All Radiologie 2016-2017, by bonG thoM

10. 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. Cerebral abscess
B. Cerebritis
C. Subdural empyema
D. Ventriculitis
11. 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?11. 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. Boot-shape heart
B. Enlarged hila
C. Pulmonary plethora
D. Splaying of hila
12. 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. Acute glomerulonephritis
B. Acute tubular necrosis
C. Renal vein thrombosis
D. Renal artery stenosis
13. 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. Cavitation
B. Diffuse interstitial patters
C. Hilar enlargement
D. Consolidation
14. 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. Congenital lobar emphysema
B. Congenital cystic adenomatoid malformation (CCAM)
C. Bronchopulmonary sequestration
D. Congenital diaphragmatic hernia
15. 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. Neuroblastoma
B. Meduloblastoma
C. Nephroblastoma (Wilm’s tumor)
D. Lymphoma
16. 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. Sharp margins are associated with pneumonia
B. The absence of an air bronchogram makes tumor lore likely
C. Ill-defined margins make pneumonia more likely
C. Ill-defined margins make pneumonia more likely
17. 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. The chest radiograph typically shows patchy consolidation with areas of hyperinflation
B. The chest radiograph typically shows a fine ground glass appearance
C. Pneumothorax and pneumomedianum are uncommon complications
D. Radiological resolution is usually seen within 48-72hours
18. 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. Subluxation of up to 7mm of C2 anteriorly on C3 is normal
B. Subluxation of up to 3mm of C2 posteriorly 0n C3 is normal
C. The soft tissues anterior to C2 must be no wider than 1/4 of the width of the C2 vertebral body
D. The distance between the anterior arch of C1 and the dens can be up to 5mm
19. 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. A contrast enema showing pellets of meconium within the terminal ileum
B. A contrast study showing narrow loops of proximal ileum
C. A contrast enema showing a dilated terminal ileum
D. A plain abdominal radiograph (ASP) showing a soap bubble appearance within the left iliac fossa
20. Following a recent viral illness, a 5-year-old girl presents with a fluctuating conscious level, seizures and left leg weakness. She is apyrexial and does not have a rash. An MRI is performed. This shows bilateral areas of increased T2 signal in the subcortical white matter and cerebellum and deep grey matter. Which one of the following is the most likely diagnosis?
Bacterial meningitis
B. Viral encephalitis
C. Multiple sclerosis
D. Acute disseminated encephalomyelitis (ADEM)
21. 3-day-old neonate demonstrates signs of respiratory distress. A chest radiograph demonstrates a right pleural effusion. Which one of the following is the commonest cause?
A. Hydrops fetalis
B. Meconium aspiration syndrome
C. Pulmonary hemorrhage
D. Chylothorax
22. 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?
A. Craniopharyngioma
B. Meningioma
C. Ependymoma
D. Choroid plexus tumor
23. 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. Fragmentation of the femoral head
B. Hip effusion
C. A subchondral lucency
D. Sclerosis of the femoral head
24. 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. Meduloblastoma
B. Ependymoma
C. Pilicystic astrocytoma
D. Cerebellar heamangioma
25. 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. An ultrasound is of little diagnostic use
B. If an intussusception is seen it is likely to be difficult to reduce
C. An ultrasound finding of hypoechoic, thickened bowel wall would be supportive the clinical diagnosis
D. Involvement of the GI tract is seen in 10% of patients with HSP
26. 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?
A. AP and frogleg lateral radiographs of the pelvis
B. PA and frogleg lateral radiographs of the pelvis
C. Ultrasound of the hip
D. CT with 3D reconstruction of the affected hip joint
27. 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. Cerebral abscess
B. Neurocysticercosis
C. Brain Tuberculoma
D. Brain tumor
29. 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. JEV encephalitis
B. HSV encephalitis
C. Bacterial encephalitis
D. HIV encephalitis
30. 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. CT head with contrast injection
B. CT head without contrast injection
C. MRI head
D. AP and Lateral view radiographs of the head
31. Signe appartient au syndrome alvéolaire:
A) Opacité en anneau
B) Opacité hilifuge
C) Opacité réticulo-micronodulaire
D) Opacité linéaire en rail
E) Opacité systématisée
32. Signe appartient au syndrome bronchique:
A) Opacité en verre dépoli
B) Opacité en rayon de miel
C) Opacité en doigt de gant
D) Micronodules
E) Opacité réticulaire
33. Signe appartient au syndrome interstitiel:
A) Opacité hilifuge
B) Opacité en aile de papillon
C) Brochocèle
D) Opacité nodullaire à contours flous
E) Opacité confluente
34. Signe appartient au syndrome de condensation
A) Opacité en verre dépoli
B) Opacité systématisée
C) DDB
D) Abcès du poumon
E) Emphysème
35. Signe indirect du syndrome bronchique:
A) Ligne septale
B) Bronchectasie
C) Opacité linéaire en rail
D) Atélectasie
E) Bronchogramme aérien
37. Le signe de la shilouette est appliqué dans:
A) TDM
B) IRM
C) Echographie
D) Radiographie du thorax de face
E) Radiographie du thoax de profil
38. La radiographie du thorax de face chez une primo-infection tuberculeuse montre un foyer de condensation pulmonaire au lobe moyen droit, quelle lésion associée la plus fréquente?
A) Cavitation
B) Pleurésie
C) Adénopathie hilaire
D) Pneumothorax
E) Lignes septales
40. Dans le syndrome vasculaire, quelle cardiopathie congénitale qui peut donner une hypovascularisation pulmonaire généralisée?
A) CIA
B) CIV
C) PCA
D) ToF
E) CAV
41. Masse la plus fréquente au médiastin moyen chez l’enfant:
A) Lymphome
B) Thymus
C) Adénopathie
D) Malformations
E) Neuroblastome
42. Cause d’hydronéphrose unilateral chez un nouveau-né:
A) Calcul renal
B) Reflux vésico-rénal
C) Valve urètrale postérieure
D) Syndrome de jonction pyélo-urétérale
E) Vessie neurologique
43. En cas d’occlusion haute néonatale, sur le cliché d’ASP en couché, montre:
A) Hyperaération intestinale généralisée
B) Estomac dilaté
C) Image” double bulle”
D) ASP comme normal
E) Côlon dilaté
44. Dans la méningite bactérienne non compliquée, sur l’échographie transfontanellaire, on peut voir:
A) Le résultat de l’examen est comme normal
B) L’espace péricérébrale est élargi
C) Le systéme ventriculaire est dilaté
D) Signe de ventriculite
E) Signe de vascularite
45. La pleurésie de petite abondance, la radiographie du thorax de face en couché, montre:
A) Effacement de coupole diaphragmatique
B) Ligne bordante pleurale
C) Courbe de damoiseau
D) Hémithorax atteint est opaque
E) Thorax normal
46. Diagnostic en imagerie de sténose hypertrophique du pylore de nourrisson se fait par:
A) TDM
B) IRM
C) TOGD
D) ASP
E) Echographie
47. Signe “ Iceberg” appliqué dans:
A) Masse thoraco-abdominale
B) Masse cervico-thoracique
C) Masse médiastinale antérieure
D) Masse médiastinale postérieure
E) Masse hilaire
48. Un prematuré avec maladie de membrane hyaline, sur le cliché du thorax on peut voir:
A) Thorax comme normal
B) Opacités non homogènes aux deux poumons
C) Poumons blancs avec volume augmenté
D) Poumons blancs avec volume diminué
E) Poumons hyperclartés
49. Hyperclarté pulmonaire se voit dans:
A) Syndrome alvéolaire
B) Syndrome pleural
C) Syndrome brochique
D) Syndrome médiastinal
E) Syndrome vasculaire
50. Image “double bulle” vu à l’ASP d’un nouveau-né, montre:
Hernie hyatale
B) Sténose hypertrophique du pylore
C) Volvulus gastrique
D) Occlusion haute duodénale
E) Occlusion basse.
51. Cochez la proposition fausse :
A) Une partie du corps est proximale lorsqu’elle est plus proche de la racine du membre. Elle est dite distale dans le cas contraire.
B) Un élément est médial lorsqu’il est situe plus près du plan sagittal médiane. Il est dit latéral dans le cas contraire.
C) Le squelette appendiculaire représente l’ensemble des os présentant un appendice, par exemple le sternum qui comporte l’appendice xiphoïde.
D) Les os longs sont des os dont la longueur est prédominante par rapport aux autres dimensions.
E) Un os long est compose d’une diaphyse et de deux épiphyse.
52. Choisissez la proposition fausse à propos squelette :
A) L’humérus appartient au squelette appendiculaire.
B) La clavicule appartient au squelette zonal.
C) Le rachis cervical appartient au squelette axial.
D) La scapula est un os plat.
E) Le sphénoïde est un os court.
53. Choisissez la proposition vraie. L’articulation entre la crête sphénoïdale inferieure et la rainure du bord supérieur du vomer est une :
A) Synfibrose.
B) Syndesmose
C) Schindylese
D) Synchondrose
E) Gomphose
54. Quelle structure contient des cellules musculaires lisses ?
A) Muscle de l’iris.
B) Muscle diaphragme.
C) Muscle deltoïde.
D) Muscle grand fessier.
E) Muscle quadriceps.
55. Indiquez, parmi les os suivants, celui qui ne s’articule pas directement avec le frontal chez l’adulte :
A) L’os temporal.
B) Le sphénoïde.
C) L’ethmoïde
D) L’os zygomatique.
E) L’os maxillaire.
56. A propos du système nerveux
A) Les nerfs vagues accélèrent la fréquence cardiaque.
B) Les nerfs sympathiques innervant le cœur sont issus des chaines sympathiques thoraciques.
C) La moelle épinière est une partie du système nerveux périphérique.
D) Un nerf spinal est par définition un nerf mixte.
E) Un nerf crânien comporte toujours des fibres sensitives et des fibres motrices.
57. Cochez les nerfs moteurs de l’œil :
A) I.
B) II
C) III
D) IV
E) V
58. Choisissez la proposition exacte parmi les suivantes. L’axe de la tête cartilagineuse de l’humérus est oriente :
A) En haut, en avant, en dedans.
B) En haut, en arrière, en dedans.
C) En haut, en avant, en dehors.
D) En bas, en avant, en dehors.
E) En bas, en avant, en dedans.
59. Quel muscle appartient a la coiffe des rotateurs ?
A) Le deltoïde.
B) Le triceps brachial.
C) Le grand rond.
D) L’infra-épineux.
E) Le trapèze.
60. Concernant le tarse, cochez la proposition vraie :
A) Le tarse est constitué de 6 os.
B) Le métatarsien V est médial.
C) Le tarse postérieur comprend le talus et le calcanéus.
D) Tous les doigts du pied ont 3 phalanges.
E) Les métatarses et les phalanges ne sont pas tous constitués d’un corps, d’une base, et d’une tête.
1. 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. Hydrocephalus
B. intra-cerebral hemorrhage
C. Loss of gray-white matter differentiation
D. Subdural hematoma
2. 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. Posterior fat pad may be a normal finding on flexed lateral view
B. An anterior fat pad is always abnormal
A. An anterior fat pad is always abnormal B. The line from the anterior cortex of the humerus should pass through the anterior third of the capitellum
D. The radiocapitellar line should intersect on all views
3. 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. A ground glass opacities throughout both lungs
B. Hyper inflated lung
C. Loss of lung volume
D. The presence of a pleural effusion
4. 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. A pylorus that does not open
B. Pyloric canal length of greater than 11mm
C. Pyloric muscle wall thickness of 1mm
D. Transverse pyloric diameter of greater than 11mm
5. 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. Extramedullary hematopoiesis
B. Lymphoma
C. Neuroblastoma
D. Teratoma
6. 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. Angiomyolipoma
B. Lymphoma
C. Neuroblastoma
D. Wilm’s tumor
7. 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. Pulmonary stenosis
B. Tetralogy of Fallot
C. Tricuspid atresia
D. Ventricular septal defect (VSD)
8. Interstitial lung disease is suspected in a 3-year-old child who has a long history of breathlessness on exertion. A chest radiograph reveals interstitial change at the lung base. The clinical symptoms are more severe that the radiographic changes appear to suggest and a diagnosis is yet to be established. Which one of the following would be the next appropriate investigation?
A. Bronchoscopy
B. Contrast-enhanced CT of the chest
C. HRCT (high resolution CT)
D. MRI
9. 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. Corkscrewing’ appearance of the duodenum and jejunum
B. On the supine radiograph the D-J flexure lies to the left of the midline
C. On lateral view the D-J flexure is posterior
D. On the supine radiograph the D-J flexure lies above the duodenal bulb
61. Le talus n’articule pas avec :
A) Le tibia.
B) La fibula.
C) Le calcanéum
D) L’os naviculaire.
E) Le cuboïde.
62. Concernant l’articulation de la hanche, cochez la proposition fausse :
A) Le col fémoral est orienté en avant, en dedans, en haut
B) L’ acetabulum (= cotyle) est orienté en avant, en bas, en dehors.
C) L’angle cervico-diaphysaire est de l’ordre de 90 degré.
D) L’échancrure ischio-pubienne est située entre les deux cornes de l’acetabulum.
E) L’arrière-fond de l’acetabulum n’est pas recouvert de cartilage articulaire.
63. Concernant les poumons :
A) Les poumons droit et gauche ont en commun une face costale et une face médiatisnale concave.
B) Le cul de sac pleural se projette en regard de la 7e côte.
C) Sur la face médiatisnale du poumon gauche, l’œsophage laisse son empreinte en arrière du hile pulmonaire.
D) Le ligament pulmonaire unit le poumon au muscle diaphragmatique.
E) L’empreinte de l’artère subclavière gauche est clairement visible sur la face médiatisnale du poumon droit
64. Le bol alimentaire passe successivement par :
A) La bouche, le rhinopharynx, l’œsophage, l’estomac, l’iléum, le duodénum.
B) L’estomac, le duodénum, le jéjunum, l’iléum, le colon descendant, le colon transverse.
C) L’œsophage, l’estomac, le jéjunum, l’iléum, le duodénum.
D) L’œsophage, l’estomac, le duodénum, le jéjunum, l’iléon, le colon ascendant, le colon transverse, le colon pelvien (sigmoïde), le colon descendant, le rectum.
E) Toutes les propositions précédentes sont fausses.
65. Concernant le colon :
A) Il forme un carde étendu du jéjunum à l’anus.
B) L’appendice vermiculaire se situe au niveau du caecum
C) Le rectum débute au niveau de la vertèbre L3.
D) Le colon est vascularisé par des branches du tronc coeliaque.
E) Le colon intra-péritonéal se draine dans la veine cave.
66. La vascularisation du sein n’est pas assurée par :
A) Des branches de l’artère thoracique interne.
B) Des branches de l’artère thoracique latérale.
C) Des branches de l’artère pulmonaire.
D) Des branches de l’artèresub-scapulaire
E) Des branches de l’artère axillaire.
67. A propos du rachis :
A) Le rachis cervical présente une cyphose.
B) Le sommet de la cyphose thoracique est normalement au niveau de T3-T4.
C) Le rachis lombaire comprend le plus souvent 6 vertèbres lombaires.
D) La crête iliaque se projette horizontalement au niveau de L4.
E) Le disque L5-S1 est oblique en bas et en arrière.
68. Parmi les propositions suivantes concernant les os du pied, lequel se n’articule pas avec le cuboïde ?
A) L’os cunéiforme latéral.
B) L’os calcanéus.
C) L’os talus.
D) Le quatrième métatarsien.
E) Le cinquième métatarsien
69. A propos des voies aériennes et des poumons :
A) Les voies aériennes inferieures commencent en regard de C2.
B) La bronche souche droite est plus verticale que la bronche souche gauche.
C) Le pédicule fonctionnel du poumon droit comprend la bronche souche droite, l’artère pulmonaire droite et les veines bronchiques droites supérieure et inférieure.
D) Le parenchyme pulmonaire est divisé en 3 segments à droit et 2 segments a gauche.
E) Le hile pulmonaire est recouvert par la ligne de réflexion de la plèvre.
70. Concernant l’œsophage cervical :
A) L’œsophage cervical mesure environ 15 cm de hauteur.
B) L’œsophage cervical prend son origine en projection de C2-C3.
C) L’œsophage cervical est la continuité du larynx.
D) Les fibres musculaires longitudinales de l’œsophage prennent insertion sur la face postérieure du chaton (plaque) du cartilage cricoïde.
E) Les fibres musculaires longitudinales de l’œsophage sont plus internes que les fibres circulaires.
71. Concernant l’appareil urinaire :
A) Il est composé d’une a) Il est composé d’une portion sécrétrice (glandes surrénales) et d’une portion excrétrice (reins).
B) Les organes situés dans la région retro péritonéale sont recouverts en partie par le péritoine pariétal.
C) Les gros vaisseaux de l’appareil urinaire sont recouverts par le péritoineviscéral.
D) Les reins occupent la région comprise entre L1 et L3.
E) Le hile rénal se situe sur le bord latéral du rein.
72. Choisissez la proposition inexacte parmi les suivantes. Font partie de la deuxième (=distale) rangée des os du carpe les os suivants :
A) Trapèze.
B) Triquetum (pyramidal).
C) Capitatum (= grand os).
D) Trapézoïde.
E) Hamatum (= os crochu).
73. A propos des poumons :
A) Le lobe inferieur droit comprend 6 segments.
B) Le lobe moyen droit comprend 2 segments.
C) Le lobe moyen gauche comprend 2 segments.
D) La scissure oblique sépare lobe supérieur et lobe moyen droits.
E) La plèvre s’insinue dans les parenchymes pulmonaires.
74. Concernant la vascularisation de l’appareil digestif :
A) Le tronc coeliaque assure toute la vascularisation artérielle du tube digestif.
B) L’artère splénique chemine en avant du pancréas.
C) L’artère mésentérique supérieure vascularise tout le colon.
D) L’artère mésentérique supérieure vascularise tout le colon descendant.
E) L’artère mésentérique inferieure vascularise les 2/3 distaux du colon transverse.
75. Parmi les composants du rein qui suivent, un seul appartient au cortex. Lequel ?
A) Tube droit.
B) Papille.
C) Glomérule.
D) Calice.
E) Sinus.
76. A propos des os longs on peut dire que :
A) Ils sont entoures en tout point par le périoste.
B) Le canal médullaire contient du tissu osseux spongieux.
C) Le cartilage articulaire est de couleur rosée.
D) Le tissu spongieux des extrémités est formé de travéesorganisées en colonnes verticales.
E) Le cartilage épiphysaire est le cartilage de croissance entre l’épiphyse et la métaphyse.
77. 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. A normal chest radiograph
B. Linear atelectasis
C. Localized peripheral oligaemia
D. Peripheral airspace opacification
E. Pleural effusion
78. 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. Bronchopneumonia
B. Cavitation
C. Empyema
D. Large pleural effusion
E. Lobar consolidation
79. 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. Cavitation
B. Mediastinal lymphadenopathy
C. Multifocal lesion
D. Ranke complex
E. Rasmussen aneurysm
80. 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. Air bronchograms
B. Cavitation
C. Central calcification
D. Lymphadenopathy
E. Pleural effusion
81. A 30-year-old man is HIV positive with a most recent CD4 count = 100 cells/L. 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. Streptococcus pneumoniae
B. Cryptococcus neoformans
C. Cytomegalovirus
D. Mycobacterium avium complex
E. Pneumocystis carinii
82. 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. Left lower lobe collapse
B. Left upper lobe collapse
C. Right middle lobe collapse
D. Right lower lobe collapse
E. Right upper lobe collapse
83. 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. Adenocarcinoma of the colon
B. Anaplastic thyroid carcinoma
C. Chondrosarcoma of the femur
D. Invasive ductal carcinoma of the of the breast
E. Squamous cell carcinoma of the oesophagus
84. 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. Dislocated left sternoclavicular joint
B. Fractured left 2nd rib
C. Fractured left humerus
D. Left tension pneumothorax
E. Right anterior shoulder dislocation
85. 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. A nasogastric tube coiled within the left hemithorax
B. A right pleural effusion
C. Elevated left hemidiaphragm
D. Hollow viscera seen within the chest
E. Mediastinal shift towards the left
86. 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. Flail chest
B. Pneumopericardium
C. Ruptured oesophagus
D. Tracheobronchial rupture
E. Traumatic aortic rupture
87. 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. A fine nodular parenchymal lung pattern if chronic PVH develops
B. Kerley A septal lines radiating from the hilum to the pleural surface
C. Kerley C septal lines seen at right angles to the pleural surface within the peripheral lower zones
D. Lower lobe pulmonary venous blood diversion
E. Relative thinning of bronchial wall thickness compared with normal subjects
88. 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. Air bronchograms
B. Cavitating nodules
C. Empyema
D. Pleural effusion
E. Scattered multifocal opacities
89. 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. Diaphragmatic hernia
B. Extensive consolidation
C. Lung collapse
D. Mesothelioma
E. Pleural effusion
90. Whilst reporting plain radiographs from a respiratory outpatient clinic, you view a CXR that demonstrates bilateral hypertransradianthemithoraces. The lung volumes are normal and, unfortunately, there is no clinical history accompanying the request card. Which diagnosis would best explain these finding?
A. Acute bronchiolitis
B. Asthma
C. COPD
D. Multiple pulmonary emboli
E. Tracheal stenosis
91. 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. Coal worker’s pneumoconiosis
B. Miliaryhistoplasmosis
C. Miliary tuberculosis
D. Sarcoidosis
E. Silicosis
92. You are asked by the Emergency Department clinicians to review a trauma series of plain radiographs of a young man involved in a road traffic accident. The clinicians suspect that the patient has multiple right-sided rib fractures. Which one of the following is the correct radiological consideration as you review these films?
A. A double fracture of a single rib leads to a “flail segment”.
Of the 1st to 3rd ribs imply a minor trauma.
C. If fractures of the 10th to 12th ribs are present, further imaging is likely to be required.
D. Rib fractures are commonly seen in children.
E. The supine chest radiograph is a sensitive screening test for rib fractures.
93. 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. Alveolar rupture.
B. Diaphragmatic rupture.
C. Oesophageal perforation.
D. Pneumothorax.
E. Tracheobronchial rupture.
94. 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. Chondroblastoma.
B. Chondroma.
C. Chondromyxofibroma.
D. Chondrosarcoma.
E. Osteochondroma.
95. A 32-yea-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. A fracture of the distal radius with an associated dislocation of the radial head.
B. A fracture of the distal radius with an associated disruption of the distal radioulnar joint.
C. A fracture of the distal ulna with an associated dislocation of the radial head.
D. A fracture of the proximal ulna with an associated dislocation of the radial head.
E. A fracture of the proximal radius with an associated disruption of the distal radioulnar joint.
96. 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. Aneurysmal bone cyst.
B. Chondrosarcoma.
C. Ewing’s sarcoma.
D. Metastasis.
E. Osteosarcoma.
97. 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?
A. Greater trochanter fracture
B. Intertrochanteric fracture of the left proximal femur.
C. Pertrochanteric fracture of the left proximal femur.
D. Subcapital fracture of the left neck of femur
E. Subtrochanteric fracture of the left proximal femur.
98. A 19-year-old student returns to the UK following 4 months’ travelling around the world. Radiographs reveal multiple oval areas of calcification, up to 1 cm in long axis, aligned in the direction of muscle fibres. What is the most likely diagnosis?
A. Cysticercosis.
B. Dracunculus (guinea worm) infection.
C. Hydatid disease.
D. Loiasis.
E. Schistosomiasis.
99. 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. Carcinoma of the bladder.
B. Carcinoma of the breast
C. Carcinoma of the bronchus
D. Carcinoma of the colon
E. Carcinoma of the stomach
100. 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. Ankylosis of the apophyseal joints
B. Anterior longitudinal ligament calcification
C. Osteophyte formation
D. Sclerosis of the anterior corners of the vertebrae
E. Vertebral body squaring
101. 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. Early reduction in bone mineralisation.
B. Erosions of the terminal tufts of the distal phalanges
C. Joint ankylosis
D. Pencil-in-cup deformities of the middle phalanges
E. Periosteal reaction
102. 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?
A. Chondroblastoma
B. Chondromyxoid fibroma
C. Enchondroma
D. Giant cell tumour
E. Osteoid osteoma
103. 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?
A. Capitellum
B. Internal epicondyle
C. Olecranon
D. Lateral epicondyle
E. Trochlea
104. 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. Aneurysmal bone cyst.
B. Chondroblastoma
C. Giant cell tumour
D. Non-ossifying fibroma
E. Osteoid osteoma
105. 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. Barium evacuation proctogram
B. CT colonography
C. CT with rectal contrast media
D. Endoanal ultrasound
E. MRI of the pelvis with a body coil.
106. 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 ansonographic details, what is the most likely diagnosis?
A. Amoebic abscess
B. Hydatid cyst
C. Pyogenic liver abscess
D. Simple liver cyst
E. Solitary metastasis
107. 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. Carcinoma of the sigmoid colon
B. Endometriosis
C. Pelvic lipomatosis
D. Radiation enteritis
E. Solitary rectal ulcer syndrome
108. 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. Hypoechoic mass in the pancreatic head with common bile duct measuring 14 mm and pancreatic duct measuring 6 mm in diameter
B. Nodular liver surface, mixed reflectivity liver texture and ascites
Intrahepatic duct dilatation with no cause identified
D. Several large gallstones with gallbladder wall measuring 5 mm and a rim of pericholecystic fluid
E. Several small gallstones with gallbladder wall thickness of 2 mm
109. 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?
A. Acute mesenteric ischaemia
B. Emphysematous cholecystitis
C. Gallstones ileus
D. Obstructed right inguinal hernia
E. Small bowel obstruction due to adhesions
110. 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. Gastroenteritis with incidental pneumatosis coli
B. Emphysematous pyelonephritis with a paralytic ileus
C. Ischaemic colitis causing intramural bowel gas
D. Perforated sigmoid diverticulitis with gas in the retroperitoneum
E. Small bowel obstruction due to a gallstone ileus
111. 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. Breast cancer
B. Gastric adenocarcinoma
C. Melanoma
D. Ovarian cancer
E. Primary peritoneal carcinoma
112. 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. Decreased reflectivity of the liver parenchyma
B. Increased reflectivity of the liver parenchyma
C. Nodular liver surface
D. Normal ultrasound appearances
E. Retrograde portal venous flow
113. 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. Candida oesophagitis
B. CMV oesophagitis
C. Intramural pseudodiverticulosis
D. Oesophageal lymphoma
E. Squamous cell carcinoma of the oesophagus
114. 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. Achalasia
B. Oesophageal web
C. Presbyoesophagus
D. Scleroderma
E. Squamous cell carcinoma of oesophagus
115. 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. Colonic carcinoma
B. Gallstone ileus
C. Intussusception
D. Psoas abscess
E. Strangulated femoral hernia
116. 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. Acalculouscholecystitis
B. Acute cholangitis
C. Gallbladder haematoma
D. Traumatic hepatic artery pseudoaneurysm
E. Xanthogranulomatouscholecystitis
117. 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. Acute pyelonephritis
B. Amyloidosis
C. Reflux nephropathy
D. Renal papillary necrosis
E. Xanthogranulomatous pyelonephritis
118. 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. Focal areas of reduced reflectivity in the renal parenchyma
B. Focal atrophy of segments of the right kidney
C. Increased echogenicity of the renal calyces
D. Enlarged right kidney and diffusely hyperechoic parenchyma
E. Shrunken right kidney and diffusely hyperechoic parenchyma
119. A 55-yea-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. Calcium oxalate
B. Cysteine
C. Indinavir phosphate
D. Struvite
E. Uric acid
120. 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. If present, an ectopic ureterocoele is usually related to the lower moiety ureter
B. The lower moiety ureter usually obstructs at the vesicoureteric junction
C. The upper moiety calyces are prone to vesicoureteric reflux
D. The upper moiety ureter is prone to ureteric obstruction
Upper moiety ureter usually inserts into the bladder superior to the lower moiety ureter.
121. 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. Acute hydronephrosis
B. Acute pyelonephritis
C. Acute renal infarction
D. Acute renal vein thrombosis
E. Chronic pyelonephritis
122. 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. Abdominal ultrasound
B. Contrast-enhanced CT abdomen and pelvis
C. Emergency catheter renal angiography
D. Gadolinium-enhanced renal MRI
E. IVU
123. 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. Anterior urethral injury is more commonly due to iatrogenic or penetrating trauma than to blunt trauma.
B. Cystography should precede a retrograde urethrogram in a patient with suspected urethral injury
C. In men, on digital rectal examination the prostate is lower than normal in patients with urethral trauma
D. Urethral injuries occur in 50% of major pelvic fractures.
E. Urethral injury due to blunt trauma more commonly affects the penile urethra
124. Which one of the following statements best describes the radiological appearances of parapelvic renal cyst?
A. It does not opacity during IVU.
B. If hydronephrosis is present, a parapelvic cyst can be excluded.
C. It shows delayed (10 min) filling on IVU.
D. It may have similar appearances to calyceal diverticula on IVU
E. The majority arise from the lower renal pole.
125. 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. Adult polycystic kidney disease
B. Hyperparathyroidism
C. Medullary sponge kidney
D. Primary hyperoxaluria
E. Sacoidosis
126. 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. Bulbar urethra
B. Membranous urethra
C. Penile urethra
D. Penoscrotal urethra
E. Prostatic urethra
127. You are the radiologist reviewing the mammograms of a 56-year-old woman. When compared with her previous mammograms, areas of calcification previously seen within the left upper outer quadrant have now disappeared. Which of the following is not a possible explanation?
A. Breast surgery
B. Chemotherapy
C. Postmenopausal changes
D. Radiotherapy
E. Spontaneous resolution
128. 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. Adenomyosis
B. Endometrial polyposis
C. Gestational trophoblastic disease (GTD)
D. Stage 1A endometrial cancer
E. Uterine fibroid
129. 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. Fat necrosis
B. Fibroadenoma
C. Hamartoma
D. Oil cyst
E. Papilloma
130. 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. An interval cancer has a better prognosis, when compared with other screen-detected cancers.
B. This is known as a Type 1interval cancer.
C. This is known as a Type 2a interval cancer
D. This is known as a Type 2b interval cancer.
E. This is known as a Type 3interval cancer.
131. 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. Bilateral vesicoureteric reflux.
B. Chronic glomerulonephritis
C. Medullary sponge kidney
D. Pyelonephritis.
E. Renal tuberculosis.
132. 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. Absent right nephrogram and no evidence of contrast excretion on the right
B. An increasingly dense right nephrogram that remains present after 6 hours
C. An initially dense right nephrogram, which then resolves within 30 minutes
D. The right kidney being 10% longer than the left kidney
E. The right kidney being small with an irregular cortical surface.
133. 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. A larger transverse than anterior-to-posterior diameter
B. Ill-defined echogenic halo around the lesion
C. Less than 1 cm in greatest diameter
D. Posterior acoustic enhancement
E. Uniform hyperechogenicity
134. Which one of the following statements best describes the course of the normal ureter within the pelvis?
A. Anterior to the inferior pubic ramus, the ureter runs posteromedially to enter the urinary bladder.
B. In females, the ureter lies within the broad ligament where it is intra-peritoneal for a short portion of its length and runs inferomedially to enter the urinary bladder.
C. In males, the ureter runs anterior to the cremasteric artery and turns medially to enter the urinary bladder.
D. In the region of the ischial spine, the ureter turns medially, anteriorly and inferiorly to enter the bladder.
E. The ureter enters the pelvis by crossing the bifurcation of the common iliac artery and runs medially to enter the urinary bladder.
135. 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?
A. Blood clot
B. Bladder calculi
C. Cystitis
D. Fungal ball
E. Schistosomiasis
136. Which of the following best describes the radiological findings of urinary tract malakoplakia?
A. Intramural bladder wall gas
B. Multiple filling defects in the pelvicalyceal systems and proximal ureters on IVU, with sparing of the urinary bladder.
C. Multiple small oval filling defects at the bladder base
D. Plaque-like thickening of the pelvicalycealurothelium
E. Tram-track calcification within the bladder wall
137. 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. A well-positioned CC view usually contains all the breast tissue.
B. A well-positioned MLO view rarely shows the nipple in profile because of the oblique compression.
C. On a well-positioned MLO the nipple should be at the lower border of the pectoralis minor.
D. The MLO view is taken with the radiograph beam directed from superomedial to inferolateral.
E. The pectoralis major muscle is demonstrated at the posterior border of a CC view in approximately 70% of individuals.
138. 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. Bladder diverticulum
B. External iliac artery aneurysm
C. Mullerian duct cyst
D. Seminal vesicle cyst
E. Urethral cyst
139. 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. Enlarged, oedematous ovaries with multiple packed follicles and pelvic-free fluid.
B. Enlarged ovaries with multiple peripheral cyst
C. Normal appearances of the ovaries
D. Ovarian mass with mixed cystic and solid components
E. Ovaries replaced by multiple large cyst
140. 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. Conventional angiography
B. CT
C. Echocardiogram
D. MRI
E. Plain radiograph
141. 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. A subchondrallucency
B. Fragmentation of the femoral head
C. Hip effusion
D. Periarticular osteopenia
E. Sclerosis of the femoral head
142. A 2-year-old has an elbow radiograph performed following a fall. Which one of the following epiphyses should be visible?
A. Capitellum
B. Medial epicondyle
C. None
D. Olecranon
E. Radial head
143. On a 20-weeks antenatal ultrasound, unilateral fetal hydronephrosis is detected. Which one of the following findings would confirm the diagnosis of renal pelvic dilatation (RPD)?
A. During the second trimester, the AP renal pelvis measures more than 3 mm
B. During the third trimester, the AP renal pelvis measures greater than 5 mm
C. Megaureters are present.
D. The AP renal pelvis measures greater than 25% of the longitudinal length of the kidney
E. The AP renal pelvis measures greater than 50% of the longitudinal length of the kidney
144. 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. Acute glomerulonephritis
B. Acute tubular necrosis
C. Renal artery stenosis
D. Renal vein thrombosis
E. Unilateral obstruction
145. 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. Fractures of multiple ages
B. Fracture of the middle third of the clavicle.
C. Fracture of the lateral third of the clavicle.
D. Linear skull fracture
E. Spiral humeral fracture.
146. 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. Cryptococcosis
B. Histiocytosis
C. HIV encephalopathy
D. Multiple cerebral metastasis
E. Toxoplasmosis
147. 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. CT orbits
B. MRI orbits
C. Orbital radiographs
D. Repeat ophthalmoscopy by ophthalmologist
E. Ultrasound
148. 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. CMV encephalitis
B. Cryptococcosis
C. HIV encephalitis
D. Toxoplasmosis
E. Tuberculosis
149. A 37-yeao-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. They are crescentic is shape
B. They are commonest in the temporoparietal region
C. They are rarely associated with a skull fracture
D. They are usually due to laceration of the middle cerebral artery
E. They commonly cross the cranial sutures
150. 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. Arachnoid cyst
B. Cerebral infarct
C. Colloid cyst
D. Dermoid cyst
E. Epidermoid cyst
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