Master Specialist Diagnostic Radiology (SDR6042)
for DHA Speciality

A 68-year-old man presents to the emergency department with sudden-onset severe abdominal pain and hypotension (BP 82/54 mmHg). He has a history of hypertension and atrial fibrillation, for which he takes warfarin. His INR is 3.2. A non-contrast CT scan of the abdomen is performed, which shows a hyperdense thrombus in the superior mesenteric artery (SMA) but no bowel wall thickening or pneumatosis. The radiology resident suggests immediate CT angiography (CTA) to confirm the diagnosis before any intervention. What is the most appropriate next step in management?

A 32-year-old woman, 28 weeks pregnant, presents with sudden-onset pleuritic chest pain and dyspnea. Her heart rate is 118 bpm, respiratory rate 24/min, and blood pressure 110/70 mmHg. She has no history of renal disease. The emergency physician orders a CT pulmonary angiogram (CTPA) to rule out pulmonary embolism. The radiology resident notes that the patient is pregnant and suggests a V/Q scan instead. What is the most appropriate next step?

A 45-year-old man with a history of peptic ulcer disease presents with sudden-onset severe headache described as 'thunderclap'. He is alert and oriented, with a blood pressure of 160/90 mmHg and no focal neurological deficits. A non-contrast CT of the head is performed within 2 hours of symptom onset and is reported as normal. The emergency physician considers a lumbar puncture (LP) to rule out subarachnoid hemorrhage (SAH). What is the most appropriate next step?

A 70-year-old woman with a history of hypertension and diabetes presents with sudden-onset left-sided weakness and aphasia. Her blood pressure is 180/100 mmHg, and her blood glucose is 12.3 mmol/L. A non-contrast CT of the head shows no hemorrhage. The stroke team decides to administer intravenous alteplase. The radiology resident notes that the patient had a recent colonoscopy with biopsy 5 days ago. What is the most appropriate next step?

A 55-year-old man presents with severe right flank pain and hematuria. He is afebrile, with a blood pressure of 130/80 mmHg and a serum creatinine of 1.8 mg/dL (baseline 1.0 mg/dL). A non-contrast CT of the abdomen shows a 6 mm obstructing stone in the right proximal ureter with moderate hydronephrosis. The urology team plans for urgent ureteroscopy. The radiology resident suggests a contrast-enhanced CT to better define the stone. What is the most appropriate next step?