FMGE 2025 - Radiology PYQs Practice Questions

Q: A patient presents with a history of dysphagia, which is more pronounced for liquids than solids. Which radiological sign is most likely to be seen?

Rat-tail sign. ***Rat-tail sign*** - Dysphagia that is more pronounced for liquids (**paradoxical dysphagia**) than solids is the hallmark symptom of **Achalasia**, a primary esophageal motility disorder. - The **rat-tail sign** (or **bird-beak sign**) seen on **barium swallow** is due to the non-relaxed, smoothly tapered distal esophagus resulting from **Lower Esophageal Sphincter (LES) failure** to relax. *Filling defect* - This is a general radiological term indicating any mass lesion protruding into the esophageal lumen, such as a **polyp**, **foreign body**, or a large tumor mass. - It is not specific to motility disorders like Achalasia, which cause smooth, concentric narrowing rather than a discrete filling absence. *Corkscrew esophagus* - This classic radiographic finding is characteristic of **Diffuse Esophageal Spasm (DES)**, where uncoordinated and severe contractions occur intermittently throughout the esophagus. - DES typically causes intermittent dysphagia and significant non-cardiac **chest pain**, and the dysphagia pattern is usually not strictly *liquids more than solids*. *Apple-core lesion* - The **apple-core lesion** (or **napkin-ring sign**) is the classical appearance of an infiltrative, malignant stricture, most commonly seen in cases of advanced **esophageal carcinoma**. - Malignant strictures cause progressive dysphagia, typically starting with difficulty swallowing **solids before liquids**, which contradicts the patient’s presentation. [Practice more Radiology PYQs on OnCourse]

Q: Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?

Tension Pneumothorax. ***Tension pneumothorax*** - The clinical presentation of severe dyspnea, **distended neck veins**, and **hypotension** (BP 80/50 mmHg) after trauma is a classic triad for tension pneumothorax, which is a medical emergency. - The chest X-ray confirms this diagnosis by showing a completely collapsed right lung with a significant **contralateral shift of the mediastinum and trachea** to the left, and flattening of the right hemidiaphragm, indicating high intrapleural pressure. *Primary Spontaneous Pneumothorax* - This type of pneumothorax occurs without any preceding trauma or underlying lung disease, typically in tall, thin young men due to the rupture of **apical blebs**. - The patient's presentation follows a fight, clearly indicating a **traumatic etiology**, which rules out a spontaneous pneumothorax. *Traumatic Pneumothorax* - While the cause is trauma, this is a less specific diagnosis. The term **Tension pneumothorax** is more accurate given the life-threatening signs of **hemodynamic instability** and **mediastinal shift**. - A simple traumatic pneumothorax does not typically involve the one-way valve mechanism that leads to the progressive accumulation of air and the resulting **obstructive shock** seen in this patient. *Bilateral Pneumothorax* - This diagnosis is incorrect as the chest X-ray clearly demonstrates a **unilateral** condition affecting only the right side. - The left lung, although compressed by the shifted mediastinum, remains inflated with visible lung markings extending to the chest wall. [Practice more Radiology PYQs on OnCourse]

Q: Identify the procedure shown in the image

Intravenous Pyelogram. ***Intravenous Pyelogram*** - In this procedure, a contrast agent is injected **intravenously** and is then excreted by the kidneys, allowing for visualization of the entire urinary tract, including the renal calyces, pelvis, ureters, and bladder. - The image demonstrates the **nephrogram phase** (contrast in the kidney parenchyma) and the **excretory phase** (contrast in the collecting systems and ureters) simultaneously on both sides, which is characteristic of an IVP. *Retrograde pyelogram* - This procedure involves the injection of contrast material directly into the ureter via a **cystoscope** passed into the bladder, resulting in retrograde (bottom-to-top) filling of the collecting system. - A **ureteral catheter** would typically be visible on the image, and usually, only one side is opacified at a time, which is not the case here. *Combined Retrograde Pyelogram and Ureteroscopy* - This is an invasive procedure where a **ureteroscope** (a thin, flexible camera) is passed up the ureter to directly visualize and treat pathologies like stones or tumors. - The presence of the **ureteroscope** or other instruments would be evident on the radiograph, which are absent in this image. *Antegrade pyelography* - This technique involves inserting a needle or catheter through the skin of the back directly into the renal collecting system (**percutaneous access**) to inject contrast. - A **percutaneous nephrostomy tube** or needle would be visible on the image, which is not seen here. [Practice more Radiology PYQs on OnCourse]

Q: A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?

Radiation Pneumonitis. ***Radiation Pneumonitis*** - This is a non-infectious inflammatory response of the lung parenchyma following radiotherapy, typically occurring **1-6 months** after treatment, which fits the patient's timeline after **Cobalt-60 therapy**. - Imaging findings classically show **diffuse haziness**, consolidation, or ground-glass opacities that are sharply demarcated and conform to the **radiation port**, as seen in the provided chest X-ray. *Recurrence of Breast Cancer* - **Pulmonary metastases** from breast cancer usually present as discrete **nodules**, masses, or lymphangitic carcinomatosis on imaging, not a diffuse haziness confined to a prior radiation field. - The onset of symptoms in this case is more acute and temporally related to radiation therapy, making an inflammatory process like pneumonitis more likely than metastatic recurrence. *Pulmonary Embolism* - While cancer is a risk factor for **pulmonary embolism (PE)**, a chest X-ray is often normal or shows non-specific findings like atelectasis or a **Hampton's hump**; the diffuse haziness seen here is not a typical feature of PE. - Diagnosis of PE requires a **CT pulmonary angiogram (CTPA)** or V/Q scan, as the clinical signs can overlap but the radiographic evidence points elsewhere. *Infective Pneumonia* - **Infective pneumonia** typically presents with symptoms like **fever**, chills, and a productive cough, which are not described in the clinical vignette. - The radiographic opacities in bacterial pneumonia are usually lobar or segmental and do not have the sharp, straight borders that correspond to a radiation field. [Practice more Radiology PYQs on OnCourse]

Q: Which of the following is a primary use of this imaging modality? ![img-42.jpeg](img-42.jpeg)

Staging of esophageal cancer. ***Staging of esophageal cancer*** - The image displays an **Endoscopic Ultrasound (EUS)**, which is the most accurate modality for the locoregional staging of esophageal cancer. - EUS provides detailed imaging of the esophageal wall layers, allowing for precise assessment of the **depth of tumor invasion (T stage)** and involvement of **regional lymph nodes (N stage)**, which is critical for treatment planning. *Evaluation of gastroesophageal reflux disease (GERD)* - The diagnosis of GERD is primarily based on clinical symptoms and may be confirmed with **upper endoscopy** to look for esophagitis or **ambulatory pH monitoring**. - EUS is not used for evaluating reflux itself, as it doesn't measure acid exposure or lower esophageal sphincter function. *Identifying the cause of dysphagia* - The initial investigation for dysphagia typically involves a **barium esophagram** or a standard **upper endoscopy** to visualize the esophageal lumen directly. - EUS is a secondary test used to further characterize a mass or stricture already identified by other means, rather than as a primary tool for dysphagia workup. *Assessing cardiac and aortic pathology* - While EUS can visualize adjacent mediastinal structures, including the heart and aorta, it is not the primary imaging modality for their assessment. - **Echocardiography** is the standard for cardiac evaluation, and **CT or MR angiography** is superior for assessing aortic pathology. [Practice more Radiology PYQs on OnCourse]

Question 1

A patient presents with a history of dysphagia, which is more pronounced for liquids than solids. Which radiological sign is most likely to be seen?

Accepted Answer

Rat-tail sign

Answer

Corkscrew esophagus

Answer

Apple-core lesion

Answer

Filling defect

Question 2

Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Primary Spontaneous Pneumothorax

Answer

Bilateral Pneumothorax

Answer

Traumatic Pneumothorax

Question 3

Identify the procedure shown in the image

Accepted Answer

Intravenous Pyelogram

Answer

Combined Retrograde Pyelogram and Ureteroscopy

Answer

Antegrade pyelography

Answer

Retrograde pyelogram

Question 4

A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?

Accepted Answer

Radiation Pneumonitis

Answer

Infective Pneumonia

Answer

Pulmonary Embolism

Answer

Recurrence of Breast Cancer

Question 5

Which of the following is a primary use of this imaging modality?

![img-42.jpeg](img-42.jpeg)

Accepted Answer

Staging of esophageal cancer

Answer

Evaluation of gastroesophageal reflux disease (GERD)

Answer

Identifying the cause of dysphagia

Answer

Assessing cardiac and aortic pathology

Question 6

What is the investigation shown in the image?

Accepted Answer

Intravenous Pyelogram (IVP)

Answer

Retrograde Pyelogram

Answer

Computed Tomography (CT) Urography

Answer

Magnetic Resonance Urography

Question 7

A chest X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Pulmonary oedema

Answer

Hydrothorax

Answer

Pleural effusion

Answer

Pulmonary fibrosis

Question 8

Based on the provided chest X-ray images, what is the most likely diagnosis?

Accepted Answer

Pulmonary Edema

Answer

Hydrothorax

Answer

Pleural Effusion

Answer

Pulmonary Fibrosis

Question 9

A 65-year-old patient presents with abdominal distension and constipation. What is the most likely diagnosis based on the abdominal X-ray shown?

Accepted Answer

Sigmoid Volvulus

Answer

Caecal Volvulus

Answer

Intestinal Obstruction

Answer

Small Bowel Volvulus

Question 10

Based on the provided X-ray image, identify the most likely diagnosis.

Accepted Answer

Osteosarcoma

Answer

Chondrosarcoma

Answer

Gout

Answer

Ewing sarcoma

FMGE 2025 — Radiology