FMGE Radiology questions from past papers

1. Q1. A patient is counselled before pelvic radiotherapy. Radiosensitivity rises with mitotic rate and falls with differentiation, so which tissue inside the treatment field will show injury earliest?

   • A. Fibrous scar tissue
   • B. Intestinal crypt epithelium
   • C. Mature bone matrix
   • D. Peripheral nerve trunk

   Answer: B. Intestinal crypt epithelium

2. Q2. In oncological PET-CT, tumour uptake reflects increased glycolysis. Which radiopharmaceutical is used?

   • A. Technetium-99m methylene diphosphonate
   • B. Fluorine-18 fluorodeoxyglucose
   • C. Iodine-131 sodium iodide
   • D. Gallium-68 DOTATATE

   Answer: B. Fluorine-18 fluorodeoxyglucose

1. Q1. A man has a rising PSA after radical prostatectomy but no lesion on conventional imaging. Which PET tracer binds a membrane antigen expressed by prostate cancer cells?

   • A. Fluorine-18 FDG
   • B. Gallium-68 DOTATATE
   • C. Fluorine-18 sodium fluoride
   • D. Gallium-68 PSMA

   Answer: D. Gallium-68 PSMA

1. Q1. A patient receives 2 Gy once daily, five days a week, for six weeks. What is this schedule called, and what is the radiobiological reason for splitting the dose?

   • A. Hyperfractionation, allowing a higher total dose in less time
   • B. Hypofractionation, exploiting a low alpha/beta ratio
   • C. Conventional fractionation, letting normal tissue repair sublethal damage between fractions
   • D. Brachytherapy, delivering dose from an implanted source

   Answer: C. Conventional fractionation, letting normal tissue repair sublethal damage between fractions

2. Q2. A pan-scan is requested for a polytrauma patient. Which region is not part of the standard protocol, and how is it assessed instead?

   • A. The cervical spine, which is cleared clinically in every patient
   • B. The limbs, which are imaged with targeted radiographs guided by clinical findings
   • C. The abdomen, which is assessed by FAST alone
   • D. The head, which is imaged only if consciousness is impaired

   Answer: B. The limbs, which are imaged with targeted radiographs guided by clinical findings

1. Q1. A man has months of back pain, night sweats and weight loss. Imaging shows destruction of two adjacent vertebral bodies with collapse of the intervening disc space and a paraspinal soft-tissue collection. What is the diagnosis?

   • A. Multiple myeloma
   • B. Ankylosing spondylitis
   • C. Tuberculous spondylodiscitis
   • D. Metastatic carcinoma

   Answer: C. Tuberculous spondylodiscitis

2. Q2. An elderly man has weight loss, anorexia and iron deficiency anaemia. Chest imaging shows multiple well-defined rounded opacities of varying size in both lungs. What does this pattern represent, and what should be sought?

   • A. Haematogenous metastases, prompting a search for a gastrointestinal primary
   • B. Primary bronchogenic carcinoma with local spread
   • C. Pneumoconiosis from occupational dust exposure
   • D. Malignant pleural mesothelioma

   Answer: A. Haematogenous metastases, prompting a search for a gastrointestinal primary

1. Q1. A patient has intermittent dysphagia and chest pain. Barium swallow shows multiple simultaneous non-propulsive tertiary contractions giving a corkscrew appearance, and the lower oesophageal sphincter relaxes normally. What is the diagnosis?

   • A. Achalasia cardia
   • B. Diffuse oesophageal spasm
   • C. Oesophageal carcinoma
   • D. Peptic stricture

   Answer: B. Diffuse oesophageal spasm

2. Q2. Which contrast study gives the best distension and mucosal detail of the small bowel by infusing barium and methylcellulose through a naso-jejunal tube?

   • A. Barium meal
   • B. Barium meal follow-through
   • C. Enteroclysis
   • D. Barium enema

   Answer: C. Enteroclysis

1. Q1. An obese adolescent has hip and referred knee pain with limited internal rotation, and the hip rolls into external rotation when flexed. Radiographs show the femoral head slipping posteroinferiorly relative to the neck. What is the diagnosis?

   • A. Slipped capital femoral epiphysis
   • B. Legg-Calve-Perthes disease
   • C. Developmental dysplasia of the hip
   • D. Transient synovitis

   Answer: A. Slipped capital femoral epiphysis

2. Q2. A young man has right flank pain, fever and pain on passive extension of the right hip, with leukocytosis. CT shows a rim-enhancing collection within the right psoas muscle. What is the diagnosis, and which sign was elicited?

   • A. Acute appendicitis, with Rovsing sign
   • B. Psoas abscess, with a positive psoas stretch sign
   • C. Acute pyelonephritis, with renal angle tenderness
   • D. Testicular torsion, with an absent cremasteric reflex

   Answer: B. Psoas abscess, with a positive psoas stretch sign

1. Q1. On an axial brain image, which structure shows the cerebral peduncles anteriorly and the colliculi posteriorly, with the cerebral aqueduct between them?

   • A. The pons
   • B. The midbrain
   • C. The medulla
   • D. The cerebellum

   Answer: B. The midbrain

2. Q2. On ultrasound of the liver, which vessel has bright echogenic walls because it is invested by fibrofatty connective tissue of the portal tracts?

   • A. The hepatic veins
   • B. The inferior vena cava
   • C. The hepatic artery
   • D. The portal vein

   Answer: D. The portal vein

1. Q1. On M-mode lung ultrasound, normal pleural sliding produces a granular pattern below a smooth line. What is this called, and what replaces it in pneumothorax?

   • A. The seashore sign, replaced by the barcode or stratosphere sign
   • B. The barcode sign, replaced by the seashore sign
   • C. The lung point, replaced by A-lines
   • D. The deep sulcus sign, replaced by B-lines

   Answer: A. The seashore sign, replaced by the barcode or stratosphere sign

2. Q2. A 10-year-old girl has a painless structural scoliosis with no neurological signs, normal vertebral morphology and no underlying disorder. What is the most likely cause?

   • A. Congenital vertebral malformation
   • B. Neurofibromatosis type 1
   • C. Idiopathic scoliosis
   • D. Neuromuscular scoliosis

   Answer: C. Idiopathic scoliosis

1. Q1. A hypertensive man has sudden tearing chest pain radiating to the back. Contrast CT shows an intimal flap dividing the aortic lumen in two. What is the diagnosis?

   • A. Aortic dissection
   • B. Pulmonary embolism
   • C. Aortic aneurysm without dissection
   • D. Cardiac myxoma

   Answer: A. Aortic dissection

2. Q2. Which nuclear medicine study is regarded as the most reproducible for measuring left ventricular ejection fraction?

   • A. Thallium-201 SPECT
   • B. Multigated acquisition (MUGA) blood pool scanning
   • C. PET myocardial perfusion imaging
   • D. Sestamibi scanning with pharmacological stress

   Answer: B. Multigated acquisition (MUGA) blood pool scanning

1. Q1. Which two imaging modalities depend on the same underlying physical principle?

   • A. CT and MRI
   • B. Ultrasound and HIDA scanning
   • C. MRI and PET
   • D. CT and plain radiography, both using differential attenuation of X-rays

   Answer: D. CT and plain radiography, both using differential attenuation of X-rays

2. Q2. A woman has right upper quadrant pain and a positive Murphy sign, but ultrasound is equivocal for cholecystitis. Which study best confirms cystic duct obstruction?

   • A. Repeat ultrasound in 24 hours
   • B. Hepatobiliary iminodiacetic acid (HIDA) scanning, where non-visualisation of the gallbladder confirms obstruction
   • C. Plain abdominal radiography
   • D. Barium meal

   Answer: B. Hepatobiliary iminodiacetic acid (HIDA) scanning, where non-visualisation of the gallbladder confirms obstruction

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.