NEURORADIOLOGY IMAGING IN-SERVICE EXAM

(NOVEMBER 27, 2022)

Kindly fill-up your answer sheets properly including your YEAR LEVEL opposite your name. DO NOT forget
to put your resident number and shade the corresponding numbers. Kindly shade well all your answers
using PENCIL. Answers shaded with ballpen/ pentel pen will NOT be checked. God bless.

1-12: Trauma and Cerebrovascular Disease

1. Subarachnoid hemorrhage in what location warrants CT angiography screening for ruptured
aneurysm regardless of mechanism of injury? *
A. Suprasellar cistern
B. Cortical sulci
C. Interpeduncular cistern
D. Cerebello-pontine angle cistern

2. What is the most common intracranial finding in confirmed cases of abusive head trauma? *
A. Subdural hemorrhage
B. Epidural hemorrhage
C. Cortical contusion
D. Diffuse axonal injury

3. In descending transtentorial herniation, where is the Kernohan notch seen? *

A. Herniating temporal lobe
B. Dorsolateral midbrain
C. Central midbrain
D. Contralateral cerebral peduncle

4. What is the earliest sign of post traumatic brain swelling? *

A. Subfalcine herniation more than or equal to 3 mm than width of epidural / subdural
hematoma
B. Small ventricles
C. Indistinct gray white matter differentiation
D. Sulcal effacement

5. What is the most common brain herniation that causes post traumatic cerebral infarction? *
A. Transalar herniation
B. Subfalcine herniation
C. Tonsillar herniation
D. Descending transtentorial herniation

6. What is the most common traumatic extra-axial hemorrhage? *

A. Subdural hemorrhage
B. Venous epidural hemorrhage
C. Subarachnoid hemorrhage
 D. Arterial epidural hemorrhage

7. Subarachnoid hemorrhage confined anterior to the pons and around the midbrain is self-
limited and is usually due to what pathology? *
A. Venous hemorrhage
B. Amyloid angiopathy
C. Ruptured aneurysm
D. Reversible cerebral vasoconstriction

8. In what stage in the evolution of intracranial hemorrhage does met-Hgb become

extracellular? *
A. Late subacute hemorrhage
B. Hyperacute hemorrhage
C. Acute hemorrhage
D. Early subacute hemorrhage

9. What is the most common cause of spontaneous intracranial hemorrhage in children 1-18
years old?
A. Dural venous sinus thrombosis
B. Hematologic disorder
C. Vascular malformation
D. Neoplasm

10. What is the most common location of hypertensive intracranial hemorrhage? *

A. Putamen / external capsule
B. Thalamus
C. Lobar hemispheric
D. Pons / cerebellum

11. Acute subdural hemorrhage may be isodense with the underlying cortex EXCEPT in which of
the following? *
A. Diffuse cerebral edema
B. Extremely anemic patients
C. Patients with coagulopathy
D. CSF leaks admixing with blood in the subdural space

12. Which of the following aneurysms usually rupture into the Sylvian fissure? *
A. Anterior communicating artery aneurysm
B. Vertebrobasilar artery aneurysm
C. Middle cerebral artery bifurcation aneurysm
D. Internal carotid-posterior communicating artery aneurysm
(12) 13-24: Central Nervous System Neoplasms and Tumor-Like Masses
13. True in newborn astrocytoma except
a. supratentorial is the most common location than infratentorial
b. large , bulky and highly malignant hemispheric neoplasm
c. Glioblastoma is the most common
d. Infratentorial is the most common location than supratentorial

14. Notorious for their ability to spread via multiple routes

a. Glioblastoma
b. Medulloblastoma
c .Germinoma
d. Ependymoma

15. True in IDH -wild type Glioblastoma multiforme except

a. Arises for malignant degeneration of lower grade tumor
b. Thick irregular enhancing tumor “rind “around central necrotic core
c. Hemorrhage is common
d. Angiography shows prominent capillary phase tumor blush , enlarged/irregular- appearing
vessels and pooling of contrast

16. Hypodense on NECT,most common location is frontal lobe,”fried egg cell with chicken wire
vascularity , hemorrhage and necrosis are less common , with gyriform calcification is a very
suggestive of
a. Oligodendroglioma. IDH mutant
b Diffuse astrocytoma
c. Anaplastic oligodendroglioma
d. ganglioglioma

17. Less than 1% of all primary neoplasm however, represent 10-20 of brain tumor occurring in
the first year of life A well delineated lobulated intraventricular mass
a. Choroid Plexus papiloma
b. Craniopharyngioma
c. Primitive neuroectodermal tumor
d.Choroid plexus carcinoma

18. Most common mixed glioneuronal tumor and common seen in children with seizures . CT
findings of well circumscribed hypodense cyst with isodense mural nodule
a. ganglioglioma
b. diffuse astrocytoma
c. pilocytic astrocytoma
d. oligodenroglioma

19. Most common tumor associated with temporal lobe epilepsy

a. DNET
 b. Diffuse low grade astrocytoma
c. ganglioglioma
d.Pilocytic astrocytoma

20.Most common affected cranial nerve in intracranial schwannomas

a. CN I
b. CNVII
c. CN VIII
d. CNIII

21. Imaging findings of Pineocytomas are except

a. Well delineated masses that are mixed iso to hypodense on NECT scan
b. Calcification typically appear engulf toward the periphery of the pineal gland
c. iso-to-hypointense on T1W1 and hyperintense on T2W1and FLAIR
d. T2 GRE may show blooming foci secondary to calcification or hemorrhage

22.The most common posterior fossa of childhood neoplasm

a. Ependymoma
b. astrocytoma
c. Classic medulloblastoma
d. Choroid plexus tumors

23.Imaging findings of meningioma except

a. Hyperdense in CT
b. hemorrhage is common
c. Usually isointense with gray matter
d. “Sunburst” vascularity

24. Intra-axial lesions with marked surrounding edema includes except

a. metastasis
b. abscess
c. Glioblastoma
d. radiation necrosis
e. Hematoma

(1-11) 25-35: CNS Infections

25. Which imaging finding favors the diagnosis of congenital cytomegalovirus infection over
congenital toxoplasmosis infection?
A. Macrocephaly
B. Periventricular calcifications
C. Subcortical cysts
D. Ventriculomegaly
26. What is the most striking and consistent imaging finding of congenital HIV?
A. Bilateral symmetric basal ganglia calcifications
B. Cerebral atrophy
C. Ectasia of intracranial arteries
D. Hemispheric white matter calcifications

27. Neonate patient appears normal in the first few days of life develops lethargy, poor feeding,
seizures, and bulging fontanelles after two weeks. MRI shows restricted diffusion in both
cerebral hemispheres. No magnetic susceptibility artifacts, migrational anomalies, or
ventriculomegaly demonstrated. What is the most likely diagnosis?
A. Bilateral MCA acute embolic infarcts
B. Congenital herpes simplex encephalitis
C. Congenital syphilis
D. Lymphocytic choriomeningitis

28. In cases of pyogenic meningitis, which MRI sequence is especially helpful in demonstrating
purulent exudates in the subarachnoid and subdural spaces?
A. DWI
B. FLAIR
C. T1WI
D. T2WI

29. Which imaging finding favors the diagnosis of demyelinating disease over abscess?
A. Incomplete rim enhancement with “open” non-enhancing segment facing the cortex
B. Presence of cytosolic amino acids (0.9 ppm) on MR spectroscopy
C. Presence of satellite lesions
D. Strong restricted diffusion on DWI

30. Which imaging finding is characteristic of herpes simplex encephalitis?

A. Bilateral asymmetric temporal lobe and insular involvement
B. Confluent curvilinear “blooming” foci in the basal ganglia in T2* images
C. Gyriform restricted diffusion early in the disease
D. Patchy gyriform enhancement of the parietal lobes

31. True of tuberculous meningitis

A. Brain infarctions as a sequela of vasculitis is more common in bacterial meningitis than
tuberculous meningitis
B. Chest radiograph is normal in 40% to 75% of patients
C. Imaging studies show peripherally distributed meningeal enhancement
D. Mycobacterial CSF cultures is more sensitive in confirming the infection than polymerase
chain reaction (PCR) studies
32. What stage of cerebritis and brain abscesses is characterized by a well-defined lesion with
thin enhancing rim and central necrosis?
A. Early cerebritis
B. Late cerebritis
C. Early capsule
D. Late capsule

33. What is the most frequently reported CNS fungal infection?

A. Aspergillosis
B. Candidiasis
C. Cryptococcosis
D. Mucormycosis

34. At what stage of the neurocysticercosis infection is brain parenchymal inflammation most
evident?
A. Vesical
B. Colloid
C. Nodular granular
D. Nodular calcified

35. What is the most common imaging finding of CNS toxoplasmosis in patients with HIV?
A. Diffuse T2W hyperintensities in the basal ganglia and subcortical white matter
B. Generalized volume loss
C. Multiple punctate and ring-enhancing lesions
D. Thickening and undue enhancement of the meninges

(1-11) 36-46: Demyelinating and Inflammatory Diseases, Toxic, Metabolic, Degenerative and
CSF Disorders
36. All of the following factors are reported predictors of developing clinical multiple sclerosis
among patients with radiologically isolated syndrome EXCEPT:
A. Abnormal visual evoked potentials
B. Age less than or equal to 37 years
C. Female sex
D. Presence of oligoclonal bands in CSF

37. Which is a severe form of acute demyelinating disease that preferentially involves the spinal
cord and optic nerves with relative sparing of the cerebral white matter?
A. Devic syndrome
B. Guillain-Barré syndrome
C. Miller Fisher syndrome
D. Susac syndrome

38. Which of the following diseases is a differential diagnosis of

hypothalamic/infundibular/pituitary neurosarcoidosis?
 A. Histiocytosis
B. Intracranial inflammatory pseudotumor
C. Lymphoma
D. Meningioma

39. Which of the following imaging features is a common finding among intracranial
inflammatory pseudotumors?
A. Lytic permeative destruction adjacent to a dural-based soft tissue mass
B. Parenchymal demyelinating foci that is isointense on T1 and hyperintense on
T2/STIR
C. Thickened dura along the posterior falx and tentorium that is T2 hypointense
and exhibits strong enhancement around a central non-enhancing area
D. Tumefaction or mass-like lesion that involves the adjacent brain

40. MRI of a 23 year old woman with bilateral cranial nerve V deficits shows striking
hyperintensity and fusiform enlargement of both trigeminal nerves, enlarged and markedly
hyperintense ophthalmic nerves, and fusiform, rope-like enlargement and moderate
hyperintensity of both mandibular nerves. What is the most likely diagnosis?
A. Acute ophthalmoplegia and ataxia
B. Charcot-Marie-Tooth disease
C. Chronic inflammatory demyelinating polyneuropathy
D. Neuromyelitis optica spectrum disorder

41. Which is a rare but important cause of hyperintense CSF on FLAIR sequence?
A. CSF metastases
B. Fat from ruptured dermoid
C. Meningitis
D. Susceptibility flow artifact

42. What is the most common lesion that affects the putamen
A. Hypertensive hemorrhage
B. Hypoxic-ischemic injury
C. Osmotic demyelination
D. Toxic poisoning

43. Which of the following MRI findings is pathognomonic for Wernicke encephalopathy?
A. Corpus callosum necrosis
B. Petechial hemorrhages in the medial thalami
C. Restricted diffusion in the putamina and thalami
D. Strong uniform enhancement of the mamillary bodies

44. Which of the following imaging findings is a major manifestation of cocaine-induced brain
damage?
A. Acute hypertensive encephalopathy
 B. Delayed toxic leukoencephalopathy
C. Mycotic aneurysm formation
D. Stroke

45. Which is a manifestation of early delayed radiation injury to the brain?

A. Mineralizing microangiopathy
B. Necrotizing encephalopathy
C. Radiation-induced neoplasm
D. Vascular malformation

46. MRI of a six month old boy shows macrocephaly, enhancing T1 hypointensity and T2/FLAIR
hyperintensity involving the frontal white matter, caudate nuclei and anterior putamina,
enlarged caudate heads and fornices. What is the diagnosis?
A. Alexander disease
B. Canavan disease
C. Glutaric aciduria
D. Mucopolysaccharidoses

(1-11) 47-57: Pediatric Neuroimaging

47. In normal infant, myelination appears complete on conventional T1-weighted images (TIWI)
by around what monnths?
A. 4 months
B. 6 months
C. 8 months
D. 12 months

48. Which among the following primary brain vesicles represents the midbrain?
A. Prosencephalon
B. Mesencephalon
C. Rhombencephalon
D. Telencephalon

49. What is the procedure of choice in assessing brain malformation?

A. CT
B. MRI
C. Ultrasound
D. PET

50. This type of Chiari malformation is defined as caudal cerebellar tonsillar ectopia.
A. Type I
B. Type II
C. Type III
D. Type IV
51. This is the most common type to Chiari Malformation
A. Type I
B. Type II
C. Type III
D. Type IV

52. This is the largest and the most important of the forebrain commisures
A. Anterior Commissure
B. Posterior Commissure
C. Corpus Callosum
D. Hippocampal Commissure

53. The “spoke-wheel” gyral pattern is seen in what anomaly?

A. Rhombencephalosynapsis
B. Callosal Dysgenesis
C. Joubert Syndrome
D. Chiari Malformation

54. What type of Holoprosencephaly shows the “pancake” brain with central monoventricle?
A. Alobar holoprosencephaly
B. Semilobar holoprosencephaly
C. Lobar holoprosencephaly
D. Variant holoprosencephaly

55. This is a congenital malformation in which the olfactory bulb and tracts are absent.
A. Lobar holoprosencephaly
B. Arrhinencephaly
C. Hydranencephaly
D. Chiari Malformation

56. This genetic syndrome is considered a “Ras-opathy”.

A. NF type I
B. NF type II
C. Schwannomatosis
D. Multiple meningiomatosis

57. This syndrome is also called encephalo-trigeminal angiomatosis.

A. Hereditary hemorrhagic telangiectasia
B. PHACE Syndrome
C. Sturge-Weber Syndrome
D. Ataxia telangiectasia

(1-13) 58-70: Diseases of the Spine

58. In this location, the CSF forms acute angles with the mass, which may exhibit a “marble on
the carpet” appearance. This results in a “meniscus” around the mass.
A. Intramedullary
B. Intradural-extramedullary
C. Extradural
D. None of the above.

59. This is the most common spinal cord “inflammatory” disorder and the most common cause
of intramedullary lesions seen on MR.
A. Devic Disease
B. ADEM
C. Multiple Sclerosis
D. Neuromyelitis Optica

60. Two thirds of spinal multiple sclerosis lesions occur in what region?
A. Cervical
B. Thoracic
C. Lumbar
D. Sacral

61. Best MR screening protocol for multiple sclerosis:

A. Sagittal T2-weighted sequence
B. Inversion recovery sequence
C. Sagittal T1-weighted sequence
D. A and B are correct
E. A and C are correct

62. Peak incidence of radiation myelitis after initial treatment:

A. 0-6 months
B. 6-12 months
C. 12-18 months
D. 18-24 months

63. In this pathology, normally free-layering lumbar roots become adherent to each other or to
the peripheral wall of the thecal sac, giving the sac a “bald” appearance on myelography or
T2WI images.
A. Arachnoiditis
B. Myelitis
C. Bursitis
D. Carditis

64. The most common spinal site of hematogenous infectious “seeding”:

A. Pedicle
B. Lamina
 C. Spinous process
D. Vertebral body

65. The most sensitive imaging examination for meningitis in both the brain and the spine.
A. Contrast-enhanced CT scan
B. Contrast-enhanced MRI
C. Myelography
D. Nuclear scan

66. Most common cause of spine infection in adults.

A. Escherichia coli
B. Pseudomonas
C. Klebsiella
D. None of the above.

67. Most common spinal cord tumor in adults.

A. Astrocytoma
B. Medulloblastoma
C. Ependymoma
D. Hemangioblastoma

68. Most common location of spinal astrocytomas.

A. Cervical cord
B. Upper to mid thoracic cord
C. Mid to lower thoracic cord
D. A and B are correct
E. A and C are correct

69. The conus medullaris in a newborn is normally at the level of:

A. L1
B. L2
C. L3
D. L4

70. Most common cause of central canal stenosis.

A. Degenerative disease of the facets
B. Bony hypertrophy that encroaches on the central canal
C. A and B are correct
D. None of the above.
Journal Questions

71. In what stage is a subdural hematoma which has a low-attenuation value similar to, but
slightly higher than CSF?

A. Acute
B. Chronic
C. Hyperacute
D. Subacute

72. What is the MRI sequence to request to distinguish old lesions from new?

A. DWI
B. Gradient echo
C. T1WI
D. T2WI

73. Which of the following strokes will result in severe contralateral hemiparesis?
A. Angular gyrus
B. Inferior occipital lobe
C. Posterior limb of the internal capsule
D. Splenium of the corpus callosum

74. Which of the following areas when affected implies severe diffuse axonal injury?
A. Dorsolateral midbrain
B. Parasagittal frontal lobes
C. Peripheral gray-white matter junction
D. Temporal periventricular white matter

75. The following are signs of early infarction EXCEPT:

a) Sulcal effacement
b) Midline shift
c) Traction effect
d) Local swelling

76. This modality is the unquestioned “cardiogram of the brain”.

a) Ultrasound
b) CT Scan
c) MRI
d) PET Scan

77. Which among the following has occasionally been mistaken for a tumour or abscess,
because of the ring-enhancing appearance?
 a. Luxury perfusion
b. Odd-looking infarct
c. Effacement
d. Loss of visibility effect

78. This sequence improves the conspicuity of focal grey matter abnormalities, white matter
abnormalities, shier injuries and SAH by eliminating the bright cerebrospinal fluid.

a. DWI
b. Gradient-echo imaging
c. T2WI
d. Fluid-attenuated inversion recovery

79. Stroke in the lateral pons leads to ipsilateral ataxia, contralateral spinothalamic deficits and
contralateral weakness and loss of pain and temperature what type of brainstem syndrome

a. Marie-Foix
b. Foville
c. Raymond
d. Millatd -Gubler

80. High risk source of emboli except

a. Left ventricular thrombus

b Dilated cardiomyopathy
c. Left atrial myxoma
d. Atrial septal aneurysm

CONTRIBUTORS:

NEURORADIOLOGY
QUEZON CITY GENERAL HOSPITAL – Anna Marie S. Aggabao, MD
UP-PHILIPPINE GENERAL HOSPITAL – Romelito Jose G. Galsim, MD
WESTERN VISAYAS MEDICAL CENTER – Jose Hernany L. Abello, MD
ST. LUKES MEDICAL CENTER, GLOBAL CITY – Marirose Lazo, MD (Team Leader)
AMANG RODRIGUEZ MEDICAL CENTER – Lina Flavia R. Pipo, MD
FATIMA UNIVERSITY MEDICAL CENTER - Michael Rico B. Mesina, MD