I85PREP
⌘ K
ABR Core Exam study materials
ABR Core Exam study resources

ABR Core Exam practice questions

One question at a time. Build your ABR Core Exam understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Clinical practice domains across all imaging modalities

A 62-year-old man presents with sudden-onset severe abdominal pain and hypotension. CT shows a hyperdense crescent within the wall of the infrarenal aorta with surrounding stranding. Which finding most specifically supports the diagnosis of a symptomatic abdominal aortic aneurysm rather than a ruptured one?

  1. Frank contrast extravasation beyond the aortic contour
  2. Active blush within the psoas muscle
  3. Hyperdense crescent confined to the mural thrombus Correct answer.
  4. Retroperitoneal hematoma displacing the kidney

Explanation

A high-attenuation crescent within the mural thrombus on unenhanced CT represents acute intramural hemorrhage, the hallmark of a symptomatic but contained aneurysm. Frank extravasation, retroperitoneal hematoma, and active blush all indicate free rupture beyond the wall.

Question 2Clinical practice domains across all imaging modalities

Which imaging modality is the reference standard for detecting acute intracranial hemorrhage in an emergency setting?

  1. PET-CT of the brain
  2. Carotid duplex ultrasound
  3. T2-weighted MRI of the brain
  4. Noncontrast CT of the head Correct answer.

Explanation

Noncontrast head CT is highly sensitive for acute hemorrhage because fresh blood appears hyperdense and the exam is rapid and widely available. MRI is more sensitive for subacute and posterior fossa hemorrhage but is slower and less suited to acute triage.

Question 3Clinical practice domains across all imaging modalities

A 34-year-old woman at 28 weeks gestation presents with right lower quadrant pain and fever. Which imaging study is the most appropriate initial evaluation for suspected appendicitis?

  1. Fluoroscopic barium enema
  2. Gadolinium-enhanced MRI
  3. Abdominal radiograph
  4. Ultrasound of the right lower quadrant Correct answer.

Explanation

Ultrasound is the preferred first-line test in pregnancy because it avoids ionizing radiation and gadolinium. If nondiagnostic, MRI without gadolinium is the next step.

Question 4Clinical practice domains across all imaging modalities

A screening mammogram shows a spiculated mass. Which feature on diagnostic workup most strongly suggests malignancy?

  1. Well-circumscribed oval margins
  2. Simple cyst on ultrasound
  3. Microcalcifications in a linear branching pattern Correct answer.
  4. Bilateral symmetric density

Explanation

Linear branching microcalcifications suggest ductal carcinoma in situ because calcification follows the ductal distribution. Circumscribed margins, symmetry, and simple cysts favor benignity.

Question 5Clinical practice domains across all imaging modalities

A 55-year-old smoker has a 3 cm solitary pulmonary nodule with a fat-density component on CT. Which diagnosis is most likely?

  1. Hamartoma Correct answer.
  2. Pulmonary metastasis
  3. Bronchogenic carcinoma
  4. Carcinoid tumor

Explanation

Macroscopic fat within a solitary pulmonary nodule strongly suggests a hamartoma, which also may show popcorn calcification. Fat is uncommon in primary lung carcinoma or metastasis.

Question 6Clinical practice domains across all imaging modalities

A 45-year-old man has sudden tearing chest pain radiating to the back. CT angiography shows a dissection flap beginning distal to the left subclavian artery. Which classification applies?

  1. Stanford type A
  2. DeBakey type I
  3. Stanford type B Correct answer.
  4. DeBakey type II

Explanation

Stanford type B dissections originate distal to the left subclavian artery and do not involve the ascending aorta. Type A involves the ascending aorta, and DeBakey I and II both involve the ascending aorta.

Question 7Clinical practice domains across all imaging modalities

Which imaging finding is most characteristic of a complete hydatidiform mole on ultrasound?

  1. Snowstorm appearance with multiple cystic spaces Correct answer.
  2. Echogenic liver mass
  3. Simple gestational sac with fetal pole
  4. Thickened placenta with a single fetal pole

Explanation

A complete mole shows a heterogeneous, echogenic mass with multiple cystic spaces, often described as a snowstorm pattern. A normal gestational sac or fetal pole is inconsistent with a complete mole.

Question 8Clinical practice domains across all imaging modalities

A 70-year-old woman has a lytic vertebral lesion with an extraosseous soft tissue mass and cortical destruction. Which primary malignancy is most likely?

  1. Osteoid osteoma
  2. Osteosarcoma
  3. Ewing sarcoma
  4. Multiple myeloma Correct answer.

Explanation

Multiple myeloma typically produces lytic lesions with soft tissue extension in older adults. Osteosarcoma and Ewing sarcoma usually occur in younger patients, and osteoid osteoma is a small benign lesion.

Question 9Clinical practice domains across all imaging modalities

A 58-year-old man with cirrhosis has a 2.5 cm liver lesion showing arterial hyperenhancement and portal venous washout. Which diagnosis is most likely?

  1. Hepatic cyst
  2. Focal nodular hyperplasia
  3. Hepatic hemangioma
  4. Hepatocellular carcinoma Correct answer.

Explanation

Arterial hyperenhancement with washout in a cirrhotic liver meets LI-RADS criteria for hepatocellular carcinoma. Hemangiomas show peripheral nodular enhancement, focal nodular hyperplasia has a central scar, and cysts are nonenhancing.

Question 10Clinical practice domains across all imaging modalities

Which imaging modality is most appropriate to evaluate a suspected scaphoid fracture when initial radiographs are negative?

  1. Ultrasound of the shoulder
  2. CT of the chest
  3. MRI of the wrist Correct answer.
  4. Radiograph of the wrist with a cast

Explanation

MRI is highly sensitive for occult scaphoid fractures and can also assess for avascular necrosis. CT can be used but MRI is more sensitive for early marrow edema.

Question 11Clinical practice domains across all imaging modalities

A 3-day-old infant has bilious vomiting. Abdominal radiograph shows a double-bubble sign without distal gas. Which diagnosis is most likely?

  1. Hirschsprung disease
  2. Pyloric stenosis
  3. Malrotation with volvulus
  4. Duodenal atresia Correct answer.

Explanation

The double-bubble sign with absent distal gas indicates duodenal atresia. Pyloric stenosis occurs in older infants with nonbilious vomiting, and malrotation and Hirschsprung disease typically show distal gas.

Question 12Clinical practice domains across all imaging modalities

A 40-year-old woman has a thyroid nodule. Ultrasound shows a solid hypoechoic nodule with irregular margins and microcalcifications. Which next step is appropriate?

  1. Radioiodine therapy
  2. Fine-needle aspiration Correct answer.
  3. Total thyroidectomy without biopsy
  4. Repeat ultrasound in 5 years

Explanation

A solid hypoechoic nodule with irregular margins and microcalcifications is highly suspicious (TI-RADS 5) and warrants fine-needle aspiration. Radioiodine and surgery are not first-line without cytologic confirmation.

Question 13Clinical practice domains across all imaging modalities

Which finding on MRI of the lumbar spine most strongly suggests acute vertebral osteomyelitis?

  1. Endplate destruction with adjacent disc involvement and marrow edema Correct answer.
  2. Disc desiccation with a small annular tear
  3. Symmetric disc bulging at multiple levels
  4. Facet joint hypertrophy

Explanation

Vertebral osteomyelitis typically involves two adjacent endplates with intervening disc destruction and marrow edema. Degenerative changes spare the endplate and do not produce marrow edema.

Question 14Clinical practice domains across all imaging modalities

A 68-year-old man presents with a pulsatile abdominal mass. CT shows a 5.5 cm infrarenal abdominal aortic aneurysm. What size threshold generally warrants elective repair in men?

  1. 3.0 cm
  2. 7.0 cm
  3. 4.0 cm
  4. 5.5 cm Correct answer.

Explanation

Elective repair is generally recommended when the abdominal aortic aneurysm reaches 5.5 cm in men or grows rapidly. Smaller aneurysms are typically followed with surveillance.

Question 15Clinical practice domains across all imaging modalities

A 25-year-old woman has a cystic ovarian lesion with a thin wall, no septations, and no solid components. What is the most appropriate management?

  1. Chemotherapy
  2. Follow-up ultrasound in 6-12 weeks Correct answer.
  3. Immediate surgical resection
  4. Percutaneous drainage

Explanation

A simple cyst with a thin wall, no septations, and no solid components is benign and typically managed with follow-up ultrasound to confirm resolution. Surgery and chemotherapy are reserved for complex or suspicious lesions.

Question 16Clinical practice domains across all imaging modalities

Which imaging study is the most appropriate first-line test for suspected deep vein thrombosis of the lower extremity?

  1. MRI of the thigh
  2. Compression ultrasound of the leg Correct answer.
  3. CT venography of the abdomen
  4. Radionuclide venography

Explanation

Compression ultrasound is the first-line test for lower extremity deep vein thrombosis because it is noninvasive, accurate, and rapid. CT and MRI venography are reserved for specific situations.

Question 17Clinical practice domains across all imaging modalities

A 50-year-old man has a renal mass with macroscopic fat on CT. Which diagnosis is most likely?

  1. Renal oncocytoma
  2. Renal abscess
  3. Renal cell carcinoma
  4. Angiomyolipoma Correct answer.

Explanation

Macroscopic fat within a renal mass is characteristic of an angiomyolipoma. Renal cell carcinoma and oncocytoma rarely contain fat.

Question 18Clinical practice domains across all imaging modalities

Which finding on CT most reliably distinguishes a simple hepatic cyst from a cystic neoplasm?

  1. Thick irregular septations
  2. Peripheral nodular enhancement
  3. Water attenuation with no enhancement Correct answer.
  4. Mural nodularity

Explanation

A simple cyst has water attenuation and shows no enhancement. Peripheral nodular enhancement, thick septations, and mural nodularity suggest a cystic neoplasm.

Question 19Clinical practice domains across all imaging modalities

A 60-year-old woman has a 1.5 cm lung nodule with smooth margins, diffuse calcification, and stability over 2 years. Which management is most appropriate?

  1. Chemoradiation
  2. No further imaging Correct answer.
  3. Percutaneous biopsy
  4. Immediate lobectomy

Explanation

A stable, diffusely calcified nodule with smooth margins is benign and requires no further imaging. Biopsy, resection, or chemoradiation are not indicated.

Question 20Clinical practice domains across all imaging modalities

A 28-year-old woman has a 2 cm thyroid nodule with a spongiform appearance on ultrasound. What is the most appropriate management?

  1. Follow-up ultrasound Correct answer.
  2. Fine-needle aspiration
  3. Radioiodine ablation
  4. Total thyroidectomy

Explanation

A spongiform nodule is a low-suspicion finding (TI-RADS 1-2) and typically requires only follow-up ultrasound. Fine-needle aspiration is reserved for higher-suspicion nodules or those with growth.

Question 21Clinical practice domains across all imaging modalities

A 65-year-old woman with a history of breast cancer has a solitary hypermetabolic bone lesion on PET-CT. Which imaging study best characterizes the lesion?

  1. Bone scan
  2. Radiograph of the involved bone
  3. MRI of the involved bone Correct answer.
  4. Ultrasound of the involved bone

Explanation

MRI is the most sensitive modality for characterizing bone marrow involvement and soft tissue extension. Radiographs may be normal early, and bone scan is less specific.

Question 22Clinical practice domains across all imaging modalities

A 45-year-old man has a pancreatic head mass with a double duct sign on CT. Which diagnosis is most likely?

  1. Serous cystadenoma
  2. Pancreatic pseudocyst
  3. Insulinoma
  4. Pancreatic adenocarcinoma Correct answer.

Explanation

The double duct sign, with dilation of both the common bile duct and pancreatic duct, suggests a pancreatic head mass, most commonly adenocarcinoma. Serous cystadenomas and pseudocysts do not typically cause this sign.

Question 23Clinical practice domains across all imaging modalities

A 70-year-old man has a 3 cm renal mass with a central scar and spoke-wheel enhancement on CT. Which diagnosis is most likely?

  1. Renal cell carcinoma
  2. Renal cyst
  3. Oncocytoma Correct answer.
  4. Angiomyolipoma

Explanation

A central scar with spoke-wheel enhancement is characteristic of an oncocytoma. Renal cell carcinoma may have a scar but typically shows heterogeneous enhancement and necrosis.

Question 24Clinical practice domains across all imaging modalities

A 30-year-old woman has a 2 cm cystic lesion in the pineal region with peripheral enhancement. Which diagnosis is most likely?

  1. Pineocytoma
  2. Pineoblastoma
  3. Ependymoma
  4. Pineal cyst Correct answer.

Explanation

A simple pineal cyst is a benign cystic lesion that may show thin peripheral enhancement and does not require treatment. Pineocytomas and pineoblastomas are solid tumors.

Question 25Clinical practice domains across all imaging modalities

Which imaging finding is most specific for a malignant pleural effusion on CT?

  1. Simple pleural fluid
  2. Pleural thickening with nodularity Correct answer.
  3. Pleural calcification
  4. Loculated fluid

Explanation

Nodular pleural thickening is highly specific for malignant pleural disease. Simple fluid, calcification, and loculation can occur in benign processes.

Question 26Clinical practice domains across all imaging modalities

A 62-year-old woman has a 4 cm solid mass in the right lobe of the liver. On MRI, the mass shows marked arterial phase enhancement and remains hyperintense to liver on delayed hepatobiliary phase imaging after gadoxetate administration. Which diagnosis is most likely?

  1. Hepatic hemangioma
  2. Hepatocellular adenoma
  3. Hepatocellular carcinoma
  4. Focal nodular hyperplasia Correct answer.

Explanation

Focal nodular hyperplasia contains functioning hepatocytes and biliary canaliculi that retain hepatocyte-specific contrast agents, producing iso- or hyperintensity on delayed hepatobiliary phase images. Hepatocellular carcinoma typically shows hypointensity on hepatobiliary phase because malignant hepatocytes lack normal OATP transporter expression.

Question 27Clinical practice domains across all imaging modalities

Which feature on high-resolution CT most reliably indicates that a pulmonary nodule is benign?

  1. Popcorn calcification Correct answer.
  2. Pleural tagging
  3. Spiculated margin
  4. Cavitation with thick wall

Explanation

Popcorn-like (chondroid) calcification is a benign pattern classically seen in hamartomas. Spiculation, thick-walled cavitation, and pleural tagging are features associated with malignancy.

Question 28Clinical practice domains across all imaging modalities

A 34-year-old man has sudden severe headache. Noncontrast head CT is normal, but lumbar puncture shows xanthochromia. Which vascular lesion is most likely?

  1. Cerebral venous sinus thrombosis
  2. Cerebral amyloid angiopathy
  3. Berry aneurysm rupture Correct answer.
  4. Arteriovenous malformation

Explanation

A ruptured berry (saccular) aneurysm is the most common cause of nontraumatic subarachnoid hemorrhage, and xanthochromia confirms hemorrhage when CT is negative. Aneurysms most often arise at branch points of the circle of Willis.

Question 29Clinical practice domains across all imaging modalities

Which imaging finding on MRI best distinguishes an epidermoid cyst from an arachnoid cyst in the cerebellopontine angle?

  1. Restricted diffusion on DWI Correct answer.
  2. T2 hyperintensity
  3. Cerebrospinal fluid signal on FLAIR
  4. Absence of enhancement

Explanation

Epidermoid cysts contain keratinaceous debris that restricts diffusion, appearing bright on DWI and dark on ADC, whereas arachnoid cysts follow CSF signal and do not restrict diffusion. T2 hyperintensity and lack of enhancement are shared by both lesions.

Question 30Clinical practice domains across all imaging modalities

A 55-year-old woman has a 2.5 cm solid renal mass with a central stellate scar and spoke-wheel enhancement pattern. Which diagnosis is most likely?

  1. Angiomyolipoma
  2. Oncocytoma Correct answer.
  3. Clear cell renal cell carcinoma
  4. Renal lymphoma

Explanation

Oncocytomas are benign tumors that classically show a central stellate scar and a spoke-wheel pattern of enhancement. However, imaging cannot reliably exclude chromophobe renal cell carcinoma, and biopsy or resection is often required.

Question 31Clinical practice domains across all imaging modalities

A 47-year-old man has acute right lower quadrant pain. Ultrasound shows a noncompressible blind-ending tubular structure measuring 9 mm with surrounding hyperechogenicity and no internal flow. Which diagnosis is most likely?

  1. Acute appendicitis Correct answer.
  2. Mesenteric adenitis
  3. Terminal ileitis
  4. Epiploic appendagitis

Explanation

A noncompressible blind-ending tubular structure greater than 6 mm with periappendiceal fat stranding is the classic sonographic appearance of acute appendicitis. Absence of internal flow supports necrosis or perforation risk.

Question 32Clinical practice domains across all imaging modalities

Which imaging study is the most appropriate first-line test for suspected acute cholecystitis?

  1. Abdominal radiograph
  2. CT abdomen without contrast
  3. Right upper quadrant ultrasound Correct answer.
  4. MRCP

Explanation

Right upper quadrant ultrasound is the first-line imaging test for suspected acute cholecystitis, evaluating for stones, wall thickening, pericholecystic fluid, and a sonographic Murphy sign. It is rapid, portable, and lacks ionizing radiation.

Question 33Clinical practice domains across all imaging modalities

A 70-year-old woman has a T-score of -3.0 at the lumbar spine. Which finding on dual-energy x-ray absorptiometry defines osteoporosis?

  1. T-score between -1.0 and -2.5
  2. Z-score of -2.0 or lower
  3. T-score of -2.5 or lower Correct answer.
  4. T-score of -1.0 or lower

Explanation

Osteoporosis is defined by a T-score of -2.5 or lower at the lumbar spine, hip, or femoral neck. T-scores between -1.0 and -2.5 indicate osteopenia.

Question 34Clinical practice domains across all imaging modalities

A 28-year-old woman has a 3 cm well-circumscribed mass in the left breast. Ultrasound shows an oval, hypoechoic mass with circumscribed margins, homogeneous echotexture, and wider-than-tall orientation. Which diagnosis is most likely?

  1. Papilloma
  2. Invasive ductal carcinoma
  3. Phyllodes tumor
  4. Fibroadenoma Correct answer.

Explanation

A well-circumscribed, oval, hypoechoic mass with wider-than-tall orientation in a young woman is characteristic of a fibroadenoma. These features suggest a benign fibroadenoma, though tissue sampling is sometimes required.

Question 35Clinical practice domains across all imaging modalities

A 35-year-old woman has a 2 cm nodule in the left thyroid lobe. Fine-needle aspiration shows a follicular neoplasm. Which imaging feature on ultrasound is most helpful in distinguishing follicular adenoma from follicular carcinoma?

  1. Hypoechogenicity
  2. No reliable ultrasound feature distinguishes them Correct answer.
  3. Microcalcifications
  4. Irregular margins

Explanation

Follicular adenoma and follicular carcinoma cannot be reliably distinguished by cytology or ultrasound; the diagnosis requires histologic evaluation of capsular or vascular invasion. Surgery is therefore often needed for follicular neoplasms.

Question 36Clinical practice domains across all imaging modalities

A 68-year-old man has a 4 cm mass in the tail of the pancreas with cystic spaces and a central scar. Which diagnosis is most likely?

  1. Serous cystadenoma Correct answer.
  2. Mucinous cystic neoplasm
  3. Pancreatic ductal adenocarcinoma
  4. Solid pseudopapillary neoplasm

Explanation

Serous cystadenomas are typically microcystic tumors with a central fibrous scar, often described as a honeycomb or sponge-like appearance. They are almost always benign and occur more frequently in older women.

Question 37Clinical practice domains across all imaging modalities

A 24-year-old man has a lytic lesion in the distal femur with a sclerotic margin and no periosteal reaction. Which lesion is most likely?

  1. Osteosarcoma
  2. Nonossifying fibroma Correct answer.
  3. Osteoid osteoma
  4. Ewing sarcoma

Explanation

A well-defined lytic lesion with a sclerotic margin in the metaphysis of a long bone in a young patient is characteristic of a nonossifying fibroma, a benign fibroxanthoma. The sclerotic rim indicates slow growth.

Question 38Clinical practice domains across all imaging modalities

A 50-year-old man has a 3 cm mass in the left kidney that is entirely cystic with a thick irregular wall and nodular enhancement. Which Bosniak classification category applies?

  1. Bosniak II
  2. Bosniak III
  3. Bosniak I
  4. Bosniak IV Correct answer.

Explanation

Bosniak IV cysts contain enhancing nodular solid components and are considered malignant until proven otherwise, requiring surgical resection. Bosniak III lesions have thickened irregular walls or septa with measurable enhancement.

Question 39Clinical practice domains across all imaging modalities

A 60-year-old woman has a 2 cm ovarian mass with a solid component and internal septations. Which imaging feature most suggests malignancy?

  1. Fat within the lesion
  2. Ascites Correct answer.
  3. Bilateral simple cysts
  4. Thin smooth wall

Explanation

Ascites in the presence of a complex adnexal mass suggests peritoneal spread and malignancy. Solid components and thick septations are also concerning features.

Question 40Clinical practice domains across all imaging modalities

Which finding on MRI is most characteristic of a full-thickness rotator cuff tear?

  1. Fluid signal extending through the entire tendon Correct answer.
  2. Tendon thickening with intermediate signal
  3. Subacromial bursal fluid alone
  4. Humeral head cyst

Explanation

A full-thickness tear is diagnosed when fluid signal completely traverses the tendon from the articular to the bursal surface. Partial-thickness tears show fluid signal that does not span the full tendon thickness.

Question 41Clinical practice domains across all imaging modalities

A 72-year-old man has a 3 cm right upper lobe lung mass with ipsilateral mediastinal lymph node enlargement but no distant metastases. What is the stage?

  1. Stage I
  2. Stage IV
  3. Stage III Correct answer.
  4. Stage II

Explanation

Ipsilateral mediastinal (N2) nodal involvement with no distant metastasis corresponds to stage III NSCLC. Stage IV requires distant metastasis.

Question 42Clinical practice domains across all imaging modalities

A 45-year-old woman has a 2 cm enhancing mass in the right frontal lobe with surrounding edema. MR spectroscopy shows elevated choline and decreased N-acetylaspartate. Which diagnosis is most likely?

  1. Infarct
  2. High-grade glioma Correct answer.
  3. Demyelinating plaque
  4. Abscess

Explanation

Elevated choline with reduced N-acetylaspartate reflects membrane turnover and neuronal loss, consistent with a neoplasm such as high-grade glioma. An abscess would show restricted diffusion with a central necrotic core and possibly amino acids.

Question 43Clinical practice domains across all imaging modalities

Which imaging modality is most appropriate to evaluate suspected acute osteomyelitis of the foot when radiographs are normal?

  1. Ultrasound
  2. CT
  3. MRI with contrast Correct answer.
  4. Radionuclide bone scan

Explanation

MRI is the most sensitive and specific test for acute osteomyelitis, showing marrow edema and enhancement before bony destruction is visible on radiographs. Contrast helps delineate abscess and soft tissue involvement.

Question 44Clinical practice domains across all imaging modalities

A 30-year-old man has sudden onset of severe scrotal pain. Doppler ultrasound shows an enlarged testis with absent or decreased intratesticular flow. Which diagnosis is most likely?

  1. Hydrocele
  2. Testicular torsion Correct answer.
  3. Epididymitis
  4. Varicocele

Explanation

Absent or decreased intratesticular flow with acute severe pain suggests testicular torsion, a surgical emergency. Prompt detorsion is required to preserve testicular viability.

Question 45Clinical practice domains across all imaging modalities

A 58-year-old woman has a 4 cm mass in the right atrium on echocardiography. Which imaging feature most suggests a benign myxoma rather than a malignant tumor?

  1. Narrow stalk attachment at the interatrial septum Correct answer.
  2. Extension into the pericardium
  3. Broad-based attachment to the atrial wall
  4. Multiple chambers involved

Explanation

Cardiac myxomas typically arise from the interatrial septum at the fossa ovalis and often have a narrow stalk. Broad-based attachment and invasion suggest malignancy.

Question 46Clinical practice domains across all imaging modalities

Which finding on CT most reliably indicates a malignant pleural effusion?

  1. Pleural calcification
  2. Pleural fluid loculation
  3. Bilateral effusions
  4. Nodular pleural thickening Correct answer.

Explanation

Nodular pleural thickening, especially involving the mediastinal pleura, strongly suggests malignancy. Other features include pleural masses and mediastinal pleural thickening greater than 1 cm.

Question 47Clinical practice domains across all imaging modalities

A 55-year-old man has a 2.5 cm cystic lesion in the pineal region with peripheral enhancement and restricted diffusion. Which diagnosis is most likely?

  1. Pineoblastoma Correct answer.
  2. Germinoma
  3. Pineal cyst
  4. Pineocytoma

Explanation

Pineoblastomas are aggressive, often cystic with peripheral enhancement, and show restricted diffusion due to high cellularity. They occur more commonly in children and young adults.

Question 48Clinical practice domains across all imaging modalities

Which imaging feature on chest CT is most characteristic of usual interstitial pneumonia (UIP)?

  1. Honeycombing with basal and peripheral predominance Correct answer.
  2. Ground-glass opacity with centrilobular nodules
  3. Mediastinal lymphadenopathy with calcification
  4. Upper lobe predominant consolidation

Explanation

UIP shows subpleural, basal-predominant reticulation, honeycombing, and traction bronchiectasis. These findings reflect the underlying fibrotic process of idiopathic pulmonary fibrosis.

Question 49Clinical practice domains across all imaging modalities

A 40-year-old woman has a 3 cm mass in the right orbit causing proptosis. MRI shows a well-circumscribed extraconal mass that is isointense to muscle on T1 and enhances homogeneously. Which diagnosis is most likely?

  1. Thyroid eye disease
  2. Cavernous hemangioma Correct answer.
  3. Lymphoma
  4. Optic nerve glioma

Explanation

Cavernous hemangiomas are common benign orbital tumors that appear well-circumscribed, isointense to muscle on T1, and show progressive fill-in enhancement. They are typically intraconal but can be extraconal.

Question 50Clinical practice domains across all imaging modalities

A 62-year-old man has acute flank pain and hematuria. CT shows a 4 mm stone in the distal ureter with proximal hydronephrosis. Which imaging feature most predicts spontaneous passage?

  1. Stone location at the ureterovesical junction
  2. Presence of hydronephrosis
  3. Stone composition of cystine
  4. Stone size less than 5 mm Correct answer.

Explanation

Stones smaller than 5 mm have a high likelihood of spontaneous passage, whereas stones larger than 6 mm often require intervention. Location and composition also affect passage but size is the strongest predictor.