The Final FRCR

Self-Assessment

Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9780429529740
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This is an SBA question book aimed at the post-graduate radiology market, specifically those taking the Fellowship of the Royal College of Radiology (FRCR) part 2 ('final') exams. This is a complementary title to The Final FRCR: Complete Revision Notes, which published in 2018.

Part 2 of the FRCR is itself composed of two elements. Part 2a is a series of six multiple choice exams covering the major body systems: musculoskeletal & trauma, gastrointestinal, genitourinary, head and neck, pediatrics and chest. Part 2b involves a written exam and an oral viva and is typically taken at the beginning of the fourth year of specialty training. Approximately 700-1000 trainees sit the exam each year. The SBAs would also be applicable for those studying for other exams or coming to the UK to sit the UK exams from Asia and the Middle East.

Key Features

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• Resource designed for those taking the final FRCR (UK exam) designed to be a complementary product to The Final FRCR: Complete Revision Notes.

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• Templated question format across the six major body systems.

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• Written by recent graduates of the FRCR exams who know how best to approach the topic.

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• Reviewed by senior advisors.

Paper 1

1. A 57 year old man had an abdominal aortic aneurysm endovascular repair 6 months ago. The stent graft extends from the infrarenal region to hyperintense and enhance the common iliac arteries bilaterally. A recent CT abdomen and pelvis demonstrates that the aneurysm sac has enlarged following the repair with a blush of contrast within the sac at the origin of the inferior mesenteric artery from the abdominal aorta.
   What is the most likely diagnosis?
   • a. Type 1a endoleak
   • b. Type 1b endoleak
   • c. Type 2 endoleak
   • d. Type 3 endoleak
   • e. Type 5 endoleak
2. A 46 year old man has an MRI head for persistent headache which demonstrates a 5-mm area in the pituitary with reduced enhancement compared to the rest of the gland. This is isointense on T1 weighted sequences and mildly hyperintense on T2 weighted sequences. Other recent plain films requested by the GP for joint pain demonstrate generalised osteopenia, chondrocalcinosis at the knees and joint space widening at the ankle.
   What other radiological finding would support the diagnosis?
   • a. Eleven pairs of ribs
   • b. Heel pad thickness of 30 mm
   • c. Increased interpedicular distance
   • d. Madelung deformity
   • e. Sclerosis of the vertebral end plates
3. A 36 year old female patient originally presented to her GP with difficulty swallowing solids and liquids, associated chest discomfort and occasional episodes of regurgitation. Barium swallow helps to obtain the diagnosis. There is smooth distal oesophageal tapering with proximal oesophageal dilatation and tertiary contractions. This is successfully treated at the time but 19 years later the same patient presents with dysphagia again. The barium swallow now demonstrates an irregular, shouldered narrowing with proximal oesophageal dilatation. Endoscopy confirms malignancy.
   Where is the new narrowing most likely to be sited?
   • a. Cervical oesophagus
   • b. Distal oesophagus
   • c. Mid-oesophagus
   • d. Mid and distal oesophagus
   • e. Proximal stomach
4. A 42 year old female patient, undergoing long-term peritoneal dialysis, has an abdominal ultrasound for left-sided flank pain with haematuria. The kidneys measure up to 5.5 cm in bipolar length with cortical thinning. There is no hydronephrosis or renal calculi. There are several bilateral renal lesions. These are small, exophytic, anechoic and well defined. One lesion on the left side has internal echoes and dependent debris. There is a moderate amount of free fluid in the abdomen and pelvis.
   What is the most likely underlying diagnosis causing the renal lesions?
   • a. Acquired cystic kidney disease
   • b. Autosomal dominant polycystic kidney disease
   • c. Autosomal recessive polycystic kidney disease
   • d. Idiopathic bilateral renal cysts
   • e. Tuberous sclerosis
5. A CT head is performed on a toddler who has tripped at home, hitting his head. The paediatric team are concerned about a possible seizure following the event and a couple of episodes of vomiting. The scan shows no intracranial haemorrhage. However, there is a hypodense posterior fossa lesion. An MRI more clearly demonstrates that this is in the posterior midline of the posterior fossa displacing the cerebellum anteriorly. The tentorium cerebelli and cerebellar vermis appear intact and have normal appearances. There is no hydrocephalus and the fourth ventricle is within normal limits. There is no significant enhancement following contrast administration. There is no restricted diffusion. On a FLAIR sequence the lesion is isointense to cerebrospinal fluid.
   Which diagnosis is most likely?
   • a. Dermoid cyst
   • b. Epidermoid cyst
   • c. Ependymal cyst
   • d. Pilocytic astrocytoma
   • e. Mega cisterna magna
6. An MRI of the spine is performed in a 43 year old patient with no significant medical history complaining of cervical pain. This reveals a solitary, oval, intradural extramedullary lesion extending from C5 to C6. It is sited anteriorly within the spinal canal and is isointense to the cord on T1, hyperintense on T2 sequences with heterogenous enhancement following contrast. It is displacing the spinal cord and right C5 nerve root and mildly widening the neural foramen.
   What is the most likely underlying cause?
   • a. Epidermoid
   • b. Meningioma
   • c. Metastasis
   • d. Paraganglioma
   • e. Schwannoma
7. A 44 year old male presents to the emergency department with left side renal colic; he has an unenhanced CT urinary tract to investigate. There is no renal calculus and no other significant finding in the abdomen or pelvis. There is an incidental finding of a partially visualised 2-cm subpleural nodule in the right lower lobe. He is discharged back to the care of the GP, with advice to further investigate the nodule. An unenhanced outpatient CT chest demonstrates that the nodule is solitary and slightly lobulated with punctate calcification. There are low density foci within the nodule that have a density of negative Hounsfield units. No other abnormality is seen on the CT chest.
   What is the most appropriate next course of action?
   • a. Staging CT scan to look for a primary malignancy
   • b. Investigation of the nodule with CT angiogram
   • c. FDG PET scan to assess whether the nodule is avid
   • d. Discharge the patient
   • e. Investigation with a Gallium 68 PET scan
8. A 53 year old diabetic patient presents with right shoulder pain and reduced range of movement which does not improve despite community physiotherapy. The patient is reviewed in the orthopaedic outpatient clinic and an MRI shoulder arthrogram is requested.
   Which of the options below is most consistent with adhesive capsulitis?
   Table 1.1:

   	Joint Capsule	Subscapularis Bursa	Coracohumeral Ligament	Lymphatic Filling
   a	Thickened	Small	Thickened	Present
   b	Thickened	Enlarged	Thinned	Present
   c	Thinned	Enlarged	Thinned	Absent
   d	Thinned	Small	Thickened	Present
   e	Normal	Enlarged	Thinned	Absent

9. A 56 year old male presents with gradual onset right upper quadrant pain. An ultrasound examination is performed which demonstrates absence of Doppler flow in the hepatic veins. Budd-Chiari syndrome is suspected.
   Which of the following imaging features differentiates chronic from acute Budd-Chiari?
   • a. Hepatomegaly
   • b. Hypertrophied caudate lobe
   • c. Heterogeneous hepatic echotexture
   • d. Splenomegaly
   • e. Ascites
10. A 5 year old girl has an obvious deformity affecting the right side of her upper back and shoulder with a visible ‘bump’. She has spinal imaging which detects fusion of the C2-C4 vertebrae. The patient has also had an MRI brain and spine.
    Given the other findings, which of the following is most likely to be found on the MRI brain?
    • a. Chiari I malformation
    • b. Haemangioblastoma
    • c. Holoprosencephaly
    • d. Optic glioma
    • e. Polymicrogyria
11. An oncology patient has an MRI spine due to increasing back pain. Apart from mild generalised motor weakness he has no significant neurology. The MRI identifies multiple areas of abnormal T1 and T2 signal which are hypointense compared to the adjacent disc. There is heterogenous high STIR signal in these regions and restricted diffusion. There is no significant narrowing of the canal or neural foramina. The cord returns normal signal.
    What is the most likely underlying primary site of malignancy?
    • a. Colorectal carcinoma
    • b. Melanoma
    • c. Non-small cell lung carcinoma
    • d. Prostate carcinoma
    • e. Renal cell carcinoma
12. A 47 year old man complains of progressive discomfort and swelling of his right knee over a couple of years which is now causing difficulty walking. An MRI shows no significant degenerative change but there is synovial proliferation. There is some erosion of the bones on both sides of the joint and multiple small, lobulated intra-articular foci which are intermediate signal on T1 and T2 hyperintense. An earlier radiograph confirms some of these intra-articular bodies are calcified.
    What is the most likely diagnosis?
    • a. Pigmented villonodular synovitis
    • b. Primary osteochondromatosis
    • c. Secondary osteochondromatosis
    • d. Synovial chondrosarcoma
    • e. Synovial haemangioma
13. A 36 year old man is referred by his GP following a diagnosis of hypertension and has a chest radiograph. The lungs and pleural spaces are clear. The mediastinum is abnormal and the aorta has a ‘reverse 3’ sign with bilateral inferior rib notching.
    What other finding is magnetic reson...