Vascular and Cardiac Imaging (CT Angiography, Coronary, Aortic, Doppler) MCQs

Radiology · 22 free questions with answers & explanations.

1. On a CT pulmonary angiogram, the right/left ventricular diameter ratio is measured at 1.4 on axial images, the interventricular septum bows to the left, and there is reflux of contrast into the inferior vena cava and hepatic veins. These findings indicate:
2. On a CT aortogram, an aortic diameter of 5.8 cm at the infrarenal level is found in a 67-year-old man. The threshold for elective surgical or endovascular repair of an infrarenal abdominal aortic aneurysm (AAA) in men is:
3. A 55-year-old diabetic male with atypical chest pain undergoes coronary CT angiography (CCTA). The report describes a stenosis with a low-attenuation plaque occupying >50% of the lumen with positive remodelling and a 'napkin-ring' sign. The CT-FFR value is 0.76. What is the appropriate management?
4. On Doppler ultrasound of the portal vein, the hepatic vein waveform shows a monophasic flat pattern instead of the normal triphasic waveform. This finding is MOST consistent with:
5. A 65-year-old man with acute chest pain and CXR showing widened mediastinum undergoes CT aortography. Imaging reveals an intimal flap extending from the ascending aorta through the arch. According to Stanford classification, what type of aortic dissection is this?
6. A 72-year-old man with a known 5.8 cm infrarenal abdominal aortic aneurysm undergoes CT angiography for EVAR planning. Which of the following anatomical features would be an absolute contraindication to standard EVAR?
7. On carotid Doppler ultrasound, a patient shows peak systolic velocity (PSV) of 280 cm/s in the internal carotid artery (ICA) and 60 cm/s in the common carotid artery (CCA). The ICA/CCA PSV ratio is 4.67. Which degree of ICA stenosis does this correspond to?
8. A 55-year-old man with chest pain and elevated troponin undergoes CT coronary angiography (CTCA). A plaque is identified in the LAD with a CT attenuation value of -40 HU within the plaque core. What type of plaque is this, and what is its clinical significance?
9. A CT pulmonary angiogram shows a saddle embolus straddling the main pulmonary artery bifurcation with right heart strain (RV:LV ratio >1.0, interventricular septum D-sign). What does the D-sign indicate?
10. On coronary CT angiography (CCTA), a lesion is identified with a CT attenuation of −30 HU within a coronary plaque. This finding indicates:
11. A 65-year-old hypertensive man presents with tearing chest pain radiating to the back. CT aortogram shows an intimal flap in the ascending aorta. According to Stanford classification, which type is this and what is the primary management?
12. Doppler ultrasound of a renal artery reveals a resistive index (RI) of 0.85 and a delayed systolic upstroke (parvus-tardus waveform). What is the most likely diagnosis?
13. On CT angiography of an abdominal aortic aneurysm, an endoleak is seen on delayed phase with contrast within the excluded sac but no direct connection to the graft or patent lumbar arteries. What type of endoleak is this?
14. A 58-year-old male smoker presents with progressive dyspnoea. CT chest shows bilateral basal-predominant areas of ground-glass opacity with superimposed irregular reticulation, traction bronchiectasis, and honeycombing in the subpleural regions. There is no ground-glass opacity in excess of fibrosis and no peribronchovascular predominance. Which pattern does this CT most closely represent?
15. A 35-year-old woman is referred for a chest X-ray following a high-speed road traffic accident. The radiograph shows widening of the superior mediastinum to more than 8 cm, obliteration of the aortic knuckle, tracheal deviation to the right, and depression of the left main bronchus below 40 degrees from the horizontal. Which diagnosis must be excluded first?
16. A 28-year-old man with a known history of asthma presents acutely with severe breathlessness. Chest X-ray reveals hyperinflation, a thin vertical line of visceral pleural edge parallel to the chest wall on the left with no lung markings peripheral to it, and shifting of the mediastinum to the right. What is the most accurate description of the radiological finding and its management implication?
17. On echocardiography-guided cardiac MRI of a 50-year-old man with recent anterior STEMI, late gadolinium enhancement (LGE) is noted in the mid-wall of the inferior and inferolateral segments bilaterally. This mid-wall pattern is distinct from subendocardial or transmural enhancement. What is the most likely aetiology of this LGE pattern?
18. A 45-year-old woman with no smoking history presents with bilateral hilar lymphadenopathy on chest X-ray. CT confirms bilateral symmetrical hilar and right paratracheal lymphadenopathy (the classic 1-2-3 or pawn-broker sign) with multiple small pulmonary nodules along bronchovascular bundles and subpleural regions. Serum ACE is elevated. What is the most likely diagnosis?
19. A 68-year-old man with hypertension presents with sudden severe tearing chest pain radiating to the back. CT aortography shows an intimal flap in the ascending aorta extending into the descending aorta. According to the Stanford classification, this is:
20. On Doppler ultrasound of the carotid artery, a post-stenotic flow pattern distal to a critical stenosis shows 'tardus-parvus' waveform. This waveform is characterised by:
21. CT coronary angiography (CTCA) is performed in a 55-year-old with atypical chest pain and intermediate pre-test probability. The calcium score (Agatston score) is 0. What does a calcium score of 0 indicate?
22. A 72-year-old male with a known 6.0 cm abdominal aortic aneurysm undergoes CT angiography for planning endovascular aneurysm repair (EVAR). Which measurement is MOST critical for determining proximal fixation zone adequacy for EVAR?