Mixed bag
What is the best type of radiograph for evaluating pneumothorax?
A. Apical lordotic
B. Expiratory view
C. Oblique view
B. Expiratory view.
It is safe for the mother and infant to continue breast feeding immediately after receiving iodinated contrast medium or gadolinium-based contrast agent.
True
False
True. But if concern, may abstain from breast-feeding for 24 hours with active expression and discarding of breast milk from both breasts during that period.
The most appropriate exam to evaluate for a bakers/popliteal fossa cyst would be:
B. Ultrasound soft tissue (Lee)
When ordering leg ultrasound for DVT, D-dimer is required for which group of patients:
a. Low risk
b. Intermediate risk
c. High risk
d. Low and Intermediate risk
C) d. Low and Intermediate risk (Ormsby)
24 year old female with sudden onset severe headache that reaches maximal severity within one hour. What is the most appropriate initial imaging study?
a. CT head without IV contrast
b. CTA head with IV contrast
c. MRA head with IV contrast
d. CT head with IV contrast
a. CT head without IV contrast (Navarro)
Imaging is required for the diagnosis of acute pyelonephritis.
a. Yes
b. No
c. Depends on the patient.
Answer: B – No. Imaging is not needed for the diagnosis of acute pyelonephritis if the history, physical exam, and results of laboratory testing indicate acute pyelonephritis. Early imaging can be considered in patients at high risk for complications (gas-forming infection, abscess formation, urinary obstruction). The American College of Radiology’s Appropriateness Criteria consider patients with diabetes, immune compromise, a history of urolithiasis, or anatomic abnormality to be at highest risk for complications.
Which of the following is NOT a complication of contrast extravasation
a. Compartment syndrome
b. Renal failure
c. Skin ulceration
d. Blistering
e. Tissue necrosis
Answer is b. Renal failure (Sonik)
Patient with minor blunt trauma and suspected rib fracture - recommended initial imaging?
a. Xray chest
b. Xray ribs
c. Chest CT without contrast
a. CXR to r/o pneumothorax and hemothorax.
Rib xray or CT are not a necessity as they do not change conservative management.
The most appropriate exam to follow up a known rectal abscess is:
CT pelvis (Lee, Steve)
What would be the best radiology study to evaluate for suspected fishbone lodged in oropharynx/esophagus?
a. Plain film
b. Non-contrast CT
c. Contrast CT
d. MRI
b. The study of choice would be a noncontrast CT of the neck.
Diagnosis on plain films is difficult as vast majority of fish bones are radiolucent. Contrast enhancement on a CT of the neck can easily obscure thin linear hyperdensities/fish bones.
40 y M w N/V and diffuse abdominal pain, high concern for small bowel obstruction. Which study is the best first study:
a. XR Abdominal series (Supine & upright AXR, upright CXR)
b. CT AP with IV contrast only
c. UGI with Small Bowel Follow through (Fluoro)
c. CT AP with IV and PO contrast
d. All of these are legitimate imaging options
b. CT AP with IV contrast only.
What is the best way to contact the radiologist who read a film if AFM have questions?
a. TEAMS (Stokes)
Which of the following is not compatible with an allergic reaction to contrast
a. Warm feeling
b. Itching
c. Hives
d. Difficulty breathing
e. Anaphylaxis
Answer is a. Warm feeling (Sonik)
A 42-year-old pregnant patient presents for breast cancer screening with average risk of breast cancer. According to American College of Radiology guidelines, which of the following are usually or may be appropriate?
A) Contrast enhanced mammography
B) MRI breast with IV contrast
C). Digital breast tomosynthesis
D). Ultrasound
Answer: C. Mammography is considered safe during pregnancy. (Navarro)
US is safe in pregnancy but there have not been studies on the usefulness of screening whole breast ultrasound during pregnancy.
An elderly patient presents with acute, severe abdominal distension and obstipation. An upright abdominal radiograph demonstrates a massive, inverted U-shaped loop of bowel rising out of the pelvis with the absence of gas shadow in the left lower quadrant. What is the classic name of this radiographic sign?
A. Bird beak sign
B. Rigler's sign
C. Double bubble sign
D. Coffee bean sign
D. Coffee bean sign (Lovell)
For which patient is CT coronary artery calcium scoring most appropriate?
A. Asymptomatic patient at high risk of coronary artery disease who is already on a statin
B. Asymptomatic patient at intermediate risk whose treatment decision is uncertain
C. Patient with acute chest pain in the office
D. Patient with known prior PCI
Answer: B - CAC scoring earns its value only when it will change a decision, and that happens in a narrow band. The 2019 ACC/AHA Primary Prevention Guideline and the 2026 ACC/AHA Dyslipidemia Guideline recommend considering CAC in asymptomatic adults (roughly 40-75 years, LDL-C 70-189 mg/dL, no diabetes) at borderline (5% to <7.5%) or intermediate (≥7.5% to <20%) 10-year ASCVD risk when the statin decision is uncertain, because reclassification is strongest in this group (Tanveer)
What is this best way for the radiologist to contact a PCP with results they feel need to be discussed urgently?
a. TEAMS
b. Chart Chat
c. Staff Message
d. Call FUM Charge Nurse listed on ClinConnect
e. All of above
e. All of above (Stoke)
This is the next step if radiology imaging report says epiploic appendagitis ?
a. More imaging
b. Surgical consult
c. Conservative treatment
Conservative treatment.
What is the ACR stance on Metformin use in patients with AKI or severe CKD (GFR <30)?
A. Discontinue Metformin prior to procedure or at time of procedure, with-hold for 48 hours after procedure and re-start Metformin only after renal function.
B. New ACR guideline does not require patient to discontinue Metformin, before or after IV administration, nor is there need to re-assess renal function after procedure
For GFR <30: Discontinue Metformin prior to procedure or at time of procedure, with-hold for 48 hours after procedure and re-start Metformin only after renal function.
For GFR >30:No need to discontinue Metformin, before or after IV administration, nor is there need to re-assess renal function after procedure.
A. Ultrasonography of the neck
B. Contrast-enhanced CT of the neck
C. Contrast-enhanced MRI of the neck
D. CT angiography of the neck
E. FDG-PET/CT
Answer: B – U/S is incorrect here because ultrasonography is the first-line choice specifically for thyroid, parotid, and salivary gland masses (and in children), not for this nonthyroid/nonparotid mass. (Tanveer)
Which statement about contrast-associated risk is correct?
A. Gadolinium carries the greatest nephrogenic systemic fibrosis risk at eGFR >60
B. Iodinated contrast nephropathy risk rises at eGFR <30 mL/min/1.73 m²
C. Iodinated contrast is the main cause of nephrogenic systemic fibrosis
D. Coronary calcium scoring requires IV iodinated contrast
Answer: B - Patients with eGFR <30 mL/min/1.73 m² have increased risk of contrast nephropathy with iodinated media and of nephrogenic systemic fibrosis with gadolinium-based agents.(Tanveer)
Which of the following requires premedication for CT scan with IV con?
a. Prior bronchospasm with iodinated CT contrast
b. Povidone-Iodine (Betadine) allergy in chart
c. Shellfish allergy
d. Prior rash with gadolinium MRI contrast
a. Biggest risk factor for allergic-like reaction to contrast is history of prior contrast reaction to same class = 5-6x increased risk of subsequent reaction.
Shellfish or Povidone-iodine (Betadine) allergies are at no increased risk from iodinated contrast medium than are patients with other allergies.
No cross reactivity between different classes of contrast medium.
An 82-year-old woman falls and cannot bear weight. Hip radiographs are negative, but clinical suspicion for fracture remains high. What is the preferred next examination?
A. MRI hip without contrast
B. CT hip without contrast
C. Nuclear Medicine bone scan
D. Repeat radiographs in 2 weeks
A. MRI hip without contrast. May order CT if MRI is not available (Boyle)
52 y s/p ORIF for ankle fracture has symptoms concerning for osteomyelitis. What is the next test if plain film is normal?
a. Ultrasound
b. CT
c. MR
d. NM scan
d. NM scan: Tagged WBC is sensitive in postsurgical patients with hardware.
Which of the following abdominal CT findings is most specific for transmural bowel infarction and strangulation in a patient with a closed-loop small bowel obstruction?
A. Mesenteric fluid and engorged, crowded mesenteric vessels.
B. Pneumatosis intestinalis or gas within the porto-venous system.
C. Concentric bowel wall thickening with a target/halo enhancement pattern.
D. Dilated, fluid-filled small bowel loops measuring greater than 2.5 cm in caliber.
B. Pneumatosis intestinalis or gas within the porto- venous system. (Lovell)