Q-1. A complex renal cyst was incidentally detected on ultrasound in a patient following which he underwent a CT for an insurance workup. What is the likely diagnosis?
a) Oncocytoma
b) Peri-nephric cyst
c) Angio-myo-lipoma
d) Renal cell carcinoma
Answer: Angio-myo-lipoma
Explanation:
Renal angiomyolipomas are benign lesions and usually single.
Twenty-thirty percent of renal angio-myolipomas are associated with tuberous sclerosis.
These lesions are often diagnosed incidentally on routine imaging studies. Despite their benign nature, rare cases have been reported with lymph node and vascular extension.
CT scan of abdomen with contrast:
Demonstrates a well-defined round fat containing lesion in the mid upper pole of the right kidney
There is a tumor thrombus extending from the right renal vein and inferior vena cava caudal to the hepatic veins.
Q-2. A middle aged male patient presents with fever and diarrhoea for one week and acute onset pain abdomen for 6 hours. An erect abdominal X-Ray was taken as shown in below film. What is probable diagnosis?
a) Appendicitis
b) Perforation peritonitis
c) Toxic megacolon
d) Pneumatosis intestinalis
Answer: Toxic megacolon
Explanation:
Above film shows dilatation of transverse colon and descending colon with loss of haustrations.
Radiographic features of toxic megacolon:
Dilatation of transverse colon at least 6 cm or more
Loss of haustral markings with pseudo-polyps often extending into the lumen
Thumb-printing from mucosal edema
Q-3. Which is the best investigation to delineate parathyroid abnormalities?
a) CECT Neck
b) Sestamibi Scan
c) Radioiodine Scan
d) Ultrasound Neck
Answer: Sestamibi Scan
Explanation:
Sestamibi is investigation of choice to localize parathyroid glands.
Important point:
The nuclear medicine scan can be fused with the CT scan as a SPECT scan to increase diagnostic accuracy and aid in anatomical localisation.
Q-4. A patient with pain abdomen for 2 hours presents to the casualty and the following X-ray abdomen was obtained. What is the probable diagnosis?
a) Pneumo-peritoneum
b) Pneumo-mediastinum
c) Sub-phrenic abscess
d) Amoebic liver abscess
Answer: Pneumo-peritoneum
Explanation:
Radiological features of pneumo-peritoneum:
Chest and abdominal X-ray: Sub-diaphragmatic free gas
Important point:
CT is regarded as the criterion standard for the detection of a pneumo-peritoneum.
Q-5. Chest X-ray shown below is showing all the features except:
a) Right atrial enlargement
b) Pulmonary vascular hypertension
c) Narrow vascular pedicle
d) Decreased pulmonary blood flow
Answer: Pulmonary vascular hypertension
Explanation:
Above film shows:
Right atrial enlargement
Small aortic knob and decreased vascular pedicle
Less prominent vascular marking- Decreased pulmonary blood flow
Important point:
Absence of enlarged central pulmonary arteries rule out pulmonary vascular hypertension
Radiological features of pulmonary vascular hypertension:
Elevated cardiac apex due to right ventricular hypertrophy
Filling of the retro-sternal airspace a result of right ventricular dilatation lateral chest radiograph
Right atrial enlargement
Enlarged central pulmonary arteries
Peripheral vessel opacity-oligemic lung fields (Pruning of peripheral pulmonary vessels)
Increased diameter (15 mm in women and 16 mm in men) of the right inter-lobar artery