Free FRCR Part 2A (Radiology) - CR2A Practice Questions

Sample Practice Questions

Try these 10 sample questions from the FRCR Part 2A (Radiology) - CR2A practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1An adult arrives with abrupt, severe tearing chest pain and hypotension. The emergency team strongly suspects thoracic aortic dissection. Which examination should be arranged directly rather than waiting for the D-dimer result?

   1. A.CT aortographyCorrect answer: A
   2. B.Coronary CT angiography
   3. C.Ventilation–perfusion scintigraphy
   4. D.Myocardial perfusion scintigraphy

   Explanation: The RCR/RCEM guideline states: "D-dimer results should not be awaited in this case." Abrupt severe tearing pain with cardiovascular compromise warrants direct CT aortography, rather than coronary or pulmonary perfusion testing.

   Reference: RCR/RCEM Diagnosis of Thoracic Aortic Dissection — Recommendations, p.6

2. 2An older adult develops hip pain after a low-energy fall. No imaging has yet been obtained. Which examination is the most appropriate first imaging test for a suspected hip fracture?

   1. A.MRI of the hip and pelvis
   2. B.CT of the hip and pelvis
   3. C.Radiographs of the hip and pelvisCorrect answer: C
   4. D.Bone scintigraphy of the pelvis

   Explanation: The ACR summary states: "Radiography, or x-ray, of the hip and pelvis is the most appropriate first imaging test following fall or minor trauma". This patient has that initial presentation; cross-sectional tests are used when further assessment is needed.

   Reference: ACR/RSNA RadiologyInfo: Acute Hip Pain—Suspected Fracture — Acute Hip Pain—Suspected Fracture

3. 3A patient with colorectal cancer is being considered for curative treatment of liver metastases. CT leaves uncertainty about subcentimetre hepatic lesions. Which dedicated modality does the RCR identify as optimal for detecting these small metastases?

   1. A.Contrast-enhanced liver ultrasound
   2. B.Fluorodeoxyglucose PET-CT
   3. C.Multiphase contrast-enhanced liver CT
   4. D.Dedicated liver MRICorrect answer: D

   Explanation: The RCR states: "Liver MRI is now widely accepted as the optimal imaging modality for detecting liver metastases, particularly subcentimetre lesions not visible on other forms of imaging." Dedicated MRI addresses this uncertainty before curative treatment planning.

   Reference: RCR Liver Metastases and Primary Liver Cancer — Staging, p.4

4. 4A nonpregnant adult presents with sudden flank pain and suspected urinary stones, with no previous stone history. Which CT protocol is usually appropriate for initial stone detection?

   1. A.Abdomen and pelvis without IV contrastCorrect answer: A
   2. B.Abdomen and pelvis in the arterial phase
   3. C.Abdomen and pelvis in the portal venous phase
   4. D.Abdomen and pelvis in the delayed excretory phase

   Explanation: The ACR summary states: "CT of the abdomen and pelvis without intravenous (IV) contrast is usually appropriate." This applies to suspected stones without prior stone history, rather than a contrast-enhanced multiphase protocol.

   Reference: ACR/RSNA RadiologyInfo: Acute Onset Flank Pain — Acute Onset Flank Pain—Suspicion of Stone Disease

5. 5A clinically stable 10-year-old has blunt chest trauma. Which investigation is the primary imaging test under the RCR paediatric trauma guidance?

   1. A.Contrast-enhanced chest CT
   2. B.Chest MRI
   3. C.Chest radiographyCorrect answer: C
   4. D.Lung perfusion scintigraphy

   Explanation: The RCR states: "The primary investigation for blunt chest trauma is the chest X-ray." Subsequent imaging depends on the clinical findings and radiograph rather than an automatic adult whole-body CT approach.

   Reference: RCR Major Paediatric Trauma Radiology Guidance — 4.2.10, p.7

6. 6An adult presents with sudden unilateral weakness and speech disturbance. Which distinction is the immediate priority on initial brain imaging because it separates fundamentally different acute stroke treatment pathways?

   1. A.Ischaemic stroke versus haemorrhagic strokeCorrect answer: A
   2. B.Cortical stroke versus subcortical stroke
   3. C.Anterior circulation versus posterior circulation
   4. D.Dominant hemisphere versus nondominant hemisphere

   Explanation: The source states: "The first step in assessing a stroke patient is to determine whether the patient is experiencing an ischemic or hemorrhagic stroke so that the correct treatment can begin." Location matters, but haemorrhage versus ischaemia first changes the treatment pathway.

   Reference: ACR/RSNA Stroke — How is a stroke diagnosed and evaluated?

7. 7A radiologist protocols CT for suspected acute aortic syndrome. What is the principal reason for including an initial non-contrast acquisition before the angiographic phase?

   1. A.To demonstrate delayed renal excretion
   2. B.To assess intramural haematomaCorrect answer: B
   3. C.To measure myocardial perfusion reserve
   4. D.To demonstrate systemic venous reflux

   Explanation: The guideline states: "Initial non-contrast acquisition should form part of the scanning protocol for its value in assessment of intramural haematoma." Unenhanced imaging helps identify mural blood; the alternatives describe contrast-dependent functional or vascular observations.

   Reference: RCR/RCEM Diagnosis of Thoracic Aortic Dissection — Introduction, p.5

8. 8An older patient cannot bear weight after a minor fall despite negative hip radiographs. MRI is available and the patient can tolerate it. Which is the preferred next examination for a subtle occult hip fracture?

   1. A.Contrast-enhanced hip MRI
   2. B.Contrast-enhanced pelvic CT
   3. C.Fluoroscopic hip arthrography
   4. D.Non-contrast hip and pelvis MRICorrect answer: D

   Explanation: The ACR summary states: "When a hip fracture is not seen on x-ray but is suspected clinically, MRI of the pelvis and hips without intravenous (IV) contrast is the next best imaging test." This directly matches the persistent clinical concern after negative radiographs.

   Reference: ACR/RSNA RadiologyInfo: Acute Hip Pain—Suspected Fracture — Acute Hip Pain—Suspected Fracture

9. 9Liver CT is being planned for metastases from a neuroendocrine tumour. Which additional enhancement phase is useful because these deposits are often hypervascular?

   1. A.Late arterial phaseCorrect answer: A
   2. B.Delayed excretory phase
   3. C.Precontrast acquisition
   4. D.Late equilibrium phase

   Explanation: The RCR recommends that an "Additional late arterial phase" may be used for neuroendocrine tumours and other typically hypervascular lesions. An excretory or late delayed phase does not replace the arterial assessment of hypervascular enhancement.

   Reference: RCR Liver Metastases and Primary Liver Cancer — CT technique, p.5

10. 10A pregnant patient develops flank pain suggesting a urinary stone. Which examination is usually appropriate as the initial imaging approach?

    1. A.Contrast-enhanced CT urography
    2. B.Renal and bladder ultrasoundCorrect answer: B
    3. C.Intravenous urography
    4. D.Contrast-enhanced MR urography

    Explanation: The ACR summary states: "For pregnant women suspected of having kidney stones, retroperitoneal ultrasound of the kidneys and bladder is usually appropriate." Pregnancy changes the initial imaging choice.

    Reference: ACR/RSNA RadiologyInfo: Acute Onset Flank Pain — Acute Onset Flank Pain—Suspicion of Stone Disease