Abdominal and Pelvic Radiology Practice Questions

Q: The feathery appearance seen in the jejunum is due to which of the following structures?

Valvulae conniventes. **Explanation:** The characteristic **"feathery appearance"** of the jejunum on a barium study is due to the **Valvulae conniventes** (also known as Plicae circulares or Kerckring folds). These are permanent mucosal folds that project into the intestinal lumen. In the jejunum, these folds are tall, thick, and numerous, creating a dense, feathered pattern when coated with contrast. **Analysis of Options:** * **Valvulae conniventes (Correct):** These folds are most prominent in the proximal small bowel (jejunum). On X-ray, they appear as thin lines that cross the **entire width** of the bowel lumen. In the ileum, they become sparse and shorter, leading to a smoother appearance. * **Haustrations:** These are characteristic of the **large intestine**. Unlike valvulae, haustral folds are incomplete and do **not** cross the entire diameter of the bowel. They give the colon a sacculated appearance, not a feathery one. * **Luminal gas:** Gas provides a negative contrast (black) on X-ray. While it can outline the bowel, it does not create the specific feathery mucosal pattern. * **Vascular network:** While the jejunum has a rich blood supply (vasa recta), these are located within the mesentery and wall; they are not responsible for the intraluminal mucosal pattern seen on contrast studies. **High-Yield NEET-PG Pearls:** 1. **Stack of Coins Appearance:** When the small bowel is dilated (as in obstruction), the valvulae conniventes become prominent and parallel, resembling a stack of coins. 2. **Jejunum vs. Ileum:** Jejunum is characterized by a "feathery" pattern; Ileum is characterized by a "featureless" or smooth appearance. 3. **Rule of 3-6-9:** Normal diameter limits are <3 cm for small bowel, <6 cm for colon, and <9 cm for the cecum. 4. **Moulage Sign:** Loss of the feathery pattern (appearing like "poured wax") is seen in Celiac disease due to mucosal atrophy.

Q: Which of the following is an initial investigation for acute abdomen?

Ultrasound (USG). **Explanation:** In the clinical evaluation of an **acute abdomen**, the choice of imaging depends on the suspected pathology, but **Ultrasound (USG)** is considered the **initial investigation** of choice. This is primarily due to its high accessibility, lack of ionizing radiation, cost-effectiveness, and real-time imaging capabilities. It is particularly superior for evaluating the hepatobiliary system (e.g., acute cholecystitis), pelvic pathologies in females (e.g., ectopic pregnancy, ovarian torsion), and pediatric cases (e.g., intussusception, appendicitis). **Analysis of Options:** * **B & C (MDCT/CECT):** While **Contrast-Enhanced CT (CECT)** is the **Gold Standard** and the most sensitive investigation for most causes of acute abdomen (like acute pancreatitis, bowel ischemia, or perforation), it is not the *initial* step due to radiation exposure, cost, and potential nephrotoxicity of contrast. It is usually reserved for cases where USG is inconclusive. * **D (X-ray):** While an Erect Abdominal X-ray is useful for detecting pneumoperitoneum (free air under the diaphragm) or bowel obstruction, its sensitivity is much lower than USG for a broad range of abdominal pathologies. **High-Yield Clinical Pearls for NEET-PG:** * **Investigation of Choice (IOC) for Acute Cholecystitis:** USG. * **Gold Standard for Acute Pancreatitis:** CECT (performed after 48–72 hours for maximum accuracy). * **IOC for Ureteric Colic:** Non-Contrast CT (NCCT) KUB. * **IOC for Intestinal Perforation:** X-ray Chest PA view (Erect) to see free gas under the diaphragm. * **FAST (Focused Assessment with Sonography for Trauma):** The initial USG screening tool used in hemodynamically unstable blunt trauma patients.

Q: A unilateral small smooth kidney is seen in which of the following conditions?

Renal artery stenosis. **Explanation:** The correct answer is **Renal artery stenosis (RAS)**. The size and contour of the kidney are determined by the adequacy of blood supply and the integrity of the renal parenchyma. **1. Why Renal Artery Stenosis is correct:** In RAS, the chronic reduction in renal blood flow leads to **ischemic atrophy**. Because the global blood supply is reduced, the kidney shrinks uniformly. This results in a **small, smooth-surfaced kidney**. It is typically unilateral if only one artery is affected (e.g., due to atherosclerosis or fibromuscular dysplasia). **2. Analysis of Incorrect Options:** * **Reflux Nephropathy:** This typically causes **unilateral small kidneys with irregular outlines**. The hallmark is polar scarring (usually at the poles) and associated calyceal clubbing, making the surface "bumpy" rather than smooth. * **Lobar Infarction:** An infarct leads to localized tissue death and subsequent scarring. This results in a **focal contour defect** or a "depressed scar" on the kidney surface, not a global smooth reduction in size. * **Chronic Glomerulonephritis:** While this causes small smooth kidneys, it is a systemic metabolic/immunological process that almost always affects both kidneys. Therefore, it presents as **bilateral** small smooth kidneys. **Clinical Pearls for NEET-PG:** * **Unilateral Small Smooth Kidney:** Renal artery stenosis, Congenital hypoplasia. * **Unilateral Small Irregular Kidney:** Chronic pyelonephritis, Reflux nephropathy, Renal infarction. * **Bilateral Small Smooth Kidneys:** Chronic glomerulonephritis, Hypertensive nephrosclerosis, Bilateral RAS. * **Goldblatt Kidney:** A classic experimental model of hypertension caused by unilateral renal artery constriction.

Q: Which imaging modality is best for detecting focal liver lesions?

MRI. **Explanation:** **MRI (Magnetic Resonance Imaging)** is the gold standard for detecting and characterizing focal liver lesions. Its superiority lies in its **high soft-tissue contrast resolution** and the ability to use **Hepatobiliary-specific contrast agents** (e.g., Gadoxetate disodium/Primovist). These agents are taken up by functional hepatocytes, allowing for the differentiation between lesions containing hepatocytes (like FNH) and those that do not (like metastases or HCC), significantly increasing sensitivity and specificity. **Why other options are incorrect:** * **CT (Computed Tomography):** While excellent for staging and rapid assessment, CT has lower soft-tissue contrast than MRI. It relies heavily on vascularity patterns (Triple-phase CT) but may miss small or isodense lesions that MRI can easily detect. * **USG (Ultrasonography):** This is the **initial screening modality** of choice due to its cost-effectiveness and lack of radiation. However, it is operator-dependent and has limited sensitivity for very small lesions or lesions in cirrhotic livers. * **PET Scan:** Primarily used for detecting metabolic activity (metastases or recurrence). It is not the primary modality for initial detection or anatomical characterization of primary liver lesions. **High-Yield Clinical Pearls for NEET-PG:** * **Best Initial Investigation:** USG. * **Best Modality for Characterization:** MRI. * **IOC for Hemangioma:** MRI (shows peripheral globular enhancement with "filling in"). * **IOC for HCC:** Triple-phase CT or Dynamic MRI (shows arterial enhancement with venous "washout"). * **Steatosis:** MRI (In-phase and Out-of-phase imaging) is the most sensitive for quantifying hepatic fat.

Q: Which is not a usual feature of Ulcerative colitis on barium enema?

Colovesical fistula. **Explanation:** The correct answer is **Colovesical fistula**. Ulcerative Colitis (UC) is a mucosal disease characterized by continuous inflammation limited to the mucosa and submucosa. Because it does not involve transmural inflammation, the formation of fistulae (such as colovesical or perianal fistulae) is extremely rare. Fistula formation is a hallmark of **Crohn’s Disease**, which involves transmural inflammation. **Analysis of Options:** * **Fine mucosal granularity (A):** This is the earliest radiological sign of UC on a double-contrast barium enema. It represents edema and hyperemia of the mucosa. * **Pseudopolyps (B):** These are islands of regenerating or normal mucosa surrounded by areas of extensive mucosal ulceration and depletion. They are a common feature of chronic UC. * **Lead pipe colon (C):** This refers to a featureless, narrowed, and shortened colon. It occurs in chronic stages due to the loss of haustral markings, longitudinal shortening, and muscular hypertrophy. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign on Barium Enema:** Fine mucosal granularity. * **Collar-button ulcers:** Deep ulcers formed when the inflammatory process undermines the mucosa (also seen in UC). * **Backwash Ileitis:** Involvement of the terminal ileum in UC (occurs in ~10% of cases of pancolitis); unlike Crohn's, the ileocecal valve is usually patent/incompetent. * **Toxic Megacolon:** A life-threatening complication of UC where the transverse colon diameter exceeds **6 cm** on plain X-ray.

Q: All of the following are signs of Hydatid Cyst except?

Mercedes Benz sign. **Explanation:** The **Mercedes Benz sign** is the correct answer because it is a characteristic radiological feature of **cholelithiasis (gallstones)**, not hydatid disease. It represents the presence of triradiate, nitrogen-filled gas fissures within a gallstone, seen on a plain X-ray or CT scan. **Analysis of Hydatid Cyst Signs (Echinococcus granulosus):** * **Camalote sign (Water Lily sign):** This occurs when the endocyst ruptures, causing the germinal membrane to detach and float on the surface of the remaining cyst fluid. It is a classic sign seen on imaging (USG/CT/MRI). * **Floating membrane sign:** This is essentially the same mechanism as the Camalote sign, where detached membranes are seen undulating within the cyst cavity. * **Cartwheel (Ca wheel) appearance:** This occurs when multiple daughter cysts are arranged peripherally within the mother cyst, separated by internal septations (hydatid sand and matrix). This is characteristic of a **Type II hydatid cyst** (Gharbi classification). **High-Yield Clinical Pearls for NEET-PG:** * **Gharbi Classification:** Used to stage hydatid cysts (Type I: Pure fluid; Type II: Split wall/Membranes; Type III: Daughter cysts; Type IV: Solid/Heterogeneous; Type V: Calcified wall). * **Eggshell Calcification:** A common finding in the wall of a chronic hydatid cyst (Type V). * **Treatment:** The **PAIR** technique (Puncture, Aspiration, Injection of scolicidal agent, Re-aspiration) is a minimally invasive treatment option. * **Serology:** ELISA for Echinococcus IgG is the most common screening test.

Q: What is the characteristic appearance of a "Ca-wheel" on ultrasound?

Hydatid cyst. **Explanation:** The **"Cartwheel appearance"** (also known as the "spoke-wheel" or "honeycomb" appearance) is a classic radiological sign of a **Hydatid cyst** (caused by *Echinococcus granulosus*) on ultrasonography. This appearance occurs during the **WHO Stage CE2** (Active stage). It is produced by the presence of multiple **daughter cysts** separated by internal septations (representing the collapsed germinal membranes) within a larger mother cyst. **Why the other options are incorrect:** * **Intussusception:** Characteristically shows a **"Target sign"** or **"Donut sign"** on transverse sections and a **"Pseudokidney sign"** on longitudinal sections due to the telescoping of bowel loops. * **Hydatidiform mole:** Displays a characteristic **"Snowstorm appearance"** on ultrasound, caused by multiple hydropic villi appearing as tiny echogenic foci with interspersed cystic spaces. **High-Yield Clinical Pearls for NEET-PG:** 1. **Gharbi Classification:** Used for staging Hydatid cysts on USG. * **Type I:** Pure fluid collection (Anechoic). * **Type II:** Fluid collection with a split wall (**Water-lily sign** - detached endocyst). * **Type III:** Daughter cysts with septations (**Cartwheel/Honeycomb appearance**). * **Type IV:** Heterogeneous mass (Solid pattern). * **Type V:** Calcified wall (Inactive/Dead cyst). 2. **Treatment of Choice:** PAIR (Puncture, Aspiration, Injection, Re-aspiration) or surgical excision, usually covered with Albendazole. 3. **Serology:** ELISA is the most sensitive screening test for Hydatid disease.

Q: A 43-year-old woman presents with right upper quadrant abdominal pain and vomiting. She has had three children. The white blood cell count is 14.3x10^9/L and liver function tests are normal. What is the test of choice to establish the diagnosis in this patient?

Ultrasound. **Explanation:** The clinical presentation of right upper quadrant (RUQ) pain, vomiting, and leukocytosis in a middle-aged woman (fitting the "4F" profile: Female, Forty, Fertile, Fat) is highly suggestive of **Acute Cholecystitis** or symptomatic cholelithiasis. **Why Ultrasound is the Correct Answer:** Ultrasound (USG) is the **initial investigation of choice** for suspected gallbladder disease. It has high sensitivity (>90%) and specificity for detecting gallstones and signs of inflammation. Key sonographic findings of acute cholecystitis include gallbladder wall thickening (>3 mm), pericholecystic fluid, and the **Sonographic Murphy’s sign** (maximal tenderness over the gallbladder when compressed by the probe), which has a high positive predictive value. **Analysis of Incorrect Options:** * **A. CT Scan:** While useful for detecting complications (like perforation or gangrene) or alternative diagnoses, it is less sensitive than USG for detecting gallstones and involves ionizing radiation. * **C. HIDA Scan (Hepatobiliary Iminodiacetic Acid):** This is the **most sensitive (Gold Standard)** test for diagnosing acute cholecystitis (showing non-visualization of the gallbladder). However, it is not the *initial* test of choice because it is time-consuming, expensive, and involves nuclear medicine. * **D. MRI/MRCP:** These are excellent for visualizing the biliary tree (choledocholithiasis) but are not first-line due to cost and lack of immediate availability. **NEET-PG High-Yield Pearls:** * **Initial test for RUQ pain:** Ultrasound. * **Most sensitive/Gold Standard for Acute Cholecystitis:** HIDA Scan. * **Best test for Choledocholithiasis (CBD stones):** MRCP (Non-invasive) or ERCP (Invasive/Therapeutic). * **WES Triad on USG:** Wall-Echo-Shadow (indicates a gallbladder packed with stones).

Q: Cobra head deformity in the lower end of ureter is seen in which of the following conditions?

Ureterocele. **Explanation:** The **Cobra Head sign** (also known as the Adder head sign) is a classic radiological finding seen on an Intravenous Pyelogram (IVP) or Contrast CT, diagnostic of an **orthotopic ureterocele**. 1. **Why Ureterocele is correct:** A ureterocele is a congenital cystic dilatation of the distal-most intramural portion of the ureter. On a contrast study, the dilated ureter is filled with contrast (the "head"), which is surrounded by a thin, radiolucent halo representing the wall of the ureterocele and the bladder mucosa. This appearance mimics the hood of a cobra. 2. **Why other options are wrong:** * **Vesical diverticula:** These appear as contrast-filled outpouchings from the bladder wall (Hutch diverticulum), not as a filling defect within the bladder. * **Carcinoma of the urinary bladder:** This typically presents as an irregular, fixed filling defect. If it involves the ureteric orifice, it may cause hydroureter, but not the smooth, cystic "cobra head" appearance. * **Urethral stricture:** This is a narrowing of the urethra, best visualized on a Retrograde Urethrogram (RGU), and does not affect the distal ureteric morphology. **High-Yield Clinical Pearls for NEET-PG:** * **Simple (Orthotopic) Ureterocele:** Located at the normal vesicoureteric junction; usually seen in adults and produces the Cobra Head sign. * **Ectopic Ureterocele:** Located at the bladder neck or urethra; more common in children and often associated with a **duplicated collecting system** (Weigert-Meyer Law). * **Negative Cobra Head Sign:** If the radiolucent halo is thick or irregular, suspect a "pseudoureterocele," which can be caused by a stone impacted at the UVJ or a bladder tumor infiltrating the ureteric orifice.

Question 1

The feathery appearance seen in the jejunum is due to which of the following structures?

Accepted Answer

Valvulae conniventes

Answer

Haustrations

Answer

Luminal gas

Answer

Vascular network

Question 2

Which of the following is an initial investigation for acute abdomen?

Accepted Answer

Ultrasound (USG)

Answer

Multidetector CT

Answer

Contrast-enhanced CT

Answer

X-ray

Question 3

A unilateral small smooth kidney is seen in which of the following conditions?

Accepted Answer

Renal artery stenosis

Answer

Reflux nephropathy

Answer

Lobar infarction

Answer

Chronic glomerulonephritis

Question 4

A plain radiograph of the abdomen demonstrates gas within the bowel wall (pneumatosis). Which of the following would MOST likely be associated with this finding?

Accepted Answer

Gas in the portal vein

Answer

Air in the biliary tract

Answer

Blood in the biliary tract

Answer

Gas in the hepatic veins

Question 5

Which imaging modality is best for detecting focal liver lesions?

Accepted Answer

MRI

Answer

CT

Answer

USG

Answer

PET scan

Question 6

Which is not a usual feature of Ulcerative colitis on barium enema?

Accepted Answer

Colovesical fistula

Answer

Fine mucosal granularity

Answer

Pseudopolyps

Answer

Lead pipe colon

Question 7

All of the following are signs of Hydatid Cyst except?

Accepted Answer

Mercedes Benz sign

Answer

Camalote sign

Answer

Floating membrane sign

Answer

Ca wheel appearance

Question 8

What is the characteristic appearance of a "Ca-wheel" on ultrasound?

Accepted Answer

Hydatid cyst

Answer

Intussusception

Answer

Hydatidiform mole

Answer

All of the above

Question 9

A 43-year-old woman presents with right upper quadrant abdominal pain and vomiting. She has had three children. The white blood cell count is 14.3x10^9/L and liver function tests are normal. What is the test of choice to establish the diagnosis in this patient?

Accepted Answer

Ultrasound

Answer

Computerized axial tomography scan

Answer

Hydroxy iminodiacetic acid scan

Answer

Magnetic resonance imaging scan

Question 10

Cobra head deformity in the lower end of ureter is seen in which of the following conditions?

Accepted Answer

Ureterocele

Answer

Vesical diverticula

Answer

Carcinoma of the urinary bladder

Answer

Urethral stricture

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?