Abdominal and Pelvic Radiology Practice Questions

Q: A "saw-tooth" appearance of the colon on barium enema is typically seen with which of the following conditions?

Colonic diverticulosis. **Explanation:** The **"saw-tooth" appearance** is a classic radiological sign of **Colonic Diverticulosis**, most commonly observed in the sigmoid colon. This appearance is not caused by the diverticula (outpouchings) themselves, but rather by the **circular muscle hypertrophy** and shortening of the taeniae coli that often accompany the condition. This leads to a series of sharp, serrated indentations along the colonic wall, resembling the teeth of a saw. **Analysis of Options:** * **Colonic Diverticulosis (Correct):** Muscle thickening and spasm create the characteristic serrated or "saw-tooth" contour on barium enema. * **Colonic Volvulus:** Typically presents with a **"bird-beak"** sign (at the site of twist) or a **"coffee bean"** sign (on plain X-ray) in sigmoid volvulus. * **Colonic Carcinoma:** Classically presents with an **"apple-core"** lesion or a "napkin-ring" sign, representing a short-segment, irregular circumferential narrowing with overhanging edges. * **Ulcerative Colitis:** In the chronic stage, it presents with a **"lead-pipe"** appearance due to the loss of haustral folds and shortening of the colon. In acute phases, "collar-stud" ulcers may be seen. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for diverticula:** Sigmoid colon (due to high intraluminal pressure). * **Diverticulitis:** Barium enema is generally **avoided** in the acute phase due to the risk of perforation; **CECT** is the investigation of choice. * **True vs. False Diverticula:** Colonic diverticula are "false" diverticula (pseudodiverticula) because they consist only of mucosa and submucosa herniating through the muscularis layer.

Q: Which of the following is NOT a radiological finding of papillary necrosis on excretory urography?

Increased dense nephrogram. **Explanation:** **Renal Papillary Necrosis (RPN)** is a clinicopathologic entity characterized by ischemic necrosis of the renal papillae. On excretory urography (IVP), the findings depend on the stage of the disease (medullary vs. papillary) and the degree of sloughing. **Why "Increased dense nephrogram" is the correct answer:** An **increased dense (persistent) nephrogram** is a hallmark of **Acute Tubular Necrosis (ATN)**, acute ureteric obstruction, or renal vein thrombosis. It is not a feature of papillary necrosis. In RPN, the primary pathology involves the destruction of the papilla and the formation of cavities that communicate with the collecting system, rather than a generalized delay in contrast excretion. **Analysis of Incorrect Options:** * **Tracks and horns:** These represent the early "medullary" type of necrosis where contrast tracks into the necrotic papilla from the fornices, creating a "lobster claw" or "horn" appearance. * **Ring shadow:** This occurs when a necrotic papilla sloughs off entirely and is surrounded by contrast medium within the calyx. * **Egg in cup appearance:** This refers to the "papillary" type of necrosis where the entire central portion of the papilla sloughs off, leaving a hollowed-out, clubbed calyx (the "cup") containing the necrotic debris (the "egg"). **Clinical Pearls for NEET-PG:** * **Mnemonic for Causes (POSTCARDS):** **P**yelonephritis, **O**bstruction, **S**ickle cell disease, **T**uberculosis, **C**irrhosis, **A**nalgesic abuse (most common), **R**enal vein thrombosis, **D**iabetes mellitus, **S**ystemic lupus erythematosus. * **Ball-on-tee appearance:** Another classic description of RPN where contrast fills a central cavity in the papilla. * **Differential Diagnosis:** RPN can mimic **Renal Tuberculosis**, but TB usually presents with more extensive strictures and "putty kidney" (autonephrectomy).

Q: A 32-year-old man presents with fever and pain in the right upper quadrant after food intake. What is the investigation of choice?

Ultrasound. **Explanation:** The clinical presentation of fever and right upper quadrant (RUQ) pain triggered by food intake (post-prandial) is highly suggestive of **Acute Cholecystitis** or symptomatic cholelithiasis. **Why Ultrasound is the Correct Answer:** Ultrasound (USG) is the **initial investigation of choice** for any patient presenting with RUQ pain. It is highly sensitive (up to 95%) and specific for detecting gallstones and gallbladder wall thickening. It is non-invasive, cost-effective, lacks ionizing radiation, and allows for the assessment of the **Sonographic Murphy’s Sign** (maximal tenderness over the gallbladder when compressed by the transducer), which has a high predictive value for acute cholecystitis. **Why Other Options are Incorrect:** * **CECT (Contrast-Enhanced CT):** While excellent for identifying complications (like perforation or gangrene) or alternative diagnoses (like pancreatitis), it is less sensitive than USG for detecting gallstones and involves radiation. * **MRI/MRCP:** These are highly accurate but are generally reserved for suspected common bile duct (CBD) stones (choledocholithiasis) or when USG results are equivocal. They are too time-consuming and expensive for initial screening. * **HRCT (High-Resolution CT):** This is a specialized imaging modality for lung parenchyma (interstitial lung diseases) and has no role in evaluating abdominal pain. **Clinical Pearls for NEET-PG:** * **Gold Standard for Acute Cholecystitis:** HIDA Scan (Cholescintigraphy) is the most accurate test if USG is inconclusive. * **Investigation of Choice for Choledocholithiasis:** MRCP (Non-invasive) or ERCP (if therapeutic intervention is needed). * **USG Findings in Acute Cholecystitis:** Gallstones, GB wall thickening (>3mm), pericholecystic fluid, and a positive Sonographic Murphy’s Sign.

Q: Hand joining sign is characteristic of?

Horseshoe kidney. **Explanation:** The **Hand joining sign** is a classic radiological sign seen in a **Horseshoe kidney**. This sign is observed on an intravenous pyelogram (IVP) or CT scan. It refers to the appearance of the lower poles of the kidneys as they curve medially and fuse across the midline, typically anterior to the aorta and IVC. This fusion creates a visual effect resembling two hands joined together at the fingers or palms. **Why the correct answer is right:** In a horseshoe kidney, the fusion most commonly occurs at the **lower poles** (90% of cases). Because the kidneys are trapped by the **inferior mesenteric artery (IMA)** during their embryonic ascent, they remain lower in the pelvis and are rotated medially. This anatomical configuration results in the characteristic "Hand joining" appearance on imaging. **Why the incorrect options are wrong:** * **Pelvic duplication & Ureteral duplication:** These refer to anomalies of the collecting system (e.g., duplex kidney). While they may show a "drooping lily" sign (in cases of obstructed upper poles), they do not involve the fusion of renal parenchymal poles across the midline. * **Ureterocele:** This is a cystic dilatation of the distal intramural portion of the ureter. On IVP, it presents with the **"Cobra head"** or "Adder head" sign, not the hand joining sign. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of fusion:** Lower poles. * **Vascular constraint:** Ascent is arrested by the **Inferior Mesenteric Artery (IMA)** at the level of L3-L4. * **Associated Complications:** Increased risk of nephrolithiasis (due to stasis), hydronephrosis (UPJ obstruction), and a higher incidence of **Wilms tumor** and **Renal Cell Carcinoma**. * **Other Signs:** "Flower vase" appearance (due to the orientation of the axes of the calyces).

Q: Widening of the C-loop of the duodenum is diagnostic of which of the following conditions?

Carcinoma of the head of the pancreas. **Explanation:** The **C-loop of the duodenum** is the anatomical space formed by the first, second, and third parts of the duodenum, which snugly cradles the **head of the pancreas**. **Why Option B is Correct:** In **Carcinoma of the head of the pancreas**, the tumor mass causes a significant focal enlargement of the pancreatic head. As the mass expands, it exerts outward pressure on the inner curvature of the descending (2nd) and horizontal (3rd) parts of the duodenum. This results in the classic radiological sign known as **"Widening of the C-loop."** On a Barium swallow/meal, this may also be associated with the **"Frostberg’s inverted 3 sign,"** caused by the tumor fixing the ampulla while the rest of the duodenum is pushed outward. **Why Other Options are Incorrect:** * **Chronic Pancreatitis (A):** While it can cause some contour changes due to fibrosis or pseudocysts, it typically leads to a shrunken, atrophic pancreas rather than a massive expansion that widens the C-loop. * **Periampullary Carcinoma (C):** These tumors arise near the ampulla of Vater. While they cause early biliary obstruction (jaundice), they are usually small at the time of presentation and do not typically reach a size sufficient to displace the entire duodenal sweep. * **Calculi in the Ampulla (D):** Stones cause ductal obstruction and pain but do not create a space-occupying mass effect. **NEET-PG High-Yield Pearls:** * **Rose-Thorn Appearance:** Seen in the duodenum in cases of Crohn’s disease. * **Double Bubble Sign:** Classic for Duodenal Atresia. * **Coiled Spring Appearance:** Seen in intramural duodenal hematoma. * **Pad Sign:** Indentation on the antrum of the stomach or duodenum due to a pancreatic mass.

Q: Plain abdominal X-ray is useful in which of the following conditions?

Sigmoid volvulus. ### Explanation **Sigmoid Volvulus (Correct Answer)** Sigmoid volvulus is a surgical emergency where the sigmoid colon twists on its mesenteric axis. A plain abdominal X-ray is the **initial investigation of choice** and is often diagnostic. The characteristic finding is a massively dilated, air-filled loop of sigmoid colon rising out of the pelvis, known as the **"Coffee Bean sign"** or **"Omega sign."** The absence of haustral markings and the presence of two fluid levels within the loop are classic radiographic features. **Why other options are incorrect:** * **Acute Pancreatitis:** While X-rays may show non-specific signs like a "sentinel loop" (localized ileus) or the "colon cut-off sign," they are not diagnostic. **Contrast-Enhanced CT (CECT)** is the gold standard for diagnosing complications and assessing severity. * **Cholesterol Stones:** Approximately 80-85% of gallstones are radiolucent (cholesterol-rich) and cannot be seen on a plain X-ray. **Ultrasonography (USG)** is the investigation of choice for cholelithiasis. * **Caecum Cancer:** Plain X-rays lack the soft-tissue resolution to identify colonic masses. Diagnosis requires **Colonoscopy** (for biopsy) or **CT Colonography**. X-rays would only be useful if the cancer caused a secondary bowel obstruction. **High-Yield Clinical Pearls for NEET-PG:** 1. **Sigmoid Volvulus:** Look for the "Coffee Bean sign." On Gastrografin enema, it shows a **"Bird’s Beak"** or **"Ace of Spades"** appearance. 2. **Cecal Volvulus:** Shows a "fetal lamb" or "comma-shaped" air shadow; unlike sigmoid volvulus, the apex usually points toward the left upper quadrant. 3. **Pneumoperitoneum:** The most sensitive plain X-ray sign for hollow viscus perforation is free air under the right diaphragm on an **erect chest X-ray**. 4. **Rigler’s Sign:** Seeing both sides of the bowel wall on an X-ray, indicating pneumoperitoneum.

Q: What diagnosis is suggested by this barium swallow?

Diffuse esophageal spasm. ***Diffuse esophageal spasm*** - Shows characteristic **corkscrew** or **rosary bead** appearance on barium swallow due to simultaneous contractions of the esophageal smooth muscle. - Causes **chest pain** and **dysphagia** with non-peristaltic contractions, creating the distinctive radiographic pattern. *Ingested foreign body* - Would appear as a **radiopaque object** with a defined shape and clear borders on barium swallow. - Typically causes **sudden onset dysphagia** and may show **obstruction** or **filling defect** rather than spastic contractions. *Esophageal diverticula* - Appears as **outpouching** or **sac-like projections** from the esophageal wall on barium studies. - Shows **retained barium** in the diverticular pouches, not the undulating pattern seen in spasm. *Gastric linitis plastica* - Presents as **leather bottle stomach** with rigid, non-distensible gastric walls on barium study. - Affects the **stomach**, not the esophagus, and shows **loss of gastric rugae** with decreased capacity.

Q: What is the normal number of air fluid levels seen in an X-ray of the abdomen?

Three to Four. **Explanation:** In a normal, healthy individual, a limited number of air-fluid levels are considered physiological when seen on an erect abdominal X-ray. These occur in areas where gas and liquid naturally coexist. **Why Option D is Correct:** Under normal conditions, **three to five (commonly cited as 3–4)** air-fluid levels are acceptable. These are typically located in: 1. **The Stomach:** The most common site (gastric bubble). 2. **The Duodenal Bulb:** Often seen in the first part of the duodenum. 3. **The Terminal Ileum/Cecum:** Occasional levels may be seen here due to the transition of liquid chyme. **Why Other Options are Incorrect:** * **Option A (Zero):** This is incorrect because the stomach almost always contains a fluid level in the erect position. * **Option B & C (One or Two):** While these are not "abnormal," they do not represent the upper limit of what is considered a normal physiological finding. **Clinical Pearls for NEET-PG:** * **Pathological Air-Fluid Levels:** More than 5 air-fluid levels, or levels broader than 2.5 cm, are highly suggestive of **Intestinal Obstruction**. * **Step-ladder Pattern:** Multiple air-fluid levels arranged centrally in the abdomen are a classic sign of **Small Bowel Obstruction**. * **String of Beads Sign:** Small bubbles of gas trapped between valvulae conniventes in a fluid-filled small bowel; pathognomonic for small bowel obstruction. * **Positioning:** An erect film is essential to visualize air-fluid levels. If the patient cannot stand, a **Left Lateral Decubitus** view is the preferred alternative to detect free air (pneumoperitoneum).

Q: Which of the following imaging modalities is NOT included in the PI-RADS reporting scheme for prostate glands?

Magnetic resonance spectroscopy. The **PI-RADS (Prostate Imaging-Reporting and Data System)** is a standardized scheme used to evaluate and report multiparametric MRI (mpMRI) of the prostate for suspected malignancy. ### **Explanation of the Correct Answer** **Option A (Magnetic Resonance Spectroscopy):** In the current version of PI-RADS (v2.1), **MR Spectroscopy is NOT included**. While it was part of the original PI-RADS v1, it was removed because it is technically demanding, time-consuming, and did not significantly improve diagnostic accuracy compared to the core sequences. ### **Explanation of Incorrect Options** The PI-RADS v2.1 assessment is based on three core components of **Multiparametric MRI (mpMRI)**: * **Option D (T2-weighted imaging):** This is the anatomical backbone of the exam. It is the **dominant sequence** for evaluating the **Transition Zone (TZ)**. * **Option C (Diffusion-weighted MRI - DWI):** This assesses water molecule movement (cellularity). It is the **dominant sequence** for evaluating the **Peripheral Zone (PZ)**. * **Option B (Dynamic contrast enhancement - DCE):** This evaluates the vascularity of the lesion. It is used as a "tie-breaker" in the peripheral zone to upgrade a PI-RADS 3 lesion to a PI-RADS 4. ### **High-Yield Clinical Pearls for NEET-PG** * **Dominant Sequences:** Remember **PZ = DWI** and **TZ = T2W**. * **Scoring:** PI-RADS scores range from **1 (Very low risk)** to **5 (Very high risk)** of clinically significant prostate cancer. * **Anatomy:** Most prostate cancers (70-75%) occur in the **Peripheral Zone**. * **Biparametric MRI:** A newer trend that uses only T2W and DWI (omitting contrast/DCE) to save time and cost.

Q: What is the spot diagnosis for the given image/description?

Bicornuate uterus. ***Bicornuate uterus*** - Shows classic **heart-shaped external contour** with a **fundal cleft >1cm** and **intercornual angle >105°** on imaging - **HSG** demonstrates two separate uterine horns with **divergent lateral walls** and **MRI** confirms external fundal indentation *Unicornuate uterus* - Appears as a **single horn** with **banana-shaped** or **comma-shaped** configuration on imaging - Associated with **renal agenesis** on the same side and **rudimentary horn** may be present *Arcuate uterus* - Shows **minimal external fundal indentation <1cm** with **broad fundal impression** on imaging - **Intercornual angle <105°** and considered a **mild variant** with minimal clinical significance *Septate uterus* - Demonstrates **normal external uterine contour** with **internal septum** dividing the cavity - **MRI** shows **low signal intensity septum** and **intercornual angle <75°** differentiating from bicornuate

Question 1

A "saw-tooth" appearance of the colon on barium enema is typically seen with which of the following conditions?

Accepted Answer

Colonic diverticulosis

Answer

Colonic volvulus

Answer

Colonic carcinoma

Answer

Ulcerative colitis

Question 2

Which of the following is NOT a radiological finding of papillary necrosis on excretory urography?

Accepted Answer

Increased dense nephrogram

Answer

Tracks and horns from calyces

Answer

Ring shadow

Answer

Egg in cup appearance

Question 3

A 32-year-old man presents with fever and pain in the right upper quadrant after food intake. What is the investigation of choice?

Accepted Answer

Ultrasound

Answer

CECT

Answer

MRI

Answer

HRCT

Question 4

Hand joining sign is characteristic of?

Accepted Answer

Horseshoe kidney

Answer

Pelvic duplication

Answer

Ureterocele

Answer

Ureteral duplication

Question 5

Widening of the C-loop of the duodenum is diagnostic of which of the following conditions?

Accepted Answer

Carcinoma of the head of the pancreas

Answer

Chronic pancreatitis

Answer

Periampullary carcinoma

Answer

Calculi in the ampulla of Vater

Question 6

Plain abdominal X-ray is useful in which of the following conditions?

Accepted Answer

Sigmoid volvulus

Answer

Acute pancreatitis

Answer

Cholesterol stones

Answer

Caecum cancer

Question 7

What diagnosis is suggested by this barium swallow?

Accepted Answer

Diffuse esophageal spasm

Answer

Ingested foreign body

Answer

Esophageal diverticula

Answer

Gastric linitis plastica

Question 8

What is the normal number of air fluid levels seen in an X-ray of the abdomen?

Accepted Answer

Three to Four

Answer

Zero

Answer

One

Answer

Two

Question 9

Which of the following imaging modalities is NOT included in the PI-RADS reporting scheme for prostate glands?

Accepted Answer

Magnetic resonance spectroscopy

Answer

Dynamic contrast enhancement

Answer

Diffusion-weighted MRI

Answer

T2-weighted imaging

Question 10

What is the spot diagnosis for the given image/description?

Accepted Answer

Bicornuate uterus

Answer

Unicornuate uterus

Answer

Arcuate uterus

Answer

Septate uterus

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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