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 conditions shows a "snowstorm appearance" on ultrasonography?

Hydatidiform mole. **Explanation:** The **"snowstorm appearance"** is the classic ultrasonographic hallmark of a **Hydatidiform Mole** (specifically a complete molar pregnancy). This appearance is caused by the presence of multiple small, hydropic (fluid-filled) chorionic villi that undergo cystic degeneration. On ultrasound, these vesicles appear as a complex pattern of numerous small, low-level echoes (hyperechoic areas) interspersed with tiny sonolucent (anechoic) spaces, resembling a snowstorm or "bunches of grapes." **Analysis of Options:** * **Hydatidiform Mole (Correct):** The absence of a fetus and the presence of a heterogeneous mass filling the uterine cavity with characteristic cystic spaces confirm this diagnosis. * **Tubal Pregnancy:** Typically presents as an adnexal mass (e.g., "blob sign" or "bagel sign") with an empty uterus. * **Abdominal Pregnancy:** Characterized by a fetus located outside the uterus, often with an empty uterine cavity and oligohydramnios. * **Fibroid:** Usually appears as a well-defined, hypoechoic, solid mass with whorled patterns and posterior acoustic shadowing. **High-Yield Clinical Pearls for NEET-PG:** * **Complete Mole:** 46 XX (most common), paternal origin, "snowstorm" appearance, no fetal parts, high risk of choriocarcinoma. * **Partial Mole:** 69 XXY (triploidy), fetal parts may be present, focal cystic changes in the placenta. * **Theca Lutein Cysts:** Often seen bilaterally in the ovaries due to extremely high levels of β-hCG associated with molar pregnancies. * **Clinical Triad:** Painless vaginal bleeding, uterus larger than gestational age, and hyperemesis gravidarum.

Q: Fifteen years after menopause, what is the maximum normal ovarian volume on ultrasound?

2 mL. **Explanation:** The size and volume of the ovaries are highly dynamic and depend primarily on the hormonal status of the woman. Post-menopause, the cessation of follicular development leads to progressive ovarian atrophy. **1. Why 2 mL is Correct:** In the postmenopausal period, the ovaries shrink significantly. While the average volume is often cited around **1.2 to 1.5 mL**, the established upper limit of normal for a woman more than 10–15 years post-menopause is **2 mL**. Any volume exceeding this, or a volume more than double that of the contralateral ovary, warrants further investigation to rule out malignancy. **2. Analysis of Incorrect Options:** * **A (1 mL):** While many postmenopausal ovaries are this small, it is the average/mean volume rather than the "maximum normal" threshold. * **C (8 mL):** This is the upper limit of normal for a **premenopausal** (reproductive age) woman. In a postmenopausal patient, an 8 mL ovary is considered significantly enlarged and suspicious. * **D (10 mL):** This is the standard upper limit for a normal ovary in a menstruating female. In postmenopause, this would be a clear indication for a surgical consult. **High-Yield Facts for NEET-PG:** * **Formula for Ovarian Volume:** $0.523 \times \text{length} \times \text{width} \times \text{thickness}$. * **Premenopausal Normal:** Up to 10 mL (mean 4–6 mL). * **Postmenopausal Normal:** Up to 2 mL (mean 1.2–1.5 mL). * **The "Rule of Two":** A simple way to remember postmenopausal limits is that the volume should be less than **2 mL** and the difference between the two ovaries should not exceed **2x**. * **Clinical Pearl:** Postmenopausal ovaries are often difficult to visualize on ultrasound due to their small size and lack of follicles; if they are easily seen and appear "prominent," it is a red flag.

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: Apple core appearance in barium enema is seen in which condition?

Colonic carcinoma. **Explanation:** The **Apple Core Appearance** (also known as the "napkin-ring" sign) is a classic radiologic finding on barium enema, most commonly associated with **annular, constricting colonic carcinoma** (typically of the descending or sigmoid colon). **1. Why Colonic Carcinoma is correct:** This appearance is caused by an infiltrating tumor that grows circumferentially around the lumen of the colon. The tumor causes focal, irregular narrowing of the bowel lumen with "overhanging edges" or "shouldering" at the proximal and distal ends. On a barium study, the contrast fills the narrow central channel, resembling the core of an apple after the outer fruit has been eaten. **2. Why other options are incorrect:** * **Fissure in ano:** This is a small tear in the lining of the anal canal. It is a clinical diagnosis and does not produce large-scale luminal narrowing or the apple core sign on imaging. * **Rectal carcinoma:** While rectal cancer is a malignancy, it usually presents as a bulky mass or an irregular filling defect. The specific "apple core" morphology is classically described for colonic segments where the circumferential growth can constrict the lumen symmetrically. * **Hemorrhoids:** These are vascular cushions in the anal canal. On imaging, they may appear as small, smooth filling defects but never cause circumferential constriction. **Clinical Pearls for NEET-PG:** * **Most common site:** The apple core sign is most frequently seen in the **sigmoid colon**. * **Differential Diagnosis:** While highly suggestive of malignancy, similar appearances can rarely be seen in chronic Crohn’s disease, ulcerative colitis with stricture, or ischemic colitis. * **Next Step:** The definitive investigation for a patient with an apple core sign is **Colonoscopy and Biopsy** to confirm malignancy.

Q: The "Double Bubble" sign on an abdominal skiagram is suggestive of which of the following conditions?

Duodenal Atresia. ### Explanation The **"Double Bubble" sign** is a classic radiological hallmark of **Duodenal Atresia**. This sign is seen on an abdominal skiagram (X-ray) and represents two air-filled pockets: 1. **The first bubble:** Represents the dilated stomach. 2. **The second bubble:** Represents the dilated proximal duodenum. The "double bubble" occurs because there is a complete obstruction in the duodenum (usually at the second part). Air swallowed by the neonate can fill the stomach and the proximal duodenum but cannot pass further into the distal bowel, resulting in a **gasless distal abdomen**. #### Analysis of Options: * **Duodenal Atresia (Correct):** The most common cause of this sign. It is frequently associated with **Down Syndrome** (Trisomy 21) and polyhydramnios in utero. * **Ileal Atresia:** This presents as a **"Triple Bubble" sign** or multiple dilated bowel loops with air-fluid levels, as the obstruction is much lower in the gastrointestinal tract. * **Anorectal Malformation:** This typically presents with features of distal large bowel obstruction. Diagnosis is usually clinical or via an **Invertogram** (Wangensteen-Rice view) to determine the level of the lesion. * **Bladder Calculi:** These appear as radiopaque (white) densities in the pelvic region, not as air-filled "bubbles." #### High-Yield Clinical Pearls for NEET-PG: * **Differential Diagnosis for Double Bubble:** While Duodenal Atresia is the most common, other causes include **Annular Pancreas**, **Malrotation with Midgut Volvulus** (Ladd’s bands), and **Duodenal Web**. * **Association:** Approximately 30% of infants with Duodenal Atresia have **Down Syndrome**. * **Clinical Presentation:** Neonates present with **bilious vomiting** within the first 24–48 hours of life (unless the atresia is pre-ampullary, which is rare). * **Management:** Initial stabilization with an orogastric tube followed by surgical repair (**Duodenoduodenostomy**).

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.

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 conditions shows a "snowstorm appearance" on ultrasonography?

Accepted Answer

Hydatidiform mole

Answer

Tubal pregnancy

Answer

Abdominal pregnancy

Answer

Fibroid

Question 3

Fifteen years after menopause, what is the maximum normal ovarian volume on ultrasound?

Accepted Answer

2 mL

Answer

1 mL

Answer

8 mL

Answer

10 mL

Question 4

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 5

Apple core appearance in barium enema is seen in which condition?

Accepted Answer

Colonic carcinoma

Answer

Fissure in ano

Answer

Rectal carcinoma

Answer

Hemorrhoids

Question 6

The "Double Bubble" sign on an abdominal skiagram is suggestive of which of the following conditions?

Accepted Answer

Duodenal Atresia

Answer

Ileal atresia

Answer

Anorectal malformation

Answer

Bladder calculi

Question 7

What is true about virtual colonoscopy?

Accepted Answer

It provides better image quality than conventional colonoscopy.

Answer

Virtual colonoscopy is performed using CT and MRI.

Answer

It takes longer to perform than conventional colonoscopy.

Answer

It is easy to take tissue samples during virtual colonoscopy.

Question 8

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 9

What is the best investigation for bilhemia?

Accepted Answer

ERCP

Answer

MRCP

Answer

CT

Answer

EUS

Question 10

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

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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