A woman with two previous caesarean sections is found at 20 weeks to have a complete placenta praevia lying under the scar. At 28 weeks, transabdominal and transvaginal ultrasound show many irregular placental lacunae with turbulent flow, loss of the clear zone behind the placenta and bridging vessels to the bladder wall on colour Doppler. Her haemoglobin is 10.6 g/dL and she has had no bleeding. She lives three hours from the medical college, has no other illness, and asks where and when she should deliver. What is the best plan?

Planned caesarean hysterectomy at 34-36 weeks in a tertiary centre

Trial of vaginal birth after caesarean

Elective caesarean at 39 weeks at the district hospital

Manual separation of the placenta at delivery

A screening mammogram is reported as BI-RADS category 0. What does this category mean?

Incomplete; more imaging is needed

Breast, obstetric and paediatric imaging

24 NEET-PG practice questions on Breast, obstetric and paediatric imaging, part of Radiology. The first 24 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 · Hard
A woman with two previous caesarean sections is found at 20 weeks to have a complete placenta praevia lying under the scar. At 28 weeks, transabdominal and transvaginal ultrasound show many irregular placental lacunae with turbulent flow, loss of the clear zone behind the placenta and bridging vessels to the bladder wall on colour Doppler. Her haemoglobin is 10.6 g/dL and she has had no bleeding. She lives three hours from the medical college, has no other illness, and asks where and when she should deliver. What is the best plan?
1. ATrial of vaginal birth after caesarean
2. BElective caesarean at 39 weeks at the district hospital
3. CPlanned caesarean hysterectomy at 34-36 weeks in a tertiary centre
4. DManual separation of the placenta at delivery
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Answer: C · Planned caesarean hysterectomy at 34-36 weeks in a tertiary centre
Lacunae, loss of the retroplacental clear zone and bladder-wall vascularity in a praevia over a caesarean scar indicate placenta accreta spectrum, and MRI helps judge depth and parametrial invasion. Planned delivery at about 34-36 weeks in a centre with a multidisciplinary team, blood bank and interventional radiology reduces blood loss; the usual approach is caesarean hysterectomy with the placenta left in place. Forcible removal of an accreta causes massive haemorrhage. Key point: Suspected placenta accreta spectrum calls for planned caesarean hysterectomy at 34-36 weeks in a tertiary centre; never pull the placenta.
- A: Vaginal birth is contraindicated with a praevia.
- B: Waiting to 39 weeks risks emergency bleeding, and a district hospital lacks the support needed.
- D: Manual separation of an accreta causes torrential haemorrhage.
Question 2 · Medium
First-trimester ultrasound at 12 weeks of a twin pregnancy shows a thick inter-twin membrane that meets the placenta with a triangular tongue of placental tissue projecting into its base. Which type of twin pregnancy is this?
1. AMonochorionic diamniotic
2. BMonochorionic monoamniotic
3. CConjoined twins
4. DDichorionic diamniotic
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Answer: D · Dichorionic diamniotic
The lambda (twin peak) sign is chorionic tissue extending between the two layers of the inter-twin membrane and means a dichorionic pregnancy; a thin membrane meeting the placenta at a right angle (T sign) means monochorionic diamniotic. Chorionicity is best judged at 11-14 weeks, and it matters because monochorionic twins risk twin-twin transfusion syndrome and need scans every 2 weeks from 16 weeks. Key point: A lambda sign at 11-14 weeks means dichorionic twins; a T sign means monochorionic.
- A: Monochorionic diamniotic twins show a thin membrane with a T sign.
- B: Monoamniotic twins have no dividing membrane.
- C: Conjoined twins have no membrane and fused bodies.
Question 3 · Easy
A screening mammogram is reported as BI-RADS category 0. What does this category mean?
1. ANegative study
2. BBenign finding
3. CProbably benign finding
4. DIncomplete; more imaging is needed
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Answer: D · Incomplete; more imaging is needed
BI-RADS 0 means the assessment is incomplete: the radiologist needs more imaging, such as spot compression or magnification views, ultrasound or comparison with old films, before a final category can be given. Categories 1 to 6 are final assessments. Key point: BI-RADS 0 is incomplete and needs additional imaging before a final category.
- A: Negative is BI-RADS 1.
- B: Benign is BI-RADS 2.
- C: Probably benign is BI-RADS 3.
Question 4 · Medium
A college student, 23, has a smooth, mobile, rubbery 2 cm lump in the left breast that she noticed 2 months ago. There is no family history of breast cancer, and the lump is not tender. Which is the first imaging test?
1. AMammography
2. BUltrasound of the breast
3. CMRI of the breast
4. DFDG PET-CT
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Answer: B · Ultrasound of the breast
In young women the breast is dense with glandular tissue, so mammography is less sensitive and irradiates young breast tissue; ultrasound is the first test. It separates cysts from solid masses, shows the features of a fibroadenoma and guides core biopsy if needed as part of triple assessment. Key point: For a breast lump in a woman under 30, ultrasound is the first imaging test.
- A: Mammography is first-line from about 35-40 years, not in young dense breasts.
- C: MRI is for high-risk screening, implants and problem solving.
- D: PET-CT is used for staging advanced cancer.
Question 5 · Easy
Nuchal translucency for first-trimester screening is measured in which gestational window?
1. A14+0 to 16+6 weeks
2. B18+0 to 20+6 weeks
3. C8+0 to 10+6 weeks
4. D11+0 to 13+6 weeks
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Answer: D · 11+0 to 13+6 weeks
NT is measured between 11+0 and 13+6 weeks, when the crown-rump length is about 45-84 mm, in a true mid-sagittal section with the neck neutral. Combined with maternal age, free beta-hCG and PAPP-A, it detects about 90% of trisomy 21. Before this window the fetus is too small, and after it the fluid is reabsorbed. Key point: NT is measured at 11+0 to 13+6 weeks (CRL 45-84 mm).
- A: After 14 weeks nuchal fluid is reabsorbed; a nuchal fold is measured later instead.
- B: 18-20 weeks is the time of the anomaly scan.
- C: Before 11 weeks the fetus is too small for accurate measurement.
Question 6 · Medium
A crying baby girl of 4 months is brought at night with a swollen thigh; the parents say she rolled off the bed. X-ray shows a spiral fracture of the femur, and there are bruises of different colours on her back. Fundoscopy and CT head are normal. Which imaging should be done next?
1. ASkeletal survey of the whole body
2. BBone scan alone
3. CUltrasound of both hips
4. DNo further imaging
Answer and explanation in LearnFree account
Question 7 · Hard
Pneumatic enema reduction is planned for a toddler with ultrasound-proven intussusception of 3 days' duration. Before the procedure he becomes lethargic, with pulse 168/min, a rigid, tender abdomen and fever of 39 °C, and a left lateral decubitus X-ray shows free intraperitoneal gas. What is the correct management?
1. AResuscitation, then laparotomy
2. BProceed with air enema reduction
3. CHydrostatic reduction under ultrasound
4. DRepeat ultrasound after 6 hours
Answer and explanation in LearnFree account
Question 8 · Easy
In the paediatric casualty, an infant of 9 months has had bouts of screaming with drawing up of the legs, vomiting and one stool like red-currant jelly. A sausage-shaped mass is felt in the right upper abdomen. Ultrasound shows a 3.5 cm 'target' of concentric rings in cross-section and a 'pseudokidney' appearance in long section. What is the diagnosis?
1. AIleocolic intussusception
2. BMidgut volvulus
3. CHypertrophic pyloric stenosis
4. DMeckel diverticulitis
Answer and explanation in LearnFree account
Question 9 · Medium
Diagnostic mammogram and ultrasound of a woman in her 40s with no palpable lump: a 9 mm oval, circumscribed, parallel, hypoechoic solid mass with no calcification, no posterior shadowing and no earlier films for comparison. The radiologist reports BI-RADS 3. What is the recommended management?
1. ASurgical excision
2. BCore needle biopsy now
3. CRepeat imaging after 6 months
4. DReturn to routine annual screening
Answer and explanation in LearnFree account
Question 10 · Medium
Ultrasound of a first-born boy of 5 weeks with projectile, non-bilious vomiting after every feed shows a pyloric muscle thickness of 4.5 mm and a channel length of 19 mm, with no fluid passing into the duodenum. Before surgery, which acid-base disturbance is expected?
1. AHyperkalaemic metabolic acidosis
2. BHypochloraemic hypokalaemic metabolic alkalosis
3. CHyperchloraemic metabolic acidosis
4. DRespiratory alkalosis with hypernatraemia
Answer and explanation in LearnFree account
Question 11 · Medium
Ultrasound confirms an ileocolic intussusception in a toddler with 14 hours of colicky pain. After IV fluids he has pulse 120/min, good capillary refill and a soft abdomen without guarding, and the abdominal X-ray shows no free gas. Which treatment should be tried first?
1. ABarium meal and follow-through
2. BImage-guided air or saline enema reduction
3. CImmediate laparotomy
4. DIV fluids and observation only
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Question 12 · Hard
At a 12-week scan in a fetal medicine unit, a woman of 29 with no previous scans has a crown-rump length of 62 mm and a nuchal translucency of 4.1 mm. The nasal bone is present, ductus venosus flow is normal and no structural anomaly is seen. What should she be offered?
1. ARepeat NT at 16 weeks
2. BTermination of pregnancy now
3. CReassurance, as NT under 5 mm is normal
4. DCVS for karyotype or microarray
Answer and explanation in LearnFree account
Question 13 · Medium
Anomaly scan at 24 weeks: polyhydramnios (AFI 28 cm) and two fluid-filled structures in the upper fetal abdomen that connect with each other, with no fluid-filled bowel beyond. The heart shows an atrioventricular septal defect. Which chromosomal abnormality is most strongly associated with this picture?
1. ATrisomy 18
2. BMonosomy X
3. CTrisomy 13
4. DTrisomy 21
Answer and explanation in LearnFree account
Question 14 · Medium
A hard 2 cm lump in the upper outer quadrant of the right breast of a homemaker from Kottayam: mammography shows an irregular spiculated mass with fine pleomorphic calcifications, and ultrasound shows a taller-than-wide hypoechoic mass with posterior shadowing and an abnormal axillary node. It is graded BI-RADS 5. What is the next step?
1. AWide local excision without a biopsy
2. BRepeat mammogram after 6 months
3. CImage-guided core needle biopsy
4. DFine-needle aspiration cytology only
Answer and explanation in LearnFree account
Question 15 · Medium
On day 18 after delivery, a breastfeeding mother has a hot, tender, swollen lower inner quadrant of the right breast with fever for 4 days despite oral cloxacillin. Ultrasound shows a 3 cm loculated fluid collection with debris. What is the best management?
1. AUltrasound-guided needle aspiration with antibiotics
2. BMammography to exclude inflammatory cancer
3. CStop breastfeeding and change the antibiotic
4. DIncision and drainage under general anaesthesia
Answer and explanation in LearnFree account
Question 16 · Easy
Mammogram of a postmenopausal woman: a well-circumscribed 1.5 cm oval mass containing coarse, chunky 'popcorn' calcifications, unchanged from a film taken 3 years ago. Which is the likely lesion?
1. AInvasive ductal carcinoma
2. BPhyllodes tumour
3. CDuctal carcinoma in situ
4. DInvoluting fibroadenoma
Answer and explanation in LearnFree account
Question 17 · Hard
In the NICU, a preterm baby born at 28 weeks and weighing 1.1 kg has been on treatment for necrotising enterocolitis for 2 days, with nil by mouth, gastric decompression and IV antibiotics. She now has increasing apnoeas, platelets of 48,000/µL and a tense, discoloured abdomen, and her blood pressure is falling despite fluids. A supine abdominal X-ray shows a large oval lucency over the whole abdomen with both sides of the bowel wall visible and the falciform ligament outlined, together with branching lucencies over the liver. What is the next step?
1. AContinue nil by mouth and antibiotics alone
2. BSurgical review for laparotomy or a peritoneal drain
3. CRestart small trophic feeds
4. DContrast enema to locate the perforation
Answer and explanation in LearnFree account
Question 18 · Medium
Regarding the BI-RADS assessment categories: 1. Category 3 carries a malignancy risk of 2% or less. 2. Category 6 is used for a suspicious lesion before biopsy. 3. Category 4 lesions need a tissue diagnosis. 4. Category 0 means the study is negative. Which statements are correct?
1. A3 and 4 only
2. B2 and 4 only
3. C1, 2 and 3 only
4. D1 and 3 only
Answer and explanation in LearnFree account
Question 19 · Medium
On the third day of life, a term neonate starts vomiting bright green fluid; the abdomen is not distended. An upper GI contrast study shows the duodenojejunal flexure lying to the right of the spine and below the duodenal bulb, with the jejunum spiralling downward in a corkscrew pattern. What is the next step?
1. ARamstedt pyloromyotomy
2. BContrast enema
3. CEmergency laparotomy (Ladd procedure)
4. DNasogastric drainage and review in 24 hours
Answer and explanation in LearnFree account
Question 20 · Easy
Abdominal X-ray of a neonate born at 29 weeks, now on day 8 of feeds with abdominal distension, feed intolerance and blood-streaked stools, shows bubbly and linear lucencies within the wall of dilated bowel loops in the right lower quadrant. What is the diagnosis?
1. ANecrotising enterocolitis
2. BHirschsprung disease
3. CMalrotation with volvulus
4. DMeconium ileus
Answer and explanation in LearnFree account
Question 21 · Medium
Signs in paediatric imaging: 1. Steeple sign on a frontal neck film suggests croup. 2. Thumb sign on a lateral neck film suggests acute epiglottitis. 3. Double bubble sign suggests hypertrophic pyloric stenosis. 4. Target sign on ultrasound suggests intussusception. Which are correctly matched?
1. A1, 2, 3 and 4
2. B2, 3 and 4 only
3. C1, 2 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 22 · Medium
At the anomaly scan at 19 weeks in a district hospital, the fetal frontal bones are scalloped inwards, giving a lemon-shaped skull, the cerebellum is curved like a banana around the brainstem and the cisterna magna is obliterated. The lateral ventricles measure 12 mm. Which defect should the sonographer look for next?
1. AHoloprosencephaly
2. BAnencephaly
3. COpen lumbosacral spina bifida
4. DDandy-Walker malformation
Answer and explanation in LearnFree account
Question 23 · Hard
In the gynaecology casualty at night, a woman with 7 weeks of amenorrhoea and mild left iliac fossa pain is haemodynamically stable with a soft abdomen. Serum beta-hCG is 1,350 IU/L, and the repeat value 48 hours later is 1,420 IU/L. Transvaginal ultrasound shows an empty uterus with a thin endometrium, a 2.5 cm adnexal mass separate from the left ovary with a bright ring and no fetal heart, and a little free fluid in the pouch of Douglas. Haemoglobin is 11.8 g/dL, and liver and kidney tests are normal. What is the most appropriate treatment?
1. AExpectant: repeat scan in 2 weeks
2. BDilatation and curettage
3. CLaparoscopic salpingectomy
4. DSystemic methotrexate
Answer and explanation in LearnFree account
Question 24 · Medium
Which major fetal anomaly can be diagnosed reliably at the 11-14 week scan?
1. AAnencephaly
2. BDuodenal atresia
3. CVentricular septal defect
4. DCleft palate
Answer and explanation in LearnFree account

Breast, obstetric and paediatric imaging

First-trimester ultrasound at 12 weeks of a twin pregnancy shows a thick inter-twin membrane that meets the placenta with a triangular tongue of placental tissue projecting into its base. Which type of twin pregnancy is this?

A screening mammogram is reported as BI-RADS category 0. What does this category mean?

A college student, 23, has a smooth, mobile, rubbery 2 cm lump in the left breast that she noticed 2 months ago. There is no family history of breast cancer, and the lump is not tender. Which is the first imaging test?

Nuchal translucency for first-trimester screening is measured in which gestational window?

A crying baby girl of 4 months is brought at night with a swollen thigh; the parents say she rolled off the bed. X-ray shows a spiral fracture of the femur, and there are bruises of different colours on her back. Fundoscopy and CT head are normal. Which imaging should be done next?

Diagnostic mammogram and ultrasound of a woman in her 40s with no palpable lump: a 9 mm oval, circumscribed, parallel, hypoechoic solid mass with no calcification, no posterior shadowing and no earlier films for comparison. The radiologist reports BI-RADS 3. What is the recommended management?

Ultrasound of a first-born boy of 5 weeks with projectile, non-bilious vomiting after every feed shows a pyloric muscle thickness of 4.5 mm and a channel length of 19 mm, with no fluid passing into the duodenum. Before surgery, which acid-base disturbance is expected?

Ultrasound confirms an ileocolic intussusception in a toddler with 14 hours of colicky pain. After IV fluids he has pulse 120/min, good capillary refill and a soft abdomen without guarding, and the abdominal X-ray shows no free gas. Which treatment should be tried first?

At a 12-week scan in a fetal medicine unit, a woman of 29 with no previous scans has a crown-rump length of 62 mm and a nuchal translucency of 4.1 mm. The nasal bone is present, ductus venosus flow is normal and no structural anomaly is seen. What should she be offered?

On day 18 after delivery, a breastfeeding mother has a hot, tender, swollen lower inner quadrant of the right breast with fever for 4 days despite oral cloxacillin. Ultrasound shows a 3 cm loculated fluid collection with debris. What is the best management?

Mammogram of a postmenopausal woman: a well-circumscribed 1.5 cm oval mass containing coarse, chunky 'popcorn' calcifications, unchanged from a film taken 3 years ago. Which is the likely lesion?

Regarding the BI-RADS assessment categories: 1. Category 3 carries a malignancy risk of 2% or less. 2. Category 6 is used for a suspicious lesion before biopsy. 3. Category 4 lesions need a tissue diagnosis. 4. Category 0 means the study is negative. Which statements are correct?

Abdominal X-ray of a neonate born at 29 weeks, now on day 8 of feeds with abdominal distension, feed intolerance and blood-streaked stools, shows bubbly and linear lucencies within the wall of dilated bowel loops in the right lower quadrant. What is the diagnosis?

Signs in paediatric imaging: 1. Steeple sign on a frontal neck film suggests croup. 2. Thumb sign on a lateral neck film suggests acute epiglottitis. 3. Double bubble sign suggests hypertrophic pyloric stenosis. 4. Target sign on ultrasound suggests intussusception. Which are correctly matched?

Which major fetal anomaly can be diagnosed reliably at the 11-14 week scan?