NEET-PG 2018 - Radiology Practice Questions

Q: The following Skull X-ray is seen in:

Thalassemia. ***Thalassemia*** - The image shows a classic **hair-on-end appearance** of the skull, which is a characteristic radiological finding in severe forms of thalassemia. - This appearance results from **marrow hyperplasia** in response to chronic hemolysis, leading to widening of the diploic space and expansion of bone marrow at the expense of outer cortical bone. *Multiple myeloma* - Multiple myeloma typically presents with multiple well-demarcated, **punched-out lytic lesions** in the skull, without a "hair-on-end" pattern. - The bone lesions are due to plasma cell infiltration and osteoclast activation, leading to discrete areas of bone destruction. *Histiocytosis-X* - Histiocytosis-X, also known as Langerhans cell histiocytosis, can cause **lytic bone lesions** in the skull, often referred to as "geographic" or "punched-out" lesions. - While it can cause diffuse bone involvement, it does not typically produce the organized trabecular pattern characteristic of "hair-on-end." *Paget's disease* - Paget's disease of bone often manifests as areas of **bone enlargement**, cortical thickening, and a mixture of lytic and sclerotic changes, sometimes described as a **cotton-wool appearance** in the skull. - It does not present with the "hair-on-end" pattern, which is primarily associated with conditions causing chronic marrow expansion.

Q: The following barium swallow study shows which of the following?

Esophageal varices. ***Esophageal varices*** - The Barium Swallow image clearly demonstrates a **serpiginous**, worm-like, or **rosary bead-like appearance** along the esophageal wall, which is characteristic of esophageal varices. - Varices are dilated submucosal veins and appear as **filling defects** on barium studies, especially when distended. *Schatzki ring* - A Schatzki ring is a **thin, symmetric mucosal ring** at the esophagogastric junction, causing solid food dysphagia. - It presents as a **smooth, circumferential narrowing** on a barium swallow, which is not seen here. *Candida esophagitis* - Candida esophagitis typically appears as **ulcerations, plaques, or nodularity** with an irregular, cobblestone pattern on barium swallow. - This image does not show the characteristic **"shaggy" or "cobblestone"** appearance associated with candidal plaques. *Reflux esophagitis* - Reflux esophagitis can manifest as **mucosal irregularity, erosions, or strictures**, but not the distinct serpiginous filling defects seen in this image. - Severe reflux can cause peptic strictures, which appear as **smooth, tapered narrowings**, different from the irregular variceal pattern.

Q: Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

CD1A positivity. ***CD1A positivity*** - The skull X-ray shows multiple punched-out lytic lesions without sclerotic borders, characteristic of **Langerhans Cell Histiocytosis (LCH)**. - **Langerhans cells** in LCH express surface markers like **CD1a** and S100 protein, which are diagnostic when detected via **immunohistochemistry on tissue biopsy**. - CD1a positivity is the **gold standard** for confirming LCH diagnosis. *Elevated SAP* - **Serum Alkaline Phosphatase (SAP)** is typically elevated in conditions with increased osteoblastic activity or liver/biliary disease. - LCH lesions are generally **lytic** and not associated with increased osteoblastic activity, thus SAP elevation is not a specific or common finding. *Bence Jones proteins* - **Bence Jones proteins** (monoclonal light chains) are found in the urine of patients with **Multiple Myeloma**, which can also cause lytic bone lesions. - However, the image shows more discrete, "punched-out" lesions typical of LCH, whereas myeloma lesions are often more diffuse or "salt-and-pepper" in appearance, and LCH does not secrete Bence Jones proteins. *Elevated HbA2* - **Elevated HbA2** is a characteristic finding in **beta-thalassemia trait**, a genetic blood disorder. - There is no clinical or radiological indication in the provided image or question to suggest a connection to thalassemia.

Q: Identify this condition?

Prune belly syndrome. ***Prune belly syndrome*** - The image shows the characteristic **wrinkled, prune-like appearance** of the abdominal wall due to **absent or deficient abdominal wall musculature**. - This condition is part of a triad including **urinary tract abnormalities** and **undescended testes** in males, with the distinctive loose, redundant abdominal skin. *Omphalocele* - An **omphalocele** presents with **abdominal contents herniating through the umbilical ring**, covered by a peritoneal membrane. - The image does not show any **herniated organs** or a sac-like protrusion at the umbilical area. *Gastroschisis* - **Gastroschisis** involves an **abdominal wall defect** typically to the right of the umbilical cord with **exposed bowel loops**. - No evidence of **herniated intestinal contents** or abdominal wall dehiscence is visible in this image. *Peritonitis* - **Peritonitis** is an **inflammatory condition** of the peritoneum presenting with abdominal rigidity and systemic signs. - This is not a structural abnormality visible externally but rather an **internal inflammatory process** requiring clinical assessment.

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 following test was performed on the patient. Which is correct about the patient?

Pain decreases on standing still. ***Pain decreases on standing still*** - The image depicts the measurement of **Ankle-Brachial Index (ABI)**, a diagnostic test for **Peripheral Artery Disease (PAD)**. - **Intermittent claudication** is the hallmark symptom of PAD, characterized by cramping pain in the legs that develops **after walking a certain distance** and is **relieved by rest** (standing still). - This occurs because the narrowed arteries cannot supply adequate blood flow during exercise, causing muscle ischemia and pain that resolves when activity ceases. *Pain is present on first step of walking* - This is **incorrect** for claudication, which requires time to develop as muscles become ischemic during sustained activity. - Pain on the **first step** would suggest **musculoskeletal pathology** (arthritis, plantar fasciitis) or **neurological issues** (nerve compression), not vascular claudication. - Claudication distance is a key diagnostic feature - patients can walk a reproducible distance before pain begins. *Pain is present at rest* - **Rest pain** indicates **critical limb ischemia**, a severe form of PAD where blood flow is inadequate even at rest. - This represents advanced arterial disease beyond simple claudication and requires urgent evaluation for revascularization. - Rest pain typically affects the forefoot and is worse at night when lying flat. *Pain increases on limb dependency* - Actually, **limb dependency (hanging the leg down)** typically **relieves pain** in severe PAD by using gravity to improve distal perfusion. - Patients with critical limb ischemia often sleep with legs dependent or dangle feet off the bed for relief. - This is opposite to **venous insufficiency**, where elevation improves symptoms.

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

The following Skull X-ray is seen in:

Accepted Answer

Thalassemia

Answer

Multiple myeloma

Answer

Histiocytosis-X

Answer

Paget's disease

Question 2

The following barium swallow study shows which of the following?

Accepted Answer

Esophageal varices

Answer

Schatzki ring

Answer

Candida esophagitis

Answer

Reflux esophagitis

Question 3

Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

Accepted Answer

CD1A positivity

Answer

Elevated SAP

Answer

Bence Jones proteins

Answer

Elevated HbA2

Question 4

Identify this condition?

Accepted Answer

Prune belly syndrome

Answer

Omphalocele

Answer

Gastroschisis

Answer

Peritonitis

Question 5

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 6

The following test was performed on the patient. Which is correct about the patient?

Accepted Answer

Pain decreases on standing still

Answer

Pain is present at rest

Answer

Pain is present on first step of walking

Answer

Pain increases on limb dependency

Question 7

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 8

The following image shows the presence of?

Accepted Answer

Bladder stone

Answer

Ureter stone

Answer

Urethral stone

Answer

Prostate calcification

Question 9

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

Accepted Answer

Maxillary

Answer

Frontal

Answer

Ethmoidal

Answer

Sphenoidal

Question 10

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