FMGE 2025 - Radiology Practice Questions

Q: Based on the provided MRI images of the knee (A and B), which show a well-defined fluid collection anterior to the patella, what is the most likely diagnosis?

Housemaid's knee. ***Housemaid's knee*** - The MRI shows fluid accumulation specifically in the **prepatellar bursa**, which is located anterior to the patella. This finding is the hallmark of prepatellar bursitis. - This condition is colloquially termed **"Housemaid's knee"** as it commonly results from chronic irritation and inflammation of the bursa due to repetitive kneeling. *Subdermal abscess* - A **subdermal abscess** would appear as a collection of pus in the subcutaneous tissue, often with irregular borders and significant surrounding **inflammatory changes (cellulitis)**, which are not the primary findings here. - The fluid collection is well-defined and confined to the anatomical location of the **prepatellar bursa**, not a disorganized subcutaneous collection. *Gout* - Gout typically presents as an acute **intra-articular** inflammation with a large joint effusion. Chronic gout can show characteristic **"rat-bite" erosions** on imaging, which are not visible here. - While gout can cause bursitis, the diagnosis is confirmed by identifying **negatively birefringent urate crystals** in aspirated fluid, and the imaging is less specific than for simple bursitis. *Rheumatoid arthritis* - Rheumatoid arthritis is a systemic disease causing **synovitis** and **pannus formation**, leading to joint destruction and bone erosions, none of which are seen in the image. - While bursitis can be associated with rheumatoid arthritis, it is typically part of a widespread **polyarthritis**, not an isolated finding as shown.

Q: A patient presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.

Laryngotracheobronchitis. ***Laryngotracheobronchitis*** - The AP neck radiograph displays the classic **"steeple sign,"** which is a tapered narrowing of the subglottic trachea (indicated by the arrow) due to inflammation. - This condition, also known as **croup**, is typically caused by a viral infection (most commonly **parainfluenza virus**) and presents with a characteristic **barking cough** and inspiratory stridor. *Epiglottitis* - This condition is characterized by the **"thumb sign"** on a *lateral* neck X-ray, which shows a swollen epiglottis, not the subglottic narrowing seen here. - Patients typically present more severely with high fever, **drooling**, dysphagia, and assume a **"tripod" posture**, which differs from the presentation of croup. *Bronchitis* - Bronchitis is an inflammation of the larger airways (bronchi) and would not produce findings in the subglottic region of a neck X-ray. - The primary symptom is a productive cough, and a **chest X-ray**, not a neck X-ray, would be the relevant imaging, which is often normal. *Laryngomalacia* - This is a congenital condition causing inspiratory stridor due to the collapse of soft laryngeal structures; it is not an acute infectious process. - The diagnosis is typically confirmed with **flexible laryngoscopy**, and plain radiographs are usually normal and do not show a steeple sign.

Q: A patient presents with SOB and fatigue. CXR was done. What is the diagnosis? ![img-18.jpeg](img-18.jpeg)

Asbestosis. ***Asbestosis*** - The chest X-ray demonstrates classic features of asbestosis, including **pleural plaques** (calcifications on the pleura) and diffuse **interstitial fibrosis**, which is most prominent in the **lower lung zones**. - Asbestosis is a type of pneumoconiosis caused by the inhalation of **asbestos fibers**, and these radiographic findings are highly characteristic of long-term exposure. *TB* - Tuberculosis typically presents with findings in the **upper lobes** or apical segments of the lungs, such as **cavitations**, consolidation, or a **Ghon complex**. - The diffuse lower lobe interstitial pattern and pleural plaques seen in this image are not features of a typical TB infection. *Silicosis* - Silicosis is a pneumoconiosis that classically affects the **upper lung zones**, presenting as multiple small, rounded opacities that can coalesce into larger masses. - A characteristic finding, though not always present, is **"eggshell calcification"** of the hilar lymph nodes, which is absent here. Pleural plaques are not a typical feature. *Byssinosis* - Byssinosis, or "brown lung disease," is caused by exposure to cotton dust and often presents with a normal chest X-ray or non-specific findings of hyperinflation. - The diagnosis is primarily clinical, based on a history of chest tightness and dyspnea that improves over the work week. It does not cause the distinct pleural and parenchymal changes seen in asbestosis.

Q: A patient presents with severe headache. A CT scan of the brain reveals hyperdense areas in the right basal region, marked as 'X'. Which of the following is the most likely diagnosis?

Subarachnoid hemorrhage. ***Subarachnoid hemorrhage*** - The non-contrast CT scan shows **hyperdensity** (appears white) within the basal cisterns and Sylvian fissures (indicated by 'X'), which is the classic appearance of acute blood in the subarachnoid space. - This condition classically presents with a sudden, severe "**thunderclap headache**" and is most commonly caused by a ruptured **berry aneurysm**. *Meningococcal meningitis* - A non-contrast CT in meningitis is often normal. Key findings like **meningeal enhancement** would only be visible on a post-contrast CT scan, which is not the pattern seen here. - The clinical presentation typically involves a triad of **fever**, **nuchal rigidity**, and altered mental status, which are classic signs of meningeal irritation. *Brain abscess* - A brain abscess on a non-contrast CT typically appears as a **hypodense** (dark) or isodense mass within the brain parenchyma, often with surrounding vasogenic edema. - On a contrast-enhanced CT, it characteristically shows a **ring-enhancing lesion**, which is not depicted in this image. *Pneumocephalus* - Pneumocephalus refers to air within the cranial cavity, which appears as profoundly **hypodense** (black) on a CT scan. - The primary finding in the image is **hyperdensity** (blood), not the extreme hypodensity characteristic of air.

Q: The following radiological image was taken to assess the urinary tract. Identify the investigation shown below.

Intravenous pyelogram (IVP). ***Intravenous pyelogram (IVP)*** - An **IVP**, also known as intravenous urography (IVU), involves injecting a radiopaque **contrast agent** intravenously, which is then excreted by the kidneys, allowing for visualization of the entire urinary tract including the kidneys, ureters, and bladder. - This investigation provides both anatomical detail, such as identifying obstructions or masses, and functional information about the kidneys' ability to excrete the contrast. *Pelvic X-ray* - A standard **pelvic X-ray** is primarily used to evaluate the bony structures of the pelvis and would not typically involve contrast media to outline the urinary tract. - While it can reveal radiopaque **kidney stones** (calculi) or bladder stones, it does not provide detailed visualization of the kidneys or ureters as an IVP does. *Retrograde pyelogram* - In a **retrograde pyelogram**, contrast dye is injected directly into the ureters or renal pelvis via a catheter inserted through a **cystoscope** into the bladder. - This procedure visualizes the collecting system in a retrograde fashion (from bottom to top) and does not assess renal excretory function. *Micturating cystourethrogram (MCU)* - An **MCU** (also known as voiding cystourethrogram or VCUG) involves retrograde filling of the bladder with contrast through a urethral catheter, followed by fluoroscopic imaging during voiding. - This investigation is primarily used to evaluate **vesicoureteral reflux** and urethral anatomy, not for assessing the upper urinary tract (kidneys and ureters) as shown in an IVP.

Q: Identify the investigation shown in the image:

Mammography. ***Mammography*** - The image displays the characteristic features of a mammogram, which is a specialized **low-dose X-ray** of the breast used for screening and diagnosis. - It clearly delineates the breast's internal structures, including **glandular tissue**, **adipose tissue**, and **ducts**, which is the primary purpose of this imaging modality. *CT* - A **Computed Tomography (CT)** scan produces cross-sectional (slice) images, whereas the image shown is a projectional view of the entire breast, typical of mammography. - CT scans of the chest would typically show surrounding structures like ribs, lungs, and the sternum, which are absent in this focused view. *X-ray* - While mammography is a type of X-ray, in clinical practice, the term "X-ray" usually refers to a standard radiograph (e.g., chest X-ray) that is not optimized for detailed **soft-tissue differentiation** of the breast. - The technique involves breast compression and specific views (like mediolateral oblique or craniocaudal) that are unique to mammography, not general radiography. *MRI* - **Magnetic Resonance Imaging (MRI)** of the breast produces images with different tissue contrast and appearance, often using gadolinium contrast to assess vascularity. - The texture and resolution of an MRI are distinct, and it does not typically show microcalcifications with the same clarity as a mammogram.

Q: What does a linear accelerator (LINAC) produce in radiation therapy?

X-rays and electrons. ***X-rays and electrons*** - A linear accelerator (LINAC) accelerates **electrons** to high energies, which can be used directly as an **electron beam** to treat superficial tumors. - To treat deeper tumors, these high-energy **electrons** are made to strike a heavy metal target (like tungsten), which then produces high-energy **X-rays** (photons) through a process called **bremsstrahlung**. *Alpha and beta rays* - **Alpha particles** (helium nuclei) and **beta particles** (electrons from nuclear decay) are forms of particulate radiation emitted by radioactive substances, not generated by a LINAC. - While the LINAC beam consists of electrons, it does not produce **alpha particles**, which have very low penetration and are not used in external beam radiotherapy. *X-rays and gamma rays* - A LINAC produces **X-rays**, but not **gamma rays**. Although both are high-energy photons, their origin differs. - **Gamma rays** are emitted from the nucleus of a decaying radioactive atom (e.g., Cobalt-60), whereas **X-rays** from a LINAC are produced extranuclearly when electrons interact with a target. *Neutrons and positrons* - **Neutron therapy** is a specialized form of radiation that requires different equipment, like a cyclotron, and is not a primary output of a standard medical LINAC. - **Positrons** are the antimatter counterpart of electrons and are used in diagnostic imaging (**Positron Emission Tomography or PET**), not for therapeutic purposes in a LINAC.

Q: Identify the imaging study shown in the image.

Intravenous pyelogram (IVP). ***Intravenous pyelogram (IVP)*** - This imaging study involves the **intravenous injection** of a contrast agent, which is then excreted by the kidneys, allowing for visualization of the entire urinary tract, including the kidneys, ureters, and bladder, as seen in the image. - The antegrade (forward) filling of the renal calyces, pelvis, ureters, and bladder is the classic appearance of an IVP, which assesses both the structure and function of the urinary system. *Pelvic X-ray* - A standard pelvic X-ray is a **plain radiograph** without any contrast material, primarily used to visualize the pelvic bones. - The image clearly shows opacification of the urinary tract with a contrast agent, which is not a feature of a plain pelvic X-ray. *Retrograde pyelogram* - This procedure involves injecting contrast material directly into the ureters via a **cystoscope** in a retrograde (backward) fashion, from the bladder towards the kidneys. - The image shows contrast originating from the kidneys and flowing down to the bladder, which is characteristic of an **antegrade** study like an IVP, not a retrograde one. *Micturating cystourethrogram (MCUG)* - In an MCUG, contrast is instilled directly into the bladder via a **urinary catheter** to assess the bladder and urethra, primarily during voiding. - While reflux into the ureters can be seen, the primary filling of the entire upper urinary tract via renal excretion, as shown here, is the defining feature of an IVP.

Q: A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Silicosis. ***Silicosis*** - The presence of **bilateral hilar lymphadenopathy** with **eggshell calcification** is a classic, pathognomonic finding for silicosis. - This pneumoconiosis is caused by inhalation of silica dust, often seen in miners and sandblasters, and typically shows multiple small nodules predominantly in the **upper lung zones**. *Sarcoidosis* - While sarcoidosis is a common cause of **bilateral hilar lymphadenopathy**, the presence of **eggshell calcification** is much less frequent compared to silicosis. - Calcification in sarcoidosis, when it occurs, is more often amorphous or diffuse, not the distinct peripheral rim seen in the image. *Tuberculosis* - Tuberculosis can cause hilar lymphadenopathy, but it is often **unilateral**, and calcification typically occurs in a healed **Ghon complex** as a solid, dense nodule. - The specific pattern of **eggshell calcification** is not a characteristic feature of tuberculosis. *Pneumoconiosis due to asbestos* - Asbestosis characteristically involves the **lower lung zones** and is associated with **pleural plaques**, pleural thickening, and interstitial fibrosis. - Significant hilar lymphadenopathy and **eggshell calcification** are not typical features of asbestos-related lung disease.

Q: A 30 year old apparently healthy man who was carrying laxatives and enema apparatus developed abdominal pain at the airport and an x-ray was done which appears as shown below. Which of the following is the likely diagnosis?

Body packer syndrome. ***Body packer syndrome*** - This diagnosis is indicated by the presence of multiple, well-defined, uniformly shaped, and hyperdense foreign bodies within the gastrointestinal tract, as seen on the abdominal X-ray. - The clinical context of being at an airport with laxatives and enema apparatus is highly suggestive of an individual attempting to smuggle illicit drugs by ingesting them in packets. *Bezoar syndrome* - A **bezoar** is a mass of indigestible material (like hair or vegetable fibers) trapped in the GI tract, which appears on X-ray as a mottled, heterogeneous mass, not as multiple discrete, uniform packets. - Bezoars typically conform to the shape of the stomach or bowel lumen and lack the smooth, regular outlines seen in this image. *Pica due to anaemia* - **Pica** is the ingestion of non-nutritive substances and might show foreign objects on an X-ray, but these would typically be of varied shapes and sizes (e.g., coins, dirt, paint chips), not uniform packets. - The clinical presentation does not suggest anaemia, and the scenario points towards illegal activity rather than a compulsive eating disorder. *Constipation due to fecalith* - A **fecalith** is a hardened mass of stool that appears as a mottled density within the colon, consistent with retained feces. - The objects in the X-ray have sharp, smooth borders and a uniform density, which is inconsistent with the appearance of a fecalith.

Question 1

Based on the provided MRI images of the knee (A and B), which show a well-defined fluid collection anterior to the patella, what is the most likely diagnosis?

Accepted Answer

Housemaid's knee

Answer

Rheumatoid arthritis

Answer

Gout

Answer

Subdermal abscess

Question 2

A patient presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.

Accepted Answer

Laryngotracheobronchitis

Answer

Epiglottitis

Answer

Bronchitis

Answer

Laryngomalacia

Question 3

A patient presents with SOB and fatigue. CXR was done. What is the diagnosis? ![img-18.jpeg](img-18.jpeg)

Accepted Answer

Asbestosis

Answer

Silicosis

Answer

TB

Answer

Byssinosis

Question 4

A patient presents with severe headache. A CT scan of the brain reveals hyperdense areas in the right basal region, marked as 'X'. Which of the following is the most likely diagnosis?

Accepted Answer

Subarachnoid hemorrhage

Answer

Brain abscess

Answer

Pneumocephalus

Answer

Meningococcal meningitis

Question 5

The following radiological image was taken to assess the urinary tract. Identify the investigation shown below.

Accepted Answer

Intravenous pyelogram (IVP)

Answer

Pelvic X-ray

Answer

Retrograde pyelogram

Answer

Micturating cystourethrogram (MCU)

Question 6

Identify the investigation shown in the image:

Accepted Answer

Mammography

Answer

CT

Answer

X-ray

Answer

MRI

Question 7

What does a linear accelerator (LINAC) produce in radiation therapy?

Accepted Answer

X-rays and electrons

Answer

Alpha and beta rays

Answer

X-rays and gamma rays

Answer

Neutrons and positrons

Question 8

Identify the imaging study shown in the image.

Accepted Answer

Intravenous pyelogram (IVP)

Answer

Pelvic X-ray

Answer

Micturating cystourethrogram (MCUG)

Answer

Retrograde pyelogram

Question 9

A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Accepted Answer

Silicosis

Answer

Tuberculosis

Answer

Sarcoidosis

Answer

Pneumoconiosis due to asbestos

Question 10

A 30 year old apparently healthy man who was carrying laxatives and enema apparatus developed abdominal pain at the airport and an x-ray was done which appears as shown below. Which of the following is the likely diagnosis?

Accepted Answer

Body packer syndrome

Answer

Pica due to anaemia

Answer

Bezoar syndrome

Answer

Constipation due to fecalith

FMGE 2025 — Radiology