, multiple,
circumscribed punctuate densites are seen, the cysts do not fill
during RGP and the cysts are confluent. In renal papillary necrosis,
the kidneys can be. small or large, cavity is single, fills during RGP,
sloughed papilla are multiple and discrete.
70. A-T, B-T, C-T, D-T, E-T

In papillary necrosis, the kidneys are normal or small in analgesics,
large in infection or obstruction. Contour is smooth. Tracts are
faint streaks of contrast from fornix parallel to the long axis of
papilla. This is seen in sicklers. Cavitation is central or eccentric,
sharp or irregular margins. Slough is seen as a band of density
across the base of the papilla and can be smooth or irregular.
Calcification is very common in analgesics, ring shaped and not
seen in sicklers. Nephrograrn is diminished except in obstruction.
Necrosis in situ is not visualised. Can be unilateral or bilateral
71. A-T, B-T, C-T, D-F, E-F

Autosomal recessive polycystic kidney, acute rejection, acute renal
failu�e, infection, toxins are other causes.
72. A-T, B-F,C-T, D-T, E-T

Dietatry factors, milk Alkali syndrome, sarcoidosis, immobili
sation, hypercalcemia, hyperparathyroidisrn are other causes.
73. A-T, B-T, C-F, D-F, E-F

Cortical calcification is a feature of acute cortical necrosis, not acute
tubular necrosis.
74. A-T, B-T, C-F, D-T, E-T

Renal resistance index more than 0.70 is considered abnormat and
is measured in interlobar or arcuate arteries. It is also elevated
in renal transplant rejection and tubulointerstitial disease. It is not
always abnormal in renal diseases. There is no correlation with
creatinine values. After treatment the RI decreases in hemolytic
uremic syndrome, even before clinical improvement occurs.
75. A-F, B-T, C-F, D-F, E-T

Sickle cell disease, analgesic nephropathy, diabetes mellitus,
infection, obstruction, tuberculosis, trauma, cirrhosis and renal vein
thrombosis are the common causes of renal papillary necrosis.
76. A-T, B-T, C-T, D-T, E-T

-- Calcification is ring like and upto 5 mm in diameter. It is not seen
in sickle associated necrosis but seen in analgesic nephropathy.
77. A-F, B-F, C-T, D-T, E-F

The kidney is normal in early stages. In late stages, it is atrophic.
Enlargement if it is post infectious or post obstructi,·e. The earliest
finding is papillary swelling. Clubbing and widened fomix can be
seen in late stages.
78 • A-TI B-FI C-TI D-FI E-T

The diffuse high signal in kidney in sickle cell disease is due to
interstitial fibrosis and is seen in less than 5%. The kidneys are
enlarged in early stages and renal failure is seen in terminal stages.
Focal high signal areas due to iron deposition are seen.
79 •
A-T I B-TI C-FI D-FI E-T
Medullary sponge kidney is a non genetic disorder. It is the
commonest cause of medullary nephrocalcinosis. Calcification is
seen in the p l ai n film.When contrast enters the tubules, the
calcification blends with the dense contrast and becomes
imperceptible. The density appears to increase.
80. A-T, B-T, C-T, D-T, E-T

Angiomyolipoma is the commonest cause. Fat is seen in renal
tumours due to encircling or invasion of fat.
81. A-T, B-T, C-T, D-T, E-F

Multicystic dysplastic kidney is not a tumour.
82. A-F, B-T, C-F, D-F, E-T

Bertins column is due to excessive i n folding of cort�x. It is
continuous with the renal cortex and has enhar,ce:n ::. : '. i'l. · -.i
Renal Imaging 65
echogenicity similar to cortex. It deforms the calyces and

infundibula and indents the renal sinus.
83. A-T, B-T, C-T, D-T, E-F

Only the rim of cortex receives colateral blood supply fro m
capsular vessels.
84. A-T, B-T, C-F, D-F, E-T

.
-· Any renal prolife rative disease with cause faint, persistent
I nephrogram.
85. A-T, B-F, C-T, D-T, E-T

Any cause of acute renal failure will cause immediate distinct,
l: persistent nephrogram.
I
86. A-T, B-T, C-T, D-T, E-T
I Acute tubular necrosis produces increasingly dense nephrogram

in 30% of cases and immediate distinct persistent nephrogram in
60% of cases. Acute obstruction, renal vein thrombosis, amyloi
dosis, multiple m yeloma are other causes.
87. A-F, B-F,C-T, D-T, E-F

Acute obstruction and infantile polycystic kidney are other causes.
88. A-T, B-T, C-T, D-T, E-F

Tumours, technical factors, infection and partial nephrectomy are
other causes.
89. A-T, B-T, C-F, D-T, E-T
90. A-T, B-F, C-T, D-T, E-T

Leukemia, Acute glomerulonephrits, Acute pyelonephritis, Acute
papillary necrosis, HIV, Bilateral RVT are other c auses.
91. A-T, B-T, C-F, D-T, E-T
92. A-T, B-F, C-F, D-T, E-T

High osmolar contrast, ind uces diuresis, which triggers off
a u toregulatory constriction of afferent art eriL)les leading to
reduced glomerular filtration rate.
In normal states, lot of nitric o xide and prostocyclin are produced
in the kidney; which keeps them in vasodilated state. The produc
tion is not decrease d in nephrotoxicity, but increased in the renal

medulla, which increases oxygen demand in ascending limb of
Henles loop, when osmotic load natriuresis happens.
93. A-F, B-T, C-T, D-T, E-T

Adenosine produces intrarenal vasoconstriction and theophylline
can reduce the incidence of reactions. Endothelin is another
vasoconstrictor that is increased in blood and kidneys when
contrast is administered and produces nephrotoxicity.
94. A-F, B-T, C-T, D-T, E-T

95. A-T, B-T, C-T, D-T, E-F
96. A-T, B-T, C-T, D-T, E-T
By definition, hydronephrosis is aseptic dilatation of collecting
system and does not necessarily indicate obstruction. Megaureter,
overhydration, pregnancy, tuberculosis and tumour are other causes.
-97 •
A-T B-T C-T D-F E-F
I I I I
Retroperitoneal fibrosis is a common cause.

98. A-T, B-T, C-T, D-F, E-F
Iliac artery aneurysm causes focal lateral deviation of lower part
of ureter.
99. A-T, B-T, C-T, D-T, E-T
Tumour and clot are common causes.
100. A-T, B-F, C-F, D-F, E-T

Vicarious excretion, is excretion of contrast outside the renal system
-·and is usually seen in the biliary tract. Unilateral obstruction
causes, but not bilateral obstruction.
101. A-T, B-T, C-T, D-T, E-F
102. A-F, B-T, C-T, D-T, E-T

Splenic impression is another normal variant.
103. A-T, B-T, C-T, D-T, E-F
104. A-T, B-T, C-T, D-T, E-T
105. A-T, B-T, C-T, D-F, E-T
Stone, clot, fungal ball, sloughed papilla, tumour, cystitis cystica
are common causes.
106. A-T, B-T, C-F, D-T, E-F

Hypotension is the commonest cause, and this can be seen in
childbirth, sepsis and haemorrhage.
107. A-T, B-F, C-F, D-F, E-F

In RTA, the distal tubule does not secrete enough hydrogen ions.
H e n c e, there is not enough acidification in urine, which is
compensated by hypercalciuria. Hypercalciuria and low citrate in
urine are predisposing factors for nephrocalcinosis and stones in
RTA. Kidneys have normal size and contour with bilateral, diffuse,
symmetrical calcifications.
108. A-F, B-T, C-F, D-T, E-F

Medullary nephrocalcinosis with normal sized kidneys indicate
RTA , with bilateral small scarred kidneys indicates analgesic
nephropathy. Calcification is seen in 10% of renal tuberculosis.
Cortical nephrocalcinosis due to transplant rejection is seen only
in the transplanted kidneys.
1. Xanthogranulomatous pyelonephritis:
A. Renal calculi are almost always seen
B. Associated with coliform organisms
C. May mimic tumour on angiography
D. Haematuria is a common symptom
E. May extend beyond renal capsule
2. Xanthogranulomatous pyelonephritis:
A. Contracted renal pelvis
B. Absent nephrogram
C. Hyperechoic masses in ultrasound due to fat containing
xanthomas
D. Parenchymal calcifications
E. Shrunken kidneys
3. HIV:
A. HIV nephropathy causes bilateral symmetrical renomegaly
B. 100% mortality in 6 months with HIV nephropathy
C. PCP kidneys is due to aerosolised pentamidine
D. A IDS related lymphoma is high grade T cell
E. Cystitis is commonly due to Candida
4. Pyelonephritis:
A. Hematogenous spread is me commonest mode of infection
B. Fimbriated E. coli is neci?ssary for colonising kiqney in a
patient with vesicoureteral reflux
C. Seen in 10% of pregnant women
D. More common in females
E. Wedge shaped distribution within the renal parenchyma
5. Features of renal tuberculosis:

A. Putty kidney is small shrunken kidney
B. Autonephrectomy is non visualisation of kidney
C. Tracts from calyces into papilla
D. Papillary necrosis
E. Smudged papilla
68 Genitourinary, Obstetrics & Gynaecology-and Breast Radiology
6. Renal tuberculosis:
A. Extension to perinephric space indicates superadded pyoge nic
infection
B. Renal calculi is associated in 10%
C. Uretral tuberculosis always has evidence of renal tuberculosis
D. The proximal third of the ureter is most commonly in v ol v ed
E. Pipestem ureter is due to diffuse calcification of the ureter
7. The following are predisposing factors of acute pyelonephritis:

A. Bladder malignancy B. Analgesic abuse
C. Calculus D. Papillary necrosis
E. Sarcoidosis
8. Pyelonephritis-indications for imaging:

A. Neurogenic bladder B. History of stones
C. First attack of UTI D. Diabetes
-�· High fever
9. Pyelonephritis- IVU:
A. Majority are normal
B. Mucosal striations
C. Delayed increasingly dense nephrogram
D. Wedge shaped low dense areas
E. Non visualisation of kidney
10. CT of pyelonephritis:
A. Hypodense in nephrographic phase
B. Enhancement homogenously in nephrographic phase
C. Loss of enhancement in delayed scans
D. Parenchymal sta:ning after 3-6 hours
E. MRI shows contrast enhancing lesions
11. Acute pyelonephritis:

A. Ultrasound is normal in 75% of cases
B. Proteus is the commonest organism in an elderly patient who
is catheterised
C. Hematogenous spread is usually cortical
D. Ascending infection can spread by lymphatics
E. Inadequately treated acute pyelonephritis develops into acute
bacterial nephritis
12. Emphysematous pyelonephritis:

A. Clostridia is the commonest infection
B. Ureteral obstruction is a predisposing factor
C. Localising signs are seen in majority
·
D. Bilateral in 48%
E. Has better prognosis than emphysematous pyelitis
Infections GS
13. Emphysematous pyelonephritis:

A. Type I has worse prognosis
B. Type I has abscess
C. Streaky mottled gas in type I
D. Perinephric gas in type II
E. Gas within collecting system in I
14. Pyelonephritis:
A. High uptake i n wedge shaped distribution in renal scans
B. Non enhanced CT shows high dense areas
C. Thickened walls of renal pelvis
D. Filling defect in collecting system
E. Thickened Gerotas fascia indicates perinephric involvement
15. Pyonephrosis:
A. P mirabilis is the commonest organism
B. Dependent internal echoes within collecting system
C. Gas is inside collecting system
D. Fistula to duodenum and pleura is a complilation
E. Calculus is seen in 50% of cases and there is obstructive
nephrogram
16. Reflux:
A. Grade V reflux is associated with tortuosity of ureter
B. Gade II reflux is associated with mild dilatation of pelvicalyceal
system
C. Grade ill reflux will resolve with maturation of the UV junction
D. 20% chance of scarring in Grade II reflux
E. Grade IV requires surgery
17. Reflux:
A. In bladder Midline to ureteric orifice distance is more than
9 mm
B. Thickened renal pelvic wall is seen

C. Large thin walled bladder
D. Variable size of collecting system
E. Direct radionuclide cystography is done by iv injection of
Tc99m DTPA
18. Pyonephrosis:
A. Ultrasound has high specificity for differentiation of hydro
nephrosis and pyonephrosis
B. Pyonephrosis excluded if there are no low level echoes in
collecting system
C. CT shows perirenal stranding
D. Wall of pelvis measures more than 2 mm
E. Requires emergency drainage
19. Pyone ph ros is:

A. The CT density of urine is atleast 20 HU more than uninfected
unne
B. Calyceal filling is poor
C. Increased density of the renal parenchyma
D. The most common sonographic pattern is fluid debris level
which shifts with position
E. Layering of contrast is seen around the debri
20. Renal abscess:

A. Majority of organisms reach kidney by hematogenous route
B. Diabetics are twice involved as non diabetics
C. Positive urine culture in 75%
D. Positive blood culture in 50%
E. Hot spot is seen in the Gallium images
21. Renal/ perirenal abscesses:

-· A. Carbuncle is multiple coalescent renal abscesses
B. Obliteration of perinephric fat
C. Scoliosis concave to involved side
D. Decreased mobility of kidney with respiration
E. Impaired urinary excretion
22. Tuberculosis:
A. Always spread is by hematogenous route
B. Sterile pyuria is the classical presentation
C. History of TB is found in 50%
D. Calcified granulomas can be seen in other abdominal organs
E. Renal tuberculosis is found in 6% of those with pulmonary
tuberculosis
23. Tuberculosis:
A. 75% are unilateral
B. 5% have cavitatory pulmonary TB at the time of renal TB
presentation
C. In early stages the kidney is enlarged
D. The earliest change is erosion of the calyx
E. Tuberculomas are calcified
24. Tuberculosis:
A. Seminal vesicular and epididymal involvement occurs by
ascending route than hematogenous
B. Saw tooth ureter is due to multiple strictures along the course
of ureter
C. Ureteral cal:-:>ications are common
D. Vesicourete. · reflux is not seen in tuberculosis
E. Ureteric d� ·2 is mostly bilateral
Infections 71
25. Cystitis:
B. Cystitis cystica is premalignant
C. Tuberculous cystitis starts at the trigone
D. Decreased capacity of bladder is a feature of tuberculous
cystitis
E. Interstitial cystisis is common at the base of the bladder
26. Emphysematous Cystitis:

A. Pathognomonic of diabetes
B. E. Aerogenes is the commonest organism
C. Associated with emphysematous pyelonephritis
D. Pneumaturia is the commonest clinical presentation
E. The gas is seen within the bladder lumen
27. Causes of haemorrhagic cystitis:

A. Cyclophosphamide
B. Busulfan
C. E. coli
D. Adenovirus
E. Gonococcus
28. Genitourinary sc histos om iasis:

A. Calcification of bladder will resolve with time and treatment
B. Involvement of ureters at the vesicoureteric junction is the most
common cause of renal failure
C. Causes squamous carcinoma of the bladder
D. Earliest radiographic manifestation of bladder schistosorniasis
is thickening of bladder wall
E. The dome of the bladder is the portion that is calcified first
29. Reflux:
A. Seen in 30% of children with first UTI
B. Normally seen in 10% of normal babies
C. In ureteric duplication involves the upper muiety
D. Renal scar is seen in 50%
E. Disappears in 80%
30. Reflux:
A. The submucosal tunnel has a ratio of 4 :1
B. The ureteric orifice is large and medially situated
C. End stage renal disease is seen in 15% of adults
D. Reflux atrophy is seen in 50%
E. Renal scarring with UT! is seen in 60%
31. Acquired reflux is seen in following conditions:

A. Recently passed stone
B. Hutch diverticulum
C. Urethral valves
D. N eurogenic bladder
E. Cystitis
32. Perinephric inflammation:

A. The commonest mode of infection is from adjacent organs like
colon
B. Pyonephrosis can cause infection of the perinephric space
C. 60% have pyuria
D. There is exaggeration of renal outline in plain X-rays
E. The commonest site of collection is the dorsomedial part of
perinephric fat
33-. Perinephric inflammation:

A. Neurogenic bladder is a predisposing factor for development
of perinephric inflammation
B. Lateral displacement of the kidney indicates haematoma than
infection
C. Perinephric gas is very common in diabetics
D. Appendicitis can cause perinephric inflammation
E. Rim enhancement indicates perinephric abscess formation
34. Perinephric inflammation:

B. Causes superior displacement of the hepatic flexure
C. Causes scoliosis with convexity to the side of the lesion
D. If the flank stripe is widened it indicates infiltration o f
paranephric space
E. The Gerotas fascia is visualised during IVU
35. Malakoplakia:
A. Associated with motor neuron disease
B. Association with tuberculosis
C. Affects hip joint
D. Bladder is the commonest location in urinary tract
E. Commonest cause of renal infection resistant to antibiotics in
renal transplant
36. Malakoplakia:
A. Granulomatous inflammation
B. Multiple nodules are seen in post void films of bladder
C. In the kidney the lesions are mainly seen in the pelvis
D. Kidney is enlarged with distorted echotexture
E. The prognosis is worse if the lower tract is involv;d
Infections 73
37. Associations of Anti phospholipid antibody syndrome:

A. Recurrent fetal loss
B. Lupus anticoagulant is positive
C. Thrombocytosis
D. Anti cardiolipin antibody
E. Recurrent thrombosis
38. Antiphospholipid a ntibody syndrome:

A. Males are more commonly affected
B. Affects older aged p eople compared to SLE
C. Arterial thrombosis is commoner than venous thrombosis
D. Adrenal infarction is a feature
E. Cirrhosis with portal hypertension is the terminal event
ANSWERS
1. A-T, B-T, C-T, D-F, E-T
Staghorn calculus is seen in 75% Proteus mirabilis, E. Coli and
Staphylococcus are involved. The lesion can be hypervascular with
blush, mimicking tumour. Pyuria, flank pain and fever are more
common than microscopic hematuria. Extends to involve all
adjacent structures including psoas, colon, spleen, diaphragm,
posterior abdominal wall and skin.
2. A-T, B-T, C-F, D-F, E-F

XGPN is diffuse in majority of cases, but it can be focal mimicking
carcinoma. The kidneys are enlarged with smooth contours or
focal mass. The calyces are dilated and pelvis is contracted The
masses are hypoechoic in ultrasound and hypodense in CT.
3. A-T, B-T, C-T, D-F, E-F

-· With the advent of aerosolised pentamidine, the systemic spread
of PCP is increasing, with involvement of kidneys. AIDS lymphoma
is usually high grade B cell lymphoma.
Cystitis is commonly due to gram negative bacteria.
4. A-F, B-F, C-F, D-T, E-T

Commonest mode is ascending infection, fimbriated E. coli being
the organism being able to do it. If there is reflux, there is no need
for fimbria, as all organism can be carried to kidney due to reflux.
Seen in 1-2 % of p regnant women. The -infection extends
centrifugally along the medullary rays.
5. A-F, B-F, C-T, D-T, E-T

Putty kidney is tuberculous pyonephrosis. Autonephrectomy is
small, shrunken, scarred, calcified, non functioning kidney
Smudged papilla is one of the earliest signs of tuberculosis.
6. A-F, B-T, C-T, D-F, E-F

Tuberculosis itself can extend to the perinephric space including
the psoas. Distal third of ureter is commonly involved. Pipestem
ureter indicates rigid, straight, aperistaltic ureter.
7 •
A-T B-T C-T D-F E-F
I I I I
Other risk factors include congenital anomalies, diabetes, reflux,

pregnancy, obstruction and altered host resistance.
8. A-T, B-T, C-F, D-T, E-F

Recurrent UTI, analgesic abuse, atypical organisms and poor
response to antibiotics are other indications. First attack of UTI
is not an indication.
Infections 75
9. A-T, B-T, C-F, D-T, E-T

Immediate persistent nephrogram, dilated collecting system,
compressed collecting system are other presentations. The kidneys
are enlarged and smooth.
10. A-T, B-F, C-F, D-T, E-T

The infected kidney shows wedge shaped hypodense areas in the
early nephrographic phase. Linear, alternating bands of high and
low density (tubular obstruction by inflammation and slow
contrast due to ischemia) in excretory phase. Persistent contrast
enhancement seen in delayed scans is an important finding which
will differentiate the wedge shaped pyelonephritis from renal
infarction which is also wedge shaped but does not enhance in
delayed scans. The lesions are hyperintense in T2W MRI.
11. A-T, B-T, C-T, D-T, E-T
12. A-F, B-T, C-F, D-F, E-F

E.coli, Proteus, kliebsella, Pseudomonas and Candida are more common
than clostridia.Diabetes and ureteral obstruction are predisposing
factors. Fever, abdominal pain, chills, sepsis are recognised clinical
findings. Bilateral in 7%. Emphysematous pyelitis has a better
prognosis.
13. A-T, B-F, C-T, D-F, E-F

I. Worse prognosis, streaky, mottled gas in interstitium from
medulla to cortex, perinephric and subcapsular space, but no
fluid collection or abscess
II. Better prognosis, bubbly, loculated gas, abscess, perirenal fluid
collection, gas inside collecting system.
Gas can also be demonstrated within renal veins.
14. A-F, B-T, C-T, D-T, E-T

Nuclear medicine scans show wedge shaped areas of diminished
uptake. Non enhanced scans shmv high dense areas of haemor
rhage. The renal pelvis and collecting system may be dilated or
have thick walls. Filling defect is due to debris, clot or papillary
necrosis.
The kidneys may be smoothly enlarged.
15. A-F, B-T, C-T, D-T, E-T

Fistula formation, renal and perinephric abscess are complications
of pyonephrosis.
E. coli is the commonest cause. Gas is rarely seen, and may indicate
emphysematous pyelonephritis.
16. A·T, B-F, C-T, D-T, E-T

I-reflux into distal ureter, upto pelvic brim.
II-reflux into collecting system

III-reflux + mild dilatation of the pelvicalyceal system
IV-reflux + moderate dilatation of collecting system with clubbed
calvces
J
V-reflux + tortous ureters

I-III-resolve with age, IV-V-surgery
- 17. A-T, B-T, C-T, D-T, E-F

Direct radionuclide cystogram is done by instilling ImCi Tc99m
pertechna le
18. A-T, B-T, C-T, D-T, E-T

Ultrasound has 97% specificity for differentiating pyonephrosis and
hydronephrosis.
It is difficult to differentiate in the early stages, where a guided
aspiration may be helpful.
19.. A-TI B-TI C-FI D-FI E-T

The renal function is impaired in pyonephrosis and hence there
will be decreased opacification in IVU and CT scan. The calyceal
filling is also delayed and little. There are four patterns in ultrasound.
The commonest is presence of debri in the most dependent part
of the collecting system. There are three other patterns, 2-fluid
debri level which shifts with patients change of position, 3-coarse
strong echoes with shadov•ing, 4-multiple \\·eak echoes.
20. A-F, B-T, C-F, D-T, E-T

Majority of organisms reach kidney via the ureter. Urine culture
is positive in only one third. Hot spot is also seen in I n 111
leukocvtes.
21. A-T, B-T, C-T, D-T, E-T

The perirenal inflammation restricts mobility of kidneys.
22. A-T, B-T, C-F, D-T, E-T

History of TB is present in only 25%
23. A-T, B-T, C-T, D-T, E-T

Majority of cases are unilateral. In late stages the kidney is shrunken.
Very few patients have evidence of pulmonary tuberculosis.
24. A-F, B-F, C-F, D-F, D-F

Seminal vesicular involvement also occurs by hema togenous
spread. Saw tooth ureter is due to multiple granulomas inside the
ureter.
Multiple strictures produce the beaded or corkscrew appearance.
Ureteral calcifications are uncommon. Ureteric disease is unilateral
or bilateral asvmmetrical.
J
Infections n
25. A-T, B-T, C-T, D-T, E-F

Cystitis cystica is characterised by small cyst like mucosal
elevations, and is considered to be premalignant. Tuberculous
cystitis has wall calcification and eventually results in small
capacity thimble bladder. Interstitial cystitis or Hunners ulcer, is
commonly seen at the vertex of the bladder.
26. A-T, B-F, C-T, D-F, E-F

E. coli is the commonest organism. The ga!' is seen within the
bladder wall, which is thickened.
27. A-T, B-F, C-T, D-T, E-F
28. A-F, B-F, C-T, D-F, E-F

The earliest finding of bladder schistosomiasis is blurred, indistinct
bladder walls due to submucosal edema. Calcification is of egg
shell type and seen all around the bladder wall. Although the
whole bladder is affected, base is earliest part to be affected. Filling
defects are due to schistosomial polyps. Calcification is seen in 30%
of plain X-rays.
29. A-T, B-T, C-F, D-T, E-T

Lower moiety is involved in duplicated systems.
30. A-F, B-F, C-T, D-T, E-T

The submucosal tunnel is shorter in those with reflux.
The ureteric orifice is l arger and situated laterally.
31. A-F, B-T, C-T, D-T, E-T

Duplication, uretrocele, prune belly syndrome are other ca u ses .
32. A-F, B-T, C-T, D-F, E-F .

The commonest mode of infection is ascending infection through
the renal tract. Pyonephrosis, cortical abscess, renal inflammation,
ureteral inflammation are the common causes. Hem a to genous
spread occurs in children from other sources in body. There is loss
of the normal renal o utline in 50% of cases. The commonest site
of collection is the dorsolateral aspect of the p eri n e p h r i c fat, and
hence the kidney is commonly displaced medially, upward and
vertically.
33. A-T, B-F, C-T, D-T, E-T

Calculi, neurogenic bladder, diabetes, UTI, iv drug abuse are other
predisposing factors. Lateral displacement of the kidney o ccurs
in large abscesses and does not necessarily have to be h aematoma.
Perinephric gas indicates infection with E. coli, Aerobacter or
Clostridium and is common in diabetics. Appendictis p ancre3.titis,

,
di v ert i cu liti s , PIO and perforated colonic cancer spread to

perinephric space.
34. A-F, B-F, C-F, D-T, E-T

There is no sexual predilection. It causes inferior displacement of
the hepatic flexure and medial displacement of duodenum. Causes
scoliosis with concavitv to the side of the lesion. The Gerotas fascia
is visualized during IVU due to inflammatory thickening and
hypervascularity.
-35. A-T, B-T, C-T, D-T, E-T

There is also association \Vith diabetes, sarcoidosis and renal
transplanta tion. It affects bladder, ureter, renal pelvis, PUJ,
urethra, tl'stis, epididymis, hip joint, vertebra, adrenals, brain,
lungs, pleura, pancreas, endometrium, broad ligament, tonsils,
spleen and buttock.
36. A-T, B-T, C-F, D-T, E-F

Mala koplakia is histolog ically characterized by presence o f
mononuclear cells called Von Hanseman cells. Multiple nodules,
-· 5 mm to 3 cm are seen in the bladder as filling defects. The kidney
is enlarged and most of the lesions are seen as multiple nodules
in the cortex. Ultrasound can shO\\. a diffuse change in echotexture
or a focal hypoechoic mass. Occasionally the kidney is not
visualized in IVU. The prognosis is worse if the upper tract is
involved.
37. A-T, B-T, C-F, D-T, E-T

Thrombocytopenia is characteristic. Recurrent arteriovenous
thrombosis is seen.
38. A-F, B-F, C-F, D-T, E-F

Females are more commonly affected, but the difference is not as
marked as in SLE. It affects people younger than in SLE. Venous
thrombosis is commoner than arterial thrombosis. Adrenal
haemorrhage and infarction are recognised features. The liver is
not affected.
i
I
t
�
1-
1
I
I
I
I
I
I 1. Normal anatomical N arrowings of ureter.

!
\
A. Pelviureteric junction ·
!
B. Pelvic brim
C. Upp er ureter near L2
D. Iliac vessels crossing
E. Vesicoureteric junction
2. Ureter:
A. The pelv i c ureter can measure upto 10 mm
B. The left common iliac artery has a larger extrinsic effect on
the left ureter than the right comrnon iliac artery on the right
ureter
C. The ureteric muscles run in longitudinal fashion
D. Ureteric peristalsis is maintained by sympathetic fibers from
T12-L2
E. The ureter passes inferior to the uterine artery in the base of
the broad ligament
3. Ureter:
A. Normal ureter is always m edial to the transverse process of
the corresponding lumbar vertebrae
B. Ureter should not pass medial to the corresponding pedicle
C. Ureteric spindle is seen above the level of iliac artery crossing
D. Ureters should be separated by atleast five cm in the abdomen
E. Ureter can pass h orizontally at level of L3
4. Causes of acute Hydronephrosis:

A. Passage of blood clot
B. Ureteral edema
C. Renal vein thrombosis with collateral formation
D. Sulfonamides
E. Pregnancy
5. Causes of normal collecting system in obstruction:

A. Staghorn calculus
B. Hyperacute obstruction
C. Dehydration
D. Spontaneous decompression
E. Renal infarction
- 6. Causes of dilatation of collecting system without obstruction:

A. Diuretics
B. Pyelonephritis
C. Post obstructive
D. Diabrtes mellitus
E. Reflux
7. Features of acute hydronephrosis:

A. Resistive index is more than 0.7
B. >0.08 d i fference in resi tive index between normal and
abnormal kidney
C. In grade three hydronephrosis, the periphery of echogenic
sinus is discontinuous (ultrasound)
D. The collecting system has avoid configuration in grade 2
E. The amount of residual renal cortex is not significant
8. Findings in acute obstruction:

A. Severe caliectasis
B. Gross renomegaly
C. Pyelosinus extravasation
D. Increasingly dense nephrogram
E. Delayed visualisation of calyces
9. Radiology of urinary obstruction:

A. False positive result in ultrasound is obtained due to peripelvic
fibrosis
B. False negative result is obtained due to staghorn calculus
C. A lower polar accessory artery is a cause of vascular obstruction
at PUJ
D. The calyceal size can be normal in post obstructive atro
_ phy
E. Urinomas are too soft to cause ureteric obstruction
10. Features of Chronic obstruction:

A. Small kidneys
B. Negative pyelogram
C. Ball pyelogram
D. Mucosal striations in the. ureter
E. Nephrographic density is increased
Obstruetion, Interventions and Transplantation 81
11. Acquired causes of PUJ obstruction:

A. Reflux B. Squamous cell carcinoma
C. Polyp D. Cholesteatoma
E. Retroca val ureter
12. Congenital causes of ureteric obstruction:

A. Megatureter B. Circumcaval ureter
C. Ureteric valve D. Bladder diverticulum
E. Ureterocele
13. Hydronephrosis:
A. In Grade II dilatation, calyces are enlarged without blunting
of forniceal angle
B. Papillae are obliterated in Grade III
C. Peak nephrographic density in obstructed kidney occurs in 3-
6 hours
D. In severe obstruction, obstructive nephrogram will not be seen
if there is superimposed severe infection
E. Obstructive nephrogram persists even after months after acute
obstruction
14. Obstruction:
A. Obstructed nephrogram can occur partially in one part of
kidney
B. Once contrast is seen in collecting system, no further vie\.\'S
are necessary
C. Contrast appears in the collecting system at one hour, hence
the next film should be done in two hours
D. Calculus less than 15 mm is passed during IVU
E. The obstructive nephrogram immediately fades, if the stone
passes during the proced ur e
15. Obstruction:
A. The degree of dilatation depends on the level of obstruction
B. S tan ding column is seen in normal persons if bladder is full
C. Stand ing colum n is commoner in high doses
D. The maximal diameter of the male ureteris 15 mm
E. Pyelosinus extrava sta tion tracks down the ureter and psoas
16. Obstruction:
A. Urinoma is opacified during IVU
B. Forniceal tears are always pre existing before IVU
C. Urinomas cause upward and medial displacement of kidney
D. A difference in resistive index of more than 0.1 between the
two sides indicates obstruction
E. The entire kidne y can rupture due to obstruction
17. Obstruction:
A. Presence of ureteric jet excludes total obstruction
B. Normal ureteral jets are seen only due to high flow from ureter
C. Continuous flow of ureteral jet excludes obstruction
D. All the stones are hyperdense in CT scan, even those which
are radiolucent in X-ray
E. Reverse corticomedullary nephrogram is an indicator o f
obstruction
18. Obstruction:
A. The normal renal parenchymal thickness is 3.5 cm in the poles
B. Mucusal striations in children indicates previous obstruction
C. The term non functioning is preferred to non excreting
D. In giant hydronephrosis, there is accumulation more than 1 liter
E. In beer drinker syndrome, the obstruction is worsened by
fluid consumption
i9. Congenital Causes of PUJ obstruction:

A. Lower pole artery
B. Valve
C. Low insertion
D. Adhesion
E. Kink
20. Obstruction:
A. A routine IVU precipitates PUJ obstruction
B. Diuretics should be given if intermittent obstruction suspected
C. Urine debri level in ultrasound indicates- chronicity
D. Cystitis is a known cause of urinary obstruction
E. Crescent sign and fluid levels i;,vithin collecting system cannot
be differentiated in IVU
21. Percutaneous nephrolithotomy:

A. A double J ureteric stent should be placed
B. If calculus is in the renal pelvis, upper polar calyx should be
used instead of the normal lower pole
C. General anaesthesia is required
D. Calculi larger than 1 cm should be fragmented before removal
E. 20% of patients develop haemorrhage
22. Pregnancy and urinary system:

A. Dilation is seen only upto the pelvic brim
B. Hypertophy of Waldeyers sheath is a cause of dilation
C. Maximal dilation is seen in the 2nd trimester
D. Seen in 90% women
E. The peristalsis is decreased
Obstruetion, Interventions and Transplantation 83
· 23. Percutaneous nephrolithotomy:

A. Cannot be undertaken under GA
B. Puncture of anterior calyx is mandatory
C. Matrix calculi are difficult to disintegrate
D. Baloon dilatation of the tract is unsuccessful
E. The tract for percutaneous procedures should be atleast 10 mm
24. Indications of Emergency Nephrostomy:
I-
i
A. Obstruction with infection
B. Obstruction with severe pain
I C. Obstruction with renal failure
I D. Obstruction due to recurrent pelvic tumour
! E. Pressure flow studies for equivocal upper tract obstruction
Il 25. Indications for therepeutic ureteric occlusion:

A. Urinary fistula following irradiation for pelvic malignancy
B. Urinary fistula with severe cutaneous infections
!
C. Uncontrollled hypertension
D. Severe haematuria
E. Severe dysuria
26. Ureteric occlusion is done using the following techniques:

A. Gelatin sponge B. Coils
C. Balloons D. Occluding catheter
E. Electocautery
27. Complications of nephrostomy:

A. Pneumothorax B. Pleural effusion
C. Sepsis D. Renal AVM
E. Ureteric rupture
28. Nephrostomy:
A. The needle should be placed into one of the anterior calyces
B. Upper polar calyces are avoided
C. The avascular line of Brodel is situated anterolaterally
D. The Brodels line is 2-3 cm below the 12th rib
E. The contrast injected should not exceed the urine removed
from the system
29. Obstruction:
A. Scintigraphy differentiates dilated non obstructed system from
obstructed system
B. Antegrade pyelography is used to obtain renal urine for
bacteriological study
C. Even in obstruction lasting for only a short period of time,
the GFR will not be restored
D. Tubular damage is more than glomerular damage in chronic
obstruction
E. The renal concentration capacity is unaffected in long term
obstruction
30. Stones:
A. 3% of pop ulation experience stones in their life time
B. 70% of patients with first time stones have a metabolic disorder
C. Calcium oxalate stones constitute 75% of stones
D. 70% of patients with acute flank pain have renal calculi
E. Females are affected more than males
- 31. Renal arterial stenosis in renal transplant:

A. Peak systolic velocity > 150 cm/sec
B. 3:1 rntio between pre and post stenotic velocities
C. Main renal artery: external iliac artery ratio 3.5:1
D. No signal distal to stenosis
E. Post stenotic turbulence
32. Helical CT signs of calculus:

A. Ureteric rim sign
B. Stranding of periureteric fat
C. Perinephric collection
D. Edema at UV junction
E. Free fluid
33. Causes Non opaque s tones:

A. Indinavir B. Matrix
C. Cystine D. Cric acid
E. Xanthine
34. Renal conditions associated with increase incidence of stones:

A. ADPKD
B. Medullary sponge kidney
C. Vesicouretral reflux
D. Eagle Barett syndrome
E. Calyceal diverticulum
35. Renal stones:

A. Calcium phosphate is more fragile to lithotripsy than calcium
oxalate
B. 85% of calcium stones are idiopathic
C. Majority of hypercalciuria are renal in origin
D. Type IV renal tubular acidosis is a recognised cause
E. Sarcoidosis produces stones due to incresed reabsorption of
·calcium
36. Renal graft dysfunction between days 2 and 7 is caused by:

A. Acute rejection B. ATN
C. Renal vein thrombosis D. Cyclosporine toxicity
E. Infection
Obstruction, Interventions and Transplantation 85
37. Causes of h yperoxaluria:

A. Inflammatory bowel disease
B. Vitamin D overdose
C. Vitamin C overdose
D. Renal f ailure
E. Liver failure
38. The following s tones are amenable to lithotripsy:

A. Struvite B. Cystine
C. Uric acid D. Calcium oxalate
E. Xanthine
39. Stones:
A. Leukemia increases incidence of cystine stones
B. Uric stones are increaed in gout
C. Uric acid stones are lucent in CT also
D. Salicylates produce stones
E. 80% of stones less than 6 mm pass spontaneously
40. Laparoscopic donor nephrectomy is contr ain dicat e d in :

A. Unilateral agenesis
B. Cortical atrophy
C. Urolithiasis
D. Medullary sponge kidney
E. Renal papillary necrosis
41. Causes of hypertension in a renal transplant patient:

A. U reteral obstruction
B. Essential hypertension
C. Cyclosporine toxicity
D. Urinoma
E. Chronic rejection
42. Avascular necrosis after renal transplan tation :

A. Commonest site is the humeral head
B. Symptoms can develop within 3 months after transplantation
C. Bilateral in majority
D. The duration of dialysis before transplantation decides the
development
E. The dose of steroid has a role in deciding
43. Renal transplant:

A. The commonest cause of death in renal transplant is hypertension
B. The most common disabling complication is avascular necrosis
C. Most common cause of parenchymal failure is acute tubular
necrosis
D. GI bleed is associated in 40%
E. Bone scan is the test of choice for early diagnosis of a':ascular
necrosis
44. Common Causes of GI bleeding in renal transplant patient:

A. Haemorrhoids B. Pseudomembranous colitis
C. Erosions D. Lymphomas
E. Yarices
45. Rejection:
A. Occurs in all transplants
B. Hyperacute rejection is due to cellular immunity
C. Acute rejection is due to combination of cellular and humoral
D. Accelerated acute is rejection between 5-10 days
E. Chronic rejection is due to endothelial proliferation in small
arteries
46. Rejection:
A. Hyperacute rejection shov..'s complete absence of renal
perfusion
B. Hyperacute rejection requires immediate surgery
C. High resistive index is seen in cyclosporine toxicity
D. Kidneys enlarged in cyclosporine toxicity
E. Small kidney in chronic rejection
47. A cu te rejection:
A. Renal function normal in early stages
B. Renal perfusion and function decreased
C. Non visualisation of interlobar arteries
D. Prolonged arterial opacification
E. Prolonged excretory phase in nuclear scans
48. Risk factors for ATN:

A. Cadaveric kidnevs ;
B. Multiple renal arteries

C. Prolonged cold ischemia time
D. Prolonged duration of surgery
E. Cross clamping of renal vessels
49. ATN in renal transplant:

A. Starts within 72 hours
B. Increased resistive index
C. Delayed uptake of isotope
D. Delayed excretion
E. Improvement in one month
SO. Renal vascular problems afer transplantation:

A. Pseudoaneurysm is common in arcuate arteries
B. Pseudoaneurysm need intervention to prevent graft dysfunction
C. High resistance flow is seen in A VM
D. Arterialisation of waveform is seen in veins in A V1v1
E. Biopsy is the commonest cause of A Vrv1
51. Causes of ureteral obstruction in renal transplant:

A. Stricture common at anastomostic site
B. Lymphocele
C. Fungal ball
D. Calculus
E. Fibrosis
52. PTLD (post transplant lymphoproliferative disorder):

A. Multiple pulmonary nodules are seen
B. Mediastinal lymphadenopathy
C. Bowel perforation
D. Polyclonal B cell hyperplasia
E. Patchy ari space opacities are seen
53. Causes of Renal graft dysfunction in the first 48 hours:

A. Hyperacute rejection
B. Renal arterial stenosis
C. Renal vein thrombosis
D. Discordant size
E. Obstruction from collections
54. Renal graft dysfunction after one week is due to:

A. ATN
B. Extrinsic compression
C. Acute rejection
D. Renal vein thrombosis
E. Renal artery stenosis
55. Delayed graft dysfunction is seen i n :

A. Cyclosporine B. Pyelonephriti s
C . ATN D. Urinorna
56. Renal arterial stenosis 1n transplant kidney:

A. Seen in 10%
B. Commonly seen in li v ing related donor kidney than cadaver
kidney
C. Starts in immediate post operath:e period
D. Majority start within 3 years
E. Bruit over graft site
57. Causes of renal arterial stenosis post tran splan t a tion:

A. Chronic rejection
B. Ischemia of donor vessel
C. Atherosclerosis
D. Scar
E. Thrombosis
58. High vascular impedance in renal transplant is seen in:

A. Renal vein obstruction
B. Pyelonephritis
C. Urinoma
59. Para renal fluid collections:

A. Urinomas are septated
B. Lymphoceles are larger than urinomas
C. Seen in 50% of transplantations
D. Page kidney is a recognised complication
E. Lymphoceles require surgery to prevent damage to the
transplant
60. Post transplant lymphoproliferative disease:

A. 80% association with Epstein barr virus
B. Majority are proliferation of T lymphocytes
C. Can start one month after transplantation
D. Commonly seen in renal transplantation than bone marrow and
cardiac transplantation
E. Incidence of NHL is 35 times that of general population
61. The following conditions are contraindi catio n s for percutaneous

nephrolithotomy:
A. Stag horn calculus
B. Single stone more than 2 cm in diamete_r
C. Multiple stones more than 3 cm in diameter
D. Complete ureteral obstruction
E. Patients unsuitable for ESWL
62. ESWL (Extracorporeal shock wave lithotripsy):

A. IVU is always indicated before ESWL
B. Ideally, the stones should be fragmented to 10 mm f ragments
C. Larger the stones, better the success with ESWL
D. Cystine stones have the best response rate among all the stones
E. Obstruction develops following procedure in 25% of cases
63. Renal interventions:

A. Lipiodol is used to ablate renal cysts
B. The renal cysts should be completely filled with absolute
alcohol to ablate cyst
C. The sclerosant is left permanently inside the renal cyst for
ablation
D. In endopyelotomy, incision is made anterolaterally at PUJ
E. lOmm balloons are used for dilating percutaneous tracts
Obstruction, lnteNentions and Transplantation 89
64. Urinary tract interventions:

A. Renal cell carcinoma requires confirmation by imaging guided
biopsy
B. A solitary mass in a patient with known metastasis or
lymphoma is a definite indication for renal biopsy
C. Medical renal disease is not an indication for renal biopsy
D. The commonest location for taking biopsy is the posterolateral
aspect of the upper pole
E. Cortex should b e avoided in the biopsy sample t o avoid
spurious results
65. Percutaneous nephrostomy:

A. Posterior calyces are more lateral than anterior calyces
B. Posterior calyces are usually seen in profile in AP views
C. Air will always home in the posterior calyces when injected
in prone position
D. For stent placement, a lower polar calyx is preferred
E. It is preferable to puncture the patient in complete prone
position
66. Percutaneous drainage:

A. A 14 F tube is required for draining solitary kidney
B. Haematuria is normal upto one week after procedure
C. Two months is the maximum in dwelling time for a catheter
D. Bacteriuria with or without obstruction is very significant and
requires aggressive management
E. Two guidewires are used for stent placement.
..
ANSWERS
1. A-T, B-T, C-F, D-T, E-T
2. A-F, B-F, C-F, D-F, E-T

Ureter measures upto 5 mm in abdomen and 7 mm in pelvis. The
right common iliac artery has a larger extrinsic impression on right
ureter. That is why it is easily compressed in pregnancy. The
ureteric muscle runs in multiple directions. The ureteric peristalsis
is independent of innervation.
3. A-F, B-T, C-T, D-T, E-T

Normal ureter courses over the transverse process of the lumbar
vertebrae and never passes more than 1 cm lateral to the transverse
process and usually does not pass medial to the pedicles. In 20%
of young individuals, ureter can course over the lower lumbar or
upper sacral pedicle, but usually the ureters are separated by
atleast five cm . In pelvis, they pass medially then, laterally to reach
the posterolateral surface of bladder.
4. A-T, B-T, C-F, D-T, E-T

Passage of stone is the commonest causes.
5. A-T, B-T, C-T, D-T, E-F
6. A-T1 B-T, C-T, D-F, E-T

Diabetes insipidus is another cause, not diabetes mellitus. Full
bladder is another well recognised cause.
7. A-T, B-T, C-T, D-F, E-F

Ultrasound grading of hydronephrosis
Grade I-separation of sinus, ovoid, peripheral sinus echoes
continuous
Grade II-separation of sinus, round, peripheral sinus echoes
continuous
Grade III-separation of sinus, peripheral sinus echoes not
continuous
The amount of residual renal cortex is clinically significant.
8. A-F, B-F, C-T, D-T, E-T

The caliectasis is only mild to moderate and the renal enlargement
is also mild.
9. A-F, B-T, C-T, D-T, E-F

Ultrasound- False positive- extrarenal pelvis, parapelvic cyst,
hydration, nonobstructive dilation. False negative- renal failure,
peripelvic fibrosis, staghorn calculus.
I n post obstructive atrophy, the kidney is small, smooth with
dilatation of calyces, but in atypical cases, the calyces are .:ot
dilated, but the kidneys are smooth urinomas can obstr'.Jc':.
10. A-T, B-T, C-T, D-T, E- F

Kidneys will be large if there is partial obstruction.T h e
nephrogram density is normal o r low. It is increased only if there
is superimposed acute obstruction. The parenchymal thickness is
reduced. Cresent, soap bubbles, rims or shell nephrogram will be
seen.
Dilated collecting system and ureter are seen.
11. A-T, B-T, C-T, D-T, E-F

Other intraluminal causes are stone, clot, papilla, malakoplakia,
leukoplakia and TCC.
12. A-T, B-T, C-T, D-T, E-T

Atresia and stenosis are other well recognised causes of congenital
ureteric stenosis.
13. A-F, B-T, C-T, D-T, E-F

Grade I- minimal dilatation of calyces with slight blunting of
calyc�al fornices.
II- blunting of fornices, enlarged calyces, papillae flattened.
III- rounding of calyces, obliterated papillae.
IV- extreme calyceal ballooning.
Obstructive nephrogram is not seen after many weeks. It will
develop if there is superimposed acute on chronic obstruction.
14. A-T, B-F, C-F, D-F, E-T

Obstructed nephrogram occurring in a part of the kidney is called
segmental nephrogram and is seen ·when there is a duplex system
that is obstructed. In acute obstruction, there is delay in
appearance of nephrogram, which becomes progressively denser.
There is delay in the appearance of contrast in the collecting
system. Once the contrast appears in the collecting system, further
views should be performed to find the level of obstruction. The
rule of eight is followed to calculate the timing of the film after
contrast appears in the collecting system. If the contrast appears
at 15 mins, next film is done at 2 hours, if it appe•irs at 30 mins,
next film at four hours, if 45 mins, next film at 6 hours and if at
one hour, next film at 8 hours. Only stones less than 5 mm pass
during IVU, after which there will be abrupt fading of nephrogram
and reduced density in pyelogram.
15. A-F, B-T, C-T, D-F, E-T

The degree of dilatation depends on the duration and severity of
obstr_)lction and does not depend on the level of obstruction.
Standing column is normal in one or two films. If persistent and
if seen in post micturition film, it indicates obstruction. The
maximal diameter of male ureter is 7 mm and it is more in female

due to pregnancy induced changes. In early stages pyelosinus
extravastation is seen as smudging of papilla. Then the contrast
tracks to the renal sinus and then to the ureter and psoas muscles.
16. A-T, B-F, C-F, D-T, E-T

Urinoma is encapsulated urine collection due to obstruction or
trauma. It opacifies during IVU. It causes upward anterior and
lateral displacement of kidney. It can get infected and cause
abscess. If the underlying kidney has parenchymal disease,
obstruction can cause rupture of the entire kidney. Fomiceal tears
can be preexisting or can be caused by IVU due to high pressure.
17. A-T, B-F, C-T, D-F, E-T

Ureteric jet is flow o f urine from ureter into bladder. This is
normally seen due to difference in specific gravity between the
urine from ureter and that in bladder. In obstruction the ureteric
jet is not seen or there will be continuous flow due to increased
pressure in ureter but without normal peristalsis. Most of the
stones which are lucent in plain X-rays are dense in CT, except
matrix stones. Persistence of corticomedullary nephrogram for a
log time is a salient feature of acute obstruction. In delayed images,
there is persistence of dense nephrogram. The medulla eventually
opacities and becomes more dense than the cortex producing the
reversed corticomedullary nephrogram.
18. A-T, B-F, C-F, D-T, E-T

Normal renal parenchymal thickness is 2.5 cm, and 3.5 cm in poles.
Mucosa! striations within collecting sy stem indicates previous
obstruction in adults, but in children indicates reflux and infections.
Non functioning is a diagnosis that could not be made in IVU. If
there is non visualization of kidney even after 72 hours, the term
non excreting can be u sed. In intermittent PUF obstruction,
increased urine flow p recipitates obstruction and brings the
symptoms. In children the pain is not. related to fluid intake.
19. A-T,B-T, C-F, D-T, E-T

High insertion, stenosis, dysfunction are other congenital causes.
20. A-T, B-T, C-F, D-T, E-F

The diuresis initiated by IVU contrast precipitates intermittent
obstruction. If it does not, frusemide should be given. If pain and
caliectasis develops, the diagnosis is confirmed. If there is no pain,
but caliectasis, diuresis renogram i s done. Urine debri level
indicates pyelonephrosis. Crescents do not change appearances
with position but fluid levels do.
21. A-T, B-F, C-T, D-T,E-F

Ureteric stent should be placed to prevent large fragments of
calculus passing down the ureter. If calculus is present in the renal
pelvis, lower polar calyx is punctured.
22. A-T, B-T, C-F, D-T, E-T

Dilatation of the collecting system and decreaed peristalsis is seen
in 90% of women, maximal in the third trimester. The reasons are
multifactorial. Smooth muscle relaxation induced by progesterone,
compression b y gravid uterus, ovarian vein, ilia c vessels,
hypertrophy of Waldeyers sheath and hypertrophy /hyperplasia
of smooth muscle.
23. A-F, B-F, C-F, D-F, E-T

In percutaneous procedures, the posterior calyx is punctured.
Usually the upper polar calyx is punctured to allow access to the
largest portion of the intrarenal collecting system.
24. A-T, B-T, C-T, D-F, E-F

Recurrent pelvic tumour causing obstruction is a dilemma, since
the patient may be allowed to die with painless pelvic tumour
instread of allowing the tumour to spread and worsen the pain.
Other indications for an elective percutaneous nephrostomy are
Obstruction with minor symptoms before treatment, Diversion of
urine to heal urinary fistula. Pressure flow studies for equi\·ocal
upper tract obstruction and Percutaneous access for manipulation
within kidney or ureter.
25 •
A-T B-T C-F D-T E-T
I I I I
Ureteric occlusion with percutaneous drainage is done to avoid

urine flo w through the ureter. Also done f o r total urinary
incontinence in inoprable patients.
26. A-T, B-F, C-T, D-T, E-T

Silicone and nylon plugs, ureteric clipping, sclerosing agents and
synthetic tissue adhesi\·e are other methods for occluding the
ureter.
27. A-T, B-F, C-T, D-F, E-F

Pneumothorax is a complication of high puncture.
28. A-F, B-T, C-F, D-T, E-T

The avascular plane of Brodel is at the junction of the anterior hvo
thirds and posterior third of the renal cortex and situated
posterolaterally, 2-3 cm from 12th rib, in posterior axillary line.
Usually the posterior calyces, mid or lower· are used.
29. A-T, B-T, C-F, D-F, E-F

Scintigraphy cannot visualize the cause of obstruction, but on
differentiate non obstructive dilation from obstruction. If fru�e'.'nic!e
is administered, there will be complete washout if there is dilated

non obstructive sytem in 10 mins, but no washout in obstruction.
Antegrade pyelography is also used to find the level of
obstruction after IVU and RGP fails or the localize the collecting
system before nephrostomy. In short duration obstruction, the
GFR is preserved. After certain time, there is nephronal loss and
fall of GFR, resulting in obstructive atrophy. Relief of obstruction
causes some improvement of frenal function. Glomerular loss is
more than t ubular loss. Kidneys are shrunken with loss of
concentrJ ti on and acidification mechanisms.
30. A-T, B-T, C-T, D-T, E-F

Males are more commonly affected.
31. A-F, B-T, C-T, D-F, E-T

Peak systolic velocity is more than 250 cm/ sec. Decreased flow
distal to stenosis.
32. A-T, B-T, C-T, D-T, E-F

Ureteric rim sign is edema surrounding the calculus in ureter.
Stranding can be seen in the soft tissue adjacent to the ureter due
to edema or inflammation. Edema at the CV junction is an indicator
of CV junction calculus.
33. A-T, B-T, C-F, D-T, E-T
34. A-T, B-T, C-F, D-F, E-T

Horse shoe kidney is another cause of calculus formation due to
stasis in the collecting system and increaed incidence of infections.
Eagle-Barrett syndrome- prune belly syndrome.
35. A-F, B-T, C-F, D-F, E-F

Calcium phosphate and monohydrate are not easily fragile.
Majority are a combination of calcium oxalate and phosphate and
are intermediately amenable for lithotripsy pure calcium oxalate
stones are very fragile. Eighty percent are idiopathic and due to
hypercalciuria most of which are due to increased absorption from
diet. The secondary causes are hyperparathyroidism, sarcoidosis,
milk alkali syndrome and immobilisation.Type I and II RT A
produce stones, but not type IV. Sarcoidosis produces vitamin D
from abnormal macrophages.
36. A-F, B-T, C-T, D-F, E-F
37. A-T, B-F, C-T, D-T, E-T

Bowel surgery is another cause. Primary oxaluria is a genetic (AR)
disease.
38. A-F, B-F, C-T, D-T, E-F
39. A-F, B-T, C-F, D-T, E-F

Leukemia, gout and starvation increase incidence of uric acid
stones. Cystine stones are increased in cystinuria. Uric acid stones
are lucent in X-rays but dense in CT scans. Sulpha drugs and
triamterene are other drugs producing stones. 80% of stones less
than 4 mm, 50% of stones between 4-6 mm and 20% of stones
more than 6 mm are passed spontaneously.
40. A-T, B-T, C-T, D-T, E-T

Multiple renal arteries, venous anomalies, other congenital
anomalies, varices, hydronephrosis and tumours are other
contraindications.
41. A-T, B-T, C-T, D-F, E-T

Renal artery stenosis, acute rejection, renin production in native
kidney and the primary disease are the other causes.
42. A-F, B-F, C-T, D-T, E-T

Commonest site is the femoral head. Symptoms develop after
5 months. Mean is 9-19 months.
43. A-T, B-T, C-F, D-T, E-F
Most common cause of parenchymal failure is rejection.
1v1RI is the test of choice for diagnosis of avascular necrosis.
44. A-T, B-T, C-T, D-F, E-F

Cecal ulcers and polyps are other causes.
45. A-T, B-F, C-F, D-F, E-T

Hyperacute (within mins)- humoral, preformed antibodies present
at time of transplantation: Accelerated acute (2-5 days )- cellular
and humoral
Acute (Sd-6 months)-cellular: Chronic (months to years)
46. A-T, B-T, C-F, D-F, E-T

The kidney is of normal size and res is ti ve index is normal in
cyclosporine toxicity.
47 ' A-FI B-TI C-Tf D-TI E-T

In early stages, the renal perfusion may be normal, but function
is decreased. Subsequently, renal perfusion is decreased along with
renal function.
The nephrogram is in homogenous and excretory p h ase is
prolonged.
48. A-T, B-T, C-T, D-F, E-F
49. A-T, B-T, C-T, D-T, E-T

The onset and symptoms are similar to that of acute rejection. The
main way by which they can be differentiated is that, the changes
in ATN are reversible and the renal function and perfusion i s
restored to normal in a week to month.
The transplant may be enlarged. Decreased perfusion and function
of the transplant in nuclear scans.
- 50. A-T, B-F, C-F, D-T, E-T

Pseudoaneurysm usually undergoes spontaneous regression. In
AVM, high velocity low resistance flow in arteries and arterial flow
in \-eins l1 re seen.
51. A-T, B-T, C-T, D-T, E-T
52. A-T, B-T, C-T, D-T, E-T
53. A-T, B-F, C-T, D-T, E-F
:;t. A-T B-F C-T·o-F

511 I I
E-F I I
55. A-T, B-T, C-F, D-T, E-T
56. A-T, B-F, C-F, 0-T, E-T

Cada\·er kidney is more commonly affected than living related
donor kidney.
l\.1ajority arise within the 3 years of transplantation.
Transient elevation of \·eloci:ies is seen in the post operative period
due to edema or spasm and does not signify renal stenosis.
Si. A-T, B-T, C-T, D-T, E-F
58. A-T, B-T, C-T, D-T, E-F

High vascular impedance indicates a resistive index more than 0.7
and pulsatility index of more than 1.8. Also seen in acute rejection,
other causes of pyelonephritis, large collections and obstruction.
Excessive pressure by the ultrasound probe can also produce
spurious result.
59. A-F, B-T, C-T, D-T, E-F

Lymphoceles are largest, with thick septations and internal debris.
They can be managed by percutaneous drainage. Urinomas are
small, with no septations and contain creatinine.
Page kidney is due to compression of kidney which results i n
hypertension.
60. A-T, B-F, C-T, D-F, E-T

This is reactive proliferation of B lymphocytes after
transplantation, mainly due to immunosupressive drugs and
a s sociated with Epstein barr virus. Only 11 % arise from T
lymphocytes. Cardiac > renal > bone rnarro\.\' transplantation.
- -
61. A-F, B-F, C-F, D-F, E-F

All the above are indications for percutaneous nephrolithotomy.
Large stone volume, stag horn calculus, stones refractory or
u n s u itable for ESWL, partial or complete obstru ction are
indications.
62. A-T, B-F, C-F, D-F, E-F

Plain X-ray assesses the type of stone and stone burden_ IVU is
necessary for finding obstruction, which is contraindication for
ESWL. Ideally the stone should be fragmented to pieces less than
3 mm. Smaller fragments pass through the ureter easily. In 10-15%
the stones do not pass and produce obstruction which requires
further interventions. Cystine stones do not respond well to
ESWL. Large stones and staghorn calculi do not respond.
63. A-F, B-F, C-F, D-F, E-T

Absolute alcohol is used to ablate simple renal cysts, if they are
large or uncomfortable. The renal cysts are filled with 30% of
volume with alcohol. It is left inside the cyst for 10 minutes, during
which time the patient moves around to evenly distribute the
alcohol and subsequently the alcohol is aspirated. Endopyelotomy
is used for PUJ obstruction. Since the aberrant vessel commonly
crosses the PUJ anteriorly, the incision is made posterolaterally.
Tracts for PCNL are dilated with 9F diameter using balloon 10
mm diameter and 10 cm length.
64. A-F, B-T, C-F, D-F, E-F

Renal carcinoma, angiomylipoma and other typical solid masses
do not require biopsy for confirmation. Imaging findings are
characteristic and biopsy has complications. Solitary mass in these
circumstances should be biopsied, since the management is
different. If it is a RCC, nephrectomy is indicated. But a metastas·s
or lymphoma warrants chemotherapy. Medical renal disease is a
common indication for renal biopsy. The commonest site is the

posterolateral aspect of the lower pole. A 1-! G needle is used to
obtain core biopsy, which should include cotex to obtain as nv.ich
of glomeruli as possible.
65. A-F, B-F, C-T, D-F, E-F

Posterior calyces are used for puncturing in PCN. These are usually
more medially seen than anterior calyces and are seen enface in
AP films. This is confirmed by injecting air. For simple drainage,
the lower polar calyces are preferred, but for interventions, upper
polar calyces are preferred for better manipulation. Patient is
usually tilted to 25-30 degree position for proper entry into the
collecting system.
66. A-T, B-F, C-T, D-F, E-T

Usually 8-10 F catheters are used for draining kidneys. In ·thick
collection and solitary kidney 12-14 F tubes are used. Haematuria
is normal only upto 3 days. Catheters should be changed every
8 weeks. Bacteriuria without obstruction is not significant. But if
there is obstruction, septicemia usually ensues and tube should be
rem oved. In stent p lacement, one g uidewire is used for
manipulation and other is a safety guidewire.
1. Bladder:
A. The ureter opens on the anterolateral aspect of the bladder
B. The urachal remnant runs extraperitoneally
C. The empty bladder projects outside the pelvic inlet in children
D. The urethra arises from the apex
E. The superior surface of bladder is completely covered by
peritoneum
2. Bladder:
A. The bladder lies at a lower level in pelvis in females
B. The bladder neck lies directly on the pelvic fascia above the
urogenital diaphragm in females
C. The peritoneal reflections around bladder and pelvic viscera
are similar in males and females
D. The bladder is more mobile in males
E. The interior surface of the entire bladder is trabecula ted
3. Bladder:
A. Bladder drains into external iliac nodes
B. The bladder thickness should not exceed 3 mm
C. Tl W images are ideal for assessment of blJdder wall
pathologies
D. Ureter has an intramural course of 2 cm
E. Ureter crosses the vasdeferens anterornedially
4. Urethra:
A. The membranous urethra contains the external urethral
sphincter
B. The paraurethal glands in female, open into the urethra at the
distal part
C. Bulbourethral glands open into the prostatic sinus
D. The urethra passes through corpus spongiosum
E. There are two dilatations in the peni:e urethra
5. Causes of Gas inside the Bladder:

A. Necrotic tumour n. Proteus infection
C. Catheterisation D. Carcinoma cervix
E. RTA
6. Urethra:
A. The bulbous urethra is the widest part of the urethra
B. The prostatic ducts open into the verumontanum
C. The ejaculatory ducts open into the prostatic sinus
D. The di:-tal part of the prostatic urethra is the most fixed part
of the urethra
E. The me1nbranous urethra is the least dilatable segment of the
urethra
7. Pear shaped bladder is seen in:

A. Pelvic lipomatosis IL Iliac artery aneurysms
_C. Cervical cancer D. Bladder rupture
E. Psoas abscess
8. Causes of bladder calcification:

A. Tuberculosis
B. Schistosomiasis
C. Cyclophosphamide
D. Methotrexa te
E. Squamous cell carcinoma
9. Schistosomiasis:
A. Schistosomiasis japonic-�'11 affects bladder
B. Schistosomiasis haemarobium produces cirrhosis with portal
hypertension
C. Commonest cause of bladder calcification worldwide
D. Increased risk of transitional cancers
E. Increased risk of stone formation
10. Schistosomiasis:
A. Bladder is not distensib!e
B. Ureters involved in 65%
C. Calcification is seen in tlte fibrous tissue elicited by the eggs
D. Bladder capacity is reduced
E. Ureteric strictures are common in the mid third
11. Causes of alkaline encrustation in bladder:

A. Urinary infection
B. Radiotherapy
C. Cyclophosp:-tamide
D. Schistosom: asi�
E. Mitomycir ::::
Bladder 101
12. Bladder calculus:

A. All the stones are passed from the kidney into the bladder
B. Apatite stones are seen in cystitis
C. Struvite stones are the commonest in bladder outlet obstruction
D. Predispose to development of transitional cell carcinoma
E. Are usually denser than the contrast medium
13. Cobra head sign:

A. Seen best in unopacified bladder
B. Always seen in orthotopic ureteroceles
C. The ureterocele portion has all the layers of the bladder and
ureteric wall
D. Intravesical ureteroceles are usually diagnosed in the neonatal
period
E. Intravesical ureteroceles are commoner in women
F. Seen in 50% of ureteroceles only
14. Intravesical ureterocele:

A. Always congenital
B. Caused due to distal ureteric obstruction
C. High incidence of stone formation
D. Predisposes to infection
E. Cobra head sign indicates that the ureterocele is uncomplicated
15. Ureterocele:
A. Ectopic ureterocele almost al ways associated with duplex
ureter
B. Always associated with the ureter arising from the lower pole
C. In boys, can be seen without duplex ureter
D. Cobra head sign is seen in filled bladder
E. Ureteric orifice stenosis produces non functioning system
16. Common causes of neurogenic bladder:

A. Diabetes B. Multiple sclerosis
C. Carcinoma D. Syphilis
E. Spina bifida
17. Radiology of neurogenic bladder:

A. Hour glass bladder indicates hypertonic neurogenic bladder
B. The bladder is small in atonic lesions
C. Neurogenic bladder can be deviated to the right side of
normal position
D. A pseudosphinter is formed behveen the internal and external
urethral sphincter
E. Occult non neurogenic/neurogenic bladder is seen due tc
detrusor bladder sphincter dyssynergia
18. Pseudou r e t erocele:

A. Stones are the only recognized cause
B. Halo is thicker than that of true ureterocele
C. Irregular halo
D. Asymmetry of dilated ureteral lumen
E. No ureteric obstruction is seen unlike ureterocele
-19. Causes of outpouching of bladder wall:

A. Ureterocele
B. Cystocele
C. Bladder hernia
D. Diverticulum
E. Bladder neck obstruction
20. Neurogenic bladder:

A. Detrusor instability-hyperactive detrusor due to decreased
compliance
B. Detrusor hyperreflexia-idiopa thic
C. Detrusor areflexia- Due to upper motor neurone lesion in the
spinal cord
D. Bladder trabeculation is very common in hyperreflexia
E. Prominent interuretric iri.dentation and serrations are specific
signs
21. Causes of involuntary incontinence:

A. Brain trauma
B. Alzheimers dementia
C. Prostatic hypertrophy
D. Faecal impaction
E. Parkinsons
22. Neurogenic diseases of bladder:

A. Pine tree appearance is seen in detrusor hyperreflexia
B. Spinal cord injuries above T12 cannot initiate micturition
C. Incontinence is not seen in spinal cord injuries
D. Sphincter dyssynergia is a feature of spinal cord injury
E. In autonomous neurogenic bladder, overflow incontinence is
seen
23. Bladder diverticula:

A. Close to the ureteric orifice
B. Cause medial displacement of lower ureter
C. Cause extrinsic compression of bladder
D. The diverticula has all layers of the bladder wall and has
trabeculated wall
E. Filling defect in a diverticulurn is commonly due to carcinoma
Bladder 103
24. The following are associations of bladder diverticula:

A. Prune belly syndrome
B. Menkes disease
C. Williams syndrome
D. Ehler-Danlos syndrome
E. Marfans syndrome
25. Bladder diverticula:

A. Diverticula never opacifies bef ore the bladder is opacified
during IVU
B. Not all the diverticula have to opacify during IVU
C. 98% of congenital diverticula are seen in males
D. Diverticula are always more than 2 cm
E. Fundal diverticula are

' seen posteriorly unlike bladder ears
which occur anteriorly
26. Causes of stress incontinence:

A. Vagi nal hysterectomy
B. Cervical cancer
C. Spondylolisthesis
D. Peripheral neuropathy
E. Cystitis
27. Stress incontinence:

A. Multiparity is a predisposing factor
B. Descent of bladder neck more than 1.0 cm with stress is
abnormal
C. Periurethral inflammation causes incompetent urethral
sphincter
D. Most common cause of stress incontinence in men is deformed
sphincter
E. Open urethra at rest in cystogram is diagnostic of incompetent
sphincter
28. Causes of Vesicovaginal fistula:

A. Bladder calculus B. Radiation
C. IUCD migration D. Foleys catheter
E. Schistosomiasis
29. Schistosomiasis:
A. The intermediate host is dog
B. The larva enters human being by ingestion
C. The changes in bladder are elicited by the adult fluke
D. The degree of calcification is directly proportional to the
number of eggs
E. It takes atleast two years for calcification to form
30. Vesicovaginal fistula:

A. Cancer of bladder is a more common tause than cancer of
vagina
B. The first step in the diagnosis of fistula is cystoscopy
C. Oral pyridium is used for clinical diagnosis
D. In first degree uterine descent, the cervix is descended into
the introitus
E. IVU is the more common radiological method for dia
. gnosis of
VVF
31. Cancer bladder- predisposing factors:

A. Smoking B. Alcohol
C. Schistosorniasis D. �eurogenic bladder
E. Analgesic abuse
32. Bladder cancer.

A. 70% are epithelial and 30% are mesenchymal
-· B. More common in women
C. 20% are squamous type
D. Rhabdomyosarcoma is the commonest non epithelial neoplasm
in adults
E. Second commonest cancer in the urinary tract after kidneys
33. Bladder cancer.

A. Papillary cancers are more likely to metastasis than sessile cancers
B. 20% of papillary cancers ha•.-e calcificati_on
C. The treatment depends on the depth of invasion of wall
D. All the epithelial tumours are malignant
E. Pheochromocytoma is the comm onest benign tumour of
bladder
34. Bladder cancer staging:

A. T3a and B2 are the same
B. Invasion of perivesical fat is Cl
C. CT can differentiate stages Bl an d B2
D. Invasion of adjacent organs is Stage Dl
E. Carcinoma in situ cannot be detected by CT or MRI
35. Bladder cancer.

A. Even if a tumour is detected in ultrasound, a cystoscopy and
biopsy are required
B. Thickened bladder wall adjacent to polypoid tumour indicates
infiltraton
C. Tumours in the vesical neck are the easiest to be identified
D. Recurrence develops in 50% of superficial tumours
E. Superficial TCCs refers to TCCs not extending beyond
superficial layer of muscle
Bladder 105
36. Bladder:
A. MRI has accuracy of upto 96%
B. Nodes greater than 15 mm are considered malignant
C. Internal iliac node is the first group to be involved
D. Loss of seminal vesicle fat angle in prone CT indicates invasion
E. Dilute contrast should be used in CT scans
37. Bladder cancer:
A. Sagittal images are unnecessary for staging purposes

B. MRI is good for differentiation inflammatory and neoplastic
changes in the fat
C. Loss of angle between posterior wall of bladder and seminal
vesicle indicates invasion
D. High signal in T2 in rectal wall indicates invasion
E. MRI is best for assessing tumour at the dome
38. Bladder cancer:
A. Trigone is the commonest location

B. Squamous carcinoma has worse prognosis than adenocarcinoma
C. Calcification is seen in 25% of cases
D. 10% of diverticula can have carcinomas
E. The degree of wall thickening has correlation with the depth
of infiltration of the tumour
39. The following are risk factors for the development of

adenocarcinoma of bladder:
A. Bladder exstrophy B. Cystitis cystica
C. Sc h istosomiasis D. Urachal remnant
E. Smoking
40. Bladder:
A. The urine is sterile in Hunners ulcer
B. Radiation p r oduc es cy stitis o nl y i f the dose is more than
4000Gy
C. An impression in the left lateral of dome of the bladder is likely
to be from rectosigmoid
D. The risk of squamous cell carcinoma is 25% if a catheter has
been in situ for more than 10 vears
,
E. Staphylococcus is the most common agent to infect urachus
41. Carcinoma of urethra:

A. Commoner in males than females
B. Majority arise from the penile urethra
C. Transitional cell carcinoma is the commonest histological
subtype
D. Squamous cell carcinoma is the commonest histological type
rising from urethral diverticulum
E. Ca uses stricture in majority
42. Mal e urethral carcinoma:

A. Urethral stricture is a predisposing cause
B. TCC is commoner in the navicular fossa
C. STD is a predisposing cause
D. Penile urethra cancer spreads to the internal iliac nodes
E. TCC of urethra is associated with transurethral resection for
bladder carcinoma
43. Urachal tumours:

A. All adenocarcinomas at or near the dome of the bladder is
suggestive of urachal carcinoma
B. Calcification in urachal carcinoma indicates mucinous type
C. Arises from remnant of vitellointestinal duct
D. Involvement of abdominal wall is more common than other
bladder tumours
E. The urachus is lined by transitional epithelium
44. Cau s es of p s eudotumours in bladder.

__
A. Condyloma acuminata
B. Endometriosis affects the serosa of the bladder
C. �vfalakoplakia
D. Radiotherapy
E. Hunners ulcer
45. Bladder cancer:

A. IVUs can detect 90% of all tumours
B. 75% of tumours are superficial
C. 50% of superifical tumours eventually become invasive
D. T rigone is the commonest location
E. Presence of hydroureter implies muscle invasion
46. Bladder cancer.

A. Co existent upper tract cancer is seen in 25%
B. Infiltrating tumours are easily detected than superficial
tumours
C. Ultrasound is not good for detecting nodes extension
D. CT is not adequate for staging tumours confined to bladder
wall
E� CT has 95% accuracy for assessing wall involvement
47. Bladder tumours:

A. Pheochromocytoma of bladder produces Hypertension o n
micturition
B. Haematuria is uncommon in leiomyosarcoma of bladder
C. Hemangioma is the commonest benign mesenchymal bladder
tumour
D. Rhabdomyosarcoma in children completely fills the bladder
E. Rhabdomyosarcoma of prostate is associated with thickened
levator anirnuscle
Bladder 107
48. Exstrophy of bladder:

A. In adults, symphysis pubis is widened only if its more than
10 mm
B. Anterior abdominal wall is absent

C. Testis is undescended
D. All the patients are infertile
E. Associated with epispadias
49. Associations of exstrophy of bladder:

A. Rotation of innominate bones laterally and outwards
B. Vas deferens and seminal vescicles are hypoplastic
C. Direct in g uinal hernia
D. Absent fallopian tubes
E. Horseshoe kidney
SO. Bladder exstrophy:

A. The risk of carcinoma is 200 times that of normal people
B. 50% of carcin omas are squamous cell carcinomas
C. Carcinomas in bladder exstrophy are higher grade than from
normal bladde r
D. Hydronephrosis is seen in IVU
E. Hockey st ick appearance of distal ureter is a characteristic
feature
51. Bladder exstrophy:

A. Hydronephrosis will disappear if the bladder is pushed back
B. In female epispadias, the upper wall of u r e t hra is defecti\'e
C. Widening of symphysis is severe in epispadias than exstrophy
D. In covered exstrophy, fuere is no defect in the abdominal wall, .
but the bladder wall is defective
E. No functional abnormality is seen in covered exstrophy
52. Bladder cancer MRI:

A. TlW images are best for assessing extent of tumour in the wall
B. Tumours less than 13mm cannot be assessed by 0.i1RI
C. The intraluminal part cf tumour is best assessed in Tl weighted
unages
D. Staging is significantly improved by using endorectal coils
E. Presence of an intact hypointense layer outside the tumour in
T2 is essential for dilierentiating stage B2 and Cl
53. Congenital anomalies of bladder.

A. In complete duplication of bladder, the ureters are usually bilid
and dra in corresponding sides of both bladders
B. Bladder duplication is associated with duplication of penises,
urethras and vaginas
C. If there are multiple septa within the bladder, the ureters are
multiple and urethras are multiple as well
D. In hourglass bladder, one ureter drains into the upper segment
and the other into the lower portion
E. In incomplete duplication, there are two urethras
54. Causes of widened p ubic symphysis:

A. Marfan's syndrome
B. Imperforate anus with rectovaginal fistula
C. Osteomyelitis
D. Ankylosing spondylitis
E. Hyper·parathyroidism
Bladder 109
ANSWERS
1. A-F, B-T, C-T, D-F, E-T

Ureter opens in the posterolateral surface.The urachal remnant
runs extraperitoneally and forms the median umbilical
ligament.The bladder has a base, apex, superior and inferior
surfaces.The apex is b ehind the pubic symphysis. The urethra
arises from the neck.
2. A-T, B-T, C-F, D-F, E-F

From the bladder, the peritoneum forms rectovesical pouch in
males, but in females it forms the rectouterine and then the
vesicouterine pouch.The bladder is less mobile in males due to
puboprostatic ligaments.Trigone is not trabeculated.
3. A-F, B-F, C-F, D-T, E-F

Bladder drains into internal iliac nodes. The bladder thickness
should not exceed 5 mm.
Tl W images will show both bladder wall and .contents as dark
and o f not use. The intramural course is initially oblique, which
prevents reflux.The vas deferens crosses the ureter anteromedially .
4. A-T, B-F, C-F, D-T, E-F

The paraurethral glands ·of Skene, open into the vestibule on either
side o f the urethra.
The b ulbourethral glands open into the mem�ranous urethra.The
penile urethr a has one dilatation at the distal end called the
navicular fossa. The other dilatation is seen in the bulbous urethra,
called infrabulbar fossa.
5. A-F, B-F, C-T, D-T, E-T

Penetrating inj uries, Instrumentation, Infection with gas forming
organisms such as E. coli or Clostridium, especially in diabetics and
vesicointestinal fistula (car cinoma cervix, Crohns disease,
diverticular disease) are the causes of gas inside the bladder.
6. A-F, B-F, C-F, D-F, E-T

Prostatic ure thra is the widest part of the urethra.The prostatic
urethra has a prostatic crest in the posterior wall, which has
prostatic sinuses on ·its side. Above the prostatic crest lies the
verumontanum. The prostatic ducts open into the p rostati c sin us.
The p r ostatic u tricle and ejaculatory ducts o p e n into the
verumontanu m.The distal part of prosta tic urethra is fixed by
puboprostatic ligaments, but membranous urethra is the narro1,,;est,
most fixed and least dilatable part of urethra.
110 Genitourinary, Obstetrics & Gynaeco_logy and Breast Radiology
7. A-T I B-TI C-Ff D-TI E-T

Pelvic lipomatosis, haematoma, fluid collections, urine, lymph
node, aneurysms and bilateral iliopsoas hypertrophy are common
causes.
8. A-T, B-T, C-T, D-T, E-T

Transitional cell carcinoma is another well recognised cause.
9. A-F, B-F, C-T, D-F, E-T

Schistorniasis haematobium affects the bladder, whereas japonicum
and mansoni lodge in the portal vein. Increased risk of squamous
cell cancers. Strictures and obstruction are also common.
10. A-F, B-T, C-F, D-F, E-F

Bladder i s distensible and capacity is not reduced unlike
tuberculosis. Calcification is seen in the ova, not in fibrous tissue.
Upto 1 million eggs can be seen per cc, when bladder is calcified.
Ureteric strictures are seen at level of bladder. Ureteric beading
and calcification are other features.
11. A-T, B-T, C-T, D-T, E-T

Alkaline encrustation is dystrophic calcification (calcium phosphate
or struvite) in areas of necrosis, v;hich is precipitated by infection
with proteus or coliforms.
12. A-F, B-T, C-F, D-F, E-F

Bladder stones can be formed in situ due to stasis or infection.
In obstruction, uric acid stones are commonly seen. Struvite and
apatite stones are seen in infection. The mechanical irritation of
stones predispose to development of squamous cell carcinoma. The
stones are usually less dense than contrast, ·hence seen as filling
defect.
13. A-F, B-T, C-F, D-F, E-T, F-T

Cobra head sign is dilated distal end of ureter with surrounding
edema which will produce a cobra head like filling defect in the
opacified bladder. This is seen only in ureteroceles which insert
normally into the trigone of the bladder and is common in women,
and is usually diagnosed in adults, because they don't produce
symptoms like ectopic ureteroceles. Ureteroceles are formed due
to prolapse of the distal ureteric mucosa into the bladder, pulling
a layer of bladder mucosa. Since they are formed only of mucosa
without muscle or collagen, when urine fills the distal portion, it
distends and forms the ureterocele.
14 . A-F B-T C-T D-T E-T

' ' ' '
Intravesical ureteroceles are believed to be caused secondary to

distal ureteric obstruction and can be seen either conge:litai:y or
Bladder i 11
acquired due to obstruction or infection. Cobra head sign indicates

that the ureterocele is uncomplicated. There is increased incidence
of stone formation and infection with ureterocele.
15. A-T, B-F, C-T, D-F, E-T

Ectopic ureteroceles are usually associated with duplex ureter,
especially from the one arising from the upper pole. However in
boys, it can be seen even without a duplex ureter. Cobra head
sign is not seen, unlike intravescial ureterocele. Ureteric orifice
stenosis produces obstruction.
16. A-T, B-T, C-T, D-T, E-T
17. A-T, B-F, C-T, D-T, E-T

Hour glass bladder and pine tree bladder are appearances seen
i n hypertonic n eurogenic bladder. T h e bladder is small in
hypertonic bladder and large in atonic bladder. Common causes
of a tonic neurogenic bladder include spina bifida, tuberculosis,
syringomyelia. Bladder obstruction causes large hypertonic
bladder. Lateral deviation of the bladder is believed to be due
to presence of sigmoid colon in the left side of pelvis. Urethra can
be funnel shaped or saccular dilation at the mid portion. External
sphincter can be spastic or relaxed. Vesicoureteral reflux is also
seen.
18. A-F, B-T, C-T, D-T, E-F

Stones and tum o urs produce pseudoureteroceles. They also
produce filling defect with surrounding halo, but they do not have
the typical cobra head sign. The halo is usually thicker and
irregular than that of simple ureteroceles. The halo is occasionally
thick in ureteroc ele due to edema but never irregular. tvfoderate
to severe obstruction is usually seen in pseudoureteroceles also.
19. A-F, B-T, C-T, D-T, E-T

Bladder outlet obstruction, produces raised intravescical pressu:-e,
which can cause herniation of the bladder mucosJ through the
muscles, causing saccules and diverticula. Saccules are less than 2
cm, and diverticula more than 2 cm.
20. A-F, B-F, C-F, D-F, E-T

Involuntary contractions of the detrusor, interfering with proper
filing of bladder, is called detrusor hyperactivity. This may be
idiopathic when it is called detrusor instabi lity o r due t o
neurological causes, when it is called detrusor hyperreflexia or due
to decreased bladder compliance. In cystog:rarn, this manifests as
serrations and prominent interureteric ridge. Trabeculati.on.: :1�·c
very uncommon and a late feature. The biadde: is s:.nall. A.n.r' x>
is caused due to lower motor neuron, and not upper motor neuron
lesion.
21. A-T, B-T, C-T, D-T, E-T

Neurological diseases which result in loss of control (uninhibited
n eurogenic bladder) of detrusor by micturition center and
conditions causing spastic bladder are common causes of
involuntary incontinence. Cerebrovascular disease, brain tumour,
bladder infections/ tumours and prolapse are other causes.
22. A-T, B-T, C-F, D-T, E-T

Pine tree appearance is due to obstruction and loss of bladder
sensation resulting in overdistension and subsequent changes in
wall. This can be seen in both hyperreflexia and areflexia. Spinal
cord injuries result in detrusor hyperreflexia and sphi n c t er
dyssynergia. These patients cannot initiate· micturition. There is
incoordination between detrusor and sphincter. So there is
inadequate emptying. Eventually there is overflow incontinence
or incontinence due to hyperactive detrusor. Autonomous
neurogenic bladder is due to injury to nerves supplying bladder,
resulting in loss of bladder sensation and contraction, hence the
detrusor cannot have adequate tone to empty bladder. Overflow
incontinence results.
23. A-T, B-T, C-T, D-F, E-F

The diverticula has only mucosa and submucosa. It is commonly
due to bladder outlet obstruction. It has smooth walls although
seen in a trabeculated bladder. Predisposes to stone, infection and
reflux. Filling defect in diverticulum is more likely to be a calculus
than carcinoma. The diverticula close to the UV junction is called
Hutchs diverticulum.
24 • A-T B-T C-T D-T E-F

I I f f
25. A-F, B-T, C-T, D-T, E-F

A diverticulum can opacify earlier than the bladder if a part of
the ureter is incorporated into the diverticula. If the diverticula
h a s a narrow neck, it may not opacify at all. Usually, t h e
diverticulum opacifies after the bladder i s filled. B y definition1 any
outpouching less than 2 cm is called saccule. Fundal diverticula is
bilaterally symmetrically in the anterior aspect. Bladder ears are
seen in males before 6 months. They are transitory puches, but
do not have necks.
26. A-T, B-F, C-T, D-T, E-F

Stress incontinence can be caused by decreased tone of pelvic floor
caused by aging, surgery or multiparity or due to incompetcr.::
Bladder 113
urethral sphincter which is caused by periurethral inflammation

or cauda equine lesions or spondylolisthesis or deformed sphincter
27. A-T, B-F, C-T, D-T, E-T

Normal bladder can descend upto 1.5 cm with stress and in those
with stress incontinence it descends upto 2.0 cm. Surgeries,
especially radical prostatectomy are the commonest cause of
sphincter deformity in men, causing stress incontinence.
28. A-T, B-T, C-F, D-T, E-T

Surgery (gynaecological, urological, GIT) is the commonest cause.
Other causes include prolonged difficult labour, Caesarean,
forceps, rupture of uterus, congenital, trauma, tuberculosis,
Carcinoma cervix, carcinoma vagina, carcinoma bladder and
bladder calculus.
29. A-F, B-F, C-F, D-T, E-F

Man is the definitive host. The eggs are passed in the urine into
water and taken by snails where larval development happens. The
larvae enter the legs of htL'Tians, reach the circulation and mature
in liver. In haematobium, the worm reaches perivesical plexus, lays
eggs. The eggs elicit foreign body granulomatous react ion,
producing calcification as early as 50 days.
30. A-F, B-F, C-T, D-F, E-F

Cancer of the vagina is commoner than cancer of the bladder in
causing VVF.
The first step is clinical examination and instillation of dye into
bladder and visualizing its presence in the vagina. If fistula is not
visualized, and high clinical suspicion, cystoscopy is performed.
If fistula is not visualised in the initial examination and if there
is low clinical suspicion, oral pyridiurn test is performed. The
pyridiurn is excreted in the urine and has a orange colour, and
this will stain a tampon placed in the vagina.
There are four stages of uterine descent, I-Descent of cervix to
the vagina; II-descent of cervix to introitus, III-dl'scent of cervix
outside the introitus, procidentia- entire uterus is outside the
introitus. Vaginogram is the commonest radiological method.
Contrast is introduced into the vagina with a foleys catheter and
fistulous tract can be visualsied. NU is used for assessing the upper
tract and for ureterovaginal fistula.
31. A-T, B-F, C-T, D-T, E-T

Dyes including acrolein, aromatic amines, nitrosamines are otl:er
predisposing factors. Long term catheter usage, cystitis, pelvic
irradiation and a typical metaplasia are other conditions. Coff-=�,
beer, artificial sw e etneres and grilled food have also been

implicated.
32. A-F, B-F, C-F, D-F, E-F

95% of t u mours are epithelial and only less than 5% are
mesenchymal. 90% of epithelial tumours are transitional cell, 5%
are squamous cell and 2% are adenocarcinomas. Leiomyosarcomas
are the c o mmonest mesenchymal tumours in adults, whereas
rhabdomyosarcoma is commoner in children. Bladder cancers are
the commonest malignancies in the urinary tract. More common
in men.
33. A -F, B-F, C-T, D-T, E-F
Papillary type of bladder cancer is less likely to metastasise than
sessile and invasive types. Calcification is seen in approximately
1-6% of cases only. Epithelial tumours are malignant. Mesenchymal
tumours can be benign or malignant. Leiomyoma is the commonest
-- benign tumour, others being hemangioma, lipoma, neurofibroma,
hamartoma and pheochromocytoma.
34. A-T, B-T, C-F, D-F, E-T

Jewett Marshall staging
A-Limited to mucosa and submucosa, Bl-superficial muscle
invasion, B 2-deep muscle invasion, Cl-perivesical fat C2-
adjacent organs, Dl-lymph nodes, D2-distal metastasis
TNM staging
TI-mucosa, submucosa, T2-superfical muscular invasion, T3A
deep muscle, T4-adj organs
35. A-T, B-T, C-F, D-T, E-F

Ultrasound and IVU can detect m_any of the tumours. They might
miss very small tumours, hence a cystoscopy and biopsy are
required for confirmation. Tumours that are confined to the
mucosa and submucosa without involvement of muscle, are called
superficial tumours. After treatment, 50% of them recur within
two years.
36. A-T, B-T, C-F, D-F, E-T

Nodes more than 10 mm are considered pathological. Obturator
and external iliac are involved followed by internal iliac and
common iliac nodes. Loss of seminal vesicle fat angle with bladder
is a reliable sign of invasion, but is interpretated with caution in
prone position and overdistended rectum.
37. A-F, B-F, C-T, D-T, E-T

Sagittal images are very useful for assessing seminal vesical/
uterus/vaginal involvement. MRI or CT cannot differentiate
inflammatory and neoplastic changes. Seminal vesicie in1.·::i.si.c-"". �--=
Bladder 115
also demonstrated by low signal intensity with T2W images. MRl

is also good for the bladder base.
38. A-T, B-T, C-F, D-T, E-F

Calcification is seen in only approximately 6% of cases. There is
no direct correlation between the thickening of the wall and depth
of infiltration.
39. A-T, B -T, C-F, D-T, E-F

Adenocarcinoma can also extend from adjacent organs such as
rectum, prostate and uterus and metastases from stomach and
breast.
40. A-T, B-T, C-T, D-F, E-T

Hunners ulcer i s interstitial cystitis. The characteristic triad is
interstitial ulcer, sterile urine and irritative voiding symptoms.
Impression in bladder base is likely to be prostate. In trigone, the
impression is likely to be uterine or cervical lesion. Urachal
infections produce a cystic swelling at the bladder dome. The risk
of squamous cell carcinoma is 5% if cathether is in situ for more
than 10 years.
41. A-F, B-F, C-F, D-F, E-F

Urethral carcinoma is more common in the females. ivfajority are
squamous cell type. 15% are transitional cell type. Those arising
from diverticula are usually adenocarcinomas, since the diverticula
originate from infection in paraurethral glands. Urethral carcinoma
is more commonly seen as filling defects and stricture formation
is not common. Most common in the bulbar and membranous
urethra. The anterior urethral cancer spreads to superficial and
deep inguinal nodes while the posterior spreads to iliac nodes.
42. A-T, B-F, C-T, D-F, E-T

Urethral stricture and other chronic inflammations including STD
are predisposing causes for urethral carcinoma. :Nlajority are
squam ous cell carcinomas, commonly seen in the bulbar and
membranous urethra. The transitional type is seen in the posterior
urethra and is associated with previous transurethrnl resection for
bladder carcinoma. Navicular fossa has the squamous type. The
penile carcinoma spreads to deep inguinal nodes and external iliac
nodes. The posterior urethral cancers spread to internal iliac and
obturator nodes.
43. A-T, B-T, C-F, D-T, E-T

Urachu.s is obitered remnant of allatnois, which persists after the
bladder descends into pelvis. This is a fibrornuscular tube
surrounded by adventitia and lined by transitional epithelium.
116 Genitourinary, Obstetrics & Gynaecol9gy and Breast Radiology
Invasion into the muscular layer is more common than in bladder

tumours. The typical location is in the dome of the bladder.
Invasion of the space of Retzius and abdominal wall is easier for
these tumours.
44. A-T, B-T, C-T, D-T, E-T

Inflammatory polyp, fibrous polyp, follicular cystitis, eosinophilic
cystitis, tuberculosis, bullous cystitis, amyloidosis and
chemotherapy are other causes of pseudotumour.
45. A-F, B-T, C-F, D-T, E-T

IVU can detect 60% and ultrasound can detect 95% of bladder
tumours. 15% of superficial tumours become invasive. Trigone and
posterolateral wall are commonest sites:
Accuracy of CT is 95%
46. A-F, B-T, C-T, D-T, E-F

_
Coexistent upper tract cancer is seen in 2% and metachronous
cancers are seen in 7%, these two subtypes being associated with
higher incidence of recu!'rent tumours. CT cannot differentiate the
different levels of involvement in the wall and it has an accuracy
of 75% at the best.
47. A-T, B-T, C-F, D-T, E-T

Leiomyosarcoma and other mesenchymal tumours involve the
submucosa without rnucosal involvement. Hence, hematuria is
uncommon. Leiomyorna is the commonest benign mesenchyrnal
bladder tumour. Rhabdomyosarcoma arises from the prostate or
bladder, vagina, testis, pelvic floor or perineum or ovary.
48. A-F, B-T, C-T, D-F, E-T

Pubic symphasis is widened if it is more than 10 mm in neonates,
> 9 mm upto 3 years and > 8 mm in those above seven years. The
anterior abdominal wall and anterior wall of bladder is absent and
the bladder is exposed. Testis is undescended due to abnormal
position of pubic bones. Not all the patients are infertile and adult
survival is good.
49. A-T, B-F, C-F, D-F, E-T

The innominate bones are rotated outward along the sacroiliac
joint and the pubic bone is rotated outward at is junction. Vas
deferens, seminal vesicles and ejaculatory ducts are normal. Penis
is short or duplicated or hypoplastic. Hernia is indirect due to
persistent processus vaginalis, large internal and external rings and
lack of obliquity of inguinal canal. Urethra is short, uterus, tubes
and ovaries are normal. Kidneys can be horseshoe,or pelvic or
hypoplastic or solitary or dysplastic with megaureter.
Bladder 117
50. A-T, B-F, C-F, 0-T, E-T

90% of carcinomas are adenocarcinomas and they are lower grade
than normal. Hydronephrosis is seen due to trapping of ureter
between everted bladder and anterior abdominal wall.
51. A-T, B-T, C-F, 0-F, E-F

Since hydronephrosis is due to trapping of ureter between the
everted bladder and abdominal wall, pushing it back will cure the
� hydronephrosis. In epispadias, the urethra opens on the dorsum
l of the penis, but in females the upper wall is deficient. Widening
of symphysis in epispadias is lesser than in exstrophy. In covered
exstrophy there is a slight defect in the lower aspect of the rectus
abdominis and a thin walled bladder herniates through this. The
patients have incontinence.
52. A-F, B-F, C-T, D-T, E-T

Tl W images are best for assessing the intraluminal portion, since
it will bright against the dark urine. �1RI is not good for assessing
tumours less than 8 mm only. T2 W images or contrast enhanced
Tl images are used for assessing wall involvement, since the
tumour will be bright against the dark wall and contrasted with
bright urine in lumen. Presence of the hypointense muscular layer
is essential for excluding breach of the deep layer and extension
into perivesical fat.
53. A-F, B-T, C-F, 0-F, E-F

In complete duplication, there are h•;o bladders and urethras. The
right ureter drains into the right bladder and left ureter drains
into the left bladder. Incomplete duplication have only one urethra.
They have two separate fundi but a single base. The bladder can
also have a sagittal or frontal septum, which can be complete or
incomplete. In multiple septae, there are usually four segments,
ureters are duplicated and drain into each of the segments, and
there is usually only one urethra. In hourglass bladder there is
a dysplastic junction between bladder and urachu'.j producing a
transverse narrowing. The ureters usually drain into the lower
segment, but can drain occasionally into the upper segment.
54 ' A-FI B-TI C-TI D-TI E-T

Pregnancy, trauma, rheumatoid arthritis, osteitis pubis, metastasis,
exstrophy of bladder, epispadias, hypospadias, Prune belly
syndrome, urethral duplication are the comm.on causes.
1. Renal cysts:
A. Class IV can be followed up for more sinister transformation
B. 100% of class II lesions are benign
C. Thick, irregular septa are seen in stage III
D. Increased density of contents in class II
E. Class IV are malignant
2. Expansile tumours in kidney:

A. Lymphoma
B. Transitional cell carcinoma
C. Angiolipoma
D. Oncocytoma
E. Juxtraglomerular twnour
3. Infiltrative tumours:
A. Xanthogranulomatous pyelonephritis
B. Metastases
C. Leukemia
D. Mesenchymal twnour
E. Lymphoma
4. Features in favour of a kidney lesions being benign in CT:

A. No enhancement
B. Rim enhancement
c. Hypodense center
D. Cystic lesion with septations
E. Intralesional fat
5. Common causes of multiple expansile masses m kidney:

A. Van Hippe! Lindau disease
B. Renal cell carcinoma
C. Tuberous sclerosis
D. Lymphoma
E. Simple cysts
Renal Tumors 119
6. Features of renal cell carcinoma:

A. Solitary bony metastasis
B. Expansile sclerotic bone metastasis
C. Polychythemia
D. Haemorrhagic cerebral metastasis
E. Extensive neovascularity
7. Wilms tumour:
A. Bilateral in 30%
B. Calcification is seen in 5%
C. Microscopic haematuria is presenting feature in 40%
D. If IVC is not seen, it means it is invaded
E. Increased subsequent incidence of renal cell carcinomas
8. Staging of renal tumours:

A. Involvement of adrenal- TNM-T3a
B. Extension to perinephric fat, within Gerotas fascia- Robsons2
C. Intrarenal tumour-5 cm- TNM- Tl
D. Regional lymph nodes- Robsons III-B
E. Involvement of IVC- Robsons IV
F. Involvement of renal vein- TNM s- T3b
9. Renal tumours:
A. Majority of renal tumours are isoechoic in ultrasound
B. Calcification is seen i n 50%
C. In hyperechoic lesions there is peripheral halo
D. Absence of intratumoral cvstic areas differentiates it from
�
angiomyolipoma
E. Papillary tumours have better prognosis
10. Associations of renal tumours:

A. Von Hippel Lindau disease
B. Multiple endocrine neoplasia
C. Hepatic dysfunction
D. Hypertension
E. Hypocalcemia
11. Renal cancers:

A. Scintigraphy shows hot spot in renal tumour
B. Undergoes spontaneous r�gression
C. The most common recipient of metastasis of another cancer
D. Absence of renal excretion can occur only if there is renal vein
. .
mvas10n
E. Re�al carcinoma gene is chromosome 19
. .
12. Renal tumours:

A. There is a direct correlation between the size of primary renal
tumour and development of metastasis
B. Venous invasion indicates bad prognosis
C. IVC involvement unequivocally reduces prognosis
D. Spontaneous regression of renal tumour metastasis may occur
E. Partial nephrectomy or nucleation gives comparable results to
radical nephrectomy in intrarenal tumours < 2 cm
13. Renal tumour:

A. Partial nephrectomy is precluded if adrenal gland is involved
B. Resection of involved lymph nodes improves prognosis
C. Incidence o f metastasis is hig her by 50% in t h o s e with
locoregional lymph nodes
D. Renal vein extension occurs in 10% of RCC at presentation
E. IVC extension occurs in 5-10% of tumours at presentation
F. Thrombus involves suprahepatic portion of IVC in 40% of cases
14. Renal tumour:

A. Upper extent of IVC extension is essential f or s urgical
approach
B. Nephrectomy is ad,·ised in patients with solitary metastasis
to bone
C. Regression of metastasis following nephrectomy occurs in 3%
of cases
D. Ultrasound is equally effective as CT and MR in staging of
renal tumour
E. Accuracy of CT staging of renal tumour is 72-90%
15. Venous invasion in RCC:

A. Multiphasic CT scans are useful in diagnosis of thrombus
B. Persistent filling defect in renal vein has a specificity of 100%
C. Enlarged renal vein without identifiable thrombosis is a highly
specific sign
D. Assessment of renal venoµs extension is more difficult on the
right side
E. The differentiation of bland t hrombosis f ro m tumour
thrombosis can be reliably made with CT scan and this is very
important in the clinical management
F. False positive results for blood clot may be caused due to
unopacified contrast from extremities
,
'
i{ Renal Tumors 121
16. Angiomyolipoma:
A. Spontaneous haemorrhage is a major presenting feature
B. Biopsy required for confirming diagnosis
C. Tumours more than 4 cm require regular follow up
D. Hyperechogenicity in ultrasound is characteristic
E. Non fat containing lesion in tuberous sclerosis is likely to be
AML than RCC
17. AML (Angiography):

A. Onion peel appearance is characteristic in angiogram
B. Avascular in angiography
C. Aneurysms are characteristic
D. Lymph nodes can be involved
E. Calcification is very uncommon
18. Renal tumour.

A. In assessment of lymph nodal involvement in RCC, a false
positive rate of 45% has been reported, using a size of 1 cm
B. Specificity is increased by increasing the cut off size to 2cm
C. IVC thrombosis results in higher false positive rate for lymph
nodal involvement
D. Hilar lymph n o d al involve men t can occur in renal cell
carcinoma
E. CT has a sensitivity of 89% for assessment of l y mph nodal
involvement
F. CT has a false negative rate of 20% d u e to m i c r o s c o pi c
metastasis
19. Renal tumour:

A. Adrenal mass in a patient with RCC may be due to
pheochrom oc y toma
B. Presence of a synchronous tumour is common in the ipsilateral
rather than contralateral kidnev ,
C. Lung is the commonest site of metastases

D. Presence of Budd chiari syndrome due to IVC involvement
makes visualization of liver metastasis difficult
E. Loss of fat plane betvveen tumour and adjacent structures like
liver or psoas is a specific sign of tumour involvement
20. Renal tumour:

A. Resection of solitary pulmonary metastasis increases survival
to 56%
B. Lung metastasis is more common in RCC with IVC Lrwolvement
C. A solitary nodule in X-ray is an indication of CT chest
D. CT is not indicated if there are multiple nodules in chest X
ray
E. CT scan is not indicated if the chest X-ray is normal
I
21. Sequences used in MRI of renal tumour:

A. Tl and T2 spin echo
B. Fast spin echo
C. Cardiac gating
D. Gad enhanced GRE and fat suppressed Tl W images
E. Fat suppressed T2
F. Renal MRA
22. MRI in renal carcinoma:

A. Specificity of MRI for detection of perinephric extension is
higher than CT scans
B. Perincphric extension is low signal on Tl, intermediate in T2
C. Contrast enhancement in fat suppressed contrast images in
perinephric space suggests infiltration
D. MRI is the best method for assessment of venous involvement
E. Accuracy of venous extension is improved by use of contrast
F. Tumour clot is seen as high signal area in gradient echo images
23. MRI in renal tumours:

A. Tumour thrombosis is seen as high signal lesion in spin echo
images
B. :1\·1RI has an accuracy of 100% for vena caval involvement
C. �1RI has superior accuracy than CT in assessment of lymph
nodal involvement
D. :!\.1RI is superior to CT in assessment of adrenal metastasis
E. MRI is useful for detection of small renal tumours
F. MRI is at best an adjunctive to contrast enhanced CT
24. Erythrocythemia occurs in:

B. Renal adenoma
C. Hemangiopericytoma
D. Hepatoma
E. Hemangioma
25. Perinephric extension in Renal tumour:

A. CT has a sensitivity of 85% in diagnosing perinephric extension
of RCC
B. Presence of a �iscrete perinephric mass, measuring atleast 1
cm has a specificity of 98% for perinephric extension
C. False positive diagnosis of perinephric extension occurs in 50%
due to perinephric stranding
D. Blurring of renal outline may indicate capsular invasion
E. Thickning of perirenal fascia indicates capsular invasion
Renal Tumors 123
----r.-�-��-
---�=-·
26. Bosniaks class 3 cysts are caused by:

A: Renal cell carcinomas
B. Simple cysts
C. Multilocular cystic nephroma
D. Haemorrhagic cyst
E. Infected cyst
27. Cystic RCC:

A. Majority are in Stage III
B. Cystic RCCS are rare before fourth decade
C. Can be seen as Bosniak simple cyst
D. The only known mechanism is cystic necrosis of solid RCC
E. 15% incidence
28. Renal cell tumours:

A. Bilateral in 4%
B. Mulicentric in 13%
C. Oassical triad of flank pain, mass and haematuria is seen only
in 25% of cases
D. Solid renal lesions are renal cell carcinomas unless proven
otherwise
E. All renal cell carcinomas should be confirmed b y biopsy
29. Transitional cell tumours :

A. 75% of papillomas con\·ert into transitional cell carcinor:tas
B. 30% of ICCs are multicentric
C. Oncocalyx is a typical appearance in renal ICC
D. The renal contour is preserved in renal ICC
E. Spread medially through the hilum and cause hilar adenopathy
30. Transitional cell tumours:

A. 10% of renal tumours are transitional cell type
B. 99% of urothelial tumours are derived from transitional cells
C. Upto 40% of those with upper ureteric ICC have bladder ICC
D. Upto 10% of those �xith bladder ICC have upper tract ICC
E. 40% of ureteric ICC patients develop bladder ICC within 2
years
31. Urothelial tumours:

A. Transitional cell tumours are very vascular, more than the RCC
B. 10% of renal tumours are urothelial
C. AV shunting is a typical feature of ICC
D. Coiling of the RGP catheter in the inf::-a tumoral space
E. Ureteral carcinoma metastasises more than bladder carcinoma
32. Transitional cel l cancers:

A. Stippled pattern of accumulation of contrast inside the tumour
is a specific feature seen only in transitional cell and
adenocarcinomas of the collecting system
B. Champagne glass sign is a pa thognomonic sign of ureteric TCC
C. They are seen as hyperechoic lesions in ultrasound
D. Intense enhancement is seen in post contrast images
E. 85% of TCCs are exophytic with stalk
33. Risk factors for transitional cell tumours:

J\. Radiotion
B. Phenytoin
C. Smoking
D. Dyes
E. Cyclophosphamide
34. Histology of Wilms tumour.

A. Higher the degree of anaplasia, worse the prognosis
B. Bilateral tumours are associated with nephroblastomatosis
C. Fetal kidneys have stromal elements
D. Clear cell sarcoma is a \·ariant of Wilms tumour
E. Presence of rhadornyoblastic elements worsens prognosis
35. Renal l ymphangiomatosis:

A. Renal lymphangiomatosis is exacerbated by pregnancy
B. The cysts in renal lyrnphangioma are scattered in the parapelvic
region
C. Surgery is the treatment of renal lymphangiomatosis
D. Percutaneous drainage of cysts is the treatment of choice
E. Page kidney is a complication
36. Oncocytorna:
A. Arise from intercalated cells
B. Locally malignant tumour
C. Fat is seen within lesion
D. Eosinophilic cytoplasm
E. Common in females
37. Oncocytomas:
A. Renal vein invasion, similar to renal cell carcinoma
B. Central scar seen in 75%
C. Can be differentiated from central necrosis of renal cell
carcinoma
D. Isodense in contrast enhanced scans
E. Scar enhances in MRI
Renal Tumors 125
38. Angiomyolipoma:
A. Majority are associated with tuberous sclerosis
B. The lesions are smaller when associated with tuberousclerosis
I
C. 80% of tuberous sclerosis have angiomyolipoma
D. Associated with lymphangiomatosis
E. Commoner in females
39. Angiomyolipoma:
-t A. Hamartomatous renal lesion
i
B. Hyperplastic elastic tissue in blood vessels
l C. Encapsulated
i D. Invasion of renal vein recognised
I
E. Aneurysm formation characteristic in angiograms
40. Renal lymphoma:

A. If there is massive associated retroperitoneal node, RCC is likely
B. Solitary hypoechoic mass is the commonest pattern of
involvement
C. Renal function is preserved in diffuse infiltration
D. Homogenous hypoechoic in ultrasound, cannot be differen
tiated from cyst
E. Diffuse infiltration is more common in leukemia than lymphoma
41. Renal lymphoma:

A. If a renal mass does not regress at the same time as other
lymphomatous deposits, think of renal cell carcinoma
B. Extension from adjacent organs, happens via renal sinus or
hilum
C. Thickening of ureteral wall happens i n extension from
retroperitoneum
D. There is no uptake in bone scan or in gallium scan
E. Isolated perirenal deposit is hyperdense on non contrast scans
42. Renal tumours:

A. Leiomyosarcoma arises from the renal capsule
B. Leukemia involves the kidnev in 65% of casrs
C. Wilms tumour in adults has a better progno�is
D. Wilms tumour in adults is very vascular
E. Wilms tumour in adults peaks in the 2nd decade
43. Renal metastases:

A. A normal sized kidney excludes metastasis
B. Secondaries in kidney are common than primary tumours
C. Can present as a solitary mass and biops y is required for
confirmation
D. M�ltiple discreted nodules are the commonest type of
presentation
E. Patients die before the tumour causes sympto::i.s
F. The third commonest site of metastasis
44. Multilocular cystic nephroma:

A. Has a thin walled capsule
B. There is a bimodal age distribution
C. Those presenting before two years are exclusively seen in females
D. There is a second peak at 40-60 years
E. Characteristic protrusion into the renal pelvis
45. Multilocular cystic nephroma:

A. Calcification is common in the septa
B. Septations do not enhance in contrast administration
C. Dilatation of collecting system is associated
D. No change in the function of kidneys
E. The cysts are lined by transitional cells
46. Causes of cholesteatoma of kidney:

A. Sarcoidosis B. Papillary necrosis
C. Vitamin A deficiency D. Obstruction
E. Syphilis
47. Prominent mucosa! thickening in the collecting sty stem is seen
A. Vesicoureteral reflux B. Leukoplakia

C. Hydronephrosis D. Varices
E. Haemorrhage
48. Uncommon renal tumours:

A. Leukoplakia has onion skin or laminate_d appearance
B. Adenocarcinoma of pelvis is associated with stones
C. Adenocarcinoma can be obscured by a large stone
D. Thorotrast produces squamous cell carcinoma
E. Carcinosarcoma is association of TCC and SCC
49. Squamous cell carcinoma:

A. Squamous cell tumours of the renal pelvis is associated with
calculus in the pelvis in 80% of cases
B. Squamous cell carcinoma usually affects the perinephric space
C. There is no distortion of the renal contour in squamous cell
carcinoma
D. Squamous cell tumours constitute 10% of renal tumours
E. Angiography is not as vascular as in Renal carcinoma
50. Etiological factors for renal cell carcinoma.

A. End stage kidney without dialysis
B. Renal transplants
C. Diethyl stilbesterol
D. Analgesic abuse
E. Acquired cysts in kidney
Renal Tumors 127
ANSWERS
1. A-F, B-T, C-T, D-T, E-T

Bosniaks classification of renal cysts.
I-simple cyst, well defined wall, clear contents, acoustic
enhancement, no contrast enhancement. N o follow up is required.
II-minim.al complicated, thin septations, fine calcifications, dense
contents. No constrast enhancement. IIF-same features, but need
follow up at 3,6,9,12 months. III-more complications,wall thicken
ing, thick and irregular septations, thick and irregular calcificati�ns,
non enhancing solid components, multiloculated cysts. 50% malignant
N-malignant, non uniform wall thickening, irregular margins, solid
enhancing components. Nephrectomy is required
2. A-F, B-F, C-T, D-T, E-T

TCC produces infiltrative pattern
3. A-T, B-T, C-T, D-F, E-T

Expansile-RCC, a denoma, oncocytoma, angiomyo lipoma,
juxtraglomerular tumour, metastasis, mesenchymal tumour
Infiltrative-transitional cell carcinoma, lymphoma, leukemia,
xanthogranulomatous pyelonephrities, metastases
4. A-T, B-F, C-T, 0-F, E-T

Rim enhancement, septations can be seen in abscesses/ tumours
5 • A-T B-T C-T 0-T E-T

I I I I
ADPKD, metastasis are other causes.
6. A-T, B-F, C-T, 0-T, E-T

Expansile lytic lesions are seen, similar to thyroid and pheochro
mocytoma. Hemorrhagic meta stasis are also seen i n thyroid
carcinoma and melanoma Polycythemia is caused due to
erythropoietin production.
7' A-F B-F C-F D-F E-F

I I f I
Bilateral in 5%. Calcification in 15%. Microscopic h,1.ematuria is

seen in 15-20%.
8. A-T, B-T, C-T, D-T, E-F, F-T

There are two staging systems for renal cell tumours, the Robsons
staging and TNM staging.
Robsons staging of renal cancer
I-tumour confined to kidney, II-tumour extends outside kidney
but within Gerotas fascia
III-tumour extends outside Gerotas fascia, A-involvement of
renal vein or IVC, B-involvement of lymph nodes, (-renal vein
or IVC a nd lymph nodes
IV A-involvement of adjacent organs, B-Distal me:astasis
TNM staging
T1-intrarenal tumour < 7cm
T2-intrarenal tumour > 7 cm
T3-extension outside kidney, but within Gerotas fascia, 3a
extension to perinephric tissue or adrenal, within Gerotas fascia
3b-Extension to renal vein or IVC below diaphragm, 3c
Extension to IVC above diaphragm.
T4-Involvement of adjacent organism
N1-Sing1e regional node
N2-Multiple regional nodes
Ml-Metastasis
9. A-T, B-F, C-T, 0-F, E-T

In ultrasound, renal tumours can be isoechoic (85%) or hypoe\.'.hoic
or hyperechoic (4%) or anechoic. Hyperechoic tumours represent
papillary, microcystic or tubular subtypes, are less than 3 cm and
_ can be due to calcification, or fibrosis. The main differential
diagnosis of hyperechoic lesion is angiomyolipoma. There are two
important differentiating points. In hyperechoic renal tumours
there is a peripheral halo and int;:-atumoral cystic spaces, which
are absent in angiomyolipoma. Calcification is seen in only 8-18%
10. A-T, B-F, C-T, D-T, E-F
Raised ESR, hypertension, hypercalcemia, anemia, polycythemia,
amyloidosis, dysfibrinogenemia, leukemoid react ion, gynae
comastia and Cushings syndrome. Hypertension is produced due
to increased rennin production. Hypercalcemia is due to PTH like
substance. Polycythemia is due to erythropoietin production.
Hepatic dysfunctior. is called Stauffer syndrome. Amyloidosis is
another manifestation. Anemia is due to bleeding.
11. A-F, B-T, C-T, D-F, E-F

Scintigraphy shows a cold spot in renal tumour. The metastasis
is seen as hot spot. Renal tumour is one of the few tumours to
demonstrate spontaneous regression like choriocarcinoma,
neuroblastoma and malignant melanoma. It also occurs in· very
unsusual places, the other two tumours having this feature being
choriocarcinoma and malignant melanoma. It is the only tumour
to receive a metastasis of lung cancer. Abse�ce of renal excretion
can be due to renal arterial encasement or renal venous invasion
or extensive infiltration or infiltration of pelviureteric junction.
Renal carcinoma gene is in short arm of chromosome 3.
12. A-T, B-F, C-F, D-T, E-T

There is usually a direct relationship between the tumour spread
and survival. Tumour size alone is not useful as a predictor o:
�
i
t Renal Tumors 129
t
� prognosis. There is direct relationship between the size of the
'
primary tumour and development of metastases. Larger the

tumour, greater the incidence of metastases and worse the
j
'
I
l prognosis. Renal Venous in vasion without ly mph nodal or
l
metastatic disease, may have a better prognosis, if the tumour is
confined within kidney. But there are recent .studies which indicate
that venous invasion means bad prognosis. So the results are
controversial. The significance of IVC invasion is also controversial.
i
.
Some studies indicate that mobile tumour thrombi (survival 9.9
I
i
years) have better prognosis than thrombi with wall invasion
(survival 1.2 years) Recent studies indicate that IVC involvement
unequivocally reduces survival.
J 13. A-T, B-F, C-T, D-F, E-T, F-T

Nephrectomy can be radical or partial. Differentiation between T2
and T3a is important, as partial nephrectomy or enucleation of
tumours is preferred in s maller tumcurs confined to kidney,
especially in patients with solitary kidneys or multiple tumours.
The results are comparable with that of radical nephrectomy. The
presence of adrenal or perinephric involvement outside Gerotas
fascia i s a contraindication for partial surgeries. Adrena !
involvement occurs in 6°'o of tumours, especially in upper left sided
tumour s and tumours involving whole kidney. There is r.o
e\·idence that lymph node resection improves prognosis. lymph

nodal invol\·ement occurs at the same time as hematogenous
spread and indicates poor prognosis. The incidence of metastasis
is 50% higher in those \\·ith regional lymph node involvement.
Renal venous involvement is seen in 20% of patients and is
managed by ligation of the vein.
14. A-T, B-T, C-F, D-F, E-T

IVC i n volvement occurs in 5-10%. An abdominal approach is
in dicated for IVC extension below level of hepatic veins and
thoracic for suprahepatic. 5-lOq'o extend to right atrium, whtcn
requires cardiopulmonary bypass. Nephrectomy is not performed
for those with distal metastases. The exception is a solitary
metastasis in a bone, resection of which gives a 5 year survival
of 25-35%. The survival is only 0.3% if a nephrectomy is performed
in those with multiple metastasis. Ultrasound is not as effecti \·e
as CT or MR, in staging RCC, because of bowel gas which obscures
retroperitoneum, renal vessels and IVC. The accuracy of CT in
staging of RCC is 72-90%.
15. A-T, B-F, C-F, D-T, E-F, F-T

Detection of venous invasion is the most important step ir. t:i.e
staging of renal tumours. CT scan is done in variJus p!--.J.:;es,
especially non contrast, early vascular, and venous stages to detect

renal venous thrombosis in the earlier scans and NC involvement
in the later scans. The presence of a persistent filling defect in veins
is the most specific sign, with a specificity of 100%. Renal venous
enlargement without a identifiable thrombus has a high false
positive rate of 78% (hypervascular tumours cause increased renal
flow) and a high false negative rate of 90% (thrombus need not
cause enlargement of vein). The assessment is more difficult in
right as the vein is short and straight and large tumours may
caused distension of veins, which makes assessment of caval
extension difficult. False positive diagnosis of caval extension may
be caused due to artifacts such as streaming of contrast, layering
of contrast and mi xing of unopacified blood from lower
extremities. A tumour thrombosis may be differentiated from a
bland blood clot by presence of neovascuiarity and enhancing
vessels, direct continuity of clot with tumour and direct invasion
of wall. This distinction is sometimes difficult and anyway, does
not alter management. Longitudinal reconstruction images improve
visualization.
16. A-T, B-F, C-T, D-F, E-F

Haematuria, abdominal pain and mass are recognised features.
Imaging findings are characteristic and biopsy is not required.
Hyperechogenicity can also be seen in one third of renal cell
carcinomas. A non fat containing lesion in tuberous sclerosis is
likely to be renal cell carcinoma.
17. A-T, B-F, C-T, D-T, E-T

Angiography shows hypervascular lesion with pseudoaneurysms,
venous pooling and onion peel appearance. Occasionally lymph
nodes, renal vein, IVC are involved. Calcification is uncommon
and should prompt alternate diagnosis.
18 • A-TI B-TI C-TI D-TI E-Tf F-F

The renal lymphatic drainage is through the renal hilar nodes to
the paraaortic nodes to the lumbar trunk and cisterna chyli. Direct
communication may exist to mediastinal and hilar nodes. If a cut
off size of 1 cm, is used for renal tumour, the false positivity rate
is 45% because of reactive hyperplasia, the incidence of which is
increased in tumours with necrosis and tumour thrombosis within
IVC, False negative rates are only 4-5% due to microscopic tumour
infiltration. Lymph nodes greater than 2 cm are always due to
metastasis. CT has an accuracy of 83-89% for lymph nodal
involvement. It has a sensitivity of 88-95% and spe<:ificity of 99-
100% for diagnosing stage III (vascular and -venous in- ·::.: :<.
. .
Renal Tumors 131
19. A-T, B-T, C-T, D-T, E-F

CT has a sensitivity of 98% and specificity of 99% for detection
of Robsons stage IV disease. Detection of involvement of adjacent
organs and metastatic disease is done using CT scan. Loss of fat
plane between the rumour and adjacent organs like liver and psoas
is not a reliable sign. Presence of density change or enlargement
within the involved structure is the definitive sign. Adrenal mass
may be d ue to metastati� disease or co existent adenoma or
pheochrornocytorna in a patient with Von Hippel Lindau disease.
j Presence of synchronous tumour is higher in ipsilateral kidney
I
I
rather than contralateral kidney(2%). Liver metastasis is usually
hypervascular. Budd chiari disease of liver due to invasion of IVC,
I� makes visualization of hepatic metastasis difficult.
20. A-T, B-T, C-T, D-F, E-F

'
Lung is the commonest site of metastasis from RCC with an

incidence of 50-60%. The incidence is more in those with extensive
abdominal disease especially larger tumours, lymph nodal spread
and venous involvement. CT scan is the most sensitive method
of detection of pulmonary metastasis. The detection of metastasis
is significant as a solitary pulmonary metastasis can be resected
and survival increased to up 56%. A CT scan of chest is indicated
if there is 1). Chest X-ray with solitary nodule, where a resection
may be done .2) Normal chest X-ray, but extensive regional spread
3) Normal chest X-ray, but extensi\·e chest symptoms 4) Ylultiple
nodules, where immunotherapy or chemotherapy may be done
experimentally.
21. A-T, B-T, C-T, D-T, E-T, F-T

The common sequences are spin echo Tl and T2 sequences. Fast
spin echo s e quences increase resolution and reduc e motion
artifacts. Fat suppressed T2 images reduce chemical shift artifact
and reduce dynamic range of abdominal signal intensities. Gd
enhanced GRE and fat suppessed Tl vV images are useful for
vascular invasion. Cardiac gating is used for assessing IVC and
atrial extension. Coronal and sagittal images are useful for vascular
invasion and hepatic metastasis.
22. A-T, B-T, C-T, D-T, E-T, F-F

Perinephric extension of tumour is seen as low signal in Tl \V
images and intermediate signal in T2 sequences and show contrast
enhancement, well seen in fat suppressed images. Sensitivity is
60-70% and specificity is 94%, both higher than CT scans. MRI is
the best method of assessment of vascular invasion, especially for
the upper extent, as multiplanar images are acquired. The tlliTtOur
thrombus has the same signal as the primary tumour. It is seen

best in Tl W spin echo images as a relatively high signal lesion
within flow void. It is seen as a medium signal filling defect lesion
within bright blood flow i n Gradient echo images. Contrast
increases the accuracy. MRl has an accuracy of 100% for IVC, 88%
for renal vein and 80% for atrial invasion. Negative predictive value
is 98%. Sagittal and coronal images are very useful in vascular
assessment.
23. A-T,B-T,C-F,D-T,E-F,F-T
MRI is not superior to CT in assessment of lymph nodal
involvement. It is better than CT in differentiating nodes from
collateral vessels which are seen as signal voids. They are not useful
in differentiating bowel and nodal masses. MRI is not useful in
detection of small renal cancers, especially less than 1 cm and
calcification. It is very useful in differentiating adrenal adenomas
from metastasis. The accuracy is 98% for detection of adjacent
-·
visceral involvement. Contrast enhanced spiral CT scan is still the

best method of staging of renal cell carcinoma and MRI is an
adjunctive tool, especially for Yenous invasion.
24. A-T, B-F, C-T, D-T, E-F

The tumours that produce erythrocythemia are RCC, wilms,
polycystic kidney disease, hep a toma, regenera ting nodular
hyperplasia, pheochromocytoma, cushings, adenoma and cerebellar
hemangiopericytoma.
25. A-F, B-T, C-T, D-T, E-T

Assessment of perinephric extension of tumour is very important,
as it precludes a partial nephrectomy. The oniy specific sign, with
a specificity of 98% for perinephric extension, is the presence of
a discrete perinephric soft tissue mass measuring atleast lcm. This
has a sensitivity of only 46%, as it is not present in most of cases
with perinephric extension. The other subtle signs are presence
of perinephric stranding, thickening of perirenal fascia, blurring
of renal outline and indistinct tumour margin- Focal thickening of
Gerotas fascia near the tumour is more specific than a general
thickening. Falsve positive rates are also as high as 50% a s
perinephric stranding may b e seen due t o oedema, fibrosis, fat
necrosis, hemorrhage or collateral vessels.
26. A-T, B-F, C-T, D-T, E-T

Type 3 cysts are complicated cysts.
27. A-F, B-T, C-T, D-F, E-T

Majority are in stage I. It can be due to cystic necrosis or solid
growth within a simple cyst or intrinsic cystic growth.
Renal Tumors 133
28. A-T, B-T, C-F, D-T, E-F

Classical triad is seen only in 9%
29. A-F, B-T, C-T, D-T, E-T

25% of solitary papillomas and 50% of multiple papillomatosis
convert into TCC. Oncocalyx is ballooned tumour filled calyx.
TCC is an infiltrative tumour and hence the renal contour is
preserved. The tumour has a density of upto 20 HU in non contrat
scans and enhances to 20-55 HU in contrast scans. Contrat is
trapped in curvilinear calyceal spaces around tumour.
30. A-T, B-F, C-T, 0-F, E-T

TCCs constitute 5-10% of all renal tumours. 90% of urothelial
tumours are transitional cell type, with 5% being adeno and 5%
being squamous. 20-40% of upper tract TCCs have bladder TCC
and 20-40% develop one within 2 years. 2% of those with bladder
TCC have upper tract TCC.
31. A-F, B-T, C-F, 0-T, E-T

Transl.tonal tumours are characteristically avascular unlike the
vascular RCCs. AV shunting is not seen. Coiling of the RGP
catheter is called Bergman sign. Creteral carcinoma spreads more
because lack of barriers to spread. It has thin walls and there is
extensive lymphatic drainage. Creteral tumours are common in the
5th-7th decades and commoner in the lo\ver third.
32. A-F, B-T, C-F, D-F, E-T

Stippled pattern of contrast enhancement and champagne glass
appearance (due to expansion of ureter distal to the filling defect
of tumour, unlike the stone which causes spasm and narrowing)
are specific for TCCs. They are hypoechoic in ultrasound and
hypodense in CT. They show mild enhancement in contrast scans.
85% of TCC s are exophytic. Champagne glass sign refers to dila ta ti on
of ureter below the tumour in the shape of champgene glass. Tr.is
is a specific sign of TCC and not seen in calculus. This is due to
accommodation of ureter to the predominantly intrnluminal gro-v,·th
of tumour and recurrent orolapse of tumour during ureteral
peristalsis.
33. A·F, B-F, C-T, D-T, E-T

Smoking, analgesic abuse, cyclophosphamide, aniline dyes and
chronic stasis are well known risk factors for transitional cell
carcinoma development.
34. A-T, B-T, C-T, D-F, E-F

Fetal kidney s have epithelial elements: nephrogenic rests haxe
stromal elements and Wilms tumour has biastemal eleme;\:s.
Triphasic tumours have all these components.

Rhabd o m yoblastic features are not unfavourable. Clear cell
sarcoma and malignant rhabdoid tumour are independent entitites.
35. A-T, B-T, C-F, D-T, E-T

Percutaneous drainage of cysts is the treatment of choice, in
symptomatic patients. Surgery is usually the last resort.
36. A-T, B-F, C-F, D-T, E-F

Oncocytoma is a benign tumour arising from intercalated cells of
collecting duct. It is a benign tumour with eosinophilic cytoplasm,
positive for cathepsin H. Recurrence is uncommon. More common
in males. There is no fat ,..,·ithin the lesion.
37. A-F, B-F, C-F, D-F, E-F

There is n o invasion of renal vein or adjacent structures. Central
scar is seen in 35-50% and difficult to differentiate from central
-- necrosis of RCC. The lesion is hypodense in non contrast scans
and hypo in contrast enhanced scans. The lesion is homogenous
in MRI and there is no scar enhancement.
38. A-F B-F, C-T, D-T, E-T

Only 20% are associated \\·ith tuberous sclerosis and 80% are
sporadic. 80% of tuberous sclerosis haYe angiomyolipomas. These
t..Imors are larger, multiple and bilateral than sporadic types.
39. AF, B-F, C-F, D-T, E-T

It is not a hamartoma but a choristoma, since the elements of fat
and smooth muscle are not normal in kidneys. Capsule is not seen.
It is a benign tumour but invasion into renal vein and IVC are
recognised features. The newly formed blood vessels lack elastic
tissue accounting for the intrarenal aneurysm formation seen in
angiograms.
40. A-F, B-F, C-F, D-F, E-T

There are three patterns of lymphomatous involvement, solitary I
multifocal/ diffuse infiltrative. The lyphomas are very rarely
primary renal and usually secondary to systemic l ymphoma.
Solitary pattern is very rare presenting with solitary homogenous
hypoechoic lesion, which may have perinephric or renal sinus
involvement. Multifocal lesions can mimick metastasis and are the
commonest t ype. Diffuse infiltration causes bilaterally enlarged
kidneys with loss of function. The lesions are h omogenous,
hypoechoic in ultrasound, but unlike cysts there is no acoustic
enhancement behind the cysts.
Renal Tumors 135
41. A-T, B-T, C-T, D-F, E-T

There are two rare types of renal lymphoma. One is extension from
adjacent retroperito n e al disease and second is perirenal
involvement. Contigous spread can occur by tranascapsular I renal
sinus or hilum or along ureter or pelvis. There is thickened ureteral
wall, high density mass in renal sinus, invasion of renal medulla,
calycela dilation without dilated pelvis, invasion of renal medulla
and encasement of vessels. Perirenal space involvement can be
secondary to spread from parenchymal disease or by direct spread
from retroperitoneal diseae. This is characterized by thick Gerotas
fascia, small densities and soft tissue nodules. Occasionally isolated
perirenal deposit happens. There is no uptake in bone scan, but
it is taken up by gallium scan.
42. A-T, B-T, C-F, D-T, E-T

Leiomyosarcoma can also arise from the perinephric fat. Leukemia
causes diffuse infiltration of the kidney and renal enlargement.
Wilms tumour in adults can be confused with hypovascular renal
cell carcinomas.
43. A-F B-T C-T D-T E-T F-F

f I f f f
Metastasis to kidney happens through hematogenous spread. Lung,

breast, kidney, colon and stomach are common primaries. It is the
fifth common site of m e tastasis after lung, liver, bone and
adrenals. In autopsy, secondary tumours are more common than
primary tumours. Many patients die before the metastases
becomes large enough to cause symptoms. It can present as a
solitary mass or multiple masses or extrarenal mass. The kidney
is enlarged or normal size with diffuse infiltration.
44. A-F, B-T, C-F, D-T, E-T

:tvlultilocular cystic nephroma has a thick well defined fibrous
capsule and has numerous cysts ranging in size from a few mm
t o many ems. Those occurring before t\vo years are seen
exclusively in males. Females have a bimodal distrihution, behveen
4-20 years and 40-60 years.
45. A-T, B-F, C-T, D-F, E-F

The septa range in size from a few mm to cm, The cysts are lined
by cuboidal or flattened epithelium. There is delayed or absence
o f excretion of contrast in IVU and CT.
46. A-F, B-F, C-T, E-T, E-T

Tuberculosis and schistosomias are other casues of cholesteaton�a,
which is a mass of desquamated keratin attached to or lying free
in th�· presence of squamous metaplasia.
47. A-T, B-T, C-T, D-T, E-T

Prominent mucosal thickening produces linear lucencies. This is
seen in leukoplakia which is pathologically a \\·hite patch, seen due
to squamous rnetaplasia. It is also seen in intermittent obstruction.
48. A-T,B-T, C-T, D-T, E-F

Leukoplakia produces the onion skin appearance due to contrast
material entering spaces in and around the mass. Adenocarcinoma
of renal pelvis is a rare neoplasm and is frequently associated with
stone and calcification. It can be seen as multilocular mass with
calcification and calculus. Thorotrast also produces transitional cell
carcinoma. Carcinosarcoma is association of TCC or SCC with
osteosarcoma or rhabdomvosarcoma or chondrosarcoma.
;
49. A-T, B-T, C-T, D-F, E-T

Squamous cell cancers are only 0.5% of renal malignancies and are
common in the renal p e l\'is. They are secondary t o chron i c
irritation by calculus or chronic infection. A calculus is associated
in 40-80% of cases. The kidney can be nonfunctioning.
Angiography is avascular or hypo\·ascular.
50. A-T, B-T, C-T, D-T, E-T

Acquired cystic kidney has 30 times risk of renal cell carcinoma.
Smoking, obesity, lead and cadmium are other causes. Occupations
associated with renal carcinoma are leather tarmers, shoe workers,
asbestos, thorium dioxide, petroleum prod�cts and cadmium.
1. Adrenals:
A. The adrenals are easier to scan in neonates
B. The adrenals are considered enlarged if they are 1.5 times the
size of the corresponding crus
C. The right adrenal is fixed to the posterior aspect of IVC
D. The left adrenal is fixed to the left crus
E. 6.5 mm is the upper limit for a normal limb of adrenal gland
2. Adrenals:
A. The right suprarenal is crescenteric
B. The left suprarenal is V shaped
C. The adult suprarenal \.veights the same as neonatal suprarenal
D. The adrenal atrophies from birth till five years of age
E. Zona fasciculata is the largest
u
laver in adrenal cortex
•
3. Bilateral adrenal calcification:

A. In the absence of symptoms, does not need follow up
B. Reduced adrenal reserve is seen due to calcification
C. Seen at level of 12th rib
D. Commonest cause is birth trauma
E. If associated with soft tissue mass, should be investigated
·4. Adrenal metastasis:

A. Lung cancers have the highest proportion of tumours
metastasising to adrenals
B. Addisions is a presenting feature
C. Cushings syndrome is commonly seen
D. Always indicates stage IV
E. Rim enhancement is seen
5. Adrenal cyst:
A. Pseudocyst is due to haematoma
B. Endothelial and epithelial cysts can be differentiated by doppler
C. Thick yvalled cysts always indicates malignancy
D. Hydatid cyst spares the adrenal
E. Calcification is very rare in adrenal cyst
6. Causes of bilateral adrenal masses:

A. Neuroblastoma B. Lymphoma
C. Myelolipoma D. Hyperplasia
E. Woolman disease
7. Adrenal masses:
A. Adenomas and adrenal carcinomas are the commonest causes
of adrenal masses in a patient with no primary malignancy
B. Metastasis is the commonest cause of adrenal mass in a person
with known malignancy
C. Masses less than 3 cm are presumed to be adenomas
D. Masses more than 3 cm are surgically removed
E. Chemical shift imaging MRI is indicated for adrenal masses
between 3 5 cm
-
8. Adrenal masses:
A. Contrast enhanced CT can reliably differentiate adrenal
adenoma and metastasis
B. Metastasis are usually more than 4 cm
C. Adenomas show low density due to presence of fat
D. CT density of less than 0 HC in an adrenal mass, confirms
adenoma with a specificity of 100%
E. 10 HU is used as the cut off point for differentiating betv,:een
adenomas and metastasis in most centers
F. 30-40% of adenomas hzve high density
9. Adrenal adenomas:
A. Cushings syndrome is commonly due to adenomas
B. Conns syndrome is corrunonly due to hyperplasia
C. The mean size of Cushings adenoma is 2-2.5 cm
D. Conns syndrome accounts for 0.1-0.5% of hypertension
E. Corms adenomas are generally smaller than cushings adenoma
10. Adrenal �nasses:

A. 3mm sections are necessary for diagnosing aldosteronomas
B. CT detection of aldosteronoma has sensitivity of 80%
C. Adrenal vein sampling is the gold standard in distinguishing
adenoma and hyperplasia
D. CT has a high accuracy rate in diagnosis of hyperplasia
E. Bilateral adrenal nodules in CT scan is considered equivocal
ll. Adrenal carcinoma:

A. A mass more than 5 cm should indicate adrenal cortical carcinoma
B. Bilateral in 10%
C. Rapid washout is seen
D. The wall is more irregular than other adrenal benign tumours
E. Calcification is a high indicator for malignancy
Adrenals 139
12. Adrenal cortical carcinoma:

A. More common in men
B. Usually associated with hemorrhage and necrosis
C. Calcification associated in 30%
D. 50% of adrenal carcinomas are hormonally active
E. Invades renal vein and IVC
13. Associations of neuroblastoma:

A. Beckwith Wiedeman syndrome
B. Neurofibromatosis
C. Renal cell carcinoma
D. Hirschprungs disease
E. Phenytoin
14. Neuroblastoma:
A. The most common tumour in children
B. The most common tumour in infants
C. More common in the left than right side
D. More common in males
E. 90%· are seen under two years
15. Neuroblastoma:
A. Arises form symphaticoblast cells
B. Only 40% of these tumours arise from the adrenal gland
C. A primary neuroblas toma may not be f ound after all
investigations
D. Hutchinsons syndrome indicates bony metastasis
E. Pepper syndrome indicates liver metastasis
16. Adrenal masses:

A. Delayed images after contrast enhanced scans, can distinguish
adenomas and metastasis
B. A cut off value of 37 HU has 100% specificity for distinguishing
adenomas and metastasis in delayed scans
C. Adenomas enhance rapidly and washout rapidly
D. Metastasis enhance rapidly and washout slo\vly
E. Delayed washout curve is a reliable way of differentiating lipid
poor adenomas from metastasis
17. Adrenal mass:

A. Unenhanced CT and chemical shift MRI are used to determine
which adrenal mass requires biopsy
B. Unenhanced CT and chemical shift MRI have equal specificity
and accuracy for adrenal masses
C. Adenomas lose signal in opposed phased images
D. Metastasis lose signal in opposed phase images
E. The tv1R signals in phase and oppo5€d images in chemical shift
imaging are compared with that of liver
. .
140 Genitourinary, Obstetr;cs & Gynaecology and Breast Radiology
18. Common p res ent a tion s of neuroblastoma:

A. Dancing feet, dancing eyes
B. Diarrhoea
C. Horners syndrome
D. Elevated urinary VMA
E. Lung metastasis
19. Neuroblastoma:
A. In\·olvement of bony cortex is stage IV S
B. II- crosses midline
C. Mediilstinal tumours have good prognosis
D. Bony lesions are bilaterally symmetrical
E. Irregular metaphyseal luceencies are seen
20. Pheoch romocytoma:

A. Mediastinum is the commonest site of extraadrenal pheo
chromocytoma
B. Organ of Zuckerkandl is the commonest extraadrenal site of
pheochromocytoma
C. MIBG scan is the most sensitive method for detection of
pheochromocytomas
D. MAO I (\1onoamine oxidase inhibition) should be stopped
prior to MIBG scan
E. Smaller when associated with �-1EN svndrome.
,
21. Neuroblastoma:
A. Calcification is seen in 83% of CT scans and is large globular
B. In 111 pentetriotide scans are negative in undifferentiated
tumors
C. If !\1IBG scan is done, bone scan is not required
D. Bone scan is positive only in secondaries
E. Psoas muscle is spared even in high grade tumours
22. Adrenal c ortical carcinoma:

A. Has bimodal age distribution
B. Functioning tumours are commoner in women
C. Virilisation is the commonest hormonal presentation in adult
females
D. Very vascular in angiography
E. No lymphatic spread
23. Recognised causes of adrenal haemorrhage:

A. Hypotension
B. Bums
C. Infection
D. Metastasis
E. Tuberculosis
Adrenals 141
24. Pheochromocytoma:
A. Hypertension is seen in 90% of affected patients
B. Stress precipitates a hypertensive crisis
C. Hypercalcaemia is seen
D. Hematocrit is increased
E. Cushings syndrome is a presentation
25. Pheochromocytoma:
A. Anxiety attacks are a common presentation
B. The urine contains acetylcholine in addition to VMA
C. Tumours in opposite side occur in 10%
D. Association with medullary carcinoma of thyroid
E. Associated r e n al artery stenosis is a known ca use of
hypertension
26. Cushings syndrome:

A. Cushings due to Ectopic ACTH happens more commonly due
to lesions in abdomen
B. In chest, ectopic ACTH happens mainly in thymus
C. Pituitary adenoma is more than 10 mm in size
D. ACTH producing adenoma is more common than hyperplasia
E. MRI is more sensiti,;e than CT
27. Adrenal tumours:

A. Pheochromocytoma enhances homogenously on contrast
administration
B. Gadolinium is contraindicated as a contrast agent
C. 1vfyelolipomas are seen in tuberous sclerosis
D. Myelolipomas invade liver
E. Opposed phase imaging shows reduced signal in adenomas
28. Conns syndrome is characterized by:

A. Hyperkalemia
B. Large adrenal adenoma
C. Osteopenia
D. Hypertension
E. Nephrocalcinosis
29. Cushings syndrome:

A. Adrenal carcinoma is the commonest cause in adults
B. CT is the best way to diagnose the cause following failed
adrenalectomy
C. Scintigraphy is not helpful if rem nant exists f ollowing
adrenalectomy
D. Scintig�aphy vv·ill diagnose adrenal carcinoma
E. Thymic carcinoids produce Cushings syndrome
142 Genitourinary, Obstetrics & Gynaecology and Breast Radiology_
30. Pheochromocytoma :
A. 10% are extraadrenal
B. Carneys triad is associated with pulmonary granulomas
C. Pheochromocytomas are larger in patients with MEN
D. Contrast i s absolutely contraindicated in patients with
pheochromocytorna
E. The tumour is homogenously hyperintense i n T2 weighted
images
31. As sociations of pheochromocytoma:

A. Sturge Weber disease
B. Tuberous sclerosis
C. Von Hippel Lindau disease
D. MEN I syndrome
E. Autosomal dominant polycystic kidney disease
32. The following are recognized locations of extradrenal

-· pheochromocytoma:
A. Cavernous sinus
B. Gall bladder
C. Trachea
D. Nose
E. Pericardium
33. Imaging of pheochrornocytorna:

A. Angiography can show associated renal arterial stenosis
B. If clinical and biochemical diagnosis is established, an
unenhanced scan is enough to localize
C. If a mass < 2 cm is arising from one of the limbs, it indicates
adenoma and excludes pheochromocytoma
D. The left adrenal gland is seen anterior to the splenic vein
E. Plain X-ray can show increased density over the superior and
medial aspect of the kidney
34. The following are components of Carneys complex:

A. Adrenal cortical hyperplasia
B. Pheochromocytoma
C. Pulmonary hamartoma
D. Pituitary adenoma
E. Cardiac myxoma
35. Heterotopic adrenal is seen m:
A. Spleen B. Kidney
C. Hydrocele sac D. Lung
E. Brain
Adrenals 143
36. Multiple endocrine neoplasia is associated with :

A. Pineal tumours
B. Medullary carcinoma thyroid
C. Pheochromocytoma
D. Pancreatic cystadenocarcinoma
E. Pituita ry adenoma
· 37. Multiple endocrine neoplasia:

A. Marfanoid features are seen in Ila
B. Pheochromocytomas are seen in I
C. Parathyroid adenomas are seen in I and II
D. Medullary carcinoma thyroid is seen in type II
E. Mucosa! neuromas are seen in IIb
38. Myelolipoma:
A. Due to metaplasia of capillaries
B. Spontaneous rupture is unknown
C. Mali gnant transformation is common
D. Haematuria can be presenting feature
E. Cushings syndrome is a recognised presentation
39. Myelolipoma is seen in the following locations:

A. Mediastinum
B. Retroperitoneum
C. Kidney
D. Presacral
E. Extradural
40. Myelolipoma:
A. Fat in adrenal mass is pathognomonic
B. Has same density as adrenal adenoma with low values of fat
C. Calcification rules out m yelolipoma
D. The fat c omponent enhances on contrast administration
E. Increased signal in out of phase images
41. Adrenal venous sampling:

A. Catheterisation of left adrenal vein is difficult than right
adrenal vein
B. Suspect abnormality if the concentration of hormone is twice
the normal
C. In adenoma, elevation of renin in one side is associated with
elevation in opposite side as well
D. Should always be done before phlebography
E. Side holes should not be used
42. Adrenal phlebography:

A. Adrenal insufficiency is a complication
B. The tip of a cobra catheter is oriented to the left and
posteriorly for the right adrenal vein
C. In contrast to hepatic vein, adrenal vein ijection does not
produce any blush, but may produce slight pain
D. The left adrenal vein is situated near the Ll-2 interspace
E. 10 ml of contrast is required for satisfactory phlebography
43. Adrenal imaging:

A. Contrast should be avoided in congenital adrenal hyperplasia
B. Right adrenal mass causes flattening of the upper pole of right
kidney
C. Cushings syndrome can be present in a normal thickness
adrenal gland
D. The right adrenal gland is better visualised in ultrasound
scanning than the left adrenal gland
E. The lateral limb of the right adrenal gland is in continuity with
-
·
the posterior aspect of IVC
44. Adrenal gland function:

A. 50% is composed of cortex and 50% medulla
B. Medulla produces nor epinephrine and epinephrine in the ratio
") -01
0 f /.J
�,..Of
10, .... .::> 10
C. Corticosterone is secreted by all the layers of the adrenal

cortex
D. Zona fasciculata for�s the largest mass· in the cortex
E. In fetuses, only 20% have all the three layers
45. Causes of Adrenal insufficiency:

A. Hemochrornatosis
B. Amyloidosis
C. Lymphoma
D. Steroid therapy
E. Goodpastures syndrome
46. Addisons disease:

A. Calcification is very common in autoimmune adrenal
insufficiency
B. Increased density with atrophied glands i s seen in
hemochromatosis
C. Bilateral metastasis produces adrenal insufficiency in 70% of
cases
D. Medical treatment of tuberculosis in early stage can reverse
adrenal insufficiency
E. Adrenocortical insufficiency is called chronic if lasting more
than 6 months
Adrenals 145
47. The following statements are true:

A. Adrenal vein thrombosis produces bilaterally enlarged
hyperdense glands
B. Hypertonic neurogenic bladder is large in bladder outlet
obstruction
C. Renal infarct less than 5 mm does not produce scarring
D. Unilateral adrenal haemorrhage is commoner on the left side
E. A hyperdense mass in adrenal, with previous normal CT
indicates haemorrhage
48. Associations with retroperitoneal fibrosis:

A. Riedel thyroiditis
B. Orbital pseudotumour
C. Sclerosing cholangitis
D. Pulmonary fibrosis
E. Peyronies disease
49. Drugs causing retroperitoneal fibrosis:

A. LSD
B. Amphetamines
C. Hydralazine
D. Sulfonamides
E. Methyldopa
50. Causes of retroperitoneal f i bro sis :

A. Lymphoma
B. Liposarcoma
C. Carcinoid
D. Polyarteris nodosa
E. Iliac artery aneurysm
51. Retroperitoneal fibrosis:

A. Dilated ureter above L4/5
B. The ureter is deviated laterally by the mass
C. Homogenous mass in ultrasound
D. Contrast enhancement indicates active inflammation
E. No uptake in gallium scans
52. Retroperitoneal fibrosis:

A. Duodenum is involved in the fibrosis
B. Encircles the aorta
C. Enhances on post contrast CT ·
D. Causes obstruction to ureteric catheter
E. Causes medial deviation of caecum
146 Genitourinary, Obstetrics & Gynaecology and Brt?ast Radiology
53. Retroperitoneal fib rosis:

A. Back pain is the commonest presentatio n
B. Medial deviation of ureter is normal in about 20% of no rmal
individuals
C. The RPF in methysergide treatment is reversible once drug is
stopped
D. RGP cannot be done as catheter cannot be passed beyond the
level of obstruction
E. Marfons syndrome is a recognized cause of retroperitoneal
fibrosis
54. Retroperitoneal fib rosis:

A. .\utoimmune disease
.
B. Antibodies to ceroid are responsible

C. Begins from level of renal hilum and extend below
D. !\ever extends below pelvic brim
-- E. Responds to steroids
Adrenals 147
ANSWERS
1. A-T, B-F, C-T, D-T, E-T

The adrenals are larger in the neonates making it easier to scan.The
adrenals are considered enlarged if they are more than the
diameter of the crus, and if either limb is more than 6.5 mm across.
2. A-F, B-F, C-T, E-F, E-T

The right adrenal is V· shaped and left is crescenteric. The neonatal
adrenal is 1 /3rd the size of kidney. But it atrophies till two years
and grows slowly to reach adult size.
There are three layers in cortex, zona glomerulosa, zona fasciculate
and zona reticularis.
3. A-T, B-F, C-T, D-T, E-T

Calcification does not affect adrenal function reserve and shows
normal response to ACTH. Seen at the level of 11th and 12th ribs,
just lateral to the vertebrae.
4. A-F, B-T, C-F, D-T, E-T

Melanomas have 50% metastasising to adrenals followed by lung
and b reast.
Cushings is very uncommon. Heterogenous large mass, can show
rim enhancement.
5. A-T, B-F, C-F, D-F, E-F

Pseudocyst is due to bleeding into a normal or abnormal adrenal
and subsequent resolution. It is usually lined by endothelium.
Other types are epithelial cysts and parasitic cysts, and it is difficult
to differentiate these cysts by ultrasound alone. Thick wall and
calcification a re very common in adrenal cysts and do not
necessarily indicate malignancy. Hydatid cyst can involve adrenal.
6. A-T, B-T, C-F, D-T, E-T

Metastasis is a common cause.
7. A-T, B-F, C-T, D-F, E-T

Adenomas and adrenal carcinomas are the top two causes of an
incidentally discovered adrenal mass in a person without a known
malignancy. Tumours greater than 5 cm, are usually surgically
resected, because of high incidence of adrenal carcinoma in
tumours of this size. N1asses less than 3 cm, are likely to be
adenornas. Tumours between 3-5 cm, are ambiguous and usually
imaged further with chemical shift rv1RI to rule out a malignant
tumour.. Some surgeons prefer to remove all tumours more than
3 cm. I n a patient with known malignancy1 an incidentally
discovered adrenal mass can either be an. adenoma or a :net3stas�s.
. .
8. A-F, B-T, C-T, D-T, E-T, F-T

In a patient with a known malignancy and adrenal mass, the
differential is between a m etastasis and adenoma. In contrast
enhanced scans, adenomas are well defined, 1-4 cm, homogenous
low density. Metastases are larger, ill defined and have
heterogenous density. However, because of significant overlap in
the contrast characteristics, contrast enhanced CT scan is not useful
for differentiating the two. Because of presence of fat in adenomas,
unenhanced CT scans can be r e l iably used to differentiate
adenomas and metastasis. If the mass measures less than 0 HU,
an adenoma can be confirmed with a specificity of 100%. Most
radiologi:,ts use a cut off of 10 HU and this still gives a high
specificity of 90%. A density higher than 10 HU will not exclude
adenoma as lipid poor adenomas account for 30-40% of cases.
9. A-F, B-F, C-T, D-T, E-T

The causes of Cushings syndrome are Hyperplasia (75-80%),
adenoma (10-15%) and carcinoma (5%). The mean size is 2.5 cm
with a range of 2-5 cm. Contralateral gland may be atrophied due
to s u p pression by over functioning gland. Conns syndrome
(Primary Hyperaldosteronism) is caused by Adenoma (75%),
Hyperplasia (25%). These adenomas are smaller \Vith a range of
0.5-3.5 cm with a mean of 1.5 cm. These adenomas are charac
terized by hypertension (0.1-0.5% of all cases of hypertension) and
hypokalemia.
10. A-T, B-T, C-T, D-F, E-T

Thin C T sections (3-5 mm) are required for diagnosis of
aldosteronomas as they are quite small (0.5-3.Scrn). CT has a
diagnosis rate of 80% in detection of aldosteronomas especially
when there is a focal nodule withi n an adrenal with normal
contralateral adrenal. If there are normal glands or bilateral
nodules of hyperplastic glands, in a symptomatic person, the CT
scan is reported as equivocal and adrenal vein sampling must be
done for confirmation. Adrenal vein sampling is the most accurate
method for differentiating adenoma and hyperplasia and for
localizing adenoma. CT is unreliable for diagnosis of hyperplasia.
11. A-T, B-T, C-F, D-T, E-T

Slow washout is seen in adrenal cortical carcinoma. Irregular wall,
necrotic areas, calcification are suspicious features. Large primary
masses in adrenals are usually adrenal cortical carcinomas.
12. A-F, B-T, C-T,D-T,E-T

Adrenal cortical carcinomas are more common in women. Patients
present with abdominal mass and pain. In 50% of patients, the
Adrenals 149
tumour is overtly hormonally active. The tumours are large, wit.i.11

areas of heamorrhage and necrosis. Calcification is seen in 30%
of patients. The tumours show heterogenous areas of contrast
enhancement. They may invade adjacent structures, lymph nodes,
renal vein and IVC. Distal metastasis occurs in liver and lung.
13. A-T, B-T, C-F, D-T, E-T

Fetal phenytoin syndrome and congenital neuroblastoma are
associated.
14. A-F, B-T, C-T, D-T, E-T .

The most common extracranial tumour in children. Constitutes 8%
of paediatric neoplasms. Mean age of presentation is 2 years.
15. A-T, B-T, C-T, 0-T, E-T

The neural crest cells differentiate into symphaticogonia, which
then subdivided into sympathicoblasts (which differentiates into
sympathetic gangliona cells) and pheochromoblast (which
differentiates into pheochromocyte). Neuroblastoma arises from
sympathicobl ast o f pheochromoblast. Ganglion cells form
ganglioneuroma and pheochromocyte form pheochromocytoma.
16. A-T, B-T, C-T, D-F, E-T

A lthough a routine contrast enhanced CT, cannot reliably
distinguish adenomas and metastasis, ( because of overlap of signal
characteristics), a delayed CT scan after contrast is very reliable
in differentiating adenoma and metastasis. Images are obtair.::d
after 15-30 mins, and a cut off value of 37 HU is used, which gi\·es
a specificity of 100%. This is used if unenhanced scans could not
be obtained. Washout curves are another useful way of ,
differentiating adenomas and metastases. Adenomas show rapid

enhancement and have rapid washout rate beginning at 5 m�:-ts
and reaching a maximum of 60-70% at 15 mins. Non adenorr,as
retained contrast material and had slower washout at 15 mins (:5-
25%). Some studies indicate that lipid poor adcnom.ls and i'l'Jn
adenomas have different delayed washout cun·1·s.
17 •
A-TI B-TI C-TI D-FI E-F
Chemical shift "tv1R imaging is the other method which is use:=.J.l
for differentiating metastases and adenoma. Adenomas have lipid
and metastases do not. In phase and out of phase images are
obtained and the signals are compared with that of spleen. Lirtd
rich lesions like adenomas lose signal on opposed or out of ph2se
images. .N1etastases and non lipid adenomas do not lose sigr::i.l.
This technique has an equal accuracy with that of unenhanced CT.
Tnere is a linear correlation between unenhanced CT numbers a::id
relative loss of signal intensity on chemical shift MRI and also with
the amount of lipid in pathological specimens. If the lesion does
not lose signal it signifies that it does not contain fat, and it can
be either metastasis of non lipid adenomas. A biopsy, will be
indicated at this stage for confirming this.
18. A-T, B-T, C-T, D-T, E-F

Dancing feet, dancing eyes is also called opsomyoclonus syndrome.
Diar rhea a n d malabsorption are due to production of VIP
hormone. l lorners syndrome is due to neck mass. Mediastinal and
retroperitoneal mass are other presentations. Lung metastasis are
uncommon in neuroblastoma, unlike Wilms.
19. A-F, B-F, C-T, D-T, E-T

I- confined to organ of origin, II- beyond organ of origin, not
across midline, III- beyond rnidline, IV- distal metastasis, IV
D-localized primary tumour, not crossing rnidline, spread to liver
-·or subcutaneous tissues or bone marrow. Bony lesions a r e
bilaterally symmetrical, irregular with periosteal reaction and
erosm.
20. A-F, B-T, C-T, 0-F, E-T

Pheochromocvtomas are catecholamine tumours of the adrenal
.I
medulla. Organ of Zuckerkandl in the lower paraaortic region,

adjacent to the superior mesenteric ganglion is the commonest
location of extraadrenal p heochromocytoma. Other sites are
retroperitoneurn and mediastinum. Pheochromocytomas associated
with MEN syndromes are smaller, bilateral and multicentric, in
contrast t o the sporadic tumours which are usually larger,
unilateral, associated with necrosis and hemorrhage. They show
intense contrast enhancement. Contrast can be given in
pheochromocytomas with control of hypertension. There is no
elevation of catecholamines, subsequent to non ionic contrast
administration. I-131 MIBG scan is the most accurate method (90%)
of detection of pheochromocytomas especially extraadrenal,
recurrent and metastatic lesions. In MRI, the lesion is hypointense
in Tl images and can be homogenously hyperintense in T2W
images. In 20% of cases the appearances are indistinguishable from
those of other adrehal lesions. MAO I need not be stopped, but
tricyclic antidepressants should be stopped.
21. A-F, B-F, C-F, D-F, E-F

Calcification is seen i n 85% of neuroblastomas and commoner in
CT scans than plain X-rays. It is usually stippled. Bone scan is taken
up by primary and secondary tumours. The bone scan can be positive
even after treatment, for some time. Flare up can ha?pen after
Adrenals 151
treatment before normalizing. MIBG scan is taken up by catechola

mine secreting cells and is taken by primary and secondary tumour.
But MIBG cannot differentiate cortical and marrow involvement
and hence MIBG and bone scans should be combined. In 111
pentetriotide is positive in undifferentiated tumours.
22. A-T, B-T, C-F, D-F, E-F

i Tumours can be seen before 5 years, when it is common in girls
I -
I
and presents with irilisation. There is a second peak at 40-50 years,
!
which commonly present with Cushings syndrome. The tumour
is avascular in angiography, unlike renal adenocarcinoma which
is very vascular. Lymph nodal spread is seen in 70% Septicemia,
DIC, coagulation abnormalities are other causes. Stress, bums and
trauma release ACTH and this increased activity of the gland
results in haemorrhage.
23. A-T, B-T, C-T, D-T, E-F
24. A-T, B-F, C-T, D-T, E-T

Hypertension is usually paro x ysmal . It can be sustained
hypertension, or present as h ypertension of pregnancy. The
hypertension occurs in younger population and is uncontrolled
with routine medial treatment. Stress is not a precipitator of crisis.
Lifting, straining, bending, coughing and other movements which
are likely to move the abdominal contents are the precipitating
factors for pheochromocytoma. Hypercalcemia is either due to
stimulation of parathyroid by catecholamines or bone resorbing
actor. Increased hematocrit is due to decreased blood volume or
release of erythropoietin.
25. A-T, B-F, C-T, D-T, E-T

Vanillyl mandelic acid is the commonest chemical present in the
urine. Acetylcholine is not present in urine. N1edullary carcinoma
of thyroid is associated in multiple endocrine neoplasia. Renal
artery stenosis is associated with pheochromocytoma, especially
in a patient with neurofibromatosis.
26. A-F, B-F, C-F, D-F, E-F

In chest, although thymic carcinoids produce ectopic ACTH, the
commonest cause is bronchogenic carcinoma. Lung cancer is also
the most commonest cause of ectopic ACTH production. Cushings
adenoma is usually microadenoma and less than 10 mm. In
C u shings syndrome, hyperplasia is commoner than adenoma. The
sensiti:rity of i\·1RI and CT for detection for adrenal adenoma is
similar. The specificity is higher with specialised techniques like
opposed phase imaging, contrast enhanced CT and washout
curves.
27. A-F, B-F, C-F, D-F, E-T

Pheochromocytomas are vascular tumours and have areas of
necrosis within them, hence enhancement is heterogen eous.
Iodinated contrast agents are contraindicated in uncontrolled
hypertension, but Gadolinium is not a contraindication. There is
no association between myelolipomas and tuberous sclerosis.
Myelolipomas are benign hunours and do not show any invasion.
28. A-F, B-F, C-F, D-T, E-F

Conns syndrome produces excess aldosterone, which reabsorbs
nodium and excretes potassium, hence there is hypernatremia,
hypokalemia, hypertension.
29. A-F, B-F, C-F, D-F, E-T

Hyperplasia is the commonest cause in adults. Scintigraphy shows
Filling defect in carcinoma Somatostin scintigraphy is highly
sensitive for finding ectopic production.
30. A-T, B-F, C-F, D-F, E-T,

10% of pheochromocytomas are malignant, extraadrenal, bilateral
and occur in children. Carney triad has pulmonary hamartoma,
extradrenal pheochromocytoma and leiomyoblastoma.
Pheochromocytomas are smaller in those with MEN syndrome.
Contrast can be administered if the hypertension has been
controlied.
31. A-T, B-F, C-T, D-F, E-T

Neurofibrornatosis, Carneys triad, renal artery stenosis are other
associations. Majority of tumours are sporadic, but it may be
associated with MEN II, III syndromes, neurofibrornatosis, von
Hippel Landau disease, Sturge-Weber disease and Carneys triad.
MEN I has pituitary, parathyroid and pancreatic lesions. MEN II
has medullary carcinoma thyroid, parathyroid lesions and
pheochromocytornas. MEN III has lesions of MEN II, with
associated neuromas. Carneys triad has pulmonary harmartomas,
extraadrenal pheochromocytomas and leiomyoblastorna of
stomach.
32 ' A-T B-T C-T D-T E-T

f I I f
Can occur anywhere, including bladder, pineal gland, paranasal

sinuse, tongue, trachea, th yroid, lung, uterus, cuda equine and
spermatic cord.
33. A-T, B-T, C-F, D-F, E-T

Renal arterial stenosis can be seen due to tumour encasernent of
the renal artery or functional stenosis due to catecholamine release.
Localisation can be tried V\ri.th CT, but if CT is negative ar.d :.1..'..!·1ic1l
Adrenals 153
suspicion is high, MIBG scan is very specific. The left adrenal gland
is seen posterior to the splenic vein. Plain X-ray can also show
inferior disp�acernent and lateral rotation of the kidney.
34. A-T, B-F, C-F, D-T, E-T

The adrenal hyperplasia is nodular adrenal cortical hyperplasia.
Cushings disease, melanotic schwannoma, myxoid fibroadenoma
of breast and sertoli tumour of testis are also associated.
35. A-F, B-T, C-T, D-T, E-T

Retroperitoneum, around celiac plexus, along gonadal essels, testis,
epididymis, broad ligament, hernial sac, misoappendix, liver, dural
space are other locations.
36. A-F, B-T, C-T, D-F, E-T
37. A-F, B-F, C-T, D-T, E-T

MEN I-Pituitary adenoma, parathyroid adenoma, pancreatic islet
cell tumours
MEN II a-Medullary carcinoma thyroid, parathyroid adenoma,
pheochromocytoma
MENU b-Medullary carcinoma thyroid, parathyroid adenoma,
pheochromocytoma, mucosal neuromas and ganglioneuromas,
Marfanoid features
38. A-T, B-F, C-F, D-T, E-F

Myelolipoma is pre sumed to arise from metaplasia of
reticuloendothelial cells in capillaries. It is a benign tumour and
does not undergo malignant transformation. It does not produce
hormonal syndromes.
39 ' A-TI B-Tf C-FI D-Tf E-F
40. A-T, B-F, C-F, D-F, E-F

Fat in an adrenal mass is very specific for myelolipomn. It can be
seen in adenomas and rarelv in carcinomas. In adenoma the fat
,
value is usually not less than -20 HC'. But it is more lovver in
myelolipoma. Calcif i c a tion can be seen in 20%. Contrast
enhancement occurs in the myeloid component, the fatty
component being non enhancing.
41. A-F, B-T, C-F, D-T, E-T

Catheterisation is difficult in right is difficult than the left side and
often the catheter tip has to be rotated. It is easy to catheterise
the left vein, because it is larger and has a constant anatomy.
Venous sampling is performed if there is incidental adrenal mass,
and a clinical diagnosis of Cushings or Conns with negative or
indeterminate CT. In adenoma, there is elevated hormone in one
side and there is suppression of hormone leYel in the other side.

In hyperplasia, there is elevation on both sides. Side holes may
be lodged in IVC and they may be occluded.
42. A-T, B-T, C-F, D-F, E-F

Hepatic vein injection produces no pain, but has a perisistent
homogenous blush, but injection of adrenal vein produces pain,
without any blush. The left adrenal vein is constant in position,
cranial to the level of Ll and close to the T12-Ll interspace. 0.5-
1.5 ml of contrast is normally required. A visceral cobra is used
for the right side, a double curve is required for the left side, to
negotiate the renal vein and adrenal \·ein.
43. A-T, B-T, C-T, D-T, E-T

Contrast in congenital adrenal hyperplasia produces shock. Right
adrenal mass causes inferior displacement and flattening of upper
pole of the right kidney. The left adrenal mass causes inferior and
- lateral displacement of the upper pole. Uniform enlargement of
the adrenal is likely to be hyperplastic. Nodular enlargement is
seen in nodular hyperplasia.
44. A-F, B-F, C-T, D-T, E-T

Only 30% is medulla and 70% of adrenal gland is made up of
adrenal cortex. The cortex has the zona glomerulosa, zona
fascicuiata, and zona reticulosa. Aldosterone is secreted by zona
glom erulosa. Sex steroids and cortisol are produced by zona
fasciculata and zona reticulosa. Corticosterone is secreted by all
layers. Fetal adrenal cotex secretes sulfate conjugates of androgen,
which can be converted into estrogen in the placenta.
45. A-T, B-T, C-T, D-T, E-F

The commonest cause is Addisons disease. Other causes include
hypothalmic disease, pituitary disease, autoimmune, TB, AIDS,
metastasis, adrenalectomy, radiation. Polyglandular diseaes is
another rare causes.
46. A-F, B-T, C-F, D-T, E-F

In autoimmune disease, the glands are atrophied, but not calcified.
In tuberculosis and histoplasmosis the glands are atrophied and
calcified. Increased ·density is also seen in adrenal haemorrhages.
Bilateral metastasis are the commonest adrenal masses, but they
produce insufficiency in only 20% of cases. Addisions is subacute
if less than 2 years and chronic if more than 2 years. Diagnosis
at the subacute stage is important as medical treatment can reverse
insufficiency in tuberculosis.
Adrenals i 55 ·
47. A-T, B-T, C-T, D-F, E-T

A drenal haemorrhage is another cause of bilaterally enlarged
hyperdense glands. Usually hypertonic bladders are small. Renal
infarct more than 5 mm prouces scarring. Adrenal haemorrhage
can be bilateral or unilateral. Unilateral haemorrhage is commoner
o n the right side than left side. The right adrenal vein drains
directly into the IVC and hence any increase in central venous
pressure is directly transmitted to the right adrenal vein and
results in rupture of medullary sinusoids producing haemorrhage.
48. A-T, B-T, C-T, D-F, E-T

Mediastinal fibrosis is associated
49. A-T, B-T, C-T, D-F, E-T

Also in beta blockers, practolol, phenacetin, ergotamine.
50 •
A-T B-F C-T D-T E-T
' I ' I
Retroperitoneal metastases, fluid collection and radiation are other

causes..
Inflammations- pancreatitis, diverticulitis, apenditcitis, Crohns
disease, aortitis, pan arteritis. Marfans syndrome, trauma, urine
extravasation and retroperitoneal haemorr hage.
51. A-T, B-F, C-T, D-T, E-F

The classical triad is diiated ureter abo1:e L-±/3, m ed ial ly de1:ia:ed
ureter and gradually tapering ureter. Cltrasound shO\\·s
homogeneous hypoechoic lesion. Gallium scan shows increa5ed
uptake in active inflammation. Ureter is displaced med ially .
52. A-T, B-T, C-T, D-T, E-F

The retroperitoneal fibrosis completely encases the abdominal
aorta. It is seen as a hypodense mass in the paraaortic region and ,
enhances on contrast administration.
53. A-T, B-T, C-T, D-T, E-F

90% present with back pain. Retrograde pyelohraphy can be
performed, as the catheter can pass bey ond the obstruction and
contrast can be instilled.
54 • A-TI B-TI C-FI D-FI E-T

Ceroid is presumed to be extruded from plaque in abdominal aortic
aneury sm .
The plaque usually begins from the aortic bifurcation and extends
. . Us ually it does not extend
cranially upto the level of renal hilu.m
below _pelvic rim, but can extend to bladder and sigmoid. Primary
form us uall y responds to steroids, since it is an autoimmune
dis eas e .
1. Prostate:
A. The prostate is separated from rectum by the Denonvilliers
fascia
B. The cave of Retzius is seen between the prostate and bladder
C. The base of the prostate is continuous with the neck of the
bladder
D. An adult prostate has five recognized lobes
E. The lobes are well demarcated in prostate
2. Prostate:
A. The peripheral zone occupies 70% of glandular zone
B. The transition zone occupies 10% of glandular zone
C. The Central zone surrounds urethra below the level o f
ejaculatory ducts
D. The transitional zone lies between central zone and peripheral
zone
E. The inner gland is seen only above the level of ejaculatory ducts
3. Prostate:
A. The central zone is equivalent to the median lobe of prostate·
B. The peripheral zone comprises the base of the prostate
C. The central and peripheral zone form the outer glands
D. The fibromuscular stroma is seen anteriorly
E. The venous drainage of prostate is only to internal iliac veins
4. Prostate ultrasound:
A. The central and peripheral zone can be differentiated clearly
B. The inner gland region is very hypoechoic and easily
differentiated from the outer gland region
C. The ejaculatory ducts are seen
D. The seminal vesicles are separated from prostate by a clear
zone of fat
E. The transition zone increases with age
Imaging of Prostate 157
5. MR1 of prostate:
A. The neurovascular bundles are seen at 6 and 8 o clock position
B. The gland is of uniform low intensity in Tl sequences
C. The zonal anatomy is well demonstrated in T2 weighted images
0. The central zone and transitional zone have high signal in T2
E. The seminal vesicle has high signal in T2
6. MRI of prostate:
A. The central gland cannot be further differentiated into central
zone and transitional zone by any MR technique
B. Anterior fibromuscular stroma shows high signal in T2 and
low in Tl
C. Verurnontanum is seen as high signal area in T2
D. Fat suppressed T2 is used for contrasting the peripheral zone
and periprostatic fat
E. In benign pros ta t i c hypertrophy, a pseudocapsule is seen
between the central zone and transitional zone
7. Seminal vesicle:
A. Has s i gnal characteristics of fluid
B. There should be a clear fat plane between the seminal vesicle
and bladder base in CT scans
C. The best sequence to assess the fat plane between seminal
vesicle and bladder is T2
0. The wall of seminal vesicles return low signal
E. The seminal vesicles are 10 crr« long
8. Prostatic ultrasound:
A. Corpora amyl acea can mimic pr osta tic carcinoma
B. Most carcinomas are seen in central zone
C. Well defined capsule is seen
0. Central zone is hyperech oic
E. Periprostatic venous plexus is prominent in prostatitis
9. Benign p rostatic hypertrophy:

A. Complete emptying of the bladder on IVU excludes obstruction
B. Normal renal function and absence of hydronephrosis excludes
obst ru cti on
C. Nodules develop in the transitional and periureth eral regions
D. Capsule is seen around the nodules
E. Causes hypertrophy of detrusor muscle of bladder
10. PSA (prostate specific antigen ) is found in:

A. Prostatitis B. Endometrium
C. Females D. BPH
E. Pros ta tic carcinoma
11. Prostatitis:
A. E. coli is the causative organism in 80% of cases
B. Enterococcus fecalis is a causative organism
C. Reflux of urine into prostate is the etiology
D. Majority are due to single infection
E. Non specific prostatitis is due to Chlamydia
-12. Prostatic carcinoma- predisposing factors:

A. Smoking B. Cadmium exposure
C. Toluene exposure D. Vitamin D
E. Fatty diet
13. Prostate carcinoma:

A. More common in caucasians
B. Screening starts at 50 years for those with family history of
prostatic cancer
C. Blacks have higher grade tumours
- D. Commonest malignancy in males
E. The histologic incidence of tumours in blacks and whites are
same
l4. Causes of hypoechoic lesion in the peripheral zone in transrectal

ultrasound:
A. Benign prostaic hyperplasia nodules
B. Atypical hyperplasia
C. Chronic prostatitis
D. Focal atrophy
E. Diverticulum
15. IVU in prostate lesion:

A. Normal bladder emptying indicates bladder is not
decornpensated
B. Prostatic impression indicates BPH with high degree of
sensitivity and specificity
C. Absence of bladder impression indicates lack of obstruction
D. Size of intravesical prostates is essential for deciding approach
for surgery
E. In carcinoma prostate, hydronephrosi can be due to urethral
narrowing
16. Prostate biopsy:

A. The diagnostic yield is the same in blind and guided prostate
biopsies
B. To increase the yield of biopsies, upto 7 samples are obtained
in a systematic fashion
C. Antibiotic cover has now been proved not absolutely necessary

for prostatic biopsy
D. The biopsy is done under local anaesthesia
E. If a lesion is identified in ultrasound, obtain targeted biopsy
instead of doing systematic and targeted biopsies
17. Imaging of prostate cancer:

A. MRI is reliable in assessing capsular invasion
B. MRI cannot differentiate malignant and reactive
lymphadenopathy
C. MRI is done only on those who have high probability of
capsular invasion, based on Gleasons score
D. Scintigraphy should not be done if PSA is less than 20 ng/ ml
E. CT and N1RI are useless if done when PSA is less than 25 ng/
ml
18. Benign prostatic hyperplasia:

A. 90% of men are affected by the eighties
B. 50% of people with microscopic BPH only develop clinically
significant BPH
C. There is no racial difference in the incidence of BPH
D. The obstructive s ymptoms are due to increased detr usor
response
E. The severity of symptoms correlates well with the prostatic
size
19. Imaging in BPH:

A. !VU is routinely indicated in all those with BPH for assessing
the upper tract
B. IVU is avoided when there is renal insufficiencv ./
C. Post voiding residual urine should be assessed in all cases

D. Incidence of cancer is higher in people with BPH than those
without it
E. Ultrasound is advisable than the routine IVU
20. Prostate cancer:

A. Rise of PSA w ithin one year of surgery suggests local
recurrence
B. Rise of PSA after hvo year indicates metastasis
C. Recurrence is common at the vesicourethral anastomosis
D. MRI has same accuracy as PSA level assessment for recurrence
E. Assessment of radioactive seeds in prostate is best done with
CT
21. Imaging in BPH:

A. MRI of prostate gland is required to exclude malignancy in
those who are being considered for transurethral resection of
prostate
B. Urinary retention is an indication for evaluating upper urinary
tract
C. History of stones warrants upper urinary tract investigation
D. Post void residual urine is the most accurate predictor of
degree of obstruction
E. Dil att�d tortous ureter indicates significant bladder outlet
obstruction
22. IVU for BPH:

A. Trabeculation is more common due to detrusor instability than
with obstructed bladder outlet
B. Hockey stick elevation of the distal ureter is a comm on finding
C. Anterior aspect of dome is a common site for diverticulum
formation
D. Reflux is due to diverticula
E. Asvmmetrical indentation of bladder excludes BPH
J
23. BPH:
A. Satisfactory evaluation of the di\·erhcula requires cystography
B. IVU is as effectiYe as ultrasound in assessing prostatic size
C. TransYerse ovoid filling defects indicates development of
:;uperadded transitional cell tumour .
D. IVU is the best test for initial eYaluation of post prostatectomy
patients
E. In renal insufficiency, IVU should be done only if the serum
creatinine is normal
24. Prostate MRI:

A. Tl images are best for diagnosing cancer
B. Mucin producing adenocarcinornas are difficult to visualize in
T2 images
C. Gross extracapsular spread is best assessed in T2W images
D. Presence of coexistent BPH alters the signal intensity in the
gland .
E. Any suspected lymph node should be sampled
25. Ultrasound of prostate:

A. Transrectal ultrasound is the only route available in those with
abdominoperineal resection
B. The normal transitional zone is more echogenic than the central
zone
C. The periurethral zone becomes hyperechoic in BPH, compared

to peripheral zone
D. Hyperplastic nodules are hypoechoic ompared to peripheral
zone
E. Hypoechoic rim is seen around the nodules
26. Prostate:
A. Corpora amylacea are precursors of calculi
B. Prostatic calculi are made up of ammonium phosphate
C. Corpora amylacea do not have acoustic shadows
D. Prostatic calculi are normally formed along the urethra
E. In BPH, prostatic calculi are seen in the capsule
27. Prostate:
A. If prostate weighs 20 g it is considered enlarged
B. The peripheral zone of prostate is lower density than central
zone in contrat enhanced CT
C. Zonal anatomy is better seen in young patients rather than old
patients
D. Asymmetrical enlargement is specific for cancer than BPH
E. The levator ani and prostate can be well differentiated in CT
28. iv1RI for BPH:

A. The signal difference between central and peripheral zones
seen in T2 is lost
B. T2 images are best for identifying BPH
C. The J\ifRl signal intensity is always high signal nodule 1vvith low
signal rim in T2
D. A purely fibrous tumour has signal similar to prostatic
carcinoma in central zone
E. Heterogenous enhancement of the central zone is seen on
Gadolinium and this is more than the peripheral zone
29. l\tIRI of prostate cancer:
A. :N1RI can detect early microscopic capsular inv:ision

B. 60% of prostate cancer are confined to the gL1nd only
C. Use of endorectal coil alone, will miss the lesions in anterior
aspect of gland
D. Scan should be performed as soon as possible after biopsy
E. The diagnostic accuracy of endorectal coil MRI and transrectal
ultrasound are same
30. Prostate l\tIRI:

A. Visualisation of collagen fibers in the peripheral zone indicates
absence of cancer
B. Post biopsy haemorrhage can make the lesion better in Tl

weighted images
C. More risk of haemorrhage following prostate biopsy due to
citrate
D. MRI is not used for diagnosing prostate cancer
E. Dynamic contrast enhanced images increase the accuracy of
MRI
31. Prostate cancer:

A. Prostn te cancers are characterized by low choline and high
citrate in spectroscopy
B. Seminal \·esicles can be involved by skip metastasis
C. Seminal vesicle invasion has to be confirmed by biopsy
D. If there is no subjacent tumour in the prostate, seminal vesicle
invasion is unlikely
E. Low signal in seminal vesicle is pathognomonic of invasion
32. Prostate:
A. 90% of cancers occur in the peripheral zone
B. PSA high, negative biopsy necessitates no further imaging
C. Majority of prostate cancers present with bone pain or pelvic
pain
D. Screening for prostate cancer begins in all males at 40 years
E. Transrectal ultrasound is the most effective screening tool
which is used.
ANSWERS
1. A-T, B-F, C-T, D-F, E-F

The cave of Retzius is the retropubic space, between the prostate
and pubis. The fetal prostate has five lobes. There are only three
lobes, a median and two lateral in adults.
The lobes are fused and only differentiated into glandular and
nonglandular zone.
2. A-T, B-F, C-F, D-F, E-T
3. A T, B-F, C-T, D-T, E-F

-
Outer glands-Peripheral zone (70%), central zone (25%)

Inner glands- Transitional zone (5%), periurethral glands,intemal
sphincter(seen o nly above the level of ejaculatory d u cts/
verumontanum)Peripheral zone- seen in posterior, inferior and
lateral surfaces. Central zone- corresponds to median lobe, seen
in base, surrounds urethra. Transitional zone- surrounds urethra
and inside the central zone. Prostatic venous drainage is to internal
iliac veins and vertebral venous plexus.
4 • A-F B-T C-T D T E-T

I f I -
I
There are only subtle differences between central and peripheral

zone, even in TRUS.
The inner zone, made of transitional zone, periurethral glands and
internal sphincter is very hypoechoic when compared with the
outer glands
vVith age the central zone atrophies and the transitional zone
enlarges.
5. A-F, B-T , C-T, D F , E-T-
Neurovascular bundles are seen in 5 and 7 o clock position.The

gland is of uniform low signal in Tl. Zonal anatomy is seen in T2.
The peripheral zone is high signal, central and transihon zone are
of low signal. Seminal vesicle is low in Tl and high in T2.
6. A -T, B-F, C-T, D-T, E-F

Anterior fibromuscular stroma shows low signal in all sequences.
The fat suppressed T2 shows good contrast between high signal
in peripheral zone -and periprostatic fat.
In BPH, central zone atrophies, transitional zone_ hypertrophies
and compresses the peripheral zone. A pseudocapsule is produced
between the peripheral zone and transitional zone.
7. A-T, B-T, C-F, D-T, E-F

Tl W sequence is the best to assess the fat plane as it gives contrast
between the high signal fat and low signal seminal vesicle in T2,
both will b e brigh t. The wall is seen as low signal area if

endorectal high resolution sequences are used.
8. A-F, B-F, C-T, D-F, E-T

Carcinomas are predominantly seen in the peripheral zone Corpora
are very bright.
9. A-T, B-F, C-T, D-T, E-T

BPH prod u c e s bladder outlet obstr uction, which results in
compensatory hypertrophy and trabeculation. Herniation of bladder
mucosa through the muscle produces sacc ules and diverticula. In
early stages, the raised pressure in bladder is not transmitted to
the ureter. Later, there is functional obstruction, due to high pressure
and residual urine. Eventually the system dilates
10. A-T, B-T, C-T, D-T, E-T

PSA is elevated following ejaculation, urinary retention, prostate
-· massage, p rostatic biopsy and occasionaly finarteride. It takes
4 weeks after biopsy and 2 days afetr urinary retention for PSA
le,·els to return to normal.
11. A-T, B-T, C-T, D-T, E-T

E. coli, Enterococcus Jecalis, Kleibsella, Proteus and Bacteroides are
common organisms.
Intraprostatic reflux is the predisposing factor.
12. A-F, B-T, C-F, D-T, E-T

Old age, sedentary lifestyle, family history are other risk factors.
13 •
A-FI B-F I C-TI D-FI E-F
It is common in blacks, who also present at h igher stage. Screening
normally starts at 50 years but at 40 years for those with family
history. Lung cancer is the commonest malignancy in males
followed by prostate.
14. A-T, B-T, C-T, D-T, E-F

Carcinoma is the commonest cause. Other causes include cysts and
infections.
15. A-T, B-F, C-T, D-T, E-T

If bladder is large, it indicates decompensation. Bladder wall may
be thickened with saccules and diverticula. Prostatic impression
can be absent and yet there might be severe obstruction. In prostate
carcinoma, hydronephrosis can be due to ureteral involvement and
extrinsic compression by lymph nodes.
16. A-F, B-T, C-F, D-F, E-F

The yield is more in image guided biopsies than blind biopsies.
Antibiotics are routinely administered before the procedu::-e lo
avoid sepsis. Biopsy does not require local anaesthesia, although

some prefer to infiltrate the periprostatic capsule. Normally 4-7
samples are obtained in a systematic way using different segments
of prostate. Systemic biopsy with targeted biopsy of visualized
lesion is always better than doing only targeted biopsy.
17. A-F, B-T, C-T, D-T, E-T

MRl is not reliable in assessing capsular invasion. CT and MRI ar_ e
not done when the PSA is less than 25 ng/ ml, because the
diagnostic yield is low and the chances of extracapsular spread
is low. MRI i s done only in those with a high probability of
capsular invasion based on clinical staging, Gleasons and PSA level.
18. A-T, B-T, C-F, D-F, E-F

Although any race can be affected by BPH, it is common in Afro
Americans. The symptoms are divided as irritative (nocturia,
frequency, urgency, urge incontinence) which are due to detrusor
hyperreflexia, secondary to obstruction. Obstrutive symptoms are
tin stream, hesitancy, incomplete emptying and retention. The
severity of symptoms do not correlate with either the prostatic
size of the pa thological severity of the lesion.
19. A-F, B-T, C-T, D-F, E-T

Although the upper tract needs to be evaluated, a routine IVC is
not at all necessary. IVU should be performed only if there is
haematuria or history of stones or malignancy or previous surgery
or flank pain. Ultrasound is done, if there is renal insufficiency.
There is no increased incidence of cancer in BPH. According to
present consensus, there is no significant benefit in imaging upper
urinary tract.
20. A-F, B-F, C-T, D-T, E-F

Rise of PSA within one year is due to metastasis and after two
years is due to local recurrence. Local recurrence can be seen as
low signal Tl, high T2, enhancing soft tissue mass .-1 t vesicourethral
junction. But PSA assessment has the same accuracy as ·MRI. Hence,
it is not used for diagnosing local recurrence. CT produces artifacts
with radioactive seeds and .N1RI is the procedure of choice.
21. A-F, B-T, C-T, D-F, E-T

MRI and CT are not routinely indicated for BPH. IVU or
ultrasound can be done in select instances mentioned in t:P..e above
question. There is no direct correlation between IVU appearances
of upper tract and post residual urine with the ext( 't of bladder
outlet ob'struction.
22. A-T, B-T, C-T, D-T, E-F

Fish hook or hockey stick elevation of the distal ureter due to
enlarged prostate is a common finding. Diverticula can be seen
anywhere, but are more common in the anterior dome,
posterosuperior to trigone and UV junction. The diverticula can
cause reflux. Although the bladder indentation is usually smooth,
it can be asymmetrical.
23. A-T, B-F, C-F, D-F, E-T

In IVU, the diverticula may not be filled satisfactorily and hence
evaluation is not complete. Transverse ovoid filling defect i s
usually due to median lobe enlargement. Cystoscopy a n d
urodynamics are the best initial diagnostic procedures for post
prosta tectomy patients.
24. A-F, B-T, C-F, D-T, E-T

The zonal anatomy of the gland is best seen in T2. In Tl, both
- the central and peripheral zone are dark. In T2, the central zone
is dark and the peripheral glandular zone is bright. Hence a
tumour, which is low in both Tl and 12, is best seen in T2 against
the backdrop of high signal in the peripheral zone. Tl images are
useful for identifying haemorrhage. Gross extracapsular spread is
also best assessed in this sequence. If there is coexistent BPH, the
signal of the central zone can he high, intermediate or low
depending on the content of the BPH nodules. Bilateral lymph
nodes have worst prognosis.
25. A-T, B-F, C-F, D-T, E-T

The normal periurethral region and transitional zone are
hypoechoic and coarse compared to the hyperchoic and stippled
peripheral zone. The B P H nodules usually are seen in the
periurethral and transitional zone which are still hypoechoic in
comparison to the peripheral and central zones. The nodules in
later stages can be hyper or hypo or isoechoic depending on the
ratio of fibrous, muscular and glandular elements. A fibrous
capsule gives the hypoechoic rim.
26. A-T, B-F, C-T, D-T, E-T

Corpora amylacea is a proteinaceous material extruded from
pancreatic acini. It is a precursor of calculus, which is usually made
of calcium phosphate or carbonate. Usually corpora do not have
acoustic shadows, but very large ones do have shadowing. There
is no correlation between the presence of prostatic calculi and
severity of BPH.
27. A-F, B-T, C-F, D-F, E-F

Normal prostate can weigh 20 g. Any prostate more than 40 g is
considered enlarged. The zonal anatomy is not very well marked
in CT as in transrectal ultrasound. Since the peripheral part of
gland has more water, it may appear more hypodense than the
central part, in contrast CT, in elderly patients and in those with
BPH. Asymmetrical enlargement usually occurs in cancer, but can
be seen in BPH, especially around bladder neck. The levator ani
or anterior rectal wall are often very difficult to distinguish from
prostate gland.
28. A-F, B-T, C-F, D-T, E-T

Normally in T2, the peripheral zone is bright and the central zone
is dark. In BPH, the central zone enlarges but n o chan g e in
intensity is noted. The signal depends on the amount of fibrous,
muscular and glandular elements. If it is purely glandular, the
signal is quite high and is highest for cystic glandular dilatation.
If it is fibrous o r muscular, the signal is low and difficult to
distinguis h from carcinoma in central zone. Enhancement makes
the enlarged central zone, more heterogenous, while the peripheral
z one shows less intense homogenous enhancement.
29. A-F, B-T, C-T, D-F, E-F

w1RI is used for diagnosing extracapsular spread, but microscopic
c apsular invasion cannot be detected. Endorectal coil is good for
detecting lesions in posterior aspect of gland. This is usually
combined with a pelvic phase arrayed coil for the anterior aspect
of gland. Scan should be avoided for three weeks post biopsy,
because post biopsy haemorrhage can be confused for tumour. The
diagnostic accuracy of endorectal coil MRI is superior to transrectal
ultrasound.
30. A-T, B-T, C-T, D-T, E-F

The normal prostate shm\·s low signal in the central zone and high
si gn al in. the peripheral zone in T2. weighted images. I\ormal
collagen fibers c a n be seen as dark structures in the bright
peripheral zone. The presence of these fibers indicJ tes the absence
of tumour in that location. Usually the post biopsy haemorrhage
produces low signal in T2, which will be confused for the tumour.
But in Tl the bright haemorrhage can outline the low signal
intensity tumour, since the cancer does not bleed. The· prostate
biopsy is likely to cause more haemorrhage because of presence
of citrate wl:tich is an anticoagulant and absence of macrophages
to clear it. MRI is not used for diagnosis, but for assessing
extracapsular extension, which makes it inoperable. Dynamic
contrast enhanced images do not add to the diagnostic accuracy

of non contrast enhanced scans.
31. A-F, B-T, C-T, D-T, E-F

Prostate cancers have high choline and low citrate. Seminal vesicles
can be involved by direct spread from prostate base or along
ejaculatory ducts or skip metastasis. Seminal vesicle biopsy has to
be done to confirm involvement, before surgery is precluded. False
positive results can be due to haemorrhage, in which case there
will be no subjacent tumour and there will be history of biopsy,
high signol in Tl. Another cause is amyloid deposition seen in 10%
.., .,
�-· A-F, C-T, C-F, D-F, E-F
70% of prostate cancers occur in the peripheral zone. If the PSA
is high and the biopsy is negati\·e, there is a chance of it being
a central zone cancer, seen in 30% and missed by blind biopsy,
hence a MRI scan or biopsy of central zone should be performed.
tv1ajority of cancers are asymptomatic and nearly 80% are confined
to prostate gland. Screening begins only at 50 years, unless there
is family history or in Afro-A.mericans. PSA and digital rectal
examination are the screeni::g tools u sed.
1. Penis:
A. The corpora cavemosa are situated on the ventral side of the
penis
B. The Bucks fascia is attached to the suspensory ligament
C. The lymphatics drain to superficial and deep inguinal nodes
D. The dorsal artery supplies mainly the glans
E. The deep dorsal vein drains to the periprostatic venous plexus
2. MRI of penis:
A. The corpora are of high signal than muscle in Tl
B. The tunica albuginea and Bucks fascia can be differentiated in
PD (Proton density)
C. Corpora cavemosa gives uniform high signal in T2
D. Gadolinium enhancement is seen in all corpora
E. Corpora spongiosa shows heterogenous signal in T2
3. Testis:
A. The left testis is lower than the right testis in 85%
B. The upper pole of testis is slightly tilted backwards
C. The process us vaginalis is normally obliterated at birth
D. The tunica vaginalis covers the anterior posterior and lateral
surfaces of testicles
E. The epididymis is posteromedial to the testis
4. Testis:
A. The median fibrous raphe between the two testis is deficient
superiorly
B. The spermatic cord has four layers
C. The epididymis is lined by tunica vaginalis
D. The vas deferens runs lateral to the inferior epigas tric artery
at the deep inguinal ring
E. The ·Vas deferens turns medially at the ischial spine level
5. Ultrasound:
A. The tunica albuginea is routinely visualized
B. Mediastinum testis is seen as high echogenic structure
posteriorly
C. Sperm granulomas are the common cause of high echogenicity
within the testis
D. Rete testis can be visualized as prominent tubules sometimes
E. The testicular septa are not visualized in scans
6. Ultrasound:
A. The epididymal head has higher signal than the testis
B. The epididymal head shows a typical streak artefact
C. Vas deferens is routinely visualized
D. Globus major is helpful in identifying the orientation of testis
E. 1-2mrn fluid is normal within the tunica
7. MRI:
A. On TlW the testis has signal similar to fat
B. On T2W, the testis has signal higher than fat
C. Epididymis has low signal than testis in T2W
D. Pampiniform plexus shows high signal due to slow flow
E. Spermatic cord structures are resolved well in Tl W images
8. Testis:
A. The pampiniform plexus is formed at the posteriN portion of
the testis
B. The cremasteric artery is a branch of the inferior vesical artery
C. The presence of anastomosis between testicular artery and
cremasteric and ductus deferens artery reduces the testicular
ischemia when flow is compromised
D. The cremasteric plexus is situated anterior to the pampiniform
plexus
E. The testis descends into scrotum in the seventh month of
intrauterine life
9. Differential diagnosis of multiple intratesticular masses:

A. Leukemia B. Sarcoidosis
C. Metastasis D. Chronic orchitis
E. Lymphoma
10: Causes of gas in scrotum:

A. Bowel perforation
B. Hernia
C. Abscess
D. Fourniers gangrene
E. Faulty chest tube positioning
Imaging of Male Reproductive Tract 171
11. Scrotal wall thickening is seen in:

A. Ventriculoperitoneal shunt
B. Torsion of epididymal appendage
C. Henoch schonlein purpura
D. Idiopathic scrotal edema
E. Testicular tumour
12. Common causes of cystic lesions of epididymis:

A. Spermatocele B. Sarcoma
C. Cyst D. Cystic degeneration
E. Tuberculosis
13. Common causes of priapism:

A. Sickle cell anemia B. Diabetes mellitus
C. Malignancies D. Cavemosal arterial injury
E. Perinea! trauma
14. Priapism:
A. Erection is painless in low flow type
B. Low flow priapism is more of an emergency than high flow type
C. Erectile dysfunction is permanent after high flow priapism
D. There is no further rigidity with sexual stimulation in both types
E. Priapism in high flow type is due to release of nitric oxide
15. Doppler testis:

A. The testicular arterial system is a high resistance system
B. The ductus arteries always show high resistance
C. The resistive index of testicular arteries is 1.0 in children
D. The capsular and centripetal branches of testicular artery also
show the same low resistance pattern as seen in the main
testicular artery
E. 0.7 is the upper limit of normal resistive index in an ad ult
16. Predisposing factors for testicular torsion:

A. Large bare area
B. Broad mesenteric attachment
C. Gubernaculum not attached to the testicular wall
D. Infection
E. Trauma
F. Tumour
17. Scrotum:
A. Hernia is easier to diagnose when there is ornentum rather
than bowel within it
B. Scrotal mouse usually refers to epididymal cyst
C. Supernumerary testis are prone for torsion
D. Fibrous· pseudotumour is common in tunica than testis
E. Reflux of sterine urine causes epididyrnitis involving only the
tail
18. Epididymal lesions:

A. 75% are epididymal cysts
B. Spermatoceles are more commoner after vasectomy
C. Sperrnatoceles have septations and higher echogenic contents
than simple cysts
D. l;1trasound cannot differentiate simple cysts and spermatoceles
E. Spermatoceles are due to foreign body reaction to sperms
19. Epididyrnal lesions and vasectomy:

A. Sperm granulomas are found in 45% of cases after vasectomy
B. Corrunonest location of sperm granuloma is tail of epididymis
C. Enlargement of epididymis is common after vasectomy
D. Commonest cause of pain after vasectomy is epididymitis
E. Dilated ductal system is the commonest ultrasonographic
finding in post vasectomy pain syndrome and shows large
epididymis, prominent ducts and sperm granulomas
20�· Epididyrnal tumours:

A. Papillary cyst adenoma associated with tuberoussclerosis
B. Commonest tumour is adenocarcinoma
C. Adenomatoid tumour is always benign
D. Adenomatoid tumour is hypoechoic in majority of cases
E. Li?oma is the commonest paratesticular neoplasm
21. Epididymis:
A. Combined epididymoorchitic involvement is more common
than pure epididymal inYolvement in tuberculosis
B. 100% of those with papillary cystadenorna have von Hippel
Lindau disease
C. In lymphoma, e?ididymis is involved more than testis
D. Bilateral cysadenomas are pathognomonic of VHL
E. Sperm granulomas are hyperechoic in majority of cases
22. Common causes of thickening of spermatic cord:

A. Lymphoma B. Hernias
C. Lipomas D. Torsion
E. Epididyrnitis
23. Scrotum:
A. Rhabdomyosarcoma is the commonest paratesticular malignancy
B. Varicocele is diagnosed when the testicular veins are more than
3 mm
C. Majority of testicular rhabdomyosarcornas have retroperitoneal
lyrnphadenopathy
D. Intratesticular solid mass is malignant unless proved otherwise
E. Majority of extratesticular solid masses are malignant
Imaging _of Male Reproductive Tract 173
24. Common causes of Epididymal enlargement:

A. Leukemia B. Lymphoma
C. Sperm granulomas 0. G ranuloma inguinale
E. Metastasis
25. Scrotal pearl:

A. Has a calcium oxalate core
B. Situated in tunica albuginea
C. High association with hydrocele and cyclists
D. Torsion of appendix of testis is an etiological factor
E. Non mobile in majority
26. Acute epidid ymitis:

A. Hematogenous spread
B. Chlamydia is the commonest organism in males after 35 years
C. E. coli is the commonest organism prior to 35 years.
D. Spread to testis is very common
E. Focal epididymitis is common in the body of epididymis
27. Scrotal injury:

A. Testicular rupture is associated with infarction
B. The testis is heterogenous in rupture
C. A fracture line is seen in 75% of rupture
D. Rupture indicates tearing of tunica albuginea
E. Differentiation of haematoma and rupture is not clinically
significant
28. Testicular appendages:

A. Appendix testis is the commonest appendage
B. Scrotal pearl is an infracted testicular appendage
C. The appendix epididyrnis is the commonest torsed appendage
D. Doesn't happen after 12 years
E. Hydrocele is uncommon, unlike testicular torsion
29. Clinical features of testicular torsion:

A. Neonatal torsion is very rare
B. Blue dot in skin suggests testicular appendage torsion
C. Increased volume of testis predisposes to torsion during
·
puberty
D. Cremasteric contractions are responsible for warning pains
E. Inguinoscrotal mass is the only finding of a neonatal torsion
30. Varicocele:
A. Contrast venography shows contrast stasis for more than 20
minutes
B. Doppler shows decreased flow with valsalva manouvre
C. 75% of treated men have normal sperm profile
D. Successful pregnancy seen in 40%
E. Bag of worms felt clinically
31. Cryptorchidism:
A. Orchipexy does not reduce risk of malignancy
B. 50 times increased risk of malignancy
C. No increased risk of malignancy in the normal testis
D. 10% incidence at one year
E. 25% risk of malignancy
- 32. Undescended testis:

A. Infertility in 70%
B. Non seminomatous germ cell tumour is the commonest
malignancy associated
C. If diagnosed in neonatal period surgery should be done before
one year to reduce risk of malignant transformation.
D. 75% of undescended testis is located in the abdomen
E. Testicular venography is the most effective method of diagnosis
33. Testicular torsion:

A. Scrotal edema is the earliest clinical finding
B. Pampiniforrn plexus is compressed earlier than the crernasteric
plexus
C. Venous infarction occurs earlier
D. Only a twist of 720 degrees V\ill produce a complete testicular
infarction
E. Irreversible ischemia occurs after 24 hours

A. Peak incidence is in puberty
B. Halo sign is highly specific for testicular torsions
C. Nubbin sign is due to high activity lateral to iliac artery
D. Increased doppler flow rules out testicular torsion
E. Testis is never small in the acute stage of torsions
35. Sonographic Features of epididymitis:

A. Thickened sperrnatic cord
B. Thickend tunica albuginea
C. Hyperechoic fat in the spermatic cord
D. Hyperechoic epididymis
E. Hydrocele
36. Epididymitis:
A. Peak systolic veloctiy > 15 cm/ sec
B. Increased diastolic flow in the testicular artery
C. Venous flow is detected
D. Pyuria is seen in 95%
E. Elevating the scrotum worsens the pain in epididymitis unlike
testicular torsion
37. Epididymitis- nuclear imaging:

A. Sensitivitity of 99%
B. Increased perfusion through spermatic vessels
C. Increased activity laterally to the scrotum
D. Increased activity of scrotal contents
E. Decreased activity in the testis
38. Testicular tumours:

A. Incidence of testicular tumour 25% in ambigous genitalia
B. Incidence of testicular tumour 20% in cryptorchidism
C. In stage IIIA- bony metastasis is seen
D. Stage II- lymph nodes above diaphragm
E. Choriocarcinomas peak in 40-50 years
39. Testicular tumour:

A. Azzopardi tumour indicates a highly malignant tumour
B. Majority of tumours are hyperechoic
C. Extratesticular masses are benign in majority
D. Seminornas are usually heterogenously hypoechoic
E. Embryonal cell carcinomas have more cystic component than
other types

A. 15% of seminornas present with metastasis at the time of
presentation
B. Invasion of scrotum means involvment of ing uinal nod e s
C. Invasion of epididymis will subsequently result in involvement
of external iliac nodes
0. 5% of testicular carcinomas origin ate in extragonadal sites
E. Lymphangiography increases sensitivity in staging lymph nodal
spread
41. Complications of acute epididymiti s:

A. Testicular infarction
B. Fournier gangren e
C. Testicular abscess
D. Testicular atrophy
E. Epididymal carcinoma
42. Fournier gangrene:

A. Thrombosis of s ubcutaneous vessels
B. High association with diabetes
C. Primary focus of infection seen in 95%
D. Gas in pe rineum
E. Bacteroides is a ca use
43. Testicular malignancy:

A. Tumours of epididymis are usually malignant
B. Ultrasound can reliably differentiate seminoma and teratoma
C. Testicular microlithiasis is premalignant
D. Testicular cysts occur in 20% of normal population
E. Any testicular mass with hydrocele indicates malignancy
44. Extragonadal germ cell tumours:

A. Almost always secondary than primary
B. Testicular microcalcification seen in 45% of germ cell tumours
C. Can be seen in axillary nodes
D. Majority are seen in the same side as the primary testicular
lesion
E. Ultrasound of scrotum should always be done
45. Varicoceles:
A. Due to incompetent valves
B. 50% of men have varicoceles
C. 10 times increased incidence in left side
D. The right spermatic vein is larger than the left
E. Retroperitoneal mass compressing right spermatic vein should
be suspected, if there is isolated right \·aricocele
46. Causes of infertility in varicocele:

A. Lowered testicular temperature
B. Ischemia
C. Occult hormonal changes
D. Reflux of toxic renal metabolities
E. Seen in 40% of infertile men
47. Varicocele embolisation:

A. Success rates approach 100%
B. Sperm motility increases after the procedure
C. Sperm count is unchanged after embolisation
D. Gelfoam is the commonest agent used
E. Not done if seen on the right side

A. If the testis is al!eady devitalised, there is no need for surgery
B. Orchipexy should be done in the opposite testis also
C. Bell clapper deformity is bilateral in more than 70% of cases
D. Intravaginal torsion- short mesenteric attachment of cord to
testis
E. Pertechnate scan is more sensitive than doppler for intermittent
torsion
-- Imaging of Male Reproductive Tract 1n

A. Hydrocele is seen in acute phase
B. Epididymis enlarged, hypoechoic
C. Before seven hours, increased flow is seen in the pertechriate
scans
D. Photophenic area is not seen in early stages
E. Presence of even a single small vessel within testis showing
flow within it, rules out torsion
50. Causes of focal hypoechoic lesion in ultrasound of testis:

A. Epididymitis B. Infarct
C. Haematoma D. Abscess
E. Sperm granuloma
51. Causes of testicular calcification:

A. Seminoma B. Epidermoid cyst
C. Sertolic cell tumour D. Testicular torsion ·
E. Tuberculosis

A. 50% of germ cell tumours are malignant
B. Seminomas constitute 95% of germ cell tumours
C. Endodermal sinus tumour is the most malignant non
seminoma tous germ cell tumour
D. Pure germ cell tumours are more common than mixed gen::t
cell tumours
E. Functioning Leydig and Sertoli tumours are not usually
malignant

A. Alpha fetoprotein is raised in seminomas
B. B HCG is elevated in yolk sac tumour
C. B HCG is elevated in seminoma
D. Elevated estrogen in Sertoli cell tumour
E. Increased testosterone seen in theca cell tumour

A. The sentinel lymph node for right renal tumour is at the level
of renal parahilar
B. It is more common for left sided tumour to cross to the right
side of the retrop e ritoneum then from right to left
C. All testicular tumours involve the lymphatics before involving
lunas
0
D. CT negative lymph nodes are positive for malignancy in almost

50%.
E. Lymphoma is the com.rnonest malignancy in 60-70 year group
SS. Testicular trauma:

A. Disruption of tunica vasculosa is pathognomonic of rupture
B. Fracture is seen in 50% of traumas
C. Testicular rupture produces heterogenous testis
D. MRI is the procedure of choice for diagnosis
E. Acute haematoceles are usually hypoechoic
S6. Associations of Testicular microlithiasis:

A. Kline felters syndrome B. Cryptorchidisrn
C. Pseudoherrnaphroditism D. Ahreo lar microlithiasis
E. Testicular tumour s
S7. Testicular microlithiasis:

A. Associated with Downs syndrome
B. Infertility is seen
C. Incidence of 0.6%
D. Calcification is seen in seminiferous tubules
E . Atleast ten should b e present for diagnosing classic microlithia
sis

A. :tv1ature teratomas are generally mzlignant in adults
B. Endoderrnal sinus tumour is the corrunonest non sein.inomatous
germ cell tumour in prepuberal group
C. Choriocarcinoma has the worst prognosis
D. Non serninomatous tumours haYe b etter prognosis than
seminomas
E. Carcinoma in situ is seen in 20% of contrala teral testis in
cancers
59. Tuberculosis scrotum:

A. Infertility is uncommon even in extensive disease
B. Painless, unlike acute epididymoorchitis
C. Common in elderly men, more than 60 years
D. Bilateral in majority of cases
E. Infection is usually ascending
60. Epidermoid cyst

A. It is a variant in the development of teratoma
B. Ultrasound can differentiate the epidermoid and teratoma
C. Echogenic capsule is characteristic
D. Orchidectomy is required in all cases to exclude sinister tumour
E. Cyst con tent is clear
61. Causes of erectile dysfunction:

A. Prostatectomy B. Cerv ical spondylosis
C. Multiple sclerosis D. Parkinsonism
E. Anticonvulsants
62. Doppler of penile vasculature:

A. Normal peak systolic velocity is less than 25 cm/ sec
B. End diastolic velocity more than 3 cm/ sec indicates venous
incompetence
C. Doppler i s best performed before and administration of
tolazoline
D. Asymmetrical peak systolic velocity by more than 2 cm/ sec
between the two cavernosal arteries indicates arteriogenic
incompetence
E. The cavemosal arteries are further compressed in size after
administration of smooth muscle relaxant
63. Penile carcinoma:

A. Adenocarcinoma is the commonest type
B. Seen in 3rd and 4th decade
C. Circumscision is not a determining factor
D. Human papilloma virus 16, 18 associated
E. Higher incidence in Cau casians than Afro-Americans
64. Testicular microlithiasis:

A. Follow up s h oul d be done every six months
B. Acoustic sh adowing is commonly seen from the calcification
C. Snowstorm appearance is pathognomonic appearance
D. Symmetrical involvement in 80%
E. Associated with testicular malignancy in 40% of cases
65. Penile car cinoma:

A. Painful lesions
B. Begins in the skin over glans
C. Cavernosal invas io n worsens prognosi s
D. The lesions enhance more than the corpora cavernosa m
contrast MRI>
E. Stage II lesions involve penile shaft and the inguinal nodes
66. Urethral carcino ma:

A. Commonest part of urethra involved is the prostatic portion
B. The prostatic urethra is lined by col umnar cells
C. Fossa navicularis lined by s quam ous cells
D. Squamous ce ll carcinoma is the com.n1onest type in the anter:or
urethral carcinomas
E. B ulb o us segment is lined by stratified columnar e?itheliur..
ANSWERS
1. A-F, B-T, C-T, D-T, E-F

Corpora spongiosa is ventral.The penis has a tunica albuginea,
Bucks fascia (deep fascia) and superficial fascia Dorsal artery
supplies glans and there are arteries to bulb and crura.
Deep dorsal vein drains internal pudendal V, superficial dorsal
vein drains periprostatic venous plexus.Body drains to superficial
inguinal nodes: proximal penis to deep inguinal nodes
2. A-T, B-T, C-F, D-T, E-F

Corpora are of high signal than muscle but less than fat in Tl.
Corpora spongiosa is of uniform high signal in T2. Corpora
cavernosa is of heterogenous high signal due to variable blood
flow and cavernosal volume. Tunica albuginea is of low signal in
both.
Tunica and Bucks fascia can be occasionally differentiated in PD
sequences.
3. A-T, B-F, C-T, D-F, E-F

The upper pole of testis is slightly tilted forwards. The tunica
vaginalis covers the anterior, lateral and medial surfaces of the
testis. The epididymis is posterolateral to the testis.
4. A-T, B-F, C-T, D-T, E-T

The spermatic cord has three layers, the external spermatic fascia,
cremasteric fascia and internal spermatic fascia. The epididymis
is loosely covered by tunica vaginalis.
5. A-F, B-T, C-T, D-T, E-F

Phleboliths and sperm granulomas are seen as bright echoes with
acoustic shadowing.
Septa can be visualized as hyper or hypoechoic structures
6. A-T, B-T, C-F, D-T, E-T

The epididymal body and tail are smaller and show less
echogenicity than the head.
Vas deferens is not routinely visualized and sometimes shows a
central bright stripe.
Globus major is always related to the upper pole of the testis.
7. A-F, B-T, C-T, D-F, E-F

Testis -Tl-intermediate, high than muscle, low than fat:72-higl°'.e::
than fat. Epididymis Tl-l: w or equal to testis:T2-low than t�.::::.:..
Pampiniform plexus-flov. voids. Sp_:-matic �ord struc:--..I::-es w:: :·:
be seen even in high res:-. ·.ition irr1c.. :s. Tu::- .:a, medias:i:"'.�.:..
septa are low signal i.r, . sequenc :
8. A-F, B-F, C-F, D-F, E-T

Cremasteric artery is a branch of the inferior hypogastric artery
and supplies the scroum and the cord coverings. The artery to
ductus defere n s is a branch of superior vesical artery. The
parnpiniform plexus is situated at the superior portion of the testis
and the cremasteric plexus, draining the scrotum is seen posterior
to this. Although extensive anastomosis exist between the arteries,
it is not enough to prevent ischemia, when testicular artery is
compromised.
9. A-T, B-T, C-T, D-T, E-T
10. A-T, B-T, C-T, D-T, E-T

Scrotal emphysema can be seen due to extension from bowel
perforation arid faulty chest tube positioning.
11. A-T, B-T, C-T, D-T, E-F

Epididymoorchitis and t5ticular torsion are common causes.
12. A-T, B-F, C-T, D-T, E-F
13. A-T, B-F, C-T, D-T, E-T

Priapism is painful, sustained erection.
14. A-F, B-T, C-F, D-F, E-F

Low flow type- p ainful e:ection, cannot be increased, due to low
venous flow causing ische!!lia, emergency, if untreated permanent
disability, sickle, malignancies.
High flow type- p ainless partial erection, can be increased with
stimulation, high flow in arteries with normal venous flow, shear
of high oxygen blood leaking from cavemosal artery into lacuna
mimics release of nitric oxide, usualy post trawnatic, no permanent
disabilitv.,,
15. A-F, B-F, C-T, D-T, E-T

The testicular arterial syste!!l is a low resistance system, showing
broad systolic peak and high diastolic flow. Tne Sdme pattern is
seen in the peripheral branches also. Although the epidid ymal
vessels theoretically should be of high resistance, due to extensive
anastomosis, the pattern is no� of high resistance. The resistive
index is upto 1.0 in children and 0.72 in adults.
16. A-F, B-F, C-T, D-F, E-T, F-T

Presence of narrow mesenteric a t�achment and ba:-e a!."e3. a ,..0
p r edisposing factors for testicular Jrsion.
17. A-F, B�F, C-T, D-T, E-T

Eernias are easier to di· ::ose wh:- �. there '.:: 'Jow;;:. ·1:r<· b.:::::
c .:lentum. Sere: al mol!s 1 pai.nle•: mobile S:::'.a
. ll :-:- ·3,. . : or:.:::'.
a fibrous pseudotumour involving the tunica. Supernumerary testis

are usually seen within scrotum and are prone for carcinomas and
torsion. Chemical epididymitis, occurs due to reflux of urine into
vas deferens due to high pressure, involving only vas and tail.
18. A-T, B-T, C-F, D-T, E-F

Spermatoceles have sperms, lymphocytes and cells, but they cannot
be differentiated by ultraso und from simple cysts. High e r
incidence i s found after vasectomy. They are believed to b e
secondary to obstruction of efferent ductules. They have echogerric
contents and separate from epididymis.
19. A-T, B-F, C-T, C-F, D-T

Sperm granulom as are due to foreign body reaction of the host
to the extravasated sperm cells and are very commonly seen at
the site of vasectomy. It is usually less than 3 cm. Commonest cause
of pain after vasectomy is obstruction of the efferent ductal system
with associated perineural inflammation.
20. A-F, B-F, C-T, D-F, E-T

Papillary cystadenoma shows strong association with von Hippel
Lindau disease.
Commonest tumour in epididymis is adenomatoid tumour, which
is benign, small and hyperechoic. It is common in the tail.
21. A-F, B-F, C-F, D-T, E-F

66% of papillary cystadenomas are associated with VHL. 100% of
bilateral tumours are associated with VHL 25% of VHL patients
have papillary cystadenornas.
Tuberculosis, sacoidosis affect epididymis m o re than testis.
Lymphoma affects testis more than epdidymis. Sperm granulomas
·
are usually hypoechoic.
22. A-T, B-T, C-T, D-T, E-T
23. A-T, B-T, C-T, D-T, E-F

Rhabdornyosarcorna and leiomyosarcoma are the commonest
extratesticular malignancies. It has a high incidenc of retroperi
toneal lymphadenopathy. It is commoner in childre.r · · .. · ,1rcomas
have fat. Majority (more than 95%) of extratesticu: masses
are benign, unlike testicular solid masses.
24 A-F B-F C-T D-T E-T

• I I I I
Epididymitis and tuberculosi,; are common cau�
25. A-F, B-F, C-T, D-T, E-F

Scrotal pearl has a core of t-ydroxyapatite. It :
vaginalis, associated with J: ·droceie. Trauma,
. .
torsion of appendix testis and inflammation are proposed

etiological factors. It can be single or multiple, mobile and upto
1 cm in size.
26. A-F, B-F, C-F, 0-T, E-F

Majority of infections are ascending.
Chlamydia is the commonest organism prior to 35 years and E. coli,
after 35 years.
!- Focal epididymitis is common in the tail.
i
27. A-T, B-T, C-F, D-T, E-F
'
Testicular rupture requires surgery, but haematoma does not, and

hence differentiation is essential. Rupture is associated with
hematoma, hydrocele and fragmentation. Fracture line is seen in
ultrasound in only less than 10% of cases.
28. A-T, B-T, C-F, D-F, E-F

Appendix testis is the commonest vestigial appendage and is the
commonly torsed appendage. Seen between 7 -12 years but no
age is exempt. The appendix becomes hyperchoic with central
hypoechogenicity. Hydrocele may be seen. It may be sloughen off
and produce scrotal pearl.
29. A-T, B-T, C-T, D-T, E-T

Torsion in neonatal period is rare and is commonly due to prenatal
torsion. It may be seen only as a mass in the scrotal region.
Increasing volume of testis, in puberty and tumour predispose to
torsion. Cremasteric contractions, give the warning pains, before
the torsion. Testicular appendageal torsion may present as a blue
dot in the skin.
30. A-T, B-F, C-F, D-T, E-T

Contrast venography is the gold standard, but invasive and shmvs
reflux into pampiniform plexus. Doppler will show dilated
paratesticular veins with increase in flow with Valsah·a
After surgery or embolisation, normal sperm profile is seen in one
third.
31. A-T, B-T, C-F, D-F, E-F,

The risk of malignancy is 10% in the undescended testis, which
is 50 times more than normal testis. The risk is not altered bv ,
orchlpexy and is increased in the norm·al testis too. Tne i.ncidence

is less than 1 % at one year.
32. A-T, B-F, C-F, D-F, E-F

Infertility �s- seen in 70% of bilateral cases. SeDi:-i.c :nJ.s are the
commonest associated tumours. Surgery is not dor.e ·oefore on-2
year, since the testis can descend r:ormal\. lltrasot.:..
�.._ is ;::.-_:: bes�
modality for diagnosis. !\i1ajority are in �nguinai :e .;:on.
33. A-T, B-F, C-T, D-T, D-T

The low pressure cremasteric plexus is affected earlier, resulting
in scrotal edema which is the earliest clinical finding. Venous
supply is compressed earlier and venous infarction occurs earlier.
A twist of 720 degrees produces complete cessation of testicular
blood flow, but commonly the torsion is between 360-720 degrees.
Some believe torsion above 360 degrees is complete. Testicular
infarction begins to appear within 2 hours after complete cessation
of testicular blood supply, irreversible ischemia in 6 hours and
complete established infarction in 24 hours.
34. A-T, B-F, C-F, D-F, E-T

Halo sign is due to a central phophenic area with peripherally
increased dartos flow' and Nubbin sign is. seen at the twisted site,
which is usually medial to the iliac artery. Although Halo sign is
suggestive in the appropriate clinical context, it is not very specific,
as it may be caused by abscess or hematoma. Increased flow is
seen in doppler in the mid and late phases. In acute stages, the
testis is large or normal.
35. A-T, B-T, C-T, D-F, E-T

The scrotum is also thickened; Epididymis is hypochoic.
36. A-T, B-F, C-T, D-T, E-F

There is increased flow in the epididymal a�teries, with increased
peak systolic velocity, being tvvice as much as the normal side. The
diastolic component of testicular artery is reversed due to
obstruction of venous flow by epididymal inflammation and
edema.
37. A-T, B-T, C-T, D-T, E-F

The testicular activity is also increased if it is involved. Symmetrical
perfusion in the iliac and femoral vessels.
38. A-T, B-F, C-F, D-F, E-F

2-4% incidence in cryptorchidism. Stage I- confined to testis, II
lymph nodes below diaphragam (A-minimal enlargement, B
bulky), IIIA- lymph nodes above diaphragm, IIIB- distal
metastasis. Chorirn;arcinomas 10-30 years, seminomas 4th a.Tl.cl 5th
decade.
39. A-F, B-F, C-T, D-F, E-T

Azz o pardi tumours are burnt out heavily calcified tumours.
Majority of testicular tumours are hypoechoic. Serr<nomas ar
typically homogenously hypoechoic. Embryonal cell ca :i.nor.,as a:
heterogenous with a lot of cystic components.
40. A-T, B-T, C-F, D-T, E-T

15% of seminomas and 30% of non seminoma to us tumours
metastasise at the time of presentation. Invasion of epididymis
results in spread to internal iliac nodes. Extragonadal sites include
mediastinum, retroperitoneum and sac rococcygeal reg ion.
Lymphangiography can find lymph nodal involvement, not found
in CT, making it more sensitive, but they are bes t when used
together.
41. A-T, B-T, C-T, D-T, E-F

Orchitis, epididymal abscess, hydrocele and pyocele are the other
complications.
42. A-T, B-T, C-T, D-T, E-T

Fournier gangrene is fulminant fascitis of scrotum with soft tissue
necrosis. The primary source is either in the urethra or soft tissue
or skin. Staphylococcus, E. coli, Proteus, Anerobes, Clostridia are other
organisms.
43. A-F, B-F, C-T, D-T,E-F

Hydrocele can be seen in inflammatory, traumatic and neopl astic
masses. Forty percent of microlithiasis associated with malignancy.
44. A-T, B-T, C-T, D-T, E-T

Primary extragonadal germ cell tumours are extremely rare. If the
b iopsy shows this, ultrasound scrotum should be done.It is
common in retroperitoneum, mediastinum, supraclavicular, cervical
and axillary nodes.
45. A-T B-F C-T D-F E-T

f I f f
Varicocele is dilated pampiniform plexus internal spermatic veins

seen in 15%
Varicocele is commoner on the left side, because the left spermatic
vein is longer and it j oins the left renal vein at right angles.
46. A-F, B-T, C-T, D-T, E-T

Varicocele produces increased testicular temperJ ture, affecting
spermatogenesis.
Reflux of toxic adren2.1 metabolities is another cause. Seen in 20-
40% of in fertil e men, :he incidence in normal men b e in g 10%. It
is still controversial �at varicocele is associated with L""'.fertilitv.
,
47. A-T, B-T, C-F, D-F, :>F

Sperm motility and c mt increase. Coils, balloons are cG:::t.i.i'.only
use dl
. t can b e d on -- n b oth si.
. ' ..j.. .:.es.
48. A-F, B-T, C-T, D-T -F

Testis should be re. :ed even it is devit�'.:::2d, beca:.:5,;; ii it is
left, it will prod uc iut o a n tibo,iies to soi::
'
:-i:'l whicl--. ::na·· b'2
produced by the contralateral testis. Since the deformity producing

torsion is usually bilateral, bilateral orchipexy is performed. In
extravaginal torsion, torsion of cord abo\·e level of scrotum occurs.
In intravaginal, the testis is incompletely fixed to the posterior
scrotal wall and the mesentery is short, resulting in the testis
falling forward and rotating within tunica vaginalis. Doppler is
more sensitive for intermittent torsion, because if there is no flow,
it can be repeated to exclude intermittent torsion.
49. A-T, B-T, C-F, D-F, E-F

Flow is normal in the dartos vessels before seven hours. Increased
dartos flo\v is seen in mid and late phases, after 24 hours. Central
photopenic area is seen in early mid and late torsion. In torsion,
the doppler does not show any flow within testis inspite of
scanning for one minute with proper settings or there is only one
intratesticular vessel with flow, but opposite testis has diffuse
- flow.
50. A-F, B-T, C-T, D-T, E-F

Neoplasm is the commonest cause. Orchitis can also cause the
appearance. Sperm granuloma is usually extratesticular.
51. A-T, B-T, C-T, D-F, E-T

Also seen in other tumours such as teratomas, embrv
,
onal
carcinomas and leydig cell tumours.
52. A-F, B-F, C-F, D-F, E-T

Majority of testicular tumours are malignant. Seminomas and non
seminomatous germ cell tumors constitute equally the testicular
tumours. Choriocarcinoma is t he most malignant non
seminomatous tumour. Mixed germ cell tumours such as teratomas
(40%) are more common than pure germ cell tumour. Fu nctioning
tumours are benign in 90%
53. A-F, B-F, C-T, D-T, E-F

Alpha fetoprotein is ele"· ·.ted in yolk sac tumour and teratomas
B HCG in seminoma (10° · of cases), choriocarcinoma. Both alpha
fetoprotein and hCG are levated in embryonal carcinoma S ertoli
cell tumours produce es: )gen and Leydig cell tumours produce
androgens.
54 . A-� B-� C-� D-T, E-T

The first nodal group (sE. :inel node) is fr : lef: -,:; :-- � hilar on the
l . -
left side and right parac
.
11 group c :-1 th ·:g: �rammg o.t v
left sided retroperitonea: ·mph noc ) frc 3. -:d primary

is more common than · :ining of ·sh:
testicular tumour. St.. �quently Jth�. ·eal
·t .. t ....
::1r
""" ' ..
mediastinal nodes will be involved. Most of the testicular tumours

drain into the lymphatics and via thoracic duct or its equivalent
drains into the lung. Choriocarinoma can have primary
hematogenous metastases, producing canon ball type metastasis.
55. A-T, B-F, C-T, D-F, E-F

Fracture line is seen in less than 20%. Ultrasound has 100%
sensitivity and is the procedure of choice. Acute haematoceles are
hyperechoic and chronic haematoceles are hypoechoic.
56. A-T, B-T, C-T, D-T, E-T

Calcification i s also normal in prepubertal testis and testicular
torsion.
57. A-T, B-T, C-T, D-T, E-F

Microlithiasis originates in the seminiferous tubules which have
glycoprotein and cellular debri. In classic microlithiasis, there are
atleast five and in limited, less than five. The bright foci are
approximately 1-2 mm, usually diffuse but can be clustered.
Infertility is the commonest association.
58. A-T, B-T, C-T, D-F, E-F

Mature teratomas are generally considered benign in children and
malignant in adults.
Seminomas have a better prognosis than non seminomas.
Carcinoma in situ is seen in. only 3°10 of contrala teral testis, a:.d
a routine biopsy is not very he lp f u l .
59. A-F, B-F, C-F, D-T, E-F

Infertility is commonly seen in tuberculosis due to extensi·:e
epididymoorchitis causing destruction of seminiferous tubules or
ductal obstruction. The testis and the cord are swollen, painfol
and tender. It is commonly seen in young men, with 70% occurrir:g
after 35 years, only 20% occurring after 65 years. The disease :.S
unilateral in the early stages, but becomes bilateral in the lat��
stages. Infection is hematogenous, unlike acute epididymoorchi::S,
which is usually ascending, but can be hematogenous.
60. A-T, B-F, C-T, D-F, E-F

Epid ermoid cyst is a benign tumour, which is co r s i d o:: r e d. a
monomorphic development of teratoma along ectodo::�xal cell

differentiation. It is usually a w ell defined tumour, v�:hich is
hypoechoic with internal echoes, echogenic calcified capsule, :-'.O
enhancement. Differentiation from teratoma is not oos5��le in l
imaging· and biopsy is required. The lesion is managed c:..- i.:x�

excision. Orchiectomy ca:i. be do:-te.
61. A-T, B-T, C-T, D-F, E-T

Common causes of erectile dysfunction are-psychogenic, diabetes,
hypertension, high prolactin, hypogonadism, neurologic causes
including multiple sclerosis, neuropathy, CVA, alzheimers,
spondylosis, drugs including alcohol, antihypertensions,
antipsychotics, surgery including cystectomy, and vascular causes.
- 62. A-F, B-T, C-F, D-F, E-F

Doppler is performed both in flaccid state and after administration
of the smooth muscle relaxant,.. papaverine. Normal cavernosal
artery measures less than 0.6 mm before erection and increases
more than 75% after papaverine. Normal peak systolic velocity >
25 cm I sec; Less than 25 cm I sec or asymmetry of more than 10

cm/ sec between two cavernosal arteries indicates arteriogenic
impotence. Normal end diastolic velocity < 3 cm/ sec, more than
3cm/ sec- indicating venous leakage.
63. A-F, B-F, C-F, D-T, E-F

Squamous cell carcinoma is the rommonest type. Seen in the 6th/
7th decade. Commoner in uncircumscised men. Higher incidence
in Africans than Caucasians.
64. A-T, B-F, C-T, D-T, E-T

Follow up is done to detect deYelopment of testicular tumom:s.
In testicular tumours the microlit� can be seen within the tumour
or they are displaced by tumour. Majority are symmetrical in both
testes. Intraepithelial germ cell tumours are commonly associated.
Acoustic shadowing is not seen. MRI shows low signal lesions.
20-45% association with tumours_
65. A-F, B-F, C-T, D-F, E-F

The lesions are painless and begin in the glans. In MRl the lesions
enhance, but less than that of cavemosa. MRI is not for diagnosis
but for staging.
In jackson staging, I-confined to g lans, II-involves shaft, III
inguinal nodes, IV- pelvic nodes/metastasis.
66. A-F, B-F, C-T, D-T, E-T

Bulbar and membranous.
Urethra the commonest parts of urethra involved, prostate ure
is lined by transtional cells.
1. Breast anatomy and development:
A. The breast is a modified apocrine sweat gland
B. The embroyonic milk line runs from base of forelimb to the
hindlimb
C. The mammary ridge is formed from the 15th week o f
intrauterine life
D. The breast ridge is formed in mesenchyme
E. The breast ducts are not canalized at term
2. Breast anatomy:
A. The male breast has a simple ductal system
B. The ducts are lined by columnar cells and myoepithelial cells
C. The ductules are lined by single layer of cuboidal cells only
D. The terminal duct lobular unit is the basic functional unit of
the breast
E. A lobule is supplied by one terminal duct
3. Breast anatomy:
A. The Montgomery tubercles are modified sebaceous glands seen
in the areola
B. The Mongomery tubercles become prominent only during
pregnancy
C. Changes at puberty are due to pituitary hormones only
D. :tv1arked stromal proliferation is seen during secretory phase
E. Lactation produces dilation of ducts and acini
4. Vascular and lymphatic supply of breast:

A. The major artery to breast is internal thoracic ar:ery
B. Intercostal arteries supply the breast
C. Azygous vein drains the breast
D. Lymphatic flow to the opposite breas� is ul\co:..:::c:-'.
E. Level III nodes indicate bad prognosis
5. Technical requirements for a good mammography:

A. Mo l ybd e n u m anode with two peaks
B. Large focal spot
C. Low sensitive film screen combination
D. Xeroradiography
E. High energy X-ray spectra
6. Mammography:
A. The skin is thickest over the upper outer quadrant
B. The arteries are best seen in the upper inner quadrant
C. The veins are best visualized in the upper outer quadrant
D. The ducts are best seen in the upper outer quadrant
E. Intramrnary nodes are seen in the upper outer quadrant
7. The following structures should be vi�ualized in rnediolateral

view of mammography:
A. The pectoralis major should be visualized atleast to the nipple
level
B. The skin should be clearly visualized
C. Inframarnmary fold should be visible
D. The nipple should be seen in profile
E. Focal skin thickening in the areolar region
8. The foll owing are Linear structures seen in breast:

A. Coopers ligaments
B. Ducts
C. Ductules
D. Arteries
E. Veins
9. Mammography:
A. The craniocaudal view shmvs more breast tissue than the
mediolateral view
B. The craniocaudal view has a better q u ali t y than the
mediolateral view
C. The mediolateral view is the commonest view that is used ir.
mammography
D. Tr ue lateral view shows more pectoral muscle than the
mediolateral oplique view
E. The pectoral muscle is not visualized in the cra:--,:·�caudal view
10. Types of mammographic patterns of breast tissc

A. DY- highest risk of malignancy
B. P2-ductal and fibroglandular pat"�rn more thar..
C. Pl- ductal and fibroglandular ?�ttern less fr.
D. Nl-with l·::mph nodes
E. Male bre� ;t- prominent ducta� -�ruc:ares w:
Breast Imaging 191
11. ·-congenital anomalies:

A. In amazia, nipple is not visualized
B. In amastia, the nipple and breast tissue are not visualized
C. 3-6% have polythelia
D. 10% have asymmetrical breasts
E. The breast tissue is not affected in Polands syndrome
12. Breast ultrasound:

A. The skin is a three layered structure
B. The Coopers ligaments produce acoustic shadowing
C. The ducts are clearly visualized
D. Fat appears hypoechoic
E. The breast is uniformly bright due to the fibroglandular tissue
13. Mammography:
A. Microcalcification is diagnostic of malignanc
. y
B. Microcalcification is seen in cysadenocarcinoma phylloides
C. Microcalcification is seen in comedocarcir.oma
D. Microcalcification is not seen in fat necrosis
-* E. Ultrasound is as accurate as mammography in dense breasts
14. Mammography:
A. .tvficrocalcification is calcification less than 0.5 mm
B. Macrocalcification is never seen in carcinoma
C. Microcalcification is specific to carcinoma
D. Summation shadows are homogenous
' ,:;_ E. Spicula ted masses are carcinomas until proved by biopsy
·
15. Breast screening:

!'--"' A. Current recommendations are that the women betvveen 50-6-±
should be screened
B. Screening is performed every two years
C. 2 views should be taken of each breast in the p re v ale n t
screening period
D. Women with a family history of breast c::mcer are exclude1.::
from the screening program
E. Interval cancer is defined as a tumour that occurs between t.:-�e
prevalent and the incident screening round
16. Phylloides tumour.

A. 1v1ore common in a younger woman < 30 years
B. Spiculated in mammogn.phy
C. Bilateral in 10%
D. Colqur Doppler differentiates from cancer
E. Increased incidence in hormone reob·:emen � the:-?..:;y
. . ,
I
' ./ , t
..... /
· .
17. Breast c a ncer in males: �.I?
J
f
.... ,
tl.· • , \
A. 20% of all breast cancers

I
: '\·.� : 'r
B. More advanced than that of females

C. Macrocalcifications commoner than females
D. Arise near areola
E. Commoner in Klinefelter's syndrome
-1s. Breast anatomy:

A. The lower outer quadrant has the highest amount o f
fibroglandular tissue
B. The breast extends laterally upto the anterior axillary line
C. The axillary tail of Spence extends upto the posterior axillary
line
D. The lateral aspect of breast lies over the serratus anterior and
external oblique
E. The breast completely lies in the superficial fascia only
19.- The following patterns of calcification are definitely benign:

A. Egg shell calcification
B. Floating calcification
C. Macrocalcification of one size
D. Pop corn calcification
E. Calcification > 2 mm, single
20. Ma mmogra phy:

A. The breast is denser after radiotherapy
B. Isolated subareolar duct dilatation is highly suspicious o f
malignancy
C. Macrocalcification alone may be a sign of malignancy
D. Mammographic lesions less than 5 mm are not visualised
satisfactorily in ultrasound
E. Mass i n a female less than 20 years should be evaluated by
ultrasound only
21. The following fea tures in screening mammography indicate:

A. Pleornorphic .:alcifications-invasive :ancer
B. Amorphous -.Icifications- DCIS
C. Spiculated :-. ss without calcificat .- invasive cancer
D. Linear and nching calcification :- CIS
D. Linear and mching calcificatior ·de 3 invasive cancer
22. Breast:
A. Screenin - 1.mography reduce� ·lity by 50%
B. Density Jreast is the most i 1t factor determinL.1.g
detectic �ast lesions
C. Pick up -�ammography is 5 '"eS
.:> On l.C..-et
J..L .J i;;-.,.en�;....
- \...l. ... ..
._
., 0
"T
-... �
D. Benefi: e age range 40-6: .ar

E. A cran. : and lateral vievv
r .�::wrt
Breast Imaging 193
23. Mammography:
A. The biopsy rate is 5%
B. Incidence of Carcinoma in screening is 6-7 /1000
C. The recall rate is 5-6%
D. The minimal acceptable attendance is 60%
E. 20% of screening examinations need some form of follow up
in the first year
24. Groups of breast microcakification seen in:

A. Fibroadenoma
B. Fat necrosis
C. Radiotherapy
D. Ductal carcinoma
E. Sclerosing adenitis
25. Ductal carcinoma:

A. Constitutes 60% of all breast carcinoma
B. Associated with invasive lobular carcinoma
C. Mammographic appearance is larger than clinical size
D. Well defined margin and absence of acoustic shadowing
indicates well differentiated mass
E. Arises from the large ducts epithelium
26. Infiltrating lobular carcinoma:

A. Bilateral in 35%
B. A central tumour nidus with radiating bands is see:i.
C. The least common of all histological types of breast cancer
D. Commonly presents as asymmetrical increased density
E. Ultrasound shows echogenic corolla
27. Medullary carcinoma:

A. More common over 50 years
B. Mimicks cyst in ultrasound
C. Well defined margin is characteristically seen tr. m::mr:i.o
graphy
D. Acoustic shadowing is seen in ultrasound
E. Diffusely inflltrating
28. Breast carcinoma:

A. Mucinous carciroma has the worst prognosis of breast :1ncers
B. The imaging fe tures of mucinous and medullary c?.r-:::nomJ.

are same
C. No posterior e� .1ancement is seen in mucinou.3 .::uc:::--..:;ma
D. Tubular carcir ·na is c:ssociated i:.vith r:i..dia! s-:a:
E. Tubular carcir. :i.a has the best pr:=-g:tos�s
29. Gynaecomastia is caused by:

A. Cimetidine B. Methyldopa
C. Lung cancer D. Cirr hosis
E. Renal tumour
30. Breast lesions:

A. Cysts and fibroadenomas can be differentiated by
mammography
B. Cirrhosis carcinoma causes acoustic shadowing on ultrasound
C. Metastases are discrete lesions in mammography
D. Ultrasound is unreliable in adolescent breasts
E. Deodorants produce dense opacities in the axilla
31. Mammographic features of neoplasm:

A. Mass appearing larger than it feels
B. Radiating spicules
C. Lucent halo
D. Localised increase in density
E. Punctate calcification
32. Tumour with well defined margins m ultrasound:

A. Im·asive ductal carcinoma
B. Tubular carcinoma
C. Papillary carcinoma
D. Med ullary carcinoma
E. Mucinous carcinoma
33. B reast cancers:

A. Papillary cancers are seen predominantly in the thirties and
forties
B. Cystic with solid projection is seen in papillary tumours
C. Papillary tumours have grave prognosis
D. D iabetics have changes in breast mimicking malignant lesion
E. Papillary cancers present with nipple bleedLng
34. Ductal ectasia:

A. Commonly associated with retroareolar mass
B. Increased risk of malignancy
C. Commonly causes a retracted nipple
D. Causes ring calcification
E. Produces skin thickening
35. Differential diagnosis of unilateral breast e _
A. Unilateral breast feeding

B. Cardiac failure
C. HRT
.D. \formal variant
E. �ibroadenoma
Breast Imaging 195
36. Fibroadenomas:
A. Contains microcalcification on mammography
B. Enlarges in pregnancy
C. Involutes after menopause
D. Ill defined posterior wall is seen in mammography
E. Seen typically in women more than 40 years of age
37. Causes of calcification in mammography:

A. Intramammary lymph nodes
B. Radial scar
C. Fat necrosis
D. Galactocele
E. Cyst
38. Causes of ossification in breast:

A. Fibroadenoma B. Phyllodes tumour
C. Fibrosarcoma D. Amyloid
E. Fat necrosis
39. Unilateral breast lymphadema:

A. If associated with a > 5 cm patch of calcification indicates
carcinoma with spread
B. Can be a feature of primary lymphede ma of the body
C. Is a feature of i'v1ilroys disease
D. Is knovv"Il to be associated with inflammatory carcinoma of the
breast
E. Seen in portal hyperte nsion
40. Edematous breast is seen in mammography m:
A. Radiotherapy B. Abscess
C. Mastitis carcinomatosa 0. Gynaecomastia
E. Wide local excision
41. Mammography:
A. Thicke n ed skin is seen in fat necrosis
B. Enlarged axillary nodes may be seen in rheunutoid arth.:itis
C. Pagets disease of the nipple causes microcalciticatior.
D. Tea cup calcification is malignant
E. Pagets disease begins in the humerus
42. 50 years old woman, normal mammogram, tissue diagnosis is

required after the following:
A. Well defined anechoic area with acoustic e:i..h.:1:-:ce=te:i..t
B. Poorly defined mass with acous�ic shadow�r.5
C. \Ven defined lump with homogen01.:.; interna� '::cl- :es
..
D. Du:tal dilatation
E. Ge: .eralised heterc � e nou s echoes
43. Mammographic appearances not requiring biopsy for diagnosis:

A. Large areas of amorphous calcification
B. Irregular branching calcification
C. Shell calcification
D. Scattered cresenteric calcification
E. Smooth linear calcification
Abnormal bone scan uptake in breast

A. Fibroa9enoma B. Carcinoma
C. Prosthesis D. Tuberculosis
E. Lymphoma
45. Breast ultrasound:

A. 3.5 Mhz probe is used
B. Carcinoma produces distal attenuation
C. Impalpable lesions can be localized for biopsy
D. Microcalcification is demonstrated as good as mammography
E. Is the recommended method for screening
46. Indications of biopsy of solid masses:

A. Highly suggestive of malignancy
B. Suspicious masses
C. Probably benign mass
D. 1v1ultiple masses
E. Definitely benign mass
47. Ultrasound features of fibroadenoma:

A. Long axis parallel to the skin
B. Isoechoic with fat
C. Acoustic enhancement
D. Heterogenous, lobulated
E. Oval
48. MR of breast
A. Can diagnose carcinoma in situ
B. Used to differentiate between scar anc carcir10ma recurrence
C. Can be performed without a dedicatf: breast coil
D. Sensitive to demonstrate chest wall e :ens10n
E. Fibroadenoma shows enhance:nent w: - Gadolinium contrast
49. MRI of breast

A. Sagittal scans reduce motion utefact
B. Delaved contrast enhanced sc:.'5 can
,
c :::tiate -�,from
malignant lesions with high �nsitiv�
c. Marr.mography is more ser. :ive tc .:.tL �'
· -
recu ·�ence
D. 1v1Rl _s more sensitive than . T to c ·o
Breast Imaging 197
50. Marnmographic appearances not requiring biopsy for diagnosis:

A. Shell calcification
B. Scattered cresenteric calcification
C. Smooth linear calcification
D. Irregular branching calcification
E. Large areas of amorphous calcification
51. MR of breast is 90-95% sensitive to detect

A. Lymph node metastasis
B. Chest wall recurrence
C. Recurrence after conservative surgery
D. Post menopausal primary carcinoma
E. Leaking silicone implants
52. Calcifi cation in mammography:

A. Microcalcification is diagnosed if less than lrnm
B. Egg shell calcification is seen in fibroadenomas
C. Tramline calcification is an indication for b iopsy
D. Floating calcification can b e ignored, as they are benign
E. Varying shape of calcification indicates malignancy
53. Breast implants:

A. Always placed behind glandular tissue
B. Resurgery is required in less than 1 % o f cases
C. Both the s ilicone and saline implants are opaque m
mammogram
D. The folds of the im pl an t are better seen in silicone implan:s
E. The breast tissue is completely obscured in silicone irr.?lar.ts
54. Silicone implants:

A. Calcification is more common in subglandular im plants
B. There is no use in scanning a breast with implant, since the
normal tissues are completely obscured
C. Fluid around the implant can occur only in ru?ture
D. Implant becomes rounder �Nith more enca?stila ti on
E. Silicone within folds is indicative of intrac;:tpsutar r upt�re
55. MRI of Breast:

A. Cardiac artifact follows frequency encoding gradient
B. Motion artifact can be corrected by post processing algc:ifr.2
C. Flow compensation can reliably redLlce cardiac artii3c:s
D. 2D sequences are less sensitive than 3D �eque:-:.ces
E. For elimination of high signal fat, fat su?p:essior. is s�?e�:c:
to the subtraction technique
56. MRI of Breast:

A. Contrast dose of> 0.1 mmol/ kg can be used in 2D sequences
B. Contrast injection is followed by 20 ml of saline
C. Contrast MRI should be performed between days 6- 16 of
menstrual cycle
D. Enhanced MRI is ideal for women < 35 years
E. Postmenopausal patients usually show enhancement of normal
breast tissue
F. Areolar enhancement indicates abnormality
57. MRI of breast:

A. Quantitative Image Analysis is useful for tissue characterization
B. Carcinomas do not shm...' characteristic signal characteristics
C. Contrast enhancement reliably differenti ates benign and
malignant lesions
D. Contrast enhancement is used to assess breasts with scarring
within 6 months of surgery and radiation
E. Absence of enhancement excludes malignancy with probability
of> 98%
58. Characteristics of malignant enhancement m MRI breast:

A. Irregular contour of enhancing lesin
B. Enhancement starting from periphery
C. Slow rise of enhancement
D. Early wash out
E. Follows ducts
59. The following management options are true:

A. MR +ve lesion, mammography -ve Follow up
B. MR +ve, but low probability, biopsy is always performed
C. MR guided core biopsy is indicated if lesion is seen only by
enhancement
D. MR +ve, low probability, clinically suspicious - biopsy do!1e
E. MR is ideal for detection of malignancy with scac-ed tissued
and cystic changes in scarred breast
60. Indications for breast MRI:

A. Implants
B. Dense breasts
C. Negative mammogram with good clinical history
D. Post surgical scarring
E. Recurrence
Breast Imaging 199
61. Implant rupture:

A. MRI is required for confirming diagnosis of saline implant
rupture
B. Ruptured saline is toxic to breast tissue
C. Intracapsular silicone rupture is best seen in mamm ograph y
D. 40% of ruptures are asymptomatic
E. Implant can rupture during mammography
62. Signs of extracapsular implant rupture:

A. Hypoechoic masses are seen outside the implant in ultrasound
B. The appearance of siliconomas is radicall y different from
malignancies
C. Silicone can b e deposited along the Astley Cooper ligaments
D. Silicone can migrate to the brachia! plexus producing
neuropathy
E. Implant shows snowstorm appearance in ultrasound
63. Silicone implant rupture:

A. Free silicone is seen as high signal in T2 with water suppression
B. Linguine sign is seen i.I1 extracapsular rupture
C. Step ladder sign is seen in intracapsular rupture
D: Noose sign is collection of silicone within the folds and seen
in intracapsular rupture
E. Silicone collects on the surface of the shell in extracapsular
rupture
64. Hormone replacement therapy:

A. Longer the usage, hi gher the risk of cancer
B. Breast cancers are of higher grade than in those without
hormone replacement
C. Most of the tumours do not have nodes
D. Density changes are more common in Estrogen alone HRT than
combination
E. The sensitivity of diagnosis in mammogram is decreased
65. Galactography:
A. Can be done only if there is visible ductal disch ar ge
B. Sialography needle is used for cannulation
C. Conventional X r a ys are taken and mammogra?hY i s not
-
needed
D. 5 cc is the usual amount of contrast introduced
E. Pain is normal d uring foe ?rccedure
66. Breast:
A. The commonest cause of granulomatous mastitis is tuberculosis
B. The most common sequelae of trauma to breast is fat necrosis
C. Post traumatic haematomas take six weeks to resolve
D. Mammography is not indicated if clinical history of trauma and
a lump
E. Star like markings are produced by static electricity artifacts
67. Hormone replacement therapy:

A. Causes proliferation of glandular elements
B. Increased risk of intraductal carcinoma in sit u
C. Increased density of breast depends on the duration o f
therapy
D. Asymmetrical increase in density is suspicious f or
superimposed carcinoma
E. Ultrasound is hyperechoic
68. Breast and pregnancy:

A. FNA is the most specific diagnostic procedure in pregnancy
B. Pregnancy increases the risk of developing breast cancer
C. Increased fatty deposition in pregn�ncy
D. The breast is more dense than normal in pregnancy
E. Ultrasound echogenicity is increased
69. Breas t cancer in pregnancy:

A. Pregnancy associated breast cancer is more aggressive than
normal breast cancers
B. Mammography is false positive in 35%
C. Contrast enhanced MRI is the most specific modality for
diagnosis
D. Increased incidence of inflammatory breast cancers
E. Tumours present with earlier stage than in nonpregnancy
cancers
70. Stereotactic breast biopsy:

A. Stereotactic images are taken 90 degrees ea·:hside o f
perpendicular t o film plane
B. The system directs needle entry into the Z (depth :0ordinate
and the X and Y coordinates have to be calcula: · - . ·:-i.e
parallax shift
C. The biopsy sample has to be X-rayed to confirr:
calcification
D. MRI is not useful for biopsying lesions
E. Easy technicall�· in thin breasts
Breast Imaging 201
71. Breast lesions common in pregnancy:

A. Papilloma B. Galactocele
C. Fat necrosis D. Fibrocystic disease
E. Cancer
72. The following distribution of calcification suggest benign nature:

A. Segmental B. Regional
C. Diffuse D. Linear
E. Clustered
73. DCIS:
A. Constitutes 40% of all breast cancers in mammography
B. 80% of lesions present with mass and calcifications.
C. Mutifocal lesions are those which are seen in multiple
quadrants
D. All the DCIS convert into cancer within a few months
E. Mammograph y is good for accurately predicting the size of
lesion in the low grade than the high grade types
74. Mammography:
A. A tubular density can be a presentation of ductal carcinoma
in situ
B. Presence of f a t w ithin axillary lymph node excludes
malignancy
C. The skin is thickened if it is more than 2rnm
D. Enhancement of mass and adjacent pectoralis muscle ir,dicates
invasion
E. Staphylococcus infection produces more diffuse infection than
streptococcus
75. MRI of Breast:

A. The signal intensities in breast correlate well with the t-..1.mour
B. Is the second most sensitive imaging modality of breast c1pture
after ultrasound
C. Enhancement of tumour is almost the same as that of :i.ormal
glandular tissue
D. Scirrho us carcinoma shows low signal on T2
E. 1vledullary carcinoma shows high signal on T2
76. MRI ci Breast

A. Si: �:2
J
breast coils are ideal
B. C - _;-:�l slice thickness is 5 mm
C. I: ;=_:�.g time after cor.t:-ast enhancement shou:d not e·<ceec:
D. - .;osition is the iC.eal one

E • a,.�; "act.. i'ncrea·-"'
.l'- .t
.. -'':..� af�0,..
- ··e of (;"'
t..._.:. the u�
.; ,; : �;
_;.....,ul 4'.. .. -.
. .. ...
. . �
...... �
77. Accessory breast:

A. Commoner on the right side than left side
B. Does not have a separate nipple
C. Mammary line extends from the axilla to the medial aspect of
the knee joint
D. Accessory nipples are never found above the level of normal
breast and can be seen anywhere along the breast line
E. Carcinoma can occur in the vulval breast tissue
78. Breast cyst:

A. Arises due to blocked distal duct
B. Commonest mass in breast
C. T he cyst has its maximum size in follicular phase of menstrual
cvcle
D. If more than 3 cm, requires complete aspiration
E. L'sually causes architectural distortion
79� Breast:
A. Diabetes produces dense fibrous tissue in breasts
B. Diabetic fibrosis produce posterior acoustic shadowing
C. Cigar shaped calcification is made of calcium phosphate
D. Plasma cell mas ti tis produces secretory calcification
E. Secretory calcification radiates from the retroareolar region
80. Ductal ectasia:

A. Ductal ectasia is not seen in ultrasound
B. Duct ectasia associated with phenothiazine
C. Smoking and ductal ectasia are associated
D. Calcification seen around ducts
E. Dilated duct clinically palpable
81. Fat necrosis:

A. Seat belt injury is a common cause
B. Radiotherapy causes fat necrosis
C. Commonest in deeper areas of breast near the pectoralis major
D. Calcifications are pleomorphic and dystrophic
E. Ultrasound can show a complex mass
82. Fibroadenomas:
A. Prominent vascularity in colour Doppler is see.I1 in malignant
lesions and is a reliable method of differentiating from benign
lesions
B. Fibroadenomas do not shJw enhancement " ch--cont::-ast :n
MRI
C. Intracanalicu'.ar fibroade:ornas have wor.:
pericanalicuL :- ones
D. Multiple in � �% of cases
E. Produces thE :harac:eristic -;reast v:: ·:hi.r :"L'·::
.
__
M •
Breast Imaging 203
83. Differential diagnosis of well defined and encapsulated fatty

lesions:
A. Hibernoma
B. Chondrolipoma
C. Galactocele
D. Oil cyst
E. Fibroadenoma
84. MRI Breast

A. Involvement of nipple by Pagets i s more common than
extension from underl ying tumour
B. Involvement of nipple changes management in breast
conserving surgery
C. Mammography is good for assessing nipple and retroareolar
abnormalities in pagets disease
D. The nipple enhancement is markedly increased if it is involved
by tumour
E. Breast MRI is better than mammography for accurately
predic ting nipple involvement
85. Galactocele:
A. Prolactinoma is a recognized cause of galactocele
B. It is not seen in male infant s
C. Associated with fat necrosis
D. Caused due to ductal dilatation
E. Fat fluid levels are seen
86. Breast:
A. Hyperplasia of the ducts is normal in pregnancy
B. Increased risk of malignancy in ductal hyperplasia
C. Usual ductal hyperplasia \vill not produce any marnmographic
findings
D. Ductal hyperplasia is associated with cellular a typia
E. Proliferation of cell layers to 3--± layers is consid�red se\·:::re

hyperplasia
87. Breast:
A. Papillomatosis occurs in terminal ductal lobular units
B. Presence of cysts exclude papilllomai:osis
C. The imaging appearances of lactating ader,oma is sarn.e as
galactocele
D. "tvfajority of lactc::. :"ing adenomas do not reg ress afte: ?repar.cy
unli...1<.e galactoc . -;;
E. Milk of calciu�·- '.n a breast lesion is ai·,vays ccnign
88. Breast:
A. Increased flow is seen within the veins in Mondors disease
B. In milk of calcium, the calcification is seen within ducts
C. Exercise is a predisposing factor for Mondors disease
D. Oil cyst is a sequelae of fat necrosis
E. Oil cysts are premalignant
-· 89. Skin calcification:

A. Presence of lucency excludes skin calcification
B. Due to calcification in sebaceous glands
C. Tatoos produce dense calcification
D. Talc produces calcification in the sweat glands
E. Radiotherapy can produce subcutaneous calcification
90. Breast Papilloma:

A. Papillomas and papillomatosis have the same age distribution
B. Ductal papilloma is a premalignant lesion
C. Intracystic papilloma is seen \Vithin a simple breast cyst
D. Papillomas are seen in peripheral ducts
E. Can undergo spontaneous infarction
91. Breast:
A. Breast arterial calcification indicates hypertension
B. Tnere is no increased incidence of breast arterial calcification
in diabetics
C. Arterial calcification in diabetics indicates increased risk of
cardiovascular morbidity:
D. 99% of nipple discharges are benign
E. Increased risk of breast cancer on both sides, with diagnosis
of atypical ductal hyperplasia
92. Radial scar:

A. Central lucency seen within a spiculated lesion
B. Associated with tubular carcinoma
C. M a mmographically detected radial scars have �igher
ass o ciation with malignancy and larger compared ·Nith
surgically detected radial scars
D. Calcification is seen in one third
E. The appearance varies with the projection
93. Breast cancer:

A. The annual rate of recurrence is 2%
B. 90% of recurrences are invasive duct.· :nas
C. The prognosis i.s worse, if the recu:::-e: ·--:>rv
'-
.I
'1a�e
..
-r'+or
� '-\..-
the first c agn )Si:�

·
D. MRI will ·.ov · .:',i'_ · Jar enhanceme · : ..':!1ce is ':'CIS

E. Post ope: .ve . .:itoma is see::1 :· � if .Ci:-i ... :: ..
is used
Breast Imaging 205
95. Breast:
A. Post operative edema lasts for 3 years
B. MRI enhancement after surgery is abnormal and indicates
recurrence
C. Skin edema more than 4 mm post operative cannot be
secondary to radiation alone
D. The severity of breast edema after radiation depends on the
dose of radiation
E. Post operative edema and mastitis carcinomatosa cannot be
differentiated by mammography
96. Post breast cancer:

A. One third of patients develop calcifications after radiation
B. Post surgical mammogram screening should be started at one
year
C. Fat necrosis is a recognized complication after treatment for
breast cancer
D. Seromas have lower echogenicity than haematomas in post
operative ultrasounds
E. Peripheral enhancement in �1RI is a feature of haematoma
97. The following are causes of intramamrn ary lymphadenopathy:

A. Lymphoma
B. 1v1etastasis
C. Mondors disease
D. Histiocytosis X
E. Neurofibromatosis
98. 1'11ale breast cancer:

A. Family history is seen in on 30°:0
B. Increased risk in Klinefelters svndrorne
C. High risk in undescended testis
D. Estrogen receptor positive in S3°'o of cases
E. Ductal carcinoma in situ is the commonest pa tho l o gical ty?e
99. Breast:
A. Interval cancers have higher stage than routine screening
cancers
B. Cancers missed from previous screening have bet:er prognos�s
than true interv1l cancers
C. Mammography :an dLagnose SO�� of recurrent · · � .:i. s t cance:-s
D. Mamrnographv
u ,
s mo::-2 likelv
,
t.J detect i:--· -�' . . 1rren-::e s
than non inva'.:. ·e rec ..:.rrences

E. The commone:· .::ausc: of breas: .::ancer t- .us is .J.
new C ancer a.,..� ·'o '-

�a r.,.. �a
"' u41·r··,;:
::... ... .:>ni
- .. c ;.i,;i-
ct."'.
100. High incidence of breast cancer recurrence is seen in:

A. Estrogen receptor positive
B. Comedo carcinoma
C. Age > 40 years
D. More intraductal component
E. Negative margins
101. Common Ultrasound features of typical breast carcinoma:

A. Sharp margins
B. Hypoechoic
C. The lt •ng axis is perpendicular to the skin
D. HypoL:choic rim of tissue
E. Echogenicity same as adjacent fibrogland ular tissue, but less
than fat
102. The fo llow i ng are indications for aspirating a breast cyst:

A. Confirmation of diagnosis
B. Not fulfilling criteria for simple cyst
C. Infected cvst
,
D. Symptomatic but non palpable cysts

E. Palpable cyst, for documenting e\·acuation of cyst
03. Lesions producing spiculated mass in mammography:

A. Fat necrosis
B. Sclerosing adenosis
C. Fibroadenoma
D. Abscess
E. Hamartoma
Breast Imaging 207
ANSWERS
1. A-T, B-T, C-F, D-T, E-F

The mammary ridge is developed in mesenchyme, in the thoracic
region of the milk line, between 5-7 weeks of intrauterine life. This
is penetrated b y epithelial cords, which give rise to 15-20
outbuddings. These canalize at term to form brea s t lobes. The
ducts open on surface, which undergoes mesenchymal proliferation
to form the nipple
2. A-T, B-F, C-F, D-T, E-T

There are 15-20 Iactiferous ducts, lined by columnar cells and a
terminal dilation is seen prior to opening into nipple. The ductules
are lined by cuboidal cells and myoepithelial cells. The terminal
duct lobular unit is the basic functional unit of breasts. This is made
of a lobule, which consists of a group of acini supplied by a single
terminal duct.
3. A-T, B T, C-F, D-F, E-T

-
Montgomery tubercles secretion pr ote cts the n ip p l e s during

suckling. Ch anges at puberty are due to pi tui tary, ovarian and
a dren a l h or m o nes . D u ring proliferative phase a n d during
pregnancy, there is marked epithelial prolife r ation .
4. A-T, B-T, C-T, D-F, E-T

Arterial supply of breast is by internal thoracic A, l a teral thoracic
A, intercos tal A and thoracoacromial A. Venous drainage is
thr o ugh internal thoracic, axillary, subclavian and azygous vei2'"'.s.
Lymphati c drainage is to axillary nodes, internal thoracic and
i nterc o sta l nodes. Opposite breast is frequently involved. Levei
I nodes are inferol ateraL II behind and III s u p r o m edi a l �o
pectoralis minor.
5. A-T, B-F, C-F, D-F, E-F

Low energy spectra is essential for good contrJst resolution.
Molybdenum i.vith two peaks at 17.-± and 19.6 Kev is ideal. Sr.i.Jll
focal spot and sensitive film screen combination are ideal.
6. A-T, B-F, C-F, D-T, E-T

The skin thickness varies and it is thinnest med ially and thickest
upper outer quadrant.
Arteries, ducts and intramammary ly m ph nodes are seen in tl-:::
upper outer quadrant.
The veins a ::-2 seen v\'herever thev
/
are suoerL::ial.
4
7. A-T, B-F, C ·T, D-T, E-T

The skin r' .:d not be clear!•,- demonst:-at�,.:
,
. :. A.reola ts see:". a:=
thickened -:; :n.

8. A-T, B-T, C-F, D-T, E-T
9. A-F, B-T, C-T, D-F, E-T

The craniocaudal view shows less tissue than the mediolateral view,
1 but has a higher quality due to better compression.Tht:_pectora�s
,. i muscle is":!:lot_. seen in the true lateral or craniocaudal views.
10. A-T, B-F, C-T, D-F, E-F

Wolfes classification of female breast
Nl- normal with fat tissue
Pl- ducta I and fibroglandular pattern less than 14 of breast
P2- more than % of breast
DY-diffuse fibroglandular pattern without ductal appearance.
Male breast- has some fat, but no visible ductal system.
11. A-F, B-T, C-T, D-F, E-F

In amazia, the nipple is present, but breast tissue is absent. In
amastia, both are absent.
3% have asymmetrical breasts. Hypoplastic breasts are seen in
Polands syndrome.
12. A-T B-T C-T D-T E-F

I I I 1
The skin shows two hyperechoic layers with a hypoechoic layer

in between.
The fat is hypoechoic. The fibroglandular tissue and fat lobules
in breast gi\·e an inhomogenous apperance. The ducts are dearly
visualised in the retroareolar region.
The Coopers ligaments and fibroglandular tissue may produce
acoustic shadowing
13. A-F, B-F, C-T, D-F, E-T

Microcalfication is seen in 30-40% of malignancies.
14. A-T, B-F, C-F, D-F, E-T

Calcification less than 0.5
-· ·
mm is termed microcalfication and more
than that is macrocalcification . Microcalcification is seen in 30-±0%
of malignancies and is not specific for malignancy. Macrocalci
fication is sometime seen in malignancies. Summation shadows are
usuallyinhomogenous, gradual tapering at margin, two dimen
sional, no spiculation and not associated with clinical rr.Jss.
15. A-T, B-F, C-T, D-F, E-T

Screening done every
-
three years, start earlier in those wi
· ··--
. :m'.y
history.
16. A-F, B-F, C-F, D-F, E-F

Seen in 40-50 year group-They ar: usually benign, b· :'e
borderline malignart-Usually hc.. ·e well-defined rr .:1
mammog7aphy.
Breast Imaging 209
17. A-T, B-T, C-F, D-T, E-T

Breast cancer in males spreads fast and infiltrates chest wall early
than in femles.
18. A-F, B-F, C-T, D-T,E-T

The upper outer quadrant has the maximum glandular tissue. The
breast extends laterally upto the mid axillary line. The axillary tail
extends upto the posterior axillary line.
The medial aspect of breast lies over the pectoralis major and the
lateral part lies over serratus anterior and external oblique.
19. A-T, B-T, C-F, D-T, E-T

Definitely benign calcifications are A. Egg shell calcification-cysts,
B-floating calcification-milk of calcium cysts. C- Pop corn
fibroadenorna D- > 2mm, iridividual- Involuting fibroadenoma, E
arterial, F-ductal- linear, rod like, with lucent center, G- smooth,
widely separated with lucent center
20. A-T, B-F, C-F, D-T, E-T

Isolated subareolar duct dilatation indicates ductal ectasia.
21
(;/ -;·
• A-F B-T C-T D-T E-T
I f I I
Plernorphic or amorphous calcif ica t i on s alone- indicate DCIS.

Spiculated mass \vithout calcification indicates invasi\·e ductal
cancer. Linear and branching calcification can indicate either DCIS
or grade 3 invasive cancer.
22. A-F, B-T, C-T, D-F, E-F
23. A-F, B-T, C-T, D-F, E-F

According to Forrest report, the incidence of carcinoma is -6.S/
1000. The reduction in mortality is 25%. The minimal acceptable
rate of attendance is 70%i. The biopsy rate is 1.5% and the refer::-al
rate is 3-5%. Forrest report recommended one view only but r.•:o
views are routinely done. Screening done from 50 ye.:irs e\·2:y
three years. Recall r a t e- aroun d 5-3%-for f u rth e r assessme�t.
Attendence rate- 75%. Benignbiopsies are expected tn be <3.6/lCCO
and malignant detection>3.6/1000 Standardised detection r2:io
> 1.0 mortility reduction is more i n the 50-65 group th an .;,:'-�9
age group. Reduction in mortality expected to be 250/0.
24. A-F, B-T C-F, D-T, E-T
25. A-F, B-T, C-F, D-F, E-F

It constitutes 80% of all breast cance�s. It arises from the epit:- -<:'..L."":1
of mediUI':l. and small sized duc:s. It can be assoc:...:ted 1,v::h >- · :.3:·:e
tubular a:·d lobular c�r:.:inomas. T}1e clinical size is 12.::;2: ··.:: �o
desmoplc- :ic reaction. ·_-3ually ��•.e t'...l:nour has ii� defined :--;. ..:. :- :; .: .; ..
heterogenous with acoustic shadov..ring. Occasionally it may be

well defined, with no shadowing, usually seen i n p o o r l y
differentiated tumours.
26. A-TI B-FI C-F I D-TI E-T

Infiltrating lobular carcinoma is the second commonest tumour,
upto 10%. It is known for being bilateral and multicentric in upto
35%. It grows in linear pattern into the surrounding breast tissue
without a central nidus. It can be seen as a speculated mass or
a vague area of asymmetrical increased density. Ultrasound will
show hypoechoic lesion, \'\'ith irregular borders, with occasional
echogenic corolla, acoustic shadowing.
27. A-F, B-T, C-T, D-F, E-F

This is seen in women, less than 50 years, constituting 5% of breast
cancers. It is a well circumscribed tumour in mammography. In
ultrasound, the tumour has well defined margin, hypoechoic with
posterior enhancement, all features of a cyst, often requiring cyst
aspiration or biopsy for confirmation. There might be internal
echoes. It is not diffusely infiltrative and has a good prognosis.
28. A-F, B-T, C-T, D-T, E-T

l\1ucinous (colloid) carcinoma is characterized by presence of mucin.
The imaging features are same as medullary carcinoma, well
defined, homogenous, hypoechoic, but there is no enhancement
because there is mucin, which gives low level echoes and it occurs
in older population. Tubular carcinoma has the best prognosis. The
imaging features are non specific. It can have speculated, irregular
margins. Tubular and mucinous carcinomas constitute 1-2% of
breast carcinomas.
29 • A-TI B-T1 C-TI D-TI E-F

Other drug-Estrogen, digitalis, Anti-neoplastic, spironolaction,
Antidepressants, Rerospine, phenothiogine
C.A-Bronchus tetatoma testis, Adrenal tumours, hypopiturtarium
and hypogonadism are other causes.
30. A-F, B-T, C-T, D-F, E-T
31. A-T, B-T, C-F, D-T, E-T
32. A-T, B-F, C-T, D-T, E-T

Invasive ductal carcinoma can occasional�· :-:ave well defined
margins. Papillary carcinoma, muci:tous anc ··11arir carcinn"T'::>c.
...i.. 4J
L.A. - .J • ,. ---
are usually well defined and can t � confus ',en1'

_, c
er""
\ .::i. � s
� l e-;('\"' . ·- .
Tubular carciI1omas have irregula:- :targms .tnd muc�r.c�.s

carcinomas constitute 1-2% of b. J.St ca� ::.. - - ......
prognosis.
Breast Imaging 211
33. A-F, B-T, C-F, D-T, E-T

Papillary cancers are seen in post menopausal females. It usually
has a good prognosis and presents with nipple bleeding. Diabetics
can have fibrosis that mimicks malignancy.
34. A-T, B-F, C-T, D-T, E-T

Mortality can be reduced by 50%, by high quality mammogram.
But 40% of carcinomas are detected only when they are more than
1.5 cm.
35. A -T, B-T, C-T, D-T, E-F

36. A-T, B-T, C-T, D-F, E-F
Fibroademas are seen in younger women. They rarely develop I
grow after menopause well-defined margins in mammography
ultrasound have large calcifications but can be micro-calcification.
37. A-T, B-T, C-T, D-T, E-T
38. A-T, B-T, C-T, D-T, E-F

Osteosarcoma, osteochondrosarcoma, malignant mesenchymoma,
pleomorphic adenoma and occasionally epithelial tumou:s are
other causes of ossification
39. A-F, B-T, C-T, D-T

Milroy's disease is congenital hereditary lymphedema.
40. A-T, B-T, C-T, D-F, E-T

Recent surgery, radiothenpy, 1 ym? ha tic obstruction, venous
obstruction, inflamma tory ca rcinoma and abscesses are the
common causes of breast edema \1lhich is seen in mammogn?hY
as skin thickening > 1.3 mm, diffuse increased density and
prominent Cooper ligaments.
41. A-T , B-T, C-T, D-F

Teacup calcification is seen in cysts, Pagets disease has no bony
involvement.
42. A-F, B-T, C-T, D-F, E-F

Biopsy required in unpected malignant lesions well-defined les�or.s
w ith enhancement is a cyst. Hetrogenon echoes is b enign
fibrocystic disease.
43. A-F, B-F, C-T, D-T, E-T
44. A-T, B-T, C-T, D-T, E-F

Any calcification will sho-.,... increased u?date.
·
45. A-F, B-T, C-T, D-F, E-F

High frequ ency probe is used-Impalpa': � be loc:.'.'.se·-�
lesions C<l:-\
by ultrasound guidence-\1icroc1cific -Jn are not ...�etecto::· .· ;.;.._�

hence, it is not good for screen�.:--,g
212 Genitourinary, Obstetrics & Gynaeco/9gy and Breast Radiology
46. A-T, B-T, C-T, D-T, E-F

Probably benign masses are sometimes biopsied to a l leviate
patfents anxiety and to confirm the diagnosis.
47. A-T, B-T, C-T, D-T, E-T

Fibroadenomas are usually well defined, hypoechoic to the fibrous
tissue but isoechoic to fat, with heterogenous elements, can be
lobulated, oval, long axis usually parallel to skin, usually acoustic
enhancement, but sometimes has acoustic shadowing due to
calcification.
48 • A-F B-T C-T D-T E-T

I I I I
Fibroadcnornas are well-defined; enhance on contrast non

enhancing septic seen.
49. A-T, B-F, C-F, D-T

MRI 11vith dynamic contrast differentiates scan and recurrence,
better than mammography
50. A-T, B-T, C-T, D-F, E-F
51. A-F, B-T, C-T, D-T, E-T
52. A-F, B-F, C-F, D-T, E-T

�-1icrocalcification is less than 0.5 mm. Egg shell calcification is seen
in cvsts and fat necrosis. Tramline calcification is seen in vascular
v,;alls. Floating calcification is seen in cystic diseases. Varying
shape indicates malignancy.
53. A-F, B-F, C-F, D-F, E-F

Implant can be p laced behind the glandular tissue or betv.reen
pectoralis major and minor. Resurgery is required in 20% of cases.
Silicone implants are opaque, saline implants are semiopaque.
Hence the breast tissue is more obscured in silicone than saline.
Folds are visualized in saline, but not in silicone implants.
54. A-T, B-F, C-F, D-T, E-T

Ultrasound is still useful for assessing a breast with implant in
place. Fluid around the implant does not necess:-:�:Iy indicate
rupture. A fibrous capsule around the implant is forr: � with time.
Most of the capsule becomes calcified, which is · :·. - ; the
surface of the implant.
55. A-F, B-T, C-F, D-T, E-F

Cardiac artifact follows phase encoding gradie.:
the left breast and both axillae. ¥\Then imaging i::
plane, the phase gradient can be oriented alor.
cardiac artifacts. Flow compensation/ presa t:.: :.
cardiac artifa.:::t but other signals are suppress::.

Breast Imaging 213
contrast enhanced 30 Gradient echo sequences give good spatial

and temporal contrast resolution and high signal to noise ratio.
Subtraction of pre and post contrast images is the most robust
method for eliminating fat signal, compared to selective fat
saturation and selective water excitation, as these may cause signal
inhomogeneities, resulting in underestimation.
56. A-F, B-T, C-T, D-F, E-F, F-F

In 20 sequences, contrast > 0.1 mmol/kg could not be used
because of saturation effects. But higher doss can be used in 30
sequences. 0.1 -D.2 mmol/ kg of body weight is the normal dose
and this is followed by 20 ml of saline push as the contrast volume
is low. Following contrast, normal breast tissue does not show
any enhancement. Exceptions are postmenopausal women on
hormonal replacement therapy, premenopausal women in 1st and
4th week of menstruation. Contrast enhanced MRI should not be
performed on women < 35 years unless strong indications exist,
as the focal/diffuse enhancement of normal tissue may obscure
lesion and mimic m alignant lesions. Areolar enhancement is
normal.
57. A-F, B-T, C-F, D-F, E-T

The quantitative ima ge analysis of lesion in Tl/T2 sequences are
non sp ecific. No characteristic signal changes are seen in MRI. 0.16
mmol/kg body weight of Gadolinium is administered and withi..'1
2-3 mins, coronal, 30 FLASH sequences are obtained. Arl
enhancement more than 50% above the base is considered
significant . If there is no enhancement, it can be safely assumed
that there is no m align ancy greater than the slice thick eness.
10-15% of carcinomas enh ance. Breast MR is indicated in presence
of sc arring (>6 months after sugery or > 12 months after surgery
and radiation combined, > 6 months after silicone implant). It is
also used in assessment of dense breast.
58. A-T, B-T, C-F, D-T, E-T

"tvf align ant enhancement is characterized by ir:egu b.r center of
enhancement, following ducts, starting from periphery, fast rise
of enhancement and early washout. Well circumscribed center of
enhancement, septation within a loculated mass and diffuse m ilk y I
patchy enhancerr.ent, and slow rise indicate ben ign pathology.
59. A-F, B-F, C-T, I. -T, E T -
N1R +ve. Mamre -ve lesion in high probability cases ar� b�opsie•:
even if mamm .
.;:,
.
• neO •t: e F 0 r 1 e :::>
er a L ;LV •
:
- t 0 n s s e '::
. ...., 0-·'•J
.c .... c0 i•C
h . 1° .. n .. - ., ;,c
• -L
••
enhanc :i :N1RI, :">/CT 0�1ded wire tCCc:. .. Z...:.c.\.,r. .::- pc��.- . . e� ar...�
"
' cr1•' .· 1 -l; _...; . .., :. ,.. c J::>,...,.. . r.;
"tv1R g:J :ed cor 'iopsy I surgical e x c isio n is cor.�. IF \fR is +1:2
but low clinical probability, the patient is follm"'ed by mammo/

MR at 1 year.
60. A-T, B-T, C-T, D-T, E-T
61. A-F, B-F, C-F, D-F, E-T

Saline implant rupture can be seen in mammography and MRI is
not needed. Ruptured saline is eYentually absorbed into the body
and is not toxic. Intracapsular silicone rupture is not seen in
mammography. 6-10% of ruptures are asymptomatic and incidental
findi ngs.
62. A-T, B-F, C-T, D-T, E-T

Silicon escapes around the capsule in extracapsular rupture. It can
either organize and formed focal siliconomas or can migrate to
adjacent structures. The siliconornas are hypoechoic in ultrasound
and dense in mammogram, and are difficult to differentiate from
- malignancies. A biopsy may be required. Fibrosis may also be
caused.
63. A-T, B-F, C-T, D-T, E-F

Linguine sign is seen in int:-acapsular rupture. In this the fibrous
capsule is intact and there are cun·ilinear lines, due to collapsed
envelop floating in silicone. Step ladder sign is ultrasound appearance
of intracapsular rupture, with echogenic lines and collapsed en\'elope.
Collection of silicone on the surface of shell is called subcapsular
line sign and is also seen in intracapsular rupture.
64. A-T, B-F, C-T, D-F, E-F

Breast cancers are of low grade in those with hormone
replacement. Most of the tumours are in stage I and do not have
nodes. Density changes are common in combination therapy than
pure estrogen. The sensitivity of mammogram is not decreased
but the specificity may be decreased.
65. A-T, B-T, C-F, D-F, E-F

Galactography is indicated for single ductal discharge. A 30 G
needle is used for cannulation. Mammography is required. 0.5 cc
is the usual amount of contrast introduced. Pain is not normal
during procedure and indicates contrast extravasation.
66. A-F, B-F, C-T, D-T, E-T

Most of granuloma tous m as titis are non spec:·::: w! t!tout any
known infectious etiology and are probably a· · ···· ::---.:ne. Pos:
surgical haernatomas can last as !ong as a year. � 3. stron�
history of trauma and develOf''.'.1ent of lump z-: · �idence
mammography is not indic .::d and follo· ougr
Breast Imaging 215
Haematoma has appearances of malignancy and it can obscure

underlying lesion. Contusions are more diffuse and ill defined than
focal haematomas
67. A-T, B-F, C-F, D-F, E-T

Increased risk of breast cancer, but no increased risk of DCIS.
Increased density does not depend on the duration of therapy.
Although the increase in breast density is bilaterally symmetrical,
it can be asymmetrical and does not indicate cancers.
68. A-F, B-F, C-F, D-T, E-F

FNA is not specific. Normal breast is very cellular in pregnancy
and it is difficult to differentiate malignant and benign lesion.
Hence a core biopsy is better. Pregnacy reduces the risk of breast
cancer. Women who were never pregnant, have higher incidence
of breast cancer than those who have been preganant. During
pregnancy the fat content is decreased, and breast density is
increased making difficult to assess lesions. Ultrasound
echogenicity is decreased normally.
69. A-F, B-F, C-F, D-F, E-F

The pregnancy associated breast cancers is not more aggressive,
but it presents with a higher stage, with larger tumours more
lymph nodees and more metastasis. \.!arrunography is usually false
negative in upto 35% of cases a!1d this is due to denser breasts
during pregnancy. Tnere is no inc-eased incidence of inflammatory
cancers. The incidence of breast cancer is 1/3000-10000.
70. A-F, B-F, C-T, D-F, E-F

Stereotactic images are obtained at 15 degrees on each side of the
perpendicular film plane. System directs needle entry into the X
and Y plane and Z axis has to be calculated. 1v1RI and ultrasound
can be useful in biopsies. Retroareolar region, posterior lesion, very
superficial lesion and thin breasts are difficult to biopsy.
71. A-T B-T, C-F, D·T, E-T

,
Fibroadenoma, adenornas and lipomas are other causes.
72. A-F, B-T, C-T, D-T, E-F

Segmental pattern suggests ductal involvement. Linear pattern
indicates involvement of the ducts. Clustered pattern c3n occur
in benign artd malignant process.
73. A-T, B-F, C-F, D F , E-F

-
80% of lesior.s present with calcifications only. 0:-Jy 10.:i10 prese:--,t

only with mass. 1v1ultifocal lesions are multiple lesions i·� ::-:.e sam2
quadrant. Multicentric lesions are seen in m1...;.ltip;2 quad:-J.nts. :\o:

all the DCIS convert into cancers. Mammography is accurate in

assessing the size of high grade types than the low and
intermediate grade types.
74. A-T, B-F, C-T, D-T, E-F

Tubular density is due to single dilated duct. It can be a
presentation of ductal carcinoma in situ. Streptococcus causes more
diffuse involvement than Staphylococcus. Presence of fat in
intramammary node or axillary node is more common in benign
disease, but does not exclude malignancy.
75. A-F, B-F, C-F, D-T, E-T

Although MR plays a significant part in diagn osis of breast
carcinoma, the signal intensities and tissue parameters, which
depend on content of water modified by cells and fibers does not
correlate well with the biological nature of tumour. Fibrous lesions
like scirrhous carcinoma, and fibrous d ysplastic lesions mimic
_ scarring. Invasive ductal carcinoma, medullar carcinoma, fibrocystic
changes show high signal on T2 images. Gadolinium adminis
tration shows enhancement of tissues \·vhich is ah"·ays more than.
natural glandular tissue.
76. A.-F B-F C-T D-T E-T

.1. f I f I
Double breast coils are prefe::-red to single breast coils as they gi\·e
the same image quality as single breast coil and also allo\"'
examination of contralteral breast, for multicentric lesions. High
spatial resolution is necessary for e\·aluation and the ideal slice
thickness is less than 4 mm, optimally 1-2 mm. Selective contrast
enhancement of cancer decreases from 2-5 min after contrast.
Breast motion artifacts could be reduced by proper subtraction
techniques of pre and post contrast images. Vibration can be
reduced by tight T shirt/ cotton fitted coil/ compression devise.
Prone position is ideal since it reduces respiratory motion artifacts.
77. A-F, B-F, C-F, D-F, E-T

Commoner on the left side. Mammary line extends from the axilla
to the inguinal region. Accessory nipples can be found below or
above the normal breast. These tissues can increase d uri:n g

pregnancy and lactation and can develo p any disease that is see:-':.
in normal breast.
78. A-T, B-T, C-F, D-F, E-F

Cyst is maximal during the secretory phase. A t -' :.. .:..;.
,...l·... ?1.0
h.
.. c··, :: .
,L
does not require aspiration. It is well defined a �enous�::

hypoechoic in ultrasound. In 1v1RI, it is hypo · Tl a:--..::
hyperintense in T2. Mammography shov-.7s a we·

curvilinear calcification. Does not cause archi
Does not require complete aspiration.
Breast Imaging 217
79. A-T, B-T, C-T, D-T, E-T

Diabetes can produce dense fibrous tissue, which might be difficult
to differentiate from carcinoma. Secretory calcification is
calcification in dilated fluid filled ducts, which radiate from the
retroareolar region. It is seen also in mammary duct ectasia.
80. A-F, B-T, C-T, D-T, E-T

Dilated subareolar ducts can be seen in ultrasound. Calcification
can b e seen in and around ducts.
81. A-T, B-F, C-F, D-T, E-T

Fat necrosis is caused by injuries, whether traumatic or iatrogenic.
It is common in the superficial regions, especially in the subareolar
area. Calcifications are initially pleomorphic, but they evolve to
becom e coarse and dystrophic. Ultrasound can be anechoic,
hypoechoic or complex and heterogenous.
82. A-F, B-F, C-F, D-T, E-F

Prominent vascularity is usually seen in malignant lesions, but can
occasionally be seen in benign lesions also, and hence is not a
reliable method of differentiating the two. Intracanalicular and
pericanalicular fibroadenomas ha\·e the same prognosis. 20°� of
breast masses are fibroadenomas. Breast within breast appeaonce
is produced by fibroadenolipoma, but not in fibroadenomas A .
well defined fat mass inside breast is seen in such cases. The
adenomatous components of the fibroadenoma can e!!hance on
contrast administration.
83. A-T. B-T, C-T, D-T, E-T
84 "
A-FI B-TI C-FI D-TI E-T
Primary P agets disease of nipple is l ess common than nipple
involvement from underlying ductal carcinoma. Mammography
severely underestimates the nipple involvement. The nipple
symmetry and enhancement are different in nipple in\·olvme!lt. If
nipple is not involved, it can be retained i.n breast consetTing surg2::-ies.
85. A-T, B-F, C-T, D-T, E-T

This a n1ilk containing cyst, which is lined by epithe li um Typ�cally
.
seen in pregnancy and lactation and in hyperprolactinemia. It is

a well circumsc ribed mass in mammog:-aphy. Ultrasound shows
a hypoechoic lesion with internal echoes and pos te r io r acoustic
enhancement
86. A-T, B-T, C-F, D-T, E-F

Usual ductal hyper pl a sia is also called ductal in::-aep�::r.�::�1
neoplasia. It is diagnosed w hen there is proliferation :: =:':or .:.e
--
!".ormal two cell layer wi thout any cellu�.1r atyFla or .:7'...:!Ls�·
It is mild when there are only 3- 4 layers. Moderate when there

are more than 5 layers. Ductal distension and proliferative occlusion
is florid type. There is twice the risk of malignancy in proliferation.
Can be s e e n in mammography as microcalcifications or
asymmetrical density.
87. A-T, B-F, C-F, D-F, E-T

Papillomatosis are seen as multiple nodular masses in
mammography. Ultrasound shows a predominantly hypoechoic
mass with multiple cystic areas. Lactating adenomas are seen in
pregnant and lactating women a..11d the imaging appearances are
s a me as fibroadenomas. They are well defined homogenous
masses with acoustic enhancement. Often a biopsy is required for
confirmation. They usually regress spontaneously, unlike
galactoceles which require aspiration or surgery.
88. A-F, B-F, C-T, D-T, E-F

Mondors disease is superficial th.""Ombophlebitis. It is seen due to
exercise, trauma or surgery. Tram track calcification can be seen
in chronic cases. Doppler can sh0w the thrombosis and there is
no flow. Oil cysts are not premalignant. They are usually seen as
sequelae to fat necrosis. In milk of calcium, the calcification is seen
within rnicrocysts.
89. A-F, B-F, C-T, D-F, E-T

Skin calcification is in the sweat glands. They are 2 mm, dense,
polygonal, with lucent centers, more common in the medial side
of the breast. Tatoos can also produce dense opacification. Talc
produces high density calcification in the pores. Calcification can
also occur in the skin scar.
90. A-F, B-F, C-F, D-F, E-T

Papillomas are seen in large ducts and are usually seen above 50
years. It is not premalignant. Intracystic papilloma is seen within
a dilated duct. Papillomatosis are multiple and seen in peripheral
ducts. They are seen before 20 yfi1rs.
91. A-T, B-F, C-T, D-T, E-T

Breast arterial calcification indicates either diabetes or
hypertension. Atypical ductal hyperplasia, has some, but not all
features of i ntraductal carcinoma in situ. It can present with
microca:.:ification or mass. It requires surgical excision.
92. A-T, B-", C-T, D-T, E-T

The tyf al appearance of a radial scar is a s:- :ulateci · :n, with
no cent- : mass, but a lucency. High incidence f ass;'· :ubular
carcinc · �' lobular carcinoma in si�..i and du: � ca:- :n situ.
Breast Imaging 219
T h ey do not have a palpable mass. The manageme n t is

controversial, and is often excised, especially if there is atypical
ductal hyperplasia.
93. A-T, B-F, C-F, D-F, E-T

50% of recurrences could be invasive ductal carcinomas and 50%
could be DCIS. Prognosis is better if the recurrence occurs very
late. MRI shows nodular enhancement if the recurrence is invasive
and linear if it is DCIS. Haematoma is seen upto a year.
95. A-T, B-F, C-T, D-F, E-F

MRI enhancement in the breast and skin can be seen for long time
after surgery and may not indicate pathology. Skin edema more
than 4 mm is abnormal a n d other pos sibilities have to b e
considered including recurrence. The radiation dose does not have
a relationship with the severity of breast edema. Post operative
edema and mastitis carcinomatosa cannot be differentiated and it
may require biopsy.
96. A-T, B-F, C-T, D-T, E-T

Post surgical mammogram should be started at six months. Seromas
and haematomas have similar appearances in mammogram
Peripheral enhanc ement in �fRI, is a recogn i zed feature, due to
granulation tissue.
97. A-T, B-T, C-F, D-F, E-F

Lymphoi d hyperplas i a, sinus histiocytosis are other ca use s .
98. A-T, B-T, C-T, D-T, E-F

Invasive ductal carcinoma is the commonest type, seen in 85%
associated with BRCA 2 gene. There is association with positi ve
family history, orchidectomy, estrogen u se, diabetes, cirrhosis,
obesity.
99. A-T, B-T, C-T, D-F, E-F

Interval cancers are those v.:hich present in betr.,.veen the normal
breast screenings and they are usually oi a higher st;}ge and have
bad prognosis than screening detected cancers. Some of lhe cancers
that are detected in the interval period can be cancers which were
previously missed in the screening tests, but these ha·1e a better
prognosis. "tvfammography is more likely to de tect non invasive
cancers such as DCIS, which present ',vith microcalcifications. T:te
commonest cause of breast mass before t\•·o vears is recur:-e:ice
at surgical ma r gin and the commonest cause afte.:- two years v•·ill
be a ne i.• cancer mass i� :he remnant bre3.s�, awa v fror.. :hi;: su;:-·.·
·
,
�., :cal �
marg i n .
100. A-F, B-T, C-F, 0-T, E-F

Estrogen receptor negative, Age < 40 years, positive margins, DCIS
> 5 c m are other predisposing factors.
101. A-F, B-T, C-T, 0-F, E-F

A typical breast carcinoma has irregular margins, hypoechoic
compared to the adjacent fibroglandular tissue and fat, hypoechoic,
heterogenous, hyperechoic rim (tumour/ desmoplasia/ compressed
breast tissue), posterioc acoustic shadowing. The mass is usually
round.
102. A-T, B-T, C-T, D-T, E-T

Imaging guidance is required for cysts which are non palpable,
but symptomatic. Occasionally it is also required for palpable cysts,
just to document complete. evacuation of cyst and monitor accurate
placement of needle.
103. ·A-T, B-T, C-T, D-T, E-F

Carcinoma is the commonest cause. Scarring, fibrous rnastopathy,
hvalinised fibroadenoma are other causes.
J
1. Embryo:
A. The morula has 16 cells
B. The outer cell mass of morula forms the amnion
C. The inner cell of morula produces the yolk sac
D. Implantation is complete by 2 weeks after Uv1P
E. The chorionic cavity develops by 3 weeks
2. Structures seen in first trimester ultrasound:

A. Primary ossification center of clavicle
B. Primary ossification center of maxilla
C. Primary ossficaiton center of mandible
D. Limb bud
E. Stomach
3. BPD:
A. The thalamus should be positioned in midline to measure BPD
B. Accurate assessment can be made onlv after ossification of skull
,
has reached the top of llte head

C. The occipitofrontal diameter is 80-90% of biparietal diamete:-.
D. Distance from the outer ed g e of the vault away from the
transducer to the inner edge of the vault close to the tonsducer
is used.
E. The BPD/OFD ratio is lower in breech presentation
4. Ultrasound of fetal brain:

A. The lateral ventricles are filled by choroid plexus in t.b.e second
t rimester
B. Distance from midline to the lateral margin of the £rental hor�
of lateral ventricle is usually 12 mm.
C. The brain surface is smo•)th until 20 weeks
D. T he third ventricle is nc- =een in a nor:T\a� fet11s
E. Cerebellum is seen in 1S :eeks
5. High signal in vertebral canal ultrasound is seen in:

A. Spinal cord
B. Craniocervical junction
C. Conus medullaris
D. Leptomeninges
E. Central canal
- 6. Fetal ultrasound:
A. V shaped spinal laminar ossification centers is abnormal
B. The normal nose and lips are consistently imaged in ultrasound
C. The hcC1rt is more vertical in fetal life.
D. The right \·entricle is slightly larger than the left side.
E. The four chambered vie\'\' for screening is obtained just belmv
the diaphragm.
7. Fetal ultrasound:
A. The fetal stomach has a constant volume
B. The small bm.'\1el is hyperechoic in second trimester
C. Colonic peristalsis can be visualized from the third trimester.
D. l\1econium is seen from 16 weeks
E. The ductus venosus divides the fetal left lobe and caudate lobe
of liver
8. Embryo:
A. The chorionic membrane and placenta ha\·e the same origin
B. The decidua covering the implanting blastocyst is the deciduas
parietalis
C. The chorionic membrane is derived from chorionic leavae
D. The decidua lining the uterine cavity is the deciduas capsularis
E. Chorionic frondosum develops into the placenta
A. Umbilical vein has two branches in the abdomen.
B. Umbilical vein drains into the left portal vein
C. Liver and spleen have different echotextures
D. If bladder is not visualized, renal disease should be suspected.
E. The left suprarenal lies above the kidney
10. Fetal renal system:

A. The kidneys will be visualized only after 18 w<:>eks
B. The renal pelvis can measure upto 10 mm · ·- .-.\P dimensior,
C. The renal cap-;ule can be distinguished fr:- ·� 9 \\'eeks
D. Fetal lobulati._ '.1 is seen from 24 \'\.··�eks
E. Corticomedur ry differentiation is ::�en �::"'t t ·· ::-'. J trirne�:e:-
Obstetrics and Fetal Ultrasound 223

A. Bladder is visualized from 1-1 weeks
B. Umbilical part of portal vein is the m arker for abdominal
circumference
C. Penis can be identified early in second trimester
D. The upper ureter can be normally seen in a careful scan
E. Ossification of proximal humeral epiphysis is a good indication
of lung maturity

A. The ulna extends slightly below the level of radius
B. Capitate is the only carpal bone to be ossified at birth
C. Placenta is seen as a discrete structure from 12 weeks
D. The placental lobes have no physiological significance
E. The placenta can be seen from 6-8 weeks
13. Antiphospholipoid syndrome:

A. Hereditary
B. Recurrent abortions are characteristic
C. Treated with warfarin
D. Treated with heparin
E. Associated with rheumatoid arthritis
1-1. Ultrasound in early pregnancy:

A. Gestation sac is first seen in S weeks
B. Gestation sac occupies less than half of uterine ca1.·ity in te:t
weeks
C. Accurate biparietal measurement can be done at 13 i,,·eeks
D. Placenta can be identified at 10 weeks
E. Yolk sac is seen in 5 weeks
13. Pregnancy ultrasound:

A. Fundal endometrial thickening 1s the earliest sig:t of preg:iar.cy
B. The gestational sac grov1.:s at a rate of 0.3 r:Lm/ dJ'.; from =-
11 weeks.
C. Cardiac movement is not identified till 8 i,vceks
D. Gestational age can be accurately measured by L�.:ra.sound till
30 weeks
E. Asymmetrical gestational sac is abnormal in S -..vet:;;.s

A. The bowel loop u nd e rgoes a clockwise rotat:on of 270 ,_:!egrees
outside the abdome::
b
B 'Tine h.errnate
• d b O\ve 11.oops to t::e a cor:i.en
I I ' -. • l
• 1 . :-etur a�:-::>. r:-.,:>r,�.:-:

C. Caecum i s. the last portion of bowel to come back into the

abdomen.
D. Abdominal wall defec�s can be detected from 10 \veeks
onwards .
E. The ductus venosus does not have recognizable walls
17. Antenatal ultrasound scan:

A. Abdominal defect in gastroschisis is central.
B. Abdominal defect in omphalocele involves the umbilical
vessels.
C. AqueJuct stenosis is a feature of Dandy \Valker syndrome
D. Banana sign in neural tube defects is due to raised intracranial
pressure.
E. Anencephaly is the commonest neural tube defect.
18. Ultrasound findings of viable pregnancy:

A. Fluid in pouch of Douglas
B. Multiple cysts with no decidual reaction
C. Intrauterine sac, 15 mm with no fetal parts
D. Intrauterine sac, 30 mm v:ith no fetal parts
E. Intrauterine sac v·:ith \·olk sac and no foetus
19. Fetal u l traso u nd:

A. The echogenicity of lu:ng is the same as that of li"1:er and srleen
B. J\ lediastinal shift towards cpposite side is more marked if the
lesion is in the right side
C. Small diaphragmatic defects can be seen by using high
resolution ultrasounds
D. There is a 10% incidence of associated chromosomal anomalies
in fetal lung anomaly
E. Polyhydramnios is associated with fetal lung anomalies
20. Fetal hydrops is seen in:

A. Rhesus incompatibility
B. Twins
C. Diaphgramatic hernia
D. Pulmonary lymphangiectas�a
E. Gastric volvolus
21. Fetal hydrops is seer. m:
A. Cardiomyopathie�-
B. Intracerebral haer: Jrrha
c. Downs syndrornt-
D. Turners syndrorr:
E. Fetoma ternal :ra:· �USlOr
22. Ectopic pregnancy:

A. Thin endometrial stripe excludes ectopic pregnancy
B. High veloci ty flow seen in ectopic pregnancy
C. Progesterone level more than 25 ng I ml excludes ectopic
pregnancy
D. 1I100 incidence in in vitro fertilisation
E. Missed p€riod is seen in 100% of patients
23. Endometrial three layer pattem-

A. Ectopic pregnancy
B. Implantation in follicular stimulation
C. Normal
D. Intrauterine pregnancy
E. Trophoblastic tumour
24. Obstetric scans:

A. Yolk sac is an organ of production of blood in fetus
B. Calcification of yolk sac indicates poor prognosis
C. 75% of subchorionic haem a tomas are associated with
pregnancy failure
D. Double decidual sign precedes intradecidual si g n
E. Multiple 'lessels in umbilical cord indicates conjoined hvins
Causes of raised hCG:

A. Complete abortion
B. Choriocarcinoma
C. Theca lutein cyst
D. Follicular cyst
E. Incomplete abortion
26. The following f eatures are predictors of early pregnancy failure:

A. Increased resistive index in the spiral arte:-!es
B. Any flow in the intervillous space in first :ri.:.-:i.ester
C. Polvhvdramnios
D. Large aID.Lt.ion
E. Small amnion
27. Raises alphafetoprotein is se�n m:
A. Closed neural tube defects

B. Missed abortion
C. Gastroschisis
D. Renal ager1esis
E. Sacrococcygeal ter :· ·oma
28. Polyhydramnios is seen m:
A. Bone dysplasias
B. Duodenal atresia
C. Diaphragmatic abnormalities
D. Anencephaly
E. Tracheoesophageal fistula
-· 29. The following ultrasound findings are suggestive of chromo

somal anomaly:
A. Single umbilical artery
B. Omphlllocele
C. NuchJI membrane> 3 mm in 2nd trimester
D. Cystic hygroma
E. Cystic placenta
30. Placental ultrasound:

A. Hydrops is associated with thin placenta
B. Diabetes mellitus is associated with thick placenta
C. Hyperechoic chorionic plate is normally seen in twelve \\·eeks
D. Calcification is commonly seen in the second trimester
E. Full bladder is associated with false positi\·e posterior placenta
pre\·1a
31. Pelvimetry:
A. The pelYic outlet diameter is not \·ery important
B. The transverse outlet diameter is usuallv 10.5 cm
C. Breech presentation at 30 \">'eeks is an indication of peh·imetry
D. Past history of difficult labour is an indication of pelvimet:-y
E. In breech deliverv, the measurements should be on th2 ·,.::.:-;;er
, . .
range, to allow safe vaginal delivery
32. Increased nuchal translucency is seen in:

A. Downs svndrome
;
B. Noonans syndrome
C. Joubert syndrome
D. Congenital cardiac anomalies
E. Normal state
33. Thick placenta is seen in:

A. Intrauterine infections
B. Hydrops
C. Twins
D. Triploidy
E. Diabetes
34. Causes of thin placenta:

A. Polyhydramnios
B. Oligohydramnios
C. Eclampsia
D. Intrauterine growth retardation
E. Diabetes melitus
35. Causes of inaccurate estimation of gestational age:

A. Irregular cycle s
B. Bl ee ding in first trimester
C. Lactation
D. OC pills
E. Fibroids
36. Biophysical profile has the following components:

A. Fetal movement recorded for 30 mins
B. Fe tal breathing movements
C. Fetal cardiac activity
D. Amniotic fluid volume
E. Non stress test
37. The f o ll ow ing are normal in biophysical profile:

A. B reathing mo,:ement should last atleast for 30 seconds
B. iv1 o vemen t of either limb is considered as fetal mo\·ement
C. Hiccup is considered retal breathing
D. Amniotic fluid volume in each pocket should be aHeast five c.m
E. Normal fetal tone is extension of limbs with flexion of spine

A. The cephalic pole is identified in 7 weeks
B. Nuchal thickness is best assessed between 6-10 \veeks
C. No increased risk of congenital anomalies if there is increas2d
nuchal thickness, but normal karyotype
D. Frontal and parietal bones are not visualised before: 20 \".:eeks
E. Elevated pregnancy plasma protein .\ along with i�ceJsed
.
nuchal thickness is indicator of Dov.;n's synJrome

A. The brain is normal in first trimester in anencerhalv . ,
B. Cerebellar vermis is the most prominent stuc ture in brain by

11 weeks
C. If there is no ossification in mid sagittal pb:<e, at � l .:� "":ee��.;,
it is a clue for anencechalv
L •
D . In hydrocephalus, the c horoid ?lexus flo.!ts <::_: :��.'2 r:--.os�

superiJr part
E. Lemon sign can be seen irt a scan dor.� before :� ..,--:'=�.;; -
228 Genitourinary, Obstetrics & Gynaecolo'gy and Breast Radiology
40. Fetus:
A. The spine ossifies first in the cerYical region and it continues
downwards
B. Spinal ossification begins by �-± \";eeks
C. There is high incidence of absent nasal bone in Downs
syndrome than in normal foetuses
D. Increased incidence of diaphragmatic hernia if nuchal thickness
is increased
E. Nuchal thickness is not of use when measured in second
t rimester
41. Causes of multilocular cystic lesions in f etal thorax:

A. Diaphragmatic hernia
B. Sequestration
C. Bronchogenic cyst
D. Cystic hygroma
E. Congenital lobar emphysema
42. Causes of fluid in the fetal pleural cavity:

A. Diaphragmatic hernia
B. Cystic adenomoid malfo:-mation
C. Downs s\·ndrome
,
D. Cystic hygroma
E. Pulmonary hypoplasia
43. Fetal heart:

A. VSD closes in later weeks of pregnancy
B. The velocities are higher in fetal life tr.an after birth
C. Noonans syndrome associated with hypertrophic
cardiomyopathy
D. Flap of foramen ovale lies in the right atrium
E. Any pericardia! fluid seen in fetus is abnor�al
44. Common causes of fetal pericardial effusions:

A. Arryth mias
B. Posterior urethral valves
C. Fetal h ydrops
D. Cytomegalovirus infection
E. IUGR
45. Fetal heart:

A. Eustachian valve is between IVC an -�ght ·. ·::-1:.1m
·e
B. :tvfoderator band is ::t the apex of le r: �
C. Chiaris net1.vork are seen in left atr:'. :. .:- ' :-e:-:-:--1ar.t.; of

embryonic valves
D. Narro'Ning of the : :-tic isthmus inc
E. Any dilation of +:E: ulmonary arter;.
valve is :'..ue tc ·)c ste:;otic dilatat
46. Causes of non visualization of bladder:

A. Gastroschisis B. Renal hypoplasia
C. Exstrophy D. Posterior urethral valve
E. PUJ obstruction
47. Delay in return of midgut to abdominal cavity:

A. Cystic fibrosis
B. Diaphragmatic hernia
C. Volvulus
D. Obstruction
E. Congenital small bowel
48. Absent/small fetal stomach:

A. Normal till 30 weeks
B. Cleft lip
C. Oligohydramnios
D. Cystic hygroma in neck
E. Esophageal atresia
49. Causes of absent end diastolic blood flow in umbilical arteries:

A. Polyhydramnios
B. SLE
C. Normal phenomenon
D. IUGR
E. Preterm deliverv .I
30. Causes of ech og enic f etal bow el :

A. Cvstic fibrosis
.I
B. Necrotising enterocolitis
C. Meconium ileus
D. Intra amniotic haemorrhage
E. Down's syndrome
51. Differential diag n osis of rnultiloculated mass m abdomen:

A. Duodenal atresia
B. Jejunal atresia
C. Choledochal cyst
D. Mesenchymal hamartoma
E. Lymphangioma
52. Causes of non vi sualization of ga'.- 'ladder:

A. Normal in 40% o f fetuses
B. Cvstic fibrosis
.I
C. Biliary atresia
D. C0r.genital infection.3
E. Gall stones
53. Causes of echogenic kidneys in fe tu s:

B. Meckel Gruber svndrome
J
C. Autosomal dominant polycystic kidney

D. Cytomegalovirus infection
E. Multicystic renal dysplasia
54. Causes of large urinary bladder in fetus:

A. Microcolon hypoperistalsis syndrome
B. Prune belly syndrome
C. Urethral atresia
D. Caudal regression syndrome
E. Exstrophy
55. Causes of short femur:

A. Amniotic band svndrome
J
B. Osteogenesis imperfecta
C. Campomelic dysplasia
D. J\1etaphyseal dysplasia
E. Down's syndrome
56. Feta l heart:

A. The four chambers are easily assessed in early pregnancy than
late pregnancy
B. The ideal time in first trimester to assess heart is 11 weeks
C. In high risk cardiac fetuses, if fetal heart is normal in first
trimester, no further imaging is required
D. The aorta is \·isualised earlier than pulmonary artery
E. The nuchal thickness is increased in those with cardiac
problems
57. The following are components of Pentalogy of Cantrell:

A. Hypospadias B. Posterior diaphragmatic defect
C. Cardiac defects D. Undescended testis
E. Pulmonary hamartoma
58. Causes of abruptio placenta e:

A. Preterm B. Maternal drug abuse
C. Smoking D. Diabetes
E. Hypertension
59. Omphalocele:
A. Associated with trisomv 18J
B. B ladder exstrophy is a component of o 1ssociated

syndrome
C. Omphalocele syndrome is c'.ue to d -:.on of
cephalic embryonic fold
D. Tne umbilical cord is inserted tc .-..e rigli"
.
E. Free floating bowel loops ex. lde o:.

60. Fetal urinary tract:

A. Polycystic kidneys are always seen in first trimester if they
are present
B. Kidneys can be seen almost always, in first trimester
C. Amniotic fluid is mainly formed by fetal urine in first trimester
D. Absence of bladder in first trimester does not indicate
abnormality
E. Bladder more than 7mm in the first trimester is associated with
chromosomal anomalies
61. Fetal musculoskeletal system:

A. Ulnar ossification is not visualised before 15 weeks
B. Accurate measurement of bone length cannot be done before
20 weeks
C. The normal ratio between upper and lower limb bones is 1:1.5
D. Fetal limb movements are first obser ved at 6 weeks
E. Distal phalanges are seen in 11 weeks
62. Multiple gestatio n :

A. The prognosis for multiple gestation depends on the amniocity
B. Higher mortal i t y in dichorio:tic h,·ins than monochorionic
twins
C. Twin peak sign always indin:es presence of dichorionicity
D. A thin interhvin membrane i:;dicates dichorionicitv
E. The chorionicity is best assessed ir, early pregnancy
63. Causes of hepatomegaly in fetus:

A. Rubella B. Rh i.nccr..oatibilitv
.
C. Arnyloidosis D. Beckv·.:ith \.Viedeman svndrome

,
E. Spherocytosis
64. Twins:
A . .tvfonochorionic twins are always monozygotic
B. In rnonochorionic hvins, the larger nuchal thick::-iess should be
used for assessing risk in both
C 1 ' '"'�--
Dl. s c repa nlL'- nuchal c' h .1 C N � ; -i, n L· c
� ; o ll 1:c- ... � ·
1.o
• . c: ::> :::> ;n '-·\..
•• . • •
i-.,·
L� d in.... ;�
·
·"·" ·•"e:::;,
..,.,.:.�
� • . •• <
to t\vin transfusion
D. A pyopagus conjoined tw i n is joine d at pelvis
E. Conjoined hvins result from embryonic split Jues not happen
at 4 days after fertilisation
65. Single umbilical artery:

A. The normal cJrd has two arteries and two ve�ns
B. Tris o m y 18 :s t h e commo:-:est congenital abn1.)r::T'.a�ity
associated
c. A l most 50% .: n.... .; ...,..,, Drea�an-
l c" .:�.:::
. ::>
.
;
" - :::;·ino-!e
ha,._, ' 0 ··-'.J"li-·
!..u:,
1
l _1...:1
2-- ,_, .
-'= · '
•
,
D. 20% have co :enital .:mor..a.lic-3
E. Familial
66. The following anomalies are transient and normal in the first
trimester:
A. Cystic hygroma
B. Pericardia! effusion engulfing the he;:rt
C. P\·electasis < 2 mm
D. Pleural effusion
E. Bright bowel
67. Umbilical vessels:

A. l;mbilical vein thrombosis is in\·ariabh· fatal
B. r\ormdlly only the right umbilical \·e1n is present
C. PersislL'nt right umbilical ;·ein passes to the left side of the
gallbladder to join the portal \·ein
D. Lmbilical vein to artery to vein ratio of less than 2:1 indicates,
single umbilical artery
E. Single umbilical artery is best diagnosed before 20 weeks of
gestation
68. The following are features of fetal hydrops:

A. Placenta is thick
B. Hydrocephalus
C. Oligohydramnios
D. The skin of fetus is thicke:1ed
E. Pericardia! effusion
69. J\1easurements in obstetric ultrasound:

A. Crown rump length is the most accurate method for c.ssessing
gestational age
B. \IVhen the sac is round an a\·erage of anteropost2::-�cr a:1d
transverse diameters are taken
C. Crown rump length is altered by uterine compressior.
D. Crown rump length varies "'·ith the maternal age
E. Femoral length is best used in conjunction with bi?ari,::<:i
diameter
70. The following are indications for amniocentesis:

A. Polyhydramnios
B. To find lecithin spingomyelin ratio
C. 1'1anagement of fetal hydrc:tephrosis
D. Cardiac arrthymias
E. Diabetes
71. Differential diagnosis of int:- !terine f .d CC' � :�1-'.'n:

A. Ectopic pregnancy B. ..:om?le: .::o"."-
C. Endometrial carcinoma D. :)foid

E. Adenom yosis
72. Fetal death X ray:

-
A. Spalding sign is seen only after fou r days

B. Spalding sign is not useful in early pregnancy
C. Spalding sign is more sensitive after the head is engaged
D. Gas in heart indicates fetal death and seen within 12 hours
E. Gas in chest and abdomen seen only in the last trimester
73. Fetal death, X ray :

-
A. Halo sign is the earliest finding after fetal death

B. Exaggerated flexion is an indication of death
C. Abnormal flexion takes four weeks to develop
D. Failure to grow over a period of time is a helpful finding
E. Spalding sign is optimum, between 26- 36 weeks
74. Gestational trophoblastic neoplasia:

A. Hydatid Mole is always benign
B. Invasive mole is always malignant
C. Serum HCG is the only way of telling whether hydatidiform
mole is benign or malignant
D. In a mole, if HCC does not fall, after 8-12 weeks, it can be
only due to malignancy
E. Pulmonary metastasis is not seen in malignant hydaditiform
mole, unlike choriocarcinoma
75. Gestational tropho b las tic neop lasia :

A. Partial mole is maEgnant in only 2·)0 of cases
B. There are no villi in choriocarcinoma
C. 50% of choriocarcinomas de1,·elop from term preagnancy
D. Choriocarcinoma developing from hydatidiform mole has '.Joth
paternal and maternal chromosomes
E. hCG more than -±0000 indica t es very bad prognoSlS rn
choriocarci �oma
76. Gestational trophoblastic n e o plasia hydatidiform mole:

-
A. In Complete mole, all the chromosomes a re dt.:' >:eJ fro;:-:

female
B. Snowstorm appearance in ultrasound is char�1derisL:: of rr.•Jle
C. Partial mole has a chromosome pattern of -!6 XX
D. 46 XY pattern never seen in moles
E. Methotrexate is used in choriocarcinoma and not in moles
77. Features of hydatidiforrn mole:

A. Uterine size larger in majority of C3.Ses
B. Produces hypertension
C. Hypothyroidism is a recogni3ed ·.::>·.�-::Jl prese:::�-,_::,;n
D. AmenC'rrhoea is seen
E. Absenc.:: of fetus with positi\·e ;: · ·�lncv :2st
ANSWERS
1. A-T, B-F, C-T, D-F, E-T

The outer cell mass forms the fetal part of the placenta and the
chorionic membrane. The inner cell mass produces the embyo,
secondary yolk sac, amnion and cord. Implantation is complete
bv 3 weeks LMP.
,,
2. A-T, B -T, C-T, D-T, E-F

Limb buds are also seen in the first trimester.
3. A-T, B-F, C-F, D-F, E-T

Accurate assessment can be made e\·en before ossification reaches
the top of the vault.
The skull is oval, normally, with the frontal end narrower than
the occipital end, and the BPD is 80-90% of OFD. BPD-outer edge
of skull near transducer to inner edge of skull away from
transducer.
4. A-T, B-F, C-T, D-T, E-T

9 mm is the maximum acceptable distance from the mid line to
the lateral margin of frontal horn of lateral \·entricle.
:>. A-F, B-T, C-T, D-T, E-T

...\ithough spinal canal is usually hypoechoic, occasionally high
echoes can be returned from the abO\·e structures.
6. A-F, B-T, C-F, D-T, E-F

The spine has three ossification centers one for body and h"IO for
the neural arches, which are seen as triangular structures in
ultrasound. V shape is normal. Very divergent ossification centers
are abnormal. The heart is oriented more in horizontal direction.
The four chamber view is obtained at a plane just abo\·e the
diaphragm.
7. A-T, B-T, C-F, D-T, E-T

Small bowel is reflective in 2nd trimester due to meconium fluid.
Progressively it becomes hypoechoic as the rneconium is
swallowed. Small bowel peristalsis i s v 3ualized from th�rd
trimester. Colonic peristalsis is not usuali · 'een.
8. A-T, B-F, C-T, D-F, E-T

Both placenta and chorionic membrane ::erived fro::·. :'.le
chorio n. The decidua lining the impla -. '_.3.stoc:st i:� ::-.e
Decidua capsularis, the one lining the ute:. · · is the Dt: :: : -.:a
parietalis. The endometriJl ca\ it is oblik
· y >\·en"1•::<l
·... \.'"'4- -
; ..-:·
.. _ _ n
i
of Decid c' capsularis an:- parietalis.

9. A-F, B-T, C-F. D-F, E-T

Umbilical vein has no branches and drains into the left portal vein.
Liver and spleen have identical echotexture and it may be difficult
to differentiate them. If bladder is not visualized, repeat scan
should be done in half an hour, since bladder empties every hour.
The left suprarenal lies over the left kidney and migrates caudally
slowly. The adrenals measure 20 times the relative adult size.
10. A-F, B-F, C-T, D-T, E-F

Kidneys are visualized from 14 weeks. The pelvis can measure
only upto 5 mm.
Corticomedullary differentiation is seen from third trimester only.
11. A-T, B-T, C-T, D-F, E-T

Abdominal circumference is taken at level of fetal liver and the
umbilical part of portal vein is equidistant from both sides of liver.
Upper ureter is not seen normally.
12 A-FI B-FI C-TI D-TI E-T

Ulna extends more proximally than radius at elbow, but at wrist
both are at same level.
No carpal bones are ossified at birth.
13. A-T, B-T, C-T, D-T, E-F

Associated \vith SLE
14. A-F, B-F, C-T, D-T, E-F

Gestation sac is first see::i. at .5 weeks volk. sac is see!l in 6 weeks.
J
15. A-T, B-F, C-F, D-F, E-F

Gestational sac grows at the rate of 0.7-1.7 mm/day from .5-ll
weeks. Cardiac movement is identified from 6 112 weeks. Ges�J
tional age can be accurately identified till 22 weeks. Asymme�:-y
is normal at five weeks.
16. A-F, B-F, C-T, D-F, E-F

The bowel loop herniates at 6 weeks and returr.s tlt 3 months. Tll.e
herniated loops elongate and undergo a counterclu(k\.vise rot:ltion
of 270 degrees about the axis of the superior mcsenteric artery.
The jejunum comes back first and caecum is the last to enter.
The ductus venosus has echogenic walls.Physiological her:;ia
persists till 14 weeks, hence a diagnosis of abdominai wall defect
could not be made before this.
17. A-F, B-T, C-F, D-F, E-T

In gastroschisis, the defec: is seen in the rig'.-.: side. In Ci.1;:.+.alc �2'>,
the defect is centra� and associated w:t� ::Jnge�ital a,.oma.>:).
-
Banana sign is due t:) do... :-iward displa-."� · :::�t of ..:ere':-eL·_trr.
-
vermis defect. 600,!� f :-:-: :-al tube defe·. · ·iue to ar:.2:-ic�:-r. ..: .
1 •
·.
18. A-F, B-F, C-T, D-F, E-T

E mp t y sac (blighted) ovum is diagnosed \\·hen there is no yolk
sac within a sac >20 mm or no fetal parts ""'ithin a sac >30 m m
o r irregular sac.
19. A-F, B-F, C-F, D-F, E-T

The echogenicity of lung is slightly lower than of liver and spleen.
Mediastinal shift is markedlv
;
seen if lesion is in the left side, as
changes in position of heart is ""'·ell recognised. Small defects can
not be se0n. 1 % incidence of associated chromosomal anomalies.
Polyhydr;unnios is seen probably due to esophageal compression
or dispbccment.
20. A-T, B-T, C-T, D-T, F-T
21. A-T, B-F, C-T, D-T, E-T

Fetal hydrops is the identified in ultrasound by subcutaneous plus
. either ascites or pleural or pericardia! effusion. The commonest
cause is i m mune hydrops caused by Rh or ABO blood group
in co mpati bili ty . Thenonimmunecausesare (1) ch ro mosomal- Down s,
Turners, (2) cardio\·ascular- cardiomyopathies, arrhythmias (3)
Infections (4) Ga s t roi nesti na !- voh·olus, atresias, perforation (5) twin
to n"·in transfusion (6) hematological-alpha th a l essemias (7) Urinary
congenital nephrosis (8) thor ac ic- diaphra5matic hernia, cystic
adenomatoid malformatio:r., pu l m on a ry ly h"� ph an giect asia
22. A-F, B-T, C-T, D-T, E-F

Progesterone le\'el more than 25 n g / ml is seen only in viable
pregnancies. A higher level virtually excludes ectopic pregnancy.
Missed periods are seen in only 60% of patients.
23. A-T, B-T, C-T, D-T, E-T
Three layers a r e-Endometrial lumen (bright), Endometrium
functionalis (hypo) and endometrium baralis (bright). This is seen
in the proliferative phase. This pattern is lost is secretory ph.>e.
24. A-T, B-T, C-F, D-F, E-T

10% of subchorionic haernatomas are associated with pregn::::- :v
failure, higher with large haematomas. Double decidual sign �s a
double ring due to indentation of uterus by gestational sac ��..:::

this is preceded by intradecidual sign which is due to embed:.:�.�.;
of gestational sac within decidua.
A-T, B-T, C-T, D-F, E-T

Pregnancy and ectopic pregnancy are common c:. uses.
26. A-T, B-T, C-F, D-T, E-T

Flow in intervi llous space in first trimest · is ab:-lc��
Oligohydramnios in first trimester is pr2dic� .� jf :)reag:--. : ..
. ·· ·
failure. Amnion/yolk sac are abnormal when they are too large
or too small. Bradycardia is often associated with congenital
cardiac anomalies
27. A-F, B-T, C-T, 0-T, E-F

Raised alpha fetoprotein is seen in Wrong dates, Twins, CNS
abnormalities (open neural tube defects, anencephaly, encephalo
cele, hydrocep h a l us), Renal abnormalities (renal agenesis,
hydronephrosis and multicystic dysplasia), abdominal wall defects
(omphalocele, gastroschisis) and missed abortion.
28. A-T, B-T, C-T, 0-T, E-T

Cardiovascular diseases, neuromuscular diseases, and tracheoeso
phageal fistula are the other causes.
29. A-T, B-T, C-F, D-T, E-T

Nuchal membrane > 6 mm in 2nd trimester, symmetrical growth
retardation, hydrops, multiple structural abnormalities in different
systems, hydrops, cystic hygroma, omphalocele, renal, cardiac
anomalies, duodenal atresia and a cystic placenta.
30. A-F, B-T, C-T, D-F, E-T

The placenta is thick in hy drops Calcification is commonest in the
.
third trimester.
31. A-T, B-T, C-F, D-T, E-T

Since there is increase in the pel�:ic outlet diameter d ur ing labour,
the measurements are not very helpful.Breech p r e se n ta t i o n if ,
persistent at 36 weeks, is indication for pelvimetry. Many breech

presentations tend to become vertex presentations before 36 \';eeks.
32. A-T, B-T, C-T, D-T, E-T

The incidence of chromosomal anomaly is approximately 125'0
33. A-T, B-T, C-F, D-T, E-T

Thick pl a cen ta (>-! cm) is seen in Diabetes, Rh Incorr:;Jatab�li:�:,
L J
Intrauterine infection, Hydrops and triploidy.
34. A-T, B-F, C-T, D-T, E-F

Infection is another common cause.
35. A-T, B-T, C-T, D-T, E-F
36. A-T, B-T, C-F, D-T, E-T

B iophysical profile measures the fetal ·well be i ng ar.d assesses �e:al
movement, fetal breat:-i.ing mo\·ement, feta! :one, :10:. .:.::-ess :c:st
and amniotic fl�id vo>..:me.
.
37. A-F, B-F, C-F, D-F, E-F

Breathing mO\·ements- 1 breathing, >60 seconds, in 30 mins, hiccup
is not breathing.
Fetal movement- three mo\·ements, in 30 mins, (mo\·ement of
trunk and limbs)
Tone- flexion of upper limb, lmver limb and abdomen (extension
is loss of tone)
Non stress test- 2 accelerations, atleast 15 beats more than normal,
atleast 15 secs, in 20 rninsAmniotic volume- pockets >1 cm, total
over four quadrants > 5 cm.
38. A-T, B-F, C-F, D-F, E-T

Nuchal thickness is best assessed in 11-14 weeks. Increased nuchal
thickness is associated \\·ith Trisomy 21 in presence of adYanced
maternal age, elevated BHCG and plasma protein A. Even if
karyotype is normal, there i s increased risk of congenital
· anomalies. Frontal and parietal bones are formed by 11 \\··eeks and
visible.
39. A-T, B-F, C-T, D-F, E-T

Choroid plexus, which is bright, is the most prominent structure
in cranial ultrasound before 11 \•:eeks. Lemon sign il1dicates
indentation of the frontal bones and is seen in SFina bifida alorlg
\\'ith the banana sign. Ossification in mid sagittal plane is normal,
\\·hereas a bsence of ossification at 11-1-l weeks is suggesti\·e of
anencephaly. Choroid plexuses are denser than tlle CSF and hence
will go to the most dependent part of ventricle.
40 A-F, B-F, C-T, D-T, E-F
Spine ossifies first i:-i the mid thoracic spine and continues both
cranially and caudally. 73% of downs syndrome patients have
nasalbone hypoplasia, which can be used as screening tool. There
is increased risk of congenital abnormalities in those with increased
nuchal thickness, even if karyotypL.11g is normal, including cardiac
defects. Hence screening for other anomalies is indicated.
41. A-T, B-T, C-T, D-T, E-F

Cystic adenomatoid malformation and neurenteric cysts are other
anomalies
42. A-T, B-T, C-T, D-T, E-T
43. A-T, B-F, C-T, D-F, E-F

Velocities are lower in fetal life. It is difficult to \·isc. . a small
VSD during pregnancy, si11ce the defect may be too
resolution of ultrasou'.ld lnd the flmv across it ma·
to be detected by ult-as1. 1nd. ::lap of foramen o\·;·.
left atrium. A little r
.
'ric :-dial �luid is llormal in f
44. A-T, B-T, C-T, D-T, E-T

Any cardiac anomaly, tumours, renal agenesis are other causes.
45. A-T, B-F, C-F, D-F, E-F

Moderator band is seen at the apex of the right ventricle. Chiaris
network is seen in the right atrium and is a remnant of embryonic
valve. Narrowing of aortic isthmus is normal in fetuses due to
absent blood flow, and does not indicate coarctation. Dilatation
of the pulmonary artery distal to the pulmonary valve is normal
in fetuses and does not necessarily indicate pulmonary stenosis.
46. A-T, B-T, C-T, D-F, E-T

Bilateral agenesis/dysplasia/PUJ obstruction are recognized
causes. Bladder has to be observed for atleast 45 mins, before
making the decision that it is not visible. Bladder is large in
posterior urethral valve, due to obstruction.
47. A-F, B-F, C-T, D-T, E-T

Mid gut should return to abdominal cavity by 10 weeks.
48. A-F, B-T, C-T, D-T, E-T

Normal till 18 weeks. Any thing which interferes s1-vallowing will
result in non visualization of stomach. Cleft lip, nec k masses are
causes. In oligohydramnios, there is paucity of amniotic fluid for
fetus to si.vallow and this is a recognized cause.
49. A-F, B-T, C-1, D-T, E-T

It is quite normal not to have the end diastolic component e3.rly
in pregnancy.
50. A-T, B-F, C-T, D-T, E-T

NEC is seen only after b irth. IUGR, obstruction, ischemia and
infections are other recognized ca uses.
51. A-F, B-F, C-T, D-T, E-T

1v1esenchymal hamartoma is seen in liver and l'ymphangi•)ma is 5e�ri.
in the retroperitoneum. Ovarian· cyst is very common in fer. .lles..
1v1esenteric cyst, meconium pseudocyst and ter a t uma are other

causes.
52. A-F, B-T, C-T, D-T, E-F

Gall bladder is se en in majority of fetuses. It is not seen only in
5%. Gall bladder atresia is another causes .
53. A-T, B-T, C-T, D-T, E-F

Very common ca use is au tosoma 1 recessive kid=-:-;:•: ::. > ·: .::;e.
O ccasi o n a lly even ADPKD can also cause e�::- .);�:-- >. '."''2ys.
i'vt:eckel Gruber syndrome has polydac:;:ly, er.U?�· ::::� a:<G
renal cvsts. Beckwith vV�edeman svndrome is c.nofr
J ;
·!use.
54. A-T, B-T, C-T, 0-T, E-F

Megacystis microcolon hypoperistalsis syndrome has microcolon,
hypoperistalsis, obstruction, malrotation and large bladder . In
Exstrophy, the bladder is small. In caudal regression syndrome,
sacral agenesis, genitourinary, gastrointestinal, cardiac anomalies
are seen.
55. A-T, B-T, C-T, D-F, E-T

Achondroplasia, proximal femoral deficiency and campomelic
dysplasia are other causes of short femur.
56. A-F, B-F, C-F, D-F, E-T

Four chambers are better seen in second trimester than first
trimester. The ideal time in first trimester is 13 \veeks than 11
weeks. If there is high risk of cardiac anomaly, a repeat scan should
be done around 20 weeks, e\·en if first trimester scan was normal.
Pulmonary trunk is visualised earlier than aortic root.
57. A-F, B-F, C-T, D-F, E-F

Pentalogy of Cantrell-Sternal defect ectopia cordis, cardiac defects,
anterior diaphragmatic defect and supraumbilical abdominal v\·all
defect.
58. A-T, B-T, C-T, D-F, E-T

Eclampsia, trauma and \·ascular diseases are other common causes.
59. A-T, B-T, C-F D-F, E-T

,
Omphalocele, Exstrophy of bladder, imperfora.te anus and sacral

defects are components of OEIS syndrome \·vhich is due t o
defective caudal fold formation, unlike pentalogy of cantrell which
is due to defectivE cranial fold formation. In omphalocele, fre
bowel loops are contained, the defect is midline, the cord is
inserted at apex of sac and there are associated anomalies.
60 •
A-F B-T C-F D-F E-T
I I 1 I
Polycystic kidneys are usually seen only in late pregnancy. KiC::ie::3

and bladder are seen in 99% of cases in first trimester, the'.:
absence indicating abnormality. Bladder is less than 6 mm L.1l r::·:.-:
trimester, with megacystis associated with chromosomal anc�,31:-::s
and obstruction. Amniotic fluid; I trimester-plasma ultrafibrz::e ::.::--._:
trimester-desquamated skin; 3rd trimester-urine.
61. A-F, B-F, C-F, D-F, E-T

The ossification centers of all long bones 1:::.:1 be visuah�·� �� -:-:.·
weeks and phalanges by 11 weeks. Accur :: measurerr.e!�. · :.:::-·
done by 11 weeks. The normal ratio is

Fetal limb movements are also seen by . ·�:es.
62. A-F, B-F, C-T, D-F, E-T

Prognosis depends on chorionicity (mono or dichorionic) rather
than amniocity. Higher mortality is seen in monochorionic tvvins.
In monochorionic twins, the intertwin membrane is thin and there
is a T shaped junction. In dichorionic twins, the membrane is thick
and attached in a triangular fashion. (Twin peak sign, best seen
before 14 weeks)
63. A-T, B-T, C-F, D-T, E-T
64. A-T, B-F, C-F, D-F, E-F

In dichorionic twins, the nuchal thickness of both twins can be
measured and correlated separately with the maternal age for
chromosomal abnormalities and they can be different. In
monochorionic twins, if there is discrepant nuchal thickness, it
indicates twin to twin transfusion. It is not clear, whether to use
the higher or lower nuchal thickness. Pyopagus is fusion at sacrum,
ischiopagus- is fusion at pelvis, omphalophagus at abdomen. In
conjoined twins, the normal split of embryonic disc at 12 weeks
does not happen.
65. A-F, B-T, C-T, D-T, E-F

Normal cord has two arteries ar.d one vein only. Trisomy 18 , 13
and Turners are commonly associa:ed v'lith single umbilical artery.
which is associated with congenital abnor:nalities in 20°0. There
is no familial incidence.
66. A-T, B-F, C-F, D-T, E-T

Pericardia! effusion around AV vah-e and along ventricular wail
are normal. Effusion generalised, is not normal. Pyelectasis < 0.7'3
mm is normal. Nuchal translucency can also be a transient feature.
67. A T, B-F, C-F, D-T, E F

- -
Only the left umbilical vein is present. Persistent right umbilical

vein passes to the right side of the gall b l a dder to join the po:::ll
vein. Umbilical artery more than -l: mm (transver�e diameter) is
another sign of single umbilical artery. Sin gle umbilical artery is
usually not diagnosed before 20 weeks and is better seen in later
stages of gestation.
68. A-T, B-F, C-T, D-T, E-T

Ascites, pleural effusion, pericardia! effusion and skir. t:-.�c ke ning
are cardinal features of fetal hvdroos. , 1
69. A-T,. B-F, C-F, D-T, E-T

Crown rump length is not alte!"eci :,y ::xterr.a! ccr::?ress�l)n bu: tt
is a 1 t er e d by fe ta l flex ion, ma : e r n a'. as 2 a nc ::- .: c e of mo : h::: � .
Bipa rietal d i ameter is the most commonly used method of

assessing gestational age and femoral length is used when it can
be :neasured, along with BPD, especially when the head is in the
peh-is making measurement of BPD difficult.
70. A-T, B-T, C-F, D-T, E-F

In polyhydramnios, amniocentesis is done to reduce maternal
distress. In preterrn babies, lecithin sphingomyelin ratio is an useful
indicator for assessing pulmonary maturity. Other choromosomal
anomalies are indicators for amniocentesis. Occasionally drugs can
b e introduced through this route, such as anti arrthymics and
thyroxine.
71. A-T, B-T, C-T, D-F, E-F

Gestational sac and pseudogestational sac of ectopic pregnancy are
the commonest causes. Retained products of conception, and
endometrial inflammation are other etiologies.
72. A-T, B-T, C-F, D-T, E-T
73. A-F, B-T, C-T, D-T, E-T

Spaiding sign- O\·erriding of fetal cranial bones- not useful in early
preg:tancy and after head is er.gaged. Optimal between 26-36
weeks. Takes 4-15 days Gas in a'.:idomen, chest and heart-seen
\\·it!lin 12 hours, only in last trir.tester. Halo sign- Edema around
the body, seen in 2 days, only in last trimester. Abnormal
exaggerated flexion-takes four \'\'eeks. Failure to grow and
constant position are other findings.
74. A-F, B-T, C-T, D-T, E-F

Gestational trophoblastic neoplasia includes Hydaditiform mole
(benign or malignant), Invasive mole (malignant), choriocarcinoma
(malignant) and placental CTN. HCC level is elevated in all these
lesions. In hydatidiform mole, the HCG level is very high, till 8-
12 weeks, in both benign and malignant subtypes. In 80% of
lesions, the levels fall after 12 weeks and these are benign. But
in 20%, the levels are persistently high ·and indicates malignant
lesion.
75. A-T, B-T, C-F, D-F, E-T

Partial mole has fetus and molar elements. Choric :noma have
trophoblasts and haemorrhage but no villi. Chari -'.omas-50%
develop from hydatidiforrn mole, 25% after abort 25% after
full term pregnancy. Choriocarcinoma c -� from
hydatidiform mole has only paternal chrorr ':1t that
developing from term pregnancy has both pat, :er;-1�1
chromosomes. Other high risk factors iri chori::: ·:ude-
brain metastasis, hepatic metastasis, following term pregnancy,

> 14 months and unresponsive to chemotherapy.
76. A-F, B-T, C-F, D-F, E-F

Complete mole-has 46 XX- all chromosomes derived from the male.
A haploid sperm fertilises an egg with no maternal chromosomes
and then reduplicates its chromosomal pattern. 15% have 46 XY
pattern, with 2 sperms one with X and other with Y fertilising an
empty egg.
Partial mole-69 XXY-2 sets of paternal chromosomes.
Methotrexate/ Adriamycin are used even in hydatidiform mole.
77. A-F, B-T, C-F, D-T, E-T

Uterine size is normal or smaller in majority of cases. It can be
large in a few cases. Hyperthyroidism is a recognised feature, not
hypothyroidism. Theca lutien cysts in the ovary are seen in 20%
of cases.
1. Female genital tract:
A. The labia rnajora is equi\·alent of scrotum
B. Vestibular bulb equi\·alent to penile bulb
C. Round ligament equi\·alent to gubernaculums testis
D. The vagina has two fornices
E. The a n terior and posterior wall of vagina are normally
opposed
F. The anterior fornix of the vagina is the deepest
2. Uterus:
A. The cavity is seen as a cleft in the sagittal plane
B. The external os lies in the same plane as pubic symphysis
C. The external os is circular in nulliparous
D. The external os has a longer anterior lip in rnultiparous
E. The long axis of uterus normally forms an angle of ninety
degrees with the vagina
3. Uterus:
A. Cervical canal usually measures 2 mm
B. Cervical canal is spindle shaped
C. Normal uterus measures upto 35 mm and has higher vertical
than coronal dimension
D. Tube can measure 10 cm or more
E. Tubes have columnar epit.�eliurn
4. Uterus:
A. Ultrasoun .: of uterus is difficult when it is retrove-rted and
retroflexe1 :iosition
B. The uten: ·. :1d cervix are equal size in prepubertal age group
c. There is � .n layer of submucosa ber.veen the er-�demetrillm
and rnvc
.I
·:-mm
D. The enti �erus is co\·e.:-ed by peritoneum
E. The ure: !::-e close to -�e lateral fornix of ..: ::-.::=. :-.::
-
Gynaecological Diseases 245
:J. Pelvi s :
A. Levator ani has sphincter action on the vagina
B. There are four groups of muscles in the levator ani
C. A plane through the ischial spines divides the perineum into
urogenital triangle anteriorly and anal triangle posteriorly
D. The urogenital diaphragm is pierced by urethra and rectum
in males
E. The Calles fascia enclosing the superficial perineal pouch is
continuous above with the Fascia Scarpa
6. Vag in a:
A. The vagina, urethra and rectum are parallel to each other
B. The vaginal receives blood from uterine artery
C. The entire vagina drains into superficial inguinal nodes
D. The fornices disappear with aging
E. The pouch of Douglas is related to the lower third of the
posterior aspect of vagina
7. Structures attached to the perineal body:

A. Levator ani B. Bulbospongiosus
c. Ischiocavernos us D. Anal sphincter
E. Transverse perineal m uscles
8. Pelvic vessels:
A. The left common iliac \·eins are r.1.·ice the size of r:ght c orn.1.-non
.
iliac veins
B. The external iliac artery is larger than the internal iliac artery
in the fetus
C. The external iliac artery gives the inferior epigastric artery and
superficial circumflex iliac artery
D. The ureter crosses the external iliac artery, nea: its origi�
E. The round ligament passes posteriorly to externa: iEac artc:::y
9. Internal iliac artery:

A. Has the most variable branching pattern in th1" body
B. Superior gluteal A is a branch of anterior division
C. 1v1edian sacral is a branch of posterior divisio;
D. The vaginal artery is equivalent to superior vc:::;ical artery in
male
E. Inferior gluteal artery is the largest branch of the in terr.al diac A
10. Contents of s u perf ic ia l perinea! pouch in males:

A. Bulbospongiosus
B. Ischiocavernosus
C. Bartholins glands
D. Urethra
E. Deep transverse perir.;:11 muscles
11. Contents of Deep perineal pouch:

A. Deep transverse perineal muscles
B. Bulbospongiosus
C. Cowpers glands
D. Sphincter urethrae
E. Internal pudendal artery
12. Pelvic vessels:

A. Persistent sciatic artery is seen in 1 %
B. The fetal vascular supply to lmver limb is by superior gluteal
artery
C. Prof unda femoris A is absent in persistent sciatic artery
D. Obliterated umbilical artery is the first branch of internal iliac
artery in fetus
E. Normal obturator and iliac nodes are visualized in CT scans
13. Uterus drains to the following lymph nodal groups:

A. Superficial inguinal
B. Deep inguinal
C. Internal iliac
D. External iliac
E. Preaortic
14. The following constitute supports of uterus:

A. Uterosacral ligament
B. Broad ligament
C. Cardinal ligament
D. Pubovesical ligament
E. Vesicou terine fascia
15. Contents of broad ligament:

A. Ovarian ligaments
B. Mesosalpinx
C. Ovary
D. Iliac nodes
E. Round ligament
16. Ovarian ligaments:

A. The ovarian fossa lies behind the obliterated umbilical artery
B. The ovarian ligament is a continuation of the round ligament
C. The mesovariurn attaches the ovary to the anterior surface of
broad ligament
D. The suspensory ligament attaches the ovary to the �ateral pelvic
wall
E. The ovarian fossa is in contact with the obtur3 :::-r vessels ar.�
nerves laterally
17. Tubal blockage:

A. Vaginal leak produces a false tubal blockage
B. Tubal spasm relaxes with time
C. Adhesions are a common cause
D. Hysterosalpingography is better than laparoscopy
E. Tuberculous salpingitis produces dilatation but never occlusion
18. Ovary:
A. There are ovarian follicles at birth
B. In children the follicles are less than 2 mm in size
C. In adults 6 or more follicles can be seen
D. After menopause, the ovary can measure upto J cm
E. Average adult ovary weights 2-8 g
19. Ova ry :
A. The ovary is oriented in horizontal direction, usually
B. The ovary has no peritoneal covering
C. There are 750000 follicles in neonate
D. The ovary has a tunica vasculosa covering i.t
E. Corpora albicantia marks the site of ruptured follicles
20. Ul traso un d of fem ale:

A. It is normal to ha.....-e an e!l.dometrial thickness of S mm in the
24th dav of the cHle
, .
B. It is normal t o ha v e an e::ldometrical thickness of S mm in the

9th dav of the cvcle
, ,
C. There i s a narrO\\. zor.e of hypoechogenicity under the

endometrial echo, during proliferative phase
D. The endometrial echogerlicity increases during the secretory
phase
E. In postmenopausal age group, the endometrial thickness
reduces even if the patient is ha\·ing HRT>
21. Ultrasound ovaries:

A. N orma lly upto 6 follicles are seen in O\·ary
B. Many follicles are seen in O\·aries in pouch of Dou_;'..E
C. Fluid in po uch of Douglas is abnormal to'.vards the en.J of the
cycle
D. Tubal patency can be assessed with t r ansv a g i r.. a l contrast
agents
E. Adnexal evaluation is better with transvaginal scans
22. CT of uterus:
A. The broad ligameilt is well see::1 in obese ir:d i v:d '.13.:s
B. The uterus shows a cent::-al hvoodensitv
, l ,
C. The uterus enhances in�enselv on c ontrast adr:.::-:i.::�:::�on

D. The ovaries are seen as s:.7lall structu.:-es adj2u:- � :c· ::·.:: 1:e::-·b
..
E. Vagina is normally seer'. as an air filled st:-:..:c::..::c

23. MRI:
A. The MR appearances of female geni ta! organs are \'ariable
B. In T2 \V images, the \·agina shows uniformly high signal in
proliferative phase
C. The highest signal of mucosa is seen in the secretory phase
D. In pregnancy, the contrast between mucosa and wall is lost
E. The vagi na does not shO\\' enhancement on con tr a st
administration
24. l'v1RI cervix:

A. The crrvical signal \·aries \\·ith the menstrual phase
B. Oral cuntraceptives make the zonal anatomy in cen-ix indistinct
C. The outer zone, is continuous \\·ith the myometrium of uterus
D. The central hyperintense str:pe measures up to 4.5 mm at the
maxunum
E. The low signal in the inter:nediate zone, is due to fibrous stroma
25. MRI:
A. The ovarian stroma enhances intensely on contrast
B. The follicles are always hyperintense on 12 VV images
C. The round and broad liga2ents are easily identified
D. Endometrial polyps are COI:"':!Tl.On in those less than 30 years
E. Contrast ultrasound is the �est for differentiating endometrial
polyp and fibroid
26. Salpingitis isthmica nodosa:

A. Multiple nodular filling defects are seen in the tube
B. Commonly seen in the isthmus
C. 2 m m at the maximum
D. Hypertrophied tubal mucosa
E. Hypertrophied muscular layer of tube
27. Fallopian tube:

A. The entir·e tube is wrapped :n mesosalpinx
B. Ciliated cuboidal epithelium lines the fallopian tubes
C. Both ovarian and uterine arteries supply it
D. Lymph drains mainly to internal iliac nodes
E. Ampulla is the most dilated part
28. Hysterosalpingography:
A. Polypoid filling defects are normal during proliferative phase
B. Endometrial glands are opacified in secretory phase
C. Longitudinal folds are normal in cervix and abno:-n."'lal :n ute:-us
D. Intravasation of contrast is a common complimbo!'., if :i-'.e st'..ldy
is done d '_lfing menstruation
E. Plicae pa .. :ate are common in multiparous
29. Hysterosalpingographyis contraindicated m:
A. Tubal surgery within 6 months

B. Contrast allergy
C. Hypertension
0. Premenstrual stage
E. Immediate Post menstrual
30. Indications of hysterosalpingography:

A. Uterine bleeding B. Infection
C. Miscarriages D. Major pelvic trauma
E. Post caesarean
31. Complications of HSG:

A. Pain reduced b y rapid injection of contrast rather than
prolonged injection
B. Analgesics are not neeaed for the pain following procedure
C. Pain reduced by using balloon catheters
0. Spotting is common for upto a week
E. Post procedural bleeding is usually uterine
32. Lymphatic i ntravastat i on :

A. Causes non fatal pulmonary embolism
B. Images not compromised after intravasation
C. Produces more pain
D. Balloon catheter reduces intra'l::isation
E. Increased incidence when done during me:l.sturation
33. Hyster o so nog ra phy:

A. SHU 430 is used
B. Done bet\Neen 8-14th day of cycle
C. Contraindicated in galactosemia
0. Not done if WBC is more than 10000
E. Done under local anesthesia
34. Salpi ngit i s i s thm ica n od osa:

A. Increased incidence of ectopic pregnancy
B. Hinders mo\·ement of sperm
C. Congenital disease
D. High chlamydial antibody titers
E. Unilateral disease not seen
35. MRI uterus:

A. The zonal anatomy is "''ell differentiated in the Tl 'N images
B. The thickness of junctional zone is constant in aU phases of
menstrual cvcle
C. The signal of outer myor.tetrium is high::st in se•:re:'i : ry phase
and lowest in proliferati\·e phase, in T2\'i i:":' 1g·:::3 ..
D. The 1 unct ion al zone is not seen i:1 :ne

·
: e �:c::·:.;: �:.i� zrouD
.l 1 ..... ..... .i.
E. Highest sig�al of junchonal zor:.2 is see:--. �:, ?·::.s�:-:-.e:-.!_)?at!:3c:i

wome:l
36. Hysterosal pingography:

A. It is not essential to clean the cen-ix during procedure
B. 30 ml of contrast is the maximum tolerable dose
C. One image is enough for demonstrating anatomy and spill
D. Traction is essential for demonstrating the complete anatomy
E. Fluoroscopic images are adequate for showing tubal detail
_ 37. Abnormalities in uterus caused due to diethylstilbesterol m
u tero:
A. T shaped uterus B. Strictures
C. Adenucarcinoma D. Cen-ical metaplasia
E. \' agin il carcinoma
..
A. Should not be done 10 days after last menstrual period
B. Vasm·agal reaction is a side effect
C. Polyps resemble submucosal fibroid
- D. Subserosal fibroid produces irregular cavity
E. HSG differentiates septate uterus and bicornis unicollis uterus
39. Tubal occlusion:

A. �1id segment is the commonest affected segment of the tube
B. Tuberculosis is the commonest cause of distal tubal occlusion
C. Endometriosis affects mid tube
D. Chlamydia affects the proximal tube
E. Hydrosalpinx causes tubular dilation of ampullary segment
A. It is not essential to clean the cen-ix during procedure
B. 30 ml of contrast is the maximum tolerable dose
C. One image is enough for demonstrating anatomy and spill
D. Traction is essential for demonstrating the complete anatomy
E. Fluoroscopic images are adequate for showing tubal detail
41. Causes of Ashermans syndrome:

A. Tuberculosis
B. Schistosomiasis
C. Chlamydiasis
D. Dilatation and currettage
E. Evacuation of retained products of conception
42. Antibiotics a:·. indicated in HSG in the followin_; situations:

A. Hydrosal� -:x
B. Prolonge!. : rocedure
C. Known F
D. Using be:. ··'."'. catheters
E. Traumat: ·.xedure

A. Normal intrauterine gestation sac excludes it
B. Ring seen on ultrasound confirms unruptured tube
C. Less than 10% occurs in the ovary
D. Methotrexate therapy is useful in unruptured cases
E. Increased incidence is seen in IVF
44. Ultrasound of ectopic pregnancy:

A. 25% have detectable heart beat
B. Fluid in pouch of Douglas excludes the diagnosis
C. Absence of fluid in the pouch of Douglas excludes the diagnosis
D. GIFT increased the incidence of coexistent intrauterine foetus
and ectopic
E. 95% of ectopic pregnancies have positive pregnancy test
45. Polycystic ovaries:

A. The ovaries are more spherical than normal
B. Biochemical abnormality may be seen with normal ovarian
appearances on ultrasound
C. Characteristic ultrasound appearances may be diagnostic with
normal biochemistry
D. Associated with cushings syndrome
E. MRI shows increased signal \\·it:t Tl \';e!ghting 1,vithi:1 the
stroma
46. Causes of diffuse uterine enlargement:

A. Adenom yosis
B. Endometrial carcinoma
C. Lymphoma
D. Pyometra
E. Diffuse leiomyomatosis
47. Causes of fundal depression m HSG:

A. Septate uterus
B. Bicornuate uterus
c. Polyp
D. Arcuate uterus
E. Fundal myoma
48. Common causes of metastasis to uterus:

A. Leukemia
B. Fallopian tube
C. Vagina
0. Ovarv
. ,
E. Cervix
252 Gendourinary, Obstetrics & Gynaecology and Breast Radiolo_fjt,
-19. Tuberculous salpingitis:

A. ..\ norm.<1 l hysterosalpingogra m excludes tuberculosis
B. L terus is often affected befc,re the fallopian tube
C. High signal is seen in T2\\' images of myometrium
0. Pulmonary disease is associated in -W110 of cases
E. The commonest mode of spread is ascending
50. Tuberculous salpingitis:

A. The tube is invoh·ed in 100�� of cases
B. Loss uf tubal peristalsis is an earlier finding
C. Cotton pl u g appearance is a pathognomonic feature o f
tuberculosis
0. The uterine ca\·it\· does not sho\,. an\· abnormalities in
-
hysterosalpingogram
E. The tube is commonly obstructed, but hydrosalpinx is not seen
unlike pyogenic salpingitis
51. Gynaecological causes of urinary obstruction:

A. Prolapse
B. Endometriosis
C. Q\·arian remnant sYnd rome
D. :\ c?.bothian cvst
E. Hydrocolpos
32. Causes of enterovaginal fistula:

A. Crohns B. Di,·erticular disease
C. Carcinoma \·agina 0. Radiation
E. Cervical stenosis
53. Causes of endometrial thickening:

A. Polyp
B. Hyperplasia
C. Tamoxifen
0. Incomplete abortion
E. Hvdatidiform mole
,
54. The following produce complex pelvic masses:

A. Ectopic pregnancy B. Haemorrhagic cyst
C. Haematoma D. Brenner tumour
E. Paraovarian cyst
55. Free fluid in cul-de-sac is seen m:
A. Ovarian tumour
B. Pelvic inflammatorv disease
C. Torsion of o\·arian cyst
D. Ovulation
E. Endometriosis
56. The following are solid ovarian tumours:

A. Sertoli leydig cell tumour
B. Fibrosarcoma
C. Granulosa cell tumour
D. Mucinous adenoma
E. Endometrioma
57. Ovarian calcification 15 seen m:
A. Brenner tumour B. Granulosa cell tumour

c. Thecoma D. Dermoid
E. Endometriosis
58. Cervix:
A. Cervical pregnancy is increased in induced abortions
B. Neisseri a and Chlamydia affect the ectocervix
C. Herpes simplex affects only the endocervix
D. Cervical polyps are commonest in the post menopausal age
group
E. Commonest t y pe of polyp is a haematoma
59. Nabothian cyst:

A. Covered by columnar epitheli u m
B. If more th a n 1 cm, think of sarcomatous c o n v e r sion
C. A sequelae of chronic cen·icitis
D . .tv1ulticystic nabothian cyst is called tunnel cluster
E. Solid components are occasionally found in the cyst i:t \1RI
60. Fibroids and degeneration:

A. Red degeneration- High signal in Tl
B. Myxoid degeneration-Intense enhancement and hig:t signal in
T2
C. Hyaline degeneration- low signal in Tl and T2
D. Cystic degeneration low signal in Tl and enhances in delayeL�
images
E. Interstitial edema shm.vs iri.tense enhancemer1t
61. Common locations of endometrial implants:

A. Fallopian tube B. Lungs
C. Bladder D. Rectosigmoid
E. Liver
63. Lymph nodal involvement in pelvic cancer depends on:

A. Stage of primary tumour
B. Size of orimarv tu mo u r
l ,
C. Histology of primary tumour

D. Determines prognosis
E. Dete rm i ne s recurrence rate
_
64. Solid endometriosis:
A. Commonest location is uterine ligaments
B. Low in T2W images
C. Seen in caesarean section scars
0. Punctate high signal areas are seen in Tl\\' images
E. Solid due to malignant conYersion

A. l.Jterine enlargement occurs
B. Endometrial thickening common
C. If a chnrionic sac is identified in the fundus ectopic is excluded
0. Ca use� first trimester bleeding
E. Increased risk with Hydatidiform mole
66. Uterus:
A. The size of the uterus is larger in the secretory phase than in
the follicular phase
B. The upper limit of normal for endometrial stripe in secretory
phase is 3 mm
C. Post menopausal uterus on hormonal replacement therapy
car.not be differentiated from premenopausal uterus
D. l"se of o:-al contracepti\·es reduces the size of endometrial stripe
E. Cs:ng GnRH analogue ,,·ill increase the 5ize of endometrial
sr:·1?e
67. Lterus signal in MRI:

:\. The junctional zone is smaller in oral contraceptive use
B. The myornetrial signal is brigher than normal when GnRh is
used
C. The size of uter-..1s is decreased when GnRH is used
D. Radiotherapy decreases signal from endometrium and
increases from rnyometrium
E. Zonal anatomy is lost v.:ith radiotherapy within three months
68. Fibroids l\.·1RI:

A. Better \·isualized in. Tl vV images
B. Hyaline degeneration produces high signal 'iNhereas carneous
degeneration produces low signal
C. A high signal rim is seen around the fibroids and is sue to
edema
D. Using GnRH analogues decreases the \·ascularity of fi:i:-oids
E. If a fibroid is situated at the subserosal location, fe::'.Et\· ,,-:ll
not be affected
69. Teratomas of ovary:

A. No need to be surgically removed if they are cystic
B. 46 XX diploid type with arrest of meiosis 2nd phase
C. Chemical shift artifact with bright and dark bands reversed
from the abdominal wall fat is pathognomonic of teratoma
D. Malignancy can develop in only the ectodermal component
E. Using Fat saturation sequences increases the sensitivity and
specificity for detection to upto 100%
70. Adenomyosis:
A. Seen in 60% of menopausal women
B. Cannot be resected without hvsterectomv
, ,
C. There is a well defined pseudocapsule around the adenomyosis
D. Presence of tenderness is a feature in favour of adenomyosis
E. Ultrasound can reliably differentiate between fibroid and
adenomyosis
71. tvtRI of adenomyosis:

A. The lesion is predominantly hypointense due to decreased
vascularity
B. Focal high signal areas in T2 \ \. images due to endometrial
glands
C. High signal in both Tl and T2 i nd i ca tes haemorrhage
D. Contrast enhancement is obse'."':ec: in dni.amic contrast \1R sc:rn�
E. Large veins can be seen at the :-:-�J rgi:t of the junctiona 1 ZLme
72. Fibroids uterus:

A. Common in Afro Caribbean than Caucasians
B. Arises from a single myometrial cell
C. Seen in 45% of women of repr o ducti\·e age
D. Fibroids grmv more rap idl y in ...\fro Caribbean than whites
E. Fibroids do not occur in wome:i. less than 20 ve-Hs
73. Fibroids produce the following symptoms:

A. Amenorrhea B. � 1eno:-rhagi,1
C. Constipation D. Diarrhoea
E. Urinary frequency
74. Fibroid embolisation:

A. Pedunculated and subserious fibroids respond well to fil:roid
embolisation than intersti"tial and submucous tvce fib ro ids
, l
B. Fibroids over 8.5 cm, do not respond well to embolisa�: ...m

C. Studies have proved that uterine artery embolisation doe:::: t:::
aff�ct fertility
D. There is rapid revascularisation of myo1-::etriur:1. sucsequ�:-'� to
embolisa tion
E. , once embolis.:d C(\es 1:ot recar..:i.lise
The uterine arterv

A. Bleeding is the major complication
B. Infection is more common in submucous fibroids
C. High temperature after embolisation indicates infection
D. Fibroids pass vaginally after embolisation
E. The incidence of ovarian failure is more than 40%

A. Prophylactic antibiotics should be given after the procedure
B. Occlusion of uterine artery is the desired end point of the
procedure
C. Occlusion of the perifibroid vascular plexus is enough for
treatment
D. Free flow embolisation is essential to prevent ovarian artery
blockage
E. The normal myometrium also undergoes necrosis along with
the fibroid

A. 15% of maternal deaths
B. 10% of ectopics are in the cornua
C. 1/100 of those with assisted reproduction techniques have
coexisting heterotopic pregnancy
D. Double decidual sign i!ldicates ectopic pregnancy
E. Ectopic pseudogesta tional sac is situated eccentrically within
the uterus
78. Predisposing factors for ectopic pregnancy:

A. Hormonal ovulation induction
B. Diethy stilbesterol
C. Sterilization
D. PID
E. Endometriosis
79. Sonographic features of ectopic pregnancy:

A. Hematosalpinx
B. Echogenic ascites
C. Adnexal ring
D. Extrauterine gestational sac with yold sac only
E. Solid adnexal mass

A. 1000 U I L is the cut off point for visualisation of gestational
sac in transvaginal scan
B. 5000 IU /L is the cut off for visualisation of g�s>caticnal sac in
transabdominal s.:an
C. Intrauterine preg::mcy virtually excludes ect�?i.: ?;.c.; _: .'.3:-::::y
D. 15% risk of rec..: :---=nee
E. B- HCG does r·. : � > 66%i, in �3 hours
81. Differential diagnosis of ectopic pregnancy:

A. Bowel loop B. Bi comate uterus
C. Endometrioma D. Hemorrhagic corpus luteum
E. Thecal cell tumour

A. Diagnos tic laparoscopy is 100% accurate
B. Tubal rupture occurs in 25%
C. Aspiration of clotted blood in culdocentesis is highly sugestive
of ectopic pregnancy
D. C orp us luteum cyst in the same side ovary in 50%
E. Infertility is the sequela in 40%
83. Features of ectopic pregnancy:

A. Deciduai cyst
B. Decidual cast
C. Low impedance flow in endometrium
D. Low impedance flow in ectopic sac
E. Absence of peritrophoblastic flow after 36 days
84. Low impedance flow in adnexa:

A. Ectopic pregnancy
B. Corpus luteum cyst
C. Vesicular mole
D. Fibroid
E. Tubovarian abscess
85. PID:
A. Hemat o logic spread is common
B. Chlamydia is the commonest organism
C. Bilaterally svmmetrical disease
, J
D. Small bowel obstruction is a complication

E. Unilateral in appendicitis
86. Features of PIO:

A.. Normal in early stages
B. Intraluminal air
C. Endometrial thickening
D. Irregular uterus
E. Hyperechoic uterus
87. PID CT features:

A. Enhancing tube
B. Thickened mesosalpinx
C. Thicked uterosacral liga:r.e�t
D. Renal hilar lymphadenop.:: :'.;y
E. Hyperdcnse perirecta! i2t
88. Torsion is common in the fol lowing lesions:

A. Paraovarian cvst
B. Long mesosalpinx
C. Fibroid
D. Dermoid
E. Cysadenocarcinoma
-89. Fibroids:
A. The recurrence rate after myomectomy is less than 20%
B. MRI scan should be done in all patients prior to fibroid
emboli::.c1 tion
C. Adenomyosis should be excluded prior to embolisation
D. Uterine sarcoma should be excluded prior to embolisation
E. MRI is helpful in excluding uterine sarcoma before fibroid
embolisation
90. Torsion ovary:

-
A. Primary torsion is commoner than secondary torsion
B. Common in the right side
C. Palpable mass is seen in 50%
D. Spontaneous detorsion is the commonest sequela
E. Uterus is deviated to the side of torsion
91. Torsion ovary:

A. Enlarged o\·ary is the most consistent finding
B. Enlarged ovary with peripheral cysts is the commonly seen
finding
C. Ascites
D. Demonstrating arterial flow is the crucial factor in diagnosis
E. Increased sound transmission
92. CT findings of ovarian torsion:

A. Intravascular air within an ovarian tumour is specific
B. High density within the ovary
C. Draping of lesion by thick vessels
D. Intense enhancement
E. Engorgement of blood vessels on side of lesion
93. Complications of placental abruption:

A. Small infants B. DIC
C. Amniotic embolism D. Prolonged labour
E. Threatened abortion
94. Placenta abruption is seen in:

A. Smokers B. Fibroid
C. Cocaine D. Fetal malformation
E. Hypertension
95. Abruptio placenta:

A. Cause for 25% of perinatal deaths
B. Contained haematomas have good prognosis
C. Fetal h ypoxia is seen in all haematomas, regardless of size
D. Normal delivery is seen in 80% of all abruptions before 2C
weeks
E. Normal term delivery is seen in 50% of abruptions after 20
weeks
96. Placental abruptions:

A. Retroplacental abruptions are common
B. Marginal abruption is high pressure bleed due to rupture of
spiral arteries
C. Retroplacental bleed is associated with smoking
D. Fetal parts can be felt clearly on examination
E. Venous bleeding are more common
97. Differential diagnosis of placental abruption:

A. Retroplacental myoma
B. Focal contraction
C. Molar pregnancy
D. Normal uterine tissue
E. Basal veins
98. Cervical cancer:

A. Carcinoma of cervix is the SeCOf1.d comrnonest gynaecologiol
malignancy world\.._,·ide
B. Carcinoma of cervix is the third most common gynaecological
malignancy in the western world
C. MRI is the most reliable imaging modality in evaluatin g cervical
cancer
D. Parametrial invasion is best seen in coronal MRI images
E. Phased array i'vfR coils, will gi\·e a better indication of stromal
invasion
99. Carcinoma cervix- i\!RI:

A. Endovaginal coils are good in evaluating pelvic nodes
B. CA cervix is usually hypointense in T2 weighted images
C. The signal intensity abnormality in 12 weighted images does
not correlate well with pathological specimens
D. 1v1RI is very useful to detect the cervical cancers that are
completely situated \.vithin the canal
E. 1v1RI does not have a role in the diagnosis of cerv�cal cancers.
and are mainly used for stagi:.\s
260 Genitourinary, Obstetrics & Gynaecology and Breast Radiolog��
100. MRI in CA cervix:

A. 70% of cervical cancers are microin\·asi\·e
B. T2Vv' images are good in identifying stage I disease
C. Dynamic MRI has good potential in diagnosing stage I disease
D. The absence of a normal low signal intensity outside the high
signal of tumor in T2 W images, indicates that the tumour has
extended outside the cen:ix
E. Sagittal imaging is essential for management for CA cervix in
a young fertile patient
101. MRI in CA Cervix:

A. Extension to \'agina is demonstrated by thick hyperintense
\·agina in T2VV images
B. Extension to vagina is demonstrated by segmental disruption
of the normal high signal intensity of vagina
C. Iv1R has an accuracy of 93% in diagnosing vaginal extension
. D. Parametrial invasion is best assessed in axial images
E. Presence of a low signal intensity ring outside the cen·ical
cancer, has a specificity of 100% in ruling out parametrial
extension
102. rv1RI in CA cervix:

A. Contrast enhancement OYeresti.rnates parametrial involvement
B. Parametrial in\·asion is indicated if tumour extends through
thin \·aginal fornix
C. Complete loss of parametrial signal, indicates pelvic wall
invasion
D. MRI is very sensitive in assessing extension of tumour to
bladder
E. MRI is very sensitive in assessing extension to Vesicoureteric
junction

A. Rectal invasion is suggested by loss of hypointense signal of
anterior rectal wall
B. MR is more accurate than CT in assessing lymph node
involvement
C. Oval lymph nodes are suggestive of malignancy
D. Signal intensity is useful in distinguishing benign and malignant
nodes
E. Ultra small superparamagnetic iron oxide is useful in
characterizing lymph nodes in pelvic cancer
Gynaecological Oise�-�-E!.�- ?61
_

A. Demonstration of low signal in T2W images has a 97% negative
predictive value for residual tumour
B. Presence of high signal, has a 86% positive predictive value
in predicting residual tumour
C. Delayed response to radiotherapy is seen in larger tumours
D. After total tumour regression, the cervix has a lower signal
than before the tumour
E. MRI is the best modality for assessing recurrence and residual
tum.our

A. The commonest site of recurrence is vaginal apex
B. Presence of tumour mass is the most important indicator of
tumour recurrence
C. Hyperintensity in T2W images always indicates tumour
recurrence rather than fibrosis, even after twelve months
0. Dynamic MRI can help in differentiating recurrence and fibrosis
E. Contrast enhancement is useful in diagnosis of post treatment
fistulas
106. Staging of cervical carcinoma:

A. Involvement of parametrium-IU B
B. Clinically invasive cancer-IA
C. Extension to lower third of vagina-IIL\
D. Hydronephrosis-IIIB
E. Pelvic side wall-IIIB
107. MRI for cervical cancer.

A. Cervical tumours are best seen in T2W images
B. Characterisation of signal intensities is best done in Tl vV
rmages
C. Invasion of uterus and vagina is best seen in cornnal images
D. Contrast studies results in overestimation of tumciur size and
extension
E. Dynamic contrast enhancement can distinguish recurrence from
benign disease after treatment
F. Contrast is used for assessment of rectal and bladder invasion
108. Anatomy of cervix:

A. The cervix shows three different signals in T2 weighted images
B. The inner layer is of low signal
C. The intermediate layer is of lmv signal
D. The outer lay er is of high signal
E. Normal width of cervical canal is less t::a:L 2 cm
· -

A. The most important information in cervical cancer staging is
parametrial invasion
B. Parametrial in\·asion indicates that surgery is not the favoured
treatment option
C. FICO staging is based on clinical examination only
D. The discrepancy between clinical FICO staging and Surgical
staging in upto 67% of patients
E. MRI is the most accurate modality in the staging of cervical
cancer
110. Choriocarcinoma:
A. Spontaneous regression is recognized
B. Hypovascularity is characteristic
C. Causes pulmonary hypertension
D. Ultrasound is characteristic
E. High LDH is pathognomonic
111. Endometrial carcinoma:

A. In stage I, the uterine body and cervix are involved
B. In stage III- pelvic nodes are invoked
C. In stage IIIb- bm.,'el and bladder mucosa are involved
D. 100°.� of endometrial cancers are adenocarcinomas
E. Second commonest gynaecological malignancy after o\·arian
112. Ovarian tumours:

A. Clear cell adenocarcinoma is the commonest malignancy arising
from endometriosis
B. Papillary projection is the single most reliable predictor of
malignancy in ovarian tumours
C. Clear cell tumours are always malignant
D. Clear cell tumours have the worst prognosis
E. Brenner tumours are associated with ovarian tumours in 30%
of cases

A. Brenner tumour is associated with Meig syndrome
B. Brenner tumour has transitional elements
C. Brenner tumour is malignant in 50% of cases
D. Malignant germ cell tumours constitute 25% of malignant
ovarian tumours
E. Teeth in teratoma arises from the Rokitansky nodule
. _ _ _.._�---�
114. Endometrial cancer:

A. Lymphadenopathy is the most important prognostic indicator
B. There is no correlation between the depth of m yometrial
invasion and lymphadenopathy
C. Hematogenous metastasis is unkr..own
D. Ne v er seen before 40 years
E. 90% present with bleeding
115. Endometrial cancer:

A. Treatment of stage I and II are same
B. Endometrial strip above 8 mm is always abnormal in post
menopausal ladies
C. Presence of thin endometrial stripe <5mm automatically means
that diagnostic yield of endometrial tissue is poor
D. Focal thinning of the myometrial hypoechogenicity indicates
deep myometrial invasion
E. Myometrial invasion is pathognomonic of endometrial cancer
116. l\tetastasis to ovary commonly occurs from:

A. Stomach
B. N1elanoma
C. Appendix
D. Breast
E. Bladder
117. Associations of Ovarian carcinomas:

A. Carcinoma breast
B. Carcinoma uterus
C. Carcinoma rectum
D. Peutz Jeghers syndrome
E. Blood group A
118. Krukenbergs tumours:

A. Ovary infiltrated by signet cells
B. Older age group than other O\·arian tumours
C. N1ajority are bilateral
D. Always complex cystic
E. Ascites is not seen
119. Uterine artery embolisation in post partum haemorrhage:

A. Small collateral vessels causing bleeding cannot be occluded
B. Occludes proximal ves
· sels
C. Fertilitv is not affected
,
D. Embolisation is avoided if the�e is no active bleeding at the

time of angiography
E. Very useful in placenta accreta
120. Endometrial tumours:

A. Majority of endometrial tumours present in stage I
B. In d ynarnic MRI, the endometrial cancer enhances more than
adjacent myometrium
C. Half of endometrial sarcomas have well defined margins
D. Sarcomas and carcinomas of endornetriurn cannot be
differentiated by MRI
E. Adenosarcoma is a combination of uterine carcinoma and
sarcoma
121. Tumours of fallopian tube:

A. Constitutes only 0.5°0 of female genital tract cancers
B. Staging is the same as endometrial cancer
C. Carcinosarcoma is the commonest type of tumour
D. Presence of liver capsule in\·olvement indicates stage IV disease
E. Unlike other tumours of genital tract, occur in younger group
of 20-30 years

A. Clear cell adenocarcinoma is associated with endometriosis
B. Enhancement of peritoneum in :YfRI is indicative of metastasis
C. 60% of epithelial tumours are malignant
D. Dynamic contrast !'ARI enables differentiation of different cell
types of O\·arian tumours
E. Vv ell defined cystic lesion v;ith heterogenous density and
intensity of the contents v.;ithout any solid ·component is likely
to be a serous adenoma than mucinous

A. Serous cvsadenocarcinomas are more common than mucinous
,
cystadenocarcinomas
B. Serous tumours are more often bilateral
C. Serous cystadenocarcinoma is a recognised cause of
pseudomyxoma peritonei
D. Calcification is common and psammomatous in mucinous
tumours
E. Mucinous are larger than serous tumours
124. Following are suggestive of malignant than benign ovanan

tumour:
A. Size> 2 cm
B. Wall thickness 5 mm
C. Papillary projections
D. Bilateral
E. Endometrial hypeq:·lasia
Gynaecological Ois<:Jasas 265
125. Ovarian teratomas:

A. Presence of fat within teratomatous cyst, indicates that lesion
is benign
B. Rokitansky nodule is bright in ultrasound with acoustic
shadowing
C. Struma ovari has predominantly stromal elements
D. Carcinoid syndrome is produced by teratomas
E. Rupture of teratomas produces peritonitis

A. High HCG can be seen in dysgerminomas
B. Dysgerminomas have similar pathology as ernbryonal cell
carcinoma in testis
C. 25% of teratoma are immature and malignant
D. Yolk sac tumours occur in second decade
E. Yolk sac tumours are very low grade
127. Ovarian tumours- sex cord stromal:

A. Theca cell tumour is the commonest malignant sex cord stromal
tumour
B. Granulosa cell tumour produces endometrial hyperplasia
C. Granulosa cell tumour commonest in adolescent age grou?
D. Papillary projections and p eri tone a l seedling uncof:".rnor, tn
granulosa tumours
E. Fibroma is the most common sex c o rd stromal tumour

A. Purely solid fibromas are malignant
B. Fibrothecomas are hypointense in Tl and T2
C. Commonest ovarian tumour producing peripheral enhance
ment and subsequent centripetal filling is hemangioma
D. Thecomas are the commonest \·irilising tumours of O\·ary
E. 75% of Sertoli Leydig cell tumours are functioning

A. Bilateral uterine arteries are embolised
B. Sidewinder catheter is used for selective uterine artery
catheterization
C. PV A 100 micrometer particles are used
D. In selective catheterization, catheter is placed in transverse
portion of uterine artery
E. Left femoral approach is simpler and commonly used
130. Fi b roi d embolisation:

A. The external iliac arterv is catheterized for embolising the
artery supplying the fibroid
B. High signal in Tl after e mbolisation correlates with good
volume reduction
C. Presence of menorrhagia is a contraindication for the procedure
D. Lignocaine is injected into the arteries as analgesia
E. Antibiotics are absolutely essential for the procedure
131. Intervention in female infertility:

A. Laparuscopy cannot visualise abnormalities in the fimbrial
portion of the tube
B. The commonest cause of block of the interstitial segment of
tube is debri
C. Tubal recanalisation procedure is successful in only 25% of
patients
D. 6F catheter is used for cannulating the tube
E. Balloon dilatation is done for reestablishing tubal patency
132. Cervical incompetence:

A. Endocervical canal is less than 3 cm
B. Internal cen-ical os is narrov;ed and measures less than -1 mm
C. \'\.idth of the cen-ical canal is the most reliable predictor
D. Cltrasound can diagnose incompetence in both pregnant and
non pregnant
E. Prostaglandins are responsible for incompetence.
Gynaecological Ois�3sc_s .. ?67
ANSWERS
1. A-T, B-T, C-T, D-F, E-T, F-F
The vagina has anterior, posterior and two lateral fornices.
The posterior fornix is the deepest.
2. A-T, B-T, C-T, D-F, E-T

The uterine cavity is triangular in the coronal plane and a thin cleft
in the sagittal plane.
The external os i s circular in nulliparous and transverse i n
multiparous. T h e anterior lip I shorter and thicker than t h e
posterior lip. The long axis o f uterus forms 90 degrees with vagina
(anteverted) and the fundus is flexed anteriorly in relation to
cervix (anteflexed).
3. A-F, B-T, C-F, D-T, E-T

Uterus measures 6-8 x 5-7 cm and 3 cm thickness. The tube can
extend for upto 10 cm from cornue infundibulum cervix measures
3-4 cm, canal measures 7-8 mm.
4. A-T, B-T, C-F, D-F, E-T

In fetus, the cervix is very large than uterus. In childhood, this
relationship persists. In prepubert3.l age grnup, they are airr.ost
equal. After puberty, the body increases in size. There is n1J
submucosal layer in uterus. The ute:-:.ts is co\·ered by peritoneum
onlv abo\·e the level of internal os.
;
:>. A-T, B-F, C-F, 0-F, E-T

Levator ani has sphincter action on anus and vagina. There are
three groups of muscles-levator prostati/sphincter vaginae,
puborectalis and pubo and ileococcygeus. The plane dividing the
perineum passes through the ischial tuberosities. The urethra and
vagina pierce the urogenital membrane.
6. A T, B-T, C-F, D-T, E-F

-
Vagina receives blood from vagina! artery, a br�1nch of intern-11

iliac artery and a branch from uterine artery.The upper third of
vagina drains into external iliac nodes, mid third to internal iliac
nodes and lovver third to superficial inguinal nodes.The pouch of
Douglas is related to the upper third, the rectum to the mid third
and perineal body to the lower third of posterior aspect of vagina.
7. A-T, B-T, C-F, D-T, E-T
8. A-T, B-F, CF, D T, E-F

-
The lcrrge left common iliac veins may mimic a mass if there is nv
contrast. The external iliac artery is larger thart ir.ter::.al in adults,

but not in foetus due to the umbilical ar�er·: i,,vh'.:h arise:; i ·: ·
- ·
268 Genitourinary, Obstetrics & Gynaecology and Breast Ra�io�9[l)'
internal iliac A. Ext Iliac A gives the inferior epigastric A and deep
circumflex iliac A. Ureter, round ligament, testicular vessels and
\·as deferens cross Ext Iliac A.
9. A-T, B-F, C-F, D-F, E-F

The branches of anterior division are-superior vesical, inferior
vesical (vaginal), middle rectal, uterine, \·aginal, obturator, inferior
gluteal, internal pudendal. Posterior division- Iliolumbar, lateral
sacral, superiogluteal. Median sacral artery is a branch of arota.
Superior gluteal artery is the largest branch.Vaginal artery is
equival ent to inferior vesical artery.
10. A-T, B-T, C-F, D-T, E-F

Bartholins glands are seen in females. Superficial perineal muscles
are seen, not the deep.
11. A-T, B-F, C-T, D-T, E-T

Bulbospongiosus is in superficial pouch.
12. A-T, B-F, C-T, D-T, E-F

Persistent sci a tic artery· is en!a rged inferior gluteal artery
representing persistence of fetal \·ascular supply to lower limb. The
SFA and profound are absent in this cases.
l'\ormal obturator and iliac nodes are small and are not normallv
\·isualized in CT.
13. A-T, B-F, C-T, D-T, E-F

Fundus- paraaortic: Body and cen·ix- internal and external iliac
nodes
Along round ligament- superficial inguinal nodes.
14. A-T, B-T, C-T, D-F, E-F

Levator ani, Round ligament, pubovesical ligaments are other
ligaments.
15. A-T, B-T, C-T, D-F, E-T

Uterine vessels, lymph channels and mesoovarium are other
components.
16. A-T, B-T, C-F, D-T, E-F

The ovarian fossa lies in the lateral pelvic wall, with the obliterated
umbilical artery anteriorly and the internal iliac artery and ureter
posteriorly. The ovarian ligament extends from medial surface of
ovary to side of the uterus. The mesovarium attaches the ovary
to the back of the broad ligament. The suspensory ligament is also
called infundibulopelvic ligament. The ovarian fossa is separated
from the ob turator nerves bv parietal oeritoneum.
,/ l
17. A-T, B-T, C-T, D-F, E-F

Laparoscopic visualisation is the most effective method for
assessing tubal patency. Tuberculous salpingitis can produce
dilatation and occlusion.
18. A-T, B-T, C-T, D-F, E-T

Maternal hormones produce some ovarian follicles at birth. In
children, volume is less than 1 m and follicles less than 2 mm.
In adults, six or more, more than 4 mm diameter. Adult ovaries-
3xl.Sx2, 2-8 g Menopause 2 cm, 2 g
19. A-F, B-T, C-T, D-F, E-T

Usually ovary is oriented in the vertical direction.Tunica albuginea
is the covering of ovary.
20. A-T, B-F, C-T, D-T, E-F

During menstrual and proliferative phase,the endometrial
thickness is upto 4 mm, slightly echogeni: with a thin hypoechoic
myometrium seen underneath.
In secretory phase, the endometrium is more echogenic and can
be upto 8 mm .
In postmenopausal age, the endometrium thi..r1s, unless the- patient

is on HRT
21. A-T, B-F, C-F, D-T, E-T

If ovaries are in Pouch or dough�:;, the follicles are not clearl \.
visualized. Fluid in Poucl-1, towards end of cycle is normal.
22. A-T, B-T, C-T, D-F, E-F

Uterus enhances due to mvometrial vascularitv.
, ,
The ovaries are not routinely seen.
23. A-T, B-F, C-T, D-T, E-F

The MR appearances vary depending o n age, hormonal status.
Phase mucosa wall contrast
Proliferative high loi.v good
Secretory high, thick high, thick poor
Postmenopausal low, thin low, thin poor
Prepuberal low low poor
Pregnancy medium to high mediur:1 to high poor
We can see, the best contrast is seen in the proliferative phase.
The mucosa enhances on contrast administration.
24. A-F, B-F, C-T, D-T, E-T

The cervical signal does not vary much \.Vith the cycle or orJl
contraceptives. The inner mucosal zone, shows high sign.:l,
measures upto 4.5 mm. Th-e intermediate lovv signal zor.e, due to
fibrous stroma, shows 10\v signal, upto -t2 mm, is continous with
the junctional zone. The outer zone shows intermediate signal and
is continous \vith the outer m\'ometrium of uterus.
25. A-T, B-T, C-T, D-F, E-F

The follicles are hypo in Tl and hyper in T2 and are best visualized
in con trast enhanced images, when the ovarian stroma enhances
and follicles do not enhance. Endometrial polyps are common in
those abo\·e 50 years and is not possible to differentiate polyps
and fibroids.
26. A-F, B-T, C-T, D-T, E-T

Multiple 2 mm di\·erticulae are seen in the tube, common in the
isthmus but also seen in other locations. The hypertrophied tubal
mucosa herniates through the muscular layer, \vhich can also be
hypertrophied and nodular. Lined by ciliated column epithelium.
27. A-F, B-F, C-T, D-F, E-T

-
Tube has interstitial part, isthmus, ampulla and infundibulum.The

interstitial part is not covered by mesosalpinx. Lymph drains
mainly into paraaortic nodes. Ampulla is the most dilated part and
isthmus is n arro\V and long.
<...;
28. A-F, B-T, C-F, D-T, E-F

Polypoid filling defects and endometrial glands are normal in the
secretory phase.
Longitudinal folds are normally seen in an�erior and posterior
1.•;alls of cervix and occasionally in uterus. Branching folds are called
plicae palmate and are common in nulliparous \.VOmen.
29. A-F, B-T, C-F, D-T, E-T

Ideally done within 10 days of menstrual cycle. Surgery within
6 weeks is a contraindication.
30. A-T, B-F, C-T, D-T, E-T

Commonly used for assessing tubal patency, especially for
infertility and after surgery.
31. A-F, B-F, C-F, D-F, E-F

Rapid injection and balloon catheter increase the pain. Analgesics
reduce the pain. Spotting is normal for up to 24 hours and i s
commonly due to cervical bleeding
32. A-F, B-F, C-F, D-F, E-T

No pulmonary embolism is seen. Venous filling degrades image
quality. Performing during or near menstruation, forceful injection,
misplaced tube anc recent surgery are predisposing factors.
Gynaecological Diseases �71
33. A-T, B-T, C-T, 0-T, E-F

Tnis is the technique of injecting a ultrasound contrast agent into
the cervix, when it is dilated behveen 8-14 davs of the cvcle. \Jo
, ,
anaesthesia is required .
34. A-T, B-T, C-F, 0-T, E-F

The exact etiology is not known, but high association w ith PIO.
Unilateral/ bilateral.
35. A-F, B-T, C-T, D-T, E-F

The zonal anatomy is not seen in Tl vV images.
In TI, endometrium, a junctional zone (inner myometrium) and
outer myometrium is differentiated.
Phase endometrium jimctional outer contrast

myometrillm
Proliferative High, 3mm low, Smm medium a-ood

Cl
Secretory high, 7mm low, Smm high good

Prepubertal absent/ minimal indistinct thin poor
Post meno thin, 3mm indistinct 10\v poor
The junctional zone blends \':ith the low signal of cervicalstrorna
36. A-F, B-F, C-F, 0-T, E-F

The cervix is normally sterilised. 10 ml of contrast is the maximum
dose. Four images, one AP, right and left anterior oblique vie1,,·s
and early filling images are essential for proper examination.
37. A-T, B-T, C-T, 0-T, E-T

The strictures are short and irregular. There is also increased risk
o f infert ility, abortion, pret erm deliveri es, carcinomas and
hypoplastic u terus.
38. A-T, � -T, C-T, D-F, E-F

Vaso vagal reaction requires conserYative management. Subserosal
fib r o i d vvill produce only extrinsic irr.pression, no mucosu.l
irregularity.
39. A-F, B-F, C-F, D-F, E-T

D i s t al > p roximal > middle.
Proximal- infection, isthmica nodosa, endometriosis: i'vlid- TB,
distal- chlamvdia.
40. A-F, B-F, C-F, 0-T, E-F

The cervix is normally sterilised. 10 rr.1 of contrast is the maximum
dose. Four images, one AP, right and left 3nterior oblique vie\\'S
and early filling images are essential for proper examination.
272 Genitourinary, Obstetrics & Gynaecology and Breast Radiol�_gy
41. A-T, B-T, C-F, 0-T, E-T

Ashermans syndrome refers to intrauterine adhesions. It is usually
post infectious or surgical. Produces irregular filling defect in HSG.
42. A-T, B-T, C-T, 0-F, E-T

Routine use of antibiotics is not required. Recent pelvic surgery
is another indication.
- 43. A-F, B-F, C-T, 0-T, E-T

Echogenic ring with fetus/yolk sac is seen in only early pregnancy.
Free fluid I clotted blood indicate rupture. Methotrexate is also
useful for persistant disease after salpingostomy. PID, Adhenosis,
tmours, endometriosis, surgerior are predisposing factors 95%
occur in tubes, 2-5% are intoutitial. Cen·ical, ovarian, peritoneal-
10%.
44. A-F, B-F, C-F, D-T, E-F

Fluid in the pouch of Douglas is ,·ery common in ectopic pregnancy
and can be haemorrhage. GIFT is gamete intrafallopian transfer
and has increased the incidence of ectopic pregnancy. Pregnancy
test is positive in only of pa:ients. Positive pregnancy test and
no intrauterine pregnancy.
45. A-T, B-T, C-T, D-T, E-F

The LH. is ele\·ated, FSH is normal or low. The high level of
androgen in blood produces h.irsutism, acne and baldnoss o\·aries
and enlarged, upherical, multiple small follicles and echogenic
strome 30% of clinical peas haYe normal USG, 25% of ultrasonic
PCOD have no biochemical findings.
46. A-T, B-T, C-F, 0-F, E-T
47. A-T, B-T, C-F, D-T, E-T
48. A-T, B-T, C-F, D-T, E-T
49 •
A-F B-F C-T D-F E-F
I I I I
The hystcrosalpingogram is normal i n the early stages of the

disease. Fallopian tube is always affected. The commonest mode
of spread is hematogenous.
50. A-T, B-F, C-T, D-F, E-F

Fallopian tube is involved in 100% of cases. Strictures, obstruction,
hydrosalpinx, sccules, sinus trads, calcification, beading, tonic wall,
loss of peristalsis, cloud like spreading of contrast are features of
tuberculous salpingitis. Calcification and loss of peristalsis are late
findings. Uterine cavity can be irregular, with synechiae, adhesions
and obliteration of the cavity.,
Gynaecological Oiseas es 273
.
51. A-T, B-T, C-T, 0-F, E-T
52. A-T, B-T, C-T, D-T, E-F
53. A-T, B-T, C-T, D-T, E-T

Carcinoma, endometritis, leiomyoma, hormone replacement
therapy, ectopic pregnancy are other causes.
54. A-T, B-T, C-T, D-T, E-F

Abscess, cysadenoma, endometrioma, dermoid are other ca uses.
55. A-T, B-T, C-T, D-T, E-F

Follicular rupture is the commonest cause.
56. A-T, B-T, C-T, D-F, E-T
Si. A-F, B-F, C-F, D-T, E-F

Papillary cysadenoma/ carcinoma is another common cause.
58. A-T, B-F, C-F, D-T, E-F

Cervix has a proximal columnar lining and distal squamous lining.
Gonorrhoea and Chlamydia are common in the endocerviol part,
Herpes, trichomonas and Candida common in the ectocen:ix part.
Cervical polyps can be due to tumour, fibroid, or inflammation
or haematomas. The commonest type is endocervical polyp.
59. A-F, B-F, C-T, D-T, E-F

Nabothian cyst, a retention cyst, is a sequelae of chronic cen·icitis,
which results in proliferation of squamous cells which encloses the
endocenrical glands and its secretions. It is usually only a few mm
but can be large. l\1RI is intermediate in Tl and bight in T2. Solid
areas are not seen and indicate a neoplastic lesion such as adenoma
malign um .
60. A-T, B-F, C-T, D-F, E-T
Tl T2 C111tr;1st
Red Hi0
ah int l\o
Hyaline low low no
Interstitial edema low hiah
0
intense
Cystic degeneration low hi0
ah no
iY1yxoid low very high gradual
62. A-T, B-T, C-T, D-T, E-F

Endometrial i m pla n t s are also seen in O\'Jry \\·hich is the
commonest location. Other locations are uterine lig.::..'.Tlents,
peritoneum over uterus, and cul-de-sac.
63. A-T, B-T, C-T, D-T, E-T

274 Genitourinary, Obstetrics & Gynaecology and Breast Radiolq,gx
The incidence of nodal invoh·ement increases with primary tumour

stage, histological grade and tumour bulk The recurrence rate and
O\'erall sun·iyal rate are directely related to nodal spread.
64. A-F, B-T, C-T, 0-T, E-F

Commonest location is rectovaginal septum foilowed by
uterineligaments. Smooth muscle proliferation and fibrosis are
reasons for solid nature. Tl- hypo, punctate high signal areas,T2-
hypo. Seen in Pfannensteil incisions for caesarean
Differential diagnosis is tumour
65. A-I, B-T, C-T, 0-T, E-F

Vaginal \·ii eeding, abdominal I sho ulder pain, faintness a re
presenting features. Absence of intrauterine sac, decidual sac, low
resistance flow, ad nexal mass seen in USG.
66. A-F, B-F, C-T, D-T, E-F

There is no variation in size of uterus with the cvcle. The maximum
.;
- size of endometrial strip in the follicular phase is 3 mm and is 5

mm in secretory phase. GnRh analogues also decrease the size of
the endometrial stripe.
6i. A-T, B-F, C-T, D-F, E-T

GnRh-L�terus smalle:-, endometrial stripe- thi:lner, myometrium
thin..'1er \\·ith lower signal. Radiotherapy- loss of zonal anatomy
if the woman is prernenopausal and causes endornetrial thinning
\Vith low signal in endometrium and myometriurn.
68. A-F, B-F, C-T, 0-T, E-T

Fibroids are low signal in Tl and T2 and are better seen in T2
images. High signal rim around the fibroid is due to vascularity
or edema or lymph, hyaline, carneous and cystic degeneration
produce high signal in T2 weighted images.
69. A-F, B-F, C-T, D-F, E-T

Malignancy can develop in any component of the teratoma and
hence, it has to be surgically removed, when diagnosed. The
meiosis is arrested in the first phase. The second phase can occur
only after fertilization. Chemical shift artifact will give alternate
dark and light bands, which will be seen in teratoma in the reverse
direction of fat in abdominal wall. Using fat saturation sequences
are very helpful in increasing accuracy for detection o f f a t
containing and hae morrhagic lesions especially teratomas and
endometriosis.
70. A-T, B-T, C-F, D-T, E-F

Adenomyosis is often confused with fibroid. But adenomyosis is
a diffuse disease process, wi:'.iout any capsule, and interdigitate3
Gyraecological Diseases 275
with the myometrium. Ultrasound will show diffuse heterogenous

echotexture, but i t is occasionally difficult to differentiate from
fibroids which might have similar features. Because of the intimate
attachment with myometrium, focal resection of the mass is not
possible.
71. A-T, B-T, C-T, D-F, E-F

Adenomyosis i s t h e presence of endometrial glands in the
myometrium. T h e l esion is characterized by widening of the
junctional zone, which is low to intermediate in Tl and T2 images.
There are no vessels at the margin, which differentiates this lesion
from fibroid. There is no contrast enhancement and the lesion is
not vascular.
72. A-T, B-T, C-F, D-T, E-F

Fibroids can occur in any age after menarche. It is more commor.,
occurs a t younger age and grows rapidly in Afro Caribbea::..
women. It is seen in 20-25% of women of reproductive age group.
73. A-T, B-T, C-T, D-F, E-T

Mehorrhagia is caused due to expansion of endometrial surface
and due to hypervascular p�udocapsule. Bloating and backache
are other symptoms.
74. A-F, B-F, C-F, D-T, E-F

Pendunculated and subse!:iC:.!S fibroids do not respond well to
embolisation, unlike the ofr.e: t\,·o and are more associated \'.: i th
complications. Fibroids O':er 8.5 cm were thought to be poorly
responsive to embolisation, but recent studies prove otherwise.
The effects of embolisation on pregnancy and fertility are yet to
be proved conclusively. Subsequent to embolis�tion, there is rapid
revascularisation and sometimes the embolised uterine artery may
recanalise.
75. A-F, B-T, C-F, D-T, E-T

Infection is the most common complication and is more common
in submucous fibroids. High temperature is nut s pe c ific for
infection and can occur in infarction also. The incidence of ovarian
failure is high in o lder patients, and is 43% in those abo\·e -t5.
76. A-F, B-T, C-T, D-T, E-F .

Intravenous antibiotics are giYen during the procedure and are
not required after it. Occlusion of uterine a rtery is the desired end
point. But nO\V more and more radiologists prefer selecti\·e
occlusion of fibroid vasculatur::. A l tho u gh the embolic age n t is
injected into the uterine artery there is selecti\·e flmv into the larger
tumour vessels supplying the fibroid, resuitirtg in s paring of
ovarian artery uterine artery rnlla tera l s .
77. A-T, B-F, C-T, D-F, E-F

Ectopics are predominantly located in the ampulla and isthmus.
Cornua, cervix, ovary and abdomen are unusual locations. A true
gestational sac and pseudogestational sac of the ectopic pregnancy
should be differentiated. The true sac is eccentric and has two
decidual rings. The pseudo sac is located centrally and has a single
layer. Normal incidence of co existing heterotopic pregnancy is
1 /30000. It is increased in assisted reproduction.
78. A-T, B-T, C-T, D-T, E-T

Prior tubal pregnancy, altered tubal transport are other causes.
Endometriosis, advanced maternal age are other known risk
factors.
79. A-T, B-T, C-T, D-T, E-T

Empty gestational sac is a common finding. Adnexal ring is 1-3
cm. Adnexal mass can be c\·stic or solid and is due to clotted blood
g
and hematosalpinx. Echo enic ascites has' 95% predictive value.
80. A-T, B-F, C-T, D-T, E-F

> 1000 IU I L, Second International standard or > 1800 IU /L
International Reference preparation, for trans\·aginal scans.
>6500Il: /l International reference preparation, for transabdominal
scans
Al though intrauterine gestation \·irtuall y excludes ect opic
pregnancy, a pelvic scan has to be done to rule out co existent
ectopic pregnancy.
B HCG does not rise abo\·e 66% in 48 hours, unlike intrauterine
pregnancy.
81. A-T, B-T, C-T, D-T, E-F
82. A-T I B-FI C-FI D-TI E-T

Tubal rupture occurs in 15%.
Aspiration of unclotted blood with hematocrit more than 15% is
patho gnomonic.
83. A-T, B-T, C-F, D-T, E-T

Decidual cast is h)rperechoic due-to hormonal stimulation. Decidual
cyst i s 1-5 mm at junction of endo and rnyometrium. Low
i mpedance, high velocity endoII].etrial flow is seen in normal
intrauterine pregnancy. In ectopic, the low impedance endometrial
flow is absent, but is seen in the adnexa.
84. A-T, B-T, C-F, D-T, E-T
85. A-F, B-T, C-F, D-T, E-T

Disease usually is ascending and hence, bilaterally asymmetrical.
Hematological spread is rare and occurs only in tuberculo sis.
Unilateral disease is seen in sprad from adjacent structures, such

as appendicitis, diverticulitis and post surgical. Small bowel
obstruction can be seen due to adhesion to adjacent bowel loop.
86. A-T, B-T, C-T, D-T, E-F

Endometrium can be heterogenously thickened. Uterus is bulky
with ill defined margins.
87. A-T, B-T, C·T, D-T, E-T

Tube is thickened and enhances on contrast. Renal hilar and
paraaortic lymphadenopathy are seen.
U retral obstruction is a recognised feature
88. A-T, B-T, C-T, D-T, E-F
89. A-F, B-T, C-T, D-T, E-F

The recurrence rate after myomectomy is from 20-50%. MRI should
be done i n all patients to exclude other lesions, such as
adenomyosis, which have the same symptoms, but different
outcome. Uterine sarcoma should be excluded before embolisation.
B u t there are no specific clinical or radiologic features to
distinguish it from fibroid.
90. A-F, B-T, C-T, D-T, E-T

Secondary torsion of an associated lesion is common. 3 times
common in the right side.
91. A-T, B-F, C-T, D-F, E-T

T h e classical appearance of enlarged ovary, with multiple
peripheral cysts (follicular cysts with fluid), is seen in less than
20% of cases. Enlarged ovary is the most consistent finding.
Demonstrating venous flow is the most sensitive finding. Vascular
engorgement and edema causes increased sound transmission.
92. A-T, B-F, C-T, D-F, E-T

Although rare, demonstrating intravascular air within an twarian
tum.our is specific.
High density �Nithin ovary is a feature of haemorrhage and not
torsion. Blood vessels are engorged on side of lesion .:rnd the lesion
is draped by thick straight vessels. The lesion is contigous with
the lesion. No enhancement is seen due to infarction.
93. A-T, B-T, C-T, D-F, E-T

Premature l abour, fetal distress, perinatal mortality a re other
complications.
94. A-T, B-T, C-T, D-T, E-T

Alcohol, Arnniocentosis, idiopathic, premature rupture of mem
branes, Antiphospholipid antibody syndrome, clottir:g disorders
are other ca uses.
95. A-T, B-F, C-F, D-F, E-F

Contained haematomas ha\·e the worst prognosis. Fetal hypoxia
depends on the size of haematoms, especially larger ones more
than -±0°� of maternal surface. In abruptions after 20 weeks, normal
deli\·erv is seen in onlv 30%.
J ,
96. A-F, B-F, C-F, D-F, E-T

Marginal abrupti0n is common, venous bleeding from marginal
veins, smoking associated. Retroplacental is arterial (high pressure),
spiral arteries, hypertension and vascular disease associated. Fetal
parts cannot be felt clearly because of rigid uterus.
97. A-T, B-T, C-T, D-T, E-T

Chorioangioma of placenta is another differential diagnosis.
98. A-F, B-T, C-T, D-F, E-T

Carcinoma of the cervix is the leading cause of gynaecological
malignancy worldwide. But in the west, it is the third leading cause
after endometrial and ovarian malignancy, due to better screening
and a different prevalence of risk factors. MRI is the most reliable
imaging modality in evaluating cervical cancer. Phased array coils
p!"o\·ide high resolution, \\·hich will result in better detection of
stromal ini.·asion. Images are acquired in axiai, oblique axial
(perpendicular to the long axis of the cen·ix), coronal and sagittal
images. Parametrial invasion is best assessed in axial images or
axial oblique images.
99. A-F, B-F, C-F, D-T, E-F

Although endovaginal or endo rectal coils give a high resolution
and high signal to noise ratio, they are not good in evaluating high
pelvic nodes. Cancer of the cervix presents as a hyperintense signal
lesion in T2 weighted images. This signal abnormality correlates
within 5 mm of measurement in pathological specimens. Although
the diagnosis of cervical cancer is made on clinical examination
and Pap smear, MRI has a role i n diagnosing cancers that are
difficult to identify by colposcopy and situated deep in the cervical
canal or infiltrative lesions deep to epithelium.
100. A-T, B-F, C-T, D-F, E-T

The majority (70%) of cervical cancers are microinvasive and MRI
is not useful in diagnosis of these lesions, because of central high
signal intensity. Dynamic MR imaging is a new modality, which
shows the early lesions as strongly enhancing areas on arterial
phase images. The accuracy of various modalities for differen
tiating superficial and deep lesions are T2W- 76%, contrast
enhanced Tl W-63% and Dvnamic MR-98%. 95% of IB lesions are
J
detected hy MRI as high signal areas. The presence of an C'-.!ter

Gynaecological Diseases 2i9
low signal intensity ring of cervical tissue, indicates the tumour

is confined to the cervix with a specificity of 100%. The absence
of this ring, indicates that there is parametrial extension, but false
positive results occur due to exophytic tumours and peritumoral
inflammation. This sign has a positive predictive value of only 85%.
Proximal extension of the tumour into the uterine body, is best
assessed by sagittal and oblique axial images, which is very useful
in young fertile patients, where trachelectomy (excision of tumour
only) can be performed, if the tumour is confined to the cervix
only.
101. A-T, B-F, C-T, D-T, E-T

The normal vaginal mucosa and epithelium has a high signal
intensity and the vaginal wall is of low signal intensity. Segmental
disruption of this low signal epithelium or a thick hyperintense
vagina are indicators of vaginal extension. MRI has an accuracy
of 93% in diagnosing vaginal extension. Asessing a thin stretched
fomix is difficult because it may not be identified, even if its infact.
The normal parametrium shov\·s high signal intensity on T2vV
images and the normal stroma shows low signal intensity. Axial
images are best used for assessing pa rametria 1 invasion. The
presence of a low signal rim outside the cancer, has a 100'>�
specificity for ruling out par ame t r i al extension. This is the most
important factor to be assessed i.:: staging of cer'l:ical cancer and
MRI with its high negati\·e precic:i\·e vaiue is \·ery useful.
102. A-T, B-T, C-T, 0-T, E-F

The role of contrast enhancement in assessment of parametrial
invasion is controversial. ·while some studies sav that contrast
enhancement increases the ability of MRI in assessing parametrial
involvement, it may overestimate the involvement. Extension to
the pelvic side wall is IIIB and is indicated by invoh·eme:1t of pelvic
musculature or iliac vessels or radiating strands or (Omplete
replacement of the parametrial high signal. \1RI is \·ery sensi ti \·e
in diagnosis of extension to bladder and rectum. It is not useful
in assessing extension to vesicoureteric junction as ureter is not
visualized in 1v1RI.
103. A-T, B-F, C-F, D-F, E-T

Rectal invasion from cancer cervix is suggested by loss of th e lm"·
signal intensity in the anterior \.\·all of the rectum or presence of
prominent strands behveen the rectum and the tumour. i\1R has
the s;:irne accuracy as CT in assessing lymph nodal in\·olvement
(70-80%). Size and shape are the useful factors. Round nodes 21:-e
suggesti\·e of malignancy rather t:tar. o\·al rtodes. Sigr.3 '. in:e �- · · ·;

is not useful in distinguishing benign and malignant. But ultra small

superparamagnetic iron oxide may be useful in characterizing
lymph nodes.
104. A-T, B-T, C-T, D-T, E-T

MRl is the best modality for assessing the cervix after radiotherapy
for cancer. Reduction of the high signal and tumour volume in T2W
images, indicates response. Presence of a hyperintense mass in
T2W images has a 86% positive predictive value in predicting
residual tumour and the presence of a normal signal in T2W images
has a 97�/ll negative predictive value. After radiotherapy, the cervix
has a lower signal than normal due to post radiotherapy fibrosis.
Response to radiotherapy may be early or delayed (> 6 months).
Larger tumours have a delayed response.
105. A-T, B-T, C-F, D-T, E-T

The commonest site of recurrence is vaginal apex, followed by the
pelvic side wall. MRI is very useful in differentiating recurrence
from post surgical and radiation changes. In the early stages, ( <1
year), the scar is hypointense in both Tl and T2W images, whereas
a recurrent tumour is hyperintense in T2 W images. But after one
year, even the scar develops high signal on T 2W images, making
differentiation very difficult. The presence of a tumour mass is
the most important indicator of tumour recurrence. Contrast
enhancement is useful if a peripheral recurrence is suspected or
post treatment complication like fistulae are suspected. Dynamic
contrast is useful by showing early enhancement in malignant
tumours. Dynamic MRI has a sensitivity of 67% accuracy for
recurrent tumour detection, whereas the T2W images have an
at:curacy of only 22%.
106. A-F, B-F, C-T, D-T, E-T

FIGO STAGING OF CERVICAL CARCINOMA
I-confined to cervix, IA-microinvasive cancer, IB-clinically
. .
mvas1ve cancer
HA-extension to upper 2/3rd vagina, IIB-parametrial involvement
IHA-extension to lower third of vagina, III B-pelvic wall/
hydronephrosis
IVA-Spread to adjacent organs, !VB-distal metastasis.
107. A-T, B-T, C-F, D-T, E-T, F-T

Cervical tumours are best seen in T2W images. Tl W images are
used for characterization of signal intensities seen in T2W images.
Sagittal images are used for extension to uterus and vagina.
Contrast enhancemer.� is useful for assessing bladder and rectal
invasion, but it frequ,· :ttly leads to overestimation of tur_�. .:-·...:.:- s;.Z'=
and extension. Dynamic contrast enhancement also has its uses.

Early phase of dynamic ontrast studies are better for assessing
the tumour than the T2W images. It is also useful for assessing
preinvasive disease, stromal invasion, and diff e r en tia ting
recurrence from new benign disease in a post surgical patient.
108. A- T, B-F, C-T, D-F, E-T

MRI of cervix shows three layers in the T2 weighted images. The
central high signal (mucosa and secretion within the endocervical
canal), middle low signal (fibromuscular stroma) and outer
intermediate signal (cellular component).
109. A-T, B-T, C-F, D-T, E-T, F-T

The staging of CA cervix is very important for deciding the
treatment modality. The most important factor to be assessed is
the presence of parametrial invasion. Young ladies without
parametrial invasion are managed by surgery. Older patients and
younger patients with parametrial invasion are managed with
radiotherapy. The staging is done by clinical examination and
radiolog�cal investigations. There is a discreapancy of upto 67°'o
between the FIGO staging and surgical staging, in the stages II
IV and up 32% for stage 1. The accuracy for various modalities
are Clinical-70%, CT-63°·0, \1RI-83°'o, :naki..'lg \IRI the most accurate
and reliable metho d, escecialh: i:i pa:-ametrial invasion. (92');>
1 • •
accuracy, CT-70°10 and clinical -70c.)).
110. A-T, B-F, C-T, D-T, E-F

B HCG is elevated in choriocarcinoma.
111. A-F, B-T, C-F, D-F, E-F

Staging of endometrial carcinoma (commonest ca use of
gynaecological malignancy)
IA-limited to e n dometriumm, IB-in\·asion of <1 /2 of
mvom etr i u m , IC-1/2 of mvometrium
, ,
IIA-endocervical glands, II B-cen·ical stroma al:;o

IIIA-serosa, adnexa, positive peritoneal cytology, IlIB-pelvic,
·
paraaortic nodes
IVA-invasion of bowel or bladder mucosa, IVE-distal metastasis
There are many histologic types, with adenocarcinoma accounting
for 85% or more.
112. A-F, B-T, C-T, D-F, E-T

E n dometrioid cancer is the commonest malign a nc y associated 1,\·ith
endometriosis follm\:ed by clear cell cancer. Papillary projection
is more reliable than the other signs desc:-ibed. Papilla:-y
projections o ccasi o na l l y do occur in benign lesions. Ci2a.r ce�t
tumours, are aJ·ways malignant, but they usually present in Stage

I and ha \·e good prognosis.
113. A-T, B-T, C-F, D-F, E-T

Brenner tumour is an epithelial tumour \.\·ith transitional elements.
It is benign in majority of cases, usually small. Malignant germ
cell tumours constitute only 5% of all malignant ovarian tumours.
Epithelial tumours are the biggest group. Rokitansky nodule is a
solid projection seen within the cystic teratoma and usually made
of hairs, but also contains the teeth and bone, when they are
present.
114. A-F, B-F, C-F, D-F, E-T

Depth of m yometrial invasion is the most important, although
grade and lymphadenopathy are other prognostic indicators. More
deeper the myometrial in\·asion, more severe the lymphadeno-
- pathy. Hematogenous mets occurs in late stages. 5% seen before
40 years.
115. A-F, B-F, C-T, D-F E-F

In stage I disease, primary management is surgery followed by
adjuvant radiation, whereas in stage II radiation is followed by
surgery. Endometrial stripe generally is ab:iormal in postmeno
pausal ladies, if it is more than 8 mm, but upto 12 mm can be seen.
If endometrial stripe is thin, the yield v>ill be low due to atrophic
epithelium. Focal thinning indicates superfical infiltration of
myometrium and loss of the dark myometrial layer, indicates deep
infiltration. Myometrial involvment is also seen in fibroids, polyps
and normal postmenopausal women.
116. A-T, B-T, C-T, D-T, E-T
117. A-T, B-T, C-T, D-T, E-F
118. A-T, B-F, C-T, D-T, E-F

Krukenburgs tumour is ovarian metastasis with diffuse stromal
infiltration with signet cells. It is seen in younger age group.
Bpateral tumours, with ascites is common. It mimicks a primary
malignant tumor and cannot be differentiated based on imaging.
119. A-F, B-F, C-T, D-F, E-T

Small collateral vessels can be catheterized and embolised which
is a significant improvement from surgical ligation. Active bleeding
is seen only if it bleeds at the rate of 1-2 ml/min. It might not
be seen, if the uterus is atonic and bleeding is intermittent. Hence
embolisation should :ie done, even if there is no active bleeding
at time of procedur:·
120. A-T, B-F, C-T, 0-T, E F -
In dynamic MRI, enhancement of endometrial carcinoma is hetero

genous, but less that of adjacent myometrium. Adenosarcoma is
a combination of sarcoma and benign epithelial proliferation in
endometrium. Carcinosarcoma has both carcinoma and sarcoma.
121. A-T, B-F, C-F, D-F, E-F

Adenocarcinoma is the most common tumour of fallopian tube.
The staging of fallopian tube cancers is the same as that of ovarian
cancer. I-confined to tube, II-pelvic extension, III-Peritoneal
implans, IV-distal metastasis. Liver capsule involvement indicates
peritoneal disease. Seen 50-70 year age group.
122. A-T, B-T, C-F, D-F, E-F

Solid component, papillary projections, enhancement of solid
component, ascites and peritoneal enhancement are features of
malignancy. 60% of epithelial tumours are benign. 35% are
malignant. The histological subtypes cannot be differentiated on
the basis of imaging appearances. The two commonest cystic
lesions are mucinous and serous cystadenomas. Both of them are
well defined, uni or multilocular, without solid components. But
serous cystadenoma has homogenous content, but mucinous is
heterogenous. i'v1ucinous are multilocular in majority, but serous
are unilocular in majority.
123. A-T, B-T, C-F, D-F, E-T

Serous cystadenocarcinomas constitute 50°'0 of malignant ovarian
tumours, but mucinous cystadenocarcinomas constitute 10°0.
Serous tumours are usually unilocular, but can be multilocular.
Serous tumours produce peritoneal carcinomatosis, but mucinous
tumours can produce pseudomyxoma peritonei. Calcification is
commoner in serous tumours and psammomatous type. It is linear
in mucinous types.
124. A-F, B-F, C-T, 0-T, E-F

Size more than 4 cm, wall thickness more than 3 mm, heterogenous
solid and cystic components, papillary projections, invasion of
adjacent structures, lymphadenopathy, metastasis, bilaterality,
ascites, peritoneal deposits are features of malignancy.
125. A-T, B-T, C-F, D-T, E-T

Struma ovarii is a subtype of ovarian teratoma, which produces
thyrotoxicosis due to formation of thyroid epithelium. Rokitansky
nodule has hair plugs, fat, calcification which are ect.:genic \.vith
acoustic shadowing.
284 Genitourinary, Obs tetrics & Gynaecology and Breast Radiolo_f!X
126. A-T, B-F, C-F, D-T, E-F

Dysgerminoas are analogous to seminomas of testis. Usually they
do not produce any hormone, but can produce hCG. Only 1 % of
teratomas are immature. Yolk sac tumours are malignant in
majority of cases.
127. A-F, B-T, C-F, D-T, E-T

Fibromas are the most common sex cord stromal tumour, but
grar.ulosa cell tumour is the commonest malignant sex cord stromal
tumour. Cranulosa cell tumour is seen in perimenopausal age,
unlike thecomas which can occur even in premenopausal group.
Granulosa tumours are usually solid without papillary projections
and peritoneal seedling and organ invasion are uncommon. It
secretes estrogen.
128. A-F,B-T, C-F, D-F, E-F

Fibromas are usually solid and small and are not malignant. MR
signal characteristics will demonstrate the fibrous nature of the
lesion. It has to be differentiated from a subserosal mvomas.;
Sclerosing stromal tumour is a rare tumour that shows peripheral

enhancement and delayed filling in, due to cellular elements and
fibrous stroma. Sertoli leydig tumours are the commonest virilising
tumours of the m·ary and they are functioning in only 30% of cases.
12 9. A- T, B-T, C -F, D-T, E-F

Right femoral approach is commonly used. A pelvic angiogram is
obtained by pigtail catheter. Then 4-5 F sidewinder catheter is
placed selectively in the transverse portion of the uterine arteries,
bilaterally and 400-600 micrometers of PY A articles are used for
embolisation.
130. A-F, B-F, C-F, D-T, E-T

Internal iliac artery is catheterized. High signal in Tl does not
correlate, but high signal in T2 correlates. Presence of menorrhagia
is the major indication. Antibiotics are given before and after the
procedure.
131. A-F, B-T, C-F, D-F, E-F

Laparoscopy is not useful in visualising the interstitial portion of
the tube, which is covered by myometriwn. The commonest cause
of blockage in this location is debri plug. Tubal recanalisation is
successful in upto 90% of cases. A 6F catheter is placed through
the cervix, near the os. A 3F catheter and 0.018 inch guide wire
are passed through the tube. Recanalisation is achieved by passage
of the guidewire and balloon dilatation is unnecessary. Perforation
is seen in 15% of cases.
Gynaecologicai Diseases 285
.
132. A-T, B-F, C-T, D-F, E-T

Ultrasound is useful in pregnant patients. MRI is useful in both
pregnant and non pregnant patients.
Length of cervical canal < 3 cm, width of cervical canal > 2 cm,
width of internal os > 4 mm, thinning of cervical stroma are
features. DES, multiple pregnancies, trauma are other causes.
1. Causes of hypercalciuria:
A. Alcohol
B. Diabetes mellitus
C. Hypervitaminosis A
D. Scleroderma
E. Rickets
2. Good results are obtained in renal angioplasty in the following

conditions:
A. Fibromuscular hyperplasia
B. Calcified aorta
C. Ostial stenosis
D. Negative captopril reno gram.
E. Kidney length more than 9 cm
F. Post captopril resistive index less than 0.65 in high risk patient.
3. Ovarian follicles:
A. Number of foEicles is more in adults than adolescent girls.
B. Number of follicles is higher in anorexic girls
C. Do not mature in polycystic ovarian disease
D. Absent in post menopausal women.
E. Not seen at birth
4. Radiofrequency ablation of renal tumours:

A. It is difficult to identify the interface between tumour and
normal tissue in ultrasound, during ablation.
B. MRI is highly useful in radiofrequency ablation.
C. Follow up contrast CT for assessing success of therapy should
be done at five days after surgery.
D. An enhancement of more than 10 HU after contrast indicates
failure of treatment.
E. Iron compounds and saline increase the success rate of
procedure
Miscellaneous 287
5. Causes of inc reased echogenicity m the renal medulla:

A. Renal tubular acidosis
B. Leukemia
C. Chronic glomerulonephritis
0. Med ullary sponge kidney
E. Medullary cystic disease
6. Causes of renal enlargement in patient who had nephrectomy:

A. Acute tubular necrosis
B. Compensatory hypertrophy
C. Acromegaly
0. Diabetes mellitus
E. Amyloidosis
7. �1alaria:
A. Plasmodium ovale causes nephrotic syndrome
B. Splenic rupture is a complication
C. Plasmodium falciparum causes cerebral edema.
D. Pulmonary edema and hemoglobinuria are features of Vivax
infection.
E. Hepatomegaly is not a feature.
8. Embolisation of renal tumours:

A. Used mainly in inoperable tumours.
B. Embolisation of lumbar arteries mavbe indicated.
C. Embolisation of onl\· the central arteries is a\·oided.
D. Small particles should be used if there is AV shunting inside
the tumour.
E. Coils are used for embolising the peripheral small arteries
F. Diabetes is a contraindication
9. �1RI of post radiotherapy bladder:

A. The earliest changes are seen in the anterior wall of the
bladder.
B. Low signal in Tl and T2 excludes tumour.
C. T2 changes of radiation last for -l:-5 years
D. Contrast enhancement rules out simple radiation changes
E. Dynamic contrast enhancement > 1.5 at 80 seconds has high
negative predictive value in recurrence.
10. The following are indications for radiofrequency ablation of RCC:

A. Von Hippel Lindau disease
B. Multiple synchronous tumours
C. Solitary kidney
D. Minimal extrarenal spread
E. Tumours less than 3 cm.
ANSWERS
1. A-T, B-F, C-F, D-F, E-T
Hypercalciuria by definition is daily urinary calcium excretion of
more than 250 m in females, 275-300 mg in males. Causes of
hypercalciuria-animal protein, alcohol, caffeine, refined
carbohydrates,fiber, fluids, sodium, oxalates, hypervitaminosis D,
Milk alkali syndrome, sarcoidosis, renal leak of calcium o r
phosphate, p rolonged immobilization, hypercalcemia and
hyperparathyroidism are other causes.
2. A-T, B-F, C-F, D-F, E-T, F-T

Renal angioplasty is very successful in fibromuscular hyperplasia.
In atherosclerotic ostial stenosis, the restenosis rate is high. There
is not always a correlation between technical success and clinical
success rate. Positive captopril tests and renal length more than
9 cm, indicate good success rate, although the sensitivity and
- specificity of such factors is not very high. If the resistive index
(unilateral or bilateral is low) and there is a fall with adminis
tration of captopril, it indicates a pliable vasculature and hence
good outcome. This has to be correlated with the risk of the
procedure. In patient with low procedural risk a precaptopril
RI < 0.75 and renal length more than 9 cm, for intermediate risk
a precaptopril RI <0.75 and postcaptopril RI <0.70 and for high
risk patients a postcaptopril RI <0.65 and renal length > 9 cm are
used.
3. A-F, B-F, C-T,D-T, E-F

Follicles progressively decrease with age. Anorexic girls have
amennorhea. Follicles rupture when they are approximately 2.5 cm.
4. A-T, B-T, C-F, D-T, E-T

Radiofrequency ablation can be done with ultrasound, CT or MRI
guidance. MRI is helpful for obtaining images in multiple planes.
Ultrasound shows hyperechogenicity after the probe is placed,
making identification of tumour- normal interface difficult. MRI.
Immediate CT after ablation will be difficult to interpret, because
hyperaemic response to ablation produces high density and
residual tumour produces irregular enhancement. A good response
is demonstrated by lack of contrast enhancement in CT or MRI
in a previously enhancing area. This is ideally performed at one.
Saline and iron increase heat dissipation. Anti angiogenetic drugs,
vascular occlusion, ethanol, pulse therapy are other methods of
increasing the success rate.
Miscellaneous 289
5. A -T, B-F, C-F, D-T, E-F

High echogenici ty i s seen in medullary· neph r oca lcinos i s, autosomal
recessive polyc ys tic kidney disease, renal vein thrombosis, fungal
infections.
6. A-T, B-T, C-T, D-T, E-T

Acute interstiti a l n ephritis , acut e pyelo n ephri t i s, L euk e mi a,
Myeloma, amyloidosis, cirrhosis, diabetes, Beckwith Wiedemann
s yndrome, renal vein thrombo sis, hydronep h r o s is, polycystic
kidney are some of the other causes .
7 A-F, B-T, C-T, D-F,. E-F

There are four type of plasmodium species causing malaria, which
is transmitted by anop heles mosquitoes. Vivax-commonest type,
50% rela p s e in few weeks to fiv e years. Ovale-le s s severe,
r esol ves without treatment, Malariae-stays a symp tomatic for
long er time, recru descence common, nep h rotic sy ndrome
produced due to an tig en antibody deposition, Falciparum-more
severe with c o mplic ations, due to cyto adherenc e of RBCs to
endothelium a n d ob struction, produces cereb ral malaria,
p ulmonary ede m a, hemoglobinuria, haemolytic anemia and
fulminant renal failure.
8. A-T, B-T, C-T, D-F, E-F, F-F

Renal tumours were embolised for reducing tumour vas.::ularity
before surgery. But no\v !t is mainly used for inoperable tumo'.l.;s
or for small tumours i.n solitary kidney. Peripheral tumour arteries
are occluded by using particles, ethanol or l i q uid vv-ith lo\\..
vi scosity. Large p articles should be used if there are AV shunts
to avoid pulmonar y embolisation. Central arteries are occluded
by coils or liquid glue. Occlusion of only the central arteries should
be generally avoided, because the peripheral arteries will reform
due to collater al supply and the route for further int e r v en tion is
blocked. Fever, p ai n and leucocyto sis are components of post
infarction syndrome .
9. A-F, B-F, C- T, D-F, E-T

Earliest changes are seen in the trigone. High T2 signal i s seen
in the m u c o s a. Lat e r high T 2 signal i s seen in all l aye r s.
Haemorrhage produces high signal in Tl and T2. Fibrosis produces
low signal in T l and T2. Fibrosis does not enhance on contrast
but superimposed inflammatory changes can enh ance . Tumour is
lo\v in Tl and high in T2. Desrnopla stic reaction can produce low
signal in Tl and T2 R apid intense enhancement is seen in con trast
scans, but this is not reliable. Dynamic contrast sc anning , showing
290 Genitourinary, Obstetrics & Gynaecology and Breast Ra<!!9J99Y
enhancement ratio of more than 1.5 at 80 seconds post contrast,

indicates recurrence. This has a good negative predictive value.
10. A-T I B-T I C-T I D-FI E-T

Localised tumours, in solitary kidney, old age and contraindi
cations to sugery. Extrarenal extension, vascu lar extension,
metastatic disease and a candidate for nephrectomy are not
included for radiofrequency ablation. Infection, bleeding diathesis
and debilitating conditions are other contraindications.

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• MCQsin

(Question Bank for FRCR)

Senior Registrar in Radiology

Dr Biswaranjan Banerjee MBBS FRCS FRCR

2. Renal Vascular Disease and Trauma ·······-·······················-······· 17

3. Renal Imaging ·······································-········································· 35

4. Infections ································· ··················································-······· 67

5. Obstruction, Interventions and Transplantation ... ......

7. Renal Tumors ····················································-···························· 118

9. Imaging of Prostate . ... ....... . . . ..... . . . .. . .. . . . ... .. .... 156

11. Breast Imaging . . .. .. . . ... . ... .... . .. . . .

12. Obstetric and Fetal Ultrasound .. ... . . ..

13. Gynaecological Diseases .... .. . .... ....... ...

Bibliography ................... ... . . . . ........... ........................................ ..... . . ...... 291

2. The following s�ctures are formed in mesonephros:

4. Genitourinary Structures and their embryological origin:

7. Contents of anterior pararenal space:

8. Renal fas cia :

10. Renal collecting system:

11. Perinephric space:

14. Retrograde pyelography:

15. Retrograde pyelography:

C. If a filling defect is seen in ureter in IVU, RGP is required for

17. Ascending urethrography:

18. Abdominal lymph nodes:

19. Paraa ortic nodes drain the following:

20. Lymph nodes of pelvis:

22. External iliac group of lymph nodes drain the following

23. Sympathetic nerves in the abdomen:

24. Abdominal wall:

25. Abdominal wall:

26. Structures seen in the retrocrural space:

27. The following structures are absent in majority of renal a ge ne sis :

29. R enal a genesis:

30. Duplex kidneys:

31. Retrocaval ureter:

32. Pelvic kidney:

33. Congenital anomalies of kidney:

34. The following are associations of pelvic kidney:

35. Horseshoe kidney:

36. ADPKD (Autosomal dominant polycystic kidney disease):

37. Multicystic kidney s:

38. Adult polycystic kidney disease:

C. 100% of 30 year olds have cysts on ultrasound

40. Horseshoe kidney s :

42. Associations of ADPKD:

43. Horseshoe kidneys:

44. Features of Eagle-Barrett syndrome:

45. Cysts are seen in the following locations in ADPKD:

48. Medullary sponge kidney:

49. Medullary sponge kidney:

51. Associations of medullary sponge kidney:

2. A-T, B-T, C-T, D-T, E-T

3. A-T, B-T, C-F, D-F, E-F

4_. A-T, B-T, C-T, D-F,E-T

5. A-T, B-F, C-F, D-T, E-T

6. A-T, B-F, C-F, D-T, E-T

7. A-T, B-T, C-T, D-F, E-F

8. A-T, B-T, C-T, D-F, E-F

The anterior pararenal space is anterior to the anterior renal fascia