Radiology MCQs for NEET PG
1129 worked Radiology questions across 115 areas. Each one has its own page with the reasoning for every option.
What this set is
Radiology in NEET PG tests recognising classic signs, choosing the right modality and knowing basic physics and radiation safety. Image practice is the best preparation.
This page lists the 1129 Radiology questions that have a full worked page: 768 application questions that put a fact to use on a patient or a finding, and 361 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Radiology practice bank in the app is larger, with 3,323 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Radiology test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Radiology covers in the exam
- Imaging modalities and physics
- Radiation safety and radiobiology
- Chest and cardiac imaging
- Abdominal and GI imaging
- Neuroimaging
- Musculoskeletal imaging
- Radiotherapy and nuclear medicine basics
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Radiology study guide.
Worked questions by area
115 areas, largest first. Open an area to see its questions.
Neuroimaging109
- Neuroimaging · ApplicationWhat is the first investigation of choice in suspected acute subarachnoid haemorrhage?
- Neuroimaging · Multi-stepA 65-year-old man has sudden right hemiparesis and aphasia for 90 minutes. A non-contrast CT head shows no haemorrhage and no obvious abnormality. Which MRI sequence wi…
- Neuroimaging · Multi-stepA man has a head injury after a fall. A CT shows a crescent-shaped hyperdense collection along the right cerebral convexity crossing suture lines, with a 7 mm midline s…
- Neuroimaging · ApplicationA 35-year-old man has fever, headache, confusion and a focal seizure. MRI shows hyperintensity on T2 and FLAIR in the right medial temporal lobe and insula, sparing the…
- Neuroimaging: brain tumours · ApplicationA 50-year-old woman with headaches has an extra-axial, well-circumscribed, homogeneously enhancing mass on MRI attached to the dura, with a 'dural tail' and calcificati…
- Neuroimaging: hyperdense MCA sign · ApplicationA non-contrast CT of a patient with acute left hemiplegia shows a linear hyperdensity in the right Sylvian fissure. What does it represent?
- Neuroimaging: subdural haematoma · ApplicationAn elderly alcoholic patient who fell a week ago has progressive drowsiness. CT shows a crescentic extra-axial collection of mixed density crossing sutures. What is it?
- Neuroimaging: subarachnoid haemorrhage · ApplicationA patient with a thunderclap headache has a normal neurological examination. A non-contrast CT within 6 hours would most likely show which finding?
- Neuroimaging: diffuse axonal injury · Multi-stepA patient remains deeply unconscious after a high-speed road accident, but the CT head is almost normal. Which MRI finding is expected?
- Neuroimaging: aneurysm detection · ApplicationAfter a confirmed subarachnoid haemorrhage, which non-invasive test is generally used first to identify a ruptured berry aneurysm?
- Neuroimaging: glioblastoma · ApplicationMRI of a 60-year-old with headaches shows an irregular ring-enhancing mass with central necrosis that crosses the corpus callosum, forming a butterfly pattern. What is…
- Neuroimaging: meningioma · ApplicationA woman has a slowly growing extra-axial mass with broad dural attachment, homogeneous contrast enhancement and a thickened enhancing 'dural tail', with adjacent hypero…
- Neuroimaging: vestibular schwannoma · ApplicationA patient with progressive unilateral sensorineural hearing loss has MRI showing an enhancing mass in the cerebellopontine angle extending into the internal acoustic me…
- Neuroimaging: pituitary adenoma · ApplicationA patient with bitemporal hemianopia has MRI showing a large sellar mass that indents the optic chiasm and extends into the suprasellar cistern, giving a 'figure of 8'…
- Neuroimaging: craniopharyngioma · ApplicationA 9-year-old child with headache and visual field defect has CT showing a suprasellar cystic mass with calcification. What is the most likely diagnosis?
- Neuroimaging: posterior fossa tumours in children · Multi-stepA 5-year-old child with morning vomiting and ataxia has a midline vermian mass that is hyperdense on non-contrast CT and shows restricted diffusion, with hydrocephalus.…
- Neuroimaging: haemangioblastoma · Multi-stepA patient with retinal angiomas and polycythaemia has a cerebellar cystic mass with an enhancing mural nodule. Which syndrome should be considered?
- Neuroimaging: multiple sclerosis · ApplicationA young woman with relapsing neurological symptoms has MRI showing ovoid periventricular T2/FLAIR hyperintense lesions oriented perpendicular to the ventricles. What is…
- Neuroimaging: herpes simplex encephalitis · Multi-stepA patient with fever, seizures and altered behaviour has MRI showing T2 hyperintensity and swelling of the medial temporal lobes and insula bilaterally, with relative s…
- Neuroimaging: neurocysticercosis · ApplicationA young man with new-onset seizures has CT showing a small cystic lesion with an eccentric dot of high density inside. What is the diagnosis?
- Neuroimaging: tuberculous meningitis · ApplicationA child with subacute fever and cranial nerve palsies has contrast CT showing intense enhancement of the basal cisterns with communicating hydrocephalus and basal gangl…
- Neuroimaging: brain abscess · Multi-stepWhich MRI feature best distinguishes a pyogenic brain abscess from a necrotic tumour?
- Neuroimaging: toxoplasmosis in HIV · Multi-stepA patient with HIV and a CD4 count of 40 has multiple ring-enhancing lesions in the basal ganglia with surrounding oedema on CT. Which approach is appropriate?
- Neuroimaging: normal pressure hydrocephalus · Multi-stepAn elderly man has gait disturbance, urinary incontinence and cognitive decline. MRI shows ventricular enlargement out of proportion to sulcal widening, and a flow void…
- Neuroimaging: Chiari malformation · Multi-stepA neonate with a lumbar myelomeningocele has MRI showing a small posterior fossa with cerebellar tonsils and vermis displaced through the foramen magnum and a beaked te…
- Neuroimaging: Dandy-Walker malformation · ApplicationA child with macrocephaly has MRI showing vermian hypoplasia, a cystic dilated fourth ventricle that communicates with the posterior fossa cyst, and an elevated tentori…
- Neuroimaging: tuberous sclerosis · Multi-stepA child with seizures and facial angiofibromas has CT showing calcified nodules along the lateral ventricular walls. What are they?
- Neuroimaging: Sturge-Weber syndrome · ApplicationA child with a port-wine stain on the face and seizures has a skull radiograph showing gyriform tram-track calcification in the parieto-occipital region. What is the di…
- Neuroimaging: venous sinus thrombosis · Multi-stepA postpartum woman with headache and seizures has contrast CT showing a triangular filling defect with enhancing walls in the posterior superior sagittal sinus. What is…
- Neuroimaging: Moyamoya disease · Multi-stepA child with recurrent transient ischaemic attacks has angiography showing progressive stenosis of the terminal internal carotid arteries with a hazy network of collate…
- Neuroimaging: PRES · Multi-stepA woman with severe hypertension and eclampsia has headache, visual disturbance and seizures. MRI shows bilateral symmetrical T2/FLAIR hyperintensities in the parieto-o…
- Neuroimaging: Wernicke encephalopathy · Multi-stepA malnourished alcoholic with confusion, ataxia and ophthalmoplegia has MRI showing symmetric T2 hyperintensity in the mammillary bodies and medial thalami. What is the…
- Neuroimaging: Creutzfeldt-Jakob disease · Multi-stepA patient with rapidly progressive dementia and myoclonus has DWI showing cortical ribboning with basal ganglia hyperintensity. What is the likely diagnosis?
- Neuroimaging: pontine myelinolysis · Multi-stepA patient develops quadriparesis and pseudobulbar signs days after rapid correction of severe hyponatraemia. Which MRI finding is expected?
- Neuroimaging: ADC and infarct age · Multi-stepOn MRI of a patient with stroke, DWI is bright and the ADC map is dark in the right MCA territory, and FLAIR is normal. How would you interpret this?
- Neuroimaging: CT in raised intracranial pressure · ApplicationA CT head of a patient with a large MCA infarct shows effacement of sulci, midline shift of 8 mm and obliteration of the basal cisterns. What does this signify?
- Neuroimaging: hot cross bun sign · Multi-stepA 62-year-old man has parkinsonism that does not respond to levodopa, early postural hypotension and cerebellar ataxia. T2 MRI of the pons shows cruciform hyperintensit…
- Neuroimaging: eye of the tiger sign · Multi-stepA child has progressive dystonia, dysarthria and pigmentary retinopathy. T2 MRI shows bilateral globus pallidus hypointensity with a central region of hyperintensity. W…
- Neuroimaging: cerebral cavernous malformation · Multi-stepA young adult with seizures has an MRI showing a well-defined lesion with a popcorn appearance of mixed T2 signal and a complete dark haemosiderin rim, and no significa…
- Neuroimaging: ADEM · Multi-stepA 7-year-old child develops encephalopathy and ataxia two weeks after a viral illness. MRI shows multiple large, asymmetric, poorly defined T2 hyperintense lesions in t…
- Neuroimaging: schizencephaly · Multi-stepA child with seizures and hemiparesis has MRI showing a cleft in the right cerebral hemisphere lined by grey matter that extends from the ventricle to the cortical surf…
- Neuroimaging: chordoma · Multi-stepA 55-year-old man has an expansile midline mass in the clivus with bone destruction, intratumoural calcification and very bright signal on T2 MRI. What is the likely tu…
- Neuroimaging: neuromyelitis optica · Multi-stepA young woman has visual loss in one eye and then paraplegia. MRI of the spine shows a T2 hyperintense lesion spanning more than three vertebral segments centrally in t…
- Neuroimaging: adrenoleukodystrophy · Multi-stepA 7-year-old boy has deteriorating school performance, visual problems and skin pigmentation. MRI shows symmetric T2 hyperintensity in the parieto-occipital white matte…
- Neuroimaging: pineal germinoma · Multi-stepA 12-year-old boy has headache, upward gaze palsy and hydrocephalus. MRI shows a homogeneously enhancing pineal region mass engulfing calcification and a second small s…
- Neuroimaging: basilar artery occlusion · ApplicationA man has sudden vertigo, diplopia and decreasing consciousness. CT shows a hyperdense basilar artery. What is the best next imaging step?
- Neuroimaging: colloid cyst · ApplicationA young adult has episodic severe headaches worsened by posture and sudden collapse. CT shows a small round hyperdense lesion at the foramen of Monro with dilated later…
- Neuroimaging: primary CNS lymphoma · Multi-stepAn immunocompetent 65-year-old has confusion and a periventricular mass that is hyperdense on CT, shows homogeneous enhancement and marked restricted diffusion, and cro…
- Neuroimaging: hypoxic-ischaemic injury in a term neonate · Multi-stepA term neonate with severe perinatal asphyxia has seizures. MRI on day 5 shows bilateral signal abnormality in the ventrolateral thalami, posterior putamina and perirol…
- Neuroimaging: ASPECTS score · ApplicationA CT of the head for acute MCA stroke is scored out of 10 by examining defined regions for early ischaemic change. What does a low score such as 4 imply?
- Neuroimaging: hypertensive haemorrhage site · ApplicationA 60-year-old hypertensive man has sudden right hemiparesis. Non-contrast CT shows a hyperdense haematoma. At which site is hypertensive haemorrhage most common?
- Neuroimaging: hummingbird sign · Multi-stepAn elderly man has frequent backward falls and loss of vertical downgaze. Midline sagittal MRI shows a thin midbrain tegmentum with a relatively preserved pons, resembl…
- Neuroimaging: face of the giant panda sign · Multi-stepA 20-year-old has tremor, dysarthria and a Kayser-Fleischer ring. Axial T2 MRI of the midbrain shows high signal in the tegmentum with preserved red nuclei and superior…
- Neuroimaging: swallow tail sign · Multi-stepOn high-resolution susceptibility-weighted MRI of the midbrain in a healthy person, a bilateral swallow tail pattern of dorsolateral nigral hyperintensity is seen. Its…
- Neuroimaging: agenesis of the corpus callosum · Multi-stepPrenatal imaging in a fetus shows widely separated, parallel lateral ventricles with dilated occipital horns. MRI after birth shows longitudinal white matter bundles in…
- Neuroimaging: perfusion mismatch in stroke · Multi-stepA patient with a large vessel occlusion presents 9 hours after symptom onset. Perfusion imaging shows a small infarct core and a much larger region of hypoperfused but…
- Neuroimaging: cerebral amyloid angiopathy · Multi-stepA 75-year-old woman with dementia has recurrent lobar haemorrhages. Susceptibility-weighted MRI shows multiple small cortical and subcortical foci of signal loss, spari…
- Neuroimaging: septo-optic dysplasia · Multi-stepA 3-year-old has poor vision, short stature and hypoglycaemia. MRI shows absence of the septum pellucidum, small optic nerves and a hypoplastic pituitary stalk. What is…
- Neuroimaging: pituitary apoplexy · Multi-stepA man known to have a pituitary macroadenoma develops a sudden severe headache, visual loss and a third nerve palsy. Which imaging is most useful to confirm the cause?
- Neuroimaging: cerebral fat embolism · Multi-stepA young man develops confusion, petechiae and hypoxia two days after a femoral fracture. MRI shows numerous tiny diffusion-restricting foci scattered in the white matte…
- Neuroimaging: growing skull fracture · Multi-stepA child has a progressively enlarging scalp swelling three months after a linear parietal skull fracture, and radiographs show widening of the fracture edges. What is t…
- Neuroimaging: Rasmussen encephalitis · Multi-stepA 7-year-old has intractable focal seizures with continuous twitching of the right hand and progressive right hemiparesis. Serial MRI over two years shows progressive a…
- Neuroimaging: subacute sclerosing panencephalitis · Multi-stepA 12-year-old boy who had measles in infancy has progressive intellectual decline and myoclonic jerks. EEG shows periodic high-voltage complexes, and MRI shows asymmetr…
- Neuroimaging: hepatic encephalopathy · Multi-stepA patient with decompensated cirrhosis has MRI showing symmetric T1-hyperintense signal in both globi pallidi. CT shows no calcification and T2 images are normal. Which…
- Neuroimaging: methanol poisoning · Multi-stepA man brought in after drinking illicit liquor has visual loss and severe metabolic acidosis. MRI shows bilateral symmetric necrosis of the putamen with haemorrhagic fo…
- Neuroimaging: vein of Galen malformation · ApplicationA neonate has high-output cardiac failure and a cranial bruit. Cranial ultrasound shows a midline anechoic structure behind the third ventricle with turbulent colour fl…
- Neuroimaging: oligodendroglioma · ApplicationA 35-year-old has new-onset seizures. CT shows a cortical and subcortical frontal mass with coarse, clumped calcification and little oedema. Which tumour is most likely?
- Neuroimaging: MRI ageing of haemorrhage · Multi-stepA haematoma in the brain appears hyperintense on T1-weighted images and hyperintense on T2-weighted images, without a dark rim. In which stage of evolution is this haem…
- Neuroimaging: tension pneumocephalus · Multi-stepTwo days after a frontal skull base fracture, a man deteriorates. CT shows bifrontal air collections that compress and separate the frontal lobes into two pointed peaks…
- Neuroimaging: neuronal migration disorder · ApplicationAn infant with developmental delay and seizures has an MRI showing a smooth brain surface with absent sulci and a thick cortex. What is the diagnosis?
- Neuroimaging: CT before lumbar puncture · ApplicationA patient with fever and neck stiffness has a Glasgow Coma Scale of 11 and papilloedema. Before lumbar puncture, which step is needed?
- Neuroimaging: spot sign · Multi-stepA hypertensive patient has a 25 mL putaminal haemorrhage on CT. CT angiography shows a punctate focus of contrast within the haematoma. What does this finding predict?
- Neuroimaging: developmental venous anomaly · ApplicationContrast MRI in a patient with headache shows multiple linear enhancing medullary veins converging on one enlarged draining vein in the cerebellar hemisphere, with no m…
- Neuroimaging: MELAS · Multi-stepA young adult with short stature, hearing loss and lactic acidosis has recurrent stroke-like episodes. MRI shows posterior cortical lesions that do not follow an arteri…
- Neuroimaging: subdural empyema · Multi-stepA teenager with sinusitis develops fever, headache and focal seizures. MRI shows a crescentic extra-axial collection over the convexity with marked diffusion restrictio…
- Neuroimaging: idiopathic intracranial hypertension · ApplicationAn obese young woman has headache and papilloedema, with a normal CT. MRI shows a flattened pituitary with CSF in the sella, dilated optic nerve sheaths, posterior glob…
- Neuroimaging: retinoblastoma · ApplicationA 2-year-old has leukocoria. Which imaging finding best separates retinoblastoma from Coats disease?
- Neuroimaging: pituitary microadenoma · ApplicationIn a patient with suspected Cushing disease, how does a small pituitary microadenoma typically appear on early dynamic contrast MRI?
- Neuroimaging: Marchiafava-Bignami disease · Multi-stepA chronic alcoholic has dementia, dysarthria and seizures. MRI shows T2 hyperintense lesions in the splenium and body of the corpus callosum. What is the diagnosis?
- Neuroimaging: uncal herniation · ApplicationA patient with a large right temporal haematoma has a dilated right pupil. Which CT finding indicates descending transtentorial uncal herniation?
- Neuroimaging: orbital floor blow-out fracture · ApplicationA cricket ball strikes a batsman's eye. He has diplopia on upgaze and enophthalmos, and a Waters view shows a soft tissue mass hanging from the orbital floor into the m…
- Neuroimaging: Le Fort II fracture · Multi-stepA face injury causes a mobile midface with a pyramid-shaped fracture line that passes through the nasal bridge, medial orbital wall, infraorbital rim and the pterygoid…
- Neuroimaging: mesial temporal sclerosis · ApplicationA 28-year-old with childhood febrile seizures now has focal seizures preceded by a rising epigastric sensation and drug resistance. Which MRI finding is expected?
- Neuroimaging: ependymoma · Multi-stepA 4-year-old has hydrocephalus and a fourth ventricular mass that moulds around the brainstem and extends through the foramina of Luschka and Magendie into the cisterns…
- Neuroimaging: pilocytic astrocytoma · ApplicationAn 8-year-old with an unsteady gait has a large cerebellar hemispheric cystic mass on MRI containing an avidly enhancing mural nodule. What is the most likely diagnosis?
- Neuroimaging: dysembryoplastic neuroepithelial tumour · ApplicationA 10-year-old has had drug-resistant focal seizures since early childhood. MRI shows a wedge-shaped cortical lesion in the temporal lobe with a multicystic T2 appearanc…
- Neuroimaging: epidermoid cyst · Multi-stepAn MRI of a patient with facial pain shows a lobulated cerebellopontine angle mass that follows CSF on T1 and T2. FLAIR shows incomplete suppression and DWI is bright.…
- Neuroimaging: cryptococcal infection in HIV · Multi-stepA patient with HIV and a CD4 count below 50 has headache and confusion with a high CSF opening pressure. MRI shows many small non-enhancing T2-hyperintense cystic lesio…
- Neuroimaging: progressive multifocal leukoencephalopathy · ApplicationA patient with AIDS has progressive hemiparesis and visual loss. MRI shows asymmetric T2-hyperintense lesions in the parieto-occipital subcortical white matter involvin…
- Neuroimaging: tuberculoma · Multi-stepA child from an endemic area has seizures and a single ring-enhancing parenchymal lesion with a relatively T2-hypointense centre. MR spectroscopy shows a lipid-lactate…
- Neuroimaging: lacunar infarct · ApplicationA hypertensive diabetic man has pure motor hemiparesis. MRI shows a 10 mm diffusion-restricting lesion in the posterior limb of the internal capsule. Which vascular pat…
- Neuroimaging: carotid artery dissection · Multi-stepA 35-year-old develops a painful left Horner syndrome and a right hemiparesis after neck manipulation. Fat-suppressed T1 MRI of the neck shows a crescent of high signal…
- Neuroimaging: vasospasm after subarachnoid haemorrhage · ApplicationOn day 7 after clipping of a ruptured aneurysm, a patient develops a new focal deficit. Which bedside test best screens for the likely cause?
- Neuroimaging: carotid-cavernous fistula · ApplicationTwo weeks after a head injury, a man has pulsatile proptosis, conjunctival chemosis and an ocular bruit. Which imaging finding is expected?
- Neuroimaging: anterior spinal artery infarction · Multi-stepAfter aortic aneurysm repair a patient has sudden paraplegia with loss of pain and temperature sensation but preserved vibration and position sense. T2 MRI shows paired…
- Neuroimaging: bilateral basal ganglia calcification · ApplicationA CT head shows dense symmetrical calcification of the basal ganglia and dentate nuclei in a patient with tetany and low serum calcium. Which cause is most likely?
- Neuroimaging: Canavan disease · Multi-stepAn infant with macrocephaly and hypotonia has diffuse symmetrical subcortical white matter T2 hyperintensity including the U-fibres and thalami. MR spectroscopy shows m…
- Neuroimaging: Leigh syndrome · Multi-stepAn infant has developmental regression and lactic acidosis. MRI shows symmetrical T2-hyperintense lesions in the putamina and periaqueductal brainstem, and spectroscopy…
- Neuroimaging: artery of Percheron infarct · Multi-stepA patient wakes up drowsy with a vertical gaze palsy and memory loss. MRI shows bilateral paramedian thalamic diffusion restriction with a midbrain extension. What is t…
- Neuroimaging: frontotemporal dementia · ApplicationA 62-year-old man has progressive personality change and disinhibition. MRI shows marked atrophy of the frontal and anterior temporal lobes with relative sparing of the…
- Neuroimaging: intracranial hypotension · Multi-stepAfter an epidural procedure, a woman has a headache that is worse upright and relieved lying flat. Post-gadolinium MRI shows diffuse smooth pachymeningeal enhancement,…
- Neuroimaging: central neurocytoma · Multi-stepA 26-year-old has headache and obstructive hydrocephalus. MRI shows a lobulated, multicystic intraventricular mass attached to the septum pellucidum near the foramen of…
- Neuroimaging: hypothalamic hamartoma · ApplicationA child has episodes of laughing without mirth and precocious puberty. MRI shows a non-enhancing, T1 isointense mass at the tuber cinereum between the mamillary bodies…
- Neuroimaging: Kernohan notch · Multi-stepA man with a large right subdural haematoma has right-sided hemiparesis, on the same side as the lesion. MRI shows an indentation and signal change in the left cerebral…
- Neuroimaging: subfalcine herniation · ApplicationA patient with a large right frontal mass has midline shift on CT, with the cingulate gyrus pushed beneath the falx. Which vessel is most at risk of compression and inf…
- Neuroimaging: ioflupane SPECT · Multi-stepA patient with a tremor has an ioflupane (DaT) SPECT scan used to look for presynaptic dopaminergic degeneration. Which condition is expected to show a normal scan?
- Neuroimaging: subarachnoid hemorrhage · Multi-stepA patient has thunderclap headache and noncontrast CT is negative six hours after onset, but clinical suspicion for subarachnoid hemorrhage remains high. What is the ne…
- Neuroimaging: hydrocephalus · ApplicationCT head shows enlarged lateral and third ventricles with transependymal periventricular edema. What is the likely process?
- Neuroimaging: cerebral venous thrombosis · ApplicationA postpartum patient has severe headache and seizures; CT venography shows a nonopacified superior sagittal sinus with a filling defect. What diagnosis is likely?
Musculoskeletal imaging80
- Musculoskeletal imaging · ApplicationA 'bamboo spine' on a plain radiograph is characteristic of:
- Musculoskeletal imaging: metabolic bone disease · ApplicationA woman with hypercalcaemia and a raised parathyroid hormone has radiographs of the hands showing erosion along the radial side of the middle phalanges, and a skull wit…
- Musculoskeletal imaging: management of a brown tumour · Multi-stepA 40-year-old woman has bone pain and a lytic expansile lesion in the mandible with giant cells on biopsy. Serum calcium and PTH are high. What is the correct approach…
- Musculoskeletal imaging: enchondroma of the hand · ApplicationA 30-year-old has a painless swelling of a proximal phalanx. Radiograph shows a well-defined lytic lesion with stippled rings and arcs of calcification, with endosteal…
- Musculoskeletal imaging: Brodie abscess · Multi-stepA 14-year-old has months of dull, night-worse pain in the tibia with no fever. Radiograph shows a metaphyseal lucent cavity with a sclerotic rim and a small channel tow…
- Musculoskeletal imaging: double PCL sign · Multi-stepAfter a twisting injury, a young footballer has a knee locked in flexion. Sagittal MRI shows a second low-signal band lying parallel and anterior to the posterior cruci…
- Musculoskeletal imaging: displaced femoral neck fracture · ApplicationA 75-year-old woman falls and has a subcapital hip fracture with complete displacement of the fragments. Why is arthroplasty often preferred to internal fixation?
- Musculoskeletal imaging: open-book pelvic injury · Multi-stepAfter a motorcycle crash a patient is hypotensive. The pelvic radiograph shows widening of the pubic symphysis and the sacroiliac joints. Which immediate measure best r…
- Musculoskeletal imaging: pilon fracture · ApplicationA man falls from a height and lands on his feet. Radiographs show a comminuted intra-articular fracture of the distal tibial plafond. What is this fracture called?
- Musculoskeletal imaging: congenital talipes equinovarus · ApplicationAnteroposterior radiographs of an infant with congenital clubfoot are examined. What is the typical relationship between the talus and calcaneus?
- Musculoskeletal imaging: cam femoroacetabular impingement · Multi-stepA 25-year-old footballer has groin pain on hip flexion and internal rotation. A cross-table lateral radiograph shows a bump at the femoral head-neck junction with an in…
- Musculoskeletal imaging: reactive arthritis · Multi-stepA 24-year-old man develops asymmetric lower limb arthritis, urethritis and conjunctivitis after an episode of dysentery. Which pattern is typical on imaging of the spin…
- Musculoskeletal imaging: Bennett fracture · ApplicationA boxer has pain at the base of the thumb after a punch. A radiograph shows a small volar fragment at the base of the first metacarpal with proximal subluxation of the…
- Musculoskeletal imaging: early sacroiliitis · ApplicationA 24-year-old man has inflammatory back pain for four months with normal sacroiliac joint radiographs. Which investigation can show the earliest changes of sacroiliitis?
- Musculoskeletal imaging: systemic sclerosis · ApplicationA woman with Raynaud phenomenon and tight skin has a hand radiograph showing resorption of the distal phalangeal tufts with soft tissue calcification. What is the likel…
- Musculoskeletal imaging: sickle cell bone changes · ApplicationA child with sickle cell anaemia has a lateral spine radiograph showing central depression of the vertebral endplates, giving a step-like or H-shaped outline. What is t…
- Musculoskeletal imaging: hypertrophic osteoarthropathy · ApplicationA smoker with a lung mass has painful, swollen wrists and ankles and finger clubbing. What do radiographs of the long bones show?
- Musculoskeletal imaging: tuberculous arthritis · ApplicationA child from a rural area has months of knee swelling, night pain, low-grade fever and wasting of the thigh. A radiograph shows periarticular osteopenia, peripheral ero…
- Musculoskeletal imaging: transient osteoporosis of the hip · Multi-stepA 40-year-old man has sudden hip pain and a limp without trauma. MRI shows diffuse marrow oedema of the femoral head and neck with no subchondral low-signal line. What…
- Musculoskeletal imaging: Maisonneuve fracture · Multi-stepAfter a twisting ankle injury a patient has medial ankle tenderness and a widened medial clear space, but ankle radiographs show no fibular fracture. There is marked te…
- Musculoskeletal imaging: juvenile Tillaux fracture · Multi-stepA 14-year-old injures the ankle in external rotation. CT shows an avulsed fragment of the anterolateral distal tibial epiphysis. What is this injury?
- Musculoskeletal imaging: Pellegrini-Stieda lesion · ApplicationWeeks after a valgus injury to the knee, a radiograph shows a curvilinear calcification adjacent to the medial femoral condyle. What is this?
- Musculoskeletal imaging: Madelung deformity · ApplicationAn adolescent girl has wrist pain and a prominent distal ulna. A radiograph shows a short radius with volar and ulnar tilt of the distal radial articular surface and a…
- Musculoskeletal imaging: chondroblastoma · Multi-stepA 15-year-old with an open growth plate has months of knee pain. A radiograph shows a well-defined lytic lesion in the proximal tibial epiphysis with a thin sclerotic r…
- Musculoskeletal imaging: psoriatic arthritis · ApplicationA 45-year-old man with scaly skin plaques and a sausage-shaped finger has hand radiographs showing distal interphalangeal joint erosions, a tapered phalangeal head with…
- Musculoskeletal imaging: Jones fracture · ApplicationA footballer inverts his foot and has lateral midfoot pain. A radiograph shows a transverse fracture at the junction of the metaphysis and diaphysis of the fifth metata…
- Musculoskeletal imaging: traumatic spondylolisthesis of the axis · ApplicationA driver in a head-on collision with the neck hyperextended has a lateral cervical radiograph showing fractures through both pars interarticularis of C2 with anterior s…
- Musculoskeletal imaging: vertebral haemangioma · ApplicationA CT of the lumbar spine in a 50-year-old shows an L2 vertebral body with coarse vertical trabeculae that appear as small dots on axial images, and the lesion is bright…
- Musculoskeletal imaging: Baker cyst · ApplicationA patient with knee osteoarthritis develops calf swelling and tenderness that mimic a deep vein thrombosis. Ultrasound shows a fluid collection between the medial head…
- Musculoskeletal imaging: achondroplasia · ApplicationA child with rhizomelic limb shortening and macrocephaly has a pelvic radiograph with small squared iliac wings and flat acetabular roofs, and a lumbar spine in which t…
- Musculoskeletal imaging: osteogenesis imperfecta · ApplicationAn infant has repeated fractures after minimal handling and blue sclerae. A skull radiograph shows multiple small ossicles within the sutures and generalised osteopenia…
- Musculoskeletal imaging: haemophilic arthropathy · Multi-stepA 12-year-old boy with prolonged bleeding after dental extraction has recurrent bloody knee effusions. Radiographs show a widened intercondylar notch, a squared inferio…
- Musculoskeletal imaging: winking owl sign · ApplicationA smoker with lung cancer has back pain. An AP lumbar radiograph shows one oval pedicle ring missing while the opposite pedicle and the spinous process are intact. Whic…
- Musculoskeletal imaging: calcific tendinitis · ApplicationA 45-year-old woman has sudden severe shoulder pain and cannot abduct the arm. A radiograph shows a dense, fluffy calcific deposit just above the greater tuberosity. Wh…
- Musculoskeletal imaging: double-line sign · Multi-stepA T2-weighted MRI of the hip in a 38-year-old man on long-term steroids shows a serpiginous band at the margin of a segment of subchondral marrow, with an inner high-si…
- Musculoskeletal imaging: skeletal fluorosis · ApplicationA farmer from an endemic belt with mottled teeth has back stiffness. Radiographs show dense sclerotic vertebrae, osteophytes, and calcification of the forearm interosse…
- Musculoskeletal imaging: atlantoaxial subluxation · ApplicationA woman with long-standing rheumatoid arthritis has neck pain and occipital headache. What would a flexion lateral cervical radiograph show to confirm atlantoaxial subl…
- Musculoskeletal imaging: lunate dislocation · Multi-stepAfter a fall on a dorsiflexed wrist, a lateral radiograph shows the lunate tipped volarly out of the lunate fossa like a spilled cup, while the capitate remains in line…
- Musculoskeletal imaging: Hawkins sign · Multi-stepSix weeks after fixation of a displaced talar neck fracture, an ankle mortise radiograph shows a thin subchondral lucent band in the talar dome. What does this finding…
- Musculoskeletal imaging: Segond fracture · Multi-stepAfter a twisting knee injury, an AP radiograph shows a small elliptical avulsion fragment from the lateral tibial plateau. Which associated injury should be actively so…
- Musculoskeletal imaging: posterior shoulder dislocation · ApplicationAfter a generalised seizure a patient holds the arm internally rotated and cannot externally rotate it. The AP shoulder radiograph looks almost normal but shows a round…
- Musculoskeletal imaging: sacral insufficiency fracture · Multi-stepAn elderly woman on long-term corticosteroids has low back and buttock pain without trauma, and her pelvic radiograph is unremarkable. A Tc-99m bone scan shows an H-sha…
- Musculoskeletal imaging: healing rickets · ApplicationA child with rickets is started on vitamin D and calcium. Which radiographic change is the earliest sign of healing?
- Musculoskeletal imaging: acute osteomyelitis on radiograph · ApplicationA 10-year-old with fever and three days of leg pain after a skin infection has a plain radiograph of the tibia. What is the earliest abnormality expected in acute haema…
- Musculoskeletal imaging: heterotopic ossification detection · Multi-stepA patient with traumatic brain injury develops a stiff, warm hip three weeks after the injury, but the pelvis radiograph is normal. Which test can detect early heteroto…
- Musculoskeletal imaging: bone scan in myeloma · Multi-stepA 62-year-old has bone pain and anaemia, and a skeletal survey shows multiple lytic lesions. A Tc-99m MDP bone scan is nearly normal. What is the best explanation?
- Musculoskeletal imaging: pyogenic spondylodiscitis · ApplicationA diabetic man has fever and severe back pain. Which finding is earliest on the plain radiograph in pyogenic vertebral osteomyelitis?
- Musculoskeletal imaging: local staging of osteosarcoma · ApplicationA 16-year-old has a biopsy-proven osteosarcoma of the distal femur. Which imaging best defines intramedullary extent and skip lesions before surgery?
- Musculoskeletal imaging: expansile lytic metastasis · ApplicationA 60-year-old man with haematuria has a solitary expansile, lytic, blown-out lesion with a thin shell in the iliac bone. Which primary tumour is most likely?
- Musculoskeletal imaging: ivory vertebra · Multi-stepA 65-year-old man with raised alkaline phosphatase has a lateral lumbar radiograph showing an L3 vertebra that is uniformly dense, slightly enlarged, and has a thickene…
- Musculoskeletal imaging: prevertebral soft tissue swelling · ApplicationIn a trauma patient, a lateral cervical radiograph shows prevertebral soft-tissue thickness of 12 mm at the level of C2 in an adult. How should this be interpreted?
- Musculoskeletal imaging: SCIWORA · ApplicationA 6-year-old has limb weakness after a road accident, and cervical radiographs and CT show no fracture or malalignment. What is the best next investigation?
- Musculoskeletal imaging: burst fracture · ApplicationAfter a fall from height, a lateral radiograph shows loss of height of the L1 body with the posterior cortex displaced backwards. Which test best shows the extent of bo…
- Musculoskeletal imaging: congenital pseudarthrosis of the tibia · Multi-stepA 2-year-old with multiple café-au-lait macules and axillary freckling has anterolateral bowing of the tibia. Radiographs show narrowing and sclerosis of the mid-tibia…
- Musculoskeletal imaging: infantile cortical hyperostosis · ApplicationA 3-month-old irritable infant has fever and firm swelling of the jaw. Radiographs show thick layers of periosteal new bone along the mandible, clavicle and ulna. What…
- Musculoskeletal imaging: osteoblastoma · Multi-stepA 17-year-old has back pain and a painful scoliosis. CT shows an expansile lesion with a mineralised nidus of about 3 cm in the posterior elements of a thoracic vertebr…
- Musculoskeletal imaging: synovial sarcoma · Multi-stepA 28-year-old has a slowly enlarging deep swelling behind the knee. A radiograph shows a soft-tissue mass with stippled calcification next to the joint, with normal bon…
- Musculoskeletal imaging: mucopolysaccharidosis · ApplicationA child with coarse facies, corneal clouding and hepatosplenomegaly has radiographs showing oar-shaped ribs, beaked inferior vertebral bodies and a J-shaped sella. Whic…
- Musculoskeletal imaging: Modic changes · Multi-stepLumbar MRI of a patient with chronic back pain shows vertebral endplate marrow that is low on T1 and high on T2 weighted images. Which Modic type is this, and what does…
- Musculoskeletal imaging: painful scoliosis with neurological signs · Multi-stepA 12-year-old girl has a painful left thoracic scoliosis and absent abdominal reflexes. The radiograph shows a 30 degree curve. What is the next best investigation?
- Musculoskeletal imaging: Achilles tendinosis · ApplicationA runner has chronic posterior heel pain with thickening of the tendon about 4 cm above its insertion. What does ultrasound typically show?
- Musculoskeletal imaging: meniscal tear on MRI · ApplicationA sagittal proton-density knee MRI shows a linear high-signal band in the posterior horn of the medial meniscus that reaches the superior articular surface. How is this…
- Musculoskeletal imaging: renal osteodystrophy · ApplicationA 14-year-old with chronic kidney disease has a lateral lumbar spine radiograph showing dense sclerotic bands beneath the vertebral endplates with a less dense central…
- Musculoskeletal imaging: Scheuermann disease · ApplicationA 15-year-old boy has a rigid thoracic kyphosis. A lateral radiograph shows anterior wedging of at least three consecutive vertebrae by 5 degrees or more, with irregula…
- Musculoskeletal imaging: haemochromatosis arthropathy · Multi-stepA 50-year-old man with diabetes, bronze skin and hepatomegaly has hand pain. Radiographs show hook-like osteophytes at the second and third metacarpophalangeal joints w…
- Musculoskeletal imaging: acromegaly of the hand · ApplicationA man with enlarging hands and jaw has a hand radiograph showing broad spade-like terminal phalangeal tufts, widened joint spaces and thickened soft tissues. Which cond…
- Musculoskeletal imaging: ossific nucleus in hip dysplasia · ApplicationA 6-month-old girl has a breech history and a pelvis radiograph with Hilgenreiner and Perkin lines drawn. In a dysplastic hip, where does the femoral ossific nucleus lie?
- Musculoskeletal imaging · ApplicationWhich imaging modality best depicts cortical bone detail after trauma?
- Musculoskeletal imaging · ApplicationMRI is especially useful for assessing which structure after knee injury?
- Musculoskeletal imaging · ApplicationWhat imaging modality is especially useful for occult stress fracture when radiographs are normal?
- Musculoskeletal imaging · ApplicationWhich modality best depicts complex cortical bone detail?
- Musculoskeletal imaging · ApplicationMRI is especially useful for assessing which knee structures?
- Musculoskeletal imaging · ApplicationWhy are two orthogonal radiographic views generally obtained for suspected limb fracture?
- Musculoskeletal imaging · ApplicationWhich radiographic feature is typical of osteoarthritis?
- Musculoskeletal imaging · ApplicationWhen is MRI particularly useful after knee trauma with normal radiographs?
- Musculoskeletal imaging · ApplicationWhich MRI finding supports osteomyelitis before radiographic change?
- Musculoskeletal imaging · ApplicationWhat is the radiographic hallmark of osteonecrosis of femoral head?
- Musculoskeletal imaging: septic arthritis · ApplicationWhat is the preferred imaging modality to detect a hip joint effusion in a child with suspected septic arthritis?
- Musculoskeletal imaging: osteomyelitis · ApplicationWhich imaging modality is most sensitive for early osteomyelitis and marrow edema?
- Musculoskeletal imaging: fracture healing · ApplicationWhich radiographic finding is expected during normal secondary fracture healing?
Chest imaging76
- Chest imaging · Multi-stepA chest radiograph of an elderly smoker shows right upper lobe collapse with a lateral concavity and a convex bulge at the hilum, giving a reversed S shape along the el…
- Chest imaging · ApplicationA woman with long-standing mitral stenosis presents with breathlessness. Her chest radiograph shows fine, short horizontal lines at the lung periphery adjoining the ple…
- Chest imaging · ApplicationA chest radiograph in a child with fever and cough shows an opacity that obscures the right heart border but leaves the right hemidiaphragm outline visible. Which lobe…
- Chest imaging · ApplicationA 60-year-old man has progressive dyspnoea and dry cough with fine bibasal crackles. HRCT shows subpleural, basal-predominant reticulation with honeycombing and tractio…
- Chest imaging: pleural effusion · ApplicationA patient has breathlessness and dullness at the right base, but an erect chest radiograph looks nearly normal. Which investigation best detects a small pleural effusio…
- Chest imaging: lobar collapse · ApplicationA chest radiograph in a smoker shows a triangular dense opacity in the right upper zone with upward displacement of the horizontal fissure and tracheal deviation to the…
- Chest imaging: Kerley lines · ApplicationShort horizontal lines 1 to 2 cm long that reach the pleura at the lung bases are seen on a chest radiograph of a patient in left heart failure. What are these?
- Chest imaging: pulmonary embolism signs · Multi-stepWhich radiographic sign of pulmonary embolism describes a pleural-based wedge-shaped opacity with its apex pointing toward the hilum?
- Chest imaging: CT pulmonary angiography · ApplicationA patient with sudden pleuritic chest pain and tachycardia, with a normal chest radiograph and normal renal function, is suspected of pulmonary embolism. What is the in…
- Chest imaging: pneumothorax on supine film · Multi-stepA trauma patient is imaged supine. Which finding on the chest radiograph suggests an anterior pneumothorax?
- Chest imaging: tension pneumothorax · ApplicationA patient with severe dyspnoea and hypotension shows an opaque-black hemithorax with the mediastinum shifted to the opposite side and a flattened diaphragm. What is the…
- Chest imaging: aspergilloma · ApplicationA patient with old tuberculosis presents with haemoptysis, and CT shows a mobile rounded soft tissue mass within an upper lobe cavity with a surrounding crescent of air…
- Chest imaging: invasive aspergillosis · Multi-stepA neutropenic patient with leukaemia on chemotherapy has fever and CT shows multiple nodules, each surrounded by a rim of ground glass attenuation. What is the sign and…
- Chest imaging: hydatid · Multi-stepA chest radiograph shows a well-defined cystic lesion in the lower zone with a double arc and air between the layers of the wall, which later shows floating collapsed m…
- Chest imaging: sarcoidosis · ApplicationA young woman has a chest radiograph with symmetrical bilateral hilar enlargement and right paratracheal nodes, and is otherwise well apart from erythema nodosum. What…
- Chest imaging: silicosis · ApplicationA stone-quarry worker has a chest radiograph showing small upper zone nodules and thin calcification around the periphery of enlarged hilar nodes. What is the sign?
- Chest imaging: asbestos · ApplicationA retired shipyard worker has bilateral calcified plaques on the diaphragmatic pleura and chest wall. Which statement is correct?
- Chest imaging: mesothelioma · Multi-stepCT of a patient exposed to asbestos shows nodular circumferential pleural thickening that encases the lung and includes the mediastinal pleura, with a small effusion an…
- Chest imaging: Pancoast tumour · ApplicationA smoker with shoulder pain, Horner syndrome and weakness of the intrinsic hand muscles has a chest radiograph showing an apical cap opacity with rib destruction. What…
- Chest imaging: solitary pulmonary nodule · ApplicationA 50-year-old non-smoker has an incidental 2 cm solitary lung nodule on CT showing 'popcorn' calcification and internal fat. What is the likely diagnosis?
- Chest imaging: bronchiectasis on CT · ApplicationOn HRCT, a bronchus appears larger than its adjacent pulmonary artery, forming a ring with a bright dot. What is this sign?
- Chest imaging: tree-in-bud · Multi-stepOn HRCT, small centrilobular nodules joined to branching linear opacities in the lung periphery are seen in a patient with endobronchial spread of tuberculosis. What is…
- Chest imaging: usual interstitial pneumonia · Multi-stepHRCT of an elderly patient with progressive dyspnoea and finger clubbing shows basal and subpleural reticulation, traction bronchiectasis and honeycombing. Which patter…
- Chest imaging: Pneumocystis pneumonia · ApplicationA patient with advanced HIV has dyspnoea and hypoxia. A chest radiograph is near normal, but HRCT shows extensive bilateral perihilar ground glass opacities. What is th…
- Chest imaging: lung abscess · ApplicationA chest radiograph of an alcoholic patient following aspiration shows a thick-walled cavity with an air-fluid level in the posterior segment of the right upper lobe. Wh…
- Chest imaging: ARDS · Multi-stepA patient with sepsis and severe hypoxaemia has bilateral diffuse airspace opacities on CT with a gradient favouring the dependent regions and a normal heart size. Whic…
- Chest imaging: foreign body in children · ApplicationA toddler with sudden choking has an inspiratory chest radiograph that looks normal. An expiratory film shows a hyperlucent right lung with the mediastinum shifting to…
- Chest imaging: diaphragmatic hernia · Multi-stepA newborn in respiratory distress has a scaphoid abdomen, and the chest radiograph shows bowel loops in the left hemithorax with the mediastinum shifted to the right an…
- Chest imaging: traumatic aortic injury · Multi-stepAfter a high-speed deceleration accident, a supine chest radiograph shows a widened mediastinum, loss of the aortic knuckle contour and a left apical cap. Where is the…
- Chest imaging: pulmonary arteriovenous malformation · Multi-stepA patient with recurrent epistaxis and a family history of the same has a chest CT showing a well-defined lobulated nodule with a feeding artery and draining vein. What…
- Chest imaging: scimitar syndrome · Multi-stepA chest radiograph shows a small right lung with a curvilinear tubular opacity running toward the right cardiophrenic angle and dextroposition of the heart. What is the…
- Chest imaging: lateral decubitus view · ApplicationIn which situation is a lateral decubitus chest radiograph especially useful?
- Chest imaging: Swyer-James syndrome · Multi-stepA young adult with a childhood history of severe viral bronchiolitis has a chest radiograph showing a unilateral small hyperlucent lung with diminished vascular marking…
- Chest imaging: round pneumonia · ApplicationA 5-year-old child with fever and cough has a chest radiograph showing a well-defined, round 4 cm opacity in the right lower zone with no cavitation. What is the most l…
- Chest imaging: Luftsichel sign · Multi-stepA chest radiograph in a patient with a left upper lobe collapse shows a thin crescent of lucency between the aortic knuckle and the collapsed lobe. What is this sign ca…
- Chest imaging: pneumomediastinum · Multi-stepA young asthmatic with severe coughing has chest pain and neck crepitus. A radiograph shows linear lucencies outlining the mediastinum and the central part of the diaph…
- Chest imaging: lymphangitic carcinomatosis · Multi-stepA woman with known breast carcinoma is breathless. HRCT shows nodular, beaded thickening of the interlobular septa and bronchovascular bundles, more marked on the right…
- Chest imaging: pulmonary arterial hypertension · ApplicationA chest radiograph shows enlarged central pulmonary arteries with an abrupt tapering of the peripheral vessels, and the right descending pulmonary artery measures 20 mm…
- Chest imaging: central venous catheter · ApplicationImmediately after insertion of a right internal jugular central line, what is the purpose of a chest radiograph?
- Chest imaging: diaphragmatic eventration · ApplicationAn asymptomatic adult has an elevated, smooth, intact right hemidiaphragm on a chest film and fluoroscopy shows paradoxical movement. What is the likely diagnosis?
- Chest imaging: pectus excavatum · ApplicationA chest radiograph shows loss of the right heart border, leftward displacement of the heart and posterior ribs that run horizontally, while the lungs look clear. What i…
- Chest imaging: cannonball metastases · ApplicationA 30-year-old man has a testicular mass and a chest radiograph showing multiple well-defined round opacities of varying size throughout both lungs. What is this appeara…
- Chest imaging: lymphangioleiomyomatosis · Multi-stepA 35-year-old woman has recurrent spontaneous pneumothoraces and progressive dyspnoea. HRCT shows numerous thin-walled round cysts diffusely throughout both lungs with…
- Chest imaging: wall thickness of a cavity · Multi-stepA chest CT of a 60-year-old smoker shows a solitary cavitating lung lesion in the upper lobe with a thick, irregular, nodular wall and an eccentric lumen. Which feature…
- Chest imaging: anterior mediastinal mass · ApplicationA 45-year-old woman with fluctuating ptosis and diplopia has a smooth, lobulated anterior mediastinal mass on chest CT. What is the most likely mass?
- Chest imaging: posterior mediastinal mass in a child · ApplicationA 3-year-old child has a paravertebral soft tissue mass in the posterior mediastinum on chest radiograph with splaying of adjacent ribs and a few punctate calcification…
- Chest imaging: chronic eosinophilic pneumonia · Multi-stepA middle-aged asthmatic woman has weeks of cough and fever, a peripheral blood eosinophilia and a chest radiograph showing dense peripheral upper zone consolidation spa…
- Chest imaging: saber-sheath trachea · ApplicationA chest radiograph of an elderly smoker with chronic obstructive disease shows a narrowed coronal diameter of the intrathoracic trachea, with a widened sagittal diamete…
- Chest imaging: pulmonary contusion · ApplicationA man has a road traffic accident and a chest film within an hour shows patchy, non-segmental airspace opacity beneath a rib fracture. What is the expected behaviour of…
- Chest imaging: COVID-19 pneumonia on CT · ApplicationHRCT of a patient with fever, hypoxia and recent exposure to viral pneumonia shows bilateral, peripheral, subpleural ground glass opacities, with some crazy paving. Whi…
- Chest imaging: post-pneumonectomy radiograph · Multi-stepSeveral weeks after a left pneumonectomy, a chest radiograph shows a completely opaque left hemithorax. Which finding would be expected in a normal post-pneumonectomy s…
- Chest imaging: pulmonary artery sling · Multi-stepAn infant has stridor and wheeze. A barium swallow shows an anterior indentation on the oesophagus just above the carina, and CT shows the left pulmonary artery arising…
- Chest imaging: double aortic arch · Multi-stepAn infant with stridor and dysphagia has a barium swallow showing a posterior indentation on the oesophagus and bilateral lateral indentations on the trachea on frontal…
- Chest imaging: fibrocavitary tuberculosis · ApplicationA chest radiograph of a man with chronic cough shows bilateral upper zone fibrosis, cavities and elevation of both hila with a straightened mediastinal contour. What is…
- Chest imaging: opaque hemithorax · ApplicationA chest radiograph shows a completely opaque right hemithorax. The trachea and mediastinum are shifted toward the opaque side. Which cause is most consistent?
- Chest imaging: pulmonary Langerhans cell histiocytosis · Multi-stepA 30-year-old heavy smoker has dyspnoea and a pneumothorax. HRCT shows upper zone predominant nodules and bizarre-shaped thick-walled cysts, sparing the costophrenic an…
- Chest imaging: pulmonary artery catheter position · ApplicationA chest radiograph of an ICU patient with a Swan-Ganz catheter shows the tip lying in the distal right interlobar pulmonary artery, far out in the lung periphery. What…
- Chest imaging: intra-aortic balloon pump position · ApplicationA chest radiograph in a patient with cardiogenic shock shows an intra-aortic balloon pump. Where should its radiopaque tip lie?
- Chest imaging: lung ultrasound for pneumothorax · ApplicationIn an emergency, a bedside lung ultrasound shows absent lung sliding, absent B-lines and a lung point on the right. What does this suggest?
- Chest imaging: allergic bronchopulmonary aspergillosis · Multi-stepAn asthmatic patient with raised IgE and eosinophilia has recurrent opacities. HRCT shows central bronchiectasis with branching tubular opacities from mucus plugging, a…
- Chest imaging: pulmonary alveolar proteinosis · Multi-stepA 35-year-old man with progressive breathlessness has a milky fluid on bronchoalveolar lavage. Which HRCT pattern is most characteristic of his condition?
- Chest imaging: pulmonary sequestration · Multi-stepA young man with recurrent left basal pneumonia has a persistent mass in the posterior basal segment of the left lower lobe. CT angiography shows an artery arising from…
- Chest imaging: subpulmonic effusion · Multi-stepA patient's erect chest film shows an apparently elevated right hemidiaphragm with its highest point displaced laterally and a blunted costophrenic angle. What is the b…
- Chest imaging: hypersensitivity pneumonitis on HRCT · Multi-stepA bird fancier has recurrent cough and breathlessness. HRCT shows poorly defined centrilobular ground-glass nodules, and expiratory images show lobular air trapping adj…
- Chest imaging: rounded atelectasis · Multi-stepA retired shipyard worker has a peripheral pleural-based 4 cm round opacity on chest CT. Adjacent pleura is thickened, and bronchovascular bundles curve into the lesion…
- Chest imaging: loculated pleural effusion · ApplicationA patient with pneumonia has a persistent, non-layering pleural opacity on the right. Ultrasound shows echogenic fluid with septa. Which step is most appropriate for sa…
- Chest imaging · ApplicationWhat modality can provide high-resolution detail of lung interstitium?
- Chest imaging · ApplicationWhat chest radiograph sign may indicate lobar consolidation?
- Chest imaging · ApplicationWhat is a common imaging finding in pulmonary edema?
- Chest imaging · ApplicationWhat finding on chest radiograph can suggest cardiomegaly?
- Chest imaging · ApplicationWhy is a posteroanterior chest radiograph preferred over an anteroposterior portable view when feasible?
- Chest imaging · ApplicationWhich chest radiograph sign is commonly associated with a moderate pleural effusion?
- Chest imaging · ApplicationWhat does an air bronchogram within a pulmonary opacity usually indicate?
- Chest imaging · ApplicationWhich radiographic feature supports pneumothorax on an erect chest radiograph?
- Chest imaging · ApplicationWhich radiographic feature suggests upper-lobe collapse?
- Chest imaging · ApplicationWhat sign can indicate left lower-lobe collapse on frontal chest radiograph?
Nuclear medicine58
- Nuclear medicine · ApplicationIn FDG-PET imaging, why does the tracer accumulate in many malignant tumours?
- Nuclear medicine · ApplicationA 3-year-old child has painless, large-volume rectal bleeding, and Meckel diverticulum is suspected. Which radionuclide study is used?
- Nuclear medicine · ApplicationA young woman has right upper quadrant pain and an equivocal ultrasound. A hepatobiliary (HIDA) scan is performed. Which finding supports acute cholecystitis?
- Nuclear medicine · ApplicationA 4-year-old girl has had recurrent urinary tract infections. Which radionuclide study is best to detect renal cortical scarring?
- Nuclear medicine: MIBG · ApplicationA 3-year-old has an abdominal mass crossing the midline with calcifications and raised urinary catecholamine metabolites. Which nuclear study best assesses for metastat…
- Nuclear medicine: pulmonary embolism · ApplicationA young woman with severe renal impairment has suspected pulmonary embolism, and her chest radiograph is normal. Contrast should be avoided. Which test is most appropri…
- Nuclear medicine: contraindication · ApplicationI-131 therapy for hyperthyroidism is absolutely contraindicated in which situation?
- Nuclear medicine: radiopharmaceutical · ApplicationWhich is the most commonly used radionuclide in diagnostic nuclear medicine, produced from a molybdenum-99 generator?
- Nuclear medicine: bone scan · ApplicationA bone scan with Tc-99m methylene diphosphonate shows multiple focal areas of increased uptake in the spine and ribs in a patient with prostate cancer. What does this r…
- Nuclear medicine: PET indication · ApplicationFDG-PET/CT is of particular value in which of the following situations?
- Nuclear medicine: radionuclide bone pain therapy · Multi-stepWhich radionuclide, an alpha emitter, is approved for castration-resistant prostate cancer with symptomatic bone metastases?
- Nuclear medicine: Meckel diverticulum · ApplicationA child with painless rectal bleeding is suspected to have a Meckel diverticulum. Which scan is most useful?
- Nuclear medicine: thyroid scintigraphy · ApplicationA patient with thyrotoxicosis has a thyroid scan showing diffusely increased uptake of the tracer throughout both lobes. What is the diagnosis?
- Nuclear medicine: cold thyroid nodule · ApplicationA thyroid scan shows a solitary nodule that does not take up the tracer (cold nodule) in a euthyroid patient. What is the best next step?
- Nuclear medicine: parathyroid imaging · ApplicationWhich radiopharmaceutical is used to localise a parathyroid adenoma before surgery in primary hyperparathyroidism?
- Nuclear medicine: renal scintigraphy · ApplicationA child with antenatal hydronephrosis needs assessment of obstruction and split renal function. Which diuretic renography agent is preferred?
- Nuclear medicine: HIDA scan · ApplicationA patient with right upper quadrant pain undergoes a HIDA scan, and the gallbladder is not visualised after 4 hours although the bile ducts and bowel fill. What does th…
- Nuclear medicine: myocardial perfusion · ApplicationIn a myocardial perfusion scan, an area shows reduced tracer uptake on stress images that normalises at rest. What is this finding called?
- Nuclear medicine: viability · Multi-stepWhich PET tracer is used to assess myocardial viability by demonstrating glucose metabolism in hibernating myocardium?
- Nuclear medicine: neuroendocrine tumours · Multi-stepWhich functional imaging tracer is used for localising well-differentiated neuroendocrine tumours expressing somatostatin receptors?
- Nuclear medicine: lung ventilation-perfusion · Multi-stepA V/Q scan shows multiple segmental perfusion defects with normal ventilation in the same regions. What does this mismatch pattern indicate?
- Nuclear medicine: effective half-life · Multi-stepA radiopharmaceutical has a physical half-life of 6 hours and a biological half-life of 6 hours. What is its effective half-life?
- Nuclear medicine: peptide receptor radionuclide therapy · ApplicationA patient with a progressive metastatic midgut neuroendocrine tumour shows intense uptake on a gallium-68 DOTATATE PET scan. Which therapy exploits this finding?
- Nuclear medicine: yttrium-90 radioembolisation · Multi-stepWhich description best fits yttrium-90 radioembolisation?
- Nuclear medicine: dopamine transporter scan · Multi-stepA 65-year-old man has a unilateral resting tremor and the diagnosis between Parkinson disease and essential tremor is unclear. Which study helps most?
- Nuclear medicine: super scan · Multi-stepA technetium-99m MDP bone scan shows intense, diffusely increased skeletal uptake with absent renal and bladder activity. What is the best interpretation?
- Nuclear medicine: pyrophosphate scan · Multi-stepA 75-year-old man has heart failure with preserved ejection fraction, thick ventricular walls on echocardiography and a negative serum free light chain test. A techneti…
- Nuclear medicine: sentinel lymph node · ApplicationA woman with early breast cancer is to have sentinel node biopsy. Which preoperative nuclear imaging is used?
- Nuclear medicine: MUGA scan · ApplicationA woman with breast cancer is to receive trastuzumab and needs a reproducible baseline left ventricular ejection fraction. Which nuclear study provides this?
- Nuclear medicine: labelled red cell bleeding scan · ApplicationA man has intermittent lower gastrointestinal bleeding, with a negative colonoscopy and no source found. Which scan can detect slow or intermittent bleeding over severa…
- Nuclear medicine: labelled leucocyte scan · ApplicationA patient with a hip prosthesis has persistent pain and a raised CRP, and plain films are inconclusive for infection. Which nuclear study is most specific for infection?
- Nuclear medicine: PSMA PET · Multi-stepA man has a rising PSA of 0.4 ng/ml after radical prostatectomy and conventional imaging is normal. Which study best localises recurrence at this low level?
- Nuclear medicine: FDG PET preparation · Multi-stepA diabetic patient referred for FDG PET-CT has a pre-injection blood glucose of 380 mg/dl. What is the appropriate action?
- Nuclear medicine: captopril renography · Multi-stepA young woman has resistant hypertension and a suspected unilateral renal artery stenosis. On captopril renography, what is the characteristic finding in the affected k…
- Nuclear medicine: bone scan flare · Multi-stepThree months after starting hormonal therapy for prostate cancer, a patient with falling PSA and improving symptoms has a bone scan showing increased uptake in known le…
- Nuclear medicine: effect of iodinated contrast on radioiodine uptake · Multi-stepA woman with suspected Graves disease had a contrast-enhanced CT three weeks ago. A radioiodine uptake test now shows unexpectedly low uptake. What is the likeliest exp…
- Nuclear medicine: Warthin tumour on salivary scan · Multi-stepA 60-year-old man has a painless parotid swelling. Technetium-99m pertechnetate salivary scintigraphy shows an area of increased tracer uptake that persists after sialo…
- Nuclear medicine: sulphur colloid and focal nodular hyperplasia · Multi-stepA liver mass in a young woman is indeterminate on ultrasound. A Tc-99m sulphur colloid scan shows uptake equal to or greater than the adjacent liver. Which lesion is fa…
- Nuclear medicine: preparation for cardiac sarcoid FDG PET · Multi-stepA patient with suspected cardiac sarcoidosis is scheduled for FDG PET. Which preparation best allows inflammation to be seen?
- Nuclear medicine: three-phase bone scan · Multi-stepA diabetic patient with a foot ulcer has a three-phase bone scan. Which pattern favours osteomyelitis rather than cellulitis alone?
- Nuclear medicine: radionuclide cisternography · ApplicationA patient has clear watery nasal discharge after head trauma, and the source of a suspected CSF leak is unclear. Which nuclear study can help show it?
- Nuclear medicine: reducing MAA particles · Multi-stepA patient with a known right-to-left cardiac shunt needs a lung perfusion scan. What adjustment is made to the Tc-99m macroaggregated albumin dose?
- Nuclear medicine: gastric emptying scintigraphy · ApplicationA diabetic patient has early satiety and vomiting of undigested food. Which test quantifies delayed gastric emptying?
- Nuclear medicine: preparation for radioiodine ablation · Multi-stepA patient after total thyroidectomy for papillary carcinoma is booked for radioiodine remnant ablation. Which preparation increases remnant uptake?
- Nuclear medicine: complex regional pain syndrome · Multi-stepA woman develops pain, swelling and allodynia of the hand six weeks after a wrist fracture. A radiograph shows patchy periarticular osteopenia. What is the typical find…
- Nuclear medicine · ApplicationWhat does PET commonly image using FDG?
- Nuclear medicine · ApplicationWhat does a thyroid uptake scan assess?
- Nuclear medicine · ApplicationWhat does a bone scintigraphy study primarily demonstrate?
- Nuclear medicine · ApplicationWhich isotope is commonly used in many diagnostic nuclear medicine scans?
- Nuclear medicine · ApplicationWhat imaging principle is used by PET scans?
- Nuclear medicine · ApplicationWhat is a common use of thyroid scintigraphy?
- Nuclear medicine · ApplicationWhat isotope is widely used for many diagnostic nuclear scans?
- Nuclear medicine · ApplicationWhat does a bone scintigraphy study primarily detect?
- Nuclear medicine · ApplicationWhy is a ventilation-perfusion scan useful when CT pulmonary angiography is contraindicated?
- Nuclear medicine: bone scan · ApplicationWhich property makes a technetium bone scan useful for detecting skeletal metastases?
- Nuclear medicine · ApplicationWhat is the principal use of a thyroid uptake scan?
- Nuclear medicine · ApplicationWhich study is used to assess ventilation and pulmonary perfusion mismatch?
- Nuclear medicine: PET-CT · ApplicationWhat does fluorodeoxyglucose PET primarily demonstrate in many cancers?
MSK imaging49
- MSK imaging: osteosarcoma · ApplicationA 15-year-old boy has knee pain and swelling. A radiograph of the distal femur shows a destructive metaphyseal lesion with a sunburst periosteal reaction and Codman tri…
- MSK imaging: Ewing sarcoma · ApplicationA 10-year-old child has fever, pain and a raised ESR. A radiograph of the femoral diaphysis shows a permeative lytic lesion with a lamellated (onion-skin) periosteal re…
- MSK imaging: giant cell tumour · ApplicationA 28-year-old has pain near the knee, and the radiograph shows an eccentric, expansile lytic lesion in the epiphysis of the distal femur extending to the subarticular s…
- MSK imaging: osteoid osteoma · ApplicationA teenager has night pain relieved by aspirin. Radiograph shows cortical thickening with a small radiolucent nidus less than 1.5 cm. What is the diagnosis and best trea…
- MSK imaging: multiple myeloma · ApplicationA 65-year-old has bone pain, anaemia and hypercalcaemia. A skull radiograph shows multiple well-defined 'punched-out' lytic lesions without sclerotic margins. What is t…
- MSK imaging: Paget disease · ApplicationAn elderly man has a raised alkaline phosphatase and a skull radiograph showing patchy sclerosis with enlargement of the vault ('cotton wool' appearance). What is the d…
- MSK imaging: osteopetrosis · ApplicationA child with anaemia and hepatosplenomegaly has radiographs showing uniformly dense bones with a 'bone within bone' appearance, and sclerotic bands at the vertebral end…
- MSK imaging: scurvy · Multi-stepAn infant on boiled milk feeds has pain and refuses to move the legs. The radiograph shows ground-glass osteopenia, a dense zone of provisional calcification at the met…
- MSK imaging: non-accidental injury · ApplicationA 6-month-old infant has unexplained irritability. A skeletal survey shows metaphyseal 'corner' or 'bucket-handle' fractures and multiple posterior rib fractures. What…
- MSK imaging: fibrous dysplasia · Multi-stepA radiograph of the proximal femur in a young adult shows an expansile lesion with a ground-glass matrix and a deformity described as shepherd's crook. What is the diag…
- MSK imaging: rheumatoid arthritis · ApplicationA woman with symmetrical small joint pain has hand radiographs showing periarticular osteopenia, marginal erosions and symmetrical joint space narrowing at the MCP and…
- MSK imaging: gout · ApplicationA man with recurrent acute first MTP joint pain has radiographs showing 'punched-out' erosions with overhanging edges and a preserved joint space, with soft tissue swel…
- MSK imaging: ankylosing spondylitis · ApplicationA young man with inflammatory back pain has a lumbar spine radiograph showing squaring of the vertebral bodies, marginal syndesmophytes and bilateral sacroiliac joint f…
- MSK imaging: hyperparathyroidism · ApplicationA patient with recurrent renal stones and hypercalcaemia has hand radiographs showing subperiosteal resorption along the radial aspect of the middle phalanges. What is…
- MSK imaging: Looser zones · Multi-stepA radiograph of a woman with vitamin D deficiency shows bilateral symmetrical linear lucent bands perpendicular to the cortex in the pubic rami and femoral necks. What…
- MSK imaging: avascular necrosis · ApplicationA patient on long-term steroids has hip pain with normal radiographs. Which investigation is most sensitive for early avascular necrosis of the femoral head?
- MSK imaging: Perthes disease · ApplicationA 6-year-old boy has a limp and hip pain. A pelvis radiograph shows a small, dense, flattened femoral epiphysis with a subchondral lucent line. What is the diagnosis?
- MSK imaging: SCFE · ApplicationAn obese 13-year-old boy has knee pain and limited hip internal rotation. A frog-leg lateral view shows posterior and inferior displacement of the femoral epiphysis. Wh…
- MSK imaging: developmental dysplasia of the hip · ApplicationWhich imaging modality is preferred to screen a 6-week-old infant with risk factors for developmental dysplasia of the hip?
- MSK imaging: scaphoid fracture · ApplicationAfter a fall on an outstretched hand, a patient has anatomical snuffbox tenderness, but wrist radiographs are normal. What is the next step?
- MSK imaging: osteomyelitis · ApplicationA child with fever and a painful swollen knee has normal initial radiographs. Which investigation is the most sensitive for early acute osteomyelitis?
- MSK imaging: knee MRI · ApplicationAfter a twisting football injury, a patient has a positive anterior drawer test, and MRI of the knee shows discontinuity of the ACL and a bone bruise pattern. Which bon…
- MSK imaging: Monteggia fracture-dislocation · ApplicationAfter a fall, a patient has a fracture of the proximal ulnar shaft on radiograph. Which additional finding must be sought?
- MSK imaging: Galeazzi fracture-dislocation · ApplicationA radiograph shows a fracture of the distal third of the radial shaft with shortening. Which joint should be examined for injury?
- MSK imaging: Salter-Harris classification · ApplicationA 10-year-old child has a distal radius injury. A radiograph shows a fracture through the growth plate that exits through the metaphysis, producing a triangular metaphy…
- MSK imaging: Hill-Sachs and Bankart lesions · Multi-stepA young man has recurrent anterior shoulder dislocation. MRI arthrography shows a posterolateral humeral head impaction defect and a detached anteroinferior labrum. Wha…
- MSK imaging: Lisfranc injury · Multi-stepAfter a twisting injury to the midfoot, a weight-bearing radiograph shows a gap between the bases of the first and second metatarsals and a small avulsed fragment (flec…
- MSK imaging: Bohler angle · ApplicationAfter a fall from height onto the heels, a lateral radiograph of the foot shows a Bohler angle of 10 degrees. What does this indicate?
- MSK imaging: rotator cuff tear · ApplicationA 55-year-old painter has shoulder pain and cannot abduct the arm. A radiograph shows a high-riding humeral head. Which investigations best confirm a full-thickness sup…
- MSK imaging: Kienbock disease · Multi-stepA young manual worker has chronic wrist pain. Radiographs show increased density and later collapse of the lunate. What is the diagnosis?
- MSK imaging: thalassaemia skull and bones · ApplicationA child with severe anaemia needing regular transfusions has a skull radiograph showing thickened diploe with perpendicular striations. What is the appearance and cause?
- MSK imaging: Langerhans cell histiocytosis of the spine · Multi-stepA 5-year-old child has back pain. A lateral spine radiograph shows a thin, flattened, dense vertebral body with preserved disc spaces. What is this called and the likel…
- MSK imaging: aneurysmal bone cyst · Multi-stepA 14-year-old has pain and swelling at the distal femur. Radiograph shows an eccentric, expansile, lytic lesion with a thin shell, and MRI shows multiple fluid-fluid le…
- MSK imaging: simple bone cyst fallen fragment · Multi-stepA boy has a pathological fracture of the proximal humerus. Radiograph shows a central, well-defined lytic lesion with a thin cortex in the metaphysis, and a small bone…
- MSK imaging: non-ossifying fibroma · ApplicationA 12-year-old has an incidental eccentric, lobulated, lytic lesion with a thin sclerotic scalloped margin in the distal femoral metaphysis, with no periosteal reaction.…
- MSK imaging: Charcot joint · Multi-stepA long-standing diabetic has a swollen, warm but painless foot. Radiographs show fragmentation, subluxation and disorganisation of the midfoot joints with sclerosis and…
- MSK imaging: DISH · Multi-stepAn obese older man with diabetes and mild back stiffness has a lateral thoracic spine radiograph showing flowing calcification along the anterior aspect of at least fou…
- MSK imaging: Gaucher disease · Multi-stepA young adult with splenomegaly and pancytopenia has bone pain. A femur radiograph shows widening of the distal metaphysis with a flask shape and patchy lucent and scle…
- MSK imaging: calcium pyrophosphate disease · ApplicationAn elderly woman has an acutely swollen knee. A radiograph shows thin linear calcification parallel to the articular cartilage of the femoral condyles and menisci. What…
- MSK imaging: pyogenic spondylodiscitis · ApplicationA diabetic man has fever and severe back pain. MRI shows T2 hyperintense disc, endplate erosion and marrow oedema in two adjacent vertebrae, with an enhancing paraverte…
- MSK imaging: pigmented villonodular synovitis · Multi-stepA 30-year-old has a swollen knee with recurrent blood-stained aspirates. MRI shows synovial thickening with low signal on all sequences that blooms on gradient-echo ima…
- MSK imaging: unstable osteochondritis dissecans · ApplicationA 14-year-old athlete has knee pain, and MRI shows an osteochondritis dissecans lesion of the medial femoral condyle. Which finding suggests an unstable fragment?
- MSK imaging: lipohaemarthrosis · Multi-stepAfter a fall, a patient has a swollen knee and a normal-looking anteroposterior film. A horizontal-beam lateral view shows a fat-fluid level in the suprapatellar pouch.…
- MSK imaging: scapholunate dissociation · Multi-stepAfter a fall on an outstretched hand, a PA wrist film shows a widened gap of more than 3 mm between the scaphoid and lunate. What is this sign called and what does it i…
- MSK imaging: myositis ossificans · Multi-stepThree weeks after a thigh contusion in a footballer, a painful mass is seen. CT shows peripheral, eggshell-like ossification around a lucent centre. What is the diagnos…
- MSK imaging: ultrasound in carpal tunnel syndrome · ApplicationA woman has night-time tingling in her thumb, index and middle fingers. Which ultrasound finding supports carpal tunnel syndrome?
- MSK imaging: lipoma versus liposarcoma · Multi-stepA 60-year-old has a 14 cm deep thigh mass. MRI shows predominantly fat signal with thick, irregular septa and nodular non-fatty enhancing areas. What is the most likely…
- MSK imaging: Blount disease · ApplicationA 2-year-old walking toddler has progressive unilateral bowing of the leg. Radiographs show a depressed medial tibial metaphysis with beaking and a medially sloping phy…
- MSK imaging: bone island · ApplicationA 40-year-old has a 1 cm round dense sclerotic focus with feathery radiating margins in the femur on a film taken for another reason. The bone scan is normal. What is t…
Chest and cardiac imaging44
- Chest and cardiac imaging: AP film and heart size · ApplicationA bedridden ICU patient has a supine AP chest film with a cardiothoracic ratio of 0.58 and clear lungs. What is the most appropriate interpretation?
- Chest and cardiac imaging: Ranke complex · ApplicationA 4-year-old child, a household contact of a patient with sputum-positive tuberculosis, has a small peripheral parenchymal opacity in the right mid-zone together with e…
- Chest and cardiac imaging: nodal compression in primary TB · Multi-stepA 3-year-old with tuberculosis contact has persistent cough and chest film showing right middle lobe collapse with an enlarged right hilar shadow. What is the most like…
- Chest and cardiac imaging: calcium sign of aortic dissection · Multi-stepA hypertensive man with tearing chest pain has a widened mediastinum on chest film. Which radiographic finding supports aortic dissection in particular?
- Chest and cardiac imaging: PET-CT before lung cancer surgery · ApplicationA 62-year-old smoker has a 3 cm peripheral lung cancer with no obvious nodes on chest CT and is considered for lobectomy. Which investigation best detects occult medias…
- Chest and cardiac imaging: tracheal bronchus · ApplicationA child with recurrent right upper lobe pneumonia has a CT showing the apical segmental bronchus arising directly from the trachea about 2 cm above the carina. What is…
- Chest and cardiac imaging: lepidic adenocarcinoma · Multi-stepA 55-year-old non-smoking woman has a 2 cm ground-glass nodule in the right upper lobe that has persisted and slowly enlarged over three years, with a small solid core.…
- Chest and cardiac imaging: re-expansion pulmonary oedema · Multi-stepA 28-year-old man has a chest tube placed for a large pneumothorax of one week's duration. Within an hour of drainage he develops cough with frothy sputum, and a radiog…
- Chest and cardiac imaging: cervical rib · ApplicationA 28-year-old woman has tingling of the ulnar border of the hand and wasting of the thenar muscles. A radiograph shows an extra rib arising from C7. Which structure is…
- Chest and cardiac imaging: pressure half-time in mitral stenosis · ApplicationEchocardiography is used to estimate valve area in a young woman with rheumatic mitral stenosis. Which Doppler-derived measurement is used?
- Chest and cardiac imaging: dobutamine stress echocardiography · Multi-stepA patient with a recent anterior infarct and a hypokinetic septum has a dobutamine stress echocardiogram. At low dose the segment improves, and at peak dose it worsens.…
- Chest and cardiac imaging: chronic thromboembolic pulmonary hypertension · ApplicationSix months after a pulmonary embolism, a patient has persistent breathlessness and echocardiographic pulmonary hypertension. Which investigation is preferred to screen…
- Chest and cardiac imaging: tissue sampling of mediastinal nodes · Multi-stepA PET-CT in a patient with a resectable lung cancer shows FDG-avid subcarinal nodes. Which procedure is the preferred next step to confirm nodal metastasis before surge…
- Chest and cardiac imaging: right ventricular strain on CT · ApplicationCT pulmonary angiography in a hypotensive patient shows bilateral central filling defects. Which additional finding indicates right ventricular strain?
- Chest and cardiac imaging: anomalous left coronary artery · Multi-stepA 3-month-old infant sweats and is irritable during feeds. Echocardiography shows a dilated, hypokinetic left ventricle, and the ECG shows an anterolateral infarct patt…
- Chest and cardiac imaging: galaxy sign in sarcoidosis · Multi-stepA CT shows a larger nodule surrounded by many tiny satellite nodules along the bronchovascular bundles and subpleural regions, with symmetric hilar nodes. Which conditi…
- Chest and cardiac imaging: valvular pulmonary stenosis · ApplicationA 12-year-old has an ejection systolic murmur in the left second intercostal space with a thrill. The chest radiograph shows normal lung vascularity and a prominent bul…
- Chest and cardiac imaging: pulmonary venous hypertension · ApplicationA patient with mitral stenosis has a chest radiograph with upper-zone vessels larger than lower-zone vessels and no alveolar shadows. What does this pattern indicate?
- Chest and cardiac imaging: limits of coronary CT angiography · ApplicationWhich patient factor most degrades the diagnostic quality of coronary CT angiography?
- Chest and cardiac imaging: Rasmussen aneurysm · ApplicationA man with long-standing cavitary tuberculosis has massive haemoptysis. CT angiography shows an enhancing outpouching in the wall of a cavity, supplied from a branch of…
- Chest and cardiac imaging: pulmonary alveolar microlithiasis · ApplicationAn asymptomatic young adult with a family history of similar findings has a chest radiograph showing innumerable tiny sand-grain calcific densities in both lungs, dense…
- Chest and cardiac imaging: Caplan syndrome · Multi-stepA coal miner with rheumatoid arthritis has multiple well-defined peripheral lung nodules, 0.5 to 5 cm, some cavitating, on a background of mild dust-related changes. Wh…
- Chest and cardiac imaging: hilum overlay sign · Multi-stepA PA chest radiograph shows a large rounded opacity projected over the left hilum, but the hilar vessels remain visible through it. What does this tell you?
- Chest and cardiac imaging: Klebsiella pneumonia · ApplicationA chronic alcoholic has fever and jelly-like sputum. The chest radiograph shows a dense upper-lobe consolidation with the horizontal fissure bowed downward. Which organ…
- Chest and cardiac imaging: persistent left superior vena cava · Multi-stepA left-sided central venous catheter is inserted and a chest radiograph shows the catheter running vertically down along the left mediastinal border before curving medi…
- Chest and cardiac imaging: Mounier-Kuhn syndrome · Multi-stepA middle-aged man with recurrent chest infections has CT showing marked dilatation of the trachea and main bronchi with tracheal diverticula and corrugated walls. What…
- Chest and cardiac imaging: diaphragmatic rupture · ApplicationAfter a road traffic collision, a chest radiograph shows a gas-filled bowel loop above the left hemidiaphragm and a nasogastric tube that curls up into the left chest.…
- Chest and cardiac imaging: Kartagener syndrome · ApplicationA young man with chronic sinusitis, recurrent chest infections and infertility has dextrocardia on chest radiograph and bronchiectasis on CT. Which underlying defect ex…
- Chest and cardiac imaging: bronchial atresia · Multi-stepA non-asthmatic 22-year-old is asymptomatic. His chest radiograph shows a branching tubular opacity near the left hilum with a hyperlucent, hyperinflated lung segment b…
- Chest and cardiac imaging: retrosternal goitre on CT · Multi-stepA 60-year-old woman has a smooth upper mediastinal mass that is continuous with the neck and deviates the trachea. Which CT feature best supports a thyroid origin?
- Chest and cardiac imaging: Morgagni hernia · ApplicationA middle-aged woman has an incidental right cardiophrenic angle opacity on a frontal film. The lateral view shows an anterior retrosternal mass containing gas-filled bo…
- Chest and cardiac imaging: bronchogenic cyst · ApplicationCT in a 25-year-old shows a smooth, round 3 cm subcarinal mass of water-to-slightly-higher attenuation that does not enhance. It is very bright on T2-weighted MRI. What…
- Chest and cardiac imaging: bronchial carcinoid · ApplicationA 30-year-old non-smoker has recurrent right middle lobe pneumonia. CT shows a well-defined, avidly enhancing nodule within the bronchus with distal collapse. What is t…
- Chest and cardiac imaging: congenital lobar emphysema · Multi-stepA 3-month-old has progressive tachypnoea. The chest radiograph shows an overinflated hyperlucent left upper lobe with attenuated vessels within it, compressing the lowe…
- Chest and cardiac imaging: transient tachypnoea of the newborn · ApplicationA term neonate delivered by elective caesarean is tachypnoeic soon after birth. The chest radiograph shows perihilar streaky opacities, fluid in the fissures and mild h…
- Chest and cardiac imaging: random nodule distribution · ApplicationA febrile patient has 1 to 3 mm nodules on HRCT, scattered evenly through both lungs and involving subpleural, perifissural and central regions without relation to the…
- Chest and cardiac imaging: reverse halo sign · Multi-stepA patient with subacute cough and fever has not responded to a course of antibiotics. CT shows a focus of central ground-glass attenuation surrounded by a ring of dense…
- Chest and cardiac imaging: NSIP pattern · Multi-stepA woman with systemic sclerosis has HRCT showing bilateral basal ground-glass opacities with fine reticulation, sparing of the immediate subpleural lung and minimal hon…
- Chest and cardiac imaging: aortic root in Marfan syndrome · ApplicationA tall young man with ectopia lentis and arachnodactyly has a CT of the thorax. Which aortic abnormality is characteristic?
- Chest and cardiac imaging: aortic intramural haematoma · Multi-stepA hypertensive man has tearing chest pain. Non-contrast CT shows crescentic high-attenuation thickening of the descending aortic wall, and after contrast there is no in…
- Chest and cardiac imaging: split pleura sign · ApplicationContrast CT in a febrile patient with a loculated effusion shows thickened, enhancing visceral and parietal pleura separated by fluid. What does this indicate?
- Chest and cardiac imaging: bronchiectasis in cystic fibrosis · ApplicationA 12-year-old has recurrent chest infections and steatorrhoea. HRCT shows bronchiectasis with mucus plugging. Where does it predominate?
- Chest and cardiac imaging: septic pulmonary emboli · ApplicationA man who injects drugs has fever and a tricuspid valve vegetation on echocardiography. CT chest shows multiple peripheral nodules, some cavitating, with vessels leadin…
- Chest and cardiac imaging: relapsing polychondritis of the trachea · Multi-stepA patient with recurrent painful ear and nose cartilage inflammation develops stridor. CT shows smooth thickening of the tracheal wall that spares the posterior membran…
Imaging modalities and physics43
- Imaging modalities and physics: computed radiography · ApplicationA hospital replaces film cassettes with reusable cassettes holding an imaging plate. After exposure the plate is scanned by a laser reader, which releases stored light…
- Imaging modalities and physics: unknown aneurysm clip before MRI · Multi-stepA man had intracranial aneurysm surgery abroad in the 1980s and now needs MRI for a spinal complaint. The clip type is unknown and no implant card is available. What is…
- Imaging modalities and physics: signal void of cortical bone · ApplicationOn MRI, a dense cortical bone margin and a calcified nodule both appear black on T1, T2 and FLAIR images. What is the physical reason?
- Imaging modalities and physics: mammography target and kVp · ApplicationWhy does a mammography unit use a molybdenum target with a molybdenum filter and a low tube voltage?
- Imaging modalities and physics: lateral resolution · ApplicationA sonographer needs to separate two small cysts lying side by side across the beam at a fixed depth in the liver. Which adjustment most directly improves this separation?
- Imaging modalities and physics: k-space · ApplicationIn MRI reconstruction, the data acquired from the central lines of k-space mainly determine which feature of the final image?
- Imaging modalities and physics: ghosting artefact · Multi-stepOn a sagittal spine MRI, pulsation of the aorta produces repeated ghost images that overlie the spinal cord. Which simple change moves the ghosts away from the cord wit…
- Imaging modalities and physics: venous Doppler phasicity · Multi-stepA patient with a swollen left leg has a compressible left popliteal vein, but Doppler of the left common femoral vein shows continuous flow without respiratory variatio…
- Imaging modalities and physics: T1 shortening by melanin · ApplicationA patient has several brain metastases that are bright on unenhanced T1-weighted images and dark on T2-weighted images. Which primary tumour classically produces this s…
- Imaging modalities and physics: surface coils · ApplicationA radiologist images the small orbit and optic nerve and wants the best signal-to-noise ratio. Which change gives the greatest improvement?
- Imaging modalities and physics: slice cross-talk · ApplicationIn a multislice T2-weighted spin-echo acquisition with contiguous slices, signal is reduced in the images because adjacent slice excitations overlap. How is this artefa…
- Imaging modalities and physics: CT ring artefact · ApplicationOn axial CT slices, a concentric circular band of altered density centred on the rotation axis appears on every image of both a patient and a water phantom. Which fault…
- Imaging modalities and physics: renal cyst pseudoenhancement · Multi-stepA 12-mm renal lesion measures 6 HU before and 22 HU after contrast on CT. Ultrasound shows a thin-walled anechoic lesion with posterior acoustic enhancement and no inte…
- Imaging modalities and physics: MRI zipper artefact · ApplicationA brain MRI shows a narrow line of alternating bright and dark pixels running across the whole image at a fixed position. The scanner room door was found slightly open.…
- Imaging modalities and physics: arterial spin labelling · ApplicationA patient with an eGFR of 10 mL/min needs MRI assessment of cerebral blood flow after a stroke. Which perfusion technique needs no injected contrast agent?
- Imaging modalities and physics: BOLD functional MRI · ApplicationDuring finger tapping, functional MRI shows increased T2-star signal over the contralateral motor cortex. What is the intrinsic contrast mechanism?
- Imaging modalities and physics: diffusion tensor imaging · ApplicationBefore resecting a glioma near the internal capsule, the surgeon wants to see whether the corticospinal tract is displaced or infiltrated. Which MRI technique best show…
- Imaging modalities and physics: gadolinium retention · Multi-stepA patient with normal renal function has had many contrast MRI brain scans over several years. Unenhanced T1 images now show hyperintensity of the dentate nuclei. Which…
- Imaging modalities and physics: magic angle artefact · Multi-stepOn a short-TE shoulder MRI, part of a normal supraspinatus tendon near its insertion looks falsely bright, mimicking tendinopathy. The signal disappears on a long-TE se…
- Imaging modalities and physics: line focus principle · ApplicationThe electron beam strikes a rectangular track several millimetres wide on the anode, yet the focal spot projected towards the patient is much smaller because the target…
- Imaging modalities and physics: air gap technique · Multi-stepA lateral cervical spine radiograph is taken with the patient about 15 cm from the detector and no grid. Compared with a contact exposure without a grid, what is the ma…
- Imaging modalities and physics: off-level grid cutoff · Multi-stepA radiograph taken with a focused grid shows an even loss of density across the entire film. The tube was angled slightly across the grid lines, and the focus-grid dist…
- Imaging modalities and physics: truncation artefact in MRI · Multi-stepA sagittal cervical spine T2 MRI acquired with a coarse phase-encoding matrix shows a thin central line of high signal in the cord. On a repeat with a finer matrix the…
- Imaging modalities and physics: macrocyclic gadolinium chelates · ApplicationA department wishes to minimise release of free gadolinium ions in patients with eGFR near 25 mL/min. Which structural type of chelate is kinetically the most stable?
- Imaging modalities and physics: tissue harmonic imaging · ApplicationIn an obese patient, abdominal ultrasound is noisy with clutter in the near field. Switching to tissue harmonic imaging improves the picture because it:
- Imaging modalities and physics: mechanical index · ApplicationA sonographer is scanning a fetus and wants to reduce the risk of acoustic cavitation. Which on-screen output index relates to this bioeffect?
- Imaging modalities and physics: frame rate trade-off · Multi-stepA paediatric cardiologist wants higher temporal resolution when imaging a rapidly beating fetal heart and narrows the sector and reduces depth. Why does the frame rate…
- Imaging modalities and physics: side-lobe artefact · ApplicationA gallbladder ultrasound shows low-level echoes layering in the dependent part of the lumen that vanish when the patient is turned and scanned from another angle. Which…
- Imaging modalities and physics: Mo-99 Tc-99m generator equilibrium · Multi-stepA nuclear medicine technologist elutes a Mo-99/Tc-99m generator each morning. Mo-99 has a half-life of 66 hours and Tc-99m 6 hours. What explains why Tc-99m activity is…
- Imaging modalities and physics: pulse height analyser · ApplicationA gamma camera accepts only counts within a narrow energy window around 140 keV for Tc-99m. What is the purpose of this window?
- Imaging modalities and physics: F-18 half-life and distribution · ApplicationF-18 FDG has a half-life of about 110 minutes. What is the practical consequence for PET centres?
- Imaging modalities and physics: kVp and radiographic contrast · ApplicationA chest radiograph is deliberately taken at about 120 kVp rather than 70 kVp. What is the expected change in the image?
- Imaging modalities and physics: dynamic range of digital detectors · ApplicationAn ICU portable chest radiograph is taken with about double the usual mAs, yet the digital image still looks acceptable. What property of the system explains this?
- Imaging modalities and physics: dose-length product · ApplicationA CT report lists CTDIvol of 12 mGy and a dose-length product of 480 mGy-cm for an abdominal scan. How is the effective dose estimated from this?
- Imaging modalities and physics: CT noise and dose · Multi-stepA radiologist wants to halve the quantum noise in a CT image while keeping all other settings the same. By roughly what factor must the dose (mAs) be raised?
- Imaging modalities and physics: STIR near metal · Multi-stepA knee with metal hardware is imaged, and spectral fat saturation fails because of local field inhomogeneity. Which fat-suppression approach is more reliable here?
- Imaging modalities and physics: grid ratio · ApplicationWhich feature makes a high grid ratio grid more efficient at cleaning up scatter than a low ratio one, at the cost of a higher dose?
- Imaging modalities and physics: PET detector coincidence · Multi-stepIn a PET scanner, a single 511 keV photon detected on one side of the ring without a partner on the opposite side within the timing window is discarded. Why?
- Imaging modalities and physics: CT motion artefact timing · ApplicationA breathless patient moves during a CT of the chest, and images show double contours of the diaphragm and vessels. Which scanner change is the most effective in reducin…
- Imaging modalities and physics: indirect versus direct flat panel · Multi-stepA flat-panel digital radiography detector converts X-rays first into light with a caesium iodide layer, and then into charge using a photodiode array. How is this type…
- Imaging modalities and physics: ultrasound frequency and attenuation · ApplicationA sonographer changes from a 3.5 MHz curvilinear probe to a 12 MHz linear probe for a superficial lump. What is the effect on the image?
- Imaging modalities and physics: opposed-phase imaging principle · Multi-stepOn dual-echo gradient-echo MRI, an adrenal mass loses signal on the opposed-phase image compared with the in-phase image. What does this indicate about its content?
- Imaging modalities and physics: SPIO liver contrast · Multi-stepA superparamagnetic iron oxide agent is given for liver MRI. Normal liver darkens on T2-weighted images but a metastasis stays bright. Which cells take up the agent?
Abdominal and GI imaging38
- Abdominal and GI imaging: oesophageal carcinoma on barium · ApplicationA 65-year-old smoker has progressive dysphagia to solids and weight loss. A barium swallow shows a short irregular stricture with abrupt, overhanging (shouldered) margi…
- Abdominal and GI imaging: Stierlin sign · Multi-stepA barium follow-through in a patient with suspected ileocaecal tuberculosis shows rapid emptying of an inflamed terminal ileum and caecum, with barium running from the…
- Abdominal and GI imaging: grading reflux on cystourethrogram · ApplicationDuring a micturating cystourethrogram in a child, contrast refluxes up the ureter into the renal pelvis and calyces without any dilatation. Which grade of vesicoureteri…
- Abdominal and GI imaging: first structure in a gestational sac · ApplicationA woman at about 5 weeks of amenorrhoea has a positive pregnancy test. Transvaginal ultrasound shows an intrauterine gestational sac. Which structure is normally seen f…
- Abdominal and GI imaging: acute mesenteric ischaemia · Multi-stepA 72-year-old man with atrial fibrillation has sudden severe central abdominal pain with a soft, minimally tender abdomen and a rising lactate. Which investigation shou…
- Abdominal and GI imaging: biliary atresia · ApplicationA 6-week-old jaundiced infant has pale stools and conjugated hyperbilirubinaemia. Fasting ultrasound shows a small, poorly visible gallbladder and an echogenic fibrous…
- Abdominal and GI imaging: secondary aortoenteric fistula · Multi-stepA man who had an open aortic graft three years ago has a small haematemesis followed by fever. CT shows gas bubbles and soft tissue surrounding the graft next to the th…
- Abdominal and GI imaging: air enema reduction of intussusception · Multi-stepA 9-month-old has colicky pain, red currant jelly stools and a sausage-shaped mass, and ultrasound shows a target sign. He is stable with no signs of peritonitis. What…
- Abdominal and GI imaging: accessory spleen · ApplicationA patient with relapse of immune thrombocytopenia after splenectomy has a 1 cm round nodule near the splenic bed on CT, enhancing identically to the removed organ in ev…
- Abdominal and GI imaging: trichobezoar · ApplicationA 17-year-old girl with patchy scalp hair loss and a history of compulsive hair pulling has early satiety and a palpable epigastric mass. CT shows a mottled intralumina…
- Abdominal and GI imaging: bile leak scintigraphy · ApplicationOn day 3 after laparoscopic cholecystectomy a patient has fever and abdominal distension, and ultrasound shows free fluid. Which scintigraphic study best demonstrates a…
- Abdominal and GI imaging: biliary ischaemia after liver transplant · Multi-stepA liver transplant recipient on day 4 has fever and rising bilirubin. Doppler shows no flow in the hepatic artery. Why do the bile ducts become necrotic and leak in thi…
- Abdominal and GI imaging: Whitaker test · Multi-stepAn adult has persistent hydronephrosis on ultrasound and an equivocal diuretic renogram. Which test directly measures the pressure gradient across the pelviureteric jun…
- Abdominal and GI imaging: obstructed infected kidney · Multi-stepA diabetic woman has fever, rigors and flank pain. Ultrasound shows a dilated pelvicalyceal system with echogenic debris, and CT shows an obstructing ureteric stone. Sh…
- Abdominal and GI imaging: gastric volvulus · ApplicationAn elderly woman has sudden severe epigastric pain with retching but no vomiting, and a nasogastric tube cannot be passed. A chest radiograph shows a retrocardiac gas b…
- Abdominal and GI imaging: Clostridioides difficile colitis · ApplicationA patient has severe watery diarrhoea after a course of clindamycin. Contrast CT shows marked circumferential colonic wall thickening with oral contrast trapped between…
- Abdominal and GI imaging: mesenteric lymphoma · Multi-stepA patient with fever, night sweats and abdominal discomfort has CT showing bulky confluent mesenteric nodes that surround and elevate the mesenteric vessels without nar…
- Abdominal and GI imaging: mechanism of chemoembolisation · ApplicationTransarterial chemoembolisation is used for an unresectable multinodular hepatocellular carcinoma with preserved liver function. Why does hepatic artery embolisation sp…
- Abdominal and GI imaging: evacuation proctography · ApplicationA woman with years of obstructed defecation and a sense of incomplete evacuation needs a test that shows rectocele, rectal intussusception and enterocele dynamically. W…
- Abdominal and GI imaging: renal infarct cortical rim sign · Multi-stepA patient with atrial fibrillation has sudden flank pain, haematuria and raised LDH. Contrast CT shows a wedge-shaped non-enhancing area of kidney with a thin rim of en…
- Abdominal and GI imaging: pelvic phlebolith · ApplicationA kidney-ureter-bladder radiograph shows a 4-mm round pelvic calcification with a lucent centre, lying below the ischial spine. What is the most likely cause?
- Abdominal and GI imaging: meconium ileus management · Multi-stepA newborn with cystic fibrosis fails to pass meconium. The abdominal film shows dilated loops of variable calibre without air-fluid levels and a bubbly ground-glass den…
- Abdominal and GI imaging: choledochal cyst classification · ApplicationA child has jaundice, pain and a right upper quadrant mass. Ultrasound shows fusiform dilatation of the extrahepatic bile duct. Which Todani type is this?
- Abdominal and GI imaging: walled-off necrosis · Multi-stepSix weeks after an attack of necrotising pancreatitis, CT shows a peripancreatic collection with an enhancing wall and heterogeneous content containing non-liquid compo…
- Abdominal and GI imaging: serous cystadenoma of the pancreas · Multi-stepA 65-year-old woman has an incidental pancreatic head lesion. CT shows a cluster of tiny cysts in a honeycomb pattern with a central stellate calcified scar. What is th…
- Abdominal and GI imaging: phaeochromocytoma on MRI · ApplicationA 38-year-old with paroxysmal headache, sweating and hypertension has a 4 cm adrenal mass. MRI shows marked T2 hyperintensity, and the mass does not lose signal on out-…
- Abdominal and GI imaging: superior mesenteric artery syndrome · ApplicationA young woman with marked weight loss has postprandial vomiting. Barium shows a dilated stomach and duodenum with an abrupt vertical cut-off of the third part of the du…
- Abdominal and GI imaging: Chilaiditi sign · ApplicationAn asymptomatic elderly man's erect chest film shows a lucency under the right hemidiaphragm. Haustral folds can be seen within it, and it is unchanged on decubitus vie…
- Abdominal and GI imaging: hepatoblastoma · ApplicationA 2-year-old has a large right upper abdominal mass and a markedly raised serum alpha-fetoprotein. CT shows a heterogeneous enhancing liver mass with calcifications. Wh…
- Abdominal and GI imaging: fibrolamellar carcinoma · Multi-stepA 20-year-old has a large liver mass with normal alpha-fetoprotein, a central calcified scar that is T2 hypointense, and enlarged porta hepatis nodes. There is no cirrh…
- Abdominal and GI imaging: Hinchey classification · Multi-stepA patient with left iliac fossa pain has CT showing sigmoid diverticula with wall thickening, pericolic fat stranding and a 5 cm rim-enhancing collection in the pelvis,…
- Abdominal and GI imaging: anorectal malformation level · ApplicationA newborn boy with imperforate anus has a cross-table lateral film taken prone after allowing time for gas to reach the rectal pouch. The pouch ends above the pubococcy…
- Abdominal and GI imaging: portal venous flow reversal · ApplicationA cirrhotic patient with ascites and varices undergoes Doppler of the main portal vein. Which finding reflects severe portal hypertension?
- Abdominal and GI imaging: oesophageal atresia · ApplicationA newborn has frothing at the mouth and chokes on the first feed. A radiograph shows a nasogastric tube coiled in the upper chest and gas in the stomach and bowel. What…
- Abdominal and GI imaging: mesenteric carcinoid · Multi-stepA man with flushing and diarrhoea has a CT showing a calcified mesenteric mass with radiating strands of soft tissue that tether and kink adjacent small bowel loops. Wh…
- Abdominal and GI imaging: multicystic dysplastic kidney · ApplicationAn antenatal scan shows a kidney replaced by multiple non-communicating cysts of varying size with no identifiable normal parenchyma. DMSA postnatally shows no function…
- Abdominal and GI imaging: acute colonic pseudo-obstruction · ApplicationAn elderly man develops abdominal distension after hip surgery. A plain film shows a markedly dilated caecum and right colon with gas reaching the rectum, and CT shows…
- Abdominal and GI imaging: mesenteric adenitis · ApplicationA child has right iliac fossa pain and fever after a sore throat. Graded-compression ultrasound shows a normal compressible appendix, multiple enlarged ileocaecal nodes…
Radiotherapy and nuclear medicine basics38
- Radiotherapy and nuclear medicine basics: acute versus late effects · ApplicationWhich of the following is a late rather than an acute effect of radiotherapy?
- Radiotherapy and nuclear medicine basics: gallium-67 panda sign · Multi-stepA gallium-67 scan of a patient with granulomatous disease shows symmetrical uptake in the lacrimal and parotid glands and in the right paratracheal and bilateral hilar…
- Radiotherapy and nuclear medicine basics: limitation of brain FDG PET · Multi-stepA patient with a known primary tumour is suspected to have a small brain metastasis. Why is FDG PET unsuitable for excluding it?
- Radiotherapy and nuclear medicine basics: thyroglobulin follow-up · ApplicationA woman has had total thyroidectomy and radioiodine ablation for papillary thyroid carcinoma. Which blood test is the key tumour marker during follow-up?
- Radiotherapy and nuclear medicine basics: PET-CT in an unknown primary · ApplicationA man has a squamous carcinoma in a cervical lymph node. Examination, endoscopy and CT do not show a primary. Which imaging is most useful to find it?
- Radiotherapy and nuclear medicine basics: glioblastoma adjuvant therapy · ApplicationAfter maximal safe resection of glioblastoma in a fit 50-year-old, which adjuvant regimen is standard?
- Radiotherapy and nuclear medicine basics: nasopharyngeal carcinoma · ApplicationA man from north-east India has cervical nodes, serous otitis media and epistaxis. Biopsy shows non-keratinising nasopharyngeal carcinoma without distant spread. What i…
- Radiotherapy and nuclear medicine basics: connective tissue disease and radiotherapy · ApplicationWhich pre-existing condition most increases the risk of severe late tissue toxicity after therapeutic radiotherapy?
- Radiotherapy and nuclear medicine basics: radiotherapy for high-risk prostate cancer · ApplicationA man with locally advanced prostate cancer is treated with external beam radiotherapy. Which addition improves survival?
- Radiotherapy and nuclear medicine basics: radiation-induced liver disease · Multi-stepFour to eight weeks after external beam radiation to the right hepatic lobe, a patient has anicteric hepatomegaly, ascites and a markedly raised alkaline phosphatase. W…
- Radiotherapy and nuclear medicine basics: congenital hypothyroidism scintigraphy · ApplicationA newborn with congenital hypothyroidism has a thyroid scintigram showing a single focus of uptake at the base of the tongue and no uptake in the neck. What is the cause?
- Radiotherapy and nuclear medicine basics: salivary toxicity of radioiodine · ApplicationA patient who received a therapeutic dose of I-131 for thyroid cancer has painful swelling of the parotid glands two days later. What is the cause and the usual measure…
- Radiotherapy and nuclear medicine basics: neoadjuvant chemoradiotherapy for oesophageal cancer · ApplicationA fit patient has a resectable locally advanced squamous cell carcinoma of the mid-oesophagus with nodal involvement. Which strategy is commonly used before surgery?
- Radiotherapy and nuclear medicine basics: standardised uptake value · ApplicationA report of an FDG PET-CT gives a number for a lung nodule that expresses tracer concentration in the lesion relative to the injected dose and the patient's body weight…
- Radiotherapy and nuclear medicine basics: Lhermitte sign · ApplicationThree months after mantle-field radiotherapy for Hodgkin lymphoma, a patient reports electric-shock sensations down the spine on neck flexion. Examination and MRI are n…
- Radiotherapy and nuclear medicine basics: brown fat on PET · ApplicationA young woman scanned in winter for lymphoma staging has symmetric intense FDG uptake in the supraclavicular and paravertebral regions. The corresponding CT shows fat a…
- Radiotherapy and nuclear medicine basics: FDG PET in dementia · ApplicationFDG PET in a 68-year-old with progressive memory loss shows reduced uptake in both temporoparietal cortices and the posterior cingulate, with preserved sensorimotor cor…
- Radiotherapy and nuclear medicine basics: rubidium-82 PET · ApplicationWhich PET myocardial perfusion tracer is eluted from a strontium-82 generator and has a half-life of about 75 seconds?
- Radiotherapy and nuclear medicine basics: pharmacological stress agent · ApplicationA patient with severe active asthma cannot exercise and needs stress myocardial perfusion imaging. Which stress agent is preferred?
- Radiotherapy and nuclear medicine basics: brain death scintigraphy · ApplicationIn a ventilated patient with suspected brain death, apnoea testing cannot be completed. A Tc-99m HMPAO study shows no intracranial uptake, with scalp and facial uptake…
- Radiotherapy and nuclear medicine basics: gallium-68 generator · ApplicationA hospital without a cyclotron offers Ga-68 DOTATATE PET. How is the Ga-68 supplied?
- Radiotherapy and nuclear medicine basics: molybdenum breakthrough · ApplicationA radiopharmacist tests the eluate of a technetium generator for the long-lived parent radionuclide. Which test is this?
- Radiotherapy and nuclear medicine basics: thallium-201 myocardial uptake · ApplicationThallium-201 chloride is used for myocardial perfusion imaging. Which physiological analogue explains its uptake in viable myocytes?
- Radiotherapy and nuclear medicine basics: sestamibi redistribution · Multi-stepIn a Tc-99m sestamibi myocardial perfusion study, separate injections are given for stress and rest imaging. What is the reason?
- Radiotherapy and nuclear medicine basics: subacute thyroiditis · Multi-stepA woman has a painful tender thyroid, fever, raised ESR and symptoms of thyrotoxicosis. What would the 24-hour radioiodine uptake show?
- Radiotherapy and nuclear medicine basics: iodine-123 for imaging · ApplicationWhy is iodine-123 preferred over iodine-131 for diagnostic thyroid imaging?
- Radiotherapy and nuclear medicine basics: samarium-153 therapy · ApplicationA patient with painful osteoblastic metastases from prostate cancer receives samarium-153 EDTMP for pain palliation. What is the dose-limiting toxicity?
- Radiotherapy and nuclear medicine basics: MIBG interfering drugs · ApplicationA patient on labetalol and a tricyclic antidepressant is booked for an MIBG scan for suspected phaeochromocytoma. What is the correct approach?
- Radiotherapy and nuclear medicine basics: DTPA and glomerular filtration · ApplicationWhich renal radiopharmaceutical is cleared almost entirely by glomerular filtration and used to measure glomerular filtration rate?
- Radiotherapy and nuclear medicine basics: interictal FDG PET in epilepsy · ApplicationA patient with drug-resistant temporal lobe epilepsy has mesial temporal sclerosis on MRI. What is the typical interictal FDG PET finding?
- Radiotherapy and nuclear medicine basics: FDG urinary excretion · ApplicationAn FDG PET-CT is requested to stage cervical cancer, but intense tracer activity in the bladder obscures the pelvis. Which measure helps?
- Radiotherapy and nuclear medicine basics: Deauville score · Multi-stepOn interim FDG PET in Hodgkin lymphoma, residual uptake in a node is above the mediastinal blood pool but not above the liver. What is the Deauville score?
- Radiotherapy and nuclear medicine basics: F-18 sodium fluoride PET · ApplicationWhich PET tracer images osteoblastic activity by exchanging with hydroxyl groups in hydroxyapatite, and is used for detecting bone metastases?
- Radiotherapy and nuclear medicine basics: reoxygenation · ApplicationHypoxic cells in the centre of a tumour are radioresistant. During a fractionated course, which process makes them more sensitive to later fractions?
- Radiotherapy and nuclear medicine basics: radiation proctitis · ApplicationEight months after pelvic radiotherapy for cervical cancer, a woman has recurrent rectal bleeding. Sigmoidoscopy shows friable telangiectatic mucosa. Which endoscopic t…
- Radiotherapy and nuclear medicine basics: Manchester point B · Multi-stepIn the Manchester system of brachytherapy for cervical cancer, point B lies 5 cm lateral to the midline at the level of point A. What does the dose at point B approxima…
- Radiotherapy and nuclear medicine basics: heterotopic ossification prophylaxis · ApplicationA man undergoes surgery for an acetabular fracture and has a high risk of heterotopic ossification. Which radiotherapy-based approach can reduce this risk?
- Radiotherapy and nuclear medicine basics: MAA shunt study before radioembolisation · Multi-stepBefore yttrium-90 radioembolisation of hepatocellular carcinoma, a Tc-99m MAA scan is performed through the hepatic artery. What is the main purpose?
Radiation safety and radiobiology33
- Radiation safety and radiobiology: tissue weighting · ApplicationTwo workers each receive the same equivalent dose, one only to the hands and the other to the trunk including stomach, colon, lung and red marrow. Which statement about…
- Radiation safety and radiobiology: law of Bergonie and Tribondeau · ApplicationA radiation oncologist observes that a poorly differentiated, rapidly proliferating tumour shrinks faster during treatment than a well-differentiated, slowly growing on…
- Radiation safety and radiobiology: G2-M arrest as radiosensitiser · Multi-stepA radiation oncologist adds paclitaxel to radiotherapy. Which cell-cycle effect explains its radiosensitising action?
- Radiation safety and radiobiology: water radiolysis · ApplicationWith sparsely ionising radiation such as X-rays, most DNA damage arises indirectly. Which product of water radiolysis is chiefly responsible?
- Radiation safety and radiobiology: shortest latency cancer · ApplicationIn survivors of significant whole-body radiation exposure, which malignancy appears earliest, with a minimum latent period of only a few years?
- Radiation safety and radiobiology: primary and secondary barrier · ApplicationWhile planning a new radiography room, the physicist specifies thicker lead for the wall at which the primary beam is routinely directed. How are the barriers classified?
- Radiation safety and radiobiology: haematopoietic syndrome management · Multi-stepA rescue worker receives an estimated whole-body dose of 3 Gy. Two weeks later he has fever, infections and pancytopenia, with no diarrhoea or neurological signs. Which…
- Radiation safety and radiobiology: skin decontamination · ApplicationA nuclear medicine technologist spills a liquid radiopharmaceutical on her forearm. After removing contaminated clothing, what is the next step?
- Radiation safety and radiobiology: extremity dosimetry · ApplicationA technologist who draws up Tc-99m syringes every day is concerned about the dose to her hands. Which monitoring device records this specifically?
- Radiation safety and radiobiology: fluoroscopy geometry · Multi-stepAn interventional radiologist performs a long fluoroscopic procedure on a C-arm. Which arrangement gives the lowest scatter dose to the operator's upper body?
- Radiation safety and radiobiology: bystander effect · ApplicationIn a cell culture, only a few cells are traversed by an alpha particle, yet micronuclei and chromosomal damage appear in neighbouring cells that were not hit. What is t…
- Radiation safety and radiobiology: biological dosimetry · ApplicationA worker may have received a significant whole-body exposure from a lost source, but wore no dosimeter. Which blood test helps estimate the absorbed dose?
- Radiation safety and radiobiology: radiation weighting factor · ApplicationLung tissue receives an absorbed dose of 1 Gy from alpha particles in one patient and 1 Gy from X-rays in another. How do the equivalent doses compare?
- Radiation safety and radiobiology: linear no-threshold model · Multi-stepA radiation protection officer states that, for the purposes of protection, there is no dose below which the chance of cancer is assumed to be zero. Which model and eff…
- Radiation safety and radiobiology: lymphocyte count as early indicator · ApplicationAfter an accidental whole-body exposure, serial blood counts are used to estimate severity. Which circulating cell count falls earliest and most steeply?
- Radiation safety and radiobiology: latent period of acute radiation syndrome · ApplicationA worker exposed to a high whole-body dose has nausea and vomiting for the first day, then feels well for about two weeks before fever, infection and bleeding appear. W…
- Radiation safety and radiobiology: gastrointestinal syndrome mechanism · Multi-stepA person exposed to a very high whole-body dose has profuse bloody diarrhoea, dehydration and sepsis within the first two weeks and dies despite marrow support. What is…
- Radiation safety and radiobiology: oxygen enhancement ratio · Multi-stepA radiation oncologist chooses a carbon ion beam for a hypoxic radioresistant tumour. Which property explains the advantage over photons?
- Radiation safety and radiobiology: redistribution in fractionation · Multi-stepBetween daily radiotherapy fractions, surviving tumour cells that were in the resistant late S phase move into the more sensitive G2/M phase. Which of the four Rs of ra…
- Radiation safety and radiobiology: ATM and radiosensitivity · Multi-stepA child with cerebellar ataxia and conjunctival telangiectasia develops severe toxicity after a standard dose of radiotherapy. What is the cellular defect?
- Radiation safety and radiobiology: optically stimulated luminescence dosimeter · ApplicationWhich personal dosimeter uses aluminium oxide crystals that release light when stimulated by a laser, and can be re-read for dose?
- Radiation safety and radiobiology: film badge filters · ApplicationA personal monitor contains a photographic film behind filters of different metals and plastic, and the pattern of blackening is used to estimate dose and radiation ene…
- Radiation safety and radiobiology: contamination survey meter · ApplicationAfter a small spill of radioiodine in the nuclear medicine laboratory, which instrument is used to survey the bench and floor for contamination?
- Radiation safety and radiobiology: decay calculation for Tc-99m · ApplicationA syringe holds 600 MBq of Tc-99m at 8 am. The half-life is 6 hours. What activity remains at 8 pm the same day?
- Radiation safety and radiobiology: half value layer calculation · ApplicationThe half value layer of lead for a diagnostic beam is 0.5 mm. What fraction of the beam is transmitted through 1.5 mm of lead?
- Radiation safety and radiobiology: shielding a pure beta emitter · Multi-stepA technologist handles a vial of the pure beta emitter Y-90 and is told to use acrylic shielding first rather than lead. Why?
- Radiation safety and radiobiology: dose limits and patients · ApplicationA radiology resident asks whether the annual occupational dose limit also caps the radiation a patient may receive from medically indicated CT scans. What is the correc…
- Radiation safety and radiobiology: diagnostic reference levels · ApplicationA hospital compares the typical CT head dose with the national diagnostic reference level and finds that its doses are well above it. What is the correct response?
- Radiation safety and radiobiology: dosimeter placement in interventional work · ApplicationAn interventional cardiologist who wears a lead apron is issued two personal dosimeters for estimating effective dose. Where should they be worn?
- Radiation safety and radiobiology: radon · ApplicationWhich source contributes the largest share of the average annual dose to the population from natural background radiation?
- Radiation safety and radiobiology: interphase death of lymphocytes · Multi-stepUnlike most proliferating cells, which die when they try to divide, lymphocytes and oocytes die after low radiation doses without entering mitosis. What is this mode of…
- Radiation safety and radiobiology: leaded eyewear for lens protection · ApplicationCataract is the radiation tissue reaction of main concern to interventional operators. Which item most directly reduces this risk?
- Radiation safety and radiobiology: sensitivity of the fetus at 8 to 15 weeks · Multi-stepA pregnant woman's fetus is exposed to a very high radiation dose 10 weeks after conception. Which long-term outcome is characteristic of exposure at this stage?
Ultrasound28
- Ultrasound: Doppler angle · ApplicationDuring a carotid Doppler examination, no flow signal is detected even though the vessel is patent. Which technical factor best explains this?
- Ultrasound: artefacts · ApplicationOn ultrasound of the liver, a simple cyst shows increased brightness of tissues lying deep to it. What is this artefact called?
- Ultrasound: comet tail artefact · ApplicationA gallbladder wall shows short, bright, comet-shaped echoes deep to small echogenic foci. In which condition is this classically described?
- Ultrasound: colour Doppler aliasing · Multi-stepOn colour Doppler of a vessel with high-velocity flow, the colour changes abruptly from red to blue within the lumen and a mosaic appears. Which setting change is most…
- Ultrasound: elastography · Multi-stepA transient elastography (FibroScan) measurement of the liver is used to assess which property?
- Ultrasound: resistive index calculation · ApplicationOn spectral Doppler of a renal artery, peak systolic velocity is 80 cm/s and end-diastolic velocity is 20 cm/s. What is the resistive index?
- Ultrasound: mirror image artefact · ApplicationUltrasound of the right liver dome shows a bright lesion in the liver and an apparently identical lesion lying above it, seemingly within the lung. What is the explanat…
- Ultrasound: twinkling artefact · Multi-stepOn colour Doppler, a bright echogenic focus in the kidney with posterior shadowing shows a rapidly alternating mosaic of colours behind it, even though no vessel is pre…
- Ultrasound · ApplicationWhat modality has no ionizing radiation?
- Ultrasound · ApplicationWhat is the main physical basis of diagnostic ultrasound imaging?
- Ultrasound · ApplicationWhat is posterior acoustic shadowing often associated with?
- Ultrasound · ApplicationWhat does Doppler ultrasound assess?
- Ultrasound · ApplicationWhat ultrasound appearance is typical of a simple fluid-filled cyst?
- Ultrasound · ApplicationWhat term describes a sonographic image created from reflected sound waves?
- Ultrasound · ApplicationWhat Doppler ultrasound feature can support deep-vein thrombosis?
- Ultrasound · ApplicationHow does simple fluid usually appear on diagnostic ultrasound?
- Ultrasound · ApplicationWhat information does Doppler ultrasound primarily provide?
- Ultrasound · ApplicationWhich ultrasound combination most supports gallstones?
- Ultrasound · ApplicationWhich ultrasound feature supports acute appendicitis in a patient with right-lower-quadrant pain?
- Ultrasound · ApplicationWhat ultrasound appearance is expected behind a simple fluid-filled cyst?
- Ultrasound · ApplicationWhich ultrasound Doppler use is most appropriate in suspected testicular torsion?
- Ultrasound: gallbladder · ApplicationWhich ultrasound feature most strongly supports acute cholecystitis in a patient with right-upper-quadrant pain?
- Ultrasound: ectopic pregnancy · Multi-stepA patient with positive pregnancy test, pelvic pain, and vaginal bleeding has no intrauterine pregnancy on transvaginal ultrasound but has an adnexal mass and free pelv…
- Ultrasound: ectopic pregnancy · ApplicationIn a pregnant patient with pain and bleeding, an adnexal mass with no intrauterine pregnancy above the discriminatory zone suggests what?
- Ultrasound · ApplicationWhat creates comet-tail reverberation artefact on ultrasound?
- Ultrasound · ApplicationWhat Doppler change is expected distal to a severe arterial stenosis?
- Ultrasound: testicular torsion · Multi-stepA teenager with sudden scrotal pain has an enlarged hypoechoic testis with absent intratesticular Doppler flow. What is the diagnosis?
- Ultrasound: abdominal aorta · ApplicationAn abdominal ultrasound shows the infrarenal aorta measuring 5.8 cm in diameter. What is the diagnosis?
Obstetric imaging27
- Obstetric imaging · Multi-stepA woman at 20 weeks of gestation has right lower abdominal pain and tenderness, and appendicitis is suspected. Graded-compression ultrasound is non-diagnostic. What is…
- Obstetric imaging: ectopic pregnancy · ApplicationA woman with amenorrhoea, pelvic pain and a positive urine pregnancy test has transvaginal ultrasound showing an empty uterus, an adnexal mass with a ring of fire sign…
- Obstetric imaging: hydatidiform mole · ApplicationA woman at 10 weeks of amenorrhoea has hyperemesis, vaginal bleeding and a uterus larger than dates. Ultrasound shows a mass of multiple small cystic spaces filling the…
- Obstetric imaging: nuchal translucency · ApplicationA first-trimester screening ultrasound measures nuchal translucency. At what gestational age is it measured and what does an increased value suggest?
- Obstetric imaging: placenta praevia · ApplicationA woman at 32 weeks has painless vaginal bleeding. Which is the investigation of choice, and what should be avoided before it?
- Obstetric imaging: cervical length · ApplicationAt the mid-trimester scan, a woman with a previous second trimester loss has a transvaginal cervical length of 15 mm. What is the significance?
- Obstetric imaging: lemon and banana signs · ApplicationA mid-trimester ultrasound shows a scalloped, lemon-shaped fetal head and a banana-shaped cerebellum with an obliterated cisterna magna. What is the associated anomaly?
- Obstetric imaging: lambda sign in twins · Multi-stepA first trimester ultrasound of twin pregnancy shows a triangular projection of placental tissue extending into the base of the intertwin membrane. What does this indic…
- Obstetric imaging: polyhydramnios · ApplicationA diabetic woman at 32 weeks has a fundal height greater than dates. Ultrasound shows an amniotic fluid index of 28 cm. Which fetal anomaly should be specifically looke…
- Obstetric imaging: non-immune hydrops · ApplicationA fetal ultrasound shows skin oedema, ascites and pleural effusion in a fetus whose mother is Rh positive with no antibodies. What is this called?
- Obstetric imaging: placental abruption · ApplicationA pregnant woman in the third trimester has painful vaginal bleeding after a fall. Ultrasound shows a normally sited placenta and no retroplacental collection. What doe…
- Obstetric imaging: biophysical profile · ApplicationA biophysical profile combining ultrasound parameters and the non-stress test scores 2 points for each component. Which is NOT one of the ultrasound components?
- Obstetric imaging: umbilical artery Doppler · Multi-stepA growth-restricted fetus at 30 weeks has umbilical artery Doppler showing absent end-diastolic flow. What does this imply?
- Obstetric imaging: vasa praevia · Multi-stepA woman at 20 weeks with an in vitro fertilisation pregnancy and a velamentous cord insertion has a colour Doppler transvaginal scan showing fetal vessels running over…
- Obstetric imaging: oligohydramnios and Potter sequence · ApplicationA fetal ultrasound at 22 weeks shows no visible kidneys, an empty bladder and severe oligohydramnios. What complication is expected in the neonate?
- Obstetric imaging: abdominal wall defects · ApplicationA fetal ultrasound shows loops of bowel floating freely in the amniotic fluid next to the cord insertion with no covering membrane. What is the diagnosis?
- Obstetric imaging: cystic hygroma · ApplicationA first trimester scan shows a large, septated cystic mass at the back of the fetal neck with marked nuchal skin thickening. Which chromosomal disorder is most strongly…
- Obstetric imaging: twin-twin transfusion syndrome · Multi-stepIn a monochorionic diamniotic twin pregnancy at 20 weeks, one twin has a large bladder and polyhydramnios and the other has a small bladder, oligohydramnios and appears…
- Obstetric imaging: placenta accreta · Multi-stepA woman at 32 weeks with two previous caesarean sections has an anterior placenta praevia. Ultrasound shows loss of the retroplacental clear zone and multiple placental…
- Obstetric imaging: Doppler for fetal anaemia · Multi-stepA woman with Rh alloimmunisation has rising antibody titres. Which noninvasive Doppler measurement best detects significant fetal anaemia?
- Obstetric imaging: choroid plexus cyst · ApplicationAt the mid-trimester scan, a single small cyst is seen in the choroid plexus of a fetus with otherwise normal anatomy. How should this be managed?
- Obstetric imaging: caesarean scar pregnancy · Multi-stepA woman with a previous caesarean section and a positive pregnancy test has bleeding. Transvaginal ultrasound shows an empty uterine cavity and cervical canal, with a g…
- Obstetric imaging · ApplicationWhich modality avoids ionizing radiation and is standard for fetal assessment?
- Obstetric imaging · ApplicationWhat is a primary reason to use ultrasound in pregnancy?
- Obstetric imaging · ApplicationWhat fetal ultrasound parameter can help assess growth later in pregnancy?
- Obstetric imaging · ApplicationWhy is ultrasound standard for fetal assessment?
- Obstetric imaging · ApplicationWhich ultrasound feature is used to confirm an intrauterine early pregnancy?
Radiotherapy27
- Radiotherapy: fractionation principles · Multi-stepThe rationale for fractionating radiotherapy into multiple small doses includes all of the following EXCEPT:
- Radiotherapy: linear accelerator · ApplicationWhich of the following is an advantage of a linear accelerator compared with a cobalt unit?
- Radiotherapy: brachytherapy · ApplicationIn carcinoma cervix, intracavitary brachytherapy is advantageous mainly because of which property?
- Radiotherapy: Bragg peak · Multi-stepWhat property of proton beam therapy makes it attractive for tumours adjacent to critical structures, such as in children?
- Radiotherapy: radioprotector · ApplicationWhich drug is used as a cytoprotective agent to reduce xerostomia during head and neck radiotherapy?
- Radiotherapy: palliative indications · ApplicationA patient with a painful isolated vertebral metastasis from breast cancer and no neurological deficit is best managed for pain relief by which approach?
- Radiotherapy: oncological emergency · ApplicationA lung cancer patient presents with facial plethora, neck vein distension and stridor. After securing the airway, which treatment gives rapid relief for the obstruction?
- Radiotherapy: prophylactic cranial irradiation · Multi-stepIn which malignancy is prophylactic cranial irradiation established to reduce brain metastases in responders to initial therapy?
- Radiotherapy: late effects · ApplicationA patient treated years ago with radiotherapy to the neck for head and neck cancer presents with a painful exposed necrotic mandible. What is this complication?
- Radiotherapy: radiation pneumonitis · Multi-stepA patient receives chest radiotherapy for lung cancer, and 8 weeks later develops dry cough, low grade fever and dyspnoea, with a hazy opacity conforming to the radiati…
- Radiotherapy: radiosensitisers · ApplicationWhich drug is commonly given concurrently with radiotherapy for locally advanced cervical and head and neck cancer to improve local control?
- Radiotherapy: stereotactic radiosurgery · ApplicationThe Gamma Knife is used mainly for which of the following indications?
- Radiotherapy: brachytherapy sources · Multi-stepWhich isotope is used in high-dose-rate remote afterloading brachytherapy and has a half-life of about 74 days?
- Radiotherapy: IMRT · ApplicationA head and neck cancer patient is planned for intensity-modulated radiotherapy rather than parallel opposed fields. What is the main benefit sought?
- Radiotherapy: spinal cord tolerance · ApplicationA planned radiotherapy dose to a segment of the spinal cord will exceed its tolerance with conventional fractionation. Which late complication is feared?
- Radiotherapy: hyperfractionation · Multi-stepIn a hyperfractionated schedule, smaller doses are given two or more times daily. What biological principle makes this attractive?
- Radiotherapy: image-guided radiotherapy · ApplicationA prostate cancer patient's bladder and rectal filling vary between treatment days. Which approach corrects daily set-up and organ motion?
- Radiotherapy: radiation recall · Multi-stepA woman who completed breast radiotherapy months ago develops erythema and desquamation confined to the old treatment field soon after starting doxorubicin chemotherapy…
- Radiotherapy: late effect of neck irradiation · ApplicationA man treated years ago with mantle field radiotherapy for Hodgkin lymphoma should be followed up for which endocrine complication?
- Radiotherapy: second malignancy · Multi-stepA woman who received chest wall irradiation 12 years earlier now has an enlarging, painful mass in the irradiated field. Biopsy is most likely to show which tumour?
- Radiotherapy: electron beam for superficial tumours · ApplicationA 1.5 cm thick basal cell carcinoma on the cheek is to be irradiated with minimal dose to the underlying tissue. Which beam is most suitable?
- Radiotherapy: skin sparing with megavoltage photons · ApplicationWhy do patients treated with cobalt-60 or linear accelerator photons show less severe skin reactions than those treated with orthovoltage X-rays?
- Radiotherapy: stereotactic body radiotherapy · Multi-stepA 74-year-old man with severe COPD has a 2 cm peripheral stage I non-small-cell lung cancer and cannot tolerate surgery. Which treatment offers high local control with…
- Radiotherapy: HDR remote afterloading · ApplicationWhy is high-dose-rate brachytherapy with iridium-192 delivered by remote afterloading?
- Radiotherapy: hypofractionation · ApplicationWhy can prostate cancer be treated with fewer, larger fractions of radiotherapy?
- Radiotherapy: planning target volume · ApplicationIn radiotherapy planning, the planning target volume is created by adding a margin to the clinical target volume. What does this margin account for?
- Radiotherapy: craniospinal irradiation · Multi-stepA child after resection of a posterior fossa medulloblastoma is to receive postoperative radiotherapy. Why is the whole neuraxis included in the fields?
Abdominal imaging24
- Abdominal imaging · ApplicationThe 'coffee bean' sign on an abdominal radiograph indicates:
- Abdominal imaging · Multi-stepA man with severe epigastric pain radiating to the back and serum lipase of 1200 U/L is admitted. Contrast-enhanced CT is considered. When is it most useful for assessi…
- Abdominal imaging · ApplicationA 45-year-old woman has an incidental liver lesion on ultrasound. MRI shows a very bright lesion on T2 with peripheral nodular discontinuous enhancement that fills in c…
- Abdominal imaging: gallstones · ApplicationUltrasound in a patient with biliary colic shows a contracted gallbladder with a curved echogenic line, a thin rim of bile around it and a dense posterior acoustic shad…
- Abdominal imaging: appendicitis · ApplicationA 12-year-old girl has right iliac fossa pain. Which ultrasound finding supports acute appendicitis?
- Abdominal imaging: psoas shadow · ApplicationOn a plain abdominal radiograph, the left psoas muscle outline is lost while the right is clearly seen. In an unwell patient, which condition is the best consideration?
- Abdominal imaging: epiploic appendagitis · Multi-stepA fit man has acute focal left lower quadrant pain without fever or raised inflammatory markers. CT shows a small oval fat-density lesion with a hyperattenuating rim ad…
- Abdominal imaging: pseudomyxoma peritonei · Multi-stepA patient has progressive abdominal distension. CT shows low-attenuation gelatinous ascites that scallops the liver surface and displaces bowel loops, and a calcified a…
- Abdominal imaging: omental caking · ApplicationA woman with ascites and a raised CA-125 has a CT showing a thick, nodular infiltrated omentum with tumour deposits on the peritoneal surfaces. What is this omental app…
- Abdominal imaging: cupola sign · Multi-stepA supine abdominal radiograph in a patient with peritonitis shows a lucent collection of gas overlying the lower thoracic spine, beneath the central diaphragm. What is…
- Abdominal imaging: CT in suspected perforation · ApplicationAn elderly man has sudden severe abdominal pain with a rigid abdomen, and an erect chest film shows no free gas. The suspicion of perforation remains high. What is the…
- Abdominal imaging · ApplicationWhat is often the initial imaging study for suspected gallstones?
- Abdominal imaging · ApplicationWhat is a classic plain-film feature of small bowel obstruction?
- Abdominal imaging · ApplicationWhat CT feature is often associated with acute appendicitis?
- Abdominal imaging · ApplicationWhat is a common use of ultrasound in suspected appendicitis in children?
- Abdominal imaging · ApplicationA patient has suspected common-bile-duct obstruction and needs noninvasive mapping of the biliary tree; which study is most useful?
- Abdominal imaging · ApplicationWhat plain-film feature supports small-bowel obstruction?
- Abdominal imaging · ApplicationWhich CT examination is highly sensitive for suspected ureteric stone in many nonpregnant adults?
- Abdominal imaging · ApplicationWhich imaging modality is usually first line for suspected gallstones and biliary dilatation?
- Abdominal imaging · ApplicationWhat CT feature supports the diagnosis of acute appendicitis?
- Abdominal imaging · ApplicationWhat is the principal advantage of CT angiography in suspected pulmonary embolism?
- Abdominal imaging · ApplicationWhich MRI sequence is used to noninvasively depict bile and pancreatic ducts?
- Abdominal imaging · ApplicationWhat ultrasound feature is most typical of acute cholecystitis?
- Abdominal imaging: intussusception · ApplicationOn ultrasound, multiple concentric bowel rings are seen in transverse section in a child with intermittent colicky pain. What sign is this?
Cardiac imaging20
- Cardiac imaging · ApplicationA 'boot-shaped' heart (coeur en sabot) on a chest radiograph is typical of:
- Cardiac imaging: TAPVC · ApplicationAn infant with cyanosis and heart failure has a chest radiograph showing a figure-of-8 or snowman silhouette with increased pulmonary vascularity. What is the likely di…
- Cardiac imaging: coarctation · ApplicationA 14-year-old with hypertension in the arms has a chest radiograph showing inferior rib notching of the posterior ribs 3 to 8 and a 'figure of 3' sign at the aortic knu…
- Cardiac imaging: mitral stenosis · ApplicationA chest radiograph shows straightening of the left heart border, a double density behind the right heart border and splaying of the carina. Which condition is most like…
- Cardiac imaging: pericardial effusion · ApplicationA patient with tuberculous pericarditis has a globular, flask-shaped cardiac silhouette with clear lung fields. What is the name given to this radiographic appearance?
- Cardiac imaging: transposition · ApplicationA cyanosed newborn shows an oval cardiac silhouette with a narrow vascular pedicle on the chest radiograph. What is the likely diagnosis?
- Cardiac imaging: aortic dissection · ApplicationA hypertensive patient has tearing chest pain radiating to the back and unequal arm pulses. What is the investigation of choice if the patient is haemodynamically stable?
- Cardiac imaging: coronary calcium score · ApplicationA non-contrast, ECG-gated cardiac CT is performed on an asymptomatic man at intermediate risk. What does the calcium score primarily assess?
- Cardiac imaging: cardiac MRI · Multi-stepLate gadolinium enhancement on cardiac MRI in the subendocardium of a ventricular territory suggests which of the following?
- Cardiac imaging: constrictive pericarditis · Multi-stepA patient with long-standing tuberculous pericarditis has signs of right-sided heart failure, and a lateral chest radiograph shows curvilinear calcification around the…
- Cardiac imaging: atrial septal defect · ApplicationAn adult has an ejection systolic murmur and fixed splitting of the second heart sound. The chest radiograph shows cardiomegaly with right atrial prominence, a small ao…
- Cardiac imaging: figure 3 sign · ApplicationA barium swallow in a young hypertensive man shows an indentation of the oesophagus at the level of the aortic arch with a pre-stenotic and post-stenotic widening. What…
- Cardiac imaging: Eisenmenger syndrome · Multi-stepA 28-year-old woman with a long-standing ventricular septal defect is now cyanosed. A chest radiograph shows very large central pulmonary arteries that taper abruptly w…
- Cardiac imaging: coronary CT angiography · ApplicationA 48-year-old man with atypical chest pain, a low to intermediate pre-test probability of coronary disease and a normal ECG needs a non-invasive test. What is the main…
- Cardiac imaging: endocarditis on echocardiography · ApplicationA man with fever and a new regurgitant murmur has negative transthoracic echocardiography but a high clinical suspicion of prosthetic valve endocarditis. Which next tes…
- Cardiac imaging: left ventricular aneurysm · Multi-stepSix months after an anterior myocardial infarction, a patient has persistent ST elevation on the ECG and a bulge on the left heart border of the chest film with a curvi…
- Cardiac imaging: Stanford classification · Multi-stepCT angiography in a patient with tearing chest pain shows an intimal flap in the ascending aorta extending into the arch. Which classification and management follow?
- Cardiac imaging: bicuspid aortic valve and the aorta · Multi-stepA 30-year-old man has a bicuspid aortic valve on echocardiography. Which additional imaging issue should be addressed?
- Cardiac imaging: Takotsubo cardiomyopathy · Multi-stepA 62-year-old woman develops chest pain and ST elevation after bereavement. Coronary angiography is normal, and left ventriculography shows apical ballooning with hyper…
- Cardiac imaging: myocarditis on MRI · Multi-stepA 25-year-old man has chest pain after a viral illness, raised troponin and normal coronary arteries. Cardiac MRI shows myocardial oedema on T2 and patchy late gadolini…
GI imaging20
- GI imaging: Rigler sign · ApplicationA supine abdominal radiograph shows both the inner and outer walls of bowel loops clearly outlined by gas as a thin line. What is this sign?
- GI imaging: sigmoid volvulus · ApplicationA bedridden elderly patient has abdominal distension and constipation, and a radiograph shows a hugely dilated gas-filled loop rising from the pelvis toward the right u…
- GI imaging: caecal volvulus · Multi-stepWhich radiographic feature favours a caecal volvulus over a sigmoid volvulus?
- GI imaging: toxic megacolon · Multi-stepA patient with severe colitis has fever and tachycardia, and an abdominal radiograph shows a transverse colon diameter of 7 cm with loss of haustra. Which is the correc…
- GI imaging: Crohn disease · ApplicationA barium follow-through in a young patient with chronic diarrhoea shows a narrowed terminal ileum (string sign), cobblestone mucosa and skip lesions. What is the diagno…
- GI imaging: achalasia · ApplicationA barium swallow in a young adult with dysphagia for solids and liquids shows a dilated oesophagus tapering smoothly to a narrow segment at the gastro-oesophageal junct…
- GI imaging: oesophageal varices · ApplicationA barium swallow in a patient with portal hypertension shows serpiginous filling defects in the lower oesophagus. What does this represent?
- GI imaging: gastric carcinoma · Multi-stepA barium meal shows a rigid, narrow, non-distensible stomach with a featureless mucosa in a patient with weight loss. What is this appearance called?
- GI imaging: colonic carcinoma · ApplicationA barium enema shows an annular constricting lesion in the sigmoid colon with shouldered margins and an irregular mucosa. What is this sign called?
- GI imaging: gallstone ileus · ApplicationAn elderly woman with a history of gallstones has vomiting and abdominal distension. A plain abdominal film shows dilated small bowel loops, gas in the biliary tree and…
- GI imaging: feline oesophagus · ApplicationA young man with atopy and dysphagia to solids has a barium swallow that shows fine transverse folds across the mid and distal oesophagus resembling the cat's oesophagu…
- GI imaging: Carman meniscus sign · Multi-stepA double contrast barium meal in a man with epigastric pain shows a lesser curve gastric ulcer with a flat, lenticular crater whose outer margin is convex toward the lu…
- GI imaging: oesophageal perforation · Multi-stepAfter violent vomiting, a man has severe chest pain and subcutaneous emphysema. A chest film shows left pleural effusion and mediastinal air. Which investigation confir…
- GI imaging: CT enterography · ApplicationA young man with chronic diarrhoea and suspected Crohn disease has a normal colonoscopy and ileal intubation. Which imaging best assesses the small bowel wall and extra…
- GI imaging: comb sign in Crohn disease · Multi-stepIn active Crohn disease, CT enterography shows prominent engorged vasa recta of the mesentery perpendicular to a thickened ileal segment. What is this sign?
- GI imaging: coeliac disease on small bowel imaging · Multi-stepA patient with chronic diarrhoea and iron deficiency has a small bowel study showing fewer jejunal folds than usual and an increase in ileal folds. What is this pattern…
- GI imaging: Schatzki ring · ApplicationA 50-year-old man has intermittent dysphagia to solid food, particularly with meat. A barium swallow with the patient prone shows a smooth, thin ring at the gastro-oeso…
- GI imaging: pneumatosis with portal venous gas · Multi-stepAn elderly man with atherosclerosis has shock, severe abdominal pain and a raised lactate. CT shows gas within the bowel wall and branching gas in the portal venous sys…
- GI imaging: ischaemic colitis · ApplicationA 72-year-old woman with atrial fibrillation has sudden left-sided abdominal pain and bloody diarrhoea. A plain film shows thumbprinting of the descending colon. Which…
- GI imaging: CT in acute diverticulitis · ApplicationA 60-year-old man has left iliac fossa pain, fever and raised inflammatory markers. Which CT finding best supports acute diverticulitis?
Paediatric imaging20
- Paediatric imaging: pyloric stenosis · ApplicationA 5-week-old boy has projectile non-bilious vomiting and an olive-shaped mass in the epigastrium. What is the diagnostic finding on ultrasound?
- Paediatric imaging: intussusception · ApplicationA 9-month-old child has intermittent colicky pain, red currant jelly stools and a sausage-shaped mass. Which ultrasound finding is characteristic?
- Paediatric imaging: malrotation · Multi-stepA neonate presents with sudden bilious vomiting. Upper GI contrast study shows the duodenojejunal flexure to the right of the midline, and the duodenum and jejunum take…
- Paediatric imaging: Hirschsprung disease · ApplicationA newborn with delayed passage of meconium and abdominal distension has a contrast enema showing a narrow rectum with a conical transition zone and a dilated sigmoid co…
- Paediatric imaging: necrotising enterocolitis · ApplicationA premature neonate on feeds develops abdominal distension and bloody stools, and the abdominal radiograph shows linear and bubbly gas within the bowel wall. What is th…
- Paediatric imaging: Wilms tumour · ApplicationA 3-year-old child has a palpable abdominal mass that does not cross the midline. Ultrasound shows a large solid intrarenal mass with the calyces stretched around it (c…
- Paediatric imaging: neuroblastoma · Multi-stepA 2-year-old has an abdominal mass with fine stippled calcification that encases the aorta and displaces the kidney downward. Urinary VMA is raised. Which nuclear scan…
- Paediatric imaging: vesicoureteric reflux · ApplicationA child with recurrent urinary tract infections needs assessment for reflux. Which study demonstrates reflux and grades it?
- Paediatric imaging: epiglottitis · ApplicationA febrile child with drooling and stridor has a lateral neck radiograph showing a swollen, thumb-shaped epiglottis. What should be done first?
- Paediatric imaging: triple bubble sign · ApplicationA newborn with bilious vomiting has an abdominal film showing three gas-filled structures in the upper abdomen with no gas distally. Which diagnosis does this favour?
- Paediatric imaging: antenatal hydronephrosis and PUJ obstruction · ApplicationA newborn with antenatally detected hydronephrosis has an ultrasound showing a dilated renal pelvis and calyces with a non-dilated ureter and a normal bladder. What is…
- Paediatric imaging: duplex kidney and ureterocele · Multi-stepAn IVU in a girl with recurrent urinary infection shows a drooping lily appearance of the right kidney, and a cystogram shows a rounded filling defect at the bladder ba…
- Paediatric imaging: posterior urethral valves · Multi-stepA male newborn has a palpable bladder and a poor urinary stream. Ultrasound shows a thick-walled distended bladder with a dilated posterior urethra, the keyhole sign, a…
- Paediatric imaging: button battery ingestion · Multi-stepA toddler is suspected to have swallowed a coin-shaped object. The chest film shows a round radiopaque disc in the oesophagus with a double contour on the AP view and a…
- Paediatric imaging: craniosynostosis · ApplicationAn infant has a long, narrow skull with a palpable ridge along the sagittal suture. Which imaging best defines the fused sutures and plans surgery?
- Paediatric imaging: Peutz-Jeghers polyps · ApplicationA 7-year-old with pigmented macules on the lips has colicky abdominal pain. Ultrasound shows a target sign in the small bowel. What is the likely lead point?
- Paediatric imaging: transient synovitis of the hip · ApplicationA 5-year-old has a limp and mild hip pain after a viral illness. He is afebrile and walks. Ultrasound shows a small hip joint effusion. What is the role of ultrasound i…
- Paediatric imaging · ApplicationWhy is ultrasound preferred for infant hip dysplasia assessment?
- Paediatric imaging · ApplicationWhich ultrasound feature supports hypertrophic pyloric stenosis?
- Paediatric imaging · ApplicationWhat radiographic sign supports intussusception on contrast enema?
Interventional radiology19
- Interventional radiology: embolisation · Multi-stepA patient with massive haemoptysis from chronic cavitary tuberculosis is stabilised. Which interventional procedure is the preferred definitive control in the acute set…
- Interventional radiology: modalities for guided procedures · ApplicationA radiologist plans a percutaneous biopsy of a peripheral lung nodule and wishes to minimise injury to adjacent structures. Which guidance is most commonly used?
- Interventional radiology: percutaneous vertebroplasty · ApplicationAn elderly woman has persistent severe pain from a recent osteoporotic vertebral compression fracture despite analgesia. Which radiological procedure may relieve it?
- Interventional radiology: pseudoaneurysm after femoral puncture · Multi-stepTwo days after cardiac catheterisation, a patient has a pulsatile groin mass. Duplex ultrasound shows a swirling flow within a sac connected to the femoral artery by a…
- Interventional radiology · ApplicationWhat does embolization aim to achieve in active bleeding?
- Interventional radiology · ApplicationWhat imaging guidance is often used during vascular catheter procedures?
- Interventional radiology · ApplicationThe Seldinger technique is used to obtain what?
- Interventional radiology · ApplicationWhat is embolization used for?
- Interventional radiology · ApplicationWhat is image-guided biopsy intended to obtain?
- Interventional radiology · ApplicationWhat guidance is often used for vascular catheter procedures?
- Interventional radiology · ApplicationWhat is the Seldinger technique used to obtain?
- Interventional radiology · ApplicationWhat is a major advantage of image-guided percutaneous drainage of a suitable abscess?
- Interventional radiology · ApplicationWhat is a major advantage of image-guided percutaneous biopsy?
- Interventional radiology · ApplicationWhich condition may be treated by catheter-directed arterial embolization?
- Interventional radiology: drainage · ApplicationA patient has a well-defined pelvic abscess accessible by a safe percutaneous route. What interventional radiology procedure may provide source control?
- Interventional radiology · ApplicationWhat is the purpose of image-guided nephrostomy?
- Interventional radiology · ApplicationWhat is a common indication for biliary drainage by interventional radiology?
- Interventional radiology: angioplasty · ApplicationWhat is the main purpose of balloon angioplasty for a focal arterial stenosis?
- Interventional radiology: embolization · ApplicationWhat is a common interventional radiology use of transarterial embolization?
MRI19
- MRI: sequence identification · ApplicationA brain MRI shows periventricular hyperintense lesions on T2 with the CSF signal suppressed so that the ventricles are dark. Which sequence is this?
- MRI: diffusion weighted imaging · ApplicationA patient with sudden hemiparesis has a normal CT at 2 hours. Which MRI sequence would show the infarct earliest?
- MRI: contrast agent · ApplicationGadolinium chelates enhance MR images mainly by which mechanism?
- MRI: nephrogenic systemic fibrosis · Multi-stepA patient with an eGFR of 15 mL/min needs contrast-enhanced MRI. Which complication is the principal concern with older linear gadolinium agents?
- MRI: safety · ApplicationA patient scheduled for MRI is found to have an intraocular metallic foreign body from welding. What is the appropriate action?
- MRI: sequences for haemorrhage · Multi-stepIn a patient suspected to have cerebral microbleeds from hypertension, which MRI sequence is the most sensitive for detecting them?
- MRI: fat suppression · ApplicationA bone marrow oedema pattern in the femoral head is to be shown clearly against the bright marrow fat. Which sequence is the best choice?
- MRI: angiography · ApplicationWhich MR technique images vessels without any contrast injection by using inflow of unsaturated blood?
- MRI: T2 appearance of lesions · Multi-stepA well-defined, rounded liver lesion is markedly hyperintense on T2 (light bulb sign) and shows peripheral nodular discontinuous enhancement with centripetal filling. W…
- MRI: MR spectroscopy in tumours · Multi-stepProton MR spectroscopy of an enhancing brain lesion shows a high choline peak, a markedly reduced N-acetylaspartate peak and a lactate peak. What does this pattern most…
- MRI: chemical shift artefact · Multi-stepOn an abdominal MRI, a bright band and a dark band appear at opposite borders of the kidney where it abuts retroperitoneal fat, along the frequency-encoding direction.…
- MRI: metal susceptibility artefact · ApplicationA patient with spinal pedicle screws needs an MRI. The images show signal loss and geometric distortion around the metal. Which choice reduces this?
- MRI: Larmor frequency and field strength · ApplicationA technologist moves a patient from a 1.5 tesla to a 3 tesla scanner. How does the proton resonance (Larmor) frequency change?
- MRI · ApplicationWhat is a key MRI contraindication consideration?
- MRI · ApplicationWhat MRI sequence is particularly useful for demonstrating edema?
- MRI · ApplicationWhat MRI sequence is especially useful for detecting acute ischemia?
- MRI · ApplicationWhat MRI property makes fluid often bright on T2-weighted images?
- MRI: diffusion-weighted imaging · ApplicationWhich MRI sequence is particularly sensitive to early acute ischemic infarction because of restricted water diffusion?
- MRI: multiple sclerosis · ApplicationWhich MRI distribution is most characteristic of multiple sclerosis plaques?
Gynaecological imaging16
- Gynaecological imaging: dermoid · ApplicationAn ultrasound of a young woman shows an ovarian mass with a hyperechoic nodule, acoustic shadowing and echogenic lines (dermoid plug and dot-dash pattern). CT shows fat…
- Gynaecological imaging: endometrioma · ApplicationA woman with dysmenorrhoea and infertility has a unilocular adnexal cyst with homogeneous low-level echoes on ultrasound, which shows T1 hyperintensity and T2 shading o…
- Gynaecological imaging: hysterosalpingography · ApplicationIn a woman with primary infertility, when is hysterosalpingography ideally performed?
- Gynaecological imaging: uterine fibroid · ApplicationA 40-year-old woman with menorrhagia has a transvaginal ultrasound showing an enlarged uterus with a well-defined, rounded, hypoechoic mass in the myometrium causing ed…
- Gynaecological imaging: adenomyosis · Multi-stepA 42-year-old woman has dysmenorrhoea and heavy periods. MRI shows diffuse thickening of the junctional zone to 14 mm with small high signal foci within it on T2 and no…
- Gynaecological imaging: polycystic ovaries · ApplicationA woman with oligomenorrhoea and hirsutism has a transvaginal ultrasound. Which finding is a recognised criterion for polycystic ovarian morphology?
- Gynaecological imaging: postmenopausal endometrial thickness · ApplicationA 60-year-old woman has postmenopausal bleeding. On transvaginal ultrasound, which endometrial thickness is generally regarded as low risk and reassuring?
- Gynaecological imaging: ovarian torsion · Multi-stepA young woman has sudden severe lower abdominal pain and vomiting. Ultrasound shows an enlarged ovary with peripherally arranged follicles and a twisted vascular pedicl…
- Gynaecological imaging: hydrosalpinx · ApplicationA woman with infertility has a transvaginal ultrasound showing a tubular, anechoic adnexal structure with incomplete septa and folded walls, separate from the ovary. Wh…
- Gynaecological imaging: Asherman syndrome · Multi-stepA woman with secondary amenorrhoea after a curettage for retained products has a normal hormone profile. Hysterosalpingography shows irregular, angulated filling defect…
- Gynaecological imaging: septate versus bicornuate uterus · Multi-stepMRI of a woman with recurrent miscarriage shows two uterine cavities, and the external fundal contour is convex with no indentation. What is the likely diagnosis and tr…
- Gynaecological imaging: O-RADS ultrasound · ApplicationAn ultrasound of the adnexa shows a unilocular cyst of 4 cm with smooth thin walls and anechoic contents in a premenopausal woman. How is it classified in a risk strati…
- Gynaecological imaging: MRI staging of endometrial cancer · Multi-stepA woman with biopsy-proven endometrial carcinoma needs preoperative imaging. Which MRI finding determines the stage and the need for lymph node assessment?
- Gynaecological imaging: sonohysterography · ApplicationA woman with intermenstrual bleeding has a thickened endometrium on transvaginal ultrasound. Which test best distinguishes a focal polyp from diffuse thickening by dist…
- Gynaecological imaging: Krukenberg tumour · Multi-stepA 50-year-old woman with a previously resected gastric signet-ring cell carcinoma has bilateral solid ovarian masses with preserved ovarian contour on CT. What is the l…
- Gynaecological imaging: MRI before uterine artery embolisation · Multi-stepA woman with symptomatic fibroids is considering uterine artery embolisation. Which imaging step is most useful before the procedure?
Radiation safety16
- Radiation safety: lead apron · ApplicationA radiology worker wearing a lead apron for fluoroscopy is protected best if the apron has what lead equivalence?
- Radiation safety: personal monitoring · ApplicationWhich device is commonly worn by radiation workers in India for routine monthly personal dose monitoring?
- Radiation safety: pregnant worker · Multi-stepA radiographer informs the department that she is pregnant. Which approach is correct?
- Radiation safety: occupational dose limit · ApplicationUnder standard international and AERB recommendations, the annual effective dose limit for occupational workers is averaged over 5 years to be which of the following?
- Radiation safety: background dose · ApplicationThe world average annual effective dose from natural background radiation is closest to which of the following?
- Radiation safety: I-131 patient precautions · Multi-stepAfter I-131 therapy for thyroid cancer, which precaution is most appropriate?
- Radiation safety: operator dose in fluoroscopy · Multi-stepIn a fluoroscopy room, where is scattered radiation dose to the operator greatest?
- Radiation safety · ApplicationWhich worker protection reduces fluoroscopy exposure?
- Radiation safety · ApplicationWhat principle emphasizes keeping radiation exposure as low as reasonably achievable?
- Radiation safety · ApplicationWhich material is routinely used as shielding against diagnostic X-rays?
- Radiation safety · ApplicationWhat should be confirmed before any imaging examination?
- Radiation safety · ApplicationWhat is the rationale for shielding and collimation in X-ray imaging?
- Radiation safety · ApplicationWhat does ALARA stand for in radiation protection?
- Radiation safety · ApplicationWhat material is commonly used for X-ray shielding?
- Radiation safety: pregnancy · ApplicationWhen imaging a pregnant patient, what is the primary radiation-protection principle?
- Radiation safety: MRI · ApplicationWhy must patients be screened for some implanted devices before MRI?
Spine imaging15
- Spine imaging: tuberculous spondylitis · ApplicationA patient with back pain, low-grade fever and a gibbus deformity has MRI showing destruction of two adjacent vertebral bodies, preservation of the disc until late and a…
- Spine imaging: syringomyelia · ApplicationA patient has loss of pain and temperature in a cape distribution and wasting of the hands. MRI shows a long CSF-intensity cavity within the cervical cord. What conditi…
- Spine imaging: spinal trauma · ApplicationA patient with neck pain after a diving accident has a normal lateral cervical spine radiograph, but persistent neurological deficits. Which investigation best assesses…
- Spine imaging: Jefferson fracture · Multi-stepAfter a diving injury, an open-mouth view shows lateral displacement of both lateral masses of C1 relative to C2. What is the injury?
- Spine imaging: vertebral metastasis · ApplicationA bone scan shows multiple hot spots in the spine. MRI of one vertebra shows loss of the normal T1 marrow signal with sparing of the disc. What does this suggest?
- Spine imaging: tethered cord · ApplicationA child with a sacral dimple and a hairy patch has urinary urgency and foot deformity. MRI shows the conus medullaris ending at L4 with a thickened filum terminale. Wha…
- Spine imaging: Chance fracture · Multi-stepA restrained passenger in a head-on collision has back pain. Lateral spine film shows a horizontal fracture through the vertebral body, pedicles and spinous process of…
- Spine imaging: spondylolysis · ApplicationAn adolescent gymnast has low back pain on extension. An oblique lumbar radiograph shows a break in the neck of the Scottie dog at L5. What is the finding?
- Spine imaging: diastematomyelia · Multi-stepA child with a tuft of hair over the lumbar spine has an MRI showing the spinal cord split into two hemicords at L2, separated by a bony spur, with a widened interpedic…
- Spine imaging: benign versus malignant vertebral collapse · Multi-stepAn elderly woman has an acute vertebral compression fracture. Which MRI finding favours a malignant cause over osteoporosis?
- Spine imaging: cervical spondylotic myelopathy · ApplicationA 65-year-old man has gait unsteadiness, clumsy hands and brisk reflexes. MRI shows multilevel cervical spondylosis with cord compression. Which additional MRI finding…
- Spine imaging: grading spondylolisthesis · ApplicationA lateral lumbar radiograph shows L5 slipped forward on S1 by about 30 percent of the width of the S1 endplate. Using the Meyerding classification, which grade is this?
- Spine imaging: Hirayama disease · Multi-stepA 20-year-old man has progressive asymmetric weakness and wasting of one hand and forearm with sparing of brachioradialis, worsened by cold. Neutral cervical MRI is nor…
- Spine imaging · ApplicationWhat measurement is commonly used to quantify the magnitude of scoliosis on standing radiographs?
- Spine imaging: cauda equina · Multi-stepA patient has back pain, bilateral sciatica, saddle numbness, and urinary retention. Which imaging study is most appropriate urgently?
Breast imaging14
- Breast imaging · ApplicationA screening mammogram in a 52-year-old woman shows a cluster of fine, pleomorphic, linear branching microcalcifications without any mass. Core biopsy is most likely to…
- Breast imaging: BI-RADS · ApplicationOn screening mammography, a radiologist assigns BI-RADS category 4. What is the recommended management?
- Breast imaging: malignant calcifications · ApplicationWhich mammographic appearance of calcification is most suspicious for ductal carcinoma in situ?
- Breast imaging: implants · Multi-stepWhich imaging is the most sensitive for detecting intracapsular rupture of a silicone breast implant?
- Breast imaging: screening · ApplicationA woman with a BRCA1 mutation is being offered screening. Which additional modality is recommended alongside mammography because of its higher sensitivity?
- Breast imaging: tomosynthesis · ApplicationWhat is the main advantage of digital breast tomosynthesis over standard two-view mammography?
- Breast imaging: galactography · ApplicationA woman has spontaneous bloody discharge from a single duct of the left nipple, with a normal mammogram and ultrasound. Which test can show an intraductal lesion?
- Breast imaging: phyllodes tumour · Multi-stepA 40-year-old woman has a rapidly enlarging, smooth breast lump. Ultrasound shows a large, lobulated, well-circumscribed solid mass with clefts or cystic spaces. Core b…
- Breast imaging · ApplicationWhat imaging test is commonly used for population breast cancer screening?
- Breast imaging · ApplicationWhat ultrasound feature tends to favor a simple cyst?
- Breast imaging · ApplicationWhat imaging method is commonly used for breast cancer screening?
- Breast imaging · ApplicationWhich mammographic finding may prompt further assessment because it can be associated with early breast malignancy?
- Breast imaging: BI-RADS · ApplicationWhat is the purpose of the BI-RADS system in breast imaging?
- Breast imaging: ultrasound · ApplicationWhich ultrasound feature more often favors a benign breast cyst?
Imaging physics13
- Imaging physics: anode heel effect · ApplicationWhile positioning a patient for a long-field radiograph such as a thoracic spine, the radiographer places the thicker body part towards the cathode end of the tube. Thi…
- Imaging physics: photon interactions · ApplicationWhich statement about the photoelectric effect in diagnostic radiology is correct?
- Imaging physics: Compton scatter · ApplicationIn the diagnostic energy range, which interaction is the principal source of scattered radiation that reaches the operator and degrades the image?
- Imaging physics: geometric unsharpness · ApplicationA radiographer wishes to reduce geometric unsharpness (penumbra) in a radiograph. Which change would help?
- Imaging physics: CT attenuation of blood · ApplicationA non-contrast CT head shows a crescentic extra-axial collection of 65 HU. Which characteristic does this attenuation most suggest?
- Imaging physics: inverse square law · ApplicationThe radiation intensity at 1 metre from a point source is 400 units. What will it be at 2 metres, ignoring attenuation?
- Imaging physics: filtration · ApplicationWhy is an aluminium filter added to the beam of a diagnostic X-ray tube?
- Imaging physics: digital radiography · ApplicationA main advantage of digital (CR/DR) radiography over screen-film radiography is which of the following?
- Imaging physics: radiolucent versus radiopaque · ApplicationArrange these in order of increasing radiographic density (blackest to whitest) on a plain film.
- Imaging physics: image noise and dose · ApplicationOn a CT scan, the image of an obese patient looks grainy. Which adjustment reduces quantum noise?
- Imaging physics: scatter control in a lumbar radiograph · ApplicationA lateral lumbar spine radiograph in a large patient looks grey and low in contrast. Which two measures most directly improve it by reducing scattered radiation?
- Imaging physics: motion unsharpness in a child · ApplicationA restless 2-year-old has a blurred chest radiograph because of movement. Which change in technique best reduces motion unsharpness?
- Imaging physics: pulsed fluoroscopy · ApplicationDuring a long interventional procedure the operator switches from continuous to pulsed fluoroscopy at a low frame rate. What is the main benefit?
Head and neck imaging12
- Head and neck imaging: thyroid ultrasound · ApplicationWhich ultrasound feature of a thyroid nodule is most suspicious for malignancy?
- Head and neck imaging: carotid Doppler · ApplicationA patient with transient monocular blindness has carotid Doppler showing a high peak systolic velocity at the origin of the internal carotid artery. What does it indica…
- Head and neck imaging: orbital imaging · ApplicationWhich finding on CT or MRI of the orbit is characteristic of thyroid eye disease?
- Head and neck imaging: thyroglossal duct cyst · ApplicationA child has a midline anterior neck swelling that moves upward on tongue protrusion. Ultrasound shows a well-defined cystic structure near the hyoid bone. What is the d…
- Head and neck imaging: cholesteatoma on CT · Multi-stepA man with chronic foul ear discharge and conductive hearing loss has HRCT of the temporal bone showing a soft tissue mass in the epitympanum with erosion of the scutum…
- Head and neck imaging: orbital cellulitis · ApplicationA 6-year-old has a swollen red eyelid, proptosis, painful eye movements and fever. Which imaging should be done to look for a subperiosteal abscess?
- Head and neck imaging: paranasal sinus mucocele · Multi-stepA woman has frontal headache and displacement of the eye downwards. CT shows an opacified, expanded frontal sinus with thinned and remodelled bony walls and no air. Wha…
- Head and neck imaging: carotid body tumour · Multi-stepA 45-year-old has a painless, pulsatile neck mass at the carotid bifurcation. CT angiography shows an avidly enhancing mass splaying the internal and external carotid a…
- Head and neck imaging: submandibular space infection · ApplicationA diabetic man with a decayed lower molar has a woody swelling beneath the jaw, a raised tongue and drooling. Contrast CT is requested to assess airway-threatening spre…
- Head and neck imaging: antrochoanal polyp · ApplicationA teenager has unilateral nasal obstruction. CT shows a soft tissue mass filling the right maxillary sinus that extends through the widened ostium into the nasopharynx,…
- Head and neck imaging: juvenile nasopharyngeal angiofibroma · Multi-stepAn adolescent boy has recurrent profuse epistaxis. CT shows a mass at the sphenopalatine foramen with anterior bowing of the posterior wall of the maxillary sinus. What…
- Head and neck imaging: sialography in Sjogren syndrome · ApplicationA woman with dry eyes and dry mouth has bilateral parotid swelling. Sialography shows multiple small punctate collections of contrast throughout the glands. What is thi…
Liver imaging12
- Liver imaging: hepatocellular carcinoma · Multi-stepA cirrhotic patient has a 3 cm liver lesion that enhances brightly in the arterial phase and shows washout in the portal venous phase on multiphase CT. What is the diag…
- Liver imaging: focal nodular hyperplasia · ApplicationA young woman has an incidental liver lesion that is isodense on non-contrast CT, enhances intensely in the arterial phase and has a central stellate scar that enhances…
- Liver imaging: amoebic liver abscess · ApplicationUltrasound of a patient with fever and right upper quadrant pain shows a solitary, round, hypoechoic lesion with no significant wall echoes in the posterior segment of…
- Liver imaging: hydatid cyst · Multi-stepAn ultrasound of the liver shows a cystic lesion with multiple daughter cysts and a detached laminated membrane floating inside. What does this feature indicate?
- Liver imaging: Budd-Chiari syndrome · Multi-stepA young woman with ascites and tender hepatomegaly has Doppler ultrasound showing absent flow in the hepatic veins and a caudate lobe enlargement. Which diagnosis is mo…
- Liver imaging: cluster sign of pyogenic abscess · Multi-stepA diabetic man has fever and right upper quadrant pain. CT shows several small, low-density hepatic lesions that are close together and appear to coalesce into a larger…
- Liver imaging: focal fatty sparing · ApplicationA patient with diffuse fatty liver on ultrasound has a hypoechoic, geometric area next to the gallbladder fossa with no mass effect and normal vessels passing through i…
- Liver imaging: haemochromatosis on MRI · Multi-stepA middle-aged man with diabetes, skin pigmentation and raised ferritin has an MRI that shows a markedly low signal liver on in-phase gradient echo images, which drops f…
- Liver imaging: portal vein thrombosis · ApplicationA man with cirrhosis has portal hypertension. Doppler ultrasound shows no flow in the main portal vein and a tangle of tortuous collateral vessels in the porta hepatis.…
- Liver imaging: TIPS · ApplicationA patient with cirrhosis has recurrent variceal bleeding despite endoscopic therapy. Which interventional radiology procedure reduces portal pressure?
- Liver imaging: hepatic adenoma · Multi-stepA 28-year-old woman on long-term oral contraceptives presents with sudden right upper quadrant pain and hypotension. CT shows a 7 cm liver mass with a fat-containing co…
- Liver imaging: enhancement of liver metastases · Multi-stepA patient with a neuroendocrine tumour has liver metastases. In which CT phase are hypervascular metastases best detected?
Radiation protection12
- Radiation protection: radiation dose reduction in CT · Multi-stepWhich of the following methods does NOT reduce patient dose in CT?
- Radiation protection: ALARA and justification · Multi-stepA clinician requests a CT abdomen in a 25-year-old woman with mild uncomplicated abdominal pain for the third time in a month, with a normal ultrasound. Which principle…
- Radiation protection: ten day rule · ApplicationA 28-year-old woman with a regular cycle needs an elective lumbar spine radiograph series. Under the traditional ten day rule, when should it be scheduled?
- Radiation protection: potassium iodide · ApplicationA nuclear plant accident releases radioiodine into the air. Which countermeasure protects the population's thyroid glands?
- Radiation protection: decorporation of caesium · Multi-stepA worker is internally contaminated with caesium-137 from a lost sealed source. Which agent hastens faecal elimination of the radionuclide?
- Radiation protection: dose area product · ApplicationIn a long fluoroscopically guided procedure, which quantity displayed on the console is used to monitor the total radiation delivered to the patient?
- Radiation protection · ApplicationWhat does the ALARA principle mean in diagnostic imaging?
- Radiation protection · ApplicationWhat is the key first step when imaging is considered in a patient who may be pregnant?
- Radiation protection · ApplicationWhat does the ALARA principle require in diagnostic imaging?
- Radiation protection · ApplicationWhich radiation-protection principle means keeping exposure as low as reasonably achievable while obtaining diagnostic information?
- Radiation protection · ApplicationWhat is the greatest source of radiation exposure in fluoroscopy?
- Radiation protection · ApplicationWhy are radiographs usually taken in two orthogonal views for fractures?
Chest radiography11
- Chest radiography · ApplicationOn an erect chest radiograph, what finding suggests pleural effusion?
- Chest radiography · ApplicationWhat radiographic sign favors pneumothorax?
- Chest radiography · ApplicationWhat is the usual projection for a standard ambulatory chest radiograph?
- Chest radiography · ApplicationWhat projection is preferred for a standard ambulatory chest radiograph?
- Chest radiography · ApplicationWhat finding suggests pleural effusion on an erect chest radiograph?
- Chest radiography · ApplicationWhat finding favors pneumothorax?
- Chest radiography · ApplicationWhich radiographic sign most strongly indicates free intraperitoneal air in an erect patient?
- Chest radiography · ApplicationWhat does a silhouette sign on chest radiography help localize?
- Chest radiography · ApplicationWhich chest radiograph feature favors pleural effusion over lobar consolidation?
- Chest radiography: consolidation · ApplicationA chest radiograph shows a right lower-zone opacity containing branching air bronchograms without volume loss. What is the most likely interpretation?
- Chest radiography: heart failure · ApplicationWhich chest radiograph feature supports interstitial pulmonary edema from left-sided heart failure?
CT11
- CT: pitch and spiral scanning · Multi-stepIn helical CT with a single detector row, increasing the pitch from 1 to 2 (other parameters unchanged) will lead to which effect?
- CT: HRCT technique · ApplicationA patient with suspected interstitial lung disease is sent for HRCT chest. Which technical feature defines this study?
- CT: window settings · ApplicationA radiologist wants to evaluate the lung parenchyma for emphysema on a CT chest. Which window setting is the most suitable?
- CT: beam hardening artefact · Multi-stepA CT of the head shows dark streaks running between the two petrous temporal bones in the posterior fossa. What is the usual cause?
- CT: partial volume effect · ApplicationA 4 mm hypodense nodule in the liver measures 20 HU on a 10 mm slice but its true density is close to that of water. Which step best reduces this error?
- CT: bolus tracking · ApplicationIn CT angiography of the aorta, why is bolus tracking used?
- CT · ApplicationWhat CT number is assigned to water by convention?
- CT · ApplicationWhat CT appearance is expected for air?
- CT · ApplicationWhat is a common use of CT pulmonary angiography?
- CT · ApplicationWhy is noncontrast CT preferred initially in suspected acute hemorrhagic stroke?
- CT · ApplicationWhat imaging feature can indicate intracranial mass effect?
Pancreatic imaging11
- Pancreatic imaging: acute pancreatitis · ApplicationA patient with severe acute pancreatitis has a contrast-enhanced CT on day 5 showing a non-enhancing area of the pancreas involving more than 30 percent of the gland. W…
- Pancreatic imaging: pseudocyst · ApplicationFour weeks after an episode of acute pancreatitis, a patient has a well-defined, thick-walled fluid collection adjacent to the pancreas. What is this?
- Pancreatic imaging: carcinoma head · Multi-stepA patient with painless obstructive jaundice has CT showing dilatation of both the common bile duct and the pancreatic duct. Which sign is this?
- Pancreatic imaging: sentinel loop and colon cut-off · ApplicationA patient with severe epigastric pain and raised lipase has a plain film showing a localised dilated jejunal loop in the left upper abdomen and an abrupt cut-off of gas…
- Pancreatic imaging: chain of lakes · ApplicationA chronic alcoholic with recurrent upper abdominal pain has a CT showing pancreatic calcifications, an atrophic gland and an irregular beaded dilated main pancreatic du…
- Pancreatic imaging: pancreas divisum · Multi-stepA young woman with recurrent acute pancreatitis and no gallstones has MRCP (secretin enhanced) showing the dorsal duct draining separately into the minor papilla, with…
- Pancreatic imaging: insulinoma · Multi-stepA patient has fasting hypoglycaemia with high insulin and C-peptide levels. Triple phase CT shows a 1.5 cm hypervascular lesion in the pancreatic body that enhances avi…
- Pancreatic imaging: solid pseudopapillary neoplasm · Multi-stepA 22-year-old woman has an abdominal mass. CT shows a large, well-encapsulated pancreatic tail tumour with solid and cystic components and haemorrhage and no ductal dil…
- Pancreatic imaging: vascular encasement · Multi-stepA CT pancreatic protocol in a man with a head mass shows tumour in contact with more than 180 degrees of the circumference of the superior mesenteric artery. What does…
- Pancreatic imaging: autoimmune pancreatitis · Multi-stepA 55-year-old man has painless obstructive jaundice. CT shows a diffusely enlarged, sausage-shaped pancreas with a hypoattenuating peripheral halo and loss of lobulatio…
- Pancreatic imaging: intraductal papillary mucinous neoplasm · Multi-stepAn elderly man has an incidental multilocular pancreatic cystic lesion that communicates with a dilated main pancreatic duct on MRCP, and the ampulla bulges with mucus.…
Trauma imaging10
- Trauma imaging · ApplicationA hypotensive man is brought in after a road accident, and a FAST scan is done with him lying supine. Which view most commonly shows free intraperitoneal fluid?
- Trauma imaging · ApplicationA man is hit by a heavy object on the head. An open-mouth view of the cervical spine shows combined lateral mass overhang of C1 on C2 totalling more than 7 mm. Which in…
- Trauma imaging: FAST · ApplicationA haemodynamically unstable patient after a road traffic accident is assessed at the bedside with FAST. Which finding would indicate haemoperitoneum?
- Trauma imaging: sternal fracture · ApplicationAfter a steering-wheel injury, a patient has anterior chest pain and sternal tenderness. A frontal chest film is normal. Which view or test best demonstrates a sternal…
- Trauma imaging: fallen lung sign · Multi-stepAfter blunt chest trauma, a chest radiograph shows a large pneumothorax in which the collapsed lung lies at the bottom of the pleural cavity, away from the hilum. What…
- Trauma imaging: contrast blush on CT · Multi-stepA haemodynamically stable man with blunt abdominal trauma has a CT showing a grade 4 splenic laceration with a focus of arterial phase contrast pooling that increases o…
- Trauma imaging: urethral injury · Multi-stepA man with a pelvic fracture has blood at the external meatus, inability to void and a high-riding prostate. What should be done before attempting urethral catheterisat…
- Trauma imaging: bladder rupture · Multi-stepA man with a full bladder is injured in a road traffic collision and has lower abdominal pain, haematuria and ascites on CT. Which study differentiates intraperitoneal…
- Trauma imaging: renal injury · Multi-stepA stable patient with flank trauma has a CT in the portal venous phase that shows a deep renal laceration with perinephric haematoma. Which additional acquisition shows…
- Trauma imaging: limits of FAST · ApplicationA stable patient with blunt trauma has a negative FAST examination but severe flank pain and haematuria. Which statement is correct?
Vascular imaging9
- Vascular imaging: Takayasu arteritis · Multi-stepA 25-year-old woman has absent left radial pulse, a blood pressure difference between the arms and fatigue. CT angiography shows concentric, long segment thickening of…
- Vascular imaging: endoleak after EVAR · Multi-stepA patient with endovascular repair of an abdominal aortic aneurysm returns for follow-up. CT angiography shows contrast within the aneurysm sac outside the stent graft.…
- Vascular imaging: nutcracker syndrome · Multi-stepA young woman with left flank pain and haematuria has CT showing compression of the left renal vein between the superior mesenteric artery and the aorta, with dilatatio…
- Vascular imaging: tardus parvus waveform · Multi-stepA young woman with resistant hypertension has Doppler ultrasound of the kidney showing a slow, delayed systolic upstroke with reduced amplitude in the intrarenal arteri…
- Vascular imaging: splenic artery aneurysm · Multi-stepA plain abdominal film in a 35-year-old woman shows a ring-like curvilinear calcification in the left upper quadrant. She wishes to become pregnant. Why is this finding…
- Vascular imaging · ApplicationWhat is CT angiography used to visualize?
- Vascular imaging · ApplicationWhat ultrasound finding supports deep-vein thrombosis?
- Vascular imaging · ApplicationWhat ultrasound maneuver is central to evaluating suspected lower-limb deep-vein thrombosis?
- Vascular imaging · ApplicationWhich imaging test is commonly used to demonstrate pulmonary arterial emboli in a stable patient when not contraindicated?
Radiation physics8
- Radiation physics · ApplicationWhich imaging modality uses ionizing X-radiation?
- Radiation physics · ApplicationWhich modality uses a strong magnetic field and radiofrequency pulses?
- Radiation physics · ApplicationWhat is the SI unit of absorbed radiation dose?
- Radiation physics · ApplicationWhat is the main basis of image contrast in CT?
- Radiation physics · ApplicationWhich modality uses ionizing X-rays to generate cross-sectional images?
- Radiation physics · ApplicationWhich modality avoids ionizing radiation and uses magnetic fields?
- Radiation physics · ApplicationWhat radiographic density does air usually produce?
- Radiation physics · ApplicationWhat is the radiographic appearance of cortical bone?
Renal imaging8
- Renal imaging: renal cell carcinoma · ApplicationA 60-year-old man with haematuria has CT showing a 5 cm heterogeneously enhancing renal mass and a filling defect extending into the renal vein and IVC. What is the dia…
- Renal imaging: angiomyolipoma · ApplicationA CT shows a well-defined renal mass containing areas of density -80 HU. Which tumour is it, and in which genetic syndrome is it frequently bilateral and multiple?
- Renal imaging: DMSA scan · ApplicationWhich radionuclide study is best for detecting renal cortical scars after pyelonephritis?
- Renal imaging: papillary necrosis · Multi-stepA diabetic patient with chronic analgesic use and loin pain passes tissue fragments in urine. An IVU shows several calyces with ring-shaped contrast collections at the…
- Renal imaging: medullary sponge kidney · Multi-stepA young adult with recurrent renal colic has multiple small calcifications clustered in the renal pyramids on a plain film. IVU shows linear, brush-like streaks of cont…
- Renal imaging: xanthogranulomatous pyelonephritis · Multi-stepA diabetic woman with recurrent proteus infections and a long-standing staghorn calculus has CT showing an enlarged non-functioning kidney with multiple low-density rou…
- Renal imaging: emphysematous pyelonephritis · Multi-stepA diabetic woman has fever, flank pain and septic shock. CT shows gas replacing much of the renal parenchyma with little normal tissue. What is the diagnosis and approa…
- Renal imaging: ureteric jets on Doppler · ApplicationA patient with acute loin pain has an ultrasound showing mild right hydronephrosis. Colour Doppler of the bladder shows ureteric jets on the left but none on the right.…
Contrast agents6
- Contrast agents · ApplicationA patient on maintenance dialysis receives a gadolinium-based MRI contrast agent. Weeks later, he develops thickened, tight skin with joint contractures. Which complica…
- Contrast agents · ApplicationA patient with sudden severe epigastric pain is suspected of having a perforated duodenal ulcer, and a contrast study is requested to show the leak. Which agent should…
- Contrast agents: reactions · Multi-stepThree minutes after intravenous iodinated contrast, a patient develops generalised urticaria, stridor, wheeze and a blood pressure of 70/40 mmHg. What is the first-line…
- Contrast agents: effect of tube voltage on iodine contrast · Multi-stepA radiologist lowers the tube voltage for a CT angiogram in a slim patient and finds that vessels enhance more brightly at the same iodine dose. What physical principle…
- Contrast agents: metformin and iodinated contrast · Multi-stepA diabetic patient on metformin with an eGFR of 25 mL/min is to receive intravenous iodinated contrast for an urgent CT. What is the best practice?
- Contrast agents: breastfeeding after iodinated contrast · ApplicationA breastfeeding mother receives intravenous iodinated contrast for a CT abdomen and asks whether she must discard her milk. What is the appropriate advice?
Contrast safety6
- Contrast safety · ApplicationWhat history is important before administering iodinated contrast?
- Contrast safety · ApplicationWhat can reduce risk from contrast-associated kidney injury in appropriate patients?
- Contrast safety · ApplicationWhat is the appropriate immediate response to suspected contrast extravasation at an injection site?
- Contrast safety · ApplicationWhich patient factor increases concern for iodinated contrast-associated kidney injury and warrants risk assessment?
- Contrast safety · ApplicationWhat is a key precaution before iodinated contrast CT in a patient with severe kidney dysfunction?
- Contrast safety: kidney function · Multi-stepBefore iodinated contrast CT in a patient with chronic kidney disease, what is an important safety step?
Image interpretation6
- Image interpretation · ApplicationWhat is required before interpreting any image?
- Image interpretation · ApplicationOn a plain radiograph, what does a radiolucent area appear relatively like?
- Image interpretation · ApplicationWhat does cortical bone usually appear like on plain radiograph?
- Image interpretation · ApplicationWhy should radiographic image quality be assessed before making a chest radiograph interpretation?
- Image interpretation · ApplicationWhy should radiology reports compare current images with prior studies when available?
- Image interpretation · ApplicationWhat is the appropriate action after detecting an unexpected critical imaging finding?
Neuroradiology6
- Neuroradiology · ApplicationWhat is the first-line imaging study for suspected acute intracranial hemorrhage?
- Neuroradiology · ApplicationDiffusion-weighted MRI is particularly sensitive for what early process?
- Neuroradiology · ApplicationWhat first study is commonly used for suspected acute intracranial hemorrhage?
- Neuroradiology · ApplicationWhich MRI sequence is particularly sensitive for early ischemic stroke?
- Neuroradiology · ApplicationHow does acute intracranial haemorrhage commonly appear on non-contrast CT of the head?
- Neuroradiology · ApplicationWhich CT finding is an early warning sign of raised intracranial pressure?
Radiobiology6
- Radiobiology: stochastic effects · ApplicationWhich of the following is a stochastic effect of ionising radiation?
- Radiobiology: cell cycle · ApplicationIn which phase of the cell cycle are cells most sensitive and least sensitive to radiation, respectively?
- Radiobiology: oxygen effect · ApplicationHypoxic tumour cells are more resistant to low-LET radiation than well-oxygenated cells because of which mechanism?
- Radiobiology: relative biological effectiveness · Multi-stepWhich type of radiation has the highest linear energy transfer (LET) and thus the greatest relative biological effectiveness?
- Radiobiology: DNA damage · ApplicationWhich type of DNA damage is the most important lethal lesion caused by ionising radiation?
- Radiobiology: lethal dose · ApplicationIn an unprotected human exposed to uniform whole-body irradiation without medical treatment, the LD50/60 is approximately:
Biliary imaging5
- Biliary imaging: Klatskin tumour · Multi-stepA 62-year-old man has painless jaundice. MRCP shows dilated intrahepatic ducts in both lobes with a collapsed gallbladder and a normal common bile duct below an abrupt…
- Biliary imaging: Caroli disease · Multi-stepA young adult has recurrent cholangitis and portal hypertension. MRCP shows multiple saccular dilatations of the intrahepatic bile ducts, and contrast CT shows small do…
- Biliary imaging: Mirizzi syndrome · Multi-stepA patient with long-standing gallstones has jaundice. Imaging shows a stone impacted in the gallbladder neck or cystic duct that compresses the common hepatic duct, wit…
- Biliary imaging: ERCP · ApplicationA patient with ascending cholangitis has a dilated common bile duct with a stone on MRCP. Which procedure both confirms and treats the problem?
- Biliary imaging: primary sclerosing cholangitis · ApplicationA young man with ulcerative colitis has a cholestatic liver profile. Which investigation best demonstrates the likely bile duct abnormality without invasive risk?
Contrast media5
- Contrast media · ApplicationWhich contrast material is commonly used for CT enhancement?
- Contrast media · ApplicationWhich contrast agent is typically used in MRI?
- Contrast media · ApplicationWhat should be considered before gadolinium contrast in severe renal impairment?
- Contrast media · ApplicationWhat contrast is commonly administered intravenously for CT enhancement?
- Contrast media · ApplicationWhat contrast agent class is used for MRI enhancement?
Radiation effects5
- Radiation effects: acute radiation syndrome · ApplicationA worker is accidentally exposed to a whole-body dose of about 4 Gy. Which syndrome would dominate in the following weeks?
- Radiation effects: CNS syndrome · Multi-stepA patient exposed to a very high whole-body dose (above 30 Gy) develops ataxia, seizures, shock and dies within 48 hours. This presentation reflects which syndrome?
- Radiation effects: fetal exposure · Multi-stepAt which period of gestation is the risk of major malformations from radiation greatest?
- Radiation effects: radiation cataract · ApplicationWhich tissue-reaction effect has the lowest threshold in occupational exposure and is of concern to interventional staff?
- Radiation effects: prodromal phase · ApplicationAfter an industrial radiography source accident, one worker vomits within 30 minutes and another vomits 6 hours later. What does the earlier onset of nausea and vomitin…
Chest radiograph4
- Chest radiograph · ApplicationWhich sign supports lobar collapse?
- Chest radiograph · ApplicationWhich finding suggests pulmonary edema?
- Chest radiograph: pneumothorax · ApplicationWhich radiographic finding supports a pneumothorax?
- Chest radiograph: lobar collapse · Multi-stepA chest radiograph shows a triangular opacity in the right upper zone with elevation of the horizontal fissure and tracheal shift to the right. What is the best interpr…
Contrast4
- Contrast: barium versus water-soluble · ApplicationA patient with suspected perforation of the oesophagus after a foreign body needs a contrast swallow. Which agent should be used first?
- Contrast: prevention of nephropathy · ApplicationWhich measure is the most effective for reducing the risk of contrast-induced nephropathy in an at-risk patient?
- Contrast · ApplicationWhat is a key risk of barium if bowel perforation is suspected?
- Contrast · ApplicationWhat can iodinated contrast cause rarely?
CT head4
- CT head · ApplicationWhat CT finding can indicate raised intracranial pressure?
- CT head: acute hemorrhage · ApplicationOn noncontrast CT head performed immediately after symptom onset, acute intracranial blood is usually seen as what attenuation relative to brain?
- CT head: extradural hematoma · ApplicationAfter a temporal bone fracture, CT shows a biconvex lens-shaped extra-axial hyperdensity that does not cross suture lines. Which hemorrhage is this?
- CT head: subdural hematoma · ApplicationAn older patient after a minor fall has a crescent-shaped extra-axial collection that crosses suture lines on CT. What is the diagnosis?
Gastrointestinal imaging4
- Gastrointestinal imaging · ApplicationA young man has chronic diarrhoea and right iliac fossa pain. A barium follow-through shows a long, narrow, rigid terminal ileum, described as a 'string sign'. What is…
- Gastrointestinal imaging · ApplicationWhich contrast is generally avoided if bowel perforation is suspected?
- Gastrointestinal imaging · ApplicationWhich contrast is generally avoided when gastrointestinal perforation is suspected?
- Gastrointestinal imaging · ApplicationWhat fluoroscopic feature is classically sought in suspected achalasia on a barium swallow?
MRI physics4
- MRI physics · ApplicationWhich MRI sequence is particularly useful for detecting restricted diffusion in acute ischaemic stroke?
- MRI physics · ApplicationWhy is gadolinium contrast used in many MRI examinations?
- MRI physics · ApplicationWhich MRI sequence is most sensitive to blood products and susceptibility effects?
- MRI physics · ApplicationWhy is FLAIR MRI useful in periventricular brain lesions?
Neonatal imaging4
- Neonatal imaging: pulmonary interstitial emphysema · Multi-stepA ventilated premature neonate with respiratory distress syndrome suddenly worsens. The chest radiograph shows tiny cystic and linear lucencies radiating from the hila…
- Neonatal imaging: bronchopulmonary dysplasia · ApplicationA preterm infant is still oxygen-dependent at 36 weeks corrected age after prolonged ventilation. The chest film shows coarse reticular opacities alternating with cysti…
- Neonatal imaging: germinal matrix haemorrhage · ApplicationA premature infant born at 28 weeks has cranial ultrasound on day 3 showing echogenic blood in the caudothalamic groove with extension into non-dilated ventricles. How…
- Neonatal imaging: periventricular leukomalacia · Multi-stepAn ex-preterm toddler has spastic diplegia. MRI shows periventricular white matter thinning, ventricular enlargement with irregular outlines and increased T2 signal aro…
Paediatric radiology4
- Paediatric radiology · ApplicationThe 'double bubble' sign on an abdominal radiograph of a newborn suggests:
- Paediatric radiology · Multi-stepA 9-month-old infant has episodic colicky pain with drawing up of the legs and passes currant-jelly stool. He is haemodynamically stable with no peritonitis, and ultras…
- Paediatric radiology · ApplicationA 2-year-old child with a barking cough and inspiratory stridor has an anteroposterior neck radiograph showing symmetrical narrowing of the subglottic airway like the t…
- Paediatric radiology · ApplicationA neonate presents with bilious vomiting on day 3. An upper GI contrast study shows the duodenojejunal flexure on the right side of the spine with a corkscrew appearanc…
Plain radiography4
- Plain radiography · ApplicationWhat is the usual first imaging study for a suspected uncomplicated long-bone fracture?
- Plain radiography · ApplicationWhy are two orthogonal views commonly obtained for a fracture?
- Plain radiography · ApplicationWhat does a lytic bone lesion often appear as on radiograph?
- Plain radiography · ApplicationWhat does a sclerotic bone lesion usually appear as?
Ultrasound physics4
- Ultrasound physics · ApplicationA sonographer finds no Doppler signal from a vessel lying exactly perpendicular to the ultrasound beam, even though blood is flowing. Why?
- Ultrasound physics: coupling gel · ApplicationA trainee scans the abdomen without any gel on the probe and gets a poor image. What is the physical reason that coupling gel is needed?
- Ultrasound physics · ApplicationWhat causes posterior acoustic shadowing?
- Ultrasound physics · ApplicationWhat enhancement occurs behind a simple cyst?
Abdominal radiograph3
- Abdominal radiograph · ApplicationWhat pattern suggests large-bowel obstruction?
- Abdominal radiograph: small-bowel obstruction · ApplicationAn abdominal radiograph shows centrally located dilated loops with valvulae conniventes extending across the full width of the bowel. What is most likely?
- Abdominal radiograph: volvulus · ApplicationWhich plain-film appearance is classically associated with sigmoid volvulus?
Emergency imaging3
- Emergency imaging · ApplicationWhat is the preferred initial imaging test for suspected acute intracranial haemorrhage in an unstable patient?
- Emergency imaging · ApplicationWhich CT feature is most concerning for bowel ischaemia in obstruction?
- Emergency imaging · ApplicationWhat is the preferred imaging test for stable major blunt abdominal trauma?
Fluoroscopy3
- Fluoroscopy · ApplicationWhat procedure commonly uses fluoroscopy?
- Fluoroscopy · ApplicationWhat is a major practical concern with prolonged fluoroscopy?
- Fluoroscopy: contrast swallow · ApplicationA contrast swallow demonstrates contrast leaking from the esophagus into the mediastinum after forceful vomiting. What diagnosis is suggested?
Gallbladder imaging3
- Gallbladder imaging: gallbladder polyp · ApplicationAn incidental 12 mm polyp is found in the gallbladder on ultrasound in a 55-year-old patient. What is the usual recommendation?
- Gallbladder imaging: emphysematous cholecystitis · Multi-stepA diabetic man has severe right upper quadrant pain and sepsis. Ultrasound and CT show gas within the gallbladder lumen and wall. What is the diagnosis and urgency?
- Gallbladder imaging: causes of wall thickening · ApplicationOn ultrasound, the gallbladder wall measures 6 mm in a patient with ascites and hypoalbuminaemia, with no gallstones, no pericholecystic fluid and a negative sonographi…
Mammography3
Oncologic imaging3
Pediatric imaging3
- Pediatric imaging · ApplicationWhat is first-line imaging for developmental hip dysplasia in young infant?
- Pediatric imaging · ApplicationWhat principle should guide use of ionizing radiation in children?
- Pediatric imaging: pyloric stenosis · ApplicationUltrasound in an infant with projectile nonbilious vomiting shows elongated thickened pyloric muscle. What diagnosis is supported?
Reporting3
Scrotal imaging3
- Scrotal imaging: varicocele · ApplicationA young man with a dragging left scrotal ache has an ultrasound showing multiple tortuous tubular anechoic structures over 3 mm in diameter behind the testis, with flow…
- Scrotal imaging: testicular torsion · ApplicationA 14-year-old boy has sudden severe left testicular pain and vomiting. Colour Doppler ultrasound shows an enlarged heterogeneous left testis with absent intratesticular…
- Scrotal imaging: acute epididymitis · ApplicationA sexually active man has gradual scrotal pain with fever. Doppler ultrasound shows an enlarged, hypoechoic epididymal head with markedly increased colour flow, and the…
Urological imaging3
- Urological imaging: genitourinary tuberculosis · Multi-stepA young man has sterile pyuria and frequency. A cystogram shows a small, contracted bladder with thick walls and an irregular outline, and an IVU shows calyceal erosion…
- Urological imaging: schistosomiasis · ApplicationA man from an endemic region has terminal haematuria. A plain pelvic film shows a thin, curvilinear calcification outlining the bladder wall. What is the likely cause?
- Urological imaging: Fournier gangrene · Multi-stepA diabetic man has severe perineal pain, fever and crepitus over the scrotum. CT shows gas tracking along the fascial planes of the perineum and scrotum. What is the ma…
Abdomen2
Abdominal CT2
Adrenal imaging2
- Adrenal imaging: adenoma · Multi-stepAn incidental 2 cm adrenal nodule has an unenhanced attenuation of 5 HU on CT. What does this suggest?
- Adrenal imaging: myelolipoma · ApplicationAn incidental 6 cm right adrenal mass on CT contains areas of negative attenuation, about minus 80 Hounsfield units, mixed with soft tissue. What is the diagnosis?
Chest xray2
CT physics2
Emergency radiology2
Genitourinary imaging2
Hepatobiliary imaging2
- Hepatobiliary imaging: MRCP · ApplicationWhat is the main advantage of MR cholangiopancreatography in suspected choledocholithiasis?
- Hepatobiliary imaging: HIDA scan · ApplicationA patient has suspected acute cholecystitis but equivocal ultrasound. Nonvisualization of the gallbladder on hepatobiliary scintigraphy most supports what?
Imaging2
- Imaging: choice of modality · ApplicationA child with suspected foreign body inhalation has a stable airway and a chest radiograph is requested. To demonstrate air trapping on the side of an obstructing foreig…
- Imaging: resolution · Multi-stepWhich modality has the best spatial resolution for visualising fine bone detail such as a temporal bone fracture?
Magnetic resonance imaging2
Musculoskeletal radiology2
- Musculoskeletal radiology: scaphoid fracture · ApplicationA patient has anatomical snuffbox tenderness after a fall, but initial wrist radiographs are normal. What is the appropriate imaging principle?
- Musculoskeletal radiology: slipped capital femoral epiphysis · ApplicationAn overweight adolescent has hip pain referred to the knee, and the affected leg is externally rotated. Which radiographic diagnosis must be considered urgently?
Neuro CT2
Quality assurance2
Radiation biology2
Computed tomography1
CT pulmonary angiography1
Doppler ultrasound1
Hepatobiliary1
Musculoskeletal1
Musculoskeletal MRI1
Nuclear imaging1
Pediatric radiology1
Ultrasound obstetric1
Common questions
How many Radiology questions are there?
1129 original questions across 946 topics, and the bank grows over time.
Which Radiology topics are covered?
Neuroimaging, Cardiac imaging, Musculoskeletal imaging, Paediatric radiology, Abdominal imaging, Radiation biology, Ultrasound physics, Contrast agents, Nuclear medicine, Trauma imaging, Obstetric imaging, Chest imaging, and more.
How difficult are these Radiology questions?
0 are recall, 768 are application and 361 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Radiology questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Radiology for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Radiology test?
Yes. The Radiology subject test is included with a paid term, with a countdown and a question palette.
How should I use these Radiology questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Radiology questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.