INI-CET 2026 - Radiology PYQs Practice Questions

Q: An elderly female patient presents to the emergency department with acute onset left flank pain radiating to the groin. What is the most appropriate imaging protocol for initial evaluation?

Ultrasound of the abdomen followed by CT if inconclusive. ***Ultrasound of the abdomen followed by CT if inconclusive*** - In pregnant or elderly/frail patients where minimizing radiation is a priority, initial abdominal ultrasound is the preferred modality for detecting hydronephrosis. - If the ultrasound is inconclusive or findings suggest a more complex pathology, a CT scan can then be performed as a second-line investigation to confirm stones. *Direct MRI of the abdomen and pelvis* - MRI is generally not the first-line imaging modality for renal colic because it is expensive, time-consuming, and less sensitive for detecting acute urinary calculi. - It is primarily reserved for patients where radiation must be avoided entirely and ultrasound is insufficient, or when evaluating soft tissue complications of renal obstruction. *Plain X-ray of the abdomen followed by CT urogram* - Plain abdominal radiographs (KUB) have very low sensitivity for small or radiolucent kidney stones and are generally insufficient as an initial screening tool. - While CT urogram is the gold standard for stone detection, routinely using it after an X-ray is inefficient; non-contrast CT (NCCT) is preferred over CT urogram for simple suspected nephrolithiasis. *Non-contrast CT (NCCT) followed by contrast-enhanced CT (CECT)* - While NCCT is the gold standard for diagnosing renal lithiasis in the general population, it exposes the patient to ionizing radiation. - A sequential NCCT followed by CECT is unnecessary for routine renal colic and would result in excessive radiation dose and contrast exposure without clinical benefit. [Practice more Radiology PYQs on OnCourse]

Q: A 12-year-old child presents with mild fever, runny nose, sore throat, and cough for 3 days. Clinical examination is consistent with an upper respiratory tract infection (URTI). There is no respiratory distress, oxygen desaturation, or focal chest findings. What is the most appropriate next step regarding imaging?

No further radiological investigation is required. ***No further radiological investigation is required*** - In a patient with a straightforward, **uncomplicated upper respiratory tract infection** (URTI) and no concerning signs such as respiratory distress, hypoxia, or abnormal lung auscultation, clinical diagnosis is sufficient. - **Radiological investigations** like chest X-rays are not indicated for suspected viral URTIs unless there is clinical evidence of **lower respiratory tract involvement** or complications like pneumonia. *Digital chest X-ray* - An X-ray is generally not recommended for **mild, self-limiting respiratory symptoms** where physical exam findings are normal. - Routine imaging in pediatric patients with uncomplicated URTI exposes the child to **unnecessary ionizing radiation** and rarely changes management. *Plain CT chest* - A **computed tomography (CT) scan** provides significant radiation exposure and is completely inappropriate for evaluating a standard pediatric URTI. - It is a diagnostic tool reserved for complex, **diagnostic dilemmas** or suspected deep-seated thoracic disease after initial, less invasive imaging has been inconclusive. *HRCT chest* - **High-resolution computed tomography (HRCT)** is an advanced imaging modality specifically used for evaluating interstitial lung disease or complex airway pathology. - It is contraindicated as an initial screening tool in this scenario due to its high cost, radiation dose, and lack of clinical indication. [Practice more Radiology PYQs on OnCourse]

Q: A patient presents with right iliac fossa pain for 48 hours. USG image (shown with Doppler) demonstrates a hyperaemic appendix-region structure with surrounding inflammatory changes. There is no free fluid or evidence of perforation on USG. What is the most appropriate next step?

Contrast-enhanced CT (CECT) of the abdomen and pelvis. ***Contrast-enhanced CT (CECT) of the abdomen and pelvis*** - In adults with equivocal or suggestive USG findings but continuing clinical uncertainty, CECT is the **gold standard diagnostic modality** with superior sensitivity and specificity for acute appendicitis. - It helps rule out **alternative pathology** like regional enteritis, colitis, or malignancies that might mimic appendicitis, ensuring surgical planning is guided by the most accurate diagnosis. *Direct surgical management (emergency appendicectomy)* - Relying solely on USG, which is **operator-dependent** and often limited by bowel gas, leads to a higher rate of negative appendicectomy. - Further imaging is required especially if there is no pathognomonic finding (like a non-compressible appendix >6mm or appendicolith) clearly identified on the initial USG scan. *USG-guided biopsy of the lesion* - Biopsy of the appendix is **never indicated** in the acute setting as it risks **perforation, peritonitis, and seeding infection** or potential malignancy into the peritoneal cavity. - The inflammatory nature of the appendix is suspected based on imaging and clinical history, not requiring histological confirmation before intervention. *USG-guided percutaneous drainage* - Percutaneous drainage is reserved for patients with an **organized appendix mass or abscess** requiring intervention prior to definitive surgery. - Since there is **no free fluid or evidence of perforation** noted on USG, there is no fluid collection to drain. [Practice more Radiology PYQs on OnCourse]

Question 1

A radiologist is reviewing requests for gadolinium-based contrast MRI (ACR Group II agent). In
which of the following clinical scenarios is contrast-enhanced MRI CONTRAINDICATED or requires
special caution?

Accepted Answer

A 60-year-old diabetic male without available renal function tests

Answer

A child with a documented normal renal function test report

Answer

A 50-year-old patient with eGFR of 30 mL/min/1.73 m²

Answer

A 30-year-old healthy male without available renal function tests

Question 2

An elderly female patient presents to the emergency department with acute onset left flank pain
radiating to the groin. What is the most appropriate imaging protocol for initial evaluation?

Accepted Answer

Ultrasound of the abdomen followed by CT if inconclusive

Answer

Direct MRI of the abdomen and pelvis

Answer

Plain X-ray of the abdomen followed by CT urogram

Answer

Non-contrast CT (NCCT) followed by contrast-enhanced CT (CECT)

Question 3

A 12-year-old child presents with mild fever, runny nose, sore throat, and cough for 3 days.
Clinical examination is consistent with an upper respiratory tract infection (URTI). There is no
respiratory distress, oxygen desaturation, or focal chest findings. What is the most appropriate
next step regarding imaging?

Accepted Answer

No further radiological investigation is required

Answer

Digital chest X-ray

Answer

Plain CT chest

Answer

HRCT chest

Question 4

A patient presents with right iliac fossa pain for 48 hours. USG image (shown with Doppler)
demonstrates a hyperaemic appendix-region structure with surrounding inflammatory changes.
There is no free fluid or evidence of perforation on USG. What is the most appropriate next step?

Accepted Answer

Contrast-enhanced CT (CECT) of the abdomen and pelvis

Answer

Direct surgical management (emergency appendicectomy)

Answer

USG-guided biopsy of the lesion

Answer

USG-guided percutaneous drainage

INI-CET 2026 — Radiology