FMGE 2025 - Radiology Practice Questions

Q: A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Silicosis. ***Silicosis*** - The presence of **bilateral hilar lymphadenopathy** with **eggshell calcification** is a classic, pathognomonic finding for silicosis. - This pneumoconiosis is caused by inhalation of silica dust, often seen in miners and sandblasters, and typically shows multiple small nodules predominantly in the **upper lung zones**. *Sarcoidosis* - While sarcoidosis is a common cause of **bilateral hilar lymphadenopathy**, the presence of **eggshell calcification** is much less frequent compared to silicosis. - Calcification in sarcoidosis, when it occurs, is more often amorphous or diffuse, not the distinct peripheral rim seen in the image. *Tuberculosis* - Tuberculosis can cause hilar lymphadenopathy, but it is often **unilateral**, and calcification typically occurs in a healed **Ghon complex** as a solid, dense nodule. - The specific pattern of **eggshell calcification** is not a characteristic feature of tuberculosis. *Pneumoconiosis due to asbestos* - Asbestosis characteristically involves the **lower lung zones** and is associated with **pleural plaques**, pleural thickening, and interstitial fibrosis. - Significant hilar lymphadenopathy and **eggshell calcification** are not typical features of asbestos-related lung disease.

Q: A 30 year old apparently healthy man who was carrying laxatives and enema apparatus developed abdominal pain at the airport and an x-ray was done which appears as shown below. Which of the following is the likely diagnosis?

Body packer syndrome. ***Body packer syndrome*** - This diagnosis is indicated by the presence of multiple, well-defined, uniformly shaped, and hyperdense foreign bodies within the gastrointestinal tract, as seen on the abdominal X-ray. - The clinical context of being at an airport with laxatives and enema apparatus is highly suggestive of an individual attempting to smuggle illicit drugs by ingesting them in packets. *Bezoar syndrome* - A **bezoar** is a mass of indigestible material (like hair or vegetable fibers) trapped in the GI tract, which appears on X-ray as a mottled, heterogeneous mass, not as multiple discrete, uniform packets. - Bezoars typically conform to the shape of the stomach or bowel lumen and lack the smooth, regular outlines seen in this image. *Pica due to anaemia* - **Pica** is the ingestion of non-nutritive substances and might show foreign objects on an X-ray, but these would typically be of varied shapes and sizes (e.g., coins, dirt, paint chips), not uniform packets. - The clinical presentation does not suggest anaemia, and the scenario points towards illegal activity rather than a compulsive eating disorder. *Constipation due to fecalith* - A **fecalith** is a hardened mass of stool that appears as a mottled density within the colon, consistent with retained feces. - The objects in the X-ray have sharp, smooth borders and a uniform density, which is inconsistent with the appearance of a fecalith.

Q: The X-ray image provided (img-41.jpeg) shows multiple cylindrical objects in the abdominal area. Which of the following conditions is most likely represented by this image?

Body packer syndrome. ***Body packer syndrome*** - The X-ray shows multiple, well-defined, uniformly shaped, dense, cylindrical objects throughout the gastrointestinal tract, a classic radiographic finding for **body packer syndrome**. - These objects are ingested packets containing illicit drugs, often showing a "double-condom sign" (a thin lucent rim of air trapped in the wrapping), confirming their manufactured nature. *Bezoar* - A **bezoar** is a mass of indigestible material (like hair or vegetable fiber) that appears as a single, mottled, intraluminal mass on X-ray, not multiple discrete packets. - The objects in the image have a uniform shape and density, which is inconsistent with the heterogeneous appearance of a bezoar. *Pica due to anaemia* - **Pica** involves the ingestion of non-nutritive substances, which would result in radiopaque foreign bodies of various, irregular shapes (e.g., coins, stones), not uniform cylindrical packets. - While associated with conditions like **iron-deficiency anaemia**, the radiographic findings of pica do not match the organized, manufactured appearance of the objects shown. *Constipation due to fecalith* - A **fecalith** is a hardened mass of stool that appears as a mottled density within the colon, conforming to the haustral pattern, and lacks the smooth, well-defined borders seen here. - While severe **constipation** leads to significant stool burden, it does not present as multiple, encapsulated, geometrically regular objects.

Question 1

A patient presents with bilateral hilar lymphadenopathy with eggshell calcification on chest X-ray. What is the most likely diagnosis?

Accepted Answer

Silicosis

Answer

Tuberculosis

Answer

Sarcoidosis

Answer

Pneumoconiosis due to asbestos

Question 2

A 30 year old apparently healthy man who was carrying laxatives and enema apparatus developed abdominal pain at the airport and an x-ray was done which appears as shown below. Which of the following is the likely diagnosis?

Accepted Answer

Body packer syndrome

Answer

Pica due to anaemia

Answer

Bezoar syndrome

Answer

Constipation due to fecalith

Question 3

The X-ray image provided (img-41.jpeg) shows multiple cylindrical objects in the abdominal area. Which of the following conditions is most likely represented by this image?

Accepted Answer

Body packer syndrome

Answer

Pica due to anaemia

Answer

Bezoar

Answer

Constipation due to fecalith

FMGE 2025 — Radiology