NEET-PG 2018 - Radiology Practice Questions

Q: What condition is shown in the MR angiogram of the skull?

Vein of Galen malformation. ***Vein of Galen malformation*** - The image provided is an **MR angiogram (MRA)**, which clearly shows a **large, dilated vein of Galen**. This is the characteristic appearance of a Vein of Galen malformation. - This congenital vascular malformation involves a direct artery-to-vein shunt, leading to the characteristic aneurysmal dilatation of the vein. *Dandy-Walker malformation* - This is a congenital brain malformation characterized by **agenesis or hypoplasia of the cerebellar vermis** and cystic dilation of the fourth ventricle. - While it affects brain structures, it does not involve the type of vascular abnormality seen in the image. *Pneumocephalus* - **Pneumocephalus** refers to the presence of **air within the intracranial cavity**, often due to trauma or surgery. - It would appear as dark areas on imaging, representing air, not the bright, dilated vascular structures seen here. *Crouzon syndrome* - **Crouzon syndrome** is a genetic disorder characterized by **craniosynostosis**, which is the premature fusion of skull sutures. - This condition primarily affects bone growth and skull shape, with no direct involvement of the cerebral vasculature as depicted in the MRA.

Q: The CT thorax image shows:

Descending aortic dissection. ***Descending aortic dissection*** - The CT image shows a **classic intimal flap** separating the true and false lumens in the descending thoracic aorta, which is the hallmark feature of an aortic dissection. - This represents a **Stanford Type B dissection** involving the descending aorta (distal to the left subclavian artery), which is typically managed **medically** with blood pressure control and monitoring. *Aortic aneurysm* - An **aortic aneurysm** represents focal dilatation of the aortic wall (>50% increase in diameter) without separation of the intimal layers. - The key finding here is the **intimal flap dividing the lumen**, which defines dissection rather than simple aneurysmal dilatation without luminal separation. *Aortic coarctation* - **Aortic coarctation** is a congenital narrowing of the aorta, typically located at the aortic isthmus near the **ligamentum arteriosum**. - CT would show focal narrowing with **pre-stenotic dilatation** and collateral vessel formation, not an intimal flap creating dual lumens. *Ascending aortic dissection* - While the intimal flap is characteristic of dissection, the image shows involvement of the **descending thoracic aorta**, not the ascending aorta (proximal to the left subclavian artery). - Ascending aortic dissections (**Stanford Type A**) are surgical emergencies requiring **immediate operative intervention** due to high risk of rupture and cardiac tamponade.

Q: Identify the marked structure in the CT abdomen section shown below? (Recent NEET Pattern 2018-19)

Superior mesenteric artery. **Superior mesenteric artery** - The arrow points to a circular, **contrast-filled vessel** anterior to the aorta and posterior to the pancreatic head, characteristic of the **superior mesenteric artery (SMA)** - The SMA originates from the **anterior aspect of the aorta at L1 level** and supplies the midgut structures - In arterial phase CT, the SMA shows **bright contrast enhancement** and appears as a round structure between the aorta and pancreatic uncinate process *Incorrect: Aorta* - The **aorta** is the larger, more posterior vessel with a crescent or oval shape in axial sections - While the SMA branches from the aorta, the marked structure is clearly anterior to the main aortic lumen *Incorrect: Inferior vena cava* - The **IVC** is located to the **right of the aorta** in axial CT sections - The marked structure is **anterior and to the left**, not in the expected IVC position - The IVC would show less enhancement in arterial phase imaging *Incorrect: Superior mesenteric vein* - The **SMV** typically runs to the **right and slightly anterior** to the SMA - In arterial phase CT, the SMV shows **less intense opacification** compared to the arterial structures - The marked structure shows arterial-phase enhancement, indicating it is an artery, not a vein

Q: A 65-year-old man presents with bone pains. X-ray Skull shows? (Recent NEET Pattem 2018-19)

Multiple myeloma. ***Multiple myeloma*** - The X-ray shows multiple, well-defined, lytic lesions (''**punched-out lesions**'') scattered throughout the skull, which is highly characteristic of multiple myeloma. - This condition is a **plasma cell malignancy** that commonly affects older adults and often presents with **bone pain** due to osteolytic activity. *Paget's disease* - Characterized by abnormal bone remodeling, leading to bone enlargement, thickening, and a **"cotton wool" appearance** on X-ray, which is not seen here. - While it can cause bone pain and skull involvement, the lytic pattern in the X-ray is not typical for Paget's disease. *Fibrous dysplasia* - This condition involves **normal bone marrow** being replaced by **fibrous tissue** and immature bone, often presenting as a **ground-glass appearance** or expansile lesions, usually in younger individuals. - The distinct "punched-out" lesions seen in the image are not characteristic of fibrous dysplasia. *Histiocytosis-X* - Also known as Langerhans cell histiocytosis, it can cause **lytic bone lesions**, particularly in the skull, described as a **"map-like" or "geographic" pattern**. - Although it causes lytic lesions, the pattern in the image, with its numerous small, widespread lytic lesions, is more indicative of multiple myeloma in an older adult.

Q: A 9-year-old female child presents with history of headache and visual disturbances. X-Ray skull is shown below. What is the possible diagnosis? (Recent NEET Pattern 2018-19)

Craniopharyngioma. ***Craniopharyngioma*** - The X-ray skull image shows significant **intracranial calcifications**, which are a hallmark feature of **craniopharyngiomas**, especially in children (seen in 80-90% of cases). - Clinical symptoms like **headache** and **visual disturbances** are consistent with the mass effect of a suprasellar tumor like craniopharyngioma, which can compress the optic chiasm and cause hydrocephalus. - Craniopharyngioma is the **most common suprasellar tumor in children** and typically presents in this age group. *Hypothalamic hamartoma* - These are **non-neoplastic** lesions that typically do not present with diffuse calcifications on X-ray skull. - While they can cause endocrine abnormalities (precocious puberty) and gelastic seizures, headache and visual disturbances with calcifications point more toward craniopharyngioma. *Histiocytosis-X* - Histiocytosis-X (Langerhans cell histiocytosis) typically presents with **lytic bone lesions** (punched-out "geographic skull" lesions) on skull X-ray, not diffuse intracranial calcifications. - While it can affect the hypothalamic-pituitary axis causing diabetes insipidus, the dominant radiological finding would be bone destruction, not calcification. *Letterer-Siwe disease* - This is a severe, disseminated form of **Langerhans cell histiocytosis** (acute disseminated LCH) primarily affecting infants and young children under 2 years. - It usually presents with skin rash, hepatosplenomegaly, lymphadenopathy, and lytic bone lesions, but **intracranial calcifications are not a characteristic feature** on plain skull X-rays. - The age of presentation (9 years) and imaging findings make this diagnosis unlikely.

Q: Identify the structure shown in CT abdomen section. (Recent NEET Pattern 2018-19)

Portal vein. ***Portal vein*** - The arrow points to a vessel receiving blood from the splenic and superior mesenteric veins, which is characteristic of the **portal vein** entering the **liver parenchyma**. - The portal vein is typically seen anterior to the **inferior vena cava** and posterior to the **common hepatic artery** at this level. *Inferior vena cava* - The **inferior vena cava (IVC)** is a large, retroperitoneal vessel located posterior to the liver and to the right of the aorta. - The structure indicated by the arrow is clearly within the liver substance, not in the typical position of the IVC. *Splenic vein* - The **splenic vein** runs horizontally behind the body of the pancreas and joins with the superior mesenteric vein to form the portal vein. - The vessel shown is within the liver, distal to the formation of the portal vein. *Superior mesenteric vein* - The **superior mesenteric vein (SMV)** typically runs vertically in the mesentery and joins the splenic vein to form the portal vein. - The indicated structure is within the liver hilum, not in the anatomical location of the SMV.

Q: A 32-year-old lady presents with history of first trimester miscarriage and underwent HSG. The diagnosis is: (Recent NEET Pattern 2018-19)

Unicornuate uterus. ***Unicornuate uterus*** - A **unicornuate uterus** develops from one **Müllerian duct**, resulting in a single functional uterine horn with a characteristic **banana-shaped** or crescent-shaped cavity. - On **HSG**, it appears as a single, elongated cavity that **deviates to one side** and is typically smaller than normal, associated with increased risk of **first trimester miscarriage**. *Bicornuate uterus* - Would show **two distinct uterine horns** separated by a deep fundal cleft, with the uterus appearing **heart-shaped** externally. - HSG would demonstrate **bifurcation** of the uterine cavity into two separate horns at the fundal level with an **intercornual angle >105 degrees**. *Uterus didelphys* - Complete duplication with **two separate uterine bodies**, cervices, and often vaginas resulting from total failure of **Müllerian duct fusion**. - HSG would show **two completely separate uterine cavities** with no communication, not consistent with the single cavity shown. *Arcuate uterus* - Mildest form of **Müllerian anomaly** with only a slight **fundal indentation** and essentially normal uterine cavity size. - HSG shows a **broad, smooth, mild concave contour** of the fundus, not consistent with the elongated, deviated cavity shown.

Q: Comment on the arrow marked structure in CXR of an infant: (Recent NEET Pattern 2018-19)

Sail sign. ***Sail sign*** - The arrow points to an elevated, well-defined triangular shadow in the right upper mediastinum, characteristic of the **thymus gland** in an infant. - This appearance is known as the **"sail sign"** due to its resemblance to a boat's sail, caused by the normal shape of the thymus in young children. *Lingular lobe pneumonia* - Lingular lobe pneumonia would appear as an **area of consolidation** or opacification, usually in the left mid-to-lower lung field, which is not depicted here. - This pathology typically results in a loss of the normal markings of the lung parenchyma, unlike the clear outline seen in the image. *Pneumothorax* - A pneumothorax would present as a **collection of air** in the pleural space, characterized by the absence of lung markings in the affected area and a visible visceral pleural line. - There is no evidence of displaced lung tissue, collapsed lung, or an abnormal air collection in the image. *Dextrocardia* - Dextrocardia refers to a condition where the **heart is located on the right side** of the chest. - In this image, the cardiac silhouette is clearly on the left side, indicating a normally positioned heart.

Q: The following Skull X-ray is seen in:

Thalassemia. ***Thalassemia*** - The image shows a classic **hair-on-end appearance** of the skull, which is a characteristic radiological finding in severe forms of thalassemia. - This appearance results from **marrow hyperplasia** in response to chronic hemolysis, leading to widening of the diploic space and expansion of bone marrow at the expense of outer cortical bone. *Multiple myeloma* - Multiple myeloma typically presents with multiple well-demarcated, **punched-out lytic lesions** in the skull, without a "hair-on-end" pattern. - The bone lesions are due to plasma cell infiltration and osteoclast activation, leading to discrete areas of bone destruction. *Histiocytosis-X* - Histiocytosis-X, also known as Langerhans cell histiocytosis, can cause **lytic bone lesions** in the skull, often referred to as "geographic" or "punched-out" lesions. - While it can cause diffuse bone involvement, it does not typically produce the organized trabecular pattern characteristic of "hair-on-end." *Paget's disease* - Paget's disease of bone often manifests as areas of **bone enlargement**, cortical thickening, and a mixture of lytic and sclerotic changes, sometimes described as a **cotton-wool appearance** in the skull. - It does not present with the "hair-on-end" pattern, which is primarily associated with conditions causing chronic marrow expansion.

Q: The following barium swallow study shows which of the following?

Esophageal varices. ***Esophageal varices*** - The Barium Swallow image clearly demonstrates a **serpiginous**, worm-like, or **rosary bead-like appearance** along the esophageal wall, which is characteristic of esophageal varices. - Varices are dilated submucosal veins and appear as **filling defects** on barium studies, especially when distended. *Schatzki ring* - A Schatzki ring is a **thin, symmetric mucosal ring** at the esophagogastric junction, causing solid food dysphagia. - It presents as a **smooth, circumferential narrowing** on a barium swallow, which is not seen here. *Candida esophagitis* - Candida esophagitis typically appears as **ulcerations, plaques, or nodularity** with an irregular, cobblestone pattern on barium swallow. - This image does not show the characteristic **"shaggy" or "cobblestone"** appearance associated with candidal plaques. *Reflux esophagitis* - Reflux esophagitis can manifest as **mucosal irregularity, erosions, or strictures**, but not the distinct serpiginous filling defects seen in this image. - Severe reflux can cause peptic strictures, which appear as **smooth, tapered narrowings**, different from the irregular variceal pattern.

Question 1

What condition is shown in the MR angiogram of the skull?

Accepted Answer

Vein of Galen malformation

Answer

Dandy-Walker malformation

Answer

Pneumocephalus

Answer

Crouzon syndrome

Question 2

The CT thorax image shows:

Accepted Answer

Descending aortic dissection

Answer

Ascending aortic dissection

Answer

Aortic aneurysm

Answer

Aortic coarctation

Question 3

Identify the marked structure in the CT abdomen section shown below? (Recent NEET Pattern 2018-19)

Accepted Answer

Superior mesenteric artery

Answer

Aorta

Answer

Inferior vena cava

Answer

Superior mesenteric vein

Question 4

A 65-year-old man presents with bone pains. X-ray Skull shows? (Recent NEET Pattem 2018-19)

Accepted Answer

Multiple myeloma

Answer

Paget's disease

Answer

Fibrous dysplasia

Answer

Histiocytosis-X

Question 5

A 9-year-old female child presents with history of headache and visual disturbances. X-Ray skull is shown below. What is the possible diagnosis? (Recent NEET Pattern 2018-19)

Accepted Answer

Craniopharyngioma

Answer

Hypothalamic hamartoma

Answer

Histiocytosis- X

Answer

Letterer-Siwe disease

Question 6

Identify the structure shown in CT abdomen section. (Recent NEET Pattern 2018-19)

Accepted Answer

Portal vein

Answer

Inferior vena cava

Answer

Splenic vein

Answer

Superior mesenteric vein

Question 7

A 32-year-old lady presents with history of first trimester miscarriage and underwent HSG. The diagnosis is: (Recent NEET Pattern 2018-19)

Accepted Answer

Unicornuate uterus

Answer

Uterus didelphys

Answer

Arcuate uterus

Answer

Bicornuate uterus

Question 8

Comment on the arrow marked structure in CXR of an infant: (Recent NEET Pattern 2018-19)

Accepted Answer

Sail sign

Answer

Lingular lobe pneumonia

Answer

Pneumothorax

Answer

Dextrocardia

Question 9

The following Skull X-ray is seen in:

Accepted Answer

Thalassemia

Answer

Multiple myeloma

Answer

Histiocytosis-X

Answer

Paget's disease

Question 10

The following barium swallow study shows which of the following?

Accepted Answer

Esophageal varices

Answer

Schatzki ring

Answer

Candida esophagitis

Answer

Reflux esophagitis

NEET-PG 2018 — Radiology