Abdominal and Pelvic Radiology Practice Questions

Q: Which is the commonest incidentaloma detected in the liver?

Haemangioma. **Explanation:** **Liver Hemangioma** is the most common benign tumor of the liver and the most frequently encountered **incidentaloma** (a lesion found incidentally during imaging for unrelated reasons). It is a vascular malformation composed of blood-filled cavernous spaces. Most are asymptomatic, small (<5 cm), and do not require treatment unless they become "giant" and cause mass-effect symptoms. **Analysis of Options:** * **B. Haemangioma (Correct):** It has a prevalence of up to 20% in autopsy series. On imaging, it shows a characteristic **peripheral globular enhancement** with a centripetal fill-in pattern on delayed phases (CT/MRI). * **A. Focal Nodular Hyperplasia (FNH):** The second most common benign liver tumor. It is a regenerative response to a pre-existing vascular malformation, characterized by a **central stellate scar**. * **C. Hepatocellular Adenoma:** Much rarer than hemangiomas. It is strongly associated with **oral contraceptive use** and carries a risk of rupture or malignant transformation, unlike hemangiomas. * **D. Hydatid Cyst:** An infectious etiology caused by *Echinococcus granulosus*. While common in endemic areas, it is not a "tumor" and is typically symptomatic or suspected based on history, rather than being a true incidentaloma. **High-Yield Clinical Pearls for NEET-PG:** * **Most common benign liver tumor:** Hemangioma. * **Most common primary malignant liver tumor:** Hepatocellular Carcinoma (HCC). * **Most common liver malignancy overall:** Metastasis (usually from the GI tract). * **Investigation of Choice:** **MRI** is the most sensitive and specific for diagnosing hemangiomas (shows "light bulb" appearance on T2-weighted images). * **Biopsy Contraindication:** Percutaneous biopsy of a suspected hemangioma is generally avoided due to the risk of hemorrhage.

Q: What is the investigation of choice for testicular swelling?

Ultrasonography (USG). **Explanation:** **Ultrasonography (USG)**, specifically high-frequency scrotal ultrasound with **Color Doppler**, is the gold standard and initial investigation of choice for any testicular swelling. Its high sensitivity (nearly 100%) allows for the differentiation between intra-testicular and extra-testicular lesions, which is the most critical step in diagnosis. Intra-testicular masses are highly suspicious for malignancy, whereas extra-testicular masses are usually benign (e.g., hydrocele, epididymal cyst). **Why other options are incorrect:** * **FNAC:** It is generally **contraindicated** in suspected testicular tumors due to the risk of **scrotal seeding** (disrupting the lymphatic drainage and spreading cancer cells to the inguinal lymph nodes). Diagnosis is confirmed via orchidectomy. * **CECT:** While CECT of the abdomen and pelvis is the investigation of choice for **staging** a diagnosed testicular germ cell tumor (to check for retroperitoneal lymphadenopathy), it is not the primary tool for evaluating the swelling itself. * **MRI:** Though highly accurate, it is expensive and not readily available. It is reserved as a problem-solving tool when USG findings are inconclusive. **High-Yield Clinical Pearls for NEET-PG:** * **Testicular Torsion:** USG with Color Doppler shows **absent or decreased blood flow** (Investigation of choice). * **Epididymo-orchitis:** USG shows an enlarged, hypoechoic testis with **increased vascularity** (Hyperemia). * **Tumor Marker Triad:** For testicular tumors, always correlate USG findings with **AFP, beta-hCG, and LDH**. * **Microlithiasis:** Seen as multiple "starry sky" punctate calcifications on USG; it is a known risk factor for malignancy.

Q: What is the earliest radiological finding of Crohn's disease?

Aphthous lesions. **Explanation:** **Correct Answer: C. Aphthous lesions** In Crohn's disease, the earliest macroscopic radiological finding is the **aphthous ulcer**. These appear on a double-contrast barium enema as small, superficial, punctate collections of barium surrounded by a radiolucent halo of edema (the "target" or "bull's eye" sign). They typically occur over lymphoid follicles and represent the initial stage of mucosal inflammation before deeper ulceration occurs. **Analysis of Incorrect Options:** * **A. Cobblestone appearance:** This is a characteristic but **late** finding. It results from deep longitudinal and transverse ulcers intersecting, leaving islands of relatively normal, edematous mucosa between them. * **B. Raspberry appearance:** This is a classic radiological description for **Schistosomiasis** of the colon, not Crohn's disease. * **D. String sign of Kantor:** This refers to the severe narrowing of the terminal ileum due to transmural inflammation and spasm. While highly characteristic of Crohn's, it indicates **advanced** fibrostenotic disease rather than early changes. **NEET-PG High-Yield Pearls:** * **Distribution:** Crohn's is characterized by "skip lesions" (discontinuous involvement) and most commonly affects the terminal ileum. * **Proud Flesh:** These are inflammatory polyps (pseudopolyps) seen between areas of ulceration. * **Comb Sign:** On CT/MRI, this refers to the prominence of the vasa recta due to hypervascularity in the mesentery, indicating active inflammation. * **Creeping Fat:** The extension of mesenteric fat around the bowel wall is a pathognomonic surgical/radiological feature.

Q: An X-ray showing intestinal obstruction is presented. Which view is depicted?

X-ray abdomen erect. ***X-ray abdomen erect*** - The **erect abdominal X-ray** is the standard view for diagnosing intestinal obstruction as it demonstrates **air-fluid levels** and the characteristic **step-ladder pattern** of dilated bowel loops. - This view allows gravity to separate air and fluid within obstructed bowel segments, making the obstruction clearly visible with **horizontal air-fluid interfaces**. *X-ray abdomen left lateral* - This view is not routinely used for diagnosing intestinal obstruction as it provides limited visualization of **air-fluid levels** compared to the erect view. - Left lateral positioning does not optimally demonstrate the **characteristic patterns** of bowel obstruction like step-ladder appearance or multiple air-fluid levels. *X-ray in prone position* - The **prone position** is not suitable for intestinal obstruction evaluation as gravity cannot effectively separate air and fluid within the bowel loops. - This positioning makes it difficult to identify **air-fluid levels**, which are crucial diagnostic features of bowel obstruction. *X-ray in right lateral decubitus* - While this position can show **free air** in cases of perforation, it is not the standard view for diagnosing simple intestinal obstruction. - The **right lateral decubitus** position is primarily used to detect **pneumoperitoneum** rather than evaluating bowel obstruction patterns.

Q: A patient presents with severe right upper quadrant pain associated with nausea and vomiting, exacerbation during inspiration, and tenderness on palpation. Which of the following imaging modalities is the investigation of choice for this patient?

Ultrasonography. ### Explanation The clinical presentation of severe right upper quadrant (RUQ) pain, nausea, vomiting, and tenderness exacerbated by inspiration (positive **Murphy’s sign**) is classic for **Acute Cholecystitis**. **Why Ultrasonography (USG) is the Correct Answer:** USG is the **initial investigation of choice** for suspected acute cholecystitis and biliary pathologies. It is highly sensitive (up to 95%) and specific. Key diagnostic findings on USG include: * Gallbladder wall thickening (>3 mm). * Pericholecystic fluid. * Presence of gallstones (cholelithiasis). * **Sonographic Murphy’s sign:** Maximal tenderness when the USG probe is pressed directly over the gallbladder (more specific than the physical exam sign). **Why Other Options are Incorrect:** * **B. CT Scan:** While CT is excellent for identifying complications (like perforation or gangrene) and evaluating the entire abdomen, it is less sensitive than USG for detecting gallstones and is more expensive with radiation exposure. * **C. MRI (MRCP):** Highly accurate for detecting ductal stones (choledocholithiasis) but is time-consuming, expensive, and not used as a first-line emergency tool. * **D. X-ray:** Only 10–15% of gallstones are radiopaque (calcium-containing). A plain radiograph is generally non-diagnostic for cholecystitis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** While USG is the *initial* choice, **HIDA scan (Cholescintigraphy)** is the most sensitive/gold standard for diagnosing acute cholecystitis (showing non-visualization of the gallbladder). * **Emphysematous Cholecystitis:** Look for "gas in the gallbladder wall" on X-ray or CT; this is a surgical emergency often seen in diabetic patients. * **WES Triad (Wall-Echo-Shadow):** A USG sign indicating a gallbladder packed with stones.

Q: What is the investigation of choice for a pregnant lady presenting with an upper abdominal mass?

MRI. **Explanation:** The investigation of choice for a pregnant patient with an upper abdominal mass is **MRI**. **1. Why MRI is the Correct Answer:** In pregnancy, the primary goal is to achieve high diagnostic accuracy while ensuring fetal safety. MRI is the preferred modality because it provides excellent soft-tissue contrast and anatomical detail without the use of ionizing radiation. According to current guidelines, MRI is considered safe during all trimesters of pregnancy. It is particularly superior for characterizing complex masses (e.g., adnexal, hepatic, or pancreatic) when Ultrasound (the initial screening tool) is inconclusive. **2. Why Other Options are Incorrect:** * **CT Scan:** Uses ionizing radiation, which carries risks of teratogenesis and fetal carcinogenesis, especially during the first trimester. It is generally avoided unless it is a life-threatening emergency where MRI is unavailable. * **Barium Meal:** This is a fluoroscopic procedure involving significant radiation exposure to the maternal abdomen and fetus. Furthermore, it only evaluates the lumen of the GI tract and cannot characterize an extrinsic abdominal mass. * **DSA (Digital Subtraction Angiography):** An invasive procedure involving high-dose radiation and iodinated contrast. It is reserved for therapeutic interventions (like embolization), not primary diagnosis. **Clinical Pearls for NEET-PG:** * **First-line investigation** for any abdominal pathology in pregnancy: **Ultrasound (USG)**. * **Investigation of choice (IOC)** if USG is inconclusive: **MRI**. * **Contrast Safety:** Gadolinium (MRI contrast) is generally avoided in pregnancy as it crosses the placenta; however, non-contrast MRI is highly diagnostic. * **Radiation Rule:** The "10-rad rule" suggests that fetal risk is significantly increased only at doses above 100 mGy (10 rads); however, the ALARA (As Low As Reasonably Achievable) principle always favors MRI over CT.

Question 1

Which is the commonest incidentaloma detected in the liver?

Accepted Answer

Haemangioma

Answer

Focal nodular hyperplasia

Answer

Hepatocellular adenoma

Answer

Hydatid cyst

Question 2

What is the most sensitive test for ureteric stones?

Accepted Answer

Non-contrast CT scan

Answer

Ultrasound (USG)

Answer

Intravenous pyelogram (IVP)

Answer

X-ray

Question 3

What is the investigation of choice for testicular swelling?

Accepted Answer

Ultrasonography (USG)

Answer

Fine Needle Aspiration Cytology (FNAC)

Answer

Contrast-Enhanced Computed Tomography (CECT)

Answer

Magnetic Resonance Imaging (MRI)

Question 4

What is the earliest radiological finding of Crohn's disease?

Accepted Answer

Aphthous lesions

Answer

Cobblestone appearance

Answer

Raspberry appearance

Answer

String sign of Kantor

Question 5

An X-ray showing intestinal obstruction is presented. Which view is depicted?

Accepted Answer

X-ray abdomen erect

Answer

X-ray abdomen left lateral

Answer

X-ray in prone position

Answer

X-ray in right lateral decubitus

Question 6

A patient presents with severe right upper quadrant pain associated with nausea and vomiting, exacerbation during inspiration, and tenderness on palpation. Which of the following imaging modalities is the investigation of choice for this patient?

Accepted Answer

Ultrasonography

Answer

CT Scan

Answer

MRI

Answer

X-ray

Question 7

For hiatus hernia, what is the investigation of choice?

Accepted Answer

Barium meal upper GI in Trendelenburg position

Answer

Barium meal follow-through

Answer

Barium meal upper GI

Answer

Barium meal double contrast

Question 8

The triad of pelvic lipomatosis includes all of the following except?

Accepted Answer

Thickening of the colon

Answer

Pelvic radiolucency

Answer

Elevation of an intact rectosigmoid

Answer

Pear-shaped bladder

Question 9

What type of CT scan is used to characterize the chemical composition of kidney stones?

Accepted Answer

Dual-source CT

Answer

Spiral CT

Answer

Multidetector CT

Answer

HRCT

Question 10

What is the investigation of choice for a pregnant lady presenting with an upper abdominal mass?

Accepted Answer

MRI

Answer

Barium meal

Answer

CT scan

Answer

DSA

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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