Radiology — Abdominal and Skeletal Imaging, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
A patient has sudden severe abdominal pain and a rigid abdomen. A supine abdominal film appears normal. Has perforation been excluded?
Answer: No. Free gas rises and collects under the diaphragm, so it is demonstrated on an erect film after the patient has been upright long enough for it to gather. A supine film may not show it at all, so the imaging performed could not answer the question asked.
A plain abdominal film shows multiple dilated loops lying centrally, with lines crossing the full width of the bowel, and no gas in the colon. What does this suggest, and what should be examined?
Answer: Small bowel obstruction. The hernial orifices should be examined and previous abdominal surgery asked about, since an obstructed hernia and adhesions are common causes and the first is identifiable at the bedside.
A patient falls on an outstretched hand and has tenderness in the anatomical snuffbox. The radiograph is reported as normal. How should this be managed?
Answer: As a scaphoid fracture until proven otherwise — immobilise and arrange further imaging or review. Scaphoid fractures are frequently invisible on the initial film, and missing one risks the blood supply to the bone and subsequent non-union.
A child has bone pain and fever for three days. The radiograph is normal. Does this exclude osteomyelitis?
Answer: No. Bone must lose a substantial amount of mineral before plain-film changes appear, so early infection is radiologically silent. The clinical picture should be acted upon rather than the film treated as reassurance.
A pregnant woman has suspected appendicitis. How should the imaging decision be approached?
Answer: Prefer ultrasound where it can answer the question, and shield appropriately if ionising radiation is required. An urgent indication still outweighs the radiation risk — delaying diagnosis in a seriously ill patient is itself a harm, and often the greater one.
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