UPSC-CMS 2010 — Radiology

Q: Pneumobilia can be seen in

gallstone ileus. ***gallstone ileus*** - **Gallstone ileus** is a mechanical small bowel obstruction caused by a large gallstone that has eroded through the gallbladder wall into the small intestine, forming a **cholecystoenteric fistula**. - The presence of the fistula allows **gas from the bowel to enter the biliary tree**, resulting in pneumobilia, which is a classic radiographic finding in this condition. *acute pancreatitis* - **Acute pancreatitis** is inflammation of the pancreas, often caused by gallstones or alcohol, but it does **not typically involve communication between the bowel and the biliary tree**. - While gallstones can cause pancreatitis, the condition itself does **not lead to gas in the biliary system**. *Mirizzi's syndrome* - **Mirizzi's syndrome** involves obstruction of the common hepatic duct due to extrinsic compression by a stone impacted in the cystic duct or gallbladder neck, and it **does not typically create a fistula with the bowel**. - Although inflammation can be severe, it usually **does not lead to pneumobilia** unless a rare fistulous connection to the bowel also occurs separately. *carcinoma gallbladder* - **Gallbladder carcinoma** is a malignancy that can obstruct the biliary system, but it **does not inherently cause a direct communication between the gastrointestinal tract and the biliary tree** to allow for gas entry. - While advanced cancer can cause fistulas, **pneumobilia is not a typical or early sign** of gallbladder carcinoma itself. [Practice more Radiology PYQs on OnCourse]

Q: 'Double duct' sign is diagnostic of

periampullary carcinoma. ***periampullary carcinoma*** - The **"double duct sign"** refers to the simultaneous dilation of both the **common bile duct** and the **pancreatic duct**. - This sign is highly suggestive of an obstruction at the **ampulla of Vater**, most commonly caused by **periampullary carcinoma**. *hepatocellular carcinoma* - **Hepatocellular carcinoma** primarily affects the liver parenchyma and typically does not cause simultaneous dilation of both the common bile and pancreatic ducts. - It more commonly presents with symptoms related to **liver dysfunction** or a palpable **liver mass**. *gallbladder carcinoma* - **Gallbladder carcinoma** can lead to bile duct obstruction, but it generally causes dilation of the **biliary tree** proximal to the obstruction, not simultaneous dilation of both the bile and pancreatic ducts. - The obstruction is usually located at the **cystic duct** or **common hepatic duct** due to direct tumor extension or nodal involvement. *Klatskin's carcinoma* - **Klatskin's tumor** is a type of **cholangiocarcinoma** located at the **bifurcation of the common hepatic duct**. - While it causes **biliary obstruction** and dilation of the intrahepatic ducts, it does not typically cause dilation of the pancreatic duct. [Practice more Radiology PYQs on OnCourse]

Q: Consider the following radiological signs : 1. Claw sign in barium enema 2. Apple core sign in barium enema 3. Multiple fluid levels with absent caecal gas in plain skiagram of abdomen 4. Single large fluid and air level in plain skiagram of abdomen Which of the above signs is/are suggestive of ileocolic intussusception?

1 only. ***1 only*** - The **claw sign** in a barium enema is a classic radiological finding in **ileocolic intussusception**, where the intussusceptum indents the barium column, forming a characteristic claw-like appearance - This sign indicates the presence of the invaginated bowel segment within the larger bowel, as the barium passes around it - It is the most specific radiological sign for intussusception on contrast studies *3 only* - **Multiple fluid levels** with absent caecal gas on plain skiagram are indicative of **small bowel obstruction**, which can be caused by intussusception but is **not specific** to it - This finding does not pinpoint intussusception specifically and can occur with adhesions, hernias, or other causes of obstruction - Alone, this does not diagnose ileocolic intussusception *1 and 2 only* - While the **claw sign** (1) is specific to intussusception, the **apple core sign** (2) is characteristic of a **constricting colonic malignancy**, not intussusception - The apple core sign represents irregular narrowing of the bowel lumen due to an annular carcinoma - Including sign 2 makes this option incorrect for intussusception *1, 2, 3 and 4* - Only the **claw sign** (1) is specifically suggestive of intussusception - The **apple core sign** (2) indicates colonic carcinoma, not intussusception - **Multiple fluid levels with absent caecal gas** (3) indicate bowel obstruction but lack specificity - A **single large fluid and air level** (4) suggests gastric outlet obstruction or closed loop obstruction, not specifically intussusception [Practice more Radiology PYQs on OnCourse]

Q: A middle-aged man presents with a lower jaw swelling. Clinically, there is expansion of the left ramus and the X-ray mandible shows soap bubble appearance. What is the clinical diagnosis?

Ameloblastoma. ***Ameloblastoma*** - Ameloblastoma is the most common odontogenic tumor, often presenting as a **slow-growing, expansile swelling** in the posterior mandible, as seen in this patient. - The classic **"soap bubble" or "honeycomb" radiographic appearance** is highly characteristic of ameloblastoma, reflecting its multilocular nature. *Aneurysmal bone cyst* - While an aneurysmal bone cyst can cause bony expansion, it typically presents with a **blood-filled lesion** and may not consistently show a "soap bubble" appearance unless it's very large and destructive. - Radiographically, it often appears as a **lytic lesion** rather than strictly multilocular. *Odontogenic myxoma* - Odontogenic myxoma can also cause jaw swelling and has a multilocular appearance, but it's often described as having a **"tennis racket" or "stepped ladder" trabeculation** pattern rather than clear "soap bubbles." - Its incidence is lower than ameloblastoma, making it less likely given the classic presentation. *Keratocyst* - An odontogenic keratocyst (OKC), now often referred to as a **keratocystic odontogenic tumor (KCOT)**, is primarily a cyst that can grow extensively and cause expansion. - Radiographically, it typically appears as a **well-defined, unilocular or multilocular radiolucency** but rarely has the classic "soap bubble" appearance as consistently as ameloblastoma. [Practice more Radiology PYQs on OnCourse]

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Pneumobilia can be seen in

'Double duct' sign is diagnostic of

Consider the following radiological signs : 1. Claw sign in barium enema 2. Apple core sign in barium enema 3. Multiple fluid levels with absent caecal gas in plain skiagram of abdomen 4. Single large fluid and air level in plain skiagram of abdomen Which of the above signs is/are suggestive of ileocolic intussusception?

A middle-aged man presents with a lower jaw swelling. Clinically, there is expansion of the left ramus and the X-ray mandible shows soap bubble appearance. What is the clinical diagnosis?

UPSC-CMS 2010 - Radiology UPSC-CMS Practice Questions and MCQs

Question 1: Pneumobilia can be seen in

A. acute pancreatitis
B. Mirizzi's syndrome
C. carcinoma gallbladder
D. gallstone ileus (Correct Answer)

Explanation: ***gallstone ileus*** - **Gallstone ileus** is a mechanical small bowel obstruction caused by a large gallstone that has eroded through the gallbladder wall into the small intestine, forming a **cholecystoenteric fistula**. - The presence of the fistula allows **gas from the bowel to enter the biliary tree**, resulting in pneumobilia, which is a classic radiographic finding in this condition. *acute pancreatitis* - **Acute pancreatitis** is inflammation of the pancreas, often caused by gallstones or alcohol, but it does **not typically involve communication between the bowel and the biliary tree**. - While gallstones can cause pancreatitis, the condition itself does **not lead to gas in the biliary system**. *Mirizzi's syndrome* - **Mirizzi's syndrome** involves obstruction of the common hepatic duct due to extrinsic compression by a stone impacted in the cystic duct or gallbladder neck, and it **does not typically create a fistula with the bowel**. - Although inflammation can be severe, it usually **does not lead to pneumobilia** unless a rare fistulous connection to the bowel also occurs separately. *carcinoma gallbladder* - **Gallbladder carcinoma** is a malignancy that can obstruct the biliary system, but it **does not inherently cause a direct communication between the gastrointestinal tract and the biliary tree** to allow for gas entry. - While advanced cancer can cause fistulas, **pneumobilia is not a typical or early sign** of gallbladder carcinoma itself.

Question 2: 'Double duct' sign is diagnostic of

A. hepatocellular carcinoma
B. periampullary carcinoma (Correct Answer)
C. gallbladder carcinoma
D. Klatskin's carcinoma

Explanation: ***periampullary carcinoma*** - The **"double duct sign"** refers to the simultaneous dilation of both the **common bile duct** and the **pancreatic duct**. - This sign is highly suggestive of an obstruction at the **ampulla of Vater**, most commonly caused by **periampullary carcinoma**. *hepatocellular carcinoma* - **Hepatocellular carcinoma** primarily affects the liver parenchyma and typically does not cause simultaneous dilation of both the common bile and pancreatic ducts. - It more commonly presents with symptoms related to **liver dysfunction** or a palpable **liver mass**. *gallbladder carcinoma* - **Gallbladder carcinoma** can lead to bile duct obstruction, but it generally causes dilation of the **biliary tree** proximal to the obstruction, not simultaneous dilation of both the bile and pancreatic ducts. - The obstruction is usually located at the **cystic duct** or **common hepatic duct** due to direct tumor extension or nodal involvement. *Klatskin's carcinoma* - **Klatskin's tumor** is a type of **cholangiocarcinoma** located at the **bifurcation of the common hepatic duct**. - While it causes **biliary obstruction** and dilation of the intrahepatic ducts, it does not typically cause dilation of the pancreatic duct.

Question 3: Consider the following radiological signs : 1. Claw sign in barium enema 2. Apple core sign in barium enema 3. Multiple fluid levels with absent caecal gas in plain skiagram of abdomen 4. Single large fluid and air level in plain skiagram of abdomen Which of the above signs is/are suggestive of ileocolic intussusception?

A. 1 only (Correct Answer)
B. 3 only
C. 1 and 2 only
D. 1, 2, 3 and 4

Explanation: ***1 only*** - The **claw sign** in a barium enema is a classic radiological finding in **ileocolic intussusception**, where the intussusceptum indents the barium column, forming a characteristic claw-like appearance - This sign indicates the presence of the invaginated bowel segment within the larger bowel, as the barium passes around it - It is the most specific radiological sign for intussusception on contrast studies *3 only* - **Multiple fluid levels** with absent caecal gas on plain skiagram are indicative of **small bowel obstruction**, which can be caused by intussusception but is **not specific** to it - This finding does not pinpoint intussusception specifically and can occur with adhesions, hernias, or other causes of obstruction - Alone, this does not diagnose ileocolic intussusception *1 and 2 only* - While the **claw sign** (1) is specific to intussusception, the **apple core sign** (2) is characteristic of a **constricting colonic malignancy**, not intussusception - The apple core sign represents irregular narrowing of the bowel lumen due to an annular carcinoma - Including sign 2 makes this option incorrect for intussusception *1, 2, 3 and 4* - Only the **claw sign** (1) is specifically suggestive of intussusception - The **apple core sign** (2) indicates colonic carcinoma, not intussusception - **Multiple fluid levels with absent caecal gas** (3) indicate bowel obstruction but lack specificity - A **single large fluid and air level** (4) suggests gastric outlet obstruction or closed loop obstruction, not specifically intussusception

Question 4: A middle-aged man presents with a lower jaw swelling. Clinically, there is expansion of the left ramus and the X-ray mandible shows soap bubble appearance. What is the clinical diagnosis?

A. Aneurysmal bone cyst
B. Odontogenic myxoma
C. Ameloblastoma (Correct Answer)
D. Keratocyst

Explanation: ***Ameloblastoma*** - Ameloblastoma is the most common odontogenic tumor, often presenting as a **slow-growing, expansile swelling** in the posterior mandible, as seen in this patient. - The classic **"soap bubble" or "honeycomb" radiographic appearance** is highly characteristic of ameloblastoma, reflecting its multilocular nature. *Aneurysmal bone cyst* - While an aneurysmal bone cyst can cause bony expansion, it typically presents with a **blood-filled lesion** and may not consistently show a "soap bubble" appearance unless it's very large and destructive. - Radiographically, it often appears as a **lytic lesion** rather than strictly multilocular. *Odontogenic myxoma* - Odontogenic myxoma can also cause jaw swelling and has a multilocular appearance, but it's often described as having a **"tennis racket" or "stepped ladder" trabeculation** pattern rather than clear "soap bubbles." - Its incidence is lower than ameloblastoma, making it less likely given the classic presentation. *Keratocyst* - An odontogenic keratocyst (OKC), now often referred to as a **keratocystic odontogenic tumor (KCOT)**, is primarily a cyst that can grow extensively and cause expansion. - Radiographically, it typically appears as a **well-defined, unilocular or multilocular radiolucency** but rarely has the classic "soap bubble" appearance as consistently as ameloblastoma.