NEET-PG 2018 - Radiology Practice Questions

Q: Identify the following abnormality?

Schizencephaly. ***Schizencephaly*** - The image shows a **cleft-like defect** extending from the pial surface to the ventricle, lined by **gray matter**, which is characteristic of schizencephaly. - This typically results in communication between the **subarachnoid space** and the **ventricular system**. *Encephalocoele* - An encephalocoele is a **protrusion of brain tissue** and meninges through a defect in the skull, which is not depicted in this image. - It usually presents as a **sac-like bulge** on the head, often in the occipital or frontal regions. *Prosencephaly* - This term usually refers to the malformation spectrum associated with **holoprosencephaly**, characterized by a failure of the prosencephalon (forebrain) to properly divide. - Features include **fusion of the cerebral hemispheres**, a single ventricle, and facial anomalies, not a cortical cleft as seen here. *Lissencephaly* - Lissencephaly is characterized by a **lack of gyri and sulci** (smooth brain surface) or abnormally broad and flattened gyri, leading to a thickened cortex. - The image clearly displays presence of gyri and sulci, although with an additional unusual cleft, ruling out a primary diagnosis of lissencephaly.

Q: Identify the grade of vesico-ureteric reflux in the picture below?

Grade V. ***Grade V*** - This image shows **severe dilation** and **tortuosity of the ureter**, along with **blunting of the renal calyces** and loss of papillary impressions, extending all the way to the renal pelvis. - Grade V VUR indicates the most severe form of reflux, with significant distortion of the pelvicalyceal system, often associated with **renal parenchymal damage**. *Grade II* - Grade II VUR involves reflux into the **ureter, renal pelvis, and calyces**, but with **no dilation** and normal calyces. - The image clearly displays significant dilation and blunting of calyces, which is beyond Grade II. *Grade III* - In Grade III VUR, there is reflux into the **ureter** and **pelvicalyceal system (renal pelvis and calyces)** with **mild to moderate dilation** and slight blunting of the calyces. - The marked tortuosity and severe dilation seen in the image exceed the characteristics of Grade III. *Grade IV* - Grade IV VUR is characterized by **moderate to severe dilation** and **tortuosity of the ureter** and pelvicalyceal system, with **moderate blunting** of the calyces. - While there is severe dilation and tortuosity, the extent of calycial blunting and loss of papillary impressions in the image is more consistent with Grade V.

Q: The ultrasound finding of a 7 -month-old child with abdominal pain and mass in the upper abdomen is shown below. What is the diagnosis? (NEET Pattern 2018)

Intussusception. ***Intussusception*** - The ultrasound image clearly shows a "target sign" or "doughnut sign," which is pathognomonic for **intussusception**, where one segment of the intestine telescopes into another. - This condition commonly presents in infants (around 6-36 months) with **abdominal pain**, an abdominal mass, and sometimes **currant jelly stools**. *Intestinal volvulus* - **Intestinal volvulus** involves the twisting of the intestine around its mesentery, which would typically show a "whirlpool sign" on ultrasound due to twisted mesenteric vessels, not the "target sign." - It usually presents with sudden onset of severe abdominal pain, bilious vomiting, and signs of intestinal obstruction and ischemia. *Pyloric stenosis* - **Pyloric stenosis** is characterized by hypertrophy of the pyloric muscle, which would appear as an elongated, thickened pyloric canal on ultrasound with increased pyloric muscle thickness (>3mm) and length (>15mm). - Clinical presentation involves non-bilious projectile vomiting in infants, typically between 2 and 8 weeks of age, not at 7 months with an abdominal mass and the bowel-within-bowel appearance shown. *None of above* - The classic ultrasound findings and clinical presentation strongly point to intussusception, making this option incorrect.

Q: The following image shows the presence of?

Bladder stone. ***Bladder stone*** - The image displays multiple **radiopaque densities** (stones) clustered within the pelvic cavity, specifically in the region where the urinary bladder is anatomically located. - The aggregation and rounded shapes are characteristic of **vesical calculi** (bladder stones). *Ureter stone* - **Ureteral stones** would typically appear as a single or a few stones following the course of the ureters, which are tubular structures extending from the kidneys to the bladder. - The diffuse, multi-focal collection seen in the image is not consistent with the typical presentation of a ureteric calculus. *Urethral stone* - A **urethral stone** would be located within the urethra, which is inferior to the bladder and would typically present as a single, elongated calculus in the distal urinary tract. - The location and multiple, scattered appearance in the image do not match a urethral stone. *Prostate calcification* - **Prostatic calcifications** are usually smaller, often punctate, and concentrated within the confines of the prostatic gland, typically inferior to the bladder neck. - The calcifications in the image are larger and more widely distributed, not confined to the typical anatomical borders of the prostate.

Q: The following X-ray is used to evaluate \qquad sinus?

Maxillary. ***Maxillary*** - The image provided is a **Waters' view** (occipitomental view) X-ray of the paranasal sinuses, which is primarily used to visualize the **maxillary sinuses**. - In a Waters' view, the **petrous ridges** (dense bone at the base of the skull) are projected below the maxillary sinuses, allowing for a clear view of these sinuses. *Frontal* - While the **frontal sinuses** are visible in a Waters' view, they are generally better visualized in a **Caldwell view** (occipitofrontal view) or lateral view. - In this projection, their visualization can be obscured by other bony structures, and they are not the primary focus. *Ethmoidal* - The **ethmoidal sinuses** are typically comprised of multiple small air cells located between the orbits and are best seen on a **Caldwell view** or specialized oblique views. - In a Waters' view, their evaluation is limited due to superimposition of other facial bones. *Sphenoidal* - The **sphenoidal sinuses** are located deep within the skull, inferior to the sella turcica, and are quite difficult to visualize on standard plain radiographs like the Waters' view. - They are best assessed using a **lateral view of the skull** or advanced imaging like **CT scans**.

Q: A radiographic projection with X-ray beam angled at 30 degrees to the radiographic plate, with the skull positioned laterally (as shown in the image), is used to visualize which of the following structures?

Sinus tympani. ***Sinus tympani*** - The image shows a **radiographic projection** designed to visualize structures of the **temporal bone**. Specifically, an X-ray beam angled at 30 degrees to the radiographic plate, with the skull positioned laterally, is characteristic of specific views for the **middle ear structures**, such as the sinus tympani. - The **sinus tympani** is a small, deep recess in the posterior wall of the middle ear, and its detailed visualization often requires specialized **oblique radiographic projections**. *Recess of fourth ventricle* - The **fourth ventricle** is located within the brain stem, and its recesses are deep brain structures. - Visualization of the fourth ventricle and its recesses typically requires advanced imaging modalities like **CT or MRI**, not standard X-ray projections of the skull. *Round window* - The **round window** is a structure of the inner ear, specifically located at the cochlea. - While it is part of the temporal bone, standard skull X-rays are not optimal for its detailed visualization, and a specialized view for the **hypotympanum** would be needed to see it clearly, which is not depicted by this projection angle. *Lateral ventricle* - The **lateral ventricles** are located within the cerebral hemispheres of the brain. - Similar to the fourth ventricle, these structures are best visualized with **CT or MRI** and are not effectively seen with basic skull X-ray projections, especially not with an angled view designed for the temporal bone.

Question 1

Identify the following abnormality?

Accepted Answer

Schizencephaly

Answer

Encephalocoele

Answer

Prosencephaly

Answer

Lissencephaly

Question 2

Identify the grade of vesico-ureteric reflux in the picture below?

Accepted Answer

Grade V

Answer

Grade II

Answer

Grade III

Answer

Grade IV

Question 3

The ultrasound finding of a 7 -month-old child with abdominal pain and mass in the upper abdomen is shown below. What is the diagnosis? (NEET Pattern 2018)

Accepted Answer

Intussusception

Answer

Intestinal volvulus

Answer

Pyloric stenosis

Answer

None of above

Question 4

The following image shows the presence of?

Accepted Answer

Bladder stone

Answer

Ureter stone

Answer

Urethral stone

Answer

Prostate calcification

Question 5

The following X-ray is used to evaluate \qquad sinus?

Accepted Answer

Maxillary

Answer

Frontal

Answer

Ethmoidal

Answer

Sphenoidal

Question 6

A radiographic projection with X-ray beam angled at 30 degrees to the radiographic plate, with the skull positioned laterally (as shown in the image), is used to visualize which of the following structures?

Accepted Answer

Sinus tympani

Answer

Recess of fourth ventricle

Answer

Round window

Answer

Lateral ventricle

NEET-PG 2018 — Radiology