Abdominal and Pelvic Radiology Practice Questions

Q: The CT severity index is a measure for which of the following conditions?

Pancreatitis. The **CT Severity Index (CTSI)**, also known as the **Balthazar Score**, is a validated scoring system used to assess the severity and prognosis of **Acute Pancreatitis**. ### 1. Why Pancreatitis is Correct The CTSI combines two parameters to predict the morbidity and mortality of acute pancreatitis: * **Balthazar Grade (0–4 points):** Evaluates the degree of pancreatic and peripancreatic inflammation (Grade A to E). * **Pancreatic Necrosis (0–6 points):** Evaluates the percentage of non-enhancing pancreatic parenchyma on contrast-enhanced CT (CECT). * **Calculation:** A total score out of 10 is calculated. A score of 7–10 indicates severe disease with a high risk of complications and mortality. ### 2. Why Other Options are Incorrect * **Hepatitis:** Diagnosis is primarily clinical and biochemical (elevated transaminases). Imaging is used to rule out biliary obstruction but does not use a CTSI. * **Cerebral Trauma:** Severity is assessed using the **Glasgow Coma Scale (GCS)** clinically and the **Marshall or Rotterdam Scales** on CT. * **Meningitis:** This is a clinical and laboratory diagnosis (Lumbar Puncture/CSF analysis). CT is used only to rule out raised intracranial pressure or focal deficits before a tap. ### 3. High-Yield Clinical Pearls for NEET-PG * **Timing:** The best time to perform a CECT for scoring is **72–96 hours** after the onset of symptoms, as necrosis may not be fully evident earlier. * **Modified CTSI:** A newer version that includes extrapancreatic complications (e.g., pleural effusion, ascites) to better correlate with clinical outcomes. * **Balthazar Grade E:** Defined by the presence of two or more peripancreatic fluid collections or gas within the pancreas/retroperitoneum.

Q: In a high-risk population, hepatocellular carcinoma (HCC) is best detected by which imaging modality?

Ultrasound (USG). **Explanation:** The correct answer is **Ultrasound (USG)**. The key to this question lies in the phrase "best detected," which in the context of a high-risk population (e.g., patients with Cirrhosis or Chronic Hepatitis B/C) refers to **screening and surveillance**. 1. **Why Ultrasound is Correct:** According to international guidelines (AASLD/EASL), USG is the primary screening modality for HCC. It is preferred because it is non-invasive, cost-effective, widely available, and lacks ionizing radiation. When combined with serum **Alpha-fetoprotein (AFP)** levels every 6 months, it provides the best balance of sensitivity and specificity for early detection in asymptomatic high-risk individuals. 2. **Why Other Options are Incorrect:** * **CT and MRI:** While Triple-phase (Multidetector) CT and Dynamic MRI are significantly more sensitive and specific than USG for **characterizing and diagnosing** a lesion once found, they are not used for initial detection/screening due to high cost, radiation (CT), and lack of feasibility for biannual follow-up. * **PET Scan:** HCC is often not FDG-avid (due to high glucose-6-phosphatase levels in well-differentiated tumors), making PET scans unreliable for primary detection. **Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** Dynamic MRI or Triple-phase CT (showing "Arterial enhancement with venous washout"). * **Screening Interval:** Every 6 months for high-risk patients. * **LI-RADS:** The system used to standardize reporting of liver nodules in patients at risk for HCC. * **Fibrolamellar HCC:** Occurs in young patients without cirrhosis; typically shows a central stellate scar that is T2-hypointense (unlike Hemangioma/FNH).

Q: Which investigation is being performed?

T-tube cholangiography. ***T-tube cholangiography*** - Shows characteristic appearance of **T-tube** in the **common bile duct** with contrast filling the biliary tree, typically performed **post-operatively** after cholecystectomy or bile duct exploration. - The **T-shaped radiopaque tube** is clearly visible extending from the CBD to the external drainage, allowing assessment of **biliary patency** and **residual stones**. *ERCP* - Involves **endoscopic** insertion of contrast through the **ampulla of Vater** via duodenoscope, showing biliary tree without external drainage tubes. - Would not show a **T-tube** in the bile duct; instead shows contrast injected **retrograde** through the **papilla**. *MRCP* - **Non-invasive MRI** technique that visualizes biliary tree using **T2-weighted sequences** without contrast injection. - Does not involve any **tubes or catheters**; produces detailed images of bile ducts through **magnetic resonance** technology. *Percutaneous transhepatic Cholangiography* - Involves **needle puncture** through the **liver parenchyma** to access intrahepatic bile ducts, with contrast injected **percutaneously**. - Would show **needle tract** or **catheter** through liver tissue, not a T-tube configuration in the CBD.

Q: What is a characteristic feature of the post-ovulatory endometrium observed on ultrasound?

Prominent posterior enhancement. The appearance of the endometrium on ultrasound changes predictably according to the phases of the menstrual cycle. **Explanation of the Correct Answer:** After ovulation, the corpus luteum produces **progesterone**, which initiates the **secretory phase**. Under the influence of progesterone, the endometrial glands become tortuous and filled with glycogen-rich secretions, and the stroma becomes edematous. This increased vascularity and fluid content make the endometrium **hyperechoic (bright)** and thick. Because this tissue is fluid-rich and uniform, it allows sound waves to pass through easily with minimal attenuation, leading to **prominent posterior acoustic enhancement** (increased brightness behind the uterus). **Analysis of Incorrect Options:** * **A. Single hyperechoic thin line:** This is characteristic of the **menstrual phase** or the early proliferative phase, where the functional layer has shed, leaving only the thin basal layer. * **B. Three line sign:** This is the classic appearance of the **late proliferative (pre-ovulatory) phase**. It consists of a central echogenic line (uterine cavity) surrounded by two hypoechoic layers (functional zone) and two outer echogenic lines (basal layer). * **C. Prominent halo:** A hypoechoic subendometrial halo is often seen in the proliferative phase due to the compact nature of the inner myometrium; it is not a specific feature of the post-ovulatory phase. **NEET-PG High-Yield Pearls:** * **Proliferative Phase (Estrogen):** "Three-line sign" (Trilaminar appearance). * **Secretory Phase (Progesterone):** Uniformly hyperechoic, thick endometrium with posterior enhancement. * **Post-menopausal Endometrium:** Should normally be ** 5 mm or bleeding is present, a biopsy is required to rule out endometrial carcinoma. * **Dating:** Ultrasound is most accurate for dating the cycle based on endometrial morphology rather than just thickness.

Q: Fleischner sign is characteristic of which condition?

Ileocecal tuberculosis. **Explanation:** **Fleischner sign** refers to a prominent, gaping, and patulous ileocecal valve (ICV) caused by the thickening of the lips of the valve and terminal ileum. It is a classic radiological finding in **Ileocecal Tuberculosis (TB)**, typically seen on a Barium enema. 1. **Why Ileocecal TB is correct:** In intestinal TB, the ileocecal region is the most common site of involvement due to the abundance of lymphoid tissue (Peyer’s patches). Inflammation and subsequent fibrosis lead to a rigid, wide-open ICV (Fleischner sign). This is often associated with the **Stierlin sign** (rapid emptying of the inflamed segment, leaving a narrow string of barium). 2. **Why other options are incorrect:** * **Ulcerative Colitis:** Characterized by "Lead pipe" appearance (loss of haustrations) and "Backwash ileitis," but the ICV is typically incompetent rather than thickened/patulous. * **Crohn’s Disease:** Features "String sign of Kantor" (marked narrowing of the terminal ileum) and "Cobblestone appearance." While it involves the ileum, the specific patulous valve sign is not characteristic. * **Ischaemic Colitis:** Classically presents with "Thumbprinting" on X-ray/CT due to submucosal edema and hemorrhage, usually at splenic flexure (Griffith’s point). **High-Yield Clinical Pearls for NEET-PG:** * **Sterling Sign:** Rapid emptying of the terminal ileum due to irritability (seen in TB). * **Conical Cecum:** Shrunken, inverted cecum due to fibrosis in TB. * **Goose-neck deformity:** Seen in TB when the terminal ileum enters a contracted cecum at an abnormal angle. * **Key differentiator:** TB often involves the **ileocecal angle**, whereas Crohn’s more commonly involves the **terminal ileum** while sparing the cecum initially.

Q: Hyperchoice hepatic metastases on USG are seen in which of the following malignancies?

Carcinoma of colon (Mucinous adenocarcinoma). **Explanation:** The echogenicity of hepatic metastases on ultrasound (USG) is a high-yield topic for NEET-PG. While most liver metastases are hypoechoic, **hyperechoic (bright)** metastases are characteristic of specific primary tumors. **Why Option B is Correct:** **Carcinoma of the colon**, particularly **mucinous adenocarcinoma**, is the most common cause of hyperechoic liver metastases. The increased echogenicity is primarily due to **calcifications** within the tumor tissue or the presence of highly reflective interfaces within the mucin-producing cells. Other common causes of hyperechoic metastases include Renal Cell Carcinoma (RCC), Breast Carcinoma, and Neuroendocrine tumors (e.g., Carcinoid). **Analysis of Incorrect Options:** * **Option A (Carcinoma of Ovary):** While ovarian cancer can metastasize to the liver, it typically presents as peritoneal seeding or surface scalloping. When parenchymal, they are often cystic or complex, but not classically described as primarily hyperechoic unless there is significant psammomatous calcification. * **Option C (Urinary Bladder Carcinoma):** These are relatively rare causes of liver metastases compared to GI malignancies and do not typically present with a hyperechoic signature. * **Option D (Mucinous Cystadenoma):** This is a benign (though potentially pre-malignant) cystic neoplasm of the liver or pancreas. It is a primary lesion, not a metastatic one. **High-Yield Clinical Pearls for NEET-PG:** 1. **Hypoechoic Metastases:** Most common; typically from Lung, Breast (can be both), and Lymphoma. 2. **Target/Bull’s Eye Sign:** A hypoechoic halo around a hyperechoic center; highly suggestive of malignancy (often Bronchogenic Carcinoma). 3. **Calcified Metastases:** Think Mucinous Adenocarcinoma of the Colon or Stomach. 4. **Cystic Metastases:** Think Cystadenocarcinoma (Ovary/Pancreas) or Sarcomas (Leiomyosarcoma).

Q: Which of the following is NOT a CT finding of acute pancreatitis?

Dilation of the pancreatic duct. ### Explanation In the context of acute pancreatitis, CT imaging is primarily used to assess the severity, identify complications, and rule out other causes of acute abdomen. **Why Option A is the Correct Answer:** **Dilation of the pancreatic duct** is typically a hallmark of **chronic pancreatitis** or obstructive pathologies (such as a periampullary tumor or a stone in the distal CBD). In acute pancreatitis, the inflammatory process leads to interstitial edema and swelling of the pancreatic parenchyma, which tends to **compress** the duct rather than dilate it. **Analysis of Incorrect Options:** * **B. Fuzzy outline of the pancreas:** This represents peripancreatic fat stranding. It is one of the earliest signs of inflammation as the proteolytic enzymes leak into the surrounding retroperitoneal fat. * **C. Peripancreatic fluid collection:** This is a common feature of acute pancreatitis (Balthazar Grade D/E). These collections occur due to inflammation and vascular leakage and can later evolve into pseudocysts or walled-off necrosis. * **D. Edematous pancreas:** This refers to the diffuse or focal enlargement of the gland due to inflammatory exudate, which is the defining radiological feature of interstitial edematous pancreatitis. **NEET-PG High-Yield Pearls:** 1. **Balthazar Scoring System:** Used to grade the severity of acute pancreatitis based on CT findings (A: Normal, B: Focal/diffuse enlargement, C: Peripancreatic inflammation, D: Single fluid collection, E: Two or more collections/gas). 2. **CT Severity Index (CTSI):** Combines the Balthazar grade with the degree of pancreatic necrosis. 3. **Timing:** The best time to perform a CECT to assess for necrosis is **72 hours** after the onset of symptoms; scans done earlier may underestimate the extent of tissue death. 4. **Sentinel Loop:** A classic X-ray finding in acute pancreatitis representing a localized ileus of a jejunal loop near the pancreas.

Q: Which of the following is NOT a radiological sign of Ulcerative colitis?

Raspberry appearance. **Explanation:** The correct answer is **A. Raspberry appearance**, as this is a classic radiological sign of **Schistosomiasis** (caused by *Schistosoma mansoni*), not Ulcerative Colitis (UC). In Schistosomiasis, the "raspberry" appearance refers to the multiple, small, rounded filling defects seen on a barium enema due to granulomatous polyps. **Analysis of other options:** * **Lead Pipe appearance:** This is a hallmark sign of chronic UC. It occurs due to the loss of normal haustral markings, bowel shortening, and mural thickening, making the colon appear as a smooth, rigid tube. * **Toxic megacolon:** A life-threatening complication of UC characterized by total or segmental non-obstructive colonic dilatation (usually >6 cm) associated with systemic toxicity. * **Pseudopolyps:** These are islands of regenerating or normal mucosa surrounded by areas of extensive ulceration and inflammation. On imaging, they appear as multiple small filling defects. **High-Yield Clinical Pearls for NEET-PG:** * **Stove-pipe colon:** Another name for the Lead Pipe appearance. * **Collar-button ulcers:** Deep, flask-shaped ulcers seen in acute UC when the ulceration penetrates the muscularis mucosa. * **Backwash ileitis:** Involvement of the terminal ileum in UC (seen in ~10-20% of cases with pancolitis). * **String Sign of Kantor:** Associated with **Crohn’s Disease**, not UC (due to terminal ileal narrowing). * **Thumbprinting:** Suggests bowel wall edema, commonly seen in ischemic colitis or severe UC.

Question 1

The CT severity index is a measure for which of the following conditions?

Accepted Answer

Pancreatitis

Answer

Hepatitis

Answer

Cerebral trauma

Answer

Meningitis

Question 2

In a high-risk population, hepatocellular carcinoma (HCC) is best detected by which imaging modality?

Accepted Answer

Ultrasound (USG)

Answer

Computed Tomography (CT)

Answer

Magnetic Resonance Imaging (MRI)

Answer

Positron Emission Tomography (PET) scan

Question 3

What is the investigation of choice for a small intestine tumor?

Accepted Answer

Barium follow-through

Answer

Echocardiography

Answer

X-ray abdomen

Answer

CT scan with contrast

Question 4

Which investigation is being performed?

Accepted Answer

T-tube cholangiography

Answer

ERCP

Answer

MRCP

Answer

Percutaneous transhepatic Cholangiography

Question 5

What is a characteristic feature of the post-ovulatory endometrium observed on ultrasound?

Accepted Answer

Prominent posterior enhancement

Answer

Single hyperechoic thin line

Answer

Three line sign

Answer

Prominent halo

Question 6

Fleischner sign is characteristic of which condition?

Accepted Answer

Ileocecal tuberculosis

Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Ischaemic colitis

Question 7

Hyperchoice hepatic metastases on USG are seen in which of the following malignancies?

Accepted Answer

Carcinoma of colon (Mucinous adenocarcinoma)

Answer

Carcinoma of ovary

Answer

Urinary bladder carcinoma

Answer

Mucinous cystadenoma

Question 8

Which of the following is NOT a CT finding of acute pancreatitis?

Accepted Answer

Dilation of the pancreatic duct

Answer

Fuzzy outline of the pancreas

Answer

Peripancreatic fluid collection

Answer

Edematous pancreas

Question 9

Which of the following is NOT a radiological sign of Ulcerative colitis?

Accepted Answer

Raspberry appearance

Answer

Toxic megacolon

Answer

Lead Pipe appearance

Answer

Pseudopolyps

Question 10

Which is the most important sign of significance of renal artery stenosis on an angiogram?

Accepted Answer

Presence of collaterals

Answer

A percentage diameter stenosis > 70%

Answer

Post-stenotic dilatation of the renal artery

Answer

A systolic pressure gradient > 20 mm Hg across the lesion

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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