Diagnostic Radiology Prometric exam questions with answers

1. Question 1Body Imaging (Gastrointestinal, Hepatobiliary, Genitourinary and Abdominopelvic)easy

   A 42-year-old woman has an incidental 3 cm liver lesion on ultrasound. Multiphase CT shows peripheral, discontinuous nodular enhancement in the arterial phase that matches blood pool density and progressively fills in centripetally on portal venous and delayed phases. What is the most likely diagnosis?

   1. AFocal nodular hyperplasia
   2. BHepatocellular adenoma
   3. CHaemangioma
   4. DHypervascular metastasis
   Show answer and explanation▾

   Answer: C. Haemangioma

   Peripheral, discontinuous nodular enhancement that follows the blood pool and fills in centripetally is the classic pattern of hepatic cavernous haemangioma, and a typical lesion needs no further workup. Focal nodular hyperplasia shows homogeneous intense arterial enhancement, becoming isodense, with a central scar that enhances late. Hypervascular metastases usually show ring or diffuse enhancement with washout rather than progressive nodular fill-in.

2. Question 2Body Imaging (Gastrointestinal, Hepatobiliary, Genitourinary and Abdominopelvic)medium

   A 55-year-old man has an incidentally discovered 2.4 cm homogeneous, well-circumscribed left adrenal nodule on unenhanced CT, measuring 6 HU. He has no history of cancer and biochemical screening is normal. What is the most appropriate management?

   1. ANo further imaging, as this is diagnostic of a lipid-rich adenoma
   2. BAdrenal washout CT to calculate absolute washout
   3. CChemical-shift MRI to confirm intracellular lipid
   4. DCT-guided biopsy to exclude adrenocortical carcinoma
   Show answer and explanation▾

   Answer: A. No further imaging, as this is diagnostic of a lipid-rich adenoma

   An unenhanced attenuation of 10 HU or less indicates abundant intracellular lipid and is diagnostic of a benign lipid-rich adenoma, so no further imaging or follow-up is required when biochemistry is normal. Washout CT and chemical-shift MRI are used for lesions above 10 HU, where they help characterise lipid-poor adenomas. Biopsy is rarely indicated and must never precede biochemical exclusion of phaeochromocytoma.

3. Question 3Body Imaging (Gastrointestinal, Hepatobiliary, Genitourinary and Abdominopelvic)hard

   A 68-year-old woman has a branch-duct intraductal papillary mucinous neoplasm in the pancreatic body. Under the international (Fukuoka) consensus criteria, which MRI finding constitutes a high-risk stigma rather than a worrisome feature?

   1. ACyst diameter of 3.5 cm
   2. BMain pancreatic duct diameter of 7 mm
   3. CThickened, enhancing cyst wall
   4. DEnhancing mural nodule measuring 7 mm
   Show answer and explanation▾

   Answer: D. Enhancing mural nodule measuring 7 mm

   High-risk stigmata include an enhancing mural nodule of 5 mm or more, a main pancreatic duct of 10 mm or more, and obstructive jaundice with a cyst in the pancreatic head; they generally warrant resection in fit patients. Cyst size of 3 cm or more, a main duct of 5 to 9 mm and thickened enhancing cyst walls are worrisome features, which prompt endoscopic ultrasound rather than direct surgery. A 7 mm main duct is therefore worrisome but not high-risk.

4. Question 4Neuro Imaging (Brain, Spine, Head Trauma and Neurovascular)medium

   A 64-year-old man has rapidly progressive dementia over 3 months with myoclonus and ataxia. MRI shows restricted diffusion along the cortical ribbon of both cerebral hemispheres and in the caudate and putamen, without enhancement. Which diagnosis is most likely?

   1. AHerpes simplex encephalitis
   2. BSporadic Creutzfeldt-Jakob disease
   3. CWernicke encephalopathy
   4. DPosterior reversible encephalopathy syndrome
   Show answer and explanation▾

   Answer: B. Sporadic Creutzfeldt-Jakob disease

   Cortical ribboning on DWI together with restricted diffusion in the caudate and putamen, in a patient with rapidly progressive dementia and myoclonus, is highly characteristic of sporadic CJD, and DWI is the most sensitive MRI sequence. Herpes simplex encephalitis involves the medial temporal lobes and insula, usually asymmetrically, with oedema and sometimes haemorrhage. Wernicke encephalopathy affects the medial thalami, mammillary bodies and periaqueductal grey, and PRES typically shows parieto-occipital vasogenic oedema without restricted diffusion.

5. Question 5Head and Neck Imaginghard

   Fourteen months after canal wall up mastoidectomy for cholesteatoma, a patient has MRI instead of a planned second-look operation. A 6 mm focus in the mastoid cavity is hyperintense on non-echo-planar diffusion-weighted imaging with low ADC values and shows no central enhancement on delayed post-gadolinium T1 imaging. What is the best interpretation?

   1. AResidual or recurrent cholesteatoma
   2. BPostoperative granulation tissue
   3. CCholesterol granuloma
   4. DFibrous scar with entrapped fluid
   Show answer and explanation▾

   Answer: A. Residual or recurrent cholesteatoma

   Non-echo-planar DWI is the preferred technique for detecting residual or recurrent cholesteatoma: keratin restricts diffusion, appearing bright on DWI with low ADC, and lesions of a few millimetres can be detected. Granulation tissue and scar enhance on delayed post-contrast imaging and do not restrict diffusion. Cholesterol granuloma is characteristically hyperintense on both T1 and T2 without restricted diffusion.

6. Question 6Musculoskeletal Imagingeasy

   A 24-year-old footballer twists his knee. The AP radiograph shows a small elliptical bone fragment avulsed from the lateral margin of the lateral tibial plateau, just below the joint line. Which associated injury is most likely?

   1. APosterior cruciate ligament tear
   2. BIsolated medial collateral ligament tear
   3. CAnterior cruciate ligament tear
   4. DPatellar tendon rupture
   Show answer and explanation▾

   Answer: C. Anterior cruciate ligament tear

   This is a Segond fracture, an avulsion at the attachment of the anterolateral ligament and lateral capsule caused by internal rotation and varus stress, and it is associated with an ACL tear in the large majority of cases, often with meniscal injury. MRI is indicated to assess the cruciate ligaments and menisci. The reverse Segond fracture of the medial tibial plateau is associated with PCL and medial meniscal injuries.

7. Question 7Chest Imaging (Thoracic Radiology)hard

   A 66-year-old man with progressive dyspnoea has HRCT showing subpleural, basal-predominant reticulation with traction bronchiectasis and honeycombing. Which additional finding most suggests an alternative diagnosis, such as fibrotic hypersensitivity pneumonitis, rather than idiopathic pulmonary fibrosis?

   1. AMildly enlarged mediastinal lymph nodes up to 13 mm
   2. BSmall foci of ground-glass opacity within reticulated areas
   3. CHeterogeneous involvement with areas of relatively spared lung
   4. DLobules of low attenuation with air trapping in three or more lobes
   Show answer and explanation▾

   Answer: D. Lobules of low attenuation with air trapping in three or more lobes

   Mosaic attenuation with sharply defined lobular air trapping in multiple lobes (the three-density pattern) indicates small airway involvement and is a key feature favouring fibrotic hypersensitivity pneumonitis over a UIP pattern from IPF. Mild mediastinal lymph node enlargement is common in IPF and does not argue against it. Heterogeneous, patchy involvement with spared lung and minor ground glass within fibrotic areas are consistent with UIP.

8. Question 8Cardiovascular Imaginghard

   A 71-year-old hypertensive man has acute tearing chest pain. Unenhanced CT shows smooth, crescentic, hyperattenuating thickening of the descending thoracic aortic wall without an intimal flap. Which feature best distinguishes acute intramural haematoma from atherosclerotic mural thrombus?

   1. AA smooth rather than irregular luminal contour
   2. BIntimal calcification displaced inward on the luminal side of the thickening
   3. CAortic wall thickening greater than 5 mm
   4. DAbsence of enhancement after intravenous contrast
   Show answer and explanation▾

   Answer: B. Intimal calcification displaced inward on the luminal side of the thickening

   In intramural haematoma the blood lies within the media, so intimal calcification is displaced centrally and lies on the luminal side of the crescent; mural thrombus sits on top of the intima, so any calcification lies at its outer margin. Neither lesion enhances with contrast, so lack of enhancement does not discriminate. Wall thickening over 5 mm and a smooth contour can be seen in both, although thrombus is often more irregular.

9. Question 9Paediatric Imagingeasy

   An 18-month-old boy has intermittent inconsolable crying with drawing up of the legs and one episode of red currant jelly stool. He is haemodynamically stable with a soft abdomen. Ultrasound shows a 3.5 cm target-shaped mass in the right upper quadrant with no free fluid. What is the most appropriate next step?

   1. AImage-guided air or hydrostatic enema reduction
   2. BEmergency laparotomy and manual reduction
   3. CContrast-enhanced CT of the abdomen
   4. DObservation with repeat ultrasound in 24 hours
   Show answer and explanation▾

   Answer: A. Image-guided air or hydrostatic enema reduction

   Ileocolic intussusception is confirmed by the target or doughnut sign on ultrasound, and in a stable child without peritonitis or perforation the treatment of choice is pneumatic or hydrostatic enema reduction under fluoroscopic or ultrasound guidance, which succeeds in most cases. Surgery is reserved for peritonitis, perforation, shock or failed reduction. CT adds radiation without changing management, and observation risks bowel ischaemia.

10. Question 10Women's Imaging (Breast, Obstetric and Gynaecologic)medium

    A 29-year-old woman has a palpable breast lump. Ultrasound shows a 12 mm oval, circumscribed, parallel-oriented, homogeneously hypoechoic mass without posterior features. There is no prior imaging. Which BI-RADS category and management are most appropriate?

    1. ABI-RADS 2, with routine screening only
    2. BBI-RADS 4A, with ultrasound-guided core biopsy
    3. CBI-RADS 3, with follow-up ultrasound in 6 months
    4. DBI-RADS 5, with core biopsy and surgical referral
    Show answer and explanation▾

    Answer: C. BI-RADS 3, with follow-up ultrasound in 6 months

    An oval, circumscribed, parallel, hypoechoic mass with no suspicious features is the typical appearance of a fibroadenoma and qualifies as BI-RADS 3 (probably benign, 2% or less likelihood of malignancy), managed with short-interval imaging surveillance; biopsy is an acceptable alternative if the patient prefers it or follow-up is unreliable. BI-RADS 4 is reserved for suspicious features such as angular, indistinct or microlobulated margins or non-parallel orientation. BI-RADS 2 requires a definitively benign finding such as a simple cyst.

11. Question 11Contrast Media, Imaging Physics and Radiation Safetyeasy

    A 64-year-old man with type 2 diabetes taking metformin is booked for contrast-enhanced CT of the abdomen. His eGFR is 55 mL/min/1.73 m2 and he has no acute kidney injury. According to the ACR Manual on Contrast Media, what should be done about his metformin?

    1. AStop metformin 48 hours before the scan
    2. BStop metformin for 48 hours after the scan
    3. CStop metformin until eGFR is rechecked after the scan
    4. DContinue metformin without interruption
    Show answer and explanation▾

    Answer: D. Continue metformin without interruption

    In patients with eGFR of 30 or more and no acute kidney injury, the ACR advises that metformin need not be discontinued before or after intravenous iodinated contrast, because the risk of lactic acidosis is negligible. Withholding metformin for 48 hours with reassessment of renal function is reserved for patients with acute kidney injury or eGFR below 30. Stopping it before the scan is not required in any group.

12. Question 12Patient Safety and Quality in Radiologymedium

    Two minutes after intravenous iodinated contrast, a 45-year-old woman develops diffuse urticaria, wheeze, throat tightness and a blood pressure of 76/40 mmHg. Oxygen is applied and help is called. Which is the most appropriate first drug treatment?

    1. ADiphenhydramine 50 mg intravenously
    2. BEpinephrine 0.5 mg (1 mg/mL) intramuscularly
    3. CHydrocortisone 200 mg intravenously
    4. DEpinephrine 1 mg (0.1 mg/mL) as an intravenous bolus
    Show answer and explanation▾

    Answer: B. Epinephrine 0.5 mg (1 mg/mL) intramuscularly

    This is a severe anaphylactic-type reaction with hypotension and bronchospasm, and the first drug is intramuscular epinephrine 0.5 mg of the 1 mg/mL solution (or a 0.3 mg autoinjector), repeated every 5 to 15 minutes as needed, with leg elevation and rapid intravenous fluids. A 1 mg intravenous bolus is the cardiac arrest dose and risks arrhythmia and severe hypertension in a patient with a pulse. Antihistamines and corticosteroids do not treat hypotension or airway compromise and are not first-line.

13. Question 13Professionalism, Ethics, Law and Research Methodologymedium

    A study evaluates a new CT sign for appendicitis. Patients with a positive sign proceed to appendicectomy and histology, but most with a negative sign are discharged without any reference standard or follow-up. Which bias most affects the reported accuracy?

    1. APartial verification bias, inflating apparent sensitivity
    2. BSpectrum bias, inflating apparent specificity
    3. CIncorporation bias, inflating sensitivity and specificity
    4. DLead-time bias, inflating apparent survival
    Show answer and explanation▾

    Answer: A. Partial verification bias, inflating apparent sensitivity

    When the reference standard is applied preferentially to test-positive patients, false negatives go undetected, which inflates sensitivity and typically lowers specificity; this is partial verification (work-up) bias. Spectrum bias arises when the study population differs from the intended population, for example severe cases compared with healthy controls. Incorporation bias occurs when the index test forms part of the reference standard, and lead-time bias relates to screening and survival rather than diagnostic accuracy.

14. Question 14Interventional and Vascular Radiology (procedural competence)medium

    The day after coronary angiography via the right common femoral artery, a 70-year-old man on dual antiplatelet therapy has a pulsatile groin mass. Duplex ultrasound shows a 2.8 cm pseudoaneurysm with a long, narrow neck and no arteriovenous fistula. What is the preferred treatment?

    1. AUltrasound-guided compression repair for 60 minutes
    2. BOpen surgical repair of the arteriotomy
    3. CObservation with repeat ultrasound in 4 weeks
    4. DUltrasound-guided percutaneous thrombin injection
    Show answer and explanation▾

    Answer: D. Ultrasound-guided percutaneous thrombin injection

    Ultrasound-guided thrombin injection is first-line treatment for suitable femoral pseudoaneurysms, with success rates above 90% even in patients on antiplatelet or anticoagulant therapy, and a long narrow neck lowers the risk of thrombin escaping into the native artery. Compression repair is painful, time-consuming and less successful in anticoagulated patients. Observation is reasonable only for small pseudoaneurysms, and surgery is reserved for infection, rapid expansion, skin compromise or failed percutaneous treatment.

15. Question 15Nuclear Medicine, Molecular and Hybrid Imagingmedium

    A 74-year-old man with prostate cancer and a PSA of 280 ng/mL has a Tc-99m MDP bone scan. There is diffusely and uniformly increased uptake throughout the axial skeleton with excellent bone-to-soft-tissue contrast and faint or absent renal activity. What is the most likely explanation?

    1. AA normal scan in a well-hydrated patient
    2. BBilateral renal obstruction preventing tracer excretion
    3. CDiffuse skeletal metastases producing a superscan
    4. DPaget disease involving the whole skeleton
    Show answer and explanation▾

    Answer: C. Diffuse skeletal metastases producing a superscan

    A superscan shows diffusely increased skeletal uptake with high bone-to-soft-tissue contrast and reduced or absent renal activity because the skeleton takes up most of the tracer; with a very high PSA, diffuse metastatic prostate cancer is the cause, and the scan can be mistaken for normal. Metabolic causes such as renal osteodystrophy and hyperparathyroidism produce a similar pattern with more appendicular and calvarial involvement. Paget disease is usually polyostotic but focal and expansile rather than uniform.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.