EXAM 4

Question 1

GIT

A 71-year old man with a long history of alcohol-related liver cirrhosis showed a subtlebut equivocal area of abnormality on a screening ultrasound. His AFP was raised at 2,000.An MRI of the liver with contrast is performed. All of the following are expected featuresof infiltrative HCC on MRI, except
A. Hyperintense on MR images acquired during the hepatobiliary phase after injection ofhepatocyte-specific contrast agent.
B. A reticular appearance of the tumour can be seen during the venous and equilibriumphase.
C. Washout appearance of the tumour is usually reported as irregular andheterogeneous.
D. Infiltrative HCC may commonly appear as iso- or hypointense on images obtainedduring the arterial phase.
E. Infiltrative HCC may be difficult to discern from underlying heterogeneous cirrhosisbecause of its permeative appearance.

Answer 1

A. Hyperintense on MR images acquired during the hepatobiliary phase after injection of hepatocytes specific contrast agent
At contrast-enhanced CT and MR imaging, infiltrative HCC may be difficult to discern from underlying heterogeneous cirrhosis because of its permeative appearance, its minimal and inconsistent arterial enhancement and the heterogeneous washout appearance that occurs during the venous phase. The enhancement pattern of infiltrative HCC seen on images obtained during the hepatic arterial phase has been reported as minimal, patchy or miliary.
Although arterial hyperenhancement is a key diagnostic feature of nodular and massive HCC, infiltrative HCC may commonly appear as iso- or hypointense on images obtained during the arterial phase. Washout appearance is a specific CT and MR imaging feature of typical nodular HCC. Hypointensity relative to the surrounding liver parenchyma during the venous phase of enhancement remains a valid sign for the detection of infiltrative HCC. However, washout appearance of the tumour is usually reported as irregular and heterogeneous and is less frequently seen in infiltrative HCC than in other HCC subtypes.
Moreover, a reticular appearance of the tumour has been seen on images obtained during the venous and equilibrium phases, possibly related to fibrosis. Finally, the tumour generally appears as hypointense on MR images acquired during the hepatobiliary phase after injection of hepatocyte specific contrast agent because of the lack of contrast agent uptake.

Question 2

CHEST

Which of the following is false?
A. NSIP ——- Scleroderma
B. Sjögren’s syndrome ——- Lymphocytic interstitial pneumonitis (LIP)
C. Lofgren’s syndrome ——- Systemic lupus erythematosus (SLE)
D. Loeffler’s syndrome ——- Acute eosinophilia
E. Folded lungs ——- Asbestosis

Question 3

GU

Which one of the following statements regarding the testes is false?
A. Tubular ectasia of the testis is a benign condition.
B. Undescended testes are most commonly found in the inguinal canal.
C. Metastases are most commonly from prostate and lung primary.
D. Testicular cysts are mostly incidental and non-palpable.
E. Sertoli cell tumour is the most common malignant testicular tumour.

Question 4

MSK

A 21-year-old woman attends the A&E department with acute onset of pain in the right upperarm with limitation of mobility. The plain radiograph report describes a ‘fallen fragment’ sign.Which one of the following bony lesions does this finding refer to?
A. Giant cell tumour
B. Simple bone cyst
C. Eosinophilic granuloma
D. Aneurysmal bone cyst
E. Benign cortical defect

Question 5

CNS

A 43-year-old patient with known diagnosis of AIDS presented with ataxia and progressive neurological deficits. MRI brain revealed patchy high signal on T2W images in the parieto occipital white matter. No mass effect or contrast enhancement was evident What is the diagnosis?
A. Primary CNS lymphoma
B. AIDS dementia complex
C. Progressive multifocal leukoencephalopathy
D. Periventricular leukomalacia
E. Encephalitis

Question 6

CHEST

A 6-year-old with spina bifida has a chest X-ray performed for possible lower respiratory tract infection. The lungs are clear but there is a well-defined, round paraspinal mass with an air-fluid level. What is the most likely diagnosis?
A. Bronchogenic cyst
B. Morgagni hernia
C. Oesophageal duplication cyst
D. Cystic teratoma
E. Oesophageal tumour

Question 7

GIT

A 77-year-old man with weight loss and deranged LFTs had an ultrasound scan that showed multiple liver lesions suspicious for metastases. Contrast-enhanced CT of the chest and abdomen was done in search of the primary’. Which one of the following is the most common primary tumour that has hypovascular liver metastases?
A. Pancreas
B. Stomach
C. Colon
D. Kidney
E. Melanoma

Question 7

CHEST

A 65-year-old woman is recovering from a double lung transplant On the fourth day post-transplant, she starts complaining of shortness of breath. Clinical findings include some basal crackles; air entry seems satisfactory in the upper zones. An urgent chest X-ray is organised. Portable up-to-date chest X-ray shows evidence of pulmonary’ oedema. What is the most likely cause for this appearance?
A. Barotrauma
B. Acute graft failure
C. Volume overload
D. Response to antirejection treatment
E. Reimplantation response

Question 8

GU

Cryptorchidism has an increased risk of development of all of the following testicular tumours, except
A. Leydig cell tumour
B. Seminoma
C. Yolk sac tumour
D. Embryonal cell tumour
E. Choriocarcinoma

Question 9

MSK

A 15-year-old teenager presents with a worsening pain in his right ankle. He is an active sports player and plays football for the school club. A radiograph reveals an undisplaced fragment in the medial aspect of the talar dome with a small lucent line around it.
All of the following are well-recognised locations for osteochondral lesions or defects, except
A. Lateral aspect of the medial femoral condyle
B. Medial aspect of the talar dome
C. Lateral aspect of the medial tibial plateau
D. Anterior aspect of the capitellum
E. Humeral head

Question 9

CNS

A 35-year-old woman with pre-eclampsia underwent a CT of the brain to exclude intracranial haemorrhage. The CT revealed low attenuation in the white matter of the posterior aspect of both cerebral hemispheres. The abnormal area appeared low on T1W and high on T2W images and was isointense on DWI. No contrast enhancement was evident. What is the diagnosis?
A. Periventricular leukomalacia
B. Progressive multifocal leukoencephalopathy
C. Encephalitis
D. Reversible posterior leukoencephalopathy syndrome
E. CNS lymphoma

Question 10

CHEST

A male infant is bom at 39 + 3 weeks gestation. Prenatal ultrasound demonstrated a partly cystic, partly echogenic mass in the right upper lobe. Shortly after delivery the infant is in respiratory distress. Initial chest X-ray demonstrates dense lungs bilaterally with increased volume on the right. On Day 2, a repeat chest X-ray demonstrates multiple air-filled cystic masses of varying sizes within the right upper lobe with mediastinal shift to the left. What is the most likely diagnosis?
A. Bronchogenic cyst
B. Morgagni hernia
C. Congenital cystic adenomatoid malformation
D. Congenital lobar emphysema
E. Hyaline membrane disease

Question 11

GIT

A 78-vear-old woman with worsening right upper quadrant pain and worsening obstructive liver function test has a CT scan that shows a heterogeneous mass in the peripheral aspect of the liver with capsular retraction and segmental biliary duct dilatation proximal to the mass. There is no prior history of chronic Ever disease. What is the most likely diagnosis?
A. HCC
B. Siderotic nodule
C. Adenoma
D. Cholangiocarcinoma
E. Angiosarcoma

Question 12

CHEST

A 36 year old immunocompromised woman with a knowm history of gestational trophoblastic disease showed bilateral bronchopneumonic infiltrates on chest X-ray.
An HRCT was suggested for further characterisation. The HRCT showed several areas of ground glass change surrounded by a rim of consolidation. The differential diagnosis for these findings would include all of the following, except
A. Wegner s granulomatosis
B. Invasive pulmonary aspergillosis
C. Choriocarcinoma metastasis
D. Sarcoidosis
E. Lymphangioleiomyomatosis

Question 13

GU

Enhanced CT scan of an otherwise healthy motor vehicle accident victim demonstrates no enhancement of the right kidney on Day 0. A repeat contrast-enhanced CT scan obtained on Day 3 demonstrates a thin marginal rim of subcapsular enhancement of uniform thickness, described as the rim sign. The collecting system was mildly prominent. What is the most likely explanation?
A. Analgesic overuse
B. Renovascular compromise
C. Diabetes mellitus
D. Pyelonephritis
E. Developing hydronephrosis

Question 13

MSK

A 44-year-old man presents with increasingly severe and disabling pain in the left inguinal and anterior thigh region. The pain is exacerbated by weight-bearing and relieved by rest. The patient mentions that the pain began 2 months ago, was acute in onset, and there was no preceding trauma. A radiograph of his left hip reveals a focal osteopaenic region within the left femoral head; this is no longer evident on a follow-up film 8 months later. Which of the following is the most likely diagnosis?
A. Osteomalacia
B. Avascular necrosis
C. Transient osteonecrosis
D. Transient osteoporosis
E. Occult fracture

Question 13

CNS

A 35-year old woman with bilateral facial nerve palsy showed extensive nodular deposits with diffuse enhancement of the meninges on CECT of the brain. Which of the following imaging investigation will likely confirm the diagnosis?
A. MR angiogram of the circle of Willis
B. Ultrasound of the liver
C. Intravenous urogram
D. Plain chest radiograph
E. Plain radiograph of both hands

Question 13

CHEST

A 10-month-old infant attends the local infectious diseases unit with his mother who recently emigrated from Zimbabwe. The child has shortness of breath, fever and bilateral inspiratory crackles. Chest X ray demonstrates diffuse bilateral ground-glass opacification. What is the most likely diagnosis?
A. Varicella pneumonia
B. Round pneumonia
C. Pneumocystis pneumonia (PCP)
D. Bronchopulmonary dysplasia
E. Congestive cardiac failure

Question 14

GIT

A 65-year old hepatitis C-positive man is found to have a liver mass on screening ultrasound. A suspicion of HCC was raised. Which one of the following statements regarding HCC screening is false?
A. HCC is characteristically hyperechoic on ultrasound.
B. The majority of nodules that measure less than 1 cm are not HCC.
C. It develops in a background of preexisting liver parenchymal damage.
D. HCC is commonly diagnosed on the basis of imaging features alone, without histologic confirmation.
E. The nodules that are suspicious for HCC are new nodules that measure more than 1 cm or nodules that enlarge over a time interval.

Question 15

CHEST

A 42-year-old factory worker complains of chest tightness and shortness of breath during the early days of the week, settling down during the weekend over the last several months.
Chest radiograph is normal. HRCT is requested for further evaluation. What do you expect the HRCT to show?
A. Crazy paving pattern
B. Patchy ground-glass opacities with centrilobular nodules
C. Perilymphatic nodules with beaded fissures
D. Central bronchiectasis
E. Extensive mediastinal and hilar lymphadenopathy

Question 16

GU

A CT scan, obtained in a patient with haematuria after minimal trauma, reveals a rim of enhancement surrounding a markedly dilated right renal pelvis and collecting system. Note is made of variable thickness to the enhancing rim and enhancing cortical strands. The report describes it as a rim sign. What is the likely diagnosis?
A. Hydronephrosis
B. Renovascular compromise
C. Diabetes mellitus
D. Pyelonephritis
E. Fractured kidney

Question 17

CNS

In the case of a vertebral compression fracture, all the statements regarding imaging findings suggests a malignant cause, except
A. Involvement of the posterior elements
B. Persistent loss of T1W bone marrow signal on sequential imaging
C. Paravertebral soft-tissue component
D. Post-contrast gadolinium enhancement
E. Convex posterior border of the vertebral body

Question 18

CNS

All of the following are true of toxoplasmosis of AIDS, except
A. It is the most common focal CNS infection.
B. Treatment is started empirically based on imaging.
C. The basal ganglia and cerebral hemispheres are commonly involved.
D. Haemorrhage and calcification are common post-therapy.
E . A single lesion is the most common.

Question 18

CNS

On newborn heel stick screening, a newborn infant is found to suffer from congenital hypothyroidism. On ultrasound, the thyroid gland is diffusely enlarged, and on Technetium 99m thyroid scintigraphy there is increased uptake of radioactive tracer within the gland. There is no evidence of ectopic thyroid tissue.
What is the most likely cause for the congenital hypothyroidism?
A. Thyroid hypoplasia
B. Hypothalamic dysfunction
C. Thyroid dyshormonogenesis
D. Maternal antibody induced hypothyroidism
E. Hypopituitarism

Question 18

GIT

An 8-year-old child with right upper-abdominal pain and a palpable mass was sent for US of the liver. The US showed a large heterogeneous mass occupying at least half of the right lobe of the liver. The rest of the liver was normal in appearance. Which one of the following is the most common benign primary liver tumour in children?
A. Hepatocellular carcinoma
B. Hepatoblastoma
C. Angiosarcoma
D. Infantile haemangioendothelioma
E. Cholangiocarcinoma

Question 19

CNS

A 43-year-old woman with history of proteinuria presented to the A&E department with shortness of breath and haemoptysis. Chest X-ray showed diffuse airspace opacities and an HRCT was organised. The HRCT showed diffuse airspace opacities, ground-glass change and confluent consolidation, which was reported as acute diffuse alveolar haemorrhage. Which of the following can be classically expected on CT sinus study?
A. Bilateral frontal mucocoele
B. Unilateral sinusitis involving all the sinuses on one side
C. Chronic destructive sinusitis with nasal perforation
D. Hypoplastic maxillary sinuses
E. Oro-antral fistula

Question 20

GU

A CT scan, obtained to exclude retroperitoneal hematoma in a patient with sustained hypotension for 1 hour after cardiac catheterisation and subsequent cardiac arrest, shows a hypoattenuating renal cortex compared with the medullary enhancement No additional contrast material was given at the time of the CT. Which of the following signs is being described here?
A. Hydronephrotic rim sign
B. Comet tail sign
C. Crescent sign
D. Reverse rim sign
E. Soft-tissue rim sign

Question 21

MSK

A report is issued stating that there is a periosteal reaction associated with what the radiologist believes is a benign bony lesion. What type of periosteal reaction is most likely to be associated with a benign lesion?
A. Codman
B. Sunburst
C. Hair-on-end
D. Lamination
E. Buttressing

Question 22

CNS

All of the following are associated with tuberous sclerosis, except
A. Giant cell astrocytoma
B. Subependymal hamartomas
C. Pheochromocytoma
D. Cardiac rhabdomyoma
E. Chylothorax

Question 23

GIT

A 22-month-old boy presents with abdominal pain and is found on US to have an intussusception.
Which of the following statements is false with regard to his initial management and treatment?
A. The patient should be reviewed for signs of peritonitis by a paediatric surgeon.
B. Bowel infarct, peritonitis and perforation are potential complications if the intussusception is left untreated.
C. The patient should be fluid resuscitated prior to attempts at air enema reduction.
D. A plain abdominal radiograph should be obtained prior to air enema reduction to rule out signs of perforation.
E. A successful intussusception reduction is noted when air is seen to fill the small bowel loops.

Question 24

GIT

An MRI of the liver with contrast was performed in a 50-year-old woman after a complex mass was identified on US. The mass was reported as suspicious for epithelioid haemangioendothelioma. All of the following are expected features of this lesion, except
A. Vascular origin
B. Female predominance
C. Typical presentation of multifocal nodules
D. Avid arterial phase enhancement
E. Capsular retraction

Question 24

CHEST

A 37-year-old woman with asthma underwent HRCT of the chest and was diagnosed based on clinical examination, blood tests and HRCT to have Churg-Strauss syndrome or allergic granulomatosis. Which of the following appearances would fit with
the diagnosis?
A. Peripheral predominant lobular consolidation with centrilobular nodules
B. Peripheral predominant homogenous consolidation without centrilobular nodules
C. Peripheral predominant interstitial reticular opacities with underlying traction bronchiectasis
D. Central bronchiectasis and patchy airspace opacities with mucous plugs
E. Upper lobe predominant interstitial pulmonary fibrosis with architectural distortion

Question 25

GU

Which of the following is incorrect?
A. Spoke wheel sign —– Renal oncocytoma
B. Pear-shaped bladder sign —– Pelvis lipomatosis
C. Pie-in-the-sky bladder sign —– Bilateral psoas hypertrophy
D. Spaghetti sign —– Haematuria
E. Balloon-on-a-string sign —– Hydronephrosis

Question 26

MSK

A young adult man presents with a painful left wrist following a fall from height. A lateral view of the wrist shows loss of co linearity of the radius/lunate/capitate axis with the capitate displaced dorsally. What injury is this constellation of findings compatible with?
A. Midcarpal dislocation
B. Perilunate dislocation
C. Lunate dislocation
D. Volar intercalated segmental instability
E. Dorsal intercalated segmental instability

Question 27

CNS

All the following are true of venous angioma, except
A. It can be considered normal.
B. It contains small arterial channels.
C. It is associated with cavernomas.
D. It shows a spoked wheel configuration on imaging.
E. It normally has a large draining vein but no feeding arteries.

Question 28

CHEST

A 5-year old boy, who underwent a bone marrow transplantation 1 week earlier for an underlying haematological malignancy, presents with shortness of breath, cough and chest tightness.
Which of the following complications would be least likely?
A. Lymphoid interstitial pneumonitis
B. Pulmonary oedema
C. Pulmonary embolism
D. Infective interstitial pneumonitis from CMV
E. Idiopathic interstitial pneumonitis

Question 28

GIT

A 56-year-old woman presented to her GP with pain and palpable mass in the right upper quadrant. She was sent for US, which showed a large heterogeneous mass in the right lobe of the liver. A contrast-enhanced MRI of the liver is urgently organised for further characterisation. The lesion is reported as consistent with fibrolamellar carcinoma.
All of the following are expected findings, except
A. Central scar low on T1W and T2W images.
B. Solitary mass is the usual presentation.
C. Favorable prognosis.
I). Rare pathological subtype of hepatocellular carcinoma.
E. Background cirrhotic change to the liver parenchyma.

Question 29

CVS

A 37-year-old woman involved in a frontal car collision and collapse at the scene of incident was brought to the A&E department and sent for an emergency whole-body CT. All of the following are correct regarding blunt cardiac trauma, except
A. Cardiac concussion results in abnormal cardiac enzymes.
B. Traumatic pericardial rupture resulting from blunt chest trauma is rare.
C. Cardiac herniation is a serious complication of pericardial rupture.
D. Traumatic ventricular septal defects affect the muscular portion.
E. Myocardial contusion is associated with cardiac tamponade.

Question 30

GU

An 88-year-old man with obstructive uropathy and hard nodular prostate gland on digital rectal examination was being further investigated for his prostate cancer. Which one of the following magnetic resonance spectroscopic imaging metabolic peaks is expected in a patient with prostate cancer?
A. High citrate peak, low choline/creatine peak
B. High citrate peak, high choline/creatine peak
C. Low citrate peak, high choline/creatine peak
D. Low citrate peak, low choline/creatine peak
E. Low citrate peak, normal choline/creatine peak

Question 31

MSK

A 42-year old woman with knee joint stiffness, pain and reduced mobility is investigated with a plain X-ray, which reveals extensive soft-tissue swelling around the joint with
large periarticular erosions. There is no evidence of calcification and bone density is maintained. MRI shows low-signal foci within the soft-tissue mass. What is the likely diagnosis?
A. Pigmented villonodular synovitis
B. Haemophilia
C. Synovial sarcoma
D. Behcet’s syndrome
E. Psoriatic arthropathy

Question 32

CNS

A 40-year-old woman with progressive difficulty in walking and difficulty in holding objects reveals a large burn over the dorsum of her right hand on clinical examination. Sagittal MRI of the cervical spine shows a long segment lesion in the cervical and upper thoracic spinal cord with low signal on T1W images and high signal on T2W images without
any change on post-contrast images. What is the diagnosis?
A. Ependymoma
B. Syringomyelia
C. Astrocytoma
D. Haemangioblastoma
E. AVM

Question 33

CHEST

A chest CT is performed on a 10-year-old boy with known underlying chronic lung changes. Current imaging demonstrates laevocardia with areas of air trapping, bronchial dilatation and bronchial wall thickening, which were also present on previous imaging from 1 year earlier. There are no significantly enlarged mediastinal lymph nodes.
Which of the following differential diagnoses would be least likely to account for the underlying changes?
A. Cystic fibrosis
B. IgA deficiency
C. Juvenile dermatomyositis
D. Primary ciliary dyskinesia
E. Recurrent pneumonias

Question 33

MSK

A 10-year-old boy falls while running for the school bus and hurts his arm. An X-ray demonstrates a fracture through the proximal humeral diaphysis through a ‘bony lesion*. What is the most likely underlying predisposing bone pathology?
A. Giant cell tumour
B. Osteosarcoma
C. Simple bone cyst
D. Eosinophilic granuloma
E. Ewing’s sarcoma

Question 33

GIT

A 43-year-old woman with known diagnosis of tuberous sclerosis presented to her GP with increasing right upper-abdominal pain. Although the LFT was normal, the GP organised a liver MR in search of angiomyolipomas in the liver. All of the following arc MR features of angiomyolipomas of the liver, except
A. A well-defined mass.
B. Moderately hyperintense signal intensity on T1W images.
C. Moderately hyperintense signal intensity on T2W images.
D. Loss of signal on fat-suppressed sequences.
E. Usually shows late arterial enhancement on the post-contrast sequence.

Question 33

CHEST

With regard to the progression of pulmonary consolidation on CXR, all of the following options are true except
A. Lung contusion appears in 6 hours and clears in 3-7 days.
B. Aspiration appears in minutes and clears in 24-48 hours unless infected.
C. Lung infarction due to pulmonary embolism manifests after 3-5 days and clears in approximately 3 weeks.
D. Fat embolism appears in 6 hours and clears in 7-10 days.
E. ARDS with difFuse alveolar damage appears after 24-48 hours and clears in 4-6 weeks.

Question 34

GU

An 88-year-old man with obstructive uropathy and hard nodular prostate gland on digital rectal examination is being further investigated for his prostate cancer. lie has been scheduled for a staging MRI of the prostate. Which one of the following is the characteristic imaging finding of prostate cancer on DWI?
A. High on DWT, low on ADC and corresponding low signal intensity on T2W MRI
B. Low on DWI, high on ADC and corresponding low signal intensity on T2W MRI
C. High on DWI, low on ADC and corresponding high signal intensity on T2W MRI
D. Low on DWI, high on ADC and corresponding high signal intensity on T2W MRI
E. High on DWI, low on ADC and corresponding normal signal intensity on T2W MRI

Question 35

CHEST

A 50-year-old patient presents with shortness of breath to his GP. Following abnormalities on the chest radiograph, a CT is performed, demonstrating bilateral hilar and right paratracheal lymphadenopathy along with coarse reticulations and nodular thickening along the fissures and bronchovascular bundles. Elevated ACE serum levels are noted.
What is not a typical musculoskeletal manifestation of this disease?
A. Lacy lytic lesions in the phalanges of the hands
B. Polyarthralgia with tenosynovitis
C. Multiple bony lesions with high T2W and intermediate T1W signal characteristics
D. Soft-tissue calcifications
E. Dactylitis

Question 36

CNS

An infant boy was investigated with MRI for seizures. The left side of the brain is smaller than the right and there is evidence of T2 hypointensity on the gyri. There is diffuse contrast enhancement adjacent to the gyri and sulci on the same side. Some enhancement is also noted along the ipsilateral posterior globe. Which of the following is the most likely diagnosis?
A. Hypoxic ischaemic encephalopathy
B. Meningitis
C. Sturge-Weber syndrome
D. Gliomatosis cerebri
E. Tuberous sclerosis

Question 37

GIT

A 36-year-old woman on oral contraceptives was sent for a liver US by her GP following complaints of right upper-quadrant pain. No gallstones were found and bile ducts were normal. However, a large lesion was discovered in the right lobe of the liver. Which one of the following would be the most likely diagnosis in this scenario?
A. Focal nodular hyperplasia
B. Hepatocellular adenoma
C. Angiomyolipoma
D. Haemangioma
E. Biliary hamartoma

Question 37

CHEST

A 73-year-old woman with a known splenic lesion underwent a CT of the chest, which demonstrated multiple pulmonary nodules with surrounding halos. A follow-up CT chest done a few weeks later showed cavitations developing in some of the nodules and a right pneumothorax. The most likely diagnosis is
A. Lymphoma
B. Hydatid disease
C. Metastatic angiosarcoma
D. Sarcoidosis
E. Bronchoalveolar carcinoma

Question 37

GU

A 77-year-old man with obstructive uropathy and TRUS biopsy-proven prostate cancer was scheduled to have an MRI for local staging of the known prostate cancer. Which one of the following statements regarding identification of prostate cancer by dynamic contrast enhancement (DCE) is true?
A. Fast enhancement and slow washout suggest prostate cancer.
B. Slow enhancement peak and slow washout suggest prostate cancer.
C. Slow enhancement and fast washout are highly suggestive of prostate cancer.
D. Small prostate tumours are detected easily.
E. The higher the tumour grade, the greater the grade of enhancement.

Question 37

MSK

A 40 year old man presents to his general practitioner with intermittent left leg pain and stiffness of 5 years duration. Plain radiograph reveals eccentric and irregular sclerosis along the medial aspect of the distal femur, crossing the joint into the adjacent tibia. Cortical new bone formation along the outer aspect of the cortex is also seen, with an appearance similar to flowing wax. In addition, there are adjacent ossified soft-tissue masses. Which of the following is the most likely diagnosis?
A. Melorheostosis
B. Osteopoikilosis
C. Fibrous dysplasia
D. Osteoarthritis
E. Osteopetrosis

Question 38

CNS

A 37-year-old woman presented to the A&E department with acute worsening of arm weakness and pins and needles at the C4/5 levels. MRI of the spine revealed an elongated area of high T2W signal change, which showed variable contrast enhancement. There was no
associated expansion of the cord, and CSF obtained by LP had earlier shown oligoclonal immunoglobulin bands. What is the likely diagnosis?
A. Lyme disease
B. Multiple sclerosis
C. Sarcoidosis
D. LCH
E. Lymphoma

Question 39

GU

A 9-year-old female patient is incidentally found to have a pelvic mass on US. The features are thought to represent those of a mature cystic teratoma (dermoid cyst).
Which of the following complications relating to this diagnosis is the least likely?
A. Malignant transformation
B. Associated ovarian torsion
C. Rupture of the lesion
D. Autoimmune haemolytic anaemia
E. Bleeding

Question 39

GU

An 11-year-old girl is currently under investigation for an adnexal mass recently found on a US scan. Which of the following statements regarding paediatric ovarian tumours is least accurate?
A. Gonadoblastomas are associated with dysgenetic gonads.
B. Sertoli-Leydig cell tumours may present with virilizing symptoms.
C. Mature cystic teratomas are the most common ovarian tumours in children.
D. Immature teratomas are associated with elevated serum AFP levels.
E. Elevated CA-125 levels are commonly seen in children with germ cell tumours.

Question 40

GIT

A 36-year-old woman on oral contraceptives was sent for a liver US by her GP with complaints of right upper quadrant pain and fullness. No gallstones were found and bile ducts were normal. However, an incidental small hyperechoic lesion was discovered in the right lobe of the liver. The appearance was benign and the most likely diagnosis would be
A. Focal nodular hyperplasia
B. Hepatocellular adenoma
C. Biliary hamartoma
D. Angiomyolipoma
E. Haemangioma

Question 40

CHEST

A 43-year-old man with known history of arteriovenous malformation involving various organs had a chest X-ray following a recent bout of haemoptysis. The chest X-ray was abnormal and
a CTPA was organised for clarification/confirmation and help in treatment planning. All of the following CT findings are true regarding treatment of pulmonary AVM, except
A. Surgery is preferred over embolisation.
B. Coils are the preferred embolisation material.
C. Intolerance to exercise is an indication for treatment.
D. Aneurysm size greater than 2 cm needs to be treated.
E. Large feeding arteries are associated with increased risk of brain abscess.

Question 40

GU

An 81-year-old man with progressive worsening hesitancy, dribbling, incomplete voiding and haematuria was found to have a hard nodular prostate gland on digital rectal examination. He is due to have a staging prostatic MRI, which will take place shortly after TRUS biopsy. Which one of the following is characteristic of post-biopsy haemorrhage of the prostate gland on MR imaging?
A. Hyperintense on T1W imaging and hypointense on T2W imaging
B. Hypointense on T1W imaging and hypointense on T2W imaging
C. Hypointense on T1W imaging and hyperintense on T2W imaging
D. Hyperintense on T1W imaging and hyperintense on T2W imaging
E. Hyperintense on T1W imaging and isointense on T2W imaging

Question 41

MSK

A 52-year-old man has a lower-leg radiograph performed after a fall. No acute bony injury is identified, but the reviewing doctor notices a flame-shaped lucency involving the medulla of the tibia, extending superiorly from the distal subarticular into the diaphysis. He is unsure of the significance of this appearance and seeks the opinion of the radiologist. Which of the following is the most likely diagnosis?
A. Osteomyelitis
B. Giant cell tumour
C. Plasmacytoma
D. Paget disease (acute phase)
E. Paget disease (chronic phase)

Question 42

CNS

A 40-year-old woman with history of severe diarrhoea following salmonella gastroenteritis presented with increasing headache. Clinically bilateral papilloedema was noted. Acute drop in GCS prompted an urgent CT of the brain, which showed suspicious high density in the superior sagittal sinus with bilateral subcortical haemorrhages in the parietal lobes. What is your diagnosis?
A. Acute haemorrhagic infarct
B. Encephalitis
C. Meningeal metastasis
D. Superior sagittal sinus thrombosis
E. Transverse sinus thrombosis

Question 43

GIT

A 42-year-old woman was found to have a mass in the right lobe of the liver on US and sent for an MRI liver for further characterisation. All of the following are expected MR features of FNH, except
A. High signal intensity of the central scar on T2W images
B. Uniform enhancement of the mass in the arterial phase
C. Lack of capsular enhancement in the arterial phase
D. Hypointense to surrounding liver on the enhanced portal venous phase
E. Maximum intensity of central scar on enhanced delayed phase images

Question 44

CHEST

A 57-year-old woman with a personal and familial (father, brother and grandfather) history of epistaxis and multiple telangiectasia, presented with dyspnoea and weakness leading to performance of a chest and head CT scan which showed a peripheral lobulated enhancing mass in the thorax and areas of hypoattenuation in the brain.
A. Churg-Strauss disease
B. Wegener’s granulomatosis
C. Osler-Rendu-Weber syndrome
D. Metastatic choriocarcinoma
E. Kaposi sarcoma

Question 44

GU

CT of the pelvis in a 37-year-old woman who was undergoing ovulation induction showed massive cysts in the pelvis surrounding a core of central ovarian stroma with relatively higher attenuation. More cephalad images demonstrated ascites. All of the following are features of ovarian hyperstimulation syndrome, except
A. Enlarged multicystic ovaries
B. Free intraperitoneal fluid
C. Low serum estradiol levels
D. Pleural or pericardial effusion
E. Risk of deep vein thrombosis

Question 45

MSK

A 15-year-old boy, who is a keen footballer, has a radiograph taken of the left knee following a tackle. There is an area of periosteal reaction and irregular speculated periosteum at the posterior aspect of the distal femur just proximal to the physis. He denies any symptoms before the injury. The next imaging should be which one of the following?
A. A comparison radiograph of the contralateral knee
B. Non-contrast CT of the distal femur
C. Contrast-enhanced CT of the distal femur
D. MRI of the distal femur
E. A nuclear medicine bone scan

Question 46

CNS

A 16-year-old boy with learning difficulties presented to the A&E department with increasing frequency of epileptic fits, which he has had since childhood. Bilateral brisk reflexes
were noted clinically. CT of the brain performed to exclude haemorrhage revealed a large heterogeneous lobulated mass replacing the third ventricle with further areas of subependymal calcification. What is the diagnosis?
A. Sturge-Weber syndrome
B. Tuberous sclerosis
C. Arnold-Chiari malformation
D. Neuroblastoma metastasis
E. VHL

Question 47

CHEST

A previously fit and healthy 16-year-old presents with recurrent wheeze. Chest X-ray demonstrates tubular, branching structures of increased density relative to normal lung radiating from the left hilum. The surrounding lung is hyperlucent. What is the most likely diagnosis?
A. Allergic bronchopulmonary aspergillosis
B. Cystic fibrosis
C. Bronchial atresia
D. Kartagener syndrome
E. Swyer-James syndrome

Question 47

GU

A 14-year-old female patient is found on US to have a large pelvic mass comprised of mainly cystic elements. The right ovary is not seen separate to the mass.
With regard to adnexal masses in children, which of the following statements is true?
A. Mature cystic teratomas tend to be bilateral when present.
B. A raised serum AFP level is indicative of choriocarcinoma.
C. The majority of mature cystic teratomas are malignant.
D. The most common malignant germ coll tumour is a dysgerminoma.
E. Yolk sac tumours tend to have a benign clinical course.

Question 48

GIT

A 33-year-old lady with a history of right upper-quadrant pain and deranged LFTs is sent for an ultrasound, which shows a large cystic lesion in the right liver lobe. Blood tests also show’ eosinophilia. Which of the following statements regarding the imaging of Hydatid disease is false?
A. US findings are variable and range from purely cystic to solid-appearing pseudotumours.
13. Daughter cysts are frequently seen.
C. Cysts usually appear well defined on CT.
D. Coarse wall calcification may be present,
E. CT imaging best demonstrates the pericyst, matrix and daughter cysts.

Question 49

CHEST

A 50-year old man with known lung transplant presented with shortness of breath. Blood gases revealed Type 1 respiratory failure. A late post-transplant complication wras suspected and a baseline chest X-ray was organised as a start. All of the following are late complications of lung transplantation, except
A. Bronchial stenosis
B. Chronic rejection
C. Recurrence of primary disease
D. Cryptogenic organising pneumonia
E. Bronchial dehiscence

Question 50

GU

A 37-year-old woman in her third trimester presented to the labour ward with acute onset of pain in the lower central abdomen. She had had two previous caesarean sections and an appendectomy with unremarkable recovery. On clinical examination, there was definite tenderness at the site of a previous caesarean scar. The best imaging modality for evaluation of caesarean section scar dehiscence is
A. CT
B. Transabdominal US
C. MRI
D. Angiography
E. Transvaginal US

Question 50

MSK

A 23-year-old man presents with an acute injury of his knee sustained during a friendly football match following a rough tackle. The patient reports having heard a pop and the knee started swelling immediately. He is unable to weight-bear and had to be carried off the field. An MRI is organised with high suspicion of ACL injury. All of the following are indirect signs of ACL injury, except
A. Bone bruising in lateral tibiofemoral compartment
B. Deep lateral femoral sulcus >1.5 mm
C. Uncovering of the posterior horn of the lateral meniscus
D. Posterior translation of the tibia
E. PCL bowing <105 degrees

Question 50

CNS

MRI brain images of a 42-year- old man diagnosed with HIV showed areas of cloud-like high signal on T2W images in the periventricular area bilaterally. All of the following are true regarding CNS infections in HIV, except
A. High signal in the periventricular area suggest HIV subacute encephalitis.
B. Subacute encephalitis caused by HIV and CMV have similar appearances.
C. Basal meningitis suggests neurosyphilis.
D. Cerebral infarcts can occur with neurosyphilis in HIV patients.
E. CMV infection can manifest as ventriculoencephalitis.

Question 51

CHEST

A 74-year-old woman presented with post-operative gastric cancer, at 4 days after onset of fever, cough and sputum. CT was organised for characterisation. All of the following are true regarding MRSA and MSS A pneumonia on CT chest, except
A. Lung nodules are more common in MSS A.
B. Effusion is more common in MRSA.
C. There is no significant difference in zonal distribution between MSSA and MRSA pneumonia.
D. Hilar lymph nodes are more common in MRSA.
E. Consolidation is seen in both groups.

Question 52

PED

A 4-year-old girl presents with progressive enlargement of her right thigh, with episodes of unprovoked bleeding from pigmented lesions over her right thigh, which were present since birth. A lower-limb venogram of the right leg demonstrates absence of the deep
venous system, with varicose veins on the lateral aspect of the right leg. Which of the following is the most likely diagnosis?
A. Klippel-Trenaunay syndrome
B. Neurofibromatosis Type 1
C. Beckwith-Wiedemann syndrome
D. Macrodystrophia lipomatosis
E. Maffucci syndrom

Question 53

GIT

A 42-year-old man with epigastric pain and upper-abdominal fullness was sent for US assessment. No gallstones were observed and bile ducts were normal. Multiple tiny liver lesions were noted and an MRI was advised for characterisation. MRI was reported as biliary hamartomas (von Meyenburg complexes, VMC) of the liver and the patient was reassured. Which one of the following statements concerning VMC is false?
A. They may be solitary or multiple.
B. They are benign cystic biliary malformations.
C. They are high signal intensity on T1W MRI.
D. They usually are smaller than 1 cm in diameter.
E. They do not show perilesional enhancement on MRI.

Question 53

GU

A previously hypertensive 34-year-old post-partum woman who presented with right upper-quadrant pain, pelvic pain and hypotension was sent for an urgent CT. The CT scan showed a large, subcapsular liver hematoma and hemoperitoneum within the abdomen and pelvis. No liver lesions were seen on a prepartum US. What is the diagnosis?
A. Haemorrhagic adenoma
B. HELLP syndrome
C. Iatrogenic injury at caesarean section
D. Acute hepatic steatosis of pregnancy
E. Fitz-Hugh-Curtis syndrome

Question 54

MSK

A 25-year-old woman presents with pain and swelling over the sternoclavicular joints. Clinical examination reveals small pustules in the palms and soles along with facial acne. As part of the series of investigations, a bone scan shows increased uptake around the sternoclavicular joints and anterior chest wall resulting in a bull’s horn appearance. What is the diagnosis?
A. Osteomyelitis of sternoclavicular joint
B. Ankylosing spondylitis
C. SAPHO syndrome
D. POEMS syndrome
E. Soto syndrome

Question 55

CNS

A 70-year-old woman came to the A&E department with a 4-day history of generalised malaise, fever and drowsiness. Blood, urine and sputum cultures were negative and an urgent CT of the brain was advised due to rapid drop in GCS and left lower-limb motor weakness. MRI showed diffuse high signal in the right temporal lobe, inferior frontal lobe and hippocampus with a small area of haemorrhage and mass effect.
A. Tuberous sclerosis
B. Lymphoma
C. Toxoplasmosis
D. HSV encephalitis
E. Gliomatosis cerebri

Question 56

GIT

A suspected low-density lesion in the pancreas of a 59-year-old man seen on US was reassessed with CT, which confirmed the presence of a small central cyst in the proximal part of the body of the pancreas. All of the following are characteristic features of the main duct subtype of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, except
A. Long or short segments of marked stricture in the main pancreatic duct
B. Excess drainage of thick mucin from a patulous papillary orifice on endoscopic retrograde cholangiopancreatography
C. A papillary intraductal mass
D. Malignant potential
E. A nodular intraductal mass

Question 57

CHEST

A 65-year-old man presents with shortness of breath, fever and cough. His blood results show leucocytosis and a raised CRP. His CXR shows a large right-sided effusion. Empyema was suspected clinically and a contrast-enhanced CT chest was organised urgently for further evaluation. All of the following features on a chest CT would suggest an empyema, except
A. Obtuse angle with the chest wall.
B. Gas locules in the fluid is most specific.
C. Lenticular-shaped pleural fluid collection.
D. Obvious septations.
E. Enhancing thickened pleura.

Question 58

GU

Urgent MRI done on a patient who had recently undergone caesarean delivery showed a large (>5 cm) intermediate- to high-signal-intensity haematoma at the lower uterine incision site that communicates with the endometrium on sagittal fat-saturated T2W images. The uterine serosa was intact. What is the diagnosis?
A. Uterine dehiscence
B. Uterine rupture
C. Bladder flap haematoma
D. Subfascial haematoma
E. Endometritis

Question 58

MSK

All of the following are true regarding imaging of the sternum and sternoclavicular joint, except
A. Primary osteomyelitis may suggest immunodeficiency.
B. Primary osteomyelitis is more common than secondary osteomyelitis.
C. Internal mammary artery graft has a higher association with post-sternotomy infection.
D. Sternal fracture suggests high energy trauma.
E. With regard to sternoclavicular joint dislocation, anterior is more common than posterior.

Question 59

CNS

A 43-year-old man with a 2 x 2 cm lump below the car lobule on the right. The lump has been there for 4 years and is slowly increasing in size without being painful or exhibiting
any features to suggest local neural involvement. How would you investigate the lump further?
A. MRI of the neck
B. CT of the neck with contrast
C. US of the neck
D. US of the neck with FNA
E. Sialogram

Question 60

GIT

While reporting plain films in a paediatric radiology setting, you look at the plain abdominal film of an 8-year-old child admitted with abdominal pain and vomiting. The film demonstrates multiple gas filled bowel loops throughout the abdomen, with paucity of gas and a small calcific density in right lower quadrant. The right psoas outline is not clear. What is the likely diagnosis?
A. Acute appendicitis
B. Acute cholecystitis
C. Renal colic
D. Abdominal teratoma
E. Chronic peritonitis

Question 61

CNS

A young girl presents with visual disturbance and headache. The paediatrician notices papilloedema on funduscopy. CT demonstrates a posterior fossa tumour with cystic elements and obstructive hydrocephalus. The patient is referred to the neurosurgeons, who arrange an MRI of the brain and abdomen. The MRI of the brain confirms a posterior fossa tumour with a nodule and cystic components. The nodule shows strong enhancement with contrast. Multiple flow voids are demonstrated within the tumour. What is the diagnosis and what were the findings of the abdomen MRI?
A. Neurofibromatosis Type 1 - multifocal RCC
B. Neurofibromatosis Type 2 - renal AMLs
C. Sturge-Weber syndrome - renal and pancreatic AVM
D. VHL syndrome - renal and pancreatic cysts
E. Li-Fraumeni syndrome - ovarian cysts

Question 62

GIT

A 66-year-old woman with discomfort in the epigastric region was sent for US of the upper abdomen. GB and bile ducts were normal but an incidental mass was identified in the pancreas. A dual-phase CT was requested for further characterisation. The CT showed a large, lobulated, multicystic lesion with a central scar, enhancing septae and some stellate calcification. Which one of the following is the most likely diagnosis?
A. Solid pseudopapillary tumour
B. Intraductal papillary mucinous neoplasm
C. Mucinous cystic neoplasm
D. Serous cystadenoma
E. Gastrinoma

Question 62

CHEST

A 50-year-old man with chronic dyspnoea showed unresolving consolidation in both lungs on chest X-ray. Following a course of steroids, the consolidations improved and a provisional diagnosis of cryptogenic organising pneumonia was made. An HRCT was organised at this point, which showed multiple nodules and masses. All of the following are expected appearance for masses seen in COP on CT, except;
A. Sparing of subpleural region
B. Cylindrical bronchial dilatation in consolidation
C. Fissural and septal nodules
D. Small lung nodules
E. Peribronchial distribution

Question 62

GIT

A middle aged man undergoes CT ol the abdomen for chronic low-grade abdominal pain, early satiety and weight loss; the CT reveals a large retroperitoneal mass. Which one of the following primary retroperitoneal tumours is most likely to appear on CT as a soft tissue density mass with a large area of central necrosis?
A. Liposarcoma
B. Lymphoma
C. Leiomyosarcoma
D. Lymphangioma
E. Paraganglioma

Question 63

MSK

A 5-year-old girl known to the endocrinologists presented to the A&E department after a fall and had radiographs of her lower limb taken to exclude fractures. No fractures were identified, but there were several well defined lytic lesions in the metaphysis and diaphysis of the femur and tibia with an internal ground glass matrix. Clinical examinations revealed several irregular areas of skin pigmentation. What is your diagnosis?
A. McCune-Albright syndrome
B. Mazabraud syndrome
C. NF1
D. NF2
E. Cherubism

Question 64

CNS

A 37-year-old man with a lump behind the ramus of the right mandible showed a well-defined, isodense, homogenous nodule in the superficial part of the right lobe of the parotid gland; there was no involvement of the facial nerve or retromandibular vein. Previous sialogram performed for possible stones had shown displacement of the intraglandular ducts without occlusion. What is the diagnosis?
A. Pleomorphic adenoma
B. Warthin’s tumour
C. Lymphoma
D. Mucoepidermoid tumour
E. Adenoid cystic tumour

Question 64

GIT

A 50 year-old woman with palpable fullness in the epigastric region was sent for US of the upper abdomen. The GB and bile ducts were normal but a hypoechoic mass was identified in the pancreas. A dual phase CT was requested for further characterisation, which showed a multicystic lesion in the pancreatic head and reported possible serous cystadenoma. All of the following are expected features, except
A. Multiple small cysts (usually less than 2 cm)
B. High glycogen content in aspirated fluid
C. Communication with the pancreatic duct
D. Thin enhancing internal septa on MRI
E. Central stellate fibrotic scar in large lesions

Question 65

CHEST

A 25-year-old immunocompromised patient presented with a long history of progressive exertional dyspnoea and was found to have an abnormal chest X-ray. An HRCT was organised for further characterisation of disease. HRCT suggested pulmonary Mycobacterium avium complex infection. Which one of the following features is a characteristic finding on CT?
A. Upper lobe bronchiectasis
B. Lower-lobe bronchiectasis
C. Thick-walled cavities
D. Right middle lobe and lingular bronchiectasis
E. Large pleural effusion

Question 65

CNS

A child with a previous history of infantile spasms now presents with myoclonic seizures. She is noted to have a port wine stain on her face. An MRI scan of the brain is arranged to confirm the suspected diagnosis. What MRI findings would you expect in the suspected diagnosis?
A. Posterior fossa haemangioblastoma
B. Pial angioma demonstrated by leptomeningeal enhancement
C. Bilateral acoustic schwannomas
D. Multiple white matter T2 hyperintensities
E. Multiple T1W hyperintensities and cerebellar hypoplasia

Question 66

GIT

Contrast-enhanced CT of the abdomen done on a middle aged woman revealed a large heterogeneous retroperitoneal mass with distortion of regional anatomy and forward
displacement of the posterior abdominal structures. All of the following CT signs will help distinguish a tumour arising within a retroperitoneal organ from a primary retroperitoneal tumour, except
A. Beak sign
B. Phantom organ sign
C. Embedded organ sign
D. Prominent feeding artery sign
E. Soft-tissue rim sign

Question 66

MSK

A 65 year-old woman currently under the care of rheumatologists complains of worsening morning stiffness and polyarthropathy with a positive rheumatoid factor. Over the recent months she has noticed progressive worsening of shoulder pain with increasing limitation of motion. A shoulder X-ray is requested. All of the following are expected in her shoulder radiograph, except
A. Marginal erosions
B. Soft-tissue swelling
C. Superior subluxation of humeral head
D. Osteophytes
E. Osteopaenia

Question 67

CNS

A 30-year-old apyrexial, systematically well woman came to the ENT clinic with sudden appearance of a large swelling in the left side of her neck, which had been moderately painful over the past few weeks. The swelling was non-tender and fluctuant; US of
the neck showed a large fluid-filled cavity and guided FNA from the wall of the cyst showed benign histology. What is the diagnosis?
A. Metastatic squamous cell carcinoma
B. Lymphoma
C. Abscess
D. Branchial cyst
E. Thyroglossal cyst

Question 68

CHEST

A 45-year-old man with shortness of breath and bronchiectatic changes in the basal lobes showed moderate to marked dilatation of trachea on axial CT images. Which one of the following conditions is most likely?
A. Cystic fibrosis
B. Mounier-Kuhn syndrome
C. Williams-Campbell syndrome
D. Pulmonary sarcoidosis
E. Allergic bronchopulmonary’ aspergillosis

Question 69

GIT

A 65-year-old man with a cystic lesion of the pancreas detected on US was sent for a dual-phase pancreatic CT for further characterisation. The most commonly encountered cystic lesion of the pancreas is
A. Serous cystadenoma
B. Mucinous cystic neoplasm
C. Pancreatic pseudocyst
D. Main duct intraductal papillary mucinous neoplasm
E. Side branch intraductal papillary mucinous neoplasm

Question 70

CNS

Which of the following MRI sequences is most sensitive to assess normal myelination in children less than 1 year of age?
A. Fluid-attenuated inversion recovery (FLAIR)
B. T1W TSE
C. T2W TSE
D. Susceptibility-weighted imaging (SWI)
E. T2W GRE

Question 71

GU

A 33-year-old woman was referred for a transabdominal pelvic ultrasound examination to investigate for congestive dysmenorrhoea and deep dyspareunia. US examination revealed a complex right adnexal mass lesion with internal fishnet appearance. A normal right ovary was not identified separately; hence the complex mass was thought to be ovarian in origin. What is the likely diagnosis?
A. Endometrioma
B. Simple follicular cyst
C. Haemorrhagic cyst
D. Corpus luteal cyst
E. Cystadenocarcinoma

Question 72

MSK

Owing to normal appearances on initial plain radiographs, MRI is increasingly requested in suspected stress fractures, particularly in professional athletes and keen sportspersons.
MRI performed in one such instance showed periosteal oedema and increased marrow signal on T2W fat-suppressed images with hardly any signal change on T1W images.
Considering the stages of the MR grading system for stress injuries, what would be the grade of this injury?
A. 0
B. 1
C. 2
D. 3
E. 4

Question 72

CNS

A 23-year-old mail presents with a congenital swelling underneath the left jaw, which has not changed over the past few years. Clinical examination reveals a horizontal scar overlying the same area. US shows multiloculated fluid-filled spaces at the site of the swelling in the neck. What is the diagnosis?
A. Cystic hygroma
B. Abscess
C. Thyroglossal cyst
D. Branchial cyst
E. Cystic metastasis

Question 73

CHEST

A 36-year-old man with productive cough and abnormal chest X-ray had an HRCT for further characterisation and diagnosis. HRCT showed changes of bronchiectasis. Which one of the following is a direct radiographic sign of bronchiectasis?
A. Bronchial wall thickening
B. Mucoid impaction
C. Lack of tapering of a bronchus
D. Bronchial artery hypertrophy
E. Lobar atelectasis

Question 74

GIT

A 76-year-old man came to the A&E department with abdominal pain. A plain radiograph of die abdomen done in casualty was reported as showing pneumatosis intestinalis without any complications. Which one of the following statements regarding the radiographic findings in adult pneumatosis intestinalis is true?
A. Pneumatosis cystoides intestinalis is characterised by linear gas collections.
B. Pneumatosis cystoides intestinalis occurs mainly in the rectum.
C. Portal venous gas usually is located in the central portion of the liver.
D. The submucosal gas in pneumatosis cystoides intestinalis can mimic colonic polyps on a barium enema when viewed en face.
E. The linear form in the small bowel allows differentiation between the benign and life-threatening forms.

Question 74

GU

A 23-year-old woman with history of pelvic inflammatory disease, 2 months amenorrhea, left lower-abdominal pain, weakness and occasional spotting showed lower-than expected levels of HCG for pregnancy on urine assay. As far as US of the pelvis is concerned, which one of the following sonographic findings definitively distinguishes ectopic pregnancy from corpus luteum?
A. Visualisation of a yolk sac
B. ‘Ring of fire’ appearance
C. Low-impedance flow on Doppler to the ring of fire
D. Visualisation of a heartbeat
E. Presence of echogenic pelvic fluid

Question 75

CNS

Which of the following areas of the brain is normally the last to myelinate?
A. Anterior limb of the internal capsule
B. Posterior limb of the internal capsule
C. Cerebellum
D. Peritrigonal region
E. Brainstem

Question 75

CHEST

A 50-year-old woman presents with painful wrists and clubbing. An X-ray demonstrates bilateral symmetrical periostitis involving the radius. The differential diagnosis includes hypertrophic pulmonary osteoarthropathy (HPOA). Which of the following is not a known cause of HPOA?
A. Mesothelioma
B. Pleural fibroma
C. Bronchogenic carcinoma
D. Bronchiectasis
E. Pleural plaque secondary to asbestos exposure

Question 76

CNS

A 23-year old man presented with a hard swelling of the left side of the jaw. Plain radiograph showed a well-defined oval lucent lesion in the left side of the mandible with the crown
of a unerupted lower third molar. What is the most likely diagnosis?
A. Odontogenic keratocyst
B. Dentigerous cyst
C. Dental cyst
D. Periapical cyst
E. Adamantinoma

Question 76

CHEST

A 55-year-old man with progressive productive cough and copious sputum was referred for an HRCT for disease characterisation. Which one of the following radiographic features distinguishes the bronchiectasis of allergic bronchopulmonary aspergillosis from that of cystic fibrosis?
A. High-density mucus plugging
B. Upper lobe predominance
C. Cylindrical-type predominance
D. Presence of associated hilar adenopathy
E. Presence of air trapping

Question 77

GIT

A 69-year-old man came to the A&E department with abdominal pain, and a plain X-ray of the abdomen and chest was requested for further evaluation. The chest X-ray showed free gas under the diaphragm; a plain radiograph of the abdomen showed pneumatosis intestinalis with free intraperitoneal air. All of the following are causes of the life-threatening form of adult pneumatosis intestinalis, except
A. Ingestion of corrosive agents
B. Toxic megacolon
C. Post-bone marrow transplantation
D. Surgical placement of a jejunostomy tube
E. Primary infarction of the bowel wall

Question 78

GU

A 33-year-old woman with progressive congestive dysmenorrhoea, deep dyspareunia and infertility was being evaluated for possible endometriosis. Transabdominal US was organised as the first point of investigation. All of the following are acceptable features of endometrioma, except
A. Multiloculated cyst
B. Diffuse low-level echoes within a cyst
C. Homogeneous hypoechoic mass
D. Homogenous hyperechoic mass
E. A solid component with intense enhancement on Doppler

Question 78

MSK

A 28-year-old woman is referred for a CT KUB for loin pain. The study unexpectedly shows grossly enlarged and abnormal kidneys with areas of fat density tissue within it. Small cystic areas are noted within the scanned lung bases. Further investigations reveal small subependymal lesions. What is a common musculoskeletal manifestation of this disease?
A. Osteochondroma
B. Sclerotic bone lesions
C. Enostoses
D. Fibrous dysplasia
E. Enchondroma

Question 79

CNS

A 38-year-old woman presented with night-time stridor for several months. No definite lumps were felt clinically on examination, but chest radiograph showed marked deviation of the trachea to the left and a large soft-tissue mass on the right. US showed background multinodular change, but it was difficult to identify the lower pole of the right lobe of the thyroid. On detailed questioning, the patient admitted to facial and hand swelling on raising both arms for a reasonable length of time. What is the diagnosis?
A. Multinodular goitre with dominant nodule
B. Retrosternal goitre
C. Papillary carcinoma thyroid
D. Medullary carcinoma thyroid
E. Thyroid cyst with haemorrhage

Question 80

CNS

Which of the following is the correct order of normal myelination?
A. Peripheral to central, caudal to rostral, ventral to dorsal
B. Central to peripheral, caudal to rostral, ventral to dorsal
C. Central to peripheral, rostral to caudal, dorsal to ventral
D. Peripheral to central, rostral to caudal, dorsal to ventral
E. Central to peripheral, caudal to rostral, dorsal to ventral

Question 80

CHEST

A 24 year old man with chronic productive cough, fever, shortness of breath and recurrent chest infections shows predominantly lower-lobe bronchiectasis on HRCT. All the following differentials should be considered, except
A. Kartagener s syndrome
B. Sarcoidosis
C. Common variable immunodeficiency
D. α1-Antitrypsin deficiency
E. Chronic aspiration

Question 80

GIT

Which one of the following statements concerning papillary and solid epithelial neoplasms of the pancreas is true?
A. They occur mainly in elderly men.
B. They are a high-grade malignant tumour.
C. Heterogeneous content is detected within the mass on CT.
D. They typically present as a small cystic mass in the pancreatic head.
E. Weight loss and jaundice are the usual presentation.

Question 81

GU

Sagittal transvaginal US scan demonstrates a tubular-shaped cystic mass with several incomplete septa and indentations on opposite sides of the mass, often described as the ‘waist’ sign. What is the likely diagnosis?
A. Paraovarian cyst
B. Hydrosalpinx
C. Tubal pregnancy
D. Salpingitis isthmica nodosa
E. Peritoneal inclusion cyst

Question 82

MSK

A 29-year-old runner presents to his family doctor with progressive increase in forefoot pain, which is limiting his training. Initial X-rays in the A&E department were normal. A follow-up bone scan detects focal abnormality in one of the metatarsals. Which one of the following is the most likely location for a metatarsal stress fracture appearing as an area of focal linear sclerosis on radiographs?
A. Base of the first metatarsal
B. Mid-shaft of the second metatarsal
C. Head of the third metatarsal
D. Distal shaft of the fourth metatarsal
E. Base of the fifth metatarsal

Question 82

CNS

A 35-year-old woman with a palpable nodule in the left lobe of the thyroid gland showed
a corresponding area of low activity on nuclear medicine study consistent with a cold nodule. How would you investigate this patient further?
A. MRI neck
B. CT neck with contrast
C. US neck
D. US neck with FNA
E. Sialogram

Question 82

CHEST

A 3-month-old man is brought to the accident and emergency department following possible aspiration of a foreign body. The abdominal X-ray is normal, but CXR demonstrates a large mediastinal mass with wavy margins. No foreign body is identified. What is the most appropriate management?
A. Check full blood count
B. Discharge with reassurance
C. Repeat CXR in 6 weeks
D. List for bronchoscopy under anaesthetic
E. CT of chest