Abdominal and Pelvic Radiology Practice Questions

Q: A young patient presents with fever and right upper quadrant pain. Clinical examination reveals hepatomegaly but no jaundice. Ultrasound reveals a solitary, homogeneous, hypoechoic lesion in the right lobe measuring 5 cm x 5 cm x 4 cm. Tests for hydatid disease were negative. Which of the following is the best recommendation for initial treatment?

Antiamoebics/antibiotics alone. **Explanation:** The clinical presentation of fever, right upper quadrant pain, and hepatomegaly in a young patient, combined with a solitary hypoechoic lesion in the right lobe of the liver, is classic for an **Amoebic Liver Abscess (ALA)**. The negative hydatid serology further supports this diagnosis over Echinococcal cysts. **1. Why Option C is Correct:** The primary treatment for an uncomplicated amoebic liver abscess is **medical management** with antiamoebic drugs (e.g., Metronidazole or Tinidazole). Approximately 90-95% of patients respond dramatically to antibiotics alone within 48–72 hours. Unlike pyogenic abscesses, which often require drainage, uncomplicated amoebic abscesses resolve well with pharmacotherapy. **2. Why Other Options are Incorrect:** * **Options A & B:** Routine aspiration or catheter drainage is **not** recommended as initial therapy. Drainage is reserved for specific indications: lack of clinical response to drugs after 48-72 hours, large abscesses (>10 cm) at risk of rupture, abscesses in the left lobe (high risk of pericardial rupture), or if the abscess is thin-walled and imminent to burst. * **Option D:** Hepatectomy is a radical surgical procedure and is never the initial treatment for an infectious abscess. Surgery is only considered for complications like rupture into the peritoneal cavity causing peritonitis. **Clinical Pearls for NEET-PG:** * **Most common site:** Right lobe (due to the streaming effect of portal blood flow). * **Classic appearance:** "Anchovy sauce" pus (chocolate-colored, odorless). * **Radiology:** Typically a solitary, peripheral, hypoechoic lesion without a prominent wall (unlike pyogenic abscesses which are often multiple and have thicker walls). * **Gold Standard Diagnosis:** Serology (IHA/ELISA) is highly sensitive; imaging helps in localization.

Q: Ectopic mucosa of Meckel's diverticulum is diagnosed by which of the following methods?

Tc-99 radionuclide scan. **Explanation:** **Meckel’s diverticulum** is the most common congenital anomaly of the gastrointestinal tract, resulting from the failure of the vitelline duct to obliterate. Approximately 50% of symptomatic cases contain **ectopic gastric mucosa**, which secretes acid and leads to painless lower GI bleeding (melena or hematochezia). 1. **Why Tc-99m is the Correct Answer:** The **Technetium-99m pertechnetate scan** (often called a **"Meckel’s Scan"**) is the gold standard for diagnosis. The pertechnetate ion is selectively taken up by the **mucous-secreting cells of the ectopic gastric mucosa**, not the diverticulum itself. On imaging, this appears as a "hot spot" in the right lower quadrant that appears simultaneously with the stomach signal. 2. **Why Other Options are Incorrect:** * **Angiography:** Used primarily to localize the site of active, brisk bleeding (usually >0.5 ml/min) but cannot specifically identify ectopic mucosa. * **CT Scan:** While CT can identify complications like diverticulitis or bowel obstruction, it lacks the sensitivity to detect small patches of ectopic mucosa. * **Endoscopy:** Standard upper or lower endoscopy (colonoscopy) cannot reach the mid-distal ileum where Meckel’s is typically located. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of 2s:** 2% of the population, 2 inches long, 2 feet from the ileocecal valve, 2 types of ectopic tissue (Gastric > Pancreatic), and usually presents by age 2. * **Pharmacological Enhancement:** The sensitivity of a Meckel’s scan can be increased using **H2 blockers (Cimetidine)**, **Glucagon**, or **Pentagastrin**, which enhance the retention or uptake of the radionuclide. * **Most common presentation:** Painless rectal bleeding in a child.

Q: "Phantom calyx" or "Amputated calyx" on IVU is a feature of which condition?

Tuberculosis. **Explanation:** The correct answer is **Tuberculosis (A)**. Genitourinary tuberculosis (GUTB) is characterized by a chronic granulomatous infection that leads to extensive fibrosis and stricture formation. The "Phantom Calyx" or "Amputated Calyx" appearance on Intravenous Urography (IVU) occurs when a stricture develops at the **infundibulum** (the neck of the calyx). This stricture completely obstructs the drainage, preventing the contrast medium from entering that specific calyx, making it appear "missing" or "amputated" on the radiograph. **Analysis of Incorrect Options:** * **B. Hydronephrosis:** Typically shows "clubbing" of the calyces due to backpressure, but the calyces remain visible and connected to the pelvis. * **C. Bilharziasis (Schistosomiasis):** Characteristically presents with "linear calcification" of the bladder wall (fetal head appearance) and ureteric strictures, but not typically isolated infundibular amputation. * **D. UPJ Obstruction:** Results in massive dilation of the renal pelvis and calyces (ballooning), but the connection between them remains patent. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign of GUTB on IVU:** "Moth-eaten" appearance of the calyces (due to cortical erosions). * **Putty Kidney:** End-stage GUTB where the kidney is non-functional and autonephrectomized with dense calcification. * **Golf-hole Ureter:** Retraction of the ureteric orifice due to fibrosis. * **Thimble Bladder:** A small, contracted, fibrotic bladder with reduced capacity.

Q: What condition is associated with the "comb sign" on CT abdomen?

Crohn's disease. The **Comb Sign** is a classic radiological hallmark of active, hemodynamically significant **Crohn’s disease**. ### 1. Why Crohn’s Disease is Correct The "comb sign" refers to the appearance of prominent, engorged, and widely spaced **vasa recta** (the small arteries supplying the bowel) within the mesentery. In active Crohn’s disease, transmural inflammation leads to increased blood flow and fibrofatty proliferation (creeping fat). On a contrast-enhanced CT, these dilated vessels align parallel to each other, resembling the teeth of a comb. This sign is highly specific for **active inflammation** and helps differentiate acute flares from chronic fibrostenotic disease. ### 2. Why Other Options are Incorrect * **Ulcerative Colitis:** This condition primarily involves the mucosa and submucosa rather than the full thickness of the wall. Mesenteric vascular engorgement is rare; instead, CT may show "lead pipe" appearance or "target sign" due to mucosal edema. * **Tuberculosis (Abdominal):** While it can cause bowel wall thickening, it typically presents with necrotic mesenteric lymphadenopathy and asymmetric involvement of the ileocecal junction, rather than prominent vasa recta. * **Intestinal Lymphoma:** This usually presents with "aneurysmal dilatation" of the bowel lumen and bulky, non-necrotic lymphadenopathy. It does not typically cause the hypervascular mesenteric response seen in Crohn’s. ### 3. NEET-PG High-Yield Pearls * **String Sign of Kantor:** Narrowing of the terminal ileum due to spasm or fibrosis (seen on Barium studies). * **Creeping Fat:** Mesenteric fat wrapping around the bowel circumference, a precursor to the comb sign. * **Proud Flesh:** Inflammatory polyps (pseudopolyps) seen in the colon. * **Skip Lesions:** Segmental involvement of the bowel, a key differentiator from the continuous involvement in Ulcerative Colitis.

Q: Intravenous urogram shows a 'flower vase' appearance. What is the most likely diagnosis?

Horse-shoe kidney. **Explanation:** The **'flower vase' appearance** on an Intravenous Urogram (IVU) is a classic radiological sign of a **Horse-shoe kidney**. This occurs because the lower poles of both kidneys are fused across the midline (usually by an isthmus at the level of L4). This fusion prevents the normal lateral rotation of the kidneys; instead, the kidneys remain vertically oriented or medially rotated. Consequently, the long axes of the kidneys are directed downwards and medially, and the ureters arise from the anterior surface, draping over the isthmus before descending, mimicking the shape of a flower vase. **Analysis of Options:** * **A. Duplex system with upper moiety ureterocele:** Characterized by the **'Drooping Lily'** appearance, where the obstructed upper pole moiety displaces the lower pole moiety downwards and outwards. * **B. Polycystic kidney disease:** Typically shows bilateral enlarged kidneys with a **'Spider leg'** appearance due to the elongation and compression of the calyces by multiple cysts. * **C. Horse-shoe kidney:** Correct. The fusion of lower poles leads to the characteristic 'flower vase' or 'hand-holding' appearance. * **D. Retro-caval ureter:** Characterized by a **'Fish-hook'** or **'J-shaped'** ureter, where the right ureter passes behind the Inferior Vena Cava. **High-Yield Pearls for NEET-PG:** * **Embryology:** The ascent of the horse-shoe kidney is arrested by the **Inferior Mesenteric Artery (IMA)**. * **Most common site of fusion:** Lower poles (90%). * **Complications:** Increased risk of PUJ obstruction, nephrolithiasis, and infections. * **Associated Malignancy:** Increased incidence of **Wilms tumor** (in children) and **Transitional Cell Carcinoma**.

Q: What is the most common disease affecting the human body?

Dental caries. **Explanation:** **Dental caries** is recognized by the World Health Organization (WHO) and the Global Burden of Disease studies as the most common non-communicable disease affecting humans globally. It affects nearly 3.5 billion people worldwide, with untreated dental caries in permanent teeth being the single most prevalent condition. The disease involves the localized destruction of susceptible dental hard tissues by acidic by-products from bacterial fermentation of dietary carbohydrates. **Analysis of Options:** * **Gingivitis (Option A):** While extremely common and often a precursor to periodontitis, its global prevalence is lower than that of dental caries. * **Hypertension (Option B):** This is the most common "silent killer" and a leading risk factor for cardiovascular disease, affecting approximately 1.28 billion adults, but it does not surpass the sheer number of cases seen in dental decay. * **Diabetes (Option C):** Although a major global health emergency with rising prevalence (approx. 537 million adults), it remains significantly less common than dental caries. **NEET-PG Clinical Pearls:** * **Radiological Note:** In dental radiology, caries appear as **radiolucent** (dark) areas on a radiograph because the demineralized enamel/dentin is less dense than healthy tissue. * **Bitewing Radiographs:** These are the gold standard imaging modality for detecting interproximal (between teeth) caries that are not visible during a clinical exam. * **Microbiology:** *Streptococcus mutans* is the primary causative organism associated with the initiation of dental caries.

Q: The 'coffee bean sign' is characteristically seen in which of the following conditions?

Sigmoid volvulus. ### Explanation **Correct Answer: C. Sigmoid volvulus** The **'Coffee Bean Sign'** (also known as the Omega sign or Frimann-Dahl sign) is the classic radiographic hallmark of **Sigmoid Volvulus**. This condition occurs when the sigmoid colon twists on its mesenteric axis, leading to a closed-loop obstruction. * **Mechanism:** As the sigmoid loop undergoes torsion, it becomes massively distended with gas. The two medial walls of the dilated loop appose each other, forming a central dense line (the "cleft" of the bean), while the lateral walls form the rounded outer margins of the "bean." The apex of the "bean" usually points toward the Right Upper Quadrant (RUQ). **Analysis of Incorrect Options:** * **A. Intussusception:** Characterized by the **'Target sign'** or **'Doughnut sign'** on ultrasound/CT, and the **'Coiled spring sign'** on barium enema. * **B. Bowel Ischemia:** Often presents with **'Thumbprinting'** (due to mucosal edema) or **'Pneumatosis intestinalis'** (gas within the bowel wall) in advanced stages. * **D. Congenital Hypertrophic Pyloric Stenosis:** Classically shows the **'String sign'** (narrowed pyloric canal) or **'Shoulder sign'** on barium studies, and the **'Target/Donut sign'** on ultrasound. **High-Yield Clinical Pearls for NEET-PG:** * **Bird’s Beak Sign:** Seen on barium enema in Sigmoid Volvulus (tapering at the site of the twist). * **Cecal Volvulus:** Unlike sigmoid, the distended cecum usually has only one air-fluid level and the "bean" points toward the Left Upper Quadrant (LUQ). * **Management:** Initial treatment for Sigmoid Volvulus is often **sigmoidoscopic detorsion** (unless gangrene is suspected), whereas Cecal Volvulus usually requires surgery.

Q: Which ovarian tumor is characterized by the presence of a maximum radiopaque shadow?

Teratoma. **Explanation:** The correct answer is **Teratoma (Option A)**. **Why Teratoma is correct:** A Mature Cystic Teratoma (Dermoid cyst) is a germ cell tumor derived from all three germ layers (ectoderm, mesoderm, and endoderm). It characteristically contains well-differentiated tissues, including **teeth and bone**. On a plain X-ray or CT scan, these calcified structures appear as dense, **radiopaque shadows**. Additionally, the presence of sebum/fat within the cyst creates a "fat-fluid level," which is a classic radiological hallmark. **Why the other options are incorrect:** * **Dysgerminoma (Option B):** While these may show speckled or irregular calcifications in about 10-15% of cases, they lack the organized, dense radiopaque structures (like teeth) seen in teratomas. * **Mucinous Cystadenoma (Option C):** These are large, multiloculated cystic tumors. While the cyst wall may occasionally calcify, they do not typically present with significant radiopaque shadows. * **Granulosa Cell Tumor (Option D):** These are sex cord-stromal tumors known for estrogen production. They are usually solid or complex cystic masses and do not characteristically feature radiopaque calcifications. **High-Yield Clinical Pearls for NEET-PG:** * **Rokitansky Nodule (Dermoid Plug):** A solid prominence within a teratoma containing hair or teeth; often the site of malignant transformation. * **Tip of the Iceberg Sign:** An ultrasound finding in teratomas where the anterior dense acoustic shadowing from hair/sebum obscures the posterior wall. * **Psammoma Bodies:** If a question mentions "fine, sand-like calcifications" in an ovarian mass, think **Serous Cystadenocarcinoma**. * **Most common ovarian tumor in young women:** Mature Cystic Teratoma.

Question 1

A young patient presents with fever and right upper quadrant pain. Clinical examination reveals hepatomegaly but no jaundice. Ultrasound reveals a solitary, homogeneous, hypoechoic lesion in the right lobe measuring 5 cm x 5 cm x 4 cm. Tests for hydatid disease were negative. Which of the following is the best recommendation for initial treatment?

Accepted Answer

Antiamoebics/antibiotics alone

Answer

Multiple aspirations and antiamoebics/antibiotics

Answer

Catheter drainage and antiamoebics/antibiotics

Answer

Hepatectomy followed by antiamoebics/antibiotics

Question 2

Ectopic mucosa of Meckel's diverticulum is diagnosed by which of the following methods?

Accepted Answer

Tc-99 radionuclide scan

Answer

Angiography

Answer

CT scan

Answer

Endoscopy

Question 3

What is the best method to visualize the proximal bile duct?

Accepted Answer

Percutaneous transhepatic cholangiogram

Answer

Endoscopic ultrasonography (EUS)

Answer

Endoscopic retrograde cholangiopancreatography (ERCP)

Answer

Transabdominal ultrasonography

Question 4

"Phantom calyx" or "Amputated calyx" on IVU is a feature of which condition?

Accepted Answer

Tuberculosis

Answer

Hydronephrosis

Answer

Bilharziasis

Answer

UPJ obstruction

Question 5

What condition is associated with the "comb sign" on CT abdomen?

Accepted Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Tuberculosis

Answer

Intestinal lymphoma

Question 6

Intravenous urogram shows a 'flower vase' appearance. What is the most likely diagnosis?

Accepted Answer

Horse-shoe kidney

Answer

Duplex system with upper moiety ureterocele

Answer

Polycystic kidney disease

Answer

Retro-caval ureter

Question 7

Which is the best investigation to detect pneumoperitoneum?

Accepted Answer

Plain X-ray chest, erect

Answer

Plain X-ray abdomen, erect

Answer

Left lateral decubitus radiograph

Answer

CT scan

Question 8

What is the most common disease affecting the human body?

Accepted Answer

Dental caries

Answer

Gingivitis

Answer

Hypertension

Answer

Diabetes

Question 9

The 'coffee bean sign' is characteristically seen in which of the following conditions?

Accepted Answer

Sigmoid volvulus

Answer

Intussusception

Answer

Bowel ischemia

Answer

Congenital hypertrophic pyloric stenosis

Question 10

Which ovarian tumor is characterized by the presence of a maximum radiopaque shadow?

Accepted Answer

Teratoma

Answer

Dysgerminoma

Answer

Mucinous cyst adenoma

Answer

Granulosa cell tumor

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?