Abdominal and Pelvic Radiology Practice Questions

Q: Gasless abdomen is a feature of which of the following conditions?

All of the above. **Explanation:** A **gasless abdomen** on a plain X-ray refers to a significant reduction or total absence of normal bowel gas patterns. This occurs when the bowel is either empty, fluid-filled, or displaced. **1. High Intestinal Obstruction:** In cases of proximal obstruction (e.g., pyloric stenosis or duodenal atresia), gas cannot pass into the distal small and large intestines. If the patient vomits the swallowed air, the distal bowel collapses, leading to a gasless appearance below the site of obstruction. **2. Acute Pancreatitis:** While the "sentinel loop" (localized ileus) is a common sign, severe acute pancreatitis can present with a gasless abdomen. This occurs because the intense retroperitoneal inflammation causes the bowel loops to fill with fluid (exudate) rather than air, or due to persistent vomiting. **3. Congenital Diaphragmatic Hernia (CDH):** In CDH (specifically Bochdalek), the abdominal viscera herniate into the thoracic cavity. Consequently, the abdominal cavity appears scaphoid and "gasless" because the air-filled bowel loops are located in the chest rather than the abdomen. **Clinical Pearls for NEET-PG:** * **Other causes of gasless abdomen:** Acute gastroenteritis (due to hyperperistalsis and vomiting), midgut volvulus (early stage), and mesenteric ischemia. * **Normal Bowel Gas:** In adults, gas is normally seen in the stomach and colon. Small bowel gas is minimal (<2.5 cm diameter). * **Differential Diagnosis:** If you see a gasless abdomen in a neonate with respiratory distress, immediately suspect **CDH**. If seen in an adult with severe epigastric pain, consider **Acute Pancreatitis**.

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: Absolute contraindications for hysterosalpingography (HSG) include all except:

Mullerian anomalies. **Explanation:** Hysterosalpingography (HSG) is a fluoroscopic procedure used primarily to evaluate tubal patency and the uterine cavity. Understanding its contraindications is crucial for NEET-PG. **Why Mullerian Anomalies is the Correct Answer:** Mullerian anomalies (such as a septate, bicornuate, or unicornuate uterus) are actually an **indication** for performing an HSG, not a contraindication. HSG is a primary diagnostic tool used to delineate the internal architecture of the uterus to identify these structural malformations. **Analysis of Incorrect Options (Absolute Contraindications):** * **Pregnancy (A):** Performing an HSG during pregnancy is strictly contraindicated as the procedure involves ionizing radiation and the injection of contrast medium, which can lead to fetal harm or miscarriage. * **Pelvic Inflammatory Disease (B):** HSG is contraindicated in the presence of acute pelvic infection. The procedure involves injecting contrast under pressure, which can cause the retrograde spread of bacteria into the peritoneal cavity, potentially leading to peritonitis or sepsis. * **Genital Tuberculosis (D):** Active genital TB is considered a contraindication because the procedure can cause a flare-up or hematogenous spread of the infection. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** HSG should be performed during the **proliferative phase** (Day 7 to Day 10 of the menstrual cycle) to ensure the endometrium is thin (better visualization) and to avoid an early undiagnosed pregnancy. * **Water-soluble vs. Oil-based contrast:** Water-soluble contrast (e.g., Iohexol) is preferred today due to faster absorption and lower risk of granuloma formation. * **Therapeutic Effect:** HSG can sometimes have a "flushing" effect, slightly increasing conception rates in the months following the procedure.

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: The double bubble sign is a radiological feature of which condition?

Duodenal atresia. ### Explanation **Correct Answer: B. Duodenal Atresia** The **Double Bubble Sign** is a classic radiological finding seen on a plain abdominal X-ray. It represents the simultaneous dilatation of the **stomach** and the **proximal duodenum**. * **Mechanism:** In duodenal atresia, there is a complete congenital obstruction of the second part of the duodenum. Air swallowed by the neonate distends the stomach (first bubble) and the proximal duodenum (second bubble). * **Key Feature:** Because the obstruction is complete, there is typically a total absence of gas in the distal bowel (distal gasless abdomen). --- ### Why the other options are incorrect: * **A. Pyloric Stenosis:** Presents with a "Single Bubble" (distended stomach) and a gasless distal abdomen. Clinically, it presents later (3–6 weeks) with non-bilious projectile vomiting and an "olive-shaped" mass. * **C. Hirschsprung’s Disease:** This is a distal colonic obstruction. X-rays show multiple dilated loops of bowel (low intestinal obstruction) and a transition zone on contrast enema, not a double bubble. * **D. Necrotizing Enterocolitis (NEC):** The hallmark radiological finding is **Pneumatosis Intestinalis** (gas within the bowel wall). You may also see portal venous gas or pneumoperitoneum if perforation occurs. --- ### High-Yield Clinical Pearls for NEET-PG: * **Association:** Approximately 30% of infants with duodenal atresia have **Down Syndrome (Trisomy 21)**. * **Antenatal Ultrasound:** May show polyhydramnios and two fluid-filled structures in the fetal abdomen. * **Vomiting:** Since the obstruction is usually distal to the ampulla of Vater, the vomiting is typically **bilious**. * **Differential for Double Bubble:** While duodenal atresia is the most common cause, a double bubble can also be seen in **Annular Pancreas**, **Malrotation with Midgut Volvulus**, or **Duodenal Web**.

Question 1

Gasless abdomen is a feature of which of the following conditions?

Accepted Answer

All of the above

Answer

High intestinal obstruction

Answer

Acute pancreatitis

Answer

Congenital diaphragmatic hernia

Question 2

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 3

Absolute contraindications for hysterosalpingography (HSG) include all except:

Accepted Answer

Mullerian anomalies

Answer

Pregnancy

Answer

Pelvic inflammatory disease

Answer

Genital tuberculosis

Question 4

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 5

What does the term "Phrygian cap" refer to in the context of the gallbladder?

Accepted Answer

A septum or fold that separates the fundus from the body of the gallbladder.

Answer

Agenesis of the gallbladder fundus.

Answer

An abnormally large or giant gallbladder.

Answer

Duplication of the gallbladder.

Question 6

The 'string of beads' appearance on an abdominal X-ray is typically seen in which of the following conditions?

Accepted Answer

Small bowel obstruction

Answer

Large bowel obstruction

Answer

Carcinoma of the stomach

Answer

Gastric outlet obstruction

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

What is the cupola sign?

Accepted Answer

A radiological finding in supine posture for pneumoperitoneum

Answer

A radiological finding in supine posture for pneumothorax

Answer

Air in Morrison's pouch

Answer

Both walls of the bowel are seen

Question 9

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 10

The double bubble sign is a radiological feature of which condition?

Accepted Answer

Duodenal atresia

Answer

Pyloric stenosis

Answer

Hirschsprung's disease

Answer

Necrotising enterocolitis

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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