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

14 NEET-PG practice questions on Abdominal and musculoskeletal imaging signs, part of Radiology. The first 14 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
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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
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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
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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
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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
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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
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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
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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
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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

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?