Abdominal and Pelvic Radiology Practice Questions

Q: What is the most effective imaging method for the diagnosis of adenomyosis?

MRI. ***MRI*** - **MRI** offers superior soft tissue contrast, allowing for detailed visualization of the **junctional zone** and **myometrial thickening** characteristic of adenomyosis. - It can effectively differentiate adenomyosis from other uterine pathologies like **leiomyomas**, due to its ability to detect **heterogeneous myometrial signal** and small myometrial cysts. *CT scan* - **CT scans** have limited utility in diagnosing adenomyosis due to their **poor soft tissue contrast** in evaluating diffuse uterine conditions. - They expose the patient to **ionizing radiation** and are generally reserved for detecting calcifications or larger structural abnormalities in the pelvis. *Ultrasound* - **Transvaginal ultrasound** is often the first-line imaging modality due to its accessibility and non-invasiveness, but its diagnostic accuracy for adenomyosis is **operator-dependent** and can be limited in subtle cases. - While it can suggest adenomyosis through findings like **globular uterus** or **heterogeneous myometrium**, it often lacks the resolution to definitively characterize the extent and nature of the lesion compared to MRI. *Hysterosalpingography* - **Hysterosalpingography** is primarily used to evaluate the patency of the **fallopian tubes** and the contour of the uterine cavity, making it unsuitable for direct visualization of myometrial pathology. - While it might show an **irregular uterine cavity** if adenomyosis is severe and extends to the endometrium, it cannot definitively diagnose or characterize the condition within the myometrium.

Q: Step ladder pattern of gas shadow is seen in

Intestinal obstruction. ***Intestinal obstruction*** - A **step-ladder pattern** of gas shadows is a classic radiological sign seen in **small bowel obstruction** due to dilated, fluid-filled loops of small bowel stacked on top of each other. - This pattern results from the accumulation of gas and fluid proximal to the obstruction, causing dilated bowel loops to arrange horizontally. *Gastric outlet obstruction* - This condition primarily results in a **dilated stomach** with fluid and gas, not typically a step-ladder pattern in the small bowel. - Vomiting is usually a prominent symptom, and imaging would show a large fluid-filled stomach. *Duodenal obstruction* - Causes dilatation of the stomach and duodenum, leading to a "**double-bubble sign**" (dilated stomach and proximal duodenum). - It does not typically produce the extensive, stacked small bowel loops seen in a step-ladder pattern. *Sigmoid volvulus* - Characterized by a distinctive large, dilated loop of sigmoid colon, often described as a "**coffee bean sign**" or an **inverted U-shape**. - This is a large bowel obstruction and does not typically present with a step-ladder pattern of small bowel gas.

Q: Parrot beak appearance is seen in which of the following conditions?

Volvulus. ***Volvulus*** - A **parrot beak** appearance, or bird's beak sign, is characteristic of a **volvulus** on barium enema or CT imaging, representing the twisted lumen of the bowel. - This finding indicates a **torsion** of a segment of the bowel, which can lead to obstruction and ischemia. *Intussusception* - Intussusception typically presents with a **"target sign"** or **"donut sign"** on ultrasound, indicating concentric layers of bowel within bowel. - The classic presentation is a **"currant jelly stool"** and a palpable **sausage-shaped mass**. *Rectal atresia* - Rectal atresia involves a **complete blockage** or absence of the rectum, preventing passage of stool. - Imaging typically shows a **dilated colon** proximal to the atretic segment, without a specific "parrot beak" appearance. *CA colon* - Colon cancer (CA colon) appears as a **filling defect** or an **"apple core" lesion** on barium enema due to tumoral constriction. - It does not present with a "parrot beak" sign, which is indicative of a twisted bowel segment.

Q: In which condition is the 'double bubble sign' typically observed?

Duodenal atresia. ***Duodenal atresia*** - The **'double-track sign'**, also known as the **'double bubble sign'**, is a classic radiographic finding in duodenal atresia. It represents the dilation of the **stomach** and the **proximal duodenum**, separated by the pylorus. - This sign indicates an obstruction at or distal to the level of the ampulla of Vater, preventing the passage of air and fluid into the more distal small bowel. *Gastric ulcer* - Gastric ulcers are mucosal erosions in the stomach lining and are typically diagnosed via **endoscopy** or barium studies. - They do not cause the specific anatomical configuration that leads to a 'double track sign'. *Achalasia* - Achalasia is a motility disorder of the esophagus characterized by the failure of the lower esophageal sphincter to relax and a loss of peristalsis in the esophageal body. - Radiographically, it's often associated with a **'bird's beak' appearance** of the distal esophagus, not a 'double track sign'. *Congenital hypertrophic pyloric stenosis (CHPS)* - CHPS involves thickening of the pyloric muscle, which obstructs gastric emptying. The classic radiographic finding is the **'string sign'** (contrast material thinly stringing through the narrowed pylorus) or the **'shoulder sign'** on ultrasound. - While it causes gastric outlet obstruction, it affects the pylorus itself rather than creating two separate dilated segments like in duodenal atresia.

Q: Central stellate scar is typically associated with which of the following conditions?

Focal nodular hyperplasia (FNH). ***Focal nodular hyperplasia (FNH)*** - FNH is a benign liver lesion characterized by a central fibrous scar with radiating septa, giving it the characteristic appearance of a **central stellate scar** on imaging. - This scar contains **malformed blood vessels** and bile ductules, which are key diagnostic features. - On dynamic imaging, FNH typically shows **spoke-wheel arterial enhancement** pattern and the central scar shows **delayed enhancement** on MRI. *Hepatic adenoma* - Hepatic adenomas are typically composed of sheets of **hepatocytes** with absent portal triads and are usually **homogeneous** on imaging without a central scar. - They are associated with **oral contraceptive use** and have a risk of hemorrhage and malignant transformation. *Chronic liver disease* - Chronic liver disease, such as **cirrhosis**, is characterized by widespread **fibrosis** and **nodule formation** throughout the liver, but it does not typically present with a solitary lesion with a central stellate scar. - The scarring in cirrhosis is diffuse and leads to architectural distortion, rather than a focal central scar. *Hepatocellular carcinoma* - Hepatocellular carcinoma (HCC) typically presents as a **vascular mass** that may or may not be solitary, usually arising in the context of chronic liver disease or cirrhosis. - Although the **fibrolamellar variant of HCC** (seen in younger patients without cirrhosis) can show a central scar, this is less common and the scar typically shows **hypointensity on T2-weighted imaging**, unlike FNH where the scar is **hyperintense on T2**. - Typical HCC does not show a distinct central stellate scar as a characteristic feature.

Q: Which of the following is NOT a characteristic X-ray finding of small intestinal malabsorption syndrome?

Increased transit time. ***Increased transit time*** - Small intestinal malabsorption typically leads to **decreased intestinal transit time** or **accelerated transit**, as unabsorbed contents rush through the bowel. - An increased transit time is more commonly associated with conditions causing **obstruction** or **delayed gastric emptying**, not primary malabsorption. *Mucosal atrophy* - **Mucosal atrophy**, or flattening of the villi, is a classic finding in many malabsorption syndromes, such as **celiac disease**, as it reduces the absorptive surface area. - This change can be visualized indirectly through X-ray studies by assessing the mucosal fold pattern. *Dilatation of bowel* - In malabsorption, particularly chronic cases, the accumulation of unabsorbed fluid and gas can lead to **distension** and **dilatation of bowel loops**. - This is often seen in conditions like **tropical sprue** or severe giardiasis. *Flocculation of barium* - **Flocculation and segmentation of barium** are historical X-ray findings in malabsorption, where barium mixes with excess fluid and mucus, appearing clumped and discontinuous. - This indicates altered mucosal surface tension and the presence of abnormal intraluminal contents hindering uniform barium distribution.

Q: Which of the following types of urinary stones is not radio-opaque?

Uric acid stones. ***Uric acid stones*** - **Uric acid stones** are composed of purine metabolites and are **non-radio-opaque**, meaning they do not show up on standard x-rays. - Their presence often necessitates diagnostic tools like **ultrasound** or **CT scans** for detection due to their radiolucent nature. *Calcium stones* - **Calcium oxalate** and **calcium phosphate stones** are the most common type of urinary stones and are typically **radio-opaque**. - They are readily visible on plain abdominal radiographs (KUB x-rays) due to their high calcium content. *Struvite stones* - Also known as **infection stones**, struvite stones are composed of **magnesium ammonium phosphate** and are highly **radio-opaque**. - They often form in the presence of **bacterial infections** that produce urease, visible on X-rays. *Cystine stones* - **Cystine stones** result from an inherited metabolic disorder (cystinuria) and contain sulfur, making them **moderately radio-opaque**. - While not as dense as calcium stones, they are generally still detectable on plain radiographs.

Q: A 'string of pearls' appearance is seen in -

Small Bowel Obstruction. ***Small Bowel Obstruction*** - The "string of pearls" sign on an **abdominal X-ray** is a classic radiographic finding in **small bowel obstruction**. - It results from small pockets of **air trapped** between the plicae circulares of a dilated, fluid-filled small bowel, appearing as a linear array of small lucencies. *Toxic Megacolon* - Characterized by **colonic dilation** (typically transverse colon >6 cm) with signs of systemic toxicity. - X-ray findings usually show a **markedly dilated colon** with **loss of haustra**, not a string of pearls. *Ischaemic Colitis* - Radiographic features often include **thumbprinting** (due to submucosal edema/hemorrhage) and **segmental bowel thickening**. - It does not typically present with the "string of pearls" sign, which is specific to small bowel obstruction. *Ulcerative Colitis* - Common X-ray findings include **loss of haustral markings** (leading to a "lead pipe" appearance in chronic cases) and **mucosal edema**. - It is a disease of the large intestine and does not cause the "string of pearls" sign, which is characteristic of dilated small bowel loops.

Q: String sign of Kantor is a radiological feature of:

Crohn's disease. ***Crohn's disease*** - The **string sign of Kantor** is a classic radiological finding in **Crohn's disease**, particularly with involvement of the terminal ileum. - It represents severe luminal narrowing due to **inflammation, fibrosis, and spasm**, appearing as a thin, continuous stripe of barium. *Ulcerative colitis* - This condition primarily affects the **colon** and rectum, causing diffuse inflammation and ulceration. - Radiological features include **loss of haustra**, pseudopolyps, and continuous involvement, not typically a "string sign." *Ileocaecal tuberculosis* - While it can cause **strictures and inflammation** in the ileocecal region, the "string sign of Kantor" is more specifically associated with Crohn's. - **Tuberculosis** often presents with skip lesions but also involves other features like calcified lymph nodes. *Ischemic colitis* - This condition results from **reduced blood flow to the colon**, typically causing "thumbprinting" due to submucosal edema and segmental involvement. - It does not usually present with the long, thin, continuous luminal narrowing characteristic of the **string sign**.

Q: Double bubble sign is seen in -

All of the options. ***All of the options*** - The **"double bubble sign"** on an X-ray indicates **duodenal obstruction**, which can be caused by intrinsic factors like **duodenal atresia** or extrinsic compressions such as an **annular pancreas** or **Ladd's bands** associated with malrotation. - While differing in etiology, all these conditions lead to fluid and air accumulation in the stomach and proximal duodenum, creating the characteristic two dilated loops. *Duodenal atresia* - This is an **intrinsic congenital obstruction** of the duodenum, preventing the passage of gastric and duodenal contents. - On imaging, it shows **two distinct air-filled bubbles** (one for the stomach, one for the proximal duodenum) separated by the pylorus. *Ladd's band* - **Ladd's bands** are peritoneal fibrous bands that can compress the duodenum in cases of **intestinal malrotation**, leading to extrinsic obstruction. - The resulting proximal duodenal dilation, along with gastric distension, presents as the **double bubble sign**. *Annular pancreas* - An **annular pancreas** is a congenital anomaly where pancreatic tissue completely encircles and obstructs the second part of the duodenum. - This extrinsic compression causes significant dilation of the stomach and proximal duodenum, mimicking the appearance of the **double bubble sign**.

Question 1

What is the most effective imaging method for the diagnosis of adenomyosis?

Accepted Answer

MRI

Answer

CT scan

Answer

Hysterosalpingography

Answer

Ultrasound

Question 2

Step ladder pattern of gas shadow is seen in

Accepted Answer

Intestinal obstruction

Answer

Gastric outlet obstruction

Answer

Duodenal obstruction

Answer

Sigmoid volvulus

Question 3

Parrot beak appearance is seen in which of the following conditions?

Accepted Answer

Volvulus

Answer

Rectal atresia

Answer

CA colon

Answer

Intussusception

Question 4

In which condition is the 'double bubble sign' typically observed?

Accepted Answer

Duodenal atresia

Answer

Gastric ulcer

Answer

Achalasia

Answer

Congenital hypertrophic pyloric stenosis (CHPS)

Question 5

Central stellate scar is typically associated with which of the following conditions?

Accepted Answer

Focal nodular hyperplasia (FNH)

Answer

Hepatic adenoma

Answer

Chronic liver disease

Answer

Hepatocellular carcinoma

Question 6

Which of the following is NOT a characteristic X-ray finding of small intestinal malabsorption syndrome?

Accepted Answer

Increased transit time

Answer

Dilatation of bowel

Answer

Flocculation of barium

Answer

Mucosal atrophy

Question 7

Which of the following types of urinary stones is not radio-opaque?

Accepted Answer

Uric acid stones

Answer

Calcium stones

Answer

Struvite stones

Answer

Cystine stones

Question 8

A 'string of pearls' appearance is seen in -

Accepted Answer

Small Bowel Obstruction

Answer

Toxic Megacolon

Answer

Ischaemic Colitis

Answer

Ulcerative Colitis

Question 9

String sign of Kantor is a radiological feature of:

Accepted Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Ileocaecal tuberculosis

Answer

Ischemic colitis

Question 10

Double bubble sign is seen in -

Accepted Answer

All of the options

Answer

Duodenal atresia

Answer

Annular pancreas

Answer

Ladd's band

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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