NEET-PG 2025 — Radiology
7 Previous Year Questions with Answers & Explanations
History of pulsatile mass in the neck. Digital angiography image shown. Not filling on carotid compression. But refilling on releasing pressure. What is the diagnosis?
A 24-hour-old baby with severe respiratory distress was admitted to the ICU. A chest X-ray of the neonate is given. What is the most probable diagnosis?
A 30-year-old male patient presents to OPD with complaints of recurrent headache and nausea, MRI of brain shown below. What is the diagnosis?
What is the most probable diagnosis based on the image provided?
Which is the earliest imaging modality used to detect ankylosing spondylitis?
A 56-year-old female presents with chronic lower back pain. A lateral lumbar spine X-ray is provided. Based on the radiological findings, which of the following is the most likely diagnosis?
What is true about the investigation shown below?
NEET-PG 2025 - Radiology NEET-PG Practice Questions and MCQs
Question 1: History of pulsatile mass in the neck. Digital angiography image shown. Not filling on carotid compression. But refilling on releasing pressure. What is the diagnosis?
- A. Haemangioma
- B. Carotid Aneurysm
- C. Carotid Body tumour (Correct Answer)
- D. AV fistula
Explanation: ***Carotid Body tumour*** - The angiography image shows a classic **"splaying"** or **"lyre sign"** of the carotid bifurcation (Common Carotid Artery splitting into Internal and External Carotid Arteries), which is **pathognomonic for a Carotid Body Tumour** (Paraganglioma). - The tumor is **highly vascular** (tumour blush on angiography) and receives its blood supply from the **External Carotid Artery (ECA)**, thus explaining the pulsatile nature. - **Fontaine test positive**: The described finding of "not filling on carotid compression but refilling on releasing pressure" is characteristic of a carotid body tumor, as temporary compression reduces flow but the highly vascular tumor refills from collateral circulation when pressure is released. - Carotid body tumors are **paragangliomas** arising from chemoreceptor cells at the carotid bifurcation. *Carotid Aneurysm* - A carotid artery aneurysm would appear as a **localized, saccular, or fusiform dilatation** of the carotid vessel lumen on angiography, not demonstrating the splaying of the bifurcation. - While also pulsatile, its filling on angiography would be purely arterial flow within the dilated vessel, not a pathological tumor blush. - Would not show the characteristic lyre sign. *AV fistula* - An Arteriovenous (AV) fistula would typically show **early venous opacification** (rapid shunting of contrast from artery to vein), which is not the primary finding here. - The mass is described as a localized tumor mass causing splaying of the bifurcation, not the flow-related abnormalities typical of a fistula. - Would present with continuous bruit rather than pulsatile mass. *Haemangioma* - A large, highly vascular haemangioma in the neck might be pulsatile but typically presents as a less defined mass and does **not characteristically cause the splaying of the carotid bifurcation** seen in a Carotid Body Tumour. - While both can show a tumor blush, the **location** (at carotid bifurcation) and **specific radiological presentation** (lyre sign) strongly favor the Carotid Body Tumour (a type of **paraganglioma**).
Question 2: A 24-hour-old baby with severe respiratory distress was admitted to the ICU. A chest X-ray of the neonate is given. What is the most probable diagnosis?
- A. Congenital lobar emphysema
- B. Congenital Pulmonary Airway Malformation (CPAM)
- C. Neonatal pneumonia
- D. Congenital Diaphragmatic Hernia (CDH) (Correct Answer)
Explanation: ***Congenital Diaphragmatic Hernia (CDH)*** - The image shows loops of **gas-filled bowel** (multiple curvilinear lucencies) in the left hemithorax, confirming the presence of abdominal contents in the chest cavity, which is pathognomonic for **CDH** (most commonly through the **Bochdalek defect**). - There is significant **mediastinal shift** to the right, leading to compression of the right lung (pulmonary hypoplasia) and severe respiratory distress in the neonate. *Congenital Pulmonary Airway Malformation (CPAM)* - CPAM (previously CCAM) usually presents as a **mass of cysts** (Type 1 is large cysts, Type 2 is small cysts) within the lung parenchyma, which are not typically associated with gas-filled loops of bowel extending from the abdomen. - While CPAM can cause mediastinal shift, the defining feature in CDH is the presence of **abdominal viscera** above the diaphragm, which is clearly visible. *Congenital lobar emphysema* - This condition involves **hyperinflation** of one or more lobes (most commonly the upper lobes) due to air trapping, resulting in an abnormally large, radiolucent lobe on X-ray. - It would show a large area of hyperlucency and possible collapse of adjacent lung tissue but would **not show intestinal loops** in the chest cavity. *Neonatal pneumonia* - Neonatal pneumonia typically presents with generalized or focal **opacification/consolidation** (white patches) rather than distinct, gas-filled cystic appearances resembling bowel loops. - While pneumonia causes respiratory distress, it does **not cause the mediastinal shift** or the visualization of abdominal organs in the chest seen here.
Question 3: A 30-year-old male patient presents to OPD with complaints of recurrent headache and nausea, MRI of brain shown below. What is the diagnosis?
- A. Meningioma (Correct Answer)
- B. Glioma
- C. Pilocytic astrocytoma
- D. Ependymoma
Explanation: ***Meningioma*** - The MRI displays a classic **extra-axial mass** (meaning outside the brain parenchyma) arising from the convexity dura. - Key imaging features supporting this diagnosis are the **well-circumscribed, lobulated shape** and the **intense, homogenous enhancement** post-contrast. *Glioma* - Gliomas, such as **Glioblastoma Multiforme (GBM)**, are **intra-axial tumors** (arising within the brain tissue) and typically have irregular, infiltrating margins. - High-grade gliomas commonly show **ring enhancement** with central necrosis, which is not characteristic of the lesion depicted. *Ependymoma* - Ependymomas are typically found within the **ventricular system** (especially the fourth ventricle in adults, or lateral ventricles in children) or the spinal cord. - They are **intra-axial** tumors (ventricular location being the defining feature) and rarely present as extra-axial convexity lesions. *Pilocytic astrocytoma* - This tumor is predominantly seen in children and adolescents, often located in the **cerebellum** or along the optic pathways, usually presenting as an **intra-axial** tumor. - Radiologically, it typically appears as a large **cyst with an enhancing mural nodule**, which differs significantly from the solid, extra-axial lesion shown.
Question 4: What is the most probable diagnosis based on the image provided?
- A. Bronchogenic carcinoma
- B. Lung abscess
- C. RUL consolidation
- D. RUL collapse (Correct Answer)
Explanation: ***RUL collapse*** - RUL collapse (atelectasis) is identified radiographically by signs of **volume loss**, including superior displacement of the right hilum and cephalic bowing/displacement of the **minor fissure**. - The collapsed lobe causes increased opacification in the upper zone, often associated with the **"S" sign of Golden** if an obstructing hilar mass is present. *RUL consolidation* - Consolidation is characterized by filling of the airspaces with fluid/exudate, causing increased density but typically **without volume loss** (unlike collapse). - A key differentiating feature is the presence of a **patent air bronchogram**, meaning air-filled bronchi are visible against the opaque lung parenchyma. *Bronchogenic carcinoma* - While **bronchogenic carcinoma** is a very common cause of RUL collapse (due to endobronchial obstruction), the primary diagnosis based on the visible lung changes (**volume loss and opacification**) is the collapse itself. - The term carcinoma refers to the underlying **etiology**, not the specific radiological pattern of atelectasis shown in the image. *Lung abscess* - A lung abscess is defined by a localized area of necrosis and pus formation, typically appearing as a **thick-walled cavity**. - The defining characteristic feature that differentiates it from collapse is the presence of an **air-fluid level** within the cavity.
Question 5: Which is the earliest imaging modality used to detect ankylosing spondylitis?
- A. X ray
- B. MRI sacroiliac joint (Correct Answer)
- C. Bone scan
- D. CT sacroiliac joint
Explanation: ***MRI sacroiliac joint*** - **Most sensitive modality** for detecting early ankylosing spondylitis - Detects **bone marrow edema** and active sacroiliitis before structural changes appear - Shows **inflammatory changes** in cartilage, synovium, and entheses - Can identify disease **years before X-ray changes** become apparent - STIR and T1-weighted sequences with contrast are particularly useful *Incorrect: X-ray* - Detects only **late structural changes** (erosions, sclerosis, fusion) - Takes **several years** for radiographic sacroiliitis to develop - Low sensitivity in early disease stages - Still used for initial screening due to availability and cost *Incorrect: Bone scan* - Shows **non-specific** increased uptake in sacroiliac joints - Lower sensitivity and specificity compared to MRI - Cannot differentiate inflammatory from mechanical causes - Largely replaced by MRI in current practice *Incorrect: CT sacroiliac joint* - Better than X-ray for detecting **bony erosions** and structural detail - Still detects structural rather than inflammatory changes - Higher radiation exposure than X-ray - Less sensitive than MRI for early disease
Question 6: A 56-year-old female presents with chronic lower back pain. A lateral lumbar spine X-ray is provided. Based on the radiological findings, which of the following is the most likely diagnosis?
- A. Spondylitis
- B. Vertebral fracture
- C. Spondylolisthesis (Correct Answer)
- D. Osteosarcoma
Explanation: ***Spondylolisthesis*** - The lateral X-ray view demonstrates classic evidence of **anterior displacement** (slippage) of the superior vertebral body relative to the inferior body (shown by the red measurement line). - This condition is often due to a defect in the **pars interarticularis** (spondylolysis), indicated by the yellow arrows, causing mechanical instability and chronic pain. *Spondylitis* - Refers specifically to **inflammation** of the spinal vertebrae, seen in conditions like **Ankylosing Spondylitis** or infectious processes (e.g., spinal tuberculosis). - Radiological findings would include bone erosions, endplate destruction, or squaring of vertebrae, not clear mechanical vertebral slippage. *Osteosarcoma* - This is a primary malignant bone tumor, usually presenting radiographically as a solitary, aggressively lytic, or **sclerotic mass** with poorly defined margins. - It does not cause the characteristic pattern of forward vertebral body slip and pars defect visible in this chronic mechanical pathology. *Vertebral fracture* - An acute **compression fracture** results in a loss of vertebral height, often a wedge-shaped deformity, which is not the predominant finding here. - While traumatic fracture-dislocation can cause displacement, the image shows a chronic slip pattern, often secondary to a **spondylolysis** (pars defect), rather than an acute traumatic bone break.
Question 7: What is true about the investigation shown below?
- A. Gold standard for bladder cancer
- B. Done percutaneously
- C. Non invasive procedure to visualize ureteropelvic junction
- D. Invasive procedure (Correct Answer)
Explanation: ***Invasive procedure*** - The image depicts a form of **Urography** (likely Intravenous Urography or IVU), which requires the **intravenous injection** of a contrast medium, making it an invasive procedure. - If the image were a Retrograde Pyelogram (RGP), it would also be invasive, requiring instrumentation via **cystoscopy** up to the ureteric orifices. *Non invasive procedure to visualize ureteropelvic junction* - This statement is incorrect because the procedure requires the introduction of contrast material into the body, either intravenously or directly into the urinary system, which classifies it as **invasive**. - While it effectively visualizes the **ureteropelvic junction (UPJ)**, non-invasive imaging like **Ultrasound** or **Non-contrast CT** does not require contrast injection. *Gold standard for bladder cancer* - The gold standard investigation for diagnosing and staging bladder cancer is **Cystoscopy with Biopsy**, not urography. - Urography is primarily used to evaluate the **upper urinary tract** (kidneys and ureters) for filling defects, strictures, or stones. *Done percutaneously* - This procedure, typically an IVU, involves **intravenous access** for contrast injection, not a percutaneous stab into the kidney or other structures. - **Antegrade pyelography** is the investigation done percutaneously, usually through a **nephrostomy tube**, but this image represents broader visualization.