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Archives of Quizzes: Contents of Volume 6

The Archives of volumes 1-13 - ie till Dec 2012, are available as a CD. The CD contains around 593 quizzes that were put up on the REF site in the years 1999-2012. For details on purchasing the CD, click here.

Section Editors :

Abdominal : Dr. Dushyant Sahani
Neuro : Dr. Gaurang Shah
Head & Neck:Dr. Meher Ursekar

- Abdominal
- Breast
- Cardiac
- Chest
- Head & Neck

- Musculoskeletal
- Neuro
- Pelvis
- Vascular


 . A 42-year old man presented with nausea and vomiting. Plain radiographs were obtained
 1. "String of pearls" or "String of beads" sign
2. Small bowel obstruction
 A 57-year old man presented with nausea. This CT scan is the classic example of a recently described sign. Please read the question carefully.
 1. Posterior hepatic notch sign
2. Cirrhosis
 A 40-year old lady presented with abdominal pain.
 Cholelithiasis with Choledocholithiasis (Gall Stones with CBD Stones)
 A 43-year old man presented with acute onset, bilateral lower limb weakness.
 Posterior Epidural Hematoma
 A young male presented with abdominal pain.
 Roundworm in the Small Intestine
 A middle-aged man presented with distension of abdomen for six months.
 Budd-Chiari Syndrome
 A 48-year old man presented with left lower abdominal pain for a few days with tenderness on palpation. Please read the question carefully.
 1. Epiploic appendagitis
2. Hyperattenuating ring sign
 A 37-year old lady presented with recurrent bouts of abdominal distention, nausea and vomiting. Patient with multiple admissions for possible small bowel obstruction. Please read the question carefully.
 Progressive Systemic Sclerosis - Scleroderma
 A six-day old infant delivered at home presented with severe projective vomiting, foul smelling with dehydration. USG was performed for suspected hypertrophic pyloric stenosis, which was not found. Other findings however were seen
 Midgut Malrotation with Volvulus
 A 77-year old lady presented with chronic low-grade abdominal pain.
 Serous Microcystic Cystadenoma of the Pancreas
 A 35 year-old male presented with a history of abdominal pain. A contrast-enhanced CT scan of the abdomen was performed. Please see the case carefully and look at the question below.
 Hydatid Cyst of the Liver with Intra-Biliary Rupture
 A 53-year old lady presented with pain in the abdomen for five days.
 Mirizzi Syndrome
 An 8-year old presented with a history of repeated episodes of cholangitis. A CT cholangiopancreatogram (CTCP) was performed.
 a. Choledochal Cyst
b. Long Pancreatico-Biliary Channel
 This patient has multiple lesions with characteristic location and morphology
 Multiple Gastrinomas - Zollinger-Ellison Syndrome


 A 50-year old lady had a history of right breast cancer with mastectomy and reconstructive surgery with the transverse abdominal rectus muscle. She presented with a new painful palpable mass within the right breast.
 TRAM (transverse abdominal rectus muscle) Reconstruction of Breast with Fat Necrosis
 A 43-year old lady with breast microcalcifications underwent a procedure (Fig. 1). Please read the question carefully. What is the exact procedure that is being performed?
 Hook-Wire Localization


 A 40-year old man presented with chest pain and left vocal cord palsy. A chest radiograph was obtained.
 Aortic Aneurysm
 A 6-month old infant presented with severe pulmonary hypertension. There was no history of cyanosis. An echo was performed, followed by a cardiac MRI (Figs. 1-4). Multiple phases from one cine axial study are shown. Please read the question carefully.
 Cor Triatriatum
 A 55-year old man presented with multiple bouts of congestive heart failure and new mental status changes. Please read the question properly.
 Antero-Septal Infarct with Thrombus
 A 5-year old girl had a CT angio done. Please see the question carefully.
 Tetralogy of Fallot with Pulmonary Atresia / Severe Pulmonary Stenosis
 A 48-year old man presents with a history of an inferior wall infarct. A coronary CT angiogram was performed.
 Circumflex Artery Arising from the Right Coronary Cusp with Severe Proximal Stenosis


 An infant presented with cough. Please read the question carefully.
 Wave Sign of Mulvey
 A 50-year old man was referred for abdominal sonography. Please read the question carefully.
 1. Aurora Sign
2. Interstitial Lung Disease
 A 38-year old man with a systemic abnormality presented with a chest mass for further characterization. A non-contrast CT was performed due to renal insufficiency. Please read the question carefully.
 A 32-year old lady with a history of prior abdominal surgery presented with vomiting and diarrhoea. A CT of the chest and abdomen was performed. Please read the question carefully.
 Carney's Syndrome
 A 19-year old girl presented with a 3-months history of cough, expectoration and fever. Please read the question carefully.
 A. Sequestration
B. Intra-lobar
 A 36-year old lady presented with persistent cough and a history of repeated episodic infections for over a year. Please read the question carefully. What exactly is happening on the chest x-ray and CT? Which etiologies can present this way?
 A. Intermediate Bronchus Occlusion with Right Middle and Lower Lobe Post-Obstructive Collapse B. Carcinoid
 A 65-year old man presented with breathlessness. Please read the question carefully.
 Lymphangitis Carcinomatosis

Head & Neck

 This previously healthy boy presented with complaints of progressive nasal obstruction and headache. A CT scan was performed.
 Juvenile nasopharyngeal angiofibroma


 A 52 year old diabetic lady presented with sudden pain in the region of the heel. Please read the question carefully
 1. Achilles tendon tear
2. Calcification & degeneration (tendonitis)
 A 44 year old lady presented with pain in the wrist.
 Bifid Median Nerve causing Carpal Tunnel Syndrome
 A 19-year old boy presented with acute onset mid-arm pain. A plain radiograph was obtained (Fig. 1). Please read the question carefully.
 Fallen fragment sign
 A 42-year old lady presented with pain in the left TM joint and a click. An MRI was performed.
 Anterior displacement without reduction
 A 24-year old man, a bowler, had pain during hyperextension and abduction. An MRI arthrogram was performed.A 24-year old man, a bowler, had pain during hyperextension and abduction. An MRI arthrogram was performed.
 SLAP (Superior Labrum Anterior Posterior) Lesion - Type II
 A 42-year old lady presented with pain and a slight swelling in relation to the nail bed of the thumb. USG and MRI were performed.
 Glomus Tumor
 A 46-year old man presented with pain in the forefoot. An MRI was performed.
 Morton Neuroma
 A 43 year old lady presented with dyspnea.
 Diffuse Idiopathic Skeletal Hyperostosis (DISH)


 A 7 month old male presented with generalized convulsions. A plain CT of the brain was performed.
 Semilobar Holoprosencephaly with a Posterior Midline Cyst
 A 55-year old lady with a past h/o ischemic heart disease presented with left sided focal seizures, left homonymous hemianopia and intermittent visual hallucinations for 1 month. An MRI was performed.
 Sturge-Weber Syndrome
 A pregnant lady presented with severe headache for 3 days. A contrast-enhanced CT of the brain was performed (Figs. 1, 2).
 Superior Sagittal Sinus Thrombosis with Bilateral Hemorrhagic Venous Infarcts
 An adult male presented with mild headache. The MRI was unremarkable. An MRA was performed. Selected 3D TOF images are shown.
 Persistent Trigeminal Artery
 A 62-year-old man was found in a disoriented semiconscious state. His CT brain was unremarkable. He was treated as a case of brainstem stroke, based on the clinical impression and was referred for MRI.Routine MR images, including diffusion studies were normal. MR spectroscopy (Fig. 1) was done (occipital cortex, SVS proton spectroscopy TE 30). Fig. 2 is the normal spectroscopy of another patient in the same region.
 Hyponatremic / Hypo-osmolar Encephalopathy
 A 23-year old lady presented with seizures.
 Cavernous Angioma
 A 12-year old boy presented with seizures.
 Juvenile Pilocytic Astrocytoma


 A lady, 33-weeks pregnant presented for an ante-natal USG.
 CHAOS - congenital high airway obstruction
 A young lady presented with mild abdominal pain. An ultrasound of the pelvis was performed. She was eventually proved to have bilateral adnexal masses. Please read the question carefully.
 1. Bilateral ovarian dermoids
2. "Tip of the iceberg" sign


 A 63-year old man presented with abdominal pain. He had a prior history of endograft repair for an abdominal aortic aneurysm. Please read the question carefully.
 Type II Endoleak
 A 37-year old man, while lifting weights, presented with acute onset pain and swelling of the right upper limb. A contrast-enhanced MRI angiography and venography was performed.
 Paget-Schroetter Disease



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