A 28-year-old man from Nagpur has had back pain for 3 months with evening fever and weight loss. There is tenderness over the thoracolumbar junction but no neurological deficit. X-ray shows narrowing of the T11-T12 disc space with erosion of the adjacent end plates. Which investigation best shows the extent of the disease?

Contrast-enhanced MRI of the spine

A baby born at 30 weeks is on day 8 of formula feeds in the NICU. He develops abdominal distension, bilious aspirates and blood-streaked stools. Abdominal X-ray shows bubbly gas within the bowel wall of the right colon and branching gas over the liver, with no free gas under the diaphragm. He is haemodynamically stable. What is the next best step?

Stop feeds, NG decompression and IV antibiotics

A newborn baby with upslanting eyes, a single palmar crease and low muscle tone starts bilious vomiting within hours of birth. The abdomen is not distended. His mother had polyhydramnios. A plain abdominal X-ray shows two large gas bubbles in the upper abdomen and no gas further down the bowel. What is the most likely diagnosis?

Midgut volvulus with malrotation

Abdominal and musculoskeletal imaging signs

34 NEET-PG practice questions on Abdominal and musculoskeletal imaging signs, part of Radiology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 28-year-old man from Nagpur has had back pain for 3 months with evening fever and weight loss. There is tenderness over the thoracolumbar junction but no neurological deficit. X-ray shows narrowing of the T11-T12 disc space with erosion of the adjacent end plates. Which investigation best shows the extent of the disease?
1. AContrast-enhanced MRI of the spine
2. BTechnetium bone scan
3. CConventional myelography
4. DCT scan of the spine
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Answer: A · Contrast-enhanced MRI of the spine
Disc space narrowing with erosion of the adjacent vertebral end plates (the paradiscal pattern) in a young adult with constitutional symptoms suggests spinal tuberculosis. MRI with contrast is the investigation of choice: it shows marrow oedema early, the extent of vertebral and disc destruction, paravertebral and epidural abscesses, and compression of the cord. Tissue from CT-guided biopsy is sent for CBNAAT, culture and histology. Treatment is anti-tubercular therapy, with surgery for deficit or instability.
- B: A bone scan is non-specific and does not show abscess or cord compression.
- C: Myelography is invasive and outdated, replaced by MRI.
- D: CT shows bone destruction well but not marrow oedema, abscess spread or the cord.
Question 2 · Medium
In the orthopaedic OPD, a postgraduate student matches four X-ray findings with the bone lesion they usually indicate: 1. Onion-peel periosteal reaction in the diaphysis of a child: Ewing sarcoma. 2. Eccentric lytic soap-bubble lesion at the end of a long bone after physeal closure: giant cell tumour. 3. Small lucent nidus with dense surrounding sclerosis and night pain relieved by aspirin: osteoid osteoma. 4. Sunray spicules with a Codman triangle at the metaphysis: osteosarcoma. Which pairs are correctly matched?
1. A1 and 4 only
2. B1, 3 and 4 only
3. C1, 2, 3 and 4
4. D2, 3 and 4 only
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Answer: C · 1, 2, 3 and 4
All four pairs are correct. Ewing sarcoma gives layered, onion-peel periosteal new bone in the diaphysis of children and adolescents. Giant cell tumour is an eccentric, lytic, expansile lesion reaching the subchondral bone of the epiphysis in young adults. Osteoid osteoma is a small nidus under 1.5-2 cm with reactive sclerosis whose night pain responds to NSAIDs, and osteosarcoma shows sunray spicules and a Codman triangle in the metaphysis.
- A: Leaves out giant cell tumour and osteoid osteoma, both correctly matched.
- B: Leaves out giant cell tumour, which is correctly matched.
- D: Leaves out Ewing sarcoma, which is correctly matched.
Question 3 · Hard
A baby born at 30 weeks is on day 8 of formula feeds in the NICU. He develops abdominal distension, bilious aspirates and blood-streaked stools. Abdominal X-ray shows bubbly gas within the bowel wall of the right colon and branching gas over the liver, with no free gas under the diaphragm. He is haemodynamically stable. What is the next best step?
1. AStop feeds, NG decompression and IV antibiotics
2. BContrast enema to confirm
3. CEmergency laparotomy
4. DContinue feeds with probiotics
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Answer: A · Stop feeds, NG decompression and IV antibiotics
Gas in the bowel wall (pneumatosis intestinalis) with portal venous gas in a fed preterm baby is definite necrotising enterocolitis. Without free gas or deterioration it is treated medically: feeds are stopped, the stomach is decompressed with a nasogastric tube, IV fluids or parenteral nutrition are given, and broad-spectrum IV antibiotics are started, with serial X-rays every few hours. Pneumoperitoneum (perforation) or clinical deterioration despite treatment are the indications for surgery. Breast milk feeding reduces the risk.
- B: A contrast enema can perforate inflamed bowel and is avoided in acute NEC.
- C: Surgery is for perforation or worsening despite medical care; neither is present yet.
- D: Feeding must stop in suspected NEC; continuing worsens bowel injury.
Question 4 · Medium
A 14-month-old boy from an urban slum has been fed only boiled, diluted cow's milk. He cries when his legs are touched and lies with the legs in a frog position, refusing to move them. His gums around the erupted teeth are swollen and bleed. X-ray of the knees shows ground-glass osteopenia, a dense white line at the metaphysis, a dense ring around the epiphysis and small metaphyseal spurs. What is the most likely diagnosis?
1. AScurvy
2. BNon-accidental injury
3. CAcute osteomyelitis
4. DNutritional rickets
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Answer: A · Scurvy
Painful pseudoparalysis, bleeding gums and these knee X-ray signs are infantile scurvy. Boiling destroys vitamin C, and cow's milk is already poor in it. The dense metaphyseal line is the white line of Frankel, the ring around the epiphysis is the Wimberger ring, and the spurs are Pelkan spurs; subperiosteal bleeds calcify as they heal. Oral vitamin C brings rapid relief of pain.
- B: Abuse gives fractures of different ages, not generalised osteopenia with bleeding gums.
- C: Osteomyelitis is usually one bone with fever and local signs.
- D: Rickets shows cupped, frayed and widened metaphyses, not a dense white line.
Question 5 · Medium
A newborn baby with upslanting eyes, a single palmar crease and low muscle tone starts bilious vomiting within hours of birth. The abdomen is not distended. His mother had polyhydramnios. A plain abdominal X-ray shows two large gas bubbles in the upper abdomen and no gas further down the bowel. What is the most likely diagnosis?
1. AHypertrophic pyloric stenosis
2. BJejunal atresia
3. CDuodenal atresia
4. DMidgut volvulus with malrotation
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Answer: C · Duodenal atresia
The double bubble sign, air in the stomach and the dilated proximal duodenum with no distal gas, is typical of duodenal atresia. It is strongly associated with Down syndrome and causes polyhydramnios because the fetus cannot absorb swallowed amniotic fluid. Vomiting is usually bilious because most atresias lie below the ampulla of Vater. Treatment is gastric decompression, fluids and duodenoduodenostomy.
- A: Pyloric stenosis causes non-bilious vomiting at 3-6 weeks, not at birth.
- B: Jejunal atresia shows three or more dilated bubbles and a distended abdomen.
- D: Volvulus usually shows some distal gas and needs urgent contrast study or surgery.
Question 6 · Hard
A 28-year-old motorcyclist hits a truck. On arrival his pulse is 118/min and BP 88/60 mmHg; he has tender left lower ribs. After 1 litre of warm crystalloid his pulse settles to 92/min and BP to 118/76 mmHg, and it stays stable. FAST shows free fluid in the splenorenal recess. What is the next best step?
1. AContrast-enhanced CT abdomen
2. BDiagnostic peritoneal lavage
3. CImmediate laparotomy
4. DRepeat FAST and discharge if normal
Answer and explanation in LearnFree account
Question 7 · Medium
A 38-year-old man with heavy alcohol use is admitted with severe epigastric pain radiating to the back. Serum lipase is 6 times the upper limit of normal and ultrasound shows no gallstones. On the day of admission the resident asks for a contrast-enhanced CT to grade severity. What is the most appropriate imaging plan?
1. ACECT now to grade the severity
2. BMRCP now to look for duct stones
3. CERCP within 24 hours
4. DCECT after 72 hours if he does not improve
Answer and explanation in LearnFree account
Question 8 · Easy
A 16-year-old fast bowler at a cricket academy has had low back pain for 3 months, worse on bending backwards. Neurological examination is normal. An oblique X-ray of the lumbar spine shows a lucent band across the neck of the Scottie dog at L5, and the lateral view shows no forward slip. What is the diagnosis?
1. ATuberculous spondylitis
2. BSpondylolisthesis of L5
3. CSpondylolysis of L5
4. DProlapsed L5-S1 disc
Answer and explanation in LearnFree account
Question 9 · Medium
A 56-year-old woman with poorly controlled diabetes (HbA1c 11.8%) has fever, left flank pain, vomiting and confusion for 3 days. BP is 90/60 mmHg and urine is full of pus cells. Non-contrast CT shows gas within the left renal parenchyma extending into the perinephric space, with no stone or obstruction. What is the most likely diagnosis?
1. APerinephric abscess from a stone
2. BEmphysematous pyelonephritis
3. CEmphysematous cystitis
4. DXanthogranulomatous pyelonephritis
Answer and explanation in LearnFree account
Question 10 · Medium
A 35-year-old shepherd from Himachal Pradesh has dull right upper abdominal pain for 6 months. Ultrasound shows a 9 cm cyst in the right lobe of the liver containing wavy membranes floating within the fluid. Serology is pending. What is the most likely diagnosis?
1. ABiliary cystadenoma
2. BSimple hepatic cyst
3. CHydatid cyst
4. DAmoebic liver abscess
Answer and explanation in LearnFree account
Question 11 · Medium
A 29-year-old woman with known ulcerative colitis has had 12 bloody stools a day for a week. She now has a temperature of 38.9 °C, pulse 122/min, a distended, tender abdomen and Hb 9.1 g/dL. Plain abdominal X-ray shows the transverse colon dilated to 8 cm, with loss of haustra and irregular islands of mucosa. What is the most likely diagnosis?
1. AIschaemic colitis
2. BAcute colonic pseudo-obstruction
3. CToxic megacolon
4. DSigmoid volvulus
Answer and explanation in LearnFree account
Question 12 · Medium
A 9-month-old boy has had bouts of screaming with drawing up of the legs for 12 hours, between which he is pale and quiet. He has vomited twice and has passed a red, jelly-like stool. He is haemodynamically stable with no peritonitis. Ultrasound shows a target-like mass in the right upper abdomen. What is the next best step?
1. AIV fluids and observation alone
2. BBarium meal and follow-through
3. CImmediate laparotomy
4. DEnema reduction under imaging guidance
Answer and explanation in LearnFree account
Question 13 · Medium
A 56-year-old man who drinks beer daily has had attacks of a hot, swollen right big toe for 8 years, treated only with painkillers. He now has firm, chalky nodules over the toe and on the helix of the ear. X-ray of the foot shows well-defined punched-out erosions at the first metatarsophalangeal joint with sclerotic, overhanging edges; the joint space is fairly well kept and bone density is normal. What is the most likely diagnosis?
1. ACalcium pyrophosphate arthropathy
2. BRheumatoid arthritis
3. CChronic tophaceous gout
4. DPsoriatic arthritis
Answer and explanation in LearnFree account
Question 14 · Easy
A 42-year-old woman has had episodes of right upper abdominal pain after fatty meals for 4 months, each lasting about an hour. She has no fever or jaundice, and she is pain-free and well between the episodes. What is the best initial investigation?
1. AUltrasound of the abdomen
2. BContrast-enhanced CT abdomen
3. CHIDA scan
4. DPlain abdominal X-ray
Answer and explanation in LearnFree account
Question 15 · Medium
CT of a man who drank arrack for twenty years is shown; he has recurrent epigastric pain radiating to the back, greasy stools and new diabetes, with the arrow marking the relevant organ. Serum lipase is 42 U/L (reference below 60). Which test best documents the likely functional deficit at this stage?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. AFaecal elastase-1
2. BUrinary 5-HIAA
3. CSweat chloride
4. DSerum amylase
Answer and explanation in LearnFree account
Question 16 · Medium
MR enterography of a college student with eight months of diarrhoea, right lower abdominal pain, weight loss and a perianal fistula is shown; a long diseased segment is circled. Faecal calprotectin is 820 µg/g (reference below 50). If a barium follow-through were done, which sign would this narrowed segment most likely give?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. ABird-beak sign
2. BString sign of Kantor
3. CApple-core lesion
4. DLead-pipe colon
Answer and explanation in LearnFree account
Question 17 · Medium
A fast bowler in a school cricket team in Thalassery has had low back pain for three months, worse on arching backwards and better with rest. Straight leg raising is normal and there is no neurological deficit. A sagittal CT of his lumbosacral spine is shown. Which appearance would an oblique lumbar radiograph be expected to show at this level?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. AHot cross bun sign
2. BWinking owl sign
3. CInverted Napoleon hat
4. DCollar on the Scotty dog
Answer and explanation in LearnFree account
Question 18 · Medium
Regurgitation of undigested food at night and dysphagia to both liquids and solids have progressed over two years in a teacher from Palakkad, with 7 kg of weight loss. Upper GI endoscopy shows no mucosal tumour at the cardia. The barium swallow is shown. Which test confirms the diagnosis?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. AContrast-enhanced CT of the thorax
2. BRadionuclide gastric emptying study
3. CHigh-resolution oesophageal manometry
4. D24-hour oesophageal pH monitoring
Answer and explanation in LearnFree account
Question 19 · Medium
After an old appendicectomy, a patient vomits bile with colicky pain. Which feature on the film shown marks these dilated loops as small bowel?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. AFeatureless, smooth, tube-like walls
2. BFolds crossing the full lumen
3. CHaustra crossing part of the lumen
4. DThumbprinting along the bowel wall
Answer and explanation in LearnFree account
Question 20 · Easy
A newborn with upslanting palpebral fissures and a single palmar crease has bilious vomiting from the first hours of life in a district hospital labour room. There was maternal polyhydramnios, the lower abdomen stays flat, and the erect film below shows no gas beyond the two air-fluid levels. Which condition does this film indicate?
Figure: Photo: Hellerhoff, CC BY-SA 4.0, via Wikimedia Commons
1. ADuodenal atresia
2. BDistal ileal atresia
3. CHypertrophic pyloric stenosis
4. DHirschsprung disease
Answer and explanation in LearnFree account
Question 21 · Hard
Steroids were given for six weeks at a high dose to a renal transplant recipient two years ago, and since then he has had right groin pain on walking. The film of that hip is shown. Radiographs of the opposite hip remain normal, yet he now has a dull ache there too, with mild restriction of internal rotation. The orthopaedic team wishes to detect the disease in this second hip at the earliest possible stage, while joint-preserving treatment is still an option for him. Which investigation is the most sensitive?
Figure: Photo: Timcoughlin, CC BY-SA 3.0, via Wikimedia Commons
1. AMRI of both hips
2. BDoppler ultrasound of the hip
3. CRepeat plain radiographs
4. DCT of the pelvis
Answer and explanation in LearnFree account
Question 22 · Hard
An incidental finding in a nurse aged 41 years, this proximal femoral lesion appeared on a film taken after a minor fall from a stool. She has had no pain, night symptoms or swelling before or since the fall, and the clinical examination is normal. The radiologist notes no cortical destruction, no periosteal reaction, no soft-tissue mass and endosteal scalloping of less than half the cortex. Bone scan and blood counts have not been sent. Serum calcium and alkaline phosphatase are normal, and she has no history of cancer. She is anxious and asks whether it must be removed. What is the most appropriate step?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. ACurettage followed by adjuvant radiotherapy
2. BWide en-bloc resection with endoprosthetic replacement
3. CPeriodic clinical and radiographic follow-up
4. DImmediate percutaneous needle biopsy of the matrix
Answer and explanation in LearnFree account
Question 23 · Medium
Bouts of screaming with drawing up of the legs, separated by quiet spells, began twelve hours ago in a boy of 8 months brought to a medical college casualty. He has passed a red jelly-like stool. After fluid resuscitation he is alert, with a soft abdomen and no fever, and the transverse ultrasound of the right abdomen is shown. What should be done next?
Figure: Photo: Cerevisae, CC BY-SA 4.0, via Wikimedia Commons
1. AAir or hydrostatic enema reduction
2. BColonoscopic reduction under sedation
3. CImmediate exploratory laparotomy
4. DNasogastric drainage and 24-hour observation
Answer and explanation in LearnFree account
Question 24 · Medium
A child of 6 years from Thiruvananthapuram has limped for two months with mild thigh pain, and hip abduction and internal rotation are limited on the right. There is no fever, ESR is 12 mm/h and the film is shown with the right hip on the left of the image. What is the underlying process?
Figure: Photo: Hellerhoff, CC BY-SA 4.0, via Wikimedia Commons
1. ADevelopmental dysplasia of the hip
2. BSeptic arthritis of the hip
3. CSlipped capital femoral epiphysis
4. DEpiphyseal avascular necrosis
Answer and explanation in LearnFree account
Question 25 · Medium
On a routine ultrasound for vague right upper abdominal discomfort, an elderly woman in Kozhikode has a strongly echogenic gallbladder wall with shadowing, and CT is then done as shown. Liver enzymes are normal and she has no fever. Which complication has this appearance traditionally been linked with?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. ALiver abscess
2. BMirizzi syndrome
3. CBouveret syndrome
4. DGallbladder carcinoma
Answer and explanation in LearnFree account

9 more Abdominal and musculoskeletal imaging signs questions

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Abdominal and musculoskeletal imaging signs

A 35-year-old shepherd from Himachal Pradesh has dull right upper abdominal pain for 6 months. Ultrasound shows a 9 cm cyst in the right lobe of the liver containing wavy membranes floating within the fluid. Serology is pending. What is the most likely diagnosis?

A 42-year-old woman has had episodes of right upper abdominal pain after fatty meals for 4 months, each lasting about an hour. She has no fever or jaundice, and she is pain-free and well between the episodes. What is the best initial investigation?

Regurgitation of undigested food at night and dysphagia to both liquids and solids have progressed over two years in a teacher from Palakkad, with 7 kg of weight loss. Upper GI endoscopy shows no mucosal tumour at the cardia. The barium swallow is shown. Which test confirms the diagnosis?

After an old appendicectomy, a patient vomits bile with colicky pain. Which feature on the film shown marks these dilated loops as small bowel?

A child of 6 years from Thiruvananthapuram has limped for two months with mild thigh pain, and hip abduction and internal rotation are limited on the right. There is no fever, ESR is 12 mm/h and the film is shown with the right hip on the left of the image. What is the underlying process?