UPSC-CMS 2019 — Radiology

Q: A 20 years old man had history of pain in the right side of abdomen. His X-ray abdomen AP view shows radio-opaque shadow, which on lateral film falls behind the vertebral column. The probable diagnosis is:

Renal Calculus. ***Renal Calculus*** - A **radio-opaque shadow** in the right abdomen, located **behind the vertebral column** on a lateral X-ray, is highly suggestive of a **renal calculus (kidney stone)**. - Renal calculi are located in the **retroperitoneal space**. On a lateral X-ray view, retroperitoneal structures like the kidneys appear to be **superimposed over or behind the vertebral column**, which is the key anatomical landmark for localization. - The clinical presentation of right-sided abdominal pain combined with this radiological finding makes renal calculus the most probable diagnosis. *Gall stone disease* - **Gallstones** are typically located in the **right upper quadrant** of the abdomen on an AP view but would appear **anterior to the vertebral column** on a lateral X-ray, as the gallbladder is an intraperitoneal organ. - Only about 10-20% of gallstones are sufficiently **calcified** to be radio-opaque on plain X-ray. *Phlebolith* - **Phleboliths** are calcified venous thrombi, commonly found in the **pelvis** and would appear within the **vascular structures**, not typically behind the vertebral column in the mid-abdomen in a pattern consistent with a renal calculus. - While they are radio-opaque, their usual anatomical location and characteristic **central lucency** (target sign) help differentiate them. *Calcified mesenteric lymph node* - **Calcified mesenteric lymph nodes** are common incidental findings and would be located within the **mesentery**, appearing **anterior to the vertebral column** on a lateral X-ray. - They often have an irregular or lobulated appearance, distinct from the more discrete and often smoother shape of a renal calculus. [Practice more Radiology PYQs on OnCourse]

Q: In a fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?

All of these. ***All of these*** - The presence of the **banana sign**, **lemon sign**, and a **visible vertebral or overlying tissue defect** are all characteristic ultrasound findings in a fetus with spina bifida. - These signs indicate associated structural abnormalities in the **brain** and **spine** due to the neural tube defect. - All three findings are clinically significant and commonly used for prenatal diagnosis. **Banana sign** - This refers to the shape of the **cerebellum** appearing flattened and curved like a banana due to its caudal displacement into the foramen magnum in **Chiari II malformation**, which is frequently associated with spina bifida. - It is an important indicator of **hindbrain herniation**. **Lemon sign** - The lemon sign describes the shape of the fetal skull, where the frontal bones are indented, making the head appear like a **lemon** on axial view. - This sign is often seen in cases of **spina bifida** and is caused by **bifrontal bone scalloping**. **Defect seen in vertebral bodies or tissue overlying it** - This is the **direct visualization** of the open neural tube defect (myelomeningocele or meningocele) in the spine. - It involves a discontinuity in the **vertebral arches** and/or the overlying soft tissues. [Practice more Radiology PYQs on OnCourse]

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A 20 years old man had history of pain in the right side of abdomen. His X-ray abdomen AP view shows radio-opaque shadow, which on lateral film falls behind the vertebral column. The probable diagnosis is:

In a fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?

UPSC-CMS 2019 - Radiology UPSC-CMS Practice Questions and MCQs

Question 1: A 20 years old man had history of pain in the right side of abdomen. His X-ray abdomen AP view shows radio-opaque shadow, which on lateral film falls behind the vertebral column. The probable diagnosis is:

A. Gall stone disease
B. Phlebolith
C. Calcified mesenteric lymph node
D. Renal Calculus (Correct Answer)

Explanation: ***Renal Calculus*** - A **radio-opaque shadow** in the right abdomen, located **behind the vertebral column** on a lateral X-ray, is highly suggestive of a **renal calculus (kidney stone)**. - Renal calculi are located in the **retroperitoneal space**. On a lateral X-ray view, retroperitoneal structures like the kidneys appear to be **superimposed over or behind the vertebral column**, which is the key anatomical landmark for localization. - The clinical presentation of right-sided abdominal pain combined with this radiological finding makes renal calculus the most probable diagnosis. *Gall stone disease* - **Gallstones** are typically located in the **right upper quadrant** of the abdomen on an AP view but would appear **anterior to the vertebral column** on a lateral X-ray, as the gallbladder is an intraperitoneal organ. - Only about 10-20% of gallstones are sufficiently **calcified** to be radio-opaque on plain X-ray. *Phlebolith* - **Phleboliths** are calcified venous thrombi, commonly found in the **pelvis** and would appear within the **vascular structures**, not typically behind the vertebral column in the mid-abdomen in a pattern consistent with a renal calculus. - While they are radio-opaque, their usual anatomical location and characteristic **central lucency** (target sign) help differentiate them. *Calcified mesenteric lymph node* - **Calcified mesenteric lymph nodes** are common incidental findings and would be located within the **mesentery**, appearing **anterior to the vertebral column** on a lateral X-ray. - They often have an irregular or lobulated appearance, distinct from the more discrete and often smoother shape of a renal calculus.

Question 2: In a fetus with Spina bifida, which of the following sign/signs may be seen on ultrasound?

A. Banana sign
B. All of these (Correct Answer)
C. Lemon sign
D. Defect seen in vertebral bodies or tissue overlying it

Explanation: ***All of these*** - The presence of the **banana sign**, **lemon sign**, and a **visible vertebral or overlying tissue defect** are all characteristic ultrasound findings in a fetus with spina bifida. - These signs indicate associated structural abnormalities in the **brain** and **spine** due to the neural tube defect. - All three findings are clinically significant and commonly used for prenatal diagnosis. **Banana sign** - This refers to the shape of the **cerebellum** appearing flattened and curved like a banana due to its caudal displacement into the foramen magnum in **Chiari II malformation**, which is frequently associated with spina bifida. - It is an important indicator of **hindbrain herniation**. **Lemon sign** - The lemon sign describes the shape of the fetal skull, where the frontal bones are indented, making the head appear like a **lemon** on axial view. - This sign is often seen in cases of **spina bifida** and is caused by **bifrontal bone scalloping**. **Defect seen in vertebral bodies or tissue overlying it** - This is the **direct visualization** of the open neural tube defect (myelomeningocele or meningocele) in the spine. - It involves a discontinuity in the **vertebral arches** and/or the overlying soft tissues.