FHB

(Radiology golden books)

FRCR Part 1:
Cases for the Anatomy
Viewing Paper
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FRCR Part 1:
Cases for the Anatomy
Viewing Paper

Dr James D. Thomas

Editorial advisors
Dr Christopher Fang
Dr Udara Kularatne

1
1
Great Clarendon Street, Oxford ox2 6dp
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 FOREWORD

Anatomy is a core fundamental to the practice of radiology. A thorough knowledge of anatomy is

the key to describing the site of disease or abnormality, and often in understanding a disease process
and its complications. When I commenced my radiology training in 2002, anatomy had been removed
from the FRCR Part 1 syllabus. Although its exclusion from the syllabus seemed slightly odd at the
time, it did mean less revision and one less thing to fail. In the end, I never did avoid that exam in
anatomy. Perhaps appealing to their sadistic instincts, my trainers still subjected us to an ‘old style’
Part 1 examination at the end of our first year. Looking back, this was certainly of no detriment to my
training or subsequent working career.
Anatomy now makes a return to the Part 1 examination. I have been fortunate to have been involved
with this book. The author has made great efforts to provide you with variation between the papers,
with both straightforward and more challenging questions. To ensure clarity and accuracy, the papers
have been prepared meticulously with input from those who have sat the new examination and
tested out on other trainees.
In helping with the preparation of this book, I have found the questions outside my subspecialty inter-
est both challenging and a source of revision. I am therefore confident that, for the intended
audience, it will prove to be a useful resource to tighten up areas of weakness and encourage further
reading around the answer.
My training and career have taught me that a radiologist can never know too much anatomy.
Good luck.

Dr Christopher Fang
Consultant Radiologist
Royal Derby Hospital
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 ACKNOWLEDGEMENTS

I would like to extend my gratitude to Dr Chris Fang who tirelessly read all the exams and answers,
pointing out inaccuracies and making suggestions for improvement. This book has benefited greatly
from his involvement.
Thanks also goes to Dr Udara Kularatne who contributed the tricky examinations 7 and 8. He also
read through the other examinations and provided a constant stream of feedback and ideas. His
enthusiasm is infectious.
I would also like to thank the registrars who road-tested the examinations: Dr Abdullah Saeed,
Dr Waleed Al Obaydi, Dr Sachin Srivastava, Dr Arieff Abu Hassan, Dr Amit Bharath, and Dr Walter
Sprenger de Rover.
My thanks also goes to Chris Reid and others at Oxford University Press for bringing this from idea
to reality.
Finally, extra-special thanks to my other half, Tanya Monaghan, for putting up with me, this project,
and the mountains of paper that now fill half the house.
Dr James D. Thomas
Specialist Registrar in Radiology
Nottingham University Hospitals NHS Trust

The author and the publisher would like to thank Dr Antoine Rosset for permission to use screen-
shots of the OsiriX DICOM viewer.
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CONTENTS

Introduction xi

Exam 1
Questions 1
Answers 22

Exam 2
Questions 27
Answers 48

Exam 3
Questions 53
Answers 74

Exam 4
Questions 79
Answers 100

Exam 5
Questions 105
Answers 126

Exam 6
Questions 131
Answers 152
x CONTENTS

Exam 7
Questions 157
Answers 178

Exam 8
Questions 183
Answers 204

Abbreviations 209
 INTRODUCTION

The examination structure

The anatomy paper consists of 20 images (called ‘cases’), with 5 questions each. The images contain
arrows with alphabetical labels, usually from A to E, although some may contain fewer depending
on the question structure.
You will have 75 minutes to answer the questions.
At the time of writing, the images/cases are shown digitally. Each candidate has their own computer
workstation and these are arranged in rows with plenty of space between candidates. Each
workstation consists of a 19” monitor with an Apple Mac mini® attached. There is a mouse, but no
keyboard. The mouse will either be a standard Apple mouse, or an Apple ‘magic mouse’®. The
right click function on the mouse is disabled.
The Apple ‘magic mouse’® has no visible buttons or scroll wheel. The surface is touch-sensitive;
left and right click are performed in the usual way on the left and right sides of the mouse and
scrolling is performed by wiping the surface of the mouse with a finger as if using a touchpad.
Candidates for the first part of the FRCR will not need to use either of these functions so should
not be put off if unfamiliar with this.
The questions are presented in a booklet, in which you also write your answers. The choice of pen
or pencil is not specified and you will need to bring your own. Using a pencil, however, would allow
corrections to be made easily. If using a pencil, remember to bring an eraser and a sharpener.

OsiriX image-viewing software

The images/cases are shown using ‘OsiriX’, a free Apple-based DICOM- and image-viewing
program developed and maintained by Pixmeo, a Swiss company based in Geneva. Before the
examination begins, the invigilators will give a short tutorial on using the software and you will have
some example images to practice with. Apple users may wish to download this from the OsiriX
website ([Link]) to familiarize themselves with the tools. The software is easy to
use and non-Mac users will not be disadvantaged.

Apple windows
Candidates unfamiliar with Apple software will notice the brightly coloured circles at the top left of
each window (Figure 1). These are red, amber, and green. These act to close, minimize, and
optimize the window size, respectively. DO NOT press any of these during the examination.

The main image-viewing window

The images occupy the majority of the screen and the central window. To the left, there is a list of
the images in the series. See Figure 1 for an example. The list on the left can be used to navigate
through the images if necessary.
xii INTRODUCTION

Figure 1

The top of the window shows the file name of the image being displayed. You should double-check
this when entering your answers to make sure that you are filling in the correct question numbers.

The top toolbar

The OsiriX software has several image manipulation controls in the top toolbar as shown in Figure
2. The majority of these are either removed or disabled for the purposes of this examination. In
particular, you should ignore anything related to window presets, 2D/3D, orientation, slab
thickness, and the ‘title’. Some of these are used in the Part 2B examination but none are needed
for the Part 1.

Figure 2

The controls that may be of use to you are:

• The ‘Database’ button: used to return to the list of images/ cases to navigate through the
examination set.
• The left and right arrows: used to advance to the next case or return to the previous case (the
author recommends using these to proceed through the examination and using the ‘Database’
button to return to specific images at the end if necessary).
 INTRODUCTION xiii

• The ‘mouse button function’ buttons: used to manipulate the image. A close-up is shown in
Figure 3.
The mouse button functions are the only tools that you might need during this examination and are
shown in Figure 3. From left to right they are:
• Window level: click this to activate the window levelling controls. Clicking and dragging left/ right
on the image adjusts the window width; up/ down adjusts the window level. This should be familiar
to all PACS users.
• Move: use this tool to drag the image around the screen (used if you have zoomed in).
• Zoom: once this is active, click and drag upwards to zoom in, click and drag down the screen to
zoom out. You can then look around the zoomed-in image using the ‘move’ tool, which you must
select from the toolbar (see above).
• Rotate: this allows you to swivel the image around a central point. You should not need to use
this.
• Animate: this is used to scroll through stacked images (such as a CT examination). You will not
need this for the first part of the FRCR examination.
• ROI tool: this symbol looks like a green line. Activating this and clicking on the image will draw
green lines with length measurements. These are impossible to delete without a keyboard. DO
NOT press this.

Figure 3

General advice for the examination

Read the question!
Although most of the questions will be of the nature ‘Name the structure labelled …’, some may
not be. Be sure to read the question carefully each time to avoid being caught out and needlessly
losing a mark.

Left or right?
Candidates should write the side of the structure if possible. For example, if a radiograph of a thigh
is clearly marked with an ‘R’, the bone is the ‘right femur’. Axial CT (and MRI) images will be
presented in the conventional way with the patient’s right on your left as you view the screen and
vice versa. Again, the side of the structure marked should be written in the answer.
In some cases, the side will not be obvious. There may be a radiograph or cross-sectional image of
a limb with no side marker, for example. The candidate would be wise to write ‘no side marker’ to
indicate that they have tried and failed to determine the side.
xiv INTRODUCTION

Is that the ‘femur’ or the ‘greater trochanter’ ?

Confusion may arise if an arrow appears to point to part of a structure. If several parts of the same
structure are labelled, then the arrows clearly indicate those individual parts.
In general, the candidate would be wise to name the structure in the most accurate way possible.
An arrow to the greater trochanter, therefore, should be answered as ‘greater trochanter of the
femur’. If the examiners were only looking for ‘femur’, you’re not going to lose any marks! Of
course, there is a small risk that you name the wrong part and lose a mark that way.

Attempt every question

There is no negative marking so there is nothing to be gained from leaving an answer blank. Only
you and the marking examiners will know if you gave a stupid wrong answer, so take the risk!

Write clearly
The examination is hand-marked by two examiners, so ensure you write clearly for the examiner to
read your answer easily. If you have particularly illegible handwriting, consider writing in capital
letters, as long as this does not slow you down.

Good luck!
exam

1 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: Ben Nevis

2 EXAM 1 | QUESTIONS

Case 1
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 3

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
4 EXAM 1 | QUESTIONS

Case 3
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 5

Case 4
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structures labelled D.
5. Name the structure labelled E.
6 EXAM 1 | QUESTIONS

Case 5
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 7

Case 6
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
8 EXAM 1 | QUESTIONS

Case 7
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 9

Case 8
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the foramen labelled C.
4. Name the muscle that attaches to the structure labelled D.
5. Name the structure labelled E.
10 EXAM 1 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 11

Case 10
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
12 EXAM 1 | QUESTIONS

Case 11
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the bone labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 13

Case 12
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
14 EXAM 1 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 15

Case 14
1. Name the CSF space labelled A.
2. Name the structure labelled B.
3. Name the CSF space labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
16 EXAM 1 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 17

Case 16
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
18 EXAM 1 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the soft tissue opacity labelled E.
 EXAM 1 | QUESTIONS 19

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
20 EXAM 1 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 1 | QUESTIONS 21

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

1 ANSWERS

Case 1
CT abdomen. Axial section.
1. Inferior vena cava
2. Abdominal aorta
3. Spleen
4. Stomach
5. Right lung base (lower lobe)

Case 2
Orthopantomogram.
1. Right mandibular condyle
2. Hyoid bone
3. C2 vertebral body
4. Angle of the mandible (right)
5. Nasal septum

Case 3
MRI knee. T2W (with fat-suppression). Sagittal section.
1. Patella
2. Patellar tendon
3. Anterior horn of the lateral meniscus
4. Lateral femoral condyle
5. Popliteus tendon
As the fibula is included in the image, this must be the lateral part of the knee.

Case 4
Occipitomental radiograph of skull.
1. Coronoid process of the mandible
2. Dens/ odontoid peg
3. Right frontal sinus
4. Left mastoid air cells
5. Right zygomatic arch
 EXAM 1 | ANSWERS 23

Case 5
MRI brain. T2W sagittal section.
1. Genu of the corpus callosum
2. Pons
3. Optic chiasm
4. Cisterna magna
5. Splenium of the corpus callosum

Case 6
CT C-spine. Coronal section.
1. Dens/ odontoid peg
2. Trachea
3. Right clavicle
4. Left lateral mass of C1 vertebra
5. Left mandibular condyle

Case 7
Abdominal aortogram (fluoroscopic).
1. Right renal artery
2. Abdominal aorta
3. Superior mesenteric artery
4. Left renal artery
5. Right common iliac artery

Case 8
Plain radiograph. AP abdomen.
1. Right twelfth rib
2. Left transverse process of L1 vertebra
3. Left obturator foramen
4. Left sartorius
5. Right lesser trochanter

Case 9
CT chest. Axial section.
1. Sternum
2. Pulmonary trunk
3. Right oblique fissure
4. Descending thoracic aorta
5. Right main bronchus
24 EXAM 1 | ANSWERS

Case 10
Plain radiograph. DP wrist.
1. Trapezium
2. Pisiform
3. Ulnar styloid process
4. Hook of the hamate
5. Scaphoid

Case 11
CT head. Axial section.
1. Sphenoid sinus
2. Left maxillary sinus
3. Nasal septum
4. Right nasal bone
5. Right foramen ovale

Case 12
Intravenous urogram, 20-minute radiograph.
1. Left ureter
2. Left renal pelvis
3. Urinary bladder
4. Right lower pole (major) calyx
5. Right sacroiliac joint

Case 13
Plain radiograph. Oblique foot.
1. Fibula
2. Middle phalanx of fourth toe
3. Cuboid
4. Navicular
5. First metatarsal

Case 14
CT head. Axial section.
1. Left Sylvian fissure
2. Falx cerebri (anterior part)
3. Fourth ventricle
4. Right middle cerebral artery
5. Basilar artery
 EXAM 1 | ANSWERS 25

Case 15
Barium swallow. AP pharyngeal view.
1. Left pyriform sinus
2. Median epiglottic fold
3. Right lateral epiglottic fold
4. Right vallecula
5. Epiglottis

Case 16
MRI brain. T2W axial section.
1. Superior sagittal sinus
2. Head of left caudate nucleus
3. Posterior limb of right internal capsule
4. Left lentiform nucleus
5. Left thalamus

Case 17
Encephalogram.
1. Hyoid bone
2. Coronal suture
3. Pituitary fossa
4. Anterior arch of C1 vertebra
5. Epiglottis

Case 18
MRI lumbar spine. T2W sagittal section.
1. Urinary bladder
2. Spinal cord
3. Ligamentum flavum
4. Cauda equina
5. Abdominal aorta

Case 19
CT pelvis. Axial section.
1. Coccyx
2. Left common femoral vein
3. Left sartorius muscle
4. Prostate
5. Left obturator internus muscle
26 EXAM 1 | ANSWERS

Case 20
CT-pulmonary arteriogram (CTPA). Coronal section.
1. Right clavicle
2. Left subclavian artery
3. Aortic arch
4. Pulmonary trunk
5. Stomach
exam

2 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: Ben Nevis

28 EXAM 2 | QUESTIONS

Case 1
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 29

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
30 EXAM 2 | QUESTIONS

Case 3
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 31

Case 4
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
32 EXAM 2 | QUESTIONS

Case 5
1. Name bone that the vessel labelled A is passing through.
2. Name the vessel labelled B.
3. Name the vessel labelled C.
4. Name the vessel labelled D.
5. Name the vessel labelled E.
 EXAM 2 | QUESTIONS 33

Case 6
1. Name the linear normal variant labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the angle labelled D.
5. Name the structure labelled E.
34 EXAM 2 | QUESTIONS

Case 7
1. Name the bone labelled A.
2. Name the structure labelled B.
3. Name the structures labelled C.
4. Name the foramen labelled D.
5. Name the foramen labelled E.
 EXAM 2 | QUESTIONS 35

Case 8
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the notch labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
36 EXAM 2 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 37

Case 10
1. Name the organ labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
38 EXAM 2 | QUESTIONS

Case 11
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 39

Case 12
1. Name the bone labelled A.
2. Name the bone labelled B.
3. Name the bone labelled C.
4. Name the bone labelled D.
5. Name the structure labelled E.
40 EXAM 2 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 41

Case 14
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
42 EXAM 2 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 43

Case 16
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
44 EXAM 2 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 45

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
46 EXAM 2 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 2 | QUESTIONS 47

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

2 ANSWERS

Case 1
Plain radiograph. AP left shoulder.
1. Left acromion
2. Left greater tuberosity of humerus
3. Left lesser tuberosity of humerus
4. Left acromioclavicular joint
5. Left coracoid process of scapula

Case 2
MRCP
1. Gallbladder
2. Right renal pelvis
3. Left hepatic duct
4. Cystic duct
5. Common bile duct
It is important to remember that structures other than the organs in question are often revealed in
these focused examinations. On this image, both renal collecting systems are visible. The other
white structure at the bottom right-hand side of the image is the spinal canal.

Case 3
CT thorax. Axial section.
1. Ascending aorta/ aortic root
2. Left trapezius muscle
3. Right infraspinatus muscle
4. Left superior pulmonary vein
5. Superior vena cava

Case 4
Plain radiograph. Lateral left ankle.
1. Left lateral tubercle of the talus
2. Left fifth metatarsal
3. Left cuboid
4. Left head of the talus
5. Left navicula
 EXAM 2 | ANSWERS 49

Case 5
Internal carotid angiogram. Lateral view
1. Petrous temporal bone
2. Anterior cerebral artery
3. Pericallosal artery
4. Internal carotid artery within the cavernous sinus
5. Ophthalmic artery

Case 6
Plain radiograph. AP chest.
1. Azygos fissure
2. Aortic arch
3. Medial border of the left scapula
4. Right cardiophrenic angle
5. Interlobar artery
The azygos fissure is seen in about 1% of the population. The azygos vein sits at the caudal aspect
of the fissure.

Case 7
CT base of skull. Axial section.
1. Right squamous temporal bone
2. Left mandibular condyle
3. Right mastoid air cells
4. Left carotid canal
5. Left foramen lacerum

Case 8
Plain radiograph. Lateral elbow.
1. Head of radius
2. Olecranon of ulna
3. Trochlear notch of ulna
4. Coronoid process of ulna
5. Capitulum of humerus
Slightly tricky. Close inspection reveals that the structure labelled E is articulating with the radial
head, so must be the capitulum of the humerus. The ‘C’ arrow, however points to the notch on the
ulna.
50 EXAM 2 | ANSWERS

Case 9
CT abdomen. Axial section.
1. Tail of pancreas
2. Splenunculus
3. Inferior vena cava
4. Splenic vein
5. Left adrenal gland
Splenunculi are small nodules of spleen, detached from the rest of the organ. They are seen in
between 15 and 30% of people and are of no clinical significance.

Case 10
CT thorax. Sagittal section.
1. Stomach
2. Oesophagus
3. Descending aorta
4. Left lobe of liver
5. Manubriosternal joint (sternal angle)

Case 11
Ultrasound abdomen. Transverse section at the epigastrium.
1. Splenic vein
2. Body of pancreas
3. Abdominal aorta
4. Inferior vena cava
5. Vertebral body

Case 12
Plain radiograph. Oblique hand and wrist.
1. Right trapezoid
2. Right hamate
3. Right lunate
4. Right capitate
5. Sesamoid bone

Case 13
Barium follow-through. ‘Overcouch’ AP radiograph.
1. Duodenum (second part)
2. Pylorus
3. Jejunum
4. Appendix
5. Ascending colon
 EXAM 2 | ANSWERS 51

Case 14
CT brain. Axial section
1. Left choroid plexus (calcified)
2. Superior sagittal sinus
3. Falx cerebri
4. Head of the right caudate nucleus
5. Septum pellucidum

Case 15
MRI knee. T1W coronal section.
1. Anterior cruciate ligament
2. Lateral meniscus
3. Medial collateral ligament
4. Posterior cruciate ligament
5. Lateral femoral condyle

Case 16
Coeliac axis angiogram.
1. Common hepatic artery
2. Right gastroepiploic artery
3. Gastroduodenal artery
4. Splenic artery
5. Left hepatic artery
Several normal variants may exist in the arterial anatomy here, particularly in relation to the origin
of the hepatic arteries. Candidates should be aware of these. Choose your favourite anatomy book
and have a look.

Case 17
Plain radiograph. AP knee.
1. Head of the fibula
2. Lateral femoral condyle
3. Intercondylar fossa
4. Lateral tibial spine
5. Medial tibial plateau

Case 18
CT chest. Axial section.
1. Right infraspinatus muscle
2. Right common carotid artery
3. Right supraspinatus muscle
4. Right pectoralis minor muscle
5. Head of left clavicle
52 EXAM 2 | ANSWERS

Case 19
Plain radiograph. Lateral lumbar spine.
1. Superior articular process of L4
2. Pedicle of L3
3. Spinous process of L3
4. Inferior articular process of L3
5. Twelfth rib

Case 20
MRI brain. T1W coronal section.
1. Corpus callosum
2. Left trigeminal nerve
3. Pons
4. Interpeduncular cistern
5. Odontoid process (peg) of C2
exam

3 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: Ben Nevis

54 EXAM 3 | QUESTIONS

Case 1
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure that fills that space labelled E.
 EXAM 3 | QUESTIONS 55

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
56 EXAM 3 | QUESTIONS

Case 3
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 57

Case 4
1. Name the vessel labelled A.
2. Name the vessel labelled B.
3. Name the vessel labelled C.
4. Name the vessel labelled D.
5. Name the vessel labelled E.
58 EXAM 3 | QUESTIONS

Case 5
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 59

Case 6
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
60 EXAM 3 | QUESTIONS

Case 7
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 61

Case 8
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
62 EXAM 3 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 63

Case 10
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
64 EXAM 3 | QUESTIONS

Case 11
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 65

Case 12
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
66 EXAM 3 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 67

Case 14
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
68 EXAM 3 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 69

Case 16
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
70 EXAM 3 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the vessel that passes through the area labelled E.
 EXAM 3 | QUESTIONS 71

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
72 EXAM 3 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 3 | QUESTIONS 73

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

3 ANSWERS

Case 1
Lateral radiograph, knee.
1. Styloid process of the fibula
2. Patellar tendon
3. Fabella
4. Patella
5. Hoffa’s fat pad
A fabella is a small accessory bone that lies within the lateral head of the gastrocnemius muscle.

Case 2
CT abdomen with iv and oral contrast. Axial section.
1. Appendix
2. Descending colon
3. Right external oblique
4. Left common iliac artery
5. Left ureter

Case 3
Paediatric foot. DP oblique.
1. Left cuboid
2. Left lateral cuneiform
3. Left talus
4. Left distal fibular epiphysis
5. Left ossification centre of the navicula

Case 4
Aortogram.
1. Right external iliac artery
2. Left colic artery
3. Left superior gluteal artery
4. Right inferior gluteal artery
5. Right internal iliac artery
 EXAM 3 | ANSWERS 75

Case 5
AP radiograph. Pelvis.
1. Right iliac crest
2. Right anterior superior iliac spine
3. Left sacroiliac joint
4. Left greater trochanter of the femur
5. Symphysis pubis

Case 6
AP radiograph. Cervical spine.
1. Right angle of the mandible
2. Left second rib
3. Right first rib
4. Left transverse process of T1
5. Spinous process of C7

Case 7
CT coronary angiogram. Axial section.
1. Right main coronary artery
2. Left anterior descending artery
3. Aortic root
4. Right ventricular outflow tract
5. Circumflex artery

Case 8
Barium swallow. Lateral view.
1. Oesophagus
2. Epiglottis
3. Hyoid bone
4. Vallecula
5. Thyroid cartilage

Case 9
MRI internal auditory meati. T2 axial section
1. Left cerebellar peduncle
2. Right facial (VII) nerve
3. Right cochlea
4. Basilar artery
5. Right vestibulocochlear (VIII) nerve
76 EXAM 3 | ANSWERS

Case 10
MR-angiogram. Aortic arch/ neck (MIP). Oblique view.
1. Left subclavian artery
2. Right internal carotid artery
3. Left vertebral artery
4. Right brachiocephalic (innominate) artery
5. Right common carotid artery

Case 11
AP radiograph. Right thumb (paediatric)
1. Right proximal epiphysis of the proximal phalanx of the thumb
2. Right hamate
3. Right trapezium
4. Right trapezoid
5. Right proximal epiphysis of the first metacarpal
It is potentially easy to mistake unfused epiphyses for separate bones, for example the structure
labelled E. Beware.

Case 12
Fetal MRI. T2-weighted coronal section.
1. Fetal cerebellum
2. Fetal scrotum
3. Fetal liver
4. Maternal urinary bladder
5. Fetal urinary bladder

Case 13
CT neck. Axial section.
1. Right internal jugular vein
2. Left common carotid artery
3. Sternocleidomastoid
4. Left external jugular vein
5. Left vertebral artery
 EXAM 3 | ANSWERS 77

Case 14
T-tube cholangiogram (post cholecystectomy).
1. Common hepatic duct
2. Duodenum
3. Cystic duct remnant
4. Common bile duct
5. Right hepatic duct
The line extending from the common hepatic duct to the left of the image is the tube leading to the
external drain. Surgical staples can be seen projected over the image giving further clue that this is a
postoperative study.

Case 15
Plain radiograph. AP elbow.
1. Radial tuberosity (left)
2. Trochlea (left)
3. Olecranon process of the ulna (left)
4. Coronoid process of the ulna (left)
5. Olecranon fossa (left)

Case 16
Abdominal ultrasound. Oblique view at the porta hepatis.
1. Spinal column
2. Gallbladder
3. Inferior vena cava
4. Abdominal aorta
5. Hepatic portal vein

Case 17
CT orbits, non-contrast. Axial section.
1. Left lateral rectus
2. Right medial rectus
3. Sphenoid sinus
4. Left optic nerve
5. Right internal carotid artery

Case 18
MRI lumbar spine. T1W axial section.
1. Exiting nerve root (right)
2. Abdominal aorta
3. Left vertebral lamina
4. Inferior vena cava
5. Left psoas muscle
78 EXAM 3 | ANSWERS

Case 19
AP radiograph of the ankle
1. Medial malleolus (of the tibia)
2. Talus
3. First metatarsal
4. Lateral malleolus (of the fibula)
5. Fibula

Case 20
Lateral radiograph of the thumb
1. Pisiform
2. Scaphoid tubercle
3. Lunate
4. Ulna
5. Radius
Differentiating the ulna and radius is straightforward with a little careful examination. The bone
labelled E is seen to articulate with the lunate so must be the radius; the bone labelled D does not
and has the characteristic styloid process.
exam

4 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: Ben Nevis

80 EXAM 4 | QUESTIONS

Case 1
1. Name the structure labelled A.
2. Name the structure forming the mediastinal border labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the muscle that connects the structure labelled E and the thoracic cage.
 EXAM 4 | QUESTIONS 81

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the linear structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
82 EXAM 4 | QUESTIONS

Case 3
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 83

Case 4
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
84 EXAM 4 | QUESTIONS

Case 5
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 85

Case 6
1. Name the structure labelled A.
2. Name the space labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
86 EXAM 4 | QUESTIONS

Case 7
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 87

Case 8
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
88 EXAM 4 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 89

Case 10
1. Name the structure that causes the oesophageal indentation labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
90 EXAM 4 | QUESTIONS

Case 11
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 91

Case 12
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
92 EXAM 4 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 93

Case 14
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
94 EXAM 4 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 95

Case 16
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the tendon inserting on the structure labelled E.
96 EXAM 4 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 97

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
98 EXAM 4 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 4 | QUESTIONS 99

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

4 ANSWERS

Case 1
PA chest radiograph.
1. Right atrium
2. Superior vena cava
3. Left ventricle
4. Descending thoracic aorta
5. Right pectoralis minor

Case 2
CT Chest, coronal section.
1. Oesophagus
2. Left subclavian artery
3. Left oblique fissure
4. Left main bronchus
5. Left main pulmonary artery

Case 3
Oblique pelvic ‘spot’ image from a double-contrast barium enema.
1. Caecum
2. Sigmoid colon
3. Appendix
4. Ileum
5. Transverse colon

Case 4
MR wrist, coronal section, T1 weighted.
1. Triangular fibrocartilage
2. Trapezium
3. Base of third metacarpal bone
4. Scaphoid
5. Hamate
 EXAM 4 | ANSWERS 101

Case 5
CT base of skull, axial image.
1. Left cochlea
2. Left zygomatic bone
3. Left lambdoid suture
4. Squamous part of the left temporal bone
5. Right incus
As well as the bones of the skull, it is important to know the bones of the middle ear and to have
an appreciation of those parts of the inner ear that can be seen on CT.

Case 6
Cephalogram
1. Body of the C2 vertebra
2. Vallecula
3. Sphenoid sinus
4. Body of the C1 vertebra (anterior arch)
5. Posterior clinoid process of the sphenoid bone

Case 7
Axial view of the shoulder.
1. Left coracoid process
2. Left glenoid
3. Left acromium
4. Left clavicle
5. Left scapula blade
In this view, it may be easy to mistake the scapular blade for the scapular spine. The spine, however,
lies more posterior than this and is continuous with the acromium.

Case 8
MR C-spine, T2-weighted, sagittal.
1. Posterior longitudinal ligament
2. Ligamentum flavum
3. Trachea
4. Oesophagus
5. Fourth ventricle
102 EXAM 4 | ANSWERS

Case 9
Lateral wrist radiograph.
1. Fifth metacarpal
2. Second metacarpal
3. Ulna
4. Radius
5. Trapezium
This is tricky but is achievable by looking at the articulations. ‘A’ is the smallest metacarpal so almost
certainly number 5. ‘B’ is the second longest but too far away from ‘A’ to be the fourth. ‘D’
articulates directly with the lunate, so is the radius; C does not. ‘E’ articulates with the first
metacarpal so is the trapezium.

Case 10
Barium swallow. Oblique ‘spot’ view of the upper oesophagus.
1. Aortic arch
2. Spinous process of C7 vertebra
3. Left clavicle
4. Thyroid cartilage
5. Mental process of the mandible
Why the left clavicle? The patient is rotated to their left and an oblique view has been taken through
their upper chest. The mediastinal structures are projected left of centre. If this were a PA view in
the right lateral oblique position, the aortic arch would be on the other side of the image.

Case 11
MR angiogram. Neck vessels. AP view.
1. Basilar artery
2. Right external carotid artery
3. Right vertebral artery
4. Left subclavian artery
5. Left middle cerebral artery
The carotids can be confused because the ‘external’ carotids appear to branch medially. Follow the
outer branch and you see that it becomes the middle cerebral artery so is the internal carotid
artery.

Case 12
DP radiograph of a child’s foot.
1. Calcaneum
2. Distal phalanx of a parent’s finger
3. Ossification centre of the navicula
4. Proximal epiphysis of the distal phalanx of the great toe
5. Middle cuneiform
 EXAM 4 | ANSWERS 103

Case 13
CT abdomen. Axial section
1. Inferior vena cava
2. Tail of the pancreas
3. Right adrenal gland
4. Splenic artery
5. Portal vein

Case 14
MRI shoulder. T1 weighted. Axial.
1. Glenoid
2. Deltoid muscle
3. Glenoid labrum
4. Infrapinatus muscle
5. Long head of biceps tendon

Case 15
CT cerebral venogram. Sagittal MIP.
1. Posterior arch of C1 vertebra
2. Great cerebral vein (of Galen)
3. Superior sagittal sinus
4. Inferior sagittal sinus
5. Straight sinus

Case 16
DP radiograph of the right foot.
1. Right fibular head/ lateral malleolus
2. Right medial cuneiform
3. Right calcaneum
4. Right tibial sesamoid bone
5. Right peroneus brevis

Case 17
MRI pelvis. T1 weighted. Coronal section
1. Right rectus femoris muscle
2. Left pubic tubercle
3. Right anterior superior iliac spine
4. Right common femoral vein
5. Left common femoral artery
104 EXAM 4 | ANSWERS

Case 18
PA chest radiograph, child.
1. Ossification centre of the coracoid process of the left scapula
2. Tip of the left scapula
3. Right lower lobe pulmonary artery
4. Left clavicle
5. Proximal epiphysis of the left humerus

Case 19
AP skull radiograph.
1. Left zygoma
2. Right first upper incisor
3. Zygomatic process of the right frontal bone
4. Right lateral process of the C2 vertebra
5. Sagittal suture

Case 20
AP radiograph. Lumbar spine.
1. Stomach
2. Left ischial spine
3. Right pedicle of L2 vertebra
4. Right sacral ala
5. Spinous process of L1 vertebra
Remember that the spinous processes are angled caudally so usually are projected over the
vertebral body below.
exam

5 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: Kilimanjaro

106 EXAM 5 | QUESTIONS

Case 1
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 107

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
108 EXAM 5 | QUESTIONS

Case 3
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 109

Case 4
1. Name the structure labelled A.
2. Name the segment of the liver labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
110 EXAM 5 | QUESTIONS

Case 5
1. Name the structure labelled A.
2. Name the bony structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 111

Case 6
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
112 EXAM 5 | QUESTIONS

Case 7
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 113

Case 8
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
114 EXAM 5 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 115

Case 10
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
116 EXAM 5 | QUESTIONS

Case 11
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 117

Case 12
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
118 EXAM 5 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 119

Case 14
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
120 EXAM 5 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 121

Case 16
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
122 EXAM 5 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 123

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
124 EXAM 5 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 5 | QUESTIONS 125

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

5 ANSWERS

Case 1
AP radiograph. Pelvis.
1. Lesser trochanter of the right femur
2. Left sacral foramen of S3 vertebra
3. Fovea capitis of the left femur
4. Right pelvic brim
5. Caecum

Case 2
CT aortogram, abdomen. Axial section.
1. Abdominal aorta
2. Gallbladder
3. Coeliac trunk
4. Common hepatic artery
5. Splenic artery
There are several normal variants of the arterial anatomy of the coeliac axis and superior
mesenteric artery. Candidates are advised to familiarize themselves with these.

Case 3
MRI cerebral aqueduct. Sagittal section.
1. Pericallosal artery
2. Pons
3. Basilar artery
4. Cisterna magna
5. Interpeduncular cistern
The basilar artery often takes a slightly tortuous course and is, therefore, seen in cross section on
this sagittal image.
 EXAM 5 | ANSWERS 127

Case 4
CT chest/ abdomen. Axial section.
1. Right latissimus dorsi muscle
2. Segment 4(A)
3. Inferior vena cava
4. Oesophagus
5. Xiphoid process of sternum (xiphisternum)

Case 5
Plain radiograph, lateral cervical spine.
1. Soft palate
2. Angle of the mandible (not possible to say which side)
3. Inferior articular process of C6 vertebra
4. Posterior clinoid process
5. Superior articular process of C7 vertebra

Case 6
CT abdomen. Coronal section.
1. Right external iliac artery
2. Splenic vein
3. Right common femoral vein
4. Caecum
5. Portal vein
Remember that the blood vessels change their name from ‘external iliac’ to ‘femoral’
as they pass the inguinal ligament.

Case 7
CT facial bones. Axial section.
1. Right foramen transversarium (of C1 vertebra)
2. Left zygomatic bone (zygomatic process)
3. Left styloid process
4. Dens (odontoid process of the C2 vertebra)
5. Right mandibular ramus

Case 8
CT chest. Axial section.
1. Ascending aorta
2. Pulmonary trunk
3. Right serratus anterior muscle
4. Oesophagus
5. Left trapezius muscle
128 EXAM 5 | ANSWERS

Case 9
MRI shoulder. T1W axial section.
1. Transverse humeral ligament
2. Tendon of the subscapularis muscle
3. Deltoid muscle
4. Infraspinatous muscle
5. Coracoid process of the scapula
The transverse humeral ligament spans the biceps groove and is inseparable from the distal
subscapularis muscle. At this level, the muscle posterior to the scapula must be infraspinatus
(supraspinatous is much higher).

Case 10
Nephrogram, left kidney.
1. Renal papilla
2. Renal pelvis
3. Major calyx (upper pole)
4. Ureter
5. Minor calyx

Case 11
CT chest. Coronal section.
1. Left glenoid
2. Descending thoracic aorta
3. Right kidney (upper pole)
4. Left diaphragmatic crus
5. Spleen
This might look tricky at first but these should all be familiar structures, just seen in an unfamiliar
way.

Case 12
CT abdomen. Parasagittal section.
1. Right acetabulum
2. Gallbladder
3. Right rectus abdominis muscle
4. Right psoas muscle
5. Right renal pelvis
This is the right side as liver and gallbladder are on the image!
 EXAM 5 | ANSWERS 129

Case 13
Hysterosalpingogram.
1. Fundus of the uterus
2. Right uterine (Fallopian) tube
3. Cervix
4. Isthmus of the left uterine (Fallopian) tube
5. Vagina

Case 14
MRI ankle. T1W axial section.
1. Tibialis posterior tendon
2. Posterior tibiofibular ligament
3. Peroneus longus tendon
4. Peroneus brevis muscle
5. Tibialis anterior tendon

Case 15
CT chest. Parasagittal section.
1. Descending thoracic aorta
2. Left pulmonary vein
3. Left brachiocephalic vein
4. Pulmonary trunk
5. Right ventricle
B is difficult. It is straightforward to work out if not immediately obvious: a structure travelling
horizontally behind the heart; we are left of the midline as we can see the descending aorta; it is not
connected to the pulmonary arterial tree…. it must be the left pulmonary vein!

Case 16
MRI head. T1W parasagittal section.
1. Frontal sinus
2. Occipital horn of the lateral ventricle
3. Maxillary sinus
4. Superior rectus muscle
5. Optic nerve
It is not possible to determine the side (left or right) based on the image.
130 EXAM 5 | ANSWERS

Case 17
CT chest (lung windows). Axial section.
1. Lingular bronchus
2. Left oblique fissure
3. Right main bronchus
4. Ascending aorta
5. Oesophagus
Note that ‘A’ is hollow so is an airway, not a vessel.

Case 18
Plain radiograph. Lateral sternum.
1. Manubrium of sternum
2. Body of sternum
3. Trachea
4. Breast
5. Manubriosternal joint

Case 19
MRI lumbar spine.T1W sagittal section.
1. Uterus
2. Pedicle of L4 vertebra
3. Spinous process of T12 vertebra
4. Inferior articular process of L4 vertebra
5. Superior articular process of L4 vertebra

Case 20
CT chest. Axial section.
1. Left axillary artery
2. Right subscapularis muscle
3. Right subclavian vein
4. Brachiocephalic trunk
5. Left subclavian artery
The right subclavian vein is filled with dense contrast giving the streak artefact seen.
Of the two vessels in the left axilla, one would expect there to be contrast in the artery, not the
vein, at this phase of the scan.
exam

6 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: Kilimanjaro

132 EXAM 6 | QUESTIONS

Case 1
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 133

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
134 EXAM 6 | QUESTIONS

Case 3
1. Name the segment of the liver labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 135

Case 4
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
136 EXAM 6 | QUESTIONS

Case 5
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 137

Case 6
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
138 EXAM 6 | QUESTIONS

Case 7
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 139

Case 8
1. Name the craniocaudal ‘line’ labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
140 EXAM 6 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 141

Case 10
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
142 EXAM 6 | QUESTIONS

Case 11
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure that occupies the space labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 143

Case 12
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
144 EXAM 6 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 145

Case 14
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
146 EXAM 6 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 147

Case 16
1. Name the two rounded structures labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
148 EXAM 6 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the lobe of the liver labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 149

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
150 EXAM 6 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 6 | QUESTIONS 151

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

6 ANSWERS

Case 1
MRI abdomen. T2W axial section
1. Liver
2. Right renal pelvis
3. Duodenum (second part)
4. Left transversus abdominis muscle
5. Inferior vena cava
The blood vessels show flow void artefact and are black on this image. B, therefore is not a vessel.

Case 2
Plain radiograph. Shoulder ‘Y’ view.
1. Right clavicle
2. Inferior angle of the right scapula
3. Right acromium
4. Right coracoid process of the scapula
5. Right scapular spine

Case 3
CT abdomen. Axial section
1. Segment 3
2. Descending colon
3. Duodenum (second part)
4. Superior mesenteric artery
5. Left renal vein
The candidate should be familiar with the liver segments. Segments 2 and 3 make up the left lobe, 2
superiorly and 3 inferiorly, divided at the level of the portal vein.
 EXAM 6 | ANSWERS 153

Case 4
MR-angio. Circle of Willis.
1. Right posterior cerebral artery
2. Right posterior communicating artery
3. Right medial rectus muscle
4. Basilar artery
5. Superior sagittal sinus

Case 5
CT abdomen. Coronal section.
1. Inferior vena cava
2. Left common iliac artery
3. Left external oblique muscle
4. Stomach
5. Portal vein

Case 6
Plain radiograph. Right hip.
1. Right acetabulum
2. Right inferior pubic ramus
3. Right obturator foramen
4. Right ischium
5. Right fovea capitis
One should remember that the inferior portion of the obturator ring is made up of the ischium
laterally and the inferior ramus of the pubic bone medially. It is easy to mistake the whole structure
for the inferior pubic ramus.

Case 7
ERCP.
1. Common hepatic duct
2. Left hepatic duct
3. Common bile duct
4. Gallbladder
5. Cystic duct
154 EXAM 6 | ANSWERS

Case 8
CT abdomen. Axial section.
1. Linea semilunaris
2. Right internal oblique muscle
3. Duodenum (third part)
4. Superior mesenteric artery
5. Right ureter
The linea semilunaris is also known as ‘Spiegel’s line’ and is the site of Spiegelian herniae (through
the Spiegelian fascia).

Case 9
CT orbits. Axial section.
1. Left frontal sinus
2. Crista galli
3. Dorsum sellae
4. Squamous part of the right temporal bone
5. Left superior rectus muscle

Case 10
MRI pelvis. T1W coronal section.
1. Left iliac crest
2. Right ischial tuberosity
3. Right gluteus maximus muscle
4. Right sacral ala
5. Rectum

Case 11
MRI knee. T2W sagittal section.
1. Meniscofemoral ligament (of Humphrey)
2. Posterior cruciate ligament
3. Patellar retinaculum
4. Hoffa’s fat pad
5. Medial head of gastrocnemius
The meniscofemoral ligament (when visible) has two main variants and names: when passing
anterior to the posterior cruciate ligament, it is called the ligament of Humphrey; when passing
posterior to the posterior cruciate, it is called the ligament of Wrisberg.
We know the gastrocnemius seen is the medial head as the posterior cruciate lies just medial to
the midline of the knee.
 EXAM 6 | ANSWERS 155

Case 12
CT abdomen. Sagittal section.
1. Stomach
2. Pancreas
3. Left renal vein
4. Urinary bladder
5. Superior mesenteric artery
‘A’ might be mistaken for the transverse colon but this is seen lying much lower in the abdomen
near the distended loops of sigmoid. ‘C’ should now be familiar as the flattened left renal vein
passing over the abdominal aorta. ‘B’ might be mistaken for a filled duodenum but this structure is
clearly solid and the splenic vein can be seen at the posterior aspect.

Case 13
Plain radiograph. AP view of right shoulder.
1. Bicipital groove
2. Superior vena cava
3. Lesser tuberosity of the humerus
4. Greater tuberosity of the humerus
5. Anatomical neck of the humerus
The ‘surgical neck’ of the humerus is the region at the proximal diaphysis just distal to the tuberosi-
ties. This is the most common site of fractures.

Case 14
CT chest. Coronal section.
1. Inferior vena cava
2. Left main bronchus
3. Azygos vein
4. Stomach
5. Oesophagus

Case 15
MRI wrist. Volar aspect. Coronal section.
1. First (or thumb) metacarpal bone
2. Radial artery
3. Hook of the hamate
4. Pisiform bone
5. Trapezium bone
Identifying this as the wrist may be the most difficult part; once this is done, the rest is straightfor-
ward. There is nowhere else in the body where so many tendons come together through such a
narrow tunnel (and the base of thumb should be recognizable). Note that ‘B’ shows flow artefact
distally so is a vessel, not a tendon.
156 EXAM 6 | ANSWERS

Case 16
CT pelvis. Axial section.
1. Left inferior epigastric vessels
2. Left external iliac vein
3. Right external iliac artery
4. Sacrum
5. Right seminal vesicles

Case 17
Ultrasound liver.
1. Left hepatic vein
2. Inferior vena cava
3. Left lobe of the liver
4. Right hepatic vein
5. Middle hepatic vein

Case 18
MRI abdomen. T1W coronal section.
1. Right lung
2. Left lobe of the liver
3. Falciform ligament
4. Umbilicus
5. Transverse colon
As elsewhere, once one has recognized that this is an anterior slice of the abdomen, the rest should
be straightforward.

Case 19
CT chest. Axial section.
1. Hemiazygos vein
2. Right atrium
3. Azygos vein
4. Oesophagus
5. Inferior vena cava

Case 20
CT abdomen. Parasagittal section.
1. Spleen
2. Left iliacus muscle
3. Left gluteus maximus muscle
4. Left femoral head
5. Left kidney
The absence of the liver and presence of the spleen make this a left parasagittal section.
exam

7 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: North face of the Eiger

158 EXAM 7 | QUESTIONS

Case 1
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 159

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
160 EXAM 7 | QUESTIONS

Case 3
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 161

Case 4
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the joint labelled E.
162 EXAM 7 | QUESTIONS

Case 5
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 163

Case 6
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the region labelled E.
164 EXAM 7 | QUESTIONS

Case 7
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the part of the small bowel labelled D.
5. Name the part of the small bowel labelled E.
 EXAM 7 | QUESTIONS 165

Case 8
1. Name the normal variant labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
166 EXAM 7 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 167

Case 10
1. Name the CSF space labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the vessel labelled D.
5. Name the structure labelled E.
168 EXAM 7 | QUESTIONS

Case 11
1. Name the foramen labelled A.
2. Name the structure labelled B.
3. Name the foramen labelled C.
4. Name the foramen labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 169

Case 12
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
170 EXAM 7 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 171

Case 14
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
172 EXAM 7 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 173

Case 16
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
174 EXAM 7 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 175

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
176 EXAM 7 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 7 | QUESTIONS 177

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

7 ANSWERS

Case 1
Radiograph pelvis (child).
1. Right ilium
2. Right ischial ramus
3. Greater trochanter of left femur
4. Left ischiopubic syndesmosis
5. Left posterior inferior iliac spine

Case 2
CT pelvis (male) with intravenous contrast. Axial image.
1. Right tensor fascia lata muscle
2. Right iliopsoas muscle
3. Left spermatic cord
4. Left common femoral artery
5. Left rectus femoris muscle

Case 3
CT neck. Axial image.
1. Tongue
2. Left submandibular gland
3. Median glossoepiglottic fold
4. Epiglottis
5. Hyoid bone

Case 4
MRI hindfoot. T2W sagittal section.
1. Base of second metatarsal
2. Lateral cuneiform
3. Cuboid
4. Sinus tarsi/ tarsal sinus
5. Posterior talocalcaneal/ subtalar joint
 EXAM 7 | ANSWERS 179

Case 5
MRI forearm. T2W coronal section.
1. Capitulum of humerus
2. Tuberosity of radius
3. Hamate
4. Proximal phalanx of thumb
5. Trapezoid

Case 6
MRI brain. T1W midsagittal section.
1. Inferior turbinate
2. Soft palate
3. Cerebellar tonsil
4. Tectum of midbrain
5. Nasopharynx

Case 7
MRI abdomen. T2W coronal section.
1. Stomach
2. Duodenum
3. Right common iliac artery
4. Ileum
5. Jejunum

Case 8
MRI brain. T1W coronal section.
1. Cavum septum pellucidum
2. Right temporalis muscle
3. Right medial pterygoid muscle
4. Left internal carotid artery
5. Chiasmatic cistern
Candidates will be expected to be familiar with common normal variants such as the cavum
seputum pellucidum above.

Case 9
MRI pelvis (female). T2W sagittal section.
1. Rectus abdominus muscle
2. Vagina
3. Posterior fornix of vagina
4. External os of cervix
5. L5/S1 intervertebral disc
180 EXAM 7 | ANSWERS

Case 10
MRI brain. T2W sagittal section.
1. Quadrigeminal cistern
2. Medulla oblongata
3. Massa intermedia
4. Pericallosal artery
5. Posterior arch of atlas (C1)

Case 11
Occipitomental skull radiograph.
1. Right foramen rotundum
2. Right mastoid air cells
3. Right transverse foramen of C1
4. Left infraorbital foramen
5. Left innominate line/ greater wing of sphenoid

Case 12
MRI brain. Coronal section.
1. Right middle cerebellar peduncle
2. Left Sylvian fissure
3. Left fornix
4. Head of right caudate nucleus
5. Right hippocampus

Case 13
Orthopantomogram (child).
1. Hard palate
2. Right lower third molar
3. Left inferior alveolar canal
4. Left mandibular condyle
5. Hyoid bone

Case 14
MRI wrist. Axial image at the level of the distal radius.
1. Ulna
2. Radius
3. Dorsal tubercle of radius/ Lister’s tubercle
4. Radial artery
5. Tendon of extensor carpi ulnaris muscle
A difficult case. The radial artery is clearly different to the other rounded structures being circular
rather than ovoid on this section and showing flow void artefact rather than a solid low signal.
 EXAM 7 | ANSWERS 181

Case 15
Inferior mesenteric arteriogram with digital subtraction.
1. Inferior mesenteric artery
2. Superior rectal artery
3. Left colic artery
4. Marginal artery of Drummond
6. Descending colon
Digital subtraction will remove all structures that are unchanged between the pre- and postcontrast
images, effectively deleting the background. Anything that moves will remain and the patient is
asked to hold their breath to limit movement of the internal organs and bony skeleton. Bowel is
often seen, however, as it peristalses (this can be limited by the administration of buscopan).

Case 16
CT temporal bones. Coronal reconstruction.
1. Right squamous temporal bone
2. Right scutum
3. Right internal auditory meatus
4. Left superior semicircular canal
5. Left external auditory meatus

Case 17
MRI ankle. Axial section just superior to the mortise joint.
1. Peroneus brevis muscle
2. Flexor hallucis longus muscle
3. Achilles’ tendon
4. Flexor digitorum longus muscle
5. Tendon of tibialis posterior muscle
The tendons and muscles of the lower limb are not as intimidating as they first seem and should be
familiar to the candidate. Consult your favourite anatomy textbook and remember the mnemonic
‘Tom, Dick and Harry’ for structures E, D and B respectively (Tibialis posterior, flexor Digitorum
longus, flexor Hallucis longus).

Case 18
MRI knee. T1W sagittal section.
1. Vastus lateralis muscle
2. Biceps femoris muscle
3. Lateral condyle of femur
4. Head of fibula
5. Tibialis anterior muscle
182 EXAM 7 | ANSWERS

Case 19
MRI neck. T1W coronal section.
1. Right axillary artery
2. Left clavicle
3. Left sternocleidomastoid muscle
4. Aortic arch
5. Left coracoid process of scapula

Case 20
MRI shoulder. Sagittal oblique T1W section.
1. Coracoid process
2. Deltoid muscle
3. Supraspinatus muscle
4. Infraspinatus muscle
5. Clavicle
exam

8 QUESTIONS

You have 75 minutes to complete the examination

Difficulty rating: North face of the Eiger

184 EXAM 8 | QUESTIONS

Case 1
1. Name the very faint structure labelled A.
2. Name the vessel labelled B.
3. Name the vessel labelled C.
4. Name the vessel labelled D.
5. Name the vessel labelled E.
 EXAM 8 | QUESTIONS 185

Case 2
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
186 EXAM 8 | QUESTIONS

Case 3
1. Name the structure labelled A.
2. Name the foramen labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 8 | QUESTIONS 187

Case 4
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the main group of lymph nodes that the structure labelled A drains to.
188 EXAM 8 | QUESTIONS

Case 5
1. Name the muscle labelled A.
2. Name the muscle labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 8 | QUESTIONS 189

Case 6
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
190 EXAM 8 | QUESTIONS

Case 7
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the intraperitoneal space between structure C and the rectum.
 EXAM 8 | QUESTIONS 191

Case 8
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the joint labelled D.
5. Name the joint labelled E.
192 EXAM 8 | QUESTIONS

Case 9
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 8 | QUESTIONS 193

Case 10
1. Name the structure labelled A.
2. Name the gyrus labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
194 EXAM 8 | QUESTIONS

Case 11
1. Name the structure labelled A.
2. Name the space labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 8 | QUESTIONS 195

Case 12
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
196 EXAM 8 | QUESTIONS

Case 13
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 8 | QUESTIONS 197

Case 14
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the CSF space labelled D.
5. Name the structure labelled E.
198 EXAM 8 | QUESTIONS

Case 15
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. At what thoracic level does the structure labelled E pass through the diaphragm?
 EXAM 8 | QUESTIONS 199

Case 16
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
200 EXAM 8 | QUESTIONS

Case 17
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 EXAM 8 | QUESTIONS 201

Case 18
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
202 EXAM 8 | QUESTIONS

Case 19
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the muscle labelled C.
4. Name the vessel labelled D.
5. Name the vessel labelled E.
 EXAM 8 | QUESTIONS 203

Case 20
1. Name the structure labelled A.
2. Name the structure labelled B.
3. Name the structure labelled C.
4. Name the structure labelled D.
5. Name the structure labelled E.
 exam

8 ANSWERS

Case 1
Angiogram. Lower limb arteries.
1. Tibia
2. Popliteal artery
3. Anterior tibial artery
4. Posterior tibial artery
5. Peroneal artery

Case 2
MRI pelvis. Coronal T1W image.
1. Left obturator externus muscle
2. Left iliacus muscle
3. Right obturator internus muscle
4. Right gluteus minimus muscle
5. Left inferior pubic ramus

Case 3
CT base of skull. Axial imaging, ‘bone windows’.
1. Right lateral pterygoid plate
2. Incisive foramen
3. Right masseter muscle
4. Right maxillary sinus
5. Left lateral pterygoid muscle
Note that, in this case, the right maxillary sinus is partly opacified by mucous.
This is not an uncommon finding.

Case 4
Ultrasound testis. Longitudinal section.
1. Testis
2. Head of epididymis
3. Body of epididymis
4. Scrotal skin
5. Para-aortic lymph nodes
 EXAM 8 | ANSWERS 205

Case 5
CT abdomen and pelvis with intravenous contrast. Coronal reconstruction.
1. Left external oblique muscle
2. Right transversus abdominis muscle
3. Right portal vein
4. Head of right femur
5. Left lobe of liver

Case 6
MRI wrist. Coronal T2W image.
1. Ulnar styloid
2. Triangular fibrocartilaginous disc
3. Base of fifth metacarpal
4. Scaphoid
5. Scapholunate ligament

Case 7
Ultrasound pelvis (female patient). Longitudinal section.
1. Urinary bladder
2. Uterine fundus
3. Vagina
4. Endometrium
5. Pouch of Douglas
The radiologist should be familiar with the name and position of the various intraperitoneal spaces.

Case 8
CT thorax with intravenous contrast. Axial section.
1. Anterior junction line
2. Right atrium
3. Bronchus intermedius
4. Left costovertebral joint
5. Right costotransverse joint
206 EXAM 8 | ANSWERS

Case 9
MRI knee.T2W axial image.
1. Popliteal artery
2. Biceps femoris muscle
3. Lateral head of gastrocnemius muscle
4. Sartorius muscle
5. Medial patellofemoral ligament/ medial retinaculum
You should beware ghosting artefacts on MR images. These are displaced reduplications of some or
part of the image and occur in the phase encoding direction. They occur due to movement mostly
and are often seen on the sort of image shown in question 9 in which the popliteal artery appears
both above and below its true position. (This is not shown on the image in this exam.)

Case 10
Transcranial ultrasound. Neonatal brain.
1. Right Sylvian fissure
2. Right cingulate gyrus
3. Corpus callosum
4. Left lateral ventricle
5. Third ventricle
The fontanelles are used as acoustic windows to image the neonatal brain. This image is obtained
with the probe at the anterior fontanelle and angled a little posteriorly.

Case 11
MRI pelvis (male).T2W sagittal section.
1. Rectum
2. Rectovesical pouch
3. Corpus cavernosum
4. Testis
5. L5/S1 intervertebral disc

Case 12
MRI shoulder. T1W coronal section.
1. Suprascapular vein
2. Acromion
3. Deltoid muscle
4. Long head of biceps tendon
5. Supraspinatus muscle
 EXAM 8 | ANSWERS 207

Case 13
Ultrasound neck. Transverse section.
1. Left lobe of thyroid gland
2. Thyroid isthmus
3. Trachea
4. Left common carotid artery
5. Left sternocleidomastoid muscle

Case 14
MRI base of skull.T2W axial section.
1. Medulla
2. Right vertebral artery
3. Left cerebellar hemisphere
4. Cisterna magna
5. Right mandibular ramus

Case 15
CT thorax with intravenous contrast. Sagittal reconstruction.
1. Pulmonary trunk
2. Right ventricle
3. Left main bronchus
4. Interventricular septum
5. T12

Case 16
MRI abdomen. T2W axial section.
1. Right lobe of liver
2. Transverse colon
3. Inferior vena cava
4. Left renal vein
5. Left crus of the diaphragm

Case 17
CT abdomen with intravenous contrast. Parasagittal reconstruction.
1. S1 vertebral body
2. Duodenum
3. Lower lobe of right lung
4. Inferior vena cava
5. Right renal artery
‘D’ is clearly the IVC as this passes into the liver superiorly so we are looking at a slightly off-centre
parasagittal image just right of the midline. ‘E’, therefore, is a vessel passing behind the IVC on the
right so is the right renal artery.
208 EXAM 8 | ANSWERS

Case 18
Cardiac MR. T2W long-axis.
1. Left ventricle
2. Left atrium
3. Left pulmonary vein
4. Aortic arch
5. Left hemidiaphragm
Cardiac MRI images are obtained at oblique angles, in line with the axes of the heart and tend to be
named as ‘long axis’ and ‘short axis’ to match the terminology used in echocardiography.

Case 19
CT thorax with intravenous contrast. Axial section.
1. Superior vena cava
2. Azygos vein
3. Trapezius muscle
4. Right internal mammary vein
5. Left internal mammary artery
As the azygos arch courses anteriorly, oblique sections may make it appear as an ovoid structure on
some images. This risks being mistaken for a lymph node by some but the radiologist knows better!

Case 20
MR thigh. STIR axial image.
1. Tibia
2. Fibula
3. Popliteus muscle
4. Popliteal vein
5. Tibialis anterior muscle
Note that the popliteal artery is circular and has a thicker wall than the popliteal vein.
ABBREVIATIONS

AP Anteroposterior
CSF Cerebrospinal fluid
CT Computed tomography
CTPA Computed tomographic pulmonary angiogram
DP Dorsopalmar/dorsoplantar
ERCP Endoscopic retrograde cholangiopancreatography
IVC Inferior vena cava
MRI Magnetic resonance imaging
MRCP Magnetic resonance cholangiopancreatography
MIP Maximum intensity projection
PA Posteroanterior
STIR Short T1 inversion recovery