NEET-PG 2017 - Radiology PYQs Practice Questions

Q: A 40-year-old male presents with sudden onset right-sided chest pain and breathlessness following a road traffic accident. On examination, breath sounds are diminished on the right side. The chest X-ray is shown below. What is the most likely diagnosis?

Right hydropneumothorax. ***Right hydropneumothorax*** - The X-ray image reveals an **air-fluid level** in the right pleural cavity, characterized by a straight, horizontal line between the air (darker above) and fluid (whiter below). This finding is pathognomonic for a hydropneumothorax. - The **collapsed or compressed lung** is also visible superior to the air-fluid level, further supporting the diagnosis of air and fluid coexisting in the pleural space. *Hydatid cyst right lung* - A hydatid cyst in the lung appears as a **well-defined, rounded opacity (solid mass)**, often with a "water lily" sign if ruptured, but it does not present with a distinct air-fluid level as seen here. - While hydatid cysts can rupture and produce air and fluid, the X-ray findings would typically show a more complex internal structure or a cyst within a cavity, not a simple air-fluid interface across the entire pleural space. *Right pleural effusion* - A pleural effusion would appear as a **homogeneous white (effaced) opacity** blunting the costophrenic angle and, in larger effusions, rising along the lateral chest wall (meniscus sign). - Crucially, a simple pleural effusion **does not show an air-fluid level**; the fluid density would fill the pleural space without an overlying visible air component. *Perforated abdominal viscus* - A perforated abdominal viscus would typically result in **free air under the diaphragm** on an upright chest X-ray (pneumoperitoneum). - While pneumoperitoneum presents as air, it is located below the diaphragm, *not* within the pleural cavity, and would not create an air-fluid level within the lung fields as seen in this image. [Practice more Radiology PYQs on OnCourse]

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. [Practice more Radiology PYQs on OnCourse]

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. [Practice more Radiology PYQs on OnCourse]

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. [Practice more Radiology PYQs on OnCourse]

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. [Practice more Radiology PYQs on OnCourse]

Question 1

A 40-year-old male presents with sudden onset right-sided chest pain and breathlessness following a road traffic accident. On examination, breath sounds are diminished on the right side. The chest X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Right hydropneumothorax

Answer

Hydatid cyst right lung

Answer

Right pleural effusion

Answer

Perforated abdominal viscus

Question 2

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 3

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 4

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 5

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 6

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 7

An AIDS patient presents with respiratory distress. CXR shows:

Accepted Answer

Pneumocystis pneumonia

Answer

Miliary TB

Answer

Streptococcal pneumonia

Answer

Lymphocytic interstitial Pneumonitis

Question 8

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 9

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 10

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

NEET-PG 2017 — Radiology