FCPS 2,OCTOBER 2019

COMPILED BY DR SHEERAZ AHMED SHEIKH

1:A 45 year computer software engineer presents with drooping of both eyelids and slurred speech for
three weeks. His symptoms become progressively worse during periods of activity and improved after
periods of rest. His lab investigations show red cell aplasia. His physician requests for enhanced CT scan
chest.

The most likely finding on CT in this case is:

Anterior mediastinal mass

Cardiomegaly with edema

Elevated right hemidiphragm

Hilar lymphadenopathy

Lobulated pleural thickening

Reference: Sutton 7th Edition, Chapter 2, page 65, Dahnert 6th Edition, page 537-8 (answer: Anterior
mediastinal mass, C2, difficult, important)

2:A 7 year boy has multiple well defined varying sized nodules with specks of calcification bilaterally in
the lungs on x-ray chest done for immigration. No history is available.

The next step you will advise is:

Bone –scan

CT guided biopsy of nodules

Enhanced CT scan chest

MRI whole spine

Ultrasound abdomen

3: A 60 year old gentle man smoker for 35 years is diagnosed as case of lung carcinoma on bronchial
brushings. On CT chest collapse of right lower lobe is reported. For further evaluation MRI chest is
planned by mutual consensus of radiologist and physician.

To distinguish between collapse lungs from tumor the most important MR sequence is:

ADC mapping
DW sequence

FLAIR sequence

T1W sequence

T2 sequence

David Sutton 7th edition page 125 (answer: T2 sequence, C1, easy, essential)

4: A 30 year old gentleman has painless lymphadenopathy, unexplained fever, night sweats and weight
loss. CT guided biopsy of the mediastinal lymph nodes revealed Reed-Sternberg cells.

Involvement of bronchial wall by this disease process may lead to:

Collapse/Consolidation

Pleural effusion

Pulmonary arterial hypertension

COPD

Cystic spaces in lung parenchyma

David Sutton 7th edition page 118

4: A 30 year old gentleman has painless lymphadenopathy, unexplained fever, night sweats and weight
loss. CT guided biopsy of the mediastinal lymph nodes revealed Reed-Sternberg cells.

The most common extra nodal site of this disease involvement is:

Bone

Chest wall

CNS

Head and neck

Thymus

Dahnert 6th edition, page 500

5:A 50 year old gentleman smoker and worker of nickel industry complain of fever and weight loss. He
has a patch of consolidation in left lower lobe on CXR. After 7 days of antibiotics follow up X-ray did not
reveal any improvement. He was admitted and IV antibiotics were given for another week which also did
not reveal any improvement.

The next step would be:

CT guided biopsy

CT scan chest with contrast

Follow up X-ray after 1 week without treatment.

Prescribe antibiotics for another week

Ultrasound chest

David Sutton 7th edition page 108

6: A previously healthy adult male has been diagnosed with active pulmonary tuberculosis. What
imaging feature would suggest primary rather than reactivated pulmonary tuberculosis?

Bilateral reticulo-nodular shadowing

Cavitating pneumonia with left hilar lymph nodes

Fibrosis and distortion of lung architecture

Lingular consolidation with left hilar lymph nodes

Tuberculoma formation with pleural effusion

David Sutton 7th edition: 141

7 :A 60 year old man with Hodgkin’s disease and hypertension complains of shortness of breath. He was
further investigated by chest x-ray which revealed bilateral pleural effusions with clear lung fields. Which
one of the following drug is the most likely cause of his pleural effusions?

Amoxicillin

Bleomycin

Frusemide

Lisinopril

Propranolol

David Sutton 7th edition: 209

8: A two year child presented in emergency room with stridor and barking cough for six hours, no history
of fever, x-ray chest show steeple-shaped trachea.

The commonest cause of this condition is:

a) Intubation

b) laryngo-tracheobronchitis

c) Fibrosing mediastinitis

d) Wegener’s granulomatosis

e) Tuberculosis

7th edition Sutton page 161(answer: laryngo-tracheobronchitis, C1, easy, essential)

9.A 40 years lady, known case of Systemic Lupus Erathamatosis on regular treatment, started to have
left hip pain with limited movements for 4 days. No history of trauma or surgery. Her treating physician
advised. MRI of left hip joint.

MRI revealed low signal intensity band with sharp inner surface + blurred outer margin on T1 weighted
sequences.

She most likely has:

Avascular necrosis

Bony metastasis

Epiphyseal fracture

Gout

Spondyloarthropathy

(Dahnert 6th edition page 49-50)

10 :A 65 years gentleman consulted his family physician for increasing size of his hat in the last one year.
He has no co-morbid. His physician advised skull X-ray. The skull X-ray showed mixed lytic and blastic
pattern of thickened calvarium giving “cotton-wool” appearance.

The most characteristic appearance of this disease on plain x-ray is:

Bone with in bone appearance in vertabrae

Bubbly destruction of small flat bones

Multiple diaphyseal fractures at end of long bones

Thickened trabeculae in sacrum and ileum

V-shaped lytic defect in diaphysis of long bones

11: A 5 year boy presents with swelling around the knee after a fall from chair. Mother also gives
history of low-grade fever, fatigue and easy bruising with minor injuries for last two months. Plain
x-rays of knee show metaphyseal translucent band in the lower end of femur and upper end of tibia.

The child is most likely suffering from:

Acute-lymphoblastic leukemia

Langerhans cell histiocytosis

Lead poisoning

Rheumatoid arthritis

Tuberculous arthritis

Reference: David Sutton 7th edition (Haematopoietic disorder) 1327, chapter 41 (b),
Dahnert 6th edition 112 (a)

12: A 26 year old gentleman presented to the emergency department with swollen and bruised
right hand. He was involved in a street fight.

The most likely fracture which he sustained is:

1st metacarpal base

5th metacarpal shaft

5th proximal phalanx base

Scaphoid waist

Triquetral body

Reference: David Sutton 7th edition: 1410 (C1, easy, essential)

13: A 30 year old gentleman falls on his out-stretched hand. On plain lateral view of the wrist a chip of
bone is identified on dorsal aspect of the carpaus.

The most likely bone involved in the fracture is:

Hamate

Lunate

Pisiform

Scaphoid

Triquetrum

Reference: 7th edition Sutton p 1408 (C1, easy, essential)

14: A 10 year old female child presented with progressive painless swelling and deformity of the right
hand. Her plain x-ray of hand showed multiple round lytic lesions with ground glass appearance and
calcification. No cortical break noted.

The most likely diagnosis is:

Lichtenstein-Jaffe disease

Maffucci syndrome

Mazabraud syndrome

Ollier disease

Trevor disease

Reference: 7th edition Dahnert page 73 (C2, easy, essential) d

15: A 70 year old gentleman had a fall on outstretched hand .He had a Colle’s fracture on plain x ray. In
addition to this fracture he had shaggy periosteal reaction around the distal third of radius and ulna. On
further inquiry there was significant history of weight loss in the last one year.

The most likely cause of shaggy periosteal reaction in this case is:

Bronchiectasis

Bronchogenic carcinoma

Fibrous mesothelioma
Heart disease

Tuberculosis

Reference: David Sutton 7th edition page 1231

16: A 15 year boy presents with sever localized pain in right thigh for two weeks. He also has fever.
Laboratory investigations show anemia and leukocytosis. Plain x-rays of right femur are done.

The radiological feature favoring Ewing’s sarcoma is:

Cortical thickening

Hair-on-end appearance

Moth-eaten appearance

Penetration in soft tissue

Sclerotic new bone formation

Reference: David Sutton 7th edition (tumor and tumor like conditions, Ewing’s sarcoma)
1315, chapter 40 (b), Dahnert 6th edition 75

17: 20 year old boy was brought to ER with complaints of severe backache and bladder incontinence for
last 2 months. On examination surgeon noticed gait abnormality and some sensory/motor deficit as
well. MRI spine was carried out that showed an ill defined heterogeneously enhancing eccentric mass
lesion within the upper thoracic region of spinal canal with associated cord expansion with meningeal
enhancement . No significant surrounding edema seen.

Most likely diagnosis is:

Astroctytoma

Ependymoma

Hemangioblastoma

Meningioma

Metastasis

Key - a

18: 65 year old gentleman presented to neurosurgery clinic with complains of headaches off and on,
vomiting and left arm weakness for 6 months. MRI brain was performed that revealed a large
heterogeneous mass lesion in the right frontal lobe showing peripheral contrast enhancement and
extension across midline. Significant surrounding edema exceeding the tumor volume also seen.

The most appropriate diagnosis based on MRI findings is:

Glioblastoma Multiformes

Lymphoma

Meningioma

Metastasis

Tuberculous abscess

Key- d

19: A 65 years gentleman presents in neurology clinic with gait instability, urinary incontinence, and
dementia. His physician orders MRI brain.

The most characteristic finding on MRI will be:

Cerebral and cerebellar atrophy with ventricular dilatation

Normal periventricular white matter signals on FLAIR

Prominent sylvian fissures with ventricular dilatation

Rounded gyri against calvarium on all sequences

Ventricular dilatation with normal brain parenchyma

Reference: Dahnert 6th edition, page 298-9, Sutton 7th edition, page 1794(e)

20: A 5 year girl presents with progressive loss of vision in the last 6 months. On examination scoliosis of
spine was noted along with café-au-lait spots on skin. For further assessment she underwent MRI brain.

The characteristic finding seen on MRI in orbit is:

Calcification in optic nerve

Homogenous contrast enhancement

hyperostosis of lateral wall of orbit

kinking of the optic nerve

normal size optic canal

Reference: Dahnert 7th edition (optic nerve glioma) 348 (d)

21: A 6 years old female child presented with headache, vomiting and gait disturbance .Her MRI brain
showed a cystic lesion in the cerebellum with intensely enhancing mural nodule compressing the fourth
ventricle resulting in non-communicating hydrocephalus. The most likely diagnosis is :

Atypical Medulloblastoma

Ependymoma

Hemangioblastoma

Metastasis

Pilocytic Astrocytomas

Reference: Dahnert Radiology Review Manual 6th edition: 271

22: 10 years old boy presented with precocious puberty .On examination he has Parinaud syndrome
(paralysis of upward gaze).The most likely finding on MRI of the brain with contrast is:

Well-circumscribed tumor of the hypothalamus

Well-circumscribed tumor of the pes-hippocampus

Well-circumscribed tumor of the pineal gland

Well-circumscribed tumor of the pituitary gland

Well-circumscribed tumor of the tuber cinereum

Reference: 7th edition Dahnert page 321

23: A 42 yrs gentleman, who had a high speed RTA, presents acutely to ER. He has severe chest pain
radiating to his back and is hemodynamically unstable.

The most common finding on chest radiograph in this patient is:

Indistinct aortic arch contour

Obscuration of the aortopulmonary window

Right sided hemothorax

Widened right paratracheal strip

Widening of the mediastinum

24
24: 68 yrs old gentleman with tearing chest pain radiating to his back was investigated with a contrast
enhanced CT. CT demonstrated an intimal flap separating the aortic lumen in two separate channels.
The flap was seen to originate just distal to origin of left subclavian artery and to extend into the left
common iliac artery.

The appropriate Stanford classification is:

Stanford type 1

Stanford type 2

Stanford type 3

Stanford type A

Stanford type B

Reference: Sutton 7th edition, Thoracic aorta, P. 309-11

25: A 26 yrs old lady with known Marfan’s syndrome presents with chest pain and shortness of breath.
An echocardiogram is performed.

The most likely echo finding is:

aortic regurgitation and dilatation

aortic stenosis and post stenotic dilatation

global myocardial wall thickening

pulmonary stenosis

ventricular septal defect

Reference: Dahnert, 6th edition, P. 115-116

26: A 65 year old gentleman presented with bleeding per rectum 8 hours. His bleeding/clotting profile
was unremarkable. He underwent colonoscopy which was not conclusive due to presence of blood clots
in the large bowel.

The next best step in management of this patient is:

Barium Enema.

CT scan of abdomen

Digital subtraction Angiogram

RBC tagged scan.

Ultrasound abdomen

27: A 2 year old baby boy was investigated for failure to thrive. His investigations showed
decreased bone density and pseudofractures .His ultrasound kidneys showed nephrocalcinosis
.The child is most likely suffering from :

Chronic Glomerulonehritis

Fanconi syndrome

Nephritic syndrome

Renal tubular acidosis

Vitamin D-resistant rickets

Reference: 7th edition Dahnert page 153 and 154

28: A 45 year old male presents with dull abdominal pain. He has a history of weight loss, nausea and
vomiting. On examination you observe that the bilateral lower limbs are swollen along with hydrocele.
Vitals are : Temp 39c, B.P 145/90, R.R 16, pulse 89. Patient has brought an old IVP which shows
ureterectasis at L4 level, bilateral medial deviation of ureter in middle third with gradual tapering of
ureter and mild pyelocaliectasis. You order a CT abdomen which shows periaortic mass of attenuation
similar to muscle.

Most likely diagnosis in this patient will be:

Lymphoma

Metastasis

Renal Cell Carcinoma

Retroperitoneal adenopathy

Retroperitoneal fibrosis

29: A full term baby boy after 3 hours of birth presented with increasing abdominal girth. He had a
forceps delivery after 12 hours of difficult labor. His CBC then performed, shows low hemoglobin level.

The most likely diagnosis is:

Adrenal hemorrhage

Bilalteral hydronephrosis

Bowel hematoma

Congenital neuroblastoma
Splenic hematoma

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 918

30: A 22 year lady underwent plain CT scan of abdomen for suspicion of ureteric calculus. A single stone
was seen in the left mid ureter. Incidentally a 2 cm nodule was noted in the right adrenal gland. The
Hounsfield unit was 20 HU.

The most appropriate next step in management is:

Arterial & Delayed phase CT

Conventional Angiography

CT guided biopsy of nodule

Follow-up CT in three months

Ultrasound of abdomen

Reference: www.STATdx.com

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 881

31: A 70 year lady presented with severe pain in right lumbar area with high grade fever for 48 hours. Her
labs show urinary tract infection. She has history of diabetes for 3 years and recurrent UTIs. She
underwent CT urography examination. The right kidney is enlarged with distorted pelvicaliceal system
and low attenuation mass. Multiple 5-8 mm dome shaped smooth mural filling defects identified in the
right renal pelvis and upper 2/3 of ureter.

The most likely diagnosis is:

Malakoplakia

Multifocal TCC

Pyeloureteritis cystica

Urinary Tuberculosis

Xanthogranulomatous Pyelonephritis

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 933

32: A 19 year young man brought to the emergency by paramedics after road traffic accident. On
examination he had multiple injuries with severe blood loss. After initial resuscitation he underwent CT
scan which showed liver laceration. Both kidneys showed enhancement of medulla and non enhancement
of cortex; however the subcapsular cortical rim was enhancing.
The most likely cause of this appearance of kidneys is;

Acute cortical necrosis

Acute main renal artery occlusion

Acute tubular necrosis

Chronic urinary obstruction

Renal vein thrombosis

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 916.

33: A 52 year gentleman with history of diabetes underwent contrast CT scan for abdominal pain. The
next day he presented with very low urinary output. Ultrasound examination of kidneys showed bilateral
enlarged smooth kidneys with reduced echogenicity of medulla and normal echogenicity of cortex. Few
hours later his renal output improved and subsequently normalized in the next 24 hours.

The most likely diagnosis is:

Acute cortical necrosis

Acute glomerulonephritis

Acute tubular necrosis

Renal artery occlusion

Renal vein thrombosis

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 917

34: 35 year male presented to emergency with scrotal pain. Ultrasound is advised which shows multiple
scattered 1-2 mm hyperechoic nonshadowing foci scattered throughout the parenchyma of left testes. No
mass lesion is identified.

The most common association of this finding is;

Cryptochordism

Down’s Syndrome

Infertility

Klinefelter syndrome

Germ cell tumor

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 974

35: 44 year male presents with low grade fever, weight loss, and abdominal pain. CT scan is advised
which shows multiple non-necrotic lymph nodes in retroperitoneum. Multiple homogenous poorly
marginated nodular masses hypodense to renal parenchyma and showing less enhancement compared to
kidneys.

The most likely diagnosis is;

Multifocal renal cell carcinoma

Multiple renal abscesses

Renal Lymphoma

Renal metastases

Xanthogranulomatous pyelonephritis

36: 2 month baby girl presented with abdominal mass. Ultrasound of right kidney shows right renal mass.

The most common renal neoplasm in this age group is,

Mesoblastic nephroma

Nephroblastomatosis

Renal cell carcinoma

Rhabdoid tumor of kidney

Wilms Tumor

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 936

37: IVP examination of 20 year female with history of intake of analgesics due to sickle cell disease
shows normal sized right kidney. However the calyceal system is abnormal with appearance of fornix
widening, ring and claw configuration, filling defects and deformed club shape.

The most likely diagnosis is;

Congenital megacalices

Hydronephrosis

Necrotizing papilltis

Postobstructive renal atrophy

Pyelonephritis

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 943

38: A 42 year lady is referred for contrast CT due to abdominal pain and sweating. 15 minutes after
contrast injection she starts to complain of headaches, palpitation and starts sweating. After initial
reassurance blood pressure obtained was 210/105.

Administration of which of the following could have prevented such an attack;

Alpha blocker

Anti-histamine

Beta blocker

Sedatives

Steroids

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 944

39: Ultrasound examination of a 20 day newborn is advised as prenatal ultrasound showed bilateral
hydronephrosis. During ultrasound examination you notice his lower anterior abdominal wall is wrinkled.
Ultrasound shows massively dilated tortuous elongated ureters with poor peristalsis.

He is also likely to have;

Cryptochordism

Hirschsprung Disease

Malrotation

Pulmonary hypoplasia

Scoliosis

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 949

40: 22 year old comes is referred for ultrasound testes. patient complains of vague heaviness feeling in
testes. On ultrasound examination a well defined mass is identified in right testes measuring
approximately 2 cm with alternating hypoechoic and hyperechoic rings. Subsequently MRI was
performed which shows low signal intensity fibrous capsule with central high signal on T2 and T2 giving
a target appearance.

The most likely diagnosis is;

Choriocracinoma
Epidermoid cyst

Malignant Teratoma

Seminoma

Sertoild cell tumor

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 976

41: 71 year male is referred for ultrasound for evaluation of hematuria and weight loss. A 3cm cyst is
visualized in interpolar region of left kidney showing irregular thickened septa with thick hyperechoic
calcification with posterior acoustic shadowing. The cyst wall shows irregular with nodular masses.

The Bosniak Classification of this cyst is;

Class 1

Class 2

Class 2f

Class 3

Class 4

Reference: A text book of radiology and imaging: volume 2, David Sutton, 7 th edition, page 944

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 962

42: 63 year male is referred for CT abdomen for evaluation of weight loss and abdominal pain. A 4cm
cortical cyst is visualized in right kidney at the lower pole with irregular thickened septa showing slight
enhancement, irregular and thickened calcifications, irregular margination and uniform wall thickening.

The Bosniak Classification of this cyst is;

Class 1

Class 2

Class 2f
Class 3

Class 4

Reference: A text book of radiology and imaging: volume 2, David Sutton, 7 th edition, page 944

Reference: Radiology Review Manual, Wolfgang Dahnert, 6th Edition, page 962

43: Three year old baby boy underwent MCUG examination for repeated UTI. He has hypospadias.
Contrast outlined a cavity communicating with posterior urethra, what is the most likely diagnosis?

Bladder diverticulum

Cowper’s gland

Patent processus vaginalis

Prostatic utricle

Seminal vesicle cyst

Reference: David Sutton 7th edition page 1017

44: 32 year female p2+1 and g 3 presented in your ultrasound clinic for a scheduled anomaly scan at 22
weeks of gestation. Previous dating scan showed viable fetus of 8 weeks. You perform growth scan as
part of the protocol.

Accurate method of assessing Biparietal diameter on a standard axial plane passing through the widest
portion of skull is:

Cavum septum pellucidum and interhemispheric fissure in midline

Cavum septum pellucidum and third ventricle in midline

Thalami and cavum septum pellucidum in midline

Thalami and interhemispheric fissure in midline

Thalami and third ventricle in midline

Ans: Thalami and cavum septum pellucidum in midline

45: 45 year lady came to ultrasound suite for anomaly scan. She is a high risk patient with mitral valve
stenosis and has precious pregnancy after 10 years of marriage. Sonologist makes a diagnosis of
congenital diaphragmatic hernia.

Sonographic diagnosis of fetal CDH relies on:

absence of a normally positioned stomach

mediastinal displacement and lung hypoplasia

polyhydramnios and pleural effusion

Small abdominal circumference.

visualization of abdominal organs in the chest

Ans: visualization of abdominal organs in the chest

46: A 40 year old multigravida presented with painless vaginal bleeding at 36 week of gestation.

The most likely cause of her bleeding is:

Placenta accrete

Placenta increta

Placenta percreta

Placenta previa

Placental abruption

Reference: 6th edition Dahnert page 1060

47 :A 40 years old lady underwent laprotomy for small bowel obstruction. On 7 th post operative day she
developed high grade fever with chills and right upper quadrant abdominal pain. She is suspected to
have developed subphrenic abscess.

The plain film finding would not include:

Abnormal gas shadow between right hemidiaphragm

Elevated right hemidiaphragm

Erosion of right sided lower ribs

Right sided basal atelactasis

Right sided pleural effusion

David Sutton 7th edition page 53

48: A 20 year old male presents with the inability to gaze upwards. CT brain shows

moderate hydrocephalus and a rounded mass adjacent to the tectal plate. The mass

demonstrates marked homogeneous enhancement and is not calcified. MRI confirms a

well-circumscribed, relatively homogeneous mass that is isointense to grey matter on

T2-weighted imaging. The mass is hyperintense on contrast-enhanced T1-weighted

imaging. What is the most likely diagnosis?

a. Germinoma

b. Teratoma

c. Pineoblastoma

d. Pineocytoma

e. Benign pineal cyst

49: A 50 year old woman presents with visual loss. Examination reveals retinal detachment

and an ocular lesion. On MRI, the lesion is hyperintense on T1 and hypointense on

T2 relative to the vitreous. The lesion enhances post-gadolinium injection. The most

likely diagnosis is:

a. Metastases from breast cancer

b. Metastases from lung cancer

c. Choroidal haemangioma

d. Malignant melanoma

e. Vitreous lymphoma

50: A 35 year old previously well female consults an ophthalmologist with a history of

progressive loss of visual acuity over several months. Retinal examination reveals

papilloedema. Unenhanced CT shows tubular thickening of the optic nerve associated

with dense calcifications. Post-contrast injection shows a non-enhancing optic nerve

surrounded by a markedly enhancing soft-tissue mass. The remainder of the brain is

normal. The most likely diagnosis is:

a. Optic nerve glioma

b. Perioptic meningioma

c. Sarcoidosis

d. Lymphoma

e. Multiple sclerosis

51: Routine first-trimester antenatal ultrasound scan reveals a large posterior fossa cyst

and ventriculomegaly. Fetal MRI demonstrates dysgenesis of the corpus callosum, a

large posterior fossa and hypoplasia of the cerebellar vermis. What is the most likely

diagnosis?

a. Dandy–Walker malformation

b. Dandy–Walker variant

c. Megacisterna magna

d. Arachnoid cyst

e. Porencephaly

52: A 30 year old female complains of increasing headaches, episodic vomiting and

drowsiness. Fundoscopy reveals papilloedema. Non-contrast CT of the head demonstrates

hydrocephalus and a globular lesion within the lateral ventricle. There are

several small internal foci of calcification. MR shows the mass to be attached to the

septum pallucidum. It is isointense to grey matter on T1 and T2. It densely enhances

after intravenous gadolinium. What is the most likely diagnosis?

a. Ependymoma

b. Subependymoma

c. Central neurocytoma

d. Heterotopic grey matter

e. Meningioma

54: A 48 year old female presents with tinnitus. CT shows a soft-tissue mass in the region

of the hypotympanum. There is irregular bone demineralisation in the region of the

carotid canal and jugular foramen, making their margins irregular and partially

indistinct. On proton density MR imaging, the mass has mixed hyper- and hypointensity

signal. The tumour shows strong enhancement after gadolinium administration.

What is the most likely diagnosis?

a. Glomus tympanicum tumour

b. Glomus jugulare tumour

c. Carotid body tumour

d. Glomus vagale tumour

e. Cholesteatoma

55: A young man presents to A&E following a fall onto his outstretched right arm. Plain

films of the right forearm show a fracture of the distal forearm with volar angulation

of the distal fragment with no intra-articular component. The carpal bones remain

well aligned. Which of the following injuries has he sustained?

a. Smith’s fracture

b. Barton’s fracture

c. Monteggia fracture

d. Galeazzi fracture

e. Colles fracture

56: A 24 year old woman presents with worsening frontal headaches and a sixth nerve

palsy. A non-enhanced CT shows a lesion situated within the clivus with associated

bony destruction; there is soft-tissue extension into the nasopharynx. MRI shows a

large inter-osseous mass which is isointense to brain T1-weighted imaging and hyperintense

on T2. The most likely diagnosis is:

a. Sphenoid sinus cyst

b. Meningioma

c. Nasopharyngeal carcinoma

d. Metastasis

e. chordoma

57:A 73 year old female has a CT abdomen and pelvis for the investigation of anaemia and

weight loss. Massive splenomegaly (30 cm) is present with no other abnormalities.

Which of the following conditions is most likely to be the underlying cause?

a. Sarcoidosis

b. Felty’s syndrome

c. Chronic myeloid leukaemia

d. Haemochromatosis

e. Non-Hodgkin’s lymphoma

58: A 42 year old woman presents with post-coital bleeding. Transvaginal ultrasound shows

the cervix to be enlarged, irregular and hypoechoic. MRI demonstrates a large cervical

cancer with involvement of multiple pelvic lymph nodes. The left kidney is hydronephrotic.

What is the most appropriate staging based on these findings?

a. T1

b. T2b

c. T3a

d. T3b

e. T4

59:A 23 year old woman undergoes investigation for dyspareunia. Pelvic ultrasound

was unremarkable. MRI demonstrates a 1 cm thin-walled ovoid cystic lesion at the

anterolateral aspect of the upper vagina. It is homogeneously hypointense on T1 and

shows marked hyperintensity on T2. What is the most likely diagnosis?

a. Bartholin cyst

b. Nabothian cyst

c. Cervical fibroid

d. Gartner duct cyst

e. Cervical polyp

60: A five-year-old boy presented with hearing loss. An intact, dry tympanic membrane was

visualised and audiology confirmed a conductive hearing loss. A CT was performed which

revealed a lesion medial to and eroding the ossicular chain which fills the oval window niche and

does not enhance following contrast. An MRI confirmed the lesion was high intensity on Ti and high
signal intensity on T2-weighted images. What is the most likely diagnosis?

a Acquired cholesteatoma

b Glomus tympanicum

C Cholesterol granuloma

d High jugular bulb

e Congenital cholesteatoma

61:An 11 year old was investigated for widespread cutaneous lesions. Imaging revealed ribbon ribs,

tibial bowing and a hypoplastic sphenoidal ala on the left. An MRI of the spine was also performed

which showed a mid-thoracic lesion along with some bone remodelling. What is this lesion most

likely to be?

a Ependymoma

b Astrocytoma

C Neurofibroma

d Lipoma

e Dermoid cyst

62:A 32 year old was imaged following sudden onset right hemiplegia. A CT showed subtle atrophy

of the left occipital lobe and unusual gyral calcification. MRI demonstrated prominent pial and

deep medullary veins in the region with a prominent left choroid plexus. What is the underlying
aetiology?

a Tuberous sclerosis

b Ataxia telangiectasia

C Meningiomatosis

d von Hippel-Lindau syndrome

e Sturge-Weber syndrome

63:A six-year-old child presented with gait problems and neurologic deficit. An MRI of the brain and

whole spine was performed. There was a diffuse abnormality in the upper thoracic cord extending

over approximately five vertebral levels. The lesion appeared intramedullary in location and was

hypo- isointense on Ti and hyperintense on T2-weighted images with enhancement on Ti following

IV Gadolinium. A syrinx was seen more superiorly. What is the most likely diagnosis?

a Ependymoma

b Transverse myelitis

C Astrocytoma

d Metastases

e Haemangioblastoma

65: A 60-year-old woman presents with a painless mastoid swelling. Investigations reveal a mixed

hearing loss. CT shows a coarsening of the trabeculae with cortical expansion and thickening. What

is the most likely diagnosis?

a Paget's disease

b Osteomyelitis of skull base

C Ossifying fibroma

d Polyostotic fibrous dysplasia

e Monostotic fibrous dysplasia

66: Following surgery for a herniated L4/L5 disc a 66-year-old obese patient had little symptomatic

relief. An MRI scan performed in the second postoperative week revealed extradural soft-tissue

material within the spinal canal, which demonstrated little enhancement following contrast. Nerve
root enhancement was striking. What is the most likely diagnosis?

a Arachnoiditis

b Epidural haematoma

c Residual disc material

d Epidural fibrosis

e Neuritis

67: A young male presented with symptoms of neck pain and ipsilateral headache following a

weekend of rock climbing. Signs of ipsilateral Horner's syndrome were also elicited. Following an

MRI, a diagnosis of carotid artery dissection was made. Which segment of the carotid artery is

most likely to be involved?

a Cervical segment

b Petrous segment

C Lacerum segment

d Cavernous segment

e Supraclinoid segment

An eight-year-old boy with haemophilia A has repeated episodes of right knee pain and swelling.

68: A radiograph of the right knee shows a joint effusion. What bony abnormalities might be seen?

a Squared patella with widening of the intercondylar notch

b Loss of joint space with subchondral sclerosis

c Multiple erosions within the tibial plateau

d Juxta-articular osteoporosis

e Widened and irregular epiphyseal plate

69:A 50-year-old female patient with Cushing's syndrome presents with a

wheeze and nonresolving left lower lobe consolidation. CT reveals a calcified

polypoid tumour lying external to the left main bronchus, with a smaller

intraluminal component causing partial left lower lobe obstruction. Marked

enhancement is seen after the administration of contrast medium. What is the

most likely diagnosis?

A Bronchial carcinoid

B Bronchial chondroma

C Bronchial fibroma

D Bronchial haemangioma

E Bronchial hamartoma

70: A young man undergoes an MRI of the right knee due to clinical suspicion

of an acute rupture of the ACL. The ACL is indistinct, and cannot be

visualised in either the coronal or sagittal plane. Which additional features

would be supportive of a diagnosis of ACL rupture?

A Buckling up of the PCL

B Oedema within the medial collateral ligament

C Posterior translation of the femur on the tibial condyles

D Straightening of the patellar ligament

E Tear of the medial meniscus

71:A 59-year-old man undergoes surgical resection of a rectal tumour.

A contrast-enhanced CT of the abdomen is performed 3 months later

and demonstrates a new, solitary 3-cm liver metastasis. The lesion lies

inferior to the level of the left and right portal veins and posterior to the

right hepatic vein. The remainder of the CT examination is unremarkable

and the patient is assessed for surgical resection of the liver lesion.

Which segment of the liver does the liver metastasis lie in?

A Segment 4b

B Segment 5
C Segment 6

D Segment 7

E Segment 8

72: A 38-year-old woman receives an orthotopic liver transplant for chronic

liver failure due to primary biliary cirrhosis. The patient's liver enzyme

levels become markedly elevated after 24 hours and her clinical condition

deteriorates. An abdominal ultrasound is performed with Doppler

evaluation of the hepatic vessels. Given the clinical history, which vascular

complication is most likely to have occurred?

A Arterioportal fistula

B I VC thrombosis

C Hepatic artery stenosis

D Hepatic artery thrombosis

E Portal vein thrombosis

( to be modified )

74 :A patient presents with reduced T2 signals in liver and spleen however pancreas shows normal signal
intensity, which of the following describes these findings

A Primary hemochromatosis

B Hemosiderosis

C Fatty liver

75: 41-year-old HIV-positive man undergoes an MRI brain to investigate

headaches, fever and confusion. This shows multiple ovoid lesions in the basal ganglia

and brainstem which are of low signal on Tlw and high signal on T2w
images. There is no significant associated oedema and no enhancement is seen

postcontrast. What is the most likely diagnosis?

A Cryptococcosis

B Cytomegalovirus infection

C HIV encephalopathy

D Lymphoma

E Progressive multifocal leukoencephalopathy

76: A 40-year-old male presents with shortness of breath. He also has

lower back pain and stiffness of the spine. A chest radiograph

shows bilateral upper-zone fibrosis with elevation of the hila.

Spinal ligamentous ossification is also noted. High-resolution CT

shows peripheral interstitial changes with traction bronchiectasis

and paraseptal emphysematous changes in the upper zones. What

is the most likely diagnosis?

a. ankylosing spondylitis

b. Reiter’s syndrome

c. tuberculosis

d. sarcoidosis

e. chronic extrinsic allergic alveolitis

76: A 76-year-old female presents with haemoptysis and cough. A chest

radiograph shows a mass in the right upper lobe that contains a

crescent of air. Which feature on CT would make a cavitating

malignancy more likely than aspergilloma?

a. thin cavity wall

b. high-density central mass

c. enhancing central mass

d. calcification

e. adjacent bronchiectasis

77: A 42-year-old male presents with stridor and persistent cough. He

previously has had several nosebleeds. Bloods show mild renal

impairment. A chest radiograph shows multiple cavitary lesions

with irregular lining, predominantly in the lower lobes. What is

the most likely diagnosis?

a. metastatic disease from nasopharyngeal carcinoma

b. Wegener’s granulomatosis

c. sarcoidosis

d. pyogenic abscesses

e. systemic lupus erythematosus

78: A 45-year-old female presents with malaise and cough. She has a

history of multiple allergies. Her blood results show an eosinophilia,

and the chest radiograph reveals two areas of peripheral

consolidation. A further chest radiograph 2 days later shows these

to be resolving. Which of the following is the most likely diagnosis?

a. histiocytosis

b. pseudomonas pneumonia

c. Klebsiella pneumonia

d. Loeffler’s syndrome

e. lipoid pneumonia
79: A 64-year-old male presents with worsening shortness of breath and

haemoptysis. A chest radiograph shows a right hilar mass with

extensive reticulation in the ipsilateral lung, with Kerley A and B

lines and reduced lung volumes. The left lung is clear. CT of the

chest demonstrates the right hilar mass, and a thickened parenchymal

polygonal network within the mid and lower zones of the ipsilateral

lung. Beaded thickening of the interlobular septa is also

noted. What is the most likely diagnosis?

a. lymphangitis carcinomatosis

b. idiopathic pulmonary fibrosis

c. extrinsic allergic alveolitis

d. histiocytosis

e. Sarcoidosis

80: A young man is assaulted and attends accident and emergency with

a painful left mandible and inability to open and close his jaw

without pain. Radiographs show a simple linear fracture through

the left body in the parasymphyseal region. A second fracture is

most likely to be seen at which of the following sites?

a. ipsilateral condylar neck

b. ipsilateral angle

c. symphysis menti

d. contralateral body

e. contralateral condylar neck

81: On plain radiographs of the hands, hyperflexion of the proximal

interphalangeal joint of the index finger, with hyperextension of

the distal interphalangeal joint of the same finger, describes which

deformity?

a. swan-neck

b. Boutonnie`re

c. mallet finger

d. baseball finger

e. Z-deformity

82: A young adult male sustains an acetabular fracture in a high-speed

road traffic collision. Which type of acetabular fracture is most

commonly associated with significant neurological injury?

a. posterior rim/wall

b. anterior rim/wall

c. transverse T-shape

d. anterior and posterior column

e. central dislocation

83: A middle-aged woman falls on an outstretched hand, which

becomes immediately painful and swollen. A lateral radiograph

shows a small fracture fragment dorsal to the carpus, and the AP

radiograph appears normal. Which carpal bone is most likely to

be fractured?

a. scaphoid

b. lunate
c. triquetrum

d. capitate

e. hamate

84: A 70-year-old man attends a 6-week follow-up appointment after

cemented total hip arthroplasty, complaining of a poor range of

motion. Radiographs taken during the appointment show small

areas of pericapsular bone, and formation of small bony spurs at

the acetabular margin. CT demonstrates these areas to have welldefined

mineralization peripherally and indistinct centres. Which

of the following processes are responsible?

a. femoral component loosening

b. heterotopic ossification

c. periprosthetic fracture

d. postoperative infection

e. stress shielding

85: A 70-year-old hospitalized male patient presents with watery

diarrhoea and abdominal pain. CT of the abdomen demonstrates

marked circumferential bowel wall thickening involving the entire

colon, with minimal pericolonic stranding and a small amount of

ascites. The small bowel appears normal. What is the most likely

diagnosis?

a. Crohn’s disease

b. ischaemic colitis

c. diverticulitis
d. pseudomembranous colitis

e. ulcerative colitis

86: A 68-year-old woman presents with small bowel obstruction, and

undergoes contrast-enhanced CT of the abdomen. This demonstrates

dilated small bowel to the level of the mid-ileum, where a

herniated loop of small bowel is seen emerging inferolateral to the

left pubic tubercle. What is the most likely cause of small bowel

obstruction in this patient?

a. femoral hernia

b. indirect inguinal hernia

c. direct inguinal hernia

d. spigelian hernia

e. obturator hernia

87: A 48-year-old man presents with epigastric pain, weight loss and

peripheral oedema. Blood tests demonstrate hypoalbuminaemia.

At barium meal the stomach is well distended, but there is poor

mucosal coating. Markedly enlarged and tortuous gastric rugae

are seen in the fundus and body of the stomach.What is the most likely diagnosis?

a. lymphoma

b. Me´ne´trie`r’s disease

c. gastric carcinoma

d. Zollinger–Ellison syndrome

e. eosinophilic gastroenteritis
88: A 2-day-old, full-term baby boy is found to have a palpable

abdominal mass during a routine examination. He is otherwise

well. A plain abdominal radiograph demonstrates a well-defined,

dense mass containing multiple calcifications in the right lower

quadrant. What is the most likely diagnosis?

a. neuroblastoma

b. duplication cyst

c. meconium peritonitis

d. meconium ileus

e. Hirschsprung’s disease

89: A 6-year-old girl is investigated for abdominal pain, jaundice and a

palpable right upper quadrant mass. Ultrasound scan of the

abdomen demonstrates a 5 cm cystic structure at the porta

hepatis, which is separate from the normal gallbladder, and communicates

with normal intrahepatic ducts. What is the most likely

diagnosis?

a. biliary atresia

b. choledochal cyst

c. pancreatic pseudocyst

d. duodenal duplication cyst

e. pericholecystic abscess

90: Which of the following injuries is one that is not suggestive of

non-accidental injury in a 2-year-old boy?

a. metaphyseal corner fracture

b. lateral rib fractures

c. posterior rib fracture

d. spiral tibial fracture

e. depressed occipital fracture

91: A child who undergoes MR of the brain for clinically apparent

facial abnormalities is shown to have a defect of midline cleavage

of the brain. What structure is abnormal or absent in all forms of

holoprosencephaly, and therefore is the most sensitive indicator of

a midline cleavage abnormality?

a. falx cerebri

b. third ventricle

c. fourth ventricle

d. corpus callosum

e. septum pellucidum

92: A 45-year-old female fell down a flight of stairs under the influence of alcohol and presented to

the Emergency Department with a deteriorating GCS. A non-contrast CT revealed a 13-mm deep

left temporoparietal lenticular haematoma. What is the most likely source of the bleed?

a Middle meningeal artery

b Internal cerebral veins

C Bridging cortical veins

d Choroidal arteries

e Vein of Labbe

93:A 42-year-old woman with a proceeding history of flu-like symptoms presented with a day history

of increasing confusion followed by three generalised seizures. Initial CT revealed no abnormality

while an MRI showed high signal on T2 in the medial right temporal and right insula region. No

enhancement with gadolinium and little mass effect were seen. She remained in intensive care and

a repeat MRI a week later showed extensive high signal in the temporal lobes and frontal lobes

with multiple low-signal foci on T2 GRE. There was no ventricular dilatation. What is the most

likely diagnosis?

a Toxoplasmosis

b Herpes encephalitis

C Low-grade glioma

d Paraneoplastic syndrome

e Cytornegalovirus infection