EXAM 5

Question 1

CHEST

An 18-year-old girl with chronic cough and recurrent chest infections shows symmetrical upper lobe predominant varicoid and cystic bronchiectasis on HRCT Review of older abdominal plain films shows calcification across the central upper abdomen at the T12/L1level. What is the likely diagnosis?
A. Cystic fibrosis (CF)
B. Sarcoidosis
C. William-Campbell syndrome
D. ABPA
E. Kartagener’s syndrome

Answer 1

A. Cystic fibrosis (CF)
The classic diagnostic triad in patients with cystic fibrosis includes an abnormal sweat chloridetest result and manifestations of pulmonary and pancreatic disease. Upper lobe predominance is seen in many but not all cases; a diffuse distribution is also common. Normal to increased lung volumes are typical in CF and indicate air trapping and small airways disease. CT images show extensive cystic and cylindrical bronchiectasis and bronchial wall and peribronchial interstitial thickening. Findings are typically more extensive in patients with bronchiectasis due to cystic fibrosis than in patients with bronchiectasis due to other causes. Nodular opacities throughout the lungs correlate with areas of mucoid bronchial or bronchiolar impaction. Tree in bud nodules indicate the diffuse bronchiolitis that typically occurs in cystic fibrosis. In addition, a mosaic pattern of attenuation secondary to air trapping due to obstructed bronchi and bronchioles is commonly seen.

Question 2

GIT

A 53-year-old woman with upper abdominal discomfort was sent for an abdominal US,which showed a hypoechoic mass in the pancreas. A CT was performed, which reported apossible serous cystadenoma. Which one of the following statements regarding serouscystadenomas of the pancreas is true?
A. They are rich in mucin.
B. They are rich in glycogen.
C. They have malignant potential.
D. They appear only as a unilocular cyst on CT.
E. They are more common in men than in women.

Question 2

CNS

A 2-year old boy with proptosis and cats eye was investigated with CT for persistentheadache. Axial images showed a densely calcified mass replacing the right eyeball. The opticnerve was also calcified and surrounded by tumour, which had replaced most of theperiorbital fat. The optic canal was expanded with extension of the mass in the middle cranialfossa. What is the diagnosis?
A. Malignant melanoma of the choroid
B. Rhabdomyosarcoma
C. Coats’ disease
D. Neuroblastoma metastasis
E. Retinoblastoma

Question 2

GU

A 29-year-old woman with three previous miscarriages, not explained by any hormonal,biochemical or metabolic abnormality, was being investigated for a structural cause to explainthe recurrent miscarriage. A pelvic MRI was scheduled, as it was the most definitiveinvestigation for congenital structural anomalies and/or uterine masses. Which one of thefollowing descriptions would suggest the diagnosis of uterus didelphys?
A. Two separate uterine cavities with two cervices and two proximal vagina
B. Two separate uterine cavities with two cervices
C. Two separate uterine horns with common uterine cavity, with one cervix
D. External indentation of the uterine fundus with one uterine cavity
E. Single uterine horn connected to a single fallopian tube

Question 3

MSK

With regard to stress fractures affecting the lower limb in athletes, all of the following statements are correct, except
A. Anterior tibial stress fractures have a higher propensity of non-union.
B. Fibular stress fractures affect the proximal end.
C. Femoral stress fractures can affect the neck or shaft.
D. ‘Female athlete triad’ is associated with femoral and sacral fractures.
E. Tibial stress fracture can be transverse or longitudinal.

Question 4

MSK

A 3-year-old girl is referred to an endocrine clinic with unilateral jaw swelling noted at the dentist. Her general practitioner has also reported that she has signs of precocious puberty. An X-ray of the facial bones demonstrates expansion of the frontal bone and right side of the mandible. She is likely to have which other associated condition?
A. Neurofibromatosis
B. Madelung deformity
C. Lisch nodule
I). Hyperthyroidism E. Hypothyroidism

Question 5

CHEST

A 35-year-old man known to the ENT for sinonasal disease presents to the chest clinic with productive cough. The house officer examining the patient struggled to hear the heart sounds properly. HRCT, among other findings, shows left lower lobe bronchiectasis without any central endobronchial mass to explain the focal bronchiectasis. What is the
likely diagnosis?
A. Cystic fibrosis (CF)
B. Sarcoidosis
C. William-Campbell syndrome
D. Allergic bronchopulmonary aspergillosis (ABPA)
E. Kartagener’s syndrome

Question 6

GIT

A 56 year old man with gallstone pancreatitis is referred for a CT of the abdomen. The CT shows multiple cysts around the tail of the pancreas with further cysts in the lesser sac and left paracolic gutter. These are reported as pseudocysts. Which one of the following statements regarding pancreatic pseudocysts is false?
A. They usually take 4-6 weeks to mature.
B. They can be multiple.
C. They have an epithelial lining.
D. They may communicate with the pancreatic ductal system.
E. They may be extrapancreatic in location.

Question 7

GIT

A woman who was 20 weeks pregnant was referred to the US department by her midwife for a routine anomaly scan. The scan was reported as showing features consistent with congenital diaphragmatic hernia. All of the following are prenatal US findings suggestive of a diaphragmatic hernia, except
A. Failure to visualise the stomach in the left upper quadrant
B. Cardiac dextroposition
C. Echogenic mass in the left hemithorax
D. Compressed left lung
E. Increased abdominal circumference

Question 8

MSK

A 52-year-old woman presents to the orthopaedic outpatient clinic with a painful forefoot. On examination, there was a painful response elicited by Mulder’s manoeuvre. Which one of the following statements concerning Morton neuromas m the forefoot is false?
A. They are often seen in young and middle-aged women.
B. The inter space between the third and fourth toes is the most commonly affected site.
C. The characteristic MR finding is a nodule with low signal intensity on T1W images.
D. Ultrasound is a sensitive modality in identifying the lesion.
E. Gradient echo MR sequences elicit blooming artefact in the lesion.

Question 9

CNS

A 54-year-old man with suspicious findings on US was recommended for an MRI of the orbits for further evaluation. Sagittal MR images of the globe showed a focal area of thickening in the posterior aspect of the globe with hyperintense signal on T1W sequence and strongly hvpointense signal on T2W sequence. What is the diagnosis?
A. Malignant melanoma of the choroid
B. Rhabdomyosarcoma
C. Coats’ disease
D. Neuroblastoma metastasis
E. Retinoblastoma

Question 10

CHEST

A previously healthy 9 month-old is admitted with tachypnoea and fever. His white cell count and neutrophils are elevated. His temperature is 39.2°C. An AP CXR demonstrates a well-defined
5 cm rounded lung opacity with well-formed borders. What is the most likely diagnosis?
A. Bronchogenic cyst
B. Pulmonary metastases
C. Neuroblastoma
D. Congenital cystic adenomatoid malformation
E. Round pneumonia

Question 10

CHEST

A 77-year-old man with chronic inflammatory disease and renal failure is known to have secondary amyloidosis. All of the following are features of amyloid involvement of the respiratory system, except
A. Interstitial septal thickening
B. Cavitating nodules
C. Focal amyloidoma
D. Calcification of central airways
E. Calcification in peripheral consolidation

Question 10

GIT

An US of the abdomen in a 43-year-old woman with a known underlying chronic condition demonstrates small cysts in the pancreas. She is sent for a dual phase CT for further characterisation. The scan shows multiple true cysts with no obvious suspicious features. Which one of the following conditions is associated with true pancreatic cysts?
A. Tuberous sclerosis
B. Von Hippel-Lindau disease
C. Neurofibromatosis Type 1
D. Autosomal recessive polycystic kidney disease
E. Multiple neuroendocrine neoplasia

Question 10

PEDS

A woman who is 22 weeks pregnant is referred for routine anomaly scan to the US department. US shows that the ventricular atrium measure 14 mm at the level of the posterior margin of the glomus of the choroids plexus on an axial plain through the level of the thalami. What is the next appropriate step?
A. Repeat US in 4 weeks.
B. Amniocentesis.
C. Foetal MRI.
D. Check maternal oestradiol levels.
E. It is a normal finding.

Question 11

MSK

Which of the following is not a recognised radiographic finding in a patient with haemochromatosis?
A. Chondrocalcinosis
B. Arthropathy with iron deposition in the synovium
C. General used increased hone density
D. Joint space narrowing
E. Osteophyte formation

Question 12

CHEST

A 9-year-old girl with a long history of cough, wheeze, sinusitis, headache and weight loss presented to the GP with an acute history of increasing breathlessness. Sweat test analysis shows 80 mmol/L of sodium chloride in forearm sweat (normal less than 40 mmol/L). All of the following are typical features on a chest X-ray, except
A. Hyperinflation
B. Bronchial dilatation
C. Cystic areas in the lung
D. Linear interstitial opacities
E. Dextrocardia

Question 13

CNS

A 55 year old woman with asymmetrical bilateral proptosis is referred for an orbital MRI to exclude retro orbital mass lesions. MRI reveals diffuse swelling of all extraocular muscles, with the swelling primarily involving the belly of the muscle without involvement of the tendinous insertions. The muscles are isointense to normal in signal on T1W images and hypointense on T2W images. What is the diagnosis?
A. Orbital pseudotumour
B. Thyroid ophthalmopathy
C. Lymphoma orbit
D. Steroid therapy
E. Obesity

Question 14

CHEST

A 62 year-old man with progressive cough and shortness of breath has bilateral patchy ground-glass change with areas of dependent and non-dependent septal thickening in
the basal lung zones on HRCT. Which of the following is incorrect about drug-induced lung disease?
A. Diffuse alveolar damage occurs with Gold.
B. Chronic nitrofurantoin toxicity results in high-density consolidation.
C High-density liver is seen in amiodarone toxicity.
D. There is no correlation between dose of methotrexate and toxicity.
E. NSIP is generally the most common change on HRCT.

Question 14

GIT

A 50-year-old man is sent for an urgent contrast CT of the abdomen following a history of abdominal pain. The CT is unremarkable apart from inflammatory stranding in the omentum. All of the following are clinical features of omental infarction, except
A. Occurrence in patients of all ages
B. Massive rectal bleeding
C. Slightly higher incidence in men
D. Acute right-sided abdominal pain
E. Rarely, a palpable mass at the site of abdominal pain

Question 15

CNS

A 7-year-old girl with several noticeable skin lesions and reduced unilateral visual acuity, showed fusiform swelling of the optic nerve on a CT of the head performed out of hours, after a fall down a flight of stairs. MRI orbits revealed a thickened optic nerve with signal intensity similar to grey matter on T1W and T2W images, with a variable amount of contrast enhancement. What is the underlying phacomatosis?
A. Neurofibromatosis type 2
B. Neurofibromatosis type 1
C. Von Hippel-Lindau disease
D. Tuberous sclerosis
E. Down’s syndrome

Question 16

PED

Foetal MRI usually is performed in a scanner with a magnet strength of
A. 0.5 Tesla
B. 1.5 Tesla
C. 1 Tesla
D. 3 Tesla
E. 0.1 Tesla

Question 16

CNS

A patient arrives in the A&E department having been involved in a road traffic collision. He is haemodynamically stable. The Glasgow Coma Scale (GCS) at the scene was 14. On arrival in A&E, he is found to have a bruised left forehead. He suddenly becomes unresponsive, with a GCS of 4, and is intubated. As the on-call radiologist you are called to perform a head CT. Which of the following would make an epidural haemorrhage least likely?
A. Biconvex hyperdensity
B. Overlying skull fracture
C. Crossing of suture line
D. Homogenous fluid of 50 HU
E. Homogenous fluid of 80 HU

Question 16

CNS

A 12-month old presents with loss of appetite, fever and shortness of breath. Chest X-ray demonstrates a well-circumscribed paraspinal mass with a sharp pleuro-pulmonary surface. There is some calcification within the mass and the intercostal space at that level is widened. What is the most likely diagnosis?
A. Bronchogenic cyst
B. Neuroblastoma
C. Ganglioneuroma
D. Left lower lobe pneumonia
E. Teratoma

Question 17

# **PED** Foetal MRI is most commonly organised to evaluate inconclusive but potentially significant findings detected on ultrasound or to characterise definite abnormality detected on anomaly scan. Which one of the following MR imaging sequences is the most popular for foetal imaging? A. Fast spin echo T1W images B. STIR C. Fat suppressed T1W images D. Single-shot, fast spin echo (SS FSE) T2W images E. FLAIR

Question 18

# **CNS** A 45-year-old man with proptosis of the right eye is referred for an MRI for further evaluation. MRI reveals uniform swelling involving all the extraocular muscles and a markedly dilated superior ophthalmic vein. What is the likely diagnosis? A. AVM of the optic nerve B. Carotid-cavernous fistula C. Haemangioma D. Lymphatic malformation of the orbit E. Thyroid ophthalmopathy

Question 19

# **CHEST** A 4 day-old infant presents with poor feeding and lethargy. She was bom at term following premature rupture of membranes. Chest X-ray demonstrates bilateral patchy infiltrates with small effusions. What is the most likely diagnosis? A. Hyaline membrane disease B. Meconium aspiration C. Transient tachypnoea of the new-born D. Group B streptococcal pneumonia E. Congenital listeriosis

Question 20

# **CHEST** All the following statements regarding HRCT changes in cytotoxic drug-induced lung disease are true, except A. Bleomycin toxicity has a poor prognosis. B. Paclitaxel is associated with pulmonary injury. C. There is no correlation between carmustine dose and toxicity. D. Diffuse alveolar damage (DAD) is the most common manifestation. E. Bleomycin toxicity can be increased by concomitant oxygen therapy.

Question 21

# **GIT** 66-year-old person is sent for an urgent CT of the abdomen post-contrast. The CT is unremarkable apart from inflammatory stranding in the omentum. No peritoneal nodules or ascites are detected on the CT and the report states possible omental infraction. All of the following are expected to be seen on the CT, except A. Cake-like or whorled structure of mixed attenuation B. Small amount of free peritoneal fluid C. The fat-ring sign D. Minimal reactive lymphadenopathy E. Haziness of the fat anterior to the colon

Question 22

# **MSK** A skeletal survey is performed on a 2-year-old boy with short stature. The lateral film of the spine reveals abnormal vertebral bodies with a central anterior ‘beak' and generalised flattening. Radiographs of the hands shows a pointed proximal fifth metacarpal base with a notch at the ulnar aspect. Which of the following is the most likely diagnosis? A. Hunter syndrome B. Hurler syndrome C. Morquio syndrome D. Achondroplasia E. Nail-patella syndrome

Question 22

# **CHEST** Which one of the following statements regarding rheumatoid arthritis-associated thoracic manifestation is true? A. Thoracic involvement occurs early in the disease. B. Pleural effusions is usually bilateral. C. COP is a recognised pattern on HRCT in rheumatoid lungs. D. Fibrosis mostly affects the upper lobes. E. Cavitation in nodules suggests some other disease.

Question 22

# **GIT** A 39-year-old hypotensive man involved in an RTA was sent for an urgent CT of the abdomen and pelvis to evaluate for solid organ or bowel injury. Which one of the following statements concerning imaging in blunt trauma to the liver is false? A. Non-surgical treatment has become the standard of care in haemodynamically stable patients with blunt liver trauma. B. Hepatic lacerations demonstrate jagged edges. C. CT is the diagnostic modality of choice for the evaluation of blunt liver trauma in haemodynamically stable patients. D. CT features of blunt liver trauma include lacerations, subcapsular or parenchymal hematomas, active haemorrhage, juxta-hepatic venous injuries, periportal low attenuation and a Hat inferior vena cava. E. Follow up MRI is required in patients with high-grade liver injuries to identify potential complications that require early intervention.

Question 22

# **CNS** A 45 year old man with proptosis of the right eye is referred for an MRI for further evaluation. MRI reveals a moderately large, well-defined intraconal retrobulbar mass, which is isointense to muscle on T1W images and markedly hyperintense to fat on T2W images. What is the most likely diagnosis? A. Retinoblastoma B. Rhabdomyoma C. Haemangioma D. Orbital pseudotumour E. Metastatic lymphoma

Question 23

# **GU** A 32-year old woman is referred by her family doctor to the gynaecology clinic with history of congestive dysmenorrhoea, dyspareunia, fever and vaginal discharge. She had used a coil regularly in the past, which was later discontinued due to recurrent bouts of pelvic inflammation. Which one of the following statements concerning pelvic inflammatory disease is false? A. Pyosalpinx can have a high Tl signal. B. A tubular, fluid-filled structure with enhancing walls suggests pyosalpinx. C. Delay in treatment can lead to tubo ovarian abscess. D. Intense enhancement of inflamed areas on contrast-enhanced T1W MRI. E. High signal m inflammatory stranding in peritubal fat on Tl fat-suppressed images.

Question 24

# **MSK** A 40-year-old woman with short stature presents with early-onset hearing loss. Diagnostic workup reveals micromelic dwarfism, diffuse demineralisation and thinning of cortical bone, mild scoliosis and old fractures of the vertebral bodies and long bones. There was evidence of poor dentition. Which of the following is the most likely diagnosis? A. Hypophosphatasia B. Osteogenesis imperfecta C. Paget disease D. Osteoporosis E. Achondroplasia

Question 25

# **CHEST** A macrosomic neonate (secondary to maternal diabetes) is noted to be in mild respiratory distress following delivery by caesarean section (CS). A chest X-ray demonstrates mild cardiomegaly mild hyperexpansion and small pleural effusions of the lungs. No focal lung abnormality is seen. What is the most likely diagnosis? A. Respiratory distress syndrome B. Meconium aspiration C. Staphylococcal pneumonia D. Group B streptococcal pneumonia E. Transient tachypnea of the newborn

Question 26

# **GIT** A 6-year-old child is admitted to the emergency department presenting with diffuse abdominal pain, arthralgia and bilateral lower limb palpable purpura. Which of the following findings on an abdominal US examination is least expected? A. Ileocaecal intussusception B. Bowel wall thickening C. Multifocal hepatic lesions D. Bilaterally enlarged, echogenic renal cortices E. Ascites

Question 27

# **MSK** All of the following are musculoskeletal manifestations of rheumatoid arthritis that can be seen on chest radiographs, except A. Subacromial abutment of humeral head B. Superior rib notching C. Global loss of shoulder joint space D. Erosion of medial aspect of clavicle E. Erosion superolaterally in the humeral head

Question 28

# **GIT**

Question 28

# **GU**

Question 28

# **MSK** A 6-year-old boy presents with increasing pain within his upper back, which came on insidiously over a few weeks. The child is otherwise well. A radiograph of his thoracic spine reveals collapse of the T9 vertebral body. The disc spaces are preserved; there is no kyphosis, and no involvement of the posterior elements. Which of the following is the most likely diagnosis? A. Ewing’s sarcoma B. Metastasis C. Tuberculosis D. Fracture E. Eosinophilic granuloma

Question 28

# **CNS** A 6-year-old boy presents with progressive proptosis of the right eye. CT shows a homogenous hypodense mass in the upper outer corner of the right orbit associated with thinning of the roof. No infiltration of the surrounding fat is evident. On MRI, the mass returns a similar signal to that of orbital fat and showed thin ring enhancement. What is the diagnosis? A. Lymphoma B. Pleomorphic adenoma of lacrimal gland C. Epidermoid cyst D. Dermoid cyst E. Sebaceous cyst

Question 28

# **CNS** A 42-year-old man presented with right-sided proptosis with mass in the inner canthus of the eye. An axial CT scan showed soft tissue density and expansion of the right anterior ethmoid air cells bulging into the orbit. The extraocular muscles were displaced but not involved. What is the diagnosis? A. Encephalocoele B. Anterior ethmoid mucocoele C. Destructive midline granuloma D. Wagner's disease E. Esthesioneuroblastoma

Question 29

# **CHEST** A 62-year-old man, who has undergone solid organ transplant, is found to be profoundly neutropaenic and presents with progressive fever, cough and shortness of breath. He is acutely unwell. Chest X-ray shows bilateral patchy air space opacities and bronchoalveolar lavage showed Aspergillus organisms. HRCT is organised to confirm pulmonary invasive aspergillosis. All the following are typical imaging features, except: A. Nodules with surrounding ground-glass change B. Pulmonary sequestra C. Peripheral wedge shaped consolidation D. Air crescent sign E. Central bronchiectasis

Question 30

# **PEDS** A 2-year-old child presents with fever, erythema of the oral mucosa with chest and abdominal pain. Echocardiography reveals the presence of a coronary arterial aneurysms. An underlying vasculitis is suspected. Which of the following statements is least accurate in this clinical setting? A. Aneurysms are typically seen in the proximal segments of the coronary arteries. B. Aneurysms less than 5 mm in diameter are considered small. C. Smaller aneurysms have a higher likelihood of thrombosis. D. Multiple coronary artery aneurysms are more common than isolated aneurysms. E. The most common site for a coronary aneurysm is in the left anterior descending artery.

Question 31

# **GIT** A 61 -year old man with difficulty in swallowing was sent by his family doctor for a barium swallow. The examination showed a smooth filling defect in the mid lower oesophagus with minor hold up of contrast and proximal oesophageal dilatation. CT performed for further evaluation did not show any extra oesophageal organ involvement or lymphadenopathy. The most common mesenchymal tumour of the oesophagus is A. Lipoma B. Gastrointestinal stromal tumour C Haemangioma D. Leiomyosarcoma E. Leiomyoma

Question 32

# **GU** A 22 year old woman who had undergone a caesarean section presents with cyclic voiding symptoms hut no haematuria. Cystoscopy shows a filling defect and MRI is performed. Axial T2W MRI shows hypointense irregular focal wall thickening on the left posterolateral aspect of the bladder, without any fat stranding or associated lymph nodes, suggesting intrinsic bladder endometriosis. Which of the following statements is false, regarding deep pelvic endometriosis? A. Subperitoneal invasion of endometriotic tissue must exceed 5 mm. B. Endometriotic nodules can have high T2W' signal. C. Low signal nodular thickening of utcrosacral ligament on T2W images. D. Ureteric endometriosis is mostly intrinsic. E. Obliteration of pouch of Douglas is recognised in advanced disease.

Question 32

# **MSK** A 7 year-old boy fell off a bike onto his outstretched left hand. X-ray showed a fracture of the left distal radius involving the epiphyseal plate that extends into the metaphysis. The epiphysis was split into two fragments. What is the Salter-Harris classification? A. 1 B. 2 C. 3 D. 4 E. 5

Question 33

# **CHEST** An 81-year-old man with bilateral calcified and uncalcified pleural plaques, basal predominant fibrotic lungs and unilateral pleural effusion is sent for a CT scan with high suspicion of primary pleural mesothelioma. CT and pleural fluid aspirate confirmed mesothelioma. Which of these is not a feature of unresectability? A. Extension into peritoneal cavity B. Involvement of endothoracic fascia C. Pericardial involvement D. Multiple sites of extension into the chest wall E. Direct extension into the ribs and spine

Question 34

# **GIT** A 70-year-old man with a history of weight loss and iron deficiency anaemia is referred for a CT colonography study. There is no malignancy on the scan but a 5 cm cystic structure is seen next to the distal ileum, in keeping with a duplication cyst The most common site of a duplication cyst of the gastrointestinal tract is the A. Oesophagus 13. Stomach C. Duodenum D. Jejunum E. Ileum

Question 35

# **GU** A 33-year-old woman is referred by her family doctor to the infertility clinic for further investigations to identify any potentially treatable cause of infertility. Which one of the following statements regarding intracavitary uterine abnormalities as a cause of infertility is false? A. Uterine synechiae is a complication of D&C. B. Synechiae appear as linear filling defects on HSG. C. Submucosal leiomyomas distort endometrial cavity. D. Submucosal leiomyomas can obstruct fallopian tubes. E. Cervical factor infertility is the most common cause of infertility.

Question 35

# **CHEST** A 45-year-old man with ulceration of the nasal septum was investigated further with CT sinuses. CT showed bone destruction involving the nasal cavity, turbinates and paranasal sinuses without associated soft-tissue masses. Chest radiograph of the same person done to exclude infection showed multiple nodules of varying sizes. A. Churg-Strauss disease B. Ethmoid carcinoma C. Polyarteritis nodosa D. Granulomatosis with polyangitis E. Leprosy

Question 36

# **MSK** A 30-year-old sustains a knee injury while skiing. MRI shows that there is a high signal in the lateral femoral condyle and the posterolateral part of the lateral tibial plateau. What is the most likely injury? A. ACL B. PCL C. MCL D. LCL E. MPFL (Medial patellofemoral ligament)

Question 37

# **CHEST** A 14-year-old girl with chronic constitutional symptoms and sinonasal disease presents to the outpatient department. A CT of the paranasal sinuses reveals diffuse sinusitis and thickening of the paranasal sinus walls. On a plain chest radiograph, a cavitating pulmonary lesion is identified. Which of the following vasculitides would be the most likely diagnosis? A. Kawasaki’s disease B. Cogan’s syndrome C. Takayasu’s arteritis D. Granulomatosis with polyangiitis E. Polyarteritis nodosa

Question 38

# **CHEST** A 77-year-old man with a high-risk occupational history and progressive limitation of exercise tolerance was sent for a staging CT of the chest to investigate a persistent right-sided pleural effusion. All of the following pulmonary CT features are suggestive of asbestos exposure, except: A. Basal fibrosis B. Calcified pleural plaques C. Diffuse pleural thickening D. Round atelectasis E. High-density consolidation

Question 39

# **GIT** A 65 year old known diabetic woman is acutely unwell and presents with increasing epigastric tenderness. She is referred by the surgeons for an urgent contrast enhanced CT of the abdomen. The CT shows features consistent with emphysematous gastritis. All of the following are expected CT findings, except: A. Air in the stomach wall B. Pneumoperitoneum C. Pneumobilia D. Portal venous gas E. Irregular gastric mucosal fold thickening

Question 39

# **GU** A 31 -year-old woman was referred for a hysterosalpingogram for assessment of tubal anatomy and patency. The left fallopian tube was normal but no pelvic spillage was observed on the right, subject to proximal obstruction of the tube on the right. Which of the following conditions is not a cause of obstruction in the fallopian tube? A. Granulomatous salpingitis B. Intraluminal endometriosis C. Congenital atresia D. Peritubal adhesions E. Tubal spasm

Question 39

# **CNS** A 29-year-old man with history of discharge from the right ear underwent a CT of the temporal bones for further evaluation. Coronal CT images showed enlargement of the epitympanic recess and erosion of the walls and scutum with an associated soft-tissue mass. Only fragments of the ossicular chain could be identified. What is the diagnosis? A. Cholesterol granuloma B. Acquired attic cholesteatoma C. Congenital cholesteatoma D. Carcinoma of the middle car E. Malignant otitis externa

Question 39

# **MSK** An 8-year-old boy presents with a 5-week history of left hip pain and limp. Several previous pelvic X-rays were normal. A bone scan shows reduced uptake in the left femoral epiphysis. A line drawn from the lateral aspect of the femoral neck intersects the femoral head. What is the most likely diagnosis? A. SUFE B. Transient synovitis C. Perthes disease D. Developmental dysplasia of the hip E. Sickle cell disease

Question 39

# **GIT** A 6-year-old boy with abdominal pain and jaundice was sent for a specialist review because the GP identified abnormal LFTs (raised bilirubin, raised AST and ALT). Viral serology for hepatitis B and C were negative. Twenty-four-hour urinary copper excretion was >100 microgram (normal less than 40 microgram). An abnormal ring was noted in the eye on slit lamp examination. All of the following can be seen on US of the abdomen, except: A. Mild hepatomegaly B. Small echogenic liver C. Abnormally large kidneys D. Ascites E. Abnormally large spleen

Question 40

# **PED** A 3-year-old patient with Beckwith-Wiedemann syndrome presents for an abdominal US study. The clinical indication states ‘routine screening for malignancy. Which tumour is not commonly associated with the underlying syndrome? A. Rhabdomyosarcoma B. Wilms tumour C. Neuroblastoma D. Renal rhabdoid tumour E. Hepatoblastoma

Question 40

# **GIT** A 37-year-old woman with known history of inflammatory bowel disease presented to the gastroenterologist with worsening abdominal and systemic symptoms. All of the following extra-intestinal manifestations of inflammatory bowel disease parallel the activity of the disease, except: A. Erythema nodosum B. Enteropathic spondylitis C. Uveitis D. Monoarticular peripheral arthritis E. Pulmonary embolism

Question 40

# **CVS** Which one of the following statements regarding penetrating aortic atherosclerotic ulcers is true? A. They can progress to pseodoaneurysm. B. They are contrast-filled outpouchings surrounded by an intramural hematoma. C. They occur early in atherosclerotic disease. D. They can progress to aortic rupture. E. Intramural haematoma signifies its aggressive nature.

Question 40

# **GU** A 26-year old woman was referred by her family doctor to the infertility clinic for further investigations. She was scheduled to have a transvaginal US evaluation in the radiology department. All of the following are presumptive findings of ovulation on transvaginal ultrasound, except: A. Reduction in size of the dominant follicle B. Continued increase in size of the follicle C. Loss of clearly defined follicular margin D. Appearance of internal echoes in the follicle E. Increased fluid in the pouch of Douglas

Question 41

# **CNS** A 26-year-old man with facial pain shows a large, well-demarcated expansile cystic lesion in the petrous apex with erosion of the internal auditory meatus. No associated erosion of the scutum is identified, and the tympanic membrane is intact. MRI reveals a corresponding high signal lesion on both T1W and T2W sequences. What is the diagnosis? A. Cholesterol granuloma B. Acquired cholesteatoma C. Congenital cholesteatoma D. Carcinoma of petrous temporal bone E. Arachnoid cyst

Question 41

# **MSK** A 6-year-old girl complains of pain in her left shoulder. X-ray shows a lucent lesion in the proximal humeral epiphysis. The lesion has sclerotic borders with specks of calcification within the lesion. What is the most likely diagnosis? A. Simple bone cyst B. Aneurysmal bone cyst (ABC) C. Non-ossifying fibroma D. Fibrous cortical defect E. Chondroblastoma

Question 41

# **GIT** Which one of the following extra-intestinal manifestations of inflammatory bowel disease is more likely to occur in patients with Crohn's disease than in those with ulcerative colitis? A. Sclerosing cholangitis B. Pyoderma gangrenosum C. Gall stones D. Erythema nodosum E. Pulmonary embolism

Question 41

# **CNS** A 33-year-old man presents with conductive hearing loss, pulsatile tinnitus and hoarseness of voice. CT showed erosion of the jugular fossa with upward extension of soft-tissue mass into the middle ear cavity. MRI shows an intermediate signal mass on T1W images with high signal on T2W sequence interspersed with signal voids. Intense enhancement was seen on post gadolinium images. What is the diagnosis? A. Carotid body tumour B. Non-specified skull base tumour C. Neurofibroma of the XII nerve D. Glomus jugulare E. Osteoblastoma of transverse process of C2

Question 41

# **CVS** A 66-year old man with acute onset of chest pain radiating to the back is sent for an urgent post-contrast CT of the chest to exclude aortic dissection. There is no evidence of a dissection or a penetrating aortic ulcer, but the scan is reported as showing an acute intramural haematoma in the descending thoracic aorta. All of the following are characteristic CT findings, except: A. It is subintimal in location. B. It appears as a crescent of high density. C. MRI can help differentiate it from slow flow in false lumen of dissection. D. The aortic wall appears thinned out. E. They can progress to aortic rupture.

Question 42

# **GU** A 27-year-old woman is being investigated for infertility. No anatomical abnormality of the uterus was identified on US examination of the pelvis, and she was referred for f urther investigations to assess tubal patency. Patency of the fallopian tubes is best imaged by: A. MRI B. Transvaginal US C. Hysterosalpingography D. Sonohysterography E. Transabdominal US

Question 43

# **MSK** A 10-year-old girl complains of severe pain in her left hip. Plain X-ray shows there is a 5 mm lucent lesion in the medial femoral neck. On MRI, there is a 2 mm central focus, which is isointense on T1W and high on T2W images. There is surrounding high signal on T2W image. Dynamic imaging reveals peak enhancement on arterial phase with early partial washout of the lesion. There is slower progressive enhancement of the adjacent bone marrow. What is the likely diagnosis? A. Osteoid osteoma B. Osteoblastoma C. Stress fracture D. Cortical desmoid E. Osteochondroma

Question 44

# **PED** On a routine neonatal clinical examination, the paediatric registrar notes a simple sacral dimple at the natal cleft. It is blind-ended without any associated tuft of hair at the site of the dimple. What is the most reasonable subsequent management plan? A. No further management is required. B. Ultrasonography of the spine. C. Ultrasonography of the spine and cranial contents. D. MRI of the spine. E. MRI of the brain and spine.

Question 45

# **MSK** A 4-year-old child falls onto an outstretched arm while on the playground. A radiograph of the elbow demonstrates the presence of a posterior fat pad adjacent to the distal humerus. There is no cortical defect or obvious fracture on the radiograph. What is the most likely underlying pathology? A. Osteomyelitis B. Supracondylar fracture C. Head of radius fracture D. Clinoid fracture of the ulna E. Septic elbow joint effusion

Question 45

# **CHEST** All of the following structures are present in the centre of the secondary pulmonary lobule, except: A. Respiratory bronchiole B. Pulmonary artery C. Pulmonary vein D. Lymphatics E. Bronchovascular interstitium

Question 45

# **GIT** A 34-year-old woman with primary sclerosing cholangitis presents with worsening LFTs. All of the following are potential complications of primary sclerosing cholangitis in patients with inflammatory bowel disease, except: A. Cholangiocarcinoma B. Cholangitis C. Choledocholithiasis D. Liver cirrhosis E. Hepatic haemangioma

Question 45

# **GU** A woman who was 32 weeks pregnant presented to the labour ward with acute onset of sudden severe abdominal pain developing over a period of 24 hours. Clinically there was tenderness in the right lower quadrant with features of guarding and exacerbation with movement. Which one of the following statements regarding the use of MRI for evaluation of an acute abdomen during pregnancy is false? A. It has no known carcinogenic effects. B. It has no known teratogenic effects. C. It can be used when an initial US examination is equivocal. D. The result of the study potentially affects the immediate care of the mother or foetus. E. MR contrast agent is routinely used in pregnancy.

Question 46

# **MSK** Which technique reduces artefact from hip prosthesis during MRI? A. Use of a magnet with a higher field strength B. Use of FSE imaging rather than GE imaging C. Alignment of prosthesis perpendicular to the magnetic field D. Using a narrower bandwidth E. Use of the magic angle

Question 47

# **CNS** A 19-year-old man shows a large mass in the nasopharynx on CT sinuses. Post-contrast images confirmed an intensely vascular mass extending into the pterygopalatine fossa and infratemporal fossa with forward displacement of the posterior wall of the maxillary sinus. Coronal images showed erosion of the base of the pterygoid plate. What is the diagnosis? A. Inverted papilloma B. Nasopharyngeal carcinoma C. Juvenile angiofibroma D. Lymphoma E. Midline granuloma

Question 48

# **GU** A 41 year old woman was referred for a pelvic US by her family doctor after she complained of pelvic heaviness. US revealed a complex primarily solid-looking mass in the adnexa, which was thought to be ovarian in origin. A pelvic MRI was scheduled for further evaluation and characterisation. All of the following adnexal masses usually present on both T1W and T2W MR imaging with low signal intensity, except: A. Mucinous cystadenoma B. Brenner tumour C. Ovarian fibroma D. Fibrothecoma F. Exophytic leiomyoma

Question 49

# **PED** A neonate on the intensive care unit is referred for a chest and abdominal radiograph. There are several support lines and tubes in situ. Which of the following is inappropriately located? A. The umbilical venous catheter (UVC) tip within the inferior vena cava, just below/at the level of the right atrium B. The umbilical arterial catheter (UAC) tip at the Ll vertebral level C. The endotracheal tube (ETT) tip at the T2 vertebral level D. The nasogastric tube (NGT) tip located below the diaphragm within a gastric air shadow E. The central venous catheter tip located at the cavo-atrial junction

Question 50

# **CHEST** A 66 year old man presented to the A&E department with progressive chest tightness and shortness of breath. ECG was normal and inflammatory markers were normal. Chest X-ray was abnormal and an HRCT was requested. HRCT showed a diffuse interstitial pattern of small nodular opacities. All of the following may be associated with this finding, except: A. Sarcoidosis B. Talcosis C. Scleroderma D. Hypersensitivity pneumonitis E. Small nodular metastasis

Question 50

# **GIT** A 37-year old woman with known history of inflammatory bowel disease presented to the gastroenterologist with worsening abdominal and systemic symptoms. All of the following are extra-intestinal musculoskeletal manifestations of inflammatory bowel disease, except: A. Neuropathic osteoarthropathy B. Enteropathic spondylitis C. Hypertrophic osteoarthropathy D. Sacroiliitis E. Monoarticular peripheral arthritis

Question 50

# **MSK** On your routine MR reporting session, a lumbar spine shows normal alignment and multilevel low signal on both T1 and T2 in the intervertebral discs centrally, with disc space narrowing. What is the most likely diagnosis? A. CPPD B. Ochronosis C. Amyloidosis D. Renal osteodystrophy E. Gout

Question 51

# **CNS** A 64-year-old man with nasal obstruction and bloody nasal discharge showed a large heterogeneous mass in the nasopharynx on CT sinuses. There was loss of normal parapharyngeal fat planes with non-enhancement of the ipsilateral jugular vein. What is the diagnosis? A. Inverted papilloma B. Nasopharyngeal carcinoma C. Juvenile angiofibroma D. Lymphoma E. Midline granuloma

Question 52

# **CHEST** A 77-year-old man with progressive worsening of breathing and chest pain presented to his family doctor, who sent him for a chest X-ray to exclude infection. The chest X-ray showed multiple ring shadows and he was sent for an HRCT. The HRCT confirmed the presence of multiple small cystic spaces in both lungs. All of the following disorders of the lung can be associated with this HRCT pattern, except: A. Tuberous sclerosis B. Langerhans cell histiocytosis C. Lymphocytic interstitial pneumonia D. End-stage interstitial fibrosis E. Coal worker's pneumoconiosis

Question 53

# **GIT** A 67-year-old man with worsening abdominal pain and LFTs shows a peripheral mass in the right lobe of the liver. Contrast-enhanced dynamic MRI done for further characterisation confirmed the lesion seen on US, with evidence of liver capsular retraction consistent with desmoplastic reaction commonly associated with peripheral eholangiocarcinoma. All of the following are risk factors, except: A. Radium exposure B. Chronic hepatitis C. Primary sclerosing cholangitis D. Thorotrast exposure E. Clonorchis sinensis infection

Question 53

# **GU** A 59-year-old woman with an apparent lump in the lower abdomen, weight loss and new onset tremor was sent for an MRI of the pelvis to investigate. Sagittal T2W MRI showed a multiloculated, heterogeneous left ovarian lesion with very low signal intensity. Corresponding axial in-phase and out-of-phase images revealed a hypointense mass with chemical shift artefact in its ventral aspect. Axial post contrast T1W MRI showed significant enhancement of the ovarian lesion. What is the diagnosis? A. Brenner tumour B. Struma ovarii C. Ovarian thecofibroma D. Mucinous cystadenoma E. Endometrioma

Question 54

# **MSK** Posteromedial corner (PMC) of the knee involves the following structures: A. Semimembranosus tendon and posterior oblique ligament B. Popliteus muscle and arcuate ligament C. Iliotibial band and biceps femoris D. Gastrocnemius and PCL E. Medial retinaculum and medial collateral ligament

Question 54

# **CNS** A 53-year-old man with lump in the right side of the neck was investigated with US. US showed a solid lesion closely related to the carotid artery. Axial CT showed a large, well-defined mass bulging into the nasopharynx. Multiplanar reconstructed images revealed characteristic splaying of the carotid bifurcation. What is the diagnosis? A. Glomus jugulare B. Glomus tympanicum C. Thymic cyst D. Carotid body tumour E. Glomus vagale

Question 55

# **MSK** While reporting a plain radiograph of the knee in a 5-year-old child, you notice premature closure of the distal femoral growth plate. Which of the following features in the clinical history would not explain this? A. Localised radiotherapy to the leg B. Hypervitaminosis A C. Osteomyelitis D. Previous trauma to the knee E. Hyperparathyroidism

Question 55

# **CNS** A 45-year-old trumpet player presented with a lump in the right side of the neck, which appeared to grow in size when the man was playing the trumpet and become less prominent when he was relaxed. CT showed clearly defined, round, radio lucency in the soft tissue of the right side of the neck lateral to the larynx. A normal barium swallow report was available in the system for suspected swallowing difficulty performed at a different hospital. What is the likely diagnosis? A. Internal laryngocele B. External laryngocele C. External laryngocele with infection D. Laryngomalacia E. Tracheomalacia

Question 56

# **CHEST** A 67-year-old man with a progressive restrictive pattern of pulmonary function test and increasing chest tightness was sent for an HRCT for characterisation. HRCT showed nodular septal thickening with further bronchovascular nodules and thickening. Which one of the following disorders is most likely to be the cause? A. Pneumoconiosis B. Lymphangitis C. Lymphocytic interstitial pneumonia D. Hypersensitivity pneumonitis E. Churg-Strauss syndrome

Question 57

# **GIT** A 48-year-old man with a history of alcohol excess is admitted with a variceal bleed. Regarding upper gastrointestinal varices, which of the following statements is correct? A. They are the result of hepatopetal blood flow from the left gastric vein and splenic vein to the superior mesenteric vein. B. Oesophageal varices tend to bleed more severely than gastric varices. C. Splenic portography is the first-line investigation for assessment. D. Barium studies can detect gastric varices in approximately 75% of cases evidenced by lobulated folds and polypoidal fundal masses. E. Gastric varices bleed more frequently than oesophageal varices.

Question 57

# **GU** A 67-year old woman with bilateral lower limb swelling and increasing abdominal girth was scheduled to have an ultrasound as first-line investigation. Ultrasound revealed a complex primarily cystic mass in the adnexa with some solid components. A pelvic MRI was organised for further characterisation. All of the following are MR imaging features of ovarian mucinous cystadenomas that help differentiate them from ovarian serous cystadenomas, except: A. Large size B. Solid component suggesting malignancy C. More commonly multilocular than unilocular D. Higher signal intensity on T1W MRI E. Lower signal intensity on T2W MRI

Question 57

# **MSK** Which of the following anatomical variants and its associated clinical symptom is incorrect? A. Os acromiale - impingement B. Conjoint spinal nerve roots - muscle weakness C. Positive ulnar variance - TFC tear D. Discoid meniscus - locking E. Os naviculare - pain behind the heel

Question 58

# **MSK** A child is referred with a presumed diagnosis of a mucopolysaccharidosis. A skeletal survey demonstrates multiple features in keeping with dysostosis multiplex. Which one of the following radiographic features is not part of this syndrome? A. J-shaped sella B. Tilting of the radius and ulna away from each other C. Arrowhead terminal phalanx D. Calvarial thickening E. Proximal pointed metacarpals

Question 59

# **CHEST** A patient with cancer has developed bone marrow suppression as a result of chemotherapy and complains of fever and dyspnoea. A chest HRCT scan shows diffuse ground-glass opacities. All of the following are likely causes of the CT abnormality, except: A. Pneumocystis carinii pneumonia B. Pulmonary oedema C. Chemotherapy drug toxicity D. Desquamative interstitial pneumonia E. Respiratory syncytial virus infection

Question 60

# **GIT** A 65-year-old man is admitted with intractable retching and sudden onset epigastric pain. A nasogastric tube could not be passed into the stomach. Regarding gastric volvulus, which one of the following statements is correct? A. Aetiology is related to unusually short gastrohepatic and gastrocolic mesenteries. B. Sliding/para-oesophageal hernia does not predispose to gastric volvulus. C. Organo-axial volvulus is more common than mesentero-axial volvulus and creates a ‘mirror-image’ stomach. D. Mesentero-axial volvulus rotates around a line from cardia to pylorus. E. Organo-axial volvulus is associated with ‘upside down stomach' appearance.

Question 60

# **GU** A 31-year-old woman with a complex cystic adnexal mass on the left identified on pelvic ultrasound was referred for a pelvic MRI with a view towards further characterisation of the mass lesion. Which of the following statements regarding ovarian tumour is incorrect? A. Granulosa cell tumour is associated with endometrial hyperplasia. B. The presence of fat is specific for teratoma. C. Immature teratoma is mainly cystic. D. Dysgerminoma is associated with raised HCG level. E. Brenner tumour is associated with calcification.

Question 60

# **MSK** A 48-year-old woman with mid and lower back pain and shortness of breath presented to the the A&E department. Plain radiographs showed diffusely osteopaenic bones and an old superior end plate depression fracture of L1. CTPA showed acute pulmonary emboli. Plain X-ray of her hand done a year ago at a different hospital showed a metacarpal index of 9.8. What is your diagnosis? A. Marfan’s syndrome B. Homocystinuria C. Systemic lupus erythematosus D. Acromegaly E. Soto’s syndrome

Question 61

# **MSK** A 22-year-old man with a rapidly enlarging painful right maxilla showed an opacified right maxillary antrum on plain radiograph with destruction of the lateral wall. Axial CT showed extensive new bone formation on both sides of the anterolateral wall of the maxillary antrum with sun ray spiculations anteriorly. What is the diagnosis? A. Ewing's sarcoma B. Synovial sarcoma C. Antral carcinoma D. Myeloma E. Osteogenic sarcoma

Question 61

# **CHEST**

Question 62

# **CNS**

Question 63

# **CHEST**

Question 63

# **GIT**

Question 64

# **GU**

Question 64

# **MSK**

Question 64

# **CNS**

Question 65

# **CHEST**

Question 65

# **GIT**

Question 66

# **GU**

Question 67

# **GU** A 27-year-old woman was referred for a pelvic ultrasound by her family doctor to investigate irregular periods. Pelvic ultrasound revealed enlarged ovaries bilaterally with multiple peripheral cysts of similar size arranged like a garland around centrally increased ovarian stroma. All of the following are associated clinical features commonly observed in this clinical scenario, except: A. Hypertension B. Obesity C. Insulin resistance D. Menorrhagia E. Hirsutism

Question 67

# **MSK** An elderly woman with progressive worsening of back pain is initially investigated with plain films of the spine. Plain radiographs show Grade III collapse of L3 with Grade II collapse of at least two other mid-thoracic vertebrae. MRI suggested osteoporotic collapse as the most likely cause. Which one of the following is the expected progression of osteoporotic vertebral compression fractures as seen on MR imaging? A. A partial return to normal fatty marrow. B. No change. C. The progression is unpredictable. D. An increase in oedema and fibrovascular tissue. E. A decrease in normal fatty marrow.

Question 68

# **CNS** A 53-year-old man with acute left leg pain in the distribution of the left L5 nerve was referred for an MRI of the lumbar spine. MRI revealed a well-defined lesion with low signal on 'IT W images and high signal on T2W images in the lateral aspect of the spinal canal, in close relation to the L4/5 facet joint. What is the diagnosis? A. Ganglion B. Synovial cyst C. Neurofibroma D. Arachnoid cyst E. Tarlov cyst

Question 69

# **CHEST** A 45-year-old man presents to the A&E department with acute onset of dyspnoea. Serum biochemistry reveal an elevated creatinine consistent with established renal failure, and a chest HRCT scan shows isolated, diffuse ground-glass opacity. The most likely cause of the CT abnormality is: A. Pulmonary alveolar proteinosis B. Pneumocystis carinii pneumonia C. Acute interstitial pneumonia D. Respiratory bronchiolitis interstitial lung disease E. Diffuse alveolar haemorrhage

Question 70

# **GIT** A 58-year-old inpatient, admitted 10 days before for an acute exacerbation of chronic obstructive pulmonary disease, develops profuse watery diarrhoea and severe cramp-like abdominal pain. Abdominal X-ray is unremarkable, but CT demonstrates circumferential wall thickening of the rectum extending to the mid-transverse colon, an ‘accordion sign’ in the sigmoid colon, pericolonic fat stranding and ascites. What is the most likely diagnosis? A. Radiation enteritis B. Ischaemic colitis C. Diverticulitis D. Amoebiasis E. Clostridium difficile colitis

Question 71

# **GU** A 29-year-old woman with a pelvic mass on US is sent for MRI. Axial TSE MRI shows a well-defined, ovoid solid mass with low signal on T1W images and intermediate signal with multiple round internal cysts on T2W images. Gadolinium-enhanced TSE T1 FS image shows the mass as having a moderately enhancing solid portion. All the following ovarian tumours typically show solid enhancing elements, except A. Sclerosing stromal tumour B. Sertoli-Leydig cell tumour C. Struma ovarii D. Serous cystadenoma E. Cystadenofibroma

Question 72

# **MSK** Which of the following is a joint that is not characteristically involved in primary' osteoarthritis (OA)? A. Distal interphalangeal joint (DIPJ) B. First metatarsophalangeal joint (MTPJ) C. Metacarpophalangeal joint (MCPJ) D. Knee E. Lumbar spine

Question 73

# **CNS** Cervical spine MRI of a 37-year old woman with neck pain, tingling and numbness in the left C5-C7 distribution showed a well-defined intradural mass with signal characteristic similar to spinal cord in both T1W and T2W sequences. The cord was displaced posteriorly without any intrinsic signal change. Intense enhancement was noted on the post-contrast images with a dural tail. What is the diagnosis? A. Neurofibroma B. Schwannoma C. Epidural abscess D. Intraspinal aneurysm E. Meningioma

Question 73

# **GIT** A 3-day-old neonate presents with bilious vomiting and clinical suspicion for malrotation. Which of the following imaging features would best fit with this diagnosis? A. A duodeno jejunal (Df) flexure located left of the midline, above the gastric pylorus B. A double bubble sign on supine abdominal radiograph C. Retroperitoneal location of the third part of the duodenum D. Superior mesenteric artery located to the right of the superior mesenteric vein E. Distended bowel loops throughout the whole abdomen on plain radiography