NEET-PG 2017 Practice Questions

Q: A chest X-ray shows the following appearance. Identify the pathology:

Pericardial effusion. ***Pericardial effusion*** - The chest X-ray shows a classic **"water bottle" or "money bag" appearance** with a markedly enlarged, globular, and symmetric cardiac silhouette characteristic of pericardial effusion. - The **clear lung fields** combined with the dramatically increased cardiothoracic ratio indicates fluid accumulation in the **pericardial space** rather than cardiac enlargement. *Boot shaped heart* - A **"boot-shaped" heart (coeur en sabot)** is pathognomonic of **tetralogy of Fallot**, characterized by an upturned cardiac apex and concave pulmonary artery segment. - This appearance results from **right ventricular hypertrophy** and **pulmonary stenosis**, which would show a different cardiac contour than the globular shape seen here. *Egg on side appearance* - The **"egg-on-a-string" appearance** is classic for **transposition of the great arteries (TGA)**, showing a narrow vascular pedicle with an oval cardiac silhouette. - This congenital heart defect presents with **cyanosis in neonates** and has a distinctly different radiological appearance from the symmetric enlargement shown. *Normal-sized heart* - The cardiac silhouette is clearly **markedly enlarged** with a cardiothoracic ratio well above the normal limit of 0.5. - A **normal heart** would have distinct great vessel outlines and proportionate cardiac chambers, not the globular symmetric enlargement demonstrated here.

Q: A 30-year-old hypertension patient presents with daily headaches. The CXR given below shows which of the following? (Recent NEET Pattern 2016-17)

Postductal coarctation. ***Postductal coarctation*** - The image shows **rib notching** (highlighted by the arrow), a classic sign of **collateral vessel development** due to narrowing of the aorta **distal to the ductus arteriosus**. - This congenital heart defect is associated with **hypertension** in the upper extremities and can lead to symptoms like **headaches**. *Preductal coarctation* - This typically presents earlier in life, often with **heart failure** in infancy, and is less commonly associated with **hypertension** and **rib notching** in a seemingly asymptomatic adult. - The coarctation is located **proximal to the ductus arteriosus**, leading to different collateral circulation patterns. *Aortic dissection* - This condition is an acute medical emergency characterized by a tear in the **aortic wall**, often presenting with sudden, severe chest or back pain. - CXR findings typically include a **widened mediastinum**, not specifically rib notching. *Takayasu arteritis* - This is a **granulomatous vasculitis** primarily affecting the aorta and its major branches, leading to narrowing or occlusion. - While it can cause hypertension, **rib notching** is not a characteristic radiological finding; signs usually include vessel wall thickening or stenoses.

Q: An adult undergoes multiple FFP transfusions for excessive bleeding after cardiac surgery and develops respiratory distress. CXR done is shown below. What does it indicate?

TRALI. ***TRALI*** - The chest X-ray shows **bilateral pulmonary infiltrates** and **pulmonary edema** and the patient had multiple **FFP transfusions** followed by respiratory distress, which is highly suggestive of **Transfusion-Related Acute Lung Injury (TRALI)**. - TRALI is characterized by acute respiratory distress with **hypoxemia** occurring within 6 hours of transfusion, in the absence of other risk factors for **Acute Lung Injury (ALI)**. *Volume overloading of heart* - While fluid overload can cause pulmonary edema, the severity and rapid onset of distress after transfusion, coupled with the bilateral infiltrates, point more specifically to TRALI rather than isolated volume overload, especially in the context of FFP. - Cardiogenic pulmonary edema typically presents with **cardiomegaly** and signs of **heart failure**, which are not explicitly described or obviously seen as the primary cause in the given scenario and image. *Mendelson's syndrome* - Mendelson's syndrome, or **aspiration pneumonitis**, results from the inhalation of acidic gastric contents, leading to chemical pneumonitis. - This typically occurs in patients with impaired consciousness or those undergoing procedures that compromise airway protection, and there is no information in the vignette to suggest aspiration. *Pneumomediastinum* - Pneumomediastinum indicates the presence of **air in the mediastinum**, which would appear as radiolucent streaks outlining mediastinal structures on a CXR. - The image primarily shows diffuse bilateral infiltrates and pulmonary edema, rather than free air in the mediastinum.

Q: Identify the congenital heart disease presenting with cyanosis in CXR: (Recent NEET Pattern 2016-17)

Tetralogy of Fallot. ***Tetralogy of Fallot*** - The chest X-ray shows a **boot-shaped heart** (coeur en sabot) due to right ventricular hypertrophy and a concave pulmonary artery segment, which is a classic finding in Tetralogy of Fallot. - This cyanotic congenital heart disease is characterized by four defects: a **ventricular septal defect**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Truncus Arteriosus* - This cyanotic CHD involves a **single arterial trunk** arising from the heart supplying systemic, pulmonary, and coronary circulations. - CXR typically shows **cardiomegaly with increased pulmonary vascular markings** and a **right-sided aortic arch** in 30% of cases, not the boot-shaped heart seen here. - The pulmonary artery segment is **prominent or convex**, contrasting with the concave segment in Tetralogy of Fallot. *Ebstein anomaly* - This anomaly involves the **tricuspid valve** being displaced into the right ventricle, often leading to cardiomegaly and a **"box-shaped" or "globular" heart** on CXR, which is not depicted. - It can cause cyanosis, but the characteristic CXR finding is **massive cardiomegaly with diminished pulmonary vascular markings**, not a boot-shaped heart. *Snowman heart* - The "snowman heart" or **"figure of 8" sign** is characteristic of **total anomalous pulmonary venous return (TAPVR)**, specifically the supracardiac type. - This appearance is due to the dilated superior vena cava and the vertical vein draining into it, creating the "head" of the snowman, which is not seen in the provided image.

Q: A breast cancer patient presents with difficulty in breathing. CXR shows:

Cannonball metastasis. ***Cannonball metastasis*** - The chest X-ray shows multiple, well-defined, rounded opacities of varying sizes scattered throughout both lung fields, consistent with the characteristic appearance of **cannonball metastases**. - Given the patient's history of **breast cancer** and new onset **dyspnea**, pulmonary metastases are a very likely cause. *Pneumothorax* - A pneumothorax would appear as an area of translucency with absence of lung markings, often accompanied by a visible visceral pleural line and tracheal deviation in severe cases. This is not observed here; instead, the lungs are filled with multiple lesions. - The image does not show any signs of a collapsed lung, air in the pleural space, or shifted mediastinum. *Pulmonary artery hypertension* - Pulmonary artery hypertension on CXR might show **enlarged central pulmonary arteries** and pruning of peripheral vessels, or signs of right heart enlargement. - The predominant features in this image are numerous discrete nodules, not signs of vascular dilation or heart changes. *Interstitial lung disease* - Interstitial lung disease typically presents with a **reticular, nodular, or reticulonodular pattern**, often with reduced lung volumes and honeycombing in advanced stages. - The distinct, large, spherical lesions seen here are not characteristic of the diffuse, fine patterns associated with most interstitial lung diseases.

Q: An AIDS patient presents with respiratory distress. CXR shows:

Pneumocystis pneumonia. ***Pneumocystis pneumonia*** - The chest X-ray shows **diffuse bilateral interstitial infiltrates**, which is a classic presentation of *Pneumocystis jirovecii pneumonia (PJP)* in an AIDS patient. - PJP is an **opportunistic infection commonly seen in immunocompromised individuals**, especially those with AIDS and low CD4 counts, presenting with respiratory distress. *Miliary TB* - Miliary TB would typically show **numerous small (1-3 mm), well-defined, uniformly distributed nodular opacities**, resembling millet seeds, which are not clearly visible here. - While TB is common in AIDS, the diffuse interstitial pattern is less characteristic of miliary spread. *Streptococcal pneumonia* - *Streptococcal pneumonia* often presents as **lobar consolidation with air bronchograms**, typically affecting one or more lobes, rather than the diffuse interstitial pattern seen in the image. - While it can occur in AIDS patients, the radiographic features are not consistent with this diagnosis. *Lymphocytic interstitial Pneumonitis* - *Lymphocytic interstitial pneumonitis (LIP)* is more common in **pediatric AIDS patients** and often presents with more pronounced **nodular or cystic changes** and interstitial infiltrates, but the primary pattern for this acute presentation of respiratory distress as seen would be PJP. - While it is a differential consideration in AIDS patients with interstitial lung disease, the abrupt onset of respiratory distress with diffuse infiltrates points more strongly to an acute infection.

Q: An 18-year-old boy is brought to the hospital with difficulty in breathing after a bar fight. What does the given CT chest show?

Pneumothorax. ***Pneumothorax*** - The CT image shows a clear **absence of lung parenchyma** extending to the chest wall, with a visible **visceral pleural line** separated from the parietal pleura. This indicates air in the pleural space, which is characteristic of a pneumothorax. - The patient presenting with **difficulty in breathing** after a bar fight (implying trauma) is consistent with a **traumatic pneumothorax**. *Consolidation* - **Consolidation** appears as a region of increased attenuation (whitening) on CT, usually with **air bronchograms**, indicating filling of alveolar spaces, which is not seen here. - While it can cause difficulty breathing, it results from infection or inflammation, not typically direct trauma creating an empty space like in the image. *Pulmonary contusion* - **Pulmonary contusion** would appear as areas of **ground-glass opacity** or **consolidation** within the lung parenchyma due to bleeding and edema, without a significant collapse of the lung. - The image distinctly shows a collapsed lung with a clear air-filled pleural space, not parenchymal injury. *Haemothorax* - A **hemothorax** would show a **fluid collection** (appearing white or grey) in the pleural space, often layering dependently, which is not the primary finding on this image where an air-filled space is prominent. - While a traumatic event could lead to both pneumothorax and hemothorax (**hemopneumothorax**), the most striking feature evident here is the air within the pleural cavity causing lung collapse.

Q: The lung parenchyma on CT chest shown below is best described as:

Crazy pavement pattern. ***Crazy pavement pattern*** - The image distinctly shows a combination of **ground-glass opacities** and superimposed **interlobular septal thickening**, which together create the characteristic "crazy paving" appearance. - This pattern is most commonly associated with **pulmonary alveolar proteinosis**, but can also be seen in conditions like ARDS, PCP pneumonia, and lipoid pneumonia. *Honey comb pattern* - This pattern involves the presence of multiple, clustered, thick-walled **cysts** of varying sizes, typically subpleural, which are a sign of **end-stage lung fibrosis**. - While there are cystic changes in the image, the predominant finding includes ground-glass opacities and septal thickening rather than pure end-stage fibrotic changes. *Signet ring pattern* - A signet ring pattern is classically seen in **bronchiectasis**, where a dilated bronchus is paired with its accompanying smaller pulmonary artery, resembling a signet ring. - The image does not show clearly dilated bronchi adjacent to pulmonary arteries; instead, it displays diffuse parenchymal changes. *Mosaic pattern* - The mosaic pattern refers to areas of differing lung attenuation, often due to **air trapping** (causing dark areas) or areas of **perfusion abnormalities** (creating lighter areas), common in conditions like small airway disease or chronic thromboembolic disease. - While there is some heterogeneity, the specific combination of ground-glass and septal thickening is more accurately described as crazy paving.

Q: A cement slab fell on the chest of a 20-year-old construction worker. The arrow in the given CT chest points to:

Lung contusion. ***Lung contusion*** - The image shows an area of **ground-glass opacity** and **consolidation** within the lung parenchyma, consistent with **hemorrhage and edema** caused by blunt force trauma. - This finding, combined with the history of the cement slab falling on the chest, is highly suggestive of a **lung contusion**. *ARDS* - **ARDS** (Acute Respiratory Distress Syndrome) is a clinical syndrome characterized by widespread **inflammatory lung injury**, typically presenting as bilateral infiltrates on imaging. - While it can manifest with similar CT findings, ARDS is a **diagnosis of exclusion** and requires specific clinical criteria (e.g., severe hypoxemia, exclusion of cardiac failure) not provided in the question. *Diaphragmatic rupture* - A **diaphragmatic rupture** involves a tear in the diaphragm, which would appear on CT as a discontinuity of the diaphragm or **herniation of abdominal contents** into the thoracic cavity. - The image does not show any signs of diaphragmatic discontinuity or organ herniation. *Pneumothorax* - A **pneumothorax** is the presence of air in the pleural space, which would be visible as a collection of **dark air outside the lung parenchyma**, often with a visible pleural line and collapse of the lung. - The CT scan shows parenchymal changes rather than a collection of air in the pleural space.

Q: A 25-year-old patient underwent surgery for scoliosis correction. 5 days post-operatively he develops voluminous bilious vomiting. The given CT abdomen shows:

SMA syndrome. ***SMA syndrome*** - The CT image shows significant **duodenal distention** proximal to the **superior mesenteric artery (SMA)**, characteristic of SMA syndrome. The arrow points to the **compressed third part of the duodenum** between the SMA and the aorta. - This condition is often seen post-scoliosis correction surgery due to rapid **spinal extension**, which can decrease the **aortomesenteric angle** and compress the duodenum, leading to **bilious vomiting**. *Paralytic ileus* - While ileus can cause vomiting and bowel distension, it typically involves **diffuse gaseous distension** of both small and large bowels without a discrete point of obstruction like the compressed duodenum seen here. - The clinical presentation of paralytic ileus post-operatively is more often characterized by generalized **absent bowel sounds** and abdominal distension, rather than specific bilious vomiting from high obstruction. *Pneumoperitoneum* - This refers to the presence of **free air in the abdominal cavity**, usually indicating a **visceral perforation**. - The provided CT image does not show any evidence of free air, and the presenting symptom of bilious vomiting is more indicative of obstruction. *Paravertebral abscess* - A paravertebral abscess would appear as a **fluid collection adjacent to the spine**, which is not depicted on this CT scan. - Clinical symptoms would likely include **fever, severe localized back pain**, and possibly neurological deficits, differing from the purely obstructive symptoms described.

Question 1

A chest X-ray shows the following appearance. Identify the pathology:

Accepted Answer

Pericardial effusion

Answer

Boot shaped heart

Answer

Egg on side appearance

Answer

Normal-sized heart

Question 2

A 30-year-old hypertension patient presents with daily headaches. The CXR given below shows which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Postductal coarctation

Answer

Preductal coarctation

Answer

Aortic dissection

Answer

Takayasu arteritis

Question 3

An adult undergoes multiple FFP transfusions for excessive bleeding after cardiac surgery and develops respiratory distress. CXR done is shown below. What does it indicate?

Accepted Answer

TRALI

Answer

Volume overloading of heart

Answer

Mendelson's syndrome

Answer

Pneumomediastinum

Question 4

Identify the congenital heart disease presenting with cyanosis in CXR: (Recent NEET Pattern 2016-17)

Accepted Answer

Tetralogy of Fallot

Answer

Truncus Arteriosus

Answer

Ebstein anomaly

Answer

Snowman heart

Question 5

A breast cancer patient presents with difficulty in breathing. CXR shows:

Accepted Answer

Cannonball metastasis

Answer

Pneumothorax

Answer

Pulmonary artery hypertension

Answer

Interstitial lung disease

Question 6

An AIDS patient presents with respiratory distress. CXR shows:

Accepted Answer

Pneumocystis pneumonia

Answer

Miliary TB

Answer

Streptococcal pneumonia

Answer

Lymphocytic interstitial Pneumonitis

Question 7

An 18-year-old boy is brought to the hospital with difficulty in breathing after a bar fight. What does the given CT chest show?

Accepted Answer

Pneumothorax

Answer

Consolidation

Answer

Pulmonary contusion

Answer

Haemothorax

Question 8

The lung parenchyma on CT chest shown below is best described as:

Accepted Answer

Crazy pavement pattern

Answer

Honey comb pattern

Answer

Signet ring pattern

Answer

Mosaic pattern

Question 9

A cement slab fell on the chest of a 20-year-old construction worker. The arrow in the given CT chest points to:

Accepted Answer

Lung contusion

Answer

ARDS

Answer

Diaphragmatic rupture

Answer

Pneumothorax

Question 10

A 25-year-old patient underwent surgery for scoliosis correction. 5 days post-operatively he develops voluminous bilious vomiting. The given CT abdomen shows:

Accepted Answer

SMA syndrome

Answer

Paralytic ileus

Answer

Pneumoperitoneum

Answer

Paravertebral abscess

NEET-PG 2017

Radiology