Radiology 📷

A 40 year old man attends his general practitioner (GP) with a 2 year history of a soft swelling over his right scapula. He thinks the lump might have grown in size slowly over the past 6 months. The lump has not caused any pain or discomfort. He has no other lumps. He is concerned regarding its aesthetic appearance and wants to get it checked. On examination, there is a 4 cm soft tissue mass. It is not fixed to underlying tissues. There is no erythema or tenderness. There are no overlying skin changes. What is the most appropriate investigation to perform?

A 69 year old man presents to the GP surgery after developing memory problems with deterioration of mobility over 3 years. It was insidious in onset and gradually progressed over the years. He admits to having a number of episodes of wetting himself but is unsure how it happens. On examination, he has an unsteady, board-base gait with reduced stride length and step height. An MRI scan of his head was organised. What is the most likely feature expected to be seen on the MRI scan?

A 49 year old man has 6 months of productive cough with fever. He has left sided chest pain which is worse on breathing. On examination, there is absent breath sounds on the left lower lobe. The left lower chest is dull to percuss. What is the SINGLE mast likely chest X-ray finding?

A 43 year old woman was referred to the surgical assessment unit by her GP. She has been feeling unwell with right upper quadrant pain worsening over the past 2 days. On examination, her conjunctiva appears yellow. There is tenderness in the right upper quadrant. Her heart rate is 110 beats/minute and her temperature is 39°C. Her blood tests are as follows:

Haemoglobin 145 g/L (115-160 g/L)

White cell count 22 x 10^9/L (4-11 x 10^9/L)

Bilirubin 91 μmol/l (1-14μmol/l)

Alkaline phosphatase 450 IU/I (4-105 IU/

Aspartate transaminase 71 IU/L (5-35 IU/L)

Albumin 44 g/L (35-50 g/L)

CRP 282 mg/L (< 10 mg/L)

What is the next most appropriate investigation?

A 32 year old woman has weakness of both her hands and neck pain immediately after a fall down a flight of stairs. She was brought in by a scoop stretcher by paramedics with a hard cervical collar, adhesive tape and sandbags to immobilize the neck. An X-ray was ordered. Which is the SINGLE lowest vertebra that needs to be seen in a lateral cervical X-ray to help diagnose the injury?

A 79 year old woman with develops shortness of breath over a period of 2 days. Auscultation reveals widespread crepitations over both lung fields. She has a temperature of 36.7°C, heart rate of 90 beats/minute, blood pressure of 90/60 mmHg, respiratory rate of 27 breaths/minute and an oxygen saturation of 92%. Oxygen by face mask was commenced. A chest X-ray is seen below:

Which is the most appropriate management?

A 57 year old man has distension of superficial veins across the chest wall, neck, and upper arms. He has been feeling worsening breathlessness over the past few weeks. He also complains of intermittent headaches. On examination, there are distended non- pulsatile neck and upper chest veins, and oedema of his face and arm. What is the most appropriate investigation?

A 53 year old man presents to the Emergency Department with severe abdominal pain and distension which started the day before. He had an uneventful laparoscopic cholecystectomy a year ago. He has not opened his bowels for the past 7 days. An X-ray was requested which shows the following:

What is the SINGLE most likely diagnosis?

A 35 year old man had a nasogastric tube inserted following a road traffic accident. There were multiple attempts to put the nasogastric tube in. Unfortunately, aspirate cannot be pulled back from the nasogastric tube. He is short of breath. A chest X-ray is seen below.

What is the SINGLE most appropriate management?

A 45 year old woman presents to the Emergency Department with severe colicky abdominal pain, abdominal distension and vomiting. Her symptoms started 3 days ago and worsened over the past 12 hours. She has had an open hysterectomy 6 months ago as part of the management of a large uterine fibroid. She has not opened her bowels for the past 10 days. She has active bowel sounds on examination. An erect X-ray was requested which shows the following:

What is the SINGLE most likely diagnosis?

A 55 year old man presents with complaints of chronic productive cough for 8 months with copious amounts of purulent sputum. His oxygen saturation is 90%, heart rate is 90 beats/minute, respiratory rate is 20/minute and blood pressure is 110/70 mmHg. On examination, clubbing is present along with coarse early inspiratory crackles. Chest X-ray was performed which was reported as normal. A high-resolution CT was ordered which is seen below.

What is the SINGLE most likely diagnosis?

A 33 year old woman has complaints of heavy menstrual bleeding and chronic pelvic pain. She has been trying to conceive for the past 2 years with her partner but has been unsuccessful. A transvaginal ultrasound reveals a thick-walled unilocular cyst with acoustic enhancement with diffuse homogeneous ground-glass echoes located on the left ovary. What is the SINGLE most likely diagnosis?

A 49 year old man attends the Emergency Department with a severe headache associated with vomiting that started the day ago. He has neck stiffness and photophobia. He has a Glasgow Coma Scale of 14/15. He has no previous medical problems. A CT scan was performed which a slice is shown below:

What is the most likely diagnosis?

A 49 year old woman underwent a thoracentesis 24 hours ago and developed chest pain and shortness of breath. Following an X-ray, a chest drain is inserted. Another chest X-ray is taken after the insertion of the chest drain which is seen below:

What is the SINGLE most likely diagnosis?

A 38 year old man had a nasogastric tube inserted following a road traffic accident. There were multiple attempts to put the nasogastric tube in. Unfortunately, aspirate cannot be pulled back from the nasogastric tube. A chest X-ray is seen below:

What is the SINGLE most appropriate management?

A 45 year old man has had a productive cough for the past 4 weeks. He has been having swinging fevers and night sweats. He presents to the hospital with chest pain and shortness of breath. He has had a course of amoxicillin prescribed by his GP a week ago. On auscultation, there are decreased breath sounds on the left lower lobe with crackles. Percussion is dull in the same area. He has a temperature of 39.9°C, a respiratory rate of 31 breaths/minute and a pulse rate of 110 beats/minute. His blood results are as follows:

Haemoglobin 129 g/L (130-180)

White cell count 26 x 10″/L (4-11)

Platelets 450 x 10°/L (150-400)

CRP 180 mg/L (<10)

A chest X-ray shows the following:

What is the SINGLE most likely diagnosis?

A 60 year old man who has a known case of lung carcinoma presented to the Emergency Department with complaints of sudden onset of shortness of breath along with facial and bilateral upper limb swelling. He has recently travelled from India to the UK. His oxygen saturation is 89%, blood pressure is 110/70 mmHg, heart rate is 98 beats/minute, respiratory rate is 30 breaths/minute and temperature is 36.5°C. On examination, he has distended neck and upper chest veins and stridor is audible. A chest X-ray was done which is seen below.

What is the SINGLE most likely diagnosis?

A 42 year old man has had a productive cough for the past 2 weeks. He presents to the hospital with chest pain and shortness of breath. On auscultation, there are decreased breath sounds on the left lower lobe with crackles. Percussion is dull in the same area. He has a temperature of 39.1°C, a respiratory rate of 30 breaths/minute and a pulse rate of 90 beats/minute. His blood results are as follows:

Haemoglobin 129 g/L (130-180)

White cell count 14 x 10″/L (4-11)

Platelets 450 x 10°/L (150-400) CRP 90 mg/L (<10)

A chest X-ray shows the following:

What is the likely diagnosis based on the chest X-ray?

A 62 year old man presents to the Emergency Department with a sudden onset of breathlessness and left pleuritic chest pain. On examination, he has diminished breath sounds on the left with hyper-resonance over the left lung. He was given oxygen and analgesia. A chest X-ray is seen below:

What is the SINGLE most likely diagnosis?

A 48 year old man has painful swelling of the right foot which started 7 days ago. He has redness on his foot at the location of the first metatarsal joint. He has had similar pains of the foot a few years ago. He drinks an average of 22 units of alcohol a week. An X-ray shows soft tissue swelling with well defined “punched-out” erosions with sclerotic margins of the first metatarsal joint. What is the SINGLE most likely diagnosis?

A 55 year old man has been experiencing coughing, breathlessness, fever and left sided- pleuritic chest pain for 3 weeks. He is a smoker with a 30 pack-year history. His temperature is 38.6°C, pulse rate is 97 beats/minute, respiratory rate is 24 breaths/minute, blood pressure 130/70 mmHg and oxygen saturation is 93%. His ECG shows normal sinus rhythm. On auscultation, there are crepitations and reduced air entry at the base of the left lung. A chest X-ray is taken and is seen below:

What is the SINGLE most likely diagnosis?

A 31 year old man has vertigo. He has a long, progressive history of bilateral sensorineural hearing loss. He also complains of tinnitus. His past medical history is significant for neurofibromatosis type 2. What is the most appropriate investigation?

A 65 year old man with a three-year history of prostate cancer presents to the GP surgery with worsening thoracic backache over the past few weeks. He started having episodes of urinary incontinence today. He takes regular slow-release morphine for his pain however he still feels back pain at night which prevents a good night sleep. On examination, he has bilateral lower limb weakness. What is the SINGLE most appropriate investigation to request?

A 60 year old man has been coughing for 6 months and has recently had a few episodes of coughing up blood. He has been previously diagnosed with asthma-COPD averlap syndrome and uses his inhalers regularly. He has a 20 pack year smoking history. He does not complain of any shortness of breath or chest pain. On examination, he is afebrile, heart rate is 85 beats/minute, respiratory rate is 18/minute, blood pressure is 110/70 mmHg and SpO2 is 93%. A chest X-ray was performed which is seen below.

What is the SINGLE most appropriate diagnosis?

An 83 year old man with a diagnosis of heart failure, COPD and non-Hodgkin lymphoma attends the Emergency Department with a new onset of shortness of breath. He has had an ongoing cough for a few months. He has bilateral basal crepitations on auscultation. He has a temperature of 37.3°C, heart rate of 90 beats/minute, blood pressure of 110/70 mmHg, respiratory rate of 25 breaths/minute and an oxygen saturation of 88%. An X-ray is seen below.

Which is the most likely diagnosis?