Prometric Exam Questions for Diagnostic Radiology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the SDR6042 Paper

The diagnostic radiology specialist paper (SDR6042) tests the radiology registrar on the decisions behind the report: which test is right, what the described finding means, what must be phoned through now, and how to keep patients safe from radiation, contrast and the magnet. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Findings are described in words, as the exam usually presents them. Allow about 70 seconds each and read every rationale.

For titles and the route, read the radiologist guide. For timed papers use the Diagnostic Radiology specialist bank, about 2,000 questions. Radiographers sit a separate paper (radiographer sample questions).

Safety: radiation, contrast and MRI

Question 1

A 30-year-old woman with right iliac fossa pain is 8 weeks pregnant. The most appropriate first imaging is:

1. CT abdomen and pelvis with contrast
2. Ultrasound, with MRI without gadolinium as the next step if ultrasound is inconclusive, reserving CT for when the result will change management and alternatives are inadequate
3. Plain abdominal radiograph
4. Barium enema

Answer: B. Justification and optimisation apply with particular force in pregnancy; a single CT is rarely above the threshold for deterministic effects, but non-ionising alternatives are used first.

Question 2

A patient with an eGFR of 25 mL/min needs a contrast-enhanced CT for suspected pulmonary embolism. The correct approach is:

1. Cancel the scan because of the eGFR
2. Proceed when the indication is strong, using the lowest diagnostic dose of iso- or low-osmolar iodinated contrast, with hydration and review of nephrotoxic drugs, since the risk of contrast-associated acute kidney injury is modest and the risk of a missed PE is greater
3. Use gadolinium instead
4. Double the contrast dose

Answer: B. Current guidance has shifted away from refusing contrast for reduced eGFR; gadolinium is not a substitute for iodinated contrast in CT and carries nephrogenic systemic fibrosis risk in severe renal impairment.

Question 3

A patient referred for MRI has a cardiac pacemaker implanted in 2012 with no documentation. The appropriate action is:

1. Scan at 3 T to be quick
2. Do not scan until the device and leads are identified; MR-conditional systems can be scanned under the manufacturer's conditions with cardiology support, and non-conditional systems only under a formal risk-benefit protocol in specialist centres
3. Scan at 1.5 T without checks
4. Remove the pacemaker first

Answer: B. MRI safety screening is a shared responsibility; projectile, heating and device malfunction risks are all tested.

Chest

Question 4

A chest radiograph shows a 1.5 cm solid, non-calcified, spiculated nodule in the right upper lobe in a 62-year-old smoker. The next step is:

1. Repeat radiograph in a year
2. Contrast-enhanced CT chest and referral to the lung cancer pathway, with PET-CT and tissue sampling as indicated, because a spiculated solid nodule over 8 mm in a smoker has a high probability of malignancy
3. Antibiotics and repeat in six weeks
4. No action

Answer: B. Nodule management follows size, morphology and risk; incidental small nodules are followed by CT surveillance per guideline, but this nodule needs work-up.

Question 5

CT pulmonary angiography shows a saddle embolus with a right ventricle to left ventricle diameter ratio above 1.0 and contrast reflux into the IVC. The radiologist should:

1. Issue a routine report within 24 hours
2. Communicate the finding immediately to the referring clinician, reporting the signs of right heart strain, because they identify intermediate- or high-risk PE needing urgent escalation
3. Recommend outpatient follow-up
4. Repeat the scan

Answer: B. Critical findings require direct, documented communication. RV strain on CT predicts adverse outcome and guides thrombolysis decisions.

Question 6

A migrant worker's pre-employment chest radiograph shows upper-lobe fibro-nodular opacities with cavitation. The report should recommend:

1. No action; old disease
2. Urgent assessment for active pulmonary tuberculosis with sputum microscopy, culture and molecular testing, and public health notification, because cavitary upper-lobe disease is active TB until proven otherwise
3. Antibiotics for pneumonia only
4. Inhaled steroids

Answer: B. TB screening is part of every Gulf residency medical; radiologists are the first line in detecting it.

Abdomen and trauma

Question 7

Ultrasound in a jaundiced 70-year-old shows a dilated common bile duct of 14 mm, dilated intrahepatic ducts, a distended gallbladder and a mass in the pancreatic head. The next investigation is:

1. Barium meal
2. Pancreatic-protocol multiphase CT (or MRI with MRCP) for staging of a probable pancreatic head carcinoma, with EUS-guided biopsy and multidisciplinary review
3. Plain radiograph
4. Repeat ultrasound in three months

Answer: B. Painless obstructive jaundice with a double-duct sign is pancreatic cancer until proven otherwise; CT assesses vascular involvement and resectability.

Question 8

A trauma CT of a haemodynamically stable patient shows a grade III splenic laceration with a small contrast blush and moderate haemoperitoneum. The appropriate recommendation is:

1. Immediate splenectomy regardless
2. Non-operative management with close monitoring and angioembolisation for the contrast blush, reserving surgery for haemodynamic instability
3. Discharge
4. Repeat CT weekly for a month

Answer: B. Splenic preservation is favoured in stable patients; active extravasation or pseudoaneurysm is treated by embolisation.

Question 9

A 25-year-old woman has right lower quadrant pain. Ultrasound shows a non-compressible, blind-ending tubular structure 9 mm in diameter with surrounding echogenic fat. The diagnosis is:

1. Normal appendix
2. Acute appendicitis
3. Ovarian torsion
4. Mesenteric adenitis only

Answer: B. A non-compressible appendix over 6 mm with periappendiceal inflammation is diagnostic. Ultrasound is first line in young women and children to avoid radiation; MRI or low-dose CT follows if non-diagnostic.

Neuro and musculoskeletal

Question 10

A non-contrast CT head after a fall in an elderly anticoagulated patient shows a crescentic hyperdense extra-axial collection over the left convexity crossing suture lines with midline shift of 8 mm. The diagnosis and action are:

1. Epidural haematoma; routine follow-up
2. Acute subdural haematoma with mass effect; immediate communication to the clinical team and neurosurgery, with reversal of anticoagulation and surgical evacuation considered
3. Subarachnoid haemorrhage; nimodipine
4. Old infarct; no action

Answer: B. Subdurals cross sutures but not dural reflections; epidurals are lentiform and bounded by sutures. Midline shift over 5 mm or thickness over 10 mm usually warrants surgery.

Question 11

Which MRI sequence is most sensitive for detecting acute ischaemic stroke within the first hours?

1. T1-weighted imaging
2. Diffusion-weighted imaging with apparent diffusion coefficient map, showing restricted diffusion within minutes of onset
3. Gradient echo only
4. Plain CT

Answer: B. DWI detects cytotoxic oedema early; FLAIR becomes positive later, and the DWI-FLAIR mismatch helps time strokes of unknown onset for thrombolysis decisions.

Question 12

A radiograph of a 10-year-old's distal femur shows an aggressive permeative lesion with a wide zone of transition, cortical destruction, a sunburst periosteal reaction and a Codman triangle. The report should indicate:

1. A benign non-ossifying fibroma; no follow-up
2. An aggressive primary bone tumour such as osteosarcoma, recommending MRI of the whole bone, chest CT and referral to a bone tumour centre before any biopsy
3. Osteomyelitis only; antibiotics
4. Stress fracture; rest

Answer: B. Aggressive periosteal reactions and wide transition zones distinguish malignant from benign lesions; biopsy is planned by the treating centre.

Breast, paediatrics and intervention

Question 13

Screening mammography shows a new 8 mm spiculated mass with pleomorphic microcalcifications. The appropriate assessment category and action are:

1. BI-RADS 2; routine screening
2. BI-RADS 4C or 5; recall for targeted ultrasound and image-guided core biopsy with marker clip placement, and multidisciplinary review
3. BI-RADS 3; follow-up in two years
4. No further imaging

Answer: B. Spiculated masses with pleomorphic calcification are highly suspicious; tissue diagnosis precedes treatment planning.

Question 14

A 3-week-old boy has projectile non-bilious vomiting. Ultrasound shows a pyloric muscle thickness of 4.5 mm and a channel length of 18 mm. The report should state:

1. Normal pylorus
2. Findings diagnostic of hypertrophic pyloric stenosis (muscle thickness over 3 mm, channel length over 15 mm), recommending surgical referral after electrolyte correction
3. Malrotation; upper GI contrast study
4. Gastro-oesophageal reflux

Answer: B. Bilious vomiting would instead prompt an urgent upper GI contrast study to exclude malrotation with volvulus.

Question 15

Before an image-guided liver biopsy, which pre-procedure check is essential?

1. None; proceed directly
2. Coagulation profile and platelet count with correction to accepted thresholds, review and timing of antiplatelet and anticoagulant drugs, informed consent, and confirmation of the target and route on imaging
3. A chest radiograph only
4. Fasting for 24 hours

Answer: B. Bleeding is the main complication of percutaneous biopsy; most protocols require an INR below about 1.5 and platelets above 50,000 for high-risk procedures.

How to use these questions

• Learn the safety rules: justification in pregnancy, contrast in renal impairment, MRI device screening, critical result communication.
• Know the classic descriptions and what each mandates next: nodules, bleeds, bone lesions, breast categories.
• Cover paediatrics, breast and intervention, which cross-sectional generalists tend to skip.
• Practise under time in the Diagnostic Radiology bank with the error-log method.

Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool; radiologists are among the best-paid and most requested specialists in the Gulf.

Frequently asked questions

How many questions are in the radiology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Are images shown in the radiology exam?

Some forms include images; most questions describe findings in words and ask for the diagnosis, next investigation or action.

Can an MD or FRCR holder skip the exam?

Often, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.