Abdominal and Pelvic Radiology Practice Questions

Q: A 26-year-old male presents with abdominal pain and episodes of hematuria. His blood pressure is 160/100 mm Hg and is refractory to standard antihypertensive drugs. Renal Doppler shows a parvus tardus pattern. Subsequent CT renal angiogram was performed. This condition, as depicted, may occur in all of the following except?

Polyarteritis nodosa (PAN). ***Polyarteritis nodosa (PAN)*** - **PAN** typically causes **microaneurysms** and **necrotizing vasculitis** in medium-sized arteries, not stenotic lesions that would produce **parvus tardus** waveforms. - The **parvus tardus pattern** indicates **proximal renal artery stenosis**, which is not characteristic of PAN's pathophysiology involving aneurysmal dilatation rather than narrowing. *Atherosclerosis* - **Atherosclerotic plaques** commonly cause **renal artery stenosis**, especially at the **ostium**, leading to renovascular hypertension and **parvus tardus** waveforms. - This is the most common cause of **renal artery stenosis** in patients over 50 years, though can occur in younger patients with risk factors. *Fibromuscular dysplasia (FMD)* - **FMD** is a leading cause of **renal artery stenosis** in young adults, particularly women, causing the classic **"string of beads"** appearance on angiography. - The **medial fibroplasia** variant creates alternating areas of stenosis and dilatation, resulting in **parvus tardus** waveforms downstream from the stenotic segments. *Takayasu arteritis* - This **large vessel vasculitis** commonly involves the **renal arteries**, causing stenosis through inflammatory wall thickening and fibrosis. - **Takayasu arteritis** can present with **renovascular hypertension** and **parvus tardus** patterns, particularly in young Asian women with systemic inflammatory symptoms.

Q: Which of the following is NOT a feature of ischemic colitis?

Dilution of barium. **Explanation:** Ischemic colitis occurs due to a sudden reduction in blood flow to the colon, most commonly at "watershed areas" like the splenic flexure (Griffith’s point). **Why "Dilution of Barium" is the correct answer:** Dilution of barium is a characteristic radiological feature of **Malabsorption syndromes** (like Celiac disease) or **Small Bowel Obstruction**, where excessive intraluminal fluid mixes with the contrast. It is not a feature of ischemic colitis, which primarily involves mural changes rather than hypersecretion or fluid accumulation. **Analysis of Incorrect Options:** * **Thumb printing (Option A):** This is the **most characteristic** early sign of ischemic colitis on a barium enema or CT. It represents localized submucosal hemorrhage and edema, appearing as rounded indentations on the bowel lumen. * **Increased mucosal fold thickness (Option C):** Ischemia leads to inflammatory edema and congestion of the bowel wall, resulting in thickened, blunted, or distorted mucosal folds. * **Serrated mucosa (Option B):** As ischemia progresses, superficial mucosal ulcerations occur. When barium fills these small ulcers, it gives the bowel margin a "serrated" or "saw-tooth" appearance. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Splenic flexure (Griffith’s point) followed by the rectosigmoid junction (Sudeck’s point). * **Gold Standard Diagnosis:** Colonoscopy (shows pale mucosa, petechiae, or "Single Stripe Sign"). * **Imaging:** CT shows "Target Sign" (concentric wall thickening). * **Clinical Presentation:** Sudden onset left-sided abdominal pain followed by bloody diarrhea in an elderly patient with cardiovascular risk factors.

Q: The most appropriate investigation for diagnosing the condition shown in the X-ray is:

Barium meal. ***Barium meal*** - **Barium meal** is the gold standard for diagnosing and classifying **hiatus hernia**, clearly demonstrating the **gastroesophageal junction** position and **stomach herniation** into the thoracic cavity. - It can differentiate between **sliding hiatus hernia** (Type I) and **rolling/paraesophageal hernia** (Type II-IV), which is crucial for management planning. *Computer tomography (CT) scan* - While CT can identify hiatus hernia, it's **not the first-line investigation** and is more expensive with **radiation exposure**. - CT is typically reserved for **complications** like **strangulation** or when **surgical planning** is required. *Chest x-ray* - Though chest X-ray may show the **retrocardiac gas shadow** suggesting hiatus hernia, it's only a **screening tool** and cannot provide definitive diagnosis. - It lacks the **anatomical detail** needed to classify the type of hernia or assess the **gastroesophageal junction** adequately. *Upper GI endoscopy* - Endoscopy is primarily used to assess **mucosal abnormalities** and **complications** like **esophagitis** or **Barrett's esophagus**. - It cannot adequately visualize the **anatomical relationships** and **hernial sac** position that are essential for hiatus hernia diagnosis.

Q: Corkscrew appearance on radiography is typically seen in which of the following conditions?

Diffuse esophageal spasm. **Explanation:** The **corkscrew appearance** (also known as rosary bead esophagus) is the classic radiographic hallmark of **Diffuse Esophageal Spasm (DES)**. This appearance occurs due to high-amplitude, non-peristaltic, uncoordinated tertiary contractions of the esophageal smooth muscle. On a barium swallow, these simultaneous contractions compartmentalize the esophagus into multiple segments, mimicking the spiral shape of a corkscrew. **Analysis of Options:** * **Diffuse Esophageal Spasm (Correct):** Characterized by intermittent chest pain and dysphagia. The uncoordinated contractions lead to the "corkscrew" or "rosary bead" deformity. * **Achalasia Cardia:** Typically presents with a **"Bird’s beak"** or "Rat-tail" appearance due to the failure of the Lower Esophageal Sphincter (LES) to relax and proximal esophageal dilatation. * **Carcinoma Esophagus:** Usually presents with an **"Apple-core"** appearance or an irregular, eccentric filling defect with mucosal destruction (shouldering effect). * **Hiatus Hernia:** Characterized by the protrusion of the stomach through the diaphragmatic hiatus, often appearing as a retrocardiac gas-fluid level or a "Schatzki ring" at the squamocolumnar junction. **High-Yield Clinical Pearls for NEET-PG:** * **Manometry** is the gold standard for diagnosing DES (showing simultaneous, high-amplitude contractions in >20% of swallows). * **Nutcracker Esophagus:** High-pressure peristaltic waves (hypertensive peristalsis) but with normal coordination; barium swallow is usually normal. * **Pseudo-corkscrew appearance** can sometimes be seen in elderly patients (Presbyesophagus) due to tertiary contractions, but it is less severe than in DES.

Q: Confluent areas of pancreatic parenchyma that do not demonstrate enhancement after the administration of intravenous contrast material are known as?

Pancreatic necrosis. **Explanation:** The core concept in this question is the assessment of pancreatic viability using Contrast-Enhanced Computed Tomography (CECT). **1. Why Pancreatic Necrosis is Correct:** According to the **Revised Atlanta Classification**, pancreatic necrosis is defined as diffuse or focal areas of non-enhancing pancreatic parenchyma. In a normal CECT, the pancreas enhances brightly due to its rich blood supply. The absence of enhancement (typically 4 weeks after *interstitial edematous pancreatitis*. Crucially, it contains no solid/necrotic components. * **Walled-off Pancreatic Necrosis (B):** While WON involves necrosis, it refers specifically to a mature, encapsulated collection of pancreatic/peripancreatic necrosis that has developed a thick inflammatory wall (usually >4 weeks after onset). The question asks for the parenchymal finding itself, not the late-stage encapsulated collection. * **Acute Peripancreatic Fluid Collection (C):** This occurs within the first 4 weeks of *edematous* pancreatitis. It is limited to the peripancreatic spaces and does not involve parenchymal necrosis. **Clinical Pearls for NEET-PG:** * **Gold Standard Imaging:** CECT is the modality of choice for diagnosing and grading the severity of acute pancreatitis. * **Timing:** CECT performed too early (<48 hours) may underestimate the extent of necrosis. * **Balthazar Score:** Used to grade the severity of pancreatitis based on CT findings. * **Infected Necrosis:** Suggested by the presence of **extraluminal gas** within the necrotic area on CT.

Q: A CT scan of acute pancreatitis will show the following features, except:

Dilated main pancreatic duct. ### Explanation In the context of **Acute Pancreatitis**, the diagnosis is primarily clinical and biochemical (elevated amylase/lipase). Imaging, specifically Contrast-Enhanced CT (CECT), is the gold standard for assessing severity and complications rather than making the initial diagnosis. **Why "Dilated main pancreatic duct" is the correct answer:** A dilated pancreatic duct is a hallmark feature of **Chronic Pancreatitis**, often caused by ductal strictures or intraductal calculi. In acute pancreatitis, the inflammatory process leads to interstitial edema and swelling of the pancreatic parenchyma, which typically results in the **compression** of the duct rather than its dilation. **Analysis of Incorrect Options:** * **Enlargement of the pancreas:** This is one of the earliest signs of acute pancreatitis due to diffuse or focal inflammatory edema (interstitial edematous pancreatitis). * **Ill-defined outline of the pancreas:** Inflammation causes "shaggy" margins and blurring of the peripancreatic fat planes (fat stranding) due to the release of proteolytic enzymes. * **Poor contrast enhancement:** This indicates areas of **pancreatic necrosis**. Viable pancreatic tissue enhances brightly; lack of enhancement (usually <30 HU) signifies a loss of blood supply and tissue death, which is a critical prognostic factor. **High-Yield Clinical Pearls for NEET-PG:** * **Timing of CT:** CECT is most accurate for assessing necrosis **72 hours** after the onset of symptoms. * **Balthazar Scoring:** A CT-based grading system used to assess the severity of acute pancreatitis based on peripancreatic fluid collections and necrosis. * **Sentinel Loop Sign:** A dilated loop of proximal jejunum seen on X-ray, representing localized ileus near the inflamed pancreas. * **Colon Cut-off Sign:** Abrupt collapse of the colon near the splenic flexure due to inflammatory exudate spreading along the phrenicocolic ligament.

Q: Which of the following is NOT a feature suggestive of acute cholecystitis on CT abdomen?

Contracted gallbladder. **Explanation:** Acute cholecystitis is an inflammatory condition typically caused by cystic duct obstruction. On imaging, the hallmark of acute inflammation is **gallbladder distension** (transverse diameter >4 cm) rather than contraction. **1. Why "Contracted gallbladder" is the correct answer:** A **contracted gallbladder** is a feature of chronic cholecystitis or a post-prandial state. In acute cholecystitis, the gallbladder is almost always **distended** due to the accumulation of mucus and inflammatory exudate behind an obstructed duct (hydrops). **2. Analysis of incorrect options:** * **Pericholecystic fluid (Option A):** This is a specific sign of inflammation or localized perforation and is a classic CT finding in acute cholecystitis. * **Presence of gallstones (Option B):** While CT is not the gold standard for stones (Ultrasound is better), the presence of a stone lodged in the gallbladder neck is the primary inciting factor in 90-95% of cases (calculous cholecystitis). * **Air in the gallbladder wall (Option D):** This signifies **Emphysematous Cholecystitis**, a surgical emergency and a severe variant of acute cholecystitis caused by gas-forming organisms (e.g., *Clostridium perfringens*), common in diabetic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Radionuclide scan (**HIDA scan**)—failure to visualize the gallbladder confirms cystic duct obstruction. * **Investigation of Choice (Initial):** **Ultrasound**, showing wall thickening (>3mm), distension, and a **Positive Sonographic Murphy’s Sign**. * **CT Findings:** Wall thickening, pericholecystic fat stranding, and "rim enhancement" of the gallbladder wall.

Q: What is the investigation of choice for gall bladder stone?

Ultrasound (USG). **Explanation:** **Ultrasound (USG)** is the investigation of choice (gold standard screening tool) for gallbladder stones (cholelithiasis) due to its high sensitivity (>95%) and specificity. It is non-invasive, cost-effective, lacks ionizing radiation, and can detect stones as small as 1-2 mm. On USG, stones typically appear as **hyperechoic (bright) structures** with a characteristic **posterior acoustic shadow** that move with changes in patient position. **Analysis of Incorrect Options:** * **X-ray Abdomen:** Only 10-15% of gallstones are radiopaque (contain enough calcium to be seen). Most stones are cholesterol-based and radiolucent, making X-ray an unreliable screening tool. * **Oral Cholecystography (OCG):** Historically used to assess gallbladder function and stones, it has been entirely replaced by USG. It requires the ingestion of contrast and a functional gallbladder to concentrate it, making it slow and less accurate. * **Intravenous Cholangiography:** Formerly used to visualize the biliary tree, it carries a risk of contrast reactions and is inferior to modern MRCP (Magnetic Resonance Cholangiopancreatography) or USG. **High-Yield Clinical Pearls for NEET-PG:** * **WES Triad:** (Wall-Echo-Shadow) is a USG finding seen when the gallbladder is completely filled with stones. * **Investigation of choice for Acute Cholecystitis:** USG (initial); **HIDA scan** (most sensitive/confirmatory). * **Investigation of choice for Choledocholithiasis (CBD stones):** **ERCP** (Gold standard/Therapeutic); **MRCP** (Best non-invasive diagnostic). * **Sludge:** Low-level echoes without shadowing, often a precursor to stone formation.

Q: What type of pelvic appearance is this?

Champagne glass pelvis. ***Champagne glass pelvis*** - Characterized by **squared iliac wings**, **narrow pelvic inlet**, and **small sciatic notches**, creating a wine glass appearance on AP radiographs. - Commonly seen in **achondroplasia** and other skeletal dysplasias, representing abnormal bone development. *Corkscrew pelvis* - This is **not a standard radiological classification** term used in pelvic anatomy or radiology. - The term does not correspond to any recognized **pelvic morphological pattern** in medical literature. *Gynecoid pelvis* - Refers to the **normal female pelvic shape** in the **Caldwell-Moloy classification** with rounded pelvic inlet. - Features include **wide pelvic inlet**, **curved sacrum**, and **wide pubic arch**, optimal for childbirth. *None of the above* - The **champagne glass pelvis** is a well-recognized radiological sign, making this option incorrect. - The characteristic appearance is pathognomonic for certain **skeletal dysplasias**, particularly achondroplasia.

Question 1

A 46-year-old woman presents with a 6-month history of vague upper abdominal pain after fatty meals, some abdominal distension, and frequent indigestion. Physical examination shows an obese woman (BMI =32 kg/m2) with right upper quadrant tenderness. A CT scan discloses gallstones and an ectopic kidney. Which of the following is the expected location of the ectopic kidney?

Accepted Answer

Pelvis

Answer

Adjacent to the gallbladder

Answer

Attached to the left adrenal gland

Answer

Fused laterally with the contralateral kidney

Question 2

A 26-year-old male presents with abdominal pain and episodes of hematuria. His blood pressure is 160/100 mm Hg and is refractory to standard antihypertensive drugs. Renal Doppler shows a parvus tardus pattern. Subsequent CT renal angiogram was performed. This condition, as depicted, may occur in all of the following except?

Accepted Answer

Polyarteritis nodosa (PAN)

Answer

Atherosclerosis

Answer

Fibromuscular dysplasia (FMD)

Answer

Takayasu arteritis

Question 3

Which of the following is NOT a feature of ischemic colitis?

Accepted Answer

Dilution of barium

Answer

Thumb printing

Answer

Serrated mucosa

Answer

Increased mucosal fold thickness

Question 4

The most appropriate investigation for diagnosing the condition shown in the X-ray is:

Accepted Answer

Barium meal

Answer

Computer tomography (CT) scan

Answer

Chest x-ray

Answer

Upper GI endoscopy

Question 5

Corkscrew appearance on radiography is typically seen in which of the following conditions?

Accepted Answer

Diffuse esophageal spasm

Answer

Achalasia cardia

Answer

Carcinoma esophagus

Answer

Hiatus hernia

Question 6

Confluent areas of pancreatic parenchyma that do not demonstrate enhancement after the administration of intravenous contrast material are known as?

Accepted Answer

Pancreatic necrosis

Answer

Pseudocyst

Answer

Walled-off pancreatic necrosis

Answer

Acute peripancreatic fluid collection

Question 7

A CT scan of acute pancreatitis will show the following features, except:

Accepted Answer

Dilated main pancreatic duct

Answer

Poor contrast enhancement

Answer

Enlargement of the pancreas

Answer

Ill-defined outline of the pancreas

Question 8

Which of the following is NOT a feature suggestive of acute cholecystitis on CT abdomen?

Accepted Answer

Contracted gallbladder

Answer

Pericholecystic fluid

Answer

Presence of gallstones

Answer

Air in the gallbladder wall

Question 9

What is the investigation of choice for gall bladder stone?

Accepted Answer

Ultrasound (USG)

Answer

X-ray abdomen

Answer

Oral cholecystography (OCG)

Answer

Intravenous cholangiography

Question 10

What type of pelvic appearance is this?

Accepted Answer

Champagne glass pelvis

Answer

Corkscrew pelvis

Answer

Gynecoid pelvis

Answer

None of the above

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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