EXAM 6

Question 1

CHEST

A Computed tomography (CT) chest is done in a 6-month-old girl with a history ofpremature birth, chronic lung disease and MRSA pneumonia. It shows a large gas-containing,thin-walled cavity in the right lung, consistent with a pneumatocele. All the following aretrue regarding a pneumatocoele, except:
A. They are gas-filled, thin-walled spaces surrounded by lung.
B. They can be associated with lung contusion.
C. Most pneumatocoeles resolve spontaneously.
D. Pneumatocoeles do not cause mediastinal shift.
E. They can have fluid levels.

Answer 1

D. Pneumatocoeles do not cause mediastinal shift.
Pneumatocoeles typically are post-infectious or post-traumatic, discrete, thin-walled,gas-containing collections within the lung parenchyma. They also may result from positive pressure ventilation-related barotrauma and ingestion of caustic material (e.g. hydrocarbons). Post-infectious pneumatocoeles most frequently complicate staphylococcal pneumonia and occur in infants. They typically appear within 1 week of onset of infection and most spontaneously disappear within weeks to months after the infection has resolved. Rarely, persistent pneumatocoeles may require percutaneous catheter drainage or surgical management. Post-traumatic pneumatocoeles result from blunt trauma. Such pneumatocoeles are typically observed within hours of the trauma and spontaneously resolve within 3 weeks. They generally spare the lung apices.
At CT, pneumatocoeles appear as well-defined parenchymal cystic structures, with a thin wall. They may be entirely filled with gas, or an air-fluid level may be seen. Contralateral mediastinal shift may be seen with large pneumatocoeles. They are associated with contusion in blunt trauma and can rupture to cause pneumothorax.

Question 2

GIT

A 58-year-old patient is reported to have a carcinoid tumour of the gastrointestinal (GI)tract on an abdominal computed tomography scan. What is the most common primary site ofGI carcinoids?
A. Stomach
B. Colon
C. Rectum
D. Small bowel
E. Appendix

Question 2

GU

A 53-year-old man with history of haematuria which shows a gel-like polypoid filling defecton cystoscopy is sent for an MRI. The MRI shows a low Tl signal, heterogeneous T2 signal(central high and peripheral low) lesion. On post-contrast Tl W FS images, the peripheral portionenhances more than the central potion, resembling a ring-like pattern. What is the diagnosis?
A. Endometriosis
B. Inflammatory pseudotumour
C. Malakoplakia
D. Cystitis glandularis
E. Eosinophilic cystitis

Question 3

CNS

Question 3

MSK

Question 3

GIT

Question 4

CHEST

Question 5

MSK

Question 6

CVS

A 29 year old woman has come to the A&E department with 3 months’ history of shortness of breath after her second miscarriage. She had an episode of pulmonary embolism during her first pregnancy and epilepsy in her teens. Chest radiograph done in the A&E department shows progressive enlargement of cardiac silhouette and left-sided pleural effusion. What is the likely diagnosis?
A. Systemic lupus erythematosus (SLE)
B. Rheumatoid arthritis
C. Wegner’s disease
D. Polyarteritis nodosa (PAN)
E. Homocystinuria

Question 7

GIT

Abdominal computed tomography (CT) in a 57-year-old patient with non-specific abdominal pain demonstrates an elongated cystic mass in the expected region of the appendix. The lesion appears to be invaginating into the caecum and demonstrates curvilinear calcification in its wall. What is the most likely diagnosis?
A. Lipomatosis of ileocaecal valve
B. Carcinoid tumour of the appendix
C. Mucocoele of the appendix
D. Epiploic appendagitis
E. Myxoglobulosis

Question 8

MSK

Tuberculous spondylitis is diagnosed in a 44-year-old woman with progressive neurological deficit with severe discovertebral destruction and compression of the spinal cord at the Tll-12 level on sagittal T2W & STIR MR images. Post-contrast images show a rim-enhancing anterior abscess that does not encase the intercostal arteries. All of the following features are more likely to represent tuberculosis spondylitis compared to pyogenic spondylitis, except:
A. Subligamentous spread
B. Three or more vertebral level involvement
C. Skip lesions
D. Homogenous enhancement of the disc
E. Paraspinal calcification

Question 9

GU

A CT cystogram is being performed on a 40-year-old man brought to the A&E department, after a fall from a roof. Blood is seen at the external urethral meatus on examination. The CT scan shows focal thickening of the urinary bladder wall, with no extravasation outside the bladder. Which of the following is the most likely injury sustained?
A. Bladder contusion
B. Intraperitoneal bladder rupture
C. Extraperitoneal bladder rupture
D. Combined intraperitoneal and extraperitoneal bladder rupture
E. Subserosal bladder rupture

Question 9

CVS

A 28-year-old man with sudden-onset of heart murmur and a normal chest radiograph is admitted for progressive shortness of breath on exertion over the recent months. There is a positive family history for heart murmurs and sudden death of a sibling at the age of 30 years. While in the hospital he developed an acute, severe bout of central chest pain, which prompted an urgent CT of the chest. The CT of the chest shows dissection of an enlarged ascending aorta. What is the diagnosis?
A. Homocystinuria
B. Marfan syndrome
C. Ehlers-Danlos syndrome
D. Pseudoxanthoma elasticum
E. Mucopolysaccharidosis

Question 9

GIT

A 59-year-old patient is admitted with general lethargy, weight loss and gradual abdominal distension. Diagnostic work-up included an abdominal CT scan, which demonstrated thickening of the peritoneal surfaces and a large, multiloculated dense ascites, causing secondary scalloping of the liver edge. What is the most likely location of the primary tumour?
A. Stomach
B. Appendix
C. Pancreas
D. Liver
E. Rectum

Question 10

GU

A 44-year-old woman with recurrent urinary tract infections is referred for a renal tract ultrasound. This demonstrates normal kidneys and multiple fluid-filled cysts within the bladder wall. Which of the following is the most likely cause?
A. Transitional cell carcinoma
B. Cystitis cystica
C. Emphysematous cystitis
D. Eosinophilic cystitis
E. Interstitial cystitis

Question 11

MSK

A 22-year-old man presents to the A&E department with a painful swollen ankle following a twisting injury’. Plain X-rays showed no fracture, although diffuse soft-tissue swelling was evident. The ankle mortise was intact. Incidental note was made of a benign lesion in the mid- shaft of the fibula, which the reporting radiologist described as a fibrous cortical defect. Which one of the following statements regarding this entity is false?
A. They are smaller than non-ossifying fibromas.
B. Pathological fractures tend to end in non-union.
C. Both show dense sclerotic border on CT.
D. They commonly affect the metaphysis of long bones.
E. They are uncommon in the upper extremity.

Question 11

CNS

A 43-year-old man presents to the A&E department with severe headache and is sent for an urgent CT brain, which is normal. MRI shows loss of normal flow void in the basal cisterns with intense enhancement along the cisterns on post-contrast images. What is the likely diagnosis?
A. Subarachnoid haemorrhage
B. Lymphoma
C. TB meningitis
D. Ruptured dermoid cyst
E. Creutzfeldt-Jakob disease (CJD)

Question 12

CNS

A 6-year-old child is admitted to the emergency department with a head injury. The emergency department consultant demands an urgent CT of the head. Which of the following risk factors would warrant a CT of the head within 1 hour of the injury?
A. Two episodes of vomiting after the head injury
B. Amnesia of events 10 minutes preceding the head injury
C. Fall from a playground climbing frame of 3 metres in height
D. GCS of 13 on initial clinical assessment
E. Abnormal drowsiness

Question 12

CNS

An 8-year-old boy attends the emergency department after his bicycle collides with an oncoming car. The ambulance crew have immobilised his cervical spine and report that the patient was complaining of severe neck ache. All of the following risk factors warrant a CT of the cervical spine without obtaining a plain radiograph, except
A. The patient is already attending the department for a CT of the head.
B. Fall from a height of more than 1 metre.
C. Loss of sensation in the upper arms.
D. GCS of 13 on initial assessment.
E. The child needs to be intubated.

Question 12

CNS

A 34-year-old man with history of measles infection showed marked cerebral atrophy on MRI with high signal in the deep white matter bilaterally on T2 and FLAIR images. What is the most likely diagnosis?
A. Adrenoleukodystrophy
B. Alexander s disease
C. CJD
D. Progressive multifocal leukoencephalopathy (PML)
E. Subacute sclerosing panencephalitis

Question 13

MSK

A 25-year-old man presents with left hip/groin pain after exercise that worsens on internal rotation of the hip. A plain AP radiograph of the pelvis shows an osseous protrusion at the femoral head-neck junction, and the measured alpha angle is greater than 55 degrees. Which of the following is the most likely diagnosis?
A. Pincer type femoro-acetabular impingement
B. Cam type femoro-acetabular impingement
C. Missed congenital hip dislocation
D. Focal acetabular over-coverage
E. Protrusio acetabuli

Question 14

CHEST

Chest radiograph of a currently asymptomatic 84-year-old man shows a large well-defined soft tissue density mass in the left apex with a sharp inferior margin. There is underlying rib abnormality, suggesting previous surgery and sheet-like pleural calcification in the left mid and lower zone. What is the diagnosis?
A. Aspergilloma
B. Plombage
C. Pancoast tumour
D. Bronchogenic cyst
E. Lymphoma

Question 14

GIT

An adult patient was admitted to hospital with abdominal pain, jaundice and a palpable epigastric mass. Ultrasound demonstrated isolated dilatation of the common bile duct with otherwise normal appearance of the proximal biliary tree. What is the most likely diagnosis based on the sonographic findings?
A. Choledochal cyst
B. Caroli disease
C. Choledochocoele
D. Common bile duct diverticulum
E. Impacted common bile duct calculus

Question 15

GU

A 40-year-old patient emigrating from an African country is investigated for stone disease because of left-sided renal angle pain. CT of the kidneys, ureters and bladder (KUB) confirms a left renal calculus but also shows thin curvilinear calcification outlining a normal-sized bladder with involvement of the distal ureters only. Which of the following is the most likely cause?
A. Tuberculosis
B. Escherichia coli infection
C. Transitional cell carcinoma
D. Malakopiakia
E. Schistosomiasis

Question 15

CHEST

An asymptomatic military recruit showed a well-defined 2 x 2 cm solitary pulmonary nodule in the right lower zone on a plain chest radiograph. On dose inspection, the nodule showed faint calcification. CT performed for further characterisation showed areas of fat density on pixelometry. What is the diagnosis?
A. Tuberculoma
B. Aspergilloma
C. Hamartoma
D. Carcinoid
E. Haemangioma

Question 16

GIT

You are performing an abdominal ultrasound scan on a woman who has been complaining of chronic abdominal pain. There is a large 20 cm multiloculated, ovoid anechoic mass in the right lobe of liver. The internal septations are well visualised and hyperechoic. Further investigation with CT demonstrates enhancement of its thick wall and internal septations. What is the most likely diagnosis?
A. Simple hepatic cyst
B. Choledochal cyst
C. Echinococcal cyst
D. Caroli disease
E. Biliary cystadenoma

Question 16

GU

An intravenous urogram is performed on a 70-year-old diabetic for recurrent E. coli urinary tract infections. This demonstrates multiple small, smooth, plaque-like mural defects of
the bladder and distal ureteric walls. Which of the following is the most likely cause?
A. Emphysematous cystitis
B. Malakoplakia
C. Leukoplakia
D. Haemorrhagic cystitis
E. Bladder outflow obstruction

Question 16

MSK

A 45 year-old woman presents with right hip pain. An AP radiograph of the hip shows a large lucent lesion with stippled calcification and a wide destructive-appearing zone of transition. Which of the following is the most likely diagnosis?
A. Osteomyelitis
B. Osteosarcoma
C. Chondrosarcoma
D. Fibrous dysplasia
E. Chondromyxoid fibroma

Question 17

CNS

A 37-year-old woman with progressive worsening of headache had a facial series done following an injury to the face when she fell while skating. PA view of the skull and OM view did not show any fractures. Incidental note was made of enlarged optic canals. All of the following are associated with this, except
A. NF1
B. Optic glioma
C. Sarcoidosis
D. Sphenoid mucocoele
E. Ophthalmic artery aneurysm

Question 17

MSK

A 1 -year-old child is admitted with seizures and found to have bilateral subdural haematomas. There is concern regarding non accidental injury and a full skeletal survey is requested. According to the Royal (College of Radiologists guidelines, which radiograph(s) would not be routinely included in a full skeletal survey?
A. PA radiograph of the right hand
B. AP radiograph of the left tibia and fibula
C. AP radiograph of the cervical spine
D. Lateral radiograph of the lumbar spine
E. Right oblique radiograph of the chest

Question 17

PED

A term neonate is found in respiratory distress with shortness of breath and tachypnoea on Day 1 of life. An urgent chest radiograph demonstrates a right sided pneumothorax.
There is no history of any antenatal complications. What is the most likely underlying cause?
A. Respiratory distress syndrome (pulmonary surfactant deficiency)
B. Group B streptococcus infection
C. Congenital pulmonary airway malformation (CPAM)
D. Meconium aspiration
E. Congenital diaphragmatic hernia (CDH)

Question 18

CHEST

A 58-year-old man who worked in the mines for several years presented with progressive shortness of breath on exertion. Extensive interstitial thickening and small nodules bilaterally with large masses of consolidation in the upper lobes were noted on the most recent chest radiograph. Comparison with previous films suggested central migration of the consolidation like upper lobar masses. What is the diagnosis?
A. Pneumoconiosis with progressive massive fibrosis
B. End-stage sarcoidosis
C. End stage Langerhans Cell Histiocytosis (LCH)
D. Cryptogenic fibrosing alveolitis
E. Old TB

Question 19

GIT

A patient is admitted to hospital with progressively worsening jaundice and raised bilirubin levels. Ultrasound of the abdomen, demonstrates a large hyperechoic focus casting a shadow within the neck of the gallbladder, causing secondary dilation of the common hepatic and intrahepatic bile ducts proximally. The distal common bile duct (CBD) was normal.
What is the most likely diagnosis?
A. Caroli disease
B. Choledochocoele
C. Caroli syndrome
D. Mirizzi syndrome
E. Cholangiocarcinoma

Question 20

GU

A 30-year-old man is admitted with lower abdominal pain following a road traffic accident in which he was an unrestrained passenger. Blood is seen in his urine and a bladder injury is suspected. Regarding extraperitoneal bladder rupture, which of the following is incorrect?
A. It is more common than intraperitoneal rupture.
B. A flame shaped extravasation of contrast can often be seen.
C. It is usually caused by puncture from a pelvic fracture.
D. Contrast most commonly extravasates into the retropubic space of Rctzius.
E. The bladder dome is the most common site of injury.

Question 21

MSK

A 4 year-old child presents with short stature and failure to grow. Plain radiographs reveal multiple abnormalities, including generalised increased density of long bones with thickened cortices, widened cranial sutures, Wormian bones, a hypoplastic mandible and shortened pointed distal phalanges. Which of the following is the most likely diagnosis?
A. Pyknodysostosis
B. Osteopetrosis
C. Cleidocranial dysostosis
D. Osteosclerosis
E. Kinky hair syndrome

Question 22

CNS

A man with nasopharyngeal squamous cell carcinoma undergoes MRI staging. A pathological node is seen lateral to the IJV. It lies below’ the hyoid bone but above the vocal cords. At which level is this likely to be located?
A. I
B. II
c. III
D. IV
E. V

Question 23

CHEST

CT of the chest in a 68-year-old man who worked for 20 years in a coal mine, showed an ill defined 3-cm spiculated nodule in the apical segment of the lower lobe of the left lung. The lesion was avid on PET and showed high signal on axial T2W MRI thorax.
All of the following are true regarding lung cancer and progressive massive fibrosis except:
A. T2W is useful in differentiating lung cancer from PMF.
B. PET CT is useful in differentiating lung cancer from PMF.
C. PMF shows low signal compared to muscle on T1W MRI.
D. PMF commonly shows peripheral enhancement on contrast MRI.
E. Histopathologic analysis should still be performed for diagnosis.

Question 24

GIT

A patient is admitted to hospital with jaundice and recent weight loss. Abdominal ultrasound demonstrates marked dilation of the intrahepatic ducts, extending to the liver surface. Note is also made of an isocchoic mass at the porta hepatis. Which of the following is the most likely diagnosis?
A. Primary sclerosing cholangitis R. Klatskin tumour
C. Mirizzi syndrome
D. Choledochal cyst
E. Caroli disease

Question 24

GU

A 17 year-old girl is admitted following a road traffic accident where she was a restrained passenger. She has low-volume haematuria following catheterisation. Pre- and post-intravenous (IV) contrast CT is performed after administering contrast via her urinary catheter. The pre contrast CT shows contrast within the peritoneal cavity around loops of bowel and there is irregularity of the bladder wall at the dome of the bladder. No contrast blushes are seen on the arterial-phase CT. Which of the following is the most likely injury?
A. Extraperitoneal bladder rupture
B. Intraperitoneal bladder rupture
C. Subserosal bladder rupture
D. Iliac artery injury with haemorrhage
E. Pelvic haematuria from occult fracture

Question 24

MSK

A 65-year-old man presents with severe upper thoracic back pain, of insidious onset, with little relief from analgesia. Lateral radiographs of his thoracic spine reveals uniformly increased density within the T7 and T9 vertebral bodies, with retention of the vertebral body size and contour. Which of the following is the most likely cause for this finding?
A. Bone metastasis
B. Osteoid osteoma
C. Tuberous sclerosis
D. Osteopetrosis
E. Fluorosis

Question 25

CNS

A 40-year-old man was punched in the face during an altercation. Clinical examination showed left facial swelling with left-sided ophthalmoplegia and diplopia. X-rays showed a left maxillary fracture. What is the likely cause of the patient’s symptoms?
A. Superior orbital fissure syndrome
B. Cavernous sinus thrombosis
C. Carotico-cavernous fistula
D. Post-traumatic ophthalmoplegia
E. Cerebral venous sinus thrombosis

Question 26

MSK

While reporting a plain radiograph of a 10 year-old girl patient’s left hand, you notice that her bone age is delayed. There is no indication of the patient’s underlying condition on the request form. The bones of the hand are otherwise unremarkable.
Which of the following conditions may offer a possible explanation?
A. Hypothyroidism
B. Achondroplasia
C. Haemophilia
D. Cushing syndrome
E. Precocious puberty

Question 27

CHEST

A 42 year old man with cough and haemoptysis, swelling of ankles and hand, raised urea, and creatinine on recent blood biochemical profile, presented to the A&E department with bloody nasal discharge. A Chest radiograph was performed. What do you expect the chest radiograph to show given the clinical scenario?
A. Miliary nodules
B. Pew varying sized nodules, some with cavitation
C. Perihilar infiltrates in a batwing pattern
D. Bilateral upper lobe fibrosis
E. Tramline and gloved finger opacities

Question 28

GIT

An 87 year old female patient from a nursing home presents with a history of severe abdominal pain and diarrhoea. She has a past medical history of transient ischaemic attacks and two non-ST elevation myocardial infarctions. Blood results show an elevated lactate level and raised white cell count. CT report states that the most likely cause is ischaemic colitis. What is the most likely CT finding?
A. Thick-walled caecum with distended appendix
B. Dilated loop of bowel in the left iliac fossa with spiralling vessels
C. Thick-walled oedematous loops of bowel with branching lucencies peripherally in liver
D. Thick-walled oedematous colon with ascites
E. Dilated small bowel loops with branching linear lucency at the porta hepatis

Question 29

GU

A 60-year-old male smoker attends for a CT scan following an ultrasound scan that showed unilateral hydronephrosis. The scan shows a lobulated irregular bladder wall mass that enhances in the portal venous phase, to a greater extent than the bladder wall. Which of the following is the likely diagnosis?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Transitional cell carcinoma
D. Leiomyoma
E. Blood clot

Question 29

MSK

A 40-year-old man had a cardiac CT and MR! to evaluate suspected cardiomyopathy. This revealed a well-defined incidental lesion within the T10 vertebral body, with coarse vertical trabeculae on CT, and high signal on both T1 and T2 sequences on MRI. The lesion enhanced with contrast on both modalities. What is the most likely diagnosis?
A. Plasmacytoma
B. Osteosarcoma
C. Osteopathia striata
D. Enostosis
E. Haemangioma

Question 30

CNS

A 30-year-old woman presents with a painless neck mass. MRI confirms that this is a thin-walled cyst lying just anterior to the sternocleidomastoid. There is a tract from the bifurcation of the common carotid artery. What is the diagnosis?
A. Lymphangioma
B. Thyroglossal duct cyst
C. First branchial cleft cyst
D. Carotid body tumour
E. Second branchial cleft cyst

Question 31

MSK

A neonate presents with an imperforate anus and a presacral mass. MRI of the abdomen demonstrates an enhancing lesion with fatty components and T2* susceptibility artefacts. What other imaging finding would you expect?
A. Syrinx within the spinal canal
B. Anterior beaking of the vertebral bodies
C. Sacrococcygeal bony defect
D. Developmental dysplasia of the hips
E. Multiple renal cysts

Question 32

CNS

A 17-year-old boy presents with an enlarging swelling in the midline at the level of the hyoid bone. The GP suspects a thyroglossal cyst and sends him for an ultrasound. Which of the following appearances is consistent with a thyroglossal cyst?
A. Hyperechoic mass in the midline
B. Hyperechoic mass to the left of the midline
C. Anechoic mass in the midline
D. Hyperechoic mass with coarse internal echoes
E. Hypoechoic mass to the left of midline

Question 33

CHEST

A 69-year-old woman presented to her GP with one month’s history of headache and progressive swelling of both hands and face and an 8 months’ history of progressive weight loss. Chest radiograph showed widening of the mediastinum and a large mass in the right upper lobe with a midline trachea. What do you expect the CT chest to show?
A. Cavitating lung primary in RUL without mediastinal nodes
B. Right Pancoast tumour with rib destruction
C. RUL large and multiple small nodules of Wegeners granulomatosis
D. RUL lung primary with retrosternal goitre
E. RUL lung primary’ and SVC obstruction

Question 33

GIT

A 63-year-old man presents to his general practitioner having noticed recent lower gastrointestinal bleeding. While waiting for his outpatient appointment he experiences massive lower gastrointestinal blood loss. The patient is unable to have a colonoscopy and is sent for an urgent angiogram. This demonstrates patency of the major mesenteric and coeliac vessels. An abnormal tuft of vessels with early filling of the accompanying mesenteric vein is noted at the caecum. No associated mass was seen. What is the most likely diagnosis?
A. Ischaemic colitis
B. Angiodysplasia
C. Haemorrhoids
D. Colon carcinoma
E. Diverticulitis

Question 33

GU

An ultrasound scan performed on a patient with spinal trauma demonstrates features of a neurogenic bladder. Which of the following features arc most commonly encountered?
A. Thin walled bladder with decreased capacity
B. Entirely normal bladder
C. Thin-walled bladder with increased opacity
D. Trabeculated bladder with increased opacity
E. Trabeculated bladder with decreased capacity

Question 33

MSK

A 40-year-old golfer presents with sudden-onset right medial palmar wrist pain during a golf swing. On examination, he has paraesthesia in the right fourth and fifth digits. Plain AP and oblique radiographs are normal. Which of the following is the most appropriate next investigation?
A. Nerve conduction studies
B. CT scan of the wrist with 1 mm slices
C. Hook of hamate radiographic views
D. MRI of the wrist
E. Ultrasound scan of the wrist

Question 33

PED

All of the following statements regarding presacral mass lesions in children are true, except:
A. Anterior sacral meningocoele is associated with Marfan syndrome.
B. Rectal duplication cysts arc high signal on T1W images.
C. Tailgut cysts have high mucin content.
D. Dermoid cysts have areas of high T1W signal, suggesting fat.
E. Rectal duplication cysts may mimic lymphatic malformation.

Question 33

CNS

A 5-year-old girl with history of seizures and learning difficulty is referred for an abdominal ultrasound due to non specific abdominal pain. On imaging, you notice bilateral renal cysts and multiple hyperechoic lesions in the kidneys and spleen. The patient also has small red skin lesions on her face. What is the most likely unifying diagnosis?
A. Sturge-Weber Syndrome
B. Von Hippel-Lindau
C. Autosomal dominant polycystic kidney disease
D. Tuberous sclerosis
E. PHAGE syndrome

Question 33

CHEST

A patient with HIV is admitted to the medical ward with shortness of breath. Admission chest X-ray shows diffuse symmetrical air space change. There is no pleural effusion or mediastinal adenopathy. At what CD4 count would you expect Pneumocystis jiroveci to present as a potentially life threatening complication?
A. CD4 <0
B. CD4 <50
C. CD4 <100
D. CD4 <200
E. CD4 <400

Question 33

GIT

A 64-year-old man presents with left lower quadrant pain. He is very tender on clinical examination and an urgent CT scan with contrast is performed. The radiologist suggests that the findings are in keeping with epiploic appendagitis. Which of the following best describes the CT findings in epiploic appendagitis?
A. Accordion sign
B. Pericolic fat stranding
C. Ascites
D. Mucosal wall thickening with air-filled outpouchings
E. Pericolic focal hyper attenuation with a central area of fat density

Question 33

GU

A 16-year old boy presents with recurrent urinary tract infections and an MRI Urogram is performed. ‘Phis confirms ureteric duplication. Which of the following is correct regarding ureteric duplication?
A. The lower pole moiety inserts inferior to the upper pole moiety.
B. The lower pole moiety is more likely to obstruct than the upper pole moiety.
C. The upper pole moiety is often associated with an ectopic ureterocoele.
D. The upper pole moiety inserts horizontally and is associated with reflux.
E. Calyceal dilatation is usually seen in the lower pole.

Question 33

MSK

A 25-year-old woman had radiographs of her pelvis and both her lower limbs following a road traffic accident. Although no fracture was identified, multiple incidental findings were observed, including bilateral posterior iliac horns, protuberant anterior iliac spines and rudimentary patellae. Which of the following is the most likely diagnosis?
A. Osgood-Schlatter
B. Bipartite patella
C. Diastrophic dysplasia
D. Protrusio acetabuli
E. Nail-patella syndrome

Question 33

CNS

A 60-year-old woman with breast carcinoma presents with headaches. CT shows erosion of the right foramen ovale on bone windows. An MRI of the head and neck region is performed. Which of these options is a likely finding?
A. Fatty infiltration of the left side tongue muscles
B. Fatty atrophy of the right masticator muscles
C. Vocal cord deviation
D. Swelling of the right side of the face
E. Sensory loss of the right lower eyelid and cheek

Question 34

PED

A 5 month-old infant presents with one episode of urinary tract infection. The patient responds well to treatment and urinalysis reveals E. coli as the causative organism. There is no family history of ureteric reflux or renal disease. According to NICE guidelines, what imaging test(s) should be recommended?
A. Urgent urinary tract ultrasound
B. Routine urinary tract ultrasound within 6 weeks
C. Routine urinary tract ultrasound with DMSA within 4-6 months
D. Routine urinary tract ultrasound, DMSA and micturating cystourethrogram
E. Magnetic resonance cystourethrogram

Question 34

CHEST

A 55-year-old woman is found to have an incidental, pleurally based 7 cm ovoid mass with smooth tapered margins, on an otherwise unremarkable CT urography examination. MR imaging is performed for further assessment. Which of the following imaging characteristics is most suggestive of a diagnosis of benign mesothelioma?
A. T1 MR hypointense; T2 MR hyperintense; contrast enhancement on CT avid
B. T1 MR hypointense; T2 MR hyperintense; contrast enhancement on CT minor
C. Tl MR hyperintense; T2 MR hyperintense; contrast enhancement on CT avid
D. Tl MR hypointense; T2 MR hypointense; contrast enhancement on CT avid
E. Tl MR hyperintense; T2 MR hyperintense; contrast enhancement on CT minor

Question 34

GIT

A patient with known ulcerative colitis is admitted as an emergency following an episode of acute abdominal pain. The clinicians are worried about toxic megacolon and request an
abdominal radiograph. Which of the following findings on the radiograph would be most specific for toxic megacolon?
A. Preservation of haustra
B. Thumbprinting of the mucosal wall
C. Descending colon diameter of 4.5 cm
D. Dilated transverse colon with mucosal islands
E. Pseudo-diverticulae in the ascending colon

Question 35

GU

A 12-year-old boy undergoes ultrasound of his renal tract to investigate recurrent urinary tract infections. The kidneys initially appear to lie more inferiorly and anteriorly than would normally be expected. On closer examination, a bridge of renal tissue connects the lower poles of both kidneys and a diagnosis of horseshoe kidney is made. What structure has limited the ascent of the horseshoe kidney, causing its abnormal location?
A. Umbilical ligament
B. Coeliac axis
C. Inferior mesenteric artery
D. Superior mesenteric artery
E. Attachment to the dome of the bladder

Question 35

MSK

A plain film of the knee of a 33-year-old man involved in an RTA shows an pure depression fracture involving the lateral tibial plateau. What would be the Schatzker classification?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V

Question 35

GU

A 55-year-old postmenopausal woman is being treated with tamoxifen for breast cancer. Which of the following might occur as a side effect of this medication?
A. Increased size of her uterine fibroids R. Reduction in size of her uterine fibroids
C. Formation of multiple ovarian cysts
D. Cervical stenosis
F. . Thin atrophic endometrium

Question 35

CNS

A 33-year-old man with chronic sinus disease is being considered for a functional endoscopic sinus surgery (FESS) operation. The ENT surgeon refers him for CT sinuses prior to surgery. Regarding the ethmoidal sinuses, the ethmoidal air cells occasionally pneumatize laterally and posteriorly around the frontal recess. What is the name of this anatomical variation?
A. Concha bullosa
B. Agger nasi cell
C. Haller cell
D. Onodi cell
E. Paradox middle turbinate

Question 36

CVS

A 40-year-old man presents with dyspnoea and peripheral oedema and is found to have elevated jugular venous pressure. Echocardiography shows reduced mobility of the pericardium. Contrast-enhanced CT is performed. Which of the following features is least suggestive of a diagnosis of constrictive pericarditis?
A. Pleural effusion
B. Contrast reflux into the coronary sinus
C. Curvature of the interventricular septum to the right
D. Linear pericardial calcifications
E. Azygos vein dilatation

Question 37

GIT

A 65 year old woman with known histoiy of gallstones is referred for an out-of-hours ultrasound scan to investigate fever, rigors and deranged liver function tests. Ultrasound demonstrates a common bile duct measuring 11 mm diameter and mild intrahepatic biliary dilatation, and a gallbladder containing multiple calculi associated with wall thickening, pericholecystic free fluid and a positive Murphy’s sign. What diagnosis should be fed back to the referring clinicians?
A. Ascending cholangitis
B. Biliary colic
C. Acute cholecystitis
D. Primary sclerosing cholangitis
F. . Impacted calculus in common bile duct

Question 37

MSK

A 65-year-old woman presents to the orthopaedic clinic with left hip pain 3 years following a total hip joint replacement (THR). The plain radiograph shows focal radiolucencies around the prosthesis with smooth endosteal scalloping. The patient is systemically well with normal inflammatory markers. Presentation and radiographic appearances are characteristic of which of the following?
A. Mechanical loosening
B. Infection
C. Histiocytic response
D. Stress shielding
E. Heterotopic ossification

Question 38

CNS

An X-ray of the mandible demonstrates a well-defined, unilocular cyst with corticated margins at the ramus. The patient is known to have a history of multiple skin lesions. What is the most likely diagnosis?
A. Radicular cyst
B. Residual cyst
C. Cementoma
D. Odontogenic keratocyst
E. Ameloblastoma

Question 38

MSK

A tibia and fibula radiograph is performed on a 2-month-old baby for leg swelling. The radiologist notices fine periosteal reaction along the diaphysis of the tibia. Which one of the following statements is false regarding neonatal periosteal reaction?
A. Physiological periosteal reaction may be a normal finding in children up to the age of 6 months.
B. Commonly encountered sites of physiological periosteal reaction may include the humerus, tibia and femur.
C. If physiological periosteal reaction is present, it is typically asymmetric.
D. The initial presentation of non-accidental injury may include periosteal reaction of a long bone.
E. The presence of marked periosteal reaction may suggest an underlying congenital cardiac disease.

Question 39

MSK

A 16-year-old boy presents with shin pain. A tibia and fibula radiograph demonstrates a well-defined, cortically based osteolytic lesion within the diaphysis measuring 4 cm cranio-caudally without periosteal reaction.
On MRI, the lesion is solitary’, intermediate signal on T1 sequences (same as muscle) and high signal on T2. There is homogenous and avid enhancement post-contrast administration. There is no soft-tissue mass associated with the bony lesions.
Which one of the following differential diagnoses is the most likely?
A. Simple bone cyst
B. Non-ossifying fibroma
C. Fibrous cortical defect
D. Chondroid myxoid fibroma
E. Adamantinoma

Question 40

CHEST

A 73-year-old man is found to have a pulmonary nodule on routine chest radiograph.
Pre- and post-contrast-enhanced CT of the chest is performed. Which one of the following features is least suggestive of benignity of the nodule?
A. Nodule enhancement of 10 Hounsfield units
B. A peripheral rim of enhancement
C. A flattened configuration of the nodule
D. Central calcification
E. Ground glass and solid components to the nodule

Question 41

GIT

A 24-year-old man is investigated for weight loss and chronic abdominal pain. Small bowel MRI demonstrates thickened loops of small bowel. Small bowel follow-through confirms the presence of non-stenotic ulcers of the distal small bowel. Apart from Crohn’s disease, which one of the following is the most common diagnosis?
A. Yersinia
B. Tuberculosis
C. Reiter syndrome
D. Lymphoma
E. Steroids

Question 42

GU

A 30-year-old woman with dysmenorrhoea and menorrhagia has had uterine artery embolisation of her fibroid uterus. She presents with lower abdominal pain and a malodorous vaginal discharge. Ultrasound demonstrates a distended debris- and fluid-filled uterine cavity with a separate hypoechoic large mass noted at the internal cervical os, causing cervical obstruction. Which of the following is the most likely explanation for these findings?
A. Embolisation and subsequent swelling surrounding a cervical fibroid
B. Detachment of a large subserosal pedunculated fibroid following embolisation
C. Detachment of a large submucosal fibroid following embolisation
D. Incidental large endometrial polyp close to the internal cervical os
E. Cervical carcinoma

Question 43

MSK

A 20-year-old man was seen in the A&E department after an injury to his foot during a football game. On examination, there was tenderness on palpation in the forefoot. A plain film performed showed a step in the alignment of the medial aspect of the second metatarsal bone and middle cuneiform bone. The second to fourth metatarsal had moved laterally. Normal alignment was noted at the articulation between the first metatarsal and medial cuneiform bone. Which type of fracture is demonstrated on the plain film?
A. March fracture
B. Jones fracture
C. Lover’s fracture
D. Homolateral Lisfranc fracture dislocation
E. Divergent Lisfranc fracture dislocation

Question 43

CNS

A 20-year-old patient presents with long-standing halitosis and foul taste in the
mouth. MRI showed a 1.5 cm smoothly marginated midline cystic mass in the posterior roof of the nasopharynx, which does not enhance with contrast. What is the likely diagnosis?
A. Fossa of Rosenmüller tumour
B. Rathke’s pouch
C. Thornwaldt’s cyst
D. Mucous retention cyst
E. Chronic sinus disease

Question 43

MSK

‘Floating tooth’ sign is not associated with which one of the following conditions?
A. Leukaemia
B. Multiple myeloma
C. Multifocal histiocytosis
D. Burkitt lymphoma
E. Mastocytosis

Question 44

CHEST

A 40-year old man is diagnosed on the basis of a screening chest radiograph and a subsequent high-resolution thoracic CT scan with alveolar microlithiasis. Which one of the following is not an expected finding in this condition?
A. Raised serum calcium levels
B. Diffuse involvement of both lungs
C. Intense uptake on bone scintigraphy
D. Submillimeter micronodulations
E. Marked discrepancy between radiograph and clinical symptoms

Question 44

GIT

A 42-year-old patient who has a long history of ileocolic Crohn’s disease presents with weight loss and vomiting. On CT, there is a heterogeneous soft-tissue polypoidal mass halfway along the second part of the duodenum. No significant lymphadenopathy is noted. Which of the following is the most likely diagnosis?
A. Adenocarcinoma of the small bowel
B. Hamartomatous polyp
C. Lymphoma
D. Gastrointestinal stromal tumour (GIST)
E. Pancreatic carcinoma

Question 45

GU

Routine mammograms of a woman show a 1 cm retro-areolar lesion. Ultrasound demonstrates an 8 mm retro-areolar lesion with a dilated duct. Which of the following is the most likely diagnosis?
A. Papillomatosis
B. Ductal cancer
C. Ductal ectasia
D. Plasma cell mastitis
E. Papilloma

Question 46

CNS

A 57-year-old woman presents with a dry mouth and dry eyes. Ultrasound of the parotids demonstrates multiple small hypoechoic areas. MRI demonstrates a speckled honeycomb appearance on T2W images. What is the most likely diagnosis?
A. Sarcoid
B. Pleomorphic adenoma
C. Sjögren’s syndrome
D. Warthin’s tumour
E. Mucoepidermoid carcinoma

Question 46

MSK

Anteroposterior radiograph of the knee of a 14 year old boy shows proximal tibial physeal widening and irregularity. Because of continued knee pain worsening with activity, MR imaging is performed to exclude a meniscal tear. MRI shows substantial widening and irregularity of the proximal tibial physis. Physeal stress injury is diagnosed. All of the following are expected findings, except
A. Cartilage injury
B. Tongue of high signal extending into metaphysis
C. Bone bridging
D. Physeal irregularity
E. Diffuse low T1W signal to the bone adjacent to the physis

Question 46

CNS

A 50-year-old man with chronic middle car problems has a CT scan of the temporal bones, which shows a cholesteatoma. Regarding cholesteatoma, which of the following statements is false?
A. Cholesteatomas can be classified as either congenital or acquired.
B. Congenital cholesteatomas can be located everywhere in the temporal bone.
C. Primary acquired cholesteatomas develop behind an apparently intact tympanic membrane.
D. Pars flaccida (attic) cholesteatomas are located at the lower one-third portion of the tympanic membrane.
E. Pars tensa (sinus) cholesteatomas develop most often through a defect of the lower two-thirds portion of the tympanic membrane.

Question 46

GU

A 45-vear-old woman is diagnosed with a biopsy-proven cancer. A lymph node is also demonstrated in the upper outer quadrant of the breast. Which of the following features is most suggestive of malignancy in the node?
A. Hyperechoic centre
B. Round and hypoechoic node
C. Posterior acoustic shadowing
D. A 1.5 cm node in the upper outer quadrant
E. Homogeneous enhancement on MRI

Question 46

CHEST

A 56-year-old man presents with dyspnoea. Chest radiography shows increased interstitial markings with a predominantly lower zone distribution bilaterally. A diagnosis of interstitial fibrosis is made on high-resolution CT. Which of the following conditions is least likely to show interstitial fibrosis with this distribution?
A. Systemic lupus erythematosus
B. Rheumatoid arthritis
C. Ankylosing spondylitis
D. Methotrexate-induced fibrosis
E. Scleroderma

Question 46

GIT

A 60-year old man with neurofibromatosis Type 1 presents with vague abdominal pain and bloating. A CT scan reveals a well-defined hyperenhancing rounded exophytic mass within the left upper quadrant, which has a broad base with the body of the stomach with no fat plane between the two. The spleen, transverse colon and left kidney are displaced by this mass. It measures
18 cm. There is no lymphadenopathy. Which of the following is the most likely diagnosis?
A. Ectopic pancreas
B. Gastric lipoma
C. Gastric adenocarcinoma
D. Malignant GIST (gastrointestinal stromal tumour)
E. Benign GIST (gastrointestinal stromal tumour)

Question 46

MSK

With regard to ossification centres of the elbow in a child, which of the following statements is correct?
A. The absence of the internal epicondyle ossification centre suggests an avulsion injury, if the radial ossification centre is visible.
B. The absence of the lateral epicondyle ossification centre could be normal in a 12-year-old.
C. The trochlear ossification centre occurs before the capitellum ossification centre.
D. Lateral epicondyle avulsion injuries are more common that medial epicondyle avulsion injuries.
E. Medial epicondyle avulsion injuries are associated with excess forces from the common extensor tendon.

Question 46

MSK

With regard to physeal stress injury in children, all of the following statements are true, except;
A. Little Leaguer’s shoulder refers to injury of the proximal humerus.
B. Physeal injuries are more easily identified on MRI.
C. Gymnast’s wrist refers to injury to the distal radius.
D. Gymnast’s wrist results in negative ulnar variance.
E. Little Leaguers elbow refers to injury to the medial epicondyle of the humerus.

Question 47

CVS

A 34-year-old man is undergoing preoperative assessment of his mitral valve using CT angiography. Which of the following combinations represents the optimal view and timing for visualising the mitral valve on CT?
A. Two-chamber view in mid-systole
B. Two-chamber view in mid-diastole
C. Three-chamber view in mid-systole
D. Three-chamber view in mid-diastole
E. Four-chamber view’ in mid-diastole

Question 47

GIT

A 43-year-old diabetic man underwent non-contrast CT of his abdomen and pelvis, which demonstrated a dense liver. He described erectile dysfunction and arthropathy mainly affecting his second and third metacarpophalangeal joints bilaterally but also affecting his hips. Which of the following is the most likely diagnosis?
A. Amyloidosis
B. Glycogen storage disease
C. Wilson disease
D. Haemophilia
E. Haemochromatosis

Question 47

GU

A 50 year-old woman presents with refractory hypertension and palpitations. Urinary vanillylmandelic acid (VMA) levels are raised. A CT scan demonstrates normal adrenals. Which of the following should be the next line of investigation?
A. Ultrasound (US) scan of adrenal glands.
B. In-phase and out-of-phase MRI sequences to assess fatty content.
C. Radionuclide imaging using an analogue of guanethidine such as metaiodobenzylguanidine (MIBG).
D. Adrenal biopsy.
E. Radionuclide imaging using radiolabelled analogues of cholesterol such as 131I-6β- iodomethyl-19-norcholesterol (NP-59).

Question 47

MSK

A 65-year-old male patient presents with back pain and loss of sensation in his left leg. An MRI scan of his lumbar spine reveals multiple lesions within the vertebral bodies of his lower spine, of varying sizes. These were of low signal on both T1 and T2 sequences. Which of the following is the most likely diagnosis?
A. Myeloma
B. Paget disease
C. Prostate cancer metastases
D. Renal cancer metastases
E. Haemangiomas

Question 47

CNS

A 40-year-old woman with long-standing history of epistaxis has been diagnosed with Wegener’s granulomatosis. The following statements are true about Wegener’s granulomatosis affecting the head and neck except:
A. It may lead to destruction of the hard palate.
B. Premaxillary and retroantral fat are rarely involved.
C. Sarcoidosis may have a similar appearance.
D. Chronic disease may result in thickening of the paranasal sinuses.
E. The nasal septum may disappear in chronic disease.

Question 47

CNS

A large posterior fossa mass arising from the roof of the fourth ventricle is identified on an MRI brain in an 8-year-old child. The lesion is poorly defined and does not contain any internal calcification or extension into the basal cisterns.
Which imaging feature of this lesion would be considered atypical?
A. Marked associated hydrocephalus
B. Avid contrast enhancement
C. Hyperdense appearance on CT
D. Absence of drop metastases on MRI spine imaging
E. Restricted diffusion on diffusion-weighted imaging (DWI)

Question 47

PED

A preterm neonate born at 24 weeks is referred for a cranial ultrasound study. A focus of increased echogenicity is present in the right caudothalamic groove extending into the lateral ventricle, without ventricular dilatation.
Which grade germinal matrix haemorrhage would this feature most represent?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
E. Grade 5

Question 47

CNS

A 50 year old teacher with a neck lump is referred for an ultrasound, which revealed a thyroid nodule. Which of the following is an indication for FNA of a thyroid nodule?
A. Entirely cystic lesion
B. Presence of microcalcification
C. Presence of multiple cystic nodules
D. Every nodule above 2 cm
E. Every nodule that is hypervascular

Question 47

CVS

A 62-vear-old man is found to have a right-sided pleural effusion on imaging. Which of the following pathologies is more likely to result in a pleural effusion on the right side than on the left side?
A. Transection of the proximal thoracic duct
B. Traumatic rupture of the thoracic aorta (distal to left subclavian artery)
C. Spontaneous oesophageal rupture
D. Gastric carcinoma
E. Pancreatitis

Question 48

GIT

A 26-year-old diabetic man who is known to binge drink is referred to you with deranged liver function tests following antibiotics for a chest infection. On ultrasound, you see a hyperechoic area anteriorly within the left lobe of liver within Segment 4. Which of the MRI sequences from the list below will be the most helpful in determining the nature of this lesion (although all would be required for a definitive diagnosis)?
A. In-phase and out-of-phase T1-weighted images
B. T1 and T2W images
C. Diffusion-weighted images and apparent diffusion coefficient
D. Dynamic contrast-enhanced phase images
E. T2 with TE of 80 ms and T2 with TE of 160 ms

Question 48

GU

When investigating adrenal disease, which of the following statements is incorrect?
A. Biochemical evaluation is usually the first line of investigation.
B. Delayed radiolabelled analogues of cholesterol, such as 1-6β-iodomethyl-19-norcholesterol (NP-59), are used to identify and localise masses that result in adrenal cortical dysfunction.
C. MIBG, an analogue of guanethidine, is used to image adrenal cortical disorders.
D. 131I and 123I-MIBG can be used to screen the whole body for sympathomedullary tissue.
E. 18F fluorodeoxyglucose (FDG) can sometimes differentiate between benign adenomas and metastases.

Question 48

MSK

A 20-year-old male patient presents to the A&E department following a skateboard injury. He has pain in his right clavicle and plain films are subsequently performed, which reveal elevation of the clavicle above the superior border of the acromion. What statement is true in regard to this injury?
A. The acromioclavicular (AC) ligament is ruptured but the coracoclavicular (CC) ligament is intact.
B. The joint capsule is ruptured but the CC ligament is intact.
C. The CC ligament is ruptured but the AC ligament is intact
D. The AC ligament, CC ligament and joint capsule are ruptured but the deltoid attachment is intact.
E. The AC ligament and CC ligament are ruptured with detachment of the deltoid muscle.

Question 48

CHEST

You are reporting a CT pulmonary angiogram of 39-year-old man who presented with shortness of breath. You have excluded pulmonary embolism but are concerned about the appearances of the trachea, which has diffuse narrowing of the lumen with marked wall thickening. You decided to contact the A&E clinician to clarify patient symptoms. After further questioning, the patient admits to episodes of wheeze and stridor for over past few months. All of the following cause diffuse thickening of the wall with decreased diameter of the tracheal lumen, except:
A. Relapsing polychondritis
B. Tracheopathia osteoplastica
C. Tracheal Wegener’s granulomatosis
D. Mounier-Kuhn disease
E. Tracheal sarcoidosis

Question 49

GIT

A patient presents with deranged liver function tests, right upper quadrant pain, nausea, flushing and recurrent bouts of diarrhoea. The surgeon thinks the patient may have gallstone disease and requests a MRCP. A single 3 mm gallstone is noted within the gallbladder, but the bile ducts are within normal limits. A markedly hyperintense lesion on T2 is noted within the mesentery and a few of the small bowel loops in this region appear tethered. The lesion enhances avidly following administration of gadolinium. There are further hyperintense lesions noted throughout the liver, which also avidly enhance in the arterial phase. Which one of the following is the most likely diagnosis?
A. Metastatic melanoma
B. Cholangiocarcinoma with liver and mesenteric metastasis
C. Retractile mesenteritis
D. Carcinoid syndrome
E. Cholecystitis with mesenteric and liver abscesses

Question 50

GU

An adult patient undergoes ultrasound examination of the abdomen. He is known to have end-stage renal failure and has been on renal dialysis for 5 years. Incidentally, several round and well-defined anechoic lesions arc demonstrated in both kidneys. These demonstrate posterior acoustic enhancement. There is no previous relevant family history and a previous ultrasound 5 years ago was normal. Which of the following is the most likely diagnosis?
A. Adult polycystic kidney disease
B. Multicystic dysplastic kidney
C. Multiple simple renal cysts
D. Cystic renal cell cancer
E. Uraemic cystic disease

Question 51

CNS

An 80 year old patient with history of rheumatoid arthritis, has been involved in a 40 mph head-on car crash. Air bags were deployed. You are asked to review a cervical spine trauma series. No fracture is identified. The patient has mid-cervical spine tenderness. The patient wants to go home. Which of the following is the best option?
A. Let the patient be discharged since trauma scries is normal.
B. Repeat lateral and AP views.
C. Request a flexion and extension lateral cervical spine.
I). Cervical spine CT.
E. Bone scintigraphy.

Question 52

MSK

All of the following statements are true with regard to stress fractures in young athletic children, except
A. Children with limb misalignment are at greater risk.
B. Stress fracture of the femoral neck involves the superior surface.
C. Shin splints show linear oedema limited to the medial tibia.
D. Distal femoral metaphysis are recognised sites for stress fracture.
E. Pars interarticularis fractures are due to repetitive extension and torsion.

Question 53

MSK

A 7-year-old boy presents to his emergency department complaining of a limp and pain in his left hip. He is febrile and blood test results reveal raised inflammatory markers. The emergency department staff are concerned regarding an underlying diagnosis of septic arthritis.
Which one of the following statements regarding imaging in septic arthritis is false?
A. An ultrasonography can be performed to guide needle aspiration of an underlying hip effusion.
B. Destruction of underlying bone is normally seen at presentation on plain radiography.
C. The suggestion of underlying hip effusion may be identified on plain radiography of the pelvis.
D. An effusion normally collects in the anterior recess of the hip joint on ultrasound early in the process.
E. Septic arthritis is usually a mono-articular process.

Question 53

CHEST

A 42-year-old female patient with shortness of breath undergoes CT pulmonary angiogram for suspected pulmonary embolism (PE). In addition to the presence of subsegmental PE, the scan reveals two well-defined, rounded intraluminal polypoid masses on the posterior wall of the trachea and multiple small nodules in both lungs. Disseminated malignancy is suspected. Which primary malignancy is most likely to metastasize to the trachea?
A. Malignant melanoma
B. Ovarian carcinoma
C. Sarcoma
D. Transitional cell carcinoma of the urinary bladder
E. Pancreatic carcinoma

Question 54

CNS

A middle-aged woman presents with a painful anterior neck lump, associated with a rash. Ultrasound of the thyroid demonstrates an enlarged hypoechoic and hypervascular gland. Follow-up imaging 4 months later shows resolution of the previous changes. What is the diagnosis?
A. Hashimoto’s thyroiditis
B. De Quervain’s thyroiditis
C. Multinodular goitre
D. Papillary thyroid carcinoma
E. Anaplastic carcinoma

Question 55

GIT

A 72 year-old woman with B12 deficiency and achlorhydria has a barium meal. The stomach is featureless with no demonstrable rugal folds, and there is narrowing of the body of the stomach. Which of the following is the most likely diagnosis?
A. Infectious gastritis
B. Menetrier disease
C. Eosinophilic gastritis
D. Atrophic gastritis
E. Linitis plastica

Question 56

GU

A 26-year-old obese and unwell woman attends the A&E department with right-sided abdominal pain. She has a positive pregnancy test. The A&E doctor requests an abdominal and pelvic ultrasound, which demonstrates some fluid within Morrison’s pouch. The pelvic area is not well demonstrated on transabdominal ultrasound due to the patient’s obesity, but no intrauterine pregnancy is noted. Which of the following should happen next?
A. Laparotomy
B. CT of the abdomen and pelvis
C. Transvaginal ultrasound
D. MRI of the pelvis
E. Laparoscopy

Question 56

MSK

Which one of the following is not a radiographic hallmark of degenerative arthritis?
A. Asymmetrical joint space narrowing
B. Subchondral sclerosis
C. Periarticular osteoporosis
D. Subchondral cysts
E. Osteophytes

Question 57

CNS

A 30-year-old teacher presents with thyroid swelling and proptosis. Which of the following is true regarding Grave’s ophthalmopathy?
A. It commonly involves the medial rectus first.
B. It commonly involves the tendons of the eye muscles.
C. There is associated dilatation of the superior ophthalmic vein.
D. There is decreased density of the orbital fat.
E. It is an autoimmune disease unrelated to thyroid function.

Question 58

GU

A 78-year-old man presents with weight loss and frank haematuria. He had a stricture of his urethra dilated many years ago. He has no other relevant past history. Initial ultrasound and IVU show a normal upper urinary tract and bladder. As part of the standard work-up, he proceeds to flexible cystoscopy, but the urologist is unable to pass the cystoscope beyond the proximal penile urethra, lie is therefore referred for an ascending urethrogram, which demonstrates an irregular filling defect in the bulbar urethra. Which of the following is the likeliest diagnosis?
A. Prostatic carcinoma
B. Transitional cell carcinoma of the urethra
C. Squamous cell carcinoma of the urethra
D. Adenocarcinoma of the urethra
E. Recurrent benign stricture

Question 59

CHEST

A 34-year-old patient with a recent history of a prolonged stay in an intensive care unit following road traffic accident is referred to the respiratory clinic with symptoms of dyspnoea, expiratory wheeze and recurrent chest infections. A CT scan of the chest is performed.
Which one of the following is the most likely tracheal complication of the previous prolonged intubation in this patient?
A. Carrot-shaped trachea
B. Sabre-sheath trachea
C. Tracheomalacia
D. Tracheopathia osteoplastica
E. Tracheal diverticulum

Question 59

GIT

You are performing a small bowel follow-through on a 42-year-old female patient because of abdominal pain, weight loss and anaemia. The patient has had a normal endoscopy and colonoscopy. There is separation of the ileal loops within the right side of the abdomen. Some of the ileal loops in this region appear compressed on one side and one of the loops appears aneurysmal. You also note the presence of a fistula between the distal ileum and colon. Except for these ileal loops, the remainder of the small bowel appears normal. Which one of the following is the most likely diagnosis?
A. Crohn’s disease
B. Tuberculosis
C. Small bowel lymphoma
D. Metastatic serosal deposits
E. Coeliac disease

Question 59

MSK

A 65-year-old man presents with pain, swelling and paraesthesia in his left thigh. Clinical examination revealed a large 10 x 6 cm soft-tissue mass within the left thigh. The mass is of soft-tissue density on CT and demonstrates avid contrast enhancement, ’there is no involvement of the adjacent bone. On MRI, the mass returns a predominantly low signal on T1W sequences and high signal on T2W sequences. Which of the following is the most likely diagnosis?
A. Lipoma
B. Liposarcoma
C. Osteosarcoma
D. Soft-tissue fibroma
E. Lipoblastoma

Question 60

MSK

On a routine neonatal birth check, the paediatric registrar suspects an infant of having developmental dysplasia of the hip (DDH), and refers the him for a hip ultrasound.
Which one of the following statements regarding hip ultrasound according to the Graf classification is correct?
A. A normal alpha angle is less than or equal to 60 degrees.
B. A normal beta angle is greater than 20 degrees.
C. The alpha angle is measured from the triangular labral fibrocartilage to the vertical cortex of the ilium.
D. The beta angle can help to determine the dysplasia subtype.
E. The acetabular angle is measured from the acetabular roof to the vertical cortex of the ilium.

Question 61

CNS

CT of the head of a young man for chronic headache showed erosion of the left frontal sinus. Post-contrast showed focal meningeal enhancement with mucosal enhancement of the right frontal sinus. What is the most likely diagnosis?
A. Mucocoele
B. Inverted papilloma
C. Pott’s puffy tumour
D. Antrochoanal polyp
E. HIV