NEET-PG 2021 - Radiology PYQs Practice Questions

Q: Examine the abdominal X-ray shown. What is the most likely diagnosis based on the findings?

Intestinal Obstruction. ***Intestinal Obstruction*** - The abdominal X-ray demonstrates **distended loops of bowel** with **multiple air-fluid levels**, which are classic radiographic signs of intestinal obstruction. - The presence of multiple, wide air-fluid levels visible in a **stepladder pattern** is a hallmark of bowel obstruction. - **Valvulae conniventes** (transverse folds crossing the entire width of bowel) suggest **small bowel** involvement when visible with distension. *Small bowel ileus* - While ileus can show distended bowel loops, it typically presents with **gas distributed throughout the small and large bowel** without a clear transition point. - Ileus shows **less pronounced air-fluid levels** and lacks the characteristic stepladder pattern seen in mechanical obstruction. - The clinical context and presence of multiple distinct air-fluid levels favor mechanical obstruction over ileus. *Large bowel obstruction* - Large bowel obstruction would show **dilated colon** with **haustrations** (incomplete folds that don't cross the entire lumen). - The obstruction would typically show dilation **proximal to the obstruction** with collapsed bowel distally. - The pattern in this image is more consistent with small bowel or generalized intestinal obstruction rather than isolated large bowel obstruction. *Pneumoperitoneum* - Pneumoperitoneum (free air in the peritoneal cavity) appears as **air under the diaphragm** on upright films or as **Rigler's sign** (both sides of bowel wall visible) on supine films. - This is a sign of **bowel perforation**, not obstruction with air-fluid levels within the bowel lumen. - The air-fluid levels seen here are **intraluminal**, not free intraperitoneal air. [Practice more Radiology PYQs on OnCourse]

Q: What is the modality of the test shown in the image?

Hysterosalpingography. ***Hysterosalpingography*** - The image shows a **contrast-filled uterus and fallopian tubes**, characteristic of a **hysterosalpingogram (HSG)**. - An HSG uses **X-rays** and **radiopaque contrast media** to visualize the uterine cavity and assess fallopian tube patency. *Hysteroscopy* - **Hysteroscopy** involves direct visualization of the uterine cavity using a **fiber optic endoscope** inserted through the cervix. - It does not produce an X-ray image with contrast filling the fallopian tubes. *Laparoscopy* - **Laparoscopy** is a minimally invasive surgical procedure that involves inserting a **laparoscope** through an incision in the abdominal wall to view pelvic organs externally. - This image clearly depicts an internal view of the uterus and tubes through contrast, not an external, endoscopic view. *Saline infusion sonography* - **Saline infusion sonography (SIS)**, also known as sonohysterography, uses **ultrasound** imaging during the infusion of saline into the uterus. - While it assesses the uterine cavity, it is an ultrasound-based technique and does not involve X-ray contrast passing through the fallopian tubes, as seen in the image. [Practice more Radiology PYQs on OnCourse]

Q: A patient presents with abdominal distension. Based on the X-ray, which of the following bowel loops are dilated?

Jejunum. ***Jejunum*** - The image shows dilated small bowel loops with prominent **valvulae conniventes** (also known as plicae circulares), which are characteristic of the jejunum. - These folds are typically closely spaced and extend across the entire lumen, giving a "coiled spring" or "stack of coins" appearance on plain radiographs when dilated. *Duodenum* - While the duodenum is part of the small bowel, it is the most proximal segment and typically not as diffusely involved in generalized small bowel dilation as the jejunum and ileum unless the obstruction is very high. - The valvulae conniventes in the duodenum are less prominent and more sparsely distributed compared to the jejunum. *Transverse colon* - The transverse colon is part of the large intestine and would show **haustra**, which are sacculations that do not extend across the entire lumen and are typically more widely spaced than valvulae conniventes. - The dilated loops in the image clearly show mucosal folds that span the entire width of the bowel. *Ileum* - The ileum also has valvulae conniventes, but they are less prominent and more sparsely distributed than in the jejunum. - In cases of small bowel obstruction or dilation, the jejunum characteristically shows more distinct and closely packed valvulae conniventes, making it the most identifiable segment in this image. [Practice more Radiology PYQs on OnCourse]

Q: A 30-year-old female presents with sterile pyuria. The radiograph below is provided. What is the most likely diagnosis?

Putty Kidney. ***Putty Kidney*** - The image visible in the question shows a **caseous calcification** of the renal parenchyma, which is characteristic of a "putty kidney," a late manifestation of **renal tuberculosis**. - **Sterile pyuria** is commonly associated with renal tuberculosis, where Mycobacterium tuberculosis infection leads to chronic inflammation and granuloma formation in the kidney, eventually resulting in caseous necrosis and calcification. *Psoas Calcification* - This typically refers to calcification within the **psoas muscle**, which would appear as a linear or amorphous calcification along the path of the muscle, an appearance not consistent with the image. - While psoas abscesses can calcify, they would not manifest as widespread renal parenchymal calcification and are not specifically linked to sterile pyuria in this manner. *Staghorn Calculus* - A **staghorn calculus** is a large, branched kidney stone that fills all or part of the renal pelvis and calyces, resembling the antlers of a stag. - While these stones are composed of mineral salts and would be radiopaque, their morphology is distinctly different from the diffuse, caseous calcification seen in the image. *Nephrocalcinosis* - **Nephrocalcinosis** is a condition characterized by diffuse microcalcifications throughout the renal parenchyma, usually affecting the tubules. - The calcifications in the provided image appear more nodular and clustered, consistent with late-stage tuberculous caseous necrosis, rather than the fine, diffuse pattern of nephrocalcinosis. [Practice more Radiology PYQs on OnCourse]

Question 1

Examine the abdominal X-ray shown. What is the most likely diagnosis based on the findings?

Accepted Answer

Intestinal Obstruction

Answer

Small bowel ileus

Answer

Pneumoperitoneum

Answer

Large bowel obstruction

Question 2

What is the modality of the test shown in the image?

Accepted Answer

Hysterosalpingography

Answer

Hysteroscopy

Answer

Laparoscopy

Answer

Saline infusion sonography

Question 3

A patient presents with abdominal distension. Based on the X-ray, which of the following bowel loops are dilated?

Accepted Answer

Jejunum

Answer

Duodenum

Answer

Transverse colon

Answer

Ileum

Question 4

A 30-year-old female presents with sterile pyuria. The radiograph below is provided. What is the most likely diagnosis?

Accepted Answer

Putty Kidney

Answer

Psoas Calcification

Answer

Staghorn calculus

Answer

Nephrocalcinosis

NEET-PG 2021 — Radiology