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 GET
THROUGH
Final FRCR 2A:
SBAs
 GET
THROUGH
Final FRCR 2A:
SBAs

Teck Yew Chin, FRCR, MSc, MBChB

Susan Cheng Shelmerdine, MBBS, BSc, MRCS, PgCertHBE, FRCR
Akash Ganguly, MBBS, DMRD, FRCR
Chinedum Anosike, MBBS, MSc, FRCR
CRC Press
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Library of Congress Cataloging-in-Publication Data

Names: Chin, Teck Yew, author. | Shelmerdine, Susan, author. | Ganguly, Akash, author. |
Anosike, Chinedum, author.
Title: Get through final FRCR 2A : SBAs / Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly,
Chinedum Anosike.
Other titles: Get through.
Description: Boca Raton, FL : CRC Press/Taylor & Francis Group, [2017] |
Series: Get through
Identifiers: LCCN 2016054175 (print) | LCCN 2016054780 (ebook) | ISBN 9781498734844 (pbk. : alk. paper) |
ISBN 9781138743991 (hardback : alk. paper) | ISBN 9781315382708 (Master eBook)
Subjects: | MESH: Radiology | Examination Questions
Classification: LCC RC78.15 (print) | LCC RC78.15 (ebook) | NLM WN 18.2 | DDC 616.07/57076--dc23
LC record available at https://lccn.loc.gov/2016054175

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 CONTENTS
Preface vii
Acknowledgements ix
Authors xi
Abbreviations xiii

l1 Test Paper 1 – Questions 1

l2 Test Paper 1 – Answers 25

l3 Test Paper 2 – Questions 61

l4 Test Paper 2 – Answers 83

l5 Test Paper 3 – Questions 119

l6 Test Paper 3 – Answers 141

l7 Test Paper 4 – Questions 181

l8 Test Paper 4 – Answers 205

l9 Test Paper 5 – Questions 243

l10 Test Paper 5 – Answers 267

l11 Test Paper 6 – Questions 305

l12 Test Paper 6 – Answers 329

l13 Test Paper 7 – Questions 365

l14 Test Paper 7 – Answers 389

Index 425

v
 PREFACE
The examination structure of the Fellowship of Royal College of Radiologists (FRCR) Final Part A
examination (CR2A) in clinical radiology is reverting back from the current modular structure to a
single examination. The RCR has approval from the General Medical Council (GMC) and the
change will be effective from spring 2018.
From spring 2018, the examination will consist of two papers, to be taken on the same day,
each consisting of 120 single best answer–type questions per paper. Each paper will be 3 hours
long and will cover a broad range of topics from the radiology core curriculum covering
all modalities.
This book is divided into seven test papers, consisting of 120 mixed SBA-type questions covering
all modules (3 hours per paper for practice). The answers are in sequential order, followed by
a short explanation and relevant discussion around the topic with appropriate references.

vii
 ACKNOWLEDGEMENTS
Vijay Kesavanarayanan
Grant Mair
Andrew Baird
Matthew Budak
Oliver Cram
Thomas Hartley
Laura Hinksman
Menelaos Philippou
Jo Powell
Calum Nicholson
Ewen G. Robertson
Nicola Schembri
Magdalena Szewczyk-Bieda
Richard D. White
Struan W.A. Wilkie
Nadeem A. Butt
Lauren L. Millar
Karim Samji
Euan G.C. Stubbs
André Stefan Gatt
Asha Neelakantan
Bappa Sarkar
Mubeen Chaudhry
Ramya G. Dhandapani

ix
 AUTHORS
Dr. Teck Yew Chin, MBChB, MSc, FRCR, is a consultant radiologist at Khoo Teck Puat Hospital,
Singapore.

Dr. Susan Cheng Shelmerdine, MBBS, BSc, MRCS, PgCertHBE, FRCR, is a radiology research
fellow at Great Ormond Street Hospital, London, UK.

Dr. Akash Ganguly, MBBS, DMRD, FRCR, is a consultant radiologist at Warrington Hospital,
Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.

Dr. Chinedum Anosike, MBBS, MSc, FRCR, is a consultant radiologist at Warrington Hospital,
Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.

xi
 ABBREVIATIONS
ABC – Aneurysmal Bone Cyst
ABPA – Allergic Bronchopulmonary Aspergillosis
AC – Acromio-clavicular
ACA – Anterior Cerebral Artery
ACE – Angiotensin Converting Enzyme
ACL – Anterior Cruciate Ligament
ACOM – Anterior Communicating Artery
ADC – Apparent Diffusion Coefficient
ADEM – Acute Disseminated Encephalomyelitis
AED/A&E – Accident and Emergency (department)
AFP – Alpha Fetoprotein
AICA – Anterior Inferior Cerebellar Artery
AIDS – Acquired Immunodeficiency Syndrome
ALP – Alkaline Phosphatase
ALPSA – Anterior Labroligamentous Periosteal Sleeve Avulsion
ALT – Alanine Aminotransferase
AML – Angiomyolipoma
AP – Anterior Posterior
ARDS – Acute Respiratory Distress Syndrome
ASD – Atrial Septal Defect
AST – Aspartate Aminotransferase
ATN – Acute Tubular Necrosis
AVM – Arteriovenous Malformation
AVN – Avascular Necrosis
BCG – Bacillus Calmette–Guerin
BPH – Benign Prostatic Hypertrophy
CA – Carbohydrate Antigen
CADASIL – Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and
Leukoencephalopathy
CBD – Common Bile Duct
CBF – Cerebral Blood Flow
CBV – Cerebral Blood Volume
CC – Coracoclavicular
CCAM – Congenital Cystic Adenomatoid Malformation

xiii
 CDH – Congenital Diaphragmatic Hernia
ABBREVIATIONS

CEA – Carcinoembryonic Antigen

CECT – Contrast-Enhanced CT
CF – Cystic Fibrosis
CFA – Common Femoral Artery
CHD – Common Hepatic Duct
Cho – Choline
CIN – Contrast-Induced Nephropathy
CJD – Creutzfeldt–Jakob Disease
CMV – Cytomegalo Virus
CNS – Central Nervous System
COAD – Chronic Obstructive Airway Disease
COP – Cryptogenic Organising Pneumonia
COPD – Chronic Obstructive Pulmonary Disease
CPAM – Congenital Pulmonary Airway Malformation
CPM – Central Pontine Myelinolysis
CPPD – Calcium Pyrophosphate Deposition Disease
Cr – Creatine
CRL – Crown Rump Length
CRM – Circumferential Resection Margin
CSF – Cerebrospinal Fluid
CT – Computerised Tomography
CTPA – Computed Tomography Pulmonary Angiogram
CXR – Chest X-Ray
DAD – Diffuse Alveolar Damage
DAI – Diffuse Axonal Injury
DCE – Dynamic Contrast Enhancement
DCIS – Ductal Carcinoma In-situ
DDH – Developmental Dysplasia of Hip
DIC – Disseminated Intravascular Coagulation
DIPJ – Distal Inter-Phalangeal Joint
DISH – Diffuse Idiopathic Skeletal Hyperostosis
DISI – Dorsal Intercalated Segment Instability
DJ – Duodenojejunal
DNET – Dysembryoplastic Neuroepithelial Tumour
DRUJ – Distal Radioulnar Joint
DWI – Diffusion-Weighted Imaging
ECG – Electrocardiogram
ENT – Ear Nose Throat
ERCP – Endoscopic Retrograde Chloangio-pancreatography
ESR – Erythrocyte Sedimentation Rate

xiv
ETT – Endotracheal Tube

ABBREVIATIONS
EUS – Endoscopic Eltrasound
EVAR – Endovascular (Aortic) Aneurysm Repair
FAI – Femoroacetabular Impingement
FAPS – Familial Adenomatous Polyposis Syndrome
FB – Foreign Body
FCD – Fibrous Cortical Defect
FCL – Fibular Collateral Ligament
FD – Fibrous Dysplasia
FDG – F18 Fluorodeoxyglucose
FESS – Functional Endoscopic Sinus Surgery
FEV – Forced Expiratory Volume
FLAIR – Fluid Attenuation Inversion Recovery
FMD – Fibromuscular dysplasia
FNA – Fine Needle Aspiration
FNH – Focal Nodular Hyperplasia
GCA – Giant Cell Arteritis
GCS – Glasgow Coma Score
GCT – Giant Cell Tumour
GI – Gastrointestinal
GIST – Gastro Intestinal Stromal Tumour
GLAD – Glenolabral Articular Disruption
GRE – Gradient-Recalled Echo
GVHD – Graft Versus Host Disease
HCC – Hepatocellular Carcinoma
HCG – Hysterosalpingogram
HCM – Hypertrophic Cardiomyopathy
HELLP syndrome – Haemolysis, Elevated Liver enzyme Levels, and low Platelet syndrome
HHV – Human Herpes Virus
HIDA – Hepatobiliary Iminodiacetic Acid
HIV – Human Immunodeficiency Virus
HNPCC – Hereditary Non-Polyposis Colon Cancer Syndrome
HOCM – Hypertrophic Obstructive Cardiomyopathy
HRCT – High Resolution Computed Tomography
HSV – Herpes Simplex Virus
HU – Hounsfield Unit
IBD – Inflammatory Bowel Disease
ICA – Internal Carotid Artery
ICU – Intensive Care Unit
IJV – Internal Jugular Vein
INR – International Normalised Ratio

xv
 IPF – Idiopathic Pulmonary Fibrosis
ABBREVIATIONS

IPMN – Intraductal Papillary Mucinous Neoplasm

IUCD – Intra-Uterine Contraceptive Device
IV – Intravenous
IVC – Inferior Vena cava
IVU – Intravenous Urogram
JVP – Juvenile Pilocytic Astrocytoma
KUB – Kidney, Ureters, Bladder
LA – Left Atrium
LAGBP – Laparoscopic Adjustable Gastric Banding Procedure
LAM – Lymphangioleiomyomatosis
LASA-P – Lipid-Associated Aialic Acid P
LCH – Langerhans Cell Histiocytosis
LCL – Lateral Collateral Ligament
LDH – Lactate Dehydrogenase
LFT – Liver Function Tests
LIP – Lymphocytic Interstitial Pneumonitis
LLL – Left Lower Lobe
LUL – Left Upper Lobe
LV – Left Ventricle
MAC – Mycobacterium Avian Complex
MCA – Middle Cerebral Artery
MCL – Medial Collateral Ligament
MCPJ – Metacarpophalangeal Joint
MCUG – Micturating Cysto-Urethrogram
MDA – Mullerian Duct Anomaly
MDT – Multi-disciplinary Team
MELAS – Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke like episodes
MEN – Multiple Endocrine Neoplasia
MIBG – Metaiodobenzylguanidine
MPFL – Medial Patellofemoral Ligament
MR – Magnetic Resonance
MRA – Magnetic Resonance Angiography
MRCP – Magnetic Resonance Cholangio-Pancreatography
MRE – Magnetic Resonance Enterography
MRI – Magnetic Resonance Imaging
MRSA – Methicillin-Resistant Staphylococcus aureus
MRU – Magnetic Resonance Urography
MS – Multiple Sclerosis
MSSA – Methicillin-Sensitive Staphylococcus aureus
MTPJ – Metatarsophalangeal Joint

xvi
MTR – Magnetisation Transfer Ratio

ABBREVIATIONS
MTT – Mean Transit Time
NAA – N-Acetylaspartate
NAFLD – Non-Alcoholic Fatty Liver Disease
NAHI – Non-Accidental Head Injury
NAI – Non-Accidental Injury
NASH – Non-Alcoholic Steatohepatitis
NF – Neurofibromatosis
NG(T) – Nasogastric (Tube)
NHL – Non-Hodgkins Lymphoma
NICE – National Institute for Health and Care Excellence
NOF – Non-Ossifying Fibroma
NPH – Normal Pressure Hydrocephalus
NSE – Neuron-Specific Enolase
NSIP – Nonspecific interstitial pneumonitis
OA – Osteoarthritis
OCD – Osteo-Chondral Defect
OCP – Oral Contraceptive Pill
OFD – Osteo Fibrous Dysplasia
OGD – Oesophago-Gastroduodenoscopy
OKC – Odontogenic Keratocyst
OM – Occipito-Mental/Osteomyelitis
PAN – Polyarteritis Nodosa
PCA – Posterior Cerebral Artery
PCKD – Polycystic Kidney Disease
PCL – Posterior Cruciate Ligament
PCOM – Posterior Communicating Artery
PCOS – Polycystic Ovarian Syndrome
PCP – Pneumocystis Pneumonia
PDA – Patent Ductus Arteriosus
PE – Pulmonary Embolism
PET – Positron Emission Tomography
PHACE syndrome – Posterior fossa malformations, Haemangioma Arterial anomalies, Cardiac
defects, Eye abnormalities, sternal cleft and supra-umbilical raphe syndrome
PICA – Posterior Inferior Cerebellar Artery
PIN – Posterior Interosseous Nerve
PIPJ – Proximal Inter-Phalangeal Joint
PKU – Phenylketonuria
PMF – Progressive Massive Fibrosis
PML – Progressive Multifocal Leukoencephalopathy
PNET – Primitive Neuroectodermal Tumour

xvii
 POEMS syndrome – Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy,
ABBREVIATIONS

and Skin changes syndrome

PR – Per-Rectal
PSA – Prostate-Specific Antigen
PSC – Primary Sclerosing Cholangitis
PUJ – Pelvi-Ureteric Junction
PVA – Polyvinyl Alcohol
PVL – Periventricular Leukomalacia
PVNS – Pigmented Vilonodular Synovitis
PWI – Perfusion Weighted Imaging
RA – Right Atrium
RBILD – Respiratory Bronchiolitis Interstitial Lung Disease
RCC – Renal Cell Carcinoma
RFA – Radio Frequency Ablation
RLL – Right Lower Lobe
RML – Right Middle Lobe
RPF – Retroperitoneal Fibrosis
RRI – Renal Resistive Index
RRMS – Relapsing Remitting Multiple Sclerosis
RSV – Respiratory Syncytial Virus
RTA – Road Traffic Accident
RTC – Road Traffic Collision
RUL – Right Upper Lobe
RV – Right Ventricle
RVOT – Right Ventricular Outflow Tract
RYGBT – Roux-en-Y Gastric Bypass Surgery
SAH – Sub-Arachnoid Haemorrhage
SAPHO – Synovitis, Acne, Palmoplantar Pustulosis, Hyperostosis and Osteitis
SBC – Solitary Bone Cyst
SBO – Small Bowel Obstruction
SCC-A – Squamous Cell Carcinoma Antigen.
SCFE – Slipped Capital Femoral Epiphysis
SCM – Split Cord Malformation
SDH – Sub-dural Hemorrhage
SLAC – Scapholunate Advanced Collapse
SLAP – Superior Labrum Anterior Posterior
SLE – Systemic Lupus Erythematosus
SMA – Superior Mesenteric Artery
SMV – Superior Mesenteric Vein
SSPE – Subacute Sclerosing Panencephalitis
STIR – Short-Tau Inversion Recovery sequence

xviii
SUFE – Slipped Upper Femoral Epiphysis

ABBREVIATIONS
SWI – Susceptibility Weighted Imaging
TA – Truncus Arteriosus
TACE – Transcatheter Arterial Chemoembolisation
TAG-72 – Tumour Associated Glycoprotein
TAPVR – Total Anomalous Pulmonary Venous Return
TB – Tuberculosis
TCC – Transitional Cell Carcinoma
TFC – Triangular Fibrocartilage
TGA – Transposition of Great Arteries
THR – Total Hip Replacement
TIPS – Transjugular Intrahepatic Portosystemic Shunt
TKR – Total Knee Replacement
TME – Total Mesorectal Excision
TOF – Tetralogy Of Falot/Time-Of-Flight
TRUP – Transurethral Resection of Prostate
TRUS – Trans Rectal Ultrasound
TS – Tuberous Sclerosis
TSH – Thyroid Stimulating Hormone
TT-TG – Tibial Tuberosity–Trochlear Groove
TURP – Transurethral Resection of the Prostate
TVS – Trans-Vaginal Scan
UAC – Umbilical Artery Catheter
UAE – Uterine Artery Embolisation
UBC – Unicameral Bone Cyst
UCL – Ulnar Collateral Ligament
UFE – Uterine Fibroid Embolisation
UIP – Usual Interstitial Pneumonia
UPJ – Uretero-Pelvic Junction
US – Ultrasound
UTI – Urinary Tract Infection
UVC – Umbilical Venous Catheter
VHL – Von Hippel–Lindau
VISI – Volar Intercalated Segment Instability
VNA – Vanillylmandelic Acid
VSD – Ventricular Septal Defect
VUJ – Vesico-Ureteric Junction
VUR – Vesico-Ureteric Reflux
XGP – Xanthogranulomatous Pyelonephritis
βhCG – beta Human Chorionic Gonadotropin

xix
 CHAPTER 1
TEST PAPER 1
Questions
Time: 3 hours
1. A 30-year-old man has been involved in an Road Traffic Accident (RTA). Aortic injury is
suspected. CT angiogram shows a fusiform dilatation at the anteromedial aspect of the aortic
isthmus with a steep contour superiorly, gently merging with the proximal descending
thoracic aorta inferiorly. What is the likely diagnosis?
A. Pseudoaneurysm
B. Coarctation of the aorta
C. Ductus diverticulum
D. Aortic nipple
E. Avulsed left subclavian artery
2. A 40-year-old man on the third cycle of chemotherapy for non-Hodgkin’s lymphoma
presents with dysphagia and odynophagia. A recent blood count revealed neutropenia.
He is referred for a barium swallow, which shows several linear ulcers with ‘shaggy borders’
in the upper oesophagus. What is the most likely diagnosis?
A. Candida oesophagitis
B. CMV oesophagitis
C. Post-radiotherapy stricture
D. TB oesophagitis
E. Pharyngeal pouch
3. A contrast CT scan shows an incidental renal cyst that is hyperdense with thick septations
and a mural nodule. What is the Bosniak classification?
A. Type 1
B. Type 2
C. Type 2F
D. Type 3
E. Type 4
4. A 33-year-old man with short stature and normal intelligence is being investigated for lower
back pain. MRI of the thoracolumbar spine shows marked central stenosis with short
pedicles. A comment of bullet-shaped vertebra with progressive narrowing of the lumbar
interpedicular distance was noted on the report. Which of the following conditions is
most likely?
A. Hurler’s syndrome
B. Congenital pituitary dwarfism
C. Achondroplasia
D. Thanatophoric dysplasia
E. Hunter’s syndrome

1
Chapter 1 TEST PAPER 1: QUESTIONS

5. A 75-year-old woman is admitted under the physicians with confusion and dementia. She
has a history of spontaneous intracranial haemorrhage and has been diagnosed with
amyloid angiopathy. The most specific MR sequence for diagnosis of multifocal intracranial
cortical–subcortical microhaemorrhages in cerebral amyloid angiopathy is:
A. T1W spin echo
B. STIR
C. T2W spin echo
D. Gradient echo
E. FLAIR

6. Regarding sporting injuries involving the upper limbs, all of the following statements are
correct, except:
A. Anomalous anconeus epitrochlearis muscle results in Posterior Interosseous Nerve (PIN)
entrapment.
B. Atrophy of extensor muscles can be seen in chronic PIN neuropathy.
C. Partial thickness tears of the biceps can involve either the long or short heads.
D. Cubital tunnel syndrome is the most common elbow neuropathy.
E. Oedema of flexor carpi ulnaris and ulnar nerve thickening suggests cubital tunnel
nerve entrapment.

7. An obese 25-year-old man presents with atypical chest pain. Cardiac MR demonstrates
asymmetrical hypertrophy of the interventricular septum, primarily affecting the
anteroinferior portion. What is the most likely diagnosis?
A. Hypertrophic obstructive cardiomyopathy
B. Restrictive cardiomyopathy
C. Myocardial infarction
D. Dilated cardiomyopathy
E. Constrictive pericarditis

8. A 65-year-old diabetic with a history of alcohol excess is referred for a barium swallow
following a history of dysphagia. The study shows several small, thin, flask-shaped structures
along the cervical oesophagus oriented parallel to the long axis of the oesophagus. What is the
most likely diagnosis?
A. Feline oesophagus
B. Pseudodiverticulosis
C. Glycogenic acanthosis
D. Traction diverticulum
E. Idiopathic eosinophilic oesophagitis

9. A 21-year-old woman with infertility undergoes US that shows a 2-cm right adnexal mass
with posterior acoustic enhancement. Another multilocular cyst is seen in the left ovary.
Further evaluation with MR shows multiple small lesions in both the ovaries and pouch of
Douglas, which were hyperintense on fat-suppressed T1W images with shading sign on
T2W images. What is the likely diagnosis?
A. Dermoid
B. Endometrioid carcinoma of the ovary
C. Endometriosis
D. PCOS (polycystic ovarian syndrome)
E. Pelvic inflammatory disease

10. A young man presents to the ENT clinic with deepening of the voice. Going through his
history and clinical notes, the consultant reviews a recent plain radiograph report of his

2
 Chapter 1 TEST PAPER 1: QUESTIONS
hands, which describes cystic changes in the carpal bones along with enlarged phalangeal
tufts and metacarpals. What is the next appropriate imaging investigation?
A. CT brain pre- and post-contrast
B. MRI brain
C. MRI pituitary pre- and post-contrast
D. Chest X-ray
E. Lateral view of the skull
11. A 77-year-old man with gradual onset dementia shows multifocal abnormalities on cranial
CT and MRI. He has been recently diagnosed with amyloidosis. All of the following
conditions may be present in central nervous system amyloidosis, except:
A. Occurrence in elderly patients
B. Multifocal subcortical intracranial haemorrhages
C. Cerebral and cerebellar atrophy
D. Non-communicating hydrocephalus
E. Typical occurrence in normotensive patients
12. An 11-year-old boy with left shoulder pain has a shoulder X-ray, which shows a lucent lesion
in the metaphysis. This has distinct borders and lies in the intramedullary compartment. It is
orientated along the long axis of the humerus. What is the most likely diagnosis?
A. Aneurysmal bone cyst
B. GCT
C. Simple bone cyst
D. Chondroblastoma
E. Non-ossifying fibroma
13. A 50-year-old secretary presents with epigastric pain, nausea and weight loss. She also complains
of bilateral swollen ankles. She is referred for a barium meal as she is unable to tolerate an
oesophago-gastroduodenoscopy (OGD). The examination shows thickened folds in the fundus
and body of the stomach; the antrum was not involved. What is the most likely diagnosis?
A. Nephrotic syndrome
B. Lymphoma
C. Eosinophilic gastroenteritis
D. Leiomyoma
E. Ménétrier’s disease
14. A 58-year-old woman undergoes an echocardiogram followed by cardiac MRI for
investigation of exertional dyspnoea. The cardiac MRI was reviewed at the X-ray meeting,
and the radiologist diagnosed concentric hypertrophic cardiomyopathy. Which of
the following did the radiologist see?
A. Thickening of the interatrial septum at 7 mm
B. Thickening of the entire LV wall measuring 17 mm at end diastole
C. Nodular high signal in the interventricular septum on T2
D. Thickening of the LV wall measuring 14 mm with normal systolic function
E. Thickened LV with delayed hyperenhancement of midwall
15. A 50-year-old builder is involved in a high-speed RTA. CT is performed according to trauma
protocol, demonstrating extra-peritoneal rupture of the bladder. Which of the following best
describes this?
A. Contrast pooling in the paracolic gutters.
B. Contrast outlining small bowel loops.
C. Flame-shaped contrast seen in the perivesical fat.
D. CT cystogram is usually normal.
E. Intramural contrast on CT cystogram.

3
Chapter 1 TEST PAPER 1: QUESTIONS

16. An elderly patient on long-term dialysis presents to the orthopaedic clinic with right shoulder
pain. Plain films show juxta-articular swelling and erosions of the humerus, but the
joint space is preserved. MRI shows a small joint effusion and the presence of low- to
intermediate-signal soft tissue on all sequences covering the synovial membrane
extending into the periarticular tissue. What is the likely diagnosis?
A. Amyloid arthropathy
B. Gout
C. Calcium pyrophosphate deposition disease (CPPD)
D. Pigmented villonodular synovitis (PVNS)
E. Reticuloendotheliosis
17. A 33-year-old woman with recurrent episodes of optic neuritis with waxing and waning upper
limb weakness is referred for an MRI brain with high suspicion of demyelination. All of
the following are MR features of acute multiple sclerosis (MS) lesions of the brain, except:
A. High signal intensity on FLAIR
B. ‘Black hole’ appearance
C. Incomplete ring-like contrast enhancement
D. Increase in size of lesion
E. Mass effect
18. A 14-year-old boy complains of left knee pain and limp. He also has medial thigh pain.
On examination, he has full range of movement with some discomfort on internal
rotation. AP and lateral X-rays of the knee and femur are normal. What is the next
investigation?
A. CT
B. Bone scan
C. MRI
D. Frog leg lateral of the hips
E. US
19. A 30-year-old woman presents with shortness of breath and fatigue. CT shows enlargement
of the right atrium, right ventricle and pulmonary artery and normal appearance of the left
atrium. What is the most likely diagnosis?
A. VSD – Ventricular Septal Defect
B. ASD – Atrial Septal Defect
C. Bicuspid aortic valve
D. Coarctation of the aorta
E. Mitral valve disease
20. A 50-year-old man is referred to a gastroenterologist with a 6-month history of intermittent
epigastric pain and nausea. He is referred for a barium meal test due to a failed OGD –
oesophago-gastroduodenoscopy. The study shows an ulcer along the lesser curve of the
stomach. Which of the following is a malignant feature of a gastric ulcer?
A. The margin of the ulcer crater extends beyond the projected luminal surface.
B. Carman meniscus sign.
C. Hampton’s line.
D. Central ulcer within mound of oedema.
E. The ulcer depth is greater than the width.
21. Which of the following characteristics is typical of prostate cancer?
A. Low on T1 High on T2
B. Low on T1 Low on T2
C. Isointense on T1 High on T2

4
 Chapter 1 TEST PAPER 1: QUESTIONS
D. High on T1 High on T2
E. Isointense on T1 Isointense on T2

22. An eccentric expansile lesion in the metaphysis of the humerus is noted incidentally following
a routine plain radiograph investigation in a young patient following a rugby tackle. MRI
performed for further characterisation shows multiple cystic spaces, some with blood fluid
level, with an intact low-signal periosteal rim. What is the diagnosis?
A. Unicameral bone cyst
B. Aneurysmal bone cyst
C. Eosinophilic granuloma
D. Enchondroma
E. Fibrous dysplasia
23. A 34-year-old woman with previous history of upper limb weakness that resolved
spontaneously and optic neuritis was referred for an MRI brain. MRI confirms the presence
of bilateral periventricular hyperintensities on FLAIR with abnormal signal in the corpus
callosum and middle cerebellar peduncles. MRI also shows signal abnormality in the
right optic nerve. Which portion of the optic nerve does Multiple sclerosis (MS) most
commonly affect?
A. Intra-orbital.
B. Intracanalicular.
C. Intracranial.
D. Chiasmatic.
E. All portions are equally susceptible.

24. A newborn baby has US of the spine. At which level is the conus expected to be?
A. Above L1
B. Above T12
C. L2 to L3
D. L3 to L4
E. S2

25. A middle-aged woman presents with cough and haemoptysis. Her chest X-ray reveals a large
ovoid mass in the right lower lobe. She has a known history of Osler–Weber–Rendu
syndrome. What is the most appropriate next imaging investigation that you will organise?
A. MRA of the pulmonary artery
B. CTPA
C. CTPA with portal phase images covering the liver
D. Chest HRCT
E. Conventional pulmonary angiography

26. A nursing home resident is found to have a lung tumour and undergoes CT staging of
the chest and abdomen. This reveals a discrete lesion medial to the second part of the
duodenum with a fluid–fluid level. What is the most likely diagnosis?
A. Duplication cyst
B. Duodenal diverticulum
C. Duodenal web
D. Annular pancreas
E. Adenocarcinoma of the duodenum

27. Which of the following is false?

A. Skene cyst Lateral to external urethral meatus
B. Nabothian cyst Lateral to the endocervical canal

5
Chapter 1 TEST PAPER 1: QUESTIONS

C. Gartner’s dust cyst Posterolateral aspect of the upper vagina

D. Bartholin’s cyst Posterolateral aspect of the vagina
E. Urethral diverticulum Posterolateral aspect of mid-urethra

28. A 31-year-old man who is known to the gastroenterologist and rheumatologist presents to the
ophthalmology department with visual disturbances. A pelvic radiograph done a year ago
in the emergency department showed whiskering of the ischial tuberosities and greater
trochanters, with symmetrical sclerosis of both sacroiliac joints. What is the most
likely diagnosis?
A. Reiter syndrome
B. Behcet’s syndrome
C. Ankylosing spondylitis (AS)
D. Rheumatoid arthritis
E. Systemic lupus erythematosus (SLE)

29. A 36-year-old woman with resolving limb weakness and previous history of optic neuritis is
diagnosed as having relapsing remitting multiple sclerosis (RRMS). Which of the following
statements concerning MS imaging is incorrect?
A. Black holes correlate well with clinical outcome.
B. Brain atrophy is higher in MS than normal ageing.
C. The pattern of brain atrophy can mimic Alzheimer’s disease.
D. Diffusion tensor imaging demonstrates structural damage to the white matter.
E. MS lesions have low MTR (Magnetisation Transfer Ratio) representing myelin loss.

30. A 3-year-old presents as acutely unwell with a maculopapular rash, lymphadenopathy and
erythema of her palms. Her white cell count is normal, and a specific cause for her symptoms
is not found. She improves on immunoglobulins and supportive treatment. A follow-up
echocardiogram shows cardiomegaly and a coronary artery aneurysm. What is the
likely diagnosis?
A. Takayasu arteritis
B. Kawasaki arteritis
C. Moyamoya syndrome
D. Henoch–Schonlein purpura
E. Churg–Strauss syndrome

31. A 76-year-old male patient with chronic inflammatory disease and known history of
secondary generalised multisystem amyloidosis showed an abnormal appearance of the
heart on echocardiography. Dynamic enhanced cardiac MR imaging was advised for
further characterisation. All of the following are imaging findings seen with cardiac
amyloidosis, except
A. Left ventricular wall hypertrophy
B. Subendocardial delayed myocardial hyperenhancement
C. Systolic dysfunction
D. Granular echogenic myocardium
E. Interatrial septal thickening

32. A taxi driver has had recurrent episodes of abdominal pain. On CT, a lesion is seen within the
head of the pancreas. Pancreatic duct dilatation is noted with a normal CBD and atrophy of
the body and tail of the pancreas. ERCP demonstrates thick mucous material discharging
from the bulging papilla. What is the most likely diagnosis?
A. Mucinous cystadenocarcinoma
B. Serous cystadenocarcinoma

6
 Chapter 1 TEST PAPER 1: QUESTIONS
C. Main duct IPMN (Intraductal Papillary Mucinous Neoplasm)
D. Pancreatic pseudocyst
E. Pancreatic adenocarcinoma
33. A 55-year-old man with several episodes of epididymo-orchitis in the past has an ultrasound
of the scrotum. The radiologist performing the scan notices several hypoechoic structures
within the mediastinum testis and incidental epididymal cysts. There was no Doppler flow.
What is the most likely diagnosis?
A. Lymphoma of the testes
B. Cystic dysplasia of the testis
C. Seminoma
D. Abscess
E. Cystic transformation of rete testis

34. An elderly woman presents with progressive atraumatic pain within her right knee over the
course of the last month, particularly on the medial aspect, associated with functional
impairment. Her clinical history includes a meniscal tear, which was treated arthroscopically
10 years ago with a good outcome. An MRI reveals florid marrow oedema within the
medial femoral condyle associated with mild flattening of the weight-bearing surface.
What is the diagnosis?
A. Perthe’s disease
B. Sinding–Larsen’s disease
C. Blount’s disease
D. Spontaneous osteonecrosis of the knee
E. Osteochondral defect
35. A known MS patient has presented to the neurologist with clinical features of involvement of
the spinal cord. An MRI of the whole spine has been requested with a view towards
assessment of the cord for possible multiple sclerosis (MS) plaques. MS lesions in the spinal
cord occur most commonly in the
A. Cervical segment.
B. Thoracic segment.
C. Lumbar segment.
D. Sacral segment.
E. All segments are equally affected.
36. A neonate presents with non-bilious vomiting with a palpable upper abdominal lump. Which
of the following US findings would not be in keeping with pyloric stenosis?
A. Pyloric muscle thickness 3.5 mm
B. Target sign
C. Pyloric canal length 14 mm
D. Antral nipple sign
E. Cervix sign
37. A child with exertional dyspnoea and abnormal chest X-ray showing a boot-shaped heart and
oligaemic lungs is diagnosed as suffering from tetralogy of Fallot. The pulmonary oligaemia is
secondary to right ventricular outflow tract (RVOT) obstruction. Which of the following is
the most common implicated cause for obstruction of RVOT?
A. Hypoplastic pulmonary annulus
B. Pulmonary valvular stenosis
C. Infundibular stenosis
D. Combined infundibular and pulmonary valvular stenosis
E. Overriding ventricular septum

7
Chapter 1 TEST PAPER 1: QUESTIONS

38. A 50-year-old man presents with recurrent episodes of abdominal pain. Blood amylase
is normal. Chronic pancreatitis is suspected. All of the following statements regarding
MRI imaging in chronic pancreatitis are true, except
A. MRI has a poor sensitivity for detecting parenchymal calcification in chronic
pancreatitis.
B. MRI allows evaluation of the ductal system for strictures and stones, debris within
pseudocysts and fistula.
C. MRI shows good sensitivity for the differential diagnosis of focal chronic pancreatitis
from pancreatic carcinoma.
D. Both focal chronic pancreatitis and pancreatic carcinoma demonstrate abnormal
post-contrast enhancement on MRI.
E. Both focal chronic pancreatitis and pancreatic carcinoma demonstrate low signal
intensity of the pancreas on T1W fat-saturated images.

39. A 60-year-old heavy smoker presents with haematuria. US KUB shows a midline fluid-filled
cavity with mixed echogenicity and calcification adjacent to the bladder wall. CT shows a
focal low-attenuation enhancing mass along a cord-like structure extending from the
bladder to the umbilicus. What is the most likely diagnosis?
A. Complex urachal cyst
B. Vescico urachal diverticulum
C. Urachal adenocarcinoma
D. Transitional cell carcinoma
E. Urachal rhabdomyosarcoma

40. A 10 × 7 mm dense ossified focal lesion is noted in the neck of the right femur of a young
man incidentally on a pelvic radiograph performed for an unrelated reason. The lesion
has benign features and is consistent with a bone island (enostosis). No follow-up is
suggested. All of the following are true of bone islands, except
A. If more than 2 cm, they are classified as a ‘giant’ bone island.
B. They have a sclerotic appearance on imaging.
C. They show a characteristic brush border on plain films.
D. They can be positive on a bone scan.
E. Giant bone islands can be locally aggressive.

41. A patient recently diagnosed with MS has been sent for an MRI of the whole spine to detect
possible spinal plaques. All of the following are MR features of spinal cord lesions
in MS, except
A. The sole site of involvement (in some cases).
B. Imaging features similar to those of MS lesions in the brain.
C. Most lesions are centrally located.
D. The length rarely exceeds two vertebral segments.
E. Dorsal column involvement.

42. Barium enema of a neonate shows an inverted cone shape at the rectosigmoid colon. There
is marked retention of the barium on delayed post-evacuation films after 24 hours.
The cause for this is
A. Meconium ileus
B. Meconium plug syndrome
C. Hirschprung’s disease
D. Imperforate anus
E. Hyperplastic polyp of colon

8
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 ULCERATIVE STOMATITIS IN SOLIPEDS.

Causes. Apart from the ulcerations and erosions of specific

diseases (glanders, horsepox, pustulous stomatitis, aphthous fever,
etc.,) this condition is especially liable to appear in anæmic and
debilitated subjects (Cauvet), as in rachitis (Friedberger and
Fröhner), cancer (Cadeac) chronic internal abscess (Cadeac), etc. As
an exciting cause and as a means of furnishing an infection atrium
for the microbes of ulceration all conditions of simple lesion of the
mucous membrane—mechanical, chemical, thermic, venomous, etc.,
are operative. Dieckerhoff has described it in connection with
diphtheritic rhinitis, Friedberger with a nasal and conjunctival
catarrh, Zeilinger and Kohler with aphthous fever, Mobius and
Hackbarth with trefoil poisoning.
Lesions and Symptoms. There is the usual dainty feeding and
disposition to masticate imperfectly or even to drop the partly
insalivated morsels, working of the lips, the formation of froth on
their margins, and the drivelling of saliva in long strings or filaments.
As the disease advances this becomes bloody and fœtid. The local
lesions may be at first like white pulpy spots of softened and
degenerating epithelium, which is exceptionally, raised in blisters.
This is followed by desquamation and the formation of open sores
which are indolent, and show a disposition to further erosion and
extension. They may be rounded or irregularly indented in their
borders, and contain a brownish, blackish or greenish viscid debris.
They vary widely, however, in general appearance and in their
disposition to speedy or sluggish healing, being apparently
influenced by the nature of the pathogenic microbe and the
susceptibility of the subject. In some cases the molecular
degeneration extends deeply into the mucosa, and even over the
edges of the lips into the adjacent skin. Recovery and complete
cicatrization may take place in one week, or successive outbreaks
may take place in the same animal lasting in all for months as in
Cadeac’s case associated with chronic abscess of the mesentery.
Treatment. The first consideration is to correct the debility on
which the affection is based. Iron and bitter tonics, mineral acids,
and nourishing food given in the form of soft mashes, pulped roots,
or farinas, which will require little mastication, and the antiseptic
cleansing of the mouth after each meal are the main features of the
treatment. As antiseptics, vinegar is inimical to the microbes of the
mouth, which affect alkaline media, borax, boric acid, carbolic acid,
sulphurous acid, the sulphites and hyposulphites, permanganate of
potash, chlorate of potash, creolin, and sulphate or chloride of iron
furnish a sufficient choice of comparatively nontoxic agents. Ulcers
may be touched with tincture of iodine, lunar caustic, or sulphate of
copper.
 ULCERATIVE STOMATITIS (DIPHTHERIA)
IN CALVES.
Accessory causes. Infection. Experimental inoculation. Bacillus, grows on blood
serum. Lesions in mouth, nose, air passages, intestines, digits. Symptoms: difficult
sucking, fever, swollen, whitish spots on buccal mucosa, phagadenic sores, fœtor,
symptoms of extending disease, anorexia, debility, prostration. Duration.
Diagnosis from foot and mouth disease, from actinomycosis, from tuberculosis.
Prevention: cleanliness, antisepsis, segregation, diet of dam, sterilized milk.
Treatment: antiseptic and eliminating: locally antiseptic.
This has been observed at frequent intervals in calves, as a serious,
fatal, communicable disorder occurring in the first few weeks of life.
Causes. It has been attributed to unhygienic conditions of the
dams, close, damp, impure stables, unwholesome or spoiled food,
and privations of various kinds, and these, in all probability, increase
the susceptibility. The congestion and traumatism connected with
the cutting of the teeth is another predisposing cause. The ultimate
cause is, however, the contagious element and the disease has been
conveyed to healthy lambs by the introduction into their mouths of
the necrotic products from the diseased subjects (Dammann). Sheep
inoculated in the conjunctiva presented violent conjunctivitis in
forty-eight hours. Inoculated rabbits died of septicæmia. Mice
showed the same symptoms as calves, while guinea pigs showed an
abscess only at the seat of inoculation (Löffler).
The identity of the germ has not been fully demonstrated.
Dammann found a micrococcus, but testimony from the inoculation
of its pure cultures is wanting, and the buccal mucosa of the sucking
calf is full of varied germs some of which are irritating and
pathogenic to an injured mucosa.
Löffler found in the epithelial concretions (false membranes) of
the mouth and intestines, a bacillus of half the thickness of the
bacillus of malignant œdema, five times as long as broad and usually
connected with its fellows to form filaments. He failed to obtain
cultures of this in nutrient gelatine, but grew it successfully in blood
serum from a calf. Transferred to fresh serum the culture failed. The
pure culture does not seem to have been tried on the calf.
According to Dammann the lesions occur indiscriminately in the
mouth, the nose, the larynx, trachea, lungs, the intestinal canal and
the interdigital space.
It has been suggested that the mouth of the calf rendered
susceptible by the congestion caused by suction, is infected by licking
the previously infected umbilicus.
Symptoms. There are the usual symptoms of indisposition to suck,
salivation, redness of the buccal mucosa, and general indisposition.
In two or three days the mucosa shows raised, pulpy, white or
grayish patches about a line in diameter. These gradually soften and
break down and in four or five days leave dark red angry sores one-
sixth to one-third inch in diameter dotted with grayish points and
surrounded by a congested areola. These exhale an offensive odor
and tend to extend in superficial area and in depth, invading
indiscriminately the various subjacent tissues. The lips may be
perforated, the muscles, cartilages, periosteum, and periodontal
membrane invaded, the teeth may be shed, and the alveoli filled with
the offensive debris of ulceration. Swelling of the throat may follow
from implication of the pharynx and its lymph glands, symptoms of
laryngitis, bronchitis, and pneumonia may succeed, also infective
gastritis and enteritis. These various parts may be infected by the
direct transference of the infecting saliva, but the germ is also held to
be transmitted through the blood to implicate distant organs.
Appetite is gradually lost, a blackish, fœtid diarrhœa, sets in and
the calf is sunk in a profound prostration and debility due partly to
the enforced abstinence and colliquative diarrhœa, but much more to
the absorption of toxic matters. Death may ensue from the sixth to
the twelfth day. In case of recovery a month may be requisite for the
completion of convalescence.
Diagnosis. This has to be distinguished especially from aphthous
fever by the absence of the large, and clearly defined vesicles of that
disease, by the fact that the mammary region and interdigital spaces
usually escape, and especially by the immunity of the dam and of
other more mature animals. From actinomycosis of the tongue it is
diagnosed by its more rapid progress, by the marked constitutional
depression, and prostration, and by the absence of the marked
induration of the actinomycotic organ (holzzunge) and by the
sulphur yellow pin head-like nodules of actinomyces. Tuberculosis is
rare in the first weeks after birth in calves, and never makes the rapid
progress nor causes the profound depression of this disorder.
Prevention. The first object must be to destroy the infection, and
the second to obviate the susceptibility of the young animal. The
clearing away of all accumulations of litter, filth, and even fodder
from the stable proper, including the stalls where the dams lie,
should be followed by a thorough whitewashing or disinfection, with
sulphate of copper or of iron, or even mercuric chloride, (1:500.) If
the disease has already appeared in a stable the calves should be
penned singly to avoid the possibility of infection through sucking
each others navels. In all cases an antiseptic (tannin, carbolic acid)
should be applied to the navel of the new born. The food of the dam
and nurse should be nutritive and free from any suspicion of
mustiness or decomposition, and when possible the calf should be
allowed to draw its own milk from the teat. When this cannot be
allowed, artificial feeding should be surrounded by all the
safeguards, named under acute indigestion of calves.
Treatment. Cadeac strongly recommends ½ oz. common salt daily
with the food, or alcohol ¾ oz., or a strong infusion of coffee mixed
with the milk. Lenglen advises quinoa in the form of tincture, ½ to 1
oz. McGillivray sulphate of soda. Tincture of chloride of iron 30
drops in an ounce of water with each meal would be an excellent
resort.
Locally antiseptics are our main reliance. Naphthol, naphthalin,
salicylic acid, or salicylate of soda, may be applied directly to the
diseased mucous membrane. Tincture of chloride of iron in water
(1:2) is one of the best agents (James). Carbolic acid 1 drachm in 6
oz. water, and 1 oz. alcohol has been used safely and with excellent
results (Lenglen). Like most other antiseptics, however, this latter
must be used with caution as regards the amount. No actively
poisonous antiseptic is admissible. The antiseptic should be swabbed
over the whole interior of the mouth after each meal.
In case of deep gangrenous masses excision and antiseptics are
demanded.
 ULCERATIVE STOMATITIS IN LAMBS AND
KIDS.
Causes: Accessory, locality, youth, debility, unsuitable food, impure air,
parasitism, contagion. Bacteria. Symptoms: difficult sucking, frothing, salivation,
buccal redness and swelling, white, softened patches, suppuration, granulation,
fœtor, emaciation, debility, bowel symptoms, respiratory. Duration. Treatment:
Artificial feeding, antisepsis, disinfection, mild caustics, etc.
Causes. This has been noticed as an enzootic affection in young
and debilitated animals, while the mature and more robust ones
escape. Anæmic lambs, those that are fed on watery, innutritious
materials (potatoes, grains, waste of sugar factories), those kept in
close confinement, indoors, and those that suffer from distomatosis
show the disease. Impure air, damp, dark places and impure water
have their influence. The disease is manifestly contagious, but the
infecting microbe has not been demonstrated. It was formerly
supposed to be the oidium albicans, the fungus of muguet, but
Neumann demonstrated its absence, and though he found leptothrix
buccalis, bacilli, spirochcæte and micrococci he failed to show that
any one of these in pure culture would cause the disease. Rivolta
charged it on bacterium subtile agnorum and Berdt on the
polydesmus exitiosus which according to him the sheep contract
from eating rape cake. The withdrawal of the cake led to a rapid
recovery.
Symptoms. The disease may begin insidiously without at first very
marked symptoms. Sucking is painful and infrequent, an acid froth
collects about the mouth, and white patches appear on the gums or
other part of the buccal mucosa, with at times redness and swelling,
and the separation of the gums from the teeth. The white epithelial
patches soften and are easily detached, leaving bright red patches,
which bleed easily, and tend to extension and coalescence. These are
covered by a viscid mucopurulent matter, and may become the seat
of granulations, or they may involve the subjacent tissues in
ulceration causing evulsion of the teeth, or necrosis of the jaw bone.
The odor of the mouth is fœtid. Prostration and emaciation set in,
and often bear a ratio to the extension of the disease to the digestive
and respiratory organs. This is manifested by uneasy movements of
the hind feet, shaking of the tail, frequent lying down and rising,
constipation or diarrhœa: or by cough, snuffling breathing, swelling
of the submaxillary and pharyngeal glands, and hurried, oppressed
breathing. The complication of vesicular and pustular eruption has
been noticed. Death may occur in eight or ten days, or more
commonly recovery ensues.
Treatment must proceed on the same lines as in the calf. Artificial
feeding on gruels, with antiseptic washes for the mouth at each meal
are indicated. Chlorate of potash, chloride of lime, borax, sulphites
and hyposulphites of soda, carbolic acid, and the salts of iron afford
an ample field for selection. For ulcers, a pointed stick of nitrate of
silver, or a solution of muriatic acid in three times its volume of
water, applied by means of a glass rod or pledget of cotton will serve
a good purpose.
 ULCERATIVE STOMATITIS IN SWINE.

Causes: improper food; filthy pens; debility; toxins of specific diseases;

microbian infection. Symptoms: inappetence; grinding teeth; champing jaws;
salivation; fœtor; buccal swelling and redness; pulpy spots; desquamation; ulcers;
pharyngeal, enteric and osseous complications. Treatment: Segregation;
disinfection; local antiseptic washes; tonics.

This is the Scorbutus of Friedberger and Fröhner, the gloss-

anthrax of Benion.
Causes. It has been attributed to insufficient or irritant food, to
damp, close pens, and to chronic debilitating diseases and all these
act as predisposing causes. In gastritis and in infectious fevers like
hog cholera, swine plague, and rouget (hog erysipelas) the spots of
congestion and petechiæ on the buccal mucous membrane may
become the starting points for ulcerative inflammations. These
conditions appear, however, to be supplemented by infection from
bacteria present in the mouth or introduced in food and water, and
as in the case of other domestic animals the most successful
treatment partakes largely of disinfectant applications.
Symptoms. Loss of appetite, grinding of the teeth, champing of the
jaws, the formation of froth round the lips, fœtor of the breath,
redness of the gums and tongue, and the formation of vesicles or
white patches which fall off leaving red angry sores. These may
extend forming deep unhealthy ulcers, with increasing salivation and
fœtor. As the disease advances the initial dullness and prostration
become more profound, and debility and emaciation advance
rapidly. Unless there is early improvement an infective pharyngitis,
or enteritis sets in, manifestly determined by the swallowing of
virulent matters from the mouth, and swelling, redness and
tenderness of the throat, or colics and offensive black diarrhœa
hasten a fatal issue. Rachitis may be a prominent complication, as it
seems in some instances to be a predisposing cause.
Treatment. Isolate the healthy from the diseased and apply
disinfection to all exposed articles and places. Employ local
antiseptics as on the other animals. Sulphuric or hydrochloric acids
in 50 times their volume of water, or tincture of iron, chlorate of
potash, or chloride of ammonia, or borax have been used
successfully. Bitters and aromatics have also been strongly
recommended.
 ULCERATIVE STOMATITIS IN CARNIVORA.
Causes: dietary causes; constitutional debilitating diseases; dental disorders;
microbian infection; microbes. Symptoms: difficult sucking or mastication;
salivation; dullness; prostration; mucosa red with gray patches, erosions, and
ulcers; fœtor; loose teeth; excess of tartar. Extensions to face, throat, lymphatics,
nose, eyes, stomach, liver, bowels. Duration. Treatment: clean teeth; antiseptics;
mild caustics; stimulants.
Causes. This affection is more common in this class of animals
than in the herbivora, being apparently dependent in great part on
their artificial habits of life, the sweet and stimulating diet and the
derangement of the digestive organs. The lowering of the general
health in connection with privation or disease and especially canine
distemper, rachitism or indigestion must be recognized as
predisposing causes, while the accumulation of tartar on the teeth, or
the decay of the teeth themselves, constitutes a potent exciting local
cause. In connection with such cretaceous deposits the decomposing
elements of the food collect, and the irritant products of their
fermentation lead to disease of the gums, congestion and ulceration.
Superadded to this is the bacteridian infection of such diseased
parts, through which the ulceration is started, maintained and
extended. This infection is not that of a specific microbe, but usually
of a multiplicity of germs, one or more of the bacteria that live
habitually in the healthy mouth, taking the occasion of the existence
of a wound, or of a reduction of vitality to colonize the mucosa which
would otherwise have remained sound. The microbes actually found
in the ulcers are very varied. Pasteur isolated a spirillum, Fiocca the
bacillus salivarius septicus, others have found pus bacilli, and in
sucking kittens the bacillus coli communis.
But the attempts made to convey the disease to healthy mouths by
the transfer of the microbes have usually failed (Pasteur, Netter,
Cadeac). To establish their pathogenic action therefore, it appears to
be necessary to furnish a susceptible mucosa as well as an infecting
microbe. This explains why the disease does not spread as an
infection, the average mouth is immune and it is only when it
becomes the seat of a wound, bruise or other injury, or when the
general system has become so reduced that the resisting power is a
minor quantity, that the hitherto harmless germ becomes actually
pathogenic.
Symptoms. There is indisposition to suck or eat, the patient leaves
the teat or the food, and looks dull, depressed and disposed to lie
down apart. There is evident salivation and on opening the mouth we
may find the offensive odor, the tartar covered teeth with red or
ulcerated gums, and on the cheeks, lips and tongue dark red patches
of congestion, or whitish or yellowish gray, soft, pulpy spots of
disintegrating epithelium. This is followed by shedding of these
epithelial patches, and the formation of rounded ulcers of a line in
diameter or less. These are tender, and bleed readily. They may
extend to the skin of the lips, or deeply into the mucosa, the muscles
or bones, and the attendant morbid process may cause loosening and
evulsion of the teeth. There may be implication of the pharynx, the
lymph glands, the nose, the eyes, the stomach, the liver, or the
intestines with corresponding symptoms. Death may supervene in
from six to thirty days, or a more or less speedy recovery may take
place.
Treatment. The first step as a rule is to remove the tartar from the
teeth. This is often done with a wooden spud dipped in a weak
solution of hydrochloric acid. A steel scraper will usually act well and
without the solvent action of the acid.
Next will come the removal of all diseased teeth which are
operating as local irritants and as centres for infectious microbes and
their hurtful products.
Then antiseptics in the form of liquids applied as in the other
animals with each meal, will be necessary to counteract infective
action, and give the tissues an opportunity to re-establish their
integrity. Cadeac recommends a 10 per cent. solution of oil of thyme,
as a safe and efficient application. Boric acid, borax, salol, salicylic
acid, tannic acid, sulphurous acid, or carbolic acid largely diluted
may be substituted. Internally iron tonics and bitters are of great
value in improving the tone of the system and securing antisepsis of
the intestinal canal. The sulphites too may be given with advantage
internally. In depressed conditions alcoholic stimulants may be used
both as local antiseptics and general stimulants. As in other animals
ulcers may be touched with a rod dipped in tincture of iodine, or a
strong solution of chloride of zinc, or nitrate of silver.
 MERCURIAL STOMATITIS.
Animals suffering. Causes: mercurial baths, ointments, blisters and surgical
dressings; mercurial vapors; deposits on vegetation; rat poisons; malicious
poisoning. Lethal dose in horse, ox, sheep and goat. Mature and old eliminate
more slowly. Symptoms; Salivation; red, swollen buccal mucosa; gingivitis;
loosening of teeth; fœtor; ulceration; anorexia; gastro-intestinal tympany; loose,
fœtid stools; fever; weakness; dyspnœa; langor; blood extravasation in nose,
mouth, throat, bowels, womb, skin; abortion; skin eruptions. Lesions in mouth,
stomach, intestines, serosæ, kidneys, muscles, encephalon. Treatment; stop the
introduction of mercury; as antidote potassium sulphide; emetic; cathartic;
mucilaginous and albuminous antidotes; potassium iodide as an eliminating agent.
Locally potassium sulphide or chlorate. Iron tonics.
This has been especially seen in the sheep, dog and ox, and less
frequently in other domestic animals.
Causes. In sheep the use of baths containing corrosive sublimate,
or of mercurial ointment for acariasis or other cutaneous parasitism.
In other animals it comes mostly from licking mercurial dressings
applied to the skin—calomel, red precipitate, mercurial ointment,
protoiodide of mercury. The red iodide being more irritating is less
frequently taken in. The modern extensive usage of mercuric
chloride solutions as surgical antiseptics opens up a new channel of
infection. In the injection of the uterus or of large abscesses, or in the
daily irrigation of large wounds a dangerous amount may be
absorbed. The application of this agent as a caustic in cases of
tumors is correspondingly dangerous. Vapors from metallic mercury
in confined spaces as in ships’ holds, or from fires on which the
mercurial compounds have been thrown, are ready means of
poisoning, acting primarily on the air passages and lungs and later
on the mouth. The condensation of mercury on vegetation and other
food products in the vicinity of factories where mercury is handled
(Idria) affects domestic animals directly. Finally the small animals
are poisoned by eating the mercurial rat poisons, and all animals are
subject to malicious mercurial poisoning, with sublimate especially.
Stomatitis with fatal pharyngitis and enteritis will result in the
horse from 2 drs. of corrosive sublimate. About one-half of this may
poison the ox, and one-fourth the sheep or goat. Ruminants are more
susceptible to the toxic action of mercury than monogastric animals,
one evident reason being the long delay of the successive doses in the
first three stomachs, so that finally a large quantity passes over at
once into the fourth stomach and duodenum for absorption. The old
too are more readily poisoned than the young, as the functions of the
kidneys are more impaired in age and the poison is not eliminated
with the same rapidity.
Symptoms. Mercurial stomatitis is a local manifestation of a
general poisoning. Salivation is one of the most prominent
phenomena, the watery saliva falling in streams from the angles of
the mouth. The buccal mucosa generally becomes red and swollen
and the tongue becomes indented at the edges by pressure against
the molars. The gums especially suffer and the teeth raised in their
sockets by the swelling of the periodontal membrane, become loose,
and easily detached. The mucosa of the gums becomes soft and
spongy, bleeds readily under pressure and soon shows erosions and
ulcers. This condition extends to the lips, cheeks and lower surface of
the tongue while the upper surface of the latter organ, the fauces and
pharynx commonly escape. The breath and buccal exhalations are
very offensive, and the animal loathes food, and has little power of
mastication or deglutition. Sometimes the ulcers extend even to the
bones.
Along with these local symptoms there are usually gastro-
intestinal irritation, tympany, inappetence, continuous rumbling in
the belly; badly digested fœtid stools, often diarrhœa, small weak
pulse, hyperthermia, accelerated breathing, cough, and great langor
and prostration. A tendency to blood extravasation is shown in
sanguineous fæces, epistaxis, bleeding from the mouth, the throat or
the womb and even into the skin. Pregnant females may abort. The
eyes are dull and sunken, and the conjunctiva yellow. Eczematous or
pustular eruptions may appear on the skin on the nose, lips, neck,
back, loins, croup or perineum.
Lesions. In addition to the lesions described above, there are
usually gastro-intestinal inflammation, œdema of the peritoneum
and pleura, in the lung as well as in the serosæ, (pneumonia is not
uncommon especially in sheep), intestines, kidneys and muscles,
hæmorrhagic spots are not uncommon, the blood forms a loose black
coagulum, and the encephalon is anæmic and softened.
 Treatment. The first consideration is to cut off the supply of
mercury. Mercurial applications on the skin should be washed off
with tepid water and if necessary soap. An application of sulphide of
potassium will precipitate the mercury in an insoluble form. For
mercurial agents in the alimentary canal an emetic may be given (if
the animal is one susceptible to emesis) followed by a saline laxative.
This may be combined with or followed by raw eggs, mucilage, wheat
gluten or other albuminoid, sulphide of potash or sulphur, to
precipitate the mercury and prevent its absorption. Later, when the
bowels have been cleared, iodide of potassium in small doses will
serve to dissolve and remove what mercury may be lodged in the
tissues.
Locally one of the best applications is chlorate of potash as a
mouth wash, 2 drs. to the quart of water. To this may be added
tannic acid or other vegetable astringent and even alcohol.
Finally a course of iron and bitter tonics will serve a good purpose
in restoring the general tone.
 STOMATITIS FROM CAUSTICS.

Caustic Alkalies; symptoms, lesions and antidotes. Caustic Acids; symptoms,

lesions and antidotes. Caustic salts; symptoms, lesions and antidotes.

Caustic Alkalies (soda, potash, ammonia and their carbonates)

often cause stomatitis. What is supposed to be weak lye, given to
counteract indigestions, colics, and tympanies often proves
dangerously irritating, and some of the worst forms of stomatitis we
have ever seen in the horse originated in this way. As the animal
refused to swallow, the caustic liquid lay in the mouth and virtually
dissolved the epithelium and surface layers of the fibrous mucosa.
The surface in such a case is usually of a deep red, and where the
cuticular covering remains, it is white and corrugated. The antidote
is a weak, non-irritant acid, such as vinegar, boric, citric, or salicylic
acid. When the caustic alkali has been thoroughly neutralized in this
way the ordinary treatment for catarrhal stomatitis may be followed.
The attendant gastritis must receive its special treatment.
Caustic Acids. Sulphuric, nitric and hydrochloric acids act by
abstracting liquids and charring the tissues. The lesions from strong
sulphuric acid turn black, those due to nitric acid, yellow,
(zanthoproteic acid,) and those due to muriatic acid are white, with
the characteristic odor of chlorine. The antidote in such cases is a
non-irritant basic agent, such as chalk, lime water, soapsuds,
calcined magnesia, and mucilaginous liquids, albumen, gluten, flax
seed, with opium. The same agents are applicable to the attendant
gastritis and when the acids are thoroughly neutralized the treatment
is as for simple inflammation.
Caustic Salts. Among caustic salts may be named mercuric
chloride, sulphates of copper and iron, chlorides of iron and zinc,
tartar emetic. These may be treated by albumen, blood, white of egg,
milk, gluten, mucilage and other sheathing, protecting agents which
will form with the salts insoluble and harmless coagula. The
subsequent treatment will follow the lines marked out for simple
stomatitis. To prevent infection of the raw surface Cadeac
recommends: tannic acid 1 oz., benzo-naphthol 3 drachms,
powdered gentian 6 drachms, honey, sufficient to make an electuary.
 MYCOTIC STOMATITIS IN FOALS, CALVES
AND BIRDS. THRUSH. MUGUET.

Oidium (saccharomyces) albicans; a parasite of the young; cultures. Symptoms

in foals and calves; congested buccal mucosa; curd-like concretions; erosions.
Diagnosis from rinderpest. Treatment; disinfection; sunshine; open air; exercise;
locally antiseptics.

This is a form of stomatitis manifested by a raised white patch on

the mucous membrane and determined by the presence of the
oidium albicans (saccharomyces albicans), a cryptogam
discovered by Berg in 1842 in thrush in children. It is closely allied to
the mucor, and attacks only the young and feeble. The white crust
consists of epithelial cells intermingled with an abundance of the
white mycelium and oval spores of the fungus. Andry in his artificial
cultures found that it was pearly white when grown on gelatine, dirty
white on potato, and snow white on carrot.
Foals and Calves. Symptoms. The buccal mucosa red, congested
and tender, shows here and there white curdy looking elevations, or
red erosions caused by the detachment of such masses. These bear a
strong resemblance to the concretions seen on this mucosa in
rinderpest, but are easily recognized by the absence of the attendant
fever, and by the discovery, under the microscope, of the specific
microphyte. The eruption may extend to the pharynx and œsophagus
and interfere fatally with deglutition, but usually it merely renders
sucking painful and is not serious.
Treatment. It is always well to destroy floating germs by cleansing
and whitewashing the stable, and to invigorate the young animals by
sunshine, free air and exercise. Locally the most effective agent is the
old favorite remedy borax which arrests the growth of the parasite
whether in artificial cultures, or in the mouth. The powder may be
rubbed into the sores or it may be mixed with honey or molasses and
used as an electuary. As substitutes boric acid, salol, thymol, chlorate
of potash, or permanganate of potash may be used.
Birds. The affection has been twice observed as occurring in the
œsophagus and crop of two chickens. Martin tried in vain to
inoculate it on other fowls, and Neumann failed to convey it from
child to chicken by feeding. The element of individual susceptibility
was manifestly lacking. From its seat in the crop the malady passed
unnoticed during life. In cases that can be recognized, treatment
would be the same as in young mammals.
 PARALYSIS OF THE TONGUE.
GLOSSOPLEGIA.
Causes: Nervous lesions—central or peripheral, parasitic, inflammatory,
infectious, traumatic or degenerative. Symptoms: unilateral and bilateral.
Treatment: remove cause; use nerve stimulants, embrocations, blisters, frictions,
galvanism, suspension of tongue.
Paralysis of the tongue depends on a lesion of the medulla
oblongata, or of the 7th or 12th cranial nerve. The central lesions may
be connected with cœnurus or other parasites in the brain,
hydrocephalus, meningitis, cerebro spinal meningitis, infectious
pneumonia, abscess (strangles), and tumors. The distal or nerve
lesions may be due to neuroma, tumors, traumas, lacerations,
bruises, or violent distension of the tongue. Parotitis, abscess of the
guttural pouch and tubercle may be added as occasional causes. As
direct traumatic injuries those caused by wearing a poke by a
habitual fence-breaker, excessive dragging on the tongue in
operations on the mouth, and compression of the tongue by a loop of
rope passed over it, require mention.
Symptoms. In unilateral paralysis the affected half of the tongue
remains soft and flaccid and is liable to be crushed between the
teeth, the active muscles of the opposite half pushing the organ over
to the paralyzed side. In bilateral paralysis the tongue hangs out of
the mouth, and being crushed and torn by the teeth, it swells up, and
may even become gangrenous.
Treatment. Will vary according to the cause. After removal of the
central or nervous lesions, the remaining functional paralysis may be
treated by strychnia, internally or hypodermically, by frictions or
stimulating embrocations to the intermaxillary region, or by
electricity. The tongue must be suspended in a sling to prevent
œdema, inflammation and wounds by the teeth. In bad cases of
bilateral traumatic glossoplegia in meat producing animals it has
been advised to have the subject butchered.