1 5048723396339171358

MCQs
Clinical Radiology
(Question Bank for FRCR)
I
I
Prabhakar Rajiah
I >.-mos \ID ?RCR
I Senior Regis trar in Radiology

Manchester
r l:nited Kh•gdom
First published in the UK by
Anshan Ltd
in 2006
6 Newlands Road
Tunbridge Wells
KentTN4 9AT, U K
Tel/Fax: +44 (0)1892 557767

E-mail: info@anshan.co.uk
www.anshan.co.uk
Copyright© 2006 by (author)
The right of (author) to be identified as the author of this work has been
asserted in accordance with the Copyright, Designs and Patents act 1988.
ISBN 1 904798 586
British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library
All rights reserved. No part of this publication may be reproduced, stored in a

retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording and/or otherwise without the prior written
permission of the publishers. This book may not be lent, resold, hired out or
otherwise disposed of by way of trade in any form, binding or cover other than
that in 1...v""';ch it is published, without �he prior consent of the publishers.
Printed in India by Sanat Printers, Kundli, Haryana
Many of the designations used by manufacturers and sellers to distinguish

their products are claimed as trademarks. Where those designations appear in
this book and where the publisher was aware of a trademark ctaim, the
designations have been printed in initial capital letters.
I VOL LH�ff 6 f
MCQsin
Clinical Radiology
Neuroradiol�gy,
Head and Neck
Radiology
(Question Bank for FRCR)
Prabhakar Rajiah
\fBBS \[D rRCR
Senior Registrar in Radiology

011anchester
Cnited KL.1gdom
JAYPEEBROTHERS Tunbridge \.�'rff �

MEDICAL PUBLISHERS (P) LTD
New Delhi U�<
First published in the UK by
Anshan Ltd
in 2006
6 Newlands Road
Tunbridge Wells
Kent-TN4 9AT, UK
Tel/Fax: +44 (0)1892 557767

E-mail: info@anshan.co.uk
vV\vw.anshan.co.uk
Copyright© 2006 by (author)
The right of (author) to be identified as the author of this work has been
asserted in accordance with the Copyright, Designs and Patents act 1988.
ISBN 1 904798 586
British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library
All rights reserved. No part of this publication may be reproduced, stored in a

retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording and/or otherwise without the prior written
permission of the publishers. This book may not be lent, resold, hired out or
otherwise disposed of by way of trade in any form, binding or cover other than
that in which it is published, without the prior consent of the publishers.
Printed in India b y Sanat Printers, Kundli, Haryana
Many of the designations used by manufacturers and sellers to distinguish

their products are claimed as trademarks. Where those designations appear in
this book and where the publisher was aware of a trademark claim, the
designations have been printed in initial capi!al letters.
Radiology is not just X-rays anymore. The rapid strides made in
imaging technology h a s revolutionised radiology with ad vent o f
Ultrasound. Computed Tomography. Magnetic R�sonance Imaging. PET
scanning and Interventional 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 this 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 fellovvship exams and has been
1,,vritten using up w date and accurate information. This is easily the
most extensive and largest co l lecti on of \1CQs in radiology available
rnday The main strength of the book the categorisation of questi"ons
.
into related subtopics and the tho r ough derailed explanation pro\·ided
.
1,,vith the ans\vers at the end of each section. The questions are of varying
difficulty, covering amongst others. differemial diagnosis. epidemio
logy. which is the staple of any fellovvship exam and recent imaging
techniques. The questions co\·er the three key components. anacomy.
techniques and pathology. This should benefit everyone from the
beginner to rhe 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 \vould be
of interest for senior radio lo g i s r s who \vould like to update their
knO\\·ledge and stay informed about current practices and i m agin g
methods. This book is an ldeal c o mb ination of informarilH1 Jnd re\·ision
resource.
Dr Biswaranjan Banerjee
MBBS. FRCS. FRCR
Consult ant R adi o l ogist .
Tameside General Hospital.

l\1anchesEer.
United Kingd,Jm
Multiple choice questions (MCQs) have now become the standard and
the most preferred means of 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 format 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. Hov.·ever. �here 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 \.\Titten primarily
as a revision tool for those sitting MCQ exams in 0/euroradiology. This
book can be approached in two ways. The best way is to read a particular
topic in a recognised text book or journal and subsequen tly test the
knO\vledge gamed using 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. \.vho
don't have to stick to any particular format as an informal and fun \.vay
of gaining and self testing radiological knO\vledge.
The format in this book is the same as used in the FellO\YShip exams
of the Royal Colleges of UK. Ireland. Hong Kong. Australia and !\e\\"
Zealand. The R o y a l College of CK Exam has 30 quhrions to be
ans1,,vered in one and a half hours. Each question has f i ve stems 1,,\·irh
true or false answers. The book has more than 900 que�tions. 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. \.vhich are the
important components of the Fellowship Exam. A detailed bibliography
is provided at the end of this book for further reading.
Prabhakar Raj iah

1. Neuroradiology .................................... . ......................................... . ..... 1
2. Congenital Anomalies ....................................................... . .

.. ........... 15
3. Trauma .................................................................................................. 35
4. Skull and Brain Lesions ............. . ........................................ .. . ........ 46
5. Infections . . ...................... . ............................. ........... . .......................... . 65.
6. Vascular Lesions .... . ............ . ............. . ..................................... . . .. ... 78

.. . . .
7. Tumours .............................................................................................. 116
8. Degenerative and Demyelinating Lesions .............................. 149
9. Head and Neck-1 .......................................................................... 176
10. Head and Neck-2 .......................................................................... 232
11. Spinal Cord ....................................................................................... 268
12. Miscellaneous .................................................................................... 293
Bibliography ..... .. .. ..
. . . ... ... .. . . ... .. . .. .. .... .. ...
. . . . . . . . . .... . ......... .. . . .
. . . . . . . .. . . . . . . . . . . 297
1. CT an d MRI of brain:
A. The white matter appears brighter than gray matter in CT scans
of brain
B. The middle and posterior fossa are best evaluated by CT scans
C. Choroid plexus is hyperimense in unenhanced MR images
D. Images for skull base are taken parallel to the line passing from
posterior lip of foramen mag num
E. The normal CT scan images are taken parallel to the line
tangential to orbital roof
2. !v1RI scan of brain:

A. The white matter appears bright in 12 and dark in T 1
B. The gray matter appears dark on T2 and bright or. T 1
C. The internal capsule is bright on T2
D. The globus pallidus and substamia nigra are bright in Tl and
dark in TZ
E. The gray matter is hyperintense to \vhite matter in proton
density images
3. Structures enhancing on contrast administration in CT:

A. Pituitary
B. Choroid plexus
C. Pineal gland
D. Infundibulum
E. Dura mater
4. Lesions hyperintense on Tl and T2W images:

A. Melanoma
B. Cholesteatoma
C. Posterior pit uitary
D. Flowing blood
E. Subacute haematoma
2 Neuroradiology, Head and Neck Radiology
5. Arachnoid cap cells are seen:

A. Adjacent to the superior sagittal sinus
B. Choroid plexus
C. Veins
D. Root sleeves of cranial nerves
E. Root sleeves of spinal nerves
6. Lesions hyperintense on Tl but hypointense in T2:

A. Chronic haematoma
B. iv1elanoma metastasis
C. Dermo id
D. Thyroid metastasis
E. Jv1eningioma
7. The following lesions are hypointense in Tl and T2:

A. Acute haematoma B. Calcification
C. Meningioma D. Metal
E. Gliosis
8. Skull:
A. The skull is made up of five bones
B. The base of skull is formed in membrane
C. Venous lacunae are most common in the occipital bone adjacent
to the transverse sinus
D. \·1etopic suture persists in adults in 2%
E. Foramen rotundum of both sides are often asymmetrical
v 9. The fallowing foramina transmit the corre sponding structures:

A. Foramen ovale- accessory meningeal artery
B. Foramen spinosum- middle meningeal vein
C. Foramen rotundum- mandibular division of trigeminal nerve
D. Pterygoid canal-a branch of maxillary artery
E. Foramen lacerum- internal carotid artery
10. The following are normal calcifications in skull:

A. Habenular commissure B. Petroclinoid ligament
C. Interclinoid ligament D. Dura mater
E. Choroid ple xus
11. Skull radiology:

A. The arterial impressions are larger than venous impressions
B. The diploic veins have two recognized valves in them
C. Parietal foramina transmit the emissary vein of Santorini
D. The posterior cerebral artery is situated against the free edge
of falx cerebri
E. There is no subarachnoid space in the sella
Neuroradiology 3
12. Brain embryology:

A. The developing brain is supplied exclusively by the internal
carotid artery
B. The germinal matrix is supplied by Huebners artery
C. The germinal matrix involutes by term
D. The ventricles are recognized in CT after 30 weeks
E. The Rolandic fissure appears at 20 weeks itself
13. The following structures enhance on Gadoliniu m adminis

tration:
A. Dura mater B. Cavernous sinus
C. Pituitary gland D. Carotid arteries
E. Choroid plexus F. Transverse sinus
1 14. The skull and sutures:

A. The anterior fontanelle closes in the first year
B. The lambda closes by the second month
C. The pterion closes in nine months
D. The metopic suture closes at five years
E. Diploic veins are present at birth
15. Lesions that produce -�o signal in Tl and T2\V l'vfRI images:
A. Chronic haematoma B. High flO\v
C. iv1etal D. Tendon
E. Gliosis
16. Mye li nation of brain:

A. Inversion recovery images are ideal for assessment of
myelination till two years of age
B. A t birth. the complete brainstem and cerebel lum are
myelinated
C. The optic radiations is myelinated soon after birth
D. The ventral pons is myelinated at 3 months
E. The corpus callosum is myelinated at 6 months
F. The anterior limb of imernal capsule is myelinatl'd at 2 months
17. Brainstem:
A. The fasciculus gracilis is situated medially in the medulla and
spinal cord and transmit sensation from the upper body
B. The fasciculus cuneatus i� situated laterally in the posrerior
aspect of medulla and transmit sensation from the upper body
C. rfhe foramen of i\.fagendie opens laterally from the fourth
ventricle into the cerebellopontine cistern
D. The foramen of Luschka opens centrally from the fourth
ventricle
E. The sensory decussation is posterior to the mowr deCL
.;ssation
.
18. CSF cisterns- and their contents:

·I
A. Cisterna magna-posterior inferior cerebellar artery
B. Pre-pontine cistern-XI nerve
C. Ambient cistern-superior cerebellar arteries
D. Interpeduncular cistern-trochlear nerve
E. Quadrigeminal cistern-venous confluence
19. Cranial n e rves:

J
/ A. The cranial nerve with the longest intracranial course is
abdurent nerve
B. The only cranial nerve to emerge from the posterior aspect of
brainstem is the vestibulocochlear nerve
C. The cranial nerve to show neurobiotaxis is facial nerve
D. All the cranial nerves are lined by Schv·:ann cells
E. All cranial nerves have sensory and motor components
20. The following are n ormal lucencies in skull vault:

A. Pacchionian impressions
B. Vascular impressions
C. Parietal foramina
D. Sutural diastasis
E. Thinning of parietal bone
21. Brainstem:
A. The pyramids are situated medially in the anterior aspect of
the medulla and the olives are situated laterally
B. The hypoglossal nerve emerges bet\·veen the pyramid and olive
C. The vagus. glossopharyngeal nerves emerge between the
pyramid and olive
D. The glossopharyngeal nerve passes through the pars vascularis
of the jugular foramen
E. The glossopharyngeal, vagus and accessory nerves can be
separately identified in high resolution MRI images
22. Lesions that are hypointense in Tl and hyper in T2:

A. Flowing blood B. Gliosis
C. Ligament D. Meningioma
E. Edema
23. The vagus su pplies the following:

A. The posterior aspect of meninges
B. The external auditory meatus
C. Intrinsic muscles of the larynx
D. Gastrointestinal t:act
E. Palate
Neuroradiology 5
24. The following regions and the cranial nerves passing through
them:
A. Meckels cave-trigeminal nerve
B. Dorellos canal-oculomotor nerve
C. Pars vascularis-glossopharyngeal nerve
D. Lamina ciribrosa-olfactory nerve
E. Greater palatine canal-vagus nerve
\_/ 25. Cranial nerves and their nuclei:

A. Trigeminal nerve-pons. midbrain and medulla
B. Oculomotor-posterior surface of midbrain
C. Vestibular upper pons
D. Facial-lower pons
E. Hypoglossal nerve-upper medulla
: 26. The skull:

A. The mendosal suture separates the basiocciput and basis
phenoid
B. In adults, the clivus bone is hyperintense in Tl \V images
- C. Convolutional markings are absent at birth
D. Convolutional markings are markedly seen between 10 -18
years
E. The occipital bone has the largest diploic spaces
27. Brainstem:
A. The superior colliculi are involved in hearing
B. The inferior colliculi are involved in vision
C. The lateral geniculate bod y is involved in vision
D. The medial geniculate body is involved in hearing
E. The substantia nigra divides i:he cerebral peduncles inrn crus
cerebri and tegmentum
28. Myelination_ in T2 W images:

A. T2'vV images are ideal for assessment of myelination after six
months
B. The adult myelination pattern is establishe<i by two years
C. The temporal white matter is the last to myelinate
D. The anterior limb of internal capsule myelinates by 12-1�
months
E. The genu of corpus callosum myelinates by 8-11 months
29. Cerebellum:
A. The flocculus of cerebellum enhances m o r e on contrast
administration than the rest of cerebellum
B. The superior cerebella
' r peduncle passes from cer·ebellum to the
pons
C. The inferior cerebellar peduncle passes from cerebellum to

medulla
D. The middle cerebellar peduncles are the largest
E. The superior cerebellar peduncle is oriented horizontally
30. The ventricular system:

A. The ventricles contain 100 ml of CSF
B. Dilatation of temporal hor n s is a sensitive indicator o f
hydrocephalus
C. Asymmetry of frontal and occipital horns is normal
D. CSF is produced at the rate of 500 ml I day
E. Choroid plexus calcification of fourth ventricle is seen in lateral
skull X-ray occasionally
31. Brain development:

A. The midbrain is a part of rhombencephalon
B. The pineal gland and thalamus are part of diencephalons
C. The habenula and pineal gland are called epithalamus
D. The lateral ventricles are the cavities of telencephalon
E. The third ventricle is the ca\·ity of diencephalon
F. The lamina terminalis is the anterior limit of the diencephalon
32. Pi nea l gland:

A. Calcified in 70% of cases in CT scans
B. Situated in the anterior aspect of the third ventricle
C. There are two laminae arising from the pineal gland
D. Calcification is seen from five years onwards
E. 50% of plain films show pineal calcification
33. Pituitary gland:

A. The infundibulum is larger in males
B. The infundibulum is enlarged if it is larger than the basilar
artery
C. The posterior pituitary normally shows high signal in Tl \A/
D. The pituitary gland is uniformly hypointense in neonates
E. The an terior and posterior lobes o f pituitary c a nnot be
separately identified in MR scans
34. The following are components of basal gangl i a:

A. Lentiform nucleus
B. Caudate nucleus
C. Red nucleus
D. Amygdala
E. Clausstrum
Neuroradiology 7
35. Corticospinal tract:

A. The corticospinal tract is situated in the posterior limb of the
internal capsule
B. The corticobulbar tract is seen in the anterior limb of the
internal capsule
C. The corticospinal tracts are always seen in the anterior aspect
of the brainstem
D. The anterior limb is supplied by anterior choroidal artery
E. The lenticulostr?ate arteries supply the genu of the internal
capsule
36. Corpus callosum:

A. The genu is the bulkiest portion of the corpus callosum
B. The corpus callosum develops from posterior to anterior
C. The anterior fibres of internal capsule extending into the
frontal lobe are the forceps minor
D. It is the largest projection fiber and formed by 10 weeks
E. Anteriorly the corpus callosum communicates with the anterior
commissure
37. Gyri and sulci:

A. The central sulcus is situated very posteriorly in the axial
images
B. All the major sulci and gyri are satisfactorily visuali ze d in the
MR images
C. The central sulcus separates the frontal and parietal lobe
D. The sylvian fissure completely separ ates the temporal and
parietal lobe
E. The cingulate sulcus lies bet\veen the corpus callosum and
cingulate gyrus
38. The ventricular system:

A. The cavum septum pellucidum is a subarachnoid space
B. Presence of cavum vergae \Vi[hout cavum s e p t um pellucidum
is normal
C. Cavum septum pellucidum is- persistent in 10'1<'.>
D. Choroid plexus calcification is normally seen cl fter 10 years of
age
E. Cavum vergae cannot be differentiated from cistern velum
interpositum
39. Choroid plexus is seen in the follwing locations:

A. Trigone of lateral ventricle
B. Confluence of body and temporal horn
C. Roof of third vemiicle
D. Floor of fourth ventricle
E. Floor of third vemricle
8 Neuroradio/ogy, Head and Neck Radiology
40. Facial nerve supplies the following structures:

A. Anterior belly of digastric
B. Platysma
C. Srnpedius
D. Anterior two-thirds of tongue
E. Sunlingual gland
[ - 41. Nuclear medicine:

A. Pertechnate has higher lesion to background ratio than DTPA
B. Pertechnate can pass through intact bfood brain barrier, but
DTP A can cross only damaged blood brain barrier
C. Potas�ium perchlorate is also required before penechnate and
DTPA
D. H!V1PAO crosses intact blood brain barrier
E. Localisation of DTPA and pertechnate depend o n the
vascularity of lesion
42. Nuclear medicine:

A. Localisation of ECD in brain is proportional ro regional blood
flow
B. H\1PAO has the maximum shelf life
C. H\1PAO remains in the brain for 24 hours
D. H\1PAO can localize epileptic foci
E. Radiation dose is reduced by good hydration
43. Cerebal angiography:

A. General anesthesia is used for cerebral angiography
B. Heparin should not be used in cerebral angiography
C. Air bubbles are common causes of ischemia
D. Guide wire should not remain \·Vithin catheter longer than a
minute, without flushing
E. Guide wire should not be introduced into contrast filled
catheter
..
Neuroradiology 9 . rJ·";
(_....
. - ,-;' (
.\ l, \ --
c.· ·_:., \· .
-- - - \ 0 -- ' \_�
ANSWERS
- '
\ . •
•. ' . .
-,·\vJ
a.. '"
- .··"(__\·-- \1
C) \ -·- ,-) ,,
1. A-F, B-F, C-F, D-T, E- T r\ �-
'
. ,.., )
The white matter is 9ark due to fat containin g myelin. The middle
and posterior fossa shows streak artifacts in CT scans. So N1R is
better. Choroid plexus does not appear bright in MR. Images for
skull base are tangential to floor of the sphenoid sinus.
2. A-F, B-F, C-T, D-F, E-T

The signal of white matter depends on the amount of myelination.
In Tl W images, the white matter is bright and gray matter is dark.
In T2W images, the white matter is dark and gray matter is bright.
In PD images, the white matter is dark and gray matter is bright.
The internal c a p s ule, especially the posteri o r l i m b w i t h
\ corticospinal fibres. is bright in T2W images, due to lower myelin
\
'density in 50%. The globus pallidus. red nucleus and substantia
nigra are dark i n Tl c:nci T2 due to inn deposition.
.
3. A-T, B-T, C-F, D-T, E-T
These structures are outside the blood brain barrier .
,
.. .
4. A�F. B-T, C-T, D;;f_, E-T

· Fat containing lesions are bright in both. Flowing blood is usually
d ark in both. But if there is slow flmv or turbulent flow, it will
show high signal. Posterior pituitary has high signal dt.:e to
neurophysin granules.
5. A-T, B-T, C-T, D-T, E-T

Mengiomas are derived from the �r-�_hnoitj _�_<iQ_ cells, which are
meningothelial cells in the arachnoid villi penetrating the dural villi
and are commonly seen adjacent to the large dural sinuses, ,veiri·s.
' root sleeves of exiting cranial nerves and �.horoids plexus. 1.1
6. A-F, B-T. C-F, D-T, E-F

Blood flo\\.". subacute haematoma and haemorrhagic metastasis are
other causes. Meningioma not beright in Tl. Iron (hemochroma
tosis, Hallervorden-Spartz) and copper (\Vilsons disease) are other
causes.
7. A-T, B-T, C-T, D-F, E-F -

Rapidly flowing fluid, cortical bone and air are other causes.
Lipoma. dermoid. epidermoid. cholesterol granuloma. cranio
pharyngioma are hyper in Tl and intermediate in T2.
8. A-T, B-F, C-F, D-F, E-F

The skull is formed of fronral. ethmoid. sphenoid, temporal and
occipital bones. The base of skull is formed in cartilage and v3.:..:lt
is formed in membrane. Venous lacunae are most prominent in
parietal bone adjacent to the superior sagittal sinus. Metopic suture

persists in 5-10%
Foramen ovale and spinosum are asymmetrical and not foramen
rotundurri:·
9. A-T B-T, C-F, D-T, E-F

.
Foramen ovale-mandibular division of V. accessory meningeal

artery: Foramen spinosum-middle meningeal artery and vein:
Foramen rotundum-maxillary division of V: Pterygoid canal
branch of maxillary artery: Foramen lacerum-small veins and
arteries. JCA only crosses it: Formaen Vesalius-emissary vein:
Stylomastoid for amen-Facial nerve. Hypoglossal c anal
hypoglossal nerve, emissary vein: Jugular foramen- IX. X. XI
nerves, veins
10. A-T, B-T. C-T, D-T. E-T
11. A-F, B-F, C-T. D-F, E-T

The venous impressions are larger than arterial impressi.Jns. The
diploic veins are valveless. The PCA is situated against the free
edge of tentorium cerebelli. There is no subarachnoid space in
sella. since the meninges fuse.
12. A-T, B-T, C-T, D-F, D-T

The ventricles are recognized as early as 24 weeks.
13' A-T' B-T. C- TI D-·F. E-F. F T-
Carotid artery and other vessels with rapid flow d o not

enhancement in Tl W images.
The choroid plexus does not show enhancement due to rapid flow
and calcification.
Tr ansverse sinuses and other vessels with slow flow show
enhancement.
14. A-F, B-T, C-F, D-T, E-F

Anterior fontanelle closes in second year. the posterior fontanelle
in two months and the pterion in 3-4 months. The metopic suture
fuses a t five years.
The diploic veins are absent at birth.
15. A-T, B-T, C-T, D-T. E-F

Chronic haematoma has hemosiderin. Gliosis has low signal in Tl
and high signal �n T2.
16. A-F, B-F, C-T, D-T, E-T, F-F

Upto 6 months. inversion recovery images are ideal for assessment
of myelination.
Neuroracfiofo9y i 'l
I
\.. \
At term. the brainstem except the ventral pons. cerebellar white

matter and poste�ior limb of internal capsule are myelinated. Soon
after birth-optic radiation: 2-3 months-ventral pons 3-6 months
corpus callosum beginning from spenium anteriorly to the genu.
4 months-anterior limb of internal capsule.
17. A-T, B-F, C-F, D-F, E-T

The fasciculus gracilis is posteromedial and carries fibres from
upper body, whereas the fasciculus cuneatus is lateral and carries
fibres from lower body.
The foramen of Lushka opens laterally into the cerebellopontine
cistern and Magendie opens in midline posteriorly.
18, A-T, B-T, C-T, D-F, E-T

Cisterna magna-IX. X. Xl. vertebral A. PICA
Pontine cistern-V to XII. basilar artery
Interpeduncular-III. basilar artery
Ambient-IV. PICA. superior cerebellar artery. basal vein of
Rosenthal
Quadrigeminal-IV. PCA. superior cerebellar A. post choroidalA.
venous confluence
Chiasmatic-circle of \Villis
CP angle-V. VII. VIII ..\ICA. petrosal veins
.
Cistern velum interpositum-internal cerebral vein
19. A-T, B-F, C-T, D-F, E-F

The only cranial nerve \.Vhich emerges from the posterior aspect
of brainstem is the trochlear nerve. The facial nerve begins from
the nucleus in the anterior aspect of pons. courses posteriorly and
winds around the abducent nucleus, to tum anteriorly. The optic
nerve is not lined by Schwann cells. Olfactory nerve has only
special sensory nerves and no moror component. Vagus has
longest course. Trigeminal N is the largest.
20. A-T. B-T, C-T, D-F, E-T
21. A-T, B-T, C-T, D-F, E-F

The hypoglossal nerve emerges bef\veen the pyramids and olives.
The vagus. glossopharyngeal and accessory nerves emerge lateral
to the olives. The glossopharyngeal nerve exits through the pars
nervosa of jugular foramen and the vagus and spinal accessory
nerves exit through the pars vascularis These nerves cannot be
separated by high resolution �IRI.
22. A-F. B-T. C-F. D-T, E-T

Flowing blood has no signal in Tl: T2. Ligamems have low signal
in Tl/T2.
23. A-T. B-T. C-T, D-T, E-T

24. A-T. B-F, C-F, D-F, E-F

Dorellos canal is ·the dura covering the sphenoid bone and
abducent nerve passes through it. Pars vascularis has the vagus
and accessory nerve. Lamina ciribrosa in the internal auditory
meatus is traversed by the facial nerve.
Olfactory nerve passes through cribriform plate.
25. A-T, B-F, C-F, D-T, E-F

Oculomotor-ventral part of midbrain upper portion (superior
colliculus)
Trochlear-ventral part of midbrain lower portion (inferior
colliculus)
Trigeminal-two in pons. one in midbrain and one in medulla and
uppercord.
-i
- -Abducens-lmver pons, posteriorly. Facial-lov,rer pons, ant. eriorly
r-.. . Vestibular-pontomedullary junction. Cochlear-dorsal and
ventral nuclei-lmver P9..!1?
"- ( \,, \, ' '" Glossopharyngeal, vagus. spinal accessory. hypoglossal - from
above below in medulla
26. A-F, B-T, C-T. D-F, E-F

!\·1 endosal suture is seen i n ben,..:ee n the in te rparietal and
supraoccipital portion of the basiocciput. The cli\·us is hyperintense.
after 7 years. due to fatty replacement. This should not be
mistaken for any lesion. Convolutional markings are absent at
birth. prominent at 2-5 years and disappear at 12 years. Occipital
bone does not have diploic space inferiorly.
27. A-F, B-F, C-T, D-T, E-T

The superior colliculi and lateral geniculate body are involved in
vision. The inferior colliculi and medial geniculate body are
involved in hearing. The midbrain has the cerebral peduncle
anterior to the aqueduct and the tectum posterior to it. The
cerebral peduncle is divided into crus and tegementum by
substantia nigra.
28. A-T, B-T, C-T, D-T, E-T

The T2W images are ideal for assessment of myelination after 6
months. 6-8 months-splenium of corpuscallosum is myelinated com
pletely. 8-11 months genu of corpus callosum completely myelinated.
11-14 months-anterior limb of internal capsule. 14 months-frontal
white matter. 14-18 months-temporal white matter.
29. A-T. B-F, C-T, D-T, E-F

The superior cerebellar peduncle passes to midbrain, middle
peduncle LO pons and inferior peduncle to medulla. The middle
cerebell' · ::- · �'Jncle is the largest.
Neuroradiology i3
The superior and inferior cerebellar peduncles are vertical and

middle is horizontal.
30. A-F, B-T. C-T, D-T. E-F

Ventricles contain 20-25 ml of CSF. Choroid plexus calcification ir.
fourth ventricle can be occasionally seen in CT scans. but not in
lateral skull X-ray.
31. A-F, B-T, C-T, D-T, E-T, F-T

Brain is divided into prosencephalon(telencephalon and
diencephalons). mesencephalon and rhombencephalon. Telencepha
lon is made of cerebral hemispheres. Lateral ventricles are the
cavities. Diencephalon-Thalamus. hypothalamus. pineal gland and
habenula. Pineal and habenula are epithalamus. Third ventricle is
the cavity. Mesencephalon-midbrain. Rhombencephalon
cerebellum. pons and medulla. Fourth ventricle is the cavity.
32. A-F. B-F, C-T, D-F, E-T

Pineal gland calcification is seen from 10 years. It is seen in 50-
70% of plain X-rays and all CT scans. The habenular commissure
superiorly and posterior commissure inferiorly are the t\vo laminae
from pineal gland.
33. A-F, B-T. C-T, D-F. E-F

lnfundibulum is larger in females. Posterior pirnitary is of high
signal in Tl due to neurosecrernry granules. The anterior and
posterior lobes can be differentiated by NIRI.
The gland is uniformly hyperintense in neonates.
34. A-T, B-T, C-F, D-T, E-T

The caudate nucleus is situated medially. The internal capsule
separates it from the lentiform nucleus. The medial aspect of
lentiform nucleus has globus pallidus and lateral portion is the
putamen. Lateral to it are external capsule. claustrum. extreme
capsule and insular cortex.
35. A-T, B-F, C-T, D-F. E-T

The corticospinal tract is in the posterior limb of internal capsule
and corticobulbar tract is seen in the genu. The anterior limb is
supplied by Huebners recurrent artery from ACA. the genu by
lenticulostriate arteries and posterior limb by anterior choroidal
artery.
36. A-F, B-T. C-T, D-F. E-T

The corpus callosum ls the largest association fiber. which connects
t\vo hemispheres.
The rostrum. genu, body and spleniurr. are the parts fro1·i°'
anteriorlv. The splenium is the bulkies� oa:�. Anterior!\· i;:
J �
communicates with the anterior commissure. The fibers extending

into the frontal lobe are called forceps minor and into the occipital
lobe are called forceps major.
37. A-T. B-F, C-T, D-F, E-F

All the sulci and gyri are not consistently imaged. The central
sulcus is seen only in 75% of people. The sylvian fissure separates
the superior temporal lobe from anterior parietal lobe only. The
cingulate sulcus is situated superior to the cingulate gyrus on the
medial cerebral hemisphere.
38. A-F, B-F. C-T, D-T, E-F

Cavum septum pellucidum is due to separation of two laminae of
septum pellucidum and is an extrapial space. Cavum vergae is the
continuation of cavum septum pellucidum beneath the splenium
and superior to the fornix. It normally closes from posterior to
.. anterior, and hence isolated cavum vergae is not seen. Cavum
vergae is anterior to the foramen of Monro and above the fornix.
whereas the cistern velum inerpositum. is posterior to the foramen
of iv1onro.
39. A-T, B-T. C-T, D-F, E-F

Seen in trigone. confluence. roof of third and roof of IV ventricles.
40. A-F, B-T, C-T, D-T, E-T

Motor supply-Muscles of facial expression. srylohyoid. posterior
belly· of digastric, platysma. stapedius: Sensory-anterior two
thirds of tongue
Secretomotor-Lacrimal. submandibular and sublingual glands
41. A-F, B-F, C-F, D-T, E-F

Pertechnate and DTPA are used for conv entional blood brain
barrier imaging. They cannot cross through intact blood brain
barrier. DTPA has higher lesion to background ratio than
pertechnate. Since pertechnate can localize in thyroid and salivary
glands. potassium perchlorate is essential to block uptake.
Localisation depends on absence of blood brain barrier. HMPAO
i s lipophilic and can cross intact blood brain barrier.
42. A-T, B-F, C-T, D-T, E-T

HMPAO and ECD localize in brain proportional to the regional
blood flow. HM PAO has short shelf-life. useful only 30 minutes.
ECD (ethyl cysteinate dimer) has longer shelf-life and useful for
six hours .
.
43. A-T, B-F, C-F, D-T, E-T

Heparin 2500 U I ml is used for cerebral angiography to prevent
thrombotic complications.
I
I. Congenital absence of septum pellucidum is associated with.

A. Hydrocephalus
B. Porencephaly
C. Septooptic dysplasia
D. Hydranencephaly
E. Schizencephaly
2. The following are ventral induction anomalies:

A. Encephalocele
B. Anencephaly
C. Septooptic dysplasia
D. Tuberous sclerosis
E. Dandy \.valker malformation
3. The following are considered dorsal induction anomalies:

A. Holoprosencephaly
B. Anencephaly
C. Tubreous sclerosis
D. Arnold Chiari malformation
E. Agenesis of corpus callosum
4. The following are neuronal proliferation and histoge nesis

disorders:
A. Polymicrogyria
B. Schizencephaly
C. Hydranencephaly
D. Neurofibromatosis
E. Vein of Galen aneurysm
5. The following conditions produce congenital anomalies due to

destruction:
A. Rubella B. Hydranencephaly
C. Tumour D. Porencephaly
E. Agyria
6. Colpocephaly is associated with:

A. Holoprosencephaly
B. Choroid plexus papilloma
C. Arnold chiari malformation
D. Septooptic dysplasia
E. Agenesis of corpus callosum
7. Arnold chiari malformation:

A. Chiari III is always associated with encephalocele
B. Chiari IV is always associated with cerebellar dysgenesis
C. I n Chiari I the vermis and tonsils are herniated through
foramen magnum
D. Chiari II- brainstem is caudally displaced along with fourth
ventricle
E. Chiari IV is the most severe form
8. Chiari I:
A. Frequently associated with supratentorial anomalies
B. Lumbar myelomeningocele is seen in 95% of cases
C. Syringomyelia associated in 30%
D. Herniation of tonsils > 3mm is clinically significant
E. Asymptomatic in childhood
9. Chiari m al fo rmati on:
A. Basilar impression is associated

B. Peg-like tonsils are a characteristic feature
C. Cranial nerve dvsfunction is uncharacteristic
J
D. Posteriorly angulated brainstem

E. Cisterna magna is large
10. Assocations of Chiari II malformation:

A. Corpus callosal dysgenesis
B. Hydrocephalus
C. Absent septum pellucidum
D. Basilar impression
E. Klippel fleil anomaly
11. Skull X-ray features of Chiari II malformation:

A. Small posterior fossa
B. Enlarged foramen magnum
C. Hypoplastic arch of C 1
D. Widened internal auditory canal
E. Erosion of anterior lip of foramen magnum
Congenital Anomalios 17
12. Associated brain anomalies in Chiari II malformation:

A. Colpocephaly
B. Widely spaced gyri in medial aspect of occipital lobes
C. Small caudate lobe
D. Large massa intermedia
E. Always associated with fenestration of falx
13. Intracranial lipoma:

A. Intracranial vessels and nerves run through the lipoma.
producing flow voids
B. Always apposed to malformed adjacent brain.
C. Lesion in suprasellar cistern is apposed to hypothalamus or
mamillary body
D. In pericallosal type. is always dorsal to the corpus callosum.
E. Posterior pericallosal lipomas have high association with other
congenital malformations in brain.
14. The following congenital anomalies are caused due to migration

disorder:
A. Lissencephaly
B. Agenesis of septum pellucidum
C. Agenesis of corpus callosum
D. Heterotopia
E. :tv1egalencephaly
15. The following are cerebellar anomalies in Chiari II:

A. Cerebellum extending anterior to the brainstem
B. Tentorial insertion is higher than normal.
C. Widened CP angle cistern
D. Widened fourth ventricle
E. Convex superior portion of cerebellum
16. Associations of Dandy walker malformation:

A. Cleft palate
B. Kleppe! Feil anomalies
C. Basal cell nevus syndrome
D. Polydactyly
E. Shagreen patch
17. Features of Dandy walker malformation:

A. Tentorium is low placed than normal.
B. A large cyst is invariably present.
C. Falx cerebelli hyperplastic
D. Hydrocephalus
E. Pons migrates posteriorly due to the malformation
18. Dandy walker malformation:

A. Cerebellar vermis absent or hypoplastic
B. Vermis inferiorly displaced
C. Widely separated cerebellar hemispheres
D. Torcular herophili placed below the lambdoid sutures
E. Cerebellar hemispheres closely placed after shunt procedure
19. Vascular changes se en in Dandy Walker malformation:

A. PICA is displaced superiorily
B. Elevated great vein of Galen
C. Superior cerebellar arteries are displaced posteriorly
D. Elevated posterior cerebral vessels
E. Highly placed transverse sinus
20. Dandy walker variant

A. Large posterior fossa
B. More common than Dandy walker malformation
C. Hypoplasia of posteroinferior part of vermis
D. Dilated fourth v entricle
E. Commmunication beP.veen cyst and subarachnoid cyst through
foramen of Luscka
21. Cerebellar anomalies associated with in Chiari II:

A. Fusion of cerebellar colliculi
B. vVidened quadrigeminal cistern
C. Cerebellum extends above the tentorium
D. Straight sinus is oriented vertically
E. Prominent foliae
22. Features of hemimegalencephaly:

A. Familial in origin
B. Lethal in neonates
C. Associated with pachygyria
D. The ventricles are compressed in the affected side
E. Gliosis is characterised by white matter hypointensities
23. Corpus callosal lipoma:

A. Ribbon shaped calcification is pathognomonic
B. 90% have large anterior corpus callosal lipoma
C. There are no callosal fibers dorsal to the lipoma
D. Branches of pericallosal arteries are displaced by the lipoma
E. 60% of cranial lipomas
24. Associations of agenesis of corpus callosum:

A. Hydrocephalus
B. Arachnoid cyst in the interhemispheric fissure
C. Holoprosencephaly
D. Gas�:oinestinal anomaly
E. Ca:-c.' iac anomaly
Congenital Anomalies 19
25. Corpus callosal agenesis:

A. Inferior displacement of third ventricle
B. Anterior imerhemispheric fissure adjacent to third ventricle is
a pathognomonic appearance
C. Radial orientation of cerebral sulci in the sagittal images.
D. Normal brain function
E. Septum pellucidum is present
26. Corpus callosal agenesis:

A. The frontal horns are concave if the genu is absent
B. Colpocephaly if the splenium is present
C. Crescenteric lateral ventricles
D. The internal cerebral veins are separated
E. U shape in vein of Galen
27. Encephalocele:
A. Second m o s t common anomaly in aborted fetuses after
anencephaly
B. Incidence of 4/ 10000
C. Only 20% are livebom with this anomaly
D. 25% of those with this anomaly are mentally retarded.
E. 50% survival in liveborn
28. Associations of encephalocele:

A. Chiari II B. Spina bifida
C. Callosal agenesis D. Dysplastic kidney
E. Polymicrogyria
29. Encephalocele:
A. Frontoparietal encephalocele is the most common in western
hemisphere
B. Sphenoidal is the most common type in Asian
C. Frontal is due to failure of anterior neuropore to close
D. Hypotelorism is a feature of frontaethmoidal encephalocele
E. Associated vvith midline craniofacial dysraphism
30. Encephaloceles and their route:

A. Sphenopharyngeal-through the sphenoida! 1.,ving
B. Sphenoorbital-inferior orbital fissure
C. Sphenoethmoidal-ciribriform plate
D. Sphenomaxillary-maxillary sinus
E. Parietal-sphenoid
31. Hydranencephaly:
A. Cerebellum alv·.:avs seen
J
B. Me�encephalic structures not formed

C. Inferior aspect of temporal lobe found
D. Cortical mantle absent
E. Brainstem is normal
32. Hydranencephaly:
A. Infection is the cause.
B. Sac filled with CSF.
C. Cannot be differentiated from holoprosencephaly
D. Hydrocephalus is a sequelae
E. Schizencephaly has cortical mantle.
33. Schizencephaly:
A. Lined by white matter
B. Closed lip type has no communication with ventrilces.
C. MRI shows clear cleft in both types
D. Ahvay5 bilateral.
E. The ventricles are enlarged on the affected side.
34. Migration anomalies:

A. In polymicrogyria. there is excess of white matter.
B. Polymicrogyria and pachygyria show high signal in white
matter.
C. In megalencephaly, the hemisphere is enlarged and ventricles
are compresseed.
D. In lissencephaly. gyri are broad and flat. with smooth gray
\vhite matter appearance.
E. Type II lissencephaly has a polymicrogyric appearance.
35. Holoprosencephaly:
A. Squared off ventricle indicates lobar form.
B. Septum pellucidum is absem in all subtypes
C. Falx cerebri is absent in all types
D. Interhemispheric fissue is absent in alobar form.
E. Thalami and basal ganglia are separate in alobar form.
36. Management of neurocutaneous syndromes:

A. Annual MRI scans are advisable for neurofibromatosis patients
B. In VHL, annual CT abdomen is advised
C. MRI of spine and brain should be done annually in VHL
D. In tuberous sclerosis annual CT I MRl of brain should be done
E. Relatives of patients with tuberous sclerosis should undergo
radiological examination rather than just clinical examination
37. The following are diagnostic criteria for neurofibromatosis 1:

A. Atleast six cafe au lait spots. atleast 5 mm in adults
.B. Optic nerve glioma
C. Acoustic neuroma
D. Tibial pseudoarthrosis
E. One cutaneous neurofibroma
38. Migration anomalies:

A. In laminar heterotopia. both gray an d white matter are seen.
B. Nodular hetertotopia has only gray matter.
C. The heterotopias do not enhance on CT. but enhance on MRI.
D. Isolated lissencephaly is X-linked recessive.
E. Cytomegalovirus is a cause of lissencephaly
39. NF-1:
A. Optic nerve gliomas are seen in 30%
B. Posterior extension is not seen beyon d the optic tracts
C. Gliomas are seen in midbrain and cerebral cortex also.
D. The gliomas are low grade
E. Hydrocephalus is a sequela of the glioma
40. Diagnostic criteria for NF-Z:

A. Schwannoma B. Glioma
C. Cataract D. Meningioma
E. Hydrocephalus
41. NF- 2:
A. The acoustic neuromas can be cystic
B. M enin giomas are often intravemicular
C. Third ventricle is the most common site of intraventicular
meningiomas
D. Schwannomas are exclusi vely seen in 8ch nerve
E. Schv.:annomas are seen in �-5th decades
42. Tuberous sclerosis:

A. Autosomal dominant
B. Chromosome 10 is involved
C. 95% have cortical tubers
D. The cortical tubers are easily detected in CT scans
E. The cortical tubers are low signal in Tl and high signal in T2
in all ages.
43. Di ffe ren ti al diagnosis of e nce phaloceles :

A. Branchial "i:left cyst B. Iniencephaly
C. Cystic hygroma D. Dermoid
E. Scalp edema
44. Tuberous sclerosis:

A. Subependymal nodules are seen i n 75% of cases
B. Striothalamic groove is the common location for subependymal
nodules.
C. The subependymal nodules do not enhance
D. Subependymal giant cell ast;ocytoma can be distinguished from
SEN by Gd enhanced MRI and diffusion wei ghted sequences
E. Giant cell astrocytomas are seen commor.ly in the region of
aqueduct.
45. Sturge Weber syndrome:

B. Pia mater angioma is the pathological abnormality
C. Port wine stain is seen from birth and resolves by 2 years.
D. The affected side can be enlarged.
E. High signal changes are seen in the cortical matter
46. Parietal encephalocele:

A. Cranioschisis is seen
B. Submentovertical view is best for finding the hole
C. Intracrcmial communication always best seen in MRI.
D. Mantle of cerebral tissue difficult to image.
E. Hydrocephalus is frequently associated
47. NF-1:
A. Pulsating exophthalmos is seen
B. High signal in basal ganglia indicates development of neoplasm
C. 75% of patients have high signal lesions before 10 years of age
D. Acoustic neuromas or meningiomas are diagnostic of NF-1
E. The high signal lesions are diagnostic of hamanomas

A. The superificial veins are prominent
B. The deep veins are thrombosed
C. Choroid plexus is enlarged and calcified
D. Tram track calcification is seen from birth
E. Hemiatrophy is a salient feature
49. Complications of Vein of Galen malformation:

A. Developmental celay B. Myocardial ischemia
C. Hydrocephalus D. Haemorrhage after shunting
D. Congestive cardiac failure

A. The majority of findings are due to venous ischemia
B. Maturation of myelin is delayed.
C. Orbital enhancement is seen in majority of cases.
D. Decreased flow in the transverse sinuses
E. Increased NAA is seen in MR spectroscopy
51. Von Hippel Lindau syndrome:

A. In type I. there is no pheochromocytoma
B. Atleast two hemangioblastomas should be present for
diagnosis.
C. Abdominal - should be regularly done from 20 years
D. Obstructive ::-ocephalus is a presentatior..
E. The hema:: :J.s,oma is a Grade I tumour
Congenital Anonwlic�; I��
52. Craniosynostosis and causes:

A. Dolicocephaly- premature closure of coronal suture
B. Brachycephaly- premature closure of sagittal suture
C. Plagiocephaly- unilateral premature closure of coronal/
lambdoid suture
D. Trigonocephaly- bilateral premature closure of coronal/
lambdoid suture
E. Kleeblattschadel- premature closure of coronal. lambdoid and·
sagittal suture. postnatally
53. Encysted cavurn septum pellucidum:

A. Cavum septum pellucidum is a malformation
B. Cavum vergae and septum pellucidum are the same structure
C. Cavum vergae is anterior to the column of fornix
D. Cavum septum pellucidum is lined by ependymal cells
E. Cavum velum interpositum is extension of quadrigeminai
cistern to the foramen of monro
54. Cavum septum pellucidum:

A. Septum normally closes from anterior to posterior
B. Incidence of cavum vergae is higher than cavum seotum 1
pellucidum in adults.
C. 85% of infants at two months have CSP.
D. 1 OO�'o of premature infants have CSP
E. Cavum is formed at three months
55. Associations of van Hippe! Lindau disease:

A. Renal carcinoma
B. Renal cysts
C. Meningioma
D. Cerebral aneurysm
E. Retinal angiomas
56. lv1ultifocal subependymal periventricular calcification occurs in:

A. \Vilsons disease B. Tuberous scleoris
C. CMV D. Hypoparathyroidism
E. Rubella
5 7. Periventricular leukomalacia:
A. MRI is more sensitive than ultrasound
B. Atrial enlargement is characteristic finding in the acute stage.
C. CT shows symmetrical periventricular lucency.
D. Cyst is seen in subacute stage.
E. Ultrasound shows periventricular hypoechogenicity in acute
stage
58. von Hippel Lindau disease:

A. Chromosome 3 is involved
B. Spinal cord is more frequently affected than cerebellum
C. The hemangioblastomas are confined to infratentorial region
D. Intense enhancement is seen of the v,:all of hemangioblasromas
E. The solid nodule is hyperintense to brain in T2 W images
F. The cystic component is hyperintense to CSF in T2W
59. Common masses in the posterior third ventricle region :
A. Pineal cyst B. Colloid cyst

C. Giant rell astrocytoma D. Aneurysm of vein of Galen
E. Arachnoid C\'St
J
60. Band heterotopia:

A. It is unilateral
B. Frontal lobe is the most common location of partial band
heterotopia
C. It is isointense to gray matter in all MRI sequences, without
exception.
D. Neurological examination is normal.
E. Females are commonly affected
61. Heterotopia:
A. Females have associated lissencephaly
B. Present with seizures
C. Sex linked recessive inheritance.
D. Complete arrest of migration at 5 wee�s
E. Mean age of presentation is five years
62. Vein of Galen malformation is associated with:

A. Turner's syndrome
B. Down's syndrome
C. Blue rubber bleb nevus syndrome
D. Absent straight sinus
E. Persistent falcine sinus
63. VOGM development:

A. VOGM is a AV fistula in the wall of median prosencephalic
vein
B. Median prosencephalic vein drains the diencephalic choroid
plexus
C. Internal cerebral vein replaces median prosencephalic vein by
10 weeks
D. The vein of Galen is formed by the most caudal portion of
median prosencephalic vein which it joins internal cerebral vein
E. Vein of Galen is a bridge between deep parenchymal venous
system and venous sinuses
Congenital Anornalic:s /!·
64. Vein of Galen malformation:

A. M ultiple feeders are seen in the choroidal type
B. Vein of Galen dilatation is a VOGM with single feeder
C. Vein of Galen is dilated in venous stenosis
D. In mural type there are multiple feeders
E. Choro i dal arteries are the main feeders
65. Recognised neurocutanous syndromes:

A. Wyburn mason syndrome
B. Klippel Trenauney Weber syndrome
C. Basal cell nevus syndrome
D. Klippel fleil syndrome
E. Cowdens disease
66. VOGM:
A. Associated venous stenosis increases the incidence of
congestive cardiac failure
B. H ydrocephal us increases with increasing size
C. MRI shows flow voids
D. Phase artefacts exclude a diagnosis of VOG\1
E. Increased incidence of calcification in the falx
67. Cerebellar anomalies:

A. Mega cisterna magna is a variant of arachnoid cysc
B. In Joubert syndrome. the cerebellar hemispheres are fused
C. In rhombencephalosynapsis. the vermis is split
D. There is gross thickening of folia in Lhermitt Duclos disease
E. Tectum is absent in Dandy \iValker variation
ANSWERS
1. A-T, B-T, C-T, D-F, E-F
Holoprosencephaly and callosal agenesis are other causes.
2. A-F. B-F, C-T, D-F, E-T

Dandy v\lalker malformation. agenesis of septum pellucidum.
septooptic dysplasia and holoprosencephaly are ventral induction
anomalies.
3. A-F, B-T, C-F, D-T, E-F

:\eural tube defects such as anencephaly. encephalocele. Arnold
chiari malformation. spinal dysraphism and hydromyelia are dorsal
induction anomalies.
4. A-F. B-F, C-F, D-T, E-T

'.\'eurofibromatosis, tuberous sclerosis. neoplasia. hydranencephaly
_and vascular malformations are neuronal proli feration and
histogenesis disorders. The tumour DNET. dysembryoblastic
neuroectodermal tumour is also now considered to be a disorder
of neuronal proliferation and histogenesis.
5. A-T, B-T, C-F. D-T, E-F

TORCH infections (toxoplasmosis. rubella, cytomegalovirus and
herpes 0. porencephaly. hydranencephaly and hypoxia are
destructive lesions.
6. A-T. B-F, C-T, D-F, E-T

Colpocephaly is dilation of occipital horn, temporal horn and
trigone.
7. A-T. B-T, C-F, D-T, E-F

Chiari I-herniation of cerebellar tonsils
Chiari II-herniation of tonsils, vermis, brainstem and fourth
ventricle. Most severe form.
Chiari III-herniation occurs into the encephalocel at the level of
neck.
Chiari IV-cerebellar dysgenesis
8. A-F, B-F, C-T, D-F, E-T

It is usually an isolated brain anomaly. No supratentorial anomaly
is associated. Lumbar myelomeningocele has a high association
with Chiari II, not I. Syringomyelia is seen in 20-30%. Herniation
upto 3 mm is normal. 3-Smm equivocal-> 5mm significant.
Asymptomatic in childhood unless hydrocephalus. syringomyelia
is associated.
9. A-T. B-T. C-F. D-F . E-F

Chiari I is characterised by herniation of peg-shaped tonsils and
medial cerebellar lobules through foramen magnum. elongated
undisplaced fourth ventricle, angulated brainstem and small
cisterna magna. The pathology is believed to be small posterior
fossa with large cerebellar hemisphere. Associated with platybasia.
basilar impression. Klippel Feil and craniocervical fusion anomalies
10. A-T, B-T, C-T, D-F. E-F

Polymicrogyria a n d stenogyria are other associated lesions.
Lumbar myelomeningocele is seen in 95% of cases. Hydrocephalus
is seen in 50-100%, especially following closure of meningocele.
11. A-T, B-T, C-T, D-F, E-F

Internal auditory canal is shortened due to scalloping of petrous
pyramids and clivus.
12. A-T. B-F, C-F, D-T, E-T

The gyri are closely packed and interdigiate in the medial aspect
of occipital lobes.
The caudate lobe is large, causing impressions on the frontal horns.
producing batwin g pattern. The massa intermedia are large.
causing indentati o n on �he third ventricle, like hour glass.
Fenestration of falx results in interdigitation of medial con;C31
gyri.
13. A-T. B-T, C-T, D-F, E-F.

Intracranial vessels and nerves run through the lipoma since they
develop from the inner layer of tissue that will form subarcahnoid
space. The lesion is high in Tl and T2. 'vVith flovv void due to
vessels running through it and calcifications. Most common location
is pericallosal. There are two types anterior and posterior. The
anterior type is a tubulonodular form. vvhich is association 'Aith
midline facial anomalies including fromoethmoidal encephaloce!e.
The posterior type is a ribbon form and is not a-.;soc iated \\'ith
anomalies. The lesions are usually apposed w malformed adjace:it
brain. Lesions in suprasellar cistern are apposed to hypmhalamus
or mammillary body. lesions in quadrigeminal cistern apposed ro
inferior colliculi. Lesions in CP angle involve the 7th and 8th cranial
nerve. Sylvian fissure is another common site to be involved. The
midbrain colliculi fuse giving the tectal beaking. The cingulate gyri
are hypop lastic giving the widened quadrigeminal c istern.
Cerebellum extends abo·-..:e rhe tentorium. causing to\vering
cerebellum. Straight sinus is short and verti cal. The folia a:e
indistinguishable due to cerebellar hypoplasia.
14. A-T, B-F, C-T, D-T, E-T

Hecerotopias. agyria, pachygyria. schizencephaly. lissencephaly.
polymicrogyria, megalencephaly, and agenesis of corpus callosum
are neuronal migration anomalies.
15. A-T, B-F, C-F, D-F, E-F

Cerebellum extends anteriorly to brainstem producing the triple
beaking appearance. Tentorial insertion is lower than normal.
closer to the foramen magnum and is \Nide. CP angle cistern is
small due to cerebellar herniation. The fourth ventricle is
elongated. thin and herniated. The superior portion of cerebellum
is flat due to indentation of temporoparietal lobes.
16. A-T, B-T, C-F. D-T, E-F

Also associated with corpus calossal li p o ma. meningoce le,
hamartoma. cerebellar heterotopia and holoprosencephaly.
17. A-F, B-T, C-F, D-T, E-F

Tentorium is placed higher than normal.
18. A-T, B-F, C-T, D-F, E-T

Skull-large. large posterior fossa. torcular lambdoid inversion
(the torcula and lateral sinuses are placed higher than the lambdoid
suture) large posterior fossa cyst which communicates vvith the
fourth ventricle. The verrnis is absent or hypoplastic. superiorly
displaced. cerebellar hemispheres widely separated due to the cyst.
Anterior displacement of pons the falx cerebelli is absent. The
tentorium is inserted higher than normal. Hydrocephalus is present.
19. A-F, B-T, C-F, D-T, E-T

Transverse sinus. posterior cerebral vessels. galens great vein are
displaced superiorily.
Superior cerebellar artery displaced anterosuperiorily. PICA small
or absent.
20. A-F, B-T, C-T, D-T, E-F

Posterior fossa is not as large as in Dandy walker malformation.
The cyst communicates through a key hole-shaped slit with the
dilated fourth ventricle. The posteriorinferior portion of vermis
is dysplastic. The cyst and subarachnoid space can communicate
through the foramen of Magendie.
21. A-T, B-T, C-T, D-T, E-F
22. A-F, B-T, C-T, D-F, E-F

Not familial. Associated pachygyria and heterotopia. The
hemispheres and ventricles are enlarged on the affected side.
Gliosis is seen as white rr:atter hyperintensites.
Congenital Anoma/ic;: 29
23. A-T, B-T, C-T, D-F, E-F

30% associated with small posterior lipoma. Branches of pericallosal
artery are not displaced. but course through the lipoma. 30% of
skull lipomas associated with frontal cutaneous lipoma.
24. A-T, B-T, C-T, D-T, E-T

Hydrocephalus is seen in 30%.
25. A-F, B-T, C-T, D-T. E-F

Due to absence of corpus callosum. the third ventricle is highly
placed almost in between the lateral ventricles. Septum pellucidum
is absent in corpus callosal agenesis. Radial orientation of sulci is
due to dysgenesis of cingulate gyrus.
26. A-F, B-F, C-T, D-T, E-F

If genu is absent, the frontal horn will be convex and colphocephaly
is seen if splenium is absent. The lateral ventricles are cresenteric
due to indentation by longitudinal bundles of Probst. The pericollosal
arteries and internal cerebral veins are separated due to absence
of corpus callosum. The U shape of the vein of Galen is lost.
27. A-F, B-T, C-T. D-F, E-T

Encephaloceles are made up of herniated brain tissue. CSF and
meninges. N1ost common neural anomaly in aborted fetuses. Only
20% are liveborn, of which 50% sur•ive and of vvhich 75% are
retarded.
28. A-F, B-T, C-T, D-T, E-F

Associated with Chiari III. ·oysplastic kidneys. encephalocele.
polydactyly are features of Meckel Gruber syndrome. Dandy
\Nalker malformation is also associated.
29. A-F, B-F, C-T. D-F, E-T

Occipital is the most common in western hemisphere and
frontoparietal is the most common in Asia. Frontal is failure '.)f
anterior neuropore to close at 4 \Veeks GA. Hyperrelnrism. \vice
separation of eyes is a feature of frontal encephaloccle.
30. A-F, B-F, C-F, D-T, E-T

Sphenopharyngeal-sphenoid body. Sphenoorbital-superior orbital
fissure. Transethmoidal-cribriform p late: sphenoethmoidal
ethmoid and sphenoid: sphenomaxillary. Types of frontoeth
moidal-nasoethmoidal. nasofrontal. nasoorbital and interfrontal.
31. A-T, B-F, C-T, D-T, E-F

This is caused by an abnormality of Internal carotid artery... So the
cerebral hemispheres are ischemic and not developed. except for
occasional presence of inferomedial temporal lobe. inferior fromal
lobe and occipital lobe. The mesenc�phalic and dience;:;ho lie
structures such as thalamus. hypothalamus and midbrain are

normal. Brainstem is atrophic. Cerebellum is normal.
32. A-T, B-T, C-F, D-F, E-T

This is due to absence of ICA. The complete cerebral parenchyma
is liquefied and replaced by a sac filled with CSF with no cortical
m antle. This m a y b e due to ischemic insult or infection. In
h y drocephalus and schizencephaly. a thin rim of mantle is still
persistent. In holoprosencephaly. associated anomalies are seen.
33. A-F, B-F. C-F, D-F, E-F

Schizencephaly is a CSF filled cleft that is lined by gray matter
and passes from the surface of the brain to the ventricles. There
are two types. closed lip with close apposition of the tract walls.
which might not be seen in MRI. The second type. open type. has
separted walls, which is clearly visualised in MRI. There is no
e nlargement o f ventricles. like in megalencephaly. It can b e
unilateral o r bilateral. asymmetrical or symmetrical.
34. A-F, B-T, C-F, D-T, E-T

Polymicrogyria and pachygyria are non-lissencephalic cortical
dysplasias and are also migration anomalies. In polymicrogyria.
there are multiple small gyri. \vhich are seen as irregular bumps
on the surface. There is diffuse thickening of the cortex and paucity
of white matter. vvith high signal in T2\1V images in white matter.
Pachygyria is focally thickened flattened cortex. which also has
h i g h signal in T2 in v:hite ma tter. There are three types of
lissencephaly. In type I. cortex is thick with gyri broad and flat,
type II has thick cortex with polymicrogyric appearance, type III
cerebrocerebellar type with microcephaly. In megalencephaly there
is large hemisphere with ventricle on one side.
35. A-T, B-T, C-F, D-T, E-F

In alobar form. the most severe. there is monoventricle, without
III ventricle, with fused thalamus and basal ganglia. There is no
septum pellucidum. falx cerebri, interhemispheric fisssure and there
are associated severe associated anomalies. In semHobar form. there
is a rudimentary occipital horn and III ventricle, the thalamus and
basal ganglia are partially separated. falx cerebri/interhemispheric
line are partial and there is no septum pellucidum. In lobar form,
there is squaring of the fontal horn. with separation of thalamus
and basal ganglia. The falx is well formed. interhemispheric fissure
is present and septum pellucidum is present.
36. A-T. B-T, C-T, D-F, E-F

Neurofibromatosis is assessed annually by MRI. Tuberous scleros:s
need not be assessed routinely. and symptomatic managerr:ent is
preferred. The rela(ives can be assessed clinically. In VHL. annual

MRI of brain and spine and CT/L'SG abdomen are done to
diagnose renal and adrenal tumours. The relatives should also be
assessed radiologically.
37. A-F, B-T, C-F, D-T, E-F

Atleast 2 of the following should be present
Atleast 6 cafe au lait spots. atleast Smm in children and 15 mm
in adults.
Two neurofibromas or one plexiform neurofibroma: optic nerve
glioma:
Two or more Lisch nodules: axillary or inguinal freckling: Bone
dysplasias: First degree relative with NF-1
38. A-T, B-T, C-F, D-T, E-T

There are two types of heterotopia. nodular and laminar. Nodular
has only gray matter. has signal nature of gray matter in all
sequences and do not enhance on contrast. Laminar he(erotopia
has alternating bands of gray and \\·hite mat t er . Isolated
lissencephaly is X-linked recessive and there is association \\'ith
Miller Dieker syndrome. \\·hich is aurosomal recessive and fatal
before t\.VO years.
39. A-T B-F, C-T, D-F, E-T

,
Optic nerve gliomas extend posteriorly to involve optic tracts.

chiasm and optic radiation.
They are usually lo\v grade but high grace tumours are also
commonly seen. Gliomas are also seen in rectum and tegrnentum
of mi dbrain and cerebrum. Hydrocephalus is seen due to
aqueductal stenosis or midbrain tumour.
40. A-T, B-T, C-T, D-T, E-F:

A. Bilateral acoustic neuroma
B. Family history of �F-2. with atleast t\VO of-sch\\·c.rnnoma.
meningioma. glioma. posterior si..lbsca?sular opaci[y.
41. A-T, B-T, C-F, D-F, E-F

Lateral ventricle is the most common site of intraventri cular
meningiomas. Schw·annomas are seen in any cranial nerve. in the
2nd- 3rd decade.
42. A-T, B-F, C-T, D-F, E-F

Chromosomes 9 and 16 are involYed. 95% of involved patients
have cortical tubers. which are difficult to be detected in CT scans.
In MR. ·thev are hvoer in Tl and hvoo in T2 initiallv. become hvoo
J J ' .... i .,, ... .l
in Tl and hyper in T2 later and end up being isointense in both

sequences eventually. They calcify. \Vith age.
32 Neuroradiofogy, Head and Neck Radiology
43. A-T, B-T. C-T. D-T, E-T
44. A-F, B-T, C-F, D-F, E-F

Subependymal nodules are seen in 90% of patients. They are
located in the striothalamic groove just posterior ro the foramen
of munro. They show variable signal with MR and calcify. Contrast
enhancement may be seen. Giant cell astrocytomas are commonly
seen in the Forman of Munro. They cannot be distinguished from
nodule by imaging. only by progressive growth.
45. A-F, B-T, C-F, D-T, E-F

It is a spor.1clic disorder. Pia mater angioma. with resulting absence
of superficial cortical venous drainage is the pathology. This causes
c hronic venous hypertension. ischemia.
Cortical hemiatrophy, tramtrack calcification. enhancing vascular
malformation are characteristic. Port wine stain. seen at birth, does
not resolve. The affected side is usually hemiatrophic.but occasionally
enlarged due to subdural collections. Low signal changes are seen
- in the atrophic cortex due to deoxyhemoglobin or calcification.
46. A-T, B-T, C-F, D-T, E-T

Intracranial communication often not visualised.
47. A-T. B-F, C-T, D-F, E-F

Sphenoidal wing dysplasia produces exophthalmos. High signal
lesions are due to harmartomas or demyelination or abnormal glial
cells. They are seen in pons. cerebellum internal capsule. splenium
and basal ganglia. Usually they don't have mass effect or contrast
enhancement. except for the globus pallidus ·lesions. They appear
at 3 years and peak at 10-11 years and disappear subsequently.
48. A-F,B-F, C-T, D-F, E-T

Superficial venous drainage is absent. resulting in prominent deep
venous drainage.
Choroids plexus is enlarged proportional to the leptomeningeal
malformation and calcified. Tram track calcification is seen from
one year.
49. A-T, B-T, C-T, D-T, E-T

Developmental delay is due to arterial steal or ischemia due to
enlarged veins or increased venous pressure after thrombosis.
Hydrocephalus and intraventricular haemorrhage are due to acute
thrombosis. Shunting results in massive haemorrhage from dilated
ependymal veins. High output congestive cardiac failure is the
most common complication.
50. A-T, B-F, C-T, D-T, E-F

There is accelerated maturation of myelin. Orbital enhancement
i s s e e n in 50%. There is decreased fl ov.· in the sin uses and
formation of collateral vessels. Decrea s e d NaA is seen in

spectroscopy.
51. A-T. B-T. C-T. D-T, E-T

There are three types of VHL. In type I-there is no pheochromo
cyto ma. II-pheochromocytoma and RCC. type III-Onl y
pheochromocytoma. There should be two hemangioblastomas or
one CNS hemangioblastoma and one retinal lesion.
52. A-F, B-F, C-T, D-F. E-F

Craniosynostosis is caused by premature closure of sutures and
usually occurs by 30 years of age with a male predominance
Dolicocephaly (Scaphocephaly)-premature fusion of sagittal
suture. Brachycephaly (Turricephaly) premature closure o f
coronal/lambdoid suture. Plagiocephaly-unilateral premature
fusion of coronal/lambdoid suture: Trigonocephaly-Premature
closure of metopic suture. Oxycephaly-premature closure of
coronal, sagittal. lambdoid sutures. Kleeblattschadel (cloverleaf
skull)-intrauterine closure of coronal. sagittal. lambdoid sutures.
53. A-F, B-T. C-F. D-F, E-T

Cavum vergae is posterior to the imaginary vertical line through
the column of fornix and cavum septum pellucidum is anterior.
Cavum is nO( lined by ependymal cells or choroid plexus. so it
is not appropriate to call it fifth ventricle. This is not a malfor
mation or cyst or neoplasm.
54. A-F. B-F, C-T. D-T. E-T

Cavum is formed at three months and closes at six months from
posterior to anterior.
15% of adults have cavum vergae and septum pellucidum. 30% of
term infants have CV and 85% have CSP.
55. A-T, B-T. C-T. D-F. E-T

Retinal angioma. syrinx. AVM of cord. mening i oma t'pidermoid.
.
endolymphatic sac tumours. rhabdomyomas of llean. lung cyst.

renal adenoma/ carcinoma/ c.yst/hemangioma. epididymal cyst.
papillary cystadenoma of ovary. pancreas cyst. islel cell adenoma/
CAI cystadenomic.
56. A-F, B-T, C-T, D-F, E-T

Subependymal astrocytoma is another cause.
57. A-T, B-F, C-T. D-T. E-T

Atrial enlargement is seen in chronic phase .
58. A-T, B-F. C-F, D-F, E-T, F-T

Autosomal dominant disease. involving chromosome 3. Cere
bellum. b r ainstem. spinal cord and occasionally su p ra t e n tor ial The
.
34 Neuroradiology Head and Neck Radiology
lesion is usually cystic with solid nodule. The cyst is hyperintense

ro CSF in T2. The nodule is iso to brain in T 1. hyper in T2 and
shO\vs signal voids. with intense comrast enhancement. The \Vall
of cyst does not enhance.
59. A-T, B-F, C-F. D-T, E-T
60. A-F, B-T. C-T, D-T, E-T

Band heterotopia is a migration anomaly \Vhere the gray matter
is arrested along its pathway before it reaches it final subcortical
and cortical location and qrranged in a band fashion. It is usually
bilaterally '>ymmetrical.
61. A-F, B-T, C-F, D-F, E-T

This is a sex-linked dominant disorder. The males \\·ith this chro
mosomal anomaly (in Xa22. 23) have lissencephaly. but females
have heterotopias. Arrest of migration occurs betv.:een
. 8-20 weeks.
62. A-T, B-T. C-T, D-T, E-T

Hypoplastic straight sinus is another association.
63. A-T, B-F, C-T, D-T, E-T.

Median prosencephalic vein drains the telencephalic choroid
plexus.
64. A-F, B-F, C-T, D-F, E-T

There are t\vo types of VOG\11. the choroidal and mural type. In
choroidal type-there are multiple feeders, mainly the postero
lateral. posteromedial and anterior choroidal arteries. pericallosal
and thalamoperforating arteries. In mural t�'pe-there is only a
single posterior choroidal or collicular feeder.
65. A-T. B-T, C-T, D-F, E-T

Other causes include Osler Rendu Weber syndome. menmg10-
angiomatosis. epidermal nevus syndrome, nevus of Ota syndrome.
incontinentia pigmenti. neurocutaneousmelanosis and hypomelanosis
of Ito.
66 A-F, B-T, C-T, D-F, E-F

Congestive cardiac failure is the most common complication. If
there is venous stenosis, there will be no congestive cardiac failure.
Flow voids and phase artefacts are features of VOGM. There is
no increased incidence of calcification.
67. A-F. B-F, C-F, D-T, E-F

In Joubert syndrome, the vermis is split and segmented with
disorganisation. In rhombenchephalosynapsis, the cerebellar
hemispheres are fused across the midline. In Lhermitt Duclos
syndrome. there is hypertrophy of granular cell layers and
hypermyelination �: :nolecular layers of cerebellum.
- . ·
. ··�... � �.. .. . :
1. Subdural haemorrhage:
A. Acute subdural haemorrhage is hypodense in sickle cell disease
B. The density may increase in the first two days
C. Associated brain damage is rare
D. Absence of associated fracture virtuallv excludes subdural
J
haemorrhage
E. Biconvex in shape
2. Features of descending transtentorial herniation:

A. Haemorrhage in midbrain on the same side
B. Effacement of ipsilateral suprasellar c:stern
C. \Videning of ipsilateral CP angle cistern
D. Ob litera1:ion of all basal cisterns
E. Inferior displacement of posterior cerebral artery
3. Cortical contusion:
A. Most common primary intraaxial lesion in trauma
B. Most common in frontal lobe
C. Frequently seen underneath extradural haematoma
D. Often bilateral
E. Hydrocephalus is a complication
, 4. Differential diagnosis for radiological appearance of subdural

haemorrhage:
A. Hygroma B. Empyema
C. Mega cisterna magna D. Enlarged subarachnoid spaces
E. Cortical venous thrombosis
, 5. Radiological features of chronic SDH:

A. Biconvex
B. By definition is more than a \veek old
C. History of trauma is frequently present
D. The attentuation is usually in between that of brain and CSF
E. Cortical veir.s are displaced laterally
A. The subdural window in CT is level of 50 HU and width of
500 HU
B. Subacute haemorrhage is less than 20 days old
C. In interhemispheric region. there is predominance for the
anteiror portion
D. Biconcave appearance, on both sides of the falx cerebri
E. Extends anteriorly upto the genu of corpus callosum
7. The following situations produce false negative CT scan in SDH:

A. High platelets
B. High convexity location
C. Broad \Vindow setting
D. Associated fracture
E. Subtentorial haemorrhage
1/ 8. Subdural haemorrhage:
A. Has better prognosis than extradural haemorrhage
B. Crosses midline in interhemispheric haemorrhage
C. Skull fracture is associated in 1 %
D. Bilateral in 85% of infams
E. Chronic subdural haemorrhage is hyperintense to CSF in Tl
\\.' images
9. Features of ascending transtentorial herniation:

A. The superior vermian cistern is dilated
B. Quadrigeminal cistern is unaffected
C. IV ventricle is displaced anteriorly
D. Compression of aqueductal with hydrocephalus
E. Anterior displacement of midbrain
· 10. Subdural haemorrhage:

A. Caused due to rupture of medullary veins
B. Common in infants and elderly
C. Seen in 25% of head trauma patients
D. Seen in 65% of trauma patients with prolonged loss o f
consciousness
E. Coughing and sneezing are precipitating factors in elderly
patients
11. MRI is used in subdural haemotomas in following instances:

v·
A. Chronic subdur2l haematoma
B. Subtentorial
C. Subtemporal
D. Small
E. Interhemispheric
Trauma 37
12. Increased mortality in subdural haemorrhage is seen in:

A. Evacuation delayed more than four hours
B. Young age C. Bilateral
D. Rapid accumulation E. Mass effect
13. Berry aneurysms:

A. Seen in 5% of general population
B. Seen in 20% of those with ADPKD
C. Associated with aortic coarctation
D. 20% of berry aneurysms are seen in posterior Fossa
E. Always congenital
14. Diffuse axonal injury:

A. Brainstem is the earliest affected
B. In corpus callosum the anterior aspect and splenium are
affected
C. In brainstem there is prepilection to the anterolateral quadrant
D. Cortex is spared
E. Corticomedullary junction is the most easily sheared region
of brain
15. Extradural haematoma:

A. Common in infants
B. Young patients are more rn mmonly affected than e lderly ad u lts
C. Disruption of dural \ · enn us sinuses is a cause of EDH
D. Skull fracture is associalffi in 95 '6
E. Majority of skull fractures across rr.e middle men i ngea l artery
groove result in extradural haematoma
16. The fol low in g are predisposing factors for chronic SDH:
A. Ventricular shunt R Trauma
C. Epilepsy D. Alcoholism
E. L i v er disease
17. Carotid trauma:

A. :V1ore common in young�; population
B. 10% incidence in neck injuries
C. Dissection requires only anticoagulants
D. Pseudoaneurysm al w ays requires surgical intervention
E. Horner's syndrome is ofH�n the first finding
F. 25% have no visible injury
18. Associated features of subdural haematoma:

A. \1idline shift less than the Ciameter of the subdural haemJi.:J!l1a
B. Effacement of sul c i
C. Displacement o f g ray \vhite maLCer interface
D. Contrast enhancemern of cortex
E. Th inni ng of i psilat e r a! skun due �o press;.;·::
,_
19. Clinical features of EDH:
A. Increased somnolence is a recognised clinical feature
B. Lucid interval seen in 65%
C. Clinically more significant if located in the frontal region
D. Dural venous sinus epidural haemorrhage is most common in
the temporoparietal region
E. Never crosses a suture
20. Fracture of sella turcica:

A. Usually not visible in conventional plain films
B. 60% d(•velop cranial nerve palsies
C. .\:feningitis is common
D. 7th nerve palsy is a complication
E. Hypopituitarism is a common complication seen in 30% of
patients
21. Trauma:
·A. Duret haemorrhage is due to temporal herniation
B. Kernohans notch is contusion of contralateral brainstem
C. Durets haemorrhage is common in the tegmentum
D. Pre s s ure necrosis is common in the cingulate and
parahippocampus gyrus
E. Tentorial herniation can cause infarction
22. Indications of immediate CT in trauma:

A. GCS-14 B. Altered mental status
C. Linear skull fracture D. Skull base fracture
E. Loss of consciousness at any time
23. Indications of I\1RI in trauma:

A. DAI
B. Brainstem injury
C. Subarachnoid haemorrhage
D. Vascular injuries
E. Foreign bodies
24. Head injury sequelae:

A. Hydrocephalus is seen in one-third
B. Gro w ing fracture is nothing but a cyst
C. Cerebral atrophy occurs in one-third
D. 30% of injuries are fatal
E. Subdural hygroma is due to arachnoid tear
25. The following are recognised sequela of head injury:

A. CSF Leak B. Porencephaly
C. Encephalomalacia D. Epilepsy
E. Abscess
Trauma 39
26. Intracerebral haematoma:

A. Most common in the parietal region
B. Loss of consciousness is immediate
C. Shear strain injury is the most common mechanism
D. In contusion. CT shows homogenous density
E. Intraventricular haemorrhage is best seen in the body of lateral
ventricles
27. Cortical contusion:

A. In early stage only diffuse cerebral swelling
B. Contrast enhancement is seen
C. Isodense after three weeks
D. Gliosis is hypointense in TZW images
E. Porencephaly is a long reerm sequela
28. EDH:
A. Swirled appearance indicates acuce on a chronic bleed
B. Biconvex shape of haematoma is specific for extradural
haematoma
C. Displaces falx and venous sinuses away from the haematoma
D. Meningeal artereis compressed against the inner table of skull
by the bleed
E. Can present after three \veeks

A. Isodense in 4 days
B. Hypodense in 3-4 weeks
C. Mortality 50%
D. Arteriovenous fistula is a complication
E. Small ventricles should alert to possibility of bilateral subdural
haematoma
30. Blunt carotid trauma:

A. Majority of dissection be�ween skull base and C 2
B. Doppler is the investigation of choice for clhsecrior.
C. Stenosis less than 60% is missed
D. MRI is the technique of choice for vertebral artery dissection
E. There is longer latent period in pseudoaneurysm than
dissection
31. Causes of infarction in trauma:

A. Carotid artery injury
B. MCA compression in gross cerebral edema
C. ACA compression in descending transtemorial herniation
D. Perforators compression in subfalcine herniation
E. PCA compression in desc2nding transt:entorial hcrn�atior.
32. Venous extradural haemorrhage:

A. Ah·vays adjacent to the dural sinus that has been involved in
the fracture
B. In middle fossa is due to laceration of transverse sinus
C. The bleeding is slower than arterial EDH
D. The shape is more variable than arterial
E. The onset of venous EDH is quicker than arterial EDH
33. Prognosis in head injury:

A. The number of lesions in diffuse axonal 'injury has an inverse
relatiunship with the Glasgow coma scale and lev e l of
consciousness
B. Transtt:ntorial herniation worsens prognosis regardless of the
lesion
C. Intrinsic secondary brainstern lesion worsens the prognosis
D. There is no correlation bet\.veen comusions. EDH. SDH and
prognosis
E. Involvement of corpus callosum in DAI has worst prognosis
34. Brain injury:

A. Brainstem is commonly injured in the venrrolateral quadrant
B. Cerebral peduncle is the most common part o f brainstem
involved in DAI
C. Peticheal haemorrhages are most common in the pe:-iaqueducal
region in brainstem
D. 80% of CSF fistulas are due to skull base fractures
E. A basifrontal fracture causes CSF fistula draining into the
maxillary sinus
35. The following cranial nerve injuries are produced by the

corresponding injuries:
A. Horner's syndrome-fracture of cervical spine
B. III-frontal bone fracture
C. I-ciribriform plate fracture
D. II-fracture of temporal bone
E. V-fracture extending through cavernous sinus
•
I
I Trauma 41
i
!
ANSWERS
1. A-T, B-T. C-F, D-F, E-F
Although n o rmally acute haemorrhage is hyperdense. it is
hypodense in conditions with low hemoglobin and plateles.
. Subdural haemorrtrnges ?-re f��q1:1ently associated with underlying
brain d�.n:i?ge. which reduces the prognosis. Subdural
·haemorrhages can occcur without evidence of fracture. Subdural
haemorrhages are concavoconvex. following the contour of the
brain, whereas the extradural haemorrhages are biconvex.
2. A-T, B-T. C-T, D-T, E-T

In descending transtentorial herniation. the uncal and
parahippocampal gyrus of temporal lobe. temporal horns of lateral
ventricle displaced medially and protrude over free tentorial
margin. The posterior cerebral artery. posterior communicating
artery and anterior choroidal artery are displaced inferomedially.
3. A-T, B-T, C-F, D-T, E-T

Common in the anterio r lateral and inferior surfaces of fromal
.
lobe. Hydrocephalus is due t0 adhesions caused by subarachnoid

haemorrhage.
4. A-T, B-T. C-F. D-T, E-F
5. A T B-F, C-F. D-T, E-F

- .
In early stages is cresente::c ar.d �?.�e:- is biconv�_., similar �o extracl.!:-al

haematoma. It is usually more than -�hree \veeks old. History o:
trauma is present in less than... zs·�-o. The anentuation c3n also be
as low as that of CSF. Cortical veins are displaced n: edialiy. ')
.
6. A-F, B-T, C-F, D-F, E-T
Subdural window is level of 40 HL and wid'Lh of 500 HL. Subacure
haemorrhage i s between 4-20 days old. Interhemispheric
haematoma is more common posteriorly and extends anterior!:-:
upro the genu of corpus callosum. It i s seen on 011e side of lr-.e
falx and has a cresemeric shaoe \Vith the falx.
'
7. A-F, B-T, C-F, D-F, E-F

Low platelets. l ow hemoglobin. narrow window setting. beam
hardening artefacts, delayed imaging and CSF dilution are common
causes for missing the diagnosis.
8. A-F, B-F, C-T, D-T, E-T

SDH has worse prognosis than EDH due to a higher perce rn a5 e
of as�ociated t,lnderlying q,rain damage. It ne-\·er crosses tl:e
midline. but it can cross sutural lines. Chronic subc•..::-::1
haemorrhage can be hyperintense to CSF in Tl due to high p�.:)[ei�
concentration.
9. A-F. B-F. C-T, D-T, E-T

Superior vermian cistern is effaced. Quadrigeminal cistern is
deformed. I\' ventricle and aqueduct are compressed.
10. A-F, B-T. C-F. D-T, E-T

Caused due to rupture of bridging veins. Common in infants and
elderly due to reduced \;olume of brain parenchyma in relation
to the skull. Trauma is the most common cause.
Coughing. sneezing, vomiting are precipitant factors in elderly.
Seen i n 5<?c1 of trauma victims and 15% o f closed head injuries.
11. A-F, B-T. C-T. D-T, E-F

Very useful in subacute phase. \'\·here it is isodense in CT. but
bright in MRI due to mechemoglobin. Noc needed in inter
hemispheric haematoma.
12. A-T, B-F, C-T, D-T, E-T

_Higher mortality in older age patiems.
13. A-F, B-F, C-T, D-T. E-T

Berrys aneurysms are congenital saccular aneurysms seen usually
at site of arterial bifurcations. 80% are seen in the circle of \Villis
and 20% is seen in posterior fossa. It is seen in in 2% of general
population and upto 13% o f those with ADPKD. It is also
associated with coarctation.
14. A-F, B-F, C-F, D-T, E-T

DAI is due to shearing injury due to rotational acceleration/
deceleration. There are 3 stages. I- gray white matter junction. II
internal capsule. corona radiata, cerebellar peduncles, III-corpus
callosum (posterior body and splenium common), IV- brainstem
(posterolateral aspect of midbrain).
15. A-F, B-T, C-T, D-T, E-F

It is not common in infants. Laceration of middle meningeal artery
is the most common cause. Venous epidural haemorrhage is also
recognised and is due to avulsion of small veins and dural sinuses
and is slow in onset. Only a small percent o f fractures across
middle meningeal artery groove cause EDH.
16. A-T, B-T, C-T, D-T, E-F

Old age, coagulopathy are other common causes.
17. A-T, B-T, C-T, D-T, E-T, F-T

There are two types of injury- dissection and pseudoaneurysm.
Monoparesis. hemiparesis. TIA in a patient with a history o f
trauma i s indicative of carotid trauma.
I
� 18. A-F, B-T. C-T. D-T. E-F
Trauma 43
i
I
Midline shift is usually greater than the diameter of the subdural
{
haematoma due to associated brain injury. The sulci are effaced
i and cannot be traced upto the brain surface.
The cortical surface enhances. but the haematoma does not. The
ipsilateral skull is usually thickened.
19. A-T. B-F, C-F, D-F, E-F ...,:-_ '
Lucid interval is seen only in one-third. It is more clinically

signifi cant if located in the !emporparietal region. Dural venous
sinus bleeding is more common in the posterior Foss?. Usually it
does not cross a suture. but in case of a diastatic fracture of the
suture, it does cross.
20. A-T, B-F, C-F, D-F, E-T

Cranial nerve palsies are seen in 15-20% of cases.
21. A-T, B-T, C-T, D-T, E-T

Durets- temporal lobe herniation causing haemorrhage in lateral
brainstem
Kernohans notch- contusion of opposite brainstem due to free edge
of tentorium.
Pressure necrosis is common in cingulate. parahippocampal. unca!.
cerebellar tonsils.
Compression of arteries by tf.e herniated lobes and dural edg�
cause infarction.
22. A-T, B-T, C-F, D-T, E-T

D e pressed or open skull fracture. focal neurological d ef!cit.
vomiting more than once. penetrating \vound are other recognised
indications. Presence of loss of consciousness and post-traumatic
amnesia. in a patient over 65 years and coagulation problems need
CT scan. but not necessarily within 1 hour as there is no surgical
management i n these inst:ances (\;ICE guideline':i).
23. A-T, B-T, C-F, D-T. E-F

Small EDH and SD H are indications. It is also used for post
concussive symptoms.
24. A-T, B-T, C-T, D-F, E-T

Hydrocephalus is due to residual haemorrhage. 10% of injuries
are farnl. Subdural hygroma is accumulation of CSF in subdural
space due to arachnoid tear or liquefaction of chronic SDH.
25. A-T, B-T. C-T. D-T, E-T

26. A-F, B -F, C-T, D-F, E-F

Most common locations are frontal and anterior temporal, basal
ganglia. In hematoma the density is homogenous. In contusion it
is heterogenous d u e to admixture of edema and blood.
Intraventricular haemorrhage is seen in the occipital horns.
27. A-T, B-T, C-T, D-F, E-T

G liosis is hyperintense in TZW images. Encephalomalacia is the
most common complication. Enhancement is occasionally seen due
to loss of blood brain barrier. Parencephaly is due to liquefactive
necrosis.
28. A-F, B-F. C�T. D-F, E-T

Swirled appearance indicares active bleeding. Biconvex shape is
commonly seen in EDH. But can be seen in chronic subdural bleed.
It is the only haemorrhage displacing the falx and venous sinuses
away from the inner table of skull (SDH does not do it)
.
The meningeal vessels are also displaced away from the inner table.
MRI in extrad ura l will show the lovv sign a_! intensity dura.
.
displaced medially by the haematoma ... .. .
29. A-F, B-T, C-T. D-T. E-T

In normal patients, acute subdural is hyperdense for 1 vveek,
isodense between 1-2 \/\:eeks and hypodense in 3-4 weeks. Isodense
bilateral subdural haematomas are difficult to detect, and bilateral
small ventricles is a clue. Contrast enhancement may outline the
membranes outside haematoma.
30. A-T, B-F, C-T, D-F, E-T, F-T

Since majority of dissections are above C2 , Doppler will miss it.
The only findings will be reduced flow proximally, and this is not
useful if the stenosis is less than 60%. MRI misses vertebral artery
dissection and hence angiography is the procedure of choice.
31. A-T, B-T, C-F, D-F, E-T

Perforators and PCA compression occur in descending trans
tentorial herniation. ACA compression is seen in subfalcine
herniation.
32. A-T. B-F, C-T, D-T, E-F

Venous EDH is uncommon. It is usually due to laceration of a dural
sinus. In the posterior cranial fossa it is due to laceration of the
transverse or sigmoid sinus. In the middle cranial fossa, it is
commonly due to laceration of the sphenoparietal sinus. In the
parasagittal region. it is due to laceration of the superior sagittal
sinus. The venous EDH is usually slO\v in onset. because of slow
venous oozing.
Trauma 45
33. A-T, B-T, C-T. D-T, E-T

The prognosis in EDH/ SDH/ contusion is poor if there is severe
brainstem deformity or intrinsic secondary brainstem lesion or
makred transtentorial herniation. The DAI- and brainstem injury
have the worst prognosis.
34. A-F, B-F, C-T, D-T, E-F

The dorsolateral part of the brainstem is the part that is most likely
to be involved in direct trauma due to shearing with the free
edges of the tentorium. In DAI. dorsolateral quadrants are
commonly involved than cerebral peduncles. Basifrontal region
fistula drains usually into the sphenoid and ethmoid sinus.
35. A-T, B-F, C-T, D-F, E-T

I-Fracture ciribriform plane or shearing of basifrontal region. II
fracture lesser sphenoid or optic canal. III- descending transentorial
herniation. IV- violent trauming shearing against tentorium.
Horners- extracranial carotid artery dissection. III. IV. V. V!
fracture through cavernous sinus or orbital apex.
I :. \� �/�
�· ,
�\ ':�·j
. .
Skull and Brain
4 Lesions
1. Focal Gyriform enhancement in brain is seen in:

A. Infarct
B. AVM
C. M eningitis
D. Encephalitis
E. Glioma
2. Bilateral symmetrical intracranial calcification is seen in:

A. Sturge \Neber syndrome
B. Corpus callosal lipoma
C. Lead poisoning
D. Cvsticercosis
.,;
E. Tuberous sclerosis
3. Bilateral hypodense basal ganglia is seen in:

A. Pseudohypoparathyroidism
B. Carbon monoxide poisoning
C. Leighs disease
D. Venous infarct
E. Cardiac arrest
4. Enhancement of basal cisterns is a feature of:

A. Cryptococcus
B. Tuberculosis
C. Torulosis
D. Leukemia
E. Encephalitis
5. Petrous apex lesions-Differential diagnosis:

A. Cholesterol granuloma
B. Cholesteatoma
C. Seventh ne:-ve neuroma
D. Metast2-;es
E. Chordc :,:.
Skull and Brain Lesior 1s 41
6. Lesions in foramen magnum at cervicomedullary junction:

A. Multiple sclerosis
B. Glioma
C. IV ventricle tumour
D. Hemangioblastoma
E. Glioma
7. Differential diagnosis of cystic lesions in cerebellar hemispheres:

A. Medulloblastoma
B. Astrocytoma
C. tvfetastasis
D. Hemangioblastoma
E. Choroid plexus papilloma
8. The following tumours are dense in plain CT scans:

A. Meningioma
B. Schwannoma
C. Lymphoma
D. Medulloblastoma
E. Ganglioglioma
9. Cholesterol containing lesions in brain are:

A. Epidermoid inclusion cyst
B. Congenital cholesteatoma
C. Arachnoid cyst
D. Lipoma
E. Cranipharyngioma
10. Common cystic lesions in posterior fossa:

A. Mega cisterna magna
B. Arachnoid cyst
C. Pleomorphic xanthoastrocytoma
D. Dandy 'Walker variant
E. Arnold chiari malformation
11. Suprasellar cystic lesions:

A. Colloid cyst
B. Aqueductal stenosis
C. Cysticercosis.
D. Astrocytoma
E. Epidermoid
12. High signal intensity in T2 images of brainstem is seen in:

A. ADEi\1 B. Cavernous hemangioma
C. Syringobulbia D. vVallerian degeneration
E. Lymphoma
13. Differential diagnosis for cystic lesions with mural nodule:

A. Ganglioglioma
B. Pleomorphic xanthoastrocytoma
C. Lymphoma
D. Metastases
E. Hemangioblastoma
14. Increased density in the falx is seen in:

A. Lipoma
B. Cerebral edema
C. Subarnchnoid haemorrhage
D. Hyµerµarathyroidism
E. Hypoparathyroidism
15. High signal in diffusion-weighted images is seen in:

A. ]CD
B. Multiple sclerosis
c. Cerebral a bscess
D. Herpes encephalitis
E. ivleningioma
16. Ring enhancing lesions in a AIDS patient indicates:

A. Lymphoma
B. Toxoplasmosis
C. Tuberculosis
D. Progressive mulrifocal encephalopathy
E. Cytomegalovirus
1 7. The following are dense and enhancing lesions:

A. Aneurysm
B. Lymphoma
C. Meningioma
D. Medulloblastoma
E. Ependydoma
18. Cavum septum pellucidum cyst

A. Is not a significant
B. O bstructio n of intervemricular for a mina
C. Contrast enhancement is a feature
D. Compression of subependymal veins
E. Compression of hypothalamoseptal triangle structures
19. High signal in diffusion-weighted images is seen in:

A. Chronic infarct B. Medulloblastoma
C. Lymphoma D. Arachnoid cyst
E. Epidermoid cyst
Skull and Brain Lesions 49
20. Causes of diffuse gyriform enhancement:

A. Lymphoma
B. Sarcoidosis
C. Carcinomatosis
D. Tuberculosis
E. Encephalitis
21. The following lesions produce midline cystic lesions in brain:

A. Cavum v eli inerpositi
B. Arachnoid cyst
C. Colloid cyst
D. Epidermoid
E. Pilocytic astrocytoma
22. Multifocal enhancing lesions in brain indicate:

A. Multiple infarctions.
B. M ultiple sclerosis
C. AVMs
D. Adrenoleukodystrophy
E. iv1etastasis
23. Multiple enhancing nodules in brain are se e n in:

A. Tuberculosis
B. Histoplasmosis
C. Cysticercosis
D. Sarcoidosis
E. Multiple sclerosis
24. Intraorbital calcification is seen in:

A. Retrolental fibroplasias
B. Idiopathic infantile hypercalcemia
C. Optic nerve glioma
D. Retinoblastoma
E. Pseudotumour
25. Di pl op ia occurs in th e following conditions:

A. Diabetes mellitus B. Frontal mucocele
C. Blow out fracture D. Homer's syndrome
E. M yasthenia gravis
26. B utt on sequestrum of skull is seen in:

A. Hemangioma
B. Epidermoid
C. Eosinophilic granuloma
D. Tuberculosis
E. Radiation
27. Inadequate calvarial calcification is seen in:

A. Hurlers
B. Achondroplasia
C. Hypophosphatasia
D. Osteopetrosis
E. Rickets
28. Enhancing lytic areas in the skull are seen in:

A. Histiocytosis
B. Metastasis
C. Fibrous dysplasia
D. Tuberculosis
E. Mveloma
29. Low density areas on enhanced CT scan is seen in:

A. Alzheimers disease
B. Diffuse cerebrovascular disease
C. Pyogenic meningitis
E. Multiple sclerosis
30. Hyperdense choroid plexus in CT in a child:

A. Hemorrhage
B. Choroid plexus papillorna
C. !\1elanoma of choroids plexus
D. Aortic obstruction
E. Lipoma
31. Ring enhancing lesion in brain are seen in:

A. Tuberculosis
B. Astrocytomas
C. Lymphomas
D. Herpes encephalitis
E. Bronchiectasis
F. Ganglioma
32. Low density lesions in brainstem are seen in:

A. Infarction
B. Glioma
C. Metatasis
D. Tuberculosis
E. Sarcoidosis
33. Lytic area in a bone flap is common in:

A. Paget's B. Osteomyelitis
C. Fibrous dyspla::.;'.a D. Radiation necrosis
E. Avascular nee .·s
34. Elevation of lesser wing of sphenoid occurs in:

A. Fibrous dysplasia
B. Meni ngioma
C. Coronal suture stenosis
D. Neurofibroma
E. AVivf
35. Conditions producing generalized increased skull thickness:

A. Hyperparathyroidism
B. Acromegaly
C. Cerebral atrophy
D. S ickle cell di sease
E. Ost eopetros i s
36. Causes of diffuse thinning of skull:

A. Rickets
B. Hydrocephalus
C. Hypophosphatasia
D. C leidocranial dysplasia
E. Osteogenesis imperfecta.
F. Phenvtoin
J
37. Differential diagnosis for central skull base tumours:

A. Chordoma
B. Chondrosarcoma
C. Paget's disease
D. Nasopharyngeal carcinoma
E. Juvenile nasopharyngeal angiofibroma
38. Erosion of odontoid process is a feature of:

A. Down's syndrome
B. Ankylosing spondylitis
C. Psoriasis
D. SLE
E. Hurlers
39. Leontiasis ossea is seen in:

A. Leprosy
B. Paget's
C. Fibrous dysplasia
D. Hypophosphatasia
E. Craniometaphyseal dysplasia
40. Absent innominate line is a feature of:

A. Neurofibromatosis B. Metastasis
C. Fibrous dysplasia D . Paget's
E. RhabdomvosarcomaJ
41. Multiple lytic lesions in skull are common in:

A. Myeloma B. Amyloidosis
C. AV:vl D. Hemangioma
E. Histiocytosis
42. Wormian bones are seen in:

A. Progeria
B. Rickets
C. Wilson's disease
D. Hypothyroidism
E. Cleidocranial dysostosis
43. The following lucencies are normal in skull:

A. Venous lakes
B. Pacchionian granulations
C. Leptomeningeal cyst
D. Parietal foramina
- E. Emissary \·ein
44. Basal ganglia calcification is a feature of:

A. Tuberous sclerosis
B. Idiopathic r.ypercalcemia
C. Toxoplasmosis
D. Hyperpararhyroidism
E. Cockaynes syndrome
45. Third nerve palsy occurs in:

A. Craniopharyngioma
B. Cavernous sinus thrombosis
C. Acoustic neuroma
D. Aneurysm of the posterior communicating artery
E. Aneurysm of the middle cerebral artery
46. Osteolysis of the orbital wall is seen in:

A. Histiocytosis X
B. Sphenoidal ridge meningioma
C. Neuroblastoma
D. Rheumatoid arthritis
E. Cleidocranial dysplasia
4 7. Constricted foramen magnum is seen in:

A. Microcephaly
B. Klippel Fleil syndrome
C. Achondroplasia
D. Arnold Chiari malformation
E. Occipatisation of C 1
48. Focally thinned skull is seen in:

A. Chronic subdural haematoma
B. Fibrous dysplasia
C. Arachnoid cyst
E. Neurofibromatosis
49. Sclerosis of skull base is seen in:

A. Paget's disease B. Prostate carcinoma
C. Meningioma D. Tuberous sclerosis
E. Fibrous dysplasia
50. Differential diagnosis for high signal in thalamus with sparing

of pulvinar:
A. Carbon monoxide poisoning
B. Wernickes encephalopathy
C. Infarction
D. Down's syndrome
E. Amyloid angiopathy
51. Sellar destruction is a common feature in:

A. Sphenoidal sinus mucocele
B. Sphenoidal carcinoma
C. Enlarged third vemricle
D. Sphenoidal metastasis
E. Pituitarv adenoma
,,
52. Differential diagnosis of h i gh signal in thalamus -pulvinar and

medial nucleus:
A. Cat scratch disease
B. Benign intracranial hypertens'.on
C. Sporadic CJD
D. Encephalitis
E. Variant CJD
53. Hair on end skull is seen in:

A. Iron deficiency anaemia
B. Osteomyelitis
C. Meningioma
D. Sickle cell disease
E. Cyanotic heart disease
54. Common causes of parasellar calcification:

A. Chordoma B. J\1acrnadenorna
C. Hypothalamic glioma D. Craniophar/r:gioma
E. Tuberculosis
5 5. Common causes of ring like calcification inside the brain are :

A. Pineal germinoma
B. Atherosclerosis
C. Sinus thrombosis
D. Haematoma
E. Cranipharyngoma
56. Common causes of multiple nodular calcification:

B. Hyperparathyroidism
C. Myelography
D. TORCH infections
E. Lymphoma
57. Common causes of hyp erdense cerebral cisterns(unenhanced

scans ) :
A. Mvodil contrast
J
B. Diffuse cerebral edema

C. Sarcoidosis
D. Leukemia
E. �·1etastasis
58. Common c auses of high signal in TZ weighted images of

bra instem:
A. \\"allerian degeneration
B. Lymphoma
C. Encephalitis
D. Trauma
E. Cavernous angioma
59. Common causes of hyp erdensity in basal ganglia:

A. Lymphoma B. Toxoplasomosis
C. Krabbes disease D. Alexander's disease
E. Down's syndrome
60. Causes of nodular changes in the ventricular margins:

B. TORCH infections
C. Heterotopia
D. Subependymoma
E. Choroid plexus papillorna
61. Common causes of asymmetrical ventricles:

A. Subependyrnal giant cell astrocytoma
B. Hemimegalencephaly
C. Sturge Weber syndrome
D. Silver Russell syndrome
E. Infarct
62. Common causes of cerebellar degeneration:

A. Toluene exposu re
B. Cytosine arabinoside
C. Shy Dr ag er syndrome
D. Parkinsonism
E. Small cell carcinoma lung
63. Common causes of pneumocephalus:

A. Mastoiditis
B. Air embolism
C. Osteoid osteoma of frontal sinus
D. Pituitary adenoma
E. Tuberculosis
64. Common causes of cranial nerve enhancement:

A. Sarcoidosis
B. Viral infections
C. Schwannomas
D. Leukemia
E. Meningiomas
65. Absent greater wing of sphenoid:

A. Optic glioma
B. Aneurysm
C. Retinoblastoma
D. Eosinophilic granuloma
E. Haematoma
66. ] shaped sella is a feature of:

A. Neurofibromatosis
C. Achondroplasia
D. Hydrocephalus
E. Osteogenesis imperfecta
67. Basilar impression is seen in:

A. Cleidocranial dysplasia
B. Rickets
C. Achondroplasia
D. Hyperphosphatasia
E. Hurlers
68. Destroyed temporomandibular joint is a feature of:

A. Hyperparathyroidism
B. Rheumaroid
C. Polymyalgia rheumatica
D. Infection
E. Otitis external
69. Causes of en hancing dural tail:

A. Glioblastoma multiforme
B. Metastasis
C. Aspergillosis
D. Oligodendroglioma
E. Acoustic neuroma
70. Brain calcification:

A. Vertebrobasilar system is more often calcified than internal
carotid artery
B. Calcification of dentate nucleus is associated \Nith basal ganglia
calcification
C. In basal ganglia. caudate nucleus is more often affected than
globus pallidus
D. Choroid plexus calcifies only after ten years
E. Habenular calcification is seen in the tela chroidea of the third
ventricle
71. ·Diffuse skull base lesions are seen in:

A. Dermoid
B. Pagets
C. Histiocytosis
D. Meningioma
E. Lipoma
72. The following are the common causes of cortical lesions:

A. Contusions
B. Sturge Weber syndrome
C. Hemangioblastoma
D. AVMs
E. Toxoplasmosis
73. The following are lesions found at the corticomedullary junct io n:

A. Septic emboli
B. ADEM
C. PML
D. Toxoplasmosis
E. Diffuse axo nal injury
7 4. Lesions predominantly seen in the periventricular/ pericallosal

region:
A. Marchiafava Bignami syndrome
B. Lymphoma
C. Porencephaly
D. Lipoma
E. Ependyrnoma
75. Differential diagnosis for high signal in basal ganglia:

A. Leigh diseae
B. Hypoglycemia
C. Huntingtons disease
D. Hemolytic uremic syndrome
E. Encephalitis
76. Differential diagnosis of extraaxial masses:

A. Hemangiopericytoma
B. Sarcoidosis
C. Lymphoma
D. Varix
E. Extramedullary hem atopoiesis
77. Causes of basal ganglia degeneration:

A. Nephrotic syndrome
B. Hemolytic uremic syndrome
C. Eclampsia
D. Vasculitis
E. Top of basilar syndrome
78. Causes of vasculitis in brain:

A. Amphetamine
B. Sarcoid
C. SLE
D. Henoch Schonlein disease
E. 'vVegener's disease
79. Recognised causes of arterial spasm

A. Fibromuscular hyperplasia
B. Dissection
C. Sarcoidosis
D. Radiation
E. Migraine
ANSWERS
1. A-T. B-T, C-F, D-T, E-T
2. A-F. B-T, C-T. D-F, E-F

3. A-F. B-T, C-T, D-T, E-T
Hypodense basal ganglia in CT is seen in hypoxic ischemic
encephalopathy. toxic encephalopathy (carbon monoxide. lead.
cyanide. sulphur dioxide). venous infarcts and mitochondrial
diseases (Leighs disease).
4. A-T, B-T, C-T, D-T, E-F

Infections are the most common cause of enhancement of basal
cisterns. Tumours like metastasis. lymphoma. leukemia and
subarachnoid seeding are other causes of enhancing basal cisterns.
5. A-T, B-T, C-F, D-T, E-T

V nerve neuroma. hemangioma,nasopharyngeal carcinoma, apical
petrositis. meningioma are other causes.
6. A-T, B-T, C-T, D-T, E-T

Posterior extramedullary, intradural-ependymoma. medulloblas
toma. arachnoid cyst.
Extra dural masses-RA, chordoma. metastasis. trauma.other
anhropathies
Anterior extramedullary-Basilar ectasia, meningioma. aneurysm.
epidermoid, dermoid, schwannoma. paraganglioma, arachnoid
cyst.
7. A-F, B-T, C-T, D-T, E-F

Medulloblastomas are solid. choroid plexus papillomas are solid
and intraventricular.
8. A-T, B-F, C-T, D-T, E-F

Metastasis from mucin producing tumours, haemorrhagic or
calcified are other causes. Cellular tumours are dence.
9. A-T, B-T, C-F, D-F, E-T
10. A-T, B-T, C-F, D-T, E-F
Astrocytoma (pleomorphic) seen in temporal lobe.
11. A-T, B-T, C-T, D-T, E-T
In aqueducal stenosis. the third ventricle is dilated. Cystic cranio
pharyngioma and cystic astrocytoma of hypothalamus are other
common causes.
12. A-T, B-T, C-T, D-T, E-T

Glioma, lymphoma. metastasis, infarct are other causes.
13. A-T, B-T, C-F, D-F, E-T

Pilocytic astrocytoma, glioblastoma multiforme. DNET. tuber
culosis. cysticercos'.s are other causes.
Skull and Brain Lesion�; ��;
14. A-F, B-T, C-T, D-T. E-T

Subdural haemorrhage is common cause.
15. A-T. B-T. C-T,D-T, E-T
16. A-T, B-T, C-T, D-F. E-F

Lymphoma. toxoplasmosis. tuberculosis. Cryptococcus cause ring
enhancement in AIDS.
17. A-T. B-T, C-T, D-T, E-F

Metastasis is another recognised cause.
18. A-T, B-T, C-F, D-T. E-T

Normally cavum septum pellucidum is asymptomatic. It can
become symptomatic and become pathological if there is
hydrocephalus/compression of optic chiasma/hypothalamus/
distortion of internal cerebral/subependymal veins. Contrast
enhancement indicates neoplasm.
19. A-F, B-T. C-T, D-F, E-T

Acute infarction causes high signal. This lasts for t\vo \veeks.
Highly cellular tumours usually have high signal in diffusion
weighted images. It is not possible co differerniate bet'vveen the
different tumours. Epider:noid cyst ha\·e high signal due ro
restricted \vater diffusion wirhin the cvsr.
20. A-T, B-T, C-T, D-T, E-T
21. A-T, B-T. C-T. D-F, E-F

Cavum septum pellucidum and cavum vergae are other causes.
22. A-T, B-T, C-T, D-F, E-T
23. A-T, B-T, C-T, D-T, E-T

Lymphoma and metastasis are other causes.
24. A-T, B-F, C-T. D-T, E-F

Phleboliths. meningioma. neurofibroma. carcinomJ ar2 other
causes.
25. A-T, B-T, C-T, D-F, E-T
26. A-F, B-T, C-T, D-T. E-T

Eosinophilic granuloma. epidermoid. tuberculosis. osteomyelitis.
radiation and metastasis are common causes.
27. A-F, B-T. C-T, D-F. E-T
28. A-T, B-T, C-T, D-T, E-T

Leptomeningeal cyst. trauma. epidermoid and derrnoid are other
causes.
29. A-F. B-T. C-T. D-T, E-T

30. A-T, B-T. C-F, D-T. E-F

The causes of hyperdense choroids plexus in CT scan in a child
are calcification secondary to neurofibromatosis. hemorrhage.
tumours like choroids plexus papilloma, hemangioma and
carcinoma and aortic obstruction (resulting hypertension results
in increased cerebral blood flov.. ).
:
_31. A-T, B-T, C-T, D-F, E-T, F-T

The causes of ring enhancement in a cerebral lesion are:
A . Tumours-metastasis. pilocytic astrocytpmas, hemangioblas
t omas. ganglio-gliomas, plemorphic xanthoastrocytoma.
lymphomas
B. Infections-Abscesses, tuberculosis. cysticercosis. toxoplas-
mosis, cryptococcosis
C. Vascular-Infarcts (after 2 weeks). hemorrhage.
D. Deyelination-Multiple sclerosis
E. Miscellaneous-Transient ring enhancing lesions are seen in
epileptic patients
32. A-T, B-T, C-T, D-T, E-T

Central pontine myelinolysis is a recognised cause. Syringobulbia
and decussation of superior cerebellar peduncles are common
causes.
33. A-F, B-T, C-F, D-T, E-T
34. A-F, B-T. C-F, D-T, E-T

Meningioma. neurofibroma.lymphoma, chordoma. aneurysm.
AVM.
35. A-T, B-T, C-T, D-T, E-T

T halassemia, Engelmann disease are other causes. Drugs like
phenytoin also cause.
36. A-T, B-T, C-F, D-T, E-T, F-F

Obstructive hydrocephalus. cleidocranial dysplasia, osteogenesis
imperfecta. progeria. chiari I malformation. Cushing's syndrome
and rickets are common causes.
37. A-T, B-T, C-T, D-T, E-T

Metastasis is another common cause.
38. A-T, B-T, C-T, D-T, E-F

Rheumatoid arthritis is the most common cause.
39. A-F, B-T, C-T, D-F. E-T

Leontiasis is overgrowth of facial bones. Pagets, fibrous dysplasia,
hyperphosphatasia and craniometaphyseal dysplasia are common
causes of leontiasis ossia.
40. A-T, B-T, C-T, D-F, E-T

Innominate line is the orbital process of sphenoid.
41. A-T, B-T, C-T, D-F, E-T

I
Metastasis is the most common c ause. Hyperparathyro idi sm is
another cause.
�
I
.
42. A-T, B-T, C-F. D-T. E-T
Wormian bones are small intrasutural ossicles. The causes are
(mnemonic PORK CHOPS). Pyknodysostosis. osteogenesis imper
fecta. rickets, kinky hair syndrome (Menkes disease). cleidocranial
dysostosis, hypophosphatasia/hypothyroidism/Hajdu c heney
acroosteolysis. otopalatodigital syndrome. pachydermoperiostitis/
progeria, syndrome of Down
43. A-T. B-T. C-F. D-T, E-T

Venous lakes are outpouchings of the diploic veins. Pachhionian
granulations f rom the arachnoid membrane are seen commonly
in the parasagittal region. Parietal foramina are non-ossified
embryonal rests in the parietal fissure seen bil ater a lly at superior
posterior angles of parietal bone. Emissary vein connects the intra
and extr acrani al venous channels. Leptomeningeal cyst is produced
secondary to fracture and is not a normal variant.
44. A-T. B-F. C-T. D-T, E-T

Aging. hypoparathyroidism. pseudohypo, pseudohypoparathyroi
dism. hype rpa rathyroid ism , hypothyroidism. birth anoxia. leac
poisoning. carbon monoxide poi s oni n g. D o'vvn · s sync! rome.
cockaynes. carpenters syndromes. infections. TORCH. TB.
cysticercosis. AIDS, measles.
45. A-T, B-T, C-F, D-T, E-F

3rd N lesion midbrain, cirterm. cavernoussinus. superior orbital
fissure .
46. A-T, B-F, C-T. D-F, E-F

Metastasis. infections, sarcomas are other causes.
47. A-F, B-F , C-T, D-F, E-F

Hypochondropl a sia , achondrogenesis, thanotophoric dysplasia.
metatrophic dysplasia. c leidocranial dysplasia, craniometaphyseal
dysplasia, spondylothoracic dysplasia Qarcho Le v in) are other
causes.
48. A-T, B-F, C-T, D-F, E-T

Epidermo id . meningocele, histiocytosis. oste om yelitis . heman
gioma are other causes.
49. A-T, B-T, C-T, D-F, E-T
50. A - T, B-T, C-T, D-F, E-F

CJD is another common cause.
51. A-T, B-T, C-T, D-T. E-T
52. A-T, B-T, C-F, D-T, E-T

This is a classical appearance of variant CJD. In cat scratch disease.
there will also be associated leptomeningeal enhancement. Benign
intracranial hypertension is self limiting. Another rare cause is
Alpiers disease which also has high signal in the occipital cortex.
53. A-T, B-F, C-T, D-T, E-T

Hair on end skull is seen in Haematological-thalassemia, sickle
cell anaemia, hereditary spherocytosis. elliptocytosis. G6PD
deficiency. pyruvate kinase deficiency, severe iron deficiency
anaemia. Tumour s-hemangioma. meningioma. metastasis.
osteosarcoma. Cyanotic heart disease-due to erythroid hyperplasia.
54. A-T, B-T, C-T, D-T. E-T

Aneurysm, cysticersosis. chiasmatic glioma and chondrosarcoma
are other causes.
55. A-T, B-T, C-F, D-T, E-T

Other causes are aneurys m. A V\.1. cystic astrocytoma and
teratomas. Hvdatid cvst is a rare cause in brain.
"' "'
56. A-T, B-T, C-T, D-T, E-F

\.1:yelography with oily contrast like pantopaque. myodil produces
calcification which can stay for a long time inside the nervous
svstem.
"'
57. A-T, B-T, C-T. D-F, E-F

Subarachnoid haemorrhage and meningitis are still the most
common causes.
58. A-T, B-T, C-T, D-T, E-T

Infarct. tumours, central pontine myelinolysis. multiple sclerosis.
ADEM. abscess. metastasis, synringobulbia are other recognized
causes.
59. A-T, B-F, C-T, D-F, E-F

Haemorrhage is a common cause.
60. A-T, B-F, C-T, D-T, E-F

Su bependymal nodules of tuberous sclerosis and nodular
heterotopia are the common causes.
61. A-T, B-T, C-T, D-T, E-T

SGCA can cause unilateral obstruction of foramen of Monro.
producing asymmetrical ventricles. It can be a normal anatomical
variant or it can be positional. Hemiatrophy and Dyke Davidoff
Masson syndrome are o·:-,2:- causes.
I 62. A-T, B-T, C-T, D-F, E-T
Small cell carcinoma of lung produces a paraneoplastic syndrome

producing cerebellar degeneration. Parkinsonism does not affect
cerebellum. Phenytoin. radiotherapy. alcohol are other causes.
63. A-T, B-T, C-T, D-T, E-F

Trauma and iatrogenic procedures are other common causes.
64. A-T, B-T, C-T, D-F, E-T

I Metastasis and inflammation are other caus�s.
I
f 65. A-T, B-T, C-T, D-T, E-T
t
66. A-T, B-F, C-T, D-T, E-T
:
Optic glioma. mucopolysaccharidosis and a normal variant are

other causes. Neurofibromatosis. fibrous dysplasia. meningioma.
metastases are other causes.
67. A-T, B-T, C-T, D-F. E-T

Osteomalacia. rickets, Pagets. fibrous dysplasia. hyperparathy
roidism. osteogenesis imperfecta. achondroplasia. cleidocranial
dysplasia and Hurlers are the common causes.
68. A-T, B-T, C-F. D-T, E-F
69. A-T. B-T, C-T, D-T. E-T

Meningioma is the most common cause. Astrocytomas.
lymphomas. leukemia are other causes.
70. A T, B-T. C-F, D-T. E-T,

-
Globus pallidus is the most calcified in basal ganglia.
71. A-F, B-T, C-T, D-T, E-F

Fibrous dysplasia. metastases. myeloma. lymphoma. rhabdomyo
sarcoma are other causes.
72. A-T, B-T, C-T. D-T, E-F

Protoplasmic type of astrocytoma. pleomorphic xantho.Jstr3c:ytoma
a n d dysembryoblastic neuroectodermal rurnour ar� other
r ecognized causes of cortical lesions.
73. A-T, B-T, C-T. D-T, E-T
74. A-T, B-T, C-T, D-T, E-T

Marchiafava syndrome is corpus callosal degeneration seen in
alcoholics. Other lesions in this location include multiple sderosis.
diffuse axonal injury and glioblastoma multiforme.
75. A-T, B-T. C-T, D-T, E-T

CO poisoning. Dov.;n's syndrome. lead poisoning. Wilson's disease
are other common causes.
76. A-T, B-T. C-T, D-T, E-T

Meningioma. metastasis, plasmacytoma. histiocytosis. aneurysm,
dural malformations. are other causes.
77. A-T, B-T, C-T, D-T, E-T

Hypertension. i nfarction are other causes.
78. A-T, B-T, C-T, D-F, E-F

Cocaine. phenylproponalamine. giant cell arteritis. gr anulomatous
angitis, infection are other causes.
79. A-T, B-T, C-F, D-T, E-T

Suba ra chnoid haemorrh age is the most common cause of
\·asospasm. Flow related changes can also occur in AV.\1 and A VF.
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'
1. Homosexual male, with leg weakness and a sensory level at D6:

A. HIV status should be assessed immediately
B. Hypochlorite is sufficient to sterilize any spills
C. Lumbar puncture is not risk to hospital staff since the virus
is not seen in CSF
D. Lymphoma is a complication in CNS
E. Metastasis is the most likely cause
2. Infantile toxoplasmosis:
A. Calcification is seen in basal ganglia
B. Calcification is seen around the ventricles
C. Dogs are the transmitting agems
D. Caused by a bacteria
E. Hydrocephalus is seen
3. L es ions showing mass effect and enhancement in AIDS:

A. Cryptococcus
B. Toxoplasmosis
C. Lymphoma
D. Herpes
E. Candida
4. Meningeal disease in AIDS is seen in:

A. Herpes simplex B. HIV
C. Lymphoma D. Metastasis
E. Cryptococcosis
5. Features in favour of toxoplas mosi s rather than lym phoma:

A. Higher uptake in FDG PET
B. Higher uptake in thorium 201 SPECT
C. Single lesion
D. Central low intensity in T2 vV images
E. Larger lesion
6. Lymphoma in AIDS shows the following features in comparison

with non-AIDS patients:
A. Older age group
B. Often multiple
C. Less prominent edema
D. Ring enhancement
E. No mass effect
7. The following features indicate HIV encephalopathy rather than

PML:
A. Mass effect
B. Enhancement
C. Asymmetrical
D. Sparing of subcortical U fiberes
E. Hypointense in Tl W images
8. HIV:
A. The contrast enhancement of toxoplasmosis depends on the
CD4 level
B. Cryptococcosis enters the brain by CSF
C. The herpes simplex virus enters brain by hematogenous spread
D. The most common site involved in infections is basal ganglia
E. Satellite lesions are 100% specific for toxoplasmosis
9. Toxoplasmosis:
A. Can live in any cell
B. Trophozoites are transmitted through undercooked meat
C. Oocysts are transmitted through placenta
D. 90% prevalence
E. Non granulomatous infection of brain
10. Toxoplasmosis:
A. Most common CNS mass in HIV
B. Eccentric target sign i n dicates cysticercosis rather than
toxoplasmosis
C. Response to antibiotics is seen in 7-10 days
D. Solitary in 50%
E. Basal ganglia is the most common site
11. Lesions showing enhancement without mass effect in AIDS:

A. Diffuse toxoplasmosis
B. HIV encephalopathy
C. PML
D. Infarcts
E. CMV
I
l
i
12. Cryptococcosis:
Infections 67
t
I
. A. Meningeal enhancement is the characteristic feature
I
B. Cryptococcomas show moderate enhancement
C. The second most common opportunistic infection in HIV
D. Dilated Virchow Robin spaces is an important feature
E. Increases the risk of PML
I
i
13. Basal ganglia lesion in HIV indicates:
j
' A. Cryptococcosis
B. Metabolic encephalopathy
C. Tuberculosis
D. Toxoplasmosis
E. Lymphoma
14. Common causes of ventriculitis in HIV:

A. Tuberculosis B. Lymphoma
C. CMV D. Cryptococcosis
E. Aspergillosis
15. HIV:
A. PML is a demyelinating process
B. Bifrontal distribution is common in P\.1L
C. Destruction of inner table of skull is commonly caused by
lymphoma
D. Intense enhancemem of cerebellar foliae occurs in tuberculosis
E. Vasculitis involving che veins is very common in cuberculosis
16. HIV:
A. Intraventicular l ymphoma is always secondary
B. The edema around a tuberculous lesion int e n sifies after
treatment
C. Immune reconstituti on syndrome is irreversible and is caused
by florid demyelination
D. tv'1R venography is the only in v estigation requircJ for dural
sinus thrombosis
E. Straight sinus thrombosis. produces bilateral o c c i p ital conex
haematoma
17. Tuberculoma:
A. tvf ost common cause of focal neurologic deficit in developing
countries
B. 30% of intracranial masses in developed nations
C. Not associated vvith tuberculous meningitis
D. More common in posterior fossa than supro centorial reg\or.
E. Majority are solitary
18. MRI features of tuberculoma:

A. Hypointense in. Tl
B. Hyperintense core in T2
C. Walls thinner than pyogenic abscess
D. Edema more marked than in pyogenic abscess
E. Ring enhancement is seen in nearly all of the lesions
- 19. Cysticercosis:
A. Caused by ingestion of uncooked contaminated pork
B. Edema is extensive
C. Calcification indicates disease present for atleast two years
D. Edem1.1 indicates living worm
E. Calcification indicates death of larva
20. The following are recognised sites of cysticersosis infestation in

brain:
A. Intraventricular
- B. Subcutaneous tissue
C. Quadrigeminal cistern
D. Diploic space
E. Frontal sinus
21. Cry p to co cco s is :

A. It is very common in the cerebellar foliae
B. Hydrocephalus is a recognised feature of cryptococcosis
C. Aspergillus commonly enters the CNS through paranasal sinuses
D. HIV encephalitis is commonly seen during the seroconversion
illness
E. The Cryptococcus lesions show intense peripheral enhancement
22. Neurocysticercosis:
A. Vesicular stage- has no edema
B. Scolex is hyperdense to CSF
C. Most common location is the grey white matter junction
D. Fluid is clear in the vesicular stage
E. Contrast enhancement is seen in vesicular stage
23. HIV:
A. HIV encephalopathy is seen in 60% of those infected with HIV
virus
B. Toxoplasmosis shows homogenous enhancement when they
are small
C. The Toxoplasma lesion calcifies after treatment
D. HIV encephalopathy is a type of subacute encephalitis
E. In toxoplasmosL. the organisms are found in the innermost
layer
I ------ · ·
Infections
..·
-- ,_.
69
·-
I
24. Neurocysticer cosis:
A. The cyst is hyperintense in T2 in colloidal vesicular stage
B. No enhancement is seen in granular nodular stage
I C. The capsule is thick in colloidal vesicular

D. The cyst is smaller in granular nodular than colloidal vesicular
E. Calcification is seen by eight months
25. Features of cytomegalovirus:

A. Cataract
B. Sensorineural hearing loss
•
}
C. Mental retardation
i
f D. Microcephaly
E. Hydrocephalus
26. Herpes simplex encephalitis:

A. HSY II is the most common cause in adults
B. Frontal lobe is typically affected
C. Viral prodrome is always present
D. CT has the main role in diagnosis
E. CT is positive in the first 48 hours
27. rvtRI features of Herpes encephalitis:

A. Haemorrhage
B. Hyperimense in T 1
C. Putamen is spared
D. Enhancement correlates wi[h disease activiry
E. tvlonality is 40%
28. Abscess:
A. A well established capsule has three layers
B. The early capsule formation takes two months to develop
C. Posterior fossa is involved in 50% of cases
D. An irregular enhancing rim is seen in late cerebritis stage
E. The capsule is well defined and thin in abscess
29. Abscess:
A. The capsule of an absess is thicker tO\vards th<� ependymal side
than the cortex
B. Satellite lesions are very uncommon
C. Staphylococcus is the most common agent in neonates
D. The capsule of abscess is hypointense in both T 1 and T2
E. After steroids. the capsule becomes thin and contr ast
enhancement is lost
30. The fallowing vaccines are recognized causes of AD E0.-1:

A. Chickenpox B. Diptheria
c. Hepatitis D. Typhoid
E. Tetanus
31. The following produce white matter abnorma li ties in HIV:

A. PML B. CMV
C. Cryptococcus D. Encephalitis
E. HIV encephalopathy
32. ADEM:
A. Sequelae of measles vaccination
B. Perivenous inflammation
C. Multifocal white matter hyperintensiries
D. Involves gray and white matter
E. Compll,te recovery in most
33. Differential diagnosis for high signal produced by acute

encephalitis:
A. Multiple sclerosis B. Toxic encephalopathy
C. Osmotic demyelination D. Ecclampsia
E. Thrombocytopenic purpura
34. Subdural empyema:

A. Results in infarction
B. Majority close to the temporal bone
C. Nn neurological deficit if it is epidural
D. Ri� enhancement is seen immediately after onset
E. Severe mastoiditis or sinusitis is always present
35. Common causes of cerebellitis:

A. Measles
B. Mumps
C. Varicella
D. Epstein Barr virus
E. Pertussis
36. MRI features of sporadic CJD:

A. High signal in putamen and caudate
B. Anterior half of putamen has lower signal than posterior half
C. Prominent Virchow Robin spaces
D. High signal in periaqueducal grey matter
E. Degree of cerebral atrophy correlates with the duration of
disease
37. Variant CJD:

A. Related t o mad cow disease
B. More rapid course than sporadic CJD
C. Younger age of onset
D. Same clinical features of sporadic CJD
E. Arnyloid .�'.aques are pathognomonic in thalamus
l 38. Variant CJD:
lnfoctions 71
I
l
A. Pulvinar sign is highly specific
i
B. Bilaterally symmetrical high signal in the pulvinar is very
sensitive finding
C. High signal in ventromedial nucleus of thalamus
D. Atrophy is not seen even in severe disease
E. High signal in Tl is seen in putamen due to deposition of PrP
'
!
protein
39. Infection:
A. Subdural effusion in meningitis indicates inflammation of veins
B. Subdural effusion extends into the subarachnoid space
C. Sinusitis is the most common cause of empyema
D. There is no contrast enhancement at the cerebritis stage
E. Tuberculous meningitis without any parenchymal changes is
rare
40. Meningitis:
A. Spread occurs hematogenously through choroid plexus
B. Hemophilus influenzae is the most common organism in children
before seven years
C. Neisseria meningitidis is the most common organism in older
adults
D. CT is mainly used for diagnosis of meningitis
E. The exudates in basal cisterns enhance on contrat ad:-ninis
tration
41. Menin g i t is:

A. Infarcts are nor seen in acute meningitis
B. Increased incidence of cortical venous thrombosis in meningitis
C. Hydrocephalus is always non-obstructive
D. Ventriculitis is associated in 30% of cases
E. Arterial infarcts are most common in the posterior cerebral
arterial te r ritorv
42. Herpes encephalitis:

A. Always leaves residual deficit in children
B. Ventricular dilatation seen
C. Can be confused with Sturge vVeber syndrome
D. Biopsy of brain is required for confirmation
E. Focal dense nodules of calcification are seen
ANSWERS
1. A-T, B-T, C-F, D-T, E-F
There is a high likelihood of HIV in this patient. Hypochlorite is
good for sterilising contamination with HIV virus. provided it is
given in sufficient concentration and there is little organic matter.
The virus is seen in blood and body fluids including CSF. But the
risk of contamination with lumbar puncture is very low compared
to blood and other body cavities. Lympho�a. Kaposis sarcoma
and other opportunitistic infections are very common in HIV.
2. A-T, B-T. C-F, D-F, E-T

Toxoplasmosis is an intrauterine infection caused by a protozoan
organism. Toxoplasma gondii. transmitted to preganant women in
contact with cats. Calcification around the ventricles. basal ganglia
and hemispheres, hydrocephalus. microcephaly and microphthal
mos are the common features.
3. A-F, B-T, C-T, D-F, E-T

Cryptococcus shows mass effect but no enhancement.
Tuberculosis, aspergillosis. histoplasmosis. coccidiodomycois are
other causes.
4. A-F, B-T. C-T, D-F, E-T
5. A-F, B-F, C-F, D-F, E-F

All are features of lymphoma. A large homogenous enhancing
lesion is likely to be lymphoma rather than toxoplasmosis.
Toxoplasmosis is often multiple, small. no central 10\v signal in T2,
no significant uptake in FDG or SPECT.
6. A-F, B-T, C-F, D-T, E-F.

In AIDS. lymphoma occurs at young age, multiple, ring
enhancement, more edema.
7. A-F, B-F, C-F, D-T, E-F

HIV encephalopathy PML
Distribution symmetrical asymmetrical

U fiber involvement uncommon common
PF uncommon common
Mass effect no may happen rarefy.mild
Enhancement never may happen rarely. mild
Haemorrhage never may happen rarely, mild
TIW isointense hypointense
8. A-T, B-T, C-F, D-T, E-F

Toxoplasmosis usually show ring enhancement. but this depends
on the level of CD4. If it is too low. then the host cannot me_.:-.:
Infections 73
an immune response against the toxoplasmosis. in which case.

enhancement will not be seen. Toxoplasmosis enters by hemato
genous spread. herpes simplex by axons and Cryptococcus by CSF.
The most common site involved is basal ganglia since it has long
end arteries. Satellite lesions are not pathogno monic for
toxoplasmosis and can be seen in other infections in HIV.
9. A-F, B-F, C-F, D-T, E-F

It is an obligate intracellular parasite. which can live in any cell
except non-nucleated RBCS. Trophozoites are transmitted through
placenta and oocysts through the undercooked meat. It is a
granulomatous infection.
10. A-T, B-F, C-T, D-F, E-T

Eccentric cyst is fairly specific for toxoplasmosis. This is
characterised by high signal nodule within a contrast enhancing
cysat. This is believed be due to collapse of membranes. Seen in
only 30% of toxoplasmosis. 30% of lesions are solitary.
11. A-T, B-F, C-F, D-T, E-T

PN1L produces no mass effect or enhancement. Herpes simplex ar.d
other encephalitis are other common causes.
12. A-F, B-F, C-T, D-T, E-F

Cryptococcus can present as meningitis. \vhich is difficult to ider:tify .
especially since it does not sho\1,· contrast enhancement. Other

features are Cryptococcomas \vhich are seen as non-enhancing
multicystic lesions and dilated Virchow Robin spaces.
13. A-T, B-T, C-F, D-T, E-F
14. A-T, B-T, C-T, D-F, E-F

CivfV is the commonest cause.
15. A-F, B-T, C-F, D-T. E-T

Piv1L is not a demyelinating process. but it prevents further
remyelination of damaged neurons. Destruction of inner table of
skull is a feature that is common in tuberculosis and actinomycosis.
Cerebellear tuberculosis can cause intense enhancement of cere
bellar foliae. Tuberculosis can cause parenchymal. leptomeningeal
or vasculitits patterns.
16. A-T, B-T, C-F, D-T, E-F

Edema around tuberculosis increases transiently after treatment.
and can be seen as intense hype rin t ense lesion in T2 and hypo in
. ne reconstitution syndrome is caused by demyelinat ioin
Tl. Immu
and is reversible. Straight sinus thrombos is produces Jilateral basal
ganglia infarction.
17. A-T. B-F. C-F. D-T, E-T

30% of intracranial masses in developing countries and 0.15% in
developed nations.
50% are associated with tuberculous meningitis. 70% are solitary.
18. A-F, B-T, C-T, D-F, E-T

Tl- Isointense. T2- hypointense with hyperintense core. Walls are
thinner and regular and edema is less marked than pyogenic
abscess. Ring enhancement is seen in almost all. Target sign is due
to central nodule and calcification. Can be homogenous
enhancement \vhen en plaque. CT-iso or hyperdense.
19. A-F. B-T, C-F, D-F, E-T

Tape \\"Orm infestation (Taenia solium) is caused by ingestion of
contaminated uncooked pork. But cysticercosis is caused b y
ingesting food contaminated b y tapeworm ova.
Edema is extensive and diffuse out of proportion with the
eysticercosis. Edema indicates a living worm inciting inflammatory
response or a recently dead \Norm.
Calcification can be seen as soon as eight months.
20. A-T. B-T, C-T. D-F, E F -
21. A-T. B-T. C-F. D-T, E-F

A.spergillus enters the brain through hematogenous route. The
Cr.yprococcus lesions not enhance \Vith contrast. Hydrocephalus is
seen due to meningeal involvement.
22. A-T, B-T, C-T, D-T, E-T

Vesicular stage(I)- cyst have clear contents, with live worm.thin
capsule fluid has same signal as CSF in CT and MRI. scolex is
hyperdense. no edema or contrast enhancement.
Most common location is the grey white matter junction, but also
seen in cerebellum. basal ganglia and brain stem.
23. A-T, B-T, C-T, D-T, E-F

Toxoplasmosis lesions are homogenously enhancing when they are
small, but show ring enhancement when they are large. They can
show areas of haemorrhage and necrosis and are calcified or
haemorrhagic after treatment. The lesion has three zones, the
innermost zone of necrosis. the intermediate zone where
inflammatory cells, encysted organisms and tachyzoites are seen.
and the peripheral zone where only encysted organisms are seen,
which is surrounded by a rim of vasogenic edema.
24. A-T, �-F, C-T, D-T, E-T

Colloidal vesicular(II). granular nodular(III)- the worm dies. elicits
inflammatorv reaction. cvst has turbid contents, \Vhich are
J �
hyperintense in Tl and T2. thick capsule. nodular or ring

Infections 75
enhancement due to breakage of blood brain barrier by dying

worms and toxic antigens. surrounding edema. In granular
nodular. the lesion is smaller and shows non-nodular enhance
ment. Nodular calcifed (IV)-calcification
25. A-F, B-T, C-T, D-T, E-T

Chorioretinitis, periventricular calcification are other features.
26. A-F, B-F, C-T, D-F, E-F

HSV I is the most common cause in adults and II in neonates.
Temporal lobe is typically affected. The main role of CT is to
identify biopsy site. CT is positive after three clays.
27. A-T, B-T, C-T, D-F, E-F

CT shows temporal lobe hypodensity. Small haemorrhages can be
seen. Enhancement is patchy and may persist for months. Putamen
is spared. Mass effect can be seen.
MRI shows low signal in Tl and high in T2. But haemorrhage can
give high signal in Tl.
Mortality is 70%
28. A-T. B-F, C-F, D-T, E-T

There are four stages in development of cerebral abscess. Early
cerebritis for 3-5 days late cerebritis till 10-14 days Early abscess
.
formation-from tv.;o weeks. late abscess formation-lasts for 1.veeks

and months. The late capsule has three layers, an inner
inflammatory layer middle collagenous layer and outer gliotic
.
layer. P osterior fossa is involved in 15% of case s. In early cerebritis

stage, there is hypodensity and ill-defined enhancement. In lai:e
cerebritis stage, there is hypodensity and irregular enhancing rim.
.
unlike malignancy, the capsule is thin and well-defined.
29. A-F, B-F, C-F, D-F, E-T

The capsule of abscess is thin and well defined. It is thicker on
the corticai side and thinner on the ependymal side, the opposite
of metastasis. Satellite lesions are formed due to rupture of the
capsule and spread of inflammation beyond the W<lll or coalescence
of multiple lesions in brain. Staphylococcus. Srreptococcus and Gram
negative bacteria are the organisms in adults. Proteus, Pseudomonas,
Citrobacter are common in neonates. The infection can be
hematogenous or c ontiguous spread in MRI. the lesion is
hypointense in Tl and hyperintense in T2. The capsule is iso to
hyper in Tl and iso to hypo in T2. The capsule enhances on contrast
administration.
30. A-T, B-T, C-F, D-T, E-T

ADEM is acute disseminated encephalomyelitis.
31. A-T, B-T. C-F, D-F, E-T

Small non-specific white matter hyperintensities are also seen.
32. A-T, B-T, C-T, D-F, E-T

ADEM is an encephalomyelitis following infection or vaccincation
against measles, mumps, varicella. pertussis and starts within 2
weeks. Differential is multiple sclerosis, where relapsing remitting
episodes will be seen. Involves subcortical portion of white matter.
which shows bright signal. Complete recovery.with steroids is seen
i n 80%.
33. A-T, B-T, C-T. D-T, E-T

Ecclampsia and thrombocytopenic purpura produce hypertensive
encephalopathy.
34. A-T, B-F, C-T, D-F, E-T

Subdural empyema is under the subdural space and epidural is
within the dura. I t is usually a spread from local infection.
commonly sinusitis or mastoiditis. Most common location is frontal
and inferior aspect. close to paranasal sinuses. Mass effect is seen.
Contrast enhancement is seen after a v;eek. In epidural empyema,
the restriction by dura. lirr.its the neurological deficit. Venous
thrombosis.seizures. abscess and infarction are common
complications.
35. A-T, B-T, C-T, D-T, E-T

Cerebellitis is hypointense in Tl W and hyperintense in TZW
images, and show contrast enhancement. TB is another ca use.
36. A-T, B-F, C-T, D-T, E-T

Peak incidence 60-75 years. elevated 14-3-3 protein. Rapid
progressive disease, 50% dead in 5 years. Have a characteristic
triphasic pattern in EEG. Bilaterally symmetrical. high signal in
anterior aspect of putamen and caudate nucleus is the characteristic
feature. High signal also seen in thalamus(sparing of pulvinar),
globus pallidus, periaqueducal grey matter, centrum semiovale,
cortex. Atrophy is a late feature.
37. A-T, B-F, C-T, D-F, E-T

Variant CJD is associated with bovine spongiform encephalopathy.
It is different from sCJD. It occurs in younger group, has slow
onset. slow course and non-specific clinical features. The EEG and
CSF proteins are also not useful. Tonsillar biopsy can be useful
38. A-T, B-T, C-F, D-T, E-T

High signal in pulvinar and dorsomedial nucleus of thalamus is
a specific feature of variant CJD. High signal can also be seen in
!nfectionr.;
.
ii
_____________ __ ___.�
- - �·· ·
____
periaqueductal grey matter, carted and whi te matter. Atrophy is

not seen even in severe disease. unlike sCJD.
39. A-T B-F, C-T, D-F, E-T

,
Subdural effusion indicates inflammation of veins and subsequent

exudation of albumin rich fluid, and it does not extend into
subarachnoid space. 50% of empyema is caused due to sinusitis.
35% due to craniotomy and 15% due to meningitis. Cerebritis is
early stage of inflammation of brain. before formation of frank
abscess. This is seen as hypodensity in plain scan and enhances
in contrast. Tuberculous meningitis is usually .issociated with
parenchymal nodules.
40. A-T, B-T, C-F, D-F, E-T

Group B Streptococcus, E. coli are the most common organisms in
neonates. In children less than 7 years. Hemophilus is the
commonest c ause. I n older children and young adults. N.
meningitidis is the most common organism. In older adults
Streptococcus pneumoniae is the most common cause. The spread can
be hematogenous. through CSF pathways. or local extension or
by direct implantation. CT is not essential for diagnosis. It is used
for diagnosing and moniwring of complications of meningitis.
41. A-T, B-T, C-F, D-T. E-F

Subd ural effusion. su bd ural empyema. cere bri tis. abscess.
entriculitis, ependymitis. venous infarcts, arterial infarcts and
hydrocephalus are other complications. Hydrocephalus can be
communicating, \Nith exudates at the subarachnoid spaces or
intravemricular obstructive. due to exudates in the aqueduct or
ventricles. Arterial infarcts are most common in the medial
lenticulostriate arteries followed by thalamoperforating arteries.
42. A-T, B-T. C-T, D-F. E-T

Ventricular dilatation is seen in late stages. It can produce gyriform
calcification in the posterior aspects of brain, mi :nicking Scurge
vVeber syndrome, of produces dense nodules Id' calcification.
Biopsy is not required. Acyclovir is given.
�� ·�·. - :·�;· ... -. . . . .. . . --
r·-; · ..
...
:· .. · .Vascular··�:····
.. ·;..._.. . .
.
...
. .. ·.t .
1. Stroke:
A. 85% of stroke is ischemic
B. n-PA should ideally be administered within 6 hours of onset
of stroke
C. 20% of clinically diagnosed strokes have stroke mimics
D. Trauma is the most common stroke mimic
E. Only 65% of CT brains for stroke are reported accurately
2. Stroke:
A. CT has a sensitivity of 50%. when used within 6 hours of onset
B. Cortical and subcortical infarcts are usually due to embolism
C. Lacunar infarcts are due to occlusion of penetrating arteries
D. CT has a sensitivity of 60% when used in the first two days
E. CT sensitivity is 100% at 10 days
3. Basal ganglia infarction is seen in:

A. Drowning B. Down's syndrome
C. Carbon monoxide D. Embolism
E. Cardiac arrest
4. Haemorrhage:
A. Fluid level within the haematoma has almost 100% specificity
for coagulopathy
B. 35 -40% of tumours bleed
C. Tumour haemorrhage constitutes 10% of all haemorrhage
D. 0.5% of subarachnoid hc:iemorrhage occurs due to tumour
E. 40% of lobar haemorrhage occurs after 70 years
5. Recognised causes of hypertensive encephalopathy:

A. Rheumatic fever
B. SLE
C. Hemolytic uremic syndrome
D. Cyclosporine
E. Preeclam psia
Vascular Lesions 79
6. The following are risk factors for stroke:

A. Smoking
B. Atrial fibrillation
C. Left ventricular hypertrophy
D. Alcohol
E. Atrial septal defect
7. Anatomical regions and blood supply:

A. Anterior limb of internal capsule-thalamoperforating artery
B. Head of caudate nucleus-lenticulostriate artery
C. Suprolateral surface of cerebellar hemisphere- anterior inferior
cerebellar A
D. Dorsolateral medulla-posterior inferior cerebellar
E. Midbrain-basilar artery
8. Stroke:
A. 75% of stroke occurs in the middle cerebral artery
B. If the occlusion occurs distal to the lenticulostriate artery. basal
ganglia is spared
C. ACA is second most com mon territory involved
D. ACA territory infarct can occur in transtentorial herniation
E. Distal branch occlusions are well seen in transcranial Doppler
of cerebral vascula(Ure
9. Angiographic findings in stroke:

A. AV shunting
B. Fast antegrade flo\v
C. Rapid arterial emprying
D. Retrograde filling \Vi th collaterals
E. Hyperemia .
10. Transcranial Doppler:

A. Usually done with an occpital vvindow
B. Probe is angled 20 degrees in a caudal direction towards the
occipital bone
C. The P 1 segment is seen in the interpeduncul.1r cistern
D. Has same accuracy as CT and MRI
E. Flow in anterior cerebral artery is towards the probe
11. Atherosclerosis:
A. Tandem lesions are seen in 10%
B. 40% of lesions occur in the intracran!al circulation
C. Rupture of plaque is essential for thrombosis formation in the
intracranial vessels
D. Stenosis by plaque. decreases flow velocity
E. The most com mon site inside the skull is vertebrobasilar
circulation
12. Stroke:
A. TIA precedes infarction in 309·6 of cases
B. The 5 year risk of stroke after TIA is 75%
C. If carotid stenosis is > 75% the i ncidence of stroke is 3.3%
D. 90% of stroke have worst prognosis if occurring in people more
than 70 years and with low clinical score
E. Stroke is preventable in 80% of cases
13. The common collateral pathways between internal carotid and

external carotid circulation are:
A. Faci a l artery with ophthalmic ar tery
B. Internal maxillary artery with ca\·ernous part of internal carotid
a r tery
C. S u perior thyroid artery with odontoid branches of vertebral
artery
D. Occipital and cen·ical branches of vertebral artery
E. Ascending pharyngeal artery and vertebral artery
14. Brain:
A. A VM bleed at the ra te of 10-20% per year
B. Venous angiomas bleed at the rate of 1-5% per ye a r
C. Cavernous angiomas bleed at rate of 0.5-1 % per year
D. 90S'o of intracerebral haemorrhages are caused by hypertension
E. 90% of subarchnoid haemorrha g e is caused by ruptured
aneurysm
15. Increased incidence of aneurysm is seen in the following

conditions:
A. Fibromuscular dysplasia
B. C oar ct a tion aorta
C. Bicuspid aortic valve
D. Bronchiectasis
E. Mucopolysaccharidosis
16. S troke:
A. Pla qu e ulceration increases risk of stroke
B. A complete circle of Willis is seen only 25% of population
C. The A 2 segment of anterior cerebral artery is very commonly
hypoplastic
D. Small p i al collateral vessels cross the border zone of the
different vascular territories in brain
E. The cortex is supplied by end arteries and they do not have
collaterals
Vascular Lesions 81
17. Brain:
A. In brain herniations. infarct of ACA territory is more than PCA
territory
B. Descending transtentorial herniation is less common than
ascending transtentorial herniation
C. Tonsils are considered herniated if they are more than 4 mm
in children
·n. In older age group tonsils can be seen upto 6 mm below
foramen magnum and yet be normal
E. Haemorrhage constitutes 10-15% of all strokes
18. Lacunar infarction:

A. 35% of infarctions
B. Can be pure motor or sensory
C. Severe pain if thalamus is involved
D. Thalamus is the commonly involved
E. By definition, less than 20 mm
19. Signs in stroke- hyperacute stage:

A. Hyperdense MCA is seen in 75% of acute stroke
B. Obscuration of lentiform nucleus is a very early sign
C. Low signal in diffusion \veighted imaging
D. HM PAO scan is positive before MRI
E. Increased uptake of radioisotope during venous phase
20. Infarct-CT scan findings:

A. Transient calcification is seen in subacure phase
B. Infarct is better defined in the subacute phase
C. Ring enhancement is seen before ten days
D. Gyriform enhancement does not happen in subacute phase
E. Gliosis is hallmark of chronic infarction
21. Hyperacute stroke:

A. Intravenous thrombolysis \Vith tPA is given within three hours
of onset
B. Narrowing of sylvian fissure is an early sig11
C. The hyperdense artery sign is seen only in the middle cerebral
artery
D. Absence of normal flow voids is a sensitive sign for hyperacute
stroke
E. Conventional MRI can give high false negative results in the
first few hours
22. Stroke:
A. There is no surgical benefit of carotid enarterectomy if the
stenosis is less than 30%
B. Colour Doppler is as good as angiography in evaluation of
m oderate stenosis
C. Both the NASCET trial and ECST trial used the ratio between
the diameter of stenotic segment and non-stenotic segment to
express the degree of narrowing
D. Normal flow in intracranial vessels through transcranial
Doppler excludes extracranial stenosis
E. Calcification is more common the vertebral artery than the
carotid siphon
23. Diffusion weighted imaging in stroke:

A. High signal is seen within one hour
B. High signal in diffusion images and low ADC are seen upto
72 days
· C. Ideal for estimating the age of infarct
D. ADC is low for 10 days only
E. 100% sensitivity and specificty for lesions under six hours
24. Diffusion weighted images:

A. High signal is due to increased flov..: of water
B. Seen within few minutes of onset in animal studies
C. Vasogenic edema is the underlying mechanism of high signal
in stroke
D. The high signal in diffusion images are irreversible
E. Diffusion images are better than T2W images for assessing the
size
25. Imaging of hyperacute stroke:

A. Diffusion imaging will show areas of reversible ischemia
B. Thrombolysis contraindicated if less than one-third of cerebral
hemisphere involved
C. Presence o f haemorrhage is absolute contraindication for
thrombolysis
D. Perfusion imaging cannot be performed without administering
contrast
E. Dynamic contrast susceptibility imaging is the technique of
perfusion imaging
26. Parameters that are measured in MRI perfusion studies:

A. Mean transit time B. Blood volume
C. Contrast enr.ancement D. Blood flow
E. Flow heteros;eneity
Vascular Lesions 83
27. Perfusion MRI:

A. A perfusion abnormality with normal diffusion images.
indicates penumbra
B. Mean transit times overestimate infarct size
C. Blood volume underestimates infarct size
D. tv1ismatch between initial blood flow maps and diffusion
images is a better indicator of infarct growth than mismatch
between blood volume maps and diffusion images
E. In ischemia, the flow is homogenous and heterogenity is lost
28. Radiology of infarction:

A. Sulcal effacement is seen in the acute stage.
B. Insular ribbon sign is seen in hyperacute phase
C. Acute- contrast enhanced arterial vessels in area of infarction
D. Acute-gyral swelling in MRI
E. Acute-sulcal narrowing in MRI
29. Hyperacute stroke:

A. If there is a mismatch bet'.veen perfusion and diffusion images.
there is better response vvith therapy
B. Cerebral volume deficit in CT indicates irreversible damage
C. Infarcts in the border zones indicates hypotension
D. Infarcts in border zones of two vascular territories rules ouI
emboli
E. Anterior cerebral artery supplies opposite cerebral hemisphere
in 25%
30. Thrombolysis with tPA has the f ollowing benefits over placebo:
A. Improvement in stroke by 24 hours
B. Better outcome in 3 months
C. Higher rate of mortality due to haemorrhge
D. No significant difference in outcome after 12 months
E. TPA can be given even if there is mass effect and edema in
the acute phase CT
31. Intrarterial thrombolysis:

A. Unlike venous thrombolysis, the limiting time is 24 hours
B. Recanalisation is higher than that of intravenous thrombolysis
C. Outcome better than only intravenous thrombolyssis at three
months
D. Rethrombosis i s higher in amerior circulation strokes than
posterior circulation strokes
E. Intraarterial thrombolysis absolutely cannot be performed
after· 6 hours of onset in the posterior circulation
_______ _;..._________________,
. - . .. ·-·-
.
32. Giant intracranial a neurysms:

A. Common in women
B. Present as space occupying lesions
C. Supraclinoid segment of internal carotid artery is the most
common artery involved
D. Larger than 2 cm
E. Subarachnoid haemorrhage is the most common complication
, 33. Mycotic aneurysms:

A. Occur in the peripheral circulation
B. Eventually thrombose
C. Frequently rupture
D. D o not occur in pulmonary circulation
E. Maybe secondary to patent ductus
34. Subarachnoid haemorrhage:

A. Cisterns are focal expansions of subarachnoid space
B. M y c o tic aneurysms rupture more frequently than berry
aneurysm
C. Subarachnoid haemorrhage in perimesencephalic region is
more common than penetrating artery infarction
D. Dural A VMs rupture more frequently than cerebral AVMs
E. Eventually subarachnoid haemorrhage seeps imo the lateral
ventricles
35. Persistent trigeminal artery:

A. Anastomosis between basilar artery and cistern segment of
internal carotid artery
B. The anastomosis is below the level of circle of Willis
C. Trident sign is highly specific and is seen in coronal MRI
D. 25% associated with aneurysms
E. second most common carotid basilar connection after persistent
hypoglossal artery
36. Brain:
A. Cardiomegaly is seen in vein of Galen malformation
B. Mediastinal enlargement is seen in chest X-ray of VOGM
C. In intracerebral hemorrhage. CT angiography is done only if
the h aematoma is atypical in MRI
D. 10-15% of intracerebraL haemorrhage in hypertensives. are
associated with aneurysms
E. Cortical venous thrombosis is a cause of lobar haemorrhage
37. Superficial siderosis:

A. Seen in acute subarachnoid haemorrhage
B. Dark in Tl and T2 images and bright in CT scan
C. Most common cranial nerve affected is VII nerve
D. Associated with ependymoma
E. BL .:i.teral sensorineural hearing loss in aimost all patients
85
Vascular Lesions
38. Haemorrhage:
A. In ACA aneurysm rupture, haemorrhage is locat ed in the
anterior interhemispheric fissure
B. A ventricular score of 5-8 is considered severe
C. Any blood in third or fourth ventricle is given a score of 2
D. If more than half of the ventricle is filled with blood. the score
is 4
!
39. Aneurysm clipping for subarachnoid haemorrhage:
- ! A. MRA is the imaging modality of choice for vasospasm
B. Non-ferromagnetic clips do not cause distortion of images
C. 10% risk of subarachnoid haemorrhage persists after clipping
D. 5% risk of regrowth of clipped aneurysm
E. 70% risk of vasospasm after clipping
40. Migraine:
A. 70% of migraine are classical
B. Cortical infarcts can be seen
C. Decreased perfusion in occipital region
D. No abnormalities in Tl W images
E. Hyperintensities in cemrum semiovale in T2
41. Vasculitis:
A. vVegeners involves C\.'S in 30% of cases
B. Giant cell arteritis is the most common arteritis in Cl\S
C. Syphilitic vasculitis affects conical arteries
D. Scleroderma is the most common collagen vascular disease to
involve CNS
E. Vasospasm is difficult to differentiate from vasculitis
42. Haemorrhage:
A. CT density o f haemorrhage depends on the rate of clot
retraction
B. The density of haematoma increases during the first three days
C. Surrounding edema is irregular in spontaneous haemorrhage
D. Hemosiderin and deoxyhemoglobin are paramagnetic
E. Methemoglobin conversion begins from th(• periphery of
thrombosed aneurysm
43. Cavernous sinus:

A. The Cavernous sinus is the most common intracranial sinus to
get occluded
B. Convex wall of cavernous sinus indicates thrombosis
C. Tolosa Hunt syndrome affects 3.4,5.6 nerves and is due to
cavernous sinus thrombosis

D. Dilated superior ophthalmic vein is highly specific for cavernm.:s
thrombosis
E. Caroticocavernous fistula causes cavernous sinus thrombosis
------- �----------..;...----
._ �" ·"' .... - .,.
44. Sagittal sinus thrombosis:

A. Hig h signal inT2 with enhancement is stage 2 of venous
ischemia
B. Medullary veins are occluded
C. Venous infarction is seen in 90% of sagittal sinus thrombosis
D. TOF MR venography is negative in subacute phase
E. Diffusion weighted images are not positive after three weeks
45. Acute neurological deficit:

A. Normal CT scan at 6 hours implies transient ischemic attack
is more likely than CVA
B. Normal MRI at 24 hours implies transient ischaemic attack is
more likely than a cerebrovascular accident
C. Haemorrhage is more likely to follow an embolus than a
thrombotic infarction
D. Intracranial haemorrhage can occur in transverse sinus
thrombosis
E. Normal sagittal sinus shows increased signal intensity in T2W
MRI
46. Aneury sm s:
A. Fusiform aneurysm are seen onl_y in atherosclerosis
B. Marfans syndrome produces saccular aneurysm
C. 10% prevalence of familial aneurysms
D. Muscle laver is absent in saccuiar aneurvsm
J J
E. Sickle cell anemia is a cause of saccular aneurysm
4 7. Sickle cell anemia:

A. 75% of stroke in sickle disease is due to haemorrhage due to
coagulopathy
B. Stroke is seen in 25% of those with sickle cell anemia
C. Stroke incidence is decreased if HbS is < 30%
D. Infarcts are most common in the watershed between anterior
cerebral and middle cerebral arteries
E. Stenosis is common in the distal internal carotid artery,
48. Haemorhage in drug abusers is due to:

A. Vasculitis B. Hypertension
C. Mycotic aneurysm D. Abscess
E. Anticholinergic drugs
49. Causes of intracerebral haemorrhage:

A. Metastasis B. Coagulopathy
C. Herpes infection D. Abscess
E. Venous infarction
Vascular Lesions ul
50. lntracerebral haemorrhage:

A. Hyperacute stage lasts for two days
B. Oxyhemoglobin is seen in the acute stage
C. Oxyhemoglobin is hypo in both sequences
D. Deoxyhemoglobin is iso inT 1 and hyper in T2
E. Subacute stage starts from 14 days
51. lntracerebral haemorrhage:

A. Hemichromes are hypo in both sequences
B. Intracellular methemoglobin is hyperintense in both sequences
C. Late subacute stage starts af ter .one week
D. Hemosiderin is hypointense in Tl and hyper in T2
E. MRI is very useful in the hyperacute stage
52. Haemorrhage:
A. Resorption occurs from center towards the periphery
B. Dissects into the white matter tracts
C. Decompresses into ventricles
D. Anemia gives false posirive CT scans
E. Resorption in 6 weeks

A. FLAIR has a sensitivitv of 100% in detection of acute SAH
J
B. FLAIR is superior to CT in detection of acute SAH

C. Turbo FLAIR is less sensitive than CT in detection of acute
SAH diluted by CSF, sinci: it requires more hemocrit rise for
detection of SAH
D. High signal in FLAIR in the region of basal cisterns is always
abnormal
E. MRI has equal sens itivity as CT in detection of subacute and
chronic SAH
54. Haemorrhage:
A. Haemorrhage is isodense from 2nd vveek
B. Rim enhancement is seen from 3 davs J
C. D e ns i t y decreases by 1-2 Hu per day from the 2nd week

D. Steroids reduce ring enhancement
E. Invisible in CT by 6 months
55. Imaging of cerebral haemorrhage:

A. MR has less accuracy than CT in imaging of acute haemorrhage.
within 2 .5 hours of onset
B. Spin echo images are more sensitive than gradient echo images
in the diagnosis of intracerebrai haematomas
C. Subfalcine herniation is the most common type of herniation
D. 80% of patients with intra?arenchymal haemorrhage, show
small areas of signal loss in gradient echo ir:-:ages
-----
--- �-�-·-
56. Infarct:
A. The wedge-shaped lesion is composed of cytotoxic edema only
B. Haemorrhagic transformation occurs between 24-48 hours
C. Mass effect is seen before two days in the hyperacute and acute
stages
D. Gyral enhancement \Nill be seen after one week
E. Vascular enhancement in MRI will be seen in 1-3 days
F. Meningeal enhancement is seen after three weeks
57. Causes of benign int racranial hypertension:

A. Hypervitaminosis D B. Hypercalcemia
C. Dural AVM D. Preagnancy
E. OCP
58. Intracerebral haemorrhage:

A. Kernohans notch is due to compression of contrala teral
cerebral penduncle
B. Durets haemorrhage is caused due to rupture of posterior
cerebral artery
C. Anterior cerebral artery territory infarction is the most
common in brain herniations
D. Haemorrhages are more common in infarctions secondary to
herniation
E. Compression of ipsilateral perimesencephalic cistern is often
the earliest sign of descending transtentorial herniation
59. Cerebral haemorrhages:

A. Presence of small focal signal loss associated with cerebral
haemorrhage indicates microangiopathy
B. Microangiopathy, increases the risk of rebleed
C. TOF MR is good for evaluation of AVM in a patient with
intraparenchymal haemorrhage
D. Lumbar puncture has higher sensitivity than CT scan in
diagnosis of SAH after one week
E. FLAIR MRI is superior to CT in detection of subacute SAH

A. Vasospasm is due to periarteriolar haemorrhage
B. The vasospasm seen in angiography correlates well with clinical
symptoms
C. Transcranial Doppler is the best modality for investigation of
cerebral perfusion and blood flow secondary to vasospasm
D. Angiography is negative in subarachnoid haemorrhage in upto
40% of patients
E. MR angiography has equal sensitivity to catheter angiography
in detection of small aneurysms
Vascular Lesions gq

A. Obstructive hydrocephalus may occur within one week
i
B. Communicating hydrocephalus develops after a week
t
1
C. Infarction develops within 72 hours
I D. MRI shows low signal surrounding the brain in chronic cases

E. Maximum i ncidence of rebleed is after 3 weeks
t
i
•
62. Haemorrhages:
.!
A. CT usually obviates the need for lumbar puncture in SAH
B. 30% of SAH occur in vertebral circulation
C. Blood in septum pellucidum suggests basilar arterial bleed
D. Hypertensive haemorrhage in young patient. should raise
suspicion of cocaine abuse
E. More than 50% of primary intracerebral haemorrhage do not
have hypertension
63. Subarachnoid haemorrhage from AVtv1:

A. Berry aneurysms are associated
B. More common in men
C. Associated with Ehler Danlos
D. Anterior communicating aneurysm is the cause in 30%
E. Commonly presents in the second and chird decade
64. Cerebral sinus venous thrombosis:

A. Accounts for 10% of stroke in young people
B. Mortality rate is 5-15%
C. The onset is usually acute
D. Symptoms resemble benign intracranial hypertension
E. Should be considered in any paciem with cerebral symptoms
65. Chronic subdural haemorrhage:

A. Recognised complication of subarachnoid haemorrhage
B. ivlost easily missed at 2 weeks on CT scanning
C. Calcification occurs in long standing cases
D. Suggests re bleed if seen to enlarge
E . The dura intensely enhances on contrast
66. Causes of multiple i nfarctions :

A. Cortical venous thrombosis
B. Emboli
C. Vasculitis
D. Meningitis
E. Herpes
67. Causes of cerebral venous t hrombosis:

A. Infection is the most common cause in children
B. Pregnancy is the most common cause in adults
C. Trauma
D. Collagen vascular disease
E. Hypoplastic sinuses
68. Cerebral venous thrombosis:

A. Bilateral alternating deficits and hemiparesis predominantly in
the legs is a classical feature
B. 6th nerve palsy is commonly due to cavernous sinus thrombosis
C. Impaired consciousness is due to deep cerebral venous
thrombosis
D. Vth nerve palsy is due to petrosal sinus thrombosis
E. Hemianopia may occur
69. Dural sinus thrombosis:

.. A. High density of thromnbosed sinuses in CT scan
B. The thrombosed sinuses become isodense in a few davs ,,
C. Contrast scan \Vill show empty delta sign

D. The sinus walls are supplied by separate vascular branches from
the meningeal veins
E. Empty delta sign is seen only in superiosagittal sinus
70. Features of dural sin us thrombosis:

A. Gyral enhancement
B. Dense enhancement of tentorium
C. Cerebral edema
D. Small ventricles
E. Haemorrhages
71. Dural sinus thrombosis MRI:

A. The thrombosis is hyperintense in Tl and T2 from onset
B. In early stages the thrombosis is hypo i n T2
C. Tl with contrast will show bright signal in the lumen and wall
D. The tentorium also enhances
E. Collateral venous channels are visualized
72. Cavernous sinus and its drainge:

A. Drains via superior petrosal sinus to transverse sinus
B. Drains via inferior petrosal sinus to internal jugular vein,
C. Via superior opthalmic vein to facial vein
D. Via emissary veins into pterygoid plexus..
E. Via inferior opthalmic vein to internal maxillary vein
I
Vascular Lesions 91
73. The following are tributaries of cavernous sinus:

i A. Superior ophtalmic vein
i B. Inferior opthalmic vein
I C. Inferior cerebral vein
I
D. Sphenoparietal sinus
E. Vein of Galen
� 7 4. Caroticocavemous fistula:
;-
�
A. Commonly seen due to rupture of aneurysms in young patients
i
B. Carotid artery may be demonstrated by enhanced CT within
the cavernous sinus
C. MRI may show the cavernous sinus and artery separately
D. Enlargement of the superior orbital vein occurs
E. Treated by embolisation with gelfoam
75. Caroticocavernous fistula:

A. A dural fistula between meningeal branch of internal carotid
artery and cavernous sinus is type C
B. Fibromuscular dysplasia is a cause
C. Indirect fistulas are common in females
D. Hydrocephalus is produced
E. The distal internal carotid artery is not visualis ed in
aniography
76. Caroticocavernous f istula:

A. Vertebral artery injection with compression of the carotid
artery is essential for diagnosis
B. Indirect fistulas require the most aggressive management due
to complications
C. Cortical venous drainage is an indicator for urgent
management of the fistula
D. Embolisation should al\vays be done through the arterial route
E. Indirect types are best managed by arterial route
7.7. \Vallen be rg syndrome:

A. lv1ost common cause is due to vertebral artery occlusion
B. Ipsilateral facial pain
C. Contralateral ataxia
D. Contralateral temperature loss
E. Ipsilateral paralysis of sternocleidomastoid muscle
78. Cavernous angioma:

A. No enhancement in gadolinium scan
B. lvfass effect and edema are not seen
C. Pop co_rn appearance is characteristic
D. Hypointense rim is seen in majority of cases
E. Angiogram sho\vs a reticular netwo:-k of vessels
. .
79. Features of Wallenburg syndrome :

A. Hyperdense basilar artery indicates occlusion
B. Embolic occlusion is the most common
C. Neck manipulation is a recognized cause of lateral medullary
syndrome
D. Dissection of vertebral artery is a common cause
E. Infarcts seen in thalamus
80. Moya moya disease:

A. Multiple infarcts are seen in the watershed territory
B. Increased flow velocity is seen in the carotid and posterior
circulation
C. Multiple small flow voids is characteristic
D. The puff of smoke appearance in angiography is due to the
appearance of stenosed vessels
E. There is bilaterally symmetrical involvement of internal carotid
arteries
81. Moya moya disease:

A. Infarction is seen in deep white matter in children
B. Subcortical infarction is commonly seen in adults
C. Both the cerebral hemisphers sho\v symmetrical decreased
enhancement
D. Echoplanar imaging is the best mo dality for evaluating
hemispheric perfusion
E. Hemispheric perfusion is poor
82. Differential diagnosis of Moya Moya disease (Multiple ischemic

areas):
A. William's syndrome B. Down· s syndrome
C. Sickle cell anaemia D. Radiation
E. Neurofibromatosis I
83. Moya moya disease

A. Supraclinoid middle cerebral artery is the first affected vessel
B. Lenticulostriate arteries are occluded
C. Collaterals are not seen in the leptomeninges
D. Has a bimodal age distribution
E. Presents with haemorrhage in children
84. Cavernous angioma:

A. Normal brain is seen in between the lesion
B. . Has well defined capsule and dilated endothelium lined spaces
C. There is no growth in the lesion
D. 80% of lesion occurs in the .oosterior fossa
E. Majority are multiple
l
' 85. Cavernous angioma:
Vascular Lesions 93
I A. Imaging findings depend on presence of haemorrhage in the
I
lesion
B. Majority are asymptomatic
C. I nfratentorial lesions are more prone for bleeding
D. Produces intraventricular and subarachnoid haemorrhage
E. Risk of haemorrhage is 0.1 % per year
86. Venous malformations:

A. Cavernous angioma is the most common vascular malformation
B. Venous varix is associated vein of Galen malformation
C. Angiogram is normal in venous varix
D. 70% o f venous angioma drains into the superficial venous
system
E. An enhancing tuft _of vessels near the angle of ventricle is the
most common presentation of venous angioma
87. AVM:
A. Dural AVMs are not clearly seen in MRI
B. Angiography is the best method for localising nidus
C. Serpiginous pattern of enhancement in CT is highly specific for
AV1v1
D. Aneurysm in the feeding ar�ery increases !he risk of ble€ding
E. In MRI. subacute and chronic clot are difficult ro differem!ate
from flowing blood
88. Aneurysm:
A. Dissection produces fusiform rather than saccular aneurysm
B. There is no recognisable neck in a giant serpentine aneurysm
C. The most common cause of fusiform aneurysm in basilar arrery
is dissection
D. tv1eningioma is the most common primary tumour producing
aneurysm
E. Left atrial myxoma metastasis is a well recognised cause of
oncotic aneurysm
89. Capillary telangiectasia:

A. Dilated capillaries with thick smooth muscle layer
B. Normal brain is seen between the dilated vessels
C. Pons is the most common location
D. Non contrast MRI and angiography are normal
E. Stippled enhancement in contrast :VfRI is pathognomonic oft.his
lesion
90. Differential diagnosis of early draining vein in angiography:

A. Infarction
B. Encephalitis
C. Glioblastoma multiforme
D. AVM
E. Haematoma
_ 91. Aneurysm:
A. The aneurysm sac has intima. media and adventitia
B. Multiple aneuryms are more common in females
C. 25% of aneurysms occur in the basilar artery
D. 70% or aneurysms involve the anteriocommunicating artery or
the internal carotid artery
E. Polycystic kidney disease is associated with higher incidence
of multiple aneurysms
92. Aneurysms:
- A. Presence of hemiparesis indicates Grade IV subarachnoid
haemorrhage in Hunt and Hess scale
B. Anterior communicating artery aneurysm produces III nerve
palsy
C. Aneuryms are the cause of 90% of subarachnoid haemorrhage
D. The risk of rupture is S-10% per year
E. The incidence of rebleed is upto 50% in unclipped aneurysm
93. Amyloid angiopathy:

A. Increased incidence in Down's syndror:ne
B. 20% of haemorrhage above 60 years is caused by amyloid
angiopathy
C. 90% of amyloid angiopathies in elderly patients are sene in
those with Alzheimer's dementia
D. Basal ganglia is involved more common than cortex
E. One third present with hypertension
94. Sinus pericranii:

A. Dilated diploic veins
B. Communication with intracranial and extracranial veins
C. Post-traumatic
D. Changes in size with valsalva manoeuver
E. Air embolism is a complication
95. AVM:
A. Calcification never occurs in AVM. due to high flow within
the vessels
B. There is equal distribution of AVMs between the suprater:rnrial
and infratentorial compartments
II C. In diffuse A VM. there is no nidus
Vascular Lesions 95
� D. In thrombosed A VM. the flow is very rapid in arteries and

t
very slow in veins
E. Bleeding in A VM occurs from the enlarged arterial feeder
96. Reversible posterior leukoencephalopathy syndrome(RPLS) is

caused by:
A. Eclampsia B. Thrombocytopenic purpura
C. Cisplatin D. Hemolytic uremic syndrome
E. Acute glomerulonephritis
97. RPLS:
A. Presents with seizures
B. Unilateral
C. Seen in frontal region
D. T2 hyperintensity in occipital cortex
E. Vasospasm is the only cause of this disease
98. AVM:
A. Incidence of 4% in general population
B. The base of a parenchymal AVM is situated towards the lareral
ventricle
C. In A VM, the arteries. veins and capillar� es are dilated
D. There is little flow in the nidus of the A VM
E. There is no intervening normal brain parenchyma in .� \.\1
99. AVM:
A. N1ultiple AVMs are seen in 20%of cases and are due to vVyburn
mason syndrome
B. Mass effect is very uncommon in AVM
C. Thickening of meninges seen
D. Aneurysm seen in feeding arteries
E. Vascular steal produces ischemia
100. AVM:
A. An AVM less than 6 cm is classified as sma 11 AV011
B. A single unit A VM is type I
C. Involvement of eloquent areas carry a worse prognosis
D. Involvement o f superficial venous drainage h a s a bad
prognosis
E. Small A VMs have greater surgical risk than large ones
101. The following are considered as high risk factors in A\/\f:

A. Pseudoaneurysm in feeidng artery
B. Supratentorial location
C. Paucity of venous drainage
D. PeriventriCular location
E. Small size
--------�- ---- . ·-
102. AVM:
A. The risk of bleeding is 2-4% per year
B. Seizure is the most common presentation of AVM
C. There is 30% risk of death
D. One third of patients have a normal life with AVM
E. Exericse and hypertension are risk factors for bleeding in A VM
103. Vascular malformations in brain:

A. AVM commonly presents as subarachnoid haemorrhage than
intrarerebral haemorrhage
B. The m o s t common cause of non-trumatic spontaneous
intraventricular haemorrhage in adults is aneurysm
C. If there is intracerebral haemorrhage after cocaine abuse.
suspect AVM
D. Any high signal in MRI is due to haemorrhage or thrombus
only
E. In Gradient echo images, the malformation is seen as flow
voids
104. The following are sites of hematoma and they indicate aneurysm
of corresponding arteries:
A. Sylvian fissure- Middle cerebral artery
B. Fourth ventricle-Extension from anterior cerebral artery
C. Frontal horn- Anterior cerebral artery
D. Interhemispheric fissure- Anterior communicating artery
E. Suprasellar cistern-Only from internal carotid artery
105. Dural AVM:

A. Formed secondary to sinus thrombosis
B. Cavernous sinus is the most commonly involved sinus in dural
AVF
C. Haemorrhage is very rare and is seen if there is reflux into
cortical veins due to sinus occlusion
D. Communicating hydrocephalus is seen due to decreased
absorption secondary to chronic passive venous congestion
E. There is no nidus and in majority of cases there is a solitary
feeder
106. Aneurysm:
A. The flow direction is best assessed in phase contrast images
B. Small and medium-sized aneurysms are best assessed in
3DTOF images
C. Tb.e ·..vall of aneurysm enhances on Gadolinium administration
D. A� y signal within the aneurysm can be seen only in thrombus
E. A ·:::r.iplete thrombus usually shows homogenouos high signal
Vascular Lesions 97
107. Aneurysm:
A. Thrombus enhances on contrast administration in CT
B. Aneurysm causes erosion of bone
C. The outer wall of the aneurysm is hyperdense in plain CT and
shows rim enhancement
D. In AVtvl, aneurysm can be seen in Circle of Willis secondary
to AVM
E. Intracerebral haemorrhage is the most common presentation
of aneurysm
108. Aneurysm:
A. MRI shows laminated thrombus within the lumen
B. Infundibulum is less than 3 mm
C. 10% of those with ADPKD have aneurysms
D. 20% of subarachnoid haemorrhage i s caused by familial
aneurysms
E. Aneurysms in children are more common in the second part
of middle ceerebral artery
109. Aneurysm:
A. Pencil injury commonly causes aneurysm of opthalmic artery
B. Takayasus arteritis produces stenosis and dissection but
aneurysm is not seen
C. ivlost common site o f a peripheral aneursym is the distal
anterior cerebral artery
D. Haematoma adjacent to the falx cerebri is indicative of
aneurysm of pericallosal artery
E. Skull base fracture is a risk factor for internal carotid artery
aneurysm
110. Aneurysm:
A. Giant aneuryms grow by recurrent haemorrhage into lesion
B. Rapid change of flow direction is the cause of aneurysmal
enlargement
C. Inf u n dibuli are common in the origin of posterior
communicating artery than anterior choroidal artery
D. Angiogram is negative in 45% of subarachnoid haemorrhages
E. Cross compression views in angiogram arc· essential for
assessing collateral circluation
111. Aneurysm:
A. In angiographically negative SAH, presence of blood in
suprasellar cistern has a good prognosis
B. The most common cause of angiographically negative SAH. is
due. to rupture of mesencephalic and pontine veins
C. The presence of a localised subarachnoid haemorrhage is the
most useful sign in identifying which haemorrhage has
ruptured
- -
D. Thrombosed aneurysm does not produce any mass effect

E. Early venou s filling is seen in large aneurysms
112. Causes of fusiform aneurysm:

A. Ehler Danlos syndrome
B. Dissection
C. Varicella infection
D. HIV
E. Radiation
113. The following are high risk factors for rupture of aneurysm:
A. Females
B. Aspect ratio more than 1.6
C. Presence of tit
D. Association with A VM
E. Location in the circle of Willis
--
Vascular Lcsiu11s ��s
----�-- ·-·- - ·- ---
ANSWERS
l. A-T, B-F, C-T, D-F, E T -
RtPA should ideally be administered within 3 hours of onset Upto

I
I
19% of clinically diagnosed strokes are stroke mimics. the most
I
l common being tumours (RtPA-r�combinant tissue plasminogen
I activator).
f 2. A-T, B-T, C-T, D-T, E-F
Sensitivity of CT. 1 day-48%. 1-2 -60%, 7-10 -66%. > 10-74%
3. A-T, B-F, C-T, D-T, E-T
4. A-T, B-F, C-T, D-T, E-F

10% of tumours bleed. 20% of lobar haemorrhage occurs after 70
years
5. A-T, B-T, C-T, D-T, E-'I
6. A-T, B-T, C-T, D-T. E-F

Coronary artery disease. congestive cardiac failure and diabetes
mellitus are other causes.
7. A-F, B-F, C-F, D-F, E-T

PICA-dorsolateral medulla, poste.-oinferior cerebellum. tonsil.
inferior vermis
AICA-anteroinferior cerebellar hemisphere.
Superior cerebellar A. superior vermis, suprolateral hemisphere.
Basilar A-midbrain, posterior thalamus, o�cipital temporal lobes.
8. A-T, B-T, C-F, D-F, E-F

MCA>PCA>ACA infarcts. ACA infarct can happen in subfalcine
herniation. Distal branch occlusions can not be seen in transcranial
Doppler. Asymmetrical f10w velocity indicates distal occlusion of
MCA.
9. A-T, B-F, C-F, D-T, E-T

Slow antegrade flo\v and slO\v arterial emptying are recognized
angiographic findings.
10. A-F, B-T, C-T, D-F, E-F

The temporal bone is used as window.because it is the thinnest
part of the skull. Although it is good for assessing intracranial
circulation. the sensitivity and accuracy are not as good as CT or
MRI. FIO\v in MCA is tO\:rnrds the probe. but a\vay from it in
ACA.
11. A-F, B-F, .C-F, D-F, E-T

Tandem lesior.s are seen only in 2%. 10% of lesions occur �; :h.�
intracranial circulation. Rupture of plaque is not essential for

thrombosis i n intracranial circulation. Stenosis increases f1ow
velocity.
12. A-F, B-F, C-T,D-T, E-T

TIA precedes infarction in only 10% and the five year risk of stroke
after TIA is only 33%. If carotid stenosis is less than 75% the risk
of stroke is 1. 3%
13. A-T, B-T, C-F, D-T, E-T

Ascending pharyngeal artery anastomoses with odontoid branches
of vertebral artery. Transverse branches anasto mose vvith
leptomeningeal branches or internal carotid artery. \Nhe n a
vertebral artery is occluded, blood flow from the opposite
vertebral and basilar artery. producing the subclavian s tea I
syndrome.
14. A-F. B-F, C-T, D-T, E-T

A VMs bleed at the rate of 2-3% per year, but venous angiomas
do not bleed.
15. A-T, B-T, C-F, D-F, E-F
16. A-T, B-T, C-F, D-T, E-T

A 1 Segment of anterior cerebral artery is commonly hypoplastic.
17. A-F, B-F, C-F, D-F, E-T

Tonsils-children upto 6 mm. 2-3rd decades- 5 mm, 4- 8 decades-
4 mm, 9th decade- 3 mm. Ascending transtentorial herniation is
less common than descending type. Infarct of PCA territory is more
common than ACA territory.
18. A-F, B-T, C-T, D-F, E-F

By definition, less than 10 mm. Penetrating arteries are affected
by fibrinoid necrosis. Putamen > Caudate > Thalamus > Pans >
Internal capsule. 15% are lacunar infarction can present as pure

motor I pure sensory Iataxia/ dysarthria clumsy hand syndrome.
19. A-T, B-T, C-F, D-T, E-T

CT is normal in upto 60% of acute phase. High signal is seen in
diffusion weighted imaging. due to cytotoxic edema. HMPAO is
positive very early and shows hypoperfusion. Flip Flop sign- is
dec reased uptake during arterial and capillary phase with
increased uptake in venous phase. Increased perfusion will be seen
in luxurious perfusion. Hyperdeme MCA is due to thrombosis.
I
i
;
-------
Vascular Lesions
···-
101
__ ,
20. A-T, B-F, C-F, D-F, E-T

i Infarct is not better seen in subacute phase due to the fogging
i
i
phenomenon
Ring enhancement is seen in 2-6 weeks
Gyriform enhancemen it is seen in subacute but not in chronic
infarction.
21. A-T. B-T, C-F, D-T, E-T

In North American trials, tPA found to be successful within 3
hours and in European trials, 6 hours. In CT, hyperdense arteries.
hypodensity in gray matter with loss of interface with white
matter and mass effect are early signs. IN MRI. hypointensity in
T 1. hyperintensity in T2. absence of normal flow and retention of
contrast due to slow flow and mass effect are early signs.
22. A-T, B-F, C-F, D-F, E-F

Colour Doppler i s good for assessing severe stenosis but
angiography is far better than colour Doppler for moderate
stenosis, which might be missed by Doppler. In NASCET trial. the
ratio of diameter of stenotic segment and diameter of non-stenotic
are is used. In European or ECST trial, the diameter of the stenotic
segment and the p rojected normal diameter of the stenotic
segment is used. Normal flow in intracranial circulation does not
exclude proximal stenosis. Calcification is more common in the

carotid siphon.
23. A-T, B-F, C-F, D-T, E-T

Diffusion images are very sensitive and specific for diagnosis of
acute stroke. They are positive before routine ivlRI b e comes
positive. High signal is seen in diffusion images and there is lo"v
ADC due to intracellular cytotoxic edema. ADC is low for 10 days
after which is normalises, thus helping to age the infarct. The
diffusion weighted images increase for one 1,veek and decreased
aftef\vards but can be bright for even 3 momhs or more. e\·en
though the ADC is normal, because of diffusion �hine through.
So it is not helpful for assessing the age of infarct.
24. A-F, B-T, C-F, D-F, E-T

Free movement of water will not produce bright signal. Restricted
water movement, will produce high signal. which is seen in stroke
due to cytotoxic death secondary to cell death. Initially the high
signal was thought t o be permanent. But recent studies sho\\'
decreased intensity, if rreatment is prompt. It may increase in som�
patients .after one 1,veek. Diffusion images are better for assessing
exact size than T2\V images.
25. A-F. B-F, C-T, D-F, E-T

C onventional MRI .will show high signal in areas of infarction.
Diffusion MRI will show high signal due to restricted water motion
and is usually larger than conventional MRI and indicates areas
of irreversible ischemia only. Perfusion imaging is required for
demonstrating areas with reversible ischemia. It can be performed
either with contrast (dynamic contrast susceptibility MRI) or without
contrast using arterial spin tagging. Ischemia more than one third
of vascular territory and haemorrhage are c.ontraindications
26. A-T, B-T. C-F, D-T, E-T
Normal flow has various components with varying velocities called
flow heterogenitiy.
Any of the four parameters can be used for assessing perfusion.
27. A-T, B-T, C-T, D-T, E-T
Diffusion and perfusion abnormality, indicates irreversible damage.
- If diffusion is normal, but perfusion is abnormal. it indicates
reversible ischemia, seen in the penumbra around the infarction.
Among the parameters, �vfIT overestimates and BV underestimates
final infarct size. Blood flow maps are more accurate in predicting
final infarct size. In infarct, the high velocity components of the
normal heterogenous f10\>1.: are lost and it is composed of mainly
slow velocities, vvhich can be detected.
28. A-F, B-T, C-T, D-T, E-T,
Hyperacute-< 12 hours. Acute 12-24 hours. Late acute 1-7 days.
Subacute 7-30
Insular ribbon sign is hypodense extreme capsule non-distingui
shable from insular cortex
29. A-T, B-T, C-T, D-F. E-T
Mismatch suggests reversible ischemia which can be treated
effectively. Previously infarcts at ju�ction of border between two
vessels was thought to be hypotensive and those withina vascular
territory thought to be embolic. It is first of all difficult to identify
border zones because of vascular variability in different
individuals. The present theory is that borderzone infarction is
due to emboli which are selectively directed to the end vessels
and which are not cleared due to low volume perfusion in the
distal vessels.
30. A-T, B-T, C-F. D-F. E-T
Compared to placebo, tPA improves outcome at 24 hours, 3 months
and 12 months. No significant difference in mortality, inspite of
more haemorrhage.
Vascular Lesions 103
31. A-F, B-T, C-T, D-F, E-F

Venous thrombolysis is given before three hours and intrarterial
given before 6 hours. The risk of haemorrhage is increased if it
is given beyond this limit. In posterior circulation. the risk of
haemorrhage is lesser. so it can be given u pto 24 hours. The
incidence of rethrombosis is higher in posterior circulation due to
associated atheroslcerotic disease. which is uncommon in anterior
circulation strokes. The outcome was better in intrarterial than
intravenous alone. Recanali sation was seen in upto 75% o f
vessels(40% complete). better than intravenous alone. A combined
treatment also gives better results.
32. A-F, B-T, C-F, D-F, E-T

Giant aneurysms are greater than 2. 5 cm, common in males and
have no age predilection. The common sites are intracavernous
segment of ICA. supraclinoid segment of ICA. birfurcation of ICA.
MCA, basilar artery tip AICA and vertebral artery. They present
,
with symptoms of space occupying lesior. and subarachnoid

hemorrhage is seen in 30% of patients. They may show calcificarion
or bone erosion. CT scan shO\vs complete filling with thrombosis
or a patent central lumen.
33. A-T, B-T, C-T, D-F. E-T

Mycotic aneurysms are those which are secondary to infecrion.
34. A-T, B-F, C-T, D-F, E- T

The common causes of subarachnoid haemorrhage are rupcured
aneurysm. ruptured A V\1. perimesencephalic venous bleed.
coagulopathy and drug abuse. Cerebral AV�v[s rup t u r e more
commonly than dural A V\ts.
35. A-F, B-T, C-F, D-T. E-F

Persistent trigeminal artery is the most common connection
between carotid anery and basilar artery The abrwrrnal ,.-essel
.
runs from the ca\·ernous portion of the internal c a ro t i d arte:y.

posteriorly. to meet the basilar artery. This is set ·n like a tridem
in sagittal MRI images.
36. A-T, B-T, C-T, D-T, E-T

Mediastinal enlargement is seefl due to large carotid and jugular
vessels. A typical haematoma in CT is not imaged any further. 1f
atypical. rv!RI is done and if there are multiple black dots. no more
imaging is required. Further atypical appearances require CT
angiography and if it is i nconclusive. Angiography is required_
Amy lo id angiopathy and A V\fs are other causes o f lobar
haemorrhage.
37. A-F, B-T. C-F, D-T, E-T

Superficial siderosis is deposition of hemosiderin on the surface
o f b r a i n, due to recurrent subarachnoid haemorrhage. The
haemorrhage can result from aneurysm or malformation or tumours
or trauma. The siderosis is dark in MRI and bright in CT scans.
The most common cranial nerve involved is VIII nerve, especially
in the pontine cistern, producing sensorineural loss is most of cases.
38. A-T, B-F, C-F, E-F

There is a grading system for assessing severity of the ventricular
haemorrh11ge.
Lateral ve11tricles- 1- trace of blood. 2- less than half of ventricle
filled \Vith blood, 3-more than half of ventricle filled with blood.
4- entire ventricle filled and expanded. Each ventricle is graded
separately.
Third and 4th ventricles. 1- blood present, 2- blood and expansion
o f ventricles.
1-4 i s mild. 5-8 is moderate and 9-12 is severe.
39. A-F, B-F, C-F, D-F, E-T

Angiography is required for confirming vasospasm. The risk of
subarachnoid haemorrhage is 1-2%. Risk of regrovvth is less than
0.3%. All aneurysm clips cause distortion of images.
40. A-F, B-T, C-F, D-T, E-T

Only 10% of migraine are classical. presenting with aura and visual
symptoms. Cortical infarcts are very rarely seen. \iVhite matter
hyperintensities are the most common findings.
41. A-T, B-F, C-T, D-F, E-T

Vasculitis commonly presents are areas of stenosis and dilatation
in a ngiography. MRI has low signal areas in Tl and high signal
in T2. polyarteritis nodosa is the most common vasculitis to involve
CNS and SLE is the most common collagen vascular disease.
42. A-T, B-T, C-F, D-T, E-F

Surrounding edema is irregular in traumatic haemorrhage and
smooth in spontaneous haemorrhage. Methemoglobin conversion
begins from the periphery of spontaneous haemorrhage and in
centre of partially thrombosed aneurysm.
43. A-F, B-T, C-F, D-F, E-T

Superior sagittal sinus is the most common intracranial sinus to
get o c c l u d ed. The thrombosis of cavernous sinus can be
hyperdense. Dilated superior ophthalmic vein can also be seen in
caroticocavernous fistula. Tolosa hunt syndrome is an idiopathic
disease.
44. A-F, B-F, C-F. D-T. E-T

There are four stages. I- no abnormality. II- high signal in TZ. no
enhancem ent, III- high signal in T2, enhanc e m ent. IV-venous
infarction. haemorrhage. Medullary veins are enlarged due to
colla terals, secondary to obstruction to superior sagittal sinus
thrombosis. Phase contrast r.t1RV is ideal.
45. A-F, B-T, C-T, D-T, E-F
1l
Normal sinus has no signal in Tl and T2.
46. A-F, B-F, C-T, D-T, E-F
l
'
Fusiform aneurysm is also caused by Marfans syndrome, sickle
cell anemia, HIV and collagen vascular diseas.e.
47. A-F, B-T, C-T, D-T, E-T

7 5% of stroke in sickle is due to ischemia . Stenosis is common
in the distal internal carotid artery and proximal circle of willis
vessels. resulting in distal collateral vessel formation. mimicking
Moya moya disease.
48. A-T. B-T, C-T, D-F, E-T
49. A-T, B-T, C-T, D-T, E-T

Common causes are hypert ension. amy l o i d angiopathy.
haemorrhagic transformation of infarct. ruptured A V\L ruptL!red
aneurysm, tumours. trauma. herpes. abscess and coaguloparhy.
50. A-F, B-F. C-F, D-F, E-F
51. A-F. B-F, C-T. D-F, E-F
Tl 12
Hyperacure <24 hrs oxy hemoglobin iso hyper

Acute 1-3 days deoxy hemoglobin hypo hypo
Subacute
Early 4-7 days methemoglobin-intra hyper hypo
Late 7-14 davs
.J
methemoglobin-extra hyp1·r hyper
Late >14 davs hemosiderin/hemichromes hypn hypo
52. A-F, B-T, C-T, D-F, E-T

Resorption is usually from periphery to the center. Decompresses
into ventricles or into subarachnoid space.
53. A-T. B-T, C-F, D-F, E-F

For acute SAH. CT is superior to conventional �!RI sequences. but
FLAIR and turbo FLAIR almost have a sensitivity of 100%. superior
to CT. They are especially useful for detection of blood diluted
by CSF, since turbo FLAIR requires a hematocrit of only 22°0 for
detection. whereas CT requires 27%. \tVilh longer TE. only 9°10 !s
enough. Some artefacts are produced in FLAIR images arounc �t:e
fourth ventricle. basal cisterns. fora men of Munro and in

ventricular system. MRI is far superior than CT i n detection of
subacute and chronic SAH.
54. A-F. B-F, C-T. D-T. E-T

Haemorrhage in CT.Immediately-bright. 1-3 days-progressively
increases due to clot retraction, 2-3 wks-decreased density, 1-2
H u per day. 3-10 wks-isodense. 3-6 months-decreases.6
months-invisible.1-6 weeks-rim enhancement due to luxury
reperfusion.
55. A-F. B-F, C-T, D-T

Although initially it was thought that \1RI is not as accurate as
CT in imaging of acute haemorrhage. recent studies, prove
otherwise. Gradient echo images are more sensitive in detection
o f haemorrhage. They also show multiple small peticheal
haemoorhages, causing focal signal loss in upto 80% of cases.
56 . A-F, B-F, C-F, D-F, E-T. F-F

.
\\'edge-s haped hypodensiry is due to cytoroxic edema and

\:asogenic edema.
Haemorrhagic transformation- 2-� da\·s
\fass effect 1-7 da\·s
Gyral enhancement 1- 7 days
\-leningeal enhancement 2-6 days
\'ascular enhancement 1-3 davs
57. A-F. B-F, C-T, D-T, E-T

Hypervitaminosis A. hypocalcemia. venous obstru ction and
thrombosis, brain biopsy, menstrual dysfunction are other causes.
The ventricles are normal or small and subarachnoid space volume
is increased. Headache and papilledema are seen.
58. A-T, B -F, C-F, D-T, E-F

Kernohans notch is due to compression of contralateral cerebral
peduncle. Durets haemorrhage is seen in midbrain and pons and
is secondary to rupture of penetrating arteries and veins from
basilar artery. Posterior cerebral artery is the most common
involved artery in infarction. which is often haemorrhagic. The
earliest sign of descending transtentorial herniation is effacement
of s u p rasellar cistern and prominence of ipsilateral peri
mesencephalic cistern.
59. A-T, B-T, C-F, D-T, E-T

TOF MR is not good for evaluation of AVM in a patient with
intracerebral haemorrhage as the Tl shortening produced by blood
breakdown products will interfere \Vith the flow related signals.
After one week. CT has a sensitivity of only 50%. Xanthochromia

in CSF is seen from 12 hours to 2 weeks of onset.
60. A T, B-F, C-F, D-F, E-F

-
Vasospasm is due to blood products seen around the vessels.

Angiographic vasospasm does no� correlate with the symptoms
as the clot is seen around arterioles not routinely seen in angiography.
Transcranial Doppler is not as sensitive as Xe CT. Tc H�1PAO.
diffusion and perfusion imaging for assessment of perfusion.
Angiography is negative in upto 20% of cases. But catheter
angiography is the most sensitive method. for diagnosis of small
aneurysms in view of its superior spatial and temporal resolution.
61. A-T, B-T, C-T, D-T, E-F

Maximum incidence of rebleed is at 2 weeks.
62. A-T, B-F, C-F,D-T, E-T

10% of SAH occurs in vertebral circulation. A negative CT does
not exclude subarachnoid haemorrhage. If the CT scan is normal
and there is no mass effect, lumbar puncture has to be performed.
Presence of blood and xanthochromia is indicative of subarachnoid
haemorrhage.
63. A F, B-F, C-F, D-F, E-T

-
More common i n 1.,vomen; no associated with bery aneurysm.
64. A-F, B-T, C-F, D-T, E-T

Cerebral venous thrombosis accounts for 1-2% of stroke in young
and middle age people. The mortality rate is 5-15%. The onset is
usually insidious with slow development of symptoms and signs.
since the thrombus grows slO\v and collaterisation is extensive. The
symptoms and signs are non-specific and the diagnosis should be
considered in any patient with cerebral symptoms. Headache and
papilledema are quite frequent. and this leads to confusion with
benign intracranial hypertension. which usually occurs in females
and obesitvJ
65. A F, B-T, C-T, D-F, E-T

-
Isodense DH can be missed. Chronic membrane enhances.
66. A -T, B-T, C-T, D-T, E-F
67. A-T, B-T, C -T, D-T, E- F

Common causes in adults in pregnancy and puerperial state. oral
contraceptives, infection, dehydration. trauma, tumour. collagen
vascular disease. carcinoma or blood dyscrasias. Infection or
coagulopathy are the most common causes in children.
68. A-T, B-F, C-T, D-T. E-T

The symptoms and signs are ver y variable. He adache and
papilledema are common. Venous infarction may produce seizures
or focal deficit. Superior sagittal sinus thrombosis and parasagittal
infarction may produce the classical. alternating deficits and
hemiparesis predominantly in the legs. Consciousness is impaired
due to herniation secondary to edema or deep venous system
thrombosis. Multiple cranial nerve palsies may occur including 6th
(intracranial hypertension) 3-6 (sigmoid/transverse sinus throm
bosis). 5th (petrosal sinus) and 9-12 ijugular vein) Hemianopia and
dysphasia are due transverse sinus/posterior SSS involvement.
69. A-T, B-T, C-T, D-T, E-F

The thrombus is hyperdense in the early stages and becomes
progressively hypodense and isodense in a few days. Empty delta
sign is seen on contrast enhanced scansand is due to non enhan
cing clot surrounded by enhancing dural wall which is supplied
by dural v�scular channels. It is also seen in other sinuses.
70. A-T, B-T, C-T, D-T, E-T
71. A-F. B-T, C-T, D-T, E-T

In eady stages, the thrombosis is iso in Tl and hypo in T2. but
in later stages it is hyperintense in both Tl and T2. Contrast
enhanced Tl will show bright thrombosis \\'ithin the lumen and
enhancing \Vall. Venous infarct is also seen.
72. A-T, B-T, C-T, D-T, E-F

Emissary veins in foramen ovale, foramen lacerum and sphenoidal
foramen drain the blood to the pterygoid plexus.
73. A -T, B-T, C-T, D-T, E-F

Central retinal vein, middle meningeal vein frontal branch,
superfical middle cerebral vein are other causes.
74. A-F, B-F, C-F, D-T, E-F

Common cause is laceration of the artery rather than rupture of
aneurysms. Fracture of the sphenoid bone produces a hole in the
cavernous sinus. This can be due to trauma, but can be seen in
sphenoid sinus biopsy. and Fogarty catheter during endarterctomy.
Coil embolisation is the treatment.
75. A-F, B-T, C-T, D-T, E-T

Types of CCF
A-direct single hole fistula between ICA and sinus, B-dural fistula
between meningeal branches of ICA and cavernous sinus, C-dural
fistula between meningeal branches of ECA and cavernous sinus.
D-dural fistula between combined meningeal branches of ICA.
ECA to cavernous sinus. Collagen vascular disease and rup ture

of internal carotid aneurysm are other causes apart from trauma.
The indirect type are common in females. are more often spontaneous
and there is high incidence of preagnancy. Hydrocephalus is pro
duced due to imparied venous drainage. All the contrast introduced
into the carotid artery drains into the cavernous sinus and hence
the distal internal carotid artery is ot visualised and moreover is
obscured by contrast in the cavernous sinus.
76. A-T, B-F, C-T, D-F, E-F

Contrast injected into the vertebral artery passe\ into the basilar
artery and posterior cerebral artery. Due to com pr 1·ssion of carotid
artery, the flow is directed into the posterior com111unicating artery
into the distal part of internal carotid artery and the tear can be
visualised. The fistula requires treatment if there is epistaxis. raised
intracranial tension. proptosis, cortical venous drainage. large
cvarix and thrombosis of venous drainage. Embolisation can be
done in the arterial and venous route. Direct fistulas are managed
by transarterial embolisation with coils or balloons. Venous route
is preferred when arterial route is difficult. Indirect fisultas \\·irh
multipe arterial feeders are managed best by venous route.
77. A-T. B-T, C-F, D-·T. E-T

vVallenberg syndrome. is lateral medullary or PICA syndrome.
posterior inferior cerebellar artery syndrome. Most common cause
of PICA syndrome is vertebral artery occlusion. follO\ved by PIC...\
occlusion. Ipsilateral-paralysis of tongue, vocal cord. sterno
cleidomastoid. palate. Homers. ataxia: Contralateral-loss of pain
and temperature sensations. nausea. vomiting, nystagmus
78. A-F, B-T, C-T, D-T, E-F

There is intense homogenous enhancement on gadolinium. The
lesion has a pop corn appearance due to mixed blood products
in varying stages. There is a low signal rim due to hemosiderin
and this blooms with Gadient echo images. There ic:; 111> mass effect
or de ma. Angiogram is typically negative and It• ·nee this is also
called cryptic angioma.
79. A-T, B-F, C-T, D-T, E-T

Most common cause is atherosclerosis. Embolic occlusion of
vertebraobasilar occlusion is rare. Vertebral artery dissection is
commonly seen at C 1-2 level. The posterior circulation feeds the
brainstem, thalamus and occipital cortex. Lesions can be seen in
any of these locations.
80. A-T, B-F. C-T, D-F, E-F

Characteristic appearance is the presence of multiple small flmv
voids which are due to collaterals formed secondary to S[enosis
of internal carotid arteries. Puff of smoke appearance is also due

t o hypertrophied ·collaterals. The internal carotid arteries are
involved in a bilateral assymetrical. Posterior circulation is also
involved.
81. A-F, B-F, C-F, D-T, E-T

Infarction is seen in deep white matter in adults and in subcortical
a n d cortical areas i n children. Both the hemispheres show
asymmetrically increased enhancement. which is due to poor
hemispheric perfusion.
82. A-T. B-T. C-T, D-T, E-T
83. A-T. B-F, C-F, D-T, E-F

The lenticulostriate arteries are hypertrophied since they form the
collateral pathway and contribute to the multiple signal voids seen
in !\·1RI . Collaterals are seen everyvv·here including leptomeninges
and dura. Bimodal distribution seen in children and 60-70 years
Children commonly present with ischemia and adults \vith
haemorrhage.
84. A-F, B-F, C-F, D-F, E-T

Ca\·ernous angioma is a benign vascular malformation. made up
of dilated endothelium lined spaces. There is no normal brain
parenchyma in bet\veen the vessels and there is no capsule. 80%
are supratentorial and 20% are infratentorial. Cp10 80% are multiple.
There is apparent growth due to growth of new vessels of re
endothelisation of haemorrhagic cavities or granulation tissue
proliferation.
85. A-F, B-F, C-T, D-F, E-T

The lesion has haemorrhagic products in varying stages giving the
characteristic imaging appearances. Majority are symptomatic and
it is the second most common symptomatic malformation after
A VM. It produces seizure, headache, neurological deficit. IVH and
SAH are not seen. Risk of bleeding is 0. 1-1. 1% I year. Bleeding
is seen in less than 1% of lesions. There are many blood products
in the lesion, which produce the imaging appearance, but they are
due to seepage of blood pigments from sequestration within the
cavernous angioma rather than frank haemorrhage.
86. A-F, B-T, C-F, D-T, E-T

Venous angioma is the most common malformation detected at
autopsy. It is a development anomaly and consists of dilated thin
walled anomaolus veins with intervening normal brain converging
in a large transcortical draining vein. which is the superifical vein
in 70% of cases. Ventricular angle adjacent to the frontal horn and
deep white matter are most common locations. Angiogram will

show dilated medullary veins in the venous phase converging on
the enlarged transcortical draining vein. 25% drain into sinuses.
Venous varix is dilated tortous vein usually associated with AVM.
a neurysm. Vein of Galen malformation a n d other venous
malformations.Angiography shows saccular or fusiform enlargement
of draining veins.
87. A-T, B-F, C-T, D-F, E-T

Dural AVN1s are difficult to visualise in MRI. because they are seen
as flow voids and there is contrast with the signal void of adjacent
cortical bone. Hence MR angiography is the best modality for
assessing them. Aneurysm in the feeding artery is often flow related.
due to hemodynamic stress in the feeding artery a n d do not
necessarily increase the risk of haemorrhage. Aneurysm in the nidus.
is devoid of elastic and muscular lining and are more prone for
haemorrhage. MRI is theideal method for localising the nidus ofAV\-f
and angiography is the best modality for angioarchitecture.
88. A-T, B-T, C-F, D-T, E-T

The most common cause of fusiform aneurysm is atherosclerosis.
Tumours can produce aneurysm either by vascular invasion by
t u m our or metastatic emboli disrupting the vascular wall.
Meningioma. gliomas and pituitary adenomas are the most
common tumours producing this . Left atrial myxoma and
choriocarcinoma are the common metastatic tumours producing
oncotic aneurvsm.
J
89. A-F, B-T, C-T, D-T, E-F

There are multiple nests of dilated capillaries without smooth muscle
cells. There is a racemosie type with normal brain parenchyma in
between the vessels and a cavernous type. It is common in pons.
spinal cord and cerebellum. It is usually asrnptomatic. The racemose
type is seen only in contrast �v1RI. Stippled enh;mcernent is Yery
characteristic. but can be seen in lymphoma. Cavei-11ous type is seen
as high signal lesion in Tl. Osler Rendu vVebersynd1·1 ime is associated
with this disease.
90. A-T, B-T, C-T, D-T, E-T

A VM is the most common cause of an early draining vein in
angiography. Infraction with luxury perfusion. resolving haematoma.
abscess, hypervascular metastasis are other causes.
91. A-F, B-T, C-F, D-T, E-T

Aneurysmal sac has only intima and adventitia, but no media. The
internal elastic lamina ts absent. 20% of aneurysms are multiple
and 75% of multiple aneuryms invovle tv:o arteries. 15% ir..volve
three arteries. Fibromuscular hyperplasia is another cause of

multiple aneurysm. 90% of aneurysms occur in the Circle of willis.
35% occur in the anterior communicating artery and 35% occur in
the internal carotid artery or posterior communicating artery. Only
5% involve the basilar circulation. 20% involve the middle cerebral
artery bifurcation.
92. A-T, B-F. C-T, D-F, E-T

Hunt and h e s s scale is used for grading the severity of
subarachnoid haemorrhage. I-asymptomatic or minimal headache.
II-mild or severe headache. neck rigiditiy. III-palsy, III
confusion. drowsiness. IV-Stupor. hemiparesis, V-moribund,
decerebrate rigigity. Posterior communicating artery aneurysm
causes III nerve palsy and not anteiror communicating artery. The
risk of rupture is 1-2% per year.
93. A-T, B-T, C-T, D-F, E-T

Cortical haematomas are more common than those in basal ganglia.
which is common in hypertension.
94. A-T, B-T, C-T, D-T, E-T

Sinus pericranii is a scalp vascular malformation in vvhich there is
communication between scalp veins and intracranial veins through
dilated diploic veins. It presents as a fluctuant lump in the scalp
which varies with posture and Valsalva manoeuvre.
Infection, haemorrhage and air embolism are complications. MRA/
MRV can be used for diagnosis.
95. A-F, B-F, C-T, D-F, E-F

AVMs do calcify at the location of the nidusm with an incidence
of 30%. 85% of AVMs involve the supratentorial compartment and
15% involve the infratentorial compartment. In diffuse A VM, there
is a diffuse collection of enlarged arteries and veins and there is
deep venous drainage. In thrombosed AVM, there is slow flow
in the arteries and there is only an avascular mass effect. Bleeding
is from the nidus or the arterialised portion of the vein and not
from the artery.
96. A-T, B-T, C-T, D-T, E-T

Pre-eclampsia. tacrolimus and erythropoietin are other causes.
97� A-T, B-F, C-F, D-T, E-F

RPLS h a s characteristic distribution . It is seen in the parieto
occipital region and is bilaterally symmetrical. It is hypodense in
CT and hyperintense in T2W images. It is believed to be either
due to vasospasm or due to impaired cerebral autoregulation.
Vasospasm produces cytotoxic edema and impaired autoregulation
produces vasogenic edema. both of which can be differentiated

by diffusion MRI.
98. A-F, B-F, C-F, D-F, E-T

The incidence of AVM is only 0. 14% in the general population.
The parenchymal A VM is wedge-shaped. with the base situated
towards the surface of the brain and the apex tov1ards the lateral
ventricle. The AVM is formed due to a persistence of primitive
direc t communication between arteries and veins, without
intervening capillaries. In AVM. there are dilated arteries and
veins and there is a nidus which is a tangle of vessels replacing
the normal arterioles and capillaries. demonstrating low resisrance
high flow. There may be gliotic non functioning brain parenchyma
in between the abnormal vessels.
99. A-F, B-T, C-T, D-T, E-T

Multiple AVN-ts are seen only in 2%_ of AViv1s and are due to nsler
Rendu Weber syndrome or Wybum mason syndrome. Mass efiect
is seen i n AV�1 only if there is haemorrhage or venous varices.
The feeding arteries are enlarged and can show aneurysm or
steonosis with flow related ischemia. Veins can show vasculoparhic
changes or varices or cortical veins are enlarged.
100. A-F, B-F, C-T,D-F, E-F

Small < 3 cm. medium 3-6 cm. large > 6 cm. Parkinson and Pa:'kers
classification of AV?\.I I- multiple unit AVM. 11- single unit ...\.\':'d.
III- straight lir.e A VtvI with direct AV shunt. \Vithout imervening
vessels. IV-combined AV�t fed both by cerebral and extrace�ral
vessels,V-venous wall AVM. Deep venous drainage have \\-iJrst
prognosis. Small nidus increases the risk of bleeding but la;ge
nidus carries more operative risk.
101. A-T, B-F, C-T, D-T. E-T

Intranidal aneurysm. high pressure arterial feeders. deep ver,ous
drainage. venous stenosis. temporal lobe or imr:1,·entricular
location sare other high risk factors. A small A VM is more like!y
to bleed than a large A\11v1.
102. A-T, B-F, C-T, D-T, E-F

One third o f AV.M patients have normal life. one third die of
haemorrhage and one third have stroke. Exercise, hypertension,
trauma and pain do not significantly increase the risk of bleeding
in AV1v1. Haemorrhage is che most common presentation in AV\1.
103. A-F, B-E, C-T, D-T. E-F

AVM commonly presents as spontaneous intracerebral haemor-
rhage. Aneurysm presents as subarachnoid haemorrhage. The

most common cause of spontaneous non-trumatic intraventricular
haemorrhage is A VM. A VM is seen as a tangle of flow voids in
ordinary MRI images. Any high signal can be due to thrombus
or slow flow or haemorrhage only. In gradient echo images. the
malformation is seen as hyperintense lesion.
104. A-T, B-F, C-F, D-T, E-F

Blood in frontal horn-likely to be anterior communicating artery.
suprasellar cistern- non-specific, IV ventrtcle- posterior fossa
aneurysm.
105. A-T, B-F. C-T. D-T, E-F

A dural A VF can be formed due to sinus thrombosis which when
recanalisation forms a direct artery to sinus communication or
for mation o f s i n gle A VF in dura near the sin u s or due to
venoocclusive diseaes of dural sinuses or chronic intracerebral
venous hypertension. It is most common in the sigmoid and
transverse sinus, follO\ved by cavenrous sinus and sigmoid sinus.
Haemorrhage is seen only if ther eis reflux into cortical veins or
direct drainage into cortical veins or venous varices. Hydrocepha
lus can be mechanical due to compression of the cerebral aqueduct
or communicationg due to reduced absorption resultiing from
chronic passive venous congestion. The dural arteries are enlarged
and there are multiple feeders. There is no nidus.
106. A-T. B-T, C-T. D-F, E-F

Iv1R angiography is very useful in aneurysm. especially for
delineating the parent artery. the find the size. orientation and
neck of aneurysm. A typical aneurysm is seen as flow void in both
Tl and T2. Signal within the aneurysm can be seen due to thrombus
or just due to turbulent flow. Turbulent flow is seen as iso to
hyperintense signal in Tl and T2. Thombus is seen as a multilayered
structure with varying intensity depending on the age of the clot.
107. A-F, B-T, D-F, D-T, E-F

In CT the thrombus is hypodense in plain CT and does not enhance
on contrast administration. The lumen is iso or hyperdense in plain
and enhances on contrast. There is a hypodense rim in non-contrast
s c an due to athe rosclerosis, which enhances o n contrast
administration. Flow related aneurysms are seen in A VM, in the
p roximal. distal feeding arteries and nidus. This can b e seen in
any vessel feeding the AVM or the circle of Willis. The cause of
these aneurysms is belie ved to be high hemodynamic stress in
these blood vessels. Subarachnoid haemorrhage i s the most
common presentation of aneurysm.
108. A-T, B-T, C-T, D-T, E-T

Familial aneurysms are 10% of all aneurysms. They are seen in
ii younger population. Aneuryms in children are multiple in 20% of
cases and occur also in internal carotid artery bifurcation.
I
I
109. A-F, B-F, C-T, D-T, E-T
Pencil injury causes injury of intenral carotid artery, scalp trauma
l.
produces superficial temporal artery aneurysm. middle meningeal
artery and fracture dislocation of base. involves vertebral artery.
Peripheral arterial aneurysm is seen due to shearing froce betvveen
free margin of falx and distal anterior cerebral artery. Peripheral
cortical branches are also commonly involved. It is suspected if
there is a delayed haematoma near the brain peripheray developing
adjacent to skull fracture The petrous cavernous and supraclinoid
portions of the supraclinoid part are prone for traumatic aneurysms
of the skull base.
110. A-T, B-T, C-T, D-F, E-T

Haemorrhages arise at the origin of blood vessels. since they are
the site of the maximal hemodynamic stress. The rapid change of
blood flow during systole and diastole is the most common
mechanism by which the aneurysm enlarges. Infundibuli can be
confused for aneurysms in angiogram. They are caused due to
incomplete regression of fetal vessels. They are regular and the
distal vessel exits from their apices. Angiogram is negative in 158�
of subarachnoid h aemorrhage. In cross compression. contrast is
injected into one c arotid artery and the opposite carotid artery
is compressed. The extent co which the opposite site is vascularised
is assessed and is useful when surgery is contemplated.
111. A-F B-T. C-F. D-F, E-F

.
There are t\VO groups of angiographically negative subarachnoid

haemorrhage. In the common type, there is blood in interpedun
cular and ambient cistern and is due to rupture of perimesencephalic
or ponrine ".. eins. The prognosis is good in thesP cases. There is
another group in \vhich there is blood in the suprasellar cistern.
sylvian fissure and anterior interhemispheric fissure. The subsequent
angiogram in these cases is often positive in 20% of cases and these
have a worse prognosis. Thrombosed aneurysm produces mass
effect.
112. A-T, B-T. C-T, D-T. E-F
113. A-T, B-T. C-T, D-F. E-F

Aneuryms more than 2.5 cm aie more prone for bleeding.
Hypertension. smoking and multilobated shape are other knmvn
risk factors for rupture.
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1. Features of gliomatosis cerebri:

A. Diffuse distortion of underlying architecture
B. High signal diffusely in the white matter
C. Sulcal effacement
D. Intense contrast enhancement
-E. Not contiguous
2. Differential diagnosis for gliomatosis cerebri:

A. Multifocal metastasis B. Viran encephalitis
C. ADEM D. �·1ultiple sclerosis
E. Vasculitis
3. Common Suprasellar lesions:

A. Meningioma B. Craniopharyngioma
C. Sarcoid D. Histiocytosis ·
E. Chordoma
4. Meningiomas:
A. Haemorrhage is a recognized feature
B. Tumour may invade the superior sagittal sinus
C. There may be lytic destruction of the skull vault
D. Branches of external carotid artery supply the center of the
tumour
E. Hyperostosis associated with the tumour is a pathognomonic
finding
5. Meningiomas: .
A. Hyperostosis indicates tumor infiltration to bone
B. Pneumosinus dilatans is a feature of rneningioma
C. Enlargement of forarnen spinosum is a well rec9gnized feature
D. Enlarged meningeal grooves are seen
E. Calcification is seen in 50%
Tumours 117
6. The following are locations where meningioma has been detected:

A. Parotid gland B. Mediastinum
C. Adrenal gland D. Kidneys
E. Lung
7. Chordomas:
A. 1 / 3 rd are seen in the clivus
B. Locally invasive
C. Infants a re affected
D. Calcifica tion is seen in 90%
E. Sacrum is inv olved in 20%
8. The following cause cerebellopontine masses:

A. Cholesterol gran u loma
B. Petrositis
C. Lipoma
D. Epidermoid cyst
E. Melanoma
F. Pituitary adenoma
9. CP angle lesions:
A. Acoustic neuromas and meningiomas consticute upto 90°S of
all CP angle l esions
B. Acoustic neuromas tend to grow anteriorly rather th3n
posteriorly at the CP angle
C. Anterior spread of acoustic neuroma is limited by the cisterna!
segment of the facial nerve
D. Cystic changes can be seen in acoustic neuroma
E. Presence of a clear vascular cleft bet\1•.-een the tumour and the
brain indicates mening i oma
10. CP angle meningioma:

A. Dural tail sign is specific for meningioma
B. Flat base is seen
C. Rounded contour
D. Hyperostosis is not seen in C P angie lesions unlike other
locations of meningiomas
E. Widening of internal auditory canal
11. Epidermoid Cyst:

A. Third most common cause 'of CP angle lesion
B. Displaces the arteries and nerves in the cisterns rather thar.
encasing them
C. Contains keratin and cholesterol
D. Irregular lobulated margins
E. Lined by columnar epithelium
12. Epidermoid cysts:

A. Are isoattenuating to CSF in CT scan images
B. Show high signal in diffusion weighted images and low signal
in FLAIR images
C. Hyperintense to CSF in T2 weighted images
D. CISS sequence are required for assessing accurate extent of
tumour.
E. Produces reactive changes in the adjacent bone
F. Contrast enhancement occurs
13. CT scan of p osterior fossa:

A. Cerebellar hemangioblastomas show ring enhancement
B. Ependydoma s are usually seen from third ventricle
C. Medulloblastomas are seen in midline in the vermis
D. Astrocytomas are most common malignant cerebellar tumour
in adults
E. Dilated fourth ventricle excludes obstructive hydrocephalus
14. Meningioma:
A. Is the most common extra axial tumour
B. More common in males
C. 1/3rd of incidentally discovered intrac ranial neoplasms are
menigiomas
D. Associated with Type 1 NF
E. Is the most common radiation induced tumour in CNS
15. Features of Von Hippe] Lindau disease:

A. Retinal phakomas
B. Cerebellar hemangioblastomas
C. Polycythemia
D. Liver cysts
E. Autosomal recessive
16. Acoustic neuroma:

A. High signal on T2 FSE
B. Intensely enhances post contrast
C. Type I neurofibromatosis is associated
D. Calcification is seen in 30-40%
E. Cannot be differentiated from meningiomas
17. Arachnoid cysts:

A. Bone erosion is common
B. High signal in diffusion images
C. Calcification is seen
D. Contrast enhancement is common
E. Tend to displace neurovascular structures rather than encasing
them
Tumours 1 i9
18. Dermoid cysts:

A. Fat fluid levels are characteristic
B. CP angle is the most common intracranial site
C. Calcification is seen
D. Lined by squamous epithelium
E. Contain all layers of the skin
19. Acoustic neuromas:

A'. Very vascular
B. Best diagnosed by CT air meatogram
C. Marked contrast enhancement
D. Extensi ve calcification
E. Hyperostosis of adjacent temporal bone is common
20. Acoustic schwannomas:

A. Arise from inferior vestibular nerve
B. Associated with arachnoid cyst in 10% of cases
C. Cystic schwannomas are more aggressive
D. Homogenous enhancment is normally seen
E. Upto 25% of intracanalicular masses are meningiomas
21. Causes of cystic metastasis to brain:

A. Sarcomas
B. Squamous carcinoma lung
C. Adenocarcinoma lung
D. Cervical carcinoma
E. Adenocarcinorna colon
22. Differential diagnosis of bilateral cavernous sinus masses:

A. Pituitary adenoma
B. Thrombosis
C. Aneurysm
D. Schwannoma
E. Caroticocavernous fistula
23; Haemorrhagic brain metastasis:

A. Renal carcinoma
B. Thyroid
C. Lung
D. Choriocarcinoma
E. Colon
24. Calcified brain metastasis:

A. Ovarian B. Colonic
c. Breast D. Lung
E. Sarcoma
25. Brain metastasis:

A. The white matter is the most common location
B. The edema surrounding metastasis is always extensive than
the tumour
C. Majority of lesions are multiple
D. N euroblastoma is the most common cause of metastasis in
children
E. Small tumours show ring enhancement
26. Arachnoid cyst:

A. Commonst location is the frontal pole
B. Filled with CSF and keratin
C. Calcification is seen in 10%
D. Hydrocephalus is seen in 60%
E. 1I3rd seen in posterior fossa
27. Acquired causes of arachnoid cyst:

_ A. Subarachnoid haemorrhage
B. Meningioma
C. Fracture
D. Neonatal infection
E. Biopsy
28. High signal in diffusion weighted images:

A. Gliomas
B. Sustained seizure
C. Eclampsia
D. Venous infarction
E. Central pontine myelinolysis
29. Brain tumours:

A. Spine MRI should be done for staging of brain tumours
B. 50% of brain tumours in children are supratentorial
C. Gliomas account for two thirds of all brain tumours
D. Axial brain images should be aligned to the anterior posterior
commissure line
E. Coronal images should be aligned parallel to the hard plate
30. Brain MRI:

A. MP RAGE sequence is a 3D gradient echo technique
B. Spurious meningeal enhancement is a common artefact in
MPRAGE
C. Aliasing is an important artefact
D. Flow compensation is required for spatial misregistration
E. Posterior fossa is devoid of artifacts i n MPRA.GE
Tumours 121
31. Dermoid cysts:

A. Common in the 30-50 year group
B. Have dermal appendages
C. CT value is that of fat
D. Rupture is more common than in epidermoid
E. No contrast enhancement
32. Dermoid cysts:

A. Majority are situated off midline
B. Calcification is very uncommon than epidermoid
C. More common in males
D. No contrast enhancement
E. The most common infratentorial site is the vermis
33. Schwannoma:
A. Spares the I and II nerve
B. Affects motor neurons than sensory neurons
C. Invasion of nerve is common than compression
D. 50% of schwannomas arise in the VIII nerve and 45% in fifth
nerve
E. Enhancement is intense in both CT and MRI
34. MRI of brain tumours:

A. T2 w e i g hted brain image should always be done for
assessment of pi tuitar y tumours
B. The most cri tical feature in assessment of convexity menin
gioma is the involvement of superior sagittal sinus
C. The relationship to anterior cerebral artery is importan t in
assessment of olfactory groove meningioma
D. En pl aque meningiomas are most common in the olfactory
groove

A. Majority of GI tumours metastasise to infratentorial region
B. 80% o f metastasis are supratentorial
C. MRI is the primary imaging modality for diagnosing cerebral
metastasis
D. In a known primary tumour. with a solitary metastasis in CT.
further imaging is of no use
E. Metastasis in grey matter produce less edema than that in white
matter

A. tv1RI is more sen sitive than CT i n detection of cerebral
metastasis
1 B. Adenocarcinoma me tas tases are hypo intense in T2 weighted
I images
I
C. Gray white matter junction is the most common site of

metastasis
D. Double dose enhanced MR scans should be performed if a
solitary metastasis is identified
E. The vasogenic edema around cerebral metastasis is always
disproportionate to the metastasis
37. Common tumours in third ventricle:

A. Meningioma
B. Ependymoma
C. Choroid plexus papilloma
D. Colloid cyst
E. Aneurysm
38. Common masses in the fourth ventricle:

A. AVM B. Hemangioblastoma
C. Epidermoid D. Choroid plexus papilloma
- · E. Craniopharyngioma
39. Common causes of unilateral cavernous sinus mass:

A. Metastases B. Schwannoma
C. }v1eningioma D. Lymphoma
E. Glioma
40. Tumours in the anterior third ventricle or optic chiasma:

A. Colloid cyst
B. Glioma
C. Glioependymal cyst
D. Metastases
E. Meningioma
41. Pineal gland:

A. Pineal gland calcification greater than 8 mm is pathological
B. Pineal gland calcification under six years is pathological
C. Paralysis of downward g aze is the earliest sign of pineal
lesions
D. Pineal gland secretion inhibits the secretion of all other
hormones
E. Pineal gland is less receptive to light changes rather than blood
changes
42. Pineal tumours:

A. Pinealoblastomas are the most common tumours
B. Pineal cysts more than 5 mm are clinically significant
C. Germinomas are hyperdense on plain CT studies
D. Germinomas displace the pineal calcification
E. Pineal gliomas engulf the pituitary calcification
Tumours 123
43. Pituitary lesions:

A. More than 20% of normal pituitary glands show hypodense
lesions in MRl ·
B. 75% of pituitary adenomas produce excess hormones

C. ACTH producing adenomas are the most common adenomas
D. Microadenomas are less than 15 mm
E. Microadenomas are hypodense in non-contrast and enhance
on contrast administration
44. Pituitary tumours:

A. Sphenoidal sinus assessment is best done by MRI
B. MRI is very sensitive in assessment of cavernous sinus extension
C. Tilting of pituitary stalk is one of the reliable subtle signs of
microadenoma
D. Intense enhancement of microadenomas is seen in .NfRI
E. Pituitary haemorrhage is a uncommon occurrence in treated
adenomas
45. Radiological findings in acromegaly:

A. Thickened vocal cord
B. Organomegaly is more common in females
C. Plain film shows normal pituitary fossa
D. Hypertrophy of articular cartilage prevents osteoarthritis
E. Posterior scalloping of vertebra is seen
46. Craniopharyngiomas:
A. Cystic component has CSF density
B. In children, 75% are calcified
C. Peripheral enhancement occurs
D. 1 /3rd are completely intrasellar
E. Second most common suprasellar mass after meningioma
47. Craniopharyngioma:
A. Solid in 40% of cases
B. Consistently hyperintense in T 1 �V images
C. Hyperintense in T2vV
D. Marginal enhancement of solid components in MRI
E. Vascular in angiography
48. Pineoblastoma:
A. Extends into cerebellar vermis
B. Hyperdense in non-contrast scans
C. Calcification common
D. Haemorrhage common
E. Good contrast enhance:nent
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49. Clinical symptoms of craniopharyngioma:

A. Parinauds syndrome B. Biremporal hemianopia
C. Growth retardation D. Diabetes insipidus
E. Sheehans syndrome
50. Colloid cysts:

A. Intermittent headaches may be the presenting symptom
B. Headache is postural
C. The lesions are hyperdense on unenhanced scans
D. Intense contrast enhancement is seen
E. Calcification is common
51. Colloid cyst:

A. Has a fibrous capsule
B. Lined by ciliated columnar cells
C. Can present with acute herniation
D. Seen only in the foramen of Monro region
E. Hyperintense in T2 and hypo in Tl
52. Choroid plexus papilloma:

A. Most common location is fourth ventricle in children
B. 86% of tumours are seen in children less than five years
C. CSF is produced at rate of 0.5 ml/ min in this condition
D. Glomus of choroid plexus in rrigone is the most common
location in adults
E. Growth into surrounding white matter indicates choroid plexus
carcinoma
53. Craniopharyngioma:
A. Extends into posterior cranial fossa in 25%
B. Malignant transformation is recognised feature
C. Has bimodal age distribution
D. Can be seen in floor of anterior third ventricle
E. Sphenoidal bone is a recognised location
54. Choroid plexus papilloma:

A. Malignant transformation is a complication
B. Hydrocephalus is only due to increased CSF production
C. The lesion is hyperdense in CT
D. Hyperintense in T l and T2
E. Intense enhancement
55. Differential diagnosis of choroid plexus tumours:

A. Hemangioma B. Xanthogranuloma
C. Ependymoma D. Colloid cyst
E. Metastasis
Tumours 125
56. Choroid plexus cyst:

A. Lined by columnar epithelium
B. Trisomy 13 has a high incidence of association with choroid
plexus cysts
C. Amniocentesis s h ould be done for other c h r omosomal
anamolies if choroid plexus cyst is identified in antenatal scan
D. Common at level of fourth ventricle
E. Seen in the newborn in 20% of cases
57. The following tumours are hyperdense in unenhanced CT scans:

A. Choroid plexus papilloma
B. Acute subdural haematoma
C. Giant aneurysm
D. Colloid cyst
E. Sub ependydymal giant cell astrocytoma
58. Glomus jugulare tumours:

A. Hypervascular
B. Embolisation is not quite useful in management
C. Can cause bone destruction involving the floor of the posterior
fossa
D. Can be definitively diagnosed if the plain film shmvs enlarged
jugular fossa
E. Pulsatile tinnitus is diagnostic
59. Perisellar vascular lesions:

A. Internal carotid artery aneurysm
B. Ectactic carotid artery
C. Tortous basilar artery
D. Caroticocavernous fistula
E. ivledullary venous malformation
60. Enhancing supra and intrasellar masses:

A. Germinoma
B. Craniopharyngioma
C. Pituitary adenoma
D. Dermoid
E. Hypothalamic glioma
61. The following are low density s uprasell ar masses:

B. Meningioma
C. Lipoma
D. Epidermoid
E. Pituitary adenoma
I
62. Calcifying suprasellar masses:

B. Dermoid
C. Germinoma
D. Granuloma
E. Meningioma
- 63. Enlarged pituitary gland is seen in:

A. Primary hypothyroidism
B. Dural AV fistula
C. Infection
D. Lymphocytic hypophysistis
E. Adenoma
64. Common causes of intrasellar masses:

A. Rathke cleft cyst B. Empty sella
C. Chordoma D. Sarcoidosis
E. Myeloblastoma
65. Cause of suprasellar hot spot in TIW images:

B. Rathkes cleft cyst
C. Sarcoidosis
D. Dermoid
E. Congenital ectopic neurohypophysis
66. Prolactin microadenomas:

A. Polymenorrhoea occurs
B. Galactorrhoea
C. Hyperdense on enhanced CT scans
D. Pituitary fossa is enlarged
E. Infertility
67. Prolactin secreting tumours:

A. Intrasellar calcification is a characteristic finding in plain films
B. Bromocriptine therapy is an effective method of producing
tumour size reduction
C. Suprasellar extension is commonly associated with homony
mous hemianopia
D. The most common hormonally active pituitary tumours
E. Microadenomas are frequently hypodense in enhanced CT
studies
68. Tumours presenting at birth:

A. Primitive neuroectodermal tumour
B. Lymphoma C. Ependymoma
D. Craniopharyngiorna E. Choroid plexus carcinoma
Tumours 127
69. Primary brain tumours:

A. 85% of brain neoplasms occur in adults
B. Metastasis constitutes 2/3rds of brain tumours
C. 75% are supratentorial
D. The incidence of malignancy increases with age
E. Metatasis is more common in adult than children
70. Hypointense lesions· in sella:

A. Intrasellar aneurysm
B. Empty sella
C. Hemochromatosis
D. Persistent trigeminal artery
E. Pituitary stone
71. Common mid.line tumours in the brain:

A. Lipoma
B. Craniopharyngioma
C. Germinoma
D. Hypothalamic glioma
E. Hemangioblastoma
72. Intracranial tumours:

A. Pineal calcification under the age of 10 suggests pinealoma
B. Papilloma of choroids plexus produces high volume hydro
cephalus
C. Harmartomas are characteristically found in the cerebellum
D. Pineal calcification is seen in the frontal skull film and not on
the lateral views
E. Astrocytoma are characteristically midline in the cerebellum
73. Intracranial tumours:

A. Ependydomas always arise from the ventricular walls
B. Dermoids and teratomas are found near the skull base or
posterior fossa
C. Rt sided hemianopia indicates suprasellar tumour
D. Meningiomas are the most common brain tumour in adults
E. Lipomas cause bony destruction
74. Common tumours in the jugular foramen:

A. Meningioma B. Glomus tumour
C. Epidermoid tumour D. Neuroma
E. Metastasis
75. Dum bb e ll masses in petrous apex:

A. Meningioma B. Epidermoid cyst
C. Metastasis D. Trigeminal schwannoma
E. Acoustic schwannoma
76. Lesion expanding the cavernous sinu s:

A. Trigeminal schwannoma
B. Parasellar metastasis
C. Skull base tumour
E. Tolosa hunt syndrome
77. Low density lesion in the extra-axial region:

A. Acoustic schwannoma B. Arachnoid cyst
C. Lipoma D. Rathkes cleft cyst
E. Epidermoid
78. Common mu lticentri c tumors:

A. Gliomas B. Meningiomas
C. Lymphomas D. Hemangioblastomas
E. Medulloblastomas
79. Medulloblastoma:
A. Most common intracranial primary tumour in children
B. Benign tumour behaving aggressively
C. Hyperdense in non-contrast CT
D. Calcification is very common
E. i\1ost common location is cerebellar hemisphere
80. Hemangioblastomas:
A. High association with tuberous sclerosis
B. Associated with pheochromocytoma
C. Always cystic with mural nodule
D. The cyst wall enhances but the nodule does not enhance in
CT and MRI
E. There is early venous drainage in angiography
81. Pilocytic astrocytoma:

A. Distorts the fourth ventricle
B. Imaging features similar to hemangioblastoma
C. Enhancement of cyst wall differentiates it from other cystic
lesions in posterior fossa
D. Most common location is the vermis
E. Grade IV astrocytomas
82. Pineal tumours:

A. Difficult to differentiate from colloid cyst of third ventricle
B. Metastasizes to lung if a Holt Spitz shunt is used
C. Metastases to suprasellar cistern
D. Can have massive calcification
E. Produce bitemporal hemianopia
Tumours 129
83. Glioblastoma multiformes:

A. Mo st common primary brain tumour
B. Peak incidence in 30-40 years
C. Spares gray matter
D. Te m p oral lobe is commonly involved
E. Ass o ci ated with NF2
84. GBM:
A. Multiple in 15%
B. Hem a togen o us spread to bone
C. Invasion of se ptum pellucidum indicates butterfly gli oma
D. Meninges can be involved in primary and sec on d ary spread
E. Arises from e m bry ologic glioblasts
85. GBM- common imaging features:

A. Ring enhancement
B. Tumour always extends beyond ma rgin s of enhancement
C. Fluid l e vel seen within tumour
D. Calcification
E. E xtensive perilesional interstitial edema
86. Gliomas:
A. Contrast enhan c ement is inversely proportional to the degree
of anap lasi a
B. Hypothalmic g lio mas are associated with NF2
C. Optic chiasm gliomas are seen in 2-4 years
D. G angli ocyt om a has absolutely no glial component
E. G ang li ocytom a i s m alignant
87. Brainstem gliomas:

A. Usually gr ad e I or II
B. Peak age 20-30 years
C. M ed u l l a is most commonly involved
D. Pontine gliomas are of lmv grade than midbrain and medulla
E. E xop hytic type more common than infiltrati\·e type
88. Hypointense lesion s in sella:

A. Intrasellar aneursym B. Empty seila
C. Hemochromato sis D. P er si stent trigeminal art e ry
E. P itui t ary stone
89. CT and MRI features of Br ai nstem gliomas:

A. Narrowed CP angle cistern
B. Narrowed in ter ped uncu l ar cistern
C. Hydrocephalus very common
D. Anterior disp lacement of fourth ventricle
;
E. Haemorrhage common
i
90. Secondary neoplasms in CNS tumours are seen in:

A. 70% are gliomas
B. Less dose is required for children
C. The secondary tumours are more aggressive than the primary
neoplasm
D. Increased risk in those who survive ALL (Acute leukemoid
leukemia)
E. There is direct correlation between the dose and incidence of
secondary tumours
91. Oligodendroglioma:
A. Frontal lobes commonly affected
B. 90% are calcified
C. Marked edema is a prominent feature
D. Haemorrhage is seen in 20%
E. Arises from white matter and grows towards the cortex
F. 85% are supratentorial
92-. Brain tumour:

A. Choroid plexus papilloma is the most common ventricular
tumour in the second and third decade
B. �falignant meningiomas are more common in males
C. 1\.falignant meningiomas cause pial involvement
D. Presence of cholesterol in angioblastic meningioma, change the
imaging appearance
E. Multiple meningiomas are common in the convexity
93. Central neurocytoma:

A. Most common site is the temporal horn of lateral ventricle
B. Homogenous
C. Calcification
D. Mostly attached to septum pellucidum
E. Small cysts seen within the tumour
94. Radiation induced tumours of CNS:

A. Meningioma B. High grade gliomas
C. PNET D. Ependydoma
E. Head and neck tumours
95. Radiation induced tumours:

A. Life long MRI is required for following patients with tumours
who had radiation
B. Head and neck tumours develop after a latent period of 15 years
C. The incidence of tumours in a radiated person is 10 times the
normal population
D. The risk of developing cancer is directly proportional to the
radiation dose
E. Prophylactic thyroidectomy for medullary carcinoma thyL:.:.,:
in MEN IIA at 5 years
.t
;! t Tumours 131
I ------ ·-- . ··-·· .. ·-
96. Pleomorphic xanthoastrocytoma:

A. Common in frontal lobe
B. Mural nodule is seen within the mass
C. Enhancing meninges adjacent to the mass
D. Psychomotor epilepsy common
E. Homo genously solid tumour
97. Hemangioblastoma:
B. 80% are seen in children
C. Childhood tumours are common in girls and adult tumours
in men
D. Anemia is a recognised clinical feature
E. Multiple in 10%
98. Associations of hemangioblastoma:

A. Tuberous sclerosis B. Pheochromocytoma
C. Syringomyelia D. Von Hippel Lindau disease
E. At axia telangiectasia
A. Enhancing nodule is seen in 75%
B. Solid in 30%
C. Hypointense in Tl and T2
D. Gadolinium shows draining vessels
E. Haemorrhage is common
100. Medulloblastoma:
A. Second common posterior fossa neoplasm after astrocytoma.
in children
B. Arises from floor of the fourth ventricle
C. Seen in cerebellar hemisphere in older age group
D. 75% are seen below ten years
E. Most malignant infratentorial neoplasm
101. Iv1edulloblastoma s preads to the following locations:

A. Cervical cord B. Sylvian fissure
C. CP angle D. Cauda equina
E. Suprasellar cistern
102. Rathke cleft cysts:

A. Ivfajority are less than 2 cm
B. Pituitary hypofunction is the most common clinical presentation
C. Thick wall is very common in CT scan
D. Enhancement of wall indicates abscess formarion
E. Derived from posterior pituitary gland
103. Ependydomas:
A. Associated with neurofibromatosis
B. Jn children seen in posteior fossa only
C. Peak age is less than 10 years
D. In adults most common location in third ventricle
E. 15% of posterior fossa tumours in children
104. Primary intracerebral lymphoma is a complication of:

A. SLE B. Sjogren's syndrome
C. AIDS D. Immunoglobulin A deficiency
E. Renal transplantation
105. Primary intracPrebral lymphoma:

A. Corpus callosum is a common site
B. Location in the deep gray nucleus with extension i n t o
ependymal region i s characteristic
C. Significant mass effect
- D. Biopsy is not useful if the patient is o steroids
E. Spine is involved frequently
106. Primary intracerebal lymphoma:

A. The lesion is hyperdense in non-contrast images
B. Constitutes 4% of all lymphomas
C. Common in dural/ leptomeningeal location than parenchyma
D. l\1ultiple in 4%
E. T2\V is hypointense
107. Ependydomas:
A. 80% of spinal gliomas
B. Most common location in the fourth ventricle
C. Calcification is seen in -SO%
D. Cystic areas and haemorrhage indicate malignancy
E. Conus is the most common site of spinal tumours
108. Ependydoma:
A. Malignam tumour
B. Subarachnoid dissemination common
C. Expansion through foramen of Magendie is characteristic
D. Infiltrates blood vessels
E. Communicating hydrocephalus is seen in 100%
109. Epidermoid cyst:

A. Rich in cholesterol and triglycerides
B. Peaks in second and third decade
C. Causes meningitis
D. Cranial nerve palsy is unusual
E. Hydrocephalus is uncommon due to consistency of the tumo u r
Tumours 133
110. Causes of h ype rd en s i ty of epidermoid cyst:

A. Protein
B. Neutrophils
C. Iron containing pigment
D. Haemorrhage
E. Keratin /
.I
. '
111. Epidermoid cyst:

A. Most common location in the suprasellar region
B. 90% are extradural.
C. Displaces blood vessels rather than infiltrating them
D. Associated with dermal sinus tract
E. Hydrocephalus
112. Low signal intensity in T2W in epidermoid is due to:

A. Calcificaton
B. Saponification of triglycerides
C. Viscous secretion
D. Iron containing p igment
E. Keratin
113. In gliomas reconsider diagnosis if:

A. Intraventricular B. High densily pre contrasr
C. Thin enhancing rim D. Only grey maner involved
E. No enhancement
114. Ependydoma:
A. Fluid fluid level seen
B. Hemosidern deposits seen in the margin of tumour
C. Low density halo seen around the lesion
D. Hyperdense in plain CT scan
E. Homogenous contrast enhancement in MRI
115. Common causes of corpus callosal tumours crossing midline:

A. Lymphoma B. Glioma
C. Tuberculosis D. Toxoplasmosis
E. Metastasis
116. Metastasis:
A. Carcinomatous meningitis is infiltration of the leptomeninges
B. Subarachnoid space is involved in 15% of metastasis to brain
C. Skull is involved in 15% of metastasis to head
D. The tumour is lmv· intensity than edema in T2 weighred images
E. Melanoma and mucinous adenocarcinoma are more bright in
T2 weighted images
117. Skull tumours:

A. The most common primary skull tumour is osteosarcoma
B. Osteochon d r omas arise only from the bones formed by
endochondral ossification
C. Embryonic tumours like epidermoid and dermoid are not seen
off midline
D. Epidermoid s r u pture into CSF to p r odue Mollaret cell
meningitis
E. Lipid droplets in CSF can be seen due to rupture of dermoid
into CSF
118. Osteomas of skull:

A. Most common in the ethmoidal sinus
B. Ivory osteomas have more cancelllous bone and lot of fibrous
tissue
C. The density of osteoma depends on the amount of compact
bone
D. Compact osteomas in skull arises from the outer ta:, le
E. Arises only from bones formed in endochondral ossification
119. Intensely enhancing mass in pineal region:

A. Germinoma
B. Pinealoblastoma
C. Glioma of brainstem
D. Vein of Galen malformation
E. Metastasis
120. Germ cell tumours:

A. Teratoma i.s the most common germ cell tumour in skull
B. Most common location is suprasellar region
C. Pineal tumours have a high male distribution
D. Second third decades
E. 3-8% of brain tumours
121. Clinical presentations of germ cell tumours:

A. Hydrocephalus B. Precocious puberty
C. Parinaud syndrome D. Visual loss
E. Diabetes insipidus
122. Pineoblastoma
A. Highly malignant
B. Spread through CSF
C. Common in children than germ cell tumours
D. Histologically similar to medulloblastoma
E. Highly cellular
I
.I
Tumours 135
ANSWERS
1. A-F, B-T, C-T, D-F, E-F
Gliomatosis cerebri is a diffusely infiltrating neoplasm. There is
.
I no distortion of underlying architecture. but there is sulcal
!
effacement. Contrast enhancement is patchy and subtle. It can be
I
I
i in the leptomeninges or parenchymal. If contrast enhancement is

.. !
intense, a focal high grade malignant change has to be considered.
It"is contiguous.
2. A-T, B-T, C-T, D-T, E-T

The differential includes all conditions producing diffuse increased
in white matter signal intensity.
In multifocal metastasis the lesions are not con tiguous
Lymphomatosis cerebri is another disease with similar appearance.
ADEM and acute MS do not have the mass effect. In vasculitis
there will be patchy involvement. with multifocal enhancement.
3. A-T, B-T, C-T, D-T, E-F

.Nf eningioma, C raniopharyngioma, aneurysm. metastasis.
sarcoidosis, histiocytosis are some of the suprasellar lesions.
Chordoma is common in dives.
4. A-T, B-T, C-T, D-T, E-T

Haemorrhage is common in the more vascular type of
meningiomas. especially the telangiectactic type.
5. A-F, B- T , C-T, D-T, E-F

Hyperostosis i n d i c ates bony proliferation adjacent to the
meningioma. It does not indicate infiltration of the bone. The sinuses
may show blistering and sclerosis, called pneumosinus dilatans.
Enlargement of cranial foramina. including foramen spinosum and
enlargement of meningeal grooves are well recognized features.
Calcification is seen in 20% of patients. and is radial or circular.
6. A-T, B-T, C-T, D-F, E-T

ivleningiomas can occur in atypical locations, which include diploic
space, ventricles.scalp.outer table of skull, scalp, paranasal sinuses,
parotid gland, parapharyngeal space, lung, mediastinum and
adrenal gland.
7. A-T, B-T, C-T, D-T, E-F

Infants are affected occasionally. 50% are seen in the sacrum and
1 /3rd are seen in the clivus. Calcification is seen in 90%.
8. A-T, B-T, C-T, D-T, E-T

The most common lesions in the cerebellopontine angle are acoustic
neuromas and meningiomas. Other lesions are arachnoid cyst.
epidermoid cyst. dermoid cyst. lipoma. aneurysm. melanoma. non

acoustic schwannomas. Lesions from petrous bone and skull base
such as cholesterol granuloma. apical petrositis. endolymphatic sac
tumour, chordoma. chon drosarcomas. paragangliomas and
pituitary adenomas can extend to involve the CP angle. Tumours
from adjacent parts of brain like glioma. medulloblastoma.
hemangioblastoma, ependydoma. choroids plexus tumours.
lymphoma and dysembryoplastic epithelial tumours can extend to
involve CP angle.
9. A-T, B-F, C-T, D-T, E-F

Acoustic neuromas and meningiomas constitute 85-90% of all
tumours in the cerebellopontine angle. Acoustic neuromas arise
from the vestibular nerve in the internal auditory canal, expand
a n d e x it through the meatus and grows posteriorly in the
cerebellopontine angle. since it is limited anteriorly by the cisternal
segment o f the facial nerve. The lesion is heterogenous with
occasional cystic changes and show contrast enhancement. Presence
of a CSF or vascular cleft between tumour and brain just indicates
extra-axial nature of mass .
10. A-F, B-T, C-F, D-F, E-F

Dural tail sign is seen in any dural based tumour. The tumour does
not cause widening of imernal auditory canal like acoustic neruoma
and it has a flat base \\ith hemispheric contour. Hyperostosis of
adjacent bone is seen.
11. A-T, B-F, C-T, D-T, E-F

Epiderrnoid cysts are the third most common lesions of the CP
angle after the acoustic neuromas and meningiomas. They arise
from epithelial cells included during closure of the neural tube.
They are lined by squamous epithelium and contain keratin and
cholesterol . They tend to encase the neurovascular structures in
the cisterns than displacing them. They have irregular lobulated
margins.
12. A-T, B-F, C-T, D-T, E-F, F-T

Epidermoid cysts have to be differentiated from arachnoid cysts,
which resemble them . Epidermoid cysts are almost isodense to
CSF in CT scan images. They do not show any reactive changes
in the adjacent bone. unlike the arachnoid cyst. They are hyperintense
to CSF in Tl and T2 W irnages(heterogenous and marbled), bright
in FLAIR images and bright in diffusion weighted images. since
they have low apparent diffusion coefficient. But arachnoid cysts
are isointense to CSF in Tl , TZW. FLAIR and Diffusion weighted
images. since they are composed of CSF. Contrast enhancement
Tumours 137
and marginal calcifications may occur. Diffusion images are very

helpful in assessing postoperative residual tumour. Heavily T2
weighted CISS and 3 D FSE sequences are necessary for assessing
the extent of the lesion. (CISS-constructive interference in steady
state-high resolution images)
13. A-T, B-F, C-T, D-F, E-F

Hemangioblastomas show ring enhancment plus enhancement of
the solid nodule. Ependydomas are usually seen in fourth ventricle.
Metastasis are the most common cerebellar lesions in adults.
Tumour involving the lower portion of fourth ventricle. may still
cause dilated upper portion of fourth ventricle.
14. A-T, B-F, C-T, D-F, E-T

Meningioma is the most common extraaxial tumour in the central
nervous system.. comprising 15-18% of intracranial tumours in
adults and one third of all incidentally discovered meningiomas
in adults. It has a female predominance (4:1). It is the most
common radiation induced tumour in CNS with a latent period
of 20-35 years. Menigiomas are associated with NF-2.
15. A-F, B-T, C-T, D-T, E-F

Retinal ph akom a s are seen in tuberous sclerosis. He mangi o
blastomas are seen in cerebellum. spinal cord and supratentorial.

P olycythemia produced due to ectopic erythropoietin pr oduc rio n
by the tumour. Liver, adrenal. renal and pancreatic cysts are
common. Autosomal dominant with variable penetrance.
16. A-F, B-T, C-F, D-F, E-F

Intermediate signal in T2.
17. A-T, B-F, C-F, D-F, E-T

Arachnoid cysts are outpouchings of CSF. They have signal
intensity similar to CSF in all sequences including Tl. T2, FLAIR
and Diffusion weighted images. The y may show erosion of the
adjacent bone. especially the inner table. But calcification and
contrast enhancement are rare. They displace the neurovascular
structures, rather than encasing them. The absence of high signal
in diffusion image is an important differentiating feature from
epidermoid, which has high signal in diffusion images.
18. A-T, B-F, C-T, D-T, E-T

Dermoid cyst is lined by s quamous epithelium and contain all the
layers of the skin(fat. hair, sebaceous glands, S\veat glands). and
is derived from epithelial remams included during neural tube
closure. but a b it earlier than that of epidermoid cy s t They are
.
hypoden se in CT an d hyperimense in MRI images. They sho,,v
i
calcification and fat fluid level is characteristic feature. Common

site is in posterior fossa. in IV ventricle or vermis.
19. A-F, B-F. C-T, D-F,E-F

High resolution MRI and contrast enhanced MRJ are adequate for
assessing acoustic neuromas. They are isodense in CT scan and
enhance in contrast administration. Calcification is very infrequent.
H yperostosis is a f e ature of meningioma.
20. A-F, B-T, C-T, D-T, E-F

The schwannomas arise from superior vestibular nerve. Upto 90%
of intracanalicular masses are schwannomas.
21. A-F, B-T, C-T, D-F, E-F

Lung. breast. colorectal. renal. melanoma and choriocarcinoma are
rhe most common metastases to the brains. Sarcoma is a rare cause.
22. A-T, B-T, C-T, D-F, E-F

Meningioma, lymphoma are other causes
23. A-T, B-T. C-T, D-T, E-F

!\·1alignant melanoma is another common cause.
24. A-T. B-T. C-T, D-T, E-T

!v1any tumours get calcified afrer radiotherapy. Mucin producing
tumours are rhe most common causes.
25. A-F, B-T, C-T. D-T, E-F

The gray white matter junction is the most common location. 2/
3rds are multiple. Leukemia. lymphoma and neuroblastoma are
most common causes in children. Small tumours show nodular
enhancement, whereas large ones show ring enhnacement.
26. A-F, B-F, C-F, D-T, E-T

Most common location is temporal pole.Others are suprasellar
c istern, convexity, posterior fossa and cisterns. Filled with CSF
alone. Calcification does not occur.
27. A-T, B-T, C-T, D-T, E-T
28. A-T, B-T, C-T, D-T, E-T

Gliomas have ,-ariable signal.
29. A-T, B-T, C-F,D-T, E-F

MRI of the spine should be done in brain tumours that are known
to metastasis. In children 50% of tumours are infratentorial. whereas
in adults. majority are supratentorial. Gliomas account for more
than one thirds of brain ri 1mours. Axial images are usually obtained
parallel to the anterior posterior commissure line or the hard palate
and the coronal images are obtained perpendicular to them.
Tumours 139
30. A-T, B-T, C-T, D-T, E-F

M.P RAGE is a 3 D gradient echo technique. which is very fast
and reconstruction can be done in any plane. with or without
contrast. Spurious meningeal enhancement is a common artifact.
Flow related enhancement produces aliasing, in both venous and
arterial structures. Flow compensation may be required in vicinity
of blood vessels, due to spatial misregistration and this is common
in the posterior fossa. This sequence is commonly used in paediatric
neuroradiology.
31. A-T, B-T. C-T, D-T, E-T

Unlike epiderm o i d cysts, which have dermal appendages,
dermoids have no dermal appendages. Rupture into CSF produces
Mollaret cell meningitis. There is no contrast enhancement.
32. A-F, B-F, C-T, D-F, E-T

Majority of the lesions are situated in midline. Parasellar region
and frontobasal regions are the most common in brain. In the
infratentorial it i s common in the vermis and IV ventricle.
Calcification is very common.
33. A-T, B-F, C-F, D-F, E-T

95% affect the VIII nerve and 0. 5% affect the V nerve. Affects
sensory neurons more than motor neurons. It arises eccentrically
from the nerve sheath and hence it compresses rather than
invading it. Intense enhancement is seen in both CT and �v1RI. It
is usually homogenous enhancement but can be heterogenous.
34. A-T, B-T, C-T, D-F

En plaque meningioms are most common in the sphenoidal ridge.
35. A-T, B-T, C-F, D-F, E-T

GI. GU tumours are very rare to metastasise to brain (10%). Lung.
breast and melanoma are the common lesions. CT is still the
primary imaging modality for diagnosis. A solitary lesion may be
managed by surgery. so a double dose enhanced MRI s h ould be
done to exclude other lesions.
36. A-T, B-T, C-T, D-T, E-T

MRI is more sensitive and is better for assessment of small tumours.
meningeal enhancement and posterior fossa involvem ent.
Adenocarcinomas are usually hypointense on T2. partly due to
mucin and partly due to calcification. Melanomas are hyperinte n s e
on Tl weighted images.
37. A-T, B-T. C-T, D-T, E-T

Glioma, craniopharyngioma, are other cau s es.
l
· -
38. A-T. B-T, C-T, D-T. E-F

Ependydoma, vermian metastasis. cyst are other causes.
39. A-T, B-T, C-T, D-T, E-F

Aneurysm is a common cause.
40. A-T, B-T, C-T, D-F, E-F
41. A-F, B-T. C-F, D-T, E-F

Pineal gland calcification > 10 mm and under 6 years is pathologicaL
Paralysis of upward gaze and convergence(Parinauds syndrome
) . hydrocephalus. precocious puberty. polydipsia and polyuria are
clinical sy11dromes. Pineal gland is very receptive to green yellow
light. \\1hich is important for maintenance of circadian rhythm_
42. A-F, B-F, C-T, D-F, E-F

Germinomas are the most common. Teratomas. gliomas. pineoblas
toma. pineocytoma are other causes. Pineal cysts are not clinically
significant. Germinoas engulf the pineal calcification. hyperdense
-
in plain CT and enhance intensely and can spread by CSF.
Gliomas displace the gland anteriorly and superiorly.
43. A-T, B-T, C-F, D-F, E-F

Prolactin producing adenomas are most common. Microadenomas
are less than 10 mm.
Microadenomas are hypodense in both non-contrast and contrast
enhanced scans.
44. A-F, B-F. C-F, D-F, E-F

Sphenoidal sinus assessment prior to transphenoidal surgery is
done by CT. MRI and CT are not sensitive for assessment of
cavernous sinus extension. Tilting of pituitary stalk is non-specific.
Microadenomas are hypointense in Tl and T2. No enhancement
is seen.
Pituitary haemorrhage is commonly seen in post-bromocriptine
scans.
45. A-T, B-F, C-F, D-F, E-T

Premature osteoarthritis is a feature of acromegaly.
46. A-F, B-T, C-T, D-F, E-T

Cystic component has higher density than CSF due to presence
of keratin, cholesterol and necrotic debris. In children 70-90% are
calcified, unlike adults where only 30-40% are calcified. 10% are
purely intrasellar. Majority (70% ) are intra and suprasellar.
47. A-F, B-F, C-T, D-T, E-F

It is cystic in 50-75%. solid in 15% and mixed in 30%The signal
is variable in Tl, hyper or iso or hypo, but uniformly hyperintense
in T2. Avascular in angiography_
Tumours 141
48. A-T, B-F, C-F, D-F, D-F.

This pineal tumour can extend into the third ventricle or into the
cerebellar vermis. The lesion is hypodense, no calcification or
haemorrhage, no contrast enhancement. In MRI. the lesion is
heterogenous, low signal in Tl and high signal TZ.
49. A-F, B-T, C-T, D-T, E-F

Parinauds syndrome is seen in pineal tumours
Bitemporal hemianopia-compression of nasal fibers of optic
chiasma. Growth retardation-compression o f hypothalamus
Diabetes insipidus-compression o f pituitary. H eadache
hydrocephalus at aqueduct or foramen of Monro.
50. A-T, B-T, C-T, D-F, E-F

Intermittent positional headache due to intermittent obstruction
at foramen of Monro is the salient clinical feature. Hyperdense in
80% due to m u cin, hemosidern. desquamated cells and
proteinaceous debris.
51. A-T, B-T, C-T, D-T, E-F

Although a benign tumour, it can present as an emergency \vith
raised intracranial pressure and herniation. Seen exclusively in the
Foramen of Monro region. It is hyperintense in both Tl and T2
due to large protein molecules, paramagnetic effect of iron. copper
in c yst.
52. A-F, B-T, C-F, D-F, E-F

In children the most common location is the trigone and in adults
fourth ventricle is the most common location. CSF production is
increased and the rate is 1 ml/ min.
Although growth into \.Vhite matter occurs more in choroid plexus
carcinoma, it occurs in choroid plexus papilloma also.
53. A-T. B-F, C-T, D-T, E-T

Commonly extends into middle cranial fossa. but also in anterior
and posterior cranial fossa. Has t\.vo peaks. one in the first t\vo
decades and second in fifth decade. The older age group tumours
are more often solid than cystic and show less calcification. They
may behave more aggressively than the childhood tumours.
Anterior third ventricular floor, and sphenoid are ectopic locations
of craniopharyngioma.
54. A-T, B-F, C-T, D-F, E-T

Choroid plexus carcinoma is a complication. Hydrocephalus is due
to increased CSF production. obstruction due to tumour. The
lesion is hyperintense in Tl and hypointense in T2. Calcification
is frequently seen.
55. A-T, B-T. C-T, D-F, E-T

I\foningioma is another differential diagnosis
56. A-F, B-F, C-F, D-F, E-F

There is no lining for choroid plexus cyst. which is due to folding
of neuroepithelium, which is usually of no significance. There is
a high incidence with trisomy 18. 70% of trisomy 18 have this
anomaly. In p resence of choroid plexus cyst. trisomy 18 is seen
in 1 % of cases in absence of other anomalies and in 4% of cases
in presenre of other anomalies. If there are no other anomalies
in the anomaly scan. the chance of finding associated trisomy is
so low that the risk of amniocentesis and fetal \vastage is not
indicated. Common at the atrium. Can be uni or bilateral. Almost
all disppear b y 28th week.
57. A-T. B-T. C-T, D-T, E-T
58. A-T, B-F, C-T, D-F, E-F

- Embolisarion reduces vascularity before surgery. enlarged jugular
fossa can also be seen in deturscent jugular bulb. Pulsatile tinnitus
is non-specific.
59. A-T. B-T. C-F. D-T, E-F
60. A-T, B-T, C-T, D-F, E-T

l'v1eningioma is another common cause
61. A-T, B-F, C-T, D-T, E-T

Necrotic pituitary adenoma can be very hypodense. Dermoid. cyst
and hypothalamic glioma are other causes.
62. A-T, B-T, C-F, D-T, E-T
63. A-T, B-T. C-T, D-T, E-T

Any other tumour will cause pituitary enlargement.
64. A-T, B-T. C-T, D-T, E-T
65. A-T, B-T, C-T, D-T, E-T

Thrombosed aneurysm, haemorrhage neoplasm, post-operative,
lipoma. dermoid, disturbed .transport of releasing hormones from
hypothalamus (traumatic stalk resection, hypophysectomy, sarcoi-.
dosis, histiocytoma, pituitary and other tumours.
66. A-F, B-T, C-F, D-F, E-T

Amenorrhoea is seen.
67. A-F, B-T, C-F, D-T, E-T

Bromocriptine is used for treating prolactinoma. Calcification in
non-specific. Supravellon extension produces biremporal hemianopia.
Tumours 143
68. A-T, B-F, C-T, D-T, E-T

Choroid plexus papilloma. teratoma. hypothalamic astrocytoma are
other causes.
69. A-T, B-F, C-T, D-T, E-T

Primary brain tumours constitute 2/3rds and metastasis 1 /3rds
70. A-T, B-T, C-T, D-T, E-T

Any calcification will produce low intensity.
71. A-T, B-T, C-T, D-T, E-F

Pinealoblastoma and pituitary adenorna are other causes.
Hemangioblastoma is in cerebellar hemisphere.
72. A-T, B-T, C-F, D-F, E-F

Hamartomas are seen in CP angle. Astrocytomas are seen in
cerebellar hemispheres .
73. A-T, B-T, C-F, D-F, E-F

Ependydomas arise from the ependymal lining of the ventricles
74. A-T, B-T, C-F, D-T, E-T
75. A-T, B-T, C-F, D-T, E-F
76. A-T, B-T, C-T, D-T, E-T

i
77. A-T, B-T, C-F, D-F, E-T
78. A-T, B-T, C-T, D-T, E-F

Metastases are a common cause.
79. A-T, B-F, C-T, D-F, E-F

This is a malignant tumuor. which spreads into subarchnoid space.
The most common site of origin is the superior medullary velum
and is situated in vermis than cerebellear hemispheres. Calcification
is uncommon. Enhancement is patchy, heterogenous and there can
be associated hydrocephalus.
80. A-F, B-T, C-F, D-F, E-T

There is high association with Von Hippel Lindau syndrome. in
which there can be multiple tumors.in posterior fossa. spinal cord
associated with retinal angiomas, pheochromocytoma. renal cell
carcinoma and pancreatic tumours. It is usually cystic with mural
nodule. which enhances intensely on contrast. Occasionally there
can be a completely solid variant.
81. A-T, B-F, C-F, D-F, E-F

This is a low grade cystic astrocytoma, commonly seen in the
posterior fossa, in the cerebellar hemisphers, well defi:�·:.cLi::ysric,
with enhancing walls. with n o mu r a l nodule. Tl.-.: ··,:'. rast
enhancement is or specific and cannot be used to differentiate from

other lesions. It is a grade I lesion. common in children.
82. A-F, B-T, C-T, D-T, E-F

Colloid cysts are uncommon and they are hyperdense. Bitemporal
hemianopias are produced by suprasellar tumours.
83. A-T, B-F, C-T, D-F, E-F

50% of brain tumours. Peak incidence in 65-75 years. Most common
in centrum semiovale. frontal lobe, temporal lobe. Relative sparing
of gray matter and basal ganglia. Associated with NFI
84. A-F, B-T. C-T, D-T, E-F

Mu ltifoc;:il in 5%. Hematogenous spread is extremely rare.
Butterfly gliomas invade corpus callosum and cross midline.
Primary leptomeningeal gliomatosis can occur and CSF seeding can
occur in GBM. Arises from preexisting low grade astrocytomas
rather than from glioblasts.
85: A-T, B-T, C-T, D-F, E-F

Usual pattern is heterogenous or ring enhancement. Homogenous
enhancement can be seen occasionally. Fluid level is seen due to
haemorrhage, debri or contrast.
Calcification is very uncommon. Extensive necrosis. cystic changes
and haemorrhage are common. The edema is \·asogenic and not
interstitial. Interstitial edema is seen around the ventricles in
hydrocephalus due to exudation of CSF.
86. A-F, B-F, C-T, D-T, E-F

Conrast enhancement is porportional to the degree of anaplasia.
Hypothalamic optic chiasm gliomas are associated with NF-1 and
not 2.
Gangliocytoma is a bening tumour from ganglion cells and has no
glial component. like in unlike ganglioglioma which has glial
component.
87. A-F, B-F, C-F, D-F, E-F

Usually high grade.
Peak age is 3-13 years.
Pons > midbrain > medulla
Medulla and midbrain are of lower grade than pontine lesions.
Usually infiltrative type.
88. A-T, B-T, C-T, D-T, E-T

Any calcification will produce low intensity.
89. A-F, B-T, C-F, D-T, E-F

Prepontine and interpeduncular cisterns are narrowed, but CP
angle cistern is paradoxically wide. Hydrocephalus is uncommon
since the tumour presents quite early.
Tumours 145
Usually the fourth ventricle is compressed and displaced pos

teirorly. But the tumour can involve the cisterna magna when it
can displace the fourth ventricle anteriorly.
Exophytic lesions enhance more. Ring enhancement or minimal
enhancement is common.
90. A-F, B-T, C-T, D-T, E-T

70% are meningiomas, 20% are gliomas.
91. A-T, B-T, C-F, D-T, E-T, F-T

Calcification can be of any type and is best seen in CT scans.
Calcification in MR is dark and similar to haemorrhage. Calcifica
tion can also be of high signal and difficult to differentiate from
the lesion. Edema and contrast enhancement are not marked.
92. A-F. B-T, C-T, D-T, E-T

Xantho m a tous degeneration is common in the a ngioblastic
mening i omas. Normally the angi oblastic meningiomas are
hypointense in Tl and hyperintense in T2. The signal will vary
depending on the presence of fat. Ependymoma is common in 2nd.
3rd decade.
93. A-F, B-F, C-T, D-T, E-T

Most common site is the frontal horn and body of the l a[eral
ventricle, frquently anached to the septum pellucidum and
extending to the foramen of �1onro. The tumour is heterogenous
with areas of cysts. calcifcation and enhancing nodules.
94. A-T, B-T. C-T, D-T, E-T

Sarcomas. medulloblastomas. salivary gland. thyroid tumours are
also caused by radiation
95. A-T, B-T, C-T, D-T, E-F

Head and neck cancers develop after a latent period of 8-15 years.
Prophylactic thyroidectomy for MEN IIA- at 2 year'1. ME'.\' II B
1 year.
96. A-F, B-T, C-T. D-T, E-F

It is a low grade tumour in middle aged women. Common in the
temp o r a l lob e . C ystic tumour with enhancing n odule and
enhancement of adjacent meninges.
97. A-T, B-F, C-T, D-F, E-F

80% are seen i n adults and 20% in children. Ir produces
polycythemia due t o erythropoietin production in tumour.
98. A-F, B-T, C-T, D-T, E-F

99. A-F, B-T, C-T, D-T, E-T

The tumour is solid in one third. It is usually cystic or cystic with
mural nodule.
Enhancing mural nodule is seen in 50%. It can be hyperintense in
Tl due to haemorrhage. Cystic areas are hypo in Tl and hyper
in T2. Signal voids are seen due to high velocity flow.
_ 100. A-F. B-F, C-T. D-T. E-T

Most common posterior fossa neoplasm in children arises from the
inferior medullary velum in the roof of the fourth ventricle. Seen
in vermis in children and hemisphere in older age group. 30-40%
of childhood posterior fossa tumours.
101. A-T. B-T, C-T, D-T. E-T

Direct spread-frouth ventricle. aqueduct, cerebellar hemisphere,
CP angle, cervical cord.
CSF seeding-spinal cord. cauda equina. convexities. zylvican
-· fissure. suprasellar cistern. ventricles. Metastasis-bone. lung.
102. A-T, B-T. C-F, D-F, E-F

Rathke cleft cysts are derived from the embryological Rathkes
pouch. It is lined by epithelium. usually thin \\:alled, contains
mucinous fluid. Calcification is very uncommon. The lesion is
usually in the sellar region. tvfRI signal depends on mucinous
content, cholesterol. haemorrhage and inflammation. Enhancement
i s uncommon. Inflammation of adjacent structures can cause
enhancement. Although majority are asymptomatic. pituitary
dysfunction. headache and visual disturbances can be seen.
103. A-T, B-F, C-T, D-F, E-T

In adults commonly supratentorial especially in the atrium and
foramen of Monro.
In children predominantly seen in posterior fossa(70%) but can also
be seen in supratentorial region.
104. A-T, B-T. C-T, D-F, E-T
105. A-T. B-T, C-F, D-T, E-F

There is no mass effect. The response to steroids is very good and
this may result in non-specific appearances in biopsy. Spine is not
often involved in primary cerebal lymphoma.
106. A-T. B-T, C-F, D-T, E-T

Lymphoma is one of the few lesions which are hyperdense in non
contrast images. Primary lymphoma is more common i n the
parenchyma than secondary lymphomas which are common in the
dura/ leptomeninges. The lesion is hypo in Tl and hypo in T2.
Tumours 147
due to high cellularity. Enhances homogenously on contrast

administration.
107. A-F, B-T. C-T. D-F, E-T

65% of spinal glial tumours, majority of which occur in the conus
medullaris. Cystic areas and haemorrhage are common in epen
dymoma. Floor of the fourth ventricle is the most common
location.
108. A-F, B-T, C-T. D-F, E-T

It expands through foramen of Lusckha to the cerebellopontine
angle and through foramen of Magendie to the cisterna magna,
which is a characteristic finding.
It insinuates around the blood vessels and cranial nerves and does
not infiltrate them.
Communicating hydrocephalus due to protein exudates.
It is a benign tumour (Grade 2).
109. A-T, B-F. C-T, D-F, E-F
Peaks in fourth and fifth decades. Chemical meningitis results
when the cyst ruptures into the subarachnoid space(1vlollaret
meningitis). Cranial nerve palsy is common in the cerebellopontine
angle dermoid. Hydrocephalus is common in suprasellar tumoL!.rs.
110. A-T, B-T, C-T, D-T. E-T
111. A-F, B-F, C-F, D-T. E-F

1v1ost common location is CP angle, followed by supra sellar.
ventricles, brainstem.
90% are intradural. It characteristically moulds around the blood
vessels and cranial nerves. than displacing them. No mass effett
or hydrocephalus.
112. A-T, B-F, C-T, D-T, E-F

Low hydration is another cause.
113. A-F, B-F, C-F, D-T. E-F
114. A-T, B-T, C-T, D-T, E-T

Fluid level is seen due to the cyst. Hemosiderin deposits give a
low signal rim around the lesion in MRl. Low density halo is due
to effaced fourth ventricle. Hyper or isodense, uniform enhance
ment. 1v1RI shows low signal in Tl, and areas of high signal in T2.
with uniform intense enhancement.
115. A-T, B-T, C-F, D-F, E-T

1v1etastasis, lymphoma and butterfly glioma are the common
causes.
116. A-F, B-T, C-F. D-T, E-F

Carcirnomatous meningitis is infiltration of subarachnoid space.
Leptomeningeal enhancement is seen in tumours like ependydoma.
Skull js involved in 5% and subarachnoid space in 15%. Tumours
are usually more hypointense than edema in T2 weighted images.
melarmma and mucinous adenocarcinoma more hypointense than
other rumours.
117. A-F, B-T, C-F, D-T, E-F

The rmst common skull primary tumour is osteoma. Embryonic
tumoUirs are usually seen in midline due to inclusion of ectodermal
cells duri1 ig development. Although it is usually midline. it can
be off mid line when the ectopic stem cells are accidentally
transµorted ni fetal life. Lipid droplets are seen due to rupture
of epi<dermoid into CSF.
118. A-F, B-F, C-T, D-T, E-F

Osteomas of skull arise from the junction of endochondral and
membranous junction. It is most common in the frontal followed
by ethmoidal sinus. There are three types, Ivory-has cortical
bone ;. v ithout fibrous tissue. cancellous-compact bone. with
trabec,.ilae, fibrous tissue and fat. fibrous-mature lamellar bone
\Vith predominant soft tissue matter. The density depends on the
composition.
119. A-T, R-T, C-T, D-T, E-F

Subspienial meningioma and pinealocytoma are other common
caus�
120. A-F, B-F, C-T, D-T, E-T

Germmomas are the most common tumours.
Most common location is the pineal region followed by the
suprasellar region
Pineal tumours have a ten times male distribution, but suprasellar
tumours dont have.
121. A-T, B-T, C-T, D-T, E-T

Hydrocephalus due to compression of aqueduct of sylvius. Preco
cious puberty is due to production of B hcG Parinaud syndrome
due to compression of superior colliculus.
Visual loss-optic chiasm compression. Diabetes insipidus-pituitary
infundibulum lesion.
122. A-T, B-T, C-F, D-T, E-T

It is seen in the pineal gland. Pathologically it is very cellular. It
prodoces extensive local invasion and spreads by CSF.
1. Normal iron deposition in brain:
A. Ferrous iron is the normal iron deposited
B. Globus pallidus has iron by 6 months
C. The zona fasciculata of substantia nigra by 12 months
D. Red nucleus and thalamus have normal iron
E. Putamen
2. The common causes of T2 hyperintensities with aging are:

A. Myelin pallor B. Perivascular spaces
C. Perivenous collagen D. Plaques
E. Axonal loss
3. Aging brain:
A. White matter volume progressively decreases after 20 years
B. Iron content in brain is stable between 20-60 years
C. Cortical CSF increases by the rate of 0.6 ml/year after 20 years
D. Vermian subarachnoid space is increased only after 70 years
E. Ventricular CSF increase at the rate of 0.3 ml/ year after 20
years
4. Virchow Robin spaces:

A. Not seen in centrum semiovale
B. Increase in size with age
C. Seen around end arteries
D. Lined by pia mater
E. Measures upto 2 cm
5. Aging brain:
A. Periventricular rim of high signal is due to focal loss o f
ependymal cells
B. Gray matter volume increases till 20 years
C. White matte·r volume increases upto 4 years only
D. Loss of gray matter white matter differentiation by 7th decade
E. About 60% of gray matter is pruned in children after 4 years
6. Structures in and their vascular supply:

A. Inferomedial frontal lobe-MCA
B. Inferomedial temporal lobe-PCA
C. Thalamus - posterior choroidal artery
D. Tegmentum-thalamoperforating A
E. Genu of � nternal capsule-Huebeners artery
7. Common causes of communicating hydrocephalus:

A. Extradural haematoma B. SAH .
C. Aquerluct stenosis D. Choroids plexus papillomas
E. Colloid cysts
8. Radiation- the following patterns of diseases are seen:

A. Telangiectasia
B. Meningioma
C. Focal radiation necrosis
D. Diffuse white matter changes
E. �1ineralising angiopathy
9. Radiation:
A. The earliest changes are not seen before 6 months
B. Even the early changes are ir�eversible
C. Fibrosis is the pathology in the early acute lesions
D. Late change require radiation of more than 100 Cy
E. Chronic changes take atleast 5 years to develop
10. In Alzheimer's disease:

A. Anxiety and depression are prominent features
B. Myoclonus and extrapyramidal signs may occur
C. Atrophic changes occur typically with temporal and frontal
predominance
D. PET scan shows specific changes within brain
E. Anosmia may be a feature
11. Normal pressure hydrocephalus:

A. Gait abnormality precedes dementia
B. Urinary incontinence occurs early in course of illness
C. Periventricular edema is a feature
D. Maybe a sequel a of meningitis
E. Maybe a sequela of head injury
12. Small infarcts may result in cognitive dysfunction if they occur

in:
A. Hippocampal gyri B. Thalamic nuclei
C. Limbic system D. Parietal lobes
E. Basal ganglia
Degenerative and Oemyelinating Lesions 151
13. Amyloid angiopathy:

A. There is deposition of amyloid in larger vessels of the brain
B. Haemorrhage occurs in the cortical region
C. Haemorrhage occurs in subcortical region
D. Recurrent haemorrhage is a feature
E. Shows p r ogressive dementia indisti n guishable from
Alzheimer's
14. Causes of siderosis:

A. Spinal ependydomas
B. Chronic subdural haemorrhage
C. Vascular malformation
D. Pseudomeningocele
E. Meningioma
15. Aging brain:

A. 3rd ventricle is enlarged by 6th decade
B. Ventricular size is a reasonably accurate predictor of progress
of dementia
C. White matter tracts are highsignal in Tl and low signal in T2
D. Hyperintense triangular cap around frontal horn is due to
transependymal edema
E. Non-specific leukoencephalopathy seen in subcortical regions
16. Superficial siderosis:

A. Cranial nerves I. II, \'III are in\·olved
B. Inferior cerebral hemisphers are affected
C. Hypodense in CT
D. Hypointense in all MRI sequences
E. Atrophy of vermis is seen
17. �1RI features of alcoholism:

A. Sulcal widening
B. Marchiafava Bignami syndrome occurs
C. tvlamillary body shows changes
D. Cerebellum is spared in the degenerative changes
E. Central pontine myelinolysis is recognized
18. Aging brain:

A. Cortical sulci are abnormal if more than 2 mm
B. Interhemispheric fissure is 'prominent. if more than 6 mm
C. Sulcal size can be used to predict the progression of dementia
D. Vircho\v robin space is seen around lenticulcstriate arteries in
anterior perforated substance
E. Patchy periventricular T2 hyperintensities are very commonl.Y
seen due w infarcts
19. Aging brain:

A. 3rd ventricle is enlarged by 6th decade
B. Ventricular size is a reasonably accurate predictor of progress
of dementia
C. vVhite matter tracts are high signal in Tl and low signal in T2
D. Hyperintense triangular cap around frontal horn is due to
transependymal edema
E. Non-specific leukoencephalopathy seen in subcortical regions
20. Brain:
A. Huntingtons chorea causes focal enlargement of occipital horn
of later<il ven. tricles
B. Subcortical fibers are spared in radiotherapy and
chemotherapy induced demyelination
C. Focal radiation necrosis resembles neoplasm
D. Mineralising angiopathy is seen in leukemia
E. Diabetes mellitus can produce multiple white matter hyper
intensiteis
21. Hypoxic ischemic encephalopathy:

A. Hyperintensities are seen in the peritrigonal region
B. The vvatershed area is seen in the perventricular region
C. Atrophy of the posterior corpus callosum
D. In term infants. the gray matter is also affected
E. Ventricular contour is irregular in preterm infants
22. Causes of reversible gray matter degeneration:

A. Dehydration B. Anorexia nerv·osa
C. Steroids D. Hypertension
E. Starvation
23. Multiple sclerosis:

A. Increased association of sinusitis is noted in those with
multiple sclerosis
B. Is the most common cause of demyelination in temperate
countries
C. Posterior fossa involvement is more common in children
D. 85% affect the callasoseptal interface
E. MRI spectroscopy is the most sensitive method for diagnosis
24. Causes of toxic demyelination:

A. Cyclosporine
B. Hydrocarbons
C. Phenytoin
D. Methotrexate
E. Lead
Degenerative and Demyelinating Lesions 153
25. Alcoholism:
A. Marchiafava Bignami disease is degeneration of cerebellum
B. High signal is seen in corpus callosum due to demyelina tion
C. Ophthalmoplegia is a component of the triad in Wernickes
encephalopathy
D. Mamillary bodies are pathognomonically affected in Wernickes
disease-
E. High signal in T2 and enhancement around the III ventricle
II is due to deficiency of thiamine
26. The following are causes for central pontine myelinolysis:

A. SIADH B. Renal failure
i
i
C. Dehydration D. Diabetes
( E. l'vfalnutrition
!
!
27. Central pontine myelinolysis:
A. Pons is affected commonly since it has the greatest white grey
matter apposition
B. The corticospinal tracts are often involved early in the lesion
C. Axons are spared in this disease
D. High signal intensity is seen in diffusion weighted images
E. Apparent diffusio n coefficient is increased in thalamus
28. l'v1esial temporal lobe sclerosis:

A. Most common cause of chronic epilepsy
B. Indicates neuronal death
C. Decreased volume and decre ased signal intensity of
hippocampus in T2\V imaged due to fibrosis.
D. Decreased signal intensity seen in ant erior temporal lobe
cortex
E. Compensatory hyper t rophy of fornix and mamillary body

A. Atleast one of the plaque should be more than 6 mm
B. L ymes disease mimicks multiple sclerosis
C. 70% of ivfS is relapsing remitting
D. Binswangers disease is an acute type of multiple sclerosis
E. Binswangers disease affects long penetrating medullary
arteries

A. Acute MS is called M arburg disease
B. Posterior fossa is involved in 50% of cases
C. 90% ofthose with corpus callosum involvement are symptomatic
D. In Devics disease. the brain and optic nerve are involved
E. The spinal cord is involved in all cases of multiple sclerosis
31. Clinical criteria for MS:

A. Onset less than 50 years
B. Episodes· should last atleast 24 hours
C. Atleast three parts of CNS should be affected
D. Atleast five episodes
E. Predominant white matter involvement

A. Common in females
B. Common in temperate climates
C. Uncommon before 30 years
D. Relapsing progressive is the most common clinical course
E. Periarterial inflammation is the hallmark of acute stage diseaes
33. The following features exclude multiple sclerosis:

A. Bladder involvement
B. CSF abnormality
- C. Totally local disease
D. No eye disease
E. No sensory disease
34. MS:
A. Sparing of subcortical fibers is a characteristic feature
B. \:umber and extent of plaques correlate \Vith the disease
seYerity and durarion
C. Chronic plaques can show contrast enhancement
D. Mass effect excludes MS
E. In pons the dorsolateral aspect affected
35. Differential of MS:

A. Ischemic changes are not seen in infratentorial part of brain
B. Ischemic lesions are larger than the multiple sclerosis plaques
C. ADEM will also show lesions of different ages
D. Vaccination gives rise to similar appearances
E. AIDS
36. Isotopes used in parkinsonism:

A. H MPAO B. 1231 IBZM
C. 1 lC raclopride D. 18F DOPA
E. 1231 FPCIT
3 7. Diseases and the findings in MR spectroscopy:

A. Demyelination-decreased NAA. raised choline
B. HIV-increased NAA, decreased choline
C. Epilepsy-decreased NAA
D. Tumours-decreased NAA, increased lactate
E. Hyperacute rnubple sclerosis-decreased NAA
Degenerative and Oemyelinating Lesions I �·5

A. Dawsons fingers are pathognomic
B. Proton density images are the most sensitive for detection
C. Sagittal images are the most sensitive
D. Contrast enhancement can be seen upto two months
E. The lesions are low signal in p roton density and high signal
in FLAIR images
39. Causes of cerebellar atrophy:

A. Toluene poisoning B. Shy Drager syndrome
C. Phenytoin D. Lung cancer
E. Cytosine arabinoside
40. Causes of diffuse cerebral atrophy:

A. Dehydration B. Malnutrition
C. Anorexia D. Steroids
E. Radiotherapy F. Parkinsonism
41. Causes of selective cerebral atrophy and the locations:

A. Alzheimers-mesial temporal lobe
B. Progressive supranuclear palsy-pons
C. Pick s-frontotemporal
D. Shy Drager-vermis
E. · Huntingtons-putamen
42. Cerebrospinal fluid:

A. The normal volume in a adult male is 50 ml
B. 500 ml is produced in a day
C. 1.0 ml/ min is the rate of production
D. 20% is produced by cerebral parenchyma
E. 20% enter spinal subarachnoid space before entering cerebral
subarachnoid space
43. Common causes of dementia:

A. Normal pressure hydrocephalus
B. Brain tumour
C. Extradural haemorrhage
D. Binswanger disease
E. Neimann Pick disease
44. Neurofibrillary tangles are seen in:

A. Alzheimers disease
B. Hallervorden disease
C. Subacute sclerosing panencephalitis
D. Parl<inson dementia complex
E. Dementia pugilistica
45. Alzheimer's disease:

A. Neurofibrillary tangles are more specific feature of AD than
neuritic plaques
B. There is a direct correlation between the density of neuritic
plaques and severity of dementia
C. The neuritic plaques and neurofibrillary tangles are formed
independent of each other
D. The neurofibrillary tangles are formed secondary to the toxic
effect of beta amyloid
E. There is a direct correlation between the density of the
neurofibrillary tangles and the severity of dementia
46. Alzheimer's disease:

A. Generalised disorder
B. Hippocampus is the earliest affected
C. Changes are bilateral and symmetrical
· D. Spectroscopy shows elevated NAA
E. Spectroscopy can differentiate alzheimers from aging
47. Alzhemier's disease functional imaging:

A. Changes in functional imaging are due to atrophic changes
B. Changes in cerebral blood flow correlate \Vith the cognitive
decline
C. Perfusion defects are seen in parietal lobe
D . FollO\ving donezepil, increased frontal rCBF is seen
E. Increased glucose uptake is seen in PET
48. Dementias frontotemporal:

A. Memory loss is earlier than behavioural, motor and speech
. defects
B. Atrophy is seen in the anteiror and medial parts of temporal
lobe
C. 30% of dementias
D. Thin section volumetric coronal MRI is the best positive
predictive value
E. Structural imaging is essential for excluding psychiatric cause
49. Bilateral high singal in Tl in basal ganglia;

A. Hepatorenal degernation
B. Calcification
C. Haemorrhage
D. Toxic encephalopathy
E. Manganese toxicity
50. Causes of bilater�l low signal in basal ganglia in T2W images:

A. Multi ple sclerosis
B. Parkinsonism
t
i C. Venous infarction
t
D. Leigh disease
I
t
E. Aging
I
51. Reduced frontal perfusion is seen in the following disorders:
'
'
, _
A. Picks diseaes
B. ]CD
C. HIV encephalopathy
D. Alzheimer's
E. Schizophrenia
52. Lewy body dementia:

A. Can be reliably differentiated from Alzheimer's
B. Reduced uptake in cerebellum in PET
C. Increased uptake in frontal lobe in HMPAO SPECT
D. Decreased uptake in visual cortex
E. Second most common cause of dementia
53. Jakob Creutzfeldt disease:

A. Bilateral symmetrical hyperintensity in putamen and caudate
nucleus in 50% of cases
B. Increased uptake in the posterior thalamus indicates -:\\· CJD
C. Myoclonus vvith dementia is a clinical hallmark
D. Contrast enhancement in acute stage
E. There is no white matter involvement
54. Radiological features of lv!S:

A. Symmetrical involvement of cerebral hemispheres
B. Cerebral atrophy is seen in late stages
C. Subependymal location is characteristic
D. The location of lesion always correlates \Vith the s:ymptoms
E. iv1RI has a specificity of 95%
55. Parkinsonism:
A. Diagnosis is based on functional imaging. but not on structural
imaging
B. There is increased uptake of �sotopes binding to dopaminergic
receptors. in the early stage of parkinsonism
C. Parkinsonism is always bilateral
D. The uptake in basal ganglia is compared vvith that of frontal
cortex
E. Increased uptake of D recep ror binding isotopes is also seen
in multisys t em atrophy and progressive supranuclear palsy
56. Movement disorders:

A. Atrophy is seen in pons in progressive supranuclear palsy
B. High signal is within putamen in multisystem atrophy
C. Pontine atrophy is seen in multisystem atrophy
D. Decreased uptake of IBZ� is seen in Huntingtons
E. Functional imaging detects the. Huntingtons disease before
clinical presentation
57. Common complications of ventricular shunt:

A. Subdural effusion
B. Intracerebral haemorrhage
C. Ventriculitis
D. Loculated ascites
E. Intraventricular haemorrhage
58. Epilepsy:
A. Contrast enhanced scan should be done in all patients with
focal seizures
B. tv1RI should be done in all patients with unprovoked seizures
C. In developing countries, 50% of epileptic CT scans will have
pathological abnormalities
D. In chronic epilepsy, the hippocampus is sclerotic and hence
dark in MR images
E. Sagittal images are the best for detecting hippocampal sclerosis
59. Imaging epilepsy:

A. Functional imaging is more sensitive and specific than structural
imaging in those patients in whom surgery is considered
B. Ictal SPECT is less sensitive than PET scanning in detecting
epileptogenic focus
C. Inter ictal SPECT is better than ictal SPECT
D. Increased metabolism is seen in PET SCANS
E. Spectroscopy shows decreased lactate immediately after seizure
60. Causes of chronic epilepsy:

A. Infarct
B. Trauma
C. Dysplastic neuroepithelial tumour
D. Cortical venous thrombosis
E. Cavernous angioma
61. Common causes of aqueductal obstruction:

A. Web B. Chiari malformation
C. Pineal tumour D. Meningioma
E. Achondroplasia
I Degenerative and Demyelinating Lesions 159
', 62. Causes of small ventricles:
i
A. Pseudotumour cerebri
l
B. Diffuse edema
I C. Shunt
I
D. Leptomeningeal disease
E. Bilateral subdural haemorrhage
63. Causes of nodular ventricles:

t
•
B. Subependydoma
c. Heterotopia
D. Metastasis
E. Cysticercosis
64. Increased signal intensity in T2W images are seen in

•
A. Multiple sclerosis
B. Normal sagittal sinus
c. Normal pituitary gland
D. Unenhanced meningiomas
E. Colloid cysts
65. Features in favour of hydrocephalus rather than atrophy:

A. Normal temporal horn
B. Narrowing of ventricular angle
C. Narrowing of frontal horn radius
D. Ventricular enlargment disproportionate to the sulcal
enlargement
E. Intersitial edema
66. Causes of communicating hydrocephalus:

A. Spinal tumours
B. Meningitis
C. Subdural haemorrhage
D. Trauma
E. Carcinomatosis
67. N ormal pressure hydrocephalus:

A. Normal intracranial pressure
B. Normal pressure at lumbar puncture
C. Corpus callosum is flattened
D. Prominent cortical gyri
E. Flow void lost in the aqueduct
68. Featur es of NPH:

A. Dementia B. Incontinence
C. Gait apraxia D. Subarachnoid haemorrhage
\,..;
E. Achondroplasia
69. Congenital hydrocephalus - bad prognostic facto rs:

A. Head circumference > 50 cm
B. Absence of septum pellucidum
C. Cortical thickness > 10 mm
D. Associated anomalies
E. Absent corpus callosum
70. Causes of congenital hydrocephalus:

A. Suoa rachn o id haemorrhage
B. Cerebellar agenesis
C. Vitamin A intoxication
D. Rubella
E. Syphilis
71. Hydrocephalus:
A. In obstructive hydrocephalus. the radionuclide tracer injected
through CSF, willl persist in lateral ventricles for upto 48 hours
B. In communicating hydrocephalus. the tracer has delayed ascent
over the convexities
C. Increased uptake is seen in choroid plexus papilloma
D. The resistnace index is increased in obstructive hydrocephalus
E. Cerebral sulci can be normal in obstructive hydrocephalus
72. Common causes of third ventricular obstruction:

A. Germ!noma
B. Teratoma
C. Cranipharyngioma
E. Hypothalmic glioma
73. I ndica tions for i sotope cisternography:

A. Ventricular shunt
B. Obstructive hydrocephalus
C. Leptomeningeal cyst
D. Tumours
E. CSF otorrhoea
7 4. Causes of ventricular obstruction at the level of foramen of

Monro:
B. Colloid· cyst
C. Septum pellucidum cyst
D. Meningioma
E. Glioma
•
i
! Degenerative and Oemyelinating Lesions 161
7 5. Wilson diseaes:
A. Low signal in thalamus in T2vV im ages
B. High signal in Tl is due to hepatic dys fun ction
C. Globus pallidus shows low signal
D. Severe disease is irreversible
E. Autosomal recessive
76. Neurological complications of IV drug abuse.

A. Epidural abscess
B. Meningitis
C. Subdural haemorrhage
D. Intracranial haemorrhage
E. Infarct
77. Causes of t emporal lobe atrophic disease:

A. Hamartomas
B. Heterotopics
C. Cavernous angiomas
D. Hippocampal sclerosis
E. Picks disease
78. Brain:
A. Vascular dememias are mainly in the periventricular region
B. Binswangers disease is due to arterioscelrosis of penetrating
medullar arteries
C. Binswangers disease is seen in the cortical and subcor�ical
region
D. Picks disease has knife shaped gyri
E. Parkinsons disease has characteristic high signal in T 1 and 12
of basal ganglia
79. Wallerian degeneration:

A. Axons are first affected portion
B. Seen in str oke
C. FLAIR is the most sensiti\·e method for diagnr 1'iing early stage
D. Pyramidal tracts are hyperintense
E. Brainstem is atrophied
80. Amyotrophic lateral sclerosis:

A. Bilaterally symmetrical
B. Peak age is 50-70 years
C. Affects anterior limb of internal capsule
D. vVhite matter of precentral gyrus is affected
E. Lov.;er motor neurons of spinal cord and brain stem are
affected
81. Antineoplastic drugs that produce changes in the brain are:

A. Cyclophosphamide B. Cyclosporin
C. Methotrexate D. Cv1arabine
J
E. 5 fluorouracil
82. Chemotherapy and brain:

A. Radiation is required along with chemotherapy for brain
changes
B. Diffuse necrotising leucoencephalopathy
C. Calcifiration is seen in basal ganglia
D. Subcorrical white matter spared
E. No enhancement on contrast
83. The following are lysosomal storage diseases:

A. Metachrornatic leukodystrophy
B. Adrenoleukodystrophy
C. Neimann Pick disease
- D. Canavan disease
E. Fabry disease
84. Salient features of leukody strophy:

A. Canavan disease- macrocephaly
B. Pelizaeus disease- tigroid pattern of enhancement
C. Metachromatic leukodystrophy-tigroid pattern
D. Adrenoleukodystrophy- gyral abnormality
E. MELAS-migrating infarct
85. Location of leukodystrophies:

A. Alexander disease- parietoocciptal
B. Adrenoleukodystrophy-frontal
C. MELAS-parietooccipital
D. Metachromatic leukodystrophy- no specific location
E. Pelizaeus-frontal
86. Leukodystrophies which show contr ast enhancement:

A. Metachromatic leukodystrophy
B. PMD
C. Alexander
D. Leigh
E. Adrenoleukodystrophy
87. Subcortical fibers are spared in the following dystrophies:

B. Adrenole.ukodystrophy
C. Pelizaeus dissease
D. Alexander disease
E. Zellweger syndrome
88. Metachromatic leukodystrophy:

A. Deficiency of arylsulfatase A
B. Late infantile is the most common type of disease
C. Disease is relapsing and remitting
D. Sparing of subcortical fibers
E. Tigroid a n d leopard pattern indicate sparing of the
perivascular white matter
89. Adrenoleukodystrophy:
A. The corpus callosum genu is affected earliest
B. Demyelination extends cephald from caudal regions
C. The intermediate areas show good contrast enhancement in
MRI
D. The outer most zone is the most active of three zones and
shows intense enhancement
E. The innermost zone shows low signal in Tl and high signal
in T2
F. Autosomal recessive in majority
90. Corticospinal tract is involved i n the following leukodystrophies:

B. Krabbe disease
C. Alexander
D. PMD
E. Adrenoleuko dy str op hy
91. Alexander Disease:

A. Frontal lobe predilection
B. Cysts can be seen in the brain
C. Subcortical fibers are involved early in the disease
D. Enhancement near the tips of the frontal horn
E. Adult form. is indi st ing uishable from mu ltiple sclerosis
92. Pelizaeus Merzbacher disease:

A. Early involvement of subcortical fibers
B. X-linked recessive in all forms
C. Tigroid pattern due to patchy areas of sparing
D. Commonly seen in late infantile stage
E. Early invovlement of internal capsule
93. Hallervorden Spatz disease:

A. Eye of tiger sign is pathognomonic of disease
B. Basal ganglia has a low signal in T2 vV images with high signal
rim
C. D eposit i on of iron in basal ganglia
D. Autosomal recessive disease
E. Iron levels incresed in serum
ANSWERS
1. A-F, B-T. C-F, D-F. E-T
Fe r ric iron and hemosiderin are the common for m s of iron
deposited. Zona reticulosa of substantia nigra has iron. Thalamus
does not normally have iron. Red nucleus acquires iron by 2 years.
Dentate nucleus of cerebellum is another structure which has iron.
- 2. A-T, B-T. C-T, D-F, E-T

Microcystic degeneration. arteriosclerosis and small lacunar
infarcts are other causes.
3. A-F, B-T. C-T, D-F, E-T

\Vhite matter volume is stable after 20 years. unlike gray matter
volume which progressively decreases. Vermian subarachnoid
space increases after 50 years.
4. A-F, B-T, C-F, D-T, E-T

Can be seen in centrum semio\·ale and these are seen around veins.
5. A-T, B-F, C-F. D-T, E-T

Grav matter volume increases onlv till four vears. after \\·hich the
- J J
volu;ne is pruned to 40% of its size. After 20 years the volume

progressi\·ely decreases . \iVhite matter \"Olume increase till 20 years
and is stable between 20-60 vears.
6. A-F. B-T. C-T, D-T, E-T

Inferamedial surface of temporal lobe supplied by PCA.
Inferomedial surface of frontal lobe-ACA.. Posterior limb of
internal capsule, thalamus and tegmentum-posterior choroidal
artery and thalamoperforating A.
Septum pellucidum. genu of corpus callosum, head of caudate
nucleus and anterior limb of internal capsule are supplied by
Huebners recurrent artery.
7. A-F, B-T, C-F, D-T, E-F
8. A-T, B-T, C-T, D-T, E-T
9. A-F, B-F, C-F, D-F, E-F

Earliest changes can be seen from few weeks to 3 months. The
pathology is demyelination and the changes are reversible. Chronic
chan�s take 1-10 years to develop and requires atleast 50 Gy to
cause changes
·
10. A-T, B-T, c -T. C-T, E-T
11. A-T, B-T, C-T, D-T, E-T

The CSF pressure is normal in NPH (Hakim Adam syndrome)
classical triad is gait disturbance. dementia and incontinence.
I Degenerative and Oemyelinating Lesions
12. A-T, B-T, C-T, D-F, E-F

165
Small infarct in the caudate nucleus produces severe cognitive

dysfunction.
13. A-F, B-T, C-T, D-T, E-T

Amyloid is usually deposited around the small vessels. Haemor
rhage is characteristically seen in the cortical and subcortical
regions and in differing ages.
14. A-T, B-T, C-T, D-T, E-F

Superficial siderosis is deposition of hemosiderin the surface of
brain.
15. A-T. B-F, C-T, D-T, E-T

Ventricular size is not a reliable predictor of the severi(y or
progress of dementia. Hyperintense triangular cap is due to loose
myelin in this region, and transependymal leakage of CSF . v\ihite
matter signal changes due to loss of normal water . The changes
are marked in the anterior commissure. corpus callosum and optic
radiation.
16. A-T, B-T, C-F, D-T, E-T

The involvement of cranial nerves is proportional to the presence
of central mvelin. Cranial nerves I and II have central mvelin over
J J
their. entire cisternal course. VIII nerve has central myelin up to

the internal acoustic meatus.
CT is hyperdense and MRI is hypointense.
17. A-T. B-T, C-T, D-F, E-T

Sulcal widening is secondary to cerebral degeneration. Marchiafava
Bignami disease is degeneration of corpus callosum. Mamillary
bodies s ho\v high signal, i n the Wernickes encephalopathy.
Cerebellum also shows degenerative changes with prominent
foliae. Central pontine myelinolysis produces high signal in the
pons.
18. A-F, B-T, C-F, D-T, E-T

Cortical sulci are abnormal if more than 4 mm.
19. A-T, B-F, C-T, D-T, E-T

Ventricular size is not a reliable p redictor of the severity or
progress of dementia. Hyperintense triangular cap is due to loose
myelin in this region. and transependymal leakage of CSF . 'vVhite
matter signal changes due to loss of normal water . The changes
are marked in the anterior commissure. corpus callosum and optic
radiation.
20. A-F, B-T, C-T, D-T, E-T

Huntingtons chorea affects the caudate nucleus and hence can cause
focal dilation of frontal horn of lateral ventricle. Mineralising
angiopathy is characterized by calcification and is seen in leukemic
children treated with chemotherapy and radiotherapy.
21. A-T, B-T, C-T, D-T, E-T

In preterm infants, the lesions are mainly seen in perventricular
white matter, in term infants-cortex. subcortical white matter and
deep gray matter nuclei. children adults- anywhere.
22. A-T. B-T, C-T, D-F, E-T

Alcoholism and chemotherepeutic drugs are other common causes.
23. A-T, B-F, C-T, D-T. E-T

A theory postulated for development of multiple sclerosis is that
the autoimmune process is rriggered by viral infection, probably
b y sinusitis. since there is a high association. There should be
atleast 3 lesions, > 5 mm for diagnosis. Vascular and age related
demyelination are still more common.
24. A-T, B-T, C-F, D-T, E-T

l\1ercury is another vvell known causes.
25. A-F, B-T, C-T, D-T, E-T

J\1archiafava Bignami disease is due to demyelination of corpus
callosum. \'v'hich is seen as low signal in Tl and high signal in T2.
\Nernickes encephalopathy is due to thiamine deficiency and affects
mamillary bodies, perventricular region, medial thalamic nuclei,
III ventricular floor. periaqueductal region. The characteristic triad
is ataxia, confusion, ophthalmoplegia.
26. A-T, B-T, C-T, D-T, E-T

Rapid correction of hyponatremia and alcoholism are common
causes. High risk is seen in cirrhosis, liver transplants, burns and
after surgery for pituitary tumours.
27. A-T, B-F, C-F, D-T, E-T

Although pons is the most common site, it also occurs in caudate
nucleus. basal ganglia and thalamus. The tegmentum, corticospinal
tract and peripheral portions of the pons are usually spared. Axons
are also involved in the disease. High signal intensity is seen in
diffusion weighted images and ADC is increased. The lesion is of
low signal in Tl and high signal in T2 weighted images. (ADC
A pparent diffusion co-efficient)
28. A-F, B-T. C-F, D-F, E-F

Mesial temporal lobe sclerosis is not a cause of chronic epilepsy
but indicates chronic epilepsy. It is an area of neuronal death. due
I
to entry of calcium. which is secondary to activation of NMDA

t receptors due to excitatory aminoacids produced during epilepsy.
The hippocampal volume is decreased but the signal intensity is
high in the mesial temporal lobe and anterior temporal lobe. The
fornix and mamillary body are atrophic
29. A-T, B-T, C-T, D-F, E-T

Majority of the plaques are 3 mm. Atleast one should be more than
6 mm. Binwangers dementia is a type of vascular dementia. due
to involvement of medullary arteries.
30. A-T, B-F, C-T, D-F, E-T

Posterior fossa is involved in 10% of cases. 50-90% of those with
corpus callosum will develop symptoms. In Devics disease, spinal
cord and optic nerve are involved. The brain is not involved. Spinal
cord is involved in all cases of multiple sclerosis which were
autopsied. It may not always be seen in imaging.
31. A-T, B-T, C-F, D-F. E-T

Episodes should last atleast 24 hours and there should be atleast
two episodes within a one month period. Remission should be
present. CNS signs and symptoms seen.
32. A-T, B-T, C-F, D-F, E-F

Common in 20-50 wirh peak at 25-30. Relapsing r emi t t ing is the
most common course followed by relapsing progressive and
chronic progressive. Perivenular inflammati·on. with lymphocyes.
demyelination and reaC(ive astrocytosis is the hallmark of acwe
inflammation.
33. A-F, B-F, C-T, D-T, E-T

Bladder abno rmali ty is seen in MS. CSF shows oligoclonal bands.
No clinical remission excludes MS.
34. A-F, B-T, C-F, D-F, E-F

Subcortical fibers are not spared. O n ly acute pl;.iques shov.;
enhancement and can ha v e mass effect and edrma. In pons the
ventrolateral aspect is typically affected.
35. A-T, B-F, C-F, D-T, E-T

Isc h e m i c changes are in older population. not seen in the
infratentorial portion, are < Smm (MS is usua l l y 5-20 mm). no
contrast enhancement at any stage.
ADEivf and subacute sclerosing panencephalitis produce similar
multiple lesions but t hey will be of same nature and age. In !v1S
the les i o'ns will be of different age and morphol ogy and contrast
enhancement due to the typical relapsing remitting course.
168 Neuroradiology, Head and Ne.ck Radiology
36. A-F, B-T, C-T, D-T, E-T

H!\·1PAO is not very helpful 123 I IBZM binds to dopaminergic
receptors. 18 F DOPA and 11 c raclorpride are PET isotopes. 123
I BCIT and 123 I FPCIT bind to dopamine co-transporters. l 8F
FPCIT is the PET isotope for dopamine transporter binding.
37. A-T, B-F, C-T, D-T, E-F

HIV- decreased NAA. increased choline: Infarct- Low NAA and
high Lactate
Tumours-low NAA. high lactate and choline: Demyelination- Low
NAA. high choline
Multiple sclerosis- Hyperacute stage- No changes. acute-high
choline. subacute and chronic stages- low NAA. Alzheimer·s- low
NAA, high choline and myoinositol
Leukodystrophies- low NAA except Canavans with high NAA
38. A-T, B-F, C-T, D-T, E-F

The lesions are hypo in Tl. hyper in T2, PD. FLAIR. Sagittal FLAIR
is the most sensitive technique. Enhancement indicates active
disease and seen upto 2 months.
39. A-T, B-T. C-T, D-T, E-T

Lung cancer produces cerebellar degeneration and atrophy as a
paraneoplastic syndrome.
Alcohol is still the most common casue. Olivopontocerebellar
atrophy and radiotherapy are other recognised causes.
40. A-T, B-T, C-T, D-T, E-T, F-F

Other causes are congenital infections.HIV, Huntingtons disease,
]CD.trauma, malformations. leukodystrophies. Alzheimer's. Picks,
ischernia. alchohol. chemotherapy.
41. A-T, B-F, C-T, D-T, E-T

PSP- midbrain: ShyDrager- cerebellar hemisphers and vermis.
brainstem
H untingtons- caudate nucleus and putamen. Olivopontocerebellar
atrophy- inferior olivary nucleus. pons. cerebellum
42. A-F, B-T, C-F, D-T, E-T

The normal CSF volume ranges from 50 ml in a neonate to 150
ml in an adult.
43. A-T, B-T, C-F, D-T, E-F

Chronic subdural haemorrhage is a recognised cause. Picks disease
causes dementia but not Neimann pick disease.
44. A-T, B-T, C-T, D-T . E-T

Neurofibrillary tangles which are seen in almost all patients of
Alzheimer's disease is a pair of helical filaments. made up ot

microtubule associated protein called tau protein and seen \.Vithin
the neurons. It is seen in virtually all of the patients with AD.
Parkinson dementia complex and dementia pugilistica. There is
elevation of neurofibrillary tangles in the CSF of all patients with
these conditions.
45. A-F, B-F, C-T, D-T, E-T

The hall marks o f Alzheimer's disease are the presence o f
neurofibrillary tangles and neuritic plaques. Neurofibrillary tangles
are seen within the neurons and are a pair of helical filaments
composed of microtubule associated protein. Neuritic plaques are
seen in the extracellular space and are composed of B amyloid,
reactive astrocytes. microglia and dead neurons. Senile plaques seen
as a part of aging do not contain the neurons or astrocytes. The
neuritic plaques and neurofibrillary tangles can be seen
independent of each other. Neuritic plaques are more specific for
Alzheimers than the tangles. But there is a direct correla tion
between the density of the tangles and the presence and severity
of the dementia. whereas the neuritic plaques do not show this
correlation. Although these t\VO can be formed independently.
studies show that the tangles are produced by the toxic effect of
b amyloid proteins.
46. A-T, B-T, C-T. D-F, E-T

The disease is generalised although the medial temporal lobe.
hippocampus are affected earliest. Spectroscopy shows decreased
NAA and decreased NAA/mvoinositol ralio. which is not seen
.,
in normal aging.
47. A-F, B-T, C-T, D-T, E-F

CT and MR show atrophic changes. Functional imaging sho\vs
perfusion deficits which are more than that could be explained by
atrophy. Perfusion defects are seen in posterior temporal and
parietal lobes and SPECT changes correlate 1.,vell with cognitive
decline. Following treatment, increased global novv· and frontal
blood flow is seen. PET scan sho\.vs decreased glucose uptake.
48. A-F, B-T, C-F, D-T, E-T

tvfotor speech and behavioural changes are earlier than the memory
loss.
10% of dementias. Structural imaging, using CT or MRI is abnormal
in 50% of cases, very useful for differentiation from psychiatric
disorders. Functional imaging vvith rCBF SPECT and FDG PET will
show reduced perfusion in the anterior temporal and frontal
regions.
49. A-T, B-T, C-T, D-F. E-T

Neurofibromatosis is another cause of high signal. Toxic
encephalopathy. hypoxic ischemic encephalopathy. Leigh disease
and venous infarction produces low signal in Tl.
50. A-T. B-T, C-F, D-F, E-T

Hypoxic insults are another cause.
_ 51. A-T. B-T, C-T, D-T, E-T

Also seen in depression.
52. A-F, B-T. C-F, D-T, E-T

Lev..y body dementia is the second common cause. accounting for
20% of cases.
Structural and functional imaging (rCBF)cannot reliably
differentiate this and Alzheimer's. It shows reduced uptake in
cerebellum and visual cortex in Pet and in frontal lobe in HMPAO
SPECT
53. A-F, B-T, C-T, D-F, E-T

CJD is a prion disease. Bilateral symmetrical hyperintensity in
caudate and putamen is seen only in 10% but highly suggestive.
Increased uptake in posterior thalamus is seen in 50% of nvCJD.
No contrast enhancement or white matter involvement is seen.
Rapid progressive dementia, myoclonus and ataxia are charac
teristic clinical features.
54. A-T, B-T. C-T, D-F, E-T

The location of lesion need not correlate with symptoms.
55. A-F, B-T, C-F, D-T, E-F

Diagnosis is clinical. not based on imaging. Parkinsonism can
present as unilateral disease. In parkinsonism there is depletion
of dopamine in the nigrostriatal tract.
In early stages. this is compen. s ated by upregulation of D2
receptors, which can be detected by the isotopes(increased uptake).
which is useful to find which patients will benefit. The increased
uptake is not visible, but compared with the frontal cortex,
yielding the BG: FC ratio. This is increased in the early stages and
decreased later. when all receptors are lost. Even earlier than this,
binding to dopamine transporters can be used for diagnosing.
Parkinson mimics like MSA and PSP, can be differentiated b y
functional imaging. b y their low uptake and low BG: FC ratio.
56. A-F, B-F, C-T, D-T, E-F

Atrophy is seen in midbrain in PSP. Atrophy of cerebellum and
pons. seen in olivopontocerebellar degeneration type of MSA.
High signal is seen in the outer layer of putamen. but low signal
within putamen in MSA. In huntingtons. the functional imaging
is abnormal before the structural changes in caudate nucleus. but
does not preceded clinical changes.
57. A-T. B-T, C-T, D-T, E-T
58. A-F, B-T, C-T, D-F, E-F

Contrast enhanced images are not mandatory in focal seizures.
Due to high prevalence of tuberculosis and cysticercosis in deve
loping nations. there is high incidence of abnormalities in scans.
In chronic epilepsy, hippocampal sclerosis may be seen and it is
characterised by volume loss in hippocampus which will be brighter
than normal.
Coronal images are the optimal plane for assessing hippocampal
sclerosis.
59. A.-F, B-F, C-F, D-T, E-F

Structural MRJ is very useful in predicting lesions that can be cured
by surgery. If it is negative. then surgery won't be helpful. If
functional imaging is positive after structural MRI is negative. it
is not specific and should be confirmed by deep electrode recordings.
PET sho\l.:s increased metabolism during and after seizure. SPECT
will show increased perfusion immediately after seizure. Bu t the
contrast should be injected during seizure. for SPECT to be sensiti\·e.
Interictal injection is not as sensitive as ictal SPECT or PET.
Spectroscopy shows reduced NAA and elevated lactate
immediately after seizure.
60. A-T, B-T. C-T, D-F, E-T

Hippocampal sclerosis, A V1vfs. heterotopia and cortical dysplasias
are other common causes of chronic epilepsy.
61. A-T. B-T, C-T, D-T, E-F

Tentorial meningioma is a recognised cause. tv!idbrain tumours.
infection and haemorrhage are other causes.
62. A-T. B-T, C-T, D-F, E-T
63. A-T, B-T, C-T, D-T, E-F
64. A-T, B-F, C-T, D-F, E-T

High signal is seen in posterior pituitary. Normal sagittal sinus
has no signal.
65. A-F, B-T, C-F, D-T, E-T

Temporal horn is dilated in hydrocephalus. Ventricular angle is
between the anterior and superior margins of frontal horns at level
of monro foramen. The fronral horn radius is the widest diameter

of frontal horns taken at 90 degrees to its long axis.
66. A-T, B-T. C-T. D-T, E-T

Subarachnoid haemorrhage is the most common cause. Previously
communicating hydrocephalus was called as non-obstructive
hydrocephalus. Now it is referred as extraventricular obstructive
hydrocephalus. Achondroplasia. Hurlers syndrome. Morquios
syndrome, hemosiderosis and congenital absence of Pacchionion
g r a nulations are other recognised causes of communicating
hydroceph1tlus.
67. A-F, B-T. C-F, D-F, E-F

In NPH. the imracranial pressure is high. but the lumbar puncture
CSF pressure is normal. Corpus callosurn is arched superiorly and
cotical gyri are flattened. Flow void is exaggerated i n the
aqueduct. Periventricular hyperintensity and ventricular dilatation
.are seen.
68. A-T. B-T, C-T. D-T. E-T

NPH. also called as Hakim Adan syndrome is characterised by
the clinical triad of dementia. incontinence and gait apraxia.
69. A-T, B-F, C-F, D-T, E-F

Absence of cortex, conical thickness less than 10 mm and midline
shift are other bad prognostic features.
70. A-T, B-T, C-T, D-T, E-T

Dandy \Valker malformation. Hurlers, VOGM, achondroplasia,
aqueductal stenosis. Congenital atresia of foramen, spina bifida.
communicating hydrucephalus. TORCH infections are other causes.
Choroid plexus papilloma is a recognised cause.
71. A-F, B-T. C-T, D-T, E-F

In obstructive hydrocephalus. the tracer will not reach the lateral
ventricle. In communicating hydrocephalus. the tracer will reach
the lateral ventricle, but there will be delay in ascending the
convexities( since the obstruction is at the site of absorption ) and
persistence of isotope in the ventricles for upto 48 hours. Cerebral
sulci are flattened in obstructive and normal or slighly flattened
in communicating hydrocephalus.
72. A-T, B-T, C-T, D-T, E-T
73. A-T, B-F, C-T, D-F, E-T

Also useful in CSF rhino,rrhoea. normal pressure hydrocephalus.
porencephy and posterior forssa cyst.
74. A-T, B-T. C-T, D-T, E-T

Tuberous sclerosis can produce a subependymal giant cell
astrocytoma which is a recognised cause of foramen of Monro
obstruction.
75. A-T, B-T, C-F, D-F, E-T

Low signal is seen inthe ventroposterior nucleus of thalamus.
Globus pallidus is hyperintense due to hepatic dysfunction. Even
severe disease is reversible with aggressive therapy. Affects basal
ganglia. thalamus, dentate nucleus of cerebellum.· posterior limb
of internal capsule, cerebral hemispheres. corticospinal tract.
dentarubrothalamic tract, pontocerebellar tract and ventro
posterior thalamic nucleus.
76. A-T, B-T, C-F, D-T, E-T

Cord compression is another common pathology due to vertebral
collapse secondary to infection.
77. A-T, B-T. C-T, D-T, E-F

Alzheimer's dementia is the most common cause of temporal lobe
atrophy. Hippocampal sclerosis causes chronic intractable epilepsy
and is characterised by atrophy of temporal lobe and high signal
in dentate gyri and Ammons horn.
78. A-F, B-T, C-F, D-T, E-F

Vasular dementias are seen in the cortical and subcortical region.
Binswangers disease is similar to multiinfarct dementia. but is
localized to the periventricular region. Parkinson·s disease has low
signal due to iron deposition.
79. A-F, B-T, C-F, D-T, E-T

Cell bodies are the main affected portion and it then extends into
the axons. Seen in stroke and trauma. Magnetisation Transfer
Imaging is the most sensi tive imaging method for diagnosing
vVallerian degeneration. Pyramidal tracts are hypPrintcnse for t\\"O
weeks.
The sequence of pathological events is acute demyclination. edema
and fibrosis.
80. A-T, B-T, C-F, D-T, E-T

Otherwise known as motor neuron disease. Hyperintense in 12.
predominantly in posterior limb of internal capsule. cerebral
peduncle and white matter of precentral gyrus. Upper motor
neurons in cerebral cortex and lower mocor neurons in spinal cord
and brainstem are affected.
17 4 Neuroradiology, Head and Neck Radiology
81. A-F, B-T, C-T, D-T, E-T

Levamisole is another cause.
82. A-F, B-T, C-T, D-F, E-F

C hemotherapy in itself will cause changes in brain. The
pathological changes are demyelination, coagulation necrosis.
gliosis in periventricular region and centrum semiovale. Diffuse
necrotising leukoencephalopathy and mineralising angiopathy are
the pathological chances. Calcification is seen_in basal ganglia and
subcortical fiberes.
Minimal t•nhancement is seen in contrast administration.
83. A-T, B-F, C-T, D-F, E-T

Adrenoleukodystrophy is a peroxisomal disease. Abetalipopro
teinemia, Zellweger disease,adrenoleukodystrophy. neonatal ALD.
and Refsum disease are other peroxisomal diseases. Canavan
disease is a disorder of amino acid and organic acid metabolism.
Krabbe disease, gangliosidosis. fucosidosis, mucolipoidosis and
mucopolysaccharidosis are other common diseases of lysosomal
storage. Leigh disease. MERRF syndrome and MELAS syndrome
are mitochondrial diseases. Alexander disease. Pelizaeus
J'v1erzbacher disease and congenital muscular dystrophy are
diseases with no definite causes.
84. A-T, B-T, C-T, D-F, E-T

Gyral abnormality is seen in Zellwager syndrome
85. A-F, B-F, C-T, D-T, E-F

Adrenoleukodystrophy and MELAS have characteristic
parietooccipital dis�ribution.
Alexander disease is characteristically in the frontal region.
86. A-T, B-F, C-T, D-T, E-T
87. A-F, B-F, C-F, D-F, E-T

Usually in metachromatic dystrophy. subcortical f ibers are not
involved. but in later stages. the whole brain is involved.
88. A-T, B-T, C-F, D-T, E-T

There are three forms of the disease, late infantile. juvenile and
adult.
· Late infantile is the most common. beginning at 12-18 months and
the patient dies within 6 months to four years. The disease is
characterised by bilaterally symmetrical periventricular white
matter hyperintensities. due to dysmyelination, with sparing of
cortical fibers. A tigroid or leopard pattern is seen. due to small
spots or linear bands through this high signal dysmyelination, due
to sparing of peri vascular white matter. No contrast enhancement
89. A-F, B-T, C-T, D-F, E-T, F-F

The common type of adrenoleukodystrophy is X-linked and is due
to deficiency o f acyl Coa synthase. The subtype neonatal
adrenoleukodystrophy is autosom al recessive and is due to
deficiency of multiple enzymes. The disease affects brain, adrenal
glands and testis. The peritrigonal white matter and corpus
callosum splenium are affected earliest and the disease then
spreads anteriorly, with eventual involvement of all white matter,
without sparing the subcortical fibers.
There are three zones of the disease.
Tl T2 Enhancement
Inner gliosis low high no
Intermediate active inflammation low iso/hypo yes
Outer leading dysmyelination low high no
90. A-T, B-T, C-F. D-T, E-T
91. A-T, B-T, C-T, D-T, E-T

There are three subgroups. �lost common is infantile
macrocephaly. Death in 2-3 years
Juvenile-7-14 years- bulbar sympmms. spasticitiy. Adults-2nd-7th
decade- similar to multiole sclerosis.
92. A-T, B-F, C-T, D-T, E -T

Caused due to deficiency of myelin specific proteolipid protein.
Two subtypes- Classical- X recessive-late infantile.
Connatal AR or XR -birth. infancy.
Bilateral diffuse hyperintensities in the \vhite matter. involving
subcortical fibers and internal capsule without any contrast
enhancement. Tigroid pattern due to perivascular sparing.
93. A-T, B-F. C-T, D-T, E-T

This is an iron deposition disease of basal ganglia vvirh normal
serum iron. transferrin and ferritin. Globus pallidu5 shO\VS the
typical eye of tiger appearance, \\'hich is high sign<1I in center and
low signal in periphery. Affects substantia nigra. zona reticularis
layer. Associated with defective chromosome 20. presents before
20 years with choreoathetosis. dysarthria.seizures.corticopinal tract
involvement. optic neuritis and retinitis pigmentosa. Relentlessly
progressive and fatal.
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1. Cleft lip:
A. Common in the midline
B. Midline cleft is due to failure of development of frontonasal
process
C. The common cleft is due to failure of fusion of frontonasal
process and maxillary process
D. Cleft lower lip is associated \".'ith cleft tongue and mandible
E. Cleft upper lip extends up to the orbit
2. The following structures develop from the frontonasal process:

A. r'\asal septum
B. Lower lip
C. Pre-maxilla
D. Nostril
E. Upper lip
3. The pharyngeal arches and their nerves:

A. First -Facial
B. Second-Trigeminal
C. Third- glossopharyngeal
D. Fourth- vagus
E. Sixth- Cranial accessory N.
4. Tongue:
A. The tongue is derived from first and third pharyngeal arches
only
B. All muscles of tongue are innervated by hypoglossal nerve
C. The circumvallate papilla is the boundary between the portions
of tongue derived from the first and fourth pharyngeal arch
D. The most posterior aspect of the tongue is innervated by vagus
nerve
E. The anterior two thirds of the tongue receives taste fibres from
facial nerve branches
Head and Neck-1 177
5. T hyro i d:
A. The thyroid development begins from the tongue
B. Lingual thyroid corresponds to the position of foramen
caecum
C. The pyramidal lobe is usually seen on the right side
D. The thyroglossal duct_ runs separately from the hyoid
bone
i -
!I E. The thyroid reaches the definitive adult position in the neck
by 18 weeks
6. The following are contents of Parapharyngeal space:

A. Mandibular nerve branches
B. Maxillary artery
C. Pharyngeal venous plexus
D. Ascending pharyngeal artery
E. Lymph nodes
7. Carotid space contents:

A. Glossopharyngeal nerve
B. Sympathetic nerves
C. Lymph nodes
D. External and internal jugular veins
E. Internal carotid artery
8. Contents of pharyngeal mucosal space:

A. Pharyngobasilar fascia
B. Ascending pharyngeal art ery
C. Pharyngeal venous plexus
D. Pharyngobasilar fascia
E. Pharyngeal constrictors
9. F oramen magnum transmits the following structures:

A. Cerebellar tonsils
B. N1eningeal artery
C. Cranial accessory nerve
D. Spinal artery
E. Meningeal vein
10. Contents of pterygopalatine fossa:

A. Ganglion
B. Lymph nodes
C. Maxillary artery third portion
D. Sphenopalatine artery
E. Greater palatine nerve
11. Face:
A. Zygoma forms the lateral portion o f inferior orbital rim
B. All the skull and facial bones are united by synchondrosis
C. The facial bones are joined inferiorly by the hard palate
D. There are three groups of srruts supporting the face
E. The mid-face extends from the i nfraorbital ridge to the
maxillary alveolus
12. Head and neck:

A. The infratemporal fo ssa communicates with the pterygopalatine
fossa through the pterygomaxillary fissure
B. The infratemporal fossa is siruated behind the maxilla
C. The inf1 atemporal fossa has the maxillary artery and maxillary
nerve
D. The pterygopalatine fossa communicates with the nasal cavity
through the ·sphenopalatine foramen
E. There is no communication between the pterygopalatine fossa
and orbit
13. The following are contents of retropharyngeal space:

A. Lymph nodes
B. Fat
C. Glossopharyngeal nerve
D. Posterior cervical veins
E. Ascending pharyngeal artery
14. !\.1andible:
A. �·1ental foramen opens on the inner aspect and the mandibular
foramen opens on the outer aspect of the mandible
B. The inferior alveolar nerve is transmitted through the
mandibular foramen
C. Arthrography is the ideal method for investigating TM joint
D. The muscles of tongue originate from the inner surface of the
mandible
E. Mandible is the second strongest facial bone after alveolar
process of maxilla
15. Teeth:
A. There are 24 decidious teeth
B. The canines are the first deciduous teeth formed
C. The first molar tooth is the first permanent tooth formed at
6 years
D. The second molars are formed at 8 vears J
E. The third molars are formed at 18 vears

J
Head and Neck-1 179
16. Nose:
A. There are 20 small foramina in the ciribriform plate
B. The ciribriform plate transmits only the olfactory nerve fibers
C. The sphenopalatine foramen is seen behind the superior meatus
D. Septal deviation is seen in 25% of cases
E. Hiatus semilunaris is seen in the superior meatus
17. Sinuses and their drainage:

A'. Posterior ethmoidal- superior meatus
B. Sphenoidal- superior meatus
C. Frontal- inferior
D. Anterior ethmoidal-inferior
E. Maxillary- middle
18. Nasal cavity and paranasal sinuses:

A. The Littles areas is seen in the posteroinferior aspect of the
nasal septum
B. The Littles area shows an anastomosis between a n terior
ethmoidal artery and sphenopalatine artery
C. The nasal cycle happens every three hours
D. Erectile cavernous tissue is seen in the middle and inferior
conchae
E. Littles area is the most common site of epistaxis
19. Osteomeatal complex consists of:

A. Hiatus semilunaris
B. Bulla ethmoidalis
C. Frontal recess
D. Maxillary sinus ostium
E. Ethmoid infundibulum
20. Paranasal sin u ses :

A. Maxillary sinus hypoplasia is seen in 20% of population
B. Roots of molar and premolar teeth directly can project into
the maxillary sinus \.vithout any co,.:ering
C. The hiatus semilunaris is seen belovv· the ethmoidal bulla
D. The maxillary ostium opens into the ethmoidal infundibulum
E. Accessory ostia are seen in coronal CT scans
21. Masticator space contents:

A. Inferior alveolar nerve
B. Medial pterygoid
C. Lateral pterygoid
D. Buccinator
E. Temporalis
22. Parotid space contents:

A. Facial nerve B. Lymph nodes
C. Internal carotid artery D. iv1axillary artery
E. I m ernal jugular vein
23. Normal contents of the prevertebral space:

A. Vertebral artery B. Phrenic nerve
C. Brachial plexus D. Prevertebral muscles
E. Trapezius
24. Paranasal sinuses:

A. Concha bullosa is seen in 12% of individuals
B. Haller cells are the most anterior ethmoidal cells
C. ..l.gger nasi cells are situated in the floor of the orbit
D. The largest middle ethmoidal cells are seen in the ethmoidal
bulla
E. Agger nasi is close to the distal medial aspect of lacrimal sac
and duct
25. Tongue and oral cavity:

A. The palawpharyngeus marks the boundary bet\\·een the oral
ca\·ity and pharynx
B. The tongue has midline fibrofany septum seen in t--1RI
C. The genioglossus is the largest intrinsic muscle in the tongue
D. The lingual artery is seen lateral to the hypoglossus
E. Lymphoid follicles in the posterior surface of tongue are
abnormal
26. Parotid gland:

A. The parotid gland is divided into superficial and deep portions
by the facial nerve
B. The facial nerve is identified in Tl W MR images
C. Accessory parotid gland is seen in 20% of cases
D. The density of p arotid gland is equal to that of muscle in
children
E. The parotid gland has signal intensity of fat
27. Pharynx:
A. The pharynx has six groups of muscles
B. The muscle coat of pharynx is a continuous layer from the skull
to the esophagus
C. The pharyngobasilar fascia is a continuous sheath which forms
the superior po:-tion of the pharynx
D. The sinus of Morgagni i s the site of origin of 50% of
nasopharyngeal carcinomas
E. The fossa of Rosenmuller is superior to the torus tubarius in
the Coronal CT and MR images
Head and Neck-1 181
28. Pharynx:
A. Adenoids obliterate the fossa of Rosenmuller in young patients
B. The tonsils are hyperintense in Tl and T2
C. The Kilia n s dehiscence is a defect in between the
thyropharyngeus and cricopharyngeus
D. Posterior indentation in laryngopharynx. at C5/6 is due to
normal venous plexus
E. The epiglottis is the boundary between oropharynx and
· laryngopharynx
29. Fascia of the neck:

A. All the muscles of the neck are deep to the investing layer of
deep fascia
B. The carotid sheath is derived from all the three layers of deep
fascia
C. The visceral layer encloses the thyroid cartilage
D. The prevertebral fascia extends to superior medastinum
E. The parotid gland is surrounded by the investing layer of deep
fascia
30. Ear:
A. The scutum is the lateral border of epitympanum
B. The scutum is the superior portion of the tympanic r1ng
C. Epitympanum is the portion of middle ear that is in front of
the plane of anterior \Vall of external auditory canal
D. Protympanum is the portion of middle ear that is above the
tympanic membrane
E. Mesotympanum is at the level of tympanic membrance
31. Paranasal sinuses:

A. Sphenoid sinus is present at birth
B. The frontal sinus is seen at birth
C. The maxillary sinus is seen only at 718 years
D. The frontal sinus septum can be seen on one side
E. Persistent metopic suture results in developmt�nt of sinus on
one side of the suture
32. Larynx :
A. The cricoarytenoid joint is a fibrous joint
B. The false cords lie below the level of true cords
C. The epiglottis arises from the hyoid
D. The laryngeal sinus is situated above the level of the false
cords
E. The paraglottic soft tissues are the only soft tissue structures
seen within the cricoid ring
33. Thyroid:
A. The left lobe is larger than the right lobe
B. The right lobe is more vascular than the left lobe
C. The left lobe is more involved in diffuse processes
D. The calcitonin is secreted by follicular cells
E. Foramen caecum is the only remnant of thyroglossal duct in
normal people
34. The thyroid receives blood supply from the following arteries:
A. External carotid artery
B. Brachiocephalic artery
C. Subclavian artery
D. Costocervical trunk
E. Aorta
35. Lymph nodes of neck:

A. Juguloomohyoid drains the tonsils
B. Jugulodigastric drains the tongue
C. Jugulodigastric nodes are enlarged if more than 1.2 cm
D. Submandibular nodes are enlarged if more than 1.cm
E. Lymph nodes from the right side of the neck drains in the
thoracic duct
36. Salivary glands:

A. The CT density of submandibular gland is higher than that of
parotid
B. Active secretion of iodine is seen in submandibular gland
C. The parotid and submandibular glands are separated by
stylomandibular ligament
D. The sublinguc.I glands drain into the sublingual papilla
E. The sublingual glands drain into the submandibular duct
37. Neck nodes:

A. Group 1-nodes are in the submental and submandibular
region
B. Group 6-posterior triangle
C. Group 5-jugular nodes above the level of hyoid bone
D. Group 7-superior mediastinal nodes
E. Group 8-pr evertebral
38. Brachia! plexus:

A. There are five anterior rami and five nerves
B. The second thoracic root contributes to brachia! plexus
C. The terminal branches are formed in behind the clavicle
D. The divisions lie behind the scalenus anterior
E. The cords surround the axillary artery
Head and Neck-1 183
39. Ear:
A. The lateral two-thirds of external ear is c artilagn eous
B. The tympanic membrane is oriented perpendicular to the floor
of the external auditory meatus
C. The pars tensa is the upper part of the tympanic membrane
D. The pars flaccida has no fibrous layer
E. The pars tensa has three layers
40. Contents of the cerebellopontine cistern:

A. Petrosal vein
B. V nerve
C. Anterior inferior cerebellar artery
D. Posterior inferior cerebellar artery
E. Labyrinthine vein
41. The following are c ontents of the Jugular foramen:

A. Superior petrosal sinus
B. Pars nervosa has inferior petrosal sinus
C. Jugular b ulb
D. Cranial accessory
E. The anteromedial parsvascularis is the smaller
42. Base of skull:

A. The right jugular foramen is larger than the left one
B. The j ugular foramen lies anterior to the mesotympanum
C. In dehiscent jugular bulb, the jugular bulb is inside the middle
cranial fossa
D. Laterally placed aberrant carotid artery can be mistaken for
a j ugul ar mass
E. The left lateral sinus is larger than the right one
43. Middle ear:

A. The stapedius and tensor tympani are supplied by facial nerve
B. The pyramidal eminence is seen in the anterior wall of middle
ear
C. Tensor tympani inserts into incus
D. Stapedius originates from pyr amidal emine nce
E. Th e aditus connects the middle ear to the inner ear
44. Middle ear:

A. The mastoid antrum is symmetrical on both sides
B. Prussaks space is between the pars flaccida and neck of malleus
C. Incudomalleolar articulation is seen in the mesotympanum
D. Head of malleus is seen in epitympanic recess
E. The lateral process of malleus is attached to the tympanic
membrane
. .
45. Inner ear:

A. The cochlea is anterior to the vestibule in the bony labyrinth
B. The spiral lamina is seen in high resolution CT scans
C. The apex of the organ of corti points· anterolaterally
D. There are five openings for the semicircular canals into the
vestibule
E. Both the anterior and posterior semicircular canals are in the
vertical plane
46. Inner ear:

A. The anterior and posterior semicircular canals share a common
opening into the vestibule
B. The semicircular canals are at ninety degrees to each other
C. The anterior semicircular canal is perpendicular to the long axis
of the pterous
D. The posterior semicircular canal is seen underneath the arcuate
eminence
E. Anterior s emicircular canal is the most common site for
labyrinthine fistula
47. Middle ear:

A. The tegmen tympani separates the middle ear from middle
cranial fossa
B. The promontory overlies the lateral semicircular canal
C. The o\·al v\·indO\v is above the promontory
D. The facial nerve passes in the anterior part of the medial \Vall
of middle ear
E. The canal for tensor tympani is above the canal for Eustachian
tube, in the anterior wall of mesotympanum
48. Carotid arteries:

A. The external carotid artery has 12 branches
B. The external carotid artery is anteromedial to internal carotid
artery
C. Ascending pharyngeal artery and occipital branches are the
terminal branches of external carotid artery
D. A common linguofacial trunk is seen in 20%
E. Facial artery supplies the submandibular gland
49. Ear:
A. Inner ear develops at three weeks
B. Inner ear reaches adult proportions by 5th year
°
C. The bony labyrinth is the first part of cranium to ossify
D. The external ear develops at eight weeks
E. The middle ear is developed from otic capsule along with the
inner ear
Head and Neck-1 185
50. Arteries in neck:

A. The posterior auricular artery is consistently seen in
angiography
B. The maxillary artery is divided into three portions by medial
pterygoid muscle
C. Middle meningeal artery arises from the second portion of
maxillary artery
D. Vertebral artery passes through the foramen transversarium
of C2-6
E. Maxillary artery has 15 branches
51. Inner ear.

A. The semicircular ducts open into the saccule
B. The utricle lies anteriorly within the vestibule
C. Saccule and utricle are resolved as separate structures in MRI
D. The membranous labyrinth is of high signal due to the peri
and endolymph
E. The cochlear duct has endolymph
52. Doppler of neck arteries:

A. The internal carotid does not show systolic velocity more than
10 cm/sec
B. External carotid artery shows high resistance flow patte:-n
C. Common carotid artery shows \Vaveform of external carotid
artery
D. Reversal of flow during diastole is seen in external carotid
artery
E. Vertebral artery cannot be assessed by Doppler
53. Pneumatisation can be seen in the following structures:

A. Pterygoid process
B. Greater wing of sphenoid
C. Body of sphenoid
D. Lesser w ing of sphenoid
E. Posterior clinoid process
54. In dental panoramic radiography:

A. One third of films are usually diagnostically unacceptable
B. Lucency s e e n under the i nferior premolar a n d molar is
abnormal
C. Lucency over mandibular angle is always abnormal
D. Midline sclerosis in mandible may be due superimposition of
cervical spine
E. Impaction almost always affects the third molar
55. Anatomy of teeth:

A. Enamel is formed from odontoblasts
B. Dentine is laid from ameloblasts
C. The root is covered by cementum
D. The lamina dura is seen in X-rays as a lucent line
E. Supernumery teeth are common in incisor region
56. Common causes of radioopaque lesions in jaw:

A. Bone island
B. Torus mandibularis
C. Hypercementoma
D. Osteoradionecrosis
E. Cementoma
57. Middle ear:

A. Foot plate of stapes attached to the round window
B. Incudostapedial joint is a synovial joint
C. The short limb of incus is parallel to the manubrium of malleus
D. The incus is anterior to malleus
E. The short limb articulates with the stapes
58. Causes of mixed radioopaque and lucent lesions in jaw:

A. Cementoma
B. Chronic osteomyelitis
C. Compound composite odomome
D. Fibrous dysplasia
E. Ossifying fibroma
59. Causes of multilocular cystic lesions in jaws:

A. Giant cell tumour
B. Brown tumour
C. Pagets disease(Early stages)
D. Ameloblastoma
E. Dental cyst
60. Causes of radiolucent lesions in mandible:

A. Nasopalatine cyst
B. Stafne bone cavity
C. Ewings
D. Osteosarcoma
E. Alveolar abscess
61. Ameloblastomas:
A. It is n ot a true neoplasm
B. This lesion is of dentine origin
C. Anatomically benign tumour
D. Common in females
E. Resorption of tooth root is a feature
Head and Neck-1 187
62. Ameloblastomas:
A. It is most common in the incisor area
B. Seen in the first decade of life
C. Follicular type is multilocular
D. Plexiform type is common in the maxilla
E. 80% of ameloblastomas occur in the mandible
63. Dentigerous cysts:

A. Most common odongogenic cyst
B. Associated with unerupted crown
C. Most common site is the 3rd molar region of maxilla
D. Lined by columnar epithelium
E. Resorption of adjacent teeth is very common
64. Dentigerous cyst:

A. Always unilocular
B. Arises due to degeneration of enamel organ
C. 40% of radiographically detected dentigernous cysts are
odontogenic keratocysts
D. Small cysts can be completely sclerotic
E. Periosteal reaction is seen in upto 30% of individuals
65. Nasopalatine cyst:

A. Seen between the central and lateral incisors
B. Nlost common developmental non-dental cyst
C. The nasopalatine canal is enlarged and measures more than
10 mm
D. Seen between nasal fossa and incisive foramen
E. It is the same as median palatine cyst
66. Cysts of jaw:

A. Globulomaxillary cyst is seen between the lateral incisor of
maxilla and canine teeth
B. Globulomaxilary cyst is at site of fusion of medial and lateral
nasal processes
C. Giant cell reparative granuloma crosses the midline
D. The root tips of adjacent teeth are resorbed in giant cell
granuloma
E. Anterior mandible is the location of giant cell reparative
granuloma
67. Jaw lesions without cortical perforation:

A. Histiocytosis X
B. Dental cyst
C. Hemangioma
D. Hyperparathyroidism
E. Odontogenic keratocyst
68. Dental cyst:

A. Inflammatory origin
B. Starts as widening of periodontal membrane
C. Most common in the anterior maxillary region
D. Irregular margin indicates infection
E. Always associated with non-vital tooth
_ 69. Dental cysts:

A. Do not cause resorption of teeth
B. Lesions less than one cm are called granulomas not cysts
C. Large tumours can enter maxillary sinus
D. Increaspd uptake is seen around the cyst
E. The cyst is usually lined by keratinized squamous epithelium
70. Ameloblastomas:
A. Can arise from wall of dental cysts
B. Expansion is seen in the buccal surface and not in the lingual
side
C. 40% associated with impacted tooth
D. The teeth roots extend into the lesion
E. The CT density of the lesion is similar to that of gingival
epithelium
71. Odontomas:
A. Compound odontomas are associated \vith Gardners syndrome
B. Odontoma is the most common odontogenic neoplasm of ja\v
C. Odontoma is abnormal grO\vth of enamel tissue
D. Complex odontomas are seen in molar region
E. Small fully formed teeth are seen in com.plex odontomas
72. Jaw lesion:

A. Cementoblastomas arise from periodontal membrane
B. Osteochondroma is the most common osseus tumour of the
jaw
C. Torus palatinus is seen in the anterior aspect of midline of hard
palate
D. Torus mandibularis is seen bilaterally
E. Torus mandibularis is seen at the level of molars
73. Jaw tumours:

A. Sunburst periosteal reaction is seen in 75% of osteosarcomas
of jaw
B. Osteosarcomas can be associated with localized supereruption
of tooth
C. There i s no tooth resorption in osteosarcoma
D. Fibrous dysplasia is more common in the mandible
E. Thick trabeculae is characteristic of fibrous dysplasia
Head and Neck-1 189
74. Osteomyelitis of jaw:

A. Staphylococcus is the most common organism
B. Tonsillitis is a predisposing condition of osteomyelits
C. The lamina dura is intact in osteomyelitis
D. Involucrum and sequestrum are not seen in osteomyelitis of
jaw
E. Onion peel periosteal reaction is seen in Garres sclerosing
osteomyelits
I
75. Odontogenic keratocyst:
A. Known for its recurrence
B. Associated with Gardners syndrome
I
C. Associated with Carlin syndrome
D. Associated with missing 3rd lower molar
l E. Most common location is posterior part of mandible
76. Odontogenic keratocysts:

A. Arises from dental lamina remants
B. Grows in anteroposterior direction
C. Unilocular lesion associated with tooth
D. Gross expansion of the mandible is a typical feature
E. CT scan shows values of a simple cyst
77. Co mmon causes of poorly circumscribed cystic lesions in the jaw:

A. Osteomyelitis
B. Dentigerous cyst
C. Metastasis
D. Acute osteomyelits
E. Actinomycosis
78. Wh en compared with long bone osteosarcoma, osteosarcoma of

jaw:
A. Has \Norse prognosis
B. Low grade
C. Less hematogenous metastasis
D. Same age group
E. Rapid growth
79. Jaw lesions:

A. Dental extraction in a patient with open tuberculosis produces
tuberculosis of jaw
B. Caffeys disease affects mandible more common than maxilla
C. Stafne bone cavity is seen below the inferior dental canal
D. Aneurysmal bone cyst in the jaws have more bone destruction
and soft tissue component than the long bone lesions
E. Burkitts lymphoma produces extensive bone destruction
80. Osteosarcoma of jaw:

A. Widened periodontal ligament
B. Localized supereruption of teeth
C. Sclerotic type is more common than lytic
D. Bone formation above alveolar crest
E. No resorption of bone
- 81. Causes of enlarged muscles in the orbit:

A. Hypothyroidism
B. Lymphoma
C. Acrornegaly
D. Carotid cavernous fistula
E. Optic nerve glioma
82. Colour Doppler is used in the following situations in orbit:

A. Central retinal artery occlusion
B. Carotid cavernous fistula
C. Malignant melanoma
D. Extraconal lesions
E. Severe m yopia
83. Orbit:
A. Ultrasound is the best modality for e\·aluation of eyeball
B. Colour Doppler is the most useful modality for evaluation of
Graves opthalmopathy
C. Caroticocavernous fistula is the main indication for orbital
arteriography
D. Orbit is supplied by branches from internal carotid artery and
external carotid artery
E. Dacryocystography is done by instilling contrast into the
inferior canaliculus
84. Causes of concentrically enlarged optic foramen:

A. Sarcoidosis
B. Pseudotumour
C. Raised intracranial pressure
D. Neurofibroma
E. Retinoblastoma
85. Causes of focal narrowing of optic foramen:

A. Ethmoidal carcinoma
B. Mucocele
C. Meningioma
D. Opthalmic artery aneurysm
E. Orbital varix
Head and Neck-1 191
86. Common causes of orbital calcification:

A. Dermoid
B. Lacrimal gland malignancy
C. Hemangioma
D. Cataract
E. Neurofibroma
87. Bare orbit is seen in:

B. Lymphoma
C. Metastasis
D. Meningoma
E. Optic ne rve glioma
88. Enlarged orbit is a feature of:

A. Lymphoma
B. Metastasis
C. Orbital cellulitis
D. Glaucoma
E. Neurofibromatosis
89. The following are common extraconal lesions:

A. Rhabdomyosarcoma B. Cellulitis
C. Teratoma D. Metastasis
E. Lymphoma
90. Ult rasound or o rbit :

A. Probe is placed over conjuctiva
B. Local anaesthetic is not required
C. 10 MHZ is the best frequency for evaluation of orbit
D. A mode is very useful in orbital lesions.
E. 8 MHz is used for evaluation of eyeball
91. The fa llowing lesions occur in the orbital wall:

A. Sphenoidal mucocele B. Histiocytosis
C. Metastasis D. Hemangioma
E. Neurofibroma
92. Uveal melanoma

A. Constitutes 70% of ocular malignancies
B. There is an association with neurofibromatosis
C. Choroidal excavation is a typical finding in ultrasound of orbit
D. Lung cancer produces paraneoplastic p roliferation of uveal
melanocytes
E. Associated retinal detachment makes visualization of lesion
difficult
93. Orbital lesions:

A. Choroidal metastasis cannot be differentiated from choroidal
melanoma
B. Wegeners involves orbits in 40%
C. Pseudotumour causes massive enlargement of lacrimal gland
D. Orbital hematomas continue with extradural haematoma
E. The most common site of orbital hematoma is the floor
94. The following features are in favour of inflammatory or

lymphoid lesion in lacrimal gland than epithelial carcinomas;
A. Involvement of only the orbital part
B. Oblong appearance
C. Straight posterior margin
D. No anterior extension
E. Scleral enhancement
95. Recognised causes of Mickulicz syndrome:

- A. Leukemia
B. Sarcoidosis
C. Syphilis
D. Tuberculosis
E. Bacterial infection
96. The following are cystic lesions in orbit:

A. Lacrimal cyst
B. Hemangioma
C. Hydatid
D. Lymphangioma
E. Dermoid
97. Common masses in the suprolateral quadrant of orbit:

A. Lymphoma B. Wegeners
C. Dermoid D. Lacrimal sac tumour
E. Sarcoidosis
98. Intraconal tumours without optic nerve involvement:

A. L ymphoma
B. Hemangioma
C. Carticocavernous fistula
D. Hematoma
E. AVM
99. Orbital lesions arising from the muscle:

A. Graves B. Pseudotumour
C. Lymphoma D. Leiomyosarcoma
E. Varix
l Head and Neck-1 193
i 100. Causes of bilateral microphthalmia;

f
! A. Congenital rubella
'
I B. Lowe syndrome
i C. Retinopathy of premaurity
l D. Toxoplasmosis
I
E. Persistent hyperplastic vitreous
101. Lesions arising from orbital muscles:

A. . Lymphoma has more muscle enlargement than Graves and
l pseudotumour
'
i
' B. Pain is the clinical p r esentation in pseudotumour and
!
,.
i
lymphoma
t C. Lymphoma has the youngest age distribution
t D. Lymphomas and Graves are bilateral
E. The tendon is spared in Graves and lymphoma
102. Bilateral lacrimal gland masses:

A. Sj o gren' s syndrome
B. Mickuliz syndrome
C. Lymphoma
D. Sarcoidosis
E. Graves opthalmopathy
103. Enlarged superior orbital fissure is seen in:

B. Tuberous sclerosis
C. Chordoma
D. Hemangioma
E. Metastasis to sphenoid
104. Common causes of orbital hyperostosis:

A. Fibrous dysplasia B. Pagets
C. Sarcoidosis D. Histiocytosis
E. Meningioma
1os·. Common causes of choroidal metastasis:

A. Neuroblastoma B. Renal
C. Breast D. Skin melanoma
E. Squamous carcinoma of head and neck ·
106. Causes of large globe:

A. Marfan syndrome
B. Posterior staphyloma
C. Persistent hyperplastic primary vitreous
D. Coloboma
E. Buphthalmos
107. Rhabdomyosarcoma:
A. Vision is lost early
B. Second most common oribital malignancy in children after
retinoblastoma
C. Most common in superolateral portion of orbit
D. 20% of rhabdomyosarcoma arises from orbit
E. Extension into brain is not common
108. Rhabdomyosarcoma:
A. 90% present before 16 years
B. 50% survival after radiotherapy
C. Metastases to cervical lymph nodes
D. Associated with neurofibromatosis
E. Rapidly progressive exophthalmos
109. The following are common intraconal lesions:

A. Hemangioma B. Optic nerve glioma
· C. Neurofibroma D. Pseudotumour
E. Lymphoma
110. Causes of vitreous haemorrhage:

A. Diabetes
B. Hypertension
C. Coats disease
D. Raised intracranial pressure
E. Melanoma
111. Causes of white eye in children:

A. Toxocaris
B. Retrolental fibroplasia
C. Persistent hyperplastic vitreous
D. Retinal detachment
E. Coats disease
112. The following features indicate orbital meningioma rather than

optic nerve glioma:
A. Well defined margins
B. Heterogenous enhancement
C. Calcification
D. Buckling of optic nerve
E. Negative image of optic nerve within tumour
113. Features suggestive of optic ner:ve glioma:

A. Hyperostosis B. Widening of optic canal
C. Neurofibromatosis II D. Middle aged women
E. Calcification
Head and Neck-1 195
114. Optic glioma:

A. Most common cause of optic nerve enlargement
B. 80% of primary tumours of optic nerve
C. High grade glial tumour
D. More common in males
E. Proptosis is commonly seen
115. Orbit:
A. The normal diameter of the globe is 2.7 cm
B. The fovea is seen 3-4 mm temporal to the optic disc
C. The optic nerve is parallel to the hard palate
D. The super io r fibers of optic nerve pass through the
inferomedial optic tract
E. The nasal fibers of the left eye are located in the left lateral
geniculate body
116. Orbit:
A. The periorbital fascia is fused with sheath of optic nerve
B. Periorbita is continuation of meningeal layer of the dura
C. The tarsal plate is a thickening of the orbital septum
D. The Tenons capsule fuses with sclera around entrance of optic
nerve
E. All the extraocular muscles pierce the Tenons capsule
117. The following are anechoic lesions in ultrasound:

A. lacrimal sac cysts
B. Mucocele
C. Varix
D. Silicone implants
E. Lymphoma
118. Hyperechoic lesions in ultrasound:

A. Cavernous hemangioma
B. Lymphangioma
C. Foreig n body
D. Lacrimal gland adenoma
E. Dermoid
119. Enlarged optic nerve is seen in:

A. Acromegaly
B. Subarachnoid haemorrhage
C. Raised intracranial pressure
D. Central retinal vein thrombosis
E. Thyroid ophthalmopathy
120. Causes of unilateral exophthalmos:

A. Fibrous dysplasia
B. Histiocytosis X
C. N euroblastoma
D. Caffeys disease
E. Craniosynostosis
-121. Common orbital masses in children:

A. Choroidal melanoma
B. Lymphoma
C. Retinoblastoma
D. Rhabdomyosarcoma
E. Optic nerve glioma
122. Optic nerve glioma:

A. Extension into the optic tracts makes the lesion unresectable
B. Visual acuity is not affected
C. The lesion is isointense to muscle in both T l and T2 sequences
D. NF associated in 50%
E. 50% of NF have optic nerve gliomas
123. Orbital lesion s:

A. \·1etasrases spares the bone
B. Ultrasound can reliably distinguish retinal detachment and
vitreous haemorrhage
C. One-third of retinoblastomas are bilateral
D. Pseudotumour is associated with autoimmu
_ ne thyroiditis
E. The most common cause of proptosis is orbital cellulitis
124. Causes of unilateral microphthalmia:

A. Retinoblastoma B. Melanoma
C. Surgery D. Pthisis bulbi
E. Radiation
125. Orbital lymphoma:

A. Affects the posterior more commonly than the anterior portion
B. Extraocular in most of cases
C. Calcification occurs in 20%
D. Associated with displacement of lamina papyracea
E. Hodgkins is more common than non-Hodgkins
126. Orbital lymphoma:

A. Second most common cause of proptosis
B. Systemic disease is common when orbit is involved
C. More common in children than adults
D. Lacrimal gland is the most commonly invovled structure
E. Exophthalmos is the presenting feature
Head and Neck-1 197
127. Causes of endocrine exoph thalmos:

A. Graves
B. Cushings
C. Acromegaly
D. Addisons
E. Hyperadrenalism
128. Graves disease:

A. Graves disease is the most common cause of proptosis
B. There is good correlation between the tfiyroid hormone level
I and Graves opthalmopathy

C. Volume of the retroocular fat is reduced due to muscle
I
'
•
hypertrophy
D. Stretching and thinning of muscles seen
I E. The fat has homogenous density .
'
l
129. Graves opthalmopathy:

A. Unilateral disease excludes Graves opthalmopathy
B. The thyroid hormones can be normal
C. Cornea is spared
D. The upper eyelid is retracted
E. The proptosis is always reducible
130. Orbital pseudotumour:

A. Unilateral or bilaterally asymmetrical
B. Lacrimal gland is the most common structure involved
C. Sclera shows intense contrast enhancement in CT
D. Biopsy is the confirmatory test for diagnosis
E. Decreased visual acuity
131. Pseudotumour associated with:

A. Wegeners B. Cholangitis
C. Lymphoma D. Sarcoidosis
E. Coats disease
132 . . Orbit:
A. Graves opthalmopathy is the most common cause of orbital
mass lesion in adult
B. Retinal astrocytoma is a tumour associated with tuberous
sclerosis
C. Retinal astrocytomas arise near the macula
D. Most common vasc ular tumour or orbit in children is
lymphangioma
E. Abscess of orbit is most common in the subperiosteal space
in the inferior wall
133. Caroticocaernous fistula commonly drains into:

A. Superior opthalmic vein
B. Inferior opthalmic vein
C. Petrosal sinus
D. Transverse sinus
E. Cortical veins
J34. Caroticocavernous fistula:

A. Decrease in vision is uncommon
B . Doppler shows increased venous flow in the superior ophthalmic
vein
C. Carotid angiography shows flow into superior ophthalmic vein
D. Wall of internal carotid artery is incomplete in angiography
E. Rupture of intracavernous ICA aneurysm is the most common
cause
135. Orbital dermoid:

A. Dermoid is most common in the upper nasal quadrant
B. Does not erode the orbit, since it is a benign tumour
C. Most common benign tumour in children
D . High signal in Tl and T2
E. AJ\i\:avs seen at sites of embrvonic fusion
J J
136. Orbit:
A. Influenza is the most common organism which infects the
lacrimal gland
B. High intensity echoes inside vitreous occurs only in haemorrhage
C. Most common cause of endophthalmitis is hematogenous
spread from infection in distal parts of body
D . Epidermoid is the most common benign tumour in orbit in
adults
E. Orbital hemangioma is associated with Von Hippe! Lindau
disease
137. Coloboma:
A. B egins at 12 weeks gestational age
B. Associated with corpus callosal agenesis
C. Associated with Chiari malformation
D. Outpouching of vitreous at medial to the optic nerve
E. Involves either choroid or iris
138. Graves opthalmopathy:

A . Optic nerve is thickened
B. The lateral rectus is the most common muscle affected
C. The anterolateral extraconal space is commonly affected
D. The swelling affectes the anterior portion of the muscle at the
junction with the tendon
E. All structures in the orbit are affected
Head and Neck-1 199
139. Imaging of Graves ophthalmopathy:

A. Tl shows hypointensity
B. TZ shows hypointensity
1
C. TZ shows hyperintensity in acute stages
D. Colour Doppler shows increased forward flow in malignant
exophtalmos
I
L
E. The muscles are hypoechoic relative to the fat in ultrasound
f 140. Orbital hemangioma:

A. Capillary hemangioma is the most common in adults
I B. There is arterial supply to the cavernous hemangioma
C. Retrobulbar extraconal space is the most common location for
hemangiomas
D. There is ·no enhancement unlike hepatic hemangiomas
¥
E. Compression of optic nerve is a recognized feature
I
(
141. Orbital tumours:
A. Lymphangiomas are hyperintense in both Tl and T2 sequences
B. All the hemangioperictyomas are malignant
C. Contrast enhancement in hemangiopericytoma is sluggish than
in hemangioma
D. Orbital varix is best seen in prone position
E. In sch wannomas. the optic nerve is always engulfed or
displaced by tumour
142. Orbital tumours:

A. Schwannomas commonly arise from the optic nerve
B. The most common location of schwannoma is extraconal
C. Persistent hyperplastic primary vitrous is seen at the level of
optic disc
D. Fibrous dysplasia shows marked sclerosis with irregular cystic
ares within
E. Esthesioneuroblastoma causes more orbital destruction than
squamous cell carcinoma
143. Orbital changes of neurofibromatosis:

A. Enlarged superior orbital fissure
B. Constricted orbit
C. Herniation of temporal lobe into orbit
D. Glaucoma
E. Myopia
144. Retinal detachment:

A. Chronic retinal detachment is hyper in Tl and hypo in T2
B. In choroidal detachment the optic disc is not involved
C. Retinal detachment appears V shaped at the level of lens
D. Acute choroidal hematoma is hypointense in both sequences
E. Inflammatory choroidal detachment is position dependent
145. TMJ Internal derangement:

A. More common in females
B. Posterior displacemem of disk is the most common subtype
C. Transverse displacements is most common type
D. Disk displacement is diagnosed on open mouth view
E. Disk is considered displaced only if it is more than 30 degrees
away from the 12 0 dock position in ':(losed mouth view
146. TMJ anatomy:

A. There is no cartilage covering for articular discs
B. The anterior and posterior bands are wider than longer
C. The central portion of the disk is the most toughest portion of
disk
D. \Nater signal is seen in central portion of disk
E. Posterior band is bigger than anterior band
147. TMJ anatomy:

A. Bilaminar zone is situated near the articular eminence in
normal persons
B. Superior belly of lateral pterygoid is responsible for pulling
disk anteriorly when mouth is opened
C. Medial pterygoid is inYolved in mouth opening
D. Anterior and posterior displacements are best assessed in
coronal plane
E. The posterior translation of mandible is limited by bilaminar
zone
148. Anatomy of ear:

A. In coronal images. the stapes sits over the oval window
B. Normal stapes is seen above the tympanic portionof facial
nerve
C. The normal vertical dimension of oval window is atleast 2 mm
D. The normal width of middle ear cavity is 1 mm
E. The normal stapes is seen below the lateral semicircular canal
149. Temporal bone sclerosis is seen in:

A. Osteogenesis imperfecta
C. Otospongiosis
D. Meningioma
150. Pulsatile tinnitus is seen in:

A. Aberrant internal carotid artery
B. Dehiscent jugular bulb
C. Carotid artery dissection
D. Fibromuscular hyperplasia
E. Meningioma
Head and Neck-1 201
151. Glomus tumours are found in the fo ll owing locations :

A. Cochlear promontory
B. Mediastinum
C. Bladder
D. Carotid body
E. Vagus nerve
152. Glomus jugulare:

A. More common in females
B. Multicentric in 50%
C. Carotid body involved in majori ty of multicentric tumours
D. Histologically malignant
E. Invasion of adjac ent structures
153. Glomus jugulare destroys the following structures:

A. Incus
B. Petrous posteromedial portion
C. Jugular spine
D. Otic capsul e
E. Oval window
154. Glomus tympanicum:

A. Situatetl over the oromontarv
' J
B. Arises from the geniculate ganglion

C. Erodes through inferior wall of middle ear cavi(y
D. Angiography shovvs well defined hypervascular mass
E. Very large at presenta(ion
155. Orbital wall osteolysis is seen in:

A. �1eningioma
B. N euroblastoma
C. Rheumatoid arthritis
D. Histiocytosis X
E. Lymphoma
156. Common externaf ear masses:

A. Keratosis obturans B. Cholesteatoma
C. Surfers ear D. Histiocytosis
E. Basal cell carcinoma
157. Differential diagnosis for masses in th e inner ea r:

A. Labvrinthine
.., neuroma
B. Facial neurinoma
C. Hemangioma
D. Mucoceie
E. Metastases
158. Common masses in the petrous apex:

A. Mucocele
B. Facial nerve schwannoma
C. Epidermoid
D. Cholesterol granuloma
E. Metastasis
_ 159. Inner ear:

A. The vestibular aqueduct is commonly mistaken for internal
auditory meatus
B. The cochlear aqueduct has the endolymphatic sac and duct
C. The cochlear duct opens into the subarchnoid space inferior
to the internal auditory meatus
D. The vestibular duct is widest proximally
E. The vestibular duct opens from the posteromedial aspect of
the vestibule
160. Internal auditory meatus:

A. Labyrinthine artery passes through internal auditory meatus
B. The crista falciformis is a vertical bar dividing the IAM
C. Intermediate nerve is anterosuperior
D. Cochlear nerve, posteroinferior
E. Facial nerve passes through lamina ciribrosa
161. Cholesteatoma:
A. Tympanic membrane is usually intact
B. Facial nerve palsy seen
C. Pars tensa cholesteatoma is common than pars flaccida
D. The handle of malleus is the first bone to be eroded by pars
tensa cholesteatoma
E. Pars flaccida is the secondary acquired cholesteatoma
162. Pars flaccida cholesteatoma:

A. Extension to aditus to mastoid antrum
B. The roof of th€ attic is the earliest affected bone
C. Prussaks space is involved early stages
D. Destruction of scutum is the hallmark
E. Extension through tensor tympani
163. Glornus jugulare tumour:

A. Arises from adventitia of jugular vein
B. Situated in the middle ear
C. Salt and pepper appearance is characteristic -:::T scan
D. Occludes jugular bulb
E. Intense enhancement on contrast
F. Blood supply is derived from internal jugular vein
Head and Neck-1 203
164. Glomus jugulare:

A. Spreads along carotid artery into the middle cranial fossa
B. Involvement of IX. X and XI nerve is called Tolosa Hunt
syndrome
C. A high placed jugular bulb produces cortical erosion unlike
glomus jugulare
D. An aberrant placed carotid artery is usually placed medially
than normal
E. In MRI, glomus jugulare shows a lot of signal voids. but not
glomus tympanicum
165. Cholesteatoma:
A. Perforation is more common in the pars tensa
B. Perforation is most common in the anterosuperior quadrant
C. The posterior semicircular canal is the most commonly affected
D. Extends to the extradural space
E. Enhances with gadolinium
166. Regarding dental panoramic radiography:

A. The distance between X-rav tube and cassette holder is 150
J
cm
B. The cassette moves in the opposite direction as X-ray beam

C. The patients tongue should be placed against the palate
D. Lead aprons are recommended to prevent excess radiation
exposure
E. Patient should always be seated
167. Facial nerve palsy :

A. Contrast enhancement of intrameatal and lab.yrinthine portions
of facial nerve is specific for inflammation or trauma
B. Enhanced geniculate ganglion and tympanomastoid portions
is suggestive of facial nerve disease
C. Enhancement of tympanomastoid portion occurs in normal
individuals
D. There is good correlation between intensity of c ontrast
enhancement of facial nerve and severity or disease
E. All the infections of facial nerve originate in the geniculate
ganglion
F. T2W images can indicate .severity of disease
168. Complications of cholesteatorna:

A. Labyrinthine fistula
B. Cerebral abscess
C. CSt rhinorrhea
D. Cavernous sinus t hrombosis
E. Bezolds abscess
169. Ch olestero l granuloma:

A. Cholesterol granuloma is bright in T 1 and T2
B. Cholesteatoma is bright in Tl and dark in T2
C. Cholesterol granuloma shows contrast enhancement
D. Pulsatile tinnitus
E. Ossicles destroyed
170. The following features are in favour of c holesteatoma than otitis

media:
A. Seutum erosion
B. Retracted tympanic membrane
B. Gadolinium enhancement
C. Ossicular erosion
D. Opacification of middle ear
171. Masses arising from the promontory:

A. Aberrant carotid artery
- B. Persistent stapedial artery
C. 'tv1etastases
D. Cholesteatoma
E. Glomus tympanicum
172. Apical petrositis:

A. Trigeminal nerve involved a n d produces Gradin ogos
syndrome
B. Seen only in those with air cells in petrous apex
C. 60% of population have air cells in petrous apex
D. Virus infection is the most common cause
E. Bone destruction seen
173. Transverse fractur e:

A. Fracture line passes through apex of internal auditory canal
B. Stenvers view is the best for diagnosis
C. Irreversible sensory hearing loss
D. Irreversible facial nerve palsy
E. CSF rhinorrhoea
174. Traumatic facial nerve transaction:

A. Contrast enhancement is seen even before clinical facial palsy
B. Contrast enhancement can predict delayed onset of facial palsy
C. The vestibule enhances in labyrinthitis, Bells palsy and Ramsay
Hunt syndrome
D. Enhancement of vestibule is seen in trauma to temporal bone
E. Hearing loss produced by fracture through vestibule is
irreversible
Head and Neck-1 205
175. Otosclerosis:
A. Most common type of otosclerosis is seen in c o c hlea
B. Fenestral otosclerosis involves the oval window
C. Otosclerosis involves all the layers of otic capsule
D. The involved bones enhance on administration of Gadoli niu m
E. The bones are denser than normal
F. Hearing loss is conductive type. with sensorineural function
I . intact
I 176. Longitudinal fracture of temporal bone:
I
I
A. Incudostapedial joint is dislocated
B. Sensory hearing loss
C. Pneumocephalus
D. CSF otorrhea
E. Facial nerve -no spontaneous recovery due to disruption of
nerve fibers
177. Osteogenesis imperfecta:

A. Younger patients have sensorineural loss and older patients
have conductive loss
B. Van der Howeve syndrome involves blue sclera
C. Affects all three layers of otic capsule
D. Fractures of ossicles seen
E. Associated with otosclerosis
178. The following auditory structures are involved in osteogen e s is

imperfecta:
A. Cochlea B. Malleus
C. Vestibule D. Semicircular canal
E. Tympanic membrane
179. Inner ear tumours- endolymphatic sac tumours:

A. Associated with tuberous sclerosis
B. Seen at hiatus of vestibular aqueduct
C. No destruction of bone
D. High signal in T 1 and T2
E. Middle third of endolymphatic sac
180. The following lesions are seen in the intracanalicular region:

A. Meningioma B. Lyme disease
C. Labyrinthine artery D. Metastasis
E. Facial nerve schwannoma
181. Causes of labyrinthine ossification:

A. La by r i nthine fistula B. Meningitis
C. Trauma D. Measles
E. Labyrinthitis
- -
182. Congenital aural dysplasia:

A. \Vhen the external ear is involved. the mastoids are invariably
involved
B. Severity of auditory dysplasia is directly proportional to extent
of auditory canal malformation
C. Inner ear is never involved with external ear malformation,
because of independent development
D. Usually bilateral than unilateral
E. :t\.1ore common in the right side
183. Congenit a l aural dysplasia:

A. Involvrnent of otic capsule means that surgery (atresioplasty)
is of no use
B. Fusion of malleus and stapedius is the most common ossicular
involvement
C. Absent malleoincudal articulation is best seen in coronal images
D. Stapedial integrity is the most imponant information required
for surgery
E. More thicker the atretic plate, more hypoplastic are the middle
ear cavity and mastoids
184. Mondini malformation:

A. The basal turn of cochlea is alv,=ays present
B. High frequency hearing is lost
C. Two and half turns of cochlea are present
D. Interscalar septum and spiral lamina are hyperplastic
E. Hearing can be unaffected
185. Lefort fractures:

A. Pterygoid plates are fractured in all the three types
B. Lefort I has a free moving face
C. Lefort II has a free moving hard palate
D. Lefort II has floating maxilla
E. Zygomatic arches are involved in II
186. Fractured temporal bone:

A. Transverse fracture is common than longitudinal
B. Longitudinal fracture ends in foramen lacerum
C. Transverse fracture is parallel to the long axis of petrous
pyramid
D. Facial nerve palsy is common in transverse fracture
E. Malleus is the commonly fractured ossicle
187. Bilaterally symmetrical otic capsule demineralisation:

A. Syphilis B. Otosclerosis
C. Pagets disease D. Osteogenesis imperfecta
E. Metastasis
Head and Neck-1 207
ANSWERS
1. A-F, B-T, C-T, D-T, E-T
Cleft upper lip is common on one side and is due to failure of
fusion of fronto nasal process and maxillary process. Midline cleft
is uncommon and is due to failure of development of frontonasal
process. The cleft may extend to nose. alveolus and side of nose
upto orbit. Cleft lower lip is uncommon and is associated with
cleft tongue and mandible.
2. A-T, B-F, C-T, D-T, E-T

Upper jaw. palate, cheeks. lateral part of the palate and lateral part
of the upper lip develop from the maxillary process.
3. A-F, B-F, C-T, D-T

First-mandibular division of V. II- Facial. III-glosspharyngeal. IV
vagus. Cranial accessory supplies via vagus.
4. A-F, B-F, C-F, D-T, E-T

The tongue is derived from first. third and fourth pharyngeal
arches. The anterior third is derived from first arch. The
innervation is by mandibular branch of trigeminal nerve and taste
fibres are from chorda tympani of facial nerve. The circumvallate
papilla separates this from the posterior third. which is derived
from the third arch and receives sensory and taste fibres from
glosspharyngeal N. The most posterior third of congue is from
IV arch and supplied by superior laryngeal nerve a branch of
vagus. Palatoglossus is supplied by pharyngeal plexus.
5. A-T, B-T, C-F, D-F, E-F

The thyroid development begins from foramen caecum just behind
circumvallate papilla.
It reaches the adult position by seven weeks. The thyroglossal duct
runs very close to the hyoid bone. which is also removed vvhen
a thyroglossal cyst is formed. The pyramidal lobe is more common
in the left side.
6. A-T, B-T, C-T, D-T, E-T

Some lymph nodes are also seen.
7. A-T, B-T, C-T, D-F, E-T

Only internal jugular vein is a component and not the external
jugular vein. Cranial nerves. IX. X, Xl, Xl 1 are also seen.
,•
8. A-T, B-F, C-F, D-T, E-T

Ascending pharyngeal artery and pharyngeal venous plexus are
in the parapharyngeal space. Adenoids and tonsils are also seen.
Buccal space contains the facial artery. facial vein, buccinator.

parotid duct and buccal fat pad.
9. A-T, B-T, C-F, D-T, E-T

Spinal accessory nerve travels through the foramen and not cranial
accessory.
10. A-T, B-F, C-T, E-T, E-F

Maxillary nerve also passes through the foramen rotundum
11. A-T, B-F, C-T, D-T, E-F

The audito r y ossicles and mandible are not joined by
synchondrosis or sutures.
The upper face is upto the supraorbital margin, midface from
supraorbital margin to maxillary alveolus and lower face is the
mandible.The coronal struts are the frontonasal and alveolar
processes anteriorly and posterior \Nall of maxillary antra and
_ pterygoid posteriorly.The sagirtal struts are the medial and lateral
walls of the orbit and maxillary antra and the nasal septum.The
horizontal struts are the roof and floor of the orbits, zygomatic
processes and hard palate.
12. A-T, B-T, C-F, D-T, E-F

The infratemporal fossa has the maxillary artery and mandibular
nerve. The infratemporal fossa and pterygopalatine fossa
communicate with the orbit through the inferior orbital fissure.
13. A-T, B-T, C-F, D-F, E-F
14. A-T, B-T, C-F, D-T, E-F

MRI is the ideal method for investigating TM]. Mandible is the
strongest facial bone.
15. A-F, B-F, C-T, D-F, E-T

There are 20 deciduous and 32 permanent teeth. The central
incisors are the first formed deciduous teeth.
The first molar tooth are formed first at 6 years. The second molars
are formed at 12 years and third at 18 years.
16. A-T, B-F, C-T, D-T, E-F

Ciribriform plate transmits olfactory nerve fibers. anterior
ethmoidal nerves and vessels.
Hiatus semilunaris is situated in the middle meatus. Sphenopalatine
foramen- Nasopalatine nerve and vessels
17. A-T, B-T, C-F, D-F, E-T

Anterior ethrnoidal and frontal sinuses also drains into the middle
meatus.
Head and Neck-1 209
18. A-F, B-T, C-T, D-T, E-T

Littles area is seen in the anteroinferior portion o f the nasal
septum.
19. A-T, B-F, C-T, D-T, E-T

Osteometal complex drains the anterior and middle ethmoidal.
frontal and maxillary sinuses into the middle meatus.
20. A-F, B-F, C-T, D-T, E-T

10% of people have accessory ostia. The protruding roots of molar
and premolar teeth are covered by bone and mucosa. The medial
wall of maxillary sinus has a large maxillary hiatus postero
superiorly. This is closed by inferior concha and uncinate process
of ethmoid. except for the maxillary ar:id accessory ostia. The
maxillary ostium opens into the ethmoid infundibulum, which is
a channel between uncinate process. lamina papyracea and anterior
surface of ethmoidal bulla. The infundibulum opens into the hiatus
semilunaris situated below the ethmoidal bulla. The accessory ostia
are seen only in axial CT images.
21. A-T, B-T, C-T, D-F, E-T

Masseter and mandible are also contents. Buccinator is in buccal
space.
22. A-T, B-T, C-F, D-T, E-F

External carotid artery and parotid gland are also comerns.
23. A-T, B-T, C-T, D-T, E-F

Scalene muscles are also components.
24. A-T, B-F, C-F, D-T, E-T

Concha bullosa is pnuematisation of middle turbinate. Haller cells
are ethmoidal cells seen in the floor of the orbit. Agger nasi cells
are the most anterior of the anterior ethmoidal air cells. seen close
to the lacrimal duct and sac.
25. A-F, B-T, C-F, D-F, E-F

The palagoglossus forms the boundary between oral cavity and
pharynx. The intrinsic muscles of tongue are divided by septae
and there is a midline septum. seen in NfRI.
The genioglossus is the largest extrinsic muscle of the tongue, the
others being hyoglossus and palatoglossus. The hypolgossus is the
lateral border of the tongue .. The lingual artery is medial to it
and the lingual vein and hypoglossal nerve are lateral.
26. A-T, B-T, C-T, D-T, E-F

The facial nerve. although not seen routinely in CT is occasionally
seen in coronal Tl 'vV images. The parotid gland is made up of fatty
interstitial tissue and density of parotid gland is in between that

of muscle and fat. In children and some adults. the density is same
as muscle.
27. A-F, B-F, C-F. D-F. E-T

The pharynx is made up of five groups of muscles. the three
constrictors and stylopharyngeus and palatopharyngeus.
The muscle layer, is defective superiorly. where there is a
pharyngobasilar fascia.
The pharyngobasilar fascia has a defect the Sinus of Morgagni.
through which the auditory tube and levator palatini pass through.
The Fossa of Rosenmuller is protusion of pharyngeal mucosa
through the fascia! defect and is the most common site of origin
of nasopharyngeal carcinoma.
28. A-T, B-T. C-T. D-F, E-T

The posterior indentation at CS/6 is due to cricopharyngeus
indentation, which is normal in old patients. Cricoid venous plexus
usually produces the anterior irregularity.
The palate is the boundary between oro and nasopharynx and
epiglottis is the boundary between ore and layngopharynx. The
pharynx extends upto C6.
29. A-F, B-T, C-T, D-T, E-T

The fascia of neck is divided into a superficial subcutaneous fascia
and deep fascia.
The deep fascia has an investing layer. visceral layer and
prevertebral layer.
Only platysma and superficial lymph nodes are superficial to
investing layer, which encloses all deep structures.
The visceral layer encloses thyroid. trachea and esophagus.
30. A-T, B-T, C-F, D-F, E-T

In the coronal plane, epitympanum- above level of tympanic
membrane, mesotympanum-at the level: hypotympanum- below
level of TM: In the axial plane-protympanum- in front of the plane
o f anterior wall of external auditory m e autus: posterior
tympanum- posterior to the posterior wall of external auditory
meatus, and mesotympanum.
31. A-T, B-F, C-F, D-T, E-F

Sphenoid sinus and maxillary sinuses are present at rudimentary
stage at birth.
The other sinuses develop at 7 I 8 years.
In presence of metopic suture, the frontal sinuses develop on either
side of suture, thus excluding fracture.
Head and Neck-1 211
32. A-F, B-F, C-F, D-F, E-F

Cricoarytenoid joint is a synovial joint. The false cords lie above
the level of true cords and laryngeal sinus or ventricle is situated
in between these two. The epiglottis arises from the thyroid
cartilage. The paraglottic soft tissue ends above the level of cricoid
ring, so any soft tissue within the cricoid ring is abnormal.
33. A-F, B-T, C-F, D-T, E-F

Calcitonin is produced in the parafollicular cells. Thyroid hormones
are secreted in the follicular cells. Right lobe is larger. more
vascular and more often involved in diffuse disorders. Foramen
caecum not seen normally.
34. A-T, B-T, C-T, D-F, E-T

Superior thyroid A is a branch of external carotid artery.
Inferior thyroid A is a branch of thyrocervical trunk of subclavian
artery.
Arteria thyroidea ima is occasionally seen. arising from the
brachiotephalic A or aorta.
35. A-F, B-F, C-F, D-F, E-F

Juguloomohyoid drains the tongue and jugulodigastric drains the
tonsils. Jugulodigastric and submandibular are enlarged if more
than 1. Scm. >Jades on the left side of neck drain into the thoracic
duct and on Lf-ie right side drain into the junction of internal jugular
vein and subclavian vein.
36. A-T, B-T, C-T, D-T, E-T

The sublingual glands drain through the ducts of Rivinius. in the
sublingual papilla, posterior to the submandibular duct orifice.
Occasionally, they join to produce the Bartholins duct, which drains
into submandibular duct. Parotid duct is also called Stensons and
submandibular is called \Vharcons duct.
37. A-T, B-F, C-F, D-T, E-F

IA-submental
IB-submandibular
II-along jugular vein. from skull base to hyoid bone
III-along jugular vein, from hyoid bone to cricoid
IV-along jugular vein, from c,ricoid to clavicle
V-posterior triangle nodes
VI-visceral nodes
VII-superior mediastinal nodes
38. A-T, B-T, C-F, D-T, E-T

There are five anterior cervical rami from CS-Tl. with occasional
contributions from C4 and T2. C5.C6 join to form upper trunk
between scalenus anterior and medius. C7 forms the middle trunk

and C8 and Tl form the lower trunk. behind scalenus anterior.
The trunks divide into anterior and posterior divisions. which lie
behind scalenus anterior and clavicle.They give rise to cords,
which are f ormed above and behind pectoralis minor and pass
between the clavicle and first rib.Branches are formed in the axilla.
39. A-F, B-F, C-F, D-T, E-T

The lateral one third of ear is cartilaginous and medial two thirds
is osseus. The tympanic membrane is oriented at an angle. The
pars tensa is the lower part and pars flaccida is the upper part
of the tympanic membrane. The pars tensa has skin. fibrous layer
and mucosa. pars flaccida does not have the fibrous layer.
40. A-T, B-T, C-T, D-F. E-F

Anterior cerebellar arterv, shows enhancement on contrast .
.I
mimicking acoustic neuroma. PICA is not seen in CP angle cistern.
41°. A-F, B-T. C-T, D-F, E-F

Jugular foramen i s divided into a smaller pars nervosa
anteromedially and larger pars nervosa laterally. Pars nervosa
i nferior petrosal sinus, glossopharyngeal N
Pars vasculosa-jugular bulb. vagus. spinal accessory N
42. A-T, B-F, C-T. D-T, E-F

The right jugular foramen is larger due to the larger right lateral
sinus. The jugular foramen lies inferior to the hypotympanum.
separated only by a thin bone. High jugular bulb and aberrant
carotid artery are common causes of vascular tympanic mass.
mistaken for glomus jugulare.
43. A-F, B-F, C-F, D-T, E-F

Stapedius-from pyramidal eminence to stapes neck.supplied by
facial nerve
Tensor tympani-from anterior wall of middle ear to malleus. V
nerve supply.
Pyramidal eminence is in the posterior wall separates sinus tympani
medially and facial recess laterally.
44. A-T, B-T, C-F, D-T, E-T

Head of malleus and incudomalleolar articulation is i n the
epitympanic recess.
Prussaks space(superior tympanic recess) is between pars flaccida
and neck of malleus and is the most common site of CSOM. Lateral
process of malleus and manubrium are attached to the tympanic
membrane laterally.
45. A-T, B-T, C-T, D-T, E-T

Head and Neck-1 213
46. A-T, B-T, C-T, D-F, E-F

The bony labyrinth has the cochlea anteriorly. vestibule and
semicircular canal posteriorly. The organ of corti. for hearing is
inside the c o c hlea. with the base at m e dial e n d and apex
anterolaterally. The spiral lamina is from the central modiolus. The
vestibule has the utricle and saccule. There are three semicircular
canals, each at right angles to one another. Anterior(superior)
perpendicular to long axis of petrous, under the arcuate eminence:
Posterior-parallel to the long axis of petrous. Lateral (horizontal).
These three canals open by 5 openings with the vestibule, the
anterior and posterior sharing a common crus. Labyrinthine fistula
is common in the lateral semicircular canal.
47. A-T, B-F, C-T, D-F, E-T

The promontory overlies the basal turn of the cochlea. The oval
window is above this and round window is below. The facial
nerve is posterior to this.
48. A-T, B-T, C-F, D-T, E-F

Although usually the external carotid has 8 branches. the number
is variable from 4-12.
Superficial temporal artery and maxillary artery are the terminal
branches.
Lingual artery supplies the submandibular gland.
49. A-T, B-F, C-T, D-T, E-F

Inner ear develops from the otic capsule at 3 weeks. Bony
labyrinth is the only bone in cranium to ossify at birth. Inner ear
reaches adult proportions at birth itself. The external and middle
ear develop from the 1st and 2nd pharyngeal arches. The external
ear develops at eight weeks.
50. A-F, B-F, C-F, D-F, E-T

Posterior auricular artery is not consistently seen. The maxillary
artery is divided into three by lateral pterygoid and has 15
branches. The largest branch, middle meningeal arl ery arises from
the first part. Vertebral artery passes through the foramen from
C3-6.
51. A-F, B-F, C-F, D-T, E-F

The saccule is anterior and utricle is posterior within the vestibule.
and semicircular duct opens into the utricle. The saccule and utricle
cannot be resolved by MRI.
The cochlear duct has perilymph.
52. A-T, B-T, C-F, D-T, E-F

Internal carotid artery shows a low resistance flow pattern. \Vith
low systolic velocities and continuous flow during diastole.
External carotid artery shows high resistance flow pattern, with

high systolic velocities and absent or reversed flow in diastole.
Common carotid shows waveform of internal carotid arterv. J
Vertebral artery can be seen in Doppler.
53. A-T. B-T. C-T, D-T, E-F
54. A-T, B-F,C-F, D-T, E-T

Dental panoramic radiography requires good technique, failing
which the images are considered unacceptable for diagnosis.
Lucency under the mandibular premolar and molar is normal and
is bilaterally symmetrical. It can be confused for lytic lesion. Intra
oral densities can also appear as areas of mandibular sclerosis.
Positioning the patient too forward produces narrowing and
blurring of incisors. positioning far too back produces widened,
blurred incisors. Lucency in mandibular angle can be produced
by improper positioning of tongue.
55. A-F,B-F, C-T, D-F, E-T

Enamel- From ameloblasts, covers the crown.
Cementum- Covers the root. periodontal ligament anchors
cementum to lamina dura.
Dentine- From odontoblasts. covers the pulp cavity of crown and
root canal of root. underneath the enamel and cementum. Lamina
dura is cortical bone and hence dense.
Alveolar bone surrounds the teeth and basal bone supports it.
Supernumerary teeth are called mesiodens.
56. A-T, B-T, C-T, D-F, E-T

Osteoradionecrosis causes mixed sclerotic and lucent areas. Other
causes include root fragment, supplemental or supernumerary
tooth, hypercerntosis, torus palatinus, Pagets, fibrous dysplasia.
ossifying fibroma, osteoma, osteochondroma, osteopetrosis.
osteitis. complex composite odontome, and osteochondroma.
57. A-F, B-T, C-F, D-F, E-F

The incus is posterior to the malleus. The short limb is attached
to posterior epitympanum by ligaments. Long limb is parallel to
manubrium, and articulates with the stapes head. The incudo
mal leolar and incudostapedial joint are synovial joints. The
footplate of stapes articulates with the oval window.
58. A-T, B-T, C-T, D-T, E-T

Osteoradionecrosis is another cause.
59. A-T, B-T, C-F, D-T, E-T

Odontogenic keratocyst, non-epithealial cyst. giant cell reparative
granuloma, dentigerous cysts are other common causes.
Head and Neck-1 215
60. A-T, B-T, C-T, D-T, E-T

Apical granulomas, dental cyst. dentigemous cysts. nasopalatine
c ysts, non-epithelial cysts, odontogenic keratocystis and
globulomaxillary cysts are the common cysts in the jaw.
61. A-F, B-F, C-T, D-F, E-T

This is a true neoplasm which rises from enamel tissue. This is
common in males. Other hypothesis for formation include surface
epithelium and remnants of dental lamina.
62. A-F, B-F, C-T, D-T, E-T

80% of amelobfastomas occur in the mandible and is most common
in the molar r a m us area. There are many histological types.
follicular. plexiform, acanthamous. granufar and basal cells. The
most common follicular type is seen in males. 3-5 decade, common
in the mandible and is frequently multilocular. The plexiform type
is seen in females. younger age. in the maxilla and unilocular.
63. A-F, B-T, C-F, D-F, E-F

Dental cyst is the most common odontogenic cyst followed by
·
dentigerous cyst. It is associated with papially or fully formed

u nerupted to ot h . Most common in the 3rd molar region of
m andible followed by ma x ill a . It is lined by stratified non
keratinized e pithe li um. The teeth are more commonly displaced
rather than resorbed. This is common in males and seen in 10- 30
year group.
64. A-F, B-T, C-T, D-F, E-F

It is usually uni l ocular may be multilocular.
.
65. A-F, B-T, C-F, D-T. E-F

Nasopalatine cyst is due to degeneration and proliferation of
remnants of nasopalatine duct. and is located between the nasal
fossa and incisive foramen and is seen as typical ovoid lucency
between roots of central ma.,xillary incisors. The normal nasopalatine
canal measures less than 1 Smm, more than 20 mm is considered
abnormal. Median palatine cyst is seen in the midline of the palate
and median mandibular cyst is seen in the midline of mandible.
66. A-T, B-F, C-T, D-T, D-T

Globulomaxillary cyst is formed at the site of fusion of globular
process of median nasal process and maxillary process laterally.
Giant cell reparative granuloma is believed to be formed secondary
to intramedullary haemorrhage.
67. A-T, B-T. C-T, D-T, E-T

Dentigerous cyst is another lesion without cortical perforation.
68. A-T, B-T, C-T, D-T, E-T

Dental cyst is the most common odontogenic cyst in the jaw. It
is common in the 2-4 decades and in males. It starts in relation
to apex of non-vital erupted tooth. It begins as pulpitis. progressing
subsequently to periapical granuloma which undergoes proli
feration followed by necrosis and cavitation to form the cyst.
Initially the radiographs show only separation of the periodontal
space, but subsequently a well defined unilocular cyst is seen
around tooth apex. Ill defined margins can be·seen due to infection
or fracture or large advanced cyst.
69. A-T, B-T, C-T, D-T, E-F

Large tumours can be multilocular, expansile and can enter the
maxillary sinus. The cyst is lined by non keratinized squamous
epithelium.
70. A-F, B-F, C-T, D-T, E-T

Ameloblastomas can arise from the pluripotential cells in the wall
of dentigerous cysts. Expansion is seen in both the buccal and
lingual side, thus differentiating from dentigerous cysts which
expand only on the buccal side. 40% are associated with }mpacted
3rd molar and 40% are associated with toorh root resorption. The
roots tend to extend into lesion rather than straddle it.
71. A-T, B-T, C-F, D-T, E-F

Odontomas are hamartomas which are formed due to abnormal
growth of calcified dental tissue. It usually stops growing once
the individual stops growing. It is called simple if it contains one
dental element and composite when more than one are present.
In compound composite, there are small fully formed teeth
containing enamel, dentine, cementum. In complex composite type,
there i s a well defined mass made up of enamel, dentine and
cementum, but no formation of teeth. It is more common in the
molar region.
72. A-T, B-F, C-F, D-T, E-F

Osteomas are the most common osseous tumours of jaw and there
is an association with Gardners syndrome. Osteochondraoms are
seen in the condylar or coronoid process of mandible which can
interfere with the tempormandibular joint function. Cemento
blastoma i s a benign tumour which is sclerotic. Torus palatinus is
seen as a sclerotic nodule in the midline of hard palate posteriorly.
Torus mandibularis is seen bilaterally. on the lingual surface of
medial aspect of mandible at level of premolars.
Head and Neck-1 21.7
73. A-F, B-T, C-T, D-F, E-T

Osteosarcomas of jaw occur in 5%. This is associated with lucent
areas and focal new bone formation close to the teeth. Although
the teeth is displaced, there is no resorption. Fibrous dysplasia is
common the maxilla. Fibrous dysplasia can be seen as a expanding
lucent lesion with sclerosis around the periphery. CT is hetero
genous and MRI is hypointense in Tl and hyperintense in T2.
74. A-T. B-T, C-F, D-F, E-T

Osteomyelitis of jaw can be formed due to extension of adjacent
infections of trauma or surgery. All the typical signs of osteo
myelitis are seen including sequestrum. involucrum. pathological
fracture and periosteal reaction. Chronic osteomyelitis can be
sclerosing or suppurative of Garres osteomyelitis (which is
characterized by proliferative periostitis).
75. A-T, B-F, C-T, D-T, E-T

Odontogenic keratocyst shows recurrence in upto 60%. Gardners
syndrome is associated with osteomas. Carlin syndrome has basal
cell carcinomas. odontogenic keratocysts, skeletal developmernal
anomalies and soft tissue calcification. Mandible posterior part
followed by maxillary posterior part are the common locations.
76. A-T, B-T, C-T, D-F, E-F

Odontogenic keratocyst is a common development odontogenic
cyst the origin of which is still unclear. It can either arise from
primordial odontogenic epithelium or from dental lamina/ epi
thelial remants or a basal cell hamartoma. It is lined by keratinized
stratified squamous epithelium. It is common in the 2-4 decade
and in males. It is usually a lucent lesion associated with tooth.
similar to dentigerous cyst. It can also be confusd for arneloblas
toma. But this lesion grows in ameroposterior direction and is non
expansile. Ameloblastomas grow in the buccolingual direC[ion and
are expansile. OKC can gross midline. CT values are higher rhan
that of a simple cyst measuring between 40-50 HU. MRI i s
intermediate signal i n Tl and PD and high signal i n T2.
77. A-T, B-F, C-T, D-T, E-T
78. A-F, B-T, C-T, D-F, E-T

Older age group, 30-40 years, rapid growth and local infiltration,
no hematogenous metastasis, low grade, better prognosis.
79. A-T, B-T, C-T, D-F, E-T

Aneurysmal bone cyst produces eccentric, multilocular expansile
lesion. with cortical ballooning and thinning. Destruction and soft
tissue are rare. Stafne bone cavity is a well corticated cystic lesion
which is a normal variant. Burkitts lymphoma is associated with

Epstein barr virus and has a good prognosis.
80. A-T, B-T, C-T, C-T, E-T

Osteosarcoma of jaw is seen in 30-40 year olds and constitutes
only 5% of all osteosarcomas. Floating or hanging tooth is another
finding. The lesion. can be lytic or mixed or blastic. L ytic lesion
is most common. Sunburst periosteal reaction is seen in 25% of
cases.
81. A-T, B-T.C-T, D-T, E-T

Any lesion in orbital apex which compresses the venous outflow
can cause muscle enlargement. Orbital metastasis, pseudotumour,
pseudolymphoma are other common causes.
82. A-T, B-T, C-T, D-T, E-T

Also in diabetes, glaucoma, retinal detachment, foreign body
localisation, vitreous haemorrhage, extraocular lens work up and
central retinal vein occlusion. Ultrasound biomicroscopy uses a 200
MHz probe and is used for evaluating cornea, corneal opacities.
iris, ciliary body, anterior segment. globe length.
83. A-T, B-F, C-T, D-T, E-F

CT scan is the best modlaity for assessment of Graves opthalmo
pathy. Arteriography is done for caroticocavernous fistula and
venography for orbital varices. Dacryocystography is done
through superior canaliculus.
84. A-T, B-T, C-F, D-T, E-T

Raised intracranial pressure causes focal narrowing of the roof.
Optic nerve glioma. ophthalmic artery aneurysm. AVM are other
causes.
85. A-T, B-T, C-T, D-F, E-F

Roof will be affected by lesions in floor of anterior cranial fossa
and due to rais�d intracranial pressure. Medial wall is affected
by sphenoidal and ethmoidal lesions including tumours and
mucocele.
86. A-T, B-T, C-T, D-T, E-T

Tumours including retinoblastoma are other causes.
87. A-T, B-F, C-T, ·D-T, E-F
88. A-T, B-T, C-T, D-T, E-T

Congenital glaucoma causes orbital enlargement.
89. A-F, B-T, C-T, D-T, E-T

Abscess, dermoid, lymphangioma are other causes.
Head and Neck-1 219
90. A-T, B-F, C-F, D-T, E-F

Probe can be placed over conjunctiva or over-close eyelid. Local
anaesthesia and methylcellulose gel are used. 10 MHz is the best
for eyeball and 8 MHz for orbital lesions.
91. A-F, B-T, C-T, D-F, E-F

Ethmoidal mucocele, tumours and infections. lymphoma are other
causes.
92. A-T, B-T, C-T, D-T, E-F

The lesion is hypoechoic in ultrasound. Ultrasound is superior for
small lesions and is not ideal for ciliary body lesions. Uvea. being
the most vascular portion of the eye, is a suitable substrate for
tumour cells. It usually arises from preeisting nevi. More common
in whites. It is seen as high signal mass in T 1 and low signal in
T2. The retinal detachment will be seen as high signal in Tl and
T2 . Hence the melanoma is seen as a contrasting mass in T2W
images. Paraneoplastic proliferation is also seen in ovarian
carcinoma.
93. A-F, B-T, C-T, E-T, E-F

Orbital hematomas are most common in the roof. Charaid al
metastasis are usually hyperimense in Tl and T2. but choroidal
melanomas are hyper in Tl and 10\v in T2.
94. A-F, B-T, C-T, D-F, E-T

The common lesions in lacrimal gland include pseudo tumour,
pseudolymphoma and lymphoma. These have to be differentiated
from epithelial tumors such as carcinoma. The inflammatory I
lymphoid lesions are d iffuse. with involvement of orbital and
palpebral part. oblong, with straight posterior margin. both
posterior and anterior extension, mold the orbital wall. scleral
enhancement, myositis of lateral retus. No flattening of globe I
fossa formation/sclerosis/calcification. But epithelial lesions are
seen only in the orbital part, round, round posterior border.
extends posteriorly but not anteriorly. erodes and destroys bone,
flattened globe, no scleral enhancement or myositis, Causes
flattening of globe/fossa formation/ sclerosis/ calcification.
95. A-T, B-T, C-T, D-T, E-F

Lymphoma is another cauase of Mickulicsz syndrome which is
characterized by enlargement of salivary and lacrimal glands.
96. A-T, B-F, C-T, D-T, E-T

Abscess and hematoma are other causes.
97. A-T, B-T, C-T, D-F, E-T

Lacrimal gland tumour occurs in the superolateral part.
98. A-F, B-T, C-T, D-T, E-T

Orbital varix. lymphangioma are other causes.
9 9. A-T, B-T, C-T, D-F, E-F

Rhabdomyosarcoma is the common cause.
100. A-T, B-T, C-T, D-F, E-T

These are also associated with bilateral cataracts. In Lowes
syndrome bilateral small globes with small orbit.
101. A-T, B-F, C-F,D-F, E-F

Muscle enlargement-maximal in lymphoma. Graves involves
multiple muscles. pseudo- single or multiple, lymphoma-single.
P ain-only in pseudotumour. tendon sparing only in Graves,
Lymphoma and pseudorumour are unilateral. Graves-bilateral.
Pseudotumour-young age. Graves-middle age, L:ymphoma-5,6.
decades.
J02. A-T, B-T, C-T, D-T, E-F
103. A-T, B-F, C-T, D-T, E-T

Parasellar chordoma, aneurysm and orbital lesions such as
mengioma, hemangioma. lymphoma are other cal!ses.
104. A-T, B-T, C-F, D-T, E-T

Radiation, osteomyelitis and osteopetrosis are other causes.
105. A-T, B-T, C-T, D-T, E-F

Lung is another common cause.
106. A-T, B-T, C-F, D-T, E-T

Another cause is idiopathic macropthalmia. Myopia is a common
cause. Hyperplastic primary vitreous causes small globe.
107. A-F, B-F, C-F, D-F, E-T

Vision is usually preserved till late. Most common o r b i t al
malignancy in children.
Common in supromedial portion. Posterior spread is not common.
10% arises from orbit.
108. A-T, B-F, C-T, D-T, E-T

Mean age is seven years. 90% survival after radiotherapy and 40%
survival after exanteration. Rhabdomyosarcoma is one of the rare
sarcomas to metastasise to lymph nodes. It also spreads to bones
and lungs.
109. A-T, B-T, C-T, D-T, E-T

Optic nerve gliorna and orbital sheath meningioma are common
causes.
110. A-T, B-T, C-T, D-F, E-T

Head and Neck-1 221
111. A-T, B-T, C-T, D-T, E-T

These are the commonest causes of opacity inside eye.
112. A-F, B-F, C-T, D-F, E-T
113. A-F, B-T, C-F, D-F, E-F

Optic glioma-well defined, calcification rare. heterogenous
mottled enhancement. no hyperostosis. widened optic canal.
kinked, buckled but smooth optic nerve, NF I. less than 5 years.
Meningioma-infiltrative, calcification. homogenous enhancement.
hyperostosis, widened optic canal not as frequent. straight optic
nerve, negative image of optic nerve within tumour. middle aged
women, not associated with NF.
114. A-T, B-T, C-F, D-F, E-F

Optic glioma is a low grade tumour. More common in females.
Proptosis is uncommon
115. A-T, B-T, C-T, D-T, E-F

The normal fovea is about 1. 5 mm in diameter. The retina is 0.
4-0. 14 thick. The nasal fibers cross in the chiasma, oass to the ootic
1 '
tract of the opposite side and end in the opposite side lateral
geniculate. The fibers from the superior aspect of the eye. pass
through the inferomedial aspect of the optic tract and those from
the inferior quadrant pass through the suprolateral portion.
116. A-T, B-F, C-T, D-T, E-T

The periosteum has tvvo layers. the superifical fibrous and inner
cambium. The periorbita or orbital fasica is a continuation of the
periosteal layer of the dura and the meningeal layer of the dura
continues as the optic nerve sheath. The orbital fascia is loosely
united with bone except at SOF, optic foramen. IOF and trochelar
fossa. The orbital septum is a fibrous layer of eylid and continues
with priorbita. The septum thickens to form tarsal plates. the
superior plate attaches to levator palpebrae superioris and inferior
tarsal plate to inferior rectus. The Tenons capsule is a fibroelastic
membrane covering the sclera and extends from the optic nerve
to the sclerocorneal junction and encloses th� posterior 4/5 th of
optic nerve. There is a potential space between it and sclera, which
is filled with loose areolar tissue. Continues with subarachnoid
and subdural space. The orbital fat is divided by septa into
peripheral orbital fat and central orbital fat.
117. A-T, B-T, C-T, D-T, E-F

Subpreiosteal hematomas, epithelial inclusion cys ts in the
conjunctive, dacryops, mucocele associated with bone defect are
also anechoic. Orbital cellulites. optic nerve glioma. lymphoma.

sarcoma. pseudotumour. hemangioma are all hypoechoic.
118. A-T, B-T, C-T, D-T, E-F

Dermoids and meningiomas are intermediately echogenic
119. A-F, B-?T, C-T, D-F, E-T
120. A-T, B-T, C-T, D-F, E-F
121. A-F, B-T, C-T, D-T, E-T
122. A-T, B-F, C-F, D-T, E-F

Extension to optic tracts is seen in 60-70%. Visual acuity is affected
earlier. Tl- iso. T2- hyper to muscle. NF is associated in 10-50%.
15% of NF- 1 have optic nerve gliomas.
123. A-F, B-T, C-T, D-T, E-F

l\1etastasis can involve any compartment of the orbit including the
bone. Graves opthal mopathy is the most common cause of
proptosis.
124. A-F, B-F, C-T, D-T, E-T

Trauma is another common cause.
125. A-F, B-T, C-F, D-T, D-F

T h e anterior extraconal space is more commonly involved.
Calcification is uncommon, unless radiotherapy is given. Smooth
indentation of lamina papyracea which is not destroyed. Non
Hodgkins and Burkitts are more common than Hodgkins.
126. A-F, B-F, C-F, D-T, E-F

Pseudotumour >hemangioma> lymphoma-causes of proptosis.
Systemic disease is uncommon\�;hen orbit is invovled and it usually
develops subsequently. Common in adults 50 years can affect any
part of orbit.
Exophthalmos is a very late feature.
127. A-T, B-T, C-T, D-F, E-T
128. A-T, B-F, C-F, D-T, E-F .

There is no correlation between the level of thyroid hormone and
ophthalmopathy. The volume of retroocular fat is increased due
to infiltration with mucopolysaccharide or collagen or glyco
protein. The fat is usually homogenous density, but may have
streaky high densities. The muscles are enlarged, but they can be
thin and stretched due to the high volume of retroocular fat.
129. A-F, B-T, C-F, D-T, E-F

Although Graves ophthalmopathy bilateral is majority of cases,
unilateral disease do occur. The thyroid hormones can be elevated,
Head and Neck-1 223
low or normal. In severe irreducible ophthalmopathy, the corn2a

can be affected.
130. A-T, B-T, C-T, D-F, E-F

Lacrimal gland. extraocular muscles{affects entire muscle including
anteiror portion). sclera and optic nerve are affected.
Optic nerve and sclera show intense contrast enhancement in CT.
The signal changes are similar to that of Graves in MRI.
Visual acuity is not affected. Painful ophthalmoplegia is the most
common symptom.
Response to steroids is used for confirming diagnosis.
131. A-T, B-T, C-T, D-T, D-F

Associated with other fibrosing disorders. Polyarteritis nodosa,
rheumatoid, SLE. sarcoid. Erdheim chester dise ase are other
associations.
132. A-F, B-T, C-F, D-F, E-F

Pseudotumour is the most common cause of orbital mass in adults.
Retinal astrocytoma is close to the optic disc.
Most common vascular tumour is capillary hemangioma.
Abscess is common in the medial wall. extending from adjacent
sinuses.
133. A-T, B-F, C-T, D-F, E-T
134. A-F, B-F, C-T, D-T, E-F

Decrease in vision is seen in 50%. Pulsatile exophthalmos. orbital
bruit and conjunctiva! edema are most common clinical features.
Laceration of intracavernous portion of internal carotid artery.
commonly by a fracture is the most common cause. Doppler shov..:s
arterial flow i n the superior opthalmic vein. Angio s h ows
incomplete wall of ICA and retrograde filling of veins.
135. A-F, B-F, C-T, D-T. E-T

Most common in the upper temporal quadrant followed by the
upper nasal quadrant. Erosion of orbit is produced by pressure
indentation. High signal seen due to fat.
136. A-F, B-F, C-F, D-F, E-F

Staphylococcus is the most comn:on cause. Mumps and other viral
infections are other causes. High intensity echoes can also be seen
in endophthalmitis but not as mobile as in haemorrhage. Most
common cause is direct entry of organism through trauma or
surgery.
Hemangioma is the most common benign tumour in adults. Orbiral
hemangioma is associated with tuberous sclerosis.
137. A-F. B-T, C-F, D-F, E-F

Coloboma is a defect in choroid/retina/iris/eyelid/macula/lens.
It is due to incomplete closure of choroidal fissure and starts at
6 we eks g e sta tional age. Associated with encephalocele.
Outpouching of vitreous occurs at the optic nerve attachment.
138. A-F, B-F, C-F, D-F, E-T

Optic nerve is usually stretched out and thinned. The optic nerve
sheath m a y be thickened. The inferior rectus> medial rectus>
superior rectus > lateral rectus. The anteriomeaial extraconal space
is commonly affected. The swelling affects the central belly of the
tendon. All structures in the orbit are affected by fatty
hypertrophy, edema and infiltration.
139. A-F, B-T, C-F, D-F, E-F

Tl-isointense, hyperintense if fatty infiltration, T2-hypointense,
Hyperintense if fatty infiltration or in acute stages. Ultrasound
- hyperechoic in relation to fat.
Colour Doppler- reversal of flow in superior opthalmic vein due
to compression by orbital infiltration in malignant exophthalmos.
HO. A-F, B-F, C-T, D-F, E-T

Cavernous hemangioma is most common in adults. It has large.
endothelium lined vascular spaces . There is no arterial supply to.
these lesions. Contrast enhancement is seen. There is no destruction
of adjacent structures but it indents the globe and it can compress
the optic nerve. Slow enlargemern is seen . It does not involute
like capillary hemangioma.
141. A-T, B-F, C-F, D-T, E-T

Lymphangiomas are lined by capillaries are common in children.
They are benign and they can cause expansion of the orbit, but
do not cause destruction. They are extraconal. Differentiating
hemangioma and lymphangioma is difficult. Hemangiopericytoma
is benign in 50% and malignant in 50%. The contrast enhancement
is intense and early than hemangiomas.
142. A-F, B-F. C-F, D-T, E-F

Schwannomas are not seen in the optic nerve which does not have
Schwann cells. It usually arises from oculomotor or trochlear or
abducens nerve and is intraconal. Persistent hyperplastic primary
vitreous is always seen eccentric to the disc. Fibrous dysplasia has
a characteristic appearance, with expansion, sclerosis and ground
glass appearance. Esthesioneuroblastoma arises from olfactory
groove and grows slowly. Squamous cell carcinoma from paranasal
sinuses produces the most extensive bony destruction.
Head and Neck-1 225
143. A-T, B-F, C-T, D-T, E-F

Enlarged superior orbital fissure. inferior orbital fissure. expansion
of orbit. pulsatile exophthalmos. buphthalmos. optic glioma.
perioptic meningioma. sphenoid wing dysplasia and p le xiform
neuro-fibroma are other manifestations of neurofibromatosis.
144. A-T, B-T. C-T, D-T, E-T

Retinal detach ment can be rhegmatogenous or traction or
exudative. Choroidal detachment is neoplastic or inflammatory.
Acute choroidal hematoma is hypo in Tl and TZ. choroidal
effusion is hyper in both sequences. The appearances of retinal
detachment depends on the amount of exudates and organization
of subretinal material. Choroidal detachment does not involve the
optic disk due to restriction of the anchoring posterior ciliar nerves
and arteries. Retinal detachment is seen as V shaped at the level
of lens, with the apex at the optic disc and the base at ciliary body.
Above or below the lens. detachment is seen as homogenous
increase in density.
145. A-T, B-F, C-F, D-F, E-F

Unidirectional anterior is most common. f o ll owed by
multidirectional anterolateral and anterolateral. Posterior is the
least common. Disk displacement should be confimed in closed
mouth view. Disk is displaced. if it is more than 10 degrees from
neutral position .
146. A-F, B-T, C-F, D-T, E-T

The TMJ has hyaline cartilage covering both articular surfaces.
The re is a biconcave disk. which has anterior band, anterior
attachment, central zone. posterior band, posterior attachment.
Anterior band attaches to articular eminence. condyle and capsule.
Posterior band attaches to vascular bilaminar zone. i'v1ediallv
.,,
and
laterally disk is attached to the capsule and condylar neck.
Anteromedially attached to pterygoid muscle.
147. A-F, B-T, C-F, D-T, E-F

Bilaminar zone i s situated posteriorly within the mandibular fossa.
The posterior translation of mandible is prevented by the lateral
ligament. Lateral pterygoid is involved in mouth opening along
with suprahyoid muscles.
148. A-T, B-F, C-T, D-F, E-T

Normal stapes is seen below the tympanic portion of facial nerve
and lateral semicircular canal. The width of middle ear is measured
from the promontory which overlies basal turn of cochlea to the
lateral wall and s h ould be atleast 3 mm.
149. A-T, B-T, C-T, D-T, E-T

Other causes are otoscler9sis. otosyphilis, metastasis, osteosarcoma
and osteopetrosis.
150. A-T, B-T, C-T, D-T, E-T,

Glomus tumour is the most common cause. It can be seen without
any abnormality in 20%.
Vascular variants, tumours and cholesterol granuloma are other
recognised causes.
151. A-T, B-T, C-T, D-T E-T

Glomus tumour is also seen in petrous temporal bone. Retroperi
t oneum is an uncommon location. It can be seen along the
Jacobsons nerve which is the tympanic branch of glossopharyngeal,
Arnolds nerve, (Auricular branch of X). vertical portion of facial
nerve in middle ear, bony canal from jugular foramen to middle
ear, along aorta and its branches. vagal body, ciliary body, adrenal
. m edulla, paraadrenal area, bladder.
152. A-T, B-F, C-T, D-F, E-T

M ulticentric in 10% . Histologically benign but extensive local
invasion. It can be inherited as an autosomal dominant form.
153. A-T, B-T, C-T, D-T, E-F
154. A-T, B-F, C-F, D-F, E-T

It arises from the tympanic plexus situated over the promontary.
It erodes the ossicles and presents very early as a small mass.
It is difficult to recognise in angiography due to the size.
Does not erode and inferior wall and is confined within the middle
ear.
155. A-F, B-T, C-F, D-T, E-T
156. A-T, B-F, C-T, D-T, E-T

Surfers ear is exostosis. Osteoma, ceruminoma, squamous cell
carcinoma, melanoma, adenoid cystic carcinoma, adenocarcinoma,
metastases are other cause.
157. A-F, B-T, C-T, D-T, E-T

Mucocele can be seen in the petrous apex.
158. AT, B-F, C-T, D-T, E-T

Trigeminal nerve schwannoma is recognised to happen in this
location. Apical petrositis is another cause.
159. A-F, B-F, C-T, D-F, E-T

The cochlear duct. extends from cochlea t o. open into the
subarchnoid space inferior to the internal auditory metus and filled
Head and Neck-1 227
with perilymph. The cochlear duct is commonly mistaken for

internal auditory meatus. The vestibular duct. with endolymphatic
sac and duct. arises from the posteromedial aspect of vestibule
and opens in the posterior surface of temporal bone.
160. A-T, B -F, C-T, D-F. E-T

The horizontal crista falciforrnis and vertical crests divide the IAM
into four compartments. Anterosuperior-facial nerve, inter
mediate nerve Anteroinferior-cochlear.
Posterosuperior-Superior vestibular Posteroinferior-lower
Inferior vestibular Lamina ciribrosa and vestibulocochlear nerve
lie laterally.
161. A-T, B-T, C-F, D-F, E-F

Pars flaccida cholesteatoma is more common than pars tensa. Pars
flaccida is the primary acquired and pars tensa is secondary
acquired cholesteatoma. Long process of incus is the first affected
ossicle
162. A-T, B-F, C-T, D-T, E-F

The lateral wall of attic. scutum and Prussaks space are involved
in the early stages.
163. A-T, B-F, C-F, D-T, E-T. F-F

The glomus jugulare tumour is situated in the jugular bulb. but
glomus jugulotympanicum extends into the middle ear. It is a non
chromaffin paraganglioma. It presents as a pulsatile mass with
inflammed vascular tympanic membrane. Salt and pepper
appearance is due to flow voids, seen best in MRI. It occludes
jugular bulb. either with thrombosis or as direct invasion. It is a
hypervascular mass. Malignant transformation is seen in �%.
Posterior auricular artery, internal carotid artery, occipital artery
and itnernal maxillary artery supply the jugular tumour.
164. A-T, B-F, C-F, D-F, E-T

Spread ocurs via eustachian tube into nasopharynx, along jugular
vein into posterior cranial fossa, along tegmen tympani into
middle cranial fossa floor, along round window into intrnal
auditory meatus. The differential diagnosis for a mass behind
tympanic membrane includes glqmus jugulare. glomus tympanicum,
aberrant carotid artery and high jugular bulb. CT can show
enlarged o·r normal jugular fossa.
Jugular fossa large with bone erosion-glomus jugulare
Jugular. fossa large with normal bone-high jugular bulb
Jugular fossa normal with normal carotid c anal-glomus
tympanicum.
Jugular fossa normal with lateral carotid canal-aberrant carotid

artery
Tolosa Hunt syndrome is involvement of III. IV, V, VI. Vernet
syndrome is involvement of IX. X and XI nerves.
165. A-F, B-F, C-F, D-T, E-F

Perforation is common in the posterosuperior quadrant of the pars
flaccida. Lateral semicircular canal is the most commonly affected.
Intracranial extension occurs after breach of the tegmen tympani
superiorly. Does not enhance with gadolinium. Iso /hypo to brain
in TlW.
166. A-F, B-F, C-T, D-F, E-F

The distance between tube and casette is usually 50-70 cm. Both
of these move in the same direction, but the cassette moves at a
slighly slower speed. Only structures in the image layer are in
. focus. all others being blurred. Patient can be sitting or standing
with immbolisation of head. Tongue is placed against palate to
prevent lucency in maxillary teeth. Lead aprons interfere with
movement of machine and can produce artefacts and there is no
significant reduction of radiation.
167. A-T. B-T, C-T, D-F, E-T, F-T

r\ormal facial nerve can enhance in the tympanic and mastoid
segments due to perineural aneriovenous plexuses. However
enhancement of the labyrinthine and imrameatal portions(due to
loss of blood -nerve barrier or venous congestion ) . is suggestive
of either infection or trauma. There is no correlation between the
intensity of enhancement and the disease severity. T2W images
show high signal in the geniculate ganglion and tympanic segment
of facial nerve only in chronic stages.
168. A-T, B-T, C-T, D-F, E-T

Sigmoid sinus thrombosis, neck abscesses, ossicular destruction.
facial nerve palsy, meningitis. are other complications. Bezolds
abscess is extension of infection along sternomastoid muscle from
the mastoid tip cells.
169. A-T, B-T, C-F, D-F, E-F

Tinnitus is non-pulsatile and ossciles are not destroyed.
The lesion is bright in Tl and T2 and non-enhancing.
170. A-T, B-T, C-F, D-T, E-F

Opacification of middle ear and gadolinium enhancement occur
in both conditions. Scutal erosion, ossicular erosion. expansion of
aditus to antrum, labyrinthine fistula and tympanic retraction are
seen only in cholesteatoma. The T2 signal intensity is slightly
Head and Neck-
· 1 229
different. In otitis it is bright and in cholesteatoma it is inter

mediate.
171. A-T. B-T. C-F. D-T.E-T.

Promontory is located over the basal turn of the cochlea.
172. A-T, B-T, C-F, D-F. E-T

Apical petrositis occurs in those with air cells in petrous apex.
w hich is 30%.
Clinically, Gradenigos syndrome seen. Ear discharge, retroorbital
pain (trigeminal N). VI nerve palsy. Pseudomonas and Enterococcus
most common causes. Fluid in middle ear,. mastoid. petrous apex,
destruction, enhancing mass.
173. A-T, B-F, C-T, D-T, E-T

Irreversible sensorineural hearing loss due to fracture passing
through apex of internal auditory canal. Townes view is the best
for diagnosis irreversible facial nerve palsy due to disruption of
nerve fibers. CSF rhinorrhoea as the tympanic membrane is intact.
174. A-T, B-T, C-F, D-T, E-T

Contrast enhancement in traumatic facial nerve palsy is seen even
before clinical symprnms are seen. and when seen is suggestive
of delayed onset of facial palsy. The vestibule vyill enhance if there
is labyrinthitis or trauma bur not in Bells palsy or genicula�e
ganglion infection.
175. A-F, B-T, C-F, D-T, E-F. F-F

There are two types. fenestral- involving oval window and
retrofenestral around cochlea. fenestral being more common .
. Otosclerosis involves only the endochondral layer of otic capsule,
which has periosteal and endosteal layers too. The involved bones
are of low density than normal, due to replacement by vascular
bone. Contrast enhancement can be seen. Conductive hearing loss
fixation of stapes to oval windo\v. Sensorineural loss- cochlear
involvement.
176. A-T, B-F, C-T, D-T, E-F

Incudostapedial joint is the weakest joint and easily dislocated.
Conductive hearing loss due to ossicular disruption. Stenvers view
is best for diagnosis. Facial nerve palsy mostly due to edema or
facial canal fracture and recovers spontaneously. CSF otorrhea due
to ruptured tympanic membrane.
177. A-F, B-T, C-T, D-T. E-T

Younger patients have conductive hearing loss and older patients
have either sensorineural or mixed loss. Conductive hearing loss
is either due to stapedial fixation/ fracture or ossicular fracture/
ankylosis. In Van Der Howe syndrome. there is OI. blue sclera

and hearing loss. Associated with otosclerosis and the hearing loss
can b e due to either of them.
178. A-T, B-T, C-T. D-T, E-F
179. A-F, B-T, C-F, D-T, E-T

This is a papillary adenomatoid tumour. seen in the mid-third of
endolymphatic sac at the hiatus of vestibular aqueduct, associated
with destruction of retrolabyrinthine petrous temporal bone. The
tumour has high signal due to methemoglobin or protein or blood
filled cysts. Associated with von Hippel Lindace disease.
180. A-T, B-T, C-T, D-T, E-T

Acoustic neuroma is the most common cause. Subarachnoid seeding
can occur here.
181. _A-T. B-T, C-T. D-T, E-T

Ossification occurs in infection. trauma and post surgical. Chronic
otitis media and cholesteatoma are most common causes.
182. A-T, B-T, C-F, D-F. E-T

External ear. middle ear and mastoid develop from the pharyngeal
p o uches and the inner ear develops separately from the otic
capsule. Inner ear can be involved in upto 30%. although it
develops separately. Usually unilateral and more common in the
right side. Family history can be seen in 15%. More common in
males, believed to occur due to viral illness o� teratogenic factors
during preagnancy.
183. A-T, B-F, C-F, D-T, E-T

Fusion o f malleus and incus is the most common ossicular
involvement and this is best assessed in the axial images. Tegmen
tympani is placed low than normal. Detailed assessment of ear is
deferred till 4-5 years when the temporal bone develops and atretic
plate can be assessed.
184. AT, B-F, C-F, D-F, E-T

There are only one and half turns of cochlea instead of the normal
two a n d half turns . The basal turn is always present. The
interscalar septum
. and spiral lamina are absent. resulting in fusion
of apical an� middle turns. Hearing loss is complete or it can be
unaffected, because development of auditory cells is variable.
185. A-T, B-F, C-F, D-T, E-F

Le Fort I-nasal septum, medial. anterior, lateral andposterior wall
of maxillary sinus, pterygoid plates- produces floating hard palate.
II- nasal septum. frontal process of maxilla. medial wall of orbit.
Head and Neck-1 231
orbital floor, infraorbital rim, anterior, lateral and posterior wall

o_f maxilla. pterygoid plates. Floating maxilla. Zygomatic arches
not involved.
III- in addition to type II, involves the lateral wall of orbit.
zygomatic arch, floating face.
186. A-F, B-T, C-F, D-T, E-T

75% are longitudinal and 25% are transverse. Longitudinal runs
parallel to long axis of petrous pyramid. Starts from squamous
temporal. passes through tegmen tympani. eac, middle ear and
foramen lacerum. Transverse fracture runs perpendicular to the
long axis of petrous pyramid. Starts from occpital bone, passes
across petrous pyramid. Incus is the commonly fractured ossicle.
being least a n chored. F acial nerve palsy is seen in 20% of
longitudinal and 50% of transverse fracture.
187. A-T. B-T. C-T, D-T, E-T

1. Differenti al diagnosis for multiple lesions in parotid gland:
A. AIDS.
B. Sjogrens syndrome
C. l'v1etastases
D. Hemangioma
E. Warthins tumour
2. Sialography:
A. Occlusal vievv· is required for submandibular sialography
B. Biting the catheter should be avoided
C. Lateral and AP films are the only films required in parotid
sialography
D. I\ o contrast should be introduced after pain is experienced
E. Post-drainage views demonstrate sialectasis better
3. Salivary glands are visualized using the following isotopes:

A. Tc pertechnetate
B. Ga citrate
C. Thallium chloride
D. I 131 MIBG
E. I 123 iodide
4. Thyroid scanning:
A. I 123 sodium iodide is not organified inside the thyroid gland
and is the best isotope for imaging
B. Tc pertechnate can be used for thyroid scanning
C. Sodium iodide and Tc pertechnate can be given orally or
·
intravenously
D. Imaging starts only after 24 hours in oral administration
E. Imaging performed after 3 hours in iv administration of
pe\technate
Head and Neck-2 233
5. Parathyroid scanning:
A. Tc pertechnate and 201 thallium subtraction is the most
common technique
B. It is preferable to use MIBI first when using subtracting image;:;
with pertechnate
C. MIBI washes early from thyroid than parathyroid
D. Delayed i m ages increase the sensitivity for visualizing
parathyro id glands
E. Tetroforsmin cannot be used for subtraction images
6. Pleomorphic adenoma:
A. Hyperintense in Tl due to mucoid matrix
B. Facial nerve is involved
C. Malignant transformation occurs
D. Seen before 50 years
E. Contrast enhancement homogenous
7. Salivary gland tumours:

A. 80% of parotid tumours are pleomorphic adenomas
B. Malignant tumours are common in minor salivary glands
C. Adenoid cystic carcinoma is rhe most common malignancy
D. 80% of salivary gland rumours are in the parotid g land
E. Hypointense capsule is seen in pleomorphic adenoma
8. Differential diagnosis of bilateral cystic lesions in parotid

glands:
A. Sjogrens syndrome
B. vVarthins
C. HIV
D. Parotitis
E. Polycystic disease
9. Adenoid cystic carcinoma:

A. Most common in submandibular gland
B. Hot in technetium scan
C. Perineural spread along facial nerve
D. Hypointense in TZ due to cellularity
E. Lung metastasis seen
10. Parotid tumours:

A. Hemangiorna is the most common paediatric mass
B. Lymphoepithelial cysts can be hypo or iso or hyperintense in
TlvV images
C. Oncocvtomas are hot in Tc99m scans
J
D. Lyrnphoepithelial cyst is due to sialadenitis

E. 1v1etastasis spares the parotid gland
11. Warthins tumour:

A. Cold in Tc99m scan
B. · Intense contrast enhancement
C. High signal in Tl W images
D. Focal hyperintense areas are seen in TZW
E. Bilateral in 50%
12. The following techniques are helpful in evaluation of head and

neck tumours:
A. Puffing cheek B. Valsalva maneuver
C. Phonation D. Phonation
E. Deglutition
13. Parotid gland:

A. Accessory parotid gland is seen in 20% of individuals
B. Increased risk of carcinoma in Sjogrens disease
_ C. Parotid gland shows more fat in children than adults
D. Accessory gland drains via accessory duct in majority of cases
E. Snowstorm appearance is specific for Sjogrens syndrome
14. Branchial cleft cysts:

A. There are six types of branchial cleft cysts
B. Sinuses associated with the cysts are seen usually internal and
medial to the cysts
C. Type 3 is the most common type of branchial cyst
D. Branchial cyst has clear internal contents
E. Type 1 cyst connects directly with the external auditory canal
15. Branchial cleft cysts:

A. First-situated close to the internal carotid artery
B. Third- close to the recurrent laryngeal nerve
C. Fourth-close to the laryngeal ventricle
D. Second type 1- anterior to sternocleidomastoid
E. Second type 3- pharyn geal wall
16: Congenital abnormality of ear:

A. Most common isolated congenital ossicular abnormality is
incudostapedial discontinuity
B. If there is no CT evidence for congenital conductive deafness,
stapedial fixation should be suspected
C. Vestibular aqueduct is considered enlarged only when it is
more than 3mm
D. Large vestibular aqueduct produces acute onset hearing loss
in a preexisting fluctuating hearing loss ·
E. Sensorineural loss with calcified cochlea indicates meningitis

as the cause
Head and Neck-2 235
17. Parotid gland:

A. Is involved in 60% of cases of sarcoidosis
B. If involved, indicates a good prognosis in HIV
C. Lymphoepi t h e lial cysts show posterior enhancement in
ultrasound
D. Presence of necrotic nodes indicates tuberculosis than pyogenic
parotitis
E. In HIV. the cysts are more often solitary than multiple
18. Parotid gland:

A. The most common disease of parotid in children is hemangioma
B. Hemophilus influenzae is the most common cause of suppurative
adenitis in children
C. Lymphoma is more common in the submandibular gland than
parotid gland
D. Squamous cell carcinoma is the most common malignancy in
children
E. Lymphoma in parotid is under the group of mucosal associated
lymphoid tissue related lymphoma (MALT).
19. Parotid lesions in children:

A. The most common multiple tumour is lymphoma
B. Warthins shovvs low uptake in rhallium 201
C. Warthins is more common in the tail of the gland
D. The appearance of pleomorphic adenoma depends on the size
E. Treatment of choice for pleomorphic adenoma is enucleation
20. Coronal CT anatomy of paranasal sinuses:

A. Onodi cell is seen above the level of sphenoid
B. Onodi cell is a posterior ethmoidal cell
C. Paradoxically curved middle turbinate is seen in 20%
D. Sphenoid sinus infection will produce trigeminal neuralgia if
the groove for the V second division projects ir.co the sphenoid
sinus
E. Pneumatosed uncinate process obstructs the infundibulum in
100% of cases
21. Sinusitis:
A. Complicating common cold is seen in 10%
B. Air fluid level is specific for acute sinusitis
C. CT scan shows hyperdense secretions in chronic sinusitis
D. MRI is hyperintense in both Tl and T2 in acute sinusitis
E. In chronic sinusitis, MRI is hypo in Tl and hyper in 12
22. Masses in the paranasal s inu ses:

A. Mucocele B. Inverting papilloma
C. Vv'egeners D. Retention cyst
E. Osteoma
23. Causes for dense sinus secretions:

A. Fungal sinusitis
B. Haemorrhage
C. Inspissated secretions
D. Chronic sinusitis
E. Cystic fibrosis
24. Sinus opacification with destruction of bone:

A. Polyp
B. Aneurysmal bone cyst
C. Esthesioneuroblastoma
D. Hemangioma
_ E. Fibrous dysplasia
25. Opacification of sinus without destruction of bone:

A. Ameloblastoma
B. Dentigerous cyst
C. Hypoplastic sinus
D. Inverting papilloma
26. Types of sinusitis:

A. Infundibular pattern-frontal sinus affected
B. Osteomeatal unit -only maxillary sinus affected
C. Sphenoethmoidal recess- most common pattern
D. Sinonasal polyposis-all sinuses affected
E. Thickening of adjacent bone seen in sinonasal polyposis
27. Sinusitis:
A. Mucosa is thickened when it is more than 3 mm
B. Protein concentration more than 10% will give hypointense
signal in both Tl and T2
C. Chronic sinusitis will show peripheral contrast enhancement
D. Allergic sinusitis is bilaterally symmetrical
E. Uniform enhancement indi�ates bacterial sinusitis
28. The following are complications of sinusitis:

A. Meningitis
B. Sinus thrombosis
C. Orbital cellulitis
D. Mucocele
E. Otitis media
Head and Neck-2 237
29. Si n u siti s :
A. Fungal sinusitis is very bright in T2weighted images
B. Calcification is characteristic of fungal sinusitis
C. Candida is the most common fungal organism
D. Can be infiltrating or fulminant
E. Beta hemo lytic Streptococcus is the most common organism
causing bacterial sinusitis
30. Inverted papilloma:

A. Associated with human papilloma virus .11
B. Associated with squamous cell carconima
C. Usually bilateral
D. Arises mainly from the nasal septum
E. Ethmoid i s the commonly involved sinus
31. Inverted papilloma:

A. Very vascular tumour
B. More common in females
C. Children commonly affected
D. Septum is invaded
E. Destroyed lamina papyracea
32. Mucocele:
A. High incidence in cystic fibrosis
B. Proptosis is the most common clinical presentation
C. i'v1ost common in the ethmoidal
D. Sphenoid is the least commonly affected
E. Calcification is seen in 5%
33. C arci noma PNS:

A. Most common in the maxillary sinus
B. Adenocarcinoma is the most common type
C. Frequent sinusitis is a predisposing factor
D. Bone expansion is common than destrucrion
E. tv1ajority are over 40 years
34. Nasopharyngeal carcinoma

A. Most common in chinese
B. Epstein Barr virus is the etiological factor
C. Juvenile nasopharyngeal angiofibroma is a predisposing factor
D. Extends through foramen lacerum
E. Extends to middle ear through sinus of Mrogagni
35. Inverted papilloma of nasal cavity:

A. 10% undergo malignant transformation
B. High signal intensity in T2 and low in Tl
C. Surgery is curative
D. Commonly occurs after nasal surgery
E. Widened infundibulum is seen
36. Nasopharyngeal carcinoma:

A. Asymmetry in the aeration of the Fossa of Rosenmuller is a
very sensitive, but non-specific sign of cancer
B. Obliteration of the fat stripe between tensor and levator
palatini is highly sensitive
C. High signal in mastoids and middle ear can be seen
D. Adenoids should not measure more than 5 mm in adults
E. Enhancement of paravertebral muscles indicates involvment
37. Juvenile nasopharyngeal angiofibromas:

A. Origin is from fossa of Rosenmuller
B. Forward displacement of posterior wall. of maxillary antrum
is very specific
C. Destroys the medial pterygoid plate
D. Direct vascular supply from internal carotid artery
E. Never seen in females
38. Juvenile nasopharyngeal angiofibromas:

A. Biopsy is the definitive diagnostic procedure
B. Embolisation is curative
C. The extent of tumour in infratemporal fossa is important in
surgery
D. The tumour is highly aggressive malignant tumour
E. The signal intensity is homogenous in all MR sequences
39. Nasopharygeal carcinoma:

A. Deafness is a clinical presentation
B. Epstein Barr virus infection is a predisposing factor
C. Originates from the sphenopalatine foramen
D. Asymmetry i n the Fossa of R o s enmuller is the earliest
radiological finding
E. CT is superior to MR in assessment of lymphatic spread
40. Mucocele of sinuses:

A. Irregular margin is seen in CT
B. Most common in sphenoidal sinus
C. Increased signal is seen in Tl MRI
D. Enhances with Gadolinium
E. 10% occur in frontal sinus
4L Salivary glands:
A. Pleomorphlc adenomas are commonly seen in the deep lobe
of the parotid
B. Dynamic contrast enhanced CT scans are helpful in identifying
facial nerve
C. Parotid is of greater attenuation than masseter on unenhanced
CT scans
Head and Neck-2 239
D. Pleomorphic adenoma is most common in the submandibular

gland
E. Takes up pertechnate
42. Salivary glands:

A. Stones are more common in the parotid than submandibular
ducts
B. 80% of submandibular stones are seen in X-rays
C. Sialography can be done in acute febrile sialoadenitis
D. Sialography can differentiate sialdenitis from calculus
E. Submental gland is not visualised by sialography
43. Cystic hygromas:

A. Diagnosed antenatally
B. Usually multiloculated
C. Abnormal lymphatic development
D. 10% extend into superior mediastinum
E. Associated with high B HCC levels in maternal serum
44. Cystic lesions of the jaw:

A. Dentige rous cysts occur adjacent to the crown of an unerupted
molar
B. 20% of cysts are periodon t al cysts
C. Residual dental cysts occur in edenrulous pat ients
D. Giant cell reparative granuloma occurs in a younger age group
than giant cell tumours
E. Giant cell reparative granuloma occurs adjacent to decayed
teeth
45. Parotid tumours:

A. Sial ography is useful to differentiate from ben ign and
malignant tumours
B. Sialectasis is seen in parotid tumours
C. Salivary duct stones are associated with squ a mous cell
carcinoma
D . Pleomorphic adenomas shO\v increased density in compariSDn
to the normal gland in CT
E. The most common parotid malignant tumour is mucoepi
dermoid carcinoma
46. Carotid artery dissection:

A. ivfajority occur at the level of C3-4
B. Accounts for 10% of stroke in persons 40- 60 years
C. 1 /3rd are multiple
D. Bilateral in 15%
E. Vertebral artery is involved in 20%
4 7. Carotid dissection:
A. Horners syndrome is a clinical presen tation
B. Bruit is seen in 95%
C. Headache is more common than neck pain
D. Immediate surgery is mandarory
E. The dissection reconstitutes at level of carotid canal
48. Carotid ste nosis:

A. Significant stenosis is more than 50% reduction in cross
sectional area
B. 40% incidence of stroke with significant steno.sis
C. 10% of stroke in non significant stenosis
D. 2% incidence of stroke follo\ving endarterectomy
E. The stenosis is progressive in 25%
49. The following are clinical indications for carotid artery doppler:
A. Retinal cholesterol embolus
B. Family history of stroke
C. Historv of stroke
J
D. Before maj or heart surgery

E. Plaque monitoring
SO. A ssociations of carotid dissection :

A. i\.farfans B. Ehler Danlos svndrome
J
C. Ankylosing spondylitis D. Smoking

E. 1\-hgraine
51. Oropharyngeal carcinoma:

A. Involvment of preepiglottic fat. warrants laryngectomy
B. Even if tumour abuts the mandible, it has to be resected
C. Invasion of prevertebral muscles makes it inoperable
D. Atrophy of the masticator muscles indicates invasion of
pterygopalatine fosssa
E. CT is more effective in staging for oropharyngeal carcinoma
52. Differential diagnosis of nasopharyngeal masses:

A. Adenoids B. Lymphoma
C. Polyp D. Neuroma
E. Tuberculosis
53. Channels in pterygopalatine fossa and their routes of spread:

A. Posterosuperioly through superior orbital fissure
B. Greater palatine canal into skull
C. Pterygoid canal-posterosuperior extension
D. Foramen rotudum-extends into middle cranial fossa
E. Lateral extension is through pterygomaxillary fissure
Head and Neck-2 241
54. Neck:
A· The only aerodigestive cancer to encase the carotid artery is
glottic carcinoma
B· The only extralaryngeal primary tumour to infiltrate thyroid
and cricoid cartilage is a hypopharyngeal carcinoma
C. Hypopharyngeal carcinoma is frequently associated with
subglottic carcinoma
D· A central density with surrounding hypodensity in a sinus
mass excludes tumour
E· Invasive sinusitis can extend to the soft tissue of the cheek
55. Differential diagnosis of masses in the nasal vault:

A. Inverted papilloma
B. Hemangioma
C. Granuloma gravidarum
D. Pyogenic granuloma
E. Metastases
56. Temporomandibular joint:

A. There is communication between the superior and inferior jcint
compartments
B. Rotational movements occur in the superior joint
C. The articular disc is biconca\·e in sagittal plane
D. The mid-portion of disc lies anterior to the mandibular c o n dyle
E. The posterior attachmern to condyle is tightly attachec
57. rv'lasses in the pharyngeal mucosa! space:

A. Retention cyst
B. Thornwaldt cyst
C. Tonsillar abscess
D. Minor salivary gland tumour
E. Lymphoma
58. Air containing masses in neck :

A. Laryngocele
B. Branchial cleft cyst
C. Tracheal diverticulum
D. Retropharyngeal abscess
E. Lateral pharyngeal diverticulum
59. Causes of calcified lymph nodes in the neck:

A. Metastasis from mucinous adenocarcinoma
B. Thyroid metastasis
C. Ly}T1phoma before radiation
D. Castleman disease
E. Tuberculosis
60. Neck lymph nodes:

A. Nodes larger than 15 mm a r e neoplastic unless proven
otherwise
B. Rounded nodes are more likely to be benign than oval shaped
C. Central necrosis in a normal sized lymph node is m.=lignant
D. Fat indicates benign nature of lymph node
E. N odes are bright in T2vV images
61. Carotid stenosis:

A. 40% reduction of stroke at 2 years in patients \Vith significant
stenosis after endarterecromy
B. 10% rhk of neurologic deficit in carotid endarterctomy
C. !v1onality is 1 % \.Vith carotid endanerectomy
D. Severity of stenosis is graded according to reduction in cross
sectional area
E. The Doppler should ah\'ays be done on both sides
62. Neck spaces:

A. A lymph node in the retropharyngeal space makes the tumour
inoperable
B. A leison in prevertebral space al\�.:ays involves the vertebral
body
C. Lesion in prevenebral space displaces the carotid sheath
laterally
D. A paraphagyneal space lesion displaces the medial pterygoid
laterally
E. The parotid space lesion can be differentiated from a
parapharyngteal mass lesion by presence of a rim of praotid
in the mass
63. The following are hypercellular tu mours in the neck:

A. Lymphoma
B. Thyroid carcinoma
C. Angiosarcoma
D. Hemangioma
E. Metastasis from renal carcinoma
64. The following lesions produce high signal in Tl W images:

A. Cholesteatoma
B. Tornwaldt cyst
C. Endolymph sac tumours
D. Branchial cleft cyst
E. Lymphoma
Head and Neck-2 243
65. Neck masses:

A. In Tl W images. proteinaceous fluid initially has low signal and
there is sustained progressive rise in signal with no fall
B. Psammoma bodies are seen in thin section CT scans
C. In dynamic curve after contrast enhancement. paraganglioma
is the only tumour that shows a dip at 20-50 sec
D. Contrast enhancement of enlarged cranial nerves indicates
invasion
E. If vessels are i n volved more than 90 degrees. they are
inoperable
66. Lesions which show intermediate signal in T2W i mages:

A. Lymphoma B. Schwannoma
C. Warthins tumour D. Inverted papilloma
E. Minor salivary gland tumour
67. Laryngocele:
A. Commonly seen between the false and true vocal cord
B. External type extends through thyrohyoid membrane
C. External type presents as a neck mass near the thryoid
cartilage
D. Bilateral in 80%
E. Decreases in size during Valsalva manoeuvre
68. Predisposing factors for laryngocoele:

A. Chronic granulomatous disease
B. Larynge� cancer
C. Glass blowing
D. Laryngeal papillomatosis
E. Excessive coughing
69. Neck nodes:

A. Necrotic nodes indicate squamous cell carcinoma
B. MRI is more sensitive than CT for demonstrating necrosis
C. Contrast enhancement and fat suppression
_ incri:ases sensitivity
for MRI
D. Lymph nodes can show rim enhancement
E. All necrosis shows low signal in Tl and high in T2
70. Neck lymph nodes, ultrasound imaging:

A. 50% of nodes in malignant primaries are usually benign lesions
B. A lymph node with longitudinal/transverse ratio. more than
2, is likely to be malignant
C. Size criteria has a sensitivity of only 50%
D. The nodes are more heterogenous in malignancy
E. The density of the node in CT scan is a good correlation 1.,vith
the N stage of the disease
71. Neck lymph nodes:

A. Necrosis more than 3 mm is indicative of malignancy
B. If ultrasound of the node, shows fat in the hilum, it is
suggestive of malignancy
C. Necrosis is best seen in T2 weighted images
D. The pulsatility index is high in metastatic nodes
E. Resistivity index is low in metastatic nodes
72. Cervical lymph nodes:

A. Contrast e nhanced ultrasound shows predominantly central
vessels in malignancy
B. Peripheral vessels are prominent in metastasis
C. Contrast ultrasound is useful for borderline nodes
D. Obliteration of fat plane around node is always abnormal
E. If a structure is completley surrounded by nodal mass. it is
fixed.
73. ·Lymph nodes in neck and their characterisation:

A. Large homogenous lymph node- Sarcoidosis
B. Total uniform enhancement- Kaposis sarcoma
C. Calcifcation- Thvroid carcinoma
J
D. \1ultiple nodes \Vith varied appearance-Thyroid carcinoma

E. Bilateral nodes with unknown primary-Tongue
7 4. Postoperative neck:
A. Baseline scan after surgery is done in six months
B. If a patient is free of recurrence after two years. he is not
followed up further
C. 90% of recurrences occur in the first year
D. Recurrence after surgery occurs in the center of the tumour
bed
E. Recurrence at the primary site is always more than that at nodal
site
75. Causes of cyst in aryepiglottis:

A. Retention cyst
B. Dermoid cyst
C. Cystic hygroma
D. Lymphangioma
E. Thyroglossal cyst
76. Common congenital cysts in the neck:

A. Parathyroid cyst B. Bronchogenic cyst
C. Second branchial cyst D. Thymic cyst
E. First branchial cleft cyst
Head and Neck--2 245
77. Causes of enlarged epiglottis:

A. Angioneurotic edema
B. Radiation
C. Aryepiglottic cyst
D. Crou p
E. Stevens Johnson syndrome
78. The following are common tracheal tumours:

A. Adenoid cystic carcinoma
B. Carcinoid
C. Adenocarcinoma
D. Squamous carcinoma
E. Mucoepidermoid carcinoma
79. Vocal cord paralysis is seen in:

A. Arnold Chiari malformation
B. Vacsular ring
C. Thyroidectomy
D. Intracranial tumour
E. Bronchogenic cyst
80. Differential diagnosis of prevertebral space mass:

A. Chordoma
B. Neurofibroma
C. Osteomyelitis
D. Metastases
E. 1vfeningioma
81. tvlasticator space masses :

A. Squamous cell carcinoma
B. Periodontal abscess
C. Sarcoma
D. Accessory parotid gland
E. Benign masseteric hypertrophy
82. Causes of carotid space mass:

A. Paraganglioma B. Jugular vein thrombosis
C. Neurofibroma D. Non-Hodgkin's
E. Branchial cleft cyst
83. Carotid space le sion s:

A. Schwannomas can affect only the vagus nerve in the neck
B. Intermediate signal in Tl and high signal in T2 is seen in
schwannoma
C. Neurofibromas have a capsule
D. N eurofibromas can show fluid values in non enhanced CT
E. Neurofibromas are brighr in T 1 'vV images
84. Paragangliomas:
A. Multiple in 5%
B. Family history seen in 30%
C. Splaying of carotids is specific
D. Permeative pattern of destruction of jugular foramen in glomus
jugulare
E. Salt and pepper appearance in MRI is pathognomonic
85. Paragangliomas:
A. Grow at the rate of 5 mm per year
B. The carotid bifurcation is shifted anteromedially by carotid
body tumour
C. Paragangliomas show incorporation of vessels into the mass
rather than displacement, in comprison with schwannoma
D. Schwannoma show homogenously hyperdense lesion in
contrast enhnced CT scans
E. In dynamic contrast scans. there is early drop in contrast
enhancement in paraganglioma
86. Common causes of retropharyngeal space mass:

A. Abscess
B. Lymph nodes
C. Hemangioma
D. Lipoma
E. Direct invasion by squamous carcinoma
87. The following masses are common in the parapharyngeal region:

A. Second branchial cleft cyst
B. Parotid tumours
C. Lymph nodal masses
D. Hemangioma
E. Neurofibromas
88. Cystic hygroma of the neck is associated with:

A. Fetal alcohol syndrome
B. Turners
C. Downs
D. Achondroplasia
E. Hurlers
89. Cystic hygroma:

A. 80% associated with chromosomal abnormality
B. 60% seen by 2 years
C. Alphafetoprotein elevated
D. Blocked lymphatic drainage is the pathology
E. Shows rapid increase in size
F. 75% are seen in posterior triangle
Head and Neck-
·2 247
90. Toxic multinodular goitre:

A. Toxic multinodular goitre is also called Plummers disease
B. I-123 is better for imaging thyroid than I -131
C. Normal range uptake in a patient with thyrotoxicosis with
suppressed TSH. suggests toxic multinodular goitre
D. The high energy gamma rays of I-131 are used in treatment
of toxic multinodular goitre
E. The half life of I-123 is 2 days
91. Perineural spread of tumour is seen in:

A. Lymphoma
B. Chordoma
C. Squamous cell carcinoma
D. Adenoid cystic carcinoma
E. Chondrosarcoma
92. Histiocytosis of temporal bone:

A. Middle ear less affected
B. Occurs in children more than adults
C. Commonly affects the external auditory meatus
D. Erosion of petrous apex is caused
E. Hyperostosis is associated
93. Blunt trauma:

A. Common carotid is commonly involved
B. Hyperextension rotation injury is the common injury causing
this
C. Carotid sinus fistula occurs in 4%
D. In dissection, anticoagulation is used
E. 40% have bilateral carotid injury
94. Thyroid gland:

A. Ultrasound is very sensitive for pathological characterization
B. Scintigraphy is superior for thyroglossal cyst
C. Calcification is suggestive of benign lesion
D. Ectopic thyroid tissue is best looked at with scintigraphy
E. Ultrasound can differentiate benign and malignant nodule
95. Cystic hygroma:

A. Webbed neck
B. High signal intensity in T 1
C. Solid component indicates malignancy associated
D. Fluid fluid level
E. Does not compress adjacent structures
96. Carotid body tumour:

A. Derived from neural crest cells
B. Chromatin positive granules seen
C. The tumour is mobile laterally and vertically
D. Malignant transformation seen
E. Seen just lateral to the bifurcation
97. Prominent pyramidal lobe of thyroid is seen in:

A. Thyroiditis
B. Hypothyroidism
C. Normal variant
D. Malignancy
E. Thyroid cyst
98. Cysti c hygroma:

A. 1 /3d die intrauterine
B. 100% mortality if associated with hydrops
C. Spontaneous regression is seen
D. 10% healthy living children
E. Lesions in axilla have a good prognosis
99. Normal uptake of I 131 is seen in the fo llowing structures:

A. Breasts B. Colon
C. Bladder D. Liver
E. Stomach
100. Increased uptake in thyroid scan is seen in:

A. Late Hashimatos
B. Lithium toxicity
C. Secondary toxic goiter
D. Withdrawal of anithyroid drugs
E. Iodine deficiency
101. Thyroglossal duct cyst:

A. 65% are suprahyoid
B. Presence in the hyoid can occur only with erosion of a supra
or infrahyoid lesion
C. Constitutes 70% of congenital neck masses
D. Embedded in infrahyoid strap muscles
E. Peripheral enhancement is seen in CT scans
F. There is··no uptake in the thyroid scans
102. Decreased uptake in thyroid scan is seen in:

A. Subacute thyroiditis B. Carcinoma of thyroid
C. Iodine treatment D. Thyroxine treatment
E. Carbimazole treatment
Head and Neck-2 249
103. Hot thyroid nodule is common in:

A. Adenoma
B. Cancer
C. Th yro i ditis
D. Lymphoma
E. Parathyroid tumour
104. Cold nodule is common in:

A. .tvlalignancy B. Abscess
C. Parathyroid tumour D. Cyst
E. Lymphoma
105. Thryoid:
A. Cold nodule in Graves disease is likely to be malignant
B. Solitary cold nodule in nuclear medicine are multiple in 10%
of ultrasound
C. Cold nodule is isoechoic in ultrasound in 50% of cases
D. A �olitary cold nodule is malignant in 45% of cases
E. 15% of multiple cold nodules are malignant
106. Thyroid carcinoma:

A. Follicular carcinoma-20-30.
B. Papillary carcinoma-hemarngenous spread
C. Anaplastic carcinoma-worst prognosis
D. Papillary carcinom A-early tracheal compression
E. Follicular-bony metastasis
107. Thyroid carcinoma:

A. Radiation carcinoma takes atleast five years to develop
B. Atleast 6. S rads are required for radiation carcinoma
C. The nodule is usually semisoft
D. Ill defined border
E. Haemorrhage and necrosis
108. Medullary carcinoma thyroid:

A. Seen in iv1EN I and II
B. Arises from parafollicular cells
C. Arises around 60 years
D. Early spread to lymph nodes
E. Elevated calcium
109. Medullary carcinoma thyroid:

A. Decreased calcitonin
B. Decreased uptake in technetium and radio-iodine scan
C. Increased uptake of thallium 201
D. 90% survival without nodal metastasis
E. Hypodense in CT scan
110. Papillary carcinoma th yroid:

A. Commonly mixed with follicular elements
B. Peaks in the fifth decade
C. Thyroglobulin is produced by the cancer
D. Concentrates radioiodine
E. Heterogenous mass
111. Scinti scan for metastases:

A. Bone scan is better than iodine scan for detecting bony
metastasis
B. False negative scan in 25%
C. Tc 99m pertechnate is useful
D. Thyroidectomy has to be done for assessing metastasis
E. Post-therapy scan identifies more lesions than diagnostic scan
112. Complications of radiation therapy to thyroid carcinoma:

A. Pulmonary fibrosis B. Thyroiditis
· C. Parotitis D. Leukemia
E. Anaplastic carcinoma
113. Anaplastic carcinoma:

A. Invades carotid artery B. Invades larynx
C. 60% calcify D. 5% 5 year sun·ival
E. Lymph nodal spread is uncommon
114. T hyr oid cancer:

A. Incidental discovery of cancer in surgeries for benign disease
in 25%
B. 40% of multiple cold nodules have thyroid cancer
C. Benign disease are more common in radiation thyroid disease
D. Papillary carcinomas are l� than 1 cm
E. Gallium scan is useful for differentiating lymphoma from
thyroid carcinoma
115. Follicular carcinoma of thyroid:

A. Produces thyroglobulin
B. Cytology differentiates follicular adenoma and carcinoma
C. Accumulates pertechnate
D. Miliary metastases to lung
E. 90% 10 year survival even with slight vascular invasion
116. Hashimatos thyroiditis:

A. Predisposes to lymphoma thyroid
B. Presents with hyperthyroidism
C. Hypothyroidism in early stages
D. Painful enlarged gland
E. Females are commonly affected than males
Head and Neck-2 251
117. Hashimatos thyroiditis:

A. Cold nodules seen B. Prominent pyramidal lobe
C. Patchy tracer uptake D. Low tracer uptake
E. H yperemi a in doppler
118. Dequervains thyroiditis:

A. Tender grossly enlarged gland
B. H igh radioi odine uptake
C. Can cause permanent hypothyroidism
D: Viral prodrome is seen
E. H yperthyroidism is common than hypothyroidism
119. Right recurrent laryngeal nerve palsy:

A. Epi glott is i s displaced to the right
B. The right laryngeal ventricle is larger than the left
C. The right vallecula is larger than the left
D. Produces hoarseness of voice and called Ortners syndrome
E. Th yroartyenoid
120. E ctopi c parathyroid is seen in:

A. Behind esophagus B. Carotid sheath
C. Parotid gland D. Thymus
E. Inferior mediastinum
121. Hyperparathyroidism:
A. 85% is due to hyperplasia
B. For adenomas, all the glands are removed
C. In subtotal parathyroidectomy two glands are removed
D. 95% success i n surgery without pre operative localisarion
E. Preoperative imaging is done to avoid re operation
122. Parathyroid scans:

A. 201 Thallium is selectively taken by parathyroid glands
B. Tc- Th subtraction scan can identify adenomas less than 300 mg
C. The scan localises 40-80% of adenomas
D. Adenomas are more common in the superinr parathyroid
gland
E. Combined imaging can localise 100% of adenomas
123. Ultrasound for parathyroid:

A. Any visualised parathyroid is abnormal
B. Adenomas are ovoid along the horizontal direction
C. If only one o r two glands are involved, it is likely to be
adenoma than hyperplasia
D. Adenomas are hypervascular in doppler
E. Homogenous appearance in adenomas
124. The following are commonly confused for parathyroid adenomas

in ultrasound:
A. Thyroid nodule
B. Recurrent laryngeal nerve
C. Vagus nerve
D. Longus colli muscle
E. Esophagus
125. Common causes of Homers syndrome:

A. B ronchogenic carcinoma
B. Syringomyelia
C. Temporal arteritis
D. Increased sweating on the affected side
E. Constricted pupils
126. Features of acquired cholesteatoma:

A. E rosion of auditory ossicles
- B
. Erosion of lateral semicircular canal
C. \Vell defined erosions with no sclerosis
D. Painful ear
E. Hyperdense on CT
127. Mucocele of the frontal sinus:

A. \Nell defined mass isodense with the brain is seen on CT scan
B. Enhances uniformly on contrast administration
C. Increased density of the affected sinus
D. Expands to involve the adjacent ethmoidal sinus
E. Progressive unilateral proptosis is produced
128. The following are predisposing factors for sinusitis:

A. Septal deviation
B. Concha bullosa
C. Paradoxical turbinate
D. Haller cells
E. Pneumatised uncinate process
Head and Neck-2 253
ANSWERS
L A-T, B-T, C-T, D-F, E-T
Multiple cystic lesions are seen in HZV I AID.
2. A-T, B-F, C-F, D-T, E-T

Parotid-AP, lateral and lateral oblique views, Submandibular
occlusal, lateral and lateral oblique views. Biting the cathether will
help i n retaining the catheter.
3. A-T, B-T, C-F,D-T, E-T

Tc pertechnate is the most common isotope used for evaluation
of salivary glands.
4. A-F, B-T. C-F, D-T, E-F

Both pertechnate and I-123 Sodium iodide are taken up into the
thyroid by active transport, but after that sodium iodide is
organified but pertechnate is not. Pertechnate is given intra
venously and images are acquired after 15 minutes. Sodium iodide
can be intravenously administered and images acquired after 3
hours or given orally and images acquired after 24 hours.
5. A-F, B-F, C-T, D-T, E-F

Technetium pertech nate is taken up by thyroid . \IIBI and
tetrafosmin are taken up by both thyroid and p arathyroid.
Subtraction will yield parathyroid images. Csually Technetium
pertechnate is given first. and :VIIBI can be given within 30 minutes.
( if MIBI is used first. pertechnate has to wait for several hours
till MIBI is washed out).
6. A-F, B-F, C-T, D-F, E-F

The lesion is very hyperintense in T2 , due to mucoid matrix.
Malignant transformation can occur. Facial nerve involvement
indicates malignancy. Seen after 50 years. Contrast enhancement
is heterogenous due to presence of epithelial and myoepithelial
cells.
7. A-T, B-T, C-F, D-T, E-T

Mucoepidermoid carcinoma is the most common malignancy.
Capsule is not always seen.
8. A-T, B-T, C-T, D-T, E-T

Multiple lymph nodes due to infection or tumour is another
common cause.
9. A-F, B�F. C-T, D-F, E-T

Most common in minor salivary glands(30%) than submandibular
gland (15%)
Cold in technetium scan. Very aggressive tumour with perineural

spread into skull along facial nerve. Hyperintense in T2 due to
cellularity. Lung. liver. cervical nodes. bony metastasis.
10. A-T, B-T, C-T, D-T, E-F

Lymphoepithelial cyst is either due to sialadenitis or due to reactive
nodal changes.
11. A-F, B-F, C-T, D-T, E-F

Warthins tumour is typically hot in Tc99m scan. The lesion is high
or intermrdiate signal in Tl and focal hyperintense areas are seen
in T2W. No contrast enhancement is seen. Bilateral-15%.
12. A-T, B-F, C-T, D-T, E-F

Puffing cheek-makes structures around mouth clearer. Modified
Valsalva maneuver (forced expiration against closed lips) is useful
(not Valsalva maneuver) m akes the vocal cords and vestibule
clearer.Open mouth view is useful for avoiding dental artifacts.
13. A-T, B-F, C-F, D-F, E-T

Accessory parotid g land drains via the main parotid duct.
I n c r e ased risk of l ymphoma in Sjogrens disease. Parotid
accumulates more fat in adulthood than children.
14. A-F. B-F, C-F, D-F , E-T

There are four types of branchial cleft cysts. Sinuses associated
with cysts are usually external and lateral to the cyst. Type 2 is
the most common type of cysts. Usually the contents are not clear
and have particulate material in them. They are usually hypo in
Tl and hyper in T2
15. A-F, B-F, C-F, D-T, E-F

F irst-parotid region,
Second-I-Anterior to stemocleidomastoid, II-mandibular angle,
III-between inernal and external carotid artery, IV-attached to
pharynx
Third-Close to laryngeal ventricle, posterior to carotid artery and
internal jugular vein.
Fourth-Adjacent to recurrent laryngeal nerve.
16. A-T, B-T, C-T, D-T, E-T

The incus long process is absent or longer and posterior than
normal. Large vestibular aqueduct is the most common cause of
sensorineural loss. It starts gradually, with flucutating hearing loss.
and a n acute worsening due to trauma or infection.
17. A-F, B-T, C-F. D-F, E-F

Parotid gland is involved in 30% of cases of sarcoidosis. 70% of
parotid cysts are multiple, in HIV and they don't show
Head and Neck-2 255
enhancement. Necrotic nodes and abscesses are seen both in

pyogenic and tuberculous infections.
18. A-F, B-F, C-F, D-F, E-T

The most common parotid disease in children is parotitis. The most
common benign neoplasm is hemangioma and the most common
malignancy is mucoepidermoid carcinoma. Lymphoma. infection
and other tumours commonly involve parotid than other salivary
glands.
19. A-F, B-F, C-T, D-T, E-F

The most common multiple tumour in children is Warthins.
Warthins shows increased uptake in Technetium and Thallium 201
scan. When small, pleomorphic adenoma has signal like a cyst.
homogenously hypodense in CT and hypo in Tl and hyper in T2.
Larger adenomas are heterogenous. Pleomorphic adenomas are
managed usually by superficial parotidectomy. sparing the facial
nerve.
20. A-T, B-T, C-T,"D-T, E-F

Onodi cell is a posterior ethmoidal cell which extends lateral and
superior to sphenoid sinus and abuts otic nerve. Paradoxically
curved turbinate produces narro\ving of the meatus.
21. A-F, B-T, C-T, D-F, E-F

Complicating common cold is seen only in 0.5% . .;cute-CT
.
hypodense. MR-Tl-hypo. T2-hyperchronic (inspissated

secretions) CT hyperdense Tl-hypo T2-hypo.
22. A-T, B-T, C-F, D-T, E-T

Polyps are the most common masses-carcinomas, lymphomas are
also seen.
23. A-T, B-T, C-T, D-T, E-T
24. A-T, B-T, C-T, D-F, E-T

. Lymphoma. plas macytoma. mucocele, invorting papilloma.
carcinoma and sarcoma are causes. Syphilis. tuberculosis,
actinomycosis. mucormycosis and aspergillosis.
25. A-T, B-T, C-T, D-F, E-F
26. A-F, B-F, C-F, D-T, E-F

Infundibular pattern is the most common. 26% affecting only the
maxillary sinus.
Osteometal unit pattern-25% affects maxillary. anterior ethmoidal
and frontal sinuses.
Sphenoethmoidal recess- sphenoid and posterior ethmoidal
Sinonasal polyposis-polyps involving all sinuses.
27. A-F, B-F, C-T, D-T, E-F

Mucosa is considered thickened only when it is more than 5 mm.
Protein concentration more than 28% will cause hypointense signal
in both Tl and T2. Peripheral enhancement indicate sinusitis unlike
neoplasm which enhances centrally. Allergic sinusitis is bilaterally
symmetrical, involves multiple sinuses, polyps are seen and shmvs
uniform enhancement.
28. A-T, B-T, C-T, D-T, E-F

Cerebral abscess, epidural abscess, subdural empyema, septic
thrombophlebitis and rention cyst are other causes.
29. A-F, B-T, C-F, D-T, E-F

Due to inspissated secretions. iron, magnesium and manganese,
fungal sinusitis is dark in T2W images. Aspergillus is the most
common fungus. Infiltrating in immunocompetent and fulminant
in immunodeficient individuals. Streptococcus pneumoniae and
. Hemophilus influenzae are the most common organisms in acute
sinusitis.
30. A-T, B-T, C-F, D-F, E-F

Associated with squamous cell carcinoma in upto 27%. Usually
unilateral. Arises from the lateral \\'all of nasal ca\·it\· and extends
into sinuses (antrum and ethmoid). Can also arise from the
paranasal sinuses. most commonly maxillary and also from nasal
septum.
31. A-T, B-F, C-F, D-F, E-T

More common in males, 40-60 years. Septum is displaced not
invaded.
Destroys the antral wall, lamina papyracea and anterior cranial
fossa wall.
32. A-T, B-T, C-F, D-T, E-T

Common in frontal(60), ethmoid(30), maxillary(l 0), sphenoidal.
33. A-T, B-F, C-F, D-F, E-T

80% occur in maxillary sinus. 80% are squamous carcinoma.
Bone destruction is common. More common in men. -
34. A-T, B-T, C-F, D-T, E-T

Through foramen lacerum, encases the carotid artery.
35. A-T, B-F, C-F, D-T, E-T

Low to intermediate signal in T2. Surgery is not curative as the
disease is characteristically recurrent.
36. A-T, B-T, C-T, D-F, E-T

Asymmetry i n the aeration of fossa of Rosenmuller is very
senstive, but fs non-specific since it may be caused by reained
Head and Neck-2 257
secretions or lymphoid hyperplasia. High signal in mastoid and

middle ear is due to obstruction of eustachian tube and accumu
lation of secretions. Adenoids can measure upto 1 cm in the
anteroposterior direction in adults. Enahcement of paravertebral
muscles indicates infilrtation. The paraphyrangeal fat stripe.
retropharyngeal fat stripe are also obliterated.
37. A-F, B-T, C-T, D-F, E-T

Origin is from the sphenopalatine foramen. Seen in boys between 7
and 20 years.Forward displacmeent of the posterior wall of maxilllary
sinus is called Holman Miller sign. Although it is a very benign
tumour, it infiltrates and erodes surrounding structures including
the medial pterygoid plate. It can extend into the skull through the
foramina and surrounding tissues. Vascular supply is from internal
maxillary Iascending pharyngeal/ascending palatine arteries.
38. A-F, B-F, C-T, D-F, E-F

This is a benign vascular tumour, which bleeds profusely on
biopsy. which is usually avoided. The embolisation procedure is
used to reduce vascularity before surgery and is not curative. �IR
shows characteristic flow voids. due to the vascularity.
39. A-T, B-T, C-F, D-T, E-T

It arises initially from the Fossa of Rosenmuller. the asymmetry
of which is often the only radiological sign seen in early stages.
CT is superior to MRI for nodal spread. since it sho\VS nodal
necrosis and extranodal spread. important pointers for infiltration.
40. A-T, B-F, C.T, D-T, E-F

Frontal sinus is the most commonly involved sinus. The sinus are
expanded and filled with mucinous material. which causes thinning
of the wall of the sinuses. Due to the proteinaceous nature of the
contents. there is high signal in both Tl and T2 vV images.
41. A-F, B-F. C-F, D-F, E-T

Facial nerve is difficult to visualise in CT scans. PC1rotid gland has
very l o w density than the masseter due to presence of fat.
Pleomorphic adenomas are most common in the parotid gland.
42. A-F, B-T, C-F, D-T, E-T

Stones are common in the submandibular duct due to viscous
secretions and non dependent drainage. Sialography should not
be done in the acute stage. High pressure can cause tumour
dissemination.
43. A-T, B-T, C-T, D-T, E-T

Cystic hygromas are well defined multilocular lymphatic massses.
commonly seen in the neck. but can extend into the mediastinum.
44. A-T, B-T, C-T, D-T, E-T
45. A-T, B-T, C-T, D-T, E-T

Normal parotid gland has density of fat. hence pleomorphic
adenomas have higher density than the parotid gland. Adenoid
cystic carcinoma, acinic cell carcinoma, adenocarcinoma and
malignant pleomorphic adenoma are other malignant parotid
tumours.
46. A-F, B-F, C-T, D-T, E-T

Majority occur at C 1-2 level. Accounts for 2% of stroke between
40-60 years.
47. A-T, B-F, C-T, D-F, E-T

Bruit is seen only in 50%. Anterior headache. unilaterally is more
common than neck pain. Anticoagulants are administered. The
di_s section produces subarachnoid haemorrhage if it occurs
_ intracranially, aneurysm and thromboembolism.
48. A-F. B-F, C-F, D-T, E-T

16% incidence of stroke with significant stenosis and 2% incidence
in non-significant stenosis. Stenosis is progressive in 25% and non
progressive in 70%. Significant stenosis is 75%
49. A-T, B-F, C-T, D-T, E-T

Intraoperative and postoperative monitoring is also done.
50. A-T, B-F, C-F, D-T. E-T

Hypertension is a well recognised association.
51. A-T, B-F, C-T, D-T, E-F

MRl is the ideal method for staging oropharyngel cancers.
Involvmeent of pre-epiglottic fat is assessed by loss of the normal
fat signal. False positive results are seen i n edema and
inflammation. Atrophy of masticator muscles indicates involvmeent
of the trigeminal nerve and MRI can show obliteration of fat in
the pterygopalatine fossa. Just abutitng the mandible- periosteal
rese<:tion only. Superficial invasion- resection of cortex, marrow
invasion- segmental resection of mandible. Bilateral or deep
invasion of tongue requires glossectomy.
52. A-T, B-T, C-T, D-F, E-T
53. A-F, B-F, C-T, D-T, E-T

There are eight channels in pterygopalatine fossa through which
nasopharyngeal cancer can spread.
Sphenopalatine foramen- in the vertical part of palate. Extends into
nasal cavity.
Head and Neck-2 259
Inferior orbital fissure-orbit- superior orbital fissure-anterosuperior

extension into middle cranial fossa.
Foramen rotundum-posterosuperior extension into cranial cavity
Pterygoid canal -posterosuperior extension.
Pterygomaxillary fissure-latearlly into infratemporal fossa.
Greater palatine canal-anterioinferiorly into oropharynx.
Lesser palatine canal-anteroinferiorly into oropharynx.
Palatovaginal canal
54. A-F, B-T, C-F, 0-T, E-T

The only aerodigestive cancer to encase the carotid artery is the
hypopharyngeal carcinoma, which is frequently associated with
supraglottic carcinoma. A central hyperdensity with surrounding
hypodensity indicates central inspissated secretions and indicates
fungal sinusitis or chronic sinonasal polyposis. Invasive sinusitis
is seen in immunocompromised hosts.
55. A-T, B-T, C-T,. D-T, E-T

Granuloma gravidarum is hemangioma seen i n pregnancy.
Nasopharyngeal carcinoma and juvenile nasopharyngeal
angiofibroma are common causes. Lymphoma. melanoma. and
hemangiopericytoma are other causes.
56. A-F, B-T, C-T, D-F, E-F

The joint is divided into superior and inferior compartment. \vhich
do not communicate by the articular disc. The disc has an anterior
and posterior band and a thin mid-portion which is in between
the condyle and articular eminence. Anteriorly the disc is attached
medially and laterally to the joint capsule and condyle and
posteriorly it is loosely attached to condyle and temporal bone.
The disc moves anteriorly when the mouth is opened. The disc
is bi concave in sagittal and cresenteric in the coronal plane.
57. A-T, B-T. C-T, D-T, E-T

Carcinomas are the most common.
58. A-T, B-F, C-T, D-T, E-T

Branchial cyst has n o air.
59. A-T, B-T, C-F, D-F, E-T

Lymphoma usually calcifies only after treatment.
60. A-T, B-F, C-T, D-T, E-T

Rounded nodes are more likely to be neoplastic than oval shaped
nodes.. Central necrosis is an importan t factor in determining
malignancy. the exception being known tuberculosis or lymphoma
on treatment. Nodes are bright in T2W images. unlike muscle. the
both being isointense in Tl \V images.
61. A-F, B-F, C-T, D-F, E-T

15% reduction of stroke. 2% risk of neurologic deficit. Severity of
stenosis is graded according to reduction in luminal diameter. Both
sides waveforms should always be compared to avoid pitfalls.
62. A-T, B-T, C-T, D-T, E-T

Rhabdomyosarcoma and metastasis are the most common lesions
in the prevertebral space. Lesions·in this space also displace the
retropharyngeal space anteriorly. Parapharyngeal space lesion
displaces the visceral space medially. parotid gland laterally. medial
pterygoid laterally and carotid sheath posterirly. But a parotid
space lesion v,:ill displace the parapharyngeal space medially, with
a rim of parotid. involvement of superifical lobe.
63. A-T, B-T, C-T, D-T, E-T
64. A-T, B-T, C-T, D-T, E-F

. High signal in Tl can be due to haemorrhage or malanin or
fat(lipoma. dermoid) or proteinaceous secretion (colloid cyst,
brachia! cleft cyst. Tornwaldt cyst. lymphocele, mucocele)or
cholesterin cystals (Cholesteatoma. cholesterol granuloma).
65. A-F, B-F, C-T, D-T, E-F

Proteinaceous fluid has low signal initially. followed by
progressive rise, then there is a later fall. Psammoma bodies are
not seen in CT scans. In dynamic curve. all the hypervascular
tumours show gradual progressive enhancement, except for
paraganglioma \.Vhich shows a dip. The crania°l foramen are also
enlarged when they are infiltrated. The tumour is inoperable if
more than 270 degrees of the vessel is involved.
66. A-T, B-T, C-T, D-T, E-T

Hypercellular tum ours are intermediate i n T2. Oncytoma.
adenocarcinoma and adenoid cystic tumours are other causes of
intermediate signal in T2W images. Squamous cell caricnomas have
large areas of necrosis which produce high signal in T2W images.
67. A-T, B-T, C-F, D-F, E-F

Laryngocele is herniation of the sacculus of laryngeal ventricle due
to raised intraglottic pressure. Internal-limited by thyrohyoid
membrane. Presents as hoarseness. stridor.
External, extends above thyroid cartilage and extends through
thyrohyoid membrane. Presents as a mass at the level of hyoid
bone. just below angle of mandible.
Mixed-has internal and external component. Unilateral in 80%
and bilateral in 20%.
Increases during Valsalva and decreases with compression.
Head and Neck-2 261
68. A-T, B-T, C-T, D-T, E - T
69. A-T, B-F, C-F, D-T, E-F

CT has sensitivity upto 100%, whereas MRI is lower and upto 65%.
The sensitivity of MRI does not significantly increase after contrast
or fat suppression. Usually necrosis is low n Tl and high In T2.
But it c a n be b right in Tl i f there is h aemorrhage or fatty
hyperplasia.
70. A-T, B-F, C-F, D-T, E-F

A lymph node with L/T ratio more than 2. indicates that it is oval.
Oval lymph nodes are more likely to be benign and round lymph
nodes are more likely to be malignant. Size criteria is the most
common used and it has 96% sensitivity. Nodes are homogenous
in benign lesions and heterogenous in metastasis. but it is not a
n absolute criterion. Density of lymph node in CT has n o
correlation with N stage. which depends on the number o f nodes
and the groups involved.
71. A-T, B-F, C-F, D-T, D-F

Fat in the hilum. indicates benign lesion. But it is not very specific
sign. Necrosis is best seen in contrast enhanced Tl weighted
images or fat suppressed images. Pulsatility index and resistivity
index are both elevated in metastatic nodes. They are lm.v in
reactive hyperplasia. But this is not a very reliable technique.
72. A-F, B-T , C-T, D-T, E-T

Contrast enhanced ultrasound shows. hilar vessels in reactive
hyperplasia and peripheral vessels in malignancy.
73. A-T, B-T, C-T, D-T, E-T

Large homogenous node- NHL, HL, sarcoid osis. in fectious
mononucleosi:os
Good enhancement- Kaposis. RCC. thyroid metastasis
Calcification- Gr anuloma, Radiotherapy or chemotherapy or
lymphoma. papillary carcinoma thyroid.
Multiple nodes with varied appearance- Tuberculosis, thyroid
carcinoma.
74. A-F, B-F, C-T, D-F, E-F

Baseline scan should be done before two months. Post-operative
edema can be present till this time . Any growth after this time
is abnormal. The recurrence is ac tumour margin after surgery and
in center of tumour bed in radiation. Recurrence at primary site,
nodal site, primary and nodal site share equal incidence.
75. A-T, B-F, C-T, D-T, E T -

76. A-T. B-T, C-T, D-T, E-T

Thyroglossal cyst. cystic hygroma and dermoid are other cysts of
congenital origin.
77. A-T, B-T, C-T, D-F, E-T

It may be enlarged as a normal variant. Epiglottitis and caustic
ingestion are other common causes.
78. A-T, B-T, C-F, D-T, E-T
79. A-T, B-T, C-T, D-T, E-T

Mediastinal tumours or cysts, malignancies and birth injuries are
other common causes.
80. A-T, B-F, C-T, D-T, E-F

Meni ngiomas and neurofibromas are seen i n extradural
compartment and can be seen in the paravertebral region. Anterior
disk herniation is a common cause.
81 . . A-T, B-T, C-T, D-T, E-T
82. A-T. B-T, C-T, D-T, E-F
83. A-F, B-T, C-F, D-T, E-F

Schwannomas can affect vagus, cervical sympathetic chain and
cervical spinal nerves. They are encapsulated. Low to intermedia�e
in Tl and high in T2. Neurofibromas are not encapsulated. They
have characteristic low values in CT scan and can even appear like
fluid. They are still low signal in Tl and high in T2. The contrast
enhancement is moderate .
84. A-T, B-T, C-T, D-T, E-T

Paragangliomas, are very vascular and the areas of flow void
within them have a salt and pepper appearance in MRl. The tumour
arises from the posteromedial aspect of common carotid artery
near the bifurcation.
85. A-T, B-F, C-F, D-F, E-F

I n the region of carotid bifurcation. the two most common
tumours are paragangliomas or carotid body tumours and
schwannomas. The paragangliomas are ovoid, arise from the
posterormedial aspect of CCA (from sympathetic chain). hence
displace the bifurcation laterally. homogeno-usly hyperdense on
contrast. incorporation of vessels, show rapid uptake and rapid
drop in dynamic contrast scans. MRl shows the typical salt and
pepper appearance of signal voids. Angiography is coarsely
vascular. But Schwannoma commonly rises from the vagus nerve.
round, displaces the birfurcation anteromedia-lly, heterodense on
CT (due to presence of cellular Antoni A and i1ypocellular Antoni
Head and Neck-2 263
B areas), displacement rather than incorporation of vessels. Rapid

uptake and slow washout in dyanmic contrast scans. MRI is
heterogenous.
86. A-T, B-T, C-T, D-T, E-T
87. A-T, B-T, C-T, D-F, E-T

Deep lobe of parotid tumours are seen in this space.
88. A-T, B-T, C-T, D-F, E-F

There is also an association with achondrogenesis.
89. A-T, B-F, C-T, D-T. E-T, F-T

90% are seen by two years. Failure of communiction of jugular
lymphatic sac '_with the jugular vein is the cause. Other locations
include mediastinum, retroperitoneum, scrotum and axilla.
90. A-T, B-T, C-T, D-F, E-F

I-123 , a pure gamma emitter, has energy of 160 Kev and half life
of 13 hours, making it ideal for thyroid imaging than I 131, which
emits gamma rays with energy of 364 Kev and beta particles. with
half life of 8 days. In toxic goitre. the thyroid hormone levels are
high and TSH is low. The thyroid uptake would be expected to
be low in this setting because of low TSH. But increased uptake
will be seen in toxic functioning nodules, which suppress the rest
of the gland. These nodules also specifically take up the beta
particles emitted by the I 131 , which is used for therapy.
91. A-T, B-F, C-T, D-T, E-F

Adenoid cystic carcinoma is the most common tumour with
perineural spread.
92. A-T, B-T, C-F, D-T, E-F

Temporal bone involved in 15.61% children < 3 years commary
a f f ected. martoid and other portions are des troyed. with
squamous portion and middle ear least affected. petrous apex
involvement is very rare. Extensive destruction. indistinct margins,
ossicles/inner ear less frequently involved; N!R-Tl variable, T2-
high; marked enhancement.
93. A-F, B-T. C-T, D-F, E-F

15% have bilateral carotid injury.
94. A-F, B-F, C-F, D-T, E-F

Ultrasound is not good for pathological characterisation. Fine
need le. aspiration cytology or biopsy should be done for
confirmation and characterisation. Scintigraphy can find small
amounts of thyroid remants in thyroglossal cyst. Calcification is
seen in both �enign and malignant les.ions. They are more fine and
stippled in malignant and solid in benign lesions. but it is not

posssible to predict the nature of the calcification.
95. A-T. B-T. C-F, D-T, E-F

High or low siignal intensity in Tl depending on protein content.
L:sually cystic with multiple septa. solid components may be seen.
Fluid fluid level in haemorrhage.
Compresses airways and esophagus.
96. A-T, B-T, C-F, D-T, E-F

The tumour is fixed vertically and mobile laterally. M alignant
transformCltion in 6%.
Seen at the· bifurcation with splaying of the bifurcation.
97. A-T. B-F, C-T, D-F, E-F

Hyperthyroidism is another cause.
98. A-T, B-T, C-T, D-F, E-T

Spontaneous regression occurs in 15%, especially in axilla and
anterior neck.
2-3% healthy children.
99. A-T, B-T, C-T, D-T, E-T

Breasts of lactating women. saliYary glands and nasopharynx are
other causes for normal uptake.
100. A-F. B-T, C-T. D-T, E-T

Early hashimatos shows hyperthyroidism. but late sho\\'S
hypothyroidism.
101. A-F, B-F, C-T, D-T, E-T, F-F

65% are infrahyoid, 20% are suprahyoid and 15% are hyoid. Usually
it is a well defined cystic lesion. But occasionally can show septations
and rim enhancement. There is uptake in the thyroid scans.
102. A-T, B-T, C-T, D-T, E-F

Subacute and chronic thyroiditis, iodine and thyroxine load,
antithyroid medication, surgery and radiation, congenital
hypothyroidism are common causes.
103. A-T, B-F, C-F, D-F, E-F

Adenoma is the most common cause. Cancer is extremely rare. I
123 can differentiate the two.
104. A-T, B-T, C-T, D-T, E-T

Malignancy is a very common cause.
105. A-T, B-F, C-F, D-F, E-F

Solitary cold nodule is multiple in ultrasound in atleast 25% of
cases. Cold nodules are hypoechoic in 70%. iso in 22%. hyper in
Head and Neck-2 265
3%. Solitary cold nodule is malignant in 25% and multiple nodules

are malignant in upto 6%.
106. A-F, B-F. C-T, D-F, E-T

Papillary-20-30. lymphatic spread, multicentric, may present as
lymph nodal mass
Follicular 30-50, hematogeneous spread, bony metastases
Anaplastic. 50-70, compression of airways.
107. A-T, B-T. C-F. D-T, E-F

6 . 5 - 1500 rads in 5-30 years. Hard nodule. Hemoarrhage and
necrosis are not common.
108. A-T, B-T. C-T. D-T. E-F

Seen only in MEN II. Arises from parafollicular C cells which
produce calcitonin. There are two types, the sporadic one, which
starts around 60 years and the one associated with MEN which
arises in younger age group.
Early spread to lymph nodes, liver and bone. Calcium is not
affected.
MEN I-pituitary. parathyroid pancreas
MEN II-medullary carcinoma thyroid. parathyroid adenoma,
pheochromocytoma
109. A-F B-F, C-T. D-T, E-T

,
Calcitonin levels are increased. There is no uptake of radioiodine

or pertechnate but increased uptake of thallium 201 is seen.
40% survival with nodal metastses,
110. A-T, B-T, C-T, D-T, E-T

Common in females. Solid/complex mass with calcification,
haemorrhage. necrosis
90% 10 year survival.
111. A-F, B-T, C-F, D-T, E-T

Il31 scan is better than bone scan, which misses 40% of thyroid
·
metastasis.
False negative scan is seen in 25% of 1131 scan .. due to non
functioning metastasis.
Tc99m is useless because of lack of organification.
If thyroid gland is intact, the isotope will be taken by the thyroid
and there will b e no uptake in the metastases. Hence. thyroidec
tomy has to be done for assessing metastases.
112. A-T, B-T, C-T, D-T, E-T

Pulmonary fibrosis due to irradiation of lung metastases. Bone
marrow depression is mild.
113. A-T, B-T, C-T, D-T, E-F

75% spread to lymph nodes invasion of carotid artery.jugular vein
·
and larynx.
15% of all cancers. 7th decade .
114. A-T, B-T, C-T, D-T, E-T

Out of 20% of thyroid disease following radiation, 14% is benign
and 6% are malignant.
.
115. A-T, B-F, C-T, D-T, E-T

Cytology cannot reliably differentiate between follicular adenoma
and carcinoma and invasion of capsule has to be demonstrated
for this purpose, which requires biopsy.
Accumulates perte chnate, but not iodine. 35% survival with
extensive invasion.
116. A-T, B-F, C-F, D-F, E-F

In early stage, there is thyrotoxicosis, but in later stage there is
hypothyroidism.
The gland is enlarged but painless. Males are commonly affected,
fifth decade.
117. A-T, B-T, C-T, D-T, E-T

Multiple cold nodules are seen in 40%. normal thyroid occasionally
seen.
Echogenic fibrosis can be seen in end stage disease with acoustic
shadowing, in ultrasound.
118. A-F, B-F, C-T, D-T, E-T

The gland is very tend�r but not enlarged. Low radioiodine
, uptake with high thyroid hormones. Hyperthyroidism is seen in
50% and hypo in 25%.
119. A-F, B-T, C-F, D-F, E-T

Ortners syndrome is hoarsness. pr9duced by enlarged left atrium
pressing on left recurrent laryngeal nerve . Recurrent laryngeal
nerve palsy produces atrophy of thy r o artyenoid muscle,
anteromedial devitation of arytenoid, enlarged ipsilateral laryngeal
ventricle and pyriform sinus, paramedian position of vocal cord
and atrophy of cricoarytenoid muscle.
120. A-T, B-T, C�F. D-T, E"'F

3% of parathyroid glands are ectopic.
121. A-F, B-F, C-F, D-T, E-T

85% are due to adenomas. 15% due to hyperplasia and very few
due to carcinomas.
Head and Neck-2 267
For adenomas, the affected gland is removed and biopsy is done

i n the three other glands. For hyperplasias, 3.5 glands are
removed. Complete removal in carcinoma.
122. A-F, B-F, C-T, D-F, E-T

Thallium is taken by parathyroid and thyroid gland. Technetium
is taken only b y thyroid. Subtraction of these two, will enable
visualisation of parathyroid glands.
Adenomas less than 300 mg are not identified. More common in
the inferior parathyroid.
A combination of parathyroid scans, ultrasound. CT. MRI can
localise 80% of adenomas with 90% specificity.
123. A-T, B-F, C-T, D-T, E-T

Adenomas are homogenous, ovoid in the vertical direction.
ultrasound has 50-90% accuracy in localising adenomas. If no lesion
is seen, ectopic areas should scannned.
124. A-T, B-T, C-F, D-T, E-T

Lymph nodes and thyroid vessels are other differential diagnosis.
125. A-T, B-T, C-F. D-F. E F

-
Ptosis, miosis, anhidrosis. enophthalmos and loss of ciliospinal

reflex are the characteristics of Horners syndrome. It is seen in
pancoasts tumour, syringomyelia, brainstem demyelination and
caroid artery aneurysm are the common- causes.
126. A-T, B-T, C-T, D-T, E-F
127. A-T, B-T, C-T. D-F, E-T
128. A-T, B-F, C-F, D-F, E-F

Horizontally oriented uncinate process is another well known
predisposing factor.
1. Anatomy of spinal cord:
A. The lower extent of spinal cord varies with flexion and
extension
B. There is a difference of three segments between the spinal cord
level and the lumbar vertebrae
C. The transverse diameter of the spinal cord is less than the
anterioposterior dimension
D. There are three prominent bulges in the spinal cord
E. The lumbar expansion of cord is seen from the level of DlO
to L 1 vertebra
2. Spinal cord:
A. The sympathetic fibres arise from the anterior horn in the
thoracic level -
B. The white matter is divided into anterior and posterior column
.
C. In the posterior column, the sacral fibres are medial and the
cervical fibers are the most lateral
D. The posterior column transmits crude touch and temperature.
E. The sensory fibres are large and myelinated
3. Spinal meninges: .
A. The spinal duramater is continuous with the cerebral dura
mater
B. The dural space is wide anteriorly in the cervical and thoracic
spine
C. The dura extends upto the S2 level
D. The dura extends beyond the intervertebral foramina
E. The dural space occupies more than half the spinal canal in the
lumbar region
Sp;nal Cord 269
4. Blood supply of the spinal cord:

A. There are two posterior spinal arteries and one anterior spinal
artery
B. The anterior spinal artery supplies the anterior one third of
the cord
C. The anterior spinal artery is branch of the basilar artery
D. The posterolateral spinal arteries are branches of posterior
inferior cerebellar arteries
E. The anterior and posterolateral branches anastomose with
ascending branches in the conus
5. Central canal in spinal cord:

A. Continuous above with the cisterna magna
B. The central canal is situated in .midline ·in the cervical and
thoracic cord
C. The central canal is not seen in conus medullaris
.
D. The fifth ventricle is seen in 5 % of adults
E. The central canal is lined by epithelium
6. Spine myelography:
A. Cervical and thoracic cords cannot be visualized by lumbar
myelography
B. Cervical puncture is done between C3/ 4 level
C. Severe neck pain indicates. injury to nerve root
D. In cervical puncture. not more than 10 ml of contrast should
be given
E. In cervical puncture. the stilletter is perpendicular to the long
axis of the spine
7. Lumbar myelOgraphy:
A. Headache is seen in 25% of patients
B. Seizures occur in 2% of patients
C. In spinal dysraphism. the puncture should be made higher than
normal to avoid complications
D. Arnold Chiari malformation is a contraindication to cervical
puncture
E. If nerve roots are visualized beyond exit foramen, it indicates
subdural injection
,_,, 8. Lumbar myelography:

A. Lumbar puncture should not be repeated before one week
after a failed attempt
B. Prone position is the ideal for lumbar puncture
C. In sitting position. the contrast is diluted
D. Interspinous ligament is painful and should be anaesthesised.
E. Once the thecal sac is entered, stillette should be removed and
needle advanced further
9. Discography:
A. Discitis is the rhost common complication of discography
B. Lateral approach avoids the dural space
C. 21 G needle is used to puncture the annulus fibrosus and enter
the nucleus pulposus
D. Bupivacaine is introduced if discography produces pain
E. 5 ml is the normal amount of contrast introduced
10. Radicular branches to the spinal cord are:

A. Supreme intercostal artery
B. Thyrorcrvical trunk
C. Median sacral artery
D. Deep cervical arteries
E. Vertebral arteries
'.1. Radiculomedullary arteries:

A. The Adamkiewicz artery arises most commonly from tenth or
··
eleventh radicular arteries

B. The Adamkiewicz artery is more common in the right side
C. The junction of radiculomedullary arteries with the anterior
spinal artery is always like hair· pin bend
D. Radiculomedullary branches may arise together with bronchial
artery
E. Paraplegia is a recognized complication of aortography
12. Spinal cord vascular supply:

'
A. If one of the radiculomedullary arteries is occluded, flow

through the entire anterior spinal artery may not be
maintained
B. Occlusion of a single perforating artery from the anterior spinal
artery will produce significant ischemia
C. There are two anterior spinal veins
D. There is one large posterior spinal vein
E. The spinal veins drain into the paraspinal_ veins
13. Widened interpedicular distance is seen in:

A. Achondroplasia
B. Acromegaly
C. Hurlers syndrome
D. Neurofibromatosis
E. Diastomatomyelia
14. High signal in Tl W images in vertebra is seen in:

A. Hemangioma B. Anemia
C. Radiation D. Degeneration
E. Normal aging
Spinal Cord 271
15. Low signal in TlW i mages is seen in:

A. Degeneration
B. Paget's disease
C. Metastasis
D. Increased red marrow
E. Blood transfusion
16. Spinal cord:

\· A. The anterolateral tract transmits fine touch and vibration
B. The sacral fibers are laterally situated in the anterolateral tract
and cervical fibers are medial
C. The fibers of pain and temperature cross the midline in spinal
cord
D. The cell bodies for sensation are situated in the dorsal root
ganglia
E. The spinocerebellar tracts are concerned with proprioception
17. Ivory yertebra is seen in:

A. Primary hyperparathyroidism
B. Osteopetrosis
C. Hemangioma
D. Spondylitis
E. Sickle disease
18. Spinal meninges:

A. The denticulate ligament divides the arachnoid space inrn
medial and lateral
B. The ciribriform septum is formed from arachnoid mater
C. The denticulate ligament is seen upto L 1 level
D. The pia mater does not extend beyond the intervertebral
foramen
E. The ciribriform septum is prominent in the thoracic level
19. Common causes of pachymeningitis:

A. Sarcoidosis
B. Metastasis
C. Rheumatoid
D. Tuberculosis
E. Haemorrhage
I
·'
20. Radiculomedullary arteries:

A. There are only six to ten radiculomedullary arteries
B. The largest cervical branch enters at C6 level
C. There are three maj or territories of spinal cord vascular supply
D. The intermediate territory extends from Tl-T 12
E. The lower territory is only the lumbar region
21. Expanded cord in frontal view of myelogram occurs in:

A. Ependydoma
B. tv1engioma
C. Disc protrusion
D. Hydromyelia
E. Astrocytoma
22. Spinal meninges:

A. The dura is attached anteriorly to the posterior longitudinal
ligament at all vertebral levels
B. The dura cannot be seen in any MR sequence
C. The spinal CSF is half the total CSF volume
D. The spinal cord is stablised by denticulare ligament
E. The pia mater extends upto the 52 segment
23. The following are common causes of extradural masses:

A. Neurofibroma B. Disc prolapse
C. Haematoma D. ?v1eningioma
E. Dermoid
24. Common causes of failed back surgery syndrome:

A. Arachnoiditis
B. Conus tumour
C. Hematoma
D. Surgery at wrong level.
E. Mechanical instability
25. The following produce intradural extramedullary masses:

A. Lipoma
B. Ependymoma
C. Medulloblastoma metastasis
D. Glioblastoma
E. Dermoid
26. Neurofibroma:
A. Most common extramedullary mass.
B. Maj or ity rise from the dorsal sensory root
C. Multiple in neurofibromatosis
D. Malignant conversion higher in neurofibromatosis
E. Males and females equally affected
27. Common intramedullary lesions:

A. Hemangioblastoma
B. Hydatid cyst
C. Abscess
D. Glioblastoma
E. Methemoglobinemia
Spinal Cord 273
28. Tarlovs cyst:

A. Seen proximal to dorsal root ganglion
B. The wall of the cyst has neural elemems
C. Seen within neural foramen
D. Causes scalloping of vertebral body
E. Widened neural foramen
29. Conjoined nerve root:

A Most common at L4-5 level
..
B. Seen in 8% of autopsy specimens

C. Produces radicular pain
D. Single dural sheath is seen
E. Loss of symmetry in epidural fat
30. Causes of diffuse thickening of nerve roots:

A. Neurofibroma
B. Sarcoidosis
C. Dejerine Sotas neuropathy
D. Lyrnphorna
E. Arachnoiditis
31. Common tumours metastasising to spinal cord in adults:

A. Melanoma B. Lymphoma
C. Gastric D. Gliobastoma multiforme
E. Oligodendroglioma
32. The following are features of asrrocytoma that differentiate from

e pendymoma:
A. Eccentric, posterior location
B. Predominantly located in the conus medullaris
C. Presence of pseudocapsule and a cleft bet\veen mass and cord
D. Haemorrhage
E. Cyst formation
33. Ependymoma:
A. Usually occur in the thoracic region
B. Commonly present as extradural mass
C. Can be treated by excision
D. Involves whole width of spinal cord
E. Cystic degeneration is seen
34. Spinal canal tumours:

A. Metastatic depostis are usually intradural. extramedullary in
position
B. Extradural tumours are usually benign
C. Intra dural tumours are usually benign
D. Intramedullary tumours are usually glioiT.3S
E. Plain film changes are seen in less than �0%
27 4 Neuroradiology, Head and Neck Radiology
35. Astrocytomas:
A. Majority of astrocytoms in spine are high grade
B. Situated centrally within the cord
C. Dilated veins are seen on the surface of the cord
D. Intrathecal contrast. will enter the tumour
E. Most common in the thoracic level
A. Sporadic in majority of cases
B. 20% are in the nerve roots
C. Multi pie in 60% of instances
D. Signal void is seen in tv1RI
E. Cystic degeneration in 60%
37. Lipoma:
A. Majority occur in the first five years of life
B. 5% of intraspinal tumours
C. Paralysis is uncommon
D. Overlying skin is often normal
E. Elevated proteins in CSF
38. Spinal tumours:

A. The typical hemangioma in spine is hypo in Tl and hyper in
T2
B. Osteoid osteomas and osteoblastomas are differentiated only
by size
C. Osteochondroma i s most common from the body of the
vertebra
D. Chordomas have the typical physaliphorous cells
E. Aneurysmal bone cyst is more common in cervical than lumbar
spine
39. Intradural lipoma:

A. Spinal cord is open dorsally
B. Common in the anterolateral aspect of the cord.
C. Neural foramina enlarged
D. Exophytic component seen in the upper pole and not in the
lower pole
E. Spina bifida is seen
40. Pseudomeningocele:
A. Caused by tear of arachnoid and dura
B. Majority have back pain
C. Pain increased by coughing
D. Seen anterior to the lamina
E. Majority are lined by arachnoid
Spinal Cord 275
41. Ependydoma:
A. Involves many vertebral segments.
B. The tumour margin is h ypointense in Tl and T2
C. Contrast enhancement is intensely homogenous
D. Vertebral body is eroded
E. Haemorrhage is a recognised complication.
42. Causes of signal void inside CSF:

A. Dural AVM
B. Lipoma
C. Calcified mass
D. Flow phenomenona
E. Epidural anaesthesia
43. Tumours metastasising to the spinal cord in children:

A. Retinoblastoma
B. Pineoblastoma
C. Ependymomoma
D. Leukemia
E. Hemangioblastoma
· 44. Hemangiomas:
A. The most common benign spinal tumour
B. 75% of bone hemangi o mas occur in the spine
C. Symptomatic lesions are more common in females
D. Preagnancy exacerbates lesion
E. Strama is p r edominan tly faery and has vascular elements
45. Pseudohydromyelia:
A. Produced by chemical shift artefact
B. Seen perpendicular to high comrast borders
C. The defect is in the Fourier transform reconstr u c t i o n
D. Eliminated by decreasing number of phase encoding steps
E. Eliminated by using phased array coils
46. Common causes of intramedullary lesions in AIDS:

A. Herpes zoster B. Cytamegalovirus
C. Toxoplasmosis D. Hodgkins lymphoma
E. Vacuolar myelopathy
4 7. Common Causes of spinal cotd i nfarction:

A. Meningitis
B. Aortic dissection
C. Decompression sickness
D. SL2
E. AV::V1
48. Caissons disease:

A. Spinal cord is atrophied
B. Gray matter is affected more than the white matter
C. Syringomyelia is associated
D. TZ hyperintensity is seen in acute stage
E. Predilection for posterior aspect
49. Common causes of spinal metastasis:

A. Lymphoma
B. Melanoma
C. Choriocarcinoma
D. Thyroid
E. Liver
50. Common causes of drop metastases:

A. Teratoma
B. Hemangioblastoma
C. Ependydoma
D. Pineboblastoma
E. Choroid plexus papilloma
51. Diastomatomyelia:
A. 'tv1ost common in cervical spine
B. Associated \vith spinal bifida
C. Associated with cord tethering
D. Enlarged intervertebral foramina
E. Progressive spinal cord dysfunction is seen
52. Associations of Diastomatomyelia:

A. Myelomeningocele B. Clubfoot
C. Teratoma D. Hemangioma
E. Lipoma
A. The hemicords do not reunite
B. Bony I cartilagenous spur or fibrous band should be present for
making diagnosis
C. Each hemicord is covered by their own pial covering in all
cases
D. A common dural sac for both the hemicords is seen in 60%
E. Common dural sac is associated with bony spurs
54. Associations of lipomyelomeningocele:

A. Large s;: ··"Ji canal B. Butterfly vertebra
C. Posteri( · ·'.ioping D. Sacral agensis
E. Sacroc · .il ceratoma
Spinal Cord 277
55. Lipomyelomeningocele:
A. Constitutes 50% of occult spinal dysraphism
B. Intradural lipomas and lipomyelomeningocele accounts for 70%
of skin covered lumbosacral mases
C. Lipoma is attached to the dorsal surface of the neural placeode
D. Can extend the entire length of spinal canal
E. Pedicles are eroded
56. Lipomas occur in the following regions:

A. Intradural B. Intradural intramedullary
C. Epidural D. Filum terminale
E. Within central canal
57. The following conditions are considered as occult spinal

dysraphism:
A. Tethered cord B. Myelomeningocele
C. Dorsal dermal sinus D. Caudal regression syndromes.
E. Meningocele
58. iv!yelomeningocele:
A. Most common congenital Cl\IS anomaly.
B. I /200 incidence
C. Common in women more than 35 years
D. Positive family history in 25�6
E. Reurrence rate 20% in those with an affected sibling
59. iv!yelomeningocele associations:

A. Hydrocephalus in 75%
B. Chiari I malformation in 100%
C. Diastomatomyelia
D. Congenital scoliosis in 90%
E. Duplicated central canal caudal to the level callosum. hip
deformities are also associated
A. Congenital scoliosis is seen in 7 5%
B. Narrowed vertebral bodies
C. Widened interpedicular distance
D. Disc space narrowed
E. Intersegemental laminar flisions
61. As soc iat i on s of tethered cord syndrome:

A. Lipoma is seen in 78%
B. Imperforate anus
C. Sacrococcygeal teratoma
D. Diastemawmyelia
E. Hair patch in 50%
62. Tethered cord syndrome:

A. The nerve roots have abnormal lateral course
B. Filum terminale measures < 2mm at LS-Sl level
C. Conus medullaris below the level of L2 after age of 12
D. Triangular thecal sac
E. Low signal in center of spinal cord in Tl W images
63. Hydromyelia is associated with the following conditions:

A. Klippel feil syndrome
B. Tethered cord
C. Spinal segmentation defects
D. Dorsal sinus
E. Anencephaly
64. Syringomyelia is associated with:

A. Trauma B. Tuberculosis
C. Syphilis D. Herniated disk
E. Vascular insufficiency
A. \1ajority have thick filum terminale
B. Conus is low in 75% of cases
C. �fore common in femalt:s than males
D. Each hemicord has two ventral and dorsal horns
E. Each hem icord have their own central canal
66. Traumatic syringomyelia:

A. 70% are seen in cervical cord
B. Associated with arachnoid cyst in 45% of cases
C. Frequently has multiple septations
D. Measures upto 40 cm in length
E. Seen in 15% ·�fter spinal injury
67. Syringomyelia:
A. Is lined by ependydymal tissue
B. Metameri.c hasutrations are seen in. h ydromyelia associated
with trauma
C. Low signal flow void is seen in MRI
D. High signal in T2W images
E. The central canal is obliterated in 80% of normal individuals
68. Sacrococcygeal teratoma:

A. Type II is predominantly external
B. Type IV has exernal and internal component
C. Type I and Hare the most common
D. Most common congenital solid tumour in neonates
E. Common in females
Spinal Cord 279

A. Majority are immature teratomas
B. 40% present more than 2 years of age
C. Elevation of alphafetoprotein in neonate indicates teratoma
D. Alfafetoprotein is elevated in malignant teratomas only.
E. Branches from profunda femoris artery supply the teratoma.
70. Imaging of syringomyelia:

A. The cord is atrophic
B. Contrast enhancement is seen around the syringomyelia
C. Intrathecal CT contrast fills the syringomyelia after 4 hours
D. Flattening of vertebral border
E. Intrathecal contrast opacification of the synringomyelia is due
to direct communication with the subarachnoid space

A. Homogenous signal intensity in MRI
B. Haemorrhage and necrosis are suggestive of malignancy
C. Tumours in more than 2 months age. is hightly malignant
D. Cystic lesions have high likelihood of malignancy
E. The lesions are solid in 50% of cases
72. Spinal infarction:

A. Most common in the upper thoracic cord
B. Cord is enlarged in the acute stage
C. No changes are seen in the Tl\V images
D. The posterior part of spinal cord not affected
E. Contrast enhancement is seen in MRI of subacute stage
73. Dural AVF:

A. Type IV of malformations
B. Constitutes 80% of spinal maiformat!ons
C. ivfost common in the cervical cord
D. The pi al veins are occluded due to shunt of flow in lhe venous
malformation
E. Cord is not affected
7.:t. Vascular malformations in spinal cord:

A. Dural AVF are spontaneous in majority of cases
B. No neurological deficit is seen in dural AVF
C. In type IV. arterial feeder is anterior spinal artery
D. In Type IV-there is no intervening vascular network
E. IV- more commonst in the anterior aspect of conus medullaris
F. Cobbs syndrome ahvays has a cutaneous angioma in the
dermatome
75. Vascular malformations:

A. Extradural haemorrhage is seen in rype II
B. \1ultiple arterial feeders are present in II and III
C. Type II is most common in rhe dorsal aspect of thoracic
vertebra
D. The most common malformation is type II
E. Cavernous angiomas are not seen in the spinal cord
76. Sacral agenesis:

A. Common in diabetic mothers
B. Associated with neurogenic bladder
C. Associ<1ted with V.� TER svndrome
D. Dural sac stenosis and high termination
E. Tethered cord is associated
77. Spinal infarction:

A. Venous infarction more common than arterial
.B. Arterial infarction affects one side of the cord
C. Complicates surgery for aortic aneurysm
D. Anterior spinal artery occlusion is the cause of arterial
infarction
E. Cantre.st enhancement is seen in \1RI
78. Spinal cord diseases:

A. Subacute combined degeneration affects the \'entral columns
of spinal cord
B. The dorsal spine is the most commonly affected in SCD
C. MRI does not show any change in SCD
D. Gout rarely affects the spine
E. Gout is most common at the craniocervical junction

A. Plaques oriented perpendicular to the spinal axis
B. Length of plaque is less than two vertebral body segments
C. Width is more than half the crossection of cord
D. Dorsal region is the most commonly affected
E. Always seen with co existent intracranial plaques
80. Differential for plaque(high signal lesion in TZW images):

A. Transverse myelitis
B. Tumour
C. Astrocytoma
D. Syringomyelia
E. Metastasis
Spinal Cord 281
81. Epidural abscess:

A. High signal in disk in TZW images
B. Multiple segmental involvement is common
C. Diskitis is associated in 80% of cases
D. Absence of rim enhancement rules out epidural abscess
E. Gram negative organisms are the most common
82. Spinal infections:

A. Myelitis is the most common infection of the spinal axis
B. There is no imaging finding in meningitis _
C. Nodular enhancement is common in MRI of meningitis

D. Herpes virus is a common cause of myelitis
E. Contrast enhancement of the spinal cord without a focal mass
is a specific sign of myelitis
83. Acute transverse myelitis:

A. The sensory level is usually in the cervical cord
B. Onset within one hour
C. Systemic tumours cause transverse myelitis
D. MRI features are not specific
E. The cord is enlarged in early stages itself
84. High sign al in Tl weigh ted f\.-IRI is seen i n :

A. Oxyhaemoglobin
B. Deoxyhaemoglobin
C. Methemoglobin
D . Haemosiderin
E. Iron deposition
,J: t··
\" ANSWERS
( .�
: ...·,
.
s
'
.1. A-T, B-T, C-F, D-F, E-T

, / i: 1 There is a difference of one v�rtebral �egmen.t between flexion
' , Jcy·\and extension. Normally the spinal cord extends upto Ll/2. There
is a difference of one segment between vertebral and spinal levels
t/
t1\
1•
; .>'in the cervical region, two in the thoracic and three in the lumbar.
./.•
. 1 / The trans v e r s e diameter is more than the AP. There are two
\. )\ . ·v·
expansions, one in the cervical level. where br�chial plexus emerges
. \,-
\
and the other at the lumbar level. The cervical expansion is from
'
' '
,CS-Tl spinal segments. corresponding to C3-C7 vertebra and the

lumbar expansion from L2-S3 spinal segments corresponding D 10-
. c.l L 1 vertebrae.
2. A-F, B-F, C-T, D-F, E-T

The sympathetic fibers are situated in the lateral column of thoracic
cord. The white matter is divided into anterior. posterior and
lateral column s . The posterior column transmits fine touch.
vibration and proprioception. via large myelinated fibers.
3. A-T, B-F, C-T, D-T, E-T

The dural space is attached to the tectorial membrane above and
the posterior longitudinal ligament of axis. but not attached
any-v..:here else. Dural space is wide posteriorly in the cervical and
thoracic spine. There is a small slit anteriorly. In the lumbosacral
region. it is more than half of spinal canal. It extends for a short
distance beyond the imervertebral foramen and merges with the
epineurium of the nerve.
4. A-T, B-F, C-F, D-T, E-T

The anterior spinal artery supplies anterior two-thirds of cord.
The anterior spinal artery is formed by fusion of two anterior
spinal branches. of vertebral arteries.
The posterolateral arteries arise from PICA.
The anterior spinal, posterolateral. ascending branches from
lumbar, medial and lateral sacral arteries anastomose in the conus
region.
5. A-F, B-F, C-F, D-F, E-F

The central canal is continous above with fourth ventricle and
below 5-6 mm into the filum terminale. The central canal i s
situated anteriorly in the cervical and thoracic cord, central in
upper lumbar and posterior in conus. The fifth ventricle is
expansion of the central canal in conus. seen in 3% of children.
The central canal is lined by ependyma.
Spinal Cord 283
6. A-F , B-F, C-T, D-T. E-F

Lumbar myelography with proper positioning can visualize
thoracic and cervical cords. Puncture is made between C 1 /2 level.
The stillette is parallel to the long axis of spine to avoid cutting
fibers o f interlaminar ligament.
7. A-T, B-F, C-F, D-T, E-F

Seizures are n o t seen with non-ionic contrast media. Spinal
dysraphism is associated with tethered cord. and hence injection
should be made lower than normal. Arnold Chiari is associated
with herniation o f tonsil and cervical puncture can damage the
cerebellum. Visualisation of nerve root beyond exit foramen
indicates extradural injection.
8. A-T, B-F, C-T, D-F, E-F

If lumbar puncture is repeated before one week, needle can enter
the subdural space. Lateral decubitus position is the best position.
Prone position is technically difficult as the spinous processes are
closer together. Sitting position also causes syncope. Interspinous
ligament need not b e anaesthesised. After thecal sac is entered.
stillette removed to confirm CSF, then stillette reintroduced for
a dvancing the needle, just 2 mm.
9. A-T, B-T, C-F, D-T, E-F

There are two approaches. lareral and the posterior- \vhich crosses
through the thecal sac. 21 G needle is used till the annulus fibrosus.
after which a smaller needle is used to traverse rhe nucleus
pulposus. Injection of contrast into the discal space can reproduce
the pain of discal disease, and the effect of bupivacaine to relieve
the pain can be assessed. 1 ml is the normal amount of contrast
introduced.
10. A-T, B-T, C-T, D-T, E-T

The radicular arteries enter £hrough intervertebral foramina.
Cervic a l-Vertebral. deep cervical. thyroce 1·vical trunk.
costocervical trunk.
Thoracic-supreme intercostal arteries. intercost;il arteries.
Lumbar-median and lateral sacral arteries and lumbar arteries
11. A-T, B-F, C-F, D-T, E-T

The radiculomedullary artery of the lumbar enlargment. the arteria
radicularis magna of Adamkiewicz. arises between ninth thoracic
and first lumbar segmem. usually from eleventh or t\velfth thoracic
segment. being on left in 80%.
The junction is usually hair pin bend, but Y shaped in cerv'.:al
levels.
Bronchial artery embolisation and aonography may give rise to

paraplegia due to these anastomoses.
12. A-T, B-F, C-T, D-T, E-T

The anastomosis between anterior spinal arteries is variable, hence
.there might be cessation of flow, if one of the smaller arteries is
occluded.
Occlusion of single perforating artery into cord will not produce
significant ischemia since, there are many such smaller branches
anastomosing freely.
The spinal veins, drain into the epidural veins. which drain into
the paraspinal veins.
13. A-F, B-T, C-T, D-T, E-T

Meningomyolecele. ependymoma and other intraspinal tumours
are other causes.
14. A-T, B-F, C-T, D-T, E-T

Hemangiomas are bright due to fatty nature. Radiation
characteriscailly produces high signal due to fatty replacement of
the vascular marrow. Aging is characterised by fatty replacement
of the vascular marrow, and the high signal. Type II degenerative
change is bright in Tl. Haemorrhage and Gauchers disease are
other causes. Anemia produces low signal.
15. A-T, B-T. C-T, D-T, E-T

Type I and III degenerative changes have low signal in Tl. Pagets
is low due to sclerosi�,. �!Y:f in.er.ease of re
. 9 �ar�ow or .t\,l[flO�rs
infiltrating red marrow produce low signal.
16. A-F. B-T, C-T, D-T, E-T

T h e anterolateral column transmits crude touch, pain and
temperature. The pain and temperature fibers pass through the
posterior root, then synapses with cells in substantia gelatinosa
in the cord and crosses to the opposite side anterolateral tract.
17. A-F, B-T, C-T, D-T, E-T

The three most common causes of Ivory_ vertebra(dense sclerosis)
are osteoblastic metastasis. Pager's- disease and lymphoma. Other
causes included. trauma. sclerosing osteomyelitis. osteopetrosis,
fluorosis, renal osteodystrophy, osteopetrosis, myelosclerosis.
hemangioma, osteosarcoma, myeloma.
18. A-F, B-T, C-T, D-F. E-T

The denticulate ligament extends from the arachnoid to the dura
laterally and divides the space into anterior and posterior. The
lower extent is at _Ll. The ciribriform septum is situated
Spinal Cord 285
posteriorly. and derived from arachnoid membrane. This is

prominent a t thoracic level. The dura. arachnoid. pia and CSF
extend for a short distance beyond the intervertebral foramen.
where it is fused with the epineurium.
19. A-T, B-T, C-T, DT. E-T

Syphilis and fungal infections are also recognised causes.
20. A-T, B-T, C-T, D-F, E-F

Radiculomedullary a rteries are branches of radicular arteries
which supply the anterior spinal artery. There are six to ten in
total. The upper cervical region from Cl-D2 has three arteries at
.
3. 6, 8 cervical roots. 6th being the largest. The intermediate region

from D3-D8, is poorly vascularised. The lower region is from D9-
filum terminate.
21. A-T, B-F, C-F, D-T, E-T

_lntramedullai-y lesions caused cord expansion.
22. A-F, B-F, C-T, D-T, E-F

The dura is attached only to the tectorial membrane and PLL of
axis. not to any other structure. The dura can be seen in T2"'
sequence. The spinal CSF is 7 5ml.
The spinal cord is stablised by denticulate ligament. filum terminate
and attachment of nerv e roots. The pia mater extends upco the
coccygeal segment.
23. A-T, B-T, C-T, D-F, E-T

Bone lesions are the most common causes. Other tumours include
malignancies such as metastasis. myeloma. chordoma. sarcoma.
lymphoma and osteosarcoma.
24. A-T, B-T, C-T, D-T, E-T

Residual or recurrent disk and epidural fibrosis are the most
common causes.
25. A-T, B-T, C-T, D-F. E-T

Meningioma and neurofibroma are the most common causes of
intradural extramedullary masses. Other CSF met'> like ependy
moma. melanoma and carcinoma are other causes.
26. A-T, B-T, C-T, D-T, E-T

On Tl-iso/hypo. T2-shyper. enhancement homogenous or
heterogenous depending on amount of hae m orrh a ge necrosis and
.
xanthomatous changes.
27. A-T, B-T, C-T. D-T, E-T

Astrocytorna. ependymoma. syringomyelia. infections. metJscasis
are other causes.
28. A-F, B-T, C-T, D-T, E-T

It is seen distal to dorsal root ganglion. Associated with dural
ectasia and occasionally it can involve multiple vertebral levels.
The common differential diagnosis is cystic nerve root dilatation.
b ut this happens proximal to dorsal root ganglion.
29. A-F, B-T, C-F, D-T, E-T

Conjoined nerve root is the presence of more than one nerve root
in a single dural sheath at a single level. It is seen in 8% of autopsy
speciments. It is ��ymptomatic and do� not produce any pain.
But if this is affected by a disc or other pathologies in the spinal
canal. multiple levels will be affected. It is diagnosed by loss of
.
symmetry in the epidural fat.- Most common at L5-51 level.
Differential diagnosis for this appearance are soft tissue mass,
herniated disc and nerve root -�!��ve cyst.
30. A-T, B-T, C-T, D-T, E-T

Carcinomatous meningitis Charcot-Marie Tooth Neuand vascular
anomalies are other causes.
31. A-T, B-T, C-T, D-T. E-T

Lung and breast carcinoma are the most common causes.
32. A-T, B-F, C-F, D-F, E-T

Ependymmna-adults, conus. central in cord. pseudocapsule. cleft
betv.:een l�sion and cord, haemorrhage. no cyst.
Astrocytoma-children. cervicai cord. eccentric. posterior. no
capsule. nv cleft, no haemorrhage. cyst.
33. A-F, B-F, C-T, D-T, E-T

Ependydoma is common in the c o n us medullaris whereas
astrocytoma is common in the cervical region. Ependydoma is
commonly an intramedullary mass.
34. A-F, B-F, C-T, D-T, E-T

Although. metastasis can occur in any location. extradural is the
most common of them all. The most common extradural tumour
is metastasis .
35. A-F, B-F, C-T, D-T, E-F

Majority of astrocytomas are .low grade.
It is situated eccentrically in the aord. Intrathecal contrast will enter
the cystic spaces of the cord. Most common in the cervical level.
36. A-T, B-T, C-F, D-T. E-T

Associated with Von Hippel Lindau disease. 75% are intramedul
lary. Can occur intradural extramedullary. Majority are in the
cervicothoracic spine and are solitary.
Spinal Cord 287
The tumour has a large cystic component and the tumour nodule
enhances intensely ..
Signal voids are seen due to vascular channels.
37. A-F, B-F, C-F, D-T E-T ,
Majority occur in the second and third decades. Only 25% occur
in the first five years.
One percent of all spinal tumours. Flaccid paralysis and slow
ascending paralysis are common.
38. A-F. B-T, C-F, D-T, E-T

The signal of spinal hemangioma depends on the stroma . M�J�Jrity_
..
of the hemangiomas seen in MRI are of fatty stroma and hence

hyper i n T 1 a n d T 2. This can be confused with focal fatty
replaceme n t a n d can be differentiated by fat suppression
techniques. The hemangiomas with vascular stroma have low
signal in Tl and high signal in T2. Osteoid osteomas are less than
2 cm and osteoblsatomas more than 2 cm. osteochondroma is most
common in the spinous or transverse process. Chordomas are
common in the sacrococcygeal region and divus. Aneurysmal bone
cyst is common in the cervical and thoracic spine and is localized
in the posterior element of the vertebra.
39. A-T, B-F, C-T, D-F, E-T

Common in the posterior aspect of the cord and not in the anterior
or anterolateral aspect.
Exophytic component is seen in the upper or 10\.ver pole.
40. A-T, B-F, C-T, D-F, E-F

Pseudomeningocele is postoperative extradural cyst. Tear of
arachnoid and dura, which communicates with posterior vertebral
space. It is seen posterior to lamina. Usually asymptomatic. but
can produce b a ck pain and sciatica, especially with raised
intraadnominal pressure like coughing and sneezing. when ner:e
roots prolapse into the cyst. It is lined by fib�q-�� ssue. although
occasionally arachnoid can prolapse into 'fr.
41. A-T, B-T, C-T, D-T, E-T
42. A-T, B-F, C-T, D-T, E-T

Epidural analgesia introduces air inside thecal sac, which \Vill
produce signal void.
43. A-T, B-T, C-T, D-T, E-F

Lymphoma and pineal germinoma are other recognised causes.
44. A-T, B-T, C-T, D-T, E-T

60% are asymptomatic. But it may present with back �ain c:
neurological symptoms. Spinal cord compression is seen in 20%.

The nature of stroma decides the symptoms. Fatty stroma has a

very benign course and usually asymptomatic. Those with vascular
stroma are usually symptomatic.
n.<.
4·5. A-F B-T )C-T D-F E-F

' .__.... ' t
Pseudohydromyelia is low signal in cord mimicking hydromyelia.

It is called truncation artefact and is due to defect in the Fourier
transform mechanism. The Fourier transform. is designed to be
accurate when gradual changes in signal intensity occur. But if there
is sharp transition between tissues of different signal intensity.
there will be overshooting of Fourier. called Gibbs .P0�nomenon
which produces the truncation artifact. which is seen paralleTfo
high contrast borders. Reduced by increasing matrix sizeand-phase
encoding steps.
46. A-T, B-T, C-T, D1f., E-T

Non-Hodgkin's lymphoma. tuberculosis and herpes simplex are
other causes.
47. A-T, B-T, C-T, D-T, E-T

Chronic meningitis is a recognised cause of infarction. Vasculitis
and trauma are other causes.
48. A-T. B-F. C-T, D-T, E-F

Decompression sickness is di\·ided into t\\·o types. I- mild II
severe. \Nhite matter is affected more. There is no predilection
for posterior aspect. In early stages. the cord is edematous, with
Tl-hypointensity and T2- hyperintensity. In chronic stage. the cord
is atrophic and syringomyelia is a long term complication.
49. A-T, B-T, C-T, D-F, E-F

Breast, lung and re.1al are other causes.
50. A-F, B-F, C-T, D-T, E-T

Medulloblastoma, glioblastoma multiforme, pineocytoma and
germinoma are other causes. Drop metastasis occurs b y CSF
seeding.
51. A-F, B-T, C-T, E-F, F-T

Most common in the lower thoracic spine
52. A-T, B-T, CtV

lj -
D-T, E-T
Skin nevus. hypertrichosis. dimple are also associated.
53. A-F, B-F, C-T, D-T. E-F

There are two types of diastomatomyelia
A. (60.%) Common dural and subarachnoid space. Separate pia.
No spur or band.
B. (40%). Separat'� d·..iral, subarchnoid. pial space. Spur (75%).
band (25%).
Spinal Cord 289
54. A-T, B-T, C-T, D-T, E-F
55. A-T, B-F, C-T, D-T, E-T

Lipomyelomeningocele-20% of skin covered masses, 50% of
occult spinal dysraphism
Lipomyelomeningocele+ intradural lipoma-35% of skin covered
masses. 20-50% of spinal dysraphism.
56. A-T, B-T, C-T, D-T, E-F
57. A-T, B-F, C-T, D-T, E-F

Lipomas, split notochord syndromes are other types of occult spinal
dysraphism. in which the neural tissue is not exposed.
58. A-T, B-T, C-T, D-F, E-F

Positive family is seen in 10%.
Recurrence rate is 7%.
59. A-T, B-F, C-T, D-F, E-F

Chiari II malformation is associated in 100% and not Chiari I
In diastomatomyelia the cord can be split above. at or below the
level of myelomeningocele.
The central canal is duplicated at or above the level of myelo
meningocele and not caudally. Lipomas. dermoid. epidermoid.
agenesis of corpus.
60. A T B-T, C-T, D-T, E-T

- .
5% of congential scoliosis patients have diastomatomyelia.

The lamina are fused in 90% of patients. either at same level or
intersegmental level.
61. A-T, B-T, C-F, D-F, E-T

Dorsal nevus and dermal sinus tract are also seen.
62. A-T, B-F, C-T, D-T, E-T

The nerve roots follow an angle of more than fifteen degrees in
relation to the spinal cord. !\iormal spinal cord ends at L 1-12 after
three months. In 90% of tethered cord. the conus lies below L2
after 12 years. The thecal sac is triangular due to posterior tenting
by flilum. Low signal in center of cord is due to either
myelomalacia or hydromyelia.
63. A-T, B-,T C-T, D-F, E-T

Other associations include spinal dysraphism. spinal segmentaiton
defects, myelocele, Arnold Chiari malformation. Dandy \Valker
malformation and scoliosis.
64. A-T, B-T, C-T, D-T, E-T

Subarachnoid haem orrhage. adhesions. surgery, spinal cord
tumours are other common associations.
65. A-T, B-T, C-T. D-F, E-T

Each hemicord have their central canal and one ventral and dorsal
horn.
66. A-F. B-T. C-T, D-T. E-F

70% are seen in thoracic cord. Associated with arachnoid cyst in
the upper part of the syringomyelia. Measures 6 cm in average.
Seen in 3. 5% after spinal injury.
67. A-T. B-T, C-T, D-T, E-T

The central canal is obliterated in 80% of normal individuals. It
is persistent and communicates iwth the fourth ventricle. causing
hydromyl'lia. It is usually low signal in Tl and high signal in T2.
but flow void can be seen due to pulsations.
Metameric haustrations are seen due to incomplete septations
within the cavity.
68. A-T, B-F, C-T, D-T, E-T .

Altmans classification I-predominantly external. II-predominantly
external with presacral component. II-predominanlty sacral with
external component. IV-only presacral I and II comprise 80% of
all teratomas.
69. A-F. B-F, C-F, D-T, E-T

55-75% are mature. 10-30% are immature. 10-20% are malignant.
!\1ajority present in the first fevv days of life. 80% present by six
months and only 10% prese!1t after t\\·o years of age. In neonate
the alphafetoprotein is WJrmally ele\'ated. v.;hich can be confused
with alpha protein caused to teratoma. Malignant teratomas with
endodermal sinus tumour are the most common causes of elevated
alphafeto protein. The teratoma is supplied by median sacral artery,
glut eal branches of internal .iliac artery and branches from
profunda femoris artery. The feeding vessels are enlarged with
arterial encasement. blushes and arteriovenous shunting.
70. A-T, B-F, C-T, D-T, E-T

The cord is �nlarged or atropic or normal. No enhancement of
the syringomyelia or surrounding cord is seen. The sac may fill
with contrast, either early due to direct communication with the
subarachnoid space or late due to permation of contrast.
Vertebral border may be flattened due to enlarged cord.
71. A-F, B-T, C-T, D-F, E-F

The tumours are of heterogenous signal. because of different
components such as fat, muscle. soft tissue, hair and others. Cystic
lesions are likely to be benign.
Majority of tumours are mixed solid and cystic. 25% are solid and
15% are cystic.
Spinal Cord 291
72. A-T, B-T, C-T, D-F, E-T

Upper thoracic area is most common site because it is the border
zone of arterial territories. Cord is enlarged in the acute stage.
but atrophied in the chronic stage. Tl is usually normal. T2 shows
bright signal in MRI. Enhancement is seen in subacute stages. Any
part of the cord can be involved, depending o n the vascular
territory affected.
73. A-F, B-T, C-F, D-F, E-F

There are four type of malformations, I-dural A VF, II-glomus
AVM intramedullary, III-juvenile AVM. intra/ extra, IV- intradural
AVF. The most common malformation is the dural AVF, which
is common in the _conus �ed�ll. ar_ is and the dorsal aspect of lower
. r�. The cord is enlarged and hyperintense i n T2\N
th�-�?._cic ..cC?
images and is surrounded by dilated pial veins.
74. A-T, B-F, C-T, D-T, E-T, F-T

Type I-Dural A VF. II-intramedullary AV�vf (glomus
malformation). III-intramedullary with extraspinal component.
IV-intradural extramedullary AVF
IV-There i s a arteriovenous fistula. with large draining vein .
Common in the conus medullaris. anterior to the cord. :\eurologic
deficit is seen.
_. .. .
( I-Dural AVF. is spontaneous in 60% and post traumatic in 40°0.

Type I and IV, both do not have intervening vascular net\vork
like II or III. whereas I- is dural. seen dorsally within the cord.
IV-is imradural extramedullay. seen anteriorly. Cobbs syndrome
is association of spinal vascular malformation with cutaneous
angioma in the same dermatomal distribution.
75. A-F, B-T, C-T, D-F, E-F

Type II and III vary only in their location. Type II is intramedul
lary. III is intramedullary with extramedullary component. They
produce intramedullary haematomas. Type IV is tlte most common
malformation, common in the thoracolumbar regilln. Neurological
deficit is due to chronic venous hypertension. Cavernous angiomas
are seen in the cord.common in the thoracic region. in the 3-6
decades. The imaging features are the same as in brain.
76. A-T, B-T, C-F, D-T, E-T

Foot deformities. hypoplasia of extremeitis. hip dislocation and
spina bifida are common associations.
77. A-F, B-F, C-T, D-F, E-T

Arterial infarction is more common. Arterial is due to occlusion
of sulcocommisural branch of anterior spinal anery a:id ven')L:.5
is due to occlusion of local pial veins. Venous infarction affects

one side. while arterial affects both sides. In early stages the cord
is enlarged vvith high signal and some contrast enhancement.
whereas in later stages the cord shrinks.
78. A-F, B-F, C-F, D-T, E-T

Subacute combined degeneration is due to vitamin Bl2 deficiency.
The changes are seen in the dorsal and lateral columns, commonly
in the cervical spine from C2-5. High signal is seen and they
occasionally show contrast enhancement. Gouty tophi can be seen
as extradural mass.
79. A-F. B-T, C-F, D-F, E-F

Plaques are oriented parallel to the spinal axis. Length of plaque
is less than two vertebraf body segments and \\·idth is less than
half the crossection of cord.
, Cervical reg !gn commonly affected. In 10% intracranial plaques not
. seen.
80. A-T. B-T, C-F. D-F, E-T
81. A-T, B-T. C-T, D-F, E-F

Epidural abscess occurs in tv·:o stages. In the initial stage there is
or:ly a phlegmanous collection. v;hich will shO\\. homogenous or
he:erogenous enhancement. In next stage. a well defined abscess
is formed. \\·hich is hypo in Tl. hyper in T2 and shows rim
enhancement. causing cord compression. Discitis and osteomye
tlitis are associated in 80% of cases. The disk space is narrowed
and high signal is seen in the disc. �taphylococcus aureus is the most
common organism and the infection commonly spreads by the
hematogenous route.
82. A-F, B-F, C-T, D-T, E-F

The most com!"11on infection of the . spinal axis is meningitis. This
can be seen as smooth linear enhancement of the meninges. cord
and nerve roots or nodules on surface of meninges or diffusely
thickened soft tissue. Herpex, polio, HIV, coxsackie virus,
vaccination, meningitis and epidural abscess are causes of myelitis.
83. A-F, B-T, C-T, D-T, E-T

The sensorY. level is usually at the thoracic cord. The common
.
. causes are' viral infection .. vaccination;� systemic tumours and
.
· i:· autoimmune. The imaging findings are very non-specific. The cord
is enlarged, .hypointense in Tl and hyperfritense in T2 and can
show contrast enhancement.
84. A-F, B-F, C-T, D-F, E-F

Oxyhemoglobin hypo. deoxyhemoglobin, hemosiderin and iron are
dark.
1. Medical devices:
A. Position of programmable shunts is best assessed in enface view
of the valve
B. Ventriculoperitoneal shunt tubes are radiolucent
C. Cerebral palsy is managed by thalamic electrodes
D. Tantalum aneurysm clips are an absolute contraindication to
tvf RI
E. Any radiopaque dip is contraindication to :-VfRI
2. Causes of hypoplastic mandible:

A. Goldenhar syndrome
B. Treacher Collins syndrome
C. Cretinism
D. Gardners svndrome
E. Hyperparathyroidism
3. CSF Leaks:
A. 80% are caused by non-surgical trauma
B. 80% present in 48 hours
C. Testing the nasal discharge for glucose is the gold standard
D. Meningitis occurs in 60 % of cases
E. Two thirds resolve spontaneously on one month
4. CSF Leaks:
A. Meningitis does not happen after the defect is closed
B. Glucose level < 30 mg/ dl excludes CSF
C. Prognosis is better for aural than nasal leaks
D. Tc labelled albumin is injected intrathecally to diagnose
E. CT cisternography is the most useful investigation when active
leak is present
5. Temporal lobe epile psy:

A. 't\1esial temporal sclerosis i s bilateral i n 1 5 %
B. 35-65% of those who undergo temporal lobe surgery have
mesial temporal sclerosis
C. Cavernous angioma is the most common vascular malformation
i n temporal lobe epilepsy
D. Tl W images are best for assessing the asymmetry of ventricles
E. The most common cause of complex partial seizure is a tumour
Miscellaneous 295
ANSWERS
1. A-T, B-T, C-F, D-F, E-F
The tip of the ventriculoperitoneal shunt is radiopaque. Position
of the programmable shunt is best assessed in en face view. where
the small right hand side indicator will be on the right hand side
of the larger central marker of the valve. The spasticity of cerebral
palsy is relieved by stimulation of cerebellum, whereas Parkin
sonism is controlled by deep thalamic stimulation. Aneurysm clips
can be ferromagnetic or non-ferromagnetic (Tantalum). Both are
radiopaque. F erromagnetic clips are absolute contraindication to
MRI.
2. A-T, B-T, C-F, D-F, E-F

Treacher Collins syndrome. Pierre Robin syndrome. Hallermann
Streiff syndrome. pyknodysostosis. TMJ ankylosis (disuse).
DiGeorge syndrome. Summitt syndrome and other chromosomal
abnormalities.
3. A-T, B-T,C-F, D-F, E-T

95 % present by three months. The discharge has glucose unlike
normal nasal secretions. But Beta 2 transferrin is the gold standard
as it is present only in CSF, perilymph and vitreous fluid.
Meningitis occurs in 10-25%.
4. A-F. B-F, C-T, D-T, E-T

Meningitis can happen even after the defect is closed. In CSF. the
glucose level is usually more than 30 mg/dl. False positive results
are obtained in serous exudates post surgery. False negative results .
are obtained in meningitis, when the CSF glucose is reduced. Tc
Labelled albumin and In 111 labelled DTPA are injected intra
thecally and leak can be demonstrated.
5. A-T, B-T, C-T, D-T, E-F

Mesial temporal sclerosis is the most common cause of complex
partial seizure. Tl shows the hippocampal atrophy and asymmet
rical ventricular sizes. T2 and FLAIR are best for signal changes.
Hippocampal volume can be assessed. Cortical dysplasia, tumours
are other causes. Low grade astrocytoms and oligodendrogliomas
are the most common in adults. Pilocytic astrocytoma and
ganglioglioma are the common tumours in children.
Bibliography
l. American Journal ofRoentgenology. American Roentgen Ray Society.

2. Anne G Osborne. Diagnostic Neuroradiology. �osby.
3. Anne Osborne. Pocket Radiologist. Brain: Top 100 Diagnoses. Saunders.
4. Clinical Radiology. Royal College of Radiologists. UK.
5. David Sutton. Textbook ofRadiology and Imaging. 7th edn. Churchill Livingstone.
6. CH Whitehouse. Brian S Worthington. Graham H Whitehouse. BS Worthington. Techniques
in Diagnostic Imaging. Blackwell.
7. Grainger and Allison's Diagno.stic Radiology. A Te:<tbook o fMedical Imaging. 4th edn. Churchill
Livingstone Publishers.
8. Hamsberger. Handbooks in Radiology. Head and Neck Imaging. Year Book.
9. Jamie Wier. Peter H A b r ah ams . Imaging Atlas of Human Anatomy. M os by .
10. Jeffrey S Ros s. MRI of the Spine. 2nd edn. Lippincott Williams & Wilkins.
11. KC Clark. E Naylor. EJ Roebuck. AS Whitley. R.A.. Swai!ow. Positioning in Radiography.
Buttef\.vorth Heinemann.
12. Michael Brant- Sawadzki. W illam G Bradley Jr. Jane Cambray- Forker. MRI of the Brain. 2nd
edn. Lippincott Williams & Wilkins.
13. PF Butler. Applied Radiological Anatomy. Cambridge C nive rsit y Pres s.
14. Radiographies Journal. Radiological S oci ety of >;orth A merica.
15. Radiological Clinics of North America. Saunders.
16. Radiology. Radiological Soc ie t y of North America.
17. Ric Hamsber ger. P ocket Radi olog is t. Temporal Bone: Top 100 D iag nose s. Saunder s.
18. Robert Grossman. D avid Yousem. >leuroradiolog_v: The R equisites. Mos b y.
19. S Ryan. Mc�ichols. Anatomy for Diagnostic Imaging. Saunders.
20. Scott Atlas. Magnetic Resonance Imaging of 'he Br ain and Spine. lippincoct Raven.
21. Seminars in Roencg e n ol og y . S a u nder s.
22. So m . Bergaron. Head and Neck I maging. Mosby.
23. Stephen C hapman. Richard Nakielny. A Guide to Ra diological Procedures. S aunders.
24. Stephen Chapman. Richard Nakielny. AIDS Radio logical Differential Diagnosis. Saunders.
25. Theodore E Keats. Mark W Anderson. Atlas of:\ormal Roentgen Variants that may Stimulate
Disease. Mosby.
26. Wolfgang H Dahnert. Radiology Review \.fanual. 5ch edn. Lippincon Wi lliams & Wilkins.

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I Senior Regis trar in Radiology

Tel/Fax: +44 (0)1892 557767

Copyright© 2006 by (author)

ISBN 1 904798 586

British Library Cataloguing in Publication Data

All rights reserved. No part of this publication may be reproduced, stored in a

Printed in India by Sanat Printers, Kundli, Haryana

Many of the designations used by manufacturers and sellers to distinguish

Senior Registrar in Radiology

JAYPEEBROTHERS Tunbridge \.�'rff �

Tel/Fax: +44 (0)1892 557767

Copyright© 2006 by (author)

ISBN 1 904798 586

British Library Cataloguing in Publication Data

All rights reserved. No part of this publication may be reproduced, stored in a

Printed in India b y Sanat Printers, Kundli, Haryana

Many of the designations used by manufacturers and sellers to distinguish

Consult ant R adi o l ogist .

Tameside General Hospital.

Prabhakar Raj iah

2. Congenital Anomalies ....................................................... . .

4. Skull and Brain Lesions ............. . ........................................ .. . ........ 46

5. Infections . . ...................... . ............................. ........... . .......................... . 65.

6. Vascular Lesions .... . ............ . ............. . ..................................... . . .. ... 78

7. Tumours .............................................................................................. 116

8. Degenerative and Demyelinating Lesions .............................. 149

9. Head and Neck-1 .......................................................................... 176

10. Head and Neck-2 .......................................................................... 232

11. Spinal Cord ....................................................................................... 268

12. Miscellaneous .................................................................................... 293

2. !v1RI scan of brain:

3. Structures enhancing on contrast administration in CT:

4. Lesions hyperintense on Tl and T2W images:

5. Arachnoid cap cells are seen:

6. Lesions hyperintense on Tl but hypointense in T2:

7. The following lesions are hypointense in Tl and T2:

v 9. The fallowing foramina transmit the corre sponding structures:

10. The following are normal calcifications in skull:

11. Skull radiology:

12. Brain embryology:

13. The following structures enhance on Gadoliniu m adminis­

1 14. The skull and sutures:

16. Mye li nation of brain:

18. CSF cisterns- and their contents:

19. Cranial n e rves:

20. The following are n ormal lucencies in skull vault:

22. Lesions that are hypointense in Tl and hyper in T2:

23. The vagus su pplies the following:

\_/ 25. Cranial nerves and their nuclei:

: 26. The skull:

28. Myelination_ in T2 W images:

C. The inferior cerebellar peduncle passes from cerebellum to

30. The ventricular system:

31. Brain development:

32. Pi nea l gland:

33. Pituitary gland:

34. The following are components of basal gangl i a:

35. Corticospinal tract:

36. Corpus callosum:

37. Gyri and sulci:

38. The ventricular system:

13. The following structures enhance on Gadoliniu m adminis