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Welcome to the first full-length MedGuide clinical imaging MCQ.  For the vast majority of doctors, our exposure to anatomy will be the relatively non-invasive approaches of surface palpation and imaging.  Therefore it is crucial – increaingly so each year – that the medical student of today is comfortable with the principles of imaging modalities. Best of luck in this quiz! 

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A Gentle Introduction to Neuro-Radiology - Part One

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Question 1
Study the image below

In which of the following circumstances would you be best placed to order the above imaging modality as first-line?
A
To check oedematous signs of cerebrovascular accidents
B
Spinal cord malformation diagnoses routinely
C
Non-communicating hydrocephalus of the neonate
D
Neuroinfection e.g. meningitis and cerebritis
E
Post-traumatic haematoma localisation and confirmation
Question 1 Explanation: 
This is a CT head, relatively cheap (vs MRI) and quick - so excellent for the acute emergency case.
Question 2
Study the image below

In which of the following circumstances would you be best placed to order the above modality?
A
Ventricular imaging to note sizing and location
B
Calcified tumour sizing and localisation
C
Extracerebral traumatic bleeds that are pre-operative (e.g. for neurosurgical consult)
D
Multiple sclerosis diagnostic pathway
E
Cerebral arteriovenous abnormalities (e.g. AVM)
Question 2 Explanation: 
AVM = arteriovenous malformation
Question 3
Study the image below

Given a lesion to the internal capsule as indicated by increased signal (DWI-MR scan), what is the best fitting presentation?
A
Paraesthesia of the right upper limb
B
Paralysis of the right upper limb
C
Paraesthesia of the left upper limb
D
Paralysis of the left upper limb
E
Visual field defect
Question 3 Explanation: 
Given the location (right internal capsule, posterior limb), and its dorsal nature, most fibres in this region will be sensory (cf motor). Note also that the high signal is from the right internal capsule, thus due to decussation of the DCML, the contralateral body is affected. This is a lacunar infarct of the right anterior choroidal artery. A classic case study for this type of stroke.
Question 4
Which meningeal layer divides the inferior cranial fossa into supratentorial and infratentorial regions?
A
Periosteal layer of dura mater
B
Meningeal layer of dura mater
C
Arachnoid mater
D
Pia mater
E
None of the above
Question 5
Study the image of an elderly gentlemen who has fallen and hit his head on the pavement.  He has a reduced GCS and feels nauseated.

Which of the following is the most likely diagnosis?
A
Extradural haematoma
B
Subdural haematoma
C
Subarachnoid haematoma
D
Intraparenchymal haematoma
E
None of the above
Question 5 Explanation: 
This is an acute subdural haematoma (SDH), more common in the elderly population - particularly those with recent history of falls causing head trauma. His decreased GCS and nausea symptoms point to a worrying increase in intracranial pressure - confirmed with several signs on the above CT head (SDH, midline shift, uncal herniation more caudally).
Question 6
Which of the following structures is best used in coronal CT to detect midline shift and mass effect?
A
Tentorium cerebelli
B
Tentorium cerebri
C
Falx cereberi
D
Falx cerebelli
E
Parahippocampal gyrus
Question 7
A tumour is compressing the intraventricular foramen.  Which of the following regions will first become dilated?
A
Lateral ventricles
B
Third ventricle
C
Fourth ventricle
D
Central canal of the spinal cord
E
None of the above
Question 8
Which of the following best matches the relation of the caudate nucleus of the basal ganglia (nuclei) to the lateral ventricles?
A
Superior
B
Inferior
C
Medial
D
Lateral
E
None of the above
Question 9
A hydrocephalus with profound dilatation of the third ventricle is most likely to impinge which of the below structures first?
A
The region containing place cells to allow memory of location
B
The region containing the cell bodies of upper motor neurons for the corticobulbar tract
C
The region where third order neurons from the dorsal column medial lemniscus system arise
D
The region where deep nuclei receive unconscious proprioception
E
The region where executive functionality is processed and societal norms and developed
Question 9 Explanation: 
The thalamus is the region first impinged due to it being immediately lateral (the lateral wall) to the ventricle.
Question 10
A patient with ependymoma has developed anterograde amnesia and enhanced basal anxiety.  State which region of the CT head is most likely to be lesioned in this presentation.
A
Blue pin
B
Yellow pin
C
Green pin
D
Pink pin
E
Red pin
Question 11

Stem 1 of 2

Study the image below:

Using your knowledge of the drainage of the central nervous system, which is the most appropriate statement of the region pinned in the image?
A
Receives the superoanterior portion of the anterior cerebral hemispheres
B
Drains to the straight sinus posteriorly
C
Inferoposteriorly placed grooved into the occipital bone
D
The termination of the dural venous sinus into the internal jugular vein
E
The vertebral vein
Question 12

Stem 2 of 2

Study the image below:

An MR venogram is shown.   Which of the following fracture types would affect the ordinary drainage of the structure pinned?
A
Fracture of the foramen magnum
B
Fracture of the internal occipital protuberance
C
Fracture of the mentis
D
Fracture of the facial canal
E
Fracture of the jugular foramen
Question 13
Study the image below

Appropriately label A, B, C, D and E on the image above
A
Pons, cerebellum, genu of the corpus callosum, thalamus, body of the corpus callous,
B
Pons, cerebellum, genu of the corpus callosum, hypothalamus, body of the corpus callosum
C
Pons, cerebellum, splenium of the corpus callosum, hypothalamus, body of the corpus callosum
D
Pons, cerebellum, splenium of the corpus callosum, thalamus, genu of the corpus callosum
E
Pons, cerebellum, splenium of the corpus callosum, genu of the corpus callous, thalamus
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With thanks to (in order of apperance): 

  • Case courtesy of Dr Derek Smith, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/46232″>rID: 46232</a>
  • Case courtesy of Dr Derek Smith, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/53692″>rID: 53692</a>
  • Case courtesy of Dr C. Igler, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/42143″>rID: 42143</a>
  • Case courtesy of A.Prof Frank Gaillard, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/17970″>rID: 17970</a>
  • Case courtesy of Dr Craig Hacking, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/62571″>rID: 62571</a>
  • Case courtesy of Dr Bruno Di Muzio, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/57738″>rID: 57738</a>
  • Case courtesy of A.Prof Frank Gaillard, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/54863″>rID: 54863</a