Prof_ParaClinic I

A 10-year-old child presented 5 weeks ago with prolonged fever and headache with new onset seizures. A CT head pre-and post-contrast injection shows frontal isodense mass with peripheral enhancement centered by a calcification. What is the most likely diagnosis?

A 12-year-old child with CF (cystic fibrosis) had been followed up with annual chest radiographs. Which of the following features is a late radiographic change associated with the disease?

A 19-year-old HIV-positive man is admitted with headache, confusion and disorientation. He is mildly pyrexial. A CT brain reveals multiple hypodensities, particularly in the brainstem and in the periventricular white matter. There is some ependymal enhancement postcontrast. What is the most likely cause for these findings?

A 2 week-old septic neonate shows worsening renal function and proteinuria. Seven days after his initial illness, an ultrasound is performed which reveals a unilateral enlarged kidney, with loss of corticomedullary differentiation and reversal of end-diastolic arterial flow. Associated adrenal hemorrhage is noted. What is the most likely diagnosis?

A 2-week-old baby presents with poor feeding and bilious vomiting. Malrotation is suspected and an upper GI contrast study (TOGD) is requested. What specific radiological finding would confirm the diagnosis?

A 2-week-old septic neonate shows worsening renal function and proteinuria. He is currently being monitored on the pediatric ITU. Seven days after his initial illness, an ultrasound is performed which reveals a unilateral enlarged kidney, with loss of corticomedullary differentiation and reversal of end diastolic arterial flow. Associated adrenal haemorrhage is noted. What is the most likely diagnosis?

A 2-year-old child presents to Emergency Department with a greenstick fracture of the ulna. On the radiograph, there is evidence of an old fracture to the same limb and the history given by the parents is inconsistent. Non-accidental injury (NAI) is clinically suspected and a skeletal survey is performed. Which of the following fractures have a high specificity for NAI?

A 2-year-old has an elbow radiograph performed following a fall. Which one of the following epiphyses should be visible?

A 22-year-old woman presents to her GP with irregular menstrual periods. She is overweight with a body mass index of 32 and has excess body hair. Her LH/FSH ratio is elevated and her GP refers her for a pelvic ultrasound. Which one of the following findings are most likely to be present on ultrasound?

A 24-year-old man presents to his GP with increased urinary frequency. Physical examination is normal and he is referred for ultrasound. Transabdominal ultrasound demonstrates a cystic structure posterior to the urinary bladder and a TRUS is performed for further evaluation. TRUS reveals a midline anechoic structure in the posterior portion of the prostate gland, superior to the verumontanum. It does not communicate with either the bladder or the seminal vesicles. Which of the following is the most likely diagnosis?

A 24-year-old motorcyclist involved in a traffic accident presents to the Emergency Department with a broken leg and bruising over his left flank. He is found to have microscopic haematuria and fractures of the left 8th and 9th ribs. The patient is haemodynamically stable and clinicians suspect a left renal injury. Which one of the following imaging investigations is the most appropriate?

A 25-year-old male pedestrian has been hit by a car and is currently being resuscitated in the Emergency Department. He complaint of paraesthesia involving his left shoulder. Which one of the following radiological features is the most likely related cause?

A 27-year-old man has been involved in a high-speed road traffic accident. There is significant diagonal bruising over the abdomen, due to the wearing of a seat belt. He is heamodynamically stable, but complains of severe abdominal pain and a CT of the chest and abdomen is performed. Which one of the following radiographic sings on a CXR would be most likely to suggest a right-side diaphragmatic injury?

A 27-year-old man is referred by his GP with progressively painful swelling of his left knee following a minor football injury some weeks ago. The radiograph shows a 5-cm ill-defined lytic lesion within the left distal femoral metaphysis, with a permeative pattern of bone loss and areas of cloud-like ossification. There is an extensive periosteal reaction, predominantly orientated perpendicular to the cortex. What is the most likely diagnosis?

A 27-year-old man is referred to the hepatology outpatient clinic with a 3-week history of malaise, lethargy and mild upper abdominal pain. Liver function tests performed by his GP are significantly abnormal. The results of hepatitis serology performed in the clinic are consistent with an acute hepatitis B infection. An abdominal ultrasound is performed. What is the most likely finding on ultrasound?

A 27-year-old man with membranous glomerulonephritis presents with a 1-day history of right-sided flank pain and haematuria. An abdominal radiograph did not reveal any renal calcification but his renal function has significantly deteriorated over the past 24 hours. On ultrasound there is a large, oedematous right kidney with loss of the corticomedullary differentiation. On a subsequent IVU, there is a faint nephrogram with absent pelvicalyceal filling after 15 minutes. What is the most likely diagnosis?

A 27-year-old woman has severe asthma. She is admitted to ITU with a severe, life-threatening exacerbation requiring mechanical ventilation. Two days later, a supine CXR is performed. This demonstrates a lucent line around the left heart border and aortic arch with surgical emphysema at the root of the neck. The lungs are hyperinflated but appear clear. Which complication is likely to have occurred?

A 27-year-old, previously fit and well man presents to his GP with a short history of pyrexia, cough and haemoptysis. He has never previously been admitted to hospital. Sputum culture has grown Streptococcus pneumoniae. What is most likely chest radiograph finding?

A 28-year-old woman with a history of an appendectomy presents with a non-tender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient.

A 29-year-old man has an IVU performed following an episode of haematuria. This demonstrates complete right-sided ureteric duplication. Which one of the following statements is true?

A 29-year-old man presents with a 4-hour history of sudden onset right loin pain, radiating to the right groin. The clinicians request an emergency IVU for suspected acute urinary obstruction. Which one of the following IVU features would be most consistent with acute urinary obstruction?

A 3-month-old infant with failure to thrive and tachypnea. No evidence of central or peripheral cyanosis. A chest radiograph shows enlarged central and peripheral pulmonary vessels throughout both lungs. Which one of the following is a potential diagnosis?

A 3-month-old infant with Tetralogy of Fallot is waiting surgery. A pre-operative chest radiograph is performed when the child has no current illness. Which one of the following features are you most likely to see?

A 3-year-old boy presents with a short history of shortness of breath. Clinical examination is unremarkable, but on the chest radiograph there are multiple pulmonary nodules suggestive of metastases. Which one of the following tumors would be the most likely source of pulmonary metastasis?

A 3-year-old girl presents with a purpuric rash, abdominal pain and blood-stained stools. Henoch-Schönlein purpura (HSP) is the clinical diagnosis. Which one of the following statements is true when investigating this girl?

A 30-year-old male engineer has recently returned from North America having inspected a number of construction sites. He develops flu-like symptoms and CXR reveals the presence of a solitary well-defined nodule. What additional finding would make a diagnosis of Histoplasmosis infection more likely, rather than Cryptococcus infection?

A 30-year-old man attends the Emergency Department with a 2-day history of abdominal pain and vomiting. On examination, he is afebrile with a firm mass palpable in the right lower quadrant of the abdomen. A supine abdominal radiograph is performed and demonstrates dilated loops of small bowel with a large soft tissue mass in the right lower quadrant. On ultrasound, the mass has a “pseudotumour” appearance. What is the most likely diagnosis?

A 30-year-old man is HIV positive with a most recent CD4 count = 100 cells/μL. He presents to the infectious diseases team with a cough, dyspnea and general malaise. A CXR demonstrates bilateral, diffuse, medium-sized reticular opacities. An air-filled parenchymal cavity (pneumatocoele) is seen, but there is an absence of either mediastinal lymphadenopathy or a pleural effusion. What is the most likely underlying opportunistic infection?

A 30-year-old warehouse employee has been admitted to the Emergency Department, having been crushed between a reversing lorry and a wall. A supine CXR demonstrates a pneumomediastinum and a right-side pneumothorax that has not responded to the insertion of an appropriately sited chest drain. The right lung is seen to sag towards the floor of the right hemithorax. Which one of the following is the most likely diagnosis?

A 32-year-old man attends hospital following a fall onto his flexed left arm. He is referred to the duty orthopaedic team with a “Monteggia injury”. What are the most likely radiological findings?

A 32-year-old man involved in a high-speed traffic accident is found to have blood at the urethral meatus and a high riding prostate during the secondary clinical survey. The examining doctor suspects a urethral injury. Which part of the urethra is most likely to be involved?

A 32-year-old man presents to his GP with increasing pain on swallowing solids and liquids. He has lost 15 kg in weight over the preceding 2 months. After a full history and examination, he is found to be HIV positive with a very low CD4 count. The GP refers him for a barium swallow examination and this demonstrates a single ulcer in the mid-oesophagus. The ulcer has a smooth margin, measures 4 cm in length and is oval in shape. There is no stricture identified. Which diagnosis is most likely?

A 33-year-old HIV-positive woman presents with increasing headache and confusion. On examination she is pyrexial and has left leg and right facial weakness. A CT head demonstrates multiple lesions measuring between 2 and 4 cm, which are predominantly situated at the corticomedullary junction. These lesions have a thin enhancing rim as well as associated oedema and local mass effect. Which one of the following is the most likely diagnosis?

A 33-year-old woman presents to her GP with a one year history of intermittent rectal bleeding. She experiences regular episodes of fresh blood per rectum with associated lower abdominal pain, lasting several days at a time. A flexible sigmoidoscopy is normal. A double contrast barium enema is performed and demonstrates an irregular appearance of the anterior wall of the sigmoid colon with mild extrinsic mass effect. What is the most likely diagnosis?

A 34-year-old man with chronic back pain is referred by his GP for thoracic and lumbar spine radiographs. The GP is concerned about the possibility of ankylosing spondylitis. Which radiological feature is atypical for ankylosing spondylitis, and might suggest an alternative diagnosis?

A 35-year-old woman is referred to thee Radiology Department following the birth of her first child. The baby was delivered 8 days post-term and was a vaginal delivery following a prolonged labour and episiotomy. Two months later, the patient continues to experience faecal incontinence and an anal sphincter tear is suspected. Which investigation would be most useful to demonstrate anal sphincter damage?

A 35-year-old woman presents with a painless lump in the outer upper quadrant of her left breast. She is referred for an ultrasound examination of the left breast. Which of the following ultrasound findings would suggest a malignant rather than a benign breast mass?

A 37-year-old man presents to his GP with increasing right upper quadrant pain. On examination, he is afebrile with right upper quadrant tenderness and fullness. An abdominal ultrasound is performed and demonstrates a 5-cm diameter cystic lesion in the right lobe of liver. The mass contains multiple septations with a large cyst centrally and multiple small cystic spaces peripherally. Echogenic debris is seen within the cystic lesion and alters in position when the patient lies on his side. From the clinical an sonographic details, what is the most likely diagnosis?

A 37-year-old woman is involved in a road traffic accident and sustains a severe head injury. Her CT head shows acute blood within the extradural, subdural and subarachnoid spaces. Which one of the following statements is true regarding extradural haematomas?

A 4-week-old male neonate presents with milky vomiting and a hypochloraemic alkalosis. Hypertrophic pyloric stenosis is suspected and ultrasound is performed. Which one of the following ultrasound findings would confirm the diagnosis?

A 4-year-old child presents with shortness of breath and fever. The chest radiograph shows a round opacity within the right lower lobe. No previous chest radiographs are available for comparison. Which one of the following statements is true when trying to distinguish pneumonia from a tumor in a child?

A 4-year-old child presents with upper back pain. Hepatomegaly and blood tests show iron deficiency anemia. Chest radiograph demonstrates an abnormal mediastinal contour, and CT confirms an 8-cm posterior mediastinal mass which contains calcifications. The lungs are clear. Which one of the followings is most likely the diagnosis?

A 40-year-old female diabetic patient has right loin pain, vomiting and a fever. An ultrasound examination is requested to exclude urinary obstruction. This demonstrates no evidence of upper tract dilatation, but features of acute pyelonephritis are present. What are the most likely sonographic findings within the right kidney?

A 40-year-old male diabetic patient has an intravenous urogram (IVU) for left-sided renal colic. On the IVU, the left kidney shows papillary and calyceal abnormalities that give an “egg in a cup” appearance at some calyces and “tracks and horns” at other calyces. The affected left kidney has preserved renal cortical thickness despite the calyceal/papillary abnormalities. The contralateral kidney appears normal. What is the most likely diagnosis?

A 41-year-old man has previously had a large anterior myocardial infarction. He now presents with increasing shortness of breath on exertion and it is suspected that he has a degree of pulmonary venous hypertension (PVH) due to left ventricular failure. Which one of the following is the most likely radiological finding?

A 42-year-old man is referred for investigation of painless microscopic haematuria. An IVU is performed and demonstrates bilateral small areas of calcification within the kidneys on the control image. On the 5-min postcontrast IVU film, the calcification appears to lie within the collecting system. On ultrasound, there are numerous small hyperechoic rounded areas within the medullary pyramids, many of which cast an acoustic shadow. What is the most likely diagnosis?

A 42-year-old man with known Wegener’s granulomatosis develops haematuria. He has an abdominal ultrasound which reveals small, smooth kidneys with diffuse thinning of the renal parenchyma. The pelvicalyceal systems appear normal but there is an increased amount of renal sinus fat. What is the most likely diagnosis?

A 43-year-old man is investigated for pain related to his left arm. Plain radiography demonstrates a well-defined, lytic lesion in the proximal humerus, with chondroid matrix mineralisation and a narrow zone of transition. There is deep endosteal cortical scalloping and the suggestion of bone expansion. What is the most likely diagnosis?

A 49-year-old man is involved in a road traffic accident and sustains serious head and chest injuries. He is ventilated on the intensive care unit and his injuries are managed conservatively. Ten days later, he develops a temperature of 39.5°c, becomes tachycardic and requires inotropic support to maintain his blood pressure. An abdominal ultrasound is performed and shows a cystic structure in the right upper quadrant measuring 12 x 8 cm in size. The mass has a 6-mm thick wall, contains a layer of echogenic material and is surrounded by a rim of fluid. What is the most likely diagnosis?

A 49-year-old man presents to his GP with increasing shortness of breath. A CXR demonstrates a “white out” of left hemithorax with displacement of mediastinum towards the left. What is the most likely explanation?

A 49-year-old woman has experienced increasing difficulty swallowing over the past 6 months, with associated retrosternal discomfort. A barium swallow is performed and demonstrates virtually no peristaltic activity within a dilated oesophagus. The gastro-oesophageal junction appears widened and there is marked reflux of barium when the patient lies supine. An upper GI endoscopy shows moderate reflux oesophagitis. Given these findings, what is the most likely underlying diagnosis?

A 5 ans, fille est amenée au service d'urgence en Décembre par sa mère, qui se plaint que sa fille semble confuse. La mère signale que sa fille se plaint de maux de tête intermittents puisque les deux d'entre eux déplacés dans le premier étage d'un immeuble ancien il y a 6 mois. La mère a été à la maison avec la fille au cours des dernières 24 heures et la jeune fille semble léthargique et se plaint de douleurs articulaires, des nausées et des maux de tête. Son pouls est de 120 / min, la pression artérielle est 130/85 mm Hg, fréquence respiratoire est de 25 / min, et la saturation en oxygène est de 100% à l'air ambiant. La mère de la fille note également avoir un léger mal de tête qui a commencé hier. Lequel des tests de diagnostic suivants devraient être poursuivis le plus rapidement?

A 5-month-old child presents to Emergency Department with a reduced conscious level. No history of trauma, but he appears neglected. No physical injury is identified on clinical examination. A CT head is performed. Which one of the following is the most common intracranial finding in non-accidental injury?

A 5-year-old boy is involved in traffic accident and is complaining of neck pain. Which of the following statements is true regarding the cervical spine radiograph?

A 5-year-old boy who had a coarctation of his aorta repaired 12 months ago requires follow-up. Which of the following imaging modalities is the gold standard?

A 5-year-old child presented 1 week ago with bacterial meningitis and is now persistently pyrexial with new onset seizures. A CT head with contrast injection shows frontal leptomeningeal enhancement, with hypodense material within the subdural space, but hyperdense to CSF. What is the most likely diagnosis?

A 5-year-old child presents with vomiting, lethargy and a persistent headache. A CT head is performed and shows a hyperdense midline posterior fossa mass, abuting the fourth ventricle with associated hydrocephalus. There is significant peritumoral oedema but no calcification, and avid homogenous enhancement is seen postcontrast. Which one of the following posterior fossa tumors is the most likely diagnosis?

A 50-year-old lifelong male smoker has presented to his GP with increasing shortness of breath. A CXR shows that the right atrial border is a little indistinct. On thee lateral view there is a triangular density with its apex directed towards the lung hilum. Which one of the following is the most likely diagnosis?

A 50-year-old man has a CT head after sustaining a head injury during a mechanical fall. The only positive finding is a large low attenuation lesion in the left middle cranial fossa, which is well defined, and of the same attenuation as cerebrospinal fluid (CSF). There is some thinning of the overlying temporal bone. Which one of the following is the most likely diagnosis?

A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. The most appropriate diagnostic test is:

A 50-year-old woman complains of painful swelling of the joints of the hands and wrists. Radiographs show evidence of an erosive arthropathy. Which radiological feature would favour a diagnosis of rheumatoid rather than psoriatic arthritis?

A 52-year-old postmenopausal woman presents for her first screening mammogram. Within the right upper outer quadrant, there is a 2-cm well-defined, oval mass that has dense “popcorn” calcification within it and is surrounded by a thin radiolucent rim. On ultrasound, the mass is well defined and hyperechoic with areas of acoustic shadowing due to contained calcification. What is the most likely diagnosis?

A 53-year-old woman is invited to attend a mobile breast-screening unit for routine screening mammograms. Which one of the following statements is correct regarding the standard mammographic projections (the mediolateral oblique (MLO) and craniocaudal (CC) views)?

A 55-year-old HIV-positive man presents with macroscopic haematuria and right-sided renal colic. An IVU does not demonstrate any renal tract calcification, but there is a dense right nephrogram with no excretion of contrast on a delayed film. The urologist performs a retrograde ureteroscopy and retrieves a 9-mm right ureteric calculus. What is the likely composition of the calculus?

A 56-year-old female smoker presents with increasing shortness of breath, fever and a productive cough. Her CXR demonstrates diffuse opacification at the right lung base and treatment is commenced for community-acquired pneumonia. Which additional radiological finding is most likely to suggest a diagnosis of Streptococcus pneumoniae rather than Staphylococcus aureus?

A 56-year-old woman is found to have a screen-detected breast cancer on her second screening mammogram. Two breast radiologists both agree that there is no evidence of malignancy on the previous mammograms, even in retrospect. Which one of the following statement best describes this interval cancer?

A 56-year-old woman presents with a 4-day history of right upper quadrant pain and vomiting. She describes a previous episode one year ago that resolved after a few day. On examination, she is very tender in the right upper quadrant with guarding on deep palpation during inspiration. Laboratory investigations reveal elevated white cell count and CRP but normal liver function tests and an abdominal ultrasound is performed. What are the most likely ultrasound findings?

A 6-month-old child with palpable abdominal mass. Ultrasound is revealing a mixed echogenic mass in the left kidney. CT demonstrates a large mass within the left kidney which has a moderate enhancing component. Which one of the following would be the most likely diagnosis?

A 6-year-old boy is involved in traffic accident and is complaining of headache and subsequently developed altered conscious level. Which one of the following investigations is appropriate in this condition?

A 6-year-old boy presents with a right-side limp of a few week’s duration. He is apyrexial. Which one of the following is the earliest radiographic sign that would support a diagnosis of Perthes’disease of the hip?

A 6-year-old boy presents with a right-sided limp of a few weeks’ duration. He is apyrexial. Which one of the following is the earliest radiographic sign that would support a diagnosis of Perthers’ disease of the hip?

A 68-year-old man is involved in a traffic accident and sustains a pelvic fracture, head and limb injuries. Attempted urethral catheterisation in the Emergency Department is unsuccessful and a cystourethrogram is requested to exclude urethral injuries. Regarding urethral injuries, which one of the following statements is correct?

A 68-year-old woman presents with a 2month history of generalized abdominal bloating and two episodes of vaginal bleeding. On examination, the abdomen is distended with clinical evidence of ascites. Tumour makers are performed; CA 15-3 is normal, CA 125 and CEA are slightly elevated and CA 19-9 is markedly elevated. An abdominopelvic ultrasound demonstrates a moderate volume of ascites, multiple liver metastases and bilateral mixed solid/cystic adnexal masses. What is the most likely underlying primary tumour?

A 7-year-old boy has fallen on an outstretched hand and complains of a painful right elbow. When reviewing the radiographs for evidence of bony injury, which one of the following statements is true?

A 7-year-old girl presents with a fluctuating conscious level, seizures and contractures. Lumbar tab is consistent with viral encephalitis. An MRI is performed. This shows bilateral areas of increased T2 signal in the thalami. Which one of the following is the most likely diagnosis?

A 7-year-old girl, who has recently migrated migrated to this country from India, presents with a productive cough, fever, night sweats and weight loss. A CXR demonstrates marked consolidation in the right upper lobe. Sputum cytology reveals the presence of acid-fast bacilli. What additional radiological finding is most likely to suggest a diagnostic of current primary tuberculosis as opposed to post-primary tuberculosis?

A 70-year-old man recently underwent a laparoscopic prostatectomy. He now presents to the Emergency Department complaining of shortness of breath, pleuritic chest pain and haemoptysis. D-dimer levels were measured and found to be significantly elevated. A CXR is performed as part of the initial set of investigations. Which one of the following is the most likely CXR finding?

A 72-year-old man is referred to hospital as an emergency admission by his GP. He has experienced vomiting and abdominal pain for 24 hours following a takeaway meal. There is a past medical history of ischaemic heart disease, chronic obstructive pulmonary disease and hypertension. An abdominal radiograph is performed and demonstrates several gas-filled loops of small bowel centrally measuring up to 2.5 cm diameter. In the left side of the abdomen, multiple round foci of gas are projected over the wall of a loop of large bowel. No free gas or mucosal thickening is identified, what is the most likely explanation for the clinical and radiographic findings?

A confused 70-year-old man with a history of cough and some shortness of breath attends your Radiology Department for a CXR. It is noted that there are multiple discrete, spherical and well-defined pulmonary nodules with a peripheral distribution. Some calcification is noted within some of these nodules but cavitation is not evident. The accompanying nurse from the care home tells you that he has a “growth” somewhere but is not sure what this is. What is the most likely primary tumour?

A CXR is performed on a 62-year-old man with a chronic cough. This demonstrates multiple tiny nodules throughout both lungs, measuring up to 2 mm in size. These micronodules appear to be of greater density than soft tissue. Which one of the following is the most likely diagnosis?

A fifty-eight year old female patient presents to the emergency department with a 24-hour history of several hematemesis. She is found to be hypotensive and anemic. Resuscitative measures are instituted. What is the most appropriate next step?

A GP requests your advice regarding an 18-month-old girl whose mother has noticed that her left pupil appears white. The GP has performed ophthalmoscopy and is suspicious that there is a retinal mass. Which one of the following is the investigation of choice?

A neonate presents at 24 hours old with vomiting, abdominal distension and failure to pass meconium. A series of investigations are performed. Which of the following would be in keeping with a diagnosis of meconium ileus?

A neonate with a history of worsening cyanosis and respiratory distress has a series of chest radiographs taken. The initial chest radiograph reveals a solid left upper lobe mass and over the course of 3 weeks, this becomes aerated. The progressive mediastinal shift is seen as the mass enlarges. Which one of the following is the most likely diagnosis?

A newborn baby is hypoxic immediately following delivery. There is evidence of meconium- stained amniotic fluid. Which one of the following statements is true regarding meconium aspiration syndrome?

A newborn delivered by cesarean section shows signs of respiratory distress soon after birth. A chest radiograph is performed. Which one of the following features favors the diagnosis of transient tachypnea of the newborn (TTN)?

A patient of 45 years old comes to see you for symptom of irritable bowel syndrome about 2 months. He has rectal bleeding one to two times weekly. Which investigation is the most likely diagnostic?

A patient of 55 years old comes to see you for symptoms of dyspepsia. Anamnesis and clinical examination revealed that he lost 5 kg for the past 2 months and his father died of gastric cancer so you have to diagnose whether the patient was infected by H. Pylori. Which of the following tests would you think is the most appropriate?

A previously well 80-year-old woman sustains a subcapital fracture of the right neck of femur following a fall onto hard ground. The plain film reveals multiple lytic lesions within the pelvic bones and proximal femora, which are highly suspicious for bone metastases. What is the most likely occult primary lesion?

A radiograph of the left knee of a 35-year-old man reveals a 3-cm lytic lesion sited eccentrically in the proximal tibia. It has a well-defined non-sclerotic margin, and extends to the tibial articular surface. What is the most likely diagnosis?

A sixty-six-year old man presents to the emergency department with a history of one episode of melena. Past history includes coronary artery disease, hypertension. He is on one baby aspirin daily. An urgent upper endoscopy is negative. What is the most appropriate next step?

A transvaginal ultrasound is performed on a 36-year-old woman with dysfunctional uterine bleeding. This demonstrates an enlarged globular uterus with a heterogeneous appearance of the myometrium. The myometrium contains diffuse echogenic nodules, subendometrial echogenic linear striations and 2- to 6-mm subendometrial cysts. Color Doppler demonstrates a speckled pattern of increased vascularity within the heterogeneous area of myometrium. What is the most likely diagnosis?

A young girl is brought to the Emergency Department with a painful right elbow following a fall. The radiograph reveals that the radial head is ossified. Which other structure should be visible?

An 11-year-old boy presents with right hip pain. He is apyrexial and the clinicians are concerned that he has a slipped femoral epiphysis (epiphysiolyse aseptique). Which one of the following would be appropriate first-line imaging?

An 18-year-old man attends his general practitioner with a painful right knee. His radiograph shows a well-defined, lobular, lytic lesion within the proximal tibial epiphysis, extending into the metaphysis. There is a faintly sclerotic margin and no matrix calcification. What is the most likely diagnosis?

An 8-month-old child who was previously well presents with vomiting and altered conscious level. A CT head reveals significant hydrocephalus with a hyperdense mass. An MRI is arranged and reveals a lobulated mass adjacent to the trigone of lateral ventricles. The lesion yields low signal on both T1w and T2w sequences with avid enhancement postcontrast. Which one of the following is likely the most likely diagnosis?

An 80-year-old woman is admitted to hospital following a fall. The patient had a right mastectomy and axillary dissection 5 years ago to treat an invasive ductal carcinoma. The pelvic radiograph reveals a left hip fracture. Which fracture site would be most suggestive of a pathological fracture?

An 82-year-old woman is referred to the on-call surgical team as an emergency admission. The patient lives in a residential care home and has a 48-hour history of generalised abdominal pain and vomiting. On examination, she is dehydrated and tachycardic and an abdominal radiograph demonstrates multiple dilated small bowel loops measuring up to 4.8 cm in diameter. A linear gas-filled structure is present in the right upper quadrant with short branches extending from it. What is the most likely diagnosis?

An immunosuppressed 24-year-old man presents with left renal colic. He is referred for an IVU. The control film shows a gas containing, round lamellated mass within the urinary bladder. Postcontrast, there are multiple filling defects within the urinary bladder. What is the most likely cause of these appearances?