Ultrasound, MRI and interventional radiology

37 NEET-PG practice questions on Ultrasound, MRI and interventional radiology, 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.

1. Question 1 · Medium

   After 20 minutes of painless loss of vision in the right eye that then recovered, a retired bus driver with hypertension and diabetes has a carotid duplex scan. The right internal carotid artery shows a heterogeneous plaque with colour aliasing and spectral broadening beyond it. Which Doppler measurement is mainly used to grade the stenosis?

   1. AResistive index of the common carotid
   2. BDiameter of the external carotid artery lumen
   3. CPeak systolic velocity in the internal carotid
   4. DIntima-media thickness of the wall

   Show answerHide answer

   Answer: C · Peak systolic velocity in the internal carotid

   Velocity rises through a narrowing in proportion to its severity, so internal carotid peak systolic velocity is the primary grading criterion; the ICA/CCA velocity ratio and end-diastolic velocity support it. Amaurosis fugax is a retinal TIA, and a symptomatic stenosis of 70% or more benefits from early endarterectomy. Key point: Carotid stenosis is graded mainly by internal carotid peak systolic velocity on Doppler.

   • A: Resistive index describes downstream resistance, not the degree of stenosis.
   • B: The external carotid is not the vessel that is graded.
   • D: Intima-media thickness marks early atherosclerosis but does not grade stenosis.

2. Question 2 · Easy

   On the fourth day after a total knee replacement at a district hospital, a retired teacher has a swollen, tender left calf that measures 3 cm more than the right. Her Wells score is 3, and a compression ultrasound of the leg veins is done. Which finding confirms deep vein thrombosis?

   1. ALoss of respiratory phasicity in the femoral vein
   2. BVein does not collapse under probe pressure
   3. CAugmented flow on squeezing the calf
   4. DReflux lasting over 1 second on Valsalva

   Show answerHide answer

   Answer: B · Vein does not collapse under probe pressure

   A normal vein collapses completely when the probe presses on it; a vein that does not compress contains thrombus, and this is the main diagnostic criterion of compression ultrasonography. Echogenic clot in the lumen and absent colour flow support it. Loss of phasicity is only an indirect sign of a more proximal block. Key point: Non-compressibility of the vein under the probe is the key ultrasound sign of DVT.

   • A: Loss of phasicity hints at a proximal obstruction but does not confirm thrombus at the site.
   • C: Normal augmentation on calf squeeze shows the vein between probe and calf is patent.
   • D: Prolonged reflux on Valsalva indicates valve incompetence (venous insufficiency), not DVT.

3. Question 3 · Medium

   A man on maintenance haemodialysis, eGFR under 15 mL/min/1.73 m2, needs an MRI to characterise a 2 cm liver lesion seen on ultrasound, and the radiologist considers gadolinium. Which complication of gadolinium is the main concern in this patient?

   1. ANephrogenic systemic fibrosis
   2. BLactic acidosis
   3. CContrast-induced acute kidney injury
   4. DIodine-induced thyrotoxicosis

   Show answerHide answer

   Answer: A · Nephrogenic systemic fibrosis

   Nephrogenic systemic fibrosis is a rare, disabling fibrosis of the skin, joints and internal organs linked to gadolinium in patients with eGFR under 30 or on dialysis, mainly with older linear agents. If contrast is essential, a low-risk macrocyclic agent at the lowest dose is used, and dialysis is arranged soon after. Key point: In severe renal failure gadolinium carries a risk of nephrogenic systemic fibrosis; use a macrocyclic agent only if essential.

   • B: Lactic acidosis relates to metformin, not gadolinium.
   • C: At MRI doses gadolinium rarely harms the kidneys; contrast-induced AKI is linked to iodinated contrast.
   • D: Thyrotoxicosis can follow iodinated contrast, not gadolinium.

4. Question 4 · Medium

   Child-Pugh A cirrhosis from hepatitis B: surveillance ultrasound and then contrast CT of a woman show a single 2.5 cm lesion in segment 6 with arterial-phase enhancement and portal-venous washout. Platelets are 72,000/µL and there are large oesophageal varices, so the surgeon declines resection, and she is not listed for transplant. Which treatment is most appropriate?

   1. ATransarterial chemoembolisation
   2. BBest supportive care
   3. CSystemic sorafenib
   4. DPercutaneous radiofrequency ablation

   Show answerHide answer

   Answer: D · Percutaneous radiofrequency ablation

   Arterial enhancement with washout in a cirrhotic liver is diagnostic of HCC (LI-RADS 5) without biopsy. For a single HCC of 3 cm or less when resection is unsafe because of portal hypertension, image-guided thermal ablation gives survival close to that of resection. TACE is for multinodular intermediate disease and systemic drugs for advanced disease. Key point: A single HCC of 3 cm or less, unfit for resection, is treated by percutaneous thermal ablation.

   • A: TACE is for intermediate-stage multinodular HCC.
   • B: Supportive care is for end-stage (BCLC D) disease.
   • C: Systemic therapy is for advanced disease with vascular invasion or spread.

5. Question 5 · Hard

   A cirrhotic man, Child-Pugh A with bilirubin 1.2 mg/dL and albumin 3.6 g/dL, ECOG performance status 0, has four HCC nodules of 2-5 cm in both lobes on multiphase CT. There is no portal vein invasion and no spread outside the liver, and he is outside transplant criteria. Which treatment is preferred?

   1. ARadiofrequency ablation
   2. BRight hepatectomy
   3. CAtezolizumab plus bevacizumab
   4. DTransarterial chemoembolisation

   Show answerHide answer

   Answer: D · Transarterial chemoembolisation

   Multinodular HCC with preserved liver function and good performance status, without vascular invasion or spread, is BCLC stage B (intermediate). TACE delivers chemotherapy and embolic particles through the hepatic artery, which supplies the tumour, and improves survival in this group. Ablation suits up to three small nodules, and systemic therapy is for advanced stage C. Key point: Intermediate (BCLC B) multinodular HCC with good liver function is treated by transarterial chemoembolisation.

   • A: Ablation is for very early or early HCC with few small nodules.
   • B: Resection is not suitable for bilobar multinodular disease.
   • C: Atezolizumab-bevacizumab is first-line for advanced (BCLC C) disease or after TACE failure.

6. Question 6 · Medium

   Two minutes after iodinated contrast is injected in the angiography suite, a woman develops generalised urticaria, wheeze, hoarseness and a fall in BP to 70/40 mmHg. Oxygen is given and her legs are raised. What should be given first?

   1. AIM adrenaline 0.5 mg (1 mg/mL)
   2. BIV hydrocortisone 200 mg
   3. CIV chlorpheniramine 10 mg
   4. DNebulised salbutamol 5 mg by mask

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   An Rh-negative woman in her third pregnancy, whose second baby needed an exchange transfusion, is now at 26 weeks with an anti-D titre of 1:64. She attends the fetal medicine clinic of a medical college. Which non-invasive test is used to detect fetal anaemia and decide on cordocentesis?

   1. AUterine artery notching
   2. BDuctus venosus a-wave
   3. CMiddle cerebral artery peak systolic velocity
   4. DUmbilical artery pulsatility index

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   A schoolteacher with three children has heavy menstrual bleeding from multiple intramural fibroids, the largest 7 cm, and haemoglobin 8.9 g/dL despite oral iron. She does not want a hysterectomy or another pregnancy, and her anaesthetist calls her a poor surgical candidate because of severe asthma. Which treatment by an interventional radiologist suits her?

   1. AInternal iliac artery ligation
   2. BUterine artery embolisation
   3. CEndometrial ablation
   4. DHysteroscopic myomectomy

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   MRCP shows the bile and pancreatic ducts without any contrast agent. On which imaging principle does it depend?

   1. AT1-weighted imaging after gadolinium
   2. BHeavily T2-weighted imaging of still fluid
   3. CDiffusion restriction in bile
   4. DTime-of-flight signal of flowing blood

   Answer and explanation in LearnFree account

10. Question 10 · Hard

    MRI brain is done on day 5 after a hypertensive bleed into the right thalamus in a man of 58. The haematoma is bright on T1-weighted images and dark on T2-weighted images, with a thin dark rim on gradient echo. Which haemoglobin product and stage does this pattern show?

    1. AIntracellular methaemoglobin, early subacute
    2. BHaemosiderin, chronic
    3. CExtracellular methaemoglobin, late subacute
    4. DDeoxyhaemoglobin, acute

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    Regarding safety in the MRI suite, consider these statements: 1. A conventional pacemaker that is not MR-conditional is a contraindication. 2. A metallic foreign body in the orbit must be excluded before scanning. 3. A titanium hip prosthesis is an absolute contraindication. 4. Gadolinium should be avoided in pregnancy unless essential. Which are correct?

    1. A2, 3 and 4 only
    2. B1, 2, 3 and 4
    3. C1, 2 and 4 only
    4. D1 and 2 only

    Answer and explanation in LearnFree account

12. Question 12 · Easy

    An ultrasound at a CHC for a woman with recurrent right upper quadrant pain after fatty meals shows a 12 mm bright echogenic focus in the gallbladder lumen. The focus moves to the dependent part when she turns on to her left side. Which artefact behind it confirms that it is a stone?

    1. AComet-tail reverberation
    2. BPosterior acoustic shadowing
    3. CPosterior acoustic enhancement
    4. DMirror-image artefact

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    A pelvic MRI for a 5 cm left adnexal mass found on ultrasound in a young woman shows a lesion that is bright on T1 and bright on T2. On the fat-saturated T1 image the signal of most of the lesion drops out. CA-125 is 18 U/mL (normal under 35). What is the likely diagnosis?

    1. AEndometrioma
    2. BMucinous cystadenoma
    3. CMature cystic teratoma
    4. DHaemorrhagic corpus luteum cyst

    Answer and explanation in LearnFree account

14. Question 14 · Easy

    For a thyroid lump, a 10-12 MHz linear probe is chosen over a 3.5 MHz curvilinear probe. What does the higher frequency give?

    1. ABetter resolution of superficial tissue
    2. BWider field of view at depth
    3. CLess tissue heating
    4. DDeeper penetration

    Answer and explanation in LearnFree account

15. Question 15 · Easy

    Within an hour of sudden weakness of the right arm and slurred speech, a shopkeeper with atrial fibrillation has a normal non-contrast CT head. An MRI scanner is free in the same hospital. Which MRI sequence shows the ischaemic brain earliest?

    1. ADiffusion-weighted imaging
    2. BT2-weighted spin echo
    3. CContrast-enhanced T1-weighted imaging
    4. DFLAIR

    Answer and explanation in LearnFree account

16. Question 16 · Easy

    A welder needs an MRI of his knee. Which test screens him first for a metallic foreign body in the eye?

    1. AUltrasound of the globe
    2. BFundus photography
    3. CPlain radiograph of the orbits
    4. DSlit-lamp examination of both eyes

    Answer and explanation in LearnFree account

17. Question 17 · Medium

    MRI brain of a software engineer who had optic neuritis last year and now has numbness of both legs shows several ovoid lesions at right angles to the bodies of the lateral ventricles, with others in the corpus callosum and the cervical cord. Which sequence displays these periventricular plaques best?

    1. AFLAIR
    2. BUnenhanced T1
    3. CTime-of-flight MR angiography
    4. DGradient echo (T2*)

    Answer and explanation in LearnFree account

18. Question 18 · Hard

    In the trauma bay, a construction worker who fell 6 metres has pulse 132/min and BP 80/50 mmHg after 2 litres of crystalloid and 2 units of blood. Chest X-ray is normal. Pelvic X-ray shows an open-book fracture with wide symphyseal diastasis, and FAST shows no free fluid in the abdomen or pericardium. There is no blood at the urethral meatus and the GCS is 15. A pelvic binder has been applied over the greater trochanters, and the interventional radiology suite is open at night. What is the most appropriate next step?

    1. AContrast CT of the abdomen
    2. BExploratory laparotomy
    3. CWait for repeat FAST
    4. DPelvic angiography with embolisation

    Answer and explanation in LearnFree account

19. Question 19 · Hard

    In the coronary care unit, a man with poorly controlled hypertension has had tearing chest pain radiating to the back for 1 hour. BP is 84/50 mmHg in the right arm and 60/40 mmHg in the left after fluids, a new early diastolic murmur is heard at the left sternal edge, and portable chest X-ray shows a widened mediastinum. Troponin is normal and the ECG shows sinus tachycardia only. He has no history of trauma or drug use. He is too unstable to be moved out of the unit. Which imaging is most appropriate?

    1. ACatheter aortography
    2. BMR angiography of the aorta
    3. CBedside transoesophageal echocardiography
    4. DCT aortic angiography

    Answer and explanation in LearnFree account

20. Question 20 · Medium

    Which fat-suppressed MRI sequence best shows the bone marrow oedema of an early stress fracture in an army recruit?

    1. AGradient echo T2*
    2. BSTIR
    3. CTime-of-flight angiography
    4. DT1 spin echo

    Answer and explanation in LearnFree account

21. Question 21 · Medium

    Massive haemoptysis of about 400 mL in 24 hours brings a man with post-tubercular bronchiectasis of the right upper lobe to the medical college. After he is placed right side down, intubated with a large tube and stabilised, CT angiography shows a hypertrophied, tortuous right bronchial artery. Sputum for AFB is negative. Which procedure should be done next?

    1. APulmonary artery embolisation
    2. BEmergency right upper lobectomy
    3. CTranexamic acid infusion alone
    4. DBronchial artery embolisation

    Answer and explanation in LearnFree account

22. Question 22 · Medium

    A farm labourer from Kollam with an amoebic liver abscess (positive serology) has had metronidazole for 4 days but still has fever of 39 °C and severe pain. Ultrasound shows a 9 cm thin-walled hypoechoic abscess in the left lobe of the liver, close to the pericardium. What is the most appropriate next step?

    1. ASwitch to diloxanide furoate alone
    2. BOpen surgical drainage
    3. CContinue metronidazole alone for 3 more weeks
    4. DUltrasound-guided percutaneous drainage

    Answer and explanation in LearnFree account

23. Question 23 · Medium

    Doppler of the intrarenal arteries in a man with resistant hypertension, a rise in creatinine after starting ramipril and a right kidney 1.8 cm smaller than the left shows, on the right, a slow systolic upstroke with a delayed, rounded peak and a long acceleration time. The left kidney has normal sharp waveforms. What does the right-sided waveform indicate?

    1. AUpstream renal artery stenosis
    2. BAcute tubular necrosis
    3. CRenal vein thrombosis
    4. DObstruction of the ureter

    Answer and explanation in LearnFree account

24. Question 24 · Medium

    MRI brain of a man with long-standing discharge from the left ear, fever and headache for 10 days shows a 3 cm ring-enhancing lesion in the left temporal lobe with a thin, smooth wall. Its centre is bright on diffusion-weighted images with low ADC values. Which diagnosis fits best?

    1. ACystic metastasis
    2. BNecrotic glioblastoma
    3. CPyogenic brain abscess
    4. DNeurocysticercosis

    Answer and explanation in LearnFree account

25. Question 25 · Easy

    Which space is the most dependent part of the upper abdomen in a supine patient, and so the commonest FAST window to show free blood?

    1. AHepatorenal pouch (Morison pouch)
    2. BSubphrenic space
    3. CRight paracolic gutter
    4. DSplenorenal recess

    Answer and explanation in LearnFree account