Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology Indian Medical PG Practice Questions and MCQs

Question 281: Thumb printing on imaging is characteristic of which of the following conditions?

A. Crohn's disease
B. Ischemic colitis (Correct Answer)
C. Lymphogranuloma venereum (LGV)
D. Ulcerative colitis

Explanation: **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).

Question 282: Which of the following is NOT an investigation for the small intestine?

A. Radionuclide enteroclysis, MRI enteroclysis, CT enteroclysis, USG enteroclysis (Correct Answer)
B. Enteroclysis, ABD
C. Enteroclysis, ABD, ABCD
D. Enteroclysis, ACDE

Explanation: **Explanation:** The small intestine has traditionally been difficult to image due to its length and overlapping loops. **Enteroclysis** is a specialized technique where a tube (e.g., Bilbao-Dotter or Sellink tube) is passed through the nose or mouth into the duodenum/jejunum to infuse contrast directly. This achieves superior distension compared to oral ingestion. **Why Option A is the Correct Answer:** The question asks which is **NOT** an investigation for the small intestine. While CT, MRI, and USG enteroclysis are established modalities, **Radionuclide Enteroclysis** does not exist as a clinical investigation. Nuclear medicine studies for the small bowel (like Technetium-99m pertechnetate scans for Meckel’s diverticulum or labeled RBC scans for GI bleeds) rely on intravenous injection of tracers, not direct intubation and infusion into the small bowel lumen. Therefore, the inclusion of "Radionuclide enteroclysis" makes this option the incorrect set of investigations. **Analysis of Other Options:** Options B, C, and D contain various combinations of letters (ABD, ABCD, ACDE) which appear to be distractors or typographical placeholders in the question format. In the context of radiology exams, "Enteroclysis" (Fluoroscopic, CT, or MR) remains a gold standard for mucosal detail and luminal distension. **High-Yield Clinical Pearls for NEET-PG:** * **CT Enteroclysis:** Best for evaluating "mural" pathologies (e.g., Crohn’s disease) and extraluminal complications like fistulas or abscesses. * **MR Enteroclysis:** Preferred in young patients (e.g., chronic Crohn’s) to avoid ionizing radiation; offers excellent soft tissue contrast. * **Capsule Endoscopy:** The investigation of choice for "obscure" GI bleeding. * **Meckel’s Scan:** Uses **Tc-99m Pertechnetate**, which is taken up by ectopic gastric mucosa. * **String Sign of Kantor:** Classic radiological sign of Crohn’s disease seen on small bowel follow-through (SBFT) or enteroclysis.

Question 283: What is the investigation of choice for a pregnant patient presenting with an upper abdominal mass?

A. Ultrasound (USG) (Correct Answer)
B. X-ray
C. CT scan
D. MRI

Explanation: **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.**

Question 284: The inverted "3" sign is seen in which of the following conditions?

A. Ampullary carcinoma
B. Insulinoma
C. Carcinoma of the pancreatic head (Correct Answer)
D. Carcinoma of the stomach

Explanation: **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).

Question 285: What is the investigation of choice in suspected gall bladder stone?

A. Ultrasound (Correct Answer)
B. X-ray
C. Barium study
D. Oral cholecystography

Explanation: **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.

Question 286: Rigler's triad is seen in which of the following conditions?

A. Pneumoperitoneum
B. Intestinal obstruction
C. Gallstone ileus (Correct Answer)
D. Ulcerative colitis

Explanation: **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).

Question 287: Which of the following renal stones are radio-lucent?

A. Cysteine and Uric acid (Correct Answer)
B. Calcium phosphate and Uric acid
C. Calcium phosphate and Xanthine
D. Cysteine and Xanthine

Explanation: ### Explanation The visibility of renal stones on a plain X-ray (KUB) depends on their atomic weight and density. Stones containing calcium are the most **radio-opaque**, while those composed of pure organic compounds are **radio-lucent**. **1. Why Option A is Correct:** * **Uric Acid Stones:** These are the classic example of **completely radio-lucent** stones. They are formed in acidic urine and do not contain heavy metallic elements, making them invisible on X-ray but visible on Non-Contrast CT (NCCT) or Ultrasound. * **Cysteine Stones:** These are often described as **"ground-glass"** or **faintly radio-opaque** due to the presence of sulfur atoms. However, in the context of standard MCQ classifications (and compared to calcium stones), they are frequently grouped with lucent stones or categorized as poorly opaque. * *Note:* While the question lists Cysteine as lucent, it is technically "semi-opaque." However, among the given choices, Option A contains the two most recognized non-calcium stones. **2. Why Other Options are Wrong:** * **Calcium Phosphate (Options B & C):** These are the **most radio-opaque** stones. Calcium has a high atomic number, which absorbs X-rays significantly. * **Xanthine (Options C & D):** These are extremely rare and **completely radio-lucent**. While Xanthine is lucent, the presence of Calcium Phosphate in Option C makes it incorrect. **3. High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** **NCCT Abdomen** (Non-Contrast Computed Tomography) is the investigation of choice for urolithiasis as it detects all stones (except Indinavir stones). * **Mnemonic for Opacity (Decreasing order):** **I** **C**an **S**ee **U**seless **X**-rays * **I**ron/Calcium (Most Opaque) * **C**ystine (Semi-opaque/Ground glass) * **S**truvite (Semi-opaque) * **U**ric Acid (Lucent) * **X**anthine (Lucent) * **Indinavir Stones:** These are the only stones truly lucent even on CT scan (seen in HIV patients). * **Struvite Stones:** Associated with Proteus infections and form "Staghorn" calculi.

Question 288: Thickened gall bladder wall in USG is seen in which of the following conditions?

A. Acute cholecystitis
B. Mucosal thickening
C. Cholesterosis (Correct Answer)
D. Ascites

Explanation: **Explanation:** The gallbladder (GB) wall is considered thickened when it measures **>3 mm** on ultrasonography. **Why Cholesterosis is the Correct Answer (in the context of this specific question):** Cholesterosis (Strawberry Gallbladder) is characterized by the deposition of cholesterol esters within the lamina propria (macrophages). On USG, this typically presents as **multiple, small, non-shadowing echogenic foci** attached to the wall (cholesterol polyps). While it does not cause generalized wall thickening, it represents a form of **mucosal thickening/irregularity**. *Note:* This question is a classic "except" style or "least likely" variant often seen in older patterns. In clinical practice, Acute Cholecystitis and Ascites are major causes of wall thickening. However, in many academic MCQ banks, Cholesterosis is highlighted because it involves **intramural deposition** rather than simple edema or inflammation. **Analysis of Other Options:** * **Acute Cholecystitis:** A primary cause of GB wall thickening due to inflammation and edema. Associated findings include gallstones, pericholecystic fluid, and a positive sonographic Murphy’s sign. * **Ascites:** A common **extrabiliary cause** of wall thickening. The wall becomes thickened and edematous due to increased portal pressure or hypoalbuminemia, not primary GB disease. * **Mucosal Thickening:** This is a descriptive term for the physical change seen in various pathologies (like chronic cholecystitis or polyps) that leads to a measured increase in wall thickness. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of GB wall thickening:** Acute Cholecystitis. * **Extrabiliary causes:** Congestive heart failure, Cirrhosis (Ascites), Chronic renal failure, and Hypoalbuminemia. * **Comet-tail artifact:** Pathognomonic for **Adenomyomatosis** (thickening due to Rokitansky-Aschoff sinuses). * **Porcelain Gallbladder:** Calcification of the GB wall; highly associated with GB carcinoma.

Question 289: What is true about ectopic pregnancy?

A. Transvaginal ultrasonography is the first imaging test of choice. (Correct Answer)
B. It is associated with a decidual reaction.
C. Doppler has significance in its diagnosis.
D. An interstitial ring sign is seen in interstitial ectopic pregnancies.

Explanation: **Explanation** **1. Why Option A is Correct:** Transvaginal Ultrasonography (TVUS) is the **gold standard and first-line imaging modality** for suspected ectopic pregnancy. It offers superior resolution compared to transabdominal scans, allowing for earlier detection of an intrauterine pregnancy (IUP) or an adnexal mass. Diagnosis is typically based on the "discriminatory zone" of beta-hCG (usually 1,500–2,000 mIU/mL), where an IUP should be visible on TVUS. **2. Analysis of Incorrect Options:** * **Option B:** While a decidual reaction (thickening of the endometrium) occurs, it is **not specific** to ectopic pregnancy. It occurs in normal IUPs and even in some non-pregnant states. A more characteristic but non-specific finding is the "pseudogestational sac." * **Option C:** While Doppler can show the "Ring of Fire" (hypervascularity around the adnexal mass), this sign is **not pathognomonic** as it is also seen in a normal Corpus Luteum. Diagnosis primarily relies on B-mode morphology and hCG correlation. * **Option D:** The "interstitial ring sign" is a distractor. The characteristic sign for an interstitial (cornual) pregnancy is the **"interstitial line sign"**—an echogenic line extending from the endometrial canal to the center of the ectopic sac. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the Fallopian tube (>70%). * **Most dangerous site:** Interstitial/Cornual (risk of massive hemorrhage due to proximity to uterine arteries). * **Tubal Ring Sign:** An adnexal bag/ring (gestational sac) separate from the ovary; it is the most common USG finding. * **Heterotopic Pregnancy:** Coexistence of an IUP and an ectopic pregnancy (increased risk with IVF).

Question 290: All of the following features are diagnostic features in barium follow-through of ileocecal tuberculosis, EXCEPT?

A. Apple core appearance (Correct Answer)
B. Pulled up or contracted cecum
C. Widening of the ileocecal angle
D. Stricture involving the terminal ileum

Explanation: **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."

Practice by Chapter

Imaging of Liver

Practice Questions

Biliary Tract Imaging

Practice Questions

Pancreatic Imaging

Practice Questions

Spleen and Lymphatic System

Practice Questions

Gastrointestinal Tract Imaging

Practice Questions

Renal and Urinary Tract Imaging

Practice Questions

Adrenal Imaging

Practice Questions

Female Pelvic Imaging

Practice Questions

Male Pelvic Imaging

Practice Questions

Abdominal Trauma Imaging

Practice Questions

Acute Abdomen Imaging

Practice Questions

Imaging of Peritoneal Cavity and Retroperitoneum

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free