Abdominal and Pelvic Radiology Practice Questions

Q: Thumb printing on imaging is characteristic of which of the following conditions?

Ischemic colitis. **Explanation:** **Thumbprinting** is a classic radiologic sign seen on plain abdominal X-rays or barium studies. It represents **submucosal edema and hemorrhage**, which causes the bowel wall to bulge into the lumen, creating indentations that resemble thumbprints. **Why Ischemic Colitis is Correct:** In **Ischemic Colitis**, sudden hypoperfusion leads to capillary leakage and intramural hemorrhage. This most commonly occurs at "watershed areas" like the splenic flexure (Griffith’s point) or the rectosigmoid junction (Sudeck’s point). The resulting focal submucosal thickening produces the characteristic thumbprinting appearance. **Analysis of Incorrect Options:** * **Crohn's Disease:** Characterized by transmural inflammation, "skip lesions," and a "string sign" (due to strictures) or "cobblestone appearance" (due to deep longitudinal ulcers). * **Ulcerative Colitis:** Typically presents with a "lead pipe" appearance in chronic stages due to the loss of haustral markings and shortening of the colon. * **Lymphogranuloma venereum (LGV):** A sexually transmitted infection that primarily causes proctocolitis and strictures in the rectum, but does not typically present with acute submucosal edema/thumbprinting. **NEET-PG High-Yield Pearls:** 1. **Most common site for Ischemic Colitis:** Splenic flexure (Griffith’s point). 2. **Other causes of Thumbprinting:** While ischemic colitis is the classic answer, it can also be seen in severe ulcerative colitis (toxic megacolon), pseudomembranous colitis, and bowel wall hematomas. 3. **Clinical Presentation:** Typically an elderly patient with sudden onset left-sided abdominal pain followed by bloody diarrhea (hematochezia).

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

Ultrasound (USG). **Explanation:** The investigation of choice for a pregnant patient with an upper abdominal mass is **Ultrasound (USG)**. This is primarily due to the **ALARA principle** (As Low As Reasonably Achievable), which prioritizes non-ionizing radiation to protect the developing fetus. **Why Ultrasound is the Correct Choice:** * **Safety:** USG uses high-frequency sound waves rather than ionizing radiation, making it safe for both the mother and the fetus throughout all trimesters. * **Efficacy:** It is highly effective at differentiating between cystic and solid masses and can accurately localize the origin of the mass (e.g., hepatic, pancreatic, or obstetric). * **Accessibility:** It is portable, cost-effective, and allows for real-time evaluation. **Why Other Options are Incorrect:** * **X-ray (B):** Involves ionizing radiation. While a single chest X-ray has low fetal exposure, it provides poor soft-tissue resolution for abdominal masses and is generally avoided unless necessary. * **CT Scan (C):** Contraindicated as a first-line tool due to high doses of ionizing radiation, which poses risks of teratogenesis and childhood carcinogenesis (especially in the first trimester). * **MRI (D):** While safe (non-ionizing) and excellent for soft tissue, it is expensive and less accessible. It is considered the **second-line** investigation if USG results are inconclusive. **High-Yield Clinical Pearls for NEET-PG:** * **IOC for Gallstones/Appendicitis in pregnancy:** Ultrasound. * **IOC for Nephrolithiasis in pregnancy:** Ultrasound. * **MRI in Pregnancy:** Generally avoided in the 1st trimester if possible; Gadolinium contrast is contraindicated as it crosses the placenta. * **Rule of Thumb:** For any acute abdominal or pelvic condition in a pregnant female, **USG is always the initial investigation.**

Q: The inverted "3" sign is seen in which of the following conditions?

Carcinoma of the pancreatic head. **Explanation:** The **inverted "3" sign** (also known as **Frostberg’s sign**) is a classic radiological sign seen on a barium meal follow-through or hypotonic duodenography. It occurs in **Carcinoma of the head of the pancreas**. **Why it occurs:** The sign is produced when a mass in the head of the pancreas enlarges and invades or exerts pressure on the medial wall of the second part (descending) of the duodenum. The "3" shape is formed because the duodenum is fixed at the point where the common bile duct and pancreatic duct enter (the Ampulla of Vater). The pressure from the tumor causes the duodenal segments above and below the ampulla to bulge outward, while the ampulla remains tethered, creating the central indentation of the "3". **Analysis of Incorrect Options:** * **Ampullary carcinoma:** While it can cause duodenal changes, it typically presents with a filling defect or "irregularity" rather than the classic inverted "3" configuration. * **Insulinoma:** These are usually small, hypervascular functional neuroendocrine tumors that do not typically grow large enough to cause significant extrinsic compression or the Frostberg sign. * **Carcinoma of the stomach:** This usually presents with signs like the "Leather bottle stomach" (Linitis plastica) or "Carman’s meniscus sign" (for gastric ulcers), but does not affect the duodenal sweep in this specific pattern. **High-Yield Clinical Pearls for NEET-PG:** * **Frostberg’s Sign:** Inverted "3" sign = Pancreatic Head Carcinoma. * **Double Bubble Sign:** Duodenal Atresia. * **Rose-thorn appearance:** Crohn’s disease (deep ulcers). * **Coiled Spring appearance:** Intussusception. * **Courvoisier’s Law:** In a patient with painless obstructive jaundice and a palpable gallbladder, the cause is unlikely to be gallstones and is more likely to be a malignancy (like pancreatic head CA).

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

Ultrasound. **Explanation:** **Ultrasound (USG)** is the investigation of choice (IOC) for suspected gallbladder stones (cholelithiasis) due to its high sensitivity (>95%) and specificity. The underlying medical concept relies on the fact that gallstones appear as **hyperechoic (bright) structures** within the gallbladder lumen that demonstrate **posterior acoustic shadowing** and move with changes in patient positioning. USG is non-invasive, radiation-free, cost-effective, and can simultaneously evaluate for complications like cholecystitis (e.g., gallbladder wall thickening or pericholecystic fluid). **Why other options are incorrect:** * **X-ray:** Only about 10–15% of gallstones are radiopaque (contain enough calcium to be seen). Most gallstones are cholesterol-based and radiolucent, making X-ray an unreliable screening tool. * **Barium study:** This is used to visualize the gastrointestinal lumen (esophagus, stomach, or bowel). It has no role in visualizing the interior of the gallbladder. * **Oral Cholecystography (OCG):** Historically used to assess gallbladder function and stones, it has been entirely replaced by USG because it is time-consuming, requires contrast ingestion, and depends on adequate hepatic function and intestinal absorption. **Clinical Pearls for NEET-PG:** * **Gold Standard for Choledocholithiasis (CBD stones):** ERCP (Therapeutic) or MRCP (Diagnostic). * **IOC for Acute Cholecystitis:** Ultrasound (look for Murphy’s sign under the probe). * **Most Sensitive/Gold Standard for Acute Cholecystitis:** HIDA scan (Radionuclide scan). * **WES Triad (Wall-Echo-Shadow):** A classic USG finding seen when the gallbladder is completely filled with stones.

Q: Rigler's triad is seen in which of the following conditions?

Gallstone ileus. **Explanation:** **Rigler’s Triad** is a classic radiological finding diagnostic of **Gallstone Ileus**. This condition occurs when a large gallstone erodes through the gallbladder wall into the adjacent bowel (usually the duodenum) via a cholecystoenteric fistula. The stone then travels distally until it impacts, typically at the narrowest part of the small bowel—the **ileocecal valve**. The triad consists of: 1. **Pneumobilia:** Air within the biliary tree (due to the fistula). 2. **Small Bowel Obstruction:** Dilated loops of small bowel with fluid levels. 3. **Ectopic Gallstone:** A radiopaque stone visible in the right iliac fossa or pelvis. *(Note: Presence of two out of three signs is often sufficient for diagnosis on imaging.)* **Analysis of Incorrect Options:** * **A. Pneumoperitoneum:** Characterized by **Rigler’s Sign** (not triad), where air on both sides of the bowel wall makes the wall clearly visible. * **B. Intestinal Obstruction:** While gallstone ileus causes obstruction, "Rigler’s triad" is specific to the etiology involving a gallstone. Simple obstruction lacks pneumobilia. * **D. Ulcerative Colitis:** Associated with "Lead pipe appearance" (loss of haustrations) or "Toxic megacolon," but not Rigler’s triad. **High-Yield Pearls for NEET-PG:** * **Rigler’s Sign vs. Rigler’s Triad:** Do not confuse them. Sign = Pneumoperitoneum; Triad = Gallstone ileus. * **Most common site of impaction:** Terminal ileum. * **Most common fistula:** Cholecystoduodenal fistula. * **Gold standard investigation:** CT Abdomen (more sensitive than X-ray for identifying the triad).

Q: All of the following features are diagnostic features in barium follow-through of ileocecal tuberculosis, EXCEPT?

Apple core appearance. **Explanation:** The correct answer is **A. Apple core appearance**. This is because the "apple core" or "napkin ring" sign is the classic radiological hallmark of **Colorectal Carcinoma** (specifically annular constricting lesions), not tuberculosis. It represents an irregular, circumferential narrowing of the bowel lumen with overhanging edges (shouldering). **Analysis of other options (Features of Ileocecal TB):** * **Pulled up or contracted cecum:** Chronic inflammation and longitudinal fibrosis in tuberculosis cause the cecum to shrivel and move superiorly. This is often referred to as a **conical cecum**. * **Widening of the ileocecal angle:** Fibrosis and contraction of the terminal ileum and cecum lead to the loss of the normal acute angle between them, making it obtuse or "widened." * **Stricture involving the terminal ileum:** TB is a granulomatous disease that frequently causes circumferential thickening and fibrosis, leading to short or long-segment strictures. **High-Yield Clinical Pearls for NEET-PG:** * **Stierlin’s Sign:** Rapid emptying of the inflamed terminal ileum into the cecum (appears as a narrow streak of barium). * **Kantor’s String Sign:** A thin string-like appearance of the terminal ileum (also seen in Crohn’s disease). * **Fleischner Sign:** A gaping, thickened, and incompetent ileocecal valve. * **Sterling Sign:** A sign of irritability where the cecum is empty but the terminal ileum and ascending colon are filled with barium. * **Differential Diagnosis:** The primary differential for ileocecal TB is **Crohn’s Disease**. TB typically involves the ileocecal valve and causes a "pulled-up" cecum, whereas Crohn’s often spares the valve and involves "skip lesions."

Question 1

Thumb printing on imaging is characteristic of which of the following conditions?

Accepted Answer

Ischemic colitis

Answer

Crohn's disease

Answer

Lymphogranuloma venereum (LGV)

Answer

Ulcerative colitis

Question 2

Which of the following is NOT an investigation for the small intestine?

Accepted Answer

Radionuclide enteroclysis, MRI enteroclysis, CT enteroclysis, USG enteroclysis

Answer

Enteroclysis, ABD

Answer

Enteroclysis, ABD, ABCD

Answer

Enteroclysis, ACDE

Question 3

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

Accepted Answer

Ultrasound (USG)

Answer

X-ray

Answer

CT scan

Answer

MRI

Question 4

The inverted "3" sign is seen in which of the following conditions?

Accepted Answer

Carcinoma of the pancreatic head

Answer

Ampullary carcinoma

Answer

Insulinoma

Answer

Carcinoma of the stomach

Question 5

What is the investigation of choice in suspected gall bladder stone?

Accepted Answer

Ultrasound

Answer

X-ray

Answer

Barium study

Answer

Oral cholecystography

Question 6

Rigler's triad is seen in which of the following conditions?

Accepted Answer

Gallstone ileus

Answer

Pneumoperitoneum

Answer

Intestinal obstruction

Answer

Ulcerative colitis

Question 7

Which of the following renal stones are radio-lucent?

Accepted Answer

Cysteine and Uric acid

Answer

Calcium phosphate and Uric acid

Answer

Calcium phosphate and Xanthine

Answer

Cysteine and Xanthine

Question 8

Thickened gall bladder wall in USG is seen in which of the following conditions?

Accepted Answer

Cholesterosis

Answer

Acute cholecystitis

Answer

Mucosal thickening

Answer

Ascites

Question 9

What is true about ectopic pregnancy?

Accepted Answer

Transvaginal ultrasonography is the first imaging test of choice.

Answer

It is associated with a decidual reaction.

Answer

Doppler has significance in its diagnosis.

Answer

An interstitial ring sign is seen in interstitial ectopic pregnancies.

Question 10

All of the following features are diagnostic features in barium follow-through of ileocecal tuberculosis, EXCEPT?

Accepted Answer

Apple core appearance

Answer

Pulled up or contracted cecum

Answer

Widening of the ileocecal angle

Answer

Stricture involving the terminal ileum

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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