NEET-PG 2017 - Radiology Practice Questions

Q: Which is correct about the intracranial bleeding shown below?

Chronic subdural hematoma, hypodensity. ***Chronic subdural hematoma, hypodensity*** - The image displays a crescent-shaped collection of fluid with **hypodense characteristics** (darker than brain parenchyma) that crosses suture lines, which is typical for a subdural hematoma. - The **hypodensity indicates older, chronic blood** where the hemoglobin has degraded, differentiating it from acute (hyperdense) or subacute (isodense) collections. *Acute subdural hematoma, hypodensity* - An **acute subdural hematoma** would typically appear **hyperdense** (bright) on CT due to fresh blood. - The observed collection is clearly hypodense, ruling out an acute presentation. *Chronic epidural hematoma, hyperdensity* - An **epidural hematoma** is typically **lenticular (lens-shaped)** and does not cross suture lines, unlike the crescent shape seen here. - While chronic blood *can* be hypodense, an epidural hematoma by definition is outside the dura mater and would not present with this morphology. *Acute epidural hematoma, hyperdensity* - An **acute epidural hematoma** is characterized by a **lenticular (lens-shaped) hyperdense** collection of blood, which is distinctly different from the crescent-shaped, hypodense collection in the image. - Epidural hematomas occur between the dura mater and the skull, typically from arterial injury, and are bound by sutures.

Q: The CXR shows markings near the costophrenic angle. Which of the following is the cause of these markings? (Recent NEET Pattern 2016-17)

Lymphangitis carcinomatosis. ***Lymphangitis carcinomatosis*** - The image shows **reticulonodular interstitial markings** with preserved lung volumes, particularly prominent near the costophrenic angle, which are classic for **lymphangitis carcinomatosis**. - This condition is caused by the infiltration of **malignant cells into the lymphatic channels** of the lung, leading to thickening of the interlobular septa and a characteristic radiographic appearance. *Pulmonary alveolar proteinosis* - This condition typically presents with diffuse ground-glass opacities and consolidation, often described as a **"crazy-paving" pattern** on CT, which is not seen here. - It involves the accumulation of lipoproteinaceous material within the **alveoli**, rather than lymphatic infiltration. *Lung abscess* - A lung abscess would appear as a **cavitated lesion** with an air-fluid level, indicating necrosis and fluid accumulation, which is distinctly different from the interstitial markings in the image. - It is typically caused by **bacterial infection** and is a focal process, not diffuse interstitial infiltration. *Pneumatocele* - A pneumatocele is a **thin-walled, air-filled cyst** commonly seen after pneumonia in children or trauma, appearing as a clear, defined space on imaging. - It does not present with the diffuse reticulonodular pattern or interstitial thickening characteristic of the image.

Q: The CT chest of a patient given below shows presence of: (Recent NEET Pattern 2016-17)

Bronchiectasis. ***Bronchiectasis*** - The CT image shows a cluster of **dilated, thick-walled bronchi** in the left lung, which are characteristic findings of bronchiectasis, especially when they are larger than adjacent pulmonary arteries. - The arrow specifically points to these abnormal, saccular dilations of the bronchi, often described as a **"cluster of grapes"** or **cystic appearance**. *Pneumatoceles* - **Pneumatoceles** are typically thin-walled, air-filled cysts that develop as a complication of pneumonia or trauma, and are usually solitary or few in number, not a widespread cluster of dilated airways. - They also often resolve spontaneously, unlike the chronic, irreversible bronchial dilation seen in the image. *Normal scan* - A **normal CT chest scan** would show finely branching airways that progressively narrow as they extend peripherally, without the presence of prominent thick-walled, dilated bronchi or cystic changes. - The image clearly depicts significant structural abnormalities in the left lung making a normal scan highly improbable. *Loculated empyema* - A **loculated empyema** would appear as a collection of pus within the pleural space, characterized by **fluid attenuation**, internal septations, and enhancement of the pleura. - None of these features are the primary findings seen in this image, which shows dilated airways rather than pleural fluid collections.

Q: CT abdomen shows: (Recent NEET Pattern 2016-17)

Diverticulosis. ***Diverticulosis*** - The image shows an out-pouching of the colonic wall (indicated by the white arrow), characteristic of a **diverticulum**. - **Diverticulosis** refers to the presence of multiple such diverticula, often seen in the colon on CT scans. *Hiatus hernia* - A hiatus hernia involves the protrusion of the **stomach** through the **esophageal hiatus** of the diaphragm into the chest cavity. - This image does not show any gastric organ extending above the diaphragm. *Gallstones* - Gallstones are calcified deposits found within the **gallbladder**, appearing as bright, high-density structures. - The structure indicated by the arrow is clearly an out-pouching of the bowel wall, not a calcified stone within the gallbladder. *Acute pancreatitis* - Acute pancreatitis is characterized by **inflammation of the pancreas**, often visible as pancreatic enlargement, peripancreatic fat stranding, and fluid collections. - The image does not show any signs suggestive of pancreatic inflammation or changes in the pancreas itself.

Q: X-ray skull shows: (Recent NEET Pattern 2016-17)

Silver-beaten appearance. ***Silver-beaten appearance*** - The image shows a skull with multiple **gyral impressions** on the inner table, giving it a **bumpy**, 'silver-beaten' or 'copper-beaten' appearance. - This pattern is classically associated with **chronically increased intracranial pressure**, which causes the brain's convolutions to press against the skull. *Multiple myeloma* - Multiple myeloma typically presents with multiple, sharply demarcated **"punched-out" lytic lesions** in the skull, not diffuse gyral impressions. - These lesions often lack a sclerotic rim and are more discrete than the pattern seen here. *Histiocytosis-X* - Histiocytosis-X (now called Langerhans cell histiocytosis) can cause lytic skull lesions, often described as **"beveled edge"** or geographically distributed lesions. - While it can cause osteolytic bone destruction, it does not typically produce the widespread, uniform gyral impressions of a silver-beaten skull. *Letterer-Siwe disease* - Letterer-Siwe disease is an aggressive, disseminated form of **Langerhans cell histiocytosis** affecting infants. - While it can cause bone lesions, including in the skull, it typically manifests as generalized lytic lesions rather than the "silver-beaten" pattern indicative of chronic elevated intracranial pressure.

Q: Identify the condition on the basis of infantogram shown in the image:

Congenital diaphragmatic hernia. ***Congenital diaphragmatic hernia*** - The infantogram shows loops of **bowel within the thoracic cavity**, displacing the heart and mediastinum. - This classic appearance, with visible **gas-filled loops** in the chest, is characteristic of a congenital diaphragmatic hernia, typically on the left side (Bochdalek hernia). *Cystic adenomatoid malformation* - This condition involves an abnormal growth of lung tissue forming **cysts**; these cysts typically appear as discrete radiolucencies or a solid mass within the lung. - Unlike in the image, it does not typically show distinct **bowel loops in the chest cavity**. *Pneumomediastinum* - This condition is characterized by air in the **mediastinum**, which would appear as lucency outlining the mediastinal structures, such as the heart and great vessels. - It does not involve the presence of **abdominal contents** within the chest cavity. *Congenital lobar emphysema* - This condition presents with **hyperinflation of a single lobe** (usually left upper lobe) causing mass effect and mediastinal shift. - It appears as a hyperlucent, overexpanded lobe, but does not show **bowel gas pattern** or abdominal contents in the thorax.

Q: A pregnant woman undergoes a routine antenatal ultrasound scan in the second trimester. The sonologist notes an abnormal appearance of the fetal skull. What is the sign demonstrated in the given antenatal USG image?

Lemon sign. ***Lemon sign*** - The **lemon sign** refers to the shape of the fetal skull on ultrasound, where the frontal bones are indented, making the head appear lemon-shaped. - This sign is often associated with **Chiari II malformation** and spina bifida, where there is downward displacement of the cerebellar vermis and fourth ventricle. *Boomerang sign* - The **boomerang sign** is typically observed in imaging of the knee, referring to a meniscal tear where the displaced fragment resembles a boomerang. - It is not a sign used for fetal cranial abnormalities in ultrasound. *Spring coiled sign* - The **spring coiled sign** is a feature seen in intussusception on ultrasound, where layers of bowel are invaginated within another, resembling a coiled spring. - This sign is related to intestinal pathology, not fetal head anomalies. *Banana sign* - The **banana sign** describes the appearance of the cerebellum on fetal ultrasound when it is displaced or compressed due to Chiari II malformation, making it appear banana-shaped. - While also associated with Chiari II, the image provided shows the **head shape**, not the cerebellum, aligning with the lemon sign.

Q: A patient presents with abdominal pain, diarrhea and weight loss. He gives past history of pulmonary TB. Barium film of the patient indicates which of the following condition?

Pulled up cecum. ***Pulled up cecum*** - The barium study shows an **abnormally high position** of the cecum, often caused by **adhesions** or **inflammatory processes** from previous infections like TB. - The **String sign of Kantor** (narrowed bowel segments appearing as thin strings) indicates **inflammatory bowel involvement**, commonly seen in **TB enteritis** or **Crohn's disease**. *Intestinal obstruction* - Would show **dilated bowel loops** proximal to the obstruction with **air-fluid levels** and minimal contrast passage beyond the blockage. - The radiological findings described (pulled up cecum and string sign) do not indicate mechanical obstruction. *Intestinal perforation* - Would demonstrate **extraluminal contrast leak** into the peritoneal cavity on barium study, which is not present here. - Clinical presentation would be **acute peritonitis** with severe pain and signs of sepsis, not chronic symptoms. *Diverticulum formation* - Would show **sac-like outpouchings** (diverticula) from the bowel wall, which are **not visualized** on this barium study. - The described findings of **string sign** and **cecal displacement** are inconsistent with diverticular disease.

Q: The given IVU shows:

Horseshoe kidney. ***Horse shoe kidney*** - The IVU image clearly shows both kidneys are **fused at their lower poles**, forming a 'U' shape across the midline, characteristic of a **horseshoe kidney**. - This fusion often results in the kidneys lying lower in the abdomen and can cause anatomical variations in the **collecting system and vasculature**, as hinted by the lower position and altered calyces. *Hydronephrosis* - **Hydronephrosis** would manifest as **dilatation of the renal pelvis and calyces** due to urine outflow obstruction. - While horseshoe kidneys can be prone to hydronephrosis due to their abnormal anatomy, the primary finding here is the fusion, not significant dilatation. *Polycystic kidney* - **Polycystic kidney disease** would present with multiple **cysts replacing normal kidney parenchyma**, leading to enlarged, typically non-functioning kidneys. - The image does not show multiple fluid-filled sacs or significant renal enlargement typical of polycystic disease. *Duplication of collecting system* - A **duplication of the collecting system** (e.g., duplicate ureters) would show two distinct collecting systems draining from a single kidney. - The image shows a single collecting system for each kidney, albeit abnormally shaped due to the fusion, but not duplicated.

Q: Which of the following kidney stones best explains the findings in this X-ray KUB?

Uric acid. ***Uric acid*** - The X-ray KUB image shows **radio-lucent stones** (stones that are not visible) within the kidneys, which is characteristic of **uric acid** stones. - Uric acid stones appear radio-lucent because they **do not contain calcium** and have a low atomic number, making them poorly visible on plain radiographs. *Xanthine* - **Xanthine stones** are also typically **radio-lucent** on X-ray, similar to uric acid stones. - However, they are much **rarer** than uric acid stones, often associated with genetic disorders of purine metabolism or allopurinol use. *Phosphate* - **Phosphate stones**, such as **calcium phosphate** and **magnesium ammonium phosphate (struvite)** stones, are typically **radio-opaque** and appear bright white on X-ray. - Struvite stones often grow large, forming **staghorn calculi**, which is not depicted as a radio-opaque lesion here. *Cystine* - **Cystine stones** are usually **faintly radio-opaque** or **semi-opaque** on X-ray, appearing less dense than calcium stones but more dense than uric acid stones. - They tend to form in acidic urine environments due to a genetic defect in amino acid transport.

Question 1

Which is correct about the intracranial bleeding shown below?

Accepted Answer

Chronic subdural hematoma, hypodensity

Answer

Acute subdural hematoma, hypodensity

Answer

Chronic epidural hematoma, hyperdensity

Answer

Acute epidural hematoma, hyperdensity

Question 2

The CXR shows markings near the costophrenic angle. Which of the following is the cause of these markings? (Recent NEET Pattern 2016-17)

Accepted Answer

Lymphangitis carcinomatosis

Answer

Pulmonary alveolar proteinosis

Answer

Lung abscess

Answer

Pneumatocele

Question 3

The CT chest of a patient given below shows presence of: (Recent NEET Pattern 2016-17)

Accepted Answer

Bronchiectasis

Answer

Pneumatoceles

Answer

Normal scan

Answer

Loculated empyema

Question 4

CT abdomen shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Diverticulosis

Answer

Hiatus hernia

Answer

Gallstones

Answer

Acute pancreatitis

Question 5

X-ray skull shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Silver-beaten appearance

Answer

Multiple myeloma

Answer

Histiocytosis-X

Answer

Letterer-Siwe disease

Question 6

Identify the condition on the basis of infantogram shown in the image:

Accepted Answer

Congenital diaphragmatic hernia

Answer

Cystic adenomatoid malformation

Answer

Pneumomediastinum

Answer

Congenital lobar emphysema

Question 7

A pregnant woman undergoes a routine antenatal ultrasound scan in the second trimester. The sonologist notes an abnormal appearance of the fetal skull. What is the sign demonstrated in the given antenatal USG image?

Accepted Answer

Lemon sign

Answer

Boomerang sign

Answer

Spring coiled sign

Answer

Banana sign

Question 8

A patient presents with abdominal pain, diarrhea and weight loss. He gives past history of pulmonary TB. Barium film of the patient indicates which of the following condition?

Accepted Answer

Pulled up cecum

Answer

Intestinal obstruction

Answer

Intestinal perforation

Answer

Diverticulum formation

Question 9

The given IVU shows:

Accepted Answer

Horseshoe kidney

Answer

Hydronephrosis

Answer

Polycystic kidney

Answer

Duplication of collecting system

Question 10

Which of the following kidney stones best explains the findings in this X-ray KUB?

Accepted Answer

Uric acid

Answer

Xanthine

Answer

Phosphate

Answer

Cystine

NEET-PG 2017 — Radiology