1. A 45-year-old woman presents with chronic cough and hemoptysis. A chest radiograph shows a spiculated mass in the right upper lobe. The most appropriate next step in the management of this patient is:
A. CT-guided biopsy
B. Bronchoscopy
C. Surgical resection
D. Watchful waiting
2. A 60-year-old man with a history of smoking presents with left-sided weakness and aphasia. MRI of the brain shows a hyperdense area in the right middle cerebral artery territory. The most likely diagnosis is:
A. Ischemic stroke
B. Hemorrhagic stroke
C. Brain tumor
D. Multiple sclerosis
3. A 35-year-old woman presents with abdominal pain and vaginal bleeding. Pelvic ultrasound shows a heterogeneous mass arising from the right ovary. The most appropriate next step in the management of this patient is:
A. CA-125 tumor marker
B. CT scan of the abdomen and pelvis
C. Exploratory laparotomy
D. Watchful waiting
4. A 70-year-old man with a history of coronary artery disease presents with chest pain. An electrocardiogram shows ST-segment elevation in the anterior leads. The most appropriate next step in the management of this patient is:
A. Cardiac catheterization
B. Echocardiography
C. Exercise stress test
D. Watchful waiting
5. A 25-year-old woman presents with a palpable breast mass. Mammography shows a well-circumscribed, oval-shaped mass with microcalcifications. The most likely diagnosis is:
A. Fibroadenoma
B. Ductal carcinoma in situ
C. Invasive ductal carcinoma
D. Phyllodes tumor
Here are 45 more USMLE-style MCQs with a high difficulty level on radiology:
6. A 55-year-old man with a history of alcoholism presents with jaundice and abdominal pain. CT scan of the abdomen shows a dilated common bile duct with a mass in the head of the pancreas. The most likely diagnosis is:
A. Chronic pancreatitis
B. Gallstone pancreatitis
C. Pancreatic adenocarcinoma
D. Pancreatic pseudocyst
7. A 70-year-old woman with a history of rheumatoid arthritis presents with progressive weakness and numbness in the lower extremities. MRI of the cervical spine shows compression of the spinal cord at the C5-C6 level. The most appropriate next step in the management of this patient is:
A. Cervical laminectomy
B. Corticosteroid therapy
C. Physical therapy
D. Watchful waiting
8. A 40-year-old woman with a family history of breast cancer presents for screening mammography. The mammogram shows clustered microcalcifications in the upper outer quadrant of the right breast. The most appropriate next step in the management of this patient is:
A. Breast MRI
B. Excisional biopsy
C. Stereotactic core biopsy
D. Watchful waiting
9. A 65-year-old man with a history of smoking presents with a persistent cough and weight loss. Chest CT scan shows a spiculated mass in the right upper lobe with mediastinal lymphadenopathy. The most likely diagnosis is:
A. Bronchogenic carcinoma
B. Pulmonary tuberculosis
C. Sarcoidosis
D. Silicosis
10. A 45-year-old woman with a history of Crohn’s disease presents with right lower quadrant pain and fever. CT scan of the abdomen and pelvis shows bowel wall thickening and an inflammatory mass in the right iliac fossa. The most likely diagnosis is:
A. Appendicitis
B. Colonic diverticulitis
C. Crohn’s disease flare
D. Ovarian torsion
11. A 60-year-old man with a history of smoking presents with a slowly enlarging neck mass. CT scan of the neck shows a heterogeneous mass in the thyroid gland with calcifications and lymphadenopathy. The most likely diagnosis is:
A. Anaplastic thyroid carcinoma
B. Follicular thyroid carcinoma
C. Medullary thyroid carcinoma
D. Papillary thyroid carcinoma
12. A 35-year-old woman presents with a palpable breast mass. Breast ultrasound shows a hypoechoic, irregular mass with posterior acoustic shadowing. The most appropriate next step in the management of this patient is:
A. Core needle biopsy
B. Excisional biopsy
C. Fine-needle aspiration
D. Watchful waiting
13. A 70-year-old man with a history of prostate cancer presents with severe back pain. Bone scan shows multiple areas of increased uptake in the vertebral bodies and pelvic bones. The most likely diagnosis is:
A. Bone metastases
B. Multiple myeloma
C. Osteoporosis
D. Paget’s disease
14. A 45-year-old woman presents with a palpable breast mass. Mammography shows a spiculated mass with microcalcifications in the upper outer quadrant of the left breast. The most appropriate next step in the management of this patient is:
A. Breast MRI
B. Excisional biopsy
C. Sentinel lymph node biopsy
D. Stereotactic core biopsy
15. A 60-year-old man with a history of smoking presents with hemoptysis. Chest CT scan shows a cavitary mass in the right upper lobe with mediastinal lymphadenopathy. The most likely diagnosis is:
A. Bronchogenic carcinoma
B. Lung abscess
C. Pulmonary tuberculosis
D. Sarcoidosis
16. A 55-year-old woman with a history of breast cancer presents for follow-up CT scan of the chest, abdomen, and pelvis. The scan shows multiple hypodense lesions in the liver. The most likely diagnosis is:
A. Hepatic cysts
B. Hepatic hemangiomas
C. Hepatic metastases
D. Hepatocellular carcinoma
17. A 40-year-old man presents with severe headache and blurred vision. MRI of the brain shows a heterogeneous mass in the sellar region with suprasellar extension. The most likely diagnosis is:
A. Craniopharyngioma
B. Meningioma
C. Pituitary adenoma
D. Rathke’s cleft cyst
18. A 65-year-old woman with a history of smoking presents with chronic cough and dyspnea. Chest CT scan shows diffuse bilateral centrilobular emphysematous changes with areas of bullae formation. The most likely diagnosis is:
A. Asthma
B. Bronchiectasis
C. Chronic obstructive pulmonary disease (COPD)
D. Interstitial lung disease
19. A 50-year-old man with a history of rheumatoid arthritis presents with progressive weakness and numbness in the lower extremities. MRI of the lumbar spine shows spinal stenosis at the L4-L5 level with compression of the cauda equina. The most appropriate next step in the management of this patient is:
A. Epidural steroid injection
B. Lumbar laminectomy
C. Physical therapy
D. Watchful waiting
20. A 35-year-old woman presents with a palpable breast mass. Breast ultrasound shows a complex cystic and solid mass with internal vascularity. The most appropriate next step in the management of this patient is:
A. Core needle biopsy
B. Excisional biopsy
C. Fine-needle aspiration
D. Watchful waiting
21. A 70-year-old man with a history of smoking presents with weight loss and fatigue. CT scan of the chest, abdomen, and pelvis shows a large retroperitoneal mass with encasement of the aorta and inferior vena cava. The most likely diagnosis is:
A. Lymphoma
B. Pancreatic adenocarcinoma
C. Renal cell carcinoma
D. Retroperitoneal sarcoma
22. A 45-year-old woman presents with a palpable breast mass. Mammography shows a stellate mass with spiculated margins in the upper outer quadrant of the right breast. The most likely diagnosis is:
A. Ductal carcinoma in situ
B. Fibroadenoma
C. Invasive ductal carcinoma
D. Phyllodes tumor
23. A 60-year-old man with a history of smoking presents with hemoptysis and weight loss. Chest CT scan shows a large hilar mass with mediastinal lymphadenopathy and pleural effusion. The most likely diagnosis is:
A. Bronchogenic carcinoma
B. Mesothelioma
C. Pulmonary tuberculosis
D. Sarcoidosis
24. A 35-year-old woman presents with severe headache and visual disturbances. MRI of the brain shows a well-circumscribed, enhancing mass in the sellar region with compression of the optic chiasm. The most likely diagnosis is:
A. Craniopharyngioma
B. Meningioma
C. Pituitary adenoma
D. Rathke’s cleft cyst
25. A 65-year-old man with a history of smoking presents with persistent cough and hemoptysis. Chest CT scan shows a spiculated mass in the right upper lobe with ipsilateral hilar lymphadenopathy. The most appropriate next step in the management of this patient is:
A. Bronchoscopy with biopsy
B. Mediastinoscopy
C. Positron emission tomography (PET) scan
D. Surgical resection
26. A 50-year-old woman with a history of breast cancer presents for follow-up CT scan of the chest, abdomen, and pelvis. The scan shows multiple hypodense lesions in the liver and lytic lesions in the vertebral bodies. The most likely diagnosis is:
A. Bone metastases
B. Hepatic cysts
C. Hepatic hemangiomas
D. Hepatic metastases
28. A 60-year-old woman with a history of rheumatoid arthritis presents with progressive weakness and numbness in the upper extremities. MRI of the cervical spine shows compression of the spinal cord at the C3-C4 level. The most appropriate next step in the management of this patient is:
A. Cervical laminectomy
B. Corticosteroid therapy
C. Physical therapy
D. Watchful waiting
29. A 55-year-old man presents with severe headache and blurred vision. CT scan of the head shows a hyperdense mass in the sellar region with suprasellar extension and erosion of the sellar floor. The most likely diagnosis is:
A. Craniopharyngioma
B. Meningioma
C. Pituitary adenoma
D. Rathke’s cleft cyst
30. A 70-year-old woman with a history of smoking presents with persistent cough and hemoptysis. Chest CT scan shows a cavitary mass in the right upper lobe with ipsilateral hilar lymphadenopathy. The most likely diagnosis is:
A. Bronchogenic carcinoma
B. Lung abscess
C. Pulmonary tuberculosis
D. Sarcoidosis
31. A 40-year-old woman presents with a palpable breast mass. Breast ultrasound shows a hypoechoic, irregular mass with angular margins and posterior acoustic shadowing. The most appropriate next step in the management of this patient is:
A. Core needle biopsy
B. Excisional biopsy
C. Fine-needle aspiration
D. Watchful waiting
32. A 65-year-old man with a history of smoking presents with persistent cough and weight loss. Chest CT scan shows a spiculated mass in the right upper lobe with ipsilateral hilar and mediastinal lymphadenopathy. The most likely diagnosis is:
A. Bronchogenic carcinoma
B. Pulmonary tuberculosis
C. Sarcoidosis
D. Silicosis
33. A 45-year-old woman with a history of breast cancer presents for follow-up CT scan of the chest, abdomen, and pelvis. The scan shows multiple hypodense lesions in the liver and lytic lesions in the vertebral bodies and pelvic bones. The most likely diagnosis is:
A. Bone metastases
B. Hepatic cysts
C. Hepatic hemangiomas
D. Hepatic metastases
34. A 55-year-old man with a history of alcoholism presents with jaundice and abdominal pain. CT scan of the abdomen shows a dilated common bile duct with a mass in the head of the pancreas and multiple hypodense lesions in the liver. The most likely diagnosis is:
A. Chronic pancreatitis
B. Gallstone pancreatitis
C. Pancreatic adenocarcinoma with liver metastases
D. Pancreatic pseudocyst
35. A 35-year-old woman presents with a palpable breast mass. Breast ultrasound shows a complex cystic and solid mass with internal vascularity and microcalcifications. The most appropriate next step in the management of this patient is:
A. Core needle biopsy
B. Excisional biopsy
C. Fine-needle aspiration
D. Watchful waiting
36. A 70-year-old man with a history of prostate cancer presents with severe back pain and lower extremity weakness. MRI of the spine shows compression of the spinal cord at the T8-T9 level due to a vertebral body lesion. The most likely diagnosis is:
A. Bone metastasis
B. Multiple myeloma
C. Osteoporotic compression fracture
D. Spinal stenosis
37. A 50-year-old woman presents with a palpable breast mass. Mammography shows a stellate mass with spiculated margins and microcalcifications in the upper outer quadrant of the left breast. The most appropriate next step in the management of this patient is:
A. Breast MRI
B. Excisional biopsy
C. Sentinel lymph node biopsy
D. Stereotactic core biopsy
38. A 65-year-old man with a history of smoking presents with persistent cough and weight loss. Chest CT scan shows a spiculated mass in the right upper lobe with ipsilateral hilar lymphadenopathy and pleural effusion. The most likely diagnosis is:
A. Bronchogenic carcinoma
B. Mesothelioma
C. Pulmonary tuberculosis
D. Sarcoidosis
39. A 40-year-old woman with a family history of breast cancer presents for screening mammography. The mammogram shows clustered microcalcifications in the upper outer quadrant of the left breast. The most appropriate next step in the management of this patient is:
A. Breast MRI
B. Excisional biopsy
C. Stereotactic core biopsy
D. Watchful waiting
40. A 55-year-old man with a history of smoking presents with persistent cough and hemoptysis. Chest CT scan shows a cavitary mass in the right upper lobe with ipsilateral hilar lymphadenopathy and pleural effusion. The most likely diagnosis is:
A. Bronchogenic carcinoma
B. Lung abscess
C. Pulmonary tuberculosis
D. Sarcoidosis
41. A 60-year-old woman presents with a palpable breast mass. Breast ultrasound shows a hypoechoic, irregular mass with angular margins and posterior acoustic shadowing. The most appropriate next step in the management of this patient is:
A. Core needle biopsy
B. Excisional biopsy
C. Fine-needle aspiration
D. Watchful waiting
42. A 45-year-old man presents with severe headache and visual disturbances. MRI of the brain shows a well-circumscribed, enhancing mass in the sellar region with compression of the optic chiasm and extension into the suprasellar cistern. The most likely diagnosis is:
A. Craniopharyngioma
B. Meningioma
C. Pituitary adenoma
D. Rathke’s cleft cyst
43. A 70-year-old woman with a history of smoking presents with chronic cough and dyspnea. Chest CT scan shows diffuse bilateral centrilobular emphysematous changes with areas of bullae formation and pulmonary hypertension. The most likely diagnosis is:
A. Asthma
B. Bronchiectasis
C. Chronic obstructive pulmonary disease (COPD)
D. Interstitial lung disease
44. A 50-year-old man with a history of rheumatoid arthritis presents with progressive weakness and numbness in the lower extremities. MRI of the lumbar spine shows spinal stenosis at the L4-L5 level with compression of the cauda equina and associated myelomalacia. The most appropriate next step in the management of this patient is:
A. Epidural steroid injection
B. Lumbar laminectomy
C. Physical therapy
D. Watchful waiting
45. A 35-year-old woman presents with a palpable breast mass. Breast ultrasound shows a complex cystic and solid mass with internal vascularity and microcalcifications. The most appropriate next step in the management of this patient is:
A. Core needle biopsy
B. Excisional biopsy
C. Fine-needle aspiration
D. Watchful waiting
46. A 60-year-old man with a history of prostate cancer presents with severe back pain and lower extremity weakness. MRI of the spine shows compression of the spinal cord at the T12-L1 level due to a vertebral body lesion. The most likely diagnosis is:
A. Bone metastasis
B. Multiple myeloma
C. Osteoporotic compression fracture
D. Spinal stenosis
47. A 45-year-old woman presents with a palpable breast mass. Mammography shows a stellate mass with spiculated margins and microcalcifications in the upper outer quadrant of the right breast. The most appropriate next step in the management of this patient is:
A. Breast MRI
B. Excisional biopsy
C. Sentinel lymph node biopsy
D. Stereotactic core biopsy
49. A 55-year-old man with a history of alcoholism presents with jaundice and abdominal pain. CT scan of the abdomen shows a dilated common bile duct with a mass in the head of the pancreas and multiple hypodense lesions in the liver and peritoneal carcinomatosis. The most likely diagnosis is:
A. Chronic pancreatitis
B. Gallstone pancreatitis
C. Pancreatic adenocarcinoma with liver and peritoneal metastases
D. Pancreatic pseudocyst
50. A 40-year-old woman presents with a palpable breast mass. Breast ultrasound shows a hypoechoic, irregular mass with angular margins, posterior acoustic shadowing, and increased vascularity on Doppler imaging. The most appropriate next step in the management of this patient is:
A. Core needle biopsy
B. Excisional biopsy
C. Fine-needle aspiration
D. Watchful waiting