FC Rad Diag(SA) Part II

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Radiologists of South Africa

25 January 2021

Paper 1 (3 hours)

All questions are to be answered in one book

1 a) Acute mesenteric ischaemia (AMI) is a potentially life-threatening condition

i) List the subtypes of AMI. (2.5)
ii) Tabulate the bowel wall findings seen at CT and CTA in patients with AMI. (4)
b) Image guided percutaneous biopsy of the musculoskeletal system has to a large extent
replaced open surgical biopsy as the preferred method of histological diagnosis for soft
tissue and bone tumours
i) List 3 considerations in determining the biopsy path with specific reference to patients
where surgical resection or limb sparing surgery is planned. (1.5)
ii) List technical factors which may affect the biopsy yield. (2)
[10]

2 a) Discuss the imaging approach to pulsatile tinnitus. (2.5)

b) Describe the imaging findings of the following
i) Glomus tympanicum. (1.5)
ii) Glomus Jugulare. (2.5)
iii) Aberrant Internal Carotid Artery. (1.5)
c) Describe the ultrasound findings in benign lymphoepithelial lesions. (2)
[10]

3 a) Imaging is critical to the diagnosis and management of the patient with acute TBI (Traumatic
brain injury). What are the two most important goals of emergency neuroimaging? (1)
b) With reference to acute brain trauma, what is the significance of a hypodensity within an
extra - axial collection? (2)
c) A 52-year-old known hypertensive presents 3 hours post onset left sided weakness. List the
positive and negative imaging findings which influence acute stroke management. (2)
d) What three parameters are assessed on Perfusion CT, and what does each of these criteria
signify? (3)
e) A 44-year-old female with a chronic restrictive lung disease and elevated ACE levels
presents with worsening headaches and diplopia
i) What is the most likely diagnosis? (0.5)
ii) List the MRI features of CNS involvement in this disease. (5.5)

PTO/Page 2/Question 3f)…

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f) What is the role of preoperative diffusion tensor imaging (DTI) in Brain tumor surgery? (1)
[15]

4 a) Although not pathognomonic, what are the lung CT findings suggestive of COVID-19
involvement of the lung (COVID-19 pneumonia)? (4)
b) Tabulate the different lung HRCT distribution patterns of interstitial pulmonary nodules. (1.5)
Under each one of the distribution patterns
i) List the method of spread of disease responsible for this pattern. (1.5)
ii) List the distribution of the nodules in relation to the anatomical structures of a
secondary pulmonary lobule. (1.5)
iii) Give an example of a disease responsible for each of the patterns. (1.5)
iv) Describe mosaic perfusion on a HRCT lung. (3)
v) List the pulmonary radiographic features of Mycobacterium Tuberculosis–associated
Immune Reconstitution Inflammatory Syndrome. (2)
[15]

5 a) i) Describe a CT enterography scan protocol to assess a patient for Crohn's disease.(2.5)

ii) How would you adapt it to evaluate small bowel haemorrhage? (0.5)
iii) List the liver and biliary extraintestinal manifestations of Crohn's disease. (3)
iv) Describe the CT findings of Coeliac disease. (2)
v) Describe the ultrasound findings of acute appendicitis. (7)
[15]

6 a) Regarding sarcoidosis of the heart

i) What is the gold standard for the diagnosis of cardiac sarcoidosis? (1)
ii) Describe the typical imaging characteristics observed on cardiac MRI in active
sarcoidosis of the myocardium. (2)
iii) List the differential diagnoses to consider in a patient presenting for imaging to exclude
cardiac sarcoidosis. (2)
b) Describe the most common clinically significant coronary artery anomaly associated with
sudden cardiac death in young adults. (2)
c) List 3 classic signs of hypertrophic obstructive cardiomyopathy on cardiac MRI. (3)
[10]

7 a) Tabulate the imaging features of benign and malignant gallbladder polyps. (4)
b) List the 6 major features LIRADS criteria used to determine the risk for developing
hepatocellular carcinoma in patients with liver cirrhosis and chronic hepatitis B infection. (3)
c) List the MRI findings of Budd-Chiari syndrome. (3)
[10]

8 a) Discuss protocol guidelines that may be adopted by a radiology department to manage and
reduce the spread of the Covid 19 virus in the facility and among personnel. (7)
b) Bladder injuries are suspected in a patient presenting to casualty with pelvic trauma after a
motor vehicle accident
i) Classify the various bladder injuries. (3)
ii) Tabulate the CT findings for each. (5)
[15]
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FC Rad Diag(SA) Part II

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Radiologists of South Africa

26 January 2021

Paper 2 (3 hours)

All questions are to be answered in one book.

Section A

1 a) Discuss the findings on CT which raise suspicion of abusive head trauma in a 6-month-old
infant. (6)
b) A 6-year-old has back pain and an abnormal x-ray. Discuss the imaging findings on MRI that
would assist you in differentiating between bacterial and tuberculous disease. (4)
[10]

2 a) Discuss your imaging approach to a 30-week pregnant patient with suspected renal colic.
(2)
b) List the guidelines for the use of MRI in pregnancy. (3)
c) List the imaging characteristics on ultrasound that increase the likelihood of malignancy in
an ovarian mass. (5)
[10]

3 a) A variety of imaging tests are available to assess recurrent and metastatic disease following
cystectomy for bladder carcinoma
i) What is the most sensitive imaging modality in this setting? (0.5)
ii) Give reasons for your answer. (1)
b) A 32-year-old woman undergoes an IVU which demonstrates bilateral striated nephrograms.
Write short notes on the underlying pathology and list conditions that could cause this
appearance. (3.5)
c) A middle-aged immunosuppressed woman presents with haematuria. List 4 ultrasound
findings which would suggest a diagnosis of malakoplakia. (2)
d) Abdominal CT images show retroperitoneal air in a 28-year-old woman following a road
traffic accident
i) List the zonal anatomy of the retroperitoneum. (1.5)
ii) List possible causes of retroperitoneal air in this setting. (1.5)
[10]
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4 a) Define and describe the clinical presentation of patella chondromalacia. (1)

b) What is the difference between fatigue and insufficiency fracture? (1)
c) Give 4 examples of different sites in the foot presenting with fatigue fractures and common
causes/predisposing factor. (4)
d) List the plain film findings in the hand in secondary hyperparathyroidism. (4)
[10]

5 a) What is the role of ultrasound in the workup of palpable breast abnormality in males?
(2.5)
b) A mammogram demonstrates a BIRADS 5 lesion. There are suspicious microcalcifications
beyond the lesion. Discuss your approach to and the significance of these
microcalcifications in further management of the patient. (5.5)
c) What is the role of ultrasound in the workup of a palpable breast lump in a lactating woman?
(2)
[10]